Four States and 400 Cases of Cyclospora, Says the CDC. The State Health Departments Have Counted Closer to 7,000.

The CDC’s official multistate outbreak of cyclosporiasis is four midwestern states — Michigan, Ohio, West Virginia and Kentucky — and just over 400 cases it has managed to tie to a  yet unnamed, common, source. That is the number the word “outbreak” gets attached to. On its own surveillance page, the CDC counts 1,645 lab-confirmed domestic cases across 34 states and admits it is aware of more than 5,100 more it has not finished confirming. Add up what the state health departments are actually reporting and the total sits closer to 7,000. The official outbreak and the real one are not the same size.

Start with Michigan, which has passed 3,700 cases on its own dashboard in a state that in a normal year sees forty or fifty, and whose investigators have named lettuce and salad greens as the likely vehicle. Set that one state against the CDC’s 400-case, four-state cluster and the federal figure stops looking like the outbreak and starts looking like the slice of it investigators have so far been able to stitch together.

Ask all fifty health departments whether they are part of this and you get three different answers. Ohio, West Virginia and Kentucky say yes and are working the case alongside Michigan. Indiana, sitting on 206 cases, calls itself part of a nationwide outbreak. And then a run of states carrying real, elevated counts says, in effect, nothing unusual here: New York, at roughly 394 cases, calls it “not a major deviation from the norm”; Illinois, at 216, says there is “no evidence of a large outbreak”; New Jersey, at 46, is “not experiencing … outbreaks”; Massachusetts, at 18, calls it a “normal seasonal amount”; and Virginia, at 10, says its cases are not a pattern that would “constitute an outbreak”. Two of the largest states never entered the outbreak at all: California is seeing fewer cases than last year, and Washington says flatly that it “is not seeing an outbreak.” Whether a sick person is counted as part of an outbreak depends heavily on which state line they were standing behind when they got sick.

This is what last summer’s paperwork looks like once it reaches the produce aisle. When the CDC quietly made Cyclospora reporting optional under its FoodNet program in July 2025, it weakened the very machinery that turns a scatter of state counts into one fast national picture. The parasite is nationally notifiable in only 47 states, it is invisible on a routine stool test unless a physician asks for it by name, and every figure in the chart below is a floor, not a ceiling. When Oklahoma and Kansas finally opened their own books this week, each found roughly five times the cases the CDC had listed for it. So, the gap widens: a parasite moving through the national salad supply on one side, and on the other an official tally that trails the real one by thousands of cases.

The four-state outbreak isn’t the outbreak. It’s the part of the outbreak we can still see.

For the person on the third week of watery diarrhea, whether their state is “officially” part of the outbreak is a distinction without a difference. They are sick, the source is still on the shelf, and the system built to find it is being asked to do the job with fewer people and a smaller net.

Here is where all fifty state health departments stood as of July 15, 2026 — the number each reports for 2026, and whether it calls those cases part of the outbreak.

Notes: State figures mix confirmed and probable cases and use different start dates (some “since May 1,” some “year-to-date”), so they are not strictly comparable. “In CDC count” means the state appears in the CDC’s 34-state domestic tally but has not published its own 2026 number; “no domestic cases” means the state is not in that tally (it may still have travel-related cases). Every count is a floor. Figures current to July 15, 2026.