Probe into explosive diarrheal cases points to Taco Bell and bad lettuce
Probe into explosive diarrheal cases points to Taco Bell and bad lettuce
腹泻病例激增调查指向塔可钟（Taco Bell）及受污染生菜
Lettuce and salad greens have become the prime suspects in an explosive outbreak of the diarrheal parasite Cyclospora, which is surging nationwide but erupting to extraordinary heights in Michigan. In recent years, Michigan has typically reported around 50 cases of cyclosporiasis, which causes urgent bouts of watery diarrhea, abdominal cramps, and nausea. But, this year, as of July 14, the state has reported 3,309 cases of the food-borne pathogen. Of those 44 have been hospitalized. 生菜和沙拉蔬菜已成为导致圆孢子虫（Cyclospora）寄生虫腹泻疫情爆发的主要嫌疑对象。该疫情目前正在全美范围内激增，而在密歇根州更是呈现出惊人的爆发态势。近年来，密歇根州通常报告约 50 例圆孢子虫病（该病会导致突发性水样腹泻、腹部绞痛和恶心）。然而，截至今年 7 月 14 日，该州已报告了 3,309 例此类食源性病原体感染病例，其中 44 人住院治疗。
Based on interviews with more than 1,000 people sickened in Michigan, the latest data is pointing to leafy greens as the source, according to the Michigan Department of Health and Human Services (MDHHS). “Although we do not have a definite product identified as the source of the outbreak, we want to let Michiganders know what we have learned so far so they can take steps to protect their families,” Natasha Bagdasarian, Michigan’s chief medical executive, said in an announcement. “Early information has shown lettuce as a common product that regularly comes up during the investigation. We will continue to provide updates as we learn more.” 根据密歇根州卫生与公众服务部（MDHHS）的消息，基于对密歇根州 1,000 多名患者的访谈，最新数据指向绿叶蔬菜是感染源。密歇根州首席医疗官娜塔莎·巴格达萨里安（Natasha Bagdasarian）在公告中表示：“虽然我们尚未确定具体的致病产品，但我们希望让密歇根州民众了解目前掌握的情况，以便他们采取措施保护家人。初步信息显示，生菜是调查中经常出现的一种常见产品。随着调查的深入，我们将继续提供最新消息。”
Taco Bell suspected
塔可钟（Taco Bell）受质疑
Separately, The Washington Post reported that state and federal officials are looking into whether Taco Bell restaurants may have been a source of food contaminated with the single-cell parasite. According to local media sources in the Detroit area, Taco Bell restaurants put up signs reading, “We are currently unable to sell Lettuce, Cilantro, Onion, Pico de Gallo, and Guacamole due to a nationwide recall.” It’s unclear what recall the restaurant is referring to; no nationwide recalls have been announced by Michigan or federal authorities related to cyclosporiasis cases. 另外，《华盛顿邮报》报道称，州和联邦官员正在调查塔可钟餐厅是否可能是导致食物被这种单细胞寄生虫污染的源头。据底特律地区的当地媒体报道，塔可钟餐厅张贴了告示，称：“由于全国范围内的召回，我们目前无法销售生菜、香菜、洋葱、莎莎酱（Pico de Gallo）和鳄梨酱。”目前尚不清楚该餐厅所指的召回具体为何，因为密歇根州或联邦当局并未宣布任何与圆孢子虫病相关的全国性召回。
The Post reported that Taco Bell did not respond to multiple requests for comment on the signs or the decision to pull certain produce. A source familiar with the investigation told the outlet that some sickened people interviewed reported having eaten at Taco Bells, while others did not, suggesting that there could be multiple sources of the contaminated food item. 《华盛顿邮报》报道称，塔可钟未回应多次置评请求，未就告示内容或下架特定农产品的决定做出解释。一位熟悉调查的消息人士告诉该媒体，受访的部分患者表示曾在塔可钟用餐，而另一些人则没有，这表明受污染的食品可能存在多个来源。
Identifying the source of Cyclospora can be difficult because it can take up to two weeks between when a person eats contaminated food and when they develop symptoms, making recall of the possible food sources difficult, the MDHHS noted. They also pointed to the “complex food distribution networks” as complicating factors in tracking the source or sources. MDHHS 指出，确定圆孢子虫的来源非常困难，因为从食用受污染食物到出现症状可能需要长达两周的时间，这使得追溯可能的食物来源变得复杂。他们还指出，“复杂的食品分销网络”也是追踪感染源的阻碍因素。
National situation
全国情况
While Michigan is seeing the highest numbers of cases, at least 33 other states are also reporting illnesses. New York has reported 470 cases. Ohio is seeing at least 397 cases. North Carolina has reported at least 240. The Centers for Disease Control and Prevention is collecting data on cases, but has been slow in reporting them. 尽管密歇根州的病例数最高，但至少还有其他 33 个州也报告了疫情。纽约州报告了 470 例，俄亥俄州至少有 397 例，北卡罗来纳州至少报告了 240 例。美国疾病控制与预防中心（CDC）正在收集病例数据，但报告进度缓慢。
After this story was published, representatives for the CDC and the Food and Drug Administration updated their data and held a press briefing on the cyclosporiasis situation. The CDC is now reporting 1,645 cases across 34 states as of July 13, with 141 of the cases being hospitalized. There have been zero deaths (this infection is rarely ever fatal). Additionally, the CDC said it is aware of reports of more than 5,100 additional cases from state and local health departments. But these cases require follow-up to confirm the infections and whether they were domestically acquired, the CDC said. 在本文发布后，CDC 和美国食品药品监督管理局（FDA）的代表更新了数据，并就圆孢子虫病疫情举行了新闻发布会。截至 7 月 13 日，CDC 报告在 34 个州共发现 1,645 例病例，其中 141 人住院。目前零死亡（该感染极少致命）。此外，CDC 表示已获悉州和地方卫生部门报告的另外 5,100 多例病例。但 CDC 表示，这些病例需要进一步跟进，以确认感染情况以及是否为国内感染。
The CDC and FDA believe that multiple clusters of disease are driving the large case count and wide distribution of illnesses across the country this year. The skyrocketing cases in Michigan, however, are thought to be part of a multi-state outbreak, spanning Ohio, Virginia, and West Virginia. In the briefing, Gwen Biggerstaff, deputy director of CDC’s Division of Foodborne, Waterborne, and Environmental Diseases, said it appears that the cases in this region may be from a single source, however a clear genetic or epidemiological link has not been confirmed. CDC 和 FDA 认为，今年全国范围内病例激增且分布广泛，是由多个疾病集群引起的。然而，密歇根州病例的激增被认为是跨州疫情的一部分，波及俄亥俄州、弗吉尼亚州和西弗吉尼亚州。在发布会上，CDC 食源性、水源性和环境疾病部门副主任格温·比格斯塔夫（Gwen Biggerstaff）表示，该地区的病例似乎来自同一来源，但尚未确认明确的遗传或流行病学联系。
While both the CDC and the FDA representatives were aware of reports linking the cases to salad greens and Taco Bell, they would not confirm in the briefing that either are leading suspects in the eyes of the federal agencies. Biggerstaff said the agency is pulling together data on what people ate and where, genetic data from the parasites, and trace-back data on food sources. “Right now we don’t have a specific source identified and we’re working very hard to continue collecting and analyzing those data,” she said in the briefing. 尽管 CDC 和 FDA 的代表都知道有关病例与沙拉蔬菜和塔可钟有关的报道，但他们在发布会上并未确认这两者是联邦机构眼中的主要嫌疑对象。比格斯塔夫表示，该机构正在汇总人们的饮食地点、寄生虫的遗传数据以及食品来源的追溯数据。她在发布会上说：“目前我们还没有确定具体的来源，我们正在努力继续收集和分析这些数据。”
Donald Prater, FDA’s acting deputy commissioner for food, added only: “What I can say at this point is that we’re continuing our traceback investigation on multiple produce items, including the lettuce.” FDA 食品代理副局长唐纳德·普拉特（Donald Prater）仅补充道：“我目前能说的是，我们正在继续对包括生菜在内的多种农产品进行追溯调查。”
Combining the CDC’s confirmed and probable cases, the US is already over 6,745 cases at this point in the summer, which is when cyclosporiasis cases peak. This tally is well above historical numbers; the US has typically reported between 2,000 and 5,000 cases a year. 综合 CDC 确认和疑似的病例，美国在夏季（圆孢子虫病的高发期）目前的病例总数已超过 6,745 例。这一数字远高于历史水平；美国往年通常每年报告 2,000 至 5,000 例病例。
Amid the outbreak with no clear source as of yet, health officials are recommending that people be cautious about leafy greens, particularly bagged or boxed greens. It’s recommended to instead buy whole heads of lettuce, discard the outer two or three layers of leaves, and then wash the rest thoroughly. But, sticking with peel-able or smooth-surfaced produce is safer. The safest choice is cooking produce to at least 158° F (70° C), which will kill the parasite. 在疫情源头尚不明确的情况下，卫生官员建议人们对绿叶蔬菜保持谨慎，尤其是袋装或盒装蔬菜。建议购买整颗生菜，丢弃外层的两三片叶子，然后彻底清洗其余部分。不过，选择可去皮或表面光滑的农产品更为安全。最稳妥的选择是将农产品加热至至少 158° F (70° C)，这可以杀死寄生虫。
Past cyclosporiasis outbreaks have been linked to bagged salad mixes and kits, fresh cilantro, fresh basil, raspberries, snow peas, and green onions, MDHHS notes. People who experience frequent watery diarrhea should consult with their healthcare provider. An antimicrobial treatment can treat the infection, along with rest. MDHHS 指出，过去的圆孢子虫病疫情曾与袋装沙拉混合菜、新鲜香菜、新鲜罗勒、覆盆子、荷兰豆和青葱有关。出现频繁水样腹泻的人应咨询医疗保健提供者。抗菌治疗结合休息可以治愈该感染。