title: An outbreak in 1996 of cyclosporiasis associated with imported raspberries. The Cyclospora Working Group.
abstract: BACKGROUND
  Cyclospora cayetanensis is a parasite that causes gastroenteritis. Until last year most of the documented cases of cyclosporiasis in North America were in overseas travelers. In 1996, a large outbreak of cyclosporiasis occurred in North America. We investigated this outbreak.
  
  
  METHODS
  Health departments solicited information from clinicians and laboratories on cases of cyclosporiasis, which were then reported to the Centers for Disease Control and Prevention and to Health Canada. We conducted retrospective cohort studies for the cases associated with events (e.g., luncheons) and attempted to identify the sources of the implicated food.
  
  
  RESULTS
  A total of 1465 cases of cyclosporiasis were reported by 20 states, the District of Columbia, and 2 provinces. Of these cases, 978 (66.8 percent) were laboratory confirmed and 725 (49.5 percent) were associated with 55 events that were held from May 3 through June 14. Raspberries were definitely served at 50 events and may have been served at 4 events. For 27 of the 41 events for which adequate data were available (65.8 percent), the associations between the consumption of berries (raspberries with or without other berries) and cyclosporiasis were statistically significant (P<0.05). For all 29 events for which there were good data, the raspberries definitely came from Guatemala (21 events, 72.4 percent) or may have come from Guatemala (8 events, 27.6 percent). As few as five Guatemalan farms could have accounted for the 25 events for which the raspberries could be traced to a single exporter per event. The mode of contamination of the raspberries remains unclear.
  
  
  CONCLUSIONS
  This large outbreak of cyclosporiasis in North America in 1996 was associated with the consumption of Guatemalan raspberries. The outbreak illustrates the need to consider that a local cluster of foodborne illness may be part of a widespread outbreak and to pursue investigations to the source of the implicated vehicle.
authors.affiliation: Division of Parasitic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30341-3724, USA.
authors.forename: B L
authors.initials: BL
authors.lastname: Herwaldt
authors.forename: M L
authors.initials: ML
authors.lastname: Ackers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D003048:Coccidiosis / Q000453:epidemiology* / Q000469:parasitology; D015331:Cohort Studies; D004196:Disease Outbreaks; D016783:Eucoccidiida / Q000302:isolation & purification; D005260:Female; D016266:Food Parasitology; D005517:Foodborne Diseases / Q000453:epidemiology; D005638:Fruit / Q000469:parasitology* / Q000506:poisoning; D005759:Gastroenteritis / Q000453:epidemiology / Q000469:parasitology; D006166:Guatemala; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology