“This summer there have been several clusters of Cyclospora illness associated with various foods that are commercially available. This week [the Iowa Department of Public Health] has identified 15 Iowans who ate McDonald’s salads in late June to early July prior to getting ill,” Patricia Quinlisk, medical director of the state health department, said in a statement. “Anyone who ate these salads since the middle of June and who developed diarrhea, especially watery diarrhea and fatigue, should see their health care provider and get tested for Cyclospora to ensure an accurate diagnosis and appropriate treatment.”<doc-sep>A man shops for vegetables beside Romaine lettuce stocked and for sale at a supermarket in Los Angeles. Frederic J. Brown | AFP | Getty Images U.S. food safety regulators are recalling about twice as many products as a decade ago, pulling Ritz crackers, Goldfish and Swiss rolls off grocery shelves just last week, McDonald's salads about two weeks ago and Kellogg's Honey Smacks last month. Approximately one in six Americans get sick every year from eating contaminated foods, according to the Centers for Disease Control and Prevention. And as the number of recalls rises, so do questions about U.S. food safety. Flower Foods, Mondelez and Pepperidge Farm — owned by Campbell Soup — recalled their crackers and other products last week after public health officials flagged a whey powder ingredient from a supplier that might be contaminated with salmonella. The CDC blamed Kellogg's Honey Smacks for a salmonella outbreak that caused more than 100 people to become ill in 33 states in June. McDonald's was forced to pull salads from 3,000 restaurants in the Midwest after public health officials in Illinois and Iowa linked the restaurant chain to an outbreak of cyclosporiasis, which causes diarrhea and fever and has infected at least 286 people in 15 states so far, according to U.S. health officials. While the rise in high-profile food recalls in recent years may be worrisome, it doesn't necessarily mean that U.S. food safety is declining, according to federal safety and foodborne illness specialists. Companies have been getting more aggressive in issuing voluntary recalls while physicians and public health officials are getting better at reporting and tracing the origins of contamination, they said. "We're better at figuring these outbreaks out," said Bill Marler, an attorney specializing in food safety issues. "Public health has been cut back but not so much that it can't do good surveillance." Recalls on the rise Annual product recalls by the U.S. Department of Agriculture, which regulates meat producers, rose 83.4 percent from 2012 through 2017 while those issued by the Food and Drug Administration, which regulates everything else, jumped by 92.7 percent, according to an analysis of food and beverage recalls by industry consultant Stericycle Expert Solutions. The Food Safety Modernization Act and new technology has "allowed for federal health officials and companies to discover problems sooner and take action more quickly to remove a product from the marketplace," FDA spokesman Peter Cassell told CNBC. "We continue to improve the safety of our food supply and consumers can rest assured that the FDA and CDC routinely monitor for outbreak signals across the country." The FDA disputes Stericycle's data. In truth, the two count recalls differently with Stericycle looking at the number of products pulled and the FDA counting the number of incidents. The FDA would count the recent whey powder recall, for instance, as just one incident — even though several products were pulled off shelves. Cassell also noted that the number of Class I recalls, which involve a probable or immediate public health threat, has not changed significantly from 2012 through 2017. Food safety officials also point to increased product segmentation in the food sector as another reason for increasing food recalls. Small variations in these products mean that they travel through virtually the same supply chain, so an issue with one supplier can mean recalling multiple products. Marler said the rise in food recalls is a cyclical thing, not an indication that food is more dangerous. Slow response The path to pulling contaminated food from shelves and menus can be long. In December, the Inspector General of Department of Health and Human Services, the investigative arm of the agency, found that food companies took 57 days on average to recall food after the agency was informed of potential risks in a study of 30 out of 1,557 food recalls from 2012 through 2015. The IG's office also said the "FDA did not always have an efficient and effective food-recall process that ensured the safety of the nation's food supply." FDA Commissioner Scott Gottlieb said the samples studied by the IG's office included "very challenging" recalls, according to his response to the report. Gottlieb also said that recalls occur, on average, within four calendar days after the problem is discovered. Public health officials try to detect foodborne diseases by studying geographic and temporal patterns in illnesses. Microbiological technology allows officials to obtain a DNA fingerprints of the pathogen, according to the CDC. Officials test food collected from the infected person's home, restaurants and manufacturing facilities for a DNA match to identify the source. Records and environmental assessments can also help officials pinpoint how the outbreak began, the CDC said. The agency then contacts the company linked to the outbreak to request a voluntary recall, and the company is supposed to alert their grocers about the contamination. But not all retailers immediately pull the food off their shelves, as happened with Kellog's Honey Smacks. The FDA said the cereal was still being sold a month after it was supposed to be pulled. Larger retailers like Walmart or Target can target a specific UPC barcode for a recall, but smaller retailers might not have that level of sophistication in place. New food safety laws<doc-sep>The U.S. Department of Agriculture issued a health alert over pre-made salads and wraps sold at stores including Trader Joe's, Kroger and Walgreens, due to concerns they may be contaminated with cyclospora, an intestinal parasite. The concern is over recalled romaine lettuce that may have been used in the wraps and salads, according to the USDA. People are being warned to check their refrigerators for any of the beef, pork and poultry products affected by the alert. Unlike E. coli and salmonella, which are bacteria, cyclospora is a parasite. It's what caused at least 286 people to become sick in an outbreak likely linked to McDonald's salads. The parasite, which causes an intestinal illness, is usually transmitted by consuming food or water contaminated with feces, according to the Centers for Disease Control and Prevention. The items listed in the health alert were produced between July 15 and July 18, and have a sell-by date ranging from July 18 to July 23. Customers can find a complete list of the products here, and labels of the products here. The products come from Caito Foods, a distributor in Indianapolis, Indiana, which learned from its lettuce supplier, Fresh Express, that the romaine that is used to manufacture some of its salads and wraps was being recalled, according to the USDA. The USDA issued the alert "out of an abundance of caution," but urged customers with the possibly affected products to throw them away or return them to the stores.<doc-sep>
Nearly 300 people have been infected by a parasite in McDonald's salads. As of July 26, the Centers for Disease Control and Prevention (CDC) reports a total of 286 people in 15 states have been infected with a parasite called Cyclospora, an increase of 120 people in the last week alone. So far, there have been 11 hospitalizations but no deaths associated with this outbreak. The parasite has been linked to salads from McDonald’s. So what is this parasite, and why are the numbers still increasing? What is Cyclospora? Cyclospora is a parasite found in contaminated food or water -- which in the U.S. can mean fresh produce -- and causes a short-term illness known as Cyclosporiasis. The parasite isn’t typically transmitted from one person to another, but rather, makes people sick after it is ingested. What are the signs of an infection? Once someone ingests food or water contaminated with Cyclospora, symptoms of the infection may not begin until about a week later, sometimes even up to two weeks. The symptoms include copious, sometimes explosive, watery diarrhea, low-grade fever, cramping or bloating with increased gas, nausea, and tiredness. These symptoms can last anywhere from one to several weeks. Without treatment, symptoms can come and go for several months. Why is the number of people infected increasing? McDonald’s voluntarily recalled salads from over 3000 restaurants in 14 states on July 13. The people who ate those salads before July 13th may just be starting to develop symptoms -- prompting them to seek medical attention. Therefore, the official number of people infected by this parasite may continue to increase in the next few weeks as more reports come in. What should people do if they have symptoms that may indicate Cyclosporiasis? If people have eaten at a McDonald’s restaurant in the affected states recently and develop diarrhea, they should see a healthcare provider to discuss whether testing for Cyclospora is warranted. If the infection is confirmed, it is typically treated with a course of antibiotics and rehydration as needed. Signs of severe dehydration that require immediate medical attention include: increasing sleepiness, dizziness or confusion, fainting, or chest pains. Dying from cyclosporiasis is rare in healthy adults. Children and those with impaired immune systems are at increased risk for complications. Dr. Stephanie Sophie Lee is a pediatrician and preventive medicine resident in South Carolina and a resident in the ABC News Medical Unit.