CDC reports 641 cases of Cyclospora linked to recalled salad mixes nationwide

Since the last case count update on July 9, 2020, the U.S. Centers for Disease Control reported 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.

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.

This investigation is ongoing.

The CDC says that it is specifically examining salad ingredients (iceberg lettuce, carrots, red cabbage) for the purposes of its investigation. The affected products include salad mixes made by Fresh Express, Hy-Vee Inc., Little Salad Bar, Signature Farms, Marketside and Hy-Vee. The products were sold at ALDI, Giant Eagle, Hy-Vee, Jewel-Osco, ShopRite, and Walmart locations.

The products were manufactured in Streamwood, Illinois at a Fresh Express production facility.

“Cyclosporiasis is an intestinal infection caused by the Cyclospora parasite,” the CDC says. “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.”

Specifically, the CDC says the products with a Z178 code or lower and “Best by” date that runs through July 14, 2020 are the ones potentially affected by the contamination.

However, only Georgia, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Pennsylvania, South Dakota and Wisconsin have reported cases of Cyclospora related to eating the salad mix. According to the CDC, the dates of the illness range from May 11, 2020 to July 5, 2020, with 37 people hospitalized as of Friday. Patients are ages 10 to 92 years with a median age of 59 years as of Friday’s data. No related deaths have been reported. People can go 4 to 6 weeks before noticing any symptoms of Cyclospora, the CDC says.

Write down what you ate in the two weeks before you started to get sick.

Report your illness to the health department.

Assist public health investigators by answering questions about your illness.

The CDC issued its recall warnings June 19, and Giant Eagle issued a recall on its Fresh Express products on June 29.

On June 27, 2020, Fresh Express Fresh Express brand and private label brand salad products produced at its Streamwood, IL facility that contain iceberg lettuce, red cabbage, and/or carrots due to possible Cyclospora contamination.

The Public Health Agency of Canada is investigating an outbreak of Cyclospora infections occurring in three Canadian provinces. 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.

  • Epidemiologic and traceback evidence indicates that bagged salad mix containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express is a likely source of this outbreak.
  • 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.
  • CDC will provide updates when more information is available.

US Cyclospora infections from salads rise, found in Canada

Chris Koger of The Packer reports that cases of Cyclospora infection linked to Fresh Express salads continue to rise, according to the Centers for Disease Control and Prevention, and Canada is reporting its first cases.

Lab-confirmed cases thought to be linked to iceberg lettucecarrots or red cabbage in garden salads were 509 in the U.S, as of July 9, according to the CDC. The Canadian Food Inspection Agency on July 8 reported 37 cases in Ontario, Quebec and Newfoundland and Labrador.

The salads, including private-label bagged garden salads, were processed at Fresh Express’ Streamwood, Ill., facility, according to the FDA.

Fresh Express has recalled salads from the plant containing the three ingredients under investigation, along with Aldi, Giant Eagle, Hy-Vee, Jewel-Osco, ShopRite and Walmart issuing recalls of private label salads.

The Canadian Food Inspection Agency reported on June 28 Fresh Express had recalled products in Canada. They were distributed nationwide by Crescent Multi-Foods, Federated Co-Operatives Ltd., Fresh Express and Walmart Canada Corp., according to the Canadian Agency.

An edited version of the latest CDC update is below:

On June 27, 2020, Fresh Express recalled Fresh Express brand and private label brand salad products produced at its Streamwood, IL facility that contain iceberg lettuce, red cabbage, and/or carrots due to possible Cyclospora contamination.

509 people with laboratory-confirmed Cyclospora infections and who reported eating bagged salad mix before getting sick have been reported from 8 Midwestern states (Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Wisconsin).

Illnesses started on dates ranging from May 11, 2020 to July 1, 2020.

33 people have been hospitalized. No deaths have been reported.

The Public Health Agency of Canada  is investigating an outbreak of Cyclospora infections occurring in three Canadian provinces. 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.

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

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. CDC will provide updates when more information is available.

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

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.

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.

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.

How the hell would I know? 395 sickened by Cyclospora linked to McDonalds salads

There was this one time, in 2010, I got a phone call at 6 a.m. from the esteemed Michael Osterholm of the Minnesota food safety system.

My wife does a better Minnosotan accent, spending her yute in Albert Lea, eh?

