More than 1,000 Washtenaw County residents have been sickened in a cyclosporiasis outbreak that has sent 46 people to the hospital, according to data the Washtenaw County Health Department published Thursday, Aug. 6.

The county's case count stood at 1,021 as of that update. Statewide, MDHHS has recorded 12,485 cases, 279 hospitalizations and two deaths since June, according to its Aug. 6 data. Michigan is the hardest-hit state in a multistate outbreak the CDC has linked to iceberg lettuce from Taylor Farms de Mexico.

On the same day the county crossed the 1,000-case mark, the Michigan Department of Health and Human Services ended its broad recommendation that residents avoid bagged salad mixes. MDHHS chief medical executive Dr. Natasha Bagdasarian said in a press release that new case reports and diarrhea-related emergency department visits are declining, and that most exposures occurred in late June to early July. The contaminated produce is likely no longer on shelves, the department said.

The recalled iceberg lettuce remains off-limits.

Taylor Farms de Mexico recalled all iceberg lettuce sourced from central Mexico on July 17 after the CDC traced the outbreak to lettuce served at Taco Bell locations across 15 states.

MDHHS is shifting from daily to weekly data updates, published Thursdays.

What residents should know

Cyclosporiasis is caused by the parasite Cyclospora cayetanensis, which infects the small intestine. Symptoms typically appear about a week after exposure and include watery diarrhea, stomach cramps, bloating, fatigue, nausea and low-grade fever. The illness does not spread person to person.

The CDC says children, older adults and people with weakened immune systems face higher risk of severe symptoms. The two Michigan deaths involved individuals with significant underlying health conditions.

Treatment requires the antibiotic trimethoprim-sulfamethoxazole, sold under brand names Bactrim, Septra or Cotrim. Without treatment, symptoms can last a month or longer and may relapse.

Local health department response

The outbreak has strained the Washtenaw County Health Department. Public health nurses were pulled from immunization clinic duties to conduct contact-tracing interviews with hundreds of patients, asking them to pull up restaurant receipts and grocery store app purchase histories, NPR reported Aug. 1.

"We have one clear implicated food, but it doesn't explain everything," Washtenaw County Health Department spokesperson Susan Ringler Cerniglia told Reuters on Aug. 3, when the county's case count was 875.

When to seek care

The health department advises anyone experiencing sudden, ongoing diarrhea to contact a health care provider. Severe dehydration is the primary complication requiring emergency care.

Residents can reach the Washtenaw County Health Department at 734-544-6700 or [email protected]. The next statewide data update is expected Thursday, Aug. 13.