The multistate outbreak of cyclosporiasis linked specifically to contaminated iceberg lettuce has expanded to 20 states, with federal health officials reporting 11,458 illnesses and 495 hospitalizations as of Aug. 27.
Georgia, Tennessee and Texas were the latest states added to the outbreak investigation, according to updates from the U.S. Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC). Two deaths have been associated with the outbreak, both in Michigan.
The latest case count represents an increase of 528 illnesses from the 10,930 cases reported in the previous weekly update. The states currently reporting illnesses associated with the outbreak are Arkansas, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Massachusetts, Maine, Michigan, Missouri, Nebraska, New Hampshire, North Carolina, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas and West Virginia.
The increase, however, does not necessarily mean that contaminated lettuce is continuing to infect people.
Federal health officials have emphasized that there can be a substantial delay between when a person consumes contaminated food, develops symptoms, seeks medical care, receives a diagnosis and is ultimately linked to an outbreak. The CDC says it can take as long as six weeks for case information to reach investigators.
The FDA said the last reported illness onset associated with the lettuce outbreak was Aug. 15. The agency also said it remains confident that the recalled iceberg lettuce connected to the outbreak has been removed from the market. The recall began July 17, meaning most illnesses identified in the investigation occurred before the product was removed from distribution.
That distinction is important for retailers, foodservice operators and consumers monitoring the outbreak. The continued rise in reported cases is largely reflecting the identification and confirmation of illnesses that occurred earlier, rather than evidence of an ongoing wave of new exposure.
Investigation Continues
The FDA and CDC continue to investigate the source and distribution of the contaminated lettuce. FDA investigators have been conducting inspections and sampling in Mexico in coordination with Mexican authorities.
The FDA’s latest investigation identifies confirmed product distribution across 31 states and territories, with the agency noting that the product may have reached additional locations beyond those for which distribution has been confirmed.
The outbreak has become one of the largest documented U.S. outbreaks of cyclosporiasis. Separately from the lettuce-linked investigation, CDC surveillance has recorded 17,180 domestically acquired cyclosporiasis cases in 48 states and the District of Columbia since the beginning of the 2026 season on May 1. That broader number includes illnesses not associated with the lettuce outbreak.
Cyclospora is a microscopic parasite that typically causes gastrointestinal illness. Symptoms can include frequent watery diarrhea, abdominal cramping, nausea, fatigue and weight loss. Illness can persist or recur if untreated.
For the grocery industry, the immediate concern has shifted from removing the implicated product to monitoring the continuing investigation and managing consumer confidence around fresh produce.
The FDA continues to advise retailers, foodservice operators and consumers to follow recall information and food-safety guidance while the investigation remains active. At this point, federal officials say the recalled lettuce associated with this outbreak should no longer be available for sale or service.
The case count is therefore expected to remain fluid in the coming weeks as additional illnesses are investigated and linked to the outbreak, even if no new exposure is occurring.