MMWR News Synopsis

Outbreak of Norovirus Illness Among Wildfire Evacuation Shelter Populations — Butte and Glenn Counties, California, November 2018

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Given the increasing number of wildfires in the U.S., future events requiring large-scale sheltering are likely. Although disaster relief must address multiple urgent and competing needs, advanced planning by local, state, and federal public health partners and non-government organizations to facilitate timely, effective shelter illness surveillance and infection prevention and control practices in both planned and unanticipated shelters is crucial to prevent, identify, and contain infectious disease outbreaks. The Camp Fire, California’s deadliest wildfire, left more than 1,100 evacuees seeking emergency shelter. Beginning in November of 2018, outbreaks of acute gastroenteritis occurred in 8 of 9 Camp Fire evacuation shelters in Butte and Glenn counties, sickening a total of 292 patients between November 10–December 1. Norovirus, which is highly infectious and spreads quickly in congregate settings, was detected in 16 of 17 unique patient stool specimens. Health officials with the Butte County Public Health Department, assisted by the California Department of Public Health, collaborated with partner agencies to implement screening for acute gastroenteritis, institute isolation protocols and 24-hour cleaning services, and promote proper hand hygiene. This outbreak illustrates that implementing effective illness surveillance and infection prevention and control practices early is essential to prevent transmission of infectious diseases in shelters.

Update on Extensively Drug-Resistant Salmonella Serotype Typhi Infections Among Travelers to or from Pakistan and Report of Ceftriaxone-Resistant Salmonella Serotype Typhi Infections Among Travelers to Iraq — United States, 2018–2019

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New findings from CDC’s enhanced surveillance system show that ceftriaxone-resistant Salmonella Typhi, the bacteria that causes typhoid fever, is a growing public health threat in Pakistan and Iraq. Typhoid fever is a life-threatening disease usually spread through contaminated food or water. In response to an outbreak of extensively drug-resistant (XDR) typhoid fever in Pakistan in 2018, CDC enhanced efforts to identify and test samples from patients with typhoid fever who recently traveled to Pakistan. From January 1, 2016 through August 31, 2019, CDC identified 96 Typhi infections among U.S. travelers to or from Pakistan. Among these infections, almost 1 in 3 (31%) were identified as XDR by antimicrobial susceptibility testing. Additionally, a second type of ceftriaxone-resistant Typhi was found in August 2018 linked to travel to Iraq and appeared to be genetically distinct from the isolates identified in patients traveling to or from Pakistan. The emergence of XDR Typhi underscores the importance of effective prevention measures, including vaccination and safe food and water precautions.

Surveillance to Track Progress Toward Polio Eradication — Worldwide, 2018–2019

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CDC and World Health Organization researchers analyzed 2018–2019 poliovirus surveillance data and found that only 25 out of 40 priority countries (63% of outbreak/endemic and at-risk countries) met acute flaccid paralysis surveillance indicators nationally, and that surveillance performance at subnational levels varied widely. The primary method for detecting poliovirus is through acute flaccid paralysis (AFP) surveillance supplemented by environmental surveillance (regular testing of sewage samples) to provide awareness of the extent and duration of poliovirus circulation. Poliovirus surveillance data from 2018-2019 were assessed, focusing on 40 priority countries with wild-poliovirus/vaccine-derived-poliovirus outbreaks or at high risk for importation because of their proximity to a country with an outbreak. Of the 40, only 25 countries (63%), down from 33 in 2018, met both key AFP surveillance indicators nationally, and surveillance performance at subnational level varied widely. High-quality surveillance, both for AFP among children aged <15 years and environmental surveillance, is critical to quickly detect and respond to circulating vaccine-derived polio and to stop wild poliovirus transmission in two remaining endemic countries, Pakistan and Afghanistan.

Decline in Child Vaccination Coverage During the COVID-19 Pandemic — Michigan Care Improvement Registry, May 2016–May 2020 (Early release May 18, 2020)

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High COVID-19 Attack Rate Among Attendees at Events at a Church — Arkansas, March 2020 (Early release May 19, 2020)

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• Assessing the Role of Food Handlers in Hepatitis A Virus Transmission — Multiple States, 2016–2019

Among almost 23,000 hepatitis A outbreak cases reported from 26 states as of September 13, 2019,  fewer than 4% occurred among food handlers; secondary infections among patrons accounted for only 0.2% of outbreak cases. The risk for secondary infection from hepatitis A–infected food handlers to food establishment patrons in the ongoing person-to-person hepatitis A outbreaks is less than 1%. Since 2016, unprecedented person-to-person outbreaks of hepatitis A have occurred in the United States. During these outbreaks, hepatitis A infections among food handlers have raised public alarm, often prompting health departments to divert limited vaccine resources away from at-risk populations. Using survey data from state health departments, investigators found that of the 22,825 outbreak cases reported from these states during the survey period, fewer than 4% occurred among food handlers (>67% of whom reported risk behaviors commonly associated with the current person-to-person outbreaks), and secondary infections among patrons accounted for fewer than 1% of outbreak cases. This suggests that the risk of secondary infection from a hepatitis A–infected food handler is extremely low and emphasizes the importance of vaccination strategies targeting populations at risk.

• Percentage of Adults Aged ≥18 Years with Disability, by Diagnosed Diabetes Status and Age Group — National Health Interview Survey, United States, 2018

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CDC works 24/7 protecting America’s health, safety and security. Whether diseases start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.