Romaine on Wendy’s sandwiches linked to an outbreak of E. multistate coli

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Wendy’s is removing romaine lettuce from its sandwiches in some of its restaurants because it has been linked to a multi-state outbreak of E. coli infections.

The CDC reported this afternoon that 37 people are now confirmed to be sick, up from 29 on Tuesday this week. Patients live in Michigan, Ohio, Pennsylvania and Indiana.

Of 26 people interviewed so far by public health investigators, 22 said they had eaten sandwiches from different Wendy’s restaurants in the week before falling ill.

The restaurant chain uses a different type of romaine lettuce for salads. The Food and Drug Administration reports that the romaine lettuce used on Wendy’s burgers is a hybrid of romaine and iceberg lettuce that is smaller than regular romaine heads.

The restaurants where sick people have eaten are known to be in Michigan, Ohio and Pennsylvania. The sick person in Indiana has not yet been interviewed by investigators, according to the Centers for Disease Control and Prevention.

At least 10 of the sick people had to be hospitalized. As of this afternoon, three of them in Michigan have been confirmed with a type of kidney failure called hemolytic-uremic syndrome (HUS), according to the CDC. No deaths have been reported.

“Investigators are working to confirm if romaine lettuce is the source of this outbreak and if romaine lettuce used in Wendy’s sandwiches was served or sold at other businesses. Wendy’s is cooperating fully with the investigation,” according to the CDC.

The number of infected patients and their states of residence are Indiana with 1, Michigan with 15, Ohio with 19 and Pennsylvania with 2. The illnesses began on dates ranging from July 26 to August 8.

Patients range in age from 6 to 91, with a median age of 21, and 62% are male. The life-threatening complication of HUS usually attacks children due to their underdeveloped immune system.

“At this time, there is no evidence that romaine lettuce sold in grocery stores, served in other restaurants, or in people’s homes is linked to this outbreak,” according to the CDC.

The Ohio Department of Health said Thursday that patients in the state have been reported in Wood, Lucas, Mahoning, Clermont, Cuyahoga, Franklin, Lorain and Summit counties. The department reported that four people in Ohio have been hospitalized in connection with the outbreak. So far, Wood County has reported 20 illnesses.

Michigan officials reported earlier this week that the Michigan Department of Health and Human Services, Michigan Department of Agriculture and Rural Development and three local health departments — Kent, Ottawa and Oakland — are investigating a recent increase in the number of illnesses linked to E. coli bacteria. So far, the state health department reports 98 illnesses for the month of August.

State disease reports may lag numbers reported by the CDC due to the time required for testing, follow-up testing, and the reporting process from local to state and then to federal authorities.

Seattle food safety attorney Bill Marler said he’s not surprised a leafy green was involved in the outbreak. He is disappointed that we “continue to see what are essentially regular intervals of outbreaks linked to leafy greens”.

“This underscores that the FDA and the leafy greens industry need to address the underlying problem, which is environmental contamination,” Marler said. “I suspect we’ll find a cow nearby.”

About E. coli Infections
Anyone who has developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are needed to diagnose infections, which can mimic other illnesses.

Symptoms of E. coli infections vary from person to person, but often include severe stomach cramps and diarrhea, often bloody. Some patients may also have a fever. Most patients recover in five to seven days. Others may develop serious or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

About 5-10% of people diagnosed with E. coli infections develop a life-threatening complication of kidney failure known as hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruising or bleeding, and paleness.

Many people with HUS recover within weeks, but some suffer permanent injuries or die. This condition can occur in people of any age, but is more common in children under the age of five due to their immature immune system, older people due to deteriorating immune system, and people whose immune system is weakened, like cancer patients.

People with symptoms of HUS should seek emergency medical attention immediately. People with HUS will likely be hospitalized because the disease can cause other serious and persistent problems such as high blood pressure, chronic kidney disease, brain damage, and neurological problems.

The table below shows a sample of outbreaks of E. coli associated with lettuce and leafy greens in recent years. The information is based on data collected by the Center for Science in the Public Interest, Kansas State University, and the Centers for Disease Control and Prevention:

Date Vehicle Etiology Confirmed
Case
States/Provinces
July 1995 Lettuce (leafy green; red; romaine) E.coli O157:H7 74 MT
September 1995 Romaine lettuce) E.coli O157:H7 20 IDENTIFIER
September 1995 Lettuce (iceberg) E.coli O157:H7 30 ME
october 1995 Lettuce (iceberg; unconfirmed) E.coli O157:H7 11 OH
May-June 1996 Lettuce (mesclun; red leaf) E.coli O157:H7 61 CT, IL, NY
May 1998 salad E.coli O157:H7 2 California
Feb.-March. 1999 Lettuce (iceberg) E.coli O157:H7 72 NOT
october 1999 salad E.coli O157:H7 92 OR, PA, OH
october 2000 Salad E.coli O157:H7 6 IN
Nov 2001 Salad E.coli O157:H7 20 TX
July-August 2002 Romaine lettuce) E.coli O157:H7 29 WA, ID
November 2002 Salad E.coli O157:H7 13 He
Dec. 2002 Salad E.coli O157:H7 3 MN
Oct. 2003-May 2004 Lettuce (mixed salad) E.coli O157:H7 57 California
Apr. 2004 Spinach E.coli O157:H7 16 California
November 2004 Salad E.coli O157:H7 6 New Jersey
September 2005 Romaine lettuce) E.coli O157:H7 32 MN, WI, OR
September 2006 Spinach (baby) E.coli O157:H7 and other serotypes 205 Multistate and Canada
Nov./Dec. 2006 Salad E.coli O157:H7 71 NY, NJ, PA, DE
Nov./Dec. 2006 Salad E.coli O157:H7 81 IA, MN, WI
July 2007 Salad E.coli O157:H7 26 AL
May 2008 Roman E.coli O157:H7 9 Washington
october 2008 Salad E.coli O157:H7 59 Multistate and Canada
Nov 2008 Salad E.coli O157:H7 130 Canada
September 2009 Lettuce: Romaine or Iceberg E.coli O157:H7 29 Multistate
September 2009 Salad E.coli O157:H7 ten Multistate
April 2010 Roman E.coli O145 33 MI, NY, OH, PA, TN
October 2011 Roman E.coli O157:H7 60 Multistate
April 2012 Roman E.coli O157:H7 28 CA, Canada
June 2012 Roman E.coli O157:H7 52 Multistate
September 2012 Roman E.coli O157:H7 9 Pennsylvania
October 2012 Mix of spinach and spring E.coli O157:H7 33 Multistate
Apr. 2013 Leafy greens E.coli O157:H7 14 Multistate
August 2013 Leafy greens E.coli O157:H7 15 Pennsylvania
October 2013 Ready-to-eat salads E.coli O157:H7 33 Multistate
Apr. 2014 Roman E.coli O126 4 MN
Apr. 2015 Leafy greens E.coli O145 seven MD, SC, VA
June 2016 Mesclun Mix E.coli O157:H7 11 IT, MI, WI
Nov 2017 Leafy greens E.coli O157:H7 67 Multistate and Canada
March 2018 Roman E.coli O157:H7 219 Multistate and Canada
October 2018 Roman E.coli O157:H7 62 Multistate and Canada
Nov 2019 Roman E.coli O157:H7 167 Multistate
Dec. 2020 Leafy greens E.coli O157:H7 40 Multistate
Jan 2021 baby spinach E.coli O157:H7 15 Multistate
March 2022 Wrapped salad E.coli O157:H7 ten Multistate

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