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Volume 19, Number 2—February 2013
Volume 19, Number 2—February 2013 PDF Version [PDF - 8.69 MB - 175 pages]
Rift Valley Fever and a New Paradigm of Research and Development for Zoonotic Disease Control
PDF Version [PDF - 554 KB - 5 pages]
O. Dar et al.View SummaryView Abstract
To control this disease, funding and research should be prioritized on the basis of determined needs.
Although Rift Valley fever is a disease that, through its wider societal effects, disproportionately affects vulnerable communities with poor resilience to economic and environmental challenge, Rift Valley fever virus has since its discovery in 1931 been neglected by major global donors and disease control programs. We describe recent outbreaks affecting humans and animals and discuss the serious socioeconomic effects on the communities affected and the slow pace of development of new vaccines. We also discuss the mixed global response, which has largely been fueled by the classification of the virus as a potential bioterrorism agent and its potential to migrate beyond its traditional eastern African boundaries. We argue for a refocus of strategy with increased global collaboration and a greater sense of urgency and investment that focuses on an equity-based approach in which funding and research are prioritized by need, inspired by principles of equity and social justice.
Medscape CME Activity
Eastern Equine Encephalitis in Children, Massachusetts and New Hampshire,USA, 1970–2010 PDF Version [PDF - 2.48 MB - 9 pages]M. A. Silverman et al.View SummaryView Abstract
A short prodrome in children is associated with more severe disease and increased risk for death.
We describe the clinical, laboratory, and radiographic characteristics of 15 cases of eastern equine encephalitis in children during 1970–2010. The most common clinical and laboratory features were fever, headache, seizures, peripheral leukocytosis, and cerebrospinal fluid neutrophilic pleocytosis. Radiographic lesions were found in the basal ganglia, thalami, and cerebral cortex. Clinical outcomes included severe neurologic deficits in 5 (33%) patients, death of 4 (27%), full recovery of 4 (27%), and mild neurologic deficits in 2 (13%). We identify an association between a short prodrome and an increased risk for death or for severe disease.
Lessons and Challenges for Measles Control from Unexpected Large Outbreak, Malawi
PDF Version [PDF - 791 KB - 8 pages]
A. Minetti et al.View SummaryView Abstract
Supplementary immunization activities are crucial to reduce the number of susceptible children.
Despite high reported coverage for routine and supplementary immunization, in 2010 in Malawi, a large measles outbreak occurred that comprised 134,000 cases and 304 deaths. Although the highest attack rates were for young children (2.3%, 7.6%, and 4.5% for children <6, 6–8, and 9–11 months, respectively), persons >15 years of age were highly affected (1.0% and 0.4% for persons 15–19 and >19 years, respectively; 28% of all cases). A survey in 8 districts showed routine coverage of 95.0% for children 12–23 months; 57.9% for children 9–11 months; and 60.7% for children covered during the last supplementary immunization activities in 2008. Vaccine effectiveness was 83.9% for 1 dose and 90.5% for 2 doses. A continuous accumulation of susceptible persons during the past decade probably accounts for this outbreak. Countries en route to measles elimination, such as Malawi, should improve outbreak preparedness. Timeliness and the population chosen are crucial elements for reactive campaigns.
Nipah Virus Infection Outbreak with Nosocomial and Corpse-to-Human Transmission, Bangladesh
PDF Version [PDF - 881 KB - 8 pages]
H. Sazzad et al.View SummaryView Abstract
Particularly vulnerable are health care workers who do not use personal protective equipment and persons who do not wash hands after traditional burial practices.
Active Nipah virus encephalitis surveillance identified an encephalitis cluster and sporadic cases in Faridpur, Bangladesh, in January 2010. We identified 16 case-patients; 14 of these patients died. For 1 case-patient, the only known exposure was hugging a deceased patient with a probable case, while another case-patient’s exposure involved preparing the same corpse for burial by removing oral secretions and anogenital excreta with a cloth and bare hands. Among 7 persons with confirmed sporadic cases, 6 died, including a physician who had physically examined encephalitis patients without gloves or a mask. Nipah virus–infected patients were more likely than community-based controls to report drinking raw date palm sap and to have had physical contact with an encephalitis patient (29% vs. 4%, matched odds ratio undefined). Efforts to prevent transmission should focus on reducing caregivers’ exposure to infected patients’ bodily secretions during care and traditional burial practices.
