Hold the lettuce: Updates on the ‘explosive’ cyclospora outbreak

[MUSIC PLAYING] FLORA LICHTMAN: Hey, I’m Flora Lichtman, and you’re listening to Science Friday. Step away from the Taco Bell Crunchwrap Supreme, says the FDA. An outbreak of foodborne illness caused by the parasite, cyclospora, has been cropping up across the country, sickening thousands.

And after months of trying to track down the source, investigators have linked some cases to shredded iceberg lettuce supplied to Taco Bells in five States– Indiana, Kentucky, Michigan, Ohio, and West Virginia. The Washington Post broke the story, and linked the lettuce to one company, Taylor Farms.

Here to give us the latest on this investigation and to take us into the world of food detective work, is Byron Chaves, a food safety expert from Rutgers University. Hey, Byron, welcome back to Science Friday.

BYRON CHAVES: Hey, happy to be here. Thanks for the invite.

FLORA LICHTMAN: Thank you for coming. Thousands of people have gotten sick. Many of the rest of us have been wondering what not to eat this summer. I feel like this has been a real nail biter. Has the cyclospora mystery been solved?

BYRON CHAVES: So not quite yet. We actually have, today, probably more questions than we did yesterday.

FLORA LICHTMAN: Oh, say more. Tell me.

BYRON CHAVES: Well, with this new development, that lettuce might be implicated, then we have a number of other questions about how this contamination happened. Is this really a single source? Is, potentially, Taco Bell the only retail chain that is involved? Is any of these lettuce in the market right now?

FLORA LICHTMAN: Right. Because I know that the States called out by the FDA and CDC didn’t include, for example, New York, where there have been a bunch of cases. So what does that mean?

BYRON CHAVES: Yeah, it probably means what we’ve been thinking about for the last couple of months, almost. It seems like this outbreak has been lingering for forever. But that there’s actually more than one outbreak happening at the same time.

So we finally have a lead about a proportion of the cases that might be associated with consumption of contaminated lettuce. But that doesn’t mean that there are not other outbreaks happening simultaneously. And like you mentioned, there’s five States associated with the lettuce one, but there’s many other States. There’s 34 states where people have reported getting sick, including New York. And so there might be a series of outbreaks happening.

FLORA LICHTMAN: So news outlets have been pointing to Taylor Farms. Does that suggest that the parasite came from processing or from the farm itself?

BYRON CHAVES: I would be cautious about pointing towards a specific source right now, because as of Friday morning, I think it’s too early to tell exactly where this is coming from. Now, what I would say is that cyclospora is not what we would typically call an environmental organism in food processing.

So when the lettuce is getting shredded in a food facility and mixed with a lot of other lettuce coming from different places, it’s not like this microbe is surviving in the processing environment. What is more likely to happen is that the microbe already came with the heads of lettuce that were introduced into processing facilities.

So think about lettuce that got irrigated with contaminated water and stuff like that. So the more likely cause of direct contamination is irrigation water.

FLORA LICHTMAN: Why has it taken so long to figure this out?

BYRON CHAVES: Yeah, epidemiologists are working really, really hard to figure that out themselves. I think that, again, there’s this hypothesis that there’s a series of outbreaks that are happening at the same time. And while some of the cases may be attributed to consumption of contaminated lettuce, there could be other cases associated with either recreational water or potentially, other foods that are happening across the country.

FLORA LICHTMAN: Recreational water. Do you think it’s a possibility that people are getting it from swimming?

BYRON CHAVES: I think that there’s multiple hypotheses, and recreational waters, despite what the Michigan Department of Health and Human Services is saying has been implicated in outbreaks of cyclosporiasis. And there’s documented evidence from other places in the world. Maybe there’s untreated wastewater or semi-treated wastewater that ended up in recreational lakes and such. And because we’re seeing so many thousands of cases that it is a possibility that recreational waters could have contributed to some of those cases.

Now, the other thing that we have seen is there’s no reported cases in Canada. And so I do wonder what’s happening across the lakes when people in Detroit and other places in the country here are getting sick and no, Canadians are getting sick. So that will also give us a little bit of a hint as to what foods were distributed in the US that were not potentially distributed to Canada. And we could, potentially, start narrowing this down.

FLORA LICHTMAN: So we’ve talked on this show about budget and staffing cuts at various government agencies. Do you believe that those played a big part in this outbreak being so big?

BYRON CHAVES: I would also be cautious about that. I think that by the loss of life, the outbreak or outbreaks would have happened anyway. I think that what we are missing here is a little bit of connection between the CDC and other federal agencies and state governments.

Every time that we make cuts to public health infrastructure, there’s going to be a consequence. And the consequence here was probably that the response could have been faster, but certainly, the outbreak would have happened anyway.

FLORA LICHTMAN: Tell me a little bit about the parasite itself. I mean, I’ve heard that it can cause problems for weeks. Someone had symptoms for 100 days. Is it exceptionally hardy?

BYRON CHAVES: Yeah, parasites are one of those things that, in general, we’re terrified because of the way that these things, these organisms have been portrayed in the media. And there’s some reality to that. Now, the truth about cyclospora is that as scientists and microbiologists, we still don’t understand a lot of the infectious cycle, the biology of this organism. The detection methods that we may not be the most adequate. And so certainly, we have a lack of scientific resources in that regard.

What we do know is that this is not a person-to-person transmission. So we know that the infectious cycle happens in a variety of stages. And when people have cyclosporiasis and they shed the parasite in their feces, that parasite that comes out, it’s not immediately infectious. It needs some time in the environment, at the right temperature and the right relative humidity– contaminated water or produce– so that then people will consume that water, produce and get sick themselves. So it is an interesting life cycle.

FLORA LICHTMAN: I mean, explosive diarrhea has been the cyclospora catchphrase. Is that scientifically real?

BYRON CHAVES: Explosive diarrhea, it’s not really a clinical term. So it is an interesting term. But what we mean by explosive diarrhea is that a proportion of the cases will have gas. We’ll have a lot of gas accumulated in their bowels. And then this, basically, makes you have a very loud a.k.a. explosive bowel movement. But the diarrhea– we’ll describe that as a watery diarrhea. That is a better term for that.

FLORA LICHTMAN: Why does bagged salad so often seem to be a culprit in these food safety stories?

BYRON CHAVES: Yeah, that is a phenomenal question and a phenomenal mystery as well. Now, bagged salads is a product of convenience and a product of we want produce year round, and we want accessibility to things, and that is great.

Now, when we bring any raw agricultural commodity from a farm into a processing operation, there is a chance that that raw agricultural commodity, like lettuce, may be contaminated with something. There’s, obviously, on-farm food safety practices that are followed, but there’s always chances.

Now, one of the things that happens here is that hundreds of heads of lettuce are being mixed and cut and chopped and placed into packages. So we have a variety of heads of lettuce that come from either a single source or multiple farms, increasing the chances that there could be cross-contamination. So even if only a proportion of the lettuce that came into that processing operation is contaminated, then when we chop it and mix it, then everything is just going to be contaminated.

FLORA LICHTMAN: You’re a food safety expert. Is there some kind of magic technology in the pipeline or process that would prevent outbreaks like this?

BYRON CHAVES: If I had an answer for that, I wouldn’t be a college professor, I would be a billionaire. But I think people are working really, really hard on finding alternatives for what we currently have.

Now, what we currently have is things like chlorine, chlorinated water where produce is immersed, but that is not effective for pathogens like cyclospora. It is effective for things like E. coli and Salmonella, which are bacterial foodborne pathogens. But cyclospora is a very hardy organism. When we find it in the environment, it’s in this sporulated oocyte that is extremely resistant.

So we are finding other ways. For water, there are technologies like microfiltration and reverse osmosis, but those are expensive. So it’s not always available

FLORA LICHTMAN: Given current info, what are you going to avoid at the supermarket?

BYRON CHAVES: That is a great question. And I’m not in the business of telling people what not to eat, but the way that I’m going to save myself and my soul is by saying that I do consume produce, but I don’t typically eat salads.

And so the produce that I consume at home is just typically cooked or stuff like that. I have never really been a big fan of leafy greens myself, except for spinach. And then I eat it cooked at home. So that’s the way that I’m saving myself.

FLORA LICHTMAN: Cook your food. That’s what I’m hearing. That’s what I’m hearing from you, Byron.

BYRON CHAVES: Totally. But we don’t want to cook cilantro. I mean, what kind of experience would we have? But keep an eye on the news. Once the sources are confirmed, we will have, of course, more certainty. But if you do want to cook your produce, then 158 degrees would likely kill the parasite.

FLORA LICHTMAN: There you go. 158 degrees. Byron Chaves is an associate extension specialist and professor in the Department of Food Science at Rutgers University in New Jersey. Thanks for joining me today.

BYRON CHAVES: Thanks for having me.

FLORA LICHTMAN: This segment was produced by Annette Heist and Charles Bergquist. Do us a solid, rate and review the show. And number two, tell your friends about us. Thanks for listening. I’m Flora Lichtman.

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