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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 23, Number 1—January 2017


  • Epidemiology of Hospitalizations for Invasive Candidiasis, United States, 2002–2012
    S. Strollo et al.
  • Epidemiology of Human Anthrax in China, 1955−2014
    Y. Li et al.
        View Abstract

    Using national surveillance data for 120,111 human anthrax cases recorded during 1955−2014, we analyzed the temporal, seasonal, geographic, and demographic distribution of this disease in China. After 1978, incidence decreased until 2013, when it reached a low of 0.014 cases/100,000 population. The case-fatality rate, cumulatively 3.6% during the study period, has also decreased since 1990. Cases occurred throughout the year, peaking in August. Geographic distribution decreased overall from west to east, but the cumulative number of affected counties increased during 2005−2014. The disease has shifted from industrial to agricultural workers; 86.7% of cases occurred in farmers and herdsmen. Most (97.7%) reported cases were the cutaneous form. Although progress has been made in reducing incidence, this study highlights areas that need improvement. Adequate laboratory diagnosis is lacking; only 7.6% of cases received laboratory confirmation. Geographic expansion of the disease indicates that livestock control programs will be essential in eradicating anthrax.

  • Oral Cholera Vaccine Coverage during an Outbreak and Humanitarian Crisis, Iraq, 2015
    E. Lam et al.
        View Abstract

    During November–December 2015, as part of the 2015 cholera outbreak response in Iraq, the Iraqi Ministry of Health targeted ≈255,000 displaced persons >1 year of age with 2 doses of oral cholera vaccine (OCV). All persons who received vaccines were living in selected refugee camps, internally displaced persons camps, and collective centers. We conducted a multistage cluster survey to obtain OCV coverage estimates in 10 governorates that were targeted during the campaign. In total, 1,226 household and 5,007 individual interviews were conducted. Overall, 2-dose OCV coverage in the targeted camps was 87% (95% CI 85%–89%). Two-dose OCV coverage in the 3 northern governorates (91%; 95% CI 87%–94%) was higher than that in the 7 southern and central governorates (80%; 95% CI 77%–82%). The experience in Iraq demonstrates that OCV campaigns can be successfully implemented as part of a comprehensive response to cholera outbreaks among high-risk populations in conflict settings.

  • Cost-effectiveness of Increasing Access to Contraception during the Zika Virus Outbreak, Puerto Rico, 2016
    R. Li et al.
        View Abstract

    We modeled the potential cost-effectiveness of increasing access to contraception in Puerto Rico during a Zika virus outbreak. The intervention is projected to cost an additional $33.5 million in family planning services and is likely to be cost-saving for the healthcare system overall. It could reduce Zika virus–related costs by $65.2 million ($2.8 million from less Zika virus testing and monitoring and $62.3 million from avoided costs of Zika virus–associated microcephaly [ZAM]). The estimates are influenced by the contraception methods used, the frequency of ZAM, and the lifetime incremental cost of ZAM. Accounting for unwanted pregnancies that are prevented, irrespective of Zika virus infection, an additional $40.4 million in medical costs would be avoided through the intervention. Increasing contraceptive access for women who want to delay or avoid pregnancy in Puerto Rico during a Zika virus outbreak can substantially reduce the number of cases of ZAM and healthcare costs.

  • Comparison of Anthrax Immune Globulin Intravenous and Antimicrobial Treatment in Injection Drug Users, Scotland, 2009–2010
    X. Cui et al.
    View Summary

    Differences between recipients and nonrecipients and the small number of higher risk patients confounded assessment of AIG-IV effectiveness.

