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Coronavirus








Articles from Emerging Infectious Diseases

Synopses

Case Manifestations and Public Health Response for Outbreak of Meningococcal W Disease, Central Australia, 2017 [PDF - 1.12 MB - 9 pages]
E. L. Sudbury et al.

Neisseria meningitidis serogroup W has emerged as an increasingly common cause of invasive meningococcal disease worldwide; the average case-fatality rate is 10%. In 2017, an unprecedented outbreak of serogroup W infection occurred among the Indigenous pediatric population of Central Australia; there were 24 cases over a 5-month period. Among these cases were atypical manifestations, including meningococcal pneumonia, septic arthritis, and conjunctivitis. The outbreak juxtaposed a well-resourced healthcare system against unique challenges related to covering vast distances, a socially disadvantaged population, and a disease process that was rapid and unpredictable. A coordinated clinical and public health response included investigation of and empiric treatment for 649 febrile children, provision of prophylactic antimicrobial drugs for 465 close contacts, and implementation of a quadrivalent meningococcal ACWY conjugate vaccine immunization program. The response contained the outbreak within 6 months; no deaths and only 1 case of major illness were recorded.

EID Sudbury EL, O’Sullivan S, Lister D, Varghese D, Satharasinghe K. Case Manifestations and Public Health Response for Outbreak of Meningococcal W Disease, Central Australia, 2017. Emerg Infect Dis. 2020;26(7):1355-1363. https://dx.doi.org/10.3201/eid2607.181941
AMA Sudbury EL, O’Sullivan S, Lister D, et al. Case Manifestations and Public Health Response for Outbreak of Meningococcal W Disease, Central Australia, 2017. Emerging Infectious Diseases. 2020;26(7):1355-1363. doi:10.3201/eid2607.181941.
APA Sudbury, E. L., O’Sullivan, S., Lister, D., Varghese, D., & Satharasinghe, K. (2020). Case Manifestations and Public Health Response for Outbreak of Meningococcal W Disease, Central Australia, 2017. Emerging Infectious Diseases, 26(7), 1355-1363. https://dx.doi.org/10.3201/eid2607.181941.

Transmission of Chikungunya Virus in an Urban Slum, Brazil [PDF - 449 KB - 10 pages]
R. O. Anjos et al.

After a chikungunya outbreak in Salvador, Brazil, we performed a cross-sectional, community-based study of 1,776 inhabitants to determine chikungunya virus (CHIKV) seroprevalence, identify factors associated with exposure, and estimate the symptomatic infection rate. From November 2016 through February 2017, we collected sociodemographic and clinical data by interview and tested serum samples for CHIKV IgG. CHIKV seroprevalence was 11.8% (95% CI 9.8%–13.7%), and 15.3% of seropositive persons reported an episode of fever and arthralgia. Infections were independently and positively associated with residences served by unpaved streets, a presumptive clinical diagnosis of chikungunya, and recall of an episode of fever with arthralgia in 2015–2016. Our findings indicate that the chikungunya outbreak in Salvador may not have conferred sufficient herd immunity to preclude epidemics in the near future. The unusually low frequency of symptomatic disease points to a need for further longitudinal studies to better investigate these findings.

EID Anjos RO, Mugabe V, Moreira P, Carvalho CX, Portilho MM, Khouri R, et al. Transmission of Chikungunya Virus in an Urban Slum, Brazil. Emerg Infect Dis. 2020;26(7):1364-1373. https://dx.doi.org/10.3201/eid2607.190846
AMA Anjos RO, Mugabe V, Moreira P, et al. Transmission of Chikungunya Virus in an Urban Slum, Brazil. Emerging Infectious Diseases. 2020;26(7):1364-1373. doi:10.3201/eid2607.190846.
APA Anjos, R. O., Mugabe, V., Moreira, P., Carvalho, C. X., Portilho, M. M., Khouri, R....Ribeiro, G. S. (2020). Transmission of Chikungunya Virus in an Urban Slum, Brazil. Emerging Infectious Diseases, 26(7), 1364-1373. https://dx.doi.org/10.3201/eid2607.190846.

Public Health Role of Academic Medical Center in Community Outbreak of Hepatitis A, San Diego County, California, USA, 2016–2018 [PDF - 1.02 MB - 8 pages]
M. Kang et al.

During 2016–2018, San Diego County, California, USA, experienced one of the largest hepatitis A outbreaks in the United States in 2 decades. In close partnership with local healthcare systems, San Diego County Public Health led a public health response to the outbreak that focused on a 3-pronged strategy to vaccinate, sanitize, and educate. Healthcare systems administered nearly half of the vaccinations delivered in San Diego County. At University of California San Diego Health, the use of informatics tools assisted with the identification of at-risk populations and with vaccine delivery across outpatient and inpatient settings. In addition, acute care facilities helped prevent further disease transmission by delaying the discharge of patients with hepatitis A who were experiencing homelessness. We assessed the public health roles that acute care hospitals can play during a large community outbreak and the critical nature of ongoing collaboration between hospitals and public health systems in controlling such outbreaks.

EID Kang M, Horman SF, Taplitz RA, Clay B, Millen M, Sitapati A, et al. Public Health Role of Academic Medical Center in Community Outbreak of Hepatitis A, San Diego County, California, USA, 2016–2018. Emerg Infect Dis. 2020;26(7):1374-1381. https://dx.doi.org/10.3201/eid2607.191352
AMA Kang M, Horman SF, Taplitz RA, et al. Public Health Role of Academic Medical Center in Community Outbreak of Hepatitis A, San Diego County, California, USA, 2016–2018. Emerging Infectious Diseases. 2020;26(7):1374-1381. doi:10.3201/eid2607.191352.
APA Kang, M., Horman, S. F., Taplitz, R. A., Clay, B., Millen, M., Sitapati, A....Torriani, F. J. (2020). Public Health Role of Academic Medical Center in Community Outbreak of Hepatitis A, San Diego County, California, USA, 2016–2018. Emerging Infectious Diseases, 26(7), 1374-1381. https://dx.doi.org/10.3201/eid2607.191352.

Macrolide-Resistant Mycoplasma pneumoniae Infections in Pediatric Community-Acquired Pneumonia [PDF - 2.79 MB - 10 pages]
Y. Chen et al.

