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Volume 15, Number 3—March 2009
Volume 15, Number 3—March 2009 PDF Version [PDF - 5.95 MB - 159 pages]
Meeting the Challenge of Influenza Pandemic Preparedness in Developing Countries
PDF Version [PDF - 196 KB - 7 pages]
D. S. FedsonView Abstract
Developing countries face unique difficulties preparing for an influenza pandemic. Our current top-down approach will not provide these countries with adequate supplies of vaccines and antiviral agents. Consequently, they will have to use a bottom-up approach based on inexpensive generic agents that either modify the host response to influenza virus or act as antiviral agents. Several of these agents have shown promise, and many are currently produced in developing countries. Investigators must primarily identify agents for managing infection in populations and not simply seek explanations for how they work. They must determine in which countries these agents are produced and define patterns of distribution and costs. Because prepandemic research cannot establish whether these agents will be effective in a pandemic, randomized controlled trials must begin immediately after a new pandemic virus has emerged. Without this research, industrialized and developing countries could face an unprecedented health crisis.
Shiga Toxin–producing Escherichia coli Strains Negative for Locus of Enterocyte Effacement
PDF Version [PDF - 317 KB - 9 pages]
H. J. Newton et al.View Abstract
Most Shiga toxin–producing Escherichia coli (STEC) infections that are associated with severe sequelae such as hemolytic uremic syndrome (HUS) are caused by attaching and effacing pathogens that carry the locus of enterocyte effacement (LEE). However, a proportion of STEC isolates that do not carry LEE have been associated with HUS. To clarify the emergence of LEE-negative STEC, we compared the genetic composition of the virulence plasmids pO113 and pO157 from LEE-negative and LEE-positive STEC, respectively. The complete nucleotide sequence of pO113 showed that several plasmid genes were shared by STEC O157:H7. In addition, allelic profiling of the ehxA gene demonstrated that pO113 belongs to a different evolutionary lineage than pO157 and that the virulence plasmids of LEE-negative STEC strains were highly related. In contrast, multilocus sequence typing of 17 LEE-negative STEC isolates showed several clonal groups, suggesting that pathogenic LEE-negative STEC has emerged several times throughout its evolution.
Sources of Hepatitis E Virus Genotype 3 in the Netherlands
PDF Version [PDF - 207 KB - 7 pages]
S. A. Rutjes et al.View Abstract
Non–travel-related hepatitis E virus (HEV) genotype 3 infections in persons in the Netherlands may have a zoonotic, foodborne, or water-borne origin. Possible reservoirs for HEV transmission by water, food, and animals were studied. HEV genotype 3/open reading frame 2 sequences were detected in 53% of pig farms, 4% of wild boar feces, and 17% of surface water samples. HEV sequences grouped within 4 genotype 3 clusters, of which 1 is so far unique to the Netherlands. The 2 largest clusters contained 35% and 43% of the animal and environmental sequences and 75% and 6%, respectively, of human HEV sequences obtained from a study on Dutch hepatitis E patients. This finding suggests that infection risk may be also dependent on transmission routes other than the ones currently studied. Besides the route of exposure, virus characteristics may be an important determinant for HEV disease in humans.
Integron-mediated Multidrug Resistance in a Global Collection of Nontyphoidal Salmonella enterica Isolates
PDF Version [PDF - 359 KB - 9 pages]
M. G. Krauland et al.View Abstract
Salmonella enterica bacteria have become increasingly resistant to antimicrobial agents, partly as a result of genes carried on integrons. Clonal expansion and horizontal gene transfer may contribute to the spread of antimicrobial drug–resistance integrons in these organisms. We investigated this resistance and integron carriage among 90 isolates with the ACSSuT phenotype (resistance to ampicillin, chloramphenicol, streptomycin, sulfamethoxazole, and tetracycline) in a global collection of S. enterica isolates. Four integrons, dfrA12/orfF/aadA2, dfrA1/aadA1, dfrA7, and arr2/blaOXA30/cmlA5/aadA2, were found in genetically unrelated isolates from 8 countries on 4 continents, which supports a role for horizontal gene transfer in the global dissemination of S. enterica multidrug resistance. Serovar Typhimurium isolates containing identical integrons with the gene cassettes blaPSE1 and aadA2 were found in 4 countries on 3 continents, which supports the role of clonal expansion. This study demonstrates that clonal expansion and horizontal gene transfer contribute to the global dissemination of antimicrobial drug resistance in S. enterica.
