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Volume 20, Number 7—July 2014
Volume 20, Number 7—July 2014 PDF Version [PDF - 9.05 MB - 183 pages]
Salmonella enterica Serovar Enteritidis, England and Wales, 1945–2011
PDF Version [PDF - 687 KB - 8 pages]
C. R. Lane et al.View SummaryView Abstract
A focus on eliminating phage type 4 in egg and poultry production has greatly reduced foodborne disease among humans.
In England and Wales, the emergence of Salmonella enterica serovar Enteritidis resulted in the largest and most persistent epidemic of foodborne infection attributable to a single subtype of any pathogen since systematic national microbiological surveillance was established. We reviewed 67 years of surveillance data to examine the features, underlying causes, and overall effects of S. enterica ser. Enteritidis. The epidemic was associated with the consumption of contaminated chicken meat and eggs, and a decline in the number of infections began after the adoption of vaccination and other measures in production and distribution of chicken meat and eggs. We estimate that >525,000 persons became ill during the course of the epidemic, which caused a total of 6,750,000 days of illness, 27,000 hospitalizations, and 2,000 deaths. Measures undertaken to control the epidemic have resulted in a major reduction in foodborne disease in England and Wales.
Medscape CME Activity
Lessons for Control of Heroin-Associated Anthrax in Europe from 2009–2010 Outbreak Case Studies, London, UK PDF Version [PDF - 449 KB - 8 pages]A. Abbara et al.View SummaryView Abstract
Serologic surveillance should be implemented to identify the prevalence of this disease in persons who inject drugs.
Outbreaks of serious infections associated with heroin use in persons who inject drugs (PWIDs) occur intermittently and require vigilance and rapid reporting of individual cases. Here, we give a firsthand account of the cases in London during an outbreak of heroin-associated anthrax during 2009–2010 in the United Kingdom. This new manifestation of anthrax has resulted in a clinical manifestation distinct from already recognized forms. During 2012–13, additional cases of heroin-associated anthrax among PWIDs in England and other European countries were reported, suggesting that anthrax-contaminated heroin remains in circulation. Antibacterial drugs used for serious soft tissue infection are effective against anthrax, which may lead to substantial underrecognition of this novel illness. The outbreak in London provides a strong case for ongoing vigilance and the use of serologic testing in diagnosis and serologic surveillance schemes to determine and monitor the prevalence of anthrax exposure in the PWID community.
Epidemiology, Clinical Manifestations, and Outcomes of Streptococcus suis Infection in Humans
PDF Version [PDF - 768 KB - 10 pages]
V. Huong et al.View SummaryView Abstract
Infection occurs mainly in Asia; occupational and food exposures are the primary risk factors.
Streptococcus suis, a bacterium that affects pigs, is a neglected pathogen that causes systemic disease in humans. We conducted a systematic review and meta-analysis to summarize global estimates of the epidemiology, clinical characteristics, and outcomes of this zoonosis. We searched main literature databases for all studies through December 2012 using the search term “streptococcus suis.” The prevalence of S. suis infection is highest in Asia; the primary risk factors are occupational exposure and eating of contaminated food. The pooled proportions of case-patients with pig-related occupations and history of eating high-risk food were 38.1% and 37.3%, respectively. The main clinical syndrome was meningitis (pooled rate 68.0%), followed by sepsis, arthritis, endocarditis, and endophthalmitis. The pooled case-fatality rate was 12.8%. Sequelae included hearing loss (39.1%) and vestibular dysfunction (22.7%). Our analysis identified gaps in the literature, particularly in assessing risk factors and sequelae of this infection.
Independent Lineages of Highly Sulfadoxine-Resistant Plasmodium falciparum Haplotypes, Eastern Africa
PDF Version [PDF - 629 KB - 9 pages]
S. M. Taylor et al.View SummaryView Abstract
Parasites with increased resistance to sulfadoxine might undermine malaria control measures.
