All questions or comments should be directed or sent to LDH Dept of Public Health.

Domestically Acquired Cyclosporiasis Cases, 2026

Multiple states are investigating cases of domestically acquired cyclosporiasis. Since May 1, 2026, the Centers for Disease Control and Prevention (CDC) has received reports of 1,645 confirmed domestic cases of cyclosporiasis and is aware of more than 5,100 cases that require further analysis to confirm the illness as domestically acquired cyclosporiasis. This is substantially higher than the 249 cases reported nationally by this same time last year. Of the 1,645 case-patients with available information, 141 (9%) were hospitalized, and none have died. CDC, the 

, and state and local health departments are working together to investigate multistate outbreaks of Cyclospora infections and to identify the sources of illness. Because cyclosporiasis is often underdiagnosed and underreported, the true number of illnesses is likely higher than what has been reported to CDC. This Health Advisory provides background information about cyclosporiasis, current U.S. surveillance data, and recommendations for clinicians, laboratorians, and public health departments to support recognition, diagnosis, and reporting.

Cyclosporiasis is a gastrointestinal illness caused by the microscopic parasite Cyclospora. People can become infected by consuming food or water contaminated with the parasite. This illness is not usually spread directly from person to person. Case counts typically rise during spring and summer months, and CDC considers May 1-August 31 the annual cyclosporiasis season. Previous outbreaks have been linked to consuming contaminated fresh produce.

Symptoms of cyclosporiasis typically begin about 1 week after exposure. Onset of symptoms can occur 2-14 days after being exposed. The most common symptoms include watery diarrhea, which can be frequent, along with loss of appetite, weight loss, bloating, nausea, and fatigue. Less common symptoms include low-grade fever and vomiting. Without treatment, symptoms can follow a remitting-relapsing course that can last from a few days to a month or longer. Illness can be severe, but is not usually life-threatening. Complications can include malabsorption, cholecystitis, and reactive arthritis.

As of July 14, 43 cases of cyclosporiasis have been reported in Louisiana during 2026. By comparison, over the past five years, Louisiana confirmed an average of 30 cases during the same time period.

Cyclosporiasis cases have been reported among Louisiana residents in nearly every region of the state. The parishes with the highest number of reported cases are East Baton Rouge and Lafayette. Five patients have been hospitalized, and none have died. Eighty percent of the cases were domestically acquired.

Recommendations for Healthcare Professionals

Consider cyclosporiasis in patients presenting with prolonged or relapsing watery diarrhea, particularly during the May–August cyclosporiasis season, even without a history of international travel.

Ask patients with suspected or confirmed cyclosporiasis about their recent food and travel history to assist local investigations.

Laboratory detection of Cyclospora in stool can be challenging even in symptomatic patients, and standard ova and parasite exams might not detect it reliably. Clinicians should specifically request diagnostic testing for Cyclospora when it is clinically suspected. Consider molecular (PCR-based) diagnostic testing where available, because it can improve detection.

Treat confirmed cases of cyclosporiasis with 7-10 days of trimethoprim-sulfamethoxazole (TMP-SMX) for immunocompetent adults and children over age 2 months; consider longer courses for patients with immunocompromising conditions. Consult current 

Advise patients to stay well hydrated, especially if diarrhea is frequent or severe.

Cyclosporiasis is a Class B reportable condition in Louisiana, which requires public health reporting within one business day. Cases can be reported electronically, via fax (504-568-8290), or reported to the respective LDH 

. To reach LDH’s on-call epidemiologist, call 800-256-2748. Cyclosporiasis cases can sometimes be identified in clusters due to common exposures.  Outbreaks or clusters of any infectious disease are considered Class A Conditions in the State Sanitary Code, which require immediate reporting by phone to LDH’s clinician hotline: 800-256-2748.

Recommendations for Disinfecting Cyclospora in Healthcare Settings

Given the typical lifecycle of Cyclospora, person-to-person transmission is unlikely, even within healthcare settings. If an affected patient is continent of stool, the level of environmental contamination is probably small.

Cyclospora is unlikely to be killed or inactivated by routine chemical disinfection. No EPA-registered disinfectant products have been demonstrated to be effective against Cyclospora. When affected patients are incontinent or diapered, the risk of contamination of healthcare surfaces might be higher. Facilities should clean surfaces initially with a detergent to remove any visible soil and scrub the surfaces thoroughly. After this cleaning, an EPA-registered hospital disinfectant should be used. Immediately after cleaning, healthcare personnel (HCP) should remove gloves used during cleaning and clean their hands.

HCP should always use Standard Precautions, including wearing gloves when there might be direct contact with feces. A gown, facemask, and eye protection, or face shield should be used if splashing might occur. Hand hygiene should be performed before and after every patient contact. If hands are visibly soiled, HCP should wash them with soap and water, scrubbing vigorously for 15-20 seconds. If hands are not visibly soiled, alcohol-based hand sanitizer may be used. For patients with gastroenteritis who are diapered or incontinent of stool, HCP should use Contact Precautions when providing direct patient care in healthcare settings.

, pursuant to LSA-R.S. 42:19(A), that the Louisiana State Board of Medical Examiners (the "Board"), within the Louisiana Department of Health, State of Louisiana, shall convene a Regular

and teleconference for the public session and via non-streaming video and teleconference during the executive 

. Click the appropriate committee’s name then “Live Stream Here” next to the date. The YouTube link will be posted immediately prior to

Camp Street, New Orleans, Louisiana, or remotely.

Individuals who wish to make a public comment before or during the meeting, may do so by

Members of the public may give verbal comment on any agenda item when the matter comes up for discussion.

Individuals wishing to make verbal comment must email 

“ZOOM LINK REQUEST” to request a link to the videoconference, identifying themselves by name and relevant affiliation, if any, and the agenda item about which they wish to make verbal comment. 

This request should be made as far in advance of the meeting as possible so that the request can be processed. 

The committee will make reasonable efforts to accommodate requests made while the meeting is in progress but cannot guarantee that such requests can be honored. The committee reserves the right to limit or prohibit participation in order to maintain orderly conduct of the meeting in accordance with La. R.S. 42:17(C). Members of the public who choose to view the video meeting at the anchor location may give verbal comments by notifying the presiding officer at the anchor location.

Regular Meeting held and noticed pursuant to La. Rev. Stat. §42:17A(1), (2), (4), (5) and (10), R.S. 42:17.3 and Act 408 of the 2022 Regular Session. Further, agenda items may be taken out of order and/or in executive session pursuant to R.S 42:17A. La. R.S. 42:17A states “A public body may hold an executive session pursuant to La. R.S. 42:16 for one or more of the following reasons: (1) Discussion of the character, professional competence, or physical or mental health of a person, provided that such person is notified in writing at least twenty-four hours, exclusive of Saturdays, Sundays, and legal holidays, before the scheduled time contained in the notice of the meeting at which such executive session is to take place and that such person may require that such discussion be held at an open meeting.….In cases of extraordinary emergency, written notice to such person shall not be required; however, the public body shall give such notice as it deems appropriate and circumstances permit; (2) Strategy sessions or negotiations with respect to collective bargaining, prospective litigation after formal written demand, or litigation when an open meeting would have a detrimental effect on the bargaining or litigating position of the public body;….(4) Investigative proceedings regarding allegations of misconduct; (5) Cases of extraordinary emergency, which shall be limited to natural disaster, threat of epidemic, civil disturbances, suppression of insurrections, the repelling of invasions, or other matters of similar magnitude; and,….(10) Or any other matters now provided for or as may be provided for by the legislature.”

Occupational Therapy Advisory Committee Meeting

, pursuant to LSA-R.S. 42:19(A), that the Louisiana State Board of Medical Examiners (the "Board"), within the Louisiana Department of Health, State of Louisiana, shall convene a Regular Call meeting of the Clinical Laboratory Personnel Advisory Committee starting at 3:00 P.M., Tuesday,

live- streaming video and teleconference for the public session and via non-streaming video and teleconference during the executive session.

