In November through December of 2019, the Centers for Disease Control and Prevention (CDC), U.S. Food and Drug Administration (FDA), and public health officials from several states investigated an outbreak of E. coli in 2019. Cases were identified using the PulseNet system. 167 people infected with the outbreak strain of E. coli O157:H7 were reported from 27 states. The Public Health Agency of Canada also reported several illnesses that were genetically related to the US cases. Eighty-five hospitalizations were reported, including 15 cases who reported developing hemolytic uremic syndrome (HUS). No deaths were reported. Illnesses occurred between September 20 and December 21, 2019. Cases ranged between less than 1 to 89 years old, with a median age of 27 years old. Sixty-four percent of ill cases were female.
Whole-genome sequencing (WGS) analysis from 159 ill people determined that bacteria isolated from ill people were closely genetically related, implying that the people in this outbreak more likely than not shared a common source of infection. It also revealed that this same strain of E. coli O157:H7 responsible for this outbreak caused the outbreaks linked to leafy greens in 2017 and to romaine lettuce in 2018. WGS did not predict antibiotic resistance in 157 of the isolates but did predict resistance in two isolates.
Ninety-five percent of interviewed people reported eating leafy greens in the week before illness. Eighty-three percent of interviewed people reported eating specifically romaine lettuce prior to developing illness. Of the cases who provided brand information, 43% reported Fresh Express products. Ill people reported eating different types of romaine lettuce in several restaurants and at home. The Maryland Department of Health identified the outbreak strain in an unopened package of Ready Pac Foods Bistro® Chicken Caesar Salad (best by: 11/14/19, lot #: Z301 A05B 9:16 68), collected from a case’s home in Maryland. Likewise, the Wisconsin Department of Health Services identified the outbreak strain in an unopened bag of Fresh Express® Leafy Green Romaine collected from a case’s home in Wisconsin. The Salinas Valley growing region was the common source for both products.
The FDA investigated ranches where the suspected romaine lettuce was harvested, but they were unable to sample any lettuce since the growing season had already ended. Therefore, investigators collected water, soil, and compost to be analyzed. Results came back negative for the outbreak strain of E. coli O157:H7. FDA continues its investigation through the new year’s planting, growing, and harvesting season. On November 21, 2019, the USDA FSIS announced a recall by Missa Bay, LLC of roughly 75,233 pounds of salad products containing meat or poultry because the lettuce in these products could have been contaminated with E. coli O157:H7 related to this outbreak, because the products used the same lettuce found to be contaminated by the Maryland Department of Health.
Epidemiologic, laboratory, and traceback evidence indicated that romaine lettuce from the Salinas Valley growing region in California was the likely source of this outbreak, as it was found to be contaminated with the outbreak strain of E. coli O157:H7. This outbreak was given the outbreak code 1911MLEXH-1. As of January 15, 2020, the outbreak was declared over. 
E. coli outbreaks associated with lettuce, specifically the “pre-washed” and “ready-to-eat” varieties, are by no means a new phenomenon. In fact, the frequency with which this country’s fresh produce consuming public has been hit by outbreaks of pathogenic bacteria is astonishing. Here are just a sample of E. coli outbreaks based on information gathered by the Center for Science in the Public Interest, Kansas State University and the Centers for Disease Control and Prevention:
|July 1995||Lettuce (leafy green; red; romaine)||E. coli O157:H7||74||1:MT|
|Sept. 1995||Lettuce (romaine)||E. coli O157:H7||20||1:ID|
|Sept. 1995||Lettuce (iceberg)||E. coli O157:H7||30||1:ME|
|Oct. 1995||Lettuce (iceberg; unconfirmed)||E. coli O157:H7||11||1:OH|
|May-June 1996||Lettuce (mesclun; red leaf)||E. coli O157:H7||61||3:CT, IL, NY|
|May 1998||Salad||E. coli O157:H7||2||1:CA|
|Feb.-Mar. 1999||Lettuce (iceberg)||E. coli O157:H7||72||1:NE|
|Oct. 1999||Salad||E. coli O157:H7||92||3:OR, PA, OH|
|Oct. 2000||Lettuce||E. coli O157:H7||6||1:IN|
|Nov. 2001||Lettuce||E. coli O157:H7||20||1:TX|
|July-Aug. 2002||Lettuce (romaine)||E. coli O157:H7||29||2:WA, ID|
|Nov. 2002||Lettuce||E. coli O157:H7||13||1:Il|
|Dec. 2002||Lettuce||E. coli O157:H7||3||1:MN|
|Oct. 2003-May 2004||Lettuce (mixed salad)||E. coli O157:H7||57||1:CA|
|Apr. 2004||Spinach||E. coli O157:H7||16||1:CA|
|Nov. 2004||Lettuce||E. coli O157:H7||6||1:NJ|
|Sept. 2005||Lettuce (romaine)||E. coli O157:H7||32||3:MN, WI, OR|
|Sept. 2006||Spinach (baby)||E. coli O157:H7 and other serotypes||205||Multistate and Canada|
|Nov./Dec. 2006||Lettuce||E. coli O157:H7||71||4:NY, NJ, PA, DE|
|Nov./Dec. 2006||Lettuce||E. coli O157:H7||81||3:IA, MN, WI|
|July 2007||Lettuce||E. coli O157:H7||26||1:AL|
|May 2008||Romaine||E. coli O157:H7||9||1:WA|
|Oct. 2008||Lettuce||E. coli O157:H7||59||Multistate and Canada|
|Nov. 2008||Lettuce||E. coli O157:H7||130||Canada|
|Sept. 2009||Lettuce: Romaine or Iceberg||E. coli O157:H7||29||Multistate|
|Sept. 2009||Lettuce||E. coli O157:H7||10||Multistate|
|April 2010||Romaine||E. coli O145||33||5:MI, NY, OH, PA, TN|
|Oct. 2011||Romaine||E. coli O157:H7||60||Multistate|
|April 2012||Romaine||E. coli O157:H7||28||
|June 2012||Romaine||E. coli O157:H7||52||Multistate|
|Sept. 2012||Romaine||E. coli O157:H7||9||1:PA|
|Oct. 2012||Spinach and Spring Mix Blend||E. coli O157:H7||33||Multistate|
|Apr. 2013||Leafy Greens||E. coli O157:H7||14||Multistate|
|Aug. 2013||Leafy Greens||E. coli O157:H7||15||1:PA|
|Oct. 2013||Ready-To-Eat Salads||E. coli O157:H7||33||Multistate|
|Apr. 2014||Romaine||E. coli O126||4||1:MN|
|Apr. 2015||Leafy Greens||E. coli O145||7||3:MD, SC, VA|
|June 2016||Mesclun Mix||E. coli O157:H7||11||3:IL, MI, WI|
|Nov. 2017||Leafy Greens||E. coli O157:H7||67||Multistate and Canada|
|Mar. 2018||Romaine||E. coli O157:H7||219||Multistate and Canada|
|Oct. 2018||Romaine||E. coli O157:H7||62||Multistate and Canada|
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. coliand other foodborne illness infections and have recovered over $800 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. coliand 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.
If you or a family member became ill with an E. coli infection or HUS after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark E. coli attorneys for a free case evaluation.