Volume 14, Number 3—March 2008
Volume 14, Number 3—March 2008 PDF Version [PDF - 5.24 MB - 179 pages]
Rescinding Community Mitigation Strategies in an Influenza Pandemic
PDF Version [PDF - 582 KB - 8 pages]
V. J. Davey and R. J. GlassView Abstract
Using a networked, agent-based computational model of a stylized community, we evaluated thresholds for rescinding 2 community mitigation strategies after an influenza pandemic. We ended child sequestering or all-community sequestering when illness incidence waned to thresholds of 0, 1, 2, or 3 cases in 7 days in 2 levels of pandemic severity. An unmitigated epidemic or strategy continuation for the epidemic duration served as control scenarios. The 0-case per 7-day rescinding threshold was comparable to the continuation strategy on infection and illness rates but reduced the number of days strategies would be needed by 6% to 32% in mild or severe pandemics. If cases recurred, strategies were resumed at a predefined 10-case trigger, and epidemic recurrence was thwarted. Strategies were most effective when used with high compliance and when combined with stringent rescinding thresholds. The need for strategies implemented for control of an influenza pandemic was reduced, without increasing illness rates.
Mycobacterium ulcerans Disease, Peru
PDF Version [PDF - 271 KB - 5 pages]
H. Guerra et al.View Abstract
Eight adult patients (ages 18–58, 5 women) with Buruli ulcer (BU) confirmed by at least 2 diagnostic methods were seen in a 10-year period. Attempts to culture Mycobacterium ulcerans failed. Five patients came from jungle areas, and 3 from the swampy northern coast of Peru. The patients had 1–5 lesions, most of which were on the lower extremities. One patient had 5 clustered gluteal lesions; another patient had 2 lesions on a finger. Three patients were lost to follow-up. All 5 remaining patients had moderate disease. Diverse treatments (antituberculous drugs, World Health Organization [WHO] recommended antimicrobial drug treatment for BU, and for 3 patients, excision surgery) were successful. Only 1 patient (patient 7) received the specific drug treatment recommended by WHO. BU is endemic in Peru, although apparently infrequent. Education of populations and training of health workers are first needed to evaluate and understand the full extent of BU in Peru.
Multicenter Cross-Sectional Study of Nontuberculous Mycobacterial Infections among Cystic Fibrosis Patients, Israel
PDF Version [PDF - 178 KB - 7 pages]
I. Levy et al.View Abstract
This 2-year cross-sectional evaluation of nontuberculous mycobacterial (NTM) infections involved all Israeli medical centers that treat cystic fibrosis patients. The study comprised 186 patients whose sputum was analyzed for NTM. The prevalence of NTM isolates was 22.6%, and 6.5% and 10.8% of the patients fulfilled the 1997 and 2007 American Thoracic Society criteria for NTM lung disease, respectively. Mycobacterium simiae (40.5%), M. abscessus (31.0%), and M. avium complex (14.3%) were the most prevalent. Presence of Aspergillus spp. in sputum and the number of sputum specimens processed for mycobacteria were the most significant predictors for isolation of NTM (odds ratio [OR] = 5.14, 95% confidence interval [CI] 1.87–14.11 and OR = 1.47, 95% CI 1.17–1.85, respectively). The incidence of NTM pulmonary infections is increasing among cystic fibrosis patients, reflecting the increase in longevity of such patients as well as environmental exposure to various species of mycobacteria.
Mycobacterium xenopi Clinical Relevance and Determinants, the Netherlands
PDF Version [PDF - 185 KB - 5 pages]
J. van Ingen et al.View Abstract
In the Netherlands, isolation of Mycobacterium xenopi is infrequent, and its clinical relevance is often uncertain. To determine clinical relevance and determinants, we retrospectively reviewed medical files of all patients in the Netherlands in whom M. xenopi was isolated from January 1999 through March 2005 by using diagnostic criteria for nontuberculous mycobacterial infection published by the American Thoracic Society. We found 49 patients, mostly white men, with an average age of 60 years and pre-existing pulmonary disease; of these patients, 25 (51%) met the diagnostic criteria. Mycobacterial genotype, based on 16S rRNA gene sequencing, was associated with true infection. Most infections were pulmonary, but pleural and spinal infections (spinal in HIV-infected patients) were also noted. Treatment regimens varied in content and duration; some patients were overtreated and some were undertreated.
