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Volume 18, Number 10—October 2012

Volume 18, Number 10—October 2012   PDF Version [PDF - 4.60 MB - 167 pages]


  • Constant Transmission Properties of Variant Creutzfeldt-Jakob Disease in 5 Countries PDF Version [PDF - 274 KB - 6 pages]
    A. B. Diack et al.
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    Current diagnostic criteria should be sufficient to detect new cases of vCJD.

       View Abstract

    Variant Creutzfeldt-Jakob disease (vCJD) has been reported in 12 countries. We hypothesized that a common strain of agent is responsible for all vCJD cases, regardless of geographic origin. To test this hypothesis, we inoculated strain-typing panels of wild-type mice with brain material from human vCJD case-patients from France, the Netherlands, Italy, and the United States. Mice were assessed for clinical disease, neuropathologic changes, and glycoform profile; results were compared with those for 2 reference vCJD cases from the United Kingdom. Transmission to mice occurred from each sample tested, and data were similar between non-UK and UK cases, with the exception of the ranking of mean clinical incubation times of mouse lines. These findings support the hypothesis that a single strain of infectious agent is responsible for all vCJD infections. However, differences in incubation times require further subpassage in mice to establish any true differences in strain properties between cases.

  • WU and KI Polyomaviruses in Respiratory Samples from Allogeneic Hematopoietic Cell Transplant Recipients PDF Version [PDF - 295 KB - 9 pages]
    J. Kuypers et al.
    View Summary

    Routine testing for these viruses in immunocompromised patients is not recommended.

       View Abstract

    Data are limited regarding 2 new human polyomaviruses, KI polyomavirus (KIPyV) and WU polyomavirus (WUPyV), in immunocompromised patients. We used real-time PCR to test for these and 12 respiratory viruses in 2,732 nasal wash samples collected during the first year after allogeneic hematopoietic cell transplantation from 222 patients. Specimens were collected weekly until day 100; then at least every 3 months. One year after hematopoietic cell transplantation, the cumulative incidence estimate was 26% for KIPyV and 8% for WUPyV. Age <20 years predicted detection of KIPyV (hazard ratio [HR] 4.6) and WUPyV (HR 4.4), and detection of a respiratory virus in the previous 2 weeks predicted KIPyV detection (HR 3.4). Sputum production and wheezing were associated with detection of KIPyV in the past week and WUPyV in the past month. There were no associations with polyomavirus detection and acute graft versus host disease, cytomegalovirus reactivation, neutropenia, lymphopenia, hospitalization, or death.

  • Wild Birds and Urban Ecology of Ticks and Tick-borne Pathogens, Chicago, Illinois, USA, 2005–2010 PDF Version [PDF - 239 KB - 7 pages]
    S. A. Hamer et al.
    View Summary

    No longer do you have to visit rural areas to find ticks; birds are flying them directly to you. When researchers sampled several thousand birds in Chicago, they found that some carried ticks and that some of these ticks carried the organism that spreads Lyme disease. Although the number of infected ticks on these birds was low, risk for their invading an area and spreading infection to humans cannot be ignored. If conditions are favorable, a few infected ticks can quickly multiply. Migratory birds also carried tick species only known to be established in Central and South America. Limited introduction and successful establishment of ticks and disease-carrying organisms pose a major health risk for humans, wildlife, and domestic animals in urban environments worldwide.

       View Abstract

    Bird-facilitated introduction of ticks and associated pathogens is postulated to promote invasion of tick-borne zoonotic diseases into urban areas. Results of a longitudinal study conducted in suburban Chicago, Illinois, USA, during 2005–2010 show that 1.6% of 6,180 wild birds captured in mist nets harbored ticks. Tick species in order of abundance were Haemaphysalis leporispalustris, Ixodes dentatus, and I. scapularis, but 2 neotropical tick species of the genus Amblyomma were sampled during the spring migration. I. scapularis ticks were absent at the beginning of the study but constituted the majority of ticks by study end and were found predominantly on birds captured in areas designated as urban green spaces. Of 120 ticks, 5 were infected with Borrelia burgdorferi, spanning 3 ribotypes, but none were infected with Anaplasma phagocytophilum. Results allow inferences about propagule pressure for introduction of tick-borne diseases and emphasize the large sample sizes required to estimate this pressure.

