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

304 sick from Cyclospora in US, some linked to fresh cilantro from Puebla, Mexico

The U.S. Centers for Disease Control and federal, state, and local public health partners are continuing surveillance to identify and interview additional ill persons and to identify sources of infection.

  • cilantro.slugs.powell.10Cyclospora cayetanensis is a single-celled parasite that causes an intestinal infection called cyclosporiasis.
  • As of August 26, 2014 (5pm EDT), CDC had been notified of 304 ill persons with confirmed Cyclospora infection in 2014; of these, 207 ill persons from the following states had no history of international travel within two weeks before onset of illness: Arkansas, California, Connecticut, Florida, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nebraska, Pennsylvania, New Jersey, New York (and New York City), Texas, Virginia, Wisconsin, and Washington.

◦       Most (133; 64%) of the cases were reported from Texas.

◦       Most (133; 64%) of the cases were reported in July 2014.

◦       Most (176; 85%) of the illness onset dates occurred in June and July.

◦       Among 183 persons with available information, 7 (4%) have reported being hospitalized. No deaths have been reported.

◦       Among 204 persons with available information, ill persons range in age from 3 to 88 years, with a median age of 49 years.

◦       Among 204 persons with available information, 115 (56%) of ill persons are female.

  • To date, 133 ill persons with Cyclospora infection have been reported among Texas residents who did not travel outside of the country within the two weeks before becoming ill. 

◦       Epidemiologic and traceback investigations conducted in Texas by state and local public health and regulatory officials and the FDA indicated that some illnesses among Texas residents were linked to fresh cilantro from Puebla, Mexico.

◦       Reported cases of cyclosporiasis in Texas have returned to baseline levels in August; therefore, it is likely that the outbreak has ended.

  • Investigations are ongoing in other states.

◦       To date, there is no evidence to suggest that any illnesses outside of Texas are linked to cilantro from Puebla, Mexico.

  • Consumers should continue to enjoy the health benefits of eating fresh fruits and vegetables as part of a well-balanced diet.
  • Consumers and retailers should always follow safe produce handling recommendations.

Cyclospora redux: Cilantro linked to 21 illnesses in Texas

We eat a lot of cilantro in my house; whether in fresh salsa, guacamole or as an ingredient in tacos it’s a favorite.

I’m rethinking my love of the herb as it’s entering the raw sprouts realm.

After notable recalls in 2009, 2011 and a 2013 Cyclospora outbreak where the U.S. Food and Drug Administration and Centers for Disease Control and Prevention concluded that fresh cilantro grown in Puebla, Mexico was the source, cilantro is at it again.cilantro.slugs_.powell.10-300x225

According to NBCDFW a current outbreak of Cyclospora has been linked yet again to the fresh herb.

The Texas Department of State Health Services said Thursday the its investigation has linked the cases in four restaurants clusters to fresh cilantro from Puebla, Mexico.

Texas DSHS says a total of 21 people got sick and all of them reported eating food containing cilantro within two weeks of becoming ill.

The FDA and DSHS traced the cilantro from all four restaurants to Puebla, Mexico. While investigators could not find cilantro contaminated with cyclospora they say there’s a strong enough “epidemiological link” between the illnesses and the cilantro to draw the conclusion.

In October 2013, the Centers for Disease Control and Prevention also linked a cyclospora outbreak to cilantro from Puebla, Mexico.

The Texas DSHS reported a total of 166 confirmed cyclospora cases in the state, but only 126 cases were considered part of the outbreak.

Dallas County reported the majority of this year’s cases with 38, 19 cases were confirmed in Tarrant County and 12 in Collin County.


Why I don’t eat fresh cilantro and parsley: prevalence and diversity of enterotoxigenic Escherichia coli strains in fresh produce

Analysis of fresh produce showed that enterotoxigenic Escherichia coli (ETEC) strains are most often found in cilantro and parsley, with prevalence rates of approximately 0.3%. Some ETEC strains also carried Shiga cilantro.slugs.powell.10toxigenic E. coli (STEC) genes but had no STEC adherence factors, which are essential to cause severe human illness. Most ETEC strains in produce carried stable toxin and/or labile toxin genes but belonged to unremarkable serotypes that have not been reported to have caused human illnesses.

Journal of Food Protection®, Number 5, May 2014, pp. 696-863 , pp. 820-823(4)

Feng, Peter C. H.; Reddy, Shanker P.

