#USA, #Cyclospora #outbreak linked to iceberg #lettuce expanded to four new states (CDC, July 25 '26)

 

A CDC food safety alert regarding a multistate outbreak of cyclosporiasis infections has been updated at https://www.cdc.gov/cyclosporiasis/outbreaks/07-26/index.html.

Key Points:

    ° Since the last update on July 18, 2026, 4 states have been added to the multistate outbreak, and the total case count is now 1,947. The 4 additional states are Illinois, Kansas, Oklahoma, and Pennsylvania.

    ° Illnesses have now been reported from: 

        § Illinois, 

        § Indiana, 

        § Kansas, 

        § Kentucky, 

        § Michigan, 

        § Ohio, 

        § Pennsylvania, 

        § Oklahoma, and 

        § West Virginia.

    ° At least 98 people have been hospitalized, and no deaths have been reported.

    ° Epidemiologic and traceback data continue to show that iceberg lettuce from Taylor Farms de Mexico was contaminated with Cyclospora and has made people sick.

    ° This alert only includes illnesses that are lab confirmed and have been linked to this product, not all cyclosporiasis illnesses being reported to and by CDC.

    ° CDC is also investigating other outbreaks and illnesses of cyclosporiasis nationally that are unrelated to this outbreak.

What You Should Do:

    ° Do not eat any recalled Taylor Farms iceberg lettuce. Throw it away or return it.

    ° If you have symptoms of cyclosporiasis, contact your healthcare provider to receive care and report symptoms.

    ° You may need to request that your healthcare provider tests you for Cyclospora.

Cyclosporiasis Symptoms:

    ° Some people may not experience symptoms.

    ° Symptoms can include watery diarrhea, loss of appetite, and weight loss.

    ° Symptoms usually begin about one week after becoming infected.

    ° Without treatment, symptoms can last anywhere from a few days to a month or longer.

    ° If you have symptoms, stay well hydrated.

    ° If you have questions about cases in a particular state, please call that state's health department.

    ° If you are a member of the media, please fill out this Request for Comment form to submit your media inquiry to CDC.

Thank you, CDC News Media Branch

Source: 

Link: https://www.cdc.gov/media/releases/2026/cyclospora-outbreak-linked-to-iceberg-lettuce-expanded-to-four-new-states.html

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#USA, #Michigan DHHS updates #recommendations for #cyclosporiasis prevention (July 14 '26)

 

    LANSING, Mich. – The Michigan Department of Health and Human Services (MDHHS) continues to investigate an outbreak of cyclosporiasis with 2,640 cases reported as of Monday, July 13. 

    While the investigation is ongoing, current results point to lettuce or salad greens as a potential source for this outbreak, although other food items cannot be completely ruled out. 

    No specific type of produce, grower or supplier has been identified as the source. 

    “Although we do not have a definite product identified as the source of the outbreak, we want to let Michiganders know what we have learned so far so they can take steps to protect their families,” said Dr. Natasha Bagdasarian, chief medical executive. 

    “Early information has shown lettuce as a common product that regularly comes up during the investigation. We will continue to provide updates as we learn more.” 

    Cyclospora is a parasite that infects the intestines and causes watery diarrhea, nausea, and stomach cramps. It is often contracted by eating or drinking something contaminated with the parasite. Typically, Michigan only records 40 to 50 cases of cyclosporiasis annually.  

    MDHHS continues to work closely with local health departments to conduct in-depth interviews of individuals testing positive for cyclosporiasis, as well as with other state and federal partners to conduct traceback investigations. More than 1,000 interviews have than have been completed to date. 

    Given the extent of the outbreak, the incubation period of up to two weeks for symptoms to develop after exposure and complex food distribution networks across the state and country, it will take some time for agencies to complete their investigation.   

    Recreational water exposure, such as swimming in lakes, is not a recognized risk factor for cyclosporiasis and there is currently no evidence linking recreational water activities to this outbreak. While people should always avoid swallowing recreational water, foodborne exposure – particularly exposure to contaminated produce – remains the primary focus of this outbreak investigation. 

    MDHHS recommends the following safe practices for all individuals serving, preparing, or consuming lettuce and salad greens in impacted counties, this includes restaurants and commercial kitchens. Because this is an active and evolving situation, these recommendations may change as more information becomes available. 

Focus on lettuce and salad greens 

    Given early information and the historical link between cyclospora and pre-packaged salad greens, MDHHS recommends adopting the following lettuce-specific safety measures: 

    ° Purchase whole heads: 

        - Buy whole heads of lettuce rather than pre-washed, bagged lettuce or pre-mixed salad kits. 

    ° Discard outer layers: 

        - Before preparation, throw away the outer two to three layers of leaves. 

    ° Wash inner leaves: 

        - Thoroughly wash the remaining inner leaves under clean running water. 

    ° Prioritize cooking: 

        - For any greens that can be cooked, cooking to a temperature of at least 158 F (70 C) is the safest option, as the parasite is resistant to routine chemical disinfection and washing alone cannot guarantee its removal. 

Previous outbreaks 

    The following foods have been specifically linked to previous cyclospora outbreaks in the United States and Canada: 

    ° Bagged salad mixes and kits.  

    ° Fresh cilantro (coriander leaves). 

    ° Fresh basil. 

    ° Raspberries. 

    ° Snow peas. 

    ° Green onions (scallions). 

General rules to reduce risk 

    ° Cook when possible. Heating food to 158 F (70 C) or higher kills cyclospora. 

    ° Peel produce. Peeling is highly effective for food items with removable skin as the parasite sits on the outer surface. 

    ° Wash all fresh produce. Wash under clean running water, even if you plan to peel it. “Pre-washed” does not guarantee safety and rewashing bagged lettuce is unlikely to remove cyclospora. While washing alone may not fully eliminate cyclospora, it enhances protection when combined with cooking or peeling. 

    These recommendations are particularly important for people who have a higher risk of dehydration or weakened immune systems such as patients on chemotherapy, organ transplant recipients, infants and young children and elderly people. 

If you do become ill  

    People experiencing frequent, watery diarrhea are encouraged to contact their health care provider and specifically request testing for cyclospora as routine stool tests may miss the parasite. Cyclosporiasis is treated with antibiotics along with rest and drinking plenty of fluids to maintain hydration. 

(...)

Source: 

Link: https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2026/07/13/cyclo-3

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#USA, #Michigan Dept. of Health makes #recommendations on preventing #foodborne illness amid growing #cyclosporiasis #outbreak (July 6 '26)

 

July 04, 2026

    As cyclosporiasis cases continue to rise, with the largest increase occurring in Southeast Michigan, the Michigan Department of Health and Human Services (MDHHS) is providing additional recommendations to help prevent foodborne illness related to fresh produce.  

    As of July 4, 2026, no specific produce grower/supplier, or specific produce type has been identified as the source of the outbreak.

    In Michigan, the number of reported cases has risen to 572 as of Saturday, July 4, up from 170 on Tuesday, June 30. 

    Cases remain the highest in Monroe, Lenawee, Washtenaw, Wayne, Shiawassee, Jackson, Oakland and Livingston counties. 

    MDHHS is working with local health departments and the Michigan Department of Agriculture and Rural Development (MDARD) and will update information as it becomes available.

    Cyclosporiasis is an intestinal illness caused by the Cyclospora parasite. People can become infected by consuming food or water that contains the parasite. 

    Cyclospora infects the small intestine (bowel) and usually causes frequent, watery and explosive diarrhea. 

    The time between being exposed and becoming sick is usually about one week but can range from two days to two weeks or more. 

    Untreated, the illness may last from a few days to more than a month. Symptoms may go away and then return.

    Cyclosporiasis is not usually life-threatening, but dehydration from frequent bouts of diarrhea can cause severe illness, particularly among younger or older people and those who have weakened immune systems.

Previous outbreaks

The following foods have been specifically linked to previous Cyclospora outbreaks in the United States and Canada:

    ° Bagged salad mixes and kits (pre-cut lettuce blends with romaine, iceberg, red cabbage, carrots)

    ° Fresh cilantro (coriander leaves)

    ° Fresh basil

    ° Raspberries

    ° Snow peas

    ° Green onions (scallions)

    

    Given the large and increasing number of cases in Michigan, MDHHS recommends that entities in Southeast Michigan who are preparing, processing, or serving raw produce, including restaurants and other commercial kitchens, take the following steps to reduce risks of exposure:

        ° Lettuce/leafy greens:  

            - buy whole heads of lettuce (rather than prewashed, bagged lettuce or salad mixes), throw away the outer 2–3 layers of leaves and wash the inner leaves under running water. For leafy greens that can be cooked, cooking is the safest option.

        ° Cilantro, basil: 

            - Wash thoroughly under running water, separating the leaves.  Safest when cooked.

        ° Green onions: 

            - Trim the root end and remove the outer layer, wash thoroughly under running water. Safest when cooked.

        ° Raspberries: 

            - Their bumpy surface makes them especially hard to clean; the parasite can hide in the tiny crevices.  Safest when cooked (pies, jams etc.). Consider frozen raspberries as an alternative (freezing may reduce but does not guarantee elimination of the parasite).

        ° Snow peas: 

            - Wash under running water and rub the surface. Safest when cooked.

 

    These recommendations are particularly important for people who have a higher risk of dehydration or weakened immune systems such as patients on chemotherapy, organ transplant recipients, infants and young children and elderly people. 

General Rules to Reduce Your Risk

    ° Cook when you can. Heating food to 158°F (70°C) or higher kills Cyclospora.

    ° Wash all fresh produce under clean running water, even if you plan to peel it.

Reminders about routine food safety practices

    ° Wash hands with soap and water before and after handling or preparing food.

    ° Scrub firm fruits and vegetables, such as melons and cucumbers, with a clean produce brush.

    ° Cut away any damaged or bruised areas on fruits and vegetables before preparing and eating.

    ° Wash and sanitize utensils and surfaces before and after handling food. Wash and sanitize display cases and refrigerators where fresh produce is stored.

    ° Wash and sanitize cutting boards, surfaces and utensils used to prepare, serve or store fresh produce.

    ° Refrigerate cut, peeled or cooked fruits and vegetables as soon as possible. 

If you do become ill

    ° People experiencing gastrointestinal illness, such as sudden and ongoing diarrhea, are encouraged to contact their health care provider and reach out to their local health department. 

    ° Cyclosporiasis is treated with antibiotics along with rest and drinking plenty of fluids to maintain hydration.

Source: 

Link: https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2026/07/04/mdhhs-makes-recommendations-on-preventing-foodborne-illness-amid-growing-cyclosporiasis-outbreak

____

#USA, #Outbreak of #cyclosporiasis occurring in #Michigan (Dept. of Health, July 1 '26)

 

July 01, 2026

No cause identified for illnesses at this time; state offers prevention tips

LANSING, Mich. - The Michigan Department of Health and Human Services (MDHHS) and Michigan Department of Agriculture and Rural Development (MDARD), in partnership with several local health departments, are actively investigating a large and growing outbreak of cyclosporiasis, a diarrheal illness.  

    As of Tuesday, June 30, more than 170 cases have been reported in Monroe, Lenawee, Washtenaw, Wayne, Livingston, Shiawassee and Jackson counties in the past nine days. Typically, Michigan only identifies around 50 cyclosporiasis cases per year.  

    “Outbreaks of cyclosporiasis have been occurring across the United States and now here in Michigan,” said Dr. Natasha Bagdasarian, chief medical executive. 

    “Based on the unusual number of cases we have identified in a little over a week, we anticipate additional cases of illness being reported. We recommend Michiganders contact their health care provider if they experience sudden, ongoing diarrhea and reach out to their local health department if additional members of their family are suffering from the same symptoms.” 