  • Spread of Influenza Virus A (H5N1) Clade to Bulgaria in Common Buzzards PDF Version [PDF - 287 KB - 7 pages]
    A. Marinova-Petkova et al.
    View Summary

    Detection of this highly pathogenic clade in Europe poses a health threat to poultry and humans

       View Abstract

    On March 15, 2010, a highly pathogenic avian influenza virus was isolated from the carcass of a common buzzard (Buteo buteo) in Bulgaria. Phylogenetic analyses of the virus showed a close genetic relationship with influenza virus A (H5N1) clade viruses isolated from wild birds in the Tyva Republic and Mongolia during 2009–2010. Designated A/common buzzard/Bulgaria/38WB/2010, this strain was highly pathogenic in chickens but had low pathogenicity in mice and ferrets and no molecular markers of increased pathogenicity in mammals. The establishment of clade highly pathogenic avian influenza viruses of the H5N1 subtype in wild birds in Europe would increase the likelihood of health threats to humans and poultry in the region.

  • Dengue Outbreaks in High-Income Area, Kaohsiung City, Taiwan, 2003–2009 PDF Version [PDF - 346 KB - 9 pages]
    C. Lin et al.
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    Cases distribute in a clustered pattern, and elderly persons have the highest risk for illness and death.

       View Abstract

    Kaohsiung City, a modern metropolis of 1.5 million persons, has been the focus of dengue virus activity in Taiwan for several decades. The aim of this study was to provide a temporal and spatial description of dengue virus epidemiology in Kaohsiung City by using data for all laboratory-confirmed dengue cases during 2003–2009. We investigated age- and sex-dependent incidence rates and the spatiotemporal patterns of all cases confirmed through passive or active surveillance. Elderly persons were at particularly high risk for dengue virus–related sickness and death. Of all confirmed cases, ≈75% were detected through passive surveillance activities; case-patients detected through active surveillance included immediate family members, neighbors, and colleagues of confirmed case-patients. Changing patterns of case clustering could be due to the effect of unmeasured environmental and demographic factors.

  • Nontuberculous Mycobacteria in Household Plumbing as Possible Cause of Chronic Rhinosinusitis PDF Version [PDF - 194 KB - 6 pages]
    W. S. Tichenor et al.
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    Millions of Americans live with chronic sinus infection. Most infections are caused by either bacteria or fungi. Some of these infections can be hard to treat, eluding medical and surgical treatment and persisting for months or even years. A recent study in New York found that some patients with a chronic sinus infection had tuberculosis-like organisms (mycobacteria) in their sinuses and that the same organisms were also in the tap water at their homes. These mycobacteria can be resistant to commonly used antimicrobial drugs. Doctors should check for mycobacteria in patients with treatment-resistant sinus infection. Patients who flush their sinuses at home should use sterile saline, not tap water.

       View Abstract

    Symptoms of chronic rhinosinusitis (CRS) often persist despite treatment. Because nontuberculous mycobacteria (NTM) are resistant to commonly used antimicrobial drugs and are found in drinking water that patients may use for sinus irrigation, we investigated whether some CRS patients were infected with NTM in New York, New York, USA, during 2001–2011. Two approaches were chosen: 1) records of NTM-infected CRS patients were reviewed to identify common features of infection and Mycobacterium species; 2) samples from plumbing in households of 8 NTM-infected patients were cultured for NTM presence. In 3 households sampled, M. avium sharing rep-PCR and pulsed field gel electrophoresis fingerprints identified M. avium isolates clonally related to the patients’ isolates. We conclude that patients with treatment-resistant CRS may be infected with NTM and should have cultures performed for NTM so appropriate therapy can be instituted. In addition, the results suggest that CRS patients can be infected by NTM in their household plumbing.

  • Autochthonous and Dormant Cryptococcus gattii Infections in Europe PDF Version [PDF - 217 KB - 7 pages]
    F. Hagen et al.
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    Dormant infections can become reactivated years after having been acquired on another continent.

