FDA, working with the CDC and state and local officials, is investigating an outbreak of cyclosporiasis in the US that has affected 358 people in 26 states.

According to FDA, clusters of illnesses were identified in Texas, Wisconsin and Georgia. Through initial investigations, authorities concluded that cilantro from the state of Puebla, Mexico was supplied to restaurants where some of those who became ill ate.

The investigation is ongoing and FDA says “a conclusive vehicle for the contamination has not been identified.”

CDC and state public health officials identified annually recurring outbreaks (in 2013 and 2014) of cyclosporiasis in the US which have been associated with fresh cilantro from the state of Puebla, Mexico.

FDA says it is working with the government of Mexico’s National Agro-Alimentary Health, Safety and Quality Service (SENASICA) and Federal Commission for the Protection from Sanitary Risks (COFEPRIS) to enhance the safety of fresh cilantro with produce safety controls on both sides of the border.

The controls implemented by COFEPRIS and SENASICA incorporate a system for risk reduction, including export controls, for cilantro from the state of Puebla. Correspondingly, on July 27, 2015, the FDA implemented a supportive framework of import controls to detain without physical examination shipments of fresh cilantro from the state of Puebla from April 1, 2015, through August 31, 2015, as well as this time period in ensuing years.

During an investigation into cilantro growing operations in Puebla, FDA observed human waste and toilet paper in the growing fields. FDA inspected 11 farms and packing houses that produce cilantro in Puebla. Five of these facilities were linked to the illnesses in the US and objectionable conditions were observed at eight. In addition to human feces and toilet paper found in the growing fields, FDA discovered some farms had no running water, toilets or hand washing facilities. At one farm, water in a holding tank used by employees to wash their hands tested positive for the parasite.

 According to FDA, Cyclospora cayetanensis is a human specific parasite that causes prolonged and severe diarrheal illness known as cyclosporiasis. Illnesses are seasonal though the parasite is not known to be native to the US as it prefers warmer, tropical regions.

More information can be found here