Volume 19, Number 3—March 2013
Volume 19, Number 3—March 2013 PDF Version [PDF - 6.22 MB - 180 pages]
Measles Elimination Efforts and 2008–2011 Outbreak, France
PDF Version [PDF - 1.58 MB - 8 pages]
D. Antona et al.View SummaryView Abstract
Most cases occurred in unvaccinated young adults.
Although few measles cases were reported in France during 2006 and 2007, suggesting the country might have been close to eliminating the disease, a dramatic outbreak of >20,000 cases occurred during 2008–2011. Adolescents and young adults accounted for more than half of cases; median patient age increased from 12 to 16 years during the outbreak. The highest incidence rate was observed in children <1 year of age, reaching 135 cases/100,000 infants during the last epidemic wave. Almost 5,000 patients were hospitalized, including 1,023 for severe pneumonia and 27 for encephalitis/myelitis; 10 patients died. More than 80% of the cases during this period occurred in unvaccinated persons, reflecting heterogeneous vaccination coverage, where pockets of susceptible persons still remain. Although vaccine coverage among children improved, convincing susceptible young adults to get vaccinated remains a critical issue if the target to eliminate the disease by 2015 is to be met.
Nontuberculous Mycobacterial Infection after Fractionated CO Laser Resurfacing
PDF Version [PDF - 1.40 MB - 6 pages]
D. A. Culton et al.View SummaryView Abstract
Two case-patients were likely infected by posttreatment exposure.
Nontuberculous mycobacteria are increasingly associated with cutaneous infections after cosmetic procedures. Fractionated CO2 resurfacing, a widely used technique for photorejuvenation, has been associated with a more favorable side effect profile than alternative procedures. We describe 2 cases of nontuberculous mycobacterial infection after treatment with a fractionated CO2 laser at a private clinic. Densely distributed erythematous papules and pustules developed within the treated area within 2 weeks of the laser procedure. Diagnosis was confirmed by histologic analysis and culture. Both infections responded to a 4-month course of a multidrug regimen. An environmental investigation of the clinic was performed, but no source of infection was found. The case isolates differed from each other and from isolates obtained from the clinic, suggesting that the infection was acquired by postprocedure exposure. Papules and pustules after fractionated CO2 resurfacing should raise the suspicion of nontuberculous mycobacterial infection.
Human Leptospirosis Trends, the Netherlands, 1925–2008
PDF Version [PDF - 589 KB - 8 pages]
M. Goris et al.View SummaryView Abstract
This disease is endemic to this country, and increased infections are acquired during travel abroad.
To increase knowledge of leptospirosis in the Netherlands and identify changing trends of this disease over time, we analyzed historical passive surveillance reports for an 84-year period (1925–2008). We found that 2,553 mainly severe leptospirosis cases were diagnosed (average annual incidence rate 0.25 cases/100,000 population). The overall case-fatality rate for patients with reported leptospirosis was 6.5% but decreased over the period, probably because of improved treatment. Ninety percent of reported leptospirosis cases were in male patients. Most autochthonous leptospirosis infections were associated with recreational exposures, but 15.5% of the cases were attributed to accidents that resulted in injury and to concomitant water contact. Since the end of the 1950s, the proportion of imported infections gradually increased, reaching 53.1% of the total during 2005–2008. Most (80.1%) imported infections were associated with sporting and adventurous vacation activities.
Parallels in Amphibian and Bat Declines from Pathogenic Fungi
PDF Version [PDF - 579 KB - 7 pages]
E. A. Eskew and B. D. ToddView SummaryView Abstract
Pathogenic fungi have driven recent extinctions and declines in at least 2 vertebrate taxa, and effective management of fungal disease will likely be increasingly important to biodiversity conservation.
