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Public Health Notice – Outbreak of E. coli infections linked to romaine lettuce

There are now a total of 40 cases of E. coli O157 under investigation. There appears to be an ongoing risk of E. coli infections associated with the consumption of romaine lettuce. Individuals in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador are advised to consider consuming other types of lettuce, instead of romaine lettuce, until more is known about the outbreak and the cause of contamination.

The Public Health Agency of Canada is collaborating with provincial public health partners, the Canadian Food Inspection Agency and Health Canada to investigate an outbreak of Escherichia coli O157, commonly called E. coli. The outbreak involves five eastern provinces. Based on the investigation findings to date, exposure to romaine lettuce has been identified as the source of the outbreak, but the cause of contamination has not been identified. The outbreak appears to be ongoing, as illnesses linked to romaine lettuce continue to be reported to the Public Health Agency of Canada. These illnesses indicate that contaminated romaine lettuce may still be on the market (including in restaurants, grocery stores and any establishments that serve food). At this time, the investigation evidence suggests that there continues to be a risk of E. coli infections associated with the consumption of romaine lettuce.

Because of the ongoing risk in eastern Canada, the Public Health Agency of Canada is advising individuals in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador to consider consuming other types of lettuce, instead of romaine lettuce, until more is known about the outbreak and the cause of contamination.

The outbreak investigation is continuing, and this public health notice will be updated on a regular basis as the investigation evolves.

E. coli are bacteria that live naturally in the intestines of cattle, poultry and other animals. A common source of E. coli illness is raw fruits and vegetables that have come in contact with feces from infected animals. Leafy greens, such as lettuce, can become contaminated in the field by soil, contaminated water, animals or improperly composted manure. Lettuce can also be contaminated by bacteria during and after harvest from handling, storing and transporting the produce. Contamination in lettuce is also possible at the grocery store, in the refrigerator, or from counters and cutting boards through cross-contamination with harmful bacteria from raw meat, poultry or seafood. Most E. coli strains are harmless to humans, but some varieties cause illness.

It is difficult to know whether a product is contaminated with E. coli because you can’t see, smell or taste it. Romaine lettuce can have a shelf life of up to five weeks; therefore it is possible that contaminated romaine lettuce purchased over the past few weeks may still be in your home. Individuals in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador should consider consuming other types of lettuce, instead of romaine lettuce, until more is known about the outbreak and the cause of contamination.

If you do choose to eat romaine lettuce, the following food handling tips can help to reduce the risk of an E.coli infection, but they will not fully eliminate the risk of illness.

  • Wash your hands thoroughly with warm water and soap for at least 20 seconds, before and after handling lettuce.
  • Unwashed lettuce, including whole heads of lettuce sold in sealed bags, should be handled and washed using these steps:
    • Discard outer leaves of fresh lettuce.
    • Wash unpackaged lettuce under fresh, cool running water. There is no need to use anything other than water to wash lettuce. Washing it gently with water is as effective as using produce cleansers.
    • Keep rinsing your lettuce until all of the dirt has been washed away.
    • Don’t soak lettuce in a sink full of water. It can become contaminated by bacteria in the sink.
    • Store lettuce in the refrigerator for up to seven days. Discard when leaves become wilted or brown.
    • Use warm water and soap to thoroughly wash all utensils, countertops, cutting boards and storage containers before and after handling lettuce to avoid cross-contamination.
  • Ready-to-eat lettuce products sold in sealed packages and labelled as washed, pre-washed or triple washed do not need to be washed again. These products should also be refrigerated and used before the expiration date.

What are the symptoms?

People infected with E. coli can have a wide range of symptoms. Some do not get sick at all, though they can still spread the infection to others. Others may feel as though they have a bad case of upset stomach. In some cases, individuals become seriously ill and must be hospitalized.

The following symptoms can appear within one to ten days after contact with the bacteria:

  • nausea
  • vomiting
  • headache
  • mild fever
  • severe stomach cramps
  • watery or bloody diarrhea

Most symptoms end within five to ten days. While most people recover completely on their own, some people may have a more serious illness that requires hospital care, or may lead to long-lasting health effects. In rare cases, some individuals may develop life-threatening symptoms, including stroke, kidney failure and seizures, which could result in death.

There is no real treatment for E. coli infections, other than monitoring the illness, providing comfort, and preventing dehydration through proper hydration and nutrition. People who develop complications may need further treatment, like dialysis for kidney failure. You should contact your health care provider if symptoms persist.

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Source: Media Release

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