A heavenly match: Cilantro and cyclospora

According to Food Safety Magazine, since 2014, the U.S. Food and Drug Administration (FDA) has been trying a new approach to produce sampling to assess microbial contamination in food commodities. The approach involves collecting a statistically-valid number of samples of targeted foods over a 12-18 month period, then identifying common microbial factors among them.

For fiscal year 2018, FDA had already been sampling fresh herbs, specifically basil, parsley, and cilantro, along with processed avocado and guacamole–all from both domestic and imported sources. The fresh herbs were chosen for sampling because they are eaten without having gone through any type of kill step (ie. cooking) to reduce or eliminate pathogens. Also, these items are grown low to the ground, which makes them susceptible to contamination. Initially, the sampling was to measure the prevalence of Salmonella and Shiga toxin-producing E. coli (STEC) in these herbs.

Recently, FDA added a new test to this sampling group: Cyclospora cayetanensis. The agency has a new analytical testing method for this parasite.

And my kid is really into this song; also no explanation.

Bugs be passed around on leafy greens

Several outbreaks of foodborne illness traced to leafy greens and culinary herbs have been hypothesized to involve cross-contamination during washing and processing. This study aimed to assess the redistribution of Salmonella Typhimurium LT2 during pilot-scale production of baby spinach and cilantro and redistribution of Escherichia coli O157:H7 during pilot-scale production of romaine lettuce.

Four inoculated surrogate: uninoculated product weight ratios (10:100, 5:100, 1:100, and 0.5:100) and three inoculation levels (103, 101, and 10−1 CFU/g) were used for the three commodities. For each of three trials per condition, 5-kg batches containing uninoculated product and spot-inoculated surrogate products at each ratio and inoculation level were washed for 90 s in a 3.6-m-long flume tank through which 890 L of sanitizer-free, filtered tap water was circulated. After washing and removing the inoculated surrogate products, washed product (∼23, 225-g samples per trial) was analyzed for presence or absence of Salmonella Typhimurium or E. coli O157:H7 by using the GeneQuence Assay.

For baby spinach, cilantro, and romaine lettuce, no significant differences (P > 0.05) in the percentage of positive samples were observed at the same inoculation level and inoculated: uninoculated weight ratio. For each pathogen product evaluated (triplicate trials), inoculation level had a significant impact on the percentage of positive samples after processing, with the percentage of positive samples decreasing, as the initial surrogate inoculation level decreased.

The weight ratio of contaminated: noncontaminated product plays an important role: positive samples ranged from 0% to 11.6% ± 2.05% and from 68.1% ± 33.6% to 100% among the four ratios at inoculation of 10−1 and 101 CFU/g, respectively.

To our knowledge, this study is the first to assess the redistribution of low levels of pathogens from incoming product to leafy greens during processing and should provide important data for microbial risk assessments and other types of food safety analyses related to fresh-cut leafy greens.

Transfer and redistribution of Salmonella typhimurium LT2 and Escherichia coli O157:H7 during pilot-scale processing of baby spinach, cilantro, and romaine lettuce

Journal of food Protection vol.81 no. 6 June 2018

HALEY S. SMOLINSKI,1 SIYI WANG,1 LIN REN,1 YUHUAN CHEN,2 BARBARA KOWALCYK,3 ELLEN THOMAS,3 JANE VAN DOREN,2 and ELLIOT T. RYSER1*

https://doi.org/10.4315/0362-028X.JFP-17-420

http://jfoodprotection.org/doi/abs/10.4315/0362-028X.JFP-17-420

Cyclospora in cilantro: Again and again and again

Thomas Burke, a Kansas boy pursuing his Masters in Public Health at Emory University, with an emphasis in epidemiology, writes that Cyclospora-laden cilantro from the State of Puebla in Mexico had already sickened large parts of the U.S. in the summers of 2013 and 2014. Unfortunately, the summer of 2015 repeated the same pattern: a large, multi-state outbreak dispersed across the nation.

cilantro.slugs.powell.10The Georgia Food and Feed Rapid Response Team (GaRRT) activated in July 2015 to counter this threat to food safety. In any outbreak investigation, three of the most important pieces of evidence are place, time and the means of exposure to the suspected pathogen (the disease-causing bug). During this investigation, GaRRT members worked together through a combination of surveillance, fact-finding detective work, interstate communications and international collaboration in both public health interventions and policy changes.

Like many detective stories, the Cyclospora outbreak began with a phone call; complaints of gastrointestinal distress reached the Georgia Department of Public Health (DPH). As with any positive Cyclospora case, these complaints were reported due to Cyclospora being a reportable pathogen, or one of “the usual suspects” for severe or rare outbreaks. Cyclospora has the distinction of being the only parasite on Georgia’s list.

Epidemiologists at DPH noted the uptick in Cyclospora cases, which were clusters confined to particular localities across the state. From the epidemiologic evidence, DPH determined the connection — certain restaurants were the common denominator to those found ill with Cyclospora. It became clear at this point that the investigation would span other agencies, because of the many possible leads and evidence involved.

Though DPH is traditionally the lead agency to investigate restaurant outbreaks, the Georgia Department of Agriculture (GDA) routinely works in conjunction by tracing ingredients used in restaurants. Among GDA’s responsibilities are inspecting retail and wholesale food establishments as well as food manufacturers. Since fieldwork members represent both GDA and DPH on the GaRRT, it was easy to bring together the 2 agencies during this investigation, to share the work and combine resources.

Because of the previous 2 outbreaks of Cyclospora, the Centers for Disease Control and Prevention (CDC) asked regulatory agencies across the country to pay particular attention to the origin and distribution of cilantro in the investigation. In 2013 and 2014, cilantro from the State of Puebla, Mexico had been implicated in multi-state outbreaks of Cyclospora, making cilantro the chief suspect in the investigation.

Once the details began to crystalize, the GaRRT officially activated to coordinate federal, state and local entities pertaining to the outbreak. As the epidemiologic evidence from Georgia and Texas (among other states) was assembled, the chase to trace the cilantro started. DPH interviews with restaurant owners and staff directed investigators towards the restaurants’ wholesale suppliers who purchase, store and ship ingredients to restaurants and other food establishments. These interviews led the investigation team down the trucking route to Texas.

Teaming up with officials at the Texas Rapid Response Team, the GaRRT ascertained ports of entry for the cilantro under investigation: Hidalgo and McAllen, Texas. Thanks to this discovery, the team found the cilantro originated from the State of Puebla in Mexico, the same state that produced cilantro contaminated by Cyclospora in the summers of 2013 and 2014.

Because of continuing problems with this region, Mexican and U.S. Food & Drug Administration (FDA) authorities collaborated to address the conditions that allowed for another Cyclospora outbreak. Enhancing fresh cilantro safety was the priority during and after the outbreak. The safety mechanisms incorporated a system for risk reduction — including export controls — for cilantro from the State of Puebla.

Correspondingly, on July 27, 2015, the FDA (a member organization of the GaRRT) implemented a supportive framework of import controls to detain without physical examination shipments of fresh cilantro from Puebla from April through August, 2015. This control framework will continue to be implemented for the same time period in future years.

Shipments of fresh cilantro from other states in Mexico were cleared for importation into the U.S. during this timeframe last summer, but only if documentation demonstrated the cilantro was harvested outside of Puebla. Additionally, the FDA and Mexican public health agencies worked collaboratively to prepare a “Green List” of companies not implicated in the outbreak that are known and documented to be safe in Puebla, whose shipments of fresh cilantro were not detained.

When the outbreak concluded, Cyclospora illnesses attributed to cilantro affected 546 persons in 31 states. Georgia had the third highest case count with 26 documented illnesses. Through the GaRRT, our state also had the distinction of identifying clusters and investigating leads that ultimately helped solve questions presented by the outbreak. 

