"FDA Foodborne Illness Outbreak Investigation Update."  There is new information available on this topic at the URL below, and for your convenience the update is also provided below. New information is in bold.

http://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm470410.htm

FDA Investigates Multistate Outbreak of E. coli O26 Infections Linked to Chipotle Mexican Grill Restaurants

December 22, 2015

The U.S. Food and Drug Administration along with the Centers for Disease Control and Prevention (CDC) and state and local officials are investigating an outbreak of E. coli infections.

Update: December 22, 2015

• The FDA, CDC, and state and local officials are investigating a second, more recent outbreak of a different, rare DNA fingerprint of Shiga toxin-producing Escherichia coli O26 (STEC O26) linked to Chipotle Mexican Grill restaurants.
• The CDC reports that five people have been reported with the new variant of STEC O26 from a total of three states: Kansas (1), North Dakota (1), and Oklahoma (3).
• The Kansas and North Dakota cases ate at the same restaurant in Kansas. The three separate Oklahoma cases all ate at the same Chipotle restaurant.
• As of December 18, 2015, 53 people infected with the previously reported outbreak strain of STEC O26 have been reported from nine states: California (3), Illinois (1), Maryland (1), Minnesota (2), New York (1), Ohio (3), Oregon (13), Pennsylvania (2), and Washington (27).
• The epidemiologic evidence available at this time suggests that a common meal item or ingredient served at Chipotle Mexican Grill restaurants in several states is a likely source of both outbreaks.
• The investigations are still ongoing to determine what specific food is linked to illness.

What is the Problem and What is Being Done About It?  

The FDA and the Centers for Disease Control and Prevention (CDC) along with state and local officials are investigating two separate outbreaks of E. coli O26 infections that have been linked to food served at Chipotle Mexican Grill restaurants in several states.

As of December 4, 2015, the CDC reports a total of 52 people infected with the outbreak strain of STEC O26 from a total of nine states: California (3), Illinois (1), Maryland (1), Minnesota (2), New York (1), Ohio (3), Oregon (13), Pennsylvania (1), and Washington (27). There have been 20 reported hospitalizations. There have been no reports of hemolytic uremic syndrome (HUS) and no deaths. Of the three most recent illnesses reported in November, only one ill person, whose illness started on November 10, reported eating at Chipotle Mexican Grill in the week before their illness began. The majority of these cases were reported from Oregon and Washington during October 2015.

Investigators are also using whole genome sequencing, an advanced laboratory technique, to get more information about the DNA fingerprint of the STEC O26 bacteria causing illness. To date, whole genome sequencing has been performed on STEC O26 isolates from 21 ill people from California (2), Minnesota (2), New York (1), and Washington (16). All 21 isolates were highly related genetically to one another. This provides additional evidence that illnesses outside the Pacific Northwest, could be related to the illnesses in Washington .

Chipotle Mexican Grill closed 43 restaurants in Washington and Oregon in early November 2015 in response to the initial outbreak. All these restaurants reopened in November 2015. Chipotle Mexican Grill worked in close consultation and collaboration with health officials throughout the investigation to determine whether it was appropriate to reopen these restaurants. Chipotle reports taking the following actions, among others, prior to opening:

• Confirming that all microbial testing performed by the company did not yield E. coli (more than 2,500 tests of Chipotle's food, restaurant surfaces, and equipment all showed no E. coli)
• Confirming that no employees in these restaurants were sickened from this incident
• Expanded testing of fresh produce, raw meat, and dairy items prior to restocking restaurants
• Implementing additional safety procedures, and audits, in all of its 2,000 restaurants to ensure that robust food safety standards are in place
• Working closely with federal, state, and local government agencies to ensure that robust food safety standards are in place
• Replacing all ingredients in the closed restaurants
• Conducted additional deep cleaning and sanitization in all of its closed restaurants (will conduct deep cleaning and sanitization additionally in all restaurants nationwide)

The FDA, CDC, and state and local officials began investigating an outbreak of a different Shiga toxin-producing Escherichia coli O26 (STEC O26) linked to Chipotle Mexican Grill restaurants during December 2015. This outbreak has a rare DNA fingerprint, which is different from the larger, previously reported outbreak. It is not known at this time if these infections are related to the previously reported outbreak. Because it is not known if these infections are related to the previously reported outbreak of STEC O26 infections, these illnesses are not being included in the case count for that investigation. Interviews were conducted with five ill people, who all reported eating at Chipotle Mexican Grill restaurants. Whole genome sequencing is being used to see this strain is genetically related to the STEC O26 that caused the larger outbreak. This investigation is ongoing.

The FDA continues to work with Chipotle Mexican Grill restaurants as well as federal, state and local agencies to gather information about the supply chain(s). The FDA will continue to provide updates on the investigation as they become available.

What are the Signs & Symptoms of E. coli O26?

• People usually get sick from STEC (Shiga toxin-producing E. coli) 2-8 days (average of 3-4 days) after swallowing the organism (germ).
  • Most people infected with STEC develop diarrhea (often bloody) and abdominal cramps.
  • Most people recover within a week.
• Some illnesses last longer and can be more severe, resulting in a type of kidney failure called hemolytic uremic syndrome (HUS).
  • HUS can occur in people of any age, but is most common in young children under 5 years, older adults, and people with weakened immune systems.
  • Symptoms of HUS can include fever, abdominal pain, pale skin tone, fatigue and irritability, small, unexplained bruises or bleeding from the nose and mouth, and decreased urination.
  • People who experience these symptoms should seek emergency medical care immediately.
• STEC infection is usually diagnosed by testing of a stool sample for Shiga toxins.
  • Clinical laboratories are required in some states to send Shiga toxin-positive specimens from ill people to the state public health laboratory for identification of STEC and PulseNet testing.

Who is at Risk?

People of any age can become infected. Very young children and the elderly are more likely than others to develop severe illness and HUS, but even healthy older children and young adults can become seriously ill. In this particular outbreak, the age range of ill patients is 1 - 67 years.

What Do Consumers Need To Do?

Consumers who have recently become ill after eating at a Chipotle should contact their health care provider.

Who Should be Contacted?

Contact your healthcare provider if you have diarrhea that lasts for more than 3 days, or is accompanied by high fever, blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine.

The FDA encourages consumers with questions about food safety to call 1-888-SAFEFOOD Monday through Friday between 10 a.m. and 4 p.m. Eastern time, or to consult the FDA website.