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Volume 9, Number 5—May 2003

Volume 9, Number 5—May 2003   PDF Version [PDF - 11.58 MB - 107 pages]

Perspective

  • Planning against Biological Terrorism: Lessons from Outbreak Investigations PDF Version [PDF - 165 KB - 5 pages]
    D. A. Ashford et al.
        View Abstract

    We examined outbreak investigations conducted around the world from 1988 to 1999 by the Centers for Disease Control and Prevention’s Epidemic Intelligence Service. In 44 (4.0%) of 1,099 investigations, identified causative agents had bioterrorism potential. In six investigations, intentional use of infectious agents was considered. Healthcare providers reported 270 (24.6%) outbreaks and infection control practitioners reported 129 (11.7%); together they reported 399 (36.3%) of the outbreaks. Health departments reported 335 (30.5%) outbreaks. For six outbreaks in which bioterrorism or intentional contamination was possible, reporting was delayed for up to 26 days. We confirmed that the most critical component for bioterrorism outbreak detection and reporting is the frontline healthcare profession and the local health departments. Bioterrorism preparedness should emphasize education and support of this frontline as well as methods to shorten the time between outbreak and reporting.

        Cite This Article
    EID Ashford DA, Kaiser RM, Bales ME, Shutt K, Patrawalla A, McShan A, et al. Planning against Biological Terrorism: Lessons from Outbreak Investigations. Emerg Infect Dis. 2003;9(5):515-519. https://dx.doi.org/10.3201/eid0905.020388
    AMA Ashford DA, Kaiser RM, Bales ME, et al. Planning against Biological Terrorism: Lessons from Outbreak Investigations. Emerging Infectious Diseases. 2003;9(5):515-519. doi:10.3201/eid0905.020388.
    APA Ashford, D. A., Kaiser, R. M., Bales, M. E., Shutt, K., Patrawalla, A., McShan, A....Dannenberg, A. L. (2003). Planning against Biological Terrorism: Lessons from Outbreak Investigations. Emerging Infectious Diseases, 9(5), 515-519. https://dx.doi.org/10.3201/eid0905.020388.

Synopses

  • Endemic Gastrointestinal Anthrax in 1960s Lebanon: Clinical Manifestations and Surgical Findings PDF Version [PDF - 521 KB - 6 pages]
    Z. Kanafani et al.
        View Abstract

    Anthrax is an ancient disease caused by the gram-positive Bacillus anthracis; recently, it has gained much attention because of its potential use in biologic warfare. Anthrax infection occurs in three forms: cutaneous, inhalational, and gastrointestinal. The last type results from ingestion of poorly cooked contaminated meat. Intestinal anthrax was widely known in Lebanon in the 1960s, when a series of >100 cases were observed in the Bekaa Valley. We describe some of these cases, introduce the concept of the surgical management of advanced intestinal anthrax, and describe some of the approaches for treatment.

        Cite This Article
    EID Kanafani Z, Ghossain A, Sharara A, Hatem JM, Kanj S. Endemic Gastrointestinal Anthrax in 1960s Lebanon: Clinical Manifestations and Surgical Findings. Emerg Infect Dis. 2003;9(5):520-525. https://dx.doi.org/10.3201/eid0905.020537
    AMA Kanafani Z, Ghossain A, Sharara A, et al. Endemic Gastrointestinal Anthrax in 1960s Lebanon: Clinical Manifestations and Surgical Findings. Emerging Infectious Diseases. 2003;9(5):520-525. doi:10.3201/eid0905.020537.
    APA Kanafani, Z., Ghossain, A., Sharara, A., Hatem, J. M., & Kanj, S. (2003). Endemic Gastrointestinal Anthrax in 1960s Lebanon: Clinical Manifestations and Surgical Findings. Emerging Infectious Diseases, 9(5), 520-525. https://dx.doi.org/10.3201/eid0905.020537.

Research

  • Vero Cytotoxin–Producing Escherichia coli O157 Gastroenteritis in Farm Visitors, North Wales PDF Version [PDF - 231 KB - 5 pages]
    C. J. Payne et al.
        View Abstract

    An outbreak of Vero cytotoxin–producing Escherichia coli O157 (VTEC O157) gastroenteritis in visitors to an open farm in North Wales resulted in 17 primary and 7 secondary cases of illness. E. coli O157 Vero cytotoxin type 2, phage type 2 was isolated from 23 human cases and environmental animal fecal samples. A case-control study of 16 primary case-patients and 36 controls (all children) showed a significant association with attendance on the 2nd day of a festival, eating ice cream or cotton candy (candy floss), and contact with cows or goats. On multivariable analysis, only the association between illness and ice cream (odds ratio [OR]=11.99, 95% confidence interval [CI] 1.04 to 137.76) and cotton candy (OR=51.90, 95% CI 2.77 to 970.67) remained significant. In addition to supervised handwashing, we recommend that foods on open farms only be eaten in dedicated clean areas and that sticky foods be discouraged.

