Southeastern Grocers announced Friday that they are voluntarily recalling SE Grocers Naturally Better Organic Fresh Cut Basil.

The recall is due to Cyclospora. Cyclospora infections, known as cyclosporiasis, can cause diarrhea, abdominal cramps, nausea and vomiting, among other symptoms.

SE Grocers says if customers still have this product, regardless of the expiration date, they should throw it out or return it to the store purchased for a full refund.

BI-LO, Fresco y Más, Harveys Supermarkets and Winn-Dixie are all SEG stores.

Customers with questions about the recalled products may contact the Southeastern Grocers Customer Call Center at (844) 745-0463, Monday through Friday from 8 a.m. to 7 p.m., and Saturday from 8 a.m. to 4 p.m.

The UPC code for SE Grocers Naturally Better Organic Fresh Cut Basil is as follow:

  • SE Grocers Naturally Better Organic Fresh Cut Basil – 0.5 oz container: 6-07880-20230-4

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.

Cyclosporiasis is an intestinal illness caused by the parasite Cyclospora cayetanensis, which is transmissible by ingestion of fecally contaminated food or water.[1] Cyclosporiasis is most common in tropical and subtropical regions of the world. In the United States, foodborne outbreaks of cyclosporiasis have been linked to various types of imported fresh produce (e.g., basil, raspberries, and snow peas). Validated molecular typing tools, which could facilitate detection and investigation of outbreaks, are not yet available for C. cayetanensis.

Outbreaks of cyclosporiasis in humans have been reported mostly from North America, from the infection sources of contaminated fresh food products, such as soft fruits (raspberries), leafy vegetables (coriander, basil, and mixed salad), and herbs. Soil is another possible infection source, particularly in areas with poor environmental sanitation.[2]

The Centers for Disease Control and Prevention (CDC) has been conducting national surveillance for cyclosporiasis since it became a nationally notifiable disease in January 1999. As of 2015, cyclosporiasis was a reportable condition in 42 states, the District of Columbia, and New York City (NYC). Health departments voluntarily notify CDC of cases of cyclosporiasis through the National Notifiable Diseases Surveillance System and submit additional case information using the CDC cyclosporiasis case report form or the Cyclosporiasis National Hypothesis Generating Questionnaire (CNHGQ).[3]

While cyclosporiasis cases are reported year-round in the United States, cyclosporiasis acquired in the United States (i.e., “domestically acquired,” or cases of cyclosporiasis that are not associated with travel to a country that is considered endemic for Cyclospora) is most common during the spring and summer months. The exact timing and duration of U.S. cyclosporiasis seasons can vary, but reports tend to increase starting in May. In 2020, multiple outbreaks of cyclosporiasis were identified and found to be linked to different produce items. As of September 23, 2020, the CDC documented 1,241 laboratory-confirmed cases of cyclosporiasis in people who had no history of international travel during the 14-day period before illness onset.[4]

What are the typical symptoms of Cyclospora infection?

Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, bloating, increased gas, stomach cramps, and loss of appetite, nausea, low-grade fever, and fatigue. In some cases, vomiting, explosive diarrhea, muscle aches, and substantial weight loss can occur. Some people who are infected with Cyclospora do not have any symptoms. The time between becoming infected and becoming ill is usually about one week. If not treated, the illness may last from a few days up to six weeks. Symptoms also may recur one or more times (relapse). In addition, people who have previously been infected with Cyclospora can become infected again.[5]

Where does Cyclospora come from?

The modes of transmission of C. cayetanensis are still not completely documented, although fecal–oral transmission is the major route. Direct person-to-person transmission is unlikely. Indirect transmission can occur if an infected person contaminates the environment, the oocysts sporulate under the right conditions, and then contaminated food and water are ingested. The role of soil in transmission has also been proposed. The relative importance of these various modes of transmission and sources of infection is not known.[6]

The dissemination of infective Cyclospora oocysts via water, soil, and unprocessed foods (e.g., fruits and vegetables, including ready-to-eat salads) is enabled by their small size (8–10 μm), low specific gravity, and high infectivity. Such oocysts can survive for weeks to months in water and food, depending on the environmental temperature, and are resistant to the routine sanitization or chemical disinfection procedures used in irrigation systems, recreational waters, or drinking water treatment plants.[7]

How is Cyclospora diagnosed?

