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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 11—November 2016


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

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



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

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

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

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

  • Reassortant Eurasian Avian-Like Influenza A(H1N1) Virus from a Severely Ill Child, Hunan Province, China, 2015
    W. Zhu et al.
    View Summary

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

        View Abstract

    In 2015, a novel influenza A(H1N1) virus was isolated from a boy in China who had severe pneumonia. The virus was a genetic reassortant of Eurasian avian-like influenza A(H1N1) (EA-H1N1) virus. The hemagglutinin, neuraminidase, and matrix genes of the reassortant virus were highly similar to genes in EA-H1N1 swine influenza viruses, the polybasic 1 and 2, polymerase acidic, and nucleoprotein genes originated from influenza A(H1N1)pdm09 virus, and the nonstructural protein gene derived from classical swine influenza A(H1N1) (CS H1N1) virus. In a mouse model, the reassortant virus, termed influenza A/Hunan/42443/2015(H1N1) virus, showed higher infectivity and virulence than another human EA-H1N1 isolate, influenza A/Jiangsu/1/2011(H1N1) virus. In the respiratory tract of mice, virus replication by influenza A/Hunan/42443/2015(H1N1) virus was substantially higher than that by influenza A/Jiangsu/1/2011(H1N1) virus. Human-to-human transmission of influenza A/Hunan/42443/2015(H1N1) virus has not been detected; however, given the circulation of novel EA-H1N1 viruses in pigs, enhanced surveillance should be instituted among swine and humans.

  • Epidemiology of La Crosse Virus Emergence, Appalachia Region, United States
    S. Bewick et al.
    View Summary

    Emergence may involve invasive mosquitoes other than Asian tiger mosquitoes, climate change, and changes in wildlife densities.

        View Abstract

    La Crosse encephalitis is a viral disease that has emerged in new locations across the Appalachian region of the United States. Conventional wisdom suggests that ongoing emergence of La Crosse virus (LACV) could stem from the invasive Asian tiger (Aedes albopictus) mosquito. Efforts to prove this, however, are complicated by the numerous transmission routes and species interactions involved in LACV dynamics. To analyze LACV transmission by Asian tiger mosquitoes, we constructed epidemiologic models. These models accurately predict empirical infection rates. They do not, however, support the hypothesis that Asian tiger mosquitoes are responsible for the recent emergence of LACV at new foci. Consequently, we conclude that other factors, including different invasive mosquitoes, changes in climate variables, or changes in wildlife densities, should be considered as alternative explanations for recent increases in La Crosse encephalitis.

  • Increased Hospitalizations for Neuropathies as Indicators of Zika Virus Infection, according to Health Information System Data, Brazil
    C. Barcellos et al.
    View Summary

    Neurologic manifestations of Zika infection must be adequately recognized and treated; our study methods can be used for monitoring and warning systems.

        View Abstract

    Evidence is increasing that Zika virus can cause extensive damage to the central nervous system, affecting both fetuses and adults. We sought to identify traces of possible clinical manifestations of nervous system diseases among the registers of hospital admissions recorded in the Brazilian Unified Health System. Time series of several diagnoses from the International Classification of Diseases, 10th Revision, were analyzed by using control diagrams, during January 2008–February 2016. Beginning in mid-2014, we observed an unprecedented and significant rise in the hospitalization rate for congenital malformations of the nervous system, Guillain-Barré syndrome, encephalitis, myelitis, and encephalomyelitis. These conditions are compatible with viral infection and inflammation-associated manifestations and may have been due to the entrance of Zika virus into Brazil. These findings show the necessity of adequately diagnosing and treating suspected cases of Zika virus infection and also that health surveillance systems can be improved by using routine data.

  • Global Escherichia coli Sequence Type 131 Clade with bla Gene
    Y. Matsumura et al.
    View Summary

    Increased extended-spectrum β-lactamase–producing E. coli in Japan resulted mainly from a global sequence type 131 clade containing blaCTX-M-27.

  • Risk Factors for Middle East Respiratory Syndrome Coronavirus Infection among Healthcare Personnel
    B. M. Alradaddi et al.
    View Summary

    Infections occurred exclusively among personnel who had close contact with MERS-CoV patients.

  • Ambulatory Pediatric Surveillance of Hand, Foot and Mouth Disease as Signal of an Outbreak of Coxsackievirus A6 Infections, France, 2014–2015
    A. Mirand et al.
    View Summary

    Outbreaks can be detected by syndromic surveillance, rapid enterovirus testing, and genotyping.



  • Group B Streptococcus Sequence Type 283 Disease Linked to Consumption of Raw Fish, Singapore
    P. Rajendram et al.
        View Abstract

    An outbreak of invasive group B Streptococcus (GBS) disease occurred in Singapore in mid-2015. We conducted a case–control study of 22 adults with invasive GBS infections during June 21–November 21, 2015. Consumption of raw fish was strongly associated with invasive sequence type 283 infections, but not with non–sequence type 283 infections.

  • Imported Chikungunya Virus Strains, Taiwan, 2006–2014
    C. Yang et al.
  • Mayaro Virus in Child with Acute Febrile Illness, Haiti, 2015
    J. Lednicky et al.
        View Abstract

    Mayaro virus has been associated with small outbreaks in northern South America. We isolated this virus from a child with acute febrile illness in rural Haiti, confirming its role as a cause of mosquitoborne illness in the Caribbean region. The clinical presentation can mimic that of chikungunya, dengue, and Zika virus infections.

  • Group B Streptococcus Serotype III Sequence Type 283 Bacteremia Associated with Consumption of Raw Fish, Singapore
    S. Tan et al.
        View Abstract

    We conducted a retrospective study of 40 case-patients and 58 controls as part of a nationwide investigation of a group B Streptococcus outbreak in Singapore in 2015. Eating a Chinese-style raw fish dish (yusheng) was a major risk factor for bacteremia, particularly caused by serotype III sequence type 283.

  • Increased Community-Associated Infections Caused by Panton-Valentine Leukocidin–Negative MRSA, Shanghai, 2005–2014
    M. Li et al.
  • Severe Fever with Thrombocytopenia Syndrome in Patients with Suspected Scrub Typhus
    Y. Wi et al.
  • Severe Fever with Thrombocytopenia Syndrome Complicated by Coinfection with Spotted Fever Group Rickettsiae
    Q. Lu et al.
  • Guinea Worm (Dracunculus medinensis) Infection in a Wild-Caught Frog, Chad
    M. Eberhard et al.
        View Abstract

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

  • Co-infections with Chikungunya and Dengue Viruses, Guatemala, 2015
    T. Edwards et al.
  • Early Growth and Neurologic Outcomes of Infants with Probable Congenital Zika Virus Syndrome
    A. Moura da Silva et al.
        View Abstract

    We report the early growth and neurologic findings of 48 infants in Brazil diagnosed with probable congenital Zika virus syndrome and followed to age 1–8 months. Most of these infants had microcephaly (86.7%) and craniofacial disproportion (95.8%). The clinical pattern included poor head growth with increasingly negative z-scores, pyramidal/extrapyramidal symptoms, and epilepsy.

  • Capsular Switching and Other Large-Scale Recombination Events in Invasive Sequence Type 1 Group B Streptococcus
    A. Neemuchwala et al.
        View Abstract

    We report several cases of recombination events leading to capsular switching among sequence type (ST) 1 group B Streptococcus strains. These strains otherwise shared a common genome backbone with serotype V ST1 strains. However, the genomes of ST1 serotype V strains and those of serotypes VI, VII, and VIII strains differed substantially.

  • Novel Levofloxacin-Resistant Multidrug-Resistant Streptococcus pneumoniae Serotype 11A Isolates, South Korea
    M. Park et al.
        View Abstract

    Of 608 Streptococcus pneumoniae clinical strains isolated at a hospital in South Korea during 2009–2014, sixteen (2.6%) were identified as levofloxacin resistant. The predominant serotype was 11A (9 isolates). Two novel sequence types of multidrug-resistant S. pneumoniae with serotype 11A were identified, indicating continuous diversification of resistant strains.

  • Role of Nasopharyngeal Pneumococcal Density in Evolution of Acute Respiratory Illnesses in Young Children, Peru, 2009–2011
    R. R. Fan et al.
  • Serotype IV Sequence Type 468 Group B Streptococcus Neonatal Invasive Disease, Minnesota, USA
    S. Teatero et al.
        View Abstract

    To further understand the emergence of serotype IV group B Streptococcus (GBS) invasive disease, we used whole-genome sequencing to characterize 3 sequence type 468 strains isolated from neonates in Minnesota, USA. We found that strains of tetracycline-resistant sequence type 468 GBS have acquired virulence genes from a putative clonal complex 17 GBS donor by recombination.

  • Staphylococcus aureus Colonization and Long-Term Mortality, United States
    A. Mendy et al.
  • Changing Pattern of Chlamydia trachomatis Strains in Lymphogranuloma Venereum Outbreak, France, 2010–2015
    O. Peuchant et al.
        View Abstract

    We describe a change in the molecular epidemiology of Chlamydia trachomatis strains involved in an outbreak of rectal lymphogranuloma venereum in France during January 2010–April 2015. Until 2012, the C. trachomatis L2b strain predominated; however, starting in 2013, most cases involved the L2 strain. We also identified 4 genetic L2b ompA variants.


