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Chikungunya virus (CHIKV), an alphavirus that causes fever and severe polyarthralgia, swept through the Americas in 2014 with almost 2 million suspected or confirmed cases reported by April 2016. In this study, we estimate the direct medical costs, cost of lost wages due to absenteeism, and years lived with disability (YLD) associated with the 2014-2015 CHIKV outbreak in the U.S. Virgin Islands (USVI). For this analysis, we used surveillance data from the USVI Department of Health, medical cost data from three public hospitals in USVI, and data from two studies of laboratory-positive cases up to 12 months post illness. On average, employed case-patients missed 9 days of work in the 12 months following their disease onset, which resulted in an estimated cost of $15.5 million. Estimated direct healthcare costs were $2.9 million for the first 2 months and $0.6 million for 3-12 months following the outbreak. The total estimated cost associated with the outbreak ranged from $14.8 to $33.4 million (approximately 1% of gross domestic product), depending on the proportion of the population infected with symptomatic disease, degree of underreporting, and proportion of cases who were employed. The estimated YLDs associated with long-term sequelae from the CHIKV outbreak in the USVI ranged from 599-1,322. These findings highlight the significant economic burden of the recent CHIKV outbreak in the USVI and will aid policy-makers in making informed decisions about prevention and control measures for inevitable, future CHIKV outbreaks.

Zika virus is a mosquito-borne flavivirus that was first identified in Uganda in 1947 (1). Before 2007, only sporadic human disease cases were reported from countries in Africa and Asia. In 2007, the first documented outbreak of Zika virus disease was reported in Yap State, Federated States of Micronesia; 73% of the population aged ≥3 years is estimated to have been infected (2). Subsequent outbreaks occurred in Southeast Asia and the Western Pacific (3). In May 2015, the World Health Organization reported the first local transmission of Zika virus in the Region of the Americas (Americas), with autochthonous cases identified in Brazil (4). In December, the Ministry of Health estimated that 440,000-1,300,000 suspected cases of Zika virus disease had occurred in Brazil in 2015 (5). By January 20, 2016, locally-transmitted cases had been reported to the Pan American Health Organization from Puerto Rico and 19 other countries or territories in the Americas* (Figure) (6). Further spread to other countries in the region is being monitored closely.

Feral swine populations in the United States (US) are capable of carrying diseases that threaten the health of the domestic swine industry. Performing routine, near-real time monitoring for an unusual rise in feral swine slaughter condemnation will increase situational awareness and early detection of potential animal health issues, trends, and emerging diseases. In preparation to add feral swine to APHIS weekly monitoring, a descriptive analysis of feral swine slaughter and condemnations was conducted to understand the extent of commercial feral swine slaughter in the US at federally inspected slaughter establishments and to determine which condemnation reasons should be included. There were 17 establishments that slaughtered 242,198 feral swine across seven states from 2017 to 2019. For all 17 establishments combined, feral swine accounted for 63% of slaughtered animals. A total of 23 types of condemnation reasons were noted: Abscess/Pyemia, Arthritis, Contamination, Deads, Emaciation, General Miscellaneous, Icterus, Injuries, Metritis, Miscellaneous Degenerative & Dropsical Condition, Miscellaneous Inflammatory Diseases, Miscellaneous Parasitic Conditions, Moribund, Nephritis/Pyelitis, Non-ambulatory, Pericarditis, Pneumonia, Residue, Sarcoma, Septicemia, Sexual Odor, Toxemia, and Uremia. Exploratory analysis was conducted to determine which condemnation reasons should be included for weekly monitoring. For most condemn reasons, weeks of unusually high condemnations were noted. For example, a period of high pneumonia condemnations occurred from December 2, 2018 through February 3, 2019 with a spike on January 6, 2019 and a spike in dead swine occurred on November 3, 2019. The seasonal impacts on limited quality food resources, seasonal variation in the pathogen(s) causing pneumonia, and harsher weather are suspected to have an impact on the higher condemnation rates of pneumonia and dead swine during the winter months. Based on condemnation frequencies and the likelihood of enabling situational awareness and early detection of feral swine health emerging diseases, the following were selected for weekly monitoring: abscess/pyemia, contamination/peritonitis, deads, emaciation, injuries, miscellaneous parasitic conditions, moribund, pneumonia and septicemia. Detection of notable increases in condemnation reasons strongly suggestive of foreign animal or emerging diseases should contribute valuable evidence toward the overall disease discovery process when the anomalies are both confirmed with follow up investigation and combined with other types of surveillance.

Zika virus is a flavivirus closely related to dengue, West Nile, and yellow fever viruses. Although spread is primarily by Aedes species mosquitoes, two instances of sexual transmission of Zika virus have been reported, and replicative virus has been isolated from semen of one man with hematospermia. On February 5, 2016, CDC published recommendations for preventing sexual transmission of Zika virus. Updated prevention guidelines were published on February 23. During February 6-22, 2016, CDC received reports of 14 instances of suspected sexual transmission of Zika virus. Among these, two laboratory-confirmed cases and four probable cases of Zika virus disease have been identified among women whose only known risk factor was sexual contact with a symptomatic male partner with recent travel to an area with ongoing Zika virus transmission. Two instances have been excluded based on additional information, and six others are still under investigation. State, territorial, and local public health departments, clinicians, and the public should be aware of current recommendations for preventing sexual transmission of Zika virus, particularly to pregnant women. Men who reside in or have traveled to an area of ongoing Zika virus transmission and have a pregnant partner should abstain from sexual activity or consistently and correctly use condoms during sex with their pregnant partner for the duration of the pregnancy.

