DRC Ebola outbreak is now the country's largest on record; raw-milk cheese E. coli sickens 13: Health risk update, Sep. 19–25, 2026
This week's official updates cover the Democratic Republic of the Congo's largest Ebola outbreak on record, a new raw-milk cheese E. coli outbreak with three cases of kidney failure in children, measles counts in Pennsylvania and Wisconsin, seven FDA recalls, and an updated global polio travel notice.
The week's signal
From September 19 through September 25, 2026, the Ebola outbreak in the Democratic Republic of the Congo became the largest the country has ever recorded and spread into two more health zones, one of them on the border with South Sudan. The World Health Organization counted 7,890 confirmed cases and 3,799 deaths as of September 23, a case fatality ratio of 48.1%. 1
The Food and Drug Administration opened a multistate investigation into a Shiga toxin–producing E. coli outbreak linked to Sierra Nevada Graziers raw-milk cheese, and the manufacturer recalled all of it on September 25 after 13 people fell ill and eight were hospitalized. 2 Three of the 13 developed hemolytic uremic syndrome, a form of kidney failure, and more than half of the people sickened are children 5 years old and younger. 3
Measles kept climbing in the two states carrying the largest U.S. outbreaks. CDC put the national 2026 total at 3,659 confirmed cases on September 24, and Pennsylvania's own dashboard reported 835 cases in 39 counties with four deaths. 45
The FDA posted seven recalls during the window, covering ground cinnamon, frozen ravioli, apple sauce, alfalfa sprouting seed, a tejocote supplement, and two injectable drugs. 6 CDC updated its global polio travel notice, adding four countries and removing five. 7 The agency's weekly journal carried an investigation of hepatitis A among Florida residents who had traveled to Cuba and a campylobacteriosis outbreak at a Pennsylvania wedding traced to untreated spring water, and the WHO announced the influenza vaccine composition for the 2027 southern hemisphere season. 8910 U.S. routine immunization schedules held steady. 11
The household action this week is a refrigerator check, since the recalled cheese has a long shelf life and reached retailers nationwide. The travel action is a polio booster decision for anyone flying to the four countries added to that list. The clinical action is watching for the kidney complication that E. coli can cause in young children who ate the cheese.
Actions for households, travelers, and clinical teams
| Alert | Who should act | What to do now |
|---|---|---|
| Sierra Nevada Graziers raw-milk cheese | Anyone who bought Graziers raw-milk cheese | Throw away medium cheddar, sharp cheddar, jalapeño jack, and Monterey jack sold under the Sierra Nevada Graziers label, in 8-ounce or 16-ounce retail packages or 5-pound food-service loaves. If you froze or refrigerated the cheese without its packaging and cannot tell whether it is part of the recall, throw it away. Wash and sanitize anything it touched, and call a provider for bloody diarrhea, diarrhea with a fever above 102°F, or signs of dehydration. 2 |
| Lior ground cinnamon | Shoppers in New York, New Jersey, Pennsylvania, Texas, Florida, and Illinois | Discard or return Lior Cinnamon Ground Seasoning, 90-gram (3.2-ounce) containers, UPC 794711005484, lot code GAP11304, sold between November 18, 2025 and September 7, 2026. The Maryland Department of Health found elevated lead in a sample. Questions: 1-516-496-7400. 12 |
| Wholesome Pantry apple sauce | Shoppers at ShopRite, Price Rite Marketplace, The Fresh Grocer, Gourmet Garage, and Fairway Market | Return 23-ounce jars of Wholesome Pantry Organic Unsweetened Apple Sauce, UPC 04119005677, best-by June 16, 2027. Routine FDA testing found patulin, a mold byproduct, above food-safety limits. Refunds at the store; questions: 1-800-746-7748. 13 |
| Berlin Seeds alfalfa sprouting seed | Home sprouters and retailers | Stop sprouting, planting, or eating the seed, and discard it in a sealed bag. The 5-pound and 50-pound bags carry lot code SAL2-24JB; the quarter-pound, half-pound, and 1-pound bags carry no lot code. Sold at the Millersburg, Ohio store and the company website from February 13 to August 23, 2026 to 44 states. Questions: 877-464-0892. 14 |
| Niwali tejocote supplements | Anyone who bought Niwali Tejocote Capsules or Pieces online | Stop using them. FDA testing found the products were yellow oleander, a plant whose cardiac glycosides can cause dangerous heart-rhythm changes. Capsules, 90-count, lot RM500925; pieces, 90-day supply, lot RM400925; both best-by March 3, 2028; five units sold on eBay and Everymarket.com. Refunds: 646-419-5884. 15 |
| ICU Medical sodium chloride | Hospital pharmacies and clinicians | Quarantine and stop using 0.9% Sodium Chloride Injection, USP, 100 mL flexible containers, NDC 0990-7984-23, lot 1042188, expiration October 31, 2027. The overwrap is labeled sodium chloride but may hold 10 mEq potassium chloride, which can cause cardiac arrest. Returns through ICU Medical customer care: 1-800-258-5361. 16 |
