Abanyie F, Harvey R R, Harris J R, Wiegand R E, Gaul L, Desvignes-Kendrick M, Irvin K, Williams I, Hall R L, Herwaldt B, Gray E B, Qvarnstrom Y, Wise M E, Cantu V, Cantey P T, Bosch S, DA Silva A J, Fields A, Bishop H, Wellman A, Beal J, Wilson N, Fiore A E, Tauxe R, Lance S, Slutsker L, Parise M
Center for Global Health,Division of Parasitic Diseases and Malaria,Centers for Disease Control and Prevention,Atlanta,GA,USA.
Epidemic Intelligence Service,Centers for Disease Control and Prevention,Atlanta,GA,USA.
Epidemiol Infect. 2015 Dec;143(16):3451-8. doi: 10.1017/S0950268815000370. Epub 2015 Apr 13.
The 2013 multistate outbreaks contributed to the largest annual number of reported US cases of cyclosporiasis since 1997. In this paper we focus on investigations in Texas. We defined an outbreak-associated case as laboratory-confirmed cyclosporiasis in a person with illness onset between 1 June and 31 August 2013, with no history of international travel in the previous 14 days. Epidemiological, environmental, and traceback investigations were conducted. Of the 631 cases reported in the multistate outbreaks, Texas reported the greatest number of cases, 270 (43%). More than 70 clusters were identified in Texas, four of which were further investigated. One restaurant-associated cluster of 25 case-patients was selected for a case-control study. Consumption of cilantro was most strongly associated with illness on meal date-matched analysis (matched odds ratio 19·8, 95% confidence interval 4·0-∞). All case-patients in the other three clusters investigated also ate cilantro. Traceback investigations converged on three suppliers in Puebla, Mexico. Cilantro was the vehicle of infection in the four clusters investigated; the temporal association of these clusters with the large overall increase in cyclosporiasis cases in Texas suggests cilantro was the vehicle of infection for many other cases. However, the paucity of epidemiological and traceback information does not allow for a conclusive determination; moreover, molecular epidemiological tools for cyclosporiasis that could provide more definitive linkage between case clusters are needed.
2013年的多州疫情导致美国报告的环孢子虫病病例数达到1997年以来的年度最高值。在本文中，我们重点关注德克萨斯州的调查情况。我们将疫情相关病例定义为2013年6月1日至8月31日期间发病且在发病前14天内无国际旅行史的实验室确诊环孢子虫病患者。开展了流行病学、环境和溯源调查。在多州疫情报告的631例病例中，德克萨斯州报告的病例数最多，为270例（43%）。在德克萨斯州发现了70多个聚集性病例群，其中4个进行了进一步调查。选取了一个与餐厅相关的由25例病例组成的聚集性病例群进行病例对照研究。在就餐日期匹配分析中，食用香菜与发病的关联性最强（匹配比值比19.8，95%置信区间4.0至无穷大）。在另外三个接受调查的聚集性病例群中的所有病例患者也都食用了香菜。溯源调查指向了墨西哥普埃布拉的三家供应商。香菜是所调查的四个聚集性病例群中的感染载体；这些聚集性病例群与德克萨斯州环孢子虫病病例总体大幅增加在时间上的关联表明，香菜也是许多其他病例的感染载体。然而，流行病学和溯源信息的匮乏使得无法得出确凿结论；此外，还需要能够在病例群之间提供更明确关联的环孢子虫病分子流行病学工具。
