By Julie Steenhuysen and Tom Polansek
CHICAGO, July 25 (Reuters) - Two weeks before the U.S. Centers for Disease Control and Prevention issued its cyclosporiasis health warning on July 14, Michigan warned of an unusually large outbreak of parasitic disease that was causing explosive diarrhea.
New cases are still being reported in the nine-state outbreak. Michigan is the hardest hit, with more than 8,100 cases.
The state is straining to keep up with the caseload in part due to federal funding cuts, as well
as what officials in two counties and a third source familiar with the state's response called lagging or limited communication from federal agencies.
As a result, state and county health officials are borrowing staff and recruiting volunteers to sleuth out potential causes for the outbreak beyond the bagged lettuce that has been linked to Taylor Farms and Taco Bell, Michigan state and local health officials said in interviews.
The strain illustrates how states are struggling to get ahead of a fast-spreading foodborne outbreak without the federal resources that have been available in past health emergencies.
Michigan has 23 fewer infectious disease workers and 123 fewer county health staff after the Trump administration in 2025 canceled around $12 billion in COVID-era grants to states.
"We have had to pull in dozens of staff from other areas, from hepatitis C and interns who are working on gun violence prevention," said Dr. Natasha Bagdasarian, Michigan's chief medical executive.
Ingham County, which includes most of the state capital of Lansing, has reported about 700 cases.
However, its health department's staff of five nurses has only investigated about half of those. It has decided to drop old cases and focus on new ones, said Anne Barna, deputy health officer for Ingham County, which has a population of 290,000.
"That way we can try to help the state and the feds understand what is still causing people to get cyclospora," she said.
Cuts to federal agencies have made the response more challenging, former CDC officials and food safety experts said.
The Trump administration's cuts to the U.S. Agency for International Development also cut $40 million in funding that supported a CDC lab that investigates parasitic diseases. Resignations and staffing cuts last year have also taken a toll, said Dan Jernigan, a former senior CDC official.
COMMUNICATION LAG
The U.S. Food and Drug Administration on July 17 linked the outbreak to iceberg lettuce served at Taco Bell restaurants sourced from privately held Taylor Farms' operations in central Mexico. The agency says it is still investigating other sources.
Taco Bell, owned by Yum Brands, has stopped using iceberg lettuce supplied from Taylor Farms nationwide, and Taylor Farms has removed lettuce sourced from central Mexico from shelves.
The CDC has reported 4,173 laboratory-confirmed domestic cases of cyclosporiasis and said there are more than 7,400 unconfirmed cases nationwide.
Michigan's investigation did not identify a single fast-food chain as a source, Bagdasarian said. She noted about 12% of patients have no clear link to having consumed lettuce or eaten at a fast-food chain.
In past outbreaks, the CDC has taken a leadership role in coordinating information among states, the officials said. The state then passes information along to local health departments. But Ingham County's Barna said there were several instances where she first learned new information from the news.
Typically states involved in a large outbreak would be meeting with the CDC at least weekly, said John Besser, a former CDC food safety expert.
While Michigan has received prompt answers to technical questions put to CDC and the FDA, they are not having regular, formal meetings with their federal partners, said a source familiar with the state's response, who was not authorized to speak publicly.
A spokesperson for the U.S. Department of Health and Human Services rejected that characterization, saying the CDC was meeting daily with FDA and state officials nationwide to share updates and gather information about the outbreak.
Spokespeople for Ohio and West Virginia, both of which are part of the nine-state outbreak, said they had been having regular calls with federal agencies. The CDC sent a group of epidemic intelligence experts to Ohio on July 22 for three weeks, the HHS spokesperson said.
LABOR INTENSIVE
Because cyclospora, the parasite involved in the outbreak, cannot be traced using advanced testing methods, states rely largely on labor-intensive interviews that can take up to 45 minutes each.
In Oakland County, which has nearly 1.3 million residents, a team of four communicable disease nurses and three epidemiologists is handling interviews. As of July 24, they had reported 710 cases.
During the COVID pandemic, Oakland County's health department had 12 additional staff members to help with outreach, said Kate Guzman, county health officer. That included four other nurses who were let go this past spring, she said.
The county has pulled in nurses from its hepatitis C and HIV programs to help with outreach.
Guzman said the state health department was passing along as much information as possible to local health departments, but she said she believes the state often lacks details from federal partners.
Staff at the Washtenaw County Health Department are investigating more than 770 cases, leaving less time for dealing with other illnesses or clinic appointments, spokesperson Susan Ringler Cerniglia said.
The outbreak feels mysterious because it is large and officials do not have definitive answers for what is causing it, she said.
"We've got this huge volume (of cases) and so many people working on it and it's not getting clearer," Ringler Cerniglia said.
In rural Shiawassee County, with a population of about 68,000 people, the health department is bringing in qualified volunteers to help investigate about 450 cases, said Larry Johnson, its director.
"This really just hit us so fast," he said. "It was like, 'Boom, here it is.'"
(Reporting by Julie Steenhuysen and Tom Polansek in Chicago; Additional reporting by Leah Douglas and Yasmeen Abutaleb in Washington; Editing by Caroline Humer and David Gaffen)
