FDA Investigating Multistate Outbreak of E. coli O157:H7 Infections Likely Linked to Romaine Lettuce Grown in California
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Outbreaks > FDA Investigating Multistate Outbreak of E. coli O157:H7 Infections Likely... Page 1 of 8
FDA Investigating Multistate
Outbreak of E. coli O157:H7
Infections Likely Linked to Romaine
Lettuce Grown in California
Update: December 17, 2018
https://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm626330.htm 12/21/2018
Outbreaks > FDA Investigating Multistate Outbreak of E. coli O157:H7 Infections Likely... Page 2 of 8
The FDA, along with CDC, state and local agencies, is investigating a multistate outbreak of
E. coli O157:H7 illnesses linked to romaine lettuce grown in California this fall. The Public
Health Agency of Canada (PHAC) and Canadian Food Inspection Agency (CFIA) are also
coordinating with U.S. agencies as they investigate a similar outbreak in Canada.
On December 13, 2018, Adam Bros. Farming, Inc., in Santa Barbara County, recalled prod-
ucts (/Safety/Recalls/ucm628583.htm) that may have come into contact with water from the
water reservoir where the outbreak strain was found. The firm recalled red leaf lettuce, green
leaf lettuce and cauliflower harvested on November 27 through 30, 2018. According to the
firm, cauliflower was distributed to wholesalers in the U.S. Mexico, and Canada.
The Adam Bros. recall has prompted a recall by Spokane Produce Inc. of Spokane, WA
(/Safety/Recalls/ucm628583.htm). The firm recalled sandwiches and other products under
the Northwest Cuisine Creations and Fresh&Local labels.
Recommendation:
Consumers:
Consumers should not eat recalled products and should throw them away. Consumers also
should not eat romaine from Monterey, San Benito, and Santa Barbara counties in California.
Based on discussions with producers and distributors, romaine lettuce entering the market will
now be voluntarily labeled with a harvest location and a harvest date or labeled as being
hydroponically- or greenhouse-grown. Romaine lettuce with the new labeling is available in
stores. Consumers should look for signs in stores where labels are not an option. If signs or
labels do not have this information, you should not eat or use it.
If it does have this information, we advise avoiding romaine from Monterey, San Benito, and
Santa Barbara counties in California. Romaine from outside those regions need not be
avoided. Additional counties may be added or subtracted as FDA traceback investigation
continues.
For example, romaine lettuce harvested from areas that include, but are not limited to, the
following do not appear to be related to the current outbreak:
• the desert growing region near Yuma, Arizona
• the California desert growing region near Imperial County and Riverside County
• the counties of Ventura, San Luis Obispo, and Santa Cruz in California
• the state of Florida
• Mexico
Additionally, there is no evidence hydroponically- and greenhouse-grown romaine is related to
the current outbreak, and there is, also, no recommendation to avoid romaine from these
sources.
Restaurants and Retailers:
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Restaurants and retailers should not serve or sell romaine from Monterey, San Benito, and
Santa Barbara counties in California. Romaine from outside those regions need not be
avoided. See the list above of examples of growing areas not related to the current outbreak.
Retailers and restaurants should discard any recalled product.
Retailers should ensure that there is labeling with the harvest date and location on each bag
of romaine, or that there is signage when labels are not an option.
Suppliers and Distributors:
Suppliers, distributors and others in the supply chain should not ship or sell romaine from
Monterey, San Benito, and Santa Barbara counties in California. Romaine from outside those
regions need not be. Distributors and suppliers should discard any recalled product.
FDA recommends that labels are placed on romaine lettuce entering the market to help
consumers, restaurants and retailers determine that the romaine is from unaffected growing
regions outside of Monterey, San Benito, or Santa Barbara counties in California.
• What Products are Recalled?
• What are the Symptoms of E. coli Infections?
• Who is at Risk?
• What Else Should Restaurants and Retailers Do?
• What Else Should Consumers Do?
• Investigation Timeline
• Additional Information
Case Counts
Total Illnesses:59
Hospitalizations: 23
Deaths: 0
Last illness onset: November 16, 2018
States with Cases: CA (12), CT (1), DC (1), FL (1), IL (2), LA (1), MA (1), MD (1), MI (7), NH (6), NJ (12), NY
(7), OH (1), PA (4), RI (1), WI (1)
Who to Contact
Consumers who have symptoms should contact their health care provider to report their symptoms and
receive care.
