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Volume 14, Number 11—November 2008
Volume 14, Number 11—November 2008 PDF Version [PDF - 7.87 MB - 155 pages]
Framework for Leadership and Training of Biosafety Level 4 Laboratory Workers
PDF Version [PDF - 110 KB - 4 pages]
J. W. Le Duc et al.View Abstract
Construction of several new Biosafety Level 4 (BSL-4) laboratories and expansion of existing operations have created an increased international demand for well-trained staff and facility leaders. Directors of most North American BSL-4 laboratories met and agreed upon a framework for leadership and training of biocontainment research and operations staff. They agreed on essential preparation and training that includes theoretical consideration of biocontainment principles, practical hands-on training, and mentored on-the-job experiences relevant to positional responsibilities as essential preparation before a person’s independent access to a BSL-4 facility. They also agreed that the BSL-4 laboratory director is the key person most responsible for ensuring that staff members are appropriately prepared for BSL-4 operations. Although standardized certification of training does not formally exist, the directors agreed that facility-specific, time-limited documentation to recognize specific skills and experiences of trained persons is needed.
Antimicrobial Drug–Selection Markers for Burkholderia pseudomallei and B. mallei
PDF Version [PDF - 135 KB - 4 pages]
H. P. Schweizer and S. J. PeacockView Abstract
Genetic research into the select agents Burkholderia pseudomallei and B. mallei is currently hampered by a paucity of approved antimicrobial drug–selection markers. The strict regulations imposed on researchers in the United States but not in other parts of the world lead to discrepancies in practice, hinder distribution of genetically modified strains, and impede progress in the field. Deliberation and decisions regarding alternative selection markers (antimicrobial and nonantimicrobial drugs) by the international community, regulatory authorities, and funding agencies are needed.
Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus, Rural Southwestern Alaska
PDF Version [PDF - 205 KB - 7 pages]
M. Z. David et al.View Abstract
USA300 is the dominant strain responsible for community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) infections in most of the United States. We examined isolates from outbreaks of MRSA skin infections in rural southwestern Alaska in 1996 and 2000 (retrospective collection) and from the hospital serving this region in 2004–2006 (prospective collection). Among 36 retrospective collection isolates, 92% carried Panton-Valentine leukocidin (PVL) genes; all carried staphylococcal chromosomal cassette mec (SCCmec) type IV. None belonged to clonal complex (CC) 8, the CC associated with USA300; 57% were sequence type (ST) 1, and 26% were ST30; 61% were clindamycin resistant. In the prospective collection, 42 isolates were PVL+ and carried SCCmec type IV; 83.3% were ST1, 9.5% were ST30, and 7.1% were ST8. Among 120 prospective isolates, 57.5% were clindamycin resistant. CA-MRSA epidemiology in southwestern Alaska differs from that in the lower 48 states; ST8 strains were rarely identified and clindamycin resistance was common.
Multidrug- and Extensively Drug-Resistant Tuberculosis, Germany
PDF Version [PDF - 120 KB - 7 pages]
B. Eker et al.View Abstract
We evaluated risk factors and treatment outcomes associated with multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB) in Germany in 2004–2006. In 177 (4%) of 4,557 culture-positive TB cases, Mycobacterium tuberculosis isolates were identified as MDR TB; an additional 7 (0.15%) met criteria for XDR TB. Of these 184 patients, 148 (80%) were born in countries of the former Soviet Union. In patients with XDR TB, hospitalization was longer (mean ± SD 202 ± 130 vs. 123 ± 81 days; p = 0.015) and resistance to all first-line drugs was more frequent (36% vs. 86%; p = 0.013) than in patients with MDR TB. Seventy-four (40%) of these 184 patients received treatment with linezolid. Treatment success rates ranged from 59% for the entire cohort (59% for MDR TB and 57% for XDR TB) to 87% for those with a definitive outcome (n = 125; 89% for MDR TB and 80% for XDR TB). Extensive drug susceptibility testing and availability of second- and third-line drugs under inpatient management conditions permit relatively high treatment success rates in MDR- and XDR TB.
