Category Archives: Cyclosporiasis

USA – FDA Coe Investigation Table Update

FDA

What’s New

  • An outbreak of E. coli O157:H7 (ref# 1081) in an unidentified product was added to the table and FDA has initiated a traceback investigation. CDC has issued an Investigation Notice.
  • An outbreak of Salmonella Senftenberg (ref# 1087) in an unidentified product was added to the table.
  • An outbreak of Salmonella Typhimurium (ref# 1095) in an unidentified product was added to the table and traceback has been initiated.
  • For the outbreak of Salmonella Braenderup (ref# 1075) in an unidentified product, the outbreak has ended.
  • For the outbreak of Cyclospora in an unidentified product (ref# 1084), the case count has increased from 77 to 98.
  • For the outbreak of hepatitis A illnesses linked to fresh strawberries (ref# 1066), the FDA investigation has closed and the outbreak is over.
Date
Posted
Ref
Pathogen
Product(s)
Linked to
Illnesses

(if any)
Total
Case Count

Status
8/17/

2022

1081 E. coli
O157:H7
Not Yet Identified See CDC Investigation Notice Active
8/17/

2022

1087 Salmonella
Senftenberg
Not Yet Identified 19 Active
8/17/

2022

1095 Salmonella
Typhimurium
Not Yet Identified 44 Active
8/3/

2022

1080 Cyclospora Not Yet Identified 6 Active
7/27/

2022

1084 Cyclospora Not Yet Identified 98 Active
6/29/

2022

1076 Not Yet Identified Frozen Food See Outbreak
Advisory
Active
6/22/

2022

1075 Salmonella
Braenderup
Not Yet Identified 74 Active
6/22/

2022

1072 Salmonella
Paratyphi B var. L(+) tartrate+
Not Identified 14 Closed
6/15/

2022

1070 Listeria
monocytogenes
Not Identified 12 Closed
6/8/

2022

1068 E. coli
O157:H7
Not Identified 10 Closed
6/1/

2022

1066 Hepatitis A Virus Strawberries See Outbreak
Advisory
Closed
5/25/

2022

1067 Salmonella 
Senftenberg
Peanut Butter See Outbreak Advisory Closed
4/20/

2022

1064 Not Yet
Identified
Dry Cereal 558 adverse
event reports
Active
4/13/

2022

1057 Listeria
monocytogenes
Ice Cream See Outbreak Advisory Active
3/30/

2022

1060 None
Identified
Meal Replacement
Drink
6 adverse
event reports
Closed
3/16/

2022

1055 Salmonella
Saintpaul
Not Identified 60 Closed
2/17/

2022

1056 Cronobacter
sakazakii
Powdered
Infant
Formula
See
Advisory
Active (IMG)
2/9/

2022

1040 Listeria
monocytogenes
Not Identified 20 Closed
2/2/

2022

1054 Enteroinvasive
E. coli
O143:H26
Not
Identified
16 Closed
1/10/

2022

1050 E. coli
O121:H19
Romaine 4 Closed

USA – FDA Core Investigation Table Update

FDA

What’s New

  • For the outbreak of Cyclospora in an unidentified food (ref # 1084) the total case count has increased from 60 to 77.
Date
Posted
Ref Pathogen or
Cause of Illness

Product(s)
Linked to
Illnesses

(if any)
Total
Case Count
Status
8/3/

2022

1080 Cyclospora Not Yet Identified 6 Active
7/27/

2022

1084 Cyclospora Not Yet Identified 77 Active
6/29/

2022

1076 Not Yet Identified Frozen Food See Outbreak
Advisory
Active
6/22/

2022

1075 Salmonella
Braenderup
Not Yet Identified 74 Active
6/22/

2022

1072 Salmonella
Paratyphi B var. L(+) tartrate+
Not Identified 14 Closed
6/15/

2022

1070 Listeria
monocytogenes
Not Identified 12 Closed
6/8/

2022

1068 E. coli
O157:H7
Not Identified 10 Closed
6/1/

2022

1066 Hepatitis A Virus Strawberries See Outbreak
Advisory
Active
5/25/

2022

1067 Salmonella 
Senftenberg
Peanut Butter See Outbreak Advisory Closed
4/20/

2022

1064 Not Yet
Identified
Dry Cereal 558 adverse
event reports
Active
4/13/

2022

1057 Listeria
monocytogenes
Ice Cream See Outbreak Advisory Active
3/30/

2022

1060 None
Identified
Meal Replacement
Drink
6 adverse
event reports
Closed
3/16/

2022

1055 Salmonella
Saintpaul
Not Identified 60 Closed
2/17/

2022

1056 Cronobacter
sakazakii
Powdered
Infant
Formula
See
Advisory
Active (IMG)
2/9/

2022

1040 Listeria
monocytogenes
Not Identified 20 Closed
2/2/

2022

1054 Enteroinvasive
E. coli
O143:H26
Not
Identified
16 Closed
1/10/

2022

1050 E. coli
O121:H19
Romaine 4 Closed

USA – Cyclospora Illnesses Spike to 384 Sick with 30 Hospitalized

Food Poisoning Bulletin

Cyclospora Illnesses Spike to 384 Sick with 30 Hospitalized

Cyclospora illnesses have spiked to 384 sick in 22 states and 30 hospitalized, according to the Centers for Disease Control and Prevention (CDC). There has been a cyclospora outbreak, in fact, usually several cyclospora outbreaks, in the United States during the spring and summer months every year since 2013. This is an increase of 323 cases since the last update was issued on June 30, 2022. Cases are still being reported.

USA – FDA Shares Updates on Cyclospora Action Plan

Food Safety Magazine

The U.S. Food and Drug Administration (FDA) recently updated its constituents about the agency’s ongoing Cyclospora cayetanensis prevention and research efforts. In 2021, FDA released its “Cyclospora Prevention, Response and Research Action Plan.” The action plan was developed by the agency’s Cyclospora Task Force and details FDA’s strategy for reducing the public health burden of foodborne cyclosporiasis in the U.S. It also defines the agency’s priorities for Cyclospora food safety research and supports ongoing efforts to combat foodborne illness in alignment with FDA’s New Era of Smarter Food Safety initiative.

Since releasing the Cyclospora action plan, FDA has made progress on several goals. The agency’s activities related to the Cyclospora action plan include:

  • Collaboration with the National Advisory Committee on Microbiological Criteria for Foods to develop a charge document that will inform FDA’s prioritization of Cyclospora research and propose novel food safety research projects in collaboration with stakeholders
  • Implementation of a genotyping approach for Cyclospora in environmental and food samples based on the same method published by the U.S. Centers for Disease Control and Prevention (CDC)
  • Implementation of a distance learning plan and a series of Cyclospora methodology training webinars on the “Bacteriological Analytical Manual (BAM) Chapter 19b – Detection of C. cayetanensis in Fresh Produce” using a real-time PCR-analytical method in Spanish for regulatory lab personnel at food safety authorities in Mexico through the FDA-SENASICA-Cofepris Food Safety Partnership
  • Collaborated with the U.S. Centers for Disease Control and Prevention (CDC) to publish an article in Food Safety Magazine summarizing the data on all cyclosporiasis outbreaks from 2013 to 2020
  • Delivered eight webinars directed to the fresh produce industry, regulators, and other stakeholders for Cyclospora outreach and educational purposes
  • Completed a microbial survey of fresh herbs that included over 800 samples tested for C. cayetanensis.

Canada – Mystery Cyclospora Outbreak spreads to Canada

Food Poison Journal

Public Heath Canada is working with its public health and food safety partners to identify possible ways non-travel related Cyclospora infections are occurring in Canada.

As of June 30, a total of 84 cases of Cyclospora infections were reported in the following provinces: British Columbia (1), Ontario (75), and Quebec (8). 4 individuals have been hospitalized and no deaths have been reported. To date, there is no recall or Public Health Notice, the investigation is ongoing.

In case you are experiencing Cyclosporiasis symptoms such as watery diarrhea (most common), cramping, bloating, increased gas, nausea, fatigue, and possibly vomiting and low-grade fever, it is important to report it. It can help to detect & resolve outbreaks early and prevent others from being harmed, and it enables better surveillance. If symptoms persist, seek medical care.

USA – Domestically Acquired Cases of Cyclosporiasis — United States, May–June 2022

CDC

LAST UPDATED JUNE 30, 2022 4:00 PM EDT

Cyclosporiasis illnesses are reported year-round in the United States. However, during the spring and summer months there is often an increase in cyclosporiasis acquired in the United States (i.e., “domestically acquired”). The exact timing and duration of these seasonal increases in domestically acquired cyclosporiasis can vary, but reports tend to increase starting in May. In previous years the reported number of cases peaked between June and July, although activity can last as late as September. The overall health impact (e.g., number of infections or hospitalizations) and the number of identified clusters of cases (i.e., cases that can be linked to a common exposure) also vary from season to season. Previous U.S. outbreaks of cyclosporiasis have been linked to various types of fresh produce, including basil, cilantro, mesclun lettuce, raspberries, and snow peas.

At a Glance
  • Illnesses: 61
  • Hospitalizations: 6
  • Deaths: 0
  • States reporting cases: 13

CDC, along with state and federal health and regulatory officials, monitor cases of cyclosporiasis in the United States in the spring and summer months to detect outbreaks linked to a common food source. However, many cases of cyclosporiasis cannot be directly linked to an outbreak, in part because of the lack of validated laboratory “fingerprinting” methods needed to link cases of Cyclospora infection. Officials use questionnaires to interview sick people to determine what they ate in the 14-day period before illness onset. If a commonality is found, CDC and partners work quickly to determine if a contaminated food product is still available in stores or in peoples’ homes and issue advisories.

Latest Information

  • This is the first monthly report on the number of domestically acquired cyclosporiasis illnesses with onset on or after May 1, 2022. Cases continue to be reported.
  • As of June 28, 2022, 61 laboratory-confirmed cases of cyclosporiasis in people who had no history of international travel during the 14-day period before illness onset have been reported to CDC by 13 states since May 1, 2022.
    • The median illness onset date is May 31, 2022 (range: May 3–June 20, 2022).
    • At least 6 people have been hospitalized; no deaths have been reported.

USA – Will There Be a Cyclospora Outbreak in the U.S. This Summer?

Food Poisoning Bulletin

Will there be a cyclospora outbreak in the United States this summer? There have been multiple cyclospora outbreaks in the past nine years, including in 2013, 2014, 2015, 2016, 2017, 2018, 2019, 2020, and 2021. This year may be no exception.

In the past, Cyclospora outbreaks have been linked to fresh produce, including cilantro, raspberries, basil, mesclun, vegetable trays, bagged salad mixes, and snow peas. The cyclospora parasite is transmitted through human feces. The oocyst must mature, or sporulate, outside of the body before it becomes infectious. This infection is not passed person-to-person.

It is very difficult to protect yourself against this parasite, since it can cling to produce, especially produce such as leafy greens and herbs, and is not easily washed or rinsed off. And since most of the foods it contaminates are eaten without being heated, there is no kill step to destroy the parasite.

USA – CDC – Lettuce, Other Leafy Greens, and Food Safety

CDC

Leafy greens arranged on a white background

Vegetables are an important part of a healthy diet. Leafy vegetables (called leafy greens on this page), such as lettuce, spinach, cabbage, kale, and bok choy, provide nutrients that help protect you from heart diseasestroke, and some cancers.

But leafy greens, like other vegetables and fruits, are sometimes contaminated with harmful germs. Washing leafy greens does not remove all germs. That’s because germs can stick to the surface of leaves and even get inside them. If you eat contaminated leafy greens without cooking them first, such as in a salad or on a sandwich, you might get sick.

Although anyone can get a foodborne illness, sometimes called food poisoning, some groups of people are more likely to get one and to have a serious illness. These groups include:

  • Adults aged 65 and older
  • Children younger than 5 years
  • People who have health problems or take medicines that lower the body’s ability to fight germs and sickness (a weakened immune system)external icon
  • Pregnant people

Eating Leafy Greens

Are leafy greens safe to eat?

Millions of servings of leafy greens are eaten safely every day in the United States. But leafy greens are occasionally contaminated enough to make people sick. To reduce your chance of getting sick, always follow the steps for safely handling and preparing leafy greens before eating or serving them.

Are leafy greens safe for my pet to eat?

Some animals can get sick from some germs that also make people sick. Always follow the steps for safely handling and preparing leafy greens before feeding them to pets and other animals. Never feed recalled food to pets or other animals.

Safely Handling and Preparing Leafy Greens

Do I need to wash all leafy greens?

Prewashed greens don’t need to be washed again. If the label on a leafy greens package says any of the following, you don’t need to wash the greens:

  • Ready-to-eat
  • Triple washed
  • No washing necessary

Prewashed greens sometimes cause illness. But the commercial washing process removes most of the contamination that can be removed by washing.

All other leafy greens should be thoroughly washed before eating, cutting, or cooking.

What is the best way to wash leafy greens?

The best way to wash leafy greens is by rinsing them under running water. Studies show that this step removes some of the germs and dirt on leafy greens and other vegetables and fruits. But no washing method can remove all germs.

Follow these steps to wash leafy greens that you plan to eat raw:

  • Wash your hands for 20 seconds with soap and water before and after preparing leafy greens.
  • Get rid of any torn or bruised leaves. Also, get rid of the outer leaves of cabbages and lettuce heads.
  • Rinse the remaining leaves under running water. Use your hands to gently rub them to help get rid of germs and dirt.
  • Dry leafy greens with a clean cloth or paper towel.

Should I soak leafy greens before washing them?

No. Do not soak leafy greens. If you soak them in a sink, germs in the sink can contaminate the greens. If you soak them in a bowl, germs on one leaf can spread to the other leaves. Rinsing leafy greens under running water is the best way to wash them.

Should I wash leafy greens with vinegar, lemon juice, soap, detergent, or produce wash?

Use plain running water to wash leafy greens and other produce. Kitchen vinegar and lemon juice may be used, but CDC is not aware of studies that show vinegar or lemon juice are any better than plain running water.

Do not wash leafy greens or other produce with soap, detergent, or produce wash. Do not use a bleach solution or other disinfectant to wash produce.

What other food safety steps should I keep in mind when I select, store, and prepare leafy greens and other produce?

  • Select leafy greens and other vegetables and fruits that aren’t bruised or damaged.
  • Make sure pre-cut produce, such as bagged salad or cut fruits and vegetables, is refrigerated or on ice at the store.
  • Separate produce from raw meat, poultry, seafood, and eggs in your shopping cart, grocery bags, and refrigerator.
  • Store leafy greens, salads, and all pre-cut and packaged produce in a clean refrigerator with the temperature set to 40°F or colder.
  • Use separate cutting boards and utensils for produce and for raw meat, poultry, seafood, and eggs. If that isn’t an option, prepare produce before working with raw meat.
  • Wash utensils, cutting boards, and kitchen surfaces with hot, soapy water after each use.
  • Cook thoroughly or throw away any produce that touches raw meat, poultry, seafood or their juices.
  • Refrigerate cooked or cut produce, including salads, within 2 hours (1 hour if the food is exposed to temperatures above 90°F, like a hot car or picnic).

Germs, Outbreaks, and Recalls

How do leafy greens get contaminated with germs?

Germs that make people sick can be found in many places, including in the soil, in the feces or poop of animals, in refrigerators, and on kitchen surfaces.

Germs can contaminate leafy greens at many points before they reach your plate. For example, germs from animal poop can get in irrigation water or fields where theexternal icon vegetables grow. Germs can also get on leafy greens in packing and processing facilities, in trucks used for shipping, from the unwashed hands of food handlers, and in the kitchen. To prevent contamination, leafy greens should be grown and handled safely at all points from farm to fork.

Read a study by CDC and partners on what we have learned from 10 years of investigating E. coli outbreaks linked to leafy greens.

How common are outbreaks linked to leafy greens?

In 2014–2018, a total of 51 foodborne disease outbreaks linked to leafy greens (mainly lettuce) were reported to CDC. Five of the 51 were multistate outbreaks that led CDC to warn the public. Among those five outbreaks, two were linked to packaged salads, two were linked to romaine lettuce, and one could not be linked to a specific type of leafy greens.

Most recently, in 2019–2021, CDC investigated and warned the public about nine multistate outbreaks linked to leafy greens. Among those outbreaks, six were linked to packaged salads, one was linked to romaine lettuce, one was linked to baby spinach, and one could not be linked to a specific type of leafy greens. Learn about these outbreaks.

Most foodborne illnesses are not part of a recognized outbreak. The nearly 2,000 illnesses reported in 2014–2020 outbreaks linked to leafy greens represent only a small part of illnesses caused by contaminated leafy greens during those years.

Does CDC warn the public about every foodborne disease outbreak?

No. CDC does not warn the public about every foodborne outbreak—including ones linked to leafy greens. Some reasons for this include:

  • Most sources of foodborne outbreaks are never identified.
  • By the time a source is identified, it might no longer be in stores, restaurants, or homes. This can happen with foods that are perishable (foods that spoil or go bad quickly), such as leafy greens.
  • Most outbreaks affect people in only one state, so local or state health departments lead the work to identify, investigate, and communicate about those outbreaks. CDC typically communicates only about outbreaks that affect people in more than one state.

