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Volume 9, Number 9—September 2003

Volume 9, Number 9—September 2003   PDF Version [PDF - 30.05 MB - 167 pages]

Perspective

  • Role of China in the Quest to Define and Control Severe Acute Respiratory Syndrome PDF Version [PDF - 149 KB - 5 pages]
    R. F. Breiman et al.
        View Abstract

    China holds the key to solving many questions crucial to global control of severe acute respiratory syndrome (SARS). The disease appears to have originated in Guangdong Province, and the causative agent, SARS coronavirus, is likely to have originated from an animal host, perhaps sold in public markets. Epidemiologic findings, integral to defining an animal-human linkage, may then be confirmed by laboratory studies; once animal host(s) are confirmed, interventions may be needed to prevent further animal-to-human transmission. Community seroprevalence studies may help determine the basis for the decline in disease incidence in Guangdong Province after February 2002. China will also be able to contribute key data about how the causative agent is transmitted and how it is evolving, as well as identifying pivotal factors influencing disease outcome. There must be support for systematically addressing these fundamental questions in China and rapidly disseminating results.

        Cite This Article
    EID Breiman RF, Evans MR, Preiser W, Maguire J, Schnur A, Bekedam H, et al. Role of China in the Quest to Define and Control Severe Acute Respiratory Syndrome. Emerg Infect Dis. 2003;9(9):1037-1041. https://dx.doi.org/10.3201/eid0909.030390
    AMA Breiman RF, Evans MR, Preiser W, et al. Role of China in the Quest to Define and Control Severe Acute Respiratory Syndrome. Emerging Infectious Diseases. 2003;9(9):1037-1041. doi:10.3201/eid0909.030390.
    APA Breiman, R. F., Evans, M. R., Preiser, W., Maguire, J., Schnur, A., Bekedam, H....MacKenzie, J. S. (2003). Role of China in the Quest to Define and Control Severe Acute Respiratory Syndrome. Emerging Infectious Diseases, 9(9), 1037-1041. https://dx.doi.org/10.3201/eid0909.030390.
  • Lessons from the Severe Acute Respiratory Syndrome Outbreak in Hong Kong PDF Version [PDF - 146 KB - 4 pages]
    A. S. Abdullah et al.
        View Abstract

    Severe acute respiratory syndrome (SARS) is now a global public health threat with many medical, ethical, social, economic, political, and legal implications. The nonspecific signs and symptoms of this disease, coupled with a relatively long incubation period and the initial absence of a reliable diagnostic test, limited the understanding of the magnitude of the outbreak. This paper outlines our experience with public health issues that have arisen during this outbreak of SARS in Hong Kong. We confirmed that case detection, reporting, clear and timely dissemination of information, and strict infection control measures are essential in handling such an infectious disease outbreak. The need for an outbreak response unit is crucial to combat any future outbreak.

        Cite This Article
    EID Abdullah AS, Tomlinson B, Cockram CS, Thomas GN. Lessons from the Severe Acute Respiratory Syndrome Outbreak in Hong Kong. Emerg Infect Dis. 2003;9(9):1042-1045. https://dx.doi.org/10.3201/eid0909.030366
    AMA Abdullah AS, Tomlinson B, Cockram CS, et al. Lessons from the Severe Acute Respiratory Syndrome Outbreak in Hong Kong. Emerging Infectious Diseases. 2003;9(9):1042-1045. doi:10.3201/eid0909.030366.
    APA Abdullah, A. S., Tomlinson, B., Cockram, C. S., & Thomas, G. N. (2003). Lessons from the Severe Acute Respiratory Syndrome Outbreak in Hong Kong. Emerging Infectious Diseases, 9(9), 1042-1045. https://dx.doi.org/10.3201/eid0909.030366.
  • Automated, Laboratory-based System Using the Internet for Disease Outbreak Detection, the Netherlands PDF Version [PDF - 270 KB - 7 pages]
    M. Widdowson et al.
        View Abstract

    Rapid detection of outbreaks is recognized as crucial for effective control measures and has particular relevance with the recently increased concern about bioterrorism. Automated analysis of electronically collected laboratory data can result in rapid detection of widespread outbreaks or outbreaks of pathogens with common signs and symptoms. In the Netherlands, an automated outbreak detection system for all types of pathogens has been developed within an existing electronic laboratory-based surveillance system called ISIS. Features include the use of a flexible algorithm for daily analysis of data and presentation of signals on the Internet for interpretation by health professionals. By 2006, the outbreak detection system will analyze laboratory-reported data on all pathogens and will cover 35% of the Dutch population.

        Cite This Article
    EID Widdowson M, Bosman A, van Straten E, Tinga M, Chaves S, van Eerden L, et al. Automated, Laboratory-based System Using the Internet for Disease Outbreak Detection, the Netherlands. Emerg Infect Dis. 2003;9(9):1046-1052. https://dx.doi.org/10.3201/eid0909.020450
    AMA Widdowson M, Bosman A, van Straten E, et al. Automated, Laboratory-based System Using the Internet for Disease Outbreak Detection, the Netherlands. Emerging Infectious Diseases. 2003;9(9):1046-1052. doi:10.3201/eid0909.020450.
    APA Widdowson, M., Bosman, A., van Straten, E., Tinga, M., Chaves, S., van Eerden, L....van Pelt, W. (2003). Automated, Laboratory-based System Using the Internet for Disease Outbreak Detection, the Netherlands. Emerging Infectious Diseases, 9(9), 1046-1052. https://dx.doi.org/10.3201/eid0909.020450.
  • Automated Laboratory Reporting of Infectious Diseases in a Climate of Bioterrorism PDF Version [PDF - 324 KB - 5 pages]
    N. M. M’ikanatha et al.
        View Abstract

    While newly available electronic transmission methods can increase timeliness and completeness of infectious disease reports, limitations of this technology may unintentionally compromise detection of, and response to, bioterrorism and other outbreaks. We reviewed implementation experiences for five electronic laboratory systems and identified problems with data transmission, sensitivity, specificity, and user interpretation. The results suggest a need for backup transmission methods, validation, standards, preserving human judgment in the process, and provider and end-user involvement. As illustrated, challenges encountered in deployment of existing electronic laboratory reporting systems could guide further refinement and advances in infectious disease surveillance.

        Cite This Article
    EID M’ikanatha NM, Southwell BG, Lautenbach E. Automated Laboratory Reporting of Infectious Diseases in a Climate of Bioterrorism. Emerg Infect Dis. 2003;9(9):1053-1057. https://dx.doi.org/10.3201/eid0909.020486
    AMA M’ikanatha NM, Southwell BG, Lautenbach E. Automated Laboratory Reporting of Infectious Diseases in a Climate of Bioterrorism. Emerging Infectious Diseases. 2003;9(9):1053-1057. doi:10.3201/eid0909.020486.
    APA M’ikanatha, N. M., Southwell, B. G., & Lautenbach, E. (2003). Automated Laboratory Reporting of Infectious Diseases in a Climate of Bioterrorism. Emerging Infectious Diseases, 9(9), 1053-1057. https://dx.doi.org/10.3201/eid0909.020486.

Research

  • Human Metapneumovirus Detection in Patients with Severe Acute Respiratory Syndrome PDF Version [PDF - 285 KB - 6 pages]
    R. C. Chan et al.
        View Abstract

    We used a combination approach of conventional virus isolation and molecular techniques to detect human metapneumovirus (HMPV) in patients with severe acute respiratory syndrome (SARS). Of the 48 study patients, 25 (52.1%) were infected with HMPV; 6 of these 25 patients were also infected with coronavirus, and another 5 patients (10.4%) were infected with coronavirus alone. Using this combination approach, we found that human laryngeal carcinoma (HEp-2) cells were superior to rhesus monkey kidney (LLC-MK2) cells commonly used in previous studies for isolation of HMPV. These widely available HEp-2 cells should be included in conjunction with a molecular method for cell culture followup to detect HMPV, particularly in patients with SARS.

        Cite This Article
    EID Chan RC, Tam JS, Lam C, Chan E, Wu A, Li C, et al. Human Metapneumovirus Detection in Patients with Severe Acute Respiratory Syndrome. Emerg Infect Dis. 2003;9(9):1058-1063. https://dx.doi.org/10.3201/eid0909.030304
    AMA Chan RC, Tam JS, Lam C, et al. Human Metapneumovirus Detection in Patients with Severe Acute Respiratory Syndrome. Emerging Infectious Diseases. 2003;9(9):1058-1063. doi:10.3201/eid0909.030304.
    APA Chan, R. C., Tam, J. S., Lam, C., Chan, E., Wu, A., Li, C....Sung, J. (2003). Human Metapneumovirus Detection in Patients with Severe Acute Respiratory Syndrome. Emerging Infectious Diseases, 9(9), 1058-1063. https://dx.doi.org/10.3201/eid0909.030304.
  • Severe Acute Respiratory Syndrome: Clinical Outcome and Prognostic Correlates PDF Version [PDF - 281 KB - 6 pages]
    P. T. Tsui et al.
        View Abstract

    Severe acute respiratory syndrome (SARS) poses a major threat to the health of people worldwide. We performed a retrospective case series analysis to assess clinical outcome and identify pretreatment prognostic correlates of SARS, managed under a standardized treatment protocol. We studied 127 male and 196 female patients with a mean age of 41±14 (range 18–83). All patients, except two, received ribavirin and steroid combination therapy. In 115 (36%) patients, the course of disease was limited. Pneumonitis progressed rapidly in the remaining patients. Sixty-seven (21%) patients required intensive care, and 42 (13%) required ventilator support. Advanced age, high admission neutrophil count, and high initial lactate dehydrogenase level were independent correlates of an adverse clinical outcome. SARS-associated coronavirus caused severe illnesses in most patients, despite early treatment with ribavirin and steroid. This study has identified three independent pretreatment prognostic correlates.

        Cite This Article
    EID Tsui PT, Kwok ML, Yuen H, Lai ST. Severe Acute Respiratory Syndrome: Clinical Outcome and Prognostic Correlates. Emerg Infect Dis. 2003;9(9):1064-1069. https://dx.doi.org/10.3201/eid0909.030362
    AMA Tsui PT, Kwok ML, Yuen H, et al. Severe Acute Respiratory Syndrome: Clinical Outcome and Prognostic Correlates. Emerging Infectious Diseases. 2003;9(9):1064-1069. doi:10.3201/eid0909.030362.
    APA Tsui, P. T., Kwok, M. L., Yuen, H., & Lai, S. T. (2003). Severe Acute Respiratory Syndrome: Clinical Outcome and Prognostic Correlates. Emerging Infectious Diseases, 9(9), 1064-1069. https://dx.doi.org/10.3201/eid0909.030362.
  • Hantavirus Infection in Humans and Rodents, Northwestern Argentina PDF Version [PDF - 320 KB - 7 pages]
    N. Pini et al.
        View Abstract

    We initiated a study to elucidate the ecology and epidemiology of hantavirus infections in northern Argentina. The northwestern hantavirus pulmonary syndrome (HPS)–endemic area of Argentina comprises Salta and Jujuy Provinces. Between 1997 and 2000, 30 HPS cases were diagnosed in Jujuy Province (population 512,329). Most patients had a mild clinical course, and the death rate (13.3%) was low. We performed a serologic and epidemiologic survey in residents of the area, in conjunction with a serologic study in rodents. The prevalence of hantavirus antibodies in the general human population was 6.5%, one of the highest reported in the literature. No evidence of interhuman transmission was found, and the high prevalence of hantavirus antibody seemed to be associated with the high infestation of rodents detected in domestic and peridomestic habitats.

        Cite This Article
    EID Pini N, Levis S, Calderón G, Ramirez J, Bravo D, Lozano E, et al. Hantavirus Infection in Humans and Rodents, Northwestern Argentina. Emerg Infect Dis. 2003;9(9):1070-1076. https://dx.doi.org/10.3201/eid0909.020768
    AMA Pini N, Levis S, Calderón G, et al. Hantavirus Infection in Humans and Rodents, Northwestern Argentina. Emerging Infectious Diseases. 2003;9(9):1070-1076. doi:10.3201/eid0909.020768.
    APA Pini, N., Levis, S., Calderón, G., Ramirez, J., Bravo, D., Lozano, E....Enria, D. (2003). Hantavirus Infection in Humans and Rodents, Northwestern Argentina. Emerging Infectious Diseases, 9(9), 1070-1076. https://dx.doi.org/10.3201/eid0909.020768.
  • DNA Vaccine for West Nile Virus Infection in Fish Crows (Corvus ossifragus) PDF Version [PDF - 308 KB - 5 pages]
    M. J. Turell et al.
        View Abstract

    A DNA vaccine for West Nile virus (WNV) was evaluated to determine whether its use could protect fish crows (Corvus ossifragus) from fatal WNV infection. Captured adult crows were given 0.5 mg of the DNA vaccine either orally or by intramuscular (IM) inoculation; control crows were inoculated or orally exposed to a placebo. After 6 weeks, crows were challenged subcutaneously with 105 plaque-forming units of WNV (New York 1999 strain). None of the placebo inoculated–placebo challenged birds died. While none of the 9 IM vaccine–inoculated birds died, 5 of 10 placebo-inoculated and 4 of 8 orally vaccinated birds died within 15 days after challenge. Peak viremia titers in birds with fatal WNV infection were substantially higher than those in birds that survived infection. Although oral administration of a single DNA vaccine dose failed to elicit an immune response or protect crows from WNV infection, IM administration of a single dose prevented death and was associated with reduced viremia.

        Cite This Article
    EID Turell MJ, Bunning ML, Ludwig GV, Ortman B, Chang J, Speaker T, et al. DNA Vaccine for West Nile Virus Infection in Fish Crows (Corvus ossifragus). Emerg Infect Dis. 2003;9(9):1077-1081. https://dx.doi.org/10.3201/eid0909.030025
    AMA Turell MJ, Bunning ML, Ludwig GV, et al. DNA Vaccine for West Nile Virus Infection in Fish Crows (Corvus ossifragus). Emerging Infectious Diseases. 2003;9(9):1077-1081. doi:10.3201/eid0909.030025.
    APA Turell, M. J., Bunning, M. L., Ludwig, G. V., Ortman, B., Chang, J., Speaker, T....Mitchell, C. J. (2003). DNA Vaccine for West Nile Virus Infection in Fish Crows (Corvus ossifragus). Emerging Infectious Diseases, 9(9), 1077-1081. https://dx.doi.org/10.3201/eid0909.030025.
  • Aseptic Meningitis Epidemic during a West Nile Virus Avian Epizootic PDF Version [PDF - 193 KB - 7 pages]
    K. G. Julian et al.
        View Abstract

    While enteroviruses have been the most commonly identified cause of aseptic meningitis in the United States, the role of the emerging, neurotropic West Nile virus (WNV) is not clear. In summer 2001, an aseptic meningitis epidemic occurring in an area of a WNV epizootic in Baltimore, Maryland, was investigated to determine the relative contributions of WNV and enteroviruses. A total of 113 aseptic meningitis cases with onsets from June 1 to September 30, 2001, were identified at six hospitals. WNV immunoglobulin M tests were negative for 69 patients with available specimens; however, 43 (61%) of 70 patients tested enterovirus-positive by viral culture or polymerase chain reaction. Most (76%) of the serotyped enteroviruses were echoviruses 13 and 18. Enteroviruses, including previously rarely detected echoviruses, likely caused most aseptic meningitis cases in this epidemic. No WNV meningitis cases were identified. Even in areas of WNV epizootics, enteroviruses continue to be important causative agents of aseptic meningitis.

        Cite This Article
    EID Julian KG, Mullins JA, Olin A, Peters H, Nix W, Oberste M, et al. Aseptic Meningitis Epidemic during a West Nile Virus Avian Epizootic. Emerg Infect Dis. 2003;9(9):1082-1088. https://dx.doi.org/10.3201/eid0909.030068
    AMA Julian KG, Mullins JA, Olin A, et al. Aseptic Meningitis Epidemic during a West Nile Virus Avian Epizootic. Emerging Infectious Diseases. 2003;9(9):1082-1088. doi:10.3201/eid0909.030068.
    APA Julian, K. G., Mullins, J. A., Olin, A., Peters, H., Nix, W., Oberste, M....Campbell, G. L. (2003). Aseptic Meningitis Epidemic during a West Nile Virus Avian Epizootic. Emerging Infectious Diseases, 9(9), 1082-1088. https://dx.doi.org/10.3201/eid0909.030068.
  • Aggregated Antibiograms and Monitoring of Drug-Resistant Streptococcus pneumoniae PDF Version [PDF - 407 KB - 7 pages]
    C. A. Van Beneden et al.
        View Abstract

    Community-specific antimicrobial susceptibility data may help monitor trends among drug-resistant Streptococcus pneumoniae and guide empiric therapy. Because active, population-based surveillance for invasive pneumococcal disease is accurate but resource intensive, we compared the proportion of penicillin-nonsusceptible isolates obtained from existing antibiograms, a less expensive system, to that obtained from 1 year of active surveillance for Georgia, Tennessee, California, Minnesota, Oregon, Maryland, Connecticut, and New York. For all sites, proportions of penicillin-nonsusceptible isolates from antibiograms were within 10 percentage points (median 3.65) of those from invasive-only isolates obtained through active surveillance. Only 23% of antibiograms distinguished between isolates intermediate and resistant to penicillin; 63% and 57% included susceptibility results for erythromycin and extended-spectrum cephalosporins, respectively. Aggregating existing hospital antibiograms is a simple and relatively accurate way to estimate local prevalence of penicillin-nonsusceptible pneumococcus; however, antibiograms offer limited data on isolates with intermediate and high-level penicillin resistance and isolates resistant to other agents.

        Cite This Article
    EID Van Beneden CA, Lexau C, Baughman W, Barnes B, Bennett NM, Cassidy PM, et al. Aggregated Antibiograms and Monitoring of Drug-Resistant Streptococcus pneumoniae. Emerg Infect Dis. 2003;9(9):1089-1095. https://dx.doi.org/10.3201/eid0909.020620
    AMA Van Beneden CA, Lexau C, Baughman W, et al. Aggregated Antibiograms and Monitoring of Drug-Resistant Streptococcus pneumoniae. Emerging Infectious Diseases. 2003;9(9):1089-1095. doi:10.3201/eid0909.020620.
    APA Van Beneden, C. A., Lexau, C., Baughman, W., Barnes, B., Bennett, N. M., Cassidy, P. M....Whitney, C. G. (2003). Aggregated Antibiograms and Monitoring of Drug-Resistant Streptococcus pneumoniae. Emerging Infectious Diseases, 9(9), 1089-1095. https://dx.doi.org/10.3201/eid0909.020620.
  • Antibiotic Use in Hispanic Households, New York City PDF Version [PDF - 219 KB - 7 pages]
    E. Larson et al.
        View Abstract

    Trained interviewers visited 631 inner city households to determine community prevalence and predictors of antibiotic use. Infectious disease symptoms were reported in 911 (33.2%) of 2,743 household members in the previous 30 days: medical attention was sought by 441 (48.4%) of 911 persons, and 354 (38.9%) of 911 took antibiotics for symptoms. Reported symptoms were respiratory (68.9%), gastrointestinal (15.3%), fever (12.8%), and skin infection (2.8%). Medical attention was sought significantly more often among those with chronic illness, those born in the United States, and those with fever, runny nose, or skin infections (all p<0.05). Antibiotics were taken significantly more often among those with poor health, those who spent more time at home, and those with fever and respiratory symptoms. Interventions to promote judicious use of antibiotics must include clinicians and the public, and for the Hispanic population such interventions must also be culturally relevant and provided in Spanish.

        Cite This Article
    EID Larson E, Lin SX, Gomez-Duarte C. Antibiotic Use in Hispanic Households, New York City. Emerg Infect Dis. 2003;9(9):1096-1102. https://dx.doi.org/10.3201/eid0909.020371
    AMA Larson E, Lin SX, Gomez-Duarte C. Antibiotic Use in Hispanic Households, New York City. Emerging Infectious Diseases. 2003;9(9):1096-1102. doi:10.3201/eid0909.020371.
    APA Larson, E., Lin, S. X., & Gomez-Duarte, C. (2003). Antibiotic Use in Hispanic Households, New York City. Emerging Infectious Diseases, 9(9), 1096-1102. https://dx.doi.org/10.3201/eid0909.020371.
  • Dyspepsia Symptoms and Helicobacter pylori Infection, Nakuru, Kenya PDF Version [PDF - 332 KB - 5 pages]
    H. Shmuely et al.
        View Abstract

    The prevalence of Helicobacter pylori infection was studied in 138 patients with dyspepsia in a hospital in Nakuru, Kenya, and in 138 asymptomatic sex- and age-matched controls from the same population. Anti–H. pylori immunoglobulin (Ig) G was more prevalent in dyspeptic than asymptomatic persons (71% vs. 51%), particularly those <30 years old (71% vs. 38%). H. pylori seropositivity was associated with dyspepsia after adjusting for age, sex, and residence (urban or rural). Among adults, the association between H. pylori infection and dyspepsia remained after adjusting for the above factors and for educational attainment, family size, and manual occupation. H. pylori infection in asymptomatic residents of Nakuru, Kenya, was more prevalent in older persons, with a rate of 68%, than in those 31–40 years of age. However, young persons with dyspepsia had an unexpectedly high prevalence of H. pylori infection. H. pylori test-and-treat strategy should be considered in Kenyan patients with dyspepsia, particularly in persons <30 years of age.

