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

    December 14, 2017

    Update

    This notice is being updated to include additional provinces, Ontario and Nova Scotia, which have reported illnesses linked to this outbreak. Since the original notice was issued, there are nine additional cases of E. coli that have been added to the outbreak investigation. There are now a total of 30 cases of E. coli O157 under investigation. One individual has died.

    Why should you take note?

    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 provinces and is linked to romaine lettuce. At this time, there are no product recalls associated with this outbreak. The outbreak investigation is ongoing, and this public health notice will be updated on a regular basis as the investigation evolves.

    The risk to Canadians is low. However, Canadians are reminded to follow safe food handling practices for lettuce to avoid becoming ill. Most people with an E. coli infection will become ill for a few days and then recover fully. Some E. coli infections can be life threatening, though this is rare.

    How does lettuce become contaminated with E. coli?

    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.

    Investigation summary

    Currently, there are 30 cases of E. coli O157 illness under investigation in five provinces: Ontario, (6), Quebec (5), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13). Individuals became sick in November and December 2017. Twelve individuals have been hospitalized. One individual has died. Individuals who became ill are between the ages of 4 and 80 years of age. The majority of cases (70%) are female.

    Many individuals who became sick reported eating romaine lettuce before their illnesses occurred. The Canadian Food Inspection Agency is working with public health officials to determine the source of the romaine lettuce that ill individuals were exposed to.

    Who is most at risk?

    Although anyone can get an E. coli infection, pregnant women, those with weakened immune systems, young children and older adults are most at risk for developing serious complications.

    What should you do to protect your health?

    The following food safety tips for lettuce will help you reduce your risk of getting an E. coli infection.

    - 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 and cutting boards 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.

    What is the Government of Canada doing?

    The Government of Canada is committed to food safety. The Public Health Agency of Canada leads the human health investigation into an outbreak and is in regular contact with its federal and provincial partners to monitor the situation and to collaborate on steps to address the outbreak.

    Health Canada undertakes food-related health risk assessments to determine whether the presence of a certain substance or microorganism poses a health risk to consumers.

    The Canadian Food Inspection Agency conducts food safety investigations into the possible food source of an outbreak.

    Public Health Agency of Canada

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