Transcript - Update on CDC's Cyclosporiasis Response – 7/14/26

Transcript - Update on CDC's Cyclosporiasis Response - 7/14/26

Please note: This transcript is not edited and may contain errors.

00:00:00 Operator

Good afternoon, and thank you all for standing by for the duration of today's call. All listeners are in a listen-only mode until the question and answer section. At that time, credentialed members of the media can press star one to ask a question or star two to withdraw your question. Today's call is being recorded. If you have any objections, please disconnect at this time. And I will now introduce Mr. Benjamin Haynes. Thank you, sir. You may begin.

00:00:27 Benjamin Haynes, CDC Moderator

Thank you, Amanda and thank you for joining us. We're joined by Dr. Gwen Biggerstaff, the deputy Division Director of NCEZID's Division of Foodborne, Waterborne, and Environmental Diseases, who will give you an update on the outbreaks of cyclosporiasis in multiple states that CDC has been tracking since early May.

We're also joined by Dr. Donald Prater, FDA's Acting Deputy Commissioner for Food, who will speak about their traceback investigation and food safety guidance.

With that, I'll turn the call over to Dr. Biggerstaff.

00:00:59 Gwen Biggerstaff, Deputy Director of CDC's Division of Foodborne, Waterborne, and Environmental Diseases

Thank you, and good afternoon, everyone.

States are continuing to report an unusually high number of cyclosporiasis cases, and in particular, we are seeing a large outbreak in at least four midwestern states that likely have an epidemiological link.

Given that, we felt it was important to hold this briefing today to walk through what cyclosporiasis is, what we know about the outbreaks and case counts, and what our investigation has found so far.

Cyclosporiasis is an intestinal illness caused by a microscopic parasite called Cyclospora. It's spread when people consume food or water contaminated with the parasite - typically fresh produce that has not been adequately washed or cooked.

Symptoms include watery diarrhea - sometimes frequent - along with cramping, nausea, loss of appetite, fatigue, and low-grade fever. Symptoms generally begin about one to two weeks after exposure.

I want to underscore an important point: this illness does not spread directly from person to person. The source of this outbreak is what we eat or drink - not casual contact with someone who's sick.

As of today, CDC has received reports of at least 1,645 lab-confirmed cases of domestically acquired Cyclospora since May 1, the start of the typical cyclosporiasis season. We're also aware of more than 5,100 additional reports that require further analysis to confirm they meet the case definition.

Cases have now been identified in 34 states. We want to be clear: the true number of infections is almost certainly higher than what's reflected in these numbers, because many people with mild illness recover without seeking medical care and are never tested.

So, there are two things happening at once: elevated case counts nationally, and targeted outbreak investigations when cases are linked. One of these investigations is showing a likely common source and today we have posted an investigation notice about the specific outbreak.

Public health officials are working right now to combine detailed epidemiological interviews with genotyping of Cyclospora from stool specimens to identify clusters of related cases, alongside traceback conducted by state and local health departments and FDA.

Historically, cyclosporiasis outbreaks have been associated with travel to other countries, but in the last few years we have seen an increasing number of cases tied to domestic and imported produce. Currently, we have not confirmed a specific food source for the current multistate outbreak. Cyclospora investigations are particularly challenging and take a significant amount of time and effort for two reasons. One, because people usually get sick two days to two weeks after being exposed to the parasite and by the time a case is reported, many weeks have passed. And two, there's not currently whole genome sequencing available to help match a contaminated product to the outbreak strain, which adds to the difficulty of linking a specific product and sick individuals. Instead, federal partners use targeted genotyping, which is useful for detection but not as fast and precise as whole genome sequencing that is used for traditional bacterial pathogens. This is why cyclosporiasis investigations generally take longer to link cases to each other and identify a potential source. And in some cases, a specific source may never be identified.

We want to be transparent that this is an active and evolving investigation, and CDC and our federal partners will update the public as soon as we have actionable findings. We anticipate continuing to see cases increase, possibly through the end of August, which is the end of the cyclosporiasis season.

I also want to highlight three steps we're taking today to strengthen our response. First, CDC has issued a Health Alert Network, or HAN advisory. This goes out to clinicians and public health partners nationwide, reminding them what we want them look for in patients with prolonged gastrointestinal illness, and encouraging them to specifically request Cyclospora testing, since it isn't part of routine stool testing panels. Second, CDC has launched a new outbreak investigation webpage that details the information around the multistate outbreak. And third, and importantly, we're increasing how often cyclosporiasis data are updated. Rather than the monthly surveillance updates we've historically posted, the surveillance webpage and outbreak investigation page will be updated at least weekly.

