Eight-state E coli outbreak strikes 50, kills 1

Editor's note: The following story was published the morning of Sep 15 with current FDA data. During the day more cases were reported in the news media. The numbers as of late afternoon stand at almost 60 cases in 10 states (Ohio and Kentucky are the additional states).

Sep 15, 2006 (CIDRAP News) – People should avoid eating bagged fresh spinach after an outbreak of the virulent Escherichia coli strain, O157:H7, the US Food and Drug Administration (FDA) warned yesterday.

The outbreak has affected 50 people in eight states, including 20 in Wisconsin, which also reported the only death, according to news sources. And in eight people, the infection led to hemolytic uremic syndrome (HUS), which can cause kidney failure and even death.

The news comes less than 3 weeks after the FDA and California health officials launched a probe focusing on Salinas Valley in California, the nation's main producer of leafy green vegetables and the source of at least eight E coli outbreaks since 1995 (see yesterday's CIDRAP story). No growing region, grower, brand, or retail store has been implicated in the current outbreak, according to news sources.

"To date," yesterday's FDA release says, "preliminary epidemiological evidence suggests that bagged fresh spinach may be a possible cause of this outbreak. Based on the current information, FDA advises that consumers not eat bagged fresh spinach at this time."

A New York Times story yesterday reported that federal health officials are not certain that bagged spinach is to blame, but it is the only food that all the patients have in common, according to David Acheson, MD, of the FDA's Center for Food Safety and Applied Nutrition (CFSAN).

"Given the severity of this illness and the seriousness of the outbreak, FDA believes that a warning to consumers is needed. We are working closely with the US Centers for Disease Control and Prevention (CDC) and state and local agencies to determine the cause and scope of the problem," said CFSAN director Robert Brackett, PhD, in yesterday's FDA release.

The first case was reported Aug 23, and the most recent Sep 3, according to the FDA. The federal investigation into the outbreak is ongoing.

Commenting on the scope of the outbreak, Acheson said in the Times story, "It's increasing by the day. We may be at the peak; we may not. We're giving preliminary data here."

Christopher Braden, MD, a medical epidemiologist at the CDC's National Center for Infectious Disease, said in a Washington Post story yesterday, "I think we will see quite a few more cases. And I think we will see them from other states."

In addition to Wisconsin, other affected states include Utah, Oregon, Indiana, Idaho, Michigan, New Mexico, and Connecticut, according to the FDA.

Of the 20 Wisconsin cases, 11 occurred in Milwaukee County, according to a Milwaukee Journal Sentinel story yesterday. No details have been reported on the Wisconsinite who died, but the Journal Sentinel article said that the person is not from Milwaukee County.

O157:H7 produces a toxin that causes diarrhea—often bloody—and abdominal cramps, but typically no fever. The illness usually resolves in 5 to 10 days but causes HUS in 2% to 7% of patients.

See also

FDA Sep 14 release
http://www.fda.gov/bbs/topics/NEWS/2006/NEW01450.html

CIDRAP E coli overview
http://fever.cidrap.umn.edu/cidrap/content/fs/food-disease/causes/ecolioview.html

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