Abstract

Background

On July 8, 2022, North Central Health District (NCHD) was notified by a local hospital of a possible Cyclospora outbreak among hospital employees. The hospital noted the employees had eaten at the hospital’s cafeteria, particularly the salad bar. An investigation was conducted to test this hypothesis and determine which salad bar ingredients were the cause of illness.

Methods

An electronic survey was shared with all hospital employees through their email distribution system. Employees were asked to complete the survey regardless of illness or exposure history. Lab- confirmed cases were interviewed using the Cyclosporiasis National Hypothesis Generating Questionnaire. Environmental health (EH) visited the facility and obtained product invoices for fresh produce. EH also took samples of romaine lettuce from 3 different lots for product testing. Twenty-two clinical Cyclospora specimens were submitted to CDC for genotyping and 6 romaine samples were submitted to FDA for Cyclospora testing.

Results

Of the 211 survey responses, 86 were cases and 88 non-cases. A case was defined as someone who had diarrhea lasting 2 or more days and ate from the cafeteria. The odds of eating from the salad bar were 70% higher among cases than non-cases (p=.05). The odds of eating romaine lettuce were 2.3 times higher for cases than non-cases (p=.02); romaine was the only item significantly associated with illness after controlling for other salad ingredients that were initially associated with illness. In total, 31 lab- confirmed cases were identified and 13 genotyped specimens submitted to CDC were genetically similar. The romaine lettuce tested negative for Cyclospora.

Conclusion

The survey allowed us to identify the source of illness during the largest Cyclospora outbreak in Georgia. By July 16th, the investigation determined that romaine lettuce was the likely source. Close partnerships between the hospital, epidemiology, environmental health, and state agencies were essential to the rapid investigation.

Key Words: Outbreak, Multi-agency Investigation

Keywords

Outbreak, Multi-agency Investigation

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May 1st, 12:00 AM May 1st, 12:00 AM

Please Romaine Calm! A Multi-Disciplinary Investigation of a Cyclospora Outbreak Among Hospital Employees

Background

On July 8, 2022, North Central Health District (NCHD) was notified by a local hospital of a possible Cyclospora outbreak among hospital employees. The hospital noted the employees had eaten at the hospital’s cafeteria, particularly the salad bar. An investigation was conducted to test this hypothesis and determine which salad bar ingredients were the cause of illness.

Methods

An electronic survey was shared with all hospital employees through their email distribution system. Employees were asked to complete the survey regardless of illness or exposure history. Lab- confirmed cases were interviewed using the Cyclosporiasis National Hypothesis Generating Questionnaire. Environmental health (EH) visited the facility and obtained product invoices for fresh produce. EH also took samples of romaine lettuce from 3 different lots for product testing. Twenty-two clinical Cyclospora specimens were submitted to CDC for genotyping and 6 romaine samples were submitted to FDA for Cyclospora testing.

Results

Of the 211 survey responses, 86 were cases and 88 non-cases. A case was defined as someone who had diarrhea lasting 2 or more days and ate from the cafeteria. The odds of eating from the salad bar were 70% higher among cases than non-cases (p=.05). The odds of eating romaine lettuce were 2.3 times higher for cases than non-cases (p=.02); romaine was the only item significantly associated with illness after controlling for other salad ingredients that were initially associated with illness. In total, 31 lab- confirmed cases were identified and 13 genotyped specimens submitted to CDC were genetically similar. The romaine lettuce tested negative for Cyclospora.

Conclusion

The survey allowed us to identify the source of illness during the largest Cyclospora outbreak in Georgia. By July 16th, the investigation determined that romaine lettuce was the likely source. Close partnerships between the hospital, epidemiology, environmental health, and state agencies were essential to the rapid investigation.

Key Words: Outbreak, Multi-agency Investigation