Days after health officials warned of a growing outbreak of Cyclospora infections "potentially linked" to certain store brands of garden salad mixes, more salads have been recalled and illnesses confirmed.
The Food and Drug Administration and the Centers for Disease Control and Prevention said in updated alerts Friday that the number of reported cases grew to 206 with 23 hospitalizations. The agencies are advising consumers to avoid select salads sold at Walmart, Hy-Vee, Aldi and Jewel-Osco stores.
According to the FDA, all of the recalled salads were sold in mid-western states and manufactured by a Fresh Express production facility in Streamwood, Illinois. Other retail brands of salad may be impacted, the FDA said.
"Consumers should not eat and restaurants and retailers should not sell or serve any Fresh Express products currently on the market that were made in the Streamwood, Illinois, production facility and contain either iceberg lettuce, red cabbage or carrots," the FDA notice said.
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In a news release announcing the Marketside Classic Iceberg Salad recall at Walmart stores, Fresh Express said it is "working in close coordination with FDA in its continuing investigation to identify a source of the Cyclospora outbreak that has occurred in primarily midwestern states."
Cyclosporiasis is an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis that can cause symptoms including diarrhea, loss of appetite, weight loss, stomach cramps, bloating, increased gas, nausea and fatigue, the CDC says.
Last week, the FDA and CDC advised consumers in six Midwestern states to not eat certain salads bought at those supermarkets. On Tuesday, the heath alerts were expanded to 12 states. An Iowa couple has filed a lawsuit against Fresh Express.
Walmart Marketside Classic Iceberg Salad recall
Fresh Express recalled 12- and 24-ounce bagged Walmart brand Marketside Classic Iceberg Salad, which was sold in Walmart stores in Iowa, Minnesota, Michigan, Nebraska, North Dakota, South Dakota and Wisconsin.
The recalled products have "best-if-used-by-dates of May 19 to July 04" and were distributed to select stores between June 1 and June 21 in the seven states.
Walmart stores are removing the recalled product from store shelves and inventories and customers should "discard it immediately and not consume it," according to a news release. For questions or to obtain refunds, contact Fresh Express Consumer Response Center toll-free at 800-242-5472 weekdays from 8 a.m. to 7 p.m. Eastern time.
Aldi Little Salad Bar garden salads recall
Aldi, along with Fresh Express, recalled 12-ounce bags of Aldi Little Salad Bar Brand Garden Salads from stores in Arkansas, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, North Dakota, South Dakota and Wisconsin.
The affected bags have a UPC code of 4099100082975 and have "Best If Used By dates of May 1 through June 29."
Aldi said in a news release if "customers have the affected Little Salad Bar Garden Salad, they should discard it immediately."
Jewel-Osco Signature Farms Garden Salad recall
Jewel-Osco, part of Albertsons, is recalling 12-ounce bags of Signature Farms Garden Salad sold in Illinois, Indiana and Iowa, and it advised consumers to discard or return the bags.
The affected bags have “best if used by” dates of May 16 through July 4. The product has a UPC code of 21130 98135 and includes the plant number S5417.
For questions, consumers can call 1-877-723-3929.
Hy-Vee brand Garden Salad recall
Twelve-ounce bags of Hy-Vee brand Garden Salad have been recalled from the grocer's eight-state region, which is Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, South Dakota and Wisconsin.
All UPCs and expiration dates are included, Hy-Vee said in a news release, noting no other Hy-Vee food items are impacted by this recall.
For questions, contact Hy-Vee Customer Care representatives at 1-800-772-4098.
Follow USA TODAY reporter Kelly Tyko on Twitter: @KellyTyko