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Volume 13, Number 9—September 2007

Volume 13, Number 9—September 2007   PDF Version [PDF - 10.80 MB - 167 pages]


  • Threat of Hantavirus Pulmonary Syndrome to Field Biologists Working with Small Mammals PDF Version [PDF - 66 KB - 3 pages]
    D. A. Kelt et al.
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    Low risk for hantavirus pulmonary syndrome (HPS) has been reported among biologists engaged in fieldwork with rodents. The overall probability of acquiring HPS when working with rodents appears to be 1 in 1,412 (0.00071). Nonetheless, a causal link between HPS and lack of personal protective equipment (PPE) use is suggested by some investigators. However, supporting data are incomplete and consequently misleading. A recent HPS case was assumed to be acquired during rodent-handling activities, although substantial peridomestic exposure was evident. Regulatory groups interpret inadequate data as evidence of the need for rigorous PPE, which can hamper field research and instructional efforts. PPE recommendations should be reviewed and revised to match the risk associated with different types of fieldwork with small mammals.


  • Frequent Travelers and Rate of Spread of Epidemics PDF Version [PDF - 244 KB - 7 pages]
    T. D. Hollingsworth et al.
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    A small proportion of air travelers make disproportionately more journeys than the rest of travelers. They also tend to interact predominantly with other frequent travelers in hotels and airport lounges. This group has the potential to accelerate global spread of infectious respiratory diseases. Using an epidemiologic model, we simulated exportation of cases from severe acute respiratory syndrome–like and influenza-like epidemics in a population for which a small proportion travel more frequently than the rest. Our simulations show that frequent travelers accelerate international spread of epidemics only if they are infected early in an outbreak and the outbreak does not expand rapidly. If the epidemic growth rate is high, as is likely for pandemic influenza, heterogeneities in travel are frequently overwhelmed by the large number of infected persons in the majority population and the resulting high probability that some of these persons will take an international flight.

  • Detection of Group 1 Coronaviruses in Bats in North America PDF Version [PDF - 286 KB - 6 pages]
    S. R. Dominguez et al.
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    The epidemic of severe acute respiratory syndrome (SARS) was caused by a newly emerged coronavirus (SARS-CoV). Bats of several species in southern People’s Republic of China harbor SARS-like CoVs and may be reservoir hosts for them. To determine whether bats in North America also harbor coronaviruses, we used reverse transcription–PCR to detect coronavirus RNA in bats. We found coronavirus RNA in 6 of 28 fecal specimens from bats of 2 of 7 species tested. The prevalence of viral RNA shedding was high: 17% in Eptesicus fuscus and 50% in Myotis occultus. Sequence analysis of a 440-bp amplicon in gene 1b showed that these Rocky Mountain bat coronaviruses formed 3 clusters in phylogenetic group 1 that were distinct from group 1 coronaviruses of Asian bats. Because of the potential for bat coronaviruses to cause disease in humans and animals, further surveillance and characterization of bat coronaviruses in North America are needed.

  • Landscape Elements and Hantaan Virus–related Hemorrhagic Fever with Renal Syndrome, People’s Republic of China PDF Version [PDF - 286 KB - 6 pages]
    L. Yan et al.
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    Hemorrhagic fever with renal syndrome (HFRS) is an important public health problem in the People’s Republic of China, accounting for 90% of human cases reported globally. In this study, a landscape epidemiologic approach, combined with geographic information system and remote sensing techniques, was applied to increase our understanding of HFRS due to Hantaan virus and its relationship with landscape elements in China. The landscape elements considered were elevation, normalized difference vegetation index (NDVI), precipitation, annual cumulative air temperature, land surface temperature, soil type, and land use. Multivariate logistic regression analysis showed that HFRS incidence was remarkably associated with elevation, NDVI, precipitation, annual cumulative air temperature, semihydromorphic soils, timber forests, and orchards. These findings have important applications for targeting HFRS interventions in mainland China.

  • Precautionary Behavior in Response to Perceived Threat of Pandemic Influenza PDF Version [PDF - 176 KB - 7 pages]
    M. Z. Sadique et al.
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    Faced with an epidemic of an infectious disease, persons may take precautionary actions to try to reduce their risk. Such actions include avoiding situations that persons perceive to be risky, which can have negative health and economic effects. Therefore, we conducted a population-based survey of persons’ precautionary actions in response to a hypothetical influenza pandemic. For the 5 European and 3 Asian regions that had been affected by severe acute respiratory syndrome, the pattern of reported precautionary action was broadly similar across the regions; ≈75% of respondents reported that they would avoid public transportation and 20%–30% would try to stay indoors. Some regional differences were noted; Europeans were more likely than Asians to avoid places of entertainment, and Asians were more likely to avoid seeing physicians. This international survey provides insight into what might be expected during an influenza pandemic.

  • Simian Foamy Virus Transmission from Apes to Humans, Rural Cameroon PDF Version [PDF - 275 KB - 7 pages]
    S. Calattini et al.
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    Simian virus infections of humans are an increasing public health concern. Simian foamy virus (SFV) infections have been reported in persons occupationally exposed to nonhuman primates and in a few hunters in Cameroon. To better understand this retroviral zoonosis in natural settings, we studied persons who lived in southern Cameroon, near nonhuman primate habitats. First we studied a general population of 1,164 adults; 4 were SFV positive according to serologic and molecular assays. Then we studied 85 persons who reported having been bitten or scratched by nonhuman primates; 7/29 (24.1%) of those who had contact with apes (gorillas or chimpanzees) were SFV positive, compared with only 2/56 (3.6%) of those who had had contact with monkeys. These data demonstrate efficient transmission of SFVs to humans in natural settings in central Africa, specifically following ape bites, and viral persistence in the human host.

