Month: October 2026

Public Health Notes

By Kenton K. Murthy, DO, MS, MPH, AAHIVS
TCPH Assistant Director & Deputy Local Health Authority

This article was originally published in the September/October 2026 issue of Tarrant County Physician.

As physicians, we spend much of our careers focused on the patient in front of us. Public health often focuses on the patient we never see: the illness that was prevented, the outbreak that was contained, or the emergency that never materialized. When the system works as intended, its greatest successes can look like nothing happened.

The summer of 2026 has provided four very different reminders of why that infrastructure matters: a rapidly expanding Ebola outbreak in Central Africa, the return of New World screwworm to Texas, a large rise in cyclosporiasis associated in part with iceberg lettuce, and the successful completion of the largest FIFA World Cup in history. Each event required a different response, but all depended on the same foundation: timely clinical recognition, laboratory capacity, surveillance, clear communication, and coordination across jurisdictions and disciplines.

Ebola: A Global Threat Requiring Local Readiness
The current Ebola outbreak is caused by Bundibugyo virus, one of the Orthoebolaviruses that can cause severe hemorrhagic disease. As of August, the Democratic Republic of the Congo had reported over 4,000 confirmed cases and 1,916 deaths. The outbreak had become the largest Ebola outbreak recorded in the country. Uganda declared the end of its locally transmitted outbreak on July 28 after 42 days without a new locally acquired case, although ongoing transmission in the DRC leaves neighboring countries at risk for reintroduction._¹

For physicians in the United States, the immediate risk remains low. No cases associated with this outbreak have been confirmed here. CDC describes the overall risk to the American public and travelers as low and the likelihood of spread to the United States as very low.² Low risk does not eliminate the need for readiness. Early Ebola symptoms, including fever, fatigue, headache, myalgias, vomiting, and diarrhea, overlap with much more common illnesses. Recognition begins with a careful travel and exposure history, particularly during the 21 days before symptom onset.

If a patient has compatible symptoms and a relevant exposure, the first steps are to isolate the patient, implement appropriate infection-prevention precautions, notify the facility’s infection-prevention team, and contact the local or state health department to coordinate assessment and testing.³ That early call protects the patient, clinical staff, laboratory personnel, and the broader community. Local health departments, state agencies, and international partners have different responsibilities, but the value lies in how those responsibilities connect. In the affected areas, conflict, population displacement, limited diagnostic access, shortages of protective equipment, and infections among health workers have made control substantially more difficult. The biology of the virus is only one part of the outbreak; the strength of the surrounding system helps determine what happens next.

New World Screwworm: One Health in Real Time
Closer to home, New World screwworm is no longer only a threat approaching the southern border; it has been confirmed in Texas. The first US animal detection in the current outbreak was confirmed in a calf in Zavala County on June 3. By early August, the Texas Animal Health Commission reported confirmed animal cases on 35 premises in 15 counties.⁴

New World screwworm may sound primarily like an agricultural concern, but it is also a health issue with implications for veterinary medicine, wildlife, human health, and the Texas economy. The larvae of Cochliomyia hominivorax feed on living rather than necrotic tissue. Its reemergence reminds us that protecting health sometimes requires veterinary medicine, agriculture, wildlife management, laboratories, emergency management, and human public health to operate as a system.

There have been no reports of locally acquired human infestation in the United States, and CDC characterizes the current risk to people as very low.⁵ Clinicians should nevertheless recognize the presentation: a rapidly worsening, painful, foul-smelling wound; bloody drainage; visible larvae; or the sensation of movement in a wound or body opening. Treatment requires removal and safe disposal of all visible larvae and eggs, repeat examination of the lesion, wound care, and treatment of secondary infection when present. Suspected human cases should be reported immediately, and intact larvae should be preserved for identification rather than discarded.⁶