643 sick in separate cyclospora outbreaks

In 2005, my aunt was part of a cyclospora outbreak linked to fresh basil that struck at least 300 in Florida.

Cyclospora is miserable, until a correct diagnosis comes along and cilantro.slugs.powell.10appropriate anti-parasitics prescribed.

But cyclospora outbreaks keep popping up, year after year.

The U.S. Food and Drug Administration and Centers for Disease Control and Prevention have concluded the 2013 outbreaks were at least two different sources: fresh cilantro grown in Puebla, Mexico, felled some of those in Texas, while salad mix supplied by Taylor Farms de Mexico, S. de R.L. de C.V.,   to Olive Garden and Red Lobster restaurants, both owned by Darden Restaurants, was linked to those sick in Iowa and Nebraska.

As of September 20, 2013, CDC has been notified of 643 cases of Cyclospora infection from 25 states:  Arkansas,  California, Connecticut, Florida, Georgia, Illinois, Iowa , Kansas, Louisiana, Masssachusetts, Michigan, Minnesota, Missouri, Nebraska , New Hampshire, New Jersey, New York (including New York City), Ohio, Pennsylvania, South Dakota, Tennessee, Texas , Virginia, Wisconsin , and Wyoming. 

Cilantro recalled because of Salmonella risk

In the long-running series of fresh herbs as vectors for dangerous microorganisms, Fresco Green Farms Inc. of Winchester, Calif. is recalling 1,643 cases of cilantro harvested from July 18th 2012 to July 27th 2012, because it has the potential to be contaminated with Salmonella.

The cilantro was on store shelves in California and Minnesota beginning July 19, 2012 and likely sold or removed from sale before August 6, 2012. There have been no illnesses reported. The cilantro is bunched and tied together with a brown rubber band. Each bunch has the following dimensions; 10 inches of length and 1 ¼ width. The individual bunches have no identifying labels or lot numbers. They were distributed in shipping cases labeled “Fresco Green Farms Inc., Hemet, CA. Produce of USA cilantro 2.5dz “ Consumers who may have purchased the cilantro should contact the store where hey purchased it to determine whether the cilantro was included in the recall.

The recall was as the result of a routine sampling program by the USDA, which revealed that the cilantro harvested from July 18th to July 27th has the potential to be contaminated with Salmonella.

Grow harvest sort pack or ship fresh cilantro? FDA has some guidance

Sorenne and I continued with our gardening this morning, concluding that it was finally warm enough to plant some cold tolerant crops down in the main garden. We also noticed that several of our herbs are emerging from seed.

I find rosemary the most versatile for cooking, but basil and cilantro have their roles. Unfortunately, basil and cilantro are particularly prone to bacterial contamination, even in home gardens (Sorenne, the snails are back).

Recognizing the number of recalls and outbreaks, the U.S. Food and Drug Administration issued guidance on March 31, 2011 for those who grow, harvest, sort, pack or ship fresh cilantro.

Some highlights are below. The complete document is available at:

FDA is concerned about positive sample findings for human pathogens in fresh cilantro and recommends that this produce industry segment take action to enhance the safety of these products.

Since 2004, FDA has confirmed the presence of Salmonella species in 28 samples of fresh cilantro that was in, or entering into, commerce. The samples of fresh cilantro were of both U.S. and non-U.S. origin.

Fresh cilantro is commonly consumed in its raw state without processing or cooking to adequately reduce human pathogens. The manner in which it is grown, harvested, sorted, packed, and shipped is crucial to ensure that the potential for microbial contamination is minimized, thereby reducing the potential risk of illness to consumers.

In 1998, FDA issued a “Guide to Minimize Microbial Food Safety Hazards for Fruits and Vegetables,” (Ref. 3; the GAPs Guide). The GAPs Guide recommends good agricultural practices (GAPs) and good manufacturing practices (GMPs) that growers, harvesters, sorters, packers, and shippers can use to address risk factors common to the growing, harvesting, washing, sorting, packing, and transporting of fresh fruits and vegetables and thereby minimize food safety hazards potentially associated with fresh produce.

“… in view of continued positive findings for Salmonella spp. in fresh cilantro, FDA recommends that firms in the fresh cilantro industry review their current operations in the context of the GAPs Guide, as well as other available information regarding adequately reducing pathogens in or on fresh produce. We further encourage these firms to assess hazards unique to the production of cilantro and to develop commodity-specific preventive control strategies that would identify potential hazards that may be specific to fresh cilantro. Since the available information concerning some of the recent positive findings for Salmonella spp. does not definitively identify the point of origin of the contamination, we recommend that firms take these steps for all points from the farm through distribution.

