This is an official CDC Health Update distributed via the Health Alert Network (HAN) December 14, 2006 13:50 EST (1:50PM EST).

CDC Health Update 

Multi-state Outbreak of E. coli 0157 Infections, November-December 2006

As of Wednesday, December 13, 2006, 71 persons have become ill with Escherichia coli 0157:H7 associated with eating contaminated lettuce at Taco Bell restaurants in the northeastern United States. Cases have been reported to CDC from five states: New Jersey (33), New York (22), Pennsylvania (13), Delaware (2) and South Carolina (1). Other cases of illness are under investigation by state public health officials. Among the 71 persons with illness, 53 (75 %) were hospitalized and 8 (11%) developed a type of kidney failure called hemolytic-uremic syndrome (HUS). Illness onset dates have ranged from November 20-December 6. New cases have declined substantially. The last week of November was the peak time when persons became ill.

Of the 71 persons with illness, 48 have been confirmed as cases. Strains are routinely “DNA fingerprinted” by laboratories in all 50 states as part of CDC’s PulseNet Network (the network of public health laboratories that sub-type bacteria). E. coli 0157 strains from other cases are being tested by PulseNet. As a result of testing, cases found with the outbreak strain “fingerprint” are being re-classified as confirmed cases and cases with an unrelated “fingerprint” pattern are being dropped from the case count. There have been no illnesses with onset within the past 5 days among identified cases, including suspects; therefore, the outbreak has ended.

Concerning the outbreak of E. coli O157 infections associated with Taco John's restaurants, Minnesota and Iowa are reporting 27 and 50 associated illnesses, respectively. Isolates from these outbreaks cases of E. coli O157 demonstrate indistinguishable patterns, confirming that the two clusters are linked. However, this pattern is distinct from the Taco Bell outbreak pattern. One other matching isolate from Wisconsin has been identified. Investigators in Minnesota and Iowa have independently identified lettuce as the contaminated food vehicle in that outbreak. Trace back efforts are underway.

CDC is working with state and local health officials, the Food and Drug Administration (FDA), the Department of Agriculture (USDA), and the restaurant chain to determine what food caused the outbreak. Public health investigators have identified a few ingredients that were consumed more often by ill persons than well persons and were statistically linked with illness: lettuce, cheddar cheese, and ground beef. This analysis also indicates that onions of any type are not linked to this outbreak. Evaluation of data indicates that shredded lettuce consumed at Taco Bell restaurants in the northeastern United States was the most likely source of the outbreak.  Because multiple Taco Bell restaurants were involved during the same time period, contamination of lettuce likely occurred before reaching the restaurants.  Health officials and the restaurant chain are working collaboratively to learn more about the shredded lettuce to determine how it may have become contaminated.

E. coli O157 causes diarrhea that is often bloody and accompanied by severe abdominal cramps, but fever is typically absent or mild. Persons who have developed such symptoms after eating at a Taco Bell restaurant in an affected state are advised to consult a physician and to inform their local health department.

For more information on E. coli infection and this outbreak, please refer to the following website: http://www.cdc.gov/ecoli/