July 2020

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 26, No. 7, Jul 2020

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 July 2020 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. This issue will feature Emerging Viruses. The articles are embargoed until June 10, 2020, at 12 p.m. EDT.

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.     Bat and Lyssavirus Exposure among Humans in Area that Celebrates Bat Festival, Nigeria, 2010 and 2013, Neil M. Vora et al.

Bats can host several organisms harmful to people, including the rabies virus, which is a lyssavirus in phylogroup I. Despite this risk, some people in the Idanre area of Nigeria hold a semi-annual bat festival, during which boys and men enter designated caves to capture bats, typically with their bare hands. Captured bats are cooked and eaten, sold in markets, or used in cultural ceremonies. To determine human exposure to bats and lyssaviruses among people living that area, researchers surveyed residents and bat hunters and tested human and bat samples for evidence of exposure (antibodies) to lyssaviruses. They found strong evidence that lyssaviruses in phylogroup II (which does not include rabies virus) circulate among bats in the festival caves but no evidence of exposures among the people in the area. Regardless, the findings indicate that people who interact with bats in this area are probably at risk for exposure to phylogroup II lyssaviruses. Specific recommendations include educating the population about the health risks (and ecosystem benefits) associated with bats, providing preexposure rabies prophylaxis for bat hunters, and developing capacity to detect outbreaks.

Contact: CDC Press Office, media@cdc.gov or 404-639-3286.

2.     Atypical Manifestations of Cat-Scratch Disease, United States, 2005–2014, Courtney C. Nawrocki et al.

People usually acquire cat-scratch disease by being scratched or bitten by a cat infected with Bartonella henselae bacteria, which are carried by fleas. Most (80% to 95%) people with cat-scratch disease experience the typical signs of fever and a red lump at the site of the scratch or bite, followed by swollen lymph node(s) near the site of the bite/scratch. The other 5% to 20%, however, experience atypical signs, which can involve the eyes, nervous system, heart, liver, spleen, skin, or musculoskeletal system. Atypical cat-scratch disease can be severe, difficult to diagnose, and lead to lasting impairment. To learn more about who is most affected by atypical cat-scratch disease and its associated complications, researchers examined nationwide insurance claims data. They found that atypical cat-scratch disease was most likely to affect female patients 10–14 years of age and least likely to affect older adults 50–64 years of age. The most common organs affected were the eyes and the liver. They also found that persons with atypical cat-scratch disease were more likely to need hospitalization than were those with the typical form of disease. Clinician awareness of these atypical signs and the patient groups at highest risk should lead to earlier diagnoses and treatment.

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

3.    Heartland Virus in Humans and Ticks, Illinois, USA, 2018–2019, Holly C. Tuten et al.

Heartland virus was discovered in 2009 when two human cases were detected at Heartland Regional Medical Center in Missouri; infections were subsequently documented in nearby states. Illness often requires hospitalization and has resulted in death. The virus is believed to be spread by Amblyomma americanum, commonly called the “Lone star tick.” This tick, known for its aggressive biting behavior and willingness to feed on humans, is abundant throughout the southeast and mid-Atlantic states. It has been documented in southern and central Illinois and models suggest it will eventually spread throughout the state. After two cases of human Heartland virus in 2018, the University of Illinois INHS-Medical Entomology Lab and Illinois Department of Public Health collected ticks at the suspected human exposure locations for their statewide tick surveillance program. They developed a novel method to collect live ticks for virus testing at the Centers for Disease Control in Ft. Collins, Colarado. The interdisciplinary team from academia, public health, and wildlife conservation underscores the utility of joining stakeholders together in vector-borne disease investigations. Heartland virus was detected in males from two locations separated by 439 km. Lone star ticks were found at a much higher density than expected at the northern site indicating establishment of this species there. These findings reaffirm A. americanum as the primary vector of Heartland virus. Medical and public health officials should be aware of the possibility of Heartland virus infection in patients as far north as Chicago.