Pathogenic fungi have substantial effects on global biodiversity, and 2 emerging pathogenic species—the chytridiomycete Batrachochytrium dendrobatidis, which causes chytridiomycosis in amphibians, and the ascomycete Geomyces destructans, which causes white-nose syndrome in hibernating bats—are implicated in the widespread decline of their vertebrate hosts. We synthesized current knowledge for chytridiomycosis and white-nose syndrome regarding disease emergence, environmental reservoirs, life history characteristics of the host, and host–pathogen interactions. We found striking similarities between these aspects of chytridiomycosis and white-nose syndrome, and the research that we review and propose should help guide management of future emerging fungal diseases.
Medscape CME Activity
Increasing Pneumocystis Pneumonia, England, UK, 2000–2010 PDF Version [PDF - 570 KB - 7 pages]R. Maini et al.View Abstract
After an increase in the number of reported cases of Pneumocystis jirovecii pneumonia in England, we investigated data from 2000–2010 to verify the increase. We analyzed national databases for microbiological and clinical diagnoses of P. jirovecii pneumonia and associated deaths. We found that laboratory-confirmed cases in England had increased an average of 7% per year and that death certifications and hospital admissions also increased. Hospital admissions indicated increased P. jirovecii pneumonia diagnoses among patients not infected with HIV, particularly among those who had received a transplant or had a hematologic malignancy. A new risk was identified: preexisting lung disease. Infection rates among HIV-positive adults decreased. The results confirm that diagnoses of potentially preventable P. jirovecii pneumonia among persons outside the known risk group of persons with HIV infection have increased. This finding warrants further characterization of risk groups and a review of P. jirovecii pneumonia prevention strategies.
Medscape CME Activity
Clinical and Therapeutic Features of Pulmonary Nontuberculous Mycobacterial Disease, Rio de Janeiro, Brazil PDF Version [PDF - 530 KB - 7 pages]K. Couto de Mello et al.View SummaryView Abstract
Despite the high prevalence of tuberculosis in Brazil, patients with nontuberculous disease exist who are not being detected and given treatment.
To identify clinical and therapeutic features of pulmonary nontuberculous mycobacterial (PNTM) disease, we conducted a retrospective analysis of patients referred to the Brazilian reference center, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, who received a diagnosis of PNTM during 1993–2011 with at least 1 respiratory culture positive for NTM. Associated conditions included bronchiectasis (21.8%), chronic obstructive pulmonary disease (20.7%), cardiovascular disease (15.5%), AIDS (9.8%), diabetes (9.8%), and hepatitis C (4.6%).Two patients had Hansen disease; 1 had Marfan syndrome. Four mycobacterial species comprised 85.6% of NTM infections: Mycobacterium kansasii, 59 cases (33.9%); M. avium complex, 53 (30.4%); M. abscessus, 23 (13.2%); and M. fortuitum, 14 (8.0%). A total of 42 (24.1%) cases were associated with rapidly growing mycobacteria. In countries with a high prevalence of tuberculosis, PNTM is likely misdiagnosed as tuberculosis, thus showing the need for improved capacity to diagnose mycobacterial disease as well as greater awareness of PNTM disease prevalence.
Medscape CME Activity
Tuberculosis and HIV Co-infection, California, USA, 1993–2008 PDF Version [PDF - 820 KB - 7 pages]J. Z. Metcalfe et al.View SummaryView Abstract
Persons from high tuberculosis settings often acquire HIV infection during the peri-immigration period.
To understand the epidemiology of tuberculosis (TB) and HIV co-infection in California, we cross-matched incident TB cases reported to state surveillance systems during 1993–2008 with cases in the state HIV/AIDS registry. Of 57,527 TB case-patients, 3,904 (7%) had known HIV infection. TB rates for persons with HIV declined from 437 to 126 cases/100,000 persons during 1993–2008; rates were highest for Hispanics (225/100,000) and Blacks (148/100,000). Patients co-infected with TB–HIV during 2001–2008 were significantly more likely than those infected before highly active antiretroviral therapy became available to be foreign born, Hispanic, or Asian/Pacific Islander and to have pyrazinamide-monoresistant TB. Death rates decreased after highly active antiretroviral therapy became available but remained twice that for TB patients without HIV infection and higher for women. In California, HIV-associated TB has concentrated among persons from low and middle income countries who often acquire HIV infection in the peri-immigration period.
