Infection Control Today® Editorial Staff

Close-up of a sucking female tick on human irritated skin. The bloated 

, a dangerous parasite, is biting into the pink, irritated epidermis. Danger of Encephalitis and Lyme disease infection.

A positive Lyme disease antibody result may signal a need to consider other tick-borne pathogens, according to a study of 193,260 individuals tested at Quest Diagnostics. Researchers found antibodies to at least 1 additional tick-borne pathogen in 29.5% of individuals who were seropositive for 

, compared with 5.5% of those who were seronegative. However, the findings identify overlapping antibody responses, which do not establish that patients had multiple active infections simultaneously.

, the study, "Coseropositivity to tick-borne pathogens among patients suspected to have Lyme disease" examined serological testing performed from January 2021 through December 2025. Its findings highlight the diagnostic complexity facing clinicians evaluating possible tick-borne illness, particularly in the Northeast, where overlapping antibody positivity was most frequent. For infection preventionists and other health care professionals, the results offer an opportunity to strengthen education about tick-borne pathogens while emphasizing the limitations of antibody testing.

Other tick-borne antibodies were detected in 29.5% of Lyme-seropositive individuals, compared with 5.5% of Lyme-seronegative individuals.

Overlapping antibody positivity was most frequent in the Northeast, supporting awareness of pathogens beyond Lyme disease.

Antibody detection does not prove active coinfection, making clinical context essential when interpreting results.

Lyme disease is transmitted through the bite of infected 

. These organisms cause anaplasmosis and babesiosis, respectively. Because multiple pathogens share a tick vector, focusing exclusively on Lyme disease may leave other possible causes of illness unexamined. As the investigators noted, “The strong association between seropositivity for 

 is consistent with underlying biology given that all 3 are transmitted by 

Researchers analyzed each individual’s first eligible tick-borne disease serological panel during the study period, excluding results without age, sex, or state-of-residence information. The cohort included 108,878 female and 84,382 male individuals, with a median age of 51 years. Adults represented 92.4% of participants, 70.6% lived in the Northeast, and 40.7% underwent testing between June and August. These characteristics are important when considering how broadly the findings apply beyond this tested population.

Overall, 9609 individuals (5.0%) were seropositive for 

 were detected in 6003 individuals, or 3.1%; antibodies to 

 species in 1980, or 1.0%. Altogether, 13,014 individuals, representing 6.7% of the cohort, had antibodies to at least 1 tick-borne pathogen other than the organism associated with Lyme disease.

The association persisted after researchers accounted for age, sex, testing month, and region. Individuals with 

 antibodies had an adjusted seropositivity ratio of 4.46 for other tick-borne pathogens compared with those without those antibodies (95% CI, 4.30–4.63; 

 < .001). Among individuals seropositive for 

, 31.1% in the Northeast also had antibodies to another tick-borne pathogen, compared with 13.6% to 16.6% in other regions.

The investigators considered the associations between 

 to be biologically consistent with their shared transmission via 

 was more complicated. Possible explanations included exposure to multiple tick species through work or outdoor recreation, cross-reactivity with 

. The study could not determine which explanation accounted for individual results.

Babesia findings are of particular clinical significance because doxycycline, a first-line treatment for Lyme disease, is ineffective against the parasite. The authors therefore emphasized maintaining a high index of suspicion for other tick-borne pathogens, particularly in the Northeast. That message requires careful interpretation: an antibody result alone does not establish an active infection or determine whether additional treatment is necessary.

Several limitations prevent translating these findings into a coinfection rate.

“This study has limitations, including unknown clinical indications driving test ordering and unknown disease stage (eg, acute or chronic symptoms), a lack of molecular testing, and an unknown seropositivity level for non-LD tick-borne pathogens, as well as potential false-positive and false-negative serological results,” the authors wrote.

Serological assays can produce false-positive and false-negative results, and the less specific IgM component may “which may partly explain the higher rates of coseropositivity observed across pathogens.” Early Lyme disease can also be missed by standard 2-tier antibody testing. The investigators explicitly cautioned that “coseropositivity does not prove active coinfection.”

