Latest / Morning Medical with Dr. Chow / Cyclospora in Canada, Oral PCSK9 Inhibitor, and Carfentanil Overdose Concerns

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Cyclospora in Canada, Oral PCSK9 Inhibitor, and Carfentanil Overdose Concerns · Morning Medical with Dr. Chow

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  Good morning, everyone, and welcome to another episode of Morning Medical with Dr.
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  Chow.
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  I'm Dr.
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  Chi-Ming Chow, your host for today, and as always, we're here to bring you the latest in
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  medical and health news from around the globe, powered by artificial intelligence.
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  Today, we're diving into a range of topics that are making headlines, and first up, we're
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  discussing the current status of cyclosporiasis cases in Canada amidst a significant outbreak
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  in the United States.
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  Cyclosporiasis is an intestinal illness caused by the parasite cyclospora, which is typically
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  transmitted through the consumption of contaminated food or water.
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  This condition is characterized by symptoms such as watery diarrhea, abdominal bloating,
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  gas, and an overall loss of appetite.
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  While the United States is experiencing a notable outbreak, particularly in Michigan,
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  it's important to understand how this situation is affecting Canada.
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  In Quebec, health officials have reported an uptick in cyclosporiasis cases this year, with
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  107 cases identified as of July 11th.
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  This is a significant increase from the same period last year, which saw only 30 cases.
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  However, it's crucial to note that most of these cases are linked to travel, primarily to
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  Mexico, and not connected to the U.S.
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  outbreak.
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  Less than five of these cases involved individuals who had traveled to the United
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  States.
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  Similarly, British Columbia has reported 93 cases this year, which is considered typical as
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  cases are reported annually.
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  Most of these are related to travel, and while the situation is being monitored closely due to
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  the U.S.
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  outbreak, there isn't a direct link identified yet.
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  Health officials in British Columbia have noted an increase in non-travel related infections,
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  often due to the consumption of contaminated, imported raw produce during the spring and
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  summer months.
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  In Alberta, there have been six reported cases, with five identified within the past six weeks.
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  These cases also coincide with the timeline of the U.S.
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  outbreak, but investigations have shown no direct connections to travel to the United
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  States.
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  Instead, most cases were linked to travel to Mexico.
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  Routine surveillance activities are ongoing to ensure any potential links to ongoing outbreaks
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  are identified and addressed.
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  It's interesting to note that provinces such as the Northwest Territories, Nova Scotia, New
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  Brunswick, Saskatchewan, and Prince Edward Island have reported no cases of cyclosporiasis
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  this year.
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  Meanwhile, Nunavut has confirmed five cases, also with no evidence linking them to the U.S.
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  outbreak or imported produce from the U.S.
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  As of now, the Public Health Agency of Canada is not investigating any specific outbreaks of
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  cyclosporiasis within the country.
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  However, they do acknowledge that there is typically an increase in infections during the
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  spring and summer months due to the consumption of fresh fruits and vegetables imported from
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  other countries.
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  It's important for Canadians to stay informed and cautious, especially during this time of
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  the year when the risk of such infections can be higher due to imported produce.
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  As always, thorough washing of fruits and vegetables and being mindful of travel-related
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  exposures can help mitigate the risk of cyclosporiasis.
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  In exciting news for cardiology, the Food and Drug Administration has approved the first ever
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  oral PCSK9 inhibitor pill for lowering cholesterol.
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  The drug, known as enlicitide and marketed under the name Lipfendra, provides a new
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  non-invasive option for patients with high cholesterol or heterozygous familial
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  hypercholesterolemia.
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  This marks a significant advancement in the management of cholesterol, offering an
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  alternative to the injectable PCSK9 inhibitors that have been available up until now.
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  Enlicitide is taken as a 20-milligram tablet, once daily, and is recommended to be consumed
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  after a six to eight-hour fast with no food intake for 30 minutes following the dosage.
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  This oral administration offers a more convenient option for patients who may have
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  been hesitant about injection-based treatments.
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  The approval of enlicitide was based on the results from two pivotal phase three clinical
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  trials, CORALreef Lipids and CORALreef HeFH.
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  These trials demonstrated impressive reductions in low-density lipoprotein cholesterol, with
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  enlicitide lowering levels by 56 percent and 59 percent, respectively, compared to placebo
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  after 24 weeks.
