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Volume 15, Number 10—October 2009
Volume 15, Number 10—October 2009 PDF Version [PDF - 7.03 MB - 171 pages]
A Model-based Assessment of Oseltamivir Prophylaxis Strategies to Prevent Influenza in Nursing Homes
PDF Version [PDF - 672 KB - 9 pages]
C. van den Dool et al.View Abstract
Prophylaxis with neuraminidase inhibitors is important for controlling seasonal influenza outbreaks in long-term care settings. We used a stochastic individual-based model that simulates influenza virus transmission in a long-term care nursing home department to study the protection offered to patients by different strategies of prophylaxis with oseltamivir and determined the effect of emerging resistance. Without resistance, postexposure and continuous prophylaxis reduced the patient infection attack rate from 0.19 to 0.13 (relative risk [RR] 0.67) and 0.05 (RR 0.23), respectively. Postexposure prophylaxis prevented more infections per dose (118 and 323 daily doses needed to prevent 1 infection, respectively) and required fewer doses per season than continuous prophylaxis. If resistance to oseltamivir was increased, both prophylaxis strategies became less efficacious and efficient, but postexposure prophylaxis posed a lower selection pressure for resistant virus strains. Extension of prophylaxis to healthcare workers offered little additional protection to patients.
Nontuberculous Mycobacteria Infections and Anti–Tumor Necrosis Factor-α Therapy
PDF Version [PDF - 425 KB - 6 pages]
K. L. Winthrop et al.View Abstract
Patients receiving anti–tumor necrosis factor-α (anti–TNF-α) therapy are at increased risk for tuberculosis and other granulomatous diseases, but little is known about illness caused by nontuberculous mycobacteria (NTM) in this setting. We reviewed the US Food and Drug Administration MedWatch database for reports of NTM disease in patients receiving anti–TNF-α therapy. Of 239 reports collected, 105 (44%) met NTM disease criteria. Median age was 62 years; the majority of patients (66, 65%) were female, and most (73, 70%) had rheumatoid arthritis. NTM infections were associated with infliximab (n = 73), etanercept (n = 25), and adalimumab (n = 7); most patients were taking prednisone (n = 68, 65%) or methotrexate (n = 58, 55%) concurrently. Mycobacteria avium (n = 52, 50%) was most commonly implicated, and 9 patients (9%) had died at the time their infections were reported. A high rate of extrapulmonary manifestations (n = 46, 44%) was also reported.
Nontuberculous Mycobacteria–associated Lung Disease in Hospitalized Persons, United States, 1998–2005
PDF Version [PDF - 690 KB - 8 pages]
M. E. Billinger et al.View Abstract
The prevalence and trends of pulmonary nontuberculous mycobacteria (NTM)–associated hospitalizations in the United States were estimated using national hospital discharge data. Records were extracted for all persons with a pulmonary NTM International Classification of Diseases code (031.0) hospitalized in the 11 states with continuous data available from 1998 through 2005. Prevalence was calculated using US census data. Pulmonary NTM hospitalizations (031.0) increased significantly with age among both sexes: relative prevalence for persons 70–79 years of age compared with those 40–49 years of age was 15/100,000 for women (9.4 vs. 0.6) and 9/100,000 for men (7.6 vs. 0.83). Annual prevalence increased significantly among men and women in Florida (3.2%/year and 6.5%/year, respectively) and among women in New York (4.6%/year) with no significant changes in California. The prevalence of pulmonary NTM–associated hospitalizations is increasing in selected geographic areas of the United States.
Mycobacterium tuberculosis Genotype and Case Notification Rates, Rural Vietnam, 2003–2006
PDF Version [PDF - 742 KB - 8 pages]
T. N. Buu et al.View Abstract
Tuberculosis case notification rates (CNRs) for young adults in Vietnam are increasing. To determine whether this finding could reflect emergence of Mycobacterium tuberculosis Beijing genotype, we studied all new sputum smear–positive pulmonary tuberculosis patients registered for treatment in 3 rural districts in Vietnam during 2003–2006. Beijing strain infections were more frequent in younger patients (15–24 years of age, 53%) than in older patients (31%; p<0.001). The increase in CNRs for youngest patients was larger for disease caused by the Beijing genotype than by other genotypes, but the difference was not significant. For patients 15–24 years of age, 85% of fluctuations in CNRs between years was caused by fluctuations in Beijing genotype infections compared with 53% and 23% in the groups 25–64 and >65 years of age, respectively (p<0.001). These findings suggest that young adults may be responsible for introducing Beijing strains into rural Vietnam.
Lack of Airborne Transmission during Outbreak of Pandemic (H1N1) 2009 among Tour Group Members, China, June 2009
PDF Version [PDF - 471 KB - 3 pages]
K. Han et al.View Abstract
During June 2–8, 2009, an outbreak of influenza A pandemic (H1N1) 2009 occurred among 31 members of a tour group in China. To identify the mode of transmission and risk factors, we conducted a retrospective cohort investigation. The index case-patient was a female tourist from the United States. Secondary cases developed in 9 (30%) tour group members who had talked with the index case-patient and in 1 airline passenger (not a tour group member) who had sat within 2 rows of her. None of the 14 tour group members who had not talked with the index case-patient became ill. This outbreak was apparently caused by droplet transmission during coughing or talking. That airborne transmission was not a factor is supported by lack of secondary cases among fellow bus and air travelers. Our findings highlight the need to prevent transmission by droplets and fomites during a pandemic.
Medscape CME Activity
Community-Associated Methicillin-Resistant Staphylococcus aureus, Iowa, USA PDF Version [PDF - 660 KB - 8 pages]P. Van De Griend et al.View SummaryView Abstract
The proportion of invasive methicillin-resistant Staphylococcus aureus infections caused by USA300 increased in 2006.
We performed antimicrobial drug susceptibility testing and molecular typing on invasive methicillin-resistant Staphylococcus aureus (MRSA) isolates (n = 1,666) submitted to the University of Iowa Hygienic Laboratory during 1999–2006 as part of a statewide surveillance system. All USA300 and USA400 isolates were resistant to <3 non–β-lactam antimicrobial drug classes. The proportion of MRSA isolates from invasive infections that were either USA300 or USA400 increased significantly from 1999–2005 through 2006 (p<0.0001). During 2006, the incidence of invasive community-associated (CA)–MRSA infections was highest in the summer (p = 0.0004). Age <69 years was associated with an increased risk for invasive CA-MRSA infection (odds ratio [OR] 5.1, 95% confidence interval [CI] 2.06–12.64), and hospital exposure was associated with decreased risk (OR 0.07, 95% CI 0.01–0.51).
Healthcare Worker Occupation and Immune Response to Pneumocystis jirovecii
PDF Version [PDF - 516 KB - 8 pages]
R. Tipirneni et al.View Abstract
The reservoir and mode of transmission of Pneumocystis jirovecii remain uncertain. We conducted a cross-sectional study of 126 San Francisco General Hospital staff in clinical (n = 103) and nonclinical (n = 23) occupations to assess whether occupational exposure was associated with immune responses to P. jirovecii. We examined antibody levels by ELISA for 3 overlapping fragments that span the P. jirovecii major surface glycoprotein (Msg): MsgA, MsgB, and MsgC1. Clinical occupation participants had higher geometric mean antibody levels to MsgC1 than did nonclinical occupation participants (21.1 vs. 8.2, p = 0.004); clinical occupation was an independent predictor of higher MsgC1 antibody levels (parameter estimate = 0.89, 95% confidence interval 0.29–1.48, p = 0.003). In contrast, occupation was not significantly associated with antibody responses to either MsgA or MsgB. Healthcare workers may have occupational exposure to P. jirovecii. Humans may be a reservoir for P. jirovecii and may transmit it from person to person.
Nosocomial Outbreak of Novel Arenavirus Infection, Southern Africa
PDF Version [PDF - 607 KB - 5 pages]
J. T. Paweska et al.View Abstract
A nosocomial outbreak of disease involving 5 patients, 4 of whom died, occurred in South Africa during September–October 2008. The first patient had been transferred from Zambia to South Africa for medical management. Three cases involved secondary spread of infection from the first patient, and 1 was a tertiary infection. A novel arenavirus was identified. The source of the first patient’s infection remains undetermined.
Review of an Influenza Surveillance System, Beijing, People’s Republic of China
PDF Version [PDF - 548 KB - 7 pages]
P. Yang et al.View Abstract
In 2007, a surveillance system for influenza-like illness (ILI) and virologic data was established in Beijing, China. The system tracked ILI and laboratory-confirmed influenza in 153 general hospitals from September 1, 2007, through April 30, 2008. To analyze the ILI surveillance data (weekly ILI rates and counts) and the effectiveness of the system, we used the US Centers for Disease Control and Prevention Early Aberration Reporting System. The data indicated that the highest rate of influenza isolation and the highest ILI count occurred in the first week of 2008. The system enabled us to detect the onset and peak of an epidemic.
Discriminatory Ability of Hypervariable Variable Number Tandem Repeat Loci in Population-based Analysis of Mycobacterium tuberculosis Strains, London, UK
PDF Version [PDF - 537 KB - 8 pages]
P. Velji et al.View Abstract
To address conflicting results about the stability of variable number tandem repeat (VNTR) loci and their value in prospective molecular epidemiology of Mycobacterium tuberculosis, we conducted a large prospective population-based analysis of all M. tuberculosis strains in a metropolitan setting. Optimal and reproducible conditions for reliable PCR and fragment analysis, comprising enzymes, denaturing conditions, and capillary temperature, were identified for a panel of hypervariable loci, including 3232, 2163a, 1982, and 4052. A total of 2,261 individual M. tuberculosis isolates and 265 sets of serial isolates were analyzed by using a standardized 15-loci VNTR panel, then an optimized hypervariable loci panel. The discriminative ability of loci varied substantially; locus VNTR 3232 varied the most, with 19 allelic variants and Hunter-Gaston index value of 0.909 unNN. Hypervariable loci should be included in standardized panels because they can provide consistent comparable results at multiple settings, provided the proposed conditions are adhered to.
Excess Deaths and Immunoprotection during 1918–1920 Influenza Pandemic, Taiwan
PDF Version [PDF - 523 KB - 3 pages]
Y. HsiehView Abstract
To determine the difference in age-specific immunoprotection during waves of influenza epidemics, we analyzed excess monthly death data for the 1918–1920 influenza pandemic in Taiwan. For persons 10–19 years of age, percentage of excess deaths was lowest in 1918 and significantly higher in 1920, perhaps indicating lack of immunoprotection from the first wave.
Rabies in Foxes, Aegean Region, Turkey
PDF Version [PDF - 398 KB - 3 pages]
A. Vos et al.View Abstract
At the end of the 1990s in the Aegean region of Turkey, rabies rapidly spread among foxes. This spread likely resulted from spillover infection from dogs and led to increased rabies cases among cattle. To control this outbreak, oral rabies vaccination of foxes has been used.
Fine-scale Identification of the Most Likely Source of a Human Plague Infection
PDF Version [PDF - 474 KB - 4 pages]
R. E. Colman et al.View Abstract
We describe an analytic approach to provide fine-scale discrimination among multiple infection source hypotheses. This approach uses mutation-rate data for rapidly evolving multiple locus variable-number tandem repeat loci in probabilistic models to identify the most likely source. We illustrate the utility of this approach using data from a North American human plague investigation.
Borrelia hispanica Relapsing Fever, Morocco
PDF Version [PDF - 588 KB - 4 pages]
M. Sarih et al.View Abstract
We found that 20.5% of patients with an unexplained fever in northwestern Morocco had tick-borne relapsing fever. Molecular detection specific for the 16S rRNA gene identified Borrelia hispanica. The noncoding intergenic spacer sequence domain showed high sensitivity and good resolution for this species.
Diversity and Origin of Dengue Virus Serotypes 1, 2, and 3, Bhutan
PDF Version [PDF - 534 KB - 3 pages]
T. Dorji et al.View Abstract
To determine the serotype and genotype of dengue virus (DENV) in Bhutan, we conducted phylogenetic analyses of complete envelope gene sequences. DENV-2 (Cosmopolitan genotype) predominated in 2004, and DENV-3 (genotype III) predominated in 2005–2006; these viruses were imported from India. Primary dengue infections outnumbered secondary infections, suggesting recent emergence.
Ducks as Sentinels for Avian Influenza in Wild Birds
PDF Version [PDF - 411 KB - 4 pages]
A. Globig et al.View Abstract
To determine the effectiveness of ducks as sentinels for avian influenza virus (AIV) infection, we placed mallards in contact with wild birds at resting sites in Germany, Austria, and Switzerland. Infections of sentinel birds with different AIV subtypes confirmed the value of such surveillance for AIV monitoring.
Immunologic Response of Unvaccinated Workers Exposed to Anthrax, Belgium
PDF Version [PDF - 473 KB - 4 pages]
P. Wattiau et al.View Abstract
To determine immunologic reactivity to Bacillus anthrax antigens, we conducted serologic testing of workers in a factory that performed scouring of wool and goat hair. Of 66 workers, ≈10% had circulating antibodies or T lymphocytes that reacted with anthrax protective antigen. Individual immunity varied from undetectable to high.
