{"id":206,"date":"2014-07-29T11:28:43","date_gmt":"2014-07-29T11:28:43","guid":{"rendered":"http:\/\/209.151.87.121\/~fomes\/iom\/?p=206"},"modified":"2016-03-16T20:16:36","modified_gmt":"2016-03-16T20:16:36","slug":"bagged-spinach","status":"publish","type":"post","link":"https:\/\/www.outbreakmuseum.com\/mobile\/e-coli-o157\/bagged-spinach\/","title":{"rendered":"Bagged Spinach"},"content":{"rendered":"\n<table id=\"tablepress-26\" class=\"tablepress tablepress-id-26\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\"><b>Outbreak:<\/b> Bagged Spinach<\/th>\n<\/tr>\n<\/thead>\n<tbody class=\"row-striping\">\n<tr class=\"row-2\">\n\t<td class=\"column-1\"><b>Product:<\/b> Spinach<\/td>\n<\/tr>\n<tr class=\"row-3\">\n\t<td class=\"column-1\"><b>Investigation Start Date:<\/b> 09\/08\/2006<\/td>\n<\/tr>\n<tr class=\"row-4\">\n\t<td class=\"column-1\"><b>Location:<\/b> Multi-State<\/td>\n<\/tr>\n<tr class=\"row-5\">\n\t<td class=\"column-1\"><b>Etiology:<\/b> <i>E. coli<\/i> (STEC) O157:H7<\/td>\n<\/tr>\n<tr class=\"row-6\">\n\t<td class=\"column-1\"><b>Earliest known case onset date:<\/b> 08\/25\/2006<\/td>\n<\/tr>\n<tr class=\"row-7\">\n\t<td class=\"column-1\"><b>Latest case onset date:<\/b> 09\/13\/2006<\/td>\n<\/tr>\n<tr class=\"row-8\">\n\t<td class=\"column-1\"><b>Confirmed \/ Presumptive Case Counts:<\/b> 5 \/ 0<\/td>\n<\/tr>\n<tr class=\"row-9\">\n\t<td class=\"column-1\"><b>Positive Samples (Food \/ Environmental):<\/b> 0 \/ 0<\/td>\n<\/tr>\n<tr class=\"row-10\">\n\t<td class=\"column-1\"><b>Hospitalizations:<\/b> 98<\/td>\n<\/tr>\n<tr class=\"row-11\">\n\t<td class=\"column-1\"><b>Deaths:<\/b> 3<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-26 from cache -->\n<div id=\"metaslider-id-223\" style=\"width: 100%; margin: 0 auto;\" class=\"ml-slider-3-99-0 metaslider metaslider-flex metaslider-223 ml-slider ms-theme-default\" role=\"region\" aria-label=\"Spinach 2006-200\" data-width=\"400\">\n    <div id=\"metaslider_container_223\">\n        <div id=\"metaslider_223\">\n            <ul class='slides'>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2147 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-04-02 08:20:18\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/04\/spinach-phonecall-400x200.jpg\" height=\"200\" width=\"400\" alt=\"\" class=\"slider-223 slide-2147 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Oregon, CDC, and Wisconsin share hypotheses via conference call about their locally emerging (but nationally connected) E. coli O157 clusters; Oregon is convinced of bagged spinach.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2148 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-04-02 08:22:57\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/04\/spinachx6-400x200.jpg\" height=\"200\" width=\"400\" alt=\"\" class=\"slider-223 slide-2148 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Contaminated spinach purchased just before the national product recall of these brands was initiated. Packaging with replica spinach are museum exhibits.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-224 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-07-29 11:38:50\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/07\/Douglas-County-e1425547465900-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Douglas County\" class=\"slider-223 slide-224 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Contaminated spinach collected from the home of a case of E. coli O157:H7 infection from Douglas county, Oregon.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-227 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-07-29 11:38:55\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/07\/Malheur-County-e1425547383963-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Malheur County\" class=\"slider-223 slide-227 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Contaminated spinach collected from the home of a case of E. coli O157:H7 infection from Malheur county, Oregon.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1796 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:06:35\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Spinach-Farm-12_28_2006-007-1024x768-e1425608260988-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Spinach-Farm-12_28_2006-007-1024x768\" class=\"slider-223 slide-1796 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Spinach field in Salinas Valley, CA.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1806 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:06:50\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Spinach-processing-Farrar-1-1024x768-e1425608201801-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Spinach-processing-Farrar-1-1024x768\" class=\"slider-223 slide-1806 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Out tending the spinach in the field.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2149 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-04-02 08:26:11\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/04\/spinach-headlines-400x200.jpg\" height=\"200\" width=\"400\" alt=\"\" class=\"slider-223 slide-2149 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Headlines in the news as the recall story breaks wide open.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1804 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:06:47\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Spinach-newspaper-clippings-08-1024x746-e1425608212607-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Spinach-newspaper-clippings-08-1024x746\" class=\"slider-223 slide-1804 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">A selection of newspaper clippings about the outbreak investigation.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1797 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:06:36\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Spinach-newspaper-clippings-01-1024x919-e1425608254833-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Spinach-newspaper-clippings-01-1024x919\" class=\"slider-223 slide-1797 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">A selection of newspaper clippings about the outbreak investigation.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1800 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:06:41\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Spinach-newspaper-clippings-04-1024x870-e1425608237177-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Spinach-newspaper-clippings-04-1024x870\" class=\"slider-223 slide-1800 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">A selection of newspaper clippings about the outbreak investigation.