The Wake County Health Department is conducting interviews with those who test positive for cyclospora. The goal is to determine what produce is making people sick in North Carolina.
Health Director Rebecca Kaufman said no direct source has been found, but the culprit is believed to be a vegetable or herb.
“We do an interview with a communicable disease nurse that lasts about an hour and a half, because we ask them to go back about two weeks and review everything they’ve eaten with us,” Kaufman said, detailing the county’s investigation.
Kaufman said interview responses are then analyzed to try and determine if there are any commonalities between patients who have tested positive for cyclospora.
The Wake County Health Department explained cyclosporiasis cases in North Carolina must be reported by physicians within 24 hours of a positive test. The department added the state requires all reportable disease investigations be completed within 30 days from the date of the initial report.
NC State Food Safety Specialist Ben Chapman said the challenging part with cyclospora is how long it can take for someone to get sick after consuming the infected produce.
“Investigating an outbreak of something like cyclospora is very similar to investigating something like other food-borne pathogens where you’re really looking for: What are the common elements that these individuals have? Did they eat the same foods? Did they eat the same dishes? Did they eat at the same restaurants?” Chapman said.
He further explained, “Where it differs from pathogens like salmonella or listeria is that cyclospora, it can impact anybody. It’s not one of the pathogens that we look at and say ‘Hey, it’s most likely young or the elderly or pregnant individual or someone that’s immune compromised,' which is really what we focus on when it comes to listeria.”
Cyclospora can take anywhere from a few days to weeks to make someone sick. Symptoms of something like salmonella usually occur within 72 hours.
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James Rogers, director of food safety research and testing at Consumer Reports, underscored the time traceback investigations like these can take.
“If they’re lucky, they can test and trace the outbreak all the way back to the distributor, the producer or even the farm or country where this food was produced so they have a complete picture farm-to-patient of what’s causing the problem,” he said.
The FDA lists traceback investigations have been initiated in three ongoing outbreaks, according to theOutbreak Investigation Table. It's unclear any of those listed investigations are connected to North Carolina.
An administration spokesperson tells WRAL News, "This is an ongoing and rapidly evolving investigation and additional information will be provided as we learn more about the potential source of this outbreak."
The administration said that a public health advisory will be issued for investigations that have resulted in "specific, actionable steps for consumers to take to protect themselves."
Rogers and Chapman both highlighted the use of modern technology to aid in difficult pathogen investigations.
“It is true the outbreak could continue until they get a handle on it,” said Rogers. “But what they could also do for instance is take your credit card receipt where it will show you where you went to eat, your membership card in grocery stores you scan for discounts. They can use that to trace back.”
“To be able to ask individuals can we go into your history and see what you ordered if you don’t remember, is not something we had at our fingertips a decade ago at this same rate,” Chapman added. “Not always are public health investigators doing that because not every outbreak necessitates that, but certainly we’ve seen done nationally and here in North Carolina successfully.”
The Wake County Health Department still hasn’t identified the restaurants linked to any of the confirmed cases in Wake County.
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Kaufman previously told WRAL News that part of the reason was because only 22 of the 135 cases had been linked to three restaurants, none of which were in the same town in the county.
She also stated investigations into the restaurants revealed no wrongdoings by the businesses.
Rogers told WRAL that investigations like this can take time, but added Consumer Reports advocates for information to be shared with consumers.
“They haven’t named the actual source, either the restaurant or grocery store, which is unfortunate. We at Consumer Reports advocate that you give actionable information to consumers so they can make a difference in their own health and reducing risk of exposure,” Rogers said.
Chapman said that it is rare in an investigation to quickly have “a proverbial smoking gun.”
“This one specifically sounds like there’s very little information: not an identified food source, not an identified supplier,” he said. “In a case like this, I wouldn’t say anybody had a misstep or is doing anything wrong. I think this is just the way it plays out when you have low information.”
In addition to Wake, Durham and Orange counties additionally tell WRAL News that they have seen one confirmed case in each county, reported in July.
Chatham and Johnston counties have reported no cyclospora outbreaks in recent months.
People who believe they are suffering from a cyclosporiasis infection should seek medical care through their primary doctor and request the parasite be specifically tested through a stool sample.
