Volume 20, Number 1—January 2014
Volume 20, Number 1—January 2014 PDF Version [PDF - 7.80 MB - 179 pages]
Severe Fever with Thrombocytopenia Syndrome, Shandong Province, China, 2011
PDF Version [PDF - 471 KB - 5 pages]
H. Wen et al.View SummaryView Abstract
Supportive therapy is recommended before laboratory confirmation of this disease.
Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease in China. The incidence and clinical and laboratory characteristics of SFTS are not clearly defined. During May 22–October 2, 2011, a total of 24 patients with fever, thrombocytopenia, and leukopenia were clinically diagnosed as having SFTS in Yiyuan County, Shandong Province, China. We conducted laboratory tests for these SFTS patients. SFTS virus (SFTSV) infection was confirmed in 22 patients by using reverse transcription PCR and ELISA by acute-phase and convalescent-phase serum samples. Clinical and laboratory manifestations included fever (100%), gastrointestinal symptoms (91%), myalgia (55%), chills (41%), thrombocytopenia (100%), and leukopenia (95%).
A Historical Perspective of Influenza A(H1N2) Virus
PDF Version [PDF - 375 KB - 7 pages]
N. Komadina et al.View SummaryView Abstract
Emergence and ongoing reassortment of these viruses among animals and humans suggest potential for pandemics.
The emergence and transition to pandemic status of the influenza A(H1N1)A(H1N1)pdm09) virus in 2009 illustrated the potential for previously circulating human viruses to re-emerge in humans and cause a pandemic after decades of circulating among animals. Within a short time of the initial emergence of A(H1N1)pdm09 virus, novel reassortants were isolated from swine. In late 2011, a variant (v) H3N2 subtype was isolated from humans, and by 2012, the number of persons infected began to increase with limited person-to-person transmission. During 2012 in the United States, an A(H1N2)v virus was transmitted to humans from swine. During the same year, Australia recorded its first H1N2 subtype infection among swine. The A(H3N2)v and A(H1N2)v viruses contained the matrix protein from the A(H1N1)pdm09 virus, raising the possibility of increased transmissibility among humans and underscoring the potential for influenza pandemics of novel swine-origin viruses. We report on the differing histories of A(H1N2) viruses among humans and animals.
Molecular Barriers to Zoonotic Transmission of Prions
PDF Version [PDF - 1.07 MB - 10 pages]
M. A. Barria et al.View SummaryView Abstract
Chronic wasting disease in elk might be a threat to human health.
The risks posed to human health by individual animal prion diseases cannot be determined a priori and are difficult to address empirically. The fundamental event in prion disease pathogenesis is thought to be the seeded conversion of normal prion protein to its pathologic isoform. We used a rapid molecular conversion assay (protein misfolding cyclic amplification) to test whether brain homogenates from specimens of classical bovine spongiform encephalopathy (BSE), atypical BSE (H-type BSE and L-type BSE), classical scrapie, atypical scrapie, and chronic wasting disease can convert normal human prion protein to the abnormal disease-associated form. None of the tested prion isolates from diseased animals were as efficient as classical BSE in converting human prion protein. However, in the case of chronic wasting disease, there was no absolute barrier to conversion of the human prion protein.
Multisite Validation of Cryptococcal Antigen Lateral Flow Assay and Quantification by Laser Thermal Contrast
PDF Version [PDF - 459 KB - 9 pages]
D. R. Boulware et al.View SummaryView Abstract
This assay is a major advance in the diagnosis of cryptococcal meningitis.
