Cyclosporiasis outbreak linked to McDonald’s salads sickens more than 100 in Iowa, Illinois

Health officials in Iowa and Illinois said more than 100 cases of cyclosporiasis may be linked to salads made by McDonald’s.

The Illinois Department of Public Health (IDPH) said 90 cases of the gastrointestinal illness have been confirmed in the state, and the Iowa Department of Public Health has identified 15 cases.

“McDonald’s has been in contact with public health authorities from Iowa and Illinois about an increase in Cyclospora infections in those states,” McDonald’s spokesman Khim Aday told Infectious Disease News. “Out of an abundance of caution, we decided to voluntarily stop selling salads at impacted restaurants until we can switch to another lettuce blend supplier. We are in the process of removing existing salad blend from identified restaurants and distribution centers — which includes approximately 3,000 of our U.S. restaurants primarily located in the Midwest.”

Last year, the CDC reported a sharp increase in cyclosporiasis cases in the U.S. In June, federal officials said they were investigating a separate multistate cyclosporiasis outbreak linked to Del Monte vegetable trays containing fresh broccoli, cauliflower, celery sticks, carrots, and dill dip. As of July 12, the CDC said 227 confirmed cases have been reported from in Iowa, Minnesota, Michigan and Wisconsin, although the products have been recalled from retailers in Illinois and Indiana as well. There have been seven hospitalizations and no deaths.

According to the CDC, cyclosporiasis is a difficult foodborne outbreak to investigate, and it usually requires extensive time and resources to identify outbreak clusters.

“This is in part due to the lack of validated molecular typing methods for linking cases to each other,” Shannon Cooney Casillas, MPH, epidemiologist in the CDC’s Division of Parasitic Diseases and Malaria, told Infectious Disease News.

The infected vegetable trays had a “best if enjoyed by” date of June 17, 2018 and were voluntarily recalled by Del Monte on June 15, according to the FDA.

Because of this, the CDC does not expect large numbers of new cases to be reported, Casillas said.

The Cyclospora outbreak linked to McDonald’s salads began in mid-May, in Illinois, and late June to early July, in Iowa, according to health officials. State investigators found that approximately one-quarter of the people infected in Illinois reported eating McDonald’s salads. Iowa investigators likewise noted a similar increase in cases related to the fast food salads, although both state health departments are investigating other possible sources.

“Although a link has been made to salads sold in McDonald’s restaurants in some Illinois cases, public health officials continue to investigate other sources,” IDPH director Nirav D. Shah, MD, JD, said in a statement.

A Cyclospora infection can be treated with antibiotics. Symptoms commonly begin approximately 1 week after exposure and can include watery diarrhea, loss of appetite and weight, cramping, bloating, and/or increased gas, nausea, fatigue and low-grade fever.

“McDonald’s is committed to the highest standards of food safety and quality control. We are closely monitoring this situation and cooperating with state and federal public health authorities as they further investigate,” Aday said. – by Marley Ghizzone

References:

Iowa Department of Public Health. Cyclospora infections associated with salad at fast food chain (7/12/18). https://www.idph.iowa.gov/News/ArtMID/646/ArticleID/158228/Cyclospora-Infections-Associated-with-Salad-at-Fast-Food-Chain-71218. Accessed July 13, 2018.

CDC. Parasites - Cyclosporiasis (Cyclospora infection). https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2018/a-062018/index.html. Accessed July 13, 2018.

Illinois Department of Public Health. IDPH investigating increase in foodborne illnesses. http://www.dph.illinois.gov/news/idph-investigating-increase-foodborne-illnesses. Accessed July 13, 2018.

FDA. Del Monte Fresh Produce N.A., Inc. voluntarily recalls limited quantity of vegetable trays in a multistate outbreak of Cyclospora illnesses in select retailers in Illinois, Indiana, Iowa, Michigan, Minnesota, and Wisconsin, because of possible health risk. https://www.fda.gov/Safety/Recalls/ucm610992.htm. Accessed July 13, 2018.

Disclosures: Aday works for McDonald’s. Casillas works for the CDC. Shah works for Illinois’s Department of Public Health.

Health officials in Iowa and Illinois said more than 100 cases of cyclosporiasis may be linked to salads made by McDonald’s.

The Illinois Department of Public Health (IDPH) said 90 cases of the gastrointestinal illness have been confirmed in the state, and the Iowa Department of Public Health has identified 15 cases.

“McDonald’s has been in contact with public health authorities from Iowa and Illinois about an increase in Cyclospora infections in those states,” McDonald’s spokesman Khim Aday told Infectious Disease News. “Out of an abundance of caution, we decided to voluntarily stop selling salads at impacted restaurants until we can switch to another lettuce blend supplier. We are in the process of removing existing salad blend from identified restaurants and distribution centers — which includes approximately 3,000 of our U.S. restaurants primarily located in the Midwest.”

Last year, the CDC reported a sharp increase in cyclosporiasis cases in the U.S. In June, federal officials said they were investigating a separate multistate cyclosporiasis outbreak linked to Del Monte vegetable trays containing fresh broccoli, cauliflower, celery sticks, carrots, and dill dip. As of July 12, the CDC said 227 confirmed cases have been reported from in Iowa, Minnesota, Michigan and Wisconsin, although the products have been recalled from retailers in Illinois and Indiana as well. There have been seven hospitalizations and no deaths.

According to the CDC, cyclosporiasis is a difficult foodborne outbreak to investigate, and it usually requires extensive time and resources to identify outbreak clusters.

“This is in part due to the lack of validated molecular typing methods for linking cases to each other,” Shannon Cooney Casillas, MPH, epidemiologist in the CDC’s Division of Parasitic Diseases and Malaria, told Infectious Disease News.

The infected vegetable trays had a “best if enjoyed by” date of June 17, 2018 and were voluntarily recalled by Del Monte on June 15, according to the FDA.

Because of this, the CDC does not expect large numbers of new cases to be reported, Casillas said.

The Cyclospora outbreak linked to McDonald’s salads began in mid-May, in Illinois, and late June to early July, in Iowa, according to health officials. State investigators found that approximately one-quarter of the people infected in Illinois reported eating McDonald’s salads. Iowa investigators likewise noted a similar increase in cases related to the fast food salads, although both state health departments are investigating other possible sources.

“Although a link has been made to salads sold in McDonald’s restaurants in some Illinois cases, public health officials continue to investigate other sources,” IDPH director Nirav D. Shah, MD, JD, said in a statement.

A Cyclospora infection can be treated with antibiotics. Symptoms commonly begin approximately 1 week after exposure and can include watery diarrhea, loss of appetite and weight, cramping, bloating, and/or increased gas, nausea, fatigue and low-grade fever.

“McDonald’s is committed to the highest standards of food safety and quality control. We are closely monitoring this situation and cooperating with state and federal public health authorities as they further investigate,” Aday said. – by Marley Ghizzone

References:

Iowa Department of Public Health. Cyclospora infections associated with salad at fast food chain (7/12/18). https://www.idph.iowa.gov/News/ArtMID/646/ArticleID/158228/Cyclospora-Infections-Associated-with-Salad-at-Fast-Food-Chain-71218. Accessed July 13, 2018.

CDC. Parasites - Cyclosporiasis (Cyclospora infection). https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2018/a-062018/index.html. Accessed July 13, 2018.

Illinois Department of Public Health. IDPH investigating increase in foodborne illnesses. http://www.dph.illinois.gov/news/idph-investigating-increase-foodborne-illnesses. Accessed July 13, 2018.

FDA. Del Monte Fresh Produce N.A., Inc. voluntarily recalls limited quantity of vegetable trays in a multistate outbreak of Cyclospora illnesses in select retailers in Illinois, Indiana, Iowa, Michigan, Minnesota, and Wisconsin, because of possible health risk. https://www.fda.gov/Safety/Recalls/ucm610992.htm. Accessed July 13, 2018.

Disclosures: Aday works for McDonald’s. Casillas works for the CDC. Shah works for Illinois’s Department of Public Health.

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