CDC reports 641 cases of Cyclospora linked to recalled salad mixes nationwide

Since the last case count update on July 9, 2020, the U.S. Centers for Disease Control reported 132 new laboratory-confirmed Cyclospora infections have been reported, including 16 from three new states: Georgia, Pennsylvania, and South Dakota.

As of  July 22, 2020, a total of 641 people with laboratory-confirmed Cyclospora infections associated with this outbreak have been reported from 11 states: Georgia (1), Illinois (198), Iowa (195), Kansas (5), Minnesota (73), Missouri (57) Nebraska (55), North Dakota (6), Pennsylvania (2), South Dakota (13) and Wisconsin (36). The ill person from Georgia purchased and ate a bagged salad product while traveling in Missouri.

Illnesses started on dates ranging from May 11, 2020 to July 5, 2020. Ill people range in age from 10 to 92 years with a median age of 59 and 52% are female. Of 636 people with available information, 37 people (6%) have been hospitalized. No deaths have been reported.

Illnesses might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 4 to 6 weeks. If the number of cases reported by CDC is different from the number reported by state or local health officials, data reported by local jurisdictions should be considered the most up to date. Any differences may be due to the timing of reporting and website updates.

This investigation is ongoing.

The CDC says that it is specifically examining salad ingredients (iceberg lettuce, carrots, red cabbage) for the purposes of its investigation. The affected products include salad mixes made by Fresh Express, Hy-Vee Inc., Little Salad Bar, Signature Farms, Marketside and Hy-Vee. The products were sold at ALDI, Giant Eagle, Hy-Vee, Jewel-Osco, ShopRite, and Walmart locations.

The products were manufactured in Streamwood, Illinois at a Fresh Express production facility.

“Cyclosporiasis is an intestinal infection caused by the Cyclospora parasite,” the CDC says. “A person may become infected after ingesting contaminated food or water. Common symptoms include severe abdominal pain, diarrhea, nausea and vomiting, body aches and fatigue. The infection is treated with antibiotics and most people respond quickly to treatment.”

Specifically, the CDC says the products with a Z178 code or lower and “Best by” date that runs through July 14, 2020 are the ones potentially affected by the contamination.

However, only Georgia, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Pennsylvania, South Dakota and Wisconsin have reported cases of Cyclospora related to eating the salad mix. According to the CDC, the dates of the illness range from May 11, 2020 to July 5, 2020, with 37 people hospitalized as of Friday. Patients are ages 10 to 92 years with a median age of 59 years as of Friday’s data. No related deaths have been reported. People can go 4 to 6 weeks before noticing any symptoms of Cyclospora, the CDC says.

Write down what you ate in the two weeks before you started to get sick.

Report your illness to the health department.

Assist public health investigators by answering questions about your illness.

The CDC issued its recall warnings June 19, and Giant Eagle issued a recall on its Fresh Express products on June 29.

On June 27, 2020, Fresh Express Fresh Express brand and private label brand salad products produced at its Streamwood, IL facility that contain iceberg lettuce, red cabbage, and/or carrots due to possible Cyclospora contamination.

The Public Health Agency of Canada is investigating an outbreak of Cyclospora infections occurring in three Canadian provinces. Exposure to certain Fresh Express brand salad products containing iceberg lettuce, carrots, and red cabbage, has been identified as a likely source of the outbreak.

  • Epidemiologic and traceback evidence indicates that bagged salad mix containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express is a likely source of this outbreak.
  • CDC and FDA continue to investigate to determine which ingredient or ingredients in the salad mix was contaminated and whether other products are a source of illnesses.
  • CDC will provide updates when more information is available.

US Cyclospora infections from salads rise, found in Canada

Chris Koger of The Packer reports that cases of Cyclospora infection linked to Fresh Express salads continue to rise, according to the Centers for Disease Control and Prevention, and Canada is reporting its first cases.

Lab-confirmed cases thought to be linked to iceberg lettucecarrots or red cabbage in garden salads were 509 in the U.S, as of July 9, according to the CDC. The Canadian Food Inspection Agency on July 8 reported 37 cases in Ontario, Quebec and Newfoundland and Labrador.

The salads, including private-label bagged garden salads, were processed at Fresh Express’ Streamwood, Ill., facility, according to the FDA.

