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Volume 19, Number 12—December 2013

Volume 19, Number 12—December 2013   PDF Version [PDF - 12.87 MB - 175 pages]


  • Review of Institute of Medicine and National Research Council Recommendations for One Health Initiative PDF Version [PDF - 314 KB - 5 pages]
    C. Rubin et al.
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    Review of Institutes of Medicine publication articles on One Health themes concludes that future studies and workshops should consider progress made and address remaining gaps.

       View Abstract

    Human health is inextricably linked to the health of animals and the viability of ecosystems; this is a concept commonly known as One Health. Over the last 2 decades, the Institute of Medicine (IOM) and the National Research Council (NRC) have published consensus reports and workshop summaries addressing a variety of threats to animal, human, and ecosystem health. We reviewed a selection of these publications and identified recommendations from NRC and IOM/NRC consensus reports and from opinions expressed in workshop summaries that are relevant to implementation of the One Health paradigm shift. We grouped these recommendations and opinions into thematic categories to determine if sufficient attention has been given to various aspects of One Health. We conclude that although One Health themes have been included throughout numerous IOM and NRC publications, identified gaps remain that may warrant targeted studies related to the One Health approach.


  • Medscape CME Activity
    Potential Role of Deer Tick Virus in Powassan Encephalitis Cases in Lyme Disease–endemic Areas of New York, USA PDF Version [PDF - 588 KB - 8 pages]
    M. Y. El Khoury et al.
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    The epidemiologic pattern and limited laboratory testing indicate that this virus lineage might account for most of these illnesses.

       View Abstract

    Powassan virus, a member of the tick-borne encephalitis group of flaviviruses, encompasses 2 lineages with separate enzootic cycles. The prototype lineage of Powassan virus (POWV) is principally maintained between Ixodes cookei ticks and the groundhog (Marmota momax) or striped skunk (Mephitis mephitis), whereas the deer tick virus (DTV) lineage is believed to be maintained between Ixodes scapularis ticks and the white-footed mouse (Peromyscus leucopus). We report 14 cases of Powassan encephalitis from New York during 2004–2012. Ten (72%) of the patients were residents of the Lower Hudson Valley, a Lyme disease–endemic area in which I. scapularis ticks account for most human tick bites. This finding suggests that many of these cases were caused by DTV rather than POWV. In 2 patients, DTV infection was confirmed by genetic sequencing. As molecular testing becomes increasingly available, more cases of Powassan encephalitis may be determined to be attributable to the DTV lineage.

  • Twenty-Year Summary of Surveillance for Human Hantavirus Infections, United States PDF Version [PDF - 405 KB - 4 pages]
    B. Knust and P. E. Rollin
       View Abstract

    In the past 20 years of surveillance for hantavirus in humans in the United States, 624 cases of hantavirus pulmonary syndrome (HPS) have been reported, 96% of which occurred in states west of the Mississippi River. Most hantavirus infections are caused by Sin Nombre virus, but cases of HPS caused by Bayou, Black Creek Canal, Monongahela, and New York viruses have been reported, and cases of domestically acquired hemorrhagic fever and renal syndrome caused by Seoul virus have also occurred. Rarely, hantavirus infections result in mild illness that does not progress to HPS. Continued testing and surveillance of clinical cases in humans will improve our understanding of the etiologic agents involved and the spectrum of diseases.

  • Medscape CME Activity
    Epidemiologic Investigations into Outbreaks of Rift Valley Fever in Humans, South Africa, 2008–2011 PDF Version [PDF - 528 KB - 8 pages]
    B. N. Archer et al.
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    Rift Valley fever continues to pose a notable public health threat to humans.

       View Abstract

    Rift Valley fever (RVF) is an emerging zoonosis posing a public health threat to humans in Africa. During sporadic RVF outbreaks in 2008–2009 and widespread epidemics in 2010–2011, 302 laboratory-confirmed human infections, including 25 deaths (case-fatality rate, 8%) were identified. Incidence peaked in late summer to early autumn each year, which coincided with incidence rate patterns in livestock. Most case-patients were adults (median age 43 years), men (262; 87%), who worked in farming, animal health or meat-related industries (83%). Most case-patients reported direct contact with animal tissues, blood, or other body fluids before onset of illness (89%); mosquitoes likely played a limited role in transmission of disease to humans. Close partnership with animal health and agriculture sectors allowed early recognition of human cases and appropriate preventive health messaging.


  • Spontaneous Generation of Infectious Prion Disease in Transgenic Mice PDF Version [PDF - 674 KB - 10 pages]
    J. M. Torres et al.
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    A single amino acid change induces a new infectious prion.

       View Abstract

    We generated transgenic mice expressing bovine cellular prion protein (PrPC) with a leucine substitution at codon 113 (113L). This protein is homologous to human protein with mutation 102L, and its genetic link with Gerstmann–Sträussler–Scheinker syndrome has been established. This mutation in bovine PrPC causes a fully penetrant, lethal, spongiform encephalopathy. This genetic disease was transmitted by intracerebral inoculation of brain homogenate from ill mice expressing mutant bovine PrP to mice expressing wild-type bovine PrP, which indicated de novo generation of infectious prions. Our findings demonstrate that a single amino acid change in the PrPC sequence can induce spontaneous generation of an infectious prion disease that differs from all others identified in hosts expressing the same PrPC sequence. These observations support the view that a variety of infectious prion strains might spontaneously emerge in hosts displaying random genetic PrPC mutations.