Attribution of Foodborne Illnesses, Hospitalizations, and Deaths to Food Commodities by using Outbreak Data, United States, 1998–2008
PDF Version [PDF - 1.36 MB - 9 pages]
J. A. Painter et al.View Abstract
Each year, >9 million foodborne illnesses are estimated to be caused by major pathogens acquired in the United States. Preventing these illnesses is challenging because resources are limited and linking individual illnesses to a particular food is rarely possible except during an outbreak. We developed a method of attributing illnesses to food commodities that uses data from outbreaks associated with both simple and complex foods. Using data from outbreak-associated illnesses for 1998–2008, we estimated annual US foodborne illnesses, hospitalizations, and deaths attributable to each of 17 food commodities. We attributed 46% of illnesses to produce and found that more deaths were attributed to poultry than to any other commodity. To the extent that these estimates reflect the commodities causing all foodborne illness, they indicate that efforts are particularly needed to prevent contamination of produce and poultry. Methods to incorporate data from other sources are needed to improve attribution estimates for some commodities and agents.
Treatment Outcomes for Extensively Drug-Resistant Tuberculosis and HIV Co-infection
PDF Version [PDF - 581 KB - 9 pages]
M. R. O’Donnell et al.View SummaryView Abstract
Sputum culture conversion was poorly predictive of successful treatment.
High mortality rates have been reported for patients co-infected with extensively drug-resistant tuberculosis (XDR-TB) and HIV, but treatment outcomes have not been reported. We report treatment outcomes for adult XDR TB patients in KwaZulu-Natal Province, South Africa. Initial data were obtained retrospectively, and outcomes were obtained prospectively during 24 months of treatment. A total of 114 XDR TB patients were treated (median 6 drugs, range 3–9 drugs); 82 (73%) were HIV positive and 50 (61%) were receiving antiretroviral therapy. After receiving treatment for 24 months, 48 (42%) of 114 patients died, 25 (22%) were cured or successfully completed treatment, 19 (17%) defaulted from the study, and 22 (19%) showed treatment failure. A higher number of deaths occurred among HIV-positive patients not receiving antiretroviral therapy and among patients who did not show sputum culture conversion. Culture conversion was a major predictor of survival but was poorly predictive (51%) of successful treatment outcome.
Foodborne Disease Prevention and Broiler Chickens with Reduced Campylobacter Infection
PDF Version [PDF - 2.48 MB - 6 pages]
S. Bahrndorff et al.View SummaryView Abstract
Fly screens reduce Campylobacter spp. prevalence among broiler chickens during summer.
Studies have suggested that flies play a linking role in the epidemiology of Campylobacter spp. in broiler chickens and that fly screens can reduce the prevalence of Campylobacter spp. We examined the year-round and long-term effects of fly screens in 10 broiler chicken houses (99 flocks) in Denmark. Prevalence of Campylobacter spp.–positive flocks was significantly reduced, from 41.4% during 2003–2005 (before fly screens) to 10.3% in 2006–2009 (with fly screens). In fly screen houses, Campylobacter spp. prevalence did not peak during the summer. Nationally, prevalence of Campylobacter spp.–positive flocks in Denmark could have been reduced by an estimated 77% during summer had fly screens been part of biosecurity practices. These results imply that fly screens might help reduce prevalence of campylobacteriosis among humans, which is closely linked to Campylobacter spp. prevalence among broiler chicken flocks.
Lack of Norovirus Replication and Histo-Blood Group Antigen Expression in 3-Dimensional Intestinal Epithelial Cells
PDF Version [PDF - 4.08 MB - 8 pages]
M. M. Herbst-Kralovetz et al.View SummaryView Abstract
The 3-dimensional intestinal model is not sufficient as a virus replication system for developing vaccines or drugs to control human norovirus infections.
