Eighteen years ago, more than 2,000 people fell ill in Walkerton, Ontario and 6 died. E. coli and campylobacter contamination of the water supply was responsible. In Dec 2017, E. coli-contaminated romaine lettuce left many sick in both the US and Canada. There have been other outbreaks in the news over the years involving different fruits and vegetables. Now this? What gives? Should we be worried?

First and foremost, this is an outstanding piece of detective work. Millions of people in the US and Canada eat all sorts of foods coming from all over the planet. Even one case of food contamination is too many but think of what’s involved here. Less than 100 people (out of millions) in both the US and Canada get sick in a very non specific way (nausea, vomiting, diarrhea) and within a month not only is this picked up as a serious outbreak but the bug is characterized; the general source is identified; and, the warning goes out. Very impressive sleuthing.

What’s happening?

E. coli is a family of bacteria happily living in the intestines of healthy sheep, cows, pigs, poultry and even us. Occasionally there’s a strain of E. coli with the ability to make a poison (for example 0157:H7). Food — most often fruits and vegetables — can become contaminated as a result of run off; contaminated manure being used as fertilizer; or, contamination entering into the food handling process at any stage from the producer to your table.

The E. coli that makes this poison causes some people to develop typical gastroenteritis symptoms (nausea, vomiting and diarrhea) that typically lasts 5 — 10 days. As long as you have no underlying health issues and can keep up with your liquids so that you don’t become dehydrated, most people recover without any problems. The issue is that not everyone has a healthy immune system; some people have underlying health issues so they can’t tolerate any dehydration at all; and pregnant women and little children do not handle this type of infection well. So these groups of people can get very sick. Also, for unknown reasons, about 5 – 10 per cent of the people who are infected may develop hemolytic-uremic syndrome, which can lead to kidney failure and death.

What are we to do to keep from getting infected?

The shelf life of romaine lettuce is about five weeks. So if you have any in your fridge you should throw it out even if you’ve eaten some already and not gotten sick. Wash any surfaces with soap and water that may have been in contact with the lettuce and wash your hands and any utensils as well. Plain soap and water is more than enough. If you do get sick, make certain to keep up with your fluids. High fever, blood from either end, inability to keep up with your fluids, confusion, severe weakness or lethargy all mean you need to be seen. If you have any underlying health issues like diabetes or kidney disease; if you’re pregnant; or, your child is sick; these are all groups of people that need to be seen sooner.

Why no recall?

To issue a recall you need to know what specific product and lot number is affected. That’s why the issues of a general advisory for now. They do suspect that the source is in California, which is important because Arizona and other states will soon be harvesting and their products (which could be completely safe) will be on the market. So as soon as we know which specific products we need to avoid we’ll be able to issue the recall and clear the other sources. In the meantime, avoidance and careful hand-washing are keys to staying healthy.

Dr. Mitch Shulman is an Assistant Professor, Dept. of Surgery, McGill Medical School and an Attending Physician, Emergency Department, McGill University Health Centre. He’s also the CJAD AM 800 Medical Consultant.

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