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Volume 17, Number 9—September 2011

Volume 17, Number 9—September 2011   PDF Version [PDF - 7.89 MB - 215 pages]


  • Risk-based Estimate of Effect of Foodborne Diseases on Public Health, Greece PDF Version [PDF - 314 KB - 10 pages]
    E. Gkogka et al.
    View Summary

    These infections may account for 896 disability-adjusted life years per 1 million inhabitants annually.

        View Abstract

    The public health effects of illness caused by foodborne pathogens in Greece during 1996–2006 was quantified by using publicly available surveillance data, hospital statistics, and literature. Results were expressed as the incidence of different disease outcomes and as disability-adjusted life years (DALY), a health indicator combining illness and death estimates into a single metric. It has been estimated that each year ≈370,000 illnesses/million inhabitants are likely caused because of eating contaminated food; 900 of these illnesses are severe and 3 fatal, corresponding to 896 DALY/million inhabitants. Ill-defined intestinal infections accounted for the greatest part of reported cases and 27% of the DALY. Brucellosis, echinococcosis, salmonellosis, and toxoplasmosis were found to be the most common known causes of foodborne illnesses, being responsible for 70% of the DALY. Overall, the DALY metric provided a quantitative perspective on the impact of foodborne illness that may be useful for prioritizing food safety management targets.


  • Intrahousehold Transmission of Pandemic (H1N1) 2009 Virus, Victoria, Australia PDF Version [PDF - 252 KB - 9 pages]
    C. van Gemert et al.
        View Abstract

    To examine intrahousehold secondary transmission of pandemic (H1N1) 2009 virus in households in Victoria, Australia, we conducted a retrospective cross-sectional study in late 2009. We randomly selected case-patients reported during May–June 2009 and their household contacts. Information collected included household characteristics, use of prevention and control measures, and signs and symptoms. Secondary cases were defined as influenza-like illness in household contacts within the specified period. Secondary transmission was identified for 18 of 122 susceptible household contacts. To identify independent predictors of secondary transmission, we developed a model. Risk factors were concurrent quarantine with the household index case-patient, and a protective factor was antiviral prophylaxis. These findings show that timely provision of antiviral prophylaxis to household contacts, particularly when household members are concurrently quarantined during implementation of pandemic management strategies, delays or contains community transmission of pandemic (H1N1) 2009 virus.

  • Epidemiologic Modeling with FluSurge for Pandemic (H1N1) 2009 Outbreak, Queensland, Australia PDF Version [PDF - 298 KB - 7 pages]
    P. R. Baker et al.
        View Abstract

    At the beginning of the pandemic (H1N1) 2009 outbreak, we estimated the potential surge in demand for hospital-based services in 4 Health Service Districts of Queensland, Australia, using the FluSurge model. Modifications to the model were made on the basis of emergent evidence and results provided to local hospitals to inform resource planning for the forthcoming pandemic. To evaluate the fit of the model, a comparison between the model’s predictions and actual hospitalizations was made. In early 2010, a Web-based survey was undertaken to evaluate the model’s usefulness. Predictions based on modified assumptions arising from the new pandemic gained better fit than results from the default model. The survey identified that the modeling support was helpful and useful to service planning for local hospitals. Our research illustrates an integrated framework involving post hoc comparison and evaluation for implementing epidemiologic modeling in response to a public health emergency.

  • Differential Effects of Pandemic (H1N1) 2009 on Remote and Indigenous Groups, Northern Territory, Australia, 2009 PDF Version [PDF - 364 KB - 9 pages]
    J. M. Trauer et al.
        View Abstract

    Pandemic (H1N1) 2009 influenza spread through the Northern Territory, Australia, during June–August 2009. We performed 2 cross-sectional serologic surveys on specimens from Northern Territory residents, with 445 specimens obtained prepandemic and 1,689 specimens postpandemic. Antibody titers were determined by hemagglutination inhibition against reference virus A/California/7/2009 on serum samples collected opportunistically from outpatients. All specimens had data for patients’ gender, age, and address, with patients’ indigenous status determined for 94.1%. Protective immunity (titer >40) was present in 7.6% (95% confidence interval [CI] 5.2%–10.1%) of prepandemic specimens and 19.5% (95% CI 17.6%–21.4%) of postpandemic specimens, giving a population-standardized attack rate of 14.9% (95% CI 11.0%–18.9%). Prepandemic proportion of immune persons was greater with increasing age but did not differ by other demographic characteristics. Postpandemic proportion of immune persons was greater in younger groups and around double in indigenous persons. Postpandemic proportion immune was geographically heterogeneous, particularly among remote-living and indigenous groups.