Clinical Laboratory Personnel Advisory Committee Meeting

Although the risk of Louisiana and the rest of the United States is considered low at this time, the Louisiana Department of Health (LDH) is issuing this Health Alert Network (HAN) Health Advisory to raise awareness about an outbreak of Ebola disease in the Democratic Republic of the Congo (DRC) and Uganda. The HAN also provides recommendations for healthcare workers about potential Ebola disease case identification and testing.

The outbreak of Ebola disease was confirmed by the Ministry of Health of the Democratic Republic of Congo (DRC) on May 15, 2026, and CDC issued 

 for people traveling to DRC and Uganda. On May 17, the World Health Organization (WHO) determined this outbreak to be a 

public health emergency of international concern

. As of June 17, DRC and Uganda have reported 856 confirmed cases and 198 confirmed deaths with many more suspected cases and deaths. No suspected, probable, or confirmed Ebola cases related to this outbreak have been reported in the United States.

The U.S. Centers for Disease Control and Prevention (CDC) redirects U.S.-bound travelers coming from Ebola-affected regions to designated airports for enhanced entry screenings. After screening, CDC is providing contact information for low-risk travelers arriving from an affected country to states and local jurisdictions so that health monitoring can be performed for the duration of the 21-day incubation period.

Again, the risk of spread to Louisiana and the rest of the United States is considered low at this time

, but it is possible for travelers from affected areas in DRC or Uganda to enter the United States. Therefore, as an additional precaution, LDH is working to raise awareness of this outbreak among Louisiana healthcare providers.

Ebola disease is a viral hemorrhagic fever (VHF) caused by a group of viruses known as orthoebolaviruses. Ebola disease most commonly affects humans and nonhuman primates, such as monkeys, chimpanzees, and gorillas. Four orthoebolaviruses cause illness in people, presenting as clinically similar disease. The current outbreak is caused by Bundibugyo virus (species Orthoebolavirus budibugyoense). There are currently no FDA-approved or authorized treatments or vaccines for this species of orthoebolavirus.

Early “dry” symptoms include fever, aches and pains in the muscles and joints, severe headache, sore throat, and fatigue. Later “wet” symptoms include loss of appetite, diarrhea, vomiting, abdominal pain, and unexplained bleeding.

Ebola disease is spread through direct contact (through broken skin or mucous membranes) with the body fluids (e.g., blood, urine, feces, saliva, semen, or other secretions) of a person who is sick with or has died from Ebola disease. It can also be transmitted through contact with objects like needles that are contaminated with the virus. 

Ebola virus is not spread through airborne transmission.

The incubation period ranges from 2 to 21 days after exposures. A person infected with Ebola virus is not considered contagious until after symptoms appear.

Ebola Outbreak

R.S. 42:17.3 and Act 408 of the 2022 Regular Session, the advisory committee will participate via live- streaming video and teleconference for the public session and via non-streaming video and teleconference during the executive session.

 Click the appropriate committee’s name then “Live Stream Here” next to the date. The YouTube link will be posted immediately prior to

Respiratory Therapy Advisory Committee Meeting

, pursuant to LSA-R.S. 42:19(A), that the Louisiana State Board of Medical Examiners (the "Board"), within the Louisiana Department of Health, State of Louisiana, shall convene a Regular Call meeting of the Medical Psychology Advisory Committee starting at 1:00 P.M, Friday, June 12, 2026, at the offices of the Board, 630 Camp Street, New Orleans, Louisiana. Pursuant to La. R.S. 42:17.3 and Act 408 of the 2022 Regular Session, the advisory committee will participate via live-streaming video and teleconference for the public session and via non-streaming video and teleconference during the executive session.

. Click the appropriate committee’s name then “Live Stream Here” next to the date. The YouTube link will be posted immediately prior to the meeting.  Members of the public may view the video meeting at the anchor location at 630 Camp Street, New Orleans, Louisiana, or remotely.

. Public comments comprised of videos and/or audio content must be limited to no more than 3 minutes length and the email size must be less than 10 megabytes.

