Ketevan POTOVA

Oct 18
18. Over the last several years there have been many recalls of romaine lettuce and leafy
greens due to contamination with E. coli. While the cause of all of these outbreaks may
not have been definitively determined, there have been some findings indicating the
potential cause.
Assignment: Perform a literature search on these outbreaks (find at least 3
outbreaks) and write a 2-page case summary (minimum; typed; 12 pt font, single
spaced) describing the outbreaks, likely causes of the contamination, and strategies that
could have been taken to reduce the likelihood of these outbreaks occurring. (40 pts)

Obesity and mental health issues are one of the most challenging for the United States.
To address the problem, health care workers recommend good sleeping habits, exercising,
drinking enough water, and healthy diet. Therefore, it is not surprising that the demand on fresh
food, especially on those, consumed directly raw, in the recent years has increased. A general
opinion, “green means healthy” is popular among the people, thus when it comes to choosing
healthy dietary options, subconsciously individuals tend to consume greener fruits and
vegetables, compared to other healthy food. Roman lettuce and leafy greens are leaders in that
target green market. The roman lettuce production brought $3.6 billion, in a single year, in 2017.
However, America’s favorite green products are losing their trust from outbreak to outbreak, by
creating safety issues. Food safety related concerns and causes can be different, among which
microbiological hazards are dominating. In this short review article, we will discuss the recent E.
coli outbreaks associated with the fresh produce of roman lettuce and leafy greens, possible
contamination reasons, and at the end, we will suggest recommendations for the further
prevention.
One of the first large multistate E. coli outbreaks of recent years, related to Romaine
lettuce, took place in 2011, infecting 58 people across the 9 states. Traceback investigation
analysis was able to identify a single lot associated with causing illnesses, however the lack of
records made it difficult to build synapses between different locations of outbreak.
Relatively smaller size of outbreak was reported in 2017, with 25 cases, but for 1 person
discovered to be fatal. Investigation was not able to find the certain type of leafy green
responsible for the outbreak. Shorter shelf-life was making it more difficult to have the track of
infectious lots and inform consumers for the possible contaminations.
36 states, 210 cases, 96 hospitalizations, 5 deaths – these drastic numbers describe the
largest 2018-year multistate outbreak. A beautiful city of Yuma, in the south of Arizona, is
possibly major responsible actor for infecting hundreds of people nationwide. Traceback analysis
found the outbreak strains in the irrigation canals, adjacent to the leafy green fields. Agricultural
water was the cause of another outbreak in the same year, causing 62 cases from 16 states.
The last two years are certainly not positive for leafy green growers and sellers, since
they have had millions of dollars of loss from outbreaks. But economical loss is not that
significant compared to the numbers of unlucky consumers, infected with E. coli. A total of 167
people from 27 states got contaminated in 2019, with 15 patients developed kidney failure.
Traceback investigation suggests that the outbreaks were sourced from farms, located close to
livestock. Additionally, same infectious strains were found in the samples of fece-soil taken from
a cattle grate close to the target farm.
 Ketevan POTOVA
Oct 18
The last known multistate outbreak took place in 2020, infecting 40 people across the 19
states. Investigators confirmed the possible source of contamination from the feces.
In response to increased number of outbreaks related to leafy greens, FDA developed an
updated Leafy Greens STEC Action Plan, which includes preventive and responsive actions, as
well as the measures for addressing knowledge gaps. This document has high significance, and it
is important to conduct further work for implementing it in practice.
Described E. coli outbreaks related to romaine lettuce and leafy greens, give us the idea
about the possible contamination sources and the ways to address preventive actions.
 Labeling – FDA investigation reports suggest that in many cases, they were unable to
identify the source due to the lack of proper documentation. Many growers don’t practice
the accurate labeling for separate lots, information about the origin and the product.
 Agricultural water – Several outbreaks showed the evidence for matching strains in
infected people and the contaminated agricultural water. Improper growing, harvesting,
and post-harvesting practice create a threat for a serious infection, which consequentially
is resulted into nationwide outbreaks.
 Livestock – fields that are closer to livestock farms, are more susceptible to get
contaminated for E. coli than the others located further. In the field study, researchers
found negative correlation between the distance from the field to cattle farm, and the
number of bacteria found in the product.

Recommendations:
 For Postharvest water management builders should prevent a small contamination for
becoming a big one.
 For harvest and postharvest uses, should only use water that has non-detectable generic
E. coli in 100 mL sample.
 Builders should consider adding a sanitizer to postharvest water
 Develop SOPs for key water management steps
 Monitor key variables of both the water and any sanitizer used to ensure postharvest
water quality
 Take corrective actions when needed
 Keep detailed records
 Develop or keep good labeling practice
 Avoid the contamination from nearby livestock farms.