A high prevalence rate of macrolide-resistant Mycoplasma pneumoniae (MRMP) has been reported in Asia. We performed a systematic review and meta-analysis to investigate the effect of macrolide resistance on the manifestations and clinical judgment during M. pneumoniae infections. We found no difference in clinical severity between MRMP and macrolide-sensitive Mycoplasma pneumoniae (MSMP) infections. However, in the pooled data, patients infected with MRMP had a longer febrile period (1.71 days), length of hospital stay (1.61 day), antibiotic drug courses (2.93 days), and defervescence time after macrolide treatment (2.04 days) compared with patients infected with MSMP. The risk of fever lasting for >48 hours after macrolide treatment was also significantly increased (OR 21.24), and an increased proportion of patients was changed to second-line treatment (OR 4.42). Our findings indicate diagnostic and therapeutic challenges after the emergence of MRMP. More precise diagnostic tools and clearly defined treatment should be appraised in the future.

EID Chen Y, Hsu W, Chang T. Macrolide-Resistant Mycoplasma pneumoniae Infections in Pediatric Community-Acquired Pneumonia. Emerg Infect Dis. 2020;26(7):1382-1391. https://dx.doi.org/10.3201/eid2607.200017
AMA Chen Y, Hsu W, Chang T. Macrolide-Resistant Mycoplasma pneumoniae Infections in Pediatric Community-Acquired Pneumonia. Emerging Infectious Diseases. 2020;26(7):1382-1391. doi:10.3201/eid2607.200017.
APA Chen, Y., Hsu, W., & Chang, T. (2020). Macrolide-Resistant Mycoplasma pneumoniae Infections in Pediatric Community-Acquired Pneumonia. Emerging Infectious Diseases, 26(7), 1382-1391. https://dx.doi.org/10.3201/eid2607.200017.
Research

Efficient Surveillance of Plasmodium knowlesi Genetic Subpopulations, Malaysian Borneo, 2000–2018 [PDF - 2.55 MB - 7 pages]
P. C. Divis et al.

Population genetic analysis revealed that Plasmodium knowlesi infections in Malaysian Borneo are caused by 2 divergent parasites associated with long-tailed (cluster 1) and pig-tailed (cluster 2) macaques. Because the transmission ecology is likely to differ for each macaque species, we developed a simple genotyping PCR to efficiently distinguish between and survey the 2 parasite subpopulations. This assay confirmed differences in the relative proportions in areas of Kapit division of Sarawak state, consistent with multilocus microsatellite analyses. Analyses of 1,204 human infections at Kapit Hospital showed that cluster 1 caused approximately two thirds of cases with no significant temporal changes from 2000 to 2018. We observed an apparent increase in overall numbers in the most recent 2 years studied, driven mainly by increased cluster 1 parasite infections. Continued monitoring of the frequency of different parasite subpopulations and correlation with environmental alterations are necessary to determine whether the epidemiology will change substantially.

EID Divis PC, Hu TH, Kadir KA, Mohammad D, Hii KC, Daneshvar C, et al. Efficient Surveillance of Plasmodium knowlesi Genetic Subpopulations, Malaysian Borneo, 2000–2018. Emerg Infect Dis. 2020;26(7):1392-1398. https://dx.doi.org/10.3201/eid2607.190924
AMA Divis PC, Hu TH, Kadir KA, et al. Efficient Surveillance of Plasmodium knowlesi Genetic Subpopulations, Malaysian Borneo, 2000–2018. Emerging Infectious Diseases. 2020;26(7):1392-1398. doi:10.3201/eid2607.190924.
APA Divis, P. C., Hu, T. H., Kadir, K. A., Mohammad, D., Hii, K. C., Daneshvar, C....Singh, B. (2020). Efficient Surveillance of Plasmodium knowlesi Genetic Subpopulations, Malaysian Borneo, 2000–2018. Emerging Infectious Diseases, 26(7), 1392-1398. https://dx.doi.org/10.3201/eid2607.190924.

Bat and Lyssavirus Exposure among Humans in Area that Celebrates Bat Festival, Nigeria, 2010 and 2013 [PDF - 1.39 MB - 10 pages]
N. M. Vora et al.

Using questionnaires and serologic testing, we evaluated bat and lyssavirus exposure among persons in an area of Nigeria that celebrates a bat festival. Bats from festival caves underwent serologic testing for phylogroup II lyssaviruses (Lagos bat virus, Shimoni bat virus, Mokola virus). The enrolled households consisted of 2,112 persons, among whom 213 (10%) were reported to have ever had bat contact (having touched a bat, having been bitten by a bat, or having been scratched by a bat) and 52 (2%) to have ever been bitten by a bat. Of 203 participants with bat contact, 3 (1%) had received rabies vaccination. No participant had neutralizing antibodies to phylogroup II lyssaviruses, but >50% of bats had neutralizing antibodies to these lyssaviruses. Even though we found no evidence of phylogroup II lyssavirus exposure among humans, persons interacting with bats in the area could benefit from practicing bat-related health precautions.

EID Vora NM, Osinubi M, Davis L, Abdurrahman M, Adedire EB, Akpan H, et al. Bat and Lyssavirus Exposure among Humans in Area that Celebrates Bat Festival, Nigeria, 2010 and 2013. Emerg Infect Dis. 2020;26(7):1399-1408. https://dx.doi.org/10.3201/eid2607.191016
AMA Vora NM, Osinubi M, Davis L, et al. Bat and Lyssavirus Exposure among Humans in Area that Celebrates Bat Festival, Nigeria, 2010 and 2013. Emerging Infectious Diseases. 2020;26(7):1399-1408. doi:10.3201/eid2607.191016.
APA Vora, N. M., Osinubi, M., Davis, L., Abdurrahman, M., Adedire, E. B., Akpan, H....Recuenco, S. (2020). Bat and Lyssavirus Exposure among Humans in Area that Celebrates Bat Festival, Nigeria, 2010 and 2013. Emerging Infectious Diseases, 26(7), 1399-1408. https://dx.doi.org/10.3201/eid2607.191016.

Medscape CME Activity
Rickettsioses as Major Etiologies of Unrecognized Acute Febrile Illness, Sabah, East Malaysia [PDF - 2.09 MB - 11 pages]
M. J. Grigg et al.

Orientia tsutsugamushi, spotted fever group rickettsioses, and typhus group rickettsioses (TGR) are reemerging causes of acute febrile illness (AFI) in Southeast Asia. To further delineate extent, we enrolled patients >4 weeks of age with nonmalarial AFI in Sabah, Malaysia, during 2013–2015. We confirmed rickettsioses (past or acute, IgG titer >160) in 126/354 (36%) patients. We confirmed acute rickettsioses (paired 4-fold IgG titer rise to >160) in 38/145 (26%) patients: 23 O. tsutsugamushi, 9 spotted fever group, 4 TGR, 1 O. tsutsugamushi/spotted fever group, and 1 O. tsutsugamushi/TGR. PCR results were positive in 11/319 (3%) patients. Confirmed rickettsioses were more common in male adults; agricultural/plantation work and recent forest exposure were risk factors. Dizziness and acute hearing loss but not eschars were reported more often with acute rickettsioses. Only 2 patients were treated with doxycycline. Acute rickettsioses are common (>26%), underrecognized, and untreated etiologies of AFI in East Malaysia; empirical doxycycline treatment should be considered.

