Free the Salads and Veggies – take them out of the bag

The CDC, public health and regulatory officials in several states, and the US Food and Drug Administration (FDA) are investigating a multistate outbreak of Cyclospora infections linked to bagged salad mix containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express.

How to identify recalled products:

• Products were sold in many states under either the brand name Fresh Express or the store brand labels ALDI Little Salad Bar, Giant Eagle, Hy-Vee, Jewel-Osco Signature Farms, ShopRite Wholesome Pantry, and Walmart Marketside.
• You can identify the recalled products by looking for the Product Code, located in the upper right-hand corner of the front of the package.
  • The recall includes products marked with the letter “Z” at the beginning of the Product Code, followed by the number “178” or lower.
• A full listing of recalled products is available on the Fresh Express recall page.

What to do if you have recalled products:

• Do not eat, sell, or serve recalled salad products.
• Check your home for any of these recalled salads. Throw any remaining salad away, even if some of it has been eaten and no one has gotten sick.
• If you don’t know whether the bagged salad mix you have in your home is one of the recalled salads, do not eat it. Throw it away.

Take action if you have symptoms of a Cyclospora infection:

• Talk to your healthcare provider.
• Write down what you ate in the two weeks before you started to get sick.
• Report your illness to the health department.
• Assist public health investigators by answering questions about your illness.

At a Glance

• Reported laboratory-confirmed cases: 641
• States: 11
• Deaths: 0
• Hospitalizations: 37
• Recall: Yes

Case Count Map – Click map to view case count map.

More Information

• FDA Outbreak Investigation of Cyclospora: Bagged Salads (June 2020)external icon
• Fruit and Vegetable Safety
• Infographic: Steps to Safe and Healthy Fruits and Vegetables
• 5 Steps to Clean Your Refrigerator
• How to Report a Foodborne Illness
• CDC’s Food Safety Information

Latest Outbreak Information

• 641 people with laboratory-confirmed Cyclospora infections and who reported eating bagged salad mix before getting sick have been reported from 11 states (Georgia, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Pennsylvania, South Dakota and Wisconsin).
  • Illnesses started on dates ranging from May 11, 2020 to July 5, 2020.
  • 37 people have been hospitalized. No deaths have been reported.
• The Public Health Agency of Canadaexternal icon is investigating an outbreak of Cyclospora infections occurring in three Canadian provinces. 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.
• Epidemiologic and traceback evidence indicates that bagged salad mix containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express is a likely source of this outbreak.
• CDC and FDA continue to investigate to determine which ingredient or ingredients in the salad mix was contaminated and whether other products are a source of illnesses.
• CDC will provide updates when more information is available.

Investigation Details

July 24, 2020

Since the last case count update on July 9, 2020, 132 new laboratory-confirmed Cyclospora infections have been reported, including 16 from three new states: Georgia, Pennsylvania, and South Dakota.

As of  July 22, 2020, a total of 641 people with laboratory-confirmed Cyclospora infections associated with this outbreak have been reported from 11 states: Georgia (1), Illinois (198), Iowa (195), Kansas (5), Minnesota (73), Missouri (57) Nebraska (55), North Dakota (6), Pennsylvania (2), South Dakota (13) and Wisconsin (36). The ill person from Georgia purchased and ate a bagged salad product while traveling in Missouri.

Illnesses started on dates ranging from May 11, 2020 to July 5, 2020. Ill people range in age from 10 to 92 years with a median age of 59 and 52% are female. Of 636 people with available information, 37 people (6%) have been hospitalized. No deaths have been reported.

Illnesses might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 4 to 6 weeks. If the number of cases reported by CDC is different from the number reported by state or local health officials, data reported by local jurisdictions should be considered the most up to date. Any differences may be due to the timing of reporting and website updates.

1. Modified Atmosphere Packaging (MAP)

Some packaging controls used for fresh-cut produce affect the environment within the package by reducing the levels of oxygen. Low oxygen levels help maintain the quality of fresh produce and extend shelf-life by slowing respiration and senescence in plant tissues. Oxygen can be reduced passively by using gas permeable films in packaging that result in the natural development of the desired atmosphere; the desired atmosphere is a consequence of the products’ respiration as gas diffuses through the film (Ref. 6). Oxygen can also be reduced actively by displacing the mixture of gases in a package with a gas mixture that has a low concentration of oxygen (1-5%). Microorganisms respond differently to the surrounding gases depending on their tolerance. While reduced oxygen and elevated carbon dioxide retard the growth of spoilage microorganisms such as Pseudomonas spp., the same gas conditions may provide growth opportunities for pathogenic microorganisms. At extremely low oxygen levels (< 1%), anaerobic respiration can occur, resulting in tissue destruction that affects product quality and creating the potential for growth of foodborne pathogens such as Clostridium botulinum (Ref. 6). It is generally believed, however, that fresh-cut produce will spoil before the toxin becomes a concern (Ref. 6). Non-pathogenic aerobic and facultative microorganisms are present at the time of packaging and persist after packaging.

