Case count surges in mid-western Cyclospora outbreak

More than 200 people in eight US states have become infected with Cyclospora since the first half of May, according to the US Centers for Disease Control and Prevention (CDC). Twenty-three people have been hospitalized.

Epidemiological and traceback investigations are pointing the finger at bagged salads containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express.

A total of 206 cases of cyclosporiasis have been confirmed in Illinois (57), Iowa (74), Kansas (1), Minnesota (25), Missouri (10) Nebraska (20), North Dakota (6), and Wisconsin (13).

Four Cyclospora oocysts from fresh stool stained using a modified acid-fast stain. The oocysts are variably acid fast (that is, they range from unstained to light pink to deep red or purple). (Credit: CDC/DPDx)

The average incubation period for Cyclospora is 1 week. Symptoms of infection can appear from 2 days to 2 weeks following ingestion of a contaminated food and may include: watery diarrhea, loss of appetite, weight loss, cramping, bloating, increased gas, nausea and fatigue. Some patients may also experience vomiting and low-grade fever.

Jewel-Osco, Fresh Express, ALDI and Hy-Vee have recalled bagged iceberg lettuce salad in recent days, including the following items:

  • Signature Farms Garden Salad (12-oz bags; BEST IF USED BY dates of May 16 through July 4; UPC 21130 98135; Plant #S5417). Sold in Jewel-Osco stores in Illinois, Indiana, and Iowa.
  • Marketside Classic Iceberg Salad (12-oz bags (UPC 6 81131 32894 4) and 24-oz bags (6 81131 32895 1); Best if used by May 19 to July 04). Sold in Wal-Mart stores in Iowa, Minnesota Michigan, Nebraska, North Dakota, South Dakota, and Wisconsin.
  • Little Salad Bar Garden Salad (12-oz bags; Best If Used By dates of May 1 through June 29; UPC 4099100082975). Sold in ALDI stores in Arkansas, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, North Dakota, South Dakota and Wisconsin.
  • Hy-Vee Bagged Garden Salad (All UPCs and expiration dates). Sold in Hy-Vee stores in Iowa, Illinois, Missouri, Kansas, Nebraska, South Dakota, Minnesota and Wisconsin.

CDC warns that the items recalled so far do not account for all reported outbreak cases. Additional suspect products may be identified and added to the recall list.

Do not eat or serve any of the recalled items. Check your home for any of these recalled salads. Throw any remaining salad away, even if some of it has been eaten and no one has gotten sick.

If you live in Arkansas, Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota, or Wisconsin and don’t know whether the bagged salad mix you have in your home is one of these recalled salads, do not eat it. Throw it away.

FDA is working with Fresh Express to identify other retailers that may have received the implicated bagged salad mix, and is working with retailers to ensure that all of the recalled products have been removed from the marketplace.

CDC requests that anyone experiencing symptoms of Cyclospora infection should do the following:

  • Talk to your healthcare provider.
  • Write down what you ate in the two weeks before you started to get sick.
  • Report your illness to the health department.
  • Assist public health investigators by answering questions about your illness.

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