text: January 9, 2019 
   
   CDC, public health and regulatory officials in several states, Canada, and the FDA investigated a multistate outbreak of Shiga toxin-producing Escherichia coli O157:H7 (E. coli O157:H7) infections. 
   
   Public health investigators used the PulseNet system to identify illnesses that might be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting was performed on E. coli bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE. WGS performed on E. coli bacteria from ill people in this outbreak showed that the strains were closely related genetically. This means that the ill people were more likely to share a common source of infection. 
   
   As of January 9, 2019, 62 people infected with the outbreak strain of E. coli O157:H7 were reported from 16 states and the District of Columbia. A list of the states and the number of cases in each can be found on the Map of Reported Cases page. 
   
   Illnesses started on dates ranging from October 7, 2018, to December 4, 2018. Ill people ranged in age from 1 to 84 years, with a median age of 25. Sixty-six percent of ill people were female. Of 54 people with information available, 25 (46%) were hospitalized, including two people who developed hemolytic uremic syndrome, a type of kidney failure. No deaths were reported. 
   
   WGS analysis did not identify predicted antibiotic resistance in 51 isolates from 53 ill people. Two isolates contained genes for resistance to ampicillin. Antibiotic resistance testing by CDC’s National Antimicrobial Resistance Monitoring System laboratory is currently underway. This finding does not affect treatment guidance since antibiotics are not recommended for patients with E. coli O157 infections. 
   
   Investigation of the Outbreak 
   
   Epidemiologic, laboratory, and traceback evidence indicated that romaine lettuce from the Central Coastal growing regions of northern and central California was the likely source of this outbreak. 
   
   In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Thirty (83%) of 36 people interviewed reported eating romaine lettuce. This percentage was significantly higher than results from a survey [PDF – 787 KB] of healthy people in which 47% reported eating romaine lettuce in the week before they were interviewed. Ill people reported eating different types of romaine lettuce in several restaurants and at home. 
   
   Two illness clusters were identified at restaurants where ill people reported eating romaine lettuce. An illness cluster is defined as two or more people who do not live in the same household who report eating at the same restaurant location, attending a common event, or shopping at the same location of a grocery store in the week before becoming ill. In these two clusters, several ill people reported eating at the same restaurant or shopping at the same location of a grocery store. Investigating illness clusters provides critical clues about the source of an outbreak. If several unrelated ill people ate or shopped at the same location of a restaurant or store within several days of each other, it suggests that the contaminated food item was served or sold there. 
   
   Traceback information from the FDA indicated that ill people in this outbreak ate romaine lettuce harvested from specific counties in the Central Coastal growing regions of northern and central California. The FDA, along with CDC and state partners, investigated farms and cooling facilities in California that were identified in traceback. CDC analyzed water and sediment samples from an Adam Bros. Farming, Inc. farm in Santa Barbara County, which was one of the farms identified in the traceback investigation. The outbreak strain of E. coli O157:H7 was found in sediment within an agricultural water reservoir on the farm. WGS results showed that the E. coli O157:H7 found in the agricultural water reservoir was closely related genetically to the E. coli O157:H7 isolated from ill people. 
   
   WGS results also showed that the E. coli O157:H7 strain isolated from ill people in this outbreak is closely related genetically to the E. coli strain isolated from ill people in a 2017 outbreak linked to leafy greens in the United States and to romaine lettuce in Canada. The outbreak described here is not related to a spring 2018 multistate outbreak of E. coli O157:H7 infections linked to romaine lettuce. People in the spring outbreak were infected with E. coli O157:H7 bacteria with a different DNA fingerprint. 
   
   FDA is continuing to investigate to learn more about how the E. coli bacteria could have entered the agricultural water reservoir and ways romaine lettuce from the farm could have been contaminated. The FDA is able to confirm that Adam Bros. Farming, Inc. has not shipped romaine since November 20, 2018. Romaine lettuce from Adam Bros. Farming, Inc. linked to this outbreak is no longer available for sale. 
   
   FDA continues its investigation of farms identified in traceback. 
   
   As of January 9, 2019, this outbreak appears to be over. ||||| Breaking News Emails Get breaking news alerts and special reports. The news and stories that matter, delivered weekday mornings. 
   
   Nov. 20, 2018, 8:12 PM GMT By Maggie Fox 
   
   Federal health officials are warning about a fresh outbreak of E.coli linked to romaine lettuce Tuesday and cautioned people not to eat any romaine lettuce. 
   
   At least 32 people are sick, and 13 hospitalized in the outbreak, the Centers for Disease Control and Prevention said. No one has died. 
   
   “Consumers who have any type of romaine lettuce in their home should not eat it and should throw it away, even if some of it was eaten and no one has gotten sick,” the CDC said in a notice on its website. 
   
