Iowa Dept. of Health Investigates Intestinal Illness (July 8 2013): Cyclospora

[Giuseppe]

Re: Iowa Dept. of Health Investigates Intestinal Illness (July 8 2013): Cyclospora

[Source: Iowa Department of Public Health, full PDF document: (LINK). Edited.]


Iowa Cyclospora Outbreak 2013

Outbreak Update 7.31.13


IDPH, CDC, Iowa Department of Inspections and Appeals, the State Hygienic Laboratory and local public health agencies are investigating an outbreak caused by Cyclospora.

The epidemiologic investigation completed by local public health departments in Iowa and IDPH has implicated a prepackaged salad mix as the source of the outbreak. The food trace back investigation performed by DIA determined that at least 80 percent of these cases had been exposed to the same prepackaged salad mix.

• The salad mix contained iceberg and romaine lettuce, carrots and red cabbage.
• This salad mix is no longer in Iowa?s food supply chain.

Onset dates of the illness suggest the ill people had eaten the contaminated food in mid-June. This is a very good indication the food which was the source of the outbreak has already been consumed or discarded, since fresh vegetables have a limited shelf life.

At no time was an Iowa-grown fruit or vegetable suspected to be the cause of the outbreak.

• Bagged salads and all other vegetables are safe to eat.
• Public Health encourages Iowans to make fruits and vegetables part of their daily diet. It is always a good idea to wash all fresh fruits and vegetables thoroughly before eating.

As of today, 145 cases of Cyclospora infections have been reported to IDPH. Case counts with county breakdown are posted to the IDPH website every weekday at approximately 10:00 a.m. at https://www.idph.state.ia.us/EHI/Iss...sue=Cyclospora Outbreak Investigation&pg=Cyclospora Case Count Updates

• IDPH continues to receive reports of confirmed cases of Cyclospora infection and interview those who are ill, but numbers are decreasing.
• Cyclospora is a rare parasite.
• People become infected with Cyclospora by consuming food or water contaminated with the parasite.

CDC updates on the Cyclosporiasis outbreak, which includes Iowa and several other states, can be found at www.cdc.gov/parasites/cyclosporiasis/outbreaks/investigation-2013.html.

Cyclospora infection causes a watery diarrhea that lasts an average of 57 days, if untreated.

• Specific laboratory testing (not commonly ordered) must be done to detect Cyclospora.
• Specific treatment (not typically used to treat more common diarrheal illnesses) can be prescribed.

If you are experiencing diarrhea, or have recently had a long bout with diarrhea, you should contact your health care provider and see if you should be tested for Cyclospora infection.

• Additional symptoms of cyclosporiasis (the infection caused by Cyclospora) include:
  • Watery diarrhea
  • Fatigue (severe tiredness)
  • Loss of appetite
  • Weight loss
  • Bloating
  • Increased gas
  • Stomach cramps
  • Nausea
  • Vomiting
  • Muscle aches
  • Low-grade fever

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[Giuseppe]

Re: Iowa Dept. of Health Investigates Intestinal Illness (July 8 2013): Cyclospora

[Source: Iowa Department of Public Health, full page: (LINK). Edited.]


Posted: Wed, 31 Jul 2013 12:50 CDT / Category: Food Safety

Cyclospora Outbreak Slows in Iowa


The Iowa Department of Public Health (IDPH), in cooperation with the Iowa Department of Inspections and Appeals (DIA), local public health officials and the CDC and FDA, has been investigating what has become a national Cyclospora outbreak for several weeks. Iowa continues to have the most cases reported in the multi-state outbreak, with 145 cases reported as of today. The number of new cases being reported continues to decline.

Interviews with ill individuals and food trace back investigations have led to the identification of a pre-packaged salad mixture as the source of Iowa?s outbreak. More than 80 percent of Iowa?s cases reported eating the same pre-packaged salad mix that contained iceberg and romaine lettuce, red cabbage, and carrots. The mixture came into Iowa already packaged and already contaminated. ?The process that led to the implication of the pre-packaged salad mixture as the outbreak source is a good illustration of how public health investigations work,? said IDPH Medical Director, Dr. Patricia Quinlisk.

As cases began to be reported to IDPH in early July, epidemiologists interviewed those who were ill to determine what and where they had eaten. As an example of the complexity of this investigation, over 100 different restaurants were patronized by cases during the time they could have been exposed to Cyclospora. It was determined exposures occurred at more than 50 possible sites (including more than 15 restaurants, more than 30 grocery stores and other possible sites).

Since Cyclospora has historically been associated with contaminated fresh fruits and vegetables, these exposures were looked at very closely. It was quickly determined there were no fruit or fruit products in common and IDPH informed the public a vegetable was likely the source. As the public health investigation progressed, detailed interviews were performed where clusters of cases occurred. These cluster investigations further implicated a specific type of prepackaged salad mixture (that included iceberg lettuce, romaine lettuce, red cabbage, and carrots). The DIA investigation continued in parallel and began to point to a specific prepackaged salad mix. Further investigation determined the salad mixture came from the same origin, even though exposures occurred at various locations. DIA was instrumental in determining that 80 percent of Iowa cases had been exposed to the specific pre-packaged salad mix. Once it was determined this was an interstate, and possibly international food product, FDA became involved.

