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Volume 17, Number 7—July 2011
Volume 17, Number 7—July 2011 PDF Version [PDF - 5.59 MB - 191 pages]
Understanding the Cholera Epidemic, Haiti
PDF Version [PDF - 413 KB - 8 pages]
R. Piarroux et al.View Abstract
After onset of a cholera epidemic in Haiti in mid-October 2010, a team of researchers from France and Haiti implemented field investigations and built a database of daily cases to facilitate identification of communes most affected. Several models were used to identify spatiotemporal clusters, assess relative risk associated with the epidemic’s spread, and investigate causes of its rapid expansion in Artibonite Department. Spatiotemporal analyses highlighted 5 significant clusters (p<0.001): 1 near Mirebalais (October 16–19) next to a United Nations camp with deficient sanitation, 1 along the Artibonite River (October 20–28), and 3 caused by the centrifugal epidemic spread during November. The regression model indicated that cholera more severely affected communes in the coastal plain (risk ratio 4.91) along the Artibonite River downstream of Mirebalais (risk ratio 4.60). Our findings strongly suggest that contamination of the Artibonite and 1 of its tributaries downstream from a military camp triggered the epidemic.
Rickettsia parkeri Rickettsiosis, Argentina
PDF Version [PDF - 264 KB - 4 pages]
Y. Romer et al.View Abstract
Rickettsia parkeri, a recently identified cause of spotted fever rickettsiosis in the United States, has been found in Amblyomma triste ticks in several countries of South America, including Argentina, where it is believed to cause disease in humans. We describe the clinical and epidemiologic characteristics of 2 patients in Argentina with confirmed R. parkeri infection and 7 additional patients with suspected R. parkeri rickettsiosis identified at 1 hospital during 2004–2009. The frequency and character of clinical signs and symptoms among these 9 patients closely resembled those described for patients in the United States (presence of an inoculation eschar, maculopapular rash often associated with pustules or vesicles, infrequent gastrointestinal manifestations, and relatively benign clinical course). Many R. parkeri infections in South America are likely to be misdiagnosed as other infectious diseases, including Rocky Mountain spotted fever, dengue, or leptospirosis.
Medscape CME Activity
Neurognathostomiasis, a Neglected Parasitosis of the Central Nervous System PDF Version [PDF - 323 KB - 7 pages]J. Katchanov et al.View Abstract
Gnathostomiasis is a foodborne zoonotic helminthic infection caused by the third-stage larvae of Gnathostoma spp. nematodes. The most severe manifestation involves infection of the central nervous system, neurognathostomiasis. Although gnathostomiasis is endemic to Asia and Latin America, almost all neurognathostomiasis cases are reported from Thailand. Despite high rates of illness and death, neurognathostomiasis has received less attention than the more common cutaneous form of gnathostomiasis, possibly because of the apparent geographic confinement of the neurologic infection to 1 country. Recently, however, the disease has been reported in returned travelers in Europe. We reviewed the English-language literature on neurognathostomiasis and analyzed epidemiology and geographic distribution, mode of central nervous system invasion, pathophysiology, clinical features, neuroimaging data, and treatment options. On the basis of epidemiologic data, clinical signs, neuroimaging, and laboratory findings, we propose diagnostic criteria for neurognathostomiasis.
Effectiveness of Seasonal Influenza Vaccine against Pandemic (H1N1) 2009 Virus, Australia, 2010
PDF Version [PDF - 225 KB - 7 pages]
J. E. Fielding et al.View Abstract
To estimate effectiveness of seasonal trivalent and monovalent influenza vaccines against pandemic influenza A (H1N1) 2009 virus, we conducted a test-negative case–control study in Victoria, Australia, in 2010. Patients seen for influenza-like illness by general practitioners in a sentinel surveillance network during 2010 were tested for influenza; vaccination status was recorded. Case-patients had positive PCRs for pandemic (H1N1) 2009 virus, and controls had negative influenza test results. Of 319 eligible patients, test results for 139 (44%) were pandemic (H1N1) 2009 virus positive. Adjusted effectiveness of seasonal vaccine against pandemic (H1N1) 2009 virus was 79% (95% confidence interval 33%–93%); effectiveness of monovalent vaccine was 47% and not statistically significant. Vaccine effectiveness was higher among adults. Despite some limitations, this study indicates that the first seasonal trivalent influenza vaccine to include the pandemic (H1N1) 2009 virus strain provided significant protection against laboratory-confirmed pandemic (H1N1) 2009 infection.
