This post has been updated.
The Centers for Disease Control and Prevention reported Friday that 14 more people have become sickened by the E. coli outbreak involving romaine lettuce, bringing the total to 98 people from 22 states.
The latest numbers make this the biggest multistate outbreak involving E. coli since 2006, when contaminated baby spinach was the culprit.
Three more states have now reported ill people: Mississippi, Tennessee, and Wisconsin. Forty-six people out of 87 on which information is available — or 53 percent — have been hospitalized. Ten of those developed severe kidney failure, including three children.
Laboratory testing has confirmed that the strain of deadly E. coli O157:H7 bacteria causing this outbreak produces a type of toxin that tends to cause more severe illness, which may explain why there is a high hospitalization rate. No deaths have been reported, CDC said.
The search for the source of the outbreak is ongoing. The CDC and the Food and Drug Administration say the Yuma, Ariz., growing region is the source, and the FDA has identified one farm there as the source of whole-head romaine that sickened eight inmates in Alaska. Because the growing season in Yuma is at its end, that farm is not growing any more lettuce, said officials, who are still investigating about two dozen farms in the Yuma region as well as other businesses all along the national supply chains.
Lettuce contaminated with this E. coli strain was supplied to restaurants and retailers from many different processors, growers and shippers and farms, the agency said.
The whole-head lettuce from Harrison Farms was harvested from March 5-16 and is past its 21-day shelf life. Investigators have not determined where in the supply chain the contamination occurred — whether in the growing, harvesting, packaging or distribution stage — that caused those inmates' illness.
Stic Harris, director of the FDA's outbreak response and evaluation network, told reporters on Friday that investigators have not yet gone to the farm to see what else it is growing. But he added: “We're not seeing any other implicated products.”
A person answering the phone at Harrison Farms hung up twice on a Washington Post reporter after she identified herself as a member of the media. A Facebook page indicates the farms grow or have grown cotton and wheat in addition to lettuce.
The Yuma area grows most of the lettuce harvested in the United States during the winter months, but officials say that lettuce now in stores or at restaurants is probably from California's Central Valley or Salinas Valley and has not been implicated in the outbreak. No other types of lettuce or romaine grown outside the Yuma region have been implicated in the outbreak, officials said.
CDC's information for consumers and retailers remains unchanged. The agency urges not to eat any romaine lettuce unless they know it is not from the Yuma area. That includes all kinds of lettuce, whether chopped, whole head or in a salad mix. The CDC advises consumers to throw away any romaine that might be from the Yuma region even if some already has been eaten with no sign of illness. It's often hard for consumers to know where their grocery-store lettuce was produced because labels are not specific.
“When I look at a bag of lettuce and it says product of the USA, do I know it's from Yuma? No,” Harris said during Friday's media briefing. “Do I know it's from California? No. That's solved by more descriptive labeling, but in the end, that's industry's call as to how to get that implemented.”
Restaurants and retailers should not serve or sell any romaine lettuce from the Yuma region. This includes whole heads and hearts of romaine, chopped romaine, baby romaine, organic romaine, and salads and salad mixes containing romaine lettuce.
Pennsylvania has led the nation in reported cases, with 18, followed by California with 16 and Idaho with 10. The most recent case involved a person becoming sick April 20, but the CDC notes that sicknesses since April 5 may not have been reported yet to authorities.
Given the two to three week delay between someone getting sick and reporting of the case, CDC officials say they expect the number of cases to grow in the coming weeks.
E. coli is a bacterium that can be present in animal or human feces. This particular strain produces a Shiga toxin that causes severe symptoms, such as vomiting and diarrhea, and can also lead to kidney failure. During the 2006 E. coli outbreak involving baby spinach, a different strain that also produces Shiga toxin sickened 238 people, including 103 who were hospitalized and five who died.
In the current outbreak, Izabella Radovich of Wilton, Calif., was among those who got sick from eating contaminated salad. The 16-year-old from rural Sacramento had been eating salad every day the week before she got sick.
“She’s a teenager. She was trying to cut out junk food and be healthier,” her mother, Tiffany Halley, told The Washington Post. But Radovich started getting chills, fever and stomach cramps April 6. Within two days, she was doubled over in pain and having bloody stools and diarrhea.
Over the course of several days, Halley took her daughter to see a pediatrician twice, and twice rushed her to the emergency room because she was in so much pain. By April 10, the CDC had issued its first announcement about the E. coli illness outbreak. The next day, Halley went to the pediatrician’s office and remembers being told that this dangerous E. coli strain could affect her daughter’s kidneys.
The doctor said that Radovich was young and had healthy kidneys, Halley said.
“She told us, ‘her kidneys are perfect,’ ” Halley recalled. Two days later, on April 13, Radovich’s skin had turned pale and yellow, and she was no longer urinating, signs that she was suffering from a potentially life-threatening type of kidney failure known as Hemolytic Uremic Syndrome, or HUS.
They went back to the emergency room, where the hospital said Radovich was having kidney failure and sent her by ambulance to a nearby children’s hospital in Roseville. The teenager stayed in the ICU for eight days. She has had to receive all her nutrition intravenously, and has had four blood transfusions to treat severe anemia.
“They’re waiting for the toxins to leave her body completely,” Halley said. On Monday, test results from her stool samples confirmed her illness is part of the outbreak. The teenager was still in the hospital on Wednesday, and doctors said it could take three months for her blood count to rise to a normal level, Halley said.
Even after her daughter became sick, some friends and acquaintances didn’t realize how serious the illness was until they saw Radovich in the hospital.
“This has been an absolute nightmare,” said Halley, 36. “The only way I can describe it, just watching your child get sick like that, it's the most gut-wrenching feeling on Earth.”