Imports. Domestic. Plenty of food safety issues are home-grown: Salmonella at the market

Salmonella continues to rank as one of the most costly foodborne pathogens, and more illnesses are now associated with the consumption of fresh produce.

cilantro.slugs.powell.10 U.S. Department of Agriculture Microbiological Data Program (MDP) sampled select commodities of fresh fruit and vegetables and tested them for Salmonella, pathogenic Escherichia coli, and Listeria. The Salmonella strains isolated were further characterized by serotype, antimicrobial resistance, and pulsed-field gel electrophoresis profile. This article summarizes the Salmonella data collected by the MDP between 2002 and 2012.

The results show that the rates of Salmonella prevalence ranged from absent to 0.34% in cilantro. A total of 152 isolates consisting of over 50 different serotypes were isolated from the various produce types, and the top five were Salmonella enterica serotype Cubana, S. enterica subspecies arizonae (subsp. IIIa) and diarizonae (subsp. IIIb), and S. enterica serotypes Newport, Javiana, and Infantis. Among these, Salmonella serotypes Newport and Javiana are also listed among the top five Salmonella serotypes that caused most foodborne outbreaks. Other serotypes that are frequent causes of infection, such as S. enterica serotypes Typhimurium and Enteritidis, were also found in fresh produce but were not prevalent. About 25% of the MDP samples were imported produce, including 65% of green onions, 44% of tomatoes, 42% of hot peppers, and 41% of cantaloupes. However, imported produce did not show higher numbers of Salmonella-positive samples, and in some products, like cilantro, all of the Salmonella isolates were from domestic samples. About 6.5% of the Salmonella isolates were resistant to the antimicrobial compounds tested, but no single commodity or serotype was found to be the most common carrier of resistant strains or of resistance.

The pulsed-field gel electrophoresis profiles of the produce isolates showed similarities with Salmonella isolates from meat samples and from outbreaks, but there were also profile diversities among the strains within some serotypes, like Salmonella Newport.

 

Prevalence and characteristics of Salmonella serotypes isolated from fresh produce marketed in the United States

Journal of Food Protection, January 2016, No.1, pp. 4-178, pp. 6-16(11)

DOI: http://dx.doi.org/10.4315/0362-028X.JFP-15-274

Shanker P. Reddy, Hua Wang, Jennifer K. Adams, Peter C. H. Feng

http://www.ingentaconnect.com/content/iafp/jfp/2016/00000079/00000001/art00002

587 sick: CDC and FDA try to contain cyclosporiasis outbreak

As the numbers of those sickened with cyclosporiasis reached 495 in the U.S. and 92 in Canada, the only lead appears to be cilantro imported from Mexico.

cilantroCyclospora is a microscopic single-celled parasite that is passed in people’s feces. If it comes in contact with food or water, it can infect the people who consume it. This causes an intestinal illness called cyclosporiasis.

Previous foodborne illness outbreaks of Cyclospora, in Canada and U.S. have been linked to various types of imported fresh produce, such as pre-packaged salad mix, basil, cilantro, berries, mesclun lettuce and snow peas.

To date, no multi-jurisdictional outbreaks have been linked to produce grown in Canada.

Cyclospora will do that: Cilantro shortage hits Illinois restaurants, grocery stores

In the produce aisle at a Round Lake Beach grocery store, Valerie Brown hesitated before plucking a bunch of cilantro from between the parsley and green onions.

cilantro.slugs.powell.10She’s used to paying 75 cents for a bundle of the leafy green herb, she said. Today, the price read $1.99.

Even that was better than last week, said Brown, who lives in Antioch. Her husband visited three grocery stores and couldn’t find a single sprig. Cilantro is her parakeets’ favorite food, so she put a bundle in her cart despite the sticker shock.

Grocery stores and restaurants in the area said they’ve been noticing the same higher-than-usual prices and tighter-than-usual supply since officials implemented a partial import ban on some cilantro imported from Mexico.

The Centers for Disease Control and Prevention, Food and Drug Administration and state public health officials linked cilantro from the state of Puebla, Mexico to outbreaks of cyclosporiasis in the U.S. in 2013 and 2014 and identified it as the possible cause of a 2015 outbreak, according to an import alert the FDA posted in July. About 40 percent of cilantro sold in the U.S. is grown in Puebla, said FDA spokeswoman Lauren Sucher.

476 sick with cyclosporiasis in US, 87 in Canada

As of August 17, 2015 (3pm EDT), a total of 476 ill persons with confirmed Cyclospora infection were reported to CDC in 2015. Most of these persons—282 (59%) of 476—experienced onset of illness on or after May 1, 2015, and did not have a history of international travel within 2 weeks before illness onset.

 cilantro.slugs.powell.10These 282 persons were from the following 22 states: Arkansas (2), California (2), Connecticut (3), Florida (10), Georgia (23), Illinois (7), Iowa (1), Kansas (2), Maryland (1), Massachusetts (9), Michigan (2), Missouri (1), Montana (3), Nebraska (1), New Jersey (6), New Mexico (2), New York (excluding NYC) (8), New York City (21), Texas (162), Utah (1), Virginia (3), Washington (2), and Wisconsin (10).

Clusters of illness linked to restaurants or events have been identified in Texas, Wisconsin, and Georgia. Cluster investigations are ongoing in Texas and Georgia. Cluster investigations in Wisconsin and Texas have preliminarily identified cilantro as a suspect vehicle. Investigations are ongoing to identify specific food item(s) linked to the cases that are not part of the identified clusters.

87 cases have been reported in Canada.

Probably cilantro: Cyclosporiasis outbreak hits 358

The stories we could – and will — tell about implementing on-farm food safety programs for the past 15 years.

cilantro.slugs_.powell.10-300x225Don’t have a shit around fresh produce; don’t make the worker incentives such that they crap in the fields because they lose money if they go to the bathroom; provide decent handwashing facilities, and stop with nonsensical soundbites.

As of July 30, 2015 (11am EDT), the U.S. Centers for Disease Control and Prevention had been notified of 358 ill persons with confirmed Cyclospora infection from 26 states in 2015.

Most (199; 56%) ill persons experienced onset of illness on or after May 1, 2015 and did not report international travel prior to symptom onset.

Clusters of illness linked to restaurants or events have been identified in Texas, Wisconsin, and Georgia.

Cluster investigations are ongoing in Texas and Georgia.

Cluster investigations in Wisconsin and Texas have preliminarily identified cilantro as a suspect vehicle.

Investigations are ongoing to identify specific food item(s) linked to the cases that are not part of the identified clusters.

Previous U.S. outbreaks of cyclosporiasis have been linked to imported fresh produce, including cilantro from the Puebla region of Mexico. Read the related FDA Import Alert issued July 27, 2015.

The U.S. Food and Drug Administration, the Centers for Disease Control and Prevention (CDC) and state public health officials have identified annually recurring outbreaks (in 2012, 2013, and 2014) of cyclosporiasis in the United States which have been associated with fresh cilantro from the state of Puebla, Mexico. There is currently (in July 2015) another ongoing outbreak of cyclosporiasis in the United States in which both the Texas Department of State Health Services and the Wisconsin Department of Health Services and the Wisconsin Department of Agriculture, Trade and Consumer Protection have identified cilantro from the Mexican state of Puebla as a suspect vehicle with respect to separate illness clusters.

From 2013 to 2015, FDA, SENASICA, and COFEPRIS inspected 11 farms and packing houses that produce cilantro in the state of Puebla, 5 of them linked to the US C. cayetanensis illnesses, and observed objectionable conditions at 8 of them, including all five of the firms linked through traceback to the U.S. illnesses.

Conditions observed at multiple such firms in the state of Puebla included human feces and toilet paper found in growing fields and around facilities; inadequately maintained and supplied toilet and hand washing facilities (no soap, no toilet paper, no running water, no paper towels) or a complete lack of toilet and hand washing facilities; food-contact surfaces (such as plastic crates used to transport cilantro or tables where cilantro was cut and bundled) visibly dirty and not washed; and water used for purposes such as washing cilantro vulnerable to contamination from sewage/septic systems. In addition, at one such firm, water in a holding tank used to provide water to employees to wash their hands at the bathrooms was found to be positive for C. cayetanensis.

Based on those joint investigations, FDA considers that the most likely routes of contamination of fresh cilantro are contact with the parasite shed from the intestinal tract of humans affecting the growing fields, harvesting, processing or packing activities or contamination with the parasite through contaminated irrigation water, contaminated crop protectant sprays, or contaminated wash waters.

