Volume 15, Number 5—May 2009
Volume 15, Number 5—May 2009 PDF Version [PDF - 8.01 MB - 175 pages]
Use of Unstructured Event-Based Reports for Global Infectious Disease Surveillance
PDF Version [PDF - 129 KB - 7 pages]
M. Keller et al.View Abstract
Free or low-cost sources of unstructured information, such as Internet news and online discussion sites, provide detailed local and near real-time data on disease outbreaks, even in countries that lack traditional public health surveillance. To improve public health surveillance and, ultimately, interventions, we examined 3 primary systems that process event-based outbreak information: Global Public Health Intelligence Network, HealthMap, and EpiSPIDER. Despite similarities among them, these systems are highly complementary because they monitor different data types, rely on varying levels of automation and human analysis, and distribute distinct information. Future development should focus on linking these systems more closely to public health practitioners in the field and establishing collaborative networks for alert verification and dissemination. Such development would further establish event-based monitoring as an invaluable public health resource that provides critical context and an alternative to traditional indicator-based outbreak reporting.
Chronic Wasting Disease Prions in Elk Antler Velvet
PDF Version [PDF - 2.39 MB - 8 pages]
R. C. Angers et al.View Abstract
Chronic wasting disease (CWD) is a contagious, fatal prion disease of deer and elk that continues to emerge in new locations. To explore the means by which prions are transmitted with high efficiency among cervids, we examined prion infectivity in the apical skin layer covering the growing antler (antler velvet) by using CWD-susceptible transgenic mice and protein misfolding cyclic amplification. Our finding of prions in antler velvet of CWD-affected elk suggests that this tissue may play a role in disease transmission among cervids. Humans who consume antler velvet as a nutritional supplement are at risk for exposure to prions. The fact that CWD prion incubation times in transgenic mice expressing elk prion protein are consistently more rapid raises the possibility that residue 226, the sole primary structural difference between deer and elk prion protein, may be a major determinant of CWD pathogenesis.
Virulent Strain of Hepatitis E Virus Genotype 3, Japan
PDF Version [PDF - 311 KB - 6 pages]
K. Takahashi et al.View Abstract
Hepatitis E virus (HEV) genotype 3, which usually causes asymptomatic infection in Japan, induced severe hepatitis in 8 patients. To better understand genetic features of HEV associated with increased virulence, we determined the complete or near-complete nucleotide sequences of HEV from these 8 patients and from 5 swine infected with genotype 3 strain swJ19. Phylogenetic analysis showed that the isolates from the 8 patients and the 5 swine grouped separately from the other genotype 3 isolates to create a unique cluster, designated JIO. The human JIO-related viruses encoded 18 amino acids different from those of the other HEV genotype 3 strains. One substitution common to almost all human HEV strains in the JIO cluster was located in the helicase domain (V239A) and may be associated with increased virulence. A zoonotic origin of JIO-related viruses is suspected because the isolates from the 5 swine also possessed the signature V239A substitution in helicase.
A Case–Control Study on the Origin of Atypical Scrapie in Sheep, France
PDF Version [PDF - 394 KB - 9 pages]
A. Fediaevsky et al.View Abstract
A matched case–control study (95 cases and 220 controls) was designed to study risk factors for atypical scrapie in sheep in France. We analyzed contacts with animals from other flocks, lambing and feeding practices, and exposure to toxic substances. Data on the prnp genotype were collected for some case and control animals and included in a complementary analysis. Sheep dairy farms had a higher risk for scrapie (odds ratio [OR] 15.1, 95% confidence interval [CI] 3.3–69.7). Lower risk was associated with organic farms (OR 0.15, 95% CI 0.02–1.26), feeding corn silage (OR 0.16, 95% CI 0.05–0.53), and feeding vitamin and mineral supplements (OR 0.6, 95% CI 0.32–1.14). Genetic effects were quantitatively important but only marginally changed estimates of other variables. We did not find any risk factor associated with an infectious origin of scrapie. Atypical scrapie could be a spontaneous disease influenced by genetic and metabolic factors.
