Volume 18, Number 2—February 2012
Volume 18, Number 2—February 2012 PDF Version [PDF - 4.81 MB - 175 pages]
Pathogenic Responses among Young Adults during the 1918 Influenza Pandemic
PDF Version [PDF - 153 KB - 7 pages]
G. Shanks and J. F. BrundageView SummaryView Abstract
These responses after secondary exposures caused bacterial pneumonia and most deaths.
Of the unexplained characteristics of the 1918–19 influenza pandemic, the extreme mortality rate among young adults (W-shaped mortality curve) is the foremost. Lack of a coherent explanation of this and other epidemiologic and clinical manifestations of the pandemic contributes to uncertainty in preparing for future pandemics. Contemporaneous records suggest that immunopathologic responses were a critical determinant of the high mortality rate among young adults and other high-risk subgroups. Historical records and findings from laboratory animal studies suggest that persons who were exposed to influenza once before 1918 (e.g., A/H3Nx 1890 pandemic strain) were likely to have dysregulated, pathologic cellular immune responses to infections with the A/H1N1 1918 pandemic strain. The immunopathologic effects transiently increased susceptibility to ultimately lethal secondary bacterial pneumonia. The extreme mortality rate associated with the 1918–19 pandemic is unlikely to recur naturally. However, T-cell–mediated immunopathologic effects should be carefully monitored in developing and using universal influenza vaccines.
Medscape CME Activity
Invasive Pneumococcal Disease and Pandemic (H1N1) 2009, Denver, Colorado, USA PDF Version [PDF - 367 KB - 9 pages]G. E. Nelson et al.View SummaryView Abstract
Pneumococcal prevention strategies should be emphasized during future influenza pandemics.
Pneumococcal pneumonia was a complication during previous influenza pandemics but was not evident initially during pandemic (H1N1) 2009. During October 2009 in Denver, Colorado, USA, invasive pneumococcal disease (IPD) and pandemic (H1N1) 2009 peaked simultaneously, which suggests a link. We compared cases of IPD in October 2009 with cases in February 2009, the most recent peak month of seasonal influenza. During October 2009, we observed 58 IPD cases, which was 3× the average number of IPD cases that usually occur in October in Denver. Patients with IPD in October 2009 were younger and more likely to have chronic lung disease than patients who had IPD in February 2009; a total of 10/47 patients had influenza, and 33/53 patients had influenza-like illness. Thus, ≈17%–62% cases of IPD may have been associated with pandemic (H1N1) 2009. Pneumococcal disease prevention strategies should be emphasized during future influenza pandemics.
Diphtheria in the Postepidemic Period, Europe, 2000–2009
PDF Version [PDF - 288 KB - 9 pages]
K. S. Wagner et al.View SummaryView Abstract
Efforts must be made to maintain high vaccination coverage.
Diphtheria incidence has decreased in Europe since its resurgence in the 1990s, but circulation continues in some countries in eastern Europe, and sporadic cases have been reported elsewhere. Surveillance data from Diphtheria Surveillance Network countries and the World Health Organization European Region for 2000–2009 were analyzed. Latvia reported the highest annual incidence in Europe each year, but the Russian Federation and Ukraine accounted for 83% of all cases. Over the past 10 years, diphtheria incidence has decreased by >95% across the region. Although most deaths occurred in disease-endemic countries, case-fatality rates were highest in countries to which diphtheria is not endemic, where unfamiliarity can lead to delays in diagnosis and treatment. In western Europe, toxigenic Corynebacterium ulcerans has increasingly been identified as the etiologic agent. Reduction in diphtheria incidence over the past 10 years is encouraging, but maintaining high vaccination coverage is essential to prevent indigenous C. ulcerans and reemergence of C. diphtheriae infections.
Medscape CME Activity
Declining Guillain-Barré Syndrome after Campylobacteriosis Control, New Zealand, 1988–2010 PDF Version [PDF - 322 KB - 8 pages]M. G. Baker et al.View SummaryView Abstract
Food safety measures that lower incidence of campylobacteriosis might also prevent Guillain-Barré syndrome.
Infection with Campylobacter spp. commonly precedes Guillain-Barré syndrome (GBS). We therefore hypothesized that GBS incidence may have followed a marked rise and then decline in campylobacteriosis rates in New Zealand. We reviewed records for 1988–2010: hospitalization records for GBS case-patients and campylobacteriosis case-patients plus notifications of campylobacteriosis. We identified 2,056 first hospitalizations for GBS, an average rate of 2.32 hospitalizations/100,000 population/year. Annual rates of hospitalization for GBS were significantly correlated with rates of notifications of campylobacteriosis. For patients hospitalized for campylobacteriosis, risk of being hospitalized for GBS during the next month was greatly increased. Three years after successful interventions to lower Campylobacter spp. contamination of fresh poultry meat, notifications of campylobacteriosis had declined by 52% and hospitalizations for GBS by 13%. Therefore, regulatory measures to prevent foodborne campylobacteriosis probably have an additional health and economic benefit of preventing GBS.
Pathogenesis of Avian Bornavirus in Experimentally Infected Cockatiels
PDF Version [PDF - 270 KB - 8 pages]
A. K. Piepenbring et al.View SummaryView Abstract
Inoculation induced persistent infection, clinical signs, and seroconversion.
Avian bornavirus (ABV) is the presumed causative agent of proventricular dilatation disease (PDD), a major fatal disease in psittacines. However, the influencing factors and pathogenesis of PDD are not known and natural ABV infection exhibits remarkable variability. We investigated the course of infection in 18 cockatiels that were intracerebrally and intravenously inoculated with ABV. A persistent ABV infection developed in all 18 cockatiels, but, as in natural infection, clinical disease patterns varied. Over 33 weeks, we simultaneously studied seroconversion, presence of viral RNA and antigens, infectious virus, histopathologic alterations, and clinical signs of infection in the ABV-infected birds. Our study results further confirm the etiologic role of ABV in the development of PDD, and they provide basis for further investigations of the pathogenetic mechanisms and disease-inducing factors for the development of PDD.
Effect of Surveillance Method on Reported Characteristics of Lyme Disease, Connecticut, 1996–2007
PDF Version [PDF - 304 KB - 6 pages]
S. Ertel et al.View SummaryView Abstract
The epidemiology of Lyme disease varies by surveillance method.
To determine the effect of changing public health surveillance methods on the reported epidemiology of Lyme disease, we analyzed Connecticut data for 1996–2007. Data were stratified by 4 surveillance methods and compared. A total of 87,174 reports were received that included 79,896 potential cases. Variations based on surveillance methods were seen. Cases reported through physician-based surveillance were significantly more likely to be classified as confirmed; such case-patients were significantly more likely to have symptoms of erythema migrans only and to have illness onset during summer months. Case-patients reported through laboratory-based surveillance were significantly more likely to have late manifestations only and to be older. Use of multiple surveillance methods provided a more complete clinical and demographic description of cases but lacked efficiency. When interpreting data, changes in surveillance method must be considered.
Characterization of Nipah Virus from Outbreaks in Bangladesh, 2008–2010
PDF Version [PDF - 299 KB - 8 pages]
M. K. Lo et al.View SummaryView Abstract
New genotyping scheme facilitates classification of virus sequences.
Nipah virus (NiV) is a highly pathogenic paramyxovirus that causes fatal encephalitis in humans. The initial outbreak of NiV infection occurred in Malaysia and Singapore in 1998–1999; relatively small, sporadic outbreaks among humans have occurred in Bangladesh since 2001. We characterized the complete genomic sequences of identical NiV isolates from 2 patients in 2008 and partial genomic sequences of throat swab samples from 3 patients in 2010, all from Bangladesh. All sequences from patients in Bangladesh comprised a distinct genetic group. However, the detection of 3 genetically distinct sequences from patients in the districts of Faridpur and Gopalganj indicated multiple co-circulating lineages in a localized region over a short time (January–March 2010). Sequence comparisons between the open reading frames of all available NiV genes led us to propose a standardized protocol for genotyping NiV; this protcol provides a simple and accurate way to classify current and future NiV sequences.