        Cite This Article
    EID Shmuely H, Obure S, Passaro DJ, Abuksis G, Yahav J, Fraser G, et al. Dyspepsia Symptoms and Helicobacter pylori Infection, Nakuru, Kenya. Emerg Infect Dis. 2003;9(9):1103-1107. https://dx.doi.org/10.3201/eid0909.020374
    AMA Shmuely H, Obure S, Passaro DJ, et al. Dyspepsia Symptoms and Helicobacter pylori Infection, Nakuru, Kenya. Emerging Infectious Diseases. 2003;9(9):1103-1107. doi:10.3201/eid0909.020374.
    APA Shmuely, H., Obure, S., Passaro, D. J., Abuksis, G., Yahav, J., Fraser, G....Niv, Y. (2003). Dyspepsia Symptoms and Helicobacter pylori Infection, Nakuru, Kenya. Emerging Infectious Diseases, 9(9), 1103-1107. https://dx.doi.org/10.3201/eid0909.020374.
  • Epidemic and Nonepidemic Multidrug-Resistant Enterococcus faecium PDF Version [PDF - 455 KB - 8 pages]
    H. L. Leavis et al.
        View Abstract

    The epidemiology of vancomycin-resistant Enterococcus faecium (VREF) in Europe is characterized by a large community reservoir. In contrast, nosocomial outbreaks and infections (without a community reservoir) characterize VREF in the United States. Previous studies demonstrated host-specific genogroups and a distinct genetic lineage of VREF associated with hospital outbreaks, characterized by the variant esp-gene and a specific allele-type of the purK housekeeping gene (purK1). We investigated the genetic relatedness of vanA VREF (n=108) and vancomycin-susceptible E. faecium (VSEF) (n=92) from different epidemiologic sources by genotyping, susceptibility testing for ampicillin, sequencing of purK1, and testing for presence of esp. Clusters of VSEF fit well into previously described VREF genogroups, and strong associations were found between VSEF and VREF isolates with resistance to ampicillin, presence of esp, and purK1. Genotypes characterized by presence of esp, purK1, and ampicillin resistance were most frequent among outbreak-associated isolates and almost absent among community surveillance isolates. Vancomycin-resistance was not specifically linked to genogroups. VREF and VSEF from different epidemiologic sources are genetically related; evidence exists for nosocomial selection of a subtype of E. faecium, which has acquired vancomycin-resistance through horizontal transfer.

        Cite This Article
    EID Leavis HL, Willems RJ, Top J, Spalburg E, Mascini EM, Fluit AC, et al. Epidemic and Nonepidemic Multidrug-Resistant Enterococcus faecium. Emerg Infect Dis. 2003;9(9):1108-1115. https://dx.doi.org/10.3201/eid0909.020383
    AMA Leavis HL, Willems RJ, Top J, et al. Epidemic and Nonepidemic Multidrug-Resistant Enterococcus faecium. Emerging Infectious Diseases. 2003;9(9):1108-1115. doi:10.3201/eid0909.020383.
    APA Leavis, H. L., Willems, R. J., Top, J., Spalburg, E., Mascini, E. M., Fluit, A. C....Bonten, M. J. (2003). Epidemic and Nonepidemic Multidrug-Resistant Enterococcus faecium. Emerging Infectious Diseases, 9(9), 1108-1115. https://dx.doi.org/10.3201/eid0909.020383.
  • Reemergence of Epidemic Vibrio cholerae O139, Bangladesh PDF Version [PDF - 520 KB - 7 pages]
    S. M. Faruque et al.
        View Abstract

    During March and April 2002, a resurgence of Vibrio cholerae O139 occurred in Dhaka and adjoining areas of Bangladesh with an estimated 30,000 cases of cholera. Patients infected with O139 strains were much older than those infected with O1 strains (p<0.001). The reemerged O139 strains belong to a single ribotype corresponding to one of two ribotypes that caused the initial O139 outbreak in 1993. Unlike the strains of 1993, the recent strains are susceptible to trimethoprim, sulphamethoxazole, and streptomycin but resistant to nalidixic acid. The new O139 strains carry a copy of the Calcutta type CTXCalc prophage in addition to the CTXET prophage carried by the previous strains. Thus, the O139 strains continue to evolve, and the adult population continues to be more susceptible to O139 cholera, which suggests a lack of adequate immunity against this serogroup. These findings emphasize the need for continuous monitoring of the new epidemic strains.

        Cite This Article
    EID Faruque SM, Chowdhury N, Kamruzzaman M, Ahmad QS, Faruque A, Salam MA, et al. Reemergence of Epidemic Vibrio cholerae O139, Bangladesh. Emerg Infect Dis. 2003;9(9):1116-1122. https://dx.doi.org/10.3201/eid0909.020443
    AMA Faruque SM, Chowdhury N, Kamruzzaman M, et al. Reemergence of Epidemic Vibrio cholerae O139, Bangladesh. Emerging Infectious Diseases. 2003;9(9):1116-1122. doi:10.3201/eid0909.020443.
    APA Faruque, S. M., Chowdhury, N., Kamruzzaman, M., Ahmad, Q. S., Faruque, A., Salam, M. A....Sack, D. A. (2003). Reemergence of Epidemic Vibrio cholerae O139, Bangladesh. Emerging Infectious Diseases, 9(9), 1116-1122. https://dx.doi.org/10.3201/eid0909.020443.
  • Ehrlichia chaffeensis Infections among HIV-infected Patients in Human Monocytic Ehrlichiosis–Endemic Area PDF Version [PDF - 359 KB - 5 pages]
    T. R. Talbot et al.
        View Abstract

    Manifestations of human monocytic ehrlichiosis (HME), a tick-borne infection caused by Ehrlichia chaffeensis, range from asymptomatic disease to fulminant infection and may be particularly severe in persons infected with HIV. We conducted a serologic study to determine the epidemiology of HME in HIV-positive patients residing in an HME-endemic area. We reviewed charts from a cohort of 133 HIV-positive patients who were seen during the 1999 tick season with symptoms compatible with HME (n=36) or who were asymptomatic (n=97). When available, paired plasma samples obtained before and after the tick season were tested by using an indirect immunofluorescence assay (IFA) to detect antibodies reactive to E. chaffeensis. Two symptomatic incident cases were identified by IFA, resulting in a seroincidence of 6.67% among symptomatic HIV-positive participants with paired samples available for testing and 1.64% overall. The baseline seroprevalence of HME was 0%. In contrast to infection in immunocompetent patients, E. chaffeensis infection in HIV-positive persons typically causes symptomatic disease.

