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From: The eUpdate, 8.27.13

Number of Cyclosporiasis Cases Still Growing

Some cases in multistate outbreak tied to salad mix from Mexican source

 More than 600 people have been sickened in a multistate outbreak of cyclosporiasis, according to the CDC’s August 22 update on the outbreak. 

Cases of the illnesses caused by the single-celled Cyclospora parasite have been reported in 22 states to date, but the FDA and CDC say that it is not yet clear whether all cases are part of the same outbreak. A source has been confirmed for cases in only two states, Iowa and Nebraska. In those states, according to the FDA, a traceback investigation linked the infections to a salad mix supplied to Olive Garden and Red Lobster restaurants by a Mexican supplier. 

The investigation of possible sources continues, according to Monica Parise, MD, chief of the CDC’s parasitic diseases branch, who is serving as the incident manager for the cyclosporiasis outbreak.

“CDC is carefully analyzing data about cases of Cyclospora infection in other states and is following all leads,” Parise says in an August 21 email. “For example, CDC has deployed staff to Texas to assist the state and local health departments with their epidemiologic investigation and collaborate with FDA on their traceback investigation.”

The supplier identified in the Iowa and Nebraska cases, Taylor Farms de Mexico, S. de R.L. de C.V., a processor of foodservice salads, informed the FDA on August 12 that it has suspended production and shipment of salad mix, leafy greens, and other salad mix components from its Mexican facility to the U.S., and the company has committed to not resume production and shipping without FDA approval, according to the FDA website.

“This voluntary action…of Taylor Farms de Mexico exemplifies the company’s cooperation with federal and state officials throughout this ongoing, complicated investigation,” the FDA said.

The numbers of those sickened by the single-celled parasite Cyclospora has been growing steadily since the first report of two laboratory-confirmed cases on June 28, and status is updated almost daily on the CDC site. As of the August 22 update, 601 people with Cyclospora infection have been reported in 22 states. The illness onset dates mostly range from mid-June through mid-July. In cases for which information was available, about 9 percent of patients have been hospitalized, the CDC says. No deaths have been reported.

The investigating agencies “do not have molecular typing ability for Cyclospora” to tie cases together, says Parise. “We look at the food exposures among people who got cyclosporiasis compared with those who did not. If a certain food or foods are associated with being sick, FDA works to trace back the source of those foods. If possible, we test any food to check for the parasite.”

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