2006 North American E. coli outbreak

The 2006 North American E. coli outbreak was an outbreak, in two principal phases, of foodborne , a potentially deadly bacterium that can cause bloody diarrhea and dehydration. [Subcommittee of the PHLS Advisory Committee on Gastrointestinal Infections (2000). Guidelines for the control of infection with Vero cytotoxin producing Escherichia coli (VTEC). Communicable Dis Public Health; 3: 14-23. Available online at http://www.hpa.org.uk/cdph/issues/CDPHvol3/No1/vtec.pdf]

The initial outbreak occurred in September 2006 and involved fresh spinach. A subsequent outbreak, in November-December 2006, was initially attributed to green onions served by two restaurant chains -- Taco Bell and Taco John's -- but later was determined to have been caused by prepackaged iceberg lettuce. [ [http://www.about-ecoli.com/ecoli_outbreaks/news/central-valley-lettuce-cited-in-eatery-illness/ Central Valley lettuce cited in eatery illness] ]

All told, at least 276 consumer illnesses and 3 deaths have been attributed to the tainted produce.cite web |url = http://www.cdc.gov/foodborne/ecolispinach/current.htm | title = Update on Multi-State Outbreak of E. coli O157:H7 Infections From Fresh Spinach | date = October 3, 2006 | work = Centers for Disease Control and Prevention |accessdate = 2006-10-06]

First outbreak (Spinach)

In September 2006, there was an outbreak of food-borne illness caused by "Escherichia coli" ("E. coli") bacteria found in uncooked spinachcite web|url=http://www.fda.gov/bbs/topics/NEWS/2006/NEW01450.html|title=FDA Warning on Serious Foodborne E.coli O157:H7 Outbreak|date=2006-09-14|work=FDA] in 26 U.S. states.

By October 06, 2006 199 people had been infected, including three people who died and 31 who suffered a type of kidney failure called hemolytic uremic syndrome after eating spinach contaminated with the , a potentially deadly bacterium that causes bloody diarrhea and dehydration.cite news|url=http://today.reuters.co.uk/news/articlenews.aspx?type=scienceNews&storyID=2006-09-17T022232Z_01_N14336072_RTRIDST_0_SCIENCE-ECOLI-DC.XML&pageNumber=1&imageid=&c
2006-09-17|publisher=Reuters] This strain is more potent than in any other food poisoning scares. Federal health officials said half of those reported sick have been hospitalized, compared to 25 to 30 percent in past outbreaks. [cite web |url=http://www.wfsb.com/health/9894017/detail.html|title=E. coli On Spinach May Have Been Extra Potent|date=2006-09-20|work=WFSB]

The Food and Drug Administration (FDA) called for bagged fresh spinach to be removed from shelves and warned people not to eat any kind of fresh spinach or fresh spinach-containing products. [FDA: [http://www.fda.gov/bbs/topics/NEWS/2006/NEW01452.html FDA Statement on Foodborne E. coli O157:H7 Outbreak in Spinach] , #P06-133, September 16, 2006] The FDA has also speculated that washing the spinach is insufficient to sanitize it because the bacteria is systemic, meaning that it is not just on the outside of the spinach, but that it has been absorbed through the roots and is now inside the spinach. This hypothesis has since been deemed only hypothetical as there is no evidence that this can happen in spinach. The FDA has since reduced its warning to certain brands with specific dates. [http://hosted.ap.org/dynamic/stories/T/TAINTED_SPINACH?SITE=7219&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2006-09-29-20-28-40 (Reuters)] ] The Canadian Food Inspection Agency has advised consumers not to eat fresh spinach from the U.S., including bagged, loose in bulk or in salad blends. [cite web|url=http://www.inspection.gc.ca/english/corpaffr/recarapp/2006/20060918e.shtml|title=Expanded health hazad alert. Various brands of imported fresh spinach may contain E. coli 0157:H7 bacteria|date=2006-09-18|work=CFIA|accessdate=2006-09-26]

Cause of first outbreak

The outbreak was traced to organic bagged fresh spinach—sold as conventional produce—grown on a 50 acre farm in San Benito County, California. Investigators with the Centers for Disease Control initially speculated that the dangerous strain of bacteria, , originated from irrigation water contaminated with cattle feces [cite news |url=http://www.ajc.com/metro/content/metro/atlanta/stories/2006/09/16/0917meshspinach.html|title=CDC musters attack on E. coli spinach illness|date=2006-09-17|publisher=Atlanta Journal-Constitution] or from grazing deer. [cite news |url=http://www.salon.com/news/feature/2006/09/22/e_coli/|title=The truth about the E. coli outbreak|date=2006-09-22|publisher=Salon.com]

