--- title: E. coli and Romaine Lettuce – Missouri Hardest hit with Two Hemolytic Uremic Syndrome Cases date: 2011-12-07T16:55:29-08:00 author: Bill Marler canonical_url: "https://marlerclark.com/news_events/e-coli-and-romaine-lettuce-missouri-hardest-hit-with-two-hemolytic-uremic-syndrome-cases" section: News --- [All News](/news_events) / [Outbreaks](https://marlerclark.com/news_events/outbreaks) / # E. coli and Romaine Lettuce – Missouri Hardest hit with Two Hemolytic Uremic Syndrome Cases ![120711_statemap_tn.jpg](http://www.ecoliblog.com/uploads/image/120711_statemap_tn.jpg)The CDC reported today that 60 persons have been infected with the outbreak strain of E. coli O157:H7 in 10 states. The number of ill persons identified in each state is as follows: Arizona (1), Arkansas (2), Georgia (1), Illinois (9), Indiana (2), Kansas (3), Kentucky (1), Minnesota (3), Missouri (37), and Nebraska (1). Among persons for whom information is available, illnesses began from October 10, 2011 to November 4, 2011. Ill persons ranged in age from 1 to 94 years, with a median age of 29 years old. Sixty-three percent were female. Among the 45 ill persons with available information, 30 (67%) were hospitalized, and 2 developed hemolytic uremic syndrome (HUS). No deaths have been reported. ![romaine_lettuce.jpg](http://www.ecoliblog.com/uploads/image/romaine_lettuce.jpg)Collaborative investigative efforts of state, local, and federal public health agencies indicate that romaine lettuce sold primarily at several locations of a single grocery store chain (Schnucks) was the likely source of illnesses in this outbreak. Contamination likely occurred before the product reached Schnucks locations. Ill persons reported purchasing salads from salad bars at Schnucks between October 5 and October 24, 2011. A total of 9 locations of Schnucks were identified where more than one ill person reported purchasing a salad from the salad bar in the week before becoming ill. This included 2 separate locations where 4 ill persons reported purchasing a salad at each location. For locations where more than one ill person reported purchasing a salad from the salad bar and the date of purchase was known, dates of purchase were all within 4 days of other ill persons purchasing a salad at that same location. Romaine lettuce served on salad bars at all locations of Schnucks had come from a single lettuce processing facility via a single distributor. This indicates that contamination of romaine lettuce likely occurred before the product reached Schnucks locations. The FDA and several state agencies conducted traceback investigations for romaine lettuce to try to identify the source of contamination. Traceback investigations focused on ill persons who had eaten at salad bars at several locations of Schnucks and ill persons at university campuses in Minnesota (1 ill person) and Missouri (2 ill persons). Traceback analysis determined that a single common lot of romaine lettuce harvested from Farm A was used to supply Schnucks locations as well as the university campus in Minnesota during the time of the illnesses. This lot was also provided to a distributor that supplied lettuce to the university campus in Missouri, but records were not sufficient to determine if this lot was sent to this university campus. Preliminary findings of investigation at Farm A did not identify the source of the contamination. 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