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Volume 19, Number 9—September 2013
Volume 19, Number 9—September 2013 PDF Version [PDF - 11.46 MB - 207 pages]
Acute Encephalitis Syndrome Surveillance, Kushinagar District, Uttar Pradesh, India, 2011–2012
PDF Version [PDF - 1.28 MB - 2 pages]
M. Kakkar et al.View SummaryView Abstract
Low-quality data prevent informed policy making and implementation of prevention and control measures.
In India, quality surveillance for acute encephalitis syndrome (AES), including laboratory testing, is necessary for understanding the epidemiology and etiology of AES, planning interventions, and developing policy. We reviewed AES surveillance data for January 2011–June 2012 from Kushinagar District, Uttar Pradesh, India. Data were cleaned, incidence was determined, and demographic characteristics of cases and data quality were analyzed. A total of 812 AES case records were identified, of which 23% had illogical entries. AES incidence was highest among boys <6 years of age, and cases peaked during monsoon season. Records for laboratory results (available for Japanese encephalitis but not AES) and vaccination history were largely incomplete, so inferences about the epidemiology and etiology of AES could not be made. The low-quality AES/Japanese encephalitis surveillance data in this area provide little evidence to support development of prevention and control measures, estimate the effect of interventions, and avoid the waste of public health resources.
Detection of Diphtheritic Polyneuropathy by Acute Flaccid Paralysis Surveillance, India
PDF Version [PDF - 484 KB - 6 pages]
F. J. Mateen et al.View SummaryView Abstract
Throat examinations are useful for diagnosis of this disease.
Diphtheritic polyneuropathy is a vaccine-preventable illness caused by exotoxin-producing strains of Corynebacterium diphtheriae. We present a retrospective convenience case series of 15 children (6 girls) <15 years of age (mean age 5.2 years, case-fatality rate 53%, and 1 additional case-patient who was ventilator dependent at the time of last follow-up; median follow-up period 60 days) with signs and symptoms suggestive of diphtheritic polyneuropathy. All cases were identified through national acute flaccid paralysis surveillance, which was designed to detect poliomyelitis in India during 2002–2008. We also report data on detection of diphtheritic polyneuropathy compared with other causes of acute flaccid paralysis identified by this surveillance system.
PDF Version [PDF - 561 KB - 11 pages]
S. F. Dowell et al.View SummaryView Abstract
Identifying the cause of this unexplained epidemic epilepsy is a major challenge.
An epidemic illness characterized by head nodding associated with onchocerciasis has been described in eastern Africa since the early 1960s; we summarize published reports and recent studies. Onset of nodding occurs in previously healthy 5–15-year-old children and is often triggered by eating or cold temperatures and accompanied by cognitive impairment. Its incidence has increased in Uganda and South Sudan over the past 10 years. Four case–control studies identified modest and inconsistent associations. There were nonspecific lesions seen by magnetic resonance imaging, no cerebrospinal fluid inflammation, and markedly abnormal electroencephalography results. Nodding episodes are atonic seizures. Testing has failed to demonstrate associations with trypanosomiasis, cysticercosis, loiasis, lymphatic filariasis, cerebral malaria, measles, prion disease, or novel pathogens; or deficiencies of folate, cobalamin, pyridoxine, retinol, or zinc; or toxicity from mercury, copper, or homocysteine. There is a consistent enigmatic association with onchocerciasis detected by skin snip or serologic analysis. Nodding syndrome is an unexplained epidemic epilepsy.
Divergent Astrovirus Associated with Neurologic Disease in Cattle
PDF Version [PDF - 587 KB - 8 pages]
L. Li et al.View SummaryView Abstract
Cattle showing neurologic signs should be tested for BoAstV-NeuroS1.
