Volume 12, Number 10—October 2006
Volume 12, Number 10—October 2006 PDF Version [PDF - 5.66 MB - 159 pages]
Malaria Epidemics and Interventions, Kenya, Burundi, Southern Sudan, and Ethiopia, 1999–2004
PDF Version [PDF - 346 KB - 9 pages]
F. Checchi et al.View SummaryView Abstract
Effectiveness was reduced by delays and other factors.
Quantitative data on the onset and evolution of malaria epidemics are scarce. We review case studies from recent African Plasmodium falciparum epidemics (Kisii and Gucha Districts, Kenya, 1999; Kayanza Province, Burundi, 2000–2001; Aweil East, southern Sudan, 2003; Gutten and Damot Gale, Ethiopia, 2003–2004). We highlight possible epidemic risk factors and review delays in epidemic detection and response (up to 20 weeks), essentially due to poor case reporting and analysis or low use of public facilities. Epidemics lasted 15–36 weeks, and patients' age profiles suggested departures from classical notions of epidemic malaria everywhere but Burundi. Although emergency interventions were mounted to expand inpatient and outpatient treatment access, we believe their effects were lessened because of delays, insufficient evaluation of disease burden, lack of evidence on how to increase treatment coverage in emergencies, and use of ineffective drugs.
Birds and Influenza H5N1 Virus Movement to and within North America
PDF Version [PDF - 171 KB - 7 pages]
J. H. Rappole and Z. HubálekView SummaryView Abstract
TOC Summary: Migratory birds are unlikely introductory hosts for this highly pathogenic virus in its present form into North America.
Highly pathogenic avian influenza (HPAI) H5N1 expanded considerably during 2005 and early 2006 in both avian host species and geographic distribution. Domestic waterfowl and migratory birds are reservoirs, but lethality of this subtype appeared to initially limit migrant effectiveness as introductory hosts. This situation may have changed, as HPAI H5N1 has recently expanded across Eurasia and into Europe and Africa. Birds could introduce HPAI H5N1 to the Western Hemisphere through migration, vagrancy, and importation by people. Vagrants and migratory birds are not likely interhemispheric introductory hosts; import of infected domestic or pet birds is more probable. If reassortment or mutation were to produce a virus adapted for rapid transmission among humans, birds would be unlikely introductory hosts because of differences in viral transmission mechanisms among major host groups (i.e., gastrointestinal for birds, respiratory for humans). Another possible result of reassortment would be a less lethal form of avian influenza, more readily spread by birds.
Novel Chikungunya Virus Variant in Travelers Returning from Indian Ocean Islands
PDF Version [PDF - 363 KB - 7 pages]
P. Parola et al.View SummaryView Abstract
Aedes albopictus may cause epidemics when infected persons travel to areas where vectors are prevalent.
Chikungunya virus (CHIKV) emerged in Indian Ocean islands in 2005 and is causing an ongoing outbreak that involves >260,000 patients, including travelers returning home from these islands. We investigated cases in 4 patients returning from Mayotte and Reunion Islands with CHIKV infection and a nurse infected in metropolitan France after direct contact with the blood of a traveler. Four patients had tenosynovitis and pain at wrist pressure, and 1 had life-threatening manifestations. Four CHIKV strains were isolated, including 1 from the patient with the autochthonous case. The complete genomic sequence identified a new CHIKV variant emerging from the East/central African evolutionary lineage. Aedes albopictus, the implicated vector of CHIKV in Indian Ocean islands, has dispersed worldwide in recent decades. High viral loads in patients returning from Indian Ocean islands to countries where Ae. albopictus is prevalent may be a source of epidemics.
Campylobacter jejuni Multilocus Sequence Types in Humans, Northwest England, 2003–2004
PDF Version [PDF - 284 KB - 8 pages]
W. Sopwith et al.View SummaryView Abstract
MLST can be used to describe and analyze the epidemiology of campylobacteriosis in distinct human populations.
