Volume 20, Number 4—April 2014
Volume 20, Number 4—April 2014 PDF Version [PDF - 10.30 MB - 223 pages]
Distribution of Pandemic Influenza Vaccine and Reporting of Doses Administered, New York, New York, USA
PDF Version [PDF - 937 KB - 7 pages]
R. Marcello et al.View SummaryView Abstract
Mandating reporting of all doses administered during an influenza pandemic was feasible.
In 2009, the New York City Department of Health and Mental Hygiene delivered influenza A(H1N1)pdm09 (pH1N1) vaccine to health care providers, who were required to report all administered doses to the Citywide Immunization Registry. Using data from this registry and a provider survey, we estimated the number of all pH1N1 vaccine doses administered. Of 2.8 million doses distributed during October 1, 2009–March 4, 2010, a total of 988,298 doses were administered and reported; another 172,289 doses were administered but not reported, for a total of 1,160,587 doses administered during this period. Reported doses represented an estimated 80%–85% of actual doses administered. Reporting by a wide range of provider types was feasible during a pandemic. Pediatric-care providers had the highest reporting rate (93%). Other private-care providers who routinely did not report vaccinations indicated that they had few, if any, problems, thereby suggesting that mandatory reporting of all vaccines would be feasible.
Antibodies against MERS Coronavirus in Dromedary Camels, United Arab Emirates, 2003 and 2013
PDF Version [PDF - 493 KB - 8 pages]
B. Meyer et al.View SummaryView Abstract
Camels were infected with this virus >10 years before the first human cases.
Middle East respiratory syndrome coronavirus (MERS-CoV) has caused an ongoing outbreak of severe acute respiratory tract infection in humans in the Arabian Peninsula since 2012. Dromedary camels have been implicated as possible viral reservoirs. We used serologic assays to analyze 651 dromedary camel serum samples from the United Arab Emirates; 151 of 651 samples were obtained in 2003, well before onset of the current epidemic, and 500 serum samples were obtained in 2013. Recombinant spike protein–specific immunofluorescence and virus neutralization tests enabled clear discrimination between MERS-CoV and bovine CoV infections. Most (632/651, 97.1%) camels had antibodies against MERS-CoV. This result included all 151 serum samples obtained in 2003. Most (389/651, 59.8%) serum samples had MERS-CoV–neutralizing antibody titers >1,280. Dromedary camels from the United Arab Emirates were infected at high rates with MERS-CoV or a closely related, probably conspecific, virus long before the first human MERS cases.
Ciprofloxacin Resistance and Gonorrhea Incidence Rates in 17 Cities, United States, 1991–2006
PDF Version [PDF - 480 KB - 8 pages]
H. W. Chesson et al.View SummaryView Abstract
Antimicrobial drug resistance can lead to increases in gonorrhea incidence rates.
Antimicrobial drug resistance can hinder gonorrhea prevention and control efforts. In this study, we analyzed historical ciprofloxacin resistance data and gonorrhea incidence data to examine the possible effect of antimicrobial drug resistance on gonorrhea incidence at the population level. We analyzed data from the Gonococcal Isolate Surveillance Project and city-level gonorrhea incidence rates from surveillance data for 17 cities during 1991–2006. We found a strong positive association between ciprofloxacin resistance and gonorrhea incidence rates at the city level during this period. Their association was consistent with predictions of mathematical models in which resistance to treatment can increase gonorrhea incidence rates through factors such as increased duration of infection. These findings highlight the possibility of future increases in gonorrhea incidence caused by emerging cephalosporin resistance.
Active Surveillance for Avian Influenza Virus, Egypt, 2010–2012
PDF Version [PDF - 799 KB - 10 pages]
G. Kayali et al.View SummaryView Abstract
Continued circulation of influenza virus A subtypes H5N1 and H9N2 highlights the need for a revised intervention plan.
