The E. coli outbreak linked to romaine lettuce from Arizona has now sickened 149 people in 29 states, and one person has died, according to a May 9 update from the U.S. Centers for Disease Control and Prevention. The CDC said the illnesses emerged between March 13 and April 25, and those sickened were between 1 and 88 years old, with 65% of them being female. Six illnesses from this outbreak have also been reported in Canada, according to a statement from the Canadian federal government.
In contrast, the CDC reported, a 2006 E. coli outbreak linked to bagged fresh spinach sickened 199 people in 26 states, and killed three of them.
Although the current outbreak has stretched on for nine weeks, the CDC still hasn't identified the contamination source or where all of the suspect lettuce was grown. The agency did note, however, that of 112 affected people whom state and local health officials interviewed, 102 said they ate romaine lettuce in the week prior to having symptoms of E. coli infection.
This latest E. coli outbreak has continued to spread even though the suspected romaine lettuce sourced from the Yuma, Arizona, area is reportedly no longer being distributed and food companies and restaurants have switched to product from the Salinas Valley of California.
The U.S. Food and Drug Administration said it identified one Arizona farm as the source of some whole-head romaine lettuce that sickened eight people at a correctional facility in Alaska. But the agency doesn't know for sure where in the supply chain the contamination occurred — and it could have been at any point along the growing, harvesting, packaging and distribution chain before reaching Alaska. FDA and state officials have said that inconsistent records, problems with traceability labeling, and incomplete shipping information is delaying the investigation.
Another problem is the lag time between when people start having E. coli symptoms and when they report them to a medical professional. The process can take two to three weeks, CDC said. Minnesota health officials said this week they had 10 illnesses with onset of symptoms occurring this month, so outbreak numbers are still increasing.
“This particular strain does appear to be more severe than what we might normally see,” said Amy Saupe, a foodborne disease epidemiologist for the Minnesota Department of Health, in a May 8 Minneapolis Star Tribune article.
It's difficult to predict how long this outbreak might go on, or how many more cases are likely to be reported. There could be more related E. coli cases in the near future, which is why consumers are being advised not to eat any romaine lettuce if they are unsure of the source.
The 2011 Food Safety Modernization Act was designed to prevent outbreaks of all kinds from occurring, but it has taken time to develop rules and regulations about how it will work on the ground. Deadlines for compliance with FSMA's produce safety rule, which regulate farm practices and conditions to prevent contamination, only recently kicked in. Another part of the rule, aimed at ensuring all water on the farm is tested, has been delayed until 2022. FDA has estimated that the water testing may reduce total foodborne illnesses associated with produce by a fifth, adding up to $477 million in illness cost.
In the absence of more government regulations after the 2006 spinach outbreak, state-specific industry groups such as the California Leafy Green Handler Marketing Agreement and a partner one in Arizona have stepped up. They have adopted good agricultural practices and voluntary member audits to make sure their products are as safe as possible.
LGMAs from Arizona and California and other industry groups recently offered to share information with public health agencies to figure out how romaine lettuce from the Yuma area may have been the cause of the current outbreak. Not only is this a good practice from an industry group that has unique access to lots of information, but it's also vital to them. The reputation of romaine lettuce is at stake until the E. coli outbreak is solved — and maybe longer — and it isn't easy to win back customer loyalty once it's shaken. According to a USDA analysis, after the spinach outbreak in 2006, it took more than six months for spending on the crop to get back up to pre-outbreak levels.
This latest outbreak should serve as a wake-up call to all those along the fresh produce supply chain that more must be done to limit food safety problems. The policy framework is there, and the science is also available, but it still needs to be systematically applied to protect consumers and the produce industry alike. When all of the components of FSMA are in place, an outbreak like this one might not occur. In the meantime, growers, handlers, retailers and consumers have nothing to do but cautiously wait.