Health alerts for Arizona emergency physicians.

Audience: Arizona healthcare providers, ADHS Health Advisory.

Background

The Centers for Disease Control and Prevention (CDC), in collaboration with the U.S. Food and Drug Administration (FDA) and state health departments, is currently investigating multiple clusters of cyclosporiasis cases reported across at least 29 states. Although no single, widely distributed source of exposure has been identified, these investigations highlight the ongoing risk of domestically acquired cyclosporiasis during the summer months. At this time, no localized clusters or active outbreaks have been identified in Arizona, though a handful of cases are seen each summer month.

Healthcare providers should consider cyclosporiasis in patients presenting with prolonged or watery diarrhea, particularly during the summer months, regardless of international travel history. Prompt diagnosis and reporting are critical to supporting public health investigations and identifying potential foodborne sources.

Clinical presentation

Maintain a high index of suspicion for cyclosporiasis in patients presenting with:

• Acute watery diarrhea (often profuse), prolonged or recurrent
• Abdominal cramping and pain
• Nausea, vomiting, and loss of appetite
• Fatigue and malaise
• Fever (less common)

Without treatment, symptoms may persist for several weeks or longer and may relapse after initially improving. Illness is generally self-limited in healthy individuals, but immunocompromised patients are at increased risk for prolonged or more severe disease.

Diagnosis

Diagnosis requires laboratory testing of stool specimens. Providers should:

• Order a gastrointestinal PCR panel that includes Cyclospora when available.
• If PCR is unavailable, request a stool ova and parasite (O&P) examination with specific testing for Cyclospora — it is not routinely included in all O&P panels unless specifically requested.
• Recognize that parasite shedding is intermittent; multiple stool specimens collected on separate days may be necessary, since a single negative specimen does not exclude infection.
• Request that laboratories forward positive Cyclospora specimens to the Arizona State Public Health Laboratory for molecular characterization and national surveillance.
• Promptly report suspected or confirmed cases to the patient's local health agency to facilitate case investigation and identify outbreak-associated exposures.

Treatment and management

Trimethoprim-sulfamethoxazole (TMP-SMX) is the recommended treatment for most patients.

• Immunocompetent patients are generally treated with TMP-SMX twice daily for 7–10 days.
• Immunocompromised patients may require higher doses, longer courses, or secondary prophylaxis.
• For patients with a sulfonamide allergy, there is no highly effective alternative therapy — consult infectious disease for management options.

See the CDC resource page for health professionals for specific dosing guidelines and further information on treatment. Oocysts take one to several weeks to sporulate depending on temperature to become infective, so person-to-person spread is unlikely.

Resources

• CDC Cyclosporiasis for Healthcare Providers
• Contact your county / tribal public health department
• ASPHL — Arizona State Public Health Laboratory

Audience: Arizona healthcare providers, ADHS Health Advisory.

This memo is a July 10, 2026 update to the earlier Bundibugyo Ebola situational memo. Updates will be provided regularly to ensure situational awareness.

Situation overview

The Arizona Department of Health Services (ADHS) is monitoring an outbreak of Ebola disease in the Democratic Republic of the Congo (DRC) and Uganda caused by the Bundibugyo virus (Orthoebolavirus bundibugyoense). To date, no cases of Ebola disease have been confirmed in the United States because of this outbreak.

CDC and other federal agencies announced enhanced travel screening, entry restrictions, and public health measures to reduce the risk of Ebola disease caused by the Bundibugyo virus. Individuals who have traveled through the affected countries within the last 21 days and are returning to Arizona will be contacted by local or tribal public health to receive an assessment to determine risk level.

Ebola status in Arizona

• There are currently no high-risk individuals being monitored by public health in Arizona.
• The overall risk in Arizona remains low.

