May 2016

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 22, No. 5, May 2016

The articles of interest summarized below will appear in the May 2016 issues of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. This issue will feature Vectorborne Diseases. The articles are embargoed until April 13, 2016, 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. Rickettsia parkeri Rickettsiosis, Arizona, USA, Kristen L. Herrick et al.

Rickettsia parkeri is a bacterium transmitted to humans by the bite of an infected tick of the species Amblyomma. In humans, R. parkeri infection (also known as R. parkeri rickettsiosis) typically results in fever, headache, rash, and a dark, dry scab (or eschar) at the site of the tick bite. In the United States, previously reported cases of R. parkeri rickettsiosis have been linked to transmission by the Gulf Coast tick (Amblyomma maculatum), a tick whose distribution is restricted to the eastern half of the United States.  However, a recent study identified 2 cases of R. parkeri rickettsiosis in hikers who acquired their infections in a mountainous region of southern Arizona, well beyond the recognized geographic range of A. maculatum ticks. The probable vector for these 2 infections was identified as the A. triste tick, a species found predominantly in South America that has been recognized only recently in the United States. This discovery warrants a closer look at the geographic distribution of these ticks and the health risks they pose to people and pets. In the meantime, education and outreach aimed at people visiting or working in the same mountainous region of southern Arizona can improve awareness and promote prevention of tickborne rickettsioses.

Contact:   CDC Press Office, 404-639-3286 or media@cdc.gov

2. An Operational Framework for Insecticide Resistance Management Planning, Emmanuel Chanda and Edward Thomsen et al.

Insects serve as vectors for some specific organisms (e.g., viruses, bacteria, and parasites) that can cause infectious diseases in people and animals. An obvious, but not so simple, way to control vectorborne spread of infectious disease is to control the vectors by use of insecticides. However, continued, repeated use of the same insecticides is enabling insects to develop resistance. Sound familiar? A similar problem is antibiotic resistance. With only limited types of insecticides available, previously controlled vectorborne diseases, such as malaria, could reemerge if resistance reduces the effectiveness of insecticides. In response to this concern, in 2012, the World Health Organization published the Global Plan for Insecticide Resistance Management, which outlines strategies that should be implemented at the country, regional, and global level to mitigate the impact of resistance. Until now, no country has documented how to actually enact these recommendations. This paper presents the primary objectives, challenges, and preliminary impact of such policy change in Zambia. Thus far, the effects of policy changes with regard to insecticide use and malaria have been promising. Such changes should be expanded to help control other vectorborne diseases, to ensure that available insecticides are used judiciously and remain effective for a long time.

Contact:   Clare Bebb, Senior Media Officer, Liverpool School of Tropical Medicine, Liverpool United Kingdom, +44(0)151 705 3135 cell, +44(0)788 953 5222 or Clare.Bebb@lstmed.ac.uk

3. Linkage to Care for Suburban Heroin Users with Hepatitis C Virus Infection, New Jersey, USA, Eda Akyar et al.

Among young people, escalating use of injection drugs and heroin has been associated with increasing hepatitis C infection. The association comes from the fact that hepatitis C virus (HCV) can be transmitted from one person to another on shared needles or other equipment used to inject drugs. During 2006–2012, the number of new cases of HCV infections increased markedly among young people in nonurban areas of the United States. To determine the extent of this problem in New Jersey, researchers collected information from patients in a drug detoxification center during 2014–2015. They found that the frequency of HCV (genotype 3) infection in this population was unexpectedly high, more than twice the national average. Most of those with HCV infection were women, non-Hispanic white, and all were free of HIV infection. This pattern suggests a closed network of injection drug users in New Jersey who engage in risky behavior that leads to HCV transmission. Despite the attempts of 2 clinicians, few of these patients were successfully linked to care and received treatment for their HCV infection. Reasons include lack of patient return for follow-up, too few care coordinators, and problems with insurance. Because HCV infection can be cured, the authors believe that increased efforts to link people who inject drugs with care for HCV infection are worthwhile.

Contact:   Eda Akyar, ID Care, eda.akyar@gmail.com, Kathleen H. Seneca, kseneca@idcare.com, and Dr. Ronald G. Nahass, rnahass@idcare.com

4. Outbreak of Middle East Respiratory Syndrome at Tertiary Care Hospital, Jeddah, Saudi Arabia, 2014, Deborah L. Hastings et al.

Infection with Middle East respiratory syndrome (MERS) coronavirus is characterized by fever, cough, and difficulty breathing. It can range in severity from mild illness to acute respiratory distress, organ failure, and death. Since its emergence in 2012, the virus has infected more than 1,600 people and has killed nearly 600. In the spring of 2014, a MERS outbreak in Jeddah, Saudi Arabia, afflicted a number of people who either worked at, visited, or received medical treatment at King Fahd General Hospital. A joint international investigation revealed that most disease transmission occurred in the emergency department, inpatient wards, and the dialysis unit due to major lapses in infection control at the hospital, including limited separation of suspected MERS patients, patient crowding, and inconsistent use of infection control precautions. However, aggressive improvements in these areas preceded a decline in new cases. The experience proved that continued vigilance and strict application of infection control measures are vital to prevent MERS outbreaks.

Contact:   Tariq A. Madani, Department of Medicine, King Abdulaziz University, Saudi Arabia, tmadani@kau.edu.sa

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES