Multistate Food Poisoning Outbreaks

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An outbreak of food poisoning with Escherischia coli (E. coli) has hospitalized 32 people in 11 U.S. states and another 18 in Canada, according to the Centers for Disease Control and Prevention (CDC). The agency reports no deaths as of yet, although one individual has developed kidney failure.

The CDC advisers that U.S. consumers avoid eating romaine lettuce for now; restaurants and grocery stores are also recommended to stop selling any products containing the popular leafy green.  That includes whole heads as well as precut lettuce mixes such as Caesar salad. The department goes so far as to recommend throwing away all romaine products in the entire country and sanitizing refrigerator shelving.

We all have some E. coli in our intestinal tract, so an official recommendation against food items contaminated with it may seem strange. Although E. coli usually causes no ill effects, certain strains (especially O157:H7) produce a toxin known as “Shiga” which can cause severe food poisoning.

Shiga toxin-producing E. coli  infections are variable, with some manifesting as short-lived “traveler’s diarrhea” while others represent a threat to life itself. The disease usually starts within one to three days after exposure and symptoms like fever, cramps, vomiting, and bloody stools last about a week. Although antibiotics like such as azithromycin, sulfa drugs, and ciprofloxacin may be helpful, it should be noted that the CDC no longer recommends the routine use of antibiotics for this infection due to the possibility of side effects. It does, however, suggest that Pepto-Bismol (Bismuth Subsalicylate), two tablets four times a day, may help in prevention.

Over the years, the frequency of multistate food poisoning outbreaks has increased. For the five-year period from 1995-1999, there were 34 reported. From 2010-2014, 120 multistate events occurred, not counting others that may not have been recognized. The CDC suspects that there are more than the 100,000 food poisoning hospitalizations every year.

Why does it matter whether food contamination is found in only one state versus many? Because multistate outbreaks only account for 3 per cent of food contaminations, but cause 56% of all food poisoning deaths. These items are infected long before they reach the average person’s refrigerator, most probably during processing but possibly as far down the chain as the farm.

Food poisoning events are difficult to pinpoint due to the time between exposure to contamination and the start of symptoms. If the incubation period before you get sick is a week, which food caused the illness? Try to remember everything you ate during the last week and you’ll see what I mean.

Still, we are learning lessons as we investigate the growing number of multistate outbreaks. New technology is identifying the DNA blueprint of contaminated foods. For example, the recent contamination has been identified as the same one that sickened people in 2017.

Better records of where a farm or factory’s food is headed is making it easier to identify the source and nip the issue in the bud. Recalls and “discard food” alerts may prevent hospitalizations and, perhaps, save the lives of informed citizens. Stricter rules on reporting outbreaks are also being implemented.

What can you do to protect your family from food poisoning? Remember these four words: Clean, Separate, Cook, and Chill. Plus, why do you wash vegetables and fruits but not meat, poultry or eggs? We’ll explain all this and the proper way to prevent becoming a victim of bad food (on or off the grid) in our next article.

Joe Alton MD

Dr. Alton

Find out more about food poisoning and other infectious diseases is our new book “Alton’s Antibiotics and Infectious Disease: The Layman’s Guide to Available Antibacterials in Austere Settings“, now available at, or get an autographed copy at!

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