US health authorities have declared the nation’s largest recorded cyclosporiasis outbreak over after contaminated iceberg lettuce was linked to 12,883 cases across 21 states. The CDC said it is confident that all recalled lettuce connected to the outbreak has been removed from the market; the cases included 570 hospitalisations and two deaths.
What investigators found
Investigators traced the outbreak to iceberg lettuce sourced from central Mexico by Taylor Farms de Mexico. The company recalled all of its iceberg lettuce from the region on July 17 after the outbreak first drew attention to lettuce served at Taco Bell locations. Federal investigators later identified Taylor Farms as the supplier, with products distributed to restaurants and retailers across the United States. Read the context: What to know about the UK salmonella outbreak and egg safety.
Michigan was the hardest-hit state and accounted for both deaths. Infections peaked at more than 1,000 reported cases in a single day, while reported infections had fallen to fewer than two per day on average by August.
Symptoms and wider US case numbers
Cyclosporiasis symptoms usually begin about a week after exposure to contaminated food or water, but they can appear as early as two days or as late as two weeks afterward. Frequent, watery diarrhoea is the most common symptom; other possible symptoms include loss of appetite, weight loss, stomach cramps, bloating, gas, nausea and extreme tiredness.
The lettuce outbreak came during an unprecedented rise in cyclosporiasis cases nationwide. Since May 1, the United States has recorded nearly 20,000 laboratory-confirmed cases, more than 16 times the number recorded during the same period last year. The previous record year was 2019, with about 4,700 reported illnesses.
Food-safety questions remain
The outbreak has renewed scrutiny of US controls for imported food and the ability to identify contaminated produce before it reaches consumers. The FDA is required to inspect more than 19,000 international food sites annually but reached an all-time high of 1,700 inspections in 2019, according to the Government Accountability Office.
The FDA said it has completed on-site inspections and sample collection at iceberg lettuce farms and a processing facility in Mexico, but laboratory analysis of those samples is still pending. The agency said it will continue working with state and federal officials in Mexico on the investigation. The agency’s mandatory tracking programme for Cyclospora and five other pathogens has been scaled back, while a Food Safety Modernization Act traceability rule for high-risk foods, including leafy greens, has been delayed until 2028.
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