Transmission of Influenza on International Flights, May 2009
PDF Version [PDF - 305 KB - 7 pages]
A. Foxwell et al.View Abstract
Understanding the dynamics of influenza transmission on international flights is necessary for prioritizing public health response to pandemic incursions. A retrospective cohort study to ascertain in-flight transmission of pandemic (H1N1) 2009 and influenza-like illness (ILI) was undertaken for 2 long-haul flights entering Australia during May 2009. Combined results, including survey responses from 319 (43%) of 738 passengers, showed that 13 (2%) had an ILI in flight and an ILI developed in 32 (5%) passengers during the first week post arrival. Passengers were at 3.6% increased risk of contracting pandemic (H1N1) 2009 if they sat in the same row as or within 2 rows of persons who were symptomatic preflight. A closer exposed zone (2 seats in front, 2 seats behind, and 2 seats either side) increased the risk for postflight disease to 7.7%. Efficiency of contact tracing without compromising the effectiveness of the public health intervention might be improved by limiting the exposed zone.
Medscape CME Activity
Hantavirus Pulmonary Syndrome, United States, 1993–2009 PDF Version [PDF - 273 KB - 7 pages]A. MacNeil et al.View Abstract
Hantavirus pulmonary syndrome (HPS) is a severe respiratory illness identified in 1993. Since its identification, the Centers for Disease Control and Prevention has obtained standardized information about and maintained a registry of all laboratory-confirmed HPS cases in the United States. During 1993–2009, a total of 510 HPS cases were identified. Case counts have varied from 11 to 48 per year (case-fatality rate 35%). However, there were no trends suggesting increasing or decreasing case counts or fatality rates. Although cases were reported in 30 states, most cases occurred in the western half of the country; annual case counts varied most in the southwestern United States. Increased hematocrits, leukocyte counts, and creatinine levels were more common in HPS case-patients who died. HPS is a severe disease with a high case-fatality rate, and cases continue to occur. The greatest potential for high annual HPS incidence exists in the southwestern United States.
Hansen Disease among Micronesian and Marshallese Persons Living in the United States
PDF Version [PDF - 516 KB - 7 pages]
P. Woodall et al.View Abstract
An increasing proportion of Hansen disease cases in the United States occurs among migrants from the Micronesian region, where leprosy prevalence is high. We abstracted surveillance and clinical records of the National Hansen’s Disease Program to determine geographic, demographic, and clinical patterns. Since 2004, 13% of US cases have occurred in this migrant population. Although Hawaii reported the most cases, reports have increased in the central and southern states. Multibacillary disease in men predominates on the US mainland. Of 49 patients for whom clinical data were available, 37 (75%) had leprosy reaction, neuropathy, or other complications; 17 (37%) of 46 completed treatment. Comparison of data from the US mainland with Hawaii and country-of-origin suggests under-detection of cases in pediatric and female patients and with paucibacillary disease in the United States. Increased case finding and management, and avoidance of leprosy-labeled stigma, is needed for this population.
Epidemiology and Control of Legionellosis, Singapore
PDF Version [PDF - 234 KB - 7 pages]
M. C. Lam et al.View Abstract
To determine trends and clinical and epidemiologic features of legionellosis in Singapore, we studied cases reported during 2000–2009. During this period, 238 indigenous and 33 imported cases of legionellosis were reported. Cases were reported individually and sporadically throughout each year. Although the annual incidence of indigenous cases had decreased from 0.46 cases per 100,000 population in 2003 to 0.16 cases per 100,000 in 2009, the proportion of imported cases increased correspondingly from 6.2% during 2000–2004 to 27.3% during 2005–2009 (p<0.0005). The prevalence of Legionella bacteria in cooling towers and water fountains was stable (range 12.1%–15.3%) during 2004–August 2008.
