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Public Health Notice: Outbreak of Cyclospora infections linked to salad products



The Public Health Agency of Canada (PHAC) is collaborating with provincial public health partners, the Canadian Food Inspection Agency (CFIA) and Health Canada to investigate an outbreak of Cyclospora infections occurring in three provinces. The outbreak appears to be ongoing, as recent illnesses continue to be reported to PHAC.

Based on the investigation findings to date, 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. Some of the individuals who became sick reported having eaten Fresh Express brand salad products containing these ingredients before their illnesses occurred. The source of illness for the remaining individuals continues to be under investigation. The investigation is ongoing and this public health notice will be updated as the investigation evolves.

On June 28, 2020, the CFIA issued a food recall warning for certain Fresh Express brand salad products containing iceberg lettuce, carrots and red cabbage that were distributed nationally in Canada. The recalled salad products begin with lot code "Z177" or a lower number and have best before dates up to and including 20JUL08 - 20JUL14. For more information on the recalled product, please consult the CFIA's website.

Canadians are advised not to eat the recalled products. Retailers and food service establishments are advised not to sell or serve the recalled products, or any items that may have been prepared or produced using these products.

The CFIA is continuing its food safety investigation, which may lead to the recall of other products. If additional products are recalled, the CFIA will notify the public through updated food recall warnings.

The U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration are also investigating a multi-state outbreak of Cyclospora infections that has been linked to bagged salad mixes containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express.

Investigation summary

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.

Some of the individuals who became sick reported having eaten certain Fresh Express brand salad products containing iceberg lettuce, red cabbage and carrots before their illnesses occurred. The source of illness for the remaining individuals continues to be under investigation.

Cyclospora infections occur each summer in Canada. PHAC is working with provincial partners to determine if other recent cases of Cyclospora infection are linked to this outbreak.

It is possible that more recent illnesses may be reported in the outbreak because of the period between when a person becomes ill and when the illness is reported to public health officials. For this outbreak, the illness reporting period is between two and four weeks.

What you should do to protect your health

Check to see if you have any Fresh Express brand salad products in your home. If you do, follow this advice:

Do not to eat recalled products with production codes beginning with lot code "Z177" or a lower number and have best before dates up to and including 20JUL08 - 20JUL14.
Throw these products out immediately and properly wash and sanitize any containers and refrigerator drawers or shelves that were used to store these products before using them again.
If you have any Fresh Express brand salad products without the original packaging and are unsure of whether these products are included in this advice, do not eat them. Throw them away just to be safe.
Wash your hands with soap and warm water for at least 20 seconds immediately following contact with any of the recalled products.
Who is most at risk

Cyclospora is a microscopic single-celled parasite that is passed in peoples' feces. If it comes in contact with food or water, it can contaminate food and cause infection in the people who consume it. This causes an intestinal illness called cyclosporiasis. It is unlikely for Cyclospora to be passed from one person to another.

You are at higher risk for a longer or more severe illness if you:

are a young child
are an older adult
have a weakened immune system (cannot fight disease easily)
Symptoms

Most people develop the following symptoms within one week after being infected with Cyclospora:

watery diarrhea
abdominal bloating and gas
fatigue (tiredness)
stomach cramps
loss of appetite
weight loss
mild fever
nausea
When you eat or drink contaminated food or water, it may take 7 to 14 days for symptoms to appear. If left untreated, you may have the symptoms for a few days to a few months. Most people have symptoms for 6 to 7 weeks without treatment.

Symptoms may go away and then return.

If you become ill, drink plenty of water or fluids to prevent dehydration from diarrhea. If you have signs of illness and have reason to believe you have cyclosporiasis, contact your health care provider who may request a laboratory test to confirm the illness.

Antibiotics may be given to treat the illness.

What the Government of Canada is doing

The Government of Canada is committed to food safety. The Public Health Agency of Canada leads the human health investigation into an outbreak, and is in regular contact with its federal, provincial and territorial partners to monitor the situation and to collaborate on steps to address an outbreak.

Health Canada provides food-related health risk assessments to determine whether the presence of a certain substance or microorganism poses a health risk to consumers.

The Canadian Food Inspection Agency conducts food safety investigations into the possible food source of an outbreak.

The Government of Canada will continue to update Canadians as new information related to this investigation becomes available.

Epidemiological information

Figure 1 below is an epidemiological curve for this outbreak. Outbreak investigators use this information to show when illnesses begin, when they peak, and when they trail off. It can take several weeks from the time a person becomes ill to when the illness is reported and testing confirms a link to the outbreak. Data are available for 37 cases.

Figure 1: Number of people infected with Cyclospora

Table 1 – Number of people confirmed to be infected with Cyclospora by week of illness onset or specimen collection

Week of symptom onset or specimen collection

Number of cases

2020-05-03

0

2020-05-10

2

2020-05-17

4

2020-05-24

4

2020-05-31

12

2020-06-07

11

2020-06-14

3

2020-06-21

1

2020-06-28

0

SOURCE Public Health Agency of Canada

For further information: Media contact: Public Health Agency of Canada, Media Relations, 613-957-2983, hc.media.sc@canada.ca; Public inquiries: Call toll-free: 1-866-225-0709, Email: info@hc-sc.gc.ca