He didn’t like the photo, right, made by the creative couple of Heather and Christian, who used to work in my lab, and opened the conversation with, “How could you print that?”

I said it was an accurate description of what had been publically known about the leafy greens folks since the E. coli O157 spinach outbreak of 2006 (I’m old, waiting for news on the birth of my third grandson).

He then told me he was a consultant for Fresh Express and that they had an excellent food safety system.

I said great, make it public, so people can judge on their own.

Fresh Express has now been linked to 395 cases of Cyclospora through their lettuce served at McDonalds.

U.S. Rep. Rosa DeLauro, D-Conn., is pressing Food and Drug Administration Commissioner Scott Gottlieb for specifics about the investigation of the cyclosporaoutbreak linked to product sold by Fresh Express.

In an Aug. 3 letter her office released to the media, DeLauro said she wrote the letter “out of concern about the current outbreak of cyclosporiasis as well as the transparency and timeliness of your agency’s ongoing investigation.”

“Although once rare in the United States, parasitic outbreaks caused by cyclospora have become more common over the last several decades,” she said in the letter. “Many of these outbreaks have continually been found to be associated with imported fruits and vegetables.”

The recent outbreak is currently responsible for 395 infections — including 16 hospitalizations — across 15 states.

The parasite was first found when the FDA conducted testing on an unused package of Fresh Express salad mix, distributed to a McDonald’s restaurant, containing romaine lettuce and carrots.

The FDA states as of July 13, McDonald’s decided to stop selling the salads at restaurants impacted in Illinois, Iowa, Indiana, Wisconsin, Michigan. Ohio, Minnesota, Nebraska, South Dakota. Montana, North Dakota, Kentucky, West Virginia and Missouri.

In a July 20, statement, McDonald’s said the health and safety of their customers is their top priority.

“The health and safety of our customers and the people who work in McDonald’s restaurants is always our top priority. The additional states identified by the FDA and CDC are among the same states where a week ago we proactively decided to remove our lettuce blend in impacted restaurants and replace it through a different supplier. McDonald’s is committed to the highest standards of food safety and quality and we continue to cooperate and support regulatory and public health officials in their investigations. For those seeking additional information about Cyclospora, we encourage them to visit the CDC and FDA websites.”

Uh-huh.

Cyclospora sucks. My aunt, my mom’s sister, got it in Florida from basil, about a decade ago.

(Doesn’t she look amazing at 80, left.)

Cyclospora isn’t one of those things doctors routinely check for. Then you’re sick for about six weeks until some bright doc figures it out.

The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) issued an alert to the public on “beef, pork and poultry salad and wrap products potentially contaminated with Cyclospora that were distributed by Caito Foods LLC, of Indianapolis,” Indiana.

USDA also released a public health alert after Indianapolis-based food distributor Caito Foods “received notification from their lettuce supplier, Fresh Express, that the chopped romaine that is used to manufacture some of their salads and wraps was being recalled.”

“Fresh Express follows rigid food safety requirements and preventive controls throughout our supply chain that are carefully designed to mitigate against potential health risks. Working together with public health officials, we are hopeful a definitive source of the outbreak clusters will be identified soon.”

Uh-huh.

Still here, Mike. You can call me in Australia through Google voice 785-532-1925 and tell me what Fresh Express is doing, and why they are importing lettuce in the middle of North American summer.

‘We meet all standards’ Fresh Express uses Pinto defense after dead bat found in salad

The U.S. Centers for Disease Control and Prevention (CDC) are working with the Florida Department of Health and the U.S. Food and Drug Administration (FDA) to support an investigation of a dead bat that was found in a packaged salad purchased from a grocery store in Florida. Two people in Florida reported eating some of the salad before the bat was found. The bat was sent to the CDC rabies lab for laboratory testing because bats in the United States sometimes have been found to have this disease. The deteriorated condition of the bat did not allow for CDC to definitively rule out whether this bat had rabies.

Transmission of rabies by eating a rabid animal is extremely uncommon, and the virus does not survive very long outside of the infected animal. CDC is supporting Florida local and state health officials in evaluating the people who found the bat in the salad. In this circumstance, the risk of rabies transmission is considered to be very low, but because it isn’t zero, the two people who ate salad from the package that contained the bat were recommended to begin post-exposure rabies treatment. Both people report being in good health and neither has any signs of rabies. CDC is not aware of any other reports of bat material found in packaged salads.