New Respiratory Enterovirus and Recombinant Rhinoviruses among Circulating Picornaviruses
PDF Version [PDF - 295 KB - 8 pages]
C. Tapparel et al.View Abstract
Rhinoviruses and enteroviruses are leading causes of respiratory infections. To evaluate genotypic diversity and identify forces shaping picornavirus evolution, we screened persons with respiratory illnesses by using rhinovirus-specific or generic real-time PCR assays. We then sequenced the 5′ untranslated region, capsid protein VP1, and protease precursor 3CD regions of virus-positive samples. Subsequent phylogenetic analysis identified the large genotypic diversity of rhinoviruses circulating in humans. We identified and completed the genome sequence of a new enterovirus genotype associated with respiratory symptoms and acute otitis media, confirming the close relationship between rhinoviruses and enteroviruses and the need to detect both viruses in respiratory specimens. Finally, we identified recombinants among circulating rhinoviruses and mapped their recombination sites, thereby demonstrating that rhinoviruses can recombine in their natural host. This study clarifies the diversity and explains the reasons for evolution of these viruses.
Cross-Border Dissemination of Methicillin-Resistant Staphylococcus aureus, Euregio Meuse-Rhin Region
PDF Version [PDF - 560 KB - 8 pages]
R. H. Deurenberg et al.View Abstract
Because the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) differs among the 3 countries forming the Euregio Meuse-Rhin (EMR) region (Belgium, Germany, and the Netherlands), cross-border healthcare requires information about the spread of MRSA in the EMR. We investigated the emergence, dissemination, and diversity of MRSA clones in the EMR by using several typing methods. MRSA associated with clonal complexes 5, 8, 30, and 45 was disseminated throughout the EMR. Dutch isolates, mainly associated with sequence types (ST) ST5-MRSA-II, ST5-MRSA-IV, ST8-MRSA-IV, and ST45-MSRA-IV had a more diverse genetic background than the isolates from Belgium and Germany, associated with ST45-MRSA-IV and ST5-MRSA-II, respectively. MRSA associated with pigs (ST398-MRSA-IV/V) was found in the Dutch area of the EMR. Five percent of the MRSA isolates harbored Panton-Valentine leukocidin and were classified as community-associated MRSA associated with ST1, 8, 30, 80, and 89.
Chloroquine-Resistant Haplotype Plasmodium falciparum Parasites, Haiti
PDF Version [PDF - 255 KB - 6 pages]
B. L. Londono et al.View Abstract
Plasmodium falciparum parasites have been endemic to Haiti for >40 years without evidence of chloroquine (CQ) resistance. In 2006 and 2007, we obtained blood smears for rapid diagnostic tests (RDTs) and filter paper blots of blood from 821 persons by passive and active case detection. P. falciparum infections diagnosed for 79 persons by blood smear or RDT were confirmed by PCR for the small subunit rRNA gene of P. falciparum. Amplification of the P. falciparum CQ resistance transporter (pfcrt) gene yielded 10 samples with amplicons resistant to cleavage by ApoI. A total of 5 of 9 samples had threonine at position 76 of pfcrt, which is consistent with CQ resistance (haplotypes at positions 72–76 were CVIET [n = 4] and CVMNT [n = 1]); 4 had only the wild-type haplotype associated with CQ susceptibility (CVMNK). These results indicate that CQ-resistant haplotype P. falciparum malaria parasites are present in Haiti.
CTX-M β-Lactamases in Escherichia coli from Community-acquired Urinary Tract Infections, Cambodia
PDF Version [PDF - 453 KB - 8 pages]
E. Ruppé et al.View Abstract
Despite the recent global spread of CTX-M β-lactamases in Escherichia coli isolates from community-acquired urinary tract infections (CA-UTIs), their dissemination has been little studied in developing countries. In a 2-year prospective study, we documented the prevalence of extended-spectrum β-lactamases (ESBLs) in E. coli that were responsible for CA-UTIs in Phnom-Penh, Cambodia. Ninety-three E. coli strains were included. We observed a high prevalence of resistance to amoxicillin (88.2% of strains), cotrimoxazole (75.3%), ciprofloxacin (67.7%), gentamicin (42.5%), and third-generation cephalosporins (37.7%). A total of 34 strains carried ESBLs, all of which were CTX-M type. CTX-M carriage was associated with resistance to fluoroquinolones and aminoglycosides. U using repetitive extragenic palindromic–PCR, we identified 4 clusters containing 9, 8, 3, and 2 strains. The prevalence of CTX-M β-lactamases has reached a critical level in Cambodia, which highlights the need for study of their spread in developing countries.
