Welcome to the twenty-first edition of FOI Clinical. Each week, we'll send you a briefing on outbreak news. When something urgent breaks, you'll get an alert the same day.
In this edition
Infant botulism: Nara Organics – Cyclosporiasis – Measles – Mpox – Powassan virus: New England – Plague: Arizona – Ebola – Nipah: India – Measles: Americas/World Cup – Notable declines
National interest
Infant botulism: Nara Organics recall
The FDA and CDC are investigating a multistate infant botulism outbreak involving three confirmed cases in California, Pennsylvania, and Washington, all male infants aged 2–5 months, illness onset April–May 2026, all hospitalized, no deaths. All three consumed Nara Organics Whole Milk Organic Powdered Infant Formula; toxin type A was identified in each. Nara Organics recalled all infant formula on June 13 based on epidemiological evidence, before laboratory contamination was confirmed. No new cases have been added since the initial notice.
The critical finding in the June 26 update: traceback identified Organic West Milk as the raw milk supplier and Dairy Farmers of America as the spray-drying processor, the identical supply chain implicated in the November 2025 ByHeart infant formula botulism outbreak (28 confirmed, 20 probable cases across 19 states; declared over March 4, 2026). Organic West Milk had provided an incomplete customer list during the 2025 investigation that omitted Nara Organics, raising concern that additional exposed brands may remain unidentified. The formula manufacturer is Milchwerke Mittelelbe GmbH (Elb-Milch, Germany); FDA has inspected both European production facilities and issued deficiency observations. An additional suspected toxin type A case in an infant in Puerto Rico is under investigation.
This is the second product-associated infant botulism outbreak within eight months involving overlapping supply chain actors, a pattern suggesting a persistent contamination point at the raw milk or spray-drying stage rather than an isolated manufacturing event. Environmental confirmation from product testing is still pending.
Cyclosporiasis
An active Cyclospora cayetanensis outbreak is generating significant national attention. The CDC line list reports 145 domestically acquired cases across 17–20 states (last updated June 16), with illness onset May 1–June 7, 20 hospitalizations, and no deaths. During the most recent reporting week, the National Notifiable Disease Surveillance System saw 73 cases reported in a single week putting year to date totals at 589 cases (1.2x prior year). The outbreak is running well past the typical early-season acceleration.