2020 Fresh Express Cyclospora Outbreak

On June 22, 2020, the FDA and CDC and several local health officials, announced a multi-state investigation of a Cyclospora outbreak connected to bagged “garden salads”, sold at ALDI, Hy-Vee and Jewel-Osco grocery stores.

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.

Epidemiological evidence found by the CDC indicates that the bagged “garden salads” from these locations are likely the source of the illnesses.  The bagged salads contained iceberg lettuce, red cabbage, and carrots.  In order to identify the supplier and distributor, the FDA has begun a traceback investigation that will reveal the cause and source of the Cyclospora outbreak. 

Because this is the initial stages of the investigation, additional retailers and product may still be identified and recalled.  This outbreak investigation is on-going; the FDA will continue to announce updates as relevant data becomes available.

What is Cyclospora?

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 each year in the United States. The first outbreak in North America occurred in 1990 from contaminated water. Since then, several outbreaks of cyclosporiasis 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.

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.

Where does Cyclospora come from?

Cyclospora is spread by people ingesting water or food contaminated with infected stool. For example, exposure to contaminated water among farm workers may have been the original source in raspberry-associated outbreaks in North America.

Cyclospora needs time (one to several weeks) after being passed in a bowel movement to become infectious. Therefore, it is unlikely that Cyclospora is passed directly from one person to another. It is not known whether or not animals can be infected and pass infection to people.

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

Cyclospora has been associated with a variety of chronic complications such as Guillain-Barré syndrome, reactive arthritis or Reiter’s syndrome, biliary disease, and acalculous cholecystitis. 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.

How is Cyclospora infection detected?

Your health care provider may ask you to submit stool specimen for analysis. Because testing for Cyclospora infection can be difficult, you may be asked to submit several stool specimens over several days. Identification of this parasite in stool requires special laboratory tests that are not routinely done. Therefore, your health care provider should specifically request testing for Cyclospora if it is suspected. Your health care provider might have your stool checked for other organisms that can cause similar symptoms.

How is Cyclospora infection treated?

The recommended treatment for infection with Cyclospora is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim, Septra, or Cotrim. People who have diarrhea should rest and drink plenty of fluids. No alternative drugs have been identified yet for people with Cyclospora infection who are unable to take sulfa drugs. Some experimental studies, however, have suggested that ciprofloxacin or nitazoxanide may be effective, although to a lesser degree than trimethoprim-sulfamethoxazole. See your health care provider to discuss alternative treatment options.

How can Cyclospora infection be prevented?

Avoiding water or food that may be contaminated is advisable when traveling. Drinking bottled or boiled water and avoiding fresh ready-to-eat produce should help to reduce the risk of infection in regions with high rates of infection. Improving sanitary conditions in developing regions with poor environmental and economic conditions is likely to help to reduce exposure. Washing fresh fruits and vegetables at home may help to remove some of the organisms, but Cyclospora may remain on produce even after washing.

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 $750 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.