        Cite This Article
    EID Talbot TR, Comer JA, Bloch KC. Ehrlichia chaffeensis Infections among HIV-infected Patients in Human Monocytic Ehrlichiosis–Endemic Area. Emerg Infect Dis. 2003;9(9):1123-1127. https://dx.doi.org/10.3201/eid0909.020560
    AMA Talbot TR, Comer JA, Bloch KC. Ehrlichia chaffeensis Infections among HIV-infected Patients in Human Monocytic Ehrlichiosis–Endemic Area. Emerging Infectious Diseases. 2003;9(9):1123-1127. doi:10.3201/eid0909.020560.
    APA Talbot, T. R., Comer, J. A., & Bloch, K. C. (2003). Ehrlichia chaffeensis Infections among HIV-infected Patients in Human Monocytic Ehrlichiosis–Endemic Area. Emerging Infectious Diseases, 9(9), 1123-1127. https://dx.doi.org/10.3201/eid0909.020560.
  • Consumer Attitudes and Use of Antibiotics PDF Version [PDF - 383 KB - 8 pages]
    J. Vanden Eng et al.
        View Abstract

    Recent antibiotic use is a risk factor for infection or colonization with resistant bacterial pathogens. Demand for antibiotics can be affected by consumers’ knowledge, attitudes, and practices. In 1998–1999, the Foodborne Diseases Active Surveillance Network (FoodNet) conducted a population-based, random-digit dialing telephone survey, including questions regarding respondents’ knowledge, attitudes, and practices of antibiotic use. Twelve percent had recently taken antibiotics; 27% believed that taking antibiotics when they had a cold made them better more quickly, 32% believed that taking antibiotics when they had a cold prevented more serious illness, and 48% expected a prescription for antibiotics when they were ill enough from a cold to seek medical attention. These misguided beliefs and expectations were associated with a lack of awareness of the dangers of antibiotic use; 58% of patients were not aware of the possible health dangers. National educational efforts are needed to address these issues if patient demand for antibiotics is to be reduced.

        Cite This Article
    EID Vanden Eng J, Marcus R, Hadler JL, Imhoff B, Vugia DJ, Cieslak PR, et al. Consumer Attitudes and Use of Antibiotics. Emerg Infect Dis. 2003;9(9):1128-1135. https://dx.doi.org/10.3201/eid0909.020591
    AMA Vanden Eng J, Marcus R, Hadler JL, et al. Consumer Attitudes and Use of Antibiotics. Emerging Infectious Diseases. 2003;9(9):1128-1135. doi:10.3201/eid0909.020591.
    APA Vanden Eng, J., Marcus, R., Hadler, J. L., Imhoff, B., Vugia, D. J., Cieslak, P. R....Besser, R. E. (2003). Consumer Attitudes and Use of Antibiotics. Emerging Infectious Diseases, 9(9), 1128-1135. https://dx.doi.org/10.3201/eid0909.020591.
  • Early Identification of Common-Source Foodborne Virus Outbreaks in Europe PDF Version [PDF - 230 KB - 7 pages]
    M. Koopmans et al.
        View Abstract

    The importance of foodborne viral infections is increasingly recognized. Food handlers can transmit infection during preparation or serving; fruit and vegetables may be contaminated by fecally contaminated water used for growing or washing. And modern practices of the food industry mean that a contaminated food item is not limited to national distribution. International outbreaks do occur, but little data are available about the incidence of such events and the food items associated with the highest risks. We developed a combined research and surveillance program for enteric viruses involving 12 laboratories in 9 European countries. This project aims to gain insight into the epidemiology of enteric viruses in Europe and the role of food in transmission by harmonizing (i.e., assessing the comparability of data through studies of molecular detection techniques) and enhancing epidemiologic surveillance. We describe the setup and preliminary results of our system, which uses a Web-accessible central database to track viruses and provides the foundation for an early warning system of foodborne and other common-source outbreaks.

        Cite This Article
    EID Koopmans M, Vennema H, Heersma H, van Strien E, van Duynhoven Y, Brown D, et al. Early Identification of Common-Source Foodborne Virus Outbreaks in Europe. Emerg Infect Dis. 2003;9(9):1136-1142. https://dx.doi.org/10.3201/eid0909.020766
    AMA Koopmans M, Vennema H, Heersma H, et al. Early Identification of Common-Source Foodborne Virus Outbreaks in Europe. Emerging Infectious Diseases. 2003;9(9):1136-1142. doi:10.3201/eid0909.020766.
    APA Koopmans, M., Vennema, H., Heersma, H., van Strien, E., van Duynhoven, Y., Brown, D....Lopman, B. (2003). Early Identification of Common-Source Foodborne Virus Outbreaks in Europe. Emerging Infectious Diseases, 9(9), 1136-1142. https://dx.doi.org/10.3201/eid0909.020766.
  • Skunk and Raccoon Rabies in the Eastern United States: Temporal and Spatial Analysis PDF Version [PDF - 704 KB - 8 pages]
    M. A. Guerra et al.
        View Abstract

    Since 1981, an epizootic of raccoon rabies has spread throughout the eastern United States. A concomitant increase in reported rabies cases in skunks has raised concerns that an independent maintenance cycle of rabies virus in skunks could become established, affecting current strategies of wildlife rabies control programs. Rabies surveillance data from 1981 through 2000 obtained from the health departments of 11 eastern states were used to analyze temporal and spatial characteristics of rabies epizootics in each species. Spatial analysis indicated that epizootics in raccoons and skunks moved in a similar direction from 1990 to 2000. Temporal regression analysis showed that the number of rabid raccoons predicted the number of rabid skunks through time, with a 1-month lag. In areas where the raccoon rabies virus variant is enzootic, spatio-temporal analysis does not provide evidence that this rabies virus variant is currently cycling independently among skunks.

        Cite This Article
    EID Guerra MA, Curns AT, Rupprecht CE, Hanlon CA, Krebs JW, Childs JE, et al. Skunk and Raccoon Rabies in the Eastern United States: Temporal and Spatial Analysis. Emerg Infect Dis. 2003;9(9):1143-1150. https://dx.doi.org/10.3201/eid0909.020608
    AMA Guerra MA, Curns AT, Rupprecht CE, et al. Skunk and Raccoon Rabies in the Eastern United States: Temporal and Spatial Analysis. Emerging Infectious Diseases. 2003;9(9):1143-1150. doi:10.3201/eid0909.020608.
    APA Guerra, M. A., Curns, A. T., Rupprecht, C. E., Hanlon, C. A., Krebs, J. W., & Childs, J. E. (2003). Skunk and Raccoon Rabies in the Eastern United States: Temporal and Spatial Analysis. Emerging Infectious Diseases, 9(9), 1143-1150. https://dx.doi.org/10.3201/eid0909.020608.

Dispatches

  • Tick-borne Relapsing Fever Caused by Borrelia hermsii, Montana PDF Version [PDF - 276 KB - 4 pages]
    T. G. Schwan et al.
        View Abstract

    Five persons contracted tick-borne relapsing fever after staying in a cabin in western Montana. Borrelia hermsii was isolated from the blood of two patients, and Ornithodoros hermsi ticks were collected from the cabin, the first demonstration of this bacterium and tick in Montana. Relapsing fever should be considered when patients who reside or have vacationed in western Montana exhibit a recurring febrile illness.

        Cite This Article
    EID Schwan TG, Policastro PF, Miller Z, Thompson RL, Damrow T, Keirans JE, et al. Tick-borne Relapsing Fever Caused by Borrelia hermsii, Montana. Emerg Infect Dis. 2003;9(9):1151-1154. https://dx.doi.org/10.3201/eid0909.030280
    AMA Schwan TG, Policastro PF, Miller Z, et al. Tick-borne Relapsing Fever Caused by Borrelia hermsii, Montana. Emerging Infectious Diseases. 2003;9(9):1151-1154. doi:10.3201/eid0909.030280.
    APA Schwan, T. G., Policastro, P. F., Miller, Z., Thompson, R. L., Damrow, T., & Keirans, J. E. (2003). Tick-borne Relapsing Fever Caused by Borrelia hermsii, Montana. Emerging Infectious Diseases, 9(9), 1151-1154. https://dx.doi.org/10.3201/eid0909.030280.
  • Paecilomyces lilacinus Vaginitis in an Immunocompetent Patient PDF Version [PDF - 335 KB - 4 pages]
    J. Carey et al.
        View Abstract

    Paecilomyces lilacinus, an environmental mold found in soil and vegetation, rarely causes human infection. We report the first case of P. lilacinus isolated from a vaginal culture in a patient with vaginitis.