Using viral metagenomics of brain tissue from a young adult crossbreed steer with acute onset of neurologic disease, we sequenced the complete genome of a novel astrovirus (BoAstV-NeuroS1) that was phylogenetically related to an ovine astrovirus. In a retrospective analysis of 32 cases of bovine encephalitides of unknown etiology, 3 other infected animals were detected by using PCR and in situ hybridization for viral RNA. Viral RNA was restricted to the nervous system and detected in the cytoplasm of affected neurons within the spinal cord, brainstem, and cerebellum. Microscopically, the lesions were of widespread neuronal necrosis, microgliosis, and perivascular cuffing preferentially distributed in gray matter and most severe in the cerebellum and brainstem, with increasing intensity caudally down the spinal cord. These results suggest that infection with BoAstV-NeuroS1 is a potential cause of neurologic disease in cattle.
Antigenic and Molecular Characterization of Avian Influenza A(H9N2) Viruses, Bangladesh
PDF Version [PDF - 721 KB - 10 pages]
K. Shanmuganatham et al.View SummaryView Abstract
Reassortant trends in these viruses indicate the potential for transmission to mammalian hosts.
Human infection with avian influenza A(H9N2) virus was identified in Bangladesh in 2011. Surveillance for influenza viruses in apparently healthy poultry in live-bird markets in Bangladesh during 2008–2011 showed that subtype H9N2 viruses are isolated year-round, whereas highly pathogenic subtype H5N1 viruses are co-isolated with subtype H9N2 primarily during the winter months. Phylogenetic analysis of the subtype H9N2 viruses showed that they are reassortants possessing 3 gene segments related to subtype H7N3; the remaining gene segments were from the subtype H9N2 G1 clade. We detected no reassortment with subtype H5N1 viruses. Serologic analyses of subtype H9N2 viruses from chickens revealed antigenic conservation, whereas analyses of viruses from quail showed antigenic drift. Molecular analysis showed that multiple mammalian-specific mutations have become fixed in the subtype H9N2 viruses, including changes in the hemagglutinin, matrix, and polymerase proteins. Our results indicate that these viruses could mutate to be transmissible from birds to mammals, including humans.
Protection by Face Masks against Influenza A(H1N1)pdm09 Virus on Trans-Pacific Passenger Aircraft, 2009
PDF Version [PDF - 765 KB - 8 pages]
L. Zhang et al.View SummaryView Abstract
Comprehensive studies are needed to assess this protective effect.
In response to several influenza A(H1N1)pdm09 infections that developed in passengers after they traveled on the same 2 flights from New York, New York, USA, to Hong Kong, China, to Fuzhou, China, we assessed transmission of influenza A(H1N1)pdm09 virus on these flights. We defined a case of infection as onset of fever and respiratory symptoms and detection of virus by PCR in a passenger or crew member of either flight. Illness developed only in passengers who traveled on the New York to Hong Kong flight. We compared exposures of 9 case-passengers with those of 32 asymptomatic control-passengers. None of the 9 case-passengers, compared with 47% (15/32) of control-passengers, wore a face mask for the entire flight (odds ratio 0, 95% CI 0–0.71). The source case-passenger was not identified. Wearing a face mask was a protective factor against influenza infection. We recommend a more comprehensive intervention study to accurately estimate this effect.
Medscape CME Activity
Mumps Postexposure Prophylaxis with a Third Dose of Measles-Mumps-Rubella Vaccine, Orange County, New York, USA PDF Version [PDF - 544 KB - 7 pages]A. Fiebelkorn et al.View SummaryView Abstract
Mumps attack rates were 0% among third dose recipients and 5.2% among 2-dose recipients who had not received postexposure prophylaxis.
