Top tips to avoid a ‘Hot Diarrhea Summer’ amid cyclosporiasis outbreak

New Yorkers should take extra care washing their fruits and vegetables to avoid getting a punishing form of food poisoning that is spreading across the country and has sickened hundreds in the five boroughs so far this summer, city health officials said Monday.

In New York City, 374 people were diagnosed with the infection known as cyclosporiasis between May 1 and July 9, with the city logging about three times as many cases this year as it had by the same time last year, according to the city health department.

Statewide, there have been a total of 511 cases since May 1, the state health department said.

Cyclosporiasis can come with gnarly gastrointestinal symptoms such as watery diarrhea with “explosive” bowel movements, nausea and abdominal cramping, according to the U.S. Centers for Disease Control and Prevention.

“To help prevent cyclosporiasis, we strongly recommend cooking your food whenever possible and washing fresh produce thoroughly under clean, running water," said Chantal Gomez, a spokesperson for the city health department.

The infection comes from consuming a parasite known as Cyclospora cayetanensis, which can hide in feces and hitch a ride on fruits and vegetables, according to the CDC.

But which type of produce is getting people sick this summer is still a mystery.

New York City and state health officials said Monday they are still investigating the source of the outbreak. The CDC said last week that it is working with state partners to identify the source of similar outbreaks across the country.

As of July 10, the CDC was reporting outbreaks in more than 30 states and federal data placed New York state second only to Michigan in the number of cases reported. But the CDC acknowledged that the number of cases reported to the agency lags behind those released by state and local health authorities.

Here’s what we know about the outbreak so far — and what New Yorkers can do to avoid having a Hot Diarrhea Summer (sorry).

What types of produce can carry this parasite?

Past outbreaks of cyclosporiasis have been linked to a variety of fresh produce, including raspberries, basil, cilantro, snow peas and mesclun lettuce, according to the U.S. Food and Drug Administration.

Although the CDC says the parasite that causes this infection is endemic to tropical and subtropical parts of the world, cases in the United States in recent years have been linked to both imported and domestic produce, the FDA said in a 2023 report. FDA officials were concerned enough that the agency started a task force in 2019 to address the emergence of the parasite in domestically grown produce.

What can New Yorkers do to avoid getting sick?

City health officials recommend being extra diligent about food safety practices while the outbreak is ongoing.

When consuming fresh produce, city health officials say New Yorkers should:

• Wash all fruits and vegetables thoroughly under running water before eating, cutting, or cooking.
• Wash and sanitize cutting boards, surfaces and utensils used to prepare, serve or store fresh produce, as well as refrigerators used to store food.
• Scrub firm fruits and vegetables, such as melons and cucumbers, with a clean produce brush.
• Cut away any damaged or bruised areas on fruits and vegetables before preparing and eating.
• Cook your food when you can. Heating food to 158 degrees Fahrenheit or higher kills Cyclospora.

“There’s no kind of magic potion that can eliminate the parasite from contaminated food,” said Dr. Michael Cappello, chair of the Department of Epidemiology of Microbial Diseases at the Yale School of Public Health.  ”But very careful, aggressive rinsing with clean water is generally recommended.”

Is there anything grocers can do to keep customers safe?

Public guidance from city health officials on the outbreak has so far targeted consumers and healthcare providers, rather than grocers or other food vendors. Gomez, the city health department spokesperson, said anyone selling fresh produce should take the same precautions as consumers when handling prepared food, such as pre-cut fruit.

Otherwise, she said, it’s up to consumers to clean their produce when they get home.

Cappello echoed that advice, adding that individual consumers are likely to be more thorough than vendors in cleaning individual pieces of produce.

How long does it take for symptoms to show up after getting infected?

Many people exposed to the C. cayetanensis parasite don’t develop symptoms or have only minimal symptoms, especially if they have healthy immune systems, said Cappello.

Among those who do get sick, it takes an average of one week for symptoms to appear, though it can take anywhere from two to 14 days, according to the city health department.

In addition to diarrhea, nausea and stomach cramps, symptoms can include loss of appetite, fatigue, vomiting and a low-grade fever, according to the CDC.

What can be done to treat cyclosporiasis?

Cyclosporiasis can be treated with an antibiotic called trimethoprim-sulfamethoxazole.

Many people will recover on their own, but without treatment, symptoms could last longer — anywhere from a few days to a month, according to the city health department.

The city health department said doctors should specifically request that labs test for cyclosporiasis amid the current outbreak, since those tests are not routine.