Published Date: 2002-08-01 23:50:00
Subject: PRO/EDR> E. coli O157, lettuce - USA: Alert (02)
Archive Number: 20020801.4907
E. COLI O157, LETTUCE - USA: ALERT (02)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Mon 29 Jul 2002 16:17 (UTC-0700)
From: Akira Goto <firstname.lastname@example.org>
Source: The Seattle Times 29 Jul 2002 [edited]
Lettuce likely source of E. coli contamination in Eastern Washington
Scientists used genetic testing to link an _E. coli_ O157 case in Walla Walla
with an outbreak that sickened 24 people who attended a cheerleader/drill-
team camp at Eastern Washington University, health officials said on 29 Jul
[The bacteria obtained from the] romaine lettuce eaten at the cheer[leading]
camp was a genetic match for [the bacteria isolated from a case related to]
lettuce eaten by a man with no connection to the camp in a Walla Walla
restaurant, the Spokane Regional Health District said.
That connection prompted the U.S. Food and Drug Administration today to issue
a nationwide alert about romaine lettuce distributed by Spokane Produce [see
below - Mod.LL].
The FDA said 29 people were apparently sickened by the product so far, and
urged consumers to throw the lettuce away. "We have not seen any cases
outside of Washington," said Sue Hutchcroft, a spokeswoman for the FDA in
Seattle. "It's an ongoing investigation."
Romaine lettuce emerged as the main suspect in two dozen confirmed cases of
_E. coli_ at the cheer camp after the health district sent a survey to all
the people who attended the 11-14 Jul 2002 gathering at EWU, said Melanie
Rose, a spokeswoman for the health district.
Health experts analyzed the 100 survey replies and narrowed down the _E.
coli_ source to the lettuce used to make Caesar salads that were served the
first evening of the camp, Rose said.
At the same time, the state Department of Health made a genetic match of the
bacterium from the camp and a case of the disease in a Walla Walla person
with no connection to the camp, Rose said. "We narrowed it down to romaine
lettuce this person ate on a sandwich in a restaurant," Rose said. "It was
the same as the lettuce at the cheerleader camp."
The outbreak then spread to participants at a church camp last week. 7 girls
went directly from the cheer camp to Zion's Camp, near Reflection Lake in
Spokane County, Rose said.
There has been one confirmed case of _E. coli_ at the church camp and 6
suspected cases, Rose said. The church camp did not serve Spokane Produce
lettuce, but _E. coli_ O157 can be spread from person to person, she said.
There have been no deaths from the outbreak, but one teenager who attended
the cheer camp had her kidneys so damaged that she is on dialysis, the FDA
The FDA has sent investigators to Spokane Produce. A person who answered the
telephone at the business this afternoon declined comment.
Rose said it appeared the lettuce arrived at EWU already contaminated, but it
was not known whether the contamination occurred at Spokane Produce or prior.
The Spokane Produce lettuce is sold under several different brand names, and
the FDA doesn't have a complete list and isn't sure if other states received
shipments, said FDA acting commissioner Lester Crawford. The FDA urged all
consumers to throw away 5-pound bags of "Romaine Toss" sold by Spokane
Crawford said doctors are investigating another 16 people who didn't attend
the cheer camp but also are suspected of having _E. coli_ O157 linked to the
Most illnesses caused by _E. coli_ O157 stem from eating undercooked ground
beef, but manure or feces-contaminated irrigation water sometimes taints
fresh produce, too.
Spokane County only had 12 confirmed cases of _E. coli_ [O157] last year.
This year there have already been 31 cases, Rose said.
[Byline: Nicholas K. Geranios]
Date: Mon 29 Jul 2002
From: ProMED-mail <email@example.com>
Source: FDA News [edited]
FDA issues nationwide alert to consumers about Spokane Produce brand
romaine lettuce due to possible health risk
The Food and Drug Administration (FDA) is warning consumers not to consume
Spokane Produce brand romaine lettuce because this product has been
associated with an outbreak of _E. coli_ O157:H7 in a cheerleading camp in
Washington state in mid-July 2002. FDA urges consumers to throw out this
_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.
The latest reported illness associated with this outbreak was on 19 Jul 2002.
The romaine lettuce, which is sold under several different brand names, is
known to be packaged in 5-pound bags labeled "Romaine Toss" and was
distributed by Food Services of America which in the past had also
distributed this product to restaurants and institutions in Idaho, Montana,
and Oregon. The product has a shelf life of 2 weeks. To date, the outbreak
has only involved exposure to romaine lettuce packaged in these 5-pound bags.
The romaine lettuce may also be sold at retail establishments in various-
A total of 29 individuals at the cheerleading camp have been confirmed to
have _E. coli_ O157:H7. Other illnesses in Washington state are being
This situation was discovered when many individuals at the camp became ill.
The FDA is working with the Spokane Regional Health District, Washington
State Department of Agriculture, Washington State Department of Health, and
other agencies to determine the cause and scope of this problem.
Consumers should ask at the place of purchase in order to assure that they do
not consume Spokane Produce brand romaine lettuce until this health emergency
[This is a follow-up posting rela
ted to the (now identified as romaine) lettuce-linked _E. coli_ O157 outbreak
in Washington State. The source of the contamination appears to be early in
the food distribution and not at the camp, as additional cases unrelated to
the camp have occurred and are genetically linked. -Mod.LL]
[Citations related to similar cases provided are as follows:
1: Hilborn ED, Mermin JH, Mshar PA, Hadler JL, Voetsch A, Wojtkunski C,
Swartz M, Mshar R, Lambert-Fair MA, Farrar JA, Glynn MK, Slutsker L. A
multistate outbreak of Escherichia coli O157:H7 infections associated with
consumption of mesclun lettuce. Arch Intern Med. 1999 Aug 9-23;159(15):1758-
2: Ackers ML, Mahon BE, Leahy E, Goode B, Damrow T, Hayes PS, BibbWF, Rice
DH, Barrett TJ, Hutwagner L, Griffin PM, Slutsker L. An outbreak of
Escherichia coli O157:H7 infections associated with leaf lettuce
consumption. J Infect Dis. 1998 Jun;177(6):1588-93.