Cyclosporiasis is usually diagnosed symptomatically in clinical settings, including the presence of watery diarrhea, abdominal cramping, and bloating. In untreated, immunocompetent people, the diarrhea can last from days to weeks to a month or more, and can wax and wane, with variable oocyst shedding. Oocysts can continue to be shed (intermittently or continuously) by non-symptomatic people, and symptoms can also persist in the absence of oocysts in feces. In a clinical context, conventional diagnosis usually involves microscopic examination of intestinal tissue biopsy sections, stool samples for the presence of developmental stages of Cyclospora, or advanced molecular testing for DNA. Improved specificity and sensitivity have been possible largely through the use of PCR, which enables the specific amplification of genetic loci from tiny amounts of genomic DNA of Cyclospora. Because of the intermittent nature of oocyst shedding and the low numbers of this stage in feces, it is recommended that multiple stool samples be collected at 2–3 day intervals over a period of more than a week, to increase the likelihood of identifying the disease microscopically.[8]

What are the serious and long-term risks of Cyclospora infection?

Cyclospora has been associated with a variety of chronic complications such as malabsorption, reactive arthritis, and cholecystitis (inflammation of the gallbladder). 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. Extraintestinal infection also appears to occur more commonly in individuals with a compromised immune system.[9]

Although human cyclosporiasis is usually not fatal in developed countries such as the United States, protracted diarrhea often leads to dehydration, particularly in infants who are at greatest risk of severe dehydration and death, especially if cyclosporiasis is complicated by infections with other pathogens (viral, bacterial, or parasitic—e.g., Cryptosporidium and Giardia), malnutrition, or malabsorption, particularly in underprivileged communities.[10]

According to the CDC[11], the recommended treatment is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim, Septra, or Cotrim. It is advisable for people who have diarrhea to also rest and drink plenty of fluids.

[1]           Casillas, S. M., Hall, R. L., & Herwaldt, B. L. (2019). Cyclosporiasis Surveillance – United States, 2011-2015. Morbidity and mortality weekly report. Surveillance summaries (Washington, D.C. : 2002), 68(3), 1–16. https://doi.org/10.15585/mmwr.ss6803a1

[2]           Giangaspero, A., & Gasser, R. B. (2019). Human cyclosporiasis. The Lancet Infectious Diseases, 19(7), e226–e236. https://doi.org/10.1016/S1473-3099(18)30789-8

[3]           Casillas, Ibid, Note 1 at Page 1.

[4]           CDC. (2020, September 24). Cyclosporiasis Outbreak Investigations – United States, 2020. Centers for Disease Control and Prevention. https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2020/seasonal/index.html

[5]           Cyclosporiasis – Disease. (2018, May 11). https://www.cdc.gov/parasites/cyclosporiasis/disease.html

[6]           Almeria S, Cinar HN, Dubey JP. Cyclospora cayetanensis and Cyclosporiasis: An Update. Microorganisms. 2019; 7(9):317.

[7]           Giangaspero, Ibid, Note 2 at Page 1.

[8]           Giangaspero, Ibid, Note 2 at Page 3-4.

[9]           CDC. (2020, October 21). CDC – Cyclosporiasis – Resources for Health Professionals. Centers for Disease Control and Prevention. https://www.cdc.gov/parasites/cyclosporiasis/health_professionals/index.html

[10]         Giangaspero, Ibid, Note 2 at Page 2.

[11]         CDC. (2020, September 17). CDC – Cyclosporiasis – General Information – Cyclosporiasis FAQs. https://www.cdc.gov/parasites/cyclosporiasis/gen_info/faqs.html

CDC, public health and regulatory officials in 14 states, and the U.S. Food and Drug Administration investigated a multistate outbreak of Cyclospora infections.

In Canada, 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.

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 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 CDC reports that as of August 12, 2020, a total of 690 people with laboratory-confirmed Cyclospora infections associated with this outbreak have been reported from 13 states: Georgia (1), Illinois (209), Iowa (206), Kansas (5), Massachusetts (1), Minnesota (86), Missouri (57) Nebraska (55), North Dakota (6), Ohio (4), Pennsylvania (2), South Dakota (13), and Wisconsin (45). The ill person from Georgia purchased and ate a bagged salad product while traveling in Missouri.

