Early Release

Perspective

• Homelessness and Organ Donor–Derived Bartonella quintana Infection
  R. Henderson et al. View Abstract

  Louseborne Bartonella quintana infections in the United States occur almost exclusively among persons experiencing homelessness because of inadequate access to hygiene resources. Homelessness is increasing, and persons experiencing homelessness are often organ donors despite barriers to receiving donated organs themselves. Recent reports have documented B. quintana transmission via organs transplanted from donors who had recently experienced homelessness. Those reports demonstrate the threat of severe bartonellosis in immunosuppressed organ transplant recipients after donor-derived B. quintana infection. Addressing the root causes of B. quintana transmission could improve the quality of life for persons experiencing homelessness and simultaneously mitigate risk for donor-derived B. quintana transmission. Interventions include improved access to housing, consistent access to hot water for showers and laundry, early treatment of body lice infestation and B. quintana infection, and B. quintana testing and prophylactic treatment of recipients of organs from donors who have experienced risk factors for B. quintana, including homelessness.

Synopses

• Increase in Adult Patients with Varicella Zoster Virus–Related Central Nervous System Infections, Japan
  A. Yoshikane et al. View Abstract

  An increase in the number of herpes zoster patients has been reported since universal varicella immunization was introduced, perhaps because of reduced opportunities for varicella patients to experience the natural booster effect caused by reexposure. We investigated recent trends of varicella zoster virus (VZV)–related central nervous system (CNS) infections at a university hospital in Japan. We enrolled patients with suspected CNS infection during 2013–2022 and tested cerebrospinal fluid samples by real-time PCR for DNA from 7 human herpesviruses. VZV DNA was the most commonly detected in 62 (10.2%) of 615 patients. Kulldorff’s circular spatial scan statistics demonstrated a significant temporal cluster of patients with VZV-related CNS infections during 2019–2022 (p = 0.008). Among persons with such infections, the percentage with aseptic meningitis was significantly higher during 2019–2022 (86.8%), when the temporal cluster of cases occurred, than during 2013–2018 (50.0%) (p = 0.0029).

• Historical Assessment and Mapping of Human Plague, Kazakhstan, 1926–2003
  N. Rametov et al. View Abstract

  Understanding Kazakhstan’s plague history is crucial for early warning and effective health disaster management. We used descriptive-analytical methods to analyze spatial data for human cases in natural plague foci in Kazakhstan during 1926–2003. The findings revealed 565 human cases across 82 outbreaks in Almaty (32.22%), Aktobe (1.59%), Atyrau (4.42%), Mangystau (21.24%), and Kyzylorda (40.53%) oblasts. Before antibiotic drugs were introduced in 1947–1948, major plague outbreaks occurred in 1926, 1929, 1945, 1947, and 1948, constituting 80.7% of human transmission. Plague spread through flea bites, camel handling, wild animal contact, aerosol transmissions, and rodent bites. Patients were up to 86 years of age; 49.9% were male and 50.1% female. Pulmonary cases were reported most frequently (72.4%), and person-to-person infection occurred at an incidence rate of 0.29 cases/10,000 population. Risk increased with human expansion into natural plague foci areas. Swift diagnosis and treatment are essential for curbing plague outbreaks in Kazakhstan.

• Bartonella quintana Endocarditis in Persons Experiencing Homelessness, New York, New York, USA, 2020–2023
  M. Keller et al. View Abstract

  Bartonella quintana infection can lead to bacillary angiomatosis, peliosis hepatis, chronic bacteremia, and culture-negative endocarditis. Transmitted by the human body louse (Pediculus humanus humanus), B. quintana infection has become an emerging disease in recent decades among persons experiencing homelessness. By using retrospective laboratory surveillance, we identified 5 cases of left-sided, culture-negative B. quintana endocarditis among persons in New York, New York, USA, during January 1, 2020–November 23, 2023. Identifications were made by using molecular assays. All patients experienced unsheltered homelessness in the year before hospitalization. Of those patients, 4 experienced heart failure, 3 renal failure, and 2 embolic strokes; 2 died. Aortic valve replacement occurred in 4 cases. A history of possible body louse infestation was found in 4 cases. Clinicians should consider housing status and history of lice exposure in patients with suspected bartonellosis and have a low threshold for diagnostic testing and empiric treatment in patients experiencing homelessness.

