Our Work - 2021
To reflect the current state of the COVID-19 pandemic, NCEZID updated the COVID-19 Travel Health Notices (THN) to better differentiate countries with severe outbreak situations from countries with sustained, but controlled, COVID-19 spread. THNs give specific travel advice for vaccinated and unvaccinated people according to the THN level. Every Monday, THNs are updated to ensure levels reflect the current global situation and are aligned with guidance for international travel.
On June 5, 1981, CDC publishedexternal icon a description of the first known cases of what would come to be known as AIDS. The pandemic disease has since infected 75 million people globally, killing 32 million. To mark the 40th anniversary of the discovery of HIV/AIDS, three veteran CDC leaders in the response to the pandemic offer their reflections in a June 2021 article in NCEZID’s journal Emerging Infectious Diseases. The authors examine efforts of the past 10 years with an emphasis on biomedical solutions to treat HIV/AIDS and slow its spread. They also describe other strengths of the response to HIV/AIDS from funding to coordination and tragic challenges like discrimination and exclusion. The response to HIV/AIDS has been useful in gauging successes and challenges in pandemic responses that have followed. The authors remind us that, despite medical advances that are saving millions of lives, HIV/AIDS is far from over, and the global rate of new infections is high.
In this podcast, author Dr. Kevin De Cock relates the fight against HIV/AIDS to other disease responses, including to COVID-19.
On June 19, the Republic of Guinea (Guinea) Ministry of Health and the World Health Organization declared the end of the Ebola outbreak in Guinea. A total of 23 cases and 12 deaths were reported in the outbreak that was announced on February 14, 2021. A 90-day enhanced surveillance period began at the end of the outbreak to ensure that any new case is quickly detected and responded to. In the Democratic Republic of the Congo, the post-outbreak 90-day enhanced surveillance period, which began on May 3, 2021, is set to end in early August if there are no new cases.
Starting July 14, 2021, new rules were enacted to prohibit dogs entering the United States from countries at high risk for dog rabies. CDC has published a Federal Register Notice pdf icon[PDF – 43 pages]external icon announcing the temporary suspension. There is an exception: dogs with a CDC Dog Import Permit issued in advance of the dog’s arrival may enter. “Then and Now” changes are outlined and explained in FAQs. The suspension protects dogs and people from a reintroduction of dog rabies into the United States. About 98% of human victims of rabies around the world get this fatal disease from dogs. In June, CDC was informed that a dog confirmed to have rabies was brought into the United States. This shows how timely and necessary the new suspension is.
NCEZID is investigating several multistate foodborne and animal-borne outbreaks, including the following:
- Salmonella infections linked to raw frozen breaded stuffed chicken. As of June 2, six states have reported 17 cases with eight hospitalizations and no deaths.
- Salmonella infections linked to backyard poultry. As of June 17, a total of 474 people in 46 states have been reported as infected with one of the outbreak strains. Illnesses started on dates ranging from December 15, 2020, to June 4, 2021.
- Salmonella infections linked to frozen cooked shrimp. As of June 25, two states have reported 6 cases with two people hospitalized and no deaths. A Food Safety Alert was posted June 25, and the product has been recalled.
What impact does the work of a public health laboratory (PHL) have on detecting and responding to a Salmonella outbreak? To help put the impact in numbers, NCEZID partnered with the Association of Public Health Laboratories to create the PHL Impact tool. It uses data from the lab’s jurisdiction to show a laboratory’s contribution to testing for Salmonella. The tool can also be used to estimate how many people a public health response has protected from infection and hospitalization and how much in medical costs a public health response saved.
NCEZID has been investigating two clusters of infections with the fungus Candia auris that were reported between January and April 2021 in Texas and Washington, DC. Of 126 cases identified, five were confirmed to be caused by C. auris resistant to all major antifungal drugs. All infections in both states were identified in healthcare settings. Although infections with strongly drug-resistant C. auris have been identified previously in the United States, these clusters of infections are the first in the country suspected of spreading from person to person. So far, the infections in both states do not appear to be connected.
More healthcare professionals will begin their careers with the knowledge they need to protect themselves and patients from infectious diseases thanks to a new NCEZID collaboration. Project Firstline, CDC’s infection control training collaborative, is now partnering with the American Hospital Association and the League for Innovation in the Community College to integrate enhanced infection control coursework into community colleges that train healthcare professionals. The program launched this summer with more than a dozen participating community colleges. Faculty teams across the collaboration will help tailor coursework for nursing and allied health students.
Experts in antibiotic resistance (sometimes called AR) continually learn from one another. To help them do so, NCEZID’s AR Coordination and Strategy Unit started the Global AMR Exchange webinar series as a way to share knowledge and information with partners around the world. The first webinar, available online, featured experts from CDC and international organizations to discuss the latest research and lessons learned, while identifying solutions to help fight antibiotic resistance after COVID-19 with a One Health approach. Antibiotic-resistant germs—bacteria and fungi that resist drug treatment—cause over 2.8 million infections in people each year in the United States. More than 35,000 of these infected people die.
You can now registerexternal icon for the second webinar, featuring experts discussing antibiotic resistance and water.
More than 450,000 people from around the country attended the Sturgis Motorcycle Rally in South Dakota on August 7–17, 2020. Public health officials already knew then that a gathering that large could cause significant spread of COVID-19. A recent reportexternal icon by NCEZID staff and members of CDC’s COVID-19 response team traced 649 COVID-19 cases, 17 hospitalizations, and one death in various parts of the country back to the motorcycle rally. People who got COVID-19 included rally attendees, their close contacts, and contacts of contacts. The actual numbers of infections that came from the rally were likely higher than those in the study, but the data in the study alone show that the rally was a superspreading event. The study is a reminder of how important it is to communicate with the public about COVID-19, to take steps like wearing a mask and staying at least 6 feet apart if not fully vaccinated, and to encourage people to get tested during and after large events. Although COVID-19 vaccines were not available at the time of the rally, the report also serves as a reminder that people should be vaccinated before attending large gatherings to keep from getting and spreading COVID-19.
