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Volume 5, Number 3—June 1999
Volume 5, Number 3—June 1999 PDF Version [PDF - 4.58 MB - 180 pages]
International Editors:Bacterial Resistance to Antimicrobial Agents: Selected Problems in France, 1996 to 1998
PDF Version [PDF - 78 KB - 6 pages]
H. Aubry-Damon and P. Courvalin
The Cost Effectiveness of Vaccinating against Lyme Disease
PDF Version [PDF - 110 KB - 8 pages]
M. I. Meltzer et al.View Abstract
To determine the cost effectiveness of vaccinating against Lyme disease, we used a decision tree to examine the impact on society of six key components. The main measure of outcome was the cost per case averted. Assuming a 0.80 probability of diagnosing and treating early Lyme disease, a 0.005 probability of contracting Lyme disease, and a vaccination cost of $50 per year, the mean cost of vaccination per case averted was $4,466. When we increased the probability of contracting Lyme disease to 0.03 and the cost of vaccination to $100 per year, the mean net savings per case averted was $3,377. Since few communities have average annual incidences of Lyme disease >0.005, economic benefits will be greatest when vaccination is used on the basis of individual risk, specifically, in persons whose probability of contracting Lyme disease is >0.01.
Use of Antimicrobial Growth Promoters in Food Animals and Enterococcus faecium Resistance to Therapeutic Antimicrobial Drugs in Europe
PDF Version [PDF - 85 KB - 7 pages]
H. C. Wegener et al.View Abstract
Supplementing animal feed with antimicrobial agents to enhance growth has been common practice for more than 30 years and is estimated to constitute more than half the total antimicrobial use worldwide. The potential public health consequences of this use have been debated; however, until recently, clear evidence of a health risk was not available. Accumulating evidence now indicates that the use of the glycopeptide avoparcin as a growth promoter has created in food animals a major reservoir of Enterococcus faecium, which contains the high level glycopeptide resistance determinant vanA, located on the Tn1546 transposon. Furthermore, glycopeptide-resistant strains, as well as resistance determinants, can be transmitted from animals to humans. Two antimicrobial classes expected to provide the future therapeutic options for treatment of infections with vancomycin-resistant enterococci have analogues among the growth promoters, and a huge animal reservoir of resistant E. faecium has already been created, posing a new public health problem.
Bacterial Vaccines and Serotype Replacement: Lessons from Haemophilus influenzae and Prospects for Streptococcus pneumoniae
PDF Version [PDF - 199 KB - 10 pages]
M. LipsitchView Abstract
Conjugate vaccines have reduced the incidence of invasive disease caused by Haemophilus influenzae, type b (Hib), in industrialized countries and may be highly effective against Streptococcus pneumoniae. However, the serotype specificity of these vaccines has led to concern that their use may increase carriage of and disease from serotypes not included in the vaccine. Replacement has not occurred with the use of Hib vaccines but has occurred in trials of pneumococcal vaccines. Mathematical models can be used to elucidate these contrasting outcomes, predict the conditions under which serotype replacement is likely, interpret the results of conjugate vaccine trials, design trials that will better detect serotype replacement (if it occurs), and suggest factors to consider in choosing the serotype composition of vaccines.
Iron Loading and Disease Surveillance
PDF Version [PDF - 68 KB - 7 pages]
E. D. WeinbergView Abstract
Iron is an oxidant as well as a nutrient for invading microbial and neoplastic cells. Excessive iron in specific tissues and cells (iron loading) promotes development of infection, neoplasia, cardiomyopathy, arthropathy, and various endocrine and possibly neurodegenerative disorders. To contain and detoxify the metal, hosts have evolved an iron withholding defense system, but the system can be compromised by numerous factors. An array of behavioral, medical, and immunologic methods are in place or in development to strengthen iron withholding. Routine screening for iron loading could provide valuable information in epidemiologic, diagnostic, prophylactic, and therapeutic studies of emerging infectious diseases.
Human Herpesvirus 6: An Emerging Pathogen
PDF Version [PDF - 527 KB - 14 pages]
G. Campadelli-Fiume et al.View Abstract
Infections with human herpesvirus 6 (HHV-6), a ß-herpesvirus of which two variant groups (A and B) are recognized, is very common, approaching 100% in seroprevalence. Primary infection with HHV-6B causes roseola infantum or exanthem subitum, a common childhood disease that resolves spontaneously. After primary infection, the virus replicates in the salivary glands and is shed in saliva, the recognized route of transmission for variant B strains; it remains latent in lymphocytes and monocytes and persists at low levels in cells and tissues. Not usually associated with disease in the immunocompetent, HHV-6 infection is a major cause of opportunistic viral infections in the immunosuppressed, typically AIDS patients and transplant recipients, in whom HHV-6 infection/reactivation may culminate in rejection of transplanted organs and death. Other opportunistic viruses, human cytomegalovirus and HHV-7, also infect or reactivate in persons at risk. Another disease whose pathogenesis may be correlated with HHV-6 is multiple sclerosis. Data in favor of and against the correlation are discussed.
