Health Journal Online

Category: Diseases & Conditions

  • States Have Until October 2027 to Fix SNAP Error Rates, with Reviews That Could Trigger Penalties Already Underway

    States Have Until October 2027 to Fix SNAP Error Rates, with Reviews That Could Trigger Penalties Already Underway

    For the first time in the more than 50-year history of the Supplemental Nutrition Assistance Program, states are now financially on the hook for how accurately they manage food benefit payments, and the data being collected right now will determine how much they owe.

    The USDA released its annual SNAP payment error rate report on June 24, 2026, revealing a national average error rate of 10.62 percent for fiscal year 2025 — far above the 6 percent threshold that the One Big Beautiful Bill Act (OBBBA) set as the trigger for financial penalties. Beginning October 1, 2027, states with error rates at or above that threshold will be required to cover a portion of their own SNAP benefit costs — from 5 percent for states with rates between 6 and 8 percent, to 15 percent for states above 10 percent.

    Only nine states had payment error rates below 6 percent in fiscal year 2025, allowing them to avoid the new cost-sharing requirement. The remaining 41 states and the District of Columbia face financial consequences unless they reduce their error rates before the penalty calculation is finalized.

    Critically, states can choose to use either their fiscal year 2025 or fiscal year 2026 error rate — whichever is lower — to calculate what they owe. That means the data being generated right now, through the end of fiscal year 2026 in September 2026, still matters. States that act aggressively in the next several months to reduce errors may be able to lower their financial exposure.

    Why This Matters

    SNAP — the Supplemental Nutrition Assistance Program — provides grocery assistance to approximately 42 million Americans, including children, elderly adults, people with disabilities, and low-income working families. For the entirety of its history, SNAP benefits have been paid entirely by the federal government. The OBBBA ended that guarantee.

    The practical consequences are large. Using fiscal year 2025 error rates, the Center on Budget and Policy Priorities estimates states collectively could owe roughly $9 billion in SNAP cost-sharing. For individual states with already-strained budgets — many of which are also absorbing Medicaid cost shifts from the same legislation — the new SNAP obligations arrive at a particularly difficult fiscal moment.

    The accountability logic behind the policy is straightforward: states that miscalculate eligibility or benefit amounts generate either overpayments (giving recipients more than they should receive) or underpayments (giving them less). SNAP payment error rates measure how often and by how much those miscalculations occur. But advocacy groups and many state officials note that error rates are not a measure of fraud — they reflect administrative and systems errors, many of which occur when complex federal and state rules interact with limited state administrative capacity.

    What We Know So Far

    The USDA’s June 24 release established the FY 2025 error rate as the first benchmark that will be used to calculate potential cost-sharing obligations. Under the law, states may elect to use either the FY 2025 or FY 2026 error rate — whichever produces a lower obligation.

    The penalty structure, as described by Grocery Dive and confirmed by the USDA press release:

    • States with error rates between 6% and 8%: responsible for 5% of their SNAP benefit costs
    • States with error rates between 8% and 10%: responsible for 10%
    • States with error rates above 10%: responsible for 15%

    One important carve-out: states with error rates above 13.32 percent in FY 2025 qualify for a two-year delay in the cost-sharing requirement. Alaska (23.15%), Oregon (14.14%), Illinois (14.67%), Georgia (15.21%), Delaware (16%), and New Mexico (16.81%), as well as the District of Columbia (18.66%), qualify for this delay— meaning they will not face penalties until fiscal year 2030.

    Perversely, this created an incentive problem. Maryland dropped its error rate from 13.64 to 13.08 percent — an improvement — but in doing so, fell just below the 13.33 percent threshold that would have qualified it for the two-year delay. The states that made less progress are being shielded from near-term consequences, while Maryland faces an earlier and larger financial burden for having improved.

    Where the Impact Is Highest

    Maryland’s situation is among the most closely watched. State analysts project Maryland could be on the hook for at least $240 million just for the new cost-sharing requirements in fiscal year 2027, with more exposure expected in subsequent years from other OBBBA provisions. The state’s current error rate of 13.08 percent places it in the 15 percent cost-sharing tier — the maximum penalty level.

    Maryland’s Acting Secretary for Human Services Stacy L. Rodgers told Maryland Matters that the agency is “laser-focused” on bringing the error rate down and that the notion of qualifying for a delay by maintaining a high error rate has not been the agenda. But she acknowledged that FY 2026 data will not be released until June 2027 — months after the Maryland General Assembly finalizes the state budget — creating a structural planning problem.

    Oklahoma’s situation illustrates the scale in other states: with an error rate of 11.04 percent, Oklahoma projects it could owe approximately $250 million in SNAP benefit costs. California, at a lower 5 percent bracket, is projected to face over $627 million in additional spending.

    Some states are acting quickly. Arkansas is investing in AI tools to improve eligibility systems and has allocated $5 million in its FY 2027 budget to the state inspector general’s office to detect vulnerabilities. Minnesota allocated $90 million to replace 35-year-old county software used for SNAP processing. These technology investments may reduce error rates before the penalty-determining data closes.

    What Officials and Experts Say

    Agriculture Secretary Brooke Rollins, in announcing the FY 2025 data, said the payment error rates are further proof that state accountability is severely lacking in SNAP, and urged other states to prioritize needy families and the American taxpayer over politics.

    Maryland’s Stacy Rodgers offered a sharply different framing. She told WYPR that Maryland has led the nation in reducing its error rate over the past three years — from 35.56 percent in fiscal year 2022 to 13.08 percent today — but is still being penalized for a rate that remains above the threshold. She said there was simply no runway for states to drive the error rate down to 6 percent given the structural complexity of SNAP administration.

    Carolyn Vega, associate director of policy analysis for No Kid Hungry, told Maryland Matters the penalty structure creates a “really perverse incentive” — a state has almost an incentive to do worse, since dropping below 13.33 percent removes the protection of the two-year delay.

    Brookings Institution researchers warned that the combination of SNAP benefit cost-shifting, Medicaid reductions, and other OBBBA provisions could lead some states to drop out of the SNAP program entirely — an outcome that would eliminate food assistance for all participants in those states. Analysts across the political spectrum have described this as the single most significant structural change to SNAP in the program’s history.

    What the Evidence Shows and What It Does Not

    MedicalDaily Policy Check

    • Policy source: One Big Beautiful Bill Act (OBBBA), signed July 4, 2025
    • USDA data release: FY 2025 SNAP payment error rates, June 24, 2026
    • National average FY 2025 error rate: 10.62%
    • Total FY 2025 improper payments: $10.1 billion (per USDA)
    • Cost-sharing effective date: October 1, 2027 (federal fiscal year 2028)
    • States below 6% (exempt): 9 states
    • States with delay (above 13.32%): Alaska, Oregon, Illinois, Georgia, Delaware, New Mexico, DC — delay until FY 2030
    • Key option: States may choose FY 2025 or FY 2026 error rate, whichever produces a lower obligation — FY 2026 data collection is ongoing through September 2026
    • What this policy does not constitute: A measure of SNAP fraud — error rates measure administrative accuracy, including both overpayments and underpayments, often caused by eligibility or calculation mistakes

    Who Is Most Affected?

    The financial impact of the new SNAP cost-sharing rules will fall on several groups:

    • State SNAP administrators and human services agencies, who must reduce error rates under extreme time pressure with limited resources
    • State legislators and budget directors, who must now plan for large new obligations that were not anticipated in recent state budgets
    • Advocacy organizations that serve SNAP recipients, who are concerned that states facing financial pressure may tighten eligibility or create bureaucratic barriers to enrollment
    • SNAP recipients themselves — particularly in states where budget pressure from SNAP cost-sharing leads to service reductions, staffing cuts, or changes to how applications and renewals are processed
    • Residents of states with the highest error rates: Maryland (13.08%), Hawaii (10.92%), Oklahoma (11.04%), and many others where the cost-sharing obligation will be highest

    What You Can Do Now

    • If you receive SNAP benefits, respond promptly to any renewal requests, verification requests, or correspondence from your state’s human services agency. Delayed or incomplete responses are a common source of administrative errors that inflate error rates and may affect your own benefit accuracy.
    • If you are a state resident concerned about SNAP funding in your state, contact your state legislators — particularly those on budget and human services committees — to ask how the state is planning to manage new cost-sharing obligations.
    • Advocacy organizations tracking this issue include the Food Research and Action Center, the Center on Budget and Policy Priorities, and No Kid Hungry. All publish state-specific data and advocacy resources.
    • If your state has announced changes to SNAP administration or access in response to budget pressure, contact the USDA’s Food and Nutrition Service or a legal aid organization if you believe your SNAP benefits have been incorrectly reduced or terminated.

    Cost and Access: What Families Should Know

    SNAP error rates measure administrative accuracy — not whether eligible families are being helped. But the financial consequences of this policy will inevitably affect how states administer the program. States may respond by hiring more caseworkers, investing in technology, tightening verification processes, or — advocates fear — creating administrative barriers that make it harder for eligible families to receive benefits.

    If you believe you are eligible for SNAP and have been denied or had benefits reduced, you have the right to request a fair hearing through your state’s human services agency. The USDA’s Food and Nutrition Service maintains state-level contact information and complaint procedures. For families in financial crisis, local food banks remain a parallel resource — find one near you at feedingamerica.org.

    What Happens Next

    FY 2026 error rate data — the second data point states can use to calculate their obligation — will not be released until June 2027. That timing creates a difficult planning window: states will not know their final FY 2026 number until after most state legislatures have finalized their fiscal year 2027 budgets.

    Maryland’s Stacy Rodgers is banking on the National Governors Association successfully lobbying Congress to delay the penalty deadline. That lobbying effort is ongoing. Some states are filing Corrective Action Plans with USDA as required for states above the 6 percent threshold. The outcome of those plans and any Congressional action on the deadline will significantly shape how this policy ultimately affects both state budgets and SNAP recipients.

    MedicalDaily will continue tracking state error rate developments, Congressional responses, and the downstream effects on SNAP access as the October 2027 implementation date approaches.

    The Bottom Line

    The USDA’s FY 2025 SNAP error rate data revealed that 41 states and the District of Columbia exceed the threshold that will trigger financial penalties starting October 2027 — a deadline that is 15 months away. For Maryland, the potential liability exceeds $240 million. For California, it exceeds $627 million. For Oklahoma, it approaches $250 million. The data being collected right now — through September 2026 — will shape those final numbers. States that invest in better eligibility systems, caseworker capacity, and technology in the next several months may reduce their exposure. Those that do not may find themselves choosing between cutting other services, raising taxes, or creating barriers that effectively push eligible families off SNAP assistance.

    Source link

  • Ebola Fight Disrupted as Congo Response Workers Strike Over Unpaid Wages

    Ebola Fight Disrupted as Congo Response Workers Strike Over Unpaid Wages

    The workers at the epicenter of Congo’s Bundibugyo Ebola outbreak — the surveillance teams tracking contacts, the burial teams managing the dead, the community outreach workers trying to build trust in frightened neighborhoods — went on strike this week. They have not been paid since the outbreak was declared on May 15, 2026, according to reporting from the Associated Press and Reuters.

    The work stoppage — centered in Bunia, the capital of Ituri Province, and the neighboring town of Rwampara — has directly compromised continuity of essential health services at the front of an outbreak that has infected 1,759 people and killed at least 600 as of the latest government data, according to Reuters. Bunia and Rwampara together account for roughly 847 confirmed infections — nearly half of Congo’s total.

    No Ebola cases associated with this outbreak have been confirmed in the United States. The risk to U.S. residents remains low, according to the CDC. But a response team that cannot function directly threatens the global containment of a disease for which no approved vaccine or specific treatment exists.

    Why This Matters

    Ebola containment depends entirely on the human beings willing to do the most dangerous work in public health: identifying and following up with contacts of confirmed cases, isolating the sick before they can infect others, and safely burying the dead in a disease where bodily fluids at the moment of death carry the highest viral load.

    When those workers stop working, chains of transmission that would otherwise be interrupted continue unchecked. New cases that would have been caught through contact tracing are not caught. Burials conducted without trained teams become sources of additional infection. The mathematical progress the response has made — tracking contacts, sequencing isolates, mapping transmission chains — stops accumulating.

    The World Health Organization representative in Congo, Dr. Anne Ancia, said this week that the virus continues to spread, fueled by population movements and insecurity, and that some treatment centers are at near-full capacity. She has stated that the outbreak is spreading faster than the response can contain it — a warning issued before the strike added a new complicating factor.

    What We Know So Far

    According to the Associated Press, front-line workers told reporters they had not received wages or bonuses since the outbreak was declared on May 15. The affected workers span multiple roles: epidemiological surveillance committee members, community outreach and sensitization teams, burial teams, and security personnel.

    Workers at the Rwampara Ebola treatment center staged a protest on Monday, setting tires alight outside the facility. Police intervened to restore order. A senior worker confirmed to the AP that the action was continuing.

    “Since the Ebola virus disease outbreak was declared, we’ve been demanding payment for our work,” Dr. Biensi Kano, a member of the epidemiological surveillance committee in Bunia, told the AP. “The non-payment of benefits exposes us and our families to significant socio-economic difficulties and seriously undermines our living conditions.”

    Dr. Ghislain Maneba, an epidemiologist and community investigator in the Rwampara health zone, described the scope of the problem: “We are doing everything we can to make the public understand how dangerous this disease is. I came here to save people’s lives, but this is how I am being thanked. We are working day and night without being paid.”

    Congo’s Health Minister Samuel Roger Kamba acknowledged the payment problems publicly, attributing part of the delay to logistical disruptions — specifically the closure of the Bunia airport, which has complicated both the delivery of supplies and the transfer of funds to frontline workers.

    Where the Response Is Most At Risk

    The Bunia and Rwampara health zones — where the strike is most concentrated — account for close to half of Congo’s confirmed Ebola cases. They represent the geographic and epidemiological core of the outbreak. A functional lapse in contact tracing, burial safety, or community engagement in these zones is not a marginal disruption; it strikes at the most critical pressure points in the containment effort.

    Bloomberg reported that Congo’s National Institute of Public Health confirmed in a report on Wednesday that continuity of essential health services in Bunia and Rwampara has been compromised.

    The outbreak is also occurring in a region with persistent armed conflict — a factor that has repeatedly impeded response operations by restricting travel, diverting law enforcement attention, and driving population displacement that makes contact tracing vastly more difficult. The Bunia airport closure attributed by health officials as a payment bottleneck is itself a product of the security situation in eastern Congo.

    What Officials and Workers Say

    Akilimali Pierre, incident manager at Congo’s National Institute of Public Health, told the AP that the airport closure “is hampering the very implementation of the response, particularly certain aspects of the flow of funds. This is one of the reasons that may account for the delay in payment.”

    Africa CDC official Wessam Mankoula, speaking at an online press conference, said the agency was working with Congolese authorities to speed up payments. According to Reuters, Africa CDC has provided Congo approximately $2 million to support the Ebola response — some of which could be directed toward delayed worker payments.

    “This is very important to keep the morale,” Mankoula said of ensuring payment to frontline workers.

    The WHO’s Dr. Ancia had described the situation in Ituri as one where she witnessed “firsthand the dedication of staff who continue to serve their communities despite enormous challenges” — a dedication now being tested by the absence of compensation for those same workers.

    What the Evidence Shows — and What It Does Not

    As of July 10, 2026, the Bundibugyo Ebola outbreak has produced 1,759 confirmed cases and more than 600 confirmed deaths in Congo, plus 20 cases and 2 deaths in Uganda, and one imported case in France. No U.S. cases have been confirmed.

    The outbreak’s case fatality rate in the current outbreak is approximately 20% to 30%, lower than the Zaire strain of Ebola but still among the most lethal infectious diseases circulating anywhere in the world. There is no approved vaccine for Bundibugyo virus. A clinical trial of two experimental therapies — the monoclonal antibody MBP134 and the antiviral remdesivir — began July 2 but has produced no results yet.

    Whether the strike will materially worsen outbreak trajectory depends on its duration and whether payment resolutions can be reached quickly. If the work stoppage lasts days, the damage may be containable. If it lasts weeks, the modeling predictions for outbreak growth could shift significantly.

    MedicalDaily Outbreak Status Summary

    • Congo confirmed cases: 1,759 (as of latest government data)
    • Congo deaths: 600+
    • Uganda cases: 20; Uganda deaths: 2
    • Imported case: France (1)
    • U.S. cases: Zero confirmed
    • Approved vaccine: None for Bundibugyo strain
    • Approved treatment: None; clinical trial underway (MBP134 + remdesivir)
    • Strike status: Active as of July 9–10, 2026, in Bunia and Rwampara
    • Services compromised: Contact tracing, burial teams, community outreach in hardest-hit zones
    • U.S. entry restriction order: Active through approximately July 21, 2026

    Who Is Affected and Who Is at Risk

    Front-line health workers in Ituri Province face the most direct and immediate harm from the payment failure: they are working in conditions of extreme danger — physical violence from suspicious residents, biological exposure risk, and the psychological burden of managing an uncontrolled outbreak — without compensation.

    The secondary impact falls on all Congolese residents in the outbreak zone, whose exposure risk increases as contact tracing lapses.

    For U.S. residents: the CDC continues to assess the risk of Bundibugyo virus reaching the United States as low, based on the virus’s biology (direct contact with bodily fluids required; no airborne transmission), the country’s public health infrastructure, and the current entry screening measures in place at four U.S. airports. No U.S.-based cases have been confirmed from this outbreak.

    Travelers who have been in DRC, Uganda, or South Sudan within the past 21 days should monitor for fever or illness and contact their local health department before visiting a healthcare facility if symptoms develop.

    Symptoms and Warning Signs to Watch For

    For travelers who have recently returned from DRC, Uganda, or South Sudan, the following symptoms — appearing within 21 days of last potential exposure — warrant immediate contact with a public health authority (before going to a clinic):

    • Sudden fever
    • Severe headache
    • Muscle pain and weakness
    • Vomiting or diarrhea
    • Unexplained bleeding or bruising
    • Rash

    Do not go to a hospital or clinic without calling your local health department first. Public health teams need to coordinate safe isolation and transport procedures to protect healthcare workers and other patients.

    What You Can Do Now

    For U.S. residents who have recently traveled to DRC, Uganda, or South Sudan:

    • Monitor your health for 21 days after your last possible exposure to the outbreak area.
    • If you develop fever or other symptoms, call your local health department first — before going to a hospital.
    • Check the CDC Ebola situation page for current travel advisories and entry screening information.
    • Plan ahead for travel to this region: U.S. entry restrictions currently in place require routing through designated screening airports and post-arrival monitoring.

    For anyone who wants to support the Ebola response in DRC, Médecins Sans Frontières (Doctors Without Borders) and International Medical Corps are among the organizations with active operations in the affected area.

    Cost and Access: What Patients Should Know

    Any U.S. resident who is evaluated for suspected Ebola will be tested and cared for through the public health system at no direct cost, as part of emergency infectious disease protocols. No prior authorization or insurance is required for emergency isolation and testing under these circumstances.

    If a case were confirmed in the United States, treatment would occur at one of ten federally designated biocontainment units. The nearest facilities to major U.S. cities include Emory University Hospital (Atlanta), Nebraska Medical Center (Omaha), and the NIH Clinical Center (Bethesda, Maryland).

    What Happens Next

    Whether Congo can rapidly resolve the payment dispute will determine how much damage the strike causes to the outbreak trajectory. Africa CDC’s offer to redirect $2 million in existing funds toward delayed payments suggests a path to resolution, but the logistical challenge of the closed Bunia airport means financial transfers may still face delays.

    The U.S. entry restriction order from June 21 expires around July 21 — 11 days from now. The CDC’s decision on whether to renew will be shaped in part by the outbreak’s trajectory in the coming days. A strike-related worsening of case trends could shift that calculus toward extension.

    MedicalDaily will continue monitoring both the strike situation and the outbreak’s overall trajectory.

    The Bottom Line

    Ebola response workers in Congo’s hardest-hit provinces walked off the job this week because they have not been paid since the outbreak began two months ago. The strike threatens to degrade the contact tracing, burial safety, and community engagement operations that are the primary tools for containing an outbreak for which no approved vaccine or specific treatment exists. The outbreak has already infected 1,759 people and killed more than 600. The risk to U.S. residents remains low — but a failing response anywhere in the world raises the probability of wider spread, which is why the U.S. has maintained entry restrictions and airport screening since May.

    Source link

  • Michigan Officials Released Specific Produce Washing Instructions During the Cyclospora Outbreak

    Michigan Officials Released Specific Produce Washing Instructions During the Cyclospora Outbreak

    Michigan health officials have released specific, produce-by-produce washing and handling instructions for consumers as the state’s Cyclospora outbreak surpassed 1,562 confirmed cases as of July 10, 2026 — the largest outbreak of the parasitic illness in Michigan’s history, and the source of which remains unidentified.

    The Michigan Department of Health and Human Services released its detailed prevention guidance on July 4 and July 6, 2026, issuing instructions that go further than general “wash your produce” advice — spelling out, vegetable by vegetable, exactly what consumers should buy, how to prepare it, and when cooking is the safest choice.

    No specific produce grower, supplier, or food type has been identified as the source of the outbreak as of July 10.

    Why This Matters

    Cyclospora cayetanensis is a microscopic parasite that attaches tenaciously to produce surfaces — and standard washing does not guarantee its removal. The CDC notes that Cyclospora can cling to leafy vegetables and herbs in ways that make thorough removal challenging, which is why officials recommend specific preparation methods that reduce risk beyond a simple rinse.

    With more than 1,562 cases confirmed in Michigan and several hundred additional cases in adjacent areas of Ohio and other states, and with no food source yet named, consumers do not have a specific product to avoid. That gap makes produce safety guidance from health officials especially important: without knowing which item is contaminated, the most prudent approach is to take extra precautions with all fresh produce linked to prior Cyclospora outbreaks.

    Michigan officials have emphasized these recommendations for anyone preparing raw produce — especially people who are immunocompromised, elderly, on chemotherapy, or otherwise at higher risk of serious illness from dehydration or infection. The MDHHS also extended the guidance to restaurants and commercial kitchens in southeast Michigan.

    What We Know So Far

    The MDHHS outbreak dashboard showed 1,562 confirmed cases as of the morning of July 10, 2026. Cases have been reported in at least 44 Michigan counties, concentrated in Monroe, Wayne, Washtenaw, Lenawee, Shiawassee, Jackson, Oakland, and Livingston counties — all in southeastern Michigan.

    The outbreak began June 22, 2026. Michigan typically sees 40 to 50 cases per year; the current outbreak has produced more than 30 times the annual average in under three weeks.

    Approximately 44 hospitalized cases have been reported to date, according to the MDHHS dashboard. No deaths have been reported.

    The CDC and FDA are assisting Michigan investigators with whole-genome sequencing of parasite isolates and epidemiological traceback. As of July 10, no common food vehicle has been identified despite more than two weeks of active investigation.