    Cyclosporiasis is caused by infection with the parasite Cyclospora cayatenensis, which is commonly found in developing countries and spread by food or water contaminated with feces. In recent years, outbreaks have occurred in the U.S. as a result of eating contaminated fresh produce, especially during the summer months. Cyclosporiasis is not known to spread from person to person. 

    Symptoms occur two to 14 days after exposure and may include: 

        ° Frequent watery diarrhea. 

        ° Loss of appetite and weight. 

        ° Abdominal cramps and bloating. 

        ° Nausea (vomiting is less common). 

        ° Low-grade fever. 

    Individuals experiencing sudden gastrointestinal illness are encouraged to be evaluated by a health care provider. Symptoms of cyclosporiasis can be significantly improved with antibiotic treatment. If untreated, the illness may last for a few days to a month or longer. Providers are urged to consider cyclosporiasis among patients presenting with acute gastrointestinal illness in southeast Michigan. 

    “MDARD is committed to ensuring food safety across the state and is working in partnership with local health departments to identify the source of the outbreak and keep consumers safe,” said Jennifer Bonsky, Director of the Human Food Division at MDARD. 

    “In these moments, it becomes even more important to follow all of the essential food preparation guidelines, such as washing your hands before and after preparing food and washing produce before it is consumed.”  

    To help avoid any illness from cyclospora or other harmful bacteria or organisms, MDARD recommends the following: 

        ° Wash all fruits and vegetables thoroughly under running water before eating, cutting or cooking. 

        ° Scrub firm fruits and vegetables, such as melons and cucumbers, with a clean produce brush. 

        ° Cut away any damaged or bruised areas on fruits and vegetables before preparing and eating. 

        ° Refrigerate cut, peeled or cooked fruits and vegetables as soon as possible. 

    Not all cases identified in the last nine days may be connected to the outbreak and the public health investigation is ongoing. State and local officials are interviewing cases to try and identify a common exposure and prevent additional illness. Individuals diagnosed with cyclosporiasis are encouraged to talk to health department staff investigating these illnesses to help identify a potential cause. 

    Additional information is available at About Cyclosporiasis | Cyclosporiasis | CDC.

Current case county by county as of Tuesday, June 30: 

    ° Monroe: 70 

    ° Lenawee: 33 

    ° Washtenaw: 21  

    ° Wayne: 12 

    ° Jackson: 7 

    ° Shiawassee: 7 

    ° 24 cases in 11 other counties and the City of Detroit.

Age 

    ° Age range: 8 years to 84 years 

    ° Average age: 44.3 years 

    ° Median age: 41 years 

# # #

Source: 

Link: https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2026/07/01/cyclosporiasis

____

#Taiwan, potential for cross-species #human #infection by "Cryptopathic #Noda Virus (CMNV)," CDC convened an expert meeting and established a testing mechanism (May 12 '26)

 

The Centers for Disease Control (CDC) announced today (May 12) that, in response to a recent study published in the international journal *Nature Microbiology*, which suggests that the "Cryptant Morbid Noda Virus (CMNV)," found in aquatic animals, may have cross-species transmission capabilities and could potentially cause "Persistent High-Pressure Viral Anterior Uveitis (POH-VAU)" in humans, the CDC proactively convened a meeting on May 4 with relevant medical associations and experts to discuss and establish a testing mechanism to protect the health and safety of the public.

The CDC explained that CMNV has been listed as an emerging infectious disease by the World Organisation for Animal Health (OIE), and infection cases have been reported in shrimp farms in China and Thailand; currently, only China has reported suspected human cases of CMNV infection globally. 

The research report inferred that human infection with CMNV may be related to handling or consuming raw aquatic products; however, further evidence is needed to confirm whether this virus has the ability to effectively infect human eye tissues. 

Major international public health organizations, including the World Health Organization (WHO), the US CDC, and the European Centre for Disease Prevention and Control (ECDC), have not received any reports of related human cases, nor have they listed it as an urgent public health threat. 

Furthermore, regarding domestic surveillance, the Taiwan Agricultural Bureau's (Agricultural Science Institute) has not detected CMNV in any of the past five years (2021-2026) of surveillance of white shrimp cases and the domestic animal disease prevention and control network. 

Based on a comprehensive assessment, the risk of domestic transmission is extremely low. 

However, to prevent any potential outbreaks, the Taiwan Centers for Disease Control (CDC) has established a relevant specimen submission mechanism and issued a circular to the medical community today, reminding clinicians to be vigilant and, in the event of suspected cases, to thoroughly investigate the patient's exposure history to aquatic animals and seafood, and to collect clinical specimens for testing if necessary.

The CDC emphasizes that agriculture and health authorities will continue to maintain close communication, strengthen monitoring of domestic and international epidemic dynamics and transmission risks, and implement the spirit of integrated epidemic prevention. 

The Centers for Disease Control (CDC) also reiterated its reminder to tourists traveling to China and Thailand to take special precautions against CMNV (Contagious Disease Infection). 

Tourists should ensure seafood is thoroughly cooked, and high-risk groups (such as those with weakened immune systems and chronic diseases) should avoid eating raw seafood. 

When handling raw seafood, it is recommended to wear gloves, avoid direct contact with raw food if you have any open wounds, and wash your hands thoroughly with soap and water after handling to reduce the risk of infection.

Source: 

Link: https://www.cdc.gov.tw/Bulletin/Detail/y-8WwSZtKW-JANyrfc6B4A?typeid=9

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#Taiwan #CDC issued a #statement regarding journal research on transmission of viruses from farmed #shrimp in #China to #humans (Apr. 18 '26)

 

Recently, online discussions have focused on a study published in the international journal *Nature Microbiology*, which suggests that *Cryptant Dead Noda Virus* (CMNV), found in aquatic animals, may have the potential to spread across species to humans, potentially causing persistent high-tension viral anterior uveitis (POH-VAU). 

The Centers for Disease Control (CDC) stated that currently only China has reported suspected human cases of CMNV, distributed across 18 provinces with high aquaculture activity. 