Recommendations for clinicians

• Most ill travelers returning from an affected country will likely have a more common infection, such as malaria.
• Healthcare facilities should be prepared to implement immediate infection prevention measures, perform an initial assessment, diagnostic testing, and provide supportive care while awaiting confirmatory results.
• Lab testing for Ebola Virus may be negative up to within 72 hours of symptom onset and require testing at ≥72 hours.
• If results are positive, public health will collaborate with the facility on transport to a treatment center; supportive care will need to be maintained.
• Contact the local or tribal public health department if a patient may have Ebola Virus Disease. The local health department will coordinate Ebola testing at ADHS.
• Ensure appropriate PPE availability, staff training, and proficiency at donning and doffing procedures.

Funding opportunity — NETEC STAND Award (deadline Aug 3, 2026)

The National Emerging Special Pathogens Training and Education Center (NETEC) has opened a second round of funding through the National Special Pathogen System (NSPS) Level 2 Special Pathogen Treatment and Network Development (STAND) Award.

Funded by the Administration for Strategic Preparedness and Response (ASPR), the NSPS STAND Award is designed to help healthcare facilities strengthen their ability to safely identify, assess, isolate, and care for patients with high-consequence infectious diseases. All proposals must be submitted by August 3, 2026.

Resources and guidance

• Ebola Disease Basics · CDC
• ADHS Ebola Information and Resources
• Guidance for Personal Protective Equipment (PPE) · CDC
• Clinical Guidance for Ebola Disease · CDC
• Healthcare Provider Trainings on Ebola Disease · CDC
• Public Health Guidance for Ebola Disease · CDC

Laboratory information

For information on laboratory testing visit the Arizona State Laboratory Services Ebola Virus Disease Page.

Travel information

• Post-travel monitoring: Ebola: What to Do After Travel · CDC
• DRC — Level 3, Reconsider Nonessential Travel: CDC Travel Health Notice
• Uganda — Level 2, Practice Enhanced Precautions: CDC Travel Health Notice

Audience: Arizona healthcare providers, AzHAN distribution.

New World screwworm (NWS) myiasis has re-emerged in Central and South American countries. In early June 2026, the first animal cases of NWS in the United States were detected in Texas and New Mexico. NWS was previously a significant agricultural pest in the United States. To date, New World screwworm detections have not been reported in Arizona.

NWS myiasis is a parasitic infestation caused by the larvae of the Cochliomyia hominivorax fly. The fly lays eggs at the edge of a wound or on the mucous membranes; the larvae hatch and infest the wound or body cavity, feeding on and burrowing into living tissue. Larvae are not directly transmissible person-to-person or animal-to-person. NWS is primarily an animal health concern but can infest any warm-blooded host, including humans. Human NWS myiasis, in rare circumstances, can be fatal if left untreated.

Arizona healthcare providers are encouraged to:

• Consider NWS in patients with travel history to an area known to have the fly or active NWS cases within the 10 days preceding symptoms, and with compatible clinical signs:
• Visible larvae or eggs in a wound, ears, eyes, nose, mouth, or other body orifice
• Destruction of healthy tissue with visible larvae
• A painful site with sensation of movement, foul odor, bloody discharge, swelling, and destruction of healthy tissue
• Notify local or tribal public health regarding suspected NWS human infestations.
• Using standard precautions, collect all larvae and eggs:
• Collect larvae from deep within the wound (superficial maggots may be secondary infestations by another type of fly).
• Fully submerge all larvae and eggs in 70% ethanol (or 70%+ isopropanol, or 5–10% formalin if 70% ethanol is unavailable) in a leak-proof container. At least 10 larvae should be saved for identification.
• Submit specimens (pictures + sample) to ADHS via your local or tribal public health department.
• Do not dispose of any larvae or eggs in the trash or on the ground.
• Re-examine treated lesions after 24–48 hours to confirm no larvae remain.
• Monitor for and treat secondary bacterial infections as needed.

