Our Work: 2018

CDC has released the 2018 edition of the Model Aquatic Health Code (MAHC). Government officials and the aquatics sector can use the MAHC to create or update existing pool codes and reduce risk of outbreaks, drowning, and pool-chemical injuries. Learn how the MAHC helps make swimming and other water activities healthier and safer.

CDC is investigating several outbreaks linked to food products.

• A multistate outbreak of multidrug-resistant Salmonella Reading infections has been linked to raw turkey products in 26 states, resulting in 90 cases of illnesses of July 11. Raw turkey should always be handled carefully and cooked thoroughly.
• A Food Safety Alert was issued for a multistate outbreak of Salmonella Sandiego linked to Spring Pasta Salad at Hy-Vee grocery stores in five states, with 21 people infected as of July 1. Consumers should not eat recalled Hy-Vee Spring Pasta Salad.
• A multistate outbreak of Vibrio parahaemolyticus infections has been linked to fresh crab meat imported from Venezuela. Twelve people in three states and the District of Columbia have been reported to be infected after eating fresh crab meat from Venezuela. Consumers should not eat, restaurants should not serve, and retailers should not sell fresh crab meat imported from Venezuela at this time.
• CDC continues to investigate a multistate outbreak of Salmonella Mbandaka infections linked to Kellogg’s Honey Smacks Cereal. As of July 12, 100 people had been infected in 33 states. CDC continues to recommend that consumers not eat any Kellogg’s Honey Smacks cereal.

A new CDC Museum exhibit, The Refugee Journey to Wellbeing, provides insight into refugee health and the resettlement process. The exhibit introduces visitors to the programs and processes supporting refugee health along the journey from displacement to resettlement in the United States. Its installation at the David J. Sencer CDC Museum is the first public showing of this hands-on exhibit, created in 2016 by CDC’s Division of Global Migration and Quarantine, and the Emergency Response and Recovery Branch, Division of Global Health Protection, in partnership with the American Society of Tropical Medicine and Hygiene. The exhibit will be on display from July 9-October 5, 2018.

CDC is working with state and federal partners to investigate several multistate outbreaks, including the following:

• Salmonella infections linked to live poultry in backyard flocks. As of June 1, 124 sick people have been reported from 36 states; 31% of those people are children younger than 5 years old. Since 2000, 70 outbreaks of Salmonella infections have been linked to contact with backyard flocks.
• Salmonella infections linked to pre-cut watermelon, honeydew, cantaloupe, and fruit salad mixes with melon. Of the 70 ill people reported as of June 19, most are older than 60; 34 people have been hospitalized. On June 8, Caito Foods recalled pre-cut melon products that were sold in many different stores in Georgia, Illinois, Indiana, Kentucky, Michigan, Missouri, North Carolina, and Ohio. A list of the recalled products is posted on FDA’s website.
• Salmonella infections linked to Kellogg’s Honey Smacks Cereal (see our tweet, retweeted by HHS Secretary Alex Azar, above). As of June 15, the outbreak had sickened 73 people in 31 states. On June 14, the Kellogg Company recalled Kellogg’s Honey Smacks cereal. People should not eat Kellogg’s Honey Smacks cereal, and retailers should not sell or serve recalled cereal.

CDC sent staff to help local health officials investigate and control several anthrax outbreaks in Uganda. To date, there have been more than 150 probable human cases and more than 700 livestock deaths. While in the field, they investigated cases in animals and humans, collected specimens, and provided recommendations for postexposure prophylaxis and guidance on surveillance and anthrax control among livestock. They also helped local lab officials set up training and testing at non-traditional sites like an agricultural institute and regional vet lab. Confirmatory testing is under way in Uganda. Though the team has returned to Atlanta, CDC continues to work closely with Uganda on the ongoing outbreaks.

NCEZID staff from the Division of High Consequence Pathogens and Pathology were featured in a video by WIRED, in which they demonstrated donning personal protective equipment (PPE), told war stories about getting infested with fly larva, and talked about missing family and how hot and uncomfortable our work abroad can be. The WIRED video series “What’s In Your Bag?” highlights the special equipment that various professionals take when they travel. The 17-minute recording is available on YouTube and WIRED’s site.

CDC released an updated reference manual for healthcare providers on tickborne diseases of the United States. Tickborne diseases are becoming more common, and from May through July, people will get more tick bites and tickborne diseases than any other time of year in the United States. Healthcare providers should be aware of the risks for tickborne diseases as well as ways to prevent, diagnosis, and treat them.

The manual provides information to help clinicians:

• Recognize the signs of tickborne disease,
• Understand diagnostic tests and lab findings, and
• Quickly find treatment recommendations

CDC is working closely with the Ministry of Public Health of the Democratic Republic of Congo (DRC), the World Health Organization (WHO), and other partners to investigate an outbreak of Ebola virus disease in the northwestern part of the country. A CDC Ebola Coordination Team in Atlanta is managing the agency’s efforts to support the response in several areas, including epidemiology, laboratory diagnostics, infection prevention and control, border protection, emergency operations, risk communication, and vaccination strategy. As of June 6, WHO had reported a total of 60 Ebola cases (37 confirmed, 14 probable, and 9 suspected), including 27 deaths, since early April. Reports of several confirmed cases in Mbandaka (population 1.5 million) along the Congo River have raised concerns about the risk of disease spreading within DRC and to neighboring countries. On May 18, a WHO emergency committee assessed the situation in DRC and determined that current conditions do not support declaring a Public Health Emergency of International Concern. Learn more about the outbreak.

