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Epidemiol Infect. 2015 Dec;143(16):3451-8. doi: 10.1017/S0950268815000370. Epub 2015 Apr 13.

2013 multistate outbreaks of Cyclospora cayetanensis infections associated with fresh produce: focus on the Texas investigations.

Author information

1
Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
2
Epidemic Intelligence Service,Centers for Disease Control and Prevention,Atlanta,GA,USA.
3
Texas Department of State Health Services,Austin,TX,USA.
4
Fort Bend County Health & Human Services,Rosenberg,TX,USA.
5
United States Food and Drug Administration,College Park,MD,USA.
6
National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,GA,USA.

Abstract

The 2013 multistate outbreaks contributed to the largest annual number of reported US cases of cyclosporiasis since 1997. In this paper we focus on investigations in Texas. We defined an outbreak-associated case as laboratory-confirmed cyclosporiasis in a person with illness onset between 1 June and 31 August 2013, with no history of international travel in the previous 14 days. Epidemiological, environmental, and traceback investigations were conducted. Of the 631 cases reported in the multistate outbreaks, Texas reported the greatest number of cases, 270 (43%). More than 70 clusters were identified in Texas, four of which were further investigated. One restaurant-associated cluster of 25 case-patients was selected for a case-control study. Consumption of cilantro was most strongly associated with illness on meal date-matched analysis (matched odds ratio 19·8, 95% confidence interval 4·0-∞). All case-patients in the other three clusters investigated also ate cilantro. Traceback investigations converged on three suppliers in Puebla, Mexico. Cilantro was the vehicle of infection in the four clusters investigated; the temporal association of these clusters with the large overall increase in cyclosporiasis cases in Texas suggests cilantro was the vehicle of infection for many other cases. However, the paucity of epidemiological and traceback information does not allow for a conclusive determination; moreover, molecular epidemiological tools for cyclosporiasis that could provide more definitive linkage between case clusters are needed.

KEYWORDS:

Cyclospora; outbreaks; parasites

PMID:
25865140
PMCID:
PMC4657030
DOI:
10.1017/S0950268815000370
[Indexed for MEDLINE]
Free PMC Article

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