Food Poisoning Lawyer & Attorney : Marler Clark : Food Poison Journal

The Centers for Disease Control (CDC) updated their investigation information today into the developing E. coli O145 outbreak in Michigan, New York, Ohio, and Tennessee linked to shredded romaine lettuce sold by Freshway Foods.

To date, there are 23 confirmed and 7 probable cases related to this outbreak from MI, NY, OH, and TN.  Among the 30 patients with available information, 12 (40%) were hospitalized. Three patients have developed a type of kidney failure known as hemolytic-uremic syndrome (HUS).  Thankfully no deaths have been reported. 

Mounting evidence has implicated shredded romaine lettuce from one processing facility, Freshway Foods, as a source of infection in this outbreak.  This evidence includes the identification of the outbreak strain of E. coli O145 from an unopened package of shredded romaine lettuce obtained at an institution that received product from the processing facility linked to the outbreak. A case-control study in Michigan found a significant association between illness and consumption of romaine lettuce processed at the same facility that processed lettuce consumed by ill persons in New York, Ohio and Tennessee.

The breakdown of illnesses thus far by state is as follows:

• MI (10 confirmed and 3 probable)
• NY (4 confirmed and 3 probable)
• OH (8 confirmed and 1 probable)
• TN (1 confirmed)

Among the confirmed and probable cases with reported dates available, illnesses began between April 10, 2010 and April 26, 2010. Infected individuals range in age from 13 years old to 31 years old and the median age is 19 years. Sixty-six percent of patients are male.

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E. coli outbreaks linked to lettuce and other leafy green vegetables have happened again and again, particularly over the past decade and a half.  Not  all have garnered the media attention that the 2006 spinach outbreak did, and some have even gone unreported publicly.  Here is a list of lettuce and other leafy green outbreaks since 1993:

1.  August 1993 - E. coli O157:H7 outbreak linked to a salad bar; 53 reported cases in Washington State

2.  July 1995 - Lettuce (leafy green; red; romaine) E. coli O157:H7; 70 reported cases in Montana

3.  September 1995 - Lettuce (romaine) E. coli O157:H7; 20 reported cases in Idaho

4.  September 1995 - Lettuce (iceberg) E. coli O157:H7; 30 reported cases in Maine

5.  October 1995 - Lettuce (iceberg; unconfirmed) E. coli O157:H7; 11 reported cases in Ohio

6.  May-June 1996 - Lettuce (mesclun; red leaf) E. coli O157:H7; 61 reported cases in Connecticut, Illinois, and New York

7.  May 1998 - Salad E. coli O157:H7; two reported cases in California

8.  February.-March 1999 - Lettuce (iceberg) E. coli O157:H7; 72 reported cases in Nebraska

9.  July-August 2002 - Lettuce (romaine) E. coli O157:H7; 29 reported cases in Washington and Idaho

10.  October 2003-May 2004 - Lettuce (mixed salad) E. coli O157:H7; 57 reported cases in California

11.  April 2004 - Spinach E. coli O157:H7; 16 reported cases in California

12.  September 2005 - Lettuce (romaine) E. coli O157:H7; 32 reported cases in Minnesota, Wisconsin, and Oregon

13.  September 2006 - Spinach E. coli O157:H7; 205 case (five deaths) nationwide

14.  November 2006 - Lettuce E. coli O157:H7; New York, New Jersey, Pennsylvania; 71 sickened

15.  December 2006 - Lettuce E. coli O157:H7; Iowa, Minnesota, Wisconsin; 81 ill

16.  May 2008 - Lettuce E. coli O157:H7; Washington; 9 ill

Industry Warnings:

On February 5, 2004, the FDA wrote a letter to the produce industry to voice its concern about the frequent outbreaks linked to leafy green and tomato products. In the letter, the FDA counted 14 such outbreaks since 1996 that it had investigated. Among other things, the letter stated:

In view of continuing outbreaks associated with fresh lettuce and fresh tomatoes, we strongly encourage firms in your industries to review their current operations in light of the agency’s guidance for minimizing microbial food safety hazards in fresh lettuce and fresh tomatoes, as well as other available information regarding pathogen reduction or elimination on fresh produce. We further encourage these firms to consider modifying their operations accordingly, to ensure that they are taking the appropriate measures to provide a safe product to the consumer. Since the available information concerning some of the recent outbreaks does not definitively identify the point of origin of the contamination, we recommend that firms from the farm level through the distribution level undertake these steps.

