Key Objectives:
To describe the changing epidemiology of free-living ameba infections (FLA; Naegleria fowleri, Balamuthia mandrillaris, and Acanthamoeba spp.) in the United States and discuss how CDC can best support state and local health departments in identifying and managing FLA infections diagnosed in their jurisdictions in light of the changing epidemiology of these infections.
Brief Summary:
In recent years, changes in the epidemiology of rare but life-threatening FLA infections have brought them to the forefront of the public’s attention. Since 2010, Naegleria fowleri cases have been reported in northern-tier states (n=5) and associated with exposure to piped water (n=5); these represent new ecologic niches and a changing epidemiology for these amebae. Since 2009, three clusters of B. mandrillaris infections have been associated with organ transplantation. Acanthamoeba spp. have recently caused large outbreaks of microbial keratitis associated with contact lens wear. While these infections remain relatively rare, the outcomes are often severe and can undermine the public’s confidence in the safety of certain activities and procedures such as swimming in freshwater lakes, nasal irrigation, and organ transplantation. For the state or local health department that has identified an FLA infection within its jurisdiction, the resulting public health response can require extensive time and resources that may seem out of proportion to those typically devoted to single case reports. CDC offers consultation for clinicians who suspect FLA infection in a patient, laboratory testing for diagnosis of FLA infection including PCR, immunohistochemical staining, and serology, and 24/7 access to miltefosine, a drug that has shown promise in treating FLA infections. We also maintain Naegleria and Balamuthia websites that offer comprehensive referenced information for clinicians, public health practitioners, and the public. This roundtable will provide updates on the changing epidemiology described above, and allow for discussion on how CDC can support state and local health departments in the recognition, reporting, and management of these infections. In particular, CDC would like to know what communications and health messaging would best support the state and local health departments to educate the public and medical community about these infections.