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Issue Cover for Volume 9, Number 12—December 2003

Volume 9, Number 12—December 2003

[PDF - 12.45 MB - 163 pages]

Perspective

Emerging Infectious Diseases in Mongolia [PDF - 188 KB - 7 pages]
J. R. Ebright et al.

Since 1990, Mongolia’s health system has been in transition. Impressive gains have been accomplished through a national immunization program, which was instituted in 1991. Nevertheless, the country continues to confront four major chronic infections: hepatitis B and C, brucellosis, tuberculosis, and sexually transmitted diseases (STDs). As of 2001, only two cases of HIV infections had been detected in Mongolia, but concern grows that the rate will increase along with the rising rates of STDs and increase in tourism. Other infectious diseases of importance in Mongolia include echinococcus, plague, tularemia, anthrax, foot-and-mouth, and rabies.

EID Ebright JR, Altantsetseg T, Oyungerel R. Emerging Infectious Diseases in Mongolia. Emerg Infect Dis. 2003;9(12):1509-1515. https://doi.org/10.3201/eid0912.020520
AMA Ebright JR, Altantsetseg T, Oyungerel R. Emerging Infectious Diseases in Mongolia. Emerging Infectious Diseases. 2003;9(12):1509-1515. doi:10.3201/eid0912.020520.
APA Ebright, J. R., Altantsetseg, T., & Oyungerel, R. (2003). Emerging Infectious Diseases in Mongolia. Emerging Infectious Diseases, 9(12), 1509-1515. https://doi.org/10.3201/eid0912.020520.
Research

Raccoon Roundworm Eggs near Homes and Risk for Larva Migrans Disease, California Communities [PDF - 518 KB - 7 pages]
G. P. Roussere et al.

The raccoon roundworm, Baylisascaris procyonis, is increasingly recognized as a cause of serious or fatal larva migrans disease in humans and animals. We assessed the potential for infection in three northern California communities by determining the density and distribution of raccoon latrines, where transmission primarily occurs, and the prevalence of eggs at private residences. We collected fecal samples from 215 latrines and found that 44%-53% of the latrines contained B. procyonis eggs and that 16% to 32% contained infective eggs. Among the properties surveyed, 28%-49% harbored at least one latrine that was positive for B. procyonis eggs. The latrine densities in these communities were higher than any previously reported. The presence of B. procyonis eggs in raccoon latrines was common, widespread, and closely associated with human habitation. Where raccoon densities are high, education of the public and removal of raccoons may be necessary.

EID Roussere GP, Murray WJ, Raudenbush CB, Kutilek MJ, Levee DJ, Kazacos KR. Raccoon Roundworm Eggs near Homes and Risk for Larva Migrans Disease, California Communities. Emerg Infect Dis. 2003;9(12):1516-1522. https://doi.org/10.3201/eid0912.030039
AMA Roussere GP, Murray WJ, Raudenbush CB, et al. Raccoon Roundworm Eggs near Homes and Risk for Larva Migrans Disease, California Communities. Emerging Infectious Diseases. 2003;9(12):1516-1522. doi:10.3201/eid0912.030039.
APA Roussere, G. P., Murray, W. J., Raudenbush, C. B., Kutilek, M. J., Levee, D. J., & Kazacos, K. R. (2003). Raccoon Roundworm Eggs near Homes and Risk for Larva Migrans Disease, California Communities. Emerging Infectious Diseases, 9(12), 1516-1522. https://doi.org/10.3201/eid0912.030039.

Global Distribution of Rubella Virus Genotypes [PDF - 393 KB - 8 pages]
D. Zheng et al.

Phylogenetic analysis of a collection of 103 E1 gene sequences from rubella viruses isolated from 17 countries from 1961 to 2000 confirmed the existence of at least two genotypes. Rubella genotype I (RGI) isolates, predominant in Europe, Japan, and the Western Hemisphere, segregated into discrete subgenotypes; intercontinental subgenotypes present in the 1960s and 1970s were replaced by geographically restricted subgenotypes after ~1980. Recently, active subgenotypes include one in the United States and Latin America, one in China, and a third that apparently originated in Asia and spread to Europe and North America, starting in 1997, indicating the recent emergence of an intercontinental subgenotype. A virus that potentially arose as a recombinant between two RGI subgenotypes was discovered. Rubella genotype II (RGII) showed greater genetic diversity than did RGI and may actually consist of multiple genotypes. RGII viruses were limited to Asia and Europe; RGI viruses were also present in most of the countries where RGII viruses were isolated.

EID Zheng D, Frey TK, Icenogle JP, Katow S, Abernathy ES, Song K, et al. Global Distribution of Rubella Virus Genotypes. Emerg Infect Dis. 2003;9(12):1523-1530. https://doi.org/10.3201/eid0912.030242
AMA Zheng D, Frey TK, Icenogle JP, et al. Global Distribution of Rubella Virus Genotypes. Emerging Infectious Diseases. 2003;9(12):1523-1530. doi:10.3201/eid0912.030242.
APA Zheng, D., Frey, T. K., Icenogle, J. P., Katow, S., Abernathy, E. S., Song, K....Croxson, M. (2003). Global Distribution of Rubella Virus Genotypes. Emerging Infectious Diseases, 9(12), 1523-1530. https://doi.org/10.3201/eid0912.030242.

Risk Factors for Marburg Hemorrhagic Fever, Democratic Republic of the Congo [PDF - 308 KB - 7 pages]
D. G. Bausch et al.

We conducted two antibody surveys to assess risk factors for Marburg hemorrhagic fever in an area of confirmed Marburg virus transmission in the Democratic Republic of the Congo. Questionnaires were administered and serum samples tested for Marburg-specific antibodies by enzyme-linked immunosorbent assay. Fifteen (2%) of 912 participants in a general village cross-sectional antibody survey were positive for Marburg immunoglobulin G antibody. Thirteen (87%) of these 15 were men who worked in the local gold mines. Working as a miner (odds ratio [OR] 13.9, 95% confidence interval [CI] 3.1 to 62.1) and receiving injections (OR 7.4, 95% CI 1.6 to 33.2) were associated with a positive antibody result. All 103 participants in a targeted antibody survey of healthcare workers were antibody negative. Primary transmission of Marburg virus to humans likely occurred via exposure to a still unidentified reservoir in the local mines. Secondary transmission appears to be less common with Marburg virus than with Ebola virus, the other known filovirus.

