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Volume 19, Number 11—November 2013
Volume 19, Number 11—November 2013 PDF Version [PDF - 11.11 MB - 199 pages]
Medscape CME Activity
Tropheryma whipplei Endocarditis PDF Version [PDF - 654 KB - 10 pages]F. Fenollar et al.View SummaryView Abstract
This emerging clinical entity occurs mostly in middle-aged and older men with arthralgias.
Tropheryma whipplei endocarditis differs from classic Whipple disease, which primarily affects the gastrointestinal system. We diagnosed 28 cases of T. whipplei endocarditis in Marseille, France, and compared them with cases reported in the literature. Specimens were analyzed mostly by molecular and histologic techniques. Duke criteria were ineffective for diagnosis before heart valve analysis. The disease occurred in men 40–80 years of age, of whom 21 (75%) had arthralgia (75%); 9 (32%) had valvular disease and 11 (39%) had fever. Clinical manifestations were predominantly cardiologic. Treatment with doxycycline and hydroxychloroquine for at least 12 months was successful. The cases we diagnosed differed from those reported from Germany, in which arthralgias were less common and previous valve lesions more common. A strong geographic specificity for this disease is found mainly in eastern-central France, Switzerland, and Germany. T. whipplei endocarditis is an emerging clinical entity observed in middle-aged and older men with arthralgia.
Atypical Scrapie Prions from Sheep and Lack of Disease in Transgenic Mice Overexpressing Human Prion Protein
PDF Version [PDF - 727 KB - 9 pages]
J. Wadsworth et al.View Abstract
Public and animal health controls to limit human exposure to animal prions are focused on bovine spongiform encephalopathy (BSE), but other prion strains in ruminants may also have zoonotic potential. One example is atypical/Nor98 scrapie, which evaded statutory diagnostic methods worldwide until the early 2000s. To investigate whether sheep infected with scrapie prions could be another source of infection, we inoculated transgenic mice that overexpressed human prion protein with brain tissue from sheep with natural field cases of classical and atypical scrapie, sheep with experimental BSE, and cattle with BSE. We found that these mice were susceptible to BSE prions, but disease did not develop after prolonged postinoculation periods when mice were inoculated with classical or atypical scrapie prions. These data are consistent with the conclusion that prion disease is less likely to develop in humans after exposure to naturally occurring prions of sheep than after exposure to epizootic BSE prions of ruminants.
Capture–Recapture Method for Estimating Annual Incidence of Imported Dengue, France, 2007–2010
PDF Version [PDF - 2.13 MB - 9 pages]
G. La Ruche et al.View SummaryView Abstract
A revised method of quantifying data shows increase in imported dengue fever cases.
Imported dengue cases pose the public health risk for local circulation in European areas, especially southeast France, where the Aedes mosquito is established. Using a capture–recapture method with Chao’s estimator, we estimated the annual incidence of dengue fever and the completeness of existing mandatory notification and laboratory network surveillance systems. During 2007–2010, >8,300 cases with laboratory evidence of recent dengue infection were diagnosed. Of these cases, 4,500 occurred in 2010, coinciding with intense epidemics in the French West Indies. Over this 4-year period, 327 cases occurred in southeast France during the vector activity period. Of these, 234 cases occurred in 2010, most of them potentially viremic. Completeness of the mandatory notification and laboratory network systems were ≈10% and 40%, respectively, but higher in southeast areas during May–November (32% and 69%, respectively). Dengue surveillance systems in France provide complementary information that is essential to the implementation of control measures.
Pseudorabies Virus Variant in Bartha-K61–Vaccinated Pigs, China, 2012
PDF Version [PDF - 660 KB - 7 pages]
T. An et al.View SummaryView Abstract
A virulent variant can evade the protection induced by this vaccine.
The widely used pseudorabies virus (PRV) Bartha-K61 vaccine has played a key role in the eradication of PRV. Since late 2011, however, a disease characterized by neurologic symptoms and a high number of deaths among newborn piglets has occurred among Bartha-K61–vaccinated pigs on many farms in China. Clinical samples from pigs on 15 farms in 6 provinces were examined. The PRV gE gene was detectable by PCR in all samples, and sequence analysis of the gE gene showed that all isolates belonged to a relatively independent cluster and contained 2 amino acid insertions. A PRV (named HeN1) was isolated and caused transitional fever in pigs. In protection assays, Bartha-K61 vaccine provided 100% protection against lethal challenge with SC (a classical PRV) but only 50% protection against 4 challenges with strain HeN1. The findings suggest that Bartha-K61 vaccine does not provide effective protection against PRV HeN1 infection.
Migration and Persistence of Human Influenza A Viruses, Vietnam, 2001–2008
PDF Version [PDF - 712 KB - 10 pages]
M. Le et al.View SummaryView Abstract
The virus persists for >1 year and migrates to and from China, Hong Kong, Taiwan, Cambodia, Japan, South Korea, and the United States.
Understanding global influenza migration and persistence is crucial for vaccine strain selection. Using 240 new human influenza A virus whole genomes collected in Vietnam during 2001–2008, we looked for persistence patterns and migratory connections between Vietnam and other countries. We found that viruses in Vietnam migrate to and from China, Hong Kong, Taiwan, Cambodia, Japan, South Korea, and the United States. We attempted to reduce geographic bias by generating phylogenies subsampled at the year and country levels. However, migration events in these phylogenies were still driven by the presence or absence of sequence data, indicating that an epidemiologic study design that controls for prevalence is required for robust migration analysis. With whole-genome data, most migration events are not detectable from the phylogeny of the hemagglutinin segment alone, although general migratory relationships between Vietnam and other countries are visible in the hemagglutinin phylogeny. It is possible that virus lineages in Vietnam persisted for >1 year.
Severe Influenza-associated Respiratory Infection in High HIV Prevalence Setting, South Africa, 2009–2011
PDF Version [PDF - 678 KB - 9 pages]
C. Cohen et al.View SummaryView Abstract
HIV-infected persons should be prioritized to receive influenza vaccination.
Data on influenza epidemiology in HIV-infected persons are limited, particularly for sub-Saharan Africa, where HIV infection is widespread. We tested respiratory and blood samples from patients with acute lower respiratory tract infections hospitalized in South Africa during 2009–2011 for viral and pneumococcal infections. Influenza was identified in 9% (1,056/11,925) of patients enrolled; among influenza case-patients, 358 (44%) of the 819 who were tested were infected with HIV. Influenza-associated acute lower respiratory tract infection incidence was 4–8 times greater for HIV-infected (186–228/100,000) than for HIV-uninfected persons (26–54/100,000). Furthermore, multivariable analysis showed HIV-infected patients were more likely to have pneumococcal co-infection; to be infected with influenza type B compared with type A; to be hospitalized for 2–7 days or >7 days; and to die from their illness. These findings indicate that HIV-infected persons are at greater risk for severe illnesses related to influenza and thus should be prioritized for influenza vaccination.
Common Epidemiology of Rickettsia felis Infection and Malaria, Africa
PDF Version [PDF - 549 KB - 9 pages]
O. Mediannikov et al.View SummaryView Abstract
This multifaceted review posits an increased risk for Rickettsia felis infection in malaria-endemic regions of Africa
This study aimed to compare the epidemiology of Rickettsia felis infection and malaria in France, North Africa, and sub-Saharan Africa and to identify a common vector. Blood specimens from 3,122 febrile patients and from 500 nonfebrile persons were analyzed for R. felis and Plasmodium spp. We observed a significant linear trend (p<0.0001) of increasing risk for R. felis infection. The risks were lowest in France, Tunisia, and Algeria (1%), and highest in rural Senegal (15%). Co-infections with R. felis and Plasmodium spp. and occurrences of R. felis relapses or reinfections were identified. This study demonstrates a correlation between malaria and R. felis infection regarding geographic distribution, seasonality, asymptomatic infections, and a potential vector. R. felis infection should be suspected in these geographical areas where malaria is endemic. Doxycycline chemoprophylaxis against malaria in travelers to sub-Saharan Africa also protects against rickettsioses; thus, empirical treatment strategies for febrile illness for travelers and residents in sub-Saharan Africa may require reevaluation.
Use of National Pneumonia Surveillance to Describe Influenza A(H7N9) Virus Epidemiology, China, 2004–2013
PDF Version [PDF - 567 KB - 7 pages]
N. Xiang et al.View SummaryView Abstract
Closures of live poultry markets were effective in controlling virus spread.