The investigators admit that “[w]hile somewhat expected, the increased seropositivity for 

 among individuals with laboratory evidence of LD reinforces the need for clinicians to maintain a high index of suspicion for non-LD tick-borne pathogens, particularly in the Northeast region.”

For health care teams, the study supports broader awareness without overstating what laboratory evidence can establish. Education should address shared tick exposures, the possibility of additional pathogens, and differences in treatment coverage. Equally essential is distinguishing antibody detection from confirmed illness. The practical implication is to keep the diagnostic assessment open while interpreting test results in the context of each patient’s presentation and exposure history.

Articles

A study of 193,260 individuals found overlapping tick-borne antibody levels more frequently among those with Lyme antibodies, highlighting diagnostic challenges when active coinfections are not confirmed.

Lyme Testing Reveals a More Complex Picture of Tick-Borne Disease 

Paper with urinary tract infection written on it and pills.

(Adobe Stock 82815499 by Vitalii Vodolazskyi)

As antimicrobial resistance (AMR) continues to limit treatment options for common bacterial infections, an international consortium has launched one of the largest clinical trials to date evaluating bacteriophage therapy as a potential alternative to antibiotics for recurrent urinary tract infections (UTIs).

Supported by a €15 million (approximately $17 million) grant from the European Union, the P-PEAKS UTI trial will bring together 20 research and clinical partners from 13 countries to investigate whether personalized bacteriophage therapy can safely and effectively prevent recurrent 

Researchers from The Hebrew University of Jerusalem and the Hadassah Medical Organization are among the project's key collaborators, contributing expertise in phage therapy, microbiology, infectious diseases, and translational clinical research.

The trial, known as P-PEAKS UTI (Personalized-Phage against 

 with IV Antibiotic to Knockout Stable Biofilms in Urinary Tract Infections), is led by Gregory German, MD, of Canada's St. Joseph's Health Centre. The Israeli research team is headed by Ronen Hazan, PhD, Sahar Melamed, PhD, of The Hebrew University, and Ran Nir-Paz, MD, of the Hadassah Medical Organization, who also cofounded the Israeli Phage Therapy Center.

Addressing a Growing Antimicrobial Resistance Challenge

Recurring UTIs affect millions of women worldwide and are becoming increasingly difficult to manage as antibiotic-resistant organisms become more common. Many patients experience repeated infections despite multiple courses of antimicrobial therapy, creating an urgent need for alternative treatment strategies.

Unlike conventional antibiotics, bacteriophages—or phages—are naturally occurring viruses that selectively infect and destroy specific bacteria while leaving human cells unaffected. Because phages target only particular bacterial strains, researchers believe they may offer a more precise approach to treating persistent infections while reducing selective pressure that contributes to antimicrobial resistance.

Approximately 220 women with chronic recurrent 

 UTIs will be enrolled at clinical sites across Israel, the US, Canada, France, the United Kingdom, Italy, Spain, and Estonia.

Participants will receive either personalized phage therapy or a placebo in combination with a single intravenous dose of antibiotics, allowing investigators to rigorously evaluate the treatment's safety and effectiveness.

For infection prevention and antimicrobial stewardship professionals, the study represents another important step in the search for nontraditional approaches to combating multidrug-resistant infections.

While phage therapy has generated growing scientific interest over the past decade, widespread clinical adoption has been limited by the lack of large, randomized clinical trials. Investigators hope P-PEAKS UTI will provide the high-quality evidence needed to better define the role of phage therapy in routine clinical practice.

"Nonresolving infections and antimicrobial resistance are among the defining medical challenges of our time," said Ran Nir-Paz, MD. "International collaborations such as P-PEAKS allow us to combine expertise across disciplines and countries in order to evaluate innovative therapies that could significantly improve outcomes for patients who currently have few treatment options."

Beyond recurrent UTIs, investigators believe the findings could help establish a stronger scientific foundation for applying bacteriophage therapy to other difficult-to-treat bacterial infections.

As AMR continues to threaten the effectiveness of existing antibiotics, infection preventionists are increasingly recognizing that future solutions will likely require a combination of antimicrobial stewardship, infection prevention practices, rapid diagnostics, novel therapeutics, and international collaboration.

