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.

The number of reported cases of domestically acquired cyclosporiasis illnesses has increased by 402 cases since the last update on July 29, 2021. Cases continue to be reported to CDC.

As of August 25, 2021, 864 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 35 jurisdictions, including 34 states and New York City.The median illness onset date is June 24, 2021 (range: May 1, 2021–August 7, 2021).

At least 59 people have been hospitalized; no deaths have been reported.

As of July 13, 2021, 208 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.

The median illness onset date is June 17, 2021 (range: May 1, 2021–July 3, 2021).

At least 21 people have been hospitalized; no deaths have been reported.

Cyclospora cayetanensis is a unicellular, microscopic parasite that can cause food- or water-related gastrointestinal illness. Cyclospora cannot be transmitted directly from one person to another through infected fecal matter; the parasite must complete part of its lifecycle outside of a host. Most cases of cyclosporiasis occur in underdeveloped tropical and subtropical regions of the world where the parasite is endemic.

In the United States, Cyclospora causes about 11,000 illnesses and 11 hospitalizations, but infestations of this parasite do not typically result in death. Due to the self-limiting nature of the pathogen (which causes some people to not seek medical care), difficulty in diagnosing it specifically, and other factors, the Centers for Disease Control and Prevention (CDC) estimates that there could be very broad ranges of infection, from 140 to 38,000 annual cases. In North America, outbreaks of cyclosporiasis in humans have been reported mostly from contaminated fresh food products, such as soft fruits (raspberries, blackberries, and strawberries), leafy vegetables (lettuce and mixed salad), and herbs (basil and cilantro). Soil is another possible infection source, particularly in areas with poor environmental sanitation.

Since Cyclospora infections tend to respond to the appropriate treatment, complications are more likely to occur in individuals who are not treated or not treated promptly. These can include disorders of malabsorption, reactive arthritis, cholecystitis (inflammation of the gallbladder), and, possibly, Guillain-Barré Syndrome. 

Shenandoah Growers, Inc (Harrisonburg, VA) out of an abundance of caution, has issued a limited, voluntary recall of approximately 3240 units of branded fresh cut, packaged organic basil clamshells packed at its Indianapolis, Indiana location due to a possible health risk from Cyclospora.

Cyclosporiasis is an intestinal infection caused by the Cyclospora parasite. A person may become infected after ingesting contaminated food or water. Common symptoms include severe abdominal pain, watery diarrhea, nausea and vomiting, body aches and fatigue. The infection is treated with antibiotics and most people respond quickly to treatment.

Only the following specific lot codes are affected:

PV40515 1034     PV40515 3034     PV40515 4034     PV40515 3035

The affected product has a country of origin of Colombia and was harvested entirely from Puerto Vallarta Herbs SAS (Farm) and imported by Vallarta Organics LLC dba Organic Destiny (Importer).

Affected lot codes shipped:

Lot Code: Pack Date: Brand: Size: Location UPC:
PV40515 1034 2/3/2021 Shenandoah Growers by That’s Tasty 0.75 oz Indianapolis Fruit 7-68573-00101-4
PV40515 1034 2/3/2021 Shenandoah Growers by That’s Tasty 2.0 oz Indianapolis Fruit 7-68573-02143-2
PV40515 1034 2/3/2021 Shenandoah Growers by That’s Tasty 4.0 oz Indianapolis Fruit 7-68573-00141-0
PV40515 3034 2/3/2021 That’s Tasty (Pasta Blend) 0.5 oz Vine Line Produce 7-68573-52008-9
PV40515 3034 2/3/2021 That’s Tasty 0.5 oz Vine Line Produce 7-68573-50502-4
PV40515 3034 2/3/2021 Shenandoah Growers by That’s Tasty 4 oz Vine Line Produce Bulk N/A
PV40515 3034 2/3/2021 Shenandoah Growers by That’s Tasty 1 lb. Vine Line Produce Bulk N/A
PV40515 4034 2/3/2021 Simple Truth 3.0 oz Kroger 0-11110-00876-3
PV40515 1034 2/3/2021 That’s Tasty 0.25 oz J&J Distributing 7-68573-02515-7
PV40515 1034 2/3/2021 Shenandoah Growers by That’s Tasty 0.75 oz J&J Distributing 7-68573-00101-4
PV40515 3035 2/4/2021 That’s Tasty 3.0 oz Schnucks 7-68573-53001-9

Recalled products were distributed to select retail stores between 2/3/2021 to 2/4/2021 in the following states: Illinois, Indiana, Iowa, Michigan, Minnesota, Mississippi, Missouri, Ohio, Tennessee, and Wisconsin.

This recall notification is being issued due to a single instance in which a sample of bulk product was pulled at the port of entry in Miami and tested by the FDA as part of routine surveillance and indicated the potential presence of Cyclospora.

Affected Shenandoah Growers customers have been notified of the recall and instructed to immediately remove and discard recalled products from all store shelves, distribution and other inventories to ensure they are no longer available for sale or consumption.

The Shenandoah Growers recall includes only those clamshells of certified organic basil clearly marked with the affected lot codes listed above. The lot code can be found printed on each clamshell.

No other Shenandoah Growers products are subject to recall, and the company has no knowledge of any illness reported or related to this product to date.

Consumers who may have a recalled basil product should discard it immediately and not eat it.

 

Cyclospora – Salads

As of September 23, 2020, a total of 701 people with laboratory confirmed Cyclospora infections associated with this outbreak were reported from 14 states: GA, IL, IA, KS, MA, MI, MN, MO, NE, ND, OH, PA, SD, WI. Exposures were reported in 13 states (IL, IA, KS, MA, MI, MN, MO, NE, ND, OH, PA, SD, WI).

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.

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.

In interviews, ill people answered questions about the foods they ate and other exposures in the 2 weeks before they became ill. An illness cluster is defined as two or more people who do not live in the same household who report eating at the same restaurant location, attending a common event, or shopping at the same location of a grocery store in the week before becoming ill. Investigating illness clusters provides critical clues about the source of an outbreak. If several unrelated ill people ate or shopped at the same location of a restaurant or store within several days of each other, it suggests that the contaminated food item was served or sold there. In this bagged salad-associated cluster, there were several situations in which people reported purchasing the product from the same stores.

The FDA and regulatory officials in several states collected records to determine the source of the bagged salad that ill people ate in the affected areas. Product distribution information indicated that the Streamwood, Illinois Fresh Express production facility is the likely producer of the bagged salad mixes eaten by ill people.