What Consumers Want from Sprouts Going Forward

Laurie Girand
Advisory Board Member, S.T.O.P. --Safe Tables Our Priority
Public Meeting on Sprout Safety
Washington, DC
September 28, 2025

As mentioned, my name is Laurie Girand. Two years ago, in the fall of 1996, my daughter Anna almost died from complications known as Hemolytic Uremic Syndrome or HUS as a result of a being poisoned with E. coli O157:H7. Since Anna's illness, I have devoted virtually all of my spare time to understanding foodborne illness. This turned out to be useful, when this last March, my husband picked up a severe and painful diarrheal illness while traveling abroad. When cultured, it turned out to be Campylobacter, a foodborne illness commonly associated with poultry that can result in long term chronic arthritis.

As a result of my work in this area, I joined an organization called S.T.O.P., Safe Tables Our Priority, which consists of victims of foodborne illness, their family and friends who are committed to ensuring that the foodborne tragedies they have experienced are not needlessly repeated. I am on S.T.O.P.'s Advisory Board, and I run its produce programs. We are here today to explain the human side of the numbers and charts that you have been hearing about, the human cost of outbreaks that is not typically measured, the experiences that are lost. To epidemiologists and doctors at the CDC and to investigators at FDA, we are numbers and percentages. But we have faces, and I'd like to share with you some of these experiences.

What is HUS, anyway? Between 1 and 10 and 1 and 20 children infected with E. coli O157:H7 develop Hemolytic Uremic Syndrome which is a blood disorder, caused by a poison put into the bloodstream by the organism. Red blood cells are shredded, and the number of free platelets falls, as clots form and plug up capillaries. Contrary to what you may have read, the kidneys are merely the first part of the body to fail, clogged with clots and overworked trying to excrete the clots and cell fragments. The victim becomes prone to uncontrolled bleeding in all parts of the body. Every organ suffers damage, including the heart, the pancreas, and the brain. Victims can suffer strokes, blindness, coma, death. The average hospital stay is two to four weeks with some hospitalized for months. The autopsies of those who die describe their organs as having been liquefied.

Here is a face for you. This is 5 year old Haylee. One night in June of 1996, Haylee, who was 3 at the time; Haylee's 7 year old sister, Chelsea; and Haylee's Mom all developed severe cramps and frequent, watery diarrhea which continued day and night. Within the next two days, the Mom improved but the two girls got worse. On Saturday, Haylee developed some blood in her diarrhea so her mother took her and Chelsea in to see the doctor who was not overly concerned and sent them home. On Sunday, they again went to see their physician and were again sent home. That evening, the parents took the children, who had become quite dehydrated and inconsolable, to the hospital, and they were finally admitted for observation. It was the parents who cautiously and intuitively suggested that perhaps it could be an E. coli infection. Indeed, stool cultures revealed that the children had E. coli O157:H7. Over the next day, Chelsea improved, but the doctors grew concerned that Haylee was developing HUS and wanted to transfer her to another hospital. The parents were told they could not ride with their three year old in the ambulance. Chelsea cried as her parents and sister left on Monday, July 1st.

Haylee's Mom slept every night at the hospital. Haylee's father left his job to emotionally support his family and wife. At the second hospital, Haylee stopped urinating. They tried to do peritoneal dialysis, in which doctors cut a hole in the abdominal cavity, insert a tube and then pour fluid in with the hope that the wastes building up in the blood will leach into the cavity and can be siphoned out. Note that because of severely depleted platelets, surgery is particularly dangerous for these patients because they may just bleed and bleed and bleed. However, in this case, Haylee's diaphragm had holes in it which caused the dialysis fluid to leak into her chest, so instead they had to insert a catheter in her neck and perform hemodialysis for three hours every other day. In this first week at the new hospital, she had been lethargic, and she went into shock. She was put on a ventilator. But then, because she was little and couldn't lie still, the ventilator tube kept hitting her windpipe and caused her windpipe to swell, so they removed the ventilator as soon as they felt she could breathe on her own.

Haylee needed more nutrients than IV bags could provide. When they went to put in a blood line for intravenous nutrients, she vomited and inhaled her own vomit. This caused pneumonia which proceeded to respiratory failure, from which only 60% of children survive. She was put back on the ventilator. They inserted tubes into her chest to drain the fluid around her lungs. As a result of the nutritional supplements, Haylee's blood sugar level skyrocketed, and she was put on insulin. She subsequently became insulin dependent. Sometimes, when they thought the parents couldn't overhear them, even the nurses were crying.

Haylee came off of dialysis in mid-August. On August 27th, she suffered a seizure which led the doctors to discover that she had massive bleeding in her brain which required five hours of brain surgery. She remained in the hospital for another month. When she returned home on October 4th, more than three months after she was admitted, she was blind and had to take 12 medications every day. Gradually, with therapy, she learned to walk again, and her vision improved. Now, two years later, she is on one medication, has significant vision impairment, has some right side weakness and has fine motor problems. Her kidneys are not clearing her body of wastes at normal rates. Her mother describes Haylee as the most wonderful, loving child you will ever meet.