Epidemiology of Nontuberculous Mycobacteria in Patients without HIV Infection, New York City
PDF Version [PDF - 190 KB - 7 pages]
E. E. Bodle et al.View Abstract
We reviewed medical records of patients without known HIV and with positive cultures for nontuberculous mycobacteria (NTM) isolated during 2000–2003 from 1 large hospital in New York, New York. Overall, 505 patients had positive NTM cultures; 119 (24%) met the criteria for NTM disease. The difference between demographic characteristics of case-patients in our study (66% female, 61% white, and 59% >60 years of age) and those of the base population as determined by regional census data was statistically significant. Estimated incidences for positive cultures, all disease, and respiratory tract disease were 17.7, 2.7, and 2.0 per 100,000 persons, respectively. More patients with rapidly growing mycobacteria (61%), Mycobacterium kansasii (70%), or M. marinum (100%) met criteria for disease than did patients with M. avium complex (MAC) (27%, (p<0.01). NTM disease in patients without HIV is increasing. Laboratory-based surveillance may be useful for detecting non-MAC and non–respiratory tract disease.
Exposure to Novel Parainfluenza Virus and Clinical Relevance in 2 Bottlenose Dolphin (Tursiops truncatus) Populations
PDF Version [PDF - 342 KB - 9 pages]
S. Venn-Watson et al.View Abstract
Parainfluenza virus (PIV) is a leading cause of respiratory infections in humans. A novel virus closely related to human and bovine parainfluenza viruses types 3 (HPIV-3 and BPIV-3), named Tursiops truncatus parainfluenza virus type 1 (TtPIV-1), was isolated from a dolphin with respiratory disease. We developed a dolphin-specific ELISA to measure acute- and convalescent-phase PIV antibodies in dolphins during 1999–2006 with hemograms similar to that of the positive control. PIV seroconversion occurred concurrently with an abnormal hemogram in 22 animals, of which 7 (31.8%) had respiratory signs. Seroprevalence surveys were conducted on 114 healthy bottlenose dolphins in Florida and California. When the most conservative interpretation of positive was used, 11.4% of healthy dolphins were antibody positive, 29.8% were negative, and 58.8% were inconclusive. PIV appears to be a common marine mammal virus that may be of human health interest because of the similarity of TtPIV-1 to BPIV-3 and HPIV-3.
Hantavirus RNA in Saliva from Patients with Hemorrhagic Fever with Renal Syndrome
PDF Version [PDF - 342 KB - 6 pages]
L. Pettersson et al.View Abstract
Hantaviruses cause 2 zoonotic diseases, hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome. Infection is usually initiated after inhalation of virus-contaminated rodent excreta. In addition to the zoonotic infection route, growing evidence suggests person-to-person transmission of Andes virus. For this reason, we studied whether saliva from HFRS patients contained hantavirus. During an outbreak in northern Sweden of nephropathia epidemica (NE), a milder form of hemorrhagic fever with renal syndrome, we collected saliva and plasma from 14 hospitalized NE patients with verified Puumala virus (PUUV) infection. PUUV RNA was detected in saliva from 10 patients (range 1,530–121,323 PUUV RNA copies/mL) by quantitative reverse transcription–PCR. The PUUV S-segment sequences from saliva and plasma of the same patients were identical. Our data show that hantavirus RNA could be detected in human saliva several days after onset of disease symptoms and raise the question whether interhuman transmission of hantavirus may occur through saliva.
Increased Mortality Rate Associated with Chikungunya Epidemic, Ahmedabad, India
PDF Version [PDF - 177 KB - 4 pages]
D. Mavalankar et al.
Chikungunya Fever in Travelers Returning to Europe from the Indian Ocean Region, 2006
PDF Version [PDF - 249 KB - 7 pages]
M. Panning et al.View Abstract
Chikungunya fever has spread through several Indian Ocean islands and India, including popular travel destinations. To compare usefulness of diagnostic tests and to understand reasons for the magnitude and severity of an outbreak, we used 3 diagnostic methods to test 720 samples from 680 patients returning to Europe from the Indian Ocean region in 2006. Chikungunya infection was confirmed for 24.4% patients in the first half of the year and for 9.9% in the second half. Reverse transcription–PCR was positive for all samples taken up to day 4 after symptom onset. Immunofluorescence detected immunoglobulin (Ig) M on day 1 and IgG on day 2 for some patients, and in all patients from day 5 onward. Soon after onset of symptoms, patients had IgG and IgM and high viral loads (some >109 copies/mL plasma). These data will help healthcare providers select diagnostic tests for returning travelers.
High Rate of Mobilization for blas
PDF Version [PDF - 253 KB - 6 pages]
M. Barlow et al.View SummaryView Abstract
The blaCTX-Ms have been mobilized to plasmids more frequently than other class A β-lactamases.
We constructed a phylogenetic analysis of class A β-lactamases and found that the blaCTX-Ms have been mobilized to plasmids ≈10 times more frequently than other class A β-lactamases. We also found that the blaCTX-Ms are descended from a common ancestor that was incorporated in ancient times into the chromosome of the ancestor of Kluyvera species through horizontal transfer. Considerable sequence divergence has occurred among the descendents of that ancestral gene sequence since that gene was inserted. That divergence has mainly occurred in the presence of purifying selection, which indicates a slow rate of evolution for blaCTX-Ms in the pre–antimicrobial drug era.
Integrated Food Chain Surveillance System for Salmonella spp. in Mexico
PDF Version [PDF - 385 KB - 7 pages]
M. B. Zaidi et al.View Abstract
Few developing countries have foodborne pathogen surveillance systems, and none of these integrates data from humans, food, and animals. We describe the implementation of a 4-state, integrated food chain surveillance system (IFCS) for Salmonella spp. in Mexico. Significant findings were 1) high rates of meat contamination (21.3%–36.4%), 2) high rates of ceftriaxone-resistant S. Typhimurium in chicken, ill humans, and swine (77.3%, 66.3%, and 40.4% of S. Typhimurium T isolates, respectively), and 3) the emergence of ciprofloxacin resistance in S. Heidelberg (10.4%) and S. Typhimurium (1.7%) from swine. A strong association between Salmonella spp. contamination in beef and asymptomatic Salmonella spp. infection was only observed in the state with the lowest poverty level (Pearson r = 0.91, p<0.001). Pulsed-field gel electrophoresis analysis of 311 S. Typhimurium isolates showed 14 clusters with 102 human, retail meat, and food-animal isolates with indistinguishable patterns. An IFCS is technically and economically feasible in developing countries and can effectively identify major public health priorities.
Genetic Variability of West Nile Virus in US Blood Donors, 2002–2005
PDF Version [PDF - 341 KB - 9 pages]
A. Grinev et al.View Abstract
West Nile virus (WNV) was detected in the United States in 1999, has reoccurred every summer since, and has become endemic. Transfusion transmission was documented in 2002, and screening of blood donations for WNV began in 2003. We investigated genetic variation of WNV in human isolates obtained from specimens collected from 30 infected blood donors who tested positive for WNV RNA during 2002–2005. Complete genomic sequences of 8 isolates and structural gene sequences from 22 additional isolates were analyzed. We found some genetic diversity in isolates from different geographic regions and genetic divergence from reported sequences from epidemics in 1999–2001. Nucleotide divergence of structural genes showed a small increase from 2002 (0.18%) to 2005 (0.37%), suggesting absence of strong selective pressure and limited genetic evolution of WNV during that period. Nevertheless, WNV has continued to diverge from precursor isolates as geographic distribution of the virus has expanded.
Discovering and Differentiating New and Emerging Clonal Populations of Chlamydia trachomatis with a Novel Shotgun Cell Culture Harvest Assay
PDF Version [PDF - 410 KB - 9 pages]
N. Somboonna et al.View Abstract
Chlamydia trachomatis is the leading cause of preventable blindness and bacterial sexually transmitted diseases worldwide. Plaque assays have been used to clonally segregate laboratory-adapted C. trachomatis strains from mixed infections, but no assays have been reported to segregate clones from recent clinical samples. We developed a novel shotgun cell culture harvest assay for this purpose because we found that recent clinical samples do not form plaques. Clones were strain-typed by using outer membrane protein A and 16S rRNA sequences. Surprisingly, ocular trachoma reference strain A/SA-1 contained clones of Chlamydophila abortus. C. abortus primarily infects ruminants and pigs and has never been identified in populations where trachoma is endemic. Three clonal variants of reference strain Ba/Apache-2 were also identified. Our findings reflect the importance of clonal isolation in identifying constituents of mixed infections containing new or emerging strains and of viable clones for research to more fully understand the dynamics of in vivo strain-mixing, evolution, and disease pathogenesis.
Molecular Epidemiology of Eastern Equine Encephalitis Virus, New York
PDF Version [PDF - 331 KB - 7 pages]
D. S. Young et al.View SummaryView Abstract
Southern strains are undergoing amplification, perpetuation, and overwintering in New York.
Perpetuation, overwintering, and extinction of eastern equine encephalitis virus (EEEV) in northern foci are poorly understood. We therefore sought to describe the molecular epidemiology of EEEV in New York State during current and past epizootics. To determine whether EEEV overwinters, is periodically reintroduced, or both, we sequenced the E2 and partial NSP3 coding regions of 42 EEEV isolates from New York State and the Eastern Seaboard of the United States. Our phylogenetic analyses indicated that derived subclades tended to contain southern strains that had been isolated before genetically similar northern strains, suggesting southern to northern migration of EEEV along the Eastern Seaboard. Strong clustering among strains isolated during epizootics in New York from 2003–2005, as well as from 1974–1975, demonstrates that EEEV has overwintered in this focus. This study provides molecular evidence for the introduction of southern EEEV strains to New York, followed by local amplification, perpetuation, and overwintering.
Transmission of Equine Influenza Virus to English Foxhounds
PDF Version [PDF - 289 KB - 4 pages]
J. M. Daly et al.View Abstract
We retrospectively demonstrated that an outbreak of severe respiratory disease in a pack of English foxhounds in the United Kingdom in September 2002 was caused by an equine influenza A virus (H3N8). We also demonstrated that canine respiratory tissue possesses the relevant receptors for infection with equine influenza virus.
Screening Pneumonia Patients for Mimivirus
PDF Version [PDF - 293 KB - 3 pages]
R. K. Dare et al.View Abstract
Acanthamoeba polyphaga mimivirus (APM), a virus of free-living amebae, has reportedly caused human respiratory disease. Using 2 newly developed real-time PCR assays, we screened 496 respiratory specimens from 9 pneumonia-patient populations for APM. This virus was not detected in any specimen, which suggests it is not a common respiratory pathogen.
Protective Effect of Maritime Quarantine in South Pacific Jurisdictions, 1918–19 Influenza Pandemic
PDF Version [PDF - 245 KB - 3 pages]
M. A. McLeod et al.View Abstract
We reviewed mortality data of the 1918–19 influenza pandemic for 11 South Pacific Island jurisdictions. Four of these appear to have successfully delayed or excluded the arrival of pandemic influenza by imposing strict maritime quarantine. They also experienced lower excess death rates than the other jurisdictions that did not apply quarantine measures.
Dolphin Morbillivirus Epizootic Resurgence, Mediterranean Sea
PDF Version [PDF - 233 KB - 3 pages]
J. Raga et al.View Abstract
In July 2007, >100 striped dolphins, Stenella coeruleoalba, were found dead along the coast of the Spanish Mediterranean. Of 10 dolphins tested, 7 were positive for a virus strain closely related to the dolphin morbillivirus that was isolated during a previous epizootic in 1990.