In mainland China, most avian influenza A(H7N9) cases in the spring of 2013 were reported through the pneumonia of unknown etiology (PUE) surveillance system. To understand the role of possible underreporting and surveillance bias in assessing the epidemiology of subtype H7N9 cases and the effect of live-poultry market closures, we examined all PUE cases reported from 2004 through May 3, 2013. Historically, the PUE system was underused, reporting was inconsistent, and PUE reporting was biased toward A(H7N9)-affected provinces, with sparse data from unaffected provinces; however, we found no evidence that the older ages of persons with A(H7N9) resulted from surveillance bias. The absolute number and the proportion of PUE cases confirmed to be A(H7N9) declined after live-poultry market closures (p<0.001), indicating that market closures might have positively affected outbreak control. In China, PUE surveillance needs to be improved.
Medscape CME Activity
Possible Association between Obesity and Clostridium difficile Infection PDF Version [PDF - 447 KB - 6 pages]J. Leung et al.View SummaryView Abstract
Obesity was found at higher frequency among patients with C. difficile infections who had few other traditional risk factors.
Inflammatory bowel disease (IBD) is a risk factor for Clostridium difficile infections (CDIs). Because of similar disruptions to the intestinal microbiome found in IBD and in obesity, we conducted a retrospective study to clarify the role of obesity in CDI. We reviewed records of patients with laboratory-confirmed CDIs in a tertiary care medical center over a 6-month period. Of 132 patients, 43% had community onset, 30% had health care facility onset, and 23% had community onset infections after exposure to a health care facility. Patients with community onset infections had higher body mass indices than the general population and those with community onset after exposure to a health care facility, had higher rates of IBD, and lower prior antibacterial drug exposure than patients who had CDI onset in a health care facility. Obesity may be associated with CDI, independent of antibacterial drug or health care exposures.
Transmissibility of Livestock-associated Methicillin-Resistant Staphylococcus aureus
PDF Version [PDF - 436 KB - 6 pages]
D. J. Hetem et al.View SummaryView Abstract
Transmissibility MRSA associated with livestock is 4.4 times lower than that not associated with livestock.
Previous findings have suggested that the nosocomial transmission capacity of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) is lower than that of other MRSA genotypes. We therefore performed a 6-month (June 1–November 30, 2011) nationwide study to quantify the single-admission reproduction number, RA, for LA-MRSA in 62 hospitals in the Netherlands and to compare this transmission capacity to previous estimates. We used spa typing for genotyping. Quantification of RA was based on a mathematical model incorporating outbreak sizes, detection rates, and length of hospital stay. There were 141 index cases, 40 (28%) of which were LA-MRSA. Contact screening of 2,101 patients and 7,260 health care workers identified 18 outbreaks (2 LA-MRSA) and 47 secondary cases (3 LA-MRSA). RA values indicated that transmissibility of LA-MRSA is 4.4 times lower than that of other MRSA (not associated with livestock).
CTX-M β-Lactamase–producing Klebsiella pneumoniae in Suburban New York City, New York, USA
PDF Version [PDF - 531 KB - 8 pages]
G. Wang et al.View Abstract
CTX-M extended-spectrum β-lactamase (ESBL)–producing Klebsiella pneumoniae isolates are infrequently reported in the United States. In this study, we analyzed nonduplicate ESBL-producing K. pneumoniae and Escherichia coli clinical isolates collected during 2005–2012 at a tertiary care medical center in suburban New York City, USA, for the presence of blaCTX-M, blaSHV, blaTEM, and blaKPC genes. Despite a high prevalence of blaCTX-M genes in ESBL-producing E. coli since 2005, blaCTX-M genes were not detected in K. pneumoniae until 2009. The prevalence of CTX-M–producing K. pneumoniae increased significantly over time from 1.7% during 2005–2009 to 26.4% during 2010–2012 (p<0.0001). CTX-M-15 was the dominant CTX-M genotype. Pulsed-field gel electrophoresis and multilocus sequence typing revealed high genetic heterogeneities in CTX-M–producing K. pneumoniae isolates. This study demonstrates the recent emergence and polyclonal spread of multidrug resistant CTX-M–producing K. pneumoniae isolates among patients in a hospital setting in the United States.
