Amoeba Infection in America 2026
Few pathogens command as much fear per case as the brain-eating amoeba — Naegleria fowleri — a microscopic organism that turns warm freshwater into a potential death sentence. As of 2026, the Centers for Disease Control and Prevention (CDC) confirms that 167 cases of primary amebic meningoencephalitis (PAM) have been reported in the United States between 1962 and 2024, with only four people surviving across that entire six-decade span. While those raw numbers may seem small, the trajectory of amoeba infections in the US is shifting in ways that demand serious attention: confirmed cases are now appearing in northern states historically considered too cold to support the organism, environmental detections are rising in water systems beyond natural lakes, and climate science increasingly points to conditions that will make freshwater encounters with N. fowleri more frequent and more geographically widespread. The rarity of the infection does not diminish its significance — a case fatality rate exceeding 97% makes PAM one of the deadliest infections known to medicine.
Beyond Naegleria fowleri, amoeba infections in the US in 2026 span a broader category of free-living pathogens — including Acanthamoeba species and Balamuthia mandrillaris — that are increasingly appearing in tap water, nasal irrigation devices, CPAP machines, and contact lens cases, causing life-threatening brain infections, eye disease, and disseminated illness particularly in immunocompromised individuals. A 2025 CDC report published in the MMWR documented a fatal Acanthamoeba encephalitis case in New Mexico directly linked to tap water used in a nasal irrigator and CPAP machine — a stark reminder that amoeba infections are not confined to natural swimming holes. As water infrastructure ages, climate conditions intensify, and awareness gaps persist among both the public and clinicians, understanding the full scope of amoeba infection statistics in 2026 has never been more urgent.
Key Amoeba Infection Facts in the US 2026
| Fact | Statistic |
|---|---|
| Total US PAM cases recorded (1962–2024) | 167 confirmed cases (CDC) |
| US PAM survivors (1962–2024) | Only 4 people survived |
| PAM case fatality rate | >97% — nearly universally fatal |
| Typical annual US PAM cases | Fewer than 10 per year |
| Average annual cases (2006–2019) | ~3 cases per year |
| Average annual cases (2020–2024) | Just over 4 cases per year |
| Global PAM cases identified (1965–2018) | 381 confirmed cases globally |
| Global PAM cases (2025 updated estimate) | ~488 cases reported since 1962 |
| US share of global PAM cases | 41% of all global exposures |
| Patients predominantly male | 75% of all PAM cases are male |
| Median age of PAM patient | 14 years old |
| Days to death after symptom onset | Usually 1 to 18 days; coma often by day 5 |
| North American PAM survivors (documented) | Only 5 documented survivors |
| Water temperature for N. fowleri activity | Above 30°C (86°F) — thrives up to 46°C (115°F) |
| Most common exposure setting | Swimming and diving in warm freshwater lakes/ponds |
| Cases appearing in Midwest/Northern states | 6 confirmed cases — Minnesota, Kansas, Indiana |
| Projected global temperature rise by 2100 | +3.28°C — expanding N. fowleri’s ecological range |
| Global countries reporting PAM cases | 39 different nations |
| Acanthamoeba: most at-risk group | Immunocompromised individuals (transplant, HIV, cancer, diabetes) |
| Adults who think tap water is safe for nasal rinsing | Nearly two-thirds of US adults — a dangerous misconception |
Source: CDC Naegleria fowleri Infections page (August 2025); Global Review on N. fowleri Cases, MDPI March 2026; CDC MMWR March 2025; PMC One-Health Surveillance paper, December 2025; Epidemiology & Clinical Characteristics of PAM, PMC 2022
The numbers in this table carry a weight that exceeds their size. The fact that only 4 people have survived PAM out of 167 US cases spanning over six decades places Naegleria fowleri in a uniquely lethal category — a case fatality rate above 97% that has barely budged despite decades of medical research. What is perhaps more alarming than the raw case count is the demographic profile: the median age of a PAM patient is just 14 years old, and 75% of victims are male. This is a disease that disproportionately claims the lives of children and young adults — precisely the demographic most likely to be swimming in warm freshwater lakes during the summer months, exactly when water temperatures climb into the range where N. fowleri thrives. The 41% US share of all global PAM exposures underscores that this is not primarily a developing-world problem rooted in poor sanitation — it is an American problem, embedded in the country’s recreational water culture.