Coccidioidal Pneumonia, Phoenix, Arizona, USA, 2000–2004
PDF Version [PDF - 177 KB - 5 pages]
M. M. Kim et al.View Abstract
Community-acquired pneumonia (CAP) often results in severe illness and death. In large, geographically defined areas where Coccidioides spp. are endemic, coccidioidomycosis is a recognized cause of CAP, but its frequency has not been studied extensively. To determine the frequency of patients with coccidioidomycosis, we conducted a prospective evaluation of 59 patients with CAP in the Phoenix, Arizona, area. Of 35 for whom paired coccidioidal serologic testing was performed, 6 (17%) had evidence of acute coccidioidomycosis. Coccidioidal pneumonia was more likely than noncoccidioidal CAP to produce rash. The following were not found to be risk factors or reliable predictors of infection: demographic features, underlying medical conditions, duration of time spent in disease-endemic areas, occupational and recreational activities, initial laboratory studies, and chest radiography findings. Coccidioidomycosis is a common cause of CAP in our patient population. In the absence of distinguishing clinical features, coccidioidal pneumonia can be identified only with appropriate laboratory studies.
Characterization of Avian Influenza Viruses A (H5N1) from Wild Birds, Hong Kong, 2004–2008
PDF Version [PDF - 201 KB - 6 pages]
G. J. Smith et al.View Abstract
From January 2004 through June 2008, surveillance of dead wild birds in Hong Kong, People’s Republic of China, periodically detected highly pathogenic avian influenza (HPAI) viruses (H5N1) in individual birds from different species. During this period, no viruses of subtype H5N1 were detected in poultry on farms and in markets in Hong Kong despite intensive surveillance. Thus, these findings in wild birds demonstrate the potential for wild birds to disseminate HPAI viruses (H5N1) to areas otherwise free from the viruses. Genetic and antigenic characterization of 47 HPAI (H5N1) viruses isolated from dead wild birds in Hong Kong showed that these isolates belonged to 2 antigenically distinct virus groups: clades 2.3.4 and 2.3.2. Although research has shown that clade 2.3.4 viruses are established in poultry in Asia, the emergence of clade 2.3.2 viruses in nonpasserine birds from Hong Kong, Japan, and Russia raises the possibility that this virus lineage may have become established in wild birds.
Prevalence and Seasonality of Influenza-like Illness in Children, Nicaragua, 2005–2007
PDF Version [PDF - 156 KB - 7 pages]
A. Gordon et al.View Abstract
Although information about seasonality and prevalence of influenza is crucial for development of effective prevention and control strategies, limited data exist on the epidemiology of influenza in tropical countries. To better understand influenza in Nicaragua, we performed a prospective 2-year cohort study of influenza-like illness (ILI) involving 4,276 children, 2–11 years of age, in Managua, during April 2005–April 2007. One peak of ILI activity occurred during 2005, in June–July; 2 peaks occurred during 2006, in June–July and November–December. The rate of ILI was 34.8/100 person-years. A household risk factor survey administered to a subset (61%) of participants identified the following risk factors: young age, asthma, and increasing person density in the household. Influenza virus circulation was confirmed during each ILI peak by laboratory testing of a subset of samples. Our findings demonstrate a high rate of ILI, with seasonal peaks, in children in Nicaragua.
Medscape CME Activity
Clinical Risk Factors for Severe Clostridium difficile–associated Disease PDF Version [PDF - 228 KB - 8 pages]T. J. Henrich et al.View Abstract
Identifying patients who are at high risk for severe Clostridium difficile–associated disease (CDAD) early in the course of their infection may help clinicians improve outcomes. Therefore, we compared clinical features associated with severe versus nonsevere CDAD by retrospectively reviewing records of hospitalized patients whose fecal assays were positive for C. difficile toxin. Of 336 patients, 12.2% had severe disease and 10.1% died from all causes. Regression modeling showed the following to be significantly associated with severe CDAD (p<0.05): age >70 years (odds ratio [OR] 3.35), maximum leukocyte count >20,000 cells/mL (OR 2.77), minimum albumin level <2.5 g/dL (OR 3.44), maximum creatinine level >2 mg/dL (OR 2.47), small bowel obstruction or ileus (OR 3.06), and computed tomography scan showing colorectal inflammation (OR 13.54). These clinical and laboratory markers for severe disease may be useful for identifying patients at risk for serious outcomes or death.
Capacity of Thailand to Contain an Emerging Influenza Pandemic
PDF Version [PDF - 1.45 MB - 10 pages]
W. Putthasri et al.View Abstract
Southeast Asia will likely be the epicenter of the next influenza pandemic. To determine whether health system resources in Thailand are sufficient to contain an emerging pandemic, we mapped health system resources in 76 provinces. We used 3 prepandemic scenarios of clustered cases and determined resource needs, availability, and gaps. We extended this analysis to a scenario of a modest pandemic and assumed that the same standards of clinical care would be required. We found that gaps exist in many resource categories, even under scenarios in which few cases occur. Such gaps are likely to be profound if a severe pandemic occurs. These gaps exist in infrastructure, personnel and materials, and surveillance capacity. Policy makers must determine whether such resource gaps can realistically be closed, ideally before a pandemic occurs. Alternatively, explicit assumptions must be made regarding allocation of scarce resources, standards of care, and priority setting during a pandemic.
Epidemiology of Bluetongue Virus Serotype 8, Germany
PDF Version [PDF - 530 KB - 3 pages]
F. J. Conraths et al.View Abstract
In Germany, bluetongue disease had not been reported before 2006. During August 2006–August 2008, >24,000 bluetongue virus serotype 8 infections were reported, most (20,635) in 2007. In 2006 and 2007, respectively, case-fatality rates were 6.4% and 13.1% for cattle and 37.5% and 41.5% for sheep. Vaccination in 2008 decreased cases.
Evaluation of Commercially Available Anti–Dengue Virus Immunoglobulin M Tests
PDF Version [PDF - 323 KB - 4 pages]
E. A. Hunsperger et al.View Abstract
Anti–dengue virus immunoglobulin M kits were evaluated. Test sensitivities were 21%–99% and specificities were 77%–98% compared with reference ELISAs. False-positive results were found for patients with malaria or past dengue infections. Three ELISAs showing strong agreement with reference ELISAs will be included in the World Health Organization Bulk Procurement Scheme.
Detection of Newly Described Astrovirus MLB1 in Stool Samples from Children
PDF Version [PDF - 581 KB - 4 pages]
S. R. Finkbeiner et al.View Abstract
The prevalence of the recently identified astrovirus MLB1 in a cohort of children with diarrhea in St. Louis, Missouri, USA, was defined by reverse transcription–PCR. Of 254 stool specimens collected in 2008, 4 were positive for astrovirus MLB1. These results show that astrovirus MLB1 is circulating in North America.
Introduction into Nigeria of a Distinct Genotype of Avian Influenza Virus (H5N1)
PDF Version [PDF - 212 KB - 3 pages]
A. Fusaro et al.View Abstract
Genetic characterization of highly pathogenic avian influenza viruses (H5N1) isolated in July 2008 in Nigeria indicates that a distinct genotype, never before detected in Africa, reached the continent. Phylogenetic analysis showed that the viruses are genetically closely related to European and Middle Eastern influenza A (H5N1) isolates detected in 2007.
Border Disease Virus among Chamois, Spain
PDF Version [PDF - 169 KB - 4 pages]
I. Marco et al.View Abstract
Approximately 3,000 Pyrenean chamois (Rupicapra pyrenaica pyrenaica) died in northeastern Spain during 2005–2007. Border disease virus infection was identified by reverse transcription–PCR and sequencing analysis. These results implicate this virus as the primary cause of death, similar to findings in the previous epizootic in 2001.