       View Abstract

    Until recently, Cryptococcus gattii infections occurred mainly in tropical and subtropical climate zones. However, during the past decade, C. gattii infections in humans and animals in Europe have increased. To determine whether the infections in Europe were acquired from an autochthonous source or associated with travel, we used multilocus sequence typing to compare 100 isolates from Europe (57 from 40 human patients, 22 from the environment, and 21 from animals) with 191 isolates from around the world. Of the 57 human patient isolates, 47 (83%) were obtained since 1995. Among the 40 patients, 24 (60%) probably acquired the C. gattii infection outside Europe; the remaining 16 (40%) probably acquired the infection within Europe. Human patient isolates from Mediterranean Europe clustered into a distinct genotype with animal and environmental isolates. These results indicate that reactivation of dormant C. gattii infections can occur many years after the infectious agent was acquired elsewhere.

  • Medscape CME Activity
    Epidemiology of Foodborne Norovirus Outbreaks, United States, 2001–2008 PDF Version [PDF - 215 KB - 8 pages]
    A. J. Hall et al.
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    In the United States, the leading cause of foodborne illness is norovirus; an average of 1 foodborne norovirus outbreak is reported every day. The more we know about how this virus is spread and in which foods, the better we can ward off future outbreaks. A recent study identified the most common sources of foodborne norovirus outbreaks as ready-to-eat foods that contain fresh produce and mollusks that are eaten raw, such as oysters. Most implicated foods had been prepared in restaurants, delicatessens, and other commercial settings and were most often contaminated by an infected food worker. Although possible contamination during production, harvesting, or processing cannot be overlooked, food safety during meal preparation should be emphasized. Food handlers should wash their hands, avoid bare-handed contact with ready-to-eat foods, and not work when they are sick.

       View Abstract

    Noroviruses are the leading cause of foodborne illness in the United States. To better guide interventions, we analyzed 2,922 foodborne disease outbreaks for which norovirus was the suspected or confirmed cause, which had been reported to the Foodborne Disease Outbreak Surveillance System of the Centers for Disease Control and Prevention during 2001–2008. On average, 365 foodborne norovirus outbreaks were reported annually, resulting in an estimated 10,324 illnesses, 1,247 health care provider visits, 156 hospitalizations, and 1 death. In 364 outbreaks attributed to a single commodity, leafy vegetables (33%), fruits/nuts (16%), and mollusks (13%) were implicated most commonly. Infected food handlers were the source of 53% of outbreaks and may have contributed to 82% of outbreaks. Most foods were likely contaminated during preparation and service, except for mollusks, and occasionally, produce was contaminated during production and processing. Interventions to reduce the frequency of foodborne norovirus outbreaks should focus on food workers and production of produce and shellfish.

  • Medscape CME Activity
    Methicillin-Resistant Staphylococcus aureus Sequence Type 239-III, Ohio, USA, 2007–2009 PDF Version [PDF - 291 KB - 9 pages]
    S. Wang et al.
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    Identification of virulent strains emphasizes the need for molecular surveillance.

       View Abstract

    Methicillin-resistant Staphylococcus aureus (MRSA) is a human pathogen that has diverse molecular heterogeneity. Most MRSA strains in the United States are pulsed-field gel electrophoresis USA100 sequence type (ST) 5 and USA300 ST8. Infections with MRSA ST239-III are common and found during health care–associated outbreaks. However, this strain has been rarely reported in the United States. As part of a study supported by the Prevention Epicenter Program of the Centers for Disease Control and Prevention (Atlanta, GA, USA), which evaluated transmission of MRSA among hospitals in Ohio, molecular typing identified 78 (6%) of 1,286 patients with MRSA ST239-III infections. Ninety-five percent (74/78) of these infections were health care associated, and 65% (51/78) of patients had histories of invasive device use. The crude case-fatality rate was 22% (17/78). Identification of these strains, which belong to a virulent clonal group, emphasizes the need for molecular surveillance.


  • Echinococcus multilocularis in Urban Coyotes, Alberta, Canada PDF Version [PDF - 355 KB - 4 pages]
    S. Catalano et al.
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    Echinococcus multilocularis is a zoonotic parasite in wild canids. We determined its frequency in urban coyotes (Canis latrans) in Alberta, Canada. We detected E. multilocularis in 23 of 91 coyotes in this region. This parasite is a public health concern throughout the Northern Hemisphere, partly because of increased urbanization of wild canids.

