Romain Lettuce from Yuma: The FDA and the CDC, along with state and local health officials, are investigating an outbreak of Shiga toxin-producing E. coli O157:H7 infections.

There are 197 cases in 35 states: Alaska (8), Arkansas (1), Arizona (9), California (45), Colorado (3), Connecticut (2), Florida (1), Georgia (5), Idaho (11), Illinois (2), Iowa (1), Kentucky (1), Louisiana (1), Massachusetts (4), Michigan (5), Minnesota (12), Mississippi (1), Missouri (1), Montana (9), Nebraska (1), New Jersey (8), New York (10), North Carolina (1), North Dakota (3), Ohio (7), Oklahoma (1), Oregon (1), Pennsylvania (24), South Dakota (1), Tennessee (3), Texas (3), Utah (1), Virginia (1), Washington (7), and Wisconsin (3). 89 people have been hospitalized, including 26 people who have developed a type of kidney failure called hemolytic uremic syndrome.5 deaths have been reported from Arkansas (1), California (1), Minnesota (2), and New York (1).

The current outbreak is not related to a recent multistate outbreak of E. coli O157:H7 infections linked to leafy greens. People in the previous outbreak were infected with a different DNA fingerprint of E. coli O157:H7 bacteria.

The most recent information collected by the FDA, in conjunction with federal, state, and local partners, indicates that the romaine lettuce that ill people ate was likely grown or originated from the winter growing areas in or around the Yuma region. This region generally supplies romaine lettuce to the U.S. during November-March each year.

Del Monte Vegetable Trays: The FDA, CDC, state, and local partners are currently investigating several Cyclospora illnesses associated with recalled Del Monte 6oz and 12oz vegetable trays containing broccoli, cauliflower, carrots and dill dip that were sold by Kwik Trip/Kwik Star locations in IA, MN, and WI. Additionally, Del Monte is recalling “small veggie trays,” which are 28oz and include broccoli, cauliflower, carrots, celery and dill dip that were distributed to Illinois and Indiana.

As of June 15, 2018, CDC has reported 78 laboratory-confirmed cases of cyclosporiasis in persons from IA, MN, WI and MI who reportedly consumed the vegetable trays. The two cases from Michigan reportedly purchased the vegetable tray in Wisconsin and therefore Michigan is not impacted from this outbreak.

On June 8, 2018, Del Monte withdrew their 6oz and 12oz vegetable trays from retail market locations, and they are not currently available for purchase. However, consumers who purchased these trays before the withdrawal may still have product in their homes since the expiration date is June 17, 2018 or earlier. The 28oz vegetable trays that were distributed to IL and IN are being recalled as of June 15, 2018. Del Monte reports the recalled products were distributed to: Kwik Trip, Kwik Star, Demond’s, Sentry, Potash, Meehan’s, Country Market, FoodMax Supermarket and Peapod in Illinois, Indiana, Iowa, Michigan, Minnesota, and Wisconsin and have “Best If Enjoyed By” date of June 17, 2018 or earlier.

Kellogg’s Honey Smacks: The CDC and FDA report that as of June 15, 2018, there are 73 people ill with this strain of Salmonella in 31 states: Alabama (2), Arizona (1), California (5), Connecticut (3), Georgia (2), Illinois (1), Indiana (3), Kentucky (1), Louisiana (2), Massachusetts (5), Maryland (1), Michigan (4), Mississippi (1), Montana (1), North Carolina (3), New Hampshire (1), New Jersey (3), New York (7), Ohio (1), Oklahoma (2), Oregon (1), Pennsylvania (5), Rhode Island (2), South Carolina (1), Tennessee (1), Texas (2), Utah (1), Virginia (4), Washington (3), Wisconsin (1), West Virginia (3).The ages of the ill people range from less than one year to 87 (median 58 years) and 65% of cases are female. Reported illness onset dates range from 3/3/18 – 5/28/18. Among 55 with available information, 24 (44%) have been hospitalized. No deaths have been reported.

Epidemiologic evidence indicates that Kellogg’s Honey Smacks cereal is a likely source of this multistate outbreak. In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Thirty (77%) of 39 people interviewed reported eating cold cereal. In interviews, 14 people specifically reported eating Kellogg’s Honey Smacks cereal. Ill people in this outbreak reported this cereal more often than any other cereals or food items.On June 14, 2018, the Kellogg Company recalled packages of Kellogg’s Honey Smacks cereal.

Caito Foods Cut Melons: The FDA, CDC, along with state and local officials are investigating a multi-state outbreak of Salmonella Adelaide infections. Epidemiologic and preliminary traceback evidence indicates that pre-cut melon distributed by Caito Foods, LLC is a likely source of this outbreak. The recalled products were packaged in clear, plastic clamshell containers and distributed to Alabama, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Michigan, Minnesota, Missouri, Nebraska, North Carolina, North Dakota, Ohio, Pennsylvania, South Dakota, Tennessee, Virginia, West Virginia, and Wisconsin. The FDA is currently working with state partners to trace back the pre-cut melons to identify the source of the pathogen, to determine the full distribution of the pre-cut melons, and to learn more about how the contamination occurred.  The FDA is advising consumers to discard any recalled products purchased at the listed locations.

