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Cyclosporiasis Outbreak Exposes Strained U.S. Public Health System
Cyclosporiasis is an illness caused by a parasite that can lead to severe diarrhea, stomach pain and tiredness.
More than 11,000 people in 20 states became sick during this outbreak.
Two people died.
Investigators connected the outbreak to shredded lettuce served at Taco Bell restaurants.
The lettuce came from Taylor Farms operations in Mexico, which recalled the product.
Michigan officials warned people about lettuce before federal agencies publicly identified the source.
Health workers had to stop some normal duties to call patients and trace what they had eaten.
Some laboratories ran out of tests or developed backlogs.
Officials and experts disagreed about whether the federal response was fast enough, while everyone faced a very large number of cases.
A cyclosporiasis outbreak linked to shredded iceberg lettuce sickened more than 11,000 people across 20 states and caused two deaths.
The lettuce was served at Taco Bell restaurants and came from Taylor Farms operations in Mexico, prompting a recall.
Michigan officials warned residents to avoid lettuce and some other produce on July 4, before the federal outbreak announcement on July 16.
Local health departments reassigned nurses, inspectors and other staff to investigate cases, interview patients and support healthcare providers.
Experts and state officials said staffing shortages and delayed identification exposed weaknesses in the United States food-safety response system.
- Who
- More than 11,000 people, state and local health workers, the U.S. Food and Drug Administration, and the Centers for Disease Control and Prevention were involved; Taco Bell and Taylor Farms were linked to the recalled lettuce.
- What
- A cyclosporiasis outbreak was linked to shredded iceberg lettuce served at Taco Bell restaurants.
- Where
- The outbreak affected 20 U.S. states, with major response pressures reported in Michigan, including Washtenaw and Ingham counties.
- When
- The outbreak surged in late June and July; federal agencies announced the link on July 16, and Taylor Farms issued a recall on July 17.
- Why
- The illness spread after contaminated lettuce entered the food supply, while officials investigated the source and tried to contain additional infections.
Critics and State Officials
Federal Agencies
Speed of the response
Critics and State Officials
Michigan officials and food-safety experts said the federal announcement came too late and argued that earlier investigations could have removed the product sooner.
Federal Agencies
The U.S. Food and Drug Administration said it could not identify lettuce as the likely vehicle until it received necessary supplier information on July 13, and the Centers for Disease Control and Prevention said it prioritized coordination and state support.
Distribution of responsibility
Critics and State Officials
Michigan’s chief medical executive said the state took on work normally handled by the federal government and lacked the staffing and capacity to sustain that level of response.
Federal Agencies
The Centers for Disease Control and Prevention said it held weekly calls with states, met daily with federal and state officials, and conducted outreach with states at least four times a week.
Key facts
- Illness
- Cyclosporiasis, a parasitic disease causing diarrhea, abdominal pain and fatigue
- Reported scope
- More than 11,000 illnesses in 20 states
- Deaths
- Two deaths were reported
- Suspected food
- Shredded iceberg lettuce
- Restaurant link
- Taco Bell restaurants
- Supplier
- Taylor Farms operations in Mexico
- Recall date
- July 17, following the federal identification of the lettuce link
- Michigan impact
- Ingham County recorded 915 cases by late August
Quotes
Barbara Kowalcyk
Food safety expert at George Washington University
“Had we had more boots on the ground doing investigations and interviewing people, my view is that this outbreak would have been caught earlier. We would have gotten product pulled off the market.”
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“What you’re seeing this summer demonstrates the vulnerabilities in the system and what happens when they’re put under stress.”
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Natasha Bagdasarian
Michigan’s chief medical executive
“The state health department was taking on far more responsibility than is normally the case. I don’t think that this is sustainable. We simply don’t have the staffing; we don’t have the bandwidth.”
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