E. coli infection linked to Romaine lettuce


November 20, 2019

At least 20 people in Wisconsin have E. coli infections that could be linked to an outbreak in Maryland that has been traced to ready-to-eat romaine lettuce saladsReady Pac, the brand of the salads involved, is owned by Bonduelle Fresh Americas.

Food safety experts have expressed concern over the investigative response to the outbreak in Maryland:


  • Ready Pac has not identified any specific retailers, rather stating the implicated product was shipped to “a club retailer in the state of Maryland.”  [The Maryland health department notified the public that it is investigating a cluster of E. coli O157:H7 infections among seven patients in the state. All of the patients reported eating Ready Pac Bistro Bowl Chicken Caesar Salad purchased from various Sam’s Club locations in Maryland.]
  • The company has not reported how many pounds or packages of salad are involved.
  • A recall notice has not been issued, despite the severity of the illnesses linked to contaminated product. There has been one hospitalization but no deaths associated with the Maryland cases.
  • Ready Pac officials say they tested the romaine in the fields but the company statement did not indicate whether it does any testing during the processing and packaging processes (where contamination – cross contamination – is likely to occur).

In the outbreak in Wisconsin, the Department of Health Services reported three of the 20 patients in that state are children. Children’s immature immune systems mean they are more likely to develop serious complications from E. coli infections. 

Dr. Larry Lutwick, an infectious disease specialist with the Mayo Clinic in Eau Claire, WI, said he’s seen three cases of E. coli at his facility and believes they may be linked to the outbreak. He thinks his patients could have contracted the bacteria from lettuce.  “In two of the three cases they suspected it was from a salad or salad ingredient,” Lutwick said.

About E. coli infections
Anyone who has eaten any of the implicated product and developed symptoms of E. coli infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses.

Most people with an E. coli O157 infection start feeling sick three to four days after eating or drinking something that contains the bacteria. However, illnesses can start anywhere from one to 10 days after exposure.

The symptoms of E. coli infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within five to seven days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).  Due to the nature of the toxin that causes the symptoms, E. coli O157 infection is generally not treated with an antibiotic (and an antibiotic may make the illness worse).

Individuals who suspect they have a foodborne illness linked to this outbreak should seek medical care.

Stay food-safe.


Dr. Barbara Ingham

Professor, Food Safety Specialist

University of Wisconsin-Madison

Madison, WI 53706




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