Like last year, shoppers are probably going to avoid romaine lettuce and maybe other leafy greens like spinach just ahead of Thanksgiving due to fears over yet another expanding multistate outbreak of E. coli O157: H7.

Officially, the federal Centers for Disease Control and Prevention (CDC) says consumers should not eat, and retailers should not sell any romaine lettuce harvested from the Salinas, CA growing region. If there is no label to be found, CDC says “don’t eat it, and throw it away.” And the same advice applies to mixed salads containing romaine when the growing area isn’t known..

Two days after the first 17 E. coli illnesses in eight states were reported and just one day after the Missa Bay, LLC, recall of 50 tons of salad products, CDC Friday announced the expansion of the outbreak where contaminated romaine being the source of 40 E. coli infections in 16 states.

No deaths are yet associated with the outbreak, but 70 percent or 28 of the infected individuals required hospitalization. One case of E. coli O157 infection in a Minnesota resident, who developed hemolytic uremic syndrome (HUS) and is hospitalized, has recently been identified and linked to the multi-state outbreak.

And this latest outbreak is caused by the same strain of E. coli O157: H7 that caused outbreaks linked to leafy greens in 2017 and romaine lettuce in 2018.

USDA’s Food Safety and Inspection Service (FSIS) also late Friday warned against consuming any wraps, sandwiches, prepackaged salad, salad kits, or other products containing romaine lettuce harvested from the Salinas, California, growing region. Additionally, FSIS says consumers should not eat any salad products identified in a Missa Bay, LLC, recall announced by FSIS on November 21, 2019.

“FSIS-regulated establishments are advised not to serve, ship, or sell products that contain romaine lettuce from the Salinas, California, growing region,” the agency said.   “This advice includes all types of romaine lettuce from the Salinas, California, growing region, such as whole heads of romaine, hearts of romaine, and packages of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad. If you do not know the source of your romaine lettuce, and if you cannot obtain that information from your supplier, you should not serve, ship, or sell the product.

 E. coli O157: H7 is a potentially deadly bacterium that can cause dehydration, bloody diarrhea and abdominal cramps 2–8 days (3–4 days, on average) after exposure to the organism. While most people recover within a week, some develop a type of kidney failure called hemolytic uremic syndrome (HUS). The condition can occur among persons of any age but is most common in children under 5-years old and older adults. It is marked by easy bruising, pallor, and decreased urine output. Persons who experience these symptoms should seek emergency medical care immediately.

In a statement issued by the California Leafy Green Marketing Agreement (LGMA), said the expanding E. coli outbreak “is being met with frustration and heartbreak” by romaine growers.

The California LGMA, formed in 2007 to prevent foodborne illnesses caused by lettuce and leafy greens, says the root cause of “this and other recent outbreaks linked to romaine lettuce” remain a mystery.”

Industry spokesmen also say they are  “working cooperatively” with their retail and foodservice customers to remove all romaine grown in the Salinas region quickly and effectively from market channels to protect public health.  And they are getting help.

“The Grower Shipper Association has retained Dr. David Acheson, former Associate Commissioner of Food for the FDA and The Acheson Group, to help us and our members identify and prioritize the next steps toward better solutions as well as work collaboratively with government health agencies and other food safety experts,” the GSA announced.

“We said that many have worked hard to improve, and this is true – we have strengthened our food safety practices which are verified through mandatory government audits and new studies are now underway to advance new science and solutions at the Center for Produce Safety,” the GSA statement said.  ” This diligent work should not be diminished but we must do more and we must do it faster.”

“To those who are suffering from this illness and their families and loved ones, we know our apologies aren’t enough, as heartfelt as they are, ” it said.  ” GSA is committed to keeping you informed about how we advance continuous improvement in food safety for romaine products because that is truly what this is about: Making both the big and small changes throughout the supply chain, from farm to fork, each and every day. And, most importantly, keeping the health of consumers in our hearts and minds with every decision we make.”

The outbreak is occurring as leafy green production in central California is transitioning to growing areas in southern California and Arizona. The romaine currently making people sick was likely harvested during September and October in the Salinas Valley, according to the California LGMA.

A foodborne illness outbreak investigation by the Maryland Department of Health was likely first to identify contaminated lettuce in salad products. The recalled salad products by Missa Bay, LLC, included products with “Use By” dates ranging from Oct.29, 2019 to Nov. 1, 2019.

Epidemiologic, laboratory, and traceback evidence collected to date all point to romaine lettuce contaminated with E. coli O157: H7 in Salinas, CA, growing region for making people sick.

Whole-genome sequencing shows the E. coli strain in romaine lettuce tested by the Maryland Department of Health is closely related genetically to the E.coli found in six people in this outbreak. The romaine lettuce came from the Salinas, CA, growing area.

The Food and Drug Administration (FDA), FSIS, and CDC are all involved in the romaine investigation along with the various state agencies.

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.