Continuous circulation of influenza A(H5N1) virus among poultry in Egypt has created an epicenter in which the viruses evolve into newer subclades and continue to cause disease in humans. To detect influenza viruses in Egypt, since 2009 we have actively surveyed various regions and poultry production sectors. From August 2010 through January 2013, >11,000 swab samples were collected; 10% were positive by matrix gene reverse transcription PCR. During this period, subtype H9N2 viruses emerged, cocirculated with subtype H5N1 viruses, and frequently co-infected the same avian host. Genetic and antigenic analyses of viruses revealed that influenza A(H5N1) clade 2.2.1 viruses are dominant and that all subtype H9N2 viruses are G1-like. Cocirculation of different subtypes poses concern for potential reassortment. Avian influenza continues to threaten public and animal health in Egypt, and continuous surveillance for avian influenza virus is needed.
Contact Investigation for Imported Case of Middle East Respiratory Syndrome, Germany
PDF Version [PDF - 359 KB - 6 pages]
A. Reuss et al.View SummaryView Abstract
No evidence was found for nosocomial transmission of this coronavirus.
On March 19, 2013, a patient from United Arab Emirates who had severe respiratory infection was transferred to a hospital in Germany, 11 days after symptom onset. Infection with Middle East respiratory syndrome coronavirus (MERS-CoV) was suspected on March 21 and confirmed on March 23; the patient, who had contact with an ill camel shortly before symptom onset, died on March 26. A contact investigation was initiated to identify possible person-to-person transmission and assess infection control measures. Of 83 identified contacts, 81 were available for follow-up. Ten contacts experienced mild symptoms, but test results for respiratory and serum samples were negative for MERS-CoV. Serologic testing was done for 53 (75%) of 71 nonsymptomatic contacts; all results were negative. Among contacts, the use of FFP2/FFP3 face masks during aerosol exposure was more frequent after MERS-CoV infection was suspected than before. Infection control measures may have prevented nosocomial transmission of the virus.
Efficiency of Points of Dispensing for Influenza A(H1N1)pdm09 Vaccination, Los Angeles County, California, USA, 2009
PDF Version [PDF - 462 KB - 6 pages]
S. Saha et al.View SummaryView Abstract
Placing vaccine clinics in high population density areas could be an effective strategy to reach large numbers of people.
During October 23–December 8, 2009, the Los Angeles County Department of Public Health used points of dispensing (PODs) to improve access to and increase the number of vaccinations against influenza A(H1N1)pdm09. We assessed the efficiency of these units and access to vaccines among ethnic groups. An average of 251 persons per hour (SE 65) were vaccinated at the PODs; a 10% increase in use of live-attenuated monovalent vaccines reduced that rate by 23 persons per hour (SE 7). Vaccination rates were highest for Asians (257/10,000 persons), followed by Hispanics (114/10,000), whites (75/100,000), and African Americans (37/10,000). Average distance traveled to a POD was highest for whites (6.6 miles; SD 6.5) and lowest for Hispanics (4.7 miles; SD ±5.3). Placing PODs in areas of high population density could be an effective strategy to reach large numbers of persons for mass vaccination, but additional PODs may be needed to improve coverage for specific populations.
Epidemic of Mumps among Vaccinated Persons, the Netherlands, 2009–2012
PDF Version [PDF - 694 KB - 6 pages]
J. Sane et al.View SummaryView Abstract
Mainly vaccinated students were affected, indicating inadequate vaccine effectiveness, but vaccination reduced risk for complications.
To analyze the epidemiology of a nationwide mumps epidemic in the Netherlands, we reviewed 1,557 notified mumps cases in persons who had disease onset during September 1, 2009–August 31, 2012. Seasonality peaked in spring and autumn. Most case-patients were males (59%), 18–25 years of age (67.9%), and vaccinated twice with measles-mumps-rubella vaccine (67.7%). Nearly half (46.6%) of cases occurred in university students or in persons with student contacts. Receipt of 2 doses of vaccine reduced the risk for orchitis, the most frequently reported complication (vaccine effectiveness [VE] 74%, 95% CI 57%–85%); complications overall (VE 76%, 95% CI 61%–86%); and hospitalization (VE 82%, 95% CI 53%–93%). Over time, the age distribution of case-patients changed, and proportionally more cases were reported from nonuniversity cities (p<0.001). Changes in age and geographic distribution over time may reflect increased immunity among students resulting from intense exposure to circulating mumps virus.
