Emerging Infectious Diseases journal
Volume 22, Number 6—June 2016 PDF Version [PDF - 89.91 MB - 208 pages]
Debate Regarding Oseltamivir Use for Seasonal and Pandemic Influenza
PDF Version [PDF - 1.10 MB - 7 pages]
A. C. Hurt and H. KellyView SummaryView Abstract
Data on outpatients with relatively mild disease should not form the basis for policies on the management of more severe disease.
A debate about the market-leading influenza antiviral medication, oseltamivir, which initially focused on treatment for generally mild illness, has been expanded to question the wisdom of stockpiling for use in future influenza pandemics. Although randomized controlled trial evidence confirms that oseltamivir will reduce symptom duration by 17–25 hours among otherwise healthy adolescents and adults with community-managed disease, no randomized controlled trials have examined the effectiveness of oseltamivir against more serious outcomes. Observational studies, although criticized on methodologic grounds, suggest that oseltamivir given early can reduce the risk for death by half among persons hospitalized with confirmed infection caused by influenza A(H1N1)pdm09 and influenza A(H5N1) viruses. However, available randomized controlled trial data may not be able to capture the effect of oseltamivir use among hospitalized patients with severe disease. We assert that data on outpatients with relatively mild disease should not form the basis for policies on the management of more severe disease.
Perspectives on West Africa Ebola Virus Disease Outbreak, 2013–2016
PDF Version [PDF - 2.38 MB - 8 pages]
J. R. Spengler et al.View SummaryView Abstract
Many features of this outbreak reinforce the benefit of continued investment in global health security.
The variety of factors that contributed to the initial undetected spread of Ebola virus disease in West Africa during 2013–2016 and the difficulty controlling the outbreak once the etiology was identified highlight priorities for disease prevention, detection, and response. These factors include occurrence in a region recovering from civil instability and lacking experience with Ebola response; inadequate surveillance, recognition of suspected cases, and Ebola diagnosis; mobile populations and extensive urban transmission; and the community’s insufficient general understanding about the disease. The magnitude of the outbreak was not attributable to a substantial change of the virus. Continued efforts during the outbreak and in preparation for future outbreak response should involve identifying the reservoir, improving in-country detection and response capacity, conducting survivor studies and supporting survivors, engaging in culturally appropriate public education and risk communication, building productive interagency relationships, and continuing support for basic research.
Medscape CME Activity
Human Infection with Influenza A(H7N9) Virus during 3 Major Epidemic Waves, China, 2013–2015P. Wu et al.View SummaryView Abstract
Variation in risk for death might be associated with differences in case ascertainment, changes in clinical management, or virus genetic diversity.
Since March 2013, a novel influenza A(H7N9) virus has caused 3 epidemic waves of human infection in mainland China. We analyzed data from patients with laboratory-confirmed influenza A(H7N9) virus infection to estimate the risks for severe outcomes after hospitalization across the 3 waves. We found that hospitalized patients with confirmed infections in waves 2 and 3 were younger and more likely to be residing in small cities and rural areas than were patients in wave 1; they also had a higher risk for death, after adjustment for age and underlying medical conditions. Risk for death among hospitalized patients during waves 2 and 3 was lower in Jiangxi and Fujian Provinces than in eastern and southern provinces. The variation in risk for death among hospitalized case-patients in different areas across 3 epidemic waves might be associated with differences in case ascertainment, changes in clinical management, or virus genetic diversity.
Integration of Genomic and Other Epidemiologic Data to Investigate and Control a Cross-Institutional Outbreak of Streptococcus pyogenes
PDF Version [PDF - 1.13 MB - 8 pages]
V. J. Chalker et al.View SummaryView Abstract
Genomic surveillance can effectively detect such outbreaks, providing increased intelligence to support infection control.
Single-strain outbreaks of Streptococcus pyogenes infections are common and often go undetected. In 2013, two clusters of invasive group A Streptococcus (iGAS) infection were identified in independent but closely located care homes in Oxfordshire, United Kingdom. Investigation included visits to each home, chart review, staff survey, microbiologic sampling, and genome sequencing. S. pyogenes emm type 1.0, the most common circulating type nationally, was identified from all cases yielding GAS isolates. A tailored whole-genome reference population comprising epidemiologically relevant contemporaneous isolates and published isolates was assembled. Data were analyzed independently using whole-genome multilocus sequencing and single-nucleotide polymorphism analyses. Six isolates from staff and residents of the homes formed a single cluster that was separated from the reference population by both analytical approaches. No further cases occurred after mass chemoprophylaxis and enhanced infection control. Our findings demonstrate the ability of 2 independent analytical approaches to enable robust conclusions from nonstandardized whole-genome analysis to support public health practice.
Medscape CME Activity
Infectious Disease Risk Associated with Contaminated Propofol Anesthesia, 1989–2014 PDF Version [PDF - 1.14 MB - 12 pages]A. Zorrilla-Vaca et al.View SummaryView Abstract
Transmission of illness to 144 patients, resulting in 10 deaths, has been linked to extrinsic contamination.
Administration of propofol, the most frequently used intravenous anesthetic worldwide, has been associated with several iatrogenic infections despite its relative safety. Little is known regarding the global epidemiology of propofol-related outbreaks and the effectiveness of existing preventive strategies. In this overview of the evidence of propofol as a source of infection and appraisal of preventive strategies, we identified 58 studies through a literature search in PubMed, Embase, and Lilacs for propofol-related infections during 1989–2014. Twenty propofol-related outbreaks have been reported, affecting 144 patients and resulting in 10 deaths. Related factors included reuse of syringes for multiple patients and prolonged exposure to the environment when vials were left open. The addition of antimicrobial drugs to the emulsion has been instituted in some countries, but outbreaks have still occurred. There remains a lack of comprehensive information on the effectiveness of measures to prevent future outbreaks.
Improved Global Capacity for Influenza Surveillance
PDF Version [PDF - 1.32 MB - 9 pages]
L. S. Polansky et al.View SummaryView Abstract
CDC’s international capacity-building program shows evidence of progress.
During 2004–2009, the Centers for Disease Control and Prevention (CDC) partnered with 39 national governments to strengthen global influenza surveillance. Using World Health Organization data and program evaluation indicators collected by CDC in 2013, we retrospectively evaluated progress made 4–9 years after the start of influenza surveillance capacity strengthening in the countries. Our results showed substantial increases in laboratory and sentinel surveillance capacities, which are essential for knowing which influenza strains circulate globally, detecting emergence of novel influenza, identifying viruses for vaccine selection, and determining the epidemiology of respiratory illness. Twenty-eight of 35 countries responding to a 2013 questionnaire indicated that they have leveraged routine influenza surveillance platforms to detect other pathogens. This additional surveillance illustrates increased health-system strengthening. Furthermore, 34 countries reported an increased ability to use data in decision making; data-driven decisions are critical for improving local prevention and control of influenza around the world.
Reemergence of Dengue in Southern Texas, 2013
PDF Version [PDF - 1.85 MB - 6 pages]
D. L. Thomas et al.View SummaryView Abstract
Of 53 cases detected, about half were acquired locally.
During a dengue epidemic in northern Mexico, enhanced surveillance identified 53 laboratory-positive cases in southern Texas; 26 (49%) patients acquired the infection locally, and 29 (55%) were hospitalized. Of 83 patient specimens that were initially IgM negative according to ELISA performed at a commercial laboratory, 14 (17%) were dengue virus positive by real-time reverse transcription PCR performed at the Centers for Disease Control and Prevention. Dengue virus types 1 and 3 were identified, and molecular phylogenetic analysis demonstrated close identity with viruses that had recently circulated in Mexico and Central America. Of 51 household members of 22 dengue case-patients who participated in household investigations, 6 (12%) had been recently infected with a dengue virus and reported no recent travel, suggesting intrahousehold transmission. One household member reported having a recent illness consistent with dengue. This outbreak reinforces emergence of dengue in southern Texas, particularly when incidence is high in northern Mexico.
Transmission of Mycobacterium chimaera from Heater–Cooler Units during Cardiac Surgery despite an Ultraclean Air Ventilation System
PDF Version [PDF - 1.60 MB - 6 pages]
R. Sommerstein et al.View SummaryView Abstract
All such units should be separated from air that can gain access to sterile areas.
Heater–cooler units (HCUs) were recently identified as a source of Mycobacterium chimaera causing surgical site infections. We investigated transmission of this bacterium from HCUs to the surgical field by using a thermic anemometer and particle counter, videotape of an operating room equipped with an ultraclean laminar airflow ventilation system, and bacterial culture sedimentation plates in a nonventilated room. Smoke from the HCU reached the surgical field in 23 s by merging with ultraclean air. The HCU produced on average 5.2, 139, and 14.8 particles/min in the surgical field at positions Off, On/oriented toward, and On/oriented away, respectively. Culture plates were positive for M. chimaera <5 m from the HCU in the test room. These experiments confirm airborne transmission of M. chimaera aerosols from a contaminated HCU to an open surgical field despite ultraclean air ventilation. Efforts to mitigate infectious risks during surgery should consider contamination from water sources and airflow-generating devices.
Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo
PDF Version [PDF - 2.01 MB - 8 pages]
L. Nolen et al.View SummaryView Abstract
During the outbreak, 50% of household members living with an infected person developed symptom of monkeypox infection.
A 600-fold increase in monkeypox cases occurred in the Bokungu Health Zone of the Democratic Republic of the Congo during the second half of 2013; this increase prompted an outbreak investigation. A total of 104 possible cases were reported from this health zone; among 60 suspected cases that were tested, 50 (48.1%) cases were confirmed by laboratory testing, and 10 (9.6%) tested negative for monkeypox virus (MPXV) infection. The household attack rate (i.e., rate of persons living with an infected person that develop symptoms of MPXV infection) was 50%. Nine families showed >1 transmission event, and >6 transmission events occurred within this health zone. Mean incubation period was 8 days (range 4–14 days). The high attack rate and transmission observed in this study reinforce the importance of surveillance and rapid identification of monkeypox cases. Community education and training are needed to prevent transmission of MPXV infection during outbreaks.
Use of Population Genetics to Assess the Ecology, Evolution, and Population Structure of Coccidioides
PDF Version [PDF - 1.55 MB - 9 pages]
M. M. Teixeira and B. M. BarkerView SummaryView Abstract
Although Coccidioides genotypes are highly genetically variable, they cluster into discrete populations, which has implications for human infections.
During the past 20 years, a general picture of the genetic diversity and population structure of Coccidioides, the causal agent of coccidioidomycosis (Valley fever), has emerged. The genus consists of 2 genetically diverse species, C. immitis and C. posadasii, each of which contains 1 or more distinct populations with limited gene flow. Genotypic data indicate that C. immitis is divided into 2 subpopulations (central and southern California populations) and C. posadasii is divided into 3 subpopulations (Arizona, Mexico, and Texas/South America populations). However, admixture within and among these populations and the current paucity of environmental isolates limit our understanding of the population genetics of Coccidioides. We assessed population structure of Coccidioides in Arizona by analyzing 495 clinical and environmental isolates. Our findings confirm the population structure as previously described and indicate a finer scale population structure in Arizona. Environmental isolates appear to have higher genetic diversity than isolates from human patients.
Infection, Replication, and Transmission of Middle East Respiratory Syndrome Coronavirus in Alpacas
PDF Version [PDF - 1.74 MB - 7 pages]
D. R. Adney et al.View SummaryView Abstract
These animals might be useful surrogates for camels in laboratory studies of this virus.
Middle East respiratory syndrome coronavirus is a recently emerged pathogen associated with severe human disease. Zoonotic spillover from camels appears to play a major role in transmission. Because of logistic difficulties in working with dromedaries in containment, a more manageable animal model would be desirable. We report shedding and transmission of this virus in experimentally infected alpacas (n = 3) or those infected by contact (n = 3). Infectious virus was detected in all infected animals and in 2 of 3 in-contact animals. All alpacas seroconverted and were rechallenged 70 days after the original infection. Experimentally infected animals were protected against reinfection, and those infected by contact were partially protected. Necropsy specimens from immunologically naive animals (n = 3) obtained on day 5 postinfection showed virus in the upper respiratory tract. These data demonstrate efficient virus replication and animal-to-animal transmission and indicate that alpacas might be useful surrogates for camels in laboratory studies.
Rapid Detection of Polymyxin Resistance in Enterobacteriaceae
PDF Version [PDF - 1.57 MB - 6 pages]
P. Nordmann et al.View SummaryView Abstract
The test is inexpensive, easy to perform, sensitive, specific, and can be completed in <2 hours.
For identification of polymyxin resistance in Enterobacteriaceae, we developed a rapid test that detects glucose metabolization associated with bacterial growth in the presence of a defined concentration of colistin or polymyxin B. Formation of acid metabolites is evidenced by a color change (orange to yellow) of a pH indicator (red phenol). To evaluate the test, we used bacterial colonies of 135 isolates expressing various mechanisms of colistin resistance (intrinsic, chromosomally encoded, and plasmid-mediated MCR-1) and 65 colistin-susceptible isolates. Sensitivity and specificity were 99.3% and 95.4%, respectively, compared with the standard broth microdilution method. This new test is inexpensive, easy to perform, sensitive, specific, and can be completed in <2 hours. It could be useful in countries facing endemic spread of carbapenemase producers and for which polymyxins are last-resort drugs.
Human Adenovirus Associated with Severe Respiratory Infection, Oregon, USA, 2013–2014
PDF Version [PDF - 1.76 MB - 8 pages]
M. Scott et al.View SummaryView Abstract
HAdV-B7 might be reemerging in the United States.
Several human adenoviruses (HAdVs) can cause respiratory infections, some severe. HAdV-B7, which can cause severe respiratory disease, has not been recently reported in the United States but is reemerging in Asia. During October 2013–July 2014, Oregon health authorities identified 198 persons with respiratory symptoms and an HAdV-positive respiratory tract specimen. Among 136 (69%) hospitalized persons, 31% were admitted to the intensive care unit and 18% required mechanical ventilation; 5 patients died. Molecular typing of 109 specimens showed that most (59%) were HAdV-B7, followed by HAdVs-C1, -C2, -C5 (26%); HAdVs-B3, -B21 (15%); and HAdV-E4 (1%). Molecular analysis of 7 HAdV-B7 isolates identified the virus as genome type d, a strain previously identified only among strains circulating in Asia. Patients with HAdV-B7 were significantly more likely than those without HAdV-B7 to be adults and to have longer hospital stays. HAdV-B7 might be reemerging in the United States, and clinicians should consider HAdV in persons with severe respiratory infection.
Heterogeneous and Dynamic Prevalence of Asymptomatic Influenza Virus Infections
PDF Version [PDF - 651 KB - 5 pages]
L. Furuya-Kanamori et al.View SummaryView Abstract
Extreme heterogeneity was found within and between influenza types, which should be considered in planning of mitigation campaigns.
Influenza infection manifests in a wide spectrum of severity, including symptomless pathogen carriers. We conducted a systematic review and meta-analysis of 55 studies to elucidate the proportional representation of these asymptomatic infected persons. We observed extensive heterogeneity among these studies. The prevalence of asymptomatic carriage (total absence of symptoms) ranged from 5.2% to 35.5% and subclinical cases (illness that did not meet the criteria for acute respiratory or influenza-like illness) from 25.4% to 61.8%. Statistical analysis showed that the heterogeneity could not be explained by the type of influenza, the laboratory tests used to detect the virus, the year of the study, or the location of the study. Projections of infection spread and strategies for disease control require that we identify the proportional representation of these insidious spreaders early on in the emergence of new influenza subtypes or strains and track how this rate evolves over time and space.
High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus
PDF Version [PDF - 1.52 MB - 10 pages]
R. San-Juan et al.View SummaryView Abstract
Patients infected with these bacteria were more likely to have local endovascular complications.
We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011–June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 μg/mL and 0.5 μg/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2–5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1–5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications.
Population-Level Effect of Cholera Vaccine on Displaced Populations, South Sudan, 2014
PDF Version [PDF - 1.55 MB - 4 pages]
A. S. Azman et al.View Abstract
Following mass population displacements in South Sudan, preventive cholera vaccination campaigns were conducted in displaced persons camps before a 2014 cholera outbreak. We compare cholera transmission in vaccinated and unvaccinated areas and show vaccination likely halted transmission within vaccinated areas, illustrating the potential for oral cholera vaccine to stop cholera transmission in vulnerable populations.
Experimental Infection and Response to Rechallenge of Alpacas with Middle East Respiratory Syndrome Coronavirus
PDF Version [PDF - 736 KB - 4 pages]
G. Crameri et al.View Abstract
We conducted a challenge/rechallenge trial in which 3 alpacas were infected with Middle East respiratory syndrome coronavirus. The alpacas shed virus at challenge but were refractory to further shedding at rechallenge on day 21. The trial indicates that alpacas may be suitable models for infection and shedding dynamics of this virus.
Scarlet Fever Upsurge in England and Molecular-Genetic Analysis in North-West London, 2014
PDF Version [PDF - 1.90 MB - 4 pages]
C. E. Turner et al.View Abstract
Scarlet fever notifications surged across the United Kingdom in spring 2014. Molecular epidemiologic investigation of Streptococcus pyogenes infections in North-West London highlighted increased emm4 and emm3 infections coincident with the upsurge. Unlike outbreaks in other countries, antimicrobial resistance was uncommon, highlighting an urgent need to better understand the drivers of scarlet fever activity.
Possible Case of Novel Spotted Fever Group Rickettsiosis in Traveler Returning to Japan from India
PDF Version [PDF - 1.86 MB - 4 pages]
I. Takajo et al.View Abstract
A 60-year-old woman experienced fever, headache, rash, and altered vision after returning to Japan from India. Testing detected elevated antibody titers to spotted fever group rickettsia; PCR on blood yielded positive results for the rickettsial outer membrane protein A gene. We isolated a unique rickettsial agent and performed a full-genome analysis.
Shigella Antimicrobial Drug Resistance Mechanisms, 2004–2014
PDF Version [PDF - 834 KB - 3 pages]
M. Nüesch-Inderbinen et al.View Abstract
To determine antimicrobial drug resistance mechanisms of Shigella spp., we analyzed 344 isolates collected in Switzerland during 2004–2014. Overall, 78.5% of isolates were multidrug resistant; 10.5% were ciprofloxacin resistant; and 2% harbored mph(A), a plasmid-mediated gene that confers reduced susceptibility to azithromycin, a last-resort antimicrobial agent for shigellosis.
MERS-CoV Antibodies in Humans, Africa, 2013–2014
PDF Version [PDF - 884 KB - 4 pages]
A. Liljander et al.View Abstract
Dromedaries in Africa and elsewhere carry the Middle East respiratory syndrome coronavirus (MERS-CoV). To search for evidence of autochthonous MERS-CoV infection in humans, we tested archived serum from livestock handlers in Kenya for MERS-CoV antibodies. Serologic evidence of infection was confirmed for 2 persons sampled in 2013 and 2014.
Microcephaly in Infants, Pernambuco State, Brazil, 2015
PDF Version [PDF - 969 KB - 4 pages]
We studied the clinical characteristics for 104 infants born with microcephaly in the delivery hospitals of Pernambuco State, Brazil, during 2015. Testing is ongoing to exclude known infectious causes. However, microcephaly peaked in October and demonstrated central nervous system abnormalities with brain dysgenesis and intracranial calcifications consistent with an intrauterine infection.
Prospective Validation of Cessation of Contact Precautions for Extended-Spectrum β-Lactamase–Producing Escherichia coli
PDF Version [PDF - 1.06 MB - 4 pages]
S. Tschudin-Sutter et al.View Abstract
After contact precautions were discontinued, we determined nosocomial transmission of extended-spectrum β-lactamase (ESBL)–producing Escherichia coli by screening hospital patients who shared rooms with ESBL-producing E. coli–infected or –colonized patients. Transmission rates were 2.6% and 8.8% at an acute-care and a geriatric/rehabilitation hospital, respectively. Prolonged contact was associated with increased transmission.
Whole-Genome Analysis of Cryptococcus gattii, Southeastern United States
PDF Version [PDF - 652 KB - 4 pages]
S. R. Lockhart et al.View Abstract
Cryptococcus gattii is a recognized pathogenic fungus along the Pacific coast of the United States from California to Washington. Here we report that C. gattii may also be endemic to the southeastern United States and has probably been present there longer than in the Pacific Northwest.
Prevalence of Nontuberculous Mycobacterial Pulmonary Disease, Germany, 2009–2014
PDF Version [PDF - 479 KB - 4 pages]
F. C. Ringshausen et al.View Abstract
We analyzed routine statutory health insurance claim data to determine prevalence of nontuberculous mycobacterial pulmonary disease in Germany. Documented prevalence rates of this nonnotifiable disease increased from 2.3 to 3.3 cases/100,000 population from 2009 to 2014. Prevalence showed a strong association with advanced age and chronic obstructive pulmonary disease.
Post-Ebola Measles Outbreak in Lola, Guinea, January–June 2015
PDF Version [PDF - 438 KB - 3 pages]
J. E. Suk et al.View Abstract
During public health crises such as the recent outbreaks of Ebola virus disease in West Africa, breakdowns in public health systems can lead to epidemics of vaccine-preventable diseases. We report here on an outbreak of measles in the prefecture of Lola, Guinea, which started in January 2015.
Changes in Childhood Pneumonia Hospitalizations by Race and Sex Associated with Pneumococcal Conjugate Vaccines
PDF Version [PDF - 636 KB - 4 pages]
A. D. Wiese et al.View Abstract
Introduction of pneumococcal conjugate vaccines in the childhood immunization schedule was associated with decreases in all-cause pneumonia hospitalizations among black and white children in Tennessee, USA. Although racial disparities that existed before introduction of these vaccines have been substantially reduced, rates remain higher in boys than in girls among young children.
Antibody Response and Disease Severity in Healthcare Worker MERS Survivors
PDF Version [PDF - 464 KB - 3 pages]
A. N. Alshukairi et al.View Abstract
We studied antibody response in 9 healthcare workers in Jeddah, Saudi Arabia, who survived Middle East respiratory syndrome, by using serial ELISA and indirect immunofluorescence assay testing. Among patients who had experienced severe pneumonia, antibody was detected for >18 months after infection. Antibody longevity was more variable in patients who had experienced milder disease.
Epidemiology of Pulmonary Nontuberculous Mycobacterial Disease, Japan
PDF Version [PDF - 309 KB - 2 pages]
H. Namkoong et al.
Elevated Pertussis Reporting in Response to 2011–2012 Outbreak, New York City, New York, USA
PDF Version [PDF - 307 KB - 3 pages]
R. J. Arciuolo et al.
Hemophagocytic Lymphohistiocytosis and Progressive Disseminated Histoplasmosis
PDF Version [PDF - 347 KB - 3 pages]
K. Ferguson-Paul et al.
Novel Avian Influenza A(H5N8) Viruses in Migratory Birds, China, 2013–2014
PDF Version [PDF - 832 KB - 3 pages]
L. Zhou et al.
Interferon-γ Autoantibodies as Predisposing Factor for Nontuberculous Mycobacterial Infection
PDF Version [PDF - 356 KB - 3 pages]
F. Valour et al.
Loss of 89K Pathogenicity Island in Epidemic Streptococcus suis, China
PDF Version [PDF - 286 KB - 2 pages]
X. Shi et al.
Next-Generation Sequencing of Mycobacterium tuberculosis
PDF Version [PDF - 460 KB - 3 pages]
I. Mokrousov et al.
MERS-CoV Infection of Alpaca in a Region Where MERS-CoV is Endemic
PDF Version [PDF - 360 KB - 3 pages]
C. Reusken et al.
Cryptococcus gattii VGIIb-like Variant in White-Tailed Deer, Nova Scotia, Canada
PDF Version [PDF - 985 KB - 3 pages]
D. P. Overy et al.
Zika Virus in a Traveler Returning to China from Caracas, Venezuela, February 2016
PDF Version [PDF - 535 KB - 4 pages]
J. Li et al.
Pericarditis Caused by Hyperinvasive Strain of Neisseria meningitidis, Sardinia, Italy, 2015
PDF Version [PDF - 298 KB - 2 pages]
C. Fazio et al.
Ecologic Study of Meningococcal B Vaccine and Neisseria gonorrhoeae Infection, Norway
PDF Version [PDF - 419 KB - 3 pages]
J. Whelan et al.
Neisseria gonorrhoeae Resistant to Ceftriaxone and Cefixime, Argentina
PDF Version [PDF - 692 KB - 3 pages]
R. Gianecini et al.
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About the Cover
Perspective and Surprise in the Floating World
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B. Breedlove and J. Friedberg
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