Cyclospora outbreaks grow in Midwest, Texas

Health departments in several states confirmed more cases in two cyclosporiasis outbreaks in the Midwest, one linked to Del Monte vegetable trays and the other to McDonald's salads. Meanwhile, more Texans are sickened in a Cyclospora outbreak with no known origin.

Fifteen more people have been sickened with the Cyclospora parasite in the outbreak linked to pre-packaged vegetable trays from Del Monte Produce and sold at Kwik Trip gas stations in Minnesota, Wisconsin, Iowa, and Michigan, according to an update from the Centers for Disease Control and Prevention (CDC).

There are now 227 confirmed cases of the parasitic infection, which causes intestinal illness. The number of hospitalized patients remains at 7, and no deaths have been reported.

Michigan reports its first cases

The cases in Michigan are the state's first in this outbreak. Lynn Sutfin, a public information officer with the Michigan Department of Health and Human Services, told CIDRAP News that the two patients in Michigan bought veggie trays in Wisconsin.

Trisha Robinson, MPH, an epidemiologist with the Minnesota Department of Health, told CIDRAP News that Minnesota has 54 cases, but reports of new cases have been dwindling in recent weeks.

Del Monte recalled the veggie trays (containing broccoli, cauliflower, carrots, and dill dip) on Jun 15, and all recalled products have a "best if enjoyed by" date of Jun 17.

According to the CDC, the median illness-onset date among patients is May 31 (range: May 14 to Jun 13). Ill people range in age from 13 to 79 years old, and 53% are female. Most patients report eating a Del Monte veggie tray in the week prior to illness onset.

The CDC said illnesses that began after May 31 might not have been reported yet. CDC first reported this outbreak on Jun 15, when 78 cases had been confirmed.

Illinois, Iowa see illnesses tied to salads

Yesterday both the Illinois and Iowa departments of health confirmed cyclosporiasis cases in people who reported eating McDonald salads.

According to the Illinois Department of Health (IDPH), approximately 90 people have been sickened with the parasite, and 25% of those patients said they ate McDonald salads in the days prior to illness.

"Although a link has been made to salads sold in McDonald's restaurants in some Illinois cases, public health officials continue to investigate other sources," said IDPH director Nirav D. Shah, MD, JD, in a press release. "If you ate a salad from McDonald's since mid-May and developed diarrhea and fatigue, contact a health care provider about testing and treatment."

The Iowa Department of Health said 15 Iowans have also been diagnosed as having cyclosporiasis and reported eating McDonald's salads in late June through July. The Iowa Department of Health said anyone who ate a salad at McDonald's and later developed symptoms of Cyclospora infection should go to a physician.

The Iowa Department of Health said on its website, "McDonald's is concerned about this situation and has been fully cooperating with IDPH, the Illinois Department of Public Health, and the Iowa Department of Inspections and Appeals. McDonald's and involved federal partners continue to investigate to determine what further steps should be taken."

Cyclosporiasis symptoms typically begin within 7 days of exposure and include frequent episodes of watery diarrhea and fatigue.

Texas reports 18 new cases

Finally, earlier this week the Texas Department of State Health Services (TDSHS) said six more counties are reporting Cyclospora infections. A total of 74 people have fallen ill, up from 56 cases reported on Jul 2.

So far, Texas officials have not provided any information on the possible source of its outbreak, or if these cases are related to the ongoing outbreaks in the Midwest.

See also:

Jul 13 CDC update

Jul 12 IDPH press release

Jul 12 Iowa Department of Health statement

Jul 9 TDSHS update

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