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Volume 20, Number 5—May 2014
Volume 20, Number 5—May 2014 PDF Version [PDF - 10.66 MB - 191 pages]
Bat Flight and Zoonotic Viruses
PDF Version [PDF - 326 KB - 5 pages]
T. J. O’Shea et al.View SummaryView Abstract
High metabolism and body temperatures of flying bats might enable them to host many viruses.
Bats are sources of high viral diversity and high-profile zoonotic viruses worldwide. Although apparently not pathogenic in their reservoir hosts, some viruses from bats severely affect other mammals, including humans. Examples include severe acute respiratory syndrome coronaviruses, Ebola and Marburg viruses, and Nipah and Hendra viruses. Factors underlying high viral diversity in bats are the subject of speculation. We hypothesize that flight, a factor common to all bats but to no other mammals, provides an intensive selective force for coexistence with viral parasites through a daily cycle that elevates metabolism and body temperature analogous to the febrile response in other mammals. On an evolutionary scale, this host–virus interaction might have resulted in the large diversity of zoonotic viruses in bats, possibly through bat viruses adapting to be more tolerant of the fever response and less virulent to their natural hosts.
Medscape CME Activity
Outbreaks of Kingella kingae Infections in Daycare Facilities PDF Version [PDF - 501 KB - 8 pages]P. YagupskyView SummaryView Abstract
Improved methods for identifying infected children and carriers are needed to adequately investigate outbreaks of K. kingae.
During the past decade, transmission of the bacterium Kingella kingae has caused clusters of serious infections, including osteomyelitis, septic arthritis, bacteremia, endocarditis, and meningitis, among children in daycare centers in the United States, France, and Israel. These events have been characterized by high attack rates of disease and prevalence of the invasive strain among asymptomatic classmates of the respective index patients, suggesting that the causative organisms benefitted from enhanced colonization fitness, high transmissibility, and high virulence. After prophylactic antibacterial drugs were administered to close contacts of infected children, no further cases of disease were detected in the facilities, although test results showed that some children still carried the bacterium. Increased awareness of this public health problem and use of improved culture methods and sensitive nucleic acid amplification assays for detecting infected children and respiratory carriers are needed to identify and adequately investigate outbreaks of K. kingae disease.
Molecular Investigation of Tularemia Outbreaks, Spain, 1997–2008
PDF Version [PDF - 646 KB - 8 pages]
J. Ariza-Miguel et al.View SummaryView Abstract
This disease has reemerged because of persistence of local reservoirs of infection.
Tularemia outbreaks occurred in northwestern Spain in 1997–1998 and 2007–2008 and affected >1,000 persons. We assessed isolates involved in these outbreaks by using pulsed-field gel electrophoresis with 2 restriction enzymes and multilocus variable number tandem repeat analysis of 16 genomic loci of Francisella tularensis, the cause of this disease. Isolates were divided into 3 pulsotypes by pulsed-field gel electrophoresis and 8 allelic profiles by multilocus variable number tandem repeat analysis. Isolates obtained from the second tularemia outbreak had the same genotypes as isolates obtained from the first outbreak. Both outbreaks were caused by genotypes of genetic subclade B.Br:FTNF002–00, which is widely distributed in countries in central and western Europe. Thus, reemergence of tularemia in Spain was not caused by the reintroduction of exotic strains, but probably by persistence of local reservoirs of infection.
Bovine Leukemia Virus DNA in Human Breast Tissue
PDF Version [PDF - 626 KB - 11 pages]
G. Buehring et al.View SummaryView Abstract
Molecular evidence for this virus in humans raises public health concerns.
Bovine leukemia virus (BLV), a deltaretrovirus, causes B-cell leukemia/lymphoma in cattle and is prevalent in herds globally. A previous finding of antibodies against BLV in humans led us to examine the possibility of human infection with BLV. We focused on breast tissue because, in cattle, BLV DNA and protein have been found to be more abundant in mammary epithelium than in lymphocytes. In human breast tissue specimens, we identified BLV DNA by using nested liquid-phase PCR and DNA sequencing. Variations from the bovine reference sequence were infrequent and limited to base substitutions. In situ PCR and immunohistochemical testing localized BLV to the secretory epithelium of the breast. Our finding of BLV in human tissues indicates a risk for the acquisition and proliferation of this virus in humans. Further research is needed to determine whether BLV may play a direct role in human disease.
Trends in Infectious Disease Mortality Rates, Spain, 1980–2011
PDF Version [PDF - 484 KB - 7 pages]
T. López-Cuadrado et al.View SummaryView Abstract
Surveillance and control systems should be reinforced to provide reliable data.
