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Texas Cyclospora Cases Linked to Mexican Cilantro

At least 126 Cyclospora-related illnesses in Texas reported this year have now been traced back to fresh cilantro imported from Mexico, according to the Texas Department of State Health Services.

State and federal health officials revealed the source of the outbreak at the same time they announced that the outbreak was considered over.

The case count spiked in June and July 2014, but any illness occurring after May 1 was considered part of the outbreak. At least 166 Cyclospora cases have been reported in Texas this year.

Of the outbreak cases, 21 were traced back to four restaurants in North Texas that all carried cilantro sourced from Puebla, Mexico. All 21 of those consumed dishes containing the cilantro.

Officials did not find any samples of cilantro contaminated with Cyclospora, but they said there is strong enough epidemiological evidence to link the illnesses to cilantro.

Last year at this time, 631 people in 25 states — including 270 people in Texas — fell ill in a Cyclospora oubreak also linked to cilantro from Puebla, Mexico, as well as to salad mix from Taylor Farms de Mexico.

Cyclospora is a single-celled parasite that can be found in food or water contaminated by infected feces and often in tropical areas. Symptoms usually appear roughly one week after ingestion and can include watery diarrhea, loss of appetite, stomach cramps and nausea.

Food Safety News

Cyclospora Outbreak Reaches 202 Cases; More Than Half are in Texas

Just like last summer, illnesses involving prolonged watery diarrhea and other gastrointestinal symptoms caused by the parasite Cyclospora cayetanensis are spreading across the country from Texas. Public health officials suspect the parasite is riding into the United States on contaminated fresh produce grown in Mexico for the U.S. market. They just don’t yet know the exact source, where it’s grown, and how it’s being distributed here.

During the past week, the outbreak has expanded by several states, with the number of confirmed cases growing to 202, up from the 61 illnesses reported nationally as recently as July 23.  With 110 illnesses, the Lone Star State accounts for more than half of the nation’s current cases, with illnesses being reported in 29 of the 254 counties in Texas.

“Though a source has yet to be identified, past outbreaks have been traced to fresh imported produce,” the Texas Department of State Health Services said. “DSHS encourages people to wash produce thoroughly, though that may not entirely eliminate the risk because Cyclospora can be difficult to wash off.”

Last summer, a June-peaking national outbreak of Cyclosporiasis ultimately saw 631 people sickened in 25 states. Last year’s Cyclospora outbreak caused some confusion and contention among the state’s investigating it. Iowa and Nebraska thought the infections were caused by bagged mixed salads served by restaurants, while Texas officials named fresh cilantro grown in Puebla, Mexico.

This year, interviews conducted by the U.S. Centers for Disease Control and Prevention (CDC) have attributed about 25 illnesses to foreign travel. Before last summer, Cyclospora outbreaks from food or water sources in the U.S. have been sporadic since imported raspberries arrived here two decades ago.

Carried by food or water contaminated by feces, the illness is cause by a parasite that’s common in tropical or subtropical counties. The onset of illness typically occurs within two to 14 days after the oocytes are consumed. It results in profuse diarrhea that can last for a couple weeks to several months. Other symptoms are a low-grade fever, nausea and vomiting, bloating and gas, anorexia and fatigue.

Food Safety News

Cyclospora Surge: 125 Cases in 13 States

Federal officials from the U.S. Centers for Disease Control and Prevention (CDC) are now stepping in to assist health officials in 13 states in investigating a spike in cases of Cyclosporiasis, according to CIDRAP. Cyclosporiasis is an intestinal infection caused by the ingestion of food or water contaminated with the parasite Cyclospora.

In total, 125 cases have been reported with no lead on a source.

At least 61 cases have been found in Texas alone. The other states with cases are: Connecticut, Florida, Georgia, Illinois, Maine, Maryland, Massachusetts, Montana, New Jersey, New York, Oregon and Tennessee.

Officials aren’t yet calling this an outbreak since it is unclear whether all of the cases are related.

Patients are currently being interviewed about international travel, with 19 so far reporting that they had recently traveled internationally, while another 35 had not. Cyclospora is more common in some tropical countries.

Symptoms of Cyclosporiasis include watery, sometimes explosive diarrhea, as well as loss of appetite, stomach cramps, nausea, vomiting, fatigue and bloating. If not treated, these symptoms may last anywhere from days to a month or more, with the potential for relapse.

Last year, a Cyclosporiasis outbreak linked to imported salad mix and fresh cilantro sickened 631 people in 25 states.

Previous Cyclosporiasis outbreaks in the U.S. have been linked to imported fresh produce such as lettuce, salad mix, snow peas, raspberries, cilantro and basil.

