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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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.
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    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.

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    Increased Risk for Severe Malaria in HIV-1–infected Adults, Zambia PDF Version [PDF - 335 KB - 7 pages]
    V. Chalwe et al.
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    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.
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    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.
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    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.


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