June 2018

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 24, No. 7, July 2018

The articles of interest summarized below will appear in the June 2018 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. This issue will feature zoonoses. The articles are embargoed until June 13, 2018, at Noon Eastern Time.

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 include a live link 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 https://wwwnc.cdc.gov/eid/ahead-of-print.


1. Legionnaires’ Disease Outbreak on Merchant Vessel, Indian Ocean, Australia, 2015, Timothy J.J. Inglis et al.

Legionnaires’ disease is a type of pneumonia, named after the 1976 outbreak at an American Legion convention in Philadelphia, Pennsylvania. Healthy people with Legionnaires’ disease may need to be hospitalized, but they usually recover after receiving antibiotics; about 1 in 10 patients die. Patients acquire the infection by breathing in mist containing the bacteria, often originating from manufactured water systems such as plumbing fixtures, fountains, or cooling towers. Cruise ship water systems have been documented as sources of contamination, but less is known about risk on working ships such as tanker ships or other merchant vessels that carry few or no passengers, where occupational health risks differ. In 2015, investigation of 2 cases of Legionnaires’ disease on working ships off the coast of Australia revealed the source to be showers and faucets. Molecular analyses (PCR) of samples from the ship’s environment (including showerheads and faucets) identified the causative organism as Legionella pneumophila serogroup 1. A rust-colored biofilm inside most showerheads indicated possible deterioration of iron pipes in the ship’s water distribution system and persistence of the Legionella bacteria in biofilms (a thin, slimy film of bacteria that adheres to a surface). The investigators recommended replacing the showerheads with simpler plastic ones, more suited to periodic removal, decontamination, and cleaning. These 2 cases heightened awareness of Legionnaires’ disease on nonpassenger working ships operating in tropical waters and the need for increased attention to control measures.

Contact: Timothy J.J. Inglis, PathWest Laboratory Medicine – Department of Microbiology & Infectious Diseases, Australia; phone: +618 6383 4548 or email: tim.inglis@health.wa.gov.au

2. Geographically Diverse Clusters of Nontoxigenic Corynebacterium diphtheriae Infection, Germany, 2016–2017, Alexandra Dangel et al.

Diphtheria is a potentially life threatening disease caused by toxin producing (toxigenic) bacteria called Corynebacterium diphtheriae (and less often zoonotic C. ulcerans and C. pseudotuberculosis). Toxigenic strains are causative agents of severe respiratory disease, myocarditis and neurological damage or cutaneous diphtheria. In Western countries, due to effective vaccination campaigns diphtheria is rarely observed today with 10–31 cases per year and is often associated with travel history or close contact to persons stemming from endemic countries. However, vaccination prevents only toxin–associated disease. Strains that do not produce toxin (non-toxigenic) strains of C. diphtheriae causing blood stream infections, endocarditis, septic arthritis and more commonly, recurrent episodes of sore throat and mild wound infections are emerging. When, during 2016–2017, local laboratories in northern Germany reported increased nontoxigenic cases to the German Consiliary Laboratory on Diphtheria, investigators found that most patients were experiencing homelessness, suffered from an alcohol or intravenous drug use disorder, or both. They also found, through genetic analysis of the bacteria that clusters of infection occurred in specific geographic areas. The bacteria were probably directly transmitted from person to person due to the lack of hygiene, shared use of needles, and close contacts sharing quarters for unsheltered people. Because strains can persist within such risk groups, nontoxigenic diphtheria can become a public health threat and lead to outbreaks in industrialized countries. The investigators suspect that this threat is not specific for Germany but that it is a potential problem for risk groups in metropolitan areas in general. Therefore, clinicians and public health authorities in all metropolitan areas should bear in mind the potential for nontoxigenic diphtheria among people in these risk groups.

Contact: Alexandra Dangel, Bavarian Health and Food Safety Authority, Germany, phone: +49 9131 6808 5433 or email: alexandra.dangel@lgl.bayern.de

3. Progress and Remaining Gaps in Estimating the Global Disease Burden of Influenza, Joseph Bresee et al.

Influenza has long been a global public health priority because of the ever-present threat of another global pandemic. Although data are available for measuring the human and economic costs of seasonal influenza in many developed countries, fewer of these disease burden data are available for low-income and tropical countries. In recent years, however, surveillance systems created as part of national pandemic preparedness efforts have produced substantial data on the epidemiology and impact of influenza in countries where data were sparse. Those data are leading to greater interest in seasonal influenza, including implementation of vaccination programs. However, a lack of quality data on severe influenza and at-risk population groups, as well as a need for better mathematical models and economic evaluations, are some of the major gaps that remain. These gaps are the focus of multilateral research and surveillance efforts that will strengthen global efforts to control influenza. For example, the World Health Organization is developing economic tools to support using disease burden data to estimate the overall costs of influenza, the cost of vaccination programs, and the cost-effectiveness of vaccination. Another example is CDC’s collaboration with more than 50 countries around the world to strengthen surveillance and laboratory testing capacities, including expanding global capacity for genetic sequencing, which, in turn, has produced invaluable data on influenza epidemiology and disease burden.

Contact: CDC Media Relations, 404-639-3286 or media@cdc.gov.

4. Perceptions of Zika Virus Risk during 2016 Outbreak, Miami-Dade County, Florida, USA, Imelda K. Moise et al.

Knowing about local residents’ health practices and concerns can help guide health officials in taking steps to prevent and control mosquito-borne disease outbreaks. During the 2016 Zika virus outbreak, more than 4 in 10 US residents mistakenly thought that Zika virus infection was fatal and that symptoms were always noticeable. In Miami-Dade County, Florida, the epicenter of that outbreak in the United States, researchers conducted a bilingual (English and Spanish) telephone survey of a random sample of adults in late spring of 2016, as the Zika virus outbreak was just beginning in Florida. The survey applied the basic concepts of the Health Belief Model (e.g., the concept that persons are influenced by their perceived susceptibility to a disease and the severity of that disease) in an attempt to understand perceptions of Zika virus risk and prevention practices among the public. The survey results showed that despite widespread media campaigns promoting knowledge about Zika virus, during the 2016 outbreak, misperceptions persisted among some subgroups. A higher percentage of women than men perceived Zika to be a severe disease, and women were more likely than men to report fear of contracting Zika. Generally, the more knowledge people had about Zika, the more confident they were in their ability to protect themselves and household from contracting Zika, and persons with bachelor’s degrees tended to be more knowledgeable than those without. In light of those findings, the researchers recommend that prevention and treatment interventions be targeted by sex and education level to lower the risk for infection in high-risk areas during arbovirus outbreaks.

Contact: Imelda K. Moise, University of Miami, Professor of Geography, Public Health Sciences, College of Arts and Sciences, Coral Gables, FL; phone:305-284-2360 or email: moise@miami.edu


Page last reviewed: June 13, 2018