As of today, August 20, 2026, four state health departments publish a count of their own residents who got cyclosporiasis while traveling inside the United States: Washington, Utah, Oregon and California. Between them they account for roughly twenty-seven people, a handful of whom have been formally tied to the Taylor Farms de Mexico lettuce outbreak. The other forty-six states publish nothing on the question at all.

Washington publishes the most complete travel breakdown in the country.

The Washington State Department of Health reports 67 cyclosporiasis cases between May 1 and August 14. Of the 65 people interviewed about travel, 42 had been to a country where the parasite is endemic and 38 of those had been to Mexico. One had traveled to a country that is not endemic. Twenty-two had not left the United States at all, and it is that group the state then breaks down again: 11 traveled to a state reporting an outbreak or an increase, three of them associated with the Taco Bell outbreak in Michigan and Indiana; four traveled to a state with no increase; and seven never left Washington.

Utah, Oregon and California report the same thing with less detail.

Utah has reported 48 cases since May 1, of which 31 involved travel outside the country, 12 involved travel to other states, and five involved no travel at all. Oregon announced two residents infected after traveling to states involved in the recall, out of 23 cases statewide this year. California says two of its cases were people who traveled to an affected state and ate at Taco Bell. Virginia belongs in the conversation as a near miss: it says some of its cases have reported travel to and exposures in outbreak states, and it publishes a domestic, international and unknown split, but it has never said how many of the domestic cases were acquired in another state.

CDC counts these people in the state they visited, not the state they live in.

CDC’s outbreak investigation page says plainly that the total case count includes sick people who traveled to one of the seventeen states but reside in different states. A Californian who ate at a Taco Bell in Michigan is a Michigan number. That is defensible epidemiology, because the exposure happened in Michigan and that is where the food was. It also means a home state has no particular reason to say anything, and forty-six of them do not. The four that speak up are doing it voluntarily.

The practical result is that the geography of this outbreak looks tighter than it is. Seventeen states are on the federal map. People from at least four more got sick from the same event and are counted somewhere else, and nobody can say how many people in the remaining states are in the same position, because their departments have not looked or have not said. Every number in the fifty-state count I keep has this problem baked into it.

San Francisco just showed what genotyping does to that arithmetic.

On August 20 CDC said for the first time that genotyping of samples from sick people shows the parasites in this outbreak are genetically related, which it treats as evidence of a common source. The same day, the San Francisco Chronicle reported that the city has confirmed 10 cyclosporiasis cases this year and that one resident’s infection was genetically associated with the multistate outbreak. That person had traveled elsewhere in the United States, and the recalled lettuce was never distributed in California.

Until this week, a case in a non-outbreak state got connected to the outbreak only if somebody remembered a meal in an interview. Now it can be connected in a laboratory, after the fact, in a city that had no reason to look. If that testing is being run widely, the seventeen-state map is going to start looking less like the footprint of the outbreak and more like a map of which states did the work.

State-published cyclosporiasis figures for residents infected while traveling within the United States, as of August 20, 2026, compiled from each state health department and, for San Francisco, from the San Francisco Chronicle. Case totals use each state’s own reporting period, which is why they are not directly comparable. Every other state and the District of Columbia publish no figure of this kind.