The Numbers:

As of Friday night, the CDC reported 53 people infected with the outbreak strain of E. coli O157:H7 being reported from 16 states.  However, the CDC reported only 1 case in Alaska while the Alaska Department of Public Health reported 8 ill from the Anvil Mountain Correctional Center in Nome, and that its investigation had confirmed that the whole head romaine lettuce consumed by the Nome patients was grown in Yuma, Arizona. In addition, the CDC reported 6 ill in Montana while the Montana Department of Public Health reported 8 and the CDC reported 3 ill in Arizona while the Arizona Department of Health reported 5. The CDC further reported that 31 people have been hospitalized, including five people who have developed hemolytic uremic syndrome (HUS).

The hardest hit states are Alaska with 8 ill, Idaho with 10 ill, Montana with 8 ill, New Jersey with 7 ill, and Pennsylvania with 12 – 5 states with 45 ill – 19 in the other 11.

As of a few moments ago, I had been contacted by nearly 30 people, most of whom are clearly part of the CDC’s and states’ counts. However, some with E. coli O157:H7 are awaiting contact by health officials.  In addition, two patients (13-year-old from New York and a 6-year-old from California) that I spoke to their families this morning, both recently developed HUS, and may not yet be counted in the CDC totals.  Given that I have also been retained by a 23-year-old HUS patient in Idaho and two adult HUS patients in New Jersey, I think the CDC count of five with HUS, is unfortunately low.

Counting the bodies in an outbreak can be the easy part; positive stool cultures for E. coli O157:H7 are genetically matched by PFGE (unclear if state and CDC labs are doing WGS yet) and people are interviewed to determine what they consumed in the 3-5 days before the onset of illness. That is how the state health authorities and the CDC have determined (thanks to the prisoners in Alaska) that whole head and chopped romaine from Yuma Arizona is the cause of this outbreak – that is likely to grow in number.

Tying the Chain Together:

What we know: there is a cluster of cases in the East – New Jersey and New York – that share a common exposure of eating salads with romaine lettuce at Panera Bread.  Panera received chopped-bagged romaine from processor Freshway Foods.  At this point, we cannot confirm where Freshway Foods, which services the Midwest and East,  sourced the romaine, but a subpoena in the lawsuit I filed last week will likely do the trick.

For Illnesses in the West, I have found a common processor for cases in Montana and Idaho, but I do not – yet – have the evidence to file suit.  If anyone reading this wants to “drop a dime” on the processor, feel free to call.

And, then there is Alaska; as noted above, the Alaska Department of Public Health announced that whole head romaine lettuce consumed by the Nome patients was grown in Yuma, Arizona.  And, Food Safety News  has learned the romaine was likely delivered to the correctional facility during the final week of March. Prison officials believe it was all consumed during the first week of April. Inmates who became ill first experienced symptoms on April 5, 6, 9 and 15. Country Foods, located three hours from Nome by air, is the food supplier for the Anvil Mountain prison.

I have been told the name of the Yuma, Arizona grower X by at least two people who would know, but I will let the FDA announce the growers name on Monday.

The bigger questions are the link between grower X and all 64 – and growing illnesses – and why the broad geographical distribution of the illnesses.