Multiple cases of E. coli potentially associated with King County Evergreens restaurants

Update (December 6, 2019):

We’ve identified additional cases linked to this outbreak. All of these cases occurred between November 8-15, 2019. For more information, view the foodborne illness disclosure for this outbreak.

Original post (November 26, 2019):

Public Health is investigating an outbreak of Shiga toxin-producing E. coli (STEC) potentially associated with four Evergreens restaurants in Seattle. Six of seven people who became ill during November 10–15, 2019, ate dishes containing raw vegetables, including leafy greens, from Evergreens restaurants during November 5–11, 2019. The seventh person did not report having eaten at Evergreens, but genetic testing showed they were infected with the same strain of E. coli as three people who did eat at Evergreens and became ill.

Genetic testing on isolates from four of the seven people (three who reported eating at Evergreens before they became ill and one who did not report eating at Evergreens) identified the same strain of E. coli, suggesting they have a common source of infection. We are still awaiting genetic testing results on isolates from the other three cases.

This strain of E. coli is different from the strain currently causing a national outbreak associated with romaine lettuce grown in Salinas, California, which the U.S. Centers for Disease Control and Prevention (CDC) announced on November 22, 2019.

Of these seven E. coli cases, six were in adults and one was in a child. One person was hospitalized and has been discharged. Everyone who reported illness has recovered. We are still investigating and do not yet have conclusive results about what caused the outbreak.

These seven cases are separate from the E. Coli case we announced last week, which is linked to the national outbreak associated with romaine lettuce.

About Public Health’s investigation

Public Health investigators visited the four Evergreens locations (University District, Pioneer Square, Chinatown – International District, Downtown – 3rd and Marion) where the ill people reported eating. During these inspections, investigators did not observe environmental or behavioral risk factors associated with the spread or proliferation of E. coli, such as lack of handwashing or improper time and temperature control of foods.

This outbreak comes in the context of a national E. coli outbreak associated with romaine lettuce from the Salinas, California growing region, which was announced by the CDC on November 22, 2019. Results of genetic testing on isolates from four of the seven cases doesn’t suggest a link to this national outbreak. We are still awaiting genetic testing on isolates from the other three cases.

Many of the people who became ill after eating at Evergreens also reported eating raw vegetables, including leafy greens, from sources other than Evergreens in the days prior to their illness, meaning they could share a separate source for their illness, unrelated to Evergreens.

Public Health collected samples of various produce for testing from the four Evergreens locations where the people who became ill ate; results are pending. Public Health is also working with the Washington State Department of Agriculture and United States Food and Drug Administration on tracing back the distributors and sources for ingredients consumed by the ills during their meals. Trace back is used to identify other points of contamination up the supply chain.

Evergreens restaurant management are cooperating fully in this ongoing investigation. They voluntarily directed all of their locations to discard all romaine lettuce products associated with the current national outbreak from their stores and to properly sanitize all utensils that had contact with romaine lettuce products. Public Health investigators reviewed with staff at all four locations proper sanitizing practices to help prevent the spread of E. coli. Evergreens restaurant management reviewed their sick policy with all employees.

As per our protocol, Public Health investigators revisited the four Evergreens restaurant locations where ill cases reported eating to confirm that these actions were taken. At this time, Public Health has not identified any employees who experienced similar symptoms before or after meal dates for the ill customers, but we are still surveying all employees. During their visit, investigators reviewed the requirement that restaurant employees are not allowed to work while having vomiting or diarrhea.

Protecting yourself from E. coli

Many different food products can carry E. coli, including undercooked ground beef and other beef products; unpasteurized milk, cheese, and juice; contaminated raw fruits, vegetables, and herbs. Consumers and food workers should always take steps to avoid the cross contamination of cutting surfaces and utensils through contact with potentially contaminated products. As a reminder, follow these precautions:

  • Regularly wash, rinse and sanitize display cases, cutting boards, refrigerators, and other food contact surfaces where potentially contaminated products were stored in order to avoid cross contamination of surfaces.
  • Wash hands with hot water and soap following the cleaning and sanitation process.
  • Always wash all leafy greens (e.g., romaine lettuce) with water thoroughly before use.
  • Always store cut leafy greens in the refrigerator under temperature control 41ºF or below.

Symptoms of E. coli

Talk to your healthcare provider if you have symptoms of an E. coli infection: diarrhea that can be bloody, severe stomach cramps, and vomiting. Let them know if you consumed leafy greens or ate at Evergreens in the 10 days before you developed symptoms. Anyone who is ill with suspected E. coli should not work in food handling, patient care, or childcare settings. Ill children with suspected E. coli should not attend daycare until they have seen a healthcare provider and been tested for E. coli infection even if their illness is mild.

More information

For more information about E. coli, visit Public Health’s webpage on Shiga-toxin producing E. coli.

For more information about Public Health’s ongoing investigation of this outbreak, visit our outbreak investigation summary.

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