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Issue Cover for Volume 10, Number 3—March 2004

Volume 10, Number 3—March 2004

[PDF - 5.81 MB - 179 pages]

Perspective

Clinical Trials and Novel Pathogens: Lessons Learned from SARS [PDF - 223 KB - 6 pages]
M. P. Muller et al.

During the recent global outbreak of severe acute respiratory syndrome (SARS), thousands of patients received treatments of uncertain efficacy and known toxicity such as ribavirin and corticosteroids. Despite this, no controlled clinical trials assessing the efficacy of these agents were conducted. If a second global SARS outbreak occurred, clinicians would not have controlled data on which to base therapeutic decisions. We discuss the unique methodologic and logistical challenges faced by researchers who attempt to conduct controlled trials of therapeutic agents during an outbreak of a novel or unknown infectious pathogen. We draw upon our own experience in attempting to conduct a randomized controlled trial (trial) of ribavirin therapy for SARS and discuss the lessons learned. Strategies to facilitate future clinical trials during outbreaks of unknown or novel pathogens are also presented.

EID Muller MP, McGeer A, Straus SE, Hawryluck L, Gold WL. Clinical Trials and Novel Pathogens: Lessons Learned from SARS. Emerg Infect Dis. 2004;10(3):389-394. https://doi.org/10.3201/eid1003.030702
AMA Muller MP, McGeer A, Straus SE, et al. Clinical Trials and Novel Pathogens: Lessons Learned from SARS. Emerging Infectious Diseases. 2004;10(3):389-394. doi:10.3201/eid1003.030702.
APA Muller, M. P., McGeer, A., Straus, S. E., Hawryluck, L., & Gold, W. L. (2004). Clinical Trials and Novel Pathogens: Lessons Learned from SARS. Emerging Infectious Diseases, 10(3), 389-394. https://doi.org/10.3201/eid1003.030702.

SARS Transmission and Hospital Containment [PDF - 103 KB - 6 pages]
G. Gopalakrishna et al.

An outbreak of severe acute respiratory syndrome (SARS) was detected in Singapore at the beginning of March 2003. The outbreak, initiated by a traveler to Hong Kong in late February 2003, led to sequential spread of SARS to three major acute care hospitals in Singapore. The critical factor in containing this outbreak was early detection and complete assessment of movements and follow-up of patients, healthcare workers, and visitors who were contacts. Visitor records were important in helping identify exposed persons who could carry the infection into the community. In the three hospital outbreaks, three different containment strategies were used to contain spread of infection: closing an entire hospital, removing all potentially infected persons to a dedicated SARS hospital, and managing exposed persons in place. On the basis of this experience, if a nosocomial outbreak is detected late, a hospital may need to be closed in order to contain spread of the disease. Outbreaks detected early can be managed by either removing all exposed persons to a designated location or isolating and managing them in place.

EID Gopalakrishna G, Choo P, Leo Y, Tay BK, Lim YT, Khan AS, et al. SARS Transmission and Hospital Containment. Emerg Infect Dis. 2004;10(3):395-400. https://doi.org/10.3201/eid1003.030650
AMA Gopalakrishna G, Choo P, Leo Y, et al. SARS Transmission and Hospital Containment. Emerging Infectious Diseases. 2004;10(3):395-400. doi:10.3201/eid1003.030650.
APA Gopalakrishna, G., Choo, P., Leo, Y., Tay, B. K., Lim, Y. T., Khan, A. S....Tan, C. C. (2004). SARS Transmission and Hospital Containment. Emerging Infectious Diseases, 10(3), 395-400. https://doi.org/10.3201/eid1003.030650.

The RUsick2 Foodborne Disease Forum for Syndromic Surveillance [PDF - 133 KB - 5 pages]
H. Wethington and P. Bartlett

The RUsick2 Foodborne Disease Forum at the National Food Safety and Toxicology Center increased reporting of foodborne diseases to more than four times the rate seen in the previous 2 years. Since November 2002, the Forum has allowed pilot-area residents with sudden-onset vomiting or diarrhea to share and compare information regarding what they ate and did before becoming sick. The purpose is to identify a common food source, perhaps resulting in identifying a cluster of persons who ate the same contaminated food item. Such information can assist health departments in detecting foodborne outbreaks while the possibility for intervention remains.

EID Wethington H, Bartlett P. The RUsick2 Foodborne Disease Forum for Syndromic Surveillance. Emerg Infect Dis. 2004;10(3):401-405. https://doi.org/10.3201/eid1003.030358
AMA Wethington H, Bartlett P. The RUsick2 Foodborne Disease Forum for Syndromic Surveillance. Emerging Infectious Diseases. 2004;10(3):401-405. doi:10.3201/eid1003.030358.
APA Wethington, H., & Bartlett, P. (2004). The RUsick2 Foodborne Disease Forum for Syndromic Surveillance. Emerging Infectious Diseases, 10(3), 401-405. https://doi.org/10.3201/eid1003.030358.
Synopses

Reemerging Leptospirosis, California [PDF - 332 KB - 7 pages]
E. Meites et al.

Leptospirosis is a reemerging infectious disease in California. Leptospirosis is the most widespread zoonosis throughout the world, though it is infrequently diagnosed in the continental United States. From 1982 to 2001, most reported California cases occurred in previously healthy young adult white men after recreational exposures to contaminated freshwater. We report five recent cases of human leptospirosis acquired in California, including the first documented common-source outbreak of human leptospirosis acquired in this state, and describe the subsequent environmental investigation. Salient features in the California cases include high fever with uniform renal impairment and mild hepatitis. Because leptospirosis can progress rapidly if untreated, this reemerging infection deserves consideration in febrile patients with a history of recreational freshwater exposure, even in states with a low reported incidence of infection.

EID Meites E, Jay MT, Deresinski S, Shieh W, Zaki SR, Tompkins L, et al. Reemerging Leptospirosis, California. Emerg Infect Dis. 2004;10(3):406-412. https://doi.org/10.3201/eid1003.030431
AMA Meites E, Jay MT, Deresinski S, et al. Reemerging Leptospirosis, California. Emerging Infectious Diseases. 2004;10(3):406-412. doi:10.3201/eid1003.030431.
APA Meites, E., Jay, M. T., Deresinski, S., Shieh, W., Zaki, S. R., Tompkins, L....Smith, D. S. (2004). Reemerging Leptospirosis, California. Emerging Infectious Diseases, 10(3), 406-412. https://doi.org/10.3201/eid1003.030431.
Research

Coronaviridae and SARS-associated Coronavirus Strain HSR1 [PDF - 198 KB - 6 pages]
E. Vicenzi et al.

During the recent severe acute respiratory (SARS) outbreak, the etiologic agent was identified as a new coronavirus (CoV). We have isolated a SARS-associated CoV (SARS-CoV) strain by injecting Vero cells with a sputum specimen from an Italian patient affected by a severe pneumonia; the patient traveled from Vietnam to Italy in March 2003. Ultrastructural analysis of infected Vero cells showed the virions within cell vesicles and around the cell membrane. The full-length viral genome sequence was similar to those derived from the Hong-Kong Hotel M isolate. By using both real-time reverse transcription–polymerase chain reaction TaqMan assay and an infectivity plaque assay, we determined that approximately 360 viral genomes were required to generate a PFU. In addition, heparin (100 μg/mL) inhibited infection of Vero cells by 50%. Overall, the molecular and biologic characteristics of the strain HSR1 provide evidence that SARS-CoV forms a fourth genetic coronavirus group with distinct genomic and biologic features.