Both requirements must be met, or the content will be refused by our system. All comments received prior to or during the meeting will be identified and acknowledged during the meeting and maintained in the meeting 

The committee will make reasonable efforts to accommodate requests made while the meeting is in progress but cannot guarantee that such requests can be honored. The committee reserves the right to limit or prohibit participation in order to maintain orderly conduct of the meeting in accordance with La. R.S. 42:17(C).  Members of the public who choose to view the video meeting at the anchor location may give verbal comments by notifying the presiding officer at the anchor location.

. Click the appropriate committee’s name then “AGENDA” next to the date.

 Regular Meeting held and noticed pursuant to La. Rev. Stat. §42:17A(1), (2), (4), (5) and (10), R.S. 42:17.3 and Act 408 of the 2022 Regular Session. Further, agenda items may be taken out of order and/or in executive session pursuant to R.S 42:17A. La. R.S. 42:17A states “A public body may hold an executive session pursuant to La. R.S. 42:16 for one or more of the following reasons: (1) Discussion of the character, professional competence, or physical or mental health of a person, provided that such person is notified in writing at least twenty-four hours, exclusive of Saturdays, Sundays, and legal holidays, before the scheduled time contained in the notice of the meeting at which such executive session is to take place and that such person may require that such discussion be held at an open meeting.….In cases of extraordinary emergency, written notice to such person shall not be required; however, the public body shall give such notice as it deems appropriate and circumstances permit; (2) Strategy sessions or negotiations with respect to collective bargaining, prospective litigation after formal written demand, or litigation when an open meeting would have a detrimental effect on the bargaining or litigating position of the public body;….(4) Investigative proceedings regarding allegations of misconduct; (5) Cases of extraordinary emergency, which shall be limited to natural disaster, threat of epidemic, civil disturbances, suppression of insurrections, the repelling of invasions, or other matters of similar magnitude; and,….(10) Or any other matters now provided for or as may be provided for by the legislature.”

Medical Psychology Advisory Committee Meeting

, pursuant to LSA-R.S. 42:19(A), that the Louisiana State Board of Medical Examiners (the "Board"), within the Louisiana Department of Health, State of Louisiana, shall convene a Regular Call meeting of the Medical Psychology Advisory Committee starting at 1:00 P.M, Friday, March 20, 2026, at the offices of the Board, 630 Camp Street, New Orleans, Louisiana. Pursuant to La. R.S. 42:17.3 and Act 408 of the 2022 Regular Session, the advisory committee will participate via live-streaming video and teleconference for the public session and via non-streaming video and teleconference during the executive session.

The committee will make reasonable efforts to accommodate requests made while the meeting is in progress but cannot guarantee

to limit or prohibit participation in order to maintain orderly conduct of the meeting in accordance with La. R.S. 

42:17(C).  Members of the public who choose to view the video meeting at the anchor location may give verbal comments by notifying the presiding officer at the anchor location.

Regular Meeting held and noticed pursuant to La.Rev.Stat.§42:17A(1), (2), (4), (5) and(10), R.S. 42:17.3and Act 408 of the 2022 Regular Session. Further, agenda items may be taken out of order and/or in executive session pursuant to R.S 42:17A. La. R.S. 42:17A states “A public body may hold an executive session pursuant to La. R.S. 42:16 for one or more of the following reasons: (1) Discussion of the character, professional competence, or physical or mental health of a person, provided that such person is notified in writing at least twenty-four hours, exclusive of Saturdays, Sundays, and legal holidays, before the scheduled time contained in the notice of the meeting at which such executive session is to take place and that such person may require that such discussion be held at an open meeting.….In cases of extraordinary emergency, written notice to such person shall not be required; however, the public body shall give such notice as it deems appropriate and circumstances permit; (2) Strategy sessions or negotiations with respect to collective bargaining, prospective litigation after formal written demand, or litigation when an open meeting would have a detrimental effect on the bargaining or litigating position of the public body;….(4) Investigative proceedings regarding allegations of misconduct; (5) Cases of extraordinary emergency, which shall be limited to natural disaster, threat of epidemic, civil disturbances, suppression of insurrections, the repelling of invasions, or other matters of similar magnitude; and,….(10) Or any other matters now provided for or as may be provided for by the legislature.”