EID Bausch DG, Borchert M, Grein T, Roth C, Swanepoel R, Libande ML, et al. Risk Factors for Marburg Hemorrhagic Fever, Democratic Republic of the Congo. Emerg Infect Dis. 2003;9(12):1531-1537. https://doi.org/10.3201/eid0912.030355
AMA Bausch DG, Borchert M, Grein T, et al. Risk Factors for Marburg Hemorrhagic Fever, Democratic Republic of the Congo. Emerging Infectious Diseases. 2003;9(12):1531-1537. doi:10.3201/eid0912.030355.
APA Bausch, D. G., Borchert, M., Grein, T., Roth, C., Swanepoel, R., Libande, M. L....Rollin, P. E. (2003). Risk Factors for Marburg Hemorrhagic Fever, Democratic Republic of the Congo. Emerging Infectious Diseases, 9(12), 1531-1537. https://doi.org/10.3201/eid0912.030355.

Intensity of Rainfall and Severity of Melioidosis, Australia [PDF - 209 KB - 5 pages]
B. J. Currie and S. P. Jacups

In a 12-year prospective study of 318 culture-confirmed cases of melioidosis from the Top End of the Northern Territory of Australia, rainfall data for individual patient locations were correlated with patient risk factors, clinical parameters, and outcomes. Median rainfall in the 14 days before admission was highest for those dying with melioidosis (211 mm), in comparison to 110 mm for those surviving (p = 0.0002). Median 14-day rainfall was also significantly higher for those admitted with pneumonia. On univariate analysis, a prior 14-day rainfall of ≥125 mm was significantly correlated with pneumonia (odds ratio [OR] 1.70 [confidence interval [CI] 1.09 to 2.65]), bacteremia (OR 1.93 [CI 1.24 to 3.02]), septic shock (OR 1.94 [CI 1.14 to 3.29]), and death (OR 2.50 [CI 1.36 to 4.57]). On multivariate analysis, rainfall in the 14 days before admission was an independent risk factor for pneumonia (p = 0.023), bacteremic pneumonia (p = 0.001), septic shock (p = 0.005), and death (p < 0.0001). Heavy monsoonal rains and winds may cause a shift towards inhalation of Burkholderia pseudomallei.

EID Currie BJ, Jacups SP. Intensity of Rainfall and Severity of Melioidosis, Australia. Emerg Infect Dis. 2003;9(12):1538-1542. https://doi.org/10.3201/eid0912.020750
AMA Currie BJ, Jacups SP. Intensity of Rainfall and Severity of Melioidosis, Australia. Emerging Infectious Diseases. 2003;9(12):1538-1542. doi:10.3201/eid0912.020750.
APA Currie, B. J., & Jacups, S. P. (2003). Intensity of Rainfall and Severity of Melioidosis, Australia. Emerging Infectious Diseases, 9(12), 1538-1542. https://doi.org/10.3201/eid0912.020750.

Comparative Molecular and Microbiologic Diagnosis of Bacterial Endocarditis [PDF - 317 KB - 5 pages]
I. Podglajen et al.

Sequencing of 16S rDNA, and of sodAint and rpoBint in some cases, was applied to DNA from heart valves of 46 patients (36 with definite and 10 with possible endocarditis). Sequence-based identifications were compared with those obtained with conventional methods. Among the 36 definite cases, 30 had positive blood cultures and 6 had negative cultures. Among the 30 positive cases, sequencing of 16S rDNA permitted identification of species (18), genus (8), or neither (4); sodAint and rpoBint sequencing was necessary for species identification in 8 cases. Species identifications were identical in only 61.5%, when conventional techniques and DNA sequencing were used. In five of the six blood culture–negative endocarditis cases, sequencing identified Bartonella quintana (3), B. henselae (1), and Streptococcus gallolyticus (1). Our results demonstrate a clear benefit of molecular identification, particularly in cases of blood culture–negative endocarditis and of possible endocarditis, to confirm or invalidate the diagnosis. Moreover, in 19.4% of the definite cases, the improvement in species identification by sequencing led to improved patient management.

EID Podglajen I, Bellery F, Poyart C, Coudol P, Buu-Hoï A, Bruneval P, et al. Comparative Molecular and Microbiologic Diagnosis of Bacterial Endocarditis. Emerg Infect Dis. 2003;9(12):1543-1547. https://doi.org/10.3201/eid0912.030229
AMA Podglajen I, Bellery F, Poyart C, et al. Comparative Molecular and Microbiologic Diagnosis of Bacterial Endocarditis. Emerging Infectious Diseases. 2003;9(12):1543-1547. doi:10.3201/eid0912.030229.
APA Podglajen, I., Bellery, F., Poyart, C., Coudol, P., Buu-Hoï, A., Bruneval, P....Mainardi, J. (2003). Comparative Molecular and Microbiologic Diagnosis of Bacterial Endocarditis. Emerging Infectious Diseases, 9(12), 1543-1547. https://doi.org/10.3201/eid0912.030229.

Emerging Genotype (GGIIb) of Norovirus in Drinking Water, Sweden
K. Nygård et al.

From May through June 2001, an outbreak of acute gastroenteritis that affected at least 200 persons occurred in a combined activity camp and conference center in Stockholm County. The source of illness was contaminated drinking water obtained from private wells. The outbreak appears to have started with sewage pipeline problems near the kitchen, which caused overflow of the sewage system and contaminated the environment. While no pathogenic bacteria were found in water or stools specimens, norovirus was detected in 8 of 11 stool specimens and 2 of 3 water samples by polymerase chain reaction. Nucleotide sequencing of amplicons from two patients and two water samples identified an emerging genotype designated GGIIb, which was circulating throughout several European countries during 2000 and 2001. This investigation documents the first waterborne outbreak of viral gastroenteritis in Sweden, where nucleotide sequencing showed a direct link between contaminated water and illness.

EID Nygård K, Torvén M, Ancker C, Knauth SB, Hedlund K, Giesecke J, et al. Emerging Genotype (GGIIb) of Norovirus in Drinking Water, Sweden. Emerg Infect Dis. 2003;9(12):1548-1552. https://doi.org/10.3201/eid0912.030112
AMA Nygård K, Torvén M, Ancker C, et al. Emerging Genotype (GGIIb) of Norovirus in Drinking Water, Sweden. Emerging Infectious Diseases. 2003;9(12):1548-1552. doi:10.3201/eid0912.030112.
APA Nygård, K., Torvén, M., Ancker, C., Knauth, S. B., Hedlund, K., Giesecke, J....Svensson, L. (2003). Emerging Genotype (GGIIb) of Norovirus in Drinking Water, Sweden. Emerging Infectious Diseases, 9(12), 1548-1552. https://doi.org/10.3201/eid0912.030112.