EID Grigg MJ, William T, Clemens EG, Patel K, Chandna A, Wilkes CS, et al. Rickettsioses as Major Etiologies of Unrecognized Acute Febrile Illness, Sabah, East Malaysia. Emerg Infect Dis. 2020;26(7):1409-1419. https://dx.doi.org/10.3201/eid2607.191722
AMA Grigg MJ, William T, Clemens EG, et al. Rickettsioses as Major Etiologies of Unrecognized Acute Febrile Illness, Sabah, East Malaysia. Emerging Infectious Diseases. 2020;26(7):1409-1419. doi:10.3201/eid2607.191722.
APA Grigg, M. J., William, T., Clemens, E. G., Patel, K., Chandna, A., Wilkes, C. S....Reller, M. E. (2020). Rickettsioses as Major Etiologies of Unrecognized Acute Febrile Illness, Sabah, East Malaysia. Emerging Infectious Diseases, 26(7), 1409-1419. https://dx.doi.org/10.3201/eid2607.191722.

Meningococcal W135 Disease Vaccination Intent, the Netherlands, 2018–2019 [PDF - 1.48 MB - 10 pages]
M. de Vries et al.

To control the rise in Neisseria meningitidis strain W infections, during 2018–2019, the Netherlands launched a catch-up meningococcal conjugate (MenACWY) vaccination campaign for teenagers (13–18 years of age). Applying a mental models approach, we surveyed teenagers and their parents about their knowledge and beliefs about meningococcal disease, the MenACWY vaccination, vaccinations in general, and their MenACWY vaccination intentions. Using random forest analysis, we studied predictions of vaccination intentions by knowledge and beliefs. Survey response rate was 52.8% among teenagers and 59.4% among parents. MenACWY vaccination intentions were best predicted by knowledge and beliefs about vaccinations in general, surpassing knowledge and beliefs about meningococcal disease and the MenACWY vaccination. For teenagers, their parents’ intention that the teenager be vaccinated was a strong predictor of the teenagers’ own vaccination intention. To optimize vaccination uptake during future outbreaks, we recommend that communications emphasize the effectiveness and safety of vaccines and continue to focus on parents.

EID de Vries M, Claassen L, te Wierik M, Coban F, Wong A, Timmermans D, et al. Meningococcal W135 Disease Vaccination Intent, the Netherlands, 2018–2019. Emerg Infect Dis. 2020;26(7):1420-1429. https://dx.doi.org/10.3201/eid2607.191812
AMA de Vries M, Claassen L, te Wierik M, et al. Meningococcal W135 Disease Vaccination Intent, the Netherlands, 2018–2019. Emerging Infectious Diseases. 2020;26(7):1420-1429. doi:10.3201/eid2607.191812.
APA de Vries, M., Claassen, L., te Wierik, M., Coban, F., Wong, A., Timmermans, D....Timen, A. (2020). Meningococcal W135 Disease Vaccination Intent, the Netherlands, 2018–2019. Emerging Infectious Diseases, 26(7), 1420-1429. https://dx.doi.org/10.3201/eid2607.191812.

Risk for Coccidioidomycosis among Hispanic Farm Workers, California, USA, 2018 [PDF - 422 KB - 8 pages]
S. A. McCurdy et al.

To determine occupational risk factors for coccidioidomycosis among adult Hispanic outdoor agricultural workers in California, USA, we conducted a case–control study of workers seen at the Kern County medical facility and referred to the public health laboratory for coccidioidomycosis serologic testing. Participants completed an interviewer-administered health and work questionnaire. Among 203 participants (110 case-patients with positive and 93 controls with negative serologic results), approximately half were women, and more than three quarters were born in Mexico. Associated with coccidioidomycosis were self-reported dust exposure and work with root and bulb vegetable crops. A protective factor was leaf removal, an activity associated with grape cultivation. We conclude that subjective dust exposure and work with root and bulb vegetable crops are associated with increased risk for coccidioidomycosis among Hispanic farm workers. The agricultural industry should evaluate and promote dust-reduction measures, including wetting soil and freshly harvested products.

EID McCurdy SA, Portillo-Silva C, Sipan CL, Bang H, Emery KW. Risk for Coccidioidomycosis among Hispanic Farm Workers, California, USA, 2018. Emerg Infect Dis. 2020;26(7):1430-1437. https://dx.doi.org/10.3201/eid2607.200024
AMA McCurdy SA, Portillo-Silva C, Sipan CL, et al. Risk for Coccidioidomycosis among Hispanic Farm Workers, California, USA, 2018. Emerging Infectious Diseases. 2020;26(7):1430-1437. doi:10.3201/eid2607.200024.
APA McCurdy, S. A., Portillo-Silva, C., Sipan, C. L., Bang, H., & Emery, K. W. (2020). Risk for Coccidioidomycosis among Hispanic Farm Workers, California, USA, 2018. Emerging Infectious Diseases, 26(7), 1430-1437. https://dx.doi.org/10.3201/eid2607.200024.

Medscape CME Activity
Atypical Manifestations of Cat-Scratch Disease, United States, 2005–2014 [PDF - 1.37 MB - 9 pages]
C. C. Nawrocki et al.

Atypical manifestations that can be severe and difficult to diagnosis develop in 5%–20% of patients with cat-scratch disease. To clarify the epidemiology of atypical cat-scratch disease in the United States, we analyzed data from the 2005–2014 MarketScan national health insurance claims databases by using the International Classification of Diseases, 9th Revision, Clinical Modification, codes for cat-scratch disease and selected atypical manifestations: retinitis/neuroretinitis, conjunctivitis, neuritis, encephalitis, hepatosplenic disease, osteomyelitis, erythema nodosum, and endocarditis. Atypical cat-scratch disease accounted for 1.5% of all cases, resulting in an average annual incidence of 0.7 cases/100,000 population. Atypical cat-scratch disease was associated with increased risk for hospitalization (risk ratios 8.77, 95% CI 6.56–11.72) and occurred most often in female patients 10–14 years of age. Ocular (48.7%), hepatosplenic (24.6%), and neurologic (13.8%) manifestations were most common among patients. A more comprehensive understanding of atypical cat-scratch disease can improve patient diagnosis and potentially elucidate pathophysiology of the disease.