Rapid Increase in Pertactin-deficient Bordetella pertussis Isolates, Australia
PDF Version [PDF - 566 KB - 8 pages]
C. Lam et al.View SummaryView Abstract
This pattern is consistent with continuing evolution in response to vaccine selection pressure.
Acellular vaccines against Bordetella pertussis were introduced in Australia in 1997. By 2000, these vaccines had replaced whole-cell vaccines. During 2008–2012, a large outbreak of pertussis occurred. During this period, 30% (96/320) of B. pertussis isolates did not express the vaccine antigen pertactin (prn). Multiple mechanisms of prn inactivation were documented, including IS481 and IS1002 disruptions, a variation within a homopolymeric tract, and deletion of the prn gene. The mechanism of lack of expression of prn in 16 (17%) isolates could not be determined at the sequence level. These findings suggest that B. pertussis not expressing prn arose independently multiple times since 2008, rather than by expansion of a single prn-negative clone. All but 1 isolate had ptxA1, prn2, and ptxP3, the alleles representative of currently circulating strains in Australia. This pattern is consistent with continuing evolution of B. pertussis in response to vaccine selection pressure.
Underdiagnosis of Foodborne Hepatitis A, the Netherlands, 2008–2010
PDF Version [PDF - 380 KB - 7 pages]
M. Petrignani et al.View SummaryView Abstract
Routine typing of virus from serum from reported patients is useful for detection of foodborne outbreaks.
Outbreaks of foodborne hepatitis A are rarely recognized as such. Detection of these infections is challenging because of the infection’s long incubation period and patients’ recall bias. Nevertheless, the complex food market might lead to reemergence of hepatitis A virus outside of disease-endemic areas. To assess the role of food as a source of infection, we combined routine surveillance with real-time strain sequencing in the Netherlands during 2008–2010. Virus RNA from serum of 248 (59%) of 421 reported case-patients could be sequenced. Without typing, foodborne transmission was suspected for only 4% of reported case-patients. With typing, foodborne transmission increased to being the most probable source of infection for 16%. We recommend routine implementation of an enhanced surveillance system that includes prompt forwarding and typing of hepatitis A virus RNA isolated from serum, standard use of questionnaires, data sharing, and centralized interpretation of data.
Regional Variation in Travel-related Illness acquired in Africa, March 1997–May 2011
PDF Version [PDF - 558 KB - 10 pages]
M. Mendelson et al.View SummaryView Abstract
Travel-related illness acquired in Africa varies markedly by the geographic region visited on the continent.
To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.
Large Outbreak of Cryptosporidium hominis Infection Transmitted through the Public Water Supply, Sweden
PDF Version [PDF - 1.03 MB - 9 pages]
M. Widerström et al.View SummaryView Abstract
Use of inadequate microbial barriers at water treatment plants can have serious public health consequences.
In November 2010, ≈27,000 (≈45%) inhabitants of Östersund, Sweden, were affected by a waterborne outbreak of cryptosporidiosis. The outbreak was characterized by a rapid onset and high attack rate, especially among young and middle-aged persons. Young age, number of infected family members, amount of water consumed daily, and gluten intolerance were identified as risk factors for acquiring cryptosporidiosis. Also, chronic intestinal disease and young age were significantly associated with prolonged diarrhea. Identification of Cryptosporidium hominis subtype IbA10G2 in human and environmental samples and consistently low numbers of oocysts in drinking water confirmed insufficient reduction of parasites by the municipal water treatment plant. The current outbreak shows that use of inadequate microbial barriers at water treatment plants can have serious consequences for public health. This risk can be minimized by optimizing control of raw water quality and employing multiple barriers that remove or inactivate all groups of pathogens.
