title: 2013 multistate outbreaks of Cyclospora cayetanensis infections associated with fresh produce: focus on the Texas investigations.
abstract: The 2013 multistate outbreaks contributed to the largest annual number of reported US cases of cyclosporiasis since 1997. In this paper we focus on investigations in Texas. We defined an outbreak-associated case as laboratory-confirmed cyclosporiasis in a person with illness onset between 1 June and 31 August 2013, with no history of international travel in the previous 14 days. Epidemiological, environmental, and traceback investigations were conducted. Of the 631 cases reported in the multistate outbreaks, Texas reported the greatest number of cases, 270 (43%). More than 70 clusters were identified in Texas, four of which were further investigated. One restaurant-associated cluster of 25 case-patients was selected for a case-control study. Consumption of cilantro was most strongly associated with illness on meal date-matched analysis (matched odds ratio 19·8, 95% confidence interval 4·0-∞). All case-patients in the other three clusters investigated also ate cilantro. Traceback investigations converged on three suppliers in Puebla, Mexico. Cilantro was the vehicle of infection in the four clusters investigated; the temporal association of these clusters with the large overall increase in cyclosporiasis cases in Texas suggests cilantro was the vehicle of infection for many other cases. However, the paucity of epidemiological and traceback information does not allow for a conclusive determination; moreover, molecular epidemiological tools for cyclosporiasis that could provide more definitive linkage between case clusters are needed.
authors: Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: F
authors: F
authors: Abanyie
authors: Epidemic Intelligence Service,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: R R
authors: RR
authors: Harvey
authors: Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: J R
authors: JR
authors: Harris
authors: Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: R E
authors: RE
authors: Wiegand
authors: Texas Department of State Health Services,Austin,TX,USA.
authors: L
authors: L
authors: Gaul
authors: Fort Bend County Health & Human Services,Rosenberg,TX,USA.
authors: M
authors: M
authors: Desvignes-Kendrick
authors: United States Food and Drug Administration,College Park,MD,USA.
authors: K
authors: K
authors: Irvin
authors: National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: I
authors: I
authors: Williams
authors: Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: R L
authors: RL
authors: Hall
authors: Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: B
authors: B
authors: Herwaldt
authors: Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: E B
authors: EB
authors: Gray
authors: Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: Y
authors: Y
authors: Qvarnstrom
authors: National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: M E
authors: ME
authors: Wise
authors: Texas Department of State Health Services,Austin,TX,USA.
authors: V
authors: V
authors: Cantu
authors: Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: P T
authors: PT
authors: Cantey
authors: National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: S
authors: S
authors: Bosch
authors: Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: A J
authors: AJ
authors: DA Silva
authors: United States Food and Drug Administration,College Park,MD,USA.
authors: A
authors: A
authors: Fields
authors: Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: H
authors: H
authors: Bishop
authors: United States Food and Drug Administration,College Park,MD,USA.
authors: A
authors: A
authors: Wellman
authors: United States Food and Drug Administration,College Park,MD,USA.
authors: J
authors: J
authors: Beal
authors: Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: N
authors: N
authors: Wilson
authors: Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: A E
authors: AE
authors: Fiore
authors: National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: R
authors: R
authors: Tauxe
authors: National Center for Emerging and Zoonotic Infectious Diseases,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: S
authors: S
authors: Lance
authors: Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: L
authors: L
authors: Slutsker
authors: Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
authors: M
authors: M
authors: Parise
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D028526:Coriandrum / Q000469:parasitology*; D021744:Cyclospora / Q000302:isolation & purification*; D021866:Cyclosporiasis / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D013781:Texas / Q000453:epidemiology; D055815:Young Adult
keywords: Cyclospora; outbreaks; parasites