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Volume 16, Number 10—October 2010
Volume 16, Number 10—October 2010 PDF Version [PDF - 4.23 MB - 151 pages]
Influenza A (H5N1) Viruses from Pigs, Indonesia
PDF Version [PDF - 722 KB - 9 pages]
C. A. Nidom et al.View SummaryView Abstract
Pigs may serve as intermediate hosts in which this avian virus can adapt to mammals.
Pigs have long been considered potential intermediate hosts in which avian influenza viruses can adapt to humans. To determine whether this potential exists for pigs in Indonesia, we conducted surveillance during 2005–2009. We found that 52 pigs in 4 provinces were infected during 2005–2007 but not 2008–2009. Phylogenetic analysis showed that the viruses had been introduced into the pig population in Indonesia on at least 3 occasions. One isolate had acquired the ability to recognize a human-type receptor. No infected pig had influenza-like symptoms, indicating that influenza A (H5N1) viruses can replicate undetected for prolonged periods, facilitating avian virus adaptation to mammalian hosts. Our data suggest that pigs are at risk for infection during outbreaks of influenza virus A (H5N1) and can serve as intermediate hosts in which this avian virus can adapt to mammals.
Mobile Phone–based Infectious Disease Surveillance System, Sri Lanka
PDF Version [PDF - 297 KB - 8 pages]
C. Robertson et al.View Abstract
Because many infectious diseases are emerging in animals in low-income and middle-income countries, surveillance of animal health in these areas may be needed for forecasting disease risks to humans. We present an overview of a mobile phone–based frontline surveillance system developed and implemented in Sri Lanka. Field veterinarians reported animal health information by using mobile phones. Submissions increased steadily over 9 months, with ≈4,000 interactions between field veterinarians and reports on the animal population received by the system. Development of human resources and increased communication between local stakeholders (groups and persons whose actions are affected by emerging infectious diseases and animal health) were instrumental for successful implementation. The primary lesson learned was that mobile phone–based surveillance of animal populations is acceptable and feasible in lower-resource settings. However, any system implementation plan must consider the time needed to garner support for novel surveillance methods among users and stakeholders.
Oral Fluid Testing during 10 Years of Rubella Elimination, England and Wales
PDF Version [PDF - 324 KB - 7 pages]
G. Manikkavasagan et al.View Abstract
Surveillance of rubella in England and Wales has included immunoglobulin M testing of oral (crevicular) fluid from reported case-patients since 1994. The need for laboratory confirmation to monitor rubella elimination is emphasized by poor sensitivity (51%, 95% confidence interval 48.9%–54.0%) and specificity (55%, 95% confidence interval 53.7%–55.6%) of the clinical case definition. During 1999–2008, oral fluid from 11,709 (84%) of 13,952 reported case-patients was tested; 143 (1.0%) cases were confirmed and 11,566 (99%) were discarded (annual investigation and discard rate of clinically suspected rubella cases was 2,208/100,000 population). Incidence of confirmed rubella increased from 0.50 to 0.77/1 million population when oral fluid testing was included. Oral fluid tests confirmed that cases were more likely to be in older, unvaccinated men. Testing of oral fluid has improved ascertainment of confirmed rubella in children and men and provided additional information for assessing UK progress toward the World Health Organization elimination goal.
Human Monkeypox Outbreak Caused by Novel Virus Belonging to Congo Basin Clade, Sudan, 2005
PDF Version [PDF - 316 KB - 7 pages]
P. Formenty et al.View SummaryView Abstract
This virus should be considered endemic to the wetland areas of Bentiu, Unity State, Sudan.
To determine the outbreak source of monkeypox virus (MPXV) infections in Unity State, Sudan, in November 2005, we conducted a retrospective investigation. MPXV was identified in a sub-Sahelian savannah environment. Three case notification categories were used: suspected, probable, and confirmed. Molecular, virologic, and serologic assays were used to test blood specimens, vesicular swabs, and crust specimens obtained from symptomatic and recovering persons. Ten laboratory-confirmed cases and 9 probable cases of MPXV were reported during September–December 2005; no deaths occurred. Human-to-human transmission up to 5 generations was described. Our investigation could not fully determine the source of the outbreak. Preliminary data indicate that the MPXV strain isolated during this outbreak was a novel virus belonging to the Congo Basin clade. Our results indicate that MPXV should be considered endemic to the wetland areas of Unity State. This finding will enhance understanding of the ecologic niche for this virus.
