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Case Study: Georgia Response to E. Coli in Romaine Lettuce

August 21, 2018
Romaine lettuce

This past spring saw a leafy green frenzy as Romaine lettuce was recalled amid an ongoing multi-state E. Coli O157 illness outbreak.

Outbreak Impact

Utter panic spread across the country as stores and restaurants cleared their inventory of whole heads and chopped Romaine, and people avoided lettuce at all costs.

Tallies from the Centers from Disease Prevention and Control (CDC) came in at 210 people sick across 36 states, 96 hospitalized, and five dead due to the illness outbreak. It was clear to see why people were worried.

Analyzing the Problem

When we know people are getting sick, how do we stop it? We must work together to find the source.

First the consumer must report their illness, so that the local health authorities can track it to the restaurant or retail grocery store (known as the point of service). A food borne illness outbreak cannot be stopped if those affected do not report it.

So, if you ever think you might have food poisoning going to a doctor can be crucial to not only your health, but others in your community as well.

Impact in Georgia

Georgia had five reported cases linked to this E. Coli O157 outbreak. With initial cases coming in to the Georgia Department of Public Health (DPH) at the local and state level, the Georgia Food and Feed Rapid Response Team activated.

A Rapid Response Team (RRT) is a group of people trained and ready to respond to human and animal food emergencies. Currently 21 states have a RRT, and the groups are generally made up of various professions, all with a common goal: Keeping our food/feed supply safe and preventing consumer illnesses.

My internship started during the chaos of the recall, and I got to see firsthand how much work goes into breaking down and finding the root cause of an outbreak. A traceback is started, which is the process of finding the original source of an issue or illness outbreak. The GA RRT works with individuals, inspectors (local, state and/or federal), and companies to figure out where the product in Georgia came from, whether it be from instate or elsewhere.

Team Effort

Traceback work may involve local county health departments, the State Departments of Agriculture and Public Health, federal regulatory partners, academia, industry associations and other subject matter experts.

The CDC oversees the public health investigation from a national level, with local/state officials working in Georgia; the FDA oversees the traceback/food-related investigation from a national level, while also working with the local/state officials in Georgia – the FDA even has a special group who does this and only this for their jobs, through FDA CORE (Coordinated Outbreak Response and Evaluation Network).

Once the RRT tracks down what store(s) and/or restaurant(s) the food came from, the traceback investigation can start. Most businesses keep a “one step forward and one step back” system, meaning they know who the product came from and where it went. This is one reason why a traceback can take time and become difficult; each level in the distribution chain may have their own way of keeping track of a product, they may change a product’s lot numbers, codes, serial numbers, or even the general name of the product. These factors make connecting the dots in a paper trail tough; however, when the connections are made, the traceback continues.

The investigation generally starts at the local or state level and then documentation and information is passed to FDA for inclusion in the multi-state outbreak investigation. The traceback for the Romaine lettuce illness outbreak is believed to be sourced back to canal water from the Colorado River because the affected farms all shared this source for their irrigation this year. But the road to this finding this information was not smooth, and was filled with many obstacles that may never be seen by the public.

Looking Ahead

A traceback can begin when the FDA deems the outbreak large enough to be worth the resources and effort. One person in one state is not reason enough to start a traceback (although an illness investigation would still occur). This goes back to the importance of the public seeing a doctor for confirmation and reporting of a foodborne illnesses, to allow the state to see that there is an issue that needs to be investigated.

Consumers must also be patient as a traceback occurs. Obstacles such as limited growing periods for a raw agricultural commodity like Romaine, myriads of business owners including brokers and transportation companies, and mismatched paperwork can lengthen and increase the difficulty for those conducting the traceback.

If you ever have any questions about a foodborne illness or an outbreak, contact the Georgia Department of Agriculture Food Safety Division at 404-656-3627.

Sadie Hobbs

About the Author

Sadie Hobbs interned with the Georgia Department of Agriculture Food Safety Division during the summer of 2018.

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