The Snohomish Health District said Tuesday it has identified two cases of Shiga toxin-producing E. coli (STEC) in Snohomish County residents. Following public health interviews, these cases do appear to be connected to a cluster of STEC cases among seven children in King County.

Seattle King County Public Health is investigating a new cluster of seven children infected with Shiga toxin-producing E. coli (also known as STEC) in King County. All cases are currently under 15 years of age, and three are under 5 years of age. Cases have been reported during April 22–May 1, 2021.

Our investigation is ongoing. We have identified multiple types of fresh produce, mostly organic, in common among the majority of cases but cannot yet rule out other possibilities. We are still uncertain if these cases share the same source of their infection or not. Updates will continue to be posted when more information is available.

All 7 children developed symptoms consistent with STEC, including diarrhea (often bloody), abdominal cramping, nausea, and vomiting. Illness onsets occurred during April 17–29, 2021. Six children have been hospitalized; this includes two children who developed a type of kidney complication called hemolytic uremic syndrome (HUS) and both are recovering.

The local cases involve a woman in her 20s and a child under 10 years of age from separate households. The child has been hospitalized, but no further information will be shared on the cases due to patient privacy.

Summary

Public Health is investigating a new cluster of seven children infected with Shiga toxin-producing E. coli (also known as STEC) in King County. All cases are currently under 15 years of age, and three are under 5 years of age. Cases have been reported during April 22–May 1, 2021.

Our investigation is ongoing. We have identified multiple types of fresh produce, mostly organic, in common among the majority of cases but cannot yet rule out other possibilities. We are still uncertain if these cases share the same source of their infection or not. Updates will continue to be posted when more information is available.

Illnesses

All 7 children developed symptoms consistent with STEC, including diarrhea (often bloody), abdominal cramping, nausea, and vomiting. Illness onsets occurred during April 17–29, 2021. Six children have been hospitalized; this includes two children who developed a type of kidney complication called hemolytic uremic syndrome (HUS) and both are recovering.

Public Health actions

Public Health is conducting interviews with cases and their parents/guardians to help identify any common exposures. We are also working with the Washington State Department of Health to complete further testing, to help identify possible related cases in other counties, and to begin traceback of any products in common.

Public Health message

Fruits and vegetables can sometimes have germs like STEC on them, and many types have been associated with outbreaks in the past. You should always wash all fresh produce well before consuming. See this CDC link on fruit and vegetable safety for more details.

If you or your child develop painful or bloody diarrhea, diarrhea that lasts more than 3 days or is accompanied by a high fever or decreased urine, contact your healthcare provider to see if testing for STEC is indicated.

STEC and other foodborne infections occur throughout the year but may increase in frequency during late spring and summers months.

Anyone ill with suspected or known STEC should not work in or attend childcare or preschool, or work in food handling or healthcare until cleared by Public Health.

Laboratory testing

Six of the cases have preliminary testing indicating infections with E. coli O157 via PCR, and the seventh case has a positive EIA test for STEC. Further testing to confirm the strain and do genetic fingerprinting (whole genome sequencing or WGS) is underway at the Washington State Public Health Laboratory. These WGS results will help determine whether these cases were infected with the same strain of STEC.

JBS USA Food Company, a Greeley, Colo. firm and Importer of Record, is recalling approximately 4,860 pounds of imported boneless 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, frozen, boneless beef products were imported on or around Nov. 10, 2020 and distributed for further processing. The following products are subject to recall:

  • 60-lb. cardboard boxes containing “95CL BONELESS BEEF PRODUCT OF AUSTRALIA” with “PACKED ON: 02-SEP-20” and Australian “EST. 4” on the packaging label.

The products were shipped to distributors and further processors in New York and Pennsylvania.

The problem was discovered when FSIS collected a routine product sample that confirmed positive for the presence of E. coliO157:H7. There have been no confirmed reports of adverse reactions due to consumption of these products.

Anyone concerned about an illness should contact a healthcare provider. E. coliO157: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 frozen and in cold storage at distributor or further processor locations. Distributors and further processors who received these products are urged not to utilize them.

Escherichia coli (E. coli) is a gram-negative bacterium that is highly diverse; there are an enormous number of types and strains with different characteristics. Most types of E. coli occur as normal inhabitants of the intestines of animals and do not cause disease. Some, however, can cause devastating illness, such as E. coli O157:H7. 