A follow-up report by the CDCcite news |url=http://www.santacruzsentinel.com/archive/2007/March/24/local/stories/12local.htm|title=Inside the CDC's report on the deadly E. coli spinach outbreak|date=2007-03-24|publisher=Santa Cruz Sentinel] and a joint report by the California Department of Health Services (CDHS) and U.S. Food and Drug Administration (FDA) [cite news |url=http://www.msnbc.msn.com/id/17755937/|title=Source of tainted spinach finally pinpointed|date=2007-03-23|publisher=MSNBC.com] [cite news |url=http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/03/23/BAGJDOQM1H8.DTL|title=San Benito County ranch source of tainted spinach|date=2007-03-23|publisher=San Francisco Chronicle] concluded that the probable source of the outbreak was Paicines Ranch, an Angus cattle ranch that had leased land to spinach grower Mission Organics. The report found 26 samples of "E. coli" “indistinguishable from the outbreak strain” in water and cattle manure on the San Benito County ranch, some within a mile from the tainted spinach fields. [cite news |url=http://www.latimes.com/news/printedition/california/la-me-spinach24mar24,1,3361085.story?coll=la-headlines-pe-california|title=Tainted spinach tied to cattle ranch|date=2007-03-24|publisher=Los Angeles Times] Although officials could not definitively say how the spinach became contaminated, both reports named the presence of wild pigs on the ranch and the proximity of surface waterways to irrigation wells as "potential environmental risk factors." The reports also noted that flaws in the spinach producer's transportation and processing systems could have further spread contamination. Paicines Ranch is not under investigation for its alleged role in the outbreak.

Soon after the reports were released, California's farm industry announced that it will adopt a set of "good agricultural practices" to reduce the risk of "E. coli" contamination for leafy green vegetables. [cite news |url=http://www.santacruzsentinel.com/archive/2007/March/24/local/stories/13local.htm|title=Tainted spinach linked to Paicines Ranch: Officials say San Juan Bautista plant though failed to follow its own safety procedures|date=2007-03-24|publisher=Santa Cruz Sentinel] Those participating in the voluntary program will be eligible for product seal of approval.

Two companies in California voluntarily recalled spinach and spinach-containing products: Natural Selection Foods LLC, [http://www.nsfoods.com/ Natural Selection Foods] ] based in San Juan Bautista, and River Ranch Fresh Foods.cite news|title=FDA: E. coli linked to Natural Selection Foods|date=2006-09-15|url=http://www.cnn.com/2006/HEALTH/09/15/tainted.spinach.ap/index.html|publisher=CNN] cite web |url=http://www.fda.gov/bbs/topics/NEWS/2006/NEW01453.html|title=FDA Statement on Foodborne E. coli O157:H7 Outbreak in Spinach|date=2006-09-17| work= FDA] Natural Selection brands include Natural Selection Foods, Pride of San Juan, Earthbound Farm, Bellissima, Dole, Rave Spinach, Emeril, Sysco, O Organic, Fresh Point, River Ranch, Superior, Nature's Basket, Pro-Mark, Compliments, Trader Joe's, Ready Pac, Jansal Valley, Cheney Brothers, D'Arrigo Brothers, Green Harvest, Mann, Mills Family Farm, Premium Fresh, Snoboy, The Farmer's Market, Tanimura & Antle, President's Choice, Cross Valley, and Riverside Farms. Affected brands from River Ranch include Hy-Vee, Farmer's Market and Fresh and Easy. Later, a third company, RLB Food Distributors, issued a multiple East Coast states recall of spinach-containing salad products for possible "E. coli" contamination. [cite web |url=http://www.fda.gov/oc/po/firmrecalls/rlb09_06.html| title=RLB Food Distributors Issues a Multiple East Coast States Recall of Fresh Spinach Salad Products for Possible E. coli Contamination|date=2006-09-20|work=FDA] Natural Selection Foods announced on September 18, 2006 that its organic produce had been cleared of contamination by an independent agency, but did not lift the recalls on any of its organic brands. [cite news |url=http://www.usatoday.com/news/health/2006-09-17-spinach_x.htm| title=Company says organic spinach OK, but E. coli recall still in effect|date=2006-09-18|publisher=USA Today] On September 22, Earthbound Farm announced that the FDA and the CDHS confirmed that its organic spinach had not been contaminated with "E. coli". [cite web |url=http://www.ebfarm.com/press/SpinachUpdates/| title=Consumer Update on e. coli Investigation|date=2006-09-22|work=Earthbound Farm Organic]

Impact

26 states were affected, with at least 200 cases of the disease being reported as of December 23 2006. Three deaths were confirmed to be from the outbreak source with an elderly woman in Wisconsin, a 2 year old in Idaho, and an elderly woman in Nebraska. A fourth death of an elderly woman in Maryland is still under investigation to determine if it is linked to this outbreak. [ [http://today.reuters.com/news/articlenews.aspx?type=topNews&storyID=2006-09-22T192306Z_01_N22168366_RTRUKOC_0_US-SPINACH.xml] Dead link|date=March 2008] Spinach has also been distributed to Canada and Mexico; one case has been reported in Canada. [ [http://www.cbc.ca/consumer/story/2006/09/25/contaminated-spinach.html First case of contaminated spinach recorded in Canada ] ] [cite web
last =
first =
authorlink =
coauthors =
title = E. COLI O157:H7 OUTBREAK IN UNITED STATES ASSOCIATED WITH BAGGED FRESH SPINACH
work =
publisher = Canadian Food Inspection Agency (CFIA)
date = 2006-09-15
url = http://www.inspection.gc.ca/english/corpaffr/newcom/2006/20060915e.shtml
format =
doi =
accessdate = 2006-09-24 ] There have been over 400 produce-related outbreaks in North America since 1990. [cite web |url=http://www.foodsafetynetwork.ca/articles/870/produce-outbreak-chart.pdf|title=A selection of North American produce related outbreaks from 1990-2005|date=2006-05-03|work=Food safety network|format=PDF]

The areas reported to be affected are: [cite web|url=http://www.cdc.gov/foodborne/ecolispinach/case_count_us_map.htm|title=E. coli O157:H7 Outbreak Case Counts by State| work = CDC |accessdate = 2006-10-04]
*Arizona (8 cases first outbreak, 0 second)
*California (2, 0)
*Colorado (1, 0)
*Connecticut (3, 0)
*Idaho (7, 0)
*Illinois (2, 0)
*Indiana (10, 0)
*Kentucky (8, 0)
*Maine (3, 0)
*Maryland(3, 0)
*Michigan (4, 0)
*Minnesota (2, 0)
*Nebraska (11, 0)
*New Mexico (554,0)
*Nevada (2, 0)
*New York (11, 49)
*New Jersey (0, 44)
*Ohio (25, 0)
*Ontario (1, 0)
*Oregon (6, 0)
*Pennsylvania (89, 7)
*Tennessee (1, 0)
*Utah (19, 0)
*Virginia (2,0)
*Washington (3, 0)
*West Virginia(1, 0)
*Wisconsin (49, 0)
*Wyoming (2, 0)

Economic impact

In California, where three-quarters of all domestically grown spinach is harvested, farmers could face up to $74 million in losses due to the "E. coli" outbreak. In 2005, the spinach crop in California was valued at $258.3 million, and each acre lost amounts to a roughly $3,500 loss for the farmer. [ [http://www.msnbc.msn.com/id/15095551/ October 2, 2006 and in October 4, 2006 AP story reported on MSNBC.com] ]

Online Help

The PulseNet system, part of the Association of Public Health Laboratories and coordinated by CDC, detected clusters of infection in two states, Oregon and Wisconsin, which initiated investigations in each state. The first cluster was detected on Friday September 8 in one state, and the second cluster emerged in the second state on Wednesday September 13, by which time PulseNet had also identified potential associated cases in other states. [http://www.cdc.gov/ecoli/2006/september/response/091606.htm CDC | E. coli Outbreak From Spinach | What CDC and Other Agencies Are Doing - Sep. 16, 2006 ] ]

The OutbreakNet, a group of state public health officers who investigate foodborne infection outbreaks, shared information with CDC that indicated that Oregon and Wisconsin were considering the same hypothesis: fresh spinach was the possible vehicle of infection. The group tracked and updated the increasing case count and exposure information. During a multistate call on Thursday, September 14, the group noted that the data strongly suggested that fresh spinach was a likely source. Within 24 hours of the outbreak, the data indicated that the outbreak was probably ongoing.

