(WASHINGTON) -- The Trump administration has begun mailing out $500 Affordable Care Act (ACA) checks to enrollees who were allegedly overcharged for coverage.

The Treasury Department is issuing the checks to 950,000 Americans in 30 states due to marketplace "user fee" overcharges, according to the administration.

In a video posted on X last month announcing the initiative, President Donald Trump claimed without evidence that the Biden administration sat on a pool of unused surplus money.

Here's what to know about who is eligible, where the checks are being sent and when they may arrive.

Who is eligible?

An administration official told ABC News on Thursday that the primary recipients of the checks will be people with incomes "above" 400% of the federal poverty level. The federal poverty level is $15,960 a year for an individual in the contiguous 48 states and Washington, D.C.

However, some recipients are those who earn between 100% and 400% of the federal poverty level who did not receive subsidies, the official said.

Residents in the following states will receive checks: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Hawaii, Indiana, Iowa, Kansas, Louisiana, Michigan, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, Wisconsin and Wyoming.

The administration official told ABC News that residents in these 30 states "do not operate their own ACA insurance plan exchanges and instead rely on federal exchanges administered by [the Centers for Medicare & Medicaid Services]."

The official said residents in the 20 remaining states will not receive checks "because their states run their exchanges, and thus the federal government did not oversee collecting user fees on them."

Texas and Florida have the highest numbers of individuals who will be receiving refund checks followed by Wisconsin, Arizona and Oregon, respectively, according to data provided by the administration.

Gerard Anderson, a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health, told ABC News he's skeptical the checks will be going to the Americans most in need.

The payment "does not target the people most likely to have been harmed by the policy changes made by the administration, including the end of the tax credits," Anderson said.

The subsidies, or premium tax credits, helped lower or eliminate the out-of-pocket cost of monthly premiums for those who purchase insurance through the health insurance marketplace. They expired at the end of last year and have yet to be renewed.

Anderson added that the check amount is also not tied to a person's medical condition, which has a large impact on the cost of their premiums.

When will the checks be delivered?

Initially, the administration said checks would be sent to eligible Americans beginning in October 2026, but the administration official said the checks were sent out beginning Wednesday.

It's unclear how long it will take eligible Americans to receive the checks.

The checks will also come with a letter, according to the administration official.

"For years, the Biden Administration overcharged you to fund the operation of HealthCare.gov," the letter, viewed by ABC News, reads in part. "That money belongs to hard-working Americans, not the Government, and now, I am returning it to you."

The checks are separate from a proposal Trump made during the GOP midterm convention in Dallas to offer a $5,000 "dividend" to all adult Americans if Republicans keep control of the House and Senate in the midterm elections.

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Breast cancer is the second most common cancer among women, with one in eight developing breast cancer in their lifetime.

It is expected that more than 381,000 new cases of invasive, non-invasive and pre-invasive breast cancer will be diagnosed in women this year and about 42,000 women will die, according to the American Cancer Society (ACS).

Knowing your personal risk of developing breast cancer risk could help you and your doctor choose the right screening schedule and prevention methods.

ABC News is teaming up with the ACS for Breast Cancer Awareness Month.

The American Cancer Society encourages women to take the ACS CancerRisk360 free assessment to learn more about the factors they can change to improve their health and lower their cancer risk.

The tool is available to use for anyone ages 18 and older. The tool asks questions about things that can raise an individual's cancer risk, including:

Individual health historyFamily health historyDaily habits and lifestyleCancer screening history

Based on someone's answers, the tool gives tips on how to lower one's cancer risk.

Cancer risk can be controlled or modified with several lifestyle changes including diet, physical activity, tobacco use, HPV vaccination and sun/UV protection, according to ACS. Certain risk factors -- such as age and family history -- cannot be controlled or modified.

The tool does not cover every type of cancer but does offer steps to lower the risk for cancers such as breast, cervical, colorectal, lung and prostate cancer.

"Understanding your cancer risk should make the next step clearer, not more complicated," Shane Jacobson, CEO of the American Cancer Society, said in a statement. "CancerRisk360 gives people trusted, personalized guidance they can use to start a conversation with their healthcare provider and take practical steps that may help lower their risk."

ACS says the tool is not a substitute for speaking with and getting medical advice from an individual's doctor.

"Always talk to a qualified health care provider who knows your situation and personal health needs," ACS states on its website. "Do not ignore or delay getting professional medical advice because of anything you read in this assessment or in your recommendations."

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Oct. 1 marks the beginning of Breast Cancer Awareness Month, putting a spotlight on the second most common cancer diagnosed among women.

Although the rates of women diagnosed with breast cancer have increased, death rates have been declining and five-year survival rates have risen.

It's not just women; men are also diagnosed with the disease. Additionally, disparities persist among races and ethnicities.

Here's what you need to know about breast cancer by the numbers. 

Diagnosis rates

Breast cancer is the most frequently diagnosed cancer among women in the United States, aside from skin cancer, with more than 320,000 new invasive cases expected each year, according to the American Cancer Society (ACS). 

Breast cancer diagnoses have risen with a 1% increase per year in recent years, ACS says.

"Breast cancer is one of the most common cancers in women, but most women diagnosed with breast cancer do very well and outcomes have improved tremendously over the years," Hannah Rose Naughton, breast surgical oncologist at Hackensack Meridian Health, told ABC News. 

Breast cancer accounts for roughly one in every three new cancers diagnosed in women each year and is the second leading cause of cancer death among women in the U.S., behind lung cancer, according to the ACS.

"The earlier we find the cancer, the better the outcome for the patient," Naughton said. 

While breast cancer affects women far more often, the disease can also occur in men. 

"One percent of breast cancer cases occur in men; it's extremely rare," Priya Thomas, breast oncologist at the University of Texas MD Anderson Cancer Center, told ABC News.

Declining death rates

The breast cancer death rate among U.S. women decreased by 44% from 1989 to 2024, preventing an estimated 500,000 to 517,900 deaths, according to ACS.  

"The decrease in breast cancer death rates is probably a combination of our screening advances, as well as advances in the treatments that we have for different subtypes of breast cancer," Thomas said. "Artificial intelligence is also being investigated and possibly can also increase sensitivity and detection." 

Improving survival rates

In the late 1970s, the five-year relative survival rate for women with invasive breast cancer -- which compares how many patients are alive five years after diagnosis with people of the same age who don't have cancer -- was roughly 75%.

As of 2022, it is above 90%, according to the National Cancer Institute (NCI). The increase reflects major advances in screening and earlier diagnosis.

Where breast cancers are found

Stage at diagnosis remains one of the biggest predictors of outcome. 

Most breast cancers are discovered before they have spread to other parts of the body, according to the NCI. 

About 64% of cases are diagnosed at a localized stage, meaning the cancer has not spread beyond the breast. About 27% have spread to nearby lymph nodes or tissue, and about 6% are diagnosed after the cancer has spread to distant parts of the body. About 2% have an unknown stage. 

"If you feel a lump, if you notice a skin change, if you notice nipple discharge or any change that is different from your normal baseline, that warrants an evaluation by your provider," Thomas said.

Persisting disparities

The burden of breast cancer is not shared equally. 

"Black women are more likely to develop triple-negative breast cancer, which can be a more aggressive subtype, and unfortunately they do have a higher breast cancer mortality rate," Naughton said.

As with many other diseases,  the risk of breast cancer increases with age. The average age at breast cancer diagnosis in women is 63, according to the NCI. 

In men, the ACS reports the average age at diagnosis is between 60 and 70. Although for both women and men, the disease can occur at virtually any age, and diagnosis at a younger age is linked to increased mortality.

"I know that recently some of the guidelines, depending on where you're looking, have changed and may recommend mammograms every one to two years, but I still recommend yearly mammograms starting at age 40 for women at average risk,"  Naughton said. 

Beyond regular screening, experts say being aware of changes in your body is important.

