The Federal Cyclospora Count Covers Twenty-Eight Percent of the People Sick in the Fifteen Outbreak States. It Runs From Zero Percent in North Carolina to More Than the State Itself Reports in Pennsylvania and Nebraska.

The fifteen states in the federal Cyclospora outbreak, as of August 5, 2026. The thirty-five states in grey are not in the outbreak; several of them are reporting cyclosporiasis cases of their own.

CDC and FDA expanded this outbreak to fifteen states and put the federal count at 6,358 illnesses. Here is that count broken out state by state, next to what each of those same fifteen health departments is telling its own residents.

Read down the last column. That is where the story is.

The federal share ranges from zero percent in North Carolina to more than one hundred percent in Pennsylvania and Nebraska. Same parasite. Same summer. Same country. Fifteen state health departments, and a range that runs from almost none of a state’s illness to more than all of it.

Nothing about the parasite explains that. What explains it is the chain of events required before a sick person enters the federal count. They have to get sick enough to see a doctor. The doctor has to think of ordering a test that is not on every panel. The laboratory has to find it. Somebody has to interview the patient. The patient has to remember, weeks later, eating at a particular restaurant or eating a particular lettuce. And the state has to report all of it upward. Every one of those steps is a place where a person drops out of the count, and every state completes that chain at a different rate.

The last column is a measure of investigative labor. It is not a measure of illness.

Take the two ends. Missouri sits at fifty-two percent, the highest genuine share on the table, and Missouri is the state whose health department told the Washington Post that its investigators had interviewed patients at length and found Taco Bell exposure. High share, heavy interviewing. That is not a coincidence.

Now North Carolina. The federal outbreak count for North Carolina is two people. North Carolina tells its own residents 867. Its dashboard still says the increase in the state does not appear to be associated with the Taco Bell outbreak, and still notes that recent patients reported eating parsley and cilantro more often than population surveys would predict. The federal number agrees with the dashboard rather than with the expansion. North Carolina was added to this outbreak on two people while 865 other North Carolinians are sick with the same parasite in the same summer and remain outside it.

At the other end, Pennsylvania and Nebraska show federal counts larger than the state figures. That is not the federal government over-counting. It is the two states under-publishing. Pennsylvania has no dashboard and takes cyclosporiasis reports voluntarily; its own last published figure was 28 confirmed on July 16, and 82 is the best number in circulation. Nebraska’s 91 is a spokesman’s figure from July 20 that nobody has refreshed in more than two weeks. When Atlanta can find more sick Pennsylvanians than Pennsylvania can, the problem is not the parasite either.

It would be reasonable to guess that the spread tracks how long a state has been in the outbreak — that the nine states named in July have had more time to work their cases than the six added this week. The table says otherwise. Among the original nine the shares run from sixteen percent to forty-five, plus Pennsylvania. Among the six added, from zero to fifty-two, plus Nebraska. Both groups cover nearly the whole range. Time in the outbreak does not explain it.

The largest absolute gaps are worth naming, because percentages flatten them. Michigan’s federal count is 3,491 against a state count of 12,218 — 8,727 Michiganders sick and outside the outbreak. Ohio’s gap is 3,368. Indiana’s is 979. Illinois, at sixteen percent, has 831 people the federal count does not reach.

Add the column up and the fifteen states report 22,997 illnesses against a federal outbreak count of 6,358. 16,639 people — roughly seven in every ten sick people in the outbreak states — are outside the number the federal government is using to describe this outbreak.

None of that makes the federal figure wrong. It is doing what it was built to do, which is to count people whose illness has been laboratory-confirmed and affirmatively linked to an identified exposure. FDA says as much on its own page: it and CDC report laboratory-confirmed cases only, while states also report probable ones. Both numbers are honest.

The problem is that only one of them gets quoted. When a news story says this outbreak has sickened 6,358 people, it is repeating a number that is true of the investigation and false about the country. And when a state’s share of that number reflects how many epidemiologists it could put on the phone, the national total ends up measuring public health capacity as much as it measures disease.

That is the argument for reading the middle column instead. 22,997 people in fifteen states, and 16,639 of them are not in the federal file.