State of the Cyclosporiasis Outbreak

WNYC with your questions about those, call or text, 212, 433-9692. Lena, first tell us what exactly is being recalled with respect to jalapenos. It's not just the peppers themselves, right? No. In this case, the FDA has found that Taylor Farms has some prepared foods, sandwiches, dips, and like salasas that were made with jalapenos that were made with jalapenos that they... the FDA believes are linked to the salmonella outbreak traced to this one farm in Mexico that was a supplier that supplied Taylor Farms. So Taylor Farms has recalled those products as well. And it's not, so that's separate from the lettuce outbreak. Right. And you report that a large majority of the people reporting the salmonella illness so far said they ate at Mexican-style restaurants before they got sick, like Chipotle or Codoba, you report. But you also have a list of major food store chains where some of these products are sold, like those dips that you're talking about, you know, with salsa, et cetera. And some of the chains are the biggest. Walmart, Target, Whole Foods, Kroger, Haniford, Stop and Shop, and the Salmonella cases linked to this one supplier have occurred in 27 states. So is this industry almost a monopoly, or would that be overstating it? I think what you see happening is that with a lot of the industries in the United States, they have consolidated. And Taylor Farms is one of the biggest suppliers of fresh produce in the country. And they supply to distributors and... places where most of us have never heard of because we just shop at the store. And then those places send to hospitals, nursing homes, schools. So for this, for example, for the lettuce, it's, you know, also more than 20 states. And this is also more than 20 states. And there is a difference. The salmonella outbreak is caused by a bacteria. And the lettuce outbreak is caused by a parasite. And there is a biological difference. The bacteria is easier for us to do genetic fingerprinting and figuring out that if you ate something and I ate something and we look at the samples, they can make a link. With the parasite, the cyclospora parasite, it is harder.

You can't get as much of the genetic fingerprinting to do that disease detective work, which is why it's taking them, going to take them longer to figure out what the source of that outbreak is, even though most of that contaminated product, the lettuce product, is probably no longer out there. Do you understand how the production chain works? Like, what exactly is Taylor Farms, for example, if they're selling jalapenos that weren't grown on farms they own? Well, 60% of the produce that now comes into the United States is imported from Mexico. 60%. It's gone up. So there's a lot of stuff that's grown in Salinas, California, lettuce, other stuff. But a lot of it is imported. And so Taylor got their jalapenos from this supplier in California that the FDA says came from a farm. in one farm in Mexico. That's just the nature of our industry now, you know, places that have better climate and can produce the kinds of food we want year-round. You have to go to places that could grow them year-round. So we have hundreds of people with salmonella linked to Taylor Farms, jalapenos, and thousands of people with cyclospiriasis linked to their lettuce. Are the two outbreaks related, or is the Taylor Farms connection a coincidence? It's a coincidence. They're not related. They're only related and it's just the same. It's a big company and they make a lot. They produce, they sell a lot of produce all over the country. So you see that Taylor Farms has said that a lot of those packaged salad kits that you see in the grocery store, you know, like just that they have, that has not been effective. But has not been affected. But Taylor Farms. has not been very transparent about all the places that have received the recalled lettuce. Despite questions from many reporters, their recall page remains the same. They list the products, but they don't tell you in more specific detail where each one of those products went. Huh. So considering what you wrote in your article about how widespread this is and, you know, not just in fresh jalapenos that are used in restaurants like Chipotle or Codoba, but also in packaged things like, you know, guacamole that you might buy in a jar at Walmart, Target, Whole Foods, Kroger, Haniford, Stop and Shop, you mentioned all those chains. Are they each individually doing a recall from their customers? How does that work? So what I think in many cases, when once, I know Chipotle and Quedopa have said they have stopped using.