Contact: Holly. C. Tuten, Biocontrol Laboratory, Champaign, IL; email: htuten@illinois.edu; phone: 919-537-6944.

4.     Transmission of Legionnaires’ Disease through Toilet Flushing, Jeanne Couturier et al.

Legionella pneumophila is a bacterium usually found in small amounts in water in nature and humanmade water systems. In larger amounts, L. pneumophila can cause a severe pneumonia known as Legionnaires’ disease. Transmission occurs almost exclusively from the environment, such as when someone inhales contaminated aerosols from nearly any water source. Sources include showers, air conditioning cooling towers, and decorative water fountains. Person-to-person transmission is extremely rare. Although research has implicated some other, uncommon sources of contamination (e.g., supermarket mist machine and windshield washer fluid), transmission through flushing toilets has been suspected but not demonstrated. Researchers now report two cases of Legionnaires’ disease in hospitalized immunocompromised patients hospitalized in the same room five months apart in France, potentially caused by L. pneumophila transmission through flushing contaminated toilets. Whole-genome sequencing analyses showed that clinical isolates from the patients and isolates from the room’s toilet were closely related genetically. Toilet contamination by L. pneumophila could pose a risk for exposure through flushing. However, laboratory-based studies can confirm whether flushing toilets can indeed generate and spread contaminated droplets through the air.

Contact: Jeanne Couturier, Laboratoire de Microbiologie de l’Environnement, Hôpital Saint-Antoine, 75012, Paris, France via media relations office of the AP-HP institution (Assistance Publique-Hôpitaux de Paris) : Service.presse@aphp.fr +01 40 27 30 00.

5.     Surveillance and Testing for Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, March 2016–March 2019, Abdullah Alzahrani et al.

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) can cause severe respiratory illness. About a third of patients reported with MERS have died. Transmission typically occurs through close contact with MERS-CoV–infected patients, particularly in healthcare settings, or through contact with camels. Most cases worldwide have been reported by Saudi Arabia. The Saudi Arabia Ministry of Health monitors MERS-CoV testing and cases throughout the country using the Health Electronic Surveillance Network, an internet-based system for health authorities to gather case reports from health facilities and laboratories. During March 2016 – March 2019, a total of 200,936 suspected cases of MERS-CoV infection were tested in Saudi Arabia; infections were confirmed in 698 cases (0.3% [0.7 cases per 100,000 persons per year]). Continued surveillance is necessary for detecting these cases early and for controlling infections quickly.

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

6.     CrAssphage as a Novel Tool to Detect Human Fecal Contamination on Environmental Surfaces and Hands, Geun Woo Park et al.

A bacteriophage is a type of virus that infects and replicates itself in bacteria. Recently, a new bacteriophage associated with the human gut was discovered by computational analysis of publicly accessible data on the genetic composition of human fecal matter. It was named crAssphage, referring to the Cross-Assembly software that researchers used in its discovery. CrAssphage can be found at high levels in sewage and have been shown to be an indicator of fecal contamination of water sources associated with outbreaks of acute gastrointestinal illness (e.g., those caused by Escherichia coli bacteria or norovirus). Researchers at CDC explored the potential use of crAssphage for detecting human fecal contamination on environmental surfaces and hands. They tested stool samples, hand samples, and environmental swab samples from 17 norovirus outbreaks for crAssphage. They also tested stool samples from healthy people, respiratory samples, and animal fecal specimens, and further sequenced positive samples. Overall, they detected crAssphage in 71.4% of outbreak stool samples, 48%–68.5% of stool samples from healthy persons, 56% of environmental swabs, and 60% of hand rinse samples. However, no crAsspage were detected in human respiratory samples or animal fecal samples, confirming that these organisms are specific to the human gut. In summary, crAssphage can potentially be used to identify environmental surfaces, in settings where norovirus outbreaks are common, for enhanced cleaning and disinfection (e.g. long-term care facilities, cruise ships).

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



Page last reviewed: June 18, 2020