While the investigation continues, here is what we recommend: Wash your hands and any fresh produce thoroughly under running water before eating, cutting, or cooking. This will reduce the risk of infection. Cooking kills the parasite, so heating food to 158°F or 70°C or higher is effective. If you develop prolonged watery diarrhea, especially lasting more than a few days, along with fatigue or loss of appetite, contact your healthcare provider, and mention cyclosporiasis specifically. Routine stool tests don't always screen for this parasite. You may need to specifically request testing for Cyclospora. People with symptoms should stay well-hydrated and avoid preparing food for others while acutely ill, out of general caution, even though person-to-person spread is very unlikely.

So, to summarize, we're seeing an unusually high number of cyclosporiasis cases this season, spread across more than 30 states, with no deaths reported. The investigation into the source is ongoing, and we're committed to updating the public as soon as we know more. Our guidance right now is to follow safe food-handling practices and seek care if symptoms develop.

Thank you and I'll turn it over my colleague Dr. Prater. 00:06:37 Donald Prater, FDA's Acting Deputy Commissioner for Food

Thanks, Dr. Biggerstaff, and really appreciate all the good collaboration between our FDA and CDC teams and state partners to investigate these multiple outbreaks. Again, I'm Dr. Don Prater, Acting Deputy Commissioner for Food at the FDA.

FDA is working closely with our CDC partners to support food traceback activities once CDC has identified food sources of interest based on their case review, as soon as FDA has actionable information, we work rapidly to ensure any contaminated product is removed from the market, and guidance is communicated clearly to consumers.

As Dr. Biggerstaff mentioned, Cyclospora is a foodborne hazard with a seasonal aspect. In recent years, FDA has developed improved methods for cyclosporine detection and attribution, and has worked with domestic and international regulatory partners to share these methods.

As such, we expect to see increased detection with these strengthened surveillance efforts. Still, Cyclospora remains a challenging agent, and epidemiology and traceback are key elements of the outbreak investigation.

So to reiterate, our outbreak investigation team is hard at work to follow all the leads we have from CDC on potential food sources for all the various outbreak clusters we are tracking at the moment.

Provide updated information and actionable information as soon as we have it, as soon as it's available, and we'll also continue our efforts to ensure industry is taking appropriate measures to control Cyclospora in the environment and on produce.

I'll end by sharing that tomorrow and every Wednesday, FDA will update the public on active FDA outbreak investigations. Our core investigations table currently shows the multiple outbreak clusters FDA is investigating. It will be updated tomorrow and every week with the latest information.

Back over to you, Ben.

00:08:37 Mr. Haynes

Thanks Dr. Prater. Amanda, we're ready to take questions.

00:08:42 Operator

Thank you. If you are a credentialed member of the media and you would like to ask a question during the call, please press star one on your touchtone phone. Please press star two to withdraw your question. You may ask one question and one follow-up question. If you have additional questions, please rejoin the queue.

Our first question will come from Erica Edwards with NBC News. Your line is open.

00:09:06 Erika Edwards, NBC News

Hey, thanks so much for doing this and for taking my questions. For the FDA, is there any specific national supplier, distributor, restaurant chain being eyed? Are you looking specifically at Taco Bell, for example? I'm also curious about what Michigan has said about lettuce or salad greens. And for the CDC, I'm wondering if you could tell us a little bit more about the epidemiological link in those four states you mentioned. How did you determine that? Thank you.

00:09:34 Dr. Prater

Yeah, thanks, Erica. It's Don here. FDA certainly is continuing its traceback investigation on multiple produce items, also including locations that are reported by the case patients before they became sick. 00:09:51 Dr. Biggerstaff

And hi, this is Dr. Biggerstaff. Thanks for the question about the data that we have so far for the multi-state outbreak, and hopefully, I think most of you have probably seen the web update that went up today. That web update does contain the most up-to-date information for that multi-state outbreak investigation, and we will continue to update on that web page.