        Cite This Article
    EID Carey J, D’Amico R, Sutton DA, Rinaldi MG. Paecilomyces lilacinus Vaginitis in an Immunocompetent Patient. Emerg Infect Dis. 2003;9(9):1155-1158. https://dx.doi.org/10.3201/eid0909.020654
    AMA Carey J, D’Amico R, Sutton DA, et al. Paecilomyces lilacinus Vaginitis in an Immunocompetent Patient. Emerging Infectious Diseases. 2003;9(9):1155-1158. doi:10.3201/eid0909.020654.
    APA Carey, J., D’Amico, R., Sutton, D. A., & Rinaldi, M. G. (2003). Paecilomyces lilacinus Vaginitis in an Immunocompetent Patient. Emerging Infectious Diseases, 9(9), 1155-1158. https://dx.doi.org/10.3201/eid0909.020654.
  • Fluoroquinolone and Macrolide Treatment Failure in Pneumococcal Pneumonia and Selection of Multidrug-Resistant Isolates PDF Version [PDF - 307 KB - 4 pages]
    E. Pérez-Trallero et al.
        View Abstract

    Streptococcus pneumoniae serotype 3, isolated from a penicillin-allergic patient and initially susceptible to fluoroquinolones, macrolides, lincosamides, quinupristin-dalfopristin, and telithromycin, became resistant to all these drugs during treatment. Mutations in the parC and gyrA and in the 23S rRNA and the ribosomal protein L22 genes were detected in the resistant isolates.

        Cite This Article
    EID Pérez-Trallero E, Marimon JM, Iglesias L, Larruskain J. Fluoroquinolone and Macrolide Treatment Failure in Pneumococcal Pneumonia and Selection of Multidrug-Resistant Isolates. Emerg Infect Dis. 2003;9(9):1159-1162. https://dx.doi.org/10.3201/eid0909.020810
    AMA Pérez-Trallero E, Marimon JM, Iglesias L, et al. Fluoroquinolone and Macrolide Treatment Failure in Pneumococcal Pneumonia and Selection of Multidrug-Resistant Isolates. Emerging Infectious Diseases. 2003;9(9):1159-1162. doi:10.3201/eid0909.020810.
    APA Pérez-Trallero, E., Marimon, J. M., Iglesias, L., & Larruskain, J. (2003). Fluoroquinolone and Macrolide Treatment Failure in Pneumococcal Pneumonia and Selection of Multidrug-Resistant Isolates. Emerging Infectious Diseases, 9(9), 1159-1162. https://dx.doi.org/10.3201/eid0909.020810.
  • Microbiologic Characteristics, Serologic Responses, and Clinical Manifestations in Severe Acute Respiratory Syndrome, Taiwan PDF Version [PDF - 445 KB - 5 pages]
    P. Hsueh et al.
        View Abstract

    The genome of one Taiwanese severe acute respiratory syndrome-associated coronavirus (SARS-CoV) strain (TW1) was 29,729 nt in length. Viral RNA may persist for some time in patients who seroconvert, and some patients may lack an antibody response (immunoglobulin G) to SARS-CoV >21 days after illness onset. An upsurge of antibody response was associated with the aggravation of respiratory failure.

        Cite This Article
    EID Hsueh P, Hsiao C, Yeh S, Wang W, Chen P, Wang J, et al. Microbiologic Characteristics, Serologic Responses, and Clinical Manifestations in Severe Acute Respiratory Syndrome, Taiwan. Emerg Infect Dis. 2003;9(9):1163-1167. https://dx.doi.org/10.3201/eid0909.030367
    AMA Hsueh P, Hsiao C, Yeh S, et al. Microbiologic Characteristics, Serologic Responses, and Clinical Manifestations in Severe Acute Respiratory Syndrome, Taiwan. Emerging Infectious Diseases. 2003;9(9):1163-1167. doi:10.3201/eid0909.030367.
    APA Hsueh, P., Hsiao, C., Yeh, S., Wang, W., Chen, P., Wang, J....Yang, P. (2003). Microbiologic Characteristics, Serologic Responses, and Clinical Manifestations in Severe Acute Respiratory Syndrome, Taiwan. Emerging Infectious Diseases, 9(9), 1163-1167. https://dx.doi.org/10.3201/eid0909.030367.
  • Co-trimoxazole–Sensitive, Methicillin-Resistant Staphylococcus aureus, Israel, 1988–1997 PDF Version [PDF - 175 KB - 2 pages]
    J. Bishara et al.
        View Abstract

    Among bloodstream methicillin-resistant Staphylococcus aureus (MRSA) isolates from adult patients in a single hospital, susceptibility to co-trimoxazole increased progressively from 31% in 1988 to 92% in 1997 (p<0.0001). If also observed in other institutions, these findings should encourage the performance of a clinical trial of sufficient size to compare co-trimoxazole to vancomycin in treating MRSA infections.

        Cite This Article
    EID Bishara J, Pitlik S, Samra Z, Levy I, Paul M, Leibovici L, et al. Co-trimoxazole–Sensitive, Methicillin-Resistant Staphylococcus aureus, Israel, 1988–1997. Emerg Infect Dis. 2003;9(9):1168-1169. https://dx.doi.org/10.3201/eid0909.020666
    AMA Bishara J, Pitlik S, Samra Z, et al. Co-trimoxazole–Sensitive, Methicillin-Resistant Staphylococcus aureus, Israel, 1988–1997. Emerging Infectious Diseases. 2003;9(9):1168-1169. doi:10.3201/eid0909.020666.
    APA Bishara, J., Pitlik, S., Samra, Z., Levy, I., Paul, M., & Leibovici, L. (2003). Co-trimoxazole–Sensitive, Methicillin-Resistant Staphylococcus aureus, Israel, 1988–1997. Emerging Infectious Diseases, 9(9), 1168-1169. https://dx.doi.org/10.3201/eid0909.020666.
  • Enteroaggregative Escherichia coli Serotype O126:H27, Israel PDF Version [PDF - 230 KB - 4 pages]
    G. Shazberg et al.
        View Abstract

    Enteroaggregative Escherichia coli (EAEC) is a newly diarrheagenic agent wherein several predominant serotypes are reported. We studied the association between those serotypes, as clonal indicators, and the trait of enteroaggregative adherence to host cells, tested by polymerase chain reaction. We also evaluated the clinical manifestations of infection in 17 hospitalized children by our most common EAEC serotype, O126:H27.

