Early Release

Synopses

• Maternal and Fetal Implications of Oropouche Fever, Espírito Santo State, Brazil, 2024
  J. Cola et al. View Abstract

  Reemergence of Oropouche fever in Brazil raises concerns about potential risks for infection in pregnancy. We describe a case series of Oropouche fever in pregnant women and their neonates in Espírito Santo State, Brazil, in 2024. Of 73 pregnancies, 15 pregnancies concluded by the end of the study period; of those, 14 resulted in live births and 1 in spontaneous abortion. Placental reverse transcription PCR tests were positive for Oropouche virus RNA in 5 infections in the third trimester. Two infections occurred in the first trimester, resulting in 1 spontaneous abortion and 1 live birth with corpus callosum dysgenesis. Of 13 infections that occurred in the third trimester, 1 showed possible intrapartum transmission with clinical manifestations in the neonate, whereas the others were asymptomatic. We found no anomalies in third-trimester infections. These findings suggest possible vertical transmission of Oropouche virus and a potential link with spontaneous abortion or malformation.

• Lower Frequency of Multiple Erythema Migrans Skin Lesions in Lyme Reinfections, Europe
  F. Strle et al. View Abstract

  The erythema migrans (EM) skin lesion is the most common clinical manifestation of Lyme borreliosis. Information about EM in Lyme borreliosis reinfection is limited. Of the 12,384 cases with diagnosed EM at an outpatient clinic during 1990–2014 in Slovenia, 1,962 (15.8%) cases occurred in patients who were treated previously for Lyme borreliosis, including 1,849 (94.2%) who had previously had EM. The percentage of reinfected patients who sought care with disseminated Lyme borreliosis at the time of reinfection, as manifested by multiple EM skin lesions, was significantly lower than for EM patients with no history of Lyme borreliosis (5.5% [108/1,962] vs. 7.4% [769/10,427]; p = 0.002). None of the clinical manifestations of Lyme borreliosis in Europe will completely protect against EM developing in patients in the future. The reoccurrence of Lyme borreliosis manifested by multiple EM lesions is significantly less likely than for patients with no history of Lyme borreliosis.

• Alistipes Bacteremia in Older Patients with Digestive and Cancer Comorbidities, Japan, 2016–2023
  N. Watanabe et al. View Abstract

  The clinical characteristics of Alistipes bacteremia remain insufficiently understood. We retrospectively analyzed 13 cases of Alistipes bacteremia at a tertiary care center in Japan. Ten patients were >65 years of age; 7 were female and 3 male. Of 9 patients with comorbidities, 7 had solid tumors or hematological malignancies and 11 had gastrointestinal symptoms. Isolates identified were Alistipes finegoldii in 4 cases, A. onderdonkii in 4, A. putredinis in 3, A. indistinctus in 2, and A. ihumii in 1. Ten strains exhibited low MICs against β-lactam/β-lactamase inhibitors and metronidazole. We observed high MICs against penicillin, ceftriaxone, and minocycline. Several strains harbored antimicrobial resistance genes, including adeF, tet(Q), cfxA3, cfxA4, and ermG. Twelve patients received β-lactam/β-lactamase inhibitors; 2 patients with solid tumors experienced septic shock and died. Alistipes bacteria can translocate from the gastrointestinal tract into the bloodstream, particularly in cases of inflammation, obstruction, or perforation, leading to severe infections.

Research

• Foodborne Illness Acquired in the United States—Major Pathogens, 2019
  E. Scallan Walter et al.
• Population-Based Matched Cohort Study of COVID-19 Healthcare Costs, Ontario, Canada
  B. Sander et al. View Abstract

  Estimates of COVID-19–related healthcare costs are key to health system planning, but attributable cost data remain limited. We characterized healthcare costs attributable to COVID-19 through a population-based matched cohort study in Ontario, Canada, by using health administrative data. We matched SARS-CoV-2–positive persons from 2020 to unexposed historical control persons from 2016–2018. We estimated phase-based and survival-adjusted COVID-19–attributable healthcare costs from the health system perspective. We matched 159,817 persons. Mean (95% CI) attributable 10-day costs per person were $1 ($–4 to $6) preindex, $240 ($231–$249) during acute care, $18 ($14–$21) in postacute phases, $3,928 ($3,471–$4,384) in the terminal phase for early deaths, and $1,781 ($1,182–$2,380) for late deaths. Mean cumulative survival-adjusted cost at 360 days was $2,553 ($2,348–$2,756) per person. SARS-CoV-2 infection is associated with substantial long-term healthcare costs, consistent with understanding of post-COVID condition. Determining phase-specific costs can inform budget and pandemic planning.

• Detection and Decontamination of Chronic Wasting Disease Prions during Venison Processing
  M. Milstein et al.
• Epidemiology of Tularemia among Humans and Animals, Baden-Wuerttemberg, Germany, 2012–2022
  S. Nothdurfter et al.
• Neutralizing Antibodies against California Serogroup Orthobunyaviruses in Human Serum Samples, Montana, USA
  T. A. Woods et al. View Abstract

  Viral encephalitis is often underreported and undiagnosed. To understand the potential causes of viral encephalitis in the state of Montana, USA, we examined the relative incidence of human infections for the California serogroup (CSG) of Orthobunyaviruses by screening random convenience serum samples obtained from different hospitals across Montana. We initially screened deidentified samples for neutralizing antibodies against Jamestown Canyon virus (JCV), a CSG virus that has caused encephalitis in Montana. We then analyzed JCV-positive samples for neutralization of other CSG viruses, and detected neutralizing antibodies against La Crosse virus, California encephalitis virus, and Trivittatus virus. We also found a high level of cross-reactivity, particularly between JCV and California encephalitis virus. Our findings indicate that the relative CSG virus infection rates in humans are quite high, between 21% and 40%. Clinicians should consider CSG viruses in differential diagnosis for cases of encephalitis of unknown etiology in Montana.

• Prevalence of Herpes B Virus in Wild Long-Tailed Macaques, Thailand, 2018–2024
  K. Sapkanarak et al. View Abstract

  Herpes B virus (B virus) is an enigmatic zoonotic virus that has caused severe neurologic symptoms in humans exposed to captive macaques used for experimentation. We examined 864 wild long-tailed macaques from 22 locations across Thailand for B virus infection. All 22 macaque populations tested positive for B virus antibodies; seropositivity ranged from 25% to 100%. B virus shedding was detected in 9 (1.04%) oral swab samples by using quantitative PCR of the virus UL29 gene. We phylogenetically analyzed partial genome sequences of B virus (US5-US6 genes) from 6 of the PCR-positive samples. All 6 sequences were clustered in clade II, which includes B virus strains from rhesus, Japanese, and long-tailed macaques, suggesting co-evolution of B virus with macaques. Continued surveillance and sequencing of B virus in macaque populations will be needed to prevent B virus transmission to humans and to develop appropriate vaccines to prevent human B virus infections.

• Predictive Model for Estimating Annual Ebolavirus Spillover Potential
  C. T. Telford et al.
• Oz Virus Infection in 6 Animal Species, Including Macaques, Bears, and Companion Animals, Japan
  A. Matsuu et al. View Abstract

  Oz virus (OZV) was isolated from an Amblyomma tick in Japan and shown to cause lethal viral myocarditis in humans. However, the natural reservoirs and the distribution of OZV remain unknown. We describe epidemiologic studies conducted by using serum samples collected from mammals throughout Japan. The results showed that 27.5% of wild boars, 56.1% of Sika deer, 19.6% of Japanese macaques, and 51.0% of Asian black bears were positive for virus-neutralizing antibodies against OZV. Approximately 2.9% of dogs and 0.9% of cats also were seropositive. OZV RNA was not detected in any of the examined animal serum samples. Most seropositive animals were distributed in central and western Japan. OZV infects a wide range of animal species, including companion animals and nonhuman primates, and is distributed through central and western Japan, suggesting that further countermeasures are required to prevent this tickborne zoonotic infection.

• Carbapenem-Resistant, Virulence Plasmid–Harboring Klebsiella pneumoniae, United States
  J. Jiang et al. View Abstract

  Carbapenem-resistant and virulence plasmid–harboring Klebsiella pneumoniae (pVir-CRKP) has emerged and spread globally, yet clinical investigations from the United States remain limited. We conducted a genomic analysis of 884 unique carbapenem-resistant K. pneumoniae isolates from a multicenter US cohort and identified 6 pVir-CRKP isolates, including 2 sequence type (ST) 23, 2 ST893, and 2 ST11 isolates. Patients infected with pVir-CRKP experienced high Pitt bacteremia scores and a 33% 30-day mortality rate. The pVir-CRKP isolates exhibited significant sequence variation in virulence genes and plasmids, along with differences in mucoviscosity, capsule production, survival in normal human serum, resistance to killing by human polymorphonuclear neutrophils, and in vivo pathogenicity. Phylogenetic analyses showed that most pVir-CRKP isolates were genetically similar to strains reported from other global regions. The emergence of pVir-CRKP with higher virulence potential and carbapenem resistance in the United States than the predominant carbapenem-resistant K. pneumoniae clone underscores the need for active global surveillance.

• Antiviral Susceptibility of Influenza A(H5N1) Clade 2.3.2.1c and 2.3.4.4b Viruses from Humans, 2023–2024
  P. Q. Pascua et al. View Abstract

  During 2023–2024, highly pathogenic avian influenza A(H5N1) viruses from clade 2.3.2.1c caused human infections in Cambodia and from clade 2.3.4.4b caused human infections in the Americas. We assessed the susceptibility of those viruses to approved and investigational antiviral drugs. Except for 2 viruses isolated from Cambodia, all viruses were susceptible to M2 ion channel-blockers in cell culture-based assays. In the neuraminidase inhibition assay, all viruses displayed susceptibility to neuraminidase inhibitor antiviral drugs oseltamivir, zanamivir, peramivir, laninamivir, and AV5080. Oseltamivir was ≈4-fold less potent at inhibiting the neuraminidase activity of clade 2.3.4.4b than clade 2.3.2.1c viruses. All viruses were susceptible to polymerase inhibitors baloxavir and tivoxavir and to polymerase basic 2 inhibitor pimodivir with 50% effective concentrations in low nanomolar ranges. Because drug-resistant viruses can emerge spontaneously or by reassortment, close monitoring of antiviral susceptibility of H5N1 viruses collected from animals and humans by using sequence-based analysis supplemented with phenotypic testing is essential.

• Case–Control Study of Factors Associated with Hemolytic Uremic Syndrome among Shiga Toxin–Producing Escherichia coli Patients, Ireland, 2017–2020
  D. Espadinha et al. View Abstract

  Shiga toxin–producing Escherichia coli (STEC) infection can cause potentially fatal hemolytic uremic syndrome (HUS). To determine epidemiologic and bacterial genomic factors associated with HUS, we conducted a retrospective case–control study with 108 HUS cases and 416 unmatched controls (non-HUS) selected among STEC notifications in Ireland during 2017–2020. We combined routinely collected epidemiologic data on STEC notifications with genomewide association study findings and used logistic regression to estimate adjusted odds ratios. Our findings reaffirmed known risk factors, such as young age (0–9 years) and presence of specific stx genes or gene combinations (stx2a; stx1a + stx2a; stx1a + stx2c), and additionally suggest that having outbreak-associated infection, residence within the East region of Ireland, and the combined presence of both ygiW and group_5720 or both pfkA and fieF genes are potentially associated with developing HUS. Our findings could improve early identification of high-risk STEC infections and help guide enhanced surveillance and public health management.

• Attribution of Salmonella enterica to Food Sources by Using Whole-Genome Sequencing Data
  E. Rose et al.

Dispatches

• Alpha-Gal Syndrome after Ixodes scapularis Tick Bite, Maine, USA, 2014–2023
  E. F. Saunders et al.
• Onset of Alpha-Gal Syndrome after Tick Bite, Washington, USA
  W. K. Butler et al.
• Reemergence of Brucella abortus, Israel, 2021
  S. Bardenstein et al. View Abstract

  After nearly 4 decades, Brucella abortus has reemerged in Israel, triggering an outbreak across 2 dairy farms (82/137 cows affected), as well as cases in dogs and 1 human case. Despite thorough epidemiologic and genomic investigation, the outbreak source remains unidentified. Such reemergence poses One Health challenges and necessitates ongoing surveillance.

• Bartonella quintana Endocarditis and Pauci-Immune Glomerulonephritis in Patient
  W. Yu et al. View Abstract

  We report an unexpected case of Bartonella quintana endocarditis and pauci-immune glomerulonephritis in a patient without known risk factors in Los Angeles, California, USA, highlighting that infection can occur in the general population without a history of homelessness. The diagnosis was challenging and made definitively through extensive diagnostic tests and multidisciplinary investigation.

• Dynamics of Bagaza, West Nile, and Usutu Viruses in Red-Legged Partridges, Portugal, 2018–2022
  C. Fontoura-Gonçalves et al. View Abstract

  Long-term serologic surveillance of red-legged partridges suggests emergence of Bagaza virus in Portugal in 2021, associated with disease outbreaks in this species. Results also reveal sporadic circulation of Usutu virus and endemic circulation of West Nile virus, highlighting the role of red-legged partridges in the transmission and maintenance cycle and as sentinels of orthoflaviviruses.

• Exposure of Wild Mammals Inhabiting Alaska to Influenza A(H5N1) Virus
  A. M. Ramey et al.
• Yaws Circulating in Nonhuman Primates, Uganda and Rwanda
  T. L. Goldberg et al. View Abstract

  The bacterium Treponema pallidum pertenue causes yaws in humans and nonhuman primates. We describe 33% T. pallidum pertenue seropositivity in 9 species of nonhuman primates in Uganda and Rwanda, seroconversion during a lethal outbreak and a novel bacterial genomic lineage. Yaws may threaten both public health and conservation in the region.

• Brucella suis Infection in Cardiac Implantable Device of Man Exposed to Feral Swine Meat, Florida, USA
  J. A. Rodriguez et al. View Abstract

  Brucella suis infection in the United States is typically from feral swine exposure. We describe a case of B. suis cardiac implantable device infection in a man exposed to meat and blood from feral swine in Florida, USA. The infection was diagnosed using culture, molecular diagnostics, and whole-genome sequencing.

• Detection of Batborne Hantaviruses, Laos, 2023–2024
  C. Vanhnollat et al. View Abstract

  We report the detection of batborne hantaviruses in 2 bat species (Aselliscus stoliczkanus and Hipposideros gentilis) in Laos, expanding the known geographic distribution of hantaviruses in Southeast Asia. Given the frequent human–wildlife contact in the region, researchers should continue to characterize the viruses and investigate their zoonotic potential.

• Highly Pathogenic Avian Influenza A(H5N1) Virus Stability in Irradiated Raw Milk and Wastewater and on Surfaces, United States
  F. Kaiser et al. View Abstract

  We measured stability of infectious influenza A(H5N1) virus in irradiated raw milk and wastewater and on surfaces. We found a relatively slow decay in milk, indicating that contaminated milk and fomites pose transmission risks. Although the risk is low, our results call for caution in milk handling and disposal from infected cattle.

• Molecular Epidemiology of Oropouche Virus, Ceará State, Brazil, 2024
  S. de Lima et al. View Abstract

  During May–December 2024, we detected Oropouche virus (OROV) in 13.9% (263/1,890) of febrile patients in Ceará state, Brazil. Genomic sequencing revealed those cases were caused by a novel OROV reassortant previously identified in the Amazon region. Our data show the introduction and establishment of OROV transmission in Ceará, northeastern Brazil.

Research Letters

• Nipah Virus Detection in Pteropus hypomelanus Bats in Central Java, Indonesia
  D. W. Putro et al.
• Rabbit Hepatitis E Virus, Ukraine, 2024
  S. Santos-Silva et al.
• Human Adenovirus B55 Infection in Patient without Recent Travel History, France
  M. Mohamedi et al. View Abstract

  We report a rare case of pneumonia caused by human mastadenovirus (HAdV) B55 in France in a patient without recent travel history. HAdV-B55 infection was identified retrospectively after being detected in feces during an investigation for concomitant diarrhea. This case suggests possible silent endemic circulation of HAdV-B55 in France.

• Local Circulation of Sindbis Virus in Wild Birds and Horses, the Netherlands, 2021–2022
  K. Streng et al.
• Increased Recognition of Human Anaplasmosis, Ontario, Canada, 2021
  C. Dai et al.
• Emerging Trends in Streptococcal Toxic Shock Syndrome, Japan
  M. Ujiie View Abstract

  Japan experienced substantial increases in streptococcal toxic shock syndrome and group A Streptococcus pharyngitis after relaxing COVID-19 restrictions in May 2023. Increased detection of the M1_UK lineage of Streptococcus pyogenes, especially in the vicinity of Tokyo, emphasizes the need to raise awareness of disease characteristics and epidemiologic trends.

• Spread of Dual-Resistant Mycoplasma genitalium Clone among Men, France, 2021–2022
  S. Pereyre et al.
• Co-Circulation of 2 Oropouche Virus Lineages during Outbreak, Amazon Region of Peru, 2023–2024
  C. D. Cruz et al. View Abstract

  We describe introduction of the 2022–2023 Oropouche virus lineage from Brazil, which has caused large-scale outbreaks throughout Brazil, into the Amazon Region of Peru. This lineage is co-circulating with another lineage that was circulating previously. Our findings highlight the need for continued surveillance to monitor Oropouche virus in Peru.

• Coxiella burnetii Infections Identified by Molecular Methods, United States, 2006–2023
  C. K. Maki et al. View Abstract

  We identified 34 patients with Coxiella burnetii infection using PCR; 31 (86%) cases were diagnosed from cardiac specimens. Nearly half (15/31, 48%) of those cases were not reported to any channel of national disease surveillance, indicating substantial underreporting for diseases identified using molecular methods at noncommercial laboratories.

• Genomic Characterization of Yersinia enterocolitica Isolates, Costa Rica
  C. Savin et al. View Abstract

  Data on enteric yersinioses in Central America are limited. Genomic characterization of 78 Yersinia enterocolitica isolates from Costa Rica indicated persistent infection-source circulation between animal reservoirs and humans, as well as unusual antimicrobial resistance levels. Our study highlights the importance of genomic surveillance to monitor Yersinia-caused infections in Costa Rica.

• Yellow Fever Virus in Mosquitoes from Rainforest Bordering Manaus, Brazil, 2022
  V. Bernardi et al.
• Neutralizing Antibody Response to Influenza A(H5N1) Virus in Dairy Farm Workers, Michigan, USA
  M. Z. Levine et al. View Abstract

  Since March 2024, highly pathogenic avian influenza A(H5N1) viruses have caused outbreaks in dairy cattle and poultry in the United States, and they continue to spill over into humans. However, data on human immune response to those viruses is limited. We report neutralizing antibody responses in 2 dairy farm worker H5N1 cases.

Synopses

• Establishing Methods to Monitor H5N1 Influenza Virus in Dairy Cattle Milk, Massachusetts
  E. Stachler et al.
• Advantages of Software Containerization in Public Health Infectious Disease Genomic Surveillance
  K. R. Florek et al.

Research

• Real-Time Utilization of Mpox Genomic Surveillance, King County, Washington, USA, 2022–2024
  K. M. Lau et al.
• Integrating Genomic Data into Public Health Surveillance for Multidrug-Resistant Organisms, Washington, United States
  L. Torres et al.
• Using Genomic Epidemiology to Estimate Pathogen Burden in a Population
  W. Porter et al.
• Pathogen Genomics in Public Health Practice: a Decade of Partnerships and Progress
  D. MacCannell et al.

Supplement

• SARS-CoV-2 Genomic Surveillance from Community-Distributed Rapid Antigen Tests, Wisconsin, USA
  I. E. Emmen et al.
• Strategies and Opportunities to Improve Community Health through Advanced Molecular Detection and Genomic Surveillance of Infectious Diseases
  J. Moore et al.

Synopses

• Comprehensive Survival Analysis of Patients with Alveolar Echinococcosis, University Hospital Zurich, 1973–2022
  A. Deibel et al.
• Outbreak of Marburg Virus Disease, Equatorial Guinea, 2023
  S. Ngai et al.

Research

• Nationwide Observational Case-Control Study of Risk Factors for Aerococcus Bloodstream Infections, Sweden
  J. Walles et al.

Dispatches

• Self-Reported SARS-CoV-2 Infections among National Blood Donor Cohort, United States, 2020–2022
  B. R. Spencer et al.
• Recent and Forecasted Increases in Coccidioidomycosis Incidence Linked to Hydroclimatic Swings, California
  S. K. Camponuri et al.
• Tropheryma whipplei Infections, Mexico, 2019–2021
  J. Delgado-de la Mora et al.
• High Prevalence of Influenza D Virus Infection in Swine, Northern Ireland
  P. Lagan and K. Lemon
• Orthomarburgvirus, Paramyxovirus, and Orthonairovirus Co-Infections in Egyptian Rousette Bats, Uganda and Sierra Leone
  B. R. Amman et al.

Research Letters

• Emergence of Feline Sporotrichosis near Brazil Border, Argentina, 2023–2024
  K. Vizcaychipi et al.
• Clinical and Epidemiologic Characteristics of Mpox Cases, Dominican Republic, July 2022–February 2023
  R. Paulino-Ramirez et al.