Major international public health organizations such as the WHO, the US CDC, and the European Centre for Disease Prevention and Control (ECDC) have not reported any CMNV-related cases or listed it as an urgent threat. 

The CDC assesses the risk of domestic transmission as extremely low and will continue monitoring with agricultural authorities.

The CDC further explained that the study infers that human infection with CMNV may be related to handling or consuming raw seafood; however, further evidence is needed to confirm whether this virus has the ability to effectively infect human eye tissue. 

The Taiwan Centers for Disease Control (CDC) emphasizes that there have been no large-scale human outbreaks or community transmission events caused by CMNV globally at present, and there is no evidence of infection through the general consumption of cooked seafood. 

The CDC will continue to monitor relevant international outbreaks, develop human specimen testing technologies and methods, and establish relevant sampling and testing conditions for risk monitoring and early warning.

According to the monitoring of the Animal and Plant Health Inspection and Quarantine Bureau of the Ministry of Agriculture, there have never been any CMNV outbreaks in shrimp farms in Taiwan. 

The CDC's overall assessment is that the risk of domestic transmission is extremely low, but both agriculture and health authorities will continue to strengthen monitoring. 

CMNV has been listed as an emerging infectious disease by the World Organisation for Animal Health, and infection cases have been reported in shrimp farms in China and Thailand. 

The CDC urges travelers to China and Thailand to take special precautions against CMNV, including thoroughly cooking seafood, avoiding raw seafood for high-risk groups (such as those with chronic diseases), wearing gloves when handling raw seafood, avoiding direct contact with raw food if hands are open, and washing hands thoroughly with soap and water after handling to reduce the risk of infection by various pathogens.

Source: 

Link: https://www.cdc.gov.tw/Bulletin/Detail/JAKoFRedyjAVo_zmdBsCfQ?typeid=9

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#International #food safety event: #Infant #formula and products containing arachidonic acid oil contaminated with #cereulide #toxin - Multi-country (#WHO, March 13 '26)

 

Situation at a glance

Multi-country recalls of infant formula and other products have been initiated after cereulide toxin, was detected in batches of multiple internationally distributed brands. 

Investigations have identified arachidonic acid (ARA) oil, used as an ingredient in the implicated products, as the source of contamination. 

However, the full root cause analysis and complete traceability of all affected batches remains under investigation. 

Contaminated formulae, nutritional products, and oil mixes have been distributed to 99 countries and territories across six WHO Regions, with the first product recalls initiated on 10 December 2025. 

Between 1 January and 25 February 2026, 144 suspected and confirmed cases were reported across ten countries in three WHO Regions, with investigations ongoing. 

Based on the available information, WHO assesses the overall public health risk as moderate due to the vulnerability of the affected population (infants), the ongoing uncertainty regarding the full extent of distribution and exposure, and remaining gaps in case detection and root cause information.

Description of the situation

Since 10 December 2025, and as of 25 February 2026, 99 countries and territories have been identified as having received batches of infant formula products subject to recall due to contamination with cereulide toxin. 

During this period, 144 suspected and confirmed cases were reported across 10 countries. The epidemiological investigations and product‑traceback activities remain ongoing in many countries.

The case definitions in use by the International Food Safety Authorities Network (INFOSAN) are currently:

-- Suspect case: 

- A person presenting symptoms of cereulide intoxication with a history of consumption of the recalled product, without laboratory confirmation in a clinical sample.

-- Confirmed case: 

- A person presenting symptoms of cereulide intoxication with a history of consumption of recalled product, with laboratory confirmation in a clinical sample.

Health authorities are actively searching for cases and conducting laboratory testing of human specimens and infant formula products. 

However, case definitions used may differ from those established by INFOSAN, such as those established by the European Centre for Disease Prevention and Control, creating challenges with comparability of reported case numbers.

Since this is not a routinely tested contaminant or condition, diagnostic challenges and limited surveillance capacity are hindering Member States’ ability to identify confirmed cases. One country has laboratory confirmed cases linked to the contaminated products (Belgium).

The limited case numbers appearing in multiple, geographically separated areas is consistent with sporadic exposures to contaminated products that were widely distributed.

​Precautionary recalls have been issued across all countries and territories where products were distributed. 

These measures aim to prevent further exposures, although the speed and completeness of product recall and withdrawal vary by location according to various factors including inspection and enforcement capacities. 

Epidemiology

Cereulide is a heat-stable toxin produced by certain strains of Bacillus cereus, a Gram-positive, spore-forming bacterium ubiquitous in soil, dust, and food production environments. 

The primary hazard in this event is suspected to have occurred during the production of ARA oils used in infant formula, although a root cause analysis has not yet been provided to WHO. 

Cereulide is not contagious; illness occurs only when a person ingests the toxin, such as through consumption of contaminated products. 

The toxin withstands cooking temperatures (stable up to 121°C) and common pasteurization, persisting in finished products. 

Symptoms manifest rapidly, typically within 0.5–6 hours post-ingestion, and usually present as acute gastrointestinal symptoms (nausea, vomiting, abdominal pain) with risk of rapid dehydration and electrolyte imbalance which can be particularly severe in infants due to their physiological vulnerability and limited reserves. 

The toxin has a very low symptomatic dose threshold and remains fully active despite gastric conditions, contributing to its clinical potency. 

For babies who rely entirely on formula, repeated feedings can increase the amount of toxin consumed, and using contaminated formula for rehydration can worsen illness.

The absence of specific antidotes or targeted therapies places greater emphasis on supportive clinical care, effective risk communication to caregivers and health workers, and robust coordination between food safety and public health authorities. 

Where there is limited access to health care and where there may be delays in care seeking, rapid dehydration and electrolyte imbalance in infants may be fatal.

As of 25 February 2026, the following countries have notified suspected cases: 

1) Austria (9), 

2) Brazil (5),  

3) China, Hong Kong SAR, (1), 

4) Czechia (4), 

5) France (11), 

6) Italy (1), 

7) Singapore (3), 

8) Spain (41), and 

9) the United Kingdom of Great Britain and Northern Ireland (61).  