EID Vicenzi E, Canducci F, Pinna D, Mancini N, Carletti S, Lazzarin A, et al. Coronaviridae and SARS-associated Coronavirus Strain HSR1. Emerg Infect Dis. 2004;10(3):413-418. https://doi.org/10.3201/eid1003.030683
AMA Vicenzi E, Canducci F, Pinna D, et al. Coronaviridae and SARS-associated Coronavirus Strain HSR1. Emerging Infectious Diseases. 2004;10(3):413-418. doi:10.3201/eid1003.030683.
APA Vicenzi, E., Canducci, F., Pinna, D., Mancini, N., Carletti, S., Lazzarin, A....Clementi, M. (2004). Coronaviridae and SARS-associated Coronavirus Strain HSR1. Emerging Infectious Diseases, 10(3), 413-418. https://doi.org/10.3201/eid1003.030683.

Laboratory Analysis of Tularemia in Wild-Trapped, Commercially Traded Prairie Dogs, Texas, 2002 [PDF - 88 KB - 7 pages]
J. M. Petersen et al.

Oropharyngeal tularemia was identified as the cause of a die-off in captured wild prairie dogs at a commercial exotic animal facility in Texas. From this point source, Francisella tularensis–infected prairie dogs were traced to animals distributed to the Czech Republic and to a Texas pet shop. F. tularensis culture isolates were recovered tissue specimens from 63 prairie dogs, including one each from the secondary distribution sites. Molecular and biochemical subtyping indicated that all isolates were F. tularensis subsp. holarctica (Type B). Microagglutination assays detected antibodies against F. tularensis, with titers as great as 1:4,096 in some live animals. All seropositive animals remained culture positive, suggesting that prairie dogs may act as chronic carriers of F. tularensis. These findings demonstrate the need for additional studies of tularemia in prairie dogs, given the seriousness of the resulting disease, the fact that prairie dogs are sold commercially as pets, and the risk for pet-to-human transmission.

EID Petersen JM, Schriefer ME, Carter LG, Zhou Y, Sealy T, Bawiec D, et al. Laboratory Analysis of Tularemia in Wild-Trapped, Commercially Traded Prairie Dogs, Texas, 2002. Emerg Infect Dis. 2004;10(3):419-425. https://doi.org/10.3201/eid1003.030504
AMA Petersen JM, Schriefer ME, Carter LG, et al. Laboratory Analysis of Tularemia in Wild-Trapped, Commercially Traded Prairie Dogs, Texas, 2002. Emerging Infectious Diseases. 2004;10(3):419-425. doi:10.3201/eid1003.030504.
APA Petersen, J. M., Schriefer, M. E., Carter, L. G., Zhou, Y., Sealy, T., Bawiec, D....Chu, M. C. (2004). Laboratory Analysis of Tularemia in Wild-Trapped, Commercially Traded Prairie Dogs, Texas, 2002. Emerging Infectious Diseases, 10(3), 419-425. https://doi.org/10.3201/eid1003.030504.

Monkeypox Transmission and Pathogenesis in Prairie Dogs [PDF - 427 KB - 6 pages]
J. Guarner et al.

During May and June 2003, the first cluster of human monkeypox cases in the United States was reported. Most patients with this febrile vesicular rash illness presumably acquired the infection from prairie dogs. Monkeypox virus was demonstrated by using polymerase chain reaction in two prairie dogs in which pathologic studies showed necrotizing bronchopneumonia, conjunctivitis, and tongue ulceration. Immunohistochemical assays for orthopoxviruses demonstrated abundant viral antigens in surface epithelial cells of lesions in conjunctiva and tongue, with less amounts in adjacent macrophages, fibroblasts, and connective tissues. Viral antigens in the lung were abundant in bronchial epithelial cells, macrophages, and fibroblasts. Virus isolation and electron microscopy demonstrated active viral replication in lungs and tongue. These findings indicate that both respiratory and direct mucocutaneous exposures are potentially important routes of transmission of monkeypox virus between rodents and to humans. Prairie dogs offer insights into transmission, pathogenesis, and new vaccine and treatment trials because they are susceptible to severe monkeypox infection.

EID Guarner J, Johnson BJ, Paddock CD, Shieh W, Goldsmith CS, Reynolds MG, et al. Monkeypox Transmission and Pathogenesis in Prairie Dogs. Emerg Infect Dis. 2004;10(3):426-431. https://doi.org/10.3201/eid1003.030878
AMA Guarner J, Johnson BJ, Paddock CD, et al. Monkeypox Transmission and Pathogenesis in Prairie Dogs. Emerging Infectious Diseases. 2004;10(3):426-431. doi:10.3201/eid1003.030878.
APA Guarner, J., Johnson, B. J., Paddock, C. D., Shieh, W., Goldsmith, C. S., Reynolds, M. G....Zaki, S. R. (2004). Monkeypox Transmission and Pathogenesis in Prairie Dogs. Emerging Infectious Diseases, 10(3), 426-431. https://doi.org/10.3201/eid1003.030878.

Acute Spotted Fever Rickettsiosis among Febrile Patients, Cameroon [PDF - 256 KB - 6 pages]
L. M. Ndip et al.

Although potential arthropod vectors are abundant in Cameroon, acute febrile illnesses are rarely evaluated for arboviral or rickettsial infections. Serum samples from 234 acutely febrile patients at clinics in Tiko and Buea, Cameroon, were examined for antibodies to Rickettsia africae and African alphaviruses and flaviviruses. These serum samples did not contain antibodies against typhoid, and blood malarial parasites were not detected. Serum samples of 32% contained immunoglobulin M antibodies reactive with R. africae by immunofluorescence assay and were reactive with outer membrane proteins A and B of R. africae by immunoblotting. These findings established a diagnosis of acute rickettsiosis, most likely African tick-bite fever. Hemagglutination inhibition testing of the serum samples also detected antibodies to Chikungunya virus (47%) and flaviviruses (47%). High prevalence of antibodies to arboviruses may represent a major, previously unrecognized public health problem in an area where endemic malaria and typhoid fever have been the principal diagnostic considerations.

EID Ndip LM, Bouyer DH, Da Rosa AP, Titanji V, Tesh RB, Walker DH. Acute Spotted Fever Rickettsiosis among Febrile Patients, Cameroon. Emerg Infect Dis. 2004;10(3):432-437. https://doi.org/10.3201/eid1003.020713
AMA Ndip LM, Bouyer DH, Da Rosa AP, et al. Acute Spotted Fever Rickettsiosis among Febrile Patients, Cameroon. Emerging Infectious Diseases. 2004;10(3):432-437. doi:10.3201/eid1003.020713.
APA Ndip, L. M., Bouyer, D. H., Da Rosa, A. P., Titanji, V., Tesh, R. B., & Walker, D. H. (2004). Acute Spotted Fever Rickettsiosis among Febrile Patients, Cameroon. Emerging Infectious Diseases, 10(3), 432-437. https://doi.org/10.3201/eid1003.020713.

Genomic Changes of Chagas Disease Vector, South America [PDF - 142 KB - 9 pages]
F. Panzera et al.

We analyzed the main karyologic changes that have occurred during the dispersion of Triatoma infestans, the main vector of Chagas disease. We identified two allopatric groups, named Andean and non-Andean. The Andean specimens present C-heterochromatic blocks in most of their 22 chromosomes, whereas non-Andean specimens have only 4–7 autosomes with C-banding. These heterochromatin differences are the likely cause of a striking DNA content variation (approximately 30%) between Andean and non-Andean insects. Our study, together with previous historical and genetic data, suggests that T. infestans was originally a sylvatic species, with large quantities of DNA and heterochromatin, inhabiting the Andean region of Bolivia. However, the spread of domestic T. infestans throughout the non-Andean regions only involved insects with an important reduction of heterochromatin and DNA amounts. We propose that heterochromatin and DNA variation mainly reflected adaptive genomic changes that contribute to the ability of T. infestans to survive, reproduce, and disperse in different environments.

EID Panzera F, Dujardin JP, Nicolini P, Caraccio MN, Rose V, Tellez T, et al. Genomic Changes of Chagas Disease Vector, South America. Emerg Infect Dis. 2004;10(3):438-446. https://doi.org/10.3201/eid1003.020812
AMA Panzera F, Dujardin JP, Nicolini P, et al. Genomic Changes of Chagas Disease Vector, South America. Emerging Infectious Diseases. 2004;10(3):438-446. doi:10.3201/eid1003.020812.
APA Panzera, F., Dujardin, J. P., Nicolini, P., Caraccio, M. N., Rose, V., Tellez, T....Pérez, R. (2004). Genomic Changes of Chagas Disease Vector, South America. Emerging Infectious Diseases, 10(3), 438-446. https://doi.org/10.3201/eid1003.020812.

Internet Use and Epidemiologic Investigation of Gastroenteritis Outbreak [PDF - 46 KB - 4 pages]
M. Kuusi et al.
EID Kuusi M, Nuorti JP, Maunula L, Miettinen I, Pesonen H, von Bonsdorff C. Internet Use and Epidemiologic Investigation of Gastroenteritis Outbreak. Emerg Infect Dis. 2004;10(3):447-450. https://doi.org/10.3201/eid1003.020607
AMA Kuusi M, Nuorti JP, Maunula L, et al. Internet Use and Epidemiologic Investigation of Gastroenteritis Outbreak. Emerging Infectious Diseases. 2004;10(3):447-450. doi:10.3201/eid1003.020607.
APA Kuusi, M., Nuorti, J. P., Maunula, L., Miettinen, I., Pesonen, H., & von Bonsdorff, C. (2004). Internet Use and Epidemiologic Investigation of Gastroenteritis Outbreak. Emerging Infectious Diseases, 10(3), 447-450. https://doi.org/10.3201/eid1003.020607.

Correlating Epidemiologic Trends with the Genotypes Causing Meningococcal Disease, Maryland [PDF - 259 KB - 6 pages]
M. C. McEllistrem et al.

Epidemic meningococcal infection is generally caused by single clones; whether nonepidemic increases in infection are clonal is unknown. We studied the molecular epidemiology of meningococcal infection during a period that the incidence increased in two age groups. Serogroup C and Y meningococcal isolates were analyzed by pulsed-field gel electrophoresis and multilocus sequence typing. From 1992 to 1999, 96.4% (27/28) of serogroup C isolates from persons 15–24 years of age were in clonal group 1, compared with 65.6% (21/32) of isolates from persons ≤14 years, and 64.3% (9/14) of isolates from adults ≥25 years (p ≤ 0.01). The proportion of clonal group 2 serogroup Y strains increased from 7.7% (1/13) in 1992 to 1993 to 52.0% (13/25) in 1998 to 1999 (p < 0.01). The nonepidemic age-specific increases in serogroup C meningococcal infection in Maryland were clonal in nature and the changes in serogroup Y incidence were associated with a shift in the genotypes of strains causing invasive disease.

EID McEllistrem MC, Kolano JA, Pass MA, Caugant DA, Mendelsohn AB, Pacheco AG, et al. Correlating Epidemiologic Trends with the Genotypes Causing Meningococcal Disease, Maryland. Emerg Infect Dis. 2004;10(3):451-456. https://doi.org/10.3201/eid1003.020611
AMA McEllistrem MC, Kolano JA, Pass MA, et al. Correlating Epidemiologic Trends with the Genotypes Causing Meningococcal Disease, Maryland. Emerging Infectious Diseases. 2004;10(3):451-456. doi:10.3201/eid1003.020611.
APA McEllistrem, M. C., Kolano, J. A., Pass, M. A., Caugant, D. A., Mendelsohn, A. B., Pacheco, A. G....Harrison, L. H. (2004). Correlating Epidemiologic Trends with the Genotypes Causing Meningococcal Disease, Maryland. Emerging Infectious Diseases, 10(3), 451-456. https://doi.org/10.3201/eid1003.020611.

Legionella Infection Risk from Domestic Hot Water [PDF - 82 KB - 8 pages]
P. Borella et al.

We investigated Legionella and Pseudomonas contamination of hot water in a cross-sectional multicentric survey in Italy. Chemical parameters (hardness, free chlorine, and trace elements) were determined. Legionella spp. were detected in 33 (22.6%) and Pseudomonas spp. in 56 (38.4%) of 146 samples. Some factors associated with Legionella contamination were heater type, tank distance and capacity, water plant age, and mineral content. Pseudomonas presence was influenced by water source, hardness, free chlorine, and temperature. Legionella contamination was associated with a centralized heater, distance from the heater point >10 m, and a water plant >10 years old. Furthermore, zinc levels of <20 μg/L and copper levels of >50 μg/L appeared to be protective against Legionella colonization. Legionella species and serogroups were differently distributed according to heater type, water temperature, and free chlorine, suggesting that Legionella strains may have a different sensibility and resistance to environmental factors and different ecologic niches.

EID Borella P, Montagna MT, Romano-Spica V, Stampi S, Stancanelli G, Triassi M, et al. Legionella Infection Risk from Domestic Hot Water. Emerg Infect Dis. 2004;10(3):457-464. https://doi.org/10.3201/eid1003.020707
AMA Borella P, Montagna MT, Romano-Spica V, et al. Legionella Infection Risk from Domestic Hot Water. Emerging Infectious Diseases. 2004;10(3):457-464. doi:10.3201/eid1003.020707.
APA Borella, P., Montagna, M. T., Romano-Spica, V., Stampi, S., Stancanelli, G., Triassi, M....D’Alcalà, G. R. (2004). Legionella Infection Risk from Domestic Hot Water. Emerging Infectious Diseases, 10(3), 457-464. https://doi.org/10.3201/eid1003.020707.

Cysticercosis-related Deaths, California [PDF - 59 KB - 5 pages]
F. J. Sorvillo et al.