Medscape CME Activity
Laboratory-based Surveillance for Hepatitis E Virus Infection, United States, 2005–2012 PDF Version [PDF - 635 KB - 6 pages]J. Drobeniuc et al.View SummaryView Abstract
Clinicians should consider this virus in the differential diagnosis of hepatitis, regardless of patient travel history.
To investigate characteristics of hepatitis E cases in the United States, we tested samples from persons seronegative for acute hepatitis A and B whose clinical specimens were referred to the Centers for Disease Control and Prevention during June 2005–March 2012 for hepatitis E virus (HEV) testing. We found that 26 (17%) of 154 persons tested had hepatitis E. Of these, 15 had not recently traveled abroad (nontravelers), and 11 had (travelers). Compared with travelers, nontravelers were older (median 61 vs. 32 years of age) and more likely to be anicteric (53% vs. 8%); the nontraveler group also had fewer persons of South Asian ethnicity (7% vs. 73%) and more solid-organ transplant recipients (47% vs. 0). HEV genotype 3 was characterized from 8 nontravelers and genotypes 1 or 4 from 4 travelers. Clinicians should consider HEV infection in the differential diagnosis of hepatitis, regardless of patient travel history.
Severe Lower Respiratory Tract Infection in Early Infancy and Pneumonia Hospitalizations among Children, Kenya
PDF Version [PDF - 467 KB - 7 pages]
P. Munywoki et al.View SummaryView Abstract
Close postdischarge follow-up could help prevent future severe respiratory disease.
Severe lower respiratory tract infection (LRTI) in infants caused by respiratory syncytial virus (RSV) has been associated with later pneumonia hospitalization among children. To determine risk for pneumonia after RSV hospitalization in infancy, we conducted a retrospective cohort analysis of 2,813 infants admitted to a hospital in Kenya and identified readmissions for pneumonia among this group during early childhood (<60 months of age). Incidence of readmission for pneumonia was higher for children whose first admission as infants was for LRTI and who were <3 months of age than for children who were first admitted as infants for non-LRTI, irrespective of RSV status. Incidence of readmission for pneumonia with wheeze was higher for children whose first admission involved RSV compared with those who had non-RSV LRTI. Excess pneumonia risk persisted for 2 years after the initial hospitalization. Close postdischarge follow-up of infants with LRTI, with or without RSV, could help prevent severe pneumonia later in childhood.
Plague Outbreak in Libya, 2009, Unrelated to Plague in Algeria
PDF Version [PDF - 3.25 MB - 7 pages]
N. Cabanel et al.View SummaryView Abstract
Neighboring but independent (unlinked) plague foci coexist in Algeria and Libya.
Plague Outbreak in Libya, 2009
After 25 years of no cases of plague, this disease recurred near Tobruk, Libya, in 2009. An epidemiologic investigation identified 5 confirmed cases. We determined ribotypes, Not1 restriction profiles, and IS100 and IS1541 hybridization patterns of strains isolated during this outbreak. We also analyzed strains isolated during the 2003 plague epidemic in Algeria to determine whether there were epidemiologic links between the 2 events. Our results demonstrate unambiguously that neighboring but independent plague foci coexist in Algeria and Libya. They also indicate that these outbreaks were most likely caused by reactivation of organisms in local or regional foci believed to be dormant (Libya) or extinct (Algeria) for decades, rather than by recent importation of Yersinia pestis from distant foci. Environmental factors favorable for plague reemergence might exist in this area and lead to reactivation of organisms in other ancient foci.
Phylogenetic and Ecologic Perspectives of a Monkeypox Outbreak, Southern Sudan, 2005
PDF Version [PDF - 1.56 MB - 9 pages]
Y. Nakazawa et al.View Abstract
Identification of human monkeypox cases during 2005 in southern Sudan (now South Sudan) raised several questions about the natural history of monkeypox virus (MPXV) in Africa. The outbreak area, characterized by seasonally dry riverine grasslands, is not identified as environmentally suitable for MPXV transmission. We examined possible origins of this outbreak by performing phylogenetic analysis of genome sequences of MPXV isolates from the outbreak in Sudan and from differing localities. We also compared the environmental suitability of study localities for monkeypox transmission. Phylogenetically, the viruses isolated from Sudan outbreak specimens belong to a clade identified in the Congo Basin. This finding, added to the political instability of the area during the time of the outbreak, supports the hypothesis of importation by infected animals or humans entering Sudan from the Congo Basin, and person-to-person transmission of virus, rather than transmission of indigenous virus from infected animals to humans.
