Cyclospora in Travellers Returning From Mexico

Cases of Cyclospora 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 Cyclospora infection have been reported in travellers returning from Mexico.

In 2017,as of 27 September, 132 cases (in total) were reported in The UK, with the majority (92) reported in June and July.

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.

Health care professionals should raise awareness of cyclospora infection with all travellers to Mexico, and should strongly advise that travellers maintain a high standard of food, water and personal hygiene, even if staying in high-end resorts.

Advice for Travellers

An advice sheet for travellers can be accessed via the following link:

• Cyclospora Advice for Travellers

Infection is transmitted through consumption of contaminated food or water, direct person to person spread does not occur. Foods often implicated in outbreaks include soft fruits like raspberries and salad products such as coriander, basil and lettuce.

Key points:

• Drinking water must be bottled, boiled, or purified with a special filter designed for drinking water.
• Iodine and chlorine do not kill cyclospora.
• Food should be freshly prepared, thoroughly cooked and eaten hot whenever possible.
• Uncooked berries, unpeeled fruit and salad leaves are best avoided since these are difficult to clean.

• Further food and water advice
• Preventing and treating travellers' diarrhoea

Advice for Healthcare Professionals

Protozoan parasitic infection (including cyclospora) should be considered as a diagnosis in travellers returning from Mexico presenting with gastrointestinal symptoms. Stool sampling and testing should be carried out in the normal way through local laboratories, travel history should be included, and confirmed cases should be reported to the local health protection team.

Further information on Cyclosporiasis