March 2016

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 22, No. 3, March 2016

The articles of interest summarized below will appear in the March 2016 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. This issue will feature tuberculosis, in conjunction with World TB Day, designated by World Health Organization as March 24, the date on which Robert Koch announced discovery of the TB bacillus in 1882. The articles are embargoed until February 10, 2016, at 12 p.m. EST.

Note: Not all articles published in EID represent work done at CDC. In your stories, please clarify whether a study was conducted by CDC (“a CDC study”) or by another institution (“a study published by CDC”). The opinions expressed by authors contributing to EID do not necessarily reflect the opinions of CDC or the institutions with which the authors are affiliated.

1. Lyme Disease in Hispanics, United States, 2000–2013, Christina A. Nelson et al.

People who work outdoors are at higher risk for Lyme disease because they more likely to get bitten by ticks, which can carry the bacteria that cause the disease. Because Hispanics account for nearly half the U.S. workforce in grounds maintenance, farming, fishing, and forestry, and little is known about Lyme disease in this population, CDC researchers examined national Lyme disease incidence (number of new cases) for 2000–2013 to assess whether these workers were at higher risk. Researchers found that reported cases of Lyme disease among Hispanics were identified more commonly when the infection was more advanced (at a later stage of infection when the bacteria has spread throughout the body) and diagnosed later in the year (i.e., fall months versus summer months). As a result, diagnosis could be delayed. Researchers also found that the overall incidence of Lyme disease was actually lower among Hispanics than among non-Hispanics. Possible reasons for the overall lower reported incidence include underdiagnosis, meaning the disease was present but not detected or reported. Underdiagnosis could result from inadequate access to healthcare, language barriers, and lack of awareness of the disease. Although some educational materials on preventing Lyme disease and other tickborne illnesses have been translated into Spanish, additional translations and modifications to address cultural differences would be helpful.

Contact: CDC Press Office
email: media@cdc.gov
phone: 404-639-3286

2. Whole-Genome Sequencing to Determine Origin of Multinational Outbreak of Sarocladium kiliense Bloodstream Infections, Kizee A. Etienne et al.

Despite advances in reducing fungal contamination in medical products and devices, fungal infections continue to occur. Determining the source of these infections is difficult but crucial for stopping the spread of infection. Conventional genotyping methods (determining genetic variants in an organism) used for viruses and bacteria are not yet available for most fungi. Therefore, during a 2013–2014 outbreak of a rare fungal bloodstream infection among more than 50 cancer patients in South America, researchers used a different method to determine the source. After the investigation linked the infections to receipt of ondansetron, an antinausea medication, researchers used whole-genome sequencing (which determines the exact sequence of DNA) to confirm that the fungus isolated from the patients was genetically similar to that in the contaminated medication. Contamination of medical products, especially with rare fungi, poses growing concern and a public health threat, especially among cancer patients and others with weakened immune systems. Use of advanced molecular technologies such as whole-genome sequencing will help researchers pinpoint and remove the source of contamination.

Contact: CDC Press Office
email: media@cdc.gov
phone: 404-639-3286

3. Epidemiology of Histoplasmosis Outbreaks, United States, 1938–2013, Kaitlin Benedict and Rajal K. Mody

Histoplasmosis is caused by a fungus (Histoplasma) that lives in the environment, particularly in soil that contains large amounts of bird or bat droppings. People can get histoplasmosis by breathing in fungal spores from the air. Although many people exposed to the spores do not get ill or recover without medication, people with weakened immune systems can become very sick. To update information about the epidemiology (patterns, causes, and effects) of histoplasmosis in the United States, researchers reviewed published reports of outbreaks that occurred during 1938–2013. They found 105 outbreaks reported in 26 states and Puerto Rico. Almost all outbreaks were associated with disturbance of bird or bat droppings, soil or plant matter disruption, or demolition or construction. The continued occurrence of histoplasmosis outbreaks, particularly work-related ones involving disturbance of bird or bat droppings, highlights the need to increase awareness of the disease.

Contact: CDC Press Office
email: media@cdc.gov
phone: 404-639-3286

4. Faster Detection of Poliomyelitis Outbreaks to Support Polio Eradication, Isobel M. Blake et al.

Eradication of polio has almost, but not quite, been achieved. During the last stages of eradication, prompt detection of new outbreaks is critical for mounting a fast and effective response. Delayed detection of outbreaks can result in more cases. Current tracking involves reporting cases of acute flaccid paralysis (the most common sign of polio) followed by sample collection and laboratory testing, both of which take time. For faster outbreak detection, researchers used weekly statistical modeling to map the locations and times of cases of acute flaccid paralysis. Because polio cases tend to occur in clusters (same place, same time), detection of a cluster could serve as an early warning of a polio outbreak. Statistical modeling detected outbreaks sooner than traditional surveillance alone (11 and 39 days sooner for 2 outbreaks) and with fewer false-positives. Weekly testing for clusters could be integrated into the current tracking system to support rapid outbreak response.

Contact: Isobel Blake, MCR Centre for Outbreak analysis and Modelling, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Pl, London W2 1PG, UK;
email: isobel.blake@imperial.ac.uk

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES