E coli cases reach 183 in 26 states

Sep 27, 2006 (CIDRAP News) – The case count in a national outbreak of Escherichia coli O157:H7 infections linked to fresh spinach rose to 183 yesterday, according to the US Food and Drug Administration (FDA).

The 183 cases represent an increase of 8 since Sep 25. Ninety-five people (52%) were hospitalized, and one more case of the serious kidney condition known as hemolytic uremic syndrome (HUS) was reported, bringing the total to 29 (16%).

The number of affected states grew by one, to 26. Only one death has been attributed to the outbreak so far, though health officials in Maryland and Idaho are waiting for lab results in two deaths possibly related to it.

Canada reported that one case of E coli infection in a person who ate bagged spinach has been matched to the outbreak strain, the FDA said.

Meanwhile, the Pennsylvania Department of Health reported finding a bag of spinach contaminated with the outbreak strain of E coli, according to the FDA. The brand and product are the same as two other bags, one from New Mexico and one from Utah, that have been tied to the outbreak so far: Dole baby spinach.

The bags from New Mexico and Utah were processed at the same Natural Selections Foods processing plant, on the same day (Aug 15), and on the same shift, according to an Associated Press (AP) report today. Natural Selections Foods is a major spinach supplier and packages several brands that have been recalled, along with those of four other companies.

Dr. Kevin Reilly, deputy director of prevention services for the California Department of Health Services, told the AP that investigators were aggressively looking at what was produced on that date. "Much of the feedback we got from patients right now was related to Dole packaging," he said.

Bags of fresh spinach from two other states, Ohio and Illinois, were found to contain E coli O157:H7, and further testing is under way to see if it matches the outbreak strain, the US Centers for Disease Control and Prevention (CDC) said yesterday.

The CDC has been monitoring the outbreak strain for about 10 years, and infections from it have been reported sporadically since 2003, according to a Morbidity and Mortality Weekly Report (MMWR) supplement issued yesterday. The outbreak strain is one of 3,520 unique E coli O157:H7 strains and has been responsible for about 21 infections a year for the last 3 years. "This finding suggests the occasional presence of this strain in the environment and food supply; however, it has not been associated with a recognized outbreak in the past," the report said.

Last week, the FDA said federal and state investigators had narrowed their search for the E coli contamination source to nine spinach farms in three California counties: Monterey, San Benito, and Santa Clara. As the agency narrowed its focus, it cleared spinach grown in other areas as safe for consumers to eat.

Spinach producers in unaffected areas are working to get their products back on the market in a way that lets consumers know where the spinach was grown.

The CDC is still advising that people who develop diarrhea after eating fresh spinach should contact their healthcare provider and ask to be tested for E coli O157:H7.

See also:

Sep 26 FDA news release

Sep 26 CDC statement

CDC. Ongoing multistate outbreak of Escherichia coli serotype O157:H7 infections associated with consumption of fresh spinach—United States, September 2006. MMWR Dispatch 2006 Sep 26;55 [Full text]

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