Molecular Epidemiology of Clade 1 Influenza A Viruses (H5N1), Southern Indochina Peninsula, 2004–2007
PDF Version [PDF - 623 KB - 4 pages]
P. Buchy et al.View Abstract
To determine the origin of influenza A virus (H5N1) epizootics in Cambodia, we used maximum-likelihood and Bayesian methods to analyze the genetic sequences of subtype H5N1 strains from Cambodia and neighboring areas. Poultry movements, rather than repeated reintroduction of subtype H5N1 viruses by wild birds, appear to explain virus circulation and perpetuation.
Melioidosis in a Tropical City State, Singapore
PDF Version [PDF - 504 KB - 3 pages]
T. J. Lo et al.View Abstract
The incidence of melioidosis in Singapore decreased during 1998–2007, with the exception of the first quarter of 2004. After heavy rainfalls, an increase in pneumonic cases with a high case-fatality rate was detected. We show that melioidosis has the potential to reemerge following adverse climate events.
Escherichia coli as Reservoir for Macrolide Resistance Genes
PDF Version [PDF - 450 KB - 3 pages]
M. C. Nguyen et al.View Abstract
The plasmid-borne mph(A) gene that confers resistance to azithromycin and has recently emerged in Shigella sonnei is present in multidrug- and non–multidrug-resistant Escherichia coli isolates from 4 continents. Further spread of mph(A) to Shigella and Salmonella spp. may be expected.
West Nile Virus Antibodies in Wild Birds, Morocco, 2008
PDF Version [PDF - 445 KB - 3 pages]
J. Figuerola et al.View Abstract
To determine circulation of West Nile virus (WNV) during nonepidemic times, we serosurveyed wild birds of Morocco in 2008. We found antibodies against WNV in 12 (3.5%) birds, against Usutu virus in 1 (0.3%), and against both in 2 (0.6%). High WNV prevalence among juvenile birds suggests local virus circulation among resident birds.
Novel Rickettsia in Ticks, Tasmania, Australia
PDF Version [PDF - 557 KB - 3 pages]
L. Izzard et al.View Abstract
A novel rickettsia was detected in Ixodes tasmani ticks collected from Tasmanian devils. A total of 55% were positive for the citrate synthase gene by quantitative PCR. According to current criteria for rickettsia speciation, this new rickettsia qualifies as Candidatus Rickettsia tasmanensis, named after the location of its detection.
Orangutans Not Infected with Plasmodium vivax or P. cynomolgi, Indonesia
PDF Version [PDF - 474 KB - 2 pages]
B. Singh and P. C. DivisView Abstract
After orangutans in Indonesia were reported as infected with Plasmodium cynomolgi and P. vivax, we conducted phylogenetic analyses of small subunit ribosomal RNA gene sequences of Plasmodium spp. We found that these orangutans are not hosts of P. cynomolgi and P. vivax. Analysis of >1 genes is needed to identify Plasmodium spp. infecting orangutans.
Acute Q Fever and Scrub Typhus, Southern Taiwan
PDF Version [PDF - 657 KB - 3 pages]
C. Lai et al.View Abstract
Acute Q fever and scrub typhus are zoonoses endemic to southern Taiwan. Among the 137 patients with acute Q fever (89, 65.0%) or scrub typhus (43, 31.4%), we identified 5 patients (3.6%) who were co-infected with Coxiella burnetii and Orientia tsutsugamushi.
Poor Clinical Sensitivity of Rapid Antigen Test for Influenza A Pandemic (H1N1) 2009 Virus
PDF Version [PDF - 430 KB - 3 pages]
J. Drexler et al.View Abstract
Influenza A pandemic (H1N1) 2009 virus RNA was detected by reverse transcription–PCR in 144 clinical samples from Bonn, Germany. A common rapid antigen–based test detected the virus in only 11.1% of these samples. The paramount feature of rapid test–positive samples was high virus concentration. Antigen-based rapid tests appear unsuitable for virologic diagnostics in the current pandemic.
Human Rickettsialpox, Southeastern Mexico
PDF Version [PDF - 439 KB - 3 pages]
J. E. Zavala-Castro et al.View Abstract
The detection of Rickettsia akari in 2 human patients increased the diversity of rickettsioses affecting the public health in the southeast of Mexico. Rickettsialpox should be considered in the differential diagnosis with other febrile illnesses for the correct diagnosis and accurate treatment of this potential threat to human health.
West Nile Virus Infection in Plasma of Blood and Plasma Donors, United States
PDF Version [PDF - 520 KB - 3 pages]
C. B. Planitzer et al.View Abstract
This study investigated the association of ongoing West Nile virus (WNV) infections with neutralizing antibody titers in US plasma-derived intravenous immune globulin released during 2003–2008. Titers correlated closely with the prevalence of past WNV infection in blood donors, with 2008 lots indicating a prevalence of 1%.
Tick-borne Encephalitis from Eating Goat Cheese in a Mountain Region of Austria
PDF Version [PDF - 446 KB - 3 pages]
H. Holzmann et al.View Abstract
We report transmission of tick-borne encephalitis virus (TBEV) in July 2008 through nonpasteurized goat milk to 6 humans and 4 domestic pigs in an alpine pasture 1,500 m above sea level. This outbreak indicates the emergence of ticks and TBEV at increasing altitudes in central Europe and the efficiency of oral transmission of TBEV.
Surveillance System for Infectious Diseases of Pets, Santiago, Chile
PDF Version [PDF - 552 KB - 3 pages]
J. López et al.View Abstract
Pet diseases may pose risks to human health but are rarely included in surveillance systems. A pilot surveillance system of pet infectious diseases in Santiago, Chile, found that 4 canine and 3 feline diseases accounted for 90.1% and 98.4% of notifications, respectively. Data also suggested association between poverty and pet diseases.
Independent Lineage of Lymphocytic Choriomeningitis Virus in Wood Mice (Apodemus sylvaticus), Spain
PDF Version [PDF - 598 KB - 4 pages]
J. Ledesma et al.View Abstract
To clarify the presence of lymphocytic choriomeningitis virus (LCMV) in Spain, we examined blood and tissue specimens from 866 small mammals. LCMV RNA was detected in 3 of 694 wood mice (Apodemus sylvaticus). Phylogenetic analyses suggest that the strains constitute a new evolutionary lineage. LCMV antibodies were detected in 4 of 10 rodent species tested.
Influenza (H1N1) 2009 Outbreak and School Closure, Osaka Prefecture, Japan
PDF Version [PDF - 321 KB - 1 page]
R. Kawaguchi et al.
Maximizing the Value of Drug Stockpiles for Pandemic Influenza
PDF Version [PDF - 337 KB - 2 pages]
A. L. Po et al.
Intrafamilial Transmission of Methicillin-Resistant Staphylococcus aureus
PDF Version [PDF - 377 KB - 3 pages]
S. A. Langhi et al.
Rhombencephalitis and Coxsackievirus A16
PDF Version [PDF - 373 KB - 3 pages]
K. Goto et al.
Japanese Encephalitis in Hill and Mountain Districts, Nepal
PDF Version [PDF - 330 KB - 2 pages]
A. Bhattachan et al.
Group B Streptococcus Meningitis in a Child with Cochlear Implant
PDF Version [PDF - 360 KB - 2 pages]
D. Glikman et al.
Severe Necrotizing Pneumonia in Children, Houston, Texas, USA
PDF Version [PDF - 377 KB - 3 pages]
A. S. Kalaskar et al.
Human Bocavirus 2 in Children, South Korea
PDF Version [PDF - 398 KB - 3 pages]
T. Han et al.
Nontuberculous Mycobacterium Infection and Tumor Necrosis Factor-α Antagonists
PDF Version [PDF - 354 KB - 2 pages]
R. M. Swart et al.
Transmission of Varicella Vaccine Virus, Japan
PDF Version [PDF - 369 KB - 2 pages]
T. Otsuka et al.
Aichi Virus Strains in Children with Gastroenteritis, China
PDF Version [PDF - 438 KB - 3 pages]
S. Yang et al.
Appropriate Screening for Leishmaniasis before Immunosuppressive Treatments
PDF Version [PDF - 317 KB - 2 pages]
A. Cascio and C. Iaria
Lessons from a Special Service for Public Health, Brazil
PDF Version [PDF - 322 KB - 1 page]
A. L. Mayberry and T. D. Baker
Ceftazidime-Resistant Salmonella enterica, Morocco
PDF Version [PDF - 336 KB - 3 pages]
B. Bouchrif et al.
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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: September 24, 2012
- Page last updated: September 24, 2012
- Page last reviewed: September 24, 2012
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