Cryptococcal meningitis is common in sub-Saharan Africa. Given the need for data for a rapid, point-of-care cryptococcal antigen (CRAG) lateral flow immunochromatographic assay (LFA), we assessed diagnostic performance of cerebrospinal fluid (CSF) culture, CRAG latex agglutination, India ink microscopy, and CRAG LFA for 832 HIV-infected persons with suspected meningitis during 2006–2009 (n = 299) in Uganda and during 2010–2012 (n = 533) in Uganda and South Africa. CRAG LFA had the best performance (sensitivity 99.3%, specificity 99.1%). Culture sensitivity was dependent on CSF volume (82.4% for 10 μL, 94.2% for 100 μL). CRAG latex agglutination test sensitivity (97.0%–97.8%) and specificity (85.9%–100%) varied between manufacturers. India ink microscopy was 86% sensitive. Laser thermal contrast had 92% accuracy (R = 0.91, p<0.001) in quantifying CRAG titers from 1 LFA strip to within <1.5 dilutions of actual CRAG titers. CRAG LFA is a major advance for meningitis diagnostics in resource-limited settings.
Population-based Surveillance for Bacterial Meningitis in China, September 2006–December 2009
PDF Version [PDF - 580 KB - 9 pages]
Y. Li et al.View SummaryView Abstract
Greater use of appropriate specimen collection and confirmatory laboratory testing is needed.
During September 2006–December 2009, we conducted active population and sentinel laboratory–based surveillance for bacterial meningitis pathogens, including Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b, in 4 China prefectures. We identified 7,876 acute meningitis and encephalitis syndrome cases, including 6,388 among prefecture residents. A total of 833 resident cases from sentinel hospitals met the World Health Organization case definition for probable bacterial meningitis; 339 of these cases were among children <5 years of age. Laboratory testing confirmed bacterial meningitis in 74 of 3,391 tested cases. The estimated annual incidence (per 100,000 population) of probable bacterial meningitis ranged from 1.84 to 2.93 for the entire population and from 6.95 to 22.30 for children <5 years old. Active surveillance with laboratory confirmation has provided a population-based estimate of the number of probable bacterial meningitis cases in China, but more complete laboratory testing is needed to better define the epidemiology of the disease in this country.
Medscape CME Activity
Raw Milk Consumption among Patients with Non–Outbreak-related Enteric Infections, Minnesota, USA, 2001–2010 PDF Version [PDF - 580 KB - 7 pages]T. J. Robinson et al.View SummaryView Abstract
The risk for illness associated with raw milk consumption is far greater than previously realized.
Raw milk has frequently been identified as the source of foodborne illness outbreaks; however, the number of illnesses ascertained as part of documented outbreaks likely represents a small proportion of the actual number of illnesses associated with this food product. Analysis of routine surveillance data involving illnesses caused by enteric pathogens that were reportable in Minnesota during 2001–2010 revealed that 3.7% of patients with sporadic, domestically acquired enteric infections had reported raw milk consumption during their exposure period. Children were disproportionately affected, and 76% of those <5 years of age were served raw milk from their own or a relative’s farm. Severe illness was noted, including hemolytic uremic syndrome among 21% of Escherichia coli O157–infected patients reporting raw milk consumption, and 1 death was reported. Raw milk consumers, potential consumers, and policy makers who might consider relaxing regulations regarding raw milk sales should be educated regarding illnesses associated with raw milk consumption.
Effects of Drinking-Water Filtration on Cryptosporidium Seroepidemiology, Scotland
PDF Version [PDF - 399 KB - 7 pages]
C. N. Ramsay et al.View SummaryView Abstract
Improved filtration is associated with reduced prevalence of antibodies against Cryptosporidium spp.
Continuous exposure to low levels of Cryptosporidium oocysts is associated with production of protective antibodies. We investigated prevalence of antibodies against the 27-kDa Cryptosporidium oocyst antigen among blood donors in 2 areas of Scotland supplied by drinking water from different sources with different filtration standards: Glasgow (not filtered) and Dundee (filtered). During 2006–2009, seroprevalence and risk factor data were collected; this period includes 2007, when enhanced filtration was introduced to the Glasgow supply. A serologic response to the 27-kDa antigen was found for ≈75% of donors in the 2 cohorts combined. Mixed regression modeling indicated a 32% step-change reduction in seroprevalence of antibodies against Cryptosporidium among persons in the Glasgow area, which was associated with introduction of enhanced filtration treatment. Removal of Cryptosporidium oocysts from water reduces the risk for waterborne exposure, sporadic infections, and outbreaks. Paradoxically, however, oocyst removal might lower immunity and increase the risk for infection from other sources.
Dynamic Modeling of Cost-effectiveness of Rotavirus Vaccination, Kazakhstan
PDF Version [PDF - 501 KB - 9 pages]
B. Freiesleben de Blasio et al.View SummaryView Abstract
Comparison of projected rotavirus vaccine health effects and costs over 20 years showed its use to be cost-effective.
Cost-effectiveness of Rotavirus Vaccination Program
The government of Kazakhstan, a middle-income country in Central Asia, is considering the introduction of rotavirus vaccination into its national immunization program. We performed a cost-effectiveness analysis of rotavirus vaccination spanning 20 years by using a synthesis of dynamic transmission models accounting for herd protection. We found that a vaccination program with 90% coverage would prevent ≈880 rotavirus deaths and save an average of 54,784 life-years for children <5 years of age. Indirect protection accounted for 40% and 60% reduction in severe and mild rotavirus gastroenteritis, respectively. Cost per life year gained was US $18,044 from a societal perspective and US $23,892 from a health care perspective. Comparing the 2 key parameters of cost-effectiveness, mortality rates and vaccine cost at <US $2.78 per dose, vaccination program costs would be entirely offset. To further evaluate efficacy of a vaccine program, benefits of indirect protection conferred by vaccination warrant further study.
Use of Electronic Death Certificates for Influenza Death Surveillance
PDF Version [PDF - 381 KB - 5 pages]
E. A. Bancroft and S. LeeView SummaryView Abstract
These certificates might be useful during a pandemic, when resources for traditional surveillance are limited.
Surveillance for influenza deaths has been used to gauge the severity of influenza seasons. Traditional surveillance, which relies on medical records review and laboratory testing, might not be sustainable during a pandemic. We examined whether electronic death certificates might provide a surveillance alternative. We compared information retrieved from electronic death certificates that listed influenza (or a synonym) with information retrieved from medical charts on which influenza deaths were reported by traditional means in Los Angeles County, California, USA, during the 2009 influenza A(H1N1) pandemic and 2 subsequent influenza seasons. Electronic death certificate surveillance provided timely information, matched the demographics and epidemiologic curve of that obtained from traditional influenza-related death surveillance, and had a moderately positive predictive value. However, risk factors were underreported on death certificates. Because surveillance by electronic death certificates does not require obtaining and reviewing medical records, it requires fewer resources and is less burdensome on public health staff.
Genetic Variation of Vibrio cholerae during Outbreaks, Bangladesh, 2010–2011
PDF Version [PDF - 488 KB - 7 pages]
S. M. Rashed et al.View SummaryView Abstract
Most isolates are closely related, but genetic variation implies accelerated transmission of some lineages.
Cholera remains a major public health problem. To compare the relative contribution of strains from the environment with strains isolated from patients during outbreaks, we performed multilocus variable tandem repeat analyses on samples collected during the 2010 and 2011 outbreak seasons in 2 geographically distinct areas of Bangladesh. A total of 222 environmental and clinical isolates of V. cholerae O1 were systematically collected from Chhatak and Mathbaria. In Chhatak, 75 of 79 isolates were from the same clonal complex, in which extensive differentiation was found in a temporally consistent pattern of successive mutations at single loci. A total of 59 isolates were collected from 6 persons; most isolates from 1 person differed by sequential single-locus mutations. In Mathbaria, 60 of 84 isolates represented 2 separate clonal complexes. The small number of genetic lineages in isolates from patients, compared with those from the environment, is consistent with accelerated transmission of some strains among humans during an outbreak.
