The Centers for Disease Control and Prevention warned that nearly 7,000 people nationwide may have the foodborne illness cyclosporiasis after issuing a health alert that listed 1,645 confirmed cases and an additional 5,100 under investigation, with at least 34 states reporting illnesses. The agency said 141 people have been hospitalized since cases were first reported and no deaths have been reported.
Michigan has reported the bulk of illnesses, confirming 3,309 cases and 44 hospitalizations, state health officials said. Based on more than 1,000 interviews with people who tested positive, Michigan officials said lettuce or salad greens have emerged as possible sources. Michigan Chief Medical Executive Dr. Natasha Bagdasarian said contamination usually occurs where produce is grown or processed and that because distributors supply the same produce to multiple types of establishments "it’s unlikely for there to be one single place as the exposure for all of our cases." On July 13 the state urged consumers to avoid prepackaged salads, buy whole heads of lettuce rather than prewashed bags, rinse produce thoroughly, discard outer layers and wash inner leaves, and to cook vegetables when possible.
The CDC said it must confirm each case, so national counts can lag behind state reports, and it suspects at least 400 illnesses across Kentucky, Michigan, Ohio and West Virginia are connected. New York City has reported 403 cases, including 374 reported between May and July 10, city health officials said.
Federal and state officials have not implicated a single product, restaurant, grocer or distributor, and no recalls have been issued. The Food and Drug Administration has launched an investigation, and Taco Bell Corp. said it had voluntarily and temporarily removed limited ingredients at select restaurants as a precautionary measure while public health officials determine whether any illnesses reported by customers are linked to the wider outbreak.
With no confirmed source or recall, consumers have turned to social media for guidance and speculation has spread online. "This isn't a problem consumers can solve," Dr. Celine Gounder said, urging people to avoid fresh produce that is not cooked and cannot be peeled.
Investigators are interviewing people who have become sick to try to identify what they ate, but officials said the delay between infection and symptoms can make recall difficult and that the federal case count is expected to grow because of an estimated six-week gap between when illnesses begin and when they are reported to federal health authorities. Public health experts have pointed to recent changes in funding and surveillance as complicating the response; an associate professor at George Washington University said cuts and program changes have reduced local capacity to coordinate information across states. A senior HHS press secretary said the FDA is investigating in close coordination with CDC and state and local partners and added, "To be clear, cyclospora tracking never stopped. CDC is actively working with 3,000 health departments to gather data." The Ohio Department of Health reported 177 cases as of July 2, most of them occurring in June, and Dr. Bruce Vanderhoff, director of the Ohio Department of Health, said cyclosporiasis is a "serious illness that can cause dehydration and require people to seek emergency medical care, and it should be taken seriously."
The illness can cause severe, watery diarrhea that can lead to dehydration, along with nausea, fatigue, body aches, gas and stomach cramps. Sickened people have ranged in age from 5 to 88, and symptoms can appear anywhere between two days and two weeks or more after infection. Infections are typically treated with fluids and the antibiotic Bactrim. Once the parasites latch on they are hard to wash away; there is no evidence that soaking produce or dousing it with vinegar or commercial vegetable washes is enough to remove them. Heating food to 158 degrees Fahrenheit kills Cyclospora, and officials say untreated infections can linger for weeks, so people with symptoms should drink plenty of fluids and seek medical care.