"The most important message is that you shouldn't ignore a change in your breast," Naughton said. 

Dr. Tara Howard is a fourth-year dermatology resident and a member of the ABC News Medical Unit.

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(NEW YORK) -- As cases of dengue fever continue to rise in Florida, public health specialists are worried the true number of infections may be greater.

For the week ending Sept. 19, at least 190 cases of locally acquired dengue have been confirmed in the state, an increase of 38 cases from the week before, according to data from the Florida Department of Health (DOH).

Hillsborough County, which includes Tampa, is reporting the highest number of cases at 170 followed by Miami-Dade, Orange, Palm Beach, Pasco and Pinellas counties, DOH data shows.

"There's evidence of local transmission of dengue in several counties in Florida," Natalie Dean, an associate professor of biostatistics and informatics at Emory University's Rollins School of Public Health, told ABC News. "Dengue is not endemic to the United States. That means that it doesn't typically cause local transmission."

She added, "There can be occasional outbreaks in the U.S. but this one is notable for its size."

Last week, DOH reported the state's first death from dengue fever this year but did not provide any details about the patient including name, age, sex or residence.

Three counties -- Hillsborough, Pasco and Pinellas -- declared local states of emergency last week. These allow local governments to waive normal procedures, access emergency resources and strengthen efforts to control mosquito populations.

Pinellas County crews have been going door to door and spraying areas with high mosquito presence, according to local ABC News affiliate WFTS.

"I don't recall a [period] of time when it's been this high in such a sort of concentrated area before," Cameron Wolfe, an infectious diseases specialist and a professor of medicine at Duke University School of Medicine, told ABC News.

Wolfe said there may be an underestimate of the true number of cases in Florida. Cases of dengue can be mild, and people may recover on their own or never be tested. Because dengue can resemble a flu-like illness, patients may never suspect the source of their infection.

Additionally, he said that reporting of confirmed cases to either local state departments or the CDC can lag.

"For every case that we know, there's going to be a bunch that we never find out about," Wolfe said.

Dean added that people can be infected with dengue multiple times over the course of their life, but it's usually the second or later infection that is more severe, leading to further underreporting.

"I always think of like the top of an iceberg," Dean said. "We're only capturing some of the some of the cases."

The Centers for Disease Control and Prevention (CDC) told ABC News in a statement on Tuesday that the agency is "closely tracking dengue activity" and the "unprecedented" number of cases in the Tampa area.

The CDC also said they've provided $800,000 in emergency funds to help with the response.

"Because the types of mosquitoes that spread dengue, Aedes aegypti, are common throughout many areas of the United States, continued local spread of dengue is possible," the CDC statement said. "The best way to prevent dengue is to protect yourself from mosquito bites by using EPA-registered insect repellant, wearing loose fitting clothes, and controlling mosquitoes in and around your home, such as dumping water."

Some research has shown that climate change could be expanding the geographic range and severity of dengue fever.

Rising global temperature coupled with more rainfall and humidity -- leading to standing water pools that serve as breeding grounds for mosquitoes -- could increase the number of cases.

"Global warming and climate change, in fact, leave places like Florida more wet and more capable of housing these mosquito vectors, so I wouldn't be surprised if this becomes a little more of a perpetual thing," Wolfe said.

ABC News' Youri Benadjaoud contributed to this report.

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(NEW YORK) -- At least 13 new measles cases have been confirmed in Pennsylvania since Friday, bringing the total so far this year to 903, according to Monday's update from the state health department.

Cases have been recorded in 39 of Pennsylvania's 67 counties. At least 176 people have been hospitalized, and four measles-associated deaths have been reported, the Pennsylvania Department of Health (DOH) said.

Two of the deaths were among unvaccinated adults: an 18-year-old and a 40-year-old. The other two deaths were among infants who were too young to have received the measles, mumps, rubella (MMR) vaccine.

Fewer than 1% of the state's cases -- four in total -- are among those who are fully vaccinated with the MMR vaccine, according to DOH.

The majority of cases are among those between ages 25 and 49, followed by those between ages 18 and 24, according to state health department data.

Lancaster County in southeastern Pennsylvania has recorded the highest number of cases at 363 followed by Mifflin County, in the central part of the state, with 105.

At least 11 counties show evidence of community transmission, which is when infectious illness spreads through a local population without any known travel history and the specific source of infection cannot be determined.

DOH data shows staff have administered more than 8,300 doses of the MMR vaccine so far this year. Uptake was highest in August with about 3,500 vaccine doses administered, followed by September with about 2,500 doses administered.

Meanwhile, measles cases in the U.S. have surpassed 3,600 so far in 2026, with cases confirmed in 45 states and Washington, D.C., according to the latest data from the Centers for Disease Control and Prevention.

The CDC has reported one death from measles so far this year but did not say where the death occurred. A note on the agency's website said the number "is subject to change."

The CDC currently recommends that people receive two doses of the MMR vaccine, the first at ages 12 to 15 months and the second between 4 and 6 years old. Infants who are between 6 and 11 months old and traveling outside of the country may require an additional vaccination. One dose is 93% effective in preventing measles infection and two doses are 97% effective, the CDC says.

However, CDC data shows vaccination rates have been lagging in recent years. During the 2025 to 2026 school year, 92.4% of kindergartners received the MMR vaccine, according to data. This is lower than the 95.2% seen in the 2019 to 2020 school year, prior to the COVID-19 pandemic.

"If you've been exposed, it is important to talk to a healthcare professional, but don't go into an urgent care or an ER because you may be inevitably spreading it to other vulnerable people," ABC News medical contributor Dr. Alok Patel told "ABC News Live" on Friday.

"People who have been exposed may be instructed to quarantine or keep really close eye on their symptoms for up to 21 days because that's how long it can really take for measles to show itself and you could potentially spread and infect others without even knowing it," Patel added.

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(NEW YORK) -- Insomnia may be linked to an increased risk of stroke, dementia and several mental health conditions, a new study finds.

Researchers from Austria, Germany, Italy and Switzerland analyzed approximately 20 comprehensive review studies, involving millions of participants across multiple countries, to evaluate the impact of insomnia on health. 

The study, published Sunday in the journal Sleep Medicine Reviews, found that insomnia was linked to a 26% increased risk of stroke.

The results, which looked at multiple other studies also showed individuals with insomnia were more likely to have depression and attempted suicide compared to those without insomnia. 

Insomnia, the most common sleep disorder in the United States, makes it difficult to fall asleep, stay asleep or get good quality sleep, according to the National Institutes of Health (NIH).

Researchers also found that people with insomnia had nearly 30% higher odds of being hospitalized for any number of reasons.  

"Insomnia deserves attention as a warning sign of the status of brain and mental health," Luca Vignatelli, lead study author and senior researcher at the IRCCS Institute of Neurological Sciences in Bologna, Italy, told ABC News. 

Issues with sleep are often overlooked when addressing mental health concerns, experts told ABC News. 

"When you have anxiety or depression, it makes it difficult to fall or stay asleep, or it gives you poor sleep. But then when you don't sleep well, it increases that risk of anxiety and depression," Dr. Thanuja Hamilton, a board-certified sleep medicine physician at Advocare, told ABC News. "When you don't sleep well, you're more irritable, you're more anxious, you're less resilient to stress, and so you're vulnerable to depression and anxiety, and that can make it harder to sleep." 

Researchers also found a connection between insomnia and dementia, particularly Alzheimer's disease. 

Sleep has been shown to play an important role in clearing waste products linked to impaired brain function and Alzheimer's disease from the brain, according to the NIH. 

"When you sleep, that's when your brain takes out the trash," Hamilton said, referring to waste products that can accumulate throughout the day. "If you're not getting good quality sleep or enough of it, then you're going to have an excess buildup, increasing that risk of dementia down the line."

Researchers cautioned that the new findings only show associations and do not prove that insomnia directly causes the health problems examined.