Genomic Epidemiology of Vibrio cholerae O1 Associated with Floods, Pakistan, 2010
PDF Version [PDF - 545 KB - 8 pages]
M. Shah et al.View SummaryView Abstract
At least 2 subclades coexisted that had different antimicrobial-resistance profiles and patterns of spread.
In August 2010, Pakistan experienced major floods and a subsequent cholera epidemic. To clarify the population dynamics and transmission of Vibrio cholerae in Pakistan, we sequenced the genomes of all V. cholerae O1 El Tor isolates and compared the sequences to a global collection of 146 V. cholerae strains. Within the global phylogeny, all isolates from Pakistan formed 2 new subclades (PSC-1 and PSC-2), lying in the third transmission wave of the seventh-pandemic lineage that could be distinguished by signature deletions and their antimicrobial susceptibilities. Geographically, PSC-1 isolates originated from the coast, whereas PSC-2 isolates originated from inland areas flooded by the Indus River. Single-nucleotide polymorphism accumulation analysis correlated river flow direction with the spread of PSC-2. We found at least 2 sources of cholera in Pakistan during the 2010 epidemic and illustrate the value of a global genomic data bank in contextualizing cholera outbreaks.
Human Parechovirus Infection, Denmark
PDF Version [PDF - 335 KB - 5 pages]
T. K. Fischer et al.View SummaryView Abstract
HPeV should be tested for in all young children suspected to have HPeV or enterovirus infection.
Human parechoviruses (HPeVs) often cause severe illness among young children. National surveillance with routine testing of all cerebrospinal fluid, fecal, and tissue samples was conducted during January 2009–December 2012 in all counties in Denmark (6,817 samples from 4,804 children were screened for HPeV). We detected HPeV RNA in 202 (3.0%) specimens from 149 persons. Young infants were at highest risk for HPeV, and 9 (6%) of the HPeV-infected children died, probably of their HPeV illness. HPeV3 was the most common genotype identified, and 5 closely related clades of HPeV3 circulated in Denmark throughout the study period. Our study adds perspective on the prevalence and clinical and molecular virologic characteristics of HPeV infection.
Progenitor “Mycobacterium canettii” Clone Responsible for Lymph Node Tuberculosis Epidemic, Djibouti
PDF Version [PDF - 492 KB - 8 pages]
Y. Blouin et al.View SummaryView Abstract
Two outbreaks among expatriate children were caused by an epidemic clone from the Horn of Africa.
“Mycobacterium canettii,” an opportunistic human pathogen living in an unknown environmental reservoir, is the progenitor species from which Mycobacterium tuberculosis emerged. Since its discovery in 1969, most of the ≈70 known M. canettii strains were isolated in the Republic of Djibouti, frequently from expatriate children and adults. We show here, by whole-genome sequencing, that most strains collected from February 2010 through March 2013, and associated with 2 outbreaks of lymph node tuberculosis in children, belong to a unique epidemic clone within M. canettii. Evolution of this clone, which has been recovered regularly since 1983, may mimic the birth of M. tuberculosis. Thus, recognizing this organism and identifying its reservoir are clinically important.
Rapidly Fatal Hemorrhagic Pneumonia and Group A Streptococcus Serotype M1
PDF Version [PDF - 411 KB - 4 pages]
M. Santagati et al.View Abstract
We report 3 cases of fulminant hemorrhagic pneumonia in previously health patients. Sudden-onset hemoptysis and dyspnea developed; all 3 patients and died <12 h later of massive pulmonary bleeding, despite aggressive supportive care. Postmortem analysis showed that the illnesses were caused by group A Streptococcus emm1/sequence type 28 strains.
Mother-to-Child Transmission of Congenital Chagas Disease, Japan
PDF Version [PDF - 321 KB - 3 pages]
K. Imai et al.View Abstract
We report a patient with congenital Chagas disease in Japan. This report reemphasizes the role of neglected and emerging tropical diseases in the era of globalization. It also indicates the need for increased vigilance for detecting Chagas disease in non–disease-endemic countries.
