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Volume 15, Number 6—June 2009

Volume 15, Number 6—June 2009   PDF Version [PDF - 4.78 MB - 151 pages]


  • Medscape CME Activity
    Past, Present, and Possible Future Human Infection with Influenza Virus A Subtype H7 PDF Version [PDF - 501 KB - 7 pages]
    J. A. Belser et al.
    View Summary

    These viruses have resulted in >100 cases of human infection since 2002, and their pandemic potential should not be underestimated.

       View Abstract

    Influenza A subtype H7 viruses have resulted in >100 cases of human infection since 2002 in the Netherlands, Italy, Canada, the United States, and the United Kingdom. Clinical illness from subtype H7 infection ranges from conjunctivitis to mild upper respiratory illness to pneumonia. Although subtype H7 infections have resulted in a smaller proportion of hospitalizations and deaths in humans than those caused by subtype H5N1, some subtype H7 strains appear more adapted for human infection on the basis of their virus-binding properties and illness rates among exposed persons. Moreover, increased isolation of subtype H7 influenza viruses from poultry and the ability of this subtype to cause severe human disease underscore the need for continued surveillance and characterization of these viruses. We review the history of human infection caused by subtype H7. In addition, we discuss recently identified molecular correlates of subtype H7 virus pathogenesis and assess current measures to prevent future subtype H7 virus infection.


  • Diphyllobothriasis Associated with Eating Raw Pacific Salmon PDF Version [PDF - 544 KB - 5 pages]
    N. Arizono et al.
       View Abstract

    The incidence of human infection with the broad tapeworm Diphyllobothrium nihonkaiense has been increasing in urban areas of Japan and in European countries. D. nihonkaiense is morphologically similar to but genetically distinct from D. latum and exploits anadromous wild Pacific salmon as its second intermediate host. Clinical signs in humans include diarrhea and discharge of the strobila, which can be as long as 12 m. The natural life history and the geographic range of the tapeworm remain to be elucidated, but recent studies have indicated that the brown bear in the northern territories of the Pacific coast region is its natural final host. A recent surge of clinical cases highlights a change in the epidemiologic trend of this tapeworm disease from one of rural populations to a disease of urban populations worldwide who eat seafood as part of a healthy diet.


  • Geographic Clustering of Leishmaniasis in Northeastern Brazil PDF Version [PDF - 614 KB - 6 pages]
    A. Schriefer et al.
       View Abstract

    To determine whether disease outcomes and clades of Leishmania braziliensis genotypes are associated, we studied geographic clustering of clades and most severe disease outcomes for leishmaniasis during 1999–2003 in Corte de Pedra in northeastern Brazil. Highly significant differences were observed in distribution of mucosal leishmaniasis versus disseminated leishmaniasis (DL) (p<0.0001). Concordance was observed between distribution of these disease forms and clades of L. braziliensis genotypes shown to be associated with these disease forms. We also detected spread of DL over this region and an inverse correlation between frequency of recent DL diagnoses and distance to a previous DL case. These findings indicate that leishmaniasis outcomes are distributed differently within transmission foci and show that DL is rapidly spreading in northeastern Brazil.

  • Lineage 2 West Nile Virus as Cause of Fatal Neurologic Disease in Horses, South Africa PDF Version [PDF - 552 KB - 8 pages]
    M. Venter et al.
       View Abstract

    Serologic evidence suggests that West Nile virus (WNV) is widely distributed in horses in southern Africa. However, because few neurologic cases have been reported, endemic lineage 2 strains were postulated to be nonpathogenic in horses. Recent evidence suggests that highly neuroinvasive lineage 2 strains exist in humans and mice. To determine whether neurologic cases are being missed in South Africa, we tested 80 serum or brain specimens from horses with unexplained fever (n = 48) and/or neurologic signs (n = 32) for WNV. From March 2007 through June 2008, using reverse transcription–PCR (RT-PCR) and immunoglobulin (Ig) M ELISA, we found WNV RNA or IgM in 7/32 horses with acute neurologic disease; 5 horses died or were euthanized. In 5/7 horses, no other pathogen was detected. DNA sequencing for all 5 RT-PCR–positive cases showed the virus belonged to lineage 2. WNV lineage 2 may cause neurologic disease in horses in South Africa.

  • Hantaviruses in Rodents and Humans, Inner Mongolia Autonomous Region, China PDF Version [PDF - 607 KB - 7 pages]
    Y. Zhang et al.
       View Abstract

    Surveys were carried out in 2003–2006 to better understand the epidemiology of hantaviruses in the Inner Mongolia Autonomous Region of China (Inner Mongolia). Hemorrhagic fever with renal syndrome (HFRS) was first reported in this region in 1955 and has been an important public health problem here since then. During 1955–2006, 8,309 persons with HFRS were reported in Inner Mongolia (average incidence rate 0.89/100,000), and 261 (3.14%) died. Before the 1990s, all HFRS cases occurred in northeastern Inner Mongolia. Subsequently, HFRS cases were registered in central (1995) and western (1999) Inner Mongolia. In this study, hantaviral antigens were identified in striped field mice (Apodemus agrarius) from northeastern Inner Mongolia and in Norway rats (Rattus norvegicus) from middle and western Inner Mongolia. Phylogenetic analysis of hantaviral genome sequences suggests that HFRS has been caused mainly by Hantaan virus in northeastern Inner Mongolia and by Seoul virus in central and western Inner Mongolia.