If successful, the P-PEAKS UTI study could represent an important milestone in expanding the evidence base for personalized phage therapy and offering hope to patients who have exhausted conventional treatment options.

A new $17 million international clinical trial will evaluate personalized phage therapy for recurrent antibiotic-resistant urinary tract infections, bringing together researchers from 13 countries.

Global $17 Million Trial to Evaluate Phage Therapy for Drug-Resistant Recurrent UTIs

Sick baby boy applying inhaled medication by inhalation mask to cure Respiratory Syncytial Virus (RSV) on the patient's bed at the hospital.

For infection prevention and pediatric health professionals, respiratory syncytial virus (RSV) remains one of the leading causes of hospitalization among infants and young children. Although recent advances in RSV prevention have significantly reduced disease during the first RSV season, certain children continue to face elevated risk as they enter their second season. Now, Merck is seeking to extend protection for that vulnerable population.

Merck announced that the FDA has accepted a supplemental Biologics License Application (sBLA) for ENFLONSIA (clesrovimab-cfor) to expand its indication to include prevention of RSV lower respiratory tract disease (LRTD) in children younger than 2 years who remain at increased risk for severe RSV disease during their second RSV season. The European Medicines Agency (EMA) has also accepted a similar application for review.

The FDA has assigned a Prescription Drug User Fee Act (PDUFA) target action date of March 22, 2027.

While many healthy infants experience declining RSV risk after their first year of life, children with chronic lung disease of prematurity, congenital heart disease, or those born very preterm may continue to be susceptible to severe RSV illness beyond infancy.

"For some children, the potentially serious impact of RSV does not stop after their first RSV season," said Macaya Douoguih, MD, vice president and therapeutic area head of Global Clinical Development at Merck Research Laboratories. "The recent FDA and EMA regulatory filings represent important opportunities to help expand protection with ENFLONSIA for vulnerable children under two years of age during their second RSV season, potentially further reducing the significant burden of RSV on families and health care systems."

The regulatory submissions are supported by data from the Phase 3 SMART trial, a multicenter, randomized study evaluating the safety, efficacy, and pharmacokinetics of ENFLONSIA in infants and young children at elevated risk for severe RSV disease across 2 RSV seasons. Results from the study were recently published in 

 after earlier interim findings appeared in the 

The study enrolled infants born before 29 weeks' gestation, moderately preterm infants, and children with chronic lung disease or congenital heart disease. Eligible participants entering their second RSV season received an additional dose of ENFLONSIA, with nearly all participants in the second-season cohort having chronic lung disease or congenital heart disease.

Although RSV prevention is often associated with pediatricians and neonatologists, infection preventionists also play an important role in reducing RSV transmission throughout hospitals and outpatient facilities. Annual RSV seasons can strain pediatric units, increase hospital admissions, and contribute to health care-associated respiratory virus transmission among vulnerable patients.

Expanding preventive options for children who remain at elevated risk beyond infancy could help reduce severe RSV disease, potentially lowering hospitalizations and easing seasonal pressure on pediatric health care systems.

ENFLONSIA was initially approved by the FDA in 2025 for newborns and infants entering their first RSV season and is now approved in more than 40 countries. Unlike weight-based monoclonal antibodies, ENFLONSIA uses a single fixed-dose administration designed to provide protection throughout a typical 5-month RSV season.

As RSV prevention strategies evolve alongside maternal vaccination and monoclonal antibody options, infection prevention professionals will likely continue to monitor how expanded indications influence pediatric hospitalization trends, resource utilization, and seasonal respiratory virus prevention efforts.

If approved, the expanded indication would provide another option for protecting children who remain vulnerable to severe RSV disease beyond their first year of life. Until then, the FDA's review will continue through early 2027.

Merck has announced that the FDA accepted its supplemental application to expand ENFLONSIA's indication to include children younger than 2 years who remain at increased risk for severe RSV disease during their second RSV season.

FDA Accepts Merck Application to Expand ENFLONSIA Protection Into Second RSV Season 

 oocysts under magnification, stained bright red. cyclosporiasis outbreak, foodborne parasites, intestinal infections. water pollution.

As public health officials continue to investigate one of the largest documented 

 outbreaks in the US, Roche has expanded its molecular testing portfolio with 2 new real-time polymerase chain reaction (PCR) assays, providing laboratories with additional options for detecting the foodborne parasite.

The announcement comes as thousands of cyclospora infections have been reported across multiple states, underscoring the growing need for rapid laboratory identification and surveillance. Although the new assays are designated for research use only (RUO) and are not intended for diagnostic use, they provide laboratories with additional tools to study the parasite and support outbreak investigations.

Cyclospora is a microscopic parasite transmitted through contaminated food or water that can cause prolonged gastrointestinal illness. Symptoms often include severe watery diarrhea, abdominal cramping, fatigue, nausea, loss of appetite, and weight loss. While illness is typically self-limited in healthy individuals, severe dehydration and prolonged disease can lead to hospitalization, particularly among older adults and immunocompromised patients.

"Understanding disease outbreaks and how they spread can have a huge impact on public health," said Dan Malarek, president and CEO of Roche Diagnostics North America. "Our robust testing infrastructure and strong scientific partnerships enable us to provide solutions that help labs rapidly respond to evolving public health needs."

The expanded portfolio includes the LightMix Modular Cyclospora assay, which specifically detects 

, and the LightMix OneTube Gastro Para 2 assay, a multiplex PCR panel that detects 6 gastrointestinal parasites, including 

The assays are designed for Roche's LightCycler 480 and LightCycler PRO platforms and complement the company's existing UC-TIB-Gastro-PARA-2 assay, which operates on the cobas 5800, 6800, and 8800 systems for high-throughput research applications.

According to Marcus Droege, CEO of TIB MOLBIOL, the expanded portfolio provides laboratories with flexibility in choosing testing strategies.

"The cyclospora portfolio provides the option of panel size and platform type and the economics of 1, 3, or 6 targets, offering flexible and cost-effective tests," Droege said.

Although the assays are not approved for routine clinical diagnosis, infection preventionists may recognize their potential value during outbreak investigations and epidemiologic research.

Rapid molecular detection can help researchers better understand transmission patterns, identify contaminated food sources, and evaluate how outbreaks spread across geographic regions. During large multistate outbreaks, timely laboratory data also support collaboration between clinical laboratories, public health agencies, and food safety investigators.

For infection prevention and public health professionals, the announcement also reflects a broader trend toward expanding molecular surveillance capabilities for emerging infectious diseases.

Roche noted that its infectious disease portfolio already includes testing for HIV, hepatitis viruses, sexually transmitted infections, influenza, tuberculosis, dengue, malaria, and congenital infections. The company also highlighted its recent development of a research-use PCR assay for the Ebola Bundibugyo virus, which can be run within 6 days to support response efforts in Central and East Africa.

As foodborne outbreaks continue to challenge public health systems, flexible molecular testing platforms may become increasingly important for understanding pathogen transmission and supporting coordinated outbreak response.

While the new cyclospora assays remain research tools rather than diagnostic tests, they represent another example of how molecular technologies continue to evolve alongside modern infectious disease surveillance.

Roche has introduced 2 new research-use PCR assays for Cyclospora cayetanensis, expanding laboratory testing options as public health officials continue to respond to one of the largest Cyclospora outbreaks in US history.

Roche Expands Cyclospora PCR Testing Portfolio to Support Ongoing US Outbreak Response

Copacabana Beach and Ipanema Beach in Rio de Janeiro, Brazil

A once-weekly oral HIV treatment regimen could soon offer people living with HIV a new alternative to daily antiretroviral therapy, according to late-breaking phase 3 data presented at the 26th International AIDS Society Conference on HIV Science (AIDS 2026) in Rio de Janeiro, Brazil.

 announced positive results from the ISLEND-1 and ISLEND-2 phase 3 clinical trials evaluating an investigational once-weekly single-tablet regimen combining islatravir (ISL) 2 mg and lenacapavir (LEN) 300 mg in adults with virologically suppressed HIV-1. The regimen has the potential to become the first approved long-acting oral HIV treatment requiring just one dose per week.

Both studies demonstrated that participants who switched from daily oral antiretroviral therapy maintained virologic suppression through 48 weeks, at rates comparable to those of participants receiving standard daily regimens.