Mixture for Controlling Insecticide-Resistant Malaria Vectors
PDF Version [PDF - 311 KB - 8 pages]
C. Pennetier et al.View Abstract
The spread of resistance to pyrethroids in the major Afrotropical malaria vectors Anopheles gambiae s.s. necessitates the development of new strategies to control resistant mosquito populations. To test the efficacy of nets treated with repellent and insecticide against susceptible and insecticide-resistant An. gambiae mosquito populations, we impregnated mosquito bed nets with an insect repellent mixed with a low dose of organophosphorous insecticide and tested them in a rice-growing area near Bobo-Dioulasso, Burkina Faso. During the first 2 weeks posttreatment, the mixture was as effective as deltamethrin alone and was more effective at killing An. gambiae that carried knockdown resistance (kdr) or insensitive acetylcholinesterase resistance (Ace1R) genes. The mixture seemed to not kill more susceptible genotypes for the kdr or Ace1R alleles. Mixing repellents and organophosphates on bed nets could be used to control insecticide-resistant malaria vectors if residual activity of the mixture is extended and safety is verified.
Outbreak among US-bound Hmong
Refugees, Thailand, 2005
PDF Version [PDF - 178 KB - 7 pages]
J. E. Oeltmann et al.View Abstract
In January 2005, tuberculosis (TB), including multidrug-resistant TB (MDR TB), was reported among Hmong refugees who were living in or had recently immigrated to the United States from a camp in Thailand. We investigated TB and drug resistance, enhanced TB screenings, and expanded treatment capacity in the camp. In February 2005, 272 patients with TB (24 MDR TB) remained in the camp. Among 17 MDR TB patients interviewed, 13 were found to be linked socially. Of 23 MDR TB isolates genotyped, 20 were similar according to 3 molecular typing methods. Before enhanced screening was implemented, 46 TB cases (6 MDR TB) were diagnosed in the United States among 9,455 resettled refugees. After enhanced screening had begun, only 4 TB cases (1 MDR TB), were found among 5,705 resettled refugees. An MDR TB outbreak among US-bound refugees led to importation of disease; enhanced pre-immigration TB screening and treatment decreased subsequent importation.
Medscape CME Activity
Antimicrobial Drug Use and Resistance in Europe PDF Version [PDF - 207 KB - 9 pages]N. van de Sande-Bruinsma et al.View Abstract
Our study confronts the use of antimicrobial agents in ambulatory care with the resistance trends of 2 major pathogens, Streptococcus pneumoniae and Escherichia coli, in 21 European countries in 2000–2005 and explores whether the notion that antimicrobial drug use determines resistance can be supported by surveillance data at national aggregation levels. The data obtained from the European Surveillance of Antimicrobial Consumption and the European Antimicrobial Resistance Surveillance System suggest that variation of consumption coincides with the occurrence of resistance at the country level. Linear regression analysis showed that the association between antimicrobial drug use and resistance was specific and robust for 2 of 3 compound pathogen combinations, stable over time, but not sensitive enough to explain all of the observed variations. Ecologic studies based on routine surveillance data indicate a relation between use and resistance and support interventions designed to reduce antimicrobial drug consumption at a national level in Europe.
Replacement of Sublineages of Avian Influenza (H5N1) by Reassortments, Sub-Saharan Africa
PDF Version [PDF - 227 KB - 5 pages]
A. A. Owoade et al.View Abstract
Eight new full-length sequences from highly pathogenic avian influenza viruses (H5N1) from 4 states in southwest Nigeria were analyzed. All gene sequences were more closely related to the first strains found in Nigeria in 2006 than to any strain found outside the country. Six viruses had evolved by at least 3 reassortment events (ACHA/NS, ACNS) from previously identified sublineages A (EMA 2) and C (EMA 1). Our results suggest that highly pathogenic avian influenza viruses (H5N1) initially imported into Nigeria in 2006 have been gradually replaced by various reassortments. In all reassortants, nonstructural genes were derived from sublineage C with 2 characteristic amino acids (compared with sublineage A). If the high prevalence of reassortants was typical for West Africa in 2007, the absence of such reassortants anywhere else suggests that reintroductions of influenza A (H5N1) from Africa into Eurasia must be rare.
