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The Georgia Department of Public Health Northwest Health District is investigating reports of Cyclospora infection in Northwest Georgia.

In the U.S., people can get sick with cyclosporiasis by eating fresh produce that was grown outside the U.S. and contaminated with Cyclospora.  Cyclosporiasis causes an illness that can result in prolonged gastrointestinal (gut) distress, including watery diarrhea with frequent, sometimes explosive, bowel movements that can last for weeks. In severe cases, Cyclospora infection can require hospitalization.

If you have had diarrhea, stomach cramps, bloating, or other gastrointestinal symptoms lasting longer than several days, public health officials urge you to talk to your healthcare provider. If not treated, cyclosporiasis can last a month or longer.  Symptoms may subside or go away and then return several times. Your healthcare provider can order testing to confirm the illness and may treat you with antibiotics.

A Cyclospora infection can be mild or very serious. You are most at risk for a serious infection if you have a compromised (weakened) immune system, for instance, you are living with HIV/AIDS or cancer or taking immunosuppressive medications.

Cyclosporiasis is not contagious. There is no evidence it spreads from person to person. The public health officials say their investigation is ongoing and the number of cases is expected to increase.

The Centers for Disease Control and Prevention (CDC), along with health departments in 14 states and the Food and Drug Administration (FDA), investigated a national outbreak of Cyclospora in the summer of 2020. 

As of September 23, 2020, a total of 701 lab-confirmed cases were found to be associated with this outbreak from 14 states (GA (1), IL (211), IA (206), KS (5), MA (1), MI (4), MN (86), MO (57), NE (55), ND (6), OH (7), PA (2), SD (13), WI (47). Exposures were reported in 13 states (IL, IA, KS, MA, MI, MN, MO, NE, ND, OH, PA, SD, WI). Cases reported illness from May 11, 2020 to July 24, 2020. Five percent were hospitalized, and no deaths were reported. Cases ranged from 11 to 92 years of age (median of 57). Fifty-one percent of cases were female.[1]

In Canada, as of November 4, 2020, 370 confirmed cases of Cyclospora illness were reported in the following provinces and territories: British Columbia (1), Ontario (255), Quebec (105), New Brunswick (1), Newfoundland and Labrador (6), and Nunavut (2). Individuals became sick between mid-May and late August 2020. Ten individuals were hospitalized. No deaths were reported. Individuals who became ill are between 0 and 83 years of age. The illnesses are distributed equally among men (50%) and women (50%).[2]

Epidemiological and traceback evidence indicated that bagged salad mix containing iceberg lettuce, carrots and red cabbage by Fresh Express was the likely source of this outbreak. Further traceback efforts by the FDA led to the investigation of a farm in southern Florida. The FDA detected Cyclospora in a regional water management canal (C-23), located west of Port St. Lucie, Florida. However, the FDA has been unable to determine if this Cyclospora was a genetic match to cases associated with the outbreak. Nevertheless, the presence of Cyclospora in a canal that had previously supplied irrigation water in the region, and specifically to a farm identified in the traceback, was suspicious and requires the need for further investigation and response from the FDA and it’s investigating partners.

               Fresh Express recalled salad products produced at its Streamwood, Illinois facility on June 27, 2020. The Fresh Express recall included only those salads products containing the ingredients iceberg lettuce, red cabbage and/or carrots AND displaying the Product Code Z178, or a lower number. Recalled products were distributed to select retail stores – including ALDI, Giant Eagle, Hy-Vee, Jewel-Osco, ShopRite, and Walmart – between June 6 and June 26 in various states. The recalled retail store brands were ALDI Little Salad Bar, Giant Eagle, Hy-Vee, Jewel-Osco Signature Farms, ShopRite Wholesome Pantry, and Walmart Marketside. The “Best by” date on the recalled products ran through July 14, 2020. As of September 23, 2020, the outbreak was considered over.[3]

[1]           CDC. (2020, September 24). CDC – Outbreak of Cyclospora Infections Linked to Bagged Salad Mix. https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2020/index.html

