The fifty state health departments now report 28,374 cases of cyclosporiasis this season, up 318 from the 28,056 published on August 11. Four states moved since that post. Kansas went to 748, New York to 898, West Virginia to 296 and Virginia to 197.
Kansas is the day’s number. It added 133 cases in one weekly update and twelve hospitalizations, and its health department still has 225 interviews pending. It is also the day’s warning against reading a single figure too quickly. Of the 748 cases Kansas reports, 625 were reported in July and 56 so far in August. The cumulative line jumped while the weekly line fell, and both of those things are true at once. That is what the back end of an outbreak looks like on a chart that only ever goes up.
No federal number moved. FDA still reports 6,358 illnesses, 278 hospitalizations and two deaths in fifteen states, stamped August 5, which is now eight days old. Maine issued a public health advisory on August 7 saying it meets the criteria for the multistate outbreak, and five days later the federal advisory still says fifteen states and does not name it. CDC’s national surveillance page was updated August 11 and still reads 13,895 laboratory-confirmed plus at least 10,455 awaiting further investigation, a total of 24,350, covering data through August 10 across 47 states plus the District of Columbia and Puerto Rico.
The states are now 4,024 cases ahead of the combined federal figure, against 3,706 yesterday. That widening is the calendar and not the outbreak. CDC publishes once a week, on Tuesdays, so the gap opens from Wednesday through Monday and closes every Tuesday when the federal count catches up. Anyone quoting the gap should say which day of the week they are standing on.
The thirteen states that publish a hospital figure now total 700 between them, after Kansas moved from 20 to 32. CDC’s national surveillance, updated August 11, reports 740 hospitalizations among its 13,895 laboratory-confirmed cases. That corrects a number on my own chart. Last night’s post carried 517, which was CDC’s August 4 figure and should have moved when the case counts did. The correction is worth more than the error was, because the two series have nearly converged: a floor built by adding up thirteen state health departments now sits within forty of what the federal system counts from a different set of cases. The outbreak-specific federal figure is a different number again. It 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 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.
| State | 2026 cases | As of | All of 2025 | Lettuce |
| Michigan | 12,485 | Aug 6 | 50 | Yes |
| Ohio | 4,900 | Aug 4 | 76 | Yes |
| Indiana | 1,893 | Aug 10 | 27 | Yes |
| Missouri | 1,577 | Aug 9 | none reported | Yes |
| Illinois | 995 | Aug 4 | 301 | Yes |
| North Carolina | 906 | Aug 11 | 300 | Yes |
| New York | 898 | Aug 10 | 694 | Yes |
| Kansas | 748 | Aug 12 | 29 | Yes |
| Kentucky | 620 | Jul 29 | 45 | Yes |
| Oklahoma | 506 | Aug 11 | 41 | Yes |
| Florida | 342 | Aug 1 | 210 | Yes |
| West Virginia | 296 | Aug 11 | 8 | Yes |
| Arkansas | 252 | Aug 10 | 13 | Yes |
| Iowa | 226 | Jul 30 | 64 | Yes |
| Nebraska | 218 | Aug 6 | 51 | No |
| Wisconsin | 216 | Aug 5 | 65 | Yes |
| Texas | 198 | Aug 5 | 512 | Yes |
| Virginia | 197 | Aug 10 | 115 | Yes |
| Colorado | 150 | Jul 17 | 205 | No |
| Massachusetts | 145 | Aug 5 | 74 | Yes |
| Alabama | 85 | Aug 3 | 19 | Yes |
| Pennsylvania | 82 | Jul 29 | not notifiable | Yes |
| Maryland | 69 | Jul 17 | 123 | Yes |
| New Hampshire | 69 | Aug 4 | 7 | Yes |
| New Jersey | 46 | Jul 11 | 180 | Yes |
| California | 41 | Jul 14 | not available | No |
| Minnesota | 41 | Jul 17 | none reported | No |
| Washington | 36 | Aug 7 | not available | No |
| Connecticut | 35 | Jul 17 | 41 | Yes |
| Maine | 27 | Aug 7 | 4 | No |
| Oregon | 23 | Jul 24 | not available | No |
| Arizona | 19 | Jul 17 | 49 | No |
| Georgia | 11 | Jul 17 | 116 | Yes |
| Tennessee | 11 | Jul 17 | 38 | Yes |
| Alaska | 5 | Jul 16 | 6 | No |
| Rhode Island | 4 | Jul 17 | 6 | No |
| Louisiana | 1 | Jul 17 | 99 | Yes |
| Utah | 1 | Jul 17 | 37 | No |
| Delaware | no count published | — | 1 | No |
| Hawaii | no count published | — | not available | No |
| Idaho | no count published | — | not notifiable | No |
| Mississippi | no count published | — | not notifiable | Yes |
| Montana | no count published | — | 8 | No |
| Nevada | no count published | — | not notifiable | No |
| New Mexico | no count published | — | 9 | No |
| North Dakota | no count published | — | 4 | No |
| South Carolina | no count published | — | 45 | Yes |
| South Dakota | no count published | — | 3 | No |
| Vermont | no count published | — | 3 | No |
| Wyoming | no count published | — | 0 | No |
| All fifty states | 28,374 | 50 |
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. Kansas reported 29 and is at 748. West Virginia reported 8 and is at 296. 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. New York reported 694 and is at 898, which is an increase, but not the kind Michigan and Ohio are having. 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
28,374 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 898 rather than 932. Ohio and Iowa and Kansas and Arkansas are calendar-year, because that is the series those states publish.
Virginia showed this week what that mixing costs, and it deserves to be said plainly. Virginia publishes 197 cases and then breaks them down: 107 acquired in this country, 48 acquired abroad, and 42 unknown or still pending. Roughly a quarter of the Virginia number has nothing to do with lettuce from central Mexico. Some version of that is true in every state on this chart, and only a handful of them publish enough detail for anyone to see it. A floor assembled from fifty different definitions is still worth having. It is not worth mistaking for a case count.
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.
What to expect
Michigan publishes Thursday morning, and it is the number that matters most. It has moved to weekly reporting after four months of daily updates, so tomorrow is the first full week of Michigan movement collected into one figure. It sits at 12,485 with 279 hospitalizations, and its own health department says new case reports and emergency room visits are falling. Ohio is weekly and is overdue, last published at 4,900 on August 4. West Virginia posts again Friday, Missouri Sunday, Arkansas and Virginia Monday, CDC and North Carolina and Oklahoma Tuesday, Kansas and New York next Wednesday.
Two things will keep this chart climbing after the illnesses stop. CDC estimates a six-week lag between the day someone gets sick and the day the case reaches it, so August onsets will still be arriving in the middle of September. And the confirmed and unconfirmed pools are still sorting themselves out: last Tuesday the confirmed count rose by 3,427 while the unconfirmed pool fell by roughly 1,800, which was mostly laboratory confirmation catching up with cases already counted rather than new illness. Expect more of that and expect it to be reported as a surge.
The season closes on August 31, nineteen days from today. The counting does not.