Rick Barrett of the Journal Sentinel reports that Wisconsin and Minnesota health officials are investigating an increase of Cyclospora infections that may be linked to Del Monte vegetable trays purchased from Kwik Trip stores.
Eleven people in Wisconsin and three in Minnesota have reported becoming ill after eating vegetables from the trays that contained broccoli, cauliflower, carrots and dill dip, according to the Wisconsin Department of Health Services.
Kwik Trip has removed the 6-ounce and 12-ounce trays from its stores and is cooperating with state officials. The trays may also have been available from other businesses, health officials said.
During July 21–August 8, 2017, the Texas Department of State Health Services (DSHS) was notified of 20 cases of cyclosporiasis among persons who dined at a Mediterranean-style restaurant chain (chain A) in the Houston area. On August 10, 2017, DSHS requested assistance from CDC to support ongoing investigations by the City of Houston Health Department, Harris County Public Health, Fort Bend County Health and Human Services, and Brazoria County Health Department. The objectives of this investigation were to determine the source of the illnesses in the Houston area and to generate hypotheses about the source of the national increase in cyclosporiasis in 2017.
Chain A has four locations in the Houston area and a central kitchen where many dishes are prepared. A case-control study was performed using a menu-specific questionnaire focusing on items containing fresh produce. A confirmed case was defined as laboratory-confirmed Cyclospora infection and clinically compatible illness in a person who ate at any location of chain A during May 28–July 15, 2017. A probable case was defined as diarrhea and at least one additional sign or symptom compatible with cyclosporiasis (e.g., anorexia, abdominal cramping, bloating, myalgia, fatigue, vomiting, or low-grade fever) in a person within 2 weeks after dining at chain A during May 28–July 15, 2017. Controls were identified as either dining companions of case-patients who had no illness or patrons who dined at the same chain A location within 2 days of a case-patient visit and who had no illness. For controls identified by the latter method, contact information was obtained using commercially available databases used by local health agencies in Texas. Three controls per case-patient were recruited.
A total of 22 case-patients (16 confirmed and six probable) and 66 controls were enrolled in the study. Case-patients had a median age of 52 years (range = 29–79 years); 50% were female. Analysis compared menu items consumed by case-patients and controls, followed by ingredient-level analysis. The following ingredients were identified as being significantly associated with illness: green onions (matched odds ratio = 11.3; 95% confidence interval = 2.55–104.68), tomatoes (5.5; 1.2–51.7), red onions (4.7; 1.3–21.0), and cabbage (4.0; 1.1–15.9). When analysis was limited to the 16 confirmed case-patients and their corresponding 48 controls, only green onions remained significantly associated with illness (17.6; 2.5–775.7). Restaurant invoices from chain A were collected for all items identified during the epidemiologic investigation, but efforts to trace any food item to its source were inconclusive. Although the current study identified potential foods associated with illness in Texas, investigators were not able to identify the illness source or confirm whether the patients within the chain A subcluster had consumed a product reported by other ill persons in the United States.
Cyclosporiasis is an intestinal illness caused by the parasite Cyclospora cayetanensis. Since 2013, the United States has experienced annual increases in the incidence of cyclosporiasis incidence during the summer months, with some illnesses linked to imported produce (1–3). Molecular subtyping of Cyclospora is not currently available; therefore, identification of an ingredient associated with a particular illness subcluster might provide information about a source contributing to other cyclosporiasis illnesses. Previous U.S. outbreaks of cyclosporiasis have been linked to fresh produce, such as prepackaged salad mix, raspberries, and cilantro (3,4). Identification of a vehicle for Cyclospora is complicated by the short shelf life of fresh produce as well as the use of potential vehicles such as garnishes or mixtures with other items that could also harbor the parasite. Ingredient-level analysis within restaurant clusters and subclusters therefore remains critical in Cyclospora outbreak investigations.
