TOPICS > Health

More Cases of Contaminated Spinach Reported Across Country

September 18, 2006 at 6:35 PM EDT

MARGARET WARNER: The E. coli outbreak linked to spinach
spread to two more states today, bringing the total number of states with
reported cases to 21. One person has died in Wisconsin, and more than 100 have fallen ill
nationwide as a result of exposure to the bacteria. A second death, of a
2-year-old in Ohio,
is under investigation.

E. coli can cause cramps, bloody diarrhea, and in some cases
damaged kidneys. More than 50 people have been hospitalized, some with kidney

The Food and Drug Administration says it still hasn’t
positively confirmed the cause of the outbreak but believes it’s related to
consumption of fresh-bagged greens that include spinach.

All the cases so far have been linked to the products of one
company, California-based Natural Selection Foods. The company has recalled 34
brands of greens for which it provides freshly washed spinach, including
Earthbound Farm and Dole.

The bacteria can be killed if spinach is cooked properly,
but washing alone is not effective. According to the Agriculture Department,
Americans consumed over 450 million pounds of fresh spinach in 2000. About
three-quarters of that comes from California.

And for more on the outbreak and the investigation, we’re
joined by Robert Brackett. He’s director of the FDA’s Center for Food Safety
and Applied Nutrition.

And, Mr. Brackett, welcome. Give us an update on the
investigation. Where are you in determining and pinpointing how this outbreak
came about?

ROBERT BRACKETT, Food and Drug Administration: Well, we’re
getting closer. Originally when we observed the outbreak, we noticed that it
was just from spinach. But at that time, it looked like it was just consumer
salad-sized spinach, bags of spinach. We’ve now sort of expanded that a little
bit more to include all sources of fresh spinach, so this would be the consumer-sized
bags, but in addition also perhaps the salad bars and other sort of salad
brands that might contain spinach.

Now, the reason why we expanded this is because, originally,
we thought it was just the bags, but during our investigation we found that
some of the companies that produced the implicated spinach also produced food
service-sized containers, bags of spinach, and also that some food service —
that is restaurants and supermarkets — were practicing the technique of using
bagged spinach to sort of supplement their salad bars and their bulk bins.

So we wanted to make sure we cast a wider net so that the
public would be protected.

Pinpointing the problem

MARGARET WARNER: Explain to us, though, where in the chain,from the field to the bags, to the retail outlets, this spinach could becomecontaminated. And explain also where E. coli comes from.

ROBERT BRACKETT: Sure. Well, first, where E. coli comesfrom, typically we see this in association with the gut of animals, mammals,specifically ruminant animals such cattle or deer. In this particular case, ofcourse, it's with produce, so the first thing people think about, that theremust be some association with animals, but we haven't been able to find that.

It could have been contaminated anywhere from the point atwhich the product was in the ground right up actually to where a consumer couldeat it. But the fact that it's so widely distributed around the country sort ofindicates that it's somewhere near the beginning.

So it could have been contaminated during production, inwhich case perhaps contaminated water or animals or during harvest where aninfected worker may have come in contact with some repeatedly. It could havealso occurred at the processing plant where the product was actually bagged,such that contaminated equipment may have been routinely contaminating thesebags.

MARGARET WARNER: How specifically have you been able topinpoint -- for instance, are all the cases linked to this one huge supplier,this Natural whatever foods it was, Natural Selection Foods? Is it all from onefield? Can you get that specific?

ROBERT BRACKETT: Well, we'd like to be able to get thatspecific, but it's very, very difficult. All we know is from, first of all, togo back how we put these all together, there is a system run by CDC calledPulseNet, which is really a network of genetic fingerprinting. So when there isa case in one of the states, and they go identify the bacteria and they do agenetic fingerprinting of it, they send that to CDC. CDC then compares that toall the other fingerprints that happen to be coming in.