Emergence of a Unique Group of Necrotizing Mycobacterial Diseases
PDF Version [PDF - 617 KB - 12 pages]
K. M. Dobos et al.View Abstract
Although most diseases due to pathogenic mycobacteria are caused by Mycobacterium tuberculosis, several other mycobacterial diseases—caused by M. ulcerans (Buruli ulcer), M. marinum, and M. haemophilum—have begun to emerge. We review the emergence of diseases caused by these three pathogens in the United States and around the world in the last decade. We examine the pathophysiologic similarities of the diseases (all three cause necrotizing skin lesions) and common reservoirs of infection (stagnant or slow-flowing water). Examination of the histologic and pathogenic characteristics of these mycobacteria suggests differences in the modes of transmission and pathogenesis, though no singular mechanism for either characteristic has been definitively described for any of these mycobacteria.
Respiratory Diseases among U.S. Military Personnel: Countering Emerging Threats
PDF Version [PDF - 412 KB - 9 pages]
G. C. Gray et al.View Abstract
Emerging respiratory disease agents, increased antibiotic resistance, and the loss of effective vaccines threaten to increase the incidence of respiratory disease in military personnel. We examine six respiratory pathogens (adenoviruses, influenza viruses, Streptococcus pneumoniae, Streptococcus pyogenes, Mycoplasma pneumoniae, and Bordetella pertussis) and review the impact of the diseases they cause, past efforts to control these diseases in U.S. military personnel, as well as current treatment and surveillance strategies, limitations in diagnostic testing, and vaccine needs.
Q Fever in Bulgaria and Slovakia
PDF Version [PDF - 84 KB - 7 pages]
V. Serbezov et al.View Abstract
As a result of dramatic political and economic changes in the beginning of the 1990s, Q-fever epidemiology in Bulgaria has changed. The number of goats almost tripled; contact between goat owners (and their families) and goats, as well as goats and other animals, increased; consumption of raw goat milk and its products increased; and goats replaced cattle and sheep as the main source of human Coxiella burnetii infections. Hundreds of overt, serologically confirmed human cases of acute Q fever have occurred. Chronic forms of Q fever manifesting as endocarditis were also observed. In contrast, in Slovakia, Q fever does not pose a serious public health problem, and the chronic form of infection has not been found either in follow-ups of a Q-fever epidemic connected with goats imported from Bulgaria and other previous Q-fever outbreaks or in a serologic survey. Serologic diagnosis as well as control and prevention of Q fever are discussed.
Adhesins as Targets for Vaccine Development
PDF Version [PDF - 189 KB - 9 pages]
T. M. Wizemann et al.View Abstract
Blocking the primary stages of infection, namely bacterial attachment to host cell receptors and colonization of the mucosal surface, may be the most effective strategy to prevent bacterial infections. Bacterial attachment usually involves an interaction between a bacterial surface protein called an adhesin and the host cell receptor. Recent preclinical vaccine studies with the FimH adhesin (derived from uropathogenic Escherichia coli) have confirmed that antibodies elicited against an adhesin can impede colonization, block infection, and prevent disease. The studies indicate that prophylactic vaccination with adhesins can block bacterial infections. With recent advances in the identification, characterization, and isolation of other adhesins, similar approaches are being explored to prevent infections, from otitis media and dental caries to pneumonia and sepsis.
Tuberculosis in the Caribbean: Using Spacer Oligonucleotide Typing to Understand Strain Origin and Transmission
PDF Version [PDF - 408 KB - 11 pages]
C. Sola et al.View Abstract
We used direct repeat (DR)-based spacer oligonucleotide typing (spoligotyping) (in association with double-repetitive element–polymerase chain reaction, IS6110-restriction fragment length polymorphism [RFLP], and sometimes DR-RFLP and polymorphic GC-rich sequence-RFLP) to detect epidemiologic links and transmission patterns of Mycobacterium tuberculosis on Martinique, Guadeloupe, and French Guiana. In more than a third of the 218 strains we typed from this region, clusters and isolates shared genetic identity, which suggests epidemiologic links. However, because of limited epidemiologic information, only 14.2% of the strains could be directly linked. When spoligotyping patterns shared by two or more isolates were pooled with 392 spoligotypes from other parts of the world, new matches were detected, which suggests imported transmission. Persisting foci of endemic disease and increased active transmission due to high population flux and HIV-coinfection may be linked to the recent reemergence of tuberculosis in the Caribbean. We also found that several distinct families of spoligotypes are overrepresented in this region.