Fresh Express has recalled salads from the plant containing the three ingredients under investigation, along with Aldi, Giant Eagle, Hy-Vee, Jewel-Osco, ShopRite and Walmart issuing recalls of private label salads.

The Canadian Food Inspection Agency reported on June 28 Fresh Express had recalled products in Canada. They were distributed nationwide by Crescent Multi-Foods, Federated Co-Operatives Ltd., Fresh Express and Walmart Canada Corp., according to the Canadian Agency.

An edited version of the latest CDC update is below:

On June 27, 2020, Fresh Express recalled Fresh Express brand and private label brand salad products produced at its Streamwood, IL facility that contain iceberg lettuce, red cabbage, and/or carrots due to possible Cyclospora contamination.

509 people with laboratory-confirmed Cyclospora infections and who reported eating bagged salad mix before getting sick have been reported from 8 Midwestern states (Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Wisconsin).

Illnesses started on dates ranging from May 11, 2020 to July 1, 2020.

33 people have been hospitalized. No deaths have been reported.

The Public Health Agency of Canada  is investigating an outbreak of Cyclospora infections occurring in three Canadian provinces. Exposure to certain Fresh Express brand salad products containing iceberg lettuce, carrots and red cabbage, has been identified as a likely source of the outbreak.

Epidemiologic and traceback evidence indicates that bagged salad mix containing iceberg lettuce, carrots, and red cabbage produced by Fresh Express is a likely source of this outbreak.

CDC and FDA continue to investigate to determine which ingredient or ingredients in the salad mix was contaminated and whether other products are a source of illnesses. CDC will provide updates when more information is available.

Since the last case count update on June 26, 2020, 303 new laboratory-confirmed Cyclospora infections have been reported.

As of July 8, 2020, a total of 509 people with laboratory-confirmed Cyclospora infections associated with this outbreak have been reported from 8 states: Illinois (151), Iowa (160), Kansas (5), Minnesota (63), Missouri (46) Nebraska (48), North Dakota (6), and Wisconsin (30).

Illnesses started on dates ranging from May 11, 2020 to July 1, 2020. Ill people range in age from 11 to 92 years with a median age of 60 and 53% are female. Of 506 people with available information, 33 people (7%) have been hospitalized. No deaths have been reported.

Illnesses might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 4 to 6 weeks. If the number of cases reported by CDC is different from the number reported by state or local health officials, data reported by local jurisdictions should be considered the most up to date. Any differences may be due to the timing of reporting and website updates.

Additionally, the Public Health Agency of Canada  is investigating an outbreak of Cyclospora infections occurring in three Canadian provinces where exposure to certain Fresh Express brand salad products containing iceberg lettuce, carrots and red cabbage, has been identified as a likely source of the outbreak.

Organic basil recalled due to Cyclospora risk

I keep telling people that certain fresh herbs – like basil – are a ridiculously high percentage of foodborne illnesses.

They look at me like I just fell off the truck.

Sure, I walk with a cane now because I fall too much, but not off trucks.

United Natural Foods, Inc. (UNFI) is initiating a voluntary recall of a limited quantity of Wild Harvest® Organic Basil distributed out of UNFI’s Hopkins, MN distribution center to select retailers in Minnesota between 4/18/2020-5/8/2020. UNFI’s recall is issued out of an abundance of caution because of the potential for the impacted product to be contaminated by Cyclospora cayetanensis. No illnesses, including allergic reactions, involving this product have been reported to date.

This recall includes Wild Harvest® Organic Fresh Basil products sold in .25oz, .75oz, 2oz, and 4oz plastic clam shell containers (UPCs: 0071153550450, 0071153550322, 0071153550762, 0071153550323). Impacted product can be identified by a white sticker with black ink on the back of the container stating: “Product of Colombia” and “112.”

This concern was identified following routine sampling. Cyclospora cayetanensis is a microscopic parasite that can cause an intestinal illness in people called cyclosporiasis. According to the U.S. Centers for Disease Control and Prevention, the illness is usually not life threatening. Symptoms of cyclosporiasis may include: watery diarrhea (most common), loss of appetite, weight loss, cramping, bloating, increased gas, nausea and fatigue. Other symptoms that may occur but are less common include vomiting and low-grade fever.

