Skip directly to search Skip directly to A to Z list Skip directly to page options Skip directly to site content

Volume 18, Number 12—December 2012

Volume 18, Number 12—December 2012   PDF Version [PDF - 8.32 MB - 187 pages]


  • Medscape CME Activity
    Farm Animal Contact as Risk Factor for Transmission of Bovine-associated Salmonella Subtypes PDF Version [PDF - 223 KB - 8 pages]
    K. J. Cummings et al.
    View Summary

    Salmonellosis prevention should focus on safe animal contact as well as food safety.

       View Abstract

    Salmonellosis is usually associated with foodborne transmission. To identify risk from animal contact, we compared animal exposures of case-patients infected with bovine-associated Salmonella subtypes with those of control-patients infected with non-bovine–associated subtypes. We used data collected in New York and Washington, USA, from March 1, 2008, through March 1, 2010. Contact with farm animals during the 5 days before illness onset was significantly associated with being a case-patient (odds ratio 3.2, p = 0.0008), after consumption of undercooked ground beef and unpasteurized milk were controlled for. Contact with cattle specifically was also significantly associated with being a case-patient (odds ratio 7.4, p = 0.0002), after food exposures were controlled for. More cases of bovine-associated salmonellosis in humans might result from direct contact with cattle, as opposed to ingestion of foods of bovine origin, than previously recognized. Efforts to control salmonellosis should include a focus on transmission routes other than foodborne.

  • Outbreak of Influenza A (H3N2) Variant Virus Infection among Attendees of an Agricultural Fair, Pennsylvania, USA, 2011 PDF Version [PDF - 230 KB - 8 pages]
    K. K. Wong et al.
    View Summary

    Avoiding or limiting contact with swine at agricultural events may help prevent A(H3N2)v virus infections in such settings.

       View Abstract

    During August 2011, influenza A (H3N2) variant [A(H3N2)v] virus infection developed in a child who attended an agricultural fair in Pennsylvania, USA; the virus resulted from reassortment of a swine influenza virus with influenza A(H1N1)pdm09. We interviewed fair attendees and conducted a retrospective cohort study among members of an agricultural club who attended the fair. Probable and confirmed cases of A(H3N2)v virus infection were defined by serology and genomic sequencing results, respectively. We identified 82 suspected, 4 probable, and 3 confirmed case-patients who attended the fair. Among 127 cohort study members, the risk for suspected case status increased as swine exposure increased from none (4%; referent) to visiting swine exhibits (8%; relative risk 2.1; 95% CI 0.2–53.4) to touching swine (16%; relative risk 4.4; 95% CI 0.8–116.3). Fairs may be venues for zoonotic transmission of viruses with epidemic potential; thus, health officials should investigate respiratory illness outbreaks associated with agricultural events.

  • Subclinical Influenza Virus A Infections in Pigs Exhibited at Agricultural Fairs, Ohio, USA, 2009–2011 PDF Version [PDF - 221 KB - 6 pages]
    A. S. Bowman et al.
    View Summary

    Close contact between pigs and humans could result in zoonotic transmission.

       View Abstract

    Agricultural fairs are associated with bidirectional, interspecies transmission of influenza virus A between humans and pigs. We examined pigs exhibited at agricultural fairs in Ohio during 2009–2011 for signs of influenza-like illness and collected nasal swab specimens from a representative subset of these animals. Influenza virus A was recovered from pigs at 12/53 (22.6%) fairs during the 3-year sampling period. Pigs at 10/12 (83.3%) fairs from which influenza virus A was recovered did not show signs of influenza-like illness. Hemagglutinin, neuraminidase, and matrix gene combinations of the isolates were consistent with influenza virus A concurrently circulating among swine herds in the United States. Subclinical influenza virus A infections in pigs at agricultural fairs may pose a risk to human health and create challenges for passive surveillance programs for influenza virus A in swine herds.

  • Reservoir Competence of Wildlife Host Species for Babesia microti PDF Version [PDF - 283 KB - 7 pages]
    M. H. Hersh et al.
    View Summary

    Competence data will aid understanding of the spread of human babesiosis.

