Public Health Notice: Outbreak of E. coli infections linked to Fresh Express brand Sunflower Crisp Chopped Salad Kits

January 16, 2020 – Final update

This notice has been updated to advise that the outbreak appears to be over and the outbreak investigation has been closed.

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Why you should take note

The Public Health Agency of Canada (PHAC) collaborated with provincial public health partners, the Canadian Food Inspection Agency (CFIA), Health Canada, the United States Centers for Disease Prevention and Control (U.S. CDC), and the United States Food and Drug Administration (U.S. FDA) to investigate an outbreak of E. coli infections occurring across seven provinces. The outbreak appears to be over, and the investigation has been closed.

Based on the investigation findings, exposure to Fresh Express brand Sunflower Crisp Chopped Salad Kits was identified as a likely source of the outbreak. Many of the individuals who were sick reported having eaten Fresh Express brand Sunflower Crisp Chopped Salad Kits before their illnesses occurred.

On December 8, 2019, the CFIA issued a food recall warning for certain Fresh Express brand Sunflower Crisp Chopped Kits. The recalled salad kit packages were sold in Saskatchewan, Manitoba, Nunavut, Ontario, Quebec, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland Labrador, and may have been distributed in other provinces and territories. For more information on the recalled product, please consult the CFIA's website.

Contaminated Fresh Express brand Sunflower Crisp Chopped Salad Kits that made people sick in this outbreak are past their shelf-life and should no longer be available. As a result, the Public Health Agency of Canada is no longer advising that Canadians avoid eating, selling or serving Fresh Express brand Sunflower Crisp Chopped Salad Kits sold in 315g packages, UPC 0 71279 30906 4, beginning with lot code Z, and best before date up to and including 07DEC19.

Investigation summary

In total, there were 28 cases of E. coli O157 illness linked to this outbreak in seven provinces: Manitoba (3), Ontario (11), Quebec (4), New Brunswick (4), Nova Scotia (4), Prince Edward Island (1), and Newfoundland and Labrador (1). Individuals were sick between November 5 and December 10, 2019. Eight individuals were hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure. No deaths were reported. Individuals who became ill were between 2 and 85 years of age. The majority of cases (68%) were female.

The collaborative outbreak investigation was initiated because of an increase in reports of E. coli O157 illnesses in Canada.

The U.S. CDC was also investigating an outbreak of E. coli O157 illnesses that have a similar genetic fingerprint to illnesses reported in this outbreak. The U.S. also identified Fresh Express Sunflower Crisp Chopped Salad Kits as a likely source of their outbreak and issued advice to American consumers, retailers, and restaurants.

The Canadian and U.S. investigations are ongoing to identify the cause of the contamination in the chopped salad kits. Romaine lettuce is one of the ingredients in the salad kit, but more information is needed to determine if it was the contaminated ingredient in the salad kits. The E. coli strain identified in this outbreak is different from the E. coli strain identified in the illnesses linked to romaine lettuce from Salinas, California.

Who is most at risk

E. coli O157 is more likely to cause severe illness than other strains of E. coli. 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 causes long-lasting health effects. In rare cases, some individuals may develop life-threatening complications, 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 you should do to protect your health

The Public Health Agency of Canada reminds people to properly wash and sanitize drawers or shelves in refrigerators where Fresh Express brand Sunflower Crisp Chopped Salad Kits may have been previously stored.

Salad kits can be a carrier of E. coli bacteria that can make people sick. For consumers of salad kits, 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:

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 the Government of Canada is 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 28 cases.

Figure 1: Number of people infected with E. coli O157:H7
Figure 1
Figure 1 - Text Description
Table 1 - Number of people infected with E. coli O157:H7 by week of illness onset or specimen collection
Week of symptom onset or specimen collection Number of cases
2019-11-03 6
2019-11-10 12
2019-11-17 8
2019-11-24 0
2019-12-01 1
2019-12-08 1
2019-12-15 0

Additional information

Media contact

Public Health Agency of Canada
Media Relations
613-957-2983
hc.media.sc@canada.ca

Public inquiries

Call toll-free: 1-866-225-0709
Email: info@hc-sc.gc.ca

Investigation history

Public Health Notice Update - December 18, 2019

This notice has been updated to include one additional illness reported in Canada. This illness has been reported in the province of Manitoba. There are now 25 E. coli illnesses reported across seven provinces in the ongoing outbreak.
In addition, the Canadian Food Inspection Agency's food recall warning issued on December 8, 2019 was updated on December 12, 2019 to include additional distribution information. This additional information was identified during the ongoing food safety investigation.