Rift Valley Fever, Sudan, 2007 and 2010
PDF Version [PDF - 1.05 MB - 8 pages]
I. E. Aradaib et al.View SummaryView Abstract
Viral sequences analyzed indicate recent virus movement and support the need for surveillance.
To elucidate whether Rift Valley fever virus (RVFV) diversity in Sudan resulted from multiple introductions or from acquired changes over time from 1 introduction event, we generated complete genome sequences from RVFV strains detected during the 2007 and 2010 outbreaks. Phylogenetic analyses of small, medium, and large RNA segment sequences indicated several genetic RVFV variants were circulating in Sudan, which all grouped into Kenya-1 or Kenya-2 sublineages from the 2006–2008 eastern Africa epizootic. Bayesian analysis of sequence differences estimated that diversity among the 2007 and 2010 Sudan RVFV variants shared a most recent common ancestor circa 1996. The data suggest multiple introductions of RVFV into Sudan as part of sweeping epizootics from eastern Africa. The sequences indicate recent movement of RVFV and support the need for surveillance to recognize when and where RVFV circulates between epidemics, which can make data from prediction tools easier to interpret and preventive measures easier to direct toward high-risk areas.
Lessons from the History of Quarantine, from Plague to Influenza A
PDF Version [PDF - 1.94 MB - 6 pages]
E. TognottiView SummaryView Abstract
The complex and controversial history of this centuries-old public health strategy offers guidance for its future use.
In the new millennium, the centuries-old strategy of quarantine is becoming a powerful component of the public health response to emerging and reemerging infectious diseases. During the 2003 pandemic of severe acute respiratory syndrome, the use of quarantine, border controls, contact tracing, and surveillance proved effective in containing the global threat in just over 3 months. For centuries, these practices have been the cornerstone of organized responses to infectious disease outbreaks. However, the use of quarantine and other measures for controlling epidemic diseases has always been controversial because such strategies raise political, ethical, and socioeconomic issues and require a careful balance between public interest and individual rights. In a globalized world that is becoming ever more vulnerable to communicable diseases, a historical perspective can help clarify the use and implications of a still-valid public health strategy.
Crimean-Congo Hemorrhagic Fever Virus in Ticks from Migratory Birds, Morocco
PDF Version [PDF - 6.65 MB - 4 pages]
A. M. Palomar et al.View Abstract
Crimean-Congo hemorrhagic fever virus was detected in ticks removed from migratory birds in Morocco. This finding demonstrates the circulation of this virus in northwestern Africa and supports the hypothesis that the virus can be introduced into Europe by infected ticks transported from Africa by migratory birds.
Hepatitis E Virus in Pork Liver Sausage, France
PDF Version [PDF - 2.25 MB - 3 pages]
A. Berto et al.View Abstract
We investigated viability of hepatitis E virus (HEV) identified in contaminated pork liver sausages obtained from France. HEV replication was demonstrated in 1 of 4 samples by using a 3-dimensional cell culture system. The risk for human infection with HEV by consumption of these sausages should be considered to be high.
Human Infection with Rickettsia sibirica mongolitimonae, Spain, 2007–2011
PDF Version [PDF - 3.21 MB - 3 pages]
J. M. Ramos et al.View Abstract
Human infection with Rickettsia sibirica mongolitimonae was initially reported in 1996, and reports of a total of 18 cases have been published. We describe 6 additional cases that occurred in the Mediterranean coast region of Spain during 2007–2011. Clinicians should consider this infection in patients who have traveled to this area.
Ebola Virus Antibodies in Fruit Bats, Bangladesh
PDF Version [PDF - 13.19 MB - 4 pages]
K. J. Olival et al.View Abstract
To determine geographic range for Ebola virus, we tested 276 bats in Bangladesh. Five (3.5%) bats were positive for antibodies against Ebola Zaire and Reston viruses; no virus was detected by PCR. These bats might be a reservoir for Ebola or Ebola-like viruses, and extend the range of filoviruses to mainland Asia.
Usutu Virus, Italy, 1996
PDF Version [PDF - 2.54 MB - 4 pages]
H. Weissenböck et al.View Abstract
Retrospective analysis of archived tissue samples from bird deaths in the Tuscany region of Italy in 1996 identified Usutu virus. Partial sequencing confirmed identity with the 2001 Vienna strain and provided evidence for a much earlier introduction of this virus into Europe than previously assumed.
Kyasanur Forest Disease, India, 2011–2012
PDF Version [PDF - 32.27 MB - 4 pages]
G. S. Kasabi et al.View Abstract
To determine the cause of the recent upsurge in Kyasanur Forest disease, we investigated the outbreak that occurred during December 2011–March 2012 in India. Male patients >14 years of age were most commonly affected. Although vaccination is the key strategy for preventing disease, vaccine for boosters was unavailable during 2011, which might be a reason for the increased cases.
Macrolide- and Rifampin-Resistant Rhodococcus equi on a Horse Breeding Farm, Kentucky, USA
PDF Version [PDF - 947 KB - 4 pages]
A. J. Burton et al.View Abstract
Macrolide and rifampin resistance developed on a horse breeding farm after widespread use was instituted for treatment of subclinical pulmonary lesions in foals. Resistance occurred in 6 (24%) of 25 pretreatment and 8 (62%) of 13 (62%) posttreatment isolates from affected foals. Drug-resistant isolates formed 2 distinct genotypic clusters.
Campylobacter Infection in Poultry-Processing Workers, Virginia, USA, 2008–2011
PDF Version [PDF - 558 KB - 3 pages]
M. A. de Perio et al.View Abstract
During a health hazard evaluation, we investigated 29 cases of laboratory-diagnosed Campylobacter infection among workers at a poultry-processing plant. Most infected employees worked at the plant <1 month, worked as live hangers, and lived at a state-operated center. To lessen the infection risk, we recommended improvements to engineering and administrative controls at the plant.
Human Granulocytic Anaplasmosis, Japan
PDF Version [PDF - 4.12 MB - 4 pages]
N. Ohashi et al.View Abstract
We retrospectively confirmed 2 cases of human Anaplasma phagocytophilum infection. Patient blood samples contained unique p44/msp2 for the pathogen, and antibodies bound to A. phagocytophilum antigens propagated in THP-1 rather than HL60 cells. Unless both cell lines are used for serodiagnosis of rickettsiosis-like infections, cases of human granulocytic anaplasmosis could go undetected.
Genetic Variants of Echovirus 13, Northern India, 2010
PDF Version [PDF - 1.18 MB - 4 pages]
H. Maan et al.View Abstract
Nonpolio acute flaccid paralysis is increasing in India. To determine viral causes, we conducted cell culture and molecular analysis identification of nonpolio human enteroviruses associated with acute flaccid paralysis during March–August 2010 in northern India. The predominant nonpolio enterovirus found was echovirus 13, a serotype rarely isolated in India.
Transmission and Maintenance Cycle of Bartonella quintana among Rhesus Macaques, China
PDF Version [PDF - 772 KB - 4 pages]
H. Li et al.View Abstract
We detected Bartonella quintana in 48.6% of captive rhesus macaques from an animal facility in Beijing, China. Prevalence of infection increased over the period of observation. Our findings suggest that macaques may serve as reservoir hosts for B. quintana and that Pedicinus obtusus lice might act as efficient vectors.
Borrelia crocidurae Meningoencephalitis, West Africa
PDF Version [PDF - 1.12 MB - 4 pages]
S. Goutier et al.View Abstract
Borrelia crocidurae–associated relapsing fever is endemic to West Africa and is considered benign. We report 4 patients with B. crocidurae–associated neurologic symptoms; 2 of their cases had been misdiagnosed. Frequency and severity of this disease could be underestimated; molecular methods and serodiagnostic tests for Lyme disease might be helpful in its detection.
Influenza A(H5N1) Virus Surveillance at Live Poultry Markets, Cambodia, 2011
PDF Version [PDF - 19.73 MB - 4 pages]
S. Horm et al.View Abstract
In Cambodia, influenza A(H5N1) virus surveillance at live poultry markets (LPMs) relies on virus isolation from poultry specimens; however, virus is rarely detected by this method. We tested 502 environmental LPM samples: 90 were positive by PCR, 10 by virus isolation. Virus circulation could be better monitored by environmental sampling of LPMs.