The committee will make reasonable efforts to accommodate requests made while the meeting is in progress

to limit or prohibit participation in order to maintain orderly conduct of the meeting in accordance with La. R.S. 42:17(C).

verbal comments by notifying the presiding officer at the

, pursuant to LSA-R.S. 42:19(A), that the Louisiana State Board of Medical Examiners (the "Board"), within the Louisiana Department of Health, State of Louisiana, shall convene a Regular Call meeting of the Clinical Laboratory Personnel Advisory Committee starting at 3:00 P.M., Wednesday,

Multi-State Outbreak of Infant Botulism Linked to ByHeart Infant Formula 

The Louisiana Department of Health (LDH) is issuing this health advisory to alert clinicians about a 

 and assist in identification and management of suspected cases. 

To date, no cases have been identified in Louisiana.

 has been identified in the United States. As of November 14, 2025, this outbreak includes 23 infants with suspected or confirmed infant botulism from 13 states (

). All 23 infants were hospitalized and treated with BabyBIG® (Botulism Immune Globulin Intravenous medication). No deaths have been reported.

The CDC National Botulism Surveillance System records approximately 150-180 infant botulism cases each year. In 2024, over half of infants with infant botulism were exclusively breastfed and 43% were receiving powdered infant formula before becoming ill.  According to information shared by the 

Infant Botulism Treatment and Prevention Program (IBTPP)

, since August 1, 2025, through November 10, 2025, 84 infants nationwide have received BabyBIG® treatment.

Data from IBTPP have demonstrated a concerning association between consumption of ByHeart infant formula and botulism. Among the 84 infants recently receiving BabyBIG® treatment, 36 (43%) had any powdered infant formula exposure. Notably, more than 40% (15) consumed ByHeart Whole Nutrition infant formula.  This information shows that ByHeart brand formula is disproportionately represented among sick infants in this outbreak, especially given Food and Drug Administration’s (FDA) data that ByHeart represents an estimated 1% of all infant formula sales in the United States. Investigations are ongoing but have not identified any other infant formula brands or shared exposures that pose a risk to infants at this time.

 that parents and caregivers immediately stop use of all ByHeart Whole Nutrition infant formula, including cans and single serve packets.

 On November 11, ByHeart Inc. recalled all ByHeart Whole Nutrition infant formula products. FDA does not anticipate any formula shortages as a result of this outbreak.

Infant botulism occurs when an infant ingests spores from a type of bacteria called 

, which then grows in the large intestine and produces toxin that blocks the neuromuscular junction by inhibiting the release of acetylcholine. Initial signs and symptoms often include constipation, difficulty feeding (difficulty sucking or swallowing), loss of head control, weak facial expression, and reduced muscle tone. Without prompt recognition and treatment, descending paralysis may progress and involve the respiratory muscles, potentially leading to life-threatening respiratory failure. The time from ingestion to symptom presentation can be up to 30 days.

Consider infant botulism a clinical diagnosis

 in any infant presenting with unexplained weakness, poor feeding, decreased head control, or difficulty swallowing — especially if the infant has consumed ByHeart formula.

Immediate actions when suspecting a case:

Caregiver guidance when ByHeart formula was used:

Multi-State Outbreak of Infant Botulism Linked to ByHeart Infant Formula

 pursuant to LSA-R.S. 42:19(A), that the Louisiana State Board of Medical Examiners (the "Board"), within the Louisiana Department of Health, State of Louisiana, shall convene a Regular Call meeting of the Occupational Therapy Advisory Committee starting at 10:00 AM., November 14, 2025, at the offices of the Board, 630 Camp Street, New Orleans, Louisiana. Pursuant to La. R.S. 42:17.3 and Act 408 of the 2022 Regular Session, the advisory committee will participate via live-streaming video and teleconference for the public session and via non-streaming video and teleconference during the executive session. 

