Abstract
On September 14, 2006, the U.S. Food and Drug Administration (FDA) issued an advisory to consumers not to eat bagged fresh spinach because of suspected contamination by E. coli O157:H71. This advisory was based on information provided to the FDA by the Centers for Disease Control and Prevention (CDC) concerning a multi-state foodborne illness outbreak possibly associated with the consumption of fresh spinach. The FDA also informed the public that E. coli O157:H7 causes diarrhea, often with bloody stools, and urged those who believed they experienced symptoms of illness after consuming bagged spinach to contact their health care providers. The following day, the advisory was expanded to include all fresh spinach because the FDA had been informed that bagged spinach was sometimes sold in an un-bagged form at the retail level. Simultaneously, a series of voluntary recalls of fresh spinach began nationwide, as stores and restaurants quickly removed fresh spinach from their shelves and menus. By then, however, some of the contaminated spinach had already been consumed, with most people having already become ill between August 19 and September 5, 2006. As the investigation continued, the focus narrowed to products from Natural Selection Foods, LLC, of San Juan Bautista, California, with "Best if Used by Dates" of August 17, 2006 through October 1, 2006. On September 20, the FDA issued an updated press release, advising consumers to continue to avoid consuming fresh spinach or products containing fresh spinach. They added however, that it was safe to eat frozen spinach, canned spinach and spinach included in pre-made meals manufactured by food companies. The following day, the FDA issued a statement that they, working closely with the CDC and the State of California, had determined that the spinach implicated in the outbreak had been grown in Monterey, San Benito, and Santa Clara counties in California. The FDA was cautious in stating that produce other than spinach grown in these counties had not been implicated in the outbreak, however, the advisory against eating spinach was still in effect. Finally, on September 22, the FDA advised the public that they could be confident in consuming spinach grown outside the three counties in California that had been implicated in the outbreak. They added that “industry is working to get spinach from areas not implicated in the current E. coli O157:H7 outbreak back on the market”; suggesting that the incident was over. However, as late as October 6, the FDA continued to remind retailers, food service operators and consumers that they should not sell or consume raw spinach or blends that might contain spinach that were “the subject of the earlier recalls.” Ultimately, nearly 200 people in 26 states were reported to the CDC as having potentially been infected with the outbreak strain of E. coli O157:H79. More than 100 of these cases were hospitalized, and 31 developed a form of kidney failure called hemolytic uremic syndrome (HUS). This resulted in the deaths of three people (two elderly women and a two-year old boy) in confirmed cases of infection believed to be associated with the outbreak. Due to the nature, scope, and significance of this contamination incident, and the potential lessons that might be learned from it, the Food Policy Institute (FPI) at Rutgers, the State University of New Jersey undertook an analysis of the information that key actors attempted to deliver as events unfolded, the media coverage of those messages and events, and the information that consumers received, remembered, and acted upon. This report focuses on the third portion of this analysis; that is, what did consumers know, where did they get that information, and what did they do in response to the advisories issued by the FDA warning them not to eat fresh spinach.