The Public Health Agency of Canada is collaborating with provincial public health partners, the Canadian Food Inspection Agency, Health Canada, as well as the United States Centers for Disease Control and Prevention (U.S. CDC) and the United States Food and Drug Administration (U.S. FDA), to investigate an outbreak of E. coli infections linked to romaine lettuce in Ontario and Quebec, and several U.S. states.

The current outbreak appears to be ongoing as illnesses linked to romaine lettuce continue to be reported. These recent illnesses indicate that contaminated romaine lettuce may still be on the market, including in restaurants, grocery stores and any establishments that serve food. At this time, the investigation evidence in Ontario, Quebec, and New Brunswick suggests that there is a risk of E. coli infections associated with eating romaine lettuce.

As the risk is ongoing, the Public Health Agency of Canada is advising individuals in Ontario, Quebec, and New Brunswick to avoid eating romaine lettuce and salad mixes containing romaine lettuce until more is known about the outbreak and the cause of contamination. Currently, there is no evidence to suggest that residents in other parts of Canada are affected by this outbreak. The U.S. CDC has also issued communications with similar advice for U.S individuals. The outbreak investigation is ongoing, and this public health notice will be updated as the Canadian investigation evolves.

People infected with E. coli can have a wide range of symptoms. Some do not get sick at all, though they can still spread the infection to others. Others may feel as though they have a bad case of upset stomach. In some cases, individuals become seriously ill and must be hospitalized. The following symptoms can appear within one to ten days after contact with the bacteria:

• nausea
• vomiting
• headache
• mild fever
• severe stomach cramps
• watery or bloody diarrhea

Most symptoms end within five to ten days. There is no real treatment for E. coli infections, other than monitoring the illness, providing comfort, and preventing dehydration through proper hydration and nutrition. People who develop complications may need further treatment, like dialysis for kidney failure. You should contact your health care provider if symptoms persist.