03 Aug 2018
CYCLOSPORA IN TRAVELLERS RETURNING FROM MEXICOAn increase in cases of Cyclospora infection in travellers who have recently returned from Mexico
An increase in cases of Cyclospora cayetanensis infection in travellers who have recently returned from Mexico is being monitored by Public Health England, in collaboration with Health Protection Scotland, Public Health Wales and the Public Health Agency in Northern Ireland .
This is the fourth successive year since 2015 that cases of C. cayetanensis infection have been reported in travellers returning from Mexico [2-5].
In 2018, as of 3 August, 57 cases of Cyclospora have been reported in England, Scotland and Wales, of which 46 had travelled to Mexico. Where information is known, cases have stayed at several different hotels in the Cancun and Riviera Maya region (mostly on an all-inclusive basis), suggesting the source is again likely to be a foodstuff that has been distributed to hotels throughout the region.
C. cayetanensis is a protozoan parasite that infects humans and other primates. Infection can cause diarrhoea, abdominal cramping, nausea, flatulence, loss of appetite, fatigue, low-grade fever, and weight loss. Infection without symptoms is also reported. Infections in HIV positive people and those with other immune deficiencies can be more severe.
Infection is commonly derived from food or water contaminated by human faeces. There is no evidence of transmission from animals. Oocysts (a hardy form in the lifecycle of this parasite) are not infectious for around 10 days after they are passed in faeces, so person-to-person transmission does not occur. The foods commonly involved are soft fruits such as raspberries and salad products such as coriander, basil, and lettuce.
C. cayetanensis is endemic in tropical areas of the world and the vast majority of cases reported in the UK are associated with travel to these areas. The risk of infection from imported foods is considered to be low .
Advice for travellers
C. cayetanensis is transmitted through consumption of food or drink that is contaminated with human faeces containing Cyclospora. You should ensure that you maintain good food and water hygiene at all times when visiting Mexico even if staying in high-end all-inclusive resorts.
If possible, choose recently prepared food that is thoroughly cooked and served piping hot. Certain foods should be avoided, e.g. fresh uncooked berries/unpeeled fruit and salad items that have not been washed in safe water. An infographic with more specific advice is available here.
After returning from Mexico, if you have any symptoms such as rapid onset of diarrhoea, loss of appetite, weight loss, stomach cramps/pain, bloating, increased gas, nausea, or fatigue seek medical attention and tell your GP about your travel history.
Advice for health professionals
If a returning traveller from Mexico presents with gastrointestinal symptoms, consider protozoan parasites including Cyclospora as a diagnosis. Testing should be arranged through local microbiology laboratories and positive cases reported to your local health protection team.
The usual recommended treatment for Cyclospora infection is co-trimoxazole .
- Travel and Migrant Health Section at Public Health England, personal communication, 03 July 2018
- Nichols GL, Freedman J, Pollock KG, Rumble C, Chalmers RM, Chiodini P, Hawkins G, Alexander CL, Godbole G, Williams C, Kirkbride HA, Hamel M, Hawker JI. Cyclospora infection linked to travel to Mexico, June to September 2015. Euro Surveill. 2015; 20(43):pii=30048
- Public Health England. Cyclospora:clinical and travel guidance. 12 August 2016
- Public Health England. Cyclospora outbreak related to travel to Mexico (2017). Health Protection Report 2017: 11 (26)
- European Centre for Disease Prevention and Control. Rapid risk assessment: Cyclospora infections in European travellers returning from Mexico- 21 July 2017
- Chalmers RM, Nichols G, Rooney R. Foodborne outbreaks of cyclosporiasis have arisen in North America. Is the United Kingdom at risk? Commun Dis Public Health. 2000 Mar;3(1):50-5.