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  The trials collectively involved 3,207 participants, covering individuals with severe
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  hypercholesterolemia, including those with a history or at high risk of atherosclerotic
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  cardiovascular disease, as well as patients with heterozygous familial
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  hypercholesterolemia.
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  Furthermore, an additional phase three study, known as CORALreef AddOn, highlighted
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  enlicitide's efficacy when compared with other oral nonstatin therapies such as ezetimibe and
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  bempedoic acid, both alone and in combination.
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  This positions enlicitide as a strong contender in the landscape of nonstatin
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  cholesterol-lowering treatments.
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  The introduction of an oral PCSK9 inhibitor is particularly noteworthy given the challenges
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  faced with existing injectable therapies.
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  Injectable PCSK9 inhibitors, including evolocumab, alirocumab, and inclisiran, though
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  effective, have been underutilized partly due to their mode of administration.
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  Enlicitide's pill form could potentially increase accessibility and adherence to
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  treatment, thereby helping more patients achieve their cholesterol-lowering goals.
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  Statins remain the cornerstone of cholesterol management, but they are not without their
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  drawbacks, such as muscle pain and liver function abnormalities.
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  Enlicitide offers an alternative with a different side effect profile.
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  In the CORALreef trials, diarrhea and dizziness were more common with enlicitide than with
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  placebo, but importantly, no excess safety events were noted in comparison to other
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  treatments.
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  Montreal Public Health has issued a warning regarding an alarming increase in overdose
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  deaths linked to carfentanil, a synthetic opioid significantly more potent than fentanyl.
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  Since April, carfentanil has been confirmed in eight suspected overdose deaths, though the
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  actual number may be higher due to the time required for toxicology testing.
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  This spike in overdoses has led to a public health alert, highlighting the ongoing crisis
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  fueled by the presence of fentanyl and its analogues in the drug supply.
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  The situation has become critical, with ambulance crews administering as much naloxone
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  in the first half of 2026 as they did throughout the entire previous year.
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  This underscores a sustained surge in overdoses, with non-fatal cases remaining
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  unusually high since March.
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  Dr.
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  David Kaiser, a public health physician with Montreal Public Health, emphasized that while
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  these substances are highly toxic, they still respond to naloxone, a medication that can
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  reverse opioid overdoses.
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  Public health officials are raising awareness not only among individuals who use drugs but
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  also within the general public.
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  During the summer months, more overdoses are occurring in public spaces such as parks and
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  sidewalks, increasing the likelihood that bystanders could witness an overdose event.
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  Dr.
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  Kaiser urges anyone who encounters someone showing signs of an overdose, such as
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  difficulty breathing or unresponsiveness, to call emergency services immediately and
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  administer naloxone if available.
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  The increase in overdose incidents is attributed to several factors, including an
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  increasingly toxic drug supply and prolonged periods of hot weather, which can exacerbate
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  the situation, particularly for those experiencing homelessness.
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  Quebec is currently on track to record consecutive years with over 600 drug overdose
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  deaths, a troubling statistic that calls for urgent action and awareness.
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  In light of these developments, it's crucial for the community to stay informed and prepared
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  to act in the event of an overdose.
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  The presence of potent substances like carfentanil in the drug supply poses a
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  significant risk, necessitating a collective effort to manage and mitigate this public
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  health crisis.
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  In recent news, the government in England has announced that from April, children under the
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  age of sixteen will no longer be able to purchase high-caffeine energy drinks.
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  This decision comes as part of a broader effort to address health concerns related to caffeine
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  consumption among young people.
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  The ban specifically targets drinks with more than one hundred fifty milligrams of caffeine
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  per litre.
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  This means popular brands like Red Bull, Monster, Relentless, and Prime, known for their
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  high caffeine content, will be off-limits to younger teenagers.
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  However, lower-caffeine soft drinks such as Diet Coke, as well as tea and coffee, are not
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  affected by this new regulation.
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  The rationale behind this move is to tackle issues like childhood obesity, sleep
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  disturbances, increased anxiety, and concentration difficulties that have been
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  linked to excessive caffeine intake.