Increased-risk populations

People who live or travel to areas with NWS and:

• Work or live around livestock or other warm-blooded animals
• Have open sores or wounds (even small, like an insect bite or recent surgical sites)
• Spend a lot of time outdoors or sleep outdoors, especially in the daytime
• Have underlying medical or mental health conditions that may increase the risk of chronic open wounds, especially if they are unable to appropriately clean and monitor the wound

Resources

• screwworm.gov — interagency landing page
• CDC New World Screwworm Outbreak — situation summary
• CDC Recommendations for Healthcare Providers (PDF)
• CDC Telediagnosis Bench Aid (PDF)

Audience: Arizona healthcare providers, AzHAN distribution.

There has been a recent increase of Mpox in Arizona. As of 6/9/2026, Arizona reported 21 cases of Mpox, compared to <6 cases by the end of June 2025.

Provider considerations

1. Maintain a low threshold for testing for people with risk factors and clinical findings consistent with Mpox.

• HIV and syphilis testing are recommended for all individuals with suspected diagnosis of Mpox.
• Pre-exposure prophylaxis with JYNNEOS vaccine is recommended for individuals at risk.

2. Tecovirimat should only be used in individuals who are severely immunocompromised, are at higher risk of disseminated infection (i.e., have active skin conditions), have life-threatening manifestations, are pregnant or lactating, or are children (<18 years).

• Ocular involvement can be a vision-threatening condition, should be treated urgently, and may require specific therapeutic management and considerations.

Contact CDC for access to Mpox therapeutics and consultation

• Information about Mpox treatment, including how to access tecovirimat and brincidofovir through the CDC.
• The CDC provides expert Mpox clinical consultation during regular business hours at poxvirus@cdc.gov and after hours via the CDC Emergency Operations Center (EOC) at 770-488-7100.

Resources

• Year-to-date Mpox data (ADHS)
• CDC Clinical Guidance — Mpox
• CDC Mpox Clinical Care
• CDC Mpox Ocular Infection

Audience: Arizona healthcare providers, AzHAN distribution.

CDC, public health officials in several states, the Infant Botulism Treatment and Prevention Program, and FDA are investigating a multistate outbreak of infant botulism linked to ByHeart Whole Nutrition infant formula. One case has been reported in Arizona.

As of November 8, 2025, 13 infants with suspected or confirmed infant botulism have been reported from 10 states as part of this outbreak: Arizona, California (2), Illinois (2), Minnesota, New Jersey, Oregon, Pennsylvania, Rhode Island, Texas (2), and Washington. Illness onset dates range from mid-August to November 2025. All 13 infants were hospitalized and treated with BabyBIG. No deaths have been reported. Infants ranged in age from 16 to 157 days.

ByHeart Whole Nutrition Infant Formula is available for sale online and at major retailers nationwide.

Action steps for healthcare providers

• Consider infant botulism in the differential. Constipation can be the initial symptom, followed by difficulty feeding (sucking and swallowing), a weak and altered cry, and lack of head control.
• Call the California Infant Botulism Treatment and Prevention Program immediately at 510-231-7600 for consultation on suspect cases. Consultation is available 24/7.
• Begin treatment with BabyBIG® (obtained from California Department of Public Health) as soon as possible if clinical consultation supports infant botulism. Do not wait for laboratory confirmation.
• Contact local public health to get testing approval, then send clinical specimens to the Arizona State Public Health Laboratory (ASPHL) for forwarding to CDC.
• Report all suspect cases to the local health department by phone immediately: County Health Department Contacts.

Laboratory testing notes

Confirmatory testing uses the mouse bioassay to identify toxin in feces and can take up to two weeks for results. Contact your local health jurisdiction for approval before sending clinical specimens. Ideally, 10 grams of feces should be collected. If an enema is needed, use sterile, non-bacteriostatic water.

Save powdered infant formula consumed by suspected infant botulism patients. If the patient is confirmed to have botulism, the CDC may test the powdered infant formula. (The CDC is not testing formula of asymptomatic patients.)

Resources

• FDA Outbreak Investigation: Infant Botulism — Infant Formula (Nov 2025)
• CDC: Infant Botulism Outbreak Linked to Infant Formula, November 2025
• CDC: Clinical Overview of Infant Botulism
• ADHS Botulism