Food

FDA Investigates 2015 Outbreaks of Cyclosporiasis

September 16, 2015

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The U.S. Food and Drug Administration (FDA) along with the Centers for Disease Control and Prevention (CDC) and state and local officials have been investigating outbreaks of cyclosporiasis in the United States.

Update: September 16, 2015

On September 16, 2015, the CDC reported that the numbers of reported cases of cyclosporiasis in the United States have returned to baseline levels.

Clusters of illness were identified in Texas, Wisconsin, and Georgia. The FDA; the Texas Rapid Response Team; Texas Department of State Health Services; the Wisconsin Department of Health Services; the Wisconsin Department of Agriculture, Trade and Consumer Protection; the Georgia Rapid Response Team; and the Georgia Department of Public Health collaborated on traceback investigations related to these illness clusters.  These investigations found that cilantro from the state of Puebla, Mexico was supplied to restaurants at which people identified in the illness clusters ate, suggesting that some illnesses in these states may be linked to fresh cilantro from Puebla, Mexico.

The vehicles of infection for non-cluster-associated cases have not been identified..

What was the Problem and What was Done About It?

As of September 14, 2015, CDC had been notified of 546 ill people with confirmed cyclosporiasis from 31 states in 2015.

  • Clusters of illness were identified in Texas, Wisconsin, and Georgia. Most (319, 58 percent of 546) ill people experienced onset of illness on or after May 1, 2015, and did not report international travel within two weeks before illness onset.  These 319 people were from the following states: Arkansas (3), California (2), Connecticut (5), Florida (13), Georgia (26), Illinois (9), Iowa (1), Kansas (2), Maryland (1), Massachusetts (12), Michigan (2), Missouri (1), Montana (3), Nebraska (1), New Jersey (7), New Mexico (2), New York (32), North Carolina (1), Texas (179), Utah (1), Virginia (3), Washington (2), Wisconsin (11).

Clusters of illnesses were identified in Texas, Wisconsin, and Georgia.  The FDA; the Texas Rapid Response Team; Texas Department of State Health Services; the Wisconsin Department of Health Services; the Wisconsin Department of Agriculture, Trade and Consumer Protection; the Georgia Rapid Response Team; and the Georgia Department of Public Health have collaborated on traceback investigations related to these illness clusters.  These investigations found that cilantro from the state of Puebla, Mexico was supplied to restaurants at which people identified in the illness clusters ate, indicating that some illnesses in these states were linked to fresh cilantro from Puebla, Mexico.  As of September 16, 2015, the CDC reported that case numbers have returned to baseline levels.

The CDC and state public health officials have identified annually recurring outbreaks (in 2013 and 2014) of cyclosporiasis in the United States which have been associated with fresh cilantro from the state of Puebla, Mexico. Although not confirmed by epidemiological means, the FDA reviewed a cluster of Cyclosporiasis illnesses from 2012 in which the state of Texas had previously identified cilantro as one of multiple possible suspect vehicles. The FDA determined that cilantro from the state of Puebla, Mexico, was supplied to the point of service implicated in that outbreak and was one potential source of the 2012 outbreak.

The FDA and the government of Mexico’s National Agro-Alimentary Health, Safety and Quality Service (SENASICA) and Federal Commission for the Protection from Sanitary Risks (COFEPRIS) are enhancing the safety of fresh cilantro with produce safety controls on both sides of the border.

The controls implemented by COFEPRIS and SENASICA incorporate a system for risk reduction, including export controls, for cilantro from the state of Puebla. On July 27, 2015, the FDA implemented a supportive framework of import controls to detain without physical examination shipments of fresh cilantro from the state of Puebla from April 1, 2015, through August 31, 2015, as well as this time period in ensuing years. This April through August time period aligns with the seasonality of previous cyclosporiasis outbreaks.

Shipments of fresh cilantro from other states in Mexico will be allowed to enter and be released into the United States if sufficient documentation is submitted at entry demonstrating that the cilantro was harvested and packed outside of Puebla. Additionally, the FDA, COFEPRIS, and SENASICA are working collaboratively to prepare a “Green List” of companies in Puebla whose shipments of fresh cilantro will not be detained.

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What is Cyclospora?

Cyclospora cayetanensis is a microscopic parasite, which is too small to be seen without a microscope. This parasite, when it contaminates food or water and is then ingested, can cause an intestinal illness called cyclosporiasis.

Cyclospora is acquired by people ingesting something—such as food or water—that was contaminated with the parasite.  The Cyclospora parasite needs time (days to weeks) after being passed in a bowel movement to become infectious for another person. Therefore, it is unlikely that cyclosporiasis is passed directly from one person to another.

For more information on Cyclospora: http://www.cdc.gov/parasites/cyclosporiasis/ 

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Who is at Risk?

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

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What are the Symptoms?

The time between becoming infected and becoming sick is usually about one 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. People may also experience vomiting, body aches, headache, low-grade fever, and other flu-like symptoms. 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.

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What do Consumers Need to Do?

Consumers who are concerned about the source of their cilantro should ask their retailer where the cilantro they’re purchasing is from. If consumers are concerned about the source of their cilantro, they should discard it.

Cooking or heating at high temperature will kill most pathogens, including parasites such as Cyclospora, and thus significantly reduces the likelihood of illness. This holds true for any produce that may contain Cyclospora. Washing or cleaning processes may not be sufficient to eliminate the pathogen.

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Who should be Contacted? 

Contact your healthcare provider if you have diarrhea that lasts for more than three days.
The FDA encourages consumers with questions about food safety to call 1-888-SAFEFOOD or consult the fda.gov website: www.fda.gov.

Additional Information


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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