Domestic Pigs and Japanese Encephalitis Virus Infection, Australia
PDF Version [PDF - 211 KB - 3 pages]
A. F. van den Hurk et al.View Abstract
To determine whether relocating domestic pigs, the amplifying host of Japanese encephalitis virus (JEV), decreased the risk for JEV transmission to humans in northern Australia, we collected mosquitoes for virus detection. Detection of JEV in mosquitoes after pig relocation indicates that pig relocation did not eliminate JEV risk.
Influenza Virus (H5N1) in Live Bird Markets and Food Markets, Thailand
PDF Version [PDF - 418 KB - 4 pages]
A. Amonsin et al.View Abstract
A surveillance program for influenza A viruses (H5N1) was conducted in live bird and food markets in central Thailand during July 2006–August 2007. Twelve subtype H5N1 viruses were isolated. The subtype H5N1 viruses circulating in the markets were genetically related to those that circulated in Thailand during 2004–2005.
Successful Treatment of Disseminated Acanthamoeba sp. Infection with Miltefosine
PDF Version [PDF - 301 KB - 4 pages]
A. C. Aichelburg et al.View Abstract
We report on an HIV-negative but immunocompromised patient with disseminated acanthamoebiasis, granulomatous amoebic encephalitis, and underlying miliary tuberculosis and tuberculous meningitis. The patient responded favorably to treatment with miltefosine, an alkylphosphocholine. The patient remained well with no signs of infection 2 years after treatment cessation.
Delinquent Mortgages, Neglected Swimming Pools, and West Nile Virus, California
PDF Version [PDF - 262 KB - 3 pages]
W. Reisen et al.View Abstract
Adjustable rate mortgages and the downturn in the California housing market caused a 300% increase in notices of delinquency in Bakersfield, Kern County. This led to large numbers of neglected swimming pools, which were associated with a 276% increase in the number of human West Nile virus cases during the summer of 2007.
Use of Malaria Rapid Diagnostic Test to Identify Plasmodium knowlesi Infection
PDF Version [PDF - 371 KB - 3 pages]
T. F. McCutchan et al.View Abstract
Reports of human infection with Plasmodium knowlesi, a monkey malaria, suggest that it and other nonhuman malaria species may be an emerging health problem. We report the use of a rapid test to supplement microscopic analysis in distinguishing the 5 malaria species that infect humans.
Phylogenetics and Pathogenesis of Early Avian Influenza Viruses (H5N1), Nigeria
PDF Version [PDF - 236 KB - 3 pages]
C. O. Aiki-Raji et al.View Abstract
Three highly pathogenic avian influenza subtype H5N1 and 4 Newcastle disease viruses were isolated from sick or dead chickens in southwestern Nigeria. Sequencing and phylogenetic analysis placed them within H5N1 subclade 2.2.2. Intravenous and intranasal pathogenicity tests produced systemic disease with vascular endothelial cell tropism in chickens.
Growth and Geographic Variation in Hospitalizations with Resistant Infections, United States, 2000–2005
PDF Version [PDF - 131 KB - 3 pages]
M. D. Zilberberg et al.View Abstract
From 2000 through 2005, hospitalizations with resistant infections (methicillin-resistant Staphylococcus aureus, Clostridium difficile–associated disease, vancomycin-resistant enterococcus, Pseudomonas aeruginosa, and Candida infection) nearly doubled, from 499,702 to 947,393. Regional variations noted in the aggregate and by individual infection may help clarify modifiable risk factors driving these infections.
Pyemotes ventricosus Dermatitis, Southeastern France
PDF Version [PDF - 190 KB - 3 pages]
P. Del Giudice et al.View Abstract
We investigated 42 patients who had unusual pruritic dermatitis associated with a specific clinical sign (comet sign) in 23 houses in southeastern France from May through September 2007. Pyemotes ventricosus, a parasite of the furniture beetle Anobium punctatum, was the cause of this condition.
Change in Japanese Encephalitis Virus Distribution,Thailand
PDF Version [PDF - 170 KB - 4 pages]
N. Nitatpattana et al.View Abstract
Japanese encephalitis virus (JEV) genotypes in Thailand were studied in pigs and mosquitoes collected near houses of confirmed human JEV cases in 2003–2005. Twelve JEV strains isolated belonged to genotype I, which shows a switch from genotype III incidence that started during the 1980s.
Role of Human Polyomaviruses in Respiratory Tract Disease in Young Children
PDF Version [PDF - 98 KB - 3 pages]
R. L. Wattier et al.View Abstract
KI virus was detected in respiratory secretions of 8/367 (2.2%) symptomatic and 0/96 asymptomatic children (p = 0.215). WU virus was detected in 26/367 (7.1%) symptomatic and 6/96 (6.3%) asymptomatic children (p = 1.00). These human polyomaviruses may not independently cause respiratory tract disease in young children.
Identification of Potential Environmentally Adapted Campylobacter jejuni Strain, United Kingdom
PDF Version [PDF - 192 KB - 5 pages]
W. Sopwith et al.View Abstract
In a study of Campylobacter infection in northwestern England, 2003–2006, C. jejuni multilocus sequence type (ST)–45 was associated with early summer onset and was the most prevalent C. jejuni type in surface waters. ST-45 is likely more adapted to survival outside a host, making it a key driver of transmission between livestock, environmental, and human settings.
Porcine Respiratory and Reproductive Syndrome Virus Variants, Vietnam and China, 2007
PDF Version [PDF - 217 KB - 3 pages]
Q. Hu et al.View Abstract
We characterized isolates from porcine respiratory and reproductive syndrome virus epidemics in Vietnam and China in 2007. These isolates showed ≈99% identity at the genomic level. Genetic analysis indicated that they share a discontinuous deletion of 30 aa in nonstructural protein 2, which indicates that identical variants emerged in Vietnam and China.
Possible New Hepatitis B Virus Genotype, Southeast Asia
PDF Version [PDF - 284 KB - 4 pages]
C. M. Olinger et al.View Abstract
We conducted a phylogenetic analysis of 19 hepatitis B virus strains from Laos that belonged to 2 subgenotypes of a new genotype I. This emerging new genotype likely developed outside Southeast Asia and is now found in mixed infections and in recombinations with local strains in a geographically confined region.
Tourism and Specific Risk Areas for Cryptococcus gattii, Vancouver Island, Canada
PDF Version [PDF - 121 KB - 3 pages]
C. Chambers et al.View Abstract
We compared travel histories of case-patients with Cryptococcus gattii infection during 1999–2006 to travel destinations of the general public on Vancouver Island, British Columbia, Canada. Findings validated and refined estimates of risk on the basis of place of residence and showed no spatial progression of risk areas on this island over time.
Metagenomic Diagnosis of Bacterial Infections
PDF Version [PDF - 115 KB - 3 pages]
S. Nakamura et al.View Abstract
To test the ability of high-throughput DNA sequencing to detect bacterial pathogens, we used it on DNA from a patient’s feces during and after diarrheal illness. Sequences showing best matches for Campylobacter jejuni were detected only in the illness sample. Various bacteria may be detectable with this metagenomic approach.
Prevalence and Pathogenicity of WU and KI Polyomaviruses in Children, the Netherlands
PDF Version [PDF - 104 KB - 3 pages]
M. M. van der Zalm et al.View Abstract
A longitudinal study in 2004 and 2005 detected polyomaviruses WU and KI in 44% and 17% of children with and without respiratory symptoms, respectively, in the Netherlands. In some children both viruses were detected for long periods. In several symptomatic children no other respiratory pathogen was detected.
New Foci of Buruli Ulcer, Angola and Democratic Republic of Congo
PDF Version [PDF - 136 KB - 3 pages]
K. Kibadi et al.View Abstract
We report 3 patients with laboratory-confirmed Buruli ulcer in Kafufu/Luremo, Angola, and Kasongo-Lunda, Democratic Republic of Congo. These villages are near the Kwango/Cuango River, which flows through both countries. Further investigation of artisanal alluvial mining as a risk factor for Buruli ulcer is recommended.
