November 2019

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 25, No. 11, November 2019

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

The articles of interest summarized below will appear in the November 2019 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. This issue will feature Emerging Viruses. The articles are embargoed until October 16, 2019, at 12 p.m. EDT.

1.      Psittacosis Outbreak among Workers at Chicken Slaughter Plants, Virginia and Georgia, USA, 2018, A. Shaw et al.

Psittacosis is a severe respiratory illness that can result from inhalation of aerosolized droppings or respiratory secretions from birds infected with Chlamydia psittaci bacteria. The most common source of psittacosis in the United States is believed to be pet psittacine birds (e.g., parrots, cockatoos), although poultry can be a source of infection. The most recent large poultry-associated outbreaks in the US were reported three decades ago. During August–September 2018, an outbreak of psittacosis was reported among chicken slaughter plant workers in Virginia and Georgia. The slaughter plants suspended operations, and state public health authorities led investigations in their respective states. CDC confirmed the presence of C. psittaci in clinical specimens. C. psittaci was not detected in environmental samples from either plant. After extensive cleaning with EPA-registered disinfectants, the plants were reopened. A health hazard evaluation was conducted at the Virginia plant, and recommendations to reduce bacterial contamination and aerosolization included repositioning cooling fans and ensuring tools used for gutting chickens were working properly. In the absence of a more likely diagnosis, clinicians evaluating poultry slaughter plant workers with febrile respiratory illness should consider psittacosis as a possibility. Clinicians should consult with state health authorities to discuss whether to request testing through CDC, which is the only U.S.-based laboratory using rtPCR to test for C. psittaci in human specimens.

Contact: CDC Media Relations; phone: 404-639-3286 or email:

2.     Comparison of Whole-Genome Sequences of Legionella pneumophila in Tap Water and in Clinical Strains, Flint, Michigan, USA, 2016, Emily Garner et al.

When the city of Flint, Michigan switched its drinking water source from Lake Huron to the Flint River (2014-2015), a failure to continue orthophosphate corrosion control caused problems with elevated lead, red water from iron corrosion, and rapid disinfectant losses. During this same period, 2 outbreaks of Legionnaires’ disease occurred in the county where Flint is located. Legionnaires’ disease is a severe form of pneumonia caused by inhalation of tiny water droplets containing Legionella bacteria. The problems with water quality likely stimulated growth of the Legionella in some of Flint’s building plumbing systems. Researchers used whole genome DNA sequencing to analyze L. pneumophila, the Legionella species most commonly associated with disease, isolated from Flint tap water collected from large and small buildings, from nearby drinking water systems never served by the Flint River, and from Legionnaires’ disease patients. They found that both clinical and tap water L. pneumophila strains were genetically diverse. However, they also noted that 4 out of the 103 strains they isolated from Flint tap water were genetically similar to strains known to cause Legionnaires’ disease, including three strains collected from patients in Michigan in 2015 and the reference Paris strain, isolates similar to which have commonly been recovered from patients throughout France, Europe, and the USA. Thus, there is reasonable evidence that multiple L. pneumophila strains were associated with the Flint 2014–2015 LD outbreaks and that some of the strains collected from tap water were highly similar to strains known to cause disease.

Contact: Emily Garner,; Amy Pruden,; Marc Edwards,

3.    Seasonal Influenza and Avian Influenza A(H5N1) Virus Surveillance among Inpatients and Outpatients, East Jakarta, Indonesia, 2011–2014, Kathryn E. Lafond et al.

Influenza virus causes an estimated 3–5 million cases of severe illness and 291,000–646,000 deaths from respiratory illness each year globally, most in lower-income countries. In addition to seasonal influenza viruses that regularly infect people, highly pathogenic avian influenza A(H5N1) virus circulates in Indonesia among poultry. Indonesia has the second highest number of reported cases (after Egypt) and the highest fatality rate among all countries reporting human H5N1 infections. In East Jakarta, for example, an Indonesia district with high incidence of H5N1 virus infection among poultry, 12 of 13 H5N1 cases reported in humans during 2005–2015 were fatal. During October 2011–September 2014, researchers conducted enhanced surveillance for seasonal and avian flu by screening respiratory specimens among outpatients with flu-like illness and inpatients with severe acute respiratory infection (SARI) in East Jakarta. In total, 31% of flu-like illness case-patients and 15% of SARI case-patients tested positive for influenza virus. Although 28% of case-patients reported exposure to poultry, only 1 SARI case-patient with an H5N1 virus infection was detected. Therefore, targeted screening among case-patients with high-risk poultry exposures (e.g., a recent visit to a live bird market or close proximity to sick or dead poultry) might be a more efficient routine surveillance strategy for H5N1 virus in these types of settings.

Contact: CDC Media Relations; phone: 404-639-3286 or email:

4.    Availability of Injectable Antimicrobial Drugs for Gonorrhea and Syphilis, United States, 2016, William S. Pearson et al.

In the United States, rates of sexually transmitted infections (STIs) are increasing. For the bacterial infections gonorrhea and syphilis, prompt (ideally, the same day as diagnosis) treatment with an injectable antibiotic is critical for national control efforts and can help limit development of drug resistance. To determine how many physicians who treat patients with STIs had injectable antimicrobial drugs available on-site, researchers examined responses to the 2016 Physician Induction File of the National Ambulatory Medical Care Survey, which collects information about practice characteristics and habits of office-based, nonfederal physicians in the United States. They found that of office-based physicians who provide STI services, most did not have on-site access to the recommended injectable medications for gonorrhea (56.1% reported not having ceftriaxone) and syphilis (77.9% reported not having penicillin G benzathine). Possible explanations include high costs of obtaining the drugs, storage requirements, and short shelf-life (time before reconstituted medication must be discarded). Increasing availability of medications needed to treat these infections will help public health officials stop the STI increase.

Contact: CDC Media Relations; phone: 404-639-3286 or email:


Page last reviewed: October 15, 2019