Detailed understanding of the epidemiology of Campylobacter is increasingly facilitated through use of universal and reproducible techniques for accurate strain differentiation and subtyping. Multilocus sequence typing (MLST) enables discriminatory subtyping and grouping of isolate types into genetically related clonal complexes; it also has the advantage of ease of application and repeatability. Recent studies suggest that a measure of host association may be distinguishable with this system. We describe the first continuous population-based survey to investigate the potential of MLST to resolve questions of campylobacteriosis epidemiology. We demonstrate the ability of MLST to identify variations in the epidemiology of campylobacteriosis between distinct populations and describe the distribution of key subtypes of interest.
Active Surveillance of Candidemia, Australia
PDF Version [PDF - 324 KB - 9 pages]
S. Chen et al.View SummaryView Abstract
This infection has a high death rate and is predominantly associated with healthcare.
Population-based surveillance for candidemia in Australia from 2001 to 2004 identified 1,095 cases. Annual overall and hospital-specific incidences were 1.81/100,000 and 0.21/1,000 separations (completed admissions), respectively. Predisposing factors included malignancy (32.1%), indwelling vascular catheters (72.6%), use of antimicrobial agents (77%), and surgery (37.1%). Of 919 episodes, 81.5% were inpatient healthcare associated (IHCA), 11.6% were outpatient healthcare associated (OHCA), and 6.9% were community acquired (CA). Concomitant illnesses and risk factors were similar in IHCA and OHCA candidemia. IHCA candidemia was associated with sepsis at diagnosis (p<0.001), death <30 days after infection (p<0.001), and prolonged hospital admission (p<0.001). Non–Candida albicans species (52.7%) caused 60.5% of cases acquired outside hospitals and 49.9% of IHCA candidemia (p = 0.02). The 30-day death rate was 27.7% in those >65 years of age. Adult critical care stay, sepsis syndrome, and corticosteroid therapy were associated with the greatest risk for death. Systematic epidemiologic studies that use standardized definitions for IHCA, OHCA, and CA candidemia are indicated.
Active Cytomegalovirus Infection in Patients with Septic Shock
PDF Version [PDF - 231 KB - 6 pages]
L. von Müller et al.View SummaryView Abstract
Cytomegalovirus reactivation occurred in one third of patients and was associated with prolonged ventilation and stay in an intensive care unit.
Cytomegalovirus (CMV) is a pathogen of emerging importance for patients with septic shock. In this prospective study, 25 immunocompetent CMV-seropositive patients with septic shock and an intensive care unit stay of >7 days were monitored by using quantitative pp65-antigenemia assay, shell vial culture, and virus isolation. Within 2 weeks, active CMV infection with low-level pp65-antigenemia (median 3 positive/5 × 105 leukocytes) developed in 8 (32%) patients. Infection was controlled within a few weeks (median 26 days) without use of antiviral therapy. Duration of intensive care and mechanical ventilation were significantly prolonged in patients with active CMV infection. CMV reactivation was associated with concomitant herpes simplex virus reactivation (p = 0.004). The association between active CMV infection and increased illness could open new therapeutic options for patients with septic shock. Future interventional studies are required.
Antimicrobial Drugs in the Home, United Kingdom
PDF Version [PDF - 110 KB - 4 pages]
C. A. McNulty et al.View SummaryView Abstract
Persons more knowledgeable about these drugs are more likely to keep them.
A total of 6% of 6,983 households in the United Kingdom had leftover antimicrobial drugs, and 4% had standby antimicrobial drugs. Respondents with leftover drugs were more educated, more knowledgeable about antimicrobial drugs, younger, and female. Of respondents with leftover drugs, 44% kept them in case of future need, and 18% had taken these drugs without medical advice.
Human Prion Disease and Relative Risk Associated with Chronic Wasting Disease
PDF Version [PDF - 279 KB - 9 pages]
W. J. Pape et al.View SummaryView Abstract
Colorado death certificate data from 1979 through 2001 show that the risk for Creutzfeldt-Jakob disease did not increase for residents of counties where chronic wasting disease is endemic among deer and elk.
The transmission of the prion disease bovine spongiform encephalopathy (BSE) to humans raises concern about chronic wasting disease (CWD), a prion disease of deer and elk. In 7 Colorado counties with high CWD prevalence, 75% of state hunting licenses are issued locally, which suggests that residents consume most regionally harvested game. We used Colorado death certificate data from 1979 through 2001 to evaluate rates of death from the human prion disease Creutzfeldt-Jakob disease (CJD). The relative risk (RR) of CJD for CWD-endemic county residents was not significantly increased (RR 0.81, 95% confidence interval [CI] 0.40–1.63), and the rate of CJD did not increase over time (5-year RR 0.92, 95% CI 0.73–1.16). In Colorado, human prion disease resulting from CWD exposure is rare or nonexistent. However, given uncertainties about the incubation period, exposure, and clinical presentation, the possibility that the CWD agent might cause human disease cannot be eliminated.
Human Rotavirus G9 and G3 as Major Cause of Diarrhea in Hospitalized Children, Spain
PDF Version [PDF - 200 KB - 6 pages]
A. Sánchez-Fauquier et al.View SummaryView Abstract
A major shift in the predominant strains of rotavirus was detected.
In Spain, diarrhea remains a major cause of illness among infants and young children. To determine the prevalence of rotavirus genotypes and temporal and geographic differences in strain distribution, a structured surveillance study of hospitalized children <5 years of age with diarrhea was initiated in different regions of Spain during 2005. Rotavirus was detected alone in samples from 362 (55.2%) samples and as a coinfection with other viruses in 41 samples (6.3%). Enteropathogenic bacterial agents were detected in 4.9% of samples; astrovirus and norovirus RNA was detected in 3.2% and 12.0% samples, respectively; and adenovirus antigen was detected in 1.8% samples. Including mixed infections, the most predominant G type was G9 (50.6%), followed by G3 (33.0%) and G1 (20.2%). Infection with multiple rotavirus strains was detected in >11.4% of the samples studied during 2005.
Low Frequency of Poultry-to-Human H5N1 Transmission, Southern Cambodia, 2005
PDF Version [PDF - 109 KB - 6 pages]
S. Vong et al.View SummaryView Abstract
Transmission is low despite extensive human contact with poultry.
To understand transmission of avian influenza A (H5N1) virus, we conducted a retrospective survey of poultry deaths and a seroepidemiologic investigation in a Cambodian village where a 28-year-old man was infected with H5N1 virus in March 2005. Poultry surveys were conducted within a 1-km radius of the patient's household. Forty-two household flocks were considered likely to have been infected from January through March 2005 because >60% of the flock died, case-fatality ratio was 100%, and both young and mature birds died within 1 to 2 days. Two sick chickens from a property adjacent to the patient's house tested positive for H5N1 on reverse transcription–PCR. Villagers were asked about poultry exposures in the past year and tested for H5N1 antibodies. Despite frequent, direct contact with poultry suspected of having H5N1 virus infection, none of 351 participants from 93 households had neutralizing antibodies to H5N1. H5N1 virus transmission from poultry to humans remains low in this setting.
Health Benefits, Risks, and Cost-Effectiveness of Influenza Vaccination of Children
PDF Version [PDF - 461 KB - 11 pages]
L. A. Prosser et al.View SummaryView Abstract
Vaccinating children aged 6–23 months, plus all other children at high-risk, will likely be more effective than vaccinating all children against influenza.
We estimated cost-effectiveness of annually vaccinating children not at high risk with inactivated influenza vaccine (IIV) to range from US $12,000 per quality-adjusted life year (QALY) saved for children ages 6–23 months to $119,000 per QALY saved for children ages 12–17 years. For children at high risk (preexisting medical conditions) ages 6–35 months, vaccination with IIV was cost saving. For children at high risk ages 3–17 years, vaccination cost $1,000–$10,000 per QALY. Among children not at high risk ages 5–17 years, live, attenuated influenza vaccine had a similar cost-effectiveness as IIV. Risk status was more important than age in determining the economic effects of annual vaccination, and vaccination was less cost-effective as the child's age increased. Thus, routine vaccination of all children is likely less cost-effective than vaccination of all children ages 6–23 months plus all other children at high risk.
West Nile Virus Isolation from Equines in Argentina, 2006
PDF Version [PDF - 92 KB - 3 pages]
M. A. Morales et al.View Abstract
West Nile virus (WNV) was isolated from the brains of 3 horses that died from encephalitis in February 2006. The horses were from different farms in central Argentina and had not traveled outside the country. This is the first isolation of WNV in South America.
