Washtenaw County Battles Cyclosporiasis with Limited Resources

Linda Kim, a nurse at the Washtenaw County Health Department in Michigan, is on the frontline of a challenging public health investigation. She is involved in probing over 900 cases of cyclosporiasis in the area. Cyclosporiasis is a complex foodborne illness caused by the Cyclospora parasite. Its complexity arises because symptoms might not manifest until two weeks after consuming contaminated food.

Since mid-June, more than 900 residents of Washtenaw County have fallen ill from cyclosporiasis. Kim, as a public health nurse, has spoken to more than 100 affected individuals. Most describe the illness as excruciating, among the worst they have encountered. Kim even recounts calling a man who jokingly appreciated the weight loss effect of the illness, welcoming its recurrence.

From Crisis to Crisis

Linda Kim typically works in the clinic, administering free or low-cost immunizations to waiting families. However, her duties shifted to another department in March, when seven people contracted measles in the county. The outbreak, which included five children, demanded immediate attention, leading to overtime work for the staff.

In response, the state issued an advisory, urging families in Washtenaw and nearby counties to vaccinate their infants aged six months or older ahead of schedule. Kim describes the contact-tracing process for measles as contentious. People often questioned her knowledge of their test results and hesitated to share information, fearing restriction of their freedom. She emphasizes that the aim was to contain the contagious virus.

Contrastingly, cyclosporiasis patients have been more forthcoming, volunteering explicit details about their gastrointestinal distress. Their eager disclosures enable Kim and her team to delve deeper into the investigation. She notes the contrast with the measles contact tracing, where individuals were more skeptical.

The local measles outbreak concluded in May. By June, reports of cyclosporiasis surfaced, with over 10,000 cases identified across Michigan. Linda Kim addresses the distinct nature of cyclosporiasis surveillance, where people readily disclose graphic illness details.

Investigating Foodborne Illness

Investigating foodborne illnesses, especially those related to Cyclospora, is notoriously complex. Symptoms appear weeks after ingesting contaminated food, complicating recollection of food consumption. Public health staffers conduct thorough interviews, asking questions like recalling detailed purchase history and pinpointing specific brands.

Kim and her team, with laptops decorated with humorous stickers, hold interviews with residents to reconstruct possible exposure scenarios. They request restaurant receipts and even details like whether the Taco Bell taco was crunchy or soft.

Challenges Amid Funding Cuts

Linda Kim has worked at the health department for two years, witnessing the impact of federal funding cuts. The Trump administration reduced public health grants significantly, terminating contracts between the Michigan Department of Health and Human Services and local health departments. This led to a reduction of 123 full-time positions, affecting disease surveillance labs and lab equipment maintenance funding.

Some funding was restored after Michigan obtained a temporary restraining order against the administration. Despite this, the Washtenaw County Health Department has scaled back its disease surveillance and outbreak response efforts. Departing employees are seldom replaced, except within the nursing team, which remains understaffed despite active hiring efforts.

The local Health Equity Council, aimed at combating health disparities, was abruptly shut down in early 2025, resuming operations a year later with temporary funding until September. During funding chaos, a Centers for Disease Control and Prevention (CDC) employee stationed at the department faced employment disruption.

Slow Federal Response

The federal response to cyclosporiasis has been perceived as sluggish, notes Christina Zilke, a nursing supervisor. It took significant time for the CDC to identify lettuce as a source, despite fast food restaurants withdrawing it from shelves earlier.

Gwen Biggerstaff from the CDC highlights difficulties in pinpointing cyclosporiasis sources. The delays result from symptom lag times and tracing complexities. In the meantime, Zilke promotes morale by providing snacks and pizza, focusing on staff sustenance rather than rewarding them for persistent efforts.

Linda Kim remains passionately engaged, despite facing surreal public health challenges. She expresses frustration at national shortcomings in comprehending public health importance. Kim focuses on moving efficiently from one call to the next, offering her number for follow-up inquiries.

KFF Health News specializes in in-depth health journalism, serving as an independent source for health policy research, polling, and journalism.