Gnathostoma spinigerum in Live Asian Swamp Eels (Monopterus spp.) from Food Markets and Wild Populations, United States
PDF Version [PDF - 642 KB - 9 pages]
R. A. Cole et al.View SummaryView Abstract
Imported live eels are a potential source of human gnathostomiasis.
In Southeast Asia, swamp eels (Synbranchidae: Monopterus spp.) are a common source of human gnathostomiasis, a foodborne zoonosis caused by advanced third-stage larvae (AL3) of Gnathostoma spp. nematodes. Live Asian swamp eels are imported to US ethnic food markets, and wild populations exist in several states. To determine whether these eels are infected, we examined 47 eels from markets and 67 wild-caught specimens. Nematodes were identified by morphologic features and ribosomal intergenic transcribed spacer–2 gene sequencing. Thirteen (27.7%) M. cuchia eels from markets were infected with 36 live G. spinigerum AL3: 21 (58.3%) in liver; 7 (19.4%) in muscle; 5 (13.8%) in gastrointestinal tract, and 3 (8.3%) in kidneys. Three (4.5%) wild-caught M. albus eels were infected with 5 G. turgidum AL3 in muscle, and 1 G. lamothei AL3 was found in a kidney (both North American spp.). Imported live eels are a potential source of human gnathostomiasis in the United States.
Medscape CME Activity
Travel-associated Antimicrobial Drug–Resistant Nontyphoidal Salmonellae, 2004–2009 PDF Version [PDF - 669 KB - 9 pages]R. S. Barlow et al.View SummaryView Abstract
Providers should evaluate patient travel history and bacterial serotype when considering antimicrobial therapy.
To evaluate trends in and risk factors for acquisition of antimicrobial-drug resistant nontyphoidal Salmonella infections, we searched Oregon surveillance data for 2004–2009 for all culture-confirmed cases of salmonellosis. We defined clinically important resistance (CIR) as decreased susceptibility to ampicillin, ceftriaxone, ciprofloxacin, gentamicin, or trimethoprim/sulfamethoxazole. Of 2,153 cases, 2,127 (99%) nontyphoidal Salmonella isolates were obtained from a specific source (e.g., feces, urine, blood, or other normally sterile tissue) and had been tested for drug susceptibility. Among these, 347 (16%) isolates had CIR. The odds of acquiring CIR infection significantly increased each year. Hospitalization was more likely for patients with than without CIR infections. Among patients with isolates that had been tested, we analyzed data from 1,813 (84%) who were interviewed. Travel to eastern or Southeast Asia was associated with increased CIR. Isolates associated with outbreaks were less likely to have CIR. Future surveillance activities should evaluate resistance with respect to international travel.
Rotavirus Surveillance in Urban and Rural Areas of Niger, April 2010–March 2012
PDF Version [PDF - 460 KB - 8 pages]
A. Page et al.View SummaryView Abstract
The emergence of G12P warrants close attention to the characteristics of associated epidemics and possible prevention measures.
Knowledge of rotavirus epidemiology is necessary to make informed decisions about vaccine introduction and to evaluate vaccine impact. During April 2010–March 2012, rotavirus surveillance was conducted among 9,745 children <5 years of age in 14 hospitals/health centers in Niger, where rotavirus vaccine has not been introduced. Study participants had acute watery diarrhea and moderate to severe dehydration, and 20% of the children were enrolled in a nutrition program. Of the 9,745 children, 30.6% were rotavirus positive. Genotyping of a subset of positive samples showed a variety of genotypes during the first year, although G2P predominated. G12 genotypes, including G12P, which has emerged as a predominant strain in western Africa, represented >80% of isolates during the second year. Hospitalization and death rates and severe dehydration among rotavirus case-patients did not differ during the 2 years. The emergence of G12P warrants close attention to the characteristics of associated epidemics and possible prevention measures.