In other countries, including Denmark (32) and the Netherlands (221) the number of suspected cases is based on self-reporting and is therefore not comparable with the INFOSAN case definition.  

To date, Belgium is the only country with laboratory‑confirmed cases, reporting eight confirmed intoxications linked to the implicated products.

Public health response

WHO Response: 

Since 7 January 2026, when distribution of the products was confirmed to extend beyond the European Union, WHO, through the INFOSAN Secretariat, has been contacting INFOSAN Emergency Contact Points in the countries and territories identified as affected to notify them of recalled products exported to their markets and to support information exchange and coordinated response. 

Communication within the European Union has been managed through the European Rapid Alert System for Food and Feed (RASFF), with close coordination between INFOSAN and RASFF.

Response measures in affected countries and territories:

Recalls and communication campaigns have been carried out in many countries and territories where contaminated products were distributed, preventing further exposures despite variable implementation of recall and withdrawal measures. 

Active case-finding and laboratory confirmation efforts are ongoing in affected countries and territories, with most countries and territories reporting no linked illnesses to date.

WHO risk assessment

WHO assesses the overall public health risk associated with this event to be Moderate. 

This assessment is based on the information currently available and reflects the wide international distribution of contaminated products, ongoing uncertainties regarding the full extent of contaminated product distribution, case detection, and root cause of contamination, and the vulnerability of infants and young children to dehydration and electrolyte imbalance from with vomiting illness associated with cereulide toxin ingestion.

Several considerations contribute to this assessment:

-- Cereulide is a thermostable emetic toxin that can cause acute vomiting and rapid dehydration particularly in very young infants which can have severe consequences if untreated; mild or self-limiting cases are likely to go unreported, especially in settings with limited healthcare access or diagnostic capacities.

-- The extent of the contaminated ARA oil distribution remains uncertain, as complete traceability from the original implicated manufacturer has not been provided to WHO. 

-- Secondary distribution through commercial supply chains has further complicated efforts to identify all affected products. Additional investigation is required to determine the source and extent of the cereulide contamination. 

-- The international spread of contaminated products has already disrupted trade and supply chains across at least 99 countries and territories, with the possibility of further recalls if additional affected batches or product categories are identified. These recalls, while essential for public health protection, have created a risk of localized shortage of infant formula, particularly in settings where reliance on specific products is high, despite manufacturers’ efforts to increase production of unaffected products. A residual risk of exposure persists while investigations and traceability efforts continue, as competent authorities manage evolving distribution information and update risk communication measures. 

-- Mild clinical presentations can resemble common childhood illnesses, laboratory capacity for cereulide testing in contaminated products or human samples varies widely, and variations in case definitions across countries complicate consistent reporting and may delay detection. 

-- Although limited numbers of suspected and confirmed cases have been reported to date, without continued investment in surveillance for toxin‑related events, strengthened laboratory networks, training of health‑care providers, and clear communication on recalls and safe alternatives, delays in detection and response could lead to preventable morbidity in infants.

WHO advice

Based on the information available, WHO recommends Member States to maintain epidemiological surveillance, enhance readiness of laboratory capacity for cereulide testing of suspected contaminated products and in clinical samples of suspected cases, and facilitate effective implementation of recalls and withdrawals, as needed.

WHO advises Member States to:  

-- Identify, trace, and withdraw all affected products from the market.

-- Verify the effectiveness of recalls at retail and distribution levels and ensure that affected products are not available for sale, including online sales.

-- Conduct sampling and laboratory testing of suspect products and human specimens.

-- Strengthen requirements for traceability across the supply chain and food recalls.

-- Enhance inspection and oversight of facilities producing or handling ingredients used in infant nutrition.

-- Share relevant information through established international information-sharing mechanisms, including INFOSAN.

-- Issue targeted alerts to consumers, caregivers, health workers, and retailers, while providing clear guidance on identifying and disposing of affected products.

-- Promote breastfeeding and address barriers to accessing safe alternative nutrition.

-- Encourage early presentation to health facilities for infants with sudden vomiting.

-- Reinforce guidance on dehydration management and red-flag symptoms, while supporting availability of tools for safe clinical management of affected infants.

WHO recommends that no restrictions be applied for travel to, or trade with, the countries named in this report, based on the information available on the event reported here.  

Further information

-- European Centre for Disease Prevention and Control (ECDC) and European Food Safety Authority (EFSA). Multi-country foodborne event caused by cereulide in infant formula products. 19 February 2026. Available from: https://www.ecdc.europa.eu/en/publications-data/multi-country-foodborne-event-caused-cereulide-infant-formula-products  

-- European Food Safety Authority (EFSA). EFSA provides rapid risk assessment on cereulide in infant formula. EFSA; 1 February 2026. https://www.efsa.europa.eu/en/news/efsa-provides-rapid-risk-assessment-cereulide-infant-formula

-- European Centre for Disease Prevention and Control (ECDC). Communicable disease threats report, 31 January–6 February 2026 (Week 6). ECDC; 12 February 2026. https://www.ecdc.europa.eu/sites/default/files/documents/Communicable-disease-threats-report-week-6-2026.pdf  

-- European Food Safety Authority (EFSA). Precautionary global recall of infant nutrition products following detection of Bacillus cereus. EFSA; 27 January 2026. https://www.efsa.europa.eu/en/news/precautionary-global-recall-infant-nutrition-products-following-detection-bacillus-cereus  

-- European Centre for Disease Prevention and Control (ECDC). Precautionary global recall of infant nutrition products following detection of Bacillus cereus. ECDC; 27 January 2026.  https://www.ecdc.europa.eu/en/news-events/precautionary-global-recall-infant-nutrition-products-following-detection-bacillus  

-- European Centre for Disease Prevention and Control. European outbreak case definition: cereulide contamination of infant formula products (EpiPulse event 2025-FWD-00107). Stockholm: ECDC; 2026. https://www.ecdc.europa.eu/sites/default/files/documents/Case%20definition%20cereulide%20event.pdf