CDC made communication to the public a priority by developing press releases, coordinating with FDA on press documents, conducting interviews with major media, and sending out notices on Thursday September 14 to the public health community via the Health Alert Network (HAN) and the Epidemic Information Exchange (Epi-X). By the next morning, the news media warned the U.S. population not to eat bagged spinach, with remarkable coverage.

Timeline of First Outbreak

eptember

On September 14, 2006, the FDA warned consumers about an "E. coli" outbreak that was tied to bags of fresh spinach. The FDA reported that they received complaints from 19 states in the United States. The FDA advised "that consumers not eat bagged fresh spinach." Three days later, their updated warning said not to eat "fresh spinach or fresh spinach-containing products."On September 17, the United States expanded the warning to avoid all fresh spinach. The Centers for Disease Control issued an official "Health Alert", the highest category of alert message, on September 14 [CDC: [http://www2a.cdc.gov/HAN/ArchiveSys/ViewMsgV.asp?AlertNum=00249 Multiple States Investigating a Large Outbreak of E. coli O157:H7 Infections] , September 14, 2006] and started to investigate the "E. coli" outbreak. Wisconsin Governor Jim Doyle formally requested federal aid on September 15. His office said the CDC will help assess the causes and the magnitude of the outbreak in his state. [cite news |url=http://www.channel3000.com/health/9865564/detail.html|date=2006-09-16|title=CDC Starts To Investigate E. coli Outbreak In Wisconsin|publisher=WISC-TV]

On September 17th, just three days after the initial warning, the FDA issued an updated warning stating that the public should "not eat fresh spinach or fresh spinach containing products." [cite news |url=http://www.fda.gov/bbs/topics/NEWS/2006/NEW01453.html ]

On September 18, Illinois and Nebraska reported their first cases of "E. coli" infection due to spinach, bringing the total number of affected states to 21. Ohio public health officials are investigating a 2-year-old's death that may also be linked. [cite news |url=http://www.daytondailynews.com/n/content/oh/story/news/state/2006/09/18/ddn091806ohecoli.html|date=2006-09-18|title=Ohio tot's death may be linked to tainted spinach|publisher=Dayton Daily News]

By September 18, the number of people sickened by the "E. coli" laced fresh spinach reached 111. [cite news|title=E. coli spinach scare increases to 21 states|date=2006-09-19| |url=http://www.cnn.com/2006/HEALTH/09/18/tainted.spinach/index.html|publisher=CNN]

On September 19, it was reported that there may be a link to a further death in Ohio and irrigation water is being investigated as a possible source. [cite news |url=http://www.mercurynews.com/mld/mercurynews/rss/15554157.htm?source=syn|title=Farm water is suspected in outbreak|date=2006-09-19|publisher=Mercury News] [cite news|url=http://www.newsday.com/news/health/ny-hsspin194897481sep19,0,387423.story?coll=ny-health-print|title=Death linked to spinach?|date=2006-09-19|publisher=Newsday] This is the 9th outbreak traced to the Salinas Valley in California and the 25th leafy green "E. coli" outbreak (spinach or lettuce) in the United States since 1993. [cite web|url=http://www.foodsafetynetwork.ca/en/article-details.php?a=3&c=14&sc=98&id=903|title=Outbreaks of foodborne illness linked to fresh lettuce and spinach since 1993|date=2006-09-18|work=Food Safety Network]

On September 20, the CDC announced that the genetic fingerprint, a PFGE pattern, of "E. coli" O157 isolated from an opened package of "Dole Baby Spinach, Best if Used by August 30" packed by Natural Selection in the refrigerator of an ill New Mexico resident matched that of the outbreak strain. [cite web |url=http://www.cdc.gov/foodborne/ecolispinach/092006.htm|title=Update on Multi-State Outbreak of E. coli O157:H7 Infections From Fresh Spinach,September 20,2006|date=2006-09-20|work=CDC] On September 25, consumer advocates and lawmakers began urging tougher rules for fields and processing plants. [ [http://www.usatoday.com/news/health/2006-09-24-produce-rules_x.htm Safety advocates, growers debate produce rules - USATODAY.com ] ]

On September 27, a Pittsford woman filed a lawsuit concerning this matter, stating that the tainted spinach has made her ill. See [http://www.democratandchronicle.com/apps/pbcs.dll/article?AID=/20060927/NEWS01/609270327/1002 Pittsford Woman Files Tainted Spinach Lawsuit] . This source also stated that additional lawsuits were being filed nationwide.

