As of this morning, the CDC has been notified of 535 cases of Cyclospora infection from Arkansas, Connecticut, Florida, Georgia, Illinois, Iowa, Kansas, Louisiana, Minnesota, Missouri, Nebraska, New Hampshire, New Jersey, New York, Ohio, Texas, Virginia, and Wisconsin.  Although the number of ill is slowing, it is expected to continue in the coming weeks as more states announce illnesses and/or increase their case count.

Nebraska and Iowa have linked Cyclospora infections in their states to a salad mix served at Olive Garden and produced by Taylor Farms de Mexico, S. de R.L. de C.V. The CDC announced that it would continue to work with federal, state, and local partners in the investigation to determine whether this conclusion applies to the increase in cases of cyclosporiasis in other states.  CDC’s independent analyses of data from the epidemiologic investigations in Iowa and Nebraska confirmed an association between consuming salad and being ill with cyclosporiasis during June and July 2013 in those two states.

On August 2, 2013, CDC received results of a traceback investigation from FDA. The traceback investigation conducted by FDA identified Taylor Farms de Mexico, S. de R.L. de C.V., a processor of foodservice salads, as the source of the pre-packaged salad mix identified in the cyclosporiasis outbreak in Iowa and Nebraska.  As of this morning Taylor Farms de Mexico, S. de R.L. de C.V., suspended production of salad mix and leafy greens.

Illness onset dates have stretched from June 1st through July 28th.  Given that the shelf life of the suspect vector – pre-packaged salad mix – is only a few weeks at most, it does raise some interesting questions.

Assuming that the entire outbreak – or, at least most of it – is linked to the Taylor Farms de Mexico, S. de R.L. de C.V., production facility, where the contamination events (cross-contamination within the plant, water contamination within the plant or reintroduction of contaminated product) likely occurred, why did it continue for several weeks?

Also, given that 14 of 16 states are not yet identifying Taylor Farms de Mexico, S. de R.L. de C.V., as the source for illnesses in those states, it does raise the possibility that Taylor Farms de Mexico, S. de R.L. de C.V., is not the sole source of the outbreak.  True, it could have co-packed leafy greens that then went through brokers and shippers to a variety of restaurants, which has made traceback difficult.  However, there is also the possibility that the area where the leafy greens were grown harbors Cyclospora, and that those greens went both to Taylor Farms de Mexico, S. de R.L. de C.V., and other manufacturers and then on to other restaurants.

Another thought – only about 35 states require cyclosporiasis to be reported, therefore, it is possible that some states (look at Oklahoma above) have cases but are not required to count them.

Any other ideas?