[2]           Public Health Agency of Canada (2020, November 4). Public Health Notice: Outbreak of Cyclospora infections linked to salad products and fresh herbs – Final Update. https://www.canada.ca/en/public-health/services/public-health-notices/2020/outbreak-cyclospora-infections-salad-products.html

[3]           FDA. (2020, September 25). Outbreak Investigation of Cyclospora: Bagged Salads (June 2020). Outbreak Investigation of Cyclospora: Bagged Salads (June 2020) | FDA; FDA. (2020, June 29). Fresh Express Issues a Precautionary Recall of Products Containing Iceberg, Red Cabbage and Carrots Produced at its Streamwood, IL Facility Due to a Potential Cyclospora Risk. Fresh Express Issues a Precautionary Recall of Products Containing Iceberg, Red Cabbage and Carrots Produced at its Streamwood, IL Facility Due to a Potential Cyclospora Risk | FDA

Cyclosporiasis illnesses are reported year-round in the United States. However, during the spring and summer months there is often an increase in cyclosporiasis acquired in the United States (i.e., “domestically acquired”). The exact timing and duration of these seasonal increases in domestically acquired cyclosporiasis can vary, but reports tend to increase starting in May. In previous years the reported number of cases peaked between June and July, although activity can last as late as September. The overall health impact (e.g., number of infections or hospitalizations) and the number of identified clusters of cases (i.e., cases that can be linked to a common exposure) also vary from season to season. Previous U.S. outbreaks of cyclosporiasis have been linked to various types of fresh produce, including basil, cilantro, mesclun lettuce, raspberries, and snow peas.

At a Glance

  • Illnesses: 1,060
  • Hospitalizations: 69
  • Deaths: 0
  • States reporting cases: 33

CDC, along with state and federal health and regulatory officials, monitor cases of cyclosporiasis in the United States in the spring and summer months to detect outbreaks linked to a common food source. However, many cases of cyclosporiasis cannot be directly linked to an outbreak, in part because of the lack of validated laboratory “fingerprinting” methods needed to link cases of Cyclospora infection. Officials use questionnaires to interview sick people to determine what they ate in the 14-day period before illness onset. If a commonality is found, CDC and partners work quickly to determine if a contaminated food product is still available in stores or in peoples’ homes and issue advisories.

Latest Information

  • The number of reported cases of domestically acquired cyclosporiasis illnesses has increased by 260 cases since the last update on August 25, 2022. Cases continue to be reported.
  • As of September 28, 2022, 1,060 laboratory-confirmed cases of cyclosporiasis in people who had no history of international travel during the 14-day period before illness onset have been reported to CDC by 34 jurisdictions, including 33 states and New York City, since May 1, 2022.
    • The median illness onset date is June 30, 2022 (range: May 1, 2022–August 28, 2022).
    • At least 69 people have been hospitalized; 0 deaths have been reported.

Cyclospora in the United States at a glance

            •          Illnesses: 800

            •          Hospitalizations: 52

            •          Deaths: 0

            •          States reporting cases: 30

Cyclosporiasis illnesses are reported year-round in the United States. However, during the spring and summer months there is often an increase in cyclosporiasis acquired in the United States (i.e., “domestically acquired”). The exact timing and duration of these seasonal increases in domestically acquired cyclosporiasis can vary, but reports tend to increase starting in May. In previous years the reported number of cases peaked between June and July, although activity can last as late as September. The overall health impact (e.g., number of infections or hospitalizations) and the number of identified clusters of cases (i.e., cases that can be linked to a common exposure) also vary from season to season. Previous U.S. outbreaks of cyclosporiasis have been linked to various types of fresh produce, including basil, cilantro, mesclun lettuce, raspberries, and snow peas. 

CDC, along with state and federal health and regulatory officials, monitor cases of cyclosporiasis in the United States in the spring and summer months to detect outbreaks linked to a common food source. However, many cases of cyclosporiasis cannot be directly linked to an outbreak, in part because of the lack of validated laboratory “fingerprinting” methods needed to link cases of Cyclospora infection. Officials use questionnaires to interview sick people to determine what they ate in the 14-day period before illness onset. If a commonality is found, CDC and partners work quickly to determine if a contaminated food product is still available in stores or in peoples’ homes and issue advisories.

