There have been 1,645 confirmed cases of cyclosporiasis acquired in the United States since May 1, and more than 5,100 additional cases are being investigated, the US Centers for Disease Control and Prevention said on Tuesday.

A growing outbreak in Michigan and Ohio has also been linked to cases in West Virginia and Kentucky, the agency said. People with cyclosporiasis may experience symptoms, including watery diarrhea, cramping and bloating, for weeks.

Since May 1, cases have been identified in 34 states. Cyclospora activity tends to increase during the spring and summer, but the number of confirmed cases since May 1 is already more than six times higher than it was by this time last year, according to a health alert sent by the CDC. If all possible cases being investigated are included, this year’s total is 27 times higher than last year’s total at this time.

“This is much, much higher than what we’ve seen last year or the year before,” said Dr. Gwen Biggerstaff, deputy director of CDC’s Division of Foodborne, Waterborne, and Environmental Diseases, calling it “a very big shift” from previous seasons.

About 1 in every 11 cases has been hospitalized, according to data available to the CDC. No deaths have been reported. At least 34 states have reported cases.