State and federal officials are investigating a new multistate outbreak of  E. coli O157:H7 infections. The outbreak is associated with Fresh Express brand chopped salad kits. People in Canada are also sick.

“Do not eat or sell Fresh Express Sunflower Crisp Chopped Salad Kits with this identifying information: UPC 0 71279 30906 4, beginning with lot code Z, and a best-before date up to and including 07DEC19.

To view larger photo, please click on image.Courtesy of the CDC

“This information is printed on the front of the bag in the top right corner,” the U.S. Centers for Disease Control and Prevention warned in a notice posted this evening.

Officials say this is a new outbreak, separate from an ongoing E. coli O157:H7 outbreak traced to romaine lettuce from the Salinas, CA, region. That outbreak has sickened at least 102 people in the U.S. and two in Canada and involves a different strain of E. coli bacteria.

Romaine lettuce is an ingredient in the implicated Fresh Express salad kits, but investigators have not yet determined what ingredient or ingredients in the salad kits could be contaminated, according to the CDC.

In Canada the salad kits were recalled on Sunday, Dec. 8.

The U.S. Food and Drug Administration posted a notice after the CDC revealed the outbreak and reported the romaine could be the problem.

“Preliminary information indicates that the romaine lettuce in the salad kits eaten by some sick people may have contained romaine from the Salinas growing region, though the romaine and other ingredients in the kit may have come from another growing region as well,” according to the FDA outbreak investigation notice.

As of today, Dec. 9, a total of eight people have been confirmed infected with the new outbreak strain of E. coli O157:H7. They have been reported from three states. Illnesses started on dates ranging from Nov. 5 to Nov. 15. As of Dec. 8, Canadian officials report 16 people confirmed sick in their country. Patients in Canada became sick between Nov. 5 and 22.

In the United States, ill people range in age from 21 to 91, with a median age of 32. Among ill people, 63 percent  are female. Three of the eight ill people have been hospitalized, including one person who developed hemolytic uremic syndrome (HUS), a type of kidney failure. No deaths have been reported.

Information collected to date indicates that Fresh Express Sunflower Crisp chopped salad kits are a likely source of this outbreak.

State and local public health officials are interviewing ill people to determine what they ate and other exposures in the week before their illness started. Of seven ill people with information available, all seven reported eating leafy greens in the week before their illness started. Six ill people reported eating or maybe eating a Fresh Express Sunflower Crisp chopped salad kit.

The investigation is ongoing to determine which ingredient in the salad was contaminated.

Preliminary information indicates that romaine lettuce in the salad kits eaten by some of the sick people likely came from the Salinas growing region. The CDC is concerned that these kits may still be in some homes. Anyone with any of these salad kits in their homes are urged to throw them away.

About E. coli infections
Anyone who has eaten any of the implicated product 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.

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