Federal officials issued a public health alert Monday night warning people to watch for signs of parasitic infections if they have eaten any of more than two dozen varieties of wraps and salads sold nationwide by retailers including Kroger and Trader Joe’s. 

The distributor of the ready-to-eat products said lettuce supplied by Fresh Express is responsible for the health alert. Indianapolis-based distributor Caito Foods LLC reported that officials with Fresh Express had issued a recall notice for chopped romaine that was used in the wraps and salads. The products are packaged under a variety of brand names.

It was unclear Monday night whether the Fresh Express recall is only for business-to-business romaine sales — such as those to other food producers, restaurants and facilities such as hospitals and schools — or if it includes products sold directly to consumers. 

Also, it was not known Monday night if the Fresh Express romaine is linked to an outbreak of Cyclospora parasite infections associated with salads from McDonald’s. 

“As of July 26, a total of 286 laboratory-confirmed cases of Cyclospora infection were reported in people who consumed salads from McDonald’s restaurants; the cases were reported by 15 states,” the Centers for Disease Control and Prevention reported. The CDC said in that outbreak update that a single ingredient had not yet been determined as the source of the parasites.

Fresh Express, based in Salinas, CA, has a statement on its website explaining that none of its romaine was involved in a deadly E. coli outbreak earlier this year, but the company did not appear to have any information about the Cyclospora parasite situation as of Monday night.

All of the 25 varieties of implicated beef, pork and chicken salads and wraps produced and distributed by Caito Foods have been out of date since at least July 23, according to the public health alert posted Monday night (July 30) by the USDA’s Food Safety and Inspection Service (FSIS).

“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,” according to the health alert from FSIS.

“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.”

People who ate the implicated salads or wraps could be infected but not yet showing symptoms of cyclosporiasis. It usually takes from two days to two weeks after ingesting the parasite before a person becomes ill. 

To view the full sized graphic about the transmission and life cycle of Cyclospora parasites, please click on the image.

The timeframe for normal incubation related to the salads and wraps runs through Aug. 6, according to the FSIS, assuming consumers did not eat any of the products after the best-by and sell-by dates, which ranged from July 19-23. 

“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,” according to the FSIS alert.

All of the beef, pork and poultry salads and wraps included in the FSIS public health alert were produced between July 15 to 18. They all have “Best By,” “Enjoy by,” Best if Sold By” or “Sell By” dates ranging from July 18 through July 23. All of the implicated products have an establishment number of “EST. 39985” or “P-39985” printed inside or next to the USDA mark of inspection on their labels.

For other information to identify the 25 products subject to the public health alert, including product names and labeling codes, please click here. Photographs of the implicated products, provided by Caito Foods to the FSIS, are also available on the agency’s website.

Caito Foods has been in the news recently in connection with a multi-state Salmonella outbreak associated with pre-cut melon. That outbreak, just declared over by federal officials on Friday, sickened 77 people in nine states. 

“Information collected from stores where ill people shopped indicated that Caito Foods LLC supplied pre-cut melon to these stores,” according to the CDC.

Retailers that received the implicated fruit from Caito Foods included Kroger, Spartan Nash, Walmart, Walgreens, Sprouts, Trader Joes and Whole Foods.

The Indiana produce company recalled pre-cut watermelon, honeydew melon, cantaloupe, and freshcut fruit medley products containing one of these melons that were produced at its facility in Indianapolis.

Advice to consumers regarding Cyclospora exposure
Anyone who has eaten one of the implicated wrap sandwiches, 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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