There are 60 people ill with this strain of Salmonella in five states: IL (6), IN (11), MI (32), MO (10), OH (1). The ages of the ill people range from less than one year to 97 (median 67 years) and 65% of cases are female. Reported illness onset dates range from 4/30/18 – 5/28/18. Among 47 with available information, 31 (66%) have been hospitalized. No deaths have been reported.

FDA advises consumers not to eat recalled fresh cut watermelon, honeydew melon, cantaloupe, and fresh-cut fruit medley products containing any of these melons. Products have been distributed in Alabama, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Maryland, Michigan, Minnesota, Missouri, Nebraska, North Carolina, North Dakota, Ohio, Pennsylvania, South Dakota, Tennessee, Virginia, West Virginia, and Wisconsin. The products were packaged in clear, plastic clamshell containers under several different brands or labels and distributed to Costco, Jay C, Kroger, Payless, Owen’s, Sprouts, Trader Joe’s, Walgreens, Walmart, Whole Foods/Amazon. Other retail locations may be added to the list. Caito Foods, LLC has voluntarily recalled fruit salad mixes that contain pre-cut melons to prevent further distribution of potentially contaminated products.

Rose Acre Farms’  Shell Eggs: The CDC reported that 45 people infected with the outbreak strain of Salmonella Braenderup were reported from 10 states: Alaska (1), Colorado (1), Florida (2), New Jersey (2), New York (14), North Carolina (6), Pennsylvania (6), South Carolina (4), Virginia (8), and West Virginia (1). 11 people were hospitalized, and no deaths were reported.

After learning that all of the people who became ill ate eggs or egg dishes before the onset of illness, the FDA was able to trace back the source of some of the eggs to the Rose Acre Farms’ Hyde County farm. FDA investigators then inspected the farm and collected samples for testing. During the inspection, FDA investigators observed objectionable conditions and practices which are summarized here. FDA analysis of the samples revealed that the same rare strain of Salmonella Braenderup that caused the illnesses was present at the Hyde County Egg facility, tying the facility to the outbreak.

The FDA advised consumers not to eat recalled eggs produced by Rose Acre Farms’ Hyde County farm. These eggs were sold under multiple brand names, including Coburn Farms, Country Daybreak, Food Lion, Glenview, Great Value, Nelms, Sunshine Farms, Publix, and Sunups. Recalled eggs were also sold to restaurants.

As a result of these findings and discussions between the FDA and the firm, Rose Acre Farms voluntarily recalled shell eggs from the Hyde County egg farm. The affected Rose Acre Farms recalled eggs are identified with plant number P-1065 and Julian date ranges of 011 through date of 102 printed on either the side portion or the principal side of the carton or package. These eggs were sold under multiple brand names including Coburn Farms, Country Daybreak, Food Lion, Glenview, Great Value, Nelms, and Sunshine Farms. Recalled eggs were also sold to restaurants.

Following Rose Acre Farms’ recall, Cal-Maine Foods, Inc. voluntarily recalled eggs purchased from Rose Acre Farms and produced at the Hyde County facility. These eggs were repackaged and sold under multiple brand names, including Publix and Sunups.

Natural Grocers Dried Coconut: The CDC reports a total of 14 people were infected with the outbreak strain of Salmonella Typhimurium, across eight states and the District of Columbia: California (5), Colorado, Connecticut, District of Columbia, Idaho, Missouri, Oregon (2), Texas, and Utah. Three people have been hospitalized, but no deaths have been reported. Illnesses started on dates ranging from September 22, 2017 to February 26, 2018. Ill people ranged in age from 1 to 73 years, with a median age of 38. Among ill people, 62% were female. Three hospitalizations were reported. No deaths were reported. Whole genome sequencing (WGS) performed on bacteria isolated from ill people showed that they were closely related genetically. This means that people in this outbreak were more likely to share a common source of infection.

FDA and state health and regulatory officials collected leftover dried coconut from ill people’s homes, as well as dried coconut from Natural Grocers store locations where ill people shopped and from the Natural Grocers’ Distribution Center. FDA testing identified the outbreak strain of Salmonella Typhimurium in an unopened sample of Natural Grocers Coconut Smiles Organic collected from Natural Grocers. The outbreak strain was also identified in an opened, leftover sample of Natural Grocers Coconut Smiles Organic collected from an ill person’s home.

FDA also collected dried coconut from International Harvest, Inc. The outbreak strain of Salmonella Typhimurium was identified in samples of International Harvest Brand Organic Go Smile! Dried Coconut Raw and Go Smiles Dried Coconut Raw.

On March 16, 2018, International Harvest, Inc. recalled bags of Organic Go Smile! Raw Coconut and bulk packages of Go Smiles Dried Coconut Raw. The recalled Organic Go Smile! Raw Coconut was sold online and in stores in 9-ounce bags with sell-by dates from January 1, 2018 through March 1, 2019. Recalled bulk Go Smiles Dried Coconut Raw was sold in a 25-pound case labeled with batch/lot numbers OCSM-0010, OCSM-0011, and OCSM-0014. These products were sold in various grocery stores. The list of locations and cities where recalled bulk dried coconut was sold is available on the FDA website.

On March 19, 2018, Vitamin Cottage Natural Food Markets, Inc. recalled packages of Natural Grocers Coconut Smiles Organic labeled with barcode 8034810 and packed-on numbers lower than 18-075. Recalled Natural Grocers Coconut Smiles Organic were sold in 10-ounce clear plastic bags with the Natural Grocers label. The packed-on number can be found in the bottom left-hand corner of the label.

Fareway and Triple T Chicken Salad: The CDC collaborated with public health and regulatory officials in several state and the U.S. Department of Agriculture’s Food Safety and Inspection Service to investigate a multistate outbreak of Salmonella Typhimurium infections. A total of 265 people infected with the outbreak strains of Salmonella Typhimurium were reported from 8 states. A list of the states and the number of cases in each can be found on the Case Count Map page. WGS performed on bacteria isolated from ill people showed that they were closely related genetically. This means that people in this outbreak were more likely to share a common source of infection. Illnesses started on dates ranging from January 8, 2018, to March 20, 2018. Ill people ranged in age from less than 1 year to 89 years, with a median age of 57. Sixty-seven percent of people were female. Ninety-four hospitalizations were reported, including one person from Iowa who died.

Public health officials in Iowa first detected this outbreak and linked the illnesses to chicken salad sold at Fareway grocery stores. CDC searched the PulseNet database and identified illnesses in other states, and those illnesses were added to this outbreak. In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Of 222 people interviewed, 194 (87%) reported eating chicken salad purchased from Fareway grocery stores. Triple T Specialty Meats, Inc. produced the chicken salad that ill people reported eating. On February 9, 2018, Fareway stopped selling chicken salad in all of its stores after the Iowa Department of Inspections and Appeals contacted the company about the illnesses. The Iowa Department of Public Health and the Iowa Department of Inspections and Appeals issued a consumer advisory on February 13, 2018 warning that chicken salad sold at Fareway may be contaminated with Salmonella.Investigators in Iowa collected chicken salad from two Fareway grocery store locations in Iowa for laboratory testing. An outbreak strain of Salmonella Typhimurium was identified in both samples. On February 21, 2018, Triple T Specialty Meats, Inc. recalled all chicken salad produced from January 2, 2018 to February 7, 2018. The recalled chicken salad was sold in containers of various weights from the deli at Fareway grocery stores in Iowa, Illinois, Minnesota, Nebraska, and South Dakota from January 4, 2018 to February 9, 2018.

Marler Clark, The Food Safety Law Firm is the nation’s leading law firm representing victims of foodborne illness outbreaks. We are representing sickened people and their families in every outbreak above.

The parasite cyclospora has gained notoriety this week as it’s been revealed to be responsible for over 10 illnesses in the Midwest in May and June. What is this organism that is a relatively rare cause of foodborne illness outbreaks in the U.S.? Here’s a little primer:

What is cyclospora?

Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a large form of cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans. The first known human cases of illness caused by cyclospora infection (that is, cyclosporiasis) were first discovered in 1977. An increase in the number of cases being reported began in the mid-1980s, in part due to the availability of better diagnostic techniques. Over 15,000 cases are estimated to occur in the United States each year. The first recorded cyclospora outbreak in North America occurred in 1990 and was linked to contaminated water. Since then, several cyclosporiasis outbreaks have been reported in the U.S. and Canada, many associated with eating fresh fruits or vegetables. In some developing countries, cyclosporiasis is common among the population and travelers to those areas have become infected as well.

Where does cyclospora come from?

Cyclospora is spread when people ingest water or food contaminated with infected stool. For example, exposure to contaminated water among farm workers may have been the original source of the parasite in raspberry-associated outbreaks in North America.

Cyclospora needs time (one to several weeks) after being passed in a bowel movement to become infectious. Therefore, it is unlikely that cyclospora is passed directly from one person to another. It is not known whether or not animals can be infected and pass infection to people.

What are the typical symptoms of Cyclospora infection?

Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, bloating, increased gas, stomach cramps, loss of appetite, nausea, low-grade fever, and fatigue. In some cases, vomiting, explosive diarrhea, muscle aches, and substantial weight loss can occur. Some people who are infected with cyclospora do not have any symptoms. Symptoms generally appear about a week after infection. If not treated, the illness may last from a few days up to six weeks. Symptoms may also recur one or more times. In addition, people who have previously been infected with cyclospora can become infected again.

What are the serious and long-term risks of cyclospora infection?