• Bartonella quintana Infection in Kidney Transplant Recipients from Donor Experiencing Homelessness, United States, 2022
  A. M. Beeson et al. View Abstract

  Bartonella quintana infection can cause severe disease that includes clinical manifestations such as endocarditis, chronic bacteremia, and vasoproliferative lesions of the skin and viscera. B. quintana bacteria is transmitted by the human body louse (Pediculus humanus corporis) and is associated with homelessness and limited access to hygienic services. We report B. quintana infection in 2 kidney transplant recipients in the United States from an organ donor who was experiencing homelessness. One infection manifested atypically, and the other was minimally symptomatic; with rapid detection, both recipients received timely treatment and recovered. B. quintana was identified retrospectively in an archived donor hematoma specimen, confirming the transmission link. Information about the organ donor’s housing status was critical to this investigation. Evaluation for B. quintana infection should be considered for solid organ transplant recipients who receive organs from donors with a history of homelessness or of body lice infestation.

Research

• Cost-effectiveness Analysis of Japanese Encephalitis Vaccination for Children <15 Years of Age, Bangladesh
  A. Nguyen et al. View Abstract

  Japanese encephalitis (JE) is preventable using the affordable, effective, and safe live attenuated SA 14-14-2 JE vaccine (CD-JEV). We used a Markov model to evaluate the cost-effectiveness of 1 dose of CD-JEV compared with no vaccination in 3 vaccination strategies in Bangladesh: subnational campaign and routine immunization, subnational campaign and national routine immunization, and national routine immunization alone. For input parameters, we gathered information from a cost-of-illness study, medical literature, government documents, and expert opinions. The base-case analysis estimated that a subnational campaign for children <15 years of age and routine immunization over 20 birth cohorts in Rajshahi, Rangpur, and Chattogram yielded (in 2021 US dollars) a cost of $82.2 million, $981/disability-adjusted life years averted, $9,964/case averted, and $49,819/death averted (societal perspective). We projected CD-JEV vaccination would be cost-effective across cost perspectives and vaccination strategies in Bangladesh, yielding an incremental cost-effectiveness ratio of approximately one third of per capita national gross domestic product.

• Clinical Manifestations, Antifungal Drug Susceptibility, and Treatment Outcomes for Emerging Zoonotic Cutaneous Sporotrichosis, Thailand
  P. Jirawattanadon et al. View Abstract

  We analyzed clinical manifestations, antifungal susceptibility, and treatment outcomes of cutaneous sporotrichosis in Thailand during 2018–2022. The study included 49 patients whose mean age was 58.7 (SD 16.9) years; 65.3% were female and 34.7% male. A history of cat exposure was reported in 32 (65.3%) patients who had a significantly higher prevalence of upper extremity lesions than did those without cat contact (90.6% vs. 41.7%; adjusted odds ratio 18.9 [95% CI 3.2–92.9]). Among patients >60 years of age, lesions were more likely to be nonpustular than for patients <60 years of age (82.1% vs. 52.4%; p = 0.033). All 9 isolates tested for antifungal drug susceptibility exhibited an itraconazole MIC of <1 μg/mL. Oral itraconazole monotherapy was effective; the median time-to-cure was 180 days (interquartile range 141–240 days). Physicians should heighten their awareness of potential sporotrichosis causes, particularly when a history of animal contact exists.

• Effect of Sexual Partnerships on Zika Virus Transmission in Virus-Endemic Region, Northeast Brazil
  T. Magalhaes et al. View Abstract

  The epidemiologic effects of Zika virus (ZIKV) sexual transmission in virus-endemic countries remain unclear. We conducted a 2-level, linear mixed-effects logistic regression analysis by using a recently acquired population-based ZIKV and chikungunya virus (CHIKV) serologic dataset obtained from persons residing in Northeast Brazil (n = 2,070 participants). We adjusted mathematical models for housing type and age of participants; the models indicated a significantly higher likelihood of ZIKV seropositivity among persons engaged in a sexual relationship within the same household (odds ratio 1.25 [95% CI 1.00–1.55]; p = 0.047), regardless of their partner’s ZIKV serostatus, and among participants with a ZIKV-seropositive sex partner within the same household (odds ratio 1.54 [95% CI 1.18–2.01]; p = 0.002). CHIKV was also modeled as a control; no sex-associated effects were observed for CHIKV serology. Inclusion of ZIKV sexual transmission in prevention and control strategies is urgently needed, particularly in ZIKV-endemic regions.

• Highly Pathogenic Avian Influenza A(H5N1) Virus Infection in Cats, South Korea, 2023
  Y. Kang et al. View Abstract

  In July 2023, cases of highly pathogenic avian influenza (HPAI) were reported at 2 shelters for stray cats in Seoul, South Korea. The cause of infection was suspected to be improperly sterilized raw food made from domestic duck meat, which was manufactured in South Korea. All viruses isolated from cats at the shelters and from the raw food belonged to HPAI A(H5N1) clade 2.3.4.4b. The gene constellation of all viruses was most similar to that of viruses isolated in Korea in November 2022. Of note, the viruses isolated from infected cats harbored mutations E627K or D701N in polymerase basic 2, which are indicative of adaptation to mammals. Postmortem examination revealed systemic pathologic lesions and the presence of widespread virus in different tissues. Thus, consumption of raw duck meat contaminated with HPAI virus likely caused systemic symptoms and death in cats, indicating the introduction of mammal-adapted mutations of the virus.

• Human Circovirus in Patients with Hepatitis, Hong Kong
  S. Wu et al. View Abstract

  Circovirus human is a new viral species that includes the human circovirus (HCirV), which has been linked to hepatitis in immunocompromised persons. We investigated prevalence of HCirV infection in 278 patients with hepatitis and 184 asymptomatic persons using real-time PCR and sequencing assays. HCirV viremia and sequences were found in 8 (2.9%) hepatitis patients and no asymptomatic patients. Alternate causes of hepatitis (hepatitis E and cholangitis) were clearly identifiable in 2 HCirV-infected patients. HCirV could not be ruled out as a contributor to hepatitis in the remaining 6 patients, 4 of whom were immunocompromised. Persistent infections were documented in 3 patients, but only 1 had relapsing hepatitis. One HCirV patient displayed symptoms of an infectious mononucleosis-like syndrome. Isolates clustered with known HCirV strains from France and China. HCirV-derived virus-like particles bound to PLC/PRF/5 and Hep-G2 human hepatoma cells but not to lung epithelial cells, indicating hepatic tropism.

• Novel Mastadenovirus Infection as Cause of Pneumonia in Imported Black-and-White Colobuses (Colobus guereza), Thailand
  C. Piewbang et al. View Abstract

  We identified a novel mastadenovirus, herein referred to as colobus adenovirus (CoAdV), as the likely cause of fatal respiratory and enteric diseases in multiple black-and-white colobuses (Colobus guereza) imported into Thailand in 2022. Among 9 affected colobuses, 4 died. Viral antigen was abundant in respiratory and enteric tissues, where prominent lesions and clinical signs were observed. We successfully cultivated CoAdV in Vero cells and characterized the complete viral genome, which indicated the virus is genetically distinct from other simian adenoviruses. We also conducted a retrospective study of archival samples from 7 other unrelated colobuses that had respiratory distress or diarrhea and found similar viral strains in 4 of those colobuses. Although we could not determine the potential harm to humans or other nonhuman primates from current information, the zoonotic and spillover potential of this virus to other related hosts should not be neglected. Veterinarians should consider CoAdV when pneumonia is diagnosed in colobuses.

• Rio Mamore Hantavirus Endemicity, Peruvian Amazon, 2020
  M. Piche-Ovares et al. View Abstract