On May 3, the Democratic Republic of the Congo (DRC) Ministry of Health and the World Health Organization declared DRC’s Ebola outbreak over. For the outbreak to be declared over, 42 days had to pass with no new cases since the last survivor tested negative and was discharged from the Ebola treatment unit. During the outbreak, 12 people became sick with Ebola, six of whom died. A 90-day enhanced surveillance period started at the end of the outbreak to quickly detect and respond to any new cases. In Guinea, the countdown to the end of their Ebola outbreak started on May 8. As of June 6, 23 people have become sick, 12 of whom have died. NCEZID staff continue to support the preparedness, response, and post-outbreak efforts in affected and border countries.
The spread of rabies in dogs is increasing in Haiti, and NCEZID staff have created materials to alert travelers to the danger. The materials include an online Travel Health Notice, an alert card for airline gate agents to distribute to passengers traveling to Haiti, and a script for airline crew to read aloud to passengers on direct flights between Miami/Fort Lauderdale and Haiti. The information tells travelers to avoid any contact with dogs and cats in Haiti and to seek medical care right away if they are bitten, licked, or scratched. The materials also advise travelers to seek medical care outside of Haiti because human rabies vaccine is in limited supply in that country. Since April, three residents of Haiti have died from rabies, highlighting the need for these prevention materials. Only national and routine dog vaccination campaigns will eliminate rabies from Haiti, and it is unclear when those campaigns – halted due to COVID-19 – will resume.
Infections with monkeypox, a disease similar to smallpox but with milder symptoms, have nearly doubled in the Democratic Republic of the Congo (DRC) since the early 1980s. A reportexternal icon co-authored by NCEZID staff on the spread of monkeypox in Tshuapa Province, DRC, was recently published in the Journal of Infectious Diseases. In the report, more men than women had monkeypox. The single largest group of people who became infected were males 10-19 years old. This group also reported the most contact with animals likely to carry monkeypox, such as small rodents. Women aged 20-29 had the second largest rate of monkeypox infections. Women in that age group had frequent contact with other people who had common monkeypox symptoms. Rates of monkeypox were lower for people who had received a smallpox vaccine prior to the disease’s eradication. This suggests that the vaccine, which these people received prior to its discontinuation in 1980, provides some long-term protection against monkeypox. Monkeypox is an understudied disease and can be deadly for as many as 10% of people who fall sick with it.
CDC has published the first comprehensive guidelines for healthcare professionals to treat botulism. Current and former NCEZID staff spent years developing the guidelines using extensive expert input and scientific reports spanning 100 years. The guidelines provide
- Best practices for diagnosing, treating, and monitoring people with botulism
- Special considerations for infants, children, and pregnant or breastfeeding patients
- Suggestions for supportive care, including helping patients and family members cope with the disease
Healthcare professionals can use the guidelines if they’re treating one patient or many patients. The guidelines would be especially useful during an outbreak in which resources such as ventilators, medical staff, and botulism antitoxin might be in short supply.
May was Lyme Disease Awareness Month, and NCEZID developed communication materials urging people to “get the tips” to “stop the ticks.” Staff worked with a marketing agency to develop entertaining cartoon tick bite prevention videos and images for social media, as well as a full-page tick bite prevention insert in the May 16 edition of the Washington Post. See the content (and like it) by following @CDC_NCEZID and @CDC on Twitter.
CDC continues support to recipients through ELC Reopening Schools awards
CDC’s Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) program continues to distribute funds and provide technical support to recipients as they respond to COVID-19. On April 9, ELC awarded $10 billion to 64 recipients through the American Rescue Planexternal icon. ELC Reopening Schools awards support COVID-19 screening testing programs to help K–12 (public and private) schools to reopen or stay open safely. ELC recently hosted a webinar for 600+ attendees, where they were engaged by CDC, White House Task Force, Health and Human Services (HHS), Rockefeller Foundation, and school subject matter experts from the field. This webinar provided technical assistance and actionable information on using ELC funds to launch or expand school screening testing programs.
Ebola outbreaks in Democratic Republic of the Congo and Guinea
After reaching 42 days with no new cases since the last survivor tested negative and was discharged from the Ebola treatment unit, the Ministry of Health in the Democratic Republic of the Congo and WHO declared the outbreak in North Kivu Province over on May 3.
Unfortunately, the countdown to the end of the outbreak in Guinea ended soon after it began. In late March, a cluster of deaths, a woman and her two adult daughters, was reported in a village in Soulouta, a sub-prefecture of N’Zérékoré Prefecture. They were determined to be probable cases of Ebola after the son of one of the daughters tested positive for the virus on April 1. Another case was confirmed on April 3. With the new confirmed and probable cases, the Ebola outbreak in Guinea stands at 23 cases and 12 deaths as of May 6, 2021.
Foodborne and animal contact disease outbreaks
CDC, with federal and state partners, is investigating several multistate foodborne and animal contact outbreaks, including the following:
- Salmonella infections linked to wild songbirds. As of April 1, eight states had reported 19 cases with eight hospitalizations and no deaths. CDC and public health officials in several states are collecting different types of data to investigate a multistate outbreak of Salmonella Typhimurium infections in people. Data show that contact with wild songbirds and bird feeders is likely making people sick in this outbreak.
- Salmonella infections linked to ground turkey. As of April 12, 12 states had reported 28 cases with two hospitalizations and no deaths. The ground turkey productsexternal icon have the establishment number “P-244” inside the USDA’s mark of inspection. The ground turkey products were made during December 18–29, 2020 and sold nationwide. These products are no longer available in stores but could still be in your freezer. Investigators are working to determine if additional turkey products are linked to illnesses.
