Regional investigation of a cyclosporiasis outbreak linked to imported romaine lettuce – Nebraska and Iowa, June–August 2013

Authors

Bryan F. Buss, Centers for Disease Control and PreventionFollow
M. V. Joshi, University of Nebraska-Lincoln
C. D. Allensworth, Douglas County Health Department, Omaha, NE
A. Garvey, Iowa Department of Public Health
K. Obbink, Iowa Department of Public Health
S. Mandernach, Iowa Department of Inspections and Appeals,
Thomas J. Safranek, Nebraska Department of Health & Human ServicesFollow

Document Type

Article

Date of this Version

2016

Citation

Epidemiol. Infect. (2016), 144, 1807–1817.

doi:10.1017/S0950268815002484

Comments

U.S. government work

Abstract

A regional, multistate investigation into a June–August 2013 cyclosporiasis outbreak was conducted in Nebraska, Iowa, and neighbouring states. Cases were confirmed on the basis of laboratory and clinical findings. Of 227 cases in Iowa (n = 140) and Nebraska (n=87) residents, 162 (71%) reported dining at chain A/B restaurants – 96% reported house salad consumption. A case-control study identified chain A/B house salad as the most likely vehicle. Traceback was conducted to ascertain production lot codes of bagged salad mix (iceberg and romaine lettuce, red cabbage, and carrots) served as house salad in implicated restaurants. A single production lot code of salad mix supplied by both a common producer and distributor was linked to the majority of confirmed cases in persons reporting regional chain A/B exposure. The salad mix linked to illnesses contained imported romaine lettuce from two separate single-grower fields-of-origin and 51 additional field from another grower.