C.D.C. Expands Cyclospora Outbreak to Six More States

The Centers for Disease Control and Prevention has linked six additional states to a large outbreak of cyclosporiasis associated with iceberg lettuce, according to a C.D.C. official familiar with the investigation.

The agency has now confirmed cases tied to the outbreak in Arkansas, Iowa, Missouri, Nebraska, New Hampshire and North Carolina, according to the official, who spoke on condition of anonymity to disclose confidential information. The additions bring the tally of affected states to 15. The C.D.C. plans to set up a formal response team this week to contend with the outbreak, the official said.

Sarah Morris, a spokeswoman for the Arkansas Department of Health, confirmed that Arkansas was one of the states the C.D.C. had added to the list. And Lisa Cox, a spokeswoman for the Missouri Department of Health, confirmed that the same was true for Missouri.

In July, the agency linked cases in Illinois, Indiana, Kansas, Kentucky, Michigan, Ohio, Oklahoma, Pennsylvania and West Virginia to the outbreak. The iceberg lettuce was sourced from central Mexico and distributed by Taylor Farms, which has issued a recall of bagged iceberg lettuce in 27 states.

There have been more reported cases of cyclospora this year than ever before in the United States: Since 2016, the C.D.C. has reported an average of about 2,800 cases per year. The agency has confirmed about 10,400 cases since May 1 and is investigating more than 11,500 additional cases, according to the C.D.C. official.

On Monday, health officials in Michigan reported the first two deaths associated with the outbreak. The two people who died had significant underlying health issues, according to an update posted to the Michigan Health Department’s website. Although cyclosporiasis is not typically fatal, it causes severe diarrhea — infants, older adults and those who are pregnant or immunocompromised are the most vulnerable.

The illness can also lead to cramping, loss of appetite, fatigue, bloating, gas and nausea. The infection spreads when people consume food or water contaminated with human feces that contains eggs from a microscopic parasite.