Illnesses started on dates ranging from May 11, 2020 to July 20, 2020. Ill people range in age from 10 to 92 years with a median age of 57; 51% are female. Of 680 people with available information, 37 people (5%) have been hospitalized. No deaths have been reported.

Illnesses might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 4 to 6 weeks. If the number of cases reported by CDC is different from the number reported by state or local health officials, data reported by local jurisdictions should be considered the most up to date. Any differences may be due to the timing of reporting and website updates.

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.

According to the FDA, FDA’s traceback investigation identified several farms in the U.S. that may have provided product used in the Fresh Express salads that were recalled. FDA investigated multiple farms identified in the traceback. In Florida, FDA analyzed water samples from two public access points along a regional water management canal (C-23), located west of Port St. Lucie, Florida. These samples tested positive for Cyclospora cayetanensis using FDA’s validated testing method. Given the emerging nature of genetic typing methodologies for this parasite, the FDA has been unable to determine if the Cyclospora detected in the canal is a genetic match to the clinical cases, therefore, there is currently not enough evidence to conclusively determine the cause of this outbreak. Nevertheless, the current state of the investigation helps advance what we know about Cyclospora and offers important clues to inform future preventive measures.

The number of reported cases of domestically acquired cyclosporiasis has increased from the previous month and has been elevated since May 1, 2020.

As of July 29, 2020, 779 laboratory-confirmed cases of cyclosporiasis have been reported to CDC by 28 states and New York City since May 1, 2020 in people who had no history of international travel during the 14-day period before illness onset.

The median illness onset date was June 8, 2020 (range: May 1–July 20, 2020).

At least 49 people have been hospitalized; no deaths have been reported.

Total Domestically Acquired Cases

The total number of laboratory-confirmed cases reported since May 2020 includes cases from an ongoing multistate outbreak of Cyclospora infections linked to bagged salad mix (641 sick in 11 states with 37 hospitalized) containing carrots, red cabbage, and iceberg lettuce.

Total Cases Linked to Fresh Express

Products were sold in many states under either the brand name Fresh Express or the store brand labels ALDI Little Salad Bar, Giant Eagle, Hy-Vee, Jewel-Osco Signature Farms, ShopRite Wholesome Pantry, and Walmart Marketside.

Since the last case count update on July 9, 2020, 132 new laboratory-confirmed Cyclospora infections have been reported, including 16 from three new states: Georgia, Pennsylvania, and South Dakota.

As of  July 22, 2020, a total of 641 people with laboratory-confirmed Cyclospora infections associated with this outbreak have been reported from 11 states: Georgia (1), Illinois (198), Iowa (195), Kansas (5), Minnesota (73), Missouri (57) Nebraska (55), North Dakota (6), Pennsylvania (2), South Dakota (13) and Wisconsin (36). The ill person from Georgia purchased and ate a bagged salad product while traveling in Missouri.

Illnesses started on dates ranging from May 11, 2020 to July 5, 2020. Ill people range in age from 10 to 92 years with a median age of 59 and 52% are female. Of 636 people with available information, 37 people (6%) have been hospitalized. No deaths have been reported.

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.

Since the last case count update on June 26, 2020, 303 new laboratory confirmed Cyclospora infections have been reported.

The CDC reported today that as of July 8, 2020, a total of 509 people with laboratory confirmed Cyclospora infections associated with this outbreak have been reported from 8 states: Illinois (151), Iowa (160), Kansas (5), Minnesota (63), Missouri (46) Nebraska (48), North Dakota (6), and Wisconsin (30).

Illnesses started on dates ranging from May 11, 2020 to July 1, 2020. Ill people range in age from 11 to 92 years with a median age of 60 and 53% are female. Of 506 people with available information, 33 people (7%) have been hospitalized. No deaths have been reported.

Additionally, the Public Health Agency of Canada is investigating an outbreak of Cyclospora infections occurring in three Canadian provinces where 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.  Thirty-seven have reported illnesses.

