Shiga Toxin–Producing Escherichia coli Infections Associated With Romaine Lettuce—United States, 2018

Details

• Alternative Title:
  Clin Infect Dis
• Personal Author:
  Bottichio, Lyndsay ; Keaton, Amelia ; Thomas, Deepam ; Fulton, Tara ; Tiffany, Amanda ; Frick, Anna ; Mattioli, Mia ; Kahler, Amy ; Murphy, Jennifer ; Otto, Mark ; Tesfai, Adiam ; Fields, Angela ; Kline, Kelly ; Fiddner, Jennifer ; Higa, Jeffrey ; Barnes, Amber ; Arroyo, Francine ; Salvatierra, Annabelle ; Holland, April ; Taylor, Wendy ; Nash, June ; Morawski, Bozena M. ; Correll, Sarah ; Hinnenkamp, Rachel ; Havens, Jeffrey ; Patel, Kane ; Schroeder, Morgan N. ; Gladney, Lori ; Martin, Haley ; Whitlock, Laura ; Dowell, Natasha ; Newhart, Corinne ; Watkins, Louise Francois ; Hill, Vincent ; Lance, Susan ; Harris, Stic ; Wise, Matthew ; Williams, Ian ; Basler, Colin ; Gieraltowski, Laura
  More +
• Description:
  Background. ; Produce-associated outbreaks of Shiga toxin–producing Escherichia coli (STEC) were first identified in 1991. In April 2018, New Jersey and Pennsylvania officials reported a cluster of STEC O157 infections associated with multiple locations of a restaurant chain. The Centers for Disease Control and Prevention (CDC) queried PulseNet, the national laboratory network for foodborne disease surveillance, for additional cases and began a national investigation. ; Methods. ; A case was defined as an infection between 13 March and 22 August 2018 with 1 of the 22 identified outbreak-associated E. coli O157:H7 or E. coli O61 pulsed-field gel electrophoresis pattern combinations, or with a strain STEC O157 that was closely related to the main outbreak strain by whole-genome sequencing. We conducted epidemiologic and traceback investigations to identify illness subclusters and common sources. A US Food and Drug Administration–led environmental assessment, which tested water, soil, manure, compost, and scat samples, was conducted to evaluate potential sources of STEC contamination. ; Results. ; We identified 240 case-patients from 37 states; 104 were hospitalized, 28 developed hemolytic uremic syndrome, and 5 died. Of 179 people who were interviewed, 152 (85%) reported consuming romaine lettuce in the week before illness onset. Twenty subclusters were identified. Product traceback from subcluster restaurants identified numerous romaine lettuce distributors and growers; all lettuce originated from the Yuma growing region. Water samples collected from an irrigation canal in the region yielded the outbreak strain of STEC O157. ; Conclusions. ; We report on the largest multistate leafy greens–linked STEC O157 outbreak in several decades. The investigation highlights the complexities associated with investigating outbreaks involving widespread environmental contamination.
• Subjects:
  • Disease Outbreaks
  • Escherichia coli Infections
  • Escherichia coli O157
  • Food Microbiology
  • Foodborne Diseases
  • Humans
  • Lactuca
  • Pennsylvania
  • Shiga-Toxigenic Escherichia coli
  • United States
• Keywords:
  • outbreak
  • Escherichia coli
  • Romaine Lettuce
  • foodborne illness
  • produce safety
• Source:
  Clin Infect Dis. 71(8):e323-e330
• Pubmed ID:
  31814028
• Pubmed Central ID:
  PMC10982825
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  71
• Issue:
  8
• Download URL:
  https://stacks.cdc.gov/view/cdc/153626/cdc_153626_DS1.pdf
• File Type:
  [PDF - 781.55 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:6284c83bb82ab473d4b5d324be5cc645df0f6a204b3954e23d44bcd6f11d9679