. Click the appropriate committee’s name then “Live Stream Here” next to the date. The YouTube link will be posted immediately prior to the meeting. Members of the public may view the video meeting at the anchor location at 630 Camp Street, New Orleans, Louisiana, or remotely. 

Individuals who wish to make a public comment before or during the meeting, may do so by emailing: 

. Public comments comprised of videos and/or audio content must be limited to no more than 3 minutes length and the email size must be less than 10 megabytes. Both requirements must be met, or the content will be refused by our system. All comments received prior to or during the meeting will be identified and acknowledged during the meeting and maintained in the meeting minutes. 

Members of the public may give verbal comment on any agenda item when the matter comes up for discussion. Individuals wishing to make verbal comment must email 

with the subject line “ZOOM LINK REQUEST” to request a link to the videoconference, identifying themselves by name and relevant affiliation, if any, and the agenda item about which they wish to make verbal comment. This request should be made as far in advance of the meeting as possible so that the request can be processed. The committee will make reasonable efforts to accommodate requests made while the meeting is in progress but cannot guarantee that such requests can be honored. The committee reserves the right to limit or prohibit participation in order to maintain orderly conduct of the meeting in accordance with La. R.S. 42:17(C). Members of the public who choose to view the video meeting at the anchor location may give verbal comments by notifying the presiding officer at the anchor location. 

. Click the appropriate committee’s name then “AGENDA” next to the date. 

Note: Regular Meeting held and noticed pursuant to La. Rev. Stat. §42:17A(1), (2), (4), (5) and (10), R.S. 42:17.3 and Act 408 of the 2022 Regular Session. Further, agenda items may be taken out of order and/or in executive session pursuant to R.S 42:17A. La. R.S. 42:17A states “A public body may hold an executive session pursuant to La. R.S. 42:16 for one or more of the following reasons: (1) Discussion of the character, professional competence, or physical or mental health of a person, provided that such person is notified in writing at least twenty-four hours, exclusive of Saturdays, Sundays, and legal holidays, before the scheduled time contained in the notice of the meeting at which such executive session is to take place and that such person may require that such discussion be held at an open meeting.….In cases of extraordinary emergency, written notice to such person shall not be required; however, the public body shall give such notice as it deems appropriate and circumstances permit; (2) Strategy sessions or negotiations with respect to collective bargaining, prospective litigation after formal written demand, or litigation when an open meeting would have a detrimental effect on the bargaining or litigating position of the public body;….(4) Investigative proceedings regarding allegations of misconduct; (5) Cases of extraordinary emergency, which shall be limited to natural disaster, threat of epidemic, civil disturbances, suppression of insurrections, the repelling of invasions, or other matters of similar magnitude; and,….(10) Or any other matters now provided for or as may be provided for by the legislature.”

Guidance for evaluating suspected measles cases

The Louisiana Department of Health (LDH) has confirmed 

one case of measles in an adult resident of Region 9

 (comprised of Livingston, St. Helena, St. Tammany, Tangipahoa, Washington parishes). The patient was exposed to measles during 

. The patient was not hospitalized and will remain in isolation until no longer infectious. This patient’s vaccination status is unknown. 

The Department's epidemiologic investigation identified the following public exposure:

This is the third measles case reported in Louisiana in 2025. 

In 2024, three confirmed measles cases were reported in Louisiana, all five prior cases from 2024-2025 were travel-associated and in the greater New Orleans area.

Healthcare providers should proactively identify and update the immunity status of their patients and be 

vigilant for the possibility of additional cases of measles.

Importations of measles into communities with unvaccinated persons can lead to measles cases and outbreaks in the United States. Maintenance of 

are key factors to limit importations and the spread of disease.

●      Consider measles in patients who:

and clinically compatible measles symptoms (

cough, coryza (runny nose) or conjunctivitis

 that spreads from the head to trunk to the extremities.

locations in the United States with known outbreaks 

or were exposed to someone who recently traveled.