Mycobacterium tuberculosis Beijing Genotype
T. Lillebaek et al.

Molecular epidemiologic studies of strains of Mycobacterium tuberculosis are currently conducted worldwide. The genetically distinct Beijing family of strains has been associated with large outbreaks of tuberculosis, increased virulence, and multidrug resistance. However, in this first population-based search for Beijing strains in the Danish DNA fingerprint database, analysis of 97% of all culture-positive tuberculosis patients in 1992 to 2001, showed that 2.5% of 3,844 patients, 1.0% of Danish-born patients and 3.6% of immigrants (from 85 countries) had Beijing strains. No Beijing strains were found among 201 strains from Danish-born patients sampled in the 1960s, and no evidence of an increase in Beijing strains was found over time. The true prevalence of Beijing strains worldwide is unknown because only a fraction of global strains have been analyzed.

EID Lillebaek T, Andersen ÅB, Dirksen A, Glynn JR, Kremer K. Mycobacterium tuberculosis Beijing Genotype. Emerg Infect Dis. 2003;9(12):1553-1557. https://doi.org/10.3201/eid0912.030276
AMA Lillebaek T, Andersen ÅB, Dirksen A, et al. Mycobacterium tuberculosis Beijing Genotype. Emerging Infectious Diseases. 2003;9(12):1553-1557. doi:10.3201/eid0912.030276.
APA Lillebaek, T., Andersen, Å. B., Dirksen, A., Glynn, J. R., & Kremer, K. (2003). Mycobacterium tuberculosis Beijing Genotype. Emerging Infectious Diseases, 9(12), 1553-1557. https://doi.org/10.3201/eid0912.030276.

Trypanosoma cruzi in Persons without Serologic Evidence of Disease, Argentina [PDF - 408 KB - 5 pages]
O. A. Salomone et al.

Current diagnosis of chronic Chagas disease relies on serologic detection of specific immunoglobulin G against Trypanosoma cruzi. However, the presence of parasites detected by polymerase chain reaction (PCR) in patients without positive conventional serologic testing has been observed. We determined the prevalence and clinical characteristics of persons with seronegative results for T. cruzi DNA detected by PCR in a population at high risk for chronic American trypanosomiasis. We studied a total of 194 persons from two different populations: 110 patients were recruited from an urban cardiology clinic, and 84 persons were nonselected citizens from a highly disease-endemic area. Eighty (41%) of persons had negative serologic findings; 12 (15%) had a positive PCR. Three patients with negative serologic findings and positive PCR results had clinical signs and symptoms that suggested Chagas cardiomyopathy. This finding challenges the current recommendations for Chagas disease diagnosis, therapy, and blood transfusion policies.

EID Salomone OA, Basquiera AL, Sembaj A, Aguerri AM, Reyes ME, Omelianuk M, et al. Trypanosoma cruzi in Persons without Serologic Evidence of Disease, Argentina. Emerg Infect Dis. 2003;9(12):1558-1562. https://doi.org/10.3201/eid0912.030008
AMA Salomone OA, Basquiera AL, Sembaj A, et al. Trypanosoma cruzi in Persons without Serologic Evidence of Disease, Argentina. Emerging Infectious Diseases. 2003;9(12):1558-1562. doi:10.3201/eid0912.030008.
APA Salomone, O. A., Basquiera, A. L., Sembaj, A., Aguerri, A. M., Reyes, M. E., Omelianuk, M....Madoery, R. J. (2003). Trypanosoma cruzi in Persons without Serologic Evidence of Disease, Argentina. Emerging Infectious Diseases, 9(12), 1558-1562. https://doi.org/10.3201/eid0912.030008.

Risk Factors for Norovirus, Sapporo-like Virus, and Group A Rotavirus Gastroenteritis [PDF - 221 KB - 8 pages]
M. A. de Wit et al.

Viral pathogens are the most common causes of gastroenteritis in the community. To identify modes of transmission and opportunities for prevention, a case-control study was conducted and risk factors for gastroenteritis attributable to norovirus (NV), Sapporo-like virus (SLV), and rotavirus were studied. For NV gastroenteritis, having a household member with gastroenteritis, contact with a person with gastroenteritis outside the household, and poor food-handling hygiene were associated with illness (population attributable risk fractions [PAR] of 17%, 56%, and 47%, respectively). For SLV gastroenteritis, contact with a person with gastroenteritis outside the household was associated with a higher risk (PAR 60%). For rotavirus gastroenteritis, contact with a person with gastroenteritis outside the household and food-handling hygiene were associated with a higher risk (PAR 86% and 46%, respectively). Transmission of these viral pathogens occurs primarily from person to person. However, for NV gastroenteritis, foodborne transmission seems to play an important role.

EID de Wit MA, Koopmans MP, van Duynhoven YT. Risk Factors for Norovirus, Sapporo-like Virus, and Group A Rotavirus Gastroenteritis. Emerg Infect Dis. 2003;9(12):1563-1570. https://doi.org/10.3201/eid0912.020076
AMA de Wit MA, Koopmans MP, van Duynhoven YT. Risk Factors for Norovirus, Sapporo-like Virus, and Group A Rotavirus Gastroenteritis. Emerging Infectious Diseases. 2003;9(12):1563-1570. doi:10.3201/eid0912.020076.
APA de Wit, M. A., Koopmans, M. P., & van Duynhoven, Y. T. (2003). Risk Factors for Norovirus, Sapporo-like Virus, and Group A Rotavirus Gastroenteritis. Emerging Infectious Diseases, 9(12), 1563-1570. https://doi.org/10.3201/eid0912.020076.

Multidrug-resistant Mycobacterium tuberculosis in HIV-Infected Persons, Peru [PDF - 269 KB - 8 pages]
P. E. Campos et al.

During 1999 to 2000, we identified HIV-infected persons with new episodes of tuberculosis (TB) at 10 hospitals in Lima-Peru and a random sample of other Lima residents with TB. Multidrug-resistant (MDR)-TB was documented in 35 (43%) of 81 HIV-positive patients and 38 (3.9%)of 965 patients who were HIV-negative or of unknown HIV status (p < 0.001). HIV-positive patients with MDR-TB were concentrated at three hospitals that treat the greatest numbers of HIV-infected persons with TB. Of patients with TB, those with HIV infection differed from those without known HIV infection in having more frequent prior exposure to clinical services and more frequent previous TB therapy or prophylaxis. However, MDR-TB in HIV-infected patients was not associated with previous TB therapy or prophylaxis. MDR-TB is an ongoing problem in HIV-infected persons receiving care in public hospitals in Lima and Callao; they represent sentinel cases for a potentially larger epidemic of nosocomial MDR-TB.

EID Campos PE, Suarez PG, Sanchez J, Zavala D, Arevalo J, Ticona E, et al. Multidrug-resistant Mycobacterium tuberculosis in HIV-Infected Persons, Peru. Emerg Infect Dis. 2003;9(12):1571-1578. https://doi.org/10.3201/eid0912.020731
AMA Campos PE, Suarez PG, Sanchez J, et al. Multidrug-resistant Mycobacterium tuberculosis in HIV-Infected Persons, Peru. Emerging Infectious Diseases. 2003;9(12):1571-1578. doi:10.3201/eid0912.020731.
APA Campos, P. E., Suarez, P. G., Sanchez, J., Zavala, D., Arevalo, J., Ticona, E....Holmes, K. K. (2003). Multidrug-resistant Mycobacterium tuberculosis in HIV-Infected Persons, Peru. Emerging Infectious Diseases, 9(12), 1571-1578. https://doi.org/10.3201/eid0912.020731.

Human Monocytotropic Ehrlichiosis, Missouri [PDF - 222 KB - 8 pages]
J. P. Olano et al.

To determine the incidence, clinical and laboratory characteristics, and utility of molecular diagnosis of human monocytotropic ehrlichiosis (HME) in the primary care setting, we conducted a prospective study in an outpatient primary care clinic in Cape Girardeau, Missouri. One hundred and two patients with a history of fever for 3 days (>37.7°C), tick bite or exposure, and no other infectious disease diagnosis were enrolled between March 1997 and December 1999. HME was diagnosed in 29 patients by indirect immunofluorescent antibody assay and polymerase chain reaction (PCR). Clinical and laboratory manifestations included fever (100%), headache (72%), myalgia or arthralgia (69%), chills (45%), weakness (38%), nausea (38%), leukopenia (60%), thrombocytopenia (56%), and elevated aspartate aminotransferase level (52%). Hospitalization occurred in 41% of case-patients. PCR sensitivity was 56%; specificity, 100%. HME is a prevalent, potentially severe disease in southeastern Missouri that often requires hospitalization. Because clinical presentation of HME is nonspecific, PCR is useful in the diagnosis of acute HME.

EID Olano JP, Masters E, Hogrefe W, Walker DH. Human Monocytotropic Ehrlichiosis, Missouri. Emerg Infect Dis. 2003;9(12):1579-1586. https://doi.org/10.3201/eid0912.020733
AMA Olano JP, Masters E, Hogrefe W, et al. Human Monocytotropic Ehrlichiosis, Missouri. Emerging Infectious Diseases. 2003;9(12):1579-1586. doi:10.3201/eid0912.020733.
APA Olano, J. P., Masters, E., Hogrefe, W., & Walker, D. H. (2003). Human Monocytotropic Ehrlichiosis, Missouri. Emerging Infectious Diseases, 9(12), 1579-1586. https://doi.org/10.3201/eid0912.020733.

Mycobacterium abscessus and Children with Cystic Fibrosis [PDF - 206 KB - 5 pages]
I. Sermet-Gaudelus et al.

We prospectively studied 298 patients with cystic fibrosis (mean age 11.3 years; range 2 months to 32 years; sex ratio, 0.47) for nontuberculous mycobacteria in respiratory samples from January 1, 1996, to December 31, 1999. Mycobacterium abscessus was by far the most prevalent nontuberculous mycobacterium: 15 patients (6 male, 9 female; mean age 11.9 years; range 2.5–22 years) had at least one positive sample for this microorganism (versus 6 patients positive for M. avium complex), including 10 with >3 positive samples (versus 3 patients for M. avium complex). The M. abscessus isolates from 14 patients were typed by pulsed-field gel electrophoresis: each of the 14 patients harbored a unique strain, ruling out a common environmental reservoir or person-to-person transmission. Water samples collected in the cystic fibrosis center were negative for M. abscessus. This major mycobacterial pathogen in children and teenagers with cystic fibrosis does not appear to be acquired nosocomially.

EID Sermet-Gaudelus I, Le Bourgeois M, Pierre-Audigier C, Offredo C, Guillemot D, Halley S, et al. Mycobacterium abscessus and Children with Cystic Fibrosis. Emerg Infect Dis. 2003;9(12):1587-1591. https://doi.org/10.3201/eid0912.020774
AMA Sermet-Gaudelus I, Le Bourgeois M, Pierre-Audigier C, et al. Mycobacterium abscessus and Children with Cystic Fibrosis. Emerging Infectious Diseases. 2003;9(12):1587-1591. doi:10.3201/eid0912.020774.
APA Sermet-Gaudelus, I., Le Bourgeois, M., Pierre-Audigier, C., Offredo, C., Guillemot, D., Halley, S....Gaillard, J. (2003). Mycobacterium abscessus and Children with Cystic Fibrosis. Emerging Infectious Diseases, 9(12), 1587-1591. https://doi.org/10.3201/eid0912.020774.

The Rabbit as a New Reservoir Host of Enterohemorrhagic Escherichia coli [PDF - 363 KB - 6 pages]
A. García and J. G. Fox

We investigated the prevalence of enterohemorrhagic Escherichia coli (EHEC) in rabbits acquired from two commercial vendors and a local petting zoo. Fecal samples from 34 Dutch Belted (DB) and 15 New Zealand White (NZW) rabbits were cultured; and isolates were biotyped, serotyped, tested by polymerase chain reaction (PCR), and genotyped by repetitive-element sequence–based PCR (Rep-PCR). Seven (25%) of 28 DB rabbits acquired from one commercial source were positive for EHEC, including O153:H- and O153:H7. One (9%) of 11 NZW rabbits from the same source was positive for eae-, stx1+ O153 strains. In contrast, six DB rabbits from another commercial source and four rabbits from a petting zoo were negative for EHEC. Rep-PCR demonstrated that the O153 EHEC and O145 enteropathogenic E. coli were two distinct clones. Our study indicates that rabbits are a new reservoir host of EHEC that may pose a zoonotic risk for humans.