        Cite This Article
    EID Payne CJ, Petrovic M, Roberts RJ, Paul A, Linnane E, Walker M, et al. Vero Cytotoxin–Producing Escherichia coli O157 Gastroenteritis in Farm Visitors, North Wales. Emerg Infect Dis. 2003;9(5):526-530. https://dx.doi.org/10.3201/eid0905.020237
    AMA Payne CJ, Petrovic M, Roberts RJ, et al. Vero Cytotoxin–Producing Escherichia coli O157 Gastroenteritis in Farm Visitors, North Wales. Emerging Infectious Diseases. 2003;9(5):526-530. doi:10.3201/eid0905.020237.
    APA Payne, C. J., Petrovic, M., Roberts, R. J., Paul, A., Linnane, E., Walker, M....Salmon, R. L. (2003). Vero Cytotoxin–Producing Escherichia coli O157 Gastroenteritis in Farm Visitors, North Wales. Emerging Infectious Diseases, 9(5), 526-530. https://dx.doi.org/10.3201/eid0905.020237.
  • Pandemic Influenza and Healthcare Demand in the Netherlands: Scenario Analysis PDF Version [PDF - 257 KB - 8 pages]
    M. L. van Genugten et al.
        View Abstract

    In accordance with World Health Organization guidelines, the Dutch Ministry of Health, Welfare and Sports designed a national plan to minimize effects of pandemic influenza. Within the scope of the Dutch pandemic preparedness plan, we were asked to estimate the magnitude of the problem in terms of the number of hospitalizations and deaths during an influenza pandemic. Using scenario analysis, we also examined the potential effects of intervention options. We describe and compare the scenarios developed to understand the potential impact of a pandemic (i.e., illness, hospitalizations, deaths), various interventions, and critical model parameters. Scenario analysis is a helpful tool for making policy decisions about the design and planning of outbreak control management on a national, regional, or local level.

        Cite This Article
    EID van Genugten ML, Heijnen MA, Jager JC. Pandemic Influenza and Healthcare Demand in the Netherlands: Scenario Analysis. Emerg Infect Dis. 2003;9(5):531-538. https://dx.doi.org/10.3201/eid0905.020321
    AMA van Genugten ML, Heijnen MA, Jager JC. Pandemic Influenza and Healthcare Demand in the Netherlands: Scenario Analysis. Emerging Infectious Diseases. 2003;9(5):531-538. doi:10.3201/eid0905.020321.
    APA van Genugten, M. L., Heijnen, M. A., & Jager, J. C. (2003). Pandemic Influenza and Healthcare Demand in the Netherlands: Scenario Analysis. Emerging Infectious Diseases, 9(5), 531-538. https://dx.doi.org/10.3201/eid0905.020321.
  • Estimating the Incidence of Typhoid Fever and Other Febrile Illnesses in Developing Countries PDF Version [PDF - 198 KB - 6 pages]
    J. A. Crump et al.
        View Abstract

    To measure the incidence of typhoid fever and other febrile illnesses in Bilbeis District, Egypt, we conducted a household survey to determine patterns of health seeking among persons with fever. Then we established surveillance for 4 months among a representative sample of health providers who saw febrile patients. Health providers collected epidemiologic information and blood (for culture and serologic testing) from eligible patients. After adjusting for the provider sampling scheme, test sensitivity, and seasonality, we estimated that the incidence of typhoid fever was 13/100,000 persons per year and the incidence of brucellosis was 18/100,000 persons per year in the district. This surveillance tool could have wide applications for surveillance for febrile illness in developing countries.

