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Officials: Prepackaged Salad Likely Source of Cyclospora Outbreak

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DES MOINES, Iowa - The Iowa Department of Public Health has determined that bagged lettuce is likely the source by which more than 100 Iowans contracted cyclospora in recent weeks.

Steven Mandernach, chief of the Food and Consumer Safety Bureau of the Iowa Department of Inspections and Appeals said interviews with those sickened in Iowa and Nebraska and epidemiological data point to a salad mix containing iceberg and romaine lettuce, as well as carrots and red cabbage.

A release from the Iowa Department of Public Health said the Department of Inspections and Appeals traced the prepackaged salad mix back to about 80 percent of the cyclospora cases and the process was difficult because many people don't remember everything they've eaten over an extended period of time. The process was also challenging because most of the suspected product was no longer on shelves by the time the illness was identified, the release said.

Cyclospora is a parasitic disease that can cause diarrhea, nausea, vomiting, muscle aches and a low-grade fever. It's typically spread by ingesting food or water that has been contaminated with infected human feces. Those symptoms can last from nine to 43 days. Most people contracted the illness in mid to late June, and at least seven were hospitalized.

Polly Carver-Kimm, communications director for the Iowa Department of Public Health, said the department is prohibited, by state code, from releasing information concerning the identity of a business or brand unless it is deemed necessary for the protection of the public. Because the food involved in the outbreak is no longer in the supply chain, Carver-Kimm said there is no public health threat and the entity will not be identified.

Because the product isn't in circulation, Patricia Quinlisk, state epidemiologist and medical director at the Iowa Department of Public Health, said people should, as always, continue to wash fruits and vegetables. Though how hard you can scrub depends on what you're dealing with, she said she personally washes anything from a grocery store that could have been handled by someone else.

Produce that is pre-packaged -- like lettuce that is labeled to have been pre-washed -- doesn't usually need to be washed again, Quinlisk said, as this can actually cause contamination from a person's kitchen or sink. The FDA generally advises consumers to wash fresh produce by holding it under plain, running water.

"Can we be 100 percent sure that what we're going to eat is perfectly safe? Unfortunately not, but I do think people need to take some reasonable precautions," Quinlisk said. "But we don't want people to stop eating fruits and vegetables because they're part of a healthy diet."

The joint investigation was conducted by the Iowa Department of Inspections and Appeals, the Iowa Department of Public Health, the State Hygienic Laboratory, local health departments and officials in Nebraska who were investigating the outbreak. Quinlisk said that, though the business or brand connected to the product won't be released, the FDA will work to trace the contaminated product back to the field it came from to ensure the proper precautions are being taken to prevent further issues.

Tests, conducted primarily at at the State Hygienic Laboratory, confirmed 143 total cases of the stomach illness in Iowa. Forty-two of those cases came out of Linn County. According to the Iowa Department of Public Health, many people have reported they are still ill, and some have had relapses.

In the release, Mandernach said years of work to improve the food and feed inspection process in Iowa -- including a 2012 grant from the FDA that led to the creation of a Food and Feed Rapid Response Team -- can be credited for the success of the investigation. The team promotes coordination and communication between the agencies involved that workedon cyclospora outbreak, as well as the Iowa Department of Agriculture and Land Stewardship and the FDA.

"We saw those efforts pay off during this investigation, as all the players worked together seamlessly to the betterment of the public," Mandernach said in the release.

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