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  Public Health Minister Sharon Hodgson emphasized that this ban reflects a strong
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  commitment to fostering a healthier generation of children.
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  Enforcement of the ban, pending parliamentary approval, will be the responsibility of local
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  authorities.
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  Businesses found violating the law could face fines up to two thousand five hundred pounds.
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  This measure is supported by data indicating that around one hundred thousand children in
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  England consume energy drinks daily, with some brands containing more caffeine than two cups
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  of coffee or four cans of cola.
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  Experts have pointed out that young individuals are particularly sensitive to caffeine, as
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  their bodies and brains are still developing.
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  The consultation leading to this ban received over eleven hundred responses, showing strong
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  public support for the age restriction.
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  The legislation will be introduced through secondary legislation under the Food Safety Act
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  of nineteen ninety.
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  While the British Soft Drinks Association has described the ban as unnecessary, noting that
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  high-caffeine beverages already carry warnings against consumption by children, the policy has
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  been praised by health advocates.
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  Katharine Jenner, Executive Director of the Obesity Health Alliance, called it a
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  common-sense approach to safeguarding children during a critical stage of their development.
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  The move to restrict these sales aligns with a growing awareness of the potential risks
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  associated with high caffeine intake, such as rapid heart rates, abnormal heart rhythms, and
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  even seizures, albeit rare.
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  Additionally, the high sugar content in many energy drinks can contribute to obesity and
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  dental issues.
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  It's worth noting that similar bans are being considered in Northern Ireland, Scotland, and
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  Wales, indicating a broader recognition of the need to protect young people's health across
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  the United Kingdom.
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  Our next story brings us to the realm of food safety, where shredded iceberg lettuce sold at
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  some Taco Bell locations has been linked to a cyclospora outbreak.
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  This outbreak is part of a larger surge of cyclosporiasis cases across the United States,
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  with nearly seven thousand cases confirmed or under investigation since May first, according
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  to the Centers for Disease Control and Prevention.
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  The number of confirmed cases alone is more than six times higher than it was at this time
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  last year, with at least one hundred forty-one hospitalizations reported.
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  The outbreak connected to the lettuce is considered regional, primarily affecting the
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  Midwest.
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  The Centers for Disease Control and Prevention has identified at least four hundred cases
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  associated with this outbreak across Michigan, Ohio, West Virginia, and Kentucky.
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  These are the states where the affected Taco Bell locations are situated, although it's
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  possible that the produce was distributed to other areas as well.
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  Michigan has been particularly impacted, reporting over four thousand three hundred
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  cases during the outbreak investigation.
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  The Michigan state health department has conducted interviews with more than one
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  thousand individuals as part of their investigation, noting that lettuce or salad
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  greens could be a potential source.
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  The concentrated increase in cases strongly suggests that the majority of illnesses are
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  linked to the same outbreak, making it the largest cyclospora outbreak on record in the
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  United States.
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  In response, Taco Bell has taken immediate action, voluntarily removing potentially
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  affected lettuce from their supply chain in select states.
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  According to a statement from the company, the affected ingredient will be replaced within
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  twenty-four hours in the impacted areas.
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  Taylor Farms, the supplier of the lettuce, has not responded to requests for comment.
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  Cyclosporiasis is typically not spread directly from person to person.
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  Instead, infection occurs through the consumption of contaminated food or water.
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  Previous outbreaks have often been linked to fresh produce.
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  Symptoms of cyclosporiasis can include watery diarrhea, cramping, and bloating, which may
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  persist for weeks.
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  Federal health officials are conducting multiple investigations, some tied to the large
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  outbreak in the Midwest, others involving single states or cases not yet linked to any
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  specific cluster.
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  Taylor Farms, known for supplying grocery stores and restaurants nationwide, has been
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  associated with previous illness outbreaks, including E.
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  coli cases linked to slivered onions in two thousand twenty-four and cyclospora cases
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  linked to lettuce in two thousand thirteen.
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  As we conclude today’s episode, it's crucial to remain vigilant regarding food safety,
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  especially with fresh produce.
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  Consumers should thoroughly wash fruits and vegetables and stay informed about potential
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  outbreaks.
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  Thank you for joining me on this episode of Morning Medical with Dr.
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  Chow.
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  Stay healthy and informed, and we'll see you next time.