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New numbers show at least 26 American diplomats have been “medically confirmed” to have been sickened or injured by mysterious sonic attacks, US officials said Tuesday. Fortunately, there are no reports of traveling US civilians being injured yet, but the State Department has issued an alert telling US citizens in China to be on alert for any of the unexplained symptoms.

Hundreds of US diplomats and their families in seven cities spanning four countries have been tested for the mysterious illness, which first popped up in the US Embassy in Havana, Cuba, in 2016.

The new reports of sonic-related health incidents among US diplomats include a false-alarm scare regarding a US diplomatic employee in Singapore hours before the summit between US President Donald Trump and North Korean Leader Kim Jong Un earlier this month, the AP reports.

Similar symptoms also forced a USAID employee to be pulled from his post in Uzbekistan in late 2017 for medical tests. That incident also turned out to be a false alarm — but both illustrate the level of anxiety the US Department of State is feeling about these types of perplexing attacks.

The peculiar incidents first began in the US Embassy in Cuba in 2016 when US diplomats began showing health problems with symptoms of “sharp ear pain, headaches, ringing in one ear, vertigo, disorientation, attention issues and signs consistent with mild traumatic brain injury or concussion,” US officials told Congress in a January hearing, according to CNN.

The officials said that the symptoms consistently followed some type of “acoustic element,” like a “high-pitched beam of sound” or a “baffling sensation akin to driving with the windows partially open in a car.”

Then in May, the US State Department issued a health alert for China after a US official based in Guangzhou began experiencing “abnormal sensations of sound and pressure.” The employee was evacuated for medical evaluations, which did match symptoms for mild brain injury or concussion. US Secretary of State Mike Pompeo said that the sonic incident in China was “entirely consistent” with the incidents in Cuba.

“If you or members of your family experience any unusual, unexplained physical symptoms or events, auditory or sensory phenomena, or other health concerns, please contact your health care provider,” the alert reads. “Symptoms to be attentive for include dizziness, headaches, tinnitus, fatigue, cognitive issues, visual problems, ear complaints and hearing loss, and difficulty sleeping.”

The illnesses (and sometimes false-alarm symptoms) are becoming so prevalent that the US government has created a specific protocol for screening for the potential brain injuries. With the help of a team of neurologists from the University of Pennsylvania and a doctor from Miami, who was the first dispatched to Cuba, the US State Department has developed a formal process to screen employees for the early signs of brain injury from sonic attack.

Employees posted where the attacks have happened get a “baseline” screening, so if they develop symptoms, they can be compared to their original test results.

A medical team from the US State Department has been visiting all US diplomatic employees in China, offering to screen them and their families for the symptoms if they choose. At last count, the team had screened 200 American diplomats and their relatives. Of those tests in China, less than a dozen have been evacuated for further review by the University of Pennsylvania medical team.

H/T: Associated Press

Featured image by MANDEL NGAN/AFP/Getty Images.

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