The cyclosporiasis outbreak that has been affecting the United States since early May has spread to six new states, according to an anonymous source familiar with the matter cited on Wednesday by NBC News.
The newly linked states are Arkansas, Iowa, Missouri, Nebraska, New Hampshire, and North Carolina.
To the nine already confirmed: Illinois, Indiana, Kansas, Kentucky, Michigan, Ohio, Oklahoma, Pennsylvania, and West Virginia.
At the close of Tuesday, the Centers for Disease Control and Prevention (CDC) reported more than 22,000 individuals with confirmed or suspected cyclosporiasis, and 517 hospitalizations in the multistate outbreak.
In recent days, the first two deaths linked to this outbreak have been reported in the history of the United States, both in Michigan, the most affected state with over 11,000 cases.
According to the Michigan Department of Health and Human Services, “both individuals had significant underlying health conditions that may have been affected by cyclosporiasis and dehydration.”
Missouri reports an unusual increase in cases
Missouri has become one of the most striking cases: the state Health Department reported 1,095 cases as of Sunday, nearly double the approximately 595 recorded the previous week.
Under normal conditions, that state registers barely a dozen cases of cyclosporiasis each year.
Florida is maintaining surveillance due to cases of cyclosporiasis
Although Florida is not listed among the states included in this CDC update, the state has remained under health surveillance since July due to the presence of cyclospora cases.
In mid-month, the Florida Department of Health had confirmed 50 infections spread across more than 20 counties, including Miami-Dade and Broward, with no source of infection identified at that time.
Since then, federal investigations have identified shredded iceberg lettuce from Taylor Farms as the primary source of the national outbreak, distributed in 27 states.
Nevertheless, researchers continue to analyze whether all the recorded cases in the country can be attributed to the same source.
The iceberg lettuce from Taylor Farms, the main focus of the investigation
The primary source of the outbreak has been identified as shredded iceberg lettuce from Taylor Farms, processed in Guanajuato, Mexico, and distributed across 27 states between late June and mid-July.
The chain Taco Bell was one of the first hotspots identified, with approximately 1,947 infected individuals reporting that they had eaten at its restaurants.
Taylor Farms has initiated a voluntary recall of all its iceberg lettuce sourced from central Mexico.
Experts believe that the new cases correspond to previous infections
The expansion to six additional states does not necessarily mean that the outbreak continues to spread actively, warned Dr. Stephen Ostroff, former acting commissioner of the Food and Drug Administration (FDA).
The expert explained that many of these cases likely correspond to individuals who were infected weeks ago but were diagnosed and reported recently, since the parasite has an incubation period of up to two weeks.
"With an incubation period of up to two weeks, there should no longer be anyone falling ill recently from that product. However, it takes time for people to seek medical attention after symptoms begin, get tested and diagnosed, and then for those cases to be reported to state health departments and subsequently to the CDC," Ostroff noted.
The expiration dates of the recalled product expired on August 3, so if cases of exposed individuals are detected after that date, investigators will need to look for a different source.
“It’s possible that we have resolved the issue with the shredded lettuce from Taylor Farms, but it’s unlikely that explains everything we are seeing,” the expert warned.
What is cyclosporiasis and what are its symptoms?
Ciclosporiasis is an intestinal infection caused by the microscopic parasite Cyclospora cayetanensis, which is transmitted through the consumption of fresh food or water contaminated with human feces and is not spread from person to person.
Its symptoms—intense watery diarrhea, cramps, nausea, and fatigue—appear between two to 14 days after exposure, and the parasite is not eliminated by common disinfectants.
This outbreak is the largest cyclosporiasis outbreak recorded in the history of the United States, far surpassing the previous record of 631 cases
documented in 2013. The CDC projected that the case count would continue to rise as data from the states comes in.
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