Get Email Updates
To receive email updates about this page, enter your email address:
Volume 14, Number 10—October 2008
Volume 14, Number 10—October 2008 PDF Version [PDF - 6.34 MB - 179 pages]
Rise and Persistence of Global M1T1 Clone of Streptococcus pyogenes
PDF Version [PDF - 166 KB - 7 pages]
R. K. Aziz and M. KotbView Abstract
The resurgence of severe invasive group A streptococcal infections in the 1980s is a typical example of the reemergence of an infectious disease. We found that this resurgence is a consequence of the diversification of particular strains of the bacteria. Among these strains is a highly virulent subclone of serotype M1T1 that has exhibited unusual epidemiologic features and virulence, unlike all other streptococcal strains. This clonal strain, commonly isolated from both noninvasive and invasive infection cases, is most frequently associated with severe invasive diseases. Because of its unusual prevalence, global spread, and increased virulence, we investigated the unique features that likely confer its unusual properties. In doing so, we found that the increased virulence of this clonal strain can be attributed to its diversification through phage mobilization and its ability to sense and adapt to different host environments; accordingly, the fittest members of this diverse bacterial community are selected to survive and invade host tissue.
Pandemic Influenza and Excess Intensive-Care Workload
PDF Version [PDF - 325 KB - 8 pages]
R. E. Nap et al.View Abstract
In the Netherlands a major part of preparedness planning for an epidemic or pandemic consists of maintaining essential public services, e.g., by the police, fire departments, army personnel, and healthcare workers. We provide estimates for peak demand for healthcare workers, factoring in healthcare worker absenteeism and using estimates from published epidemiologic models on the expected evolution of pandemic influenza in relation to the impact on peak surge capacity of healthcare facilities and intensive care units (ICUs). Using various published scenarios, we estimate their effect in increasing the availability of healthcare workers for duty during a pandemic. We show that even during the peak of the pandemic, all patients requiring hospital and ICU admission can be served, including those who have non–influenza-related conditions. For this rigorous task differentiation, clear hierarchical management, unambiguous communication, and discipline are essential and we recommend informing and training non-ICU healthcare workers for duties in the ICU.
Risk Factors for Nipah Virus Encephalitis in Bangladesh
PDF Version [PDF - 173 KB - 7 pages]
J. M. Montgomery et al.View Abstract
Nipah virus (NiV) is a paramyxovirus that causes severe encephalitis in humans. During January 2004, twelve patients with NiV encephalitis (NiVE) were identified in west-central Bangladesh. A case–control study was conducted to identify factors associated with NiV infection. NiVE patients from the outbreak were enrolled in a matched case-control study. Exact odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by using a matched analysis. Climbing trees (83% of cases vs. 51% of controls, OR 8.2, 95% CI 1.25–∞) and contact with another NiVE patient (67% of cases vs. 9% of controls, OR 21.4, 95% CI 2.78–966.1) were associated with infection. We did not identify an increased risk for NiV infection among persons who had contact with a potential intermediate host. Although we cannot rule out person-to-person transmission, case-patients were likely infected from contact with fruit bats or their secretions.
Deforestation and Vectorial Capacity of Anopheles gambiae Giles Mosquitoes in Malaria Transmission, Kenya
PDF Version [PDF - 185 KB - 6 pages]
Y. A. Afrane et al.View Abstract
We investigated the effects of deforestation on microclimates and sporogonic development of Plasmodium falciparum parasites in Anopheles gambiae mosquitoes in an area of the western Kenyan highland prone to malaria epidemics. An. gambiae mosquitoes were fed with P. falciparum–infected blood through membrane feeders. Fed mosquitoes were placed in houses in forested and deforested areas in a highland area (1,500 m above sea level) and monitored for parasite development. Deforested sites had higher temperatures and relative humidities, and the overall infection rate of mosquitoes was increased compared with that in forested sites. Sporozoites appeared on average 1.1 days earlier in deforested areas. Vectorial capacity was estimated to be 77.7% higher in the deforested site than in the forested site. We showed that deforestation changes microclimates, leading to more rapid sporogonic development of P. falciparum and to a marked increase of malaria risk in the western Kenyan highland.
Ecologic Factors Associated with West Nile Virus Transmission, Northeastern United States
PDF Version [PDF - 191 KB - 7 pages]
H. E. Brown et al.View Abstract
Since 1999, West Nile virus (WNV) disease has affected the northeastern United States. To describe the spatial epidemiology and identify risk factors for disease incidence, we analyzed 8 years (1999–2006) of county-based human WNV disease surveillance data. Among the 56.6 million residents in 8 northeastern states sharing primary enzootic vectors, we found 977 cases. We controlled for population density and potential bias from surveillance and spatial proximity. Analyses demonstrated significant spatial spreading from 1999 through 2004 (p<0.01, r2 = 0.16). A significant trend was apparent among increasingly urban counties; county quartiles with the least (<38%) forest cover had 4.4-fold greater odds (95% confidence interval [CI] 1.4–13.2, p = 0.01) of having above-median disease incidence (>0.75 cases/100,000 residents) than counties with the most (>70%) forest cover. These results quantify urbanization as a risk factor for WNV disease incidence and are consistent with knowledge of vector species in this area.
Deaths from Norovirus among the Elderly, England and Wales
PDF Version [PDF - 280 KB - 9 pages]
J. P. Harris et al.View Abstract
The number of deaths in England and Wales associated with gastrointestinal pathogens, norovirus in particular, in persons >65 years was estimated for 2001–2006. Regression analysis was used to model monthly counts of gastrointestinal pathogens in fecal samples from infected patients against monthly counts of deaths from infectious and noninfectious intestinal diseases. Data came from the Office of National Statistics (death registrations from local registrars) and from the Health Protection Agency (laboratory results). Model results suggest that 20% (13.3%–26.8%) of deaths in persons >65 years of age caused by infectious intestinal disease other than Clostridium difficile were associated with norovirus infection in this period and that 13% (7.5%–18.5%) of deaths caused by noninfectious intestinal disease were associated with norovirus. An estimated 80 deaths each year in this age group may be associated with norovirus infection.
Norwalk Virus Shedding after Experimental Human Infection
PDF Version [PDF - 160 KB - 5 pages]
R. L. Atmar et al.View Abstract
Noroviruses are the most common cause of viral gastroenteritis in the United States. To determine the magnitude and duration of virus shedding in feces, we evaluated persons who had been experimentally infected with Norwalk virus. Of 16 persons, clinical gastroenteritis (watery diarrhea and/or vomiting) developed in 11; symptomatic illness lasted 1–2 days. Virus shedding was first detected by reverse transcription–PCR (RT-PCR) 18 hours after participant inoculation and lasted a median of 28 days after inoculation (range 13–56 days). The median peak amount of virus shedding was 95 × 109 (range 0.5–1,640 ×109) genomic copies/g feces as measured by quantitative RT-PCR. Virus shedding was first detected by antigen ELISA ≈33 hours (median 42 hours) after inoculation and lasted 10 days (median 7 days) after inoculation. Understanding of the relevance of prolonged fecal norovirus excretion must await the development of sensitive methods to measure virus infectivity.
Prophylaxis after Exposure to Coxiella burnetii
PDF Version [PDF - 177 KB - 9 pages]
C. E. Moodie et al.View Abstract
Coxiella burnetii is a category B bioterrorism agent. We numerically evaluated the risks and benefits from postexposure prophylaxis (PEP) after an intentional release of C. burnetii to the general population, pregnant women, and other high-risk populations. For each group, we constructed a decision tree to estimate illness and deaths averted by use of PEP/100,000 population. We calculated the threshold points at which the number of PEP-related adverse events was equal to the cases averted. PEP was defined as doxycycline (100 mg 2×/day for 5 days), except for pregnant women, where we assumed a PEP of trimethoprim-sulfamethoxazole (160 mg/800 mg 2×/day) for the duration of the pregnancy. PEP would begin 8–12 days postexposure. On the basis of upper-bound probability estimates of PEP-related adverse events for doxycycline, we concluded that the risk for Q fever illness outweighs the risk for antimicrobial drug–related adverse events when the probability of C. burnetii exposure is >7% (pregnant women using trimethoprim-sulfamethoxazole = 16%).
Cryptosporidium Species and Subtypes and Clinical Manifestations in Children, Peru
PDF Version [PDF - 139 KB - 8 pages]
V. A. Cama et al.View Abstract
To determine whether clinical manifestations are associated with genotypes or subtypes of Cryptosporidium spp., we studied a 4-year longitudinal birth cohort of 533 children in Peru. A total of 156 infection episodes were found in 109 children. Data from first infections showed that C. hominis was associated with diarrhea, nausea, vomiting, general malaise, and increased oocyst shedding intensity and duration. In contrast, C. parvum, C. meleagridis, C. canis, and C. felis were associated with diarrhea only. C. hominis subtype families were identified (Ia, Ib, Id, and Ie); all were associated with diarrhea. Ib was also associated with nausea, vomiting, and general malaise. All C. parvum specimens belonged to subtype family IIc. Analysis of risk factors did not show associations with specific Cryptosporidium spp. genotypes or subtypes. These findings strongly suggest that Cryptosporidium spp. and subtypes are linked to different clinical manifestations in children.
Endemic and Epidemic Lineages of Escherichia coli that Cause Urinary Tract Infections
PDF Version [PDF - 244 KB - 9 pages]
A. R. Manges et al.View Abstract
Women with urinary tract infections (UTIs) in California, USA (1999–2001), were infected with closely related or indistinguishable strains of Escherichia coli (clonal groups), which suggests point source dissemination. We compared strains of UTI-causing E. coli in California with strains causing such infections in Montréal, Québec, Canada. Urine specimens from women with community-acquired UTIs in Montréal (2006) were cultured for E. coli. Isolates that caused 256 consecutive episodes of UTI were characterized by antimicrobial drug susceptibility profile, enterobacterial repetitive intergenic consensus 2 PCR, serotyping, XbaI and NotI pulsed-field gel electrophoresis, multilocus sequence typing, and phylogenetic typing. We confirmed the presence of drug-resistant, genetically related, and temporally clustered E. coli clonal groups that caused community-acquired UTIs in unrelated women in 2 locations and 2 different times. Two clonal groups were identified in both locations. Epidemic transmission followed by endemic transmission of UTI-causing clonal groups may explain these clusters of UTI cases.
Medscape CME Activity
Microbial Interactions during Upper Respiratory Tract Infections PDF Version [PDF - 155 KB - 8 pages]M. M. Pettigrew et al.View Abstract
Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus often colonize the nasopharynx. Children are susceptible to bacterial infections during or soon after upper respiratory tract infection (URI). We describe colonization with these 4 bacteria species alone or in combination during URI. Data were from a prospective cohort of healthy children 6 to 36 months of age followed up for 1 year. Analyses of 968 swabs from 212 children indicated that S. pneumoniae colonization is negatively associated with colonization by H. influenzae. Competitive interactions shifted when H. influenzae and M. catarrhalis colonized together. In this situation, the likelihood of colonization with all 3 species is higher. Negative associations were identified between S. pneumoniae and S. aureus and between H. influenzae and S. aureus. Polymicrobial interactions differed by number and species of bacteria present. Antimicrobial therapy and vaccination strategies targeting specific bacterial species may alter the flora in unforeseen ways.