Using mortality data from National Institute of Statistics in Spain, we analyzed trends of infectious disease mortality rates in Spain during 1980–2011 to provide information on surveillance and control of infectious diseases. During the study period, 628,673 infectious disease–related deaths occurred, the annual change in the mortality rate was −1.6%, and the average infectious disease mortality rate was 48.5 deaths/100,000 population. Although the beginning of HIV/AIDS epidemic led to an increased mortality rate, a decreased rate was observed by the end of the twentieth century. By codes from the International Classification of Diseases, 9th revision, the most frequent underlying cause of death was pneumonia. Emergence and reemergence of infectious diseases continue to be public health problems despite reduced mortality rates produced by various interventions. Therefore, surveillance and control systems should be reinforced with a goal of providing reliable data for useful decision making.
Carriage Rate and Effects of Vaccination after Outbreaks of Serogroup C Meningococcal Disease, Brazil, 2010
PDF Version [PDF - 395 KB - 6 pages]
M. Sáfadi et al.View SummaryView Abstract
Polysaccharide vaccine did not affect carriage nor interrupt transmission of an epidemic strain.
During 2010, outbreaks of serogroup C meningococcal (MenC) disease occurred in 2 oil refineries in São Paulo State, Brazil, leading to mass vaccination of employees at 1 refinery with a meningococcal polysaccharide A/C vaccine. A cross-sectional study was conducted to assess the prevalence of meningococci carriage among workers at both refineries and to investigate the effect of vaccination on and the risk factors for pharyngeal carriage of meningococci. Among the vaccinated and nonvaccinated workers, rates of overall meningococci carriage (21.4% and 21.6%, respectively) and of MenC carriage (6.3% and 4.9%, respectively) were similar. However, a MenC strain belonging to the sequence type103 complex predominated and was responsible for the increased incidence of meningococcal disease in Brazil. A low education level was associated with higher risk of meningococci carriage. Polysaccharide vaccination did not affect carriage or interrupt transmission of the epidemic strain. These findings will help inform future vaccination strategies.
Human Papillomavirus Prevalence in Oropharyngeal Cancer before Vaccine Introduction, United States
PDF Version [PDF - 958 KB - 7 pages]
M. Steinau et al.View SummaryView Abstract
Prevalence of HPVs in oropharyngeal cancer DNA suggests that vaccines could prevent most cases.
We conducted a study to determine prevalence of HPV types in oropharyngeal cancers in the United States and establish a prevaccine baseline for monitoring the impact of vaccination. HPV DNA was extracted from tumor tissue samples from patients in whom cancer was diagnosed during 1995–2005. The samples were obtained from cancer registries and Residual Tissue Repository Program sites in the United States. HPV was detected and typed by using PCR reverse line blot assays. Among 557 invasive oropharyngeal squamous cell carcinomas, 72% were positive for HPV and 62% for vaccine types HPV16 or 18. Prevalence of HPV-16/18 was lower in women (53%) than in men (66%), and lower in non-Hispanic Black patients (31%) than in other racial/ethnic groups (68%–80%). Results indicate that vaccines could prevent most oropharyngeal cancers in the United States, but their effect may vary by demographic variables.
Treatment Practices, Outcomes, and Costs of Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis, United States, 2005–2007
PDF Version [PDF - 590 KB - 10 pages]
S. M. Marks et al.View SummaryView Abstract
Drug resistance was extensive and care was complex; nevertheless, high rates of treatment completion were achieved albeit at considerable cost.
To describe factors associated with multidrug-resistant (MDR), including extensively-drug-resistant (XDR), tuberculosis (TB) in the United States, we abstracted inpatient, laboratory, and public health clinic records of a sample of MDR TB patients reported to the Centers for Disease Control and Prevention from California, New York City, and Texas during 2005–2007. At initial diagnosis, MDR TB was detected in 94% of 130 MDR TB patients and XDR TB in 80% of 5 XDR TB patients. Mutually exclusive resistance was 4% XDR, 17% pre-XDR, 24% total first-line resistance, 43% isoniazid/rifampin/rifabutin-plus-other resistance, and 13% isoniazid/rifampin/rifabutin-only resistance. Nearly three-quarters of patients were hospitalized, 78% completed treatment, and 9% died during treatment. Direct costs, mostly covered by the public sector, averaged $134,000 per MDR TB and $430,000 per XDR TB patient; in comparison, estimated cost per non-MDR TB patient is $17,000. Drug resistance was extensive, care was complex, treatment completion rates were high, and treatment was expensive.
