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BACKGROUND: In the summer of 2014, the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), state and local partners, and the Mexican authorities – COFEPRIS and SENASICA, investigated an outbreak of illnesses in Texas caused by Cyclospora cayetanensis linked to consumption of cilantro at Mexican-style restaurants.
METHODS: A case was defined as a laboratory-confirmed Cyclospora infection in a person with illness onset on or after May 1, 2014 and no reported travel outside the U.S. or Canada within the 14 days prior to illness onset. Case-patients were interviewed to identify common food exposures. FDA collaborated with CDC and state partners to evaluate cyclosporiasis clusters reported during the summer of 2014 in Texas and other states. A traceback investigation was conducted by FDA and state partners to identify common cilantro suppliers to the Texas restaurant clusters.
RESULTS: A total of 126 cases of cyclosporiasis meeting the case definition were reported in Texas as of August 26, 2014, with most cases occurring in June and July. Epidemiologic and traceback investigations indicated that some illnesses in Texas were linked to cilantro from Puebla, Mexico. The traceback investigation identified firms in Puebla, Mexico that supplied cilantro to the points of service during the timeframe of interest. FDA, in collaboration with the Mexican authorities, conducted investigations of cilantro suppliers in the Puebla region. Inspections at cilantro packaging facilities focused on examining handling practices, water sources, and worker hygiene. FDA continues to work in collaboration with Mexican authorities to address observations noted during those investigations. Additionally, FDA began increased surveillance sampling of cilantro and other fresh produce imported from firms in Puebla, Mexico. Investigations of Cyclospora clusters in states other than Texas did not identify a vehicle linked to the illnesses. There is no evidence to suggest that illnesses outside of Texas are linked to cilantro from Puebla, Mexico.
CONCLUSIONS: The 2014 epidemiologic and traceback investigations of the Texas clusters identified cilantro from Puebla, Mexico as the source of some of the illnesses in Texas. An outbreak of cyclosporiasis in Texas in 2013 was also associated with cilantro imported from Puebla. Although investigations did not identify convergence on a single firm, issues with cilantro practices in the region were identified. FDA and the Mexican authorities continue to work together to promote food safety and to develop prevention strategies to improve growing and handling practices in the Puebla region.