CDC: New Cyclospora Infections Not Linked to Taylor Farms

Public health investigators have interviewed all the people with Cyclosporiasis in Texas about their exposures during the 2 weeks before they became ill. These interviews have covered what food they ate and where they ate and purchased their food. On the basis of these interviews, investigators have identified a group (cluster) of ill people who reported eating at the same restaurant. A detailed investigation of this cluster is ongoing. This investigation includes listing the different ingredients in the food that was eaten. People who did not get sick but who also ate meals at the same restaurant on the same days as ill people are also being interviewed. The preliminary analysis of results from this ongoing cluster investigation in Texas does not show a connection to salad mix, leafy greens, and salad mix components produced at Taylor Farms de Mexico.

From August 11-19, 2013, FDA with the cooperation of Taylor Farms de Mexico and Mexican government authorities conducted a thorough environmental assessment at the firm’s processing facility. The team also assessed five farms identified through traceback information from the outbreak investigation. The team found that conditions and practices at these facilities at the time of the assessment were in accordance with known food safety protocols. On August 25, 2013, Taylor Farms de Mexico, with FDA concurrence, resumed production and shipment of salad mix, leafy greens, and salad mix components to the United States.

The findings in Texas differ from those from earlier investigations in Iowa and Nebraska. In those states investigators linked cyclosporiasis cases acquired after eating in one of multiple restaurants to eating a bagged salad mix from Taylor Farms de Mexico. It is not unusual to recognize outbreaks that happen in the same season but are due to different foods. Not all cases during the same time of year are necessarily caused by the same exposure.

For example, during a several-month period in 1997, there were three separate and unrelated outbreaks of cyclosporiasis caused by different fresh produce items from various sources. Strong evidence from epidemiologic investigations led to the recognition that the outbreaks were separate and unrelated. Although the investigation of cases in 2013 is ongoing, available evidence suggests that not all of the cases of cyclosporiasis in the various states are directly related to each other. CDC continues to work with state and local partners and FDA to investigate clusters of illness, food exposures, and sources of food items.

No laboratory tests are available yet that can distinguish different strains of the parasite Cyclospora cayetanensis. CDC and other institutions are working on developing new molecular tools that could distinguish one strain from another. These tools would help public health investigators more quickly determine whether cases of Cyclospora infection are linked. These tools could also be useful for linking a possible source of infection to illnesses in people.

As of August 23, 2013 (5pm EDT), a total of 610 ill persons with Cyclospora infection have been reported from 22 states. Since the last update, 1 additional ill person was reported.

Ill persons range in age from less than one year to 92 years, with a median age of 51 years. 55 percent of ill persons are female. Among 581 ill persons for whom information is available, 43 have reported being hospitalized. No deaths have been reported.

Illnesses that occurred after July 17, 2013, might not yet have been reported because of the time it takes between when a person becomes ill and when the illness is reported. This could take up to 5 to 6 weeks.

Salads at Olive Garden and Red Lobster Caused Cyclosporiasis

New evidence on outbreak
The FDA investigation has confirmed that the salad mix identified by Iowa and Nebraska as being linked to the outbreak of cyclosporiasis in those states was supplied to restaurants in those states by Taylor Farms  a processor of food service salads. These salads were not sold retail at grocery stores  The restaurants in Iowa and Nebraska include Olive Garden and Red Lobster,

The Salad greens were grown by Taylor Farms in Mexico. They  have  been cooperating with all FDA requests during the investigation.  The FDA and the firm will be checking out  the firm's processing facility in Mexico, to try to learn the cause of the outbreak and identify preventive controls to try and prevent a recurrence. The most recent inspection, in 2011, of the processing facility of Taylor Farms. conducted by FDA found no notable issues.  Additionally, as a result of the current investigation FDA is increasing its surveillance efforts on green leafy products exported to the U.S. from Mexico. 

Mexican food regulatory authorities are also collaborating with FDA in the investigation of this outbreak.

The Iowa Department of Inspections and Appeals and the Nebraska Department of Health and Human Services have announced that they believe the contaminated salad is no longer in the food supply in those states.  The last date that someone reportedly became ill with cyclosporiasis in Iowa was on July 1, and in Nebraska on July 2.  The typical shelf life for a salad mix is up to 14 days.

As of August 1, 2013, CDC has been notified of more than 400 cases of Cyclospora infection from the following 17 health departments: Iowa, Nebraska, Texas, Wisconsin, Arkansas, Connecticut, Florida, Georgia, Illinois, Kansas, Louisiana, Minnesota, Missouri, New Jersey, New York, New York City,  and Ohio.  It is not yet clear whether the cases reported from other states are all part of the same outbreak. The investigation of increased cases of cyclosporiasis in other states continues.    

Cyclospora cayetanensis is a parasite composed of one cell, too small to be seen without a microscope. This parasite causes an intestinal infection called cyclosporiasis.

Cyclospora is acquired by people ingesting something - such as food or water - that was contaminated with the parasite.  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.

The time between becoming infected and becoming sick is usually about 1 week. 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. Some people who are infected with Cyclospora do not have any symptoms.  If not treated, the illness may last from a few days to a month or longer. Symptoms may seem to go away and then return one or more times (relapse). It’s common to feel very tired.

Consumers should always practice safe food handling and preparation measures. Wash hands, utensils, and surfaces with hot, soapy water before and after handling food.  Fresh produce should be thoroughly washed before it is eaten.