Nebraska, neighbors Iowa and Missouri join state list tied to cyclosporiasis outbreak

LINCOLN — Federal officials have added Nebraska to the growing list of states with residents who are part of a national outbreak tied to the parasite cyclospora that can cause lengthy gastrointestinal illness.

The Centers for Disease Control and Prevention reports that at least 92 Nebraska cases have been directly tied to the ongoing outbreak that has grown to more than 6,000 linked cases across 15 states. 

Health investigators have determined that iceberg lettuce sourced from central Mexico and recalled by Taylor Farms de Mexico is the most probable cause of the outbreak. Other states newly identified in the outbreak are Iowa, Missouri, Arkansas, North Carolina and New Hampshire. 

The Nebraska Department of Health and Human Services as well as the Douglas and Lincoln-Lancaster County health departments released media statements Thursday confirming Nebraska’s inclusion. 

Cases of cyclospora in Douglas, the state’s largest county, have been rising fast in recent weeks. A spokesperson said the county has confirmed 71 cases since the outbreak began.

While 46 confirmed cases have been reported in Lancaster County since June, health director Kerry Kernen said the team is working with state and federal partners to determine how many are linked to the national outbreak.

“We conducted in-depth interviews with residents who became ill and looked for potential commonalities among cases,” Kernan said. “Information gathered in our investigations showed a correlation with the shredded iceberg lettuce.”

According to federal health officials, illnesses linked to this outbreak began on June 22 and onset dates have continued through July 31, so it is possible more cases will surface. The CDC reports at least 278 hospitalizations. Two deaths have been reported in Michigan. 

Symptoms of the illness, called cyclosporiasis, include watery diarrhea that can last weeks to months, fatigue, loss of appetite, weight loss, bloating, cramping and nausea. Less common symptoms include low-grade fever and vomiting.  

Fresh vegetables and fruit are usually associated with cyclospora outbreaks, health officials said. People become sick when they eat food or drink water contaminated with the parasite. The illness does not spread from one person to another. 

Unlike viruses and bacteria, cyclospora is a parasite, making outbreaks more difficult to investigate, according to the state DHHS. Standard laboratory methods that can quickly connect illnesses are less effective for parasites so public health officials rely on  interviews with patients, epidemiologic analysis  and coordination among various health partners to identify a common source, the agency said. 

Dr. Timothy Tesmer, DHHS chief medical officer, emphasized that the state food supply is safe, yet he encouraged Nebraskans to “use proper food handling practices, exercise caution with certain produce and, when possible, choose locally sourced produce.”

The DHHS said that the risk to the general public remains low, and that recalled products have been removed from store shelves. Tesmer said Nebraska continues to work closely with local health departments and federal health officials to identify additional cases and protect Nebraskans’ health.