        Cite This Article
    EID Crump JA, Youssef FG, Luby SP, Wasfy MO, Rangel JM, Taalat M, et al. Estimating the Incidence of Typhoid Fever and Other Febrile Illnesses in Developing Countries. Emerg Infect Dis. 2003;9(5):539-544. https://dx.doi.org/10.3201/eid0905.020428
    AMA Crump JA, Youssef FG, Luby SP, et al. Estimating the Incidence of Typhoid Fever and Other Febrile Illnesses in Developing Countries. Emerging Infectious Diseases. 2003;9(5):539-544. doi:10.3201/eid0905.020428.
    APA Crump, J. A., Youssef, F. G., Luby, S. P., Wasfy, M. O., Rangel, J. M., Taalat, M....Mahoney, F. J. (2003). Estimating the Incidence of Typhoid Fever and Other Febrile Illnesses in Developing Countries. Emerging Infectious Diseases, 9(5), 539-544. https://dx.doi.org/10.3201/eid0905.020428.
  • Human Milk Secretory Antibodies against Attaching and Effacing Escherichia coli Antigens PDF Version [PDF - 230 KB - 7 pages]
    M. Noguera-Obenza et al.
        View Abstract

    Secretory immunoglobulin A (sIgA) is a primary factor responsible for preventing attachment of enteropathogens to gut epithelium in breastfeeding infants. We compared the frequency of sIgA to major surface antigens of enterohemorrhagic Escherichia coli (EHEC) in milk of 123 women from the United States and Mexico to determine whether regional differences existed in the frequency of antibodies to these surface antigens. In both groups of women, milk commonly has sIgA against various EHEC lipopolysaccharides, EspA, EspB, intimin, and less frequently against Shiga toxin. The study suggests that persons living in the U.S. are exposed to attaching/effacing enteropathogens more frequently than is generally assumed. The low frequency of antibodies to Stx1 (in 12% of Mexican and in 22% of U.S. samples) suggests that the rare appearance of hemolytic uremic syndrome in adults is not due to neutralization of toxin at the gut level. Only anti-EspA is found in most milk samples from both populations of women. EspA may represent a useful target for an immunization strategy to prevent EHEC disease in humans.

        Cite This Article
    EID Noguera-Obenza M, Ochoa TJ, Gomez HF, Guerrero ML, Herrera-Insua I, Morrow AL, et al. Human Milk Secretory Antibodies against Attaching and Effacing Escherichia coli Antigens. Emerg Infect Dis. 2003;9(5):545-551. https://dx.doi.org/10.3201/eid0905.020441
    AMA Noguera-Obenza M, Ochoa TJ, Gomez HF, et al. Human Milk Secretory Antibodies against Attaching and Effacing Escherichia coli Antigens. Emerging Infectious Diseases. 2003;9(5):545-551. doi:10.3201/eid0905.020441.
    APA Noguera-Obenza, M., Ochoa, T. J., Gomez, H. F., Guerrero, M. L., Herrera-Insua, I., Morrow, A. L....Cleary, T. G. (2003). Human Milk Secretory Antibodies against Attaching and Effacing Escherichia coli Antigens. Emerging Infectious Diseases, 9(5), 545-551. https://dx.doi.org/10.3201/eid0905.020441.
  • Endemic, Notifiable Bioterrorism-Related Diseases, United States, 1992–1999 PDF Version [PDF - 291 KB - 9 pages]
    M. Chang et al.
        View Abstract

    Little information is available in the United States regarding the incidence and distribution of diseases caused by critical microbiologic agents with the potential for use in acts of terrorism. We describe disease-specific, demographic, geographic, and seasonal distribution of selected bioterrorism-related conditions (anthrax, botulism, brucellosis, cholera, plague, tularemia, and viral encephalitides) reported to the National Notifiable Diseases Surveillance System in 1992–1999. Tularemia and brucellosis were the most frequently reported diseases. Anthrax, plague, western equine encephalitis, and eastern equine encephalitis were rare. Higher incidence rates for cholera and plague were noted in the western United States and for tularemia in the central United States. Overall, the incidence of conditions caused by these critical agents in the United States is low. Individual case reports should be considered sentinel events. For potential bioterrorism-related conditions that are endemic and have low incidence, the use of nontraditional surveillance methods and complementary data sources may enhance our ability to rapidly detect changes in disease incidence.

        Cite This Article
    EID Chang M, Glynn MK, Groseclose SL. Endemic, Notifiable Bioterrorism-Related Diseases, United States, 1992–1999. Emerg Infect Dis. 2003;9(5):556-564. https://dx.doi.org/10.3201/eid0905.020477
    AMA Chang M, Glynn MK, Groseclose SL. Endemic, Notifiable Bioterrorism-Related Diseases, United States, 1992–1999. Emerging Infectious Diseases. 2003;9(5):556-564. doi:10.3201/eid0905.020477.
    APA Chang, M., Glynn, M. K., & Groseclose, S. L. (2003). Endemic, Notifiable Bioterrorism-Related Diseases, United States, 1992–1999. Emerging Infectious Diseases, 9(5), 556-564. https://dx.doi.org/10.3201/eid0905.020477.
  • Global Illness and Deaths Caused by Rotavirus Disease in Children PDF Version [PDF - 328 KB - 8 pages]
    U. D. Parashar et al.
        View Abstract

