The FDA is recommending that consumers, restaurants, retailers and all other entities in the food supply chain avoid all romaine that does not have the new labeling information on harvest dates and regions. Public health officials are also urging the public to ask retailers and restaurant operators where the romaine they are selling and serving was harvested. This is particularly important for whole heads and hearts of romaine in grocery stores, the FDA warned. Most of the whole heads and hearts are not individually packaged and therefore do not have labels. The voluntary labeling program is expected to apply to bagged products that contain romaine and are packaged for direct sale to consumers. As of Nov. 26, the Centers for Disease Control and Prevention reported 43 confirmed patients across 12 states had been sickened in the current outbreak. Of the patients for whom the information was available, 42 percent have been so sick they had to be admitted to hospitals. The sick people range from 1 to 84 years old. One person has developed hemolytic uremic syndrome (HUS), a type of kidney failure that can be fatal. No deaths have been reported. The first illness began Oct. 8, with the most recent having begun on Oct. 31. Illnesses that occurred after Oct. 31, 2018, might not yet be reported due to the time it takes between when a person becomes ill with E. coli infection and when the illness is reported, according to the CDC. Advice to consumers Although anyone can contract an E. coli infection, pregnant women, those with weakened immune systems, young children and older adults are most at risk for developing severe complications. Anyone who has eaten romaine lettuce and developed symptoms of E. coli infection should immediately seek medical attention. Symptoms can include nausea, vomiting, headache, mild fever, severe stomach cramps, and watery or bloody diarrhea. The onset of symptoms can range from 1 to 10 days after exposure. Specific lab work is required to diagnose E. coli infections, so patients should be sure to tell their doctors about possible exposure to the bacteria. Some people do not get sick at all, but they can still spread the infection to others. Otherwise healthy adults may feel as though they have a bad case of upset stomach. In some cases, particularly when patients are in high-risk groups, people can become seriously ill and must be hospitalized. Young children and frail people who have serious infections can easily develop hemolytic uremic syndrome (HUS), a type of kidney failure that can be fatal.Many companies in the romaine lettuce supply chain resumed shipping Monday after a week-long voluntary hiatus. Nationwide, the majority of the industry shut down and recalled all romaine products Nov. 23 at the request of the FDA. The FDA made the request, two days before Thanksgiving, in conjunction with the its announcement of a new E. coli outbreak associated with romaine lettuce. It is the third E. coli outbreak linked to romaine in the past 12 months. By Nov. 26, the Food and Drug Administration had negotiated a deal with the romaine industry for a new, voluntary labeling program designed to speed up traceback investigations and recalls. Agency Commissioner Scott Gottlieb said including the harvest dates and regions on labels would help consumers stay safe. Participation in she voluntary labeling program was easy for a number of the larger shippers and processors who buy romaine from growers in the Yuma, AZ, region, according to Teressa Lopez of the Arizona Leafy Greens Marketing Agreement (LGMA). “Many began shipping Monday as soon as the word came out from the FDA because they had their labels ready,” Lopez told Food Safety News, adding that the voluntary label program does not impact growers. She said grower members of the LGMA already keep records on blocks and lots at the point of harvest. Meanwhile, the FDA’s continuing investigation has narrowed the growing region linked to the current outbreak to a few counties in California. Specifically, current evidence indicates this romaine was harvested in the Central Coast growing regions of northern and central California is the only romaine implicated in the new outbreak. The California counties named yesterday by FDA were Monterey, San Benito, San Luis Obispo, Santa Barbara, Santa Cruz, and Ventura. The seasonal harvest cycle for California- and Arizona-grown romaine allowed outbreak investigators to match illness dates with fields in those counties. “Additional counties may be added as the FDA traceback develops,” according to the FDA’s update Nov. 28. “Romaine harvested from locations outside of the California regions identified by the traceback investigation does not appear to be related to the current outbreak. “There is no recommendation for consumers or retailers to avoid using romaine lettuce that is certain to have been harvested from areas outside of the Central Coast growing regions of northern and central California.” Examples of romaine lettuce that FDA said are OK include products grown in Mexico, Florida, and California’s desert growing region near Imperial County and Riverside County. The agency also said romaine grown in greenhouses and hydroponic operations is not implicated in the current E. coli O157:H7 outbreak.