To report a complaint or adverse event (illness or serious allergic reaction), you can
https://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm626330.htm 12/21/2018Outbreaks > FDA Investigating Multistate Outbreak of E. coli O157:H7 Infections Likely... Page 4 of 8
• Call an FDA Consumer Complaint Coordinator (https://www.fda.gov/Safety/ReportaProblem/Con-
sumerComplaintCoordinators/default.htm) if you wish to speak directly to a person about your
problem.
• Complete an electronic Voluntary MedWatch form (https://www.accessdata.fda.gov/scripts/med-
watch/medwatch-online.htm) online.
• Complete a paper Voluntary MedWatch form (https://www.fda.gov/downloads/AboutFDA/Reports-
ManualsForms/Forms/UCM349464.pdf) that can be mailed to FDA.
Visit www.fda.gov/fcic (http://www.fda.gov/fcic) for additional consumer and industry assistance.
Submit Questions Electronically (https://cfsan.secure.force.com/Inquirypage)
Get E-mail Updates (/AboutFDA/ContactFDA/ucm2005606.htm)
Follow Us on Twitter (https://twitter.com/FDAfood)
What Products are Recalled?
On December 13, 2018, Adam Bros. Farming, Inc., in Santa Barbara County, recalled products
(/Safety/Recalls/ucm628583.htm) that may have come into contact with water from the water
reservoir where the outbreak strain was found. The firm recalled red leaf lettuce, green leaf lettuce
and cauliflower harvested on November 27 through 30, 2018. According to the firm, cauliflower
was distributed to wholesalers in the U.S. Mexico, and Canada.
The Adam Bros. recall has prompted a recall by Spokane Produce Inc. of Spokane, WA (/Safe-
ty/Recalls/ucm628583.htm). The firm recalled sandwiches and other products under the
Northwest Cuisine Creations and Fresh&Local labels.
What are the Symptoms of E. coli Infections?
The symptoms of Shiga toxin-producing (STEC) E. coli infections vary for each person but often
include severe stomach cramps and bloody diarrhea. If there is fever, it is usually not very high
(less than 101 degrees Fahrenheit/less than 38.5 degrees Celsius). Most people get better within 5
–7 days. Some infections are very mild, but others are severe or even life-threatening.
Around 5–10 percent of those who are diagnosed with STEC infection develop a potentially life-
threatening complication, known as hemolytic uremic syndrome (HUS).
Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of
urination, small unexplained bruises or bleeding, and pallor. Most people with HUS recover within
a few weeks, but some suffer permanent damage or die. People who experience these symptoms
should seek emergency medical care immediately. Persons with HUS should be hospitalized
because their kidneys may stop working (acute renal failure), but they may also develop other
serious problems such as hypertension, chronic kidney disease, and neurologic problems.
Who is at Risk?
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People of any age can become infected with Shiga toxin-producing (STEC) E. coli. Children under
the age of 5 years, adults older than 65, and people with weakened immune systems are more
likely than others to develop severe illness, including HUS, but even healthy older children and
young adults can become seriously ill.
What Else Should Restaurants and Retailers Do?
Restaurants and retailers should always practice safe food handling and preparation measures. It
is recommended that they wash hands, utensils, and surfaces with hot, soapy water before and
after handling food.
• Regular frequent cleaning and sanitizing of food contact surfaces and utensils used in food
preparation may help to minimize the likelihood of cross-contamination.
• Wash and sanitize display cases and refrigerators regularly.
• Wash and sanitize cutting boards, surfaces, and utensils used to prepare, serve, or store food.
• Wash hands with hot water and soap following the cleaning and sanitation process.
What Else Should Consumers Do?
Consumers should always practice safe food handling and preparation measures. It is
recommended that they wash hands, utensils, and surfaces with hot, soapy water before and after
handling food. Produce items should be rinsed in clean, running water without the use of additional
cleaners or soaps.
Investigation Timeline
December 13, 2018:
As of December 13, FDA has further refined the traceback investigation down to the farm level,
which narrows the list of romaine growing areas that FDA recommends consumers and retailers
avoid down to the following counties: Monterey, San Benito, and Santa Barbara.
San Luis Obispo, Santa Cruz and Ventura counties in California have been removed from the list
at this time. Other growing areas, for example Florida, Mexico and the desert growing regions near
Yuma, Imperial County, and Riverside County do not appear to be related to the current outbreak.
Investigation teams from FDA’s Produce Safety Network, California Department of Public Health,
California Department of Food and Agriculture, and the CDC analyzed romaine lettuce, soil, water,
sediment, and animal dropping samples at farms identified by the traceback investigation. Most of
these samples tested negative for the outbreak strain, with some samples still undergoing analysis.
