Department of Health confirms 2 new travel-related cases of Cyclospora in Hawai‘i residents

The Hawaiʻi Department of Health has confirmed two additional cases of cyclosporiasis in Hawaiʻi residents who traveled together internationally and to a U.S. state that has reported a cyclosporiasis outbreak.

These cases bring the total number of confirmed cyclosporiasis cases reported in Hawaiʻi in 2026 to three. The first case involved a nonresident visitor. All infections were acquired outside of Hawaiʻi, according to the Department of Health.

“Although these two cases involve Hawaiʻi residents, they were exposed while traveling outside the state,” said State Epidemiologist Dr. Sarah Kemble. “There is no evidence of local transmission in Hawaiʻi and the risk to the general public remains low.”

Cyclosporiasis is an intestinal illness caused by the microscopic parasite Cyclospora cayetanensis, according to a news release from the Department of Health. Eggs of the parasite are shed in the feces of infected persons must mature outside the host, in the environment, before they become infectious to another person.

The parasite has been linked to shredded Iceberg lettuce at Taco Bell served in Indiana, Kentucky, Michigan, Ohio and West Virginia.

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.

The two individuals recently infected in Hawai‘i are members of the same household. Based on their travel history, symptom onset and the known incubation period following exposure to the parasite.

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.

Kemble encourages anyone experiencing persistent diarrhea after recent travel to seek medical care.

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.

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