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Emerging Infectious Diseases journal
Upsurge of Enterovirus D68, the Netherlands, 2016 M. Knoester et al. January 2017
Reconstruction of Zika Virus Introduction in Brazil K. Zinszer et al. January 2017
Zika Virus Infection in the Central Nervous System and Female Genital Tract E. Nicastri et al. December 2016
Volume 22, Number 10—October 2016 PDF Version [PDF - 38.32 MB - 173 pages]
Outbreaks of Human Salmonella Infections Associated with Live Poultry, United States, 1990–2014
PDF Version [PDF - 1.54 MB - 7 pages]
C. Basler et al.View SummaryView Abstract
These outbreaks underscore the need for a comprehensive One Health approach that integrates human, animal, and environmental health.
Backyard poultry flocks have increased in popularity concurrent with an increase in live poultry–associated salmonellosis (LPAS) outbreaks. Better understanding of practices that contribute to this emerging public health issue is needed. We reviewed outbreak reports to describe the epidemiology of LPAS outbreaks in the United States, examine changes in trends, and inform prevention campaigns. LPAS outbreaks were defined as ≥2 culture-confirmed human Salmonella infections linked to live poultry contact. Outbreak data were obtained through multiple databases and a literature review. During 1990–2014, a total of 53 LPAS outbreaks were documented, involving 2,630 illnesses, 387 hospitalizations, and 5 deaths. Median patient age was 9 years (range <1 to 92 years). Chick and duckling exposure were reported by 85% and 38% of case-patients, respectively. High-risk practices included keeping poultry inside households (46% of case-patients) and kissing birds (13%). Comprehensive One Health strategies are needed to prevent illnesses associated with live poultry.
Vaccine-Derived Polioviruses and Children with Primary Immunodeficiency, Iran, 1995–2014
PDF Version [PDF - 580 KB - 8 pages]
M. Shaghaghi et al.View SummaryView Abstract
Polio might not be eradicated unless long-term vaccination with inactivated poliovirus vaccine is implemented.
Widespread use of oral poliovirus vaccine has led to an ≈99.9% decrease in global incidence of poliomyelitis (from ≈350,000 cases in 1988 to 74 cases in 2015) and eradication of wild-type poliovirus serotypes 2 and 3. However, patients with primary immunodeficiency might shed vaccine-derived polioviruses (VDPVs) for an extended period, which could pose a major threat to polio eradication programs. Since 1995, sixteen VDPV populations have been isolated from 14 patients with immunodeficiency in Iran. For these patients, vaccine-associated paralysis, mostly in >1 extremity, was the first manifestation of primary immunodeficiency. Seven patients with humoral immunodeficiency cleared VDPV infection more frequently than did 6 patients with combined immunodeficiencies. Our results raise questions about manifestations of VDPVs in immunodeficient patients and the role of cellular immunity against enterovirus infections. On the basis of an association between VDPVs and immunodeficiency, we advocate screening of patients with primary immunodeficiency for shedding of polioviruses.
Medscape CME Activity
Infection-Related Death among Persons with Refractory Juvenile Idiopathic Arthritis PDF Version [PDF - 458 KB - 8 pages]M. Abinun et al.View SummaryView Abstract
Bacterial sepsis led to multiorgan failure in persons receiving immunosuppressive and antiinflammatory drugs.
Severe infections are emerging as major risk factors for death among children with juvenile idiopathic arthritis (JIA). In particular, children with refractory JIA treated with long-term, multiple, and often combined immunosuppressive and antiinflammatory agents, including the new biological disease-modifying antirheumatic drugs (DMARDs), are at increased risk for severe infections and death. We investigated 4 persons with JIA who died during 1994–2013, three of overwhelming central venous catheter–related bacterial sepsis caused by coagulase-negative Staphylococus or α-hemolytic Streptococcus infection and 1 of disseminated adenovirus and Epstein-Barr virus infection). All 4 had active JIA refractory to long-term therapy with multiple and combined conventional and biological DMARDs. Two died while receiving high-dose systemic corticosteroids, methotrexate, and after recent exposure to anti–tumor necrosis factor-α biological DMARDs, and 2 during hematopoietic stem cell transplantation procedure. Reporting all cases of severe infections and especially deaths in these children is of paramount importance for accurate surveillance.