    The Produce-Specific Safety Guide From MDHHS

    The following instructions are drawn directly from MDHHS official guidance released July 4–6, 2026, confirmed across multiple MDHHS communications and media outlets.

    Lettuce and Leafy Greens

    What to buy: Buy whole heads of lettuce rather than pre-washed, bagged lettuce or salad mixes. Pre-cut and pre-washed bagged salad kits have been linked to prior Cyclospora outbreaks in the U.S. and Canada.

    How to prepare: Remove and discard the outer two to three leaves. Wash the remaining inner leaves thoroughly under running water.

    Safest option: For leafy greens that can be cooked, cooking is the safest option. Cooking to 158°F (70°C) or higher kills the Cyclospora parasite.

    Cilantro and Basil

    How to prepare: Wash thoroughly under running water. Separate the individual leaves from the stems as you wash — this increases the surface area that running water contacts and reduces the chance of parasite survival between leaves.

    Safest option: Both cilantro and basil are safest when cooked. Using them as cooked ingredients in hot dishes reduces exposure risk more than using them raw.

    Note: MDHHS did not recommend consumers stop buying or eating cilantro and basil. The guidance is about safe preparation, not elimination of these foods.

    Green Onions

    How to prepare: Trim the root end. Remove and discard the outer layer. Wash the remainder thoroughly under running water.

    Safest option: As with leafy greens, cooking green onions eliminates parasite risk. Use them in stir-fries, soups, or other hot preparations when possible during the outbreak.

    Other Produce: Universal Rules

    For all other fruits and vegetables, MDHHS recommends:

    • Wash all fresh produce under clean running water before eating or preparing, even produce with rinds or peels you do not eat
    • Scrub firm fruits and vegetables — such as melons, cucumbers, and potatoes — with a clean produce brush
    • Cut away any damaged or bruised areas on fruits and vegetables before eating
    • Wash hands thoroughly with soap and water before and after handling or preparing any produce
    • Wash and sanitize cutting boards, knives, and other utensils before and after contact with raw produce

    The Heating Rule: 158°F Kills Cyclospora

    The single most reliable way to eliminate Cyclospora from produce is heat. MDHHS confirms that cooking food to 158°F (70°C) or higher kills the parasite. This applies to any produce on the concern list. If you can cook it, do.

    What Not to Buy During the Outbreak

    MDHHS has specifically noted that the following have been linked to prior U.S. and Canadian Cyclospora outbreaks, and should be treated with extra caution:

    • Pre-washed, bagged salad mixes and kits (including pre-cut lettuce blends with romaine, iceberg, red cabbage, and carrots)
    • Fresh cilantro
    • Fresh basil
    • Green onions
    • Raspberries (linked to prior outbreaks, though not specifically identified as a source in this outbreak)
    • Snow peas

    MDHHS is not advising consumers to stop buying these items entirely — only to apply the specific preparation steps above, choose cooked preparations where possible, and avoid pre-washed bagged versions of lettuce.

    Where the Risk Is Highest

    Southeastern Michigan and the areas immediately across the Ohio border (including Lucas County and northwest Ohio, where more than 500 cases have been reported) represent the current epicenter of risk. However, because no food source has been identified, and because fresh produce from Michigan’s supply region is distributed nationally, these guidelines are relevant for consumers across the Midwest and beyond who buy fresh produce from common grocery chains and distributors.

    People at highest risk for serious illness from Cyclospora include:

    • Immunocompromised individuals (transplant recipients, chemotherapy patients, people with HIV)
    • Adults over 65
    • Infants and young children
    • Pregnant individuals

    MDHHS specifically noted that the guidance is especially important for these groups.

    What Health Officials Say

    Dr. Natasha Bagdasarian, Michigan’s chief medical executive, said the state’s leading hypothesis is that the outbreak is likely related to fresh produce, based on the geographic pattern of cases, the timing of the outbreak during summer produce season, and the historical pattern of Cyclospora outbreaks in North America. She confirmed the state is conducting food exposure interviews with all confirmed cases and performing whole-genome sequencing on parasite samples to narrow the search for a common source.

    “All fresh produce — and not just the ones I listed — should be thoroughly washed under running water,” Dr. Bagdasarian stated in public communications this week. “If it has leaves, like cilantro and basil, separate them as you wash them.”

    The CDC adds that Cyclospora can really stick to some foods, and washing alone may not fully eliminate the risk from contaminated produce — reinforcing that cooking is the most reliable protective step available to consumers right now.

    Symptoms and Warning Signs to Watch For

    Cyclospora typically causes symptoms beginning one week after exposure, though onset can range from two days to more than two weeks. Symptoms include:

    • Watery diarrhea, which can be frequent and explosive
    • Loss of appetite
    • Prolonged fatigue
    • Abdominal cramping and bloating
    • Nausea, and occasionally vomiting
    • Low-grade fever

    Without antibiotic treatment, symptoms can persist for weeks to months and may relapse after seeming to improve. The illness does not spread person-to-person.

    Seek medical care if:

    • Diarrhea lasts more than a few days
    • Symptoms include signs of dehydration (very little urination, dry mouth, dizziness)
    • You are immunocompromised, elderly, pregnant, or caring for a young child with symptoms
    • Symptoms worsened rather than improving

    A specific laboratory request is needed for Cyclospora diagnosis. Standard stool testing does not always detect the parasite. Ask your clinician specifically to test for Cyclospora if you suspect exposure.

    What You Can Do Now

    • Switch to whole-head lettuce. Put down the bagged salad mix and buy an intact head of romaine, iceberg, or butter lettuce. Remove the outer leaves before washing the inner ones.
    • Wash herbs leaf by leaf under running water. For cilantro and basil, separate the individual leaves from stems as you rinse.
    • Trim and peel green onions before washing. Remove the root end and outer layer, then wash thoroughly.
    • Cook produce when you can. During an active Cyclospora outbreak with an unknown source, cooking any fresh produce at risk to 158°F eliminates parasite risk more reliably than washing alone.
    • Wash hands before and after produce handling. Use soap and water for at least 20 seconds.
    • Sanitize surfaces and tools that contact raw produce, including cutting boards and knives.
    • See a doctor if you develop prolonged diarrhea, particularly if you live in southeast Michigan or adjacent Ohio counties. Specify that you want to be tested for Cyclospora.

    Cost and Access: What Patients Should Know

    Cyclospora treatment with the antibiotic trimethoprim-sulfamethoxazole (TMP-SMX) is available in generic form at very low cost — typically $4 to $10 at most pharmacies with a prescription. Most health insurance plans cover it.

    The parasite-specific stool test required for diagnosis is typically covered by insurance when ordered by a clinician. For uninsured patients, local health department clinics can provide evaluation and testing during an active outbreak at no or low cost. Find your local Michigan health department at Michigan.gov/mdhhs.

    What Happens Next

    The MDHHS outbreak dashboard updates daily through the investigation period. Whole-genome sequencing results comparing parasite samples across cases could provide the key link to a common food source — a result that could trigger a specific product recall or advisory.

    If a food source is identified, MDHHS, the FDA, and CDC will issue a public advisory and, if warranted, a product recall notice. Until then, the produce preparation guidance described in this article represents the most protective steps available to consumers.

    MedicalDaily will update this story when a food source is identified or case counts change materially.

    The Bottom Line

    Michigan’s Cyclospora outbreak has now reached 1,562 confirmed cases with no food source identified. Until investigators pinpoint a specific product, your best protection is: buy whole heads of lettuce rather than pre-cut bagged mixes; separate and wash cilantro and basil leaves thoroughly under running water; trim and peel green onions before washing; cook any suspect produce to 158°F when possible; and see a clinician for any diarrheal illness lasting more than a few days, specifying that you want Cyclospora testing. These are not suggestions — they are official MDHHS instructions, and they apply nationally given the reach of produce supply chains.

    Source link

  • New Study Finds Intermittent Fasting Produces Similar Weight Loss to Calorie Counting

    New Study Finds Intermittent Fasting Produces Similar Weight Loss to Calorie Counting

    Intermittent fasting produced comparable weight loss to traditional daily calorie restriction over 18 months — but people following intermittent fasting did so without the same constant feeling of needing to monitor and limit their food intake, according to a new study from Adelaide University published in the journal Clinical Nutrition.

    That distinction may matter more than the weight loss numbers alone. Difficulty sticking to a diet — not the diet’s biological effectiveness — is the primary reason people abandon calorie-restriction programs, researchers said. And the study, led by Professor Leonie Heilbronn of Adelaide University’s School of Medicine and the South Australian Health and Medical Research Institute, found that intermittent fasting could offer an alternative pathway specifically for people whose eating behaviors make sustained calorie counting feel impossible.

    Why This Matters

    Calorie counting — the most widely recommended dietary strategy for weight loss — asks people to track every gram of food consumed, stay below a daily energy target, and resist overeating at every meal, every day, indefinitely. That cognitive and emotional workload is substantial, and research consistently shows it is the primary reason people abandon the approach.

    “While many diets can result in weight loss, they may be difficult to stick to and this makes keeping that weight off long-term more challenging,” Professor Heilbronn said in an Adelaide University release.

    More than 100 million Americans are estimated to be living with obesity, and the vast majority have attempted dietary interventions at some point. The repeated cycle of dieting, initial weight loss, and gradual regain is one of the most common and frustrating experiences in clinical weight management. A strategy that produces comparable results through a different behavioral mechanism — without the constant cognitive burden of restricting every meal — could be more sustainable for specific types of patients.

    What We Know So Far

    The Adelaide University trial enrolled more than 200 adults with obesity over an 18-month period and randomized them into three groups: intermittent fasting with time-restricted eating, daily calorie restriction, or a control group receiving standard healthy-eating advice.

    The intermittent fasting protocol used in the study was specific: participants ate 30% of their normal daily energy intake during a window between 8 a.m. and noon on three non-consecutive days per week, followed by a 20-hour fast. On the remaining four days, they ate normally. The calorie-restriction group reduced their total daily intake by approximately 30% every day.

    Both dietary intervention groups lost similar amounts of weight over the study period. The key divergence was behavioral: calorie restriction participants reported consciously having to monitor their eating, avoid overeating, and restrain themselves at meals — and that improved dietary control accounted for approximately 15% of their weight loss. Intermittent fasting participants did not report the same need for constant behavioral restraint to achieve comparable results.

    The study found no evidence that intermittent fasting caused the concerns sometimes cited against it: participants did not report increased irritability, obsessive thoughts about food, or binge eating on non-fasting days, according to research coverage by ScienceDaily.

    “Psychological and behavioral effects have a major influence on people’s abilities to adhere to diets,” Professor Heilbronn said. “Intermittent fasting may help people achieve weight loss through ways that are less dependent on consciously restricting intake.”

    Where the Benefit Is Most Relevant

    The study’s findings are most applicable to people who:

    • Have tried calorie-counting diets and found the constant monitoring unsustainable
    • Repeatedly lose and regain weight (sometimes called “yo-yo dieting”)
    • Struggle with eating restraint at every meal but can manage structured fasting windows
    • Are not in a clinical category that makes fasting dangerous (see risks below)

    “If someone finds it difficult to improve eating behaviors, intermittent fasting might be better to help them still lose weight,” Professor Heilbronn told Healthline. “Previous research shows that people who improve their relationship with food and gain better control over cravings lose more weight — regardless of the specific diet they undertake.”

    What Researchers Say

    Professor Heilbronn, who has led multiple randomized trials of intermittent fasting protocols over more than a decade, was careful to frame the study’s findings as an option for specific patients rather than a universal recommendation. “Future trials should be designed to identify individuals who struggle to improve eating behaviors, as they may do better with intermittent fasting diets, enabling more personalized weight management,” she said.

    “Although intermittent fasting is a popular diet, experts agree that it’s not for everyone,” Heilbronn told Healthline. People with a history of eating disorders, those who are pregnant or nursing, people with diabetes who take insulin or sulfonylureas (where skipping meals can cause hypoglycemia), and people with certain medical conditions should discuss any significant dietary change with a clinician before starting.

    What the Evidence Shows — and What It Does Not

    This study was designed primarily to examine the psychological and behavioral effects of the two diets — eating behaviors, mood, sleep, and quality of life — rather than weight loss magnitude as its primary outcome. That design choice means the study provides strong insight into how people experience the diets differently, but does not change the existing evidence base on the magnitude of weight loss produced by each approach.

    The weight loss outcomes were comparable between groups — the study was not designed to determine whether one approach is numerically superior. The key new finding is the behavioral mechanism: the two diets appear to work through different psychological pathways, which has practical implications for patient selection.

    The protocol used — intermittent fasting on three non-consecutive days per week with a specific morning eating window — is one of several intermittent fasting approaches. Results may not apply to other IF formats such as 16:8 daily fasting, alternate-day fasting, or the 5:2 protocol.

    MedicalDaily Evidence Check

    • Study type: Randomized controlled trial
    • Published: Online May 15, 2026, Clinical Nutrition (DOI: 10.1016/j.clnu.2026.106686); ScienceDaily coverage July 8, 2026
    • Institution: Adelaide University School of Medicine; South Australian Health and Medical Research Institute
    • Protocol: 3-day intermittent fasting (30% intake 8am–noon, 20h fast) vs. 30% daily calorie restriction vs. control; 18 months; 200+ adults with obesity
    • What it found: Both groups lost similar amounts of weight; intermittent fasting participants showed less reliance on conscious eating restraint; no increase in irritability, food obsession, or binge eating in IF group
    • What it did not find: Evidence that IF produces more weight loss than calorie restriction; evidence that any IF protocol is universally superior to all other approaches
    • Key limitation: One specific IF protocol tested; results may not apply to all IF approaches; conducted in Australia with predominantly Australian participants
    • What readers should know: IF may be a viable alternative for people who struggle to sustain daily calorie counting; not appropriate for everyone; consult a clinician before significant dietary change

    Who This Finding Is Most Relevant For

    The study’s implications are most directly relevant to:

    • People with obesity who have repeatedly attempted calorie-counting diets without sustained success
    • People who find constant meal monitoring cognitively or emotionally burdensome
    • Individuals without medical contraindications to meal timing changes (diabetes on insulin, eating disorder history, pregnancy, certain medications)

    For people who are already successful at calorie counting and maintaining weight loss, there is no evidence from this study that switching to intermittent fasting would produce additional benefit.

    For people currently prescribed GLP-1 medications for obesity management, dietary strategy remains an important complement to medication — whether that is calorie restriction or intermittent fasting. This study’s findings do not change medication recommendations.

    Intermittent Fasting: Who Should Be Cautious

    Not all people should attempt intermittent fasting without medical guidance. Consult a clinician before starting if you:

    • Have Type 1 or Type 2 diabetes and take insulin or sulfonylurea medications (risk of hypoglycemia during fasting windows)
    • Have a history of eating disorders or disordered eating patterns
    • Are pregnant or planning to become pregnant
    • Take medications that require food to be taken with them
    • Are underweight or have a history of malnutrition
    • Have kidney disease, liver disease, or other conditions where meal timing and nutrient intake are closely medically managed

    What You Can Do Now

    • Identify your pattern. If you have repeatedly started calorie-counting diets and found the constant monitoring unsustainable, the adherence advantage of IF may be relevant to you.
    • Consider the specific protocol tested. This study used a 3-day-per-week approach with eating limited to the morning hours (8 a.m. to noon) on fasting days. This is different from the popular 16:8 approach. Both exist; the evidence for this specific protocol is what this trial tested.
    • Talk to a clinician before starting, particularly if you have any of the conditions listed above.
    • Don’t combine IF with severe restriction on non-fasting days. The protocol tested involved eating normally on non-fasting days. Extreme restriction on all days defeats the behavioral advantage the study identified.
    • Be realistic about weight loss magnitude. Intermittent fasting produced comparable weight loss to calorie restriction — roughly 3% to 5% of body weight over months in most trials. It is not a rapid weight loss strategy.
    • Pair dietary change with physical activity. All randomized weight loss trials produce better outcomes when participants also increase moderate exercise.

    Cost and Access: What Patients Should Know

    Intermittent fasting costs nothing in terms of products or services. It requires no meal replacement products, supplements, apps, or program subscriptions to implement. However, for people with obesity seeking medical support for weight management, several resources are available:

    • Primary care physicians can refer patients to registered dietitians, who can support implementation of either dietary approach
    • Most insurance plans cover at least one visit per year with a registered dietitian when a medical diagnosis (such as obesity or pre-diabetes) is present
    • Free dietary guidance is available through the 2020–2025 Dietary Guidelines for Americans and the CDC’s Healthy Weight resources

    What Happens Next

    Professor Heilbronn’s research team has called for future trials designed to identify specific patients who are most likely to benefit from intermittent fasting versus calorie restriction — a step toward more personalized dietary prescribing. That research has not yet been announced or registered.

    The existing evidence base on intermittent fasting continues to grow across multiple research groups. Future meta-analyses pooling this and other trials will provide stronger evidence on who benefits most and under what protocols.

    The Bottom Line

    An 18-month Adelaide University trial found that intermittent fasting and calorie restriction produce comparable weight loss — but through meaningfully different behavioral pathways. Calorie counters rely heavily on conscious restraint; intermittent fasters do not. For people who have repeatedly failed to sustain calorie-counting diets because of the cognitive burden, this study suggests intermittent fasting may offer a more tolerable path to the same destination. It is not a universal solution and is not appropriate for everyone — but the evidence that adherence, rather than biology, is the primary obstacle to sustained weight loss points clearly toward a more personalized approach to dietary counseling.

    Source link

  • Nara Organics Formula Recall: Infant Botulism Cases Rise to 4, FDA Confirms Pathogen in Open Can

    Nara Organics Formula Recall: Infant Botulism Cases Rise to 4, FDA Confirms Pathogen in Open Can

    Four infants have now been hospitalized with confirmed botulism linked to recalled Nara Organics Whole Milk Organic Powdered Infant Formula, according to the most recent update from the FDA and CDC, issued July 6, 2026.

    All four infants required hospitalization and were treated with BabyBIG — the only FDA-approved treatment for infant botulism, available exclusively through the California Department of Public Health’s Infant Botulism Treatment and Prevention Program (IBTPP). No deaths have been reported.

    Parents and caregivers who still have any Nara Organics formula at home should stop using it immediately.

    Why This Matters

    Infant botulism is a rare but potentially fatal illness that occurs in babies — primarily those under 12 months of age — when Clostridium botulinum spores are ingested and produce a toxin inside the infant’s immature digestive system. The toxin attacks the nervous system, causing progressive muscle weakness that can lead to breathing failure if untreated.

    Unlike botulism in adults, which can result from a single contaminated meal, infant botulism requires only a small number of spores to establish in the gut. That makes even trace contamination in a formula used repeatedly across weeks of feeding a potentially serious risk.

    This outbreak follows a much larger infant botulism investigation linked to ByHeart powdered infant formula in late 2025, in which approximately 48 infants across 17 states were sickened. Two formula-linked botulism outbreaks within less than a year has raised urgent questions about manufacturing safety protocols and oversight across both domestic and international production facilities.

    What We Know So Far

    The four confirmed cases involve male infants who fell ill between April and May 2026. They ranged in age from approximately 68 to 153 days old at the time of illness onset, according to reporting from Food Safety Magazine. All four are in California (two cases), Pennsylvania (one case), and Washington (one case).

    Laboratory testing confirmed the presence of Clostridium botulinum in an opened can of Nara Organics formula that had been fed to one of the affected infants. Testing of an unopened can from the same production lot is still underway; results are expected in the coming weeks, per the FDA.

    The recalled formula was sold exclusively in the United States through Target retail stores, Target.com, and Nara.com between July 2025 and June 2026. Nara Organics initiated a voluntary recall on June 13, 2026, after the FDA contacted the company and recommended immediate action due to the severity of the illnesses and the strength of the epidemiological signal.

    Nara Organics’ formula is manufactured in Germany by Milchwerke Mittelelbe GmbH (Elb-Milch), a subsidiary of the Krüger Group. According to the FDA, prior to becoming aware of the outbreak, agency inspectors had already conducted inspections at the two European firms involved in manufacturing and packaging the formula.

    Where the Risk Is Highest

    The formula was distributed nationally, meaning families in every U.S. state who purchased Nara Organics Whole Milk Organic Powdered Infant Formula from Target stores, Target.com, or Nara.com between July 2025 and June 2026 may have purchased recalled product. All lots currently on the market were included in the recall.

    The three specific lots consumed by affected infants are lot codes 709125280E14F2, 709125288E14F2, and 708125174E14F2, according to Nara Organics’ recall notice. However, given that the recall covers all lots, parents should not limit their concern to these lot numbers — any Nara Organics formula purchased during the distribution window should be treated as recalled.

    The Washington State Department of Health has confirmed a case in Thurston County. California has confirmed two cases. Pennsylvania has confirmed one case.

    What Doctors and Public Health Officials Say

    The FDA issued a direct warning in connection with the July 6 update: “Parents and caregivers should stop using Nara Organics Whole Milk Organic Infant Formula immediately,” the agency stated. “If your child is experiencing symptoms after consuming Nara Organics Whole Milk Organic Infant Formula, seek immediate health care.”

    The CDC has stated clearly that botulism can be fatal and that any parent whose infant consumed the recalled formula and is showing symptoms should seek emergency care before contacting health authorities.

    Dr. Wendy Schuchat, who has advised on prior infant botulism investigations, has noted that the rarity of this condition makes rapid recognition by parents and pediatricians critically important. “Infant botulism often starts with what looks like constipation or a tired baby — but it can escalate quickly,” she has said in previous guidance contexts. “Delayed recognition is the most dangerous factor.”

    The IBTPP at the California Department of Public Health is available 24 hours a day, seven days a week, for physician case consultation at 510-231-7600. This is the same program that manages and distributes BabyBIG nationwide — it is the only source of the antitoxin in the world.

    What the Evidence Shows — and What It Does Not

    Laboratory confirmation of Clostridium botulinum in an opened can of the recalled formula fed directly to one of the affected infants provides a strong direct link between the product and the illness. Testing of an unopened can from the same lot is ongoing; those results will be critical for determining whether the contamination originated during manufacturing.

    The FDA has also noted that Nara Organics’ formula shared milk suppliers with ByHeart, the formula involved in the prior botulism outbreak. Specifically, both used milk supplied by Organic West Milk. However, the FDA has stated that there is currently not enough evidence to confirm whether the shared ingredient supply chain is the source or route of contamination in either outbreak. This connection is being actively investigated.

    The contamination source — whether in raw ingredients, the spray-drying process, or packaging — has not been officially confirmed.

    MedicalDaily Evidence Check

    • Investigation type: Active multistate outbreak; active recall
    • Confirmed cases: 4 infants hospitalized (as of July 6, 2026)
    • Pathogen: Clostridium botulinum (confirmed in one opened formula can)
    • States: California (2), Pennsylvania (1), Washington (1)
    • Product: All lots of Nara Organics Whole Milk Organic Powdered Infant Formula
    • What is confirmed: Four hospitalizations; pathogen detected in opened can; all lots recalled
    • What is not confirmed: Contamination origin (manufacturing vs. ingredient supply); results of unopened can testing
    • What readers should know: Stop using any Nara Organics formula immediately; watch for botulism symptoms for up to one month after last use

    Who Faces the Greatest Risk?

    Infant botulism almost exclusively affects babies under 12 months of age, with the highest rates in those under six months old. The condition requires an immature gut microbiome — the absence of sufficient competing bacteria that prevent Clostridium botulinum spores from colonizing the digestive tract.

    Infants at greatest risk include:

    • Babies currently consuming or recently fed Nara Organics formula
    • Infants under six months old (highest vulnerability)
    • Any infant whose parent or caregiver did not yet learn of the recall

    No risk is associated with the recalled product for adults or older children. Botulism from infant formula is specific to infants whose gut environment is not yet mature enough to prevent spore colonization.

    Symptoms and Warning Signs to Watch For

    Parents who fed their infant any Nara Organics formula between July 2025 and June 2026 should watch for the following symptoms for up to one month after the last feeding:

    • Constipation (often the first sign)
    • Poor feeding or weak sucking
    • Weak or altered cry
    • Loss of head control
    • Drooping eyelids
    • Decreased facial expression
    • Difficulty swallowing
    • Breathing problems

    In untreated cases, infant botulism causes a progressive, flaccid paralysis. Respiratory failure can occur and requires mechanical ventilation. Hospitalization typically lasts weeks.

    Seek immediate emergency care if any of these symptoms appear. Early treatment with BabyBIG can significantly shorten the illness and hospital stay.

    What You Can Do Now

    • Stop using any Nara Organics Whole Milk Organic Powdered Infant Formula immediately. Do not feed it to your baby.
    • Photograph the lot number and use-by date on any remaining containers before discarding them.
    • Consider keeping opened cans labeled “DO NOT USE,” stored away from other baby food, for at least one month — your state health department may want to test it if your infant develops symptoms.
    • Discard unopened cans. Customers who purchased from Nara.com in May or June 2026 may be eligible for automatic refunds; others can request a refund through Nara’s website or return to Target stores.
    • Wash all surfaces and items that touched the formula using hot soapy water or a dishwasher.
    • Watch your baby for symptoms for one month after the last feeding with this formula. Symptoms can take several weeks to appear.
    • Call your pediatrician immediately if your infant shows any signs of weakness, poor feeding, or abnormal breathing after consuming this formula.

    Cost and Access: What Patients Should Know

    BabyBIG — botulism immune globulin intravenous (BIG-IV) — is the only FDA-approved treatment for infant botulism caused by toxin types A and B. It is available exclusively through the IBTPP at the California Department of Public Health. Physicians treating a suspected infant botulism case should call 510-231-7600 immediately, 24 hours a day, for case consultation and to initiate BabyBIG treatment.

    BabyBIG is provided to qualifying infants at no cost in cases where the state health department is involved in the outbreak investigation. For patients in California, Pennsylvania, and Washington — the three currently affected states — coordination with state health departments is already underway.

    The recall does not create a formula shortage. Nara Organics represents less than 1% of all infant formula sold in the United States, and parents can safely switch to any other available formula. Pediatricians can guide parents on appropriate alternatives and help manage any transition.

    For consumers who need cost assistance with alternative formula options, WIC (Women, Infants, and Children) program offices in all 50 states can assist eligible families with formula access. Find your local WIC office at www.fns.usda.gov/wic.

    What Happens Next

    Laboratory testing of an unopened can from the affected lot is expected to yield results in the coming weeks. Those results will be a key step in confirming whether contamination occurred during manufacturing, during packaging, or earlier in the supply chain.

    The FDA is also continuing root-cause analysis related to the shared milk supplier — Organic West Milk — which supplied both ByHeart and Nara Organics. Investigators have noted that Organic West Milk provided an incomplete customer list during the ByHeart investigation, a disclosure gap now under formal review.

    Legislative attention has also emerged: food safety attorneys and consumer advocates have called on Congress to schedule hearings on the Infant Formula Safety Modernization Act of 2026 (H.R. 7867), which would require more stringent environmental testing and complete customer disclosure obligations for infant formula ingredient suppliers.

    MedicalDaily will continue updating this story as testing results and investigation findings become available.

    The Bottom Line

    Four infants — all boys under five months old — have been hospitalized with confirmed botulism linked to a single recalled formula brand. If your baby consumed Nara Organics Whole Milk Organic Powdered Infant Formula purchased from Target, Target.com, or Nara.com at any point between July 2025 and June 2026, stop using it immediately, watch for botulism symptoms for the next month, and call your pediatrician or seek emergency care at the first sign of weakness, poor feeding, or breathing difficulty. This investigation is ongoing.

    Source link

  • U.S. Airport Ebola Screening Remains Active Through July 21: What Returning Travelers Need to Know

    U.S. Airport Ebola Screening Remains Active Through July 21: What Returning Travelers Need to Know

    Enhanced Ebola screening is currently active at three major U.S. international airports, and entry restrictions for travelers from the Democratic Republic of the Congo, Uganda, and South Sudan remain in effect through approximately July 21, 2026. The measures were put in place in response to a growing outbreak of Bundibugyo virus disease — a rare and potentially fatal strain of Ebola for which no approved vaccine or specific treatment exists.

    Travelers who have recently returned from those regions, or who plan to travel there, need to understand what these measures require and what symptoms demand immediate medical attention.

    Why This Matters

    The Bundibugyo strain of Ebola is not the same as the Zaire strain responsible for West Africa’s 2014–2016 epidemic. The FDA-approved Ebola vaccine that provided protection in those prior outbreaks is not considered effective against the Bundibugyo virus. There are no approved countermeasures specific to this strain, which means containment relies on surveillance, contact tracing, isolation, and border screening.

    Case fatality rates for Bundibugyo virus disease in prior outbreaks have ranged from approximately 25% to 50%, according to the CDC — lower than Zaire Ebola but still highly serious. Patients experience fever, vomiting, severe weakness, and in some cases bleeding. Without a vaccine or treatment option, early identification of cases among arriving travelers is critical to preventing domestic spread.

    The World Health Organization has declared this outbreak a Public Health Emergency of International Concern — its highest alert designation.

    What We Know So Far

    The DRC’s Ministry of Health confirmed the Bundibugyo outbreak on May 15, 2026, after laboratory analysis identified Bundibugyo virus in samples from clusters of severe illness and deaths in Ituri Province. The affected health zones — Mongbwalu and Rwampara — are in northeastern DRC near the Ugandan border.

    By mid-June 2026, the DRC had reported 837 confirmed cases and 196 confirmed deaths. Uganda confirmed cases linked to travelers from DRC. South Sudan, which borders both countries, has not confirmed any cases but is included in U.S. entry restrictions due to the geographic risk.

    The U.S. response has been layered:

    As of the most recent CDC update, one American citizen who worked in DRC tested positive for Ebola but has since fully recovered and was released from care. High-risk contacts completed 21-day monitoring without developing symptoms. The CDC assesses the risk to the general U.S. public as low. No cases have been acquired domestically.

    Which Airports Are Conducting Screening

    The CDC and U.S. Customs and Border Protection (CBP) are conducting enhanced Ebola screening at three designated airports for travelers arriving from DRC, Uganda, or South Sudan:

    • Washington Dulles International Airport (IAD) — for flights departing affected countries after May 21, 2026
    • Hartsfield-Jackson Atlanta International Airport (ATL) — for flights after May 22, 2026
    • George Bush Intercontinental Airport, Houston (IAH) — for flights after May 26, 2026

    U.S. citizens and nationals who have been in the affected countries are permitted to return but must enter through one of these designated airports and undergo enhanced public health screening, which may include a health interview, temperature check, and review of symptoms. Travelers without symptoms will receive monitoring instructions and may continue to their final destination.

    According to the U.S. Embassy in DRC, travelers should be prepared for possible flight changes or cancellations when routing through these airports.

    Where the Risk Is Highest

    The active outbreak is concentrated in Ituri Province in northeastern DRC, particularly the Mongbwalu and Rwampara health zones. The CDC notes that the affected areas experience insecurity, population displacement, mining-related movement, and frequent cross-border traffic — all factors that increase transmission risk and complicate outbreak containment.

    In the United States, travelers and healthcare workers who have recently returned from DRC, Uganda, or South Sudan face the primary risk. International humanitarian workers, aid and medical personnel, journalists, researchers, and missionaries are the groups with the highest likelihood of having been in outbreak zones.

    Healthcare facilities in Atlanta, Houston, and the Washington D.C. metropolitan area should maintain heightened awareness given their proximity to the designated screening airports. Emergency departments and infectious disease units in these cities are most likely to encounter a returning traveler who develops symptoms during the 21-day monitoring period.

    What Doctors and Experts Say

    The CDC’s Health Alert Network advisory (HAN 00530) issued May 19, 2026, emphasized that “the risk of spread to the United States is considered low at this time” but called on clinicians to remain vigilant. The agency stated it is working through its country offices and international partners to support disease tracking, contact tracing, laboratory testing, and border health screening.

    The CDC noted a specific challenge with this outbreak: the FDA-approved vaccine (Ervebo) is effective against Zaire ebolavirus — the species responsible for major past outbreaks — but is not considered effective against Bundibugyo virus. The absence of an approved countermeasure for this strain makes infection control and early case detection especially critical.

    WHO Director-General Tedros Adhanom Ghebreyesus, in public statements cited across multiple outlets covering the outbreak’s early weeks, acknowledged that the delay in detecting the initial cluster meant response teams were “playing catch-up with a very fast-moving epidemic.” Contact tracing, treatment center establishment, and infection control measures have been scaled up since.

    For healthcare providers seeing patients who have returned from affected regions, the CDC recommends immediately placing potentially symptomatic patients under appropriate infection control precautions and contacting local or state public health departments for guidance on testing and isolation.

    What the Evidence Shows and What It Does Not

    The Bundibugyo virus has caused only two prior recorded outbreaks — Uganda in 2007 and DRC in 2012 — making it less well-studied than Zaire ebolavirus. Prior outbreaks had case fatality rates of approximately 25% to 50%, but that range reflects small sample sizes and variable outbreak conditions.

    Airport screening can identify travelers who are symptomatic at the time of arrival but cannot detect those who are infected but not yet showing symptoms. As the CDC states: “Public health entry screening cannot identify travelers who are infected but not yet showing symptoms.” The incubation period for Ebola is 2 to 21 days. Screening is therefore one component of a multilayered public health response, not a complete safeguard.

    The 21-day post-departure monitoring requirement for returning travelers exists precisely because of this gap.

    Who Faces the Greatest Risk?

    Based on current epidemiological data and CDC guidance, the highest-risk individuals in the United States are:

    • People who have traveled to or from Ituri Province, DRC, within the past 21 days
    • Humanitarian aid workers, healthcare volunteers, and missionary workers returning from DRC or Uganda
    • People who had direct contact with the blood or bodily fluids of a person confirmed or suspected to have Bundibugyo virus disease
    • Healthcare workers who treated or evaluated patients with suspected BVD without full personal protective equipment
    • Individuals who attended funerals or burial ceremonies in affected areas, where transmission risk is historically elevated

    The CDC’s Level 2 Travel Health Notice recommends avoiding nonessential travel to the specific affected provinces in DRC (Ituri, Nord-Kivu, and Sud-Kivu).

