Cyclospora Outbreak:

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• The FDA released an update Sunday saying that the Cyclospora test on shredded lettuce from central Mexico should be considered a false positive, but the Taylor Farms recall notice still stands. (FDA)
  
  
• There are over 11,000 Cyclospora cases across 46 states, 3x what we see in a normal year (it’s only July). A whopping 2% of all doctors visits in the U.S. at the end of June were for diarrhea. (YLE)
  
  
• Michigan case counts are up to 6,571 as of Tuesday, an increase of over 1,400 since Friday. (MDHHS)
  
  
• Experts are emphasizing the fact that this Cyclospora outbreak is likely linked to farming practices, not anything restaurants did wrong. (NCHN)

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Health News:

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• COVID cases are rising, especially in the West and South. It’s not uncommon to see some summer surges. (FOI)
  
  
• The death toll in DR Congo from Ebola is near 1,000, with a rough case fatality rate of 39%. (CIDRAP)
  
  
• Three more patients died in the NYC Legionnaires’ outbreak, for a total of four deaths. The city believes they eliminated the sources of the bacteria after a cleanup of cooling towers in the area. (NBC)
  
  
• Delaware has its first measles case in over a decade. (ABC)
  
  
• 1,700 HIV treatment sites were closed in the U.S. after federal funding cuts. (NY Times)
  
  
• Wildfire smoke is clearing in the Midwest and Northeast, but extreme weather, including flash flooding, storms, and even tornadoes are expected this week in the two regions. (NY Times)
  
  
• Some good news: measles spread is finally starting to slow in Utah. (KSL)

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Best Question:

What the heck is happening with Cyclospora? Does a false positive mean we’re back to square one? 

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False Positive

On Saturday, the FDA announced a positive Cyclospora result in iceberg lettuce from Taylor Farms de Mexico, and reported that the company was doing a voluntary recall of all iceberg lettuce from central Mexico. But 24 hours later, in a largely unprecedented move, the FDA announced that it was a false positive result, and that no product samples were confirmed positive. They did say that a Taylor Farms product is still “implicated in the outbreak.”  

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Taylor Farms posted on their own website that the FDA apologized to them. But they’re still recalling all iceberg lettuce grown in central Mexico from stores (including Marketside brand at Walmart), restaurants, and food service companies in 27 states, and FDA still maintains that there is a link. Taylor Farms also announced that it will stop sourcing lettuce from central Mexico for the remainder of the growing season. 

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FDA has since updated their July 18th announcement, but when you go back to look at what it originally said, it confirmed that the positive test was on Mexican lettuce that was NOT part of their current voluntary recall. That likely means the test would have led to a wider recall if it were a true positive. 

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An Odd Recall Notice

Another challenge is that Taylor Farms hasn’t released lot numbers or source names in their recall, only coded customer names. While this does help protect the companies who have unknowingly purchased this potentially-infected product, it makes it much more difficult to determine where this lettuce has actually been distributed (beyond the ones we already know about, like Taco Bell and Walmart’s Marketside salads). Much of TF’s product goes to third-party distributors, not directly to restaurants or stores, which complicates things.

Testing is a Challenge

Testing for Cyclospora is also notoriously difficult (most epidemiologists we know groaned when this outbreak started and shared some version of “It’s a nightmare to find!”). That’s because the parasite is very small, and even low levels of contamination can make someone sick. But it’s also really hard to grow in a lab compared to bacteria, for example, like Salmonella or E. coli. 

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Mexican Lettuce is Still the Likely Culprit

At the end of the day, it’s still very likely that the source of this outbreak is lettuce from central Mexico. All the interviews, investigation, and traceback still point to lettuce from (at least) one farm in this region. We are still waiting to hear more about whether it’s at the farm level or a processing facility there, which will tell us more about the scope, and whether any other products may be cross-contaminated. 

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Actions to Take

For businesses: check if you have locations in any one of 27 states receiving iceberg lettuce in any form from Taylor Farms de Mexico, and pull that product. We’ll keep an eye on information coming out and let you know if other products are implicated. 

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For individuals: you may want to avoid all shredded lettuce for the next week or so until things shake out. If you’re high risk (65+, immunocompromised, pregnant, etc.), you may want to continue avoiding the other higher risk foods, like cilantro, basil, raspberries, snap or snow peas, and green onions. 

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Sources: FDA, CIDRAP, Taylor Farms, YLE, CDC

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Best Read:

New York City had its own - MUCH smaller - Cyclospora outbreak back in April. While it’s unrelated to the massive outbreak happening now, it’s interesting to see how one city health department figured out that theirs was linked to cilantro. But it’s equally interesting to note that the cilantro was from an international supplier, and no recall or confirmation has happened yet. Like most Cyclospora investigations, this one will likely be closed by FDA and CDC without an official solution, even if NYC is pretty darn sure they have the culprit. 

What Did They Eat? Here's How One Case of Cyclosporiasis Was Solved. - NY Times (Gift Article)

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