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Multistate Outbreak of Cyclosporiasis Linked to Fresh Express Salad Mix Sold at McDonald’s Restaurants — United States, 2018: Final Update

Last Updated SEPTEMBER 12, 2018 1:00 PM EDT

Highlights

  • This outbreak appears to be over.
  • CDC, public health and regulatory officials in multiple states, and the U.S. Food and Drug Administration (FDA) investigated a multistate outbreak of Cyclospora cayetanensis infections.
    • As of September 11, 2018, CDC was notified of 511 laboratory-confirmed cases of Cyclospora infections in people from 15 states and New York City who reported consuming a variety of salads from McDonald’s restaurants in the Midwest.
    • Twenty-four (24) people were hospitalized. No deaths were reported.
  • Epidemiologic and traceback evidence indicated that salads purchased from McDonald’s restaurants were one likely source of this outbreak.
  • On July 13, 2018, McDonald’s voluntarily stopped selling salads at over 3,000 locations in 14 states. The company has since reported that it has replaced the supplier of salad mix in those states.
  • On July 26, 2018, the FDA completed final analysis of an unused package of romaine lettuce and carrot mix distributed to McDonald’s by the Fresh Express processor in Streamwood, IL. The analysis confirmed the presence of Cyclospora in that sample.
  • The FDA investigation reviewed distribution and supplier information for romaine and carrots but did not identify a single source or point of contamination for this outbreak. Read the related statement from the FDA.
 

At a Glance

  • Case Count: 511
  • States: 16
  • Deaths: 0
  • Hospitalizations: 24
  • Recall: No

Progression of the Outbreak Investigation

September Updates

Outbreak Summary – September 12, 2018

CDC, public health and regulatory officials in 15 states and New York City, and the U.S. Food and Drug Administration (FDA) investigated a multistate outbreak of Cyclospora infections.

As of September 11, 2018, CDC was notified of 511 laboratory-confirmed cases of Cyclospora infections in people from 15 states and New York City who reported consuming salads from McDonald’s restaurants in the Midwest. A list of the states and the number of cases in each can be found in the Case Count Maps page. 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.

Illnesses started on dates ranging from May 20 to July 23, 2018. Ill people ranged in age from 14–91 years with a median age of 52. Among ill people, 66% were female. Out of 472 people with information available, 24 people (5%) were hospitalized. No deaths were reported.

Investigation Details

Epidemiologic and traceback evidence indicated that salads purchased from McDonald’s restaurants were one likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate in the 2 weeks before they became ill. Ill people reported eating a variety of McDonald’s salads. Ill people reported buying salads from McDonald’s restaurant locations in the Midwest. 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.

Information collected from restaurant locations where ill people purchased salads indicated that Fresh Express supplied salad mix to these restaurants and that the salad mix was produced by a processor based in Streamwood, IL. On July 13, 2018, McDonald’s voluntarily stopped selling salads in more than 3,000 locations in 14 states (Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Missouri, Montana, Nebraska, North Dakota, Ohio, South Dakota, West Virginia, and Wisconsin) that received salad mix from the Streamwood, IL processing facility.

On July 26, 2018, the FDA completed final analysis of an unused package of romaine lettuce and carrot mix distributed to McDonald’s by the Fresh Express processor in Streamwood, IL. The analysis confirmed the presence of Cyclospora in that sample. On July 27, 2018, FDA informed Fresh Express of these results.

Romaine lettuce from the same lot that tested positive for Cyclospora was distributed in pre-made salads and wraps distributed by Caito Foods, LLC of Indianapolis, IN. Fresh Express reported to FDA that the carrots in the mix went to McDonald’s restaurants only, and that the romaine lettuce was the only ingredient in the mix that was distributed to other locations.

On July 30, 2018, the U.S. Department of Agriculture’s Food Safety and Inspection Service issued a public health alert regarding these pre-made salads and wraps containing the romaine lettuce. The pre-made salads and wraps were shipped to distribution centers nationwide. Read the alert here.

As of September 11, 2018, this outbreak appears to be over.

August Updates

August 23, 2018

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Cyclospora infections. At this time, there is no evidence to suggest that this cluster of illnesses is related to the  Cyclospora outbreak linked to Del Monte fresh produce vegetable trays.

As of August 23, 2018 (12pm EDT), a total of 507 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. 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. A list of the states and the number of cases reported from each state can be found on the Case Count Maps page.

Illnesses started on or after May 20, 2018. The median illness onset date is June 29, 2018 (range: May 20 to July 21). Ill people range in age from 14 to 91 years old, with a median age of 52. Sixty-six percent (66%) are female. At least 24 people have been hospitalized; no deaths have been reported.

Illnesses that started after July 12, 2018 might not have been reported yet due to the time it takes between when a person becomes ill and when the illness is reported. For Cyclospora infections, this can take up to six weeks.

Investigation of the Outbreak

Epidemiologic evidence indicates that salads purchased from McDonald’s restaurants are one likely source of these infections. The investigation is ongoing, and FDA is working to determine the sources of the ingredients that were in common to the salads served at McDonald’s.

