(UPDATED COVERAGE, July 31) Although they stand by their belief that a cyclospora parasite outbreak is linked to packaged salad, public health officials in Iowa say state law prohibits them from releasing the names of produce companies, restaurants or retailers that may have sold the suspect produce.
“Iowa Code Section 139A.3(2)’c’ requires IDPH (Iowa Department of Public Health) to prevent the identification of any business involved in a disease outbreak, and authorizes release of the identity of a business to the public only ‘when the state epidemiologist or director of public health determines such a release of information is necessary for the protection of the public,’ ” according to a July 31 statement from the department.
“Because the vast majority of illnesses occurred in mid-June and the limited shelf life of fresh produce, IDPH and DIA (the Department of Investigation and Appeals) determined the implicated salad mix was no longer in the Iowa food supply chain. Thus, there is no ongoing threat to the public health which would require the identification of a particular brand, store, or restaurant where the salad mixture was available. In addition, these sites could not have taken any action to prevent contamination of the mixture since it came prepackaged and ready to eat.”
Iowa officials, along with those in Nebraska, Texas and several other states, have consistently encouraged consumers to continue consuming fresh produce — including packaged salads — since they began reporting the cyclospora infections.
Iowa and Nebraska health officials said July 30 they linked a nationally distributed packaged salad mix to the outbreaks in their states, which have sickened 223 people.
Almost 400 people across 15 states are confirmed with the parasite, according to the Centers for Disease Control and Prevention, but federal officials say the outbreaks might not be related.
The Iowa public health investigators said patient interviews and traceback efforts have “determined that at least 80% of these cases (in Iowa) had been exposed to the same prepackaged salad mix.”
“Our investigation implicated prepackaged, prewashed, salad mix as the cause of this outbreak,” said Nebraska’s chief medical officer, Joseph Acierno, in an online update.
Patricia Quinlisk, Iowa’s head epidemiologist and medical director of the state’s health department, said the Iowa Department of Investigations and Appeals is working to traceback individual ingredients in prepackaged salad mix, which she said has already been traced to one distributor.
“We are very confident that it’s still not in the supply chain,” Quinlisk said, “because the illness onset dates are all back at in June and very early July.”
Both Iowa and Nebraska officials said the salad mix contained iceberg and romaine lettuce, carrots and red cabbage.
Quinlisk said that Iowa’s daily count of patients continues to increase, though, because people who are have been sick for some time are just now being tested and diagnosed. Similar scenarios are playing out in the other 14 state with confirmed cases.
“The symptoms can hang on for a long time, months sometimes,” Quinlisk said.
The Food and Drug Administration has been working with state officials and the CDC since the rare parasite infections started being reported to the CDC June 28.
Iowa officials asked the federal agencies to take over the investigation in mid-July, but CDC and FDA officials said their agencies would not take the lead at least until a possible source was identified.
In an update July 30, the FDA reported what Iowa officials have found related to the salad mix, but did not indicate that the federal government would step in to take over the investigation. FDA did report it has dedicated seven people at its headquarters to investigate the outbreak.
“FDA is following the strongest leads provided by the states and has prioritized the ingredients of the salad mix identified by Iowa for the traceback investigation, but is following other leads as well,” according to FDA’s July 30 update.
The CDC reported July 31 that 378 confirmed cases of cyclospora parasite infection have been reported from 16 health departments: Iowa, Nebraska, Texas, Wisconsin, Arkansas, Connecticut, Florida, Georgia, Illinois, Kansas, Minnesota, Missouri, New Jersey, New York, New York City and Ohio.
CDC and state officials have said that the cyclospora parasite, which is a one-celled microscopic animal, is extremely rare in the U.S. It is endemic in tropical and subtropical regions of the world, and U.S. cases are generally linked to international travel, according to the federal agencies.
The FDA has consistently reported that the outbreaks are possibly linked to an undetermined food source. The CDC and state health agencies have reported that previous U.S. cyclospora outbreaks were linked to imported produce, such as a 1996 outbreak linked to fresh raspberries from Guatemala.