The Public Health Agency of Canada is collaborating with provincial public health partners, the Canadian Food Inspection Agency (CFIA), Health Canada, as well as the United States Centers for Disease Control and Prevention (U.S. CDC) and the United States Food and Drug Administration (U.S. FDA), to investigate an outbreak of E. coli infections in OntarioQuebecNew Brunswick, and several U.S. states.

In Canada, based on the investigation findings to date, exposure to romaine lettuce has been identified as a source of the outbreak. Through a collaborative investigation between public health and food safety partners in Canada and the United States, traceback information indicates that the romaine lettuce consumed by the majority of the outbreak cases was harvested in California. Specifically, the U.S. FDA has indicated that the romaine lettuce was harvested in the Central Coast growing regions of northern and central California. It has been determined that romaine lettuce grown in Canada, including hydroponic romaine lettuce and romaine lettuce grown in green-houses, is not associated with this outbreak.

As of December 24, 2018 the Canadian outbreak appears to be over as there have been no illnesses linked to the Canadian investigation since mid-November. The U.S. investigation is ongoing, and public health and food safety partners will continue to collaborate and exchange information about the possible sources of contamination in the romaine lettuce harvested in the affected California growing regions outlined on the U.S. FDA’s website.

Over the last month, the CFIA has implemented import control measures to ensure that romaine lettuce from affected regions in California identified in the U.S. FDA’s investigation is not being imported into Canada. The CFIA is continuing to monitor the U.S. FDA’s investigation into the possible causes of contamination and will amend their import control measures as necessary to ensure that romaine lettuce that was harvested in the affected California growing regions as identified by the U.S. FDA. is not being imported into Canada.

Given that there have not been any Canadian illnesses since mid-November, the Public Health Agency of Canada is no longer advising residents in the affected provinces of Ontario,Quebec and New Brunswick to avoid eating romaine lettuce and salad mixes containing romaine lettuce.

Retailers and industry partners continue to bring romaine lettuce into the Canadian marketplace from growing regions not associated with the outbreak and to help consumers easily identify the origin of romaine lettuce in the Canadian marketplace. Given the U.S. outbreak is still ongoing, Canadians who are traveling to the U.S., or who shop for groceries across the border and purchase romaine lettuce in the U.S. are advised to follow the U.S. CDC’s advice for U.S. consumers found on their website.

This investigation marks the third E. coli outbreak linked to romaine lettuce in the last year. Although the outbreak appears to be over, the Government of Canada remains vigilant in its efforts to monitor for any new E. coli illnesses linked to romaine lettuce. If future risks are identified, the Public Health Agency of Canada and its partners will take the necessary steps to notify Canadians of any increased risk to their health and to provide advice on how to prevent illness.

In Canada, as of December 24, 2018, there have been 29 confirmed cases of E. coli illness investigated in Ontario (5), Quebec (20), New Brunswick (1), and British Columbia (3). The illnesses in British Columbia were related to travel to QuebecOntario and the United States. Individuals became sick between mid-October and mid-November 2018. Ten individuals have been hospitalized, and two individuals suffered from hemolytic-uremic syndrome (HUS), which is a severe complication that can result from an E. coli infection. No deaths have been reported. Individuals who became ill are between 2 and 93 years of age. The majority of cases (52%) are female. Most of the individuals who became sick reported eating romaine lettuce before their illnesses occurred. Individuals reported eating romaine lettuce at home, as well as in prepared salads purchased at grocery stores, or from menu items ordered at restaurants and fast food chains.

Laboratory analysis indicates that the illnesses reported in this outbreak are genetically related to illnesses reported in a previous E. coli outbreak from December 2017 that affected consumers in both Canada and the U.S. This tells us that the same strain of E. coli is causing illness in Canada and the US as was seen in 2017 and it suggests there may be a reoccurring source of contamination. Investigators are using evidence collected in both outbreaks to help identify the possible cause of the contamination in these events.