Although the measles-mumps-rubella (MMR) vaccine is not recommended for mumps postexposure prophylaxis (PEP), data on its effectiveness are limited. During the 2009–2010 mumps outbreak in the northeastern United States, we assessed effectiveness of PEP with a third dose of MMR vaccine among contacts in Orthodox Jewish households who were given a third dose within 5 days of mumps onset in the household’s index patient. We compared mumps attack rates between persons who received a third MMR dose during the first incubation period after onset in the index patient and 2-dose vaccinated persons who had not. Twenty-eight (11.7%) of 239 eligible household members received a third MMR dose as PEP. Mumps attack rates were 0% among third-dose recipients versus 5.2% among 2-dose recipients without PEP (p = 0.57). Although a third MMR dose administered as PEP did not have a significant effect, it may offer some benefits in specific outbreak contexts.
Continued Evolution of West Nile Virus, Houston, Texas, USA, 2002–2012
PDF Version [PDF - 878 KB - 10 pages]
B. R. Mann et al.View SummaryView Abstract
Ongoing surveillance is needed to better understand transmission dynamics.
We investigated the genetics and evolution of West Nile virus (WNV) since initial detection in the United States in 1999 on the basis of continual surveillance studies in the Houston, Texas, USA, metropolitan area (Harris County) as a surrogate model for WNV evolution on a national scale. Full-length genomic sequencing of 14 novel 2010–2012 WNV isolates collected from resident birds in Harris County demonstrates emergence of 4 independent genetic groups distinct from historical strains circulating in the greater Houston region since 2002. Phylogenetic and geospatial analyses of the 2012 WNV isolates indicate closer genetic relationship with 2003–2006 Harris County isolates than more recent 2007–2011 isolates. Inferred monophyletic relationships of these groups with several 2006–2009 northeastern US isolates supports potential introduction of a novel WNV strain in Texas since 2010. These results emphasize the need to maintain WNV surveillance activities to better understand WNV transmission dynamics in the United States.
Underreporting of Viral Encephalitis and Viral Meningitis, Ireland, 2005–2008
PDF Version [PDF - 462 KB - 9 pages]
T. A. Kelly et al.View SummaryView Abstract
New case definitions and other measures have been implemented to improve surveillance accuracy.
Viral encephalitis (VE) and viral meningitis (VM) have been notifiable infectious diseases under surveillance in the Republic of Ireland since 1981. Laboratories have reported confirmed cases by detection of viral nucleic acid in cerebrospinal fluid since 2004. To determine the prevalence of these diseases in Ireland during 2005–2008, we analyzed 3 data sources: Hospital In-patient Enquiry data (from hospitalized following patients discharge) accessed through Health Intelligence Ireland, laboratory confirmations from the National Virus Reference Laboratory, and events from the Computerised Infectious Disease Reporting surveillance system. We found that the national surveillance system underestimates the incidence of these diseases in Ireland with a 10-fold higher VE hospitalization rate and 3-fold higher VM hospitalization rate than the reporting rate. Herpesviruses were responsible for most specified VE and enteroviruses for most specified VM from all 3 sources. Recommendations from this study have been implemented to improve the surveillance of these diseases in Ireland.
High Rates of Mycobacterium tuberculosis among Socially Marginalized Immigrants in Low-Incidence Area, 1991–2010, Italy
PDF Version [PDF - 724 KB - 9 pages]
I. Baussano et al.View SummaryView Abstract
These populations may account for substantial ongoing transmission and should be prioritized for tuberculosis screening.
Migration from low- and middle-income countries to high-income countries increasingly determines the severity of tuberculosis (TB) cases in the adopted country. Socially marginalized groups, about whom little is known, may account for a reservoir of TB among the immigrant populations. We investigated the rates of and risk factors for Mycobacterium tuberculosis transmission, infection, and disease in a cohort of 27,358 socially marginalized immigrants who were systematically screened (1991–2010) in an area of Italy with low TB incidence. Overall TB and latent TB infection prevalence and annual tuberculin skin testing conversion rates (i.e., incidence of new infection) were 2.7%, 34.6%, and 1.7%, respectively. Prevalence of both TB and latent TB infection and incidence of infection increased as a function of the estimated TB incidence in the immigrants’ countries of origin. Annual infection incidence decreased with time elapsed since immigration. These findings have implications for control policy and immigrant screening in countries with a low prevalence of TB.
Plasmodium falciparum Mutant Haplotype Infection during Pregnancy Associated with Reduced Birthweight, Tanzania
PDF Version [PDF - 509 KB - 9 pages]
D. Minja et al.View SummaryView Abstract
Suboptimal malaria treatments should urgently be replaced by screening and treatment with safe and effective drugs.
Intermittent preventive treatment during pregnancy with sulfadoxine–pyrimethamine (IPTp-SP) is a key strategy in the control of pregnancy-associated malaria. However, this strategy is compromised by widespread drug resistance from single-nucleotide polymorphisms in the Plasmodium falciparum dihydrofolate reductase and dihydropteroate synthetase genes. During September 2008–October 2010, we monitored a cohort of 924 pregnant women in an area of Tanzania with declining malaria transmission. P. falciparum parasites were genotyped, and the effect of infecting haplotypes on birthweight was assessed. Of the genotyped parasites, 9.3%, 46.3%, and 44.4% had quadruple or less, quintuple, and sextuple mutated haplotypes, respectively. Mutant haplotypes were unrelated to SP doses. Compared with infections with the less-mutated haplotypes, infections with the sextuple haplotype mutation were associated with lower (359 g) birthweights. Continued use of the suboptimal IPTp-SP regimen should be reevaluated, and alternative strategies (e.g., intermittent screening and treatment or intermittent treatment with safe and effective alternative drugs) should be evaluated.
New Estimates of Incidence of Encephalitis in England
PDF Version [PDF - 406 KB - 8 pages]
J. Granerod et al.View SummaryView Abstract
Early recognition and accurate diagnosis of this disease are necessary to reduce economic and societal costs.
Encephalitis causes high rates of illness and death, yet its epidemiology remains poorly understood. To improve incidence estimates in England and inform priority setting and treatment and prevention strategies, we used hospitalization data to estimate incidence of infectious and noninfectious encephalitis during 2005–2009. Hospitalization data were linked to a dataset of extensively investigated cases of encephalitis from a prospective study, and capture–recapture models were applied. Incidence was estimated from unlinked hospitalization data as 4.32 cases/100,000 population/year. Capture–recapture models gave a best estimate of encephalitis incidence of 5.23 cases/100,000/year, although the models’ indicated incidence could be as high as 8.66 cases/100,000/year. This analysis indicates that the incidence of encephalitis in England is considerably higher than previously estimated. Therefore, encephalitis should be a greater priority for clinicians, researchers, and public health officials.
Enzootic and Epizootic Rabies Associated with Vampire Bats, Peru
PDF Version [PDF - 409 KB - 7 pages]
R. Condori-Condori et al.View SummaryView Abstract
Three putative new virus lineages were found in hosts that may represent new reservoirs for this virus.
During the past decade, incidence of human infection with rabies virus (RABV) spread by the common vampire bat (Desmodus rotundus) increased considerably in South America, especially in remote areas of the Amazon rainforest, where these bats commonly feed on humans. To better understand the epizootiology of rabies associated with vampire bats, we used complete sequences of the nucleoprotein gene to infer phylogenetic relationships among 157 RABV isolates collected from humans, domestic animals, and wildlife, including bats, in Peru during 2002–2007. This analysis revealed distinct geographic structuring that indicates that RABVs spread gradually and involve different vampire bat subpopulations with different transmission cycles. Three putative new RABV lineages were found in 3 non–vampire bat species that may represent new virus reservoirs. Detection of novel RABV variants and accurate identification of reservoir hosts are critically important for the prevention and control of potential virus transmission, especially to humans.
Use of Staged Molecular Analysis to Determine Causes of Unexplained Central Nervous System Infections
PDF Version [PDF - 539 KB - 8 pages]
C. Hsu et al.View SummaryView Abstract
MassTag PCR may identify causes even after other analyses have yielded negative results.