On April 8, 2017, Fresh Express issued a recall of a limited number of cases of Organic Marketside Spring Mix. The salads were sold in a clear container with production code G089B19 and best-if-used-by date of APR 14, 2017 located on the front label. The recalled salads were distributed only to Walmart stores located in the Southeastern region of the United States. All remaining packages of salad from the same lot have been removed from all store locations where the salad was sold.

The company said in a statement it worked quickly with officials to remove the entire batch of salads from store shelves, and only one line of its products had been affected.

“Fresh Express takes matters of food safety very seriously and rigorously complies with all food safety regulations including the proscribed Good Agricultural Practices.”

Maybe install bat filters as the lettuce goes through a wash?

Tennessee man finds $10 bill is bagged salad

Kyle Hubbard bought a bagged salad at a Target in Cordova, Tennessee, and found another green item among the lettuce — a $10 bill.

moneylettuce_croppedHubbard purchased the Fresh Express 50/50 Mix on October 21, which contains baby spinach and spring mix. He was concerned that the $10 bill might have contaminated other salads before they were bagged.

 “You’ve seen some salad tainted with E. coli and listeria and those are germs and that’s hard to see,” Hubbard told WMC Action News 5. “But when it’s a more blatant object that’s clearly visible, it’s quite concerning how that made it outside the doors of that facility.”

Target’s corporate offices were notified of this incident.

“At Target, we take food quality very seriously,” a spokesperson told WMC Action News 5. “I have shared the information with our team and would encourage you to reach out to Fresh Express directly.”

Target also offered Hubbard $24 worth of coupons, but he declined. It is unclear whether he kept the $10 bill or not.

Fresh Express marketing missteps 2.0

Issuing a press release before publishing food safety data is a bad idea; launching an entire advertising campaign before publishing is worse.

But that’s exactly what Fresh Express is doing.

I’m all for marketing food safety directly to consumers and at retail – but only if such claims can be verified, and the most credible way to do that is publish in a peer-reviewed journal. Supermarkets are already overflowing with hucksterism.

In Sept. 2000, I called Procter & Gamble to substantiate claims their consumer-oriented FIT Fruit and Vegetable Wash removed 99.9 per cent more residue and dirt than water alone.

The PR-thingies hooked me up with some scientists at P&G in Cincinnati, who verbally told me that sample cucumbers, tomatoes and the like were grown on the same farm in California, sprayed with chemicals that would be used in conventional production, and then harvested immediately and washed with FIT or water. The FIT removed 99.9 per cent more, or so the company claimed.

One problem. Many of the chemicals used had harvest?after dates, such as the one tomato chemical that must be applied at least 20 days before harvest.

Residue data on produce in North American stores reveals extremely low levels, in the parts per million or billion. So that 99.9 per cent reduction was buying consumers an extra couple of zeros in the residue quantity, all well below health limits.

I also asked why the results hadn’t been published in a peer-reviewed journal, and the P&G types said it was an important advance that had to be made available to consumers as soon as possible, without the delays and messiness of peer-review.

In Oct. 2010, Chiquita Brands, the owners of Fresh Express and also based in Cincinnati, followed the same PR playbook for its new produce rinse, Fresh Rinse.

The new rinse, for use in the packing shed and which the company says removes microorganisms from leafy greens more effectively than conventional chlorine sanitizers, was unveiled yesterday at a news conference at the Produce Marketing Association Fresh Summit to gushing reviews.

Today, Fresh Express gushed again that its salads sold nationwide are now manufactured using its new breakthrough produce wash, Fresh Rinse. The company claims that Fresh Rinse has been scientifically validated to dramatically reduce certain bacteria while at the same time continuing to provide high levels of freshness, taste and quality consumers expect from Fresh Express salads.

The effectiveness of this new patent-pending technology has been validated by studies performed at the National Center for Food Safety and Technology – a recognized third-party research and testing facility. These independent studies confirmed that Fresh Rinse demonstrated superior effectiveness in removing pathogens from wash water and from certain leafy greens compared to traditional chlorine washes. An article detailing the Fresh Rinse technology has been peer reviewed and accepted for publication by the Journal of Food Protection.

I have an article in press by JFP right now but I don’t blabber about it until it’s published. Because until then, other mortals or food safety nerds can’t see what anyone is bragging about. Why is Fresh Express above the process?