●      Also consider measles when evaluating patients for other 

●      If you suspect measles, do the following immediately:

to minimize disease transmission (See Management of Patients below).

a suspect measles case to the Louisiana Office of Public Health (OPH) Infectious Disease Epidemiology Hotline at 

for testing from patients with suspected measles and send to State Lab. Get specimen collection advice by calling 

Management of Patients with Febrile Rash Illness

●      Ideally, all patients with suspect measles should be 

placed immediately into an airborne infection isolation room (AIIR)

. If AIIR is not available, place patient in a private room with the door closed.

●      The other steps listed below (e.g., masking patient, placing in a private room) may reduce the spread of measles, but do not eliminate the need for full post-exposure control measures.

●      Only staff with evidence of immunity to measles should attend to suspect measles patients.

    ○      Ensure that you have documented evidence of immunity to measles for all staff to ensure those who are caring for the patient are vaccinated.

 (e.g., fit-tested N95 respirator) regardless of immunity, upon entry to the patient’s room.

●      If not admitted, use standard and airborne precautions while the patient is exiting the facility.

Patients should be told to remain in isolation at home through 4 days after rash onset.

●      Measles virus can remain suspended in the air for up to 2 hours. 

Following patient discharge, “rest” non-AIIR rooms for at least two hours before allowing others to enter.

The collection of clinical specimens for measles testing on all individuals with suspect measles is extremely important. Contact the OPH epidemiology hotline (available 24/7) at 

for technical guidance on specimen collection, necessary submission forms, and to arrange for transportation to the State Laboratory.

Communication with LOPH epi and testing at the State Lab are critical to the timeliness of Louisiana’s public health response.

Post-Exposure Control Measures Should Cases be seen in Healthcare Facilities

infectious for 4 days before through 4 days after onset of rash

 (day of onset is day 0); a total of nine days.

, including individuals in the waiting and examination rooms at any time while the index case was present and up to 2 hours after, and all staff both with and without direct patient contact. Due to the airborne route of measles transmission, areas of shared air space well beyond those occupied by the patient may be considered exposed, potentially encompassing an entire facility.

all exposed individuals for acceptable evidence of immunity.

●      Contact LDH Infectious Disease Epidemiology Hotline for assistance: at 

Post-exposure measures: vaccinate all susceptible persons or provide immune globulin

Measles vaccine given within 72 hours of exposure may prevent disease. 

most effective if given within 72 hours of exposure to measles, 

MMR vaccination can still be provided after 72 hours and protect against future exposures.

aged 6 through 11 months, MMR vaccine can be administered in place of IG, if administered within 72 hours of exposure. Do 

 administer MMR vaccine and IG simultaneously, as this practice invalidates the vaccine. These infants must still receive a normal 2-dose series beginning ≥12 months of age.

without evidence of current severe immunosuppression can be vaccinated. See the

ACIP statement regarding measles, mumps and rubella for additional information.

Provide post-exposure prophylaxis with immune globulin within 6 days

to susceptible patients at increased risk of severe disease from measles (see below*).

from work from day 5 through day 21 after exposure if not vaccinated. (If the case is confirmed, even those healthcare staff vaccinated within 72 hours may need to be excluded.)

for early identification of secondary cases should be continued for two incubation periods (42 days).

Post-exposure Prophylaxis with Immune Globulin (IG)

IG can prevent or modify measles in persons who are nonimmune if given within 6 days of exposure.

●      There are three groups of patients at increased risk of severe disease from measles:

    ○      pregnant women without evidence of measles immunity;

    ○      and severely immunocompromised individuals.

●      The recommended dose of IG administered intramuscularly (IGIM) is 0.5 mL/kg of body weight (maximum dose = 15 mL) and the recommended dose of IG given intravenously (IVIG) is 400 mg/kg.

 Recommended use of IGIM in infants <12 months

: IGIM should be administered to all infants aged <12 months who have been exposed to measles. For infants aged 6 through 11 months, MMR vaccine can be administered in place of IG if administered within 72 hours of exposure.

IVIG use in pregnant women without evidence of immunity

: IVIG should be administered to pregnant women without evidence of measles immunity who have been exposed to measles. IVIG is recommended to administer doses high enough to achieve estimated protective levels of measles antibody titers.

