Regional investigation of a cyclosporiasis outbreak linked to imported romaine lettuce - Nebraska and Iowa, June-August 2013.
A regional, multistate investigation into a June-August 2013 cyclosporiasis outbreak was conducted in Nebraska, Iowa, and neighbouring states. Cases were confirmed on the basis of laboratory and clinical findings. Of 227 cases in Iowa (n = 140) and Nebraska (n = 87) residents, 162 (71%) reported dining at chain A/B restaurants - 96% reported house salad consumption. A case-control study identified chain A/B house salad as the most likely vehicle. Traceback was conducted to ascertain production lot codes of bagged salad mix (iceberg and romaine lettuce, red cabbage, and carrots) served as house salad in implicated restaurants. A single production lot code of salad mix supplied by both a common producer and distributor was linked to the majority of confirmed cases in persons reporting regional chain A/B exposure. The salad mix linked to illnesses contained imported romaine lettuce from two separate single-grower fields-of-origin and ⩾1 additional field from another grower.
Division of Public Health,Nebraska Department of Health and Human Services,Lincoln,NE,USA.
B F
BF
Buss
Division of Public Health,Nebraska Department of Health and Human Services,Lincoln,NE,USA.
M V
MV
Joshi
Douglas County Health Department,Omaha,NE,USA.
A L
AL
O'Keefe
Douglas County Health Department,Omaha,NE,USA.
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CD
Allensworth
Division of Acute Disease Prevention,Emergency Response, and Environmental Health,Iowa Department of Public Health,Des Moines,IA,USA.
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A
Garvey
Division of Acute Disease Prevention,Emergency Response, and Environmental Health,Iowa Department of Public Health,Des Moines,IA,USA.
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Obbink
Iowa Department of Inspections and Appeals,Des Moines,IA,USA.
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Mandernach
Division of Public Health,Nebraska Department of Health and Human Services,Lincoln,NE,USA.
T J
TJ
Safranek
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D021866:Cyclosporiasis / Q000453:epidemiology*; D004196:Disease Outbreaks; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology*; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D018545:Lactuca / Q000469:parasitology*; D008297:Male; D008875:Middle Aged; D009329:Nebraska / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult
Cyclospora; epidemiology; foodborne infections; outbreaks; parasites