CDC and FDA – Romaine Silent

Come on now!

2411MOEXH-2

Closeout Abstract

Closeout Date: January 15, 2025

CDC Main Contact: Angelo Lodato

Classification: Outbreak

Car: Romaine Lettuce

Car Standing: Confirmed

Publicity Sort: Multistate

Hi there Colleagues,

On November 25, 2024, PulseNet coded an outbreak of E. coli O157:H7 2411MOEXH-2. On the time of closing, this investigation included 89 instances throughout 15 states: AR (2), CO (1), IL (7), IN (8), KS (1), KY (1), MO (50), MT (1), ND (2), NE (3), OH (8), PA (1), SD (1), TN (1), WI (2), all associated inside 0-4 alleles by cgMLST. Isolation dates ranged from November 7, 2024, to December 1, 2024. Reported onset dates (n=83) ranged from November 4, 2024, to November 30, 2024. Ages ranged from 4 to 90 years with a median age of 24. Sixty of 88 instances (68%) have been feminine. Consequence data was out there for 74 instances, of which 36 (49%) have been hospitalized. There have been 7 reported instances of HUS, and 1 demise attributed to this outbreak.

A case on this investigation was outlined as an infection with E. coli O157:H7 with an isolate associated to the outbreak pressure inside 0-4 alleles by cgMLST and isolation date starting from November 7 to December 1, 2024.

This outbreak was associated to 6 historic investigations: 2302MLEXH-1, 2210MLEXH-3, 2210MLEXH-2, 2209MLEXH-1, 2112MLEXH-1, and 2106CAEXH-1. The one automobile recognized was for 2112MLEXH-1, which was closed with a confirmed automobile of natural energy greens. The NCBI tree for this pressure included quite a few nonclinical beef isolates.

This outbreak was coded following notification from colleagues in MO after they recognized and investigated a number of sickness linked to occasions catered by the identical MO-based caterer. These occasions occurred between November 6 and November 8. All occasions included the identical menu objects with just a few modifications. MO colleagues carried out a retrospective cohort examine at 2 of the occasions and located that salads have been the one statistically vital menu merchandise throughout each occasions. Salads contained an iceberg/romaine lettuce mix, carrots, purple cabbage, onions, canned pimento, canned artichokes, parmesan cheese, and a home made salad dressing.

In whole, 7 subclusters have been recognized throughout the multistate outbreak. These included 3 MO catered occasions, an OH secondary faculty, an IN restaurant, and IL restaurant, and an IL occasion catered by a different MO-based caterer. Salads have been the frequent hyperlink throughout all 7 subclusters, and instances in all subclusters ate an iceberg/romaine lettuce mix. CDC deployed a targeted questionnaire on November 26, 2024; 27 questionnaires have been returned. Epi data was out there for 65 instances, of which 60 (95%) reported consuming any sort of leafy inexperienced previous to sickness. Of 57 instances who may keep in mind the precise sort of leafy inexperienced consumed, 50 (88%) consumed romaine lettuce. That is statistically considerably greater than the background fee of 49% from the FoodNet Inhabitants survey. 

A traceback investigation was initiated in response to an E. coli O157 outbreak with leafy greens because the suspected automobile. Every case included within the traceback investigation reported consumption of leafy greens previous to sickness onset. Primarily based on data out there on the factors of service (POS), the traceback targeted on iceberg and romaine lettuce. The investigation consisted of three traceback legs representing twenty-eight instances and 5 POS. The three traceback legs recognized 4 distribution facilities, one dealer, two processors, one grower, and one ranch. The traceback investigation decided {that a} sole processer sourced romaine lettuce from a single grower that might have been out there in any respect factors of service through the timeframe of curiosity. Moreover, romaine lettuce provided to 4 of the 5 POS was traced again to a standard ranch and lot. By way of evaluation of information, 4 lot of romaine lettuce have been implicated, leading to affirmation of romaine lettuce because the automobile. 

Epidemiologic and traceback information supported the conclusion that romaine lettuce was the supply of diseases on this outbreak. CDC closed this investigation on January 15, 2025, following the elapsing of the surveillance reporting lag interval and lack of latest uploads. CDC closed this investigation as an outbreak with a confirmed automobile of romaine lettuce. This outbreak will probably be reported to NORS with NORS ID: 511856.

Thanks all on your assist with this investigation!

Here’s what I’ve been in a position to get from the CDC and FDA up to now:

https://www.marlerblog.com/recordsdata/2025/04/2411MOEXH-2-Romaine-CO-DPHE-Information.pdf

https://www.marlerblog.com/recordsdata/2025/04/2411MOEXH-2-Romaine-E.-coli-FDA-Information.pdf