  • Multiple Reassortment between Pandemic (H1N1) 2009 and Endemic Influenza Viruses in Pigs, United States PDF Version [PDF - 259 KB - 6 pages]
    M. F. Ducatez et al.
        View Abstract

    As a result of human-to-pig transmission, pandemic influenza A (H1N1) 2009 virus was detected in pigs soon after it emerged in humans. In the United States, this transmission was quickly followed by multiple reassortment between the pandemic virus and endemic swine viruses. Nine reassortant viruses representing 7 genotypes were detected in commercial pig farms in the United States. Field observations suggested that the newly described reassortant viruses did not differ substantially from pandemic (H1N1) 2009 or endemic strains in their ability to cause disease. Comparable growth properties of reassortant and endemic viruses in vitro supported these observations; similarly, a representative reassortant virus replicated in ferrets to the same extent as did pandemic (H1N1) 2009 and endemic swine virus. These novel reassortant viruses highlight the increasing complexity of influenza viruses within pig populations and the frequency at which viral diversification occurs in this ecologically important viral reservoir.

  • Role of Chlamydia trachomatis in Miscarriage PDF Version [PDF - 220 KB - 6 pages]
    D. Baud et al.
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    To determine the role of Chlamydia trachomatis in miscarriage, we prospectively collected serum, cervicovaginal swab specimens, and placental samples from 386 women with and without miscarriage. Prevalence of immunoglobulin G against C. trachomatis was higher in the miscarriage group than in the control group (15.2% vs. 7.3%; p = 0.018). Association between C. trachomatis–positive serologic results and miscarriage remained significant after adjustment for age, origin, education, and number of sex partners (odds ratio 2.3, 95% confidence interval 1.1–4.9). C. trachomatis DNA was more frequently amplified from products of conception or placenta from women who had a miscarriage (4%) than from controls (0.7%; p = 0.026). Immunohistochemical analysis confirmed C. trachomatis in placenta from 5 of 7 patients with positive PCR results, whereas results of immunohistochemical analysis were negative in placenta samples from all 8 negative controls tested. Associations between miscarriage and serologic/molecular evidence of C. trachomatis infection support its role in miscarriage.

  • Classical Bovine Spongiform Encephalopathy by Transmission of H-Type Prion in Homologous Prion Protein Context PDF Version [PDF - 616 KB - 9 pages]
    J. Torres et al.
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    Bovine spongiform encephalopathy (BSE) and BSE-related disorders have been associated with a single major prion strain. Recently, 2 atypical, presumably sporadic forms of BSE have been associated with 2 distinct prion strains that are characterized mainly by distinct Western blot profiles of abnormal protease-resistant prion protein (PrPres), named high-type (BSE-H) and low-type (BSE-L), that also differed from classical BSE. We characterized 5 atypical BSE-H isolates by analyzing their molecular and neuropathologic properties during transmission in transgenic mice expressing homologous bovine prion protein. Unexpectedly, in several inoculated animals, strain features emerged that were highly similar to those of classical BSE agent. These findings demonstrate the capability of an atypical bovine prion to acquire classical BSE–like properties during propagation in a homologous bovine prion protein context and support the view that the epidemic BSE agent could have originated from such a cattle prion.

  • Increasing Incidence of Invasive Haemophilus influenzae Disease in Adults, Utah, USA PDF Version [PDF - 293 KB - 6 pages]
    M. P. Rubach et al.
    View Summary

    Haemophilus influenzae type b (commonly called Hib) has gone from being a major cause of childhood illness to being almost nonexistent in children, thanks to a Hib vaccine. In adults, however, a different type of Haemophilus influenzae infection is increasing. This type of invasive disease can be fatal, especially for those older than 65, and there is no vaccine. Reasons for the increase might be changes in the organism, more people at high risk, or decreasing immunity. A vaccine against the invasive form in adults is needed.

        View Abstract

    Since the introduction of the Haemophilus influenzae type b vaccine, the incidence of invasive H. influenzae type b disease among children has fallen dramatically, but the effect on invasive H. influenzae disease among adults may be more complex. In this population-based study we examined the epidemiology and outcomes of invasive disease caused by typeable and nontypeable H. influenzae among Utah adults during 1998–2008. The overall incidence increased over the study period from 0.14/100,000 person-years in 1998 to 1.61/100,000 person-years in 2008. The average incidence in persons >65 years old was 2.74/100,000 person-years, accounting for 51% of cases and 67% of deaths. The incidence was highest for nontypeable H. influenzae (0.23/100,000 person-years), followed by H. influenzae type f (0.14/100,000 person-years). The case-fatality rate was 22%. The incidence of invasive H. influenzae in Utah adults appears to be increasing. Invasive H. influenzae infection disproportionately affected the elderly and was associated with a high mortality rate.

  • Central Venous Catheter–associated Nocardia Bacteremia in Cancer Patients PDF Version [PDF - 426 KB - 8 pages]
    F. Al Akhrass et al.
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    Central venous catheters, often needed by cancer patients, can be the source of Nocardia bacteremia. We evaluated the clinical characteristics and outcomes of 17 cancer patients with Nocardia bacteremia. For 10 patients, the bacteremia was associated with the catheter; for the other 7, it was a disseminated infection. N. nova complex was the leading cause of bacteremia. Nocardia promoted heavy biofilm formation on the surface of central venous catheter segments tested in an in vitro biofilm model. Trimethoprim- and minocycline-based lock solutions had potent in vitro activity against biofilm growth. Patients with Nocardia central venous catheter–associated bloodstream infections responded well to catheter removal and antimicrobial drug therapy, whereas those with disseminated bacteremia had poor prognoses.

  • Endemic Scrub Typhus–like Illness, Chile PDF Version [PDF - 364 KB - 5 pages]
    M. E. Balcells et al.
        View Abstract

    We report a case of scrub typhus in a 54-year-old man who was bitten by several terrestrial leeches during a trip to Chiloé Island in southern Chile in 2006. A molecular sample, identified as related to Orientia tsutsugamushi based on the sequence of the16S rRNA gene, was obtained from a biopsy specimen of the eschar on the patient’s leg. Serologic analysis showed immunoglobulin G conversion against O. tsutsugamushi whole cell antigen. This case and its associated molecular analyses suggest that an Orientia-like agent is present in the Western Hemisphere that can produce scrub typhus–like illness. The molecular analysis suggests that the infectious agent is closely related, although not identical, to members of the Orientia sp. from Asia.

  • Geographic Distribution of Endemic Fungal Infections among Older Persons, United States PDF Version [PDF - 274 KB - 6 pages]
    J. W. Baddley et al.
    View Summary

    Americans are living longer than ever, which means they can continue to travel and enjoy outdoor activities. However, the downside of breathing in all that fresh outdoor air is risk for fungal disease. Fungal infections are more common in older people, whose immune systems may be weakened by age, other disease, or immunosuppressive drugs. Examination of Medicare claims showed that 3 types of fungal infections in older populations occurred mostly in the midwestern and western parts of the United States. Prevention efforts should focus on these areas, and doctors in these areas should consider fungal infections in older patients with respiratory disease.

        View Abstract

    To investigate the epidemiology and geographic distribution of histoplasmosis, coccidioidomycosis, and blastomycosis in older persons in the United States, we evaluated a random 5% sample of national Medicare data from 1999 through 2008. We calculated national, regional, and state-based incidence rates and determined 90-day postdiagnosis mortality rates. We identified 776 cases (357 histoplasmosis, 345 coccidioidomycosis, 74 blastomycosis). Patient mean age was 75.7 years; 55% were male. Histoplasmosis and blastomycosis incidence was highest in the Midwest (6.1 and 1.0 cases/100,000 person-years, respectively); coccidioidomycosis incidence rate was highest in the West (15.2). On the basis of available data, for 86 (11.1%) cases, there was no patient exposure to a traditional disease-endemic area. Knowledge of areas where endemic mycosis incidence is increased may affect diagnostic or prevention measures for older adults at risk.

