The Organic Spinach and Spring Mix Blend salad makings responsible for an outbreak of Shiga toxin-producing Escherichia coli O157:H7 (STEC O157:H7) has sickened 28 and put ten people in hospitals. The federal Centers for Disease Control and Prevention (CDC) in Atlanta on Monday said most of the cases were in New York State. Of those hospitalized, two developed the kidney-threatening hemolytic uremic syndrome (HUS). CDC said as the outbreak expanded beyond the Empire State, so has the investigation. “Collaborative investigation efforts of state, local, and federal public health and regulatory agencies indicate that Wegmans brand Organic Spinach and Spring Mix blend produced by State Garden of Chelsea, Massachusetts, is one likely source of this outbreak,” the CDC said in a statement released on its website. CDC said four leftover packages of Wegmans brand Organic Spinach and Spring Mix blend collected from four ill persons’ homes yielded the outbreak strain of STEC O157:H7. Wegmans recalled 5-ounce and 11-ounce packages of Organic Spinach and Spring Mix blend on Nov. 2. Produced by State Garden, the salad makings might be contaminated with STEC O157:H7 and were removed from store shelves. CDC said the warning not to eat the salads is especially important for children under age 5, the elderly, and those with weak immune systems because such individuals at higher risk of serious illness. Other brands of pre-packaged leafy green have been reported by ill persons outside New York State, and investigations are going to determine if there are other sources for this outbreak, CDC reported. CDC first announced it was involved in the outbreak investigation on Nov. 17. Public health investigators are using DNA “fingerprints” of E. coli bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may be part of this outbreak. The investigation has also relied upon data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections. The type of bacteria responsible for this outbreak is among those referred to as Shiga toxin-producing E. coli or STEC. STEC bacteria are grouped by serogroups (e.g., O157 or O145). The STEC serogroup found most commonly in U.S. patients is E. coli O157. A total of 28 ill persons infected with the outbreak strain of STEC O157:H7 have been reported from five states. The number of ill people identified in each state with the outbreak strain is as follows: Connecticut (2), Massachusetts (2), New York (22), Pennsylvania (1), and Virginia (1). Among persons for whom information is available, illness onset dates range from October 18, 2012 to November 3, 2012. Ill persons range in age from 4 years to 66 years, with a median age of 24 years. Sixty-eight percent of ill persons are female. This PFGE pattern has very rarely been seen before in PulseNet. It has been seen only 7 times prior to this outbreak. Illnesses that occurred after October 30, 2012 might not be reported yet due to the time it takes between when a person becomes ill and when the illness is reported. Testing conducted by the New York Department Health Wadsworth Center Laboratories isolated the outbreak strain of STEC O157:H7 from four leftover packages of Wegmans brand Organic Spinach and Spring Mix blend collected from four ill persons’ homes.