  • Sequelae and Other Conditions in Ebola Virus Disease Survivors, Sierra Leone, 2015
    H. Mohammed et al.
        View Abstract

    We rapidly assessed the health of Ebola virus disease (EVD) survivors in Kenema, Sierra Leone, by reviewing medical charts of all patients attending the Survivor Clinic of Kenema Government Hospital. Data were abstracted on signs and symptoms at every attendance. As of November 2015, a total of 621 attendances by 115 survivors with laboratory-confirmed EVD were made to the Survivor Clinic. Most (60.9%) survivors were women. Survivors’ median age was 28 years (range 0.25–70 years). Survivors attended the clinic a median of 5 times (range 1–21 times) each, and the median time from EVD discharge to attendance was 261 days (range 4–504 days). The most commonly reported signs and symptoms among the 621 attendances were headache (63.1%), fever (61.7%), and myalgia (43.3%). Because health needs of EVD survivors are complex, rapid chart reviews at survivor clinics should be repeated regularly to assess the extent of illness and prioritize service delivery.

  • Mathematical Modeling of Programmatic Requirements for Yaws Eradication
    M. Marks et al.
        View Abstract

    Yaws is targeted for eradication by 2020. The mainstay of the eradication strategy is mass treatment followed by case finding. Modeling has been used to inform programmatic requirements for other neglected tropical diseases and could provide insights into yaws eradication. We developed a model of yaws transmission varying the coverage and number of rounds of treatment. The estimated number of cases arising from an index case (basic reproduction number [R0]) ranged from 1.08 to 3.32. To have 80% probability of achieving eradication, 8 rounds of treatment with 80% coverage were required at low estimates of R0 (1.45). This requirement increased to 95% at high estimates of R0 (2.47). Extending the treatment interval to 12 months increased requirements at all estimates of R0. At high estimates of R0 with 12 monthly rounds of treatment, no combination of variables achieved eradication. Models should be used to guide the scale-up of yaws eradication.


  • Reconstruction of Zika Virus Introduction in Brazil
    K. Zinszer et al.
        View Abstract

    We estimated the speed of Zika virus introduction in Brazil by using confirmed cases at the municipal level. Our models indicate a southward pattern of introduction starting from the northeastern coast and a pattern of movement toward the western border with an average speed of spread of 42 km/day or 15,367 km/year.

  • Upsurge of Enterovirus D68, the Netherlands, 2016
    M. Knoester et al.
        View Abstract

    In June and July 2016, we identified 8 adults and 17 children with respiratory enterovirus D68 infections. Thirteen children required intensive care unit admission because of respiratory insufficiency, and 1 had concomitant acute flaccid myelitis. Phylogenetic analysis showed that all of 20 sequences obtained belong to the recently described clade B3.

  • Haemophilus influenzae Type b Invasive Disease in Amish Children, Missouri, USA, 2014
    A. L. Myers et al.
        View Abstract

    During 5 months in 2014, three Amish children in Missouri, USA, were diagnosed with invasive Haemophilus influenzae type b infection. Two were rural neighbors infected with a genetically similar rare strain, sequence type 45. One child had recently traveled, raising the possibility of maintenance of this strain among unvaccinated carriers in Amish communities.

  • Prolonged Detection of Zika Virus in Vaginal Secretions and Whole Blood
    K. O. Murray et al.
        View Abstract

    Infection with Zika virus is an emerging public health crisis. We observed prolonged detection of virus RNA in vaginal mucosal swab specimens and whole blood for a US traveler with acute Zika virus infection who had visited Honduras. These findings advance understanding of Zika virus infection and provide data for additional testing strategies.

  • Acute Respiratory Disease in US Army Trainees 3 Years after Reintroduction of Adenovirus Vaccine
    N. S. Clemmons et al.
        View Abstract

    The 1999 cessation of vaccination against adenovirus types 4 and 7 among US Army trainees resulted in reemergence of acute respiratory disease (ARD) outbreaks. The 2011 implementation of a replacement vaccine led to dramatic and sustained decreases in ARD cases, supporting continuation of vaccination in this population at high risk for ARD.

