(WASHINGTON) The first two deaths of the cyclosporiasis outbreak have been reported in Michigan, the state’s health department announced Monday. The deaths come as cases in the state have surpassed 11,000 for a total of 11,234, including 193 hospitalizations, MDHHS data shows. Since May 1, cases of cyclosporiasis have topped 18,000 in 45 states, according to data updated by the CDC on Wednesday. There are at least 6,707 laboratory-confirmed cases of cyclosporiasis, including 423 hospitalizations, the data shows. Between April 30 and July 15, 67 cases have been reported among returning travelers in England, Wales and Scotland.