No agent is implicated in most central nervous system (CNS) infections. To investigate cerebrospinal fluid samples from patients with CNS infections of unknown cause in 1 hospital in Taiwan, we used a staged molecular approach, incorporating techniques including multiplex MassTag PCR, 16S rRNA PCR, DNA microarray, and high-throughput pyrosequencing. We determined the infectious agent for 31 (24%) of 131 previously negative samples. Candidate pathogens were identified for 25 (27%) of 94 unexplained meningitis cases and 6 (16%) of 37 unexplained encephalitis cases. Epstein-Barr virus (18 infections) accounted for most of the identified agents in unexplained meningitis cases, followed by Escherichia coli (5), enterovirus (2), human herpesvirus 2 (1), and Mycobacterium tuberculosis. Herpesviruses were identified in samples from patients with unexplained encephalitis cases, including varicella-zoster virus (3 infections), human herpesvirus 1 (2), and cytomegalovirus (1). Our study confirms the power of multiplex MassTag PCR as a rapid diagnostic tool for identifying pathogens causing unexplained CNS infections.
Quinto Tiberio Angelerio and New Measures for Controlling Plague in 16th-Century Alghero, Sardinia
PDF Version [PDF - 544 KB - 6 pages]
R. Bianucci et al.View SummaryView Abstract
Public health measures imposed by Angelerio spared the surrounding areas from the plague.
Plague, a zoonotic disease caused by the bacterium Yersinia pestis, has been responsible for at least 3 pandemics. During 1582–1583, a plague outbreak devastated the seaport of Alghero in Sardinia. By analyzing contemporary medical texts and local documentation, we uncovered the pivotal role played by the Protomedicus of Alghero, Quinto Tiberio Angelerio (1532–1617), in controlling the epidemic. Angelerio imposed rules and antiepidemic measures new to the 16th-century sanitary system of Sardinia. Those measures undoubtedly spared the surrounding districts from the spread of the contagion. Angelerio seems to have been an extremely successful public health officer in the history of plague epidemics in Sardinia.
Microsporidial Keratoconjunctivitis after Rugby Tournament, Singapore
PDF Version [PDF - 315 KB - 3 pages]
J. Tan et al.View Abstract
We investigated an outbreak of 47 probable and 6 confirmed cases of microsporidial keratoconjunctivitis involving participants of an international rugby tournament in Singapore in April 2012.The mode of transmission was eye contact with soil. Vittaforma corneae was identified in 4 of 6 corneal scrapings and in 1 of 12 soil water samples.
Novel Bunyavirus in Domestic and Captive Farmed Animals, Minnesota, USA
PDF Version [PDF - 421 KB - 3 pages]
Z. Xing et al.View Abstract
We tested blood samples from domestic and captive farmed animals in Minnesota, USA, to determine exposure to severe fever with thrombocytopenia syndrome virus and Heartland-like virus. We found antibodies against virus nucleoproteins in 10%–18% of samples from cattle, sheep, goats, deer, and elk in 24 Minnesota counties.
Benznidazole Treatment of Chagasic Encephalitis in Pregnant Woman with AIDS
PDF Version [PDF - 354 KB - 3 pages]
M. Bisio et al.View Abstract
We report a case of chagasic meningoencephalitis reactivation in a pregnant woman co-infected with Trypanosoma cruzi and HIV that was successfully managed with benznidazole and highly active antiretroviral therapy. Early diagnosis enabled rapid specific treatment that improved the health of the patient and her baby.
Mycobacterium chelonae Abscesses Associated with Biomesotherapy, Australia, 2008
PDF Version [PDF - 324 KB - 3 pages]
M. Ivan et al.View Abstract
An outbreak of skin abscesses occurred in Adelaide, Australia, in association with biomesotherapy, an alternative therapy practice. Mycobacterium chelonae was identified in 8 patient and 3 environmental samples. Our findings show M. chelonae infection can be associated with alternative therapies when infection-control breaches occur. Tighter regulations of alternative therapy practices are needed.