Nematode Symbiont for Photorhabdus asymbiotica
PDF Version [PDF - 127 KB - 3 pages]
J. G. Gerrard et al.View Abstract
Photorhabdus asymbiotica is an emerging bacterial pathogen that causes locally invasive soft tissue and disseminated bacteremic infections in the United States and Australia. Although the source of infection was previously unknown, we report that the bacterium is found in a symbiotic association with an insect-pathogenic soil nematode of the genus Heterorhabditis.
Chikungunya Infection in Travelers
PDF Version [PDF - 128 KB - 3 pages]
P. Hochedez et al.View Abstract
The largest described outbreak of chikungunya virus has been occurring on the islands of the southwest Indian Ocean since March 2005. We describe the manifestations of chikungunya virus infection in travelers returning from these islands, with focus on skin manifestations.
Siberian Subtype Tickborne Encephalitis Virus, Finland
PDF Version [PDF - 211 KB - 4 pages]
A. E. Jääskeläinen et al.View Abstract
We isolated 11 Siberian subtype tickborne encephalitis virus (TBEV) strains from Ixodes persulcatus ticks from a TBEV-endemic focus in the Kokkola Archipelago, western Finland. Thus I. persulcatus and the Siberian TBEV are reported in a focus considerably northwest of their previously known range in eastern Europe and Siberia.
Fourth Human Parechovirus Serotype
PDF Version [PDF - 191 KB - 4 pages]
K. S. Benschop et al.View Abstract
We identified a novel human parechovirus (HPeV) type (K251176-02) from a neonate with fever. Analysis of the complete genome showed K251176-02 to be a new HPeV genotype. Since K251176-02 could not be neutralized with antibodies against known HPeV serotypes 1–3, it should be classified as a fourth HPeV serotype.
ICD-9 Codes and Surveillance for Clostridium difficile–associated Disease
PDF Version [PDF - 196 KB - 4 pages]
E. R. Dubberke et al.View Abstract
We conducted a retrospective cohort study to compare Clostridium difficile–associated disease rates determined by C. difficile–toxin assays and International Classification of Diseases, 9th Revision (ICD-9) codes. The correlation between toxin assay results and ICD-9 codes was good (κ = 0.72, p<0.01). The sensitivity of the ICD-9 codes was 78% and the specificity was 99.7%.
Chikungunya Outbreaks Caused by African Genotype, India
PDF Version [PDF - 178 KB - 4 pages]
P. N. Yergolkar et al.View Abstract
Chikungunya fever is reported in India after 32 years. Immunoglobulin M antibodies and virus isolation confirmed the cause. Phylogenic analysis based on partial sequences of NS4 and E1 genes showed that all earlier isolates (1963–1973) were Asian genotype, whereas the current and Yawat (2000) isolates were African genotype.
Methicillin-resistant Staphylococcus aureus in Dutch Soccer Team
PDF Version [PDF - 143 KB - 3 pages]
X. W. Huijsdens et al.View Abstract
An outbreak of community-acquired methicillin-resistant Staphylococcus aureus occurred among members and close contacts of a soccer team. Typing of the isolates showed the outbreak was caused by the well-known European ST80-IV strain. To our knowledge, this is the first report of an outbreak of this strain among members of a sports team.
Helminth-related Eosinophilia in African Immigrants, Gran Canaria
PDF Version [PDF - 85 KB - 3 pages]
J. Pardo et al.View Abstract
Of 788 recent African adult immigrants to Las Palmas de Gran Canaria, 213 (27.0%) had eosinophilia. The most frequent causes were filariasis (29.4%), schistosomiasis (17.2%), and hookworm infection (16.8%). Stool microscopy and filarial and schistosomal serologic tests gave the highest diagnostic yield. Country of origin and eosinophil count were associated with specific diagnoses.
Scrub Typhus in Himalayas
PDF Version [PDF - 70 KB - 3 pages]
S. K. Mahajan et al.View Abstract
Himachal Pradesh state of India is situated in the outer Himalayan ranges. During the rainy season, several cases of acute febrile illness of unknown origin occurred. Orientia tsutsugamushi was identified as the causative agent by microimmunofluorescence and PCR. Two new genotypes of O. tsutsugamushi were identified in the region.
