Cyclospora Outbreak: Lettuce and Salad Greens Identified as Potential Contaminants

Health officials in Michigan have identified lettuce or salad greens as a potential source for an ongoing cyclospora outbreak, an illness caused by the parasite cyclospora, which spreads through food and water contaminated with fecal matter. Officials noted that while current evidence points to these vegetables, the source has not been definitively confirmed, and other food items remain under investigation. No specific grower or supplier has been named.

As of Monday evening, Michigan reported 2,640 cases and 44 hospitalizations, marking a 69% increase from Friday’s figures. This represents the highest annual case count in the state’s history, surpassing its typical average of 40 to 50 cases annually. The outbreak has also been detected in multiple other states, including New York, Ohio, Illinois, Indiana, and Kentucky, where cyclospora cases exceed normal levels. The U.S. Centers for Disease Control and Prevention (C.D.C.) has confirmed at least 843 cases across 31 states, with 86 hospitalizations reported.

Health experts note that C.D.C. figures likely underestimate the total number of cases due to reporting delays and confirmation processes. The New York Times has independently verified over 4,800 cases nationwide as of this year. Since 2016, the C.D.C. has recorded an average of approximately 2,800 cases annually, making 2023 the most significant outbreak on record, according to epidemiologist Caitlin Rivers of Johns Hopkins Bloomberg School of Public Health.

Previous cyclospora outbreaks have been linked to fresh produce, including lettuce, raspberries, basil, cilantro, and fruit mixes. In 2020, a large-scale outbreak connected to Fresh Express bagged salads containing iceberg lettuce, cabbage, and carrots sickened 701 individuals across 14 states, the largest in recent U.S. history. A 2022 Florida outbreak similarly traced to bagged salads, including Caesar kits with romaine lettuce, resulted in additional cases. Given these patterns, Michigan officials advise consumers to use whole heads of lettuce rather than pre-packaged salads, carefully washing inner leaves under running water after removing outer layers.

Health authorities emphasize thorough washing of all fresh produce, though they caution that washing cannot fully eliminate the parasite. Additional precautions include peeling produce with removable skins and cooking vegetables to at least 158°F, a temperature that destroys cyclospora. Symptoms of cyclosporiasis include watery diarrhea, cramping, nausea, and fatigue, with some individuals experiencing prolonged illness if untreated. The C.D.C. recommends medical consultation for suspected cases to enable proper testing and antibiotic treatment.

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