    Symptoms and Warning Signs to Watch For

    Anyone who has been in DRC, Uganda, or South Sudan within the past 21 days should monitor themselves carefully for the following symptoms, which may appear between 2 and 21 days after exposure:

    • Sudden onset of fever (often above 101.5°F / 38.6°C)
    • Severe headache
    • Muscle pain and weakness
    • Fatigue
    • Vomiting and diarrhea
    • Stomach pain
    • Unexplained bleeding or bruising (typically a later sign)

    The development of any of these symptoms in a person who has recently returned from an affected region requires immediate action. Do not travel to a hospital or clinic without calling first. Contact your local health department or call 911 and tell the dispatcher about your recent travel and symptoms so that appropriate isolation procedures can be prepared before you arrive.

    What You Can Do Now

    • If you recently returned from DRC, Uganda, or South Sudan, follow your state or local health department’s monitoring instructions for 21 days after your departure date from those countries.
    • Monitor your temperature daily and record any symptoms during the 21-day window.
    • Avoid international and domestic travel during your monitoring period, per CDC recommendations.
    • If you develop any symptoms, do not go directly to a hospital. Call your local health department and inform them of your travel history before seeking care.
    • Register with the Smart Traveler Enrollment Program (STEP) if you are a U.S. citizen in DRC, Uganda, or South Sudan, so the nearest embassy can provide updates and assistance.
    • Healthcare providers who evaluate a returning traveler with fever or other compatible symptoms should immediately implement infection control measures and notify their state health department and the CDC Emergency Operations Center at 770-488-7100.

    Cost and Access: What Patients Should Know

    If a returning traveler is identified as a potential Ebola case, isolation and evaluation will be coordinated by public health authorities. The CDC maintains a network of federal medical stations and Regional Ebola and Special Pathogen Treatment Centers (RESPTCs) capable of safely managing patients with highly infectious diseases.

    For general travelers concerned about health coverage abroad, the U.S. Department of State recommends purchasing travel insurance that includes medical evacuation coverage before traveling to high-risk regions.

    What Happens Next

    The current U.S. entry restriction order expires around July 21, 2026, but may be extended if the outbreak continues to grow. The CDC will assess the epidemiological situation and issue updates as warranted.

    WHO and international partners are working to scale up outbreak response in DRC and Uganda, including contact tracing, treatment access, and community engagement in affected areas. Given that no approved vaccine or specific treatment exists for Bundibugyo virus, containment measures remain the primary line of defense.

    MedicalDaily will follow CDC updates and the WHO outbreak situation report as they are published.

    The Bottom Line

    Ebola airport screening is active at Dulles, Atlanta, and Houston through at least July 21, 2026. The Bundibugyo strain currently affecting DRC and Uganda has no approved vaccine or treatment, and the outbreak has now surpassed 800 confirmed cases with nearly 200 deaths. The CDC assesses the risk to the general U.S. public as low.

    But low risk does not mean no risk. Travelers who have been in affected regions must monitor themselves for symptoms for 21 full days after departure and must contact health authorities — not walk into an emergency room — if symptoms develop. Following official CDC and state health department guidance is the single most important step returning travelers can take.

    Source link

  • Washington, D.C., Was Just Hit with a Purple Air Quality Alert, the Second-Highest Level on the Air Quality Index

    Washington, D.C., Was Just Hit with a Purple Air Quality Alert, the Second-Highest Level on the Air Quality Index

    Washington, D.C., residents and the millions of visitors who attended America 250 celebrations on the National Mall have been advised to limit outdoor activity following a rare “Purple” air quality alert — the second-worst category on the federal Air Quality Index — triggered by a convergence of record-breaking heat and smoke from the largest fireworks display in American history.

    The Metropolitan Washington Council of Governments issued the purple alert covering Washington, D.C., and parts of northern Virginia. Purple on the EPA’s Air Quality Index represents “Very Unhealthy” conditions — a level at which the EPA recommends that everyone, including healthy adults, reduce prolonged or heavy outdoor exertion.

    The heat wave stretched from Wednesday through Saturday, and Washington D.C. hit 102°F on July 3, breaking a record set in 1872. On July 4, the capital reached 101°F or higher — the hottest July 4 in D.C.’s recorded history. The combination of that heat wave with a 40-minute, multi-site fireworks display that launched hundreds of thousands of shells produced post-display particulate matter concentrations that CNN confirmed briefly ranked Washington among the worst air quality of any major city in the world.

    Why This Matters

    Most Americans are familiar with air quality alerts for “sensitive groups” — adults with asthma, heart disease, or COPD. A Purple alert is categorically different. At this level, the EPA’s guidance extends to the general population: everyone should avoid prolonged or heavy outdoor exertion, not just those with pre-existing conditions.

    The biological reason that heat and air pollution compound each other is specific. Heat causes people to breathe more deeply and rapidly — increasing the volume of air (and any particulate matter in it) inhaled per minute. Simultaneously, heat stress places additional burden on the cardiovascular system. Inhaling elevated particulate matter during cardiovascular stress creates a compound physiological challenge that healthy adults can normally tolerate but that at purple AQI levels carries documented risks.

    What We Know So Far

    The EPA’s AirNow system tracks fine particulate matter (PM2.5) at monitoring stations across the D.C. metro. Following the July 4 fireworks display:

    • D.C. July 4 temperature: 101°F or higher — the hottest July 4 in D.C.’s recorded history
    • AQI level: Purple — “Very Unhealthy” — the second-highest AQI category after Maroon (“Hazardous”)
    • PM2.5 source: Primarily fireworks smoke from the National Mall and nine additional launch sites
    • Alert area: Washington, D.C., and parts of northern Virginia
    • The AQMD in Southern California had separately issued a “Hazardous” (Maroon) air quality advisory for July 4–5 nationally, confirming the pattern
    • D.C.’s post-fireworks conditions briefly registered among the highest air pollution readings of any major global city

    Where the Risk Is Highest

    The risk is highest in:

    • Neighborhoods downwind of the National Mall and the nine additional fireworks launch sites used for the record display
    • Indoor spaces without air filtration — where smoke particulates can infiltrate through HVAC systems
    • People who remained outdoors after the fireworks ended, when PM2.5 levels were at their peak but the crowd was still dispersing

    The alert covered both D.C. proper and northern Virginia — a corridor of 4 million-plus residents.

    What the EPA Says and Who Faces the Greatest Risk

    At Purple (“Very Unhealthy”) AQI levels, the EPA’s action guidance is:

    • Sensitive groups (people with heart or lung disease, older adults, children, people with diabetes): Avoid all physical activity outdoors
    • Everyone else: Avoid prolonged or heavy outdoor exertion; consider moving activities indoors or rescheduling

    People at the highest risk from the D.C. purple alert:

    • Adults with asthma, COPD, or heart disease
    • Older adults (65+) who attended National Mall events and spent extended time outdoors
    • Children who attended events and are still outdoors
    • People who ran, cycled, or engaged in heavy exertion outdoors during or after the alert period
    • Anyone with diabetes — air pollution independently worsens glycemic control

    Symptoms and Warning Signs to Watch For

    Anyone who spent extended time outdoors during the alert period and experiences the following should contact their physician or seek urgent care:

    • Unusual shortness of breath
    • Chest tightness or discomfort
    • Worsening cough or wheezing
    • Headache, dizziness, or unusual fatigue following outdoor time
    • Worsening asthma or COPD symptoms despite rescue inhaler use

    What You Can Do Now

    • Check current D.C. area air quality at AirNow.gov by entering your zip code. If the AQI remains elevated, limit outdoor activity.
    • Run HVAC on recirculation rather than fresh-air intake to avoid pulling outdoor particulates indoors.
    • Use HEPA air purifiers indoors if available — particularly in bedrooms where nighttime air quality matters for recovery.
    • If you have asthma or COPD, review your action plan with your physician if symptoms have worsened following the alert period.
    • Do not exercise outdoors while the AQI remains in the orange, red, or purple range for your specific neighborhood.
    • If you attended National Mall events and feel unwell, contact your physician, particularly if you have cardiovascular or respiratory conditions.

    Cost and Access: What Patients Should Know

    AirNow.gov provides real-time, zip-code-level air quality data at no cost. The FEMA Wireless Emergency Alert system also broadcasts air quality warnings to mobile phones in affected areas.

    For patients experiencing air quality-related asthma exacerbation who do not have insurance, federally qualified health centers in D.C. and northern Virginia provide urgent care services on a sliding-fee basis. For severe respiratory emergencies, call 911.

    What Happens Next

    The D.C. metro air quality is expected to improve as the fireworks smoke disperses over 48 to 72 hours and as weather systems provide atmospheric mixing. The DOEE (District of Columbia Department of Energy and Environment) updates D.C. air quality data in real time.

    MedicalDaily will report on any prolonged air quality advisories or new health guidance from the D.C. health department related to the post-fireworks pollution event.

    The Bottom Line

    Washington, D.C.’s “Purple” air quality alert — triggered by record heat and the nation’s largest fireworks display — marks one of the most significant post-fireworks air pollution events the city has experienced. At this AQI level, the EPA’s recommendation extends to healthy adults, not just sensitive groups. If you were in the D.C. metro on July 4–5, limit outdoor activity while the AQI remains elevated and watch for respiratory or cardiovascular symptoms.

    Source link

  • Michigan Has More Than 300 Cyclospora Cases and No Food Source Has Been Found

    Michigan Has More Than 300 Cyclospora Cases and No Food Source Has Been Found

    More than 300 people in southeast Michigan have been diagnosed with Cyclosporiasis — a parasitic intestinal illness — since June 22, 2026. The count was 170 on July 1 and jumped to more than 300 by July 3, an increase of 130 cases in 48 hours. Health officials have called it a “large and growing outbreak,” and no food source has yet been identified.

    The Michigan Department of Health and Human Services confirmed the outbreak in Monroe, Lenawee, Washtenaw, Wayne, Livingston, Shiawassee, and Jackson counties — with an additional 24 cases across 11 other Michigan counties, including the city of Detroit. The typical annual count for all of Michigan is around 50 cases. This outbreak has already produced six times that number.

    What makes this especially frustrating for patients and clinicians: the standard stool test used to diagnose acute diarrhea does not detect Cyclospora.

    Why This Matters

    When a patient presents to an urgent care clinic, emergency room, or primary care physician with acute diarrhea, the reflex diagnostic order is typically a “routine stool culture” — a test that screens for common bacterial pathogens including Salmonella, Campylobacter, Shigella, and E. coli.

    Cyclospora cayetanensis, the microscopic parasite that causes Cyclosporiasis, is not detected by a routine stool culture. Identifying it requires a specific laboratory request: a modified acid-fast stain or a Cyclospora-specific PCR. Most clinicians treating acute diarrheal illness in Michigan — or anywhere — do not automatically order these tests.

    The result: patients with Cyclospora may receive a “negative stool test” result, be told their illness is likely viral, and go weeks without the correct diagnosis and effective antibiotic treatment. Untreated, Cyclosporiasis can last weeks to months, with symptoms that repeatedly relapse.

    What We Know So Far

    From the Michigan Department of Health and Human Services (MDHHS) and Click on Detroit / NBC News:

    • Confirmed cases as of July 1: More than 170 in 7 southeast Michigan counties
    • Confirmed cases as of July 3: More than 300 (up from 170 in 48 hours)
    • Additional cases: 24 more in 11 other Michigan counties, including Detroit
    • Age range: 8 to 84 years; median age 41
    • Typical annual Michigan total: 50 cases per year
    • Current count: Approximately 6 times the typical annual total
    • Food source: Not yet identified; investigation ongoing by MDHHS and MDARD
    • National context: Nationally, the CDC has confirmed 145 Cyclosporiasis cases in 17 states as of June 16, 2026 — Michigan cases are not included in this national count

    “Outbreaks of cyclosporiasis have been occurring across the United States and now here in Michigan,” said Dr. Natasha Bagdasarian, Chief Medical Executive at MDHHS. “Based on the unusual number of cases we have identified in a little over a week, we anticipate additional cases of illness being reported.”