MAP is only effective in extending shelf-life if used in conjunction with good refrigeration. Elevated temperatures can promote the growth of spoilage organisms and pathogens that may be present. Thus, we recommend that food processors using MAP adhere to strict temperature controls and appropriate shelf-life parameters. Because refrigeration temperatures may not be maintained during distribution of the products or while they are held by retailers or consumers, we also recommend that controls be in place to either prevent increases in temperature, as feasible, or to alert the processor, retailer, or consumer that the product may not be safe to consume. Processors may wish to consider providing product handling guidelines on temperature control and washing to the distributor, retailer, and consumer. Another potential source of contamination of fresh cut produce packed in MAP occurs when the gases, equipment, or packaging materials are not properly maintained. As with any type of packaging, we recommend that controls be put in place to ensure that the process of packaging the product and the packaging materials themselves do not cause the product to become contaminated.

D. Packaging

Anything that touches fresh-cut produce has the potential to contaminate it, including the materials used in packaging the finished product.

We recommend the following practices:

• Maintaining an effective system to prevent the use of contaminated, damaged, or defective cartons and totes in order to prevent microbial contamination of the fresh-cut produce during packing operations
• Overseeing incoming materials and gases used in packaging to confirm that they are not damaged or defective and are in appropriate working order
• Rejecting packaging materials that are damaged or contaminated
• Determining the appropriate gas mixtures for products
• Using containers and cartons for their intended purpose only. For example, we recommend against using a carton designated for holding fresh-cut produce to hold tools.
• Storing packaging containers and other packaging materials in a manner so as to protect them from contamination, such as away from pests, dirt, cleaning chemicals, and water condensation from overhead equipment and structures
• Maintaining a program to identify and correct situations where damage to containers may potentially occur
• Labeling all finished fresh-cut produce products with recommended storage instructions (e.g., “Keep Refrigerated”) or storage temperature to inform all persons handling the product of the recommended storage conditions

2. Shelf-life

Fresh-cut fruits and vegetables can cause illness due to contamination with a variety of microorganisms because these products do not undergo any processing to ensure the total elimination of microorganisms that might be present. Some packaging and storage techniques for fresh-cut produce (e.g., MAP, refrigerated storage) may slow the rate of physical deterioration by slowing respiration of the produce. However, if packaging and storage are not properly controlled, pathogens may grow to levels that could render the product unsafe for human consumption. The rate of respiration of fresh produce is inversely related to product shelf-life, which means that a higher respiration rate decreases shelf-life (Ref. 6). Fresh fruits and vegetables that have been cut or otherwise physically altered will have increased respiration, and thus, a shorter shelf-life. To address the risks of increased respiration, we recommend the following practices:

• Communicating (through product labeling) that the consumer should refrigerate the product to prevent product spoilage and the potential for growth of pathogens
• Ensuring that any “use by” date on the product package is validated by studies of the product with respect to microbiological safety

We recommend that records of these data and studies be maintained to document the reliability of the “use by” labeling.

Foods Get a “Bad Wrap” for Sustainability

What are the problems with pre-packaging?

1. Disease Outbreaks: Salmonella, lysteria, and E. coli outbreaks have been traced to bagged fresh produce, especially spinach and salad greens. Think about the possibility of a tiny bit of contamination from manure or tainted irrigation water that is in a plastic bag being trucked across the desert. A perfect incubator for bacteria.

2. More Unrecyclable Trash: Styrofoam trays are one of the least degradable packaging materials known to man. The plastic, cellophane and saran are not likely to be recycled either.

3. Loss of Nutrients: Precut vegetables and fruits lose vitamins and other nutrients faster than whole products.

4. Expensive: You generally will be paying more, by weight, when you buy packaged produce. A prepared package of cut up fruit, for instance, usually costs at least twice as much as whole fruit you can cut yourself. And if you’re buying from a farmer’s market, you probably can save 50% more.

5. More Technology Pollution: Manufacturing the plastic packaging materials for these fruits and vegetables to help them maintain their freshness may create more pollution.

6. Spoiled or Overripe: You have to inspect packed produce carefully to make sure it is not spoiled, moldy, or dried up. The refrigerated fruit could be in a “chilled gas chamber.” Packaged produce is often a lot older than fresh. Nutrients may be degraded by age of the item from when it was picked.

7. Taste and Smell: Compounds sprayed on produce (chlorine and ozone are two) to retard spoilage may leave unpleasant traces.

8. More Government Laws and Agencies: It takes government entities to make sure that packages are labeled correctly with contents, weight and place of origin. Laws and regulations have to be made to make sure fresh food is properly weighed, cleaned, processed, branded, identified, labeled, packaged, presented, transported, stored, and tested.