‍Cyclospora Outbreak:

• Michigan has topped 1,560 Cyclospora cases, adding about 300 cases every 48 hours since Monday. (MDHHS)
  
  
• Ohio is also a hotspot, with 364 confirmed cases as of Friday. (Columbus Dispatch)
  
  
• The FDA updated one and added two more unique Cyclospora outbreaks to its CORE table, all with far fewer confirmed cases than Michigan and Ohio are reporting. This indicates that not all cases are from the same source. (FDA)
  
  
• FDA is initiating traceback on white and green onions (scallions), cucumbers, and cilantro for one outbreak linked to cases in IL, NY, PA, and TX. At least eight additional clusters of cases have been found in other states. (CNN)
  
  
• Cyclospora tracking used to be mandatory for state health departments, but one year ago it was made optional through FoodNet, the main foodborne surveillance arm of the CDC. (CIDRAP)
  
  

Health News:

• Ebola cases increased by 353 last week, with 600 deaths in the DRC. (Brown Pandemic Center)
  
  
• A suspected Ebola patient was placed in the same Equatorial Guinea hotel as U.S. deportees, their lawyers say. (AP)
  
  
• China reported a new case of H9N2 avian flu in a baby, the 16th case worldwide this year (mostly in China and mostly in kids under 10). (CIDRAP)
  
  
• Measles continues to grow, with 59 new cases last week and outbreaks in Virginia and an ICE detention facility in Arizona. (Brown Pandemic Center)
  
  
• Mental health leave is rising. Workers say they need it to prevent burnout, but some employers say the strain on the business is too high. (Bloomberg)
  
  
• There’s a mystery illness among Grand Canyon rafters causing fever and respiratory symptoms. Doctors are testing for Valley fever, hantavirus, and more. (NBC)
  
  
• The Legionnaires’ cluster in NYC has grown to 46 cases and 22 hospitalizations. (NY1)

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• Some good news: a new discovery could help with earlier diagnosis and treatment of Lyme disease. (Newsweek)

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We heard FDA started traceback on food items for Cyclospora. Should we pull cilantro, onions, or cucumber if we weren’t contacted by the FDA?

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There are a lot of rumors out there right now about this massive explosion in Cyclospora cases, but it’s important to get the facts straight before you start pulling menu items. 

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What we’re hearing about fresh produce as potential culprits

CNN reports that a CDC email said FDA had started a traceback investigation into cilantro, white and green onions (scallions), and cucumbers as potentially contaminated food items in one group of cases - but it’s NOT in the largest Michigan/Ohio outbreak. Instead, it’s related to a group of cases in IL, NY (including NYC), PA, and TX. Cases are reportedly linked to a grocery store, catered event, and Mexican-style restaurants. 

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Rumors on the ground in the Detroit area of Michigan state that local franchises of one national chain restaurant had voluntarily pulled lettuce, pico-de-gallo, guacamole, cilantro and onions from their menus. 

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Likely more than one outbreak 

It’s becoming increasingly clear that there’s more than one outbreak going on. The leaked CDC email indicates up to eight unique outbreak clusters, the largest of which is centered in Michigan and Ohio. 

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It’s possible that all eight clusters will be linked back to the same food item, but it’s also likely that there’s more than one thing happening at the same time. 

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More testing = more cases

The massive jump in cases this week isn’t just due to more people getting sick - it’s also because so many more people are going to get tested, and doctors are running full GI panels that will identify Cyclospora more easily. That’s not to say that there isn’t an outbreak - it’s very clear that we are seeing a sharp increase in severe diarrheal illness related to this parasite, but it’s also a bit of a chicken and egg situation. If you have multiple employees or guests with positive Cyclospora tests, if a product sample tests positive, if the FDA or health department contacts you, or if there’s a recall, we’d feel very differently. 

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So, should we pull fresh items? 

It’s a really tough call. Some local franchises have pulled the most likely culprits - possibly because they got a letter from a produce distributor or supplier, or because they were contacted by the FDA or state health department looking into those items. But the range is still pretty broad, which may impact a lot of menu items and make operations tough. 

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It’s a balance between an abundance of caution and the risk of drawing unwanted attention. One franchise group for a national chain restaurant, for example, is being named because they appear to have voluntarily withdrawn a large variety of menu items in Michigan. This could be a savvy business move (pull it all so you’re not implicated), but also may bring more scrutiny than strictly necessary (the only restaurant being named right now in what is almost certainly an outbreak far bigger than any one chain). 

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All in all, we’re not recommending that any of our clients pull fresh produce items just yet. But that could change rapidly (as will all of today’s case numbers) as we get more information from the FDA, CDC, state, and local health departments. If you have multiple employees or guests with positive Cyclospora tests, if a product sample tests positive, or if there’s a recall, we’d feel very differently. 

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For more info on this outbreak, don’t hesitate to reach out to ZHH. We’ll continue to keep you updated and expect more info later today or early next week. 

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Sources: CNN, FDA, CDC, MDHSS, ODH, CIDRAP

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Best Read:

We’ve gotten a lot of requests for documents to share with your board or executive leadership team, so we’ve put together a 1-page situational update on the Cyclospora outbreak, updated as of Friday afternoon. Feel free to share within your organization, and reach out if you have any other questions. 

July 10th - Cyclospora Situational Update   Zero Hour Health

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