EID García A, Fox JG. The Rabbit as a New Reservoir Host of Enterohemorrhagic Escherichia coli. Emerg Infect Dis. 2003;9(12):1592-1597. https://doi.org/10.3201/eid0912.030223
AMA García A, Fox JG. The Rabbit as a New Reservoir Host of Enterohemorrhagic Escherichia coli. Emerging Infectious Diseases. 2003;9(12):1592-1597. doi:10.3201/eid0912.030223.
APA García, A., & Fox, J. G. (2003). The Rabbit as a New Reservoir Host of Enterohemorrhagic Escherichia coli. Emerging Infectious Diseases, 9(12), 1592-1597. https://doi.org/10.3201/eid0912.030223.
Historical Review

Alexander the Great and West Nile Virus Encephalitis [PDF - 214 KB - 5 pages]
J. S. Marr and C. H. Calisher

Alexander the Great died in Babylon in 323 BC. His death at age 32 followed a 2-week febrile illness. Speculated causes of death have included poisoning, assassination, and a number of infectious diseases. One incident, mentioned by Plutarch but not considered by previous investigators, may shed light on the cause of Alexander’s death. The incident, which occurred as he entered Babylon, involved a flock of ravens exhibiting unusual behavior and subsequently dying at his feet. The inexplicable behavior of ravens is reminiscent of avian illness and death weeks before the first human cases of West Nile virus infection were identified in the United States. We posit that Alexander may have died of West Nile encephalitis.

EID Marr JS, Calisher CH. Alexander the Great and West Nile Virus Encephalitis. Emerg Infect Dis. 2003;9(12):1599-1603. https://doi.org/10.3201/eid0912.030288
AMA Marr JS, Calisher CH. Alexander the Great and West Nile Virus Encephalitis. Emerging Infectious Diseases. 2003;9(12):1599-1603. doi:10.3201/eid0912.030288.
APA Marr, J. S., & Calisher, C. H. (2003). Alexander the Great and West Nile Virus Encephalitis. Emerging Infectious Diseases, 9(12), 1599-1603. https://doi.org/10.3201/eid0912.030288.
Dispatches

West Nile Virus in Mexico: Evidence of Widespread Circulation since July 2002. [PDF - 203 KB - 4 pages]
J. G. Estrada-Franco et al.

West Nile virus (WNV) antibodies were detected in horses from five Mexican states, and WNV was isolated from a Common Raven in the state of Tabasco. Phylogenetic studies indicate that this isolate, the first from Mexico, is related to strains from the central United States but has a relatively high degree of sequence divergence.

EID Estrada-Franco JG, Navarro-Lopez R, Beasley DW, Coffey LL, Carrara A, Travassos da Rosa A, et al. West Nile Virus in Mexico: Evidence of Widespread Circulation since July 2002.. Emerg Infect Dis. 2003;9(12):1604-1607. https://doi.org/10.3201/eid0912.030564
AMA Estrada-Franco JG, Navarro-Lopez R, Beasley DW, et al. West Nile Virus in Mexico: Evidence of Widespread Circulation since July 2002.. Emerging Infectious Diseases. 2003;9(12):1604-1607. doi:10.3201/eid0912.030564.
APA Estrada-Franco, J. G., Navarro-Lopez, R., Beasley, D. W., Coffey, L. L., Carrara, A., Travassos da Rosa, A....Vasilakis, N. (2003). West Nile Virus in Mexico: Evidence of Widespread Circulation since July 2002.. Emerging Infectious Diseases, 9(12), 1604-1607. https://doi.org/10.3201/eid0912.030564.

Severe Acute Respiratory Syndrome Epidemic in Asia [PDF - 189 KB - 3 pages]
G. Zhou and E. Lo

We analyzed the dynamics of cumulative severe acute respiratory syndrome (SARS) cases in Singapore, Hong Kong, and Beijing using the Richards model. The predicted total SARS incidence was close to the actual number of cases; the predicted cessation date was close to the lower limit of the 95% confidence interval.

EID Zhou G, Lo E. Severe Acute Respiratory Syndrome Epidemic in Asia. Emerg Infect Dis. 2003;9(12):1608-1610. https://doi.org/10.3201/eid0912.030382
AMA Zhou G, Lo E. Severe Acute Respiratory Syndrome Epidemic in Asia. Emerging Infectious Diseases. 2003;9(12):1608-1610. doi:10.3201/eid0912.030382.
APA Zhou, G., & Lo, E. (2003). Severe Acute Respiratory Syndrome Epidemic in Asia. Emerging Infectious Diseases, 9(12), 1608-1610. https://doi.org/10.3201/eid0912.030382.

Age and Variant Creutzfeldt-Jakob Disease [PDF - 112 KB - 2 pages]
P. Bacchetti

The young and stable median age of those who die of variant Creutzfeldt-Jakob disease has been attributed to age-dependent infection rates. This analysis shows that an influence of age on risk for death after infection better explains age patterns, suggesting that biologic factors peaking in the third decade of life may hasten disease.

EID Bacchetti P. Age and Variant Creutzfeldt-Jakob Disease. Emerg Infect Dis. 2003;9(12):1611-1612. https://doi.org/10.3201/eid0912.030361
AMA Bacchetti P. Age and Variant Creutzfeldt-Jakob Disease. Emerging Infectious Diseases. 2003;9(12):1611-1612. doi:10.3201/eid0912.030361.
APA Bacchetti, P. (2003). Age and Variant Creutzfeldt-Jakob Disease. Emerging Infectious Diseases, 9(12), 1611-1612. https://doi.org/10.3201/eid0912.030361.

Noninvasive Method for Monitoring Pneumocystis carinii Pneumonia [PDF - 410 KB - 4 pages]
M. J. Linke et al.

The progression of Pneumocystis carinii pneumonia was temporally monitored and quantified by real-time polymerase chain reaction of P. carinii–specific DNA in oral swabs and lung homogenates from infected rats. DNA levels correlated with the number of P. carinii organisms in the rats’ lungs, as enumerated by microscopic methods. This report is the first of a noninvasive, antemortem method that can be used to monitor infection in a host over time.

EID Linke MJ, Rebholz S, Collins M, Tanaka R, Cushion MT. Noninvasive Method for Monitoring Pneumocystis carinii Pneumonia. Emerg Infect Dis. 2003;9(12):1613-1616. https://doi.org/10.3201/eid0912.030270
AMA Linke MJ, Rebholz S, Collins M, et al. Noninvasive Method for Monitoring Pneumocystis carinii Pneumonia. Emerging Infectious Diseases. 2003;9(12):1613-1616. doi:10.3201/eid0912.030270.
APA Linke, M. J., Rebholz, S., Collins, M., Tanaka, R., & Cushion, M. T. (2003). Noninvasive Method for Monitoring Pneumocystis carinii Pneumonia. Emerging Infectious Diseases, 9(12), 1613-1616. https://doi.org/10.3201/eid0912.030270.

Visceral Leishmaniasis Treatment, Italy [PDF - 326 KB - 4 pages]
L. Gradoni et al.

First-line drug treatment was recorded in 573 immunocompetent patients with visceral leishmaniasis in Italy. In the past 12 years, the proportion of antimonial treatments decreased from 100% to 2.8%, while the proportion of amphotericin B treatments increased from 0% to 97.2%. The countrywide change in therapy is a response to both disease reemergence and increasing antimonial failure.

EID Gradoni L, Gramiccia M, Scalone A. Visceral Leishmaniasis Treatment, Italy. Emerg Infect Dis. 2003;9(12):1617-1620. https://doi.org/10.3201/eid0912.030178
AMA Gradoni L, Gramiccia M, Scalone A. Visceral Leishmaniasis Treatment, Italy. Emerging Infectious Diseases. 2003;9(12):1617-1620. doi:10.3201/eid0912.030178.
APA Gradoni, L., Gramiccia, M., & Scalone, A. (2003). Visceral Leishmaniasis Treatment, Italy. Emerging Infectious Diseases, 9(12), 1617-1620. https://doi.org/10.3201/eid0912.030178.

Ciprofloxacin Treatment Failure in Typhoid Fever Case, Pakistan [PDF - 170 KB - 2 pages]
T. Butt et al.

We report a case of ciprofloxacin treatment failure in a typhoid fever patient at a tertiary care hospital in Rawalpindi, Pakistan. This case shows not only the emergence of fluoroquinolone resistance in typhoid salmonellae but also the inadequacy of the current laboratory guidelines for detection of this resistance.

EID Butt T, Ahmad RN, Mahmood A, Zaidi S. Ciprofloxacin Treatment Failure in Typhoid Fever Case, Pakistan. Emerg Infect Dis. 2003;9(12):1621-1622. https://doi.org/10.3201/eid0912.030230
AMA Butt T, Ahmad RN, Mahmood A, et al. Ciprofloxacin Treatment Failure in Typhoid Fever Case, Pakistan. Emerging Infectious Diseases. 2003;9(12):1621-1622. doi:10.3201/eid0912.030230.
APA Butt, T., Ahmad, R. N., Mahmood, A., & Zaidi, S. (2003). Ciprofloxacin Treatment Failure in Typhoid Fever Case, Pakistan. Emerging Infectious Diseases, 9(12), 1621-1622. https://doi.org/10.3201/eid0912.030230.

Novel Lyssaviruses Isolated from Bats in Russia [PDF - 221 KB - 3 pages]
A. D. Botvinkin et al.

Two new rabies-related viruses were discovered in Russia during 2002. Viruses were isolated from bats in Eastern Siberia near Baikal Lake and in the western Caucasus Mountains. After preliminary antigenic and genetic characterization, we found that both viruses should be considered as new putative lyssavirus genotypes.

EID Botvinkin AD, Poleschuk EM, Kuzmin IV, Borisova TI, Gazaryan SV, Yager P, et al. Novel Lyssaviruses Isolated from Bats in Russia. Emerg Infect Dis. 2003;9(12):1623-1625. https://doi.org/10.3201/eid0912.030374
AMA Botvinkin AD, Poleschuk EM, Kuzmin IV, et al. Novel Lyssaviruses Isolated from Bats in Russia. Emerging Infectious Diseases. 2003;9(12):1623-1625. doi:10.3201/eid0912.030374.
APA Botvinkin, A. D., Poleschuk, E. M., Kuzmin, I. V., Borisova, T. I., Gazaryan, S. V., Yager, P....Rupprecht, C. E. (2003). Novel Lyssaviruses Isolated from Bats in Russia. Emerging Infectious Diseases, 9(12), 1623-1625. https://doi.org/10.3201/eid0912.030374.

Human Metapneumovirus and Respiratory Syncytial Virus, Brazil [PDF - 133 KB - 3 pages]
L. E. Cuevas et al.

We describe the epidemiologic and clinical characteristics of 111 children attending clinics and hospitals in Aracaju, northeast Brazil, with acute respiratory infections attributable to human metapneumovirus (HMPV), respiratory syncytial virus (RSV), or both in May and June 2002. Fifty-three (48%) children were infected with RSV alone, 19 (17%) with HMPV alone, and 8 (7%) had RSV/HMPV co-infections.

EID Cuevas LE, Ben Nasser AM, Dove W, Gurgel RQ, Greensill J, Hart CA. Human Metapneumovirus and Respiratory Syncytial Virus, Brazil. Emerg Infect Dis. 2003;9(12):1626-1628. https://doi.org/10.3201/eid0912.030522
AMA Cuevas LE, Ben Nasser AM, Dove W, et al. Human Metapneumovirus and Respiratory Syncytial Virus, Brazil. Emerging Infectious Diseases. 2003;9(12):1626-1628. doi:10.3201/eid0912.030522.
APA Cuevas, L. E., Ben Nasser, A. M., Dove, W., Gurgel, R. Q., Greensill, J., & Hart, C. A. (2003). Human Metapneumovirus and Respiratory Syncytial Virus, Brazil. Emerging Infectious Diseases, 9(12), 1626-1628. https://doi.org/10.3201/eid0912.030522.

Actinomyces Odontolyticus Bacteremia [PDF - 206 KB - 4 pages]
L. A. Cone et al.

We describe two immunosuppressed female patients with fever and Actinomyces odontolyticus bacteremia, a combination documented once previously in an immunocompetent male patient. The patients were treated with doxycycline and clindamycin; these drugs, with β-lactams, are effective treatment for A. odontolyticus infections. Further instances of bacteremia may be expected in immunosuppressed patients.

