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  1. Outbreaks of Foodborne Illness

FDA Investigates Multistate Outbreak of E. coli O26 Infections Linked to Chipotle Mexican Grill Restaurants

February 1, 2016  

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The U.S. Food and Drug Administration (FDA) along with the Centers for Disease Control and Prevention (CDC) and state and local officials investigated two outbreaks of E. coli O26 infections.

Update: February 1, 2016

On February 1, 2016, the CDC announced that the outbreak appears to be over.

What was the Problem and What was Being Done About It?  

The FDA and the Centers for Disease Control and Prevention (CDC) along with state and local officials are investigating two separate outbreaks of E. coli O26 infections that have been linked to food served at Chipotle Mexican Grill restaurants in several states.

As of January 27, 2016, the CDC reports a total of 55 people infected with the outbreak strain of STEC (Shiga toxin producing E. coli) O26 from a total of 11 states in the larger outbreak: California (3), Delaware (1), Illinois (1), Kentucky (1), Maryland (1), Minnesota (2), New York (1), Ohio (3), Oregon (13), Pennsylvania (2), and Washington (27). There have been 21 reported hospitalizations. The majority of these cases were reported from Oregon and Washington during October 2015.

In December 2015, the CDC reported five people infected in three states with a different, rare strain of STEC O26: Kansas (1), North Dakota (1), and Oklahoma (3). Interviews were conducted with five ill people, who all reported eating at Chipotle Mexican Grill restaurants. There were no reports of hemolytic uremic syndrome (HUS) and no deaths in either outbreak. .

Investigators used whole genome sequencing, an advanced laboratory technique, to get more information about the DNA fingerprint of the STEC O26 bacteria causing illness in both outbreaks. Whole genome sequencing (WGS) was performed on STEC O26 isolates from 36 ill people from the first outbreak. All 36 isolates were highly related genetically to one another. This provided additional evidence that illnesses outside the Pacific Northwest, were related to the illnesses in Washington and Oregon. WGS was also performed on STEC isolates from four people in the second outbreak. All were highly related to one another, although not to the isolates from the first outbreak.

Chipotle Mexican Grill closed 43 restaurants in Washington and Oregon in early November 2015 in response to the initial outbreak. All these restaurants reopened in November 2015. Chipotle Mexican Grill worked in close consultation and collaboration with health officials throughout the investigation to determine whether it was appropriate to reopen these restaurants. Chipotle reports taking the following actions, among others, prior to opening:

  • Confirming that all microbial testing performed by the company did not yield E. coli (more than 2,500 tests of Chipotle's food, restaurant surfaces, and equipment all showed no E. coli)
  • Confirming that no employees in these restaurants were sickened from this incident
  • Expanded testing of fresh produce, raw meat, and dairy items prior to restocking restaurants
  • Implementing additional safety procedures, and audits, in all of its 2,000 restaurants to ensure that robust food safety standards are in place
  • Working closely with federal, state, and local government agencies to ensure that robust food safety standards are in place
  • Replacing all ingredients in the closed restaurants
  • Conducted additional deep cleaning and sanitization in all of its closed restaurants (will conduct deep cleaning and sanitization additionally in all restaurants nationwide)

The FDA conducted tracebacks of multiple widely-distributed ingredients. Traceback can be difficult with Mexican-style foods given they are often complex dishes containing multiple ingredients. No product of interest was identified. Even without a definitive item to follow, the FDA traced back to their origins some widely distributed ingredients in an effort to identify a source for the outbreak. Unfortunately, the distribution path did not lead to an ingredient of interest.

The FDA also conducted investigations of some suppliers, but did not find any evidence that those suppliers were the source of the outbreak. Ultimately, no food item has been identified as causing the outbreak, and by the same token, no food has been ruled out as a cause .

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What are the Signs & Symptoms of E. coli O26?

  • People usually get sick from STEC (Shiga toxin-producing E. coli) 2-8 days (average of 3-4 days) after swallowing the organism (germ).
    • Most people infected with STEC develop diarrhea (often bloody) and abdominal cramps.
    • Most people recover within a week.
  • Some illnesses last longer and can be more severe, resulting in a type of kidney failure called hemolytic uremic syndrome (HUS).
    • HUS can occur in people of any age, but is most common in young children under 5 years, older adults, and people with weakened immune systems.
    • Symptoms of HUS can include fever, abdominal pain, pale skin tone, fatigue and irritability, small, unexplained bruises or bleeding from the nose and mouth, and decreased urination.
    • People who experience these symptoms should seek emergency medical care immediately.
  • STEC infection is usually diagnosed by testing of a stool sample for Shiga toxins.
    • Clinical laboratories are required in some states to send Shiga toxin-positive specimens from ill people to the state public health laboratory for identification of STEC and PulseNet testing.

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Who is at Risk?

People of any age can become infected. Very young children and the elderly are more likely than others to develop severe illness and HUS, but even healthy older children and young adults can become seriously ill. In this particular outbreak, the age range of ill patients is 1 - 67 years.

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What Do Consumers Need To Do?

Consumers who have recently become ill after eating at a Chipotle should contact their health care provider.

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What Do Retailers Need To Do?

Retailers should consult the FDA Food Code, a model code of recommendations published by the FDA for safeguarding public health, providing guidance to retail food industry to ensure food is unadulterated and honestly presented when offered to the consumer. State and local governments may enact regulations similar to that proposed in the FDA Food Code with which retail establishments are required to comply. If retail outlets have specific questions, they should consult the regulatory agency that issued their permit to operate.

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Who Should be Contacted?

Contact your healthcare provider if you have diarrhea that lasts for more than 3 days, or is accompanied by high fever, blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine.

The FDA encourages consumers with questions about food safety to call 1-888-SAFEFOOD Monday through Friday between 10 a.m. and 4 p.m. Eastern time, or to consult the FDA website.

Additional Information

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