Welcome to the twenty-third 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
Cyclosporiasis – Measles – West Nile virus – E. coli: Publix blueberries – Infant botulism update – Legionnaires': New York City – Salmonella: Shinnecock Nation – Chagas disease: California – Ebola – Marburg
National interest
Cyclosporiasis: largest U.S. outbreak on record
On July 14, the Centers for Disease Control and Prevention issued a Health Alert (CDC HAN 00531) with data suggesting 2026 could become the largest cyclosporiasis year on record, surpassing 2019's peak of approximately 4,700 cases.
As of July 14, there have been 1,645 confirmed cases across 34 states, plus 5,100+ additional cases under review, approaching 7,000 when combined. To date, there have been at least 141 hospitalizations (9%) and zero deaths.
Data from the Nationally Notifiable Disease Surveillance System shows 358 cases reported in the most recent week, with a year-to-date cumulative total of 1,838. The four-week trajectory confirms rapid acceleration, rising from 64 to 73, then jumping to 180 and 358. The full state-level burden is substantially higher; Michigan alone reported 700 cases on July 1, climbing to 3,762 by July 15.
Michigan (3,762 cases across 56 counties; 44 hospitalizations as of July 9) leads with the most cases. Michigan, as well as Ohio (397, 57 counties), West Virginia (statewide outbreak declared, 47 cases reported), and Kentucky (~100 cases) share a confirmed epidemiological link per the CDC's health alert. New York (517 statewide), North Carolina (307), and Illinois (216) are also among the states reporting elevated counts.
No food source has been confirmed and no recall has been issued. However, Michigan officials have named lettuce and salad greens as the leading hypothesis, following more than 1,000 patient interviews. Two epidemic curve peaks have been detected (~June 25 and ~July 7), suggesting possible multiple contamination sources or lots. Taco Bell voluntarily pulled select items (lettuce, cilantro, onion, pico de gallo, guacamole) in some locations; CDC and FDA have not confirmed a link.
Measles
Measles cases are outpacing 2025 levels. CDC updated this year's total to 2,231 confirmed cases as of July 9, just 58 cases short of the 2025 full-year total (2,289) with five months remaining.
State updates:
- Virginia: 177 cases, with no new cases reported since July 4. 169 of 177 cases are in unvaccinated individuals; 9 hospitalized, no deaths. Buckingham County (126), Cumberland County (17), and Prince Edward County (11) account for the core outbreak; additional cases are distributed across other localities.
- Iowa: First 2026 case added, in a Polk County adult.
West Nile virus
2026 has the worst early-season start in more than 20 years. As of July 14, 81 confirmed human cases were reported across 18 states, with 57 (70%) neuroinvasive.