Michigan Reports First Two Deaths in Lettuce-Linked Cyclosporiasis Outbreak

Michigan health officials on Monday announced the first two deaths in a cyclosporiasis outbreak that has sickened thousands of people across the Midwest and beyond, according to ABC News. The Michigan Department of Health and Human Services said both people had “significant underlying health conditions that may have been impacted by cyclosporiasis and dehydration,” and released no further details. The department said the illness is typically not life-threatening and that deaths are uncommon in the U.S.

Michigan has reported 11,234 cases and 193 hospitalizations, ABC News reported, so the two deaths amount to fewer than two in 10,000 of the state’s cases. In a typical year the state sees about 50 cases, CBS News Detroit reported on Thursday, when the count stood at 10,386. The Centers for Disease Control and Prevention said it is “aware of two cyclosporiasis-related deaths” among people with underlying conditions in Michigan.

Nationally, the CDC’s most recent update showed more than 18,000 cases in 45 states since May 1. At least 6,707 cases are laboratory-confirmed, including 423 hospitalizations, and at least 11,500 more are not yet confirmed or need further investigation, ABC News reported. ABC News reported the CDC says it can take up to six weeks to decide whether a sick person counts toward its tally. Those counts are not a single outbreak: the agency is investigating other clusters unrelated to the one linked to lettuce, ABC News said.

Cyclosporiasis is an illness caused by the Cyclospora parasite. Symptoms include watery diarrhea, sometimes frequent, along with cramping, nausea and loss of appetite, according to a CDC briefing on July 14. Biggerstaff said people usually get sick two days to two weeks after exposure.

Federal officials have tied cases in Michigan and eight other states to shredded iceberg lettuce served at some Taco Bell restaurants, ABC News reported. The lettuce was supplied by Taylor Farms, and Taylor Farms de Mexico issued a voluntary recall of all iceberg lettuce from that region that was distributed from June 29 through July 16 and shipped to 27 states. Taco Bell has said it no longer uses lettuce from Taylor Farms de Mexico at any restaurant. Officials are investigating whether other sources exist.

Finding the source is hard. Gwen Biggerstaff, deputy director of the CDC’s division of foodborne, waterborne and environmental diseases, said on July 14 that targeted genotyping for this parasite is not as fast and precise as whole genome sequencing and that in some cases a specific source may never be identified. Katrine Wallace, an epidemiologist at the University of Illinois Chicago, wrote in STAT that many routine stool panels do not test for the parasite, so infections go undiagnosed, and that the surveillance, staffing and traceability meant to help had been “cut, thinned, or deferred”. Health and Human Services Secretary Robert F. Kennedy Jr. told ABC News on July 21 that the outbreak was “under control” and that “we had no cuts in our surveillance program,” though he acknowledged cuts to the FoodNet program, which he said were for redundant surveillance; Sen. Jon Ossoff, a Georgia Democrat, criticized the federal response.

Michigan health officials advise rinsing produce under running water, scrubbing firm produce such as melons and cucumbers, and refrigerating cut produce within two hours, CBS News Detroit reported. The CDC says people with prolonged watery diarrhea should contact their provider and mention cyclosporiasis specifically, and may need to request testing for Cyclospora. The CDC anticipates cases may keep rising through the end of August, which it called the end of the cyclosporiasis season.