Cyclospora contaminated food in the US, health alert issued

Cyclospora is one of those pathogens spread through poop and water/food tends to be the most favorable vehicle of transmission.

The Federal Safety and Inspection Service has issued a health alert over certain meat products over concern for Cyclospora.
The agency is telling people to be extra cautious with beef pork and poultry salad and wrap products out of Caito Foods LLC, in Indianapolis, Indiana.
The items with “best by” or “sell by” dates ranging from July 18th to July 23rd are under the alert. 
The problem within Caito Foods is related to the lettuce supplier, Fresh Express. The chopped romaine is being recalled.
Cyclospora infection, defined by the Centers for Disease Control, is an intestinal illness caused by a parasite. The infection can cause Cyclosporiasis.
The symptoms of Cyclosporiasis include loss of appetite, weight loss, cramping, bloating, nausea, fatigue, and other flu-like symptoms.

61 sick in 7 states from Cyclospora in new outbreak linked to McDonald’s; 3000 locations removing salads

At least 61 people in seven Midwestern States have been sickened with Cyclospora possibly linked to salads served at McDonald’s restaurants.

The U.S. Food and Drug Administration and the Centers for Disease Control and Prevention (CDC) report that two people have been hospitalized and to date, no deaths have been reported.

Ashley Nickle of The Packer reports that health authorities in Illinois and Iowa have reported 105 recent cases of cyclosporiasis and have linked some of them to McDonald’s salads.

“Out of an abundance of caution, we decided to voluntarily stop selling salads at impacted restaurants until we can switch to another lettuce blend supplier,” McDonald’s said in a statement. “We are in the process of removing existing salad blends from identified restaurants and distribution centers, which includes approximately 3,000 of our U.S. restaurants, primarily located in the Midwest.”

McDonald’s spokeswoman Terri Hickey said, “McDonald’s is committed to the highest standards of food safety and quality control. We are closely monitoring this situation and cooperating with state and federal public health authorities as they further investigate”

In June, federal agencies investigated cyclosporiasis cases that were linked to Del Monte vegetable trays. More than 225 illnesses have been reported in that outbreak. At this time, no link has been made by health authorities between the outbreak linked to McDonald’s salads and the outbreak linked to Del Monte vegetable trays, which included broccoli, cauliflower, carrots and dip.

212 sick: Multistate outbreak of cyclosporiasis linked to Del Monte Fresh produce vegetable tray

The U.S. Centers for Disease Control and Prevention (CDC) reports that Cyclospora cayetanensis is a single-celled parasite that causes an intestinal infection called cyclosporiasis.

As of July 5, 2018 (9am EDT), CDC has been notified of 212 laboratory-confirmed cases of cyclosporiasis in persons who reportedly consumed pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip. The reports have come from four states.

Seven (7) of these people have been hospitalized, and no deaths have been reported.

Epidemiologic evidence indicates that pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip are the likely source of these infections.

Most ill people reported eating pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip.

Most ill people reported buying pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip in the Midwest. Most people reported buying the trays at Kwik Trip convenience stores.

The investigation is ongoing. CDC will provide updates when more information is available.

General advice for consumers about prevention of cyclosporiasis can be found here.

On June 15, 2018, Del Monte Fresh Produce recalled 6 oz., 12 oz., and 28 oz. vegetable trays containing fresh broccoli, cauliflower, celery sticks, carrots, and dill dip. Recalled products were sold in clear, plastic clamshell containers.

Recalled products were distributed to the following stores: Kwik Trip, Kwik Star, Demond’s, Sentry, Potash, Meehan’s, Country Market, FoodMax Supermarket, and Peapod.

Salmonella in pesto triggers Irish recall

Brisbane has fabulous produce and seafood, befitting a costal sub-tropical town.

Sure, it’s way too hot for three months in the summer, but the weather is ideal the rest of the year.

A friend of mine – a food safety professional — was telling me yesterday about this snapper he got, straight of the trawler, and the pesto sauce he made to go with it.

I really try not to be Debbie/Dougie downer when people tell me their proud achievements, so I didn’t go into all the outbreaks on pesto from uncooked basil.

Usually it’s cyclospora, but the Food Safety Authority of Ireland has issued a public notification that Dunnes Stores and Spar are initiating a recall of their own brand pestos, due to the possible presence of Salmonella. Consumers who have bought the implicated batches should dispose of the product or return it to the place of purchase.

185 sick: Cyclosporiasis in Del Monte veggie trays

As of June 28, 2018 (11am EDT), the U.S Centers for Disease Control (CDC) has been notified of 185 laboratory-confirmed cases of cyclosporiasis in persons who reportedly consumed pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip. The reports have come from four states.

Seven (7) of these people have been hospitalized, and no deaths have been reported.

  • Epidemiologic evidenceindicates that pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip are the likely source of these infections.
    • Most ill people reported eating pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip.
    • Most ill people reported buying pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip in the Midwest. Most people reported buying the trays at Kwik Trip convenience stores.
    • The investigation is ongoing. CDC will provide updates when more information is available.

The median illness onset date among patients is May 31, 2018 (range: May 14 to June 9).  Ill people range in age from 13 to 79 years old, with a median age of 47. Fifty-seven percent (57%) are female and 7 people have been hospitalized. No deaths have been reported.

Illnesses that began after May 17, 2018 might not have been reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Cyclospora infections linked to vegetable trays sold at Kwik Trip stores

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.

The produce problem: Ingredient analysis at restaurants in Cyclospora outbreaks

By Sept. 2017, the U.S. Centers for Disease Control reported that almost 1,000 people had laboratory-confirmed cases of cyclosporiasis for the year.

Another banner year for the parasite famously associated with Guatemalan raspberries in 1996.

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

https://www.cdc.gov/mmwr/volumes/67/wr/mm6721a5.htm

1000 sick: As North America turns to Fall, another bumper crop of Cyclospora

CDC reports that as of September 13, 2017 they have been notified of 988 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 40 states.

  • 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.

Cyclospora gets around

As summer grinds on in the Northern Hemisphere, Cyclospora is again spreading: at least 78 in the UK; 57 in Canada (which appear to be locally acquired; and, 712 lab-confirmed cases in the U.S.

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.

Cyclospora: Back to the future

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

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=22854