Accuracy of Diagnosis of Human Granulocytic Anaplasmosis in China
PDF Version [PDF - 355 KB - 4 pages]
G. P. WormserView SummaryView Abstract
Severe fever with thrombocytopenia syndrome may be misdiagnosed as human granulocytic anaplasmosis.
In 2008, human granulocytic anaplasmosis (HGA) was reported from China. However, the clinical and laboratory findings, including reports of nosocomial transmission, were inconsistent with those reported for HGA in the United States. In 2012, it was demonstrated that the patients described in the 2008 report had all been infected with a newly discovered bunyavirus, severe fever with thrombocytopenia syndrome virus, which causes an illness with the same clinical features described for the patients in the 2008 report. This finding raises the question of HGA misdiagnosis in China and establishes the need for further studies to determine whether HGA occurs there.
Population-Level Effects of Human Papillomavirus Vaccination Programs on Infections with Nonvaccine Genotypes
PDF Version [PDF - 964 KB - 9 pages]
D. Mesher et al.View SummaryView Abstract
After introduction of vaccination, some prevalences of nonvaccine types changed, without clear evidence for type replacement.
We analyzed human papillomavirus (HPV) prevalences during prevaccination and postvaccination periods to consider possible changes in nonvaccine HPV genotypes after introduction of vaccines that confer protection against 2 high-risk types, HPV16 and HPV18. Our meta-analysis included 9 studies with data for 13,886 girls and women ≤19 years of age and 23,340 women 20–24 years of age. We found evidence of cross-protection for HPV31 among the younger age group after vaccine introduction but little evidence for reductions of HPV33 and HPV45. For the group this same age group, we also found slight increases in 2 nonvaccine high-risk HPV types (HPV39 and HPV52) and in 2 possible high-risk types (HPV53 and HPV73). However, results between age groups and vaccines used were inconsistent, and the increases had possible alternative explanations; consequently, these data provided no clear evidence for type replacement. Continued monitoring of these HPV genotypes is important.
Cat-Scratch Disease in the United States, 2005–2013
PDF Version [PDF - 687 KB - 6 pages]
C. A. Nelson et al.View SummaryView Abstract
Each year, this preventable disease affects about 12,500 persons, mostly those who live in the South and are 5–9 years of age.
Cat-scratch disease (CSD) is mostly preventable. More information about the epidemiology and extent of CSD would help direct prevention efforts to those at highest risk. To gain such information, we reviewed the 2005–2013 MarketScan national health insurance claims databases and identified patients <65 years of age with an inpatient admission or outpatient visit that included a CSD code from the International Classification of Diseases, Ninth Revision, Clinical Modification. Incidence of CSD was highest among those who lived in the southern United States (6.4 cases/100,000 population) and among children 5–9 years of age (9.4 cases/100,000 population). Inpatients were significantly more likely than outpatients to be male and 50–64 years of age. We estimate that each year, 12,000 outpatients are given a CSD diagnosis and 500 inpatients are hospitalized for CSD. Prevention measures (e.g., flea control for cats) are particularly helpful in southern states and in households with children.
Community- and Healthcare-Associated Clostridium difficile Infections, Finland, 2008−2013
PDF Version [PDF - 2.28 MB - 7 pages]
S. M. Kotila et al.View SummaryView Abstract
Prudent use of antimicrobial drugs in outpatient settings is needed for reducing the burden of infection.
We evaluated incidence, case-fatality rate, and trends of community-associated (CA) and healthcare-associated (HA) Clostridium difficile infections (CDIs) in Finland during 2008–2013. CDIs were identified in the National Infectious Disease Register, deaths in the National Population Information System, hospitalizations to classify infections as CA or HA in the National Hospital Discharge Register, and genotypes in a reference laboratory. A total of 32,991 CDIs were identified: 10,643 (32.3%) were CA (32.9 cases/100,000 population) and 22,348 (67.7%) HA (69.1/100,000). Overall annual incidence decreased from 118.7/100,000 in 2008 to 92.1/100,000 in 2013, which was caused by reduction in HA-CDI rates (average annual decrease 8.1%; p<0.001). The 30-day case-fatality rate was lower for CA-CDIs than for HA-CDIs (3.2% vs. 13.3%; p<0.001). PCR ribotypes 027 and 001 were more common in HA-CDIs than in CA-CDIs. Although the HA-CDI incidence rate decreased, which was probably caused by increased awareness and improved infection control, the CA-CDI rate increased.
Carbapenem Resistance in Clonally Distinct Clinical Strains of Vibrio fluvialis Isolated from Diarrheal Samples
PDF Version [PDF - 1.12 MB - 8 pages]
G. Chowdhury et al.View SummaryView Abstract
These strains might acquire the blaNDM-1 gene without exposure to antimicrobial drugs.
Carbapenems have been used for many years to treat severe nosocomial Enterobacteriaceae infections. The spread of resistance to these drugs among other bacterial families is an emerging problem worldwide, mostly caused by New Delhi metallo-β-lactamase (NDM-1). We screened for the prevalence of NDM-1–expressing enteric pathogens from hospitalized patients with acute diarrhea in Kolkata, India, and identified 27 Vibrio fluvialis–harboring blaNDM-1 (NDM-VF) strains. These isolates were also resistant to all the tested antimicrobial drugs except doxycycline. The large plasmid of V. fluvialis harboring blaNDM-1 could be easily transferred to other enteric pathogens. Genes flanking the blaNDM-1 were found to be identical to the reported sequence from an Escherichia coli isolate. Analyses showed that the V. fluvialis possessing the NDM-VF region belonged to different clones. The pathogenicity of V. fluvialis to humans and its ubiquitous presence in the environment call for constant monitoring of this species for emerging antimicrobial drug resistance.
Whole-Genome Characterization of Epidemic Neisseria meningitidis Serogroup C and Resurgence of Serogroup W, Niger, 2015
PDF Version [PDF - 1.53 MB - 7 pages]
C. B. Kretz et al.View Abstract
In 2015, Niger reported the largest epidemic of Neisseria meningitidis serogroup C (NmC) meningitis in sub-Saharan Africa. The NmC epidemic coincided with serogroup W (NmW) cases during the epidemic season, resulting in a total of 9,367 meningococcal cases through June 2015. To clarify the phylogenetic association, genetic evolution, and antibiotic determinants of the meningococcal strains in Niger, we sequenced the genomes of 102 isolates from this epidemic, comprising 81 NmC and 21 NmW isolates. The genomes of 82 isolates were completed, and all 102 were included in the analysis. All NmC isolates had sequence type 10217, which caused the outbreaks in Nigeria during 2013–2014 and for which a clonal complex has not yet been defined. The NmC isolates from Niger were substantially different from other NmC isolates collected globally. All NmW isolates belonged to clonal complex 11 and were closely related to the isolates causing recent outbreaks in Africa.
Medscape CME Activity
Ebola Virus Disease in Children, Sierra Leone, 2014–2015 PDF Version [PDF - 1.55 MB - 9 pages]F. Fitzgerald et al.View SummaryView Abstract
Children died rapidly, more than half in Ebola holding units before transfer to treatment units.
Little is known about potentially modifiable factors in Ebola virus disease in children. We undertook a retrospective cohort study of children <13 years old admitted to 11 Ebola holding units in the Western Area, Sierra Leone, during 2014–2015 to identify factors affecting outcome. Primary outcome was death or discharge after transfer to Ebola treatment centers. All 309 Ebola virus–positive children 2 days–12 years old were included; outcomes were available for 282 (91%). Case-fatality was 57%, and 55% of deaths occurred in Ebola holding units. Blood test results showed hypoglycemia and hepatic/renal dysfunction. Death occurred swiftly (median 3 days after admission) and was associated with younger age and diarrhea. Despite triangulation of information from multiple sources, data availability was limited, and we identified no modifiable factors substantially affecting death. In future Ebola virus disease epidemics, robust, rapid data collection is vital to determine effectiveness of interventions for children.
Systematic Review and Meta-Analysis of Doxycycline Efficacy for Rectal Lymphogranuloma Venereum in Men Who Have Sex with Men
PDF Version [PDF - 611 KB - 7 pages]
C. Leeyaphan et al.View SummaryView Abstract
A high microbial cure rate was shown with 100 mg doxycycline twice daily for 21 days.
Rectal lymphogranuloma venereum (LGV) has reemerged as a sexually transmitted infection among men who have sex with men (MSM), particularly those who are HIV-positive. We undertook a systematic review and meta-analysis to determine the efficacy of doxycycline (100 mg 2×/d for 21 days) for rectal LGV in MSM. Nine studies were included: 4 prospective, 4 retrospective, and 1 combined retrospective and prospective. In total, 282 MSM with rectal LGV were included in the studies. All studies reported using nucleic acid amplification tests to assess microbial cure. Most patients (>80%) had symptomatic rectal infection. The fixed-effects pooled efficacy for doxycycline was 98.5% (95% CI 96.3%–100%, I2 = 0%; p = 0.993). Doxycycline at 100 mg twice daily for 21 days demonstrated a high microbial cure rate. These data support doxycycline at this dosage and duration as first-line therapy for rectal LGV in MSM.
Increase in Meningococcal Serogroup W Disease, Victoria, Australia, 2013–2015
PDF Version [PDF - 718 KB - 3 pages]
K. S. Carville et al.View Abstract
In Victoria, Australia, invasive meningococcal disease caused by Neisseria meningitidis serogroup W increased from 4% of all cases in 2013 to 30% in 2015. This increase resulted largely from strains similar to those in the serogroup W sequence type 11 clonal complex, previously described in the United Kingdom and South America.
Distinct Zika Virus Lineage in Salvador, Bahia, Brazil
PDF Version [PDF - 1.42 MB - 5 pages]
S. N. Naccache et al.View Abstract
Sequencing of isolates from patients in Bahia, Brazil, where most Zika virus cases in Brazil have been reported, resulted in 11 whole and partial Zika virus genomes. Phylogenetic analyses revealed a well-supported Bahia-specific Zika virus lineage, which indicates sustained Zika virus circulation in Salvador, Bahia’s capital city, since mid-2014.
Streptococcus suis Serotype 2 Capsule In Vivo
PDF Version [PDF - 923 KB - 4 pages]
J. Auger et al.View Abstract
Many Streptococcus suis isolates from porcine endocarditis in slaughterhouses have lost their capsule and are considered avirulent. However, we retrieved capsule- and virulence-recovered S. suis after in vivo passages of a nonencapsulated strain in mice, suggesting that nonencapsulated S. suis are still potentially hazardous for persons in the swine industry.
Estimation of Severe Middle East Respiratory Syndrome Cases in the Middle East, 2012–2016
PDF Version [PDF - 410 KB - 3 pages]
J. J. O’Hagan et al.View SummaryView Abstract
Our traveler-based estimate was 2.3-fold higher than the number of laboratory-confirmed cases recorded.
Using data from travelers to 4 countries in the Middle East, we estimated 3,250 (95% CI 1,300–6,600) severe cases of Middle East respiratory syndrome occurred in this region during September 2012–January 2016. This number is 2.3-fold higher than the number of laboratory-confirmed cases recorded in these countries.
Chikungunya Virus in Febrile Humans and Aedes aegypti Mosquitoes, Yucatan, Mexico
PDF Version [PDF - 659 KB - 4 pages]
N. Cigarroa-Toledo et al.View Abstract
Chikungunya virus (CHIKV) was isolated from 12 febrile humans in Yucatan, Mexico, in 2015. One patient was co-infected with dengue virus type 1. Two additional CHIKV isolates were obtained from Aedes aegypti mosquitoes collected in the homes of patients. Phylogenetic analysis showed that the CHIKV isolates belong to the Asian lineage.
