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E. Coli Outbreak Linked to Romaine

Food Safety Advisory: 

Based on new information, CDC is narrowing its warning to consumers. CDC is advising that U.S. consumers not eat and retailers and restaurants not serve or sell any romaine lettuce harvested from the Central Coastal growing regions of northern and central California. If you do not know where the romaine is from, do not eat it.

Latest Information: 

  • Romaine lettuce products will be labeled with a harvest location by region. It may take some time before these labels are available.

    • If the romaine lettuce is not labeled with a harvest growing region, do not buy, serve, sell, or eat it.
  • Check bags or boxes of romaine lettuce for a label indicating where the lettuce was harvested.
    • The specific California counties FDA identified in the traceback investigation are: Monterey, San Benito, San Luis Obispo, Santa Barbara, Santa Cruz, and Ventura.
    • Romaine lettuce labeled with a harvest region outside of the Central Coastal growing regions of northern and central California (such as the desert growing region near Yuma, the California desert growing region near Imperial County and Riverside County, the state of Florida, and Mexico) is not linked to this outbreak.
  • If you do not know where your romaine lettuce was harvested, do not eat it and throw it away.
    • This advice includes all types or uses of romaine lettuce, such as whole heads of romaine, hearts of romaine, and bags and boxes of precut lettuce and salad mixes that contain romaine, including baby romaine, spring mix, and Caesar salad.
    • If you do not know if the lettuce is romaine or whether a salad mix contains romaine, do not eat it and throw it away.
    • Wash and sanitize drawers or shelves in refrigerators where romaine was stored. Follow these five steps to clean your refrigerator.
  • Restaurants and retailers should check the label on bags or boxes of romaine lettuce, or ask their suppliers about the source of their romaine lettuce.
    • Do not sell or serve any romaine lettuce harvested from the Central Coastal growing regions of northern and central California.
    • If you do not know where your romaine lettuce was harvested, do not sell or serve it.
  • Hydroponically or greenhouse-grown romaine lettuce has not been linked to this outbreak.
  • Take action if you have symptoms of an E. coli infection:
    • Talk to your healthcare provider.
    • Write down what you ate in the week before you started to get sick.
    • Report your illness to the health department.
    • Assist public health investigators by answering questions about your illness.

Updated: December 4, 2018 at 8:20 PM ET

*Information on this page obtained through

Escherichia coli (abbreviated as E. coli) are a large and diverse group of bacteria. Most strains are harmless while others can make you sick. some kinds of E. coli can cause diarhea, while others cause urinary tranct infections, pneumonia, or some other illnesses. 

Some kinds of E. coli cause disease by making a toxin called Shiga toxin. The bacteria that make these toxins are called "Shiga toxin-producing" E. coli, or STEC for short. 

Most commonly identified STEC in North America is E. coli O157:H7 (often shortened to E. coli O157 or even just “O157”). When you hear news reports about outbreaks of “E. coli” infections, they are usually talking about E. coli O157.

Signs and symptoms of infection vary from person to person. While most start feeling sick 3 - 4 days after swallowing something that was contaminated with STEC, it is possible for the illness to start anywhere from 1 - 10 days.

Signs and symptoms can include the following: 

  • severe stomach cramps

  • diarrhea (often bloody)

  • vomiting

  • sometimes a fever less than 101˚F/38.5˚C.

Most people feel better within 5 - 7 days.

CONTACT YOUR HEALTHCARE PROVIDER if you have any of the following: 

  • have diarrhea that lasts for more than 3 days

  • diarrhea that is accompanied by high fever

  • bloody diarrhea

  • have so much vomiting that you cannot keep liquids down and

  • passing very little urine.

Almost everyone has some risk of infection. Infections start when you swallow STEC—in other words, when you get tiny (usually invisible) amounts of human or animal feces in your mouth.

Eating/drinking anything that have been contaminated by the bacteria such as: 

  • Unpasteurized (raw) milk

  • Water that has not been disinfected

  • Contact with feces of infected people or cattle

  • Eating food prepared by people who did not wash their hands well after using the restroom. 


People who are experiencing the signs and symptoms of STEC lose large amounts of water so hydration plays a key role in treatment. Some may want to treat this bacteria with antibiotics but there is no evidence that antibiotic treatment is helpful.

Imodium® and antibiotics may  increase the risk for developing HUS or Hemolytic Uremic Syndrome (a type of kidney failure).

There has been one reported case of HUS.



  • WASH YOUR HANDS thoroughly after using the bathroom or changing diapers and before preparing or eating food. WASH YOUR HANDS after contact with animals or their environments (at farms, petting zoos, fairs, even your own backyard).

  • COOK meats thoroughly. Ground beef and meat that has been needle-tenderized should be cooked to a temperature of at least 160°F/70˚C. It’s best to use a thermometer, as color is not a very reliable indicator of “doneness.”

  • AVOID raw milk, unpasteurized dairy products, and unpasteurized juices (like fresh apple cider).

  • AVOID swallowing water when swimming or playing in lakes, ponds, streams, swimming pools, and backyard “kiddie” pools.

  • PREVENT cross contamination in food preparation areas by thoroughly washing hands, counters, cutting boards, and utensils after they touch raw meat. To learn more about how to protect yourself from E. coli, see CDC’s feature, E. coli Infection.

Items you will need: 

  • Sealed bags 

  • Warm, soapy water

  • Clean towels

  • Optional: 1 gallon of water + 1 tablespoon of bleach (After cleaning your fridge with warm, soapy water, you can use a solution of 1 tablespoon of liquid bleach in 1 gallon of water to sanitize your refrigerator.)

5 Steps to Cleaning the Fridge: 

  1. Place contaminated food in a sealed bag and toss it in the garbage. If it was stored in a container, wash it out with warm, soapy water before reusing. 

  2. Take out any removable shelves and drawers, and food. Do not leave out unrefrigerated food for more than 2 hours. 

  3. Wash the removable parts with warm, soapy water then rinse with clean running water. CAUTION: running hot water over cold glass shelves may crack them. Allow them to come to room temperature before cleaning them. 

  4. Clean the inside of fridge with warm, soapy water and wipe down with clean water to rinse off the soap. Dry with a clean towel. OPTIONAL: sanitize inside with your bleach solution after you have thoroughly cleaned your fridge with warm, soapy water. 

  5. Return shelves drawers and food in the fridge. Wipe any food and drink containers with warm, soapy water before returning them. 


  • Wash your hands with warm water and soap after you are finished. 

  • Use warm, soapy water to wipe down kitchen counters and surfaces that came into contact with food. 

  • Immediately wash any towels that were used in the cleaning process before using them again. 

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