Cyclosporiasis Outbreak Expands to Six More States
The largest cyclosporiasis outbreak ever recorded in the United States has expanded to 15 states, according to NBC News. The Centers for Disease Control and Prevention has added Arkansas, Iowa, Missouri, Nebraska, New Hampshire, and North Carolina to the investigation, which is linked to shredded iceberg lettuce from Taylor Farms de Mexico supplied to Taco Bell restaurants.
More than 22,000 people have confirmed or suspected cyclosporiasis, and at least 517 people have been hospitalized nationwide. On Monday, Michigan health officials confirmed the first two deaths linked to the outbreak—both individuals had significant underlying health conditions.
The Expanding Outbreak
The newly added states join Illinois, Indiana, Kansas, Kentucky, Michigan, Ohio, Oklahoma, Pennsylvania, and West Virginia in the CDC’s outbreak investigation. The expansion marks a significant geographic broadening of the outbreak, though experts caution that the additional cases may reflect delayed reporting rather than ongoing spread.
“With an incubation period up to two weeks, there should no longer be people newly getting sick from that product,” said Dr. Stephen Ostroff, a former acting FDA commissioner. “But it takes a while for people to seek health care after onset, get tested and diagnosed, reported to state health departments and then to CDC.”
Missouri has been particularly hard hit, with the Missouri Department of Health and Senior Services reporting 1,095 cases as of Aug. 2—nearly double the 595 cases reported the previous week, according to KCTV5. North Carolina has reported 718 cases, well above its typical annual total of about 150.
Source of the Outbreak
The outbreak has been traced to shredded iceberg lettuce from Taylor Farms de Mexico, sourced from central Mexico and served at Taco Bell locations. On July 17, Taylor Farms issued a voluntary recall of all iceberg lettuce sourced from central Mexico, which was distributed to restaurants and retail stores in 27 states. Taco Bell stopped using the supplier the same day.
The FDA’s investigation identified the supplier through traceback analysis, though no confirmed positive product samples have been found. The recalled lettuce’s use-by dates ended Aug. 3, meaning the product should no longer be available.
First Deaths Reported
Michigan—the state with the most cases at 11,234—confirmed the first two deaths linked to the outbreak on Aug. 3. According to the Michigan Department of Health and Human Services, both individuals had significant underlying health conditions that may have been impacted by cyclosporiasis and dehydration. Both contracted their illness before the Taylor Farms recall.
“This development highlights the importance of identifying the source of the outbreak and preventing additional illnesses,” said Wade Syers, a food safety specialist at Michigan State University Extension, as reported by Al Jazeera.
Cyclosporiasis is generally not a life-threatening illness, and deaths from it are uncommon in the United States. However, the illness can be severe, particularly for those with compromised immune systems.
What Is Cyclosporiasis?
Cyclosporiasis is an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis, which spreads through the fecal-oral route—typically via contaminated food or water. Symptoms include watery diarrhea, loss of appetite, cramping, bloating, nausea, and fatigue, typically beginning about one week after exposure.
“Even in someone who’s perfectly healthy, they can have intermittent diarrhea for weeks to months,” said Dr. Cynthia Sears, an expert in foodborne and intestinal infections at Johns Hopkins School of Medicine, in an interview with NPR.
2026 is the worst recorded year for cyclosporiasis in U.S. history. The CDC’s national surveillance data shows 10,468 laboratory-confirmed domestic cases since May 1, with cases reported in 47 states. By comparison, only 249 cases were reported nationally during the same period in 2025.
Investigation Challenges
The CDC issued a Health Alert Network notice on July 14 about the surge in domestically acquired cyclosporiasis cases. The agency is investigating multiple concurrent outbreaks, and the FDA has identified at least four active cyclosporiasis outbreaks simultaneously.
Ostroff noted that the Taylor Farms lettuce may not explain all the cases. “We may have solved the Taylor Farms shredded lettuce piece, but that’s unlikely to explain everything we’re seeing,” he said.
The investigation has also been complicated by staffing constraints at the CDC. According to Gizmodo, the CDC lab tasked with investigating Cyclospora outbreaks was downsized from 11 members to three during the DOGE initiative, and the agency has lost an estimated 3,000 employees overall.
“The outbreak won’t stop any time soon, until public-health agencies are able to pinpoint exactly where the parasite is entering our food system,” said Joel Barratt, former lead for the CDC’s domestic surveillance team covering parasitic diseases and malaria.
What to Watch For
Health officials urge consumers who purchased recalled lettuce to discard it immediately and to contact healthcare providers if they experience symptoms. The CDC recommends specifically requesting Cyclospora testing, as routine stool exams may not detect the parasite.
As the investigation continues, key questions remain: Are there additional sources of contamination beyond Taylor Farms lettuce? Will the outbreak continue to expand to additional states? And will the CDC’s staffing constraints affect the speed and thoroughness of the investigation?
“Think of it like solving a jigsaw puzzle,” Ostroff said. “You have all these pieces sitting there, and the longer you work on it, the more likely it is you’ll figure out where each piece fits into the puzzle.”