As a summer cyclosporiasis outbreak spreads across 34 states, some hospitals have pulled leafy greens and salad bar items from their cafeterias, while others are leaving food offerings in place and watching for cases.
The moves come as case counts climb well beyond a typical season. As of July 13, the CDC had received reports of 1,645 lab-confirmed cases of cyclosporiasis acquired in the U.S. since May 1. The agency has recorded 141 hospitalizations and no deaths — and said it is aware of more than 5,100 additional cases that require further analysis to confirm.
State tallies run higher than the CDC’s confirmed count because they can include probable cases the federal agency has not yet received. The Michigan Department of Health and Human Services, for example, has reported more than 3,700 cases statewide — roughly 75 times what Michigan typically sees in a year — according to the Michigan Health & Hospital Association.
Cyclosporiasis is a foodborne illness caused by the microscopic Cyclospora parasite and is not spread person to person. Symptoms can include watery diarrhea, stomach cramps, nausea, fatigue and dehydration.
In Michigan, where public health officials have pointed to lettuce or salad greens as a likely source, some systems have changed what they serve. Kalamazoo, Mich.-based Bronson Healthcare temporarily removed certain salad bar items, leafy greens and other higher-risk fresh produce from patient and public food service areas. In a July 15 statement, the health system said the source of the outbreak remains under investigation.
A spokesperson for Corewell Health, a 21-hospital system based in Grand Rapids and Southfield, Mich., told Becker’s the organization is seeing more patients with Cyclosporiasis symptoms compared to previous years. Corewell is working with local and state public health experts to monitor this increase in positive cases.
“While public health officials continue investigating a growing cyclosporiasis outbreak linked to fresh produce, out of an abundance of caution, we have removed processed shredded lettuce from our dining facilities,” the Corewell Health spokesperson said. “We have moved to 100% locally sourced lettuce that is grown in a controlled environment, is full head and unprocessed. This lettuce continues to be available in our dining facilities. Our nutrition services teams will continue to follow the guidance provided by the Michigan Department of Health and Human Services.”
Beacon Health System, based in South Bend, Ind., has removed lettuce and salad greens from all salad bars and cafeterias across its Michigan and Indiana locations. The system has confirmed 16 cyclosporiasis cases in its outpatient facilities in the two states and expects that number to climb because of testing lags of up to seven days, according to Michelle Bache, MD, chief quality officer.
The surge has outpaced laboratory capacity, as turnaround times used to average about 24 hours.
No patients have been hospitalized with confirmed cyclosporiasis at Beacon, though its emergency departments and urgent care sites are seeing more diarrheal illness, Dr. Bache said.
“We chose to act proactively rather than wait for a definitive source to be confirmed,” she said.
Some New York systems, by contrast, have largely kept food offerings in place while monitoring for cases. The state appears to be the second hardest-hit state after Michigan, as the CDC reports between 161 and 300 cyclosporiasis cases in New York.
Mount Sinai Health System, based in New York City, has not altered its offerings but is working with its public health department to ensure produce, including greens, is handled in line with current guidance, said Nicholas Sells, MD, medical director of infection prevention and hospital epidemiologist at Mount Sinai Morningside.
“We have not experienced a significant influx of cyclosporiasis cases in our facilities and have seen no significant impact in admissions,” he said, adding that the system has asked its ED to consider testing in appropriate cases.
Montefiore Health System, also based in New York City, is likewise monitoring.
“The numbers being seen are consistent with past seasonal increases,” said Inessa Gendlina, MD, PhD, hospital epidemiologist at Montefiore Medical Center, who noted that cyclosporiasis peaks in the summer and is not spread person to person.
Michigan and New York’s hospital associations said food-related steps vary by system and that current case counts are not straining staffing.
Thomas Quatroche Jr., PhD, CEO and president of the Healthcare Association of New York State, said hospitals are following state and CDC guidance, and their measures differ because food sourcing varies from hospital to hospital.
“The case counts at this time do not pose a threat to staffing,” Dr. Quatroche said, adding that hospitals have protocols to protect patient access if an unexpected number of staff fall ill.
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