Morning, Marco. Two produce outbreaks that have been running side by side finally split in opposite directions yesterday — one got a supplier, a recall, and a closed exposure window; the other kept growing. That's the whole clinical story today, and it actually simplifies the history you take. Puerto Rico turned the taps off this morning. Coffee, then Section A, then sleep.
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Update
Jalapeño Salmonella: source named, recall issued, exposure window closed
CDC and FDA put out a formal food-safety alert Thursday. 345 people infected with the same strain of Salmonella Javiana across 27 states, 36 hospitalized, no deaths. The source is jalapeño peppers grown in Sinaloa, Mexico and distributed by Coast Citrus Distributors, which has agreed to recall remaining product and is notifying customers. Chipotle switched suppliers for affected stores on July 20; Qdoba stopped serving jalapeños entirely on July 28. FDA says both chains are safe to eat at now. Reported illness onsets run June 19 to July 20. Coast Citrus appears to have sold to restaurants and wholesalers rather than grocery, but FDA is still checking retail.
Why it matters to you: this is the useful part — the jalapeño exposure window is closed. Product left both chains two to three weeks ago. Given a typical 6-hour-to-6-day Salmonella incubation, someone you admit this weekend with acute febrile diarrhea is very unlikely to belong to this outbreak, even if they ate fast-casual Mexican. Late cases will still trickle into the count because of reporting lag, but new exposures should be done.
Action: drop the jalapeño question from the summer diarrheal H&P you've been running the last two weeks. Keep the lettuce one. If you do get a plausible case, Salmonella Javiana is a non-typhoidal serotype — supportive care, and reserve antibiotics for the elderly, bacteremic, or immunocompromised, since treatment prolongs shedding. CDC outbreak page · FDA investigation · TIME
Still open
Cyclospora is the one that hasn't closed — 22,700+ cases nationally, probable now outnumbering confirmed
No new CDC page update since Tuesday's rebuild, but the aggregate picture is now being reported nationally as roughly 22,000+ cases: 10,468 lab-confirmed across 47 states, 12,255 probable still under investigation, 517 hospitalizations, 2 deaths (both Michigan, both with significant underlying conditions where dehydration was contributory). The implicated vehicle remains iceberg lettuce from central Mexico, recalled by Taylor Farms on July 17 — but unlike the jalapeño arm, no single distributor has closed the loop, and CDC's own six-week onset-to-report lag means the curve is still filling in behind you.
Why it matters to you: the contrast with the jalapeño story is the practical teaching point. One outbreak got a named distributor and a recall inside three weeks of the last illness onset; this one is six months in with a partial recall and an open source. For your admissions, that means the parasite question stays live and the bacterial one is retiring. The presentation is different too — Cyclospora gives you the frail 80-year-old with two-plus weeks of watery diarrhea, anorexia, weight loss and a pre-renal AKI riding on a diuretic and an ACE inhibitor, not an acute febrile gastroenteritis.
Action: unchanged — any summer diarrhea over three days gets Cyclospora considered explicitly, because it won't appear on a routine O&P without being asked for. TMP-SMX 7–10 days for immunocompetent adults, longer if immunocompromised. CDC surveillance · HAN 531 · TODAY national map
New
Puerto Rico starts 48-hour rotating water cuts this morning — hospitals get priority trucking
It's live as of today. More than 180,000 customers across seven municipalities — San Juan, Carolina, Juncos, Gurabo, Trujillo Alto, Canóvanas and Loíza — go without water for 48 hours at a stretch on an alternating schedule, everything served by the Carraízo reservoir, which authorities describe as critically low. This is the worst drought on the island in more than a decade: July was the driest month recorded in San Juan in over 120 years and the second hottest, and roughly 68% of Puerto Rico is in drought per the U.S. Drought Monitor. The schedule is expected to hold at least through the end of August. AAA is running water trucks with hospitals and long-term care facilities first in line.
Why it matters to you: family first — Carolina and Trujillo Alto are on the list, so anyone you know in the San Juan metro is on a two-days-on, two-days-off cycle now. Clinically it's also a preview of the failure mode: when a hospital's water is trucked rather than piped, the first things to strain are dialysis, sterile processing, and hand hygiene compliance, in that order. Southwest Florida has its own version of this conversation coming with hurricane season.
Talking point: worth a text to family today rather than waiting for them to mention it — the alternating schedule means people often don't realize which half of the cycle they're on until the tap is already dry. NPR · NBC News · WLRN