The U.S. Food and Drug Administration (FDA) reported on Thursday that there have been 395 confirmed cases of Cyclospora infections among customers of McDonald’s Corp. (NYSE: MCD) stores in 15 states. The contaminated salad mix was supplied to McDonald’s by Fresh Express.

On Wednesday the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) issued a public health alert “out of an abundance of caution” related to Cyclospora contamination in beef, pork and poultry salad and wrap products distributed by Caito Foods that included chopped romaine lettuce from the same supplier.

Fresh Express has recalled the products that were produced between July 15 and July 19 and carry “sell-by” notices with dates ranging between July 18 and July 23. In addition to the salad mix sold at McDonald’s, the recall affects salad and wrap products sold by Walgreens Boots Alliance Inc. (NYSE: WBA), Kroger Co. (NYSE: KR) and Trader Joe’s.

McDonald’s stopped selling salads at affected stores in the following states on July 13 after the company was notified by public health officials in Iowa and Illinois of the spread of Cyclospora infections: Illinois, Iowa, Indiana, Wisconsin, Michigan, Ohio, Minnesota, Nebraska, South Dakota, Montana, North Dakota, Kentucky, West Virginia and Missouri. The company has since replaced its salad supplier in those states.

Cases of Cyclospora also surfaced in Connecticut, Tennessee, Virginia and Florida, but those were related to salads purchased while traveling in Illinois and Kentucky.

Of the 395 reported cases of Cyclospora 16 people have been hospitalized and there have been no deaths.

The FDA recommends that consumers with symptoms of cyclosporiasis contact their healthcare provider:

Most people infected with Cyclospora develop 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 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 (relapse).

The FDA also noted that anyone who consumed salads at McDonald’s after May 20 in the following states could have been exposed to Cyclospora: Iowa, Illinois, Indiana, Kentucky, Michigan, Minnesota, Nebraska, Ohio, South Dakota and Wisconsin. The possibility of exposure extends to anyone who consumed a beef, pork, or poultry salad or wrap after May 20.

The FDA website has the full report.

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