Molecular Characterization of Cryptically Circulating Rabies Virus from Ferret Badgers, Taiwan
PDF Version [PDF - 678 KB - 9 pages]
H. Chiou et al.View SummaryView Abstract
The virus has been circulating in Taiwan for about 100 years.
After the last reported cases of rabies in a human in 1959 and a nonhuman animal in 1961, Taiwan was considered free from rabies. However, during 2012–2013, an outbreak occurred among ferret badgers in Taiwan. To examine the origin of this virus strain, we sequenced 3 complete genomes and acquired multiple rabies virus (RABV) nucleoprotein and glycoprotein sequences. Phylogeographic analyses demonstrated that the RABV affecting the Taiwan ferret badgers (RABV-TWFB) is a distinct lineage within the group of lineages from Asia and that it has been differentiated from its closest lineages, China I (including isolates from Chinese ferret badgers) and the Philippines, 158–210 years ago. The most recent common ancestor of RABV-TWFB originated 91–113 years ago. Our findings indicate that RABV could be cryptically circulating in the environment. An understanding of the underlying mechanism might shed light on the complex interaction between RABV and its host.
Streptococcus mitis Strains Causing Severe Clinical Disease in Cancer Patients
PDF Version [PDF - 962 KB - 10 pages]
S. A. Shelburne et al.View SummaryView Abstract
This species has a critical role in invasive viridans group streptococci bloodstream infections.
The genetically diverse viridans group streptococci (VGS) are increasingly recognized as the cause of a variety of human diseases. We used a recently developed multilocus sequence analysis scheme to define the species of 118 unique VGS strains causing bacteremia in patients with cancer; Streptococcus mitis (68 patients) and S. oralis (22 patients) were the most frequently identified strains. Compared with patients infected with non–S. mitis strains, patients infected with S. mitis strains were more likely to have moderate or severe clinical disease (e.g., VGS shock syndrome). Combined with the sequence data, whole-genome analyses showed that S. mitis strains may more precisely be considered as >2 species. Furthermore, we found that multiple S. mitis strains induced disease in neutropenic mice in a dose-dependent fashion. Our data define the prominent clinical effect of the group of organisms currently classified as S. mitis and lay the groundwork for increased understanding of this understudied pathogen.
Persistence and Complex Evolution of Fluoroquinolone-Resistant Streptococcus pneumoniae Clone
PDF Version [PDF - 468 KB - 7 pages]
D. Ben-David et al.View SummaryView Abstract
This clone has persisted in a post–acute care facility for >5 years.
Prolonged outbreaks of multidrug-resistant Streptococcus pneumoniae in health care facilities are uncommon. We found persistent transmission of a fluroquinolone-resistant S. pneumoniae clone during 2006–2011 in a post–acute care facility in Israel, despite mandatory vaccination and fluoroquinolone restriction. Capsular switch and multiple antimicrobial nonsusceptibility mutations occurred within this single clone. The persistent transmission of fluoroquinolone-resistant S. pneumoniae during a 5-year period underscores the importance of long-term care facilities as potential reservoirs of multidrug-resistant streptococci.
PCR for Detection of Oseltamivir Resistance Mutation in Influenza A(H7N9) Virus
PDF Version [PDF - 321 KB - 3 pages]
W. Wang et al.View Abstract
Sensitive molecular techniques are needed for rapid detection of the R292K oseltamivir-resistant mutant of influenza A(H7/N9) virus strain to monitor its transmission and guide antiviral treatment. We developed a real-time reverse transcription PCR and single nucleotide polymorphism probes to differentiate this mutant strain in mixed virus populations in human specimens.
Francisella tularensis subsp. tularensis Group A.I, United States
PDF Version [PDF - 446 KB - 5 pages]
D. N. Birdsell et al.View Abstract
We used whole-genome analysis and subsequent characterization of geographically diverse strains using new genetic signatures to identify distinct subgroups within Francisella tularensis subsp. tularensis group A.I: A.I.3, A.I.8, and A.I.12. These subgroups exhibit complex phylogeographic patterns within North America. The widest distribution was observed for A.I.12, which suggests an adaptive advantage.
Novel Avian Influenza A(H7N9) Virus in Tree Sparrow, Shanghai, China, 2013
PDF Version [PDF - 427 KB - 4 pages]
B. Zhao et al.View Abstract
In spring 2013, influenza A(H7N9) virus was isolated from an apparently healthy tree sparrow in Chongming Dongping National Forest Park, Shanghai City, China. The entire gene constellation of the virus is similar to that of isolates from humans, highlighting the need to monitor influenza A(H7N9) viruses in different species.
Full-Genome Analysis of Avian Influenza A(H5N1) Virus from a Human, North America, 2013
PDF Version [PDF - 644 KB - 5 pages]
K. Pabbaraju et al.View Abstract
Full-genome analysis was conducted on the first isolate of a highly pathogenic avian influenza A(H5N1) virus from a human in North America. The virus has a hemagglutinin gene of clade 126.96.36.199c and is a reassortant with an H9N2 subtype lineage polymerase basic 2 gene. No mutations conferring resistance to adamantanes or neuraminidase inhibitors were found.
Influenza A(H5N2) Virus Antibodies in Humans after Contact with Infected Poultry, Taiwan, 2012
PDF Version [PDF - 417 KB - 4 pages]
H. Wu et al.View Abstract
Six persons in Taiwan who had contact with poultry infected with influenza A(H5N2) showed seroconversion for the virus by hemagglutinin inhibition or microneutralization testing. We developed an ELISA based on nonstructural protein 1 of the virus to differentiate natural infection from cross-reactivity after vaccination; 2 persons also showed seroconversion by this test.
Responses to Threat of Influenza A(H7N9) and Support for Live Poultry Markets, Hong Kong, 2013
PDF Version [PDF - 499 KB - 5 pages]
P. Wu et al.View Abstract
We conducted a population survey in Hong Kong to gauge psychological and behavioral responses to the threat of influenza A(H7N9) and support for closure of live poultry markets. We found low anxiety and low levels of exposure to live poultry but mixed support for permanent closure of the markets.
Role of Transportation in Spread of Porcine Epidemic Diarrhea Virus Infection, United States
PDF Version [PDF - 364 KB - 3 pages]
J. Lowe et al.View Abstract
After porcine epidemic diarrhea virus (PEDV) was detected in the United States in 2013, we tested environmental samples from trailers in which pigs had been transported. PEDV was found in 5.2% of trailers not contaminated at arrival, , suggesting that the transport process is a source of transmission if adequate hygiene measures are not implemented.
Human Infections with Rickettsia raoultii, China
PDF Version [PDF - 359 KB - 3 pages]
N. Jia et al.View Abstract
We used molecular methods to identify Rickettsia raoultii infections in 2 persons in China. These persons had localized rashes around sites of tick bites. R. raoultii DNA was detected in 4% of Dermacentor silvarum ticks collected in the same area of China and in 1 feeding tick detached from 1 patient.
Factors Associated with Antimicrobial Drug Use in Medicaid Programs
PDF Version [PDF - 337 KB - 4 pages]
P. Li et al.View Abstract
Using US Medicaid data, we found that 52% of adult Medicaid patients with acute respiratory tract infections filled prescriptions for antimicrobial drugs in 2007. Factors associated with lower likelihood of use were higher county-level availability of primary care physicians and state-level participation in a campaign for appropriate antimicrobial drug use.
Chronic Wasting Disease Agents in Nonhuman Primates
PDF Version [PDF - 441 KB - 5 pages]
B. Race et al.View Abstract
Chronic wasting disease is a prion disease of cervids. Assessment of its zoonotic potential is critical. To evaluate primate susceptibility, we tested monkeys from 2 genera. We found that 100% of intracerebrally inoculated and 92% of orally inoculated squirrel monkeys were susceptible, but cynomolgus macaques were not, suggesting possible low risk for humans.
Shigella spp. with Reduced Azithromycin Susceptibility, Quebec, Canada, 2012–2013
PDF Version [PDF - 379 KB - 3 pages]
C. Gaudreau et al.View Abstract
During 2012–2013 in Montreal, Canada, 4 locally acquired Shigella spp. pulse types with the mph(A) gene and reduced susceptibility to azithromycin were identified from 9 men who have sex with men, 7 of whom were HIV infected. Counseling about prevention of enteric sexually transmitted infections might help slow transmission of these organisms.
Acute Lower Respiratory Tract Infections in Soldiers, South Korea, April 2011–March 2012
PDF Version [PDF - 291 KB - 3 pages]
J. Heo et al.View Abstract
During April 2011–March 2012, we retrospectively reviewed medical records for South Korea soldiers to assess the etiology and epidemiology of acute viral lower respiratory tract infections. Adenovirus was the most commonly identified virus (63.2%) and the most common cause of pneumonia (79.3%) and hospitalization (76.6%); 3 soldiers died of adenovirus-related illness.
