Canada – Public Health Notice: Outbreak of Cyclospora infections linked to salad products

PHAC

The Public Health Agency of Canada (PHAC) is collaborating with provincial public health partners, the Canadian Food Inspection Agency (CFIA) and Health Canada to investigate an outbreak of Cyclospora infections occurring in three provinces. The outbreak appears to be ongoing, as recent illnesses continue to be reported to PHAC.

Based on the investigation findings to date, exposure to certain Fresh Express brand salad products containing iceberg lettuce, carrots and red cabbage, has been identified as a likely source of the outbreak. Some of the individuals who became sick reported having eaten Fresh Express brand salad products containing these ingredients before their illnesses occurred. The source of illness for the remaining individuals continues to be under investigation. The investigation is ongoing and this public health notice will be updated as the investigation evolves.

On June 28, 2020, the CFIA issued a food recall warning for certain Fresh Express brand salad products containing iceberg lettuce, carrots and red cabbage that were distributed nationally in Canada. The recalled salad products begin with lot code “Z177” or a lower number and have best before dates up to and including 20JUL08 – 20JUL14. For more information on the recalled product, please consult the CFIA’s website.

Canadians are advised not to eat the recalled products. Retailers and food service establishments are advised not to sell or serve the recalled products, or any items that may have been prepared or produced using these products.

The CFIA is continuing its food safety investigation, which may lead to the recall of other products. If additional products are recalled, the CFIA will notify the public through updated food recall warnings.

The U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration are also investigating a multi-state outbreak of Cyclospora infections that has been linked to bagged salad mixes containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express.

Investigation summary

As of July 8, 2020, there are 37 confirmed cases of Cyclospora illness linked to this outbreak in three provinces: Ontario (26), Quebec (10) and Newfoundland and Labrador (1). Individuals became sick between mid-May and mid-June 2020. One individual has been hospitalized. No deaths have been reported. Individuals who became ill are between 21 and 70 years of age. The majority of cases (76%) are female.

Some of the individuals who became sick reported having eaten certain Fresh Express brand salad products containing iceberg lettuce, red cabbage and carrots before their illnesses occurred. The source of illness for the remaining individuals continues to be under investigation.

Cyclospora infections occur each summer in Canada. PHAC is working with provincial partners to determine if other recent cases of Cyclospora infection are linked to this outbreak.

It is possible that more recent illnesses may be reported in the outbreak because of the period between when a person becomes ill and when the illness is reported to public health officials. For this outbreak, the illness reporting period is between two and four weeks.

Epidemiological information

Figure 1 below is an epidemiological curve for this outbreak. Outbreak investigators use this information to show when illnesses begin, when they peak, and when they trail off. It can take several weeks from the time a person becomes ill to when the illness is reported and testing confirms a link to the outbreak. Data are available for 37 cases.

Figure 1: Number of people infected with Cyclospora

epi curve 37 cases

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