Updates on Cyclosporiasis in Virginia
July 17, 2026
Dear Colleague,
This letter provides an update on cyclosporiasis in Virginia.
As of July 4, 2026, VDH has publicly reported 37 cases of cyclosporiasis in 2026. Although this is more than double the 5-year average number of cases reported year to date, there is not currently evidence that Virginia is experiencing an outbreak. This information is preliminary and subject to change as more information becomes available. Cases include people who travelled internationally before illness onset and others who were likely infected domestically. The number of cyclosporiasis cases reported to VDH typically increases in the spring and summer months, and it is expected that case counts may increase in the coming weeks due to the seasonal nature of this illness. Due to the heightened interest in this topic, beginning the week of July 20, 2026, weekly case counts in Virginia will be posted on the VDH Cyclosporiasis webpage.
Several states, including several in the midwestern region of the United States, are currently experiencing a significant increase in cases of cyclosporiasis and some have detected clusters or outbreaks. States are working together with federal partners to investigate these outbreaks. On July 16, the Centers for Disease Control and Prevention (CDC) and the US Food and Drug Administration (FDA) reported that shredded iceberg lettuce served at Taco Bell locations in Indiana, Kentucky, Michigan, Ohio, and West Virginia has been identified as a likely exposure source; consumers should avoid eating shredded iceberg lettuce at Taco Bell locations in these states. For more information on the multi-state outbreak investigations in the United States, visit the CDC Cyclospora webpage.
Cyclosporiasis is a gastrointestinal illness caused by the microscopic parasite Cyclospora. People can become infected by consuming food or water contaminated with the parasite. This illness is not usually spread directly from person to person. Symptoms of cyclosporiasis usually appear within one week after exposure. The most common symptoms include watery diarrhea, which can be frequent, along with loss of appetite, weight loss, bloating, nausea, and fatigue. Less common symptoms include low-grade fever and vomiting. Without treatment, symptoms can follow a remitting-relapsing course that can last from a few days to a month or longer. Untreated illness may last from several days to several weeks and may be remitting and relapsing. Illness can be severe but is not usually life-threatening. Healthcare providers should report cases of cyclosporiasis to VDH.
Stool specimen tests for ova and parasites usually do not include examination for Cyclospora unless such testing is requested. Similarly, not all gastrointestinal polymerase chain reaction (PCR) panels include a target for Cyclospora. Therefore, when evaluating persons with symptoms consistent with cyclosporiasis, specifically request testing for this parasite. If indicated, stool specimens also should be checked for other pathogens that can cause a similar illness.
Most healthy people will eventually recover from cyclosporiasis without treatment, although their illness may be prolonged. Trimethoprim-sulfamethoxazole (TMP-SMX) is the treatment of choice for cyclosporiasis. Consult CDC clinical guidance for more information on recommended dosing.
To reduce the risk of cyclosporiasis, VDH advises people to take the following steps:
- Wash all fruits and vegetables thoroughly under running water before eating, cutting, or cooking.
- Wash hands carefully with soap and water before and after food preparation, and after using the bathroom or changing diapers.
- Travelers, especially to tropical areas, should avoid eating raw or undercooked foods or drinking untreated water.
- Anyone experiencing symptoms of cyclosporiasis should visit their healthcare provider. They can test for Cyclospora and prescribe the correct treatment. Healthcare providers should report cases to the relevant local health department.
- Persons who have been ill recently with diarrhea or vomiting or other gastrointestinal illness and believe it might be related to a restaurant or other food establishment, can report illness to My Meal Detective, an online reporting system that allows persons to file a foodborne illness report. The health department will examine the report, investigate if needed, and capture real-time information about what is going on in the community.
On behalf of the entire VDH team, thank you for your partnership, dedication, and determination in keeping Virginians safe and healthy.
Sincerely,
B. Cameron Webb, MD, JD
State Health Commissioner