https://www.cidrap.umn.edu/cyclospora/worst-behind-us-cyclospora-outbreak-seems-be-slowing-michigan
‘The worst is behind us’: Cyclospora outbreak seems to be slowing in Michigan
Meghan Holohan
Today at 3:00 p.m.
Cyclospora
Foodborne Disease
“The worst is behind us, at least based on the data we have available to us today,” Natasha Bagdasarian, MD, MPH, chief medical executive for Michigan, told CIDRAP News. “We’re telling people that they can return to their routine precautions around leafy greens and salads here in Michigan.”
She added that this announcement applies only to Michigan.
“Every state, every jurisdiction is experiencing something slightly different and all of our advice and all of our recommendations from the beginning have been geared to the public here in Michigan,” she explained. “We have been making recommendations based on the data we’re seeing here.”
Testing delays contributed to increasing numbers
It takes time for Cyclospora symptoms—watery diarrhea, stomach cramps, and nausea—to start—one to two weeks after consuming food tainted with the parasite. Then people might not seek medical care right away. These factors, combined with the high number of people sick with cyclosporiasis, the illness caused by Cyclospora, contributed to an additional lag in reporting.
“We initially weren’t seeing such a delay,” Bagdasarian said. “As health systems were dealing with a backlog of testing in their laboratories, we started seeing longer delays in terms of us getting those results.”
As cases climbed, some hospitals and doctors’ offices ran out of tests.
The worst is behind us, at least based on the data we have available to us today.
Natasha Bagdasarian, MD, MPH
“They simply couldn’t keep them in stock long enough because of the sheer volume of cases,” Bagdasarian said. “It was challenging for health systems to keep up.”
This means that many of the cases now being reported are in people who experienced symptoms earlier in the summer.
“The numbers, of course, are still troubling. But what we are seeing is that many of the cases that are coming in and being reported more recently are actually of individuals who had case onset quite some time ago,” Bagdasarian said. “We are seeing that the vast majority had onset symptoms before July 16.”
The investigation on the ground
As reports of cyclosporiasis trickled in to the department in June, Michigan’s outbreak investigation team immediately detected something amiss with the number of cases.
“They were very quick to say, ‘There is something happening here that is out of the norm,’” Bagdasarian said.
Their swift discovery meant that Michigan officials informed the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) “immediately and really urged them to start doing some investigations at the national level.”
It also enabled the state to start case interviews very early, allowing Michigan to share critical information about the potential source of the Cyclospora outbreak with federal agencies as well.
“The signals around lettuce, out staff were very quick to spot them,” Bagdasarian said. “We were able to flag them for the CDC and FDA and ask them to please prioritize their investigation into lettuce.”
Bagdasarian believes that public health staff probably prevented more cases of cyclosporiasis.
“Those early and swift actions likely saved the state from thousands of additional cases,” she said. “We were very proactive in using that data to inform the public… to give them specific guidance on produce and then specific guidance on lettuce well before that lettuce recall came out.”
Having information from the investigation also allowed staff to communicate with doctors and healthcare systems to help them identify and treat people with cyclosporiasis.
“We were very vigilant,” Bagdasarian said. “We communicated to all of our healthcare providers. Every single licensed healthcare provider got an email bulletin on this very early on with instructions on how to test and who to test.”
Lessons from the outbreak
The Cyclospora outbreak connected to iceberg lettuce has expanded to 15 states, and there’s also a second outbreak unrelated to lettuce. Bagdasarian said the state’s experience with Cyclospora this summer could help future investigations.
“There are clear lessons from this,” she said. “This is demonstrating in real time why we need a federal public health response. We need to have federal funding, national systems for public health response, and for outbreak management. No single state can lead an effort like this without some sort of national consolidation of data.”
Those early and swift actions likely saved the state from thousands of additional cases.
Natasha Bagdasarian, MD, MPH
One of the challenges Michigan officials faced was not understanding what other states were experiencing.
“It would have been really helpful to hear what was happening in other states and what signals they were seeing early on,” Bagdasarian said. “It’s never been entirely clear that there was one single product that was contaminated in Michigan or whether there were other overlapping issues going on at the same time.”
While employees were able to conduct interviews that helped Michigan grapple with the outbreak, the state couldn’t conduct traceback investigations to identify the source.
“We, as a state, don’t have the mechanisms to do that traceback and look at what is happening with harvesting and processing of products outside our jurisdiction,” Bagdasarian said. “We need strong federal public health systems… going and doing those tracebacks, visiting factories, visiting processes plants.”