Through epidemiology, it was later learned that Haylee and her family were poisoned by lettuce contaminated with E. coli O157:H7. The lettuce was certified organic and shipped to Connecticut from California.

You need to understand that if someone you know gets a foodborne illness, it is highly probable that he or she will be mistreated or misdiagnosed. Antibiotics, antimotility drugs and narcotics are all believed to hasten the probability of HUS complications in an E. coli O157:H7 infection. Yet, these are commonly prescribed for diarrheal illnesses in the US. As can be seen in Haylee's case, physicians frequently do not recognize the severity of the illness. In the Odwalla apple juice outbreak, at least two children were turned away from emergency rooms for this reason. In my own daughter's case, her stool was tested only for Shigella, Campylobacter and Salmonella because the lab decided her stool wasn't bloody enough to be caused by E. coli O157:H7. We were told that we were not part of a larger outbreak. Later, they would find the E. coli O157:H7 in her stool had the same genetic fingerprint as that found in Odwalla apple juice.

Here's another face. This is Ann. In 1988, Ann was a 32 year old, active mother of four, whose youngest child was 1.5 years old. She was the healthy eater in her family, always eating fresh fruit and vegetables and trying to convince her kids to do the same, though they were much pickier eaters. During this year, she had diarrhea off and on for three months and was losing weight. Though she could still function, she never wanted to be far away from home. When she was finally diagnosed with Salmonella, the doctors had to be careful about which antibiotic they prescribed because she is severely allergic to penicillin. Indeed, for this illness, she had to have two courses of antibiotics, because she was still testing positive for Salmonella after the first course was completed. After the treatments she developed a constant ache in her right side below the rib cage. Though she had no other signs of gall bladder disease, the physicians treating her were convinced it was caused by Salmonella, which given how long she had carried it, would have established itself in the intricate network of blood vessels in the gall bladder. Despite her fears of surgery, her gall bladder was removed The gall bladder is responsible for producing bile and enzymes that aid in digestion. To this day, Ann cannot digest meals the way you and I do. For the rest of her life, if she eats a large meal one night, such as a Thanksgiving dinner, she will still feel full the next day because her digestive tract does not move food along the way ours does. After the surgery, she was hospitalized for a week with severe pain, lost significant weight, and came home, according to her, "looking like a cadaver". Thus, ended, what for her was a year of chronic illness. The pain was gone. Everyone was telling her "it must have been chicken." This was common in the late 1980's when produce had not yet been associated with fecal contamination.

In June of 1996, Ann is now 40 and has a fifth child who is three years old. She's still trying to get her kids to eat healthy foods. They've gone to the swimming pool, and she's taking orders for sandwiches which she plans to get from a local grocery store deli. She remembers telling her kids, "Hey guys, don't you want something green on your sandwiches? Don't you want a little lettuce or sprouts? Thank God, no one took me up on it." That night, after fixing a dinner the whole family eats, she feels a little under the weather when getting the kids put to bed. At 2:00 a.m., she awakens with diarrhea and terrible stomach cramps that she likens to labor pains. She is deathly ill and has a fever of 102. By 5:00 a.m., she has had so much diarrhea that she is hemmorhaging. Her doctor recommends that she go to the Emergency Room, but she can't finish talking to him because she has to go back to the bathroom. She and her husband scramble to find someone who can watch the kids. In the Emergency Room, they give her two bags of IV fluids even though ten hours before she was perfectly hydrated. They ask for a stool sample, and she remembers handing it to them and saying "Oh, this won't work, all there is is blood." Then, they send her home. It never occurs to her that it might be Salmonella because the experience is so different from that of the previous illness.

That afternoon, they call to confirm that Ann has gotten Salmonella again and to prescribe an antibiotic. The next night, the evening news confirms what the county will soon determine by matching the Salmonella in Ann's stool to that of others. Ann is a victim of Salmonella food poisoning from alfalfa sprouts. Sprout growers in California are briefly shut down, and the grocery store where she bought the sandwiches pulls them off of the shelves.

As of today, Ann doesn't eat sprouts at all. If she orders a salad in a restaurant, she tells them she doesn't want the sprouts. And if they give her a salad with sprouts by mistake, she sends the whole salad back and tells them to do it over again.

Let me ask if you are familiar with the disease Listeria? As has been mentioned, there was a Listeria-related recall of many different kinds of sprouts in the last month. Listeria can create asymptomatic infections in pregnant women. A woman can have a perfect pregnancy, have an amnio with results indicating the baby is fine, appear to be perfectly healthy, and then find, half way through her pregnancy or even close to delivery, that her baby has died. She then has a choice of whether to use a dilation and extraction procedure to remove the baby's body by sucking it out through a tube or she can experience the pain of chemically induced labor to give birth to a body that is already dead. Babies born with a Listeria infection can develop meningitis, a dangerous infection of the lining of the brain. When autopsies are performed, pathologists may not even test for Listeria, specifically because it is considered less common. As a result, epidemiologists largely do not investigate undiagnosed stillbirths, and outbreaks of Listeria largely go undetected.

To give you an idea of how far the numbers and data you've been shown so far today get from the real individuals and their experiences, I tried to get some very basic information about the victims of a single alfalfa sprout outbreak. I wanted to understand how young they were, how old they were, and whether the outbreak might have been responsible for maiming children, requiring gall bladders be removed, or perhaps killing someone. In essence, I wanted to understand the breadth and depth of the victims' experience in a sprout outbreak. I called the CDC and the Virginia State Health Department to gather further information on the victims of the E. coli O157:H7 outbreak associated with sprouts that occurred in the summer of 1997 in Michigan and Virginia. I asked two simple questions: what were the ages of all of the victims and what were their final conditions.

The bottom line is that this data is not easily available because at these levels, victims continue to be numbers. Epidemiologists study victims only so that they can identify the source of the outbreak. They put victims of a common outbreak into two groups: those they study and everyone else. In Virginia, the age of each victim is trapped on a computer of someone who has since moved to another job. Therefore, what we know about the Virginia victims is minimal. Their ages ranged from 1 to 71 years. Of the twenty enrolled in the state's study, 90% reported bloody diarrhea. 43% required hospitalization. Out of all of the victims, at least one girl developed Hemolytic Uremic Syndrome.

You might wonder why a one year old would appear to be eating sprouts. In reality, it looks as though in both states, there were secondary infections. For many of these illnesses, victims can go through a phase where they are no longer symptomatic but are still shedding organisms and can be infectious. A secondary infection occurs, for example, when an infected parent touches their child and thereby infects their daughter or son. Or a secondary infection can occur when a parent sends a child to a lake and the child swallows contaminated water in which an infected child has defecated. So a victim did not need to personally eat sprouts to necessarily share in the impact of the outbreak. What this means for parents is that there are lots of ways to give your children lifethreatening foodborne illness, and all parents need to be vigilant.

The CDC had the ages of the individual Michigan victims, but it was easier to find the ages of the victims that were studied. The rest of the ages were available but it would have taken awhile to get find them. Their ages ranged from 4 to 79. Of the thirty that were enrolled in a study, 97% reported bloody diarrhea, and 53% were hospitalized. Out of all of the vicitms, two people, age 7 and 21, developed HUS. One 64 year old developed TTP, an adult version of HUS. That person was followed up this last April and was in critical condition and still on kidney dialysis. The opinion of the epidemiologist that was in contact with the victim's family was that she could be dead now given her condition as of April but no one had followed up since.

Yet, after the epidemiologists pack up their statistical software and portable computers and publish their reports, for victims of many of these foodborne diseases, the long term consequences are what matter. As you've seen, a year passed before Ann finally had her gall bladder removed. Haylee's recovery is not complete. All HUS survivors suffer the risk of complete kidney loss in adulthood, maybe decades later after what can appear to be a "complete" recovery. They can also develop gallstones, diabetes, colon and intestinal problems, and heart problems. So the information you get from epidemiologists today, these figures that describe all the victims as recovered, are highly misleading. The epidemiologists give you only a snapshot of one moment in time, perhaps even before subsequent severe cases are identified.

So given all that we don't know, what do we know? We know that sprouts are only healthy for you if they don't make you deathly ill. We know that in all likelihood, the cases detected by epidemiologists represent a fraction of the total people infected or sickened. Think about how sick you have to be with a diarrheal illness before you go to see a doctor, and you get the idea. We also know that the outbreaks identified are a fraction of those that are actually caused. We know it takes fewer than ten organisms, perhaps as little as a single organism of E. coli O157:H7 to cause deadly illness. Think about that the next time you shake hands with someone, the next time you use a public toilet seat, or the next time you go swimming and get water in your nose. We know the FDA and California State Department of Health have issued press releases advising at-risk groups to not consume alfalfa sprouts. We also know that there are members of the sprout industry who are legitimately concerned and are trying to take steps to improve the situation.

But this is not enough.