Gastroenteritis Outbreak at Holiday Resort, Central Italy
PDF Version [PDF - 459 KB - 5 pages]
G. Migliorati et al.View Abstract
During the summer of 2003, a gastroenteritis outbreak spread throughout a holiday resort in central Italy. Fecally contaminated groundwater and seawater were leaking into the non–drinking-water system, which was found to be connected to the drinking-water system of a large resort. This contamination had a primary role in the onset of the outbreak and spread of the infection.
Methicillin-Resistant and -Susceptible Staphylococcus aureus Sequence Type 398 in Pigs and Humans
PDF Version [PDF - 331 KB - 5 pages]
A. van Belkum et al.View Abstract
Methicillin-resistant Staphylococcus aureus sequence type 398 (ST398 MRSA) was identified in Dutch pigs and pig farmers. ST398 methicillin-susceptible S. aureus circulates among humans at low frequency (0.2%) but was isolated in 3 human cases of bacteremia (2.1%; p = 0.026). Although its natural host is probably porcine, ST398 MRSA likely causes infections in humans.
Hemagglutinating Encephalomyelitis Coronavirus Infection in Pigs, Argentina
PDF Version [PDF - 354 KB - 3 pages]
M. A. Quiroga et al.View Abstract
We describe an outbreak of vomiting, wasting, and encephalomyelitis syndrome in piglets in Argentina, caused by porcine hemagglutinating encephalomyelitis coronavirus (PHE-CoV) infection. Diagnosis was made by epidemiologic factors, pathologic features, immunohistochemistry, reverse transcription–PCR, and genomic sequencing. This study documents PHE-CoV infection in South America.
Highly Pathogenic Avian Influenza Virus (H5N1) in Domestic Poultry and Relationship with Migratory Birds, South Korea
PDF Version [PDF - 441 KB - 4 pages]
Y. Lee et al.View Abstract
During the 2006–2007 winter season in South Korea, several outbreaks of highly pathogenic avian influenza virus (H5N1) were confirmed among domestic poultry and in migratory bird habitats. Phylogenetic analysis showed that all isolates were closely related and that all belong to the A/bar-headed goose/Qinghai/5/2005–like lineage rather than the A/chicken/Korea/ES/2003–like lineage.
Mutations in Influenza A Virus (H5N1) and Possible Limited Spread, Turkey, 2006
PDF Version [PDF - 231 KB - 2 pages]
E. Altiok et al.View Abstract
We report mutations in influenza A virus (H5N1) strains associated with 2 outbreaks in Turkey. Four novel amino acid changes (Q447L, N556K, and R46K in RNA polymerase and S133A in hemagglutinin) were detected in virus isolates from 2 siblings who died.
Ciprofloxacin-Resistant Salmonella enterica Serotype Typhimurium, China
PDF Version [PDF - 254 KB - 3 pages]
S. Cui et al.View Abstract
We characterized 44 Salmonella enterica serotype Typhimurium isolates from Tongji Hospital outpatients in Wuhan, China, May 2002–October 2005. All 31 ciprofloxacin-resistant isolates were also resistant to >8 other antimicrobial drugs and carried >2 mutations in GyrA and 1 mutation in ParC. Class 1 integrons were identified in 37 isolates.
Geographic Linkage and Variation in Cryptosporidium hominis
PDF Version [PDF - 225 KB - 3 pages]
R. M. Chalmers et al.View Abstract
UK Cryptosporidium hominis isolates have previously shown slight PCR fragment length polymorphism at multiple loci. To further investigate transmission, we conducted a case–control study and sequenced the GP60 locus from 115 isolates. Nine subtypes were identified; IbA10G2 predominated. Having a non-IbA10G2 subtype was significantly linked to recent travel outside Europe.
Low Frequency of Infection with Avian Influenza Virus (H5N1) among Poultry Farmers, Thailand, 2004
S. Hinjoy et al.View Abstract
In Thai provinces where avian influenza outbreaks in poultry had been confirmed in the preceding 6 months, serum from 322 poultry farmers was tested for antibodies to avian influenza virus subtype H5N1 by microneutralization assay. No study participant met the World Health Organization serologic criteria for confirmed infection.