Unsuspected Dengue and Acute Febrile Illness in Rural and Semi-Urban Southern Sri Lanka
PDF Version [PDF - 194 KB - 8 pages]
M. E. Reller et al.View SummaryView Abstract
Acute dengue may be under-recognized in other regions because of limited studies and tools for rapid diagnosis.
Dengue virus (DENV), a globally emerging cause of undifferentiated fever, has been documented in the heavily urbanized western coast of Sri Lanka since the 1960s. New areas of Sri Lanka are now being affected, and the reported number and severity of cases have increased. To study emerging DENV in southern Sri Lanka, we obtained epidemiologic and clinical data and acute- and convalescent-phase serum samples from patients >2 years old with febrile illness. We tested paired serum samples for DENV IgG and IgM and serotyped virus by using isolation and reverse transcription PCR. We identified acute DENV infection (serotypes 2, 3, and 4) in 54 (6.3%) of 859 patients. Only 14% of patients had clinically suspected dengue; however, 54% had serologically confirmed acute or past DENV infection. DENV is a major and largely unrecognized cause of fever in southern Sri Lanka, especially in young adults.
Association of Human Bocavirus 1 Infection with Respiratory Disease in Childhood Follow-up Study, Finland
PDF Version [PDF - 316 KB - 8 pages]
M. Meriluoto et al.View SummaryView Abstract
Since its discovery in 2005, human bocavirus type 1 has often been found in the upper airways of young children with respiratory disease. But is this virus the cause of the respiratory disease or just an innocent bystander? A unique study in Finland, which examined follow-up blood samples of 109 healthy children with no underlying illness starting at birth and until they were 13 years of age, found that acute bocavirus infection resulted in respiratory disease. All children had been infected by age 6. Most retained their antibodies to this virus; some lost them. Children who were later re-exposed to bocavirus did not get sick from this virus. Thus, human bocavirus type 1 is a major cause of respiratory disease in childhood.
Human bocavirus 1 (HBoV1) DNA is frequently detected in the upper airways of young children with respiratory symptoms. Because of its persistence and frequent co-detection with other viruses, however, its etiologic role has remained controversial. During 2009–2011, using HBoV1 IgM, IgG, and IgG-avidity enzyme immunoassays and quantitative PCR, we examined 1,952 serum samples collected consecutively at 3- to 6-month intervals from 109 constitutionally healthy children from infancy to early adolescence. Primary HBoV1 infection, as indicated by seroconversion, appeared in 102 (94%) of 109 children at a mean age of 2.3 years; the remaining 7 children were IgG antibody positive from birth. Subsequent secondary infections or IgG antibody increases were evident in 38 children and IgG reversions in 10. Comparison of the seroconversion interval with the next sampling interval for clinical events indicated that HBoV1 primary infection, but not secondary immune response, was significantly associated with acute otitis media and respiratory illness.
Lack of Decline in Childhood Malaria, Malawi, 2001–2010
PDF Version [PDF - 289 KB - 7 pages]
A. Roca-Feltrer et al.View SummaryView Abstract
Despite increased control activities, malaria did not substantially decline.
In some areas of Africa, health facility data have indicated declines in malaria that might have resulted from increasingly effective control programs. Most such reports have been from countries where malaria transmission is highly seasonal or of modest intensity. In Malawi, perennial malaria transmission is intense, and malaria control measures have been scaled up during the past decade. We examined health facility data for children seen as outpatients and parasitemia-positive children hospitalized with cerebral malaria in a large national hospital. The proportion of Plasmodium falciparum–positive slides among febrile children at the hospital declined early in the decade, but no further reductions were observed after 2005. The number of admissions for cerebral malaria did not differ significantly by year. Continued surveillance for malaria is needed to evaluate the effects of the increased malaria control efforts.
Non-O157 Shiga Toxin–producing Escherichia coli Associated with Venison
PDF Version [PDF - 288 KB - 4 pages]
J. M. Rounds et al.View SummaryView Abstract
News reports of “E. coli outbreaks” usually refer to Shiga toxin–producing E. coli O157. But there are other types of Shiga toxin–producing E. coli, often called STEC, about which less is known. For these other types of STEC, what is the source? What are the risk factors? An outbreak among 29 high school students in Minnesota provided some answers. The source of this outbreak was a white-tailed deer that had been butchered and eaten at the school. The risk factors for infection were handling raw or eating undercooked venison. To prevent this type of STEC infection, people should handle and cook venison with the same caution recommended for other meats.
We investigated an outbreak of non-O157 Shiga toxin–producing Escherichia coli at a high school in Minnesota, USA, in November 2010. Consuming undercooked venison and not washing hands after handling raw venison were associated with illness. E. coli O103:H2 and non-Shiga toxin–producing E. coli O145:NM were isolated from ill students and venison.
High Seroprevalence of Enterovirus Infections in Apes and Old World Monkeys
PDF Version [PDF - 255 KB - 4 pages]
H. Harvala et al.View Abstract
To estimate population exposure of apes and Old World monkeys in Africa to enteroviruses (EVs), we conducted a seroepidemiologic study of serotype-specific neutralizing antibodies against 3 EV types. Detection of species A, B, and D EVs infecting wild chimpanzees demonstrates their potential widespread circulation in primates.
Multiorgan Dysfunction Caused by Travel-associated African Trypanosomiasis
PDF Version [PDF - 196 KB - 3 pages]
L. E. Cottle et al.View Abstract
We describe a case of multiorgan dysfunction secondary to Trypanosoma brucei rhodesiense infection acquired on safari in Zambia. This case was one of several recently reported to ProMED-mail in persons who had traveled to this region. Trypanosomiasis remains rare in travelers but should be considered in febrile patients who have returned from trypanosomiasis-endemic areas of Africa.
Phylogeography of Francisella tularensis subsp. holarctica, Europe
PDF Version [PDF - 385 KB - 4 pages]
M. Gyuranecz et al.View Abstract
Francisella tularensis subsp. holarctica isolates from Austria, Germany, Hungary, Italy, and Romania were placed into an existing phylogeographic framework. Isolates from Italy were assigned to phylogenetic group B.FTNF002–00; the other isolates, to group B.13. Most F. tularensis subsp. holarctica isolates from Europe belong to these 2 geographically segregated groups.
Invasive Pneumococcal Pneumonia and Respiratory Virus Co-infections
PDF Version [PDF - 343 KB - 4 pages]
H. Zhou et al.View SummaryView Abstract
Each year, especially in the winter, many get sick and some die of invasive pneumococcal pneumonia. Does this type of pneumonia increase in the winter because people are in closer contact indoors? Or are people more susceptible to this bacterial disease after having had a seasonal respiratory virus infection? A season-by-season analysis found an association between pneumococcal pneumonia and two viruses (influenza and respiratory syncytial virus). The association varied by season and was strongest when the predominant influenza virus subtype was H3N2. Vaccination against influenza and RSV should also help protect against pneumococcal pneumonia.
To confirm whether respiratory virus infections increase susceptibility to invasive pneumococcal pneumonia, we examined data from 11 influenza seasons (1994–2005) in the United States. Invasive pneumococcal pneumonia was significantly associated with influenza and respiratory syncytial virus activities in 5 seasons. Association strength was higher when strain H3N2 was the predominant influenza A virus strain.