As the most notorious Shiga toxin-producing E. coli (STEC) serotype in the United States, E. coli O157:H7 is a common cause of bloody diarrhea and the most common cause of hemolytic uremic syndrome (HUS), a severe complication that involves kidney failure and is fatal in approximately 5-6% of cases. E. coli O157:H7 causes an estimated 63,153 illnesses, 2,138 hospitalizations, and 20 deaths in the United States each year due to foodborne transmission alone. 

Beef is the most common vehicle of foodborne E. coli O157:H7 outbreaks, accounting for almost half of outbreaks. Most beef outbreaks are associated with ground beef, but other types of beef products have also been implicated. Leafy greens (e.g., romaine lettuce, iceberg lettuce, spinach) are the second most common cause of E. coli O157:H7 outbreaks; this has been an important and difficult food safety problem for more than two decades. 

People can acquire STEC infection from food, recreational water (swimming), drinking water, contact with animals (especially cattle, goats, and sheep), and contact with a person who is or has recently been ill. Sometimes circumstances are beyond people’s control, and it is impossible to prevent becoming infected during the course of day-to-day life. However, there are certain things that can be done to reduce risk. Rinse fresh fruits and vegetables under running water without soap, bleach, or commercial produce washes. Do not wash meat, poultry, eggs, or bagged produce marked “pre-washed.” Wash your hands often, especially before, during, and after preparing food, after handling raw meat, before eating, after using the toilet, and after changing diapers or cleaning up a child who has used the toilet.

As of March 10, 2021, a total of 22 people infected with the outbreak strain were reported from 7 states (see map). Illnesses started on dates ranging from December 18, 2020, to January 12, 2021.

Sick people ranged in age from 10 to 95 years, with a median age of 28, and 68% were female. Of 20 people with information available, 11 were hospitalized. Of 18 people with information, 3 developed a type of kidney failure called hemolytic uremic syndrome (HUS). One death was reported from Washington.

State and local public health officials interviewed people about the foods they ate in the week before they got sick. CDC analyzed the interview data and did not identify a specific food item as a potential source of this outbreak. People reported eating a variety of food items, including leafy greens, broccoli, cucumbers, and strawberries. However, none of the food items were reported significantly more by sick people in this outbreak when compared to healthy people in the FoodNet population survey.

5 states, 16 sick with 1 death. Whole genome sequencing (WGS) shows cases are likely related to same food.  Previous outbreak with same WGS linked to romaine lettuce, ground beef, and recreational water. 

CDC, public health and regulatory officials in several states, the U.S. Food and Drug Administration (FDA), and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) are collecting different types of data to identify the food source of a multistate outbreak of E. coli O157:H7 infections.

As of February 1, 2021, a total of 16 people infected with the outbreak strain have been reported from 5 states. This map shows where sick people live.

Illnesses started on dates ranging from December 23, 2020, to January 7, 2021. This chart shows when people got sick. Recent illnesses may not yet be reported as it usually takes 2 to 4 weeks to link illnesses to an outbreak.

Sick people range in age from 10 to 95 years, with a median age of 31, and 88% are female. Of 12 people with information available, 9 have been hospitalized. Of 11 people with information, 3 developed a type of kidney failure called hemolytic uremic syndrome (HUS). One death has been reported from Washington.

State and local public health officials are interviewing people to find out what foods they ate in the week before they got sick.

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. CDC PulseNet manages a national database of DNA fingerprints of bacteria that cause foodborne illnesses. DNA fingerprinting is performed on bacteria using a method called whole genome sequencing (WGS).

WGS showed that bacteria from sick people’s samples are closely related genetically. This means that people in this outbreak likely got sick from eating the same food.

WGS also showed that this outbreak strain has been previously linked to various sources, including romaine lettuce, ground beef, and recreational water. More information is needed to identify the source of this outbreak.

 

E. coli – Sprouts

A total of 51 people infected with the outbreak strain of E. coli O103 were reported from 10 states.

Illnesses started on dates ranging from January 6, 2020, to March 15, 2020. Ill people ranged in age from 1 to 79 years, with a median age of 29 years. Fifty-five percent of ill people were female. Of 41 ill people with information available, 3 were hospitalized and no deaths were reported.

Epidemiologic, traceback, and laboratory evidence indicated that clover sprouts were the source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures they had in the week before their illness started. Eighteen (56%) of 32 people interviewed reported eating sprouts. This percentage is significantly higher than results from a survey of healthy people in which 8% reported eating sprouts in the week before they were interviewed.

Seventeen (63%) of 27 people interviewed reported eating sprouts at a Jimmy John’s restaurant. Jimmy John’s LLC reported that all of their restaurants stopped serving clover sprouts on February 24, 2020. Clover sprouts are no longer available at Jimmy John’s restaurants.

