Olive Garden and Red Lobster Falsely Accused

As of September 20, 2013 the CDC had been notified of 643 ill persons with of Cyclospora infection from 25 states: Arkansas, California, Connecticut, Florida, Georgia, Illinois, Iowa, Kansas, Louisiana, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, New York (including New York City), Ohio, Pennsylvania, South Dakota, Tennessee, Texas, Virginia, Wisconsin, and Wyoming.

Most of the illness onset dates have ranged from mid-June through mid-July. Among 581 ill persons with available information, 45 (8%) have reported being hospitalized. No deaths have been reported.

Public health officials in Iowa and Nebraska performed investigations within their states and concluded that restaurant-associated cases of Cyclospora infection in their states were linked to a salad mix produced by Taylor Farms de Mexico. Olive Garden and Red Lobster were named by the FDA as two places where the contaminated salad was served.

On August 12, 2013, Taylor Farms de Mexico informed FDA that the company had voluntarily suspended production and shipment of any salad mix, leafy green, or salad mix components from its operations in Mexico to the United States.

Taylor Farms did 1800 tests trying to find Cyclospora. All Tests were negative. No Cyclospora was found. 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. No announcement was made to correct the misinformation about Olive

Although the investigation of cases continued, available evidence suggests that not all of the cases of cyclosporiasis in the various states are directly related to each other.

However, unlike some other foodborne parasites, cyclospora doesn't become infectious for days or weeks this causes a real problem for investigators because most people do not remember what they ate that long ago. It is likely that we will never know what caused the outbreak.

630 Sick from 20 States from Cyclospora- Why???

So far the CDC reports a total of 609 cases of Cyclospora infection have been reported from 22 states and New York City. The number of cases identified in each area is as follows: Texas (257), Iowa (156), Nebraska (86), Florida (31), Wisconsin (16), Illinois (11), Arkansas (10), New York City (7), Georgia (5), Missouri (5), Kansas (4), Louisiana (3), New Jersey (3), Connecticut (2), Minnesota (2), New York (2), Ohio (2), Virginia (2), California (1), New Hampshire (1), South Dakota (1), Tennessee (1), and Wyoming (1).

Although the CDC reports the Texas total as 257, Texas reports that a total of 278 cases of Cyclospora infection have been reported in Texas in 2013 with the vast majority having onsets in June and July. Most Texas cases are reported from the Dallas/Fort Worth area. DSHS is investigating the cases to identify possible common exposures and to determine whether they are linked to an outbreak in other states.

No deaths have been reported but 40 have reported being hospitalized.

Nearly two months have passed since state and federal health authorities first became aware on June 28 of two related cases of Cyclospora infection in Iowa residents. Considering Iowa typically sees one or two such cases a year, the small irregularity immediately caught the attention of state health officials.

Within weeks, authorities had identified several hundred cases across a dozen states, with the bulk in Iowa, Nebraska and Texas. On Aug. 1, investigators in Iowa and Nebraska concluded that the majority of cases in those two states were connected to lettuce grown by Taylor Farms de Mexico and in salads served at Olive Gardens and Red Lobsters.

But, as time goes on, the investigations in Texas and the remaining states have still not identified an outbreak source. The U.S. Food and Drug Administration has a team of investigators at Taylor Farms in Mexico performing environmental assessments of the facilities and traceback investigations to determine where else – if anywhere – contaminated lettuce might have been sold, according to FDA spokesman David Steigman.

A number of cases in Texas are not easily connected to Darden Restaurants and Taylor Farms, said Dave Theno, Ph.D., CEO of Gray Dog Partners, a technical food safety consulting agency. But he said that the evidence remains “pretty compelling” that most of the illnesses are part of one event until an FDA investigation proves otherwise.

Because fresh produce has a relatively short shelf-life, distribution channels typically run up north from Mexico, not east to west. Based on the geography of the outbreak, it would make sense to assume that contaminated produce was sent north through Texas and ended up in Iowa and Nebraska.

Theno said the most important question for investigators in Mexico to answer is whether Taylor Farms has crop contamination problems that moved Cyclospora through their facilities or whether it’s an area-wide contamination issue – possibly from a water source – that might mean nearby crops were also affected.

A number of factors complicate the investigation as a whole.

First, a representative from Darden Restaurants told NBC News that they do not use Taylor Farms salad in their Texas restaurants. It is not clear if the restaurant sources Taylor Farms salad in any states besides Iowa and Nebraska.

A Florida woman who tested positive for Cyclospora in July ate at Olive Garden several days before getting ill. Florida has 31 confirmed illnesses, the fourth-highest number of the states involved.

Further complicating the matter, not even all of the cases in Iowa and Nebraska have a clear connection to Darden. Roughly 80 percent of Iowa cases and 75 percent of Nebraska cases appear connected to Darden, leaving the remaining 20 to 25 percent more of a mystery, according to Iowa state epidemiologist Dr. Patricia Quinlisk.

To complicate the investigation even more, the salad came into the U.S. pre-mixed with Taylor lettuce and other ingredients.

Perhaps the biggest issue distancing the Texas illnesses is that they began, on average, a week later than those in Iowa and Nebraska.

In Texas, where illnesses appear to have less of a connection  Taylor, patients are being interviewed and re-interviewed about all the places they may have dined.

The biggest roadblock, however, has been the relatively long incubation period of Cyclospora parasites. Patients may not experience symptoms such as diarrhea and nausea for several days – or even weeks – after exposure.

“It’s difficult to explain to people why it’s taking so long,” Mann said. “By the time the cases are finally reported to the CDC, several weeks have gone by. When an epidemiologist finally interviews patients, they might not remember eating the food that got them sick.”

Some cases, Quinlisk said, may be isolated Cyclospora illnesses that have gotten swept up in the outbreak investigation. A few hundred cases get reported in the U.S. each year on average.

Quinlisk described the investigation into the Iowa and Nebraska illnesses as “very detailed.”

The classic food history interview involves an 18-page questionnaire that takes more than an hour for each patient to complete. Patients may then receive additional calls from the environmental health team looking for more information.

The state health departments in those states performed targeted cluster investigations using case-control studies. In short, they interviewed patients who got sick, as well as fellow diners who didn’t get sick, to tease out any statistical differences in their meals. They even retrieved credit-card records from patients to coordinate dates of exposure.

Another issue that makes these investigations tricky is that not everyone who eats the contaminated food ends up sick. The parasite is not evenly dispersed across all the salad, and so some diners may ingest a large number of organisms, while others may eat from the same salad bowl and ingest only a few or none at all.

The general rule of thumb, Quinlisk said, is to expect about 40 percent of those who ate a contaminated food to actually end up with symptoms.

One issue this outbreak raises is the need for more coordination between state health departments during large, interstate outbreaks, said Craig Hedberg, Ph.D., environmental health professor at the University of Minnesota.

Hedberg compared the national jurisdiction of food regulation from FDA to the patchwork of state health departments that make up the majority of environmental health investigation resources.

“Our public-health system is really based on individual state authorities, and we don’t have a national framework for conducting outbreak investigations in parallel with the kind of regulation we have with respect to the food itself,” Hedberg said. “The CDC attempts to help guide those investigations, but because of limited resources and different priorities across different states, that coordination doesn’t always occur as seamlessly as we’d like to see it.”

Theno said he felt this current outbreak demonstrated the need for better cooperation and communication between federal investigators at FDA and the companies potentially involved in the outbreak.

“I think we need to find a way for companies and regulatory agencies to work much more closely together on these outbreaks,” Theno said. “It takes a long time for the agency to reach back into the supply chain. The faster we can get to the source of an outbreak, the sooner we can stop it and the better we can prevent it in the future.”

(Cyclospora is a single-celled food- or waterborne parasite that may cause diarrhea, nausea and vomiting. In the U.S., it is often associated with imported fresh produce. In 1996, at least 1,465 people were infected with Cyclospora in an outbreak linked to raspberries grown in Guatemala. Another 804 people were sickened by Guatemalan raspberries the next year. In 2005, 592 contracted Cyclospora infections after eating basil imported from Peru.)

Source Food Safety News

The Cyclospora Outbreak Continues To Grow

According To the Centers for Disease Control and Prevention (CDC) in Atlanta there are 21 more cases of Cyclospora Infection. The count for this week is 535 and now it has spread to 18 states. Thirty two have been hospitalized.

On Aug. 2  FDA had informed CDC that the traceback investigation had concluded he prepackaged salad mix blamed by Iowa and Nebraska health officials for the outbreak in those states had come from Taylor Farms in Mexico.  But it took a full week until Aug. 9, that those shipments were stopped by the producer.

“This voluntary action goes beyond the salad mix and includes iceberg lettuce, romaine lettuce, green leaf lettuce, red cabbage, green cabbage and carrots.”

The current distribution of the outbreak cases is as follows: Texas (215), Iowa (153), Nebraska (86), Florida (27), Wisconsin (10), Illinois (9), Arkansas (5), Georgia (5), Missouri (4), Kansas (3), Louisiana (3), New Jersey (2), Ohio (2), Virginia (2), Connecticut (1), Minnesota (1), New Hampshire (1), and New York (6).

Iowa and Nebraska have concluded the source of the Cyclospora outbreak is those states is a salad mix produced from Mexican grown produce, CDC says it is continuing to work with the other states to determine if that product is responsible for the entire outbreak.

CDC continues to say it is not clear whether all 535 cases are part of the same outbreak or whether it is multiple outbreaks.

Taylor Farms has said its Mexico facility has an extensive water testing program to try to find the source of the problem. Taylor Farms will use processing facilities in California, Colorado, Texas, Tennessee, Florida, and Maryland will take over the salad mix production.

Even though the implicated salad mix has been out of the supply chain since late June, the illness count continues to increase on a daily basis as sick people seek treatment and are diagnosed. The parasite infections cause symptoms that last up to three months in healthy people and up to a year in elderly or immune compromised people who do not seek treatment.

Major purchasers from Taylor Farms in Mexico included the Olive Garden and Red Lobster restaurant chains. Other smaller unnamed restaurants and grocery stores were involved

It is imperative that people wash their produce whether it is bagged or not sense  it is not clear if the outbreak was totally caused by taylor farms products. Actually this is a good practice anytime.

Iowa’s Law Keeps Consumers in the Dark

In Iowa the law makes it illegal for the Iowa Department of Public Health (IDPH) to tell the public the name of a business that caused a public health threat if the is over.

In Iowa’s recent Cyclospora outbreak the public didn't know that the salad at Red Lobster and Olive Garden were infected until the FDA finally announced the results. The IDPH said nothing, The problem with this is that it doesn't give the public the knowledge to ask Red Lobster and Olive Garden if they wash their salad greens before they serve it to their customers.

The IDHP said its investigation found 50 possible sites that were distributing the bad salad mix, including 15 restaurants, 30 grocery stores and some isolated others. But all the public hears about is Red Lobster and Olive Garden.

The FDA doesn't always come to the rescue.  The Law kept the names of public  swimming pools that have been spreading the Cryptosporidium out of the press. This blocked disclosure of the names of at least 30 public and privately owned swimming pools that have failed to manage the parasite infections. This is a yearly problem and the public doesn't know which pools are doing a good job.

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.