The Centers for Disease Control and Prevention said Friday that the multistate cyclosporiasis outbreak has expanded to nine states.
A spokesperson for the U.S. Food and Drug Administration said Thursday that federal health officials have identified a new cyclospora outbreak stemming from an unspecified product, that the agency has initiated a traceback to follow the potentially contaminated product through the supply chain and, "This is an active investigation."
The newly linked states are Illinois, Kansas, Oklahoma and Pennsylvania, which were added to cases previously connected in Indiana, Kentucky, Michigan, Ohio and West Virginia, the CDC said, and the agency has confirmed 1,947 cases in those nine states.
The FDA said last week that shredded iceberg lettuce sourced from Taylor Farms de Mexico is the likely source of the multistate outbreak and that the company voluntarily recalled the product from the U.S. market; interviews with people who got sick found many had eaten at Taco Bell in June, and the chain pulled lettuce from its menu ahead of the recall.
Investigators at the FDA are working to determine whether additional growers may have played a role, and an FDA official said, "The data that we have now really continues to home in on growers that were already identified."
The FDA updated its website on Thursday to reflect a separate investigation into 72 cyclosporiasis cases that has not yet been linked to a specific product.
The CDC has reported 4,173 lab-confirmed domestic cases of cyclosporiasis between May 1 and July 20 and said it is aware of at least 7,400 additional cases awaiting confirmation; Michigan health officials said Thursday the state has 7,664 confirmed cases. Taylor Farms has shut down the Mexican processing facility where the lettuce is suspected to have started the outbreak, and officials say the outbreak has sickened thousands in at least 41 states; the outbreak has been described as the largest recorded in U.S. history and the FDA said infections were first detected on May 13.
The CDC has sent three staffers to Ohio to help that state's investigation, and Ohio has reported 2,596 cases; New York has reported 632 cases since May and North Carolina 561, and preliminary investigations in North Carolina suggest parsley and cilantro could be behind those cases. A state health department in Kansas has reported it is investigating cases related to the multistate outbreak.
Cyclospora is a microscopic parasite that typically infects people through contaminated food or water and causes cyclosporiasis, a gastrointestinal illness that can include severe and sometimes "explosive" diarrhea; cooking can kill the parasite but officials say washing fruits and vegetables is not enough, symptoms can take weeks to show up and patients can require hospitalization. In Monroe County, Michigan, state figures show 286 people have been infected and residents have reported anxiety and widespread avoidance of fresh produce and eating out; restaurants and major retailers, including Walmart and Jack in the Box, have removed fresh-produce items from sale as a precaution. The FDA briefly announced that an iceberg lettuce sample from Taylor Farms had tested positive and then less than 24 hours later said the result was a false positive. Francisco Diez-Gonzalez, director of the Center for Food Safety at the University of Georgia College of Agricultural and Environmental Sciences, said the parasite can be "really hard to detect" and that publicizing preliminary positive results without multiple rounds of corroborating tests can erode consumer trust. Agriculture Secretary Brooke Rollins sought to reassure Americans that the nation's food supply "remains the best, the safest, the most affordable in the world, and will continue to do so," and Health Secretary Robert F Kennedy Jr said on Tuesday that cyclosporiasis was "under control."