By Leanna Coy, FNP-BC
A parasitic infection causing severe diarrhea has affected thousands of people across the United States (U.S.) this year. Cyclosporiasis is an infection caused by food or water contaminated with fecal matter. Infections from this parasite occur every year and happen more often in the warmer months. So far, Oregon hasn’t seen an unusual uptick in cyclosporiasis cases, but is facing a different kind of outbreak.
In April of this year, Oregon’s measles outbreak began and continues to quietly simmer throughout the state. Measles is a highly contagious disease that spreads through the air and settles on surfaces. Successful vaccination programs eliminated this preventable disease from the U.S. in 2000. But measles cases are now at a 35-year high due to growing vaccine hesitancy.
These outbreaks are occurring at a time when the U.S. government is making cuts to public health. At the same time, there is a decline in Americans’ trust in government agencies that work to keep them healthy. These overlapping issues are challenging the dedicated people in the public health system.
The Outbreaks, By the Numbers
Cases of cyclosporiasis have surged since last May. The Centers for Disease Control and Prevention (CDC) is reporting over 18,200 confirmed and suspected cases as of July 29, 2026. The highest rates of infection are in 5 states: Michigan, North Carolina, Ohio, Kentucky, and West Virginia. Michigan has the greatest surge with 10,077 reported cases and 160 hospitalizations. Typically, the state reports only about 50 cases a year. Two people in Oregon have tested positive for the outbreak strain of cyclosporiasis. They contracted the parasite while traveling to affected areas. Still, with only 23 cases reported, Oregon is on track for its usual number of events.
Cases of cyclosporiasis, tracked by the CDC and other state and federal agencies, are trending higher than usual. Many of the current cases are tied to pre-packaged iceberg lettuce from Taylor Farms. The Food and Drug Administration (FDA) is currently investigating four different outbreaks in multiple states. There are likely many smaller outbreaks occurring as well.
Nationally, measles numbers are also rising. As of July 24, 2026, the CDC reported 2,318 confirmed cases with 35 new outbreaks. Compare this to 2025, when the total number of confirmed cases topped out at 2,289 with 48 outbreaks. In 2024, there were only 285 cases and 16 outbreaks. Oregon’s measles outbreak that began in April currently has 35 cases, with two reported hospitalizations. These are more than the 31 measles cases reported in Oregon throughout last year. With outbreaks, the majority of the ill have not received a measles vaccination.
Even with the numbers trending higher, the reported measles cases are likely low. One issue is that the CDC only reports lab-confirmed cases, not probable ones. This means when someone becomes ill but does not seek care, they’re not counted in the total number of cases. Oregon and the CDC track measles and other diseases in wastewater. This tracking shows evidence of more infections.
According to Dr. Dean Sidelinger, Oregon’s State Health Officer, “Detection of measles in wastewater has occurred in multiple counties where we haven’t had a reported case.” Sidelinger states that when measles is detected in wastewater, there is a high confidence that someone in that area had measles. But even wastewater detection isn’t perfect. It misses those who use septic systems. Also, in densely populated areas, the levels may be too diluted to detect.
The growing number of children who aren’t fully vaccinated when they enter school is driving the rise in measles cases. Most families stay up to date with vaccines, but exemption rates are rising. Ten years ago, the number of kindergarteners not fully vaccinated in Oregon was 4.9%. In the 2025-2026 school year, it was 9.4%, with overall childhood vaccine exemptions at a record high of 10.9%. “A parent who chose not to vaccinate their child three years ago made that decision in a very different time,” says Sidelinger. “There was very little measles and less chance for exposure if they weren’t traveling to another country. Things have changed dramatically in this country and in this state.”
What Actually Changed at the Agencies
The Oregon Health Authority (OHA) projects a $9.4 billion funding shortfall due to HR1. HR1, also known as the One Big Beautiful Act, enacts federal budget cuts to reduce Medicaid spending over the next 10 years. The funding cuts will cause about 17 million Americans to lose their healthcare. Medicaid works as a partnership between the federal government and the states.
“We receive a tremendous amount of federal funding and are very dependent on that federal funding,” says Sidelinger. In Oregon, the federal government finances 70% of the Oregon Health Plan (OHP), Oregon’s Medicaid program. OHP currently covers 1.4 million children and low-income adults. In addition to Medicaid cuts, there is concern for reduced funding for public health services at the county level.
“Public health is the invisible infrastructure that keeps your communities healthy,” says Sarah Lochner, Executive Director of the Oregon Coalition of Local Health Officials. “You may not realize it’s there doing its job, but when it goes away, you will notice.” Public health involvement includes air quality and wildfire smoke response. Vaccine and reproductive health programs fall under public health. They manage infectious diseases, such as tuberculosis, and travelers exposed to infections overseas. For example, the cruise ship passenger exposed to Hantavirus earlier this year. County-level public health supports local economies by ensuring there are safe places to eat, work, and play.
When outbreaks, such as measles, occur, public health agencies prioritize the work to contain the disease. This may mean stopping or delaying other tasks. “Responding to the reported cases of measles, having community conversations with folks, answering questions about measles certainly takes up a large part of our time,” says Sidelinger. “More than it did in 2023.”
