Editor’s note: A spokeswoman for the CDC confirmed for Food Safety News on Jan. 3 that one person has died in the U.S., five have been admitted to hospitals and two have developed  kidney failure because of HUS as a result of their E. coli infections.

One person in the U.S. has died and two others are gravely ill in an ongoing E. coli outbreak linked to romaine lettuce, but U.S. officials had not made that information public as of Tuesday.

A statement from U.S. Centers for Disease Control and Prevention on Dec. 28 reported that 17 people across 13 states are confirmed in the outbreak, which Canadian officials say is linked to romaine lettuce. The CDC did not report hospitalizations or the death at that time.

Of 41 confirmed victims in Canada, 17 have required hospitalization and one person has died. Canadian officials first reported the outbreak on Dec. 11. In the U.S. and Canada, the first confirmed illnesses began Nov. 16, 2017.

The Toronto Star in Canada reported Tuesday evening that the U.S. CDC had confirmed the death. Additionally, the newspaper’s Alex McKeen reported the CDC said five patients in the U.S. have required hospitalization and two have developed hemolytic uremic syndrome, a type of kidney failure.

No news is not good news
Neither government has released information about the supplier(s), distributor(s) or retailers that handled the implicated romaine lettuce — which is believed to remain in the supply chain.

Neither government has initiated a recall. However, the Canadian grocery chain Sobeys voluntarily pulled romaine lettuce this past week.

“It would certainly seem that with two deaths and 56 other illness in multiple states and Canada, there would be an announcement of where the romaine lettuce was sold and who grew it. This outbreak extends back to November and December of last year,” said Bill Marler, the Seattle food safety attorney who’s been watching foodborne illnesses since the deadly 1993 E. coli outbreak traced to Jack in the Box.

The same variety of the pathogen, O157:H7, which sickened and killed children who ate undercooked fast food hamburgers 25 years ago, is the culprit in the current outbreak in the U.S. and Canada.

Investigators at the U.S. CDC have confirmed through whole genome sequencing that the E. coli O157:H7 sickening people in Canada has the same DNA fingerprint as the pathogen infecting people in the United States. Officials in both countries say that makes it most likely that a common source food is involved.

Cooperation but little candor
The U.S. Food and Drug Administration is working with the CDC on the outbreak investigation, but a spokesman said Tuesday he could not discuss any specific details of the FDA’s ongoing investigation. The CDC’s statement on Dec. 28 cited the Canadian officials’ identification of romaine lettuce as the cause of the outbreak, but added that U.S. officials had not yet made that determination.

“The FDA is supporting the CDC and state and local authorities in an investigation of an outbreak of Shiga toxin-producing E. coli O157:H7 illnesses,” the FDA spokesman said Tuesday.

“CDC informed FDA of this illness cluster in mid-December. As with all outbreak investigations our role is to identify the source of the food(s) the CDC identifies through case interviews and other evidence to identify what was commonly eaten among the people who became ill, and determine whether it is linked to the outbreak through testing or other evidence.”

The FDA will neither confirm nor deny that is has or is testing any samples of romaine or any other foods in connection with the outbreak investigation.

Canada renews warning; says threat is ongoing
North of the border, the Canadian Food Inspection Agency (CFIA) is testing romaine lettuce samples but results are not yet available. In the mean time, the Public Health Agency of Canada (PHAC) continues its warning against consuming romaine lettuce.

“Based on the investigation findings to date, exposure to romaine lettuce has been identified as the source of the outbreak, but the cause of contamination has not been identified,” according to the PHAC update Dec. 28.

The outbreak appears to be ongoing, as illnesses linked to romaine lettuce continue to be reported to the Public Health Agency of Canada. These illnesses indicate that contaminated romaine lettuce may still be on the market  — including in restaurants, grocery stores and any establishments that serve food.”

Since Dec. 14, the Canadian health agency has been urging consumers “to consider consuming other types of lettuce, instead of romaine lettuce, until more is known about the outbreak and the cause of contamination.”

Risks for consumers
Although anyone can get develop an E. coli infection from exposure to the pathogen, pregnant women, people with weakened immune systems, young children and older adults are most at risk for developing serious complications, public health officials warn.

“This is especially true for this outbreak strain of E. coli (O157:H7), which is more likely to cause severe illness than other E. coli strains,” Public Health Agency of Canada reported.

Laboratory testing is necessary to determine whether food is contaminated with E. coli because it can’t be seen, smelled or tasted.

“Romaine lettuce can have a shelf life of up to five weeks; therefore it is possible that contaminated romaine lettuce purchased over the past few weeks may still be in your home,” Canadian officials told consumers.

Advice to consumers
Anyone who has eaten romaine lettuce and developed symptoms of E. coli infection should immediately seek medical attention. Specific lab tests are required to diagnose E. coli infection.

Symptoms can include nausea, vomiting, headache, mild fever, severe stomach cramps, and watery or bloody diarrhea. The onset of symptoms can range from 1 to 10 days after exposure.

“Some do not get sick at all, though they can still spread the infection to others. Others may feel as though they have a bad case of upset stomach. In some cases, individuals become seriously ill and must be hospitalized,” according to the health agency notice.

People who develop hemolytic uremic syndrome (HUS) need intensive medical treatment, usually including dialysis for kidney failure.

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