The U.S. Food and Drug Administration is linking its program to more closely monitor fresh Mexican cilantro to a drop in domestically acquired Cyclospora cayetanensis infections. According to a Sept. 19 update from the U.S. Centers for Disease Control and Prevention, as of Sept. 16 there were at least 134 confirmed cases of cyclosporiasis with illness onset on or after May 1, compared with 319 for the same period last year. There are 384 total cases reported so far in 2016. 134 people who became infected in the U.S. are from: Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Maine, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, New York, North Carolina, Ohio, South Dakota, Tennessee, Texas, Virginia, Washington and Wisconsin. Since April 2015, FDA has been detaining fresh cilantro from the Puebla region of Mexico after it was implicated in several foodborne illness outbreaks in the U.S. FDA issued an Import Alert on Aug. 27, 2015, announcing that it would detain fresh cilantro on a seasonal basis after joint U.S.-Mexico inspections from 2013-2015 at Puebla-area farms and packinghouses revealed “objectionable conditions” that could contaminate produce with “human fecal pathogens.” “Beginning in 2015, from April 1 through August 31, cilantro from this region has been and continues to be detained without physical examination at the U.S.-Mexican border and refused admission into the United States. The April through August time period aligns with the seasonality of previous C. cayetanensis outbreaks,” FDA noted in a Sept. 26 update on the situation. An exception is granted for fresh cilantro from 10 Puebla-area firms on a so-called “Green List.” Inclusion on the list means that the exporting companies have met certain good production practices criteria for exclusion from detention without physical examination under the Import Alert. FDA and two agencies of the Mexican government — the National Agro-Alimentary Health, Safety and Quality Service and Federal Commission for the Protection from Sanitary Risks — established production criteria to promote the safety of fresh and minimally processed agricultural products. They signed a statement of intent on July 24, 2014, to cooperate on a Produce Safety Partnership. This year was the first full season that FDA’s Import Alert for fresh cilantro from Puebla has been in effect. The agency also started testing cilantro from Puebla and, along with CDC, has been reaching out to industry on strategies to control and prevent Cyclospora. As of Sept. 14, 2015, CDC reported 546 cases of confirmed Cyclospora infection from 31 states. Of that total, 319 had experienced illness onset on or after May 1 of last year and had no history of international travel within two weeks before becoming sickened. Twenty-one people were hospitalized, but no deaths were reported. Illness clusters linked to restaurants or events were identified in Texas, Wisconsin and Georgia, and investigations in Wisconsin and Texas preliminarily identified cilantro as a “suspect vehicle,” according to CDC.

A close-up view of Cyclospora cayetanensis.
Since the mid-1990s, foodborne outbreaks of cyclosporiasis in the U.S. have been linked to various types of imported fresh produce, including raspberries, basil, snow peas and mesclun lettuce. CDC notes that people who live in, or travel to, tropical or subtropical areas of the world may be at increased risk of infection. Tips to avoid contaminated food and water while traveling can be found here. Cyclospora infection is caused by a one-cell parasite spread by ingesting food or water that has been contaminated with feces. Symptoms begin on average about a week later and typically include watery diarrhea, loss of appetite, weight loss, cramping, bloating, increased gas, nausea and fatigue. Less-common symptoms are vomiting and low-grade fever. However, some people infected with the parasite do not have any symptoms, particularly if they live in an area where the illness regularly occurs. If Cyclospora infection remains untreated, the symptoms can persist for several weeks to a month or more. Some symptoms, such as diarrhea, can return, and some, such as muscle aches and fatigue, may continue after the gastrointestinal symptoms have gone away. The infection usually is not life-threatening. There is currently no vaccine available.

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