Human Rabies Postexposure Prophylaxis during a Raccoon Rabies Epizootic in New York, 1993 and 1994
PDF Version [PDF - 359 KB - 8 pages]
J. D. Wyatt et al.View Abstract
We describe the epidemiology of human rabies postexposure prophylaxis (PEP) in four upstate New York counties during the 1st and 2nd year of a raccoon rabies epizootic. We obtained data from records of 1,173 persons whose rabies PEP was reported to local health departments in 1993 and 1994. Mean annual PEP incidence rates were highest in rural counties, in summer, and in patients 10 to 14 and 35 to 44 years of age. PEP given after bites was primarily associated with unvaccinated dogs and cats, but most (70%) was not attributable to bites. Although pet vaccination and stray animal control, which target direct exposure, remain the cornerstones of human rabies prevention, the risk for rabies by the nonbite route (e.g., raccoon saliva on pet dogs' and cats' fur) should also be considered.
Factory Outbreak of Escherichia coli O157:H7 Infection in Japan
PDF Version [PDF - 74 KB - 5 pages]
Y. Watanabe et al.View Abstract
To determine the cause of a July 1996 outbreak of Escherichia coli O157:H7 among factory workers in Kyoto, Japan, we conducted cohort and case-control studies. Eating radish sprout salad during lunch at the factory cafeteria had been linked to illness. The sprouts were traced to four growers in Japan; one had been associated with an outbreak of E. coli O157:H7 among 6,000 schoolchildren in Sakai earlier in July.
First Case of Yellow Fever in French Guiana since 1902
PDF Version [PDF - 67 KB - 4 pages]
J. Heraud et al.View Abstract
The first case of yellow fever in French Guiana since 1902 was reported in March 1998. The yellow fever virus genome was detected in postmortem liver biopsies by seminested polymerase chain reaction. Sequence analysis showed that this strain was most closely related to strains from Brazil and Ecuador.
Risk for Rabies Transmission from Encounters with Bats, Colorado, 1977–1996
PDF Version [PDF - 57 KB - 5 pages]
W. J. Pape et al.View Abstract
To assess the risk for rabies transmission to humans by bats, we analyzed the prevalence of rabies in bats that encountered humans from 1977 to 1996 and characterized the bat-human encounters. Rabies was diagnosed in 685 (15%) of 4,470 bats tested. The prevalence of rabies in bats that bit humans was 2.1 times higher than in bats that did not bite humans. At least a third of the encounters were preventable.
Australian Bat Lyssavirus Infection in a Captive Juvenile Black Flying Fox
PDF Version [PDF - 46 KB - 3 pages]
H. E. Field et al.View Abstract
The newly emerging Australian bat lyssavirus causes rabieslike disease in bats and humans. A captive juvenile black flying fox exhibited progressive neurologic signs, including sudden aggression, vocalization, dysphagia, and paresis over 9 days and then died. At necropsy, lyssavirus infection was diagnosed by fluorescent antibody test, immunoperoxidase staining, polymerase chain reaction, and virus isolation. Eight human contacts received postexposure vaccination.
Bordetella holmesii-Like Organisms Isolated from Massachusetts Patients with Pertussis-Like Symptoms
PDF Version [PDF - 51 KB - 3 pages]
W. K. Yih et al.View Abstract
We isolated Bordetella holmesii, generally associated with septicemia in patients with underlying conditions, from nasopharyngeal specimens of otherwise healthy young persons with a cough. The proportion of B. holmesii- positive specimens submitted to the Massachusetts State Laboratory Institute increased from 1995 to 1998.
New Cryptosporidium Genotypes in HIV-Infected Persons
PDF Version [PDF - 162 KB - 6 pages]
N. J. Pieniazek et al.View Abstract
Using DNA sequencing and phylogenetic analysis, we identified four distinct Cryptosporidium genotypes in HIV-infected patients: genotype 1 (human), genotype 2 (bovine) Cryptosporidium parvum, a genotype identical to C. felis, and one identical to a Cryptosporidium sp. isolate from a dog. This is the first identification of human infection with the latter two genotypes.
Fatal Case Due to Methicillin-Resistant Staphylococcus aureus Small Colony Variants in an AIDS Patient
PDF Version [PDF - 98 KB - 4 pages]
H. Seifert et al.View Abstract
We describe the first known case of a fatal infection with small colony variants of methicillin-resistant Staphylococcus aureus in a patient with AIDS. Recovered from three blood cultures as well as from a deep hip abscess, these variants may have resulted from long-term antimicrobial therapy with trimethoprim/sulfamethoxazole for prophylaxis of Pneumocystis carinii pneumonia.
Application of Data Mining to Intensive Care Unit Microbiologic Data
PDF Version [PDF - 56 KB - 4 pages]
S. A. Moser et al.View Abstract
We describe refinements to and new experimental applications of the Data Mining Surveillance System (DMSS), which uses a large electronic health-care database for monitoring emerging infections and antimicrobial resistance. For example, information from DMSS can indicate potentially important shifts in infection and antimicrobial resistance patterns in the intensive care units of a single health-care facility.
Sentinel Surveillance for Enterovirus 71, Taiwan, 1998
PDF Version [PDF - 71 KB - 3 pages]
T. Wu et al.View Abstract
Outbreaks of enterovirus 71 have been reported around the world since 1969. The most recent outbreak occurred in Taiwan during April-July 1998. This hand, foot, and mouth disease epidemic was detected by a sentinel surveillance system in April at the beginning of the outbreak, and the public was alerted.
Chlorine Inactivation of Escherichia coli O157:H7
PDF Version [PDF - 47 KB - 3 pages]
E. W. Rice et al.View Abstract
We analyzed isolates of Escherichia coli O157:H7 (which has recently caused waterborne outbreaks) and wild-type E. coli to determine their sensitivity to chlorination. Both pathogenic and nonpathogenic strains were significantly reduced within 1 minute of exposure to free chlorine. Results indicate that chlorine levels typically maintained in water systems are sufficient to inactivate these organisms.
Fulminant Meningococcal Supraglottitis: An Emerging Infectious Syndrome?
PDF Version [PDF - 51 KB - 4 pages]
E. Schwam and J. CoxView Abstract
We report a case of fulminant supraglottitis with dramatic external cervical swelling due to associated cellulitis. Blood cultures were positive for Neisseria meningitidis. The patient recovered completely after emergency fiberoptic intubation and appropriate antibiotic therapy. We summarize five other cases of meningococcal supraglottitis, all reported since 1995, and discuss possible pathophysiologic mechanisms
Genetic Evidence of Dobrava Virus in Apodemus agrarius in Hungary
PDF Version [PDF - 80 KB - 3 pages]
J. J. Scharninghausen et al.View Abstract
Using nested polymerase chain reaction, we sequenced Dobrava virus (DOB) from the rodent Apodemus agrarius in Hungary. The samples we isolated group with DOB samples previously isolated from A. flavicollis. This grouping may indicate host switching.
Bacterial Resistance to Ciprofloxacin in Greece: Results from the National Electronic Surveillance System
PDF Version [PDF - 108 KB - 6 pages]
A. Vatopoulos et al.View Abstract
According to 1997 susceptibility data from the National Electronic System for the Surveillance of Antimicrobial Resistance, Greece has high rates of ciprofloxacin resistance. For most species, the frequency of ciprofloxacin- resistant isolates (from highest to lowest, by patient setting) was as follows: intensive care unit > surgical > medical > outpatient. Most ciprofloxacin-resistant strains were multidrug resistant.
Emergence of Related Nontoxigenic Corynebacterium diphtheriae Biotype mitis Strains in Western Europe
PDF Version [PDF - 83 KB - 4 pages]
G. Funke et al.View Abstract
We report on 17 isolates of Corynebacterium diphtheriae biotype mitis with related ribotypes from Switzerland, Germany, and France. Isolates came from skin and subcutaneous infections of injecting drug users, homeless persons, prisoners, and elderly orthopedic patients with joint prostheses or primary joint infections. Such isolates had only been observed in Switzerland.
First Case of Human Ehrlichiosis in Mexico
PDF Version [PDF - 51 KB - 1 page]
R. A. Gongóra-Biachi et al.
HIV-1 Subtype F in Single and Dual Infections in Puerto Rico: A Potential Sentinel Site for Monitoring Novel Genetic HIV Variants in North America
PDF Version [PDF - 59 KB - 3 pages]
I. Flores et al.
Paratyphoid Fever in India: An Emerging Problem
PDF Version [PDF - 56 KB - 3 pages]
S. Sood et al.
Hepatitis C Virus RNA Viremia in Central Africa
PDF Version [PDF - 55 KB - 3 pages]
N. Cancré et al.
Immunization of Peacekeeping Forces
PDF Version [PDF - 55 KB - 2 pages]
Sexually Transmitted Diseases in Ukraine
PDF Version [PDF - 50 KB - 2 pages]
D. I. Ivanov
Yellow Fever Vaccine
PDF Version [PDF - 53 KB - 2 pages]
S. C. Arya
Yellow Fever Vaccine—Reply to S. Arya
PDF Version [PDF - 52 KB - 2 pages]
T. Monath et al.
About the Cover
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: January 23, 2012
- Page last updated: January 23, 2012
- Page last reviewed: January 23, 2012
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