Casillas SM, Bennett C, Straily A, 2018. Notes from the field: Multiple cyclosporiasis outbreaks—United States, 2018. MMWR Morb Mortal Wkly Rep 67: 1101–1102.
Dubey JP, Almeria S, Mowery J, Fortes J, 2020. Endogenous developmental cycle of the human coccidian Cyclospora cayetanensis. J Parasitol 106: 295–307.
Almeria S, Cinar HN, Dubey JP, 2019. Cyclospora cayetanensis and cyclosporiasis: An update. Microorganisms 7: 317.
Gumbo T, Gordon SM, Adal KA, 1997. Cyclospora: Update on an emerging pathogen. Cleve Clin J Med 64: 299–301.
MacKenzie WR, Schell WL, Blair KA, Addiss DG, Peterson DE, Hoxie NJ, Kazmierczak JJ, Davis JP, 1995. Massive outbreak of waterborne cryptosporidium infection in Milwaukee, Wisconsin: Recurrence of illness and risk of secondary transmission. Clin Infect Dis 21: 57–62.
Centers for Disease Control and Prevention, 2020. Cyclosporiasis FAQs for Health Professionals. Available at: https://www.cdc.gov/parasites/cyclosporiasis/health_professionals/hp-faqs.html. Accessed February 15, 2023.
Dubey JP, Khan A, Rosenthal BM, 2022. Life cycle and transmission of Cyclospora cayetanensis: Knowns and unknowns. Microorganisms 10: 118.
Chalmers RM, 2014. Cyclospora cayetanensis. Percival SL, Yates MV, Williams DW, Chalmers RM, Gray NF, eds. Microbiology of Waterborne Diseases (Second Edition). London, United Kingdom: Academic Press, 327–353.
Ortega YR, Sanchez R, 2010. Update on Cyclospora cayetanensis, a food-borne and waterborne parasite. Clin Microbiol Rev 23: 218–234.
Casillas SM, Hall RL, Herwaldt BL, 2019. Cyclosporiasis surveillance—United States, 2011–2015. MMWR Surveill Summ 68: 1–16.
Ortega YR, Roxas CR, Gilman RH, Miller NJ, Cabrera L, Taquiri C, Sterling CR, 1997. Isolation of Cryptosporidium parvum and Cyclospora cayetanensis from vegetables collected in markets of an endemic region in Peru. Am J Trop Med Hyg 57: 683–686.
Orozco-Mosqueda GE, Martinez-Loya OA, Ortega YR, 2014. Cyclospora cayetanensis in a pediatric hospital in Morelia, Mexico. Am J Trop Med Hyg 91: 537–540.
Barratt J et al., 2021. Investigation of US Cyclospora cayetanensis outbreaks in 2019 and evaluation of an improved Cyclospora genotyping system against 2019 cyclosporiasis outbreak clusters. Epidemiol Infect 149: e214.
Tack DMR et al., 2020. Preliminary incidence and trends of infections with pathogens transmitted commonly through food—Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2016–2019. MMWR Morb Mortal Wkly Rep 69: 509–514.
Abanyie F et al., 2015. 2013 Multistate outbreaks of Cyclospora cayetanensis infections associated with fresh produce: Focus on the Texas investigations. Epidemiol Infect 143: 3451–3458.
Manuel DG, Neamatullah S, Shahin R, Reymond D, Keystone J, Carlson J, Ber CL, Herwaldt BL, Werker DH, 2000. An outbreak of cyclosporiasis in 1996 associated with consumption of fresh berries—Ontario. Can J Infect Dis 11: 640405.
Herwaldt BL, 2000. Cyclospora cayetanensis: A review, focusing on the outbreaks of cyclosporiasis in the 1990s. Clin Infect Dis 31: 1040–1057.
Connor B, Shlim D, 1995. Foodborne transmission of cyclospora. Lancet 346: 1634.
Buss SN, Leber A, Chapin K, Fey PD, Bankowski MJ, Jones MK, Rogatcheva M, Kanack KJ, Bourzac KM, 2015. Multicenter evaluation of the BioFire FilmArray gastrointestinal panel for etiologic diagnosis of infectious gastroenteritis. J Clin Microbiol 53: 915–925.
Ray LC et al., 2022. Changing diagnostic testing practices for foodborne pathogens, Foodborne Diseases Active Surveillance Network, 2012–2019. Open Forum Infect Dis 9: ofac344.
Tack DMM et al., 2019. Preliminary incidence and trends of infections with pathogens transmitted commonly through food—Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2015–2018. MMWR Morb Mortal Wkly 68: 465.
Ray LCC et al., 2021. Decreased incidence of infections caused by pathogens transmitted commonly through food during the COVID-19 pandemic—Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2017–2020. MMWR Morb Mortal Wkly Rep 70: 1332–1336.
Centers for Disease Control and Prevention, 2021. About FoodNet. Available at: https://www.cdc.gov/foodnet/about.html. Accessed September 13, 2022.
Bern C, Arrowood MJ, Eberhard M, Maguire JH, 2002. Cyclospora in Guatemala: Further considerations. J Clin Microbiol 40: 731–732.
Bern C, Hernandez B, Lopez MB, Arrowood MJ, Alvarez de Mejia M, Maria de Merida A, Hightower AW, Venczel L, Herwaldt BL, Klein RE, 1999. Epidemiologic studies of Cyclospora cayetanensis in Guatemala. Emerg Infect Dis 5: 766–774.
U.S. Census Bureau, 2023. Table 2. Resident Population for the 50 States, the District Of Columbia, and Puerto Rico: 2020 Census. Available at: https://www2.census.gov/programs-surveys/decennial/2020/data/apportionment/apportionment-2020-table02.pdf. Accessed January 10, 2024.
Zheng X, Zimmer DM, 2009. Racial differences in health-care utilization: Analysis by intensity of demand. Contemp Econ Policy 27: 475–490.
Davis KE, 2001. Access to Health Care of Adult Men and Women, Ages 18–64, 2012. Statistical Brief (Medical Expenditure Panel Survey (US)). Rockville, MD: Agency for Healthcare Research and Quality.
Hardnett FP, Hoekstra RM, Kennedy M, Charles L, Angulo FJ; Emerging Infections Program FoodNet Working Group, 2004. Epidemiologic issues in study design and data analysis related to FoodNet activities. Clin Infect Dis 38 (Suppl 3 ):S121–S126.
National Advisory Committee on Microbiological Criteria for Foods, 2023. Response to Questions Posed by the Food and Drug Administration (FDA): Cyclospora cayetanensis in Produce, 1–80. Available at: https://www.fsis.usda.gov/sites/default/files/media_file/documents/NACMCF_Cyclospora_Report_2023_Final.pdf. Accessed November 4, 2024.
Centers for Disease Control and Prevention, 2017. NHANES—About the National Health and Nutrition Examination Survey. Available at: https://www.cdc.gov/nchs/nhanes/about_nhanes.htm. Accessed September 14, 2022.
Eberhard ML et al., 2000. Attempts to establish experimental Cyclospora cayetanensis infection in laboratory animals. J Parasitol 86: 577–582.
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Cyclosporiasis has been a nationally notifiable disease in the United States since 1999, and cases have increased in recent years. We evaluated characteristics of U.S. cases and outbreaks to identify gaps and potential prevention measures for mitigating cyclosporiasis. We assessed Cyclospora data from the Foodborne Diseases Active Surveillance Network (FoodNet) and from the Foodborne Disease Outbreak Surveillance System (FDOSS) collected between 2015 and 2019. There were 1,376 cyclosporiasis cases in FoodNet between 2015 and 2019. Approximately one-fifth (n = 290, 21.1%) reported recent international travel. Most cases occurred in 2018 (n = 334, 24.3%) and 2019 (n = 758, 55.1%). There was strong seasonality, with 1,160 (90.9%) cases in the summer months. Most travelers reported visiting Mexico (n = 182, 62.8%) and Guatemala (n = 25, 8.6%). Approximately two-thirds of FoodNet cases were outbreak associated (n = 987, 71.7%). Of the 79 outbreaks reported to FDOSS, 31 (39.2%) occurred in 2018 and 40 (50.6%) occurred in 2019. Outbreaks tended to occur in spring and summer months (n = 78, 98.7%), The most common age groups among the 2,335 cases with data available included 20–49 years (n = 1,168, 50.0%), 50–74 years (n = 985, 42.2%), and ≥75 years (n = 120, 5.1%). Although direct comparisons between FoodNet and FDOSS are not possible, both datasets indicate that the majority of Cyclospora transmission is domestic and not travel associated, as previously thought. These findings show the need for continued investment in Cyclospora research, including identifying populations that are underrepresented, or at higher risk for cyclosporiasis, and improved understanding of national sources and pathways of infection.
Disclosure: Institutional review board approval was obtained from the CDC and each FoodNet site.
Current contact information: André O. Markon, Andrew Karasick, Cecile Punzalan, Alexandre J. da Silva, and Beverly Wolpert, Human Foods Program, U.S. Food and Drug Administration, College Park, MD, E-mails: andre.markon@fda.hhs.gov, andrew.karasick@fda.hhs.gov, cecile.punzalan@fda.hhs.gov, alexandre.dasilva@fda.hhs.gov, and Beverly.wolpert@fda.hhs.gov.
Casillas SM, Bennett C, Straily A, 2018. Notes from the field: Multiple cyclosporiasis outbreaks—United States, 2018. MMWR Morb Mortal Wkly Rep 67: 1101–1102.
Dubey JP, Almeria S, Mowery J, Fortes J, 2020. Endogenous developmental cycle of the human coccidian Cyclospora cayetanensis. J Parasitol 106: 295–307.
Almeria S, Cinar HN, Dubey JP, 2019. Cyclospora cayetanensis and cyclosporiasis: An update. Microorganisms 7: 317.
Gumbo T, Gordon SM, Adal KA, 1997. Cyclospora: Update on an emerging pathogen. Cleve Clin J Med 64: 299–301.
MacKenzie WR, Schell WL, Blair KA, Addiss DG, Peterson DE, Hoxie NJ, Kazmierczak JJ, Davis JP, 1995. Massive outbreak of waterborne cryptosporidium infection in Milwaukee, Wisconsin: Recurrence of illness and risk of secondary transmission. Clin Infect Dis 21: 57–62.
Centers for Disease Control and Prevention, 2020. Cyclosporiasis FAQs for Health Professionals. Available at: https://www.cdc.gov/parasites/cyclosporiasis/health_professionals/hp-faqs.html. Accessed February 15, 2023.
Dubey JP, Khan A, Rosenthal BM, 2022. Life cycle and transmission of Cyclospora cayetanensis: Knowns and unknowns. Microorganisms 10: 118.
Chalmers RM, 2014. Cyclospora cayetanensis. Percival SL, Yates MV, Williams DW, Chalmers RM, Gray NF, eds. Microbiology of Waterborne Diseases (Second Edition). London, United Kingdom: Academic Press, 327–353.
Ortega YR, Sanchez R, 2010. Update on Cyclospora cayetanensis, a food-borne and waterborne parasite. Clin Microbiol Rev 23: 218–234.
Casillas SM, Hall RL, Herwaldt BL, 2019. Cyclosporiasis surveillance—United States, 2011–2015. MMWR Surveill Summ 68: 1–16.
Ortega YR, Roxas CR, Gilman RH, Miller NJ, Cabrera L, Taquiri C, Sterling CR, 1997. Isolation of Cryptosporidium parvum and Cyclospora cayetanensis from vegetables collected in markets of an endemic region in Peru. Am J Trop Med Hyg 57: 683–686.
Orozco-Mosqueda GE, Martinez-Loya OA, Ortega YR, 2014. Cyclospora cayetanensis in a pediatric hospital in Morelia, Mexico. Am J Trop Med Hyg 91: 537–540.
Barratt J et al., 2021. Investigation of US Cyclospora cayetanensis outbreaks in 2019 and evaluation of an improved Cyclospora genotyping system against 2019 cyclosporiasis outbreak clusters. Epidemiol Infect 149: e214.
Tack DMR et al., 2020. Preliminary incidence and trends of infections with pathogens transmitted commonly through food—Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2016–2019. MMWR Morb Mortal Wkly Rep 69: 509–514.
Abanyie F et al., 2015. 2013 Multistate outbreaks of Cyclospora cayetanensis infections associated with fresh produce: Focus on the Texas investigations. Epidemiol Infect 143: 3451–3458.
Manuel DG, Neamatullah S, Shahin R, Reymond D, Keystone J, Carlson J, Ber CL, Herwaldt BL, Werker DH, 2000. An outbreak of cyclosporiasis in 1996 associated with consumption of fresh berries—Ontario. Can J Infect Dis 11: 640405.
Herwaldt BL, 2000. Cyclospora cayetanensis: A review, focusing on the outbreaks of cyclosporiasis in the 1990s. Clin Infect Dis 31: 1040–1057.
Connor B, Shlim D, 1995. Foodborne transmission of cyclospora. Lancet 346: 1634.
Buss SN, Leber A, Chapin K, Fey PD, Bankowski MJ, Jones MK, Rogatcheva M, Kanack KJ, Bourzac KM, 2015. Multicenter evaluation of the BioFire FilmArray gastrointestinal panel for etiologic diagnosis of infectious gastroenteritis. J Clin Microbiol 53: 915–925.
Ray LC et al., 2022. Changing diagnostic testing practices for foodborne pathogens, Foodborne Diseases Active Surveillance Network, 2012–2019. Open Forum Infect Dis 9: ofac344.
Tack DMM et al., 2019. Preliminary incidence and trends of infections with pathogens transmitted commonly through food—Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2015–2018. MMWR Morb Mortal Wkly 68: 465.
Ray LCC et al., 2021. Decreased incidence of infections caused by pathogens transmitted commonly through food during the COVID-19 pandemic—Foodborne Diseases Active Surveillance Network, 10 U.S. sites, 2017–2020. MMWR Morb Mortal Wkly Rep 70: 1332–1336.
Centers for Disease Control and Prevention, 2021. About FoodNet. Available at: https://www.cdc.gov/foodnet/about.html. Accessed September 13, 2022.
Bern C, Arrowood MJ, Eberhard M, Maguire JH, 2002. Cyclospora in Guatemala: Further considerations. J Clin Microbiol 40: 731–732.
Bern C, Hernandez B, Lopez MB, Arrowood MJ, Alvarez de Mejia M, Maria de Merida A, Hightower AW, Venczel L, Herwaldt BL, Klein RE, 1999. Epidemiologic studies of Cyclospora cayetanensis in Guatemala. Emerg Infect Dis 5: 766–774.
U.S. Census Bureau, 2023. Table 2. Resident Population for the 50 States, the District Of Columbia, and Puerto Rico: 2020 Census. Available at: https://www2.census.gov/programs-surveys/decennial/2020/data/apportionment/apportionment-2020-table02.pdf. Accessed January 10, 2024.
Zheng X, Zimmer DM, 2009. Racial differences in health-care utilization: Analysis by intensity of demand. Contemp Econ Policy 27: 475–490.
Davis KE, 2001. Access to Health Care of Adult Men and Women, Ages 18–64, 2012. Statistical Brief (Medical Expenditure Panel Survey (US)). Rockville, MD: Agency for Healthcare Research and Quality.
Hardnett FP, Hoekstra RM, Kennedy M, Charles L, Angulo FJ; Emerging Infections Program FoodNet Working Group, 2004. Epidemiologic issues in study design and data analysis related to FoodNet activities. Clin Infect Dis 38 (Suppl 3 ):S121–S126.
National Advisory Committee on Microbiological Criteria for Foods, 2023. Response to Questions Posed by the Food and Drug Administration (FDA): Cyclospora cayetanensis in Produce, 1–80. Available at: https://www.fsis.usda.gov/sites/default/files/media_file/documents/NACMCF_Cyclospora_Report_2023_Final.pdf. Accessed November 4, 2024.
Centers for Disease Control and Prevention, 2017. NHANES—About the National Health and Nutrition Examination Survey. Available at: https://www.cdc.gov/nchs/nhanes/about_nhanes.htm. Accessed September 14, 2022.
Eberhard ML et al., 2000. Attempts to establish experimental Cyclospora cayetanensis infection in laboratory animals. J Parasitol 86: 577–582.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 373 | 373 | 113 |
Full Text Views | 51 | 51 | 5 |
PDF Downloads | 106 | 106 | 8 |