1. FDA. 2010. Compliance Policy Guide Sec. 527.300, Dairy Products – Microbial Contaminants and Alkaline Phosphatase Activity.1
2. FDA. 1995. Compliance Policy Guide Sec 555.300, Foods, Except Dairy Products – Adulteration with Salmonella (CPG 7120.20)2.
3. FDA. 1998. Guide to Minimize Microbial Food Safety Hazards for Fruits and Vegetables.3
4. Institute of Food Technologists. 2001. Analysis and Evaluation of Preventive Control Measures for the Control and Reduction/Elimination of Microbial Hazards on Fresh and Fresh-Cut Produce4.
5. FDA. 2004. Letter to Firms that Grow, Pack, or Ship Fresh Lettuce and Fresh Tomatoes.5
6. FDA. 2005. Letter to California Firms that Grow, Pack, Process, or Ship Fresh and Fresh-cut Lettuce.6
7. FDA. 2009. Letter to Seed Suppliers, Distributors, and Sprouters.7
8. International Fresh-Cut Produce Association, Produce Marketing Association, United Fresh Fruit and Vegetable Association, Western Growers. Commodity Specific Food Safety Guidelines for the Lettuce and Leafy Greens Supply Chain – 1st Edition.8
9. Commodity specific Food Safety Guidelines for the Production, Harvest, Post-Harvest, and Valued-Added Unit Operations of Green Onions9
10. FDA. 2009. Guidance for Industry: Guide to Minimize Microbial Food Safety Hazards of Melons; Draft Guidance.10
11. FDA. 2009. Guidance for Industry: Guide to Minimize Microbial Food Safety Hazards of Tomatoes; Draft Guidance.11
12. FDA. 2009. Guidance for Industry: Guide to Minimize Microbial Food Safety Hazards of Leafy Greens; Draft Guidance.12

Beware the herb; cilantro with salmonella

Several fresh herbs are repeat offenders on the showing up contaminated list, this time cilantro.

Offcials with the California Department of Public Health said Friday certain fresh cilantro sold in grocery stores may be contaminated with salmonella.

No illnesses have been reported, but the cilantro is being recalled as a precaution.

The recalled cilantro was distributed by Tanimura & Antle of Salinas. It was sold in bunches containing a white twist-tie printed with blue lettering starting Jan. 14. The twist-ties contain the words “Produce of USA, Cilantro #4889” and have a blue Tanimura & Antle logo next to the UPC code 33383 80104.

Fresh herbs linked to Salmonella

AP is reporting the second Texas based Salmonella-linked cilantro recall in a week. Fresh herbs are on the FDA produce hit list along with tomatoes, leafy greens, cantaloupe and sprouts. FDA provides technical assistance to these industries to complete commodity-specific guidance documents. David Acheson, ex-food safety Czar said in May that fresh herbs were next on the list.

Frontera Produce of Edinburg, Texas, is recalling one lot of cilantro. No illness has been reported. The recalled cilantro was available at select store chains in Texas, Oklahoma, Colorado, Louisiana and New Mexico between July 20 and July 27. Details: by phone at 877-381-5701.

Snails, cilantro and Salmonella

Look kids, the snails are back.

And with the rain in Kansas this year, they haven’t really left.

Amy took this picture of our cilantro yesterday afternoon in between thunderstorms. And snails can carry any number of diseases and pathogens.

That’s probably not what’s going on with the cilantro distributed by Sweet Superior Fruit LTD of McAllen, Texas, that was recalled on the weekend after U.S. Food and Drug Administration testing found Salmonella in cilantro sold from July 13 to 16 in 15-pound black plastic crates.

Initially announced Saturday night, company types weren’t answering the phone on Monday.

The Monitor reports that while the source of the cilantro has not been disclosed, the produce was most likely grown in Mexico. A sign above the company‘s facility advertises Mexican-grown products.

Just where the 104 15-pound crates of cilantro ended up remains unclear. The U.S. Food and Drug Administration said Monday that it could not provide a list of what restaurants or retailers might have bought the leafy green because most of the purchases at Sweet Superior Fruit LTD. were made with cash. It also did not say how much of the produce had been sold.