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November 27, 2019

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  • Be aware of two current outbreaks of Shiga toxin-producing E. coli (STEC) O157:H7 affecting King County residents:

    1. An ongoing multistate outbreak of Shiga toxin-producing E. coli (STEC) O157:H7 infections linked to consumption of romaine lettuce harvested from the Salinas, California growing region; there are 2 King County cases at this time.

    2. An outbreak of a different strain of STEC O157:H7 infections among persons who reported eating raw vegetables and leafy greens from multiple Evergreens restaurants in King County, with symptom onsets ranging from November 10–15, 2019.

  • Consider STEC infection in all persons with bloody diarrhea and in persons with any diarrhea and a history of eating leafy greens OR at an Evergreens restaurant during the 10 days before symptom onset.

  • Advise patients to not eat, and to discard, all romaine lettuce harvested from the Salinas, CA growing region.

  • In patients with symptoms compatible with STEC infection, collect a stool specimen and request E. coli testing by culture and Shiga toxin test.

  1. If bloody diarrhea is present, laboratory evaluation should include a complete blood count, serum electrolytes, BUN, and creatinine.

  2. Shiga toxin immunoassays or PCR, should be obtained in addition to cultures, but should not replace culture on a sorbitol MacConkey agar plate.

Report STEC cases immediately to Public Health at (206) 296-4774. Obtain the following history during the exposure period (1 to 10 days before symptom onset):

  1. Dietary history, including: all leafy greens and other raw produce, meats, unpasteurized juices or dairy products

  2. Group and restaurant meals, including meal dates, restaurant names (ask about Evergreens), and restaurant addresses

  3. Travel history with travel dates and destinations

  4. Animal exposures (pets, farms, etc.)

  5. History of child day care center attendance
Two King County residents have been linked to a national outbreak of STEC O157:H7 associated with romaine lettuce grown in Salinas, California, which the U.S. Centers for Disease Control and Prevention (CDC) announced on November 22, 2019. Public Health is also currently investigating another outbreak of STEC O157:H7 potentially associated with multiple Evergreens restaurants in Seattle, the source is unknown at this time. Currently available data indicates that this strain is different from the strain causing the national outbreak associated with romaine lettuce. More information about the Evergreens restaurant STEC O157:H7 investigation can be found here.