For residents of Alabama, ordering fast food has become a gamble due to "lettuce-gate" — the internet's shorthand for a multistate outbreak of the severe diarrhea-causing parasite cyclospora associated with shredded lettuce.
Earlier this month, officials announced that a five-state outbreak of cyclosporiasis, an intestinal infection, has been linked to shredded iceberg lettuce supplied by Taylor Fresh Foods and used in Taco Bell menu items.
The fast-food chain has since removed the affected lettuce from its local restaurants and national supply chain, and Taylor Farms has issued a nationwide recall of iceberg lettuce sourced from Mexico. Sysco, the nation's largest food distributor, withdrew all Taylor Farms iceberg lettuce from Mexico at the supplier's request.
On Friday, the Food and Drug Administration expanded the number of states with illnesses linked to the recalled Taylor Farms iceberg lettuce to include Kansas, Oklahoma, Pennsylvania, and Illinois. These states join five other states — Michigan, Ohio, Indiana, Kentucky, and West Virginia — that have reported illnesses linked to the iceberg lettuce from central Mexico.
The agency said it expects to "continue to see the number of confirmed cases rise, despite the recall, due to the fact that it can take as long as six weeks for CDC and state officials to determine if a sick person is part of this outbreak."
Cyclospora cases rise annually in the U.S. during spring and summer, particularly from May 1 to Aug. 31, with regular outbreaks since the mid-1990s. However, 2026 is notable for an unusually high case count, including 1,947 illnesses linked to one specific source, compared to just 249 confirmed cases at this time last year.
A Friday CDC update reported 4,173 laboratory-confirmed, domestically acquired cases since May 1, with over 7,400 more awaiting analysis, heavily concentrated in Michigan and Ohio.
As of July 20, there have been 28 reported cases of cyclosporiasis in Alabama, according to the Alabama Department of Public Health (ADPH)
Of these cases, ADPH says 22 (78.6%) are in the Northern District, 2 (7.1%) are in the Southwestern District, and 1 (3.6%) each is in Mobile, Northeastern, Southeastern, and West Central Districts.
State health officials pointed out that only two cases have required hospitalization, and there have been no deaths.
ADPH also reported that four cases (14.3%) are related to international travel and eight cases (28.6%) are associated with two separate foodborne outbreaks at Mexican-style restaurants — not Taco Bell.
The cyclospora outbreak is hurting lettuce sales and restaurant traffic, with visits dropping at Taco Bell and several salad-focused chains, CBS News reported.
Here's what Alabama residents should know about safely ordering fast food:
In its July 17 statement, Taco Bell said it acted voluntarily "out of an abundance of caution" and urged other restaurants, retailers and food-service operators that received the lettuce to do the same.
The Jack in the Box burger chain told Consumer Reports it learned of the potential issue with the lettuce before the FDA's July 17 announcement and immediately notified restaurants that had received the product to remove it. There have been no known cyclosporiasis illnesses associated with food served at Jack in the Box, the company said.
Chipotle told Restaurant Business Online that it is aware of the cyclospora investigation but doesn't believe any of the ingredients used in its menu items are associated with the illnesses. The company said its romaine lettuce and Supergreens salad mix are not sourced from Mexico
A Qdoba spokesperson told the outlet there is "no data suggesting any connection between Qdoba restaurants and the reported cases."
Wendy's said its restaurants were not affected by the outbreak, according to a Reuters report.
Subway, KFC and Pizza Hut received the recalled lettuce in Alabama, the state's public health department said, adding that more businesses are likely to be added.
Restaurant customers need to be their own health advocates, food safety experts say.
"The big thing right now is going to be awareness — when you're at the restaurant, if you're going to be ordering something, especially like shredded lettuce, talking with your server and just asking them where they get their lettuce, how it is prepared," Michigan State University Extension food-safety specialist Wade Syers told ABC News.
Those seeking the lowest-risk option can skip raw lettuce and choose menu items with cooked vegetables, because cyclospora is killed at temperatures of at least 158 degrees.
Syers also recommended checking restaurant health grades and following public-health updates because the recall and outbreak information is changing quickly.
Cyclosporiasis infections most often occur when people consume food or water contaminated with feces. The cyclospora parasite is commonly transmitted through contaminated produce.
While lettuce is at the center of the current investigation, no single brand or product has been blamed for all cases. Raspberries, basil, cilantro, snow peas and mesclun lettuce have been linked to previous cyclosporiasis outbreaks — notably one in 1997 that sickened 1,000 people in North America linked to Guatemalan raspberries and a 2019 outbreak linked to Mexican basil that sickened more than 2,400.
The CDC recommends logging restaurant visits, as symptoms typically manifest about a week following exposure.
These may include watery diarrhea, stomach cramps, bloating, nausea, fatigue, and a loss of appetite. Some individuals might also experience a low-grade fever, vomiting, headaches, or body aches.
For a faster recovery and to prevent further complications, it is advisable to get a medical evaluation if symptoms persist. Contact a doctor if your symptoms worsen, continue for more than a few days, or if you run the risk of becoming dehydrated.
Sign up for free local newsletters and alerts for the
Across Alabama Patch
Patch.com is the nationwide leader in hyperlocal news.
Visit Patch.com to find your town today.