April 2022

Emerging Infectious Diseases Journal

The articles of interest summarized below will appear in the April 2022 issue of Emerging Infectious Diseases, CDC’s monthly peer-reviewed public health journal. The articles are embargoed until March 16, 2022, at noon Eastern time.

Important Note: Most articles that EID publishes do not represent work done at CDC or by CDC staff. In your stories, please use our suggested language to clarify whether a study was conducted by CDC (“a CDC study”) or by another institution (“a study published by ____ 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.

Please link directly 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. Decrease in Tuberculosis Cases during COVID-19 Pandemic as Reflected by Outpatient Pharmacy Data, United States, 2020, Kathryn Winglee et al.z
    The COVID-19 pandemic has affected many areas of public health, including tuberculosis (TB) prevention and response. TB cases reported to the U.S. National Tuberculosis Surveillance System in 2020 decreased 20% compared with the average number of cases reported during 2016–2019. Although some annual decline is expected in light of public health investments in TB control and prevention, TB incidence decreased an average of only 2%–3% annually during the previous 10 years. A decline of nearly 20% raises concern that TB cases are being left undetected or unreported to public health agencies. This decline likely represents true reduction in TB disease, as well as missed or delayed TB disease diagnoses which may be due to factors associated with the COVID-19 pandemic, including pandemic mitigation efforts, reduced immigration leading to fewer cases among persons newly arriving in the United States from regions where TB disease is more common, or underreporting of cases. Scientists at CDC analyzed pharmacy data, namely anti-TB medication dispensing, to determine the extent to which this decline was actual, a result of underreporting (but still treated), or an indicator of missed or delayed TB diagnoses. The pharmacy data also showed large declines in 2020, which strongly correlated with national TB surveillance case counts, helping to rule out underreporting as a cause. However, the strong possibility of underdiagnosis means that public health programs should be prepared for a possible rebound in TB cases after the pandemic, given that delayed and missed diagnoses could result in increased transmission because people with TB disease remain infectious for longer periods of time. Timely diagnoses of TB disease save lives and prevents further spread in communities.
    Contact: CDC’s National Center for HIV, Viral Hepatitis, STD, and TB Prevention media relations, phone: 404-639-8895 or email: NCHHSTPmediateam@cdc.gov
  2. Isolation of Heartland Virus from Lone Star Ticks, Georgia¸ USA, 2019, Yamila Romer et al.
    Since Heartland virus was identified as the cause of severe human illness in 2009 and associated with exposure to lone star ticks (Amblyomma americanum), more than 50 cases of Heartland virus disease have been identified in the United States. Most cases were severe or fatal and affected people with other health conditions. The presence of RNA (genetic information) from the virus has been detected in A. americanum ticks from Missouri, Alabama, Illinois, Kansas, and New York. After a fatal case was reported Georgia, researchers explored virus distribution by collecting ticks near the patient’s geographic location and performing molecular testing of isolated virus. They detected Heartland virus in 0.46 of every 1,000 ticks, confirming its presence in Georgia. This information about the expanding geographic range of lone star ticks, combined with increased human presence in tick-infested habitats, can be used to improve strategies for preventing tick bites and to alert physicians about this emerging tickborne virus infection.
    Contact: Gonzalo Vazquez-Prokopec, Emory University, Mathematics and Science Center, Atlanta, GA; email: gmvazqu@emory.edu or Carol Clark, Senior Science Communicator, Emory University; email: carol.clark@emory.edu
  3. Molecular Surveillance for Imported Antimicrobial Resistant Plasmodium falciparum, Ontario, Canada, Ruwandi Kariyawasam et al.
    Malaria remains the deadliest vector-borne infectious disease worldwide. Parasites of the genus Plasmodium, most commonly P. falciparum, are responsible for nearly 229 million cases and half a million deaths from malaria every year. Although malaria cases and deaths have decreased over the past decade, emerging antimalarial drug resistance, fueled by counterfeiting, overuse, and underdosing, threatens this progress. Moreover, increased international travel and climate change are exacerbating the spread of malarial vectors (e.g., certain species of mosquitoes), making drug-resistant P. falciparum malaria imported from endemic regions, in particular Africa and Southeast Asia, a growing concern. Because surveillance of antimalarial drug resistance is crucial to create universal treatment guidelines and to identify global patterns of emerging resistance, researchers aimed to identify the prevalence of several resistance markers, including genes that can cause resistance to the most commonly used antimalarial drugs (chloroquine, mefloquine, atovaquone/proguanil, and artemisinins) and to determine the number of multidrug-resistance genes appearing in P. falciparum isolates from patients with imported malaria cases in Ontario, Canada, over a 10-year period. They observed fewer mutations indicative of chloroquine resistance and more mutations conferring proguanil resistance. Importation of resistant P. falciparum infections highlights the importance of developing better surveillance tools to monitor drug-resistance patterns.
    Contact: Andrea K. Boggild, Tropical Disease Unit, Toronto General Hospital, Ontario, Canada; email: andrea.boggild@utoronto.ca


Page last reviewed: March 15, 2022