Public health
Health alerts for Arizona emergency physicians.
Outbreaks, exposures, and case-finding guidance forwarded from ADHS and the Arizona Health Alert Network. Active alerts at the top, archive below.
Active alerts
Current
- Arizona Department of Health ServicesWednesday, June 17, 2026
New World Screwworm in Texas and New Mexico — clinical guidance for AZ providers
First U.S. animal detections of NWS in early June 2026. No human cases in Arizona to date. Provider guidance on clinical signs, specimen collection (70% ethanol, ≥10 larvae), and reporting to local/tribal public health.
Primary reference →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)
- Arizona Department of Health ServicesMonday, June 15, 2026
Increased Mpox activity in Arizona
Arizona at 21 Mpox cases YTD vs. <6 by end of June 2025. Provider guidance on testing thresholds, JYNNEOS pre-exposure prophylaxis, tecovirimat criteria, and CDC consultation contacts (24/7 EOC line 770-488-7100).
Primary reference →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
Archive
Past alerts
Clinical guidance from past alerts often remains relevant. Skim before the next shift.
- Arizona Health Alert Network (AzHAN)Sunday, November 9, 2025
Infant botulism outbreak linked to ByHeart Whole Nutrition infant formula
Multistate outbreak (13 cases across 10 states, 1 in AZ as of Nov 8, 2025). All infants hospitalized and treated with BabyBIG, no deaths. Call California Infant Botulism Treatment Program 510-231-7600 24/7 for consultation; start BabyBIG without waiting for confirmatory testing.
Primary reference →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