Multistate product traceforward investigation to link imported romaine lettuce to a US cyclosporiasis outbreak - Nebraska, Texas, and Florida, June-August 2013.
During June-August 2013, 25 US states reported 631 cyclosporiasis cases including Nebraska and Iowa where a regional investigation implicated common-source imported salad mix served in two chain restaurants. At least two common-origin growing fields were likely sources of contaminated romaine lettuce. Using producer- and distributor-provided data, we conducted a grower-specific traceforward investigation to reveal exposures of ill US residents elsewhere who reported symptom onset during 11 June-1 July 2013, the time period established in the Nebraska and Iowa investigation. Romaine lettuce shipped on 2-6 June from one of these Mexico-origin growing fields likely caused cyclosporiasis in 78 persons reporting illness onsets from 11 June to 1 July in Nebraska, Texas, and Florida. Nationwide, 97% (314/324) of persons confirmed with cyclosporiasis with symptom onset from 11 June to 1 July 2013 resided in 11 central and eastern US states receiving approximately two-thirds of romaine lettuce from this field. This grower's production practices should be investigated to determine potential sources of contamination and to develop recommendations to prevent future illnesses.
Division of Public Health,Nebraska Department of Health and Human Services,Lincoln,NE,USA.
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Buss
Division of Public Health,Nebraska Department of Health and Human Services,Lincoln,NE,USA.
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Joshi
Florida Department of Health,Tallahassee,FL,USA.
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JL
Dement
Texas Department of State Health Services,Austin,TX,USA.
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Cantu
Division of Public Health,Nebraska Department of Health and Human Services,Lincoln,NE,USA.
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TJ
Safranek
D003132:Commerce; D021744:Cyclospora / Q000302:isolation & purification*; D021866:Cyclosporiasis / Q000453:epidemiology* / Q000469:parasitology; D004196:Disease Outbreaks; D005431:Florida / Q000453:epidemiology; D016266:Food Parasitology; D006801:Humans; D018545:Lactuca / Q000469:parasitology*; D008800:Mexico; D009329:Nebraska / Q000453:epidemiology; D012147:Restaurants; D013781:Texas / Q000453:epidemiology
Cyclospora; epidemiology; foodborne infections; outbreaks; parasites