       View Abstract

    Human babesiosis is an increasing health concern in the northeastern United States, where the causal agent, Babesia microti, is spread through the bite of infected Ixodes scapularis ticks. We sampled 10 mammal and 4 bird species within a vertebrate host community in southeastern New York to quantify reservoir competence (mean percentage of ticks infected by an individual host) using real-time PCR. We found reservoir competence levels >17% in white-footed mice (Peromyscus leucopus), raccoons (Procyon lotor), short-tailed shrews (Blarina brevicauda), and eastern chipmunks (Tamias striatus), and <6% but >0% in all other species, including all 4 bird species. Data on the relative contributions of multiple host species to tick infection with B. microti and level of genetic differentiation between B. microti strains transmitted by different hosts will help advance understanding of the spread of human babesiosis.

  • Diagnostic Assays for Crimean-Congo Hemorrhagic Fever PDF Version [PDF - 316 KB - 8 pages]
    J. Vanhomwegen et al.
    View Summary

    On-site testing would diminish time, costs, and risks involved in handling of highly infectious materials.

       View Abstract

    Crimean-Congo hemorrhagic fever (CCHF) is a highly contagious viral tick-borne disease with case-fatality rates as high as 50%. We describe a collaborative evaluation of the characteristics, performance, and on-site applicability of serologic and molecular assays for diagnosis of CCHF. We evaluated ELISA, immunofluorescence, quantitative reverse transcription PCR, and low-density macroarray assays for detection of CCHF virus using precharacterized archived patient serum samples. Compared with results of local, in-house methods, test sensitivities were 87.8%–93.9% for IgM serology, 80.4%–86.1% for IgG serology, and 79.6%–83.3% for genome detection. Specificity was excellent for all assays; molecular test results were influenced by patient country of origin. Our findings demonstrate that well-characterized, reliable tools are available for CCHF diagnosis and surveillance. The on-site use of such assays by health laboratories would greatly diminish the time, costs, and risks posed by the handling, packaging, and shipping of highly infectious biologic material.

  • Borrelia, Rickettsia, and Ehrlichia Species in Bat Ticks, France, 2010 PDF Version [PDF - 551 KB - 10 pages]
    C. Socolovschi et al.
    View Summary

    Physicians should consider infections with these bacteria in patients who may have been bitten by bat ticks.

       View Abstract

    Argas vespertilionis, an argasid tick associated with bats and bat habitats in Europe, Africa, and Asia has been reported to bite humans; however, studies investigating the presence of vector-borne pathogens in these ticks are lacking. Using molecular tools, we tested 5 A. vespertilionis ticks collected in 2010 from the floor of a bat-infested attic in southwestern France that had been converted into bedrooms. Rickettsia sp. AvBat, a new genotype of spotted fever group rickettsiae, was detected and cultivated from 3 of the 5 ticks. A new species of the Ehrlichia canis group, Ehrlichia sp. AvBat, was also detected in 3 ticks. Four ticks were infected with Borrelia sp. CPB1, a relapsing fever agent of the Borrelia group that caused fatal borreliosis in a bat in the United Kingdom. Further studies are needed to characterize these new agents and determine if the A. vespertilionis tick is a vector and/or reservoir of these agents.

  • Nonprimate Hepaciviruses in Domestic Horses, United Kingdom PDF Version [PDF - 379 KB - 7 pages]
    S. Lyons et al.
    View Summary

    Viruses related to human hepatitis C virus infect horses in the United Kingdom without evidence of hepatic or other systemic disease.

       View Abstract

    Although the origin of hepatitis C virus infections in humans remains undetermined, a close homolog of this virus, termed canine hepacivirus (CHV) and found in respiratory secretions of dogs, provides evidence for a wider distribution of hepaciviruses in mammals. We determined frequencies of active infection among dogs and other mammals in the United Kingdom. Samples from dogs (46 respiratory, 99 plasma, 45 autopsy samples) were CHV negative by PCR. Screening of 362 samples from cats, horses, donkeys, rodents, and pigs identified 3 (2%) positive samples from 142 horses. These samples were genetically divergent from CHV and nonprimate hepaciviruses that horses were infected with during 2012 in New York state, USA. Investigation of infected horses demonstrated nonprimate hepacivirus persistence, high viral loads in plasma (105–107 RNA copies/mL), and liver function test results usually within reference ranges, although several values ranged from high normal to mildly elevated. Disease associations and host range of nonprimate hepaciviruses warrant further investigation.

