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Disclaimer: Ahead of print articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.

Volume 22, Number 10—October 2016


  • Vaccine-Derived Polioviruses and Children with Primary Immunodeficiency, Iran, 1995–2014
    M. Shaghaghi et al.
    View Summary

    Polio might not be eradicated unless long-term vaccination with inactivated poliovirus vaccine is implemented.

        View Abstract

    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.

  • Outbreaks of Human Salmonella Infections Associated with Live Poultry, USA, 1990–2014
    C. Basler et al.
    View Summary

    An analysis of recent live-poultry–associated salmonellosis outbreaks and associated high-risk practices in the United States.

  • Infection-Related Death among Persons with Refractory Juvenile Idiopathic Arthritis
    M. Abinun et al.
    View Summary

    Bacterial sepsis led to multiorgan failure in persons receiving immunosuppressive and antiinflammatory drugs.

  • Accuracy of Human Granulocytic Anaplasmosis Diagnosis in China
    G. P. Wormser
    View Summary

    Reports of clinical, laboratory, and transmission features in China differ markedly from those in the United States.



  • Community- and Healthcare-Associated Clostridium difficile Infections, Finland, 2008−2013
    S. M. Kotila et al.
    View Summary

    Prudent use of antimicrobial drugs in outpatient settings is needed for reducing the burden of infection.

        View Abstract

    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.

  • Cat Scratch Disease in the United States, 2005–2013
    C. Nelson et al.
    View Summary

    Each year, this preventable disease affects about 12,500 persons, mostly those who live in the south and are 5–9 years of age.

  • Carbapenem (NDM-1) Resistance in Clonally Distinct Clinical Strains of Vibrio fluvialis Isolated from Diarrheal Samples
    G. Chowdhury et al.
    View Summary

    Vibrio fluvialis spp. might acquire blaNDM gene without exposure to antibiotic drugs.

  • Ebola Virus Disease in Children, Sierra Leone, 2014–2015
    F. Fitzgerald et al.
    View Summary

    Children died rapidly, more than half in Ebola holding units before transfer to treatment units.

  • Systematic Review and Meta-Analysis of Doxycycline Efficacy for Rectal Lymphogranuloma Venereum in Men Who Have Sex with Men
    C. Leeyaphan et al.
    View Summary

    A high microbial cure rate was shown with 100 mg doxycycline twice daily for 21 days.

        View Abstract

    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
    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.

  • Persistence of Antibodies against Middle East Respiratory Syndrome Coronavirus
    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.

  • Chikungunya Virus in Febrile Humans and Aedes aegypti Mosquitoes, Yucatan, Mexico
    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
    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.

  • Distinct Zika Virus Lineage in Salvador, Bahia, Brazil
    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.

  • Sporotrichosis-Associated Hospitalizations, United States, 2000–2013
    J. Gold et al.
  • Effect of Geography on the Analysis of Coccidioidomycosis-Associated Death
    J. A. Noble et al.
  • Viral RNA in Blood as Indicator of Severe Outcome in Middle East Respiratory Syndrome Coronavirus Infection
    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.

  • Estimation of Severe Middle East Respiratory Syndrome Cases in the Middle East, 2012–2016
    J. J. O’Hagan et al.
    View Summary

    Our traveler-based estimate was 2.3-fold higher than the number of laboratory-confirmed cases recorded.

        View Abstract

    Most Middle East respiratory syndrome caseshave been recorded in the Middle East. Using data from travelers to this region, we estimated 3,250 (95% CI 1,300–6,600) severe MERS cases occurred in the Middle East during September 2012–January 2016, which is 2.3-fold higher than the number of laboratory-confirmed cases recorded in these countries.

  • Streptococcus suis Serotype 2 Capsule In Vivo
    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.

  • Hypervirulent Clone of Group B Streptococcus Serotype III Sequence Type 283, Hong Kong, 1993–2012
    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.


Books and Media

  • Pandemic
    J. B. Nuzzo


Online Report

  • Global Capacity for Emerging Infectious Disease Detection, 1996–2014
    S. A. Kluberg et al.
    View Summary

    Timeliness of global outbreak discovery and public communication have gradually improved, but progress has slowed in recent years.

        View Abstract

    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.


Volume 22, Number 11—November 2016


  • Transmission of Babesia microti by Solid Organ Transplantation
    M. B. Brennan et al.
    View Summary

    Infection with this parasite should be included in differential diagnosis of fever and anemia after blood transfusion or organ transplantation.



  • Multidrug-Resistant Corynebacterium striatum Associated with Increased Use of Parenteral Antimicrobial Drugs
    W. O. Hahn et al.
    View Summary

    Device-related infections with this pathogen frequently require prolonged parenteral therapy.

  • Immune Response to Invasive Group B Streptococcal Disease in Adults
    M. S. Edwards et al.
    View Summary

    Antibodies to capsular polysaccharides and pilus proteins develop in adults recovering from group B streptococcal bacteremia.

  • Novel, Human-Origin, Eurasian Avian-Like Influenza (H1N1) Virus, China, 2015
    W. Zhu et al.
    View Summary

    Infectivity and virulence of this reassortant virus in mice are higher than for previous human-origin Eurasian avian-like viruses.



  • Group B Streptococcus Sequence Type 283 Disease Linked to Consumption of Raw Fish, Singapore
    P. Rajendram et al.
  • Imported Chikungunya Virus Strains, Taiwan, 2006–2014
    C. Yang et al.
  • Isolation of Mayaro Virus from Child with Acute Febrile Illness, Haiti, 2015
  • Group B Streptococcus Serotype III Sequence Type 283 Bacteremia Associated with Consumption of Raw Fish, Singapore
    S. Tan et al.
  • Increased Community-Associated Infections Caused by Panton-Valentine Leukocidin–Negative MRSA, Shanghai, 2005–2014
    M. Li et al.
  • Severe Fever with Thrombocytopenia Syndrome in Patients with Suspected Scrub Typhus
    Y. Wi et al.
  • Severe Fever with Thrombocytopenia Syndrome Complicated by Coinfection with Spotted Fever Group Rickettsiae
    Q. Lu et al.
  • Guinea Worm (Dracunculus medinensis) Infection in a Wild-Caught Frog, Chad
    M. L. Eberhard et al.
        View Abstract

    A third-stage (infective) larva of Dracunculus medinensis, the causative agent of Guinea worm disease, was recovered from a wild-caught Phrynobatrachus francisci frog in Chad. Although green frogs (Lithobates clamitans) have been experimentally infected with D. medinensis worms, our findings prove that frogs can serve as natural paratenic hosts.


Volume 22, Number 12—December 2016


  • Assessing the Epidemic Potential of RNA and DNA Viruses
    M. Woolhouse et al.
    View Summary

    Detecting and quantifying virus transmission is a challenge in assessing the public health threat of emerging viruses.



  • African Horse Sickness Caused by Genome Reassortment and Reversion to Virulence of Live, Attenuated Vaccine Viruses, South Africa, 2004–2014
    C. T. Weyer et al.
    View Summary

    Epidemiologic and phylogenetic analyses show repeated outbreaks derived from vaccine viruses.

        View Abstract

    African horse sickness (AHS) is a hemorrhagic viral fever of horses. It is the only equine disease for which the World Organization for Animal Health has introduced specific guidelines for member countries seeking official recognition of disease-free status. Since 1997, South Africa has maintained an AHS controlled area; however, sporadic outbreaks of AHS have occurred in this area. We compared the whole genome sequences of 39 AHS viruses (AHSVs) from field AHS cases to determine the source of 3 such outbreaks. Our analysis confirmed that individual outbreaks were caused by virulent revertants of AHSV type 1 live, attenuated vaccine (LAV) and reassortants with genome segments derived from AHSV types 1, 3, and 4 from a LAV used in South Africa. These findings show that despite effective protection of vaccinated horses, polyvalent LAV may, paradoxically, place susceptible horses at risk for AHS.

  • Anomalous High Rainfall and Soil Saturation as Combined Risk Indicator of Rift Valley Fever Outbreaks, South Africa, 2008–2011
    R. Williams et al.
    View Summary

    A prediction model that includes these factors shows promising potential for forecasting major outbreaks.

        View Abstract

    Rift Valley fever (RVF), a zoonotic vectorborne viral disease, causes loss of life among humans and livestock and an adverse effect on the economy of affected countries. Vaccination is the most effective way to protect livestock; however, during protracted interepidemic periods, farmers discontinue vaccination, which leads to loss of herd immunity and heavy losses of livestock when subsequent outbreaks occur. Retrospective analysis of the 2008–2011 RVF epidemics in South Africa revealed a pattern of continuous and widespread seasonal rainfall causing substantial soil saturation followed by explicit rainfall events that flooded dambos (seasonally flooded depressions), triggering outbreaks of disease. Incorporation of rainfall and soil saturation data into a prediction model for major outbreaks of RVF resulted in the correctly identified risk in nearly 90% of instances at least 1 month before outbreaks occurred; all indications are that irrigation is of major importance in the remaining 10% of outbreaks.

  • Whole Genome Characterization and Strain Comparison of VT2f-producing Escherichia coli Causing Hemolytic Uremic Syndrome
    L. Grande et al.
    View Summary

    VT2f-producing E. coli causing diarrhea in humans are zoonotic VTEC transmitted from the pigeon reservoir, while the strains causing HUS apparently derive from an event of acquisition of a VT2f-phage by E. coli strains possessing larger virulence gene profiles.



  • Time Course of MERS-CoV Infection and Immunity in Dromedary Camels
    B. Meyer et al.
        View Abstract

    Knowledge about immunity to Middle East respiratory syndrome coronavirus (MERS-CoV) in dromedary camels is essential for infection control and vaccination. A longitudinal study of 11 dam–calf pairs showed that calves lose maternal MERS-CoV antibodies 5–6 months postparturition and are left susceptible to infection, indicating a short window of opportunity for vaccination.

  • Hepatitis E Virus in 3 Types of Laboratory Animals, China, 2012–2015
    L. Wang et al.
        View Abstract

    We found seroprevalences for hepatitis E virus (HEV) of 7.5%, 18.5%, and 83.3% in specific pathogen-free (SPF) laboratory rabbits, monkeys, and pigs, respectively, in China. HEV RNA was detected in 4.8% of SPF rabbits, and 11 rabbits had latent infections. Screening for HEV in SPF animals before relevant experiments are conducted is recommended.

  • Genetically Different Highly Pathogenic Avian Influenza A(H5N1) Viruses in West Africa, 2015
    L. Tassoni et al.
        View Abstract

    To trace the evolution of highly pathogenic influenza A(H5N1) virus in West Africa, we sequenced genomes of 43 viruses collected during 2015 from poultry and wild birds in 5 countries. We found 2 co-circulating genetic groups within clade Mutations that may increase adaptation to mammals raise concern over possible risk for humans.