Contact Tracing for Influenza A(H1N1)pdm09 Virus–infected Passenger on International Flight
PDF Version [PDF - 321 KB - 3 pages]
A. G. Shankar et al.View Abstract
In April 2009, influenza A(H1N1)pdm09 virus infection was confirmed in a person who had been symptomatic while traveling on a commercial flight from Mexico to the United Kingdom. Retrospective public health investigation and contact tracing led to the identification of 8 additional confirmed cases among passengers and community contacts of passengers.
Resolution of Novel Human Papillomavirus–induced Warts after HPV Vaccination
PDF Version [PDF - 366 KB - 4 pages]
S. Silling et al.View Abstract
Human papillomavirus (HPV) XS2 was isolated from warts on an immunosuppressed patient. After HPV vaccination, the warts resolved. HPVXS2 was also found in warts and normal skin of HIV-positive patients and rarely in HIV-negative controls. Further studies should elucidate the mechanisms that lead to wart clearance.
Avian Hepatitis E Virus in Chickens, Taiwan, 2013
PDF Version [PDF - 807 KB - 3 pages]
I. Hsu and H. TsaiView Abstract
A previously unidentified strain of avian hepatitis E virus (aHEV) is now endemic among chickens in Taiwan. Analysis showed that the virus is 81.5%–86.5% similar to other aHEVs. In Taiwan, aHEV infection has been reported in chickens without aHEV exposure, suggesting transmission from asymptomatic cases or repeated introduction through an unknown common source(s).
Dobrava-Belgrade Virus in Apodemus flavicollis and A. uralensis Mice, Turkey
PDF Version [PDF - 497 KB - 5 pages]
I. Oktem et al.View Abstract
In 2009, human Dobrava-Belgrade virus (DOBV) infections were reported on the Black Sea coast of Turkey. Serologic and molecular studies of potential rodent reservoirs demonstrated DOBV infections in Apodemus flavicollis and A. uralensis mice. Phylogenetic analysis of DOBV strains showed their similarity to A. flavicollis mice–borne DOBV in Greece, Slovenia, and Slovakia.
Increasing Threat of Brucellosis to Low-Risk Persons in Urban Settings, China
PDF Version [PDF - 594 KB - 5 pages]
S. Chen et al.View Abstract
Cases of brucellosis were diagnosed in 3-month-old twins and their mother. An epidemiologic survey suggested that raw sheep or goat meat might be the source of Brucella melitensis infection. This finding implies that the increasing threat of brucellosis might affect low-risk persons in urban settings in China.
Detection of Infectivity in Blood of Persons with Variant and Sporadic Creutzfeldt-Jakob Disease
PDF Version [PDF - 378 KB - 4 pages]
J. Douet et al.View Abstract
We report the presence of infectivity in erythrocytes, leukocytes, and plasma of 1 person with variant Creutzfeldt-Jakob disease and in the plasma of 2 in 4 persons whose tests were positive for sporadic Creutzfeldt-Jakob disease. The measured infectivity levels were comparable to those reported in various animals with transmissible spongiform encephalopathies.
Schmallenberg Virus Infection among Red Deer, France, 2010–2012
PDF Version [PDF - 575 KB - 4 pages]
E. Laloy et al.View Abstract
Schmallenberg virus infection is emerging in European domestic and wild ruminants. We investigated the serologic status of 9 red deer populations to describe virus spread from September 2010 through March 2012 among wildlife in France. Deer in 7 populations exhibited seropositivity, with an average seroprevalence of 20%.
Pathogenic Pseudorabies Virus, China, 2012
PDF Version [PDF - 350 KB - 3 pages]
X. Yu et al.View Abstract
In 2012, an unprecedented large-scale outbreak of disease in pigs in China caused great economic losses to the swine industry. Isolates from pseudorabies virus epidemics in swine herds were characterized. Evidence confirmed that the pathogenic pseudorabies virus was the etiologic agent of this epidemic.
