The Centers for Disease Control and Prevention is investigating a cyclosporiasis outbreak detected in 31 states; the agency reported 843 confirmed and 1,500 suspected cases across those states on Friday, and public health officials said the total case count has climbed to nearly 3,000, with 86 people hospitalized and no deaths.
Michigan has borne the brunt of the outbreak, reporting 2,640 cases and 44 hospitalizations, state health officials said Monday, and the state’s chief medical executive, Dr. Natasha Bagdasarian, said “early information has shown lettuce as a common product that regularly comes up during the investigation.”
The Michigan Department of Health and Human Services cautioned that there is not enough information to identify a specific type of produce, grower or supplier and that other food items cannot be ruled out.
Michigan health officials urged consumers to avoid prepackaged salads, instead buying individual heads of lettuce that should be rinsed thoroughly, discarding outer layers and washing inner leaves, and to cook vegetables when possible.
The intestinal illness can cause diarrhea, nausea and fatigue; 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. The parasites have been associated in previous U.S. outbreaks with raspberries, basil, cilantro, snow peas and lettuce, and heating food to 158 degrees Fahrenheit or higher kills Cyclospora, officials said.
Health officials described additional symptoms that can include severe fatigue, body aches, unusually bad gas, stomach cramps and uncontrollable watery diarrhea that can lead to dehydration. Infections are typically treated with fluids and an antibiotic, and officials advise thoroughly washing fresh produce and washing hands with soap and water before and after handling produce, though the parasites are not easy to rinse off.
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 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 and officials have also pointed to recent changes in public health funding and surveillance as complicating outbreak response. An associate professor at George Washington University said cuts and program changes have reduced local capacity to coordinate information across states, and a senior HHS press secretary said the Food and Drug Administration is investigating cyclospora outbreaks in close coordination with CDC and state and local partners, adding, “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.”