December 2018

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 24, No. 12, December 2018

The articles of interest summarized below will appear in the November 2018 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. The articles are embargoed until November 14, 2018, at 12 p.m. EDT.

Important 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 link directly to the actual journal article in your stories. Once the embargo lifts, this month’s articles will be found in the Ahead of Print section of the EID website at

1.    Influences of Community Interventions on Zika Prevention Behaviors of Pregnant Women, Puerto Rico, July 2016–June 2017, Giulia B. Earle-Richardson et al.

In early 2016, in response to the rising number of Zika virus infections in Puerto Rico and the devastating effects of Zika infection during pregnancy, the Puerto Rico Department of Health activated its emergency operations center, with support from the Centers for Disease Control and Prevention. Because no Zika virus vaccine exists and no known measures can prevent prenatal mother-to-child transmission, personal protection measures and mosquito control in and around the home are the only protections for most pregnant women. To maximize these self-protection behaviors, the response team introduced four Zika prevention interventions: Zika virus training; distribution of Zika prevention kits; a mass media campaign; and free home mosquito spraying. To assess the use, utility, and effects of these interventions in supporting pregnant women an evaluation was initated. The team conducted telephone interviews with pregnant women participating in Puerto Rico’s Women, Infants, and Children Program to asses associations between receipt or exposure to interventions and Zika prevention behaviors. Prevalence of behaviors ranged from 4% (wearing long-sleeved shirt) to 90% (removing standing water). Appropriate mosquito repellent use (28%) and condom use (44%) were common. Receiving a Zika prevention kit was significantly associated with larvicide application and bed net use, suggesting the kit’s importance for encouraging lesser-known behaviors. Many women accepted the offer of free residential spraying for mosquitoes, indicating that removing cost barriers was important. These results demonstrate that interventions that address behavioral barriers, and increase capabilities and opportunities to perform the behavior, can effectively change behaviors, which can prevent disease, and ultimately save lives.

Contact: CDC Media Relations, 404-639-3286 or

2.  CTX-M-65 Extended-Spectrum β-Lactamase–Producing Salmonella enterica Serotype Infantis, United States, Allison C. Brown et al.

In the United States, Salmonella causes about 1.2 million illnesses each year. Treatment is not always needed, but when it is, it often consists of cephalosporin or penicillin antibiotics. However, some Salmonella produce an enzyme (extended-spectrum β-lactamase, or ESBL) that makes them resistant to antibiotics in these two classes. In the United States, ESBLs have rarely been found in Salmonella. However, in 2014, the US Food and Drug Administration found a new multidrug-resistant strain of ESBL-producing Salmonella Infantis in retail chicken meat.  Genetic examination of human specimens of this strain indicated that it originated in the United States among travelers who had returned from South America. Subsequent infections were domestically acquired and likely associated with consumption of retail chicken meat. Emergence of this Salmonella strain in the United States is concerning because it is associated with higher patient hospitalization rates and its antibiotic resistance eliminates all but one recommended treatment option. Until prevention and control measures can be evaluated and implemented, healthcare providers should be aware of the risks for infection with this strain, including the potential that treatment will not work.

Contact: CDC Media Relations, 404-639-3286 or

3.    Restaurant Inspection Letter Grades and Salmonella Infections, New York, New York, USA, Melanie J. Firestone and Craig W. Hedberg

People often eat away from home (e.g., in restaurants), and restaurants can be the source of Salmonella infections. In 2010, the Department of Health and Mental Hygiene in New York City explored an effort to improve restaurant food safety by converting inspection results to a letter grade (A, B, C, or grade pending) and requiring eating establishments to post their letter grade where consumers could see it before entering. To determine the effectiveness of making those letter grades visible to the public, researchers compared rates of Salmonella infection before and after displaying the grades was required. They found fewer Salmonella infections in areas that posted restaurant letter grades, thereby suggesting effectiveness.  Other health departments should consider expanding this program to their jurisdictions.

Contact: Martha Coventry, Senior Editor, University of Minnesota School of Public Health    Communications Office, phone: (612) 626-3750 email:

4.   Rat Lungworm Infection in Rodents across Post-Katrina New Orleans, Louisiana, USA, Rosalyn C. Rael et al.

The rat lungworm is a parasite that is transmitted between rats and mollusks (such as slugs or snails). Sometimes other animals (such as freshwater shrimp, land crabs, frogs) become infected and can transmit the infection to people who eat those animals raw or undercooked. In the continental United States, rat lungworms were first detected in the mid-1980s in New Orleans, Louisiana, and now seem to be widespread across the southeastern United States. In large urban areas such as New Orleans, shifting climate conditions or extreme events, such as hurricanes, can foster disease outbreaks. In recent years, New Orleans has experienced both. To determine whether the rat lungworm populations increased after Hurricane Katrina hit New Orleans in 2005, researchers examined lung samples from rats collected during 2015–2017. About 38% of the rats were infected, similar to the percentage infected in areas where rat lungworm is considered to be endemic (common). Because the rat lungworm is just one of many harmful organisms carried by urban rats, this information might be useful for tracking and policy making with regard to other infectious diseases.

Contact: Michael Blum, email:

5.   Substance Use and Adherence to HIV Preexposure Prophylaxis for Men who Have Sex with Men, Martin Hoenigl et al.

Use of substances (alcohol, stimulants, and injection drugs) is higher among men who have sex with men (MSM) and among transgender women than in other populations. Use of these substances by people in these groups is also associated with increased risk behavior and HIV acquisition. Therefore, HIV-uninfected MSM and transgender women who use substances might be ideal candidates for HIV pre-exposure prophylaxis (PrEP; drugs that lower a person’s risk for acquiring HIV infection).  However, researchers wondered whether substance use might interfere with adherence (taking medication as prescribed).  By testing samples to determine levels of PrEP in the blood (a measure of adherence), they found no difference in adherence between those who did and did not use substances. They thus concluded that substance users are excellent candidates for, and would indeed benefit from PrEP.

Contact: Martin Hoenigl, Antiviral Research Center, Division of Infectious Diseases, Department of Medicine, University of California; email (preferred): or phone (619)-543-5605.



Page last reviewed: October 9, 2018