updated 9/22/2006 8:00:28 AM ET 2006-09-22T12:00:28

Like fine wine and cheese, spinach could be labeled with a place of origin to reassure shoppers jittery about an E. coli outbreak linked to leafy greens grown in California.

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Federal health officials said Thursday that more explicit labeling was just one proposal under consideration for allowing fresh spinach back on the market. Others include stepped-up regulation of how spinach is grown and processed.

"Clearly, we do not want to deny consumers access to spinach," said Dr. David Acheson of the Food and Drug Administration's Center for Food Safety and Applied Nutrition. "Wherever it's grown, our responsibility is to make sure whatever does end up on the shelf is safe."

As of Thursday, the outbreak had sickened 157 people, killing one, according to the Centers for Disease Control and Prevention. Two more deaths were being investigated for possible links to tainted spinach. Idaho officials were probing the death of a 2-year-old on Wednesday, reportedly after eating spinach, the CDC said.

An 86-year-old Maryland woman died last week after becoming infected with E-coli. Her family says she had eaten fresh spinach before getting sick.

Since the FDA announced the E. coli outbreak a week ago, the agency has urged people not to eat fresh, raw spinach.

Federal and state officials have traced the outbreak to contaminated spinach from California's Monterey, San Benito and Santa Clara counties. The region produces more than half the nation's spinach crop.

A nationwide embargo on fresh spinach remains, enraging producers.

Acheson told reporters it could days more to figure out a way to allow spinach from outside California's greater Salinas Valley back in stores and restaurants. If labeling is the answer, one problem would be how to communicate to shoppers that the spinach came from an area not implicated in the outbreak, Acheson said.

"There is currently intense activity with industry and the state of California to develop appropriate language for consumers," Acheson said.

A bag of tainted Dole baby spinach found in the refrigerator of a New Mexico patient was a "smoking gun" that allowed investigators to zero in on farms in the Salinas Valley.

The spinach tested positive for the same strain of E. coli linked to the outbreak. Dole is one of the brands of spinach recalled late last week by Natural Selection Foods LLC of San Juan Bautista, Calif.

River Ranch Fresh Foods, of Salinas, Calif., and RLB Food Distributors, of West Caldwell, N.J., have both recalled products that included Natural Selection spinach.

Anyone who's eaten spinach and is feeling nervous about what to do, the answer is: nothing, just wait, Dr. Patricia Griffin, of the CDC, told doctors Thursday during a conference call.

E. coli typically has taken three days to incubate in patients in the current outbreak, though it can take as long as 10 to 12 days, said Dr. Phillip Tarr of the Washington University School of Medicine in St. Louis.

Anyone who does go on to develop diarrhea, especially bloody stools, and suffer severe abdominal cramps should see a doctor. Doctors should order a stool culture that looks specifically for the E. coli O157:H7 strain of the bacteria, Griffin said.

E. coli patients shouldn't take diarrhea medications like Imodium because they can cause complications. The same goes for antibiotics: No study has demonstrated any benefit to using antibiotics to treat E. coli, while multiple studies have suggested possible harm, Tarr said.

Tarr recommended hospitalization and intravenous fluids for serious patients. Hospitalization would also help prevent the spread of infection — something seen in about 10 percent of cases in the past.

"People with E. coli infection — even adults — are biohazards," Tarr said.

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