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March 2017

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 23, No. 4, April 2017

Note: Not all articles that EID publishes represent work done at CDC or by CDC staff. In your stories, please clarify whether a study was conducted by CDC (“a CDC study”) or by another institution (“a study published by CDC in the EID journal”). Opinions expressed by authors contributing to EID do not necessarily reflect the opinions of CDC or the institutions with which the authors are affiliated. EID requests that, when possible, you include a live link to the actual journal article in your stories.

The articles of interest summarized below will appear in the April 2017 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. This issue will feature Emerging Viruses. The articles are embargoed until March 15, 2017, at 12 p.m. EDT.


1.      Transmission of Hepatitis A Virus through Combined Liver–Small Intestine–Pancreas Transplantation, Monique A. Foster et al.

Each year worldwide, approximately 1.5 million people get hepatitis A. In the United States, despite high rates of vaccination, transmission of hepatitis A continues to result from close personal contact with an infected household member or consumption of contaminated food or water. In August 2015, when hepatitis A was diagnosed in 2 home health nurses who had cared for the same organ transplant recipient, state and local health departments, with support from CDC, investigated the possibility of transmission through organ transplantation. Specimens from the nurses, the recipient, and the donor contained genetically identical virus RNA, indicating that the virus was transmitted to the recipient through the transplanted organs. Although the recipient had been vaccinated, exposure was in the setting of immunosuppression. The organ donor had no record of vaccination, which might have prevented infection of the organ recipient and subsequent infection of the healthcare workers.

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


2.    Antiviral Drug–Resistant Influenza B Viruses Carrying H134N Substitution in Neuraminidase, Laos, February 2016, Tatiana Baranovich et al.

infection is treatable and testing is readily available in West Africa, semen testing programs for Ebola virus should consider offering HIV testing to male survivors of EVD. In addition, behavioral counseling on safe sex practices and condom distribution to male survivors of EVD (with or without HIV infection) and their sexual partners should remain integral to any Ebola response.In the United States, influenza B viruses cause epidemics and contribute to about 30% of influenza-associated deaths among children. The only drugs available for treating influenza B virus infections are neuraminidase inhibitors, but mutations of influenza B viruses can diminish the effectiveness of these drugs, which is what may be occurring in Laos. In February 2016, influenza B viruses isolated from 3 people in Laos, not linked by location or exposure contacts, were found to contain an H134N substitution and to be resistant to neuraminidase inhibitors. Although this analysis was done in a laboratory, it indicates that current drugs may not be effective for treating cases of disease caused by viruses harboring this mutation.

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


3.      Typhus Group Rickettsiosis, Texas, USA, 2003–2013, Kristy O. Murray et al.

Rickettsia typhi, the bacterium that causes typhus group rickettsiosis (TGR), is spread by fleas. In people, TGR typically appears as a classic triad of fever, headache, and rash. These infections can be severe and potentially fatal if not treated appropriately. In the United States, Texas reports the most TGR cases annually, and TGR is considered endemic to the southernmost part of the state. Researchers characterized the epidemiology of TGR in Texas by examining Texas Department of State Health Services data from 2003–2013. They observed an increase in the number of TGR cases reported each year and geographic expansion into areas of the state to which TGR is not considered endemic. Their results highlight the importance of educating the public about preventing flea bites and raising awareness among physicians to increase the identification of cases, particularly in children. Moreover, further research is needed to better understand the transmission dynamics between rodents, fleas, and other species and determine risk factors for infection.

Contact: Kristy O. Murray, Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital,


4.      Reassortment of Influenza A Viruses in Wild Birds in Alaska before H5 Clade Outbreaks, Nichola J. Hill et al.

The emergence of highly pathogenic avian influenza A virus subtype H5 of clade (i.e., common ancestor group) in East Asia, followed by spread into North America in 2014, highlights the importance of interactions among bird species along the Pacific Rim to the incursion of novel viruses. Introduction of influenza A subtype H5N8 into North America is thought to have occurred through wild bird movement across the Bering Strait. The virus then spread through Canada to the continental United States, concurrently infecting wild birds (e.g., ducks, geese, passerines, and raptors) and poultry (e.g., turkeys and chickens). Reassortment (i.e., the mixing of genetic material between two viruses to generate new combinations) of H5N8 with low pathogenicity avian influenza A virus in North America generated 3 new subtypes (H5N8, H5N2, and H5N1) that spread among local bird populations. H5N2 became the most widespread in US poultry, prompting the culling of 49 million chickens and turkeys in 15 states. To determine how H5N8 entered and reassorted with North American lineage viruses, researchers analyzed the influenza virus strains that existed in wild birds in Alaska before outbreaks of avian influenza occurred. The results of their analysis implicate the movement (or migration) of waterfowl as a crucial mechanism in the reassortment, spread, and possibly long-term circulation of those viruses.

Contact: MIT Media Relations, 617-253-2700,