Novel Betacoronavirus in Dromedaries of the Middle East, 2013
PDF Version [PDF - 749 KB - 13 pages]
P. Woo et al.View SummaryView Abstract
Continuous surveillance is needed to understand the potential for virus emergence in camels and subsequent transmission to humans.
In 2013, a novel betacoronavirus was identified in fecal samples from dromedaries in Dubai, United Arab Emirates. Antibodies against the recombinant nucleocapsid protein of the virus, which we named dromedary camel coronavirus (DcCoV) UAE-HKU23, were detected in 52% of 59 dromedary serum samples tested. In an analysis of 3 complete DcCoV UAE-HKU23 genomes, we identified the virus as a betacoronavirus in lineage A1. The DcCoV UAE-HKU23 genome has G+C contents; a general preference for G/C in the third position of codons; a cleavage site for spike protein; and a membrane protein of similar length to that of other betacoronavirus A1 members, to which DcCoV UAE-HKU23 is phylogenetically closely related. Along with this coronavirus, viruses of at least 8 other families have been found to infect camels. Because camels have a close association with humans, continuous surveillance should be conducted to understand the potential for virus emergence in camels and for virus transmission to humans.
High Rates of Antimicrobial Drug Resistance Gene Acquisition after International Travel, the Netherlands
PDF Version [PDF - 1.23 MB - 9 pages]
C. von Wintersdorff et al.View SummaryView Abstract
The metagenomic approach used might detect resistance genes in more species than culturing bacteria does.
We investigated the effect of international travel on the gut resistome of 122 healthy travelers from the Netherlands by using a targeted metagenomic approach. Our results confirm high acquisition rates of the extended-spectrum β-lactamase encoding gene blaCTX-M, documenting a rise in prevalence from 9.0% before travel to 33.6% after travel (p<0.001). The prevalence of quinolone resistance encoding genes qnrB and qnrS increased from 6.6% and 8.2% before travel to 36.9% and 55.7% after travel, respectively (both p<0.001). Travel to Southeast Asia and the Indian subcontinent was associated with the highest acquisition rates of qnrS and both blaCTX-M and qnrS, respectively. Investigation of the associations between the acquisitions of the blaCTX-M and qnr genes showed that acquisition of a blaCTX-M gene was not associated with that of a qnrB (p = 0.305) or qnrS (p = 0.080) gene. These findings support the increasing evidence that travelers contribute to the spread of antimicrobial drug resistance.
Spread of Virulent Group A Streptococcus Type emm59 from Montana to Wyoming, USA
PDF Version [PDF - 286 KB - 3 pages]
C. C. Brown et al.View Abstract
Full-genome sequencing showed that a recently emerged and hypervirulent clone of group A Streptococcus type emm59 active in Canada and parts of the United States has now caused severe invasive infections in rural northeastern Wyoming. Phylogenetic analysis of genome data indicated that the strain was likely introduced from Montana.
Burkholderia pseudomallei Type G in Western Hemisphere
PDF Version [PDF - 468 KB - 3 pages]
J. E. Gee et al.View Abstract
Burkholderia pseudomallei isolates from the Western Hemisphere are difficult to differentiate from those from regions in which melioidosis is traditionally endemic. We used internal transcribed spacer typing to determine that B. pseudomallei isolates from the Western Hemisphere are consistently type G. Knowledge of this relationship might be useful for epidemiologic investigations.
Invasive Salmonella enterica Serotype Typhimurium Infections, Democratic Republic of the Congo, 2007–2011
PDF Version [PDF - 419 KB - 4 pages]
B. Ley et al.View Abstract
Infection with Salmonella enterica serotype Typhimurium sequence type (ST) 313 is associated with high rates of drug resistance, bloodstream infections, and death. To determine whether ST313 is dominant in the Democratic Republic of the Congo, we studied 180 isolates collected during 2007–2011; 96% belonged to CRISPOL type CT28, which is associated with ST313.
