Since the last update on April 9, 2019, 13 more ill people were added to this outbreak.

As of April 12, 2019, 109 people infected with the outbreak strain of E. coli O103 have been reported from six states. CDC is reporting the 109 illnesses that the PulseNet laboratory network has confirmed are part of this outbreak. States are investigating additional illnesses that might be a part of this outbreak. A list of the states and the number of confirmed cases in each can be found on the Map of Reported Cases page.

Illnesses started on dates from March 2, 2019, to March 26, 2019. Ill people range in age from less than 1 year to 83 years, with a median age of 18. Fifty-three percent are female. Of 81 people with information available, 17 (21%) have been hospitalized. No deaths and no cases of hemolytic uremic syndrome have been reported.

Illnesses that occurred after March 20, 2019, might not yet be reported due to the time it takes between when a person becomes ill with E. coli and when the illness is reported. This takes an average of two to three weeks.

This multistate investigation began on March 28, 2019, when officials in Kentucky and Georgia notified CDC of this outbreak. Preliminary epidemiologic information suggests that ground beef is the 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. Sixty-three (84%) of 75 people interviewed reported eating ground beef. This percentage is significantly higher than results from a survey Cdc-pdf[PDF – 787 KB] of healthy people. Ill people bought or ate ground beef from several different grocery stores and restaurants. Many ill people bought large trays or chubs of ground beef from grocery stores and used the meat to make dishes like spaghetti sauce and sloppy joe.

Traceback investigations are ongoing to determine the source of ground beef supplied to grocery stores and restaurants where ill people ate. At this time, no common supplier, distributor, or brand of ground beef has been identified

As of April 8, 2019, 96 people infected with the outbreak strain of E. coli O103 have been reported from five states. CDC is reporting the 96 illnesses that the PulseNet laboratory network has confirmed are part of this outbreak. States are investigating additional illnesses that might be a part of this outbreak.

Illnesses started on dates from March 2, 2019, to March 26, 2019. Ill people range in age from 1 to 81 years, with a median age of 17. Fifty-one percent are female. Of 67 people with information available, 11 (16%) have been hospitalized. No deaths and no cases of hemolytic uremic syndrome have been reported.

This investigation is still ongoing and a specific food item, grocery store, or restaurant chain has not been identified as the source of infections. State and local public health officials are interviewing ill people to determine what they ate and other exposures in the week before their illness started. Federal and state regulatory officials use that information to guide efforts to identify a contaminated food and trace it to its source. Learn more about how public health and regulatory agencies investigate a foodborne disease outbreak.

CDC, several states, the U.S. Department of Agriculture’s Food Safety and Inspection Service, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Shiga toxin-producing E. coli O103 infections. This investigation includes E. coli O103 infections recently reported by the Kentucky Department of Public Health.

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is 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 from ill people in this outbreak showed that they are closely related genetically. This means that the ill people are more likely to share a common source of infection.

As of April 4, 2019, 72 people infected with the outbreak strain of E. coli O103 have been reported from five states – Georgia, Kentucky, Ohio, Tennessee and Virginia. CDC is reporting the 72 illnesses that PulseNet has confirmed are part of this outbreak. States are investigating additional illnesses that might be a part of this outbreak.

Illnesses started on dates from March 2, 2019, to March 29, 2019. Ill people range in age from 1 to 74 years, with a median age of 17. Fifty-five percent are female. Of 47 people with information available, 8 (17%) have been hospitalized. No deaths and no cases of hemolytic uremic syndrome (HUS) have been reported.

This investigation is still ongoing and a specific food item, grocery store, or restaurant chain has not been identified as the source of infections. State and local public health officials are interviewing ill people to determine what they ate and other exposures in the week before their illness started.

Kentucky, Tennessee, Georgia, Ohio and Virginia linked in growing E. coli Mystery

According to the Kentucky Department of Health and press reports, an E. coli outbreak in Kentucky has now doubled to more than 40 cases. The department confirmed Thursday that Kentucky now has at least 46 cases involving a strain of E. coli O103.

The department issued a news release last Friday, saying that 20 Kentuckians had tested positive for a Shiga-toxin producing strain that can lead to kidney failure. The number of known hospitalizations remains at six.

