The fifty state health departments now report 29,798 cases of cyclosporiasis this season, up 1,424 from the 28,374 published yesterday. One state moved, and it moved by more than any state has moved in a single day all summer. Michigan reported 13,909 cases and 314 hospitalizations on Thursday.
That is 1,424 cases in one week, and it arrived a week after Michigan told its residents to resume routine guidance for lettuce and salad greens. Both things can be true, and both are. The state health department says new case reports and emergency department visits are declining, and the weekly pace has in fact eased, from roughly 285 a day to roughly 200. It is still 1,424 people. Michigan records about fifty cases of cyclosporiasis in a normal year. It just booked twenty-eight years of them in seven days, and it is still the largest weekly increase of any state in the country. The largest age group in the Michigan data is thirty to thirty-nine, with 2,615 cases, which is to say working adults who eat lunch somewhere.
One comparison in Thursday’s numbers deserves to be pulled out and looked at. CDC reports 13,895laboratory-confirmed cases of cyclosporiasis for the entire United States since May 1. Michigan, by itself, now reports 13,909. One state has passed the national laboratory-confirmed count. The two figures are not the same measurement, and nobody should pretend they are, because Michigan counts probable cases and CDC does not. That is the point. The gap between what a state can see in its own residents and what the federal surveillance system has managed to confirm is now wider than the federal number itself.
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 six 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 5,448 cases ahead of the combined federal figure, against 4,024 yesterday. Some of that widening is the calendar. 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, and anyone quoting the gap should say which day of the week they are standing on. The rest of it is Michigan, and that part will not close on Tuesday.
The thirteen states that publish a hospital figure now total 735 between them, after Michigan moved from 279 to 314. CDC’s national surveillance, updated August 11, reports 740 hospitalizations among its laboratory-confirmed cases. Those two numbers are now five apart. A floor assembled by hand from thirteen state health departments has landed within five of what the federal surveillance system counts from a different set of cases, which is either a coincidence or a sign that the bottom-up method works. The outbreak-specific federal figure is a different number again. It is 278, and Michigan by itself reports 314. Ohio is second at 172, and that number has a trajectory of its own: 28 Ohioans hospitalized as of July 2, 96 by July 17, 172 by early August. It is also the oldest figure in this total, because Ohio has not published a newer one, so read 735 as the conservative end. 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 | 13,909 | Aug 13 | 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 | 29,798 | 50 |
What the 2025 column shows
Michigan reported 50 cases in all of last year and has reported 13,909 this year, two hundred and seventy-eight times as many. 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
29,798 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.
Two states publish enough detail to see inside their own number, and both show the same thing. Virginia reports 197 cases and breaks them down: 107 acquired in this country, 48 acquired abroad, 42 unknown or still pending. Roughly a quarter of the Virginia figure has nothing to do with lettuce from central Mexico. Florida is starker. Of its 342 cases, 201 were acquired in Florida, 31 in another state, 45 outside the country, and 65 have no known source at all. Under sixty percent of the Florida number was acquired in Florida.
Some version of that is true in every state on this chart, and forty-eight of them publish nothing that would let anyone check. A floor assembled from fifty different definitions is still worth having, because the alternative is waiting six weeks for a federal number that is itself an undercount. 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
This chart will cross 30,000 within days. It stands 202 short tonight, and West Virginia posts Friday, Missouri Sunday, Arkansas and Virginia Monday, CDC and North Carolina and Oklahoma Tuesday, Kansas and New York next Wednesday. Ohio is weekly and overdue, last published at 4,900 on August 4. Indiana updates on weekdays and was near 1,900 earlier this week. Any two of those get it there.
Two things will keep it 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: on Tuesday the confirmed count rose by 3,427 while the pool awaiting investigation 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, eighteen days from today. The counting does not.