Volume 18, Number 9—September 2012
Volume 18, Number 9—September 2012 PDF Version [PDF - 17.05 MB - 163 pages]
Hepatitis E, a Vaccine-Preventable Cause of Maternal Deaths
PDF Version [PDF - 202 KB - 4 pages]
A. B. Labrique et al.View SummaryView Abstract
These deaths are substantial and could be prevented by commercial vaccine.
Hepatitis E virus (HEV) is a major cause of illness and of death in the developing world and disproportionate cause of deaths among pregnant women. Although HEV vaccine trials, including trials conducted in populations in southern Asia, have shown candidate vaccines to be effective and well-tolerated, these vaccines have not yet been produced or made available to susceptible populations. Surveillance data collected during 2001–2007 from >110,000 pregnancies in a population of ≈650,000 women in rural Bangladesh suggest that acute hepatitis, most of it likely hepatitis E, is responsible for ≈9.8% of pregnancy-associated deaths. If these numbers are representative of southern Asia, as many as 10,500 maternal deaths each year in this region alone may be attributable to hepatitis E and could be prevented by using existing vaccines.
Medscape CME Activity
Effectiveness and Timing of Vaccination during School Measles Outbreak PDF Version [PDF - 458 KB - 9 pages]A. Marinović et al.View SummaryView Abstract
Implementing a vaccination campaign during an outbreak can effectively reduce the outbreak size.
Despite high vaccination coverage in most European countries, large community outbreaks of measles do occur, normally clustered around schools and resulting from suboptimal vaccination coverage. To determine whether or when it is worth implementing outbreak-response vaccination campaigns in schools, we used stochastic outbreak models to reproduce a public school outbreak in Germany, where no vaccination campaign was implemented. We assumed 2 scenarios covering the baseline vaccination ratio range (91.3%–94.3%) estimated for that school and computed outbreaks assuming various vaccination delays. In one scenario, reacting (i.e., implementing outbreak-response vaccination campaigns) within 12–24 days avoided large outbreaks and reacting within 50 days reduced outbreak size. In the other scenario, reacting within 6–14 days avoided large outbreaks and reacting within 40 days reduced the outbreak size. These are realistic time frames for implementing school outbreak response vaccination campaigns. High baseline vaccination ratios extended the time needed for effective response.
Medscape CME Activity
Evaluation of Diagnostic and Therapeutic Approaches for Suspected Influenza A(H1N1)pdm09 Infection, 2009–2010 PDF Version [PDF - 335 KB - 8 pages]V. Vijayan et al.View SummaryView Abstract
Variations between practice and national recommendations could inform clinical education in future influenza seasons.
To assess adherence to real-time changes in guidelines for influenza diagnosis and use of oseltamivir during the 2009 influenza A(H1N1) pandemic, we reviewed medical records of patients with confirmed or suspected influenza-like illness (ILI) and those with no viral testing in a large Los Angeles (California, USA) hospital. Of 882 tested patients, 178 had results positive for influenza; 136 of the remaining patients received oseltamivir despite negative or no results. Oseltamivir use was consistent with national recommendations in >90%. Of inpatients, children were less likely than adults to have ILI at testing and to receive oseltamivir if ILI was found. Of outpatients, children were more likely to have positive test results; 20% tested did not have ILI or other influenza signs and symptoms. Twenty-five of 96 test-positive patients and 13 of 19 with lower respiratory tract disease were, inappropriately, not treated. Variations between practice and national recommendations could inform clinical education in future influenza seasons.
Evaluation of Immigrant Tuberculosis Screening in Industrialized Countries
PDF Version [PDF - 197 KB - 8 pages]
M. Pareek et al.View SummaryView Abstract
Improvements are needed in current screening, which is insufficient and ineffective.
In industrialized countries, tuberculosis (TB) cases are concentrated among immigrants and driven by reactivation of imported latent TB infection (LTBI). We examined mechanisms used to screen immigrants for TB and LTBI by sending an anonymous, 18-point questionnaire to 31 member countries of the Organisation for Economic Co-operation and Development. Twenty-nine (93.5%) of 31 responded; 25 (86.2%) screened immigrants for active TB. Fewer countries (16/29, 55.2%) screened for LTBI. Marked variations were observed in targeted populations for age (range <5 years of age to all age groups) and TB incidence in countries of origin of immigrants (>20 cases/100,000 population to >500 cases/100,000). LTBI screening was conducted in 11/16 countries by using the tuberculin skin test. Six countries used interferon-γ release assays, primarily to confirm positive tuberculin skin test results. Industrialized countries performed LTBI screening infrequently and policies varied widely. There is an urgent need to define the cost-effectiveness of LTBI screening strategies for immigrants.