  • Seroepidemiologic Study of Pandemic (H1N1) 2009 during Outbreak in Boarding School, England PDF Version [PDF - 209 KB - 8 pages]
    S. Johnson et al.
    View Summary

    Prophylactic antiviral agents lower the odds of acute respiratory infection but not serologic infection.

        View Abstract

    We conducted a seroepidemiologic study during an outbreak of pandemic (H1N1) 2009 in a boarding school in England. Overall, 353 (17%) of students and staff completed a questionnaire and provided a serum sample. The attack rate was 40.5% and 34.1% for self-reported acute respiratory infection (ARI). Staff were less likely to be seropositive than students 13–15 years of age (staff 20–49 years, adjusted odds ratio [AOR] 0.30; >50 years AOR 0.20). Teachers were more likely to be seropositive than other staff (AOR 7.47, 95% confidence interval [CI] 2.31–24.2). Of seropositive persons, 44.6% (95% CI 36.2%–53.3%) did not report ARI. Conversely, of 141 with ARI and 63 with influenza-like illness, 45.8% (95% CI 37.0%–54.0%) and 30.2% (95% CI 19.2%–43.0%) had negative test results, respectively. A weak association was found between seropositivity and a prophylactic dose of antiviral agents (AOR 0.55, 95% CI 0.30–0.99); prophylactic antiviral agents lowered the odds of ARI by 50%.

  • Leptospirosis as Frequent Cause of Acute Febrile Illness in Southern Sri Lanka PDF Version [PDF - 212 KB - 7 pages]
    M. E. Reller et al.
        View Abstract

    To determine the proportion of fevers caused by leptospirosis, we obtained serum specimens and epidemiologic and clinical data from patients in Galle, Sri Lanka, March–October 2007. Immunoglobulin M ELISA was performed on paired serum specimens to diagnose acute (seroconversion or 4-fold titer rise) or past (titer without rise) leptospirosis and seroprevalence (acute). We compared (individually) the diagnostic yield of acute-phase specimens and clinical impression with paired specimens for acute leptospirosis. Of 889 patients with paired specimens, 120 had acute leptosoirosis and 241 had past leptospirosis. The sensitivity and specificity of acute-phase serum specimens were 17.5% (95% confidence interval [CI] 11.2%–25.5%) and 69.2% (95% CI 65.5%–72.7%), respectively, and of clinical impression 22.9% (95% CI 15.4%–32.0%) and 91.7% (95% CI 89.2%–93.8%), respectively. For identifying acute leptospirosis, clinical impression is insensitive, and immunoglobulin M results are more insensitive and costly. Rapid, pathogen-based tests for early diagnosis are needed.

  • Medscape CME Activity
    Inpatient Capacity at Children’s Hospitals during Pandemic (H1N1) 2009 Outbreak, United States PDF Version [PDF - 198 KB - 7 pages]
    M. R. Sills et al.
    View Summary

    Modestly increased rates of admission or emergency department visits would have caused substantial overcrowding.

        View Abstract

    Quantifying how close hospitals came to exhausting capacity during the outbreak of pandemic influenza A (H1N1) 2009 can help the health care system plan for more virulent pandemics. This ecologic analysis used emergency department (ED) and inpatient data from 34 US children's hospitals. For the 11-week pandemic (H1N1) 2009 period during fall 2009, inpatient occupancy reached 95%, which was lower than the 101% occupancy during the 2008–09 seasonal influenza period. Fewer than 1 additional admission per 10 inpatient beds would have caused hospitals to reach 100% occupancy. Using parameters based on historical precedent, we built 5 models projecting inpatient occupancy, varying the ED visit numbers and admission rate for influenza-related ED visits. The 5 scenarios projected median occupancy as high as 132% of capacity. The pandemic did not exhaust inpatient bed capacity, but a more virulent pandemic has the potential to push children’s hospitals past their maximum inpatient capacity.

  • Medscape CME Activity
    Mycobacterium chelonae-abscessus Complex Associated with Sinopulmonary Disease, Northeastern USA PDF Version [PDF - 312 KB - 9 pages]
    K. E. Simmon et al.
    View Summary

    Accurate identification of these organisms is needed.

