{
  "slug": "ecoli-fresh-produce",
  "question": "How likely is a US adult to be hospitalized for a serious E. coli infection — including kidney failure (HUS) — from contaminated fresh produce like leafy greens, onions, or carrots?",
  "category": "food",
  "tags": [
    "food",
    "kids"
  ],
  "no_reliable_estimate": false,
  "perceived": {
    "description": "No rigorous survey isolates how people rank their fear of E. coli from salad greens, onions, or carrots specifically. Coverage of recall outbreaks (McDonald's onions, Grimmway organic carrots) is intense and recurring, which tends to inflate the felt likelihood relative to the per-meal base rate. The intuition most people carry is that washed, raw vegetables are a near-zero risk and that meat is the real STEC hazard, which inverts the attribution data: O157 illness now traces more to produce than to beef.",
    "rough_estimate": "Most people would guess serious produce-linked E. coli is vanishingly rare for them personally (well under 1 in 100,000 lifetime), or alternatively over-weight it sharply in the weeks after a televised recall.",
    "kind": "intuition"
  },
  "native": {
    "display": "About 1,175 hospitalizations for produce-attributable E. coli O157 per year among ~335 million people",
    "numerator": 1175,
    "denominator": 335000000,
    "unit": "produce-attributable O157 hospitalizations per US person per year",
    "population": "US population (all ages), annual"
  },
  "normalized": {
    "lifetime_us_adult": 0.000207,
    "display": "About 1 in 4,800 (lifetime, US adult)",
    "log_value": -3.68,
    "assumptions": "Headline counts a HOSPITALIZED (serious) O157 infection attributable to fresh produce, not every mild case. Start from CDC's 2019 burden update: STEC O157 causes ~1,730 domestically acquired foodborne hospitalizations/yr (90% CrI on the underlying illness estimate 31,400–201,000 vs point 86,200). Multiply by IFSAC 2023's 67.9% attribution of O157 illness to vegetable row crops (leafy greens etc.): 1,730 × 0.679 ≈ 1,175 produce-attributable hospitalizations/yr. Divide by ~335M US population = 3.51e-6/yr. Over a 59-year adult horizon (age 18+, site default): 1 − (1 − 3.51e-6)^59 ≈ 2.07e-4 ≈ 1 in 4,830. Uncertainty band scales the EID credible interval (≈0.36× to ≈2.33× the point) onto the lifetime figure: 7.5e-5 to 4.8e-4. Two caveats baked into the band but worth stating: (1) the 67.9% attribution is O157-specific, so non-O157 STEC produce illness (e.g. the 2024 O121 organic-carrot outbreak) is ADDITIONAL burden not counted here; (2) serious O157 and HUS skew toward young children, so applying an all-ages hospitalization rate to an adult horizon modestly overstates the typical adult's risk and understates a toddler's.",
    "uncertainty": {
      "low": 0.000075,
      "high": 0.00048
    },
    "scope": "us_adult_lifetime"
  },
  "sources": [
    {
      "url": "https://wwwnc.cdc.gov/eid/article/31/4/24-0913_article",
      "title": "Foodborne Illness Acquired in the United States—Major Pathogens, 2019",
      "publisher": "CDC, Emerging Infectious Diseases",
      "source_type": "peer_reviewed",
      "statistic": "STEC O157 caused ~86,200 domestically acquired foodborne illnesses/yr (90% CrI 31,400–201,000) and ~1,730 hospitalizations in 2019",
      "excerpt": "STEC O157 caused more (1,730 [55%]) hospitalizations than all non-O157 STEC serogroups",
      "source_date": "2025-04-01",
      "source_accessed": "2026-06-13",
      "archive_url": "http://web.archive.org/web/20260510223909/https://wwwnc.cdc.gov/eid/article/31/4/24-0913_article",
      "calculation_notes": "Provides the serious-outcome denominator: 1,730 O157 foodborne hospitalizations/yr nationally. The illness point estimate 86,200 (90% CrI 31,400–201,000) sets the ±range carried into normalized.uncertainty (≈0.36×–2.33× the point)."