Epidemiologic and traceback evidence continues to indicate that bagged salad mix containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express is a likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the two weeks before they became ill. Ill people reported eating a variety of brands of bagged salad mix containing iceberg lettuce, carrots, and red cabbage. Salad mixes eaten by ill people were purchased from ALDI, Hy-Vee, Jewel-Osco, and Walmart stores in the Midwest.

Traceback investigations by FDA suggest that the Streamwood, Illinois Fresh Express production facility is the likely producer of the bagged salad mixes eaten by ill people. FDA has begun an inspection at this facility. CDC and FDA continue to investigate to determine which ingredient or ingredients in the salad mix was contaminated and whether other products are a source of illnesses.

Fresh Express, out of an abundance of caution, has issued a voluntary recall of branded and private label salad products produced at its Streamwood, IL facility that contain iceberg lettuce, red cabbage and/or carrot ingredients due to a possible health risk from Cyclospora. According to the Centers for Disease Control and Prevention, over 200 illnesses have been reported in connection with a current outbreak of Cyclospora occurring in primarily Midwest states.

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, diarrhea, nausea and vomiting, body aches and fatigue. The infection is treated with antibiotics and most people respond quickly to treatment.

The Fresh Express recall includes only those salads that are clearly marked with the letter Z at the beginning of the Product Code, which is located in the upper right-hand corner of the front of the package. Products containing the ingredients iceberg lettuce, red cabbage and/or carrots AND displaying the Product Code Z178, or a lower number, are recalled.

Recalled products were distributed to select retail stores between June 6 and June 26 in various states including, for example, Arkansas, Connecticut, Delaware, Iowa, Illinois, Indiana, Kansas, Kentucky, Massachusetts, Maryland, Maine, Michigan, Minnesota, Missouri, Montana, North Carolina, North Dakota, Nebraska, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Dakota, Tennessee, Virginia, Vermont, Wisconsin, West Virginia, and the District of Columbia.

Recalled Product Details

Fresh Express Precautionary Recall 06/27/2020
Streamwood IL Facility-Produced Salads Containing Iceberg Lettuce, Red Cabbage or Carrots AND Product Code
of Z178 or a Lower Number
(No other Fresh Express salads are included in this recall)