Why you should take note

The Public Health Agency of Canada (PHAC) is collaborating with provincial public health partners, the Canadian Food Inspection Agency (CFIA), Health Canada, the United States Centers for Disease Prevention and Control (U.S. CDC), and the United States Food and Drug Administration (U.S. FDA) to investigate an outbreak of E. coli infections occurring across seven provinces. The outbreak appears to be ongoing, as recent illnesses continue to be reported to PHAC.

Based on the investigation findings to date, exposure to Fresh Express brand Sunflower Crisp Chopped Salad Kits has been identified as a likely source of the outbreak. Many of the individuals who became sick reported having eaten Fresh Express brand Sunflower Crisp Chopped Salad Kits before their illnesses occurred. The investigation is ongoing, and it is possible that additional sources could be identified.

Canadians are advised not to eat any Fresh Express brand Sunflower Crisp Chopped Salad Kits sold in 315g packages, UPC 0 71279 30906 4, beginning with lot code Z, and best before date up to and including 07DEC19. Retailers and food service establishments are advised not to sell or serve these products, or any items that may have been prepared or produced using these products.

On December 8, 2019, the CFIA issued a food recall warning for certain Fresh Express brand Sunflower Crisp Chopped Kit packages. The food recall warning was updated on December 12, 2019 to include additional distribution information. The recalled salad kit packages were sold in Saskatchewan, Manitoba, Nunavut, Ontario, Quebec, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland Labrador, and may have been distributed in other provinces and territories.

For more information on the recalled product, please consult the CFIA's website.

The CFIA is continuing its food safety investigation, which may lead to the recall of other products. If additional products are recalled, the CFIA will notify the public through updated food recall warnings.

This public health notice will be updated as the investigation evolves.

Investigation summary

As of December 18, 2019, there are 25 cases of E. coli O157 illness linked to this outbreak in the following provinces: Manitoba (1), Ontario (11), Quebec (3), New Brunswick (4), Nova Scotia (4), Prince Edward Island (1), and Newfoundland and Labrador (1). Individuals became sick between November 5 and November 23, 2019. Seven individuals have been hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported. Individuals who became ill are between 3 and 73 years of age. The majority of cases (68%) are female.

The collaborative outbreak investigation was initiated because of an increase in reports of E. coli O157 illnesses in Canada.

It is possible that more recent illnesses may be reported in the outbreak because of the period 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 three and four weeks.

The U.S. CDC is also investigating an outbreak of E. coli O157 illnesses that have a similar genetic fingerprint to illnesses reported in this outbreak. The U.S. has also identified Fresh Express Sunflower Crisp Chopped Salad Kits as a likely source of their outbreak and issued advice to American consumers, retailers, and restaurants.

The Canadian and U.S. investigations are ongoing to determine which ingredient in the chopped salad kit may have been contaminated. Romaine lettuce is one of the ingredients in the salad kit, but more information is needed to determine if this outbreak is related to a current outbreak linked to romaine lettuce from the Salinas, California growing region.  The E. coli strain identified in this outbreak is different from the E. coli strain identified in the illnesses linked to romaine lettuce from Salinas, California.

Public Health Notice Update - December 11, 2019

This notice has been updated to include eight additional illnesses reported in Canada. One of these illnesses has been reported in the province of Prince Edward Island. There are now 24 E. coli illnesses reported across six eastern provinces in the ongoing outbreak.

The United States Centers for Disease Prevention and Control (U.S. CDC) is also investigating illnesses that are genetically related to the illnesses in Canada. Health and food safety partners in Canada and the U.S. are working together on this collaborative investigation.

Why you should take note

The Public Health Agency of Canada (PHAC) is collaborating with provincial public health partners, the Canadian Food Inspection Agency (CFIA), Health Canada, the United States Centers for Disease Prevention and Control (U.S. CDC), and the United States Food and Drug Administration (U.S. FDA) to investigate an outbreak of E. coli infections occurring across six eastern provinces. The outbreak appears to be ongoing, as recent illnesses continue to be reported to PHAC.

Based on the investigation findings to date, exposure to Fresh Express brand Sunflower Crisp Chopped Salad Kits has been identified as a likely source of the outbreak. Many of the individuals who became sick reported having eaten Fresh Express brand Sunflower Crisp Chopped Salad Kits before their illnesses occurred. The investigation is ongoing, and it is possible that additional sources could be identified.