The Texas response demonstrates collaboration beyond traditional health departments. USDA, the Texas Animal Health Commission, Texas Parks and Wildlife, CDC, DSHS, local health authorities, veterinarians, producers, and laboratories all have distinct roles. Surveillance, animal-movement controls, wound inspections, public education, and release of sterile male flies are being used together. The sterile insect technique helped eradicate indigenous New World screwworm from the United States in 1966. Its renewed use is a reminder that public health tools can be biological, regulatory, clinical, and operational at the same time.⁴

Cyclospora and Iceberg Lettuce: The Value of Routine Reporting
The 2026 rise in cyclosporiasis illustrates the importance of routine disease surveillance and foodborne outbreak investigation. From May 1 through August 3, CDC reported 10,468 laboratory-confirmed, domestically acquired cases in 47 states, including 517 hospitalizations and, unfortunately, two deaths. CDC was also reviewing tens of thousands of additional illnesses that were not yet laboratory confirmed or required further investigation.⁷

One major subset of these illnesses was linked epidemiologically to iceberg lettuce sourced from central Mexico. Taylor Farms de Mexico recalled affected iceberg lettuce on July 17. Although Texas was not among the 15 outbreak case states listed at that time, recalled products had been distributed through Texas retail and food-service channels.⁸

For clinicians, cyclosporiasis should be considered in patients with prolonged or relapsing watery diarrhea, fatigue, anorexia, weight loss, bloating, and cramping, particularly when symptoms begin about a week after a produce or restaurant exposure. Testing may need to be requested specifically because routine stool examinations and some gastrointestinal panels do not automatically include Cyclospora. Trimethoprim-sulfamethoxazole is the treatment of choice; for immunocompetent adults, CDC lists one double-strength tablet twice daily for seven to 10 days.⁹ Every appropriately ordered test and timely report adds one piece to a much larger puzzle. Epidemiologists, laboratorians, environmental health specialists, regulatory agencies, clinicians, and industry partners then work together to compare exposures, identify clusters, trace products, and prevent additional illness. Clinical medicine and public health are not separate systems; they are complementary parts of the same healthcare continuum.

The World Cup: Preparedness That Stayed in the Background
Perhaps the most overlooked public health success is the event that concludes without a public health emergency. The 2026 FIFA World Cup brought 48 national teams and millions of visitors to 16 host cities across the United States, Canada, and Mexico over 39 days.¹⁰ Despite signs across Tarrant County stating “We Are Dallas,” Arlington actually hosted nine matches and welcomed hundreds of thousands of visitors, and local agencies monitored communicable disease, food safety, heat, air quality, medical surge, and other routine and event-related risks.¹¹

The work began well before the first whistle blew. Locally, healthcare systems, public health, emergency management, EMS, fire, law enforcement, laboratories, airport authorities, and municipal and regional partners established communication pathways and response plans. Nationally, CDC participated in a federal coordination structure; held regular calls with public health officials from all US host sites; deployed epidemiology, laboratory, informatics, and preparedness personnel; and created a shared dashboard for disease trends, heat, and air quality. Twenty port health stations maintained around-the-clock protocols at US ports of entry.¹⁰

At the close of the tournament, available public reporting indicated that no major tournament-associated public health emergency had occurred.10 That does not mean there were no public health concerns to monitor—it means those concerns did not become a defining incident. Risks were anticipated, information was shared, and agencies knew how to reach one another when a signal required attention. An uneventful outcome is often the product of very eventful preparation.

What Public Health Infrastructure Actually Means
Public health infrastructure is not simply a building, a department, or an organizational chart. It is the workforce that answers a report after hours; the laboratory that can identify an uncommon pathogen; the data system that connects cases across counties and states; the epidemiologist who conducts a detailed interview; the infection preventionist who protects a clinical team; the veterinarian who recognizes an unusual wound; the regulatory authority that can remove a contaminated product; and the communication network that provides accurate guidance without unnecessary alarm.

The same sequence appears repeatedly. A clinician or veterinarian recognizes something unusual. A laboratory provides confirmation. Local public health investigates the patient and immediate exposures. State partners identify broader patterns. Federal and international agencies compare signals across jurisdictions. Regulatory, animal health, emergency management, and healthcare partners then act within their respective authorities. No single organization can perform the entire chain, and delays at any handoff can allow a manageable event to become more difficult.