Investigating outbreaks linked to leafy greensexternal icon can be especially challenging. These outbreaks often go unidentified or unsolved.

What should I do with leafy greens that are part of a recall?

  • Never eat, serve, or sell food that has been recalled, even if some of it was eaten and no one got sick.
  • Return the recalled food to the store or throw it away at home.
    • Throw out the recalled food and any other foods stored with it or that touched it.
    • Put it in a sealed bag in an outside garbage can with a tight lid (so animals cannot get to it).
    • If the recalled food was stored in a reusable container, wash the container in the dishwasher or with hot, soapy water.
  • Follow CDC’s instructions for cleaning your refrigerator after a food recall.

Organic, Hydroponic, and Home-Grown Leafy Greens

Are organic leafy greens less likely to be contaminated than non-organic ones?

All kinds of produce, including organic leafy greens, can be contaminated with harmful germs at any point from farm to fork. CDC is not aware of any evidence that organic greens are safer.

Learn about some outbreaks linked to organic foodsexternal icon.

Are hydroponic or greenhouse-grown leafy greens less likely to be contaminated?

Leafy greens grown using these methods also can be contaminated with harmful germs at any point from farm to fork.

Learn about an outbreak linked to greenhouse-grown leafy greens.

How do I keep leafy greens in my garden safe to eat?

Home gardens can be an excellent source of fruits and vegetables. Follow these tips to help prevent food poisoning:

  • Plant your garden away from animal pens, compost bins, and manure piles.
  • Water your garden with clean, drinkable water.
  • Keep dirty water, including storm runoff, away from the parts of plants you will eat.

Learn about raised bed gardening pdf icon[PDF – 1 page].

Looking to the Future

What steps are industry and the government taking to make leafy greens safer?

CDC is collaborating with FDA, academia, and industry to investigate the factors that contribute to leafy greens contamination.

The leafy greens industry, FDA, and state regulatory authorities have been implementing provisions of the Produce Safety Ruleexternal icon as part of the FDA Food Safety Modernization Act (FSMA).external icon They are considering what further measures can be taken. FDA’s 2020 Leafy Greens STEC Action Planexternal icon describes the agency’s plans to work with partners to make leafy greens safer.

Research – What Is Cyclospora?

Food Poisoning News

Cyclospora cayetanensis is a protozoan parasite that causes the diarrheal illness known as cyclosporiasis. People acquire this infection by consuming food or water contaminated with feces containing Cyclospora. Cyclosporiasis was not previously a reportable disease in the U.S., so its rise in prevalence is due in large part to the increased availability of tests that can detect Cyclospora. It is now a nationally notifiable disease, so physicians are required to report cases of this infection.

The first three cases of cyclosporiasis were reported in 1977 and 1978, but the parasite that was causing the illnesses could not at that time be identified as Cyclospora cayetanensis; it was not until 1979 that the correct identification was made.

Research -Surveillance of berries sold on the Norwegian market for parasite contamination using molecular methods

Science Direct

water contamination

The risk of foodborne parasite infection linked to the consumption of contaminated fresh produce has long been known. However, despite epidemiological links between the outbreaks and contaminated berries, few studies have assessed the magnitude of parasite contamination on fresh produce sold in Europe. The present study was aimed to address the knowledge gap on parasite contamination of berries sold in Norway. Samples of blueberries, strawberries, and raspberries were analysed by multiplex qPCR for detection of Echinococcus multilocularisToxoplasma gondii, and Cyclospora cayetanensis. In addition, a simplex qPCR method was employed for detecting contamination of the berries with Cryptosporidium spp. A total of 820 samples of berries, each of around 30 g (274 samples of blueberries, 276 samples of raspberries, and 270 samples of strawberries), were analysed. We found an overall occurrence of 2.9%, 6.6%, and 8.3% for T. gondii, C. cayetanensis, and Cryptosporidium spp., respectively, whereas E. multilocularis was not detected from any of the samples investigated. Strawberries and raspberries were most often contaminated with Cryptosporidium spp., whereas blueberries were contaminated mostly with C. cayetanensis. Detection of parasite contaminants on fresh berries indicates the need for a system to ensure the parasitological safety of fresh berries.