Food Safety News

Cyclospora Surge: 125 Cases in 13 States

Federal officials from the U.S. Centers for Disease Control and Prevention (CDC) are now stepping in to assist health officials in 13 states in investigating a spike in cases of Cyclosporiasis, according to CIDRAP. Cyclosporiasis is an intestinal infection caused by the ingestion of food or water contaminated with the parasite Cyclospora.

In total, 125 cases have been reported with no lead on a source.

At least 61 cases have been found in Texas alone. The other states with cases are: Connecticut, Florida, Georgia, Illinois, Maine, Maryland, Massachusetts, Montana, New Jersey, New York, Oregon and Tennessee.

Officials aren’t yet calling this an outbreak since it is unclear whether all of the cases are related.

Patients are currently being interviewed about international travel, with 19 so far reporting that they had recently traveled internationally, while another 35 had not. Cyclospora is more common in some tropical countries.

Symptoms of Cyclosporiasis include watery, sometimes explosive diarrhea, as well as loss of appetite, stomach cramps, nausea, vomiting, fatigue and bloating. If not treated, these symptoms may last anywhere from days to a month or more, with the potential for relapse.

Last year, a Cyclosporiasis outbreak linked to imported salad mix and fresh cilantro sickened 631 people in 25 states.

Previous Cyclosporiasis outbreaks in the U.S. have been linked to imported fresh produce such as lettuce, salad mix, snow peas, raspberries, cilantro and basil.

Food Safety News

CDC: Texas Cyclospora Cases Linked to Cilantro

Oct. 24, 2013

ATLANTA — Some of the cyclospora parasite cases in Texas can be traced back to fresh cilantro from Mexico, according to the Centers for Disease Control and Prevention.


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Investigations at three unnamed restaurants and a grocery store by the CDC, Food and Drug Administration and Texas health officials confirmed all ill persons had consumed cilantro from Puebla, Mexico.

A total of 278 people in Texas were sickened by cyclospora during the summer outbreak.

Health officials in Iowa and Nebraska had previously linked cyclospora illnesses in those states to salad mixes from Taylor Farms de Mexico.

The CDC said the cyclospora outbreaks were likely over. The agency reported 643 illnesses in 25 states from June to August.

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CDC Update: Some Cyclospora Cases Linked to Mexican Cilantro

In its first update since the government shutdown on this past summer’s Cyclospora outbreak, the U.S. Centers for Disease Control and Prevention reported Wednesday that epidemiologic and traceback investigations have linked some illnesses in Texas to fresh cilantro from Puebla, Mexico.

About half of the victims interviewed in Texas said they had eaten fresh cilantro 2-14 days before becoming ill. Preliminary traceback information indicates that sickened people ate cilantro from Puebla at three restaurants in Fort Bend County and central Texas.

Public health officials in Iowa and Nebraska had previously connected restaurant-associated illnesses in their states to a salad mix produced by Taylor Farms de Mexico, and investigators also determined that the cases in Texas and the remaining states were not connected to those in Iowa and Nebraska.

CDC also reported that the outbreaks now appear to be over with a case count of 643 in 25 states.

Food Safety News

Naming Likely Cyclospora Source Was ‘Rush to Judgment,’ Says ‘Perishable Pundit’

Naming Taylor Farms de Mexico as the likely source of this summer’s national Cyclosporiasis outbreak was a “rush to judgment” still without sufficient evidence, says “Perishable Pundit” Jim Prevor.

The award-winning food writer, editor and lecturer from Boca Raton, FL, says in the current digital issue of his column that  “there was an unseemly rush to announce things without satisfactory evidence or even a coherent theory.” Spread of the Cyclospora parasite eventually came to involve at least 643 people in 25 states, mostly between this past June and August.

Nebraska and Iowa public health officials connected 238 cases in those two states to a salad mix produced by Taylor Farms de Mexico and mostly served up by the Darden-owned Olive Garden and Red Lobster restaurants. Taylor voluntarily ceased shipments for a short period to give the U.S. Food and Drug Administration time to investigate, but FDA found no evidence of the Cyclospora.

Prevor points out that, as of its latest report issued Sept. 20, the federal Centers for Disease Control and Prevention (CDC) in Atlanta had “no evidence of the vast majority of cases having any connection to Taylor Farms de Mexico or any other Taylor Farms operation.”

“The Number One state having cyclosporiasis is Texas,” he adds. “It has almost half the known cases, yet to quote the CDC: ‘The preliminary analysis of results from an investigation into a cluster of cases that ate at a Texas restaurant does not show a connection to Taylor Farms de Mexico. The investigation is ongoing.’”

