Cyclosporiasis Outbreak Now Encompasses 13 States
By Laurel Maloy, contributing writer, Food Online
Starting innocuously enough, with just a report on a Tarrant County, TX television station, the first report of the outbreak occurred on July 23. By July 24, the infection has grown to 125 cases in 13 states.
What was not long reported as a small outbreak has now grown exponentially overnight. The Center for Infectious Disease Research and Policy (CIDRAP) reports 125 Cyclospora infections in 13 states including CT, FL, GA, IL, MA, MD, MN, MT, NJ, NY, OR, TN, and TX. At this writing, no common source for the outbreak has been identified. The investigation was first launched in TX as the number of reported cases grew to 61, according to the Texas Department of State Health Services (TDSHS).
Past Cyclospora outbreaks have resulted in large numbers of miserably ill consumers. The most recent of note occurred in 2013, in 25 states. No deaths were reported from that outbreak, but 49 were hospitalized and was attributed to two separate outbreaks that happened to coincide. One was the result of contaminated salad mix produced by Taylor Farms de Mexico, and the other traced back to fresh cilantro from Puebla, Mexico. Though imported fresh produce is most often at the heart of Cyclospora infections, contamination can occur when an infected person does not wash their hands after using restroom facilities and then touches food being prepared. Surface contact will not usually result in infection.
The symptoms can appear from one to two weeks following infection, with the most common ailment being watery diarrhea. Infected persons may also experience a loss of appetite, with associated weight loss, as well as bloating, cramping, increased gas, nausea, and fatigue. Less common, but also indicative of Cyclospora infection is vomiting and low-grade fever. Deaths are rare, as Cyclospora usually responds well to treatment with antibiotics.
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However, in the event a patient does not respond with this treatment, there is no highly-effective alternative. The CDC also states that disinfection with chlorine or iodine “is unlikely to be effective.” Cyclosporiasis is not routinely tested for in stool specimens, though, at this time, healthcare providers are being urged to request specific testing if patients present with symptoms.
According to the CDC, the easiest way to avoid getting sick is to avoid food or water that may have been contaminated with feces. The statement is not much help, as the majority of consumers would definitely not knowingly ingest, or even touch, something they knew to be contaminated. CIDRAP and the CDC also recommend thorough washing of fruits and vegetables, even those that will be peeled. For firm-skinned vegetables, such as potatoes or cucumbers, the CDC advises scrubbing with a brush under fresh running water. All soil should be removed and the outer leaves of leafy vegetables should be disposed of before washing. Using detergents or bleach for cleaning is not advised, though the agency recommends drying with a clean paper towel after washing.
Additionally, the FDA and the Center for Food Safety and Applied Nutrition (CFSAN) publishes a Guide to Minimize Microbial Food Safety Hazards for Fresh Fruits and Vegetables. This 1998 publication stresses the importance of good agricultural practices (GAPs) and good manufacturing processes (GMPs) for growers and producers. FSMA’s Proposed Rule for Produce Safety has been much maligned by the industry, due to its wide-reaching effects on growers — this outbreak speaks to the need for such regulation.
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FSMA’s Proposed Rule on Sanitary Transportation might have also nipped this infection in the bud, effectively preventing cross contamination. In light of this latest outbreak, it is somewhat ironic that Cyclospora is not included in the list of The World’s Most Concerning Foodborne Parasites. The parasite is endemic to many tropical and subtropical nations. In fact, 19 of the 125 patients are believed to have become infected while traveling, making it even more difficult to locate a common source for this prolific parasite. There appears to be a need for stricter and/or more consistent global monitoring and control in order to spare the public the recovery time, medical expenses, loss of income, and loss of family associated with Cyclospora and other foodborne illness.