Recent Work

CDC is providing clinicians, laboratory scientists, public health professionals, and the public the information they need to prepare for and respond to a smallpox emergency. NCEZID staff recently released a series of videos that instruct clinicians how to administer smallpox vaccine by using the bifurcated needle, interpret vaccination results, care for the vaccination site, and manage common reactions and potential serious adverse events. The videos provide a way to educate clinicians and vaccine administrators quickly, should a smallpox emergency ever occur.

The Ebola outbreak in eastern Democratic Republic of the Congo (DRC) continues unabated nearly four months after it was announced on August 1. It’s the 10th outbreak in DRC since the discovery of Ebola in 1976. As of November 24, 412 confirmed and probable cases, including 236 deaths, had been reported, making this the single largest Ebola outbreak in DRC’s history. Significant challenges continue to thwart the response. Despite having deployed about 90 staff to work on the response since the outbreak began, CDC has been limited in its ability to support on-the-ground efforts in the outbreak’s epicenter because of ongoing security risks. The armed conflict in the area is the most prominent challenge, keeping some responders out and limiting effective contact tracing and other activities necessary to contain the outbreak

New cases continue to be detected in Nigeria’s monkeypox outbreak, which began in September 2017; as of November 2018, the country reports a total of 300 cases (126 confirmed), including seven deaths. CDC staff have supported the Nigeria Centre for Disease Control by providing onsite trainings for medical, public health, animal health, and laboratory officials; technical consultation on suspected cases; monkeypox-specific tools for investigations; expertise in database management; and quality control of diagnostic assays at the national public health laboratory. From Atlanta, staff have also confirmed test results obtained in Nigeria and performed genetic sequencing to learn more about how the monkeypox virus strains are related.

Also worrisome are recent travel-related monkeypox cases that are linked to the Nigerian outbreak. In the United Kingdom, three such cases were reported in September, including two unrelated cases in travelers to Nigeria and a third case in a healthcare worker. Israel reported an imported case in October. In response, CDC posted a Level 2 Alert Travel Notice for monkeypox in Nigeria in mid-October.

To celebrate the 50th anniversary of the quarantine program at CDC, NCEZID’s Division of Global Migration and Quarantine developed a short video that chronicles CDC’s quarantine legacy.

Quarantine came out of the Venetian practice that began in the 1300s to protect against importing bubonic plague. American quarantine law goes back to the colonies in 1647 and has served as the cornerstone of public health. In 1798, President John Adams and Congress created the US Marine Hospital Service, which established a network of hospitals and staff along the coast to protect against the spread of disease. This network became the US Public Health Service.

Today, CDC has 20 quarantine stations strategically located at US airports, land borders, and seaports where most international travelers arrive. DGMQ is responsible for upholding US quarantine regulations to protect our country’s borders from contagious diseases. Check out the video for more information about the fascinating history of the US quarantine program.

Foodborne disease outbreaks received national attention in November. CDC is investigating several new and ongoing outbreaks across the country, including:

• Salmonella infections linked to tahini from Achdut Ltd.
• Listeria infections linked to pork products produced by Long Phung Food Products
• E. coli infections linked to romaine lettuce
• Salmonella infections and recalled Duncan Hines cake mix
• Multidrug-resistant Salmonella infections linked to raw chicken products
• Salmonella infections linked to ground beef
• Multidrug-resistant Salmonella infections linked to raw turkey products
• Salmonella infections linked to kosher chicken

A new surveillance summary provides information on 839 foodborne disease outbreaks reported to CDC in 2016. These outbreaks resulted in 14,259 illnesses, 875 hospitalizations, 17 deaths, and 18 food product recalls. Norovirus (145 outbreaks) and Salmonella (132 outbreaks) were the most commonly reported causes. The most common food categories linked to outbreaks were fish (26 outbreaks), mollusks (such as oysters and scallops, 21), dairy (19), and pork (18). The food categories responsible for the most outbreak-associated illnesses were mollusks (529 illnesses), pork (438), grains and beans (383), and chicken (356). Restaurants were the most commonly reported location where food was prepared (459 outbreaks), specifically restaurants with sit-down dining (363).