- Salmonella infections linked to Jule’s Cashew Brie. As of April 23, three states had reported five cases with two hospitalizations and no deaths. CDC, public health and regulatory officials in several states, and the FDA are collecting different types of datato investigate a multistate outbreak of Salmonella Duisburg infections. The recalled food can be found can be found hereexternal icon. Do not eat any recalled products.
CDC and partners strengthen surveillance for cholera in Haiti
Haiti’s Ministry of Public Health and Population (MSPP) and CDC are collaborating with the Pan American Health Organization, the CDC Foundation, CDC Haiti, and the Global Task Force on Cholera Control to strengthen Haiti’s surveillance system for choleraexternal icon and end the disease’s transmission in that country. Cholera first appeared in Haiti in October 2010; since then, the country has reported more than 820,000 cases of the disease, and nearly 10,000 people have died. Cholera cases in Haiti have dropped due to ongoing efforts by MSPP and partners; the last confirmed case was reported in February 2019. With funding from the Bill and Melinda Gates Foundation, partners are working to ensure the timely detection, investigation, and confirmation of any new, suspected cholera cases and hope to help Haiti reach the 3-year mark without any confirmed cholera cases in early 2022.
A mobile application simplifies data collection in the field
Mobile technology allows community health workers to capture and store data as they go from house to house for community-based research studies. However, until now, no single mobile data application has been able to provide everything community health workers need to conduct a home visit, and they end up using multiple devices and apps.
Data collected during home visits are crucial to the success of the CDC-led Communities to Prevent Arboviruses (COPA) project in Ponce, Puerto Rico. COPA project staff visit 3,800 participants annually to determine how many got infected with a virus spread by mosquitoes and to assess disease outcomes. For this big task, CDC’s Dengue Branch Data Team created HTrack (Household Tracking), a mobile application that provides COPA staff with integrated components needed for a successful home visit — for example, pre-loaded maps that allow offline navigation and pre-populated data collection forms that eliminate the need for data reentry after each visit. HTrack can also securely link to other popular data collection platforms used by community health workers. Read more on our monthly spotlights webpage.
CDC adds population survey data to FoodNet Fast
CDC’s Foodborne Diseases Active Surveillance Network (FoodNet) periodically surveys people in its surveillance area to learn more about foods and behaviors linked to diarrheal illness. Data from the latest survey are now available in FoodNet Fast, which allows you to search FoodNet data and see results displayed on interactive graphs and charts. One new search tool, the Population Survey Tool, allows you to see people’s responses to questions about food consumption, contact with animals, dietary practices, food handling practices, and raw milk. The tool also lets you see how responses vary for different groups of people, with the option to filter results based on age group, gender, race and ethnicity, geographic location, and season. Try out the FoodNet Fast Population Survey Tool for yourself!
New antibiotic resistance data and features on NARMS Now
A suite of upgrades to NARMS Now: Human Data makes it even easier and faster to access CDC’s antibiotic resistance data for five enteric (intestinal) bacteria commonly transmitted through food: Campylobacter, E. coli O157, Salmonella, Shigella, and Vibrio (species other than V. cholerae). Data in this interactive, online database come from the National Antimicrobial Resistance Monitoring System (NARMS). The latest version of NARMS Now includes new search, report, and export features—and more data and categories for you to explore.
CDC deploys BioFire Film Array and Warrior Panel to Laboratory Response Network
In more technology news, CDC recently distributed the BioFire FilmArray 2.0 instrument and Warrior Panel, which are used to test for biothreat agents, to 16 high-priority Laboratory Response Network (LRN) facilities. These LRN laboratories will be able to test clinical specimens for anthrax, tularemia, plague, Q fever, and hemorrhagic fevers caused by Ebola and Marburg viruses. CDC staff have also worked to support Clinical Laboratory Improvement Amendments (CLIA) requirements for assay verification, including providing materials that will test positive for these biothreat agents. CDC worked with an external vendor to create nucleic acids to be used for CLIA verification, evaluated performance, and distributed them to LRN laboratories.
CDC releases new resources to improve providers’ understanding of rickettsial disease testing options
CDC released a new video, “Rickettsial Disease Diagnostic Testing and Interpretation,” to help healthcare providers better understand rickettsial disease testing options. The 10-minute video provides a short overview of the different diagnostic assays, the best times to use each option, and an outline of the most appropriate samples to collect. A companion quick reference guide pdf icon[PDF – 1 page] directly compares the two most commonly available diagnostic methods: polymerase chain reaction (PCR) and the indirect immunofluorescence antibody (IFA) assay. The video and guide provide quick and easy references that healthcare providers can use when selecting diagnostic tests for their patients.
CDC and partners advance treatment recommendations for antibiotic-resistant Shigella
This spring, the Clinical and Laboratory Standards Institute’s (CLSI) Antimicrobial Susceptibility Testing Subcommittee published new recommendations in CLSI’s M100: Performance Standards for Antimicrobial Susceptibility Testingexternal icon that include the first “breakpoints”—numerical definitions of Shigella’s susceptibility to azithromycin. With the tools to determine whether a Shigella infection will respond to azithromycin, clinicians can now get patients on the right treatment faster, improving the patients’ care and outcomes. The new recommendations follow many months of hard work and careful deliberations. At an August 2020 meeting of the CLSI Breakpoint Working Groupexternal icon, staff from CDC’s National Antimicrobial Resistance Monitoring System (NARMS), the California Department of Health, and University of Virginia presented clinical and laboratory findings that helped CLSI propose the first breakpoints. Read more on NARMS’ webpage.