Additionally, FDA identified the outbreak strain of E. coli O103 in samples of Chicago Indoor Garden products that contain sprouts. On March 16, 2020, Chicago Indoor Garden recalled all products containing red clover sprouts.

FDA’s traceback investigation showed that a common seed lot was used to grow both the sprouts recalled by Chicago Indoor Garden and sprouts that were served at some Jimmy John’s locations. The same seed lot was also used to grow sprouts linked to an outbreak of the same strain of E. coli O103 infections in 2019.

E. coli – Unknown

As of December 16, 2020, a total of 32 people infected with the outbreak strain of E. coli O157:H7 were reported from 12 states.

Illnesses started on dates ranging from June 6, 2020, to October 25, 2020. Ill people ranged in age from 2 to 75 years, with a median age of 27 years, and 72% were female. Of 29 ill people with information available, 15 were hospitalized and 1 developed hemolytic uremic syndrome (HUS), a type of kidney failure. One death was reported from Michigan.

State and local public health officials interviewed ill people to determine what they ate and other exposures in the week before they got sick. Ill people reported eating a variety of food items. Several ill people also reported eating at the same restaurant and had eaten multiple common food items. CDC analyzed the interview data and did not identify a specific food item as a potential source of the outbreak. FDA conducted traceback investigations for several of the food items served at the restaurant and did not find a common source in the distribution chain.

E. coli – Leafy Greens

As of December 18, 2020, a total of 40 people infected with the outbreak strain of E. coli O157:H7 were reported from 19 states.

Illnesses started on dates ranging from August 10, 2020, to October 31, 2020. Ill people ranged in age from 1 to 85 years, with a median age of 33 years, and 60% were female. Of 34 ill people with information available, 20 people were hospitalized and 4 people developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths were reported.

Epidemiologic and traceback evidence showed that leafy greens were the likely source of this outbreak. Investigators were unable to identify a specific type or brand of leafy greens because people in this outbreak reported eating a variety of leafy greens and because different leafy greens are often grown, harvested, and processed together.

State and local public health officials interviewed ill people to determine what they ate and other exposures in the week before they got sick. Of the 23 ill people interviewed, 22 reported eating or maybe eating a variety of leafy greens, including spinach (16) and romaine lettuce (15).

FDA completed traceback investigations for several types of leafy greens ill people reported eating. Several farms of interest were identified, but no single ranch was a common source of the leafy greens.

FDA and state partners conducted inspections on farms of interest and collected environmental samples. FDA is analyzing the samples and continuing their investigations to identify the root cause of this outbreak.

E. coli – Leafy Greens

As of December 16, 2020, a total of 18 people infected with the outbreak strain of E. coli O157:H7 were reported from nine states.

Illnesses started on dates ranging from September 2, 2020, to November 6, 2020. Ill people ranged in age from 8 to 71 years, with a median age of 28 years, and 72% were female. Of 16 ill people with information available, 6 were hospitalized. No deaths were reported.

State and local public health officials interviewed ill people to determine what they ate and other exposures in the week before they got sick. Of the 13 people interviewed, all reported eating or maybe eating various types of leafy greens, including romaine lettuce (9), spinach (9), and iceberg lettuce (7).

Laboratory testing identified the outbreak strain in a sample of Tanimura & Antle romaine lettuce in a single-head package, which was recalled on November 6, 2020. However, investigators were unable to determine if any ill people in this outbreak got sick from eating the recalled product. No one specifically reported eating Tanimura & Antle romaine lettuce, and some people got sick before the “packed on” dates for the recalled products.

FDA conducted traceback investigations and worked with state partners to conduct inspections at several farms. However, none of the findings identified a common source in the distribution chain or linked the farms to the outbreak.

As of November 9, 2020, a total of 12 people infected with the outbreak strain of E. coli O157:H7 have been reported from six states.

Illnesses started on dates ranging from September 2, 2020, to October 14, 2020. Ill people range in age from 8 to 62 years, with a median age of 21 years. Sixty-seven percent of ill people are female. Of 11 ill people with information available, 5 have been hospitalized. No deaths have been reported.

Illnesses might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 2 to 4 weeks. Please see the Timeline for Reporting Cases of E. coli O157 Infection for more details.