Latest Information

            •          The number of reported cases of domestically acquired cyclosporiasis illnesses has increased by 323 cases since the last update on June 30, 2022. Cases continue to be reported.

            •          As of July 26, 2022, 384 laboratory-confirmed cases of cyclosporiasis in people who had no history of international travel during the 14-day period before illness onset have been reported to CDC by 23 jurisdictions, including 22 states and New York City, since May 1, 2022. The median illness onset date is June 20, 2022 (range: May 3, 2022–July 18, 2022). At least 30 people have been hospitalized; 0 deaths have been reported.

CDC, along with state and federal health and regulatory officials, monitor cases of cyclosporiasis in the United States in the spring and summer months to detect outbreaks linked to a common food source. However, many cases of cyclosporiasis cannot be directly linked to an outbreak, in part because of the lack of validated laboratory “fingerprinting” methods needed to link cases of Cyclospora infection. Officials use questionnaires to interview sick people to determine what they ate in the 14-day period before illness onset. If a commonality is found, CDC and partners work quickly to determine if a contaminated food product is still available in stores or in peoples’ homes and issue advisories.

Cyclosporiasis illnesses are reported year-round in the United States. However, during the spring and summer months there is often an increase in cyclosporiasis acquired in the United States (i.e., “domestically acquired”). The exact timing and duration of these seasonal increases in domestically acquired cyclosporiasis can vary, but reports tend to increase starting in May. In previous years the reported number of cases peaked between June and July, although activity can last as late as September. The overall health impact (e.g., number of infections or hospitalizations) and the number of identified clusters of cases (i.e., cases that can be linked to a common exposure) also vary from season to season. Previous U.S. outbreaks of cyclosporiasis have been linked to various types of fresh produce, including basil, cilantro, mesclun lettuce, raspberries, and snow peas.

At a Glance

            •          Illnesses: 61

            •          Hospitalizations: 6

            •          Deaths: 0

            •          States reporting cases: 13

Cyclosporiasis illnesses are reported year-round in the United States. However, during the spring and summer months there is often an increase in cyclosporiasis acquired in the United States (i.e., “domestically acquired”). The exact timing and duration of these seasonal increases in domestically acquired cyclosporiasis can vary, but reports tend to increase starting in May. In previous years the reported number of cases peaked between June and July, although activity can last as late as September. The overall health impact (e.g., number of infections or hospitalizations) and the number of identified clusters of cases (i.e., cases that can be linked to a common exposure) also vary from season to season. Previous U.S. outbreaks of cyclosporiasis have been linked to various types of fresh produce, including basil, cilantro, mesclun lettuce, raspberries, and snow peas. 

CDC, along with state and federal health and regulatory officials, monitor cases of cyclosporiasis in the United States in the spring and summer months to detect outbreaks linked to a common food source. However, many cases of cyclosporiasis cannot be directly linked to an outbreak, in part because of the lack of validated laboratory “fingerprinting” methods needed to link cases of Cyclospora infection. Officials use questionnaires to interview sick people to determine what they ate in the 14-day period before illness onset. If a commonality is found, CDC and partners work quickly to determine if a contaminated food product is still available in stores or in peoples’ homes and issue advisories.

Latest Information

            •          This is the first monthly report on the number of domestically acquired cyclosporiasis illnesses with onset on or after May 1, 2022. Cases continue to be reported.

            •          As of June 28, 2022, 61 laboratory-confirmed cases of cyclosporiasis in people who had no history of international travel during the 14-day period before illness onset have been reported to CDC by 13 states since May 1, 2022.

            ◦           The median illness onset date is May 31, 2022 (range: May 3–June 20, 2022).

            ◦           At least 6 people have been hospitalized; no deaths have been reported.

The CDC, public health, and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) investigated a multistate outbreak of Cyclospora infections linked to bagged salad mix purchased at ALDI, Giant Eagle, Hy-Vee, Jewel-Osco, ShopRite, and Walmart stores in 14 states, and produced at Fresh Express’s Streamwood, Illinois production facility.

According to the FDA and the CDC, as of September 23, 2020, a total of 701 people with laboratory-confirmed Cyclospora infections associated with this outbreak were reported from 14 states: Georgia (1), Illinois (211), Iowa (206), Kansas (5), Massachusetts (1), Michigan (4), Minnesota (86), Missouri (57), Nebraska (55), North Dakota (6), Ohio (7), Pennsylvania  (2), South Dakota (13), and Wisconsin (47). Exposures were reported in 13 states (IL, IA, KS, MA, MI, MN, MO, NE, ND, OH, PA, SD, WI).[1]

Illnesses started on dates ranging from May 11, 2020 to July 24, 2020. Ill people ranged in age from 11 to 92 years with a median age of 57; 51% were female. 38 (5%) people were hospitalized. No deaths were reported in this outbreak.

In Canada, as of November 4, 2020, 370 confirmed cases of Cyclospora illness were reported in the following provinces and territories: British Columbia (1), Ontario (255), Quebec (105), New Brunswick (1), Newfoundland and Labrador (6), and Nunavut (2). Individuals became sick between mid-May and late August 2020. Ten individuals were hospitalized. No deaths were reported. Individuals who became ill are between 0 and 83 years of age. The illnesses are distributed equally among men (50%) and women (50%).[2]

Epidemiologic evidence and product traceback indicated that bagged salad mix containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express was a likely source of this outbreak. Fresh Express recalled Fresh Express brand and private label brand salad products produced at its Streamwood, IL facility that contained iceberg lettuce, red cabbage, and/or carrots on June 27, 2020. The Fresh Express recall included only products containing the ingredients iceberg lettuce, red cabbage, and/or carrots, and displaying the Product Code Z178, or a lower number.

On June 20, 2020, Jewel Osco, in cooperation with Fresh Express, voluntarily recalled its 12-ounce bagged Signature Farms Garden Salad sold in its stores in Illinois, Indiana, and Iowa.

On June 22, 2020, ALDI, in association with Fresh Express, recalled ALDI’s 12-ounce Little Salad Bar Brand Garden Salad from stores in Arkansas, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, North Dakota, South Dakota and Wisconsin.

On the same day, June 22, 2020, Hy-Vee recalled its 12-ounce Hy-Vee Bagged Garden Salad product across its eight-state region due to the potential that they may be contaminated with Cyclospora. On June 29, 2020, Hy-Vee recalled an additional 12 salads across its eight-state region. The potential for contamination was brought to Hy-Vee’s attention when Fresh Express—which manufactures the product—announced that the FDA and the CDC expanded its investigation of an outbreak of Cyclospora in the upper Midwest section of the United States.

On June 25, 2020, Fresh Express recalled 12- and 24-ounce bagged Walmart Marketside Classic Iceberg Salad, sold in Walmart stores in Iowa, Minnesota, Michigan, Nebraska, North Dakota, South Dakota, and Wisconsin.

Cyclospora:   Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Cyclospora outbreaks. The Cyclospora Attorneys and Lawyers have represented victims of Cyclospora and other foodborne illness outbreaks and have recovered over $8000 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.

If you or a family member became ill with a Cyclospora infection after consuming food and you are interested in pursuing a legal claim, contact the Marler Clark Cyclospora attorneys for a free case evaluation.

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[1]           CDC. (2020, September 24). CDC – Outbreak of Cyclospora Infections Linked to Bagged Salad Mix. https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2020/index.html

[2]           Public Health Agency of Canada (2020, November 4). Public Health Notice: Outbreak of Cyclospora infections linked to salad products and fresh herbs – Final Update. https://www.canada.ca/en/public-health/services/public-health-notices/2020/outbreak-cyclospora-infections-salad-products.html

The Minnesota Department of Agriculture (MDA) is alerting consumers to avoid eating Ocean Mist Farms brand Romaine Hearts (Coeurs de laitue Romaine) with coding “22RHDM2L” and a harvest date of “MAR 10,” grown in Coachella, CA. The MDA Laboratory found Cyclospora in the product during routine surveillance sampling. Customers who purchased the product should discard the product and not eat it. No illnesses associated with this product have been reported at this time in Minnesota.