Prevor also says that the little information made public by Iowa and Nebraska officials makes it “hard to assess the accuracy of their claims, but Darden has stated it doesn’t use Taylor Farms lettuce mix in Texas.” With his own knowledge of the fresh produce industry, Prevor speculates that parasites could have come from a single growing area and Taylor was implicated for its large volumes, but “in reality, everyone buying from that growing region was affected.”

Then he knocks down his own theory, saying, “The outbreak is so long-lasting, with illness onsets spreading over two months, this doesn’t match likely growing and harvesting patterns.”

Indeed, CDC data show the illness onsets for Iowa and Nebraska peaking almost a month before Texas. And Prevor says only a small percentage of Taylor’s produce went to Iowa and Nebraska, with no indication it was widespread in Taylor’s overall production.

In taking apart the investigation, Prevor calls it “a low tech affair” for its reliance on consumer questionnaires and what people can remember about what they ate.

This is not the first time the federal-state investigation of the Cyclospora outbreak has come in for criticism. Some prominent food safety experts were critical earlier about the slow pace of the investigation. For their part, federal investigators have said that their work is complicated.

As the editor of both print and digital products, Prevor is widely recognized for his expertise in perishable food industries and has often weighed in on food safety issues involving produce.

Cyclospora is a single-cell parasite that causes the intestinal infection known as cyclosporiasis. In its last report, CDC said the evidence suggests that not all the cases of cyclosporiasis in the various states are directly related to each other.

Food Safety News

Cyclospora Illnesses Reach 646 in 24 States

At least 646 people have now fallen ill with Cyclospora infections in connection to an outbreak that hit 24 states between June and August, according to the latest update from the U.S. Center for Disease Control and Prevention.

At least 44 of those individuals have been hospitalized. Those ill range in age from less than one year to 92 years old, with a median age of 52.

According to the CDC’s count, the number ill by state is as follows:

Texas (283 illnesses), Iowa (154), Nebraska (86), Florida (32), Wisconsin (17), Illinois (12), Arkansas (12), New York (9), Georgia (5), Missouri (5), Kansas (4),  New Jersey (4), Louisiana (3), Minnesota (3), Virginia (3), Connecticut (2), Michigan (1), Ohio (2), California (1), New Hampshire (1), South Dakota (1), Tennessee (1), and Wyoming (1).

The Texas Department of State Health Services has reported a total of 307 cases of Cyclospora infection in the state this year, causing a minor discrepancy with the CDC’s count. But that’s because the CDC’s count only includes cases believed to be associated with the Cyclospora outbreak, whereas the Texas count includes all known Cyclospora illnesses in the state dating back to January 2013, according to health department spokeswoman Christine Mann.

Public health officials in Iowa and Nebraska have connected the 238 illnesses in those states to salad mix produced by Taylor Farms de Mexico and served at Olive Garden and Red Lobster restaurants. On August 12, Taylor Farms de Mexico voluntarily halted operations for an investigation from the U.S. Food and Drug Administration, which did not find any environmental contamination of Cyclospora.

Health investigators have determined that the cases in Texas and the remaining states are not connected to Iowa and Nebraska, and are still investigating the probable source of contamination. The illnesses in those states peaked a full two weeks after the illnesses in Iowa and Nebraska, suggested they came from another source.

Map for September 10, 2013

Epi Line Graph for August 28, 2013

 

 

 

Food Safety News

More Cases Counted in Multi-State Cyclospora Outbreak

A total of 658 Cyclospora cases have been counted among residents of 23 states, according to case-count updates by the Centers for Disease Control and Prevention and the Texas Department of State Health Services on Friday.

The CDC cautioned that although the investigation of cases continues, available evidence suggests that not all of the cases in the various states are directly related to each other.

Taylor Farms de Mexico, the lettuce grower whose products were connected to Cyclospora cases in Iowa and Nebraska, resumed operations this week.  The farm had suspended production at its processing facilities on August 9 after the epidemiologic investigation into the Cyclospora outbreak identified its products as the source of Cyclospora cases among customers of both Olive Garden and Red Lobster restaurants.

The latest Cyclospora case count by state is as follows:

Texas (304), Iowa (156), Nebraska (86), Florida (32), Wisconsin (16), Illinois (11), Arkansas (10), Georgia (5), Missouri (5), New York City (5), Kansas (4), Louisiana (3), Connecticut (2), Michigan (1), Minnesota (2), New Jersey (4), New York (2), Ohio (2), Virginia (3), California (1), New Hampshire (1), South Dakota (1), Tennessee (1), and Wyoming (1).

Several states’ case-counts include cases that may have been acquired out of state.

The CDC has received reports that 45 people were hospitalized due to their Cyclospora infections.  No deaths have been reported.

The median age of Cyclospora cases is 51 years, with case-patients ranging in age from less than one year to 92.