BRAND/PRODUCT NAME/SIZE SELECT STORE UPC PRODUCTION CODE USE BY OR BEFORE POSSIBLE DISTRIBUTION STATES IN SELECT STORES
Fresh Express America’s Fresh Old Fashioned Cole Slaw™
14 oz		   071279123011   Z178 or Lower   Jul-13 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express America’s Fresh 3 Color Deli Cole Slaw™ 14 oz   071279123004   Z178 or Lower   Jul-14 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Chopped Kit Asian 12 oz   071279302027   Z178 or Lower   Jul-13 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Chopped Kit Bacon & Bleu 10.9 oz   071279306063   Z178 or Lower   Jul-12 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Chopped Kit BBQ Ranch 11.3 oz   071279309071   Z178 or Lower   Jul-12 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Chopped Kit Chipotle Cheddar 11.4 oz   071279306049   Z178 or Lower   Jul-12 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Chopped Kit Pomegranate 10.3 oz   071279309101   Z178 or Lower   Jul-14 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Chopped Kit Poppyseed 11.7 oz   071279309118   Z178 or Lower   Jul-14 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Chopped Kit Southwest 5 oz   071279306025   Z178 or Lower   Jul-12 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Chopped Kit Sunflower Crisp 11.1 oz   071279309064   Z178 or Lower   Jul-13 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Chopped Kit Thai ‘N’ Cashews 11.7 oz   071279309248   Z178 or Lower   Jul-11 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Chopped Kit Thai ‘N’ Cashews 11.7 oz 071279309248 Z178 or Lower Jul-12 AR, IA, IN, IL, MN, MO, SD, WI
Fresh Express Fancy Greens 7 oz   071279241005   Z178 or Lower   Jul-11 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Farmer’s Garden 9 oz   071279281025   Z178 or Lower   Jul-9 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Gourmet Cafe Creative Classics Chopped Asian 6.25 oz   071279407111   Z178 or Lower   Jul-9 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Gourmet Cafe Creative Classics Mediterranean 12 oz   071279407142   Z178 or Lower   Jul-9 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Gourmet Cafe Creative Classics Turkey & Bacon Chef 5.75 oz   071279407081   Z178 or Lower   Jul-11 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Green & Crisp / Verde y Crujiente 11 oz   071279108049   Z178 or Lower   Jul-11 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Green & Crisp / Verde y Crujiente 11 oz   071279108049   Z178 or Lower   Jul-7 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Iceberg Garden / Lechuga Repollo 12 oz   071279103020   Z178 or Lower   Jul-10 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Iceberg Garden / Lechuga Repollo 24 oz   071279104119   Z178 or Lower   Jul-12 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Iceberg Garden / Lechuga Repollo 3 lbs.   071279106014   Z178 or Lower   Jul-11 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Iceberg Garden / Lechuga Repollo 12 oz   071279103020   Z178 or Lower   Jul-11 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Italian 9 oz   071279211008   Z178 or Lower   Jul-11 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Lettuce Trio / Lechuga Trío 9 oz   071279108094   Z178 or Lower   Jul-11 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Premium Romaine / Lechuga Romana Especial 9 oz   071279108087   Z178 or Lower   Jul-11 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Premium Romaine / Lechuga Romana