Cysticercosis is an increasingly important disease in the United States, but information on the occurrence of related deaths is limited. We examined data from California death certificates for the 12-year period 1989–2000. A total of 124 cysticercosis deaths were identified, representing a crude 12-year death rate of 3.9 per million population (95% confidence interval [CI] 3.2 to 4.6). Eighty-two (66%) of the case-patients were male; 42 (34%) were female. The median age at death was 34.5 years (range 7–81 years). Most patients (107, 86.3%) were foreign-born, and 90 (72.6%) had emigrated from Mexico. Seventeen (13.7%) deaths occurred in U.S.-born residents. Cysticercosis death rates were higher in Latino residents of California (13.0/106) than in other racial/ethnic groups (0.4/106), in males (5.2/106) than in females (2.7/106), and in persons >14 years of age (5.0/106). Cysticercosis is a preventable cause of premature death, particularly among young Latino persons in California and may be a more common cause of death in the United States than previously recognized.

EID Sorvillo FJ, Portigal L, DeGiorgio C, Smith L, Waterman SH, Berlin GW, et al. Cysticercosis-related Deaths, California. Emerg Infect Dis. 2004;10(3):465-469. https://doi.org/10.3201/eid1003.020749
AMA Sorvillo FJ, Portigal L, DeGiorgio C, et al. Cysticercosis-related Deaths, California. Emerging Infectious Diseases. 2004;10(3):465-469. doi:10.3201/eid1003.020749.
APA Sorvillo, F. J., Portigal, L., DeGiorgio, C., Smith, L., Waterman, S. H., Berlin, G. W....Ash, L. R. (2004). Cysticercosis-related Deaths, California. Emerging Infectious Diseases, 10(3), 465-469. https://doi.org/10.3201/eid1003.020749.

Amoebae-resisting Bacteria Isolated from Human Nasal Swabs by Amoebal Coculture [PDF - 250 KB - 8 pages]
G. Greub et al.

Amoebae feed on bacteria, and few bacteria can resist their microbicidal ability. Amoebal coculture could therefore be used to selectively grow these amoebae-resisting bacteria (ARB), which may be human pathogens. To isolate new ARB, we performed amoebal coculture from 444 nasal samples. We recovered 7 (1.6%) ARB from 444 nasal swabs, including 4 new species provisionally named Candidatus Roseomonas massiliae, C. Rhizobium massiliae, C. Chryseobacterium massiliae, and C. Amoebinatus massiliae. The remaining isolates were closely related to Methylobacterium extorquens, Bosea vestrii, and Achromobacter xylosoxidans. Thus, amoebal coculture allows the recovery of new bacterial species from heavily contaminated samples and might be a valuable approach for the recovery of as-yet unrecognized emerging pathogens from clinical specimens.

EID Greub G, La Scola B, Raoult D. Amoebae-resisting Bacteria Isolated from Human Nasal Swabs by Amoebal Coculture. Emerg Infect Dis. 2004;10(3):470-477. https://doi.org/10.3201/eid1003.020792
AMA Greub G, La Scola B, Raoult D. Amoebae-resisting Bacteria Isolated from Human Nasal Swabs by Amoebal Coculture. Emerging Infectious Diseases. 2004;10(3):470-477. doi:10.3201/eid1003.020792.
APA Greub, G., La Scola, B., & Raoult, D. (2004). Amoebae-resisting Bacteria Isolated from Human Nasal Swabs by Amoebal Coculture. Emerging Infectious Diseases, 10(3), 470-477. https://doi.org/10.3201/eid1003.020792.

Neutralizing Antibodies and Sin Nombre Virus RNA after Recovery from Hantavirus Cardiopulmonary Syndrome [PDF - 162 KB - 5 pages]
C. Ye et al.

Patients who later have a mild course of hantavirus cardiopulmonary syndrome (HCPS) are more likely to exhibit a high titer of neutralizing antibodies against Sin Nombre virus (SNV), the etiologic agent of HCPS, at the time of hospital admission. Because administering plasma from patients who have recovered from HCPS to those in the early stages of disease may be an advantageous form of passive immunotherapy, we examined the neutralizing antibody titers of 21 patients who had recovered from SNV infection. Even 1,000 days after admission to the hospital, 6 of 10 patients had titers of 800 or higher, with one sample retaining a titer of 3,200 after more than 1,400 days. None of the convalescent-phase serum samples contained detectable viral RNA. These results confirm that patients retain high titers of neutralizing antibodies long after recovery from SNV infection.

EID Ye C, Prescott JB, Nofchissey RA, Goade D, Hjelle B. Neutralizing Antibodies and Sin Nombre Virus RNA after Recovery from Hantavirus Cardiopulmonary Syndrome. Emerg Infect Dis. 2004;10(3):478-482. https://doi.org/10.3201/eid1003.020821
AMA Ye C, Prescott JB, Nofchissey RA, et al. Neutralizing Antibodies and Sin Nombre Virus RNA after Recovery from Hantavirus Cardiopulmonary Syndrome. Emerging Infectious Diseases. 2004;10(3):478-482. doi:10.3201/eid1003.020821.
APA Ye, C., Prescott, J. B., Nofchissey, R. A., Goade, D., & Hjelle, B. (2004). Neutralizing Antibodies and Sin Nombre Virus RNA after Recovery from Hantavirus Cardiopulmonary Syndrome. Emerging Infectious Diseases, 10(3), 478-482. https://doi.org/10.3201/eid1003.020821.
Dispatches

First Reported Prairie Dog–to-Human Tularemia Transmission, Texas, 2002 [PDF - 102 KB - 4 pages]
S. B. Avashia et al.

A tularemia outbreak, caused by Francisella tularensis type B, occurred among wild-caught, commercially traded prairie dogs. F. tularensis microagglutination titers in one exposed person indicated recent infection. These findings represent the first evidence for prairie-dog-to-human tularemia transmission and demonstrate potential human health risks of the exotic pet trade.

EID Avashia SB, Petersen JM, Lindley CM, Schriefer ME, Gage KL, Cetron M, et al. First Reported Prairie Dog–to-Human Tularemia Transmission, Texas, 2002. Emerg Infect Dis. 2004;10(3):483-486. https://doi.org/10.3201/eid1003.030695
AMA Avashia SB, Petersen JM, Lindley CM, et al. First Reported Prairie Dog–to-Human Tularemia Transmission, Texas, 2002. Emerging Infectious Diseases. 2004;10(3):483-486. doi:10.3201/eid1003.030695.
APA Avashia, S. B., Petersen, J. M., Lindley, C. M., Schriefer, M. E., Gage, K. L., Cetron, M....Kool, J. L. (2004). First Reported Prairie Dog–to-Human Tularemia Transmission, Texas, 2002. Emerging Infectious Diseases, 10(3), 483-486. https://doi.org/10.3201/eid1003.030695.

Predicting Quarantine Failure Rates [PDF - 62 KB - 2 pages]
T. Day

Preemptive quarantine through contact-tracing effectively controls emerging infectious diseases. Occasionally this quarantine fails, however, and infected persons are released. The probability of quarantine failure is typically estimated from disease-specific data. Here a simple, exact estimate of the failure rate is derived that does not depend on disease-specific parameters. This estimate is universally applicable to all infectious diseases.

EID Day T. Predicting Quarantine Failure Rates. Emerg Infect Dis. 2004;10(3):487-488. https://doi.org/10.3201/eid1003.030502
AMA Day T. Predicting Quarantine Failure Rates. Emerging Infectious Diseases. 2004;10(3):487-488. doi:10.3201/eid1003.030502.
APA Day, T. (2004). Predicting Quarantine Failure Rates. Emerging Infectious Diseases, 10(3), 487-488. https://doi.org/10.3201/eid1003.030502.

Patient Data, Early SARS Epidemic, Taiwan [PDF - 335 KB - 5 pages]
P. Hsueh et al.

Of the first 10 patients in the epidemic of severe acute respiratory syndrome (SARS) in Taiwan, 4 were closely associated with a SARS patient in an airplane. Loose stools or diarrhea, hemophagocytosis syndrome, and high serum levels of interleukin (IL)-6, IL-8, and tumor necrosis factor-α associated with lung lesions were found in all 10 patients.

EID Hsueh P, Chen P, Hsiao C, Yeh S, Cheng W, Wang J, et al. Patient Data, Early SARS Epidemic, Taiwan. Emerg Infect Dis. 2004;10(3):489-493. https://doi.org/10.3201/eid1003.030571
AMA Hsueh P, Chen P, Hsiao C, et al. Patient Data, Early SARS Epidemic, Taiwan. Emerging Infectious Diseases. 2004;10(3):489-493. doi:10.3201/eid1003.030571.
APA Hsueh, P., Chen, P., Hsiao, C., Yeh, S., Cheng, W., Wang, J....Yang, P. (2004). Patient Data, Early SARS Epidemic, Taiwan. Emerging Infectious Diseases, 10(3), 489-493. https://doi.org/10.3201/eid1003.030571.

B-Virus and Free-Ranging Macaques, Puerto Rico [PDF - 38 KB - 3 pages]
K. Jensen et al.

In Puerto Rico, risk for transmission of B-virus from free-ranging rhesus monkeys to humans has become a serious challenge. An incident with an injured rhesus monkey, seropositive for B-virus, resulted in inappropriate administration of antiviral postexposure prophylaxis. This incident underscores the importance of education about risks associated with interactions between humans and nonhuman primates.

EID Jensen K, Alvarado-Ramy F, González-Martínez J, Kraiselburd E, Rullán J. B-Virus and Free-Ranging Macaques, Puerto Rico. Emerg Infect Dis. 2004;10(3):494-496. https://doi.org/10.3201/eid1003.030257
AMA Jensen K, Alvarado-Ramy F, González-Martínez J, et al. B-Virus and Free-Ranging Macaques, Puerto Rico. Emerging Infectious Diseases. 2004;10(3):494-496. doi:10.3201/eid1003.030257.
APA Jensen, K., Alvarado-Ramy, F., González-Martínez, J., Kraiselburd, E., & Rullán, J. (2004). B-Virus and Free-Ranging Macaques, Puerto Rico. Emerging Infectious Diseases, 10(3), 494-496. https://doi.org/10.3201/eid1003.030257.

Human Metapneumovirus-associated Atypical Pneumonia and SARS [PDF - 303 KB - 4 pages]
P. Chan et al.

Acute pneumonia developed in a previously healthy man during the outbreak of severe acute respiratory syndrome (SARS) in southern China in March 2003. Antibiotic treatment was ineffective, and he died 8 days after illness onset. Human metapneumovirus was isolated from lung tissue. No other pathogen was found. Other etiologic agents should thus be sought in apparent SARS cases when coronavirus infection cannot be confirmed.

EID Chan P, To K, Wu A, Tse GM, Chan K, Lui S, et al. Human Metapneumovirus-associated Atypical Pneumonia and SARS. Emerg Infect Dis. 2004;10(3):497-500. https://doi.org/10.3201/eid1003.030513
AMA Chan P, To K, Wu A, et al. Human Metapneumovirus-associated Atypical Pneumonia and SARS. Emerging Infectious Diseases. 2004;10(3):497-500. doi:10.3201/eid1003.030513.
APA Chan, P., To, K., Wu, A., Tse, G. M., Chan, K., Lui, S....Tomlinson, B. (2004). Human Metapneumovirus-associated Atypical Pneumonia and SARS. Emerging Infectious Diseases, 10(3), 497-500. https://doi.org/10.3201/eid1003.030513.

Q Fever Endocarditis in HIV-Infected Patient [PDF - 208 KB - 4 pages]
M. G. Madariaga et al.

We describe a case of Q fever endocarditis in an HIV-infected patient. The case was treated successfully with valvular replacement and a combination of doxycycline and hydroxychloroquine. We review the current literature on Q fever endocarditis, with an emphasis on the co-infection of HIV and Coxiella burnetii.

EID Madariaga MG, Pulvirenti J, Sekosan M, Paddock CD, Zaki SR. Q Fever Endocarditis in HIV-Infected Patient. Emerg Infect Dis. 2004;10(3):501-504. https://doi.org/10.3201/eid1003.030971
AMA Madariaga MG, Pulvirenti J, Sekosan M, et al. Q Fever Endocarditis in HIV-Infected Patient. Emerging Infectious Diseases. 2004;10(3):501-504. doi:10.3201/eid1003.030971.
APA Madariaga, M. G., Pulvirenti, J., Sekosan, M., Paddock, C. D., & Zaki, S. R. (2004). Q Fever Endocarditis in HIV-Infected Patient. Emerging Infectious Diseases, 10(3), 501-504. https://doi.org/10.3201/eid1003.030971.

Bovine Necrotic Vulvovaginitis Associated with Porphyromonas levii [PDF - 159 KB - 3 pages]
D. Elad et al.

An outbreak of bovine necrotic vulvovaginitis associated with Porphyromonas levii, an emerging animal and human pathogen, affected 32 cows on a dairy farm in the northeast of Israel. Five animals had to be culled. This report appears to be the first that associates P. levii with bovine necrotic vulvovagnitis.

EID Elad D, Friedgut O, Alpert N, Stram Y, Lahav D, Tiomkin D, et al. Bovine Necrotic Vulvovaginitis Associated with Porphyromonas levii. Emerg Infect Dis. 2004;10(3):505-507. https://doi.org/10.3201/eid1003.020592
AMA Elad D, Friedgut O, Alpert N, et al. Bovine Necrotic Vulvovaginitis Associated with Porphyromonas levii. Emerging Infectious Diseases. 2004;10(3):505-507. doi:10.3201/eid1003.020592.
APA Elad, D., Friedgut, O., Alpert, N., Stram, Y., Lahav, D., Tiomkin, D....Bernstein, M. (2004). Bovine Necrotic Vulvovaginitis Associated with Porphyromonas levii. Emerging Infectious Diseases, 10(3), 505-507. https://doi.org/10.3201/eid1003.020592.

Imported Cutaneous Diphtheria, United Kingdom [PDF - 79 KB - 3 pages]
A. de Benoist et al.

Cutaneous diphtheria is endemic in tropical countries but unusual in the United Kingdom. Four cases occurred in the United Kingdom within 2 months in 2002. Because cutaneous diphtheria causes outbreaks of both cutaneous and pharyngeal forms, early diagnosis is essential for implementing control measures; high diphtheria vaccination coverage must also be maintained.

