Welcome to the twenty-fifth 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 – Salmonella: shell eggs – West Nile virus – Covid-19 – Leprosy: Florida – Legionnaires': New York City – Vibrio vulnificus – Ebola
Cyclosporiasis — nine-state cluster, outbreak deepens
The Taylor Farms de México iceberg lettuce cluster has expanded from five to nine states (Indiana, Kentucky, Michigan, Ohio, West Virginia, plus Illinois, Kansas, Oklahoma, and Pennsylvania, added ~July 22). According to CDC, the cluster now stands at 1,947 confirmed cases and 98 hospitalizations, with zero deaths. (As a reminder, CDC reporting is delayed compared to state level reporting.) Across all domestic investigations, 4,173 lab-confirmed cases in 41 states have been reported since May 1.
State burdens as of July 27–28:
| Jurisdiction | Cases | Hospitalized | As of |
|---|---|---|---|
| Michigan | 9,253 | 160 | July 27 (MDHHS) |
| Ohio (NW Ohio) | 2,689 | — | July 27 |
| Kansas | 461 | 12 | July 29 (KDHE) |
| National lab confirmed, CDC | 4,173 | 141 | ~July 22 |
| NNDSS YTD | 7,907 | — | Week 28 (July 18) |
National surveillance recorded 2,275 cases during the most recent reporting week, the highest weekly count in the past year and the first time that ceiling has been broken. Weekly counts have more than doubled in each of the last four weeks, rising from 180 → 358 → 874 → 2,275. Kansas has moved into the top five states nationally at 461 cases year-to-date, reflecting continued cluster expansion. Johnson County accounts for 143 of the state's total.
Recall status: The Taylor Farms de México voluntary recall remains in effect across 28 states covering iceberg lettuce sourced from Mexico and distributed June 29–July 16. No confirmatory positive product sample exists. FDA maintains six active cluster investigations; only Taylor Farms has a named recall.
Clinical reminders: Standard stool O&P does not detect Cyclospora. Request modified acid-fast staining or Cyclospora-specific PCR explicitly. TMP-SMX DS BID × 7–10 days. Full clinical guidance in the FOI HAN+ alert.
Measles — 35-year record
CDC updated to 2,318 confirmed cases on July 23, now in 45 jurisdictions, surpassing the 2025 full-year total (2,289) and marking the highest annual count since 1991.