An outbreak of cyclosporiasis in 1996 associated with consumption of fresh berries: DISCUSSION part 2
After the outbreak in 1996, Guatemalan berry growers voluntarily introduced control measures that focused on improving sanitary conditions and water quality on individual farms. Even so, in the spring of 1997, a cyclosporiasis outbreak in North America was associated with Guatemalan raspberries; during this time, raspberries were imported from only those farms classified by the Guatemalans as low risk. In 1997, outbreaks of cyclosporiasis in the United States were also associated with consumption of mesclun lettuce and fresh basil. In the spring of 1998, a cyclosporiasis outbreak associated with Guatemalan raspberries was identified in the Toronto area but not elsewhere. Until June 9, 1998, raspberries from low risk farms continued to be imported into Canada; no Guatemalan raspberries were imported into the United States in the spring of 1998. The mode of raspberry contamination has not been identified for any of these outbreaks. As of December 1999, the fall and winter crop (November and December) of Guatemalan raspberries, that was harvested and packed under a new and more stringent system, was allowed to be imported into Canada. Health Canada and the Canadian Food Inspection Agency are currently reviewing the importation policy for the spring crop (April and June) of Guatemalan raspberries and blackberries (personal communication, Rene Cardinal, Canadian Food Inspection Agency, 2000). Cyclosporiasis was made a nationally notifiable disease in Canada on January 1, 2000.
These outbreaks of cyclosporiasis in North America have established cyclospora as a foodborne pathogen and cyclo- sporiasis as a disease that is not restricted to travelers returning from developing countries. Laboratory diagnosis of cyclosporiasis is necessary to detect outbreaks and to differentiate the clinical presentation from that seen with other enteric pathogens. In addition, specific medical treatment (ie, with trimethoprim/sulphamethoxazole) is available once cyclosporiasis is diagnosed.
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In the past, foodborne outbreaks were often thought of as local events, affecting a group of people eating at a restaurant or attending a social event. With globalization of food products, the impact of foodborne outbreaks is also globalized. Local, national and international organizations and agencies need to work closely together to strengthen global surveillance and the capacity to control, and prevent, future outbreaks. The investigation of this international outbreak of cyclosporiasis in 1996 demonstrated the importance of a coordinated, multijurisdictional public health response.