FDA Announces New Outbreak. Could There Be E. coli In Spinach Again?

Image by Shingo_No from Pixabay

Could we see another outbreak of E. coli in spinach this year?

The U.S. Food and Drug Administration (FDA) announced a new E. coli outbreak this week. While many FDA investigated outbreaks are never linked back to a specific food source, many have been linked to leafy greens like spinach.

Here’s what we know.

New E. coli Outbreak

The FDA announced a new E. coli outbreak on August 28, 2024.

There are 25 associated cases so far!

Not much is known about the recently published outbreak, as the agency is in the traceback portion of the investigation.

How Are Outbreaks identified?

Foodborne outbreaks sometimes take time to identify. When people sick enough to seek medical treatment have diagnostic tests performed, certain test results are reported to federal agencies to monitor for illness outbreaks.

In the case of diagnostic tests positive for commonly associated foodborne illness, these results are often forwarded to a specific group within the FDA. This group monitors the database for clusters of illnesses that could be part of a larger outbreak.

An outbreak occurs when two or more people are sick with the same food from the same location. In some cases, however, the outbreak is identified by test results rather than patient food surveys. In fact, many outbreaks are identified by the genetic makeup of the bug that made them sick.

Most of the time, the genetic information for the germ is uploaded into a database that scans for genetically similar pathogens. When a cluster of genetically similar pathogens is identified, an investigation is initiated.

E. coli in Spinach and Other Leafy Greens

Previous multi-state E. coli outbreaks have been linked to other foods. Walnuts, raw cheddar cheese, frozen felafel, and cake mix have all been associated with FDA investigated multi-state E. coli outbreaks over the past five years.

Additionally, many other multi-state E. coli outbreaks never had a source identified. In fact, 10 outbreaks involving 139 illnesses were never associated with a specific food source.

Historically though, there is a huge correlation between E. coli in spinach and other leafy greens.

In 2022 an E. coli outbreak associated with romaine lettuce was responsible for sickening at least four people.

Packaged salads were associated with another E. coli outbreak in 2021 that sickened 10 people, of which four were serious enough to require hospitalization.

Leafy greens were also implicated in the 2020 multi-state E. coli outbreak that sickened at least 40 people. Half of which required hospitalization. Four people experienced hemolytic uremic syndrome complications.

But one outbreak linked to spinach in 2021 may be related.

2021 Outbreak of E. coli in Spinach May Be Related

In mid-November 2021 E. coli cases began trickling in. All in all, at least 15 people were sickened with the same strain of E. coli. Four were hospitalized. These patients reported feeling sick between October 15 through October 27, 2021.

The true number of cases was likely larger. Many people with mild illness never seek medical treatment and therefore are never tested for E. coli.

Outbreak Patients Spanned Multiple States

Patients from ten different states across the country reported illnesses with the same outbreak strain.

California – 1 reported illness
Iowa – 1 reported illness
Indiana – 4 reported illnesses
Michigan – 1 reported illness
Minnesota – 2 reported illnesses
Missouri – 1 reported illness
Nebraska – 1 reported illness
Ohio – 1 reported illness
Pennsylvania – 1 reported illness
South Dakota – 2 reported illnesses

Single cases in a state, when so many states are involved in the outbreak, is a good indicator that other illnesses were likely unreported.

Potential Source Identified – Josie’s Organics Brand Baby Spinach

The outbreak investigation began in Minnesota. During the course of the outbreak investigation, the Minnesota Department of Agriculture tested samples of products in a patient’s home.

A sample of Josie’s Organics Baby Spinach tested positive for the same E. coli O157:H7 strain found in outbreak patients.

The product had a “Best if Used By” date of October 23, 2021.

Potential Farms Identified

Using supply chain data, the product was traced back to a small number of farms located in two different geographical regions. The FDA deployed resources to those three farms located in California and Oregon.

Investigators Hit a Dead End

The FDA conducted inspections and collected samples at all three locations. However, the growing season had passed, and all fields were fallow at the time.

All samples were negative for E. coli bacteria.

The investigation hit a dead end.

Could Earlier Detection Help Traceback Efforts?

If this new E. coli outbreak is, in fact, related to the 2021 outbreak of E. coli in spinach, could this earlier detection help traceback efforts?

Absolutely!

Illnesses were reported in August, as opposed to October, so farms are likely still producing. Active processing activities provide more opportunities for sampling that could help investigators determine the source of the outbreak.

E. coli infections cause serious illness with sometimes life-threatening or fatal consequences. The faster a source is identified, the quicker product can be removed from the market, the fewer people exposed to the harmful pathogen.

E. coli Symptoms

E. coli bacteria cause intestinal symptoms. These usually include diarrhea (often bloody) and abdominal cramps. Most of the time little or no fever is present. In some cases, an infected individual may experience no symptoms at all. Generally, the illness resolves in five to ten days and a normally healthy individual may recover without the need for medical intervention.

However, this is not always the case.

Certain higher risk groups are more likely to become infected with E. coli bacteria if exposed and experience more serious symptoms if infected. This includes those under five years of age and the elderly. These individuals are more likely to experience a serious and life-threatening complication known as HUS.

Hemolytic Uremic Syndrome and E. coli

Most cases of hemolytic uremic syndrome in the U.S. are caused by E. coli infections.

During infection, sometimes the bacteria leave the digestive system and enter other parts of the body through the bloodstream. When in the blood stream, E. coli destroys red blood cells, which clog the filtering tubes in the kidneys. About 2% to 7% of all E. coli infections lead to this hemolytic uremic syndrome complication.

This complication is the principal cause of acute kidney failure in children.

About a third of those with hemolytic uremic syndrome have abnormal kidney functions for many years later. Some may require long-term dialysis.

Another 8% of those who develop hemolytic uremic syndrome will experience other life-long complications such as high blood pressure, blindness, seizures, paralysis, and the effects of having part of their bowel removed.