DOH CONFIRMS FIFTH CASE OF CYCLOSPORIASIS

HONOLULU - The Hawaiʻi Department of Health (DOH) has confirmed a case of cyclosporiasis in a member of the military based in Hawaiʻi.

The individual traveled internationally to a country where cyclosporiasis is endemic and also traveled to a U.S. state that has reported increased cyclosporiasis cases before developing symptoms. The individual was tested in Hawaiʻi. Based on the information currently available, it is not yet known whether the infection was acquired in Hawaiʻi or while traveling. DOH is continuing its investigation, and the risk of cyclosporiasis to the public in Hawaiʻi remains low at this time.

This case brings Hawaiʻi's total number of cyclosporiasis cases in 2026 to five. Four of the cases are confirmed, with one probable case. The latter case was previously identified incorrectly as confirmed. The first case involved a nonresident visitor whose infection was acquired outside of Hawaiʻi. The second and third cases involved two Hawaiʻi residents who traveled internationally. The fourth case involved a member of the military based in Hawaiʻi who had also traveled internationally before becoming ill.

At this time, DOH has found no known epidemiological connection between the fourth and fifth cases. The individuals have no known contact with each other or other direct connections. DOH is continuing to investigate both cases.

DOH is also investigating a low-level detection of Cyclospora in wastewater at the Hilo Wastewater Treatment Plant, which serves approximately 32,500 people. The detection was confirmed by metagenomic sequencing performed at the University of Missouri. Wastewater detection alone does not establish that Cyclospora infection is present in the community, identify a source of infection, or indicate that the detection is related to any of the confirmed or probable cases. DOH is actively investigating and monitoring the finding as part of its ongoing surveillance.

Federal, state and local health officials continue to investigate a multistate outbreak of Cyclospora infections linked to iceberg lettuce processed by Taylor Farms de Mexico. Epidemiologic and traceback data showed that iceberg lettuce from the company's central Mexico facility was contaminated with Cyclospora and made people sick. Taylor Farms de Mexico initiated a recall of all iceberg lettuce sourced from central Mexico on July 17, 2026. Most illnesses associated with the outbreak began before the recall. As of Aug. 13, the outbreak includes 9,481 illnesses reported from 17 states.

No recalled iceberg lettuce was identified as being distributed to or sold in Hawaiʻi and no cyclosporiasis cases reported in Hawaiʻi have been linked to the recalled iceberg lettuce. Additionally, the best-by dates for the recalled products have passed and the products should no longer be available in stores or restaurants in states where they were distributed. CDC is also investigating other outbreaks and illnesses of cyclosporiasis nationally that are unrelated to this outbreak.

Cyclosporiasis is an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis. Eggs of the parasite shed in the feces of infected persons must mature outside the host, in the environment, before they become infectious to another person. People become infected by consuming food or water contaminated with the parasite. In the United States, outbreaks have most often been linked to certain fresh produce items. The illness is not typically spread directly from person to person.

Symptoms usually begin about one week after exposure but can appear anywhere from two days to two weeks later. The most common symptom is frequent, watery diarrhea. Other symptoms may include loss of appetite, weight loss, stomach cramps or bloating, nausea, increased gas, fatigue and less commonly, vomiting or low-grade fever. Without treatment, symptoms may last for several weeks or longer and can come and go.

The DOH routinely investigates reportable diseases to identify potential sources of infection and monitors for any signs of local transmission.

People can help reduce their risk of cyclosporiasis by:

• Washing hands thoroughly with soap and water before preparing or eating food and after using the restroom.
• Washing fresh fruits and vegetables under running water before eating, cutting or cooking them.
• Following safe food handling practices when preparing meals.
• Seeking medical care if they experience prolonged or severe diarrhea, particularly after recent travel or eating fresh produce from an area associated with an outbreak.

Cyclosporiasis is treatable with prescription antibiotics. Individuals experiencing persistent diarrhea should contact their healthcare provider. Healthcare providers who suspect cyclosporiasis are encouraged to report cases to DOH and submit appropriate specimens to commercial laboratories for testing.

DOH will continue to monitor for additional cases and work closely with healthcare providers and public health partners to protect the health of Hawaiʻi residents and visitors.

For more information about cyclosporiasis, visit the Hawaiʻi Department of Health Disease Outbreak Control Division website.

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