  • Orthobunyavirus Antibodies in Humans, Yucatan Peninsula, Mexico PDF Version [PDF - 308 KB - 4 pages]
    B. J. Blitvich et al.
       View Abstract

    We performed a serologic investigation to determine whether orthobunyaviruses commonly infect humans in the Yucatan Peninsula of Mexico. Orthobunyavirus-specific antibodies were detected by plaque reduction neutralization test in 146 (18%) of 823 persons tested. Further studies are needed to determine health risks for humans from this potentially deadly group of viruses.

  • Tetanus as Cause of Mass Die-off of Captive Japanese Macaques, Japan, 2008 PDF Version [PDF - 204 KB - 3 pages]
    T. Nakano et al.
       View Abstract

    In 2008 in Japan, 15/60 captive Japanese macaques died. Clostridium tetani was isolated from 1 monkey, and 11 had tetanus-specific symptoms. We conclude the outbreak resulted from severe environmental C. tetani contamination. Similar outbreaks could be prevented by vaccinating all monkeys, disinfecting housing areas/play equipment, replacing highly C. tetani–contaminated soil, and conducting epidemiologic surveys.

  • Human Infection with Candidatus Neoehrlichia mikurensis, China PDF Version [PDF - 344 KB - 4 pages]
    H. Li et al.
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    To identify Candidatus Neoehrlichia mikurensis infection in northeastern China, we tested blood samples from 622 febrile patients. We identified in 7 infected patients and natural foci for this bacterium. Field surveys showed that 1.6% of ticks and 3.8% of rodents collected from residences of patients were also infected.

  • Anthroponotic Enteric Parasites in Monkeys in Public Park, China PDF Version [PDF - 357 KB - 4 pages]
    J. Ye et al.
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    Some infections are known to spread from animals to humans; others, from humans to animals. And some are not so neatly categorized. Recently, 3 diarrhea-causing parasites of humans were found in apparently healthy monkeys in a public park in China. How the monkeys became infected is unknown. It is possible that the parasites were spread from humans. No matter how the monkeys became infected, park visitors are at risk for infection from the monkeys. Park visitors, who are allowed to feed and play with the monkeys, should be informed that they can get diarrhea directly from the monkeys or from contaminated lake or drinking water.

       View Abstract

    Cryptosporidium spp., Giardia duodenalis, and Enterocytozoon bieneusi were detected in 45, 35, and 116 of 411 free-range rhesus monkeys, respectively, in a popular public park in the People’s Republic of China. Most genotypes and subtypes detected were anthroponotic, indicating these animals might be reservoirs for human cryptosporidiosis, giardiasis, and microsporidiosis.

  • Schmallenberg Virus as Possible Ancestor of Shamonda Virus PDF Version [PDF - 222 KB - 3 pages]
    K. V. Goller et al.
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    Schmallenberg virus (SBV), an orthobunyavirus of the Simbu serogroup, recently emerged in Europe and has been suggested to be a Shamonda/Sathuperi virus reassortant. Results of full-genome and serologic investigations indicate that SBV belongs to the species Sathuperi virus and is a possible ancestor of the reassortant Shamonda virus.

  • Monkey Bites among US Military Members, Afghanistan, 2011 PDF Version [PDF - 195 KB - 3 pages]
    L. E. Mease and K. A. Baker
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    If you were to list all the dangers faced by US military personnel serving in Afghanistan, your list would be long, but would it include monkey bites? It should. The US Army recently examined this risk and found that in just 4 months, 10 service members were bitten by monkeys. And there may have been more, unreported, bites. Most monkeys were pets owned by Afghan National Security Forces and Afghan civilians, so the risk of being bitten could increase as US forces work more closely with these Afghan people. Monkey bites can spread rabies, tetanus, or other bacterial infections, or B-virus infection to humans. Bites can be minimized by enforcing military policies that prohibit pet adoption and animal contact, and secondary infections can be reduced by providing better training to military health care providers on how to treat animal bites.

       View Abstract

    Bites from Macaca mulatta monkeys, native to Afghanistan, can cause serious infections. To determine risk for US military members in Afghanistan, we reviewed records for September–December 2011. Among 126 animal bites and exposures, 10 were monkey bites. Command emphasis is vital for preventing monkey bites; provider training and bite reporting promote postexposure treatment.

