Understanding Cyclosporiasis Outbreaks in Georgia: A Comprehensive Overview
Explore the prevalence of Cyclospora outbreaks in Georgia from 2005 to 2015, including historical data, diagnosis methods, demographic insights, and notable past outbreaks linked to foodborne sources. Learn about the parasite Cyclospora cayetanensis, its symptoms, diagnosis challenges, and the cyclical pattern of infections. Gain valuable insights into the intricacies of this infection and the importance of food safety measures in preventing further outbreaks.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
E N D
Presentation Transcript
2015 Georgia Cyclospora GA Food Safety & Defense Task Force Liz Hannapel May 23, 2016 Presentation to: Presented by: Date:
Overview Background information Historical Data 2015 Outbreak Questions http://www.cdc.gov/dpdx/cyclosporiasis/gallery.html
Cyclospora Caused by parasite Cyclospora cayetanensis Typically prolonged watery diarrhea lasting a few days to several weeks May self-resolve but often requires treatment with antibiotic Incubation period is 2 days 2 weeks, often ~7 days. Most common in tropical and subtropical regions Complicated life cycle: sporulation days weeks at temps <37 C
How to Diagnose Stool testing only Cyclospora can be shed intermittently and can sometimes require multiple stool collections for lab- confirmation Most common methods: microscopy (stain or UV) and PCR (polymerase chain reaction) http://www.cdc.gov/dpdx/cyclosporiasis/index.html
Cyclosporiasis, Georgia, 2005-2015 40 35 30 25 20 15 10 5 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 International Travel No International Travel Unknown International Travel
Cyclosporiasis by Month of Onset, Georgia, 2005-2015 50 45 40 35 30 25 20 15 10 5 0 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC International Travel No International Travel Unknown International Travel
Demographics for Georgia Cyclosporiasis, 2005-2015 Age Hospitalization 30 25 20 15 10 5 0 ER Only Not Hospitalized Unknown Hospitalized Gender: 58% (62/107) female
Historic Outbreaks in the U.S. http://www.cdc.gov/parasites/cyclosporiasis/outbreaks/foodborneoutbreaks.html
Historic Georgia Outbreaks 2000: Raspberries/Blackberries 19 ill (8 lab-confirmed) Catered bridal luncheon; cake made with fresh berries implicated 2006: Produce 3 ill (2 lab-confirmed) Common work party with raw fruit and vegetables served, no specific item determined 2011: Salad? 100 ill (3 lab-confirmed) Two separate events 5 days apart at a Fulton County catering facility; employees also ill Two cohort studies completed; salad (mixed greens, basil, and cherry tomatoes common to both salads) only significant item when events were combined Stealth ingredient also possible 2015:
2015 OUTBREAK http://www.11alive.com/story/news/local/buckhead/2015/07/16/parasite-illness-atlanta/30269969/
2015 Confirmed Cyclospora Cases County Cherokee Clarke Cobb Columbia DeKalb Forsyth Fulton Gwinnett Hall Lowndes Total Cases 1 1 8 3 1 1 16 1 1 1 34 Age: 21-86 (mean 49, median 46) Interviewed: 33/34 International Travel: 6/33 Fulton Cluster: 15 cases Columbia Cluster: 3 cases
Lab-Confirmed Cyclospora Cases by Illness Onset Date Georgia 2015 (n=33) 8 7 6 5 4 3 2 1 0 International Travel Domestic Non-Cluster Columbia Cluster Fulton Cluster
Fulton County Cluster 7/13: Restaurant first mentioned during two case interviews (one reported exposure, one reported social media activity) 7/15: News reports re: parasite infection; identified 2nd lab-confirmed case with exposure at reported restaurant; Communicated with district Epi and EH 7/16: Launched online survey 7/17: Call with CDC Confirmed Cases: Meals 6/14-6/21, Onset 6/21-6/28 Survey Responses: 176 respondents 123 probable cases, 74 Fulton restaurant Reported Meal Dates (n=13) and Onset Dates (n=15) for Lab-Confirmed Outbreak Cases 6 5 4 3 Onset Date Meal Date 2 1 0
EH Investigation First site visit 7/16 Continued collecting records Salsa per interviews, cilantro per TX & WI investigations Salsa Ingredients (fresh ingredients in bold) Fresh Tomatoes Pouch Tomatoes Jalape os Canned Chipotle Cilantro *** Only imported fresh ingredient White Onions Garlic Black Pepper Red Vinegar Salt Water http://www.cdc.gov/foodsafety/images/cilantro-300px.jpg