Medscape CME Activity
Increased Risk for Severe Malaria in HIV-1–infected Adults, Zambia PDF Version [PDF - 335 KB - 7 pages]V. Chalwe et al.View Abstract
To determine whether HIV-1 infection and HIV-1–related immunosuppression were risk factors for severe malaria in adults with some immunity to malaria, we conducted a case–control study in Luanshya, Zambia, during December 2005–March 2007. For each case-patient with severe malaria, we selected 2 matched controls (an adult with uncomplicated malaria and an adult without signs of disease). HIV-1 infection was present in 93% of case-patients, in 52% of controls with uncomplicated malaria, and in 45% of asymptomatic controls. HIV-1 infection was a highly significant risk factor for adults with severe malaria compared with controls with uncomplicated malaria (odds ratio [OR] 12.6, 95% confidence interval [CI] 2.0–78.8, p = 0.0005) and asymptomatic controls (OR 16.6, 95% CI 2.5–111.5, p = 0.0005). Persons with severe malaria were more likely to have a CD4 count <350/µL than were asymptomatic controls (OR 23.0, 95% CI 3.35–158.00, p<0.0001).
Seroprevalence of Antibodies to Avian Influenza Virus A (H5N1) among Residents of Villages with Human Cases, Thailand, 2005
PDF Version [PDF - 297 KB - 5 pages]
R. Dejpichai et al.View Abstract
In 2005, we assessed the seroprevalence of neutralizing antibodies to avian influenza virus A (H5N1) among 901 residents of 4 villages in Thailand where at least 1 confirmed human case of influenza (H5N1) had occurred during 2004. Although 68.1% of survey participants (median age 40 years) were exposed to backyard poultry and 25.7% were exposed to sick or dead chickens, all participants were seronegative for influenza virus (H5N1).
Hospitalizations and Deaths Associated with Clostridium difficile Infection, Finland, 1996–2004
PDF Version [PDF - 227 KB - 5 pages]
O. Lyytikäinen et al.View Abstract
To determine whether the rate of Clostridium difficile–associated disease (CDAD) and CDAD-related deaths were increasing in Finland, we analyzed registry data from 1996 through 2004. We determined the number of hospital discharges that had a diagnosis code specific for CDAD from the International Classification of Diseases, 10th revision: “enterocolitis due to Clostridium difficile” (A04.7) and “pseudomembranous enterocolitis associated with antimicrobial therapy” (K52.8), listed as any diagnosis in the National Hospital Discharge Registry. CDAD-related deaths were identified from death certificates. Those discharged with a CDAD diagnosis doubled from 810 (16/100,000 population) in 1996 to 1,787 (34/100,000) in 2004. The increase was most prominent for patients >64 years of age but concerned only those discharged with diagnosis code A04.7. The number of those discharged with diagnosis code K52.8 remained stable. The age-standardized mortality rate associated with CDAD increased from 9/million in 1998 to 17/million in 2004; the increase was limited to persons >64 years of age.
Methicillin-Resistant Staphylococcus aureus ST398 from Human Patients, Upper Austria
PDF Version [PDF - 255 KB - 4 pages]
K. Krziwanek et al.View Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) clonal type ST398 is usually associated with animals. We examined 1,098 confirmed MRSA samples from human patients and found that 21 were MRSA ST398. Most (16) patients were farmers. Increasing prevalence from 1.3% (2006) to 2.5% (2008) shows emergence of MRSA ST398 in humans in Austria.
Human Streptococcus agalactiae Isolate in Nile Tilapia (Oreochromis niloticus)
PDF Version [PDF - 180 KB - 3 pages]
J. J. Evans et al.View Abstract
Streptococcus agalactiae, the Lancefield group B streptococcus (GBS) long recognized as a mammalian pathogen, is an emerging concern with regard to fish. We show that a GBS serotype Ia multilocus sequence type ST-7 isolate from a clinical case of human neonatal meningitis caused disease and death in Nile tilapia (Oreochromis niloticus).
Cowpox Virus Transmission from Pet Rats to Humans, Germany
PDF Version [PDF - 215 KB - 4 pages]
H. Campe et al.View Abstract
We describe a cluster of cowpox virus (CPXV) infections in humans that occurred near Munich, Germany, around the beginning of 2009. Previously, only sporadic reports of CPXV infections in humans after direct contact with various animals had been published. This outbreak involved pet rats from the same litter.
Cowpox Virus Transmission from Pet Rats to Humans, France
PDF Version [PDF - 359 KB - 4 pages]
L. Ninove et al.View Abstract
In early 2009, four human cases of cowpox virus cutaneous infection in northern France, resulting from direct contact with infected pet rats (Rattus norvegicus), were studied. Pet rats, originating from the same pet store, were shown to be infected by a unique virus strain. Infection was then transmitted to humans who purchased or had contact with pet rats.
Babesiosis Acquired through Blood Transfusion, California, USA
PDF Version [PDF - 142 KB - 3 pages]
V. Ngo and R. CivenView Abstract
Babesiosis was reported in a California resident who received a transfusion of blood products collected in the disease-endemic northeastern region of the United States. Babesiosis should be considered year-round in the diagnosis of febrile and afebrile patients with abnormal blood cell counts who have received blood products from disease-endemic areas.
Probable Congenital Babesiosis in Infant, New Jersey, USA
PDF Version [PDF - 234 KB - 4 pages]
S. Sethi et al.View Abstract
Only 2 neonates with transplacentally or perinatally acquired (congenital) babesiosis have been reported. We describe a probable third congenital case of babesiosis in a 26-day-old infant; transmission was determined on the basis of a blood smear from the infant (15% parasitemia) and serologic results from the infant and mother.
Genotype Distribution and Sequence Variation of Hepatitis E Virus, Hong Kong
PDF Version [PDF - 199 KB - 3 pages]
W. Lam et al.View Abstract
Most acute cases of infection with hepatitis E virus (HEV) in Hong Kong were autochthonous, sporadic, and occurred in older adults. All except 1 isolate belonged to genotype 4; most were phylogenetically related to swine isolates. The epidemiology is similar to that in industrialized countries, where zoonosis is the major source of HEV infection in humans.
Canine Leishmaniasis in Southeastern Spain
PDF Version [PDF - 203 KB - 4 pages]
J. Martín-Sánchez et al.View Abstract
To examine prevalence changes and risk factors for canine leishmaniasis, we conducted a cross-sectional seroprevalence study and a survey during April–June 2006. Seroprevalence had increased at the meso-Mediterranean bioclimatic level over 22 years. Risk was highest for dogs that were older, large, lived outside, and lived at the meso-Mediterranean level.
Real-Time Surveillance for Respiratory Disease Outbreaks, Ontario, Canada
PDF Version [PDF - 199 KB - 3 pages]
A. van Dijk et al.View Abstract
To validate the utility of a chief complaint–based emergency department surveillance system, we compared it with respiratory diagnostic data and calls to Telehealth Ontario about respiratory disease. This local syndromic surveillance system accurately monitored status of respiratory diseases in the community and contributed to early detection of respiratory disease outbreaks.
Possible Seasonality of Clostridium difficile in Retail Meat, Canada
PDF Version [PDF - 255 KB - 4 pages]
A. Rodriguez-Palacios et al.View Abstract
We previously reported Clostridium difficile in 20% of retail meat in Canada, which raised concerns about potential foodborne transmissibility. Here, we studied the genetic diversity of C. difficile in retail meats, using a broad Canadian sampling infrastructure and 3 culture methods. We found 6.1% prevalence and indications of possible seasonality (highest prevalence in winter).
Novel Respiratory Virus Infections in Children, Brazil
PDF Version [PDF - 279 KB - 3 pages]
M. C. Albuquerque et al.View Abstract
Recently discovered respiratory viruses were detected in 19 (9.2%) of 205 nasal swab specimens from children in Brazil with respiratory illnesses. Five each were positive for human metapneumovirus (HMPV) alone and human bocavirus (HBoV) alone, 3 for human coronaviruses (HCoV-HKU1 or -NL63) alone, and 6 for more than 1 recently discovered virus.
Reduced Fluoroquinolone Susceptibility in Salmonella enterica Isolates from Travelers, Finland
PDF Version [PDF - 278 KB - 4 pages]
M. M. Lindgren et al.View Abstract
We tested the fluoroquinolone susceptibility of 499 Salmonella enterica isolates collected from travelers returning to Finland during 2003–2007. Among isolates from travelers to Thailand and Malaysia, reduced fluoroquinolone susceptibility decreased from 65% to 22% (p = 0.002). All isolates showing nonclassical quinolone resistance were from travelers to these 2 countries.
