Salad pegged in Iowa, Neb. cyclospora outbreak


In this image provided by the Centers for Disease Control and Prevention, a photomicrograph of a fresh stool sample, which had been prepared using a 10% formalin solution, and stained with modified acid-fast stain, reveals the presence of four Cyclospora cayetanensis oocysts in the field of view.

AP
Published: Wednesday, July 31, 2013 at 8:52 a.m.
Last Modified: Wednesday, July 31, 2013 at 8:52 a.m.

LINCOLN, Neb. — Health officials in Iowa and Nebraska on Tuesday identified prepackaged salad mix as the source of a severe stomach bug that sickened hundreds of people in both states, but federal authorities said it's not clear whether cyclospora outbreaks elsewhere in the U.S. are also linked to that produce.

Facts

Some frequently asked questions about the infection and the outbreak:

Q: What are cyclospora infections and how do people contract them?

A: Cyclospora infection, or cyclosporiasis, is caused by parasites that are spread when people ingest food or water contaminated with feces. People who are exposed usually become sick after about a week and have bad diarrhea and other flu-like symptoms that can last from a few days to a month or longer if untreated. It's common to feel tired and relapse is possible. It's not generally contagious and can be treated with antibiotics. Deaths from the infection are rare.

Q: Who is usually at risk?

A: People who live or travel in tropical or subtropical countries are most at risk, according to the CDC. The infections are rare in the United States but have been linked in the past to imported fruits and vegetables.

Q: Am I at risk in this current outbreak? How do I know if I have it?

A: You are probably OK if you have not already gotten sick. The CDC reports that most of the illnesses were reported between mid-June and early July. Fifteen states have so far reported illnesses: Arkansas, Connecticut, Florida, Georgia, Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, New Jersey, New York, Ohio, Texas and Wisconsin.

Q: How does the government trace the source of illnesses like this?

A: It takes a lot of legwork and coordination between states and the federal government. Cases are confirmed when a sick person gives a sample to his or her doctor and that sample is tested. If it is positive, it will eventually be reported to a state health department. The states then gather that data and coordinate with the CDC to look for common strains that could link the illness to a specific product. State and federal officials interview the victims and closely question them about what they ate around the time they fell ill — often a difficult task, as it is hard for most people to remember everything they ate over an extended time. That is made even harder in a cyclosporiasis investigation because the illness doesn't show up for a week.

In this outbreak, the Food and Drug Administration says its investigators have been trying to trace the paths of the food eaten by those who fell ill. Food often goes through several stops — potentially in several countries — before it reaches a grocery cart, and the FDA said the process is "labor-intensive and painstaking work, requiring the collection, review and analysis of hundreds and at times thousands of invoices and shipping documents."

The agency said it has a seven-person team in its Maryland headquarters and specialists in 10 field offices across the country working to identify the source of the outbreak.

Q: What can I do to prevent contracting an illness like this?

A: Short of growing all of your own food, it may be unavoidable. All foods — including those labeled local, natural or organic — have the potential to be exposed to safety hazards on the farm, in transit or in the store. Sometimes all it takes is one rogue animal that broke through a fence or one employee who didn't wash his hands to infect food.

What you can do is make sure you practice safe handling and preparation. The FDA recommends always washing hands, utensils and surfaces with hot, soapy water before and after handling food. You should also thoroughly wash all fresh produce before you eat it. Those measures should significantly reduce your chances of getting sick.

Cyclospora is a rare parasite that causes a lengthy gastrointestinal illness, and outbreaks of the illness have been reported in 15 states. The U.S. Centers for Disease Control and Prevention said Tuesday that it's not clear whether all of the illnesses are linked to a single source. The outbreak has sickened at least 145 residents in Iowa and 78 in Nebraska.

Nebraska officials said the salad mix in question included iceberg and romaine lettuce, along with red cabbage and carrots, which came through national distribution chains. They did not identify specific brands. A Nebraska health department spokeswoman said the agency was working with the U.S. Food and Drug Administration to get a "clear picture" of which were involved and whether they're tied to one common source, such as the same farm or producer.

"Our goal is to protect Nebraskans, pinpoint the source of the illness and make sure the risk is eliminated," said Dr. Joseph Acierno, the department's chief medical officer and director of public health.

In Iowa, officials said they were confident that most if not all of the product was no longer on the shelves. The affected products were traced to grocery stores and restaurants, said Steven Mandernach, the state's top food-safety inspector. Mandernach said cases were reported throughout the state, but the largest number was in the eastern Iowa city of Cedar Rapids.

Mandernach said officials have traced 80 percent of the Iowa cases to a common source, which he did not identify because officials believe there's no longer any immediate safety threat. Mandernach said it's possible that the parasite spread through contaminated floodwater and onto farm fields after arriving in the state. Before the outbreak, he said, Iowa had seen about 20 cases of cyclospora in the last decade.

Local health departments are working with the U.S. Food and Drug Administration to identify exactly where the contamination originated in the food production chain and where the product was distributed.

The CDC says 372 cases of the cyclospora infection, which causes diarrhea and other flu-like symptoms, have been reported in 15 states: Iowa, Texas, Nebraska, Florida, Wisconsin, Illinois, New York, Georgia, Missouri, Arkansas, Connecticut, Kansas, Minnesota, New Jersey and Ohio.

The CDC said at least 21 people have been hospitalized and most of the reported illnesses occurred from mid-June to early July. The CDC and the Food and Drug Administration are investigating the cyclospora infections but have not yet pointed to a source.

"CDC is still actively pursuing all leads and hasn't implicated any single food item as the cause of the outbreak in all states," said CDC spokeswoman Sharon Hoskins. "We're still not sure if the cases in all of the states are linked to the same outbreak."

Hoskins said that in some previous outbreaks of cyclospora, the cause was never discovered. The illness is rare in the United States but is sometimes contracted abroad or from imported food, according to the CDC.

The FDA said investigators are trying to trace the paths of food eaten by those who fell ill. That process is "labor intensive and painstaking work, requiring the collection, review and analysis of hundreds and at times thousands of invoices and shipping documents," the FDA said.

The agency said it has a seven person team in its Maryland headquarters and specialists in 10 field offices across the country working to identify the source of the outbreak.

Cyclospora illnesses are spread when people ingest food or water contaminated with feces. The illnesses are most often found in tropical or subtropical countries and have been linked to imported fresh fruits and vegetables in the past.

In Texas, public health officials have received 122 reports of the illness but have not yet found a link. The state issued an advisory that urged health care providers to test patients if they show symptoms of the infection, said Christine Mann, a spokeswoman for the Texas Department of State Health Services.

Connecticut has two reported cases, state Department of Public Health spokesman William Gerrish said Tuesday. Gerrish said the agency interviewed the two people to determine if there is any relation to the national outbreak. One patient likely acquired the infection while traveling internationally and the case is not related to the multistate outbreak, he said

In Kansas, state health department spokeswoman Miranda Steele said two cyclospora cases were tied to the outbreak. Steele said officials there believe both illnesses were caused by food eaten in Nebraska.

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