| Par dexmedetomidine | Hospital pharmacies | Discontinue Dexmedetomidine HCl in 0.9% Sodium Chloride Injection, 400 mcg/100 mL, NDC 42023-187-01, lots 87558 and 88802, expiring February and April 2027. Particulate matter identified as cellulose or stopper material can block blood vessels. Returns through Inmar: 1-833-599-3197. 17 |
| Global polio notice | Travelers to any of the 29 listed destinations | Confirm routine polio vaccination before departure. Adults who finished the routine series and have never had an adult booster may receive one lifetime booster dose. The September 23 update added Malawi, Mali, Togo, and Zambia and removed Burkina Faso, Guinea, Gaza, Poland, and Senegal. 7 |
| Pennsylvania measles outbreak | Residents and visitors across Pennsylvania | Confirm two documented MMR doses. Anyone with fever plus cough, runny nose, or red watery eyes should stay home and telephone 877-PA-HEALTH (877-724-3258) before going to a clinic. The state reported 835 cases, 39 counties, 164 hospitalizations, and four deaths on September 23, with free MMR vaccinations at the Bloomsburg Fair from September 26 through October 3. 5 |
| Southwest Wisconsin measles outbreak | Residents and visitors in Grant, Iowa, Lafayette, and Vernon counties | Check immunity through the Wisconsin Immunization Registry or a provider. Nonimmune people exposed to a known case should stay home and monitor for 10 to 21 days. Wisconsin reported 180 confirmed and 6 probable cases in the four-county outbreak and 192 statewide on September 25, and detected measles virus in wastewater from Green County on September 16. 18 |
| Ebola travel rules | Anyone whose itinerary includes the Democratic Republic of the Congo, Uganda, or South Sudan | Travelers who have been in the DRC within 21 days of their flight may not board commercial flights to the United States, and U.S. citizens and nationals who have been in the DRC should plan to spend 21 days outside the country before entering. Arrivals from Uganda or South Sudan with no DRC exposure must use designated airports for enhanced screening. 19 |
What the counts mean
This outbreak carries three different numbers depending on who cut the data. WHO's outbreak-news bulletin uses September 23: 7,890 confirmed cases, 3,799 deaths, a case fatality ratio of 48.1%. 1 WHO's regional office for Africa published its weekly external situation report on September 20 with data as of that day: 7,733 confirmed cases including 3,732 deaths, after 475 new confirmed cases and 222 new deaths in the week since the previous report. 20 CDC's situation page uses the Congolese ministry's September 23 figures and adds the cases recorded in Uganda and France, for 7,911 confirmed cases and 3,801 confirmed deaths across the three countries. 19 The three describe one outbreak at three cutoffs.
The superlatives have the same cause. WHO calls this the largest Ebola outbreak ever recorded in the Democratic Republic of the Congo, measured against every previous outbreak there whatever virus species caused it. 1 CDC calls it the second-largest Ebola outbreak on record worldwide. 19 The 2014–2016 West Africa outbreak remains ahead of it globally.
Measles counts separate into a cumulative total and a weekly one, and the weekly one keeps moving. CDC reported 3,659 confirmed U.S. cases for 2026 as of September 24, with 95% of them tied to one of 40 outbreaks; the state table behind that total counts 850 cases in Pennsylvania, 670 in South Carolina, 535 in Utah, and 164 in Wisconsin. 4 The rash-onset series shows the newest week thinnest: the week beginning September 20 held 40 cases in the September 24 update, against 101 for the week beginning September 13 and 176 for September 6. 4 CDC marks its 2025–2026 counts as preliminary and subject to change, and states count faster than the federal compilation: Pennsylvania's own dashboard read 835 cases on September 23, with 43 new cases in the two days before. 5 Wisconsin's health department adds a further caution, noting that newly reported case counts can rise or fall with how cases are being found rather than with the amount of spread. 18
Death counts differ for a reason readers can check. CDC's page lists one measles death in the United States for 2026 and marks that figure as subject to change while the agency works with the Council of State and Territorial Epidemiologists on a standard definition for deaths caused by measles. 4 Pennsylvania counts four under its own rule: a confirmed measles-associated death is one that occurs within 30 days of symptom onset in a person with clinical evidence of measles infection and a positive laboratory test, and that was caused by measles rather than something unrelated. 21 Both agencies are counting deaths inside the same outbreak under different definitions and different cutoffs.