On September 29, the FDA downgraded the warning, now only warning against specific brands packaged on specific dates, instead of just fresh spinach in general.

October

On October 5, 2006, the FBI has launched a criminal investigation into this matter. [ [http://www.ecommercetimes.com/perl/search.pl?query=FDA Criminal Probe launched into the Spinach E. coli incident] ] [ [http://www.technewsworld.com/perl/story/53460.html FBI investigates Spinach E. coli incident as a criminal matter] ] [ [http://www.cbsnews.com/stories/200609/18/health/main2016329.shtml CBS News: Feds investigate outbreak] ] [ [http://www.guardian.co.uk/worldlatest/story/0,,-6129104,00.html Feds investigate E. coli incident] ]

On October 9, 2006, a popular brand of lettuce grown in California's Salinas Valley, the region at the center of the nationwide spinach scare has been recalled over concerns about "E. coli" contamination. [http://www.myfoxla.com/myfox/pages/Home/Detail?contentId=1123172&version=1&locale=EN-US&layoutCode=TSTY&pageId=1.1.1]

On October 26, 2006, some of the largest grocery chains, including Vons, Albertsons, Ralphs and others, sent a letter to the farmer's associations, giving them 6 weeks to come up with a plan to prevent problems like the E. coli breakout from happening again. [http://www.mercurynews.com/mld/mercurynews/news/breaking_news/15914129.htm]

Overall toll

The overall toll of the spinach incident was 199 people in 28 states being infected, resulting in 141 hospitalizations, 31 people having kidney failure, and three deaths. [Surak, John G. "A Recipe for Safe Food: ISO 22000 and HACCP". "Quality Progess". October 2007. p. 21.]

econd outbreak (Lettuce)

Taco Bell

In December 2006, Taco Bell restaurants in four Northeastern states emerged as a common link among 71 sickened people across five states, 52 of whom were ultimately confirmed by the Centers for Disease Control to have tested positive the same E. coli strain. [http://www.cdc.gov/ecoli/2006/december/121406.htm CDC | E. coli Outbreak - Update: Dec. 14, 2006 | CDC Foodborne and Diarrheal Diseases Branch ] ] A total of 33 people in New Jersey, 22 in New York, 13 in Pennsylvania, 2 in Delaware, and 1 in South Carolina fell ill, according to the CDC.

The four states with Taco Bell restaurants where these consumers were confirmed to have eaten were in New Jersey, New York, Pennsylvania, and Delaware. (The patient from South Carolina ate at a Taco Bell restaurant in Pennsylvania).

Of the 71 reported cases, 53 were hospitalized and 8 developed a type of kidney failure called hemolytic-uremic syndrome. According to the CDC, illness onset dates ranged from November 20 to December 6.

On December 7, 2006, an initial investigation attributed the outbreak to green onions, which had been supplied to the Taco Bell restaurants by a single McLane Company distribution center in Burlington Township, New Jersey."2 N.J. food distributors aid contamination probe", "The Star-Ledger" (Newark, New Jersey), December 7, 2006.] McLane in turn had been supplied all of that produce by Ready Pac, a produce processing company in Florence, New Jersey.

Tainted green onions may have proven a ready culprit in part because of their involvement in at least one widely-reported prior outbreak of E. coli. In 2003, green onions were suspected as the cause of a foodborne illness involving the Chi-Chi's restaurant chain in western Pennsylvania that killed 4 people and sickened 660. [ [http://www.pittsburghlive.com/x/pittsburghtrib/s_406042.html Chi-Chi's checks to arrive soon] ]

After further investigation, Taco Bell determined that the cause of the problem was with lettuce, not green onions, and switched produce suppliers in the New York, New Jersey, Pennsylvania, and Delaware area. Company president Greg Creed stated in a press release that Taco Bell was cooperating with the CDC and the FDA in the controversy and he also stated that two of the people who claimed they got sick from eating Taco Bell actually did not eat there. [ [http://www.ift.org/cms/?pid=1000363 December 20, 2006 IFT weekly newsletter] - Accessed December 21, 2006.] Even though green onions were proven to not be the source of Taco Bell's "E. coli" outbreak, Taco Bell has no plans to put them back on the menu.