EID de Benoist A, White JM, Efstratiou A, Kelly C, Mann G, Nazareth B, et al. Imported Cutaneous Diphtheria, United Kingdom. Emerg Infect Dis. 2004;10(3):511-513. https://doi.org/10.3201/eid1003.030524
AMA de Benoist A, White JM, Efstratiou A, et al. Imported Cutaneous Diphtheria, United Kingdom. Emerging Infectious Diseases. 2004;10(3):511-513. doi:10.3201/eid1003.030524.
APA de Benoist, A., White, J. M., Efstratiou, A., Kelly, C., Mann, G., Nazareth, B....Crowcroft, N. S. (2004). Imported Cutaneous Diphtheria, United Kingdom. Emerging Infectious Diseases, 10(3), 511-513. https://doi.org/10.3201/eid1003.030524.

Antibiotic Selection Pressure and Resistance in Streptococcus pneumoniae and Streptococcus pyogenes [PDF - 152 KB - 4 pages]
W. C. Albrich et al.

We correlated outpatient antibiotic use with prevalence of penicillin-nonsusceptible Streptococcus pneumoniae (PNSP), macrolide-resistant S. pneumoniae (MRSP), and macrolide-resistant S. pyogenes (MRGAS) in 20 countries. Total antibiotic use was correlated with PNSP (r = 0.75; p < 0.001), as was macrolide use with MRSP (r = 0.88; p < 0.001) and MRGAS (r = 0.71; p = 0.004). Streptococcal resistance is directly associated with antibiotic selection pressure on a national level.

EID Albrich WC, Monnet DL, Harbarth S. Antibiotic Selection Pressure and Resistance in Streptococcus pneumoniae and Streptococcus pyogenes. Emerg Infect Dis. 2004;10(3):514-517. https://doi.org/10.3201/eid1003.030252
AMA Albrich WC, Monnet DL, Harbarth S. Antibiotic Selection Pressure and Resistance in Streptococcus pneumoniae and Streptococcus pyogenes. Emerging Infectious Diseases. 2004;10(3):514-517. doi:10.3201/eid1003.030252.
APA Albrich, W. C., Monnet, D. L., & Harbarth, S. (2004). Antibiotic Selection Pressure and Resistance in Streptococcus pneumoniae and Streptococcus pyogenes. Emerging Infectious Diseases, 10(3), 514-517. https://doi.org/10.3201/eid1003.030252.

Enterotoxin-producing Escherichia coli O169:H41, United States [PDF - 66 KB - 4 pages]
M. E. Beatty et al.

From 1996 to 2003, 16 outbreaks of enterotoxigenic Escherichia coli (ETEC) infections in the United States and on cruise ships were confirmed. E. coli serotype O169:H41 was identified in 10 outbreaks and was the only serotype in 6. This serotype was identified in 1 of 21 confirmed ETEC outbreaks before 1996.

EID Beatty ME, Bopp CA, Wells JG, Greene KD, Puhr ND, Mintz ED. Enterotoxin-producing Escherichia coli O169:H41, United States. Emerg Infect Dis. 2004;10(3):518-521. https://doi.org/10.3201/eid1003.030268
AMA Beatty ME, Bopp CA, Wells JG, et al. Enterotoxin-producing Escherichia coli O169:H41, United States. Emerging Infectious Diseases. 2004;10(3):518-521. doi:10.3201/eid1003.030268.
APA Beatty, M. E., Bopp, C. A., Wells, J. G., Greene, K. D., Puhr, N. D., & Mintz, E. D. (2004). Enterotoxin-producing Escherichia coli O169:H41, United States. Emerging Infectious Diseases, 10(3), 518-521. https://doi.org/10.3201/eid1003.030268.

Adherence Barriers to Antimicrobial Treatment Guidelines in Teaching Hospital, the Netherlands [PDF - 38 KB - 4 pages]
P. G. Mol et al.

To optimize appropriate antimicrobial use in a university hospital and identify barriers hampering implementation strategies, physicians were interviewed regarding their opinions on antimicrobial policies. Results indicated that effective strategies should include regular updates of guidelines that incorporate the views of relevant departments and focus on addressing senior staff and residents because residents do not make independent decisions in a teaching-hospital setting.

EID Mol PG, Rutten WJ, Gans RO, Degener JE, Haaijer-Ruskamp FM. Adherence Barriers to Antimicrobial Treatment Guidelines in Teaching Hospital, the Netherlands. Emerg Infect Dis. 2004;10(3):522-525. https://doi.org/10.3201/eid1003.030292
AMA Mol PG, Rutten WJ, Gans RO, et al. Adherence Barriers to Antimicrobial Treatment Guidelines in Teaching Hospital, the Netherlands. Emerging Infectious Diseases. 2004;10(3):522-525. doi:10.3201/eid1003.030292.
APA Mol, P. G., Rutten, W. J., Gans, R. O., Degener, J. E., & Haaijer-Ruskamp, F. M. (2004). Adherence Barriers to Antimicrobial Treatment Guidelines in Teaching Hospital, the Netherlands. Emerging Infectious Diseases, 10(3), 522-525. https://doi.org/10.3201/eid1003.030292.

Neisseria meningitidis C:2b:P1.2,5 with Intermediate Resistance to Penicillin, Portugal [PDF - 62 KB - 4 pages]
M. Caniça et al.

For 1 year, serogroup, serotype, serosubtype, and penicillin susceptibility of meningococci circulating in various regions in Portugal were evaluated. Most frequent phenotypes were B:4:P1.15 (13.4%) and C:2b:P1.2,5 (75.9%), which are also common in Spain. Overall, 27.5% of C:2b:P1.2,5 strains showed intermediate resistance to penicillin. Laboratory-based surveillance of meningococcal infection in Portugal provides important information to assess the adequacy of public health measures.

EID Caniça M, Dias R, Ferreira E. Neisseria meningitidis C:2b:P1.2,5 with Intermediate Resistance to Penicillin, Portugal. Emerg Infect Dis. 2004;10(3):526-529. https://doi.org/10.3201/eid1003.030357
AMA Caniça M, Dias R, Ferreira E. Neisseria meningitidis C:2b:P1.2,5 with Intermediate Resistance to Penicillin, Portugal. Emerging Infectious Diseases. 2004;10(3):526-529. doi:10.3201/eid1003.030357.
APA Caniça, M., Dias, R., & Ferreira, E. (2004). Neisseria meningitidis C:2b:P1.2,5 with Intermediate Resistance to Penicillin, Portugal. Emerging Infectious Diseases, 10(3), 526-529. https://doi.org/10.3201/eid1003.030357.

Immunofluorescence Assay for Serologic Diagnosis of SARS [PDF - 96 KB - 3 pages]
P. K. Chan et al.

We evaluated a virus-infected cell-based indirect immunofluorescence assay for detecting anti–severe acute respiratory syndrome-associated coronavirus (SARS-CoV) immunoglobulin (Ig) G antibody. All confirmed SARS cases demonstrated seroconversion or fourfold rise in IgG antibody titer; no control was positive. Sensitivity and specificity of this assay were both 100%. Immunofluorescence assay can ascertain the status of SARS-CoV infection.