   “This advice includes all types or uses of romaine lettuce, such as whole heads of romaine, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad,” the CDC added. 
   
   “If you do not know if the lettuce is romaine or whether a salad mix contains romaine, do not eat it and throw it away.” 
   
   It’s the second outbreak of E. coli in romaine lettuce this year. An outbreak lasting several weeks in the spring killed five people and sickened 210 people in 36 states. It was eventually traced to contaminated canal water in a farming area in Yuma, Arizona. 
   
   This outbreak does not appear to be linked to the Yuma outbreak, the Food and Drug Administration said. 
   
   "While the strain of E. coli 0157:H7 seen in this outbreak is different than the one identified in the large outbreak in spring 2018 linked to romaine from the Yuma growing region, it does appear to be similar to the strain that caused a smaller outbreak linked to leafy greens that occurred in the fall of 2017 in both the U.S. and Canada," the FDA said. 
   
   "Since these prior outbreaks were identified, the FDA has been working closely with the leafy greens industry and other state and federal partners to implement safety practices that can help further reduce the risk of these types of outbreaks. As a direct response to the outbreaks we have seen, the agency will also begin a special effort to sample and test romaine lettuce for contamination throughout the market." 
   
   There's not enough information to identify a specific supplier yet, the FDA said, so it's safest to just thrown out all romaine lettuce for now. 
   
   E. coli is a common bacteria but there is a strain called 0157:H7 that can make people sick. Most patients suffer stomach cramps but the 0157 strain produces a toxin that can damage the kidneys and cause a potentially deadly condition called hemolytic uremic syndrome. ||||| If you have a recalled food item in your refrigerator, it’s important to throw out the food and clean your refrigerator. Germs in the recalled food could spread to drawers or shelves in your refrigerator. 
   
   How to Clean your Refrigerator After a Food Recall 
   
   Items needed to clean your refrigerator: 
   
   Sealed Bags 
   
   Warm, Soapy Water 
   
   Clean Towels 
   
   Optional: Water + Bleach 
   
   STEP 1 – Throw out recalled food 
   
   Throw out the recalled food, and any other foods stored with it or touching it. 
   
   Put it in a sealed bag in the garbage. 
   
   If the recalled food was stored in a reusable container, wash it with warm, soapy water before reusing. 
   
   STEP 2 – Empty your Refrigerator 
   
   Empty the rest of the items in your refrigerator and put them on a counter or table while you clean. 
   
   Take out shelving, drawers, and any other removable parts. 
   
   Don’t leave unrefrigerated food out for more than two hours. 
   
   STEP 3 – Wash Removable Parts 
   
   Wash shelving, drawers, and any other removable parts by hand with warm, soapy water. 
   
   Dry with a clean towel. 
   
   Don’t run cold glass shelves or drawers under hot water – the glass could crack. Let them come to room temperature first. 
   
   STEP 4 – Clean and Sanitize Inside the Refrigerator 
   
   Wipe the inside of the empty refrigerator with warm, soapy water, then wipe with clean water to rinse off soap. 
   
   Dry with a clean towel. 
   
   Don’t forget to wipe inside the doors and any drawers that cannot be removed. 
   
   * Optional Step 
   
   Use a solution of 1 tablespoon of liquid bleach in 1 gallon of water to sanitize your refrigerator. Do this after cleaning it with warm, soapy water. 
   
   STEP 5 – Return Shelves, Drawers, and Food 
   
   Put the shelves, drawers, and other removable parts back in the refrigerator, along with the other items you took out. 
   
   Wipe food and drink containers with warm, soapy water before returning to the clean refrigerator. 
   
   And don’t forget! 
   
   Wash your hands with water and soap once you’ve finished cleaning. 
   
   Use hot, soapy water to wipe kitchen counters that held food, drinks, refrigerator parts and any cleaning materials. 
   
   Wash any towels you used to dry the refrigerator before using them again. 
   
   Stay up-to-date on the most recent food recalls. https://www.foodsafety.govExternal
target: – One thing you'll want to avoid on Thanksgiving—or at any time in the near future—is romaine lettuce. The CDC issued an alert two days before the holiday warning that no romaine is safe to eat as an E. coli outbreak spreads, reports NBC News. It doesn't matter where the romaine is from or even if you or a loved one has eaten some and not gotten sick. The advice from the CDC is the same: Toss it. A bag of mixed salad that includes romaine? Toss it. In fact, the alert includes advice on how to clean your refrigerator if romaine has been inside it recently. So far, 32 people in 11 states have gotten sick, and 13 required hospitalization. No deaths have been reported. "This advice includes all types or uses of romaine lettuce, such as whole heads of romaine, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad," the CDC said. "If you do not know if the lettuce is romaine or whether a salad mix contains romaine, do not eat it and throw it away." (Tainted water was blamed in a different outbreak involving romaine earlier this year.)