On March 17, 2018, I penned the following: (Other than Tiger Brands admitting that its product tested positive for the exact same strain of Listeria that sickened now over 1,000 and killed 200), not much.  Lawrence, I’m still willing to write the check.

Imagine that the phone call comes or an email pops into your inbox – “Sir, we have been contacted by the health authorities and they say our product (polony) has been linked to illnesses and deaths. What do we do?”

So, what do you do?  Lawrence MacDougall received that call.  Now, what has he done and what will he do?

After being involved in every major (and a few minor) food poisoning outbreaks since the Jack in the Box E. coli Outbreak of 1993, I have seen it all. I have seen good CEOs act badly and make their and their company’s problems worse and I have seen bad CEOs handle the outbreak with such aplomb that they become associated with both food safety and good PR.

So, what do you do?

Of course, it is always best to avoid the outbreak to begin with. When I have spoken to CEOs or their Boards–generally, pre-outbreak and pre-lawsuit–I always pitch them on “why it is a bad idea to poison your customers.” Putting safe food as the primary goal–yes, alas, even before profits–will (absent an error) give you a very, very good chance of never seeing me on the other side of a courtroom.

But, what if despite your best efforts, or what if you simply did not care, and an outbreak happens.

So, what do you do?

First, have a pre-existing relationship with the folks that regulate you. If someone holds your business in the palm of his or her hand, you should at least be on a first name basis. No, I am not suggesting that you can influence your way out of the outbreak but knowing who is telling you that your company has a problem allows you the ability to get and understand the facts. Do regulators and their investigators make mistakes? Perhaps, but not very often and not often enough to waste time arguing that your company did not poison customers.

Second, stop production of the implicated product and initiate a recall of all products at risk immediately. This procedure should have been practiced, and practiced, and practiced before. All possibly implicated suppliers should be alerted and all retailers should be offered assistance. Consumers need to be engaged too.  The goal now is to get poisoned product out of the marketplace and certainly out of the homes of consumers.

Third, launch your own investigation with two approaches, and at the same time. Are the regulators correct? And, what went wrong? Tell everyone to save all documents and electronic data. The goal here is to get things right. If it really is not your product, what has happened is bad, but survivable. If it really was your product, then learning what happened helps make sure it is likely to never happen again. More than anything, be transparent. Tell everyone what you find–good or bad.

According to the South African Minister of Public Health, Minister of Health Dr. Aaron Motsoaledi:

Listeria monocytogenes was isolated from stool collected from one of the ill children, and from both of the polony specimens collected from the crèche. These isolates were sent to the NICD Centre for Enteric Diseases and underwent whole genome sequencing and genomic analysis. The ST6 sequence type was confirmed on all three isolates on Saturday 27th January. Remember that in the last press conference I informed you that from clinical isolates obtained from patients (patient blood), 9 sequence types of Listeria monocytogenes were isolated and 91% were of sequence type 6 (ST6). We had then concluded that time that this outbreak is driven by ST6.

Following the lead from the tests performed on these children from Soweto and the food they had ingested, the EHPs (Environmental Health Practitioners), together with the NICD and DAFF representatives, accompanied by 3 technical advisors from the World Health Organization in Geneva, visited a food-production site in Polokwane and conducted an extensive food product and environmental sampling.

Listeria monocytogenes was isolated from over 30% of the environmental samples collected from this site, which happens to be the Enterprise factory in Polokwane.

To conclude the investigation, whole genome sequencing analysis was performed from this Enterprise factory and the results became available midnight or last night. The outbreak strain, ST6, was confirmed in at least 16 environmental samples collected from this Enterprise facility.

THE CONCLUSION FROM THIS IS THAT THE SOURCE OF THE PRESENT OUTBREAK CAN BE CONFIRMED TO BE THE ENTERPRISE FOOD-PRODUCTION FACILITY IN POLOKWANE

As of the March 14, 2018 update of Listeria monocytogenes Outbreak from the Centre for Enteric Diseases (CED) and Division of Public Health Surveillance and Response, Outbreak Response Unit (ORU), National Institute for Communicable Diseases (NICD)/National Health Laboratory Service (NHLS), a total of 978 cases has been reported since 2017. Since the last situational update (8 March 2018), 11 additional cases have been reported to the NICD. The death total remained at 183. Given the above work by NICD and the fact that the number of ill is failing post-recall, Tiger Brands – Enterprise has nothing to argue about the source of the outbreak.

Fourth, assuming that the outbreak is in fact your fault, publicly admit it. If it is not your fault, then fight it. However, pretending that you are innocent when you are actually at fault will get you nowhere. Asking for forgiveness is not a bad thing when you have something to be forgiven for. Saying you are sorry is not wrong when you are in fact wrong.

Mr. MacDougall, given the facts saying this was both heartless and stupid: “There is no direct link with the deaths to our products that we are aware of at this point. Nothing.”

Fifth, do not blame your customers.  If your food has a pathogen it is not your customers responsibility to handle it like it will likely kill them or a member of their family.  Hoping that the consumer will fix your mistake takes your eye off of avoiding the mistake in the first place.

Sixth, reach out to your customers and consumers who have been harmed. Offering to pay legitimate losses will save money and your company’s reputation in the long run.  The public with give you credit and it will be a reduction from the future award during litigation.

Seventh, teach all what you have learned. Do not hide what you have learned. Make your knowledge freely available so we all limit the risk that something similar will happen again.

Mr. MacDougall, I will match you personally 1,000,000 Rand to donate to an Organization or University in South Africa to lead a review of both food processing standards and governmental regulations and oversight.  I will help find experts from around the world to assist.

Yes, you can do all of the above and still get sued. And, I might be the one to sue you, and in Mr. MacDougall’s case I am. Yet, companies who have followed the above find their passage through an outbreak, recall, and litigation temporary. The companies that struggle for unfounded reasons will seldom exist in the long run, or they will simply pay my clients more money.

Bill Marler is trial lawyer who spends a great deal of time trying to convince companies around the world why it is a bad idea to poison customers. Twitter @bmarler and Blog at www.marlerblog.com

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.  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.

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.

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 these 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 shipped to distribution centers nationwide. The pre-made salads and wraps were produced July 15 to July 18, 2018 and have a “Best By,” “Enjoy by,” “Best if Sold By,” or “Sell By” date ranging from July 18 through July 23, 2018. See the product labels here. The pre-made salads and wraps have establishment number “EST. 39985” or “P-39985” inside or next to the USDA mark of inspection. See the full list of products, product labels, UPC code numbers, and other identifying information here.

The 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. 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.

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.

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 these 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 shipped to distribution centers nationwide. The pre-made salads and wraps were produced July 15 to July 18, 2018 and have a “Best By,” “Enjoy by,” “Best if Sold By,” or “Sell By” date ranging from July 18 through July 23, 2018. See the product labels here. The pre-made salads and wraps have establishment number “EST. 39985” or “P-39985” inside or next to the USDA mark of inspection. See the full list of products, product labels, UPC code numbers, and other identifying information here.

What is Cyclospora?

Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a large form of cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans. The first known human cases of illness caused by cyclospora infection (that is, cyclosporiasis) were first discovered in 1977. An increase in the number of cases being reported began in the mid-1980s, in part due to the availability of better diagnostic techniques. Over 15,000 cases are estimated to occur in the United States each year. The first recorded Cyclospora outbreak in North America occurred in 1990 and was linked to contaminated water. Since then, several cyclosporiasis outbreaks have been reported in the U.S. and Canada, many associated with eating fresh fruits or vegetables. In some developing countries, cyclosporiasis is common among the population and travelers to those areas have become infected as well.

Where does Cyclospora come from?

Cyclospora is spread when people ingest water or food contaminated with infected stool. For example, exposure to contaminated water among farm workers may have been the original source of the parasite in raspberry-associated outbreaks in North America.

Cyclospora needs time (one to several weeks) after being passed in a bowel movement to become infectious. Therefore, it is unlikely that Cyclospora is passed directly from one person to another. It is not known whether or not animals can be infected and pass infection to people.

What are the typical symptoms of Cyclospora infection?

Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, bloating, increased gas, stomach cramps, and loss of appetite, nausea, low-grade fever, and fatigue. In some cases, vomiting, explosive diarrhea, muscle aches, and substantial weight loss can occur. Some people who are infected with Cyclospora do not have any symptoms. Symptoms generally appear about a week after infection. If not treated, the illness may last from a few days up to six weeks. Symptoms may also recur one or more times. In addition, people who have previously been infected with Cyclospora can become infected again.

What are the serious and long-term risks of Cyclospora infection?

Cyclospora has been associated with a variety of chronic complications such as Guillain-Barre syndrome, reactive arthritis or Reiter’s syndrome, biliary disease, and acalculous cholecystitis. Since Cyclospora infections tend to respond to the appropriate treatment, complications are more likely to occur in individuals who are not treated or not treated promptly. Extraintestinal infection also appears to occur more commonly in individuals with a compromised immune system.

How is Cyclospora infection detected?

Your health care provider may ask you to submit stool specimen for analysis. Because testing for Cyclospora infection can be difficult, you may be asked to submit several stool specimens over several days. Identification of this parasite in stool requires special laboratory tests that are not routinely done. Therefore, your health care provider should specifically request testing for Cyclospora if it is suspected. Your health care provider might have your stool checked for other organisms that can cause similar symptoms.

How is Cyclospora infection treated?

The recommended treatment for infection with cyclospora is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim, Septra, or Cotrim. People who have diarrhea should rest and drink plenty of fluids. No alternative drugs have been identified yet for people with Cyclospora infection who are unable to take sulfa drugs. Some experimental studies, however, have suggested that ciprofloxacin or nitazoxanide may be effective, although to a lesser degree than trimethoprim-sulfamethoxazole. See your health care provider to discuss alternative treatment options.

How can Cyclospora infection be prevented?

Avoiding water or food that may be contaminated is advisable when traveling. Drinking bottled or boiled water and avoiding fresh ready-to-eat produce should help to reduce the risk of infection in regions with high rates of infection. Improving sanitary conditions in developing regions with poor environmental and economic conditions is likely to help to reduce exposure.

Washing fresh fruits and vegetables at home may help to remove some of the organisms, but Cyclospora may remain on produce even after washing.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Cyclospora outbreaks. The Cyclospora Attorneys and Lawyers have represented victims of Cyclospora and other foodborne illness outbreaks and have recovered over $650 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.

If you or a family member became ill with a Cyclospora infection after consuming food and you are interested in pursuing a legal claim, contact the Marler Clark Hepatitis A attorneys for a free case evaluation.

Surprised?  I did not think so.  Cattle feces from a CAFO gets into the water supply that is used to irrigate romaine lettuce – what possibly could go wrong?

Of note, the FDA still has not been transparent (except that “romaine [lettuce] from the Yuma growing region as the likely source of contamination”) as to where the romaine was consumed (except for the “Alaskan correctional facility back to a single farm – [Harrison]”).  Nor, has the FDA been transparent what farms grew the romaine, where and who processed it and who shipped it.  The FDA in fact knows most, if not all, of this, but refuses to release the information citing, “trade secrets.”

As the CDC reported in its final assessment of the outbreak on June 28, 2018, there are 210 cases in 36 states: Alabama (3) Alaska (8), Arkansas (1), Arizona (9), California (49), Colorado (3), Connecticut (2), Florida (3), Georgia (5), Idaho (12), Illinois (2), Iowa (1), Kentucky (1), Louisiana (1), Massachusetts (4), Michigan (5), Minnesota (12), Mississippi (1), Missouri (1), Montana (9), Nebraska (1), New Jersey (8), New York (11), North Carolina (1), North Dakota (3), Ohio (7), Oklahoma (1), Oregon (1), Pennsylvania (24), South Dakota (1), Tennessee (3), Texas (4), Utah (1), Virginia (1), Washington (8), and Wisconsin (3). 5 deaths were reported from Arkansas, California, Minnesota (2), and New York.  8 illnesses were reported in Canada linked to the same outbreak.

On August 6, 2018, the FDA posted an update on the status of its ongoing environmental assessment on the likely, what used to be called the “root cause.” The FDA’s update was as follows:

On July 31 and August 1, 2018, the FDA participated in a meeting of the Leafy Greens Food Safety Task Force that was formed in response to the serious outbreak of E. coli O157:H7 associated with romaine lettuce that occurred earlier this year. During the meeting FDA shared preliminary hypotheses from the Environmental Assessment in Yuma to facilitate conversations with state and local officials, industry and local growers on the hypotheses and associated actions necessary to prevent such an outbreak from occurring again.

