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Previous Volume 336:1548-1556 May 29, 1997 Number 22 Next

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ABSTRACT

Background Cyclospora cayetanensis is a parasite that causes gastroenteritis. Until last year most of the documented cases of cyclosporiasis in North America were in overseas travelers. In 1996, a large outbreak of cyclosporiasis occurred in North America. We investigated this outbreak.

Methods Health departments solicited information from clinicians and laboratories on cases of cyclosporiasis, which were then reported to the Centers for Disease Control and Prevention and to Health Canada. We conducted retrospective cohort studies for the cases associated with events (e.g., luncheons) and attempted to identify the sources of the implicated food.

Results A total of 1465 cases of cyclosporiasis were reported by 20 states, the District of Columbia, and 2 provinces. Of these cases, 978 (66.8 percent) were laboratory confirmed and 725 (49.5 percent) were associated with 55 events that were held from May 3 through June 14. Raspberries were definitely served at 50 events and may have been served at 4 events. For 27 of the 41 events for which adequate data were available (65.8 percent), the associations between the consumption of berries (raspberries with or without other berries) and cyclosporiasis were statistically significant (P<0.05). For all 29 events for which there were good data, the raspberries definitely came from Guatemala (21 events, 72.4 percent) or may have come from Guatemala (8 events, 27.6 percent). As few as five Guatemalan farms could have accounted for the 25 events for which the raspberries could be traced to a single exporter per event. The mode of contamination of the raspberries remains unclear.

Conclusions This large outbreak of cyclosporiasis in North America in 1996 was associated with the consumption of Guatemalan raspberries. The outbreak illustrates the need to consider that a local cluster of foodborne illness may be part of a widespread outbreak and to pursue investigations of the source of the implicated vehicle.

Source Information

From the Epidemiology Branch, Division of Parasitic Diseases (B.L.H.), and the Foodborne and Diarrheal Diseases Branch, Division of Bacterial and Mycotic Diseases (M.-L.A.), National Center for Infectious Diseases, and the Epidemic Intelligence Service, Epidemiology Program Office (M.-L.A.), Centers for Disease Control and Prevention, Atlanta.

Address reprint requests to Dr. Herwaldt at the Centers for Disease Control and Prevention, Division of Parasitic Diseases, 4770 Buford Hwy. NE, Mailstop F22, Atlanta, GA 30341-3724.

Full Text of this Article

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Simini B., Tritsch G. L., Tritsch D. E., Lavietes M. H., Cockerill F. R., Herwaldt B. L., Ackers M.-L., The Cyclospora Working Group , Osterholm M. T.
Extract | Full Text  
N Engl J Med 1997; 337:1170-1172, Oct 16, 1997. Correspondence

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