Equally important is the misconception gap revealed by the data. A CDC-referenced study found that nearly two-thirds of US adults believe tap water is safe for nasal rinsing — a misunderstanding with potentially fatal consequences, as tap water in the US can and does contain Acanthamoeba and, in rare cases, Naegleria fowleri. The 2025 MMWR fatal case report from New Mexico confirmed that Acanthamoeba was detected in both an electronic nasal irrigator and a CPAP machine used with tap water — and all isolates matched the same genotype found in the patient’s brain tissue. These are infections that proper education and simple behavioral changes — using distilled or boiled water for nasal irrigation, maintaining adequate chlorine levels in recreational venues — could prevent. The gap between what the public knows and what the science shows is itself a public health crisis hiding within these statistics.
PAM Case Counts and Trends in the US 2026
NAEGLERIA FOWLERI PAM CASES — US ANNUAL TREND (APPROXIMATE)
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
1962–2005 █████████████████████ Low baseline, sporadic
2006–2019 ████████████████████ ~3 cases per year average
2020–2024 █████████████████████ ~4+ cases per year average
Max in one year (any year) ≤ 8 cases (never exceeded)
Total 1962–2024 167 confirmed US cases
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━| Time Period / Metric | Data Point |
|---|---|
| Total US PAM cases (1962–2024) | 167 |
| Maximum cases recorded in one calendar year (US) | No more than 8 in a single year |
| Average annual US cases (2006–2019) | ~3 per year (40 cases over 13 years) |
| Average annual US cases (2020–2024) | Just over 4 per year (21 cases over 5 years) |
| Antemortem diagnoses rising (1965–2016) | Increased at average 3.6% per year (p < 0.0001) |
| Postmortem diagnoses trend | No significant trend — harder to detect before death |
| Global PAM cases identified (1965–2018) | 381 confirmed |
| Updated global total (2025 study) | ~488 cases since 1962 |
| Cases with adequate antemortem testing | Only 181 of 381 global cases had antemortem diagnosis |
| August 2025 Missouri case | Confirmed in adult resident, linked to Lake of the Ozarks |
| 2023 Arkansas splash pad case | Fatal PAM case — confirmed via CDC MMWR (published 2025) |
| Countries with highest PAM burden (global) | US (41%), Pakistan (11%), Mexico (9%), India (7%), Australia (7%) |
Source: CDC Naegleria fowleri Infections (August 2025); CIDRAP August 2025; MDPI Global Review on N. fowleri Cases, March 24, 2026; PMC Epidemiology of PAM, 2022; CDC MMWR, March 2025
The annual case trend for PAM in the United States reveals a slow but measurable increase that cannot be dismissed as statistical noise. While the number of cases per year has never exceeded 8 in a single calendar year, the average has crept upward — from roughly 3 cases per year between 2006 and 2019 to just over 4 cases per year between 2020 and 2024, according to data synthesized in the MDPI Global Review on N. fowleri cases published March 24, 2026. That represents a 33% increase in average annual incidence, occurring against a backdrop of rising water temperatures, northward geographic expansion of the pathogen, and new exposure routes beyond traditional lake swimming. The 2025 confirmed case in Missouri — linked to the Lake of the Ozarks — and the 2023 fatal splash pad case in Pulaski County, Arkansas — reported through the CDC’s MMWR in 2025 — illustrate that no water environment is fully exempt from risk, including chlorinated recreational facilities when disinfection standards slip.