Cyclospora has been associated with a variety of chronic complications such as Guillain-Barre syndrome, reactive arthritis or Reiter’s syndrome, biliary disease, and acalculous cholecystitis. Since cyclospora infections tend to respond to the appropriate treatment, complications are more likely to occur in individuals who are not treated or not treated promptly. Extraintestinal infection also appears to occur more commonly in individuals with a compromised immune system.

How is cyclospora infection detected?

Your health care provider may ask you to submit stool specimen for analysis. Because testing for cyclospora infection can be difficult, you may be asked to submit several stool specimens over several days. Identification of this parasite in stool requires special laboratory tests that are not routinely done. Therefore, your health care provider should specifically request testing for cyclospora if it is suspected. Your health care provider might have your stool checked for other organisms that can cause similar symptoms.

How is cyclospora infection treated?

The recommended treatment for infection with cyclospora is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim, Septra, or Cotrim. People who have diarrhea should rest and drink plenty of fluids. No alternative drugs have been identified yet for people with cyclospora infection who are unable to take sulfa drugs. Some experimental studies, however, have suggested that ciprofloxacin or nitazoxanide may be effective, although to a lesser degree than trimethoprim-sulfamethoxazole. See your health care provider to discuss alternative treatment options.

How can Cyclospora infection be prevented?

Avoiding water or food that may be contaminated is advisable when traveling. Drinking bottled or boiled water and avoiding fresh ready-to-eat produce should help to reduce the risk of infection in regions with high rates of infection. Improving sanitary conditions in developing regions with poor environmental and economic conditions is likely to help to reduce exposure.

Washing fresh fruits and vegetables at home may help to remove some of the organisms, but cyclospora may remain on produce even after washing.

FDA, CDC, state, and local partners are currently investigating several Cyclospora illnesses associated with recalled Del Monte 6oz and 12oz vegetable trays containing broccoli, cauliflower, carrots and dill dip that were sold by Kwik Trip/Kwik Star locations in IA, MN, and WI. Additionally, Del Monte is recalling “small veggie trays,” which are 28oz and include broccoli, cauliflower, carrots, celery and dill dip that were distributed to Illinois and Indiana.

As of June 15, 2018, CDC has reported 78 laboratory-confirmed cases of cyclosporiasis in persons from IA, MN, WI and MI who reportedly consumed the vegetable trays. The two cases from Michigan reportedly purchased the vegetable tray in Wisconsin and therefore Michigan is not impacted from this outbreak.

On June 8, 2018, Del Monte withdrew their 6oz and 12oz vegetable trays from retail market locations, and they are not currently available for purchase. However, consumers who purchased these trays before the withdrawal may still have product in their homes since the expiration date is June 17, 2018 or earlier. The 28oz vegetable trays that were distributed to IL and IN are being recalled as of June 15, 2018. Del Monte reports the recalled products were distributed to: Kwik Trip, Kwik Star, Demond’s, Sentry, Potash, Meehan’s, Country Market, FoodMax Supermarket and Peapod in Illinois, Indiana, Iowa, Michigan, Minnesota, and Wisconsin and have “Best If Enjoyed By” date of June 17, 2018 or earlier.

FDA has not identified which of the ingredients is the vehicle for this outbreak; each component of these vegetable trays is under consideration. FDA is currently reviewing distribution and supplier information related to the vegetable trays; the investigation is ongoing

What is Cyclospora?

Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a large form of cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans. The first known human cases of illness caused by cyclospora infection (that is, cyclosporiasis) were first discovered in 1977. An increase in the number of cases being reported began in the mid-1980s, in part due to the availability of better diagnostic techniques. Over 15,000 cases are estimated to occur in the United States each year. The first recorded Cyclospora outbreak in North America occurred in 1990 and was linked to contaminated water. Since then, several cyclosporiasis outbreaks have been reported in the U.S. and Canada, many associated with eating fresh fruits or vegetables. In some developing countries, cyclosporiasis is common among the population and travelers to those areas have become infected as well.  See, www.outbreakdatabase.com for past outbreaks related to Cyclospora cayetanensis.

Where does Cyclospora come from?

Cyclospora is spread when people ingest water or food contaminated with infected stool. For example, exposure to contaminated water among farm workers may have been the original source of the parasite in raspberry-associated outbreaks in North America.

Cyclospora needs time (one to several weeks) after being passed in a bowel movement to become infectious. Therefore, it is unlikely that Cyclospora is passed directly from one person to another. It is not known whether or not animals can be infected and pass infection to people.

What are the typical symptoms of Cyclospora infection?

Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, bloating, increased gas, stomach cramps, and loss of appetite, nausea, low-grade fever, and fatigue. In some cases, vomiting, explosive diarrhea, muscle aches, and substantial weight loss can occur. Some people who are infected with Cyclospora do not have any symptoms. Symptoms generally appear about a week after infection. If not treated, the illness may last from a few days up to six weeks. Symptoms may also recur one or more times. In addition, people who have previously been infected with Cyclospora can become infected again.

What are the serious and long-term risks of Cyclospora infection?

Cyclospora has been associated with a variety of chronic complications such as Guillain-Barre syndrome, reactive arthritis or Reiter’s syndrome, biliary disease, and acalculous cholecystitis. Since Cyclospora infections tend to respond to the appropriate treatment, complications are more likely to occur in individuals who are not treated or not treated promptly. Extraintestinal infection also appears to occur more commonly in individuals with a compromised immune system.

How is Cyclospora infection detected?

Your health care provider may ask you to submit stool specimen for analysis. Because testing for Cyclospora infection can be difficult, you may be asked to submit several stool specimens over several days. Identification of this parasite in stool requires special laboratory tests that are not routinely done. Therefore, your health care provider should specifically request testing for Cyclospora if it is suspected. Your health care provider might have your stool checked for other organisms that can cause similar symptoms.

How is Cyclospora infection treated?

The recommended treatment for infection with cyclospora is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim, Septra, or Cotrim. People who have diarrhea should rest and drink plenty of fluids. No alternative drugs have been identified yet for people with Cyclospora infection who are unable to take sulfa drugs. Some experimental studies, however, have suggested that ciprofloxacin or nitazoxanide may be effective, although to a lesser degree than trimethoprim-sulfamethoxazole. See your health care provider to discuss alternative treatment options.

How can Cyclospora infection be prevented?

Avoiding water or food that may be contaminated is advisable when traveling. Drinking bottled or boiled water and avoiding fresh ready-to-eat produce should help to reduce the risk of infection in regions with high rates of infection. Improving sanitary conditions in developing regions with poor environmental and economic conditions is likely to help to reduce exposure.

Washing fresh fruits and vegetables at home may help to remove some of the organisms, but Cyclospora may remain on produce even after washing.

.

Del Monte Fresh Produce N.A., Inc. (“Del Monte Fresh”) announced today, the voluntary recall of a limited quantity of 6 oz., 12 oz. and 28 oz. vegetable trays containing fresh broccoli, cauliflower, celery sticks, carrots, and dill dip sold to select retailers in Illinois, Indiana, Iowa, Michigan, Minnesota and Wisconsin. Del Monte was notified by state agencies of the outbreak and its potential involvement. Del Monte has recalled the products because they may be linked to this recent cluster of illnesses and have the potential to be contaminated with Cyclospora, a parasite that can cause the intestinal illness Cyclosporiasis. According to the Centers for Disease Control, the infection usually is not life threatening. Symptoms of Cyclosporiasis may include the following: watery diarrhea (most common), loss of appetite, weight loss, cramping, bloating, increased gas, nausea, fatigue. Other symptoms that may occur but are less common include the following: vomiting and/or low-grade fever.

The recalled products were distributed to: Kwik Trip, Kwik Star, Demond’s, Sentry, Potash, Meehan’s, Country Market, Food Max Supermarket and Peapod in Illinois, Indiana, Iowa, Michigan, Minnesota, and Wisconsin and have “Best If Enjoyed By” date of June 17, 2018 or earlier. The recalled products were distributed for sale in clear plastic containers with the following labels and markings:

Product Name Most Recent Components UPC Code
Best By date

Del Monte 6 oz.

6/17/2018 Baby carrots, broccoli, 7 1752472715 2

Veg Tray w/dip

cauliflower and dill dip
Del Monte 12 oz. 6/17/2018 Baby carrots, broccoli, 7 1752472518 9
Veg Tray w/dip cauliflower and dill dip
Del Monte 28 oz. 6/17/2018 Baby carrots, broccoli, 7 1752478604 3
Small Veg Tray

cauliflower, celery sticks

w/dip

and dill dip

The Minnesota Department of Health (MDH) is investigating an increase in Cyclospora infections within the last month. To date, state health officials have identified two outbreaks together involving at least three dozen Minnesotans.

One outbreak has been identified among people who ate at Sonora Grill in Minneapolis in mid-May. To date, 17 patrons have reported illness. The restaurant is fully cooperating with the investigation, and investigators say they do not have any indication that there is an ongoing risk to patrons.

To better identify the source of infection, MDH investigators want to speak with people who ate at Sonora Grill over the weekend of May 18-May 20, regardless of whether they became ill.

“Even if you have not been sick, your information can help us identify what may have caused these illnesses and prevent future illnesses,” said Trisha Robinson, an epidemiologist supervisor with MDH. “If you ate at Sonora Grill during that weekend of May 18-20, please contact the Minnesota Department of Health Waterborne Diseases Unit at 651-201-4891.”

Infection with Cyclospora, known as cyclosporiasis, is caused by the parasite Cyclospora and is spread through consumption of imported fresh produce; it is not spread person-to-person. Washing of imported produce, or routine chemical disinfection or sanitizing methods, are unlikely to kill Cyclospora. Symptoms typically include watery diarrhea, stomach cramps, nausea, loss of appetite and weight loss. People typically become ill about a week after exposure, but this period can range from 2-14 days. Diarrhea can last several weeks or longer if not treated.

A second outbreak has been linked to Del Monte vegetable trays purchased at Kwik Trip locations. To date, 20 cases have been identified among Minnesotans in this outbreak. Cases report purchasing the vegetable trays at various Kwik Trip locations around the state. Kwik Trip is cooperating with the investigation and voluntarily removed the vegetable trays from their shelves. Consumers should not eat the following products:

  • Del Monte Vegetable Tray, containing broccoli, cauliflower, carrots and dill dip, 6 oz.
  • Del Monte Vegetable Tray, containing broccoli, cauliflower, carrots and dill dip, 12 oz.

MDH investigators are working with the Minneapolis Health Department and the Minnesota Department of Agriculture (MDA) on the Sonora Grill outbreak and with MDA and other states on the Kwik Trip outbreak.

“We do not have any indication at this time that the two outbreaks are related,” Robinson said. “Besides these outbreak cases, there are other cases of cyclosporiasis that do not appear to be related to either of these outbreaks, which is not unexpected for this time of year. We typically see increases in Cyclospora infections from May through August.”

Health officials encourage anyone experiencing the symptoms of cyclosporiasis, particularly if they consumed a vegetable tray purchased at Kwik Trip or dined at Sonora Grill, to contact their health care provider.

What is Cyclospora?

Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a large form of cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans. The first known human cases of illness caused by cyclospora infection (that is, cyclosporiasis) were first discovered in 1977. An increase in the number of cases being reported began in the mid-1980s, in part due to the availability of better diagnostic techniques. Over 15,000 cases are estimated to occur in the United States each year. The first recorded Cyclospora outbreak in North America occurred in 1990 and was linked to contaminated water. Since then, several cyclosporiasis outbreaks have been reported in the U.S. and Canada, many associated with eating fresh fruits or vegetables. In some developing countries, cyclosporiasis is common among the population and travelers to those areas have become infected as well.  See, www.outbreakdatabase.com for past outbreaks related to Cyclospora cayetanensis.

Where does Cyclospora come from?

Cyclospora is spread when people ingest water or food contaminated with infected stool. For example, exposure to contaminated water among farm workers may have been the original source of the parasite in raspberry-associated outbreaks in North America.

Cyclospora needs time (one to several weeks) after being passed in a bowel movement to become infectious. Therefore, it is unlikely that Cyclospora is passed directly from one person to another. It is not known whether or not animals can be infected and pass infection to people.

What are the typical symptoms of Cyclospora infection?

Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, bloating, increased gas, stomach cramps, and loss of appetite, nausea, low-grade fever, and fatigue. In some cases, vomiting, explosive diarrhea, muscle aches, and substantial weight loss can occur. Some people who are infected with Cyclospora do not have any symptoms. Symptoms generally appear about a week after infection. If not treated, the illness may last from a few days up to six weeks. Symptoms may also recur one or more times. In addition, people who have previously been infected with Cyclospora can become infected again.

What are the serious and long-term risks of Cyclospora infection?

Cyclospora has been associated with a variety of chronic complications such as Guillain-Barre syndrome, reactive arthritis or Reiter’s syndrome, biliary disease, and acalculous cholecystitis. Since Cyclospora infections tend to respond to the appropriate treatment, complications are more likely to occur in individuals who are not treated or not treated promptly. Extraintestinal infection also appears to occur more commonly in individuals with a compromised immune system.

How is Cyclospora infection detected?

Your health care provider may ask you to submit stool specimen for analysis. Because testing for Cyclospora infection can be difficult, you may be asked to submit several stool specimens over several days. Identification of this parasite in stool requires special laboratory tests that are not routinely done. Therefore, your health care provider should specifically request testing for Cyclospora if it is suspected. Your health care provider might have your stool checked for other organisms that can cause similar symptoms.

How is Cyclospora infection treated?

The recommended treatment for infection with cyclospora is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim, Septra, or Cotrim. People who have diarrhea should rest and drink plenty of fluids. No alternative drugs have been identified yet for people with Cyclospora infection who are unable to take sulfa drugs. Some experimental studies, however, have suggested that ciprofloxacin or nitazoxanide may be effective, although to a lesser degree than trimethoprim-sulfamethoxazole. See your health care provider to discuss alternative treatment options.

How can Cyclospora infection be prevented?

Avoiding water or food that may be contaminated is advisable when traveling. Drinking bottled or boiled water and avoiding fresh ready-to-eat produce should help to reduce the risk of infection in regions with high rates of infection. Improving sanitary conditions in developing regions with poor environmental and economic conditions is likely to help to reduce exposure.

Washing fresh fruits and vegetables at home may help to remove some of the organisms, but Cyclospora may remain on produce even after washing.

As of September 13, 2017 (1:30pm EDT), CDC has been notified of 988 laboratory-confirmed cases of cyclosporiasis in persons who became ill in 2017. This number includes persons who reported international travel as well as persons who did not report travel. The reports have come from 40 states.

At least 553 (56%) of these persons did not report international travel (i.e., likely were infected in the United States) and became ill on or after May 1, 2017 (a date after which cases tend to increase each year). These 553 persons were from the following 36 states: Arizona (1), California (10), Colorado (6), Connecticut (23), Florida (68), Georgia (10), Illinois (17), Indiana (4), Iowa (14), Kansas (2), Louisiana (7), Maryland (12), Massachusetts (13), Michigan (3), Minnesota (11), Mississippi (1), Missouri (13), Montana (2), Nebraska (5), New Hampshire (4), New Jersey (19), New Mexico (1), New York (excluding NYC) (15), New York City (30), North Carolina (45), Ohio (16), Pennsylvania (2), Rhode Island (2), South Carolina (7), South Dakota (4), Tennessee (3), Texas (163), Utah (1), Virginia (7), Washington (1), West Virginia (2), and Wisconsin (9).

At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source (or sources) of infection are ongoing. It is too early to say whether cases of Cyclospora infection in different states are related to each other or to the same food item(s).

Previous U.S. outbreaks of cyclosporiasis have been linked to various types of imported fresh produce (e.g., basil, cilantro, mesclun lettuce, raspberries, snow peas). Consumers should continue to enjoy the health benefits of eating fresh fruits and vegetables as part of a well-balanced diet.

More information about Cyclospora can be found on CDC’s Cyclospora pages.

Cyclospora cayetanensis is a single-celled parasite that causes an intestinal infection called cyclosporiasis.

Advice for consumers about prevention and recognition of cyclosporiasis can be found here.

According to Food Safety News, Federal health officials are asking health care providers across the country to be on the lookout for foodborne infections from the Cyclospora parasite because more than double the number of cases have already been confirmed this year and the peak season is not yet ended.

From May 1 through Aug. 2 this year in the United States there were 206 confirmed cases of cyclosporiasis, compared with 80 confirmed cases during that time period in 2016, according to an advisory posted Monday by the Centers for Disease Control and Prevention. Such advisories are relatively rare, with Monday’s being only the sixth from the CDC this year.

“At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source of infection are ongoing. It is too early to say whether cases of Cyclospora infection in different states are related to each other and/or to the same food item(s),” according to the CDC advisory.

“Previous outbreaks in the United States have been linked to various types of imported fresh produce — e.g., basil, cilantro, mesclun lettuce, raspberries, and snow peas.”

The CDC advisory did not include a state-by-state breakdown of confirmed infections, but it did report that at least 18 people have required hospitalization. The 206 confirmed infections have been reported from 27 states, most of which have reported relatively few cases, CDC reported.

On Aug. 1 the Texas Department of State Health Services reported confirmed cases in the Lone Star state had more than doubled in the second half of July, increasing from 68 on July 17 to 160 as of Aug. 1.

The NYC Health Department reported on July 24 that it has been tracking an increase of Cyclospora parasite infections there. A total of 27 cases were reported between Jan. 1 – June 30, 2017, compared to 13 cases in 2016, and 21 cases in 2015 during the same time period,” the New York City department reported.

What is Cyclospora?

Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a large form of cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans. The first known human cases of illness caused by cyclospora infection (that is, cyclosporiasis) were first discovered in 1977. An increase in the number of cases being reported began in the mid-1980s, in part due to the availability of better diagnostic techniques. Over 15,000 cases are estimated to occur in the United States each year. The first recorded Cyclospora outbreak in North America occurred in 1990 and was linked to contaminated water. Since then, several cyclosporiasis outbreaks have been reported in the U.S. and Canada, many associated with eating fresh fruits or vegetables. In some developing countries, cyclosporiasis is common among the population and travelers to those areas have become infected as well.  See, www.outbreakdatabase.com for past outbreaks related to Cyclospora cayetanensis.

Where does Cyclospora come from?

Cyclospora is spread when people ingest water or food contaminated with infected stool. For example, exposure to contaminated water among farm workers may have been the original source of the parasite in raspberry-associated outbreaks in North America.

Cyclospora needs time (one to several weeks) after being passed in a bowel movement to become infectious. Therefore, it is unlikely that Cyclospora is passed directly from one person to another. It is not known whether or not animals can be infected and pass infection to people.

What are the typical symptoms of Cyclospora infection?

Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, bloating, increased gas, stomach cramps, and loss of appetite, nausea, low-grade fever, and fatigue. In some cases, vomiting, explosive diarrhea, muscle aches, and substantial weight loss can occur. Some people who are infected with Cyclospora do not have any symptoms. Symptoms generally appear about a week after infection. If not treated, the illness may last from a few days up to six weeks. Symptoms may also recur one or more times. In addition, people who have previously been infected with Cyclospora can become infected again.

What are the serious and long-term risks of Cyclospora infection?

Cyclospora has been associated with a variety of chronic complications such as Guillain-Barre syndrome, reactive arthritis or Reiter’s syndrome, biliary disease, and acalculous cholecystitis. Since Cyclospora infections tend to respond to the appropriate treatment, complications are more likely to occur in individuals who are not treated or not treated promptly. Extraintestinal infection also appears to occur more commonly in individuals with a compromised immune system.

How is Cyclospora infection detected?

Your health care provider may ask you to submit stool specimen for analysis. Because testing for Cyclospora infection can be difficult, you may be asked to submit several stool specimens over several days. Identification of this parasite in stool requires special laboratory tests that are not routinely done. Therefore, your health care provider should specifically request testing for Cyclospora if it is suspected. Your health care provider might have your stool checked for other organisms that can cause similar symptoms.

How is Cyclospora infection treated?

The recommended treatment for infection with cyclospora is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim, Septra, or Cotrim. People who have diarrhea should rest and drink plenty of fluids. No alternative drugs have been identified yet for people with Cyclospora infection who are unable to take sulfa drugs. Some experimental studies, however, have suggested that ciprofloxacin or nitazoxanide may be effective, although to a lesser degree than trimethoprim-sulfamethoxazole. See your health care provider to discuss alternative treatment options.

How can Cyclospora infection be prevented?

Avoiding water or food that may be contaminated is advisable when traveling. Drinking bottled or boiled water and avoiding fresh ready-to-eat produce should help to reduce the risk of infection in regions with high rates of infection. Improving sanitary conditions in developing regions with poor environmental and economic conditions is likely to help to reduce exposure.

Washing fresh fruits and vegetables at home may help to remove some of the organisms, but Cyclospora may remain on produce even after washing.

peasjpg.jpg.size.xxlarge.letterboxCostco Wholesale Canada is recalling Alpine Fresh brand snap peas in Ontario due to possible Cyclospora contamination.

The Canadian Food Inspection Agency says there have been illnesses connected with the recall, but it was not immediately clear how many people were affected.

The agency issued a news release Saturday that says the product was distributed at Costco outlets across Ontario and contain best before dates from Oct. 15 to 29.

The agency says people infected with Cyclospora can experience a wide range of symptoms including diarrhea, stomach cramps and nausea.

outbreak_map_8_25_2015As of September 14, 2015 (3pm EDT), a total of 546 ill persons with confirmed Cyclospora infection were reported to CDC in 2015. Most of these persons—319 (58%) of 546—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. These 319 persons were from the following 23 states: Arkansas (3), California (2), Connecticut (5), Florida (13), Georgia (26), Illinois (9), Iowa (1), Kansas (2), Maryland (1), Massachusetts (12), Michigan (2), Missouri (1), Montana (3), Nebraska (1), New Jersey (7), New Mexico (2), New York (excluding NYC) (10), New York City (22), North Carolina (1), Texas (179), Utah (1), Virginia (3), Washington (2), and Wisconsin (11). Clusters of illness linked to restaurants or events have been identified and investigated in Texas, Wisconsin, and Georgia. Epidemiologic and traceback investigations conducted in Texas, Wisconsin, and Georgia by state and local public health and regulatory officials and the FDA indicated that some illnesses among residents in these states were linked to fresh cilantro from Puebla, Mexico. The vehicle(s) of infection for non-cluster-associated cases has not been identified. The numbers of reported cases of cyclosporiasis in the United States have returned to baseline levels.

Illness onset dates ranged from May 1 to August 22, 2015. Ill persons ranged in age from 15 to 89 years, with a median age of 51 years. Fifty-six percent (56%) of ill persons were female.

The vehicle(s) of infection for non-cluster-associated cases has not been identified.

The numbers of reported cases of cyclosporiasis in the United States have returned to baseline levels.

Previous U.S. outbreaks of cyclosporiasis have been linked to imported fresh produce, including cilantro from the Puebla region of Mexico. Read the related FDA Import Alert.

outbreak_map_8_25_2015As of August 21, 2015, CDC had been notified of 495 ill persons with confirmed Cyclospora infection from 30 states in 2015.

Most of these persons—293 (59%) of 495—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. These 293 persons were from the following 23 states: Arkansas (3), California (2), Connecticut (3), Florida (10), Georgia (23), Illinois (8), Iowa (1), Kansas (2), Maryland (1), Massachusetts (10), Michigan (2), Missouri (1), Montana (3), Nebraska (1), New Jersey (6), New Mexico (2), New York (excluding NYC) (9), New York City (21), North Carolina (1), Texas (168), Utah (1), Virginia (3), Washington (2), and Wisconsin (10).

Clusters of illness linked to restaurants or events have been identified in Texas, Wisconsin, and Georgia. Cluster investigations are ongoing in Texas and Georgia. Cluster investigations in Wisconsin and Texas have preliminarily identified cilantro as a suspect vehicle.

Previous U.S. outbreaks of cyclosporiasis have been linked to imported fresh produce, including cilantro from the Puebla region of Mexico.