Public health nurse investigates 900+ Cyclospora cases in Michigan county

Federal funding cuts complicate local outbreak response, health officials say

Linda Kim, a public health nurse at the Washtenaw County Health Department in Michigan, has been helping to investigate the more than 900 cases of cyclosporiasis in the county since mid-June, according to a report from NPR and KFF Health News. Kim has spoken to more than 100 patients, most of whom describe the illness as excruciating, she said.

Foodborne illness investigations are complex, especially for the Cyclospora parasite, because symptoms may not appear for up to two weeks after someone has eaten contaminated food. Kim and her colleagues ask patients to pull up restaurant receipts, scroll through grocery store app purchases, and recall details such as the exact brand of bagged salad mix or the type of taco they ordered.

Kim said that unlike the measles contact tracing she did earlier this year, where people were suspicious and reluctant to share information, Cyclospora patients have been eager to divulge graphic details of their symptoms, including reports of soiling their beds. She said she tries to keep each conversation to under an hour.

The Washtenaw County Health Department had also been dealing with a measles outbreak that sickened seven people in the county, five of them children, which ended in late May. Kim was transferred to help with that outbreak in March, and the department operated on overtime.

In early 2025, the Trump administration’s sweeping cuts to public health grants eliminated a contract between the Michigan Department of Health and Human Services and 44 of the state’s 45 local health departments, a contract that funded 123 full-time employees, according to Laina Stebbins, a spokesperson for the state health department. Some funding was restored after Michigan won a temporary restraining order, but Washtenaw’s health department still scaled back disease surveillance and outbreak response work. Employees who leave or retire are not replaced, except for those on the nursing team, which remains understaffed.

The county’s Health Equity Council, which aimed to reduce health disparities, was shuttered suddenly in early 2025. Nearly a year later, it resumed its work with funding at least through September 2026.

An employee from the Centers for Disease Control and Prevention who had been stationed at the department was fired, rehired, and then furloughed during the funding chaos, according to the report.

Christina Zilke, a nursing supervisor at the Washtenaw health department, said the federal response to cyclosporiasis has felt frustratingly slow. “It took them forever to say that this was lettuce, and fast food restaurants were taking it off the shelves before the CDC ever said what it was,” she said.

Gwen Biggerstaff, Deputy Director of the CDC’s Division of Foodborne, Waterborne, and Environmental Diseases, said during a July 14 press call that it is not unusual for it to take a long time to identify a specific source for cyclosporiasis, partly due to the lag time between exposure and symptoms and the complexity of tracing the parasite.

Zilke has been stocking the coffee station and bringing in pizza to maintain staff morale, describing it as “food for survival” and a break so employees don’t quit.

Kim said the experience has been a surreal introduction to a public health career: first measles, now Cyclospora. “If nationally they don’t know what’s going on, how are we locally expected to know what’s going on?” she said. “And also just frustrating to be like, ‘Wow, I don’t think even our government knows how important public health is.’”

The Washtenaw County cases are part of a larger multistate outbreak. MSI previously reported that the Cyclospora outbreak had reached 4,173 confirmed cases across 41 states as of July 24, with Michigan accounting for the largest share of infections.