March 2019

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 25, No. 3, March 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 March 2019 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. Articles are embargoed until February 13, 2019, at 12 p.m. EST

1. Case Investigations of Infectious Diseases Occurring in Workplaces, United States, 2006–2015, Chia-ping Su, et al.

Although the risk for acquiring a work-related infectious disease has been known for a very long time, much remains unknown about workplace infections. To summarize what has been learned from recent investigations of infectious disease occurring in US workplaces, researchers performed a literature search. They identified healthcare, laboratory, animal, and public service workers to be the most common industries and occupations involved in work-related cases of infectious disease. The researchers concluded that considering occupational risk factors, strengthening biosafety programs in those industries and involving epidemiologists, physicians, industrial hygienists, and engineers could help prevent spread of occupationally acquired infectious diseases to co-workers and the general public.

When published, this article will be available at

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

2. University-Based Serogroup B Meningococcal Disease Outbreaks, United States, 2013–2018, Heidi M. Soeters, et al.

Meningococcal disease is a severe, life-threatening illness, but it can be prevented by vaccination. During 2013–2018, a total of 10 outbreaks of serogroup B meningococcal disease occurred at universities in 7 US states, causing 39 cases and 2 deaths. In response, the universities affected by those outbreaks introduced serogroup B meningococcal vaccine to quickly increase the percentage of vaccinated students (vaccination coverage). Although decisions about whether, when, and how to offer vaccine during an outbreak remain challenging and should be tailored to each unique outbreak, high vaccination coverage is important to help protect people during outbreaks of meningococcal disease caused by serogroup B.

When published, this article will be available at

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

3. Response to Isoniazid-Resistant Tuberculosis in Homeless Shelters, Georgia, USA, 2015–2017, David P. Holland, et al.

Overall in the United Sates, the number of tuberculosis (TB) cases is decreasing; but among homeless populations, outbreaks continue. TB infections can be latent (the organism is inactive; the person does not feel sick and is not contagious) or active (is causing disease). Persons with latent TB can take medicine that prevents them from getting active TB. In 2008, a total of 7 cases of active tuberculosis (TB) were reported in Fulton County, Georgia. The causative strain, which was resistant to the common treatment drug, isoniazid, was linked to 1 homeless shelter in Atlanta. Initial efforts to control the outbreak (testing only persons at affected shelters) failed. In 2014, the Metro Atlanta TB Task Force was formed, comprising the Fulton County Board of Health; a local Federally Qualified Health Center; and representatives from public health, homeless shelters, and other community service providers. The Task Force provided a coordinated response in which testing targeted the entire population of persons experiencing homelessness instead of individual facilities at which TB cases had been identified. This approach bypassed some of the challenges of disease prevention in homeless shelters (e.g., frequent mobility of residents, lack of accurate rosters for overnight residents, and lack of consistent TB screening procedures) and successfully interrupted the outbreak. For this outbreak, implementing screening at all shelters markedly increased the number of persons tested and given treatment for latent TB.

When published, this article will be available at

Contact: Alicia Cardwell Alston, District Communications Director, Fulton County Board of Health, email or phone 404-613-3544.

4. Utility of Whole-Genome Sequencing to Ascertain Locally Acquired Cases of Coccidioidomycosis, Washington, USA, Hanna N. Oltean et al.

Coccidioidomycosis, also known as Valley fever, is a disease of growing public health concern and is caused by two closely related fungal species, Coccidioides immitis and C. posadasii. This fungus resides in soil and can infect humans who inhale soil or dust that has been disturbed. Infection can lead to a wide spectrum of conditions, ranging from no symptoms at all, to mild pulmonary disease, to severe pulmonary disease that can be life threatening. Because the epidemiology of coccidioidomycosis in Washington State, USA, is poorly understood, researchers conducted whole-genome sequencing to differentiate the genetic makeup of the infecting fungi in locally acquired cases. Genetic differences among those strains suggest that there are multiple locations in the environment (environmental reservoirs) for Coccidioides throughout the state. As demonstrated in this study, whole-genome sequencing can be a valuable tool for determining the location of the patient’s exposure to Coccidioides, especially when exposure histories are unclear or unknown. This differentiation is critical to furthering our understanding of the burden and distribution of disease in Washington State.

When published, this article will be available at

Contact: Elizabeth Coleman, Washington State Department of Health; email:; phone 360-481-2016

5. Seroprevalence of Enterovirus D68 in Children and Adults before 2014 Outbreak, Kansas City, Missouri, USA, Christopher J. Harrison et al.

Enterovirus D68 (EV-D68) was first identified in 1962, and for the first half-century after its discovery, outbreaks of EV-D68 infection were infrequently identified (<100 sporadic cases and periodic outbreaks reported in 50 years). In autumn 2014, however, 1,153 confirmed EV-D68 cases were reported across the United States. Patients had mostly mild to moderate respiratory symptoms, but severe respiratory illness also occurred, mostly in school-aged children, many of whom had to be hospitalized. The 2014 nationwide outbreak led researchers at the Children’s Mercy Hospital in Kansas City, Missouri, USA, to assess local EV-D68 seroprevalence (i.e., the amount of neutralizing antibodies in a person’s blood and blood products [serum] that indicate an immune response to EV-D68). All 436 serum samples tested had neutralizing antibody against major circulating EV-D68 strains from 2014, suggesting that introduction of EV-D68 to an epidemiologically “naïve” population might not explain the 2014 outbreak. Why this large outbreak occurred despite the high prevalence of neutralizing antibody against the outbreak strains remains unclear, but enteroviruses do not induce antibodies that prevent all subsequent infections so reinfections may be common. The findings warrant additional, prospective studies that attempt to determine the level and nature (e.g. humoral vs. mucosal) of neutralizing antibody required to prevent reinfection with EV-D68, the distribution of antibody levels in children <2 years of age, and whether antibody levels differ among different races and ethnicities. Such investigations into host, virus and immune factors may help extend our knowledge regarding EV D68 outbreaks; and help us understand if and how they relate to Acute Flaccid Myelitis (AFM) cases.

When published, this article will be available at

Contact: Jake Jacobson, Children’s Mercy Hospitals and Clinics; email:



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