CLARK COUNTY, Ind. (WDRB) — When people get sick from contaminated food, figuring out what caused it can take time and a lot of questions.
Federal and state health investigators say the most common thread they’re hearing right now is iceberg lettuce, including prepackaged lettuce.
Amelia Rowlett, a nurse with the Clark County Health Department, is one of the people in southern Indiana working to trace the source of cyclospora.
"It’s pretty intensive," Rowlett said. "It’s 22 pages of information that we gather."
In an interview Friday, Rowlett said contact tracing is starting to see overlap in what patients report.
"We have detected that there is some patterns of people saying they’ve eaten at the same place, and they’ve shopped at the same place and have gotten the same prepackaged lettuce," she said, confirming iceberg lettuce when asked.
According to the Indiana Department of Health, 55% of the cases are women, and about 20% of all cases are from southern Indiana counties — Clark, Floyd and Harrison.
Health officials say timing is one of the biggest challenges when it comes to tracking the parasite. People can feel sick quickly — or much later.
"You can get sick within two days, but sometimes onset is actually two weeks later," Clark County Health Department Administrator Doug Bentfield said. "So when you’re trying to get ahold of somebody, talking about what did you eat two weeks ago, that could be a challenge."
Investigators ask patients to think back — not just to restaurant meals, but to food prepared at home.
Think about what you had for lunch days ago, or the next day, did you fix a salad on the kitchen counter, or use a food processor to shred lettuce?
Officials are also asking about group gatherings and shared meals.
"Any snacks? Do they have like an employee luncheon? Did they have a church picnic or something like that?" Bentfield said. "We would know everything."
The contact tracing in Indiana and other states is building a path back to lettuce suppliers — including those that supply Taco Bell — but investigators say it may not be a single straight line.
"We’re certainly not ruling out other sources as well," Rowlett said. "So we’re interviewing people to find out. OK, did you buy a lettuce at the grocery store? Which grocery store was it?"
Health officials say the parasite can linger for days — and in some cases up to a month — and when the phone rings, answering questions could help stop the spread.
"Everybody’s been so pleasant. So nice," Rowlett said.
Your answers, officials say, can help isolate the source and protect others.
Health officials in Indiana and Kentucky shared updated numbers for cases in both states Friday.
Kentucky officials have reported nearly 200, including 30 in Jefferson County. In Indiana, more than 300 cases had been identified as of Friday afternoon. Altogether, the CDC has tracked nearly 7,000 cases in 34 states.
Cyclospora is a microscopic, spherical parasite that commonly causes watery diarrhea "with frequent and sometimes explosive bowel movements," according to the U.S. Centers for Disease Control and Prevention. Outbreaks tend to occur most often in the late spring and summer.
The heat-loving parasite infects the bowels and spreads through feces. In the past, people have been infected by consuming fruits or vegetables that were exposed to feces-contaminated irrigation water.
The illness, called cyclosporiasis, is less common than foodborne illnesses caused by other germs, including salmonella and E. coli. Many cases are never linked to a specific food or other source and, for years, few U.S. cyclospora outbreaks were reported. But the number started rising about a decade ago, with a particularly notable spike in 2018 and 2019.
Experts say it’s likely that cyclospora cases historically were underreported, in part because some common tests used to check for food poisoning have not been geared to detect cyclospora. They attribute the increasing trend in cases to climate change and better detection.
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