  • Case-based Surveillance of Influenza Hospitalizations during 2004–2008, Colorado, USA PDF Version [PDF - 479 KB - 7 pages]
    R. Proff et al.
       View Abstract

    Colorado became the first state to make laboratory-confirmed influenza-associated hospitalizations a case-based reportable condition in 2004. We summarized surveillance for influenza hospitalizations in Colorado during the first 4 recorded influenza seasons (2004–2008). We highlight the similarities and differences among influenza seasons; no 2 seasons were entirely the same. The 2005–06 influenza season had 2 distinct waves of activity (types A and B), the 2006–07 season was substantially later and milder, and 2007–08 had substantially greater influenza B activity. The case-based surveillance for influenza hospitalizations provides information regarding the time course of seasonal influenza activity, reported case numbers and population-based rates by age group and influenza virus type, and a measure of relative severity. Influenza hospitalization surveillance provides more information about seasonal influenza activity than any other surveillance measure (e.g., surveillance for influenza-like illness) currently in widespread use among states. More states should consider implementing case-based surveillance for influenza hospitalizations.

  • Tuberculosis Disparity between US-born Blacks and Whites, Houston, Texas, USA PDF Version [PDF - 502 KB - 6 pages]
    J. A. Serpa et al.
       View Abstract

    Tuberculosis (TB) rates in the United States are disproportionately high for certain ethnic minorities. Using univariate and multivariate analyses, we compared data for 1,318 US-born blacks with 565 US-born non-Hispanic whites who participated in the Houston TB Initiative (1995–2004). All available Mycobacterium tuberculosis isolates underwent susceptibility and genotype testing (insertion sequence 6110 restriction fragment length polymorphism, spoligotyping, and genetic grouping). TB in blacks was associated with younger age, inner city residence, HIV seropositivity, and drug resistance. TB cases clustered in 82% and 77% of blacks and whites, respectively (p = 0.46). Three clusters had >100 patients each, including 1 cluster with a predominance of blacks. Size of TB clusters was unexpectedly large, underscoring the ongoing transmission of TB in Houston, particularly among blacks.

  • Changes in Fluoroquinolone-Resistant Streptococcus pneumonia after 7-Valent Conjugate Vaccination, Spain PDF Version [PDF - 469 KB - 7 pages]
    A. G. de la Campa et al.
       View Abstract

    Among 4,215 Streptococcus pneumoniae isolates obtained in Spain during 2006, 98 (2.3%) were ciprofloxacin resistant (3.6% from adults and 0.14% from children). In comparison with findings from a 2002 study, global resistance remained stable. Low-level resistance (30 isolates with MIC 4–8 μg/mL) was caused by a reserpine-sensitive efflux phenotype (n = 4) or single topoisomerase IV (parC [n = 24] or parE [n = 1]) changes. One isolate did not show reserpine-sensitive efflux or mutations. High-level resistance (68 isolates with MIC ≥16 μg/mL) was caused by changes in gyrase (gyrA) and parC or parE. New changes in parC (S80P) and gyrA (S81V, E85G) were shown to be involved in resistance by genetic transformation. Although 49 genotypes were observed, clones Spain9V-ST156 and Sweden15A-ST63 accounted for 34.7% of drug-resistant isolates. In comparison with findings from the 2002 study, clones Spain14-ST17, Spain23F-ST81, and ST8819F decreased and 4 new genotypes (ST9710A, ST57016, ST43322, and ST71733) appeared in 2006.

  • Bartonella quintana in Body Lice and Head Lice from Homeless Persons, San Francisco, California, USA PDF Version [PDF - 391 KB - 4 pages]
    D. L. Bonilla et al.
       View Abstract

    Bartonella quintana is a bacterium that causes trench fever in humans. Past reports have shown Bartonella spp. infections in homeless populations in San Francisco, California, USA. The California Department of Public Health in collaboration with San Francisco Project Homeless Connect initiated a program in 2007 to collect lice from the homeless to test for B. quintana and to educate the homeless and their caregivers on prevention and control of louse-borne disease. During 2007–2008, 33.3% of body lice–infested persons and 25% of head lice–infested persons had lice pools infected with B. quintana strain Fuller. Further work is needed to examine how homeless persons acquire lice and determine the risk for illness to persons infested with B. quintana–infected lice.

Historical Review

  • Drought, Smallpox, and Emergence of Leishmania braziliensis in Northeastern Brazil PDF Version [PDF - 602 KB - 6 pages]
    A. Q. Sousa and R. Pearson
       View Abstract

    Cutaneous leishmaniasis caused by Leishmania (Vianna) braziliensis is a major health problem in the state of Ceará in northeastern Brazil. We propose that the disease emerged as a consequence of the displacement of persons from Ceará to the Amazon region following the Great Drought and smallpox epidemic of 1877–1879. As the economic and social situation in Ceará deteriorated, ≈55,000 residents migrated to the Amazon region to find work, many on rubber plantations. Those that returned likely introduced L. (V.) brazilensis into Ceará, where the first cases of cutaneous leishmaniasis were reported early in the 20th century. The absence of an animal reservoir in Ceará, apart from dogs, supports the hypothesis. The spread of HIV/AIDS into the region and the possibility of concurrent cutaneous leishmaniasis raise the possibility of future problems.



Books and Media

About the Cover


Conference Summaries

  • Peer Reviewed Report Available Online Only
    Stockpiling Supplies for the Next Influenza Pandemic PDF Version [PDF - 85 KB - 6 pages]
    L. J. Radonovich et al.
       View Abstract

    Faced with increasing concerns about the likelihood of an influenza pandemic, healthcare systems have been challenged to determine what specific medical supplies that should be procured and stockpiled as a component of preparedness. Despite publication of numerous pandemic planning recommendations, little or no specific guidance about the types of items and quantities of supplies needed has been available. The primary purpose of this report is to detail the approach of 1 healthcare system in building a cache of supplies to be used for patient care during the next influenza pandemic. These concepts may help guide the actions of other healthcare systems.