New York State Laboratory Links Lettuce to Nationwide E. coli Outbreak

State, County Disease Detectives Track Source

ALBANY, N.Y. (May 13, 2010) – State and county public health epidemiologists, also known as disease detectives, along with the New York State Health Department's (DOH) Wadsworth Center laboratory played pivotal roles in the identification of lettuce as the source of an outbreak of Escherichia coli bacteria (E. coli O145) that has sickened at least 19 people in Michigan, Ohio and New York over the past month.

Public health experts at DOH and the Dutchess and Erie county health departments worked to pinpoint the source of the outbreak by tracking down patients and finding out what they had eaten and where they had dined before becoming ill. To date, four confirmed and three probable cases of E. coli related to the outbreak have been identified in New York State.

Food samples were then submitted to DOH's Wadsworth laboratory, which identified lettuce as the culprit. DOH quickly reported its findings to the federal Centers for Disease Control and Prevention (CDC) and the U.S. Food and Drug Administration (FDA).

"It's important to recognize the scientists and public health experts in our State who work behind the scenes on disease outbreaks to stop and prevent further illness," said State Health Commissioner Richard F. Daines, M.D. "These are exceptional professionals in their fields dedicated to protecting the public's health."

Through questioning patients in the outbreak, it became apparent that many of the sickened people had eaten romaine lettuce before becoming ill. At the same time, environmental health staff examined patterns of food processing, production and distribution of suspect products. The state-county team effort that included environmental health, communicable disease control, and laboratory staff, New York State produced multiple lines of evidence implicating shredded romaine lettuce from one processing facility as a source of infection in the nationwide outbreak.

Commenting on the role of the Dutchess County Department of Health in the investigation, County Health Commissioner Michael C. Caldwell, M.D., M.P.H, said: "Thanks to the work of our department's interdisciplinary CORe team (Coordinated Outbreak Response), Dutchess County was instrumental in solving this outbreak investigation by identifying the sample that was tested by the State laboratory. This resulted in the prevention of further illness in New York State and across the country."

The Erie County Department of Health also played a role in the outbreak response. County Health Commissioner Anthony J. Billittier IV, M.D., said: "I am extremely proud of my staff's quick detective work that rapidly identified lettuce as commonly eaten by many of our suspect cases. This early finding helped lead to the confirmation of lettuce as the contaminated food. Fortunately, we have had no new cases since April thanks to these collaborative public health efforts."

On May 5, the DOH Wadsworth Center laboratory in Albany identified the E. coli O145 pathogen in an unopened bag of Freshway Foods shredded romaine lettuce. Further DNA testing at Wadsworth confirmed the lettuce was directly linked to people who became sick in New York, Ohio and Michigan. The discovery led to a voluntary nationwide recall issued on May 6 by the Ohio-based lettuce processing company.

Wadsworth Links E. coli to Romaine Lettuce:

  • On April 28, a delivery of approximately 150 pounds of shredded romaine lettuce arrived at the Wadsworth Center laboratory.
  • Staff used an in-house test developed to optimize isolation of E. coli contamination.
  • The testing identified E. coli O145 from an unopened package of shredded romaine lettuce obtained from a school associated with the outbreak.
  • The laboratory identified the responsible bacteria as Shiga toxin-producing E. coli, or STEC, which has been associated with human illness, including bloody diarrhea and hemolytic-uremic syndrome (HUS), a potentially fatal kidney condition.

The E. coli bacterium causes diarrhea that is often bloody and accompanied by abdominal cramps. Fever is absent or mild. Symptoms usually appear about three days after exposure but may occur from one to nine days. Most people recover without treatment in five to 10 days.

Not all diarrheal illness is caused by E. coli. However, a health care provider should be consulted immediately if diarrhea is present in children, has lasted more than a day or two in adults, or is bloody. HUS can begin as the diarrhea is improving and can occur in people of any age but is most common in children under 5 years and the elderly.

DOH's investigative team for the outbreak was led by:

  • Kimberly Noyes, M.D., Director of the Bureau of Communicable Disease Control; with staff members Alexandra Newman, D.V.M.; Bryan Cherry, D.V.M., Ph.D.; Bryon Backenson, Jackie Kellachan, Madhu Anand, Nicole Spencer, Paula Pennell, Christine Barr, Christina Hidalgo, and Rohit Garg;
  • Lawrence Sturman, M.D., Ph.D., Director of the Wadsworth Center; and staff members Kim Musser, Ph.D; Nellie Dumas, Diana Bopp, Tim Root, Tanya Halse; and,
  • Michael Cambridge, Director of the Bureau of Community Environmental Health and Food Protection; and staff members Barbara Gerzonich, David Nicholas, Darby Greco, Jessica Egan, Brian Devine, Seth Schild, Ralph Van Houten and Jeff Booth.

Additional information about E. coli can be found on the DOH Web site at www.nyhealth.gov or on the CDC Web site at www.cdc.gov .