Canadians are advised not to eat any Fresh Express brand Sunflower Crisp Chopped Salad Kits sold in 315g packages, UPC 0 71279 30906 4, beginning with lot code Z, and best before date up to and including 07DEC19. Retailers and food service establishments are advised not to sell or serve these products, or any items that may have been prepared or produced using these products.

On December 8, 2019, the CFIA issued a food recall warning for certain Fresh Express brand Sunflower Crisp Chopped Kit packages. These packages were sold in Saskatchewan, Manitoba, Nunavut, Ontario, Quebec, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland Labrador, and may have been distributed in other provinces and territories. For more information on the recalled product, please consult the CFIA's website.

The CFIA is continuing its food safety investigation, which may lead to the recall of other products. If additional products are recalled, the CFIA will notify the public through updated food recall warnings.

This public health notice will be updated as the investigation evolves.

Investigation summary

As of December 11, 2019, there are 24 cases of E. coli O157 illness linked to this outbreak in the following provinces: Ontario (11), Quebec (3), New Brunswick (4), Nova Scotia (4), Prince Edward Island (1), and Newfoundland and Labrador (1). Individuals became sick between November 5 and November 23, 2019. Six individuals have been hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported. Individuals who became ill are between 3 and 73 years of age. The majority of cases (67%) are female.

The collaborative outbreak investigation was initiated because of an increase in reports of E. coli O157 illnesses in Canada.

It is possible that more recent illnesses may be reported in the outbreak because of the period 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 three and four weeks.

The U.S. CDC is also investigating an outbreak of E. coli O157 illnesses that have a similar genetic fingerprint to illnesses reported in this outbreak. The U.S. has also identified Fresh Express Sunflower Crisp Chopped Salad Kits as a likely source of their outbreak and issued advice to American consumers, retailers, and restaurants.

The Canadian and U.S. investigations are ongoing to determine which ingredient in the chopped salad kit may have been contaminated. Romaine lettuce is one of the ingredients in the salad kit, but more information is needed to determine if this outbreak is related to a current outbreak linked to romaine lettuce from the Salinas, California growing region. The E. coli strain identified in this outbreak is different from the E. coli strain identified in the illnesses linked to romaine lettuce from Salinas, California.

Public Health Notice – December 8, 2019

Why you should take note

The Public Health Agency of Canada (PHAC) is collaborating with provincial public health partners, the Canadian Food Inspection Agency (CFIA) and Health Canada to investigate an outbreak of E. coli infections occurring across five eastern provinces. The outbreak appears to be ongoing, as recent illnesses continue to be reported to PHAC.

Based on the investigation findings to date, exposure to Fresh Express brand Sunflower Crisp Chopped Salad Kits has been identified as a likely source of the outbreak. Many of the individuals who became sick reported having eaten Fresh Express brand Sunflower Crisp Chopped Salad Kits before their illnesses occurred. The investigation is ongoing, and it is possible that additional sources could be identified.

On December 8, 2019, the CFIA issued a food recall warning for Fresh Express brand Sunflower Crisp Chopped Kit, 315g packages, UPC Code: 0 71279 30906 4, beginning with lot code Z. These products have a best before date up to and including 07DE19 and were sold in Ontario, Quebec, New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador.

For more information on the recalled product, please consult the CFIA's website.

Canadians are advised not to eat the recalled product or any Fresh Express brand Sunflower Crisp Chopped Salad Kits sold in 315g packages, UPC 0 71279 30906 4, beginning with lot code Z, and best before date up to and including 07DEC19. Retailers and food service establishments are advised not to sell or serve these products, or any items that may have been prepared or produced using these products.

The CFIA is continuing its food safety investigation, which may lead to the recall of other products. If additional products are recalled, the CFIA will notify the public through updated food recall warnings.

This public health notice will be updated as the investigation evolves.

Investigation summary

As of December 8, 2019, there are 16 confirmed cases of E. coli O157 illness linked to this outbreak in the following provinces: Ontario (10), Quebec (1), New Brunswick (3), Nova Scotia (1), and Newfoundland and Labrador (1). Individuals became sick between November 5 and November 22, 2019. Four individuals have been hospitalized. No deaths have been reported. Individuals who became ill are between 11 and 73 years of age. The majority of cases (62%) are female.

The collaborative outbreak investigation was initiated because of an increase in reports of E. coli O157 illnesses.

It is possible that more recent illnesses may be reported in the outbreak because of the period 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 three and four weeks.

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