: Severely immunocompromised patients who are exposed to measles should receive IVIG prophylaxis regardless of immunologic or vaccination status because they may not be protected by the vaccine.

Guidance for Evaluating Suspected Measles Cases

Severe Illnesses Linked to Injection of Botox Products from Unlicensed Sources

alert clinicians about risks of counterfeit or mishandled botulinum toxin injections, particularly from unlicensed sources and in non-medical settings.

 following botulinum toxin injections among Louisiana residents. One patient received injections of an unlicensed botulinum toxin product 

, and one patient received injections from an individual with unknown licensure in a 

. These patients began experiencing botulism-like symptoms a few days following the injections, and 

both experienced severe illness requiring hospitalization

 is a rare and sometimes fatal illness caused by botulinum toxin. Initial botulism 

double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, and difficulty breathing

. These symptoms can be followed by a descending, symmetric 

A suspected case of botulism is a clinical and public health emergency. 

Treating patients with botulism antitoxin early in the course of disease can prevent the progression of paralysis and consequent complications.

Botulinum toxin products can be safe and effective for cosmetic and medical applications when obtained from authorized suppliers of products approved by the U.S. Food and Drug Administration (FDA) and administered by licensed and trained providers. Healthcare providers and the public should be aware of the 

serious risks associated with injection of non-FDA-approved products

. Unlicensed products may be misbranded, adulterated, counterfeit, contaminated, improperly stored and transported, ineffective, or unsafe. 

 could increase the risk of harm, even when using FDA-approved products.

·  Consider the possibility of adverse effects from botulinum toxin injection, including for cosmetic reasons, when patients present with signs and symptoms consistent with botulism near the injection site.

.  Be aware of symptom overlap between the presentation of localized adverse effects from injection of botulinum toxin and the early symptoms of botulism. To help distinguish early botulism symptoms from localized adverse effects:

.  Assess for symmetry of cranial nerve palsies; symmetric cranial nerve palsies are expected with botulism.

.  Assess for progression of cranial nerve palsies, possibly followed by a descending symmetric flaccid paralysis. These should raise suspicion for botulism.

LDH’s Infectious Disease Epidemiology Clinician 24/7 Hotline at 800-256-2748

·  If public health clinical consultation supports botulism, 

.  Antitoxin binds only to circulating toxin in the bloodstream. Careful consideration of dose, injection site, symptom presentation, and timing can help determine the need for antitoxin. Importantly, antitoxin does not:

.  Try to get information about the source and strength of the botulinum toxin products, the administration method (e.g., self-injection or injection by a licensed, trained provider), the administration site, and if others were injected with the same product.

.  Make note of details that might indicate the patient received injections with botulinum toxin products from unlicensed sources, including whether the patient:

·  Report suspected botulism immediately to LDH’s Infectious Disease Epidemiology Clinician 24/7 Hotline at 800-256-2748.

·  Report adverse events related to the use of any medications, including unverified botulinum toxin products, to 

FDA’s MedWatch Safety Information and Adverse Event Reporting Program

.  Counsel patients who report using or being interested in using botulinum toxin about risks for potential adverse effects.

·  Advise patients to receive injections only from licensed providers who are trained in proper administration of FDA-approved botulinum toxin products and practicing in accordance with state and local requirements.

·  Diagnostic testing for suspected botulism may be done through CDC.

.  Laboratory confirmation of botulism is done by demonstrating the presence of botulinum toxin in serum through either mouse bioassay or mass spectrometry.

.  For further guidance on submitting clinical specimens for testing, contact LDH’s Infectious Disease Epidemiology Clinician 24/7 Hotline at 800-256-2748.

Harmful Reactions Linked to Counterfeit “Botox” or Mishandled Botulinum Toxin Injections

Counterfeit Version of Botox Found in Multiple States

Notes from the Field: Illnesses After Administration of Presumed Counterfeit Botulinum Toxin in Nonmedical Settings — Tennessee and New York City, March 2024

Information for Health Professionals on Botulism

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