Especial 9 oz   071279108087   Z178 or Lower   Jul-11 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Premium Slaw Salad Kit Asian Avocado 9.7 oz   071279126043   Z178 or Lower   Jul-10 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Premium Slaw Salad Kit Smoked BBQ Sriracha 11.1 oz   071279126029   Z178 or Lower   Jul-10 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express SHREDS Iceberg 14 oz   071279152004   Z178 or Lower   Jul-11 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express SHREDS 8 oz   071279151014   Z178 or Lower   Jul-10 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Veggie Lover’s 11 oz   071279281001   Z178 or Lower   Jul-9 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Fresh Express Veggie Spring Mix 7 oz   071279281049   Z178 or Lower   Jun-25 AR, CT, DC, DE, IA, IL, IN, KS, KY, MA, MD,
ME, MI, MN, MO, MT, NC, ND, NE, NH, NJ,
NY, OH, OK, PA, RI, SD, TN, VA, VT, WI, WV
Giant Eagle American (Family
Size) 24 oz		 030034930370 Z178 or Lower Jul-9 MD, OH, PA, WV
Giant Eagle Chopped Asian
Style Salad Kit 12 oz		 030034923310 Z178 or Lower Jul-11 MD, OH, PA, WV
Giant Eagle Chopped BBQ
Ranch Salad Kit 11.3 oz		 030034923303 Z178 or Lower Jul-12 MD, OH, PA, WV
Giant Eagle Chopped Chipotle
Cheddar Salad Kit 11.4 oz		 030034923389 Z178 or Lower Jul-11 MD, OH, PA, WV
Giant Eagle Chopped
Mediterranean Salad Kit 9.9 oz		 030034923372 Z178 or Lower Jul-9 MD, OH, PA, WV
Giant Eagle Chopped Southwest Style Salad Kit
11.5 oz		   030034923327   Z178 or Lower   Jul-11   MD, OH, PA, WV
Giant Eagle Chopped Sunflower
Crisp Salad Kit 11.1 oz		 030034923396 Z178 or Lower Jul-10 MD, OH, PA, WV
Giant Eagle Life’s Getting
Fresher Coleslaw 16 oz		 030034923099 Z178 or Lower Jul-12 MD, OH, PA, WV
Giant Eagle Life’s Getting Fresher Fresh American Blend
11 oz		   030034923105   Z178 or Lower   Jul-11   MD, OH, PA, WV
Giant Eagle Life’s Getting
Fresher Fresh Garden Salad Blend 12 oz		   030034923198   Z178 or Lower   Jul-11   MD, OH, PA, WV
Giant Eagle Life’s Getting
Fresher Fresh Italian Blend 9 oz		 030034923112 Z178 or Lower Jul-11 MD, OH, PA, WV
Giant Eagle Life’s Getting
Fresher Fresh Romaine Garden Salad Blend 12 oz		   030034923167   Z178 or Lower   Jul-11   MD, OH, PA, WV
Giant Eagle Life’s getting
Fresher Fresh Shredded Iceberg Lettuce 8 oz		   030034923150   Z178 or Lower   Jul-10   MD, OH, PA, WV
Giant Eagle Life’s Getting
Fresher Veggie Lovers 11 oz		 030034923280 Z178 or Lower Jul-9 MD, OH, PA, WV
Giant Eagle Shredded Lettuce
16 oz		 030034923204 Z178 or Lower Jul-10 MD, OH, PA, WV
Hy-Vee American Salad Mix
12 oz		 075450120479 Z178 or Lower Jul-12 IA, IL, KS, MN, MO, NE, SD, WI
Hy-Vee Chopped Kit Asian
Salad 13.7 oz		 075450246681 Z178 or Lower Jul-11 IA, IL, KS, MN, MO, NE, SD, WI
Hy-Vee Chopped Kit Avocado
Ranch Salad 12.8 oz		 075450247152 Z178 or Lower Jul-8 IA, IL, KS, MN, MO, NE, SD, WI
Hy-Vee Chopped Kit Chipotle
Cheddar Salad 11.4 oz		 075450246728 Z178 or Lower Jul-8 IA, IL, KS, MN, MO, NE, SD, WI
Hy-Vee Chopped Kit Southwest
Salad 13.4 oz		 075450246698 Z178 or Lower Jul-11 IA, IL, KS, MN, MO, NE, SD, WI
Hy-Vee Chopped Kit Sunflower
Crunch Salad 13.2 oz		 075450246704 Z178 or Lower Jul-11 IA, IL, KS, MN, MO, NE, SD, WI
Hy-Vee Cole Slaw Mix 16 oz 075450120516 Z178 or Lower Jul-9 IA, IL, KS, MN, MO, NE, SD, WI
Hy-Vee Garden Salad 12 oz 075450246742 Z178 or Lower Jul-3 IA, IL, KS, MN, MO, NE, SD, WI
Hy-Vee Greener Supreme Salad
Mix 12 oz		 075450120462 Z178 or Lower Jul-11 IA, IL, KS, MN, MO, NE, SD, WI
Hy-Vee Italian Salad Mix 10 oz 075450120486 Z178 or Lower Jul-11 IA, IL, KS, MN, MO, NE, SD, WI
Hy-Vee Romaine Salad Mix
12 oz		 075450120585 Z178 or Lower Jul-11 IA, IL, KS, MN, MO, NE, SD, WI
Hy-Vee Shredded Lettuce 8 oz 075450120530 Z178 or Lower Jul-6 IA, IL, KS, MN, MO, NE, SD, WI
Hy-Vee Veggie Deluxe Salad
Mix 12 oz		 075450085303 Z178 or Lower Jul-10 IA, IL, KS, MN, MO, NE, SD, WI
Little Salad Bar Asian Chopped
Salad Kit 12 oz		 4099100086966 Z178 or Lower Jul-9 AR, IA, IN, IL, MN, MO, SD, WI
Little Salad Bar Chef Salad
6.2 oz		 4099100107364 Z178 or Lower Jul-9 AR, IA, IN, IL, MN, MO, SD, WI
Little Salad Bar Classic
Coleslaw 14 oz		 0041498302177 Z178 or Lower Jul-11 AR, IA, IN, IL, MN, MO, SD, WI
Little Salad Bar Garden Salad
12 oz		 4099100082975 Z178 or Lower Jul-3 AR, IA, IN, IL, MN, MO, SD, WI
Little Salad Bar Southwest
Chopped Salad Kit 12 oz		 4099100087024 Z178 or Lower Jul-8 AR, IA, IN, IL, MN, MO, SD, WI
Little Salad Bar Sunflower
Chopped Salad Kit 11.1 oz		 04099100087901 Z178 or Lower Jul-12 AR, IA, IN, IL, MN, MO, SD, WI
Marketside Baby Greens Salad
6 oz		 681131027922 Z178 or Lower Jul-7 IA, MI, MN, ND, NE, SD, WI
Marketside Chopped Salad Kit
Asian 13.7 oz		 681131007047 Z178 or Lower Jul-7 IA, MI, MN, ND, NE, SD, WI
Marketside Chopped Salad Kit
Avocado Ranch 9.5 oz		 681131221320 Z178 or Lower Jul-8 IA, MI, MN, ND, NE, SD, WI
Marketside Chopped Salad Kit Cherry Almond Gorgonzola
3.8 oz		   681131148375   Z178 or Lower   Jul-6   IA, MI, MN, ND, NE, SD, WI
Marketside Chopped Salad Kit
Kale Pecan Cranberry		 681131221528 Z178 or Lower Jul-8 IA, MI, MN, ND, NE, SD, WI
Marketside Chopped Salad Kit
Southwest 13.4 oz		 681131007061 Z178 or Lower Jul-10 IA, MI, MN, ND, NE, SD, WI
Marketside Chopped Salad Kit Sunflower Bacon Crunch
13.8 oz		   681131148344   Z178 or Lower   Jul-8   IA, MI, MN, ND, NE, SD, WI
Marketside Chopped Salad Kit Sunflower Bacon Crunch
22.1 oz		   681131276535   Z178 or Lower   Jul-8   IA, MI, MN, ND, NE, SD, WI
Marketside Classic Iceberg
Salad 12 oz		 681131328944 Z178 or Lower Jul-7 IA, MI, MN, ND, NE, SD, WI
Marketside Classic Iceberg
Salad 24 oz		 681131328951 Z178 or Lower Jul-7 IA, MI, MN, ND, NE, SD, WI
Marketside Crisp Greens
12 oz		 681131387552 Z178 or Lower Jul-7 IA, MI, MN, ND, NE, SD, WI
Marketside Kale Slaw 12 oz 681131221573 Z178 or Lower Jul-6 IA, MI, MN, ND, NE, SD, WI
Marketside Premium Romaine
Salad 18 oz		 681131388078 Z178 or Lower Jul-8 IA, MI, MN, ND, NE, SD, WI
Marketside Premium Romaine
Salad 9 oz		 681131387538 Z178 or Lower Jul-10 IA, MI, MN, ND, NE, SD, WI
Marketside Shredded Iceberg
Lettuce 16 oz		 681131532099 Z178 or Lower Jul-10 IA, MI, MN, ND, NE, SD, WI
Marketside Shredded Iceberg
Lettuce 8 oz		 681131328968 Z178 or Lower Jul-9 IA, MI, MN, ND, NE, SD, WI
Marketside Tri-Color Cole Slaw
14 oz		 681131387484 Z178 or Lower Jul-10 IA, MI, MN, ND, NE, SD, WI
Signature Farms Coleslaw
3 Color 14 oz		 021130111961 Z178 or Lower Jul-13 IA, IN, IL
Signature Farms Garden Salad
12 oz		 021130981359 Z178 or Lower Jun-27 IA, IN, IL
Signature Farms Lettuce Shreds
8 oz		 021130112180 Z178 or Lower Jul-3 IA, IN, IL
Signature Farms Green & Crisp
11 oz		 021130419128 Z178 or Lower Jul 14 IA, IN, IL
Signature Farms Premium
Romaine 9 oz		 021130419166 Z178 or Lower Jul 14 IA, IN, IL
Wholesome Pantry Organic Chopped Sesame Asian Salad
Kit 10.9 oz		   041190066308   Z178 or Lower   Jul-12   CT, DE, MD, NJ, NY, PA
Wholesome Pantry Organic
Sesame Asian Salad Kit 13 oz		 041190066292 Z178 or Lower Jul-11 CT, DE, MD, NJ, NY, PA