Cyclospora is a single-celled parasite often associated with contaminated fresh produce. Symptoms can take several days or weeks to appear and include watery diarrhea, vomiting, fatigue, nausea and stomach cramps.  It sometimes takes 5-6 weeks for confirmed illnesses to be reported to the CDC.

 

 

Food Safety News

Taylor Farms agrees to Cyclospora testing program, resumes shipments from Mexico plant

WASHINGTON — Taylor Farms de  Mexico pledges to follow a Cyclospora sampling program for leafy greens and other products from its farms and processing facility after the Food & Drug Administration gave the company the green light to begin shipping product again to the United States.

On Aug. 12, the Salinas, CA-based company officially informed FDA it was voluntarily suspending production at the Taylor Farms de Mexico facility as of Aug. 9 and would not resume production and shipping of its leafy greens or salad mix without FDA’s approval.

While Taylor Farms stopped production at the Mexico facility, FDA conducted its environmental assessment from Aug. 11-19 of the processing facility and five farms identified through the outbreak’s traceback investigation.

“The team found that conditions and practices observed at these facilities at the time of the assessment were in accordance with known food-safety protocols,” FDA said in an Aug. 26 statement. “As a result of the recent environmental assessment and FDA’s thorough review of a product sampling plan for Cyclospora put in place by Taylor Farms de Mexico, S. de R.L. de C.V., the FDA agreed to the firm resuming operations.”

Taylor Farms has agreed to conduct a comprehensive Cyclospora sampling program for leafy greens and other products for its Mexican facility that includes sampling of the products and water, as well as continued monitoring of the sanitary conditions of their facilities, FDA said.

The Centers for Disease Control reports at least 616 people from 22 states are suffering from the parasite-caused intestinal disease and 45 people have been hospitalized.

The investigation into the cause of the outbreak focused on the Mexico processor after public health officials in Iowa and Nebraska said cases of Cyclospora infection at Olive Garden and Red Lobster restaurants, both owned by Darden Restaurants, were linked to salad mix produced by Taylor Farms de Mexico. FDA said the last date someone who had eaten in one of these restaurants in those states became ill was on July 2, more than five weeks before FDA started its inspection.  

However, CDC says the Texas Department of Health & Human Services is probing cases in its state and preliminary findings do not show a connection between a cluster of cases that ate at a Texas restaurant and Taylor Farms de Mexico.

 

 

 

 

 

 

 

 

 

The Produce News | Today’s Headlines

635 Ill with Cyclospora; Taylor Farms Resumes Production

After announcing on Monday that the Cyclospora illnesses in Texas were not linked to the outbreak in Iowa and Nebraska, the U.S. Centers for Disease Control and Prevention have kept their case count at 610 people in 22 states.

That number lags behind the official count by the Texas Department of State Health Services, which has found 283 people sickened with Cyclospora in the state, bringing the total known cases to 635.

The case count by state is as follows:

Texas (283), Iowa (156), Nebraska (86), Florida (31), Wisconsin (16), Illinois (11), Arkansas (10), New York City (7), Georgia (5), Missouri (5), Kansas (4), Louisiana (3), New Jersey (3), Connecticut (2), Minnesota (2), New York (2), Ohio (2), Virginia (2), California (1), New Hampshire (1), South Dakota (1), Tennessee (1), and Wyoming (1).

Investigators from the U.S. Food and Drug Administration could not find contamination at the facilities of Taylor Farms de Mexico. The investigation into what might have caused the illnesses in each state remains ongoing.

Taylor Farms de Mexico has resumed operations after suspending them earlier this month.

On Tuesday morning the FDA released the following statement:

From August 11-19, 2013, the FDA with the cooperation of Mexican government authorities and Taylor Farms de Mexico, S. de R.L. de C.V., conducted a thorough environmental assessment at Taylor Farms de Mexico’s processing facility and five farms identified through the Cyclospora outbreak’s traceback investigation. The team found that conditions and practices observed at these facilities at the time of the assessment were in accordance with known food safety protocols.

Epidemiologic and traceback investigations by the states of Iowa and Nebraska, the CDC and the FDA had linked salad mix supplied by the firm to Olive Garden and Red Lobster restaurants, which are owned by Darden Restaurants. The last date that someone who had eaten in one of these restaurants in those states reportedly became ill with cycloporiasis was on July 2, more than five weeks prior to start of the Environmental Assessment.

As a result of the recent environmental assessment and FDA’s thorough review of a product sampling plan for Cyclospora put in place by Taylor Farms de Mexico, S. de R.L. de C.V., the FDA agreed to the firm resuming operations. The firm has committed to a comprehensive Cyclospora sampling program for leafy green and other products from their farms and processing facility in Mexico. This will include both sampling of their products and water and continued monitoring of the sanitary conditions of their facilities.

