Several states in the US are currently experiencing a significant outbreak of diarrhea brought on by cyclospora, a tiny parasite that can contaminate fresh food or water.
Recently, there has been a recall on iceberg lettuce from Taylor Farms, and it’s possible that some contaminated products have already been consumed or taken off the shelves.
“We do have the outbreak under control,” stated the US Health and Human Services Secretary, Robert F. Kennedy Jr., while noting the recall.
However, symptoms related to this illness can develop rather slowly, and the rate of new cases isn’t showing signs of decreasing just yet.
Health officials are working quickly to piece together the details surrounding the cases as part of an active investigation. Unfortunately, tracking down this parasite is notoriously tricky. Testing the produce can be a hurdle, and people who have fallen ill may need to recall what they ate weeks prior to help establish a connection.
Typically, cases of cyclosporiasis tend to peak during the spring and summer in the US, often from early May to the end of August, according to the US Centers for Disease Control and Prevention (CDC). This year, though, the numbers seem unusually high.
Here’s what we’ve gathered about this situation so far.
As of last week, the CDC recorded nearly 7,000 cases of domestic cyclosporiasis this season: about 1,645 confirmed cases and an additional 5,100 still being evaluated to see if they were contracted domestically.
This year, the US Food and Drug Administration (FDA) in collaboration with the CDC has been investigating multiple “subclusters” of cyclosporiasis cases. Two investigations are still active, including a notable multistate outbreak primarily in the Midwest.
The CDC has linked 1,644 of the cases to this particular outbreak.
However, keep in mind that the CDC’s numbers only reflect confirmed cases and haven’t been updated since last week. Data sourced from individual states indicate much higher counts.
There are five states where cases have been traced back to this ongoing outbreak: Indiana, Kentucky, Michigan, Ohio, and West Virginia.
As of Tuesday, the Michigan Department of Health and Human Services noted 6,571 cases of cyclosporiasis during the investigation period. They mentioned that while they “cannot definitively link every illness to the same exposure,” the sharp rise suggests a strong connection to this outbreak.
Ohio has reported at least 1,244 cases, while Indiana has noted 511, West Virginia 195, and Kentucky 192.
Michigan and Indiana update their data daily on weekdays, West Virginia shares totals bi-weekly, and Ohio and Kentucky update on a weekly basis.
The CDC indicates that the actual number of people affected by this multistate outbreak is likely higher than reported, and the outbreak might extend beyond the states currently identified.
In total, 34 states have recorded at least one case of cyclosporiasis acquired domestically this season, according to the CDC.
Interestingly, some states, such as California and New Jersey, have said their case numbers align with typical seasonal patterns.
People are naturally concerned about the safety of their meals. Is cilantro, for example, safe to eat? What about tomatoes or romaine lettuce?
Health officials in Michigan have conducted over 2,000 interviews with those affected by cyclosporiasis. They’ve hinted at “very strong” evidence pointing to one specific product: shredded iceberg lettuce provided by Taylor Farms seems to be the primary suspect. This contaminated lettuce was utilized in certain Taco Bell locations.
The CDC advises against consuming shredded iceberg lettuce from Taylor Farms de Mexico served at Taco Bell locations in states with known illness cases: Indiana, Kentucky, Michigan, Ohio, and West Virginia.
The FDA is in the process of determining if the contaminated iceberg lettuce reached other outlets.
Taco Bell announced on Friday that it has pulled Taylor Farms lettuce from both its restaurants and nationwide supply chain, while the supplier Taylor Fresh Foods has withdrawn all iceberg lettuce sourced from central Mexico from the US market.
Taylor Farms has also initiated a recall of iceberg lettuce sent to 27 states. Some of this lettuce ended up at Walmart and Jack in the Box, along with other food service providers.
While the investigation continues, no other foods have been identified as part of this outbreak. Historically, foods most frequently associated with cyclospora outbreaks include basil, cilantro, berries, and snap peas.
Federal health officials have mentioned multiple investigations this year regarding cyclospora, some tied to the significant Midwest outbreak, others to individual states, and some linked to cases that haven’t yet formed clusters.
Illnesses related to the current outbreak began appearing in mid-May, with new cases reported as recently as last week, according to the CDC.
Symptoms of cyclosporiasis can take several days—or even up to two weeks—to manifest after consumption of contaminated food or water.
Typical symptoms include watery diarrhea, appetite loss, weight loss, cramping, bloating, increased gas, nausea, and fatigue.
For some individuals, these symptoms can last several weeks.
At least 94 people have been hospitalized due to this current outbreak, according to the CDC, with additional cyclospora-related hospitalizations reported this year.
The states linked to the outbreak have noted hundreds of cyclospora hospitalizations:
- Michigan: 102 hospitalizations reported
- Ohio: 88 hospitalizations reported
- Kentucky: 9 hospitalizations reported
- West Virginia: 15 hospitalizations reported
- Indiana: hospitalization data not reported
No fatalities have been reported thus far.
According to a 2023 report from the US Department of Agriculture’s Food Safety Inspection Service, the largest cyclospora outbreak recorded in the US resulted in about 1,500 cases and involved raspberries. Other significant outbreaks typically have not exceeded 1,000 cases.
This latest outbreak could very well be the largest cyclospora outbreak in the US to date.
If all suspected cases this season are confirmed to be related, it will also be the largest foodborne illness outbreak recorded since tracking began in the US.
Moreover, the overall count of cyclosporiasis cases recorded this year in the US is higher than usual.
More than 4,500 cases were noted in 2023, and over 3,500 in 2024, according to federal data. Yet, this year has already seen thousands more cases reported, with still some time left in the season.
French biotech firm bioMérieux monitors gastrointestinal pathogen trends by pooling test results from a network of laboratories.
Their data reveals a notable increase in the prevalence of cyclospora and other parasites in the US recently, climbing from less than 3% of tests in the second week of June to over 18% in recent days.
However, E. coli continues to be a more prevalent cause of stomach issues in the US right now, accounting for more than 19% of tests.
Additionally, viruses can also result in gastrointestinal problems, with roughly 14% of tests in the US testing positive for these pathogens between July 19 and July 21.