It’s not a war: FDA arming itself with science to help prevent Cyclospora infections

Steven Musser Ph.D., Deputy Director for Scientific Operations, FDA’s Center for Food Safety and Applied Nutrition (CFSAN) and Alexandre da Silva, Ph.D., Lead Parasitologist at CFSAN’s Office of Applied Research and Safety Assessment, write that Cyclospora cayetanensis is so small that it can only be seen with a microscope. However, there is nothing small about the U.S. Food and Drug Administration’s work to help protect consumers from the foodborne illness that this parasite can cause.

Of course it’s small. So are the trillion of microorganisms inside each of us.

Cyclospora has been on the public radar since at least 1996.

Cyclosporiasis is an intestinal illness caused by consumption of foods, mainly fresh produce, that are contaminated with Cyclospora. The FDA has been working to help prevent contaminated product from reaching consumers, gathering the scientific knowledge that will help to better detect the parasite in food and the environment, and gathering data to better understand how food is contaminated by the parasite and help prevent contamination in the future. We’re also sharing what we know with stakeholders in the public and private sectors.

Because several past outbreaks have been associated with fresh herbs, the FDA has been conducting surveillance sampling of fresh cilantro, parsley and basil. A quarterly update on this food surveillance study was released today. As this effort continues, our goal is to collect enough samples to provide a precise estimate of the prevalence of contamination of Cyclospora in our food supply, enabling us to better understand our vulnerability to Cyclospora contamination.     

The FDA is also acting on what we already know about where Cyclospora is found and how contamination can be prevented.   

In 2019, 10% of the Cyclospora infections reported between May and August were linked to a multi-state outbreak associated with fresh imported basil that started in mid-June and was declared over in October. FDA increased its screening at the border of basil exported by the company tied to the outbreak before the company voluntarily recalled its product and ceased shipping while corrective measures were implemented.

The FDA is also tracking contamination in domestically-grown produce. The first confirmed evidence of Cyclospora in domestically grown produce was detected in 2018 in cilantro, a finding not associated with an outbreak of illnesses. As with bacterial pathogens, if the parasite is found on produce, the FDA follows up with inspections and sampling, working with the business to take the actions needed to protect public health.

The FDA has been reaching out to farmers to increase awareness of Cyclospora and actions that can be taken on the farm to reduce the likelihood of contamination. For example, ways to control sources of contamination include proper use, maintenance and cleaning of toilet and handwashing facilities. We created education and outreach materials for farmers, including the Cyclosporiasis and Fresh Produce Fact Sheet

In late 2014, the FDA’s Center for Food Safety and Applied Nutrition established a Foodborne Parasitology Research Program, and in collaboration with the CDC, has been sequencing the genomes of several different strains of C. cayetanensis, enabling the development of genetic typing methods. In 2016, we created a genome database named “CycloTrakr” to be used as a public repository of genomic data at the National Center for Biotechnology Information (NCBI). This is an important first step towards the goal of linking, in real-time, the genetic fingerprints of Cyclospora in contaminated food and sick people to pinpoint the source of the outbreaks.

The agency has also pioneered ways to detect the parasite, developing and validating new methods to test for Cyclospora in produce and water. The first of these new methods was used for the first time in 2018 to confirm the presence of the parasite in a salad mix product tied to an outbreak that sickened hundreds of people. 

In July 2019, the FDA made its second major advance in Cyclospora detection, completing studies that resulted in a novel, validated method to test agricultural water for the presence of the parasite. Water used on farms is a potential source of the contaminants that cause foodborne illnesses. Analysts from FDA laboratories are being trained in the use of this method for regulatory testing. 

Home-grown Cyclospora increasing in US

While cyclosporiasis cases are reported year-round in the United States, cyclosporiasis acquired in the United States (i.e., “domestically acquired”, or cases of cyclosporiasis that are not associated with travel to a country that is considered endemic for Cyclospora) is most common during the spring and summer months. The exact timing and duration of U.S. cyclosporiasis seasons can vary, but reports tend to increase starting in May. In previous years the reported number of cases peaked between June and July, although activity can last as late as September. The overall health impact (e.g., number of infections or hospitalizations) and the number of identified clusters of cases (i.e., cases that can be linked to a common exposure) also vary from season-to-season.