  • Family Clustering of Viliuisk Encephalomyelitis in Traditional and New Geographic Regions PDF Version [PDF - 209 KB - 6 pages]
    V. A. Vladimirtsev et al.
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    Viliuisk encephalomyelitis is an acute, often fatal, meningoencephalitis that tends to develop into a prolonged chronically progressive panencephalitis. Clinical, neuropathologic, and epidemiologic data argue for an infectious cause, although multiple attempts at pathogen isolation have been unsuccessful. To assess mechanisms of disease transmission and spread, we studied 6 multiplex families. Secondary cases occurred among genetically related and unrelated persons in a setting of prolonged intrahousehold contact with a patient manifesting the disease. Transmission to unrelated persons was documented in a densely populated region around the city of Yakutsk in which Viliuisk encephalomyelitis had not been previously known. Initially identified in a small Yakut-Evenk population on the Viliui River of eastern Siberia, the disease subsequently spread through human contacts to new geographic areas, thus characterizing Viliuisk encephalomyelitis as an emerging infectious disease.

  • HIV, Hepatitis C, and Hepatitis B Infections and Associated Risk Behavior in Injection Drug Users, Kabul, Afghanistan PDF Version [PDF - 281 KB - 5 pages]
    C. S. Todd et al.
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    Limited prevalence data for HIV, hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV) exist for Afghanistan. We studied a cross-sectional sample of adult injection drug users (IDUs) in Kabul, Afghanistan, from June 2005 through June 2006. Study participants completed interviewer-administered questionnaires and underwent testing for HIV, antibody to HCV, and HBsAg. Overall prevalences of HIV, HCV, and HBsAg were 3.0% (95% confidence interval [CI] 1.7%–5.1%), 36.6% (95% CI 32.2%–41.0%), and 6.5% (95% CI 4.2%–8.7%), respectively (N = 464). Among male IDUs (n = 463), risky behavior, including sharing syringes (50.4%), paying women for sex (76.2%), and having sex with men or boys (28.3%), were common. Needle sharing, injecting for >3 years, and receiving injections from nonmedical providers were independently associated with increased risk for HCV infection. The high prevalence of risky behavior indicate that Kabul is at risk for an HIV epidemic. Scale-up of harm-reducing interventions is urgently needed.

  • Spectrum of Infection and Risk Factors for Human Monkeypox, United States, 2003 PDF Version [PDF - 193 KB - 8 pages]
    M. G. Reynolds et al.
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    For the 2003 monkeypox virus (MPXV) outbreak in the United States, interhuman transmission was not documented and all case-patients were near or handled MPXV-infected prairie dogs. We initiated a case–control study to evaluate risk factors for animal-to-human MPXV transmission. Participants completed a questionnaire requesting exposure, clinical, and demographic information. Serum samples were obtained for analysis of immunoglobulin G (IgG) and IgM to orthopoxvirus. When data were adjusted for smallpox vaccination, case-patients were more likely than controls to have had daily exposure to a sick animal (odds ratio [OR] 4.0, 95% confidence interval [CI] 1.2–13.4), cleaned cages and bedding of a sick animal (OR 5.3, 95% CI 1.4–20.7), or touched a sick animal (OR 4.0, 95% CI 1.2–13.4). These findings demonstrate that human MPXV infection is associated with handling of MPXV-infected animals and suggest that exposure to excretions and secretions of infected animals can result in infection.

  • Effect of Interventions on Influenza A (H9N2) Isolation in Hong Kong’s Live Poultry Markets, 1999–2005 PDF Version [PDF - 414 KB - 8 pages]
    E. Lau et al.
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    Live poultry markets (LPMs) are a recognized source of influenza viruses. Since 2001 and 2003, respectively, a first and second monthly “rest-day” has been implemented in Hong Kong’s LPMs, when stalls are cleared of unsold poultry and disinfected. We assessed the incremental effectiveness of each rest-day and the banning of live quail sales in 2002 in reducing (H9N2) subtype isolation rates for chickens and minor poultry, by using a multivariable Poisson generalized linear model. There was a 58% reduction (p = 0.001) in virus isolation after 1 monthly rest-day in minor poultry compared with 27% (p = 0.22) in chickens. Combining 1 rest-day with the removal of quails further reduced virus isolation in chickens but not in minor poultry. However, an additional rest-day each month did not appear to affect isolation rates for either species.

  • Detecting Human-to-Human Transmission of Avian Influenza A (H5N1) PDF Version [PDF - 1.49 MB - 6 pages]
    Y. Yang et al.
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    Highly pathogenic avian influenza A (HPAI) subtype H5N1 has caused family case clusters, mostly in Southeast Asia, that could be due to human-to-human transmission. Should this virus, or another zoonotic influenza virus, gain the ability of sustained human-to-human transmission, an influenza pandemic could result. We used statistical methods to test whether observed clusters of HPAI (H5N1) illnesses in families in northern Sumatra, Indonesia, and eastern Turkey were due to human-to-human transmission. Given that human-to-human transmission occurs, we estimate the infection secondary attack rates (SARs) and the local basic reproductive number, R0. We find statistical evidence of human-to-human transmission (p = 0.009) in Sumatra but not in Turkey (p = 0.114). For Sumatra, the estimated household SAR was 29% (95% confidence interval [CI] 15%–51%). The estimated lower limit on the local R0 was 1.14 (95% CI 0.61–2.14). Effective HPAI (H5N1) surveillance, containment response, and field evaluation are essential to monitor and contain potential pandemic strains.


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