Noroviruses (NoVs) are a leading cause of gastroenteritis worldwide. An in vitro model for NoV replication remains elusive, making study of the virus difficult. A previous study, which used a 3-dimensional (3-D) intestinal model derived from INT-407 cells reported NoV replication and extensive cytopathic effects (CPE). Using the same 3-D model, but with highly purified Norwalk virus (NV), we attempted to replicate this study. Our results showed no evidence of NV replication by real-time PCR of viral RNA or by immunocytochemical detection of viral structural and nonstructural proteins. Immunocytochemical analysis of the 3-D cultures also showed no detectable presence of histo-blood group antigens that participate in NV binding and host tropism. To determine the potential cause of CPE observed in the previous study, we exposed 3-D cultures to lipopolysaccharide concentrations consistent with contaminated stool samples and observed morphologic features similar to CPE. We conclude that the 3-D INT-407 model does not support NV replication.
Effects of Vaccine Program against Pandemic Influenza A(H1N1) Virus, United States, 2009–2010
PDF Version [PDF - 653 KB - 10 pages]
R. H. Borse et al.View SummaryView Abstract
Vaccination likely prevented 700,000–1,500,000 clinical cases, 4,000–10,000 hospitalizations, and 200–500 deaths.
In April 2009, the United States began a response to the emergence of a pandemic influenza virus strain: A(H1N1)pdm09. Vaccination began in October 2009. By using US surveillance data (April 12, 2009–April 10, 2010) and vaccine coverage estimates (October 3, 2009–April 18, 2010), we estimated that the A(H1N1)pdm09 virus vaccination program prevented 700,000–1,500,000 clinical cases, 4,000–10,000 hospitalizations, and 200–500 deaths. We found that the national health effects were greatly influenced by the timing of vaccine administration and the effectiveness of the vaccine. We estimated that recommendations for priority vaccination of targeted priority groups were not inferior to other vaccination prioritization strategies. These results emphasize the need for relevant surveillance data to facilitate a rapid evaluation of vaccine recommendations and effects.
Emergence and Spread of Extensively and Totally Drug-Resistant Tuberculosis, South Africa
PDF Version [PDF - 1.48 MB - 7 pages]
M. Klopper et al.View SummaryView Abstract
Comparative genomics of multidrug-resistant TB isolates from the Eastern Cape, South Africa, suggests the emergence of totally drug- resistant TB.
Factors driving the increase in drug-resistant tuberculosis (TB) in the Eastern Cape Province, South Africa, are not understood. A convenience sample of 309 drug-susceptible and 342 multidrug-resistant (MDR) TB isolates, collected July 2008–July 2009, were characterized by spoligotyping, DNA fingerprinting, insertion site mapping, and targeted DNA sequencing. Analysis of molecular-based data showed diverse genetic backgrounds among drug-sensitive and MDR TB sensu stricto isolates in contrast to restricted genetic backgrounds among pre–extensively drug-resistant (pre-XDR) TB and XDR TB isolates. Second-line drug resistance was significantly associated with the atypical Beijing genotype. DNA fingerprinting and sequencing demonstrated that the pre-XDR and XDR atypical Beijing isolates evolved from a common progenitor; 85% and 92%, respectively, were clustered, indicating transmission. Ninety-three percent of atypical XDR Beijing isolates had mutations that confer resistance to 10 anti-TB drugs, and some isolates also were resistant to para-aminosalicylic acid. These findings suggest the emergence of totally drug-resistant TB.
Human Betacoronavirus 2c EMC/2012–related Viruses in Bats, Ghana and Europe
PDF Version [PDF - 3.41 MB - 5 pages]
A. Annan et al.View Abstract
We screened fecal specimens of 4,758 bats from Ghana and 272 bats from 4 European countries for betacoronaviruses. Viruses related to the novel human betacoronavirus EMC/2012 were detected in 46 (24.9%) of 185 Nycteris bats and 40 (14.7%) of 272 Pipistrellus bats. Their genetic relatedness indicated EMC/2012 originated from bats.