-- World Health Organization. Strengthening surveillance of and response to foodborne diseases. WHO; 11 December 2025. https://www.who.int/publications/i/item/9789240118188  

-- Austrian Agency for Health and Food Safety (AGES). Update: Information on cereulide in infant formula. AGES; 1 February 2026. https://www.ages.at/en/news/detail/update-information-zu-cereulid-in-saeuglingsnahrung  

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Citable reference: World Health Organization (13 March 2026). Disease Outbreak News;  Recall of internationally distributed infant formula and products containing ARA oil due to contamination with cereulide toxin. Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON596 

Source: 

Link: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON596

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Retail #Milk #Monitoring of #Influenza #H5N1 in Dairy #Cattle, #USA, 2024–2025

 

Abstract

US retail milk monitoring during April 13–May 3, 2024, identified influenza A(H5N1) viral RNA in 36% of retail milk samples, indicating widespread undetected infections in US dairy cows. After federal initiatives, reported infections more closely aligned with findings in retail milk during December 27, 2024–January 29, 2025, reflecting improved detection and control.

Source: 

Link: https://wwwnc.cdc.gov/eid/article/32/2/25-1332_article

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#Milk as a #Transmission Vehicle for Highly Pathogenic Avian #Influenza #H5N1

Abstract

Highly pathogenic avian influenza A (H5N1) (H5N1 hereafter) is an emerging pathogen in mammals. The recent recognition of H5N1 in dairy cattle increases opportunities for human exposure and infection and may accelerate a trajectory toward sustained human-to-human transmission. Furthermore, the presence of virus at high concentration in unpasteurized milk raises new risks for humans, especially infants and children. Milk has been identified as a vehicle for viral transmission in and between mammalian species, including humans. Sialic acids (SAs) found on cell surfaces are important mediators of species susceptibility to specific influenza strains and play an important role in viral tropism. New data demonstrate that SA receptors with α2,3 linkages capable of binding avian influenza strains are present in human mammary tissue. The presence of SA receptors that can bind avian influenza and a comparative analysis of viral transmission risk of raw and pasteurized milk in several mammalian species have implications for human milk feeding. During this period of sporadic human infections with H5N1, further research and collaboration is warranted to address the potential risk of human milk contamination. Infants and children are particularly vulnerable to emerging infections during pandemics and have unique needs that may be overlooked. Pandemic preparedness must address the needs of all populations at all life stages, including pregnancy and infancy, and must include support for the safety of human milk.

Source: 

Link: https://publications.aap.org/pediatrics/article-abstract/doi/10.1542/peds.2025-072525/206156/Milk-as-a-Transmission-Vehicle-for-Highly?redirectedFrom=fulltext

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Inactivation of avian #influenza virus in #yogurt made from raw #milk

 

Highlights

• Fermentation of raw milk for 7 h at 42 °C to pH 4.4 reduced AIV levelsAIV by ≤ 4.1 log10 EID50.

• Incubation of raw milk for 7 h at 42 °C to pH 6.6 reduced levels by ≤ 4.3 log10 EID50.

• PH, temperature and/or bacterial degradation appreciably reduced AIV levels in raw milk.

Abstract

In March 2024, highly pathogenic avian influenza (HPAIV) H5N1 was first detected in U.S. dairy cattle and has since spread to herds across at least 17 states. Infected cows typically present with mastitis, decreased milk production, and poor milk quality with high viral loads in milk. While commercial pasteurization of milk effectively inactivates avian influenza virus (AIV), growing consumer interest in raw milk and derived products raises public health concerns due to the risk of zoonotic transmission. Standard yogurt production includes an initial heating step at 82 °C for 30 min to denature milk proteins which also inactivates AIV. However, some home yogurt recipes omit this initial heating step. This project determined whether AIV present in raw milk could remain viable through fermentation and persist in the final yogurt product. Raw milk (ca. pH 6.7) was spiked with AIV (ca. 6.6 log10 50 % egg infectious doses (EID50) per mL and inoculated with a commercial starter culture to produce yogurt. The viability of the virus was determined before and after fermentation (ca. 7.3 h) at 42 °C with resultant pH drop ≤4.4. A significant (p < 0.05) reduction of viable AIV (≥4.1 log10 EID50) was observed in both the yogurt and the control samples of raw milk incubated at 42 °C but without starter culture (ca. pH 6.63). Viral inactivation was likely due to a combination of incubation at a sublethal temperature, pH below 4.4, and microbial degradation. Thus, properly fermented yogurt has a negligible risk of transmitting AIV to humans.

Source: 

Link: https://www.sciencedirect.com/science/article/pii/S0740002025002576?via%3Dihub

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Quantitative #risk #assessment of #human #H5N1 #infection from consumption of fluid cow's #milk

 

Abstract

The spillover of H5N1 clade 2.3.4.4b into dairy cattle has raised concerns over the safety of fluid milk. While no foodborne infection has been reported in humans, this strain has infected at least 70 people and milk from infected cows is known to be infectious by ingestion in multiple other species. Investigation into the public health threat of this outbreak is warranted. This farm-to-table quantitative microbial risk assessment (QMRA) uses stochastic models to assess the risk of human infection from consumption of raw and pasteurized fluid cow's milk from the United States supply chains. These models were parameterized with literature emerging from this outbreak, then employed to estimate the H5N1 infection risk and evaluate multiple potential interventions aimed at reducing this risk. The median (5th, 95th percentiles) probabilities of infection per 240-mL serving of pasteurized, farmstore-purchased raw, or retail-purchased raw milk were 7.66E-19 (2.39E-20, 4.02E-17), 1.56E-7 (6.67E-10, 1.28E-5), and 1.40E-7 (6.65E-10, 1.13E-05), respectively. Our results confirm that pasteurization is highly effective at reducing H5N1 infection risk. Scenario analysis revealed quantitative real-time reverse transcriptase-polymerase chain reaction (qrRT-PCR) testing of bulk tank milk to be an effective method for numerically reducing risk from raw milk. Additionally, we identify knowledge gaps related to human H5N1 dose-response by ingestion and raw milk consumption patterns. These findings emphasize the importance of mechanistic epidemiologic models for informing public health responses amidst outbreaks with foodborne potential and highlight the need for additional research into raw milk consumption patterns to better understand this exposure pathway.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

Research reported in this publication was supported by the Office of the Director, National Institutes of Health of the National Institutions of Health (NIH) under Award Number T32ODO011000 to KK. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Center for Research Resources or the NIH. Additionally, this research was partially supported by grants to RI from the National Institute of Food and Agriculture, USDA, Hatch under Accession Number 7000433, as well as Multistate Research Funds Accession Number 1016738.

