1178: Lessons from Michigan's Cyclospora Outbreak Response

JOHN SHEEHAN: 

This is Public Health Review Morning Edition for Monday, August 3, 2026. I'm John Sheehan with news from the Association of State and Territorial Health Officials.

 

Timely, transparent communication can shape the course of a public health emergency long before every answer is known. Today, Chief Medical Executive for the State of Michigan and ASTHO member Natasha Bagdasarian tells us about Michigan's response to one of the nation's largest cyclospora outbreaks. She explains how state officials used early surveillance data to warn the public before a product recall was issued, worked closely with healthcare systems to expand testing capacity, and tailored public messaging to Michigan's unique outbreak. We spoke with her on July 29. Dr. Natasha Bogdasarian, welcome back to the show.

 

NATASHA BAGDASARIAN: 

Thanks for having me on.

 

SHEEHAN: 

So, what is the current state of the cyclosporiasis outbreak?

 

BAGDASARIAN: 

Well, I can really only speak for the state of Michigan, and I can only really answer based on data that we have here in Michigan. But what I can tell you is that we have over 10,000 laboratory-confirmed cases right now. We have interviewed almost half of those cases, and you know we continue to compile that data and send it in to the federal government. But I do anticipate, and I'm seeing early signs that a slowdown is likely coming soon.

 

SHEEHAN: 

Good news. When did you realize that this was becoming a larger public health event?

 

BAGDASARIAN: 

Well, we started seeing some signals at the very end of June. We had more cases than are normally reported in a single week, and so we were flagging this quite early for the general public and making sure that the public knew there was something happening, as well as our partners at the federal level. So, we got CDC and FDA involved again at the end of June. Now, we started issuing alerts to the public starting in July. So, July 1, we issued some guidance around the outbreak and around some specific food safety precautions, and then July 4 is when we really started talking about avoiding bagged lettuce. July 13, we added some additional information again, telling people to really focus on lettuce.

 

SHEEHAN: 

Yeah, and I remember those early messages as well. Just sort of hearing them out in the world and thinking, "Uh-oh, that could be serious". Has there has there been progress on identifying the source?

 

BAGDASARIAN: 

Well, you know, it's interesting because usually the type of investigation that happens at the state level is really done for hypothesis generating, and that data is given to the feds. It's given to the CDC and to the FDA, who then compile this data, look at national trends, do traceback efforts, and try to identify a single contaminated product. In this case, we've really used the data in a way that is a little bit novel, in that we've used our data because we have simply so many cases to inform the public early. So even before there was a specific product recall, we knew that there was a signal around a certain type of food, and I think you know our rule of thumb has been we want to give people the same advice that we have access to. We want to give people the same advice that we're giving to our family and friends, and that's why this level of transparency has been so key. But yes, we have seen these signals around lettuce from the early days when we started advising the public. Yes, there has been a recall specific to lettuce at the federal level, but there is a lot happening right now nationally, and it's complicated because there are different outbreaks happening in different states, and it's also possible that not all of our cases here in Michigan are related to bagged lettuce, and so it's possible that there are other contaminated products out there in my state still.

 

SHEEHAN: 

Of course. And compounding that complicated scenario, the symptoms for cyclospora can seem like a lot of different gastrointestinal issues. It's hard to pin down what exactly is the cause. What can health departments learn about how to recognize and test for and respond to these specific outbreaks from this this kind of bacteria earlier?

 

BAGDASARIAN: 

Well, you know, I think a lot of this has been working with healthcare because healthcare systems have been seeing a majority of these cases, and these numbers are just so large. Again, over 10,000 cases in just my state alone, and so making sure that we are having communication with our healthcare systems and partnering with them has been really important. So, making sure that number one, they knew that this was happening and could prepare their labs, that meant buying additional reagents. We had heard early on that some labs were running out of reagents, and some labs just simply had a backlog and they couldn't handle all of these specimens. So, that communication was really important in making sure that our health systems were prepared. Then, as health systems have started to streamline their testing, and some of them have come up with algorithms so that they're not testing everyone. They've come up with some decision making around who to test, and those have typically been people who are immunocompromised, people with very severe illness. But we have to make sure that we're still capturing enough cases and a variety of cases, so that our traceback efforts can continue. And so, having that communication with them has been really important as well. So, I think for health departments, the key has been having those conversations and relationships with health systems.

 

SHEEHAN: 

Another important aspect of communication has been how you've communicated with the public. You mentioned those earlier messages getting out ahead of the outbreak, you know, in early days. What's the playbook for communicating to the public when the situation is still pretty murky?

 

BAGDASARIAN: 

You know, I think that this is something that public health has struggled with in the past. I think we have to be able to communicate when there is uncertainty. I think we have to be able to say "this is what we know so far, and of the cases we've interviewed, the data is telling us this, but things could change", and that's what we've really tried to do. What has been really complicated in this particular incident is, you know, we're hearing a lot from other states as well that are nowhere near in the position that Michigan is in. There is no other state in the country that has over 10,000 cases right now, and so I think for situations like this, it's very important to have state-specific communication. When I am making recommendations about bag lettuce, those recommendations are really based on what I am seeing here in the state of Michigan, and I think are tailored towards my population, to my communities, and may not apply to folks in California or you know folks in Florida. And so I think either having some sort of national communication strategies would be helpful in a situation like this, or every state needs to make sure that they are being just as transparent and just as proactive in telling their residents what they need to know about cyclosporiasis or any other disease in their state. Because I feel I have been providing data and guidance to the people in Michigan based on the data I'm seeing before me, but that that information doesn't necessarily apply to what's happening in North Carolina or Kentucky or other parts of the country.

 

SHEEHAN: 

Sure. So, how does that interstate collaboration work when you're you know looking at just your set of data?

 

BAGDASARIAN: 

I think it's been really difficult. I make sure that every time I'm talking on a national platform that I say I can only answer about Michigan. I cannot tell you about any other state. I don't have access to any other state's data, and I think this is why it's so important for us to have some sort of federal collaboration, some sort of federal public health infrastructure that can get everyone on the same page. I think it's just so important. We know that there are public health communicators out there who are trying to communicate over a you know a broad geography, and it's challenging because this is so nuanced. And again, we may be dealing with multiple somewhat overlapping outbreaks, and guidance in each state may be slightly different, so there is a true communications challenge here. And I don't know that one state necessarily has the answer to this, but what we need again is some sort of infrastructure to have combined messaging to have something that could be applicable nationally, and then we can put out our own tailored individual messaging.

 

SHEEHAN: 

And so, related to that, you know, each outbreak I'm sure brings with it you know lessons learned for health departments, in this case, it sounds like broader communication efforts could be necessary. But what would you say have been some lessons learned from this?

 

BAGDASARIAN: 

You know, I think that I truly believe in the power of proactive messaging. I think that we are already seeing a loss of public trust in public health. We're seeing a loss of public trust in national and state government, and I think that the least I can do, or the least my state can do, is put out accurate, timely information and share whatever data we have. I simply think it would be unfair if I had separate guidance that I was giving to my mom or my sister, for example, and not giving it to the rest of the community here in Michigan. So, that's really how we have tried to lead is with that level of transparency and that level of openness. I don't think that it is something that exists always in public health, and you know we'll have to see how this goes. So far, I think Michigan has been getting a lot of national applause or kudos for being so open and transparent and communicating in real time. But we'll have to see if these or if this is appreciated at the end of this outbreak.

 

SHEEHAN: 

And not to signal victory too soon, but it sounds like we might be on the downside of it. Any final thoughts as you look back at this experience?

 

BAGDASARIAN: 

You know, I think that I'll speak just a little bit about looking at coming out of this. I think that the end is likely in sight. You know, we are not only seeing a downtrend in our syndromic data for diarrheal illness, but we're also seeing that even the cases that are being reported to us, because we're still getting about 400 cases a day, even the cases that are being reported to us are now older. These are individuals who have onset typically before July 16. So that tells me that there was a level of success in terms of removing product from shelves, or getting people to stop eating contaminated products, or having people take more precautions, and so there's still more that we can sort of parse out of the data, and I believe that some of those really early interventions we made, some of the interventions we made on July 1 and on July 4, had real tangible impact, and resulted in this downtrend that we're seeing now, because again, this is a disease that has an incubation period of up to two weeks, and so those interventions we were making way back at the beginning of July, asking folks to avoid eating bad bag lettuce, for example, asking them to make sure that they were buying whole heads of lettuce and removing the outer leaves, we made the same recommendation to restaurants and commercial kitchens, and they removed product voluntarily from their shelves. And so I think those interventions that happened very early on, in early July, we're now seeing the effects of, and so I'm pleased by how we handled it. I'm not pleased that we had an outbreak that impacted 10,000 people in my state. I'm not pleased that so many people have been hospitalized and have suffered consequences. But I am really pleased that we could lead with integrity, with transparency, with using the data to inform the public really early, rather than just waiting and sitting on our hands and waiting for a recall, and so I'm really proud of the work that we've done here.

 

SHEEHAN: 

Dr. Natasha Bagdasarian is chief medical executive for the state of Michigan and an ASTHO member.

 

The cyclosporiasis outbreak has captured national attention. You can read more about it in the recent ASTO article, "Tracking Cyclosporiasis: Understanding the Current Outbreak, Case Investigations, and Preventive Efforts. Additionally, ASTHO President Manisha Duthani and Chief Medical Officer Susan Kansagra were also featured in recent reporting by The Hill and The Guardian, respectively, as these national news outlets sought expert voices in their coverage of the outbreak. Find links to all of those articles in the show notes.

 

The ASTHO Infectious Disease Preparedness Program Planning Workbook offers a structured framework to strengthen infectious disease readiness. It guides stakeholders at all levels through identifying gaps, mapping interest holders, prioritizing solutions, and developing plans that are both actionable and measurable. The result is coordinated action, continuous improvement, and effective response to outbreaks and emerging health threats. Find it at the link in the show notes.

 

This has been Public Health Review Morning Edition. I'm John Sheehan for the Association of State and Territorial Health Officials.