        View Abstract

    Members of the Mycobacterium chelonae-abscessus complex represent Mycobacterium species that cause invasive infections in immunocompetent and immunocompromised hosts. We report the detection of a new pathogen that had been misidentified as M. chelonae with an atypical antimicrobial drug susceptibility profile. The discovery prompted a multicenter investigation of 26 patients. Almost all patients were from the northeastern United States, and most had underlying sinus or pulmonary disease. Infected patients had clinical features similar to those with M. abscessus infections. Taxonomically, the new pathogen shared molecular identity with members of the M. chelonae-abscessus complex. Multilocus DNA target sequencing, DNA-DNA hybridization, and deep multilocus sequencing (43 full-length genes) support a new taxon for these microorganisms. Because most isolates originated in Pennsylvania, we propose the name M. franklinii sp. nov. This investigation underscores the need for accurate identification of Mycobacterium spp. to detect new pathogens implicated in human disease.

  • Estimating Effect of Antiviral Drug Use during Pandemic (H1N1) 2009 Outbreak, United States PDF Version [PDF - 255 KB - 8 pages]
    C. Y. Atkins et al.
        View Abstract

    From April 2009 through March 2010, during the pandemic (H1N1) 2009 outbreak, ≈8.2 million prescriptions for influenza neuraminidase-inhibiting antiviral drugs were filled in the United States. We estimated the number of hospitalizations likely averted due to use of these antiviral medications. After adjusting for prescriptions that were used for prophylaxis and personal stockpiles, as well as for patients who did not complete their drug regimen, we estimated the filled prescriptions prevented ≈8,400–12,600 hospitalizations (on the basis of median values). Approximately 60% of these prevented hospitalizations were among adults 18–64 years of age, with the remainder almost equally divided between children 0–17 years of age and adults >65 years of age. Public health officials should consider these estimates an indication of success of treating patients during the 2009 pandemic and a warning of the need for renewed planning to cope with the next pandemic.


  • High Rates of Malaria among US Military Members Born in Malaria-Endemic Countries, 2002–2010 PDF Version [PDF - 247 KB - 3 pages]
    E. R. Wertheimer et al.
    View Summary

    Before deploying soldiers to areas with malaria, the US military instructs them on malaria protection and supervises their uses of protective measures. Why, then, are rates of malaria 44 times higher among US military members who were born in West Africa? Findings of a recent study suggest that malaria risk is high when military members travel to their birth countries to visit friends and family in West Africa. While on leave in West Africa, nobody makes military members take antimalarial drugs, sleep under bednets, or take other actions to prevent mosquito bites. When growing up in their malarious homelands, current military members may not have worried about malaria; and when they return home as soldiers, they may assume that they still don't need to worry. However, childhood immunity to malaria wanes over time. As a result, US military members who are born in countries with malaria are susceptible when they return home; protective measures should be emphasized before such persons return to their homelands.

        View Abstract

    To estimate malaria rates in association with birth country, we analyzed routine surveillance data for US military members. During 2002–2010, rates were 44× higher for those born in western Africa than for those born in the United States. Loss of natural immunity renders persons susceptible when visiting birth countries. Pretravel chemoprophylaxis should be emphasized.

  • Differential Risk for Lyme Disease along Hiking Trail, Germany PDF Version [PDF - 138 KB - 3 pages]
    D. Richter and F. Matuschka
    View Summary

    Cattle and goats as protection against Lyme disease? A study of risk along a hiking trail in Germany found that risk was much lower on the parts of the trail that passed through cattle or goat pasture than through meadow or abandoned land. Not only were there fewer ticks in the pasture, but fewer ticks from those areas carried the bacterium that causes Lyme disease. Proposed reasons are that grazing decreases the tick habitat and that ticks lose Lyme disease bacteria when they feed on these animals. Thus, using land as cattle and goat pasture might also minimize Lyme disease risk for people on that land. Particular methods of landscape management also appear to support public health.

        View Abstract

    To estimate relative risk for exposure to ticks infected with Lyme disease–causing spirochetes in different land-use types along a trail in Germany, we compared tick density and spirochete prevalence on ruminant pasture with that on meadow and fallow land. Risk was significantly lower on pasture than on meadow and fallow land.

  • Bartonella quintana Infections in Captive Monkeys, China PDF Version [PDF - 241 KB - 3 pages]
    R. Huang et al.
        View Abstract

    Bartonella quintana has been considered to be specifically adapted to humans. Our isolation of the organism from 2 of 36 captive rhesus macaques in China and finding antibodies against B. quintana in 12 of 33 indicates that the reservoir hosts of B. quintana may include primates other than humans.

  • Canine Serology as Adjunct to Human Lyme Disease Surveillance PDF Version [PDF - 157 KB - 3 pages]
    P. Mead et al.
    View Summary

    Like canaries in a mine, dogs can indicate Lyme disease risk in humans. The bacterium that causes Lyme disease is spread by ticks, and whether a dog (sick or healthy) has been exposed to infected ticks can be detected by blood testing. A comparison of data from humans and dogs shows strong agreement between these 2 independent measures of Lyme disease risk. In addition, however, data from dogs may help predict areas of Lyme disease emergence. Combining data from humans and dogs could help health officials focus Lyme disease prevention efforts and help doctors interpret clinical and laboratory findings.

        View Abstract

    To better define areas of human Lyme disease risk, we compared US surveillance data with published data on the seroprevalence of Borrelia burgdorferi antibodies among domestic dogs. Canine seroprevalence >5% was a sensitive but nonspecific marker of human risk, whereas seroprevalence <1% was associated with minimal risk for human infection.

  • Predominance of Cronobacter sakazakii Sequence Type 4 in Neonatal Infections PDF Version [PDF - 107 KB - 3 pages]
    S. Joseph and S. J. Forsythe
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    A 7-loci (3,036 nt) multilocus sequence typing scheme was applied to 41 clinical isolates of Cronobacter sakazakii. Half (20/41) of the C. sakazakii strains were sequence type (ST) 4, and 9/12 meningitis isolates were ST4. C. sakazakii ST4 appears to be a highly stable clone with a high propensity for neonatal meningitis.

  • Wild Rodents and Novel Human Pathogen Candidatus Neoehrlichia mikurensis, Southern Sweden PDF Version [PDF - 155 KB - 3 pages]
    M. Andersson and L. Råberg
        View Abstract

    We examined small mammals as hosts for Anaplasmataceae in southern Sweden. Of 771 rodents, 68 (8.8%) were infected by Candidatus Neoehrlichia mikurensis, but no other Anaplasmataceae were found. Candidatus N. mikurensis has recently been found in human patients in Germany, Switzerland, and Sweden, which suggests that this could be an emerging pathogen in Europe.

  • Q Fever among Culling Workers, the Netherlands, 2009–2010 PDF Version [PDF - 359 KB - 5 pages]
    J. Whelan et al.
        View Abstract

    In 2009, dairy goat farms in the Netherlands were implicated in >2,300 cases of Q fever; in response, 51,820 small ruminants were culled. Among 517 culling workers, despite use of personal protective equipment, 17.5% seroconverted for antibodies to Coxiella burnetii. Vaccination of culling workers could be considered.

  • Syndromic Surveillance during Pandemic (H1N1) 2009 Outbreak, New York, New York, USA PDF Version [PDF - 168 KB - 3 pages]
    M. G. Plagianos et al.
        View Abstract

    We compared emergency department and ambulatory care syndromic surveillance systems during the pandemic (H1N1) 2009 outbreak in New York City. Emergency departments likely experienced increases in influenza-like-illness significantly earlier than ambulatory care facilities because more patients sought care at emergency departments, differences in case definitions existed, or a combination thereof.

  • Tubulinosema sp. Microsporidian Myositis in Immunosuppressed Patient PDF Version [PDF - 316 KB - 4 pages]
    M. M. Choudhary et al.
        View Abstract

    The Phylum Microsporidia comprises >1,200 species, only 15 of which are known to infect humans, including the genera Trachipleistophora, Pleistophora, and Brachiola. We report an infection by Tubulinosema sp. in an immunosuppressed patient.