Methicillin-Resistant Staphylococcus aureus in Poultry
PDF Version [PDF - 96 KB - 2 pages]
D. Persoons et al.View Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has been detected in several species and animal-derived products. To determine whether MRSA is present in poultry, we sampled 50 laying hens and 75 broiler chickens. MRSA was found in some broiler chickens but no laying hens. In all samples, spa type t1456 was found.
Human Bocavirus and KI/WU Polyomaviruses in Pediatric Intensive Care Patients
PDF Version [PDF - 193 KB - 4 pages]
A. C. van de Pol et al.View Abstract
We evaluated the prevalence of human bocavirus and KI and WU polyomaviruses in pediatric intensive care patients with and without lower respiratory tract infection (LRTI). The prevalence of these viruses was 5.1%, 0%, and 2.6%, respectively, in children with LRTI and 4.8%, 4.8%, and 2.4%, respectively, in those without LRTI.
Rocky Mountain Spotted Fever in Dogs, Brazil
PDF Version [PDF - 209 KB - 3 pages]
M. B. Labruna et al.View Abstract
Clinical illness caused by Rickettsia rickettsii in dogs has been reported solely in the United States. We report 2 natural clinical cases of Rocky Mountain spotted fever in dogs in Brazil. Each case was confirmed by seroconversion and molecular analysis and resolved after doxycycline therapy.
Crimean-Congo Hemorrhagic Fever Virus in High-Risk Population, Turkey
PDF Version [PDF - 250 KB - 4 pages]
T. Gunes et al.View Abstract
In the Tokat and Sivas provinces of Turkey, the overall Crimean-Congo hemorrhagic fever virus (CCHFV) seroprevalence was 12.8% among 782 members of a high-risk population. CCHFV seroprevalence was associated with history of tick bite or tick removal from animals, employment in animal husbandry or farming, and being >40 years of age.
Sudden Increases in Listeriosis Rates in England and Wales, 2001 and 2003
PDF Version [PDF - 263 KB - 4 pages]
B. J. Cairns and R. J. PayneView Abstract
The monthly incidence of listeriosis infections in England and Wales had 2 sudden increases during April 2001 (41%) and March 2003 (48%). Although no causative association is demonstrated, these increases correspond to key dates relating to the onset and aftermath of the 2001 foot and mouth disease outbreak in the United Kingdom.
Coordinated Implementation of Chikungunya Virus Reverse Transcription–PCR
PDF Version [PDF - 157 KB - 3 pages]
M. Panning et al.View Abstract
A preformulated chikungunya virus real-time reverse transcription–PCR, quality-confirmed oligonucleotides, and noninfectious virus controls were distributed by the European Network for the Diagnosis of Imported Viral Diseases. An international proficiency study with 31 participants demonstrated that ad hoc implementation of molecular diagnostics was feasible and successful.
Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae in a Malian Orphanage
PDF Version [PDF - 307 KB - 2 pages]
D. Tandé et al.View Abstract
We show high rates of extended-spectrum β-lactamase–producing Enterobacteriaceae carriage among the staff and children at an orphanage in Bamako, Mali. Enterobacteriaceae colonized in 100% and 63%, respectively, of the 38 children and 30 adults studied. Use of antimicrobial drugs appeared excessive and inappropriate; decontamination and hygiene protocols were also questioned.
Highly Pathogenic Avian Influenza Virus (H5N1) Outbreak in Captive Wild Birds and Cats, Cambodia
PDF Version [PDF - 191 KB - 4 pages]
S. Desvaux et al.View Abstract
From December 2003 through January 2004, the Phnom Tamao Wildlife Rescue Centre, Cambodia, was affected by the highly pathogenic influenza virus (H5N1). Birds from 26 species died. Influenza virus subtype H5N1 was detected in 6 of 7 species tested. Cats from 5 of 7 species were probably infected; none died.
Hepatitis E Virus Antibodies in Patients with Chronic Liver Disease
PDF Version [PDF - 164 KB - 3 pages]
M. Atiq et al.View Abstract
In the United States, the seroprevalence rate for hepatitis E virus (HEV) is ≈20%. This study examined HEV seroprevalence in persons with and without chronic liver disease. Our data indicate that HEV seropositivity is high in patients with chronic liver disease and that HEV seroprevalence increases significantly with age.
