Cyclosporiasis outbreak expands to four more states

Cyclosporiasis is a disease caused by the parasite cyclospora and is most common during the spring and summer months. People can be infected with the parasite if they consume food or water that's been contaminated with feces.

Symptoms of the disease include cramps, nausea, loss of appetite, vomiting, fatigue, diarrhea, body aches, low-grade fever, and other flu-like symptoms. Cyclosporiasis can last for a few days to over a month, and symptoms can come in waves, returning more than once after going away.

Last week, CDC linked four additional states to a multistate outbreak of cyclosporiasis tied to shredded iceberg lettuce sourced from Taylor Farms de Mexico and served at Taco Bell restaurants. The new states — Illinois, Kansas, Oklahoma, and Pennsylvania — join Indiana, Kentucky, Michigan, Ohio, and West Virginia amid the largest known cyclosporiasis outbreak in U.S. history.

According to CDC, a total of 1,947 people have so far been infected with the parasite and reported exposure to Taco Bell within the nine states. Illnesses linked to the outbreak started on June 22 and continued through at least July 20, CDC said. There have also been at least 98 hospitalizations linked to the outbreak, but no deaths have been reported.

Last week, CDC more than doubled its national confirmed case count of cyclosporiasis, adding more than 4,000 confirmed illnesses. More than 7,400 additional cases are still under review. Cyclosporiasis cases have been reported in at least 41 states so far this year, and investigators are still working to determine how many are tied to the outbreak linked to the shredded lettuce supplied by Taylor Farms and served at Taco Bell.

For example, in North Carolina, state health officials have identified illnesses that don't appear to be linked to the shredded iceberg lettuce served at Taco Bell. Instead, they said that preliminary evidence identified contaminated parsley and cilantro as possible sources.

"Those items do pop up frequently and that is not necessarily to say that's proof that that's the cause, but it's one of those situations where if something keeps showing up repeatedly — a certain type of herb like parsley or cilantro or a certain type of vegetable like lettuce — we can start to think that that's probably implicated or that may be implicated and that's when we start collecting information on where was it purchased and that we can share with our partners ... for a possible traceback," said Carl Williams, from  the North Carolina state health department.

FDA has also identified a new outbreak of cyclosporiasis that has sickened at least 72 people. Although the agency hasn't provided information about the source of the outbreak or its location, it is believed to be separate from the larger outbreak linked to Taco Bell and Taylor Farms.

The 10 things food safety experts won't eat

Amid a growing outbreak of foodborne illness, food safety experts say there are a handful of foods that they believe aren't worth the risk of getting sick, including some very common foods.

1. Raw milk and raw-milk cheese

Bill Marler, a food safety lawyer who has sued companies over outbreaks, said he's represented families of children who have died or suffered kidney damage and neurological complications as a result of foodborne illnesses linked to raw milk. "It's ridiculous," he said, especially when there's a safe alternative.

"You have such a great thing called pasteurization," he said.

Barbara Kowalcyk, director of the Institute of Food Safety and Nutrition Security at George Washington University, said she avoids raw milk and cheese made from it. "It's very risky," she said. "We've known that for decades."

2. Cantaloupe

Darin Detwiler, an associate teaching professor of food policy at Northeastern University, said it's not possible to "adequately clean the outside of a cantaloupe" and as a result, once you run a knife through it, you drag whatever is on the surface into the flesh.

Detwiler says if you want to eat cantaloupe, cut it and eat it right away, and never let cut melon sit out for more than two hours.

6. Sprouts

According to Kowalcyk, raw sprouts have been linked to a long string of foodborne illness outbreaks, "and there's really no good way to clean them."

That's because contamination often starts before the sprouts are grown, as bacteria can be present on the seeds themselves, and the warm, humid conditions needed for sprouting are ideal for helping bacteria multiply.

7. Pre-cut fruits and vegetables

While it's convenient to have a tub of pre-sliced melon or a bag of shredded carrots, it's not worth giving up control of how your food is handled. "You don't know how long it's been sitting around, or whether the knife, the cutting surface, or the hands that touched it were clean," Marler said.

8. Raw eggs

While eggs are significantly safer now than they were 20 years ago, Marler said he still won't eat them raw, which means no tasting cookie dough made with raw eggs or licking brownie batter off the beaters or eating homemade Caesar dressing made with uncooked yolks.

Marler noted most eggs sold in grocery stores are not pasteurized, so if a recipe calls for raw eggs, he'd prefer to use pasteurized ones or skip it entirely.

9. Undercooked hamburgers

While a medium-rare steak and a medium-rare burger might look similar, Griffin said they're completely different from the perspective of food safety. Bacteria typically stay on the surface of a steak, and cooking will kill them, but grinding that meat into a hamburger mixes bacteria throughout the patty.

"You're gonna take whatever bacterial contamination, E. coli, or fecal contamination, and now you're gonna mix it all deep in there," he said. That's why Griffin said he always orders burgers well done.

10. Potlucks and picnic foods

Roberts said she's wary of foods prepared outside of regulated kitchens. "If it's a potluck, I'm out," she said. "If it's a bake sale, no."

As for family cookouts, while she can see the food being grilled, she's still vigilant about anything sitting out in the summer heat. Instead of leaving a big bowl of potato salad on the picnic table, for example, she has her family keep most of it in the refrigerator and bring out just a small portion at a time, refilling the bowl as needed.