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August 2016

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 22, No. 8, August 2016

The articles of interest summarized below will appear in the August 2016 issues of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. This issue will feature Parasitology. The articles are embargoed until July 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. Multistate US Outbreak of Rapidly Growing Mycobacterial Infections Associated with Medical Tourism to the Dominican Republic, 2013–2014, David Schnabel et al.

Each year, up to 750,000 US residents travel abroad for medical care, often to save money.  But in the long run, this practice (called medical tourism) can end up being very costly, as experienced by 21 people who had undergone cosmetic surgery in the Dominican Republic during 2013–2014. They became infected with rapidly growing mycobacteria. These organisms are found in the environment worldwide. They usually infect skin or lungs and are responsible for chronic and recurrent infections that are notoriously resistant to antibiotics and difficult to treat. In healthcare settings, mycobacteria can infect patients when sterile conditions are not maintained during surgery or when nonsterile water is used. For patients who do become infected, along with additional healthcare costs (more surgery, hospitalization, and long-term antibiotic therapy), they might also be burdened by the inability to work and decreased quality of life. Clinicians and public health officials should be vigilant for these infections in patients who have undergone surgery in foreign destinations. Potential patients can learn more about the risks of medical tourism at

Contact:  CDC Press Office, 404-639-3286 or

2. Possible Role of Fish and Frogs as Paratenic Hosts of Dracunculus medinensis, , Chad, Mark L. Eberhard et al.

Thanks to the global campaign to eradicate dracunculiasis, also known as Guinea worm disease (GWD), the number of countries that still have endemic GWD has declined dramatically, from 20 countries in 1986 to 4 countries (Chad, Ethiopia, Mali, and South Sudan) in 2015. During the same period, the number of cases globally has declined from 3.5 million to 22 cases. All interventions against GWD have focused on preventing contamination of stagnant sources of drinking water by patients with GWD and preventing the ingestion of infected copepods. However, in 2013, researchers noted several unusual epidemiologic findings in Chad, including the conspicuous absence of disease outbreaks associated with shared drinking water sources and reports of numerous infections of domestic dogs with Guinea worms (Dracunculus medinensis) that were genetically indistinguishable from those infecting humans. This finding led to the hypothesis that an aquatic paratenic host (i.e., an intermediate host that serves as a transport host for parasite larvae) was involved in the transmission of D. medinensis in Chad. Indeed, since 2013, the sporadic pattern of human cases in Chad has continued, the number of infections in dogs has continued to increase, and the presence of a paratenic host in the transmission cycle seems more and more likely. The present study confirms that D. medinensis, like others in the genus, can and do utilize a paratenic host in the life cycle. Although described over 145 years ago, and well-studied by many researchers, the finding that D. medinensis can utilize a paratenic host demonstrates the need to continue to conduct research on diseases even near the end of an eradication program. Researchers at CDC, The Carter Center, and University of Georgia collaborated to conduct this work.

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3. Enterovirus D68 Infection in Children with Acute Flaccid Myelitis, Colorado, USA, 2014, Negar Aliabadi et al.

Enteroviruses affect millions of people worldwide each year and are often found in the respiratory secretions and stool of an infected person. Enterovirus D68 (EV-D68) is one of more than 100 non-polio enteroviruses and can cause mild to severe respiratory illness, or no symptoms at all. However, in Colorado in 2014, a cluster of cases of acute flaccid myelitis (a neurologic disease with muscle weakness and characteristic changes seen on MRI) in children occurred during an outbreak of EV-D68 respiratory disease. To look for an association, researchers looked for the EV-D68 virus in respiratory samples from children with and without acute flaccid myelitis. They found that the odds of having this viral infection was 10 times greater for children with acute flaccid myelitis. This finding raises concern about the potential role of EV-D68 in causing severe neurologic disease.

Contact: CDC Press Office, 404-639-3286 or