As the number of E. coli cases linked to romaine has risen to 40, federal health and regulatory officials are warning consumers not to eat romaine lettuce originating from Salinas, Calif., and the Food and Drug Administration has asked the industry to stop shipments from there.
The FDA issued a similar advisory days before Thanksgiving 2018 covering all romaine, but the current warning involves only product grown and Salinas, as well as products included in a Nov. 21 recall by Missa Bay.
“At this stage in the investigation, the most efficient way to ensure that contaminated romaine is off the market would be for industry to voluntarily withdraw product grown in Salinas, and to withhold distribution of Salinas romaine for the remainder of the growing season in Salinas,” according to a Nov. 22 notice from the FDA.
FDA investigators are in Salinas following the outbreak, which as of Nov. 22 included 40 cases in 16 states; 28 people have been hospitalized, according to the Centers for Disease Control and Prevention. Cases were reported from Sept. 24. to Nov. 10.
Investigators have yet to pinpoint a source. The FDA said it doesn’t have enough traceback information to identify a specific source that would allow it “to request a targeted recall from specific growers.”
But epidemiologic, laboratory and traceback evidence has led the FDA, CDC and state health agencies to suspect romaine lettuce from the Salinas area as a likely source.
Genetic analysis of the E. coli O157:H7 strains from patients in the current outbreak are similar to those from the fall 2017 and fall 2018 in the U.S. and Canada. In the 2017 outbreak, Canadian officials named romaine as the source, while U.S. named leafy greens, not specifically romaine.
An outcome of the November 2018 E. coli outbreak was the industry’s voluntary acceptance of labeling romaine products with growing region and harvested-by dates. The Nov. 22 notice from FDA advises consumers to throw away or return romaine products if “Salinas” is on the label, or if there is no harvest area listed.
However, if the label indicates it is hydroponic or greenhouse-grown, the FDA advises it is safe to eat. The 2018 FDA advisory covered all romaine, regardless of where it was grown or if it was field or indoor grown, bringing a backlash from greenhouse/indoor growers.
“At this time, romaine lettuce that was harvested outside of the Salinas region has not been implicated in this outbreak investigation,” according to the FDA. “Hydroponically- and greenhouse-grown romaine, which is voluntarily labeled as ‘indoor grown,’ from any region does not appear to be related to the current outbreak.”
If a restaurant or retailer is unable to determine where romaine from a menu item or salad bar is from, consumers should not eat it, according to the FDA advisory.
According to the Romaine Task Force, convened in the wake of the 2018 outbreak, the Salinas growing region includes Santa Cruz, Santa Clara, San Benito and Monterey counties.
The investigation focused on romaine after the Maryland Department of Health tested an unopened Ready Pac Foods Bistro Chicken Raised Without Antibiotics Caesar Salad that had been purchased by one of the patients with E. coli, and found the pathogen on romaine in the salad.
The states, and how many patients from each one in the outbreak, are: Arizona, 2; California, 4; Colorado, 1; Idaho, 3; Illinois, 1; Maryland, 3; Michigan, 1; Minnesota, 1; Montana, 1; New Jersey, 1; New Mexico, 2; Ohio, 5; Pennsylvania, 3; Virginia, 1; Washington, 1; and Wisconsin, 10.