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727 with Cyclospora linked to Fresh Express Salads in the US and Canada

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.

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Related Resources
Cyclospora Food Poisoning

What is Cyclospora cayetanensis? Cyclospora cayetanensis is a unicellular, microscopic parasite that can cause food- or water-related gastrointestinal illness. The oocyst form of the parasite is chlorine-resistant and must sporulate...

Epidemiology of Cyclospora

Cyclosporiasis is an intestinal illness caused by the protozoan parasite Cyclospora cayetanensis, which is transmissible by ingestion of food or water contaminated with sporulated oocysts. Most cases of cyclosporiasis occur...

Cyclospora’s Mode of Infection

The modes of transmission of C. cayetanensis are still not completely understood. Direct person-to-person transmission is unlikely because the oocysts are not infectious when initially shed (unlike Cryptosporidium, another foodborne...

Symptoms of Cyclospora Infection

What are the typical symptoms of Cyclospora infection? Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, bloating, increased gas, stomach cramps, flatulence, loss of appetite, nausea, low-grade...

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...

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