Welcome to the thirtieth 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 – Cyclosporiasis: season totals – National surveillance, week 33 – Naegleria fowleri: North Carolina and Louisiana – Chikungunya: Florida – Ebola: DRC past 6,000 

National interest

Measles

CDC reported 2,903 confirmed cases on August 27, up 126 in one week. There have been 37 outbreaks this year, 94% of cases are outbreak-associated, and 8% of cases (223 of 2,903) have been hospitalized.

Measles is back in the national headlines this week, as the first two deaths in 2026 spark controversy. One of the two deaths was a newborn. CIDRAP reports that the infant died of a lacerated spleen, and that the dispute is over whether congenital measles infection played a role. Lancaster County Coroner Stephen Diamantoni told media outlet WGAL that his office's forensic pathologist found the spleen "neither enlarged nor inflamed," and that many types of force can lacerate a spleen; his investigation is continuing. State Health Secretary Debra Bogen said she had thoroughly reviewed the case investigation information, and Governor Josh Shapiro has said the baby would not have died had the mother been vaccinated. There are no public details about the second death.

CDC's measles page, updated August 30, now lists U.S. measles deaths for 2026 as an asterisk rather than a number. The agency said that "available information does not establish whether measles caused or contributed to the deaths or whether the individuals died from other causes while infected with measles," and that it "will update the national count as additional information becomes available." The decision to include this language instead of recording two measles-associated deaths came from CDC director Erica Schwartz, according to reporting from CNN. Pennsylvania state public health officials have decried the decision to overrule submitted data.

Paul Offit of Children's Hospital of Philadelphia wrote in his newsletter that splenic rupture is “extremely rare” in neonates, and difficult to assess post-mortem. He listed CMV, rubella, hemolytic disorders, and inborn errors of metabolism as alternative explanations for a fragile neonatal spleen, and said that absent one of those, the only obvious cause left would be measles.

State updates:

• Pennsylvania: The state has reported 540 cases as of September 2, including 119 new cases in one week. 91 people have been hospitalized, 30% of cases are under 18, and 0% of cases were in people recorded as fully vaccinated. The dashboard continues to list two measles-associated deaths. The outbreak reached two new Western Pennsylvania counties, Butler and Westmoreland, with one case each. Schools across the state returned to session in late August.
• Utah: The state has reported 518 cases this year and 715 across the outbreak since 2025, but no Utah resident has been diagnosed in the last three weeks as of September 1. This marks a third consecutive week with no new cases.
• Texas: The state has reported 191 cases as of August 28, with 136 in Hudspeth County (71% of the state total). DSHS notes a subset of confirmed cases are among people housed in federal detention facilities.
• Ohio: The state's third outbreak of the year is ongoing across Tuscarawas, Ashtabula, Geauga, and Wayne counties. The emergency room at St. Joseph Warren Hospital recently reported a public exposure.
• Georgia: Four cases linked to an Atlanta-area daycare, all in children who were unvaccinated or had not completed the MMR series. The state has reported 13 cases so far this year.
• Maryland: The state is responding to an outbreak among unvaccinated people in Carroll, Cecil, and St. Mary's counties, with no evidence of widespread community transmission as of August 27.

Cyclosporiasis: season totals 

The typical peak season for cyclosporiasis extends from May 1 to August 31. CDC's case data, updated September 1, records 18,445 laboratory-confirmed domestically acquired cases, 990 hospitalisations, and two deaths across 49 states and the District of Columbia. During the same period last year, 1,180 cases were reported. The median age of cases was 46 years, with a range from 1 to 99; 57% of cases are female; and the median symptom onset was July 8.