At first glance, it appeared that the E. coli O157:H7 infections experienced by Natalia and Andrea D’Ercole were simply part of a small cluster of cases occurring in San Diego and Orange County, California.  As part of the routine case investigation, San Diego County public health investigators learned that on October 12, 2008 the D’Ercole siblings had eaten at The Cheesecake Factory restaurant located in Fashion Valley Mall in San Diego.  In neighboring Orange County, a 46-year-old man with an E. coli O157:H7 infection reported eating at a Cheesecake Factory restaurant located in Brea, California on October 13, 2008.  Genetic testing by pulsed field gel electrophoresis (PFGE) showed that Andrea, Natalia, and the Orange County patient were sickened with an indistinguishable strain of E. coli O157:H7, designated by PFGE pattern numbers EXHX01.4626/EXHA26.2558.  The strain was so unusual that it triggered a cluster investigation.  Federal officials at the Centers for Disease Control and Prevention (CDC) assigned Cluster Identification Number 08100NEXH-1mlc to the investigation.

Through OutbreakNet, a national outbreak response unit staffed at the CDC, a fourth case-patient in the cluster was identified, an 18 year old resident of South Dakota.  This patient confirmed the association between illness and eating at a Cheesecake Factory restaurant.  She had eaten at The Cheesecake Factory in Fashion Valley Mall on October 12, 2008 while on vacation in San Diego.  Natalia D’Ercole, the Orange County resident, and the South Dakota woman had symptom onset within five days of eating at the restaurant.  Andrea D’Ercole’s symptoms started several days after Natalia’s onset.  It is unclear whether Andrea’s infection was due directly to her meal at the Cheesecake Factory, or if her illness was secondarily caused via person-to-person contact with her ill sister.

Within a matter of days the outbreak grew beyond the Southern California confines.  Public health laboratories continued to report PFGE matches to the “Cheesecake Factory” strain of E. coli O157:H7.  Case-patients were identified in Illinois, Florida, New Jersey, and Ohio.  These individuals reported restaurant exposures but none ate at a Cheesecake Factory.  This led investigators to suspect a contaminated ingredient was in the marketplace.  Canadian investigators in Ontario identified an outbreak involving 55 persons with at least 13 ill case patients culturing positive for the outbreak strain. The majority of cases were linked to one of two restaurants.  Illnesses occurred between October 11 and October 28.  Canadian investigators conducted a case-control study and lettuce was statistically associated with illness.  Product traceback showed that two restaurants tied to the outbreak shared a common produce supplier and that Andy Boy brand romaine lettuce was the only lettuce in common to all Canadian restaurants with outbreak cases.

Cheesecake Factory associated case-patients were questioned about lettuce consumption at the restaurant chain.  The D’Ercole girls and the South Dakota resident consumed salads at the Cheesecake Factory located in Fashion Valley Mall on October 12.  The Orange County patient ate a salad at the Cheesecake Factory restaurant in Brea, California on October 13.  All three salads contained romaine lettuce.  San Diego County restaurant inspectors conducted an investigation into the source of the lettuce at the Fashion Valley Mall restaurant.  They learned that the restaurant was supplied by Fresh Point, a company based in the City of Industry in the Los Angeles area.  Fresh Point serviced Cheesecake Factory locations in San Diego and Orange Counties.  Romaine lettuce was from Andy Boy brand.  State investigators from California and from the U.S. Food and Drug Administration identified D’Arrigo Brothers in Salinas, California as the supplier of “Andy Boy” brand romaine lettuce.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of E. coli outbreaks and hemolytic uremic syndrome (HUS). The E. coli lawyers of Marler Clark have represented thousands of victims of E. coli and other foodborne illness infections and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our E. coli lawyers have litigated E. coli and HUS cases stemming from outbreaks traced to ground beef, raw milk, lettuce, spinach, sprouts, and other food products.  The law firm has brought E. coli lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, and Jimmy John’s.  We have proudly represented such victims as Brianne Kiner, Stephanie Smith and Linda Rivera.