  • Antiviral Susceptibility of Highly Pathogenic Avian Influenza A(H5N1) Viruses Isolated from Poultry, Vietnam, 2009–2011 PDF Version [PDF - 635 KB - 9 pages]
    H. T. Nguyen et al.
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    Monitoring of antiviral drug susceptibility in HPAI H5N1 viruses in poultry is crucial to pandemic preparedness.

       View Abstract

    We assessed drug susceptibilities of 125 avian influenza A(H5N1) viruses isolated from poultry in Vietnam during 2009–2011. Of 25 clade 1.1 viruses, all possessed a marker of resistance to M2 blockers amantadine and rimantadine; 24 were inhibited by neuraminidase inhibitors. One clade 1.1 virus contained the R430W neuraminidase gene and reduced inhibition by oseltamivir, zanamivir, and laninamivir 12-, 73-, and 29-fold, respectively. Three of 30 clade 2.3.4 viruses contained a I223T mutation and showed 7-fold reduced inhibition by oseltamivir. One of 70 clade viruses had the H275Y marker of oseltamivir resistance and exhibited highly reduced inhibition by oseltamivir and peramivir; antiviral agents DAS181 and favipiravir inhibited H275Y mutant virus replication in MDCK-SIAT1 cells. Replicative fitness of the H275Y mutant virus was comparable to that of wildtype virus. These findings highlight the role of drug susceptibility monitoring of H5N1 subtype viruses circulating among birds to inform antiviral stockpiling decisions for pandemic preparedness.

  • Zoonotic Chlamydiaceae Species Associated with Trachoma, Nepal PDF Version [PDF - 626 KB]
    D. Dean et al.
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    Zoonotic transmission of non-Chlamydia trachomatis species probably plays a role in ocular trachomatous disease.

       View Abstract

    Trachoma is the leading cause of preventable blindness. Commercial assays do not discriminate among all Chlamydiaceae species that might be involved in trachoma. We investigated whether a commercial Micro-ArrayTube could discriminate Chlamydiaceae species in DNA extracted directly from conjunctival samples from 101 trachoma patients in Nepal. To evaluate organism viability, we extracted RNA, reverse transcribed it, and subjected it to quantitative real-time PCR. We found that 71 (70.3%) villagers were infected. ArrayTube sensitivity was 91.7% and specificity was 100% compared with that of real-time PCR. Concordance between genotypes detected by microarray and ompA genotyping was 100%. Species distribution included 54 (76%) single infections with Chlamydia trachomatis, C. psittaci, C. suis, or C. pecorum, and 17 (24%) mixed infections that includied C. pneumoniae. Ocular infections were caused by 5 Chlamydiaceae species. Additional studies of trachoma pathogenesis involving Chlamydiaceae species other than C. trachomatis and their zoonotic origins are needed.

  • Guillain-Barré Syndrome Surveillance during National Influenza Vaccination Campaign, New York, USA, 2009 PDF Version [PDF - 428 KB - 7 pages]
    G. P. Giambrone et al.
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    A Clinical Network provided timely data but was less complete than traditional hospital discharge data.

       View Abstract

    The New York State Department of Health (NYSDOH) collected information about hospitalized patients with Guillain-Barré syndrome (GBS) during October 2009–May 2010, statewide (excluding New York City), to examine a possible relationship with influenza A(H1N1)pdm09 vaccination. NYSDOH established a Clinical Network of neurologists and 150 hospital neurology units. Hospital discharge data from the Statewide Planning and Research Cooperative System (SPARCS) were used to evaluate completeness of reporting from the Clinical Network. A total of 140 confirmed or probable GBS cases were identified: 81 (58%) from both systems, 10 (7%) from Clinical Network only, and 49 (35%) from SPARCS-only. Capture–recapture methods estimated that 6 cases might have been missed by both systems. Clinical Network median reporting time was 12 days versus 131 days for SPARCS. In public health emergencies in New York State, a Clinical Network may provide timely data, but in our study such data were less complete than traditional hospital discharge data.



Books and Media

About the Cover


Conference Summaries

  • Toward Proof of Concept of a One Health Approach to Disease Prediction and Control
    P. M. Rabinowitz et al.
       View Abstract

    A One Health approach considers the role of changing environments with regard to infectious and chronic disease risks affecting humans and nonhuman animals. Recent disease emergence events have lent support to a One Health approach. In 2010, the Stone Mountain Working Group on One Health Proof of Concept assembled and evaluated the evidence regarding proof of concept of the One Health approach to disease prediction and control. Aspects examined included the feasibility of integrating human, animal, and environmental health and whether such integration could improve disease prediction and control efforts. They found evidence to support each of these concepts but also identified the need for greater incorporation of environmental and ecosystem factors into disease assessments and interventions. The findings of the Working Group argue for larger controlled studies to evaluate the comparative effectiveness of the One Health approach.