New publications on antibiotic prescribing
CDC published a new studyexternal icon estimating that more than half of antibiotics prescribed in hospitals in 2015 for selected prescribing events were not consistent with recommended prescribing practices. This analysis is one of the largest to assess the appropriateness of antibiotic prescribing and establishes baseline estimates and a method for future analyses to measure the impact of antibiotic stewardship programs on prescribing antibiotics in hospitals.
CDC also published two new papers describing trends in antibiotic prescribing during the COVID-19 pandemic, showing a substantial decreaseexternal icon of antibiotic use in outpatient settings and spikes in the use of specific antibiotics intended to treat COVID-19 among nursing home residentsexternal icon.
Project Firstline releases infection control training toolkit for facilitators
Project Firstline is making it easier than ever for facilitators to lead virtual infection control trainings for public health and frontline healthcare workers, even if they are not infection control experts.
The Project Firstline Facilitator Toolkit is now available online and includes infection control training resources that work for a variety of learning styles and fit into busy schedules. The toolkit is divided into session plans and slide decks for 10-, 20-, and 60-minute presentations on foundational infection control topics that facilitators can mix and match to meet the needs of their group. Initial topics include
- The Concept of Infection Control
- The Basic Science of Viruses
- How Respiratory Droplets Spread COVID-19
- How Viruses Spread from Surfaces to People
- How COVID-19 Spreads: A Review
Project Firstline will continue to expand the infection control topics and facilitator resources in the toolkit. To stay in the loop as new resources are made available, follow Project Firstline on Facebook or Twitter or sign up for the newsletter.
CDC researchers in San Juan, Puerto Rico invented, field-tested, and improved a mosquito trap called the autocidal gravid ovitrap (AGO), which uses no chemicals. CDC’s Technology Transfer Office, which transfers CDC inventions to partners for public health benefit, and the CDC team at the National Institutes of Health’s National Institute of Allergy and Infectious Diseases Technology Transfer and Intellectual Property Office oversaw the licensing and patenting process. Once a patent license agreement was in place, AP&G Company began selling AGOs. The Federal Laboratory Consortium for Technology Transfer (FLC) recognized the work with the 2021 Excellence in Technology Transfer award. This award recognizes employees of FLC member laboratories and non-laboratory staff who have accomplished outstanding work in the process of transferring federally developed technology.
Emerging Infectious Diseases continues to see growing success with its weekly podcasts, which garner millions of hits each year. EID’s podcasts were developed to inform the general public about the latest scientific research on emerging infectious diseases, and the journal’s podcast library has amassed almost 350 titles that highlight a wide variety of subjects, including antimicrobial resistance, influenza, Lyme disease, E. coli, Ebola, and the COVID-19 pandemic. You can access EID’s podcasts through EID’s website, CDC’s Public Media Library, or wherever you listen to your podcasts.
President, Vice President visit with COVID-19 responders
CDC Director Dr. Rochelle Walensky warmly welcomed President Biden and Vice President Harris to the agency’s Emergency Operations Center on March 19 to brief them on CDC’s COVID-19 response activities. President Biden thanked CDC’s workforce “not only for your intellectual skills but your heart, your determination.” Vice President Harris added that CDC is making decisions “based on science, based on hard work, and based on commitment to public health.” Dr. Walensky thanked President Biden for his leadership, which she said has reinvigorated the whole-of-government response and CDC. Dr. Henry Walke, who oversees CDC’s COVID-19 response, told the President and Vice President that thousands of CDC responders have worked tirelessly and sacrificed much throughout the response.
Congressional staff learn about tracking COVID-19 variants
A CDC scientist briefed congressional staffers on the usefulness of genomic sequencing to track the virus that causes COVID-19. In a webinarexternal icon, NCEZID’s Greg Armstrong told participants about the data coming to CDC from public and private partnerships sequencing thousands of virus samples every week from across the nation. Dr. Armstrong, who leads CDC’s Office of Advanced Molecular Detection, also spoke on particularly contagious variants of the virus. He stressed the need to increase the use of genomic sequencing in the nation’s public health departments and elsewhere to prepare for future infectious disease threats. The public webinar was hosted by the American Society for Microbiology and opened by US Senator Tammy Baldwin (D-WI). US Representative Ami Bera (D-CA) also delivered remarks.
Nurses contribute to Alaska’s COVID-19 vaccine success
Alaska recently made headlines as having the highest rate of COVID-19 vaccination per capita in the United States. Public health nurses at NCEZID’s Arctic Investigations Program (AIP) in Anchorage have contributed to that success by helping with vaccinations. Three nurses have volunteered at more than 14 sites, which administered nearly 13,000 shots by the end of March. State and local public health officials established vaccination sites in cooperation with Alaska Respond,external icon a volunteer healthcare corps that is part of the state health department and which responds to public health emergencies. Sites were established in Anchorage and the Matanuska Valley, including at the Alaska Native Medical Center. AIP works to prevent the spread of infectious disease in the region and has played an important role in efforts to vaccinate people against COVID-19.
Order to collect contact information from travelers from DRC and Guinea
As a precaution due to recent Ebola outbreaks in Africa, CDC has issued an order requiring airlines and other aircraft operators to collect contact information from passengers who were in Guinea or the Democratic Republic of the Congo (DRC) within 21 days before arriving in the United States. The information is transmitted electronically to CDC, which provides it to state and local health departments. They are then able to monitor travelers and ensure that those who develop Ebola symptoms are quickly isolated and receive medical evaluation and care. Additionally, CDC is providing a Travelers’ Health Alert Notice (or T-HAN; image at left) to travelers arriving in the United States from DRC and Guinea, directing them to a webpage with information in English and French on how to monitor themselves for symptoms and what to do if they have symptoms.