Extended-Spectrum β-Lactamase Genes of Escherichia coli in Chicken Meat and Humans, the Netherlands
PDF Version [PDF - 525 KB - 7 pages]
I. Overdevest et al.View Abstract
We determined the prevalence and characteristics of extended-spectrum β-lactamase (ESBL) genes of Enterobacteriaceae in retail chicken meat and humans in the Netherlands. Raw meat samples were obtained, and simultaneous cross-sectional surveys of fecal carriage were performed in 4 hospitals in the same area. Human blood cultures from these hospitals that contained ESBL genes were included. A high prevalence of ESBL genes was found in chicken meat (79.8%). Genetic analysis showed that the predominant ESBL genes in chicken meat and human rectal swab specimens were identical. These genes were also frequently found in human blood culture isolates. Typing results of Escherichia coli strains showed a high degree of similarity with strains from meat and humans. These findings suggest that the abundant presence of ESBL genes in the food chain may have a profound effect on future treatment options for a wide range of infections caused by gram-negative bacteria.
Asian Lineage of Peste des Petits Ruminants Virus, Africa
PDF Version [PDF - 345 KB - 9 pages]
O. Kwiatek et al.View Abstract
Interest in peste des petits ruminants virus (PPRV) has been stimulated by recent changes in its host and geographic distribution. For this study, biological specimens were collected from camels, sheep, and goats clinically suspected of having PPRV infection in Sudan during 2000–2009 and from sheep soon after the first reported outbreaks in Morocco in 2008. Reverse transcription PCR analysis confirmed the wide distribution of PPRV throughout Sudan and spread of the virus in Morocco. Molecular typing of 32 samples positive for PPRV provided strong evidence of the introduction and broad spread of Asian lineage IV. This lineage was defined further by 2 subclusters; one consisted of camel and goat isolates and some of the sheep isolates, while the other contained only sheep isolates, a finding with suggests a genetic bias according to the host. This study provides evidence of the recent spread of PPRV lineage IV in Africa.
Co-infections of Plasmodium knowlesi, P. falciparum, and P. vivax among Humans and Anopheles dirus Mosquitoes, Southern Vietnam
PDF Version [PDF - 369 KB - 8 pages]
R. P. Marchand et al.View Abstract
A single Anopheles dirus mosquito carrying sporozoites of Plasmodium knowlesi, P. falciparum, and P. vivax was recently discovered in Khanh Phu, southern Vietnam. Further sampling of humans and mosquitoes in this area during 2009–2010 showed P. knowlesi infections in 32 (26%) persons with malaria (n = 125) and in 31 (43%) sporozoite-positive An. dirus mosquitoes (n = 73). Co-infections of P. knowlesi and P. vivax were predominant in mosquitoes and humans, while single P. knowlesi infections were found only in mosquitoes. P. knowlesi–co-infected patients were largely asymptomatic and were concentrated among ethnic minority families who commonly spend nights in the forest. P. knowlesi carriers were significantly younger than those infected with other malaria parasite species. These results imply that even if human malaria could be eliminated, forests that harbor An. dirus mosquitoes and macaque monkeys will remain a reservoir for the zoonotic transmission of P. knowlesi.
Epidemiology of Influenza-like Illness during Pandemic (H1N1) 2009, New South Wales, Australia
PDF Version [PDF - 298 KB - 8 pages]
D. J. Muscatello et al.View Abstract
To rapidly describe the epidemiology of influenza-like illness (ILI) during the 2009 winter epidemic of pandemic (H1N1) 2009 virus in New South Wales, Australia, we used results of a continuous population health survey. During July–September 2009, ILI was experienced by 23% of the population. Among these persons, 51% were unable to undertake normal duties for <3 days, 55% sought care at a general practice, and 5% went to a hospital. Factors independently associated with ILI were younger age, daily smoking, and obesity. Effectiveness of prepandemic seasonal vaccine was ≈20%. The high prevalence of risk factors associated with a substantially increased risk for ILI deserves greater recognition.