The number of reported cases of domestically acquired cyclosporiasishas increased from the previous month and remains elevated in the United States since May 1, 2019.

As of August 28, 2019, 1,696 laboratory-confirmed cases of cyclosporiasis were reported to CDC by 33 states, District of Columbia and New York City in people who became ill since May 1, 2019 and who had no history of international travel during the 14-day period before illness onset.

The median illness onset date was June 29, 2019 (range: May 1–August 13, 2019).

At least 92 people were hospitalized; no deaths were reported.

At this time, multiple clusters of cases associated with different restaurants or events are being investigated by state public health authorities, CDC, and FDA.

One multistate outbreak of Cyclospora infections has been linked to fresh basil imported from Siga Logistics de RL de CV of Morelos, Mexico . It is unknown at this time if other reported cases of Cyclospora infection in the United States this season are linked to fresh basil. This investigation is ongoing.

Many cases of cyclosporiasis could not be directly linked to an outbreak, in part because of the lack of validated molecular typing tools for C. cayetanensis.

States reporting cases: 33

Deaths: 0

Hospitalizations: 92

2019 domestically acquired cases of Cyclosporiasis

29.aug.19

CDC

https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2019/a-050119/index.html

Good year for Cyclospora bad year for humans: 205 sick linked to Mexican basil in latest outbreak

The U.S. Centers for Disease Control (CDC), public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Cyclospora infections linked to fresh basil from Siga Logistics de RL de CV of Morelos, Mexico.

CDC is advising that consumers do not eat or serve any fresh basil from Siga Logistics de RL de CV of Morelos, Mexico. This investigation is ongoing and the advice will be updated when more information is available.

Consumers who have fresh basil from Siga Logistics de RL de CV of Morelos, Mexico, in their homes should not eat it. Throw the basil away, even if some has been eaten and no one has gotten sick.

Do not eat salads or other dishes that include fresh basil from Siga Logistics de RL de CV of Morelos, Mexico. This includes dishes garnished or prepared with fresh basil from Siga Logistics de RL de CV of Morelos, Mexico, such as salads or fresh pesto.

If you aren’t sure the fresh basil you bought is from Siga Logistics de RL de CV of Morelos, Mexico, you can ask the place of purchase. When in doubt, don’t eat the fresh basil. Throw it out.

Wash and sanitize places where fresh basil was stored: countertops and refrigerator drawers or shelves.

The FDA strongly advises importers, suppliers, and distributors, as well as restaurants, retailers, and other food service providers to not sell, serve or distribute fresh basil imported from Siga Logistics de RL de CV located in Morelos, Mexico. If you are uncertain of the source, do not sell, serve or distribute the fresh imported basil.

Two hundred and five people with laboratory-confirmed Cyclosporainfections and who reported eating fresh basil have been reported from 11 states; exposures occurred at restaurants in 5 states (Florida, Minnesota, New York, Ohio, and Wisconsin).

Illnesses started on dates ranging from June 10, 2019 to July 18, 2019.

Five people have been hospitalized. No deaths attributed to Cyclospora have been reported in this outbreak.

Epidemiologic evidence and early product distribution information indicate that fresh basil from Siga Logistics de RL de CV of Morelos, Mexico is a likely source of this outbreak.

2019 Outbreak of Cyclospora infections linked to fresh basil from Mexico

15.aug.19

CDC

https://www.cdc.gov/parasites/cyclosporiasis/outbreaks/2019/weekly/index.html

Outbreak investigation of Cyclospora illness linked to imported fresh basil, July 2019

16.aug.19

FDA

https://www.fda.gov/food/outbreaks-foodborne-illness/outbreak-investigation-cyclospora-illnesses-linked-imported-fresh-basil-july-2019

11 sick: New York state investigating Cyclospora outbreak

Bethany Bump of the Times Union writes that New York state and local health departments are investigating an outbreak of cyclosporiasis in the Capital Region.

The gastrointestinal illness, which can spread through contaminated food and water, has been confirmed in 11 people so far.

Symptoms began around mid-June, and several of the patients reported eating at the Italian American Community Center in Albany, Prime Life Restaurant at the Beltrone Senior Living Community Center in Colonie, and a private buffet held at Union College in Schenectady, state health officials said.