On August 25, 2013 Taylor Farms de Mexico, S. de R.L. de C.V., resumed production and shipment of salad mix, leafy greens, and salad mix components from its operations in Mexico to the United States. The firm had voluntarily ceased production and shipment of these products on August 9, 2013.

The FDA will continue to work with its federal, state, and local partners in this investigation. 

Food Safety News

CDC Says Not All Cyclospora Cases Linked to Taylor Farms

In a Monday update on the nationwide Cyclospora outbreak from the U.S. Centers for Disease Control and Prevention (CDC), the agency stated that not all of the more than 600 current cases reported in 22 states and New York City are directly related to each other.

Many of the recent cases have been reported from Texas, so CDC is collaborating with state and local health officials there by interviewing ill people about their exposure two weeks before becoming sick and identifying a cluster of those who reported eating at the same restaurant.

“The preliminary analysis of results from this ongoing cluster investigation in Texas does not show a connection to salad mix, leafy greens, and salad mix components produced at Taylor Farms de Mexico,” the latest CDC update reported.

Officials with the U.S. Food and Drug Administration (FDA), along with Mexican government authorities, did an environmental assessment at the firm’s processing facility from Aug. 11-19 and also at five farms identified through traceback information from the investigation.

According to the agency, officials found that conditions and practices at the facility and the farms during the assessment “were in accordance with known food safety protocols.” On Aug. 25, Taylor Farms resumed export of salad mix, leafy greens and salad mix components to the U.S. The firm had voluntarily stopped production and shipment of these food products on Aug. 9.

CDC noted that the findings in Texas differ from results found in Iowa and Nebraska, which linked some Cyclospora cases to eating a bagged salad mix from Taylor Farms at certain restaurants.

“It is not unusual to recognize outbreaks that happen in the same season but are due to different foods. As in 2013 and in years past, most cases and outbreaks of cyclosporiasis in the United States are detected in spring and summer months. Not all cases during the same time of year are necessarily caused by the same exposure,” the Monday update stated.

There are no available lab tests which can distinguish different strains of Cyclospora cayetanensis, although CDC and other groups are working on developing some. If such tests were available, officials could quickly tell one strain from another, identify whether Cyclospora cases are linked and point to potential sources of the infection.

The investigation into the Cyclospora outbreak continues. Most onset of illness dates ranged from mid-June through mid-July and 43 people have reported being hospitalized. No deaths have been reported.

Food Safety News

Nationwide Tally For Cyclospora Cases Now at 618

The U.S. Centers for Disease Control and Prevention (CDC) reported seven more Cyclospora infections on Tuesday, boosting its outbreak total to 598. The number of affected states rose to 22, with the latest illness onset listed as July 31. In its latest update, CDC stated that most of the cases were reported from mid-June through mid-July.

South Dakota and Wyoming are the two new states on the list, each with one illness.

Texas, way out front in the number-one spot, reported 267 cases in its latest update, 20 more than CDC’s total for the Lone Star State. Adding those cases to the CDC total puts the national total at 618.

Cyclospora cases in Iowa and Nebraska have been linked to a bagged lettuce mix from a producer in Mexico, but it’s still not clear if cases in other states are part of the same outbreak. At least 40 people have reportedly been hospitalized so far.

On Aug. 12, FDA released information regarding the traceback investigation of Taylor Farms de Mexico salad mix and the company’s decision to suspend as of Aug. 9 “production and shipment of any salad mix, leafy green, or salad mix components from its operations in Mexico to the United States.”Cases in this outbreak are defined as laboratory-confirmed Cyclospora infection in a person with onset of illness since June 2013 and no history of travel outside of the U.S. or Canada during the 14 days prior to onset of illness.

Cyclospora is a single-celled parasite that can cause diarrhea, vomiting and nausea several days to weeks after exposure. It is most commonly associated with imported fresh produce.

Food Safety News

National Cyclospora Outbreak: What We Do and Don’t Know

Nearly two months have passed since state and federal health authorities first became aware on June 28 of two related cases of Cyclospora infection in Iowa residents. Considering Iowa typically sees one or two such cases a year, the small irregularity immediately caught the attention of state health officials.

Within weeks, authorities had identified several hundred cases across a dozen states, with the bulk in Iowa, Nebraska and Texas. Patients’ illness onset dates spread from June 1 to the middle of July.

On Aug. 1, investigators in Iowa and Nebraska concluded that the majority of cases in those two states were connected to lettuce grown by Taylor Farms de Mexico and in salads served at Olive Gardens and Red Lobsters, chains both owned by Darden Restaurants of Orlando, FL.