"I would like to emphasize that people should not be frightened by these results. An increased risk at the population level does not mean that an individual with insomnia will develop dementia, depression or have a stroke," Dr. Stefan Seidel, one of the study authors and professor of neurology at the Medical University of Vienna, told ABC News. "Instead, the findings give us another reason to take persistent sleep problems seriously, identify possible underlying causes and provide evidence-based treatment when appropriate."

What can people do to improve their sleep?

Habits like making your bed daily, keeping the room cooler and turning off the lights before bed can help improve your sleep, according to experts. 

One of the most important healthy sleep habits, they say, is maintaining a consistent sleep schedule.

"Our circadian rhythm, our internal clock, it likes consistency," Hamilton said. "If you are inconsistent with your sleep, then you confuse your brain. It doesn't know when to start sleep or when to stop sleep."

To support healthier sleep, turn off distractions such as the TV or your phone approximately 30 to 60 minutes before bedtime and avoid consuming coffee or alcohol late. 

"You go down that rabbit hole when you get on the phone," Hamilton noted. "It might distract you, but it's not relaxing you."

People with insomnia can also become anxious about whether they will be able to fall asleep, potentially making the problem worse.

"The harder you try to sleep when you have insomnia, the harder it is to sleep," Hamilton added. 

Cognitive behavioral therapy (CBT) is often the first treatment option for long-term insomnia. CBT focuses on changing thoughts and behaviors that can interfere with sleep and can include techniques such as adjusting sleep schedules and limiting the amount of time spent awake in bed, according to the NIH. 

"The gold standard of treatment for insomnia is CBT, but it's difficult and it's time-consuming and it's a lot of effort, especially for someone with chronic insomnia," Hamilton said. "But it is worth it."

Experts say sleep should become a more routine part of conversations about overall health. 

"Sleep should be a topic to discuss with your doctor when talking about health, at any age," Vignatelli said. "We need to raise public awareness about insomnia and its treatment and ensure that sleep is included in health promotion programs in our communities, schools, and workplaces."

If you or someone you know is having thoughts of suicide -- free, confidential help is available 24 hours a day, 7 days a week. Call or text the national lifeline at 988. 

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(BOSTON) -- About 4,000 registered nurses at Brigham and Women's Hospital (BWH) in Boston voted "overwhelmingly" on Thursday to authorize an open-ended strike.

The Massachusetts Nurses Association (MNA), which represents the nurses, said this could be the largest open-ended registered nurse (RN) strike in state history.

No strike date has been set yet. Before it occurs, the nurses will be legally required to give 10 days' notice. If the strike is held, it would continue until the nurses reach a contract agreement with the hospital.

Nurses say they are seeking a fair contract that will protect patient care, strengthen the workforce and provide affordable health insurance.

"[Mass General Brigham] cannot tell nurses to choose between the care our patients deserve, affordable health insurance, or fair cost-of-living wage increase," Jim McCarthy, RN, a nurse in the post-anesthesia care unit and vice chair of the BWH MNA Bargaining Committee, said in a statement.

The statement went on, "We have offered to negotiate and work toward an agreement, but CEO Anne Klibanski, who makes $9.2 million a year, and the billionaires on MGB's Board of Directors, have refused to bargain. Our vote gives nurses the power to push back hard if the MGB billionaires keep putting corporate greed over safe patient care."

Among the nurses' proposals are limiting the hospital's use of temporary nurses, fair compensation including a cost-of-living increase and affordable health insurance with plan choice.

In July, BWH nurses held a one-day strike. Since then, the nurses say the hospital has refused to "meaningfully negotiate."

MNA said that the hospital told nurses in August it was not willing to negotiate unless significant changes were made to the latest proposal.

"Brigham nurses have made clear that we are prepared to stay on strike for as long as it takes to win a contract that protects our patients and respects the nurses who care for them," Kelly Morgan, RN, a labor and delivery nurse and chair of the BWH MNA Bargaining Committee, said in a statement.

"An open-ended strike is a serious step that will undoubtedly create a healthcare crisis in Massachusetts. MGB can prevent the strike by returning to the table and negotiating the contract our nurses need to keep providing world-class care," the statement continued.

BWH did not immediately return ABC News' request for comment.

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(WASHINGTON) -- Dr. Heidi Overton is appearing before a Senate committee on Thursday for her confirmation hearing as the next commissioner of the Food and Drug Administration.

Overton was nominated in August by President Donald Trump, who described her in a post on social media as a "ROCKSTAR in my Administration."

She is sitting before the Senate Health, Education, Labor, and Pensions (HELP) committee, where she is likely to face questions about childhood vaccines and the abortion drug mifepristone.

If confirmed, Overton will be the second person to lead the FDA after the previous commissioner, Marty Makary, resigned following public clashes with lawmakers, major pharmaceutical companies and Trump over fruit-flavored vapes.

Kyle Diamantas has served as acting FDA commissioner since May 2026.

Sen. Bill Cassidy, R-La., chair of the HELP committee, began the hearing by asking Overton if the measles, mumps, rubella (MMR) vaccine Is lethal. Overton replied it is not.

When asked if the vaccine is safe and effective, Overton reiterated that the vaccine is safe and effective against measles.

"Are there any vaccines on the U.S. market right now which are unsafe?" Cassidy asked.

"Senator, every vaccine on the U.S. market right now is safe and effective, according to the FDA," Overton said.

Cassidy attempted to press Overton on whether she disagreed with the president on the safety and efficacy of the MMR vaccine, but Overton deflected from answering directly.

Sen. Patty Murray, D-Wa., asked Overton if she believes mifepristone is safe and effective. Kennedy launched an FDA safety review of the drug last year.

"I know that it has met the safety and efficacy standard according to the FDA review," Overton replied.

Murray expressed concern over an article she said Overton published three years ago, which she said described medication abortion as dangerous to women.

She also asked if Overton believed an IUD is an abortifacient, which is a substance used to induce an abortion or terminate a pregnancy. Overton did not answer directly.

"If I'm confirmed as FDA commissioner, I'll be fully briefed on all their prior decisions and make determinations according to the standards of safety and efficacy," Overton said.

She has espoused anti-abortion views and supported reductions to the childhood immunization schedule. At the executive order signing, she touted the use of what she called "gold-standard science" and restoring vaccination authority to parents.

Overton was nominated for the job, in part, because she is a loyalist of the president, two sources familiar with the nomination tell ABC News.

She's been described as a loyal staffer, particularly in the presidents' efforts to overhaul the childhood vaccine schedule, according to a former senior administration official.

"Why would you not want your own loyalist in there?" the source said about Trump's choice, adding "She [Overton] kind of goes along with things." The former official supports Overton but has previously acknowledged that, "She's been in the world of politics for a long time and understands everything's about loyalty."

Overton is a physician with a doctor of medicine degree from the University of New Mexico and also holds a doctorate from Johns Hopkins University.

Prior to her role as deputy assistant to the president for domestic policy, she was vice chair of the America First Policy Institute's (AFPI) Center for a Healthy America, where Overton was also the chief policy officer, a nonprofit that aims to advance policies that it says put the American people first. AFPI was run by Agriculture Secretary Brooke Rollins before Rollins was tapped to join the president's Cabinet.

Several Trump administration officials held positions there before he was reelected, including Education Secretary Linda McMahon.

Prior to the hearing, Cassidy expressed "strong concerns" about Overton's nomination because of her participation in the White House executive order overhauling the childhood vaccine schedule.

"That alone is almost disqualifying," Cassidy wrote in a post on X.

Cassidy, a physician and liver doctor, has long championed the efficacy of vaccines and has grilled Trump's health officials on their willingness to stand up to Health and Human Services Secretary Robert F. Kennedy Jr., including recently installed director of the Centers for Disease Control and Prevention Dr. Erica Schwartz.

In a statement to ABC News, Democratic Women's Caucus Chairwoman Teresa Leger Fernández slammed the nomination.

