September 2015

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 21, No. 9, September 2015

The articles of interest summarized below will appear in the September 2015 issues of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. This issue marks the 20-year anniversary of the founding of the Emerging Infections Program, and the articles in this issue feature this Program. The articles are embargoed until August 12, 2015, at 12 p.m. EDT.

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. Emerging Infections Program as Surveillance for Antimicrobial Drug Resistance, Scott K. Fridkin et al.

Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections. Since its inception in 1994, the CDC Emerging Infections Program has provided a large amount of data on antibiotic–resistant infections (such as respiratory bacterial infections, healthcare–associated infections, and some aspects of foodborne illnesses). These important data, which include estimates of the extent of disease nationally, determination of populations at risk, identification of causative organisms, and patient outcomes, have been used to develop national policy and guidelines to prevent antibiotic–resistant infections. Through these data, which have contributed to advancing public health knowledge of a wide spectrum of antibiotic–resistant infections, the Emerging Infections Program has played a key role in antibiotic resistance surveillance.

Contact Scott K. Fridkin via:
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2. Effect of Culture-Independent Diagnostic Tests on Future Emerging Infections Program Surveillance, Gayle Langley et al.

Culture-independent diagnostic tests (CIDTs) detect substances that indicate the presence of an organism in a specimen. They may help clinicians diagnose infections faster and easier than standard methods of identifying organisms through culture (putting patient specimens on special media to see which organisms grow).  However, their use poses challenges for public health authorities in measuring disease burden trends and the effect of interventions. Also, unlike culture, CIDTs do not yield isolates, which are needed for other more detailed types of testing (e.g., strain typing, antibiotic resistance testing, and identification of other molecular characteristics). EIP hopes to work with other domestic and international public health entities, regulatory bodies, diagnostic manufacturers and academic and clinical groups to chart a course for continuing to incorporate CIDTs into surveillance while maintaining the ability to accurately measure the burden of infectious diseases and to characterize infections. 

Contact Gayle Langley via:
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3. Foodborne Diseases Active Surveillance Network—2 Decades of Achievements, 1996–2015, Olga L. Henao et al.

The Foodborne Diseases Active Surveillance Network (FoodNet) has provided a foundation for food safety policy and illness prevention in the United States since 1996. FoodNet is an active, population-based sentinel surveillance system and the only US system focused on obtaining comprehensive information about sporadic infections caused by pathogens transmitted commonly through food. FoodNet monitors changes in the incidence of selected major bacterial and parasitic illnesses transmitted commonly by food, attributes illnesses to sources and settings, and estimates the total numbers of foodborne illnesses in the United States. FoodNet, a core component of CDC’s Emerging Infections Program, is a collaboration between CDC, 10 state health departments, US Department of Agriculture’s Food Safety and Inspection Service, and the Food and Drug Administration. FoodNet’s major contributions include the establishment of reliable, active population-based surveillance of enteric diseases; development and implementation of epidemiologic studies to determine risk and protective factors for enteric infections; population surveys that describe the features of gastrointestinal illnesses, medical care–seeking behavior, and food eating patterns; laboratory surveys of current practices; and development of a surveillance and research platform that can be adapted to address emerging issues. FoodNet has matured and transformed over the past 20 years and continues to evolve.

Contact Olga L. Henao via:
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4. Evaluating Epidemiology and Improving Surveillance of Infections Associated with Health Care, United States, Shelley S. Magill et al.

Healthcare-associated infections and inappropriate use of antibiotics are major threats to patient safety in the United States. Eliminating healthcare-associated infections is a priority of the U.S. Department of Health and Human Services and is one of CDC’s “winnable battles.” Essential tools for winning this battle include having an up-to-date and comprehensive understanding of healthcare-associated infections and the drug-resistant organisms that commonly cause them. In 2009, the CDC Emerging Infections Program launched a program to provide these tools: the Healthcare-Associated Infections Community Interface (HAIC) Activity. The HAIC Activity has become a national public health resource for investigating infectious diseases associated with healthcare. HAIC seeks to promote patient safety and healthcare quality through two main initiatives: 1) evaluation of the epidemiology and public health effects of healthcare-associated infections to provide a better understanding of emerging pathogens and populations at risk; and 2) innovation to improve strategies for detection and tracking of healthcare-associated infections. Through collaborative work between CDC, public health departments, and healthcare facilities, the HAIC Activity has addressed critical knowledge gaps and helped CDC prioritize actions to improve patient safety.

Contact Shelley S. Magill via:
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5. The US Influenza Hospitalization Surveillance Network, Sandra S. Chaves et al.

Every year, influenza viruses circulate worldwide, causing substantial illness and death and leading to considerable economic losses. From time to time, new virus strains emerge and cause a global pandemic with devastating consequences. Because influenza viruses are constantly evolving, through genetic and/or antigenic changes, almost every season or when a new strain emerges, a new vaccine needs to be made. Keeping up with these changes requires constant vigilance in the form of surveillance programs that monitor the timing and severity of seasonal flu, identify which virus strains are circulating in a community, and detect changes in the epidemiology or risk for infection. This information can be used to plan for vaccine strain selection, to alert the medical community and public health officials about the intensity and magnitude of an epidemic, and to evaluate the effects of intervention programs. One such program is Influenza Hospitalization Surveillance Network (FluSurv-NET), a program initiated by the CDC and state health departments in 2003, as part of the CDC Emerging Infections Program. FluSurv-NET comprises 13 sites, 267 hospitals and laboratories, and covers more than 27 million people (approximately 9% of the US population). FluSurv-NET data reflect the number of people hospitalized because of flu. These data have helped determine which segments of the population are at highest risk for flu, document the severity of specific flu seasons, and guide recommendations for treatment and vaccination programs. FluSurv-NET has proven to be a comprehensive yet efficient system for measuring severe influenza in the United States and the source of answers to relevant public health questions.

Contact Sandra S. Chaves via:
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6. Incidence of Clinician-Diagnosed Lyme Disease, United States, 2005–2010, Christina A. Nelson et al.

Lyme disease is a bacterial infection transmitted to animals and people by ticks. In the United States, clinicians and laboratories report cases of Lyme disease to state and local health departments. This national surveillance provides information about the age and sex of patients, seasonality and geographic distribution of cases, so that trends in Lyme disease over time can be monitored. However, national surveillance information is limited because not all cases are reported and because reporting practices vary by state and over time. To overcome those limitations, researchers identified cases of Lyme disease by examining health insurance claims filed during 2005–2010. Because insurance claims are based on billing records submitted by clinicians, they are less prone to underreporting than are surveillance data that require additional documentation. Based on extrapolation from insurance claims, the authors estimated that 329,000 cases of Lyme disease were diagnosed by clinicians each year, supporting a previous CDC estimate of about 300,000 Lyme disease cases annually. In comparison, CDC received reports of only 30,000 confirmed and probable cases in 2010. These new results indicate that in the United States, Lyme disease is a major public health problem leading to substantial healthcare utilization.

Contact Christina A. Nelson via:
CDC Press Office
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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES