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Multi-State Outbreak of E. Coli Infections From Fresh Spinach

September 28, 2006

Among the ill persons, 97 (52%) were hospitalized, 29 (16%) developed a type of kidney failure called hemolytic-uremic syndrome (HUS), and an adult in Wisconsin died. One hundred and thirty-four people (72%) were female and eighteen (10%) were children under five years old. The proportion of persons who developed HUS was 29% in children (<18 years old), 7% in persons eighteen to fifty nine years old, and 14% in persons sixty years old or older. Among ill persons who provided the date when their illnesses began, 82% became ill between August 19 and September 5. The peak time when illnesses began was August 30 to September 1 -- 32% of persons with the outbreak strain became ill on one of those 3 days.

View the enlarged map to see the number of persons reported with the outbreak strain from each state.

Two deaths among suspect cases have been reported. Suspect cases are not known to have been infected with the outbreak strain, so are not included in the confirmed case count. Idaho is investigating a suspect case in a two-year-old child with HUS who died on September 20 and reportedly had recently consumed fresh spinach. E. coli O157 has not been detected in the child. Maryland is investigating a suspect case in an elderly woman who died on September 13 and had recently consumed fresh spinach. E. coli O157 was cultured from her stool, but “DNA fingerprinting" to determine whether it is the outbreak strain has not been possible.

E. coli O157 was isolated from nine packages of spinach supplied by patients living in seven states. All packages were marketed as baby spinach and labeled with the same brand name. The “DNA fingerprints" of all nine of these E. coli match that of the outbreak strain.

CDC Advice for Consumers

The following is advice for consumers about this outbreak:

Currently, the Food and Drug Administration (FDA) is advising consumers to not eat any fresh spinach or salad blends containing spinach grown in the three counties in California implicated in the current E. coli O157:H7 outbreak -- Monterey County, San Benito County, and Santa Clara County. Spinach grown in these counties is often packaged in other areas of the country. If consumers cannot tell where fresh spinach was grown, they are advised not to purchase or consume the fresh spinach. Frozen and canned spinach can be safely eaten.

E. coli O157:H7 in spinach can be killed by cooking at 160° Fahrenheit for 15 seconds. (Water boils at 212° Fahrenheit.) If spinach is cooked in a frying pan, and all parts do not reach 160° Fahrenheit, all bacteria may not be killed. If consumers choose to cook the spinach, they should not allow the raw spinach to contaminate other foods and food contact surfaces, and they should wash hands, utensils, and surfaces with hot, soapy water before and after handling the spinach.

Persons who develop diarrhea after consuming fresh spinach or salad blends containing fresh spinach are urged to contact their health care provider and ask that their stool specimen be tested for E. coli O157.

Persons who ate fresh spinach or salad blends and feel well do not need to see a health-care provider.

Sources for More Information

For more information about the outbreak, about the investigation, and for prevention guidance, see E. coli O157:H7 Outbreak from Fresh Spinach.

Contact CDC800-CDC-INFO
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Report a Foodborne Illness

NOTE: Check the CDC website for up to date information on the recent outbreaks
As of 1 PM (ET) September 28, 2006, Thursday, 187 persons infected with the outbreak strain of E. coli O157:H7 have been reported to CDC from 26 states.

Questions and Answers

Questions & Answers

What is Escherichia coli O157:H7?

E. coli O157:H7 is one of hundreds of strains of the bacterium Escherichia coli. Although most strains are harmless, this strain produces a powerful toxin that can cause severe illness. E. coli O157:H7 has been found in the intestines of healthy cattle, deer, goats, and sheep.

Infections in the United States have been caused mostly by eating undercooked ground beef than by any other food.

How is E. coli O157:H7 spread?

The organism can be found on most cattle farms, and it is commonly found in petting zoos and can live in the intestines of healthy cattle, deer, goats, and sheep. Meat can become contaminated during slaughter, and organisms can be accidentally mixed into meat when it is ground.

Eating meat, especially ground beef, that has not been cooked sufficiently to kill E. coli O157:H7 can cause infection. Contaminated meat looks and smells normal.

Among other known sources of infection are consumption of sprouts, lettuce, spinach, salami, unpasteurized milk and juice, and by swimming in or drinking sewage-contaminated water.

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