I will say that for that outbreak, as well as all of the other investigations that are ongoing, we're working really closely with the frontline partners we have in state and local health departments and FDA to collect epidemiologic traceback and laboratory data. That's we're pulling together all three of those to triangulate when we might have a common signal across cases. So in the case of this multi-state outbreak, those are the types of data that we're using: exposure history from what people ate, where they might have been, and where they've gone in the time period before they got sick, as well as where they live and where they went, and then laboratory data, some of the genotyping data that we talked through before, and then in partnership with our ag partners and FDA to figure out how we can trace back the items that are at the places where people ate and the foods that they reported. So those are the data that we're pulling together to find a signal connecting the cases. And when you look at that update, you'll see that right now we don't have a specific source identified, and we're working very hard to continue collecting and analyzing those data. We'll share more information on that website as we learn more.

00:11:11 Mr. Haynes

Our next question please.

00:11:13 Operator

Thank you. Our next question comes from Sabrina Sadiki with the Wall Street Journal. Your line is open.

00:11:20 Sabrina Siddiqui, The Wall Street Journal

Thank you so much. I just have two questions, and one is a follow-up on Michigan identifying lettuce as a potential source, which I know you have not identified a specific source. But given what the state of Michigan is saying, are there any steps underway to interfere with the lettuce supply chain, just to try and potentially contain the outbreak, and then on the CDC, a lot of these state health departments have been talking about how they're stretched really thin. Have you deployed CDC staff to the states that have been most impacted to help with these investigations, or can you just kind of pinpoint some of the other ways that CDC staff is assisting the state health departments who say that they lack their resources and staffing to act more quickly.

00:12:10 Dr. Prater

Yeah, it's Don here. I'll jump in on the lettuce. So, FDA and CDC, of course, are working with our state partners. We are aware of the signal for lettuce, and that's being noted by our Michigan partners. What I can say at this point is that we're continuing our traceback investigation on multiple produce items, including the lettuce.

00:12:32 Dr. Biggerstaff

Thank you for the question about state resources and capacity. I think it's a really important question because while we have very robust systems for surveillance and investigation. We know that, as you mentioned, states are often under-resourced for things like freeborn outbreak detection and response. So CDC is actively engaged. We have some fantastic SMEs who are giving, or subject matter experts, sorry, who are giving a lot of time and energy into this investigation. But the state's local health departments are the front lines of this, so we're holding standing calls every week with our partners, so we can assess what their needs are and share information across all of our different groups. And we are ready to help assist in any way that is needed in the states. So we're very excited to continue working with our partners as we always have. This is how we always investigate outbreaks. It's how we always share data, and we want to make sure that they're supported. And I will say we also have a program called the Integrated Food Safety Centers of Excellence. These are five state health departments that serve with academic partners, and they are available to also provide resources and advice and support to other health departments, they're also actively engaged in all of our outbreak response and surveillance activities. So, it's another source of information and support for our state health department partners.

00:13:53 Mr. Haynes

Next question, please.

00:13:56 Operator

Thank you. Our next question comes from Kristen Shamus with the Detroit Free Press. Your line is open.

00:14:03 Kristen Shamus, Detroit Free Press

Thanks so much for taking this question. I'm wondering if you can share with us which four states have the likely common source that you've referenced, and give us any details as to what those signals of that likely common source might be.

00:14:21 Dr. Biggerstaff

Yeah, thank you for the question. The states are listed on the outbreak posting, so it's Michigan, Ohio, West Virginia, and Kentucky. The data are available on that website, and we'll continue to share more information. As I mentioned, the states are really actively tracking down and interviewing cases and collating the data that are available. That triangulation of evidence that I mentioned before. So as we continue to learn more, as states continue to gather more information, we'll share that on that on that website. So that's where we'll have more information about what that signal looks like, and as we work to try to identify a specific source.

00:15:02 Mr. Haynes

Next question, please.

00:15:05 Operator

Thank you. Our next question comes from Jacqueline Burrer with The Dallas Morning News. Your line is open.

00:15:11 Jacquelyn Burrer, The Dallas Morning News Hi. Thank you so much for hosting this conference call today. Our question pertains to the reduced surveillance activities for the CDC FoodNet programs that were repealed or reduced in activities last year to just Salmonella and STEC last July. Has that reduction or change in CDC policies contributed to the spread of Cyclosporiasis this year at all? And also, also for the CDC, can y'all speak to how this outbreak compares to previous years as well?

00:15:47 Dr. Biggerstaff

Sure. Thank you for the question because I'm really glad that gives me a chance to talk about the really fantastic, robust program of FoodNet and make the distinction between FoodNet and our general outbreak response and surveillance activities. So FoodNet is a robust program where the goal of the program is really to look at trends over time to inform our policy and prevention activities. There are only 10 participating FoodNet sites, so it doesn't really give us the same kind of data that we have from national surveillance, which is what we talked about using for Cyclosporiasis surveillance and outbreak detection and response. The change that you mentioned for FoodNet essentially the change was that the FoodNet sites are no longer required to report FoodNet specific data for cases of Cyclosporiasis.

