On 14 July 2015, Health Protection Scotland (HPS) identified an unusual increase in Cyclospora infections in travellers to Mexico. National and international partners were informed and upon further investigation, a total of 176 cases were identified in England, Scotland, Wales and Canada. An outbreak control team managed the investigation in the UK. UK patients were interviewed about travel history, food consumption, clinical symptoms and demography using a questionnaire.
The UK and Canadian cases occurred in people returning from at least 36 hotels on the Riviera Maya coast of Mexico. Drinking water was considered an unlikely source as several different water networks supply the resorts (some hotels have their own borehole and treatment). Geographical and temporal associations suggested that the outbreak was related to a consumed product(s) distributed throughout the region rather than hygiene deficiencies in individual hotels. A multistate outbreak of cyclosporiasis has also occurred in the US, concurrent with these investigations, in which fresh cilantro (or coriander) from Puebla, Mexico has been implicated as the cause of cluster-associated cases in three US states. Local investigation in Mexico suggests fresh cilantro from Puebla had been distributed to hotels in the Riviera Maya region. Food safety control measures have since been implemented by the Mexican authorities to ensure the safety of cilantro from Puebla state.
A detailed account of these investigations appears in the current issue of Eurosurveillance at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21284
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