Complete Genome of Hepatitis E Virus from Laboratory Ferrets
PDF Version [PDF - 867 KB - 4 pages]
T. Li et al.View Abstract
The complete genome of hepatitis E virus (HEV) from laboratory ferrets imported from the United States was identified. This virus shared only 82.4%–82.5% nt sequence identities with strains from the Netherlands, which indicated that the ferret HEV genome is genetically diverse. Some laboratory ferrets were contaminated with HEV.
New Alphacoronavirus in Mystacina tuberculata Bats, New Zealand
PDF Version [PDF - 541 KB - 4 pages]
R. J. Hall et al.View Abstract
Because of recent interest in bats as reservoirs of emerging diseases, we investigated the presence of viruses in Mystacina tuberculata bats in New Zealand. A novel alphacoronavirus sequence was detected in guano from roosts of M. tuberculata bats in pristine indigenous forest on a remote offshore island (Codfish Island).
Vibrio parahaemolyticus, Southern Coastal Region of China, 2007–2012
PDF Version [PDF - 390 KB - 4 pages]
Y. Li et al.View Abstract
We analyzed the prevalence and characteristics of Vibrio parahaemolyticus among patients with acute infectious diarrhea in the southern coastal region of China. V. parahaemolyticus was the leading cause of bacterial infectious diarrhea in this region during 2007–2012. Serotype O3:K6 strains were most common, followed by serotypes O4:K8 and O3:K29.
Pathology of US Porcine Epidemic Diarrhea Virus Strain PC21A in Gnotobiotic Pigs
PDF Version [PDF - 386 KB - 4 pages]
K. Jung et al.View Abstract
To understand the progression of porcine epidemic diarrhea virus infection, we inoculated gnotobiotic pigs with a newly emerged US strain, PC21A, of the virus. At 24–48 hours postinoculation, the pigs exhibited severe diarrhea and vomiting, fecal shedding, viremia, and severe atrophic enteritis. These findings confirm that strain PC21A is highly enteropathogenic.
Cetacean Morbillivirus in Coastal Indo-Pacific Bottlenose Dolphins, Western Australia
PDF Version [PDF - 614 KB - 5 pages]
N. Stephens et al.View Abstract
Cetacean morbillivirus (CeMV) has caused several epizootics in multiple species of cetaceans globally and is an emerging disease among cetaceans in Australia. We detected CeMV in 2 stranded coastal Indo-Pacific bottlenose dolphins (Tursiops aduncus) in Western Australia. Preliminary phylogenetic data suggest that this virus variant is divergent from known strains.
Hepatitis E Antibodies in Laboratory Rabbits from 2 US Vendors
PDF Version [PDF - 550 KB - 4 pages]
L. Birke et al.View Abstract
We tested laboratory rabbits from 2 US vendors for antibodies against hepatitis E virus (HEV); Seroprevalences were 40% and 50%. Retrospective analysis of an ocular herpes simplex 1 experiment demonstrated that HEV seropositivity had no effect on experiment outcome. HEV probably is widespread in research rabbits, but effects on research remain unknown.
Clinical Malaria along the China–Myanmar Border, Yunnan Province, China, January 2011–August 2012
PDF Version [PDF - 432 KB - 4 pages]
G. Zhou et al.View Abstract
Passive surveillance for malaria cases was conducted in Yunnan Province, China, along the China–Myanmar border. Infection with Plasmodium vivax and P. falciparum protozoa accounted for 69% and 28% of the cases, respectively. Most patients were adult men. Cross-border travel into Myanmar was a key risk factor for P. falciparum malaria in China.
Characteristics of Patients Infected with Norovirus GII.4 Sydney 2012, Hong Kong, China
PDF Version [PDF - 479 KB - 4 pages]
M. Chan et al.View Abstract
Norovirus GII.4 Sydney 2012 has spread globally since late 2012. We report hospitalization of patients infected with this strain skewed toward infants and young children among 174 cases during August 2012–July 2013 in Hong Kong, China. This group had higher fecal viral load (≈10-fold) than did older children and adults.
