Uptick in Cyclospora Cases Raises Concerns

The number of confirmed cases in the U.S. is markedly higher in 2018 than the number of cases reported in previous years.

September 20, 2018

WASHINGTON – The U.S. Food and Drug Administration and Centers for Disease Control and Prevention issued statements this week about the rise in domestic cases of Cyclospora.

In 2018, multiple outbreaks of Cyclospora (Cyclosporiasis) were identified and found to be linked to different produce items. Previous U.S. outbreaks of Cyclospora have been linked to various types of imported fresh produce such as basil, cilantro, mesclun lettuce, raspberries and snow peas.

Per the CDC, the overall number of domestically acquired cases reported to date from May to August 2018 (i.e., 2,173) is markedly higher than the numbers of cases reported for the same period in 2016 and 2017. In addition to these multiple large outbreaks, this increase also may be due, in part, to changes in diagnostic testing practices—namely, increased use of a multiplex molecular assay to examine stool specimens. CDC is working with state public health partners to determine whether and to what extent changes in testing practices may have contributed to increased case detection and reporting.

FDA Commissioner Scott Gottlieb said that many of this year’s illnesses with Cyclospora are linked to two very large produce-associated outbreaks announced in the last several months, including an outbreak in four Midwest states linked to Del Monte vegetable trays containing broccoli, cauliflower and carrots.

The Wisconsin Department of Health notes that based on epidemiological data or traceback evidence, it was not possible to determine if an individual component of the vegetable trays was the likely vehicle of infection.

“Our traceback efforts to determine the source of the contamination indicate that the ingredients could have come from either domestic or imported sources. While our findings were not conclusive regarding the source, we were able to work with Del Monte to voluntarily recall the vegetable trays to limit the extent of illness, and on September 6, the FDA and CDC declared this outbreak over,” Gottlieb said.

A second outbreak occurred this summer when 511 Cyclospora illnesses were reported by 16 states, per the FDA. This outbreak was linked to McDonald’s salads sold in 14 states in the Midwest that contained a romaine lettuce and carrot mix supplied by Fresh Express.

Gottlieb said that the discovery of Cyclospora in both domestic and imported produce raises both old and new concerns:

“[These findings] underscore the importance of the FDA’s surveillance activities to better define risks, like investigating why different product types like vegetable trays are being linked to Cyclospora outbreaks, and how widespread Cyclospora may be in the U.S. They also stress the need to broaden the tools, like import alerts, that we have up to this point used to prevent Cyclospora illnesses in the U.S. to also include actions that are more appropriate for addressing domestic contamination events.”

As more convenience retailers enhance their foodservice and fresh food offer, attention to food safety and food protection is evolving from more than a best practice. Convenience retailers such as Kwik Trip and QuickChek embed food safety into their company culture, and NACS Show attendees will hear from food safety experts from both companies during the “Avoiding a ‘Chipotle’ Headline” education session, taking place on October 8.   

In addition, NACS has joined the Partnership for Food Safety Education to help provide food safety education to consumers. The group’s “Fight BAC!” program is the original consumer food safety education campaign developed to eliminate food-borne illnesses.