Spread of Neisseria meningitidis Serogroup W Clone, China
PDF Version [PDF - 535 KB - 4 pages]
H. Zhou et al.View Abstract
During February 2011–June 2012, invasive infection with Neisseria meningitidis serogroup W was identified in 11 persons in southeastern China. All isolates tested had matching or near-matching pulsed-field gel electrophoresis patterns and belonged to multilocus sequence type 11. The epidemiologic investigation suggested recent transmission of this clonal complex in southeastern China.
Human Parainfluenza Virus Type 3 in Wild Nonhuman Primates, Zambia
PDF Version [PDF - 557 KB - 4 pages]
M. Sasaki et al.View Abstract
Human parainfluenza virus type 3 (HPIV3) genome was detected in 4 baboons in Zambia. Antibody for HPIV3 was detected in 13 baboons and 6 vervet monkeys in 2 distinct areas in Zambia. Our findings suggest that wild nonhuman primates are susceptible to HPIV3 infection.
Powassan Meningoencephalitis, New York, New York, USA
PDF Version [PDF - 303 KB - 3 pages]
S. Sung et al.View Abstract
Disease caused by Powassan virus (POWV), a tick-borne flavivirus, ranges from asymptomatic to severe neurologic compromise and death. Two cases of POWV meningoencephalitis in New York, USA, highlight diagnostic techniques, neurologic outcomes, and the effect of POWV on communities to which it is endemic.
Serogroup W135 Meningococcal Disease, The Gambia, 2012
PDF Version [PDF - 358 KB - 4 pages]
M. Hossain et al.View Abstract
In 2012, an outbreak of Neisseria meningitidis serogroup W135 occurred in The Gambia. The attack rate was highest among young children. The associated risk factors were male sex, contact with meningitis patients, and difficult breathing. Enhanced surveillance facilitates early epidemic detection, and multiserogroup conjugate vaccine could reduce meningococcal epidemics in The Gambia.
Novel Cyclovirus in Human Cerebrospinal Fluid, Malawi, 2010–2011
PDF Version [PDF - 381 KB - 3 pages]
S. L. Smits et al.View Abstract
To identify unknown human viruses, we analyzed serum and cerebrospinal fluid samples from patients with unexplained paraplegia from Malawi by using viral metagenomics. A novel cyclovirus species was identified and subsequently found in 15% and 10% of serum and cerebrospinal fluid samples, respectively. These data expand our knowledge of cyclovirus diversity and tropism.
Gastroenteritis Outbreak Associated with Unpasteurized Tempeh, North Carolina, USA
PDF Version [PDF - 377 KB - 4 pages]
S. E. Griese et al.View Abstract
During an investigation of an outbreak of gastroenteritis caused by Salmonella enterica serovar Paratyphi B variant L(+) tartrate(+), we identified unpasteurized tempeh as a novel food vehicle and Rhizopus spp. starter culture as the source of the contamination. Safe handling of uncooked, unpasteurized tempeh should be emphasized for prevention of foodborne illnesses.
West Nile Virus RNA in Tissues from Donor Associated with Transmission to Organ Transplant Recipients
PDF Version [PDF - 319 KB - 3 pages]
D. M. Blau et al.View Abstract
We identified West Nile virus (WNV) RNA in skin, fat, muscle, tendon, and bone marrow from a deceased donor associated with WNV transmission through solid organ transplantation. WNV could not be cultured from the RNA-positive tissues. Further studies are needed to determine if WNV can be transmitted from postmortem tissues.
