Cyclospora cases continue to grow with link to Mexico

©iStock. Past outbreaks have been associated with imported fresh produce

The number of people infected by Cyclospora across three countries has jumped again.

A total of 78 cases have now been reported in the UK this year of which 37 travelled to Mexico.

The US Centers for Disease Control and Prevention (CDC) said 206 Cyclospora infections have been reported in people who became infected in the US and became ill on or after May.

Texas makes up at least 160 of these cases and 104 illnesses have also been reported in Canada.

It is the third successive year there has been an increase with a link to Mexico. Cyclosporiasis is an intestinal illness caused by consuming food or water contaminated with the Cyclospora parasite.

Link to Mexico

Public Health England said there may be substantial under reporting of cyclosporiasis cases because not all patients are tested and not all positives are reported by some laboratories.

In the UK travel history is awaited for 20 cases, 14 reported travelling to nine other overseas destinations and seven had no overseas travel.

Of the cases that travelled to Mexico, 21 are female and 16 male; the median age group is 40-44 years.

Onset dates are known for 27 cases and range between 21/5/17 and 14/7/17, with most reporting onset in June and July.

Last year, the UK had 440 cases of cyclosporiasis between June and October and 359 travelled to Mexico, mostly the Riviera Maya and Cancun regions. The year before, 79 UK cases associated with travel to the country were reported.

Belgium reported four cases in 2017, three of whom had a travel history to Mexico.

In August 2016, France had six confirmed and three probable cases in July and August in travellers from Mexico.

The Mexican health authorities are working with the US Food and Drug Administration to ensure foods previously associated with outbreaks in the US are free from Cyclospora.

US agencies step in

Texas health authorities said they are investigating an increase in reported cases of the Cyclospora parasite beginning in mid-June.

Past outbreaks have been associated with imported fresh produce and investigations are attempting to determine whether there is a common source for the current outbreak.

There were 148 cases of cyclosporiasis in Texas last year.

DSHS recommends thoroughly washing all fresh produce but that may not eliminate risk because Cyclospora can be very difficult to wash off, however, cooking will kill the parasite.

The CDC and Food and Drug Administration (FDA) are investigating the increase in cyclosporiasis.

Testing for Cyclospora is not routinely done in most US labs, even when stool is tested for parasites.

The total US cases have been reported from 27 states and 18 people have been hospitalized.

“At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source of infection are ongoing. It is too early to say whether cases of Cyclospora infection in different states are related to each other and/or to the same food item(s),” said the CDC.

The number of cases in 2017 is higher than that seen by the same date in 2016.

Last year at this time 88 Cyclospora infections had been reported in people infected in the US and who became ill on or after May 1, 2016.

Canadian cases rise

The Public Health Agency of Canada (PHAC) said the source of the outbreak has not been identified.

It added the risk is low as Cyclospora is not found in water or food grown in Canada.

British Columbia has six cases and 98 people are ill in Ontario.

Individuals became sick between May and July of this year. The majority of cases (55%) are male, with an average age of 48 years (22-79 years).

Cyclospora infections can be prevented by consuming fresh produce grown in countries where the parasite is not common, such as Canada, the US and European countries.

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