Cyclospora, officially known as Cyclospora cayetanensis, is a type of parasite which uses the human gut as its host. The parasite enters the human body by being ingested with fresh fruits, vegetables, or water, at which point the parasite begins to live and multiply in the gut.
The U.S. Food and Drug Administration’s (FDA) reports that the investigation of the Fresh Express Bagged Salad Cyclospora Outbreak continues, as the CDC reports increasingly greater numbers of confirmed cases of infection. The last investigation report published by the FDA concerning the Fresh Express Cyclospora Outbreak, on June 28, 2020, accounted for 206 confirmed cases of Cyclospora infection. As of July 8, 2020, the FDA announced that the number of confirmed cases have jumped to a total of 509, across 8 states. Furthermore, health officials report that the outbreak has even stretched across the borders of the U.S. to three provinces of Canada, Ontario (26), Quebec (10) and Newfoundland and Labrador (1).
Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a large form of cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans. The first known human cases of illness caused by Cyclospora infection (that is, cyclosporiasis) were first discovered in 1977. An increase in the number of cases being reported began in the mid-1980s, in part due to the availability of better diagnostic techniques. Over 15,000 cases are estimated to occur in the United States each year. The first recorded Cyclospora outbreak in North America occurred in 1990 and was linked to contaminated water. Since then, several cyclosporiasis outbreaks have been reported in the U.S. and Canada, many associated with eating fresh fruits or vegetables. In some developing countries, cyclosporiasis is common among the population and travelers to those areas have become infected as well.
In 2018, CDC was notified of 511 laboratory-confirmed cases of Cyclospora infections in people from 15 states and New York City who reported consuming a variety of salads from McDonald’s restaurants in the Midwest.
On July 26, 2018, the FDA completed final analysis of an unused package of romaine lettuce and carrot mix distributed to McDonald’s by the Fresh Express processor in Streamwood, IL. The analysis confirmed the presence of Cyclospora in that sample.
A troublesome Cyclospora outbreak continues to grow in North America with 37 confirmed cases in Canada added to 206 in the midwest United States. Cyclospora is a coccidian parasite that causes diarrheal disease in humans called cyclosporiasis.
The update today involves an outbreak of Cyclospora infections traced to Fresh Express bagged garden salad products containing lettuce, carrots, and red cabbage.
As of July 8 there are 37 confirmed cases of Cyclospora illness linked to this outbreak in three Canadian provinces: Ontario (26), Quebec (10) and Newfoundland and Labrador (1). Canadians became sick between mid-May and mid-June. One Canadian 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 percent, are female.
Just one day after the Public Health Agency of Canada announced its investigation into 37 cases of Cyclospora in three Canadian provinces, the CDC made its own announcement – there were now 509 confirmed cases in this Cyclospora outbreak. Both countries have issued recalls of the Fresh Express salads that are believed to the source of this bagged salads outbreak. As of July 1, 2020, 33 people have been hospitalized.
As of July 8, 2020, the states associated with this outbreak include: Illinois (151), Iowa (160), Kansas (5), Minnesota (63), Missouri (46) Nebraska (48), North Dakota (6), and Wisconsin (30).
The investigation is still ongoing in both countries.
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
The recall of Fresh Express salad products in Canada for possible cyclospora contamination has been updated to include the correct UPC numbers, package sizes, and expiration dates. No illnesses have been reported in Canada, but there is a cyclospora outbreak in the U.S. potentially linked to Fresh Express salads.
All of the recalled products have a lot code beginning with “Z 177” or a lower number. They are all Fresh Express brand. The corrected numbers are labeled with a *.
The recalled salads are Chopped Kit Chipotle Cheddar in 323 gram packages with UPC number 0 71279 30931 6* and all best before dates up to and including July 8*, 2020; American in 312 gram packages and UPC number 0 71279 24100 5* with all best before dates up to and including July 11, 2020*; Chopped Kit Thai ‘N’ Cashews in 332 gram packages, with UPC number 0 71279 30925 5*, and all best before dates up to and including July 11, 2020*; and Veggie Lover’s in 312* gram packages with UPC number 0 71279 28106 3* and all best before dates up to and including July 11, 2020*.
Also recalled are Chopped Kit Sunflower Crisp in 315 gram packages with UPC number 0 71279 30933 0* and all best before dates up to and including July 11, 2020*; Iceberg Garden in 680 gram packages with UPC number 0 71279 10411 9* and all best before dates up to and including July 12, 2020*; Iceberg Garden in 340 gram packages with UPC number 0 71279 10302 0* and all best before dates up to and including July 12, 2020*; and Shreds Iceberg* in 227* gram packages, with UPC number 0 71279 15101 4* and all best before dates up to and including July 12, 2020*.
Finally, Green & Crisp is recalled, sold in 312 gram packages, with UPC number 0 71279 10813 1* and all best before dates up to and including July 12, 2020*; Chopped Kit Asian in 340 gram packages with UPC number 0 71279 30929 3* and all best before dates up to and including July 13, 2020*; Chopped Kit Southwest in 326 gram packages with UPC number 0 71279 30930 9* and all best before dates July 12, 2020*; and 3 Colour Deli Cole Slaw* in 397 gram packages, with UPC number 0 71279 12302 8* and all best before dates up to and including July 14, 2020*.
If you purchased any of these products don’t eat them. Throw them away in a secure garbage can or take them back to the place of purchase for a full refund. You can see pictures of product packages at the CFIA web site.
A previous version of this press release issued on June 19, 2020 stated that product bearing the facility code “S5417” and that code is incorrect. The only product bearing the product code “S5424” is subject to recall and it was made at a facility in Streamwood, IL.
In cooperation with the Fresh Express recall of bagged salads potentially linked to an outbreak of Cyclospora infections in the Midwest. Jewel-Osco is voluntarily recalling bagged Signature Farms Garden Salad, net wt. 12 oz., sold in its stores in Illinois, Indiana, and Iowa.
The recalled Signature Farms Garden Salad, UPC code of 21130 98135, was sold in 12-ounce bags in the Produce section. The recalled products have BEST IF USED BY dates of May 16 through July 4 (5-16-20 through 7-04-20). The BEST IF USED BY date and the product code are printed on the top right corner of the front of the package. The affected product with the product code is subject to recall.
A previous version of this press release issued on June 19, 2020 stated that product bearing the facility code “S5417” and that code is incorrect. The only product bearing the product code “S5424” is subject to recall and it was made at a facility in Streamwood, IL.
In cooperation with the Fresh Express recall of bagged salads potentially linked to an outbreak of Cyclospora infections in the Midwest. Jewel-Osco is voluntarily recalling bagged Signature Farms Garden Salad, net wt. 12 oz., sold in its stores in Illinois, Indiana, and Iowa.
The recalled Signature Farms Garden Salad, UPC code of 21130 98135, was sold in 12-ounce bags in the Produce section. The recalled products have BEST IF USED BY dates of May 16 through July 4 (5-16-20 through 7-04-20). The BEST IF USED BY date and the product code are printed on the top right corner of the front of the package. The affected product with the product code is subject to recall.
Cyclospora cayetanensis is a microscopic parasite of humans. This parasite, when it contaminates food or water and is then ingested, can cause an intestinal illness called cyclosporiasis. Most people infected with Cyclospora develop diarrhea. Other common symptoms include loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, and fatigue. Vomiting, body aches, headache, fever, and other flu-like symptoms may be noted. Some people who are infected with Cyclospora do not have any symptoms. If not treated, the illness may last from a few days to a month or longer. Symptoms may seem to go away and then return one or more times.
Consumers are asked to check their refrigerators for the recalled product. Consumers who have purchased the product are asked to discard or return it to the place of purchase for a refund. Customers who have questions about the recall can contact Jewel-Osco at 1-877-723-3929.