Romaine lettuce was the source of more than half of the 40 Shiga toxin-producing E. coli  (STEC) outbreaks linked to leafy greens between 2009 and 2018, according to a new report from the Centers for Disease Control and Prevention (CDC). Shiga toxins are poisons that are produced by some strains of E. coli which cause severe illness in humans. The 40 outbreaks caused 1,212 illnesses, 420 hospitalizations, 77 cases of hemolytic uremic syndrome (HUS), a form of kidney failure; and eight deaths.


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Leafy greens are the second most common source of STEC outbreaks in the U.S. (Ground beef leads the list.) Most of the outbreaks occurred during the fall (45 percent) and the spring (28 percent). The study’s authors concluded that more research is needed about the seasonality of leafy green outbreaks.

They also noted that the leafy greens industry needs to improve the traceability of these products as gaps in this area have repeatedly hamstrung epidemiologic and traceback investigations.

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STEC live in the intestines of ruminant animals, primarily cattle. These bacteria are shed in feces and can contaminate leafy greens through runoff into irrigation water, dust blowing onto crops from neighboring ranches or direct contact.

About 98 percent of all leafy greens grown in the U.S. are grown in California and Arizona. Investigations of recent outbreaks have identified neighboring cattle operations as a possible source of contamination.

The study’s authors noted that some changes were implemented by California and Arizona growers after the study period. But for those who have seen the ravages of these illnesses, the bottom line is clear. “The producers and suppliers of romaine lettuce and other produce need to get their act together and start tracking where their products come from and where they end up. Until they do, we’ll continue to get products contaminated with fecal matter, and we’ll see plenty more E. coli outbreaks in the future,” said noted Food Safety Attorney Fred Pritzker.

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