ISLEND-1 demonstrates noninferiority to BIKTARVY

 evaluated adults who switched from BIKTARVY (bictegravir/emtricitabine/tenofovir alafenamide) to once-weekly ISL/LEN.

At Week 48, investigators found the investigational regimen was statistically noninferior to continuing BIKTARVY. None (0%) of the participants who switched to ISL/LEN had HIV-1 RNA levels of 50 copies/mL or greater, compared with 0.3% of participants who remained on BIKTARVY, according to the US FDA's snapshot analysis.

Jürgen Rockstroh, MD, PhD, professor of medicine and head of the HIV Outpatient Clinic at University Hospital Bonn in Germany and primary investigator for ISLEND-1, emphasized both the clinical performance and the potential impact on patient choice.

"People living with HIV have shown strong interest in having more treatment options, including long-acting oral regimens. In the ISLEND-1 trial, switching to once-weekly oral ISL/LEN was well tolerated and maintained high rates of viral suppression. The effectiveness of the investigational combination regimen was comparable to B/F/TAF, and no treatment-emergent resistance to ISL/LEN has been seen so far. The Phase 3 results presented at AIDS 2026 and published in 

 provide strong evidence for the potential of ISL/LEN to be the first and only once-weekly oral HIV treatment option, expanding choice with a longer dosing interval that may better fit the different needs and preferences of people living with HIV."

ISLEND-2 supports switching from multiple daily regimens

 evaluated adults with virologically suppressed HIV who switched from a variety of standard daily oral antiretroviral therapies.

Results mirrored those seen in ISLEND-1. At Week 48, the once-weekly regimen met the primary end point of statistical noninferiority. Only 0.3% of participants receiving ISL/LEN had HIV-1 RNA levels of at least 50 copies/mL compared with 1.3% of participants who continued their baseline daily therapies.

Beyond maintaining viral suppression, investigators also found that participants reported greater satisfaction with the weekly regimen. According to HIV Patient Perspective of Regimen Change assessments, most participants who switched to ISL/LEN considered the once-weekly regimen less burdensome than taking daily antiretroviral medications.

Amy Colson, MD, MPH, Medical Director of the Zinberg Clinic at Cambridge Health Alliance and primary investigator for ISLEND-2, highlighted the potential quality-of-life benefits.

"The findings in the ISLEND-2 trial represent an important advance in HIV treatment. The results show that the once-weekly oral single tablet regimen of islatravir and lenacapavir maintains virologic suppression as effectively as contemporary daily oral regimens in people with well-controlled HIV-1. A once-weekly regimen has the potential to provide enhanced privacy and greater flexibility in everyday life and to reduce daily reminders of HIV status."

Although modern daily antiretroviral therapy has transformed HIV into a manageable chronic condition for many patients, investigators note that treatment preferences vary considerably. Less frequent dosing may help some individuals better integrate therapy into their daily lives while reducing treatment burden.

Long-acting injectable therapies have already demonstrated that many patients value alternatives to daily pills. If approved, ISL/LEN would introduce another option by offering long-acting treatment without injections, requiring only one oral dose each week.

The findings also reinforce continued innovation in HIV care, where treatment decisions increasingly incorporate patient preferences alongside efficacy and safety.

The ISLEND-1 and ISLEND-2 findings were featured during the AIDS 2026 press program and presented as late-breaking oral abstracts during the conference. The Phase 3 data were also published simultaneously in 

Gilead and Merck announced they plan to include these findings in upcoming regulatory submissions. If approved, the once-weekly islatravir/lenacapavir regimen would become the first long-acting oral HIV treatment for adults with virologically suppressed HIV, offering a new option that combines durable viral suppression with a simplified weekly dosing schedule.

Phase 3 ISLEND trials presented at AIDS 2026 found an investigational once-weekly oral HIV regimen maintained viral suppression comparable to daily therapy while improving treatment satisfaction and flexibility.


AIDS 2026: Long-Acting Weekly Oral HIV Therapy Advances Toward Regulatory Review 

When reports of foodborne illness begin appearing across multiple states, identifying the contaminated product is rarely straightforward. Investigators often start with little more than patients describing meals they ate weeks earlier, then painstakingly reconstruct supply chains that can span continents before determining where contamination likely occurred.

