E. coli Toll Now Stands at 173

Health officials start to ease restrictions on spinach, while examining farms in 3 Calif. counties

SUNDAY, Sept. 24, 2006 (HealthDay News) -- The number of victims in the nationwide E. coli outbreak continued to climb Sunday, even as U.S. health officials began to relax their warnings on fresh spinach.

Late Friday, the health officials said consumers could safely resume eating some fresh spinach within the next few days, as long as agriculture industry officials come up with a way to label the products that don't come from California's Salinas Valley, the suspected center of the bacterial outbreak.

"The public can be confident that spinach grown in those non-implicated areas can be consumed, and industry is working to get spinach from these areas back on the market," Dr. David Acheson, chief medical officer of the U.S. Food and Drug Administration's Center for Food Safety and Applied Nutrition, said at a telephone press conference.

"I anticipate it will be fast," he added later of that process, the Associated Press reported. "Whether it will be three days, four days -- I don't know. That will be an industry determination."

As of Sunday evening, 173 people in 25 states had been infected with the strain of E. coli O157:H7; 92 had been hospitalized; 28 had developed a type of kidney failure called hemolytic-uremia, and one had died, according to the U.S. Centers for Disease Control and Prevention.

One hundred twenty-five (72 percent) were female and 15 (9 percent) were children under 5 years old, the agency said.

The CDC also said that Idaho officials were investigating the death of a 2-year-old who died Wednesday, reportedly after she had eaten spinach. And officials are investigating the death of an 86-year-old Maryland woman who died Sept. 13 after becoming infected with E coli. Her family said she'd eaten fresh spinach before getting sick, the Herald-Mail of Hagerstown, Md., reported.

Following a breakthrough New Mexico lab test Wednesday that confirmed the E. coli strain in a partly eaten fresh spinach package from one victim, health authorities had narrowed their search to the greater Salinas Valley, where more than half the country's spinach crop is grown.

Investigators are looking at at least nine farms and several processing plants in Monterey, San Benito and Santa Clara counties.

"All the affected spinach appears to come from that area. We are getting a better handle on where it's grown," the FDA's Acheson said Wednesday night.

Thursday night, the FDA said that other produce grown in the region was not implicated in the outbreak. It also said processed spinach, either frozen or canned, was not suspect.

And health officials began talking about what it would take to lift the nationwide embargo and get fresh spinach back to consumers.

Meanwhile, tighter regulation of the growing and processing of spinach was being considered, federal officials said.

The comments followed criticism earlier Thursday from consumer groups and agriculture experts, who cited what they called lax oversight of the industry itself.

"It's a very serious problem," Jean Halloran, director of the food policy initiative for Consumers Union, told the San Jose Mercury News. "Things fall through the cracks, and they can't make a coordinated attack on a problem or share information or allocate resources properly."

In the Salinas Valley, 97 percent of irrigation water comes from private wells, but there is no mandatory inspection of them and no requirement that they ever be tested, the Mercury News reported. In addition, the newspaper said, Cal-OSHA is responsible for checking field sanitation, but with thousands of farms in the state, it conducts fewer than 1,200 inspections yearly.

And state and federal inspectors generally don't visit farms unless there's a problem, the newspaper added. The industry follows voluntary rules known as "good agricultural practices," which range from watering and fertilizing practices to field-hand sanitation and pest control.

What Acheson on Wednesday called the "confirmed positive sample" definitely linking the contamination to fresh spinach came from a bag of Dole baby spinach with a "best if used by Aug. 30" date. The source of the spinach was Natural Selection Foods, the California food producer that has been the focus of the investigation.

It became the first solid evidence to emerge after almost a week of public-health warnings on fresh spinach products, massive recalls by major spinach producers, and state-by-state reports of growing numbers of sickened people.

Acheson said that in November 2005 there had been a small outbreak of E. coli in spinach from the Salinas Valley. "More should have been done," he added. "We are learning from this outbreak."

In 18 other outbreaks of E. coli since 1995, the FDA has not been able to trace the outbreak to a specific farm, Acheson said.

"In this case, the likelihood that we will get it back to a specific farm is good because of the number of cases and because of the UPC codes on the packages," he noted. However, trying to identify a specific cause on that farm is unlikely, he added.

The earliest onset of illness known to be linked to spinach consumption was on Aug. 19.

On Thursday, Maryland and Tennessee became the latest states to report their first confirmed cases of E. coli. Also reporting cases have been Arizona, California, Colorado, Connecticut, Idaho, Illinois, Indiana, Kentucky, Maine, Michigan, Minnesota, Nebraska, Nevada, New Mexico, New York, Ohio, Oregon, Pennsylvania, Utah, Virginia, Washington, Wisconsin and Wyoming.

Wisconsin has the largest number of reported cases, and the one death.

The affected products were also distributed to Canada, Mexico, Taiwan, Hong Kong and Iceland, but no illnesses have been reported from any of those countries, the FDA said.

Natural Selection Foods, in San Juan Batista, began recalling all of its prepackaged spinach and its salad mix products that contain spinach on Sept. 16.

River Ranch Fresh Foods, which operates in Salinas and El Centro, recalled its brands of mixed salads containing spinach on Sept. 17, after FDA inspectors found that the company had bought spinach from Natural Selection.

And RLB Food Distributors, based in West Caldwell, N.J., said it was recalling salad mixes that may contain spinach supplied by Natural Selection, which were distributed on the East Coast with the "Enjoy Thru date of 9/20/06."

Meanwhile, farm growers and processors planned to unveil an industry blueprint to protect their products from future E. coli outbreaks, the AP reported.

According to the CDC, E. coli lives in the intestines of cattle and other animals and can be found in undercooked meats; vegetables like spinach, sprouts and lettuce, and unpasteurized milk and juice.

The primary symptom of E. coli contamination in humans is diarrhea, often with bloody stools. There are an estimated 73,000 cases of infection, including 61 deaths, each year in the United States, according to CDC statistics.

More information

Visit the CDC for more E. coli outbreak updates.

SOURCES: Sept. 22, 20, 2006, news conference with David Acheson, M.D., chief medical officer, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration; U.S. Centers for Disease Control and Prevention; Associated Press; San Jose Mercury News; Herald-Mail of Hagerstown, Md.
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