Editor’s note: Late this afternoon the U.S. Centers for Disease Control and Prevention updated its patient count for this outbreak. The U.S. patient count has topped 500, now standing at 509.

A troublesome Cyclospora outbreak continues to grow in North America with 37 confirmed cases in Canada added to 206 in the midwest United States. Cyclospora is a coccidian parasite that causes diarrheal disease in humans called cyclosporiasis.

The update today involves an outbreak of Cyclospora infections traced to Fresh Express bagged garden salad products containing lettuce, carrots, and red cabbage.

As of July 8 there are 37 confirmed cases of Cyclospora illness linked to this outbreak in three Canadian provinces: Ontario (26), Quebec (10) and Newfoundland and Labrador (1).  Canadians became sick between mid-May and mid-June.  One Canadian 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 percent, are female.

The Public Health Agency of Canada (PHAC) is collaborating with provincial public health authorities, the Canadian Food Inspection Agency (CFIA) and Health Canada to investigate the 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.

On June 28 the CFIA issued a food recall 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 foodservice 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.

Meanwhile, in the United States, the Centers for Disease Control and Prevention (CDC) and the  Food and Drug Administration(FDA) are also investigating the multi-state outbreak of Cyclospora infections.

At present, 206 people with laboratory-confirmed Cyclospora infections and who reported eating bagged salad mix before getting sick have been reported from eight Midwestern states — Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota and Wisconsin. Twenty-three people have been hospitalized. Illnesses started on dates ranging from May 11 to June 17.

Products were sold in many states under several brands including Fresh Express and store brand labels including: Aldi’s Little Salad Bar, Giant Eagle, Hy-Vee, Jewel-Osco Signature Farms, ShopRite Wholesome Pantry, and Walmart’s Marketside.

The recalled products can be identified 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.

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