SAN DIEGO -- A Californian has now died from the E. coli outbreak linked to romaine lettuce, health officials announced Wednesday, sending San Diegans scrambling for information on a disease they don't often have to worry about.
E. coli symptoms include severe stomach cramps, diarrhea and vomiting. They begin, on average, three to four days after ingesting the bacteria. Most people recover in five to seven days.
Those most at risk for E. coli illness include the very young, the very old and individuals with compromised immune systems.
As for the recent outbreak, first reported in April: "This is serious, and everyone should avoid romaine," said Matthew Wise, deputy branch chief for outbreak response at the CDC's Division of Foodborne, Waterborne, and Environmental Diseases.
Wise said that his advice to consumers is for everyone -- not limited to specific groups such as those most at risk for severe illness.
That advice: "Do not eat or buy romaine lettuce unless you can confirm it is not from the Yuma, Arizona, growing region. Restaurants and retailers should not serve or sell any romaine lettuce from the Yuma, Arizona, growing region."
The growing season in the Yuma region runs from November to March and then moves north to Salinas, California, for the summer. The move is underway, and some farms in Yuma have completed their season, but the FDA said it cannot confirm that no more lettuce is being shipped from the region based on the information it has from industry organizations.
The CDC and the Food and Drug Administration have yet to identify a brand, manufacturer, supplier or farm as the source of the E. coli contamination.
However, they have identified Harrison Farms in Yuma as the grower of the whole heads of romaine that caused illness in eight inmates at a correctional facility in Nome, Alaska. The growing season at that farm has ended, but health investigators are planning to visit the farm in an effort to determine the how the lettuce became contaminated.
The CDC emphasized that although the other 90 cases of illness are linked to the eight in Alaska, those 90 are from chopped bagged lettuce, and that contamination source remains a mystery.
"At this point, we are looking at the whole spectrum" of the supply chain, said Stic Harris, director of the FDA's Coordinated Outbreak Response and Evaluation Network. "As we go through the distribution of product, we are looking for places of convergence where the contamination may have happened. We are looking at each grower or shipper or supplier to see if there is a convergence."
There is no evidence that lettuce grown outside the Yuma region is part of this outbreak, according to Harris.
This is the largest outbreak of its kind since a deadly E. coli outbreak in 2006 that was linked to spinach. Unlike spinach, which is often cooked, romaine -- and lettuce in general -- is more common as a culprit in E. coli outbreaks because it's eaten raw.
"There's no kill step," Harris said, noting that he himself eats romaine several times a week.
General Information from the CDC:
There are many strains of the bacteria Escherichia coli (E. coli). Most strains are harmless and live in the intestines of healthy humans and animals.
Some kinds of E. coli cause disease by producing Shiga toxin. The bacteria that make these toxins are called "Shiga toxin-producing" E. coli (STEC). The most commonly found STEC in the United States is E. coli O157:H7.
The symptoms of STEC infections can include stomach cramps, diarrhea and vomiting. Some infections are mild, but others can be life-threatening.
The CDC estimates that 265,000 STEC infections occur each year in the United States. E. coli O157:H7 causes more than 36% of these infections.
People of all ages can be infected, but young children and the elderly are more likely to develop severe symptoms.
The types of E. coli that can cause illness can be transmitted through contaminated water or food, or through contact with animals or people.
To avoid E. coli infections, experts advise to thoroughly cook meat, avoid unpasteurized dairy products and juices, avoid swallowing water while swimming, and wash hands regularly.