        Cite This Article
    EID Shazberg G, Wolk M, Schmidt H, Sechter I, Gottesman G, Miron D, et al. Enteroaggregative Escherichia coli Serotype O126:H27, Israel. Emerg Infect Dis. 2003;9(9):1170-1173. https://dx.doi.org/10.3201/eid0909.020695
    AMA Shazberg G, Wolk M, Schmidt H, et al. Enteroaggregative Escherichia coli Serotype O126:H27, Israel. Emerging Infectious Diseases. 2003;9(9):1170-1173. doi:10.3201/eid0909.020695.
    APA Shazberg, G., Wolk, M., Schmidt, H., Sechter, I., Gottesman, G., & Miron, D. (2003). Enteroaggregative Escherichia coli Serotype O126:H27, Israel. Emerging Infectious Diseases, 9(9), 1170-1173. https://dx.doi.org/10.3201/eid0909.020695.
  • Cryptosporidium muris, a Rodent Pathogen, Recovered from a Human in Perú PDF Version [PDF - 216 KB - 3 pages]
    C. J. Palmer et al.
        View Abstract

    Cryptosporidium muris, predominantly a rodent species of Cryptosporidium, is not normally considered a human pathogen. Recently, isolated human infections have been reported from Indonesia, Thailand, France, and Kenya. We report the first case of C. muris in a human in the Western Hemisphere. This species may be an emerging zoonotic pathogen capable of infecting humans.

        Cite This Article
    EID Palmer CJ, Xiao L, Terashima A, Guerra H, Gotuzzo E, Saldías G, et al. Cryptosporidium muris, a Rodent Pathogen, Recovered from a Human in Perú. Emerg Infect Dis. 2003;9(9):1174-1176. https://dx.doi.org/10.3201/eid0909.030047
    AMA Palmer CJ, Xiao L, Terashima A, et al. Cryptosporidium muris, a Rodent Pathogen, Recovered from a Human in Perú. Emerging Infectious Diseases. 2003;9(9):1174-1176. doi:10.3201/eid0909.030047.
    APA Palmer, C. J., Xiao, L., Terashima, A., Guerra, H., Gotuzzo, E., Saldías, G....Upton, S. J. (2003). Cryptosporidium muris, a Rodent Pathogen, Recovered from a Human in Perú. Emerging Infectious Diseases, 9(9), 1174-1176. https://dx.doi.org/10.3201/eid0909.030047.
  • Malaria Clusters among Illegal Chinese Immigrants to Europe through Africa PDF Version [PDF - 140 KB - 2 pages]
    Z. Bisoffi et al.
        View Abstract

    Between November 2002 and March 2003, 17 cases of malaria (1 fatal) were observed in illegal Chinese immigrants who traveled to Italy through Africa. A further cluster of 12 was reported in August, 2002. Several immigrants traveled by air, making the risk of introducing sudden acute respiratory syndrome a possibility should such illegal immigrations continue.

        Cite This Article
    EID Bisoffi Z, Matteelli A, Aquilini D, Guaraldi G, Magnani G, Orlando G, et al. Malaria Clusters among Illegal Chinese Immigrants to Europe through Africa. Emerg Infect Dis. 2003;9(9):1177-1178. https://dx.doi.org/10.3201/eid0909.030353
    AMA Bisoffi Z, Matteelli A, Aquilini D, et al. Malaria Clusters among Illegal Chinese Immigrants to Europe through Africa. Emerging Infectious Diseases. 2003;9(9):1177-1178. doi:10.3201/eid0909.030353.
    APA Bisoffi, Z., Matteelli, A., Aquilini, D., Guaraldi, G., Magnani, G., Orlando, G....Behrens, R. H. (2003). Malaria Clusters among Illegal Chinese Immigrants to Europe through Africa. Emerging Infectious Diseases, 9(9), 1177-1178. https://dx.doi.org/10.3201/eid0909.030353.

Letters

  • First European Case of Serotype A MATa Cryptococcus neoformans Infection PDF Version [PDF - 171 KB - 2 pages]
    M. A. Viviani et al.
            Cite This Article
    EID Viviani MA, Nikolova R, Esposto M, Prinz G. First European Case of Serotype A MATa Cryptococcus neoformans Infection. Emerg Infect Dis. 2003;9(9):1179-1180. https://dx.doi.org/10.3201/eid0909.020770
    AMA Viviani MA, Nikolova R, Esposto M, et al. First European Case of Serotype A MATa Cryptococcus neoformans Infection. Emerging Infectious Diseases. 2003;9(9):1179-1180. doi:10.3201/eid0909.020770.
    APA Viviani, M. A., Nikolova, R., Esposto, M., & Prinz, G. (2003). First European Case of Serotype A MATa Cryptococcus neoformans Infection. Emerging Infectious Diseases, 9(9), 1179-1180. https://dx.doi.org/10.3201/eid0909.020770.
  • Severe Acute Respiratory Syndrome: Relapse? Hospital Infection? PDF Version [PDF - 161 KB - 2 pages]
    O. T. Tsang et al.
            Cite This Article
    EID Tsang OT, Chau T, Choi K, Tso EY, Lim W, Chiu M, et al. Severe Acute Respiratory Syndrome: Relapse? Hospital Infection?. Emerg Infect Dis. 2003;9(9):1180-1181. https://dx.doi.org/10.3201/eid0909.030395
    AMA Tsang OT, Chau T, Choi K, et al. Severe Acute Respiratory Syndrome: Relapse? Hospital Infection?. Emerging Infectious Diseases. 2003;9(9):1180-1181. doi:10.3201/eid0909.030395.
    APA Tsang, O. T., Chau, T., Choi, K., Tso, E. Y., Lim, W., Chiu, M....Lai, S. (2003). Severe Acute Respiratory Syndrome: Relapse? Hospital Infection?. Emerging Infectious Diseases, 9(9), 1180-1181. https://dx.doi.org/10.3201/eid0909.030395.
  • Remembering Jonathan M. Mann in a World Ajar PDF Version [PDF - 153 KB - 2 pages]
    K. F. Gensheimer
            Cite This Article
    EID Gensheimer KF. Remembering Jonathan M. Mann in a World Ajar. Emerg Infect Dis. 2003;9(9):1181-1182. https://dx.doi.org/10.3201/eid0909.030381
    AMA Gensheimer KF. Remembering Jonathan M. Mann in a World Ajar. Emerging Infectious Diseases. 2003;9(9):1181-1182. doi:10.3201/eid0909.030381.
    APA Gensheimer, K. F. (2003). Remembering Jonathan M. Mann in a World Ajar. Emerging Infectious Diseases, 9(9), 1181-1182. https://dx.doi.org/10.3201/eid0909.030381.
  • Mild Severe Acute Respiratory Syndrome PDF Version [PDF - 131 KB - 2 pages]
    G. Li et al.
            Cite This Article
    EID Li G, Zhao Z, Chen L, Zhou Y. Mild Severe Acute Respiratory Syndrome. Emerg Infect Dis. 2003;9(9):1182-1183. https://dx.doi.org/10.3201/eid0909.030461
    AMA Li G, Zhao Z, Chen L, et al. Mild Severe Acute Respiratory Syndrome. Emerging Infectious Diseases. 2003;9(9):1182-1183. doi:10.3201/eid0909.030461.
    APA Li, G., Zhao, Z., Chen, L., & Zhou, Y. (2003). Mild Severe Acute Respiratory Syndrome. Emerging Infectious Diseases, 9(9), 1182-1183. https://dx.doi.org/10.3201/eid0909.030461.
  • Transmission of Severe Acute Respiratory Syndrome PDF Version [PDF - 131 KB - 2 pages]
    I. Arita et al.
            Cite This Article
    EID Arita I, Kojima K, Nakane M. Transmission of Severe Acute Respiratory Syndrome. Emerg Infect Dis. 2003;9(9):1183-1184. https://dx.doi.org/10.3201/eid0909.030471
    AMA Arita I, Kojima K, Nakane M. Transmission of Severe Acute Respiratory Syndrome. Emerging Infectious Diseases. 2003;9(9):1183-1184. doi:10.3201/eid0909.030471.
    APA Arita, I., Kojima, K., & Nakane, M. (2003). Transmission of Severe Acute Respiratory Syndrome. Emerging Infectious Diseases, 9(9), 1183-1184. https://dx.doi.org/10.3201/eid0909.030471.
  • Home-prepared Hamburger and Sporadic Hemolytic Uremic Syndrome, Argentina PDF Version [PDF - 161 KB - 3 pages]
    M. Rivas et al.
            Cite This Article
    EID Rivas M, Caletti MG, Chinen I, Refi SM, Roldán CD, Chillemi G, et al. Home-prepared Hamburger and Sporadic Hemolytic Uremic Syndrome, Argentina. Emerg Infect Dis. 2003;9(9):1184-1186. https://dx.doi.org/10.3201/eid0909.020563
    AMA Rivas M, Caletti MG, Chinen I, et al. Home-prepared Hamburger and Sporadic Hemolytic Uremic Syndrome, Argentina. Emerging Infectious Diseases. 2003;9(9):1184-1186. doi:10.3201/eid0909.020563.
    APA Rivas, M., Caletti, M. G., Chinen, I., Refi, S. M., Roldán, C. D., Chillemi, G....Estani, S. S. (2003). Home-prepared Hamburger and Sporadic Hemolytic Uremic Syndrome, Argentina. Emerging Infectious Diseases, 9(9), 1184-1186. https://dx.doi.org/10.3201/eid0909.020563.
  • Q Fever in Thailand PDF Version [PDF - 205 KB - 3 pages]
    Y. Suputtamongkol et al.
            Cite This Article
    EID Suputtamongkol Y, Rolain J, Losuwanaruk K, Niwatayakul K, Suthinont C, Chierakul W, et al. Q Fever in Thailand. Emerg Infect Dis. 2003;9(9):1186-1188. https://dx.doi.org/10.3201/eid0909.030086
    AMA Suputtamongkol Y, Rolain J, Losuwanaruk K, et al. Q Fever in Thailand. Emerging Infectious Diseases. 2003;9(9):1186-1188. doi:10.3201/eid0909.030086.
    APA Suputtamongkol, Y., Rolain, J., Losuwanaruk, K., Niwatayakul, K., Suthinont, C., Chierakul, W....Raoult, D. (2003). Q Fever in Thailand. Emerging Infectious Diseases, 9(9), 1186-1188. https://dx.doi.org/10.3201/eid0909.030086.

Books and Media

  • Expedition Medicine (Revised Edition) PDF Version [PDF - 112 KB - 1 page]
    J. E. Kaplan
            Cite This Article
    EID Kaplan JE. Expedition Medicine (Revised Edition). Emerg Infect Dis. 2003;9(9):1189. https://dx.doi.org/10.3201/eid0909.030440
    AMA Kaplan JE. Expedition Medicine (Revised Edition). Emerging Infectious Diseases. 2003;9(9):1189. doi:10.3201/eid0909.030440.
    APA Kaplan, J. E. (2003). Expedition Medicine (Revised Edition). Emerging Infectious Diseases, 9(9), 1189. https://dx.doi.org/10.3201/eid0909.030440.
  • The Global Threat of New and Reemerging Infectious Diseases: Reconciling U.S. National Security and Public Health Policy PDF Version [PDF - 172 KB - 2 pages]
    P. J. McConnon
            Cite This Article
    EID McConnon PJ. The Global Threat of New and Reemerging Infectious Diseases: Reconciling U.S. National Security and Public Health Policy. Emerg Infect Dis. 2003;9(9):1189-1190. https://dx.doi.org/10.3201/eid0909.030442
    AMA McConnon PJ. The Global Threat of New and Reemerging Infectious Diseases: Reconciling U.S. National Security and Public Health Policy. Emerging Infectious Diseases. 2003;9(9):1189-1190. doi:10.3201/eid0909.030442.
    APA McConnon, P. J. (2003). The Global Threat of New and Reemerging Infectious Diseases: Reconciling U.S. National Security and Public Health Policy. Emerging Infectious Diseases, 9(9), 1189-1190. https://dx.doi.org/10.3201/eid0909.030442.

About the Cover

  • Vincent van Gogh (1853–1890). The Prison Courtyard (1890) PDF Version [PDF - 367 KB - 2 pages]
    P. Potter
            Cite This Article
    EID Potter P. Vincent van Gogh (1853–1890). The Prison Courtyard (1890). Emerg Infect Dis. 2003;9(9):1194-1195. https://dx.doi.org/10.3201/eid0909.AC0909
    AMA Potter P. Vincent van Gogh (1853–1890). The Prison Courtyard (1890). Emerging Infectious Diseases. 2003;9(9):1194-1195. doi:10.3201/eid0909.AC0909.
    APA Potter, P. (2003). Vincent van Gogh (1853–1890). The Prison Courtyard (1890). Emerging Infectious Diseases, 9(9), 1194-1195. https://dx.doi.org/10.3201/eid0909.AC0909.

Conference Summaries

  • World Health Organization Global Conference on Severe Acute Respiratory Syndrome PDF Version [PDF - 147 KB - 2 pages]
    D. Bell et al.
            Cite This Article
    EID Bell D, Jenkins P, Hall J. World Health Organization Global Conference on Severe Acute Respiratory Syndrome. Emerg Infect Dis. 2003;9(9):1191-1192. https://dx.doi.org/10.3201/eid0909.030559
    AMA Bell D, Jenkins P, Hall J. World Health Organization Global Conference on Severe Acute Respiratory Syndrome. Emerging Infectious Diseases. 2003;9(9):1191-1192. doi:10.3201/eid0909.030559.
    APA Bell, D., Jenkins, P., & Hall, J. (2003). World Health Organization Global Conference on Severe Acute Respiratory Syndrome. Emerging Infectious Diseases, 9(9), 1191-1192. https://dx.doi.org/10.3201/eid0909.030559.

Corrections

  • Correction, Vol. 9, No. 8 PDF Version [PDF - 136 KB - 1 page]
            Cite This Article
    EID Correction, Vol. 9, No. 8. Emerg Infect Dis. 2003;9(9):1188. https://dx.doi.org/10.3201/eid0909.C10909
    AMA Correction, Vol. 9, No. 8. Emerging Infectious Diseases. 2003;9(9):1188. doi:10.3201/eid0909.C10909.
    APA (2003). Correction, Vol. 9, No. 8. Emerging Infectious Diseases, 9(9), 1188. https://dx.doi.org/10.3201/eid0909.C10909.
  • Correction, Vol. 9, No. 8 PDF Version [PDF - 136 KB - 1 page]
            Cite This Article
    EID Correction, Vol. 9, No. 8. Emerg Infect Dis. 2003;9(9):1188. https://dx.doi.org/10.3201/eid0909.C20909
    AMA Correction, Vol. 9, No. 8. Emerging Infectious Diseases. 2003;9(9):1188. doi:10.3201/eid0909.C20909.
    APA (2003). Correction, Vol. 9, No. 8. Emerging Infectious Diseases, 9(9), 1188. https://dx.doi.org/10.3201/eid0909.C20909.
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