The U.S. Food and Drug Administration (FDA) and the Centers for Disease Control (CDC) are warning consumers, restaurants and retailers not to eat, serve or sell any romaine lettuce from Salinas, California as the number of those infected with E. Coli from lettuce linked to that region, has risen to more than 60.

FDA, CDC, and state health authorities are investigating an outbreak of illnesses caused by E. coli O157:H7 in the United States. Epidemiologic, laboratory, and traceback evidence indicates that romaine lettuce from the Salinas, California growing region is a likely source of this outbreak. The CDC is reporting an increase in the case count to 67 and that the most recent illness onset date is Nov. 14, 2019.

Consumers: Consumers should not eat romaine lettuce harvested from Salinas, California. Additionally, consumers should not eat products identified in the recall announced by the USDA on November 21, 2019.

Romaine lettuce may be voluntarily labeled with a harvest region. If this voluntary label indicates that the romaine lettuce was grown in “Salinas” (whether alone or with the name of another location) do not eat it. Throw it away or return it to the place of purchase. If romaine lettuce does not have information about harvest region or does not indicate that it has been grown indoors (i.e., hydroponically- and greenhouse-grown), throw it away or return it to the place of purchase. Consumers ordering salad containing romaine at a restaurant or at a salad bar should ask the staff whether the romaine came from Salinas. If it did, or they do not know, do not eat it.

At this time, romaine lettuce that was harvested outside of the Salinas region has not been implicated in this outbreak investigation. Hydroponically- and greenhouse-grown romaine, which is voluntarily labeled as “indoor grown,” from any region does not appear to be related to the current outbreak. There is no recommendation for consumers to avoid using romaine harvested from these other sources.

Restaurants and Retailers: Restaurants and retailers should not serve or sell romaine harvested from Salinas, California. If you do not know the source of your romaine lettuce, and if you cannot obtain that information from your supplier, you should not serve, nor sell it.

Suppliers and Distributors: Suppliers, distributors and others in the supply chain should not ship or sell romaine harvested in Salinas, California. If the source of the romaine lettuce is unknown, you should not ship, nor sell the product.

For Restaurants, Retailers, Suppliers and Distributors: Currently, the FDA does not have enough traceback information to identify the specific source of the contamination that would allow us to request a targeted recall from specific growers. At this stage in the investigation, the most efficient way to ensure that contaminated romaine is off the market would be for industry to voluntarily withdraw product grown in Salinas, and to withhold distribution of Salinas romaine for the remainder of the growing season in Salinas. FDA has made this request of industry.

At this time, romaine lettuce that was harvested outside of the Salinas region has not been implicated in this outbreak investigation. Hydroponically- and greenhouse-grown romaine, which is voluntarily labeled as “indoor grown,” from any region does not appear to be related to the current outbreak. There is no recommendation for consumers or retailers to avoid using romaine harvested from these other sources.

Background
According to the CDC, as of November 25, 2019, 67 people infected with the outbreak strain of E. coli O157:H7 have been reported from 19 states. The case patients report that illnesses started on dates ranging from September 24, 2019 to November 14, 2019.

The Maryland Department of Health identified E. coli O157:H7 in an unopened package of Ready Pac Bistro® Chicken Caesar Salad collected from an ill person’s home in Maryland. Analysis of this salad, through Whole Genome Sequencing (WGS), has linked strain E. coli O157:H7 to three Maryland cases and the multi-state outbreak.

The FDA and state partners are conducting a traceback investigation to trace romaine exposures to the source. Preliminary information indicates that ill people in Maryland were exposed to romaine lettuce harvested in Salinas, California.

FDA has deployed investigators to the farms in question to try to determine the source and extent of the contamination. More information will be forthcoming as the investigation proceeds.

Additionally, state partners are conducting laboratory analyses of romaine lettuce samples from case patients potentially linked to the outbreak.

The Salinas region as defined by the United Fresh Produce Association and the Produce Marketing Association Romaine Taskforce ReportExternal Link Disclaimer includes: Santa Cruz, Santa Clara, San Benito, and Monterey counties in California.

Genetic analysis of the E. coli O157:H7 strains from patients in this current outbreak are similar to strains of E. coli O157:H7 associated with a previous outbreak from the Fall of 2017 and the Fall of 2018 that affected consumers in both Canada and the U.S. The 2017 outbreak of E. coli O157:H7 was associated with leafy greens in the U.S. and romaine in Canada. The 2018 outbreak of E. coli O157:H7 was associated with romaine in both countries.

Case Counts
Total Illnesses: 67
Hospitalizations: 39
Deaths: 0
Last illness onset: November 14, 2019
States with Cases: AZ (3), CA (4), CO (1), ID (3), IL (1), MD (4), MI (1), MN (3), MT (1), NE (1), NJ (1), NM (2), OH (12), OR (1), PA (3), TX (2), VA (2), WA (1), WI (21)