The Michigan Department of Health and Human Services (MDHHS) continues to investigate an outbreak of cyclosporiasis with 2,640 cases reported as of Monday, July 13.
While the investigation is ongoing, current results point to lettuce or salad greens as a potential source for this outbreak, although other food items cannot be completely ruled out. No specific type of produce, grower or supplier has been identified as the source.
“Although we do not have a definite product identified as the source of the outbreak, we want to let Michiganders know what we have learned so far so they can take steps to protect their families,” said Dr. Natasha Bagdasarian, chief medical executive. “Early information has shown lettuce as a common product that regularly comes up during the investigation. We will continue to provide updates as we learn more.”
Cyclospora is a parasite that infects the intestines and causes watery diarrhea, nausea, and stomach cramps. It is often contracted by eating or drinking something contaminated with the parasite. Typically, Michigan only records 40 to 50 cases of cyclosporiasis annually.
MDHHS continues to work closely with local health departments to conduct in-depth interviews of individuals testing positive for cyclosporiasis, as well as with other state and federal partners to conduct traceback investigations. More than 1,000 interviews have than have been completed to date.
Given the extent of the outbreak, the incubation period of up to two weeks for symptoms to develop after exposure and complex food distribution networks across the state and country, it will take some time for agencies to complete their investigation.
Recreational water exposure, such as swimming in lakes, is not a recognized risk factor for cyclosporiasis and there is currently no evidence linking recreational water activities to this outbreak.
While people should always avoid swallowing recreational water, foodborne exposure – particularly exposure to contaminated produce – remains the primary focus of this outbreak investigation.
MDHHS recommends the following safe practices for all individuals serving, preparing, or consuming lettuce and salad greens in impacted counties, this includes restaurants and commercial kitchens. Because this is an active and evolving situation, these recommendations may change as more information becomes available.
Focus on lettuce and salad greens
Given early information and the historical link between cyclospora and pre-packaged salad greens, MDHHS recommends adopting the following lettuce-specific safety measures:
Purchase whole heads: Buy whole heads of lettuce rather than pre-washed, bagged lettuce or pre-mixed salad kits.
Discard outer layers: Before preparation, throw away the outer two to three layers of leaves.
Wash inner leaves: Thoroughly wash the remaining inner leaves under clean running water.
Prioritize cooking: For any greens that can be cooked, cooking to a temperature of at least 158 F (70 C) is the safest option, as the parasite is resistant to routine chemical disinfection and washing alone cannot guarantee its removal.
The following foods have been specifically linked to previous?cyclospora?outbreaks in the United States and Canada:
Bagged salad mixes and kits.?
Fresh cilantro?(coriander leaves).
Fresh basil.
Raspberries.
Snow peas.
Green onions?(scallions).
General rules to reduce risk
Cook when possible.?Heating food to 158 F (70 C) or higher kills cyclospora.
Peel produce. Peeling is?highly effective?for food items with removable skin as the parasite sits on the outer surface.
Wash all fresh produce. Wash?under clean running water, even if you plan to peel it. “Pre-washed” does not guarantee safety and rewashing bagged lettuce is unlikely to remove cyclospora.
While washing alone may not fully eliminate cyclospora, it enhances protection when combined with cooking or peeling.
These recommendations are particularly important for people who have a higher risk of dehydration or weakened immune systems such as patients on chemotherapy, organ transplant recipients, infants and young children and elderly people.
People experiencing frequent, watery diarrhea are encouraged to contact their health care provider and specifically request testing for cyclospora as routine stool tests may miss the parasite.
Cyclosporiasis is treated with antibiotics along with rest and drinking plenty of fluids to maintain hydration.
For more information, visit the MDHHS Infectious Disease Outbreaks web page.
While the investigation is ongoing, current results point to lettuce or salad greens as a potential source for this outbreak, although other food items cannot be completely ruled out. No specific type of produce, grower or supplier has been identified as the source.
“Although we do not have a definite product identified as the source of the outbreak, we want to let Michiganders know what we have learned so far so they can take steps to protect their families,” said Dr. Natasha Bagdasarian, chief medical executive. “Early information has shown lettuce as a common product that regularly comes up during the investigation. We will continue to provide updates as we learn more.”
Cyclospora is a parasite that infects the intestines and causes watery diarrhea, nausea, and stomach cramps. It is often contracted by eating or drinking something contaminated with the parasite. Typically, Michigan only records 40 to 50 cases of cyclosporiasis annually.
MDHHS continues to work closely with local health departments to conduct in-depth interviews of individuals testing positive for cyclosporiasis, as well as with other state and federal partners to conduct traceback investigations. More than 1,000 interviews have than have been completed to date.
Given the extent of the outbreak, the incubation period of up to two weeks for symptoms to develop after exposure and complex food distribution networks across the state and country, it will take some time for agencies to complete their investigation.
Recreational water exposure, such as swimming in lakes, is not a recognized risk factor for cyclosporiasis and there is currently no evidence linking recreational water activities to this outbreak.
While people should always avoid swallowing recreational water, foodborne exposure – particularly exposure to contaminated produce – remains the primary focus of this outbreak investigation.
MDHHS recommends the following safe practices for all individuals serving, preparing, or consuming lettuce and salad greens in impacted counties, this includes restaurants and commercial kitchens. Because this is an active and evolving situation, these recommendations may change as more information becomes available.
Focus on lettuce and salad greens
Given early information and the historical link between cyclospora and pre-packaged salad greens, MDHHS recommends adopting the following lettuce-specific safety measures:
Purchase whole heads: Buy whole heads of lettuce rather than pre-washed, bagged lettuce or pre-mixed salad kits.
Discard outer layers: Before preparation, throw away the outer two to three layers of leaves.
Wash inner leaves: Thoroughly wash the remaining inner leaves under clean running water.
Prioritize cooking: For any greens that can be cooked, cooking to a temperature of at least 158 F (70 C) is the safest option, as the parasite is resistant to routine chemical disinfection and washing alone cannot guarantee its removal.
The following foods have been specifically linked to previous?cyclospora?outbreaks in the United States and Canada:
Bagged salad mixes and kits.?
Fresh cilantro?(coriander leaves).
Fresh basil.
Raspberries.
Snow peas.
Green onions?(scallions).
General rules to reduce risk
Cook when possible.?Heating food to 158 F (70 C) or higher kills cyclospora.
Peel produce. Peeling is?highly effective?for food items with removable skin as the parasite sits on the outer surface.
Wash all fresh produce. Wash?under clean running water, even if you plan to peel it. “Pre-washed” does not guarantee safety and rewashing bagged lettuce is unlikely to remove cyclospora.
While washing alone may not fully eliminate cyclospora, it enhances protection when combined with cooking or peeling.
These recommendations are particularly important for people who have a higher risk of dehydration or weakened immune systems such as patients on chemotherapy, organ transplant recipients, infants and young children and elderly people.
People experiencing frequent, watery diarrhea are encouraged to contact their health care provider and specifically request testing for cyclospora as routine stool tests may miss the parasite.
Cyclosporiasis is treated with antibiotics along with rest and drinking plenty of fluids to maintain hydration.
For more information, visit the MDHHS Infectious Disease Outbreaks web page.
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