EID Nawrocki CC, Max RJ, Marzec NS, Nelson CA. Atypical Manifestations of Cat-Scratch Disease, United States, 2005–2014. Emerg Infect Dis. 2020;26(7):1438-1446. https://dx.doi.org/10.3201/eid2607.200034
AMA Nawrocki CC, Max RJ, Marzec NS, et al. Atypical Manifestations of Cat-Scratch Disease, United States, 2005–2014. Emerging Infectious Diseases. 2020;26(7):1438-1446. doi:10.3201/eid2607.200034.
APA Nawrocki, C. C., Max, R. J., Marzec, N. S., & Nelson, C. A. (2020). Atypical Manifestations of Cat-Scratch Disease, United States, 2005–2014. Emerging Infectious Diseases, 26(7), 1438-1446. https://dx.doi.org/10.3201/eid2607.200034.

Paradoxal Trends in Azole-Resistant Aspergillus fumigatus in a National Multicenter Surveillance Program, the Netherlands, 2013–2018 [PDF - 1.17 MB - 9 pages]
P. Lestrade et al.

We investigated the prevalence of azole resistance of Aspergillus fumigatus isolates in the Netherlands by screening clinical A. fumigatus isolates for azole resistance during 2013–2018. We analyzed azole-resistant isolates phenotypically by in vitro susceptibility testing and for the presence of resistance mutations in the Cyp51A gene. Over the 6-year period, 508 (11%) of 4,496 culture-positive patients harbored an azole-resistant isolate. Resistance frequency increased from 7.6% (95% CI 5.9%–9.8%) in 2013 (58/760 patients) to 14.7% (95% CI 12.3%–17.4%) in 2018 (112/764 patients) (p = 0.0001). TR34/L98H (69%) and TR46/Y121F/T289A (17%) accounted for 86% of Cyp51A mutations. However, the mean voriconazole MIC of TR34/L98H isolates decreased from 8 mg/L (2013) to 2 mg/L (2018), and the voriconazole-resistance frequency was 34% lower in 2018 than in 2013 (p = 0.0001). Our survey showed changing azole phenotypes in TR34/L98H isolates, which hampers the use of current PCR-based resistance tests.

EID Lestrade P, Buil JB, van der Beek MT, Kuijper EJ, van Dijk K, Kampinga GA, et al. Paradoxal Trends in Azole-Resistant Aspergillus fumigatus in a National Multicenter Surveillance Program, the Netherlands, 2013–2018. Emerg Infect Dis. 2020;26(7):1447-1455. https://dx.doi.org/10.3201/eid2607.200088
AMA Lestrade P, Buil JB, van der Beek MT, et al. Paradoxal Trends in Azole-Resistant Aspergillus fumigatus in a National Multicenter Surveillance Program, the Netherlands, 2013–2018. Emerging Infectious Diseases. 2020;26(7):1447-1455. doi:10.3201/eid2607.200088.
APA Lestrade, P., Buil, J. B., van der Beek, M. T., Kuijper, E. J., van Dijk, K., Kampinga, G. A....Verweij, P. E. (2020). Paradoxal Trends in Azole-Resistant Aspergillus fumigatus in a National Multicenter Surveillance Program, the Netherlands, 2013–2018. Emerging Infectious Diseases, 26(7), 1447-1455. https://dx.doi.org/10.3201/eid2607.200088.

Large Nationwide Outbreak of Invasive Listeriosis Associated with Blood Sausage, Germany, 2018–2019 [PDF - 2.11 MB - 9 pages]
S. Halbedel et al.

Invasive listeriosis is a severe foodborne infection in humans and is difficult to control. Listeriosis incidence is increasing worldwide, but some countries have implemented molecular surveillance programs to improve recognition and management of listeriosis outbreaks. In Germany, routine whole-genome sequencing, core genome multilocus sequence typing, and single nucleotide polymorphism calling are used for subtyping of Listeria monocytogenes isolates from listeriosis cases and suspected foods. During 2018–2019, an unusually large cluster of L. monocytogenes isolates was identified, including 134 highly clonal, benzalkonium-resistant sequence type 6 isolates collected from 112 notified listeriosis cases. The outbreak was one of the largest reported in Europe during the past 25 years. Epidemiologic investigations identified blood sausage contaminated with L. monocytogenes highly related to clinical isolates; withdrawal of the product from the market ended the outbreak. We describe how epidemiologic investigations and complementary molecular typing of food isolates helped identify the outbreak vehicle.

EID Halbedel S, Wilking H, Holzer A, Kleta S, Fischer MA, Lüth S, et al. Large Nationwide Outbreak of Invasive Listeriosis Associated with Blood Sausage, Germany, 2018–2019. Emerg Infect Dis. 2020;26(7):1456-1464. https://dx.doi.org/10.3201/eid2607.200225
AMA Halbedel S, Wilking H, Holzer A, et al. Large Nationwide Outbreak of Invasive Listeriosis Associated with Blood Sausage, Germany, 2018–2019. Emerging Infectious Diseases. 2020;26(7):1456-1464. doi:10.3201/eid2607.200225.
APA Halbedel, S., Wilking, H., Holzer, A., Kleta, S., Fischer, M. A., Lüth, S....Flieger, A. (2020). Large Nationwide Outbreak of Invasive Listeriosis Associated with Blood Sausage, Germany, 2018–2019. Emerging Infectious Diseases, 26(7), 1456-1464. https://dx.doi.org/10.3201/eid2607.200225.

Identifying Locations with Possible Undetected Imported Severe Acute Respiratory Syndrome Coronavirus 2 Cases by Using Importation Predictions [PDF - 1.62 MB - 5 pages]
P. De Salazar et al.

Cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection exported from mainland China could lead to self-sustained outbreaks in other countries. By February 2020, several countries were reporting imported SARS-CoV-2 cases. To contain the virus, early detection of imported SARS-CoV-2 cases is critical. We used air travel volume estimates from Wuhan, China, to international destinations and a generalized linear regression model to identify locations that could have undetected imported cases. Our model can be adjusted to account for exportation of cases from other locations as the virus spreads and more information on importations and transmission becomes available. Early detection and appropriate control measures can reduce the risk for transmission in all locations.

