Two deaths probed as E coli cases reach 166

Sep 22, 2006 (CIDRAP News) – Nine more cases were found in a nationwide outbreak of Escherichia coli O157:H7 infections linked to fresh spinach, raising the total to 166, and two more deaths are suspected to be part of the outbreak, the Centers for Disease Control and Prevention said today.

The outbreak has now affected people in 25 states, two more than yesterday, the CDC said. Eighty-eight people (53%) were hospitalized. Cases of hemolytic uremic syndrome (HUS), a serious complication of the illness, remain at 27. One death was previously confirmed to be linked to the outbreak.

State health officials in Maryland and Idaho are awaiting test results to determine if two patients who died from known or suspected E coli infections this week have the same strain implicated in the outbreak.

A sample from a Maryland woman and some of the spinach she ate before she got sick are being tested at a Maryland state lab, and results may not be known for several days, Washington County Health Department spokesman Rod MacRae told the Associated Press (AP) today.

The CDC said the woman died Sep 13 and had recently consumed fresh spinach. E coli O157:H7 was cultured from her stool, but DNA fingerprinting to determine if it is the outbreak strain has not been possible, the agency said.

"This is a very suspicious association at this point, there's no question about it," MacRae said. He said the woman was a Washington County resident in her 80s.

A 2-year-old Idaho boy with HUS died Sep 20, but E coli O157:H7 has not been detected in his samples, the CDC said. Christine Hahn, MD, an epidemiologist at the Idaho Department of Health, told the AP that the boy had bloody diarrhea and that family members said he had eaten packaged spinach.

"We know that if he had that kidney disease, it makes it very probable that he had E coli," Hahn said. She added that test results would likely be available next week.

The CDC said today that 31% of children under 18 in the outbreak suffered HUS. For adults aged 18 to 59, the HUS rate was 7%, and for those 60 and older the rate was 16%.

Teams from the Food and Drugs Administration (FDA) and the state of California have narrowed their investigation of the outbreak to nine farms in California's greater Salinas Valley area, on the basis of information from spinach bags found in the homes of some patients and records from three companies that recalled fresh spinach products.

Once investigators pinpoint the cause of the outbreak, federal officials will evaluate what went wrong, David Acheson, MD, chief medical officer for the FDA's Center for Food Safety and Applied Nutrition, said at a news conference yesterday. Officials will first determine if food safety rules were followed properly, he said. If spinach contamination occurred despite good compliance by farmers and producers, the FDA will consider issuing additional mandates, Acheson said.

An article in the Los Angeles Times said today that regulatory oversight for fresh produce isn't as rigorous as it is for beef, poultry, and seafood. Safety guidelines for the handling of fresh produce are voluntary, and the number of inspections of processing facilities has been declining for years, the article said.

Michael Doyle, director of the University of Georgia's Center for Food Safety, told the Washington Post, "I liken this to Jack in the Box all over again." He referred to a 1993 E coli outbreak linked to the chain's hamburgers, which sickened 700 people and killed four children. The outbreak prompted the US Department of Agriculture (USDA) to issue tougher processing standards.

Food growers have held meetings this week on how to strengthen their food safety processes. After a meeting yesterday between regulators and 200 industry members, Tom Nassif, president and chief executive officer of the Western Growers Association, told reporters that regulators said investigation findings and new industry-produced food safety guidelines are needed before the FDA will lift its warning against eating raw spinach. Nassif was quoted in the Monterey County (Calif.) Herald.

At an FDA press briefing yesterday, Acheson said one possibility would be labeling spinach with the place of origin.

The FDA issued its fresh spinach alert on Sep 14 after the CDC announced that 50 patients in eight states had been diagnosed with E coli infections and that fresh or raw spinach was the food most of them had in common.