THURSDAY, Sept. 21, 2006 (HealthDay News) -- The number of victims in the nationwide E. coli outbreak continued to rise Thursday as health officials scoured California spinach farms to pinpoint the cause.
As of Thursday evening, 157 people in 23 states had been infected with the strain of E. coli O157:H7; 83 had been hospitalized, 27 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. The CDC also reported that Idaho officials were investigating the death of a 2-year-old who died Sept. 20, supposedly after she had eaten spinach.
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 have narrowed their search to the greater Salinas Valley in California, where almost 75 percent of the country's spinach crop is grown.
Investigators are looking at at least nine farms in Monterey, San Benito and Santa Clara counties, Dr. David Acheson, chief medical officer of the U.S. Food and Drug Administration's Center for Food Safety and Applied Nutrition, said during a news conference Wednesday night.
"All the affected spinach appears to come from that area. We are getting a better handle on where it's grown," he added.
Meanwhile, as the focus on the land narrowed, consumer groups and agriculture experts 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 not to eat any fresh spinach products, massive recalls by major California 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.
Among those reporting the illness, 92 percent were sickened between Aug. 19 and Sept. 5. The earliest onset of illness known to be linked to spinach consumption was on Aug. 19. All told, 113 of the victims were females, and 11 were children under 5.
On Wednesday, Arizona and Colorado became the latest states to report their first confirmed cases of E. coli. Also reporting cases have been California, Connecticut, Idaho, Illinois, Indiana, Kentucky, Maine, Michigan, Minnesota, Nevada, Nebraska, New Mexico, New York, Ohio, Oregon, Pennsylvania, Utah, Virginia, Washington, Wisconsin and Wyoming.
Wisconsin has the largest number of reported cases, 40. The next largest number of cases are in Utah, which has 17, followed by Ohio with 20, according to the CDC.
Natural Selection Foods, in San Juan Batista, began recalling all of its prepackaged spinach and its salad mix products that contain spinach on Saturday.
River Ranch Fresh Foods, which operates in Salinas and El Centro, recalled its brands of mixed salads containing spinach Sunday, after FDA inspectors found that the company had bought spinach from Natural Selection.
And on Tuesday, RLB Food Distributors, based in West Caldwell, N.J., said it was voluntarily recalling salad mixes that may contain spinach supplied by Natural Selection. The recall included various salad mixes sold under the Balducci's and FreshPro brands and distributed on the East Coast with the "Enjoy Thru date of 9/20/06," according to the FDA.
Consumers should continue to throw away any fresh packaged spinach they may have bought in the past few weeks and not buy more until the public health warning is lifted, the FDA said. It also said that washing the spinach won't help because the bacteria is too tightly attached.
The affected products were also distributed to Canada, Mexico and Taiwan, but no illnesses have been reported from any of those countries, the FDA said.
Meanwhile, farm growers and processors planned to unveil an industry blueprint to protect their products from future E. coli outbreaks, the Associated Press reported.
A spokesman for Western Growers, an industry group representing about 3,000 fruit and vegetable farmers in California and other states, said the blueprint was developed after 75 farmers and trade association representatives met with Monterey County's agricultural commissioner Wednesday on the production and distribution processes.
In the short run, federal health officials said that more explicit labeling, which would identify where a bag of spinach came from, is one possible way to get fresh spinach back on the market quickly. Tighter regulation of the growing and processing of spinach is also being considered, the AP reported.
Clearly, we do not want to deny consumers access to spinach," Acheson said during a press conference Thursday. "Wherever it's grown, our responsibility is to make sure whatever does end up on the shelf is safe."
According to the CDC, E. coli lives in the intestines of cattle and other animals and is linked to contamination by fecal material. It can be found in undercooked meats and other foods, such as spinach, sprouts, lettuce, 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.
Visit the CDC for more E. coli outbreak updates.