On September 30, 2005, a year and a half after the FDA’s 2004 letter to the lettuce industry, the Minnesota Department of Health issued a press release stating that 11 Minnesota residents had been infected by E. coli O157:H7 from contaminated Dole romaine lettuce. Two days later, the FDA issued a nationwide public health alert regarding Dole pre-packaged salads. Further investigation indicated that 22,321 cases of potentially contaminated Dole romaine lettuce had been sent to market from a processing facility in central California. Ultimately, at least 32 people were sickened in the outbreak.

One month after the 2005 Dole lettuce outbreak, the FDA wrote the industry again. The November 4, 2005 letter began as follows: “This letter is intended to make you aware of the Food and Drug Administration's (FDA's) serious concern with the continuing outbreaks of foodborne illness associated with the consumption of fresh and fresh-cut lettuce and other leafy greens.” The letter continued:

FDA is aware of 18 outbreaks of foodborne illness since 1995 caused by Escherichia coli O157:H7 for which fresh or fresh-cut lettuce was implicated as the outbreak vehicle. In one additional case, fresh-cut spinach was implicated. These 19 outbreaks account for approximately 409 reported cases of illness and two deaths. Although tracebacks to growers were not completed in all 19 outbreak investigations, completed traceback investigations of eight of the outbreaks associated with lettuce and spinach, including the most recent lettuce outbreak in Minnesota, were traced back to Salinas, California.

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Largely due to a string of E. coli O157:H7 outbreaks linked to lettuce and other leafy greens, the FDA will soon announce new rules (as opposed to voluntary recommendations) for the production and packing of fresh produce.  See FDA Produce Rule Announcement.  The new rules will set enforceable standards for fresh produce safety at the farm and packing house.  The purpose of the proposed rule:

is to reduce the risk of illness associated with contaminated fresh produce. The proposed rule will be based on prevention-oriented public health principles and incorporate what we have learned in the past decade since the agency issued general good agricultural practice guidelines entitled “Guide to Minimize Microbial Food Safety Hazards for Fresh Fruits and Vegetables” (GAPs Guide). The prtoposed rule also will reflect comments received on the agency's 1998 update of its GAPs guide and its July 2009 draft commodity specific guidances for tomatoes, leafy greens, and melons. Although the proposed rule will be based on recommendations that are included in the GAPs guide, it does not make the entire guidance mandatory. FDA’s proposed rule would, however, set out clear standards for implementation of modern preventive controls.

One positive thing to come from the produce-related outbreaks of the past several years is a lot of data--about, among other things,  the importance of traceability, how and why outbreaks happen, and measures to take at the farm and processing level to reduce the potential for proliferation of disease causing bacteria. 

Here are several accounts of severe foodpoisoning illnesses suffered by produce outbreak victims:

Kelly Cobb--developed hemolytic uremic syndrome (HUS) after consuming E. coli O157:H7 contaminated romaine lettuce.

Heather Whybrew--hospitalized three weeks after consuming E. coli O157:H7 contaminated romaine lettuce.

Regan Erickson--developed HUS after consuming E. coli O157:H7 contaminated Dole baby spinach.

Ashley Armstrong--developed HUS after consuming E. coli O157:H7 contaminated Dole baby spinach.

June Dunning, Betty Howard, and Ruby Trautz--women who died after consuming E. coli-contaminated Dole baby spinach. 

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After a frightful two-year stretch in 2005 and 2006 that included two Dole spinach/lettuce outbreaks due to E. coli O157:H7 contamination, the resurgence of ground beef as a leading vector in E. coli cases must have caused lettuce to feel a little left out.  The last month, with the announcement of a major national outbreak linked to shredded lettuce and yesterday's announcement of a three-state outbreak also likely linked to lettuce, feels a bit like the wakening of a very mean jolly green giant. 

Here's a brief look at E. coli O157:H7 outbreaks linked to lettuce and other leafy greens over the past decade (or a little longer): 

- in October 2003, thirteen residents of a California retirement home were sickened, and two people died, after eating E. coli-contaminated, pre-washed spinach;

- in September 2003, nearly forty patrons of a California restaurant chain fell ill after eating salads prepared with bagged, pre-washed lettuce; and

- in July 2002, over fifty young women fell ill with E. coli O157:H7 at a dance camp after eating “pre-washed” lettuce, leaving several hospitalized and one with life-long kidney damage.

