Cyclospora Update
Beginning in early-mid May, case reports of people experiencing “explosive diarrhea” began to come to the CDC from local and state public health departments. The cause – Cyclospora – a microscopic parasite that causes human infections when consumed in food or water contaminated with the parasite. Although endemic to many countries in Central and South America, the Caribbean, Asia, and Africa, outbreaks in the U.S. have been associated with foodstuffs imported, from these countries, such as leafy greens, cucumbers, berries, cilantro and basil. The parasite lives in soil and groundwater, with unsanitary water supplies used for drinking or for washing and irrigating produce the primary means for contamination of food and water and human infection.
Although cases are reported year-round, infections occur most commonly in the summer and early fall, with 200-1000 cases typically reported annually. This is likely an undercount of cases, however, as the symptoms – watery “explosive” diarrhea, decreased appetite nausea and weight loss, cramping, increased gas and bloating – are common to other gastrointestinal (GI) infections. Given its incubation period from 2-14 days, many infected people may not associate their symptoms with something they ate days or weeks ago.
As of July 20th, more than 11,000 cases have been documented across 46 states, with multiple outbreaks, which are defined as two or more cases that are linked to a common exposure. Five states – Michigan, Ohio, West Virginia, Kentucky and Indiana – have been associated with the largest outbreak, that as of the 17th, included more than 1600 illnesses and almost 100 hospitalizations. Over the weekend, Michigan, the state that’s been hit hardest, reported 1000 new cases. Washington State has identified 38 cases of cyclospora infection since 01 May, of which 4 cases had traveled to Michigan.
Public health professionals in Michigan reviewed food exposure details from almost 1000 cases. Almost 200 of these reported eating at Taco Bell, and 90% of these reported eating iceberg lettuce. On July 17th, Taylor Foods de Mexico announced it was voluntarily removing all iceberg lettuce from the 27 states that had been sourced from central Mexico. The recalled products were distributed from June 29 through July 16 and have a best-by dates up to Aug. 3. Notably, this company, as a large food service provider, distributes widely across the U.S., to include fast food restaurants, large scale food suppliers such as Sysco and US Foods that supply hospitals and restaurants, and grocery stores, such as Walmart that sells bagged lettuce from the company under its Marketside brand.
With the voluntary recall now in place affecting 27 states (east of the Mississippi), Washington DOH is recommending following routine produce safety practices to reduce the risk of foodborne illnesses:
- Rinse fresh fruits and vegetables under running water before eating, cutting, or cooking.
- Wash your hands with soap and water before preparing or eating food.
- Keep knives, cutting boards, countertops, and other food preparation surfaces clean.
- Keep fresh produce separate from raw meat, poultry, seafood, and their juices.
- Refrigerate cut fruits and vegetables promptly.
While neither Washington nor Idaho are part of the above-mentioned recall, it’s important to realize the U.S. food distribution network is very complicated and Taylor Farms de Mexico is but one part of this vast system. So while an abundance of caution is noted at this time, safe food handling and preparation practices should become routine. If you experience symptoms and are concerned about possibly contracting cyclospora infection, talk to your medical provider. They’ll be able to determine if you are at risk and test for this infection, as well as other possible foodborne illnesses, if warranted. Asotin County Health District performs regular inspections of all local restaurants and is working closely with the Washington Department of Health to monitor this situation.