EID De Salazar P, Niehus R, Taylor A, Buckee C, Lipsitch M. Identifying Locations with Possible Undetected Imported Severe Acute Respiratory Syndrome Coronavirus 2 Cases by Using Importation Predictions. Emerg Infect Dis. 2020;26(7):1465-1469. https://dx.doi.org/10.3201/eid2607.200250
AMA De Salazar P, Niehus R, Taylor A, et al. Identifying Locations with Possible Undetected Imported Severe Acute Respiratory Syndrome Coronavirus 2 Cases by Using Importation Predictions. Emerging Infectious Diseases. 2020;26(7):1465-1469. doi:10.3201/eid2607.200250.
APA De Salazar, P., Niehus, R., Taylor, A., Buckee, C., & Lipsitch, M. (2020). Identifying Locations with Possible Undetected Imported Severe Acute Respiratory Syndrome Coronavirus 2 Cases by Using Importation Predictions. Emerging Infectious Diseases, 26(7), 1465-1469. https://dx.doi.org/10.3201/eid2607.200250.

High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2 [PDF - 2.08 MB - 8 pages]
S. Sanche et al.

Severe acute respiratory syndrome coronavirus 2 is the causative agent of the ongoing coronavirus disease pandemic. Initial estimates of the early dynamics of the outbreak in Wuhan, China, suggested a doubling time of the number of infected persons of 6–7 days and a basic reproductive number (R0) of 2.2–2.7. We collected extensive individual case reports across China and estimated key epidemiologic parameters, including the incubation period (4.2 days). We then designed 2 mathematical modeling approaches to infer the outbreak dynamics in Wuhan by using high-resolution domestic travel and infection data. Results show that the doubling time early in the epidemic in Wuhan was 2.3–3.3 days. Assuming a serial interval of 6–9 days, we calculated a median R0 value of 5.7 (95% CI 3.8–8.9). We further show that active surveillance, contact tracing, quarantine, and early strong social distancing efforts are needed to stop transmission of the virus.

EID Sanche S, Lin Y, Xu C, Romero-Severson E, Hengartner N, Ke R. High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis. 2020;26(7):1470-1477. https://dx.doi.org/10.3201/eid2607.200282
AMA Sanche S, Lin Y, Xu C, et al. High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases. 2020;26(7):1470-1477. doi:10.3201/eid2607.200282.
APA Sanche, S., Lin, Y., Xu, C., Romero-Severson, E., Hengartner, N., & Ke, R. (2020). High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases, 26(7), 1470-1477. https://dx.doi.org/10.3201/eid2607.200282.

Severe Acute Respiratory Syndrome Coronavirus 2−Specific Antibody Responses in Coronavirus Disease Patients [PDF - 3.14 MB - 11 pages]
N. Okba et al.

A new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has recently emerged to cause a human pandemic. Although molecular diagnostic tests were rapidly developed, serologic assays are still lacking, yet urgently needed. Validated serologic assays are needed for contact tracing, identifying the viral reservoir, and epidemiologic studies. We developed serologic assays for detection of SARS-CoV-2 neutralizing, spike protein–specific, and nucleocapsid-specific antibodies. Using serum samples from patients with PCR-confirmed SARS-CoV-2 infections, other coronaviruses, or other respiratory pathogenic infections, we validated and tested various antigens in different in-house and commercial ELISAs. We demonstrated that most PCR-confirmed SARS-CoV-2–infected persons seroconverted by 2 weeks after disease onset. We found that commercial S1 IgG or IgA ELISAs were of lower specificity, and sensitivity varied between the 2 assays; the IgA ELISA showed higher sensitivity. Overall, the validated assays described can be instrumental for detection of SARS-CoV-2–specific antibodies for diagnostic, seroepidemiologic, and vaccine evaluation studies.

EID Okba N, Müller MA, Li W, Wang C, GeurtsvanKessel CH, Corman VM, et al. Severe Acute Respiratory Syndrome Coronavirus 2−Specific Antibody Responses in Coronavirus Disease Patients. Emerg Infect Dis. 2020;26(7):1478-1488. https://dx.doi.org/10.3201/eid2607.200841
AMA Okba N, Müller MA, Li W, et al. Severe Acute Respiratory Syndrome Coronavirus 2−Specific Antibody Responses in Coronavirus Disease Patients. Emerging Infectious Diseases. 2020;26(7):1478-1488. doi:10.3201/eid2607.200841.
APA Okba, N., Müller, M. A., Li, W., Wang, C., GeurtsvanKessel, C. H., Corman, V. M....Haagmans, B. L. (2020). Severe Acute Respiratory Syndrome Coronavirus 2−Specific Antibody Responses in Coronavirus Disease Patients. Emerging Infectious Diseases, 26(7), 1478-1488. https://dx.doi.org/10.3201/eid2607.200841.

Burden and Cost of Hospitalization for Respiratory Syncytial Virus in Young Children, Singapore [PDF - 1.30 MB - 8 pages]
C. C. Tam et al.

Respiratory syncytial virus (RSV) is the most common cause of pediatric acute lower respiratory tract infection worldwide. Detailed data on the health and economic burden of RSV disease are lacking from tropical settings with year-round RSV transmission. We developed a statistical and economic model to estimate the annual incidence and healthcare cost of medically attended RSV disease among young children in Singapore, using Monte Carlo simulation to account for uncertainty in model parameters. RSV accounted for 708 hospitalizations in children <6 months of age (33.5/1,000 child-years) and 1,096 in children 6–29 months of age (13.2/1,000 child-years). The cost of hospitalization was SGD 5.7 million (US $4.3 million) at 2014 prices; patients bore 60% of the cost. RSV-associated disease burden in tropical settings in Asia is high and comparable to other settings. Further work incorporating efficacy data from ongoing vaccine trials will help to determine the potential cost-effectiveness of different vaccination strategies.

EID Tam CC, Yeo K, Tee N, Lin R, Mak T, Thoon K, et al. Burden and Cost of Hospitalization for Respiratory Syncytial Virus in Young Children, Singapore. Emerg Infect Dis. 2020;26(7):1489-1496. https://dx.doi.org/10.3201/eid2607.190539
AMA Tam CC, Yeo K, Tee N, et al. Burden and Cost of Hospitalization for Respiratory Syncytial Virus in Young Children, Singapore. Emerging Infectious Diseases. 2020;26(7):1489-1496. doi:10.3201/eid2607.190539.
APA Tam, C. C., Yeo, K., Tee, N., Lin, R., Mak, T., Thoon, K....Yung, C. (2020). Burden and Cost of Hospitalization for Respiratory Syncytial Virus in Young Children, Singapore. Emerging Infectious Diseases, 26(7), 1489-1496. https://dx.doi.org/10.3201/eid2607.190539.

