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Volume 15, Number 11—November 2009
Volume 15, Number 11—November 2009 PDF Version [PDF - 5.00 MB - 183 pages]
Health Status of Visitors and Temporary Residents, United States
PDF Version [PDF - 119 KB - 6 pages]
E. A. Yanni et al.View Abstract
Human mobility has always been associated with the spread of infection, and mobility of nonimmigrant visitors and temporary residents to the United States is increasing, from ≈12 million in 1987 to ≈37 million in 2007. Lack of information about the health status of these populations upon arrival and their need for and use of medical services in the United States hinders development of public health policy, education, and provision of adequate clinical care. After these issues and needs are clarified, intervention programs should be developed to increase access and decrease the disparities of care experienced by these populations.
Risk of Importing Zoonotic Diseases through Wildlife Trade, United States
PDF Version [PDF - 141 KB - 6 pages]
B. I. Pavlin et al.View Abstract
The United States is the world’s largest wildlife importer, and imported wild animals represent a potential source of zoonotic pathogens. Using data on mammals imported during 2000–2005, we assessed their potential to host 27 selected risk zoonoses and created a risk assessment that could inform policy making for wildlife importation and zoonotic disease surveillance. A total of 246,772 mammals in 190 genera (68 families) were imported. The most widespread agents of risk zoonoses were rabies virus (in 78 genera of mammals), Bacillus anthracis (57), Mycobacterium tuberculosis complex (48), Echinococcus spp. (41), and Leptospira spp. (35). Genera capable of harboring the greatest number of risk zoonoses were Canis and Felis (14 each), Rattus (13), Equus (11), and Macaca and Lepus (10 each). These findings demonstrate the myriad opportunities for zoonotic pathogens to be imported and suggest that, to ensure public safety, immediate proactive changes are needed at multiple levels.
Population Mobility, Globalization, and Antimicrobial Drug Resistance
PDF Version [PDF - 123 KB - 5 pages]
D. W. MacPherson et al.
Public Health Response to Imported Case of Poliomyelitis, Australia, 2007
J. A. Carnie et al.View Abstract
Australia, along with 36 other countries in the Western Pacific Region, was declared free of poliomyelitis by the World Health Organization in October 2000. Yet, the persistence of wild poliovirus in the 4 remaining polio-endemic countries—Afghanistan, India, Nigeria, and Pakistan—poses a risk for its importation into all countries declared polio free. We describe the public health response and outcomes resulting from the importation of a wild poliovirus infection in Melbourne, Australia, in July 2007. This response, based on an assessment of the risk for transmission, included offering vaccination with inactivated polio vaccine to the contacts and placing the index patient in isolation and the household contacts in quarantine until consecutive fecal specimens were negative for poliovirus by culture. The experience gained from the polio importation event in Australia may assist other polio-free countries to prepare for, and respond to, a similar event. No secondary clinical cases resulted from this importation.
Hepatitis E Outbreak on Cruise Ship
PDF Version [PDF - 180 KB - 7 pages]
B. Said et al.View Abstract
In 2008, acute hepatitis E infection was confirmed in 4 passengers returning to the United Kingdom after a world cruise. Epidemiologic investigation showed that of 789 persons who provided blood samples, 195 (25%) were seropositive, 33 (4%) had immunoglobulin [Ig] M levels consistent with recent acute infection (11 of these persons were symptomatic), and 162 (21%) had IgG only, consistent with past infection. Passenger mean age was 68 years. Most (426/789, 54%) passengers were female, yet most with acute infection (25/33, 76%) were male. Sequencing of RNA from 3 case-patients identified hepatitis E virus genotype 3, closely homologous to genotype 3 viruses from Europe. Significant association with acute infection was found for being male, drinking alcohol, and consuming shellfish while on board (odds ratio 4.27, 95% confidence interval 1.23–26.94, p = 0.019). This was probably a common-source foodborne outbreak.
Imported Infectious Diseases in Mobile Populations, Spain
PDF Version [PDF - 197 KB - 8 pages]
B. Monge-Maillo et al.View Abstract
Migration has contributed to the emergence of certain infectious diseases. To determine which infectious diseases were most common among 2 mobile immigrant groups (sub-Saharan Africans and Latin Americans) in Spain, we analyzed health and demographic characteristics of 2,198 immigrants referred to the Tropical Medicine Unit of Ramón y Cajal Hospital over a 20-year period. The most frequent diagnoses were for latent tuberculosis (716 patients [32.6%]), filariasis (421 [19.2%]), hepatropic virus chronic infection (262 [19.2%]), intestinal parasites (242 [11.0%]), and malaria (212 [9.6%]). Health screening of immigrant populations is needed to ensure early diagnosis and treatment of potentially transmissible infections.
Epidemic of Plasmodium falciparum Malaria Involving Substandard Antimalarial Drugs, Pakistan, 2003
T. Leslie et al.View Abstract
Because of instability in eastern Afghanistan, new refugees crossed into the federally administered tribal areas of northwestern Pakistan in 2002. In 2003, we investigated an epidemic of Plasmodium falciparum malaria in 1 of the camps. Incidence was 100.4 cases/1,000 person-years; in other nearby camps it was only 2.1/1,000 person-years. Anopheline mosquitoes were found despite an earlier spray campaign. Documented clinical failures at the basic health unit prompted a drug resistance survey of locally manufactured sulfadoxine-pyrimethamine used for routine treatment. The in vivo failure rate was 28.5%. PCR analysis of the P. falciparum dihydrofolate reductase and dihyropteroate synthase genes showed no mutations associated with clinical failure. However, chemical analysis of the drug showed that it was substandard. As global incidence decreases and epidemics become more of a threat, enhanced quality assurance of control interventions is essential.
Epidemiology of Hepatitis A Virus Infections, Germany, 2007–2008
PDF Version [PDF - 329 KB - 9 pages]
M. S. Faber et al.
Screening Practices for Infectious Diseases among Burmese Refugees in Australia
PDF Version [PDF - 250 KB - 4 pages]
N. J. Chaves et al.View Abstract
Increasing numbers of refugees from Burma (Myanmar) are resettling in Western countries. We performed a retrospective study of 156 Burmese refugees at an Australian teaching hospital. Of those tested, Helicobacter pylori infection affected 80%, latent tuberculosis 70%, vitamin D deficiency 37%, and strongyloidiasis 26%. Treating these diseases can prevent long-term illness.
Illness in Long-Term Travelers Visiting GeoSentinel Clinics
PDF Version [PDF - 353 KB - 10 pages]
L. H. Chen et al.
Multicenter EuroTravNet/GeoSentinel Study of Travel-related Infectious Diseases in Europe
PDF Version [PDF - 201 KB - 8 pages]
P. Gautret et al.View Abstract
We analyzed prospective data on 17,228 European patients who sought treatment at GeoSentinel sites from 1997 to 2007. Gastrointestinal illness (particularly in tourists), fever (those visiting friends and relatives [VFRs]), and skin disorders (in tourists) were the most common reasons for seeking medical care. Diagnoses varied by country of origin, region visited, or categories of travelers. VFRs who returned from sub-Saharan Africa and Indian Ocean islands were more likely to experience falciparum malaria than any other group. Multiple correspondence analysis identified Italian, French, and Swiss VFRs and expatriate travelers to sub-Saharan Africa and Indian Ocean Islands as most likely to exhibit febrile illnesses. German tourists to Southeast and south-central Asia were most likely to seek treatment for acute diarrhea. Non-European travelers (12,663 patients from other industrialized countries) were less likely to acquire certain travel-associated infectious diseases. These results should be considered in the practice of travel medicine and development of health recommendations for European travelers.
Medscape CME Activity
Multicenter GeoSentinel Analysis of Rickettsial Diseases in International Travelers, 1996–2008 PDF Version [PDF - 129 KB - 8 pages]M. Jensenius et al.
Burkholderia pseudomallei Misidentified by Automated System
PDF Version [PDF - 259 KB - 3 pages]
C. Weissert et al.View Abstract
After returning from Thailand, a 35-year-old man from Switzerland was hospitalized with an abscess of the head. Material cultured from the abscess and adjacent bone grew a gram-negative rod, which was misidentified by an automated microbiology system as Burkholderia cepacia. The organism was eventually identified by molecular methods as B. pseudomallei.
HIV Infection among Illegal Migrants, Italy, 2004–2007
PDF Version [PDF - 129 KB - 3 pages]
M. C. Pezzoli et al.View Abstract
To determine HIV prevalence and place of exposure for illegal migrants in Italy, we tested 3,003 illegal adult migrants for HIV; 29 (0.97%) were HIV positive. Antibody avidity index results (indicators of time of infection) were available for 27 of those persons and showed that 6 (22.2%) presumably acquired their infection after migration.
Serologic Analysis of Returned Travelers with Fever, Sweden
PDF Version [PDF - 304 KB - 4 pages]
H. H. Askling et al.View Abstract
We studied 1,432 febrile travelers from Sweden who had returned from malaria-endemic areas during March 2005–March 2008. In 383 patients, paired serum samples were blindly analyzed for influenza and 7 other agents. For 21% of 115 patients with fever of unknown origin, serologic analysis showed that influenza was the major cause.
Imported Melioidosis, Israel, 2008
PDF Version [PDF - 263 KB - 3 pages]
A. Cahn et al.View Abstract
In 2008, melioidosis was diagnosed in an agricultural worker from Thailand in the southern Jordan Valley in Israel. He had newly diagnosed diabetes mellitus, fever, multiple abscesses, and osteomyelitis. Burkholderia pseudomallei was isolated from urine and blood. Four of 10 laboratory staff members exposed to the organism received chemoprophylaxis, 3 of whom had adverse events.
Wealth Inequality and Tuberculosis Elimination in Europe
PDF Version [PDF - 242 KB - 3 pages]
J. E. Suk et al.View Abstract
In Europe, wealth inequality is directly related to tuberculosis (TB) notification (R2 = 0.69), while in countries with lower TB rates, higher proportions of TB cases occur in foreign-born persons. Particularly during times of financial upheaval, efforts to eliminate TB must address social inequality.
Dengue Virus Serotype 4, Northeastern Peru, 2008
PDF Version [PDF - 386 KB - 4 pages]
B. M. Forshey et al.View Abstract
In 2008, dengue virus serotype 4 (DENV-4) emerged in northeastern Peru, causing a large outbreak and displacing DENV-3, which had predominated for the previous 6 years. Phylogenetic analysis of 2008 and 2009 isolates support their inclusion into DENV-4 genotype II, forming a lineage distinct from strains that had previously circulated in the region.
Hepatitis C Seroprevalence and Associated Risk Factors, Anyang, China
PDF Version [PDF - 313 KB - 4 pages]
F. Liu et al.View Abstract
Hepatitis C virus screening was conducted among 8,226 residents 25–65 years of age in 4 counties of China; virus prevalence was 0.9%. A subsequent case–control study indicated blood transfusion (odds ratio [OR] 4.55), esophageal balloon examination (OR 3.78), and intravenous injection (OR 5.83) were associated with infection.
Travel-related Schistosomiasis Acquired in Laos
PDF Version [PDF - 202 KB - 4 pages]
E. Leshem et al.View Abstract
Twelve Israeli travelers acquired schistosomiasis in Laos during 2002–2008, and 7 of them had acute schistosomiasis. The patients were probably exposed to Schistosoma mekongi in southern Laos, an area known to be endemic for schistosomiasis. Four possibly were infected in northern Laos, where reports of schistosomiasis are rare.
Buruli Ulcer in United Kingdom Tourist Returning from Latin America
PDF Version [PDF - 305 KB - 3 pages]
H. McGann et al.View Abstract
We report a case of Buruli ulcer in a tourist from the United Kingdom. The disease was almost certainly acquired in Brazil, where only 1 case had previously been reported. The delay in diagnosis highlights the need for physicians to be aware of the disease and its epidemiology.
Mayaro Fever Virus, Brazilian Amazon
PDF Version [PDF - 175 KB - 3 pages]
R. S. Azevedo et al.View Abstract
In February 2008, a Mayaro fever virus (MAYV) outbreak occurred in a settlement in Santa Barbara municipality, northern Brazil. Patients had rash, fever, and severe arthralgia lasting up to 7 days. Immunoglobulin M against MAYV was detected by ELISA in 36 persons; 3 MAYV isolates sequenced were characterized as genotype D.
Hemorrhagic Fever with Renal Syndrome in 4 US Soldiers, South Korea, 2005
PDF Version [PDF - 283 KB - 4 pages]
J. Song et al.View Abstract
Four US soldiers acquired hemorrhagic fever with renal syndrome while training near the Demilitarized Zone, South Korea, in 2005. Hantaan virus sequences were amplified by reverse transcription–PCR from patient serum samples and from lung tissues of striped field mice (Apodemus agrarius) captured at training sites. Epidemiologic investigations specified the ecology of possible sites of patient infection.
Fatal Case of Enterovirus 71 Infection, France, 2007
PDF Version [PDF - 227 KB - 4 pages]
S. Vallet et al.View Abstract
A fatal case of enterovirus 71 infection with pulmonary edema and rhombencephalitis occurred in Brest, France, in April 2007. The virus was identified as subgenogroup C2. This highly neurotropic enterovirus merits specific surveillance outside the Asia-Pacific region.
Evidence-based Tool for Triggering School Closures during Influenza Outbreaks, Japan
PDF Version [PDF - 250 KB - 3 pages]
A. Sasaki et al.View Abstract
Guidelines available to school administrators to support school closure decisions during influenza outbreaks are usually not evidence-based. Using empirical data on absentee rates of elementary school students in Japan, we developed a simple and practical algorithm for determining the optimal timing of school closures for control of influenza outbreaks.
