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Volume 11, Number 3—March 2005
Volume 11, Number 3—March 2005 PDF Version [PDF - 9.69 MB - 163 pages]
Disease Risks from Foods, England and Wales, 1996–2000
PDF Version [PDF - 146 KB - 8 pages]
G. K. Adak et al.
Rapid Identification of Emerging Pathogens: Coronavirus
PDF Version [PDF - 333 KB - 7 pages]
R. Sampath et al.View SummaryView Abstract
New surveillance approach can analyze >900 polymerase chain reactions per day.
We describe a new approach for infectious disease surveillance that facilitates rapid identification of known and emerging pathogens. The process uses broad-range polymerase chain reaction (PCR) to amplify nucleic acid targets from large groupings of organisms, electrospray ionization mass spectrometry for accurate mass measurements of PCR products, and base composition signature analysis to identify organisms in a sample. We demonstrate this principle by using 14 isolates of 9 diverse Coronavirus spp., including the severe acute respiratory syndrome–associated coronavirus (SARS-CoV). We show that this method could identify and distinguish between SARS and other known CoV, including the human CoV 229E and OC43, individually and in a mixture of all 3 human viruses. The sensitivity of detection, measured by using titered SARS-CoV spiked into human serum, was ≈1 PFU/mL. This approach, applicable to the surveillance of bacterial, viral, fungal, or protozoal pathogens, is capable of automated analysis of >900 PCR reactions per day.
Antimicrobial Drug Prescribing for Pneumonia in Ambulatory Care
PDF Version [PDF - 115 KB - 5 pages]
C. MacDougall et al.View SummaryView Abstract
Higher levels of fluoroquinolone use were associated with increasing age and later study year.
To determine patterns and predictors of antimicrobial drug use for outpatients with community-acquired pneumonia, we examined office visit and pharmacy claims data of 4 large third-party payer organizations from 2000 to 2002. After patients with coexisting conditions were excluded, 4,538 patients were studied. Despite lack of coexisting conditions, fluoroquinolone use was commonly observed and increased significantly (p < 0.001) from 2000 to 2002 (24%–39%), while macrolide use decreased (55%–44%). Increased age correlated with increased fluoroquinolone use: 18–44 years (22%), 45–64 years (33%), and >65 years (40%) (p < 0.001). Increased use of fluoroquinolones occurred in healthy young and old patients alike, which suggests a lack of selectivity in reserving fluoroquinolones for higher risk patients. Clear and consistent guidelines are needed to address the role of fluoroquinolones in treatment of outpatient community-acquired pneumonia.
Ebola Virus Antibody Prevalence in Dogs and Human Risk
PDF Version [PDF - 199 KB - 6 pages]
L. Allela et al.View SummaryView Abstract
This first report suggests that dogs can be asymptomatically infected with Ebola virus.
During the 2001–2002 outbreak in Gabon, we observed that several dogs were highly exposed to Ebola virus by eating infected dead animals. To examine whether these animals became infected with Ebola virus, we sampled 439 dogs and screened them by Ebola virus–specific immunoglobulin (Ig) G assay, antigen detection, and viral polymerase chain reaction amplification. Seven (8.9%) of 79 samples from the 2 main towns, 15 (15.2%) of 14 the 99 samples from Mekambo, and 40 (25.2%) of 159 samples from villages in the Ebola virus–epidemic area had detectable Ebola virus–IgG, compared to only 2 (2%) of 102 samples from France. Among dogs from villages with both infected animal carcasses and human cases, seroprevalence was 31.8%. A significant positive direct association existed between seroprevalence and the distances to the Ebola virus–epidemic area. This study suggests that dogs can be infected by Ebola virus and that the putative infection is asymptomatic.
Probable Psittacosis Outbreak Linked to Wild Birds
PDF Version [PDF - 114 KB - 7 pages]
B. L. Telfer et al.View SummaryView Abstract
Residence in the upper Blue Mountains, age of 50–64 years, direct contact with wild birds, and lawn mowing without a grass catcher were associated with psittacosis.
In autumn 2002, an outbreak of probable psittacosis occurred among residents of the Blue Mountains district, Australia. We conducted a case-control study to determine independent risk factors for psittacosis by comparing exposures between hospitalized patients and other residents selected randomly from the telephone directory. Of the 59 case-patients with laboratory results supportive of psittacosis, 48 participated in a case-control study with 310 controls. Independent risk factors were residence in the upper Blue Mountains (odds ratio [OR] = 15.2, 95% confidence interval [CI] 5.6–41.7), age of 50–64 years (OR = 3.9, 95% CI 1.5–10.5), direct contact with wild birds (OR = 7.4, 95% CI 2.5–22), and mowing lawns without a grass catcher (OR = 3.2, 95% CI 1.3–8.0). Protective equipment is recommended for residents in areas frequented by free-ranging birds if contact with birds and their droppings is likely when performing outdoor activities such as lawn mowing.
Effect of Regulation and Education on Reptile-associated Salmonellosis
PDF Version [PDF - 230 KB - 6 pages]
B. de Jong et al.View SummaryView Abstract
Import restrictions and public awareness campaigns are effective against this common childhood infection.
Reptiles have become increasingly common as domestic pets, and with them reptile-associated Salmonella infections in humans. From 1990 to 2000, a total of 339 reptile-associated Salmonella cases were reported in Sweden. In 1996, as part of its efforts to adapt its import regulations to those of the European Union, Sweden no longer required certificates stating that imported animals were free of Salmonella. A subsequent increase was noted in the incidence of reptile-associated cases from 0.15/100,000 in the period 1990–1994 to 0.79/100,000 in 1996 and 1997. After a public education campaign directed toward the general public was begun through the news media, the incidence dropped to 0.46/100,000. Children were the most affected age group among patients (incidence 1.3/100,000). Salmonella enterica serotype Enteritidis was the most frequent serotype (24% of isolates), followed by S. Typhimurium (9% of isolates). Import restrictions and public information campaigns are effective public health measures against reptile-associated salmonellosis.
SARS Risk Perceptions in Healthcare Workers, Japan
PDF Version [PDF - 134 KB - 7 pages]
T. Imai et al.View Abstract
In coping with severe acute respiratory syndrome (SARS), infection control measures are a key aspect of protecting healthcare workers. We conducted a survey concerning perception of risk and countermeasures for SARS in 7 tertiary hospitals in Japan from July through September 2003, immediately after the SARS epidemic in neighboring countries. Based on 7,282 respondents out of 9,978 questionnaires administered, we found the perception of risk to be relatively high and the perception of countermeasures at the institutional level to be relatively low. Knowledge of preventive measures, concept of (opinions regarding) institutional measures, and perception of risk differed substantially among the 3 job categories, notably between physicians and nurses. The concept of institutional measures was the most important predictor of individual perception of risk. In view of the potential for future epidemics, planning and implementing institutional measures should be given a high priority.
Longitudinally Profiling Neutralizing Antibody Response to SARS Coronavirus with Pseudotypes
PDF Version [PDF - 203 KB - 6 pages]
N. J. Temperton et al.View SummaryView Abstract
SARS-CoV spike protein pseudotypes are the basis of an in vitro microneutralization assay sensitive and specific for SARS-CoV neutralizing antibodies.
The severe acute respiratory syndrome–associated coronavirus (SARS-CoV) spike protein (S) is a major target for neutralizing antibodies. Retroviral SARS-CoV S pseudotypes have been constructed and used to develop an in vitro microneutralization assay that is both sensitive and specific for SARS-CoV neutralizing antibodies. Neutralization titers measured by this assay are highly correlated to those measured by an assay using replication-competent SARS-CoV. No cross-neutralization occurred with human sera known to contain antibodies to coronavirus strains OC43 and 229E. The pseudotype assay was used to profile neutralizing antibody responses against SARS-CoV S in sequential serum samples taken from 41 confirmed SARS patients during the 2003 outbreak in Hong Kong and shows long-lasting immunity in most recovered patients. The pseudotype assay does not require handling live SARS virus; it is a useful tool to determine neutralizing titers during natural infection and the preclinical evaluation of candidate vaccines.
SARS-related Perceptions in Hong Kong
PDF Version [PDF - 168 KB - 8 pages]
J. Lau et al.View Abstract
To understand different aspects of community responses related to severe acute respiratory syndrome (SARS), 2 population-based, random telephone surveys were conducted in June 2003 and January 2004 in Hong Kong. More than 70% of respondents would avoid visiting hospitals or mainland China to avoid contracting SARS. Most respondents believed that SARS could be transmitted through droplets, fomites, sewage, and animals. More than 90% believed that public health measures were efficacious means of prevention; 40.4% believed that SARS would resurge in Hong Kong; and ≈70% would then wear masks in public places. High percentages of respondents felt helpless, horrified, and apprehensive because of SARS. Approximately 16% showed signs of posttraumatic symptoms, and ≈40% perceived increased stress in family or work settings. The general public in Hong Kong has been very vigilant about SARS but needs to be more psychologically prepared to face a resurgence of the epidemic.
West Nile Virus Risk Assessment and the Bridge Vector Paradigm
PDF Version [PDF - 194 KB - 5 pages]
A. Kilpatrick et al.View Abstract
In the northeast United States, control of West Nile virus (WNV) vectors has been unfocused because of a lack of accurate knowledge about the roles different mosquitoes play in WNV transmission. We analyzed the risk posed by 10 species of mosquitoes for transmitting WNV to humans by using a novel risk-assessment measure that combines information on the abundance, infection prevalence, vector competence, and biting behavior of vectors. This analysis suggests that 2 species (Culex pipiens L. and Cx. restuans Theobald [Diptera: Cilicidae]) not previously considered important in transmitting WNV to humans may be responsible for up to 80% of human WNV infections in this region. This finding suggests that control efforts should be focused on these species which may reduce effects on nontarget wetland organisms. Our risk measure has broad applicability to other regions and diseases and can be adapted for use as a predictive tool of future human WNV infections.
Methicillin-resistant Staphylococcus aureus in Horses and Horse Personnel, 2000–2002
PDF Version [PDF - 191 KB - 6 pages]
J. Weese et al.View SummaryView Abstract
Methicillin-resistant Staphylococcus aureus was isolated from horses and horse personnel in a pattern suggestive of interspecies transmission of a human-origin clone.
Methicillin-resistant Staphylococcus aureus (MRSA) infection was identified in 2 horses treated at a veterinary hospital in 2000, prompting a study of colonization rates of horses and associated persons. Seventy-nine horses and 27 persons colonized or infected with MRSA were identified from October 2000 to November 2002; most isolations occurred in a 3-month period in 2002. Twenty-seven (34%) of the equine isolates were from the veterinary hospital, while 41 (51%) were from 1 thoroughbred farm in Ontario. Seventeen (63%) of 27 human isolates were from the veterinary hospital, and 8 (30%) were from the thoroughbred farm. Thirteen (16%) horses and 1 (4%) person were clinically infected. Ninety-six percent of equine and 93% of human isolates were subtypes of Canadian epidemic MRSA-5, spa type 7 and possessed SCCmecIV. All tested isolates from clinical infections were negative for the Panton-Valentine leukocidin genes. Equine MRSA infection may be an important emerging zoonotic and veterinary disease.
Malaria Risk in Travelers
PDF Version [PDF - 123 KB - 6 pages]
H. Askling et al.View SummaryView Abstract
Malaria risk around the world was assessed by using Swedish surveillance data from 1997 to 2003 with an extensive travel database as denominator.
Imported malaria has been an increasing problem in several Western countries in the last 2 decades. To calculate the risk factors of age, sex, and travel destination in Swedish travelers, we used data from the routine reporting system for malaria (mixture of patients with and without adequate prophylaxis), a database on travel patterns, and in-flight or visa data on Swedish travelers of 1997 to 2003. The crude risk for travelers varied from 1 per 100,000 travelers to Central America and the Caribbean to 357 per 100,000 in central Africa. Travelers to East Africa had the highest adjusted odds ratio (OR = 341; 95% confidence intervals [CI] 134–886) for being reported with malaria, closely followed by travelers to central Africa and West Africa. Male travelers as well as children <1–6 years of age had a higher risk of being reported with malaria (OR = 1,7; 95% CI 1.3–2.3 and OR = 4,8; 95%CI 1.5–14.8) than women and other age groups.
Notifiable Disease Surveillance and Practicing Physicians
PDF Version [PDF - 62 KB - 4 pages]
G. Krause et al.View SummaryView Abstract
Surveillance data should be delivered to physicians through occasional nonelectronic reports on current issues of local public health importance.
