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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 9—September 2016


  • Treatment Outcomes for Patients with Extensively Drug-Resistant Tuberculosis, KwaZulu-Natal and Eastern Cape Provinces, South Africa
  • Clinical Features of and Risk Factors for Fatal Ebola Virus Disease, Moyamba District, Sierra Leone, December 2014–February 2015 Y. Haaskjold et al.
    View Summary

    Awareness of risk factors for death could help identify patients in need of more intensive medical support.

    View Abstract

    The 2013–2016 outbreak of Ebola virus disease (EVD) in West Africa infected >28,000 people, including >11,000 who died, and disrupted social life in the region. We retrospectively studied clinical signs and symptoms and risk factors for fatal outcome among 31 Ebola virus–positive patients admitted to the Ebola Treatment Center in Moyamba District, Sierra Leone. We found a higher rate of bleeding manifestations than reported elsewhere during the outbreak. Significant predictors for death were shorter time from symptom onset to admission, male sex, high viral load on initial laboratory testing, severe pain, diarrhea, bloody feces, and development of other bleeding manifestations during hospitalization. These risk factors for death could be used to identify patients in need of more intensive medical support. The lack of fever in as many as one third of EVD cases may have implications for temperature-screening practices and case definitions.


  • Staphylococcus aureus Regulatory RNAs as Potential Biomarkers for Bloodstream Infections V. Bordeau et al.
    View Summary

    These RNAs predict disease severity and provide targets for therapeutic approaches.

    View Abstract

    Staphylococcus aureus is a commensal bacterium and pathogen. Identifying biomarkers for the transition from colonization to disease caused by this organism would be useful. Several S. aureus small RNAs (sRNAs) regulate virulence. We investigated presence and expression of 8 sRNAs in 83 S. aureus strains from 42 patients with sepsis or septic shock and 41 asymptomatic colonized carriers. Small pathogenicity island sRNAs sprB and sprC were clade specific. Six sRNAs had variable expression not correlated with clinical status. Expression of RNAIII was lower in strains from septic shock patients than in strains from colonized patients. When RNAIII was associated with expression of sprD, colonizing strains could be discriminated from strains in patients with bloodstream infections, including patients with sepsis and septic shock. Isolates associated with colonization might have sRNAs with target expression different from those of disease isolates. Monitoring expression of RNAIII and sprD could help determine severity of bloodstream infections.

  • Use of Testing for West Nile Virus and Other Arboviruses
    J. Vanichanan et al.
    View Summary

    For patients with meningitis and encephalitis, this testing is underutilized.

  • Protection against Asian Enterovirus 71 Outbreak Strains Predicted by Cross-neutralizing Capacity of Serum Samples from Dutch Donors
    S. van der Sanden et al.
    View Summary

    The cross-neutralizing capacity of serum samples from Dutch donors against EV71 predicts protection against widespread circulation of Asian EV71 outbreak strains in Europe.

  • Emergence of Enterohemorrhagic Escherichia coli Hybrid Pathotype O80:H2 as a New Therapeutic Challenge
    N. Soysal et al.
    View Summary

    This emerging clonal group harbors the extraintestinal virulence–associated plasmid pS88 and can induce invasive infections and death.

  • A Unique, Multidrug–Resistant Clone of Shigella sonnei among Jewish Orthodox Communities across 3 Continents
    K. S. Baker et al.
    View Summary

    Shigellosis among Orthodox Jewish communities provides insight into international movement of multidrug–resistant Enterobacteriaceae.

  • Feasibility of Using Convalescent Plasma Immunotherapy for MERS-CoV Infection, Saudi Arabia Y. Arabi et al.
    View Summary

    Efficacy testing will be challenging because of the small pool of donors with sufficiently high antibody titers.

    View Abstract

    We explored the feasibility of collecting convalescent plasma for passive immunotherapy of Middle East respiratory syndrome coronavirus (MERS-CoV) infection by using ELISA to screen serum samples from 443 potential plasma donors: 196 patients with suspected or laboratory-confirmed MERS-CoV infection, 230 healthcare workers, and 17 household contacts exposed to MERS-CoV. ELISA-reactive samples were further tested by indirect fluorescent antibody and microneutralization assays. Of the 443 tested samples, 12 (2.7%) had a reactive ELISA result, and 9 of the 12 had reactive indirect fluorescent antibody and microneutralization assay titers. Undertaking clinical trials of convalescent plasma for passive immunotherapy of MERS-CoV infection may be feasible, but such trials would be challenging because of the small pool of potential donors with sufficiently high antibody titers. Alternative strategies to identify convalescent plasma donors with adequate antibody titers should be explored, including the sampling of serum from patients with more severe disease and sampling at earlier points during illness.

