Multiple outbreaks of a diarrhea-causing parasite are spreading across the U.S., with thousands of cases and hundreds of hospitalizations now reported across the country.

The outbreak of cyclosporiasis, a parasite spread through contaminated produce, has so far yielded only three cases in Nevada, none of which were acquired locally, according to the Southern Nevada Health District. At the same time, a multistate outbreak of salmonella has sickened dozens of people — including in Nevada — and led to a recall of eggs.

These outbreaks highlight the importance of public health professionals who monitor and track diseases at the local and federal level.

Brian Labus, an epidemiologist and associate professor in the UNLV School of Public Health, said that with widespread outbreaks like this, the responsibility shouldn’t fall on individuals to avoid the parasite. 

In outbreaks like cyclosporiasis, public officials are never going to tell the public to stop eating vegetables, he said. That’s why the public must instead rely on a working public health system to protect them.

“This really highlights why we have a public health system,” Labus said. “These are community-level problems that can only be solved at that level.”

Not an Individual Responsibility

Over her last two decades as a disease investigator at the Southern Nevada Health District, Devin Raman and her team have been in charge of tracking diseases like COVID-19 and West Nile.

Raman – who received her master’s degree in public health from UNLV – and her team are the ones to investigate the cases involving Clark County residents, even when they contract a disease out of state.

With a set of questions they employ for each illness, Raman and her team set out to solve the puzzle of where someone may have gotten their illness from so they can then prevent it from spreading to anyone else.

In addition to their questionnaire, Raman said the Centers for Disease Control and Prevention (CDC) has a hypothesis-generating questionnaire, which they will ask local health departments to employ when they need to identify what might link the cases in an outbreak.

“It’s one way to see a signal from confirmed cases — what is the most common thing that people are reporting?” she said.

From there, the health district reports information to the CDC, which acts as a centralized repository for information. The CDC then distributes the relevant information to the appropriate jurisdictions, including the local health district where an individual would have acquired the disease in the first place. 

“This is a perfect example of why strong public health infrastructure is so critical,” Raman said. “Quick identification of issues is going to lead to less illness. We just want to protect the health of the public.”

Piecing Together the Puzzle

Raman has always loved solving the puzzle of how diseases spread.

When someone gets sick and seeks out medical care, labs and doctors are required by law to report their disease findings to the health district, according to Labus, who was also one of its longtime disease investigators.

That’s where Raman and her team come in.

Every day, she looks at the diseases reported overnight to the district, then assigns them out to her team to request medical records from the relevant reporting institutions. 

But the most important part of that process is interviewing impacted people, she said.

As cases continue to climb across the country and the CDC has reported there are more than 11,500 additional cases that have not been confirmed and still require further investigation, Raman said there’s still a missing piece of the puzzle that disease investigators must find when it comes to identifying the sources of these outbreaks.

Iceberg lettuce from Taylor Farms was recalled earlier this year related to the outbreak of cyclosporiasis, and Taco Bell issued a statement saying it had removed the affected lettuce to limit the potential spread of sickness to their customers.

“We believe public health is a shared responsibility among restaurants, their suppliers, and authorities, and we are proud to have consistently acted quickly and proactively to protect our guests,” the company said. 

Raman said that kind of messaging to the public is an important piece in the large chain of people, agencies, and companies that need to collaborate together in order to protect the public’s health.

“That information is really important to share so people understand what is happening and what is being done to help them,” she added.

Protecting the Public

Labus said the fact that the public is hearing about this outbreak means outbreaks of this nature are rare. “If these things were common, people would be sick from their food all the time, and it wouldn’t be a big deal when it happens,” he said. “The fact that it is a big deal means that our system, for the most part, works to protect people.”

Raman said she and her team do this job because of the care and passion they have to help people and take care of their health. 

“We hope that that value is recognized by the community,” she said. “Ultimately that is who we work for. 

“We want to better our community, we want to prevent illness, and we want to help people."