Sylvatic Dengue Virus Type 2 Activity in Humans, Nigeria, 1966
PDF Version [PDF - 223 KB - 3 pages]
N. Vasilakis et al.View Abstract
Using phylogenetic analysis of complete virus genomes from human isolates obtained in Nigeria in 1966, we identified sylvatic dengue virus (DENV) strains from 3 febrile patients. This finding extends current understanding of the role of sylvatic DENV in febrile disease and documents another focus of sylvatic DENV transmission in West Africa.
Leptospirosis-associated Severe Pulmonary Hemorrhagic Syndrome, Salvador, Brazil
PDF Version [PDF - 180 KB - 4 pages]
E. L. Gouveia et al.View Abstract
We report the emergence of leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS) in slum communities in Salvador, Brazil. Although active surveillance did not identify SPHS before 2003, 47 cases were identified from 2003 through 2005; the case-fatality rate was 74%. By 2005, SPHS caused 55% of the deaths due to leptospirosis.
Pandemic Influenza, Reopening Schools, and Returning to Work
PDF Version [PDF - 191 KB - 2 pages]
M. I. MeltzerView Abstract
In this issue of Emerging Infectious Diseases, Victoria Davey and Robert Glass present a paper (1) in which they consider the question of when to “switch off” community-based interventions designed to reduce the spread of pandemic influenza. These authors attempt to answers questions such as when it would be optimal to reopen schools that have been closed as part of a nonpharmaceutical, communitywide influenza mitigation strategy.
On Rickettsia Nomenclature
PDF Version [PDF - 126 KB - 1 page]
R. F. Massung et al.
Dengue Virus, Nepal
PDF Version [PDF - 109 KB - 2 pages]
B. D. Pandey et al.
Human Tuberculosis Caused by Mycobacterium bovis, Taiwan
PDF Version [PDF - 114 KB - 3 pages]
R. Jou et al.
Marine Mammal Brucella Genotype Associated with Zoonotic Infection
PDF Version [PDF - 109 KB - 2 pages]
A. M. Whatmore et al.
Ehrlichia chaffeensis in Child, Venezuela
PDF Version [PDF - 159 KB - 2 pages]
M. C. Martínez et al.
Resource Allocation during an Influenza Pandemic
PDF Version [PDF - 167 KB - 1 page]
K. Paranthaman et al.
Novel Relapsing Fever Spirochete in Bat Tick
PDF Version [PDF - 126 KB - 2 pages]
J. S. Gill et al.
KI and WU Polyomaviruses in Children, France
PDF Version [PDF - 141 KB - 3 pages]
V. Foulongne et al.
Milk Replacers and Bovine Spongiform Encephalopathy in Calves, Japan
PDF Version [PDF - 117 KB - 2 pages]
T. Tsutsui et al.
Control of Hepatitis A by Universal Vaccination of Adolescents, Puglia, Italy
PDF Version [PDF - 129 KB - 3 pages]
P. L. Lopalco et al.
Human Rickettsia sibirica mongolitimonae Infection, Spain
PDF Version [PDF - 114 KB - 2 pages]
K. Aguirrebengoa et al.
Lymphangitis in a Portuguese Patient Infected with Rickettsia sibirica
PDF Version [PDF - 145 KB - 3 pages]
R. de Sousa et al.
Hospital Resources for Pandemic Influenza
PDF Version [PDF - 108 KB - 1 page]
M. P. Dailey
Multidrug-Resistant Acinetobacter baumannii Osteomyelitis from Iraq
PDF Version [PDF - 128 KB - 3 pages]
J. J. Schafer and J. E. Mangino
Books and Media
Cold War, Deadly Fevers: Malaria Eradication in Mexico, 1955–1975
PDF Version [PDF - 107 KB - 1 page]
P. M. Arguin
Parasites and Infectious Diseases: Discovery by Serendipity and Otherwise
PDF Version [PDF - 187 KB - 2 pages]
C. Ben Beard
About the Cover
News and Notes
- Page created: September 10, 2013
- Page last updated: February 26, 2015
- Page last reviewed: February 26, 2015
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Office of the Director (OD)