  • Ebola Virus Disease, Democratic Republic of the Congo, 2014
    C. Nanclares et al.
    View Summary

    Differences from other outbreaks could suggest guidance for optimizing clinical management and disease control.

  • Antimicrobial Drug–Resistant Shigella among Men Who Have Sex with Men, United States, 2011–2015
    A. Bowen et al.
    View Summary

    MSM were 3–77 times more likely than other persons to have shigellae resistant to >1 key drugs.


  • Persistent Bacillus cereus Bacteremia in 3 Persons who Inject Drugs, San Diego, California, USA
    G. Schaefer et al.
  • Secondary Infections with Ebola Virus in Rural Communities, Liberia and Guinea, 2014–2015 K. A. Lindblade et al.
    View Abstract

    Persons who died of Ebola virus disease at home in rural communities in Liberia and Guinea resulted in more secondary infections than persons admitted to Ebola treatment units. Intensified monitoring of contacts of persons who died of this disease in the community is an evidence-based approach to reduce virus transmission in rural communities.

  • Large-Scale Survey for Tickborne Bacteria, Khammouan Province, Laos A. J. Taylor et al.
    View Abstract

    We screened 768 tick pools containing 6,962 ticks from Khammouan Province, Laos, by using quantitative real-time PCR and identified Rickettsia spp., Ehrlichia spp., and Borrelia spp. Sequencing of Rickettsia spp.–positive and Borrelia spp.–positive pools provided evidence for distinct genotypes. Our results identified bacterial agents with human disease potential in ticks in Laos.

  • Changing Diagnostic Methods and Increased Detection of Verotoxigenic Escherichia coli, Ireland T. Rice et al.
    View Abstract

    The recent paradigm shift in infectious disease diagnosis from culture-based to molecular-based approaches is exemplified in the findings of a national study assessing the detection of verotoxigenic Escherichia coli infections in Ireland. The methodologic changes have been accompanied by a dramatic increase in detections of non-O157 verotoxigenic E. coli serotypes.

  • Mutation in West Nile Virus Structural Protein prM during Human Infection Y. Lustig et al.
    View Abstract

    A mutation leading to substitution of a key amino acid in the prM protein of West Nile virus (WNV) occurred during persistent infection of an immunocompetent patient. WNV RNA persisted in the patient’s urine and serum in the presence of low-level neutralizing antibodies. This case demonstrates active replication of WNV during persistent infection.

  • Nosocomial Outbreak of Parechovirus 3 Infection among Newborns, Austria, 2014 V. Strenger et al.
    View Abstract

    In 2014, sepsis-like illness affected 9 full-term newborns in 1 hospital in Austria. Although results of initial microbiological testing were negative, electron microscopy identified picornavirus. Archived serum samples and feces obtained after discharge were positive by PCR for human parechovirus 3. This infection should be included in differential diagnoses of sepsis-like illness in newborns.

  • Multidrug-Resistant Escherichia coli in Bovine Animals, Europe
    E. Brennan et al.
  • Enhancement of High Adherence to Standard Hand Hygiene Practices in Medical Facility Reduces Healthcare-associated Infections
    E. E. Sickbert-Bennett et al.
  • Multidrug-Resistant Campylobacter coli in Men Who Have Sex with Men, Quebec, Canada, 2015
    C. Gaudreau et al.
  • Borrelia miyamotoi–Associated Neuroborreliosis in Immunocompromised Persons
    K. Boden et al.


Conference Summary

  • Proceedings of Histoplasmosis in the Americas and the Caribbean, First Meeting, Paramaribo, Suriname, December 4–6, 2015
    M. Nacher and A. Adenis


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.


  • 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.


  • Increase in Meningococcal Serogroup W Disease, Victoria, Australia, 2013–2015
    K. S. Carville et al.
  • 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, New York, USA, February 2014–September 2015
    S. K. Greene et al.
  • 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.


Volume 22, Number 11—November 2016

Volume 22, Number 12—December 2016


  • 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.


  • 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.