Mycobacterial Lineages Causing Pulmonary and Extrapulmonary Tuberculosis, Ethiopia
PDF Version [PDF - 467 KB - 4 pages]
R. Firdessa et al.View Abstract
Molecular typing of 964 specimens from patients in Ethiopia with lymph node or pulmonary tuberculosis showed a similar distribution of Mycobacterium tuberculosis strains between the 2 disease manifestations and a minimal role for M. bovis. We report a novel phylogenetic lineage of M. tuberculosis strongly associated with the Horn of Africa.
Vibrio cholerae Non-O1, Non-O139 Serogroups and Cholera-like Diarrhea, Kolkata, India
PDF Version [PDF - 2.23 MB - 4 pages]
D. Dutta et al.View Abstract
We identified 281 Vibrio cholerae non-O1, non-O139 strains from patients with diarrhea in Kolkata, India. Cholera-like diarrhea was the major symptom (66.0%); some patients (20.3%) had severe dehydration. These strains lacked the ctxA gene but many had hlyA, rtxA, and rtxC genes. Pulsed-field gel electrophoresis showed no genetic link among strains.
Hepatitis E Virus Mixed Infection in Immunocompetent Patient
PDF Version [PDF - 400 KB - 3 pages]
D. B. Smith et al.View Abstract
We detected 2 hepatitis E virus (HEV) strains in an acutely infected immunocompetent patient. Two populations of genotype 3 virus were observed in the hypervariable regions and open reading frames 2 and 3, indicating multiple infection with hepatitis E virus. Persons with mixed infections may provide the opportunity for virus recombination.
Virulence of Pertactin-Negative Bordetella pertussis Isolates from Infants, France
PDF Version [PDF - 3.59 MB - 4 pages]
H. Bodilis and N. GuisoView Abstract
Bordetella pertussis isolates that do not express pertactin (PRN) are increasing in regions where acellular pertussis vaccines have been used for >7 years. We analyzed data from France and compared clinical symptoms among infants <6 months old infected by PRN-positive or PRN-negative isolates. No major clinical differences were found between the 2 groups.
Unexpected Increase of Alveolar Echincoccosis, Austria, 2011
PDF Version [PDF - 389 KB - 3 pages]
R. Schneider et al.View Abstract
Austria is part of the classical area of central Europe to which alveolar echinococcosis (AE) is endemic. Annual incidences in Austria were 2.4 and 2.8 cases/100,000 population during 1991–2000 and 2001–2010, respectively. Hence, the registration of 13 new AE patients in 2011 was unexpected. Increasing fox populations and past AE underreporting might have caused this increase.
Multidrug-Resistant Tuberculosis, Somalia, 2010–2011
PDF Version [PDF - 683 KB - 3 pages]
I. Sindani et al.View Abstract
In a nationwide survey in 2011, multidrug-resistant tuberculosis (MDR TB) was found in 5.2% and 40.8% of patients with new and previously treated TB, respectively. These levels of drug resistance are among the highest ever documented in Africa and the Middle East. This finding presents a serious challenge for TB control in Somalia.
Swine Influenza in Sri Lanka
PDF Version [PDF - 758 KB - 4 pages]
H. Perera et al.View Abstract
To study influenza viruses in pigs in Sri Lanka, we examined samples from pigs at slaughterhouses. Influenza (H3N2) and A(H1N1)pdm09 viruses were prevalent during 2004–2005 and 2009–2012, respectively. Genetic and epidemiologic analyses of human and swine influenza viruses indicated 2 events of A(H1N1)pdm09 virus spillover from humans to pigs.
Tuberculosis Outbreak in a Primary School, Milan, Italy
PDF Version [PDF - 403 KB - 3 pages]
M. Faccini et al.View Abstract
Investigation of an outbreak of tuberculosis (TB) in a primary school in Milan, Italy, found 15 schoolchildren had active TB disease and 173 had latent TB infection. TB was also identified in 2 homeless men near the school. Diagnostic delay, particularly in the index case-patient, contributed to the transmission of infection.