  • Transmission Routes for Nipah Virus from Malaysia and Bangladesh PDF Version [PDF - 643 KB - 11 pages]
    B. A. Clayton et al.
    View Summary

    Nipah virus infection in humans is associated with a higher death rate in Bangladesh than in Malaysia. Additionally, Nipah virus spreads from person to person in Bangladesh but not in Malaysia. To investigate why these differences occur, researchers looked for differences in the virus strains from each country. In experimentally infected ferrets, they examined which tissues each strain infected and how each strain was excreted from the body. They found higher concentrations of the Bangladesh strain in secretions from the mouth. Increased oral excretion of the Bangladesh strain in humans might explain why person-to-person transmission of Nipah virus occurs in that region.

       View Abstract

    Human infections with Nipah virus in Malaysia and Bangladesh are associated with markedly different patterns of transmission and pathogenicity. To compare the 2 strains, we conducted an in vivo study in which 2 groups of ferrets were oronasally exposed to either the Malaysia or Bangladesh strain of Nipah virus. Viral shedding and tissue tropism were compared between the 2 groups. Over the course of infection, significantly higher levels of viral RNA were recovered from oral secretions of ferrets infected with the Bangladesh strain. Higher levels of oral shedding of the Bangladesh strain of Nipah virus might be a key factor in onward transmission in outbreaks among humans.

  • Virulent Avian Infectious Bronchitis Virus, People’s Republic of China PDF Version [PDF - 876 KB - 8 pages]
    J. Feng et al.
    View Summary

    YN strain shows severe pathogenicity in chickens.

       View Abstract

    A virulent avian infectious bronchitis virus (IBV) was isolated from 30-day-old broiler chickens that exhibited respiratory symptoms, nephropathologic lesions, and a high proportion of deaths in the People’s Republic of China during 2005. The strain, designated YN, was genetically and pathologically characterized. Phylogenetic analysis showed that YN and most of the previously characterized IBV isolates found in China were phylogenetically classified into 2 main genetic clusters. The YN isolate caused severe lesions and resulted in deaths of 65% in experimental infections of 30-day-old specific-pathogen–free chickens. Tracheal and severe kidney lesions developed in all infected birds, confirming the ability of YN strain to induce both respiratory and renal disease. IBV antigens were detected by immunohistochemical analysis in the trachea, lung, kidney, and bursa, consistent with histopathologic observations, virus isolation, and reverse transcription PCR detection. We showed that YN IBV exhibits severe pathogenicity in chickens, and that similar viruses are prevalent in China.



About the Cover


Online Reports

  • Peer Reviewed Report Available Online Only
    Surveillance of Zoonotic Infectious Disease Transmitted by Small Companion Animals
    M. J. Day et al.
       View Abstract

    The One Health paradigm for global health recognizes that most new human infectious diseases will emerge from animal reservoirs. Little consideration has been given to the known and potential zoonotic infectious diseases of small companion animals. Cats and dogs closely share the domestic environment with humans and have the potential to act as sources and sentinels of a wide spectrum of zoonotic infections. This report highlights the lack of a coordinated global surveillance scheme that monitors disease in these species and makes a case for the necessity of developing a strategy to implement such surveillance.

  • Peer Reviewed Report Available Online Only
    Workshop on Treatment of and Postexposure Prophylaxis for Burkholderia pseudomallei and B. mallei Infection, 2010
    R. Lipsitz et al.
       View Abstract

    The US Public Health Emergency Medical Countermeasures Enterprise convened subject matter experts at the 2010 HHS Burkholderia Workshop to develop consensus recommendations for postexposure prophylaxis against and treatment for Burkholderia pseudomallei and B. mallei infections, which cause melioidosis and glanders, respectively. Drugs recommended by consensus of the participants are ceftazidime or meropenem for initial intensive therapy, and trimethoprim/sulfamethoxazole or amoxicillin/clavulanic acid for eradication therapy. For postexposure prophylaxis, recommended drugs are trimethoprim/sulfamethoxazole or co-amoxiclav. To improve the timely diagnosis of melioidosis and glanders, further development and wide distribution of rapid diagnostic assays were also recommended. Standardized animal models and B. pseudomallei strains are needed for further development of therapeutic options. Training for laboratory technicians and physicians would facilitate better diagnosis and treatment options.

Conference Summaries