Treat the water; then mitigate other romaine problemsDecember 3, 2019
Stephen M. Ostroff is a former deputy commissioner for foods at the Food and Drug Administration. He wrote this column recently.
Exactly a year ago, during Thanksgiving week, I was involved in the government’s decision to recommend removing romaine lettuce from grocery store shelves and restaurants. We also advised people not to eat any romaine they had purchased and to throw it away instead.
Now, right before Thanksgiving, it’s happening again.
Nobody wants to scratch romaine off the nation’s Thanksgiving menu. But these recommendations were easy ones to make.
Last year, an outbreak of E. coli bacteria linked to romaine was sweeping the country. Contaminated romaine was likely still on the market. We were unsure where the contaminated product came from, so all of it had to be removed. Even if we knew its origin, romaine wasn’t labeled to allow consumers to determine where it was grown. At least the labeling has improved since last year. But more needs to change.
During the 2018 Thanksgiving outbreak, the government’s actions clearly prevented additional illnesses. But, unfortunately, 62 people still became ill. Symptoms of an E. coli infection can include severe stomach cramps, bloody diarrhea, vomiting and fever. Some people experience only mild symptoms, but for others a severe infection can be life-threatening.
Fast forward to now, and there’s another outbreak of the same strain of E. coli linked to romaine, likely from California’s central coast. As of Nov. 22, 40 cases had been reported across 16 states, with 28 hospitalizations but no deaths. The Food and Drug Administration and Centers for Disease Control and Prevention are recommending that consumers avoid romaine from the Salinas region.
Remarkably, the specific E. coli strain (O157:H7) causing the new outbreak is genetically indistinguishable from last year’s and another one in late 2017. Last month, the FDA retroactively identified an outbreak involving romaine lettuce that occurred in late summer, causing 23 illnesses. The CDC has not posted information about that outbreak, so the epidemiologic patterns of illness and causative strain are unknown.
Notably, the 2018 Thanksgiving outbreak was not the first one that year either. It was preceded by the biggest outbreak in the United States of E. coli illness in more than a decade, with 210 illnesses, including five deaths, linked to romaine from the winter growing region around Yuma, Ariz.
With five multistate outbreaks in less than two years, it’s clear there’s a serious continuing problem with E. coli O157:H7 and romaine lettuce. The natural reservoir for this pathogen is ruminant animals, especially cattle. Moreover, one particular strain of E. coli seems to have found a home in the growing regions of central coastal California, returning each fall near the end of the growing season.
It’s not clear where this strain is hiding. Cattle? Water sources? Elsewhere? What is clear is that additional…