Most healthy children who get cyclosporiasis recover completely, even without treatment. The main concern is dehydration from prolonged diarrhea, especially in younger children. Keep offering fluids, and do not give over-the-counter anti-diarrhea medicine to young children unless your child’s doctor recommends it.

How is it different from a typical stomach bug?

Most summer stomach bugs (like norovirus) get better on their own within a few days. Cyclosporiasis is different: without treatment the diarrhea can last for weeks, and it often comes and goes — a child may seem better for a few days and then feel sick again.

When should a child see a doctor?

• Diarrhea lasting more than a few days, or symptoms that keep coming back
• Signs of dehydration, significant weight loss, or a high fever
• Bloody stools or severe stomach pain

A doctor can order a stool test for Cyclospora. Because the parasite is hard to detect, the lab may need more than one sample collected on different days.

Older adults and people with weakened immune systems — for example, people living with cancer, an organ transplant, or an immune disorder — can experience more severe and longer-lasting illness. In this outbreak, the most serious outcomes, including rare deaths, have been mostly among people with underlying health conditions.

What to do

• Contact a health care provider early if you develop watery diarrhea that lasts more than a day or two, or that comes and goes. Ask specifically about testing for Cyclospora.
• Watch for dehydration and keep up fluids. Seek care promptly if you cannot keep fluids down.
• Avoid recalled iceberg lettuce and be especially careful with raw, ready-to-eat produce. When practical, cooking produce thoroughly removes the risk.

Cyclosporiasis is treatable with antibiotics when needed, and people with weakened immune systems may need a longer course. Early contact with a provider helps.

If you prepare or serve food — in a restaurant, grocery, cafeteria, or similar setting — a few steps protect your customers and coworkers during this outbreak.

• Do not work while you have diarrhea. Tell your manager and stay home. In Ohio, food handlers with cyclosporiasis are excluded from work until they have recovered and, if treatment has been prescribed, have begun the prescribed treatment. — see provider guidance.
• Wash hands with soap and water after using the restroom and before handling food.
• Remove any recalled product from service and inventory, and follow the disposal or return instructions in the recall notice.
• Prevent cross-contamination: use separate cutting boards for produce and raw meat, remove and discard outer leaves of leafy greens, and clean and sanitize surfaces and tools.

If you provide direct patient care — in a hospital, clinic, long-term care, or home-health setting — a few steps protect your patients and coworkers during this outbreak. Many patients are older or have weakened immune systems, and are more likely to become seriously ill.

• Do not work while you have diarrhea. Although Cyclospora does not spread directly from person to person, Ohio excludes people in direct patient care who have cyclosporiasis from work until they have recovered and, if treatment has been prescribed, have begun the prescribed treatment.. Follow your facility’s return-to-work policy and provider guidance.
• Get tested if you have symptoms — especially watery diarrhea that lasts more than a day or two or comes and goes. Ask specifically about testing for Cyclospora, since it is not included on every stool test or GI panel.
• Keep up standard hand hygiene and your facility’s routine infection-control practices.
• Counsel higher-risk patients. Remind older and immunocompromised patients to avoid recalled iceberg lettuce and to seek care early if they develop diarrhea.

Cyclosporiasis is not passed directly from person to person, so it does not spread through casual contact the way a cold does. Still, childcare and daycare settings should take sensible steps during the outbreak.

• Keep sick children and staff home while they have diarrhea. Staff who work in childcare and have cyclosporiasis should follow the same exclusion guidance as food handlers — see provider guidance.
• Emphasize handwashing with soap and water — after diapering and bathroom use, and before preparing or serving food or snacks.
• Serve produce safely: rinse fruits and vegetables under running water, keep recalled product out of the kitchen, and cook produce when practical.
• Water play: a child who has had cyclosporiasis should wait two weeks after diarrhea stops before using shared water play, pools, or splash pads.