  • Persistent Zika Virus Detection in Semen in a Traveler Returning to the United Kingdom from Brazil, 2016
    K. M. Gaskell et al.
        View Abstract

    Zika virus is normally transmitted by mosquitos, but cases of sexual transmission have been reported. We describe a patient with symptomatic Zika virus infection in whom the virus was detected in semen for 92 days. Our findings support recommendations for 6 months of barrier contraceptive use after symptomatic Zika virus infection.

  • Increased Invasive Pneumococcal Disease, North East England, UK
    C. Houseman et al.
        View Abstract

    Since April 2014, invasive pneumococcal disease incidence has increased substantially across North East England, United Kingdom, reversing the decline that followed the 2006 introduction of pneumococcal conjugate vaccines. Significant increases occurred in serotypes exclusive to the 23-valent polysaccharide vaccine and in nonvaccine serotypes. Public health strategies for tackling persistent disease should adapt.

  • Travel-Related Tick-Borne Encephalitis, Israel, 2006–2014
    E. Meltzer et al.
        View Abstract

    During 2006–2014, four tick-borne encephalitis (TBE) cases occurred among Israeli travelers. We calculated TBE incidence at 321.0, 45.0, 13.2, and 7.5 cases/100,000 travelers/year of travel to Sweden, Switzerland, Austria, and Germany, respectively. TBE incidence among travelers to these destinations appears to justify TBE vaccination in accordance with World Health Organization recommendations.

  • Guillain-Barré Syndrome and Healthcare Needs during Zika Virus Transmission, Puerto Rico, 2016
    E. Dirlikov et al.
        View Abstract

    To assist with public health preparedness activities, we estimated the number of expected cases of Zika virus in Puerto Rico and associated healthcare needs. Estimated annual incidence is 3.2–5.1 times the baseline, and long-term care needs are predicted to be 3–5 times greater than in years with no Zika virus.

  • Streptococcal Toxic Shock Syndrome Caused by Group G Streptococcus, United Kingdom
    M. Baxter and M. Morgan
        View Abstract

    We describe successful management of 3 patients with streptococcal toxic shock syndrome (STSS) attributable to group G Streptococcus infection. This small series supports recognition of group G Streptococcus in the etiology of STSS. We propose intravenous immunoglobulin be used in treatment as it is for STSS caused by group A Streptococcus.

  • Norovirus Infection in Harbor Porpoises
    M. de Graaf et al.
  • Host-Associated Absence of Human Puumala Virus Infections in Northern and Eastern Germany
    S. Drewes et al.
        View Abstract

    Human hantavirus disease cases, caused by Puumala virus (PUUV), are mainly recorded in western and southern areas of Germany. This bank vole reservoir survey confirmed PUUV presence in these regions but its absence in northern and eastern regions. PUUV occurrence is associated with the presence of the Western bank vole phylogroup.

  • Sequence Analysis of Toxin Gene–Bearing Corynebacterium diphtheriae Strains, Australia
    C. J. Doyle et al.
        View Abstract

    By conducting a molecular characterization of Corynebacterium diphtheriae strains in Australia, we identified novel sequences, nonfunctional toxin genes, and 5 recent cases of toxigenic cutaneous diphtheria. These findings highlight the importance of extrapharyngeal infections for toxin gene–bearing (functional or not) and non–toxin gene–bearing C. diphtheriae strains. Continued surveillance is recommended.

  • Media Messages and Perception of Risk for Ebola Virus Infection, United States
    T. Sell et al.
        View Abstract

    News media have been blamed for sensationalizing Ebola in the United States, causing unnecessary alarm. To investigate this issue, we analyzed US-focused news stories about Ebola virus disease during July 1–November 30, 2014. We found frequent use of risk-elevating messages, which may have contributed to increased public concern.

  • Meningitis Associated with Simultaneous Infection by Multiple Dengue Virus Serotypes in Children, Brazil
    P. Marinho et al.
        View Abstract

    To determine the causes of viral meningitis, we analyzed 22 cerebrospinal fluid samples collected during the 2014–2015 dengue epidemics in Brazil. We identified 3 serotypes of dengue virus (DENV-1, -2, and -3), as well as co-infection with 2 or 3 serotypes. We also detected the Asian II genotype of DENV-2.