Source: 

Link: https://www.medrxiv.org/content/10.1101/2024.12.20.24319470v3

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#Stability of Avian #Influenza #H5N1 Virus in #Milk from Infected #Cows and Virus-Spiked Milk

 

{Excerpt}

To the Editor:

In March 2024, public health agencies in the United States reported highly pathogenic avian influenza (HPAI) virus of subtype A(H5N1) in dairy cattle, with virus detected in milk samples from symptomatic animals. Viral genetic fragments were subsequently found in pasteurized retail dairy products, which aroused concern about potential exposure through the human food supply. Heat treatment has been shown to reduce or eliminate infectious virus from both milk from infected cows and milk spiked with HPAI A(H5N1) virus. However, whether HPAI A(H5N1) virus in spiked milk from healthy cows replicates the properties of virus in milk from infected cows is unclear. We directly compared the stability of HPAI A(H5N1) virus in infected cows’ milk with that in spiked milk at 4°C (refrigeration temperature) and after heat treatment at 63°C (low-temperature, longer-duration pasteurization) or 72°C (high-temperature, shorter-duration pasteurization). (...)

(...)

Source: 

Link: https://www.nejm.org/doi/10.1056/NEJMc2502494

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Highly Pathogenic Avian #Influenza #H5N1 in Raw #Pet #Foods and #Milk: A Growing #Threat to both Companion Animals and #Human #Health, and Potential Raw Pet Food Industry Liability

 

Highlights

• Raw pet foods and raw milk are emerging sources of H5N1 in pets.

• Cats are more severely infected with H5N1 when compared to dogs.

• H5N1 persistence in mammals indicate adaptive variants with increased zoonotic potential.

• No reported pet-to-human transmission of H5N1 has been reported.

• FDA now requires RMBD makers who are covered under FSMA to assess HPAI risk.

Abstract

The increasing popularity of raw meat-based diets (RMBDs) and raw milk feeding in companion animals presents a growing concern for zoonotic disease transmission. Recent evidence has demonstrated that these products can serve as vehicles for highly pathogenic avian influenza (HPAI) H5N1, an emergent viral threat with a host range from birds, dairy cattle, and pets to humans. Since the emergence of clade 2.3.4.4b in 2020, HPAI H5N1 has caused widespread outbreaks in poultry, wild birds, and mammals, including dairy cattle and cats. Transmission to pets has been linked to ingestion of contaminated raw pet food and unpasteurized milk. Notably, multiple outbreaks in cats across Europe, Asia, and North America have been associated with raw pet food products, while recent U.S. cases confirm direct viral transmission from infected pet food, raw milk, and colostrum. Experimental studies have also supported the plausibility of gastrointestinal and respiratory routes of infection in cats and dogs, with felines appearing particularly susceptible, often exhibiting severe clinical disease and high mortality. A number of documented recalls of H5N1-contaminated raw pet food and raw milk in the US underscore the persistence of infectious viruses in cold-stored food products and highlight the risks of feeding raw diets. Although pet-to-human transmission of the HPAI H5N1 virus has not been reported yet, cat-to-human transmission of the H7N2 influenza virus has been reported in the USA. This review presents current evidence on H5N1 in RMBDs and raw milk, its epidemiology in companion animals, outbreaks, and the health implications among pets and humans. By raising awareness among pet owners, industry stakeholders, and veterinarians, this paper highlights the immediate need for stringent surveillance and improved biosecurity in raw food supply chains to minimize viral transmission risks thereby safeguarding pet health and curb the potential spillover to humans.

Source: Journal of Food Protection, https://www.sciencedirect.com/science/article/pii/S0362028X25001802?via%3Dihub

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#IAEA #DG Grossi’s #Statement to #UNSC on #Situation in #Iran (June 20 '25)

 

Attacks on nuclear sites in the Islamic Republic of Iran have caused a sharp degradation in nuclear safety and security in Iran. Though they have not so far led to a radiological release affecting the public, there is a danger this could occur.

The International Atomic Energy Agency has been monitoring closely the situation at Iran’s nuclear sites since Israel began its attacks a week ago. As part of its mission, the IAEA is the global nerve centre for information on nuclear and radiological safety, and we can respond to any nuclear or radiological emergency.

Based on information available to the IAEA, the following is the current situation at Iran’s nuclear sites. Which I offer as a follow up to my most recent report to this Security Council.

The Natanz enrichment site contains two facilities. The first is the main Fuel Enrichment Plant. Initial attacks on the 13th of June targeted and destroyed electricity infrastructure at the facility, including an electrical sub-station, the main electric power supply building, and emergency power supply and back-up generators. On the same day, the main cascade hall appears to have been attacked using ground-penetrating munitions.

The second facility at Natanz is the Pilot Fuel Enrichment Plant. It consists of aboveground and underground cascade halls. On the 13th of June the above-ground part was functionally destroyed and the strikes on the underground cascade halls were seriously damaging.

The level of radioactivity outside the Natanz site has remained unchanged and at normal levels, indicating no external radiological impact on the population or the environment.

However, within the Natanz facility there is both radiological and chemical contamination. It is possible that Uranium isotopes contained in Uranium Hexafluoride, Uranyl Fluoride and Hydrogen Fluoride are dispersed inside the facility. The radiation, primarily consisting of alpha particles, poses a significant danger if inhaled or ingested. This risk can be effectively managed with appropriate protective measures, such as using respiratory devices. The main concern inside the facility is chemical toxicity.