  • Listeriosis, Taiwan, 1996–2008 PDF Version [PDF - 182 KB - 3 pages]
    Y. Huang et al.
        View Abstract

    During 1996–2008, a total of 48 patients with listeriosis were identified at a Taiwan hospital. Average annual incidence increased from 0.029 to 0.118 cases per 1,000 admissions before and after January 2005. Serotype 1/2b predominated; serotype 4b emerged since 2004. Food monitoring and disease surveillance systems could help control listeriosis in Taiwan.

  • Tattoo-associated Mycobacterium haemophilum Skin Infection in Immunocompetent Adult, 2009 PDF Version [PDF - 168 KB - 3 pages]
    M. K. Kay et al.
    View Summary

    Cosmetic surgery, body piercing, and tattooing can lead to infection, particularly in people with weakened immune systems. Although tattooing is not a sterile procedure, measures should be taken to minimize risk for infection including properly training tattoo artists and using sterile equipment. Two newly reported infections after tattooing stand out because they occurred in people with healthy immune systems and because they were caused by a type of bacterium, Mycobacterium haemophilum, not previously found in tattoo infections. The infection might have come from the tap water used to dilute the ink. Because these bacteria are not usual suspects in tattoo infections and because testing for them is difficult and takes a long time, labs don’t routinely run these tests. From now on, however, doctors should consider Mycobacterium haemophilum as a possible cause of tattoo infection and should ask labs to test for it.

        View Abstract

    After a laboratory-confirmed case of Mycobacterium haemophilum skin infection in a recently tattooed immunocompetent adult was reported, we investigated to identify the infection source and additional cases. We found 1 laboratory-confirmed and 1 suspected case among immunocompetent adults who had been tattooed at the same parlor.

  • Pandemic (H1N1) 2009 Transmission during Presymptomatic Phase, Japan PDF Version [PDF - 232 KB - 3 pages]
    Y. Gu et al.
        View Abstract

    During an epidemiologic investigation of pandemic influenza (H1N1) 2009 virus infection in May 2009 in Osaka, Japan, we found 3 clusters in which virus transmission occurred during the presymptomatic phase. This finding has public health implications because it indicates that viral transmission in communities cannot be prevented solely by isolating symptomatic case-patients.

  • Increased Extent of and Risk Factors for Pandemic (H1N1) 2009 and Seasonal Influenza among Children, Israel PDF Version [PDF - 316 KB - 4 pages]
    D. Engelhard et al.
        View Abstract

    During the pandemic (H1N1) 2009 outbreak in Israel, incidence rates among children were 2× higher than that of the previous 4 influenza seasons; hospitalization rates were 5× higher. Children hospitalized for pandemic (H1N1) 2009 were older and had more underlying chronic diseases than those hospitalized for seasonal influenza.

  • Hospitalized Patients with Pandemic (H1N1) 2009, Kenya PDF Version [PDF - 165 KB - 3 pages]
    E. M. Osoro et al.
        View Abstract

    To describe the epidemiology and clinical course of patients hospitalized with pandemic (H1N1) 2009 in Kenya, we reviewed medical records of 49 such patients hospitalized during July–November 2009. The median age (7 years) was lower than that in industrialized countries. More patients had HIV than the general Kenyan population.

  • Ciprofloxacin-Resistant Shigella sonnei among Men Who Have Sex with Men, Canada, 2010 PDF Version [PDF - 266 KB - 4 pages]
    C. Gaudreau et al.
        View Abstract

    In 2010, we observed isolates with matching pulsed-field gel electrophoresis patterns from 13 cases of ciprofloxacin-resistant Shigella sonnei in Montréal. We report on the emergence of this resistance type and a study of resistance mechanisms. The investigation suggested local transmission among men who have sex with men associated with sex venues.

  • Multidrug-Resistant Acinetobacter baumannii in Veterinary Clinics, Germany PDF Version [PDF - 157 KB - 4 pages]
    S. Zordan et al.
        View Abstract

    An increase in prevalence of multidrug-resistant Acinetobacter spp. in hospitalized animals was observed at the Justus-Liebig-University (Germany). Genotypic analysis of 56 isolates during 2000–2008 showed 3 clusters that corresponded to European clones I–III. Results indicate spread of genotypically related strains within and among veterinary clinics in Germany.


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