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10 October 2017

Cyclospora outbreak related to travel to Mexico

Further to Current note 51/2905 (at http://www.hps.scot.nhs.uk/ewr/redirect.aspx?id=75006), the outbreak of cyclosporiasis in UK travellers to Mexico has been declared over.

As of 27 September, 132 cases of cyclosporiasis had been reported in the UK in 2017, of which 44 had been confirmed by a reference laboratory and 88 remained as probable cases (local laboratory diagnosis only). Cases have been reported in England, Scotland, Wales, Isle of Man and Jersey.

Although six cases were reported earlier in 2017 (two in January, one in March, three in May), cases began to increase from the beginning of June (week 22), with the majority of cases (N=92) reported in June and July (between weeks 22 and 30) compared to 203 cases reported in the same period in 2016 (55% decrease).

As in 2015 and 2016, Mexico has featured as the most common country of acquisition for cases of cyclosporiasis in the UK. Of the 132 cases reported in 2017, travel history information is currently known for 109 cases (83%). Of these, 84 (77%) reported travel to Mexico, 18 travelled to 14 other destinations (including three to the Dominican Republic) and seven did not travel outside the UK in the 14 days prior to onset of symptoms. For cases that travelled to Mexico with a known onset date (N=92), the earliest onset date was 19 May 2017 and the most recent 18 August 2017, 83% of cases having had onset in June and July 2017. The median age for cases that travelled to Mexico was 42 years (range 16-77), 53% being female and 47% male.

Of the cases that travelled to Mexico, 74 had information about region within Mexico or the hotel they stayed at. Of these, all but one stayed in the Riviera Maya and Cancun region on the Caribbean coast of the Yucatán peninsula, north eastern Mexico.

Cases stayed at 27 different hotels, with 37 cases having stayed at one of three different hotels and 37 cases having stayed at 24 other hotels.

Limited information on food and drink exposures was available for 50 cases that travelled to Mexico. More than two-thirds of cases consumed bottled water, mixed salad leaves, orange juice, tomatoes, mint in drinks, ice in drinks, lettuce and onions. As a case-control study was not conducted, it was not possible to identify the likely vehicle of infection. However, it is likely that the vehicle of infection was a food or drink item that is seasonally distributed to hotels in Riviera Maya given that cases have occurred during the UK summer months in 2015, 2016 and 2017 and travel to Mexico from the UK occurs year round.

Reports of cyclosporiasis in travellers returning from Mexico will continue to be monitored throughout the year but it is thought that particular vigilance will be required during the run up to the summer holidays in 2018. [Text adapted from Health Protection Report news, 6 October 2017. https://www.gov.uk/government/publications/health-protection-report-volume-11-2017/hpr-volume-11-issue-35-news-6-october]

Further information and advice for clinicians advising travellers is available from TRAVAX at http://www.travax.nhs.uk/outbreaks/outbreak-record-page.aspx?id=22259 and for the general public at http://www.fitfortravel.nhs.uk/news/newsdetail.aspx?id=22259.

Vol: 51 No: 40 Year: 2017 Page:


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