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Q&A: Multistate outbreak from romaine lettuce raises questions about food safety
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In mid-April, the CDC and FDA announced that a multistate outbreak of Shiga toxin-producing Escherichia coli 0157:H7 infections was linked to contaminated romaine lettuce. Although the exact source of the contamination has yet to be determined, investigators are focused on the Yuma, Arizona, growing region, and over two dozen farms are under investigation there.
A recall has yet to be issued, but the CDC is warning consumers to avoid all romaine lettuce unless it can be confirmed that it did not originate from the Yuma growing region. The most current CDC data indicate that there have been 121 cases of E. coli and 52 hospitalizations across 25 states. Additionally, California reported one death, and 14 patients are being treated for hemolytic uremic syndrome, which can result in kidney failure.
Infectious Disease News spoke with Robert Tauxe, MD, director of CDC’s Division of Foodborne, Waterborne, and Environmental Diseases, to learn more about the outbreak and the role of industry, consumers and clinicians. – by Marley Ghizzone
According to the CDC, this is not the first time romaine lettuce has been associated with multistate outbreaks. Is there a reason contamination appears to be more prevalent in romaine lettuce?
From 1998 to 2016, there were 45 outbreaks associated with Shiga toxin-producing E. coli in leafy vegetables reported in the United States. Harmful bacteria that may be in the soil or water where produce grows can come in contact with fruits and vegetables and contaminate them. Fresh produce may also become contaminated after it is harvested, such as during storage or preparation. Bacteria can get inside lettuce leaves, which may not be easily washed off, and it is not usually cooked before it is consumed.
What improvements, if any, can be done in the food industry at the local and state levels to reduce contamination?
We recommend that those who work in the produce industry quickly implement produce safety standards, which the FDA established to ensure safe growing, harvesting, packing and holding of fruits and vegetables. The food industry can also make food safety a core part of company culture, share proven food safety solutions with others in the industry, and choose only suppliers that use food safety best practices.
State and local public health agencies can encourage industry actions that focus on preventing foodborne disease and participate in national networks to share improved methods for investigating multistate outbreaks.
How can consumers protect themselves, not only from this outbreak, but from the next one or the one after that?
It’s a good idea to wash fruits and vegetables in running water before eating, unless the package says the contents have been washed. We need to remember to wash our hands after using the restroom or changing diapers, before eating, after preparing food, and after touching animals. People also need to be careful to thoroughly wash hands, counters, cutting boards and utensils after they touch raw meat.
Some other food safety tips include not preparing food when you are sick and cooking meats properly. We recommend using a food thermometer to check the internal temperature of the meat. You can’t tell if it’s done just by looking at it.
What is the take-home message for ID physicians following this outbreak?
It’s important for physicians to remember that antibiotics are not recommended for patients with E. coli O157 infections. Some studies show that antibiotics may increase the risk of developing a type of kidney failure called hemolytic uremic syndrome. We recommend not prescribing antibiotics for patients with suspected E. coli O157 or other Shiga toxin-producing E. coli infections until diagnostic testing can be performed and Shiga toxin-producing E. coli O157 infection is ruled out.
For more information:
CDC. Guidance to Healthcare Providers and Clinical Laboratories. https://www.cdc.gov/ecoli/clinicians.html.
References:
CDC. Multistate Outbreak of E. coli O157:H7 Infections Linked to Romaine Lettuce. https://www.cdc.gov/ecoli/2018/o157h7-04-18/index.html. Accessed April 26, 2018.
CDC. E. coli O157:H7 Infections Linked to Romaine Lettuce. https://www.cdc.gov/ecoli/2018/o157h7-04-18/map.html. Accessed April 26, 2018.
Disclosure: Tauxe reports no relevant financial disclosures.