While cyclosporiasis is endemic in some areas of the world, outbreaks in the U.S. are often associated with imported fresh produce that have been contaminated with a fecal parasite known as Cyclospora cayetanensis.

State health officials say there is no indication that the parasite was spread by poor food handling or preparation at local establishments, which are cooperating with the investigation. Instead, contamination often occurs prior to arrival at food distribution centers and restaurants, they said, and is not easily removed by standard rinsing.

Additional dining establishments may be identified as the investigation continues, they added.

Are they judging jams? Blue-ribbon panel on the prevention of foodborne Cyclospora outbreaks

When someone says a blue-ribbon panel summarized results on the prevention of foodborne Cyclospora outbreaks, I think blue-ribbons is talking about jams or Holsteins at county fairs.

She was sick for weeks.

On June 12, 1996, Ontario’s chief medical officer, Dr. Richard Schabas, issued a public health advisory on the presumed link between consumption of California strawberries and an outbreak of diarrheal illness among some 40 people in the Metro Toronto area. The announcement followed a similar statement from the Department of Health and Human Services in Houston, Texas, who were investigating a cluster of 18 cases of Cyclospora illness among oil executives.

She was sick for weeks.

It’s the fog of outbreaks..

Like the fog my daughter played in last Sat. at the Gold Coast.

On June 12, 1996, Ontario’s chief medical officer, Dr. Richard Schabas, issued a public health advisory on the presumed link between consumption of California strawberries and an outbreak of diarrheal illness among some 40 people in the Metro Toronto area. The announcement followed a similar statement from the Department of Health and Human Services in Houston, Texas, who were investigating a cluster of 18 cases of Cyclospora illness among oil executives.

Dr. Schabas advised consumers to wash California berries “very carefully” before eating them, and recommended that people with compromised immune systems avoid them entirely. He also stated that Ontario strawberries, which were just beginning to be harvested, were safe for consumption. Almost immediately, people in Ontario stopped buying strawberries. Two supermarket chains took California berries off their shelves, in response to pressure from consumers. The market collapsed so thoroughly that newspapers reported truck drivers headed for Toronto with loads of berries being directed, by telephone, to other markets.

However, by June 20, 1996, discrepancies began to appear in the link between California strawberries and illness caused by the parasite, Cyclospora, even though the number of reported illnesses continued to increase across North America. Texas health officials strengthened their assertion that California strawberries were the cause of the outbreak, while scientists at the U.S. Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) said there were not yet ready to identify a food vehicle for the outbreak. On June 27, 1996, the New York City Health Department became the first in North America to publicly state that raspberries were also suspected in the outbreak of Cyclospora.

By July 18, 1996, the CDC declared that raspberries from Guatemala — which had been sprayed with pesticides mixed with water that could have been contaminated with human sewage containing Cyclospora — were the likely source of the Cyclospora outbreak, which ultimately sickened about 1,000 people across North America. Guatemalan health authorities and producers have vigorously refuted the charges. The California Strawberry Commission estimates it lost $15 million to $20 million in reduced strawberry sales.

Cyclospora cayetanensis is a recently characterised coccidian parasite; the first known cases of infection in humans were diagnosed in 1977. Before 1996, only three outbreaks of Cyclospora infection had been reported in the United States. Cyclospora is normally associated with warm, Latin American countries with poor sanitation.

One reason for the large amount of uncertainty in the 1996 Cyclospora outbreak is the lack of effective testing procedures for this organism. To date, Cyclospora oocysts have not been found on any strawberries, raspberries or other fruit, either from North America or Guatemala. That does not mean that cyclospora was absent; it means the tests are unreliable and somewhat meaningless. FDA, CDC and others are developing standardized methods for such testing and are currently evaluating their sensitivity.

The initial, and subsequent, links between Cyclospora and strawberries or raspberries were therefore based on epidemiology, a statistical association between consumption of a particular food and the onset of disease. For example, the Toronto outbreak was first identified because some 35 guests attending a May 11, 1996 wedding reception developed the same severe, intestinal illness, seven to 10 days after the wedding, and subsequently tested positive for cyclospora. Based on interviews with those stricken, health authorities in Toronto and Texas concluded that California strawberries were the most likely source. However, attempts to remember exactly what one ate two weeks earlier is an extremely difficult task; and larger foods, like strawberries, are recalled more frequently than smaller foods, like raspberries. Ontario strawberries were never implicated in the outbreak.

