Outbreak of E. coli Infections Linked to Romaine Lettuce

On November 26, 2018, CDC updated its warning to consumers. CDC continues to advise that U.S. consumers not eat and retailers and restaurants not serve or sell any romaine lettuce harvested from the Central Coastal growing regions of northern and central California. If you do not know where the romaine is from, do not eat it.

• Some romaine lettuce products are now labeled with a harvest location by region. Consumers, restaurants, and retailers should check bags or boxes of romaine lettuce for a label indicating where the lettuce was harvested.
  • If the romaine lettuce is not labeled with a harvest growing region, do not buy, serve, sell, or eat it.
  • Romaine lettuce labeled with a harvest region outside of the Central Coastal growing regions of northern and central California is not linked to the outbreak. Areas not linked to this outbreak include the desert growing region near Yuma, Arizona; the California desert growing region near Imperial County and Riverside County; the state of Florida; and Mexico.
• If you purchased romaine lettuce and do not know where it was harvested, do not eat, serve, or sell it and throw it away.
  • This advice includes all types or uses of romaine lettuce, such as whole heads of romaine, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad.
  • Wash and sanitize drawers or shelves in refrigerators where romaine was stored. Follow these five steps(https://www.cdc.gov/foodsafety/communication/clean-refrigerator-steps.html) to clean your refrigerator.
  • If you do not know if the lettuce is romaine or whether a salad mix contains romaine, do not eat it and throw it away.
• Hydroponic or greenhouse-grown romaine lettuce has not been linked to this outbreak.
• Take action(https://www.cdc.gov/vitalsigns/foodsafety-2015/index.html) if you have symptoms of an E. coli infection(https://www.cdc.gov/ecoli/ecoli-symptoms.html):
  • Talk to your healthcare provider.
  • Write down what you ate in the week before you started to get sick.
  • Report your illness to the health department.
  • Assist public health investigators by answering questions about your illness.

Advice to Clinicians

• Antibiotics are not recommended(https://www.cdc.gov/ecoli/clinicians.html) for patients with E. coli O157 infections. Antibiotics are also not recommended for patients in whom E.coli O157 infection is suspected, until diagnostic testing rules out this infection.
• Some studies have shown that administering antibiotics to patients with E. coli O157 infections might increase their risk of developing hemolytic uremic syndrome (a type of kidney failure), and the benefit of antibiotic treatment has not been clearly demonstrated.

• People usually get sick from Shiga toxin-producing E. coli (STEC) 2–8 days (average of 3–4 days) after swallowing the germ.
• Some people with a STEC infection may get a type of kidney failure called hemolytic uremic syndrome (HUS).
• E. coli infection is usually diagnosed by testing a stool sample.
• Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out. Some studies have shown that administering antibiotics to patients with E. coli infections might increase their risk of developing HUS, and a benefit of treatment has not been clearly demonstrated.
• For more information, see Symptoms of E. coli Infection(https://www.cdc.gov/ecoli/ecoli-symptoms.html).