Salmonella Subtypes with Increased MICs for Azithromycin in Travelers Returned to the Netherlands
PDF Version [PDF - 394 KB - 4 pages]
R. Hassing et al.View Abstract
Antimicrobial susceptibility was analyzed for 354 typhoidal Salmonella isolates collected during 1999–2012 in the Netherlands. In 16.1% of all isolates and in 23.8% of all isolates that showed increased MICs for ciprofloxacin, the MIC for azithromycin was increased. This resistance may complicate empirical treatment of enteric fever.
Diagnostic Methods for and Clinical Pictures of Polyomavirus Primary Infections in Children, Finland
PDF Version [PDF - 351 KB - 4 pages]
T. Chen et al.View Abstract
We used comprehensive serodiagnostic methods (IgM, IgG, and IgG avidity) and PCR to study Merkel cell polyomavirus and trichodysplasia spinulosa-associated polyomavirus infections in children observed from infancy to adolescence. Comparing seroconversion intervals with previous and subsequent intervals, we found that primary infections with these 2 viruses were asymptomatic in childhood.
Genetic Characterization of Clade 18.104.22.168 Avian Influenza A(H5N1) Viruses, Indonesia, 2012
PDF Version [PDF - 518 KB - 4 pages]
N. Dharmayanti et al.View Abstract
After reports of unusually high mortality rates among ducks on farms in Java Island, Indonesia, in September 2012, influenza A(H5N1) viruses were detected and characterized. Sequence analyses revealed all genes clustered with contemporary clade 22.214.171.124 viruses, rather than enzootic clade 2.1.3 viruses, indicating the introduction of an exotic H5N1 clade into Indonesia.
Incorporating Research and Evaluation into Pandemic Influenza Vaccination Preparedness and Response
PDF Version [PDF - 722 KB - 2 pages]
T. T. Shimabukuro and S. C. Redd
Decline of Salmonella enterica Serotype Choleraesuis Infections, Taiwan
PDF Version [PDF - 311 KB - 2 pages]
L. Su et al.
Q Fever Endocarditis and New Coxiella burnetii Genotype, Saudi Arabia
PDF Version [PDF - 307 KB - 3 pages]
E. Angelakis et al.
Nosocomial Drug-Resistant Bacteremia in 2 Cohorts with Cryptococcal Meningitis, Africa
PDF Version [PDF - 283 KB - 3 pages]
R. Rajasingham et al.
Detection of Rickettsia sibirica mongolitimonae by Using Cutaneous Swab Samples and Quantitative PCR
PDF Version [PDF - 338 KB - 3 pages]
J. Solary et al.
Severe Babesiosis in Immunocompetent Man, Spain, 2011
PDF Version [PDF - 279 KB - 3 pages]
L. M. Gonzalez et al.
St. Louis Encephalitis Virus Infection in Woman, Peru
PDF Version [PDF - 315 KB - 3 pages]
V. Felices et al.
Pandemic Vibrio parahaemolyticus, Maryland, USA, 2012
PDF Version [PDF - 303 KB - 3 pages]
J. Haendiges et al.
Serologic Evidence of Leptospirosis in Humans, Union of the Comoros, 2011
PDF Version [PDF - 286 KB - 3 pages]
Y. Gomard et al.
Whole-Genome Sequencing for Risk Assessment of Long-term Shiga Toxin–producing Escherichia coli
PDF Version [PDF - 269 KB - 3 pages]
J. Knobloch et al.
Lack of MERS Coronavirus but Prevalence of Influenza Virus in French Pilgrims after 2013 Hajj
PDF Version [PDF - 287 KB - 3 pages]
P. Gautret et al.
About the Cover
- Page created: March 20, 2014
- Page last updated: March 20, 2014
- Page last reviewed: March 20, 2014
- Centers for Disease Control and Prevention,
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