Sulfadoxine-resistant Plasmodium falciparum undermines malaria prevention with sulfadoxine/pyrimethamine. Parasites with a highly resistant mutant dihydropteroate synthase (dhps) haplotype have recently emerged in eastern Africa; they negated preventive benefits of sulfadoxine/pyrimethamine, and might exacerbate placental malaria. We explored emerging lineages of dhps mutant haplotypes in Malawi, the Democratic Republic of the Congo, and Tanzania by using analyses of genetic microsatellites flanking the dhps locus. In Malawi, a triple-mutant dhps SGEG (mutant amino acids are underlined) haplotype emerged in 2010 that was closely related to pre-existing double-mutant SGEA haplotypes, suggesting local origination in Malawi. When we compared mutant strains with parasites from the Democratic Republic of the Congo and Tanzania by multiple independent analyses, we found that SGEG parasites were partitioned into separate lineages by country. These findings support a model of local origination of SGEG dhps haplotypes, rather than geographic diffusion, and have implications for investigations of emergence and effects of parasite drug resistance.
Norovirus Epidemiology in Community and Health Care Settings and Association with Patient Age, Denmark
PDF Version [PDF - 610 KB - 9 pages]
K. T. Franck et al.View SummaryView Abstract
Norovirus GII.4 predominated in patients ≥60 years of age and in health care settings.
Norovirus (NoV) is a major cause of gastroenteritis. NoV genotype II.4 (GII.4) is the predominant genotype in health care settings but the reason for this finding is unknown. Stool samples containing isolates with a known NoV genotype from 2,109 patients in Denmark (patients consulting a general practitioner or outpatient clinic, inpatients, and patients from foodborne outbreaks) were used to determine genotype distribution in relation to age and setting. NoV GII.4 was more prevalent among inpatients than among patients in community settings or those who became infected during foodborne outbreaks. In community and health care settings, we found an association between infection with GII.4 and increasing age. Norovirus GII.4 predominated in patients ≥60 years of age and in health care settings. A larger proportion of children than adults were infected with NoV GII.3 or GII.P21. Susceptibility to NoV infection might depend on patient age and infecting NoV genotype. Cohort studies are warranted to test this hypothesis.
Population-Based Analysis of Invasive Fungal Infections, France, 2001–2010
PDF Version [PDF - 447 KB - 7 pages]
D. Bitar et al.View SummaryView Abstract
These infections are underrecognized as a cause of death in the general population and high-risk groups.
To determine the epidemiology and trends of invasive fungal infections (IFIs) in France, we analyzed incidence, risk factors, and in-hospital death rates related to the most frequent IFIs registered in the national hospital discharge database during 2001–2010. The identified 35,876 IFI cases included candidemia (43.4%), Pneumocystis jirovecii pneumonia (26.1%), invasive aspergillosis (IA, 23.9%), cryptococcosis (5.2%), and mucormycosis (1.5%). The overall incidence was 5.9/100,000 cases/year and the mortality rate was 27.6%; both increased over the period (+1.5%, +2.9%/year, respectively). Incidences substantially increased for candidemia, IA, and mucormycosis. Pneumocystis jirovecii pneumonia incidence decreased among AIDS patients (−14.3%/year) but increased in non-HIV–infected patients (+13.3%/year). Candidemia and IA incidence was increased among patients with hematologic malignancies (>+4%/year) and those with chronic renal failure (>+10%/year). In-hospital deaths substantially increased in some groups, e.g., in those with hematologic malignancies. IFIs occur among a broad spectrum of non–HIV-infected patients and should be a major public health priority.
Deaths Attributable to Carbapenem-Resistant Enterobacteriaceae Infections
PDF Version [PDF - 409 KB - 6 pages]
M. E. Falagas et al.View SummaryView Abstract
In 7 studies, rates ranged from 26% to 44%; in 2 studies, rates were −3% and −4%, respectively.
We evaluated the number of deaths attributable to carbapenem-resistant Enterobacteriaceae by using studies from around the world published before April 9, 2012. Attributable death was defined as the difference in all-cause deaths between patients with carbapenem-resistant infections and those with carbapenem-susceptible infections. Online databases were searched, and data were qualitatively synthesized and pooled in a metaanalysis. Nine studies met inclusion criteria: 6 retrospective case–control studies, 2 retrospective cohort studies, and 1 prospective cohort study. Klebsiella pneumoniae was the causative pathogen in 8 studies; bacteremia was the only infection in 5 studies. We calculated that 26%–44% of deaths in 7 studies were attributable to carbapenem resistance, and in 2 studies, which included bacteremia and other infections, −3% and −4% of deaths were attributable to carbapenem resistance. Pooled outcomes showed that the number of deaths was significantly higher in patients with carbapenem-resistant infections and that the number of deaths attributable to carbapenem resistance is considerable.
Borrelia miyamotoi sensu lato Seroreactivity and Seroprevalence in the Northeastern United States
PDF Version [PDF - 1.00 MB - 8 pages]
P. J. Krause et al.View SummaryView Abstract
Serum from ≈4% of residents was positive for infection, compared with ≈9% for B. burgdorferi.
Borrelia miyamotoi sensu lato, a relapsing fever Borrelia sp., is transmitted by the same ticks that transmit B. burgdorferi (the Lyme disease pathogen) and occurs in all Lyme disease–endemic areas of the United States. To determine the seroprevalence of IgG against B. miyamotoi sensu lato in the northeastern United States and assess whether serum from B. miyamotoi sensu lato–infected persons is reactive to B. burgdorferi antigens, we tested archived serum samples from area residents during 1991–2012. Of 639 samples from healthy persons, 25 were positive for B. miyamotoi sensu lato and 60 for B. burgdorferi. Samples from ≈10% of B. miyamotoi sensu lato–seropositive persons without a recent history of Lyme disease were seropositive for B. burgdorferi. Our resultsA suggest thatA human B. miyamotoiA sensu latoA infection may be common in southern New England and that B. burgdorferi antibody testing is not an effective surrogate for detecting B. miyamotoi sensu lato infection.
Medscape CME Activity
Epidemiology of Influenza Virus Types and Subtypes in South Africa, 2009–2012 PDF Version [PDF - 546 KB - 8 pages]A. L. Cohen et al.View SummaryView Abstract
Patient age and co-infections, but not disease severity, were associated with virus type and subtype.
To determine clinical and epidemiologic differences between influenza caused by different virus types and subtypes, we identified patients and tested specimens. Patients were children and adults hospitalized with confirmed influenza and severe acute respiratory illness (SARI) identified through active, prospective, hospital-based surveillance from 2009–2012 in South Africa. Respiratory specimens were tested, typed, and subtyped for influenza virus by PCR. Of 16,005 SARI patients tested, 1,239 (8%) were positive for influenza virus. Patient age and co-infections varied according to virus type and subtype, but disease severity did not. Case-patients with influenza B were more likely than patients with influenza A to be HIV infected. A higher proportion of case-patients infected during the first wave of the 2009 influenza pandemic were 5–24 years of age (19%) than were patients infected during the second wave (9%). Although clinical differences exist, treatment recommendations do not differ according to subtype; prevention through vaccination is recommended.
Staphylococcus aureus Infections in New Zealand, 2000–2011
PDF Version [PDF - 556 KB - 6 pages]
D. A. Williamson et al.View SummaryView Abstract
Skin and soft tissue infections increased significantly; sociodemographic disparity was noted.
The incidence rate for invasive and noninvasive Staphylococcus aureus infections in New Zealand is among the highest reported in the developed world. Using nationally collated hospital discharge data, we analyzed the epidemiology of serious S. aureus infections in New Zealand during 2000–2011. During this period, incidence of S. aureus skin and soft tissue infections increased significantly while incidence of staphylococcal sepsis and pneumonia remained stable. We observed marked ethnic and sociodemographic inequality across all S. aureus infections; incidence rates for all forms of S. aureus infections were highest among Māori and Pacific Peoples and among patients residing in areas of high socioeconomic deprivation. The increased incidence of S. aureus skin and soft tissue infections, coupled with the demographic disparities, is of considerable concern. Future work should aim to reduce this disturbing national trend.