Pyogenic Liver Abscess as Endemic Disease, Taiwan
PDF Version [PDF - 212 KB - 9 pages]
F. Tsai et al.View Abstract
Pyogenic liver abscess has become a health problem in Taiwanese society. However, the extent of this problem has remained unclear because of the lack of a population-based study. We therefore performed a nationwide analysis of pyogenic liver abscess in Taiwan from 1996 through 2004. We analyzed 29,703 cases from the Taiwan National Health Insurance database and 506 cases from National Taiwan University Hospital. Our analysis showed that the annual incidence of pyogenic liver abscess increased steadily from 11.15/100,000 population in 1996 to 17.59/100,000 in 2004. Diabetes, malignancy, renal disease, and pneumonia were associated with a higher risk for the disease. By contrast, death due to pyogenic liver abscess decreased over time, although population-based abscess-related death increased slightly. Renal disease, malignancy, pneumonia, and heart disease correlated with higher death rates; Klebsiella pneumoniae infection and therapeutic procedures were related to lower death rates. Diabetes did not significantly change death rates for the 506 patients from the hospital.
Estimating Community Incidence of Salmonella, Campylobacter, and Shiga Toxin–producing Escherichia coli Infections, Australia
PDF Version [PDF - 186 KB - 9 pages]
G. Hall et al.View Abstract
To estimate multipliers linking surveillance of salmonellosis, campylobacteriosis, and Shiga toxin–producing Escherichia coli (STEC) infections to community incidence, we used data from a gastroenteritis survey and other sources. Multipliers for severe (bloody stool/long duration) and milder cases were estimated from the component probabilities of doctor visit, stool test, sensitivity of laboratory test, and reporting to surveillance system. Pathogens were classified by the same severity criteria and appropriate multipliers applied. Precision of estimates was quantified by using simulation techniques to construct 95% credible intervals (CrIs). The multiplier for salmonellosis was estimated at 7 (95% CrI 4–16), for campylobacteriosis at 10 (95% CrI 7–22), and for STEC at 8 (95% CrI 3–75). Australian annual community incidence rates per 100,000 population were estimated as 262 (95% CrI 150–624), 1,184 (95% CrI 756–2,670), and 23 (95% CrI 13–54), respectively. Estimation of multipliers allows assessment of the true effects of these diseases and better understanding of public health surveillance.
Automatic Outbreak Detection Algorithm versus Electronic Reporting System
PDF Version [PDF - 85 KB - 3 pages]
M. Straetemans et al.View Abstract
To determine efficacy of automatic outbreak detection algorithms (AODAs), we analyzed 3,582 AODA signals and 4,427 reports of outbreaks caused by Campylobacter spp. or norovirus during 2005–2006 in Germany. Local health departments reported local outbreaks with higher sensitivity and positive predictive value than did AODAs.
Rickettsia typhi and R. felis in Rat Fleas (Xenopsylla cheopis), Oahu, Hawaii
PDF Version [PDF - 157 KB - 3 pages]
M. E. Eremeeva et al.View Abstract
Rickettsia typhi (prevalence 1.9%) and R. felis (prevalence 24.8%) DNA were detected in rat fleas (Xenopsylla cheopis) collected from mice on Oahu Island, Hawaii. The low prevalence of R. typhi on Oahu suggests that R. felis may be a more common cause of rickettsiosis than R. typhi in Hawaii.
New Hosts for Equine Herpesvirus 9
PDF Version [PDF - 357 KB - 4 pages]
M. D. Schrenzel et al.View Abstract
Equine herpesvirus 9 was detected in a polar bear with progressive encephalitis; the source was traced to 2 members of a potential equid reservoir species, Grevy’s zebras. The virus was also found in an aborted Persian onager. Thus, the natural host range is extended to 6 species in 3 mammalian orders.
Extended Sequence Typing of Campylobacter spp., United Kingdom
PDF Version [PDF - 110 KB - 3 pages]
K. E. Dingle et al.View Abstract
Supplementing Campylobacter spp. multilocus sequence typing with nucleotide sequence typing of 3 antigen genes increased the discriminatory index achieved from 0.975 to 0.992 among 620 clinical isolates from Oxfordshire, United Kingdom. This enhanced typing scheme enabled identification of clusters and retained data required for long-range epidemiologic comparisons of isolates.