Trends in Meningococcal Disease in the United States Military, 1971–2010
PDF Version [PDF - 339 KB - 8 pages]
M. P. Broderick et al.View SummaryView Abstract
When you consider the risks undertaken by US military personnel, do you include risk for disease? Public health officials do. Military personnel are at risk for infectious disease because of crowding, the rigors of physical training, and sometimes unhygienic field conditions. Meningococcal disease (usually manifested as bacterial meningitis or blood-borne infection) can be rapidly fatal. It has historically affected the military more than the general US population. One hundred years' worth of data support this trend from as long ago as World War I. However, in 1970, a policy requiring vaccination of military recruits started lowering the rate of infection, although the rate remained higher than that for the general population. Since 1982, improvements in vaccines have lowered rates even further. As a result of these vaccination efforts, the meningococcal disease rate among military personnel has reached a historic low, which now matches that of the general population.
Meningococci have historically caused extensive illness among members of the United States military. Three successive meningococcal vaccine types were used from 1971 through 2010; overall disease incidence dropped by >90% during this period. During 2006–2010, disease incidence of 0.38 (cases per 100,000 person-years) among members of the US military was not significantly different from the incidence of 0.26 among the age-matched US general population. Of the 26 cases in the US military, 5 were fatal, 15 were vaccine failures (e.g., illness in a person who had been vaccinated), and 9 were caused by Neisseria meningitidis serogroup Y. Incidences among 17- to 19-year-old basic trainees and among US Marines were significantly higher than among comparison military populations (p<0.05). No apparent change in epidemiology of meningococcal disease was observed after replacement of quadrivalent polysaccharide vaccine with conjugate vaccine in 2007. The data demonstrate that vaccination with meningococcal vaccine is effective.
Prevention and Control of Fish-borne Zoonotic Trematodes in Fish Nurseries, Vietnam
PDF Version [PDF - 347 KB - 8 pages]
J. Clausen et al.View SummaryView Abstract
Reducing snails and trematode eggs in nursery ponds lowered trematode transmission among fish.
Worldwide, >18 million persons were infected with fish-borne zoonotic trematodes in 2002. To evaluate the effectiveness of interventions for reducing prevalence and intensity of fish-borne zoonotic trematode infections in juvenile fish, we compared transmission rates at nurseries in the Red River Delta, northern Vietnam. Rates were significantly lower for nurseries that reduced snail populations and trematode egg contamination in ponds than for nurseries that did not. These interventions can be used in the development of programs for sustained control of zoonotic trematodes in farmed fish.
Surveillance for Influenza Viruses in Poultry and Swine, West Africa, 2006–2008
PDF Version [PDF - 258 KB - 7 pages]
E. Couacy-Hymann et al.View SummaryView Abstract
West Africa might be an animal influenza–free zone.
To determine the extent of animal influenza virus circulation in Côte d’Ivoire, Benin, and Togo, we initiated systematic year-round active influenza surveillance in backyard birds (predominantly chickens, guinea fowl, and ducks) and pigs. A total of 26,746 swab specimens were screened by using reverse transcription PCR. Animal influenza prevalence was estimated at 0 (95% CIs for each of the 2 study years 0–0.04% to 0–1.48% [birds] and 0–0.28% to 0–5% [pigs]). In addition, 2,276 serum samples from the same populations were negative for influenza-specific antibodies. These data indicate that the environments and host populations previously identified as harboring high levels of influenza virus in Southeast Asia do not do so in these 3 countries. The combination of climate and animal density factors might be responsible for what appears to be the absence of influenza virus in the backyard sector of the 3 countries.
Medscape CME Activity
Control of Fluoroquinolone Resistance through Successful Regulation, Australia PDF Version [PDF - 230 KB - 8 pages]A. C. Cheng et al.View SummaryView Abstract
Restricted Fluoroquinolone use in humans and food animals has result in low rates of resistance in human pathogens
Fluoroquinolone antimicrobial drugs are highly bioavailable, broad-spectrum agents with activity against gram-negative pathogens, especially those resistant to other classes of antimicrobial drugs. Australia has restricted the use of quinolones in humans through its national pharmaceutical subsidy scheme; and, through regulation, has not permitted the use of quinolones in food-producing animals. As a consequence, resistance to fluoroquinolones in the community has been slow to emerge and has remained at low levels in key pathogens, such as Escherichia coli. In contrast to policies in most other countries, this policy has successfully preserved the utility of this class of antimicrobial drugs for treatment of most infections.