On November 6, 2020, Tanimura & Antle recalled packaged single head romaine lettuce after the Michigan Department of Agriculture and Rural Development (MDARD) identified E. coli O157:H7 in a sample of the packaged romaine lettuce. WGS results showed that the E. coli strain in the romaine lettuce sample was closely related genetically to the E. coli strain identified in ill people.

State and local public health officials are interviewing ill people to determine what they ate and other exposures in the week before they got sick. Of the 11 people interviewed, all reported eating various types of leafy greens, including romaine lettuce (5), spinach (5), iceberg lettuce (3), and red leaf lettuce (3).

There is not enough epidemiologic and traceback information available at this time to determine if ill people got sick from eating Tanimura & Antle romaine lettuce. The investigation is ongoing to determine if additional products may be contaminated with the outbreak strain of E. coli.

Do not eat, sell, or serve Tanimura & Antle’s recalled packaged single head romaine lettuce.

Tanimura & Antle Inc. is voluntarily recalling its packaged single head romaine lettuce under the Tanimura & Antle brand, labeled with a packed on date of 10/15/2020 or 10/16/2020, due to possible contamination with E. Coli 0157:H7. Packages contain a single head of romaine lettuce with the UPC number 0-27918-20314-9. No other products or pack dates are being recalled. There have been no reported illnesses associated with the recalled product.

The recall is being conducted in consultation with FDA, and is based on the test result of a random sample collected and analyzed by the Michigan Department of Agriculture and Rural Development as part of their routine sampling program. A total of 3,396 cartons of potentially affected product were distributed in the United States to the following states: AK, OR, CA, TX, AR, OK, IN, NE, MO, TN, WI, NM, SC, WA, NC, OH, VA, MA, PR, and IL.

The potentially affected product was shipped in cases packed in either 12, 15, 18 or 24 heads per case. Retailers and distributors can identify the potentially affected products through the Produce Traceability Initiative (PTI) sticker attached to exterior of the case. The PTI codes are 571280289SRS1 and 571280290SRS1.

E. coli O157:H7 causes a diarrheal illness often with bloody stools. Although most healthy adults can recover completely within a week, some people can develop a form of kidney failure called Hemolytic Uremic Syndrome (HUS). HUS is most likely to occur in young children and the elderly. The condition can lead to serious kidney damage and even death. If consumers are experiencing any of the above symptoms, please contact your physician.

Mystery E. coli Outbreak 1 – possibly linked to 2018 Yuma Romaine E. coli Outbreak.

As of October 28, 2020, a total of 21 people infected with the outbreak strain of E. coli O157:H7 have been reported from eight states.

Illnesses started on dates ranging from June 6, 2020, to October 5, 2020. Ill people range in age from  2 to 75 years, with a median age of 24 years. Sixty-seven percent of ill people are female. Of 16 ill people with information available, 8 hospitalizations have been reported, including 1 person who developed hemolytic uremic syndrome (HUS), a type of kidney failure. One death has been reported from Michigan.

Several ill people have been identified as part of an illness cluster at a restaurant. An illness cluster is defined as two or more people from different households who report eating at the same restaurant location, attending a common event, or purchasing food at the same grocery store in the week before becoming ill. Investigating illness clusters can provide 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.

The strain of E. coli O157:H7 causing illness in this outbreak has previously caused outbreaks linked to different sources, including an outbreak linked to romaine lettuce in 2018. However, food linked to a previous outbreak alone is not enough to prove a link in another outbreak of the same strain. This is because different foods can be contaminated by the same strain of bacteria.

Mystery E. coli Outbreak 2 – possibly linked to 2019 Salinas Romaine E. coli Outbreak.

As of October 28, 2020, a total of 23 people infected with the outbreak strain of E. coli O157:H7 have been reported from 12 states.

Illnesses started on dates ranging from August 17, 2020, to October 8, 2020. Ill people range in age from 5 to 81 years, with a median age of 21 years. Sixty-seven percent of ill people are female. Of 15 ill people with information available, 10 hospitalizations have been reported, including 2 people who developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths have been reported.

State and local public health officials are interviewing ill people to determine what they ate and other exposures in the week before they got sick. People have reported eating a variety of foods, including leafy greens. Of the 13 people interviewed to date, all reported eating various types of leafy greens, like iceberg lettuce (9), romaine lettuce (8), mixed bag lettuce (6), and spinach (9).

This outbreak is caused by the same strain of E. coli O157:H7 that caused an outbreak linked to romaine lettuce in 2019. However, food linked to a previous outbreak alone is not enough to prove a link in another outbreak of the same strain. This is because different foods can be contaminated by the same strain of bacteria.