R292K Substitution and Drug Susceptibility of Influenza A(H7N9) Viruses
PDF Version [PDF - 562 KB - 4 pages]
K. Sleeman et al.View Abstract
Neuraminidase inhibitors are the only licensed antiviral medications available to treat avian influenza A(H7N9) virus infections in humans. According to a neuraminidase inhibition assay, an R292K substitution reduced antiviral efficacy of inhibitors, especially oseltamivir, and decreased viral fitness in cell culture. Monitoring emergence of R292K-carrying viruses using a pH-modified neuraminidase inhibition assay should be considered.
Macrolide-Resistant Mycoplasma pneumoniae in Humans, Ontario, Canada, 2010–2011
PDF Version [PDF - 377 KB - 3 pages]
A. Eshaghi et al.View Abstract
Antimicrobial drug resistance rates for Mycoplasma pneumoniae was determined in clinical specimens and isolates obtained during 2011–2012 in Ontario, Canada. Of 91 M. pneumoniae drug-resistant specimens, 11 (12.1%) carried nucleotide mutations associated with macrolide resistance in the 23S rRNA gene. None of the M. pneumoniae specimens were resistant to fluoroquinolones or tetracyclines.
Hepatitis E Virus Genotype 4, Nanjing, China, 2001–2011
PDF Version [PDF - 328 KB - 3 pages]
X. Dai et al.View Abstract
During 2001–2011, hepatitis E virus (HEV) was found in the blood of patients in Nanjing, China. All HEV-positive patients had virus genotype 4; subgenotype 4a was predominant. The effective population of HEV in Nanjing increased in ≈1980 and continued until ≈2003 when it plateaued.
Highly Pathogenic Avian Influenza A(H7N3) Virus in Poultry Workers, Mexico, 2012
PDF Version [PDF - 731 KB - 4 pages]
I. Lopez-Martinez et al.View Abstract
We identified 2 poultry workers with conjunctivitis caused by highly pathogenic avian influenza A(H7N3) viruses in Jalisco, Mexico. Genomic and antigenic analyses of 1 isolate indicated relatedness to poultry and wild bird subtype H7N3 viruses from North America. This isolate had a multibasic cleavage site that might have been derived from recombination with host rRNA.
Outbreak of Chikungunya Virus Infection, Vanimo, Papua New Guinea
PDF Version [PDF - 480 KB - 4 pages]
P. F. Horwood et al.View Abstract
In June 2012, health authorities in Papua New Guinea detected an increase in febrile illnesses in Vanimo. Chikungunya virus of the Eastern/Central/Southern African genotype harboring the E1:A226V mutation was identified. This ongoing outbreak has spread to ≥8 other provinces and has had a harmful effect on public health.
Clostridium difficile Infection Caused by Binary Toxin–Positive Strains
PDF Version [PDF - 358 KB - 2 pages]
M. Hensgens and E. J. Kuijper
Spread of Kyasanur Forest Disease, Bandipur Tiger Reserve, India, 2012–2013
PDF Version [PDF - 329 KB - 1 page]
D. T. Mourya et al.
Chikungunya Virus Infection, Brazzaville, Republic of Congo, 2011
PDF Version [PDF - 327 KB - 2 pages]
J. Mombouli et al.
Chorea and Tick-Borne Encephalitis, Poland
PDF Version [PDF - 558 KB - 2 pages]
J. Zajkowska et al.
Streptococcus suis Meningitis and Bacteremia in Man, French Guiana
PDF Version [PDF - 320 KB - 2 pages]
M. Demar et al.
Alaria alata Infection in European Mink
PDF Version [PDF - 408 KB - 3 pages]
F. Tăbăran et al.
Serologic Survey of Plague in Animals, Western Iran
PDF Version [PDF - 378 KB - 3 pages]
S. Esamaeili et al.
Livestock Density as Risk Factor for Livestock-associated Methicillin-Resistant Staphylococcus aureus, the Netherlands
PDF Version [PDF - 333 KB - 2 pages]
P. R. Davies et al.
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When at night I go to sleep / Fourteen angels watch do keep
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