Based on new information, CDC is advising that consumers not eat and retailers not sell any romaine lettuce harvested from the Salinas, California growing region.
- Most romaine lettuce products are labeled with a harvest location showing where they were grown.
- This advice includes all types of romaine lettuce harvested from Salinas, California such as whole heads of romaine, hearts of romaine, and packages of precut lettuce and salad mixes which contain romaine, including baby romaine, spring mix, and Caesar salad.
- If you have romaine lettuce at home:
- If the packaging has “Salinas” on the label in any form (whether alone or with the name of another location), don’t eat it, and throw it away.
- If it isn’t labeled with a growing region, don’t eat it, and throw it away.
- If you don’t know if the lettuce is romaine or whether a salad mix contains romaine, don’t eat it, and throw it away.
- Wash and sanitize drawers or shelves in refrigerators where romaine lettuce was stored. Follow these five steps to clean your refrigerator.
- If you are buying romaine lettuce at a store:
- If the packaging has “Salinas” on the label in any form (whether alone or with the name of another location), don’t buy it.
- If it isn’t labeled with a growing region, don’t buy it.
- Restaurants and retailers should check the label on bags or boxes of romaine lettuce, or ask their suppliers about the source of their romaine lettuce.
- If the packaging has “Salinas” on the label in any form (whether alone or with the name of another location), don’t sell or serve it.
- If it isn’t labeled with a growing region, don’t sell or serve it.
- Suppliers, distributors, and others in the supply chain should not ship or sell romaine harvested in Salinas, California.
On November 21, 2019, Missa Bay, LLC, recalledexternal icon salad products due to possible E. coli contamination.
Do not eat or sell any of the recalled salad products, which were sold under many different brand names.
- The recalled salad products have “Use By” dates ranging from October 29, 2019, to November 1, 2019.
- The recalled products have establishment number “EST. 18502B” inside the USDA mark of inspection.
- Visit the USDA website pdf icon[PDF – 1 page]external icon for a full list of recalled products.
- This recall includes salad products that contained contaminated romaine lettuce. The romaine lettuce was tested by the Maryland Department of Health as part of a foodborne illness outbreak in Maryland.
Take action if you have symptoms of an E. coli infection.
- Talk to your healthcare provider.
- Write down what you ate in the week before you started to get sick.
- Report your illness to your local health department.
- Assist public health investigators by answering questions about your illness.
- Prevent infections in others by practicing proper hygiene, especially good handwashing.
- A total of 40 people infected with the outbreak strain of E. coli O157:H7 have been reported from 16 states.
- A total of 28 hospitalizations have been reported. Five people have developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.
- Epidemiologic, laboratory, and traceback evidence collected to date indicate that romaine lettuce from the Salinas, California growing region may be contaminated with E. coli O157:H7 and is making people sick.
- Whole genome sequencing shows that the E. coli strain in romaine lettuce tested by the Maryland Department of Health is closely related genetically to the E. coli found in sick people in this outbreak. The romaine lettuce was harvested from the Salinas, California growing region.
- The investigation is ongoing to determine the source of contamination and if additional products are linked to illness.
- CDC will provide more information as it becomes available.
- People usually get sick from Shiga toxin-producing E. coli 2 to 8 days (average of 3 to 4 days) after swallowing the germ.
- Some people with E. coli infections may get a type of kidney failure called hemolytic uremic syndrome (HUS).
- E. coli infection is usually diagnosed by testing a stool sample.
- Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out. Some studies have shown that administering antibiotics to patients with E. coli infections might increase their risk of developing HUS, and a benefit of treatment has not been clearly demonstrated.
- For more information, see Symptoms of E. coli Infection.
November 22, 2019
Since the initial investigation notice, 23 additional ill people have been reported. As of November 21, 2019, a total of 40 people infected with the outbreak strain of E. coli O157:H7 have been reported from 16 states. A list of the states and the number of cases in each can be found on the Map of Reported Cases page.
Illnesses started on dates ranging from September 24, 2019, to November 10, 2019. Ill people range in age from 3 to 89 years, with a median age of 22. Sixty-five percent of ill people are female. Of 39 ill people with information available, 28 hospitalizations have been reported, including 5 people who developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths have been reported.
Investigation of the Outbreak
Epidemiologic, laboratory, and traceback evidence indicate that romaine lettuce from the Salinas, California growing region is a likely source of this outbreak.
In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Eight (80%) of 10 people interviewed reported eating romaine lettuce. This percentage is significantly higher than results from a survey pdf icon[PDF – 787 KB] of healthy people in which 47% reported eating romaine lettuce in the week before they were interviewed. Ill people in Maryland reported eating Ready Pac Foods Bistro® Chicken Caesar Salad. To date, ill people in other states have not reported eating this particular salad, which contained romaine lettuce from the Salinas, California growing region.
As reported on November 20, 2019, the Maryland Department of Healthexternal icon identified E. coli O157 in romaine lettuce from an unopened package of Ready Pac Foods Bistro® Chicken Caesar Salad collected from a sick person’s home in Maryland. Whole genome sequencing has been completed and shows that the E. coli strain in the romaine lettuce is closely related genetically to the E. coli found in sick people in this outbreak. This provides additional evidence that people in this outbreak got sick from eating romaine lettuce.
FDA and states are tracing the source of the romaine lettuce eaten by ill people. Preliminary information indicates that some of the ill people ate lettuce grown in Salinas, California. No common grower, supplier, distributor, or brand of romaine lettuce has been identified.
CDC is advising that consumers not eat and retailers not sell any romaine lettuce harvested from Salinas, California until more information is available. The investigation is ongoing to determine the source of contamination and if additional products are linked to illness.
This outbreak is caused by the same strain of E. coli O157:H7 that caused outbreaks linked to leafy greens in 2017 and to romaine lettuce in 2018.
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Letter Submitted to Central Coast Water Board….
Will you be testing the various sources of irrigation water at the point it is used (POU) on the crop? Recycled water when tested at the production facility if often non-detect (ND) or very low counts based on MPN. When we subsequently test at the POU or sprinkler head, the counts that were originally ND are now off the chart. This appears to be either sloughing biofilm formed within the pipe’s lumen breaking off or viable but non-culturable (VBNC) bacteria that have resuscitated This eventuality has been confirmed by published studies in the peer reviewed literature.
Some time ago, the agency supplying the recycled water sought to gain permission to over drive the pumps going through the filters by 50%, That increased pressure may disrupt the ability to sequester the antibiotic resistant genes as well as ability to control other small pathogens.
There are some 45 miles of irrigation pipe within the Salinas and Letter forwarded by Dr. Edo McGowan….
Pajaro Valleys that can carry recycled. These pipes have a history of puncture. There is also an intervening reservoir. Thus, absent testing water at the POU, and with disk diffusion or qPCR, the question is not answered.
I’d like an answer as to whether you plan to test water at the POU? If not, why not?
Harwood, in testing recycled water noted that current standard tests are insufficient. Her paper is a boiled down version of WERF report 00-PUM-2T.
Dr Edo McGowan
any relationship of potable recycled water in this outbreak?