A new rabies test developed by CDC and partner organizations could result in people who’ve been exposed to potentially rabid animals foregoing the weeks-long regimen of shots needed to prevent the deadly disease. The new LN34 test, designed for use in animals, can more easily and precisely diagnose rabies infection, according to a study recently published in PLOS One. During the pilot study, the test produced no false negatives, fewer false positives, and fewer inconclusive results. It could allow doctors and patients to make better informed decisions about who needs treatment for rabies.

“Many of the areas hardest hit by rabies are also the areas least prepared to run current tests to diagnose it,” said Crystal Gigante, the study’s first author. “The LN34 test has the potential to really change the playing field. Quickly knowing who needs to receive rabies treatment—and who does not—will save lives and families’ livelihoods.”

Many Alaskans have a close relationship with their environment, which often puts them into contact with wild animals—and potentially zoonotic infectious agents. Researchers in DPEI’s Arctic Investigations Program have been studying how some groups of Alaskans might be exposed to certain infectious agents, specifically the diarrheal-disease causing Giardia duodenalis and Cryptosporidium species. They recently published a study that identifies the seroprevalence for these two intestinal protozoa among wildlife biologists, sport hunters, and subsistence hunters and their families.  The study showed increased exposure to Giardia among persons living in communities with less access to in-home running water and sanitation services. The study’s findings establish a baseline for exposure to two important infectious organisms that are likely to be affected by changes in the environment; this is an important resource to evaluate changes over time.

Almost everyone has been bitten by a mosquito, tick, or flea. These can be vectors for spreading pathogens (germs). A person who gets bitten by a vector and gets sick has a vector-borne disease, like dengue, Zika, Lyme, or plague. Between 2004 and 2016, more than 640,000 cases of these diseases were reported, and 9 new germs spread by bites from infected mosquitoes and ticks were discovered or introduced in the US. State and local health departments and vector control organizations are the nation’s main defense against this increasing threat. Yet, 84% of local vector control organizations lack at least 1 of 5 core vector control competencies. Better control of mosquitoes and ticks is needed to protect people from these costly and deadly diseases. Learn more in the May issue of Vital Signs.

CDC is working with several state and federal partners to investigate a multistate outbreak of Escherichia coli O157:H7 infections linked to romaine lettuce from the Yuma, Arizona growing region. Within eight days of first detecting the outbreak in PulseNet, CDC and its partners warned US consumers to throw away all store-bought chopped romaine lettuce at home, including salads and salad mixes containing chopped romaine. Restaurants and retailers were told not to serve or sell any chopped romaine from the Yuma, Arizona growing region. As the team learned more, the warning was expanded to include all romaine lettuce, including whole heads and hearts of romaine lettuce. No deaths have been reported. This outbreak investigation is ongoing.

CDC and partners also are investigating a multistate outbreak of Salmonella Braenderup infections linked to shell eggs. As of April 19, at least 23 cases of Salmonella Braenderup in 9 states had been identified. Rose Acre Farms and Cal-Maine Foods, Inc. recalled over 206 million eggs sold under various brand names. People should not eat, and restaurants and retailers should not serve or sell, recalled eggs. The investigation is ongoing.

CDC provided technical assistance to the Nigeria Center for Disease Control for an outbreak of Lassa fever, a potentially life-threatening disease found in much of West Africa. Nigeria experiences annual increases in Lassa fever cases during the dry season, but this year’s outbreak caused great concern due to its size and geographic spread during the early months. From early January, when the outbreak began, to April 15, a total of 413 confirmed cases and 105 deaths had been reported.However, the reported numbers of cases and deaths have been declining in recent weeks.

More than 23,000 Americans die each year from infections caused by germs resistant to antibiotics. While antibiotic resistance (AR) threats vary nationwide, AR has been found in every state. And unusual resistance germs, which are resistant to all or most antibiotics tested and are uncommon or carry special resistance genes, are constantly developing and spreading. Lab tests uncovered unusual resistance more than 200 times in 2017 in “nightmare bacteria” alone. Learn more in the current issue of Vital Signs.

Since November, CDC has been providing technical assistance to the South Africa National Institute for Communicable Diseases (NICD) on the world’s largest known outbreak of listeriosis. The outbreak has led to almost 1,000 illnesses and more than 180 deaths since January 2017. NICD conducted interviews of sick people, and product and environmental testing, and found that the outbreak was linked to polony, a type of processed meat.

Approximately 130 people die from rabies in Haiti each year. CDC is working with the Haiti Ministry of Agriculture to prevent more deaths by improving dog vaccination coverage. More than 210,000 dogs have been vaccinated against rabies since the campaign kicked off in October 2017. CDC and partners are utilizing a new strategy, which uses mobile phones to provide daily direction to rabies vaccinators and to track vaccinated dogs.

CDC has closed its investigation of a multistate outbreak of multidrug-resistant Salmonella Heidelberg infections linked to bull calves. A total of 56 people in 15 states were infected with Salmonella linked to dairy calves. Illnesses could continue because people may not know they could get a Salmonella infection from contact with dairy calves or other cattle. It is important to take steps to stay healthy around cattle.

Last month, CDC and public health laboratory partners transitioned from pulsed-field gel electrophoresis (PFGE)—used for the past 20 years—to whole genome sequencing (WGS) to conduct outbreak surveillance of Listeria. Since 2013, a nationwide Listeria pilot using WGS resulted in more outbreaks being detected with fewer cases compared with older methods like PFGE. Disease detectives identified foods like ice cream, frozen vegetables, and caramel apples as outbreak sources; this information helped to make these foods safer for the public.

Raw (unpasteurized) milk has been linked to many foodborne illnesses, including Campylobacter infections. Find out what happened after public health investigators learned of people becoming sick after drinking raw milk distributed through a herdshare program in Colorado.