The Ocean Mist Farms brand Romaine Hearts lettuce (22 oz. package) was sourced from Ocean Mist Farms of Castroville, CA. The product was sold at the following grocery locations in Minnesota:

  • Bob’s Produce Ranch – Fridley, MN
  • Brink’s Market – Chisago City, MN
  • Coborn’s Grocery – Hastings, MN
  • Daggett’s Fresh Foods – Hinckley, MN
  • Driskill’s Downtown Market – Hopkins, MN
  • Festival Foods – Andover, MN
  • Festival Foods – Bloomington, MN
  • Festival Foods – Hugo, MN
  • Festival Foods – Lexington, MN
  • Festival Foods – White Bear Lake, MN
  • Festival Foods – Brooklyn Park, MN
  • Jerry’s Market – North Branch, MN
  • Jubilee Foods – Mound, MN
  • King’s County Market – Andover, MN
  • King’s County Market – St. Francis, MN
  • Knowlan’s Fresh Foods – Maplewood, MN
  • Knowlan’s Fresh Foods – South St. Paul, MN
  • Kowalski’s Market – Eagan, MN
  • Kowalski’s Market – Excelsior, MN
  • Kowalski’s Market – Eden Prairie, MN
  • Kowalski’s Market on Grand – St. Paul, MN
  • Kowalski’s Market on Chicago – Minneapolis, MN
  • Kowalski’s Market on Lyndale – Minneapolis, MN
  • Kowalski’s Market – Oak Park Heights, MN
  • Kowalski’s Market – Shoreview, MN
  • Kowalski’s Market – White Bear Lake, MN
  • Kowalski’s Market – Woodbury, MN
  • Longfellow Market – Minneapolis, MN
  • Mackenthun’s Foods – Waconia
  • North Market – Minneapolis, MN
  • Oxendale’s Market Randolph – St. Paul, MN
  • Speedy Market – St. Paul, MN
  • Super One Plaza – Duluth, MN
  • Super One West – Duluth, MN
  • Super One – Two Harbors, MN

Symptoms of illness caused by Cyclospora typically include watery diarrhea, stomach cramps, nausea, loss of appetite, and weight loss. People typically become ill about a week after eating contaminated food, but this period can range from 2-14 days. Diarrhea can last several weeks or longer if not treated. Contact your health care provider if you have become ill.

Box sticker for Ocean Mist brand romaine hearts
                                      Box sticker for Ocean Mist brand romaine hearts.
Front package view of Ocean Mist romaine hearts
                               Front package view of Ocean Mist brand romaine hearts.
Back sticker for Ocean Mist brand romaine hearts
                                     Back sticker for Ocean Mist brand romaine hearts.

In June 2021 a limited number of cases of Dole Fresh blueberries were recalled last week due to a possible parasite contamination, but so far no illnesses have been reported in connection with the products.

On Friday, the US Food and Drug Administration (FDA) announced that Dole Diversified North America, Inc. had voluntarily recalled a limited number of its blueberry products in a variety of sizes.

The agency said that Dole was “coordinating closely with regulatory officials,” as part of the effort and confirmed that “no illnesses have been reported to date in association with the recall.”

In 2021, multiple outbreaks of cyclosporiasis cases associated with different restaurants or events were investigated by state public health authorities, CDC, and FDA.CDC investigated two large multistate outbreaks of cyclosporiasis, one including 40 illnesses and one with 130 illnesses, in which ill people reported eating various types of leafy greens. State officials and FDA conducted traceback investigations for these two outbreaks, but a specific type or grower of leafy greens was not identified as the source of either outbreak.

As of September 28, 2021, 1,020 laboratory-confirmed cases of cyclosporiasis in people who had no history of international travel during the 14-day period before illness onset have been reported to CDC by 37 jurisdictions, including 36 states and New York City, since May 1, 2021.The median illness onset date is June 25, 2021 (range: May 1–August 31, 2021).

At least 70 people have been hospitalized; no deaths have been reported.