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Are outbreaks involving fresh produce, including romaine lettuce, on the rise?

The CDC and other public health institutions are investigating another Escherichia coli outbreak linked to leafy greens, this time Fresh Express Sunflower Crisp chopped salad kits.

As of Dec. 9, the outbreak included eight cases in three states, including three hospitalizations and no deaths.

According to the CDC, the Fresh Express salad kits implicated in the outbreak contain romaine lettuce, although it is unclear if the outbreak is related to another ongoing E. coli outbreak linked to romaine lettuce from a growing region in California.

Why do there seem to be so many outbreaks linked to produce these days? Laura Whitlock, communications lead for foodborne outbreaks at the CDC, called the question “complicated.”

“Foodborne outbreaks from contaminated fresh produce have been increasingly recognized in many parts of the world in recent years,” Whitlock told Healio. “This reflects a convergence of increasing consumption of fresh produce, changes in production and distribution, and a growing ability to detect the problem on the part of public health officials.”

Kirk Smith, DVM, PhD , MS, manager of the Foodborne, Vectorborne, Waterborne, and Zoonotic Diseases Unit at the Minnesota Department of Health, suggested that outbreaks are not necessarily on the rise, but that media coverage has increased awareness of them.

“Honestly, leafy greens and E. coli 0157 have been a problem going back at least to the mid-1990s,” he told Healio. “There are leafy green/E. coli 0157 outbreaks virtually every year, and usually a few to several. We really aren’t seeing more in the past 2 or 3 years than we used to. I think they are probably just getting more attention.”

Recent outbreaks

There have been several notable foodborne outbreaks linked to produce in the past two years.

An outbreak in November and December 2017 that was linked to contaminated leafy greens sickened 25 people and hospitalized nine, including two individuals who developed hemolytic uremic syndrome (HUS). One person died. Patients lived in both the United States and Canada.

A 2018 outbreak lasting about 4 months, from March to June, sickened 210 people from 36 states. The CDC reported 96 hospitalizations, including 27 individuals who developed HUS, and five deaths. There was no recall, but the infections were linked to romaine lettuce from the Yuma growing region in Arizona.