Zika virus infection has been linked to increased risk for Guillain-Barré syndrome and adverse fetal outcomes, including congenital microcephaly. In January 2016, after notification from a local health care provider, an investigation by Dallas County Health and Human Services (DCHHS) identified a case of sexual transmission of Zika virus between a man with recent travel to an area of active Zika virus transmission (patient A) and his nontraveling male partner (patient B). At this time, there had been one prior case report of sexual transmission of Zika virus. The present case report indicates Zika virus can be transmitted through anal sex, as well as vaginal sex. Identification and investigation of cases of sexual transmission of Zika virus in nonendemic areas present valuable opportunities to inform recommendations to prevent sexual transmission of Zika virus.

The National Center for Food Protection and Defense (NCFPD), which is led by the University of Minnesota, hosted an international food defense exercise on 27 to 29 May 2008. Established in 2004, NCFPD is a Department of Homeland Security Center of Excellence with the mission of defending the food system through research and education. Tabletop exercises are practice-based scenarios intended to mimic real life experiences. The objective of the exercise discussed in this article was to facilitate discussion to increase awareness among exercise participants of both the threat that would be posed by an intentional attack on the food supply and the international impact of such an attack. Through facilitated discussion, exercise participants agreed on the following themes: (i) recognition of a foodborne disease outbreak is driven by the characteristics of the illness rather than the actual number of ill individuals; (ii) during the course of a foodborne outbreak there are generally multiple levels of communication; (iii) a common case definition for a foodborne disease is difficult to develop on a global scale; and (iv) the safety and health of all individuals is the number one priority of all parties involved. Several challenges were faced during the development of the exercise, but these were overcome to produce a more robust exercise. The following discussion will provide an overview of the challenges and the strategies used to overcome them. The lessons learned provide insight into how to plan, prepare, and host an international food defense exercise.

Since 2006, a collaborative group of egg industry, state, federal, and academia representatives have worked to enhance preparedness in highly pathogenic avian influenza (HPAI) planning. The collaborative group has created a draft egg product movement protocol, which calls for realistic, science-based contingency plans, biosecurity assessments, commodity risk assessments, and real-time reverse transcriptase–PCR testing to support the continuity of egg operations while also preventing and eradicating an HPAI outbreak. The work done by this group serves as an example of how industry, government, and academia can work together to achieve better preparedness in the event of an animal health emergency. In addition, in the event of an HPAI outbreak in domestic poultry, U.S. consumers will be assured that their egg products come from healthy chickens.

Early detection of highly pathogenic avian influenza (HPAI) infection in commercial poultry flocks is a critical component of outbreak control. Reducing the time to detect HPAI infection can reduce the risk of disease transmission to other flocks. The timeliness of different types of detection triggers could be dependent on clinical signs that are first observed in a flock, signs that might vary due to HPAI virus strain characteristics. We developed a stochastic disease transmission model to evaluate how transmission characteristics of various HPAI strains might effect the relative importance of increased mortality, drop in egg production, or daily real-time reverse transcriptase (RRT)-PCR testing, toward detecting HPAI infection in a commercial table-egg layer flock. On average, daily RRT-PCR testing resulted in the shortest time to detection (from 3.5 to 6.1 days) depending on the HPAI virus strain and was less variable over a range of transmission parameters compared with other triggers evaluated. Our results indicate that a trigger to detect a drop in egg production would be useful for HPAI virus strains with long infectious periods (6–8 days) and including an egg-drop detection trigger in emergency response plans would lead to earlier and consistent reporting in some cases. We discuss implications for outbreak control and risk of HPAI spread attributed to different HPAI strain characteristics where an increase in mortality or a drop in egg production or both would be among the first clinical signs observed in an infected flock.

Zika virus is an emerging mosquito-borne flavivirus. Recent outbreaks of Zika virus disease in the Pacific Islands and the Region of the Americas have identified new modes of transmission and clinical manifestations, including adverse pregnancy outcomes. However, data on the epidemiology and clinical findings of laboratory-confirmed Zika virus disease remain limited. During January 1, 2015-February 26, 2016, a total of 116 residents of 33 U.S. states and the District of Columbia had laboratory evidence of recent Zika virus infection based on testing performed at CDC. Cases include one congenital infection and 115 persons who reported recent travel to areas with active Zika virus transmission (n = 110) or sexual contact with such a traveler (n = 5). All 115 patients had clinical illness, with the most common signs and symptoms being rash (98%; n = 113), fever (82%; 94), and arthralgia (66%; 76). Health care providers should educate patients, particularly pregnant women, about the risks for, and measures to prevent, infection with Zika virus and other mosquito-borne viruses. Zika virus disease should be considered in patients with acute onset of fever, rash, arthralgia, or conjunctivitis, who traveled to areas with ongoing Zika virus transmission (http://www.cdc.gov/zika/geo/index.html) or who had unprotected sex with a person who traveled to one of those areas and developed compatible symptoms within 2 weeks of returning.