The cheese outbreak's 13 cases and 8 hospitalizations come from nine states, with the most recent illness beginning August 26. 2 The count is small and the severity is why the recall reached nationwide: 3 of the 13 developed hemolytic uremic syndrome, the kidney failure that Shiga toxin–producing E. coli can cause, and more than half of the sick are children 5 years old and younger. 3
Ebola's geographic expansion
Sixty-three health zones across seven of the Democratic Republic of the Congo's 26 provinces now have confirmed cases. 1 The two most recent additions are Dungu Health Zone in Haut-Uélé province, which borders South Sudan, and Bulu Health Zone in Sud-Ubangi, a new province on the north-western edge of the country. WHO links the newest expansion to a higher risk of cross-border transmission. 1
Ituri remains the epicentre with 6,032 confirmed cases since the outbreak began, and its share of the national total keeps falling, from 78.0% a week earlier to 76.9% in the regional office's September 20 report. 20 North Kivu has become the second most affected province with 1,480 cases and the outbreak's highest case fatality ratio at 59.7%, and investigators are working to explain why deaths there run higher than elsewhere. 1
The response is carrying a heavier load than the case count alone suggests. As of September 23, 26,980 of the 32,342 contacts requiring follow-up had been monitored in the previous 24 hours, or 83.4%, and 1,966 patients have recovered. 1 The regional office's September 20 report counted 202 infected health workers, 47 of whom have died, and 821 patients in isolation. 20 Bundibugyo virus has no approved vaccine or specific treatment, so control rests on finding cases quickly, isolating and treating patients, tracing contacts, and conducting safe burials. 1
U.S. entry rules held steady through the week. 19 CDC counts zero Ebola cases in the United States linked to this outbreak, rates the likelihood of spread into the country as very low, and has about 500 staff working on the response, more than 120 of them deployed to the affected countries. 19
Travel and vaccine watch
CDC updated one travel notice during the window. The global polio notice, reviewed September 23, now lists 29 destinations where poliovirus has been detected in humans or in environmental samples within the past 13 months, after adding Malawi, Mali, Togo, and Zambia and removing Burkina Faso, Guinea, Gaza, Poland, and Senegal. 7 The notice asks travelers to complete routine polio vaccination before departure and allows one lifetime booster dose for adults who finished the series. 7
The Ebola notice levels also held: Level 4 for Ituri and Nord-Kivu, Level 3 for Haut-Uélé and Tshopo, and Level 2 for the rest of the Democratic Republic of the Congo and for Uganda. 22
Cuba drew fresh travel guidance in CDC's September 24 journal. Florida's health department found that 76 of the 249 confirmed hepatitis A cases it recorded between June 2024 and February 2026 were in residents who had recently traveled to Cuba, and that 79 cases met its outbreak definition, with 72% of those patients hospitalized and no deaths. Gene sequencing linked 15 of 18 tested samples to a single genotype IA strain, which points to widespread transmission across several Cuban provinces rather than a single source. 8 The report recommends hepatitis A vaccination or immune globulin before a planned trip to Cuba, and it asks providers to consider hepatitis A in patients with compatible symptoms who have recently been there. 8
WHO announced on September 25 the virus strains it recommends for influenza vaccines in the 2027 southern hemisphere season, including an A/Missouri/11/2025 (H1N1)pdm09-like virus and an A/Darwin/1454/2025 (H3N2)-like virus for egg-based vaccines. 10 National regulators and manufacturers use the recommendation to build next season's southern-hemisphere shots, so it changes what travelers can be offered in countries south of the equator from roughly March 2027. 10 U.S. policy is untouched by it. CDC's immunization recommendations page still lists the seasonal influenza and RSV actions of July and August 2025 as its most recent adopted recommendations, and the routine child, adolescent, and adult schedules stand as published. 11
Recalls and clinical alerts
The week's food and drug recalls reached a cheese, a spice jar, a jar of apple sauce, a frozen pasta, a sprouting seed, an online supplement, and two hospital injectables.
