An ongoing outbreak of E. coli has killed one person and sickened at least 48 others in eight states, prompting the U.S. Food and Drug Administration on Thursday to advise against eating fresh, bagged spinach.
Although the investigation remains preliminary, officials suspect the virulent strain of E. coli bacteria came from pre-washed spinach, infecting people in Connecticut, Idaho, Indiana, Michigan, Oregon, New Mexico and Utah, said Dr. David Acheson, chief medical officer for the FDA’s food safety center, at an evening news conference. Wisconsin has been hit the hardest, with at least 20 cases, including the patient who died.
“It’s increasing by the day,” Acheson said of the tally of cases.
One possible case is under investigation in California, where the bulk of the nation’s spinach is grown. California health officials said they were working with federal authorities to investigate any possible sources of the outbreak in this state, a spokeswoman said.
For unknown reasons, the infections have been associated so far only with spinach that has been bagged, not unpackaged greens. That raises the possibility that contamination occurred either in fields dedicated to packaged spinach or during processing.
The FDA announcement came after Wisconsin and Oregon officials contacted the Centers for Disease Control and Prevention on Wednesday to report unexpected surges in E. coli cases. So far, the 49 cases identified share the same genetic fingerprint, suggesting a connection, officials said.
The number of cases, which primarily have affected adult women, could climb. Officials urged anyone with bloody diarrhea or diarrhea accompanied by severe cramps -- signs of E. coli infection -- to contact a doctor. When ingested, the suspected strain of E. coli, O157:H7, can produce powerful toxins and, in rare cases, trigger a serious condition that can lead to kidney failure.
Although officials recommended avoiding fresh bagged spinach altogether, boiling the greens probably would kill the E. coli.
“We are not advising people to cook product that may have E. coli,” Acheson said. “What we’re advising people is, don’t eat it.”
Acheson said the illnesses began at the end of August, but some state officials said they were investigating cases reported as recently as Thursday, which suggests the problem is not over.
Officials are not certain where the spinach involved in the outbreak came from. California, the No. 1 producer in the nation’s $200-million fresh spinach industry, supplies 74% of the country’s crop.
The announcement of the outbreak comes just weeks after federal and state officials launched a wide-ranging evaluation of growing and processing practices in the Salinas Valley, focusing on leafy greens.
That evaluation stems from eight previous outbreaks of E. coli O157:H7 nationally since 1995, all linked to lettuce and spinach grown in the area, known as the “Salad Bowl of the World.” Those outbreaks sickened at least 217 people around the nation and killed two at a retirement home in Northern California.
As a result of the latest outbreak, “I believe that consumer confidence will be shaken at least in the short term,” said Christine Bruhn, director of the Center for Consumer Research at UC Davis and a national expert on consumer attitudes toward food. “But I’m aware that the produce industry, particularly in California and throughout the nation, is working really hard to address all possible sources of contamination.”
Industry representatives Thursday encouraged consumers to heed the FDA’s advice, while acknowledging that the recommendation would probably have a significant economic impact.
“We want consumers to take the advice of the authorities, absolutely. We are working with the federal and state authorities to try to determine what the source is and exactly what we’re dealing with,” said Amy Philpott, a spokeswoman for the United Fresh Produce Assn., based in Washington, D.C.
The FDA did not identify a specific supplier, grower, brand or region of the country where the suspect spinach might have come from.
“It might be just one brand and one production date, but it might not. The evidence is ambiguous,” said William E. Keene, senior epidemiologist for the Oregon public health division, noting that most people generally don’t keep bags or receipts of the produce they buy. “The problem we’re dealing with is most of the cases cannot identify the brand and the package type clearly.”
Jeff Smith, spokesman for the Washington state Department of Health, said: “Nobody wants to point fingers yet until they know they are pointing in the right direction.”
But at least one attorney already has filed a suit related to the outbreak. Bill Marler, a lawyer specializing in foodborne illnesses, sued Dole Food Co. on Thursday on behalf of Gwyn Wellborn, 27, an escrow writer from Salem, Ore., who he said fell ill after eating a bag of Dole baby spinach.
Four days later, she was experiencing bloody diarrhea and severe cramping, said her husband, David. She spent seven days in an intensive care unit, where she had trouble breathing because of liquid in her lungs, had a blood transfusion and suffered partial kidney failure, he said. She is now recovering at home.
Dole, which issued a recall last year on suspected tainted bagged salad, could not be reached for comment late Thursday. Marler said he was preparing at least one more lawsuit against the company related to the outbreak.
Some growers say produce safety has vastly improved in the last decade and their operations are regularly inspected. At a plant recently visited by The Times in the Salinas Valley, produce was soaked, inspected and bathed in three separate baths of water, chlorine and citric acid to kill bacteria before being spun-dried and bagged by machine.
But produce need be contaminated with only a small amount of E. coli for a person to fall ill. The E. coli O157:H7 strain, which lives in the intestines of healthy cattle and is present in manure, is passed to humans when they ingest the bacteria.
How E. coli is contaminating fresh produce is a mystery to health officials. Some hypotheses include tainted dust blowing over fields, birds eating tainted cattle droppings and then contaminating fields with their own tainted droppings, contaminated floodwater, and workers carrying the bacteria on their hands or clothes.
In the 1990s, the O157:H7 strain was associated with undercooked hamburger meat served at Jack in the Box restaurants, which sickened hundreds, and unpasteurized Odwalla apple juice, which killed a baby girl and sickened more than 60 others.
In the 1996 Odwalla outbreak, sales plummeted and the company paid a $1.5-million fine after pleading guilty to 16 misdemeanor criminal charges.
Such outbreaks are difficult to trace because it can take weeks for a person to fall ill enough to go to a doctor and for the correct lab tests to be completed and forwarded to health officials.
Times staff writer Mary Engel contributed to this report.