 

Cyclospora: Mexican cilantro contamination spurs partial U.S. import ban

I try to grow my own cilantro, but the birds and cats and skinks find it yummy.

So there’s not much left.

cilantro.slugs.powell.10And this is why I’m not a farmer.

As the Cyclospora count in Texas reached 203, some Mexican cilantro is being banned in the U.S. after health officials found human feces and toilet paper in growing fields from which herbs have been linked to hundreds of intestinal illnesses among Americans dating back to 2012.d

The Food and Drug Administration will detain Mexican cilantro at the border from April to August and won’t allow products from the state of Puebla, Mexico, into the U.S. without inspections and certification, according to an import ban dated Monday by the agency. Cilantro from other parts of Mexico will need documentation to prove the product isn’t from Puebla, about a two-hour drive southeast of Mexico City.

The cilantro is linked to outbreaks of cyclosporiasis, according to the alert. Last year, at

Since 2013, the FDA and Mexican authorities have inspected 11 farms and packing houses that produce cilantro from Puebla. At eight, health officials found bathrooms without soap, toilet paper or running water, in addition to the human feces and toilet paper in growing fields. Some had a complete lack of toilet facilities.

“Based on those joint investigations, FDA considers that the most likely routes of contamination of fresh cilantro are contact with the parasite shed from the intestinal tract of humans affecting the growing fields, harvesting, processing or packing activities or contamination with the parasite through contaminated irrigation water, contaminated crop protectant sprays, or contaminated wash waters,” the alert said.

A 2013 cyclosporiasis outbreak in 25 states was linked to Puebla cilantro as well as salad mix from Taylor Farms de Mexico that was sold to Olive Garden and Red Lobster, both then owned by Darden Restaurants Inc. The FDA and Mexican officials found conditions at Taylor Farms de Mexico in Guanajuato met food safety protocols, the FDA said.

Probably cilantro that sickened hundreds with cylospora in 2013; better detection needed

The 2013 multistate outbreaks contributed to the largest annual number of reported US cases of cyclosporiasis since 1997. In this paper we focus on investigations in Texas.

cilantroWe defined an outbreak-associated case as laboratory-confirmed cyclosporiasis in a person with illness onset between 1 June and 31 August 2013, with no history of international travel in the previous 14 days. Epidemiological, environmental, and traceback investigations were conducted.

Of the 631 cases reported in the multistate outbreaks, Texas reported the greatest number of cases, 270 (43%). More than 70 clusters were identified in Texas, four of which were further investigated. One restaurant-associated cluster of 25 case-patients was selected for a case-control study. Consumption of cilantro was most strongly associated with illness on meal date-matched analysis (matched odds ratio 19·8, 95% confidence interval 4·0–∞). All case-patients in the other three clusters investigated also ate cilantro. Traceback investigations converged on three suppliers in Puebla, Mexico.

Cilantro was the vehicle of infection in the four clusters investigated; the temporal association of these clusters with the large overall increase in cyclosporiasis cases in Texas suggests cilantro was the vehicle of infection for many other cases. However, the paucity of epidemiological and traceback information does not allow for a conclusive determination; moreover, molecular epidemiological tools for cyclosporiasis that could provide more definitive linkage between case clusters are needed.

2013 multistate outbreaks of Cyclospora cayetanensis infections associated with fresh produce: focus on the Texas investigations

Epidemiology and Infection [ahead of print]

Abanyie, R. R. Harvey, J. R. Harris, R. E. Weigand, L. Gual, M., Desvignes-Kendrick, K. Irvin, I Williams, R. L. Hall, B. Herwaldt, E. E. Gray, Y. Qvarnstrom, M. E. Wise, V. Cantu, P. T. Cantey, S. Bosch, A. J. Da Silva, A. Fields, H. Bishop, A. Wellman, J. Beal, N. Wilson, A. E. Fiore, R. Tauxe, S. Lance, L. Slutsker and M. Parise

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9644741&fileId=S0950268815000370