Notes from the field: Cyclosporiasis cases associated with dining at a Mediterranean-style restaurant chain- Texas 2017
1.jun.18 CDC
Amelia A. Keaton, MD1,2; Noemi Borsay Hall, PhD2,3; Rebecca J. Chancey, MD2,4; Vivienne Heines, MPH3; Venessa Cantu, MPH3; Varsha Vakil, MPH5; Stephen Long, MD5; Kirstin Short, MPH5; Elya Franciscus, MPH6; Natasha Wahab, MPH6; Aisha Haynie, MD6; Laura Gieraltowski, PhD2; Anne Straily, DVM4
At least 553 (56%) of these persons did not report international travel (i.e., likely were infected in the United States) and became ill on or after May 1, 2017 (a date after which cases tend to increase each year). These 553 persons were from the following 36 states: Arizona (1), California (10), Colorado (6), Connecticut (23), Florida (68), Georgia (10), Illinois (17), Indiana (4), Iowa (14), Kansas (2), Louisiana (7), Maryland (12), Massachusetts (13), Michigan (3), Minnesota (11), Mississippi (1), Missouri (13), Montana (2), Nebraska (5), New Hampshire (4), New Jersey (19), New Mexico (1), New York (excluding NYC) (15), New York City (30), North Carolina (45), Ohio (16), Pennsylvania (2), Rhode Island (2), South Carolina (7), South Dakota (4), Tennessee (3), Texas (163), Utah (1), Virginia (7), Washington (1), West Virginia (2), and Wisconsin (9).
At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source (or sources) of infection are ongoing. It is too early to say whether cases of Cyclosporainfection in different states are related to each other or to the same food item(s).
Previous U.S. outbreaks of cyclosporiasis have been linked to various types of imported fresh produce (e.g., basil, cilantro, mesclun lettuce, raspberries, snow peas). Consumers should continue to enjoy the health benefits of eating fresh fruits and vegetables as part of a well-balanced diet.
The Centers for Disease Control reports Cyclospora cayetanensis is a single-celled parasite that causes an intestinal infection called cyclosporiasis.
As of August 16, 2017 (3pm EDT), CDC has been notified of 712 laboratory-confirmed cases of cyclosporiasis in persons who became ill in 2017. This number includes persons who reported international travel as well as persons who did not report travel. The reports have come from 36 states.
At least 347 (49%) of these persons did not report international travel (i.e., likely were infected in the United States) and became ill on or after May 1, 2017 (a date after which cases tend to increase each year). These 347 persons were from the following 31 states: Arizona (1), California (5), Colorado (6), Connecticut (18), Florida (36), Georgia (4), Illinois (11), Indiana (3), Iowa (8), Kansas (2), Louisiana (3), Maryland (3), Massachusetts (11), Michigan (1), Minnesota (10), Missouri (8), Montana (2), Nebraska (5), New Hampshire (2), New Jersey (10), New Mexico (1), New York (excluding NYC) (12), New York City (27), North Carolina (19), Ohio (6), Pennsylvania (1), Rhode Island (2), South Dakota (4), Texas (116), Utah (1), Virginia (2), and Wisconsin (7).
At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source (or sources) of infection are ongoing. It is too early to say whether cases of Cyclospora infection in different states are related to each other or to the same food item(s).
Previous U.S. outbreaks of cyclosporiasis have been linked to various types of imported fresh produce (e.g., basil, cilantro, mesclun lettuce, raspberries, snow peas). Consumers should continue to enjoy the health benefits of eating fresh fruits and vegetables as part of a well-balanced diet.
During the summers of 2015 and 2016, the United Kingdom experienced large outbreaks of cyclosporiasis in travellers returning from Mexico. As the source of the outbreaks was not identified, there is the potential for a similar outbreak to occur in 2017; indeed 78 cases had already been reported as at 27 July 2017. Early communication and international collaboration is essential to provide a better understanding of the source and extent of this recurring situation.
Cyclosporiasis in travellers returning to the United Kingdom from Mexico in Summer 2017: Lessons from the recent past to inform the future
Eurosurveillance, vol. 22, issue 32, 10 August 2017, DFP Marques, CL Alexander, RM Chalmers, R Elson, J Freedman, G Hawkins, J Lo, G Robinson, K Russell, A Smith-Palmer, H Kirkbride, DOI: http://dx.doi.org/10.2807/1560-7917.ES.2017.22.32.30592
Another North American summer, another Cyclospra-induced shit-fest.
The U.S. Centers for Disease Control and Prevention (CDC), State and Local Health Departments, and the Food and Drug Administration (FDA) are investigating an increase in reported cases of cyclosporiasis. The purpose of this HAN Advisory is to notify public health departments and healthcare facilities and to provide guidance to healthcare providers of the increase in reported cases. Please disseminate this information to healthcare providers in hospitals and emergency rooms, to primary care providers, and to microbiology laboratories.
Healthcare providers should consider a diagnosis of cyclosporiasis in patients with prolonged or remitting-relapsing diarrheal illness. Testing for Cyclospora is not routinely done in most U.S. laboratories, even when stool is tested for parasites. Healthcare providers must specifically order testing for Cyclospora, whether testing is requested by ova and parasite (O&P) examination, by molecular methods, or by a gastrointestinal pathogen panel test. Cyclosporiasis is a nationally notifiable disease; healthcare providers should report suspect and confirmed cases of infection to public health authorities.
As of August 2, 2017, 206 cases of Cyclospora infections have been reported to CDC in persons who became infected in the United States and became ill on or after May 1, 2017. These cases have been reported from 27 states, most of which have reported relatively few cases. Eighteen cases reported hospitalization; no deaths have been reported. At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source of infection are ongoing. It is too early to say whether cases of Cyclospora infection in different states are related to each other and/or to the same food item(s).
The number of cases (206) reported in 2017, is higher than the number of cases reported by this date in 2016. As of August 3, 2016, 88 Cyclospora infections had been reported in persons who became infected in the United States and became ill on or after May 1, 2016.
This case of cyclospora may have no relation to the Canadian outbreak; or may.
A 64-year-old French [female] with type 2 diabetes mellitus was referred to our department on [Mon 3 Jul 2017] because she was suffering from protracted diarrhea.
Symptoms began on [Sat 10 Jun 2017] as she was just returning from a touristic trip in Cancun (Quintana Roo State, Mexico) where she stayed from [Mon 29 May to Fri 9 Jun 2017] with her husband.
She acknowledged having moderate watery diarrhea with abdominal discomfort, bloating, transient vomiting, 5 kg weight [approx. 11.02 pounds] loss and fatigue. Empiric therapy with oral Metronidazole 500 mg 3 times a day for 7 days she received previously failed to improve her symptoms. Of note, a 1st microscopic stool examination failed to identify parasites and no enteropathogenic bacteria was found by culture on selective media.
Up to 3 extra stool specimens where sent to the laboratory of clinical parasitology in our hospital.
Oocysts of Cyclospora cayetanensis where evidenced by autofluorescence after Bailenger concentration technique.
Health-types in Canada are investigating locally acquired Cyclospora infections in two provinces. The source of the outbreak has not been identified. Previous outbreaks in Canada and the United States (US) have been linked to imported fresh produce. The investigation is ongoing.
In Canada, a total of 20 cases have been reported in two provinces: British Columbia (5) and Ontario (15). Individuals became sick between May and early June of this year. The majority of cases (60%) are male, with an average age of 53 years. The investigation into the source of the outbreak is ongoing. To date, no multi-jurisdictional outbreaks of Cyclospora have been linked to produce grown in Canada.
The outbreak investigation is active and the public health notice will be updated on a regular basis as the investigation evolves.
People living or travelling in tropical or subtropical regions of the world who eat fresh produce or drink untreated water may be at increased risk for infection because the parasite is found in some of these regions.
The infection can cause watery diarrhea, fatigue, stomach pain
Though uncommon in food and drinking water in Canada and the U.S., the parasite often persists on fruit and vegetables even after they have been washed. Public Health Canada recommends that people cook vegetables and fruit imported from Peru, Cuba, India, Nepal, Mexico, Guatemala, Southeast Asia and Dominican Republic.
Last week, health officials in Texas also reported a major outbreak of the disease, and are continuing an investigation into fresh produce as a possible source. After a series of outbreaks linked to imported produce from Puebla Mexico in 2015, the U.S. Food and Drug Administration banned imports from the region during summer months.
Previous outbreaks of Cyclospora have been linked to pre-packaged salad mix, basil, cilantro, raspberries, blackberries, and snap-peas.
Public Health England are now warning UK tourists to be wary of travelling to Mexico and the Foreign Office have updated their website to include a warning from health authorities about travelling to the region.
Tony Larner of the Mirror reports a British couple’s dream Mexican holiday was left in tatters after they were struck down Cyclospora.
Sandra and Lee Harper splashed out £3,700 on an all-inclusive Thomson break to Riviera Maya resort, near Cancun.
But the couple, from Birmingham, were unable to leave their room for almost a week after falling ill with Cyclospora and needing the toilet up to 30 times every day.
The pair claim they complained about their illness and hygiene issues at their hotel to Thomson, but did not got a reply until after they arrived home, the Birmingham Mail reported.
UK Health officials have issued warnings about visiting the area after almost 100 Brits were struck down with the bug since the outbreak began in June.
A spokesthingy for Thomson said: “Public Health England has advised us of a number of sickness cases associated to an issue called Cyclospora in the Riviera Maya region of Mexico.”
An issue called Cyclospora?
“Hanging on in quiet desperation is the English way.”
Eleven people in Wisconsin and three in Minnesota have reported becoming ill after eating vegetables from the trays that contained broccoli, cauliflower, carrots and dill dip, according to the Wisconsin Department of Health Services.
