Welcome to the twenty-ninth 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
Measles: Pennsylvania deaths – E. coli and Salmonella: alfalfa sprouts – Cyclosporiasis – Vibrio vulnificus: Florida – EEE: Michigan – Naegleria fowleri: Louisiana – Ebola: Uganda closed, DRC growing
National interest
Measles: first U.S. deaths of 2026
On August 25, the Pennsylvania Department of Health confirmed two measles-associated deaths in unvaccinated residents of Lancaster County. These are the first measles deaths in Pennsylvania in 35 years and the first in the United States this year. The department said it would not release further details, citing patient privacy.
The CDC's August 21 update put the national total at 2,777 confirmed cases across 47 jurisdictions as of August 20. That exceeds the total for all of 2025 (2,289) and is the highest annual count since 1991.
Recent state activity:
- Pennsylvania - 424 cases year to date across 30 counties, 197 in Lancaster County. Lancaster kindergarten two-dose MMR coverage is low at 87.6%, compared to 92.7% statewide. Lancaster's coverage is down from 88.5% last year. Roughly 35,000 Pennsylvanians were vaccinated in July, about 10,000 above the usual monthly pace.
- Ohio - 109 cases year to date, including 95 indigenous to the state.
- Texas - 190 cases year to date, mostly in Hudspeth County. The state notes that some of those cases were in people held in detention.
- Utah - 518 cases year to date. Weekly case counts have declined markedly since spring, but a handful of new cases are still reported each week.
- Maryland - 31 cases reported year to date. The state health department notes that there is an outbreak in unvaccinated people in Carroll, Cecil, and St. Mary's counties.
Pennsylvania Governor Josh Shapiro declined an offer of federal assistance from HHS Secretary Robert F. Kennedy Jr. Looking ahead, the Pan American Health Organization will review U.S. elimination status in November; Canada lost its status last year after a similar review. The United States achieved elimination in 2000.
E. coli and Salmonella: alfalfa sprouts
The FDA and CDC are investigating 55 illnesses across 15 states linked to alfalfa sprouts from Everything Sprouts, LLC of Minneapolis.
Forty-six people were infected with Shiga toxin-producing E. coli, seven with Salmonella, and two with both. Four of the 48 cases with information available were hospitalized. No deaths have been reported. Illness onset dates range from May 31 to August 8.