E. coli in Romaine Lettuce in the USA

The US Centres for Disease Prevention and Control (CDC) advises that romaine lettuce should not be sold, served or eaten anywhere in the USA until further notice.

Thirty-two people have been infected with Shiga toxin-producing E. coli (STEC) O157:H7 associated with romaine lettuce in 11 states since 18 October 2018.

E. coli infection may be accompanied by: nausea, vomiting, abdominal pain, diarrhoea, headache and fever. The illness is usually self limiting over 3–5 days (up to 10 days with STEC)

There may be persistent diarrhoea lasting more than 2 weeks. Haemolytic Uraemic Syndrome can be fatal and occurs in 4 – 10% of STEC infections.

Advice to Travellers

All travellers, irrespective of destination are potentially at risk of E. coli infection. The risk is highest in travellers visiting countries with poor hygiene and sanitation.

All travellers should be advised to practice safe food and water hygiene - see preventing travellers' diarrhoea

• STEC (EHEC/VTEC) coli strains are destroyed if food is cooked thoroughly to internal temperatures of > 70^oC. (4)

Vaccination

• No licensed vaccines are available against E. coli. (6)
• Dukoral® (oral cholera vaccine)
  • Not licensed for prevention of E. coli infection in the UK but it is in some countries including Scandinavia
  • May give some protection against heat labile toxin producing Enterotoxigenic E. coli (ETEC) (about 50% of ETEC strains)
  • Widespread use of this vaccine is not advised for travellers' diarrhoea.(4)

For information see Escherichia coli.