    Where the Risk Is Highest

    The seven-county cluster in southeast Michigan defines the primary outbreak zone:

    • Monroe County: 67+ confirmed cases as of July 1 — the county with the highest confirmed count
    • Wayne County: Includes Detroit and is confirmed in the outbreak cluster
    • Lenawee, Washtenaw, Livingston, Shiawassee, and Jackson Counties: All confirmed in the outbreak

    The concentration of cases in this specific geographic area suggests a common exposure source — likely a food product distributed in this region during the incubation window before June 22. The investigation by MDHHS and the Michigan Department of Agriculture and Rural Development (MDARD) is focused on identifying that product.

    What the MDHHS and Local Health Officials Say

    “We currently have 67 cases in Monroe County. We are currently investigating the source. This is caused by an intestinal parasite. It’s from contaminated food,” said Lindsay Patrick with the Monroe County Health Department in a statement to WXYZ Detroit.

    Jennifer Bonsky, Director of the Human Food Division at MDARD, stated: “MDARD is committed to ensuring food safety across the state and is working in partnership with local health departments to identify the source of the outbreak and keep consumers safe.”

    Clinicians at Michigan hospitals and urgent care clinics are being specifically urged to consider Cyclosporiasis in patients presenting with acute gastrointestinal illness — and to order the correct diagnostic test.

    What the Evidence Shows — and What It Does Not

    MedicalDaily Evidence Check

    • Data source: Michigan Department of Health and Human Services; Monroe County Health Department; NBC News; Click on Detroit
    • Cases as of July 3: 300+ in 7 southeast Michigan counties; investigation ongoing
    • Food source: Not yet identified; no recall issued
    • What the data show: A large, rapidly growing parasitic outbreak concentrated in a specific geographic area in southeast Michigan — consistent with a contaminated food product with regional distribution
    • What is not yet known: The specific food, supplier, or contamination source
    • Critical diagnostic limitation: Standard stool cultures do not detect Cyclospora; a specific modified acid-fast stain or PCR test is required

    Who Faces the Greatest Risk?

    Any person who consumed fresh produce in the affected Michigan counties in late May or June 2026 is potentially exposed. The highest clinical risk for prolonged illness includes:

    • Immunocompromised individuals, for whom Cyclosporiasis can last significantly longer and require more intensive treatment
    • Older adults
    • Individuals who have already experienced weeks of diarrhea with no diagnosis — who may be infected and untreated

    Symptoms and Warning Signs to Watch For

    Cyclosporiasis symptoms include:

    • Frequent, sometimes explosive watery diarrhea — the hallmark symptom
    • Stomach cramping and bloating
    • Nausea and vomiting
    • Loss of appetite
    • Fatigue and muscle aches
    • Low-grade fever

    The most diagnostically important feature: Cyclosporiasis often waxes and wanes— symptoms improve for a few days, then return. A patient who received a negative standard stool test and was told their illness is viral may actually have untreated Cyclospora if their symptoms have persisted or recurred.

    What You Can Do Now

    • If you live in Monroe, Lenawee, Washtenaw, Wayne, Livingston, Shiawassee, or Jackson counties and have had prolonged, recurring diarrhea since late May or June, contact your healthcare provider.
    • Tell your physician specifically: “I want to be tested for Cyclospora. I need a modified acid-fast stain or a Cyclospora-specific PCR, not just a routine stool culture.”
    • Do not assume a negative routine stool test rules out Cyclospora. It does not.
    • If you have already had a “negative stool test” but symptoms have persisted or returned, go back to your provider and ask specifically for Cyclospora testing.
    • Effective treatment is available: The antibiotic combination trimethoprim-sulfamethoxazole (Bactrim) is highly effective for Cyclosporiasis. Without a correct diagnosis, you will not receive it.

    Cost and Access: What Patients Should Know

    Cyclospora-specific testing must be specifically requested by a physician. The test is covered by most insurance plans; generic trimethoprim-sulfamethoxazole (Bactrim) is available at most pharmacies for under $10 with a GoodRx discount.

    Patients without primary care access can contact their county health department or a community health center. Monroe County residents with questions can contact the Monroe County Health Department directly.

    What Happens Next

    MDHHS and MDARD are continuing the investigation to identify the contaminated food source. The case count, already at more than 300 and still growing, is expected to rise further as health officials expand testing and surveillance. MedicalDaily will report immediately when a food source is identified or a recall is issued.

    The Bottom Line

    More than 300 people in southeast Michigan have been diagnosed with a parasitic intestinal illness in under two weeks — six times the state’s typical annual total. No food source has been found. And the most common diagnostic test ordered for acute diarrhea does not detect this parasite. If you have had prolonged or recurring watery diarrhea in the affected counties since late May, you need a Cyclospora-specific test — not a routine stool culture. Ask for it by name.

    Source link

  • The CDC Is Investigating Multiple Cyclospora Outbreaks, and This Parasite Is Particularly Hard to Trace

    The CDC Is Investigating Multiple Cyclospora Outbreaks, and This Parasite Is Particularly Hard to Trace

    A parasitic illness is spreading across the United States this summer, and after weeks of investigation, federal health officials still cannot identify the specific food responsible for making people sick. The frustrating lack of a recall announcement is not a failure of urgency — it is a reflection of how uniquely difficult this particular parasite is to track.

    The Centers for Disease Control and Prevention has confirmed 145 domestically acquired cases of Cyclospora cayetanensis infection in 17 states, with illness onset dates from May 1 through June 7, 2026. Three people have been hospitalized. No deaths have been reported. But the case count is almost certainly a substantial undercount, and the absence of a specific food recall does not mean the outbreak is over.

    Why This Matters

    Cyclospora is not a pathogen that clinicians or patients typically think about first when gastrointestinal illness strikes. It requires a specific test that most clinical labs do not routinely run. It has an incubation period of 1 to 2 weeks — long enough that by the time patients seek care, they may not clearly remember what they ate that could have been contaminated. And it contaminates at the farm or irrigation level, not during processing, making the traceback chain longer and harder to follow.

    The result is predictable: most infected people are never diagnosed, the food source takes weeks or months to identify, and even after the source is found, the implicated product has often already moved through the supply chain and been consumed. Summer is the peak season for Cyclospora in the United States, meaning the number of cases is expected to grow before it peaks.

    What We Know So Far

    From CDC’s Cyclospora surveillance data current as of June 16, 2026, and FDA outbreak investigation table:

    • 145 confirmed U.S.-acquired cases in 17 states
    • 20 hospitalizations confirmed among cases with information available
    • No deaths reported
    • Illness onset dates: May 1 through June 7, 2026; median onset May 19
    • Median patient age: 43 years; 62 percent female
    • 45 travel-associated cases confirmed separately (patients ill while outside the United States)
    • Only 45 of the 145 domestic cases involve people who reported recent international travel — confirming a domestic food source is responsible
    • Michigan: More than 150 cases in 7 counties reported by state health officials — a count not yet included in the CDC’s 17-state national total
    • New York leads confirmed state counts at approximately 80 cases; Texas and Illinois each report up to 30
    • Food source: Not yet identified. No recall has been issued.

    Where the Risk Is Highest

    Cyclospora illness has been reported in 17 states, with no single geographic cluster that would suggest a local exposure. That distribution is consistent with contaminated produce distributed nationally — a pattern seen in every major Cyclospora outbreak in the United States since the 1990s.

    Prior outbreaks have repeatedly linked to fresh produce from Mexico and Central America, particularly cilantro, basil, fresh leafy greens, arugula, and bagged salad kits. The 2018 Cyclospora outbreak sickened more than 511 people across the Midwest and was linked to a fast-food chain’s salad mix. In 2020, fresh cilantro from a Texas distributor sourcing from Mexico was implicated in an Alabama cluster.

    Until a specific product is identified in this investigation, no targeted recall can be issued — and public health guidance must remain general: exercise caution with fresh herbs and leafy greens, particularly those imported from high-risk regions during the summer months.

    The Three Reasons Cyclospora Is So Difficult to Trace

    1. The incubation period makes exposure memory unreliable. Cyclospora has a 1-to-2-week incubation period between exposure and symptom onset. By the time a person seeks medical care, they typically cannot accurately recall every meal from the past 10 to 14 days. This makes dietary recall interviews — the primary tool for identifying contaminated foods — less reliable than in outbreaks caused by faster-acting pathogens like Salmonella, where the exposure meal is typically more recent.

    2. The parasite is not detected by standard stool testing. Standard clinical stool cultures do not include Cyclospora testing. A physician must specifically order a modified acid-fast stain or a direct fluorescence assay for Cyclospora, or a PCR-based test in clinical labs that offer it. Most primary care physicians and emergency physicians seeing a patient with prolonged diarrhea in the summer do not reflexively order Cyclospora testing — because most GI illness is caused by something else. This means the majority of Cyclospora cases go undiagnosed, and those that are diagnosed often experience significant delays.

    3. The contamination occurs at the farm or irrigation level, not during processing. Unlike foodborne bacterial contamination that can often be traced to a specific processing step or facility, Cyclospora contamination of produce typically occurs when irrigation water contaminated with human feces contacts crops in the field. This farm-level contamination makes traceback investigations far more complex — and means that the same contaminated irrigation source may affect multiple products from the same farm, complicating identification of a single “suspect” item.

    What Doctors and Experts Say

    The CDC’s clinical guidance for Cyclospora explicitly notes that health care providers should specifically request Cyclospora testing when they see patients with prolonged or recurring watery diarrhea, particularly from May through August.

    “Cyclospora is one of those infections that really tests physicians’ diagnostic instincts,” infectious disease specialists have noted in public health communications. The infection is treatable — a full course of trimethoprim-sulfamethoxazole (Bactrim) typically resolves illness — but the window in which to catch it relies on knowing to order the right test.

    What the Evidence Shows — and What It Does Not

    The CDC has explicitly stated there is no evidence of a single, unified nationwide Cyclospora outbreak. The 145 confirmed cases reflect a surveillance count of domestically acquired infections across the United States during the summer peak season, with multiple clusters currently under separate traceback investigation.

    MedicalDaily Evidence Check

    • Investigation status: Active multistate investigation, multiple clusters
    • Confirmed U.S. cases: 145 in 17 states (as of June 16, 2026); true total likely substantially higher
    • Food source: Not yet identified; no recall issued
    • What the data show: Domestic food exposure is confirmed as the primary driver (only 45 of 145 cases involve recent international travel)
    • What remains unknown: Specific implicated product or supplier
    • What readers should know: Cyclospora requires a specific lab test not included in standard stool cultures; prolonged diarrhea lasting more than a week warrants evaluation and explicit testing for this parasite

    Who Faces the Greatest Risk?

    Anyone who has consumed fresh produce — particularly leafy greens, fresh herbs like cilantro and basil, or bagged salad mixes — since May 1, 2026, could potentially have been exposed. However, certain groups are more likely to develop prolonged or serious illness:

    • Immunocompromised individuals, including organ transplant recipients, people with HIV, and cancer patients on chemotherapy, who may develop severe or prolonged disease
    • Adults who consume large quantities of fresh herbs and leafy greens regularly
    • Older adults, in whom infection can last longer and cause more significant weight loss and dehydration

    Symptoms and Warning Signs to Watch For

    The hallmark symptom of Cyclospora infection is:

    • Frequent, watery, sometimes explosive diarrhea that waxes and wanes over days to weeks
    • Cramping and bloating
    • Nausea and decreased appetite
    • Fatigue and muscle aches
    • Low-grade fever

    Without treatment, symptoms can last weeks and frequently return in cycles. If you have had persistent, recurring watery diarrhea lasting more than a week — especially if standard tests have come back negative — ask your doctor specifically about Cyclospora testing. Standard stool cultures do not detect this parasite unless specifically requested.

    What You Can Do Now

    • If you have prolonged or recurring diarrhea, see a clinician and specifically ask about Cyclospora testing. Use the words: “I want to be tested for Cyclospora, not just a standard stool culture.”
    • Do not self-treat with over-the-counter antidiarrheal medications as a substitute for diagnosis. If the cause is Cyclospora, antibiotic treatment is needed.
    • Wash all fresh produce thoroughly under running water before eating. While washing does not kill Cyclospora (the parasite resists standard disinfection), it reduces other surface contamination.
    • Exercise caution with fresh herbs — particularly cilantro, basil, and arugula purchased in bulk or from salad bars — until a food source is identified.
    • If you are immunocompromised, discuss your risk level with your physician.

    Cost and Access: What Patients Should Know

    Testing for Cyclospora requires a specific physician order for a modified acid-fast stain or PCR Cyclospora test. Treatment with generic trimethoprim-sulfamethoxazole (Bactrim) is inexpensive — often under $10 with a GoodRx discount at most pharmacies.

    For patients without a primary care provider, urgent care clinics and community health centers can order Cyclospora-specific stool testing. People experiencing severe dehydration, blood in the stool, or inability to keep fluids down should seek emergency care.

    What Happens Next

    The FDA and CDC are continuing traceback investigations into multiple clusters. New case data will be posted at CDC’s Cyclospora surveillance page as the investigation progresses. When a food source is identified, the FDA will issue a public advisory and, if a specific product is implicated, initiate or request a recall.

    MedicalDaily will report immediately when a food source is confirmed or a recall is issued.

    The Bottom Line

    The absence of a Cyclospora food recall is not reassurance — it is a reflection of how difficult this parasite is to trace. The investigation is active, the case count is almost certainly higher than reported, and summer is the peak exposure period. If you have had prolonged, waxing-and-waning diarrhea since May and standard tests have not identified a cause, ask specifically for Cyclospora testing. Treatment is effective once the correct diagnosis is made.

    Source link

  • Infant Formula Makers Were Required to Tell the FDA When Babies Died — Records Show They Never Did

    Infant Formula Makers Were Required to Tell the FDA When Babies Died — Records Show They Never Did

    When makers of infant formula learn that babies have become seriously ill or died after using their products, federal regulations require them to notify the FDA. But in a major investigative finding published July 2, 2026, KFF Health News revealed that the FDA has no record of a single such notification from any formula manufacturer going back more than 26 years.

    That gap in the federal safety record is not because premature infants haven’t died. According to a KFF Health News analysis of federal data, approximately 2,300 newborns died from necrotizing enterocolitis (NEC) in the United States between 2017 and 2023 — roughly one per day. A wave of more than 1,700 lawsuits has alleged that formula made by Abbott (Similac) and Mead Johnson (Enfamil) caused or contributed to these deaths by triggering NEC in premature infants, and that manufacturers knew about the elevated risk without adequately warning parents or physicians.

    Why This Matters

    Federal regulations give infant formula manufacturers substantial discretion in deciding whether and when to notify the FDA that a product may have contributed to a serious adverse event. According to KFF Health News’s investigation, that discretion has translated to zero notifications — even as hundreds of lawsuits proceeded through the courts and testimony from company executives confirmed that internal records of adverse events existed and were investigated internally.

    The practical consequence is significant: parents harmed by formula have been fighting Abbott and Mead Johnson in court, with no government notification system creating an independent safety record. Families who lose a premature infant to NEC are not informed that other families have reported the same outcome to the manufacturer. And the FDA — which does not pre-approve infant formula before it reaches the market — has had no formal mechanism to detect a pattern of harm tied to specific products.

    What We Know So Far

    From KFF Health News’s FOIA investigation published July 2, 2026, and court records cited in the report:

    • Under the Freedom of Information Act, KFF Health News asked the FDA for all notifications from formula manufacturers since January 1, 2020. The agency’s Human Foods Program responded: “did not receive any.”
    • KFF Health News extended the request to January 1, 2000. The FDA responded: “After a diligent search of our files, we did not locate any responsive records.”
    • John Wallingford, a paid expert witness for Abbott, testified in Missouri court in October 2024 that “Abbott had never reported a single death under any regulation for preterm infant formula.”
    • Courtney Colombo, who identified herself in a March 2024 deposition as Abbott’s director of postmarketing medical safety and surveillance, testified she knew of no instance in which Abbott had reported to any regulatory authority anywhere in the world that one of its preterm infant formulas was possibly related to a NEC death.
    • An Abbott internal document from 2010, displayed in deposition video clips obtained by KFF Health News, stated that NEC “is the most severe GI complication of prematurity and the use of bovine milk-based fortifiers and formulas are believed to be the primary risk factor.”
    • A Mead Johnson marketing slide deck from 2020 — later used in trial — outlined a plan for “Branding NICU Babies,” a strategy to capture preterm infant feeding contracts through hospital relationships.
    • As of late January 2026, approximately 1,760 NEC lawsuits were pending against Abbott alone.
    • About 2,300 newborns died of NEC in the U.S. from 2017 through 2023, the equivalent of nearly one per day. The database does not attribute causation.

    Where the System Fails Families

    The regulatory framework governing infant formula reporting gives manufacturers the authority to determine whether adverse events — including deaths — meet the threshold requiring FDA notification. Unlike pharmaceutical drugs, which are subject to rigorous post-market surveillance and mandatory serious adverse event reporting with specific timelines, infant formula operates under a framework in which reporting is largely at the manufacturer’s discretion.

    The FDA does not approve infant formula products before they reach market. It does not license formula labeling for safety claims. And, according to the KFF Health News investigation, its Human Foods Program received zero death notifications from formula makers across a 26-year window — even as internal company documents confirmed the companies were tracking NEC-related complaints internally.

    This creates a structural gap: a manufacturer can investigate an adverse event internally, close the file internally, and the FDA may never receive a notification that allows it to identify a pattern of harm.

    What the Companies and Agencies Say

    Abbott spokesperson Scott Stoffel stated in November that “Abbott complies with all applicable FDA regulations on adverse event reporting, including by keeping detailed records of every single complaint/adverse event report Abbott receives and investigating NEC complaints.”

    The FDA stated in a 2024 joint statement with the CDC and NIH that there is “no conclusive evidence that preterm infant formula causes NEC.” Abbott’s chief executive has publicly said that claims linking preterm formula to NEC are “without merit or scientific support.”

    However, courts have repeatedly found in favor of families suing Abbott and Mead Johnson. A Chicago jury awarded $53 million to four families in April 2026, and a separate Chicago verdict in the same month awarded an additional $70 million. A Missouri appeals court upheld a $495 million verdict against Abbott. As of June 2026, approximately 798 federal NEC cases remain pending in multidistrict litigation in the Northern District of Illinois, with hundreds more in state courts.

    What the Evidence Shows — and What It Does Not

    The scientific debate over whether bovine (cow’s milk-based) formula causes NEC in premature infants versus the absence of human milk increasing NEC risk is ongoing and genuinely contested. The FDA, CDC, and NIH have stated there is no conclusive causal evidence. The American Academy of Pediatrics recommends human milk — including pasteurized donor milk — for premature infants when the mother’s own milk is not available.

    What is not contested is the reporting record: the FDA received no death notifications from formula manufacturers going back to 2000, and Abbott’s own expert witness confirmed the company made no such reports.

    MedicalDaily Evidence Check

    • Investigation type: FOIA requests + court record analysis (KFF Health News, published July 2, 2026)
    • What it found: Zero FDA death notifications from formula manufacturers from January 2000 through the present; Abbott’s expert witness confirmed Abbott never made a single death report under any regulation for preterm formula
    • What it did not prove: That the formula directly caused the deaths — this remains contested between companies and plaintiffs
    • Regulatory context: FDA does not pre-approve infant formula; adverse event reporting for formula is largely at manufacturers’ discretion
    • What readers should know: The regulatory gap in formula death reporting is confirmed by FOIA records; families of premature infants have been fighting manufacturers in court without a government notification system creating an independent safety record

    Who Is Most Affected?

    This issue affects:

    • Parents of premature infants currently in NICUs who are receiving cow’s milk-based formula or fortifiers
    • Families who have experienced a premature infant death from NEC and may not know there is a reporting gap at the regulatory level
    • NICU clinicians and hospitals whose informed consent discussions about formula feeding may not have reflected the manufacturer’s internal awareness of NEC-related adverse events
    • Policymakers and advocates working on infant formula regulation reform

    Symptoms of NEC in Premature Infants

    Necrotizing enterocolitis typically develops in premature infants two to four weeks after birth, often around the time feedings begin. Warning signs that require immediate evaluation by the neonatal team include:

    • Sudden abdominal swelling or rigidity
    • Feeding intolerance after previously tolerating feeds
    • Bloody stool
    • Temperature instability
    • Lethargy or decreased responsiveness
    • Skin discoloration over the abdomen

    If your premature infant is in the NICU, ask the neonatal team specifically about NEC risk and what the protocol is for early detection.

    What You Can Do Now

    • If your premature infant is currently in a NICU, ask the neonatologist whether your baby is receiving human donor milk or cow’s milk-based formula, and what the facility’s protocol is for NEC monitoring.
    • Ask about your baby’s NEC risk based on gestational age and birth weight — infants born before 32 weeks and those under 1,500 grams face the highest risk.
    • Inquire about human milk availability at the facility. The American Academy of Pediatrics recommends human milk — including pasteurized donor milk — as the preferred nutrition for very premature infants.
    • If your premature infant previously suffered NEC while receiving cow’s milk-based formula, you may wish to consult a legal professional about your options. As of June 2026, active multidistrict litigation is proceeding in the Northern District of Illinois.
    • Report adverse events through the FDA’s MedWatch program if you believe a formula product contributed to a serious adverse event in your infant.

    Cost and Access: What Patients Should Know

    Human donor milk is more expensive than cow’s milk-based formula, and insurance coverage varies. NICU families should ask the billing department and the neonatology team about donor milk access and coverage. Many NICUs absorb donor milk costs for the highest-risk infants.

    For families who believe their infant was harmed by formula, legal consultations are typically offered at no upfront cost by firms handling NEC formula litigation. The Pancreatic Cancer Action Network NICHD page on NEC and infant feeding provides a recent scientific overview of the evidence.

    What Happens Next

    The KFF Health News investigation is expected to prompt renewed regulatory scrutiny of infant formula adverse event reporting requirements. The ongoing multidistrict litigation will produce additional bellwether trials in 2026 that may increase pressure on Abbott and Mead Johnson to consider broader settlements.

    Congress has shown some interest in strengthening formula safety oversight following the 2022 Abbott infant formula shortage and contamination recall. Whether the KFF Health News reporting prompts legislative action on adverse event reporting requirements remains to be seen.

    The Bottom Line

    The FDA received zero death notifications from infant formula manufacturers going back to the year 2000, according to FOIA records obtained by KFF Health News — confirmed by Abbott’s own expert witness, who testified the company never made a single such report for preterm formula. Approximately 2,300 premature infants died of NEC in the U.S. between 2017 and 2023. The combination of those two facts is not proof of causation — but it is a documented regulatory gap that left families fighting for accountability in court with no independent government safety record to draw on.

    Source link