Avian Influenza A(H7N9) Virus Infection in Pregnant Woman, China, 2013
PDF Version [PDF - 282 KB - 4 pages]
J. A. Drewe et al.View Abstract
Baboons on South Africa’s Cape Peninsula come in frequent contact with humans. To determine potential health risks for both species, we screened 27 baboons from 5 troops for 10 infections. Most (56%) baboons had antibodies reactive or cross-reactive to human viruses. Spatial overlap between these species poses low but potential health risks.
Disseminated Infection Caused by Novel Species of Microsporidium, Thailand
PDF Version [PDF - 316 KB - 3 pages]
C. Suankratay et al.View Abstract
We describe a case of microsporidial myositis in a healthy man from Thailand. The small subunit rRNA sequence of this microsporidium is novel and has a close phylogenetic relationship with Endoreticulatus, a genus of lepidopteran microsporidia. Myositis could be caused by more genera of microsporidia than previously known.
Determining Mortality Rates Attributable to Clostridium difficile Infection
PDF Version [PDF - 245 KB - 3 pages]
S. S. Hota et al.View Abstract
To determine accuracy of measures of deaths attributable to Clostridium difficile infection, we compared 3 measures for 2007–2008 in Ontario, Canada: death certificate; death within 30 days of infection; and panel review. Data on death within 30 days were more feasible than panel review and more accurate than death certificate data.
Oseltamivir-Resistant Pandemic (H1N1) 2009 Virus Infections, United States, 2010–11
PDF Version [PDF - 196 KB - 4 pages]
A. D. Storms et al.View Abstract
During October 2010–July 2011, 1.0% of pandemic (H1N1) 2009 viruses in the United States were oseltamivir resistant, compared with 0.5% during the 2009–10 influenza season. Of resistant viruses from 2010–11 and 2009–10, 26% and 89%, respectively, were from persons exposed to oseltamivir before specimen collection. Findings suggest limited community transmission of oseltamivir-resistant virus.
Extended Outbreak of Cryptosporidiosis in a Pediatric Hospital, China
PDF Version [PDF - 206 KB - 3 pages]
Y. Feng et al.View Abstract
Four Cryptosporidium spp. and 6 C. hominis subtypes were isolated from 102 of 6,284 patients in 3 pediatric hospitals in People’s Republic of China. A cryptosporidiosis outbreak was identified retrospectively. The outbreak lasted >1 year and affected 51.4% of patients in 1 hospital ward, where 2 C. hominis subtypes with different virulence were found.
Pandemic (H1N1) 2009 in Captive Cheetah
PDF Version [PDF - 265 KB - 3 pages]
B. Crossley et al.View Abstract
We describe virus isolation, full genome sequence analysis, and clinical pathology in ferrets experimentally inoculated with pandemic (H1N1) 2009 virus recovered from a clinically ill captive cheetah that had minimal human contact. Evidence of reverse zoonotic transmission by fomites underscores the substantial animal and human health implications of this virus.
Shuni Virus as Cause of Neurologic Disease in Horses
PDF Version [PDF - 259 KB - 4 pages]
C. van Eeden et al.View Abstract
To determine which agents cause neurologic disease in horses, we conducted reverse transcription PCR on isolates from of a horse with encephalitis and 111 other horses with acute disease. Shuni virus was found in 7 horses, 5 of which had neurologic signs. Testing for lesser known viruses should be considered for horses with unexplained illness.
Plesiomonas shigelloides Infection, Ecuador, 2004–2008
PDF Version [PDF - 212 KB - 3 pages]
J. C. Escobar et al.View Abstract
Diarrheal risk associated with Plesiomonas shigelloides infection was assessed in rural communities in northwestern Ecuador during 2004–2008. We found little evidence that single infection with P. shigelloides is associated with diarrhea but stronger evidence that co-infection with rotavirus causes diarrhea.