Lochner sees the federal funding cuts impacting local communities with the cyclosporiasis outbreak. The cuts led to reduced staffing at federal agencies, like the CDC, to manage the outbreak early on. “That does put pressure on local public health to do that work when the CDC could have taken that off their plates had they been properly staffed and funded.”
The challenge of more work with less is a problem counties often face. According to Lochner, counties often cobble together funding from many sources to pay for staff and programs. Already, counties are making tough choices about which programs to fund. For example, Multnomah County cut a program which assisted young mothers and their children. “In the coming years, as budgets continue to shrink, (counties) may have to make the hard choice to give up those programs,” she says. It can take two years or longer to get the program up and running again if funding becomes available.
The Trust Gap
Trust in federal agencies like the CDC and FDA has dropped to historic lows. The management of the cyclosporiasis outbreak is an example of a bigger problem. Delays in tracking and collecting information, and the identification and later reversal of a source by the FDA. These issues add to confusion and the thinning of public trust.
According to a survey by the Harvard School of Public Health, trust in the CDC fell from 77% in 2025 to 50% in 2026. This trust is down across all demographic groups. Most people still have faith in their state (70%) and local (66%) health departments. But trust in the safety of childhood vaccines continues to decline. A survey by the non-profit Kaiser Family Foundation (KFF) found that fewer than half of adults are confident in federal agencies’ ability to make recommendations about childhood vaccines.
“I think there is a lot of misinformation coming out of the CDC and other organizations around vaccines and their safety and their efficacy,” says Lochner. She points to a poll that found even people in favor of vaccines viewed information from the federal government as confusing. But the government isn’t the only problem. Another KFF poll found that using social media and AI for health information is associated with a belief in vaccine myths. Vaccine myths tie to parents delaying or skipping vaccinations for their children. The poll also showed belief in vaccine myths prevails when someone lacks a trusted healthcare provider.
Sidelinger sees the rise in distrust accelerated during the COVID-19 pandemic, when public health was such a large part of the news. “I think we forget about some of the darker days, and the fact that our healthcare system was very close to being at and was over capacity at many times,” he says. Faced with an unknown disease, public health agencies had to adjust their messaging as new information emerged. He refers to changes in use of one of the COVID-19 vaccines when issues of blood clots and inflammation around the heart were found. “But we also had individuals out there, a lot of it online, but some of it through other channels and in person, that were spreading information that just wasn’t true.”
Sidelinger sees a larger problem with individuals with a history of spreading misinformation becoming public health leaders, as they create more mistrust. He points to Robert F. Kennedy Jr.’s role as the national Secretary of Health and Human Services. “His not-for-profit was certainly involved in lawsuits against vaccine manufacturers, fighting against vaccines, putting out information that wasn’t based in facts about vaccines, and that is our Secretary of State or our Secretary of Health now.”
Sidelinger wants Oregonians to know that not everyone in public health is problematic. “There are thousands of dedicated public health officials and scientists that are still at our federal health agencies and are still on the other end of the phone when I need them.” He goes on to say, “There are certainly less of them, and like those of us at the state, local, and tribal level, they’re tired. They’re tired not just of responding to diseases and responding to climate threats and other things, but of having to constantly push back against some of that misinformation and answer those questions not just at work, but when we go home to our friends and family who are like, you know, I heard this or so and so said that. We feel often fairly compelled to engage in that conversation.”
The Impact in Rural Oregon
When outbreaks occur, public health authorities must pause other tasks to focus on containing the disease. With the current cyclosporiasis outbreak, Lochner sees the cuts made to public health at the national level having a local impact. The cuts led to reduced staffing at federal agencies, like the CDC, to manage the outbreak early on. “That does put pressure on local public health to do that work when the CDC could have taken that off their plates had they been properly staffed and funded.”
Extra work with fewer employees is challenging. According to Lochner, counties often have to “cobble together” funding from multiple sources to pay for staff and programs. Already, counties are making tough choices about which programs to fund. For example, Multnomah County cut a program that assisted young mothers and their children. “In the coming years, as budgets continue to shrink, (counties) may have to make the hard choice to give up those programs,” she says. When counties lose public health programs, it can take two years or more to get them up and running again if funding becomes available.”
“We are seeing impacts on healthcare from closure of maternity sites and pharmacies, making it more difficult to access primary care and specialty care,” says Sidelinger. “So, it can be frustrating.” Especially in rural parts of the state where the impact is felt more. He notes that the federal budget includes funds set aside to invest in rural health. OHA is also working with Medicare partners to invest in rural health transformation grants. The goal is to improve access to care and to ensure accurate health information in rural areas, such as Tillamook County.
At this time, both the cyclosporiasis and measles outbreaks pose a low-risk for most people. According to Sidelinger, we are fortunate to have a strong public health system with dedicated public health professionals across the state to help keep us healthy. They exist as great sources of health information. “If you have questions, if something doesn’t seem right,” Sidelinger says, “Bring those to your next provider appointment, your next checkup, the next time you’re sick. Ask some of those questions so a person you know and trust with your healthcare can try and provide you those answers.”
