Public Health Notice – United States outbreak of E. coli infections linked to romaine lettuce with implications for Canadians
January 15, 2020 - Final update
This notice has been updated to advise that the outbreak appears to be over and the outbreak investigation has been closed.
United States (U.S.) health officials have confirmed that contaminated romaine lettuce that made people sick in this outbreak from the Salinas, California growing region in the U.S. is no longer available for sale.
As a result of this new information, the Public Health Agency of Canada is no longer advising that people avoid eating, selling, or serving romaine lettuce harvested from the Salinas, California growing region in the U.S.
On this page
- Why you should take note
- Investigation summary
- How does lettuce become contaminated with E. coli
- Who is most at risk
- What you should do to protect your health
- Symptoms
- What the Government of Canada is doing
- Epidemiological information
- Additional information
- Media contact
- Public inquiries
- Investigation history
Why should you take note
The Public Health Agency of Canada collaborated with federal and provincial partners, the United States Centers for Disease Control and Prevention (U.S. CDC), and U.S health officials to investigate an outbreak of Escherichia coli O157, commonly called E. coli, that was linked to romaine lettuce coming from the Salinas, California growing region in the United States (U.S.). E. coli can cause a serious, life-threatening illness.
The majority of illnesses were reported in the U.S., but the Public Health Agency of Canada identified four Canadian illnesses with a similar genetic fingerprint to illnesses reported in the U.S. investigation. As a result, a Canadian outbreak investigation was initiated to further investigate the four illnesses reported in Canada.
U.S. health officials have confirmed that contaminated romaine lettuce that made people sick in this outbreak from the Salinas, California growing region is no longer available for sale. Romaine lettuce that is now in stores and restaurants comes from other growing regions.
As a result of this new information, the Public Health Agency of Canada is no longer advising that people avoid eating, selling, or serving romaine lettuce harvested from the Salinas, California growing region in the U.S.
Retailers and industry partners continue to bring romaine lettuce into the Canadian market from growing regions not associated with the outbreak.
As part of this outbreak investigation, the Canadian Food Inspection Agency (CFIA) implemented actions at the border on November 22, 2019, to ensure that any affected romaine lettuce products from Salinas, California were no longer being imported into Canada. These measures were taken to protect consumers and remain in effect at this time.
This was the fourth E. coli outbreak linked to romaine lettuce affecting Canadian consumers in the last two years. The Government of Canada, along with provincial and territorial governments and regional public health units, remains vigilant in its efforts to monitor for any new E. coli illnesses linked to romaine lettuce. If future risks are identified, the Public Health Agency of Canada and its partners will take the necessary steps to notify Canadians of any increased risk to their health and to provide updated advice on how to prevent illness.
Investigation summary
In total, there were four illnesses related to the U.S. outbreak that were identified in Canada: Alberta (1), Manitoba (1), New Brunswick (1), and Ontario (1). These individuals were ill in mid-October and mid-December2019. One individual was hospitalized. No deaths were reported.
Laboratory analysis indicates that the illnesses reported in Canada are genetically related to illnesses reported in the U.S. and to previous E. coli outbreaks that occurred in 2017 and 2018 and were linked to romaine lettuce. This suggests that there may be a reoccurring source of contamination. Canadian and U.S. health officials are collaborating to identify commonalities between the recent illnesses in an effort to identify the source of contamination affecting consumers.
How does lettuce become contaminated with E. coli
E. coli are bacteria that live naturally in the intestines of cattle, poultry and other animals. A common source of E. coli illness is raw fruits and vegetables that have come in contact with feces from infected animals. Leafy greens, such as lettuce, can become contaminated in the field by soil, water, animals or improperly composted manure. Lettuce can also be contaminated by bacteria during and after harvest from handling, storing and transporting the produce. Contamination in lettuce is also possible at the grocery store, in the refrigerator, or from counters and cutting boards through cross-contamination with harmful bacteria from raw meat, poultry or seafood. Most E. coli strains are harmless to humans, but some varieties cause illness.
Who is most at risk
E. coli O157 is more likely than other E. coli strains to cause severe illness. Pregnant women, those with weakened immune systems, young children and older adults are most at risk for developing serious complications.
Most people who become ill from an E. coli infection will recover completely on their own. However, some people may have a more serious illness that requires hospital care, or long-lasting health effects. In rare cases, some individuals may develop life-threatening symptoms, including stroke, kidney failure and seizures, which could result in death. It is possible for some people to be infected with the bacteria and to not get sick or show any symptoms, but to still be able to spread the infection to others.
What should you do to protect your health
The Public Health Agency of Canada has removed its advisory against romaine lettuce harvested from the Salinas, California growing region.
The Public Health Agency of Canada reminds people to properly wash and sanitize drawers or shelves in refrigerators where romaine lettuce from Salinas, California may have been previously stored.