Some two dozen counties, including Shelby and Fayette, have reported cases in this outbreak, according to the department. Many of the initial patients were in central Kentucky but there also have been cases in northern, eastern and western Kentucky.

Cases also have been identified in Tennessee, Georgia, Ohio and Virginia, according to the department. A representative of the U.S. Centers for Disease Control and Prevention had no immediate information to convey Thursday.

The specific source of the outbreak is still being investigated, but a food source is suspected based on the interview responses of affected individuals, according to the department.

“Exposure to E. coli bacteria can be debilitating and potentially life-threatening, especially for small children and individuals with weakened immune systems,” Kentucky Public Health Commissioner Jeffrey Howard said last week. “With this in mind, the Department for Public Health has taken swift action to identify patients, ensure appropriate testing, and follow-up care as we work to determine the source of the outbreak.”

Also, health care providers across the state “have been alerted to this potential threat and are working with us to make sure patients are identified and are receiving appropriate care,” he said. “Meanwhile, we encourage all Kentuckians to be aware of the signs and symptoms of E. coli illness and to seek care if they are ill.”

People generally become ill two to five days after consuming tainted food, according to the department. Symptoms of infection include stomach cramps and diarrhea, which is sometimes bloody.

It’s also possible to develop a potentially life-threatening complication known as hemolytic uremic syndrome (HUS). The condition requires hospitalization because the kidneys may stop working, according to the CDC.

“Clues that a person is developing HUS include decreased frequency of urination, feeling very tired and losing pink color in cheeks and inside the lower eyelids,” the CDC notes. “Most persons with HUS recover within a few weeks, but some suffer permanent damage or die.”

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The CDC, public health and regulatory officials in several states, and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) investigated a multistate outbreak of Shiga toxin-producing Escherichia coli O26 (E. coli O26) infections.

As of September 19, 2018, 18 people infected with the outbreak strain of E. coli O26 were reported from 4 states.

Illnesses started on dates ranging from July 5, 2018 to July 25, 2018. Ill people ranged in age from one year to 75, with a median age of 16. Sixty-seven percent of ill people were male. Of 18 people with information available, 6 (33%) were hospitalized, including one person who died in Florida.

WGS analysis of isolates from 13 ill people did not identify any antibiotic resistance.

Epidemiologic, laboratory, and traceback evidence indicates that ground beef from Cargill Meat Solutions was a 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. Fourteen (100%) of 14 people interviewed reported eating ground beef. Ill people purchased ground beef from several different grocery stores.

USDA-FSIS conducted traceback investigations from stores where ill people reported buying ground beef. Initial information collected from ill people in Florida indicated that the ground beef was purchased from various Publix grocery stores. On August 30, 2018, Publix Super Markets, Inc. recalled ground chuck products sold in several Florida counties.

Further traceback investigation by USDA-FSIS identified Cargill Meat Solutions in Fort Morgan, Colorado as the source of the contaminated ground beef linked to illness, including the recalled ground beef sold at Publix stores in Florida. On September 19, 2018, Cargill Meat Solutions recalled ground beef products that were produced and packaged on June 21, 2018. Products are labeled with the establishment number “EST. 86R” inside the USDA mark of inspection. The products were shipped to retailers nationwide. Visit the USDA-FSIS website for a list of recalled products.

Laboratory testing identified the outbreak strain of E. coli O26 in leftover ground beef collected from the home of one ill person in Florida. WGS analysis showed that the E. coli O26 strain identified in the leftover ground beef was highly related genetically to the E. coli O26 strain isolated from ill people.

Public Health- Seattle & King County investigated an outbreak of Shiga toxin-producing E. coli (STEC) O26 associated with I Love Sushi and Café Mario at Nintendo of America campus in Redmond. Café Mario is operated by Sodexo and is not open to the public. I Love Sushi is a food establishment that operates out of Café Mario once a week. At this time, the source of the illnesses has not been identified.

Since July 2, 2018, investigators learned of at least 16 people who have developed symptoms consistent with a STEC illness, including diarrhea (bloody or non-bloody) and abdominal cramps. All of the ill people work at the Nintendo of America campus in Redmond. Illness onsets occurred during June 11-July 5th, 2018. The 16 ill people all consumed food from Café Mario on multiple days before becoming ill, and only four of the ill people also ate at I Love Sushi before becoming ill.

On July 3, 2018, Public Health- Seattle & King County Environmental Health investigators visited Café Mario. Inspections were completed for both Café Mario and I Love Sushi. At Café Mario, potential risk factors were identified, including inadequate hand washing practices and improper cold holding temperatures of food; corrective actions discussed with Café Mario’s management. At I Love Sushi, potential risk factors were also identified and discussed, including improper temperature storage of foods. Both restaurants were not open on the July 4 holiday.

On July 5, 2018, investigators closed Café Mario and the onsite I Love Sushi food services. Investigators revisited both food establishments on July 11, 2018, and both were allowed to reopen the same day. Café Mario and I Love Sushi both completed a thorough cleaning and disinfection of their facilities before reopening, and any remaining processed ready-to-eat food products were discarded.

Public Health investigators did not identify any employees of either restaurant who had a recent diarrheal illness. Investigators also reviewed with management of both food establishments the Washington State Retail Food Code requirement that staff are not allowed to work while having vomiting or diarrhea.

Of the 16 people who got sick, 4 tested positive for STEC by a healthcare provider. Further testing at the Washington State Public Health Laboratory is pending, but so far three of those tested are positive for STEC O26. Genetic fingerprint results are still pending.

Environmental swabs were collected from both food establishments for laboratory testing and all came back negative for STEC.[1]

[1]https://www.kingcounty.gov/depts/health/communicable-diseases/disease-control/outbreak/I-Love-Sushi-Cafe-Mario.aspx

In May 2018, Public Health Seattle and King County (PHSKC) officials investigated an outbreak of Shiga toxin-producing E. coli(STEC) associated with three Homegrown restaurants. The results of the investigation implicated pesto used exclusively on the chicken pesto sandwich.

Four people tested positive for STEC O26 after consuming food from three different Homegrown restaurants in King County. Symptoms included abdominal cramps and diarrhea, with one person reporting bloody diarrhea. All four ate the chicken pesto sandwich from one of the following locations: Redmond, Kirkland or Seattle (Westlake Ave). Of the four ill persons, three were adults and one was a child. Illness onsets occurred during April 24–May 6, 2018. Meal dates occurred during April 24–26, 2018.

On May 24, 2018, PHSKC Environmental Health investigators visited the three Homegrown locations where the ill people reported eating. During the field inspections, potential risk factors, including handwashing facilities violations at two of the three locations, and a cold holding temperature violation at one of the three locations, were identified and discussed with the restaurant managers. PHSKC did not identify any employees who experienced similar symptoms before or after meal dates for the ill customer.

The various ingredients of the chicken pesto sandwich were also investigated. All Homegrown locations in King County stopped selling this particular sandwich while the investigation was ongoing. The three restaurants under investigation were required to complete a thorough cleaning and disinfection. No employees reported working at Homegrown while experiencing illness in the three weeks prior to the illness onset dates of the customers who got sick. Investigators also reviewed the requirement that restaurant employees are not allowed to work while having vomiting or diarrhea.

Three of the four people who got sick, tested positive for STEC O26 with the same genetic fingerprint, suggesting that they have a common source of infection; genetic fingerprinting for the other ill person could not be completed. Pesto from each location tested negative for STEC O26.[1]

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[1]https://kingcounty.gov/depts/health/communicable-diseases/disease-control/outbreak/homegrown-2018-05-25.aspx

In June and early July 2016, the Chicago Department of Public Health (CDPH) identified an outbreak of Shiga toxin-producing E. coli O157:H7 (STEC), associated with the consumption of food at Carbón Live Fire Mexican Grill in Chicago.  CDPH officials eventually identified at least 67 cases of illness involved in the outbreak.  As part of the CDPH investigation, Carbón Live Fire Mexican Grill located at 300 W. 26th Street was temporarily closed. At least 16 individuals were hospitalized as part of this outbreak. 

“This is a serious condition that is treatable,” said CDPH Commissioner Julie Morita, M.D. “Anyone who believes they may be symptomatic and ate at this restaurant should see their medical provider immediately. CDPH is taking every precaution as part of our robust response in order to limit the impact of this outbreak.”

STEC can be transmitted through consumption of contaminated foods including undercooked beef, unpasteurized juice, raw milk and unwashed, raw produce. According to CDPH, the menu items responsible for the outbreak were not identified.