Therapeutic Drug Monitoring for Slow Response to Tuberculosis Treatment in a State Control Program, Virginia, USA
PDF Version [PDF - 316 KB - 8 pages]
S. K. Heysell et al.View SummaryView Abstract
Diabetes was associated with increased risk for slow response and low rifampin levels.
Therapeutic drug monitoring may be useful in tuberculosis management, but programmatic implementation is understudied. We performed a retrospective cohort study to determine prevalence of lower than expected levels of isoniazid, rifampin, ethambutol, and pyrazinamide measured at time of estimated peak serum concentration. Patients were tested for serum concentration at 2 hours after medication administration. When patients were tested, 22 had concentrations lower than expected range for rifampin, 23 of 39 patients had low levels of isoniazid, and 8 of 26 patients had low levels of ethambutol; all 20 patients tested for pyrazinamide were within expected range. Over 26 months, 42 patients met criteria for slow response. Diabetes was associated with slow response (p<0.001), and persons with diabetes were more likely than persons without diabetes to have low rifampin levels (p = 0.03). Dosage adjustment of rifampin was more likely to elevate serum concentration to the target range than adjustment of isoniazid given in daily doses (p = 0.01).
Risk Factors for Pandemic (H1N1) 2009 Virus Seroconversion among Hospital Staff, Singapore
PDF Version [PDF - 222 KB - 8 pages]
M. I. Chen et al.View SummaryView Abstract
Infection was associated with occupational and nonoccupational risk factors.
We describe incidence and risk factors for pandemic (H1N1) 2009 virus infection in healthcare personnel during the June–September 2009 epidemic in Singapore. Personnel contributed 3 serologic samples during June–October 2009, with seroconversion defined as a >4-fold increase in hemagglutination inhibition titers to pandemic (H1N1) 2009. Of 531 participants, 35 showed evidence of seroconversion. Seroconversion rates were highest in nurses (28/290) and lowest in allied health staff (2/116). Significant risk factors on multivariate analysis were being a nurse (adjusted odds ratio [aOR] 4.5, 95% confidence interval [CI] 1.0–19.6) and working in pandemic (H1N1) 2009 isolation wards (aOR 4.5, 95% CI 1.3–15.6). Contact with pandemic (H1N1) 2009–infected colleagues (aOR 2.5, 95% CI 0.9–6.6) and larger household size (aOR 1.2, 95% CI 1.0–1.4) were of borderline significance. Our study suggests that seroconversion was associated with occupational and nonoccupational risk factors.
Effectiveness of Personal Protective Equipment and Oseltamivir Prophylaxis during Avian Influenza A (H7N7) Epidemic, the Netherlands, 2003
PDF Version [PDF - 215 KB - 7 pages]
D. E. te Beest et al.View SummaryView Abstract
Only oseltamivir use significantly reduced the risk for human infection.
We analyzed the effectiveness of personal protective equipment and oseltamivir use during the 2003 avian influenza A (H7N7) epidemic in the Netherlands by linking databases containing information about farm visits, human infections, and use of oseltamivir and personal protective equipment. Using a stringent case definition, based on self-reported conjunctivitis combined with a positive hemagglutination-inhibition assay, we found that prophylactic treatment with oseltamivir significantly reduced the risk for infection per farm visit from 0.145 (95% confidence interval [CI] 0.078–0.233) to 0.031 (95% CI 0.008–0.073). The protective effect was ≈79% (95% CI 40%–97%). These results are comparable with the reported effect of prophylactic treatment with oseltamivir on human seasonal influenza. No significant protective effect was found for use of respirators or safety glasses, possibly because of limitations of the data.