    To estimate the global illness and deaths caused by rotavirus disease, we reviewed studies published from 1986 to 2000 on deaths caused by diarrhea and on rotavirus infections in children. We assessed rotavirus-associated illness in three clinical settings (mild cases requiring home care alone, moderate cases requiring a clinic visit, and severe cases requiring hospitalization) and death rates in countries in different World Bank income groups. Each year, rotavirus causes approximately 111 million episodes of gastroenteritis requiring only home care, 25 million clinic visits, 2 million hospitalizations, and 352,000–592,000 deaths (median, 440,000 deaths) in children <5 years of age. By age 5, nearly every child will have an episode of rotavirus gastroenteritis, 1 in 5 will visit a clinic, 1 in 60 will be hospitalized, and approximately 1 in 293 will die. Children in the poorest countries account for 82% of rotavirus deaths. The tremendous incidence of rotavirus disease underscores the urgent need for interventions, such as vaccines, to prevent childhood deaths in developing nations.

        Cite This Article
    EID Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global Illness and Deaths Caused by Rotavirus Disease in Children. Emerg Infect Dis. 2003;9(5):565-572. https://dx.doi.org/10.3201/eid0905.020562
    AMA Parashar UD, Hummelman EG, Bresee JS, et al. Global Illness and Deaths Caused by Rotavirus Disease in Children. Emerging Infectious Diseases. 2003;9(5):565-572. doi:10.3201/eid0905.020562.
    APA Parashar, U. D., Hummelman, E. G., Bresee, J. S., Miller, M. A., & Glass, R. I. (2003). Global Illness and Deaths Caused by Rotavirus Disease in Children. Emerging Infectious Diseases, 9(5), 565-572. https://dx.doi.org/10.3201/eid0905.020562.
  • Seasonal Patterns of Invasive Pneumococcal Disease PDF Version [PDF - 739 KB - 6 pages]
    S. F. Dowell et al.
        View Abstract

    Pneumococcal infections increase each winter, a phenomenon that has not been well explained. We conducted population-based active surveillance for all cases of invasive pneumococcal disease in seven states; plotted annualized weekly rates by geographic location, age, and latitude; and assessed correlations by time-series analysis. In all geographic areas, invasive pneumococcal disease exhibited a distinct winter seasonality, including an increase among children in the fall preceding that for adults and a sharp spike in incidence among adults each year between December 24 and January 7. Pneumococcal disease correlated inversely with temperature (r –0.82 with a 1-week lag; p<0.0001), but paradoxically the coldest states had the lowest rates, and no threshold temperature could be identified. The pattern of disease correlated directly with the sinusoidal variations in photoperiod (r +0.85 with a 5-week lag; p<0.0001). Seemingly unrelated seasonal phenomena were also somewhat correlated. The reproducible seasonal patterns in varied geographic locations are consistent with the hypothesis that nationwide seasonal changes such as photoperiod-dependent variation in host susceptibility may underlie pneumococcal seasonality, but caution is indicated in assigning causality as a result of such correlations.

        Cite This Article
    EID Dowell SF, Whitney CG, Wright C, Rose CE, Schuchat A. Seasonal Patterns of Invasive Pneumococcal Disease. Emerg Infect Dis. 2003;9(5):574-579. https://dx.doi.org/10.3201/eid0905.020556
    AMA Dowell SF, Whitney CG, Wright C, et al. Seasonal Patterns of Invasive Pneumococcal Disease. Emerging Infectious Diseases. 2003;9(5):574-579. doi:10.3201/eid0905.020556.
    APA Dowell, S. F., Whitney, C. G., Wright, C., Rose, C. E., & Schuchat, A. (2003). Seasonal Patterns of Invasive Pneumococcal Disease. Emerging Infectious Diseases, 9(5), 574-579. https://dx.doi.org/10.3201/eid0905.020556.
  • Entamoeba moshkovskii Infections in Children in Bangladesh PDF Version [PDF - 359 KB - 5 pages]
    I. K. Ali et al.
        View Abstract

    Entamoeba moshkovskii cysts are morphologically indistinguishable from those of the disease-causing species E. histolytica and the nonpathogenic E. dispar. Although sporadic cases of human infection with E. moshkovskii have been reported, the organism is considered primarily a free-living ameba. No simple molecular detection tool is available for diagnosing E. moshkovskii infections. We used polymerase chain reaction (PCR) to detect E. moshkovskii directly in stool. We tested 109 stool specimens from preschool children in Bangladesh by PCR; 17 were positive for E. histolytica (15.6%) and 39 were positive for E. dispar (35.8%). In addition, we found that 23 (21.1%) were positive for E. moshkovskii infection, and 17 (73.9%) of these also carried E. histolytica or E. dispar. The high association of E. moshkovskii with E. histolytica and E. dispar may have obscured its identification in previous studies. The high prevalence found in this study suggests that humans may be a true host for this ameba.

