2019 E. coli Outbreak Linked to Fresh Express Sunflower Crisp Chopped Salad Kits
Final Update
Posted on January 15, 2020 at 3:00 PM ET
This outbreak appears to be over. E. coli is an important cause of illness in the United States. Find more information about steps you can take to reduce your risk of infection on the E. coli and Food Safety web page.
CDC, public health and regulatory officials in several states and Canada, and the U.S. Food and Drug Administration investigated a multistate outbreak of E. coli O157:H7 infections linked to Fresh Express Sunflower Crisp chopped salad kits.
Contaminated Fresh Express Sunflower Crisp chopped salad kits that made people sick in this outbreak are past their shelf-life and should no longer be available. The affected salads had best-before dates up to and including December 7, 2019.
- Take action if you have symptoms of an E. coli infection:
- Talk to your healthcare provider.
- Write down what you ate in the week before you started to get sick.
- Report your illness to the health department.
- Assist public health investigators by answering questions about your illness.
- Wash your hands thoroughly after changing diapers, using the toilet, and before and after preparing food to lower the chance of infecting others.
- Follow these steps to help keep you healthy and your fruits and vegetables safer to eat:
- Wash your hands before and after preparing fruits and vegetables.
- Wash or scrub all fruits and vegetables under running water before eating, cutting, or cooking.
- Fruits and vegetables labeled “prewashed” do not need to be washed again at home.
- Use separate cutting boards for fruits and vegetables and for raw meats, poultry, seafood, or eggs.
- Use separate plates and utensils for cooked and raw foods.
- Store fruits and vegetables away from, and not next to or below, raw meat, poultry, or seafood. These items can drip juices that may have germs.
- This outbreak appears to be over as of January 15, 2020.
- Ten people infected with the outbreak strain of E. coli O157:H7 were reported from five states.
- Four people were hospitalized. One person developed hemolytic uremic syndrome, a type of kidney failure. No deaths were reported.
- The Public Health Agency of Canada identified ill people infected with the same DNA fingerprint of E. coli O157:H7 bacteria in Canada.
- Information collected during the investigation indicated that Fresh Express Sunflower Crisp chopped salad kits were the likely source of this outbreak.
- This outbreak was caused by a different strain of E. coli O157:H7 than the outbreak linked to romaine lettuce from the Salinas Valley growing region in California.
- People usually get sick from Shiga toxin-producing E. coli (STEC) 2 to 8 days (average of 3 to 4 days) after swallowing the germ.
- Some people with E. coli infections may get a type of kidney failure called hemolytic uremic syndrome (HUS).
- E. coli infection is usually diagnosed by testing a stool sample.
- Antibiotics are not recommended for patients with suspected E. coli infections until diagnostic testing can be performed and E. coli infection is ruled out. Some studies have shown that administering antibiotics to patients with E. coli infections might increase their risk of developing HUS, and a benefit of treatment with antibiotics has not been clearly demonstrated.
- For more information, see Symptoms of E. coli Infection.
January 15, 2020
CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration investigated a multistate outbreak of Shiga toxin-producing E. coli O157:H7 infections. This investigation included illnesses in Canada reported by the Public Health Agency of Canada. This outbreak was caused by a different strain of E. coli O157:H7 than the outbreak linked to romaine lettuce from the Salinas, California, growing region.
Public health investigators used the PulseNet system to identify illnesses that may have been part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on E. coli bacteria isolated from ill people by using a standardized laboratory and data analysis method called whole genome sequencing (WGS). CDC PulseNet manages a national database of these sequences that are used to identify possible outbreaks. WGS gives investigators detailed information about the bacteria causing illness. In this investigation, WGS showed that bacteria isolated from ill people in the United States and Canada were closely related genetically. This means that people in this outbreak were more likely to share a common source of infection.
A total of 10 people infected with the outbreak strain of E. coli O157:H7 were reported from five states. A list of the states and the number of cases in each can be found on the Map of Reported Cases page.
Illnesses started on dates ranging from November 5, 2019, to November 16, 2019. Ill people ranged in age from 21 to 91, with a median age of 33. Among ill people, 60% were female. Four of ten ill people were hospitalized, including one person who developed hemolytic uremic syndrome, a type of kidney failure. No deaths were reported.
WGS analysis of isolates from 10 ill people identified antibiotic resistance to chloramphenicol, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Standard antibiotic resistance testing of clinical isolates by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory is currently underway. These findings do not affect treatment guidance since antibiotics are not recommended for patients with E. coli O157 infections.
Investigation of the Outbreak
Information collected during the investigation indicated that Fresh Express Sunflower Crisp chopped salad kits were the likely source of this outbreak.
State and local public health officials interviewed ill people to determine what they ate and other exposures in the week before their illness started. Of 10 ill people with information available, all 10 (100%) reported eating any leafy greens in the week before their illness started. Eight ill people specifically reported eating or maybe eating a Fresh Express Sunflower Crisp chopped salad kit.
Romaine lettuce was one of the ingredients in the salad kit, but the investigation was not able to determine if romaine lettuce was the contaminated ingredient in the salad kit. For more information about the traceback investigation, visit the FDA website.
As of January 15, 2020, this outbreak appears to be over.
