A massive cyclosporiasis outbreak linked to shredded iceberg lettuce has expanded to an additional six states, according to a source familiar with the matter. The outbreak, caused by a microscopic parasite found in human feces, is responsible for hundreds of hospitalizations and two deaths since early May.

Affected States

The newly linked states — Arkansas, Iowa, Missouri, Nebraska, New Hampshire, and North Carolina — join Illinois, Indiana, Kansas, Kentucky, Michigan, Ohio, Oklahoma, Pennsylvania, and West Virginia. The Missouri Department of Health and Senior Services has reported 1,095 cases as of Sunday — more than double the number of cases it reported last week.

The Centers for Disease Control and Prevention’s update marks a significant expansion in the outbreak of cyclosporiasis, a foodborne illness that often leads to watery, sometimes explosive, diarrhea. The majority of the cases have been traced to lettuce at Taco Bell that was supplied by Taylor Farms and sourced from central Mexico.

Last month, the produce giant issued a voluntary recall of all iceberg lettuce supplied from central Mexico, which the company said was distributed to restaurants and retail stores in 27 states. The Food and Drug Administration hasn’t yet identified other potential sources beyond Taylor Farms.

Investigation and Response

Dr. Stephen Ostroff, a former acting FDA commissioner, said the key question about the newly added states is when their patients became sick. The recalled Taylor Farms lettuce should no longer be available in the U.S., and its use-by dates ended Aug. 3, Ostroff said. If people were exposed after that, investigators may need to look for another source.

More than 22,000 people have confirmed or suspected cyclosporiasis, and 517 people have been hospitalized in the multistate outbreak, the Centers for Disease Control and Prevention said late Tuesday. On Monday, health officials in Michigan — which has the most cyclosporiasis cases — confirmed the first deaths linked to this outbreak in the United States. Both people had underlying health conditions that may have been affected by the virus and dehydration, the officials said.

Original reporting: NBC Connecticut — read the source article.