Undiagnosed Acute Viral Febrile Illnesses, Sierra Leone
PDF Version [PDF - 391 KB - 7 pages]
R. J. Schoepp et al.View SummaryView Abstract
Various arthropod-borne and hemorrhagic fever viruses should be considered when Lassa fever is suspected.
Sierra Leone in West Africa is in a Lassa fever–hyperendemic region that also includes Guinea and Liberia. Each year, suspected Lassa fever cases result in submission of ≈500–700 samples to the Kenema Government Hospital Lassa Diagnostic Laboratory in eastern Sierra Leone. Generally only 30%–40% of samples tested are positive for Lassa virus (LASV) antigen and/or LASV-specific IgM; thus, 60%–70% of these patients have acute diseases of unknown origin. To investigate what other arthropod-borne and hemorrhagic fever viral diseases might cause serious illness in this region and mimic Lassa fever, we tested patient serum samples that were negative for malaria parasites and LASV. Using IgM-capture ELISAs, we evaluated samples for antibodies to arthropod-borne and other hemorrhagic fever viruses. Approximately 25% of LASV-negative patients had IgM to dengue, West Nile, yellow fever, Rift Valley fever, chikungunya, Ebola, and Marburg viruses but not to Crimean-Congo hemorrhagic fever virus.
Changes in Capsule and Drug Resistance of Pneumococci after Introduction of PCV7, Japan, 2010–2013
PDF Version [PDF - 607 KB - 8 pages]
N. Chiba et al.View SummaryView Abstract
Drastic changes threaten overall effectiveness of this vaccine.
We aimed to clarify changes in serotypes and genotypes mediating β-lactam and macrolide resistance in Streptococcus pneumoniae isolates from Japanese children who had invasive pneumococcal disease (IPD) after the 7-valent pneumococcal conjugate vaccine (PCV7) was introduced into Japan; 341 participating general hospitals conducted IPD surveillance during April 2010–March 2013. A total of 300 pneumococcal isolates were collected in 2010, 146 in 2011, and 156 in 2012. The proportion of vaccine serotypes in infectious isolates decreased from 73.3% to 54.8% to 14.7% during the 3 years. Among vaccine serotype strains, genotypic penicillin-resistant S. pneumoniae strains also declined each year. Among nonvaccine serotype strains, 19A, 15A, 15B, 15C, and 24 increased in 2012. Increases were noted especially in genotypic penicillin-resistant S. pneumoniae isolates of serotypes 15A and 35B, as well as macrolide resistance mediated by the erm(B) gene in 15A, 15B, 15C, and 24.
Neisseria gonorrhoeae Strain with Reduced Susceptibilities to Extended-Spectrum Cephalosporins
PDF Version [PDF - 310 KB - 3 pages]
D. Nguyen et al.View Abstract
The spread of Neisseria gonorrhoeae strains with reduced susceptibility to extended-spectrum cephalosporins is an increasing public health threat. Using Etest and multiantigen sequence typing, we detected sequence type 1407, which is associated with reduced susceptibilities to extended-spectrum cephalosporins, in 4 major populated regions in California, USA, in 2012.
Severe Malaria Not Responsive to Artemisinin Derivatives in Man Returning from Angola to Vietnam
PDF Version [PDF - 404 KB - 4 pages]
N. Van Hong et al.View Abstract
Resistance to artemisinin derivatives, the most potent antimalarial drugs currently used, has emerged in Southeast Asia and threatens to spread to Africa. We report a case of malaria in a man who returned to Vietnam after 3 years in Angola that did not respond to intravenous artesunate and clindamycin or an oral artemisinin-based combination.