One of the most important data points in the table is the gap between antemortem and postmortem diagnoses. Of the 381 global PAM cases identified through 2018, only 181 received an antemortem diagnosis — meaning fewer than half were correctly identified while the patient was still alive. This diagnostic failure is a direct contributor to the 97%+ fatality rate: PAM’s early symptoms — fever, headache, nausea, vomiting — are clinically indistinguishable from bacterial meningitis, and most clinicians will not consider a free-living amoeba as the causative agent without an explicit history of freshwater exposure. The 3.6% average annual increase in antemortem diagnoses between 1965 and 2016 is a positive signal, suggesting that growing clinician awareness and advances in PCR-based diagnostic testing are beginning to close the gap — but the survival rate remains catastrophically low, making every hour of diagnostic delay potentially fatal. In a disease where death often occurs within 5 days of symptom onset, diagnostic speed is the only meaningful lever available to clinicians.
Amoeba in Water Systems — Source and Exposure Data in the US 2026
AMOEBA EXPOSURE SOURCES — US PAM CASES (HISTORICAL TO 2026)
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
Lakes, ponds, rivers (swimming/diving) ████████████████████████ Primary source
Tap water (nasal irrigation) ████████ Emerging source
Swimming pools (inadequate chlorine) ███████ Historical source
Splash pads / water parks ████ Emerging source
Hot springs ████ Secondary source
CPAP / medical devices (Acanthamoeba) ███ Newly documented
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━| Exposure Source / Water System | Key Fact |
|---|---|
| Lakes, ponds, reservoirs (swimming/diving) | Most common exposure — #1 source globally |
| Tap water — nasal irrigation | Confirmed route; multiple US deaths linked to neti pots and irrigators |
| Swimming pools (inadequately chlorinated) | 34 pool-linked cases globally; only 1 after 1987 in US (2015) |
| Splash pads / water parks | 2023 Arkansas fatal case; 2015 US case — emerging source of concern |
| Hot springs | Thrives in geothermal water; CDC advises keeping head above water |
| Industrial thermal discharge | Power plants, metallurgical operations — create year-round hotspots |
| Tap water / municipal systems | Acanthamoeba and rarely N. fowleri detected; CPAP/nasal device risk |
| Minimum chlorine to inactivate N. fowleri | Residual chlorine levels above 0.5 g/m³ required in pools |
| Soil and sediment | N. fowleri also lives in warm soil; can wash into water via runoff |
| Nasal rinsing with tap water | 10 Acanthamoeba cases (1994–2022) linked to tap water nasal rinsing (CDC) |
| N. fowleri in properly maintained pools | Should not survive proper chlorination per CDC |
| Two-thirds of US adults | Believe (incorrectly) that tap water is safe for nasal rinsing |
Source: CDC Naegleria fowleri Infections (August 2025); CDC MMWR (March 2025); Emerging Infectious Diseases, CDC April 2024; MDPI Global Review, March 2026; PMC One-Health Surveillance, December 2025
The water system data surrounding amoeba infections in the US is undergoing a fundamental shift in 2026. For decades, the public health messaging around N. fowleri focused almost exclusively on one risk scenario: diving into warm freshwater lakes during summer. That remains the primary and most common route of exposure, accounting for the vast majority of 167 US PAM cases on record. However, the emergence of tap water as a documented transmission route is one of the most significant epidemiological developments in recent years. Multiple confirmed US deaths have been linked to the use of unboiled tap water in neti pots and electronic nasal irrigation devices, and the 2025 New Mexico MMWR case extended this risk to CPAP machines — household medical devices used by tens of millions of Americans nightly for sleep apnea treatment. The fact that Acanthamoeba — a closely related and similarly lethal free-living amoeba — was cultured from both the nasal irrigator and the CPAP machine drip tray in that case, with all isolates matching the patient’s brain tissue at the genotype level, is a finding with immediate public health implications.
Swimming pools tell a different but equally instructive story. 34 pool-linked PAM cases have been identified globally in the historical record, but only one occurred in the US after 1987 — the 2015 untreated pool case — demonstrating that proper chlorination is highly effective at preventing N. fowleri transmission in recreational facilities. The standard threshold of >0.5 g/m³ residual chlorine will inactivate the amoeba. The 2023 Arkansas splash pad case — and a separate 2015 US case — highlight that water parks and splash pads are not inherently safe when chlorine levels fall below protective thresholds. These venue types are particularly concerning because children, the most vulnerable demographic for PAM, are their primary users. Industrial thermal water discharge from power plants and metallurgical operations creates a distinct category of risk, generating year-round warm-water hotspots in rivers and lakes where N. fowleri can persist even in cooler seasons — a phenomenon documented in outbreaks in the Czech Republic and Iraq and increasingly relevant to US industrial waterways.