CDC will provide more information as it becomes available.

August 16, 2018

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Cyclospora infections. At this time, there is no evidence to suggest that this cluster of illnesses is related to the Cyclospora outbreak linked to Del Monte fresh produce vegetable trays.

As of August 16, 2018 (3pm EDT), a total of 476 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 15 states. Note, the Connecticut, Tennessee, and Virginia case-patients purchased salads while traveling in Illinois; the Florida case-patient purchased a salad while traveling in Kentucky. A list of the states and the number of cases reported from each state can be found on the Case Count Maps page.

Illnesses started on or after May 20, 2018. The median illness onset date is June 29, 2018 (range: May 20 to July 20). Ill people range in age from 14 to 91 years old, with a median age of 53. Sixty-six percent (66%) are female. At least 21 people have been hospitalized; no deaths have been reported.

Illnesses that started after July 5, 2018 might not have been reported yet due to the time it takes between when a person becomes ill and when the illness is reported. For Cyclospora infections, this can take up to six weeks.

Investigation of the Outbreak

Epidemiologic evidence indicates that salads purchased from McDonald’s restaurants are one likely source of these infections. The investigation is ongoing, and FDA is working to determine the sources of the ingredients that were in common to the salads served at McDonald’s.

CDC will provide more information as it becomes available.

August 9, 2018

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Cyclospora infections. At this time, there is no evidence to suggest that this cluster of illnesses is related to the  Cyclospora outbreak linked to Del Monte fresh produce vegetable trays.

As of August 9, 2018 (11am EDT), a total of 436 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 15 states. Note, the Connecticut, Tennessee, and Virginia case-patients purchased salads while traveling in Illinois; the Florida case-patient purchased a salad while traveling in Kentucky. A list of the states and the number of cases reported from each state can be found on the Case Count Maps page.

Illnesses started on or after May 20, 2018. The median illness onset date is June 29, 2018 (range: May 20 to July 20). Ill people range in age from 14 to 91 years old, with a median age of 53. Sixty-six percent (66%) are female. At least 20 people have been hospitalized; no deaths have been reported.

Illnesses that started after June 28, 2018 might not have been reported yet due to the time it takes between when a person becomes ill and when the illness is reported. For Cyclospora infections, this can take up to six weeks.

Investigation of the Outbreak

Epidemiologic evidence indicates that salads purchased from McDonald’s restaurants are one likely source of these infections. The investigation is ongoing, and FDA is working to determine the sources of the ingredients that were in common to the salads served at McDonald’s.

CDC will provide more information as it becomes available.

August 2, 2018

CDC, public health and regulatory officials in several states, and the FDA are investigating a multistate outbreak of Cyclospora infections. At this time, there is no evidence to suggest that this cluster of illnesses is related to the Cyclospora outbreak linked to Del Monte fresh produce vegetable trays.

As of August 2, 2018 (12pm EDT), a total of 395 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 15 states. Note, the Connecticut, Tennessee, and Virginia case-patients purchased salads while traveling in Illinois; the Florida case-patient purchased a salad while traveling in Kentucky. A list of the states and the number of cases reported from each state can be found on the Case Count Maps page.

Illnesses started on or after May 20, 2018. The median illness onset date is June 29, 2018 (range: May 20 to July 20). Ill people range in age from 14 to 91 years old, with a median age of 53. Sixty-six percent (66%) are female. At least 16 people have been hospitalized; no deaths have been reported.

Illnesses that started after June 21, 2018 might not have been reported yet due to the time it takes between when a person becomes ill and when the illness is reported. For Cyclospora infections, this can take up to six weeks.

Investigation of the Outbreak

Epidemiologic evidence indicates that salads purchased from McDonald’s restaurants are one likely source of these infections. The investigation is ongoing, and FDA is working to determine the sources of the ingredients that were in common to the salads served at McDonald’s.

CDC will provide more information as it becomes available.

August 1, 2018

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

On July 26, 2018, FDA completed analysis of an unused package of romaine lettuce and carrot mix distributed to McDonald’s by the Fresh Express processor in Streamwood, IL. The analysis confirmed the presence of Cyclospora in that mix. On July 27, 2018, FDA informed Fresh Express of the results.

Fresh Express reported to FDA that the carrots in the mix went to McDonald’s restaurant locations only, and that the romaine lettuce was the only ingredient in the mix that was distributed to other locations. Romaine lettuce from the same lot that was positive for Cyclospora was distributed in pre-made salads and wraps distributed by Caito Foods LLC of Indianapolis, IN. Fresh Express also reported that no romaine lettuce from the lot that was positive for Cyclospora was packaged for direct retail sale to consumers.

On July 30, 2018, The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) issued a public health alert about pre-made salads and wraps containing romaine lettuce that were distributed by Caito Foods LLC of Indianapolis, IN. The pre-made salads and wraps were produced between July 15 to July 18, 2018, with either a “Best By,” “Enjoy by,” Best if Sold By,” or “Sell By” date ranging from July 18 through July 23, 2018.