Melioidosis in Animals, Thailand, 2006–2010
PDF Version [PDF - 246 KB - 3 pages]
D. Limmathurotsakul et al.View Abstract
We retrospectively estimated the incidence of culture-proven melioidosis in animals in Thailand during 2006–2010. The highest incidence was in goats (1.63/100,000/year), followed by incidence in pigs and cattle. The estimated incidence of melioidosis in humans in a given region paralleled that of melioidosis in goats.
Rickettsia felis Infection in Febrile Patients, Western Kenya, 2007–2010
PDF Version [PDF - 333 KB - 4 pages]
A. N. Maina et al.View Abstract
To determine previous exposure and incidence of rickettsial infections in western Kenya during 2007–2010, we conducted hospital-based surveillance. Antibodies against rickettsiae were detected in 57.4% of previously collected serum samples. In a 2008–2010 prospective study, Rickettsia felis DNA was 2.2× more likely to be detected in febrile than in afebrile persons.
1918 Influenza, a Puzzle with Missing Pieces
PDF Version [PDF - 240 KB - 4 pages]
D. M. Morens and J. K. Taubenberger
Rapid Diagnosis of Pandemic (H1N1) 2009 in Cuba
PDF Version [PDF - 128 KB - 2 pages]
B. Acosta et al.
Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6, Japan, 2011
PDF Version [PDF - 168 KB - 3 pages]
T. Fujimoto et al.
Human and Porcine Hepatitis E Viruses, Southeastern Bolivia
PDF Version [PDF - 148 KB - 2 pages]
M. A. Purdy et al.
Baylisascaris procyonis Infection in Elderly Person, British Columbia, Canada
PDF Version [PDF - 162 KB - 2 pages]
T. Hung et al.
Dengue Surveillance among French Military in Africa
PDF Version [PDF - 135 KB - 2 pages]
F. de Laval et al.
Clonal Spread of Mycoplasma pneumoniae in Primary School, Bordeaux, France
PDF Version [PDF - 155 KB - 3 pages]
S. Pereyre et al.
Risk for Emergence of Dengue and Chikungunya Virus in Israel
PDF Version [PDF - 147 KB - 3 pages]
E. Leshem et al.
Possible Pet-associated Baylisascariasis in Child, Canada
PDF Version [PDF - 163 KB - 3 pages]
S. Haider et al.
Zika Virus Infection, Cambodia, 2010
PDF Version [PDF - 132 KB - 3 pages]
V. Heang et al.
Recombination of Human Coxsackievirus B5 in Hand, Foot, and Mouth Disease Patients, China
PDF Version [PDF - 159 KB - 3 pages]
J. Han et al.
Nontuberculous Mycobacteria in Tap Water
PDF Version [PDF - 113 KB - 1 page]
E. Hernández-Garduño and K. Elwood
Leishmania infantum and Human Visceral Leishmaniasis, Argentina
PDF Version [PDF - 172 KB - 2 pages]
A. Barrio et al.
Plasmodium falciparum in Asymptomatic Immigrants from Sub-Saharan Africa, Spain
PDF Version [PDF - 126 KB - 2 pages]
B. Monge-Maillo et al.
Pandemic (H1N1) 2009 Virus Circulating in Pigs, Guangxi, China
PDF Version [PDF - 132 KB - 3 pages]
J. Yan et al.
Cutaneous Melioidosis in Adolescent Returning from Guadeloupe
PDF Version [PDF - 126 KB - 2 pages]
R. Meckenstock et al.
Geographic Distribution of Endemic Fungal Infections among Older Persons, United States
PDF Version [PDF - 126 KB - 2 pages]
D. Haselow et al.
Books and Media
Africa in the Time of Cholera: A History of Pandemics from 1817 to the Present
PDF Version [PDF - 126 KB - 1 page]
I. N. Okeke
About the Cover
- Page created: December 18, 2013
- Page last updated: December 18, 2013
- Page last reviewed: December 18, 2013
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