Update: CDC posted another update on Tuesday, Aug. 25, 2015, detailing this outbreak investigation. As of Aug. 21, the agency stated that 495 people from 30 states with confirmed Cyclospora infections had been reported, which is 19 more people than CDC reported on Aug. 18. The previous story follows: According to the latest update posted Tuesday, as of Aug. 10, the U.S. Centers for Disease Control and Prevention (CDC) had been notified of 457 ill persons with confirmed Cyclospora infection from 29 states so far this year. That’s 73 more people and two additional states since the previous CDC update one week ago. Most of these people (275, or 60 percent of the total) experienced onset of illness on or after May 1, 2015, and did not have a history of international travel within 2 weeks before illness onset, CDC reported. These 275 persons were from the following 22 states: Arkansas (2), California (2), Connecticut (3), Florida (11), Georgia (22), Illinois (6), Iowa (1), Kansas (2), Maryland (1), Massachusetts (9), Michigan (2), Missouri (1), Montana (3), Nebraska (1), New Jersey (6), New Mexico (1), New York (excluding NYC) (8), New York City (21), Texas (157), Utah (1), Virginia (3), Washington (2), and Wisconsin (10). CDC’s previous update on this outbreak, posted Aug. 4, noted that there were 384 ill persons with confirmed Cyclospora infection from 26 states so far this year. At that time, most of them (226 people, or 59 percent) experienced the onset of illness on or after May 1, 2015, and did not report international travel prior to developing symptoms. CDC’s Aug. 11 update states that clusters of illness linked to restaurants or events have been identified in Texas (157 cases, according to CDC; 237 cases, according to the Texas Department of State Health Services), Wisconsin (10), and Georgia (22). CDC added that cluster investigations are ongoing in Texas and Georgia. Cluster investigations in Wisconsin and Texas have preliminarily identified cilantro as a suspect vehicle, the CDC update stated. Previous U.S. outbreaks of cyclosporiasis have been linked to imported fresh produce, including cilantro from the Puebla region of Mexico. According to a public health notice updated on Aug. 17, 2015, the Public Health Agency of Canada (PHAC) is collaborating with provincial public health partners, the Canadian Food Inspection Agency, and Health Canada in investigating 87 cases of Cyclospora infection in Ontario (77), British Columbia (4), Alberta (1), and Quebec (5). However, PHAC did not specify one single food item as the possible source of this outbreak. “Although the source of the outbreak has not been identified, past outbreaks have been associated with imported fresh produce, including pre-packaged salad mix, basil, cilantro, berries, mesclun lettuce and snow peas,” the Canadian agency stated. The U.S. Food and Drug Administration (FDA) issued an Import Alert on July 28, 2015, about cilantro from the state of Puebla, Mexico, due to concerns about fecal contamination which investigators reportedly found in fields and in cleaning and processing facilities in that area. On Aug. 4, FDA posted a document called, “U.S.-Mexico Partnership Enhances the Safety of Fresh Cilantro (Coriandrum sativum),” plus another document entitled, “Questions and Answers Regarding Cilantro from Puebla, Mexico.” The first FDA document explains some produce safety controls which U.S. and Mexican public health and food safety authorities are instituting and discusses what importers must do to be cleared to import fresh cilantro into the U.S. “Shipments of fresh cilantro from other states in Mexico will be released into the United States if documentation submitted with the entry demonstrates that the cilantro was harvested outside of Puebla. Additionally, the FDA, COFEPRIS, and SENASICA [Mexican counterparts] are working collaboratively to prepare a ‘Green List’ of companies in Puebla whose shipments of fresh cilantro will not be detained,” the FDA document states. The second FDA document starts with a question: “What is likely to happen to loads of cilantro from Puebla, Mexico that are currently sitting at the port?” FDA’s posted answer: “The Import Alert (IA) allows FDA District Offices to detain fresh cilantro from Puebla, Mexico without examination. Cilantro from Puebla, Mexico that comes from a firm listed on the green list of the IA will not be detained based on the IA. At this time there are no firms listed on the green list of the IA. Product detained based on the IA that is refused admission must be exported or destroyed within 90 days. These products may be exported back to Mexico.” According to CDC, Cyclospora is a single-cell parasite spread by people ingesting something, such as food or water, that was contaminated with feces (stool). Cyclospora needs time (days to weeks) after being passed in a bowel movement to become infectious for another person. Therefore, it is unlikely that Cyclospora is passed directly from one person to another. Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea with frequent, sometimes explosive, bowel movements. Other common symptoms include loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, and fatigue. Vomiting, body aches, headache, fever, and other flu-like symptoms may be noted. However, some people who are infected with Cyclospora do not have any symptoms.
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