Once epidemiology identifies a probable link, health officials have to decide whether it makes sense to warn the public. In retrospect, the decision seems straightforward, but there are several possibilities that must be weighed at the time. If the Ontario Ministry of Health decided to warn people that eating imported strawberries might be connected to Cyclospora infection, two outcomes were possible: if it turned out that strawberries are implicated, the ministry has made a smart decision, warning people against something that could hurt them; if strawberries were not implicated, then the ministry has made a bad decision with the result that strawberry growers and sellers will lose money and people will stop eating something that is good for them. If the ministry decides not to warn people, another two outcomes are possible: if strawberries were implicated, then the ministry has made a bad decision and people may get a parasitic infection they would have avoided had they been given the information (lawsuits usually follow); if strawberries were definitely not implicated then nothing happens, the industry does not suffer and the ministry does not get in trouble for not telling people. Research is currently being undertaken to develop more rigorous, scientifically-tested guidelines for informing the public of uncertain risks.

But in Sarnia (Ontario, Canada) they got a lot of sick people who attended the Big Sisters of Sarnia-Lambton Chef’s Challenge on May 12, 2010.

Michael T. Osterholm, PhD, who has a lot of titles and once called me at 5 a.m. to tell me I was an asshole (maybe not the exact words, but the sentiment) and chair of the Holstein Blue-Ribbon Panel on the Prevention of Foodborne Cyclospora Outbreaks writes that the 1996 cyclosporiasis outbreak in the United States and Canada associated with the late spring harvest of imported Guatemalan-produced raspberries was an early warning to public health officials and the produce industry that the international sourcing of produce means that infectious agents once thought of as only causing traveler’s diarrhea could now infect at home. The public health investigation of the 1996 outbreak couldn’t identify how, when, where, or why the berries became contaminated with Cyclospora cayetanensis.

The investigation results were published in the New England Journal of Medicine in 1997. I was asked to write an editorial to accompany the investigation report.2 In my editorial, I noted the unknowns surrounding the C. cayetanensis contamination. The 1997 spring harvest of Guatemalan raspberries was allowed to be imported into both the United States and Canada—and again, a large outbreak of cyclosporiasis occurred. As in the 1996 outbreak, no source for the contamination of berries was found. Later in 1997, the Food and Drug Administration (FDA) prohibited the importation of future spring harvests of Guatemalan raspberries until a cause for the contamination could be demonstrated and corrective actions taken. While the FDA did not permit the 1998 importation of the raspberries into the United States, the berries continued to be available in Canada. Outbreaks linked to raspberries occurred in Ontario in May 1998. When the U.S. Centers for Disease Control and Prevention (CDC)-led investigative team published its 1997 outbreak findings in the Annals of Internal Medicine, 3 I was again asked to write an accompanying editorial.4 As I had done in my previous editorial, I highlighted how little we know about the factors associated with the transmission Cyclospora on produce and how to prevent it.

Unfortunately, the state of the art for preventing foodborne, produce-associated cyclosporiasis had changed little since the 1996 outbreak despite the relatively frequent occurrence of such outbreaks.

Thirty-two years after that first Guatemalan raspberry-associated outbreak — and a year after produce-associated cyclosporiasis outbreaks that were linked to U.S.-grown produce — we have taken a major step forward in our understanding of these outbreaks and how to prevent them. After Fresh Express produce was identified in one of the 2018 outbreaks, I was asked by the company leadership to bring together the best minds’ around all aspects of produceassociated cyclosporiasis. The goal was to establish a Blue-Ribbon Panel to summarize state-of-the-art advancements regarding this public health challenge and to identify immediate steps that the produce industry and regulators can take to prevent future outbreaks. The panel was also formed to determine what immediate steps can be taken for any future outbreaks to expedite the scientific investigation to prevent further cases and inform public health officials. The Blue-Ribbon Panel comprises 11 individuals with expertise in the biology of Cyclospora; the epidemiology of cyclosporiasis, including outbreak investigation; laboratory methods for identifying C. cayetanensis in human and food samples and the environment; and produce production. In addition,16 expert consultants from academia, federal and state public health agencies (including expert observers from the FDA, CDC, U.S. Department of Agriculture, and California Department of Public Health), and industry, including producers and professional trade association science experts. The collaboration and comprehensiveness of this effort was remarkable. Many hundreds of hours of meetings and conference calls took place to determine our findings and establish our recommendations.