CDPH issued an alert to area physicians of the outbreak, providing medical guidance. Medical providers who suspected STEC were requested to submit specimens for testing. CDPH recommended that Antibiotics and anti-diarrheal medicines not be used to treat STEC as they may worsen symptoms. Medical experts instead encouraged supportive medical care, including intravenous fluids, where necessary.

La Rosita Fresh Market Inc., a Mt. Prospect, Ill. retail store, is recalling approximately 54 pounds of raw ground beef products that may be contaminated with E. coli O157:H7, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The raw ground beef items are ground in the store and packaged for consumers behind the meat counter in varying weights. The raw ground beef items were packed on March 13, 2019 and March 14, 2019. The following products are subject to recall: [View Labels (PDF only)]

  • Varying weights of ground beef packed in white trays with plastic wrap, containing “MOLIDA DE RES GROUND BEEF” with “Packed On 3/13/19 Sell By 3/20/19” or “Packed On 3/14/19 Sell By 3/21/19”.

These items were only sold in the La Rosita Fresh Market Inc. retail store, located at 1805 W. Algonquin Rd., Mt. Prospect, IL, 60056.

The problem was discovered on March 14, 2019, by FSIS investigators through routine product sampling. There have been no confirmed reports of adverse reactions due to consumption of these products.

 Anyone concerned about an injury or illness should contact a healthcare provider. E. coli O157:H7 is a potentially deadly bacterium that can cause dehydration, bloody diarrhea and abdominal cramps 2–8 days (3–4 days, on average) after exposure the organism. While most people recover within a week, some develop a type of kidney failure called hemolytic uremic syndrome (HUS). This condition can occur among persons of any age but is most common in children under 5-years old and older adults. It is marked by easy bruising, pallor, and decreased urine output. Persons who experience these symptoms should seek emergency medical care immediately.

FSIS is concerned that some product may be in consumers’ refrigerators or freezers. Consumers who have purchased these products are urged not to consume them.

Fifty-nine people infected with the outbreak strain of Shiga toxin-producing E. coli O157:H7 have been reported from 15 states and the District of Columbia. Since the last CDC update on December 6, an additional 7 ill people have been included in this investigation – California 12, Connecticut 1, District of Columbia 1, Florida 1, Illinois 2, Louisiana 1, Massachusetts 1, Maryland 1, Michigan 7, New Hampshire 6, New Jersey 12, New York 7, Ohio 1, Pennsylvania 4, Rhode Island 1, Wisconsin 1.

Illnesses started on dates ranging from October 5, 2018 to November 16, 2018.

Twenty-three people have been hospitalized, including two people who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

FDA Update.

The Public Health Agency of Canada has identified ill people infected with the same DNA fingerprint of E. coli O157:H7 bacteria in Canada. In Canada, as of December 6, 2018, there have been 27 confirmed cases of E. coli illness investigated in Ontario (4), Quebec (19), New Brunswick (1), and British Columbia (3). The illnesses in British Columbia were related to travel to Quebec, Ontario and the United States. Individuals became sick between mid-October and early November 2018. Nine 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 male.

The FDA, along with CDC and state partners, is investigating farms and cooling facilities in California that were identified in traceback. CDC identified the outbreak strain of E. coli O157:H7 in sediment collected within an agricultural water reservoir on Adam Bros. Farming, Inc. farm, which was identified in traceback.

CDC is advising that consumers not eat any romaine lettuce harvested from Monterey, San Benito, and Santa Barbara counties in the Central Coastal growing regions of northern and central California. FDA continues its investigation of farms identified in traceback.

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.  Twenty-five people infected with the outbreak strain of STEC O157:H7 were reported from 15 states. Illnesses started on dates ranging from November 5, 2017 to December 12, 2017. Nine people were hospitalized, including two people who developed hemolytic uremic syndrome, a type of kidney failure. One death was reported from California.

In December 2017, the Public Health Agency of Canada (PHAC) investigated an outbreak of STEC O157:H7 infections in several provinces linked to romaine lettuce. In total, there were 42 cases of E. coli O157 illness reported in five eastern provinces: Ontario (8), Quebec (15), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13). Individuals became sick in November and early December 2017. Seventeen individuals were hospitalized. One individual died. Individuals who became ill were between the ages of 3 and 85 years of age. The majority of cases (74%) were female.