Extensively Drug-Resistant Streptococcus pneumoniae, South Korea, 2011–2012
PDF Version [PDF - 315 KB - 3 pages]
S. Cho et al.View Abstract
To better understand extensively drug resistant Streptococcus pneumoniae, we assessed clinical and microbiological characteristics of 5 extensively drug-resistant pneumococcal isolates. We concluded that long-term care facility residents who had undergone tracheostomy might be reservoirs of these pneumococci; 13- and 23-valent pneumococcal vaccines should be considered for high-risk persons; and antimicrobial drugs should be used judiciously.
Influenza A Subtype H3 Viruses in Feral Swine, United States, 2011–2012
PDF Version [PDF - 486 KB - 4 pages]
Z. Feng et al.View Abstract
To determine whether, and to what extent, influenza A subtype H3 viruses were present in feral swine in the United States, we conducted serologic and virologic surveillance during October 2011–September 2012. These animals were periodically exposed to and infected with A(H3N2) viruses, suggesting they may threaten human and animal health.
Influenza-associated Hospitalizations and Deaths, Costa Rica, 2009–2012
PDF Version [PDF - 415 KB - 4 pages]
G. Saborío et al.View Abstract
Data needed to guide influenza vaccine policies are lacking in tropical countries. We multiplied the number of severe acute respiratory infections by the proportion testing positive for influenza. There were ≈6,699 influenza hospitalizations and 803 deaths in Costa Rica during 2009–2012, supporting continuation of a national influenza vaccine program.
Rickettsia spp. in Seabird Ticks from Western Indian Ocean Islands, 2011–2012
PDF Version [PDF - 726 KB - 5 pages]
M. Dietrich et al.View Abstract
We found a diversity of Rickettsia spp. in seabird ticks from 6 tropical islands. The bacteria showed strong host specificity and sequence similarity with strains in other regions. Seabird ticks may be key reservoirs for pathogenic Rickettsia spp., and bird hosts may have a role in dispersing ticks and tick-associated infectious agents over large distances.
Ciprofloxacin-Resistant Salmonella enterica Serotype Kentucky Sequence Type 198
PDF Version [PDF - 315 KB - 2 pages]
R. Rickert-Hartman and J. P. Folster
Coxsackievirus A16 Encephalitis during Obinutuzumab Therapy, Belgium, 2013
PDF Version [PDF - 274 KB - 3 pages]
T. Eyckmans et al.
Babesia venatorum Infection in Child, China
PDF Version [PDF - 300 KB - 2 pages]
Y. Sun et al.
Myasthenia Gravis Associated with Acute Hepatitis E Infection in Immunocompetent Woman
PDF Version [PDF - 306 KB - 3 pages]
A. Belbezier et al.
New Variant of Porcine Epidemic Diarrhea Virus, United States, 2014
PDF Version [PDF - 609 KB - 3 pages]
L. Wang et al.
Unique Strain of Crimean–Congo Hemorrhagic Fever Virus, Mali
PDF Version [PDF - 363 KB - 3 pages]
M. Zivcec et al.
Linezolid-Resistant Staphylococcus epidermidis, Portugal, 2012
PDF Version [PDF - 319 KB - 3 pages]
M. Barros et al.
Composite SCCmec Element in Single-locus Variant (ST217) of Epidemic MRSA-15 Clone
PDF Version [PDF - 299 KB - 3 pages]
C. Vignaroli et al.
Bartonella quintana in Body Lice from Scalp Hair of Homeless Persons, France
PDF Version [PDF - 291 KB - 2 pages]
R. Drali et al.
Serologic Evidence of Influenza A(H1N1)pdm09 Virus Infection in Northern Sea Otters
PDF Version [PDF - 289 KB - 3 pages]
Z. Li et al.
Staphylococcus aureus Carrying mecC Gene in Animals and Urban Wastewater, Spain
PDF Version [PDF - 313 KB - 3 pages]
M. Porrero et al.
Schmallenberg Virus Antibodies in Adult Cows and Maternal Antibodies in Calves
PDF Version [PDF - 314 KB - 2 pages]
A. Elbers et al.
Extended-Spectrum β-Lactamases in Escherichia coli and Klebsiella pneumoniae in Gulls, Alaska, USA
PDF Version [PDF - 302 KB - 3 pages]
J. Bonnedahl et al.
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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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- Page created: April 18, 2014
- Page last updated: April 18, 2014
- Page last reviewed: April 18, 2014
- Centers for Disease Control and Prevention,
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