By David Brown
Washington Post Staff Writer
Friday, September 15, 2006
The Food and Drug Administration yesterday warned American consumers not to eat commercially bagged fresh spinach because it may be the source of a worsening outbreak of foodborne illness that so far has caused one death.
In the past week, nine states have reported a total of 50 cases of severe diarrhea caused by Escherichia coli 0157:H7. Eight of the cases have led to a severe complication that causes kidney failure.
Interviews with victims, who have ranged from children to the elderly, point to washed and bagged spinach as a common source, said David Acheson of the FDA's Center for Food Safety and Applied Nutrition. No farm, brand, distributor or retail store has been identified as associated with the presumably contaminated product.
"Based on what we know, we advise consumers that they not eat bagged fresh spinach at this time," Acheson told reporters during a telephone news conference last night.
The FDA learned of the outbreak from epidemiologists at the Centers for Disease Control and Prevention on Wednesday, he said. The first person became ill on Aug. 23, he said.
E. coli causes about 75,000 cases of diarrhea (often severe and bloody) annually in the United States, with about 50 deaths, said Christopher Braden, an epidemiologist at the CDC's National Center for Infectious Diseases.
The fatal case during this outbreak occurred in Wisconsin. Neither the age nor sex of the victim was available.
Although not the largest, this outbreak is worrisome because it is unusually widespread and the number of cases is still growing.
"We can't say how large it is at this point," Braden said. "But we are getting reports rapidly from many different states indicating that it is ongoing. We're concerned that contaminated product could still be in the market place."
It takes about a week for a suspected case to be confirmed by the collection of fecal samples and genetic analysis of the E. coli bacterium, if it is found. There are reports of many other unconfirmed cases.
"I think we will see quite a few more cases. And I think we will see them from other states," Braden said.
Wisconsin, with 20 cases, has reported more than any other state. The other states and case numbers: Utah, 11; Oregon, five; Idaho, three; Indiana, four; Michigan, three; New Mexico, two; Connecticut, one; and Washington state, one.
The E. coli infection is most often associated with ground beef, although it has been caused by dozens of other kinds of food.
The bacterium is carried in the intestine of cattle, and meat can become contaminated with feces during slaughter. Crops such as spinach could conceivably be contaminated by liquid fertilizer sprayed on fields.
"Where cattle manure goes, E. coli 0157:H7 may go," Acheson said.
Although most infected people recover, a few develop a severe complication called hemolytic uremic syndrome. It causes anemia, low platelet count and kidney failure.
While this complication is most often seen in children, this outbreak is unusual in that many of the eight cases of hemolytic uremic syndrome recorded have been in adults, Braden said.
The genetic fingerprint of the bacteria is identical in all cases in this outbreak. But that does not necessarily mean the contamination is from the same source, he said.
The outbreak was identified quickly because of a network called PulseNet, in which state health department labs deposit the results of their genetic fingerprinting in a database housed at the CDC.