Federal health officials announced on Thursday that cases of parasitic illness tied to recalled iceberg lettuce have been confirmed in 20 states, marking the expansion of the nation’s largest Cyclospora outbreak to date.

The FDA reported that government scientists have identified infections in three more states—Georgia, Tennessee, and Texas.

The total number of people infected has risen to 11,458, up from roughly 10,900 reported the previous week.

The FDA, CDC, and state health officials have centered their investigation on lettuce produced at a central‑Mexico farm run by Taylor Farms, a leading U.S. produce supplier.

The FDA said its staffers continue to inspect and test produce at the farm, working with Mexican officials. The agency stated it “remains confident that all recalled iceberg lettuce related to this specific Cyclospora outbreak is off the market.”

Cyclospora is a microscopic parasite that commonly causes watery diarrhea “with frequent and sometimes explosive bowel movements,” according to the CDC. Outbreaks tend to occur most often in the late spring and summer.

The heat‑loving parasite invades the intestines and spreads via fecal contamination. The resulting illness, cyclosporiasis, occurs less frequently than infections from pathogens such as Salmonella and E. coli, and many cases of Cyclospora cannot be traced to a particular food or source.

Earlier this week the CDC said the United States has seen roughly 29,000 confirmed or suspected Cyclospora infections this year, with 922 hospitalizations. The agency noted that the previous peak occurred in 2019, with about 4,700 cases nationwide. Earlier this month, Michigan reported two deaths linked to Cyclospora.

Experts told MedPage Today that reductions in the CDC’s foodborne disease surveillance network made by the Trump administration could hinder efforts to trace Cyclospora outbreaks. The parasite was among six pathogens removed from tracking requirements last year.

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