Romaine lettuce can be a carrier of E. coli bacteria that can make people sick. For consumers of romaine lettuce, there is no way to fully eliminate the risk of an E. coli infection, but following safe food handling practices for leafy greens on a daily basis is the best way to avoid getting sick.
Symptoms
People infected with E. coli can have a wide range of symptoms. Some do not get sick at all, though they can still spread the infection to others. Others may feel as though they have a bad case of upset stomach. In some cases, individuals become seriously ill and must be hospitalized.
The following symptoms can appear within one to ten days after contact with the bacteria:
- nausea
- vomiting
- headache
- mild fever
- severe stomach cramps
- watery or bloody diarrhea
Most symptoms end within five to ten days. There is no real treatment for E. coli infections, other than monitoring the illness, providing comfort, and preventing dehydration through proper hydration and nutrition. People who develop complications may need further treatment, such as dialysis for kidney failure. You should contact your health care provider if symptoms persist.
What is the Government of Canada doing
The Government of Canada is committed to food safety. The Public Health Agency of Canada leads the human health investigation into an outbreak, and is in regular contact with its federal, provincial and territorial partners to monitor the situation and to collaborate on steps to address an outbreak.
Health Canada provides food-related health risk assessments to determine whether the presence of a certain substance or microorganism poses a health risk to consumers.
The Canadian Food Inspection Agency conducts food safety investigations into the possible food source of an outbreak.
The Government of Canada will continue to update Canadians as new information related to this investigation becomes available.
Epidemiological information
Figure 1 below is an epidemiological curve for this outbreak. Outbreak investigators use this information to show when illnesses begin, when they peak, and when they trail off. It can take several weeks from the time a person becomes ill to when the illness is reported and testing confirms a link to the outbreak. Data are available for four cases.
Figure 1: Number of people infected with E. coli O157:H7
Text description
| Week of symptom onset or specimen collection | Number of cases |
|---|---|
| 2019-10-13 | 1 |
| 2019-11-03 | 1 |
| 2019-12-08 | 1 |
| 2019-12-15 | 1 |
Additional information
- U.S CDC Frequently Asked Questions
- U.S. FDA investigation
- U.S. FSIS salad product recall
- CFIA measures to protect consumers
- CFIA food safety warning
- Leafy Greens
- E. coli
- Produce Safety
- General Food Safety Tips
Media contact
Public Health Agency of Canada
Media Relations
613-957-2983
Public inquiries
Call toll-free: 1-866-225-0709
Email: info@hc-sc.gc.ca
Investigation history
Public Health Notice Update - December 6, 2019
Since November 22, 2019, the Public Health Agency of Canada (PHAC) has identified one additional E. coli illness in Canada with a similar genetic fingerprint to illnesses reported in the ongoing United States (U.S.) E. coli outbreak linked to romaine lettuce harvested in Salinas, California.
PHAC has engaged federal and provincial public health partners and continues to work with U.S. health officials to determine the source of contamination affecting consumers.
Consumers are still advised to not eat, and retailers and food service establishments to not sell or serve, any romaine lettuce harvested from the Salinas, California growing region in the U.S. Romaine lettuce harvested in Canada is not affected by this advice.
Why should you take note
The Public Health Agency of Canada is collaborating with federal and provincial partners, the United States Centers for Disease Control and Prevention (U.S. CDC), and U.S health officials to investigate an outbreak of Escherichia coli O157, commonly called E. coli, that is linked to romaine lettuce coming from the Salinas, California growing region in the United States (U.S.). E. coli can cause a serious, life-threatening illness.
The majority of illnesses have been reported in the U.S., but the Public Health Agency of Canada has identified a second Canadian illness with a similar genetic fingerprint to illnesses reported in the U.S. investigation. As a result, a Canadian outbreak investigation has been initiated to further investigate the two illnesses reported in Canada.
The Canadian Food Inspection Agency (CFIA) previously confirmed that romaine lettuce from the affected areas reported in the U.S. investigation was imported to Canada up until November 22, 2019. The CFIA has taken measures to protect consumers and has implemented new actions at the border to ensure that any affected romaine lettuce products from Salinas, California are no longer being imported into Canada.
The Public Health Agency of Canada continues to advise consumers to not eat, and retailers and food service establishments to not sell or serve, any romaine lettuce harvested from the Salinas, California growing region in the U.S. Romaine lettuce harvested in Canada is not affected by this advice.
This is the fourth E. coli outbreak linked to romaine lettuce affecting Canadian consumers in the last two years. The Government of Canada, along with provincial and territorial governments and regional public health units, remains vigilant in its efforts to monitor for any new E. coli illnesses linked to romaine lettuce. If future risks are identified, the Public Health Agency of Canada and its partners will take the necessary steps to notify Canadians of any increased risk to their health and to provide updated advice on how to prevent illness.
Investigation summary
As of December 6, 2019, there are two illnesses related to the U.S. outbreak that have been identified in Canada: Manitoba (1) and Alberta (1). These individuals became ill in mid-October and early November 2019. One individual was hospitalized. No deaths have been reported.
