Record cyclosporiasis outbreak puts U.S. food-safety system under strain

A record-setting outbreak of cyclosporiasis has sickened more than 15,700 people in the United States this summer, putting pressure on a public-health system that experts say has lost staff, funding and some of its ability to monitor foodborne illness. The outbreak, caused by the microscopic Cyclospora parasite, has been concentrated in the Midwest but has involved cases across the country. Federal and state investigators have linked many illnesses to contaminated shredded iceberg lettuce imported from Mexico and served at Taco Bell locations. The Food and Drug Administration announced the investigation in July, identifying affected locations in Indiana, Kentucky, Michigan, Ohio and West Virginia. The national case total includes illnesses linked to that investigation as well as other cases and clusters that have not been tied to a common source. The true number of infections is likely higher because people with milder symptoms may not seek care or receive testing. Cyclosporiasis is an intestinal illness typically spread by eating food or drinking water contaminated with the parasite. It is not generally transmitted through casual contact with an infected person because the parasite must mature in the environment before it becomes infectious. Symptoms can include prolonged, watery diarrhea, abdominal cramping, nausea, fatigue and weight loss. The illness can last for weeks without treatment and can pose greater risks to people vulnerable to dehydration. The outbreak has exposed gaps in a response system that depends heavily on local health departments. Environmental-health workers and epidemiologists interview patients, inspect facilities, collect records and help identify what sick people ate before they became ill. Those findings are then shared with state and federal agencies attempting to trace contaminated products through a complicated supply chain. Bob Custard, a West Virginia public-health consultant and president of the West Virginia Association of Sanitarians, told NPR that local food-safety programs in the state are severely understaffed. He said some counties have lost sanitarians and epidemiologists, leaving remaining employees with more responsibilities and less capacity to investigate cases. Kentucky officials told NPR that food-safety staffing is down by roughly 30% to 50%. Ohio officials said their response has not been affected by staffing cuts, while Michigan officials said they were able to preserve surveillance and investigation work after successfully challenging a grant reduction in court. Experts also pointed to changes at the federal level. Susan Mayne, a former director of the FDA’s food-safety center, said staff reductions weakened teams responsible for public communication, outbreak coordination and work with regulators in other countries. The Department of Health and Human Services said staff who work with foreign regulatory counterparts had been reinstated. The FDA said it continues to work with federal, state and international partners and is deploying personnel where officials believe they can have the greatest public-health effect. The CDC has also reduced the scope of some foodborne-illness surveillance. Cyclospora was removed from the pathogens actively monitored through the Foodborne Diseases Active Surveillance Network, known as FoodNet. Dan Jernigan, a former CDC infectious-disease official, told NPR that the change does not eliminate the agency’s ability to respond to a current outbreak, but it makes it harder to measure long-term trends and determine whether infections are increasing. The response has been further complicated by the biology of Cyclospora. Investigators have historically had limited genetic tools for matching cases to a specific food item, so officials often rely on patient interviews and supply-chain records. FDA officials have said it can take as long as six weeks to determine whether a reported illness belongs to a particular outbreak. Public-health officials continue to advise people with symptoms to seek medical care and testing. Because contamination may occur before produce reaches restaurants or stores, identifying the source quickly is central to stopping additional illnesses. The scale of this year’s outbreak has made that task more urgent—and raised broader questions about whether the country has maintained enough public-health capacity to detect and contain the next foodborne threat.