EID Cone LA, Leung MM, Hirschberg J. Actinomyces Odontolyticus Bacteremia. Emerg Infect Dis. 2003;9(12):1629-1632. https://doi.org/10.3201/eid0912.020646
AMA Cone LA, Leung MM, Hirschberg J. Actinomyces Odontolyticus Bacteremia. Emerging Infectious Diseases. 2003;9(12):1629-1632. doi:10.3201/eid0912.020646.
APA Cone, L. A., Leung, M. M., & Hirschberg, J. (2003). Actinomyces Odontolyticus Bacteremia. Emerging Infectious Diseases, 9(12), 1629-1632. https://doi.org/10.3201/eid0912.020646.

Mycobacterium tuberculosis Beijing Genotype and Risk for Treatment Failure and Relapse, Vietnam [PDF - 195 KB - 3 pages]
N. T. Lan et al.

Among 2,901 new smear-positive tuberculosis cases in Ho Chi Minh City, Vietnam, 40 cases of treatment failure and 39 relapsing cases were diagnosed. All initial and follow-up Mycobacterium tuberculosis isolates of these case-patients had (nearly) identical restriction fragment length polymorphism patterns, and the Beijing genotype was a significant risk factor for treatment failure and relapse (odds ratio 2.8, 95% confidence interval 1.5 to 5.2).

EID Lan NT, Lien HT, Tung LB, Borgdorff MW, Kremer K, van Soolingen D. Mycobacterium tuberculosis Beijing Genotype and Risk for Treatment Failure and Relapse, Vietnam. Emerg Infect Dis. 2003;9(12):1633-1635. https://doi.org/10.3201/eid0912.030169
AMA Lan NT, Lien HT, Tung LB, et al. Mycobacterium tuberculosis Beijing Genotype and Risk for Treatment Failure and Relapse, Vietnam. Emerging Infectious Diseases. 2003;9(12):1633-1635. doi:10.3201/eid0912.030169.
APA Lan, N. T., Lien, H. T., Tung, L. B., Borgdorff, M. W., Kremer, K., & van Soolingen, D. (2003). Mycobacterium tuberculosis Beijing Genotype and Risk for Treatment Failure and Relapse, Vietnam. Emerging Infectious Diseases, 9(12), 1633-1635. https://doi.org/10.3201/eid0912.030169.

Baylisascaris procyonis in the Metropolitan Atlanta Area [PDF - 156 KB - 2 pages]
M. L. Eberhard et al.

Baylisascaris procyonis, the raccoon roundworm responsible for fatal larva migrans in humans, has long been thought to be absent from many regions in the southeastern United States. During spring 2002, 11 (22%) of 50 raccoons trapped in DeKalb County, Georgia, had B. procyonis infection. The increasing number of cases highlight this emerging zoonotic infection.

EID Eberhard ML, Nace EK, Won KY, Punkosdy GA, Bishop HS, Johnston SP. Baylisascaris procyonis in the Metropolitan Atlanta Area. Emerg Infect Dis. 2003;9(12):1636-1637. https://doi.org/10.3201/eid0912.020795
AMA Eberhard ML, Nace EK, Won KY, et al. Baylisascaris procyonis in the Metropolitan Atlanta Area. Emerging Infectious Diseases. 2003;9(12):1636-1637. doi:10.3201/eid0912.020795.
APA Eberhard, M. L., Nace, E. K., Won, K. Y., Punkosdy, G. A., Bishop, H. S., & Johnston, S. P. (2003). Baylisascaris procyonis in the Metropolitan Atlanta Area. Emerging Infectious Diseases, 9(12), 1636-1637. https://doi.org/10.3201/eid0912.020795.

Scrub Typhus Reemergence in the Maldives [PDF - 314 KB - 4 pages]
M. D. Lewis et al.

In summer 2002, an outbreak of febrile illness began in the Maldives in the Indian Ocean. Through April 2003, officials recorded 168 cases with 10 deaths. The Armed Forces Research Institute of Medicine in Bangkok confirmed Orientia tsutsugamushi and conducted a joint investigation with the Ministry of Health, Maldives. These cases of scrub typhus were the first in the Maldives since World War II.

EID Lewis MD, Yousuf AA, Lerdthusnee K, Razee A, Chandranoi K, Jones JW. Scrub Typhus Reemergence in the Maldives. Emerg Infect Dis. 2003;9(12):1638-1641. https://doi.org/10.3201/eid0912.030212
AMA Lewis MD, Yousuf AA, Lerdthusnee K, et al. Scrub Typhus Reemergence in the Maldives. Emerging Infectious Diseases. 2003;9(12):1638-1641. doi:10.3201/eid0912.030212.
APA Lewis, M. D., Yousuf, A. A., Lerdthusnee, K., Razee, A., Chandranoi, K., & Jones, J. W. (2003). Scrub Typhus Reemergence in the Maldives. Emerging Infectious Diseases, 9(12), 1638-1641. https://doi.org/10.3201/eid0912.030212.

Chlamydophila abortus Pelvic Inflammatory Disease [PDF - 178 KB - 3 pages]
G. Walder et al.

We report the first documented case of an extragestational infection with Chlamydophila abortus in humans. The pathogen was identified in a patient with severe pelvic inflammatory disease (PID) by sequence analysis of the ompA gene. Our findings raise the possibility that Chlamydiaceae other than Chlamydia trachomatis are involved in PID.

EID Walder G, Meusburger H, Hotzel H, Oehme A, Neunteufel W, Dierich MP, et al. Chlamydophila abortus Pelvic Inflammatory Disease. Emerg Infect Dis. 2003;9(12):1642-1644. https://doi.org/10.3201/eid0912.020566
AMA Walder G, Meusburger H, Hotzel H, et al. Chlamydophila abortus Pelvic Inflammatory Disease. Emerging Infectious Diseases. 2003;9(12):1642-1644. doi:10.3201/eid0912.020566.
APA Walder, G., Meusburger, H., Hotzel, H., Oehme, A., Neunteufel, W., Dierich, M. P....Würzner, R. (2003). Chlamydophila abortus Pelvic Inflammatory Disease. Emerging Infectious Diseases, 9(12), 1642-1644. https://doi.org/10.3201/eid0912.020566.
Commentaries

Influenza Pandemic Preparedness [PDF - 252 KB - 4 pages]
K. F. Gensheimer et al.
EID Gensheimer KF, Meltzer MI, Postema AS, Strikas RA. Influenza Pandemic Preparedness. Emerg Infect Dis. 2003;9(12):1645-1648. https://doi.org/10.3201/eid0912.030289
AMA Gensheimer KF, Meltzer MI, Postema AS, et al. Influenza Pandemic Preparedness. Emerging Infectious Diseases. 2003;9(12):1645-1648. doi:10.3201/eid0912.030289.
APA Gensheimer, K. F., Meltzer, M. I., Postema, A. S., & Strikas, R. A. (2003). Influenza Pandemic Preparedness. Emerging Infectious Diseases, 9(12), 1645-1648. https://doi.org/10.3201/eid0912.030289.
Letters

Generalized Vaccinia 2 Days after Smallpox Revaccination [PDF - 175 KB - 2 pages]
J. R. Miller et al.
EID Miller JR, Cirino NM, Philbin EF. Generalized Vaccinia 2 Days after Smallpox Revaccination. Emerg Infect Dis. 2003;9(12):1649-1650. https://doi.org/10.3201/eid0912.030592
AMA Miller JR, Cirino NM, Philbin EF. Generalized Vaccinia 2 Days after Smallpox Revaccination. Emerging Infectious Diseases. 2003;9(12):1649-1650. doi:10.3201/eid0912.030592.
APA Miller, J. R., Cirino, N. M., & Philbin, E. F. (2003). Generalized Vaccinia 2 Days after Smallpox Revaccination. Emerging Infectious Diseases, 9(12), 1649-1650. https://doi.org/10.3201/eid0912.030592.

Salmonella enterica Serovar Enteritidis, Japan [PDF - 157 KB - 2 pages]
H. Izumiya et al.
EID Izumiya H, Nojiri N, Hashiwata Y, Tamura K, Terajima J, Watanabe H. Salmonella enterica Serovar Enteritidis, Japan. Emerg Infect Dis. 2003;9(12):1650-1651. https://doi.org/10.3201/eid0912.030172
AMA Izumiya H, Nojiri N, Hashiwata Y, et al. Salmonella enterica Serovar Enteritidis, Japan. Emerging Infectious Diseases. 2003;9(12):1650-1651. doi:10.3201/eid0912.030172.
APA Izumiya, H., Nojiri, N., Hashiwata, Y., Tamura, K., Terajima, J., & Watanabe, H. (2003). Salmonella enterica Serovar Enteritidis, Japan. Emerging Infectious Diseases, 9(12), 1650-1651. https://doi.org/10.3201/eid0912.030172.

Factors Influencing Fluoroquinolone Resistance [PDF - 163 KB - 4 pages]
D. F. Sahm et al.
EID Sahm DF, Thornsberry C, Jones ME, Karlowsky JA. Factors Influencing Fluoroquinolone Resistance. Emerg Infect Dis. 2003;9(12):1651-1654. https://doi.org/10.3201/eid0912.030168
AMA Sahm DF, Thornsberry C, Jones ME, et al. Factors Influencing Fluoroquinolone Resistance. Emerging Infectious Diseases. 2003;9(12):1651-1654. doi:10.3201/eid0912.030168.
APA Sahm, D. F., Thornsberry, C., Jones, M. E., & Karlowsky, J. A. (2003). Factors Influencing Fluoroquinolone Resistance. Emerging Infectious Diseases, 9(12), 1651-1654. https://doi.org/10.3201/eid0912.030168.

International Travel and Sexually Transmitted Disease [PDF - 162 KB - 3 pages]
P. Etkind et al.
EID Etkind P, Ratelle S, George H. International Travel and Sexually Transmitted Disease. Emerg Infect Dis. 2003;9(12):1654-1656. https://doi.org/10.3201/eid0912.030210
AMA Etkind P, Ratelle S, George H. International Travel and Sexually Transmitted Disease. Emerging Infectious Diseases. 2003;9(12):1654-1656. doi:10.3201/eid0912.030210.
APA Etkind, P., Ratelle, S., & George, H. (2003). International Travel and Sexually Transmitted Disease. Emerging Infectious Diseases, 9(12), 1654-1656. https://doi.org/10.3201/eid0912.030210.

Salmonella in Denmark [PDF - 149 KB - 1 page]
M. E. Patrick et al.
EID Patrick ME, Wegener HC, Collignon P. Salmonella in Denmark. Emerg Infect Dis. 2003;9(12):1656. https://doi.org/10.3201/eid0912.030310
AMA Patrick ME, Wegener HC, Collignon P. Salmonella in Denmark. Emerging Infectious Diseases. 2003;9(12):1656. doi:10.3201/eid0912.030310.
APA Patrick, M. E., Wegener, H. C., & Collignon, P. (2003). Salmonella in Denmark. Emerging Infectious Diseases, 9(12), 1656. https://doi.org/10.3201/eid0912.030310.
Books and Media

Emerging Infectious Diseases: Trends and Issues [PDF - 283 KB - 1 page]
E. Larson
EID Larson E. Emerging Infectious Diseases: Trends and Issues. Emerg Infect Dis. 2003;9(12):1660. https://doi.org/10.3201/eid0912.030558
AMA Larson E. Emerging Infectious Diseases: Trends and Issues. Emerging Infectious Diseases. 2003;9(12):1660. doi:10.3201/eid0912.030558.
APA Larson, E. (2003). Emerging Infectious Diseases: Trends and Issues. Emerging Infectious Diseases, 9(12), 1660. https://doi.org/10.3201/eid0912.030558.
About the Cover

Michelangelo Merisi da Caravaggio (1571–1610). Basket of Fruit (1596) [PDF - 241 KB - 2 pages]
P. Potter
EID Potter P. Michelangelo Merisi da Caravaggio (1571–1610). Basket of Fruit (1596). Emerg Infect Dis. 2003;9(12):1663-1664. https://doi.org/10.3201/eid0912.ac0912
AMA Potter P. Michelangelo Merisi da Caravaggio (1571–1610). Basket of Fruit (1596). Emerging Infectious Diseases. 2003;9(12):1663-1664. doi:10.3201/eid0912.ac0912.
APA Potter, P. (2003). Michelangelo Merisi da Caravaggio (1571–1610). Basket of Fruit (1596). Emerging Infectious Diseases, 9(12), 1663-1664. https://doi.org/10.3201/eid0912.ac0912.
Conference Summaries

International Conference on Women and Infectious Diseases: from Science to Action
Page created: July 10, 2012
Page updated: July 10, 2012
Page reviewed: July 10, 2012
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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