Epidemiologic and laboratory data show that Josie’s Organics prepackaged baby spinach with a “best by” date of October 23, 2021, may be contaminated with E. coli and may be making people sick.

Since the last update on November 15, four more illnesses have been reported. As of December 3, 2021, a total of 14 people infected with the outbreak strain of E. coli O157:H7 have been reported from nine states. Illnesses started on dates ranging from October 13, 2021, to October 27, 2021.

Sick people range in age from 2 to 76 years, with a median age of 26, and 79% are female. Of 12 people with information available, 4 have been hospitalized and 3 developed a type of kidney failure called hemolytic uremic syndrome (HUS). No deaths have been reported.

The true number of sick people in an outbreak is likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for E. coli. In addition, recent illnesses may not yet be reported as it usually takes 3 to 4 weeks to determine if a sick person is part of an outbreak.

State and local public health officials are interviewing people about the foods they ate in the week before they got sick. Of the 12 people interviewed, 10 (83%) reported eating spinach in the week before they got sick. This percentage was significantly higher than the 46% of respondents who reported eating spinach in the previous week in the FoodNet Population Survey, a survey that helps estimate how often people eat various foods. This difference suggests that people in this outbreak got sick from eating spinach. Six people reported eating Josie’s Organics brand spinach.

On November 15, 2021, CDC reported that officials in Minnesota found E. coli O157:H7 in a package of leftover Josie’s Organics baby spinach collected from a sick person’s home. Whole genome sequencing (DNA fingerprinting for bacteria) showed that the E. coli O157:H7 in the leftover package of spinach is closely related to bacteria isolated from ill people. This means that the person likely got sick from eating the spinach.