Geographic Distribution of Amoeba Infections in the US 2026
N. FOWLERI GEOGRAPHIC SHIFT — HISTORICAL VS. EMERGING US STATES
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TRADITIONAL HIGH-RISK STATES (warm climate):
Florida ████████████████████████████████ Historically highest
Texas ██████████████████████████ High
California ███████████████████ High
EMERGING NORTHERN STATES (climate shift):
Minnesota ██████ Confirmed cases
Indiana █████ Confirmed cases
Missouri █████ Aug 2025 confirmed case
Kansas ████ Confirmed Midwest case
Iowa, Illinois ████ Cases flagged
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━| Geographic Category | Key Data Point |
|---|---|
| Historical US high-risk states | Florida, Texas, California — warm Southern climate |
| Cases in Midwest/Northern states since 2010 | Rise observed — Minnesota, Indiana, Missouri, Kansas |
| Confirmed Midwest cases to 2026 | 6 cases in Minnesota, Kansas, Indiana, and neighboring states |
| Northward expansion confirmed | Median and maximum latitudes of PAM exposures increased since 2010 |
| Missouri — August 2025 | Adult resident confirmed, linked to Lake of the Ozarks |
| Minnesota | US cases as far north as Minnesota border — closest to Canada |
| Canada — 2023 finding | 4 Naegleria species detected in recreational lakes in Alberta — first record of genus in Canada |
| Italy and Belgium | N. fowleri detected in temperate European regions — a 2025 surveillance paper confirms |
| Temperature trigger for range expansion | Consistent surface water temperature increases driving northward shift |
| Air temperature link | PAM cases rise in weeks following above-average air temperatures |
| Projected ecological niche expansion | +3.28°C global surface temperature by 2100 will significantly expand N. fowleri’s range |
| Arkansas 2023 splash pad case | Non-natural water body confirms spread beyond lakes/rivers |
Source: PMC Geographic Range Study (Recreational Water-Associated PAM, 1978–2018, PMC7774533); CIDRAP August 2025; Ohio Journal of Public Health cited by Newsweek 2023; PMC One-Health Surveillance paper, December 2025; PMC Climate Change & Amoeba, 2024
The geographic story of amoeba infections in the United States is one of creeping expansion — and it is happening in real time, visible in the case data, the environmental detections, and the peer-reviewed literature. For most of the past six decades, PAM cases were heavily concentrated in the warm, southern states: Florida historically accounts for the highest number of individual cases, followed by Texas and then other Sun Belt states. This made intuitive sense — N. fowleri is a thermophilic organism that thrives in water above 30°C (86°F) and becomes maximally active around 42°C (108°F). Southern US freshwater bodies reliably reach those temperatures during summer, while northern lakes historically stayed cooler. That pattern is now changing. A 2021 CDC-associated study published in PMC, examining recreational water-associated PAM cases from 1978 to 2018, documented a measurable increase in the median and maximum latitudes of PAM case exposures, with the Midwest rise after 2010 constituting a statistically meaningful northward shift. The August 2025 confirmed case in Missouri and the cluster of cases in Minnesota, Indiana, and Kansas since 2010 are not anomalies — they are the leading edge of a trend.
The Canada data point from 2023 is particularly striking. For the first time, four Naegleria species were identified in recreational lakes in Alberta — none of them N. fowleri, but the presence of related species suggests that the environmental conditions are now sufficient to support the genus in Canadian waters, raising the question of when N. fowleri itself might follow. Human PAM cases have already been documented in Minnesota, which borders Canada. Researchers publishing in PMC’s climate change and amoeba review (2024) explicitly link this northward progression to rising surface water temperatures, noting that N. fowleri‘s thermophilic food sources, including cyanobacteria, also flourish in warmer waters — creating a self-reinforcing ecological cycle that climate change is accelerating. With unchecked greenhouse gas emissions projecting a global surface temperature increase of +3.28°C by 2100, the ecological niche where N. fowleri can persist and multiply is set to expand dramatically — potentially bringing PAM risk to states and regions that have never had to consider it before.
