Health officials ID possible source of illness outbreak

TECUMSEH — As case counts of a diarrhea-inducing illness rise in Michigan, state health officials say their investigation has identified a possible source.

While the investigation is ongoing, current results point to lettuce or salad greens as a potential source for the cyclosporiasis outbreak, although other food items cannot be completely ruled out, the Michigan Department of Health and Human Services said Tuesday. No specific type of produce, grower or supplier has been identified as the source. 

“Although we do not have a definite product identified as the source of the outbreak, we want to let Michiganders know what we have learned so far so they can take steps to protect their families,” Dr. Natasha Bagdasarian, Michigan’s chief medical executive, said in a news release. “Early information has shown lettuce as a common product that regularly comes up during the investigation. We will continue to provide updates as we learn more.” 

MDHHS continues to work closely with local health departments to conduct in-depth interviews of individuals testing positive for cyclosporiasis as well as with other state and federal partners to conduct traceback investigations. More than 1,000 interviews have been completed to date. 

Given the extent of the outbreak, the incubation period of up to two weeks for symptoms to develop after exposure and complex food distribution networks across the state and country, it will take some time for agencies to complete their investigation, the MDHHS said.

Cyclospora is a parasite that infects the intestines and causes watery diarrhea, nausea and stomach cramps. It is often contracted by eating or drinking something contaminated with the parasite. 

There have been 3,309 cases of cyclosporiasis reported in Michigan as of Tuesday, the MDHHS reported. Of those, 161 have been in Lenawee County, which is one of eight counties with more than 100 cases.

Typically, Michigan only records 40 to 50 cases of cyclosporiasis annually.

The illness has been reported in 34 states across the country, USA Today reported Tuesday.

Michigan’s first cases this year were reported on June 22. The number of cases reported each day has generally grown, with a dip around July 4. The greatest number of cases reported in one day so far was July 9 with 239, according to an MDHHS data dashboard. That was followed by 152 cases reported on July 10, the most recent date listed.

Some businesses are taking action to reduce possible exposure to cyclospora. Hometown Pizza in Clinton announced Monday that it has suspended serving salads and other menu items with fresh vegetables until a source of the parasite is found.

“Fresh produce will still be used in items where it is meant to be thoroughly cooked. We appreciate your patience, support and understanding,” the pizzeria said in a Facebook post. “Hopefully they find the source sooner than later!”

Taco Bell on Tuesday issued a statement that it has “voluntarily and temporarily removed limited ingredients at select restaurants as a precautionary measure. We will continue to closely monitor the situation and follow the guidance of public health authorities,” according to the Associated Press.

People experiencing frequent, watery diarrhea are encouraged to contact their healthcare provider and specifically request testing for cyclospora as routine stool tests may miss the parasite. Cyclosporiasis is treated with antibiotics along with rest and drinking plenty of fluids to maintain hydration.

Prevention recommendations

To prevent cyclosporiasis, health officials recommend:
• Washing all fruits and vegetables thoroughly under running water before eating, cutting or cooking.
• Scrubbing firm fruits and vegetables, such as melons and cucumbers, with a clean produce brush.
• Cutting away any damaged or bruised areas on fruits and vegetables before preparing and eating.
• Refrigerating cut, peeled or cooked fruits and vegetables within two hours.
When handling lettuce, the MDHHS shared the following recommendations:
• Purchase whole heads: Buy whole head of lettuce rather than pre-washed, bagged lettuce or pre-mixed salad kits.
• Discard outer layers: Before preparation, throw away the outer two to three layers of leaves. 
• Wash inner leaves: Thoroughly wash the remaining inner leaves under clean running water.
With other vegetables, peeling is effective at removing the parasite, as it lives on the outer surface.
Any greens that can be cooked should be cooked to a temperature of at least 158 degrees, as the parasite is resistant to routine chemical disinfection and washing alone cannot guarantee its removal.