During a recent American Association for the Advancement of Science media briefing, Craig Hedberg, PhD, professor at the University of Minnesota, and Kalmia Kniel, PhD, professor of microbial food safety at the University of Delaware, explained how public health officials investigate foodborne outbreaks and why the ongoing Cyclospora outbreak illustrates both the strengths and limitations of today's food safety system.

Although much public attention focuses on recalls and case counts, both experts emphasized that outbreak investigations represent a complex collaboration among local and state health departments, the CDC, the Food and Drug Administration (FDA), clinical laboratories, growers, processors, and epidemiologists.

A Unique Pathogen Presents Unique Challenges

 is a protozoan parasite with biological characteristics that complicate both prevention and investigation.

"Cyclospora is really unique," Kniel said. "It is a single-celled protozoan parasite. It's not a bacterium."

She explained that Cyclospora requires a human host to reproduce and is shed only by infected individuals through feces. Even then, newly shed oocysts are not immediately infectious. Instead, they require approximately 7 to 14 days in the environment before they mature and become capable of causing illness.

That delayed maturation distinguishes Cyclospora from many other foodborne pathogens and influences how contamination occurs.

Fresh produce remains particularly vulnerable because it is frequently consumed raw, eliminating the cooking step that would normally destroy many pathogens. At the same time, modern agricultural distribution systems combine products from numerous farms before shipping them nationwide, making traceback investigations considerably more difficult.

"We are really fortunate to have access to so many different types of fresh fruits and vegetables," Kniel said. "But without that cooking step, we don't have a chance to kill any pathogens that could be present."

Consumers frequently ask why contaminated produce reaches grocery stores despite extensive food safety programs.

"We cannot visually see contamination by bacteria or by Cyclospora or norovirus," she explained.

Instead, contamination often remains undetected until multiple illnesses appear and public health officials recognize an unusual pattern. Environmental monitoring programs can occasionally identify contamination before illnesses occur, but testing alone cannot guarantee food safety.

"We can't test our way really to food safety," Kniel said. "If we tested all the food, we'd have nothing to eat."

Instead, prevention depends on strong worker hygiene programs, sanitation, environmental monitoring, pest management, and continual employee education throughout the food production process. Understanding why these measures matter is as important as implementing them.

"Training is really critical," she said. "Making sure that people understand the why."

Once illnesses are reported, epidemiologists begin what Hedberg described as the fundamental work of outbreak investigation.

"The basic process of epidemiology is talking to the people who got sick initially," Hedberg said.

Investigators ask detailed questions about symptoms, illness onset, restaurants visited, grocery purchases, and foods consumed during the days or weeks before illness developed. Because Cyclospora has a relatively long incubation period, investigators often review food exposures covering approximately 2 weeks.

Those interviews are then compared across hundreds or even thousands of patients.

The challenge is determining which foods truly stand out.

"If you are interviewing 10 people and 7 of them say they ate lettuce, that might seem like a lot," Hedberg explained. "But in fact, that's about the rate at which we generally consume lettuce."

Investigators, therefore, collect increasingly detailed information, including restaurant names, grocery stores, product varieties, and brands. They may also compare patients with healthy control groups to determine whether certain foods were consumed more frequently among those who became ill.

Once investigators identify likely food vehicles, FDA traceback specialists begin reconstructing the product's journey through the supply chain.

"The tracebacks always start with the individual information we're getting from the cases," Hedberg said.

Investigators work backward from restaurants or grocery stores to distributors, processors, and ultimately the farms where products originated.

However, modern food distribution rarely follows a single, uncomplicated path.

Distributors frequently receive products from multiple processors, while prepared foods such as salads or salsas may contain several ingredients originating from different suppliers.

"If we can't figure out which of those ingredients might have been the source," Hedberg said, "FDA might wind up tracing two or three different food items."

Every additional supplier introduces more uncertainty, making traceback investigations both labor intensive and time consuming. Ironically, investigators often become more confident as outbreaks grow because additional cases provide stronger epidemiologic evidence connecting contaminated products.