Human Adenovirus Type 55 Distribution, Regional Persistence, and Genetic Variability [PDF - 1.34 MB - 9 pages]
J. Hang et al.

Human adenovirus type 55 (HAdV-55) causes acute respiratory disease of variable severity and has become an emergent threat in both civilian and military populations. HAdV-55 infection is endemic to China and South Korea, but data from other regions and time periods are needed for comprehensive assessment of HAdV-55 prevalence from a global perspective. In this study, we subjected HAdV-55 isolates from various countries collected during 1969–2018 to whole-genome sequencing, genomic and proteomic comparison, and phylogenetic analyses. The results show worldwide distribution of HAdV-55; recent strains share a high degree of genomic homogeneity. Distinct strains circulated regionally for several years, suggesting persistent local transmission. Several cases of sporadic introduction of certain strains to other countries were documented. Among the identified amino acid mutations distinguishing HAdV-55 strains, some have potential impact on essential viral functions and may affect infectivity and transmission.

EID Hang J, Kajon AE, Graf P, Berry I, Yang Y, Sanborn MA, et al. Human Adenovirus Type 55 Distribution, Regional Persistence, and Genetic Variability. Emerg Infect Dis. 2020;26(7):1497-1505. https://dx.doi.org/10.3201/eid2607.191707
AMA Hang J, Kajon AE, Graf P, et al. Human Adenovirus Type 55 Distribution, Regional Persistence, and Genetic Variability. Emerging Infectious Diseases. 2020;26(7):1497-1505. doi:10.3201/eid2607.191707.
APA Hang, J., Kajon, A. E., Graf, P., Berry, I., Yang, Y., Sanborn, M. A....Collins, N. D. (2020). Human Adenovirus Type 55 Distribution, Regional Persistence, and Genetic Variability. Emerging Infectious Diseases, 26(7), 1497-1505. https://dx.doi.org/10.3201/eid2607.191707.
Policy Review

Policy Decisions and Use of Information Technology to Fight COVID-19, Taiwan [PDF - 1.87 MB - 7 pages]
C. Lin et al.

Because of its proximity to and frequent travelers to and from China, Taiwan faces complex challenges in preventing coronavirus disease (COVID-19). As soon as China reported the unidentified outbreak to the World Health Organization on December 31, 2019, Taiwan assembled a taskforce and began health checks onboard flights from Wuhan. Taiwan’s rapid implementation of disease prevention measures helped detect and isolate the country’s first COVID-19 case on January 20, 2020. Laboratories in Taiwan developed 4-hour test kits and isolated 2 strains of the coronavirus before February. Taiwan effectively delayed and contained community transmission by leveraging experience from the 2003 severe acute respiratory syndrome outbreak, prevalent public awareness, a robust public health network, support from healthcare industries, cross-departmental collaborations, and advanced information technology capacity. We analyze use of the National Health Insurance database and critical policy decisions made by Taiwan’s government during the first 50 days of the COVID-19 outbreak.

EID Lin C, Braund WE, Auerbach J, Chou J, Teng J, Tu P, et al. Policy Decisions and Use of Information Technology to Fight COVID-19, Taiwan. Emerg Infect Dis. 2020;26(7):1506-1512. https://dx.doi.org/10.3201/eid2607.200574
AMA Lin C, Braund WE, Auerbach J, et al. Policy Decisions and Use of Information Technology to Fight COVID-19, Taiwan. Emerging Infectious Diseases. 2020;26(7):1506-1512. doi:10.3201/eid2607.200574.
APA Lin, C., Braund, W. E., Auerbach, J., Chou, J., Teng, J., Tu, P....Mullen, J. (2020). Policy Decisions and Use of Information Technology to Fight COVID-19, Taiwan. Emerging Infectious Diseases, 26(7), 1506-1512. https://dx.doi.org/10.3201/eid2607.200574.
Dispatches

Serologic Evidence of Severe Fever with Thrombocytopenia Syndrome Virus and Related Viruses in Pakistan [PDF - 591 KB - 4 pages]
A. Zohaib et al.

We describe the seroprevalence of severe fever with thrombocytopenia syndrome virus (SFTSV) and the association of antibody occurrence with location, sex, and age among the human population in Pakistan. Our results indicate substantial activity of SFTSV and SFTSV-related viruses in this country.

EID Zohaib A, Zhang J, Saqib M, Athar M, Hussain M, Chen J, et al. Serologic Evidence of Severe Fever with Thrombocytopenia Syndrome Virus and Related Viruses in Pakistan. Emerg Infect Dis. 2020;26(7):1513-1516. https://dx.doi.org/10.3201/eid2607.190611
AMA Zohaib A, Zhang J, Saqib M, et al. Serologic Evidence of Severe Fever with Thrombocytopenia Syndrome Virus and Related Viruses in Pakistan. Emerging Infectious Diseases. 2020;26(7):1513-1516. doi:10.3201/eid2607.190611.
APA Zohaib, A., Zhang, J., Saqib, M., Athar, M., Hussain, M., Chen, J....Shen, S. (2020). Serologic Evidence of Severe Fever with Thrombocytopenia Syndrome Virus and Related Viruses in Pakistan. Emerging Infectious Diseases, 26(7), 1513-1516. https://dx.doi.org/10.3201/eid2607.190611.

Survey of Parental Use of Antimicrobial Drugs for Common Childhood Infections, China [PDF - 1.07 MB - 4 pages]
L. Lin et al.

In a large-scale survey of 9,526 parents in China, we investigated antimicrobial drug use for common childhood infections. Of children with self-limiting conditions, formal care was sought for 69.2%; of those, 53.4% received drug prescriptions, including 11.2% from parental demands. Where drugs were taken without prescriptions, 70% were from community pharmacies.

EID Lin L, Harbarth S, Wang X, Zhou X. Survey of Parental Use of Antimicrobial Drugs for Common Childhood Infections, China. Emerg Infect Dis. 2020;26(7):1517-1520. https://dx.doi.org/10.3201/eid2607.190631
AMA Lin L, Harbarth S, Wang X, et al. Survey of Parental Use of Antimicrobial Drugs for Common Childhood Infections, China. Emerging Infectious Diseases. 2020;26(7):1517-1520. doi:10.3201/eid2607.190631.
APA Lin, L., Harbarth, S., Wang, X., & Zhou, X. (2020). Survey of Parental Use of Antimicrobial Drugs for Common Childhood Infections, China. Emerging Infectious Diseases, 26(7), 1517-1520. https://dx.doi.org/10.3201/eid2607.190631.