‘The worst is behind us’: Cyclospora outbreak seems to be slowing in Michigan
Meghan Holohan
Today at 3:00 p.m.
Cyclospora
Foodborne Disease
The Cyclospora outbreak in Michigan, which has sickened 12,485 people, sent 279 people to the hospital, and caused two deaths, appears to be waning.“The worst is behind us, at least based on the data we have available to us today,” Natasha Bagdasarian, MD, MPH, chief medical executive for Michigan, told CIDRAP News. “We’re telling people that they can return to their routine precautions around leafy greens and salads here in Michigan.”
She added that this announcement applies only to Michigan.
“Every state, every jurisdiction is experiencing something slightly different and all of our advice and all of our recommendations from the beginning have been geared to the public here in Michigan,” she explained. “We have been making recommendations based on the data we’re seeing here.”
Testing delays contributed to increasing numbers
It takes time for Cyclospora symptoms—watery diarrhea, stomach cramps, and nausea—to start—one to two weeks after consuming food tainted with the parasite. Then people might not seek medical care right away. These factors, combined with the high number of people sick with cyclosporiasis, the illness caused by Cyclospora, contributed to an additional lag in reporting.
“We initially weren’t seeing such a delay,” Bagdasarian said. “As health systems were dealing with a backlog of testing in their laboratories, we started seeing longer delays in terms of us getting those results.”
As cases climbed, some hospitals and doctors’ offices ran out of tests.
The worst is behind us, at least based on the data we have available to us today.
Natasha Bagdasarian, MD, MPH
“They simply couldn’t keep them in stock long enough because of the sheer volume of cases,” Bagdasarian said. “It was challenging for health systems to keep up.”
This means that many of the cases now being reported are in people who experienced symptoms earlier in the summer.
“The numbers, of course, are still troubling. But what we are seeing is that many of the cases that are coming in and being reported more recently are actually of individuals who had case onset quite some time ago,” Bagdasarian said. “We are seeing that the vast majority had onset symptoms before July 16.”
The investigation on the ground
As reports of cyclosporiasis trickled in to the department in June, Michigan’s outbreak investigation team immediately detected something amiss with the number of cases.
“They were very quick to say, ‘There is something happening here that is out of the norm,’” Bagdasarian said.
Their swift discovery meant that Michigan officials informed the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) “immediately and really urged them to start doing some investigations at the national level.”
It also enabled the state to start case interviews very early, allowing Michigan to share critical information about the potential source of the Cyclospora outbreak with federal agencies as well.
“The signals around lettuce, out staff were very quick to spot them,” Bagdasarian said. “We were able to flag them for the CDC and FDA and ask them to please prioritize their investigation into lettuce.”
Bagdasarian believes that public health staff probably prevented more cases of cyclosporiasis.
“Those early and swift actions likely saved the state from thousands of additional cases,” she said. “We were very proactive in using that data to inform the public… to give them specific guidance on produce and then specific guidance on lettuce well before that lettuce recall came out.”
Having information from the investigation also allowed staff to communicate with doctors and healthcare systems to help them identify and treat people with cyclosporiasis.
“We were very vigilant,” Bagdasarian said. “We communicated to all of our healthcare providers. Every single licensed healthcare provider got an email bulletin on this very early on with instructions on how to test and who to test.”
Lessons from the outbreak
The Cyclospora outbreak connected to iceberg lettuce has expanded to 15 states, and there’s also a second outbreak unrelated to lettuce. Bagdasarian said the state’s experience with Cyclospora this summer could help future investigations.
“There are clear lessons from this,” she said. “This is demonstrating in real time why we need a federal public health response. We need to have federal funding, national systems for public health response, and for outbreak management. No single state can lead an effort like this without some sort of national consolidation of data.”
Those early and swift actions likely saved the state from thousands of additional cases.
Natasha Bagdasarian, MD, MPH
One of the challenges Michigan officials faced was not understanding what other states were experiencing.
“It would have been really helpful to hear what was happening in other states and what signals they were seeing early on,” Bagdasarian said. “It’s never been entirely clear that there was one single product that was contaminated in Michigan or whether there were other overlapping issues going on at the same time.”
While employees were able to conduct interviews that helped Michigan grapple with the outbreak, the state couldn’t conduct traceback investigations to identify the source.
“We, as a state, don’t have the mechanisms to do that traceback and look at what is happening with harvesting and processing of products outside our jurisdiction,” Bagdasarian said. “We need strong federal public health systems… going and doing those tracebacks, visiting factories, visiting processes plants.”