Here are a few more examples:

- Aug. 1993  E. coli O157:H7 outbreak linked to a salad bar; 53 reported cases in Washington State

- July 1995  Lettuce (leafy green; red; romaine) E. coli O157:H7; 70 reported cases in Montana

- Sept. 1995  Lettuce (romaine) E. coli O157:H7; 20 reported cases in Idaho

- Sept. 1995  Lettuce (iceberg) E. coli O157:H7; 30 reported cases in Maine

- Oct. 1995  Lettuce (iceberg; unconfirmed) E. coli O157:H7; 11 reported cases in Ohio

- May-June 1996  Lettuce (mesclun; red leaf) E. coli O157:H7; 61 reported cases in Connecticut, Illinois, and New York

- May 1998  Salad E. coli O157:H7; two reported cases in California

- Feb.-Mar. 1999  Lettuce (iceberg) E. coli O157:H7; 72 reported cases in Nebraska

- Apr. 2004  Spinach E. coli O157:H7; 16 reported cases in California

- Sep. 2005  Lettuce (romaine) E. coli O157:H7; 32 reported cases in Minnesota, Wisconsin, and Oregon

But we all know that the list does not end there. E. coli O21:H19 nearly killed two women at a Wendy's in Utah.  Also Taco Bell and Taco John's in late 2006.

2008 saw E. coli outbreaks linked to lettuce in Michigan and the State of Washington - Spinach too in Oregon.

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Lynne Terry of The Oregonian reported this afternoon that Oregon health authorities have announced a suspected link between 124 Salmonella Typhimurium illnesses nationally and lettuce.  The illnesses began appearing in mid-July and trailed off about a month later.  Seven Oregon residents fell ill between Aug. 4 to 16, including three in the Portland metro area.

One of the Oregon residents who became ill suffered a particularly severe illness and was hospitalized for several weeks.  Doctors removed a portion of her gastrointestinal tract, which had become necrotic and non-functional as a result of her severe infection with Salmonella Typhimurium.  We represent this unfortunate woman, and are working hard to discover for her what the ultimate source of her illness was.

This would certainly not be the first time that contaminated lettuce or other leafy greens caused an outbreak of severe illnesses.  In addition to the infamous Dole spinach E. coli outbreak in 2006, here are a few others:

November-December 2006 - Taco Bell and Taco Johns E. coli shredded lettuce sickened hundreds in Mid-west and East

June 2005 - 30 sickened in three states by E. coli-tainted Dole Lettuce

October 2003 - thirteen residents of a California retirement home were sickened, and two people died, after eating E. coli-contaminated, pre-washed spinach

September 2003 - nearly forty patrons of a California restaurant chain fell ill after eating salads prepared with bagged, pre-washed lettuce

July 2002 - over fifty young women fell ill with E. coli O157:H7 at a dance camp after eating “pre-washed” lettuce, leaving several hospitalized and one with life-long kidney damage

August 1993 - E. coli O157:H7 outbreak linked to a salad bar; 53 reported cases in Washington State

July 1995 - Lettuce (leafy green; red; romaine) E. coli O157:H7; 70 reported cases in Montana

September 1995 - Lettuce (romaine) E. coli O157:H7; 20 reported cases in Idaho

September 1995 - Lettuce (iceberg) E. coli O157:H7; 30 reported cases in Maine

October 1995 - Lettuce (iceberg; unconfirmed) E. coli O157:H7; 11 reported cases in Ohio

May-June 1996 - Lettuce (mesclun; red leaf) E. coli O157:H7; 61 reported cases in Connecticut, Illinois, and New York

May 1998 - Salad E. coli O157:H7; two reported cases in California

February.-March 1999 - Lettuce (iceberg) E. coli O157:H7; 72 reported cases in Nebraska

July-August 2002 - Lettuce (romaine) E. coli O157:H7; 29 reported cases in Washington and Idaho

October 2003-May 2004 - Lettuce (mixed salad) E. coli O157:H7; 57 reported cases in California

April 2004 - Spinach E. coli O157:H7; 16 reported cases in California

September 2005 - Lettuce (romaine) E. coli O157:H7; 32 reported cases in Minnesota, Wisconsin, and Oregon

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