Chikungunya Outbreak, South India, 2006
PDF Version [PDF - 125 KB - 3 pages]
P. Kaur et al.View Abstract
We investigated chikungunya outbreaks in South India and observed a high attack rate, particularly among adults and women. Transmission was facilitated by Aedes aegypti mosquitoes in peridomestic water containers, as indicated by a high Breteau index. We recommended vector control measures and health education to promote safe water storage practices.
Control Strategy for Echinococcus multilocularis
PDF Version [PDF - 173 KB - 3 pages]
D. Hegglin and P. DeplazesView Abstract
Echinococcus multilocularis, the causative agent of zoonotic alveolar echinococcosis, can be controlled effectively by the experimental delivery of anthelminthic baits for urban foxes. Monthly baiting over a 45-month period was effective for long-lasting control. Trimonthly baiting intervals were far less effective and did not prevent parasite recovery.
Mapping the Probability of Schistosomiasis and Associated Uncertainty, West Africa
PDF Version [PDF - 321 KB - 3 pages]
A. Clements et al.View Abstract
We aimed to map the probability of Schistosoma haematobium infection being >50%, a threshold for annual mass praziquantel distribution. Parasitologic surveys were conducted in Burkina Faso, Mali, and Niger, 2004–2006, and predictions were made by using Bayesian geostatistical models. Clusters with >50% probability of having >50% prevalence were delineated in each country.
Spinach-associated Escherichia coli O157:H7 Outbreak, Utah and New Mexico, 2006
PDF Version [PDF - 196 KB - 4 pages]
J. Grant et al.View Abstract
In 2006, Utah and New Mexico health departments investigated a multistate cluster of Escherichia coli O157:H7. A case–control study of 22 case-patients found that consuming bagged spinach was significantly associated with illness (p<0.01). The outbreak strain was isolated from 3 bags of 1 brand of spinach. Nationally, 205 persons were ill with the outbreak strain.
Molecular Surveillance for Multidrug-Resistant Plasmodium falciparum, Cambodia
PDF Version [PDF - 275 KB - 4 pages]
N. K. Shah et al.View Abstract
We conducted surveillance for multidrug-resistant Plasmodium falciparum in Cambodia during 2004–2006 by assessing molecular changes in pfmdr1. The high prevalence of isolates with multiple pfmdr1 copies found in western Cambodia near the Thai border, where artesunate–mefloquine therapy failures occur, contrasts with isolates from eastern Cambodia, where this combination therapy remains highly effective.
Decreased Tuberculosis Incidence and Declining Clustered Case Rates, Madrid
PDF Version [PDF - 88 KB - 3 pages]
J. Iñigo et al.View Abstract
To determine effect of recent tuberculosis transmission rates on incidence rates, we conducted 2 prospective population-based molecular epidemiologic studies in Madrid during 1997–1999 (4% immigrants) and 2002–2004 (14.9% immigrants). Case rates decreased in association with declining clustered case rates among Spanish-born persons. New strains were introduced through immigration.
Influenza A Virus Infections in Land Birds, People’s Republic of China
PDF Version [PDF - 117 KB - 3 pages]
A. T. Peterson et al.View Abstract
Water birds are considered the reservoir for avian influenza viruses. We examined this assumption by sampling and real-time reverse transcription–PCR testing of 939 Asian land birds of 153 species. Influenza A infection was found, particularly among migratory species. Surveillance programs for monitoring spread of these viruses need to be redesigned.
Invasive Group B Streptococcal Infections in Infants, France
PDF Version [PDF - 134 KB - 3 pages]
C. Poyart et al.View Abstract
Clinical features and molecular characterization of 109 group B streptococci causing neonatal invasive infections were determined over an 18-month period in France. Sixty-four percent of the strains were from late-onset infections, and 75% were capsular type III. The hypervirulent clone ST-17 was recovered in 80% of meningitis cases.
