145 or 1,400? The CDC’s Map Says One Thing About Cyclospora — the States Are Saying Another

Over at USA TODAY health reporter Mary Walrath-Holdridge asked a simple, sensible question: which states have the most cases of the “explosive diarrhea” parasite going around this summer? 

It is exactly the question a worried parent, a restaurant owner, or a public-health nurse would type into a search bar. And it is a question the country’s official outbreak map — the CDC’s Cyclosporiasis Surveillance page — cannot honestly answer right now.

Here is the problem: the federal map says 145 cases in 17 states. The state health departments feeding that map are, as of this morning, describing something closer to ten times that number. Both numbers are “official.” Only one of them is current.

Pull up the CDC surveillance page and you will see a shaded map of the United States. As of its last review on June 18, 2026, the CDC had logged 145 domestically acquired cases across 17 states, for people who got sick between May 1 and June 16. Twenty of them were hospitalized. No deaths. Add another 45 travel-associated cases and you get 190 total.

Two things about that map deserve a hard look. First, it carries no per-state numbers at all — it just colors a state in or leaves it white. If you want to know whether “most” cases are in New York or Texas, the map won’t tell you. Second, and more important, the map is frozen in mid-June. It does not include Michigan. It was last touched before the biggest cluster of the year even became public.

When you skip the map and call the states directly — which is what the reporters chasing this story have been doing — a very different picture emerges. These are the numbers state health departments have put on the record over the past week:

And that is before you count the additional clusters and case reports federal and state officials have named: Alabama, Alaska, Colorado, Connecticut, Florida, Georgia, Kentucky, Louisiana, Massachusetts, New Jersey, Tennessee, Virginia, and West Virginia. The illness has now been tied to more than a dozen states — and the CDC itself has said it is investigating clusters linked to Mexican-style restaurants and a grocery chain, with more to come.

Here is the comparison that matters — what each state says about itself, set against what the CDC’s national map says about that same state. The pattern is unmistakable: where the CDC map shows a shaded state with no number, the state itself is now reporting counts that dwarf the entire national figure the map still displays.

What is the real number? I will give you my honest arithmetic, with the caveat that no one — not me, not the CDC — can hand you a clean figure today. Add just the five states that have published totals — Michigan (700+), Ohio (177), Illinois (141), New York (120), and North Carolina (110) — and you are already at roughly 1,250 reported cases. Fold in Texas, Pennsylvania, and the smaller clusters, and a realistic national floor is 1,300 to 1,500 reported cases for the 2026 season so far. The true number is higher still, because — as the CDC itself concedes — most people with a week of diarrhea never get tested, and you cannot count what no lab ever sees.

The reason I have to estimate is the states count on rolling windows and report on their own schedules; Pennsylvania reports voluntarily; New York folds in New York City; the CDC’s surveillance count uses illness-onset dates and lags by weeks. The federal map is not lying. It is just describing a photograph taken in the middle of June while the fire is still spreading in July. That gap is not a rounding error. It is the difference between “145” and something an order of magnitude larger.

It does not help that this is in a year when the agency doing the counting has been hollowed out. When you cut the people and the pass-through money that state and local health departments rely on to detect and report outbreaks, this is what you get: a national map that can’t keep up with a national outbreak.

USA TODAY asked which states have the most cases. The right answer, today, is more than the map admits, in more places than the map shows. If you have had sudden, watery, “explosive” diarrhea that won’t quit, especially in Michigan, Ohio, Illinois, New York, North Carolina, or Texas, see a doctor and ask specifically about Cyclospora — a routine stool culture can miss it. And if you test positive, call your local health department. You are not just a patient. Right now, you are the only reliable data point the system has.

Cyclosporiasis is an intestinal illness caused by the parasite Cyclospora cayetanensis, which is transmissible by ingestion of fecally contaminated food or water. Cyclosporiasis is most common in tropical and subtropical regions of the world. In the United States, foodborne outbreaks of cyclosporiasis have been linked to various types of imported fresh produce — basil, raspberries, snow peas, cilantro, and bagged salad among them.

Cyclospora infects the small intestine and usually causes watery diarrhea, bloating, increased gas, stomach cramps, loss of appetite, nausea, low-grade fever, and fatigue. In some cases, vomiting, explosive diarrhea, muscle aches, and substantial weight loss occur. The time between becoming infected and becoming ill is usually about a week. If not treated, the illness may last from a few days up to six weeks, and symptoms may recur one or more times.

Reported cases have climbed markedly over the past decade — from 537 in 2016 to 3,519 in 2018 and 4,703 in 2019 — an increase that reflects both a genuine rise in illness and the growing use of rapid multiplex molecular stool panels that now detect Cyclospora as a matter of routine. The seasonal pattern has continued: early in the 2026 season, CDC reported those 145 domestically acquired cases across 17 states between May 1 and June 16 — the very number that has now been overtaken by events.

And here is the part people never want to hear rinsing or washing produce is not likely to remove Cyclospora oocysts, which adhere tightly to surfaces, and the parasite is resistant to routine chemical disinfection such as chlorine. The theoretical infective dose may be as low as a single sporulated oocyst. Wash your greens — but understand that washing is not a cure for a contaminated food supply.