The Centers for Disease Control and Prevention have linked 18 more cases to the E. coli outbreak attributed to chopped romaine from Arizona, bringing the total to 53.
Cases were added in five more states — Alaska, Arizona, California, Louisiana and Montana — which brings that total to 16, according to a notice on the CDC website.
Nine more hospitalizations have been reported, bringing that number to 31. Five people have experienced kidney failure. Illness onset dates range from March 13 to April 6.
The CDC and the U.S. Food and Drug Administration still have yet to identify the specific source of the outbreak. Chopped romaine from the Yuma growing region is still the focus of the investigation, with 41 of 43 people interviewed reporting that they ate romaine lettuce in the week before they became ill.
Most people said they ate a salad at a restaurant, and romaine was the only common ingredient, according to the CDC update. Ill people have not reported eating whole heads or hearts of romaine before getting sick.
The CDC initially listed 35 illnesses across 11 states, with 22 people hospitalized and three experiencing kidney failure, in its first notice about the outbreak April 13.
The CDC and the FDA elected to release the warning before they identified the source of the outbreak, the second time those agencies have made that kind of call in the last six months. The E. coli outbreak in December, ultimately attributed to leafy greens, was also announced before a source was determined.
Unlike that situation, the CDC and FDA have been clear that the current outbreak is connected only to chopped romaine from the Yuma growing region. Whole head romaine, hearts of romaine and romaine from other growing areas — California, Florida, Mexico — have not been implicated.
When the agencies issued their alerts April 13, produce industry groups stated that nearly all romaine being packed and shipped now is coming from California.
Movement reports from the U.S. Department of Agriculture show a similar picture, with the vast majority of shipments in April coming from California and shipments from Arizona declining between the first week of the month and the second week of the month.
Bob Whitaker, chief science and technology officer for the Produce Marketing Association, said numerous large romaine growers transitioned out of Yuma weeks earlier because they had already scheduled to do so, while others that were still transitioning spent the weekend after the alert making sure that any product shipped from that point forward was only from regions other than Yuma.
Jennifer McEntire, the vice president of food safety and technology for the United Fresh Produce Association, explained in a member alert why the CDC and the U.S. Food and Drug Administration elected to issue a warning even though they did not know the origin of the contaminated product.
“FDA and CDC noted their concern with the high number of illnesses in a short time frame (the most they have seen in a long time) and the severity of illness and their concern that product could still be out there,” McEntire said in the April 17 update.
The high hospitalization rate was also a factor.
“They did not want to risk people continuing to eat affected product and becoming severely ill while the investigation continued,” McEntire said. “This is a devastating illness and they did what they felt was in the interest of public health.”
Even though the CDC and FDA made it clear they are investigating only chopped romaine from Arizona, Consumer Reports advised people to avoid all romaine. In a post on its website, the organization argued that shoppers cannot be expected to figure out the origin of the food they buy.
Produce industry groups were disappointed to see such a broad warning and have requested a correction of the post, which has numerous inaccurate statements, McEntire said.
Consumer Reports stated in its article that it is unknown why the CDC and FDA have focus only on “bagged” romaine, but the outbreak alert explains the CDC made that distinction based on its interviews with the people who became sick.
Many retailers have opted to err on the side of caution, clearing shelves of products with romaine and posting signs about the outbreak.