  To explore hantavirus infection patterns in Latin America, we conducted molecular and serologic hantavirus investigations among 3,400 febrile patients from Peru during 2020–2021. Reverse transcription PCR indicated that a patient from Loreto, in the Peruvian Amazon, was positive for Rio Mamore hantavirus (3.8 × 10³ copies/mL). High genomic sequence identity of 87.0%–94.8% and phylogenetic common ancestry with a rodent-associated Rio Mamore hantavirus from Loreto in 1996 indicated endemicity. In 832 samples from Loreto, hantavirus incidence based on IgM ELISA of pooled Sin Nombre (SNV) and Andes virus (ANDV) nucleoproteins and immunofluorescence assay–based end-point titration using SNV/ANDV/Hantaan/Puumala/Saarema/Dobrava/Seoul hantaviruses was 0.5%. Across 3 ecologically distinct departments in Peru, SNV/ANDV IgG ELISA/IFA–based reactivity was 1.7%, suggesting circulation of antigenically distinct New World hantaviruses. Testing for arboviruses, nonendemic pathogens, and antigen-free ELISA corroborated nonspecific reactivity in 2 IgG and several IgM ELISA–positive serum samples. Hantavirus diagnostics and surveillance should be strengthened in Peru.

• Dogs as Reservoirs for Leishmania donovani, Bihar, India, 2018–2022
  A. Kushwaha et al. View Abstract

  Visceral leishmaniasis derived from Leishmania donovani is transmitted by sand flies (Phlebotomus argentipes) throughout the Indian subcontinent. Although considered anthroponotic, L. donovani infects other mammals susceptible to sand fly bites, including dogs. Aggressive strategies to reduce sand fly populations in India have led to flies seeking nonhuman hosts, so understanding the role of dogs in L. donovani transmission has become critical. Our study investigated L. donovani infection in dogs and the potential for such infections to be transmitted back to sand flies. We performed xenodiagnosis by using P. argentipes on dogs (n = 73) with quantitative PCR–detectible parasitemia in both endemic and outbreak villages. We found that 12% (9/73) of dogs were infectious to sand flies during winter and rainy seasons. Patients with visceral leishmaniasis remain primary sources of L. donovani transmission, but our findings suggest a possible link between canine infection and human exposure.

• Concurrent Rabies and Canine Distemper Outbreaks and Infection in Endangered Ethiopian Wolves
  J. Marino et al. View Abstract

  Intensive disease surveillance in an endangered population of Ethiopian wolves provided evidence of concurrent outbreaks of rabies and canine distemper viruses in 2019, including co-infection in an individual animal. Disease surveillance and intensive monitoring of wolf packs in Ethiopia were essential in detecting the concurrent outbreaks and enabled accurate assessment of disease from both pathogens. The study highlights the risk posed to endangered populations that are susceptible to, or live in areas with, reservoir hosts for canine distemper and rabies viruses. Instances of concurrent distemper and rabies outbreaks appear unusual in the existing literature; modeling for one disease might underestimate the risk for extinction. Concurrent outbreaks may have a larger effect than single-disease outbreaks, even in a population that has partial vaccination coverage. Researchers studying wildlife populations from a conservation perspective should be aware that both diseases can strike at once where susceptible populations exist.

• Ophthalmic Sequelae of Ebola Virus Disease in Survivors, Sierra Leone
  C. H. Choo et al.
• Autochthonous Blastomyces dermatitidis, India
  A. Chowdhary et al.

Dispatches

• Mycobacterium leprae in Nine-Banded Armadillos (Dasypus novemcinctus), Ecuador
  D. Romero-Alvarez et al. View Abstract

  We found Mycobacterium leprae, the most common etiologic agent of Hansen disease or leprosy, in tissues from 9 (18.75%) of 48 nine-banded armadillos (Dasypus novemcinctus) collected across continental Ecuador. Finding evidence of a wildlife reservoir is the first step to recognizing leprosy zoonotic transmission pathway in Ecuador or elsewhere.

• Transmission of Swine Influenza A Viruses along Pig Value Chains, Cambodia, 2020–2022
  A. Hidano et al. View Abstract

  We analyzed >4,000 pig samples from slaughterhouses in Cambodia and found higher influenza A seroprevalence (40.0%) and prevalence (1.5%) among pigs from commercial farms than smallholder farms (seroprevalence 8.9%; prevalence 0.6%). Multivariable analyses revealed evidence of transmission after leaving farms. Findings have implications for influenza risk and surveillance in emerging livestock systems.

