The recent E. coli food poisoning outbreak linked to imported green leaves and salads shows a trend towards vegetables as an additional source of E. coli.

The outbreak, which has claimed two lives and made 144 ill, has been linked mainly to catering and residential care businesses. As a result, Public Health England has stopped a small number of wholesalers from adding imported leaves to their mixed salad products as a ‘precautionary’ measure.

The important message so far is to look at your salad products and check whether it says ‘Ready to Eat’. Sometimes it’s not clear. But if it doesn’t say ‘Ready to Eat’ it will need to be washed.

In the past, meat has been considered the main source of E. coli but clearly from this and other outbreaks – such as the deaths of 49 people in Germany and France linked to Fenugreek seeds and beans – we also need to be careful with fruit and vegetables.

Why we seem to be having more E. coli outbreaks related to vegetables is not clear. It could be because the bugs are evolving, or the fact that we are importing more food, or that it has to travel further and between more points of contact so there is more opportunity for contamination.

Good hand and food hygiene practices at all times continue to be important. But caterers should remove any loose soil before storing vegetables and thoroughly wash all vegetables (including salads) that will be eaten raw unless they have been pre-prepared and are specifically labelled ‘Ready to Eat’. This should reduce the risk of infection from any E. coli contaminated vegetables, fruit and salad but will not eliminate any risk of infection completely.

E. coli food poisoning results in diarrhoea, which may be bloody, and stomach cramps and sometimes vomiting. Its onset is between one and 14 days after exposure although symptoms usually start between three and four days after.

While some people can be exposed and not develop any symptoms, a small number of people can be very badly affected and go on to develop a serious condition called haemolytic uraemic syndrome. HUS can lead to kidney failure and death and the risk is higher in very young children.

In the current outbreak HUS has affected seven patients, which includes the two people that died. Four people remain in hospital. While the outbreak has affected the whole of the country these are in clustered outbreaks with a focus on the South West, South East and North West of England.

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