  • Frequent Transmission of Gonorrhea in Men Who Have Sex with Men
    C. K. Fairley et al.
        View Abstract

    The rate of gonorrhea is much higher in men who have sex with men than in heterosexuals. Because of unique behavioral characteristics, asymptomatic sites of infection, mainly the pharynx, are principal drivers of gonorrhea prevalence in men who have sex with men. On the basis of this observation, we call for interventions.


  • Multidrug-Resistant Pathogens in Hospitalized Syrian Children
    D. Kassem et al.
  • Puumala Virus in Bank Voles (Myodes glareolus), Lithuania
    P. Straková et al.
  • Chikungunya Fever in Traveler from Angola to Japan, 2016
    S. Kutsuna
        View Abstract

    Simultaneous circulation of multiple arboviruses presents diagnostic challenges. In May 2016, chikungunya fever was diagnosed in a traveler from Angola to Japan. Travel history, incubation period, and phylogenetic analysis indicated probable infection acquisition in Angola, where a yellow fever outbreak is ongoing. Thus, local transmission of chikungunya virus probably also occurs in Angola.

  • Loiasis in US Traveler Returning from Bioko Island, Equatorial Guinea, 2016
    D. H. Priest and T. B. Nutman
  • Human Tick-Borne Encephalitis, the Netherlands
    V. Hira and B. Rockx
  • Zika Virus Knowledge among Pregnant Women Who Were in Areas with Active Transmission
    K. Whittemore et al.
        View Abstract

    We surveyed women in New York, New York, USA, who were in areas with active Zika virus transmission while pregnant. Of 99 women who were US residents, 30 were unaware of the government travel advisory to areas with active Zika virus transmission while pregnant, and 37 were unaware of their pregnancies during travel.

  • Dolphin Morbillivirus Associated with a Mass Stranding of Sperm Whales, Italy
    S. Mazzariol et al.
        View Abstract

    In September 2014, seven sperm whales were stranded along Italy’s Adriatic coastline. Postmortem investigations on 3 female adult whales and 1 male fetus carried by the largest female revealed molecular and immunohistochemical evidence of dolphin morbillivirus infection. A possible role of the virus in the stranding event was considered.

  • Scrub Typhus Leading to Acute Encephalitis Syndrome, Assam, India
    S. A. Khan et al.
        View Abstract

    To determine the contribution of Orientia tsutsugamushi, the agent of scrub typhus, as a cause of acute encephalitis syndrome (AES) in Assam, India, we conducted a retrospective study of hospital patients with symptoms of AES during 2013–2015. Our findings suggest that O. tsutsugamushi infection leads to AES and the resulting illness and death.

  • Hepatitis E Virus Infection after Platelet Transfusion in an Immunocompetent Trauma Patient
    E. Loyrion et al.
        View Abstract

    Hepatitis E virus (HEV) infection causes acute liver disease, but severe infections are rare in immunocompetent patients. We describe a case of HEV infection in a previously healthy male trauma patient in France who received massive transfusions. Genotyping confirmed HEV in a transfused platelet pool and the donor.

  • Group B Streptococcal Toxic Shock Syndrome and covR/S Mutations Revisited
    P. Sendi et al.
        View Abstract

    Gene mutations in the virulence regulator CovR/S of group A Streptococcus play a substantial role in the pathogenesis of streptococcal toxic shock syndrome. We screened 25 group B Streptococcus (GBS) isolates obtained from patients with streptococcal toxic shock syndrome and found only 1 GBS clone harboring this kind of mutation.

  • Whole-Genome Characterization of a Novel Human Influenza A(H1N2) Virus Variant, Brazil
    P. Resende et al.
        View Abstract

    We report the characterization of a novel reassortant influenza A(H1N2) virus not previously reported in humans. Recovered from a a pig farm worker in southeast Brazil who had influenza-like illness, this virus is a triple reassortant containing gene segments from subtypes H1N2 (hemagglutinin), H3N2 (neuraminidase), and pandemic H1N1 (remaining genes).

  • Avian Pox in Native Captive Psittacines, Brazil, 2015
    F. Esteves et al.
        View Abstract

    To investigate an outbreak of avian pox in psittacines in a conservation facility, we examined 94 birds of 10 psittacine species, including sick and healthy birds. We found psittacine pox virus in 23 of 27 sick birds and 4 of 67 healthy birds. Further characterization is needed for these isolates.

Volume 23, Number 2—February 2017


  • Delivering on Antimicrobial Resistance Agenda Not Possible without Improving Fungal Diagnostic Capabilities
    D. W. Denning et al.


  • Highly Pathogenic Influenza A(H5Nx) Viruses with Altered H5 Receptor-Binding Specificity
    H. Guo et al.
        View Abstract

    Emergence and intercontinental spread of highly pathogenic avian influenza A(H5Nx) virus clade is unprecedented. H5N8 and H5N2 viruses have caused major economic losses in the poultry industry in Europe and North America, and lethal human infections with H5N6 virus have occurred in Asia. Knowledge of the evolution of receptor-binding specificity of these viruses, which might affect host range, is urgently needed. We report that emergence of these viruses is accompanied by a change in receptor-binding specificity. In contrast to ancestral clade 2.3.4 H5 proteins, novel clade H5 proteins bind to fucosylated sialosides because of substitutions K222Q and S227R, which are unique for highly pathogenic influenza virus H5 proteins. North American clade virus isolates have retained only the K222Q substitution but still bind fucosylated sialosides. Altered receptor-binding specificity of virus clade H5 proteins might have contributed to emergence and spread of H5Nx viruses.

  • Livestock Susceptibility to Infection with Middle East Respiratory Syndrome Coronavirus
    J. Vergara-Alert et al.
        View Abstract

    Middle East respiratory syndrome (MERS) cases continue to be reported, predominantly in Saudi Arabia and occasionally other countries. Although dromedaries are the main reservoir, other animal species might be susceptible to MERS coronavirus (MERS-CoV) infection and potentially serve as reservoirs. To determine whether other animals are potential reservoirs, we inoculated MERS-CoV into llamas, pigs, sheep, and horses and collected nasal and rectal swab samples at various times. The presence of MERS-CoV in the nose of pigs and llamas was confirmed by PCR, titration of infectious virus, immunohistochemistry, and in situ hybridization; seroconversion was detected in animals of both species. Conversely, in sheep and horses, virus-specific antibodies did not develop and no evidence of viral replication in the upper respiratory tract was found. These results prove the susceptibility of llamas and pigs to MERS-CoV infection. Thus, the possibility of MERS-CoV circulation in animals other than dromedaries, such as llamas and pigs, is not negligible.

  • Estimated Effect of Inactivated Poliovirus Vaccine Campaigns, Nigeria and Pakistan, January 2014–April 2016
    G. Shirreff et al.
        View Abstract

    In 2014, inactivated poliovirus vaccine (IPV) campaigns were implemented in Nigeria and Pakistan after clinical trials showed that IPV boosts intestinal immunity in children previously given oral poliovirus vaccine (OPV). We estimated the effect of these campaigns by using surveillance data collected during January 2014–April 2016. In Nigeria, campaigns with IPV and trivalent OPV (tOPV) substantially reduced the incidence of poliomyelitis caused by circulating serotype-2 vaccine–derived poliovirus (incidence rate ratio [IRR] 0.17 for 90 days after vs. 90 days before campaigns, 95% CI 0.04–0.78) and the prevalence of virus in environmental samples (prevalence ratio [PR] 0.16, 95% CI 0.02–1.33). Campaigns with tOPV alone resulted in similar reductions (IRR 0.59, 95% CI 0.18–1.97; PR 0.45, 95% CI 0.21–0.95). In Pakistan, the effect of IPV+tOPV campaigns on wild-type poliovirus was not significant. Results suggest that administration of IPV alongside OPV can decrease poliovirus transmission if high vaccine coverage is achieved.


  • Nosocomial Infections with IMP-19−Producing Pseudomonas aeruginosa Linked to Contaminated Sinks, France
    L. Amoureux et al.
  • mcr-1−Producing Salmonella enterica Serotype Typhimurium Sequence Type 34 in Pigs, China
    L. Yi et al.
  • Fatal Infection with Murray Valley Encephalitis Virus Imported from Australia to Canada, 2011
    D. J. Niven et al.
  • Low Circulation of Zika Virus, Cambodia, 2007–2016
    V. Duong et al.
        View Abstract

    We describe a retrospective study on circulation of Zika virus in Cambodia during 2007–2016 among patients with dengue-like symptoms and Aedes aegypti mosquitoes. Our findings suggest that Zika virus in Cambodia belongs to the Asia genotype, is endemic, has low prevalence, and has had low-level impact on public health.

  • Biofilm-Forming Capability of Highly Virulent and Resistant Candida auris
    L. Sherry et al.
  • Norovirus GII.17 Natural Infections in Rhesus Monkeys, China
    Z. He et al.
  • Characteristics of US Travelers to Zika Virus–Affected Countries in the Americas, March 2015–October 2016
    S. Lammert et al.
  • Oral Transmission of L-Type Bovine Spongiform Encephalopathy Agent among Cattle
    H. Okada et al.
  • Persistent Infections with Diverse Co-Circulating Astroviruses in Pediatric Oncology Patients, Memphis, Tennessee USA
    V. Cortez et al.


  • Fatal Novel Emmonsia sp. Infection with Fungemia after Orthotopic Liver Transplantation
    S. Kappagoda et al.
  • Cerebrospinal Fluid Findings in an Adult with Human Metapneumovirus-Associated Encephalitis
    N. Jeannet et al.
  • Reoccurrence of Avian Influenza A(H5N2) Virus Clade in Wild Birds, Alaska, USA, 2016
    D. Lee et al.
  • Novel Reassortant Clade Avian Influenza A(H5N8) Virus in Wild Aquatic Birds, Russia, 2016
    D. Lee et al.
        View Abstract

    The emergence of novel avian influenza viruses in migratory birds is of concern because of the potential for virus dissemination during fall migration. We report the identification of novel highly pathogenic avian influenza viruses of subtype H5N8, clade, and their reassortment with other avian influenza viruses in waterfowl and shorebirds of Siberia.

  • Outbreak of Infection with Legionella pneumophila Serogroups 1 and 13, Japan, 2015
    T. Kuroki et al.
  • Diphyllobothrium nihonkaiense Tapeworm Larvae in Salmon, North America
    R. Kuchta et al.

Volume 23, Number 3—March 2017


  • Bartonella ancashensis Identified by Whole-Genome Analysis of Human Pathogens Causing Verruga Peruana, Rural Ancash Region, Peru
    K. E. Mullins et al.


  • Molecular, Spatial, and Field Epidemiology Suggesting TB Transmission in Community, Not Hospital, Gaborone, Botswana
    D. Surie et al.
        View Abstract

    During 2012–2015, 10 of 24 patients infected with matching genotypes of Mycobacterium tuberculosis received care at the same hospital in Gaborone, Botswana. Nosocomial transmission was initially suspected, but we discovered plausible sites of community transmission for 20 (95%) of 21 interviewed patients. Active case-finding at these sites could halt ongoing transmission.

  • Rhodococcus Infection in Solid Organ and Hematopoietic Stem Cell Transplant Recipients
    P. Vergidis et al.


  • Two Cases of Neisseria meningitidis Proctitis in HIV-Positive Men who Have Sex with Men
    J. Gutierrez-Fernandez et al.