Suspected cyclosporiasis cases surpass 18K

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.

As of July 29, CDC has confirmed more than 6,700 cases of cyclosporiasis. An additional 11,500+ cases are still pending confirmation, meaning the suspected number of cases in the United States is over 18,000. Currently, this is considered the largest known outbreak of cyclosporiasis in the United States.

There have also been 423 hospitalizations and two deaths reported as part of the ongoing outbreak. According to Matthew Moore, a food safety microbiologist at the University of Massachusetts Amherst, deaths from cyclosporiasis are uncommon in the United States, but lengthy bouts of diarrhea can be dangerous for high-risk groups, such as infants, older adults, pregnant individuals, and those with weakened immune systems.

Last month, CDC reported the outbreak was in part linked to shredded iceberg lettuce served at Taco Bell restaurants across nine states. Although FDA initially reported it had identified cyclospora in a sample of iceberg lettuce from Taylor Farms de Mexico, the agency later walked back the finding, saying it was a false positive and that as of July 19, "there are not confirmed positive sample results for product testing for Cyclospora."

In some areas of the country, the outbreak appears to be slowing down. In Michigan, where more than 11,200 people have gotten sick from cyclosporiasis in the last two months, case numbers seem to be dropping. The number of new cyclosporiasis cases in Michigan has dropped from 3,500 cases per week in mid-July to just over 2,000 cases last week.

"We have growing confidence that the outbreak is declining," said Laine Stebbins, a spokesperson for Michigan's health department.

However, health experts said it's still too soon to tell whether cases nationwide will also see a similar decline.

"We're right in the middle of all of that."

German Rios, senior director of food safety and quality at the produce manufacturer Fresh Express, said he's concerned about the other outbreaks of cyclosporiasis popping up around the country.

"One of the things I'm personally concerned about, we're starting to have more and more of these outbreaks here in the United States," he said. "I am concerned that we may not have really hit the peak of the outbreaks."

Frank Yiannas, former deputy commissioner for food policy and response at FDA, said it's clear there's more than one product causing illnesses.

"If, in fact, all the lettuce is pulled from the market, consumers should not be surprised that they continue to see states report illnesses, and they identify food vehicles other than lettuce," he said.

Similarly, Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, said that while the outbreak linked to shredded lettuce from Mexico "may be at or near peak" since the contaminated lettuce has either been eaten, thrown away, or taken from store shelves, "it's probably not the only thing responsible for cyclospora cases in the United States currently."

Even in a normal year, cyclosporiasis cases usually increase in the warmer months, with the highest case counts coming between May 1 and Aug. 31, according to CDC.

"There are some years that are worse than others, but this one is kind of 'off the scale' in terms of the number of human cases that have been diagnosed," Adalja said. "When you look at the numbers historically, it's usually much, much lower than what we're seeing."

This year might be especially bad in part because of a drop in resources to prevent and tackle the spread of foodborne illnesses, Adalja added.

"In the past, the FDA sometimes sent inspectors to foreign food manufacturing centers. How able are they to do that now?" he said. "We know that state and local health departments, which do a lot of the on-the-ground investigation to identify these outbreaks early, they are under-resourced chronically. We know that the whole division of CDC that deals with cyclospora has basically been eliminated."