Dirofilaria repens Infection and Concomitant Meningoencephalitis
PDF Version [PDF - 339 KB - 3 pages]
S. Poppert et al.View Abstract
Dirofilaria repens, a filarial nematode of dogs and other carnivores, can accidentally infect humans. Clinical symptoms are usually restricted to a subcutaneous nodule containing a single infertile parasite. Here, we report a case of D. repens infection with a subcutaneous gravid worm and the patient’s concomitant meningoencephalitis and aphasia.
Globally Mobile Populations and the Spread of Emerging Pathogens
PDF Version [PDF - 158 KB - 8 pages]
P. M. Arguin et al.
Preexisting Immunity to Pandemic (H1N1) 2009
PDF Version [PDF - 158 KB - 3 pages]
Z. Xing and C. J. Cardona
Serologic Survey of Pandemic (H1N1) 2009 Virus, Guangxi Province, China
PDF Version [PDF - 143 KB - 3 pages]
H. Chen et al.
Antiviral Drugs for Treatment of Patients Infected with Pandemic (H1N1) 2009 Virus
PDF Version [PDF - 143 KB - 2 pages]
D. M. Hartley et al.
Imported Ciprofloxacin-Resistant Neisseria meningitidis
PDF Version [PDF - 209 KB - 3 pages]
G. Lapadula et al.
Imported Chikungunya Virus Strains, Taiwan, 2006–2009
J. Huang et al.
Cutaneous Larva Migrans Acquired in Brittany, France
PDF Version [PDF - 180 KB - 3 pages]
N. Tamminga et al.
European Perspective of 2-Person Rule for Biosafety Level 4 Laboratories
PDF Version [PDF - 140 KB - 3 pages]
G. Ippolito et al.
Hajj Pilgrims’ Knowledge about Acute Respiratory Infections
PDF Version [PDF - 151 KB - 2 pages]
P. Gautret et al.
Persistent Extended-Spectrum β-Lactamase Urinary Tract Infection
PDF Version [PDF - 174 KB - 3 pages]
J. DeBusscher et al.
Leishmania killicki Imported from Tunisian Desert
PDF Version [PDF - 148 KB - 2 pages]
D. Maubon et al.
East African Trypanosomiasis in a Pregnant Traveler
PDF Version [PDF - 167 KB - 2 pages]
B. Nadjm et al.
Rickettsia africae Infection in Man after Travel to Ethiopia
PDF Version [PDF - 217 KB - 3 pages]
D. Stephany et al.
Rickettsia massiliae in the Canary Islands
PDF Version [PDF - 146 KB - 2 pages]
I. G. Fernández de Mera et al.
Dengue Virus Type 3 Infection in Traveler Returning from West Africa
PDF Version [PDF - 140 KB - 2 pages]
L. Ninove et al.
Low Immunity to Measles and Rubella among Female Guest Workers, Northern Mariana Islands
PDF Version [PDF - 152 KB - 3 pages]
V. Stambos et al.
Pneumonia Caused by Shigella sonnei in Man Returned from India
PDF Version [PDF - 153 KB - 3 pages]
F. Mancini et al.
Imported Human Fascioliasis, United Kingdom
PDF Version [PDF - 153 KB - 2 pages]
M. A. Chand et al.
Gastroenteritis Outbreaks in 2 Tourist Resorts, Dominican Republic
PDF Version [PDF - 164 KB - 2 pages]
A. Doménech-Sánchez et al.
Hybrid El Tor Vibrio cholerae O1, Kuwait
PDF Version [PDF - 261 KB - 2 pages]
R. M. Joshi and M. Albert
Multidrug-Resistant Mycobacterium tuberculosis Strain from Equatorial Guinea Detected in Spain
PDF Version [PDF - 193 KB - 3 pages]
P. Gavín et al.
Books and Media
Tropical Diseases in Travelers
PDF Version [PDF - 126 KB - 1 page]
L. H. Chen
Contagion and Chaos: Disease, Ecology, and National Security in the Era of Globalization
PDF Version [PDF - 132 KB - 2 pages]
S. A. Morse
Outbreak Investigations around the World: Case Studies in Infectious Disease Field Epidemiology
PDF Version [PDF - 128 KB - 1 page]
H. W. Haverkos
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.
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- Page created: December 09, 2010
- Page last updated: December 09, 2010
- Page last reviewed: December 09, 2010
- Centers for Disease Control and Prevention,
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