April 2019

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 25, No. 4, April 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 https://wwwnc.cdc.gov/eid/ahead-of-print.

The articles of interest summarized below will appear in the April 2019 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. The articles are embargoed until March 13, 2019, at noon eastern time.


1. Genomic Survey of Bordetella pertussis Diversity, United States, 2000–2013, Michael R. Weigand et al.

In the United States, cases of the vaccine-preventable disease whooping cough (pertussis) are increasing. One possible cause, among others, may be that B. pertussis circulating in the environment undergoes genetic variation so that it no longer matches that of the vaccine. Until recently, detailed genetic information was available only for B. pertussis used in laboratories (vaccine and laboratory reference strains). To learn more about the B. pertussis circulating in communities, researchers studied isolates recovered from ill patients during 2000–2013. They found that that the genetic make-up of B. pertussis in the environment is indeed shifting away from the laboratory strains used to make vaccines during this period of increasing disease. Although the current vaccines remain effective, this study highlights the value of using advanced genetic analyses to improve vaccine formulations.

When published, this article will be available at https://wwwnc.cdc.gov/eid/article/25/4/18-0812_article

Contact: CDC Media Relations; phone: 404-639-3286 or email: media@cdc.gov


2.  Self-Flagellation as a Possible Route of Human T-Cell Lymphotropic Virus Type-1 Transmission, Alice R. Tang et al.

Human T-cell lymphotropic virus type 1 (HTLV-1) can be transmitted sexually, through contaminated blood products, through organ transplantation, or from mother to child. Although disease occurs in <10% of persons who carry the virus, 2%–6% of carriers may develop adult T-cell leukemia/lymphoma, an aggressive form of cancer that kills many patients within 8–10 months despite therapy. Researchers recently investigated HTLV-1 infection associated with self-flagellation in 10 men living in the United Kingdom. Self-flagellation, one of several practices in which piercing of the body occurs as part of religious practice, typically involves beating the back with implements attached to ropes or chains, resulting in skin lacerations, as part of a public or private religious practice. In all 10 cases, the sharing of blood-stained blades, re-use of personal equipment after inadequate cleaning with a shared disinfectant or contact of infected blood with open wounds probably resulted in HTLV-1 transmission. Medical practitioners have advised all patients not to share implements during self-flagellation and to encourage fellow practitioners to be tested for blood borne viruses, including HTLV-1. The researchers have since visited the communities in which these practices occur to discuss risk elimination, raise awareness, and promote testing.

When published, this article will be available at https://wwwnc.cdc.gov/eid/article/25/4/18-0984_article

Contact:  Divya Dhasmana, National Centre for Human Retrovirology, Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, via Charlie King, media manager, phone: 020 3313 3005 or email: CHARLIE.KING1@NHS.NET


3.  Pneumonic Plague in a Dog and Widespread Potential Human Exposure in a Veterinary Hospital, United States, Paula A. Schaffer et al.

In December 2017, a dog infected with pneumonic plague was brought to a veterinary teaching hospital in northern Colorado, USA. Several factors contributed to a delayed diagnosis and resulted in the potential exposure of at least 116 persons and 46 concurrently hospitalized animals to Yersinia pestis, the bacterium that causes plague. Pneumonic plague is uncommon in dogs; most dogs with plague have bubonic or septicemic plague. Also, the case occurred in December, which is outside the predominant period of plague transmission in the Northern Hemisphere (April–October). Moreover, some of the clinical findings, including lung x-ray and CT scan studies, were not consistent with Y. pestis infection. Despite the delay, no cases of Y. pestis infection occurred in potentially exposed humans or animals. The hospital is updating its standard operating procedures to account for the fact that dogs might be affected with plague year-round and that expected clinical manifestations might not be present. This incident underscores the need for any veterinary hospital administration to continue to educate staff about diseases spread by animals, prevent exposures, and communicate rapidly to personnel when potential exposures occur. Because the usual route of transmission of Y. pestis to cats and dogs is flea bites, the control of fleas by pet owners would also aid in the prevention of plague.

When published, this article will be available at https://wwwnc.cdc.gov/eid/article/25/4/18-1195_article

Contact: Kris Browning-Blas, Director of Communications, Colorado State University College of Veterinary Medicine and Biomedical Sciences, phone: 970-491-6915, or email: kristen.browning-blas@colostate.edu.


4.  MERS-CoV Infection Dynamics and Antibody Responses among Clinically Diverse Patients, Saudi Arabia, Hail M. Al-Abdely et al.

Infection with Middle East respiratory syndrome coronavirus (MERS-CoV) results in a wide range of clinical presentations, from asymptomatic or mild illness to severe respiratory failure. About 35% of cases reported globally to the World Health Organization have died. Most cases have been reported in older adults with underlying medical conditions. MERS-CoV shedding (i.e., release of virus progeny after replication of the virus during infection) and immune system response (the production of antibodies) are not fully understood, particularly in relation to outcome, clinical manifestations, underlying medical conditions, and pre-illness exposures. To address some of those knowledge gaps, researchers enrolled MERS-CoV–positive patients at a single hospital between August 1, 2015, and August 31, 2016, and periodically collected specimens for testing. They also interviewed patients and reviewed medical charts to collect clinical, epidemiologic, and laboratory information. A key finding was that researchers found evidence of MERS-CoV infection for a longer period in survivors who had diabetes compared to other survivors. Another was the observation that among patients who died, the development of  a strong antibody response during the second and third week of illness was not sufficient for the patients to recover. These findings have fundamental implications for infection control policies in healthcare settings and the development of vaccines and immune therapies.

When published, this article will be available at https://wwwnc.cdc.gov/eid/article/25/4/18-1595_article

Contact: CDC Media Relations; phone: 404-639-3286 or email: media@cdc.gov

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Page last reviewed: July 25, 2019