Volume 9, Number 10—October 2003
Volume 9, Number 10—October 2003 PDF Version [PDF - 7.42 MB - 171 pages]
Syndromic Surveillance and Bioterrorism-related Epidemics
PDF Version [PDF - 318 KB - 8 pages]
J. W. Buehler et al.View Abstract
To facilitate rapid detection of a future bioterrorist attack, an increasing number of public health departments are investing in new surveillance systems that target the early manifestations of bioterrorism-related disease. Whether this approach is likely to detect an epidemic sooner than reporting by alert clinicians remains unknown. The detection of a bioterrorism-related epidemic will depend on population characteristics, availability and use of health services, the nature of an attack, epidemiologic features of individual diseases, surveillance methods, and the capacity of health departments to respond to alerts. Predicting how these factors will combine in a bioterrorism attack may be impossible. Nevertheless, understanding their likely effect on epidemic detection should help define the usefulness of syndromic surveillance and identify approaches to increasing the likelihood that clinicians recognize and report an epidemic.
Illness in Intensive Care Staff after Brief Exposure to Severe Acute Respiratory Syndrome
PDF Version [PDF - 240 KB - 6 pages]
D. C. Scales et al.
Superantigens and Streptococcal Toxic Shock Syndrome
PDF Version [PDF - 352 KB - 8 pages]
T. Proft et al.View Abstract
Superantigens produced by Streptococcus pyogenes have been implicated with streptococcal toxic shock syndrome (STSS). We analyzed 19 acute-phase serum samples for mitogenic activity from patients with severe streptococcal disease. The serum samples from two patients in the acute phase of STSS showed strong proliferative activity. Streptococcal mitogenic exotoxin (SME) Z-1 and streptococcal pyrogenic exotoxin (SPE)-J were identified in one patient with peritonitis who recovered after 2 weeks in intensive care. SMEZ-16 was found in a second patient who died on the day of admission. Sequential serum samples taken on day 3 after admission from patient 1 showed clearance of mitogenic activity but absence of neutralizing anti-SMEZ antibodies. Serum samples taken on day 9 from this patient showed evidence of seroconversion with high levels of anti-SMEZ antibodies that neutralized SMEZ-1 and 12 other SMEZ-variants. These results imply that a high level of SMEZ production by group A streptococcus is a causative event in the onset and subsequent severity of STSS.
Hazards of Healthy Living: Bottled Water and Salad Vegetables as Risk Factors for Campylobacter Infection
PDF Version [PDF - 350 KB - 7 pages]
M. R. Evans et al.View Abstract
Campylobacter is the most common cause of bacterial gastroenteritis worldwide, yet the etiology of this infection remains only partly explained. In a retrospective cohort study, we compared 213 sporadic campylobacter case-patients with 1,144 patients with negative fecal samples. Information was obtained on food history, animal contact, foreign travel, leisure activities, medical conditions, and medication use. Eating chicken, eating food from a fried chicken outlet, eating salad vegetables, drinking bottled water, and direct contact with cows or calves were all independently associated with infection. The population-attributable fractions for these risk factors explained nearly 70% of sporadic campylobacter infections. Eating chicken is a well-established risk factor, but consuming salad and bottled water are not. The association with salad may be explained by cross-contamination of food within the home, but the possibility that natural mineral water is a risk factor for campylobacter infection could have wide public health implications.
Escherichia coli O157 Exposure in Wyoming and Seattle: Serologic Evidence of Rural Risk
PDF Version [PDF - 251 KB - 5 pages]
J. P. Haack et al.View Abstract
We tested the hypothesis that rural populations have increased exposure to Escherichia coli O157:H7. We measured circulating antibodies against the O157 lipopolysaccharide in rural Wyoming residents and in blood donors from Casper, Wyoming, and Seattle, Washington, by enzyme immunoassay (EIA). EIA readings were compared by analysis of variance and the least squares difference multiple comparison procedure. Rural Wyoming residents had higher antibody levels to O157 LPS than did Casper donors, who, in turn, had higher levels than did Seattle donors (respective least squares means: 0.356, 0.328, and 0.310; p<0.05, Seattle vs. Casper, p<0.001, rural Wyoming vs. either city). Lower age was significantly correlated with EIA scores; gender; and, in rural Wyoming, history of bloody diarrhea, town, duration of residence, and use of nontreated water at home were not significantly correlated. These data suggest that rural populations are more exposed to E. coli O157:H7 than urban populations.
Characterization of Waterborne Outbreak–associated Campylobacter jejuni, Walkerton, Ontario
PDF Version [PDF - 426 KB - 10 pages]
C. G. Clark et al.View Abstract
The Walkerton, Canada, waterborne outbreak of 2000 resulted from entry of Escherichia coli O157:H7 and Campylobacter spp. from neighboring farms into the town water supply. Isolates of Campylobacter jejuni and Campylobacter coli obtained from outbreak investigations were characterized by phenotypic and genotypic methods, including heat-stable and heat-labile serotyping, phage typing, biotyping, fla–restriction fragment length polymorphism (RFLP) typing, and pulsed-field gel electrophoresis. Two main outbreak strains were identified on the basis of heat-stable serotyping and fla-RFLP typing. These strains produced a limited number of types when tested by other methods. Isolates with types indistinguishable from, or similar to, the outbreak types were found only on one farm near the town of Walkerton, whereas cattle from other farms carried a variety of Campylobacter strains with different type characteristics. Results of these analyses confirmed results from epidemiologic studies and the utility of using several different typing and subtyping methods for completely characterizing bacterial populations.
Cultural Contexts of Ebola in Northern Uganda
PDF Version [PDF - 186 KB - 7 pages]
B. S. Hewlett and R. P. AmolaView Abstract
Technical guidelines for the control of Ebola hemorrhagic fever (EHF) indicate that understanding local views and responses to an outbreak is essential. However, few studies with such information exist. Thus, we used qualitative and quantitative methods to determine how local residents of Gulu, Uganda, viewed and responded to the 2000–2001 outbreak of EHF. Results indicated that Acholi people used at least three explanatory models to explain and respond to the outbreak; indigenous epidemic control measures were often implemented and consistent with those being promoted by healthcare workers; and some cultural practices amplified the outbreak (e.g., burial practices). However, most persons were willing to modify and work with national and international healthcare workers.
1918 Influenza Pandemic and Highly Conserved Viruses with Two Receptor-Binding Variants
PDF Version [PDF - 263 KB - 5 pages]
A. H. Reid et al.View Abstract
The “Spanish influenza pandemic swept the globe in the autumn and winter of 1918–19, and resulted in the deaths of approximately 40 million people. Clinically, epidemiologically, and pathologically, the disease was remarkably uniform, which suggests that similar viruses were causing disease around the world. To assess the homogeneity of the 1918 pandemic influenza virus, partial hemagglutinin gene sequences have been determined for five cases, including two newly identified samples from London, United Kingdom. The strains show 98.9% to 99.8% nucleotide sequence identity. One of the few differences between the strains maps to the receptor-binding site of hemagglutinin, suggesting that two receptor-binding configurations were co-circulating during the pandemic. The results suggest that in the early stages of an influenza A pandemic, mutations that occur during replication do not become fixed so that a uniform “consensus” strain circulates for some time.
Cephamycin Resistance in Clinical Isolates and Laboratory-derived Strains of Escherichia coli, Nova Scotia, Canada
PDF Version [PDF - 345 KB - 6 pages]
B. Clarke et al.View Abstract
AmpC β-lactamase, altered porins, or both are usually responsible for cefoxitin resistance in Escherichia coli. We examined the relative importance of each. We studied 18 strains of clinical isolates with reduced cefoxitin susceptibility and 10 initially-susceptible strains passaged through cefoxitin-gradient plates. Of 18 wild-resistant strains, 9 had identical promoter mutations (including creation of a consensus 17-bp spacer) and related pulsed-field gel electrophoresis patterns; the other 9 strains were unrelated. Nine strains had attenuator mutations; two strains did not express OmpC or OmpF. After serial passage, 8 of 10 strains developed cefoxitin resistance, none developed promoter or attenuator mutations, 6 lost both the OmpC and OmpF porin proteins, and 1 showed decreased production of both. One strain had neither porin alteration or increased AmpC production. Porin mutants may occur more commonly and be less fit and less inclined to spread or cause disease than strains with increased β-lactamase expression.
Mass Antibiotic Treatment for Group A Streptococcus Outbreaks in Two Long-Term Care Facilities
PDF Version [PDF - 270 KB - 6 pages]
A. Smith et al.View Abstract
Outbreaks of invasive infections caused by group A β-hemolytic streptococcus (GAS) may occur in long-term care settings and are associated with a high case-fatality rate in debilitated adults. Targeted antibiotic treatment only to residents and staff known to be at specific risk of GAS may be an ineffective outbreak control measure. We describe two institutional outbreaks in which mass antibiotic treatment was used as a control measure. In the first instance, mass treatment was used after targeted antibiotic treatment was not successful. In the second instance, mass treatment was used to control a rapidly evolving outbreak with a high case-fatality rate. Although no further clinical cases were seen after the introduction of mass antibiotic treatment, persistence of the outbreak strain was documented in one institution >1 year after cases had ceased. Strain persistence was associated with the presence of a chronically colonized resident and poor infection control practices.
Anthelmintic Baiting of Foxes against Urban Contamination with Echinococcus multilocularis
PDF Version [PDF - 312 KB - 7 pages]
D. Hegglin et al.View Abstract
In recent years, increases in the urban fox population have been observed in many countries of the Northern Hemisphere. As a result, Echinococcus multilocularis has entered the urban environment. Because of a possible increased risk for alveolar echinococcosis, intervention strategies need to be evaluated. In Zürich, Switzerland, 50 praziquantel-containing baits per km2 were distributed monthly in six 1-km2 bait areas and one 6-km2 bait area from April 2000 through October 2001. The proportion of E. multilocularis coproantigen–positive fox fecal samples collected remained unchanged in six control areas but decreased significantly in the 1-km2 bait areas (from 38.6% to 5.5%) and in the 6-km2 bait area (from 66.7% to 1.8%). E. multilocularis prevalence in the intermediate host Arvicola terrestris also decreased significantly in baited areas. This controlled baiting study shows that a pronounced reduction of E. multilocularis egg contamination is feasible in urban areas where the organism is highly endemic.
Cephalosporin-resistant Escherichia coli among Summer Camp Attendees with Salmonellosis
PDF Version [PDF - 641 KB - 8 pages]
G. Prats et al.View Abstract
Investigation of an acute gastroenteritis outbreak involving >100 persons at a summer camp in Girona, Spain, in June 2002 led to the detection of Salmonella and extended-spectrum cephalosporin-resistant Escherichia coli (ESCREC). Stool cultures were performed for 22 symptomatic campers, three asymptomatic food handlers, and 10 healthy household members. Of the 22 campers, 19 had Salmonella enterica, 9 had an ESCREC strain carrying an extended-spectrum β-lactamase, and 2 had a second ESCREC strain carrying a plasmidic cephamycinase. Related ESCREC were detected in two (salmonella-negative) asymptomatic food handlers and in none of the healthy household members. Fecal ESCREC and its β-lactamases and plasmids were extensively characterized. Three of the five ESCREC clones were recovered from multiple hosts. The apparent dissemination of ESCREC suggests a food or water vehicle. The observed distribution of resistance plasmids and β-lactamase genes in several clones indicates a high degree of horizontal transfer. Heightened vigilance and increased efforts must be made to discover the reservoirs and vehicles for community dissemination of ESCREC.
Multijurisdictional Approach to Biosurveillance, Kansas City
PDF Version [PDF - 324 KB - 6 pages]
M. A. Hoffman et al.View Abstract
An electronic reporting system for a network of 22 laboratories was implemented in Kansas City, Missouri, with an independent organization acting as a data clearinghouse between the reporting laboratories and public health departments. The system ran in tandem with conventional reporting methods. Laboratory test orders and results were aggregated and mapped to a common nomenclature. Reports were delivered through a secure Internet connection to the Kansas City Health Department (KCHD); during the first 200 days of operation, 359 qualified results were delivered electronically to KCHD. Data were received more quickly than they were with conventional reporting methods: notification of chlamydia cases arrived 2 days earlier, invasive group A streptococcal disease cases arrived 2.3 days sooner, and salmonellosis cases arrived 2.7 days sooner. Data were more complete for all demographic fields, including address, age, sex, race, and date of birth. Two hundred fourteen cases reported electronically were not received by conventional means.
Environmental Risk and Meningitis Epidemics in Africa
PDF Version [PDF - 415 KB - 7 pages]
A. M. Molesworth et al.View Abstract
Epidemics of meningococcal meningitis occur in areas with particular environmental characteristics. We present evidence that the relationship between the environment and the location of these epidemics is quantifiable and propose a model based on environmental variables to identify regions at risk for meningitis epidemics. These findings, which have substantial implications for directing surveillance activities and health policy, provide a basis for monitoring the impact of climate variability and environmental change on epidemic occurrence in Africa.
Severe Acute Respiratory Syndrome: Lessons from Singapore
PDF Version [PDF - 222 KB - 5 pages]
K. Singh et al.View Abstract
An outbreak of severe acute respiratory syndrome (SARS) occurred in Singapore in March 2003. To illustrate the problems in diagnosing and containing SARS in the hospital, we describe a case series and highlight changes in triage and infection control practices that resulted. By implementing these changes, we have stopped the nosocomial transmission of the virus.
West Nile Virus Transmission in Resident Birds, Dominican Republic
PDF Version [PDF - 345 KB - 4 pages]
O. Komar et al.View Abstract
We report West Nile virus (WNV) activity in the Dominican Republic for the first time. Specific anti-WNV antibodies were detected in 5 (15%) of 33 resident birds sampled at one location in November 2002. One seropositive bird was <4 months old, indicating a recent infection.
West Nile Virus Encephalitis and Myocarditis in Wolf and Dog
PDF Version [PDF - 336 KB - 4 pages]
C. A. Lichtensteiger et al.View Abstract
In the third season (2002) of the West Nile virus epidemic in the United States, two canids (wolf and dog) were diagnosed with West Nile virus encephalitis and myocarditis with similarities to known affected species (humans, horses, and birds). The West Nile virus infections were confirmed by immunohistochemistry and polymerase chain reaction.
Weissella confusa Infection in Primate (Cercopithecus mona)
PDF Version [PDF - 346 KB - 3 pages]
A. I. Vela et al.View Abstract
We describe the first systemic infection by Weissella confusa in a mona monkey (Cercopithecus mona) on the basis of microbiologic, molecular genetic, and histologic data. The same strain of W. confusa, as determined by pulsed-field gel electrophoresis, was isolated in pure culture from brain, liver, spleen, and intestine of this primate, illustrating the clinical importance of the isolations.
Mycobacterium tuberculosis Beijing Genotype, the Netherlands
PDF Version [PDF - 325 KB - 4 pages]
M. W. Borgdorff et al.View Abstract
To determine whether the Beijing genotype of Mycobacterium tuberculosis is emerging in the Netherlands, we collected data on 6,829 patients during 1993 to 2000. Six percent had the Beijing genotype. This genotype was associated with diagnosis in recent years, young age, nationality, and multidrug resistance.
Saliva and Meningococcal Transmission
PDF Version [PDF - 187 KB - 2 pages]
H. J. Orr et al.View Abstract
Neisseria meningitidis carriage was compared in swab specimens of nasopharynx, tonsils, and saliva taken from 258 students. We found a higher yield in nasopharyngeal than in tonsillar swabs (32% vs. 19%, p<0.001). Low prevalence of carriage in saliva swabs (one swab [0.4%]) suggests that low levels of salivary contact are unlikely to transmit meningococci.
Small Colony Variants of Staphylococcus aureus and Pacemaker-related Infection
PDF Version [PDF - 198 KB - 3 pages]
H. Seifert et al.View Abstract
We describe the first known case of a device-related bloodstream infection caused by Staphylococcus aureus small colony variants. Recurrent pacemaker-related bloodstream infection within a 7-month period illustrates the poor clinical and microbiologic response to prolonged antimicrobial therapy in a patient infected with this S. aureus subpopulation.
West Nile Virus Detection in American Crows
PDF Version [PDF - 199 KB - 3 pages]
S. A. Yaremych et al.View Abstract
A dipstick immunochromatographic assay used for West Nile virus (WNV) detection in mosquitoes was investigated for application to testing of fecal, saliva, and tissue samples from dead American Crows (Corvus brachyrhynchos). Results suggest that VecTest may be an efficient method for WNV detection in field-collected, dead American Crows, although confirmation of results and further investigation are warranted.
Severe Histoplasmosis in Travelers to Nicaragua
PDF Version [PDF - 234 KB - 4 pages]
M. Weinberg et al.View Abstract
We investigated an outbreak of unexpectedly severe histoplasmosis among 14 healthy adventure travelers from the United States who visited a bat-infested cave in Nicaragua. Although histoplasmosis has rarely been reported to cause serious illness among travelers, this outbreak demonstrates that cases may be severe among travelers, even young, healthy persons.
Mayaro Virus in Wild Mammals, French Guiana
PDF Version [PDF - 214 KB - 4 pages]
B. de Thoisy et al.View Abstract
A serologic survey for Mayaro virus (Alphavirus, Togaviridae) in 28 wild nonflying forest mammal species in French Guiana showed a prevalence ranging from 0% to 52% and increasing with age. Species active during the day and those who spent time in trees were significantly more infected, results consistent with transmission implicating diurnal mosquitoes and continuous infectious pressure.
The European Commission’s Task Force on Bioterrorism
PDF Version [PDF - 177 KB - 3 pages]
A. Tegnell et al.View Abstract
In response to the increased threat of bioterrorism, a task force on health security was established in the European Commission. Task force members address a broad range of issues related to preparedness for and response to bioterrorist events and seek to bring about a greater collaboration between the European Union member states.
Wild-type Measles Virus in Brain Tissue of Children with Subacute Sclerosing Panencephalitis, Argentina
PDF Version [PDF - 233 KB - 4 pages]
P. R. Barrero et al.View Abstract
We studied eight children who had measles at 6 to 10 months of age during the 1998 Argentine measles outbreak and in whom subacute sclerosing panencephalitis developed 4 years later. We report the genetic characterization of brain tissue–associated measles virus samples from three patients. Phylogenetic relationships clustered these viruses with the wild-type D6 genotype isolated during the 1998 outbreak. The children received measles vaccine; however, vaccinal strains were not found.
Cat or Dog Ownership and Seroprevalence of Ehrlichiosis, Q Fever, and Cat-Scratch Disease
PDF Version [PDF - 289 KB - 4 pages]
M. Skerget et al.View Abstract
Concerns have been raised about the role of domestic cats or dogs in the acquisition of zoonoses, in particular in pregnant women or immune-suppressed persons. We report that cat or dog ownership is not associated with an increased seroprevalence of antibodies to Anaplasma phagozytophilum, Coxiella burnetii, and Bartonella henselae in symptom-free persons in Styria, Austria.
Flying Squirrel–associated Typhus, United States
PDF Version [PDF - 192 KB - 3 pages]
M. G. Reynolds et al.View Abstract
In March 2002, typhus fever was diagnosed in two patients residing in West Virginia and Georgia. Both patients were hospitalized with severe febrile illnesses, and both had been recently exposed to or had physical contact with flying squirrels or flying squirrel nests. Laboratory results indicated Rickettsia prowazekii infection.
Chlamydia trachomatis Infections in Female Soldiers, Israel
PDF Version [PDF - 317 KB - 3 pages]
E. S. Bamberger et al.View Abstract
We examined the prevalence of Chlamydia trachomatis infection in Israeli female soldiers. The prevalence was 3.2% among soldiers seeking medical care; rural residence was identified as a significant risk factor. Nevertheless, given the study design, recommending broad-scale screening of Israeli female soldiers may be premature.2
Clostridium tertium in Necrotizing Fasciitis and Gangrene
PDF Version [PDF - 165 KB - 2 pages]
P. Ray et al.
Dengue Hemorrhagic Fever, Uttaradit, Thailand
PDF Version [PDF - 169 KB - 3 pages]
J. Patumanond et al.
Antimicrobial Drug-resistant Salmonella Typhimurium (Reply to Dahl)
PDF Version [PDF - 164 KB - 2 pages]
M. Helms et al.
Serogroup A Neisseria meningitidis outside Meningitis Belt in Southwest Cameroon
PDF Version [PDF - 169 KB - 3 pages]
P. Cunin et al.
West Nile Virus Meningitis in Patient with Common Variable Immunodeficiency
PDF Version [PDF - 153 KB - 2 pages]
A. M. Alonto et al.
Isolation of Enterobacter sakazakii from Midgut of Stomoxys calcitrans
PDF Version [PDF - 193 KB - 2 pages]
J. V. Hamilton et al.
Antimicrobial Drug-resistant Salmonella Typhimurium (Reply to Helms)
PDF Version [PDF - 159 KB - 1 page]
Books and Media
About the Cover
Jacques-Louis David (1748–1825). Coronation of Empress Josephine by Napoleon I at Notre Dame de Paris, 2 December 1804 (1806–1807)
PDF Version [PDF - 134 KB - 1 page]
News and Notes
- Page created: July 10, 2012
- Page last updated: July 10, 2012
- Page last reviewed: July 10, 2012
- Centers for Disease Control and Prevention,
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
Office of the Director (OD)