EID Chan PK, Ng K, Chan RC, Lam RK, Chow VC, Hui M, et al. Immunofluorescence Assay for Serologic Diagnosis of SARS. Emerg Infect Dis. 2004;10(3):530-532. https://doi.org/10.3201/eid1003.030493
AMA Chan PK, Ng K, Chan RC, et al. Immunofluorescence Assay for Serologic Diagnosis of SARS. Emerging Infectious Diseases. 2004;10(3):530-532. doi:10.3201/eid1003.030493.
APA Chan, P. K., Ng, K., Chan, R. C., Lam, R. K., Chow, V. C., Hui, M....Tam, J. S. (2004). Immunofluorescence Assay for Serologic Diagnosis of SARS. Emerging Infectious Diseases, 10(3), 530-532. https://doi.org/10.3201/eid1003.030493.

Tick-borne Encephalitis in Southern Norway [PDF - 32 KB - 2 pages]
P. A. Csángó et al.

The first five cases of human tick-borne encephalitis in Norway were reported from Tromöya, in Aust-Agder County. Serum specimens from 317 dogs in the same geographic area were collected. An enzyme immunoassay demonstrated antibody to human tick-borne encephalitis virus in 52 (16.4%) of the dogs, which supports the notion of an emerging disease.

EID Csángó PA, Blakstad E, Kirtz GC, Pedersen JE, Czettel B. Tick-borne Encephalitis in Southern Norway. Emerg Infect Dis. 2004;10(3):533-534. https://doi.org/10.3201/eid1003.020734
AMA Csángó PA, Blakstad E, Kirtz GC, et al. Tick-borne Encephalitis in Southern Norway. Emerging Infectious Diseases. 2004;10(3):533-534. doi:10.3201/eid1003.020734.
APA Csángó, P. A., Blakstad, E., Kirtz, G. C., Pedersen, J. E., & Czettel, B. (2004). Tick-borne Encephalitis in Southern Norway. Emerging Infectious Diseases, 10(3), 533-534. https://doi.org/10.3201/eid1003.020734.

Endemic Carbapenem-resistant Pseudomonas aeruginosa with Acquired Metallo-β-lactamase Determinants in European Hospital [PDF - 109 KB - 4 pages]
C. Lagatolla et al.

Acquired metallo-β-lactamases (MBLs) can confer broad-spectrum β-lactam resistance (including carbapenems) not reversible by conventional β-lactamase inhibitors and are emerging resistance determinants of remarkable clinical importance. In 2001, multidrug-resistant Pseudomonas aeruginosa carrying blaVIM MBL genes were found to be widespread (approximately 20% of all P. aeruginosa isolates and 70% of the carbapenem-resistant isolates) at Trieste University Hospital. Clonal diversity and heterogeneity of resistance determinants (either blaVIM-1-like or blaVIM-2-like) were detected among MBL producers. This evidence is the first that acquired MBLs can rapidly emerge and establish a condition of endemicity in certain epidemiologic settings.

EID Lagatolla C, Tonin EA, Monti-Bragadin C, Dolzani L, Gombac F, Bearzi C, et al. Endemic Carbapenem-resistant Pseudomonas aeruginosa with Acquired Metallo-β-lactamase Determinants in European Hospital. Emerg Infect Dis. 2004;10(3):535-538. https://doi.org/10.3201/eid1003.020799
AMA Lagatolla C, Tonin EA, Monti-Bragadin C, et al. Endemic Carbapenem-resistant Pseudomonas aeruginosa with Acquired Metallo-β-lactamase Determinants in European Hospital. Emerging Infectious Diseases. 2004;10(3):535-538. doi:10.3201/eid1003.020799.
APA Lagatolla, C., Tonin, E. A., Monti-Bragadin, C., Dolzani, L., Gombac, F., Bearzi, C....Rossolini, G. (2004). Endemic Carbapenem-resistant Pseudomonas aeruginosa with Acquired Metallo-β-lactamase Determinants in European Hospital. Emerging Infectious Diseases, 10(3), 535-538. https://doi.org/10.3201/eid1003.020799.

Mycobacterium bovis Infection, United Kingdom [PDF - 79 KB - 3 pages]
R. Smith et al.

We describe the first documented spillover of bovine tuberculosis from animals into the human population of the United Kingdom since the resurgence of the disease in cattle in the country. This finding suggests that there may be a small risk for transmission to humans, making continued vigilance particularly necessary.

EID Smith R, Drobniewski F, Gibson A, Montague JD, Logan MN, Hunt D, et al. Mycobacterium bovis Infection, United Kingdom. Emerg Infect Dis. 2004;10(3):539-541. https://doi.org/10.3201/eid1003.020819
AMA Smith R, Drobniewski F, Gibson A, et al. Mycobacterium bovis Infection, United Kingdom. Emerging Infectious Diseases. 2004;10(3):539-541. doi:10.3201/eid1003.020819.
APA Smith, R., Drobniewski, F., Gibson, A., Montague, J. D., Logan, M. N., Hunt, D....O’Neill, B. (2004). Mycobacterium bovis Infection, United Kingdom. Emerging Infectious Diseases, 10(3), 539-541. https://doi.org/10.3201/eid1003.020819.
Commentaries

Prairie Dog: Cuddly Pet or Trojan Horse? [PDF - 60 KB - 2 pages]
A. F. Azad
EID Azad AF. Prairie Dog: Cuddly Pet or Trojan Horse?. Emerg Infect Dis. 2004;10(3):542-543. https://doi.org/10.3201/eid1003.040045
AMA Azad AF. Prairie Dog: Cuddly Pet or Trojan Horse?. Emerging Infectious Diseases. 2004;10(3):542-543. doi:10.3201/eid1003.040045.
APA Azad, A. F. (2004). Prairie Dog: Cuddly Pet or Trojan Horse?. Emerging Infectious Diseases, 10(3), 542-543. https://doi.org/10.3201/eid1003.040045.
Letters

Early Defervescence and SARS Recovery [PDF - 23 KB - 2 pages]
J. Wang et al.
EID Wang J, Wang J, Fang C, Chang S. Early Defervescence and SARS Recovery. Emerg Infect Dis. 2004;10(3):544-545. https://doi.org/10.3201/eid1003.030500
AMA Wang J, Wang J, Fang C, et al. Early Defervescence and SARS Recovery. Emerging Infectious Diseases. 2004;10(3):544-545. doi:10.3201/eid1003.030500.
APA Wang, J., Wang, J., Fang, C., & Chang, S. (2004). Early Defervescence and SARS Recovery. Emerging Infectious Diseases, 10(3), 544-545. https://doi.org/10.3201/eid1003.030500.

Babesiosis in Fairfield County, Connecticut [PDF - 26 KB - 2 pages]
J. F. Anderson and L. A. Magnarelli
EID Anderson JF, Magnarelli LA. Babesiosis in Fairfield County, Connecticut. Emerg Infect Dis. 2004;10(3):545-546. https://doi.org/10.3201/eid1003.030561
AMA Anderson JF, Magnarelli LA. Babesiosis in Fairfield County, Connecticut. Emerging Infectious Diseases. 2004;10(3):545-546. doi:10.3201/eid1003.030561.
APA Anderson, J. F., & Magnarelli, L. A. (2004). Babesiosis in Fairfield County, Connecticut. Emerging Infectious Diseases, 10(3), 545-546. https://doi.org/10.3201/eid1003.030561.

Migratory Thrombophlebitis and Acute Q Fever [PDF - 26 KB - 2 pages]
M. L. Guerrero et al.
EID Guerrero ML, Rivas P, Delgado RG. Migratory Thrombophlebitis and Acute Q Fever. Emerg Infect Dis. 2004;10(3):546-547. https://doi.org/10.3201/eid1003.030859
AMA Guerrero ML, Rivas P, Delgado RG. Migratory Thrombophlebitis and Acute Q Fever. Emerging Infectious Diseases. 2004;10(3):546-547. doi:10.3201/eid1003.030859.
APA Guerrero, M. L., Rivas, P., & Delgado, R. G. (2004). Migratory Thrombophlebitis and Acute Q Fever. Emerging Infectious Diseases, 10(3), 546-547. https://doi.org/10.3201/eid1003.030859.

West Nile Poliomyelitis [PDF - 30 KB - 3 pages]
J. J. Sejvar et al.
EID Sejvar JJ, Leis A, Van Gerpen JA, Marfin AA, Petersen LR, Holman RP, et al. West Nile Poliomyelitis. Emerg Infect Dis. 2004;10(3):547-548. https://doi.org/10.3201/eid1003.030593
AMA Sejvar JJ, Leis A, Van Gerpen JA, et al. West Nile Poliomyelitis. Emerging Infectious Diseases. 2004;10(3):547-548. doi:10.3201/eid1003.030593.
APA Sejvar, J. J., Leis, A., Van Gerpen, J. A., Marfin, A. A., Petersen, L. R., Holman, R. P....Rushing, E. J. (2004). West Nile Poliomyelitis. Emerging Infectious Diseases, 10(3), 547-548. https://doi.org/10.3201/eid1003.030593.

Typhus Group Rickettsiae Antibodies in Rural Mexico [PDF - 32 KB - 3 pages]
V. E. Alcantara et al.
EID Alcantara VE, Gallardo EG, Hong C, Walker DH. Typhus Group Rickettsiae Antibodies in Rural Mexico. Emerg Infect Dis. 2004;10(3):549-551. https://doi.org/10.3201/eid1003.030438
AMA Alcantara VE, Gallardo EG, Hong C, et al. Typhus Group Rickettsiae Antibodies in Rural Mexico. Emerging Infectious Diseases. 2004;10(3):549-551. doi:10.3201/eid1003.030438.
APA Alcantara, V. E., Gallardo, E. G., Hong, C., & Walker, D. H. (2004). Typhus Group Rickettsiae Antibodies in Rural Mexico. Emerging Infectious Diseases, 10(3), 549-551. https://doi.org/10.3201/eid1003.030438.

Schistosoma haematobium Infection and Buruli Ulcer [PDF - 27 KB - 2 pages]
J. T. Scott et al.
EID Scott JT, Johnson RC, Aguiar J, Debacker M, Kestens L, Guedenon A, et al. Schistosoma haematobium Infection and Buruli Ulcer. Emerg Infect Dis. 2004;10(3):551-552. https://doi.org/10.3201/eid1003.020514
AMA Scott JT, Johnson RC, Aguiar J, et al. Schistosoma haematobium Infection and Buruli Ulcer. Emerging Infectious Diseases. 2004;10(3):551-552. doi:10.3201/eid1003.020514.
APA Scott, J. T., Johnson, R. C., Aguiar, J., Debacker, M., Kestens, L., Guedenon, A....Portaels, F. (2004). Schistosoma haematobium Infection and Buruli Ulcer. Emerging Infectious Diseases, 10(3), 551-552. https://doi.org/10.3201/eid1003.020514.

1998 Dengue Hemorrhagic Fever Epidemic in Taiwan [PDF - 31 KB - 3 pages]
D. Chao et al.
EID Chao D, Lin T, Hwang K, Huang J, Liu C, King C. 1998 Dengue Hemorrhagic Fever Epidemic in Taiwan. Emerg Infect Dis. 2004;10(3):552-554. https://doi.org/10.3201/eid1003.020518
AMA Chao D, Lin T, Hwang K, et al. 1998 Dengue Hemorrhagic Fever Epidemic in Taiwan. Emerging Infectious Diseases. 2004;10(3):552-554. doi:10.3201/eid1003.020518.
APA Chao, D., Lin, T., Hwang, K., Huang, J., Liu, C., & King, C. (2004). 1998 Dengue Hemorrhagic Fever Epidemic in Taiwan. Emerging Infectious Diseases, 10(3), 552-554. https://doi.org/10.3201/eid1003.020518.

Rift Valley Fever Encephalitis [PDF - 52 KB - 2 pages]
A. A. Alrajhi et al.
EID Alrajhi AA, Al-Semari A, Al-Watban J. Rift Valley Fever Encephalitis. Emerg Infect Dis. 2004;10(3):554-555. https://doi.org/10.3201/eid1003.020817
AMA Alrajhi AA, Al-Semari A, Al-Watban J. Rift Valley Fever Encephalitis. Emerging Infectious Diseases. 2004;10(3):554-555. doi:10.3201/eid1003.020817.
APA Alrajhi, A. A., Al-Semari, A., & Al-Watban, J. (2004). Rift Valley Fever Encephalitis. Emerging Infectious Diseases, 10(3), 554-555. https://doi.org/10.3201/eid1003.020817.
Books and Media

Lyme Borreliosis–Biology, Epidemiology and Control [PDF - 26 KB - 1 page]
I. Schwartz
EID Schwartz I. Lyme Borreliosis–Biology, Epidemiology and Control. Emerg Infect Dis. 2004;10(3):556. https://doi.org/10.3201/eid1003.030686
AMA Schwartz I. Lyme Borreliosis–Biology, Epidemiology and Control. Emerging Infectious Diseases. 2004;10(3):556. doi:10.3201/eid1003.030686.
APA Schwartz, I. (2004). Lyme Borreliosis–Biology, Epidemiology and Control. Emerging Infectious Diseases, 10(3), 556. https://doi.org/10.3201/eid1003.030686.
About the Cover

Georgia O’Keeffe (1887–1986). Cow’s Skull with Calico Roses (1932) [PDF - 173 KB - 2 pages]
P. Potter
EID Potter P. Georgia O’Keeffe (1887–1986). Cow’s Skull with Calico Roses (1932). Emerg Infect Dis. 2004;10(3):558-559. https://doi.org/10.3201/eid1003.ac1003
AMA Potter P. Georgia O’Keeffe (1887–1986). Cow’s Skull with Calico Roses (1932). Emerging Infectious Diseases. 2004;10(3):558-559. doi:10.3201/eid1003.ac1003.
APA Potter, P. (2004). Georgia O’Keeffe (1887–1986). Cow’s Skull with Calico Roses (1932). Emerging Infectious Diseases, 10(3), 558-559. https://doi.org/10.3201/eid1003.ac1003.
Page created: April 23, 2012
Page updated: April 23, 2012
Page reviewed: April 23, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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