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Volume 20, Number 8—August 2014
Volume 20, Number 8—August 2014 PDF Version [PDF - 7.58 MB - 167 pages]
Medscape CME Activity
Leptospirosis-Associated Hospitalizations, United States, 1998–2009 PDF Version [PDF - 394 KB - 7 pages]R. M. Traxler et al.View SummaryView Abstract
Average cost and duration of hospitalizations were significantly greater than for other infectious diseases.
A small percentage of persons with leptospirosis, a reemerging zoonosis, experience severe complications that require hospitalization. The number of leptospirosis cases in the United States is unknown. Thus, to estimate the hospitalization rate for this disease, we analyzed US hospital discharge records for 1998–2009 for the total US population by using the Nationwide Inpatient Sample. During that time, the average annual rate of leptospirosis-associated hospitalizations was 0.6 hospitalizations/1,000,000 population. Leptospirosis-associated hospitalization rates were higher for persons >20 years of age and for male patients. For leptospirosis-associated hospitalizations, the average age of patients at admission was lower, the average length of stay for patients was longer, and hospital charges were higher than those for nonleptospirosis infectious disease–associated hospitalizations. Educating clinicians on the signs and symptoms of leptospirosis may result in earlier diagnosis and treatment and, thereby, reduced disease severity and hospitalization costs.
Global and Local Persistence of Influenza A(H5N1) Virus
PDF Version [PDF - 635 KB - 9 pages]
X. Li et al.View SummaryView Abstract
Region-specific surveillance policies and vaccine candidate selection strategies should be considered.
An understanding of the global migration dynamics of highly pathogenic avian influenza A(H5N1) virus is helpful for surveillance and disease prevention. To characterize the migration network of this virus, we used genetic analysis, which supported a global persistence model in which each of 9 regions acts to some extent as a source. Siberia is the major hub for the dispersal of the virus. Southeast Asia and Africa are major sources of genetically and antigenically novel strains. We found evidence of local persistence of the virus in Southeast Asia and Africa, which is rare for human influenza A viruses. The differences in migration dynamics between avian and human influenza viruses might help with the design of region-specific surveillance efforts and the selection of vaccine candidates.
Rapid Whole-Genome Sequencing for Surveillance of Salmonella enterica Serovar Enteritidis
PDF Version [PDF - 1.06 MB - 9 pages]
H. C. den Bakker et al.View SummaryView Abstract
This procedure improves outbreak cluster detection and can be an effective surveillance tool.
For Salmonella enterica serovar Enteritidis, 85% of isolates can be classified into 5 pulsed-field gel electrophoresis (PFGE) types. However, PFGE has limited discriminatory power for outbreak detection. Although whole-genome sequencing has been found to improve discrimination of outbreak clusters, whether this procedure can be used in real-time in a public health laboratory is not known. Therefore, we conducted a retrospective and prospective analysis. The retrospective study investigated isolates from 1 confirmed outbreak. Additional cases could be attributed to the outbreak strain on the basis of whole-genome data. The prospective study included 58 isolates obtained in 2012, including isolates from 1 epidemiologically defined outbreak. Whole-genome sequencing identified additional isolates that could be attributed to the outbreak, but which differed from the outbreak-associated PFGE type. Additional putative outbreak clusters were detected in the retrospective and prospective analyses. This study demonstrates the practicality of implementing this approach for outbreak surveillance in a state public health laboratory.
Human Exposure to Live Poultry and Psychological and Behavioral Responses to Influenza A(H7N9), China
PDF Version [PDF - 540 KB - 10 pages]
L. Wang et al.View SummaryView Abstract
Exposure was common in urban and rural areas and remains a potential risk factor for human infection.
