August 2020

Emerging Infectious Diseases Journal

Highlights: Emerging Infectious Diseases, Vol. 26, No. 8, August 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

The articles of interest summarized below will appear in the August 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 July 15, 2020, at 12 p.m. EDT.

1.     Factors Associated with Prescription of Antimicrobial Drugs for Dogs and Cats, United Kingdom, 2014–2016, David A. Singleton et al.
Inappropriate use of antimicrobial drugs (including overuse and inappropriate choice of drug or treatment regimen) promotes transmission of drug resistance in humans, livestock, and companion animals (e.g., dogs, cats). The role of companion animals in antimicrobial resistance is being increasingly realized, partly because these animals reside so closely with humans. Thus, to determine factors that influence veterinarians to prescribe antimicrobial drugs for companion animals, researchers analyzed electronic health records for dogs and cats seen by veterinarians in the United Kingdom during 2014–2016.  They found decreased antimicrobial drug prescriptions for animals owned by clients concerned about preventive health (i.e., had their animals vaccinated, insured, neutered) and at practices accredited by the Royal College of Veterinary Surgeons. They also found increased antimicrobial drug prescriptions for animals seen for respiratory rather than for gastrointestinal problems. Although decisions about prescribing antimicrobial drugs are multifactorial and complex, these findings indicate that these decisions might be positively influenced when veterinarians follow the Royal College of Veterinary Surgeons Practice Standards Scheme, focus client messages on preventive healthcare, and are informed about the use of antimicrobial drugs for treating respiratory conditions.

Contact: David A. Singleton, University of Liverpool, Epidemiology and Population Health, Neston, UK; email:

2.     Sporadic Creutzfeldt-Jakob Disease among Physicians, Germany, 1993–2018, Peter Hermann et al.

Creutzfeldt-Jakob disease (CJD) is an invariably fatal condition characterized by progressive dementia and other neurologic signs and symptoms; it is caused by a transmissible protein called a prion. There are several ways that the CJD prion can be spread among people, and one of them is inadvertent spread during healthcare (e.g., through growth hormones derived from cadavers, dura mater grafts, neurosurgical instrument contamination, and corneal grafts). To determine whether healthcare workers, particularly physicians, are at risk for CJD, researchers analyzed data for patients with the most common type of CJD (sporadic CJD) from 25 years of CJD surveillance in Germany. They observed that the annual number of physicians with CJD has increased over time. In recent years, sporadic CJD patients were significantly more likely than the general population to be physicians. The authors discuss their observations critically, but the data indicate that CJD might be an occupational risk factor for physicians.

Contact: University of Göttingen Corporate Communication, Press and Public Relation, Head and Press officer: Stefan Weller, University Medical Center Göttingen, Göttingen, Germany; phone: +49-551-39-61020 and email:

3.    Heartland Virus in Lone Star Ticks, Alabama, USA, Brent C. Newman et al.

Researchers have detected heartland virus (HRTV) in lone star ticks in northern Alabama, a state that is home to these ticks but where tickborne HRTV has not been documented previously. HRTV was first identified in the United States in 2009 and is now reported in 15 states. Lone star ticks (Amblyomma americanum) are the primary vectors for HRTV, meaning they spread the virus to hosts, including people, by feeding on their blood. People infected with HRTV typically experience a pronounced flu-like illness requiring hospitalization, and about 10% of them do not survive. Researchers analyzed lone start ticks (in the nymph and adult stages of development) collected in 2018 and found that the HRTV the ticks carried was genetically very similar to strains from Tennessee and Missouri. As the geographic range of lone star ticks continues to expand, these researchers encourage enhanced surveillance and screening for HRTV to provide a more accurate and up-to-date understanding of where this virus is occurring in the United States.

Contact: Brent C. Newman, Tennessee State University, Department of Agricultural and Environmental Sciences, Nashville, TN, phone: 972-897-2268 and email:

4.    Characterizing Norovirus Transmission from Outbreak Data, United States, Molly K. Steele et al.

Norovirus is the leading cause of outbreaks of acute gastrointestinal illness (or acute gastroenteritis [AGE]) in the United States. CDC collects data on AGE outbreaks through the National Outbreak Reporting System (NORS). During 2009–2017, norovirus was the suspected or confirmed cause of 47% of more than 7,000 AGE outbreaks reported to NORS. The size and severity of outbreaks varied by time of year and setting, suggesting that those factors might affect how norovirus is transmitted, so researchers applied regression modelling to assess the extent to which transmission varied by outbreak setting and season. Overall, they saw little variability in transmission across different outbreak settings in the United States. Long-term care and assisted-living facilities saw the highest transmissibility of norovirus, but it was not substantially different than what was observed for outbreaks in schools, colleges, and universities. The virus was least transmissible in summer and most transmissible in fall and winter. Better data on the total exposed population sizes in outbreaks, which heavily influence estimates of transmissibility and attack rates, are needed to further refine estimates of the factors affecting norovirus outbreaks.

Contact: Catherine Morrow, Communications Coordinator, Emory University, phone: 904-501-8783 and email:



Page last reviewed: October 13, 2020