Invasive nontuberculous mycobacteria (NTM) infections may result from a previously unrecognized source of transmission, heater-cooler devices (HCDs) used during cardiac surgery. In July 2015, the Pennsylvania Department of Health notified the Centers for Disease Control and Prevention (CDC) about a cluster of NTM infections among cardiothoracic surgical patients at 1 hospital. We conducted a case-control study to identify exposures causing infection, examining 11 case-patients and 48 control-patients. Eight (73%) case-patients had a clinical specimen identified as Mycobacterium avium complex (MAC). HCD exposure was associated with increased odds of invasive NTM infection; laboratory testing identified patient isolates and HCD samples as closely related strains of M. chimaera, a MAC species. This investigation confirmed a large US outbreak of invasive MAC infections in a previously unaffected patient population and suggested transmission occurred by aerosolization from HCDs. Recommendations have been issued for enhanced surveillance to identify potential infections associated with HCDs and measures to mitigate transmission risk.

Foreign animal diseases (FADs) are recognized as a threat to agriculture, with potential devastating effects on our nation's livestock and poultry industries. As weapons of bioterrorism, FADs also represent a threat to our nation's homeland security. Veterinarians play a vital role in protecting our nation's agricultural resources through their ability to identify and promptly respond to FADs, some of which are of public health concern. Veterinarians working in the Commonwealth of Pennsylvania were surveyed to assess their awareness of FADs and their preparedness to recognize and respond to potential cases. Two hundred thirty-seven veterinary practitioners completed an online questionnaire which included demographic and practice characteristics, federal accreditation status, awareness of FAD history in the United States, awareness of current FAD threats, training, and professional experiences with FADs. In the analysis, we identified topics respondents were most familiar, and those which they feel pose the greatest disease threat. We also assessed respondents' interest in receiving supplemental training on FADs. Results of this survey indicate that most participating Pennsylvania veterinarians are familiar with FADs and have had educational exposure to FADs either during their formal veterinary education or through the United States Department of Agriculture veterinary accreditation program. However, the majority feels unprepared to recognize FADs. Most survey respondents expressed an interest in receiving supplemental training on FADs, and were willing to travel to receive the training.

Before the current Ebola epidemic in West Africa, there were few documented cases of symptomatic Ebola patients traveling by commercial airline, and no evidence of transmission to passengers or crew members during airline travel. In July 2014 two persons with confirmed Ebola virus infection who were infected early in the Nigeria outbreak traveled by commercial airline while symptomatic, involving a total of four flights (two international flights and two Nigeria domestic flights). It is not clear what symptoms either of these two passengers experienced during flight; however, one collapsed in the airport shortly after landing, and the other was documented to have fever, vomiting, and diarrhea on the day the flight arrived. Neither infected passenger transmitted Ebola to other passengers or crew on these flights. In October 2014, another airline passenger, a U.S. health care worker who had traveled domestically on two commercial flights, was confirmed to have Ebola virus infection. Given that the time of onset of symptoms was uncertain, an Ebola airline contact investigation in the United States was conducted. In total, follow-up was conducted for 268 contacts in nine states, including all 247 passengers from both flights, 12 flight crew members, eight cleaning crew members, and one federal airport worker (81 of these contacts were documented in a report published previously). All contacts were accounted for by state and local jurisdictions and followed until completion of their 21-day incubation periods. No secondary cases of Ebola were identified in this investigation, confirming that transmission of Ebola during commercial air travel did not occur.