Sometimes the faster it gets?
The less you need to know?
But you gotta remember?
The smarter it gets the further it’s going to go?
When you blow at high dough

Tragically Hip, Canadian national anthem, 1989.

A table of leafy green foodborne illness outbreaks is available at:
http://bites.ksu.edu/Outbreaks%20related%20to%20leafy%20greens%201993-2010
 

Fresh Express makes marketing missteps

That’s the headline on Greg Johnson’s column in The Packer today, criticizing the way Fresh Express’ announced its super-duper new produce wash.

I’m all for marketing food safety, but only if it can be thoroughly backed up.

Johnson complains this kind of promotion violates the generally agreed upon, though nonbinding, industry standard after the 2006 E. coli spinach outbreak that the produce industry is in food safety together. ?

Once companies say they’re safer than others, consumers can infer that some produce is less safe or worse, unsafe, and they stop buying.

Tom Stenzel, president and CEO of the United Fresh Produce Association, said, “Food safety should never be a competitive advantage. If a new product improves food safety, we should share it with the whole industry.”

Ed Loyd, director of corporate communications for Chiquita, said the company isn’t marketing its method as safer than others because it’s offering FreshRinse technology to competitors.

Several competitors say Fresh Express’ claims about its new wash are exaggerated or flat-out false, and they have not been verified by any third party.

Bagged salad: press release before publishing a bad idea

In Sept. 2000, I called Procter & Gamble to substantiate claims their consumer-oriented FIT Fruit and Vegetable Wash removed 99.9 per cent more residue and dirt than water alone.

The PR-thingies hooked me up with some scientists at P&G in Cincinnati, who verbally told me that sample cucumbers, tomatoes and the like were grown on the same farm in California, sprayed with chemicals that would be used in conventional production, and then harvested immediately and washed with FIT or water. The FIT removed 99.9 per cent more, or so the company claimed.

One problem. Many of the chemicals used had harvest?after dates, such as the one tomato chemical that must be applied at least 20 days before harvest. Residue data on produce in North American stores reveals extremely low levels, in the parts per million or billion. So that 99.9 per cent reduction was buying consumers an extra couple of zeros in the residue quantity, all well below health limits.

I also asked why the results hadn’t been published in a peer-reviewed journal, and the P&G types said it was an important advance that had to be made available to consumers as soon as possible, without the delays and messiness of peer-review.

Maybe Chiquita Brands, the owners of Fresh Express and also based in Cincinnati, are using the same PR flunkies as P&G because the public relations around the new produce rinse – FreshRinse – is strikingly familiar and equally lame as FIT in 2000.

For the most part, pathogens and chemicals in fresh produce need to be controlled on the farm, and in transportation and distribution.

The new rinse, for use in the packing shed and which the company says removes microorganisms from leafy greens more effectively than conventional chlorine sanitizers, was unveiled yesterday at a news conference at the Produce Marketing Association Fresh Summit to gushing reviews.

Fernando Aguirre, Chiquita’s chairman and chief executive officer, said,

"Based on our extensive research, we are proud to introduce the biggest invention since the creation of prepackaged salads. … Compare FreshRinse technology to current wash standards. Chlorine is the abacus and FreshRinse is the iPad. An abacus is what people use with the beads, a great thing at the time, just like chlorine rinse was. We believe FreshRinse sets a new standard in food safety.”

Also jumping aboard the metaphor train, Mike Burness, vice president of global quality and food safety said,

“As a matter of magnitude, that’s the equivalent of chlorine walking a mile and FreshRinse making two round trips to the moon. If chlorine walked one mile, FreshRinse would have walked a marathon. We have seen a significant reduction of potential foodborne organisms that cause disease.”

Scientific advisors who gave more qualified endorsements included project advisor Dr. Michael Osterholm, a professor in the School of Public Health at the University of Minnesota, Dr. David Acheson, managing director of food and import safety for Leavitt Partners and the former the Food and Drug Administration associate commissioner for food protection and chief medical officer, and Dr. Robert Buchanan, director and professor, University of Maryland Center for Food Safety & Security Systems.

Did any of you esteemed science types say to Fresh Express, we should publish these results in a peer-reviewed journal first, because that’s the way this credibility thing works?

I told Ilan Brat of the Wall Street Journal yesterday that I couldn’t judge whether the new wash worked better or not without publication in a peer-reviewed journal.