    },
    {
      "url": "https://www.cdc.gov/ifsac/php/data-research/annual-report-2023.html",
      "title": "Foodborne Illness Source Attribution Estimates — 2023 (IFSAC Annual Report)",
      "publisher": "CDC / FDA / USDA-FSIS (Interagency Food Safety Analytics Collaboration)",
      "source_type": "govt_report",
      "statistic": "67.9% of E. coli O157 illnesses attributed to vegetable row crops (leafy greens etc.); 18.6% to beef",
      "excerpt": "Over 85% of E. coli O157 illnesses were attributed to vegetable row crops (67.9%, such as leafy greens) and beef (18.6%).",
      "source_date": "2023-12-31",
      "source_accessed": "2026-06-13",
      "archive_url": "http://web.archive.org/web/20260511082653/https://www.cdc.gov/ifsac/php/data-research/annual-report-2023.html",
      "calculation_notes": "Supplies the produce-attributable fraction (0.679) applied to the 1,730 hospitalizations: 1,730 × 0.679 ≈ 1,175/yr. Attribution is O157-specific and based on 1998–2023 outbreak data; non-O157 STEC produce burden is not included."
    },
    {
      "url": "https://www.cdc.gov/ecoli/outbreaks/e-coli-O157.html",
      "title": "E. coli Outbreak Linked to Onions Served at McDonald's",
      "publisher": "CDC",
      "source_type": "govt_report",
      "statistic": "104 infected across 14 states; 34 hospitalized; 4 developed HUS; 1 death (older adult, Colorado)",
      "excerpt": "Of 98 people with information available, 34 have been hospitalized, and 4 people developed hemolytic uremic syndrome (HUS), a serious condition that can cause kidney failure. One death has been reported from an older adult in Colorado.",
      "source_date": "2024-12-03",
      "source_accessed": "2026-06-13",
      "archive_url": "http://web.archive.org/web/20260619234658/https://www.cdc.gov/ecoli/outbreaks/e-coli-O157.html",
      "calculation_notes": "Illustrative single-outbreak proof point that slivered onions (a fresh produce item) caused serious O157 disease including HUS and death; the 34/104 ≈ 33% hospitalization fraction in an outbreak setting is far above the background rate because outbreak detection skews toward severe cases. Live CDC page confirmed 104/14/34/1 directly; the 4-HUS and 98-with-info sentence was confirmed verbatim via two independent CDC-text search returns plus the restored-CDC mirror."
    },
    {
      "url": "https://www.cdc.gov/ecoli/outbreaks/e-coli-o121.html",
      "title": "E. coli Outbreak Linked to Organic Carrots",
      "publisher": "CDC",
      "source_type": "govt_report",
      "statistic": "48 infected across 19 states; 20 hospitalized; 1 HUS; 1 death (E. coli O121, organic carrots, Nov 2024)",
      "excerpt": "Cases: 48 | States: 19 | Hospitalizations: 20 | Deaths: 1",
      "source_date": "2024-12-18",
      "source_accessed": "2026-06-13",
      "archive_url": "http://web.archive.org/web/20260511120025/https://www.cdc.gov/ecoli/outbreaks/e-coli-O121.html",
      "calculation_notes": "Second proof point and the basis for the non-O157 caveat: this outbreak was E. coli O121 (a non-O157 STEC), which the 67.9% O157 attribution does NOT capture, so the true produce-attributable serious-STEC burden is somewhat higher than the headline. Whole/baby carrots are a fresh produce item; recall was Grimmway Farms."
    },
    {
      "url": "https://pubmed.ncbi.nlm.nih.gov/19827953/",
      "title": "Hemolytic uremic syndrome and death in persons with Escherichia coli O157:H7 infection, FoodNet sites, 2000-2006",
      "publisher": "Gould et al., Clinical Infectious Diseases (PubMed)",
      "source_type": "peer_reviewed",
      "statistic": "6.3% of O157 infections progressed to HUS overall; 15.3% among children <5",
      "excerpt": "A total of 3464 STEC O157 infections were ascertained; 218 persons (6.3%) developed HUS. ... The highest proportion of HUS cases (15.3%) occurred among children aged <5 years.",
      "source_date": "2009-12-01",
      "source_accessed": "2026-06-13",
      "archive_url": "http://web.archive.org/web/20260318061716/https://pubmed.ncbi.nlm.nih.gov/19827953/",
      "calculation_notes": "Basis for the child HUS multiplier: 15.3%/6.3% ≈ 2.4× on the HUS-given-infection axis (distinct from catching the infection). Also grounds the prose claim that kidney-failure risk concentrates in young children."
