In 2010, E. coli contaminated lettuce processed by Freshway sickened 33 people in 5 states. 2008 saw a couple of lettuce E. coli outbreaks, including Aunt Mids, which caused 45 illnesses, and an E. coli outbreak in Washington State, which sickened at least 10.  It has been several years since a lettuce or other leafy green vegetable has sickened more than a few dozen people (excluding at least one major Salmonella outbreak that flew under the radar of public attention). Now, E. coli contaminated romaine lettuce, sold in salads in multiple Missouri Schnuck’s stores, has sickened at least 60 people in 10 states, causing several hemolytic uremic syndrome illnesses, and undoubtedly millions of dollars in present and future medical costs.

The romaine lettuce E. coli outbreak linked, in part, to Schnuck’s grocery stores is rivaled by only a few leafy greens E. coli outbreaks. Three of them occurred in the devastating fall of 2006. They were linked to Dole baby spinach, known in Salinas Valley California as “the outbreak,” and the Taco Bell and Taco Johns lettuce E. coli outbreaks that followed quickly on the spinach outbreak’s heels.

Spinach E. coli Outbreak, Fall 2006:

The history of outbreaks linked to lettuce, spinach, and other leafy green vegetables gave Dole, the company whose product caused the spinach outbreak, reason to know that a problem existed within the leafy-greens industry—a problem that was affecting, sometimes killing, the very people responsible for Dole’s substantial market share in the industry. If track record is any indication, the response to these outbreaks by Dole and other leafy greens companies, if they had one, was woefully inadequate. And this is not just a sentiment held by the lawyers at Marler Clark; as the industry well knows, the same sentiment has been articulated time and again by the Food and Drug Administration. The 2006 spinach outbreak, which ultimately sickened hundreds, if not thousands, was the horrific result of the industry’s lack of action, and conscious disregard of risk.

Official word of the spinach outbreak broke with the FDA’s announcement, on September 14, 2006, that a number of E. coli O157:H7 illnesses across the country “may be associated with the consumption of produce.” “Preliminary epidemiological evidence suggests,” the statement continued, “that bagged fresh spinach may be a possible cause of this outbreak.” By the date of the announcement, fifty cases had been reported to the Centers for Disease Control and Prevention (CDC), including eight cases of hemolytic uremic syndrome (HUS) and one death. States reporting illness included Connecticut, Idaho, Indiana, Michigan, New Mexico, Oregon, Utah, and Wisconsin.

The much-publicized outbreak grew substantially over the next several days. By September 15, the FDA had confirmed 94 cases of illness, including fourteen cases of HUS and, sadly, one death. Recognizing the lethality of the developing outbreak, the FDA’s September 15 release warned people should “not eat fresh spinach or fresh spinach containing products.”

Press Releases over the ensuing days announced steady growth in the number of people sickened, hospitalized, and with HUS as a result of the outbreak—109 cases from nineteen states by September 17, and 131 cases from twenty-one states just two days later. The latter statistic included 66 hospitalizations and twenty cases of HUS.

Meanwhile, the FDA and CDC, in conjunction with local and state health agencies from across the country, worked feverishly to figure out the brand names associated with illness. Early statistical analysis suggested that many brands were implicated, but the spinach sold under the several brand names had all come from the Natural Selection Foods processing center in San Juan Batista, California. Accordingly, Natural Selection recalled all of its spinach products with “use by” dates from August 17 to October 1, 2006. The recall, of course, included Dole brand spinach. But further data and study ultimately narrowed the possible sources of the outbreak down to one brand of packaged greens: Dole.

Though epidemiological evidence had already strongly linked Dole to the outbreak, the FDA found the proverbial “smoking gun” on September 20. The bag of Dole baby spinach had been purchased and consumed by an Albuquerque, New Mexico woman, and testing by the New Mexico State Health Department had confirmed that the product was contaminated with E. coli O157:H7 bearing the same genetic marker as the outbreak strain. The FDA announced the critical finding on September 21, 2006—also disclosing the “best by” date on the positive Dole bag of August 30—thereby giving a worried public a bit more information on what spinach products to eat, if any, and what to avoid.

By the date of the FDA’s September 21 announcement, the number of confirmed cases had swelled to 157 people from twenty-three states. Ultimately, the FDA confirmed 204 outbreak-related cases, with 102 hospitalizations, thirty-one cases of HUS, and three deaths, though the actual number of people affected by the outbreak was certainly much larger. In addition to the elderly Wisconsin resident, the FDA stated, the outbreak had claimed the lives of two-year-old Kyle Algood from Chubbuck, Idaho, and 81-year-old Ruby Trautz from Bellevue, Nebraska.

Epidemiological and laboratory evidence, which had already proved the link to Natural Selection and Dole, soon revealed that the contaminated spinach had been grown at Paicines Ranch in San Benito County, California. More specifically, investigators had traced the source of the contaminated spinach to one field on the ranch that had been leased by Mission Organics.

Once identified as the likely source for the outbreak, Mission Organics became host to health officials looking for the outbreak strain of E. coli O157:H7. State and federal investigators took hundreds of environmental samples and swabs from the vicinity of the implicated spinach field, which was fifty acres in size, including from a nearby cattle pasture and water source. Investigators also sampled the intestinal lining of feral pigs that had been killed as part of the investigation. Samples from a variety of sources, including the pigs, the water, and cattle feces, tested positive for the same strain of E. coli O157:H7 that had now been isolated in over 200 people nationally. Finally, the outbreak strain of E. coli O157:H7 has been isolated in at least thirteen separate bags of Dole baby spinach.

Taco Bell Lettuce E. coli Outbreak (71 ill):

Right after the Spinach E. coli outbreak came Taco Bell’s, and Taco John’s (below) own lettuce E. coli outbreaks. Taco Bell’s occurred in the Northeastern United States. Ill persons ate at Taco Bell Restaurants. At first green onions were implicated by the Centers for Disease Control; later lettuce was suspected. Ill persons ate a variety of food items at the restaurants. Public health investigators identified a few ingredients that were consumed more often by ill persons than well persons and were statistically linked with illness. These items included: lettuce; cheddar cheese; ground beef. Onions of any type were not linked to this outbreak, however a sample of chopped, yellow onion tested positive for E.coli O157: H7; this was not the outbreak strain. E.coli O157:H7 was not found in the other food items that were tested. The investigators gathered additional information about the location of the restuarants, patterns of food ingredient distribution, and the characteristics and preparation of the food ingredients. Evaluation of this data indicated that shredded lettuce was the most likely source of the outbreak. Because multiple Taco Bell restaurants were involved during the same time period, contamination of lettuce likely occurred before reaching the restaurants.

Taco John’s Lettuce E. coli Outbreak (87 ill):

Iowa and Minnesota health officials investigated an E.coli O157:H7 outbreak among patrons at Taco John’s restaurants in Iowa (Cedar Falls) and Minnesota (Albert Lea and Austin). Although this outbreak occurred at the same time (November and December) as the Taco Bell E.coli outbreak on the East Coast, the Taco John outbreak was not linked with the outbreak at Taco Bell. Shredded iceberg lettuce that was served in the restaurants was determined to be the likely vehicle of transmission. The outbreak strain matched two environmental samples gathered from dairy farms near a lettuce growing area in California’s Central Valley.