As FDA has previously stated, samples of canal water have tested positive for the outbreak strain of E. coli. FDA continues to consider that contaminated water coming into contact with produce, either through direct irrigation or other means, is a viable explanation for the pattern of contamination. But other hypotheses were discussed as well. FDA notes that the canal is close to a Concentrated Animal Feeding Operation (CAFO), a facility with a large number of cattle on the premises. The CAFO can hold in excess of 100,000 head of cattle at any one time and the FDA traceback information showed a clustering of romaine lettuce farms nearby.

Our experts continue to work on examining potential links between the CAFO, adjacent water, and geologic and other factors that may explain the contamination and its relationship to the outbreak. Additional sampling activities will be conducted to further explore and narrow down hypotheses in the near future. Our findings will be detailed in a finalized environmental assessment report.

We urge other government and non-government entities, produce growers in the region, and those engaged in managing the canal systems to work with FDA and marshal and deploy resources to achieve our collective food safety goal. Broad engagement from the surrounding community is critical to developing and implementing remediation measures to reduce the potential for another outbreak. We believe local in-depth knowledge and actions are critical in helping resolve this issue in order to protect public health.

The Environmental Assessment report will be made publicly available when complete.

And, then there is this – for those “geographically challenged,” Yuma is near the dark purple in the lower left corner:

To date, we have filed 10 lawsuits and are making great progress tracing back from restaurants and grocery stores that sold the E. coli-tainted romaine in the spring.  And, once the “points of sale” flip the supply chain of the romaine, we are making great progress finding out who brokered the sale and who processed the romaine.  We are making slower process identifying specific farms, but that information is coming. Once we have the names of more farms, we will move back up other chains of distribution identifying additional shippers, brokers, processors and eventually more restaurants and grocery stores.

Having discovery and subpoena power is a great tool for truth.

Fresh Express Statement about Recall of a Limited Number of Cases of Expired Products Not Marked or Labeled for Retail Sale:

At Fresh Express, our top priority is providing consumers with the highest quality and safest fresh lettuce and leafy greens products available.

In its investigation, the US Food and Drug Administration (FDA) took several random samples of products and one sample, yielded a positive result for Cyclospora. Although the sample taken was an already-expired institutional foodservice product, it none-the-less necessitated a precautionary recall by Fresh Express on July 27th of a limited number of cases.

The products recalled were packaged in clear plastic, multi-pound packs that did not display the Fresh Express logo and were not marked or labeled for retail sale to consumers.

The Fresh Express food safety team, along with our outside food safety experts, have collaborated closely with FDA, the US Centers for Disease Control and Prevention and state public health agencies in their outbreak investigations, and we continue to do so. As of now, there is no clear understanding about the contamination pathway or the definitive source of infection.

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.

As of Tuesday July 31, 2018, the Delaware General Health District has received a total of 683 inquiries related to a possible foodborne illness outbreak stemming from the Chipotle located at 9733 Sawmill Parkway. Of those inquiries, staff members have completed over 480 interviews.

The Ohio Department of Health returned initial stool sample results today – all have tested negative for Salmonella, Shigella, E. coli and Norovirus. Further stool testing will be conducted for other pathogens. The food samples are still in the process of being tested for Bacillus Cereus or Clostridium Perfringens in addition to the four diseases listed above that are tested in stool samples.

The Delaware General Health District suggests that you please contact your local health department to file food complaints. Posting on social media and/or a website is not an official complaint. The Health District has also received calls regarding medical attention. Please consult your doctor for all medical needs.

NICD updated this Listeria Outbreak at the end of July.  Of note, the numbers of ill have continued to drop following the recall of Tiger Brands Enterprise Foods polony in March. However, it appears that some of the “recalled” product is still being consumed.  NICD’s partial report is below.

1,060 laboratory-confirmed cases have been reported from 01 January 2017 to 17 July 2018. The number of new cases reported each week has decreased since the implicated products were recalled on 04 March 2018 with no new cases of listeriosis reported during the week prior to release of this sitrep (Figure 1). Neonates ≤28 days of age are the most affected age group (42%, 443/1 060), followed by adults aged 15 – 49 years of age (32%, 334/1 060) – Figure 2. Most cases have been reported from Gauteng Province (58%, 614/1 060), followed by Western Cape (13%, 136/1 060) and KwaZulu-Natal (8%, 83/1 060) provinces (Table 1). Final outcome (i.e. death or discharge) is known for 76% (806/1 060) of total cases to date; 27% (216/806) with known outcome died.