Ensuring access to Ebola vaccine in the United States
People in the United States who work to help stop Ebola outbreaks abroad or who are involved in the detection, prevention, and/or treatment of Ebola can now get a vaccine that protects them from infection. While an Ebola vaccine has been FDA approved, this licensed vaccine is not yet available in the United States. Therefore, a CDC-sponsored Investigational New Drug (IND) program has been in place since October 2020 to allow people who are at risk of occupational exposure to Ebola to get a vaccine in the interim. NCEZID scientists collaborated to get the FDA’s permission on the IND program, and recently, they expanded the IND protocol to include a booster dose, since it is not yet known how long protection from the initial dose of vaccine lasts.
Was it or wasn’t it a multistate outbreak of intestinal disease?
Was or wasn’t it a multistate outbreak? The first-ever issue of a new annual NCEZID report gives answers that may surprise you about multistate outbreaks of Listeria, Salmonella, and E. coli., three common causes of intestinal disease. In 2016, investigations coordinated by CDC determined that 50 out of 118 possible outbreaks actually met the criteria. Contact with animals was found to be the cause of nearly twice as many of these multistate outbreaks as contaminated food. The report reveals new concerns about foods that carry these diseases, like flour and frozen vegetables, and persistent multistate outbreaks linked to contact with backyard poultry and small turtles. CDC is working on similar reports that cover the years 2017-2019. You can find highlights from the 2016 report online, read the related MMWR article, and see the data visualized in charts in the PDF version pdf icon[PDF – 56 pages].
Six antibiotic-resistant threats that cost the United States $4.6 billion each year
Six multidrug-resistant pathogens generate national healthcare costs of more than $4.6 billion annually, according to a new studyexternal icon. CDC published the data in the journal Clinical Infectious Diseases in partnership with the University of Utah. This study is one of the largest of its kind to provide national cost estimates for antibiotic-resistant infections. Of note, it highlights a major theme from our 2019 AR Threats Report pdf icon[PDF – 150 pages]: Resistant infections that occur in communities – as opposed to healthcare settings – account for more costs than hospital-associated infections. CDC funds research like this to help public health experts and leaders better plan for prevention and response activities.
Estimating the annual burden of Lyme disease
One of the most common questions about Lyme disease is, “How many people are diagnosed and treated each year?” Although 30,000–40,000 cases of Lyme disease are reported to CDC each year, the actual number of people diagnosed and treated for Lyme disease is much higher. In the February issue of Emerging Infectious Diseases, researchers assessed whether commercial insurance claims could provide reliable data on diagnoses of Lyme disease. They then used those data to estimate that an average of 476,000 people were diagnosed with and treated for Lyme disease annually in the United States during 2010-2018. The authors noted that the estimate likely includes some overdiagnosis. But the fact that Lyme disease is diagnosed so often underscores the need for effective tick bite prevention methods.
Prestigious infectious disease journal achieves 25 years of success
As COVID-19 emerged and spread around the globe last year, the CDC journal Emerging Infectious Diseases had its 25th anniversary with little fanfare. However, the number of submissions surged to nearly 5,000 articles in 2020, up by more than 3,000 articles than in 2019. EID, founded in 1995, published more articles, figures, tables, and pages, and more pages of appendices during the pandemic than ever before. EID articles also had a broad news and social media reach, as documented by Altmetric, a service that collects data on digitally accessible scientific publications worldwide. Three EID articles are ranked among Altmetric’s top 50, eight among its top 250, and 35 among its top 5,000―out of nearly 17 million tracked scholarly articles.
Haiti faces rabies challenges due to vaccination campaign delays
The COVID-19 pandemic threatens to hinder some of the progress made toward the global goal of achieving zero human deaths from rabies caused by dog bites. The World Health Organization and its partners in the United Against Rabies collaboration want to reach that goal by 2030. Since 2013, with CDC’s support, Haiti has dramatically reduced cases of rabies in dogs. But recently the country has had to delay mass dog rabies vaccination campaigns, in part because rabies response partners needed to divert resources to respond to COVID-19. An eight-fold increase in rabid dogs was recorded for the last half of 2020 in Haiti’s capital, Port-au-Prince. Additionally, Haiti’s entire stockpile of post-exposure rabies vaccine expired last September, prompting CDC to issue a travel alert warning travelers of the risk. Despite positive steps that have been made toward eliminating rabies, only national and routine dog vaccination campaigns will eliminate rabies from Haiti, and it is unclear when those campaigns will resume.
Diversity and Inclusion Council Roundtable
To promote diversity and inclusion at NCEZID, the center holds monthly internal roundtable discussions, which have been virtual during the COVID-19 pandemic. The theme of the February roundtable was “We Shall Overcome: Building an Equitable, Safe, and Fair Workplace.” It explored how vocational barriers such as sexism, racism, and other prejudices in the workplace can limit staff opportunities for growth and productivity. NCEZID’s Diversity and Inclusion Council used a combination of informative videos, NCEZID survey results, and dialogue with staff to define inequity and fairness problems in the workplace and identify options for moving forward.
Interstellar chat with NASA astronauts
As COVID-19 wears on, it has become normal to video chat with people. But it’s still a little odd to think that you can have a video chat with people in outer space almost as easily as with a coworker across town. NCEZID’s Dr. Inger Damon hosted a live video chat with NASA astronauts Shannon Walker and Kate Rubins aboard the International Space Station on February 10, 2021. Dr. Damon asked them about their experiments in space and how they were dealing with the COVID-19 pandemic. The astronauts are tackling projects that include DNA sequencing and cataloging of microbes they found on the space station. They even gave a collective shout-out to a rare pathogen that NCEZID is known for studying – Elizabethkingia – that was also found on the space station Mir.