• Chikungunya Outbreak Risks in the Dominican Republic since the 2014 Outbreak
  G. Loevinsohn et al.
• Mpox Vaccine Acceptance, Democratic Republic of the Congo
  S. Petrichko et al. View Abstract

  We report general acceptance (61.0%) of an mpox vaccine in the Democratic Republic of the Congo among 5,226 survey respondents. Healthcare workers and respondents in historic mpox-endemic regions had higher acceptance rates. These data highlight the need for increased community engagement and sensitization before widespread deployment of mpox vaccines.

• Lobomycosis in Amazon Region, Bolivia, 2022
  M. I. Méndez et al. View Abstract

  We report a patient with lobomycosis caused by Paracoccidioides loboi fungi in the Andes-Amazon region of Bolivia. We examined clinical, epidemiologic, and phylogenetic data and describe potential transmission/environmental aspects of infection. Continued surveillance and identification of lobomycosis cases in South America are crucial to prevent the spread of this disease.

• Heartland Virus Infection in Elderly Patient Initially Suspected of Having Ehrlichiosis, North Carolina, USA
  A. M. Barbarin et al. View Abstract

  We report a patient in North Carolina, USA, with Heartland virus infection whose diagnosis was complicated by previous Ehrlichia chaffeensis infection. We identified E. ewingii–infected and Bourbon virus–infected tick pools at the patient’s residence. Healthcare providers should consider testing for tickborne viruses if ehrlichiosis is suspected.

• Incursion of Novel Eurasian Low Pathogenicity Avian Influenza H5 Virus, Australia, 2023
  M. Wille et al. View Abstract

  Australia is a sink for low pathogenicity avian influenza viruses, with isolated circulation occurring on the continent. We report the incursion of a Eurasian low pathogenicity avian influenza H5 virus into Australia. This report benefits surveillance and diagnostic work because of the risk and current absence of highly pathogenic avian influenza A(H5N1).

• Experimental Infection of Reindeer with Jamestown Canyon Virus
  K. J. Buhler et al. View Abstract

  Seroprevalence of Jamestown Canyon virus in free-ranging caribou in North America is high. We demonstrate serum antibodies and RNA of the virus in blood and tissues of experimentally exposed reindeer with no clinical illness and minimal histopathologic changes. Caribou and reindeer may play a role in emergence and dissemination of vectorborne zoonoses in Arctic regions.

• Feline Panleukopenia Virus in a Marsican Brown Bear and Crested Porcupine, Italy, 2022–2023
  G. Diakoudi et al. View Abstract

  The virus species Protoparvovirus carnivoran1 encompasses pathogens that infect both domestic and wild carnivores, including feline panleukopenia virus. We identified and characterized feline panleukopenia virus strains in a Marsican brown bear (Ursus arctos marsicanus) and a crested porcupine (Hystrix cristata) in Italy, extending the known host range of this virus.

• Umatilla Virus in Zoo-Dwelling Cape Penguins with Hepatitis, Germany
  M. Mirolo et al. View Abstract

  Analysis of liver tissue from a Cape penguin that died with hepatitis at a zoo in Germany revealed Umatilla virus. Testing uncovered Umatilla virus RNA in samples from 2 other deceased Cape penguins at the zoo. Our results expand knowledge of the prevalence of this virus in bird species across Germany.

• Human and Canine Blastomycosis Cases Associated with Riverside Neighborhood, Wisconsin, USA, December 2021–March 2022
  H. E. Segaloff et al. View Abstract

  We investigated a blastomycosis cluster among humans and canines in a neighborhood in Wisconsin, United States. We conducted interviews and collected serum specimens for Blastomyces antibody testing by enzyme immunoassay. Although no definitive exposure was identified, evidence supports potential exposures from the riverbank, riverside trails or yards, or construction dust.

• Ehrlichia canis in Human and Tick, Italy, 2023
  G. Sgroi et al. View Abstract

  In August 2023, ehrlichiosis was confirmed in a patient in Italy with a Haemaphysalis punctata tick attached to his neck. Gene sequences of Ehrlichia canis from the tick and the patient were identical, indicating a potential risk for this uncommon infection for persons participating in outdoor activities.