Mobile Phone–based Syndromic Surveillance System, Papua New Guinea
PDF Version [PDF - 763 KB - 8 pages]
A. Rosewell et al.View SummaryView Abstract
In fragile states, mobile phone technology has the capacity to improve the timeliness and efficiency of public health surveillance.
The health care system in Papua New Guinea is fragile, and surveillance systems infrequently meet international standards. To strengthen outbreak identification, health authorities piloted a mobile phone–based syndromic surveillance system and used established frameworks to evaluate whether the system was meeting objectives. Stakeholder experience was investigated by using standardized questionnaires and focus groups. Nine sites reported data that included 7 outbreaks and 92 cases of acute watery diarrhea. The new system was more timely (2.4 vs. 84 days), complete (70% vs. 40%), and sensitive (95% vs. 26%) than existing systems. The system was simple, stable, useful, and acceptable; however, feedback and subnational involvement were weak. A simple syndromic surveillance system implemented in a fragile state enabled more timely, complete, and sensitive data reporting for disease risk assessment. Feedback and provincial involvement require improvement. Use of mobile phone technology might improve the timeliness and efficiency of public health surveillance.
Middle East Respiratory Syndrome Coronavirus in Bats, Saudi Arabia
PDF Version [PDF - 541 KB - 5 pages]
Z. A. Memish et al.View Abstract
The source of human infection with Middle East respiratory syndrome coronavirus remains unknown. Molecular investigation indicated that bats in Saudi Arabia are infected with several alphacoronaviruses and betacoronaviruses. Virus from 1 bat showed 100% nucleotide identity to virus from the human index case-patient. Bats might play a role in human infection.
Hantavirus Pulmonary Syndrome Outbreak, Brazil, December 2009–January 2010
PDF Version [PDF - 380 KB - 4 pages]
A. Terças et al.View Abstract
An outbreak of hantavirus pulmonary syndrome occurred in the Sobradinho Indian settlement of the Kayabí ethnic group in northern Mato Grosso during December 2009–January 2010. We conducted a retrospective study to clarify the outbreak’s epidemiologic and clinical characteristics. Results suggest a relationship between the outbreak and deforestation and farming expansion in indigenous areas.
Increased Incidence of Campylobacter spp. Infection and High Rates among Children, Israel
PDF Version [PDF - 783 KB - 4 pages]
M. Weinberger et al.View Abstract
During 1999–2010, the annual incidence of Campylobacter spp. infection in Israel increased from 31.04 to 90.99 cases/100,000 population, a yearly increase of 10.24%. Children <2 years of age were disproportionally affected; incidence in this age group (356.12 cases/100,000 population) was >26-fold higher than for the 30–<50 age group.
Two Novel Arenaviruses Detected in Pygmy Mice, Ghana
PDF Version [PDF - 491 KB - 4 pages]
K. C. Kronmann et al.View Abstract
Two arenaviruses were detected in pygmy mice (Mus spp.) by screening 764 small mammals in Ghana. The Natal multimammate mouse (Mastomys natalensis), the known Lassa virus reservoir, was the dominant indoor rodent species in 4 of 10 sites, and accounted for 27% of all captured rodents. No rodent captured indoors tested positive for an arenavirus.
West Nile Virus, Texas, USA, 2012
PDF Version [PDF - 371 KB - 3 pages]
K. O. Murray et al.View Abstract
During the 2012 West Nile virus outbreak in Texas, USA, 1,868 cases were reported. Male patients, persons >65 years of age, and minorities were at highest risk for neuroinvasive disease. Fifty-three percent of counties reported a case; 48% of case-patients resided in 4 counties around Dallas/Fort Worth. The economic cost was >$47.6 million.
Mayaro Virus Infection, Amazon Basin Region, Peru, 2010–2013
PDF Version [PDF - 469 KB - 4 pages]
E. S. Halsey et al.View Abstract
During 2010–2013, we recruited 16 persons with confirmed Mayaro virus infection in the Peruvian Amazon to prospectively follow clinical symptoms and serologic response over a 12-month period. Mayaro virus infection caused long-term arthralgia in more than half, similar to reports of other arthritogenic alphaviruses.
Evidence of Vaccine-related Reassortment of Rotavirus, Brazil, 2008–2010
PDF Version [PDF - 343 KB - 4 pages]
T. Rose et al.View Abstract
Analysis of 27 rotavirus strains from vaccinated and unvaccinated children revealed reassortment events in 3 strains: a gene derived from a vaccine; a gene acquired from a circulating strain; and reassortment between circulating strains. Data suggest that the widespread use of this monovalent rotavirus vaccine may introduce vaccine genes into circulating human rotaviruses or vice versa.
Three Outbreak-causing Neisseria meningitidis Serogroup C Clones, Brazil
PDF Version [PDF - 376 KB - 4 pages]
D. E. Barroso et al.View Abstract
During 2003–2012, 8 clusters of meningococcal disease were identified in Rio de Janeiro State, Brazil, all caused by serogroup C Neisseria meningitidis. The isolates were assigned to 3 clonal complexes (cc): cc11, cc32, and cc103. These hyperinvasive disease lineages were associated with endemic disease, outbreaks, and high case-fatality rates.
Severe Plasmodium vivax Malaria in Pakistan
PDF Version [PDF - 575 KB - 4 pages]
A. Zubairi et al.View Abstract
To compare the severity of Plasmodium vivax malaria with that of P. falciparum malaria, we conducted a retrospective cross-sectional study of 356 adults hospitalized with malaria (2009–2011) in Pakistan. P. vivax and P. falciparum accounted for 83% and 13% of cases, respectively; 79.9% of patients with severe malaria were infected with P. vivax.
Infectious Shock and Toxic Shock Syndrome Diagnoses in Hospitals, Colorado, USA
PDF Version [PDF - 582 KB - 4 pages]
M. A. Smit et al.View Abstract
In Colorado, USA, diagnoses coded as toxic shock syndrome (TSS) constituted 27.3% of infectious shock cases during 1993–2006. The incidence of staphylococcal TSS did not change significantly overall or in female patients 10–49 years of age but increased for streptococcal TSS. TSS may be underrecognized among all ages and both sexes.
Human Bocavirus in Patients with Encephalitis, Sri Lanka, 2009–2010
PDF Version [PDF - 407 KB - 4 pages]
D. Mori et al.View Abstract
We identified human bocavirus (HBoV) DNA by PCR in cerebrospinal fluid from adults and children with encephalitis in Sri Lanka. HBoV types 1, 2, and 3 were identified among these cases. Phylogenetic analysis of HBoV1 strain sequences found no subclustering with strains previously identified among encephalitis cases in Bangladesh.
Building Influenza Surveillance Pyramids in Near Real Time, Australia
PDF Version [PDF - 345 KB - 3 pages]
C. B. Dalton et al.View Abstract
A timely measure of circulating influenza virus severity has been elusive. Flutracking, the Australian online influenza-like illness surveillance system, was used to construct a surveillance pyramid in near real time for 2011/2012 participants and demonstrated a striking difference between years. Such pyramids will facilitate rapid estimation of attack rates and disease severity.
Incidence of Influenza A(H1N1)pdm09 Infection, United Kingdom, 2009–2011
PDF Version [PDF - 405 KB - 4 pages]
S. Sridhar et al.View Abstract
We conducted a longitudinal community cohort study of healthy adults in the UK. We found significantly higher incidence of influenza A(H1N1)pdm09 infection in 2010–11 than in 2009–10, a substantial proportion of subclinical infection, and higher risk for infection during 2010–11 among persons with lower preinfection antibody titers.
Nontoxigenic Highly Pathogenic Clone of Corynebacterium diphtheriae, Poland, 2004–2012
PDF Version [PDF - 355 KB - 3 pages]
A. A. ZasadaView Abstract
Twenty-five cases of nontoxigenic Corynebacterium diphtheriae infection were recorded in Poland during 2004–2012, of which 18 were invasive. Alcoholism, homelessness, hepatic cirrhosis, and dental caries were predisposing factors for infection. However, for 17% of cases, no concomitant diseases or predisposing factors were found.
Tula Hantavirus Infection in Immunocompromised Host, Czech Republic
PDF Version [PDF - 493 KB - 4 pages]
H. Zelená et al.View Abstract
We report molecular evidence of Tula hantavirus as an etiologic agent of pulmonary-renal syndrome in an immunocompromised patient. Acute hantavirus infection was confirmed by using serologic and molecular methods. Sequencing revealed Tula virus genome RNA in the patient’s blood. This case shows that Tula virus can cause serious disease in humans.
Human Bocavirus in Children with Acute Gastroenteritis, Chile, 1985–2010
PDF Version [PDF - 479 KB - 4 pages]
J. Levican et al.View Abstract
We detected human bocavirus in 89 (19.3%) of 462 fecal samples collected during 3 periods from 1985 through 2010 from children <5 years of age in Chile who were hospitalized with acute gastroenteritis. Our findings confirm the long-term circulation of human bocavirus in Chile.
Full Genome of Influenza A (H7N9) Virus Derived by Direct Sequencing without Culture
PDF Version [PDF - 394 KB - 4 pages]
X. Ren et al.View Abstract
An epidemic caused by influenza A (H7N9) virus was recently reported in China. Deep sequencing revealed the full genome of the virus obtained directly from a patient’s sputum without virus culture. The full genome showed substantial sequence heterogeneity and large differences compared with that from embryonated chicken eggs.
Mild Illness in Avian Influenza A(H7N9) Virus–Infected Poultry Worker, Huzhou, China, April 2013
PDF Version [PDF - 573 KB - 4 pages]
H. Lv et al.View Abstract
During April 2013 in China, mild respiratory symptoms developed in 1/61 workers who had culled influenza A(H7N9) virus–infected poultry. Laboratory testing confirmed A(H7N9) infection in the worker and showed that the virus persisted longer in sputum than pharyngeal swab samples. Pharyngeal swab samples from the other workers were negative for A(H7N9) virus.
Pulmonary Nontuberculous Mycobacterial Disease, Ontario, Canada, 1998–2010
PDF Version [PDF - 329 KB - 3 pages]
T. K. Marras et al.View Abstract
We measured the prevalence and temporal trends of pulmonary nontuberculous mycobacterial disease among residents of Ontario, Canada, during 1998–2010. Five-year prevalence increased from 29.3 cases/100,000 persons in 1998–2002 to 41.3/100,000 in 2006–2010 (p<0.0001). Improved laboratory methods did not explain this increase, suggesting a surge in disease prevalence.
Severe Fever with Thrombocytopenia Syndrome, South Korea, 2012
PDF Version [PDF - 423 KB - 3 pages]
K. Kim et al.View Abstract
We report a retrospectively identified fatal case of severe fever with thrombocytopenia syndrome (SFTS) in South Korea from 2012. SFTS virus was isolated from the stored blood of the patient. Phylogenetic analysis revealed this isolate was closely related to SFTS virus strains from China and Japan.
Seoul Virus in Rats (Rattus norvegicus), Hyesan, North Korea, 2009–2011
PDF Version [PDF - 382 KB - 2 pages]
L. Yao et al.
Schmallenberg Virus Infection in Dogs, France, 2012
PDF Version [PDF - 404 KB - 2 pages]
C. Sailleau et al.
Geographic Co-distribution of Influenza Virus Subtypes H7N9 and H5N1 in Humans, China
PDF Version [PDF - 411 KB - 3 pages]
L. Wang et al.
New Variant of Rabbit Hemorrhagic Disease Virus, Portugal, 2012–2013
PDF Version [PDF - 331 KB - 3 pages]
J. Abrantes et al.
Mycobacterium yongonense in Pulmonary Disease, Italy
PDF Version [PDF - 401 KB - 3 pages]
E. Tortoli et al.
Subcutaneous Infection with Dirofilaria spp. Nematode in Human, France
PDF Version [PDF - 401 KB - 3 pages]
M. L. Eberhard
Subcutaneous Infection with Dirofilaria spp. Nematode in Human, France
C. Mary et al.
Books and Media
Cytomegaloviruses: From Molecular Pathogenesis to Intervention
PDF Version [PDF - 251 KB - 1 page]
About the Cover
Arbovirus Diseases, Southeastern United States
L. M. Gargano et al.
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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- Page last updated: December 09, 2013
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