October 21, 2018

CDC Updates Cyclospora Outbreak; Fresh Cilantro Suspected

The Centers for Disease Control and Prevention (CDC) has updated the Cyclospora outbreak in the US. This is the first update since September 24, 2013, just before the government shutdown. There has been no change in the case count; 643 people have been sickened in 25 states. Forty-five people have been hospitalized in this outbreak; there have been no deaths and no recall was associated with any product. Public health officials believe the outbreak is over.

Cyclospora-102313

The case count is as follows: Texas (278), Iowa (153), Nebraska (86), Florida (32), Wisconsin (17), Arkansas (13), Illinois (13), New York City (7), Georgia (5), Missouri (5), Kansas (4), New Jersey (4), Louisiana (3), Massachusetts (3), Minnesota (3), Ohio (3), Virginia (3), Connecticut (2), New York (2), California (1), Michigan (1), New Hampshire (1), Pennsylvania (1), South Dakota (1), Tennessee (1), and Wyoming (1). Most of the illness onset dates ranged from mid-June through mid-July.

There may have more than one outbreak. Public health officials in Iowa and Nebraska found that restaurant-associated cases of cyclosporiasis in their states were linked to a salad mix produced by Taylor Farms de Mexico and served at Olive Garden and Red Lobster restaurants. There is no evidence that the contaminated salad mix is still available on the market.

Some of the cases in Texas, which had the largest number of ill persons of any state, were linked to fresh cilantro imported from Puebla, Mexico. About 50% of ill persons who live in Texas reported eating fresh cilantro 2 to 14 days before they became ill. This proportion was significantly higher than the number of ill persons who live in Iowa and Nebraska, and higher than results from a survey of healthy people in New Mexico, where 27% reported eating fresh cilantro in the same time period. Epidemiologic and traceback investigations were conducted at three restaurants and one grocery store location in Texas where multiple unrelated ill persons ate or shopped.

The symptoms of cyclosporiasis include watery diarrhea that may be explosive, fatigue, loss of appetite, stomach cramps, nausea, vomiting, and muscle aches. The diarrhea lasts an average of 57 days if not treated, and can recur. Specific lab tests are needed to diagnose this illness. Cyclosporiasis is a reportable illness.

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