WGS performed on E. coli bacteria from ill people in this outbreak showed that the strains were closely related genetically. 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. 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. “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. 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. "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. "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. 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. Farming, Inc. has not shipped romaine since November 20, 2018. “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.
– 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.)