To investigate human exposure to live poultry and changes in risk perception and behavior after the April 2013 influenza A(H7N9) outbreak in China, we surveyed 2,504 urban residents in 5 cities and 1,227 rural residents in 4 provinces and found that perceived risk for influenza A(H7N9) was low. The highest rate of exposure to live poultry was reported in Guangzhou, where 47% of those surveyed reported visiting a live poultry market >1 times in the previous year. Most (77%) urban respondents reported that they visited live markets less often after influenza A(H7N9) cases were first identified in China in March 2013, but only 30% supported permanent closure of the markets to control the epidemic. In rural areas, 48% of respondents reported that they raised backyard poultry. Exposure to live commercial and private poultry is common in urban and rural China and remains a potential risk factor for human infection with novel influenza viruses.
Independent Origin of Plasmodium falciparum Antifolate Super-Resistance, Uganda, Tanzania, and Ethiopia
PDF Version [PDF - 352 KB - 7 pages]
M. Alifrangis et al.View SummaryView Abstract
Comprehensive surveillance is needed to support sulfadoxine–pyrimethamine intermittent preventive treatment in pregnant women.
Super-resistant Plasmodium falciparum threatens the effectiveness of sulfadoxine–pyrimethamine in intermittent preventive treatment for malaria during pregnancy. It is characterized by the A581G Pfdhps mutation on a background of the double-mutant Pfdhps and the triple-mutant Pfdhfr. Using samples collected during 2004–2008, we investigated the evolutionary origin of the A581G mutation by characterizing microsatellite diversity flanking Pfdhps triple-mutant (437G+540E+581G) alleles from 3 locations in eastern Africa and comparing it with double-mutant (437G+540E) alleles from the same area. In Ethiopia, both alleles derived from 1 lineage that was distinct from those in Uganda and Tanzania. Uganda and Tanzania triple mutants derived from the previously characterized southeastern Africa double-mutant lineage. The A581G mutation has occurred multiple times on local Pfdhps double-mutant backgrounds; however, a novel microsatellite allele incorporated into the Tanzania lineage since 2004 illustrates the local expansion of emergent triple-mutant lineages.
Human Infections with Borrelia miyamotoi, Japan
PDF Version [PDF - 343 KB - 4 pages]
K. Sato et al.View Abstract
We confirmed infection of 2 patients with Borrelia miyamotoi in Japan by retrospective surveillance of Lyme disease patients and detection of B. miyamotoi DNA in serum samples. One patient also showed seroconversion for antibody against recombinant glycerophosphodiester phosphodiesterase of B. miyamotoi. Indigenous relapsing fever should be considered a health concern in Japan.
Geographic Distribution of MERS Coronavirus among Dromedary Camels, Africa
PDF Version [PDF - 483 KB - 5 pages]
C. Reusken et al.View Abstract
We found serologic evidence for the circulation of Middle East respiratory syndrome coronavirus among dromedary camels in Nigeria, Tunisia, and Ethiopia. Circulation of the virus among dromedaries across broad areas of Africa may indicate that this disease is currently underdiagnosed in humans outside the Arabian Peninsula.
Rapid Detection, Complete Genome Sequencing, and Phylogenetic Analysis of Porcine Deltacoronavirus
PDF Version [PDF - 144 KB - 3 pages]
D. Marthaler et al.View Abstract
In February 2014, porcine deltacoronavirus (PDCoV) was identified in the United States. We developed a PDCoV real-time reverse transcription PCR that identified PDCoV in 30% of samples tested. Four additional PDCoV genomes from the United States were sequenced; these had ≈99%–100% nt similarity to the other US PDCoV strains.
Novel Reassortant Influenza A(H5N8) Viruses in Domestic Ducks, Eastern China
PDF Version [PDF - 340 KB - 4 pages]
H. Wu et al.View Abstract
Domestic ducks are natural reservoirs of avian influenza viruses and serve as reassortant hosts for new virus subtypes. We isolated 2 novel influenza A(H5N8) viruses from domestic ducks in eastern China, sequenced their genomes, and tested their pathogenicity in chickens and mice. Circulation of these viruses may pose health risks for humans.
