Testing lags in illness outbreak

FINDLAY — As of Friday afternoon, Hancock Public Health was reporting three confirmed cases and one suspected case of cyclosporiasis, but the true number of cases both locally and elsewhere may be higher than what's recorded, epidemiologist Hannah Plumley told the Board of Health. Michigan and Ohio have been among the hardest hit states in a recent outbreak of cyclosporiasis, an intestinal illness caused by the cyclospora parasite. Plumley noted both states began seeing cases around June 20. The U.S. Centers for Disease Control and Prevention (CDC) reported that sequencing has confirmed a cluster of cases of the same strain of the parasite in Ohio, Michigan, West Virginia and Kentucky. The first Hancock County case was confirmed on July 7. Cyclosporiasis is generally associated with consuming produce or contaminated water during international travel, Plumley said. However, the United States has seen an increase in domestically acquired cases since May 1, meaning cases where the person who got sick reported no recent travel. The CDC's Wednesday update reported a total of 1,645 cases confirmed in 34 states, Plumley said. However, there's a backlog of more than 5,000 samples awaiting testing at the CDC "and hundreds more coming in each day," she said. So, while the CDC is investigating multiple clusters in this outbreak, it has been hard for them to keep up, she said. Later Friday, Plumley emailed The Courier with updated CDC information Hancock Public Health had just received, indicating that the Midwest outbreak had been linked to shredded iceberg lettuce served at Taco Bell locations. The U.S. Food and Drug Administration's investigation then traced it back to a single supplier of lettuce from Mexico used by the Taco Bell locations, the CDC report states. It adds that the FDA is working directly with the supplier to determine if potentially contaminated shredded iceberg lettuce remains on the market. Taco Bell, meanwhile, has committed to no longer using lettuce from this supplier, the CDC reports. Plumley noted that the CDC's case numbers reflect only lab-confirmed cases. State and local numbers, however, include both confirmed and probable cases. She said a confirmed case means a positive lab test result along with relevant symptoms. A probable case means the symptoms and a link, such as having reported eating at one of the establishments frequently mentioned by others who got sick. Throughout Ohio, many doctors' offices and health systems are running out of testing supplies, so they are assuming people experiencing the relevant symptoms have cyclosporiasis and are treating it appropriately. So, Plumley said, the true case count is likely much higher than the official numbers. She added that many people may experience milder symptoms with cyclosporiasis and might not even go to the doctor to be tested. The health department has been putting out information about how to prevent the spread of illness, including guidelines on the safe handling of produce. Plumley also encouraged people to follow safe swimming guidelines, including rinsing off before getting in the pool. If you have any kind of gastrointestinal illness, do not go swimming, she said. People working in certain fields, such as food preparation, childcare or healthcare, must start treatment before they are allowed to return to work, so Hancock Public Health is sharing information on these protocols and requirements, Plumley said. Cyclosporiasis can be treated with antibiotics. The incubation period can be up to 14 days, which is another reason it was initially hard to find a pattern. "People hardly remember what they ate yesterday, let alone two weeks ago," Plumley said.