Why Cyclospora remains especially difficult to investigate

Laboratory technology has revolutionized outbreak investigations for many bacterial pathogens.

Whole genome sequencing now allows investigators to determine whether bacterial isolates from patients are genetically related, strengthening epidemiologic evidence.

Cyclospora presents a different challenge.

Because the parasite cannot be cultured easily, laboratories have limited material available for genetic analysis. Few laboratories possess the specialized expertise required to perform advanced molecular characterization.

"We just don't have the ability to say that this group of 5 Cyclospora cases [are] all related," Hedberg explained.

Instead, investigators rely more heavily on illness timing, geography, and patient interviews than they would for bacterial outbreaks.

Modern Surveillance Has Improved, but Resources Remain Essential

Both experts noted that foodborne disease surveillance has improved substantially during the past 2 decades.

Clinical laboratories increasingly use multiplex PCR panels that simultaneously detect more than 20 gastrointestinal pathogens, dramatically improving diagnosis and reporting.

Food companies also maintain sophisticated electronic traceability systems documenting product movement throughout the supply chain.

"We have a lot of new laboratory techniques," Hedberg said, noting that many illnesses previously would have gone undiagnosed.

However, technology alone cannot replace experienced investigators.

Hedberg emphasized that outbreak investigations still depend heavily on trained epidemiologists, laboratorians, and public health personnel.

"Our workforce is frequently a limiting factor," he said.

Recent reductions in federal and state public health funding, he warned, threaten both laboratory capacity and outbreak response.

"If we really want to invest in our ability to improve our capability of responding," Hedberg said, "a lot of it is going to be to invest in the workforce."

Another challenge lies in communicating investigations that continue to change as new information becomes available.

Kniel encouraged journalists to emphasize that outbreak investigations are dynamic.

"I think it's important to share with consumers that this investigation is ongoing," she said.

Early epidemiologic signals may point toward one product, only for additional evidence to reveal multiple contaminated foods or separate outbreaks occurring simultaneously.

Hedberg pointed to the current Cyclospora investigation as an example. Early evidence linked illnesses to shredded lettuce supplied to Taco Bell locations, prompting recalls. As additional cases emerged, investigators recognized that the recalled product likely represented only part of a more complicated outbreak.

"The outbreak investigation matures," Hedberg said, "and we're beginning to have better ways to look at the foods that were in distribution."

Despite ongoing investigations, neither expert recommends avoiding fresh produce altogether.

"This is a big outbreak," Hedberg acknowledged, "but the vast majority of produce moving through our markets is not part of this outbreak."

Avoiding fruits and vegetables entirely could create greater long-term health risks than the outbreak itself.

Instead, both experts encouraged consumers to follow standard food safety practices, including hand hygiene, preventing cross-contamination, proper refrigeration, and paying attention to recall notices.

Kniel noted that individuals at particularly high risk or those with compromised immune systems can further reduce risk by cooking produce when appropriate because heat effectively destroys Cyclospora.

She also encouraged consumers to continue supporting local producers while recognizing that no food production system can eliminate risk completely.

For both experts, Cyclospora serves as more than a current public health challenge. It represents an opportunity to strengthen future prevention efforts.

Kniel called for greater investment in scientific research, workforce training, sanitation infrastructure, traceability, and transparency throughout the food system.

"We need investments in science and research," she said.

Hedberg broadened that message beyond U.S. borders. "We do live in a global food system," he said. "The investments in safe water and sanitary sewage disposal that we want to make here, it's important that we support those in the countries outside of the United States that are also producing food for us."

Ultimately, both experts argued that every outbreak investigation contributes valuable knowledge that improves future prevention. By identifying previously unrecognized contamination pathways, strengthening surveillance systems, and refining traceback methods, today's investigations help reduce tomorrow's risks.

As food supply chains become increasingly global and complex, those investments in epidemiology, laboratory science, environmental health, and public health infrastructure will remain central to protecting consumers and maintaining confidence in the safety of the food supply.

Food safety experts explain how epidemiology, traceback investigations, surveillance, and food safety practices work together to identify contamination sources during Cyclospora outbreaks while highlighting ongoing challenges in protecting the food supply.