Borrelia crocidurae Infection in Acutely Febrile Patients, Senegal
PDF Version [PDF - 425 KB - 4 pages]
O. Mediannikov et al.View Abstract
As malaria cases in Africa decline, other causes of acute febrile illness are being explored. To determine incidence of Borrelia crocidurae infection during June 2010–October 2011, we collected 1,566 blood specimens from febrile patients in Senegal. Incidence was high (7.3%). New treatment strategies, possibly doxycycline, might be indicated for febrile patients.
Severe Murine Typhus with Pulmonary System Involvement
PDF Version [PDF - 314 KB - 3 pages]
T. W. van der Vaart et al.View Abstract
We encountered a case of severe murine typhus complicated by acute respiratory distress syndrome. To determine worldwide prevalence of such cases, we reviewed the literature and found that respiratory symptoms occur in ≈30% of murine typhus patients. In disease-endemic areas, murine typhus should be considered for patients with respiratory symptoms and fever.
Pulmonary Infection and Colonization with Nontuberculous Mycobacteria, Taiwan, 2000–2012
PDF Version [PDF - 401 KB - 4 pages]
J. Chien et al.View Abstract
We analyzed samples from 13,652 patients who had respiratory cultures positive for mycobacteria in Taiwan during 2000–2012 and found that 56.9% were positive for nontuberculous mycobacteria (NTM). Whereas annual prevalence of tuberculosis decreased during the study period, prevalence of NTM disease and colonization increased, particularly among older patients and male patients.
Levofloxacin-Resistant Haemophilus influenzae, Taiwan, 2004–2010
PDF Version [PDF - 442 KB - 5 pages]
S. Kuo et al.View Abstract
Levofloxacin resistance in Haemophilus influenzae has increased significantly in Taiwan, from 2.0% in 2004 to 24.3% in 2010 (p<0.001). Clinical and molecular investigations of 182 levofloxacin-resistant isolates revealed that the increase was mainly the result of the spread of several clones in the elderly population in different regions.
Isolation of MERS Coronavirus from a Dromedary Camel, Qatar, 2014
PDF Version [PDF - 384 KB - 4 pages]
V. Raj et al.View Abstract
We obtained the full genome of Middle East respiratory syndrome coronavirus (MERS-CoV) from a camel in Qatar. This virus is highly similar to the human England/Qatar 1 virus isolated in 2012. The MERS-CoV from the camel efficiently replicated in human cells, providing further evidence for the zoonotic potential of MERS-CoV from camels.
Antibodies against MERS Coronavirus in Dromedary Camels, Kenya, 1992–2013
PDF Version [PDF - 335 KB - 4 pages]
V. M. Corman et al.View Abstract
Dromedary camels are a putative source for human infections with Middle East respiratory syndrome coronavirus. We showed that camels sampled in different regions in Kenya during 1992–2013 have antibodies against this virus. High densities of camel populations correlated with increased seropositivity and might be a factor in predicting long-term virus maintenance.
Detection of East/Central/South African Genotype of Chikungunya Virus in Myanmar, 2010
PDF Version [PDF - 391 KB - 4 pages]
M. Tun et al.View Abstract
In 2010, chikungunya virus of the East Central South African genotype was isolated from 4 children in Myanmyar who had dengue-like symptoms. Phylogenetic analysis of the E1 gene revealed that the isolates were closely related to isolates from China, Thailand, and Malaysia that harbor the A226V mutation in this gene.
Co-circulation of Dengue and Chikungunya Viruses, Al Hudaydah, Yemen, 2012
PDF Version [PDF - 362 KB - 4 pages]
G. Rezza et al.View Abstract
We investigated 400 cases of dengue-like illness in persons hospitalized during an outbreak in Al Hudaydah, Yemen, in 2012. Overall, 116 dengue and 49 chikungunya cases were diagnosed. Dengue virus type 2 was the predominant serotype. The co-circulation of these viruses indicates that mosquitoborne infections represent a public health threat in Yemen.
Antibodies against Severe Fever with Thrombocytopenia Syndrome Virus in Healthy Persons, China, 2013
PDF Version [PDF - 324 KB - 3 pages]
L. Zhang et al.View Abstract
In June 2013, a subclinical infection with severe fever with thrombocytopenia syndrome virus (SFTSV) was detected in Zhejiang Province, China, prompting seroprevalence studies in 6 districts within the province. Of 986 healthy persons tested, 71 had IgG antibodies against SFTSV. This finding suggests that most natural infections with SFTSV are mild or subclinical.
New Introductions of Enterovirus 71 Subgenogroup C4 Strains, France, 2012
PDF Version [PDF - 502 KB - 4 pages]
I. Schuffenecker et al.View Abstract
In France during 2012, human enterovirus 71 (EV-A71) subgenogroup C4 strains were detected in 4 children hospitalized for neonatal fever or meningitis. Phylogenetic analysis showed novel and independent EV-A71 introductions, presumably from China, and suggested circulation of C4 strains throughout France. This observation emphasizes the need for monitoring EV-A71 infections in Europe.
Infection with Possible Precursor of Avian Influenza A(H7N9) Virus in a Child, China, 2013
PDF Version [PDF - 493 KB - 5 pages]
L. Ren et al.View Abstract
During the early stage of the avian influenza A(H7N9) epidemic in China in March 2013, a strain of the virus was identified in a 4-year-old boy with mild influenza symptoms. Phylogenetic analysis indicated that this strain, which has similarity to avian subtype H9N2 viruses, may represent a precursor of more-evolved H7N9 subtypes co-circulating among humans.
Role of Migratory Birds in Spreading Crimean-Congo Hemorrhagic Fever, Turkey
PDF Version [PDF - 564 KB - 4 pages]
H. Leblebicioglu et al.View Abstract
We investigated migratory birds’ role in spreading Crimean-Congo hemorrhagic fever virus (CCHFV) through attached ticks. We detected CCHFV RNA in ticks on migratory birds in Turkey. Two isolates showed similarity with CCHFV genotype 4, suggesting a role for ticks in CCHFV epidemics in Turkey and spread of CCHFV by birds.
Dengue Virus Transmission by Blood Stem Cell Donor after Travel to Sri Lanka; Germany, 2013
PDF Version [PDF - 456 KB - 4 pages]
M. Punzel et al.View Abstract
Three days after donation of peripheral blood stem cells to a recipient with acute myeloblastic leukemia, dengue virus was detected in the donor, who had recently traveled to Sri Lanka. Transmission to the recipient, who died 9 days after transplant, was confirmed.
Natural Intrauterine Infection with Schmallenberg Virus in Malformed Newborn Calves
PDF Version [PDF - 428 KB - 4 pages]
C. Bayrou et al.View Abstract
We surveyed morphologic alterations in calves in Belgium that were naturally infected in utero by Schmallenberg virus (SBV) and born with deformities during January–March 2012. SBV-specific RNA was distributed unevenly in different tissues. Natural intrauterine SBV infection of calves might cause serious damage to the central nervous system and muscles.
Shelter Dogs as Sentinels for Trypanosoma cruzi Transmission across Texas
PDF Version [PDF - 392 KB - 4 pages]
T. D. Tenney et al.View Abstract
Chagas disease, an infection with the parasite Trypanosoma cruzi, is increasingly diagnosed among humans in the southern United States. We assessed exposure of shelter dogs in Texas to T. cruzi; seroprevalence across diverse ecoregions was 8.8%. Canine serosurveillance is a useful tool for public health risk assessment.
Severe Fever with Thrombocytopenia Syndrome Virus in Ticks Collected from Humans, South Korea, 2013
PDF Version [PDF - 455 KB - 4 pages]
S. Yun et al.View Abstract
We investigated the infection rate for severe fever with thrombocytopenia syndrome virus (SFTSV) among ticks collected from humans during May–October 2013 in South Korea. Haemaphysalis longicornis ticks have been considered the SFTSV vector. However, we detected the virus in H. longicornis, Amblyomma testudinarium, and Ixodes nipponensis ticks, indicating additional potential SFTSV vectors.