However, the strain of E. coli O157:H7 causing the current outbreak was identified in one sample
collected in the sediment of an agricultural water reservoir at one ranch owned and operated by
Adam Bros. Farming, Inc., in Santa Barbara County. The strain isolated from this sample matched
those collected from ill persons in this outbreak using Whole Genome Sequencing (WGS). The
FDA is able to confirm that Adam Bros. Farming, Inc. hasn’t shipped any romaine since November
20, 2018. Experts are working with the farm to determine how contamination occurred and what
corrective actions need to be taken before their next growing season.
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Outbreaks > FDA Investigating Multistate Outbreak of E. coli O157:H7 Infections Likely... Page 7 of 8 Traceback activities in this romaine lettuce investigation are ongoing and new information continues to be gathered. Analysis of information available through November 30 has not narrowed the potential sources of contaminated romaine lettuce to a specific farm, processor, shipper or distribution center. November 26, 2018: The FDA has been conducting a traceback investigation, reviewing shipping records and invoices to trace the supply of romaine from the place where ill people were exposed to the place where that romaine was grown. Preliminary traceback information indicates that ill people in several areas across the country were exposed to romaine lettuce harvested in California. Specifically, current evidence indicates this romaine was harvested in the Central Coast growing regions of northern and central California. The specific California counties FDA identified in the traceback investigation are: • Monterey • San Benito • San Luis Obispo • Santa Barbara • Santa Cruz • Ventura Currently, the FDA does not have enough traceback information to identify the source of the contamination that would allow us to request a targeted recall from specific suppliers. On November 20, FDA recommended that the most efficient way to ensure that contaminated romaine is off the market would be for industry to voluntarily withdraw product from the market, and to withhold distribution of romaine until public health authorities can ensure the outbreak is over and/or until FDA can identify a specific source of contamination. On November 20, the United Fresh Produce Association (https://www.unitedfresh.org/pro- duce-industry-groups-respond-to-protect-consumers-in-romaine-outbreak/) and the Leafy Greens Marketing Agreement (https://lgma.ca.gov/2018/11/leafy-greens-marketing-agree- ment-and-produce-industry-groups-respond-to-protect-consumers-in-romaine-outbreak/) issued statements committing to withdraw the potentially contaminated romaine from the market. November 20, 2018: Genetic analysis of the E. coli O157:H7 strains tested to date from patients in this current outbreak are similar to strains of E. coli O157:H7 associated with a previous outbreak from the Fall of 2017 (/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm593896.htm) that also affected consumers in both Canada and the U.S. The 2017 outbreak of E. coli O157:H7 was associated with leafy greens in the U.S. and romaine in Canada. This year, romaine lettuce is the suspected vehicle for both the U.S. and Canadian outbreaks. There is no genetic link between the current outbreak and the E.coli O157:H7 outbreak linked to romaine that occurred in the Spring of 2018 (/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm604254.htm). https://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm626330.htm 12/21/2018
Outbreaks > FDA Investigating Multistate Outbreak of E. coli O157:H7 Infections Likely... Page 8 of 8
The FDA is conducting a traceback investigation to determine the source of the romaine lettuce
eaten by people who became sick. Additionally, FDA and states are conducting laboratory analysis
of romaine lettuce samples potentially linked to the outbreak.
Currently, the FDA does not have enough traceback information to identify the source of the
contamination that would allow us to request a targeted recall from specific suppliers. At this stage
in the investigation, the most efficient way to ensure that contaminated romaine is off the market
would be for industry to voluntarily withdraw product from the market, and to withhold distribution of
romaine until public health authorities can ensure the outbreak is over and/or until FDA can identify
a specific source of contamination. Until then, the FDA advises that consumers should not eat and
discard romaine, or any mixed salads containing romaine, until more information on the source of
the contamination and the status of the outbreak can be determined.
Additional Information
• Statement from FDA Commissioner and FDA Deputy Commissioner - December 13, 2018
(/NewsEvents/Newsroom/PressAnnouncements/ucm628400.htm)
• Statement from the FDA Commissioner – November 26, 2018 (/NewsEvents/News-
room/PressAnnouncements/ucm626716.htm)
• CDC Food Safety Alert (https://www.cdc.gov/ecoli/2018/o157h7-11-18/index.html)
• PHAC Public Health Notice (https://www.canada.ca/en/public-health/services/public-
health-notices/2018/outbreak-ecoli-infections-linked-romaine-lettuce.html)
• FoodSafety.gov on E. coli (https://www.foodsafety.gov/poisoning/causes/bacteriavirus-
es/ecoli/index.html)
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