A child believed to have died after contracting a rare infection from a brain-eating amoeba while swimming in a Nebraska river may be the second such death in the Midwest this summer.

According to The Associated Press, “The Douglas County Department of Health based in Omaha, Nebraska, reported Wednesday that doctors believe the child died of primary amebic meningoencephalitis, a usually fatal infection caused by the naegleria fowleri amoeba. Health officials believe the child came into contact with the amoeba on Sunday while swimming in the Elkhorn River just west of Omaha.”

In July, Iowa officials closed the beach near the Lake of Three Fires State Park near Bedford as a precaution after a Missouri resident who swam there died due to primary amebic meningoencephalitis, the infection caused by the amoeba.

The amoeba can be inhaled while swimming or diving, the Centers for Disease Control and Prevention said, though other sources have been found. For example, in 2020, tap water was tainted in the Houston area, The Associated Press reported.

And last September, a child in North Texas died after inhaling the parasite while playing at a splash pad, according to CNN.

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“Millions of recreational water exposures occur each year, while only 0 to 8 Naegleria fowleri infections are identified each year,” Nebraska state epidemiologist Dr. Matthew Donahue told CNN.

He noted that the infections typically happen between July and September “in warmer water with slower flow.”

The infection progresses in two stages, beginning with a severe frontal headache, fever, nausea and vomiting. It progresses to a stiff neck, seizures, altered mental state, hallucinations and coma, according to the CDC.

The CDC says the fatality rate from the bacterial infection is greater than 97%. Only five people are known to have survived in North America, among 154 known infections since 1962, when the amoeba was identified. Early diagnosis and treatment are crucial.

According to The Associated Press, the infection is more common in Southern states but has migrated north as water becomes warmer.

The Associated Press quoted health officials on staying safe, noting that freshwater swimmers should plug their noses and avoid putting their heads in the water. Activities like waterskiing and tubing can force water into the eyes, nose and mouth. “You cannot be infected by drinking contaminated water,” the article said.