• Lloviu Virus Not Disease Causing in Ferret Model
  P. Fletcher et al.
• Influenza A Virus Antibodies in Ducks and Introduction of Highly Pathogenic Influenza A(H5N1) Virus, Tennessee, USA
  D. E. Stallknecht et al. View Abstract

  Testing of ducks in Tennessee, United States, before introduction of highly pathogenic influenza A(H5N1) virus demonstrated a high prevalence of antibodies to influenza A virus but very low prevalence of antibodies to H5 (25%) or H5 and N1 (13%) subtypes. Antibody prevalence increased after H5N1 introduction.

• Transboundary Movement of Yezo Virus via Ticks on Migratory Birds, Japan, 2020–2021
  A. Nishino et al. View Abstract

  Migratory birds carry ticks harboring various pathogens, including the zoonotic Yezo virus. In Hokkaido, Japan, we collected ticks from migratory birds during 2020–2021. Eight of 385 pools, comprising 2,534 ticks, tested positive for Yezo virus RNA, suggesting Yezo virus might be spread through the flyways of migratory birds.

Research Letters

• Possible New Focus of Diphyllobothriasis, Central Europe
  T. Scholz et al. View Abstract

  Diphyllobothriasis is a human parasitic infection that is widespread in the Northern Hemisphere. Popular sport fish such as pike and perch are the source of human infection. We document the autochthonous origin of diphyllobothriasis in a popular tourist destination in Central Europe, which likely marks recent colonization of the parasite.

• Replication-Competent Oropouche Virus in Semen of Traveler Returning to Italy from Cuba, 2024
  C. Castilletti et al. View Abstract

  A febrile man in Italy who had traveled to Cuba in July 2024 was diagnosed with Oropouche fever. Reverse transcription PCR detected prolonged shedding of Oropouche virus RNA in whole blood, serum, urine, and semen. Sixteen days after symptom onset, replication-competent virus was detected in semen, suggesting risk for sexual transmission.

• Bacteriologic and Genomic Investigation of Bacillus anthracis Isolated from World War II Site, China
  Y. Wu et al. View Abstract

  Records suggest Bacillus anthracis was used in biowarfare during World War II, but evidence remains limited. We isolated B. anthracis from soil at the remains of a World War II–era laboratory in China. Phenotypic and genomic analyses confirmed the finding, highlighting the value of microbial forensics in biothreat investigation.

• Salmonella sp. Tied to Multistate Outbreak Isolated from Wastewater, United States, 2022
  Z. S. Goldblum et al. View Abstract

  We isolated Salmonella enterica serovar Senftenberg in raw wastewater from 2 Pennsylvania wastewater treatment facilities during June 2022. Whole genome sequencing revealed 4 isolates separated by <4 single nucleotide polymorphisms from S. enterica Senftenberg in a cluster from the 2022 nationwide outbreak linked to contaminated peanut butter.

• Perspectives of Infectious Disease Physicians on Bartonella quintana Cases, United States, 2014–2024
  S. Louis et al. View Abstract

  In a US survey of infectious disease specialists, 61 respondents reported seeing >1 Bartonella quintana infection during 2014–2024. Diagnostic challenges included limited healthcare provider awareness, inadequate testing, and inconsistent healthcare access among affected populations. Early recognition of B. quintana infections is needed to improve outcomes among affected populations.

• Zoonotic Potential of Chronic Wasting Disease After Adaptation in Intermediate Species
  T. Barrio et al. View Abstract

  Chronic wasting disease (CWD) is an emerging disease in Europe. We report an increase in interspecies transmission capacity and zoonotic potential of a moose CWD isolate from Europe after passage in an ovine prion protein–expressing host. Those results indicated some CWD prions could acquire enhanced zoonotic properties following adaptation in an intermediate species.

• Canine Multidrug-Resistant Pseudomonas aeruginosa Cases Linked to Human Artificial Tears–Related Outbreak
  E. R. Price et al. View Abstract

  We report 2 canine cases of carbapenemase-producing Pseudomonas aeruginosa within a United States veterinary hospital associated with a human outbreak linked to over-the-counter artificial tears. We investigated veterinary hospital transmission. Veterinary antimicrobial resistance surveillance and infection prevention and control enhancements are needed to reduce transmission of carbapenemase-producing organisms.

Letter

• Sporotrichosis in Domestic Cat and Zoonotic Transmission
  S. More et al.