This is not an argument for alarm or for applying the same response to every signal. Good public health is calibrated. It distinguishes common illness from low-probability, high-consequence disease; confirms findings before drawing conclusions; communicates what is known and unknown; and adjusts the response as evidence changes. Strong infrastructure makes that proportional response possible.

The Physician’s Role
For practicing physicians, participation in this system is straightforward but essential:

• Ask about travel and exposure when a patient’s syndrome or timing is unusual, particularly for acute febrile illness after travel to an outbreak area.
• Order the test that matches the clinical concern, including a specific request for Cyclospora when prolonged or relapsing watery diarrhea warrants it.
• Report early. A call to infection prevention or the local health department is not a declaration that a diagnosis is confirmed—it is the beginning of a coordinated risk assessment.

Beyond these examples, vaccination, antimicrobial stewardship, thoughtful diagnostic testing, and routine communicable disease reporting all strengthen the systems our patients depend on. Every clinician contributes to the larger public health enterprise, often without realizing it.

Public health is most visible during a crisis, but it is most effective before a crisis fully develops. Ebola, New World screwworm, cyclosporiasis, and the World Cup have very different challenges, yet they share a common lesson: timely information, defined roles, trusted partners, and coordinated action can protect both individual patients and entire communities. The strongest systems are built through relationships among clinicians, hospitals, laboratories, local health departments, state agencies, federal partners, and international organizations long before an emergency occurs. When those elements are in place, nothing happening may be the most meaningful outcome of all.

References:

1. World Health Organization, “Ebola Disease Caused by Bundibugyo Virus—Democratic Republic of the Congo,” Disease Outbreak News, August 1, 2026, https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON614. W World Health Organization
2. Centers for Disease Control and Prevention, “Ebola Outbreak: Current Situation,” July 22, 2026, https://www.cdc.gov/ebola/situation-summary/about-current-outbreak.html.
3. Centers for Disease Control and Prevention, “Screening and Evaluating an Ill Person for Viral Hemorrhagic Fevers,” updated August 3, 2026, https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/diagnosis-testing/index.html. C CDC
4. Texas Animal Health Commission, “New World Screwworms,” accessed September 2, 2026, https://www.tahc.texas.gov/emergency/nws.html.
5. Centers for Disease Control and Prevention, “New World Screwworm Outbreak,” updated August 11, 2026, https://www.cdc.gov/new-world-screwworm/situation-summary/index.html.
6. Centers for Disease Control and Prevention, “Clinical Overview of New World Screwworm,” February 24, 2026, https://www.cdc.gov/new-world-screwworm/hcp/clinical-overview/index.html. C CDC
7. Centers for Disease Control and Prevention, “Surveillance of Cyclosporiasis,” updated August 11, 2026, https://www.cdc.gov/cyclosporiasis/php/surveillance/index.html. C CDC
8. US Food and Drug Administration, “Investigation of 15-State Outbreak of Cyclospora Illnesses: Iceberg Lettuce (July 2026),” July 2026, https://www.fda.gov/food/outbreaks-foodborne-illness/investigation-15-state-outbreak-cyclospora-illnesses-iceberg-lettuce-july-2026. ” “OUR WORLD”+1
9. Centers for Disease Control and Prevention, “Clinical Overview of Cyclosporiasis,” February 29, 2024, https://www.cdc.gov/cyclosporiasis/hcp/clinical-overview/index.html. C CDC
10. Centers for Disease Control and Prevention, “Statement on CDC Public Health Readiness & Response for the FIFA World Cup 2026™,” July 19, 2026, https://www.cdc.gov/media/releases/2026/statement-on-cdc-public-health-readiness-response-for-the-fifa-world-cup-2026.html. C CDC
11. City of Arlington, “City of Arlington Prepares for FIFA World Cup 2026™,” February 20, 2026, https://www.arlingtontx.gov/News-Articles/2026/February/City-of-Arlington-Prepares-for-FIFA-World-Cup-2026%E2%84%A2.