Consumers who purchased one of these pre-made salads or wraps and have not eaten it should not eat it. They should throw it away or return it to the place of purchase. Consumers who have eaten one of these pre-made salads or wraps and developed diarrhea should see a healthcare provider to be tested for Cyclospora infection and to be treated if they are sick.

The investigation is ongoing. CDC will provide more information as it becomes available.

July Updates

July 26, 2018

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Cyclospora infections. At this time, there is no evidence to suggest that this cluster of illnesses is related to the  Cyclospora outbreak linked to Del Monte fresh produce vegetable trays.

As of July 26, 2018 (1pm EDT), a total of 286 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 15 states. Note, the Connecticut, Michigan, Tennessee, and Virginia case-patients purchased salads while traveling in Illinois; the Florida case-patient purchased a salad while traveling in Kentucky. A list of the states and the number of cases reported from each state can be found on the Case Count Maps page.

Illnesses started on or after May 20, 2018. The median illness onset date is June 29, 2018 (range: May 20 to July 12). Ill people range in age from 16 to 91 years old, with a median age of 53. Sixty-seven percent (67%) are female. At least 11 people have been hospitalized; no deaths have been reported.

Illnesses that started after June 14, 2018 might not have been reported yet due to the time it takes between when a person becomes ill and when the illness is reported. For Cyclospora infections, this can take up to six weeks.

July 19, 2018

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Cyclospora infections. At this time, there is no evidence to suggest that this cluster of illnesses is related to the Cyclospora outbreak linked to Del Monte fresh produce vegetable trays.

As of July 19, 2018 (12pm EDT), a total of 163 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 10 states. Note, the Florida case-patient purchased a salad while traveling in Kentucky. A list of the states and the number of cases reported from each state can be found on the Case Count Maps page.

Illnesses started on or after May 1, 2018. The median illness onset date is June 28, 2018 (range: May 20 to July 10). Ill people range in age from 16 to 87 years old, with a median age of 53. Sixty-six percent (66%) are female. At least three (3) people have been hospitalized; no deaths have been reported.

Illnesses that started after June 7, 2018 might not have been reported yet due to the time it takes between when a person becomes ill and when the illness is reported. For Cyclospora infections, this can take up to six weeks.

Investigation of the Outbreak

Epidemiologic evidence indicates that salads purchased from McDonald’s restaurants are one likely source of these infections. The investigation is ongoing and FDA is working to determine the source of the ingredients used in the salads served at McDonald’s. The investigation has not identified a single, common ingredient in the salads linked to illness.

State and local health departments are interviewing ill people to find out what foods they ate in the two weeks before they got sick. Many ill people reported eating salads from McDonald’s restaurants located in the Midwest. People reported eating a variety of McDonald’s salads.

CDC will provide more information as it becomes available.

 

INITIAL ANNOUNCEMENT

 

July 13, 2018

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Cyclospora infections. At this time, there is no evidence to suggest that this cluster of illnesses is related to the ongoing Cyclospora outbreak linked to Del Monte fresh produce vegetable trays.

On July 12, 2018, the Iowa Department of Public Health and the Illinois Department of Public Health reported an increase in cases of cyclosporiasis among people who ate salads sold at McDonald’s fast-food chain restaurants. CDC also has received reports of sick people who ate McDonald’s salads from locations in Indiana, Kentucky, Minnesota, Missouri, Nebraska, Ohio, South Dakota, and Wisconsin. McDonald’s is cooperating with the investigation and has voluntarily stopped selling salads in more than 3,000 locations in the following 14 states: Illinois, Indiana, Iowa, Kentucky, Michigan, Minnesota, Missouri, Montana, Nebraska, North Dakota, Ohio, South Dakota, West Virginia, and Wisconsin. Because of the proactive actions McDonald’s took to remove the affected salads from the locations in these states, there likely is not ongoing risk to consumers who eat at those McDonald’s locations.

As of July 13, 2018 (4pm EDT), a total of 61 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed salads from McDonald’s restaurants in 7 states. A list of the states and the number of cases reported from each state can be found on the Case Count Maps page.

Illnesses started on or after May 1, 2018. The median illness onset date is June 28, 2018 (range: May 20 to July 10). Ill people range in age from 16 to 79 years old, with a median age of 51. Sixty-six percent (66%) are female. Two (2) people have been hospitalized, and no deaths have been reported.

Illnesses that started after June 1, 2018 might not have been reported yet due to the time it takes between when a person becomes ill and when the illness is reported. For Cyclospora infections, this can take up to six weeks.

Investigation of the Outbreak

Epidemiologic evidence indicates that salads purchased from McDonald’s restaurants are one likely source of these infections. The investigation is ongoing and FDA is working to determine the source of the ingredients used in the salads served at McDonald’s. The investigation has not identified a single, common ingredient in the salads linked to illness.

State and local health departments are interviewing ill people to find out what foods they ate in the two weeks before they got sick. Many ill people reported eating salads from McDonald’s restaurants located in the Midwest. People reported eating a variety of McDonald’s salads.

CDC will provide more information as it becomes available.

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