So where you might have had just one case in one state andtwo cases in another state, when CDC sees it, they can see the aggregate acrossthe country and they can see the pattern. And so that's how this wasdiscovered, actually quite quickly.

MARGARET WARNER: And it is just from one locale?

ROBERT BRACKETT: Well, we don't know. So now the tricky partcomes in actually looking to find out which companies were involved. And we'repretty certain that it's Californiaand just the Salinas Valley of California.

But when we go back to the processor, the problem comes, howdo you know which field it came from? The problem here is that each of thesecompanies may source their product from perhaps a dozen different farms on agiven day. When you go, you have to go back through each one of those lines,back...

MARGARET WARNER: Sort of the way grape growers do, say, withvintners?

ROBERT BRACKETT: Yes. And the same is true on the farm end,is that a particular farm may sell to a variety of different processors, so youhave to cast a wide net in order to include them all.

In the clear

MARGARET WARNER: Have you ruled out -- first of all, isthere any distinction between organic and inorganic? Because I gather thiscompany does both. And, secondly, are all the other lettuce categories, greenscategories OK?

ROBERT BRACKETT: We have no indication that any of the othercategories have any problems at all at this point, except for those thatcontain the spinach. The other question was organic versus conventionallygrown. And at this point, there doesn't appear to be any difference between thetwo. They're both sort of under suspicion at this time, but there doesn't lookto be any greater risk with one versus the other.

MARGARET WARNER: Now, how confident is the FDA that allspinach is now off the shelves and out of restaurants? And then what does thatmean for -- I mean, we keep hearing about new cases. Are new people fallingill, or is the reporting now catching up with people who fell ill, you know, aweek a two ago?

ROBERT BRACKETT: Well, I'll answer the second part first. Andthe second that's, in fact, what is true.

What we're seeing, when we see these confirmed cases, isthat the lab work has already been done on patients who have become ill sometime back, in the last week or two weeks ago. So what we're seeing with theseadditional cases, we think, unless this continues on, are really cases thatwere in the confirmation pipeline, as it were.

MARGARET WARNER: So if a person, just in terms of consumerhelp here, if a person has not eaten spinach since you did the first recallback, the 13th, so five days ago, are they pretty much in the clear?

ROBERT BRACKETT: Yes. The incubation period for E. coli isabout, on the short end, one day and up to about five days. So if it's beenmore than a week, the likelihood that they're going to become ill is prettyslim.

Taking the industry to task

MARGARET WARNER: And let me ask you finally about FDAdetection, monitoring, inspection. This is certainly not the first case of E.coli on greens. I think you've had some 19 cases...

ROBERT BRACKETT: That's correct.

MARGARET WARNER: ... what, since 1995? And you wrote aletter last November saying, in light of continuing outbreaks, it is clear thatmore needs to be done. What were you talking about? And was more done?

ROBERT BRACKETT: Well, more has been done, and that was --the reason we sent that letter to the industry out there is because we did seethis recurring amount of E. coli. And this is a tragic sort of situation likethis. In this particular case, it's a tragedy especially for the victims, for thegrowers who are losing the production, and also for the consumers.

But what we asked the industry to do is go back, take avery, very critical look at what you're doing. Where could it possibly comefrom? And so what they have done is such things as, for instance, gone back anddeveloped commodity-specific guidelines for how products should be handled, asopposed to sort of generic good agricultural practices for all agriculturalcommodities.

Also, to invest in research, to figure out how this organismsurvives in their environment, how it could be transferred. These are the sortsof things that we were looking for and to make faster progress than had beendone before that.

MARGARET WARNER: But would you say the fact that this hashappened suggests fast enough progress has not been made?

ROBERT BRACKETT: Well, I think that's true. I think fastenough progress has not been made. The big part there is we're really going toneed a lot of research to do this. But, in fact, we're going to have to take amuch more aggressive look at protecting the public.

MARGARET WARNER: All right, Robert Brackett, thank you somuch.