The Fifty-State Cyclospora Count Is Now 28,056. The Real Number Is Near 1,155,000.

The fifty state health departments now report 28,056 cases of cyclosporiasis this season, up 699 from the 27,357 published on August 10. Six states moved since that post, and Maine appears on this chart for the first time. Missouri went to 1,577, North Carolina to 906, Oklahoma to 506, Arkansas to 252, Wisconsin to 216 and Maine to 27. 

The federal picture moved this morning for the first time in a week. FDA still reports 6,358 illnesses, 278 hospitalizations and two deaths in fifteen states, stamped August 5. CDC’s national surveillance page was updated on August 11 and now reads 13,895 laboratory-confirmed plus at least 10,455 awaiting further investigation, a total of 24,350. The confirmed count rose by 3,427 while the unconfirmed pool fell by roughly 1,800, so most of that movement is confirmation catching up rather than new illness. The states are now 3,706 cases ahead of the combined federal figure, down from 5,214 a week ago.

The thirteen states that publish a hospital figure now total 688 between them, after Oklahoma moved from 25 to 32 and North Carolina revised down from 33 to 31. CDC’s national surveillance says 517 for the entire country. The federal figure for this outbreak is 278, and Michigan by itself reports 279. Thirty-seven states publish no hospital figure at all.

Where all fifty stand

The last column of this chart is new. It is that state’s entire 2025 total from CDC’s weekly notifiable-disease tables, which is a different series from the state figures beside it. It counts travel-associated cases and covers a full calendar year against a season still running. It is there for scale, not for arithmetic.

What the 2025 column shows

Michigan reported 50 cases in all of last year and has reported 12,485 this year. Ohio reported 76 and is at 4,900, the sixty-four times figure its own health department has used. Indiana reported 27 and is at 1,893. West Virginia reported 8 and is at 291. Arkansas reported 13 and is at 252. Kentucky reported 45 and is at 620.

The same column shows which states are not unusual, and that has to be said. Texas reported 512 cases in 2025 and is at 198 this year. Colorado reported 205 and is at 150. Louisiana reported 99 and has published a single-digit count. Maryland and New Jersey are both running below last year. Not every state on this chart is having an outbreak, and the chart should not be read as though they are.

Four states do not make cyclosporiasis notifiable at all, so no figure exists to compare: Pennsylvania, Idaho, Mississippi and Nevada. Twelve states have published no 2026 count. Two of those, Mississippi and South Carolina, received the recalled lettuce.

What this figure is, and what it is not

28,056 is a floor, not an estimate. It is the sum of what fifty health departments have published, on schedules running from weekly to never, with four states reporting only a range that I count at the bottom. Where a state publishes two series, I use the one this chart has always used: for Florida that is the since-May-1 figure of 342 rather than the calendar-year 352, and for New York the since-May-1 figure of 753 rather than 787. Ohio and Iowa and Kansas and Arkansas are calendar-year, because that is the series those states publish.

Most people with cyclosporiasis never get a stool test, because the parasite is missed by the routine ova and parasite exam and has to be requested by name, and because people with a diarrheal illness that comes and goes for a month often never see a doctor. The standard estimate of that gap comes from Scallan and colleagues, Foodborne Illness Acquired in the United States, Major Pathogens, in Emerging Infectious Diseases in 2011, which puts the underdiagnosis multiplier for Cyclospora at 83.1. Applied to CDC’s 13,895 laboratory-confirmed cases, that puts the real number near 1,155,000.