Food

FDA Investigates Multistate Outbreak of Cyclosporiasis

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Posted November 21, 2013 

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November 21, 2013 

The Cyclospora illness outbreaks during the summer of 2013 have ended, based on traceback and epidemiologic investigations conducted by the FDA and Centers for Disease Control and Prevention (CDC) as well as state and local public health authorities in Iowa, Nebraska, Texas, and other states.  According to the CDC, reported cyclosporiasis cases have returned to baseline levels.  

Epidemiologic and traceback investigations by the CDC, FDA, and the states of Iowa and Nebraska had linked some illness clusters in the outbreaks in those states to salad mix supplied by Taylor Farms de Mexico, S. de R.L. de C.V., to Olive Garden and Red Lobster restaurants, both owned by Darden Restaurants. 

The FDA, in conjunction with the CDC, Mexican government, and Taylor Farms de Mexico, conducted an environmental assessment at Taylor Farms de Mexico facilities in Guanajuato, Mexico from August 12-19, 2013. The team found that conditions and practices observed at these facilities at the time of the assessment were in accordance with known food safety protocols. The report on that environmental assessment is available here.

The U.S. Food and Drug Administration (FDA) along with the Centers for Disease Control and Prevention (CDC) and state and local officials are investigating a multi-state outbreak of Cyclospora infections. We are moving quickly to learn as much as possible and prevent additional people from becoming ill. We recognize that people will be concerned about this outbreak, and we will continue to provide updates and advice.

What is the Problem and What is Being Done About It?

The Cyclospora illness outbreaks during the summer of 2013 have ended, based on traceback and epidemiologic investigations conducted by the FDA and Centers for Disease Control and Prevention (CDC) as well as state and local public health authorities in Iowa, Nebraska, Texas, and other states.  According to the CDC, reported cyclosporiasis cases have returned to baseline levels.

As of October 29, 2013, CDC had been notified of 631 cases of Cyclospora infection from 25 states:  Arkansas,  California, Connecticut, Florida, Georgia, Illinois, Iowa disclaimer icon, Kansas, Louisiana, Masssachusetts, Michigan, Minnesota, Missouri, Nebraska disclaimer icon, New Hampshire, New Jersey, New York (including New York City), Ohio, Pennsylvania, South Dakota, Tennessee, Texas disclaimer icon, Virginia, Wisconsin disclaimer icon, and Wyoming. 

On July 30, 2013, the states of Iowa disclaimer icon  and Nebraska disclaimer icon announced that their analysis indicated that the outbreak in those states was linked to a salad mix. 

The FDA traceback investigation has confirmed that the salad mix identified by Iowa and Nebraska as being linked to the outbreak of cyclosporiasis in those states was supplied to restaurants in those states by Taylor Farms de Mexico, S. de R.L. de C.V., a processor of foodservice salads.    The FDA traceback investigation found that illness clusters at restaurants were traced to a common supplier,  Taylor Farms de Mexico, S. de R.L. de C.V. The restaurants in Iowa and Nebraska include Olive Garden and Red Lobster, both of which are owned by Darden Restaurants.  FDA’s investigation has not implicated consumer packages sold in grocery stores.

The Iowa Department of Inspections and Appeals (DIA) and the Nebraska Department of Health and Human Services have announced that they believe the contaminated salad is no longer in the food supply in those states.  The last date that someone who had eaten in one of these restaurants in those states reportedly became ill with cycloporiasis was on July 2.  The typical shelf life for a salad mix is up to 14 days.  

As a result of this investigation, FDA increased its surveillance efforts on green leafy products exported to the U.S. from Mexico.

On August 12, 2013 Taylor Farms de Mexico officially informed the FDA that, as of August 9, 2013, the company had voluntarily suspended production and shipment of any salad mix, leafy green, or salad mix components from its operations in Mexico to the United States. The firm committed not to resume production and shipping of these products from its operations in Mexico without FDA’s concurrence. Only the salad mix was been implicated in the outbreak of cyclosporiasis in Iowa and Nebraska. This voluntary action went beyond the implicated salad mix and includes iceberg lettuce, romaine lettuce, green leaf lettuce, red cabbage, green cabbage and carrots. The action of Taylor Farms de Mexico exemplified the company’s cooperation with federal and state officials throughout this complicated investigation.

The Mexican government’s food regulatory authorities, the Federal Commission for Protection against Sanitary Risks (COFEPRIS), the National Agro-Alimentary Health, Safety and Quality Service (SENASICA), and state-level agricultural authorities also collaborated with FDA in the investigation of this outbreak.