Instead, they continue to participate in national surveillance, just like all of our other state and health department partners. So the data that we have for Cyclosporiasis for this outbreak is the same as we've had for all of the other seasons. We use the same systems and the same processes. So that is unchanged.

You're absolutely right to point out the difference in this season and the previous season. So the case numbers that I mentioned at the top of the call, the 1,645 laboratory confirmed domestically acquired cases, and the over 5,100 additional cases that are pending interview is a much higher number than what we typically see in a Cyclosporiasis season. This is much much higher than what we've seen last year or the year before, and that's a big part of why we wanted to have this briefing today to share our concerns and what we do know, because it is a very big outcome we've seen in previous seasons.

00:17:29 Mr. Haynes

Next question, please.

00:17:32 Operator

Thank you. Our next question comes from Yuri Benenjed with ABC News. Your line is open.

00:17:38 Youri Benadjaoud, ABC News

Hey, thanks for taking my question and doing this call. I have a question about prevention. Actually, two questions. Are there any foods right now that are safer than others that you would recommend people avoid when they're in the grocery store, at restaurants? And then, can you be a little more specific about how running water actually prevents or at least lowers your risk over fruits and vegetables? It seems like this is a pretty stubborn parasite. I'm just curious what the data show on that.

00:18:04 Dr. Prater

Yeah, thanks, Youri. It's Don here. We don't have any foods that folks should avoid at this point. We are tracing, of course, multiple produce items, and as soon as we have actionable information for consumers, we will put that on our website. It is important to wash fresh produce, and so I think that's been shown to be very helpful in lowering the risk of this parasite.

00:18:34 Operator

Thank you. 00:18:34 Mr. Haynes Next question.

00:18:35 Youri Benadjaoud, ABC News Is there any?

00:18:38 Mr. Haynes

Oh, I'm sorry, Youri. Go ahead. Did we cut him off? We can follow up.

00:18:42 Youri Benadjaoud, ABC News Is there any just...thank you. Is there any specific data that you could point to? Like, it reduces like 50%-90%. It's you know, I've seen some research that it doesn't actually eliminate the parasite when you're just running water over the fruits and vegetables.

00:18:55 Dr. Prater

Yeah, thanks, Youri. I think we'll have to follow up with you on that information. I don't have that specific information.

00:19:05 Mr. Haynes

Next question, please Amanda.

00:19:08 Operator

Thank you. Our next question comes from Julie Steenhausen with Reuters. Your line is open.

00:19:14 Julie Steenhuysen, Reuters

Yeah. Hi. Thanks for taking my call. So, so my question is this. I mean, it looks like what you're looking at is a regional outbreak, probably from a common distributor. If it's those four states, they're kind of physically similar. Is it at all possible, you know, given how like harvests would come from a specific field? If this outbreak is actually already over because whatever you know, produce has been received is now you know already all through the system. Or do you anticipate rising cases you know throughout the summer? Thank you.

00:19:36 Dr. Prater Yeah, it's Don here. We do know that produce moves through the system pretty rapidly, and so as we do conduct our traceback investigation, we'll be looking at the status of any affected produce lots that appear to be linked.

00:20:11 Julie Steenhuysen, Reuters Do you expect? But the first, so you know, the main part of the question is: Do you think this outbreak could possibly already be over? In that, you know, the infected produce or whatever it is no longer in the channel.

00:20:24 Dr. Prater

I think we're looking at multiple clusters and subclusters, so we'll still have to have more information to be able to answer that question.

00:20:35 Julie Steenhuysen, Reuters

Okay, and to clarify, then the four Epi linked states, is that one cluster, or do you think that they are multiple clusters?

00:20:49 Dr. Biggerstaff

This is this is Gwen. I can help with that one. So, for the four states that you mentioned from the multi-state outbreak investigation, the evidence that we have right now from triangulating across traceback, Epi, and lab information indicates that both cases may be linked as one multi-state outbreak. But as you see, when you look across that and the other updates we've shared today, there are a lot of cases that are not accounted for as part of that multi-state outbreak, and there are a number of other investigations that are going on, some single-state investigations, as well as investigations for the cases that are not currently linked to a cluster or outbreak.

00:21:26 Mr. Haynes

Next question, please.