the jalapenos that were imported by this, by this supplier, coast citrus. And so far, Taylor Farms has said that no illnesses have been reported specifically in connection with those recalled products. But, you know, These illnesses have been taking place, and 36 people at least have been hospitalized. And salmonella is something that if you are infected with salmonella, the symptoms start. earlier than if you're infected with cyclo, this cyclospora parasite. Sorry to jump back and forth, but one of them, salmonella, you feel bad more quickly. And most people do recover, but the bacteria can cause serious and sometimes fatal infections in young children. On cyclosporiasis, that takes sometimes up to two weeks for symptoms to develop. And this is mostly diarrhea that doesn't go away, that keeps coming back. And for that, there are antibiotics that can be taken to treat that. Some people have had very serious, serious bouts of that illness. And we're like at over. 12,000 cases of cyclosporiasis in the United States. Yeah, that's a lot. To the question then of how we can know what's safe to eat right now, I see you reported last Tuesday that the cyclospora outbreak had reported on Friday that Michigan, which... was the hardest hit state, lifted its warning on bagged salads, and said its cyclosporic cases are declining, and that most contaminated produce is no longer available for consumption. So expanding, as of last Tuesday, declining as of Friday, any further update or how those fit together into a bigger picture right now? Yeah, let me explain the numbers. So if you think about it, If you ate some contaminated lettuce with cyclospora, it might take you two weeks to figure out that your diarrhea is related to that. You know, because people get sick all the time, right? So let's say it takes two weeks and then you realize that you are actually sicker than you normally would be if you ate something bad. Then you go to the doctor and then you get tested. And you have to have a special test to look for this parasite. Not the ordinary panels that you get for GI stuff doesn't pick this up. You have to order a special test. So they order a special test. Then those test results then have to get sent to the state. The state then sends it along to the CDC. Right there, you have, look at how long that's taken. Right? Not everybody goes to the doctor.

That is why you see that the cases that are, the numbers are going up are because we have this sort of lag of cases coming through. Plus, once the State Health Department gets a notification that, hey, Lena Sun, ate something and got tested and it's positive for this parasite. And the state health department has to come and interview me and ask me a detailed question. What did I have for breakfast? What did I have for lunch? What did I have for dinner? Not just yesterday, but going back two weeks. And this is all stuff that, you know, they can't farm out to a chatbot. Somebody has to like ask you these questions. That takes time to get collected. And then they take all that information. And that is pieced together by disease detectives at the CDC and other places. They're getting this information from across the country. And they're trying to figure out, hey, what is the pattern? Are we seeing something here? Oh, look, all these people said they ate at Taco Bell. That is how in Michigan that first came up to make the link to Taco Bell. What's happening now in Michigan is... All that product that was out there was recalled. And those cases are coming down. The numbers are coming down because the detection is slowing. And, but when the... Folks at the CDC and the FDA are doing their investigation to try to figure out what's going on, they're starting to put the pieces of the puzzle together. And that's why the big numbers are going up. Does that help make sense? That helps make some sense. So let me ask you one follow-up question. Then we're going to take a caller with a political question that a number of people are also texting. Have the cases tied to lettuce only been from Taco Bell? Well, Taco Bell has been one of the few chains to come out and say, we had this lettuce and we are no longer using it. But many of these products also went to Walmart sold in Walmart stores. And Walmart has also said, we received these products, but we are note that they've been taken off our shelves. And then a big food distributor that... you know, the average person I've never heard of them before. Cisco, which distributes to hospitals, nursing homes, schools, you name it, you know, huge, huge global. They, we call them and they said, we no longer use this product. But we don't yet have a full list from Taylor Farms of all the other places that received the product, which I hope by now is off the shelves because they use by date. is like on plus, bogus lettuce does not have a long shelf life. So, yeah. Yeah. I'm surprised you don't know Cisco because if you drive around, those trucks with the name Cisco on them seem to be all over. Huge trucks in many cases as I guess they carry food products from place to place. But has it only been iceberg lettuce and only shredded iceberg lettuce in the stores?

Well, if you look at the list that Taylor Farms put on their recall, some of those items are shredded lettuce mixed with romaine and mixed with other products. But the federal officials have been very careful in their language. All the reports trace back to iceberg lettuce from this one farm in central Mexico. The federal officials have not yet said, oh, we're also looking at this product or that product. In some state health departments, North Carolina had said a few weeks ago that they did not think that their outbreak was tied to this, you know, the multi-state outbreak and that people were talking about eating parsley in cilantro. But then last week, North Carolina was included in that 15-state outbreak. And I think what you see happening is that some cases are tied to that outbreak and some cases are not. Debbie in Livingston, New Jersey. You're on WNYC with Lena Sun, National Health Reporter for the Washington Post. Hi, Debbie. Hi, thank you. I'm a great fan. I was a microbiologist for EPA health effects, so I am aware how long things take. We did all kinds of salmonella and ecoli testing. But I did hear that Taylor Farms is a big donor to the Republican Party and President Trump. And I wonder how that actually slowed up a lot of the details that the public could have used to figure some of this out. That's my question. Thank you, Debbie. And we have a related question in a text that just says, is Taylor Farms the problem or the disabled FDA? So, Lena, what do you say to the caller and the texter? Taylor Farms, their donations have been to both Democrats and Republicans. They donated a million dollars to MAGA PAC. I'm sorry, I don't know which year, but there have been donations. We've looked at the donations. There are a very big player in this industry. Other news outlets have reported that Taylor Farms has hired a former administration official to lobby with them. And I know that they have been very... The White House has been involved and very concerned in the strength of the investigation or of the data that FDA and CDC have leaking the dots. FDA, as you know, like many of the health agencies, has had cuts, and former FDA officials have said that They feel that some of the work could have been affected by the cuts. But FDA and CDC have been working, you know, and I think.

Most people don't realize the CDC does the disease part, the disease detection part. And once they figure out like, oh, everybody said they ate at Taco Bell or everybody said they ate at Chipotle, then FDA goes and gets the records and says, okay, who supplies you and who are those suppliers and do this thing called the trace back. And then they do this thing called the trace forward to try to figure out where all that product went. That's what's happening now. And they are updating that information on their websites. But it's slow. And as the microbiologists might know, previous cyclosporiasis outbreaks, sometimes they aren't able to go all the way back to find the culprit. There have been many outbreaks of leafy greens where they... they never figure out like what the ultimate source was. One more question on this, and then we're going to go to your reporting on President Trump's anti-vax executive order. The Today Show had a report yesterday, and this goes back to what is safe to eat right now, and that New York Times headline that I cited in the intro, even though it's a month old, that says New Yorkers get squeamish about salad lunches amid parasite outbreak. The Today Show had a report yesterday that said historically, Certain various types of produce have been linked to past cyclosporiasis outbreaks in the U.S. It said these include fruits and vegetables that are eaten raw and can be difficult to clean thoroughly, such as leafy greens, fresh herbs, and berries. Common culprits, they said, include lettuce, but also cilantro, basil, raspberries, green onions, and snow peas. So do you know of any outbreaks? this summer that are not from lettuce, but any of those other foods. Again, this is not including the jalapenos, which are linked to salmonella, that whole thing, but the cyclospora, those other foods which are being named in various media reports, cilantro, basil, raspberries, green onions, snow peas, anything like that? Well, those are the foods that have traditionally been linked to cyclosporiasis outbreaks. And as I mentioned, North Carolina said a few weeks ago that some of their interviees, people that they interviewed mentioned parsley and cilantro in addition to lettuce. You know, these foods are tricky to clean, you know, berries. And I think for people who want to know, wow, what's safe to eat in my state, it probably, you know, cyclosporiasis outbreak is now in at least 47 states. So practically all of the United States. And you can go to your state health department and look to see.

how many cases they are reporting. In some places, there's a baseline number of cyclospora cases that are reported every summer. It's always in the summertime because that's when we eat these, you know, items. And some states will say, you know, the number of cases we have now is about the same as we've had in past years. And then that maybe will give you a signal that maybe it is, you know, it's a little bit safer. Michigan did a very good job and told its consumers right away putting out notices. Here are the things. Here's how you should wash. When you wash ahead of lettuce, take out the outer leaves. They've dropped those recommendations because I think they feel pretty sure that the stuff is out of there. But you can go to your state health department and look. And if they're saying, we are getting three times a number of cases we normally get, then maybe you should be more on alert. And make sure that you are, you know, some people are looking at where the produce is coming from. You could look, you know, it's on the bag or it's on the box. And that is another way to sort of, you know, help you make your daily decisions. But people say you should not stop eating produce because of this because. You know, the benefits of eating produce and fruit and fresh fruits and vegetables way outweigh. Right. But if you want to be really conservative, you can always cook your vegetables because that's not. Yeah. Right. That eliminates the risk, as I understand it. Or they also say you can eat more things with an outer skin that you have to peel because that also protects us. So I guess like bananas, oranges, fresh avocados, things like that, right? Right, right. I mean, you know, nobody's eating any. Who eats an avocado peel, right? And if you stir fry your snow peas or blend them or steam them, there's a lot of these vegetables, you can. you could cook and will kill death parasite. We'll continue with Lena Sun from the Washington Post, who covers health on a national level for the Washington Post, Lena Sun, on President Trump's new anti-vax executive orders and what they mean and a lot of what they don't mean. Stay with us for that.

I am there on WNYC. We continue with Lena Sun, national reporter focusing on health for the Washington Post. All right, let's spend a few minutes before you go on President Trump's new anti-vax executive order, which you also reported on both to fact-check some of his claims and let parents know what is actually changing right away. The simple answer to that second part, and I think we should say this up front, is basically nothing is changing immediately. Is that correct? That is absolutely correct. There is nothing that changes immediately just because the White House issues an executive order does not rewrite the federal immunization schedule and states, not the federal government, set school requirements for what shots your kids need to get to go to school. The things getting the most press are splitting the MMR vaccine into three separate shots for its component parts, measles, mumps, and rebella, and the one you just referred to, using federal power to push school districts not to require vaccinations of most kids. On breaking up the MMR vaccine, it's not even available that way now, I've read everywhere. Why wouldn't it become available that way quickly with the executive order? Because that is not the way shots are made or approved by the FDA. The individual MMR shots were stopped by Merck in 2009. There is no scientific evidence, nothing to show that, to change that. These shots were given as a combination because it provides the best protection and it's the most efficacious use of the vaccine to give you protection against these three diseases. So these shots are not available now. And for the industry, for vaccine manufacturers to split them up would mean you would do new clinical trials. You would have to get separate FDA approval. That means vaccine companies would have to invest time and energy and money to do this. They ain't going to do it. There's no reason to do it because nothing has changed in the science. This is mostly driven by President Trump who has long believed. erroneously that somehow splitting up these shots would be better for your kids and that is simply not true he always talks about us the United States following peer nations in Europe Canada Australia guess what all those countries give the shots in a combination

And the concern the president expressed is a link to autism. But the American Academy of Pediatrics, and notably Republican Senator Bill Cassidy, despite voting to confirm Robert F. Kennedy Jr.., and he's also a doctor, are among those saying that claim has been thoroughly debunked. I want to read Dr. Bill Cassidy's tweet on this. Have it here, printed it out. He wrote, I'm a doctor. This executive order is wrong. The president does not have the expertise to make these changes. Vaccines are overwhelmingly safe. Vaccines are effective. Vaccines do not cause autism. Breaking up vaccines will mean children have to get more shots to get the same. And so, yeah, I'm laughing. It's not funny. But when he says the president does not have the expertise to make these changes, here's a little clip of the president at that announcement on Monday when he also referred to a claim without evidence that Tylenol. creates a autism risk in the children of women who are presently present, who are currently pregnant when they take the Tylenol, which, as we know, is acetaminophen. Effective immediately, the FDA will be notifying physicians at the use of acetya... Well, let's see how we say that. Acetaminophen. Acetaminopin. Acetaminopin. Is that okay? No, no, that was not okay. And here's an example of how exaggerated the president's rhetoric was on this on Monday. I'm playing this just to show what actual health professionals have to counter. Now that this is out there, scaring people from the White House, listen. It looks like they're pumping into a horse. You have a little child, little fragile child, and you get a vat of 80 different vaccines, I guess, 80 different blends, and they pump it in. So, Lena, do they pump vaccines into kids, like, by the vat and like into a horse? You know, just because the president says it many times does not mean it is true. And there are so many false claims, so many things that are not grounded in science. A typical vaccine contains about half a cc of liquid, which comes out to be about one-tenth of a teaspoon. One-tenth of a teaspoon. Do they make vats in that size? No, I don't think they make vats in that size. I don't know what comes in that size, but it's definitely not, well, maybe when, you know, when they're making vaccines, it's on the production, that's different. But I'm talking about what comes into the shot that you get in your arm.

I know. I was making a joke. Okay. So I just want people to think that. I hear you. One tenth of a teaspoon. Didn't Trump and Robert F. Kennedy Jr. say at the beginning of their term that they were going to get to the bottom of what causes autism in their first six months? Now it's a year in six months. They're trying to force the issue at the policy level. But have they presented any new data that more proves the claim that we always hear has been fully debunked by studies? No. There are studies going on, and what a lot of advocates for autism say is that you need to have the kind of research that can really focus on changes that take place in the brain, changes that take place, you know, in the womb, and by... constantly going back to this environmental issue of vaccines. Vaccines have been probably the most studied environmental issue related to autism. And that means it's taking money and research dollars and time and energy from things that really do need to be studied. My colleague Ariana Cha has written extensively about the links. the genetic sides and the brain and there are genes and many of the autism advocates really would like more focus on that kind of research not to go back and you know as and beat a dead horse right these vaccines have been and the link to autism have been studied not just in the united states but in multiple countries in over five million children and for decades Getting less attention, Lena, but also interesting to me is the part of the executive order that would reduce the number of childhood vaccines recommended at all from 17 to 11. Do you have the list of the six that would no longer be recommended or an example of one or two with what the argument is? Well, I think... Remember, this executive order does not change the immunization schedule. And many states, I think at least two dozen states have said they will continue following guidance and the schedule from the American Academy of Pediatrics, which doesn't break up these vaccines into different buckets. What the order would like the... What the order would like is to break them into buckets and one bucket being universally recommended vaccines and then some that would only be given to high risk and some that would be given only after, you know, this thing called shared clinical decision making, which is just a fancy way of saying, talk to your doctor first. But usually, I just want to digress for one minute, shared clinical decision making is. something that is typically saved for when they're not sure about how, it's more for when you're not that sure. And these vaccines that have been in the AAP recommendation and were part of the original CDC childhood immunization schedule have all been studied for safety and effectiveness for decades.

Ones that they want to move out of the universal column are hepatitis A, hepatitis B, meningococcal, rhodovirus, influenza, and COVID-19. And in March, a federal court said that the administration's previous attempt to get around, to make changes to the childhood immunization schedule was that they couldn't bypass the normal way to do it and that the committee that Robert F. Kennedy Jr. tried to get to do it wasn't lawfully constituted. So that's all on hold, but it does create a lot of confusion. Just because the White House issued this executive order does not mean those. vaccines in the schedule can change. Vaccine recommendations are made by an independent federal advisory committee to the CDC, and that is the committee that can make these changes. They make the recommendations, and then the CDC can decide to accept or not accept. And a lot of state laws actually are based on an insurance coverage are based on recommendations from that advisory committee. I'm glad you brought up that last point. No change in insurance coverage at this point for the childhood vaccines. We're almost at a time. I just want to ask you about one of those that would be taken off the universal list. I heard Senator Rand Paul, also a doctor and a Republican libertarian against most government mandates of things health-related. Rand Paul asked, if a new mother tests negative for hepatitis B, Why would they need to give a newborn a Hep B shot? Do you know the answer to that one? Yes. And Hep B has been one of the sort of big things that they have flagged. And hepatitis B is some just because the mom. doesn't test positive for hepatitis B. What about caregivers in the home? What if that child is being taken care of by other people? A lot of times you can pass on hepatitis B to someone and they don't even know they have hepatitis B and years later they can develop serious, serious illness. Lena Sun, national reporter focusing on health for the Washington Post. Thank you for your reporting and thank you for sharing it with us. Thank you for having me.