IDPH has not released the name of the salad mixture brand, or locations where it was purchased or eaten because of confidentiality mandated by Iowa state law. Iowa Code Section 139A.3(2)?c? requires IDPH to prevent the identification of any business involved in a disease outbreak, and authorizes release of the identity of a business to the public only ?when the state epidemiologist or director of public health determines such a release of information is necessary for the protection of the public.?

Because the vast majority of illnesses occurred in mid-June and the limited shelf life of fresh produce, IDPH and DIA determined the implicated salad mix was no longer in the Iowa food supply chain. Thus, there is no ongoing threat to the public health which would require the identification of a particular brand, store, or restaurant where the salad mixture was available. In addition, these sites could not have taken any action to prevent contamination of the mixture since it came pre-packaged and ready-to-eat.

If it had been determined the source of the outbreak was still in the food supply chain, or that a business was refusing to take some action necessary to protect the public?s health, IDPH would inform Iowans about the exact product or source in order to protect their health.

In such a case, a recall of the item would be facilitated by the FDA. Neither action was necessary in this outbreak.


Contact Information: Polly Carver-Kimm at (515) 281-6693


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[Giuseppe]

Re: Iowa Dept. of Health Investigates Intestinal Illness (July 8 2013): Cyclospora

[Source: Iowa Department of Public Health, full PDF document: (LINK). Edited.]


Iowa Cyclospora Outbreak 2013

Outbreak Update 8.1.13


IDPH, CDC, Iowa Department of Inspections and Appeals, the State Hygienic Laboratory and local public health agencies are investigating an outbreak caused by Cyclospora.

The epidemiologic investigation completed by local public health departments in Iowa and IDPH has implicated a prepackaged salad mix as the source of the outbreak. The food trace back investigation performed by DIA determined that at least 80 percent of these cases had been exposed to the same prepackaged salad mix.

• As an example of the complexity of this investigation, over 100 restaurants and 80 grocery stores were patronized by cases during the time they could have been exposed to Cyclospora. Exposures to pre-packaged salad mix could have occurred at more than 50 possible sites (including more than 15 restaurants, more than 30 grocery stores and other possible sites).
• The salad mix contained iceberg and romaine lettuce, carrots and red cabbage.
• This salad mix is no longer in Iowa?s food supply chain.

Onset dates of the illness suggest the ill people had eaten the contaminated food in mid-June. This is a very good indication the food which was the source of the outbreak has already been consumed or discarded, since fresh vegetables have a limited shelf life.

At no time was an Iowa-grown fruit or vegetable suspected to be the cause of the outbreak.

• Bagged salads and all other vegetables are safe to eat.
• Public Health encourages Iowans to make fruits and vegetables part of their daily diet. It is always a good idea to wash all fresh fruits and vegetables thoroughly before eating.

As of today, 146 cases of Cyclospora infections have been reported to IDPH. Because the number of new cases identified has declined dramatically, IDPH will discontinue daily case count updates as of today, August 1. Weekly case counts will be posted each Thursday at 10:00 a.m at https://www.idph.state.ia.us/EHI/Iss...sue=Cyclospora Outbreak Investigation&pg=Cyclospora Case Count Updates.

Daily status updates will also be discontinued; but will be posted as needed.

• IDPH continues to receive reports of confirmed cases of Cyclospora infection and interview those who are ill, but numbers are decreasing.
• Cyclospora is a rare parasite.
• People become infected with Cyclospora by consuming food or water contaminated with the parasite.

IDPH has not released the name of the salad mixture brand, or locations where it was purchased or eaten because of confidentiality mandated by Iowa state law.

• Iowa Code Section 139A.3(2)?c? requires IDPH to prevent the identification of any business involved in a disease outbreak, and authorizes release of the identity of a business to the public only ?when the state epidemiologist or director of public health determines such a release of information is necessary for the protection of the public.?
• Because the vast majority of illnesses occurred in mid-June and the limited shelf life of fresh produce, IDPH and DIA determined the implicated salad mix was no longer in the Iowa food supply chain.
• Thus, there is no ongoing threat to the public health which would require the identification of a particular brand, store, or restaurant where the salad mixture was available. In addition, these sites could not have taken any action to prevent contamination of the mixture since it came pre-packaged and ready-to-eat.
• If it had been determined the source of the outbreak was still in the food supply chain, or that a business was refusing to take some action necessary to protect the public?s health, IDPH would inform Iowans about the exact product or source in order to protect their health. In such a case, a recall of the item would be facilitated by the FDA. Neither action was necessary in this outbreak.

CDC updates on the Cyclosporiasis outbreak, which includes Iowa and several other states, can be found at www.cdc.gov/parasites/cyclosporiasis/outbreaks/investigation-2013.html.

Cyclospora infection causes a watery diarrhea that lasts an average of 57 days, if untreated.

• Specific laboratory testing (not commonly ordered) must be done to detect Cyclospora.
• Specific treatment (not typically used to treat more common diarrheal illnesses) can be prescribed.

If you are experiencing diarrhea, or have recently had a long bout with diarrhea, you should contact your health care provider and see if you should be tested for Cyclospora infection.

• Additional symptoms of cyclosporiasis (the infection caused by Cyclospora) include:
  • Watery diarrhea
  • Fatigue (severe tiredness)
  • Loss of appetite
  • Weight loss
  • Bloating
  • Increased gas
  • Stomach cramps
  • Nausea
  • Vomiting
  • Muscle aches
  • Low-grade fever

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