Risk Factors for Influenza A(H1N1)pdm09 among Students, Beijing, China
PDF Version [PDF - 610 KB - 4 pages]
Y. Zheng et al.View Abstract
To identify risk factors associated with influenza A(H1N1)pdm09 among students in Beijing, China, we conducted a case–control study. Participants (304 case-patients and 608 controls, age range 6–19 years) were interviewed by using a standardized questionnaire. We found that in addition to vaccination, nonpharmaceutical interventions appeared to be protective.
Risk Perceptions for Avian Influenza Virus Infection among Poultry Workers, China
PDF Version [PDF - 3.42 MB - 4 pages]
Q. Yu et al.View Abstract
To determine risk for avian influenza virus infection, we conducted serologic surveillance for H5 and H9 subtypes among poultry workers in Beijing, China, 2009–2010, and assessed workers’ understanding of avian influenza. We found that poultry workers had considerable risk for infection with H9 subtypes. Increasing their knowledge could prevent future infections.
High Seroprevalence for Typhus Group Rickettsiae, Southwestern Tanzania
PDF Version [PDF - 18.00 MB - 4 pages]
T. Dill et al.View Abstract
Rickettsioses caused by typhus group rickettsiae have been reported in various African regions. We conducted a cross-sectional survey of 1,227 participants from 9 different sites in the Mbeya region, Tanzania; overall seroprevalence of typhus group rickettsiae was 9.3%. Risk factors identified in multivariable analysis included low vegetation density and highway proximity.
Acute Schmallenberg Virus Infections, France, 2012
PDF Version [PDF - 376 KB - 2 pages]
C. Sailleau et al.
Toscana Virus Isolated from Sandflies, Tunisia
PDF Version [PDF - 521 KB - 3 pages]
L. Bichaud et al.
Seroprevalence of Dengue in American Samoa, 2010
PDF Version [PDF - 324 KB - 3 pages]
J. Duncombe et al.
Delayed Diagnosis of Dirofilariasis and Complex Ocular Surgery, Russia
PDF Version [PDF - 984 KB - 3 pages]
B. Ilyasov et al.
Lymphocytic Choriomeningitis Virus Infections among American Indians
PDF Version [PDF - 499 KB - 2 pages]
B. Knust et al.
Streptococcus suis Meningitis in Swine Worker, Minnesota, USA
PDF Version [PDF - 278 KB - 2 pages]
H. N. Fowler et al.
Streptococcus suis and Porcine Reproductive and Respiratory Syndrome, Vietnam
PDF Version [PDF - 462 KB - 3 pages]
N. Hoa et al.
Hepatitis E Virus Seroprevalence among Men Who Have Sex with Men, United Kingdom
PDF Version [PDF - 353 KB - 3 pages]
B. Payne et al.
Imported Hepatitis E Virus, Central African Republic, 2011
PDF Version [PDF - 379 KB - 3 pages]
J. Bouscaillou et al.
Clustered Cases of Rickettsia sibirica mongolitimonae Infection, France
PDF Version [PDF - 347 KB - 2 pages]
S. Edouard et al.
Rickettsiae in Ticks, Japan, 2007–2011
PDF Version [PDF - 378 KB - 3 pages]
Gaowa et al.
Tropheryma whipplei Genotypes 1 and 3, Central Europe
PDF Version [PDF - 659 KB - 2 pages]
N. Wetzstein et al.
Yersinia pestis Plasminogen Activator Gene Homolog in Rat Tissues
PDF Version [PDF - 306 KB - 3 pages]
I. Janse et al.
Coxiella burnetii in Ticks, Argentina
PDF Version [PDF - 3.19 MB - 3 pages]
R. C. Pacheco et al.
Epizootic Hemorrhagic Disease in Brocket Deer, Brazil
PDF Version [PDF - 2.22 MB - 3 pages]
C. Favero et al.
Books and Media
Spillover: Animal Infection and the Next Human Pandemic
PDF Version [PDF - 399 KB - 1 page]
About the Cover
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 created: January 23, 2013
- Page last updated: January 25, 2013
- Page last reviewed: January 23, 2013
- Centers for Disease Control and Prevention,
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