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Nearly 7,000 people in the country may have cyclosporiasis, a parasitic foodborne illness that can cause weeks of intestinal unrest and diarrhea, according to the latest federal figures.
There are 1,645 lab-confirmed domestic cases, and the Centers for Disease Control (CDC) and Prevention said an additional 5,100 cases are under investigation, a number substantially higher than normal. This time last year, there were fewer than 250 cases.
The parasite that causes the illness contaminates fresh produce, but health officials have said they don’t know which types of produce or which suppliers are linked to the outbreak.
No deaths have been reported from the outbreak, but 141 people have been hospitalized. Cases have now been identified in 34 states, with the bulk of them in Michigan.
Officials in Michigan on Monday tentatively identified lettuce or salad greens as a potential source for the outbreak, and the Washington Post reported that Taco Bell is being investigated.
The restaurant chain has reportedly voluntarily removed some ingredients from select locations.
During a press call Tuesday, health officials did not identify any national supplier, distributor, or restaurant chain.
Don Prater, the FDA’s acting deputy commissioner for food, said lettuce is one of multiple produce items under investigation.
“What I can say at this point is that we’re continuing our traceback investigation on multiple produce items, including the lettuce,” Prater said.
Health officials said the true number of infections is almost certainly higher, because many people with mild illness recover without seeking medical care and are never tested.
In addition, it can take several weeks to determine if a sick person is part of an outbreak; symptoms can appear up to two weeks after exposure.
CDC said it has opened an outbreak investigation into a cluster of more than 400 cases in at least four Midwestern states—Michigan, Ohio, West Virginia and Kentucky—with additional cases under investigation.
The cases appear to be epidemiologically linked, suggesting a common source of infection.
The CDC stopped routinely reporting data for cyclospora and several other pathogens last July through its FoodNet program. However, officials said that reduced surveillance did not have an impact on the current outbreak.
“FoodNet is a robust program where the goal of the program is really to look at trends over time to inform our policy and prevention activities,” Gwen Biggerstaff, deputy director of the Centers for Disease Control and Prevention’s Division of Foodborne, Waterborne, and Environmental Diseases said.
The program is not designed for real-time outbreak detection or response. There are only 10 participating FoodNet sites, and none are in Michigan.
“So it doesn’t really give us the same kind of data that we have from national surveillance,” Biggerstaff said.
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