Multiple Synchronous Outbreaks of Puumala Virus, Germany, 2010
PDF Version [PDF - 289 KB - 4 pages]
J. Ettinger et al.View Abstract
To investigate 2,017 cases of hantavirus disease in Germany, we compared 38 new patient-derived Puumala virus RNA sequences identified in 2010 with bank vole–derived small segment RNA sequences. The epidemic process was driven by outbreaks of 6 Puumala virus clades comprising strains of human and vole origin. Each clade corresponded to a different outbreak region.
MRSA Harboring mecA Variant Gene mecC, France
PDF Version [PDF - 286 KB - 3 pages]
F. Laurent et al.View Abstract
We describe human cases and clustered animal cases of mecALGA251–positive methicillin-resistant Staphylococcus aureus in France. Our report confirms that this new variant has a large distribution in Europe. It may represent a public health threat because phenotypic and genotypic tests seem unable to detect this new resistance mechanism.
Prevalence of Oral Human Papillomavirus Infection among Youth, Sweden
PDF Version [PDF - 181 KB - 4 pages]
J. Du et al.View Abstract
Human papillomavirus (HPV) causes cervical, head, and neck cancers. We studied 483 patients at a youth clinic in Stockholm, Sweden, and found oral HPV prevalence was 9.3% and significantly higher for female youth with than without cervical HPV infection (p = 0.043). Most oral HPV types matched the co-occurring cervical types.
Demographic Shift of Influenza A(H1N1)pdm09 during and after Pandemic, Rural India
PDF Version [PDF - 242 KB - 4 pages]
S. Broor et al.View Abstract
Population-based active surveillance in India showed higher incidence rates for influenza A(H1N1)pdm09 among children during pandemic versus postpandemic periods (345 vs. 199/1,000 person-years), whereas adults had higher rates during postpandemic versus pandemic periods (131 vs. 69/1,000 person-years). Demographic shifts as pandemics evolve should be considered in public health response planning.
Hospitalizations Associated with Disseminated Coccidioidomycosis, Arizona and California, USA
PDF Version [PDF - 253 KB - 4 pages]
A. E. Seitz et al.View Abstract
We analyzed hospitalization databases from Arizona and California for disseminated coccidioidomycosis–associated hospitalizations among immunocompetent persons. Racial/ethnic disease ratios were characterized by a higher incidence of hospitalization among blacks compared with other groups. This finding suggests that HIV infection, AIDS, and primary immune conditions are not a major factor in this disparity.
Reemerging Sudan Ebola Virus Disease in Uganda, 2011
PDF Version [PDF - 392 KB - 4 pages]
T. Shoemaker et al.View Abstract
Two large outbreaks of Ebola hemorrhagic fever occurred in Uganda in 2000 and 2007. In May 2011, we identified a single case of Sudan Ebola virus disease in Luwero District. The establishment of a permanent in-country laboratory and cooperation between international public health entities facilitated rapid outbreak response and control activities.
Francisella tularensis Subspecies holarctica, Tasmania, Australia, 2011
PDF Version [PDF - 256 KB - 3 pages]
J. Jackson et al.View Abstract
We report a case of ulceroglandular tularemia that developed in a woman after she was bitten by a ringtail possum (Pseudocheirus peregrinus) in a forest in Tasmania, Australia. Francisella tularensis subspecies holarctica was identified. This case indicates the emergence of F. tularensis type B in the Southern Hemisphere.
Lack of Evidence for Chloroquine-Resistant Plasmodium falciparum Malaria, Leogane, Haiti
PDF Version [PDF - 163 KB - 3 pages]
A. Neuberger et al.View Abstract
Plasmodium falciparum malaria in Haiti is considered chloroquine susceptible, although resistance transporter alleles associated with chloroquine resistance were recently detected. Among 49 patients with falciparum malaria, we found neither parasites carrying haplotypes associated with chloroquine resistance nor instances of chloroquine treatment failure. Continued vigilance to detect emergence of chloroquine resistance is needed.
Infectious Diseases in Children and Body Mass Index in Young Adults
PDF Version [PDF - 244 KB - 3 pages]
G. Suh et al.View Abstract
In a cohort of 1,863 Filipinos, diarrhea, fever, and unsanitary conditions in infancy were associated with a decreased body mass index in adulthood; upper respiratory tract infection was associated with an increased body mass index. These finding support the hypothesis that infections early in life play a role in body habitus in adulthood.
Inadequate Antibody Response to Rabies Vaccine in Immunocompromised Patient
PDF Version [PDF - 208 KB - 3 pages]
E. Kopel et al.View Abstract
We describe an inadequate antibody response to rabies vaccine in an immunocompromised patient. A literature search revealed 15 additional immunocompromised patients, of whom 7 did not exhibit the minimum acceptable level of antibodies after a complete postexposure prophylaxis regimen. An international rabies registry is needed to provide a basis for determining appropriate vaccination protocols.
Yersinia enterocolitica Outbreak Associated with Ready-to-Eat Salad Mix, Norway, 2011
PDF Version [PDF - 325 KB - 4 pages]
E. MacDonald et al.View Abstract
In 2011, an outbreak of illness caused by Yersinia enterocolitica O:9 in Norway was linked to ready-to-eat salad mix, an unusual vehicle for this pathogen. The outbreak illustrates the need to characterize isolates of this organism, and reinforces the need for international traceback mechanisms for fresh produce.
Acanthamoeba polyphaga mimivirus Virophage Seroconversion in Travelers Returning from Laos
PDF Version [PDF - 189 KB - 3 pages]
P. Parola et al.View Abstract
During January 2010, a husband and wife returned from Laos to France with probable parasitic disease. Increased antibodies against an Acanthamoeba polyphaga mimivirus virophage indicated seroconversion. While in Laos, they had eaten raw fish, a potential source of the virophage. This virophage, associated with giant viruses suspected to cause pneumonia, could be an emerging pathogen.
Rapid Detection of Carbapenemase-producing Enterobacteriaceae
PDF Version [PDF - 571 KB - 5 pages]
P. Nordmann et al.View Abstract
To rapidly identify carbapenemase producers in Enterobacteriaceae, we developed the Carba NP test. The test uses isolated bacterial colonies and is based on in vitro hydrolysis of a carbapenem, imipenem. It was 100% sensitive and specific compared with molecular-based techniques. This rapid (<2 hours), inexpensive technique may be implemented in any laboratory.
Multiple-Insecticide Resistance in Anopheles gambiae Mosquitoes, Southern Côte d’Ivoire
PDF Version [PDF - 245 KB - 4 pages]
C. Edi et al.View SummaryView Abstract
Preventing malaria used to seem as simple as killing the vector, the mosquito; however, a recent study shows that this concept is now anything but simple. The highly effective use of insecticide-treated bed nets and indoor insecticide spraying is being challenged by mosquito resistance to insecticides. In West Africa, populations of this mosquito vector are now resistant to all 4 classes of insecticide approved for this use. And no new classes of insecticide are anticipated until 2020, at the earliest. Development of newer classes of insecticide is crucial because if resistance continues unchecked, the hard-earned progress in malaria control in Africa could be quickly reversed.
Malaria control depends on mosquito susceptibility to insecticides. We tested Anopheles gambiae mosquitoes from Côte d’Ivoire for resistance and screened a subset for target site mutations. Mosquitoes were resistant to insecticides of all approved classes. Such complete resistance, which includes exceptionally strong phenotypes, presents a major threat to malaria control.
Schmallenberg Virus in Domestic Cattle, Belgium, 2012
PDF Version [PDF - 193 KB - 3 pages]
M. Garigliany et al.View Abstract
To determine prevalence of antibodies against Schmallenberg virus in adult cows and proportion of infection transmitted to fetuses, we tested serum samples from 519 cow/calf pairs in Belgium in spring 2012. Of cattle within 250 km of location where the virus emerged, ≈91% tested positive for IgG targeting nucleoprotein. Risk for fetal infection was ≈28%.
Antimicrobial Drug Use and Macrolide-Resistant Streptococcus pyogenes, Belgium
PDF Version [PDF - 312 KB - 4 pages]
L. Van Heirstraeten et al.View Abstract
In Belgium, decreasing macrolide, lincosamide, streptogramins B, and tetracycline use during 1997–2007 correlated significantly with decreasing macrolide-resistant Streptococcus pyogenes during 1999–2009. Maintaining drug use below a critical threshold corresponded with low-level macrolide-resistant S. pyogenes and an increased number of erm(A)-harboring emm77 S. pyogenes with low fitness costs.
Influenza A(H1N1)pdm09 Virus among Healthy Show Pigs, United States
PDF Version [PDF - 152 KB - 3 pages]
G. C. Gray et al.View SummaryView Abstract
Because animals can transmit some diseases to people, it is wise to be cautious around animals that carry these diseases. But how do you know which animals are carrying disease? Sometimes they appear perfectly healthy. A study of 57 apparently healthy show pigs at a 2009 US state fair found that almost 20% were carrying influenza virus and at least 4 were carrying the 2009 pandemic virus. Of concern is the possibility that different types of influenza virus—pandemic, swine, avian—could combine in pigs and emerge as new viruses that then spread to humans. Swine workers, veterinarians, and other persons with pig contact may be at high risk for infection with pig influenza and should receive seasonal influenza vaccines, use personal protective equipment when working with healthy pigs, and limit their contact with sick pigs. Regular monitoring of influenza virus among pigs and testing of sick persons who have been exposed to pigs are needed.
Within 5 months after the earliest detection of human influenza A(H1N1)pdm09 virus, we found molecular and culture evidence of the virus in healthy US show pigs. The mixing of humans and pigs at swine shows possibly could further the geographic and cross-species spread of influenza A viruses.
Aeromonas spp. Bacteremia in Pregnant Women, Thailand–Myanmar Border, 2011
PDF Version [PDF - 151 KB - 2 pages]
P. Turner et al.
bla–positive Klebsiella pneumoniae, Singapore
PDF Version [PDF - 142 KB - 2 pages]
T. H. Koh et al.
Dengue Fever in South Korea, 2006–2010
PDF Version [PDF - 152 KB - 3 pages]
J. Park and D. Lee
Brucellosis in Takins, China
PDF Version [PDF - 164 KB - 3 pages]
J. Luo et al.
Measles and Secondary Hemophagocytic Lymphohistiocytosis
PDF Version [PDF - 243 KB - 2 pages]
C. Iaria et al.
Contaminated Soil and Transmission of Influenza Virus (H5N1)
PDF Version [PDF - 167 KB - 3 pages]
R. A. Gutiérrez and P. Buchy
Rickettsia raoultii–like Bacteria in Dermacentor spp. Ticks, Tibet, China
PDF Version [PDF - 224 KB - 3 pages]
Y. Wang et al.
Leishmania (Viannia) guyanensis Infection, Austria
PDF Version [PDF - 151 KB - 2 pages]
W. Poeppl et al.
Henipavirus-related Sequences in Fruit Bat Bushmeat, Republic of Congo
PDF Version [PDF - 143 KB - 2 pages]
S. Weiss et al.
Severe Measles, Vitamin A Deficiency, and the Roma Community in Europe
PDF Version [PDF - 142 KB - 3 pages]
C. Melenotte et al.
Picobirnaviruses in the Human Respiratory Tract
PDF Version [PDF - 149 KB - 2 pages]
S. L. Smits et al.
New Delhi Metallo-β-Lactamase 4–producing Escherichia coli in Cameroon
PDF Version [PDF - 150 KB - 3 pages]
L. Dortet et al.
Salmonella enterica Serovar Agbeni, British Columbia, Canada, 2011
PDF Version [PDF - 140 KB - 2 pages]
M. Taylor et al.
Entamoeba bangladeshi nov. sp., Bangladesh
PDF Version [PDF - 151 KB - 3 pages]
T. L. Royer et al.
Autochthonous Leishmania siamensis in Horse, Florida, USA
PDF Version [PDF - 149 KB - 3 pages]
S. M. Reuss et al.
Novel Vectors of Malaria Parasites in the Western Highlands of Kenya
PDF Version [PDF - 167 KB - 3 pages]
J. Stevenson et al.View Summary
The main method of malaria control is based on a simple premise: avoid mosquito bites by killing the mosquitoes. This concept relies on spraying insecticides indoors and sleeping under insecticide-treated bed nets because it is assumed that malaria mosquitoes spend most of their time indoors and feed at night. That is, until now. A recent study has identified new species of mosquitoes that prefer to be outdoors and to feed earlier in the evening. These behavior patterns could render current control practices ineffective. New malaria control methods need to be developed according to the specific behavior of all the different vectors.
About the Cover
- Page created: October 19, 2012
- Page last updated: October 19, 2012
- Page last reviewed: October 19, 2012
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Office of the Director (OD)