Following a recall of the implicated products, the number of cases has steadily decreased. However, it is anticipated that cases could still be reported for the following reasons:

  • The incubation period of listeriosis can be up to 70 days.
  • The implicated products have a long shelf life and it is possible that despite the recall some products have not been removed from retail or consumer’s homes.
  • Cross-contamination at retail and in the home can occur.

Post recall (05 March 2018 to date), all new cases of laboratory-confirmed listeriosis are contacted by IMT members, and a comprehensive food history is obtained. Exposure to food products implicated in the listeria outbreak is determined.

Of 87 post-recall cases, 65 have been interviewed to date.

Of those interviewed, 38/65 (58%) of ill people or their proxy reported consuming polony prior to their illness onset; brands manufactured by Tiger Brands Enterprise Foods were most commonly reported to have been consumed where brand of polony was known.

Prior to 2017, an average of 60 to 80 laboratory-confirmed listeriosis cases per year (approximately 1 per week), were reported in South Africa. In July 2017, an increase in laboratory-confirmed cases of listeriosis was reported to National Institute for Communicable Diseases (NICD) which triggered further investigation. On 05 December 2017, the listeriosis outbreak was declared by the Minister of Health, Dr. Aaron Motsoaledi. The source of the outbreak was identified as ready-to-eat processed meat products manufactured at Tiger Brand’s Enterprise Foods’ Polokwane production facility. A recall of affected products was initiated on 04 March 2018.

Although, McDonalds is linked to nearly 300 illnesses, other illnesses may also be linked as recalls expand.  NOTE – FDA and Fresh Express has not yet named other retailers where product was sold.

Fast Facts from the FDA:

  • The FDA, CDC, along with state and local officials are investigating a multi-state outbreak of cyclosporiasis illnesses likely linked to salads from McDonald’s restaurants.
  • 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.
  • 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.
  • The CDC reports that 286 people in 15 states have become ill. There have been 11 hospitalizations and no deaths.
  • The investigation is ongoing and the FDA is currently reviewing distribution and supplier information for romaine and carrots.
  • 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.
  • 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. 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).
  • 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.

The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) is issuing a public health alert out of an abundance of caution due to concerns about contamination with Cyclospora. The beef, pork and poultry salad and wrap products were distributed by Caito Foods LLC, an Indianapolis, Ind. establishment.

The beef, pork and poultry salad and wrap items were produced between July 15 to 18, 2018, with the either “Best By,” “Enjoy by,” Best if Sold By” or “Sell By” dates ranging from July 18 through July 23, 2018. [View Label (PDF only)]

The complete list of products, product labels, the UPC code numbers and other identifying information can be found here.

The products bear establishment number “EST. 39985 or P-39985” inside or next to the USDA mark of inspection. These items were shipped to distribution centers nationwide.

The problem was discovered when Caito Foods LLC 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.

FSIS is concerned that some product may be in consumers’ refrigerators and that consumers may be at risk due to the length of the Cyclospora incubation period. Consumers who have purchased these products are urged not to consume them. These products should be thrown away or returned to the place of purchase. Caito Foods LLC and FSIS are working together to remove the products from commerce.

Anyone concerned about an illness should contact a health care provider. Cyclospora infection is an illness cause by the intestinal parasite, Cyclospora cayetanensis. The incubation period for Cyclospora ranges from two to 14 days, which would include the dates of July 25 through August 6, 2018. Illnesses 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 could take up to six weeks.

As of July 24, 2018, 77 people infected with the outbreak strain of Salmonella Adelaide were reported from nine states. A list of the states and the number of cases in each can be found on the Case Count Map page.

Illnesses started on dates ranging from April 30, 2018, to July 2, 2018. Ill people ranged in age from less than 1 year to 97, with a median age of 67. Among ill people, 67% were female. Out of 70 people with information available, 36 (51%) were hospitalized. No deaths were reported.

Epidemiologic and traceback evidence indicated that pre-cut melon supplied by the Caito Foods, LLC of Indianapolis, Indiana was the likely source of this multistate outbreak.

Information collected from stores where ill people shopped indicated that Caito Foods, LLC supplied pre-cut melon to these stores. On June 8, 2018, Caito Foods, LLC recalled fresh-cut watermelon, honeydew melon, cantaloupe, and fresh-cut fruit medley products containing one of these melons that were produced at the Caito Foods facility in Indianapolis, Indiana.