Even though state officials have found E. coli in romaine lettuce in an unopened package of Ready Pac salad, the federal CDC says their investigation has not determined the source of an eight-state outbreak.

If it is the romaine, it will be the fifth outbreak linked to that specific leafy green since 2017. The current coast-to-coast outbreak includes patients in Arizona with 1, California with 2, Colorado with 1, Idaho with 3, Maryland with 2, Montana with 1, Washington with 1 and Wisconsin with 6.

The Food and Drug Administration is tracing the romaine back through the supply chain and has found the source of it to possibly be farmed in the Salinas, CA, area. Federal officials have not reported whether the suspect growing fields, processing or packing facilities are used by more than one company.

Warnings today from the FDA and CDC, as well as the outbreak notice from the CDC, somewhat downplayed the pubic health danger but urged consumers to throw out any leftover Ready Pac Foods Bistro Chicken Caesar salad they may have.

“Preliminary information indicates that romaine lettuce used in the product that tested positive was harvested in mid-October and is no longer within current expiration dates,” according to the Centers for Disease Control and Prevention.

A spokesman from the FDA told Food Safety News that the agency was notified of the Maryland illnesses on Nov. 18. He said there are investigators on the ground in California.

“The FDA can confirm that investigators have been sent to the facility where the Ready Pac brand salad was packed” according to the FDA spokesman. “The agency is working to determine if other products are affected.”

Officials with Ready Pac have not provided answers to Food Safety News regarding their operational status and testing protocols throughout their harvesting and processing facilities.

Officials with the Centers for Disease Control and Prevention went public with the outbreak announcement today, following an announcement earlier this week by the Food and Drug Administration. 

Seventeen people have been confirmed in the outbreak, with seven of them requiring hospitalization, according to the CDC.

“The Maryland Department of Health identified E. coli O157 in an unopened package of Ready Pac Foods Bistro Chicken Caesar Salad collected from a sick person’s home in Maryland,” according to the CDC. The FDA made a similar statement.

“The salad had a “Best By” date of Oct. 31, 2019.” 

Federal and state officials reported that ill people in Maryland reported eating Ready Pac Foods Bistro Chicken Caesar Salad. In initial interviews, ill people in other states have not reported eating this particular salad. Patient interviews and confirmation lab work is ongoing. 

In this investigation so far, WGS showed that bacteria isolated from ill people were closely related genetically, meaning that people in this outbreak are more likely to share a common source of infection.

Illnesses started on dates ranging from Sept. 24 to Nov 8. Ill people range in age from 3 to 72 years, with a median age of 16. Fifty-six percent of ill people are female. Two patients have developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths have been reported.

Additional patients are likely to be identified because it can take a month or more for diagnosis, initial testing, confirmation testing, local reporting and eventually reporting to federal officials. 

About E. coli infections
Anyone who has eaten any of the implicated products and developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

About 5 to 10 percent of those diagnosed with E. coli infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor.

Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than five years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients.

People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

Editor’s note on Opinion originally posted Nov. 3: At this time, the credibility of the Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) is not to be trusted. Both agencies have shown a reckless disregard for the public’s right to know, and their reliability going forward remains suspect. For the next six weeks, Food Safety News will publish this note above on every story involving the FDA or CDC.

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