H5N1 Influenza Viruses in Lao People’s Democratic Republic
PDF Version [PDF - 99 KB - 3 pages]
D. A. Boltz et al.View Abstract
A prospective surveillance program for influenza viruses was established in Lao People's Democratic Republic (PDR) in July of 2005. We report isolation of H5N1 virus genetically distinct from H5N1 circulating in 2004, which indicates reintroduction of H5N1 into Lao PDR after its disappearance (i.e., no virologic or serologic evidence) for 2 years.
Chimpanzee Adenovirus Antibodies in Humans, Sub-Saharan Africa
PDF Version [PDF - 150 KB - 4 pages]
Z. Xiang et al.View Abstract
Human sera from the United States, Thailand, and sub-Saharan Africa and chimpanzee sera were tested for neutralizing antibodies to 3 chimpanzee adenoviruses. Antibodies were more common in humans residing in sub-Saharan Africa than in humans living in the United States or Thailand. This finding suggests cross-species transmission of chimpanzee adenoviruses.
Spatial Epidemiology of Plasmodium vivax, Afghanistan
PDF Version [PDF - 105 KB - 3 pages]
S. Brooker et al.View Abstract
Plasmodium vivax is endemic to many areas of Afghanistan. Geographic analysis helped highlight areas of malaria risk and clarified ecologic risk factors for transmission. Remote sensing enabled development of a risk map, thereby providing a valuable tool to help guide malaria control strategies.
ICD-9 Codes for Identifying Influenza Hospitalizations in Children
PDF Version [PDF - 30 KB - 2 pages]
R. Keren et al.
Chikungunya Virus Strains, Reunion Island Outbreak
PDF Version [PDF - 64 KB - 2 pages]
M. Bessaud et al.
Legionnaires’ Disease and Travel in Europe
PDF Version [PDF - 26 KB - 3 pages]
R. Cano et al.
Influenza A Virus PB1-F2 Gene
PDF Version [PDF - 37 KB - 3 pages]
R. Zell et al.
Enterovirus 75 and Aseptic Meningitis, Spain, 2005
PDF Version [PDF - 66 KB - 3 pages]
A. Avellón et al.
Ciprofloxacin-resistant Salmonella Kentucky in Travelers
PDF Version [PDF - 67 KB - 2 pages]
F. Weill et al.
KPC Type β-Lactamase, Rural Pennsylvania
PDF Version [PDF - 26 KB - 2 pages]
J. Pope et al.
Severe Pneumonia and Human Bocavirus in Adult
PDF Version [PDF - 51 KB - 3 pages]
B. Kupfer et al.
Leishmaniasis in Ancient Egypt and Upper Nubia
PDF Version [PDF - 44 KB - 2 pages]
A. R. Zink et al.
Tickborne Encephalitis Virus, Northeastern Italy
PDF Version [PDF - 68 KB - 3 pages]
A. Beltrame et al.
Alex Langmuir and CDC
PDF Version [PDF - 17 KB - 1 page]
W. Winkelstein and A. L. Reingold
Public Understanding of Pandemic Influenza, United Kingdom
PDF Version [PDF - 22 KB - 2 pages]
R. K. Gupta et al.
Influenza C Virus Infection in Children, Spain
PDF Version [PDF - 27 KB - 2 pages]
C. Calvo et al.
Zoonotic Cutaneous Leishmaniasis, Afghanistan
PDF Version [PDF - 52 KB - 2 pages]
M. K. Faulde et al.
Books and Media
Epstein-Barr Virus (Infectious Disease and Therapy)
PDF Version [PDF - 27 KB - 1 page]
The Power of Plagues
PDF Version [PDF - 36 KB]
J. G. Rigau-Pérez
Molecular Principles of Fungal Pathogenesis
PDF Version [PDF - 170 KB - 2 pages]
About the Cover
- Page created: December 09, 2011
- Page last updated: May 04, 2012
- Page last reviewed: May 04, 2012
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Office of the Director (OD)