The data come from reports that state, local, and territorial public health agencies submitted to the Foodborne Disease Outbreak Surveillance System through the National Outbreak Reporting System (NORS), and includes single-state and multistate outbreaks.

CDC is investigating several outbreaks linked to food products:

• A multistate outbreak of multidrug-resistant Salmonella Infantis infections has resulted in 92 cases reported from 29 states. Evidence suggests that many types of raw chicken products from a variety of sources are a likely source of this outbreak. Consumers and retailers should always handle raw chicken carefully and cook it thoroughly to prevent illness.
• CDC and USDA are investigating a multistate outbreak of Salmonella Newport infections linked to ground beef produced by JBS Tolleson, Inc., of Tolleson, Arizona. The company recalled approximately 6.5 million pounds of beef products that may be contaminated. As of October 23, 120 cases had been reported.
• A multistate outbreak of Listeria infections was linked to ready-to-eat deli ham produced by Johnston County Hams, Inc., in Smithfield, North Carolina. Several companies have recalled the ham products, and people should not eat, sell, or serve these recalled ready-to-eat ham products.

CDC recently published the 2016 Healthcare-Associated Infections Progress Report, which shows year-to-year progress on the prevention of key healthcare-associated infections (HAIs) to highlight progress and target areas for improvement.

The report shows that overall, prevention progress has been made, but more work is needed. Specifically, acute care hospitals saw significant reductions in most HAIs across the board, with the exception of some types of surgical site infections. Greatest prevention improvements were seen for central line-associated bloodstream infections, particularly in neonatal intensive care units.

The 2016 HAI Progress Report is the first report to measure year-to-year HAI prevention progress against the 2015 baseline and is the first progress report to be published in the AR Patient Safety Atlas. Moving forward, CDC will publish progress report data in the Atlas to make the data more accessible and easier to view.

CDC’s Travelers’ Health launched the Think Travel campaign for healthcare providers to build greater awareness of the need to incorporate travel health into patient care. The campaign includes resources to help providers talk with patients before and after their trips about health risks and possible exposures related to travel.

Dr. Casey Barton Behravesh, a veterinarian and Director of the CDC One Health Office, appeared on an episode of The Dr. Oz Show to discuss recent reports of Capnocytophaga infections in people linked to dogs. On the show, Dr. Barton Behravesh explained the facts about this rare disease, while also providing tips on how to stay healthy while enjoying your dogs and other pets.

During the United Nations (UN) General Assembly on September 25, the United States launched the AMR Challenge, a yearlong effort spearheaded by HHS and CDC to call global stakeholders to action on antimicrobial resistance (AMR). During the kick-off, participants described the global threat of AMR and its impact on all people and industries, underscored how everyone can slow its development and spread, and highlighted success stories. The event included organizations that had already made commitments or submitted a commitment in at least one of five action categories: infection prevention and control; antibiotic use; vaccine, therapeutic, and diagnostic development; environment and sanitation; and tracking and data. To date, there have been 99 commitments from over 100 partner organizations and countries.

September was Sepsis Awareness Month, and marked the 1-year anniversary of the launch of Get Ahead of Sepsis, CDC’s national educational effort that promotes early recognition and timely treatment of sepsis, as well as the prevention of infections that could lead to sepsis. Each year, at least 1.7 million Americans develop sepsis, and nearly 270,000 die as a result. As part of outreach efforts, CDC launched this public service announcement.