Daily Reportable Disease Spatiotemporal Cluster Detection, New York City, New York, USA, 2014–2015
PDF Version [PDF - 937 KB - 5 pages]
S. K. Greene et al.View Abstract
Each day, the New York City Department of Health and Mental Hygiene uses the free SaTScan software to apply prospective space–time permutation scan statistics to strengthen early outbreak detection for 35 reportable diseases. This method prompted early detection of outbreaks of community-acquired legionellosis and shigellosis.
Viral RNA in Blood as Indicator of Severe Outcome in Middle East Respiratory Syndrome Coronavirus Infection
PDF Version [PDF - 1.28 MB - 4 pages]
S. Kim et al.View Abstract
We evaluated the diagnostic and clinical usefulness of blood specimens to detect Middle East respiratory syndrome coronavirus infection in 21 patients from the 2015 outbreak in South Korea. Viral RNA was detected in blood from 33% of patients at initial diagnosis, and the detection preceded a worse clinical course.
Sporotrichosis-Associated Hospitalizations, United States, 2000–2013
PDF Version [PDF - 795 KB - 4 pages]
J. Gold et al.View Abstract
To determine frequency and risk for sporotrichosis-associated hospitalizations, we analyzed the US 2000–2013 National (Nationwide) Inpatient Sample. An estimated 1,471 hospitalizations occurred (average annual rate 0.35/1 million persons). Hospitalizations were associated with HIV/AIDS, immune-mediated inflammatory diseases, and chronic obstructive pulmonary disease. Although rare, severe sporotrichosis should be considered for at-risk patients.
Effect of Geography on the Analysis of Coccidioidomycosis-Associated Deaths, United States
PDF Version [PDF - 374 KB - 3 pages]
J. A. Noble et al.View Abstract
Because coccidioidomycosis death rates vary by region, we reanalyzed coccidioidomycosis-associated mortality in the United States by race/ethnicity, then limited analysis to Arizona and California. Coccidioidomycosis-associated deaths were shown to increase among African-Americans but decrease among Native Americans and Hispanics. Separately, in a Native American cohort, diabetes co-varied with coccidioidomycosis-associated death.
Persistence of Antibodies against Middle East Respiratory Syndrome Coronavirus
PDF Version [PDF - 426 KB - 3 pages]
D. C. Payne et al.View Abstract
To determine how long antibodies against Middle East respiratory syndrome coronavirus persist, we measured long-term antibody responses among persons serologically positive or indeterminate after a 2012 outbreak in Jordan. Antibodies, including neutralizing antibodies, were detectable in 6 (86%) of 7 persons for at least 34 months after the outbreak.
Case-Fatality Rates and Sequelae Resulting from Neisseria meningitidis Serogroup C Epidemic, Niger, 2015
PDF Version [PDF - 1.39 MB - 3 pages]
M. E. Coldiron et al.View Abstract
We describe clinical symptoms, case-fatality rates, and prevalence of sequelae during an outbreak of Neisseria meningitidis serogroup C infection in a rural district of Niger. During home visits, we established that household contacts of reported case-patients were at higher risk for developing meningitis than the general population.
Reemergence of Mycobacterium chimaera in Heater–Cooler Units despite Intensified Cleaning and Disinfection Protocol
PDF Version [PDF - 1.03 MB - 4 pages]
P. W. Schreiber et al.View Abstract
Invasive Mycobacterium chimaera infections after open-heart surgery have been reported internationally. These devastating infections result from aerosols generated by contaminated heater–cooler units used with extracorporeal circulation during surgery. Despite intensified cleaning and disinfection, surveillance samples from factory-new units acquired during 2014 grew nontuberculous mycobacteria after a median of 174 days.
Hypervirulent Clone of Group B Streptococcus Serotype III Sequence Type 283, Hong Kong, 1993–2012
PDF Version [PDF - 818 KB - 4 pages]
M. Ip et al.View Abstract
We describe a hypervirulent clone of group B Streptococcus serotype III, subtype 4, sequence type 283, that caused invasive disease with a predilection for meningitis in Hong Kong during 1993–2012. The organism is associated with high mortality and increased summer prevalence and is linked to diseased fish from freshwater fish farms.
Synovial Tissue Infection with Burkholderia fungorum
PDF Version [PDF - 307 KB - 2 pages]
S. Loong et al.
Naegleria fowleri Meningoencephalitis Associated with Public Water Supply, Pakistan, 2014
PDF Version [PDF - 368 KB - 3 pages]
N. K. Ghanchi et al.
Unmet Needs for a Rapid Diagnosis of Chikungunya Virus Infection
PDF Version [PDF - 329 KB - 3 pages]
E. Burdino et al.View Summary
Rapid Diagnosis of Chikungunya Virus Infection
Novel Single-Stranded DNA Circular Viruses in Pericardial Fluid of Patient with Recurrent Pericarditis
PDF Version [PDF - 444 KB - 3 pages]
S. Halary et al.
Reemergence of Japanese Encephalitis in South Korea, 2010–2015
PDF Version [PDF - 343 KB - 3 pages]
J. Sunwoo et al.
Recombinant Enterovirus A71 Subgenogroup C1 Strains, Germany, 2015
PDF Version [PDF - 527 KB - 4 pages]
S. Böttcher et al.
Cerebral Syphilitic Gumma within 5 Months of Syphilis in HIV-Infected Patient
PDF Version [PDF - 539 KB - 3 pages]
M. Tsuboi et al.
African Tick-Bite Fever in Traveler Returning to Slovenia from Uganda
PDF Version [PDF - 306 KB - 9 pages]
P. Bogovic et al.
Polymyxin B Resistance in Carbapenem-Resistant Klebsiella pneumoniae, São Paulo, Brazil
PDF Version [PDF - 455 KB - 3 pages]
F. Bartolleti et al.
Resolution of a Chikungunya Outbreak in a Prospective Cohort, Cebu, Philippines, 2012–2014
PDF Version [PDF - 312 KB - 3 pages]
A. Srikiatkhachorn et al.
Resurgence of Yellow Fever in Angola, 2015–2016
PDF Version [PDF - 372 KB - 2 pages]
A. A. Grobbelaar et al.
Sexual Transmission of Zika Virus and Persistence in Semen, New Zealand, 2016
PDF Version [PDF - 406 KB - 3 pages]
J. Harrower et al.
Culex pipiens and Aedes triseriatus Mosquito Susceptibility to Zika Virus
PDF Version [PDF - 337 KB - 3 pages]
M. T. Aliota et al.
Yellow Fever—More a Policy and Planning Problem than a Biological One
PDF Version [PDF - 273 KB - 2 pages]
C. H. Calisher and J. P. Woodall
Books and Media
About the Cover
Global Capacity for Emerging Infectious Disease Detection, 1996–2014
PDF Version [PDF - 2.66 MB - 9 pages]
S. A. Kluberg et al.View SummaryView Abstract
Timeliness of global outbreak discovery and public communication have gradually improved, but progress has slowed in recent years.
The speed with which disease outbreaks are recognized is critical for establishing effective control efforts. We evaluate global improvements in the timeliness of outbreak discovery and communication during 2010–2014 as a follow-up to a 2010 report. For all outbreaks reported by the World Health Organization’s Disease Outbreak News, we estimate the number of days from first symptoms until outbreak discovery and until first public communication. We report median discovery and communication delays overall, by region, and by Human Development Index (HDI) quartile. We use Cox proportional hazards regression to assess changes in these 2 outcomes over time, along with Loess curves for visualization. Improvement since 1996 was greatest in the Eastern Mediterranean and Western Pacific regions and in countries in the middle HDI quartiles. However, little progress has occurred since 2010. Further improvements in surveillance will likely require additional international collaboration with a focus on regions of low or unstable HDI.
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- Page created: September 20, 2016
- Page last updated: September 20, 2016
- Page last reviewed: September 20, 2016
- Centers for Disease Control and Prevention,
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