Parasite causing illnesses through unwashed produce

SANDUSKY — The Erie County Health Department and its board are requesting that all residents and commercial food establishments properly wash all fruits and vegetables prior to use. The health department has launched an active investigation following multiple laboratory-confirmed cases of cyclosporiasis within Erie County. Cyclosporiasis is a prolonged, painful gastrointestinal illness caused by the microscopic parasite Cyclospora cayetanensis. As of Monday, there are four active cases in the county with others pending. Because the summer months mark the peak season for this parasite, and multiple states — including neighboring regions in northern Ohio — are experiencing an active surge in cases, the health department on Monday issued what's known as an immediate advisory. We are requesting targeted action from the general community, local health care networks and, specifically, our commercial kitchens, restaurants and large food vendors to help mitigate and contain the spread of this illness. Symptoms, how it transmits Cyclosporiasis is a foodborne illness typically contracted by consuming fresh produce or water contaminated with microscopic amounts of human feces. Direct person-to-person transmission is highly unlikely. The parasite requires one to two weeks in the environment outside the body before it becomes infectious, meaning you cannot catch it directly from a brief interaction with an infected individual. Instead, the risk stems entirely from contaminated food or water handling. What to look for Symptoms usually appear for about one week, lasting from two days to two weeks, after consuming contaminated produce. If left untreated, symptoms can last from several weeks to more than a month and frequently return in waves after an initial period of improvement. Here are some symptoms to look out for: • Watery, frequent or explosive diarrhea, which is the most common symptom • Severe abdominal cramps and bloating • Prolonged fatigue and body aches • Loss of appetite and subsequent weight loss • Nausea and low-grade fever Directive for restaurants, food vendors Because no single food item or specific supplier has yet been identified as the root source of this regional spike, commercial food businesses must escalate their food handling safety protocols. Past outbreaks have heavily implicated raw, imported produce, like pre-washed bagged salad mixes, cilantro, basil, green onions, raspberries and snow peas. The health board is advising all food service operations to execute the following two-pronged mitigation strategy: 1. Mandatory safe handling and produce-specific washing protocols The Cyclospora parasite is sticky and resilient. Standard chemical sanitizers do not easily destroy it. Food prep staff must strictly isolate unwashed produce from ready-to-eat items to prevent cross-contamination. Always thoroughly wash hands, cutting boards and knives after handling unwashed fruits and vegetables before moving on to clean food or prepping plates. Proper mechanical friction under clean, running water is required. More specifically, regarding: • Leafy greens and lettuce: Vendors are strongly encouraged to purchase whole heads of lettuce instead of pre-washed, pre-cut bagged salad mixes. Discard the outer two to three layers of leaves entirely, and wash the inner leaves thoroughly under cold running water. • Herbs like cilantro and basil: Completely separate the leaves and thoroughly wash under a stream of running water. • Green onions/Scallions: Trim the root end and discard the outer layer completely before washing under running water. • Berries, like raspberries and blackberries: The bumpy surfaces of fresh berries contain tiny crevices where the parasite can easily hide. Wash them thoroughly. If serving vulnerable populations, consider using cooked or frozen alternatives, as heat effectively destroys the parasite. • Firm produce, like melons and cucumbers: Scrub the exterior surfaces vigorously with a clean produce brush under running water before cutting. • The cook-when-you-can rule: Whenever practical, cooking vegetables and herbs is the safest choice, as heat completely neutralizes the parasite. 2. Strict-sick leave enforcement In accordance with the Ohio Administrative Code, any food service employees or individuals in sensitive occupations who exhibit diarrheal symptoms must be excluded from food handling operations. They are not permitted to return to work until their diarrhea has completely ceased and they have been started on an effective antibiotic regimen. Guidance on what not to do To ensure the safety of the wider community and protect our local recreational waters, residents must observe strict personal boundaries if they are sick. • Do not swim if you are ill: If you are currently experiencing diarrhea or are recovering from a confirmed or suspected case of cyclosporiasis, do not enter public pools, hot tubs, water parks, lakes or splash pads until symptoms subside. Accidental fecal contamination in recreational waters can easily spread the parasite to hundreds of other swimmers. • Do not handle food for others: If you have symptoms, do not prepare meals for family members, friends or co-workers until you have completely recovered. • Do not rely on routine stool tests: If you have been suffering from persistent diarrhea for more than a few days, see your doctor and explicitly mention Cyclospora. Important note for local health care providers The Erie County Health Department reminds all area clinicians and medical facilities that there is no in-house test for Cyclospora. All testing samples must be sent to outside labs. Cyclospora is not detected by routine ova and parasite examinations. Because of the influx of gastrointestinal illnesses, if a patient presents with persistent, watery diarrhea and you suspect cyclosporiasis, please proceed immediately with a full gastrointestinal panel through your contracted laboratory testing partner. Cyclosporiasis is a legally reportable disease in Ohio. Please ensure that all positive laboratory findings are immediately reported to the Erie County Health Department so that our epidemiological team can conduct timely patient interviews and trace the contamination source. Contact information for inquiries For specific questions regarding the advisory: • Medical and public health questions: If you are a medical provider needing clarification on testing/reporting or a member of the general public with questions regarding symptoms and disease transmission, please contact the health department's epidemiologist, Taylor Kula, at 419-626-5623, ext. 5103. • Commercial and food safety inquiries: If you are a restaurant owner, commercial kitchen manager, or food vendor seeking guidance on safe handling practices and compliance, please contact the health department's environmental health director, Mark Janowich, at 419-626-5623, ext. 5108.