Cyclospora: What you need to know with Dr. Erika Noel

Q: What is the current situation with the Cyclospora outbreak?
Dr. Noel: "There has been over 1,600 confirmed cases across more than 34 states. However, there has been the thought that there are than 5,000 cases nationwide, and we're expecting that number to grow, unfortunately."

Q: Why is this outbreak more concerning than previous years?
Dr. Noel: "Cyclospora is something that we see annually, particularly in the spring to summer months, May through August. But what's been so scary about this current outbreak is that we don't currently know what the main source is. In previous years it has been traced back to things like raspberries, pre-washed salad mixtures, and other produce. However, in this particular incidence, we don't have a clear source on it yet, and that's why it's been such a scary time for some people."

Q: For a physician like yourself, it it tough to decipher between cyclospora and norovirus?
Dr. Noel: "In norovirus, the infection is pretty much automatic, where the particular patient will have really explosive diarrhea right away, and it stays that way. Whereas cyclospora, gradually gets worse and worse as time goes. So there are some key differences that are traditionally seen. However, not everyone presents in the same exact way, so it is quite challenging. The good thing about both of these diarrheal illnesses is that it rarely causes serious complications and are not typically life-threatening. However, vulnerable people such as the elderly or immunocompromised do hospitalizations such as in the case of dehydration. So it is important to take food safety seriously."

Q: Can Cyclospora spread from person to person?
Dr. Noel: “First and foremost Cyclospora is not contagious, as in it cannot be passed by person to person. It is transmitted by when people consume food or water that is contaminated with human feces containing the oocysts, or the eggs, of the parasite.”

Q: What are the best ways to reduce your risk?
Dr. Noel: "The best way to prevent illness is to, first and foremost, follow standard hygiene and food safety practices. Washing our hands with soap and water after using the bathroom and before and after preparing food is important, as alcohol-based hand sanitizers do not kill cyclospora. However, soap and water does. Cleaning produce with vinegar has been more effective than just running water on its own. For example, one part vinegar, three parts water. It doesn't kill the cyclospora, but it helps the cyclospora detach from the fruits and vegetables, which has been shown to reduce the risk of getting sick or making the illness less severe. Produce is safest when it's heated to 158 degrees or higher, which actually kills the cyclospora."

Q: So when in doubt, just cook it?
Dr. Noel: Absolutely. When in doubt at this time, it's the best thing to cook. Fruits with crevices such as raspberries or strawberries with the bumpy surfaces, we actually recommend cooking them in pies or jam to greater than 150 degrees because we know that that's been linked to previous cyclospora outbreak. Freezing them can reduce the number of parasites, but probably not entirely, so we do recommend cleaning. Other things like cilantro and basil, those small leaves, we do want them to be washed thoroughly, separating the leaves in order to decrease the chances of an outbreak. For green onions, we'd like for you to trim the root end and removing the outer layer."

Q: If you’re living in one of the states that haven’t seen many cases yet, what should people be doing? Should people change what they eat during this outbreak? Is this a time to buy local?
Dr. Noel: "I would say that most of the cases, we have not seen these outbreaks from local farms or one particular source. The main message we would like to get out is it's important for our communities not to panic. It's definitely not a time for us to completely avoid fruits and vegetables altogether. We want make sure everyone's still eating very healthy. But it's just most important to practice washing and handling."

Q: What should people know about Cyclospora if they become infected?
Dr. Noel: "It is part of the reportable diseases to the Department of Health, and we do see some cases every year throughout the nation. So it's relatively common in the sense that it happens throughout the nation every year, just not to this degree. One of the greatest things about cyclospora is that there are treatments for it. We always say do not take over-the-counter anti-diarrheal medications like Imodium or Pepto-Bismol without the consultation of your primary care physician. What's interesting is that even though it is a parasite, it's been found that an antibiotic is very effective in treating cyclospora."

Q: What symptoms should people watch for?
Dr. Noel: "The symptom range looks like a typical stomach bug: diarrhea, nausea, feeling tired, cramping, and bloating. Because of that, many cases fly under the radar. Some people ride the illness out at home rather than seeing a doctor. Most of the time people will recover from the illness on their own with symptoms resolving within about a week or so. So it is definitely not something to panic about. Again, it's important for us to be aware, but not panic about the cyclospora outbreak during this time."

Q: What is your final advice?
Dr. Noel: "Even though we can't eliminate our risk completely, it's just important for us that we go back to the basics and always wash our hands. If you are sick, please do not prepare food for yourself or other people. Make sure to call out sick, and know that alcohol-based hand sanitizers do not kill the cyclospora. So always go back to soap and water hand washing for at least 20 seconds."