FDA Expands Cyclospora Outbreak Investigation to 9 States as Nearly 2,000 Confirmed Cases Highlight Challenges for Health Care Facilities

The US Food and Drug Administration (FDA), working with the CDC and state health departments, has expanded its investigation into a multistate Cyclospora outbreak linked to recalled iceberg lettuce sourced from central Mexico. The outbreak now includes 9 states, with 1,947 laboratory-confirmed illnesses and at least 98 hospitalizations, making it one of the largest Cyclospora outbreaks investigated in the United States. No deaths have been reported.

For infection preventionists (IPs), the outbreak serves as a reminder that foodborne pathogens are not confined to restaurants or grocery stores. Health care facilities, particularly those that prepare or serve fresh produce, must remain vigilant when food recalls involve products commonly used in patient meals, cafeterias, and long-term care settings.

According to the FDA, illnesses included in this investigation are linked to exposure at Taco Bell restaurants and have been reported in Illinois, Indiana, Kansas, Kentucky, Michigan, Ohio, Oklahoma, Pennsylvania, and West Virginia. Illness onset dates range from June 22 through July 20, 2026. Officials expect the case count to continue to rise because it can take up to 6 weeks for investigators to determine whether newly reported illnesses are part of the outbreak.

The investigation prompted Taylor Farms de Mexico to voluntarily remove all iceberg lettuce sourced from central Mexico from the US market on July 17. The recall includes Marketside-brand iceberg salad and shredded lettuce products sold at Walmart, as well as numerous foodservice products distributed to restaurants, institutional kitchens, and other commercial customers. Product distribution has been confirmed across 28 states, underscoring the importance of reviewing food inventories even in states without confirmed illnesses.

For hospitals and other health care organizations, IPs may want to work with dietary services, supply chain teams, and environmental health personnel to verify that recalled products have been removed from inventory and that foodservice vendors are aware of the recall. Although Cyclospora is not spread person-to-person through routine patient care, recognizing foodborne outbreaks remains an important component of infection prevention and public health surveillance.

The FDA also clarified a laboratory finding that briefly created confusion during the investigation. An iceberg lettuce sample initially reported as positive for Cyclospora cayetanensis was later determined to be a false positive after additional laboratory review. The agency emphasized that this does not change the epidemiologic evidence or traceback investigation, both of which continue to implicate shredded iceberg lettuce supplied by Taylor Farms de Mexico.

Cyclospora causes cyclosporiasis, a gastrointestinal illness characterized by prolonged watery diarrhea, abdominal cramping, bloating, nausea, fatigue, weight loss, and decreased appetite. Symptoms may persist for weeks or recur if untreated. Immunocompromised patients are at increased risk for prolonged illness and complications, making early recognition particularly important in hospitals caring for transplant recipients, oncology patients, and others with weakened immune systems.

Although health care-associated transmission is not expected, clinicians and IPs should consider Cyclospora infection in patients presenting with persistent diarrheal illness who have recently consumed fresh produce or eaten at establishments receiving recalled products. Prompt diagnosis not only improves patient management but also supports public health investigations by helping identify additional outbreak-associated cases.

The FDA continues to advise consumers, retailers, restaurants, and institutional foodservice operators not to consume, serve, or distribute recalled iceberg lettuce products. The agency also recommends cleaning and sanitizing surfaces and containers that may have come into contact with recalled products to reduce the risk of cross-contamination.

As traceback activities continue, the FDA cautioned that additional brands, retailers, restaurants, or distribution channels may be identified. For infection preventionists, staying informed about evolving food recalls and maintaining close collaboration with nutrition services and facility leadership can help ensure recalled products do not reach vulnerable patient populations.