Cases will likely be in all of these states soon: Arkansas, Illinois, Indiana, Iowa, Kansas, Missouri, Michigan, Minnesota, Missouri, Nebraska, North Dakota, South Dakota and Wisconsin.  Salads contaminated with Cyclospora were sold at other stores (Walmart).  All salads appear to have been manufactured by one processor (Fresh Express)

122 people with laboratory-confirmed Cyclospora infections and who reported eating bagged salad mix before getting sick have been reported from 7 Midwestern states (Illinois, Iowa, Kansas, Missouri, Minnesota, Nebraska, and Wisconsin). Illnesses started on dates ranging from May 11, 2020 to June 15, 2020. 19 people have been hospitalized. No deaths have been reported.

Epidemiologic evidence indicates that ALDI Little Salad Bar brand Garden Salad, Hy-Vee brand Garden Salad, or Jewel-Osco brand Signature Farms Brand Garden Salad are a likely source of this outbreak.

Bagged salad mixes from ALDI, Hy-Vee, and Jewel-Osco do not explain all of the illnesses in this outbreak.

CDC and FDA continue to investigate to determine whether other products are a source of illnesses in this outbreak.

The CDC and FDA warn do not eat, sell, or serve:

ALDI recalled Little Salad Bar brand Garden Salad sold in Arkansas, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, North Dakota, South Dakota and Wisconsin

Hy-Vee recalled Hy-Vee brand 12-ounce bagged Garden Salad sold in Illinois, Iowa, Kansas, Missouri, Minnesota, Nebraska, South Dakota, and Wisconsin.

Jewel-Osco recalled Signature Farms brand 12-ounce bagged Garden Salad sold in Illinois, Indiana, and Iowa.

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Cyclospora infections linked to bagged salad mix purchased at ALDI, Hy-Vee, and Jewel-Osco stores in Iowa, Illinois, Kansas, Missouri, Minnesota, and Nebraska. As of June 19, 2020, a total of 76 people with laboratory-confirmed Cyclospora infections associated with this outbreak have been reported from 6 states:  Iowa (28), Illinois (23), Kansas (1), Minnesota (10), Missouri (7) and Nebraska (7).

People with laboratory-confirmed Cyclospora infections and who reported eating bagged salad mix before getting sick have been reported from 6 states (Iowa, Illinois, Kansas, Missouri, Nebraska, and Minnesota). Illnesses started on dates ranging from May 11, 2020 to June 14, 2020. Sixteen people have been hospitalized. No deaths attributed to Cyclospora have been reported.

Consumers who have ALDI Little Salad Bar Brand Garden Salad, Hy-Vee Brand Garden Salad, or Jewel-Osco Signature Farms Garden Salad purchased at ALDI, Hy-Vee, and Jewel-Osco stores in Iowa, Illinois, Kansas, Missouri, Minnesota, and Nebraska in their homes should not eat it.

At least 20 people in this cluster shopped at ALDI, and of those, at least 16 (80%) people specifically report purchasing bagged salad mix.  Among people who remembered the specific name of the product, most reported the Little Salad Bar Brand Garden Salad.

At least 37 people in this cluster shopped at Hy-Vee, and of those, at least 16 (43%) people specifically report purchasing bagged salad mix from Hy-Vee.  Among people who remembered the specific name of the product, most reported the Hy-Vee Brand Garden Salad.

At least 6 people in this cluster shopped at Jewel-Osco, and of those, at least 5 (80%) people specifically report purchasing bagged salad mix from Jewel-Osco.  Among people who remembered the specific name of the product, most reported the Signature Farms Brand Garden Salad.

Cyclospora in the United States

While cyclosporiasis cases are reported year-round in the United States, cyclosporiasis acquired in the United States (i.e., “domestically acquired”, or cases of cyclosporiasis that are not associated with travel to a country that is considered endemic for Cyclospora) is most common during the spring and summer months. The exact timing and duration of U.S. cyclosporiasis seasons 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.

Latest Information

  • The number of reported cases of domestically acquired cyclosporiasis has increased from the previous month and remains elevated in the United States since May 1, 2019.
  • As of July 23, 2019, 580 laboratory-confirmed cases of cyclosporiasis were reported to CDC by 30 states, District of Columbia and New York City in people who became ill since May 1, 2019 and who had no history of international travel during the 14-day period before illness onset.
    • The median illness onset date was June 24, 2019 (range: May 3—July 13, 2019).
    • At least 38 people were hospitalized; no deaths were reported.
    • At this time, multiple clusters of cases associated with different restaurants or events are being investigated by state public health authorities, CDC, and FDA.
    • One multistate outbreak of Cyclospora infections has been linked to fresh basil imported from Siga Logistics de RL de CV of Morelos, Mexico . It is unknown at this time if other reported cases of Cyclospora infection in the United States this season are linked to fresh basil. This investigation is ongoing.
    • Many cases of cyclosporiasis could not be directly linked to an outbreak, in part because of the lack of validated molecular typing tools for C. cayetanensis.