"I call on my colleagues in the Senate to reject her nomination," Fernández wrote, adding "Overton has publicly denied scientific fact and repeatedly launched conspiratorial attacks against our right to abortion access, the safety of mifepristone, and Planned Parenthood."

Fernández added: "She is not qualified to serve as FDA Commissioner, and her extremist beliefs and loyalty to the Trump administration will put the lives of millions of women at risk."

In a statement, Dr. Amesh Adalja, senior scholar at the Johns Hopkins University Center for Health Security, also criticized her nomination.

"The fact that Dr. Overton played a central role in an executive order that shrinks the childhood vaccine schedule and calls for splitting MMR into shots that don't exist, all without new evidence, calls into question her scientific judgement," Adalja said. "The fact that she has garnered the praise of the nation's chief anti-vaccine propagandist, Secretary Kennedy, is also concerning."

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(NEW YORK) -- Missouri health officials are warning of a possible measles exposure at Busch Stadium and nearby local businesses in St. Louis and the larger county.

The Missouri Department of Health and Senior Services (MDHSS) said the possible exposures occurred between Sept. 12 and Sept. 14 and included local bars, a cafe, a restaurant, a sandwich shop, a grocery store and a convenience store.

The health department said exposed individuals should monitor for measles symptoms for 21 days starting from the date of exposure.

If symptoms appear, individuals are recommended to contact their local public health agency. Additionally, those who think they have measles should isolate themselves and call their healthcare provider before arriving to be tested.

The MDHSS did not immediately respond to an ABC News request for comment on the possible exposures.

Earlier this month, MDHSS announced a possible measles exposure at a train station in Sedalia, Missouri, after a vaccinated individual boarded a Chicago-bound train on Aug. 27.

About a week later, the St. Louis County Department of Public Health said a second individual who boarded the train on Aug. 27 was confirmed to have measles. The second individual was fully vaccinated and is the first case of measles in a county resident in 20 years, according to DPH.

The potential measles exposures at Busch Stadium and the St. Louis region is the third case linked to "train exposure in Missouri," the health department said.

"Vaccination is one of the most effective ways to protect ourselves, our families and our community from measles," Dr. Kanika Cunningham, director of the Saint Louis County Department of Public Health, said in a statement. "We encourage residents to review their vaccination status, monitor for symptoms and contact their healthcare provider before seeking care if they believe they may have been exposed."

Measles cases in the U.S. have surpassed 3,400 so far in 2026 with cases confirmed in 45 states and Washington, D.C., according to the latest data from the Centers for Disease Control and Prevention.

The CDC currently recommends that people receive two doses of the measles, mumps, rubella (MMR) vaccine, the first at ages 12 to 15 months and the second between 4 and 6 years old. One dose is 93% effective against preventing measles infection and two doses are 97% effective, the CDC says.

However, CDC data shows vaccination rates have been lagging in recent years. During the 2025 to 2026 school year, 92.4% of kindergartners received the MMR vaccine, according to data. This is lower than the 95.2% seen in the 2019 to 2020 school year, prior to the COVID-19 pandemic.

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(NEW YORK) -- Eating more ultra-processed foods is linked to higher health risks, including death, according to a new study published in Family Medicine and Community Health. 

Researchers found that consuming higher amounts of ultra-processed foods increased the risk of heart disease, strokes, obesity, diabetes, depression and anxiety, digestive issues, and cancer. 

Ultra-processed foods contain “significant amounts of added sugars, salts, fats” and can be hyper-palatable, meaning they are engineered to taste especially appealing, Maya Feller, a registered dietitian, told ABC News. 

Examples include packaged snacks, processed meat products, cookies, cakes, sugary drinks, and many ready-to-eat meals. 

“Ultra-processed food is one of the major problems in public health,” Dr. Xiao Liu, lead author of the study, a physician at Sun Yat-Sen Memorial Hospital and research fellow at Duke-NUS Medical School, told ABC News.

In the study, researchers examined the intake of ultra-processed foods globally, by reviewing over 50 studies that evaluated the diets of nearly 9 million adults worldwide over a timeframe ranging from 2 to 32 years. 

The risk of cardiovascular disease, which is the leading cause of death in the United States, was found to increase by 24% after consuming higher amounts of ultra-processed foods. 

The more people ate ultra-processed foods, the higher their risk of poor health outcomes. Each additional 100 grams a day was linked to a 14% higher heart risk and an 11% higher blood pressure risk. 

Higher consumption of ultra-processed foods was also linked to a higher risk of metabolic diseases, with the risk of diabetes increasing 24% and the risk of obesity increasing 23%.

More than 100 million Americans in the United States are living with obesity and more than 22 million have severe obesity, according to numbers from the CDC. The agency also found that the average American gets over half their daily calories from ultra-processed foods. 

Not all processed foods are the same,  Feller said, using an apple to explain the difference.

“You have a tree with apples, and the apples on the tree are in their whole form. You take the apple off the tree, and that is a step of processing. You slice the apple. That’s another step of processing. You puree the apple. You haven’t added anything to it. That’s also processing,” she said.

As more ingredients are added, the food becomes more processed, she explained.

Canned vegetables, cheese, and freshly made bread are considered processed because salt, sugar, or oil may have been added to preserve them. Unprocessed or minimally processed foods can include fresh or frozen fruits and vegetables, eggs, milk, beans, grains, meat, and fish that do not have salt, sugar, oils or additives.  

When shopping, Feller said consumers can look at ingredient lists to get a better sense of how processed a food is.

“Flip the package over, and if the front says blueberries, then the ingredient list should say blueberries,” she said.

For people trying to limit ultra-processed foods without significantly increasing their grocery bills, frozen and canned foods can still be useful options.

“Go to the freezer section. Look for frozen vegetables, frozen fruits, frozen grains that have nothing added to them,” Feller added. 

She also recommended lower-sodium canned foods and affordable staples such as pasta, rice and beans.

For parents trying to help children make healthier choices, Feller noted that strict control may be less realistic than education and modeling healthy habits at home.

“We can’t control what they do when they have at lunch,” she said. “Once they’ve left the house, it’s about education, positive modeling and open conversation.”

She added that family meals give parents more control over the foods children are exposed to at home, while conversations about nutrition can help guide the choices they make on their own.

Feller says that people do not need to eliminate all ultra-processed foods from their diets. Instead, the research points to the potential benefits of reducing overall intake as a more reachable goal.

“Don’t expect that you’re going to swap your pantry over or your refrigerator overnight,” Feller said. “Choose two or three things that you eat on a regular basis that are ultra-processed and think about swapping those out for things in their whole or minimally processed form.” 

The researchers noted that people can lower their risk of these health conditions by improving their diets, which include limiting ultra-processed foods and eating more vegetables and fruits. 

“In our modern society, our diet and food is maybe not safe… we should eat more vegetables and reduce the ultra-processed food to make us healthier,” said Liu. 

Dr. Ashley Thomas is board-certified in internal medicine, board-eligible in occupational and environmental medicine, and a member of the ABC News Medical Unit.

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(NEW YORK) -- Los Angeles County is seeing the highest number of West Nile virus cases in nearly a decade, health officials said Monday.

The county has reported 100 cases so far this year. This is the highest figure since 2017 when 268 cases were recorded for the entire season. 

The number of current cases is also greater than the five-year average during the same period, according to the Los Angeles County Department of Public Health (LA County DPH).

So far, 94 people have been hospitalized and five people have died, the health department said.

Of the 100 cases, 96 were symptomatic with the most recent onset of illness occurring on Sept. 4, according to LA County DPH.

The health department said that one-third of infected patients live in the East Los Angeles area, about a quarter live in the San Fernando Valley area and about a fifth live in the South Bay region.

It comes as the California Department of Public Health is reporting the highest levels of West Nile virus activity in five years, local health officials said.

