CCMS Medicine Fall 2017 - 21

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(DVH) has been assisting several state and local health
departments with ongoing and sometimes fatal hepatitis A virus
(HAV) outbreaks, apparently among two different person-toperson risk groups: the first being urban homeless who use illicit
drugs, and their close contacts; the other appears to be primarily
among men having sex with men (MSMs).

local antibiotic-resistant threats, especially antibiotic-resistant
foodborne infections and infections in healthcare facilities
and communities. Some of the funds will also go to enhance
the ability of the Antibiotic Resistance Lab Network (AR Lab
Network) to sound the alarm when known and emerging
antibiotic resistance threats are detected.

On 8/25/17 the CDC notified all state and local health
departments about the investigation of a cluster of HAV,
genotype I-B, infections in homeless and drug-using groups.
They encouraged all U.S. jurisdictions to be watchful for
increases in those cases, and asked that they submit confirmed
HAV specimens to their DVH lab.

The CDC continues to provide ongoing epidemiology and
laboratory support, as well as support in vaccine supply and
vaccine policy development. Portions of the funding will help
new activities aimed at: (1.) increasing testing nationwide for
the emerging fungal threat, Candida auris; (2.) strengthening
national tuberculosis (TB) surveillance and infrastructure
by adding a new national lab (the National TB Molecular
Surveillance Center) which will be equipped to perform whole
genome DNA sequencing (WGS) of M. tuberculosis specimens
taken from newly diagnosed TB patients; (3.) enhancing
detection of drug-resistant gonorrhea threats using WGS to
allow more rapid outbreak response and control; (4.) all 50
states, 6 large cities and Puerto Rico will continue to test for
carbapenem-resistant enterobacteriaceae (CRE), "the deadly
germ resistant to nearly all antibiotics"; (5.) the remaining funds
will go to more than 40 other projects, including enhancing
epidemiology surveillance and testing for parasitic diseases,
tick-borne diseases, food- and water-borne diseases, vaccinepreventable diseases, Zika surveillance, and strengthening
cross-cutting national surveillance, boosting lab infrastructure
and technology, and enhancing health information and
communications systems.

San Diego County, California, has had a serious ongoing
outbreak of HAV since early 2017 and finally had to declare a
"Public Health Emergency" in mid-September. This outbreak,
which extended to other counties in April, turned out to
involve mainly homeless people and drug users and spread to
Los Angeles by mid-September. By early October, San Diego
County alone had 481 cases, including 17 deaths. They don't
have enough shelter beds to handle the numbers and, in a new
preventive step, they are now advising HAV vaccination of food
handlers.
But cases among the MSM population are perhaps now more
worrisome because of the potential for spread to the bi- and
heterosexual populations. While no direct connection has been
found to the West Coast cases, subsequent outbreaks among
MSMs in New York apparently involve Hepatitis A, genotype
I-A, which more closely relates to the strain circulating among
that risk group in Paris and other parts of Europe.
Consequently, in this fiscal year, CDC has invested over
$300 million to help in the detection, control, and prevention
of infectious diseases here in the U.S. State programs are the
foundation of the American public health system and are
integral to the nation's efforts to control infectious disease
threats. Importantly, then, $77 million of the most recent
awards are intended to help every state health department fight

(The author is a retired Public Health physician, a longterm member of the CCMS Board, and former Director
of the CCHD.)
For questions and further detailed information, visit
https://www.cdc.gov, and its many links, which the
author has used freely in the preparation of this article.

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CCMS Medicine Fall 2017

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