Outbreaks of Cyclosporiasis — United States, June–August 2013

During June-August 2013, CDC, state and local public health officials, and the Food and Drug Administration (FDA) investigated an unusually large number of reports of cyclosporiasis (compared with annual reports to the National Notifiable Disease Surveillance System [e.g., 123 cases in 2012]), an intestinal infection caused by the parasite Cyclospora cayetanensis. By September 20, CDC had been notified of 643 cases from 25 states, primarily Texas (278 cases), Iowa (153), and Nebraska (86). Investigations in Iowa and Nebraska showed that restaurant-associated cases in these two states were linked to a salad mix that contained iceberg lettuce, romaine lettuce, red cabbage, and carrots. Most patients in Iowa and Nebraska became ill during June 15-29; cases reported during July and August were primarily from Texas.