Volume 22, Number 12—December 2016


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

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

  • Investigation and Response to 2 Plague Cases, Yosemite National Park, California, USA, 2015
    M. Danforth et al.
    View Summary

    Rapid interagency investigation and public health response reduced the risk for transmission to other Yosemite visitors and staff.



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

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

        View Abstract

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

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

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

        View Abstract

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

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

    Strains from diarrheal illnesses could be transmitted from pigeons, but HUS-associated strains may derive from phage acquisition by isolates with larger virulence assets.

        View Abstract

    Verotoxigenic Escherichia coli infections in humans cause disease ranging from uncomplicated intestinal illnesses to bloody diarrhea and systemic sequelae, such as hemolytic uremic syndrome (HUS). Previous research indicated that pigeons may be a reservoir for a population of verotoxigenic E. coli producing the VT2f variant. We used whole-genome sequencing to characterize a set of VT2f-producing E. coli strains from human patients with diarrhea or HUS and from healthy pigeons. We describe a phage conveying the vtx2f genes and provide evidence that the strains causing milder diarrheal disease may be transmitted to humans from pigeons. The strains causing HUS could derive from VT2f phage acquisition by E. coli strains with a virulence genes asset resembling that of typical HUS-associated verotoxigenic E. coli.

  • Cutaneous Granulomas in Dolphins Caused by Novel Uncultivated Paracoccidioides brasiliensis
    R. Vilela et al.
    View Summary

    Our findings could stimulate research of lacaziosis/lobomycosis (paracoccidioidomycosis ceti) caused by this fungi.

  • Vertebrate Host Susceptibility to Heartland Virus
    A. M. Bosco-Lauth et al.
    View Summary

    Virus-infected Ag129 mice could be a useful model for identifying tick infection or virus transmission.

  • Infectious Dose of Listeria monocytogenes in Outbreak Linked to Ice Cream, United States, 2015
    R. Pouillot et al.
    View Summary

    In susceptible populations illness can occur from low-level contamination that does not cause illness in the general population.

  • Live Poultry Market Interventions for Influenza A(H7N9) Virus, Guangdong, China
    J. Wu et al.
    View Summary

    Temporary closure of live poultry markets appears not to have halted virus transmission or prevented its dissemination.



  • 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.

  • Highly Pathogenic Reassortant Avian Influenza A(H5N1) Virus Clade in Poultry, Bhutan
    A. Marinova-Petkova et al.
        View Abstract

    Highly pathogenic avian influenza A(H5N1), clade, with an H9-like polymerase basic protein 1 gene, isolated in Bhutan in 2012, replicated faster in vitro than its H5N1 parental genotype and was transmitted more efficiently in a chicken model than in a ferret model. These properties likely help limit/eradicate outbreaks, combined with strict control measures.

  • Highly Divergent Dengue Virus Type 2 in Traveler Returning from Indonesia to Australia
    W. Liu et al.
  • Baylisascaris procyonis Roundworm Seroprevalence among Wildlife Rehabilitators, United States and Canada, 2012–2015
    S. Sapp et al.
  • Detection of Vaccinia Virus in Dairy Cattle Serum Samples from 2009, Uruguay
    A. Franco-Luiz et al.
  • Detection and Genotyping of Coxiella burnetii in Pigs, South Korea, 2014–2015
    M. Seo et al.
  • Human Brucellosis in Febrile Patients Seeking Treatment at Remote Hospitals, Northeastern Kenya, 2014–2015
    J. Njeru et al.
        View Abstract

    During 2014–2015, patients in northeastern Kenya were assessed for brucellosis and characteristics that might help clinicians identify brucellosis. Among 146 confirmed brucellosis patients, 29 (20%) had negative serologic tests. No clinical feature was a good indicator of infection, which was associated with animal contact and drinking raw milk.

  • Human Infection with Novel Spotted Fever Group Rickettsia species,China, 2015
    H. Li et al.
  • Horizontal Transmission of Chronic Wasting Disease in Reindeer
    S. Moore et al.
  • Tuberculosis-Associated Death among Adult Wild Boars, Spain, 2009–2014
    J. A. Barasona et al.


Volume 23, Number 1—January 2017


  • Epidemiology of Hospitalizations for Invasive Candidiasis, United States, 2002–2012
    S. Strollo et al.


  • 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.