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Outbreak investigation hampered by lack of business records

Snarl of distribution networks, inadequate traceability stymies search for source of romaine

Public health officials continue to be frustrated by a lack of traceability information from romaine lettuce growers and their customers as the investigation into an ongoing E. coli outbreak continues.

For three weeks state and federal investigators have been trying to identify the source of the implicated romaine, which has sickened dozens across 16 states. The best the government agencies can do is to stand by an April 13 warning against consuming romaine from the Yuma, AZ, growing region.

Produce industry groups have said the Yuma season is over, with virtually all romaine coming out of California at this point. But the public warning continues as government officials struggle with intertwined distribution networks, incomplete or unavailable shipping and receiving records, and virtually no product labeling or coding to lead them back to a specific source.

“The one thing we can confirm is that all the romaine lettuce that made people ill was shipped by distributors from Yuma. That’s why we are advising people to ask their grocer or restaurateur where their romaine lettuce came from and avoid it if it’s from Yuma or if they don’t know the source,” a spokesperson for the U.S. Food and Drug Administration said Tuesday evening. 

“At this point, we don’t have concrete evidence to any one grower or farm. Once we do, we will name them.”

Part of the problem in identifying the source of the romaine is the lack of traceability coding on the leafy green. Federal law requires entities in the food chain to maintain records one step forward and one step back from their own operations. That leaves epidemiologists and other outbreak investigators stuck in a quagmire of stair steps leading from one entity to the next in the supply chain. 

Traceability labeling and coding, such as that developed by the Produce Traceability Initiative, would mean finished product sent to retailers and foodservice operations could be traced back through the supply chain virtually immediately. Many fresh produce companies have not adopted the voluntary  traceability labeling.

“We are continuing to work on the traceback for this investigation, which is important not to oversimplify. When we are executing a full traceback investigation, as we are currently, we are working to identify multiple distribution channels that can explain the entire nationwide outbreak,” the FDA’s spokesperson said.

“We are tracing back from multiple groupings of people reported ill that are located in diverse geographic areas. The reason for this is to avoid redundant distribution channels, and find unique distribution channels that converge on a single source or grower. One distribution channel does not necessarily explain the entire outbreak…”

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Outbreak numbers, timeline
In its most recent case count update, posted April 18, the Centers for Disease Control and Prevention reported 53 people in 16 states had been confirmed with the outbreak strain of E. coli O157:H7. No deaths have been recorded, but an unusually high percentage of victims have required hospitalization. Of the confirmed victims, 31 have been admitted to hospitals and five have developed kidney failure.

New Jersey officials were the first to go public with any information about the outbreak. They warned the state’s residents on April 4 about illnesses thought to be linked to an unnamed restaurant chain. The restaurant chain implicated in New Jersey is Panera Bread, according to court documents in a civil case filed by one of the victims.

Panera corporate officials identified the romaine supplier as Freshway Foods Inc. of Sidney, OH. Freshway is owned by US Foods, the second largest broadline foodservice provider in the country. On Tuesday a spokeswoman for Freshway Foods declined to comment on who had provided the company with the implicated romaine.

Once New Jersey reported its investigation, outbreak detectives from other states public health agencies and epidemiologists from the FDA and CDC quickly joined in efforts to find the cause of the E. coli infections. 

On April 10 the CDC posted an outbreak announcement, but reported it had not yet identified a link to a specific food. At that point, 17 people from seven states were confirmed sick.

By April 13 both the CDC and FDA had enough epidemiological evidence to warn the public against eating chopped romaine lettuce grown in the Yuma, AZ, region. Neither agency named any brands or specific growers, repackers or distributors. They also did not name retailers, restaurants or institutional foodservice operators that had received romaine from the Yuma area.

The federal agencies had enough evidence by April 20 to expand their initial warnings about chopped romaine to include all romaine from the Yuma area, including whole heads and hearts.

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