Drug-Resistant Tuberculosis in High-Risk Groups, Zimbabwe
PDF Version [PDF - 302 KB - 3 pages]
J. Z. Metcalfe et al.View Abstract
To estimate prevalence of multidrug-resistant tuberculosis (MDR TB) in Harare, Zimbabwe, in 2012, we performed microbiologic testing on acid-fast bacilli smear-positive sputum samples from patients previously treated for TB. Twenty (24%) of 84 specimens were consistent with MDR TB. A national drug-resistance survey is needed to determine MDR TB prevalence in Zimbabwe.
Novel Avian Coronavirus and Fulminating Disease in Guinea Fowl, France
PDF Version [PDF - 511 KB - 4 pages]
E. Liais et al.View Abstract
For decades, French guinea fowl have been affected by fulminating enteritis of unclear origin. By using metagenomics, we identified a novel avian gammacoronavirus associated with this disease that is distantly related to turkey coronaviruses. Fatal respiratory diseases in humans have recently been caused by coronaviruses of animal origin.
Fatal Metacestode Infection in Bornean Orangutan Caused by Unknown Versteria Species
PDF Version [PDF - 550 KB - 5 pages]
T. L. Goldberg et al.View Abstract
A captive juvenile Bornean orangutan (Pongo pygmaeus) died from an unknown disseminated parasitic infection. Deep sequencing of DNA from infected tissues, followed by gene-specific PCR and sequencing, revealed a divergent species within the newly proposed genus Versteria (Cestoda: Taeniidae). Versteria may represent a previously unrecognized risk to primate health.
Epidemiology of Influenza A Virus among Black-headed Gulls, the Netherlands, 2006–2010
PDF Version [PDF - 492 KB - 4 pages]
J. H. Verhagen et al.View Abstract
We sampled 7,511 black-headed gulls for influenza virus in the Netherlands during 2006–2010 and found that subtypes H13 and H16 caused annual epidemics in fledglings on colony sites. Our findings validate targeted surveillance of wild waterbirds and clarify underlying factors for influenza virus emergence in other species.
Co-Production of NDM-1 and OXA-232 by Klebsiella pneumoniae
PDF Version [PDF - 258 KB - 3 pages]
Y. Doi et al.
Salmonellosis and Meat Purchased at Live-Bird and Animal-Slaughter Markets, United States, 2007–2012
PDF Version [PDF - 337 KB - 3 pages]
M. Imanishi et al.
Foodborne Trematodiasis and Opisthorchis felineus Acquired in Italy
PDF Version [PDF - 353 KB - 2 pages]
H. F. Wunderink et al.
Bat Lyssaviruses, Northern Vietnam
PDF Version [PDF - 296 KB - 3 pages]
A. Nguyen et al.
Endemicity of Opisthorchis viverrini Liver Flukes, Vietnam, 2011–2012
PDF Version [PDF - 359 KB - 3 pages]
J. Waikagul et al.
Tour Leaders’ Knowledge of and Attitudes toward Rabies Vaccination, Taiwan
PDF Version [PDF - 283 KB - 3 pages]
C. Huang et al.
Corynebacterium ulcerans in Ferrets
PDF Version [PDF - 287 KB - 3 pages]
R. P. Marini et al.
Ground Beef Recall Associated with Non-O157 Shiga Toxin–producing Escherichia coli, United States
PDF Version [PDF - 310 KB - 3 pages]
A. Robbins et al.
MLB1 Astrovirus in Children with Gastroenteritis, Italy
PDF Version [PDF - 315 KB - 2 pages]
M. Medici et al.
Indigenous Hepatitis E Virus Genotype 1 Infection, Uruguay
PDF Version [PDF - 407 KB - 3 pages]
S. Mirazo et al.
Hepatitis E Virus Genotype 4, Denmark, 2012
PDF Version [PDF - 311 KB - 2 pages]
S. Midgley et al.
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About the Cover
- Page created: January 31, 2014
- Page last updated: January 31, 2014
- Page last reviewed: January 31, 2014
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