  • Hepatitis E Virus Seroprevalence among Adults, Germany PDF Version [PDF - 285 KB - 4 pages]
    M. S. Faber et al.
       View Abstract

    We assessed hepatitis E virus (HEV) antibody seroprevalence in a sample of the adult population in Germany. Overall HEV IgG prevalence was 16.8% (95% CI 15.6%–17.9%) and increased with age, leveling off at >60 years of age. HEV is endemic in Germany, and the lifetime risk for exposure is high.

  • Scarlet Fever Epidemic, Hong Kong, 2011 PDF Version [PDF - 298 KB - 4 pages]
    E. Luk et al.
       View Abstract

    More than 900 cases of scarlet fever were recorded in Hong Kong during January–July, 2011. Six cases were complicated by toxic shock syndrome, of which 2 were fatal. Pulsed-field gel electrophoresis patterns suggested a multiclonal epidemic; emm12 was the predominant circulating type. We recommend genetic testing of and antimicrobial resistance monitoring for this reportable disease.

  • Visceral Leishmaniasis in Rural Bihar, India PDF Version [PDF - 243 KB - 3 pages]
    E. Hasker et al.
       View Abstract

    To identify factors associated with incidence of visceral leishmaniasis (VL), we surveyed 13,416 households in Bihar State, India. VL was associated with socioeconomic status, type of housing, and belonging to the Musahar caste. Annual coverage of indoor residual insecticide spraying was 12%. Increasing such spraying can greatly contribute to VL control.

  • Influenza A(H1N1)pdm09 Virus in Pigs, Réunion Island PDF Version [PDF - 342 KB - 4 pages]
    E. Cardinale et al.
       View Abstract

    During 2009, pandemic influenza A(H1N1)pdm09 virus affected humans on Réunion Island. Since then, the virus has sustained circulation among local swine herds, raising concerns about the potential for genetic evolution of the virus and possible retransmission back to humans of variants with increased virulence. Continuous surveillance of A(H1N1)pdm09 infection in pigs is recommended.

  • Powassan Virus Encephalitis, Minnesota, USA PDF Version [PDF - 230 KB - 3 pages]
    J. Birge and S. Sonnesyn
       View Abstract

    Powassan virus (POWV) is a rare tick-borne agent of encephalitis in North America. Historically, confirmed cases occurred mainly in the northeastern United States. Since 2008, confirmed cases in Minnesota and Wisconsin have increased. We report a fatal case of POWV encephalitis in Minnesota. POWV infection should be suspected in tick-exposed patients with viral encephalitis.

  • Influenza Virus Infection in Nonhuman Primates PDF Version [PDF - 268 KB - 4 pages]
    E. A. Karlsson et al.
       View Abstract

    To determine whether nonhuman primates are infected with influenza viruses in nature, we conducted serologic and swab studies among macaques from several parts of the world. Our detection of influenza virus and antibodies to influenza virus raises questions about the role of nonhuman primates in the ecology of influenza.

  • Human Polyomaviruses in Children Undergoing Transplantation, United States, 2008–2010 PDF Version [PDF - 206 KB - 4 pages]
    E. A. Siebrasse et al.
       View Abstract

    Immunocompromised patients are at risk for disease caused by infection by some polyomaviruses. To define the prevalence of polyomaviruses in children undergoing transplantation, we collected samples from a longitudinal cohort and tested for the 9 known human polyomaviruses. All were detected; several were present in previously unreported specimen types.

  • Preventing Maritime Transfer of Toxigenic Vibrio cholerae PDF Version [PDF - 215 KB - 3 pages]
    N. J. Cohen et al.
       View Abstract

    Organisms, including Vibrio cholerae, can be transferred between harbors in the ballast water of ships. Zones in the Caribbean region where distance from shore and water depth meet International Maritime Organization guidelines for ballast water exchange are extremely limited. Use of ballast water treatment systems could mitigate the risk for organism transfer.

  • Human Parvovirus 4 in Nasal and Fecal Specimens from Children, Ghana PDF Version [PDF - 252 KB - 4 pages]
    J. Drexler et al.
       View Abstract

    Nonparenteral transmission might contribute to human parvovirus 4 (PARV4) infections in sub-Saharan Africa. PARV4 DNA was detected in 8 (0.83%) of 961 nasal samples and 5 (0.53%) of 943 fecal samples from 1,904 children in Ghana. Virus concentrations ≤6–7 log10 copies/mL suggest respiratory or fecal–oral modes of PARV4 transmission.

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