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The U.S. Food and Drug Administration (FDA) is urging those with romaine lettuce in their home both cut or uncut to dispose of it unless the source could be confirmed. This warning comes after nearly 100 people in 22 states across the United States have become ill with E. Coli.

The illnesses have been reported between March 13, 2018, and April 20, 2018, with 96% of the 67 people interviews reported eating romaine lettuce in the week prior to the onset of the illness. The illness is linked to romaine lettuce which grew during the winter in areas in and around Yuma, Arizona, FDA officials said. There are 98 cases in 22 states: Alaska (8), Arizona (5), California (16), Colorado (2), Connecticut (2), Georgia (1), Idaho (10), Illinois (1), Louisiana (1), Michigan (3), Mississippi (1), Missouri (1), Montana (8), New Jersey (7), New York (2), Ohio (3), Pennsylvania (18), South Dakota (1), Tennessee (1), Virginia (1), Washington (5), and Wisconsin (1).

The only batches of contaminated romaine lettuce that have been pinpointed to a specific grower were from Harrison Farms in Yuma, Arizona. This is determined to be the sole source of whole-head romaine lettuce that sickened several subjects at an Alaska correctional facility. At this time the FDA is unclear where the contamination occurred and are seeking to determine if it occurred in growing, harvesting, packaging, or during the distribution chain. This particular batch was grown from March 5-16, and is past its normal 21 day shelf life. FDA officials said that the Yuma region is at the end of the growing season and no additional lettuce is growing there at this time.

Still, the remainder of the illnesses have not been linked to a grower and are not linked to Harrison Farms. The others who reported illness reported eating salad at a restaurant. “The restaurants reported using bagged, chopped romaine lettuce to make salads,” FDA officials said. “Traceback does not indicate that Harrison Farms is the source of the chopped romaine that sickened these people.” The FDA has identified dozens of other fields as “possible sources” but recommends consumers to ask grocers, restaurants, and other food service establishments where their romaine lettuce originated, and avoid any romaine lettuce, whether chopped, whole head or hearts, that originated from the Yuma growing region. Those who can not confirm where the lettuce was grown should dispose of it.

Infections in a healthy person should resolve in 5-7 days, but serious illness including hemolytic uremic syndrome can occur. Symptoms can vary from person to person, but most experience severe stomach cramping accompanied by bloody diarrhea for some. Some also report feeling very tired, decreased urination, small unexplained bruises or bleeding. Mild fevers, usually under 101 degrees can occur. Some may experience very mild symptoms, while 5-10% can experience severe or life-threatening symptoms. Those who experience the symptoms should seek emergency medical care due to the possibility of acute renal failure (kidney failure). Some also develop hypertension, chronic kidney disease, and neurologic problems.Children under the age of 5 years, adults older than 65, and people with weakened immune systems are more likely than others to develop severe illness, including HUS, but even healthy older children and young adults can become seriously ill.

Consumers should follow these simple steps:

Wash the inside walls and shelves of the refrigerator, cutting boards and countertops; then sanitize them with a solution of one tablespoon of chlorine bleach to one gallon of hot water; dry with a clean cloth or paper towel that has not been previously used.
Wash hands with warm water and soap for at least 20 seconds before and after handling food.
Wipe up spills in the refrigerator immediately and clean the refrigerator regularly.
Always wash hands with hot, soapy water following the cleaning and sanitization process.
Persons who think they might have become ill from eating potentially contaminated foods should consult their healthcare provider.

The FDA reports that they will be continuing their investigation in an attempt to pinpoint addition sources.