00:21:29 Operator

Thank you. Our next question comes from Hilary Brueck with Business Insider. Your line is open.

00:21:35 Hilary Brueck, Business Insider

Hi. Thanks for taking my question. I wanted to ask why you're not using whole genome sequencing for this outbreak, and why the use of targeted genotyping?

00:21:47 Dr. Biggerstaff

I will mention I have one of my esteemed lab colleagues here with me in case I need some assistance for more details on this. But in general, the main difference is that the genome of the parasite is a lot more complicated, and that means that we have to do different kinds of testing. And so we use the genotyping that we described earlier because even though it does take a little bit longer and it does not have all of the same features as whole genome sequencing, it is what is the best test that we have available to us to find those temporal and geographic clusters using the laboratory data.

00:22:27 Mr. Haynes

Our next question, please.

00:22:29 Operator

Thank you. Our next question comes from Aubrey Whelan with Philadelphia Inquirer. Your line is open.

00:22:37 Aubrey Whelan, Philadelphia Inquirer

Hi, I'm Aubrey Whalen with the Inquirer. I am in Pennsylvania, where which is one of the very few states that do not have to report Cyclospora cases to the state, and the state the state does monitor it, but it's basically they just you know take whatever people send them. I'm curious as to like how the CDC monitors incidents of cyclospora in states like ours, where there might be another can of cases, simply because we don't conduct the kind of surveillance that other states do.

00:23:11 Dr. Biggerstaff

Yeah, thanks for raising the difference between nationally notifiable and reportable diseases. And so, cyclosporine is nationally notifiable and is reportable in 47 states. So, we know that there are some differences in the required surveillance. A little bit like when I was talking about the difference in food net data being required or optional, many states, even if Cyclospora is not reportable in their jurisdictions, still collect robust data and share that routinely with CDC. So, the same data can flow through our nationally notifiable diseases surveillance system and into our other outbreak systems where we collect Epi lab and traceback data. Think just because a pathogen isn't reportable in a given jurisdiction, it doesn't mean that they cannot report that to CDC. So we work closely with all of our state and local health department partners, and those data are included the same way as they are from states where the disease is reportable. Are you concerned at all that you know...

00:24:13 Mr. Haynes

Oh, sorry. Go on. No, you go ahead. I'm sorry. Finish.

00:24:15 Aubrey Whelan, Philadelphia Inquirer

I was going to ask if you were concerned at all that like because of the reporting system in Pennsylvania or other states differs from you know places with a more robust surveillance system that cases here might have an undercount. We border Ohio, West Virginia, you know where there's this outbreak that's connected. I was just wondering if that's a concern that it might be spreading here without a salient.

00:24:36 Dr. Biggerstaff

Yeah, I think that you the states are really actively engaged in this investigation as they are every season, and so I will say that we have great partnerships with our state mobile health department partners, and they are all working very diligently on this. So, the gap in surveillance that that I would like to focus on is actually the gap in people who might not seek care, or when they do seek care, aren't tested, and we have some of that information in our in our HON and on our website as well to really encourage people that if they're experiencing these symptoms, to talk to their doctor about that so they can get tested, so that those cases can be identified and reported and then investigated.

00:25:18 Mr. Haynes

Amanda, we have time for one more question, please.

00:25:22 Operator

Okay, our final question will come from Dryden Quigley with ABC 7. Your line is open.

00:25:28 Dryden Quigley, ABC 7

Hi, thanks for taking this question. What do you have to say to people who are concerned, you know, cooking dinner or anything? Just because I know they said there's no exact foods to avoid. What are you saying? How to reassure people during the time?

00:25:45 Dr. Biggerstaff

I would say the same thing that I say to my friends and family to follow the food safety advice that we have about how to safely prepare food, and to follow the information that we're able to share, and that I know FDA that Dr. Prater has talked about that they'll continue to share as we investigate this. So, as my best advice is to follow our standing food safety practices and guidelines, and to stay aware of the food safety alerts and investigation updates, so that they know what foods are safe and they know how to keep their families safe and protected.

00:26:17 Mr. Haynes

Thank you, Dr. Biggerstaff. I'm sorry, Dr. Prater. Go ahead.

00:26:22 Dr. Prater

No, I think that's good advice. Thank you.

00:26:27 Mr. Haynes

Well, thank you both for your time today, and thank you all for joining us. There will be a transcript and audio file on the CDC media site later today. This will conclude our briefing.

00:26:39 Operator

That concludes today's conference. Thank you for participating. You may disconnect at this time.