Novel Human Rhinoviruses and Exacerbation of Asthma in Children
PDF Version [PDF - 127 KB - 4 pages]
N. Khetsuriani et al.View Abstract
To determine links between human rhinoviruses (HRV) and asthma, we used data from a case–control study, March 2003–February 2004, among children with asthma. Molecular characterization identified several likely new HRVs and showed that association with asthma exacerbations was largely driven by HRV-A and a phylogenetically distinct clade of 8 strains, genogroup C.
Methicillin-Resistant Staphylococcus aureus in a Beauty Salon, the Netherlands
PDF Version [PDF - 107 KB - 3 pages]
X. W. Huijsdens et al.View Abstract
An outbreak of community-associated USA300 methicillin-resistant Staphylococcus aureus occurred in a beautician and 2 of her customers. Eight other persons, who were either infected (n = 5) or colonized (n = 3), were linked to this outbreak, including a family member, a household contact, and partners of customers.
Unusual Cryptosporidium Genotypes in Human Cases of Diarrhea
PDF Version [PDF - 132 KB - 3 pages]
G. Robinson et al.View Abstract
Several Cryptosporidium spp. are known to infect humans, but most cases of illness are caused by Cryptosporidium hominis or C. parvum. During a long-term genotyping in the United Kingdom, we identified 3 unusual Cryptosporidium genotypes (skunk, horse, and rabbit) in human patients with diarrhea.
Shiga Toxin–producing Escherichia coli Serogroups in Food and Patients, Germany
PDF Version [PDF - 145 KB - 4 pages]
D. Werber et al.View Abstract
We compared 61 Shiga toxin–producing Escherichia coli (STEC) serogroups from 448 food isolates with 71 STEC serogroups from 1,447 isolates from patients in Germany. Two thirds (41/61), representing 72% of food isolates, were also found in patients. Serogroups typically isolated from patients with hemolytic uremic syndrome were rarely found in food.
Paralysis Case and Contact Spread of Recombinant Vaccine–derived Poliovirus, Spain
PDF Version [PDF - 144 KB - 3 pages]
A. Avellón et al.
Widespread Oseltamivir Resistance in Influenza A Viruses (H1N1), South Africa
PDF Version [PDF - 121 KB - 2 pages]
T. G. Besselaar et al.
Human Parvovirus 4 in Kidney Transplant Patients, France
PDF Version [PDF - 137 KB - 2 pages]
P. Biagini et al.
Establishment of Biomphalaria tenagophila Snails in Europe
PDF Version [PDF - 185 KB - 3 pages]
G. Majoros et al.
Rickettsia aeschlimannii Infection, Algeria
PDF Version [PDF - 216 KB - 2 pages]
N. Mokrani et al.
Severe Malaria and Artesunate Treatment, Norway
PDF Version [PDF - 185 KB - 3 pages]
K. Mørch et al.
Bacteremia Caused by Mycobacterium wolinskyi
PDF Version [PDF - 172 KB - 2 pages]
Y. Chen et al.
Incubation Period for Human Cases of Avian Influenza A (H5N1) Infection, China
PDF Version [PDF - 137 KB - 3 pages]
Y. Huai et al.
Mycobacterium haemophilum Infection after Alemtuzumab Treatment
PDF Version [PDF - 146 KB - 3 pages]
M. Kamboj et al.
Prior Evidence of Putative Novel Rhinovirus Species, Australia
PDF Version [PDF - 149 KB - 3 pages]
I. M. Mackay et al.
Books and Media
Food-Borne Viruses: Progress and Challenges
PDF Version [PDF - 113 KB - 1 page]
Searching Eyes: Privacy, the State, and Disease Surveillance in America
PDF Version [PDF - 118 KB - 2 pages]
K. F. Gensheimer
Emerging Pests and Vector-borne Diseases in Europe
PDF Version [PDF - 185 KB - 2 pages]
A. Van Gompel and W. Van Bortel
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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: November 18, 2010
- Page last updated: November 18, 2010
- Page last reviewed: November 18, 2010
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
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