Seattle/King County Public Health is investigating an outbreak of Shiga toxin-producing E. coli O157:H7 (STEC) potentially associated with seven Evergreens restaurants in King County, WA. This outbreak appears to be over. The most recent illness in this outbreak reported to Public Health started on November 17, 2019. We are still investigating and do not yet have conclusive results about what caused the outbreak. We will post an update if more information becomes available.

Genetic testing on isolates from 11 of the 15 cases indicates that the strains are closely related, suggesting a common source. The remaining people who got sick were not tested for STEC, but their symptoms are suggestive of an E. coli O157:H7 infection.

Currently, available data indicates that this outbreak is different from the strain of E. coli currently causing a national outbreak of E. coli associated with romaine lettuce grown in Salinas, California, which the U.S. Centers for Disease Control and Prevention (CDC) announced on November 22, 2019.

Since November 20, 2019, we have learned of 15 people in WA (13 in King County and 2 in Snohomish County) who developed symptoms consistent with an E. coli illness after consuming food from seven different Evergreens restaurants in King County.

Illness onsets occurred during November 8–17, 2019. Meal dates were during November 5–11, 2019.

Three people were hospitalized. Everyone who reported illness has recovered.

During November 21 to December 12, 2019, Environmental Health investigators visited 6 of the Evergreens locations where the ill people reported eating and are planning to visit the 7th location. During their field inspections, investigators did not observe environmental or behavioral risk factors associated with the spread of E. coli, such as poor handwashing practices, improper time and temperature control of foods, or other types of risk factors that can be associated with E. coli infections. Out of an abundance of caution, Environmental Health investigators are visiting all Evergreen restaurants (total of 15 locations) in King County.

This outbreak comes in the context of a national E. coli outbreak associated with romaine lettuce from the Salinas, California growing region, which was announced by the CDC on November 22, 2019. Genetic testing completed on 11 of the 15 cases in this local cluster did not match the genetic fingerprint of the strain currently associated with this national outbreak. Genetic testing was not done on the other 4 cases.

This local outbreak could be the result of a contaminated product delivered to and served at Evergreens. In addition, many of the people who became ill after eating at Evergreens also reported eating raw vegetables, including leafy greens, from sources other than Evergreens in the days prior to their illness, meaning they could share a separate source for their illness, unrelated to Evergreens.

Public Health investigators reviewed with staff at six locations, proper sanitizing practices to help prevent the spread of E. coli. In accordance with CDC’s recommendations, Evergreens restaurants discarded all romaine lettuce products from their stores, including romaine on the line and in coolers. Finally, management reviewed their sick policy with all employees.

As per our protocol, Public Health investigators revisited six Evergreens restaurant locations where ill cases reported eating to confirm that these actions were taken.

Public Health has identified two employees who experienced symptoms consistent with an E. coli infection after eating at Evergreens but were not tested. However, there is no evidence indicating these people were the source of the outbreak. During their visits, investigators reviewed the requirement that restaurant employees are not allowed to work while having vomiting or diarrhea.

Public Health collected samples of various produce samples from two Evergreens locations where the ill people ate. E. coli testing of these food products at the Washington State Public Health Laboratory were negative.

Public Health is continuing to work with the Washington State Department of Agriculture and United States Food and Drug Administration on tracing back the distributors and sources for ingredients the people who became ill consumed in their meals. Trace back is used to identify other points of contamination up the supply chain.

Eleven of 15 people reporting illness tested positive for E. coli O157:H7. All 11 isolates shared a closely related E. coli genetic fingerprint, suggesting that they have a common source of infection.

None of these 11 cases shared the same genetic fingerprint currently identified in the nationwide E. coli outbreak associated with romaine lettuce from Salinas, California.

The remaining four people who got sick were not tested for STEC, but their symptoms are suggestive of an E. coli infection.
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