A massive cyclosporiasis outbreak linked to shredded iceberg lettuce has expanded to an additional six states, according to a source familiar with the matter. The outbreak, caused by a microscopic parasite found in human feces, is responsible for hundreds of hospitalizations and two deaths since early May.
The newly linked states — Arkansas, Iowa, Missouri, Nebraska, New Hampshire, and North Carolina — join Illinois, Indiana, Kansas, Kentucky, Michigan, Ohio, Oklahoma, Pennsylvania, and West Virginia.
More than 22,000 people have confirmed or suspected cyclosporiasis, and 517 people have been hospitalized in the multistate outbreak, the CDC said late Tuesday.
The Source of the Outbreak
The majority of cases have been traced to lettuce at Taco Bell that was supplied by Taylor Farms and sourced from central Mexico. Last month, the produce giant issued a voluntary recall of all iceberg lettuce supplied from central Mexico, which the company said was distributed to restaurants and retail stores in 27 states.
The FDA hasn’t yet identified other potential sources beyond Taylor Farms.
The recalled Taylor Farms lettuce should no longer be available in the US, and its use-by dates ended Aug. 3, said Dr. Stephen Ostroff, a former acting FDA commissioner.
Why the Outbreak Is Still Growing
The newly linked cases may involve people who ate the recalled lettuce weeks ago but were only recently diagnosed and reported to health officials, Ostroff said.
“With an incubation period up to two weeks, there should no longer be people newly getting sick from that product,” Ostroff said. “But it takes a while for people to seek health care after onset, get tested and diagnosed, reported to state health departments and then to CDC.”
He added: “Think of it like solving a jigsaw puzzle. You have all these pieces sitting there, and the longer you work on it, the more likely it is you’ll figure out where each piece fits into the puzzle.”
The Human Toll
On Monday, health officials in Michigan — which has the most cyclosporiasis cases — confirmed the first deaths linked to this outbreak in the United States. Both people had underlying health conditions that may have been affected by the illness and dehydration.
Ostroff said the key question about the newly added states is when their patients became sick. If people were exposed after Aug. 3, investigators may need to look for another source.
“We may have solved the Taylor Farms shredded lettuce piece, but that’s unlikely to explain everything we’re seeing,” he said.
The Bottom Line
A cyclosporiasis outbreak linked to shredded iceberg lettuce from Taylor Farms has expanded to six more states, bringing the total to at least 15 states. More than 22,000 people have been sickened, 517 hospitalized, and two people have died. The recalled lettuce is no longer available, but cases are still being reported as diagnoses are confirmed. Health officials are investigating whether there may be other sources of the outbreak.