Epi Investigation Contacted lab-confirmed cases for interview Cyclosporiasis National Hypothesis-Generating Questionnaire (13 pages of fun!) and supplemental questions re: restaurants, food items, activities Compared lab-confirmed case interviews to 2006-7 FoodNet Population Survey control interviews conducted May - August Table 1: Demographics for lab-confirmed outbreak cases and population survey controls Cases n=15 Controls n=427 Age Median Min 46 Max 71 Median Min 55 Max 87 30 18 Female n 10 66.67 Male n 5 33.33 Female n 283 66.28 144 33.72 Male n Gender % % % %
Table 2. Reported produce item consumption for lab-confirmed outbreak cases and population survey controls Cases n=15 Controls n=427 Attack Rate 1 93.33 2 83.33 3 78.57 2 83.33 5 66.67 5 61.54 2 85.71 6 40.00 4 66.67 5 64.29 6 60.00 Attack Rate 95% Confidence Interval* 6.89, 2047.60 6.25, 311.12 5.16, 122.78 1.40, 65.67 1.30, 170.28 1.18, 17.24 1.00, 43.67 0.75, 17.16 0.82, 14.76 0.80, 10.88 0.11, 1.36 0.09, 1.20 0.75, 9.69 0.68, 7.60 0.55, 8.94 0.45, 6.22 0.35, 8.85 0.48, 5.30 0.46, 20.71 0.17, 2.44 0.22, 2.46 0.40, 4.38 0.27, 3.15 Item Salsa Avocado Cilantro Lemon or Lime Scallions or Green Onion Mesclun Lettuce Tomatoes Basil Prepackaged Salad Romaine White or Yellow Onions Bell Peppers Watermelon Blueberries Strawberries Other Leafy Greens Parsley Pineapple Cucumber, Zucchini, or Squash Iceberg Broccoli Grapes Cantaloupe * Fisher Exact values ^ 2-tailed test for significance Yes No 14 10 11 10 10 8 12 4 8 9 9 5 10 33.33 10 5 66.67 8 7 53.33 10 4 71.43 5 9 35.71 3 10 23.08 7 8 46.67 12 2 85.71 5 8 38.46 7 8 46.67 8 7 53.33 6 9 40.00 Yes 50 172 22.52 27 175 13.37 33 192 14.67 85 117 42.08 63 139 31.19 60 161 27.15 126 98 56.25 33 191 14.73 87 138 38.67 88 136 39.29 161 40 80.10 118 84 58.42 99 125 44.20 68 134 33.66 112 89 55.72 53 170 23.77 28 197 12.44 79 146 35.11 148 54 73.27 107 116 47.98 109 93 53.96 105 120 46.67 92 133 40.89 No Odds Ratio 48.16 32.41 21.33 p-value*^ 0.0000 0.0000 0.0000 0.0064 0.0088 0.0225 0.0473 0.0550 0.0704 0.0911 0.0959 0.1023 0.1112 0.1606 0.2809 0.3396 0.3860 0.4097 0.5278 0.5769 0.6035 0.7904 1.0000 6.88 4.41 4.29 4.67 3.86 3.17 2.78 0.37 0.36 2.53 2.25 1.99 1.78 2.11 1.62 2.19 0.68 0.75 1.31 0.96
So you think its the salsa? Table 2. Reported produce item consumption for lab-confirmed outbreak cases and population survey controls Cases n=15 Controls n=427 Attack Rate 1 93.33 2 83.33 3 78.57 2 83.33 5 66.67 5 61.54 2 85.71 Attack Rate 95% Confidence Interval* 6.89, 2047.60 6.25, 311.12 5.16, 122.78 1.40, 65.67 1.30, 170.28 1.18, 17.24 1.00, 43.67 Item Salsa Avocado Cilantro Lemon or Lime Scallions or Green Onion Mesclun Lettuce Tomatoes Yes No 14 10 11 10 10 8 12 Yes 50 172 22.52 27 175 13.37 33 192 14.67 85 117 42.08 63 139 31.19 60 161 27.15 126 98 56.25 No Odds Ratio 48.16 32.41 21.33 p-value*^ 0.0000 0.0000 0.0000 0.0064 0.0088 0.0225 0.0473 6.88 4.41 4.29 4.67 Fresh salsa ingredients: tomatoes, cilantro, white onions, and jalapenos White onions not significant (but combined with yellow) Jalape os could not assess
Traceback Investigation Farm not in Puebla Supplier Supplier Supplier WI Restaurant 8 Lab-Confirmed Cases Farm not in Puebla Supplier Puebla Farm A Supplier Farm not in Puebla Supplier Supplier Farm not in Puebla Puebla Farm B Supplier Puebla Farm C TX Restaurant 6 Lab-Confirmed Cases Supplier Supplier Supplier Supplier Puebla Farm D Supplier Puebla Farm E Supplier Puebla Farm F Supplier Puebla Farm G Supplier Puebla Farm H Supplier Puebla Farm I Supplier Farm not in Puebla GA Restaurant 15 Lab-Confirmed Cases Puebla Farm J Supplier Supplier Supplier Supplier Farm not in Puebla
The Bigger Picture CDC: Nation-wide increase Outbreak domestically-acquired 5/1/15-8/22/15 (n=319) 179 from TX, 26 from GA Cluster investigations in TX, WI, and GA -> suspect vehicle FDA Import Alert on 7/28 re: cilantro from Puebla CDC data updated 9/16/15, accessed 1/21/16
Thank you! District Epi District EH State Epi State EH State Ag Federal Epi Federal Ag Anyone that was on-call during the outbreak www.cdc.gov/parasites/cyclosporiasis/disease.html
Questions? For example, who photoshopped this image? FDA: CDC: http://www.fda.gov/Food/RecallsOutbreaksEmergencies/Ou tbreaks/ucm361637.htm http://www.cdc.gov/dpdx/cyclosporiasis/gallery.html