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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 6—June 2016

Perspective

  • Perspectives on West Africa Ebola Virus Disease Outbreak, 2013–2016 J. R. Spengler et al.
    View Summary

    Many features of this outbreak reinforce the benefit of continued investment in global health security.

    View Abstract

    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.

  • Debate Regarding Oseltamivir Use for Seasonal and Pandemic Influenza A. C. Hurt and H. Kelly
    View Summary

    Data on outpatients with relatively mild disease should not form the basis for policies on the management of more severe disease.

    View Abstract

    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 trial s 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.

Synopses

  • Integration of Genomic and Other Epidemiologic Data to Investigate and Control a Cross-Institutional Outbreak of Streptococcus pyogenes V. J. Chalker et al.
    View Summary

    Genomic surveillance can effectively detect such outbreaks, providing increased intelligence to support infection control.

    View Abstract

    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.

  • Improved Global Capacity for Influenza Surveillance
    L. S. Polansky et al.
    View Summary

    CDC’s international capacity-building program shows progress.

  • Nosocomial Infection Risk Associated with Contaminated Propofol Anesthesia, 1989–2014
    A. Zorrilla-Vaca et al.
    View Summary

    Transmission of illness to 144 patients causing 10 deaths have been linked to extrinsic contamination of propofol.

  • Reemergence of Dengue in Southern Texas, 2013
  • Human Infections with Influenza A(H7N9) Virus during 3 Major Epidemic Waves, China, 2013–2015
    P. Wu et al.
    View Summary

    Variation in risk for death among hospitalized cases in different areas might be associated with differences in case ascertainment, changes in clinical management, or genetic diversity in the virus.

Research

  • Transmission of Mycobacterium chimaera from Heater–Cooler Units during Cardiac Surgery despite an Ultraclean Air Ventilation System R. Sommerstein et al.
    View Summary

    All such units should be separated from air that can gain access to sterile areas.

    View Abstract

    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.

  • Infection, Replication, and Transmission of Middle East Respiratory Syndrome Coronavirus in Alpacas D. R. Adney et al.
    View Summary

    These animals might be useful surrogates for camels in laboratory studies of this virus.

    View Abstract

    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.

  • Prevalence of Asymptomatic Influenza Virus Infections: A Systematic Review and Meta-Analysis
    L. Furuya-Kanamori et al.
    View Summary

    Extreme heterogeneity was reported within and between types, which should be considered in the planning of mitigation campaigns.

  • Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo
    L. Nolen et al.
    View Summary

    A 50% household attack rate, multiple transmission events in households and communities, and an 8-day mean incubation time for infections occurred.

  • Use of Population Genetics to Assess the Ecology, Evolution, and Population Structure of Coccidioides, Arizona, USA M. M. Teixeira and B. M. Barker
    View Summary

    Although Coccidioides genotypes are highly genetically variable, they cluster into discrete populations, which has implications for human infections.

    View Abstract

    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.

  • High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus R. San-Juan et al.
    View Summary

    Patients infected with these bacteria were more likely to have local endovascular complications.

    View Abstract

    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.

  • Rapid Detection of Polymyxin Resistance in Enterobacteriaceae P. Nordmann et al.
    View Summary

    The test is inexpensive, easy to perform, sensitive, specific, and can be completed in <2 hours.

    View Abstract

    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 M. Scott et al.
    View Summary

    HAdV-B7 might be reemerging in the United States.

    View Abstract

    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.

Dispatches

  • MERS-CoV Antibodies in Humans, Africa, 2013–2014 A. M. 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.

  • Experimental Infection and Response to Rechallenge of Alpacas with Middle East Respiratory Syndrome Coronavirus 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.

  • Whole-Genome Analysis of Cryptococcus gattii, Southeastern United States 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 F. C. Ringshausen et al.
    View Abstract

    We analyized 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.

  • Possible Case of Novel Spotted Fever Group Rickettsiosis in Traveler Returning to Japan from India 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.

  • Changes in Childhood Pneumonia Hospitalizations by Race and Sex Associated with Pneumococcal Conjugate Vaccines 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.

  • Shigella Antimicrobial Drug Resistance Mechanisms, 2004–2014 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.

  • Antibody Response and Disease Severity in Healthcare Worker MERS Survivors 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.

  • Prospective Validation of Cessation of Contact Precautions for Extended-Spectrum β-Lactamase–Producing Escherichia coli 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.

  • Population-Level Effect of Cholera Vaccine on Displaced Populations, South Sudan, 2014 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.

  • Microcephaly in Infants, Pernambuco State, Brazil, 2015
    View Abstract

    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.

  • Post-Ebola Measles Outbreak in Lola, Guinea, January–June 2015 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.

  • Scarlet Fever Upsurge in England—Molecular-Genetic Analysis in North-West London, 2014 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.

Letters

Books and Media

Etymologia

Volume 22, Number 7—July 2016

Synopses

  • Turtle-Associated Salmonellosis in the United States
    S. Bosch et al.
    View Summary

    Enhanced efforts to minimize risk of human disease acquired from small pet turtles are needed.

  • Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease in Clinical and Public Health Settings, United States
    A. Moore et al.
    View Summary

    Clinicians must consider patient medical history, timeline of symptoms, and hazards of alternative laboratory tests.

  • A Literature Review of Zika Virus A. R. Plourde and E. M. Bloch
    View Summary

    We summarize what is known about this virus and its global expansion as of mid-February 2016.

    View Abstract

    Zika virus is a mosquitoborne flavivirus that is the focus of an ongoing pandemic and public health emergency. Previously limited to sporadic cases in Africa and Asia, the emergence of Zika virus in Brazil in 2015 heralded rapid spread throughout the Americas. Although most Zika virus infections are characterized by subclinical or mild influenza-like illness, severe manifestations have been described, including Guillain-Barre syndrome in adults and microcephaly in babies born to infected mothers. Neither an effective treatment nor a vaccine is available for Zika virus; therefore, the public health response primarily focuses on preventing infection, particularly in pregnant women. Despite growing knowledge about this virus, questions remain regarding the virus’s vectors and reservoirs, pathogenesis, genetic diversity, and potential synergistic effects of co-infection with other circulating viruses. These questions highlight the need for research to optimize surveillance, patient management, and public health intervention in the current Zika virus epidemic.

  • Pregnancy, Labor, and Delivery after Ebola Virus Disease and Implications for Infection Control in Obstetric Services, United States, 2015
    A. Kamali et al.
    View Summary

    Women who become pregnant after recovery pose little risk for transmitting the virus to the baby or others.

  • 2 Linked Enteroinvasive Escherichia coli Outbreaks, Nottingham, UK, June 2014
    S. Newitt et al.
    View Summary

    These outbreaks highlight the necessity to consider this bacterium as a potential pathogen in foodborne outbreaks.

Research

  • Comparing Disease Characteristics of Sporadic and Outbreak Foodborne Illnesses
    E. D. Ebel et al.
    View Summary

    The hypothesis that case characteristics of outbreak and sporadic foodborne illness are similar is examined.

  • High Incidence of Chikungunya Virus and Frequency of Viremic Blood Donations during Epidemic, Puerto Rico, USA, 2014 G. Simmons et al.
    View Summary

    Deaths were rarely observed, but newborns and other vulnerable populations are at risk for severe complications.

    View Abstract

    Chikungunya virus (CHIKV) caused large epidemics throughout the Caribbean in 2014. We conducted nucleic acid amplification testing (NAAT) for CHIKV RNA (n = 29,695) and serologic testing for IgG against CHIKV (n = 1,232) in archived blood donor samples collected during and after an epidemic in Puerto Rico in 2014. NAAT yields peaked in October with 2.1% of donations positive for CHIKV RNA. A total of 14% of NAAT-reactive donations posed a high risk for virus transmission by transfusion because of high virus RNA copy numbers (104–109 RNA copies/mL) and a lack of specific IgM and IgG responses. Testing of minipools of 16 donations would not have detected 62.5% of RNA-positive donations detectable by individual donor testing, including individual donations without IgM and IgG. Serosurveys before and after the epidemic demonstrated that nearly 25% of blood donors in Puerto Rico acquired CHIKV infections and seroconverted during the epidemic.

  • Tropheryma whipplei as a Cause of Epidemic Fever, Senegal, 2010–2012
    H. Bassene et al.
    View Summary

    Findings suggest that the bacterium has role in febrile episodes, is contagious, and has an epidemic character.

  • African Swine Fever Epidemic, Poland, 2014–2015
    K. Śmietanka et al.
    View Summary

    Epidemiological and phylogenetic analysis suggest repeated introductions of the virus and a principle role of wild boar in disease maintenance.

  • Restaurant Cooking Trends and Increased Risk for Campylobacter Infection
    A. K. Jones et al.
    View Summary

    Perceived consumer preferences for rare chicken liver are increasing exposure to Campylobacter.

  • Heat Wave–Associated Vibriosis, Sweden and Finland, 2014

Dispatches

  • Red Fox (Vulpes vulpes) as a Sentinel for Blastomyces dermatitidis, Ontario, Canada
    N. M. Nemeth et al.
  • Vesicular Disease in 9-Week-Old Pigs Experimentally Infected with Senecavirus A
    N. Montiel et al.
  • Expanding Distribution of Lethal Amphibian Fungus Batrachochytrium salamandrivorans in Europe A. Spitzen-van der Sluijs et al.
    View Abstract

    Emerging fungal diseases can drive amphibian species to local extinction. During 2010–2016, we examined 1,921 urodeles in 3 European countries. Presence of the chytrid fungus Batrachochytrium salamandrivorans at new locations and in urodeles of different species expands the known geographic and host range of the fungus and underpins its imminent threat to biodiversity.

  • Travel-Associated Rabies in Pets and Residual Rabies Risk, Western Europe
    F. Ribadeau-Dumas et al.
  • Surveillance for Highly Pathogenic Avian Influenza Virus in Wild Birds during Outbreaks in Domestic Poultry, Minnesota, 2015 C. S. Jennelle et al.
    View Abstract

    In 2015, a major outbreak of highly pathogenic avian influenza virus (HPAIV) infection devastated poultry facilities in Minnesota, USA. To understand the potential role of wild birds, we tested 3,139 waterfowl fecal samples and 104 sick and dead birds during March 9–June 4, 2015. HPAIV was isolated from a Cooper’s hawk but not from waterfowl fecal samples.

  • Effective Chemical Inactivation of Ebola Virus E. Haddock et al.
    View Abstract

    Reliable inactivation of specimens before removal from high-level biocontainment is crucial for safe operation. To evaluate efficacy of methods of chemical inactivation, we compared in vitro and in vivo approaches using Ebola virus as a surrogate pathogen. Consequently, we have established parameters and protocols leading to reliable and effective inactivation.

  • Identification of Streptococcus suis Meningitis through Population-Based Surveillance, Togo, 2010–2014
    H. Tall et al.
  • Outbreak of Vibrio parahaemolyticus ST-120, Peru, 2009
    N. Gonzalez-Escalona et al.
  • Spread of H5 Clade 2.3.4.4 Highly Pathogenic Avian Influenza Virus Subgroups and Generation of Novel Reassortant Viruses, USA
    D. Lee et al.
  • Post-Booster Antibodies as Source of Diphtheria Antitoxin
  • Major Persistent 5′ Terminally Deleted Coxsackievirus B3 Populations in Endomyocardial Tissues of an Idiopathic Dilated Cardiomyopathy Patient
    A. Bouin et al.
  • Natural Norovirus Infections in Rhesus Macaques, Louisiana, USA
    T. Farkas
  • Single-Reaction Multiplex Reverse Transcription PCR for Detection of Zika, Chikungunya, and Dengue Viruses J. J. Waggoner et al.
    View Abstract

    Clinical manifestations of Zika virus, chikungunya virus, and dengue virus infections can be similar. To improve virus detection, streamline molecular workflow, and decrease test costs, we developed and evaluated a multiplex real-time reverse transcription PCR for these viruses.

  • Extended-Spectrum Cephalosporin-Resistant Salmonella enterica serovar Heidelberg Strains, the Netherlands
    A. Liakopoulos et al.
  • Two Related Occupational Cases of Legionella longbeachae Infection, Quebec, Canada
    M. Picard-Masson et al.
  • Increased Mortality Rates Associated with Staphylococcus aureus and Influenza Co-infection, Maryland, USA
    J. S. McDanel et al.
  • Clinical Manifestations of Senecavirus A Infection in Neonatal Pigs, Brazil, 2015
    R. A. Leme et al.
  • Hepatitis E Virus Infection in Dromedary Camels, North and East Africa, United Arab Emirates, and Pakistan, 1983–2015
    A. Rasche et al.

Letters

Online Report

  • Development of Medical Countermeasures to Middle East Respiratory Syndrome Coronavirus
    T. M. Uyeki et al.

Volume 22, Number 8—August 2016

Synopsis

  • Probable Rabies Virus Transmission through Organ Transplantation, China, 2015 H. Zhou et al.
    View Summary

    Implementation of an effective regulatory system for testing donors would decrease the occurrence of donor-derived infectious diseases.

    View Abstract

    During July 2015, physicians at a hospital in Beijing, China, diagnosed rabies in 2 patients who had each received a kidney from a common organ donor who had died from acute progressive encephalitis of unknown cause. The patients had rabies incubation periods of 42 and 48 days. Altered mental status developed in both patients and progressively worsened to deep coma within 80 days after transplantation; both patients died. Two other transplant recipients received corneas but remained well after receiving timely rabies prophylaxis. An effective regulatory system for testing donors should be implemented to decrease the occurrence of donor-derived infectious diseases. In addition, health education should be improved to enhance public awareness of transplant-associated infectious diseases. Transplant recipients and other persons with exposure to organs or tissues from donors with rabies must be provided consistent health monitoring and follow-up, including rabies postexposure prophylaxis; any remaining organs and tissues must be quarantined and not transplanted.

Research

  • Hemolysis after Oral Artemisinin Combination Therapy for Uncomplicated Plasmodium falciparum Malaria
    F. Kurth et al.
    View Summary

    Clinicians should be aware of hemolysis in malaria patients with anemia who were given these drugs.

  • Cutaneous Melioidosis Cluster Caused by Contamination of Wound Irrigation Fluid
    A. J. Merritt et al.
    View Summary

    Burkholderia pseudomallei is capable of healthcare-associated infection outside the recognized tropical melioidosis zone.

  • Exposure-Specific and Age-Specific Attack Rates for Ebola Virus Disease in Ebola-Affected Households, Sierra Leone H. Bower et al.
    View Summary

    Risk for disease correlated with level of exposure and was lowest for children 5–19 years of age.

    View Abstract

    Using histories of household members of Ebola virus disease (EVD) survivors in Sierra Leone, we calculated risk of EVD by age and exposure level, adjusting for confounding and clustering, and estimated relative risks. Of 937 household members in 94 households, 448 (48%) had had EVD. Highly correlated with exposure, risk ranged from 83% for touching a corpse to 8% for minimal contact and varied by age group: 43% for children <2 years of age; 30% for those 5–14 years of age; and >60% for adults >30 years of age. Compared with risk for persons 20–29 years of age, exposure-adjusted relative risks were lower for those 5–9 (0.70), 10–14 (0.64), and 15–19 (0.71) years of age but not for children <2 (0.92) or 2–4 (0.97) years of age. Lower risk for 5–19-year-olds, after adjustment for exposure, suggests decreased susceptibility in this group.

  • Time Lags between Exanthematous Illness Attributed to Zika Virus, Guillain-Barré Syndrome, and Microcephaly, Salvador, Brazil I. Paploski et al.
    View Summary

    There is strong evidence of a temporal relationship between virus infection in pregnant women and birth outcome.

    View Abstract

    Zika virus infection emerged as a public health emergency after increasing evidence for its association with neurologic disorders and congenital malformations. In Salvador, Brazil, outbreaks of acute exanthematous illness (AEI) attributed to Zika virus, Guillain-Barré syndrome (GBS), and microcephaly occurred in 2015. We investigated temporal correlations and time lags between these outbreaks to identify a common link between them by using epidemic curves and time series cross-correlations. Number of GBS cases peaked after a lag of 5–9 weeks from the AEI peak. Number of suspected cases of microcephaly peaked after a lag of 30–33 weeks from the AEI peak, which corresponded to time of potential infections of pregnant mothers during the first trimester. These findings support the association of GBS and microcephaly with Zika virus infection and provide evidence for a temporal relationship between timing of arboviral infection of pregnant women during the first trimester and birth outcome.

Dispatches

  • Onchocerca lupi Nematodes in Dogs Exported from the United States into Canada
    G. G. Verocai et al.
  • Lyssavirus in Indian Flying Foxes, Sri Lanka
    P. S. Gunawardena et al.
  • Q Fever and Spotted Fever Group Rickettsiosis Seroconversions among US Marines Deployed to Afghanistan, 2001–2010
    C. M. Farris et al.

Letters

Volume 22, Number 9—September 2016

Synopsis

  • Treatment Outcomes for Patients with Extensively Drug-Resistant Tuberculosis, KwaZulu-Natal and Eastern Cape Provinces, South Africa

Letters

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