Lymphogranuloma Venereum in Men Screened for Pharyngeal and Rectal Infection, Germany
PDF Version [PDF - 751 KB - 5 pages]
K. Haar et al.View Abstract
To determine prevalence of lymphogranuloma venereum among men who have sex with men in Germany, we conducted a multicenter study during 2009–2010 and found high rates of rectal and pharyngeal infection in men positive for the causative agent, Chlamydia trachomatis. Many infections were asymptomatic. An adjusted C. trachomatis screening policy is justified in Germany.
Prioritizing Tuberculosis Clusters by Genotype for Public Health Action, Washington, USA
PDF Version [PDF - 420 KB - 4 pages]
S. Lindquist et al.View Abstract
Groups of tuberculosis cases with indistinguishable Mycobacterium tuberculosis genotypes (clusters) might represent recent transmission. We compared geospatial concentration of genotype clusters with independent priority rankings determined by local public health officials; findings were highly correlated. Routine use of geospatial statistics could help health departments identify recent disease transmission.
Anisakiasis and Gastroallergic Reactions Associated with Anisakis pegreffii Infection, Italy
PDF Version [PDF - 1.39 MB - 4 pages]
S. Mattiucci et al.View Abstract
Human cases of gastric anisakiasis caused by the zoonotic parasite Anisakis pegreffii are increasing in Italy. The disease is caused by ingestion of larval nematodes in lightly cooked or raw seafood. Because symptoms are vague and serodiagnosis is difficult, the disease is often misdiagnosed and cases are understimated.
Bordetella hinzii in Rodents, Southeast Asia
PDF Version [PDF - 345 KB - 2 pages]
T. Jiyipong et al.
Melioidosis and Hairy Cell Leukemia in 2 Travelers Returning from Thailand
PDF Version [PDF - 606 KB - 3 pages]
B. Rossi et al.
Plague Epidemics and Lice, Democratic Republic of the Congo
PDF Version [PDF - 253 KB - 2 pages]
R. Piarroux et al.
Armillifer armillatus Pentastomiasis in African Immigrant, Germany
PDF Version [PDF - 1.71 MB - 2 pages]
D. Tappe et al.
Mycobacterium kyorinense Infection
PDF Version [PDF - 313 KB - 3 pages]
H. Ohnishi et al.
Recurring Influenza B Virus Infections in Seals
PDF Version [PDF - 429 KB - 2 pages]
R. Bodewes et al.
Reemerging Schmallenberg Virus Infections, Germany, 2012
PDF Version [PDF - 801 KB - 2 pages]
F. J. Conraths et al.
Peritoneal Tuberculosis in a Pregnant Woman from Haiti, United States
PDF Version [PDF - 339 KB - 3 pages]
K. L. Ard et al.
Microsporidial Keratoconjunctivitis Outbreak among Athletes from Hong Kong Who Visited Singapore, 2012
PDF Version [PDF - 270 KB - 2 pages]
T. Lam et al.
Mycobacterium fortuitum Endocarditis Associated with Cardiac Surgery, Serbia
PDF Version [PDF - 316 KB - 3 pages]
D. Vuković et al.
Cryptococcus gattii, Florida, USA, 2011
PDF Version [PDF - 379 KB - 3 pages]
R. Kunadharaju et al.
Characterization of Mycobacterium orygis
PDF Version [PDF - 260 KB - 2 pages]
J. van Ingen et al.
Mycobacterium tuberculosis Beijing Type Mutation Frequency
PDF Version [PDF - 585 KB - 2 pages]
About the Cover
Issues in the Development of a Research and Education Framework for One Health
L. M. Gargano et al.
- Page created: March 21, 2013
- Page last updated: March 21, 2013
- Page last reviewed: March 21, 2013
- Centers for Disease Control and Prevention,
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