Fordow is Iran’s main enrichment location for enriching uranium to 60%. The Agency is not aware of any damage at Fordow at this time.

At the Esfahan nuclear site, four buildings were damaged in last Friday’s attack: the central chemical laboratory, a uranium conversion plant, the Tehran reactor-fuel manufacturing plant, and the enriched uranium metal processing facility, which was under construction.

No increase of off-site radiation levels was reported. As in Natanz, the main concern is chemical toxicity.  

The Khondab Heavy Water Research Reactor under construction in Arak, was hit on the 19th of June. As the reactor was not operational and did not contain any nuclear material, no radiological consequence is expected. The nearby Heavy Water Production Plant is also assessed to have been hit, and similarly no radiological consequence is expected.

As stated in the IAEA’s update of the 18th of June, at the Tehran Research Center, one building, where advanced centrifuge rotors were manufactured and tested, was hit. At the Karaj workshop, two buildings, where different centrifuge components were manufactured, were destroyed. There was no radiological impact, internally or externally.

Let me now refer to the Bushehr Nuclear Power Plant. This is the nuclear site in Iran where the consequences of an attack could be most serious. It is an operating nuclear power plant and as such it hosts thousands of kilograms of nuclear material. Countries of the region have reached out directly to me over the past few hours to express their concerns, and I want to make it absolutely and completely clear: In case of an attack on the Bushehr Nuclear Power Plant a direct hit could result in a very high release of radioactivity to the environment.

Similarly, a hit that disabled the only two lines supplying electrical power to the plant could cause its reactor’s core to melt, which could result in a high release of radioactivity to the environment. In their worst-case, both scenarios would necessitate protective actions, such as evacuations and sheltering of the population or the need to take stable iodine, with the reach extending to distances from a few to several hundred kilometres. Radiation monitoring would need to cover distances of several hundred kilometres and food restrictions may need to be implemented.

Any action against the Tehran Nuclear Research Reactor could also have severe consequences, potentially for large areas of the city of Tehran and its inhabitants. In such a case, protective actions would need to be taken.

I will continue to provide public updates about the developments at all these sites and their possible health and environmental consequences.

The Agency is, as madame Undersecretary kindly reminded, and will remain present in Iran and inspections there will resume, as required by Iran’s safeguards obligations under its NPT Safeguards Agreement, as soon as safety and security conditions allow.

In this context, let me restate that the safety of our inspectors is of utmost importance. The host country has a responsibility in this regard, and we expect every effort to be made to ensure that their security and their communication lines with the IAEA headquarters will be maintained.

As stated in my most recent report to the Agency’s Board of Governors and based on inspections conducted at the relevant facilities since then, Iran’s uranium stockpiles remain under safeguards in accordance with Iran’s comprehensive safeguards agreement. You may recall that more than 400kg of this stockpile is uranium enriched up to 60% U-235. It is essential that the Agency resumes inspections as soon as possible to provide credible assurances that none of it has been diverted.

Importantly, any special measures by Iran to protect its nuclear materials and equipment must be done in accordance with Iran’s safeguards obligations and the Agency.  

Therefore, it is of paramount importance that the Agency’s inspectors are allowed to verify that all relevant materials, especially those enriched to 60%, are accounted for. Beyond the potential radiological risks, attacks on such materials would make this effort of course more difficult.

Madame President,

The IAEA has consistently underlined, as stated in its General Conference resolution, that armed attacks on nuclear facilities should never take place, and could result in radioactive releases with grave consequences within and beyond the boundaries of the State which has been attacked.

I therefore again call on maximum restraint. Military escalation threatens lives and delays indispensable work towards a diplomatic solution for the long-term assurance that Iran does not acquire a nuclear weapon.

Madame President,

The presence, support, analysis and inspections of technical experts are crucial to mitigating risks to nuclear safety and security – that is true during peacetime and even more so during military conflict.

For the second time in three years, we are witnessing a dramatic conflict between two UN and IAEA Member States in which nuclear installations are coming under fire and nuclear safety is being compromised. The IAEA, just as has been the case with the military conflict between the Russian Federation and Ukraine, will not stand idle during this conflict.

As I stated in this chamber just a few days ago, I am ready to travel immediately and to engage with all relevant parties to help ensure the protection of nuclear facilities and the continued peaceful use of nuclear technology in accordance with the Agency mandate, including by deploying Agency nuclear safety and security experts, in addition to our safeguards inspectors in Iran, wherever necessary.

For the IAEA to act, a constructive, professional dialogue is needed. I urge the Members of this Council to support us in making it happen sooner rather than later.

The IAEA must receive timely and regular technical information about affected nuclear facilities and their respective sites. I urge in this regard the Iranian regulatory authorities to continue a constructive dialogue with the IAEA Incident and Emergency Centre, which has been operating 24/7 since the beginning of this conflict.

Nuclear facilities and material must not be shrouded by the fog of war.

Yesterday there was an incorrect statement to the media by an Israeli military official that Bushehr Nuclear Power Plant had been attacked. Though the mistake was quickly identified and the statement retracted, the situation underscored the vital need for clear and accurate communication, and the Agency’s unique role in providing it in a technically accurate and politically impartial way is obvious.

Let me conclude by assuring the international community of the IAEA’s continued support at this very grave time.

A diplomatic solution is within reach if the necessary political will is there. Elements for an agreement have been discussed. The IAEA can guarantee, through a watertight inspections system, that nuclear weapons will not be developed in Iran.  They can form the basis of a long-standing agreement that brings peace and avoids a nuclear crisis in the Middle East. This opportunity should not be missed. The alternative would be a protracted conflict and a looming threat of nuclear proliferation that, while emanating from the Middle East, would effectively erode the NPT and the non-proliferation regime as a whole.

Source: IAEA, https://www.iaea.org/newscenter/statements/iaea-director-general-grossis-statement-to-unsc-on-situation-in-iran

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