Severe Plasmodium knowlesi Malaria in a Tertiary Care Hospital, Sabah, Malaysia
PDF Version [PDF - 288 KB - 8 pages]
T. William et al.View Abstract
The simian parasite Plasmodium knowlesi causes severe human malaria; the optimal treatment remains unknown. We describe the clinical features, disease spectrum, and response to antimalarial chemotherapy, including artemether-lumefantrine and artesunate, in patients with P. knowlesi malaria diagnosed by PCR during December 2007–November 2009 at a tertiary care hospital in Sabah, Malaysia. Fifty-six patients had PCR-confirmed P. knowlesi monoinfection and clinical records available for review. Twenty-two (39%) had severe malaria; of these, 6 (27%) died. Thirteen (59%) had respiratory distress; 12 (55%), acute renal failure; and 12, shock. None experienced coma. Patients with uncomplicated disease received chloroquine, quinine, or artemether-lumefantrine, and those with severe disease received intravenous quinine or artesunate. Parasite clearance times were 1–2 days shorter with either artemether-lumefantrine or artesunate treatment. P. knowlesi is a major cause of severe and fatal malaria in Sabah. Artemisinin derivatives rapidly clear parasitemia and are efficacious in treating uncomplicated and severe knowlesi malaria.
Age as Risk Factor for Death from Pandemic (H1N1) 2009, Chile
PDF Version [PDF - 155 KB - 3 pages]
J. Dabanch et al.View Abstract
Pandemic (H1N1) 2009 affected Chile during the winter of 2009. The hospitalization rate was 0.56% overall and 3.47% for persons >60 years of age at risk for severe disease and death independent of concurrent conditions. Age >60 years was the major risk factor for death from pandemic (H1N1) 2009.
Multidrug-Resistant Mycobacterium tuberculosis, Southwestern Colombia
PDF Version [PDF - 183 KB - 4 pages]
B. E. Ferro et al.View Abstract
Using spoligotyping, we identified 13 genotypes and 17 orphan types among 160 Mycobacterium tuberculosis isolates from patients in Valle del Cauca, Colombia. The Beijing genotype represented 15.6% of the isolates and was correlated with multidrug-resistant tuberculosis, female sex of the patients, and residence in Buenaventura and may represent a new public health threat.
Visceral Larva Migrans in Immigrants from Latin America
PDF Version [PDF - 152 KB - 3 pages]
M. Turrientes et al.View Abstract
To determine whether increased migration is associated with an increase in incidence of toxocariasis (visceral larva migrans), we analyzed clinical data obtained from immigrants from Latin America. Although infection with Toxocara sp. roundworm larvae is distributed worldwide, seroprevalence is highest in tropical and subtropical areas.
Pandemic (H1N1) 2009 and Hajj Pilgrims Who Received Predeparture Vaccination, Egypt
PDF Version [PDF - 171 KB - 3 pages]
A. Kandeel et al.View Abstract
In Egypt, vaccination against pandemic (H1N1) 2009 virus was required of pilgrims departing for the 2009 Hajj. A survey of 551 pilgrims as they returned to Egypt found 542 (98.1% [weighted]) reported receiving the vaccine; 6 (1.0% [weighted]) were infected with influenza virus A (H3N2) but none with pandemic (H1N1) 2009 virus.
Bartonella spp. in Bats, Guatemala
PDF Version [PDF - 509 KB - 4 pages]
Y. Bai et al.View Abstract
To better understand the role of bats as reservoirs of Bartonella spp., we estimated Bartonella spp. prevalence and genetic diversity in bats in Guatemala during 2009. We found prevalence of 33% and identified 21 genetic variants of 13 phylogroups. Vampire bat–associated Bartonella spp. may cause undiagnosed illnesses in humans.
