The Centers for Disease Control came out Tuesday with a warning for everyone in the United States: Do not eat any romaine lettuce.
CDC officials are investigating the cause of an E. coli outbreak that has infected 32 people in 11 states. They were infected from October 8, 2018 through October 31, 2018. So far, there have been no cases in Washington State.
Thirteen people were hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported, according to the CDC. People in this outbreak were infected with the same type of E. coli strain that made people sick in a 2017 outbreak linked to leafy greens.
In a message posted to the CDC's website, the agency said, "CDC is advising that U.S. consumers not eat any romaine lettuce, and retailers and restaurants not serve or sell any, until we learn more about the outbreak."
The CDC also said consumers who have any type of romaine lettuce in their home should not eat it and should throw it away. The agency said even if you have already eaten some of the lettuce in your home and have not gotten sick, you should still throw it away.
The warning includes all types of romaine lettuce and any salad mix that contains romaine lettuce.
Consumers who have any type of romaine lettuce in their home should not eat it and should throw it away, even if some of it was eaten and no one has gotten sick.
Click here for more information on E. coli and symptoms.
All brands and types of romaine lettuce
No one distributor or source has been identified, so the FDA is warning consumers to avoid all types and brands of romaine lettuce, Gottlieb said. Consumers should not eat any romaine lettuce product, including "whole heads of romaine, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, such as spring mix and Caesar salad.
Retailers and restaurants also should not serve or sell any until more is known about the outbreak.
Illnesses in the current outbreak started in October, and it is not related to another multistate outbreak linked to romaine lettuce this summer.
A similar outbreak caused by contaminated romaine lettuce occurred in December, Gottlieb said, and affected the United States and Canada. "The strain in 2017 is the same as the strain in this fall 2018 outbreak, and the time of year is exactly the same. So It's likely associated with end of season harvest in California," he said.
What's different this year is that the FDA has higher confidence that it's romaine lettuce in both countries. "This year, we're a month earlier, so we're earlier in the process, earlier in the throes of an outbreak," Gottlieb said. "So we're able to actually get real-time information and conduct effective trace back and isolate what the source is."
Symptoms of E. coli infection, which usually begin about three or four days after consuming the bacteria, can include watery or bloody diarrhea, fever, abdominal cramps, nausea and vomiting, according to the CDC. Most people infected by the bacteria get better within five to seven days, though this particular strain of E. coli tends to cause more severe illness.
People of all ages are at risk of becoming infected with Shiga toxin-producing E. coli, according to the US Food and Drug Administration, which is also investigating the outbreak. Children under 5, adults older than 65 and people with weakened immune systems, such as people with chronic diseases, are more likely to develop severe illness, but even healthy children and adults can become seriously ill.
"That's why we think it's critical to get this information out," Gottlieb said. "We understand fully the impact this has, not just on the growers and the distributors but also on consumers -- consumers who are preparing meals for the holidays, who have product now that they're going to need to discard, maybe food that they've already cooked."
How does the US prevent foodborne illness?
Foodborne illness hits one in six Americans every year, the CDC says, estimating that 48 million people get sick due to one or another of 31 pathogens. About 128,000 people end up in the hospital and 3,000 die annually.
Preventing foodborne illness in the United States is the job of the US Department of Agriculture's Food Safety and Inspection Service, which oversees the meat, poultry and processed egg supply, and the FDA, responsible for domestic and imported foods.
With frequent news of outbreaks, which are investigated by the CDC, many people might wonder whether foodborne illness is on the rise -- and whether safety measures across the nation adequately protect our food supply.
As of Tuesday, the CDC has investigated 21 multistate foodborne illness outbreaks this year, more than any year in the past decade.
"I think that the issue isn't that there's more unsafe food," Gottlieb said. "I think what's happening is that we have better technology than ever before to link outbreaks of human illness to a common pathogen."
In all 50 states, the CDC has the capacity to do genomic testing on samples from infected patients (such as blood samples). It also can genetically link the identified pathogens in human illness to actual food sources.
What is lagging is the ability to do track and trace to a single distributor or grower "because we don't have as good a technology as we would like in our supply chain," Gottlieb said.
Another recent development in protecting the US food supply is the Food Safety Modernization Act, which became law in 2011. Gottlieb said the act represents a "paradigm shift," as it is based on prevention instead of reaction.
"I think food is more safe now than it's ever been. We have much more resources and additional tools to do effective surveillance."