Medscape CME Activity
Bloodstream Infections among HIV-Infected Outpatients, Southeast Asia PDF Version [PDF - 291 KB - 8 pages]J. K. Varma et al.View SummaryView Abstract
Mycobacterium tuberculosis was the most common pathogen.
Bloodstream infections (BSIs) are a major cause of illness in HIV-infected persons. To evaluate prevalence of and risk factors for BSIs in 2,009 HIV-infected outpatients in Cambodia, Thailand, and Vietnam, we performed a single Myco/F Lytic blood culture. Fifty-eight (2.9%) had a clinically significant BSI (i.e., a blood culture positive for an organism known to be a pathogen). Mycobacterium tuberculosis accounted for 31 (54%) of all BSIs, followed by fungi (13 [22%]) and bacteria (9 [16%]). Of patients for whom data were recorded about antiretroviral therapy, 0 of 119 who had received antiretroviral therapy for >14 days had a BSI, compared with 3% of 1,801 patients who had not. In multivariate analysis, factors consistently associated with BSI were fever, low CD4+ T-lymphocyte count, abnormalities on chest radiograph, and signs or symptoms of abdominal illness. For HIV-infected outpatients with these risk factors, clinicians should place their highest priority on diagnosing tuberculosis.
Medscape CME Activity
Changing Epidemiology of Pulmonary Nontuberculous Mycobacteria Infections PDF Version [PDF - 319 KB - 9 pages]R. M. ThomsonView SummaryView Abstract
Pattern of disease has changed from cavitary disease in middle-aged men who smoke to fibronodular disease in elderly women.
Nontuberculous mycobacteria (NTM) disease is a notifiable condition in Queensland, Australia. Mycobacterial isolates that require species identification are forwarded to the Queensland Mycobacterial Reference Laboratory, providing a central opportunity to capture statewide data on the epidemiology of NTM disease. We compared isolates obtained in 1999 and 2005 and used data from the Queensland notification scheme to report the clinical relevance of these isolates. The incidence of notified cases of clinically significant pulmonary disease rose from 2.2 (1999) to 3.2 (2005) per 100,000 population. The pattern of disease has changed from predominantly cavitary disease in middle-aged men who smoke to fibronodular disease in elderly women. Mycobacterium intracellulare is the main pathogen associated with the increase in isolates speciated in Queensland.
Mortality Rate Patterns for Hemorrhagic Fever with Renal Syndrome Caused by Puumala Virus
PDF Version [PDF - 200 KB - 3 pages]
M. Hjertqvist et al.View Abstract
To investigate nephropathia epidemica in Sweden during 1997–2007, we determined case-fatality rates for 5,282 patients with this disease. Overall, 0.4% died of acute nephropathia epidemica <3 months after diagnosis. Case-fatality rates increased with age. Only women showed an increased case-fatality rate during the first year after diagnosis.
Pandemic (H1N1) 2009 Virus on Commercial Swine Farm, Thailand
PDF Version [PDF - 232 KB - 4 pages]
D. Sreta et al.View Abstract
A swine influenza outbreak occurred on a commercial pig farm in Thailand. Outbreak investigation indicated that pigs were co-infected with pandemic (H1N1) 2009 virus and seasonal influenza (H1N1) viruses. No evidence of gene reassortment or pig-to-human transmission of pandemic (H1N1) 2009 virus was found during the outbreak.
Toxoplasma gondii Oocyst–specific Antibodies and Source of Infection
PDF Version [PDF - 167 KB - 3 pages]
C. A. Muñoz-Zanzi et al.View Abstract
Infection source can determine cost-effective public health interventions. To quantify risk of acquiring Toxoplasma gondii from environmental sources versus from meat, we examined serum from pregnant women in Chile. Because 43% had oocyst-specific antibodies, we conclude that contaminated meat remains the primary source of infection but that environmental sources also pose substantial risk.
Predicting Need for Hospitalization of Patients with Pandemic (H1N1) 2009, Chicago, Illinois, USA
PDF Version [PDF - 195 KB - 4 pages]
S. Vasoo et al.View Abstract
In the absence of established guidelines for hospitalization of patients with pandemic (H1N1) 2009, we studied emergency department patients to identify clinical parameters that predict need for hospitalization. Independent predictors of hospitalization include multiple high-risk medical conditions, dyspnea, and hypoxia. These findings are easily applicable, with a 79% positive predictive value for hospitalization.