Books and Media

• On Call: A Doctor’s Journey in Public Service
  D. J. Hu

Online Report

• Operational Risk Assessment Tool for Evaluating Leishmania infantum Introduction and Establishment in the United States through Dog Importation
  D. R. Marquez et al. View Abstract

  International pet travel and commercial operations have increased animal disease importation risks, including for Leishmania infantum, a deadly parasite of humans and domestic dogs. Collaborating as an interdisciplinary working group, we developed an operational tool for veterinary and public health practitioners to assess and manage L. infantum risk in dogs imported to the United States. Overall risk varies by dog, human, and geographic factors but could be high without proper controls. We determined dog risk management strategies should include application of sand fly insecticides and repellents, sterilization, and treatment. US public health authorities can use a One Health approach to manage L. infantum importation risks via infected dogs.

Synopses

• Cluster of Legionellosis Cases Associated with Manufacturing Process, South Carolina, USA, 2022
  H. M. Mohamed et al.
• Rickettsia sibirica mongolitimonae Infections in Spain and Case Review of the Literature
  S. Santibáñez et al.

Research

• Ongoing Evolution of Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, 2023–2024
  A. M. Hassan et al.
• Social Contact Patterns and Age-Mixing Before and During COVID-19 Pandemic, Greece, January 2020–October 2021
  V. Engeli et al.
• Novel Trichuris incognita with Low Albendazole/Ivermectin Sensitivity Identified through Fecal DNA Metabarcoding of Patient Samples from Côte d’Ivoire
  A. Venkatesan et al.

Dispatches

• Case Reports of Human Monkeypox Virus Infections in Uganda, 2024
  N. Bbosa et al.
• Fatal Case of Crimean-Congo Hemorrhagic Fever, Portugal, 2024
  L. Zé-Zé et al.
• Detection and Genomic Characterization of Novel Mammarenavirus in European Hedgehogs, Italy
  B. Di Martino et al.
• Influenza A(H5N1) Virus Clade 2.3.2.1a in Traveler Returning to Australia from India, 2024
  Y. Deng et al.

Research Letters

• Equine Encephalomyelitis Outbreak, Uruguay, 2023–2024
  S. Frabasile et al. View Abstract

  We report the genomic analysis from early equine cases of the Western equine encephalitis virus outbreak during 2023–2024 in Uruguay. Sequences are related to a viral isolate from an outbreak in 1958 in Argentina. A viral origin from South America or continuous enzootic circulation with infrequent spillover is possible.

• Cocirculation of 4 Dengue Virus Serotypes, Putumayo Amazon Basin, 2023–2024
  J. van der Ende et al.
• Low IgG Seroconversion among Persons Vaccinated against Measles, Republic of the Congo
  Y. T. Mavoungou et al.
• Fatal Mixed Plasmodium Infection in Traveler Returning to Colombia from Comoros Islands, 2024
  L. J. Medina-Lozano et al. View Abstract

  During 2014–2022, only Plasmodium falciparum malaria cases were reported in the Comoro Islands. We report a fatal case of mixed Plasmodium malaria infection in a traveler returning from the Comoros to Colombia in 2024, highlighting the need to strengthen laboratory detection and identification of Plasmodium spp. in sub-Saharan Africa.

• Identification and Characterization of Vancomycin-Resistant Staphylococcus aureus CC45/USA600, North Carolina, USA, 2021
  J. K. MacFarquhar et al.
• Evidence of H5N1 Influenza Spillover Infections in Horses, Mongolia
  B. Damdinjav et al.
• Spread of Antifungal-Resistant Trichophyton indotineae, United Kingdom, 2017–2024
  A. Abdolrasouli et al.

Letter

• Case Report of Leprosy in Central Florida, USA, 2022
  A. B. Auyeung et al.

Online Report

• Research and Development of Medical Countermeasures for Emerging Infectious Diseases, China
  J. Ma et al.

Dispatch

• Reemergence of Echinococcus granulosus Infections after 2004 Termination of Control Program in Magallanes Region, Chile
  C. A. Alvarez Rojas and J. Alvarez

Research Letter

• Detection of Mycoplasma phocimorsus in Woman with Tendinous Panaritium after Cat Scratch, Denmark
  A. Skafte-Holm et al.