Over $30 billion to help health departments fight COVID-19
As of January, NCEZID has awarded over $30 billion in COVID-19 funding to 64 public health departments across the country. This includes a recent distribution through the Coronavirus Response and Relief Supplemental Appropriations (CARES) Act pdf icon[PDF – 13 pages]external icon of $19.11 billion to expand COVID-19 testing and practices to track the spread of the disease. In December 2020, $87 million went to special projects like preparing public health laboratories to detect molecular characteristics of the virus that causes COVID-19. These efforts will strengthen public health departments beyond the current crisis, readying them for future threats. These awards were made through a long-standing funding and cooperation agreement with health departments, the Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC) program, which boosts the departments’ ability to prepare for and respond to infectious diseases.
COVID-19 funding strengthens laboratories’ ability to respond
In the marathon response to COVID-19, state and local public health laboratories overcame many obstacles despite chronic underfunding that left little room to advance lab capabilities. NCEZID recently strengthened public health labs by awarding COVID-19 funding to the Laboratory Response Network (LRN). LRN is a network of laboratories ready to respond to biological and chemical threats, and it includes state and local public health laboratories. LRN partners will use these funds to invest in new technologies such as next generation whole genome sequencing and to expand their capabilities to detect infectious diseases. The funds also will help proactively get necessary equipment and supplies in place in LRN member laboratories and enable the shipping of lab samples to other laboratories for deeper examination. And more labs will be able to connect to electronic laboratory reporting systems that enable them to report results faster and more efficiently.
CDC issues mask order for travelers
On January 29, CDC issued an order requiring people to wear masks on public transportation and at transportation hubs in the United States. CDC staff have worked around the clock to apply this and other provisions of President Biden’s Executive Order on Promoting COVID-19 Safety in Domestic and International Travelexternal icon, issued January 21. Prior to this, on January 12, CDC issued an order requiring a negative COVID-19 test result or documentation of recovery from COVID-19 for all air passengers coming to the United States from a foreign country.
Project Firstline launches video series for healthcare workers
In February, Project Firstline continued its Facebook video series for frontline healthcare workers called Inside Infection Control. The videos have been viewed over 70,000 times on YouTube. February’s videos answered questions that frontline healthcare workers may have during the current stage of the pandemic. New episodes include content on personal protective equipment (PPE) worn for respiratory protection and were produced in collaboration with the National Institute for Occupational Safety and Health. Project Firstline also published videos about why cleaning, disinfection, and ventilation matter for infection control. It dedicated one episode to discussing what new strains of COVID-19 mean for infection control. New Inside Infection Control videos post every Tuesday and Thursday on Project Firstline’s Facebook page.
Looking back on 2020’s fight against emerging infectious diseases
Last year was a year like no other. In 2020, nearly 2,000 of NCEZID’s staff supported CDC’s COVID-19 emergency response, while other staff stretched to meet ongoing emerging disease threats and challenges. The year’s work is summed up in the recently released Protecting Health in 2020: NCEZID Progress Report pdf icon[PDF – 16 pages]. The report highlights our involvement in new discoveries, unprecedented support for states during the COVID-19 pandemic, accelerated data use, and advances that are saving lives and strengthening preparedness across all our efforts against emerging infectious diseases.
Ebola vaccine recommendations
In December 2019, the Food and Drug Administration approvedexternal icon the first vaccine to prevent Ebola infections caused by the most deadly species of the virus, Zaire ebolavirus. CDC’s Advisory Committee on Immunization Practices developed recommendations for the use of the vaccine, which is called Ervebo®, in the United States. NCEZID staff played a leading role in these recommendations, which were published in the January 8 Morbidity and Mortality Weekly Report. The report outlined three groups of adults considered at highest risk for occupational exposure to Ebola – responders to outbreaks, healthcare professionals at Ebola treatment centers, and staff at laboratory facilities that require the highest level of safety precautions.
New cases of Ebola confirmed in DRC and Guinea
As we were nearing the anticipated deactivation of CDC’s Ebola response, the Democratic Republic of the Congo’s (DRC) Ministry of Health announced on February 7 that a case of Ebola had been confirmed in North Kivu Province. As of February 24, eight cases had been confirmed in DRC. Sequencing of samples suggests that those cases are linked to cases in the area during the 2018-2020 outbreak and were likely caused by a persistent infection in a survivor who either relapsed or sexually transmitted the virus. Then, on February 14, an Ebola outbreak was confirmed by Guinea’s Ministry of Health. The outbreak is in an area affected by the 2014-2016 West Africa Ebola outbreak, which was the largest Ebola outbreak in history. Sequencing of samples will be conducted to determine if the cases are due to a new introduction of the virus or are linked to the 2014-2016 outbreak. As of February 24, eight cases had also been recorded in Guinea. CDC is supporting response and preparedness efforts in DRC, Guinea, and surrounding countries.
New botulism treatment resources for healthcare professionals
A new video demonstrates to healthcare professionals how to prepare a treatment for botulism and give it to a patient. The video, titled Preparing and Administrating Heptavalent Antitoxin for the Treatment of Botulism, also answers questions that healthcare professionals often ask during clinical consultations with CDC. In addition, public health officials and first responders may turn to the video for guidance if a large botulism outbreak occurs.
NCEZID also posted a new page on CDC’s botulism website that guides healthcare providers on what to do if a baby has signs of infant botulism. The webpage, “Infant Botulism: Information for Clinicians,” includes detailed information on treatment, diagnostic testing, reporting, and more.
Cheese and turtles are focus of disease outbreak investigations
NCEZID and its federal and state partners are investigating several outbreaks of foodborne diseases and infections spread through animal contact:
- Listeria infections linked to queso fresco made by El Abuelito Cheese Inc. As of March 1, four states reported 11 ill people with ten hospitalizations and one death. Connecticut officials found the outbreak strain of Listeria in samples of El Abuelito brand queso fresco cheese. El Abuelito Cheese Inc. recalled all cheeses, sold under multiple brands, made in the same facility as the contaminated queso fresco cheese.