Owner Valuation of Rabies Vaccination of Dogs, Chad
PDF Version [PDF - 103 KB - 3 pages]
S. Dürr et al.View Abstract
We estimated the association between amount charged and probability that dog owners in N’Djaména, Chad, would have their dogs vaccinated against rabies. Owners would pay ≈400–700 CFA francs (US $0.78–$1.36)/animal. To vaccinate >70% of dogs, and thus interrupt rabies transmission, health officials should substantially subsidize these vaccinations.
Unexplained Deaths and Critical Illnesses of Suspected Infectious Cause, Taiwan, 2000–2005
PDF Version [PDF - 93 KB - 3 pages]
T. Wang et al.View Abstract
We report 5 years’ surveillance data from the Taiwan Centers for Disease Control on unexplained deaths and critical illnesses suspected of being caused by infection. A total of 130 cases were reported; the incidence rate was 0.12 per 100,000 person-years; and infectious causes were identified for 81 cases (62%).
Murine Typhus and Febrile Illness, Nepal
PDF Version [PDF - 263 KB - 4 pages]
M. D. Zimmerman et al.View Abstract
Murine typhus was diagnosed by PCR in 50 (7%) of 756 adults with febrile illness seeking treatment at Patan Hospital in Kathmandu, Nepal. Of patients with murine typhus, 64% were women, 86% were residents of Kathmandu, and 90% were unwell during the winter. No characteristics clearly distinguished typhus patients from those with blood culture–positive enteric fever.
Effects of School Closures, 2008 Winter Influenza Season, Hong Kong
PDF Version [PDF - 148 KB - 3 pages]
B. J. Cowling et al.View Abstract
In winter 2008, kindergartens and primary schools in Hong Kong were closed for 2 weeks after media coverage indicated that 3 children had died, apparently from influenza. We examined prospective influenza surveillance data before, during, and after the closure. We did not find a substantial effect on community transmission.
Recent Shift in Age Pattern of Dengue Hemorrhagic Fever, Brazil
PDF Version [PDF - 96 KB - 1 page]
M. G. Teixeira et al.
Confirmed Mycoplasma pneumoniae Endocarditis
PDF Version [PDF - 113 KB - 2 pages]
J. P. Scapini et al.
Human Rhinovirus Group C Infection in Children with Lower Respiratory Tract Infection
PDF Version [PDF - 122 KB - 3 pages]
Z. Xiang et al.
Serogroup A Neisseria meningitidis with Reduced Susceptibility to Ciprofloxacin
PDF Version [PDF - 128 KB - 3 pages]
J. Strahilevitz et al.
Identification of All Dengue Serotypes in Nepal
PDF Version [PDF - 112 KB - 2 pages]
S. Malla et al.
Detecting Avian Influenza Virus (H5N1) in Domestic Duck Feathers
PDF Version [PDF - 108 KB - 2 pages]
Y. Yamamoto et al.
Neisseria gonorrhoeae Meningitis in Pregnant Adolescent
PDF Version [PDF - 124 KB - 3 pages]
M. C. Martín et al.
Echinococcoses and Tibetan Communities
PDF Version [PDF - 109 KB - 2 pages]
P. S. Craig et al.
Resource Allocation during an Influenza Pandemic
PDF Version [PDF - 145 KB - 2 pages]
N. F. Phin and L. Davies
Books and Media
Risky Trade: Infectious Disease in the Era of Global Trade
PDF Version [PDF - 106 KB - 2 pages]
The Making of a Tropical Disease: A Short History of Malaria
PDF Version [PDF - 101 KB - 1 page]
About the Cover
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.
Get Email Updates
To receive email updates about this page, enter your email address:
- Page created: July 13, 2010
- Page last updated: July 13, 2010
- Page last reviewed: July 13, 2010
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Office of the Director (OD)