Primary care physicians in Germany are essential participants in infectious disease surveillance through mandatory reporting. Feedback on such surveillance should reflect the needs and attitudes of these physicians. These issues were investigated in a questionnaire survey among 8,550 randomly sampled physicians in Germany in 2001. Of the 1,320 respondents, 59.3% claimed not to have received any feedback on infectious disease surveillance, and 3.7% perceived feedback as not important. Logistic regression analysis showed that physicians in the former East Germany were 2.2 times more likely to have received feedback than those in the former West Germany. Physicians preferred to receive occasional reports (e.g., in case of outbreaks, 31.6%) as opposed to actively having to search for constantly updated information on the Internet (7.8%). The preferred formats were fax (31.7%), mail (30.9%), and the official organ of the German Medical Association (Deutsches Arzteblatt) (30.5%). Feedback of surveillance data to physicians should be delivered through occasional nonelectronic reports on current issues of local public health importance.
SARS-associated Coronavirus Transmitted from Human to Pig
PDF Version [PDF - 168 KB - 3 pages]
W. Chen et al.View AbstractSevere acute respiratory syndrome–associated
coronavirus (SARS-CoV) was isolated from a pig during a survey for possible routes of viral transmission after a SARS epidemic. Sequence and epidemiology analyses suggested that the pig was infected by a SARS-CoV of human origin.
Mimivirus in Pneumonia Patients
PDF Version [PDF - 248 KB - 4 pages]
B. La Scola et al.View Abstract
Mimivirus, the largest virus known to date, is an amebal pathogen like Legionella spp. When mimivirus was used as an antigen in a migration inhibition factor assay, seroconversion was found in patients with both community- and hospital-acquired pneumonia. Mimivirus DNA was found in respiratory samples of patients with hospital-acquired pneumonia.
Methicillin-resistant Staphylococcus aureus in Neonatal Intensive Care Unit
PDF Version [PDF - 218 KB - 4 pages]
G. Regev-Yochay et al.View Abstract
A neonatal intensive care unit outbreak was caused by a strain of methicillin-resistant Staphylococcus aureus previously found in the community (ST45-MRSA-IV). Fifteen infected neonates were identified, 2 of whom died. This outbreak illustrates how a rare community pathogen can rapidly spread through nosocomial transmission.
Inquilinus limosus in Patients with Cystic Fibrosis, Germany
PDF Version [PDF - 61 KB - 3 pages]
N. Wellinghausen et al.View Abstract
We identified Inquilinus limosus, a recently described α-proteobacterium, in sputum of 2 patients with cystic fibrosis whose respiratory tracts were persistently colonized for >9 months. We present data on the epidemiology, antimicrobial susceptibility, and molecular characteristics of I. limosus.
Fever Screening at Airports and Imported Dengue
PDF Version [PDF - 57 KB - 3 pages]
P. Shu et al.View Abstract
Airport fever screening in Taiwan, July 2003–June 2004, identified 40 confirmed dengue cases. Results obtained by capture immunoglobulin (Ig) M and IgG enzyme-linked immunoassay, real time 1-step polymerase chain reaction, and virus isolation showed that 33 (82.5%) of 40 patients were viremic. Airport fever screening can thus quickly identify imported dengue cases.
Rumor Surveillance and Avian Influenza H5N1
PDF Version [PDF - 176 KB - 4 pages]
G. Samaan et al.View Abstract
We describe the enhanced rumor surveillance during the avian influenza H5N1 outbreak in 2004. The World Health Organization’s Western Pacific Regional Office identified 40 rumors; 9 were verified to be true. Rumor surveillance informed immediate public health action and prevented unnecessary and costly responses.
Human Metapneumovirus RNA in Encephalitis Patient
PDF Version [PDF - 230 KB - 4 pages]
O. Schildgen et al.View Abstract
We describe a fatal case of encephalitis that might be correlated with primary human metapneumovirus (HMPV) encephalitis. Postmortem HMPV RNA was detected in brain and lung tissue samples from the patient. Furthermore, HMPV RNA was found in culture fluids from cells coincubated with lung tissue.
Japanese Encephalitis Virus in Meningitis Patients, Japan
PDF Version [PDF - 112 KB - 3 pages]
M. Kuwayama et al.View Abstract
Cerebrospinal fluid specimens from 57 patients diagnosed with meningitis were tested for Japanese encephalitis virus. Total RNA was extracted from the specimens and amplified. Two products had highest homology with Nakayama strain and 2 with Ishikawa strain. Results suggest that Japanese encephalitis virus causes some aseptic meningitis in Japan.
