Unseen danger in bagged salads

AN UPDATE Sept. 15, 2006: News of E.coli in spinach Lea Thompson: The FDA is asking everyone not to eat commercially bagged spinach until investigators can pin down what products have been contaminated.  Health officials suspect the outbreak is tied to bagged fresh spinach, but no recall has been issued -- and none will be -- until the source, or sources, of the E.coli can be determind and confirmed.  For now, please listen closely to announcements from health officials.

Lea Thompson Chief consumer correspondent • Profile

For other people, it’s just a child strolling through the mall. But for 11-year-old Amber Brister, a trip to the mall is a very big deal. Amber is out of the hospital, and happy to be shopping again with her mom and sister.

Amber was a healthy child until last September, when she had a frightening brush with death. 

Amber Brister: My stomach hurt really bad and I just didn’t feel good.

Her mother Lori Olson says suddenly and out of the blue, Amber became violently ill.

Lori Olson, Amber's mother: She had kidney failure. She had to have a tube inserted through her abdomen and she was hooked up to a dialysis machine for 24 hours a day for about 18 days.

Amber was gravely ill. She couldn’t eat solid foods, had to be fed intravenously, and needed four blood transfusions. Lori said the doctors told her there was a real chance amber could die.

Lori Olson: It was horrible. When she started the dialysis, there was one point that she was in so much pain they gave her morphine and it didn’t even help. It was a really awful thing to watch. 

The same week Amber was fighting for her life, across town in Minneapolis, 54 year-old-old Roi Dahl was also having serious medical problems.

Roi Dahl: It scared the hell out of me. I cried.

He had been sick for days, but says he figured it was just something he would get over. But then came the pain—he says he was doubled over, unable to move, and hemorrhaging.

His family rushed him to the emergency room where doctors tried to stop the bleeding.

Dahl: The first night I was there they were holding their breath whether I was going to make it through the night or not.  And the next day, they wanted to take out my entire colon and put a colostomy bag on me. And they still weren’t sure what was wrong.

Ten similar cases hit Minneapolis hospitals in three days, and no one was sure what was causing it. A public health investigation was launched.

Teams began calling patients to find out what they had eaten.

Dr. Steve Swanson of the Centers for Disease Control and the Minnesota department of public health suspected a food borne illness.  

Dr. Steve Swanson: We were actually contacting people who were ill and interviewing them while they were still in the hospital.

Because of the symptoms, Swanson thought it might be an outbreak of E.coli 0157 bacteria. E.coli comes from animal or, sometimes, human feces and is usually associated with undercooked ground beef. But health officials found the victims hadn’t eaten ground beef --- but they all had eaten something that you might never suspect of giving you food poisoning—bag salad.

Dr. Swanson: It’s a remarkable fact that most are not aware of that next to ground beef, lettuce is the most commonly implicated food item for E.coli 0157 infections.

Dr. Swanson and the CDC issue a public health warning about contaminated bag salad. Roi Dahl saw it and realized he still had part of the partially eaten bag in his refrigerator.

Dr. Swanson: He called me from the hospital and spoke with me, and said he believed that he was one of our outbreak victims. We then mobilized some people to get over to his house and to get the lettuce before it had decomposed too much. We sent it to our laboratory.

Minnesota Department Of Health / Steve Swanson An electron microscope iamge of E.coli O157:H7 attached to alfalfa sprouts. These images are not part of the outbreak reported on Dateline, and are enhanced with color (e.coli would not be necessarily purple in color). They offer detail of what the bacterium appears like when viewed with electron microscopy and attached to sprouts.

It was Roi Dahl’s leftover lettuce that cracked the case. At the lab, scientists showed us how they were able to extract and isolate E.coli 0157 in the lettuce, then, using DNA markers, they compared it to the strain of E.coli that sickened Dahl, Amber Brister and the others. It was a perfect match.

Dr. Swanson: It’s the first time ever in an outbreak of E.coli 0157 from lettuce that the outbreak strain has ever been found in the lettuce. That’s the proverbial ‘smoking gun.’

Dole Foods issued a voluntary recall for the ‘American Blend’ and ‘Classic Romaine’ bag salads implicated in the outbreak, but not before at least 26 people in three states had gotten very sick. Dr. Swanson believes there were probably many more victims.

Dr. Swanson: Those who become ill, and come to our attention in public health, are just the tip of the iceberg. In fact, with E.coli O157, probably 20 times as many people get ill during an outbreak as you actually know about. 

Lori Olson says she still can’t believe it was bag salad that made Amber so sick.

Lori Olson: Who would think that you could eat lettuce and almost die?

Most consumers would have no reason to suspect their lettuce. After all, it’s become part of the American diet. In fact, the industry says six million bags of salad are sold every day in this country.

Jim Gorney, food industry consultant: It’s a great product. It’s convenient, it’s wholesome, and it’s ready to go.

Industry Consultant Dr. Jim Gorney says bagged salad really is the greatest food innovation since, well, sliced bread. And millions do eat it safely every day.  He says the outbreak that sickened Amber Brister and the others was unfortunate.

Gorney: My heart goes out to those people who have become ill. I have a 7-year-old myself and it’s really a tragedy when someone gets ill.  It shouldn’t occur.

While the E.coli outbreak was unusual, it is not an isolated incident. The Food and Drug administration says there have been at least 19 food borne illness outbreaks linked to leafy greens—including raw spinach since 1995 —425 people have become seriously ill, and two have died. 

Dr. Robert Brackett, head of food safety at the FDA: I’m very concerned about the welfare of the consumers.

Dr. Robert Brackett is head of food safety at the federal government’s Food and Drug Administration. He is worried about E.coli contamination of produce, especially lettuce.

Brackett: Over the last five years or so, we have noticed a real increase in the number of outbreaks that were traced back to fresh produce.

Lea Thompson, Dateline’s chief consumer correspondent: Would you consider these outbreaks a serious public health issue?

Brackett: Outbreaks of E. coli 0H157 are always a serious public health issue. E.coli can debilitate, it can kill, even a few cases is too much for us.

Minnesota Department Of Health / Steve Swanson A bag of Dole Classic was recovered from a household. It was served at a college potluck dinner, and two individuals became ill with confirmed E.coli O157:H7 after consuming this bag.

E.coli in beef is usually killed by thorough cooking, but Dr. Brackett says if fresh lettuce is contaminated by E. coli, the person eating it is likely to get very sick.

Brackett: Because unlike ground beef or unlike some other products, there is no heating step. So, the interesting part here is that you have opportunities for contamination all the way from before the product is even planted, right up unto the consumer’s table.

Dr. Brackett says finding how E.coli is contaminating lettuce is a lot like trying to find a needle in a haystack. There are millions of acres of lettuce, and thousands of workers, processors and shippers involved in bringing salads to American tables.

Brackett: It could be something as simple as a deer walking through the field that contaminated a few heads or it could have been from a flooding. Or it could have been an ill food worker.

Thompson: Right now it’s really a mystery?

Brackett: It really is a mystery how this happened.  But it’s one we have to solve.

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