(WHDH) — A parasite infection linked to a product in McDonald’s salads has led to a sickness that has impacted nearly 400 people across 15 states.

The FDA says the infection outbreak started in May. An additional 109 cases were reported by the FDA Thursday.

At least 16 people have been hospitalized due to a parasite, called “cyclospora.” The parasite causes an intestinal illness that can cause diarrhea, vomiting, fever, and body aches and can last anywhere from a few days to a few months.

According to the FDA, an unused package of “Fresh Express” salad mix tested positive for the parasite.

McDonald’s said in July that it had removed the mix from impacted restaurants. In a statement, Fresh Express says it issued a “precautionary recall” on July 27.

The FDA says the states affected do not include New England states, but that one person in Connecticut was sickened after traveling to and eating at one of the impacted restaurants.

The states that are impacted are Iowa, Illinois, Indiana, Kentucky, Michigan, Minnesota, Missouri, Nebraska, Ohio, South Dakota, and Wisconsin. People in four other states were sickened after traveling to one of these locations.

For more information on the outbreak, click here.

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