From August 12-19, 2013, the FDA with the cooperation of Mexican government authorities  and Taylor Farms de Mexico, S. de R.L. de C.V., conducted a thorough environmental assessment at Taylor Farms de Mexico’s processing facility and five farms identified through the Cyclospora outbreak’s traceback investigation.  The team found that conditions and practices observed at these facilities at the time of the assessment were in accordance with known food safety protocols. A previous inspection, in 2011, of the processing facility of Taylor Farms de Mexico, S. de R.L. de C.V. conducted by FDA found no notable issues. The report on that environmental assessment is available here.

As a result of the environmental assessment and FDA’s thorough review of a product sampling plan for Cyclospora put in place by Taylor Farms de Mexico, S. de R.L. de C.V., the FDA agreed to the firm resuming operations.  The firm has committed to a comprehensive Cyclospora sampling program for leafy green and other products from their farms and processing facility in Mexico.  This will include both sampling of their products and water and continued monitoring of the sanitary conditions of their facilities.

On August 25, 2013 Taylor Farms de Mexico, S. de R.L. de C.V., resumed production and shipment of salad mix, leafy greens, and salad mix components from its operations in Mexico to the United States.

Epidemiologic and traceback investigations by state and local public health authorities in Texas as well as the FDA and the CDC indicate that some illnesses among Texas residents were linked to fresh cilantro grown in Puebla, Mexico. Investigations conducted by the CDC at three unrelated restaurants and one grocery store in Texas found that  fresh cilantro was the only ingredient that was consumed by all persons in all the four locations during  the 7-14 day incubation period for the parasite.   

A CDC epidemiologic study among persons who reported eating at a single Mexican-style restaurant in Fort Bend County, Texas, compared foods eaten at the restaurant by 25 ill persons and 65 healthy persons. Ingredient-level analyses were conducted using meal consumption data and recipes. Four fresh produce ingredients were significantly associated with illness: cilantro, whole onions, garlic, and tomatoes. Since these ingredients were served together in many different dishes, such as salsa, the statistical analysis could not definitively identify which of these ingredients was independently associated with illness. However, fresh cilantro was the only ingredient consumed by all 25 ill persons in this study. Consumption of lettuce was not associated with illness in this analysis, and traceback information indicated that lettuce served in this restaurant was not from Taylor Farms de Mexico.  

Preliminary traceback information indicated that fresh cilantro harvested from the Puebla, Mexico area, was supplied to restaurants and the grocery store in Texas during the period when the persons who became ill purchased it. The FDA is working with Mexican authorities to determine if there is a common farm or growing area in Puebla, Mexico, which could have provided fresh cilantro to the three restaurants and the grocery store associated with the clusters of ill persons in Texas.  

As a result of this investigation, FDA has increased its surveillance efforts on cilantro products exported to the U.S. from Mexico.  FDA will continue to work with its federal, state and local partners in the investigation.

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What is Cyclospora?

Cyclospora cayetanensis is a parasite composed of one cell, too small to be seen without a microscope. This parasite causes an intestinal infection called cyclosporiasis.

Cyclospora is acquired by people ingesting something - such as food or water - that was contaminated with the parasite.  Cyclospora needs time (days to weeks) after being passed in a bowel movement to become infectious for another person. Therefore, it is unlikely that Cyclospora is passed directly from one person to another.
For more information on Cyclospora: http://www.cdc.gov/parasites/cyclosporiasis/ disclaimer icon

Who is at Risk?

People can become infected with Cyclospora by consuming food or water contaminated with the parasite.  People living or travelling in countries where cyclosporiasis is endemic, including certain tropical or subtropical regions of the world may be at increased risk for infection.

What are the Symptoms?

The time between becoming infected and becoming sick is usually about 1 week. Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, with frequent, sometimes explosive, bowel movements. Other common symptoms include loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, and fatigue. Vomiting, body aches, headache, fever, and other flu-like symptoms may be noted. Some people who are infected with Cyclospora do not have any symptoms.  If not treated, the illness may last from a few days to a month or longer. Symptoms may seem to go away and then return one or more times (relapse). It’s common to feel very tired.

What do Consumers Need to Do?

Consumers should always practice safe food handling and preparation measures. Wash hands, utensils, and surfaces with hot, soapy water before and after handling food.  Fresh produce should be thoroughly washed before it is eaten.

If more specific information becomes available, FDA and CDC will share it with the public, along with any steps consumers can take to prevent illnesses.

Who should be Contacted? 
Contact your healthcare provider if you have diarrhea that lasts for more than 3 days.

The FDA encourages consumers with questions about food safety to call 1-888-SAFEFOOD or consult the fda.gov website: www.fda.gov .


The information in this release reflects the FDA’s best efforts to communicate what it has learned from the manufacturer and the state and local public health agencies involved in the investigation. The agency will update this page as more information becomes available.  

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Page Last Updated: 03/31/2014
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