- Salmonella infections linked to contact with small pet turtles. As of February 20, seven states reported 22 ill people with eight hospitalizations and one death. Most people sick in this outbreak are children. The U.S. Food and Drug Administration bansexternal icon the sale and distribution of the turtles involved. They can sometimes be found illegally at stores, flea markets, and roadside stands.
Tick bite data tracker displays emergency department visits
Your chances of being bitten by a tick and getting a tickborne disease rise in the spring and stay higher through the fall. In January, NCEZID launched a new tick bite data tracker. The dashboard displays data on the number of people visiting emergency departments with symptoms of or concerns about tick bites—before a diagnosis of a tickborne disease is confirmed. Updated weekly, these data give public health officials a rapid indicator of when cases of tickborne illness might be rising in different parts of the country. It can also help public health officials and healthcare providers target outreach on tick bite prevention and risk to the public.
New map shows CDC investments to combat antibiotic resistance
NCEZID recently updated its Antibiotic Resistance (AR) Investment Map, showing CDC’s funding in 2020 to its partners and continued collaborative efforts to combat AR. The site includes several of CDC’s COVID-19 response efforts that also slow the spread of AR in the United States, including in healthcare settings. The map showcases how CDC’s AR investments are working in every US state, some large cities, and in more than 15 other countries.
Rare fungal infections investigated at a medical center in Arkansas
In February, a CDC team deployed to Little Rock, Arkansas, to help state public health colleagues investigate fungal infections called mucormycosis occurring in a hospital. The source of the infections is unknown. CDC has provided guidance and expertise remotely to the Arkansas Department of Health (ADH) since February 2020, but after a new patient with a compromised immune system came down with a mucormycosis skin infection, ADH requested in-person help from CDC. The CDC team included NCEZID staff and a colleague from the Center for Surveillance, Epidemiology, and Laboratory Services (CSELS).
Toolkit helps epidemiologists better use genomic data to track COVID-19 variants
Epidemiologists tracking variants of the virus that causes COVID-19 in states and localities have a new tool to help them stay on top of the latest scientific data. CDC’s Office of Advanced Molecular Detection recently released a COVID-19 Genomic Epidemiology Toolkit to teach epidemiologists how to optimize the use of whole genome data in their investigations. In infectious disease, molecular detection technology identifies important clues in germs. Identifying their genetic blueprints, or whole genomes, is among the most advanced available forms of molecular detection. The new toolkit consists of video training modules, audio transcripts, case studies, and more. The toolkit includes introductions to genomic epidemiology and concentrates on the genome of the virus that causes COVID-19. Sign up to receive email updates when new modules are added to the COVID-19 Genomic Epidemiology Toolkit.
Testing order for air travelers flying to the US from other countries
CDC has issued an Order requiring a negative COVID-19 test or documentation of recovery for all air passengers 2 years of age or older before boarding a flight to the United States from another country. The order took effect on January 26 and includes US citizens and legal permanent residents. Testing before and after travel is a critical step to slow the introduction and spread of COVID-19 in the United States. As variants of the virus that causes COVID-19 continue to emerge around the world, there is growing evidence that some of them are more contagious. With COVID-19 surging in the United States, the testing requirement for air passengers will help slow the spread of the virus as more people in the United States get vaccinated.
Serving as a COVID-19 vaccine hub for Alaska
When Alaska needed help distributing a vaccine to prevent COVID-19, it turned to its partners at CDC. The Alaska Department of Health and Social Services (DHSS) asked NCEZID’s Arctic Investigations Program (AIP) for assistance in receiving and redistributing the vaccine developed by Pfizer-BioNtech. AIP manages several ultracold freezers, the same type needed to store the vaccine, and agreed to serve as one of Alaska’s three vaccine hubs. AIP developed a database to track vaccine shipments, completed vaccine order redirects from Pfizer, and established a process to redistribute the vaccine to communities across the state. AIP helped distribute more than 23,000 doses of the vaccine to sites across the state, including to remote villages and smaller communities. AIP has since transitioned its vaccine hub responsibilities to the state.
Yellow fever vaccination campaigns continue safely during COVID-19 pandemic
Yellow fever, a disease transmitted by mosquitoes, kills an estimated 30,000 people annually. A WHO strategy aims to drive deaths down to zero by 2026, but COVID-19 has threatened prevention campaigns in countries at risk for yellow fever. For example, a vaccination campaign targeting 5.6 million people in Ghana was planned for November 2020, but personal protective equipment (PPE) and infection prevention and control (IPC) supplies were too low to adequately prevent the spread of COVID-19. Also, officials planned to use “yellow cards” to note who was vaccinated, but the country did not have supplies needed to create them. To purchase all necessary PPE, IPC, and yellow cards, CDC, in particular its Arboviral Diseases Branch, a close partner with WHO on insect-borne diseases, raised over $7 million internally, including from CDC Foundation. The vaccination campaign in Ghana was successfully carried out at the end of November 2020. The funding will also allow yellow fever vaccination campaigns to move forward in Nigeria and the Democratic Republic of the Congo.
Project Firstline launches video series for healthcare workers
In December, Project Firstline launched a Facebook video series for frontline healthcare workers called Inside Infection Control. The videos range from three to five minutes and are designed to answer questions received from frontline healthcare workers. December’s episodes describe important infection control concepts and serve as a foundation for understanding infection control in healthcare. New Inside Infection Control videos are posted every Tuesday and Thursday. January videos focused on infection control actions that are important for healthcare workers to apply during this phase of the COVID-19 pandemic. To stay up to date on new video and infection control content from Project Firstline, follow along on Facebook and Twitter.