May I ask how many of you are parents? Thank you. And how many of you are children? We live in a society of warnings which we choose to read or disregard at will. There are warnings about inhaling gasoline fumes at gas pumps. There are warnings about putting a child in a seat with an airbag and how to secure a child's carseat. There are warnings about the effects of alcohol on a fetus. There are warnings about the side effects of medicines. There are warnings about riding bicycles with helmets. There are safehandling labels on meats. And, obviously, there are warnings on poisons. As a parent, I take each and every one of these into account when I look at my child's longterm health consequences. Yet, the single greatest crisis in my family's life was the one for which I received absolutely no warning. That unpasteurized juice could harbor organisms that would try to kill my daughter. My mother consumed the same juice, and it is by the grace of God that I did not lose both my mother and daughter in the fall of 1996.

You, as parents, can understand that I was distraught when I learned that the FDA and the CDC had known for years that unpasteurized juices were making people sick. Their response through that time: fund more research and tell industry to do some cleanup. In doing so, they robbed me of my right to protect my family by refusing to share with me what they knew: that more outbreaks were likely to occur. They also sentenced my daughter to a lifetime of health uncertainty.

S.T.O.P. is united in its efforts to ensure that consumers will not be repeatedly misled into believing that a food is healthier when it can cause potentially deadly illness in a matter of hours or days. We support the FDA and State of California's press releases warning at-risk consumers against consuming alfalfa sprouts until they are deemed safe. We expect the FDA to add pregnant women to the list of at-risk groups as the recent evidence of Listeria has shown they are at-risk. Press releases are good, but we must do better. Information must be placed where at-risk consumers will encounter it in order for them to be able to execute informed choices about their risks. Until sprouts can be made safely, e are asking FDA to introduce an expedited ruling to place warning labels on sprouts, whether packaged, sold in bulk or as part of prepared foods through delis or restaurants. We are asking that FDA meet with the American Academy of Pediatrics to ensure that parents are warned through their pediatricians that until further measures are taken, alfalfa sprouts represent a serious risk. We, and we believe you, do not want naive parents throwing alfalfa sprouts into a salad for a school potluck.

S.T.O.P.'s position on any produce that is served ready-to-eat is that there must be a zero tolerance for an infectious dose level of pathogens. As a result, we cannot be supportive of efforts that merely reduce organisms such as O157:H7 down to a single bacterium only to encourage it to grow back again 10,000 or 100,000 times. The suggestion that consumers or industry can achieve safe produce by rinsing off pathogens with water defies both scientific evidence and reason when addressing highly infectious pathogens.

We understand that the evidence of sprout contamination points to the seed itself. It is largely recognized that if the seed cannot be made safe, sprouts cannot be made safely. If, after the conclusion of this meeting, there is a consensus that there is a technology that would result in a dramatic reduction of organisms, preferably a complete elimination of them, we would advocate that it be required of all companies immediately. If a technology superior to this consensus becomes available, we will support FDA moving quickly to implement it.

We applaud the efforts of the sprout industry to introduce sanitary procedures, but we cannot support self-policing alone. All industries have low quality producers, and this industry is no exception. The slides from California's investigations show rusty ceilings dripping into sprout beds; rodent feces on the ground near seed; dirty bins being stacked on top of open seed containers. To imagine that all producers will comply with voluntary anything is to waste valuable time and continue to jeopardize consumer safety and, to be frank, industry economics. The sprout industry was given warnings and guidance by FDA years ago, yet outbreaks continue to be caused by producers.

In addition to pathogen-free seed, the FDA must impose mandatory HACCP on sprout suppliers as soon as pathogen-free seed is available, and not in two years or three years. We must have end product testing to ensure consumer confidence in this product. The Western Growers Association and United Fresh Fruit and Vegetables Association should insist that these steps be taken to ensure safe sprouts; without these steps, outbreaks are likely to continue. Multiple, continuing outbreaks from sprouts, a supposedly healthy product, will have a deleterious effect on the markets for other fresh produce, especially if other vegetables are mistakenly associated with sprout-caused disease because they are found in salads with sprouts.

Lastly, S.T.O.P. will be asking for mandatory traceback data which would address both seed lots and sprout batches and lots so to assist investigators in quickly identifying contamianted sprouts in order to pull them off of shelves and thus reducing the impact of an outbreak that is underway.

Let me suggest that this path might sound hard, but if pathogen-free seed can be achieved, and if the industry executes these steps quickly (interim labeling, mandatory HACCP, traceback), it is quite possible that sprouts could achieve a market position that other forms of produce cannot achieve. Not only could sprouts be healthy for the average consumer but because they can be grown with pathogen-free water and without soil, manure or other accidental animal involvement, they have the potential to be one of the safest forms of produce on the market.

S.T.O.P. believes that we are all in agreement that we need to move forward quickly. However, we are concerned that exactly

• how quickly,
• whether we will apply regulations uniformly to all sprout growers, and
• whether we will inform consumers

may be questions you are still debating. We ask only that government and industry consider the obvious: we should not wait so long to institute precautions and warnings that more people die when we all knew such a tragedy could happen. Let us all commit ourselves to no more illnesses or injuries from sprouts, starting today.

Thank you very much.