So far, the U.S. has seen 671 cases this year across 42 states, according to data from the Centers for Disease Control and Prevention.

The true number of infections is likely higher because cases typically peak in August and September and reporting is delayed.

Public health officials have been warning that rising temperatures have allowed mosquitoes to thrive, increasing the risk of the diseases they spread, including West Nile.

West Nile virus is the leading cause of mosquito-borne disease in the continental U.S., according to the CDC.

Mosquitoes typically become infected with the virus after feeding on infected birds and then spread it to humans and other animals, the federal health agency said.

Risk increases with older age; certain medical conditions such as cancer, high blood pressure and kidney disease; and a weakened immune system. 

Most people infected are believed to have lifelong immunity but those with certain conditions may have their immunity wane over time. 

Symptoms include fever, headache, body aches, vomiting, diarrhea or rash. Most symptoms disappear, but weakness and fatigue may last for weeks or months.

About one in 150 patients will develop severe disease leading to encephalitis (inflammation of the brain) or meningitis, inflammation of the membranes that surround the brain and spinal cord. Both can lead to death, the CDC says.

Each year, about 2,000 people in the U.S. are diagnosed with West Nile virus, but the CDC says this is likely an undercount because most people either don't develop symptoms or believe their mild symptoms were caused by another illness.

More than 1,300 people develop severe illness affecting the central nervous system, the CDC says.

There are no licensed vaccines or medications that protect against the virus. The CDC recomemnds using insect repellant, wearing long-sleeve shirts and pants, treating clothing and gear and taking steps to control mosquitoes. The last step includes putting screens on windows and doors, using air conditioning and emptying out containers with still water.

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Dozens of Americans have filed personal injury lawsuits against the makers of popular GLP-1 drugs, like Ozempic, Wegovy and Mounjaro, claiming they were not properly warned of the risk of a rare type of sudden vision loss, called nonarteritic anterior ischemic optic neuropathy, or NAION, when taking the medications.

Researchers have been studying a possible link between GLP-1 drugs and this eye condition in recent years after a possible safety signal was reported from a single health center in Boston in 2024, but so far, no study has proven these drugs are the cause.

Novo Nordisk, the maker of Ozempic and Wegovy, said they take “all reports of adverse events very seriously,” and pushed back against these claims, stating, “Novo believes the personal injury lawsuits filed in the U.S. are without merit and are vigorously defending them,” a spokesperson told ABC News.

Adding, "Novo is committed to patient safety and continuously monitors the safety profile of our GLP-1 RA products. Should emerging safety data warrant further action, appropriate measures will be implemented in accordance with regulatory requirements.”

A spokesperson for Lilly, who manufactures Zepbound and Mounjaro, told ABC News, “Patientsafety is Lilly’s top priority. We actively monitor, evaluate, and report safety information for all our medicines to the FDA. As part of our routine safety review process, we have ongoing discussions with regulators regarding potential safety topics, and we will continue to review data, including any data regarding ophthalmic issues."

Here’s what GLP-1 users should know about this condition and what the science says.

What is NAION?

Although a rare condition overall, Dr. John Chen, a professor of ophthalmology and neurology at Mayo Clinic, said, "NAION is the most common acute optic neuropathy in patients over the age of 50. It's essentially a lack of blood flow to the optic nerve, where patients typically have pretty acute onset of painless vision loss.”

That vision loss is usually permanent, and there is no specific treatment for the condition at this time, Chen told ABC News.

Dr. Raj Maturi, clinical spokesperson for the American Academy of Ophthalmology and ophthalmologist at Midwest Eye Institute, told ABC News that people with diabetes, regardless of GLP-1 use, can be at increased risk of developing this condition, and other risks include overnight low blood pressure or a very small optic nerve cup.

Vision problems are listed as possible side effects of these medications, but the Food and Drug Administration does not currently require the drug makers to list NAION as a specific risk.

The agency’s Sentinel Initiative does say a review is ongoing that aims to scientifically evaluate the possible safety signal related to GLP-1 drugs and NAION that is still in progress.

In a statement provided to ABC News, a spokesperson for the FDA said, "The FDA routinely monitors the safety of drug products postmarketing. The FDA identifies safety signals from a variety of sources, evaluates the available data and takes regulatory actions when appropriate.”

Other countries have required the drug makers to include a warning that there may be a possible increased risk of developing NAION if taking some of these medications based on their review of available evidence, including the European Medicines Agency and Australia’s Therapeutic Goods Administration, both citing it as a rare possible side effect.

In general, safety signals don’t alwayspan out as true risks for all medications and not every possible side effect is caused directly by the medication itself.

Drugs that are FDA-approved undergo rigorous clinical trials, are heavily scrutinized before reaching the market, and post-marketing safety is continuously monitored.

What does the science say?

“Several studies suggest that there is a potential link between NAION, or eye stroke, and GLP-1 use,” Maturi said. “However it is important to note that causation has not been proven. And the risk does seem to be rare,” Maturi said.

In 2024, researchers at a single health system in Boston published data that suggested people with type 2 diabetes who were prescribed semaglutide, a GLP-1 receptor agonist and the active ingredient in Ozempic and Wegovy, may be at increased risk of developing this type of vision loss.

Since then, more research has been done with larger studies that have shown mixed results as to whether a link does exist, and no study to date has proven that these medications cause this eye condition.

"There are significant benefits from the GLP-1’s for severe obesity, diabetes, cardiovascular disease. That's proven time and time again with these randomized clinical trials,” Chen said. “We didn't have to pull the plug on those trials because people were going blind. So again, if there is an association, it's a very low risk."

The European Medicines Agency estimates this eye condition could possibly impact 1 out of every 10,000 GLP-1 users who have diabetes, based on their analysis of available information.

In a joint statement, the North American Neuro-Ophthalmology Society and the American Academy of Ophthalmology said, "While many report a small possible increased risk of NAION in patients taking GLP-1 RAs such as semaglutide, some studies report no correlation, and the overall magnitude of the risk of NAION remains low.”

Maturi and Chen both said that the data isn’t conclusive so far and more research is needed to understand if GLP-1 drugs have a true role in developing NAION.

What should GLP-1 users do?

Doctors recommend that people always discuss any potential side effects of a medication with their own doctor and warn that there are proven health risks, including eye problems, if diabetes and obesity go untreated.

"For any patients already taking semaglutide who have not experienced any symptoms, they should continue to do so as instructed and discuss any questions or concerns with their primary care physician,” Maturi said.

Chen said he doesn’t believe this potential risk should prevent most people from using GLP-1 medications if they are recommended by a doctor to help treat an underlying health condition but cautions that people who have experienced NAION in one eye already may need to weigh the possible risks more closely with their doctor.

"We're not sure if the GLP-1 is connected or not. We know this helps with diabetes, heart disease, and severe obesity,” Chen said. "We essentially don't want you to stop your meds without talking to your doctor, and if you do have sudden painless vision loss, you should be seen by an eye doctor.”

Jade A. Cobern, MD, MPH, is a practicing physician, board-certified in pediatrics and general preventive medicine, and is a fellow of the ABC News Medical Unit. ABC News’ Elizabeth Schulze also contributed to this reporting. 

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(NEW YORK) -- The Florida Department of Health confirmed the state's first death from dengue fever this year as cases of the mosquito-borne illness continue to rise.

The department did not provide any details about the patient including name, age, sex or residence.

The Tampa Bay Times, which first reported the death, described the patient as an 80-year-old Tampa woman who died on Sept. 4.

The FDOH did not immediately return ABC News' request for comment.

For the week ending Sept. 12, Florida has confirmed 152 locally acquired cases of dengue, according to data from the state health department.

This is the highest number recorded since 2023, when the state saw 189 locally acquired cases over the course of the year, data from the Centers for Disease Control and Prevention shows.

Hillsborough County -- which includes Tampa -- has reported the most cases so far this year with 134, according to the FDOH. Other counties with confirmed cases include Miami-Dade, Orange, Palm Beach, Pasco and Pinellas.