        Cite This Article
    EID Ali IK, Hossain MB, Roy S, Ayeh-Kumi PF, Petri WA, Haque R, et al. Entamoeba moshkovskii Infections in Children in Bangladesh. Emerg Infect Dis. 2003;9(5):580-584. https://dx.doi.org/10.3201/eid0905.020548
    AMA Ali IK, Hossain MB, Roy S, et al. Entamoeba moshkovskii Infections in Children in Bangladesh. Emerging Infectious Diseases. 2003;9(5):580-584. doi:10.3201/eid0905.020548.
    APA Ali, I. K., Hossain, M. B., Roy, S., Ayeh-Kumi, P. F., Petri, W. A., Haque, R....Clark, C. G. (2003). Entamoeba moshkovskii Infections in Children in Bangladesh. Emerging Infectious Diseases, 9(5), 580-584. https://dx.doi.org/10.3201/eid0905.020548.
  • Variant Salmonella Genomic Island 1 Antibiotic Resistance Gene Cluster in Salmonella enterica Serovar Albany PDF Version [PDF - 527 KB - 7 pages]
    B. Doublet et al.
        View Abstract

    Salmonella genomic island 1 (SGI1) contains an antibiotic resistance gene cluster and has been previously identified in multidrug-resistant Salmonella enterica serovars Typhimurium DT104, Agona, and Paratyphi B. We identified a variant SGI1 antibiotic-resistance gene cluster in a multidrug-resistant strain of S. enterica serovar Albany isolated from food fish from Thailand and imported to France. In this strain, the streptomycin resistance aadA2 gene cassette in one of the SGI1 integrons was replaced by a dfrA1 gene cassette, conferring resistance to trimethoprim and an open reading frame of unknown function. Thus, this serovar Albany strain represents the fourth S. enterica serovar in which SGI1 has been identified and the first SGI1 example where gene cassette replacement took place in one of its integron structures. The antibiotic resistance gene cluster of serovar Albany strain 7205.00 constitutes a new SGI1 variant; we propose a name of SGI1-F.

        Cite This Article
    EID Doublet B, Lailler R, Meunier D, Brisabois A, Boyd D, Mulvey MR, et al. Variant Salmonella Genomic Island 1 Antibiotic Resistance Gene Cluster in Salmonella enterica Serovar Albany. Emerg Infect Dis. 2003;9(5):585-591. https://dx.doi.org/10.3201/eid0905.020609
    AMA Doublet B, Lailler R, Meunier D, et al. Variant Salmonella Genomic Island 1 Antibiotic Resistance Gene Cluster in Salmonella enterica Serovar Albany. Emerging Infectious Diseases. 2003;9(5):585-591. doi:10.3201/eid0905.020609.
    APA Doublet, B., Lailler, R., Meunier, D., Brisabois, A., Boyd, D., Mulvey, M. R....Cloeckaert, A. (2003). Variant Salmonella Genomic Island 1 Antibiotic Resistance Gene Cluster in Salmonella enterica Serovar Albany. Emerging Infectious Diseases, 9(5), 585-591. https://dx.doi.org/10.3201/eid0905.020609.
  • Aeromonas spp. and Traveler’s Diarrhea: Clinical Features and Antimicrobial Resistance PDF Version [PDF - 249 KB - 4 pages]
    J. Vila et al.
        View Abstract

    Traveler’s diarrhea is the most common health problem of international travelers. We determined the prevalence of Aeromonas spp. associated with traveler’s diarrhea and analyzed the geographic distribution, clinical features, and antimicrobial susceptibility. Aeromonas spp. were isolated as a cause of traveler’s diarrhea in 18 (2%) of 863 patients. A. veronii biotype sobria was isolated in nine patients, A. caviae in seven patients, and A. jandai and A. hydrophila in one patient each. Aeromonas spp. were isolated with a similar prevalence in Africa, Latin America, and Asia. Watery and persistent diarrhea, fever, and abdominal cramps were common complaints. All strains were resistant to ampicillin; showed variable resistance to chloramphenicol, tetracycline, and cotrimoxazole; and were susceptible to cefotaxime, ciprofloxacin, and nalidixic acid. The persistence of symptoms made antimicrobial treatment necessary.

        Cite This Article
    EID Vila J, Ruiz J, Gallardo F, Vargas M, Soler L, Figueras MJ, et al. Aeromonas spp. and Traveler’s Diarrhea: Clinical Features and Antimicrobial Resistance. Emerg Infect Dis. 2003;9(5):552-555. https://dx.doi.org/10.3201/eid0905.020451
    AMA Vila J, Ruiz J, Gallardo F, et al. Aeromonas spp. and Traveler’s Diarrhea: Clinical Features and Antimicrobial Resistance. Emerging Infectious Diseases. 2003;9(5):552-555. doi:10.3201/eid0905.020451.
    APA Vila, J., Ruiz, J., Gallardo, F., Vargas, M., Soler, L., Figueras, M. J....Gascon, J. (2003). Aeromonas spp. and Traveler’s Diarrhea: Clinical Features and Antimicrobial Resistance. Emerging Infectious Diseases, 9(5), 552-555. https://dx.doi.org/10.3201/eid0905.020451.

Dispatches

  • Emerging Rickettsioses of the Thai-Myanmar Border PDF Version [PDF - 172 KB - 4 pages]
    P. Parola et al.
        View Abstract

    To investigate the presence of rickettsioses in rural residents of the central Thai-Myanmar border, we tested the blood of 46 patients with fever. Four patients had murine typhus, three patients had scrub typhus, and eight patients had spotted fever group rickettsioses, including the first case of Rickettsia felis infection reported in Asia.

        Cite This Article
    EID Parola P, Miller RS, McDaniel P, Telford SR, Rolain J, Wongsrichanalai C, et al. Emerging Rickettsioses of the Thai-Myanmar Border. Emerg Infect Dis. 2003;9(5):592-595. https://dx.doi.org/10.3201/eid0905.020511
    AMA Parola P, Miller RS, McDaniel P, et al. Emerging Rickettsioses of the Thai-Myanmar Border. Emerging Infectious Diseases. 2003;9(5):592-595. doi:10.3201/eid0905.020511.
    APA Parola, P., Miller, R. S., McDaniel, P., Telford, S. R., Rolain, J., Wongsrichanalai, C....Raoult, D. (2003). Emerging Rickettsioses of the Thai-Myanmar Border. Emerging Infectious Diseases, 9(5), 592-595. https://dx.doi.org/10.3201/eid0905.020511.
  • Eliminating Trachoma in Areas with Limited Disease PDF Version [PDF - 310 KB - 3 pages]
    B. D. Gaynor et al.
        View Abstract

    The common wisdom is that a trachoma program cannot eliminate ocular chlamydia from a community, just reduce infection to a level where there would be minimal blindness. We describe the success of multiple mass antibiotic treatments, demonstrating that complete elimination of infection may be an attainable goal in an area with modest disease.

        Cite This Article
    EID Gaynor BD, Miao Y, Cevallos V, Jha H, Chaudary J, Bhatta R, et al. Eliminating Trachoma in Areas with Limited Disease. Emerg Infect Dis. 2003;9(5):596-598. https://dx.doi.org/10.3201/eid0905.020577
    AMA Gaynor BD, Miao Y, Cevallos V, et al. Eliminating Trachoma in Areas with Limited Disease. Emerging Infectious Diseases. 2003;9(5):596-598. doi:10.3201/eid0905.020577.
    APA Gaynor, B. D., Miao, Y., Cevallos, V., Jha, H., Chaudary, J., Bhatta, R....Lietman, T. (2003). Eliminating Trachoma in Areas with Limited Disease. Emerging Infectious Diseases, 9(5), 596-598. https://dx.doi.org/10.3201/eid0905.020577.
  • Chronic Wasting Disease in Free-Ranging Wisconsin White-Tailed Deer PDF Version [PDF - 242 KB - 3 pages]
    D. O. Joly et al.
            Cite This Article
    EID Joly DO, Ribic CA, Langenberg JA, Beheler K, Batha CA, Dhuey BJ, et al. Chronic Wasting Disease in Free-Ranging Wisconsin White-Tailed Deer. Emerg Infect Dis. 2003;9(5):599-601. https://dx.doi.org/10.3201/eid0905.020721
    AMA Joly DO, Ribic CA, Langenberg JA, et al. Chronic Wasting Disease in Free-Ranging Wisconsin White-Tailed Deer. Emerging Infectious Diseases. 2003;9(5):599-601. doi:10.3201/eid0905.020721.
    APA Joly, D. O., Ribic, C. A., Langenberg, J. A., Beheler, K., Batha, C. A., Dhuey, B. J....Samuel, M. D. (2003). Chronic Wasting Disease in Free-Ranging Wisconsin White-Tailed Deer. Emerging Infectious Diseases, 9(5), 599-601. https://dx.doi.org/10.3201/eid0905.020721.

Letters

  • Human Metapneumovirus and Community-Acquired Respiratory Illness in Children PDF Version [PDF - 144 KB - 3 pages]
    D. Vicente et al.
            Cite This Article
    EID Vicente D, Cilla G, Montes M, Pérez-Trallero E. Human Metapneumovirus and Community-Acquired Respiratory Illness in Children. Emerg Infect Dis. 2003;9(5):602-603. https://dx.doi.org/10.3201/eid0905.020615
    AMA Vicente D, Cilla G, Montes M, et al. Human Metapneumovirus and Community-Acquired Respiratory Illness in Children. Emerging Infectious Diseases. 2003;9(5):602-603. doi:10.3201/eid0905.020615.
    APA Vicente, D., Cilla, G., Montes, M., & Pérez-Trallero, E. (2003). Human Metapneumovirus and Community-Acquired Respiratory Illness in Children. Emerging Infectious Diseases, 9(5), 602-603. https://dx.doi.org/10.3201/eid0905.020615.
  • Puumala Virus Infection with Acute Disseminated Encephalomyelitis and Multiorgan Failure PDF Version [PDF - 158 KB - 3 pages]
    R. Krause et al.
            Cite This Article
    EID Krause R, Aberle S, Haberl R, Daxböck F, Wenisch C. Puumala Virus Infection with Acute Disseminated Encephalomyelitis and Multiorgan Failure. Emerg Infect Dis. 2003;9(5):603-605. https://dx.doi.org/10.3201/eid0905.020405
    AMA Krause R, Aberle S, Haberl R, et al. Puumala Virus Infection with Acute Disseminated Encephalomyelitis and Multiorgan Failure. Emerging Infectious Diseases. 2003;9(5):603-605. doi:10.3201/eid0905.020405.
    APA Krause, R., Aberle, S., Haberl, R., Daxböck, F., & Wenisch, C. (2003). Puumala Virus Infection with Acute Disseminated Encephalomyelitis and Multiorgan Failure. Emerging Infectious Diseases, 9(5), 603-605. https://dx.doi.org/10.3201/eid0905.020405.
  • Pregnancy and Asymptomatic Carriage of Pneumocystis jiroveci PDF Version [PDF - 154 KB - 2 pages]
    S. L. Vargas et al.
            Cite This Article
    EID Vargas SL, Ponce CA, Sanchez CA, Ulloa AV, Bustamante R, Juarez G, et al. Pregnancy and Asymptomatic Carriage of Pneumocystis jiroveci. Emerg Infect Dis. 2003;9(5):605-606. https://dx.doi.org/10.3201/eid0905.020660
    AMA Vargas SL, Ponce CA, Sanchez CA, et al. Pregnancy and Asymptomatic Carriage of Pneumocystis jiroveci. Emerging Infectious Diseases. 2003;9(5):605-606. doi:10.3201/eid0905.020660.
    APA Vargas, S. L., Ponce, C. A., Sanchez, C. A., Ulloa, A. V., Bustamante, R., & Juarez, G. (2003). Pregnancy and Asymptomatic Carriage of Pneumocystis jiroveci. Emerging Infectious Diseases, 9(5), 605-606. https://dx.doi.org/10.3201/eid0905.020660.
  • First Evidence of Aedes albopictus (Skuse) in Southern Chiapas, Mexico PDF Version [PDF - 152 KB - 2 pages]
    M. C. Martínez and J. L. Estrada
            Cite This Article
    EID Martínez MC, Estrada JL. First Evidence of Aedes albopictus (Skuse) in Southern Chiapas, Mexico. Emerg Infect Dis. 2003;9(5):606-607. https://dx.doi.org/10.3201/eid0905.020678
    AMA Martínez MC, Estrada JL. First Evidence of Aedes albopictus (Skuse) in Southern Chiapas, Mexico. Emerging Infectious Diseases. 2003;9(5):606-607. doi:10.3201/eid0905.020678.
    APA Martínez, M. C., & Estrada, J. L. (2003). First Evidence of Aedes albopictus (Skuse) in Southern Chiapas, Mexico. Emerging Infectious Diseases, 9(5), 606-607. https://dx.doi.org/10.3201/eid0905.020678.
  • “Acute” West Nile Virus Encephalitis (Response to Krishnamoorthy et al.) PDF Version [PDF - 186 KB - 2 pages]
    A. Hindenburg and C. Huang
            Cite This Article
    EID Hindenburg A, Huang C. “Acute” West Nile Virus Encephalitis (Response to Krishnamoorthy et al.). Emerg Infect Dis. 2003;9(5):608-609. https://dx.doi.org/10.3201/eid0905.030128
    AMA Hindenburg A, Huang C. “Acute” West Nile Virus Encephalitis (Response to Krishnamoorthy et al.). Emerging Infectious Diseases. 2003;9(5):608-609. doi:10.3201/eid0905.030128.
    APA Hindenburg, A., & Huang, C. (2003). “Acute” West Nile Virus Encephalitis (Response to Krishnamoorthy et al.). Emerging Infectious Diseases, 9(5), 608-609. https://dx.doi.org/10.3201/eid0905.030128.
  • Virus Isolation and “Acute” West Nile Virus Encephalitis (Response to Huang et al.) PDF Version [PDF - 207 KB - 2 pages]
    V. Krishnamoorthy et al.
            Cite This Article
    EID Krishnamoorthy V, Bhaskar J, Sheagren J. Virus Isolation and “Acute” West Nile Virus Encephalitis (Response to Huang et al.). Emerg Infect Dis. 2003;9(5):607-608. https://dx.doi.org/10.3201/eid0905.030018
    AMA Krishnamoorthy V, Bhaskar J, Sheagren J. Virus Isolation and “Acute” West Nile Virus Encephalitis (Response to Huang et al.). Emerging Infectious Diseases. 2003;9(5):607-608. doi:10.3201/eid0905.030018.
    APA Krishnamoorthy, V., Bhaskar, J., & Sheagren, J. (2003). Virus Isolation and “Acute” West Nile Virus Encephalitis (Response to Huang et al.). Emerging Infectious Diseases, 9(5), 607-608. https://dx.doi.org/10.3201/eid0905.030018.

Books and Media

  • Probiotics and Prebiotics: Where Are We Going? PDF Version [PDF - 108 KB - 1 page]
    M. J. Blaser
            Cite This Article
    EID Blaser MJ. Probiotics and Prebiotics: Where Are We Going?. Emerg Infect Dis. 2003;9(5):610. https://dx.doi.org/10.3201/eid0905.030134
    AMA Blaser MJ. Probiotics and Prebiotics: Where Are We Going?. Emerging Infectious Diseases. 2003;9(5):610. doi:10.3201/eid0905.030134.
    APA Blaser, M. J. (2003). Probiotics and Prebiotics: Where Are We Going?. Emerging Infectious Diseases, 9(5), 610. https://dx.doi.org/10.3201/eid0905.030134.

About the Cover

  • Henri Matisse (1869–1954). Icarus (from the illustrated book, Jazz, published in 1947 by E. Tériade) PDF Version [PDF - 104 KB - 1 page]
    P. Potter
            Cite This Article
    EID Potter P. Henri Matisse (1869–1954). Icarus (from the illustrated book, Jazz, published in 1947 by E. Tériade). Emerg Infect Dis. 2003;9(5):613. https://dx.doi.org/10.3201/eid0905.AC0905
    AMA Potter P. Henri Matisse (1869–1954). Icarus (from the illustrated book, Jazz, published in 1947 by E. Tériade). Emerging Infectious Diseases. 2003;9(5):613. doi:10.3201/eid0905.AC0905.
    APA Potter, P. (2003). Henri Matisse (1869–1954). Icarus (from the illustrated book, Jazz, published in 1947 by E. Tériade). Emerging Infectious Diseases, 9(5), 613. https://dx.doi.org/10.3201/eid0905.AC0905.

Corrections

  • Correction Vol. 9, No. 4 PDF Version [PDF - 109 KB - 1 page]
            Cite This Article
    EID Correction Vol. 9, No. 4. Emerg Infect Dis. 2003;9(5):609. https://dx.doi.org/10.3201/eid0905.C10905
    AMA Correction Vol. 9, No. 4. Emerging Infectious Diseases. 2003;9(5):609. doi:10.3201/eid0905.C10905.
    APA (2003). Correction Vol. 9, No. 4. Emerging Infectious Diseases, 9(5), 609. https://dx.doi.org/10.3201/eid0905.C10905.

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