May 2020

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 26, No.5, May 2020

The articles of interest summarized below will appear in the May 2020 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. The articles are embargoed until April 15, 2020, at noon Eastern time.

Important note for journalists and reporters: 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 of the institutions with which the authors are affiliated.

EID requests that, when possible, you include direct links to the actual journal article in your stories. Once the embargo lifts, this month’s articles will be found in the Early Release section of the EID website.

EID is publishing many articles on the COVID-19 pandemic. Because we publish those articles on an expedited track, and we have no embargo on their content, we do not include them in these monthly press notices. You may wish to subscribe to receive email notifications when EID publishes expedited articles as well as other types of articles.

Note that the most recent EID COVID-19 papers are at the top of the journal’s home page and also included in the Coronavirus Spotlight.

1.     Women’s Awareness and Healthcare Provider Discussions about Zika Virus during Pregnancy, United States, 2016–2017. Letitia Williams et al.

Infection with the Zika virus, which is transmitted primarily by the Aedes aegypti and Aedes albopictus mosquitoes, is a serious threat to pregnant women because of the risk for serious birth defects in infants, including microcephaly (abnormal smallness of the head caused by incomplete brain development). In late 2015, an unprecedented Zika outbreak emerged in South America and spread rapidly into other parts of the Americas. Although travel advisories and guidance about Zika were published during the outbreak, the level of Zika awareness among pregnant women in the continental United States (US) was largely unknown. CDC assessed data from the Pregnancy Risk Assessment Monitoring System to gauge whether a sample population of women in 17 US states who delivered a live infant during the outbreak were aware of Zika. Among those who were aware, discussions about Zika with a healthcare provider and knowledge about travel advisories to avoid Zika-affected areas during pregnancy were assessed. Zika awareness was high, as was awareness of CDC travel advisories to avoid travel to Zika-affected areas during pregnancy (both >90%). Younger women, women with less education, and women who reported Medicaid as a source of delivery payment were less aware about Zika. In addition, about 59% of women reported only moderate levels of discussion with health care providers, with approximately a third of those discussions initiated by the women themselves. A smaller proportion of women with Medicaid coverage at delivery and those who were uninsured reported provider discussions. These findings suggest the opportunity to support provision of evidence-based provider discussions to all women, especially in the case of public health threats.

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

2.   Mosquito Control Activities during Local Transmission of Zika Virus, Miami-Dade County, Florida, USA, 2016. Janet C. McAllister et al.

Zika virus (ZIKV) can cause serious birth defects and has rapidly spread throughout the Western Hemisphere. The virus is spread primarily by the bite of infected Aedes aegypti mosquitoes. Miami-Dade County, Florida,  has well-established Aedes aegypti mosquito populations and is a major travel destination. The county also has a large population of residents who routinely visit countries that had ZIKV outbreaks in 2016. In 2016, four clusters of local mosquito-borne Zika virus transmission were identified in Miami-Dade County, generating “red zones” (areas into which pregnant women were advised against traveling). The Miami-Dade County Mosquito Control Division initiated intensive control activities, including property inspections, community education, and handheld sprayer applications of larvicides and adulticides. For the first time, the Mosquito Control Division used a combination of areawide spraying to effectively control adult Aedes aegypti mosquitoes and their larvae. The number of mosquitoes rapidly decreased, and Zika virus transmission was interrupted within the red zones immediately after the combination of adulticide and larvicide spraying. These results reinforce the necessity of this combination approach to achieve and sustain progress in the effort to eradicate Zika.

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

3.   Multidrug-Resistant Salmonella Serotype Anatum in Travelers and Imported Seafood from Asia, United States. Beth Karp et al.

Multidrug-resistant strains of Salmonella can cause infections in humans and can be carried by animals, including those used for food. During 2016–2017 in Taiwan, the number of people infected with a multidrug-resistant strain of Salmonella enterica serotype Anatum increased sharply. Recently, scientists isolated this strain of bacteria from seven patients in the United States and from seafood imported from Asia to the United States. The strain carried a gene that can complicate antimicrobial susceptibility testing and treatment. Most patients probably acquired the infection while traveling in Asia. Imported food was the likely source of infection for one patient who did not travel internationally. Given the extent of international travel and trade, data sharing across geographic borders and among human health, animal health, and food production sectors (the One Health surveillance approach) is essential for detecting drug-resistant strains of bacteria and for developing strategies and interventions to prevent global spread of drug-resistant bacteria.

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

4.   Food Safety and Invasive Cronobacter Infections during Early Infancy, 1961–2018. Jonathan Strysko et al.

Cronobacter bacteria can cause severe and often life-threatening infections in infants. Early reports associated infections with hospitalized and preterm infants and consumption of contaminated powdered infant formula. In light of recent regulatory actions, enhanced surveillance and prevention efforts, and newly described modes of transmission (breast milk), researchers analyzed all cases of invasive Cronobacter infection among infants reported to CDC and documented in the literature during 1961–2018. They found continued evidence that invasive Cronobacter infections still primarily affect newborns but that there is also an increasing trend of cases among non-hospitalized and full-term infants. The most commonly identified source is open containers of contaminated powdered infant formula. These findings indicate the need to promote safer alternatives to powdered infant formula, particularly for newborns. Safer alternatives include direct breastfeeding, feeding with breastmilk that has been expressed safely, and feeding with liquid formula that has been safely handled and stored.

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

5.   Hepatitis A Hospitalization Costs, United States, 2017. Megan G. Hofmeister et al.

In the United States, the introduction of hepatitis A vaccine led to a dramatic decline in cases. However, beginning in 2016, the United States has experienced person-to-person outbreaks that are unprecedented in the vaccine era, during which a high proportion of patients have been hospitalized. To provide information useful for prevention efforts, researchers examined the costs of these hospitalizations. Data from the 2017 Healthcare Cost and Utilization Project National Inpatient Sample indicated that the average costs per hepatitis A–associated hospitalization in the United States in 2017 was $16,232, translating to total estimated hospitalization costs associated with the person-to-person outbreaks in excess of $300 million through February 2020. Given that only about 10% of U.S. adults report having received the two-dose hepatitis A vaccine series, increased vaccination coverage of those most at risk would help lower the financial burden on the healthcare system.

Contact: NCHHSTP News Media Team,, 404-639-8895


Page last reviewed: December 19, 2019