Dengue viruses are spread through bites from infected Aedes species mosquitoes, mostly found in tropical and subtropical regions, according to the CDC. These mosquitoes are also responsible for spreading Zika and chikungunya viruses.

Dengue can be caused by dengue virus strains 1, 2, 3 or 4. A person also can be infected with dengue multiple times over the course of their life.

About one in four people who contract dengue develop symptoms which typically last two to seven days and are usually mild. This may include fever, rash, nausea, vomiting, muscle pain, joint pain and bone pain.

About one in 20 infected people will develop severe dengue, which can lead to shock, internal bleeding and, in some cases, death, the CDC said.

There are no disease-specific treatments for dengue. The CDC recommends rest, fluids and over-the-counter medications to relieve symptoms. Patients with severe illness often need to be hospitalized and receive additional supportive treatments, such as intravenous fluids.

The CDC warns patients not to take aspirin or ibuprofen; it can trigger inflammation or bleeding of the stomach lining.

Currently, there is no dengue vaccine available in the U.S. In 2021, the U.S. Food and Drug Administration approved a vaccine for children between ages 9 and 16 who have a laboratory-confirmed previous dengue virus infection and live in areas where dengue is endemic, but it has since been discontinued.

Methods to help prevent dengue infection include using effective mosquito repellents, wearing long-sleeve shirts and long pants when outside and staying in places with air conditioning when possible. The CDC also recommends emptying containers of still or stagnant water to eliminate places where mosquitos can breed.

ABC News' Youri Benadjaoud contributed to this report.

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(NEW YORK) -- Philadelphia is facing a second possible measles exposure, the city's Department of Public Health warned over the weekend.

Health officials said an individual with measles passed through Philadelphia International Airport and that the case is not connected to the recent exposure that occurred at Children's Hospital of Philadelphia (CHOP).

The Philadelphia Department of Public Health said the exposure occurred in Terminals B and F, as well as areas used to connect to other terminals in C, D and E from 7:25 p.m. ET on Sept. 13 to 12:05 a.m. ET on Sept. 14.

The individual was passing through the airport and did not leave the premises, according to the health department.

"This week's measles exposures are a reminder of how important it is for all of us to be up to date on our vaccinations," Dr. Palak Raval-Nelson, health commissioner for the Philadelphia Department of Public Health, said in a statement. "Every Philadelphian who is fully vaccinated has little to fear from the situation at CHOP and the airport. Even more importantly, every one of those people is doing their part to help protect our most vulnerable from measles."

The exposures come as the number of measles cases continues to rise across Pennsylvania. As of Friday, 767 cases have been recorded so far this year, according to the state Department of Health.

There have been 150 hospitalizations so far and four measles-associated deaths, state health department data shows.

The last time the U.S. reported four measles deaths was in 1992. Last year, Texas reported two deaths and New Mexico reported one.

In the U.S., measles cases have surpassed 3,000 so far in 2026 with cases confirmed in 45 states and Washington, D.C., according to the Centers for Disease Control and Prevention.

The CDC currently recommends that people receive two doses of the measles, mumps, rubella (MMR) vaccine, the first at ages 12 to 15 months and the second between 4 and 6 years old. One dose is 93% effective, and two doses are 97% effective against measles, the CDC says.

However, CDC data shows vaccination rates have been lagging in recent years. During the 2025 to 2026 school year, 92.4% of kindergartners received the MMR vaccine, according to data. This is lower than the 95.2% seen in the 2019 to 2020 school year, prior to the COVID-19 pandemic.

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(NEW YORK) -- Health and Human Services Secretary Robert F. Kennedy Jr. told the vaccine-skeptic group Children's Health Defense on Thursday they have "a friend in the White House" in President Donald Trump.

Kennedy delivered the keynote address in Washington, D.C., at a conference hosted by the group, noting that Trump has given directives to strengthen research, transparency and parental choice around childhood vaccines.

"Let me be clear. You have a strong and steadfast friend at the White House," Kennedy said.

Kennedy also said he wanted to make more sweeping changes on "day one" but couldn't do so due to "procedures."

"In government, a bunch of things have to happen before something else happens or you get sued," he said. "It's a very laborious system and there's a lot of inertia built in that ... if we were able to overcome it we would have changed things on day one, but those would have been short-lived and I would have been out of a job because I have to manage my agency competently according to the law and according to procedures."

Children's Health Defense, which advocates against the recommended vaccine schedule for children, was co-founded by Kennedy. He resigned from the board ahead of his confirmation as HHS Secretary.

The group described the conference as a "timely conversation [that] will take place against a backdrop of unprecedented opportunity and risk for the health freedom movement."

Also scheduled to appear were Republican Sens. Ron Johnson of Wisconsin and Rand Paul of Kentucky, as well as Republican Reps. Paul Gosar of Arizona and Thomas Massie of Kentucky.

Dr. Fiona Havers, an infectious diseases physician and a former leading vaccine expert at the CDC, said the Children's Health Defense (CHD) has spread false and misleading information "that has contributed directly to declining vaccination rates across the country."

"Americans are now tragically experiencing the direct consequences of this, with more than 3,000 measles cases this year and four measles-related deaths reported in just the last few weeks," Havers told ABC News in a statement. "By speaking at CHD's conference, RFK Jr. is using his position as the U.S. government's top public health official in a way that legitimizes CHD's anti-vaccine message and undercuts efforts by CDC, state health agencies, clinicians and others to get these outbreaks under control."

The HHS did not immediately return ABC News' request for comment.

Kennedy said that Trump asked him to "vigorously investigate the potential contribution of childhood vaccines to the chronic disease epidemic."

Kennedy claimed that children went from receiving three vaccines when he was a child to 94 doses of 18 vaccines currently. Doctors have previously told ABC News that excluding annual flu and COVID-19 shots, children generally receive roughly 30 vaccine doses -- many in combined injections -- before the age of 18

"The question is ... should we be looking at the potential that some of these chronic illnesses are associated with vaccines?" Kennedy said.

"As you can see, many of these adverse events [from vaccines] include diseases, chronic illnesses that are part of the chronic disease epidemic," Kennedy said later in his speech. "In other words, illnesses that became suddenly epidemic in our kids after 1989."

The year 1989 was also when the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics and the American Academy of Family Physicians recommended children receive a second measles, mumps, rubella (MMR) dose, although Kennedy did not mention that specific vaccine.

Extensive scientific research has shown no causal link between the MMR vaccine and the development of chronic diseases.

During his confirmation hearings in 2025, Kennedy said he wouldn't prevent access to vaccines, saying that he supports vaccines. Since then, he's also said he believes the choice should be left up to parents.

Last year, Kennedy dismissed all 17 members of the ACIP and appointed his own hand-selected members.

The committee then voted to remove the universal recommendation for the hepatitis B shot at birth and to narrow existing recommendations for the combined MMRV shot that protects against measles, mumps, rubella and chickenpox.

The group also voted against recommending flu vaccines containing the preservative thimerosal, a mercury-based preservative, which is used to prevent microbial contamination of vaccines. Most flu vaccines currently used in the U.S. contain little to no thimerosal, but both the Food and Drug Administration and the CDC say there is no evidence that low doses of thimerosal in vaccines cause harm other than minor reactions at the injection site, such as redness or swelling.

Additionally, at the beginning of this year, Kennedy made changes to the childhood vaccine schedule, reducing the number of recommended shots from 17 to 11. 

In March, a federal Massachusetts judge blocked changes to the vaccine schedule, suspended the appointments of the 13 members of the CDC's vaccine advisory committee and stayed all votes taken by the Kennedy-nominated members.

Kennedy said during his speech that he would not comment on the judge's ruling because the case remains in litigation.

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(NEW YORK) -- The North Carolina teenager who died after contracting a rare brain-eating amoeba called Naegleria fowleri was likely infected from a water feature at a community center, according to state and local officials.

Naegleria fowleri, also known as primary amebic meningoencephalitis or PAM, has been found in warm freshwater, including ponds, lakes and rivers, and it grows best in hotter water, according to the North Carolina Department of Health and Human Services.

"The amoeba does not cause illness if swallowed but can be fatal if water with the amoeba in it is forced up the nose into the brain," NCDHHS said.

The North Carolina teenager was admitted to the hospital on Aug. 22 and died on Aug. 31, officials said. NCDHHS said at the time that it was working with federal and local partners to investigate all possible sources of the infection.

A report released Tuesday by NCDHHS found the teen was most likely infected by a water feature at a community center in Durham County, county officials said.

Investigators determined that on Aug. 13, the teen had contact -- including splashing water on their face -- with a water feature in the garden of a community-based mental health care center, according to the NCDHHS report.

"No other potential sources of exposure were identified," the report said.

The mental health care center said in a statement, "Our hearts are broken for the young boy who lost his life and for his family. We are committed to supporting his family and our community through this devastating loss. We will continue to fully cooperate with public health officials."

The county said the water feature has been closed since Aug. 28, when testing for Naegleria fowleri began.

The U.S. usually sees fewer than 10 cases of Naegleria fowleri infection each year. NCDHHS said the first symptoms can be severe headache, nausea, vomiting and fever, and later symptoms include stiff neck, seizures and coma. NCDHHS said, "once symptoms start, the disease progresses rapidly and usually causes death within about five days."

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(NEW YORK) -- The family of a pregnant woman who died sued Texas Attorney General Ken Paxton on Tuesday, claiming she was denied an abortion that could have saved her life.

Tierra Walker, a 37-year-old from San Antonio, died in December 2024 when she was 20 weeks pregnant. She had been diagnosed with pre-eclampsia at the time, according to the family.

Walker's family alleges that she and family members asked for an abortion as they say she reportedly faced seizures and blood clots. The family claims that doctors refused to treat her.

The lawsuit also names the executive director of the Texas Medical Board, the University of Texas at San Antonio Health Science Center, Bexar County Hospital District, individual doctors and Joe Gonzales, the district attorney for Bexar County. Additionally, the suit alleges that Texas' abortion ban is unconstitutional.

Abortion is banned in Texas with very limited exceptions and criminal and civil penalties for providers.

The lawsuit was filed by Amplify Legal, the litigation arm of the nonprofit Abortion in America, and the Marynell Maloney Law Firm.

"Tierra Walker was a wife, mother, and the glue that held together her extended family," Molly Duane, the litigation director of Amplify Legal, said during a press conference on Wednesday. "Throughout the four months of her pregnancy, Tierra and her family repeatedly asked for an abortion. Yet, none of her medical providers came forward to say what everyone knew to be true-that this pregnancy was going to kill her."

Duane continued, "Tierra Walker is proof that there is no exception because if she did not qualify, if even her doctors were too scared to act, then the medical emergency exception is nothing more than words on a page. And I just have to say that I've been doing this work in Texas for many years, and reading Tierra's medical records is one of the hardest things I've ever had to do."

Duane said the plaintiffs are seeking financial compensation for the Walker family and a legal change in the context of the constitutional allegation made.

The complaint, filed in Bexar County, alleges that Walker struggled with chronic health issues, including obesity, uncontrolled high blood pressure, a seizure disorder, Type 2 diabetes with hyperglycemia, asthma so severe she had required intubation and complicated prior pregnancies.

According to the complaint, Walker's health was improving by mid-2024. However, her family says she suffered multiple seizures for the first time in nearly a year in September 2024 and was rushed to the hospital.

At University Hospital in San Antonio, Walker learned she was nearly six weeks pregnant and suffering from elevated blood pressure, according to the complaint.

During the hospitalization, Walker allegedly suffered more seizures and reported being in "significant pain," according to the complaint. She was sent home with a blood glucose monitor and instructions to follow up pre-natal care, the lawsuit alleges.

In late October, at 11 weeks pregnant, Walker went to Kenwood Women's Health Clinic with high blood pressure and a "severe" blood clot in her left leg, the lawsuit alleges. She was transported to the hospital's main emergency room, according to the complaint.

"Ms. Walker and her family members told hospital staff and the UTHSCSA doctors that the pregnancy was going to cost Ms. Walker her life, and asked if she could terminate the pregnancy," the lawsuit alleges. "Despite the clear risk to her life in continuing the pregnancy, none of University Health's staff counseled Ms. Walker on the possibility of abortion as a life-saving medical treatment, offered her this treatment, or suggested that she leave the state. Instead, hospital staff kept insisting 'nothing is wrong with the baby' and continued to refuse the care that she needed on that basis."

According to the complaint, Walker received a thrombectomy to remove the clot but her symptoms, including seizures, nausea, headaches, asthma and high blood pressure, persisted.

Two days after being discharged, Walker returned to the emergency room, reporting abdominal pain and vomiting, the complaint alleges. She was given anti-nausea medication and sent home, according to the complaint.

Between Nov. 7 and Dec. 27, she attended regular prenatal appointments but did not receive more than an ultrasound examination and education about her various health conditions, the complaint states.

Walker was diagnosed on Dec. 27 with pre-eclampsia at the University Health emergency room, according to the complaint. Her health deteriorated rapidly and, after being discharged, she was found unresponsive at home by her teenage son on Dec. 30, according to the complaint.

"It's horrible that she's gone and she was taken from us this way," LaTanya Walker, Tierra Walker's aunt and lead plaintiff, said during Wednesday's press conference. "It' horrible that she's not here anymore. It's horrible that we can't have holidays."

ABC News could not independently verify the medical claims included in the lawsuit.

ABC News has reached out to Paxton's office, the Texas Medical Board, and Gonzales' office for comment. It's unclear if the individual doctors have legal representation.

A spokesperson for the University of Texas at San Antonio Health Science Center told ABC News, "We don’t have any information to offer at this time."

In a statement to ABC News, University Health said it "cannot comment on or disclose information about any individual patient's care without appropriate authorization. We are also unable to comment on matters related to potential or ongoing litigation."

The statement continued, "In general, our clinicians make patient care decisions based on each patient's clinical condition, applicable medical standards and legal requirements. We take concerns about patient care seriously and review them through appropriate internal clinical and quality processes."

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(NEW YORK) -- Prior to this year, Dr. John Goldman said he'd only seen two cases of measles throughout his career: one in the late 1980s and one in the early 1990s.

Now, Goldman said measles patients are being admitted to the hospital on a regular basis.

"We've had patients that have shown up in our outpatient offices. We've had patients show up in the hospital. We've had patients that have come in for other problems and then develop measles while they're in the hospital," Goldman, an infectious disease specialist for the University of Pittsburgh Medical Center in central Pennsylvania, told ABC News.

He went on, "So, we've gone from seeing this as an extremely rare disease, one that I literally have not seen in 30 years, to something that is now common, where we're seeing it literally every day."

Pennsylvania is facing one of its worst measles outbreaks in recent years, recording 693 cases so far this year with 133 hospitalizations, according to the state department of health.

The epicenter of the outbreak is in Lancaster County, in southeastern Pennsylvania, with 296 cases reported.

At least four measles deaths have been confirmed by the Pennsylvania Department of Health, which is the highest number of deaths recorded in the U.S. since 1992.

'Almost certainly underestimating cases'

Goldman, who supports about seven hospitals in the greater Harrisburg area, said UPMC Lititz in Lancaster County has had about 50 measles patients this year.

However, he believes the number of cases, both in Lancaster County and in Pennsylvania overall, is an undercount.

"The worst part is we're almost certainly underestimating the cases," Goldman said. "What often happens is someone shows up in the emergency room or shows up in the hospital, and they'll report that they have five or six people at home who were sick with what they think is measles ... so we don't test everybody."

Dr. Patrick Gavigan, a pediatric infectious disease physician at Penn State Health Golisano Children's Hospital in Dauphin County, which borders epicenter Lancaster County, said about 10 children have been admitted to the hospital with complications from measles in 2026.

Similarly, Gavigan said most of the children admitted to the hospital with measles came from families where everyone was previously sick with the disease.

"I would say fever, rash and respiratory distress are probably the most common [symptoms]," he told ABC News. "We've seen some more like gastrointestinal symptoms with some of our cases as well, including like hepatitis."

Most of the children are unvaccinated and have come from communities that "don't vaccinate," Gavigan said.

He added that hospitals are getting more calls each week about patients infected with measles.

Increasing interest in vaccination

The CDC currently recommends two doses of the measles, mumps, rubella (MMR) vaccine, the first between ages 12 and 15 months and the second between ages 4 and 6. One dose is 93% effective, and two doses are 97% effective against measles, the CDC says.

Data from the Pennsylvania Department of Health shows that 6,725 MMR doses have been administered by health department staff in 2026. Fewer than 1,000 doses were administered each month from January through July but August saw about 3,500 doses administered.

This correlates with a spike in measles cases recorded in August, according to health department data.

The doctors told ABC News there has been an increase in MMR vaccinations at their respective hospitals.

"Talking with our general pediatricians, I think there has been [an] increased desire to get MMR even potentially in some people who aren't getting other vaccines," said Gavigan.

Gavigan said pediatricians in the area have also been answering questions from parents about whether their child should get an early third dose.

The CDC said early vaccination for infants living in outbreak areas. This would result in three doses overall: an early dose between age 6 months and 11 months and then the two regularly scheduled doses.

"I think there is definitely more of a perceived threat based on people hearing about all the cases and hearing about cases nearby and potentially even getting letters that they've been exposed to measles when they've been at the hospital or various places," Gavigan said.

Local communities have also been offering opportunities to get vaccinated.

In Chester County, which also borders Lancaster and 65 confirmed measles cases, the county government has hosted free MMR clinics for children and adults, some in conjunction with the state health department.

Jeanne Franklin, public health director of the Chester County Health Department, told ABC News that local health care professionals have gone into people's homes or businesses to vaccinate them with the MMR shot.

"We basically just said, 'We've got to do some at-home vaccinations,'" Franklin explained. "It's not an everyday type of service ... but we're doing it now and that has been a huge success."

And some individuals say they're more comfortable receiving the vaccine at home, she noted.

As of Monday, the Chester County Public Health Department has administered 538 MMR doses, according to Franklin.

The ChildProtect program at Penn Medicine Lancaster General Health has continued to provide free vaccinations for uninsured children in Lancaster County usually at in remote, rural areas.

Goldman said he and colleagues have seen an increase in people visiting UPMC hospitals and clinics for the MMR vaccine, particularly since the measles outbreak began.

Some UPMC staff have partnered with healthcare providers in communities with lower vaccination rates and have offered the vaccine in those areas, Goldman said.

Goldman said he's heard anecdotally about cases of "semi-clandestine vaccination," meaning people receiving the MMR vaccine without telling their friends, family or neighbors.

"Neighbors might judge them, or they're in communities which discourage vaccination, and so they sometimes don't want to know, let their friends or neighbors know that they've been vaccinated," Goldman said.

More 'aggressive' screening

Goldman said UPMC hospitals and clinics are beginning to more aggressively screen people who arrive with measles-like symptoms so other patients aren't exposed.

This includes patients with symptoms including rash, fever, cough and conjunctivitis, also known as pink eye.

"The problem is that there are some people who will just have a fever and we later find they test positive for measles," Goldman said. "It will surprise me if we can catch every case."

avigan said Golisano Children's Hospital has put signage outside the hospital to increase awareness that there's a measles outbreak in the hopes of identifying potentially infected patients.

"It's essentially a sign that lists common symptoms, asks if you've been exposed and, if you have, to call into the hospital where they could triage you over the phone so that you're not sitting in a waiting area potentially spreading measles," Gavigan said.

Penn Medicine said signs are displayed outside hospitals and some outpatient offices requesting certain individuals to call for guidance before entering, including those who are not vaccinated or have measles symptoms.

Spreading awareness

Penn Medicine said two pediatricians in its Lancaster facilities wrote a series of op-eds for their local newspaper explaining how vaccine-preventable diseases can be dangerous and how vaccines protect both the recipient and those around them.

The two pediatricians said some of the patients have brought printed copies of the articles to discuss at appointments.

Gavigan said he occasionally meets children in clinic who are unvaccinated -- not just against measles -- and he using this as an opportunity to talk about the importance of vaccination.

"We've had lots of, I think, different conversations about the MMR vaccine in different populations," he said. "It does seem like there has been, at least anecdotally, more willingness to think about vaccines in general and MMR."

Franklin, from Chester County, said members of the public health department have gone into various communities to meet residents and assess where they are in terms of their knowledge on the disease or vaccination.

"If they think they want the vaccine, then we're focusing on the vaccine," Franklin said. "If nobody has talked to these folks, then, we're going to start at the beginning: 'What is measles? What does it look like? How does it impact you, et cetera?' And then we'll get to the vaccine."

She added, "If we're not hitting the right avenues and meeting them where they are at the start, they're not hearing it, and it's no fault of their own. So we meet them where they're at in their understanding."

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(NEW YORK) -- Pennsylvania health officials confirmed two additional measles-associated deaths in the state on Tuesday, bringing the total number of deaths in 2026 to four.

Both of the individuals were unvaccinated, according to the Pennsylvania Department of Health.

The Corner of Mifflin County said in a statement Tuesday that one of the deaths was a was an 18-year-old who died from “complications of measles.”

The coroner said they died from acute disseminated encephalomyelitis (ADEM), which is a rare and severe complication of the measles virus and includes brain inflammation and swelling.  

On Sunday, the Jefferson County Coroner's Office confirmed the other of the two deaths was a 40-year-old woman who died the day prior.

As of Tuesday, the Pennsylvania Department of Health has reported 693 measles cases in the state, in 38 counties. Of the cases, 124 have been hospitalized, and nearly all cases are among those unvaccinated against the virus, according to data from the health department.

The last time the U.S. reported four measles deaths was in 1992. Last year, Texas reported two deaths and New Mexico reported one. 

“My thoughts are with the two families who lost loved ones to this highly-contagious virus, as Pennsylvania faces the worst measles outbreak in more than three decades,” Pennsylvania's Secretary of Health Dr. Debra Bogen said in a statement.

“We remain committed to working with our partners across Pennsylvania to stem this outbreak and prevent more deaths. That means ensuring people have the facts about measles and access to the MMR vaccine – which kept measles outbreaks at bay for decades,” Bogen added.

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(WASHINGTON) -- The Centers for Disease Control and Prevention announced Friday that the cyclospora outbreak that plagued thousands of people across the country during the summer months has ended.

The outbreak, which was eventually tied to iceberg lettuce distributed by Taylor Farms, sickened almost 13,000 people in 21 states. Two people died and at least 570 people were hospitalized due to cyclospora illness.

The FDA announced in July that it was investigating cyclospora illnesses linked to shredded iceberg lettuce served at Taco Bell locations in Indiana, Kentucky, Michigan, Ohio and West Virginia after several cases of cyclospora had been reported in late June.

The CDC said Friday more than 1,000 cases were reported in a single day at the height of the outbreak, before the contaminated lettuce was recalled by Taylor Farms on July 17. The illness notably made headlines for causing “explosive diarrhea.”

Citing a decline in infections linked to the outbreak — fewer than two per day in August — and all contaminated Taylor Farms products being taken out of circulation, the CDC said it considers this specific outbreak over. It notes the best-by dates for all products linked to the outbreak have passed and are no longer available in stores or restaurants.

The FDA will continue to investigate the cause of the contamination, which has not yet been identified.

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