Identifying Relapsing Fever Borrelia, Senegal
PDF Version [PDF - 42 KB - 2 pages]
H. Brahim et al.View Abstract
We describe a nested polymerase chain reaction for the identification of Borrelia species from serum of patients with unidentified fevers. This technique, based on single nucleotide polymorphisms of the 16S ribosomal RNA gene, was used to test blood samples from 7,750 patients, 33 of whom were diagnosed with spirochete infections. Borrelia crocidurae was the only species identified.
Babesia microti, Upstate New York
PDF Version [PDF - 68 KB - 3 pages]
S. J. Kogut et al.View Abstract
Five cases of human babesiosis were reported in the Lower Hudson Valley Region of New York State in 2001. An investigation to determine if Babesia microti was present in local Ixodes scapularis ticks yielded 5 positive pools in 123 pools tested, the first detection of B. microti from field-collected I. scapularis in upstate New York.
Pythiosis in Africa
PDF Version [PDF - 192 KB - 3 pages]
C. Rivierre et al.View Abstract
We report the first case of pythiosis from Africa in an 8-month-old dog with a chronic and ulcerative cutaneous lesion. The etiologic agent belonged to the genus Pythium. Phylogenetic analysis placed the isolate in a sister group to the other P. insidiosum strains. However, the isolate may belong to a new Pythium species.
Hepatitis E Infections, Victoria, Australia
PDF Version [PDF - 73 KB - 3 pages]
B. C. Cowie et al.View Abstract
In the first half of 2004, acute hepatitis E virus infections diagnosed in Victoria, Australia, increased 7-fold. Of the interviewed patients with highly reactive serologic results, 90% reported recent clinically compatible illness and overseas travel. The increase is compared with a background of exposure in countries in which hepatitis E is endemic.
Concomitant Tickborne Encephalitis and Human Granulocytic Ehrlichiosis
PDF Version [PDF - 145 KB - 4 pages]
S. Lotric-Furlan et al.View Abstract
We report a patient with febrile illness and epidemiologic and clinical findings consistent with human granulocytic ehrlichiosis and tickborne encephalitis, in whom infection with Anaplasma phagocytophilum was demonstrated by polymerase chain reaction and seroconversion. Tickborne encephalitis virus infection was established by serum immunoglobulin (Ig) M and IgG antibodies.
Noroviruses in Archival Samples
PDF Version [PDF - 85 KB - 3 pages]
S. Skraber et al.View Abstract
Application of recent techniques to detect current pathogens in archival effluent samples collected and concentrated in 1987 lead to the characterization of norovirus GGII.6 Seacroft, unrecognized until 1990 in a clinical sample. Retrospective studies will likely increase our knowledge about waterborne transmission of emerging pathogens.
Pertussis in Soldiers, Israel
PDF Version [PDF - 42 KB - 3 pages]
E. Klement et al.
Emerging Infectious Diseases: 10 Years Running
PDF Version [PDF - 18 KB - 2 pages]
J. E. McDade et al.
Malaria and Travel to the Dominican Republic
PDF Version [PDF - 24 KB - 2 pages]
J. L. Haro-González et al.
Buruli Ulcer Distribution in Benin
PDF Version [PDF - 28 KB - 2 pages]
R. Johnson et al.
Mycobacterium tuberculosis Drug Resistance, Abkhazia
PDF Version [PDF - 61 KB - 3 pages]
M. Pardini et al.
Endogeneity in Logistic Regression Models
PDF Version [PDF - 69 KB - 3 pages]
Rectal Lymphogranuloma Venereum, France
PDF Version [PDF - 48 KB - 2 pages]
M. Herida et al.
Food Safety for First Responders
PDF Version [PDF - 28 KB - 2 pages]
M. K. Afton et al.
Rickettsiae in Ixodid Ticks, Sicily
PDF Version [PDF - 153 KB - 3 pages]
T. Beninati et al.
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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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- Page created: April 25, 2012
- Page last updated: April 25, 2012
- Page last reviewed: April 25, 2012
- Centers for Disease Control and Prevention,
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