Report on the “food” in “foodborne” illness is packed with data
A report pdf icon[PDF – 15 pages] with NCEZID co-authors examines which foods are most commonly responsible for illnesses caused by the bacteria Salmonella, Campylobacter, E. coli O157, and Listeria. The report uses data collected over 21 years to mathematically estimate the major food sources of these illnesses during 2018. Combined with other analyses, this report pdf icon[PDF – 15 pages] could help shape measures to keep more people safe from foodborne illnesses. It was produced by the Interagency Food Safety Analytics Collaboration, which includes CDC, the US Food and Drug Administration, and the Food Safety and Inspection Service of the United States Department of Agriculture. The methods used in this and prior annual reports are detailed in an article in the journal Emerging Infectious Diseases.
Monitoring drug-resistant bacteria that can come from food or live animals
Some infectious bacteria that people catch from contaminated food or contact with animals are resistant to antibiotics. A new report, the 2018 NARMS Integrated Summaryexternal icon, summarizes data on the presence of antibiotic-resistant bacteria in raw retail meat, food-producing animals at slaughter, and infected people. The report also includes data on antibiotic-resistant bacteria from dogs collected through a pilot (new) surveillance system. The National Antimicrobial Resistance Monitoring System (NARMS), a collaboration between the Food and Drug Administration, the U.S. Department of Agriculture, and CDC, issued the 2018 report. It adds data on more antimicrobial drugs and expands the number of retail meat collection sites since the last reportexternal icon. The new report can also be viewed in an interactive formatexternal icon with convenient data charts.
Reducing the spread of infections in healthcare settings
The United States has continued to drive down several kinds of infections that spread in healthcare settings. But there is still room for improvement. Both aspects are highlighted in a recent CDC report, the 2019 National and State Healthcare-Associated Infections (HAI) Progress Report. The report’s findings show that HAI prevention is possible, which is good news for patient safety. Notably, there has been a decrease of about 18% in hospital-onset infections caused by Clostridioides difficile (C. difficile) in acute care hospitals. C. difficile can cause the colon to inflame and can be deadly. The 2019 Progress Report includes data from the National Healthcare Safety Network. The report’s data are also available in CDC’s Antibiotic Resistance & Patient Safety Portal. Continued collaboration with public health departments, healthcare professionals, and other partners is critical to sustain progress in eliminating HAIs and to ensure patient safety.
A call to end deaths from an HIV-related fungal meningitis by 2030
About 20 percent of people who die in connection with HIV/AIDS globally succumb to a fungal infection called cryptococcal meningitis. CDC researchers have co-authored an articleexternal icon in the medical journal The Lancet Infectious Diseases arguing for a global strategy to end these deaths by 2030. The article appeared in late November just before World AIDS Day on December 1, 2020. It highlights major gaps in access to diagnostics and treatment that need to be addressed for this goal to be achieved. CDC is supporting a global effort against the AIDS-related disease at a time when the strategic framework to fight HIV/AIDS is being updated.
Modeling a path to fewer rabies deaths around the world
About 59,000 people around the world die every year needlessly from rabies infections passed on by dogs. To combat the problem, NCEZID has produced RabiesEconexternal icon, an analytic tool that estimates the impacts of policy choices to reduce the spread of rabies. CDC has collaborated with stakeholders in Zambia, Mexico, Guatemala, Vietnam, and Haiti to model rabies cases and the human deaths that can be averted by expanding or continuing rabies vaccination programs for dogs. RabiesEcon models helped strongly persuade policymakers in Mexico to continue funding for the country’s successful 20-year rabies vaccination program for dogs.
City water evaluated following a death from brain-eating amoeba
CDC staff recently conducted water evaluations in the city of Lake Jackson, Texas, after disinfection of its drinking water pipes. In September, CDC had detected Naegleria fowleri, commonly called brain-eating amoeba, within the city’s water system after a child was exposed at a city splash pad. The child later died. The city treated its water distribution network for 60 days with a high dose of chlorine. Afterward, CDC staff took large water samples throughout the city from water towers, fire hydrants, and monitoring points which, before treatment, had shown low levels of chlorine. CDC detected no evidence of N. fowleri in drinking water samples after the treatment. Water testing results, along with the positive data about the disinfection levels, are helping restore the public’s and local authorities’ confidence in their drinking water.
Studying mosquitoes that transmit diseases in time to take action
Outbreaks of Zika and other mosquito-borne diseases have highlighted the need to control a particular species of mosquito called Aedes aegypti. This requires a complex, layered approach that includes identifying places where mosquitoes lay eggs and detecting mosquitoes that are resistant to insecticide early enough to take effective action. A CDC team traveled to the US Virgin Islands in November to contribute knowledge and skills through an agreement that facilitates public health support in areas affected by hurricanes. On the island of St. Croix, the team worked with staff from the Virgin Islands Department of Health (VIDOH) and the Puerto Rico Vector Control Unit to collect mosquito larvae and pupae living in water-collecting containers like rain barrels or basins. In St. Thomas, the CDC team helped VIDOH colleagues collect Ae. aegypti eggs that will be tested for insecticide resistance.
On the trail of pneumonia caused by bacteria that make an anthrax toxin
A CDC disease detective and a colleague from the National Institute of Occupational Safety and Health traveled to Houston to help the Texas Department of Health investigate the source of an unusual pneumonia infection. It was caused by a rare strain of Bacillus bacteria that produces a toxin normally made by anthrax. (The infecting bacteria were not anthrax.) The team wanted to know where the patient, a welder, contracted the bacteria. This was the second time in six months that a welder came down with pneumonia caused by Bacillus bacteria containing DNA to make the anthrax toxin. It was the seventh known such case in total in the Southern United States.