The U.S. CDC continues to report multiple illnesses occurring in several U.S. states. Laboratory analysis indicates that the illnesses reported in Canada are genetically related to illnesses reported in the U.S. and to previous E. coli outbreaks that occurred in 2017 and 2018 and were linked to romaine lettuce. This suggests that there may be a reoccurring source of contamination. Canadian and U.S. health officials are collaborating to identify commonalities between the recent illnesses in an effort to identify the source of contamination affecting consumers.
It is possible that more recent illnesses may be reported in the Canadian outbreak because there is a period of time between when a person becomes ill and when the illness is reported to public health officials. For this outbreak, the illness reporting period is between 4 and 5 weeks.
What should you do to protect your health
Canadian consumers are advised not to eat, and retailers and food service establishments not to sell or serve, any romaine lettuce harvested from the Salinas, California growing region in the U.S. Romaine lettuce harvested in Canada is not affected by this advice.
Consumers are asked to check their homes for all types of romaine lettuce such as whole heads of romaine, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad.
- If you have romaine lettuce at home:
- Look for a label showing where the romaine lettuce was grown. It may be printed on the package or on a sticker.
- If the packaging shows that it is from the Salinas, California growing region in the U.S., don't eat it. Throw it away.
- If it isn't labeled with a growing region, don't eat it. Throw it away.
- If you don't know whether the lettuce is romaine or whether a salad mix, sandwich or wrap contains romaine, don't eat it. Throw it away.
- Wash and sanitize drawers or shelves in refrigerators where romaine lettuce was stored.
- If you buy romaine lettuce at a store:
- Look for a label showing where the romaine lettuce was grown. It may be printed on the package or on a sticker.
- If the packaging shows that it is from the Salinas, California growing region in the U.S., don't buy it.
- If it is an unpackaged product, or is not labelled, ask the retailer whether the romaine lettuce comes from the Salinas, California growing region in the U.S.
- If you can't confirm that the romaine lettuce in stores is not from the Salinas, California growing region in the U.S., don't buy it.
- If you order salad or any other food item containing romaine lettuce at a restaurant or at a salad bar, ask the staff whether the romaine lettuce came from Salinas. If it did, or they do not know, do not eat it.
- Restaurants and retailers should check the label on bags or boxes of romaine lettuce, or ask their suppliers about the source of their romaine lettuce.
- Suppliers, distributors and others in the supply chain should not ship or sell romaine harvested in the Salinas, California growing region in the U.S.
Public Health Notice - November 22, 2019
Why should you take note
The United States Centers for Disease Control and Prevention (U.S. CDC), the United States Food and Drug Administration (U.S. FDA), and the United States Food Safety and Inspection Service (U.S. FSIS) are investigating an outbreak of Escherichia coli O157, commonly called E. coli, that is linked to romaine lettuce coming from the Salinas, California growing region in the United States (U.S.). E. coli can cause a serious, life-threatening illness.
Although an outbreak is not occurring in Canada, the Public Health Agency of Canada (PHAC) has identified one Canadian illness with a similar genetic fingerprint to illnesses reported in the U.S. investigation.
The Canadian Food Inspection Agency (CFIA) has confirmed that romaine lettuce from the affected areas reported in the U.S. investigation is imported to Canada at this time of year. The CFIA has taken measures to protect consumers and is implementing new actions at the border to ensure that any affected romaine lettuce products are no longer being imported into Canada.
As a result of the U.S. outbreak investigation and its link to product on the Canadian market, the Public Health Agency of Canada is advising Canadians to follow the U.S. CDC's public health advice, which advises consumers to not eat, and retailers and food service establishments to not sell or serve, any romaine lettuce harvested from the Salinas, California growing region in the U.S. Romaine lettuce harvested in Canada is not affected by this advice.
This is the fourth E. coli outbreak linked to romaine lettuce affecting Canadian consumers in the last two years. The Government of Canada, along with provincial and territorial governments and regional public health units, remains vigilant in its efforts to monitor for any new E. coli illnesses linked to romaine lettuce. If future risks are identified, the Public Health Agency of Canada and its partners will take the necessary steps to notify Canadians of any increased risk to their health and to provide updated advice on how to prevent illness.
Investigation summary
At this time, there is no outbreak of E. coli occurring in Canada. The U.S. CDC is reporting multiple illnesses in several U.S. states. As of November 22, 2019, there is one Canadian illness related to the U.S. outbreak that has been identified in the province of Manitoba. This individual became ill in mid-October.
Laboratory analysis indicates that the illness reported in Canada is also genetically related to illnesses reported in previous E. coli outbreaks that occurred in 2017 and 2018 and were linked to romaine lettuce. This suggests that there may be a reoccurring source of contamination. Canadian and U.S. health officials are collaborating to identify commonalities between the recent illnesses in an effort to identify the source of contamination affecting consumers.
Page details
- Date modified: