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At a Glance

• Learn which foods experts recommend avoiding during the Cyclospora outbreak.
• Find out which fruits and vegetables are still considered safe choices.
• Get practical food safety tips to help protect your family.

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I know I’m not the only one who’s been craving salad since the cyclospora outbreak began. My friends and family have fallen into two camps: those who haven’t had a salad in several weeks and those who pick and choose their lettuce, and then don’t think more about it.

Though we’ve been hearing about it all summer and many New Yorkers have come down with the parasite, we are all still kind of confused about whether it’s safe to buy lettuce or other fresh produce. Most parents are questioning what belongs in their grocery cart and what should just stay on the shelf. (Note: the lettuce is still all out on the store shelves. My local Whole Foods’ lettuce area was surprisingly well-stocked with every type of lettuce readily available, but there was one thing missing: shoppers.)

Still, there is some good news. Experts say there’s no reason to stop eating fruits and vegetables altogether.

“There are lots of things that are safe to eat!” says Jennifer Duchon, MD, MPH, Hospital Epidemiologist and Director of Antimicrobial Stewardship at Mount Sinai Kravis Children’s Hospital, and Associate Professor of Pediatrics at the Icahn School of Medicine at Mount Sinai. “Please don’t stop eating fruits and vegetables.”

Rather than cutting out produce entirely, Dr. Duchon says the smarter move is just avoiding the specific foods tied to the outbreak, and using good judgment with everything else.

Which foods should families avoid?

For now, Dr. Duchon recommends skipping “pre-packaged, bagged and cut lettuce and salad mixes.”

Not all lettuce is affected, however.

“A safer option is whole head lettuce; discard 2-3 of the outer layers of leaves and then thoroughly wash.”

No matter what produce you’re buying, washing it is still important.

“But always wash all produce thoroughly under running water—even if labeled ‘pre-washed,’” Dr. Duchon says. “Add friction by physically rubbing or scrubbing firm produce with your hands or a brush. Thorough washing reduces the risk but cannot guarantee removal of the parasite.”

Which fruits and vegetables are still safe?

Though the outbreak’s been tied specifically to bagged lettuce, plenty of other fresh produce is still fair game.

“Cooked vegetables are the lowest-risk option because heating to at least 158°F kills the Cyclospora parasite,” Dr. Duchon explains.

She also suggests choosing produce that can be washed and peeled at home.

“Whole fruits and veggies that can be washed and peeled at home, such as bananas, oranges, avocados, and cucumbers, are also great choices. And other fruits and veggies such as peaches, plums, beans, and tomatoes, for example, are not known to be affected.”

Should we eat only cooked vegetables?

“That is the most conservative approach, but it is not necessary for most families,” Dr. Duchon says.

Instead, her advice is to focus on the highest-risk foods.

“Avoiding the highest risk foods, such as pre-packaged, bagged and cut lettuce or salad mixes, and washing other produce carefully and choosing cooked vegetables when practical provides a sensible balance.”

If someone in your family is immunocompromised, it’s probably worth erring on the side of caution.

“Families who have household members with weakened immune systems may want to be more cautious and favor cooked produce while the outbreak and investigation remain active.”

Are frozen fruits safer?

A lot of parents figure frozen fruit is the safer bet, but that’s not always true.

“Not automatically,” Dr. Duchon says. “Freezing does not reliably kill Cyclospora or many other foodborne pathogens.”

She also notes that “there is also a  recall on certain brands of frozen blueberries.”

If you’re going the frozen fruit route, cooking it first adds an extra layer of protection.

“Cooking frozen fruit—for example, in oatmeal or a cooked fruit compote—provides additional protection.”

What can salad lovers eat instead?

If salads are a regular thing at your house, you don’t have to give them up. Swap in grain bowls, pasta salads made with cooked ingredients, bean salads, or chilled cooked veggies until things settle down.

Dr. Duchon suggests trying “grain or pasta bowls with roasted vegetables, beans, lentils, cheese, eggs, chicken or fish; chilled cooked vegetables such as green beans, broccoli, corn, beets or asparagus; or ‘salads’ made from chickpeas, quinoa or white beans.”

If you want to play it even safer, she’s got one more idea.

“For the most risk-averse, a bowl of cooked vegetables chilled and dressed like a salad is an excellent temporary substitute.”

How is Cyclospora different from a stomach bug?

Part of why this outbreak’s been so tricky to pin down is that Cyclospora doesn’t act like your average stomach virus.

“The symptoms caused by Cyclospora infections can overlap quite a bit with other kinds of foodborne illness or common stomach viruses, especially in mild cases,” Dr. Duchon says. “This is why tracing the source of the outbreak can be very difficult, since people may not recognize or report their symptoms.”

She explains that “Cyclospora is not a virus or bacteria—it is a microscopic parasite, usually acquired from contaminated fresh produce or water.”

Unlike norovirus, it doesn’t hit you right away, and symptoms can take their time.

“Unlike norovirus, another common foodborne illness, which typically begins abruptly within a day or two and resolves in several days, Cyclospora symptoms usually start about a week after exposure and can cause prolonged or relapsing watery (and yes, ‘explosive’) diarrhea lasting weeks if untreated.”

She adds that “vomiting and fever are generally less prominent, and direct person-to-person spread is unlikely because the parasite must mature in the environment before it becomes infectious.”

The good news to remember is that most people recover completely.

“Most people have mild symptoms and recover completely without treatment. In severe cases or in people with compromised immune systems, there is a drug called sulfamethoxazole/trimethoprim (Bactrim), which can treat the infection.”

Could this affect school lunches?

“It is difficult to say how long the outbreak may last,” Dr. Duchon says. “Although we know which foods are highly suspect, the exact source of the outbreak is still elusive.”

Case counts will probably keep ticking up, she explains—symptoms can take a week to show up, and it takes public health officials several more weeks to report it all. And with school starting back up soon, plenty of parents are probably wondering about cafeteria food, too.

“Schools and their food-service suppliers have very careful protocols to protect students from food-borne illnesses,” Dr. Duchon says.

Still, she recommends staying in the loop

“Parents should nevertheless watch for updated FDA or CDC advisories, and should ask their school administration about any additional actions they may be implementing due to the outbreak, especially if their child has a weakened immune system.”

For now, Dr. Duchon’s advice is reassuring: don’t panic or stop serving fruits and vegetables. Instead, avoid the foods linked to the outbreak, wash produce carefully, choose cooked vegetables when it makes sense, and keep an eye on updates as health officials continue investigating the source.

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