43 confirmed E. coli cases in Michigan amid multi-state outbreak, Wendy's romaine lettuce suspected

Illustration of E. coli bacteria. E. coli bacteria carrying the mcr -1 gene was found in a urine sample from a patient in Pennsylvania in May 2016. (CDC)

Michigan has 43 confirmed E. coli O157 cases matched with the outbreak strain amid a public health alert from the Department of Health and Human Services - possibly connected to romaine lettuce from Wendy's.

A multi-state outbreak of shiga toxin producing Escherichia coli cases of illness onset dates range from late July through early August. Outbreak cases have been reported from 18 jurisdictions including the counties of Allegan, Branch, Clinton, Genesee, Gratiot, Jackson, Kent, Macomb, Midland, Monroe, Muskegon, Oakland, Ogemaw, Ottawa, Saginaw, Washtenaw, and Wayne and the City of Detroit.

More than 55% of the Michigan outbreak cases reported consumption of food items at Wendy’s restaurant locations. While a specific food item has not yet been identified as the source of illnesses, investigations are ongoing and focusing on sandwiches topped with romaine lettuce.

Currently there is not a recommendation to avoid eating at Wendy’s while the restaurant works with local public health departments to remove potentially implicated products.

The age range of those affected are 6 to 94 years old. Among the Michigan outbreak cases with available information to date, 56% have been hospitalized. Four cases of hemolytic uremic syndrome (HUS), a severe complication that occurs in some people diagnosed with STEC infection, have been identified.

"We are reminding residents in Michigan to seek medical attention if they experience symptoms of E. coli illness such as severe stomach cramps, diarrhea, vomiting or other gastrointestinal distress," said Dr. Alexis Travis, senior deputy director of public health administration at MDHHS. "Additionally, we urge residents to take proper precautions when handling food and practice safe food preparation."

MDHHS is working closely with local health departments, the Centers for Disease Control (CDC), and the U.S. Food and Drug Administration (FDA) to determine the source of the illnesses. The ongoing investigation includes the association with Wendy’s locations but may be broader than a single restaurant chain depending on the distribution of food products. MDHHS anticipates similar messaging from the CDC relative to the broader investigation that includes Ohio, Indiana and Pennsylvania matched cases.

At this time, MDHHS is recommending people experiencing symptoms of E. coli infection should consult a health care provider as soon as possible and discuss if testing is recommended. Health care providers should contact their local health department to report suspected or confirmed STEC cases.

Symptoms vary for each person, but often include:

• Severe stomach cramps.
• Diarrhea – often bloody.
• Vomiting.
• Fever.

Symptoms of E. coli infection usually appear three to four days after the exposure but may appear in as short as one day or as long as 10 days. Symptoms often improve within five to seven days. Some infections are very mild, but others can be severe or even life-threatening. Younger children and older adults may be more likely to experience severe illness.

Approximately 5% to 10% of people diagnosed with this infection develop HUS, which typically appears seven days after symptoms begin, often when diarrhea is improving. Symptoms of hemolytic uremic syndrome can include decreased frequency of urination, feeling very tired and losing color in cheeks and inside the lower eyelids.

Prevention of E. coli is often directly connected to proper hand hygiene and food handling practices, such as:

  • Washing hands with warm water and soap for at least 20 seconds, or using an alcohol-based sanitizer with at least 60% alcohol:
  • Before and after handling food.
  • After using the bathroom or changing a diaper.
  • Before preparing and feeding bottles or foods to infants and toddlers or touching pacifiers or other things that may go in an infant or toddler’s mouth.
  • After contact with animals or their environments, such as farms, petting zoos, fairs or even the backyard.
  • Rinsing fruits and vegetables well under running water. There is no need to use soap.
  • Always marinating foods in the refrigerator, not on the counter or outdoors. Never reuse sauce on cooked food used to marinate raw meat or poultry.
  • Never placing cooked food on a plate that previously held raw meat, poultry, seafood or eggs. Be sure to have on hand plenty of clean utensils and platters.
  • Never letting raw meat, poultry, eggs or cooked food sit at room temperature more than two hours before putting them in the refrigerator or freezer (one hour when the temperature is above 90 degrees Fahrenheit.
  • Cooking meats thoroughly. Ground beef and meat should be cooked to an internal temperature of at least 160 degrees Fahrenheit. Consumers should use a food thermometer as color is not an indicator of "doneness."
  • Avoiding raw milk, unpasteurized dairy products and unpasteurized juices (like fresh apple cider).
  • Avoiding swallowing water when swimming or playing in lakes, ponds, streams, swimming pools and backyard "kiddie" pools.

For additional information on E. coli, visit the USDA website on protection from foodborne illness or the CDC website on prevention. Find food safety information on the MDARD website.