S1: Welcome in San Diego. It's Jade Hindman on today's show. Epidemiologists talk about food safety in light of a nationwide stomach illness linked to a parasite found in produce. This is KPBS Midday Edition. Connecting our communities through conversation. A stomach illness caused by the Cyclospora parasite has caused a multistate outbreak , sickening many with nausea , stomach pain and diarrhea. In San Diego County , health officials have identified eight cases of Cyclospora so far this year. Here to talk more about the foodborne illness and what you need to know about it is Doctor Akira Kodaka. She is deputy public health officer with the County of San of San Diego. That's right. Sorry about that. Also joining us is Richard Griffin. He is an infectious disease expert and professor at UC San Diego. Welcome to you both.
S2: Thank you for having me here.
S1: So glad to have you both here. I'm sure a lot of people are wondering what's going on and what their safest bet is right about now. So , uh , doctor , uh , I'm I'm going to start with you. Before we get into , you know , all the ins and outs of this illness , can you give us a brief update on cases in San Diego right now? We mentioned there have been eight cases this year , but any sign of an outbreak brewing here at all?
S3: Thank you so much for having me today. I really appreciate being here and being able to talk to the public about Cyclospora. And as you know , this is a parasitic infection. It is found in our environment and in stool contaminated water. And unfortunately , the CDC did report over 1600 confirmed domestic Cases of Cyclospora , and that's in 34 states with over 5100 cases still pending. And so what does that mean? Um , the Cyclospora infection is one that is normally , uh , in travelers. And so the fact that it's being reported domestically is of concern here in San Diego County , though we have not seen any reported cases of , of domestic occurrence. And so there are eight travel related cases to date of 2026. That's actually lower than what we've seen in the past years. We've had between 20 to 25 cases for our baseline. And so we're actually seeing less cases than we normally see. And these are all travel related cases. These are not domestically acquired cases meaning they haven't been um , because of something someone has eaten here in this county.
S1: So then , doctor , Professor Griffin , I mean , late last week , the U.S. Food and Drug Administration connected the Cyclospora outbreak to this lettuce from Taylor Farms. But now the FDA says their test was a false positive. We learned that yesterday , though they are saying that , you know , their investigation is still focused on lettuce from that company. How does that change what we know about the outbreak and its cause?
S2: Yeah , thanks for having me on and thanks for making this an issue for the the program today. It's there's a couple of things that are going on with the Cyclospora outbreak that make it particularly difficult for one. Unlike some other pathogens where , um , more molecular testing can be done to basically get a fingerprint from the , the pathogen and then connect people who might have been part of the same outbreak. Cyclospora is not easy to fingerprint , so it's really hard to , um , do test to see if if two cases are related to the same , uh , the same source. So that's one thing. The other is that when it comes down to investigating food borne illnesses , whether it's Cyclospora or any of a number of food borne illnesses. Um , they predominantly rely on food recall. So when they occur , uh , health investigators interview patients who have the illness and they ask questions like , where have you eaten and what have you eaten? And it's a process that's very , very well honed by the CDC and state and local health departments in conducting these investigations to try to pin down , you know , what? What was the food , where was it from , and possibly where did did it come from? But it's , um , it's an imprecise science. And sometimes if we get it right and sometimes it's not quite right. And as Doctor Gadhafi mentioned , um , Cyclospora isn't always just occurring in outbreaks. It's it's happening , you know , throughout the year at various levels. And so there might be some cases that are involved who are interviewed , who were part of the outbreak and some who are not , and that can make things a little bit more confusing. But on on the whole , the investigators are very , very good at , um , looking for the most probable cause. And then there's , there's things that we could do to intervene and try to prevent further cases.
S1: And , you know , doctor , I mean , someone listening might be saying , what about , you know , um , just simply washing , uh , produce or pesticides. What is it about Cyclospora that has made it so resilient?
S3: Well , it is a microscopic organism , so we can't see it by the naked eye. Right. And so if we're not really practicing good hand hygiene , for instance , making sure that we're washing our hands before we're handling raw produce , changing out our cutting boards , for instance , if we're using using the same cutting board to cut our vegetables and our meats , these are ways that people can become ill. So what what's really important about Cyclospora and prevention is making sure that we're doing things that keep us healthy. So practicing good hand hygiene , making sure we're washing our hands , we can because Cyclospora is small and it is um , and usually contaminated water , the produce that can be grown in water that might be contaminated with Cyclospora. It also can affect hard rind produce. So for instance , melons , cucumbers and watermelon , even that produce which we may not normally wash the outside of that skin. It's really important that we use a produce brush and make sure we're giving it a good scrub and making sure we're washing all our vegetables and fruits with soap and water and , and , and changing out the cutting boards as well. So there are ways to prevent Cyclospora. The other thing to note , because it's so small , is even with leafy greens , it's important to pull off at the outer outer leafy greens and eat the inside of leafy greens. But again , washing well with soap and water.
S1: And also just the anatomy of this parasite. It's got a hard shell on it. Correct? Yes.
S3: Yes. It's actually a part of a , um , a parasite that is similar to Sitio Mycosis , which is a round , hard organism that we can normally see with acid fast staining. And you can see the round , harder shell. So that does make it harder to get rid of. And that's why the scrubbing of the produce is so important , to make sure to get rid of that of what is residual on the produce.
S1: Well , what do symptoms look like? Should someone be infected with it?
S3: Um , symptoms are similar to gastrointestinal disease where people can have diarrhea. It's usually a watery diarrhea. But this can be very disturbing for individuals that might be more prone to dehydration , such as young infants or older adults , or people with compromised immune systems can also have nausea , fatigue , vomiting , low grade fever , abdominal cramping , along with that watery diarrhea.
S1: And , Professor Griffin , there have been some , um , there's been some messaging , you know , about avoiding certain types of foods. What advice would you give?
S2: Well , um , you know , it's the as doctor you mentioned , you know , we want to wash the foods and be careful. And there was a 16th century physician named Marcellus who said that the dose makes the poison. And so what that means is pretty much anything can be toxic at the high enough level. And so I think what we're always trying to think of is , how do you knock down the amount of bacteria that you're consuming , or in this case , a parasite , to the point where hopefully your immune system can fight it off or you're not going to get as sick. And so just doing a good job of trying to , um , maybe you can't completely clean your foods , but do the best you can to try to , you know , minimize the amount of , uh , uh , spores that are , um , cysts that might be on the food. And so when we talk about avoiding foods , I think we really have to think about is there's always the risk that any food item that we eat could be contaminated. And so we have to be cautious. And so obviously cleaning your foods is a good idea. Um , and we should just do that as regular practice. If you're buying bagged foods like bagged lettuces where it's supposedly already washed , um , they do a pretty good job. Uh , but they look. But chlorine is one thing that is used to decontaminate and desist from this parasite. Are actually not , um , not deep. They're not , um , inactivated by by bleach. So that's one thing that this that this , uh , parasite is unique from other bacterial infections from. So but the important thing to consider is that , you know , in the whole country there's been about 55,000 cases of Cyclospora this year. And that's a big deal because it's a lot more than usual. But , you know , we have over 350 million people in this country. And so for the whole country to stop eating lettuce because of these cases , it sounds frightening. But I think that the , the health harm to avoiding healthy foods , which also have , you know , properties that help to boost your immune system would not be advisable. I think that for the most part , people should continue eating healthy. Um , but just taking precautions to try to , you know , minimize any contamination that might be on their food. Mhm.
S1: Mhm. Doctor Khadka , I want to circle back to something that you mentioned earlier , which is that this parasite can can travel through contaminated water. And so I'm wondering how , what the source of , of this contaminated water might be as you , as you understand it.
S3: In previous um , Outbreaks. The contaminated water source has has really it's just it's been individuals who might be ill with Cyclospora. And this is a disease that can be passed on in stool that contaminates water. So you may have heard of outbreaks in the past where there might be produce that is grown in water that might be contaminated with feces or stool from someone that is ill with Cyclospora , and that travels into the irrigation ditches in which the food is being grown , or the produce is being grown and someone consumes that food , then that has been contaminated with the Cyclospora. And that's usually one route of transmission. Again , it can be , um , it has been seen in other outbreaks , such as raspberries or lettuce or the salad packs , as Doctor Garfield mentioned before. Um , so Cyclospora can , uh , because of the nature of traveling and water , it is normally in the soil. So it can also be in water and soil that is being used to irrigate produce as well. And that's just one of the ways in which it can get on to the produce and be transmitted.
S1: I see. Um , you know , we know about some of the symptoms here , but what should someone do if they are are starting to show those symptoms? When should someone seek medical attention , you think? Yeah.
S3: Yeah. I mean , many people who acquire Cyclospora can actually be asymptomatic. And it's really individuals who are having severe diarrhea , experiencing dehydration if they seem confused , very weak , unable to keep food down or liquids down and the diarrhea persists , that really is an indication to go see their doctor or to get help at the emergency room or the hospital as quickly as possible. There's certain populations of people that we do worry about because they are more susceptible to the effects of dehydration , and that that's definitely older adults who may not be able to keep up with their water intake. They are experiencing diarrhea. Young infants as well , who would not be able to keep up with their water intake. Anyone who's got an immuno an immune compromising condition. This could be someone undergoing chemotherapy or someone with a disease that affects their immune system. These are all individuals that we would be concerned about because of the dehydration that can be associated with the diarrhea , and that's related to Cyclospora.
S1: Typically , how long does this last?
S3: It can last , um , for actually some time. It could be anywhere from weeks to even months. But the good news is that it can be treated with an antibiotic that we commonly use. Um , and it's called trimethoprim sulfa toxins. All. And it's an easy treatment that we can give over 7 to 10 days to try to help with decreasing the diarrhea. For really good water intake , getting to your doctor as soon as possible if you are having severe effects from the diarrhea and then an easily treatable with an antibiotic. Interesting.
S1: Interesting. So. Professor Garfield , I want to talk more about , you know , the public health response here. Um , you know , tell me about how investigations into the origin of an outbreak like this work. Yeah.
S2: Yeah. So normally what happens is cases , uh , of food borne illnesses that are what we call reportable. Certain diseases are reportable. And clinicians who see these cases are supposed to report them to their local health department. And once and in those cases , then get fed up to a state health department system where they do also do surveillance and monitoring. And then certain diseases are reported to the CDC so that they can keep track for across the nation. And what's really important about that system is that there might be a few cases identified in , you know , a county here , a county there , but it doesn't seem like that big of a deal. But when you look at it on a national level , then you start to see these patterns that might suggest that there could be some common source for these outbreaks , such as , you know , a food supplier who's supplying food to restaurants across the country. And so the system that's in place is , is critical for being able to identify and respond to these kinds of , of outbreaks. Um , there's always a little bit of delay from the time it comes from the local health department to get up to the CDC. And so sometimes we'll see the numbers might differ between what a state might be reporting on what the CDC is reporting. Um , but the once the investigation or once the outbreaks are identified , then the response is to talk to the patients , the people who have the disease , identify what they have in common , and then develop some hypotheses to to figure out where , where the infections might be coming from. And , you know , oftentimes there'll be some clues , like there was a there was a wedding that everybody went to , or there was a certain restaurant that people ate at , or there was a certain thing there.
S1: But let me ask you this. I mean , has it been difficult to do all that? Um , you know , the federal government has has been scaling back surveillance for certain illnesses. How does that outbreak , how does this outbreak rather fit in to all that?
S2: Yeah , thanks for asking that question. That's crucial. Uh , it's really important. So in 2025 , the CDC took Cyclospora off the mandatory reporting list from a system called Food Net that's managed by the CDC. There's some other infections , like salmonella and E coli that people have heard of that are still on that list , but those are the only two that are left and several have been removed. Uh , in addition , there were 11 people employed in that branch at the CDC , and they have reduced that down to three people. So in terms of our ability to do this kind of surveillance , it's been , it's been scaled back. And this has a lot to do with , you know , budget cuts at the CDC and prioritizing some of these issues. And I think it's we're starting to see the consequences of that.
S1: All right. I've been speaking with Doctor Ankita Adachi. She is deputy public health officer with the County of San Diego , along with Richard Garfield , professor and infectious disease expert at UC San Diego's Herbert Worthing or Wertheim School of Public Health. Thanks so much to you both.
S3: Thank you for having us.
S2: You're welcome. Thank you.
S1: And of course , we'll have links to health resources on our website , KPBS. That's our show for today. I'm your host , Jade Hindman. Thanks for tuning in to Midday Edition. Be sure to have a great day on purpose , everyone.
