An E. coli outbreak originating in St. Louis County has expanded to six other states, with health officials zeroing in on leafy greens as the likely source. The St. Louis County Department of Public Health announced Tuesday that its investigation, which has identified 115 cases and 13 hospitalizations, is nearing completion.
The outbreak has been linked to André's Banquets and Catering, which provided food for multiple events in early November. Whole genome sequencing (WGS) tied 25 of the cases to André's, making it the largest cluster in the outbreak. However, cases in Illinois, Indiana, Kansas, Ohio, North Dakota, and South Dakota share the same genetic profile, suggesting contamination at the supplier level.
"Whether that contamination occurred at the farm or on a truck, that part we don't know," said Amanda Brzozowski, senior epidemiologist and supervisor for the Communicable Disease Investigation program at the St. Louis County Department of Public Health.
The affected events in Missouri included two Rockwood High School band gatherings, two funerals, and a Veterans Day celebration. Genetic data and food histories have consistently pointed to leafy greens as the common exposure factor. Despite these findings, testing of unopened lettuce packages from André's by the Missouri Department of Health and Senior Services yielded negative results for E. coli.
"A negative test result for the lettuce does not conclusively rule out the salad as the source of the E. coli outbreak," health officials clarified in a statement.
The impact of the outbreak has been severe, with three patients developing hemolytic uremic syndrome (HUS), a rare but potentially fatal complication of E. coli infections. Two individuals remain hospitalized, including a child with acute kidney failure, according to Jory Lange, a food poisoning attorney representing several affected families. "We represent a child who is currently hospitalized with acute kidney failure," Lange said, adding, "It's now pretty clear that [the contamination] got contaminated upstream from André's."
André's has consistently denied responsibility, arguing that the discovery of similar genetic material in cases outside Missouri exonerates them. "Two weeks ago, state investigators reported lettuce taken from our facility tested negative for E. coli," said Ed Rhode, a spokesperson for André's Banquets and Catering. "We have said all along that it was unfair to name André's before the lettuce was tested and before the investigation was complete."
At least four lawsuits have been filed against André's in connection to the outbreak. The catering company maintains that it has cooperated fully with investigators and looks forward to the conclusion of the investigation.
Rockwood School District, where some of the earliest cases were identified, has worked closely with health officials to notify affected individuals. "The safety and well-being of our students, staff, families, and community members is something we take very seriously," said Mary LaPak, chief communications officer for the district. "We are also doing everything we can to support those students, staff, and families who are recovering and, in some cases, still hospitalized with this illness."
While the outbreak's spread to other states complicates the investigation, the St. Louis County Department of Public Health remains confident in its findings. "With 25 cases tied to one specific business and no significant increase in new cases expected, we are confident that we are nearing the conclusion of this outbreak investigation," said Dr. Kanika Cunningham, director of the department.
The outbreak highlights ongoing challenges in tracing foodborne illnesses, particularly when contamination occurs far upstream in the supply chain. As health officials finalize their report, the focus remains on preventing future outbreaks and supporting affected families.
"We are immensely grateful for the cooperation of affected individuals and families, particularly those who participated in surveys," Cunningham said. "This data has been essential to our progress and confidence in these findings."