Clonal Genotype of Geomyces destructans among Bats with White Nose Syndrome, New York, USA
PDF Version [PDF - 363 KB - 4 pages]
S. S. Rajkumar et al.View Abstract
The dispersal mechanism of Geomyces destructans, which causes geomycosis (white nose syndrome) in hibernating bats, remains unknown. Multiple gene genealogic analyses were conducted on 16 fungal isolates from diverse sites in New York State during 2008–2010. The results are consistent with the clonal dispersal of a single G. destructans genotype.
Plasmodium vivax Malaria among Military Personnel, French Guiana, 1998–2008
PDF Version [PDF - 188 KB - 3 pages]
B. Queyriaux et al.View Abstract
We obtained health surveillance epidemiologic data on malaria among French military personnel deployed to French Guiana during 1998–2008. Incidence of Plasmodium vivax malaria increased and that of P. falciparum remained stable. This new epidemiologic situation has led to modification of malaria treatment for deployed military personnel.
Burkholderia pseudomallei in Unchlorinated Domestic Bore Water, Tropical Northern Australia
PDF Version [PDF - 200 KB - 3 pages]
M. Mayo et al.View Abstract
To determine whether unchlorinated bore water in northern Australia contained Burkholderia pseudomallei organisms, we sampled 55 bores; 18 (33%) were culture positive. Multilocus sequence typing identified 15 sequence types. The B. pseudomallei sequence type from 1 water sample matched a clinical isolate from a resident with melioidosis on the same property.
Epidemiology and Investigation of Melioidosis, Southern Arizona
PDF Version [PDF - 285 KB - 3 pages]
T. Stewart et al.View Abstract
Burkholderia pseudomallei is a bacterium endemic to Southeast Asia and northern Australia, but it has not been found to occur endemically in the United States. We report an ostensibly autochthonous case of melioidosis in the United States. Despite an extensive investigation, the source of exposure was not identified.
Melioidosis, Phnom Penh, Cambodia
PDF Version [PDF - 204 KB - 4 pages]
E. Vlieghe et al.View Abstract
We describe 58 adult patients with melioidosis in Cambodia (2007–2010). Diabetes was the main risk factor (59%); 67% of infections occurred during the rainy season. Bloodstream infection was present in 67% of patients, which represents 12% of all bloodstream infections. The case-fatality rate was 52% and associated with inappropriate empiric treatment.
Viability of Baylisascaris procyonis Eggs
PDF Version [PDF - 226 KB - 3 pages]
S. C. Shafir et al.View Abstract
Infection with Baylisascaris procyonis roundworms is rare but often fatal and typically affects children. We attempted to determine parameters of viability and methods of inactivating the eggs of these roundworms. Loss of viability resulted when eggs were heated to 62°C or desiccated for 7 months but not when frozen at –15°C for 6 months.
Melioidosis Acquired by Traveler to Nigeria
PDF Version [PDF - 257 KB - 3 pages]
A. P. Salam et al.View Abstract
We describe melioidosis associated with travel to Nigeria in a woman with diabetes, a major predisposing factor for this infection. With the prevalence of diabetes projected to increase dramatically in many developing countries, the global reach of melioidosis may expand.
Natural Burkholderia mallei Infection in Dromedary, Bahrain
PDF Version [PDF - 245 KB - 3 pages]
U. Wernery et al.View Abstract
We confirm a natural infection of dromedaries with glanders. Multilocus variable number tandem repeat analysis of a Burkholderia mallei strain isolated from a diseased dromedary in Bahrain revealed close genetic proximity to strain Dubai 7, which caused an outbreak of glanders in horses in the United Arab Emirates in 2004.
