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 hereExternal .

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