Shuni Virus in Wildlife and Nonequine Domestic Animals, South Africa [PDF - 1.31 MB - 5 pages]
J. Steyn et al.

We screened nonequine animals with unexplained neurologic signs or death in South Africa during 2010–2018 for Shuni virus (SHUV). SHUV was detected in 3.3% of wildlife, 1.1% of domestic, and 2.0% of avian species. Seropositivity was also demonstrated in wildlife. These results suggest a range of possible SHUV hosts in Africa.

EID Steyn J, Motlou P, van Eeden C, Pretorius M, Stivaktas VI, Williams J, et al. Shuni Virus in Wildlife and Nonequine Domestic Animals, South Africa. Emerg Infect Dis. 2020;26(7):1521-1525. https://dx.doi.org/10.3201/eid2607.190770
AMA Steyn J, Motlou P, van Eeden C, et al. Shuni Virus in Wildlife and Nonequine Domestic Animals, South Africa. Emerging Infectious Diseases. 2020;26(7):1521-1525. doi:10.3201/eid2607.190770.
APA Steyn, J., Motlou, P., van Eeden, C., Pretorius, M., Stivaktas, V. I., Williams, J....Venter, M. (2020). Shuni Virus in Wildlife and Nonequine Domestic Animals, South Africa. Emerging Infectious Diseases, 26(7), 1521-1525. https://dx.doi.org/10.3201/eid2607.190770.

Transmission of Legionnaires’ Disease through Toilet Flushing [PDF - 900 KB - 3 pages]
J. Couturier et al.

We describe 2 cases of healthcare-associated Legionnaires’ disease in patients in France hospitalized 5 months apart in the same room. Whole-genome sequencing analyses showed that clinical isolates from the patients and isolates from the room’s toilet clustered together. Toilet contamination by Legionella pneumophila could lead to a risk for exposure through flushing.

EID Couturier J, Ginevra C, Nesa D, Adam M, Gouot C, Descours G, et al. Transmission of Legionnaires’ Disease through Toilet Flushing. Emerg Infect Dis. 2020;26(7):1526-1528. https://dx.doi.org/10.3201/eid2607.190941
AMA Couturier J, Ginevra C, Nesa D, et al. Transmission of Legionnaires’ Disease through Toilet Flushing. Emerging Infectious Diseases. 2020;26(7):1526-1528. doi:10.3201/eid2607.190941.
APA Couturier, J., Ginevra, C., Nesa, D., Adam, M., Gouot, C., Descours, G....Barbut, F. (2020). Transmission of Legionnaires’ Disease through Toilet Flushing. Emerging Infectious Diseases, 26(7), 1526-1528. https://dx.doi.org/10.3201/eid2607.190941.

Carbapenem Resistance Conferred by OXA-48 in K2-ST86 Hypervirulent Klebsiella pneumoniae, France [PDF - 1.53 MB - 5 pages]
R. Beyrouthy et al.

We recovered 2 carbapenem-resistant K2-ST86 hypermucoviscous Klebsiella pneumoniae isolates from patients in France. The isolates had genetic attributes of hypervirulent K. pneumoniae but differed in ability to cause mouse lethality. Convergence of hypervirulent K. pneumoniae toward resistance could cause a health crisis because such strains could be responsible for severe and untreatable infections.

EID Beyrouthy R, Dalmasso G, Birer A, Robin F, Bonnet R. Carbapenem Resistance Conferred by OXA-48 in K2-ST86 Hypervirulent Klebsiella pneumoniae, France. Emerg Infect Dis. 2020;26(7):1529-1533. https://dx.doi.org/10.3201/eid2607.191490
AMA Beyrouthy R, Dalmasso G, Birer A, et al. Carbapenem Resistance Conferred by OXA-48 in K2-ST86 Hypervirulent Klebsiella pneumoniae, France. Emerging Infectious Diseases. 2020;26(7):1529-1533. doi:10.3201/eid2607.191490.
APA Beyrouthy, R., Dalmasso, G., Birer, A., Robin, F., & Bonnet, R. (2020). Carbapenem Resistance Conferred by OXA-48 in K2-ST86 Hypervirulent Klebsiella pneumoniae, France. Emerging Infectious Diseases, 26(7), 1529-1533. https://dx.doi.org/10.3201/eid2607.191490.

Laboratory-Acquired Dengue Virus Infection, United States, 2018 [PDF - 1.00 MB - 4 pages]
T. M. Sharp et al.

Investigation of a dengue case in a laboratory worker in North Carolina, USA, revealed that the case-patient prepared high-titer dengue virus stocks soon before illness onset. Improper doffing of gloves with an open finger wound likely resulted in cutaneous exposure. This case reinforces recommendations for enhanced precautions when working with high-titer dengue virus.

EID Sharp TM, Fisher TG, Long K, Coulson G, Medina FA, Herzig C, et al. Laboratory-Acquired Dengue Virus Infection, United States, 2018. Emerg Infect Dis. 2020;26(7):1534-1537. https://dx.doi.org/10.3201/eid2607.191598
AMA Sharp TM, Fisher TG, Long K, et al. Laboratory-Acquired Dengue Virus Infection, United States, 2018. Emerging Infectious Diseases. 2020;26(7):1534-1537. doi:10.3201/eid2607.191598.
APA Sharp, T. M., Fisher, T. G., Long, K., Coulson, G., Medina, F. A., Herzig, C....Williams, C. (2020). Laboratory-Acquired Dengue Virus Infection, United States, 2018. Emerging Infectious Diseases, 26(7), 1534-1537. https://dx.doi.org/10.3201/eid2607.191598.

Linking Epidemiology and Whole-Genome Sequencing to Investigate Salmonella Outbreak, Massachusetts, USA, 2018 [PDF - 1.70 MB - 4 pages]
E. L. Vaughn et al.

Cross-discipline collaboration among state and local health departments improved foodborne illness surveillance for a 2018 Salmonella enterica serovar Enteritidis outbreak in Massachusetts, USA. Prompt linking of epidemiologic and laboratory data and implementation of in-state whole-genome sequencing and analysis improved public health surveillance capacity for outbreak detection and control.