Diversity of Francisella tularensis Subsp. holarctica Lineages, China
PDF Version [PDF - 617 KB - 4 pages]
Y. Wang et al.View Abstract
We analyzed 10 isolates of Francisella tularensis subspecies holarctica from China and assigned them to known clades by using canonical single-nucleotide polymorphisms. We found 4 diverse subtypes, including 3 from the most basal lineage, biovar japonica. This result indicates unprecedented levels of diversity from a single region and suggests new models for emergence.
Rates of Influenza-like Illness and Winter School Breaks, Chile, 2004–2010
PDF Version [PDF - 528 KB - 5 pages]
G. Chowell et al.View Abstract
To determine effects of school breaks on influenza virus transmission in the Southern Hemisphere, we analyzed 2004–2010 influenza-like–illness surveillance data from Chile. Winter breaks were significantly associated with a two-thirds temporary incidence reduction among schoolchildren, which supports use of school closure to temporarily reduce illness, especially among schoolchildren, in the Southern Hemisphere.
Highly Pathogenic Fowlpox Virus in Cutaneously Infected Chickens, China
PDF Version [PDF - 279 KB - 3 pages]
K. Zhao et al.View Abstract
We investigated an acute outbreak of the cutaneous form of fowlpox among chickens in China in November 2009. Using pathologic and virologic methods, we identified a novel type of fowlpox virus that carried an integrated genomic sequence of reticuloendotheliosis virus. This highly pathogenic virus could lead to severe ecologic effects and economic losses.
New Viruses in Idiopathic Human Diarrhea Cases, the Netherlands
PDF Version [PDF - 856 KB - 5 pages]
S. L. Smits et al.View Abstract
Emerging viral infections can be identified by using a viral metagenomics approach for clinical human material. Diarrhea samples of patients with unexplained gastroenteritis from the Netherlands were analyzed by using viral metagenomics. Novel circular DNA viruses, bufaviruses, and genogroup III picobirnaviruses were identified. These data expand our knowledge of the human virome.
MERS Coronavirus in Dromedary Camel Herd, Saudi Arabia
PDF Version [PDF - 952 KB - 4 pages]
M. G. Hemida et al.View Abstract
A prospective study of a dromedary camel herd during the 2013–14 calving season showed Middle East respiratory syndrome coronavirus infection of calves and adults. Virus was isolated from the nose and feces but more frequently from the nose. Preexisting neutralizing antibody did not appear to protect against infection.
Cefotaxime-Resistant Salmonella enterica in Travelers Returning from Thailand to Finland
PDF Version [PDF - 361 KB - 4 pages]
M. Gunell et al.View Abstract
During 1993–2011, cefotaxime resistance among Salmonella enterica isolates from patients in Finland increased substantially. Most of these infections originated in Thailand; many were qnr positive and belonged to S. enterica serovar Typhimurium and S. enterica monophasic serovar 4,,12:i:-. Although cefotaxime-resistant salmonellae mainly originate in discrete geographic areas, they represent a global threat.
Outbreak-Related Porcine Epidemic Diarrhea Virus Strains Similar to US Strains, South Korea, 2013
PDF Version [PDF - 553 KB - 4 pages]
S. Lee and C. LeeView Abstract
In late 2013, outbreaks of porcine epidemic diarrhea virus (PEDV) infection recurred in South Korea. Genetic and phylogenetic analyses showed that isolates from the outbreaks were most closely related to emergent US strains of PEDV. These US strain–like PEDV variants are prevalent in South Korea and responsible for recent outbreaks in the country.
Detection and Genetic Characterization of Deltacoronavirus in Pigs, Ohio, USA, 2014
PDF Version [PDF - 525 KB - 4 pages]
L. Wang et al.View Abstract
In Ohio, United States, in early 2014, a deltacoronavirus was detected in feces and intestine samples from pigs with diarrheal disease. The complete genome sequence and phylogenetic analysis of the virus confirmed that the virus is closely related to a porcine deltacoronavirus (porcine coronavirus HKU15) reported in Hong Kong in 2012.
Widespread Rotavirus H in Commercially Raised Pigs, United States
PDF Version [PDF - 357 KB - 4 pages]
D. Marthaler et al.View Abstract
We investigated the presence in US pigs of rotavirus H (RVH), identified in pigs in Japan and Brazil. From 204 samples collected during 2006–2009, we identified RVH in 15% of fecal samples from 10 US states, suggesting that RVH has circulated in the United States since 2002, but probably longer.
Genome Analysis of Mayaro Virus Imported to Germany from French Guiana
PDF Version [PDF - 286 KB - 3 pages]
B. Friedrich-Jänicke et al.
Carbapenemase-producing Bacteria in Patients Hospitalized Abroad, France
PDF Version [PDF - 323 KB - 3 pages]
F. Compain et al.
Socioeconomic Status and Campylobacteriosis, Connecticut, USA, 1999–2009
PDF Version [PDF - 326 KB - 3 pages]
K. Bemis et al.
Legionnaires’ Disease Caused by Legionella pneumophila Serogroups 5 and 10, China
PDF Version [PDF - 422 KB - 2 pages]
Q. Zhang et al.
Stability of Middle East Respiratory Syndrome Coronavirus in Milk
PDF Version [PDF - 296 KB - 2 pages]
N. van Doremalen et al.
Zoonotic Filariasis Caused by Novel Brugia sp. Nematode, United States, 2011
PDF Version [PDF - 479 KB - 3 pages]
A. Paniz-Mondolfi et al.
Rotavirus Epidemiology in Bangui, Central African Republic, 2008
PDF Version [PDF - 315 KB - 2 pages]
I. Gouandijka-Vasilache et al.
MERS–Related Betacoronavirus in Vespertilio superans Bats, China
PDF Version [PDF - 345 KB - 3 pages]
L. Yang et al.
Carbapenemase-producing Klebsiella pneumoniae and Hematologic Malignancies
PDF Version [PDF - 285 KB - 2 pages]
L. Pagano et al.
Neisseria meningitidis Serogroup W135 Sequence Type 11, Anhui Province, China, 2011–2013
PDF Version [PDF - 343 KB - 3 pages]
S. Hu et al.
Early Public Response to Influenza A(H7N9) Virus, Guangzhou, China, May 30–June 7, 2013
PDF Version [PDF - 299 KB - 3 pages]
J. Yuan et al.
Human Exposure to Tickborne Relapsing Fever Spirochete Borrelia miyamotoi, the Netherlands
PDF Version [PDF - 384 KB - 2 pages]
M. Fonville et al.
Carbapenemase-producing Organism in Food, 2014
PDF Version [PDF - 318 KB - 2 pages]
J. E. Rubin et al.
Prevalence and Drug Resistance of Nontuberculous Mycobacteria, Northern China, 2008–2011
PDF Version [PDF - 321 KB - 2 pages]
X. Wang et al.
Diphtheria-like Disease Caused by Toxigenic Corynebacterium ulcerans Strain
PDF Version [PDF - 345 KB - 2 pages]
V. Sangal et al.
Death of Woman with Peripartum Influenza B Virus Infection and Necrotizing Pneumonia
PDF Version [PDF - 344 KB - 3 pages]
J. L. Rein et al.
Candida auris–Associated Candidemia, South Africa
PDF Version [PDF - 341 KB - 2 pages]
R. E. Magobo et al.
Books and Media
Chlamydial Infection: A Clinical and Public Health Perspective
PDF Version [PDF - 293 KB - 1 page]
About the Cover
After the Resistance: The Alamo Today
PDF Version [PDF - 312 KB - 2 pages]
B. Breedlove and M. L. Cohen
New Insights from the 7th World Melioidosis Congress 2013
H. P. Schweizer et al.
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: June 23, 2014
- Page last updated: June 23, 2014
- Page last reviewed: June 23, 2014
- Centers for Disease Control and Prevention,
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