Implications of the Introduction of Cholera to Haiti
PDF Version [PDF - 116 KB - 2 pages]
S. F. Dowell and C. R. Braden
Trichostrongylus colubriformis Nematode Infections in Humans, France
PDF Version [PDF - 237 KB - 2 pages]
S. Lattès et al.
Adult Opisthorchis viverrini Flukes in Humans, Takeo, Cambodia
PDF Version [PDF - 213 KB - 3 pages]
W. Sohn et al.
Easy Test for Visceral Leishmaniasis and Post–Kala-azar Dermal Leishmaniasis
PDF Version [PDF - 202 KB - 3 pages]
S. Saha et al.
Ameba-associated Keratitis, France
PDF Version [PDF - 202 KB - 3 pages]
G. Cohen et al.
Human Herpesvirus 1 in Wild Marmosets, Brazil, 2008
PDF Version [PDF - 263 KB - 3 pages]
C. S. Longa et al.
Melioidosis in Birds and Burkholderia pseudomallei Dispersal, Australia
PDF Version [PDF - 208 KB - 3 pages]
V. Hampton et al.
Rare Case of Trichomonal Peritonitis
PDF Version [PDF - 183 KB - 2 pages]
C. A. Zalonis et al.
Plasmodium knowlesi Reinfection in Human
PDF Version [PDF - 197 KB - 2 pages]
Y. Lau et al.
Antibody to Arenaviruses in Rodents, Caribbean Colombia
PDF Version [PDF - 176 KB - 3 pages]
S. Mattar et al.
High Incidence of Guillain-Barré Syndrome in Children, Bangladesh
PDF Version [PDF - 146 KB - 2 pages]
Z. Islam et al.
Rift Valley Fever in Ruminants, Republic of Comoros, 2009
PDF Version [PDF - 150 KB - 2 pages]
M. Roger et al.
Yersinia pestis in Small Rodents, Mongolia
PDF Version [PDF - 228 KB - 3 pages]
J. M. Riehm et al.
Typhoon-related Leptospirosis and Melioidosis, Taiwan, 2009
PDF Version [PDF - 174 KB - 3 pages]
H. Su et al.
Exposure to Lymphocytic Choriomeningitis Virus, New York, USA
PDF Version [PDF - 149 KB - 2 pages]
B. Knust et al.
Tickborne Relapsing Fever Caused by Borrelia persica, Uzbekistan and Tajikistan
PDF Version [PDF - 168 KB - 3 pages]
N. Colin de Verdière et al.
Toxoplasmosis and Horse Meat, France
PDF Version [PDF - 154 KB - 2 pages]
C. Pomares et al.
Israeli Spotted Fever, Tunisia
PDF Version [PDF - 165 KB - 3 pages]
A. Znazen et al.
Catabacter hongkongensis Bacteremia with Fatal Septic Shock
PDF Version [PDF - 182 KB - 2 pages]
A. Elsendoorn et al.
Endemic Angiostrongyliasis, Rio de Janeiro, Brazil
PDF Version [PDF - 209 KB - 3 pages]
R. O. Simões et al.
Aircraft and Risk of Importing a New Vector of Visceral Leishmaniasis
PDF Version [PDF - 307 KB - 2 pages]
C. H. Costa and I. K. de Miranda-Santos
Enzootic Angiostrongyliasis, Guangdong, China, 2008–2009
PDF Version [PDF - 180 KB - 2 pages]
Z. Qu et al.
Malaria, Oromia Regional State, Ethiopia, 2001–2006
PDF Version [PDF - 156 KB - 2 pages]
D. Olana et al.
Foodborne Illness Acquired in the United States
PDF Version [PDF - 164 KB - 3 pages]
C. W. Hedberg
Comment on Zoonoses in the Bedroom
PDF Version [PDF - 201 KB - 2 pages]
S. P. Montgomery et al.
About the Cover
Peer Reviewed Report Available Online OnlyInternational Symposium on Angiostrongylus and Angiostrongyliasis, 2010Z. Diao et al.
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: November 03, 2011
- Page last updated: November 03, 2011
- Page last reviewed: November 03, 2011
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