    }
  ],
  "comparison_anchors": [
    {
      "label": "Food poisoning death (lifetime, US)",
      "lifetime_us_adult": 0.000537
    },
    {
      "label": "Home fire death (lifetime, US)",
      "lifetime_us_adult": 0.00055
    },
    {
      "label": "Plane crash death (lifetime, US)",
      "lifetime_us_adult": 0.000017
    }
  ],
  "personal_factor_multipliers": [
    {
      "factor": "Child under 5 (HUS progression, given O157 infection)",
      "multiplier": 2.4,
      "notes": "On a different axis than the headline: this is the chance an O157 infection progresses to HUS, not the chance of catching it. Gould et al. (FoodNet 2000–2006): 15.3% of O157 infections in children <5 progressed to HUS vs 6.3% overall (15.3/6.3 ≈ 2.4×). Young children carry by far the highest HUS and kidney-failure risk once infected."
    },
    {
      "factor": "Healthy adult (HUS progression, given O157 infection)",
      "multiplier": 0.5,
      "notes": "Protective relative to the all-ages average. The same Gould FoodNet data show HUS progression is lowest in older children and working-age adults; most adult O157 infections resolve without HUS. The ~6.3% overall HUS rate is pulled up by the under-5 and elderly tails."
    }
  ],
  "short_label": "Serious E. coli from fresh produce",
  "outcome_severity": "serious_harm",
  "exposure_pattern": "acute",
  "outcome_type": "serious_permanent_harm",
  "valence": "negative",
  "caveats": "Three structural caveats. (1) Scope mismatch by design: the headline counts a hospitalized (serious) O157 infection, but the 67.9% produce-attribution and the 1,730 hospitalizations are O157-specific. The 2024 organic-carrot outbreak was E. coli O121, a non-O157 STEC not captured by that attribution figure, so the true serious-STEC-from-produce burden is somewhat higher than ~1 in 4,800. (2) Age skew: serious O157 and HUS concentrate in young children and the elderly. Applying an all-ages hospitalization rate to a 59-year adult horizon slightly overstates the typical working-age adult's risk and understates a toddler's — the multipliers address the HUS-progression side of this but not the catching-it side. (3) Episodic exposure: produce-attributable risk is dominated by discrete contamination events (a single contaminated lot of onions or carrots can produce 50–100 illnesses nationally), so the long-run average smooths over a lumpy, recall-driven reality. 8D self-score average is 4.0 with all dimensions ≥3; the main soft spots are D3/D5, where the headline chains two national estimates (burden × attribution) across a US-population denominator rather than a single direct measurement, and the attribution is O157-only.",
  "quality_score": {
    "d1": 5,
    "d2": 5,
    "d3": 3,
    "d4": 4,
    "d5": 3,
    "d6": 4,
    "d7": 4,
    "d8": 4,
    "avg": 4,
    "scored_by": "claude-code-8d",
    "scored_at": "2026-06-13",
    "methodology_version": "8d-v1"
  },
  "reviewer": "8d-eval-2026-06-13",
  "last_reviewed": "2026-06-13",
  "reviewed": true,
  "generated_at": "2026-06-13",
  "image": {
    "alt": "An abstract editorial symbol evoking \"Serious E. coli from fresh produce\", muted two-tone palette, flat vector."
  },
  "attribution": "Likelier — https://likelier.app",
  "license": "https://creativecommons.org/licenses/by-sa/4.0/",
  "support": "https://buymeacoffee.com/kgluszczyk?via=likelier&utm_content=api-fear-single",
  "canonical_url": "https://likelier.app/ecoli-fresh-produce"
}