This document, “Interim Report: Blue-Ribbon Panel on the Prevention of Cyclospora Outbreaks in the Food Supply,” summarizes the state-of-the art practices for the prevention of C. cayetanensis contamination of produce and priorities for research that will inform us as we strive to further reduce infection risk. Also, we make recommendations on how to more quickly identify and more effectively respond to produce-associated outbreaks when they occur. We greatly appreciate all the organizations represented on the panel and the expert consultants. The report does not, however, represent the official policy or recommendations of any other private, academic, trade association or federal or state government agency. Fresh Express has committed to continuing the Blue-Ribbon Panel process for as long as it can provide critical and actionable information to prevent and control Cyclospora outbreaks in the food supply.

Table: Summary of U.S. foodborne outbreaks of cyclosporiasis, 2000–2017
Year(s)* Month(s)* Jurisdiction(s)* No. of cases† Food vehicle and source, if identified‡
2000 May Georgia 19 Raspberries and/or blackberries (suspected)
2000 June Pennsylvania 54 Raspberries
2001 January–February Florida 39
2001 January New York City 3
2001–02 December–January Vermont 22 Raspberries (likely)
2002 April–May Massachusetts 8
2002 June New York 14
2004 February Texas 38
2004 February Illinois 57 Basil (likely)
2004 May Tennessee 12
2004 May–June Pennsylvania 96 Snow peas from Guatemala ⁂
2005 March–May Florida 582 ¶ Basil from Peru
2005 May South Carolina 6
2005 April Massachusetts 58
2005 May Massachusetts 16
2005 June Connecticut 30 Basil (suspected)
2006 June Minnesota 14
2006 June New York 20
2006 July Georgia 3
2008 March Wisconsin 4 Sugar snap peas (likely) ⁂
2008 July California 45 ¶ Raspberries and/or blackberries (likely)
2009 June District of Columbia 34
2011 June Florida 12
2011 July Georgia 88**
2012 June–July Texas 16
2013†† June Iowa, Nebraska, and neighboring states 162 Bagged salad mix from Mexico
2013†† June–July Texas 38 Cilantro from Mexico
2013 July Wisconsin 8 Berry salad (suspected)
2014 June Michigan 14
2014‡‡ June–July Texas 26 Cilantro from Mexico
2014 July South Carolina 13
2015 May–July Georgia, Texas, and Wisconsin 90 Cilantro from Mexico
2016 June–July Texas 6¶¶ Carrots or green cabbage (suspected)
2017 May Florida 6 Berries (suspected)
2017 May–July Texas 38*** Scallions (i.e., green onions)
2017 June Michigan 29
2017 June Tennessee 4†††
2017 June Connecticut 3
2017 July Florida 3‡‡‡

UK Cyclospora shit fest

TTG reports a judge sitting at Manchester county court has ordered the disclosure of all documentary evidence relating to investigations carried out by Public Health England (PHE) surrounding cyclospora — a parasite spread by food contaminated with infected human faeces.

According to The Times, many customers claimed Tui did not tell them the Riviera Maya region of Mexico was subject to a public health warning due to cyclosporiasis before they booked.

This is in spite of 359 of the 440 British cases reported between June and October 2016 “involving travel to Mexico”, it is claimed.

Others customers allege they were handed a warning letter “only after their plane landed”.

440 sickened: Tui faces legal action from 400 people over Mexico sickness

TTG reports a  judge sitting at Manchester county court has ordered the disclosure of all documentary evidence relating to investigations carried out by Public Health England (PHE) surrounding cyclospora — a parasite spread by food contaminated with infected human faeces.

According to The Times, many customers claimed Tui did not tell them the Riviera Maya region of Mexico was subject to a public health warning due to cyclosporiasis before they booked.

This is in spite of 359 of the 440 British cases reported between June and October 2016 “involving travel to Mexico”, it is claimed.

Others customers allege they were handed a warning letter “only after their plane landed”.