As of Aug. 22, the foodborne parasite has infected at least 625 people in 22 states, making it the largest Cyclospora outbreak in the U.S. since 1997. Of those cases, 517 (83 percent) are concentrated in Iowa, Nebraska and Texas.

But, as time goes on, the investigations in Texas and the remaining states have still not identified an outbreak source. The U.S. Food and Drug Administration has a team of investigators at Taylor Farms in Mexico performing environmental assessments of the facilities and traceback investigations to determine where else – if anywhere – contaminated lettuce might have been sold, according to FDA spokesman David Steigman.

A number of cases in Texas are not easily connected to Darden Restaurants and Taylor Farms, said Dave Theno, Ph.D., CEO of Gray Dog Partners, a technical food safety consulting agency. But he said that the evidence remains “pretty compelling” that most of the illnesses are part of one event until an FDA investigation proves otherwise.

“A lot of things are possible, but what appears to be most likely is likely to be the answer,” Theno said. “If you look at the map, you could make a case that this thing went right through the heart of the country.”

Because fresh produce has a relatively short shelf-life, distribution channels typically run up north from Mexico, not east to west. Based on the geography of the outbreak, it would make sense to assume that contaminated produce was sent north through Texas and ended up in Iowa and Nebraska.

Theno said the most important question for investigators in Mexico to answer is whether Taylor Farms has crop contamination problems that moved Cyclospora through their facilities or whether it’s an area-wide contamination issue – possibly from a water source – that might mean nearby crops were also affected.

Investigation complications

A number of factors complicate the investigation as a whole.

First, a representative from Darden Restaurants told NBC News that they do not use Taylor Farms salad in their Texas restaurants. It is not clear if the restaurant sources Taylor Farms salad in any states besides Iowa and Nebraska.

A Florida woman who tested positive for Cyclospora in July told Food Safety News that she ate salad at Olive Garden several days before falling ill. This may suggest that Darden uses Taylor Farms salad in Florida, which has 31 confirmed illnesses, the fourth-highest number of the states involved.

Representatives for Darden, Olive Garden and Red Lobster have not responded to numerous requests for comment from Food Safety News.

Further complicating the matter, not even all of the cases in Iowa and Nebraska have a clear connection to Darden. Roughly 80 percent of Iowa cases and 75 percent of Nebraska cases appear connected to Darden, leaving the remaining 20 to 25 percent more of a mystery, according to Iowa state epidemiologist Dr. Patricia Quinlisk.

To complicate the investigation even more, the salad came into the U.S. pre-mixed with Taylor lettuce and other ingredients.

Perhaps the biggest issue distancing the Texas illnesses is that they began, on average, a week later than those in Iowa and Nebraska.

In Texas, where illnesses appear to have less of a connection to Darden and Taylor, patients are being interviewed and re-interviewed about all the places they may have dined.

Texas state health department spokeswoman Christine Mann told Food Safety News that illnesses in Texas generally fall into smaller clusters than those in Iowa and Nebraska, making the investigation in Texas more difficult.

The biggest roadblock, however, has been the relatively long incubation period of Cyclospora parasites. Patients may not experience symptoms such as diarrhea and nausea for several days – or even weeks – after exposure.

“It’s difficult to explain to people why it’s taking so long,” Mann said. “By the time the cases are finally reported to the CDC, several weeks have gone by. When an epidemiologist finally interviews patients, they might not remember eating the food that got them sick.”

Some cases, Quinlisk said, may be isolated Cyclospora illnesses that have gotten swept up in the outbreak investigation. A few hundred cases get reported in the U.S. each year on average.

Lessons for the future

Quinlisk described the investigation into the Iowa and Nebraska illnesses as “very detailed.”

The classic food history interview involves an 18-page questionnaire that takes more than an hour for each patient to complete. Patients may then receive additional calls from the environmental health team looking for more information.

The state health departments in those states performed targeted cluster investigations using case-control studies. In short, they interviewed patients who got sick, as well as fellow diners who didn’t get sick, to tease out any statistical differences in their meals. They even retrieved credit-card records from patients to coordinate dates of exposure.

Another issue that makes these investigations tricky is that not everyone who eats the contaminated food ends up sick. The parasite is not evenly dispersed across all the salad, and so some diners may ingest a large number of organisms, while others may eat from the same salad bowl and ingest only a few or none at all.

The general rule of thumb, Quinlisk said, is to expect about 40 percent of those who ate a contaminated food to actually end up with symptoms.

One issue this outbreak raises is the need for more coordination between state health departments during large, interstate outbreaks, said Craig Hedberg, Ph.D., environmental health professor at the University of Minnesota.

Hedberg compared the national jurisdiction of food regulation from FDA to the patchwork of state health departments that make up the majority of environmental health investigation resources.

