Has the cyclospora outbreak impacted berries? What parents of berry-aged children need to know.

When Rae Rivers read news reports about a growing foodborne illness in multiple states, the Rhode Island mother of two panicked. The disease, known as cyclosporiasis, has previously spread through imported fresh produce including raspberries and blackberries. She thought of her boys; like many toddlers, her 3-year-old is obsessed with raspberries and her 1-year-old has been learning to enjoy smushed berries.

Nearly overnight, Rivers’ social media feed filled with posts about whether berries in refrigerators across the country would cause explosive diarrhea. It overwhelmed the stay-at-home mom, who just wanted to keep her kids healthy. Rivers decided to throw out a container of blackberries.

“It was painful,” she said. “They’re expensive.”

This scenario played out in households around the country this summer, especially among the parents of berry-aged children, kids between 1 and 3 who can house cartons of fruit in a day. 

Information trickled in at first about cyclosporiasis, an intestinal infection caused by the cyclospora parasite. More than 6,700 cases have been laboratory-confirmed in at least 45 states since the start of May, according to the Centers for Disease Control and Prevention, and thousands more are suspected. An outbreak linked to iceberg lettuce has been reported in nine states.

But aside from the lettuce-related cases that spurred a recall, details about other potentially contaminated foods have been limited.

“I think that’s what caused a lot of the confusion,” Rivers said. “It was also early on, so maybe we just didn’t have all the information on it yet.”

So did Rivers throw out expensive toddler snacks for nothing? As we wait for more information to emerge, fear not, parents: Experts aren’t urging a blanket ban on berries.

In recent weeks, imported fresh produce has received increased attention among consumers because previous cases of cyclosporiasis — which have been recorded every summer, just not to this record-breaking level — have been linked to leafy greens and fruits. But public health officials to date still don’t know enough specifics about the current cases to be able to tell if toddler fan favorites could be among the culprits.

Dr. Craig Hedberg, an epidemiologist with the University of Minnesota, said during a recent media briefing that until we identify more contaminated food items, “I really would not just assume that because berries have been previously associated with other outbreaks of cyclospora, that there is any concern about berries today that are available in the marketplace.”

Public health experts say it’s hard to find the origin of a cyclosporiasis outbreak, which often spreads through contaminated water or food. Cyclospora is not a pathogen like salmonella or E. coli, types of bacteria with a genetic material that scientists can more easily trace. Cyclosporiasis is also unique because it takes up to two weeks for a person to become infected. Public health officials — some of whom are dealing with federal funding cuts and reduced services — conduct interviews with infected people who are then asked what they ate in the past two weeks. That’s a task reliant on the notoriously unreliable human memory.

“It’s very, very laborious to investigate,” said Dr. David O. Freedman, an expert in parasitology and tropical diseases and a fellow with the Infectious Diseases Society of America. “Then they have to have enough individual reports to do a statistical analysis and to look for patterns or cases that are probably clustered or a part of this outbreak. So a lot of people, a lot of forms. It does take time.”

In the meantime, that can leave a lot of anxiety for parents with berry-aged children. 

Rivers uses social media to post content about being a mom. In mid-July, she made a video offering tips on how she was approaching food prep during the outbreak. So many of the fruits and vegetables that she tries to incorporate into her kids’ diets are in season during the summer, and she didn’t want to stop eating them.

“I didn’t want to remove that from our diet, but I just didn’t know for how long this was going to go on,” she said. “I didn’t want my toddler, especially, to get more hooked on processed foods. I was just scared.”

Public health experts agree that the most important thing parents and others can do right now is practice good hygiene. That includes thoroughly washing all fruits and vegetables before consuming them and keeping utensils, cutting boards and all other cooking equipment clean. Families should also encourage hand washing.

Still, people should be aware that washing or sanitizing produce doesn’t fully eliminate cyclospora; cooking kills the parasite. That’s led some parents to suggest cooking their berries for jams and pies.

Dr. Megan L. Ranney — dean of the Yale School of Public Health, which is tracking the outbreak as a resource for the public — suggested that parents and others follow recommendations from public health officials, including local alerts about specific outbreaks and cases in their states. She added that parents make risk assessments every day for a variety of things — from knowing when a child has enough balance to ride a two-wheel bike to preparing them to walk down stairs alone.

“We’re constantly making those judgments as parents about our kids’ health and safety, and this is unfortunately another level of judgment that we now have to make,” she said. “And each parent is going to know for themselves the level of potential risk that they’re willing to tolerate, and the trade-offs. Like if your kid is one who could care less about berries, then it’s pretty easy to not feed it to them. But if berries are the only fresh fruit that they eat, you’re going to have to take a slightly different approach.”

For Rivers, that meant changing some of her shopping habits. Instead of visiting big-box grocery stores that are likely to carry imported produce, the 30-year-old started visiting a farm stand near her house that sells locally grown peaches, plums and cucumbers. She has also followed some public health guidance to pivot to foods that have layers that can be peeled and may help reduce exposure.

“Risk isn’t zero, but I feel more confident buying locally,” she said.

Still, parents may feel like there is a vacuum of trusted information, and that may weigh heavily on families with people who have weakened immune systems; they can be more susceptible to severe reactions from dehydration.

Jess Steier, a public health scientist and founder of Unbiased Science, an organization that tries to communicate complex scientific concepts, recently wrote an op-ed criticizing how the federal government has reported out information about the outbreak — there was a retracted notice around the recalled lettuce and officials have reported cases in bursts that do not clearly indicate whether they’re weeks-old cases or new ones. 

“I’d call ongoing exposure possible rather than likely, and I’d add that current numbers can’t settle it either way because CDC assumes a six-week lag between illness and case reporting,” Steier told The 19th in an email. “That uncertainty is a fair reason for immunocompromised people to stay careful. For everyone else, the risk is very low and isn’t scaring me/my family away from lettuce or other produce.”

She also observed in her op-ed that the median age of known cases at the time was 44 — which offers clues that, in this case, toddlers’ general aversion to vegetables could be helpful.

“A median age of 44 with young children underrepresented points away from foods kids eat constantly and toward foods they mostly skip (greens), which is part of how leafy greens moved up the list,” she said. “If this had been strawberries, the age curve would have looked completely different. So the only real takeaway for parents is a fairly funny one: picky eaters turn out to be useful to epidemiologists early in an investigation.”

Rivers has a small garden in her backyard where she grows lettuce, a coincidence in motion months ago that has now given her peace of mind when she wants to make a salad or sandwich. She’s also started visiting a blueberry farm that lets visitors pick their own fruit.

“We’ve actually made that into a fun outing, my toddler and I. We went for the first time last week and we’re going to go back this week because we just ran out,” she said.