Demographics and Survival Data for Amoeba Infections in the US 2026
PAM PATIENT DEMOGRAPHICS — GLOBAL & US DATA TO 2026
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
Sex:
Male patients ████████████████████████████████████ 75%
Female patients ████████████ 25%
Age:
Median age 14 years
Youngest reported case 11 days old
Eldest reported case 75 years old
Peak risk group Children & young adults (summer swimmers)
Survival:
US survivors (1962–2024) 4 people
North American survivors 5 documented
Case fatality rate >97%
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━| Demographic / Survival Metric | Data Point |
|---|---|
| Male patients (global PAM cases) | 75% |
| Female patients | 25% |
| Median age of PAM patient | 14 years old |
| Youngest recorded PAM patient | 11 days old |
| Oldest recorded PAM patient | 75 years old |
| US confirmed survivors (1962–2024) | 4 survivors |
| North American documented survivors | 5 survivors (CDC, November 2025) |
| Global confirmed PAM survivors (1965–2018) | Only 7 confirmed among 381 cases |
| Case fatality rate | >97% (some sources cite >97–99%) |
| Typical time from symptom onset to death | 1 to 18 days; coma often by day 5 |
| Most common early symptoms | Headache, fever, nausea, vomiting — mimics bacterial meningitis |
| Late-stage symptoms | Stiff neck, confusion, hallucinations, loss of balance, seizures |
| Most common misdiagnosis | Bacterial meningitis — clinically identical early presentation |
| Antemortem diagnosis rate | Less than 50% of all historical global cases |
| Drugs used in treatment | Amphotericin B + miltefosine + azole (fluconazole or posaconazole) |
| Miltefosine availability | Limited — contributed to delayed treatment in multiple cases |
Source: CDC Clinical Care of N. fowleri Infection (November 2025); PMC Epidemiology & Clinical Characteristics of PAM (2022); MDPI Global Review, March 24, 2026; StatPearls NCBI (updated March 23, 2026)
The demographic profile of PAM victims is one of the most heartbreaking aspects of this data. A median patient age of 14 years and a 75% male predominance paint a picture of healthy young people — boys diving into summer lakes, teenagers tubing down warm rivers — who encounter an organism that gives the immune system no time to respond. PAM is not a disease of vulnerability in the conventional sense; the CDC notes that most people who have died from PAM had otherwise been in good health. The amoeba does not exploit a weakened immune system the way Acanthamoeba does. It simply moves with extraordinary speed: traversing the cribriform plate, reaching the brain, triggering catastrophic inflammation and necrosis, and — in the overwhelming majority of cases — killing the patient within 5 to 18 days of the first symptom. The infection has been recorded in patients as young as 11 days old and as old as 75, but youth and male sex are the consistent risk markers.
The survival record is starkly minimal. Out of 167 US cases across six decades, only 4 people are confirmed to have survived PAM — and only 5 survivors are documented across all of North America. Globally, among the 381 cases identified through 2018, just 7 confirmed survivors were recorded. The treatment regimen — typically intravenous amphotericin B combined with miltefosine and an azole antifungal — has been associated with the rare cases of survival, but miltefosine’s limited availability has repeatedly complicated timely administration. The StatPearls NCBI review updated in March 2026 emphasizes that early consultation with the CDC Emergency Operations Center (770-488-7100) is critical for any suspected PAM case, because the combination and timing of drugs are highly specialized. The clinical challenge is made worse by the fact that PAM mimics bacterial meningitis almost exactly in its early presentation — meaning that patients often spend critical hours being tested and treated for the wrong condition before anyone considers a free-living amoeba as the cause. By then, the window for intervention has frequently already closed.