Detection of Novel SARS-like and Other Coronaviruses in Bats from Kenya
PDF Version [PDF - 242 KB - 4 pages]
S. Tong et al.View Abstract
Diverse coronaviruses have been identified in bats from several continents but not from Africa. We identified group 1 and 2 coronaviruses in bats in Kenya, including SARS-related coronaviruses. The sequence diversity suggests that bats are well-established reservoirs for and likely sources of coronaviruses for many species, including humans.
Rickettsia spp. in Ticks, Poland
PDF Version [PDF - 207 KB - 3 pages]
T. Chmielewski et al.View Abstract
Ticks are recognized as the main vectors and reservoirs of spotted fever group rickettsiae. We searched for the most prevalent Rickettsia spp. in Poland and found R. slovaca and R. helvetica bacteria in ticks in southern and central Poland; R. raoulti was found in ticks in all parts of Poland.
Merkel Cell Polyomavirus in Respiratory Tract Secretions
PDF Version [PDF - 222 KB - 3 pages]
S. Goh et al.View Abstract
Merkel cell polyomavirus (MCPyV), associated with Merkel cell carcinoma, was detected in 27 of 635 nasopharyngeal aspirate samples by real-time PCR. MCPyV was more commonly found in adults than in children. Presence in the upper respiratory tract may be a general property of human PyVs.
Merkel Cell Polyomavirus DNA in Respiratory Specimens from Children and Adults
PDF Version [PDF - 169 KB - 3 pages]
S. Bialasiewicz et al.View Abstract
Merkel cell polyomavirus (MCPyV) DNA was detected in 7 (1.3%) of 526 respiratory tract samples from patients in Australia with upper or lower respiratory tract symptoms. Partial T antigen and major capsid protein sequences of MCPyV identified in respiratory secretions showed high homology (99%–100%) to those found in Merkel cell carcinoma.
Guillain-Barré Syndrome after Chikungunya Infection
PDF Version [PDF - 94 KB - 2 pages]
G. Lebrun et al.
Cockroaches (Ectobius vittiventris) in an Intensive Care Unit, Switzerland
PDF Version [PDF - 95 KB - 2 pages]
I. Uçkay et al.
Cutaneous Anthrax, West Bengal, India, 2007
PDF Version [PDF - 85 KB - 3 pages]
T. K. Ray et al.
Cat-to-Human Orthopoxvirus Transmission, Northeastern Italy
PDF Version [PDF - 113 KB - 2 pages]
F. Carletti et al.
Pertussis in Afghanistan, 2007–2008
PDF Version [PDF - 79 KB - 1 page]
R. M. Kakar et al.
Salmonella bongori 48:z:– in Migratory Birds, Italy
PDF Version [PDF - 126 KB - 2 pages]
M. Foti et al.
Comet Sign (and Other) in Pyemotes Dermatitis
PDF Version [PDF - 121 KB - 2 pages]
J. B. Bellido-Blasco et al.
Helicobacter pylori Infection in Patients Undergoing Upper Endoscopy, Republic of Georgia
PDF Version [PDF - 85 KB - 2 pages]
N. Tarkhashvili et al.
Delinquent Mortgages, Neglected Swimming Pools, and West Nile Virus, California
PDF Version [PDF - 185 KB - 2 pages]
R. A. Goodman and J. W. Buehler
Spelling Pneumocystis jirovecii
J. R. Stringer et al.
Hypothetical Pneumocystis jirovecii Transmission from Immunocompetent Carriers to Infant
PDF Version [PDF - 79 KB - 3 pages]
P. Hauser et al.
Books and Media
PDF Version [PDF - 83 KB - 1 page]
Forgotten People, Forgotten Diseases: The Neglected Tropical Diseases and Their Impact on Global Health and Development
PDF Version [PDF - 72 KB - 2 pages]
C. Ben Beard
Travel Medicine, 2nd Edition
PDF Version [PDF - 76 KB - 1 page]
L. H. Chen
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: June 08, 2012
- Page last updated: June 08, 2012
- Page last reviewed: June 08, 2012
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