Movement of Chikungunya Virus into the Western Hemisphere
PDF Version [PDF - 686 KB - 2 pages]
R. S. Nasci
Phylogenetic Analysis of West Nile Virus Genome, Iran
PDF Version [PDF - 351 KB - 3 pages]
N. Shah-Hosseini et al.
Transcontinental Movement of Asian Genotype Chikungunya Virus
PDF Version [PDF - 396 KB - 3 pages]
R. S. Lanciotti and A. Valadere
Diagnosis of Bartonella henselae Prosthetic Valve Endocarditis in Man, France
PDF Version [PDF - 290 KB - 2 pages]
F. Gouriet et al.
Isolation of Rickettsia typhi from Human, Mexico
PDF Version [PDF - 256 KB - 2 pages]
J. E. Zavala-Castro et al.
Serologic Surveillance for West Nile Virus in Dogs, Africa
PDF Version [PDF - 291 KB - 3 pages]
B. Davoust et al.
Zika Virus Infection after Travel to Tahiti, December 2013
PDF Version [PDF - 328 KB - 3 pages]
T. Wæhre et al.
Chikungunya in the Caribbean—Threat for Europe
PDF Version [PDF - 445 KB - 3 pages]
J. Mansuy et al.
Human Infection with West Nile Virus, Xinjiang, China, 2011
PDF Version [PDF - 386 KB - 3 pages]
Z. Lu et al.
Severe Encephalitis Caused by Toscana Virus, Greece
PDF Version [PDF - 327 KB - 3 pages]
A. Papa et al.
Yersinia pestis in Pulex irritans Fleas during Plague Outbreak, Madagascar
PDF Version [PDF - 294 KB - 2 pages]
J. Ratovonjato et al.
Sika Deer Carrying Babesia Parasites Closely Related to B. divergens, Japan
PDF Version [PDF - 454 KB - 3 pages]
A. Zamoto-Niikura et al.
Babesiosis Surveillance, New Jersey, USA, 2006–2011
PDF Version [PDF - 306 KB - 3 pages]
A. Apostolou et al.
Antibodies against West Nile and Shuni Viruses in Veterinarians, South Africa
PDF Version [PDF - 285 KB - 3 pages]
C. van Eeden et al.
Chikungunya Outbreak in Bueng Kan Province, Thailand, 2013
PDF Version [PDF - 394 KB - 3 pages]
N. Wanlapakorn et al.
Decline in Japanese Encephalitis, Kushinagar District, Uttar Pradesh, India
PDF Version [PDF - 268 KB - 2 pages]
P. Ranjan et al.
Rickettsia felis Infections and Comorbid Conditions, Laos, 2003–2011
PDF Version [PDF - 296 KB - 3 pages]
S. Dittrich et al.
Books and Media
In Memoriam: Robert Emmons Kissling (1923–2013)
PDF Version [PDF - 263 KB - 2 pages]
C. H. Calisher et al.View Summary
A memorial for Robert E. Kissling, a former CDC employee (leader) who set diagnostic, pathologic, and field investigation standards for rabies and arboviruses.
About the Cover
Peer Reviewed Report Available Online OnlyPreparedness for Threat of Chikungunya in the PacificA. Roth et al.View Abstract
Chikungunya virus (CHIKV) caused significant outbreaks of illness during 2005–2007 in the Indian Ocean region. Chikungunya outbreaks have also occurred in the Pacific region, including in Papua New Guinea in 2012; New Caledonia in April 2013; and Yap State, Federated States of Micronesia, in August 2013. CHIKV is a threat in the Pacific, and the risk for further spread is high, given several similarities between the Pacific and Indian Ocean chikungunya outbreaks. Island health care systems have difficulties coping with high caseloads, which highlights the need for early multidisciplinary preparedness. The Pacific Public Health Surveillance Network has developed several strategies focusing on surveillance, case management, vector control, laboratory confirmation, and communication. The management of this CHIKV threat will likely have broad implications for global public health.
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: May 05, 2015
- Page last updated: May 05, 2015
- Page last reviewed: May 05, 2015
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
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