TY - JOUR AU - Marshall, Katherine AU - Hexemer, April AU - Seelman, Sharon AU - Fatica, Marianne AU - Blessington, Tyann AU - Hajmeer, Maha AU - Kisselburgh, Hannah AU - Atkinson, Robin AU - Hill, Kristin AU - Sharma, Davendra AU - Needham, Michael AU - Peralta, Vi AU - Higa, Jeffrey AU - Blickenstaff, Karen AU - Williams, Ian AU - Jhung, Michael AU - Wise, Matthew AU - Gieraltowski, Laura T1 - Lessons Learned from a Decade of Investigations of Shiga Toxin–Producing Escherichia coli Outbreaks Linked to Leafy Greens, United States and Canada T2 - Emerging Infectious Disease journal PY - 2020 VL - 26 IS - 10 SP - 2319 SN - 1080-6059 AB - Shiga toxin–producing Escherichia coli (STEC) cause substantial and costly illnesses. Leafy greens are the second most common source of foodborne STEC O157 outbreaks. We examined STEC outbreaks linked to leafy greens during 2009–2018 in the United States and Canada. We identified 40 outbreaks, 1,212 illnesses, 77 cases of hemolytic uremic syndrome, and 8 deaths. More outbreaks were linked to romaine lettuce (54%) than to any other type of leafy green. More outbreaks occurred in the fall (45%) and spring (28%) than in other seasons. Barriers in epidemiologic and traceback investigations complicated identification of the ultimate outbreak source. Research on the seasonality of leafy green outbreaks and vulnerability to STEC contamination and bacterial survival dynamics by leafy green type are warranted. Improvements in traceability of leafy greens are also needed. Federal and state health partners, researchers, the leafy green industry, and retailers can work together on interventions to reduce STEC contamination. KW - Shiga toxin-producing Escherichia coli KW - disease outbreaks KW - leafy greens KW - vegetables KW - bacteria KW - United States KW - Canada KW - Shiga toxin–producing Escherichia coli KW - food safety KW - E. coli KW - enteric infections KW - STEC DO - 10.3201/eid2610.191418 UR - https://wwwnc.cdc.gov/eid/article/26/10/19-1418_article ER - End of Reference