Cyclospora Risk for Travellers to Mexico

Since 2015 there has been increased awareness of seasonal outbreaks of cyclospora infection in UK travellers returning from Mexico. Annual case numbers in the UK have varied:

• 2015: 79 cases
• 2016: 359 cases
• 2017: 82 cases
• 2018: 61 cases

The majority of cases stayed in the Riviera Maya and Cancun regions of Mexico. The source of infection was likely to be contaminated food items supplied to hotels throughout the area.

Cyclospora cayetanensis is a protozoan parasite that can infect humans and other primates. Infection can cause frequent, watery diarrhoea, abdominal cramping, bloating, nausea, flatulence, low-grade fever, loss of appetite and weight. HIV positive individuals and those with other immune deficiencies can be at risk of more severe infection.

Healthcare practitioners 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

On return from Mexico, if travellers have any symptoms such as those described above they should seek medical attention and inform their GP of their travel history.

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