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1803 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:06:45\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Spinach-newspaper-clippings-07-1024x768-e1425608220350-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Spinach-newspaper-clippings-07-1024x768\" class=\"slider-223 slide-1803 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">A selection of newspaper clippings about the outbreak investigation.<\/div><\/div><\/li>\n            <\/ul>\n        <\/div>\n        \n    <\/div>\n<\/div>\n\n<table id=\"tablepress-59\" class=\"tablepress tablepress-id-59\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\">Outbreak Summary:<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class=\"row-2\">\n\t<td class=\"column-1\">This outbreak highlighted Inter-state health department cooperation.  Oregon epidemiologists identified that 4 out of 5 cases in Oregon consumed bagged spinach using their homegrown \"Shotgun\" hypothesis-generating questionnaire. Contact with WI and NM showed cases already underway with spinach showing signs of being the culprit. Contact with Utah allowed them to quickly re-interview on spinach. The rest played out nationally following a conference call with NM, UT, OR, CDC, and FDA.  FDA went public later that day.<br \/>\n<br \/>\n<ul><li>\u2022 <a href=\"http:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/04\/Spinach-MLVA-epi-curve.pdf\" target=\"_blank\">Final outbreak epidemic curve (MLVA matches only) (PDF)<\/a><\/li><li>\u2022 <a href=\"http:\/\/public.health.oregon.gov\/DiseasesConditions\/CommunicableDisease\/CDSummaryNewsletter\/Documents\/2006\/ohd5523.pdf\" target=\"_blank\">CD Summary Article (PDF)<\/a><\/li><li>\u2022 <a href=\"http:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/04\/spinach-questionnaire-Oregon.pdf\" target=\"_blank\">Spinach-focused questionnaire (PDF)<\/a><\/li><\/ul><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-59 from cache -->\n<p style=\"text-align: justify;\">\n<table id=\"tablepress-77\" class=\"tablepress tablepress-id-77\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\">Details:<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class=\"row-2\">\n\t<td class=\"column-1\"><i>Multi-state outbreak linked to bagged spinach, Dole and others from Natural Selections, Calif.<\/i><br \/>\n<br \/>\nOn Friday, 8 Sept 2006, ~1800, Janie called to report 3 that we had a match of 3 O157s, including 1 from Cowlitz Co. We had 1 form in hand already (GW), so we contacted Debby Uri at home to get the story on her case and attempted to reach Cowlitz Co on-call people. The Linn Co person had been in Idaho the whole exposure period, and presumably was exposed there. GW worked at a hospital in Oregon, but had no contact with any known O157 cases. The Washington guy had been in Oregon only briefly during during the 10 d before onset. His father visiting from Florida had also been ill but no MD. We agreed to pursue jointly on Monday.<br \/>\n<br \/>\nLate Tuesday afternoon (again around 1800) Janie reported 2 additional matches, so Melissa took over the task of shotgunning these people. She called until late Tuesday night, and finished Wed morning. The only surprising finding was 4\/5 reporting eating bagged spinach, vs. an estimated background for ANY spinach of 17% (P = 0.0036). [Testing months later showed the non-spinach eater to have a different MLVA type.] She had a mix of brands being reported, although 3\/5 said they shopped at Winco. Around noon she left to have lunch with a friend and was going to swing by Winco to get sample bags.<br \/>\n<br \/>\nSoon after she left I decided to notify CDC that we had a probable hit on this cluster, and to find out if there were any other clusters around the US. Our lab had been unable to upload the patterns because their CDC \u201cfob\u201d had expired, and we were temporarily cut off from the PulseNet data exchange. I sent Chris Braden the picture of the PFGE, and he quickly responded that it appeared by eye to match cases in WI, NM, and UT that were under investigation. He said that WI suspected some kind of fresh produce\u2014possibly based on their demographic profile alone, at which point I emailed that we suspected bagged spinach specifically. (In the earlier message I had said we had a tentative<br \/>\nproduct, but didn\u2019t say what it was. All these exchanges happened within 15-20 minutes). I followed up the 2nd email with a phone call, and he connected us to WI (Jeff Davis and John Archer at least), who had ~17 cases already and were underway with a c-c study.<br \/>\n<br \/>\nAt that point they had 8 case interviews only, but all 8 had eaten spinach, which for me certainly iced the cake. After that call ended I contacted Utah and NM (not vv as stated in the MMWR). Utah did not have spinach on the Q they were using, but agreed to quickly re-interview on spinach. NM was already interested in spinach from their interviews, and was already trying to collect leftover spinach from 1 hh. During that phone call I got a voice mail from Marilee Poulson that their cases were all reporting bagged spinach consumption.<br \/>\n<br \/>\nThat is about the end of it. The rest played out nationally following a conference call with NM, UT, OR, CDC, and FDA Thursday morning (14 Sept). FDA went public later that day.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-77 from cache --><\/p>\n<p style=\"text-align: justify;\"><a href=\"https:\/\/www.outbreakmuseum.com\/mobile\/exhibits\/\"><strong>Back to Outbreak Exhibits<\/strong><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Back to Outbreak Exhibits<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":true,"template":"","format":"standard","meta":{"footnotes":""},"categories":[66],"tags":[81,94,77,117,82,80,87,88,79,78],"class_list":["post-206","post","type-post","status-publish","format-standard","hentry","category-e-coli-o157","tag-acute-and-communicable-disease-prevention","tag-bagged-spinach","tag-dr-bill-keene","tag-e-coli-o157h7","tag-fomes","tag-integrated-food-safety-center-of-excellence","tag-international-outbreak-museum","tag-iom","tag-oregon-health-authority","tag-tribute"],"_links":{"self":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/206","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/comments?post=206"}],"version-history":[{"count":6,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/206\/revisions"}],"predecessor-version":[{"id":1779,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/206\/revisions\/1779"}],"wp:attachment":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/media?parent=206"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/categories?post=206"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/tags?post=206"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}