Sierra Nevada Cheese Company recalled all Graziers raw-milk cheeses on September 25, one day after FDA notified the firm of the outbreak. The recalled products are medium cheddar, sharp cheddar, jalapeño jack, and Monterey jack, sold nationwide and online in 8-ounce and 16-ounce retail packages and in 5-pound loaves for food service and wholesale customers, and they have a long shelf life, which is why FDA asks consumers to check freezers as well as refrigerators. 2 Nine of the nine people interviewed reported eating the cheese before they became ill. 2
Galil Importing Corporation recalled Lior Cinnamon Ground Seasoning on September 24 after a sample collected by the Maryland Department of Health showed elevated lead levels, a hazard that can cause learning disorders and developmental damage in children exposed over weeks or months. 12 Wakefern Food Corporation recalled Wholesome Pantry Organic Unsweetened Apple Sauce, published September 22, after routine FDA testing found patulin above the food-safety limit. 13 Deano's Pasta recalled about 20 pounds of Pear and Pecorino Triangoli Ravioli on September 24 because the packaging omitted lobster, a crustacean shellfish allergen; the ravioli went to retail stores in Massachusetts. 23
Berlin Seeds recalled 950 pounds of alfalfa sprouting seed on September 23 after its supplier traced the seed to a sprout grower whose finished sprouts belonged to the FDA's multistate investigation into multiple Shiga toxin–producing E. coli strains and Salmonella Agona, the alfalfa-sprout outbreak the agency has been tracing since August. 14 Global Mix recalled two Niwali tejocote products on September 21 after FDA analysis showed the material was yellow oleander; the products were sold on eBay and Everymarket.com in five units total, and the marketplace withheld buyer contact details, which is why the company issued a public notice. 15
On the drug side, Otsuka ICU Medical recalled one lot of 0.9% sodium chloride injection, published September 21, after a customer complaint and a bag found inside the wrong overwrap. 16 Par Health recalled two lots of dexmedetomidine on the same publication date for particulate matter that can cause pulmonary emboli. 17 Neither company had received reports of harm from the affected lots at the time of publication. 16
FDA's outbreak investigation table added three entries during the window: the raw-milk cheese outbreak, a Listeria monocytogenes investigation with 40 cases, and an E. coli O157:H7 investigation with 25 cases. The last two have no identified product yet. 24 The Salmonella Newport investigation rose from 111 to 116 cases, the frozen-blueberry E. coli O145:H28 outbreak closed on September 21 with a final FDA update, and three Cyclospora investigations ended while FDA traceback continues. 24
The September 24 journal also carried the environmental investigation into a June 2025 campylobacteriosis outbreak among roughly 80 wedding guests in York County, Pennsylvania. Fifteen of the 46 attendees who answered a questionnaire reported gastrointestinal illness within 1 to 10 days of the event, and state and CDC investigators traced the illnesses to untreated water from an on-site spring after a vendor's bottled water ran out. Inspectors found a broken springhouse roof admitting debris and animal feces, an ultraviolet treatment unit that had been inoperable for at least two months, animal activity around the spring, and a chicken coop and horse area nearby. 9 Private springs go largely unregulated, and the report's lesson for venues and households is that untreated water needs routine inspection and clear signage about whether it is safe to drink. 9
A separate weekly report measured falls among older adults: in 2024, unintentional fall death rates were 74.8 per 100,000 people for men aged 65 and older and 66.6 for women, with rates rising with age and highest above 85. 25
Bottom line
- Check the refrigerator and freezer for Sierra Nevada Graziers raw-milk cheese in any of its four varieties, and throw it away. Call a provider for bloody diarrhea or a fever above 102°F.
- Discard Lior ground cinnamon, UPC 794711005484, lot GAP11304, and Wholesome Pantry Organic Unsweetened Apple Sauce, UPC 04119005677, best-by June 16, 2027.
- Stop using Niwali tejocote capsules and pieces, lots RM500925 and RM400925, and Berlin Seeds alfalfa sprouting seed in any package size.
- Pharmacies should quarantine ICU Medical sodium chloride lot 1042188 and Par dexmedetomidine lots 87558 and 88802.
- Confirm two documented MMR doses for everyone in the household, and telephone ahead before any clinic visit for a rash illness — 877-PA-HEALTH in Pennsylvania.
- If you are flying internationally, check the 29-country polio list and get an adult booster if your destination is on it and you have never had one.
- Before a trip to Cuba, arrange hepatitis A vaccination or immune globulin.
- Keep the 21-day DRC flight restriction in mind for any itinerary routed through the Democratic Republic of the Congo, and plan Uganda or South Sudan arrivals through designated screening airports.
References
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- 11CDC, ACIP Recommendations
cdc.gov
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- 22CDC, Travel Health Notices
wwwnc.cdc.gov
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