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                Outbreaks of Foodborne Illness

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          Outbreaks of Foodborne Illness
          FDA Investigated a Multistate Outbreak of Cyclospora Illnesses Linked to Fresh Express Salad Mix Served at McDonald’s EndsOutbreaks of Foodborne Illness FDA Investigated a Multistate Outbreak of Cyclospora Illnesses Linked to Fresh Express Salad Mix Served at McDonald’s Ends
  
  	
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The FDA, CDC, along with state and local officials investigated a multi-state outbreak of *cyclosporiasis*illnesses likely linked to salads from McDonald's restaurants.

As of September 11, 2018, this outbreak appears to be over. A total of 511 laboratory-confirmed cases of *Cyclospora* infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 15 states and New York City.

The FDA investigated distribution and supplier information for romaine and carrots but did not identify a single source or potential point of contamination for this outbreak.

Recommendations

Consumers who have symptoms of cyclosporiasisshould contact their health care provider to report their symptoms and receive care.


On this Page

What was the Problem and What's Been Done?
	What is *Cyclospora*?
	What are the Symptoms of Cyclosporiasis?
	What  Do Restaurants and Retailers Need To Do?
	What Do Consumers Need To Do?
	Who to ContactCase Counts

**Total Illnesses:** 511**Hospitalizations:** 24**Deaths:** 0**Last illness onset:** 7/23/2018**States with Cases:** CT, FL, IA, IL, IN, KY, MI, MN, MO, NE, New York City, OH, SD, TN, VA, WI

**Note:**The Connecticut, New York City, Tennessee, and Virginia case-patients purchased salads while traveling in Illinois; the Florida case-patient purchased a salad while traveling in Kentucky.

CDC's Outbreak Page

What was the Problem and What's Been Done?

As of September 11, 2018, this outbreak appears to be over. A total of 511 laboratory-confirmed cases of *Cyclospora* infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 15 states and New York City. The FDA investigated distribution and supplier information for romaine and carrots but did not identify a single source or potential point of contamination for this outbreak.
	On July 30, 2018, the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) issued a public health alert on beef, pork and poultry salad and wrap products potentially contaminated with *Cyclospora* that were distributed by Caito Foods LLC, of Indianapolis, IN. The products were produced between July 15 and 18, 2018, with either “Best By,” “Enjoy by,” “Best if Sold By” or “Sell By” dates ranging from July 18 through July 23, 2018. Caito Foods had received notification from Fresh Express that the chopped romaine in these products was being recalled.
	On July 26, 2018, the FDA completed final analysis of an unused package of Fresh Express salad mix containing romaine lettuce and carrots, which had been distributed to McDonald's. The analysis confirmed the presence of *Cyclospora* in that sample, though the expiration date for that product, July 19, had already passed. On July 27, the FDA informed Fresh Express of the results.
	FDA instructed Fresh Express to determine whether potentially contaminated product may still be on the market. Fresh Express reported to FDA that the romaine from the same lot as the positive sample was not packaged for direct retail sale by Fresh Express and had already expired. Fresh Express committed to using recall procedures to inform those companies that received this romaine about the sample result. Fresh Express also reported that carrots used in the mix were only sent to McDonald's locations.
	As of July 13, 2018, McDonald's decided to voluntarily stop selling salads at impacted restaurants in IL, IA, IN, WI, MI, OH, MN, NE, SD, MT, ND, KY, WV, and MO. The company has since reported that it has replaced the supplier of salads in those states. More information can be found in McDonald's Statement.
	In 2015, FDA set up a multidisciplinary workgroup to prioritize the development, validation and implementation of a method for detecting *Cyclospora* in fresh produce. In 2018, FDA began using the newly validated *Cyclospora* method. The availability of this method is a significant advancement in FDA's ability to investigate outbreaks of cyclosporiasis and identify the parasite in foods.
	At this time, we do not have evidence to suggest that this cluster of illnesses is related to the ongoing *Cyclospora*outbreak linked to Del Monte vegetable trays.What is *Cyclospora*?

*Cyclospora* *cayetanensis* is a microscopic parasite of humans. This parasite, when it contaminates food or water and is then ingested, can cause an intestinal illness called cyclosporiasis.

The *Cyclospora* parasite needs time (days to weeks) after being passed in a bowel movement to become infectious for another person. Therefore, it is unlikely that cyclosporiasis is passed directly from one person to another.

*Cyclospora*
	Cyclosporiasis and Fresh ProduceWhat are the Symptoms of *Cyclosporiasis*?

Most people infected with *Cyclospora* develop diarrhea, with frequent, sometimes explosive, bowel movements. Other common symptoms include loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, and fatigue. Vomiting, body aches, headache, fever, and other flu-like symptoms may be noted. Some people who are infected with *Cyclospora* do not have any symptoms. If not treated, the illness may last from a few days to a month or longer. Symptoms may seem to go away and then return one or more times (relapse).

What Do Restaurants and Retailers Need To Do?

Based on current information available *Cyclospora*may be resistant to routine chemical disinfection methods such as those using chlorine. However, restaurants and retailers should still follow basic food safety practices:

Retailers, restaurants, and other food service operators should always practice safe food handling and preparation measures. It is recommended that they wash utensils, and surfaces with hot, soapy water before and after handling food. Wash and sanitize display cases and refrigerators where potentially contaminated products were stored.
	Wash and sanitize cutting boards, surfaces, and utensils used to prepare, serve, or store potentially contaminated products.
	Wash hands with warm water and soap following the cleaning and sanitation process.
	Regular frequent cleaning and sanitizing of food contact surfaces and utensils used in food preparation may help to minimize the likelihood of cross-contamination.What Do Consumers Need To Do?

Consumers who have symptoms of cyclosporiasis should contact their health care provider to report their symptoms and receive care. Most people infected with *Cyclospora*develop diarrhea, with frequent, sometimes explosive, bowel movements. Other common symptoms include loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, and fatigue. Vomiting, body aches, headache, fever, and other flu-like symptoms may be noted.

Who to Contact

**Consumers who have symptoms**should contact their health care provider to report their symptoms and receive care.

To report a **complaint**or **adverse event**(illness or serious allergic reaction), you can

Call an FDA Consumer Complaint Coordinator if you wish to speak directly to a person about your problem.
	Complete an electronic Voluntary MedWatch form online.
	Complete a paper Voluntary MedWatch form that can be mailed to FDA.Submit Questions/Get Assistance

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                                                                                  Content current as of:
      09/12/2018
              
              
Regulated Product(s)
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				  CORE NetworkOutbreaks of Foodborne Illness

          
                        Investigations of Foodborne Illness Outbreaks
          Public Health Advisories from Investigations of Foodborne Illness Outbreaks
          Food Safety Tips for Consumers & Retailers During an Outbreak of Foodborne Illness
          Food Safety Resources for Produce Shippers and Carriers During a Foodborne Illness Outbreak
          Outbreak Investigation Reports
          How to Report Seafood-Related Toxin and Scombrotoxin Fish Poisoning Illnesses
          About the CORE Network
          CORE Annual Reports
          CORE Publications


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