As of September 6, 2018, three US cases of leptospirosis were identified among travelers who had visited Israel, with additional suspected cases reported and under investigation. Meanwhile, dozens of cases have been confirmed in Israel by the Ministry of Health, and hundreds more people have reported symptoms. The outbreak has affected people who had been exposed to seven natural water sources in the Golan Heights region of northern Israel. In response, CDC quickly developed and posted a Health Alert Network (HAN) advisory alerting clinicians to the travel-associated risks and advising them about appropriate diagnosis and treatment methods. CDC also posted a Watch Level 1 Travel Notice.

Check out two new “I Am CDC” videos that spotlight NCEZID employees and their work. Amanda MacGurn highlights her time with CDC’s Global Border Health Team, where she works with authorities in international airports and other points of entry in French-speaking West African countries to help them plan for infectious disease outbreaks. And CDC entomologist Janet McAllister discusses her work as a research entomologist in Fort Collins, CO, and remembers helping Miami-area communities control mosquitoes during the Zika outbreak there.

Only one week after the Ebola outbreak in western Democratic Republic of Congo (DRC) was declared over on July 24, an unrelated cluster of Ebola cases was reported about 800 miles away in Nord-Kivu Province in the eastern part of the country, along the border with Uganda. Since then, the outbreak has spread and sickened more people. CDC is working closely with the DRC Ministry of Health, the World Health Organization, and other international partners. CDC has deployed Ebola experts from its Viral Special Pathogens Branch to provide on-the-ground assistance in Beni, near the outbreak’s epicenter. Additional staff have contributed to outbreak management from WHO in Geneva and provided lab training and assistance to Rwandan health officials. Additionally, CDC is assisting with border health, risk communications, community engagement, emergency response management, and other areas. The remote location of the outbreak’s epicenter, combined with security concerns, are challenges responders are working to overcome. See CDC’s Ebola website for additional information.

August 20-24 marked the fifth annual Contact Lens Health Week, organized by CDC in close collaboration with partners as a strategy to increase public awareness and promote healthy contact lens wear and care.

While contact lenses are usually a safe and effective form of vision correction, they are not entirely risk-free – especially if they are not cared for properly. Learn more about taking care of contact lenses and read a new MMWR article describing a case series of people who developed eye infections linked to sleeping in lenses.

CDC held its 10^th occurrence of the International Conference on Emerging Infectious Diseases (ICEID) from August 26-29 in Atlanta, GA. Held every 2-3 years, the conference brought together more than 1,500 public health professionals from around the world to encourage the exchange of the latest information on issues affecting the emergence, spread, and control of infectious diseases. Major topics for ICEID 2018 included surveillance and outbreak response, laboratory diagnostics and systems, factors affecting disease emergence and control, and public health preparedness.

Rocky Mountain spotted fever (RMSF) is the most deadly tickborne disease in the United States. Each year, 3,000-5,000 cases of RMSF and other spotted fever rickettsioses are reported in the US, including 5-10 deaths and substantially more severe cases. Effective treatment is available, and severe and fatal cases of RMSF can be prevented through early recognition and treatment. CDC has a new toolkit for healthcare providers, epidemiologists, and public health practitioners to aid in the diagnosis and treatment of RMSF and other tickborne diseases. The toolkit includes free Continuing Education in seven professional categories: CME, CNE, CEU, CECH, AAVSB/RACE, CPE, and CPH.

CDC and state and federal partners are investigating a multistate outbreak of Salmonella infections linked to frozen shredded coconut. On January 3, 2018, Evershing International Trading Company recalled all 16 oz. bags of Coconut Tree Brand frozen Shredded Coconut.
CDC recommends retailers not sell, restaurants not serve, and consumers not eat recalled product.

On January 10, CDC released new data in its Antibiotic Resistance (AR) Investment Map showcasing CDC’s activities to slow antibiotic resistance and meet national goals. The updated map for 2018 includes more than 170 state-reported successes in addressing AR problems. These are the first comprehensive reports on state progress made following the first year of Congress’s unprecedented investment in CDC’s Antibiotic Resistance Solutions Initiative. The map also features printable state- and city-specific fact sheets that describe how CDC invests in activities in those areas.