Climate Change, Surveillance Gaps & Future Risk in the US 2026
CLIMATE CHANGE IMPACT ON N. FOWLERI RISK — US PROJECTIONS 2026
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━
Current optimal N. fowleri water temp: 30–46°C (86–115°F)
Projected global temperature rise: 2100 +3.28°C with unchecked emissions
Northern state cases since 2010 6 confirmed (rising)
Environmental detections (proactive) Rising — but surveillance is reactive
Cases identified AFTER death >50% of historical global cases
Water systems routinely tested for N.f. Very few — no standard protocol
━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━━| Climate & Surveillance Metric | Data Point |
|---|---|
| Optimal water temperature for N. fowleri | 30–46°C (86–115°F) |
| Projected global surface temp increase by 2100 | +3.28°C with unchecked emissions |
| Effect on N. fowleri ecological niche | Significant expansion — more freshwater bodies reaching optimal temperature |
| Northern US cases (post-2010) | Confirmed northward expansion — Minnesota, Indiana, Missouri, Kansas |
| Canada — first Naegleria genus detection | 2023, Alberta — environmental conditions now support the genus |
| Extreme weather events and risk | Storms push soil amoeba into water; increased organic matter feeds N. fowleri |
| Industrial thermal pollution | Power plants and metallurgical operations create year-round warm-water hotspots |
| Surveillance model (current) | Reactive — triggered only after human cases; no routine proactive monitoring |
| Water systems routinely tested | Very few; no standardized US water testing protocol for N. fowleri in natural bodies |
| CDC’s current recommendation on natural water testing | CDC does not recommend testing natural freshwater bodies due to no standard method |
| Proposed proactive monitoring (2025 One-Health paper) | Testing high-risk systems, standardizing detection protocols, mandatory case notification |
| Cases where diagnosis occurred postmortem | More than 50% of historical global cases — critical diagnostic delay |
Source: PMC One-Health Surveillance Call to Action, December 2025; PMC Climate Change & Amoeba Review, 2024; PMC Geographic Range of Recreational Water-Associated PAM (2021); CDC (August 2025)
The intersection of climate change and amoeba infection surveillance in the US represents one of the most pressing — and most underappreciated — emerging public health challenges of 2026. The biological logic is straightforward: N. fowleri is a thermophile that requires water temperatures above 30°C to become active and grows optimally between 30 and 46°C. As global climate models project a +3.28°C increase in surface temperature by 2100, and as that warming is already measurably occurring across US freshwater systems, the organism’s ecological niche is expanding northward at a documented rate. The “flagellate-empty habitat” hypothesis — cited in multiple recent studies — adds a layer of ecological complexity: as temperatures rise and eliminate thermosensitive microbial competitors, N. fowleri faces less competition for its bacterial food sources, further boosting its population in warming waters. Extreme weather events compound the risk further, as storms wash soil-dwelling amoeba into water bodies and flood nutrient-rich organic matter into lakes and rivers, fueling the bacterial blooms that N. fowleri feeds on.
The surveillance gap identified in a December 2025 PMC One-Health paper is equally alarming from a prevention standpoint. Currently, environmental surveillance for N. fowleri in the US is almost entirely reactive — monitoring is initiated only after a human case is identified, which by definition means a person has already died or is dying. The CDC itself acknowledges there is no standardized testing protocol for natural freshwater bodies, and routine monitoring of high-risk recreational water systems does not exist at the federal level. The paper’s authors — in a call-to-action published in late 2025 — argue that proactive, routine testing of high-risk water systems (those near industrial thermal discharge, in historically affected regions, or in newly warming northern areas), combined with mandatory case notification requirements and standardized detection protocols, could save lives by enabling risk communication before infections occur rather than after. As of 2026, that recommendation remains largely unimplemented — leaving one of the most lethal known infections in the world monitored primarily through the deaths of its victims.
Disclaimer: The data research report we present here is based on information found from various sources. We are not liable for any financial loss, errors, or damages of any kind that may result from the use of the information herein. We acknowledge that though we try to report accurately, we cannot verify the absolute facts of everything that has been represented.