EID Vaughn EL, Vo QT, Vostok J, Stiles T, Lang A, Brown CM, et al. Linking Epidemiology and Whole-Genome Sequencing to Investigate Salmonella Outbreak, Massachusetts, USA, 2018. Emerg Infect Dis. 2020;26(7):1538-1541. https://dx.doi.org/10.3201/eid2607.200048
AMA Vaughn EL, Vo QT, Vostok J, et al. Linking Epidemiology and Whole-Genome Sequencing to Investigate Salmonella Outbreak, Massachusetts, USA, 2018. Emerging Infectious Diseases. 2020;26(7):1538-1541. doi:10.3201/eid2607.200048.
APA Vaughn, E. L., Vo, Q. T., Vostok, J., Stiles, T., Lang, A., Brown, C. M....Madoff, L. (2020). Linking Epidemiology and Whole-Genome Sequencing to Investigate Salmonella Outbreak, Massachusetts, USA, 2018. Emerging Infectious Diseases, 26(7), 1538-1541. https://dx.doi.org/10.3201/eid2607.200048.

Possible Bat Origin of Severe Acute Respiratory Syndrome Coronavirus 2 [PDF - 3.33 MB - 6 pages]
S. Lau et al.

We showed that severe acute respiratory syndrome coronavirus 2 is probably a novel recombinant virus. Its genome is closest to that of severe acute respiratory syndrome–related coronaviruses from horseshoe bats, and its receptor-binding domain is closest to that of pangolin viruses. Its origin and direct ancestral viruses have not been identified.

EID Lau S, Luk H, Wong A, Li K, Zhu L, He Z, et al. Possible Bat Origin of Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis. 2020;26(7):1542-1547. https://dx.doi.org/10.3201/eid2607.200092
AMA Lau S, Luk H, Wong A, et al. Possible Bat Origin of Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases. 2020;26(7):1542-1547. doi:10.3201/eid2607.200092.
APA Lau, S., Luk, H., Wong, A., Li, K., Zhu, L., He, Z....Woo, P. (2020). Possible Bat Origin of Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases, 26(7), 1542-1547. https://dx.doi.org/10.3201/eid2607.200092.

Heartland Virus in Humans and Ticks, Illinois, USA, 2018–2019 [PDF - 2.14 MB - 5 pages]
H. C. Tuten et al.

In 2018, Heartland disease virus infected 2 persons in Illinois, USA. In 2019, ticks were collected at potential tick bite exposure locations and tested for Heartland and Bourbon viruses. A Heartland virus–positive pool of adult male Amblyomma americanum ticks was found at 2 locations, 439 km apart, suggesting widespread distribution in Illinois.

EID Tuten HC, Burkhalter KL, Noel KR, Hernandez EJ, Yates S, Wojnowski K, et al. Heartland Virus in Humans and Ticks, Illinois, USA, 2018–2019. Emerg Infect Dis. 2020;26(7):1548-1552. https://dx.doi.org/10.3201/eid2607.200110
AMA Tuten HC, Burkhalter KL, Noel KR, et al. Heartland Virus in Humans and Ticks, Illinois, USA, 2018–2019. Emerging Infectious Diseases. 2020;26(7):1548-1552. doi:10.3201/eid2607.200110.
APA Tuten, H. C., Burkhalter, K. L., Noel, K. R., Hernandez, E. J., Yates, S., Wojnowski, K....Stone, C. M. (2020). Heartland Virus in Humans and Ticks, Illinois, USA, 2018–2019. Emerging Infectious Diseases, 26(7), 1548-1552. https://dx.doi.org/10.3201/eid2607.200110.

Approach to Cataract Surgery in an Ebola Virus Disease Survivor with Prior Ocular Viral Persistence [PDF - 2.33 MB - 4 pages]
J. R. Wells et al.

A 46-year-old patient with previously documented Ebola virus persistence in his ocular fluid, associated with severe panuveitis, developed a visually significant cataract. A multidisciplinary approach was taken to prevent and control infection. Ebola virus persistence was assessed before and during the operation to provide safe, vision-restorative phacoemulsification surgery.

EID Wells JR, Crozier I, Kraft CS, Sexton M, Hill CE, Ribner BS, et al. Approach to Cataract Surgery in an Ebola Virus Disease Survivor with Prior Ocular Viral Persistence. Emerg Infect Dis. 2020;26(7):1553-1556. https://dx.doi.org/10.3201/eid2607.191559
AMA Wells JR, Crozier I, Kraft CS, et al. Approach to Cataract Surgery in an Ebola Virus Disease Survivor with Prior Ocular Viral Persistence. Emerging Infectious Diseases. 2020;26(7):1553-1556. doi:10.3201/eid2607.191559.
APA Wells, J. R., Crozier, I., Kraft, C. S., Sexton, M., Hill, C. E., Ribner, B. S....Yeh, S. (2020). Approach to Cataract Surgery in an Ebola Virus Disease Survivor with Prior Ocular Viral Persistence. Emerging Infectious Diseases, 26(7), 1553-1556. https://dx.doi.org/10.3201/eid2607.191559.

Sub-Saharan Africa and Eurasia Ancestry of Reassortant Highly Pathogenic Avian Influenza A(H5N8) Virus, Europe, December 2019 [PDF - 7.72 MB - 5 pages]
E. Świętoń et al.

We report detection of a highly pathogenic avian influenza A(H5N8) clade 2.3.4.4b virus in Europe. This virus was generated by reassortment between H5N8 subtype virus from sub-Saharan Africa and low pathogenicity avian influenza viruses from Eurasia.

EID Świętoń E, Fusaro A, Shittu I, Niemczuk K, Zecchin B, Joannis T, et al. Sub-Saharan Africa and Eurasia Ancestry of Reassortant Highly Pathogenic Avian Influenza A(H5N8) Virus, Europe, December 2019. Emerg Infect Dis. 2020;26(7):1557-1561. https://dx.doi.org/10.3201/eid2607.200165
AMA Świętoń E, Fusaro A, Shittu I, et al. Sub-Saharan Africa and Eurasia Ancestry of Reassortant Highly Pathogenic Avian Influenza A(H5N8) Virus, Europe, December 2019. Emerging Infectious Diseases. 2020;26(7):1557-1561. doi:10.3201/eid2607.200165.
APA Świętoń, E., Fusaro, A., Shittu, I., Niemczuk, K., Zecchin, B., Joannis, T....Terregino, C. (2020). Sub-Saharan Africa and Eurasia Ancestry of Reassortant Highly Pathogenic Avian Influenza A(H5N8) Virus, Europe, December 2019. Emerging Infectious Diseases, 26(7), 1557-1561. https://dx.doi.org/10.3201/eid2607.200165.

Clinical Management of Argentine Hemorrhagic Fever using Ribavirin and Favipiravir, Belgium, 2020 [PDF - 788 KB - 5 pages]
I. Veliziotis et al.

We report a case of Argentine hemorrhagic fever diagnosed in a woman in Belgium who traveled from a disease-endemic area. