HPR volume 17 issue 10: news (15 and 17 August 2023)
Updated 28 December 2023
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Investigation of Cyclospora cayetanensis in travellers returning from Mexico
The UK Health Security Agency (UKHSA) has identified an increase of Cyclospora cayetanensis (a protozoan parasite that does not naturally occur in the UK) in travellers returning from Mexico.
Between 12 May and 14 August 2023, 74 cases of cyclosporiasis were reported in England, Wales and Scotland. Age and sex are known for all cases, and 52 percent of cases are female, with a median age of 44 years. For those cases where travel information is available (52 cases), 48 cases report travel to Mexico. Detailed travel information is available for 42 of these cases, who report staying in several different hotels in the Riviera Maya and Cancún regions in Mexico, and most report eating a wide variety of different food and drink within their hotel resort as part of an all-inclusive holiday package.
Seasonal outbreaks of cyclosporiasis in UK travellers returning from Mexico have been reported since 2015, except in 2020 and 2021 during the COVID-19 pandemic, although annual case numbers have varied (79 cases were reported in 2015, 359 in 2016, 82 in 2017, 61 in 2018, 67 in 2019, and 36 in 2022).
Cyclospora is transmitted through consumption of contaminated food or drink. Infection can cause frequent, watery diarrhoea, abdominal cramping, bloating, nausea, flatulence, low-grade fever, loss of appetite and weight. While Cyclospora infections usually are mild and self-limiting in most people, they can be more serious or prolonged in immunocompromised individuals. The infection is diagnosed by testing of stool samples, and although most cases resolve on their own, antibiotics can be given to treat severe or prolonged infections.
Travellers to Mexico are strongly advised to maintain good food and water hygiene at all times even if staying in high-end all-inclusive resorts. If possible, they should choose freshly prepared food that is thoroughly cooked and served piping hot. Certain foods should be avoided such as fresh uncooked berries and herbs, unpeeled fruit and salad items as these can be difficult to clean.
UKHSA is liaising with the UK trade association for travel agents (ABTA) and Mexican public health authorities to inform investigations of these clusters. UKHSA is also working with the National Travel Health Network and Centre (NaTHNaC) to ensure appropriate advice is in place for UK travellers. More advice is available on the TravelHealthPro website.
Infection reports
Haemophilus influenzae annual report
Common animal-associated infections (England): second quarter 2023