The Food and Drug Administration said a sample of iceberg lettuce from Taylor Farms that had earlier tested positive for cyclospora was a false positive after a laboratory re-review, and the Centers for Disease Control and Prevention confirmed late Thursday that shredded iceberg lettuce served at Taco Bell restaurants in Indiana, Kentucky, Michigan, Ohio and West Virginia is a source of a multistate outbreak; Taylor Fresh Foods said it is voluntarily removing all iceberg lettuce sourced from central Mexico, and an FDA recall notice said the shredded lettuce was sold in 27 states between June 29 and July 16, warning consumers not to eat that product.
The FDA-listed states where the shredded iceberg lettuce was distributed are Alabama, Arkansas, Connecticut, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maryland, Michigan, Missouri, Mississippi, North Carolina, New Hampshire, New Jersey, Ohio, Oklahoma, Pennsylvania, South Carolina, Tennessee, Texas, Virginia and Wisconsin.
In a recall notice, the company said, "We are actively removing the implicated products. The company has stopped receiving product from the implicated lot, suspended distribution of the iceberg lettuce from Central Mexico, notified our customers, and we are continuing to work with the FDA, CDC, and state authorities."
The voluntary recall includes Marketside-brand iceberg lettuce sold at Walmart locations and other products that were distributed to food service customers; the FDA said Marketside products were sold at Walmart locations in 15 states. Over the weekend Walmart announced it had removed four Marketside bagged iceberg lettuce salad products from its stores in more than two dozen states, but said there was "no indication that products sold in our stores are affected by the current Cyclospora investigations."
Taylor Fresh Foods said FDA traceback is indicating a specific independent farm, which represents less than one percent of the U.S.'s iceberg lettuce supply, as the potential source and that it has removed all iceberg lettuce from the region indefinitely. The company said no other Taylor Fresh Foods products across the country are impacted and that no Taylor Farms branded salad kits contain iceberg lettuce, and that the lettuce being removed came from its Guanajuato facility in central Mexico.
The FDA said its traceback investigation identified a single supplier of iceberg lettuce from Mexico that was used at the Taco Bell locations; a source familiar with the FDA traceback identified Taylor Farms as the supplier. The agency said it collected the sample during targeted surveillance of the import as part of its investigation, and Taylor Farms said it is working to identify whether any part of the implicated lot is available in commerce or in consumers' homes.
Taco Bell Corp. said it had completed removal of affected Taylor Farms lettuce from its restaurants as of July 17, that it removed the affected ingredient from its supply chain nationwide and that it encourages other restaurants, retailers and foodservice operators to take similar precautions.
The FDA said the infections were first detected on May 13. As of Friday, the CDC said there have been more than 1,644 confirmed cases of cyclosporiasis across the country, with 94 hospitalizations and no reported deaths so far; Michigan officials reported more than 5,000 confirmed cases as of Friday, and Ohio officials reported 1,244 cases. A backlog of more than 5,100 suspected cases remains under investigation, and the CDC said it expects the outbreak to continue through August.
The Department of Health and Human Services said the investigation is continuing. "The investigation remains active, and additional states, restaurants, retailers, or products may be identified as more information becomes available," HHS spokesperson Emily Hilliard said.
Dr. Donald Prater, acting deputy commissioner for food at the FDA, said, "We are aware of the signal for lettuce," and the agency said it is continuing its traceback investigation on multiple produce items.
Taylor Farms said Sunday in a statement, "Our thoughts remain with everyone who has fallen ill in this outbreak. We are committed to working with public health authorities as the ongoing outbreak investigation continues."
The CDC says cyclosporiasis symptoms usually begin about a week after infection and can last from two days to two weeks or more, with watery diarrhea, loss of appetite, weight loss, bloating, nausea and fatigue. Dr. Nuwan Gunawardhana said, "The best way to avoid ingesting it is to cook your food," adding that brushing or scrubbing vegetables can also help but "it's also known to be extremely adherent to surfaces, so it won't protect you 100%." Dr. Gwen Biggerstaff of the CDC's Division of Foodborne, Waterborne and Environmental Diseases urged people to "wash your hands and any fresh produce thoroughly under running water before eating, cutting or cooking," and said cooking kills the parasite, noting heating food to 158 F or 70 C or higher is effective. She added that people with symptoms should contact their health care providers to be tested specifically for cyclospora and should stay well hydrated and avoid preparing food for others while acutely ill.
The outbreak has had measurable commercial effects at the fast-food chain. According to Consumer Edge, year-over-year sales growth at Taco Bell was 4.2% in the week ending July 11, the slowest rate since April, Michael Gunther, senior vice president of research and market intelligence at Consumer Edge, said in an email. Placer.ai's analytical team said cyclospora headlines and product removals at some quick-service restaurant chains appear to be weighing modestly on visitation.
Last year, an E. coli outbreak was linked to onions provided to several restaurants from a Taylor Farms facility in Colorado, an episode that briefly forced McDonald's to stop using onions on its Quarter Pounders at some locations. On its website, Taylor Farms bills itself as the "leading global producer of salads and healthy fresh foods, with production facilities across the U.S., Canada, Mexico, and Western Europe."