2021 E. coli Outbreak Linked to Packaged Salads – Investigation Details
CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) investigated a multistate outbreak of E. coli O157:H7 infections.
Epidemiologic and traceback data showed that Simple Truth Organic brand and Nature’s Basket brand Organic Power Greens made people sick.
As of March 3, 2022, this outbreak is over.
Epidemiologic and Traceback Data
A total of 10 people infected with the outbreak strain of E. coli O157:H7 were reported from four states (see map). The true number of sick people in this outbreak is likely much higher than the number reported, and the outbreak may not have been limited to the states with known illnesses. This is because many people recover without medical care and are not tested for E. coli.
Illnesses started on dates ranging from November 27, 2021, to December 9, 2021 (see timeline). Sick people ranged in age from 26 to 79 years, with a median age of 59, and 100% were female. Of 10 people with information available, 4 were hospitalized and 2 developed a type of kidney failure called hemolytic uremic syndrome (HUS). One death was reported from Washington.
State and local public health officials interviewed people about the foods they ate in the week before they got sick. Nine people reported eating Organic Power Greens sold under the Simple Truth Organic brand (8) and the Nature’s Basket brand (1), and seven people’s shopper records showed the purchase of these products. Both brands of Organic Power Greens have the same mix of leafy greens: organic spinach, mizuna, kale, and chard.
FDA conducted a traceback investigation and identified farms from the Yuma, AZ and Salinas, CA growing regions that supplied the Organic Power Greens. However, FDA did not identify a single production code in their traceback.
Laboratory Data
Public health investigators used the PulseNet system to identify illnesses that were part of this outbreak. CDC PulseNet manages a national database of DNA fingerprints of bacteria that cause foodborne illnesses. DNA fingerprinting is performed on bacteria using a method called whole genome sequencing (WGS).
WGS showed that bacteria from sick people’s samples were closely related genetically. This suggests that people in this outbreak got sick from the same food.
WGS of bacteria from 10 people’s samples predicted resistance to chloramphenicol, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Testing of three people’s samples using standard antibiotic susceptibility testing methods by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) confirmed these results (streptomycin was not tested by this method). These findings do not affect treatment guidance since antibiotics are not recommended for patients with E. coli O157:H7 infections.
WGS also showed that this outbreak strain is similar to strains that have previously caused outbreaks linked to consumption of romaine lettuce, contact with lambs, and exposure to recreational water.
Public Health Actions
On December 30, 2021, CDC advised not to eat Simple Truth Organic Power Greens and Nature’s Basket Organic Power Greens with “best if used by” dates through December 20, 2021.
Since the last update on December 30, 2021, CDC updated the case definition and removed three illnesses from this outbreak investigation. These three people were infected with E. coli bacteria that were not as closely related genetically to the rest in this outbreak. None of the three sick people reported eating Organic Power Greens.
Epidemiologic Data
As of January 6, 2022, a total of 10 people infected with the outbreak strain of E. coli O157:H7 have been reported from four states (see map). Illnesses started on dates ranging from November 27, 2021, to December 9, 2021 (see timeline).
Sick people range in age from 26 to 79 years, with a median age of 59, and 100% are female. Of ten people with information available, four have been hospitalized and one person developed a type of kidney failure called hemolytic uremic syndrome (HUS). No deaths have been reported.
The true number of sick people in an outbreak is likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for E. coli. In addition, recent illnesses may not yet be reported as it usually takes 3 to 4 weeks to determine if a sick person is part of an outbreak.
State and local public health officials interviewed people about the foods they ate in the week before they got sick. Nine people reported eating Organic Power Greens sold under the Simple Truth Organic brand (8) and the Nature’s Basket brand (1), and seven people’s shopper records showed the purchase of these products. Both brands of Organic Power Greens have the same mix of leafy greens: organic spinach, mizuna, kale, and chard.
CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are collecting different types of data to investigate a multistate outbreak of E. coli O157:H7 infections.
Epidemiologic data show that Simple Truth Organic brand and Nature’s Basket brand Organic Power Greens may be contaminated with E. coli and may be making people sick.
Epidemiologic Data
As of December 29, 2021, 13 people infected with the outbreak strain of E. coli O157:H7 have been reported from six states (see map). Illnesses started on dates ranging from November 27, 2021, to December 9, 2021 (see timeline).
Sick people range in age from 4 to 79 years, with a median age of 54, and 92% are female. Of 12 people with information available, four have been hospitalized and one person developed a type of kidney failure called hemolytic uremic syndrome (HUS). No deaths have been reported.
The true number of sick people in an outbreak is likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for E. coli. In addition, recent illnesses may not yet be reported as it usually takes 3 to 4 weeks to determine if a sick person is part of an outbreak.
State and local public health officials are interviewing people about the foods they ate in the week before they got sick. Of 12 people interviewed, all reported eating packaged salads. Of 10 people who provided brand information, 6 ate or bought Simple Truth Organic Power Greens and 1 ate Nature’s Basket Organic Power Greens. Both Organic Power Greens salads have the same mix of leafy greens: organic spinach, mizuna, kale, and chard. Several sick people reported using these salads in smoothies.
Laboratory Data
Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. CDC PulseNet manages a national database of DNA fingerprints of bacteria that cause foodborne illnesses. DNA fingerprinting is performed on bacteria using a method called whole genome sequencing (WGS).
WGS showed that bacteria from sick people’s samples are closely related genetically. This suggests that people in this outbreak got sick from the same food.
Public Health Actions
CDC is advising not to eat Simple Truth Organic Power Greens and Nature’s Basket Organic Power Greens with “best if used by” dates through December 20, 2021. Investigators are working to determine if additional products may be contaminated.
