MONDAY, Sept. 18, 2006 (HealthDay News) -- The number of people sickened by E. coli bacteria linked to contaminated spinach from California's Salinas Valley has risen to 109 people in 19 states, as a second produce company began recalling its spinach products.
U.S. health officials on Monday, meanwhile, renewed their warning to consumers not to eat any fresh spinach at all. And the Associated Press reported that the U.S. Food and Drug Administration told California farmers to improve produce safety in a pointed warning letter last November, nearly a year before the current outbreak. This is the 20th food-poisoning episode since 1995 that has been linked to spinach or lettuce, according to the wire service.
River Ranch Fresh Foods recalled its brands of mixed salads containing spinach Sunday, after U.S. Food and Drug Administration investigators found that the company had bought spinach from Natural Selection Foods, the San Juan Bautista company linked to what is becoming the nation's largest E. coli outbreak ever.
According to the San Jose Mercury News, that now means that 37 brands of bagged salad with spinach -- 34 from Natural Selection Foods and three from River Ranch Fresh Foods, which operates in Salinas and El Centro, Calif. -- have been recalled.
The FDA on Monday was working to pinpoint the source of the bacteria but ruled out tampering as a possible cause of the outbreak, the AP reported.
"At this time we have no evidence supporting tampering," FDAspokeswoman Susan Bro said.
But Bro also dismissed a claim by Natural Selection Foods that its organic spinach products had been cleared of suspicion, according to the AP. The company, one of the largest in the business, produces both organic and conventionally grown spinach in separate areas at its San Juan Bautista plant.
"The FDA has not cleared any products from the list and continues to recommend consumers avoid eating fresh spinach products," Bro said.
And Dr. Robert Brackett, director of the FDA's Center for Food Safety and Applied Nutrition, told CNN, "We've expanded the warning actually to all of the fresh spinach. That's because we learned that some of the companies that produced the consumer bag spinach also produced larger food-service size."
Brackett added, "We want to make sure consumers are aware that they don't consume any of the fresh spinach. We don't know whether it came from the bag or another state. We just don't have the focus down that much yet."
Officials at the U.S. Centers for Disease Control and Prevention, meanwhile, have started an emergency operations center in Atlanta to assist state health agencies with testing for E. coli, which has been blamed for the death of a 77-year-old woman in Wisconsin and kidney failure in 16 of the other victims.
In addition, health officials in Ohio on Monday were investigating the death of a 23-month-old girl from E. coli poisoning to determine whether the case was related to the outbreak, AP reported.
The FDA over the weekend had broadened its warning about eating spinach to include unpackaged, loose spinach or any product containing spinach as it continues to investigate other sources of the contamination.
On Saturday, the government had identified Natural Selection Foods as the focal point of the tainted spinach outbreak. The company began recalling all of its prepackaged spinach and its salad mix products that contain spinach in all brands packed with "Best If Used By" dates of Aug. 17, 2006, through Oct. 1, 2006.
According to the FDA, Natural Selection Foods supplies its spinach to the following brands that package it:
Dole, Earthbound Farm, Natural Selection Foods, Pride of San Juan, Bellissima, Rave Spinach, Emeril, Sysco, O Organic, Fresh Point, River Ranch, Superior, Nature's Basket, Pro-Mark, Compliments, Trader Joe's, Ready Pac, Jansal Valley, Cheney Brothers, Coastline, D'Arrigo Brothers, Green Harvest, Mann, Mills Family Farm, Pro*Act, Premium Fresh, Snoboy, The Farmer's Market, Tanimura & Antle, President's Choice, Cross Valley and Riverside Farms.
Consumers should throw away any fresh packaged spinach they may have bought in the past few weeks and not buy more until the warning is lifted, the agency said. It also said that washing the spinach won't help because the bacteria is too tightly attached.
The states reporting cases of illness are: California, Connecticut, Idaho, Indiana, Kentucky, Maine, Michigan, Minnesota, Nevada, New Mexico, New York, Ohio, Oregon, Pennsylvania, Utah, Virginia, Washington, Wisconsin and Wyoming.
The affected products were also distributed to Canada and Mexico, the FDA said.
Dr. David Acheson, chief medical officer of the FDA's Center for Food Safety and Applied Nutrition, told a Sunday night press conference that all the 109 victims were infected with the strain of E. coli 0157:H7, CNN reported. Of them, 55 were hospitalized, 16 with a form of kidney failure called hemolytic uremic syndrome.
Acheson said the number of reported cases could increase Monday, when public health departments, many of which were closed over the weekend, reopen.
The dead woman in Wisconsin was identified as Marion Graff, of Manitowoc. Her son said she died of kidney failure Sept. 7. Wisconsin has reported 29 cases statewide so far.
"We are very, very upset about this," Natural Selection Foods spokeswoman Samantha Cabaluna told the AP. "What we do is produce food that we want to be healthy and safe for consumers, so this is a tragedy for us."
The company has supplied a phone number -- l-800-690-3200 -- for a refund or replacement coupons.
The FDA said the first cases of infection apparently surfaced on Aug. 23, and the most recent one was reported Sept. 3. But it wasn't until last Wednesday that the agency was able to identify bagged spinach as the possible cause.
Brackett cautioned that anyone who believes he or she has the symptoms of E. coli poisoning should contact a doctor.
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. While most adults recover completely, the bacteria is particularly harmful to the very young, the very old, and those with compromised immune systems. In more serious cases, potentially fatal kidney failure can develop.
E. coli causes an estimated 73,000 cases of infection, including 61 deaths, each year in the United States, according to CDC statistics.
You can read the FDA's latest updates on the E. coli outbreak at its Web site.