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Investigation and Outcomes

In Florida, reported numbers of cyclosporiasis cases have been increasing over the last 10 years†; 254 cases were reported in Florida in 2021, and the number doubled to 513 in 2022, including 486 (95%) laboratory-confirmed cases and 27 (5%) probable cases. Specimens from 276 (54%) cyclosporiasis patients were submitted to CDC’s Cyclospora genotyping project, including 211 (76%) which were matched to a specific temporal-genetic cluster code§ (4). Among the 513 cases reported in 2022, 469 (91%) patients reported illness onset during May 1–August 31, 2022, with a peak in early July (Figure).

The Florida Department of Health required that county public health personnel complete the CDC Cyclosporiasis National Hypothesis Generating Questionnaire (CNHGQ)¶ for all patients with illness onset dates during May 1–August 31, 2022. Among 457 completed questionnaires 330 (72%) respondents reported exposure information with no international travel, including 200 (61%) who reported exposure to bagged salad, a commercially produced package of prewashed salad greens. Among respondents reporting exposure to bagged salad, 85 (43%) noted a specific brand of Caesar salad kit containing only romaine lettuce, from a specific grocery store chain. Onset dates for this case cluster occurred during June 23–July 16, with a median disease onset date of July 1. An additional 76 persons with cyclosporiasis reported exposure to Caesar salad kits, but these persons either could not recall the salad kit brands or had purchased them from a different chain for a total of 161 potentially linked cases. Outbreaks of cyclosporiasis have been previously linked to bagged salads in the past (4). This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.**

CDC uses a genotyping tool to aid epidemiologic case linkage in near-real time. Among 211 successfully genotyped specimens from Florida, 153 (73%) were assigned to the same temporal genetic cluster (2022_001), including 43 (96%) of 45 genotyped specimens linked to the bagged salad cluster and 30 (39%) of the 76 persons reporting Caesar salad kits with no further identifying information. This information was shared with the Food and Drug Administration along with source information for the implicated product from the grocery store chain to facilitate traceback of the product; however, the source of the likely contaminated product was not identified.

Source of original article: Centers for Disease Control and Prevention (CDC) / MMWR (Journal) (
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