Molecular Epidemiology of Feline and Human Bartonella henselae Isolates
PDF Version [PDF - 183 KB - 4 pages]
R. Bouchouicha et al.View Abstract
Multiple locus variable number tandem repeat analysis was performed on 178 Bartonella henselae isolates from 9 countries; 99 profiles were distributed into 2 groups. Human isolates/strains were placed into the second group. Genotype I and II isolates shared no common profile. All genotype I isolates clustered within group B. The evolutive implications are discussed.
Clostridium difficile in Ready-to-Eat Salads, Scotland
PDF Version [PDF - 150 KB - 2 pages]
M. M. Bakri et al.View Abstract
Of 40 ready-to-eat salads, 3 (7.5%) were positive for Clostridium difficile by PCR. Two isolates were PCR ribotype 017 (toxin A–, B+), and 1 was PCR ribotype 001. Isolates were susceptible to vancomycin and metronidazole but variably resistant to other antimicrobial drugs. Ready-to-eat salads may be potential sources for virulent C. difficile.
Clostridium difficile in Retail Meat Products, USA, 2007
PDF Version [PDF - 263 KB - 3 pages]
J. G. Songer et al.View Abstract
To determine the presence of Clostridium difficile, we sampled cooked and uncooked meat products sold in Tucson, Arizona. Forty-two percent contained toxigenic C. difficile strains (either ribotype 078/toxinotype V [73%] or 027/toxinotype III [NAP1 or NAP1-related; 27%]). These findings indicate that food products may play a role in interspecies C. difficile transmission.
Bovine Kobuvirus in Europe
PDF Version [PDF - 140 KB - 2 pages]
G. Reuter and L. Egyed
Candidate Porcine Kobuvirus, China
PDF Version [PDF - 171 KB - 3 pages]
J. Yu et al.
Postoperative Panophthalmitis Caused by Whipple Disease
PDF Version [PDF - 145 KB - 3 pages]
M. Drancourt et al.
Klebsiella pneumoniae Carbapenemase, Canada
PDF Version [PDF - 162 KB - 3 pages]
D. R. Pillai et al.
Cryptosporidium Rabbit Genotype, a Newly Identified Human Pathogen
PDF Version [PDF - 139 KB - 2 pages]
R. M. Chalmers et al.
Acceptance of Public Health Measures by Air Travelers, Switzerland
PDF Version [PDF - 132 KB - 2 pages]
N. Senpinar-Brunner et al.
Near-Fatal Multiple Organ Dysfunction Syndrome Induced by Plasmodium malariae
PDF Version [PDF - 150 KB - 3 pages]
P. Descheemaeker et al.
Pulmonary Involvement and Leptospirosis, Greece
PDF Version [PDF - 119 KB - 2 pages]
A. Papa et al.
Chikungunya Outbreak, Singapore, 2008
PDF Version [PDF - 122 KB - 2 pages]
Y. S. Leo et al.
Vancomycin-Resistant Enterococci, Point Barrow, Alaska, USA
PDF Version [PDF - 139 KB - 2 pages]
M. Drobni et al.
Use of Templates to Identify Source of Norovirus Outbreak
PDF Version [PDF - 139 KB - 2 pages]
J. Liko and W. E. Keene
Epidemiologic Questions from Anthrax Outbreak, Hunter Valley, Australia
PDF Version [PDF - 149 KB - 3 pages]
D. N. Durrheim et al.
Distinct Ecologically Relevant Strains of Anaplasma phagocytophilum
PDF Version [PDF - 120 KB - 4 pages]
J. E. Foley et al.
Ovine Herpesvirus 2 Infection in Foal, Brazil
PDF Version [PDF - 188 KB - 2 pages]
É. A. Costa et al.
Community-acquired Methicillin-Resistant Staphylococcus aureus ST398 Infection, Italy
PDF Version [PDF - 140 KB - 3 pages]
A. Pan et al.
Campylobacter jejuni in Penguins, Antarctica
PDF Version [PDF - 178 KB - 3 pages]
P. Griekspoor et al.
Acute Diarrhea in Children after 2004 Tsunami, Andaman Islands
PDF Version [PDF - 127 KB - 2 pages]
S. Roy et al.
Population-Attributable Risk Estimates for Campylobacter Infection, Australia
PDF Version [PDF - 320 KB - 3 pages]
Books and Media
The Travel and Tropical Medicine Manual, 4th Edition
PDF Version [PDF - 121 KB - 1 page]
E. V. Granowitz
About the Cover
- Page created: December 21, 2010
- Page last updated: December 21, 2010
- Page last reviewed: December 21, 2010
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
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