By mid-December 2006, both green onions and McLane Company had been eliminated as possible sources of the Taco Bell contamination. ["McLane and Green Onions Cleared from List of E.coli Suspects", "Convenience Store News", December 13, 2006] An investigation by the New Jersey Department of Health and Environmental Services at McLane's distribution center in Burlington, N.J. [http://www.state.nj.us/cgi-bin/dhss/njnewsline/view_article.pl?id=3006 found no evidence] that McLane improperly stored or handled food at the site. Focus then shifted to prepackaged iceberg lettuce, which also was supplied to Taco Bell by Ready Pac, as the culprit. ["E. Coli Culprit Was Probably Lettuce, FDA Says" "The Washington Post" December 14, 2006.] Taco Bell's tainted lettuce was later traced, via packaging, to farms in the Central Valley of California, although no specific sources have been made public. ["Lettuce was culprit in latest cases", "Los Angeles Times", January 13, 2007.]

Taco John's

Later in December 2006, Iowa and Minnesota health officials investigated an E. coli outbreak that was traced to foods served at Taco John’s restaurants in Cedar Falls, Iowa and Albert Lea and Austin, Minnesota. As of December 13 2006, the Iowa Department of Health had confirmed that at least 50 Iowans had become ill with E. coli infections after eating at Taco John’s. On December 18 2006, the Minnesota Department of Health reported that 37 probable E. coli cases had been reported in connection with the Taco John’s E. coli outbreak, nine people were confirmed ill with E. coli, eight people were hospitalized, and one person had developed hemolytic uremic syndrome.

The Taco John’s E. coli outbreak was traced to contaminated lettuce sold in foods at Taco John’s restaurants that were supplied by a Minneapolis lettuce supplier. In response to the Taco John’s E. coli outbreak, Taco John’s agreed to reimburse ill individuals for medical expenses, and hired a new fresh produce supplier. [ [http://www.tacojohns.com/NewsItem_TJLetter.htm Taco John's open letter (Issue date not listed.)] - Accessed December 21, 2006] Taco John's president and CEO Paul Fisherkeller stated in an open letter that their restaurant food was safe to eat in the wake of the "E. coli" outbreak that closed three of their restaurants in Iowa and Minnesota.

Other reported 2006 outbreaks

A report of a viral outbreak at an Olive Garden restaurant in Indianapolis, Indiana [ [http://www.cnn.com/2006/HEALTH/12/18/olive.garden.outbreak/index.html CNN.com report on Olive Garden outbreak in Indianapolis, IN] - Accessed December 18, 2006 ] occurred in mid-December.

Regulatory and industry response

Since the 2006 outbreaks, various legislative proposals have emerged and the state and federal levels to require stricter food production, processing and handling. Industry participants have also taken voluntary measures to improve food safety. ["Firms debut changes for food safety", "The Californian (Salinas, California)", June 8, 2007.]

ee also

*List of foodborne illness outbreaks

References

External links

* [http://epi.ufl.edu/food/ E. coli as an emerging pathogen] from IFAS
* [http://www.cdc.gov/foodborne/ecolispinach/ E. coli O157:H7 Outbreak from Fresh Spinach] by CDC.
* [http://www.promedmail.org/pls/promed/f?p=2400:1000 Programme for monitoring emerging diseases (ProMED)]
* [http://www.inspection.gc.ca/english/corpaffr/newcom/2006/20060915e.shtml Canadian Food Inspection Agency advisory]
* [http://www.treehugger.com/files/2006/09/spinach_e_coli.php The Link Between E. Coli in Spinach and Industrial Cattle] - Guest Column by the Union of Concerned Scientists in TreeHugger Magazine
* [http://www.foodsafetynetwork.ca/en/article-details.php?a=3&c=14&sc=98&id=909 Importing E. coli] — Commentary by the Food Safety Network
* [http://www.fbi.gov www.fbi.gov:Search: FBI initiates a criminal probe into the 2006 Spinach E. coli outbreak]
* [http://content.nejm.org/cgi/content/full/355/19/1952?query=TOC Don't Eat the Spinach — Controlling Foodborne Infectious Disease] — Perspective article by D.G. Maki in N Engl J Med 2006; 355:1952-5