Iowa: Updating The Cyclospora Outbreak

 

Credit CDC

 

 

# 7483

 

Last week in Iowa & Nebraska Report Cyclospora Outbreak I wrote about an outbreak of a relatively rare (at least in the United States) intestinal illness due to the microscopic parasite Cyclospora cayetanensis.

 

A week ago (July 8th) Iowa had reported 22 laboratory confirmed cases. Today, that number has more than tripled, with 71 cases now confirmed.

 

First, two updates from the Iowa Department of Public Health, and then I’ll return with a little bit more.

 

 

IDPH Cyclospora Case Count Update

The Iowa Department of Public Health, CDC and local public health agencies are investigating an outbreak of an intestinal illness caused by Cyclospora (a rare parasite). As of today, July 15, 71 cases of Cyclospora infections have been reported to IDPH; almost all have been identified through testing at the State Hygienic Lab (SHL), including:

• Linn County - 30 cases
• Polk County - 5 cases
• Fayette County - 3 cases
• O’Brien County - 3 cases
• Dallas County - 3 cases
• Buchanan - 3 cases
• Black Hawk County - 3 cases
• Webster County - 3 cases
• Mills County - 2 cases
• Des Moines County - 2 cases
• Boone County - 3 cases
• Benton County - 1 case
• Keokuk - 1 case
• Monona - 1 case
• Butler - 1 case
• Winneshiek - 1 case
• Johnson County - 1 case
• Pottawattamie County - 1 case
• Van Buren County - 1 case
• Story County - 1 case
• Cedar County - 1 case
• Woodbury County - 1 case

Total - 71 cases

 

 

Iowa Cyclospora Outbreak 2013
Outbreak Update 7.15.13
(new information is highlighted)

• IDPH, CDC, the State Hygienic Laboratory and local public health agencies are investigating an
  outbreak caused by Cyclospora.
  • As of today, 71 cases of Cyclospora infections have been reported to IDPH. Case counts are updated at approximately 10 a.m. each day.
  • Cyclospora is a rare parasite.
  • Previous outbreaks have been associated with fresh produce (fresh fruits and
    vegetables)
  • People become infected with Cyclospora by consuming food or water contaminated
    with the parasite.
    
• The source of this outbreak is unknown at this time, however progress is being made.
  • Cyclospora illness is typically traced to consumption of fresh fruits and vegetables
    contaminated with the parasite; this investigation currently indicates fresh vegetables, not fruit, may be the source of illness.
  • IDPH is working with local public health agencies to interview individuals who are ill to determine if there is a common food exposure that would indicate the source of illness.
  • Cluster investigations continue, which ask questions of both the ill person and their
    family and friends who are not ill, to determine what the well people did not eat. 
    
• Cylospora infection causes a watery diarrhea that lasts an average of 57 days, if untreated.
  • Most of the illnesses in this outbreak began in mid to late June. Many people report still
    being ill and some have had relapses.
  • There is treatment (medicine) available to treat Cyclospora infection.
  • Specific laboratory testing (not commonly ordered) must be done to detect Cyclospora.
  • Specific treatment (not typically used to treat more common diarrheal illnesses) can be prescribed.
• If you are experiencing diarrhea, or have recently had a long bout with diarrhea, you should
  contact your health care provider and see if you should be tested for Cyclospora infection.
  • Additional symptoms of cyclosporiasis (the infection caused by Cyclospora) include: 
    Watery diarrhea 
    Fatigue (severe tiredness) 
    Loss of appetite 
    Weight loss 
    Bloating 
    Increased gas 
    Stomach cramps 
    Nausea 
    Vomiting 
    Muscle aches 
    Low-grade fever

 

Unlike cryptosporidium and the infamous norovirus, which can be easily be passed from human-to-human, Cyclospora is rarely transmitted directly from an infected host.

 

Hosts infected with Cyclospora shed unsporulated (non-infective) cysts in their stool which require days or even weeks to mature into infectious agents.

 

Neighboring Nebraska has reported more than a dozen cases of Cyclospora over the past two weeks as well, although Iowa appears to be taking the brunt of the outbreak.

 

The CDC maintains an extensive site on Parasites - Cyclosporiasis (Cyclospora Infection) where you can learn more about this water and food borne illness.

 

I’ll update this story when (or if) we learn the source.

Iowa & Nebraska Report Cyclospora Outbreak

 

Credit CDC 

 

# 7462

 

 

Although fairly common in developing tropical, or sub-tropical countries, Cyclosporiasis – an infection generally acquired through consuming food or water contaminated with Cyclospora cayetanensis - is relatively rare in the United States.

 

According to the CDC’s Epidemiology & Risk Factors:

 

In the United States, foodborne outbreaks of cyclosporiasis since the mid-1990s have been linked to various types of imported fresh produce, including raspberries, basil, snow peas, and mesclun lettuce; no commercially frozen or canned produce has been implicated.

 

U.S. cases of infection also have occurred in persons who traveled to Cyclospora-endemic areas. To reduce the risk for infection, travelers should take precautions, such as those recommended in CDC's Health Information for International Travel (Yellow Book). Travelers also should be aware that treatment of water or food with chlorine or iodine is unlikely to kill Cyclospora oocysts.

 

Unlike cryptosporidium, which can be easily be passed from human-to-human, Cyclospora is rarely transmitted directly from an infected host. Hosts infected with Cyclospora shed unsporulated (non-infective) cysts in their stool which require days or even weeks to mature into infectious agents.

 

So far, the source of this outbreak remains a mystery, but at least 3 dozen people in Iowa and Nebraska have been identified as infected – all apparently since mid-June.  Public Health departments in Iowa and Nebraska are urging lab testing for patients with prolonged diarrhea  accompanied by anorexia and fatigue.

 

This from the Iowa Department of Public Health.

 

IDPH Investigates Intestinal Illness

The Iowa Department of Public Health, CDC and local public health agencies are investigating an outbreak of an intestinal illness caused by Cyclospora (a rare parasite). As of today, July 8, 22 cases of Cyclospora infections have been reported to IDPH; almost all have been identified through testing at the State Hygienic Lab (SHL), including:

• Linn County - 10 cases
• Fayette County - 3 cases
• O’Brien County - 2 cases
• Webster County - 2 cases
• Benton County - 1 case
• Des Moines County - 1 case
• Mills County - 1 case
• Polk County - 1 case
• Van Buren County - 1 case

Most people’s illness began in mid to late June, and at least one person has been hospitalized. Many people report still being ill with diarrhea and some have had relapses.

 

Specific treatment is available (but it is not typically used for more common diarrheal illnesses). Also, very specific laboratory testing (not commonly ordered) must be done to detect Cyclospora.

 

Additional cases have been identified in Nebraska and other Midwestern states. IDPH is coordinating the investigation with public health officials in those states. The investigation is ongoing; no specific source of exposure has been identified. Fresh produce (fresh fruits and vegetables) have been implicated in previous outbreaks. Washing fresh produce is recommended; however, it can be very difficult to wash Cyclospora off all types of produce.

 

People become infected with cyclospora by consuming food or water contaminated with the parasite, which causes a watery diarrhea that lasts an average of 57 days if untreated.

Symptoms of cyclosporiasis include:

• Watery diarrhea
• Fatigue (severe tiredness)
• Loss of appetite
• Weight loss
• Bloating
• Increased gas
• Stomach cramps
• Nausea
• Vomiting
• Muscle aches
• Low-grade fever