Fresh Express had three recalls of its bagged salads this year, and was the source of a Salmonella typhirmirium outbreak that sickened eight people in May, but decided it wasn’t worth telling anyone about it.

Metaphor-man Burness, told the Journal the company chose to market the product before submitting supporting research for publication in peer-reviewed journals because "anything that advances food safety, we believe we need to leverage that for our consumers."

Sounds familiar.

He added that the company plans to submit its research to the Journal of Food Protection by the end of the year.

Dude, I’ve got a bunch of graduate students who say they have papers they are going to prepare for the Journal of Food Protection. I have about a dozen in my head too. Except that doesn’t count for shit.

If the company had instead spent the time it used coming up with terrible risk communication metaphors preparing the results for publication, they would at least have a paper submitted. Until then, I’m thinking cold fusion.

"All this data is nice—why isn’t it published in a peer-reviewed journal?" Powell said.

Still, he added, "if it does what it says it can do, that would be important, because it would be an additional tool to lower the risk" that eating salad greens could cause outbreaks of disease.

Fresh Express, you’re an industry leader and this year’s winner of the International Association for Food Protection’s Black Pearl award for food safety leadership. But I don’t get this. I’m all for marketing food safety, but with a strong caveat: be able to back it up.

A table of leafy green foodborne illness outbreaks is available at:

http://bites.ksu.edu/Outbreaks%20related%20to%20leafy%20greens%201993-2010
 

A new way to clean the greens

The New York Times is reporting tonight that the produce industry — rocked by several major recalls in recent years linked to outbreaks of salmonella, E. coli and other bacteria — has been searching for a better way to wash the lettuce, spinach and other greens it bags and sells in grocery stores and to restaurants.

Now, the nation’s leading producer of bagged salad greens, Fresh Express, says that washing them in a mild acid solution accomplishes the task.

The company plans to announce on Friday that it is abandoning the standard industry practice of washing leafy greens with chlorine and has begun using the acid mixture, which it claims is many times more effective in killing bacteria. The new wash solution, called FreshRinse, contains organic acids commonly used in the food industry, including lactic acid, a compound found in milk.

Mike Burness, vice president of global quality and food safety at Chiquita Brands International, which owns Fresh Express, said,

“We do believe it provides a much higher level of effectiveness versus the chlorine sanitizers in use today. This technology was developed to raise the bar.”

Mr. Burness said the breakthrough came when researchers at the company combined lactic acid with another organic acid, peracetic acid. The two together, he said, worked much better than either one separately and also achieved markedly better results than chlorine.

Fresh Express issued three separate recalls this year of packaged salad greens after random testing found salmonella, E. coli and listeria in bags of its products.
Fresh Express said that its new cleaning mixture was 750 times as effective as chlorine in killing bacteria suspended in wash water. It is also at least nine times as effective as chlorine in killing bacteria that has become attached to the leaves of produce.

Mr. Burness said that lettuce and other greens were cut up in the company’s plants, washed in water containing the acid mixture, typically for 20 to 40 seconds, then rinsed, dried and bagged. He said another advantage is that the acid wash did not bleach the greens, making them pale in color, as chlorine can.
The company said that it planned to license the mixture for use by other producers.

Fresh Express has not published its research, so food safety experts said on Thursday that they were unable to adequately evaluate the company’s claims.
Fresh Express said that it had informed the F.D.A. about its use of the acid wash mixture, but that it was not required to get approval for the switch because the ingredients were already approved for use in the food industry.

 

Fresh Express recalls some Romaine lettuce products because of E. coli O157:H7

No matter how good any firm’s food safety programs are, poop happens. And when it does, tell others about it. The story will get out eventually, so it’s best to go public first.

Fresh Express is voluntarily recalling certain Romaine lettuce salad products with expired Use-by Dates of July 8 – 12 and an "S" in the Product Code because they may have the potential to be contaminated with E. coli O157:H7. No other Fresh Express salads are included in the recall.

No illnesses have been reported in association with the recall. The precautionary recall action is being conducted to reach retailers as well as consumers.

The recall notification is being issued out of an abundance of caution due to an isolated instance in which one package of Fresh Express Hearts of Romaine salad yielded a positive result for E. coli O157:H7 in a random sample test collected and conducted by a third-party laboratory for the U.S. Food and Drug Administration.