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On Wednesday, the footprint of the romaine lettuce E. coli outbreak became more extensive than the historic and deadly 2006 fresh spinach outbreak.

In the May 9 update, the Centers for Disease Control and Prevention in Atlanta added four states and 28 confirmed cases of E. coli O157: H7 to the 9-week-old outbreak associated with romaine lettuce, likely grown in the Yuma, AZ area.

This year’s deadly leafy green outbreak has so far resulted in one death in California among 149 cases in 29 states with 64 hospitalizations. The numbers stand in close comparison to the outbreak associated with fresh spinach in 2006. The spinach outbreak resulted in at least 199 E. coli infections across 26 states. Three people died.

The 2006 spinach outbreak of E. coli O157: H7 was one of the critical events in the lead-up to Congress passing the Food Safety Modernization Act (FSMA), which President Obama signed into law on Jan. 4, 2011. It also caused growers and retailers to form auditing groups known Leafy Green Marketing Agreements in California and Arizona.

The latest CDC report added four new states to the outbreak map, Florida, Minnesota, North Dakota and Texas. Included in the new CDC report are illnesses with onset dates of April 25 and earlier.

Minnesota Tuesday reported it has illnesses with onset dates in May, which points to an outbreak that is still growing.

“Illnesses that occurred in the last two or three weeks might not yet be reported because of the time between when a person becomes ill with E. coli and when the illness is reported to CDC,” the agency said. Specifically, people who became sick after April 17 have probably not yet been included in the federal count.

In the seventh update since CDC’s initial public announcement of the outbreak, the agency continues to say it is romaine lettuce from the Yuma, AZ, growing area that “could make people sick.”

Ever since April 13, when the CDC first posted its warning about romaine from Yuma, representatives of the fresh produce industry have been telling the public and government investigators that the romaine harvest season in the Yuma area was winding down. By the end of April fresh produce and leafy greens, representatives were saying no romaine was being shipped from growers in the Yuma area. When Arizona’s harvest season ends, the romaine “deal,” as it’s referred to in the produce industry, shifts to California.

The federal investigation led by the Food and Drug Administration has not been able to pinpoint which romaine fields are sickening people. It has pinned its hopes on the fact that sales are over for Yuma, AZ romaine.

As of May 9, CDC said the illnesses onsets ranged from March 13 to April 25, with ill people ranging from 1 to 88 years and an average age of 30 years of age. Sixty-five percent of the sick people are female.

One very troubling aspect of the outbreak is that 17 of those sickened have developed hemolytic uremic syndrome (HUS), which can result in fatal kidney failure.

The CDC continues to advise consumers not to eat romaine lettuce unless they are confident it does not come from the Yuma, AZ, growing area. The agency urges restaurants not to serve romaine lettuce unless they are sure its source is it outside the Yuma area.

CDC says antibiotics are not recommended for patients with E. coli infections until diagnostic testing is performed and E. coli O157: H7 is ruled out. The Shiga-toxin-producing Escherichia coli outbreak is being investigated by the federal agencies and the impacted states.

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