“Our public-health system is really based on individual state authorities, and we don’t have a national framework for conducting outbreak investigations in parallel with the kind of regulation we have with respect to the food itself,” Hedberg said. “The CDC attempts to help guide those investigations, but because of limited resources and different priorities across different states, that coordination doesn’t always occur as seamlessly as we’d like to see it.”

Theno said he felt this current outbreak demonstrated the need for better cooperation and communication between federal investigators at FDA and the companies potentially involved in the outbreak.

“I think we need to find a way for companies and regulatory agencies to work much more closely together on these outbreaks,” Theno said. “It takes a long time for the agency to reach back into the supply chain. The faster we can get to the source of an outbreak, the sooner we can stop it and the better we can prevent it in the future.”

(Cyclospora is a single-celled food- or waterborne parasite that may cause diarrhea, nausea and vomiting. In the U.S., it is often associated with imported fresh produce. In 1996, at least 1,465 people were infected with Cyclospora in an outbreak linked to raspberries grown in Guatemala. Another 804 people were sickened by Guatemalan raspberries the next year. In 2005, 592 contracted Cyclospora infections after eating basil imported from Peru.)

Food Safety News

Cyclospora Illnesses Reach 630

As of this morning, the CDC reports a total of 609 cases of Cyclospora infection have been reported from 22 states and New York City. The number of cases identified in each area is as follows: Texas (257), Iowa (156), Nebraska (86), Florida (31), Wisconsin (16), Illinois (11), Arkansas (10), New York City (7), Georgia (5), Missouri (5), Kansas (4), Louisiana (3), New Jersey (3), Connecticut (2), Minnesota (2), New York (2), Ohio (2), Virginia (2), California (1), New Hampshire (1), South Dakota (1), Tennessee (1), and Wyoming (1).

Although the CDC reports the Texas total as 257, Texas reports that a total of 278 cases of Cyclospora infection have been reported in Texas in 2013 with the vast majority having onsets in June and July. Most Texas cases are reported from the Dallas/Fort Worth area. DSHS is investigating the cases to identify possible common exposures and to determine whether they are linked to an outbreak in other states.

Most of the illness onset dates have ranged from mid-June through mid-July.

Among 471 ill persons with available information, 40 (9%) have reported being hospitalized. No deaths have been reported.

National Cyclospora Outbreak: What We Do and Do Not Know

Food Safety News

Cyclospora Infections Top 589

At least 589 people in 19 states have fallen ill with Cyclospora infection since June.

The latest number of cases by state is as follows:

Arkansas (7 cases), California (1), Connecticut (1), Florida (28), Georgia (4), Illinois (11), Iowa (153), Kansas (4), Louisiana (3), Minnesota (1), Missouri (4), Nebraska (86), New Hampshire (1), New Jersey (2), New York (7), Ohio (2), Texas (258), Virginia (2) and Wisconsin (14).

These counts are based off data collected from the U.S. Centers from Disease Control and calls made to individual state health departments.

The illnesses in Iowa and Nebraska are linked to salad grown by Taylor Farms de Mexico and served at Olive Garden and Red Lobster restaurants. Investigators are still working to determine if the illnesses in other states are connected.

Most of the illness onset dates have ranged from mid-June through mid-July. At least 35 have reportedly been hospitalized.

On Aug. 12, FDA released information regarding the traceback investigation of Taylor Farms de Mexico salad mix and the company’s decision to suspend as of Aug. 9 “production and shipment of any salad mix, leafy green, or salad mix components from its operations in Mexico to the United States.”

Cases in this outbreak are defined as laboratory-confirmed Cyclospora infection in a person with onset of illness since June 2013 and no history of travel outside of the U.S. or Canada during the 14 days prior to onset of illness.

Cyclospora is a single-celled parasite that can cause diarrhea, vomiting and nausea several days to weeks after exposure. It is most commonly associated with imported fresh produce.

Food Safety News

Cyclospora Cases Reach 539, Including One in California

As of Monday, the U.S. Centers for Disease Control and Prevention has been notified of 539 cases of Cyclospora infection from the following 19 states: Arkansas, California, Connecticut, Florida, Georgia, Illinois, Iowa, Kansas, Louisiana, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, New York (including New York City), Ohio, Texas, Virginia and Wisconsin.

The California case was likely acquired out of state, according to CDC. It is not yet clear whether the cases from all of the states are part of the same outbreak. Iowa and Nebraska have linked illnesses in those states to bagged salad served at Olive Gardens and Red Lobsters and produced by Taylor Farms de Mexico.  In addition, Wisconsin added four to its count and Georgia deducted one.

Most of the illness onset dates have ranged from mid-June through mid-July. At least 32 persons have reportedly been hospitalized in five states.

