Federal officials have confirmed parasites in salad mix that Fresh Express sold to McDonald’s and other unnamed companies. Almost 300 people in 15 states, are confirmed infected.

The Food and Drug Administration is relying on Fresh Express, which is a subsidiary of Chiquita Brands LLC, to make sure other companies that bought its salad mix are no longer using it. Those companies have not been revealed to the public.

“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,” the FDA reported Wednesday.

“Fresh Express committed to using recall procedures to inform companies that received additional products of concern about the sample result. Fresh Express also reported that the carrots in the sampled salad mix only went to McDonald’s.”

The implicated salad mix, which included romaine lettuce and carrots, was marked with an expiration date of July 19.

Symptom onset dates for the confirmed victims range from May 20 to July 12, according to the Centers for Disease Control and Prevention. The agency reports that as of July 26, there were 286 laboratory-confirmed cases of Cyclospora infection reported in people who had eaten “a variety” of salads from McDonald’s restaurants. At least 11 people have required hospitalization.

People whose symptoms began after June 14 are likely not all included in the case count yet, according to the CDC. It can take up to six weeks for confirmed reports of Cyclospora infections to reach federal officials. It usually takes two days to two weeks after exposure for symptoms to develop.

A processing plant operated by Fresh Express in Streamwood, IL, produced the salad mix, according to the FDA. The agency tested an unused package of the Fresh Express salad mix from that production plant and confirmed Cyclospora parasite contamination.

The FDA finished its final analysis of the salad mix on July 26 and notified Fresh Express of the results on July 27, instructing the company to determine whether potentially contaminated product may still be on the market.

McDonald’s issued a statement in mid-July reporting the chain had stopped using the Fresh Express salad mix at implicated restaurants in Illinois, Iowa, Indiana, Wisconsin, Michigan, Ohio, Minnesota, Nebraska, South Dakota, Montana, North Dakota, Kentucky, West Virginia and Missouri on July 13. The company has since reported that it has replaced the supplier of salads in those states, according to the FDA.

Other outbreaks
It was unknown Wednesday night whether a foodborne illness outbreak this week among customers of a McDonald’s restaurant in Transylvania County, NC, is related to the Fresh Express salad. Local public health officials told The Transylvania Times newspaper that there were “lots” of reports Monday and Tuesday. Additional reports were coming in Wednesday.

The Times reported many people were reporting they had eaten at a McDonald’s restaurant in Brevard. The newspaper reported the restaurant was closed as of Wednesday afternoon.

Another outbreak, which federal officials say is not related to the Fresh Express salad mix, involves pre-cut vegetable and dip trays sold by Del Monte Fresh Produce. As of the most recent updat from CDC, 237 people across four states had been confirmed with Cyclospora infections in that outbreak.

Advice to consumers
Anyone who has eaten a McDonald’s salad — or items from recalled Del Monte vegetable-dip trays — and developed symptoms of cyclosporiasis should seek medical attention and tell their doctors about their possible exposure to Cyclospora parasites.

Symptoms usually include 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 parasites 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, making diagnosis difficult.

“The Cyclospora parasite needs time — days to weeks — after being passed in a bowel movement to become infectious for another person,” according to the Food and Drug Administration. “Therefore, it is unlikely that cyclosporiasis is passed directly from one person to another.”

Cyclospora parasites can contaminate foods or beverages, but in the United States they are most often found on fresh produce, according to federal officials.

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