Imported Lassa Fever, Pennsylvania, USA, 2010
PDF Version [PDF - 143 KB - 3 pages]
V. Amorosa et al.View Abstract
We report a case of Lassa fever in a US traveler who visited rural Liberia, became ill while in country, sought medical care upon return to the United States, and subsequently had his illness laboratory confirmed. The patient recovered with supportive therapy. No secondary cases occurred.
Type 2 Diabetes Mellitus and Increased Risk for Malaria Infection
PDF Version [PDF - 164 KB - 4 pages]
I. Danquah et al.View Abstract
A case–control study of 1,466 urban adults in Ghana found that patients with type 2 diabetes mellitus had a 46% increased risk for infection with Plasmodium falciparum. Increase in diabetes mellitus prevalence may put more persons at risk for malaria infection.
Epidemiology of Human Parvovirus 4 Infection in Sub-Saharan Africa
PDF Version [PDF - 157 KB - 3 pages]
C. P. Sharp et al.View Abstract
Human parvovirus 4 infections are primarily associated with parenteral exposure in western countries. By ELISA, we demonstrate frequent seropositivity for antibody to parvovirus 4 viral protein 2 among adult populations throughout sub-Saharan Africa (Burkina Faso, 37%; Cameroon, 25%; Democratic Republic of the Congo, 35%; South Africa, 20%), which implies existence of alternative transmission routes.
Artesunate Misuse and Plasmodium falciparum Malaria in Traveler Returning from Africa
PDF Version [PDF - 219 KB - 3 pages]
D. Shahinas et al.View Abstract
Plasmodium falciparum malaria developed in an African-born traveler who returned to Canada after visiting Nigeria. While there, she took artesunate prophylactically. Isolates had an elevated 50% inhibitory concentration to artemisinin, artesunate, and artemether, compared with that of other African isolates. Inappropriate use of artemisinin derivatives can reduce P. falciparum susceptibility.
Severe Plasmodium vivax Malaria, Brazilian Amazon
PDF Version [PDF - 192 KB - 4 pages]
M. A. Alexandre et al.View Abstract
We describe a case series of 17 patients hospitalized in Manaus (western Brazilian Amazon) with PCR-confirmed Plasmodium vivax infection who were treated with chloroquine and primaquine. The major complications were jaundice and severe anemia. No in vivo chloroquine resistance was detected. These data help characterize the clinical profile of severe P. vivax malaria in Latin America.
Erythema Migrans–like Illness among Caribbean Islanders
PDF Version [PDF - 251 KB - 3 pages]
A. Sharma et al.View Abstract
Erythema migrans is the skin manifestation of Lyme disease and southern tick-associated rash illness. Neither disease is found in the Caribbean. We report 4 cases of erythema migrans of a possible emerging clinical entity, Caribbean erythma migrans–like illness.
Pandemic (H1N1) 2009 and Seasonal Influenza A (H1N1) Co-infection, New Zealand, 2009
PDF Version [PDF - 192 KB - 3 pages]
M. Peacey et al.View Abstract
Co-infection with seasonal influenza A (H1N1) and pandemic (H1N1) 2009 could result in reassortant viruses that may acquire new characteristics of transmission, virulence, and oseltamivir susceptibility. Results from oseltamivir-sensitivity testing on viral culture suggested the possibility of co-infections with oseltamivir-resistant (seasonal A [H1N1]) and -susceptible (pandemic [H1N1] 2009) viruses.
Chemokine Receptor 5 Δ32 Allele in Patients with Severe Pandemic (H1N1) 2009
PDF Version [PDF - 209 KB - 2 pages]
Y. Keynan et al.View Abstract
Because chemokine receptor 5 (CCR5) may have a role in pulmonary immune response, we explored whether patients with severe pandemic (H1N1) 2009 were more likely to carry the CCR5Δ32 allele than were members of the general population. We found a large proportion of heterozygosity for the CCR5Δ32 allele among white patients with severe disease.
Klassevirus Infection in Children, South Korea
PDF Version [PDF - 220 KB - 3 pages]
T. Han et al.View Abstract
To investigate prevalence and clinical characteristics of klassevirus in South Korea, we performed molecular screening in fecal and nasopharyngeal samples from hospitalized children with gastroenteritis. A total of 26 (8.8%) of 294 fecal samples were positive for klassevirus. Klassevirus may be a possible cause of gastroenteritis.
Human Cases of Methicillin-Resistant Staphylococcus aureus CC398, Finland
PDF Version [PDF - 232 KB - 4 pages]
S. Salmenlinna et al.View Abstract
Nationwide surveillance identified 10 human isolates of methicillin-resistant Staphylococcus aureus clonal complex (CC) 398. Further typing in comparison with animal isolates identified 4 clusters: 1 related to a horse epidemic and 3 to persons who had no direct contact with animals or each other. These findings may indicate unrecognized community transmission.
Hepatitis E Virus Genotype Diversity in Eastern China
PDF Version [PDF - 240 KB - 3 pages]
W. Zhang et al.View Abstract
We studied 47 hepatitis E virus (HEV) isolates from hospitalized patients in Nanjing and Taizhou, eastern China. Genotypes 1, 3, and 4 were prevalent; genotype 3 and subgenotype 4b showed a close relationship with the swine strains in eastern China, thus indicating that HEV genotype 3 had infected humans in China.
Emergence of Oseltamivir-Resistant Pandemic (H1N1) 2009 Virus within 48 Hours
PDF Version [PDF - 385 KB - 4 pages]
M. Inoue et al.View Abstract
An oseltamivir-resistant influenza A pandemic (H1N1) 2009 virus evolved and emerged from zero to 52% of detectable virus within 48 hours of a patient’s exposure to oseltamivir. Phylogenetic analysis and data gathered by pyrosequencing and cloning directly on clinical samples suggest that the mutant emerged de novo.
Avian Leukosis Virus Subgroup J in Layer Chickens, China
PDF Version [PDF - 130 KB - 2 pages]
Y. Gao et al.
Healthcare Worker Acceptance of Pandemic (H1N1) 2009 Vaccination, Morocco
R. Tagajdid et al.
New Rural Focus of Plague, Algeria
PDF Version [PDF - 171 KB - 2 pages]
I. Bitam et al.
Scrub Typhus Involving Central Nervous System, India, 2004–2006
PDF Version [PDF - 133 KB - 3 pages]
S. K. Mahajan et al.
Pandemic (H1N1) 2009 and HIV Co-infection
PDF Version [PDF - 128 KB - 2 pages]
E. Barchi et al.
Dictyostelium polycephalum Infection of Human Cornea
PDF Version [PDF - 146 KB - 2 pages]
A. K. Reddy et al.
Underlying Medical Conditions and Hospitalization for Pandemic (H1N1) 2009, Japan
PDF Version [PDF - 136 KB - 2 pages]
T. Tomizuka et al.
Internet Search Limitations and Pandemic Influenza, Singapore
PDF Version [PDF - 184 KB - 3 pages]
A. R. Cook et al.
Body Lice, Yersinia pestis Orientalis, and Black Death
PDF Version [PDF - 112 KB - 2 pages]
M. Welford and B. Bossak
Clostridium difficile Infections among Hospitalized Children, United States, 1997–2006
PDF Version [PDF - 205 KB - 2 pages]
S. M. Vindigni and A. L. Shane
Books and Media
Living Weapons: Biological Weapons and International Security
PDF Version [PDF - 105 KB - 1 page]
T. J. Cieslak
Superbug: The Fatal Menace of MRSA
PDF Version [PDF - 165 KB - 2 pages]
J. P. Steinberg
About the Cover
And the Raven, Never Flitting, Still Is Sitting, Still Is Sitting
PDF Version [PDF - 141 KB - 2 pages]
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: September 08, 2011
- Page last updated: September 08, 2011
- Page last reviewed: September 08, 2011
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