On Aug. 9, CDC reported 535 Cyclospora cases in 18 states.

On Aug. 12, FDA released information regarding the traceback investigation of Taylor Farms de Mexico salad mix and the company’s decision to suspend as of Aug. 9 “production and shipment of any salad mix, leafy green, or salad mix components from its operations in Mexico to the United States.”

Additional cases are currently under investigation and will be included in Food Safety News updates as they are confirmed.

Cases in this outbreak are defined as laboratory-confirmed Cyclospora infection in a person with onset of illness since June 2013 and no history of travel outside of the U.S. or Canada during the 14 days prior to onset of illness.

Food Safety News

18-State Cyclospora Outbreak Spreads Parasite to 21 More Victims

The nation’s Cyclospora outbreak peaked some time ago, but it keeps producing cases on its current plateau.  The latest count is up to at least 535 cases in 18 states, according to the federal Centers for Disease Control and Prevention (CDC) in Atlanta.

That is 21 more cases and an additional state since CDC’s report last week.

CDC’s Aug 12 report had a cutoff for inclusion of Aug. 9. The current distribution of the outbreak cases is as follows: Texas (215), Iowa (153), Nebraska (86), Florida (27), Wisconsin (10), Illinois (9), Arkansas (5), Georgia (5), Missouri (4), Kansas (3), Louisiana (3), New Jersey (2), Ohio (2), Virginia (2), Connecticut (1), Minnesota (1), New Hampshire (1), and New York (6).

A handful of the cases were likely acquired out of the states where they are reported. Most of the onset dates range from mid-june to mid-July and a total of 32 have required hospitalization, according to CDC.

While Iowa and Nebraska have concluded the source of the Cyclospora outbreak is those states is a salad mix produced from Mexican grown produce, CDC says it is continuing to work with the other states to determine if that product is responsible for the entire outbreak.

CDC continues to say it is not clear whether all 535 cases are part of the same outbreak or whether it is multiple outbreaks.

And additional cases are under investigation, the agency said. It said: “Cases in this outbreak are defined as laboratory-confirmed Cyclospora infection in a person with onset of illness since June 2013 and no history of travel outside of the United States or Canada during the 14 days prior to onset of illness.”

The traceback investigation by the U.S. Food and Drug Administration (FDA)  identified Taylor Farms de Mexico, S. de R.L. de C.V., which makes mixed salads for restaurants and other food services, as the source of the pre-packaged salad mix identified in the cyclosporiasis outbreak in Iowa and Nebraska.  Major purchasers included the Olive Garden and Red Lobster restaurant chains.

 

Food Safety News

Cyclospora Infections Rise to 514

At least 514 people have been found ill from Cyclospora infections since June across 17 states, according to the latest update from the U.S. Centers for Disease Control.

Of those ill, 30 have been hospitalized.

New Hampshire is the latest state to include a case.

The case count by state is now as follows:

Arkansas (5 cases), Connecticut (1), Florida (27), Georgia (4), Illinois (9), Iowa (153), Kansas (3), Louisiana (3), Minnesota (1), Missouri (3), Nebraska (79), New Hampshire (1), New Jersey (1), New York (6), Ohio (2), Texas (206) and Wisconsin (10).

While the 232 illnesses in Iowa and Nebraska are known to be from salads served at Olive Garden and Red Lobster restaurants, investigators have not determined a definitive source for the illnesses in other states, including the 206 ill in Texas.

Cyclospora is a single-celled parasite often associated with contaminated fresh produce. Symptoms can take several days or weeks to appear and include watery diarrhea, vomiting, fatigue, nausea and stomach cramps.

Food Safety News

Cyclospora Outbreak Hits 480

At least 480 people have been found ill from Cyclospora infections since June across 16 states, according to the latest update from the U.S. Centers for Disease Control.

Curiously, the CDC’s case count has still not caught up with illnesses reported out of Texas yesterday, where at least 171 people were sickened.

The case count by state is now as follows:

Arkansas (3 cases), Connecticut (1), Florida (25), Georgia (4), Illinois (9), Iowa (151), Kansas (3), Louisiana (3), Minnesota (1), Missouri (3), Nebraska (85), New Jersey (1), New York (6), Ohio (1), Texas (171) and Wisconsin (12).

At least 27 people have been hospitalized due to their infections.

While the 236 illnesses in Iowa and Nebraska are known to be from salads served at Olive Garden and Red Lobster restaurants, investigators have not determined a definitive source for the illnesses in other states.

Cyclospora is a single-celled parasite often associated with contaminated fresh produce. Symptoms can take several days or weeks to appear and include watery diarrhea, vomiting, fatigue, nausea and stomach cramps.

Food Safety News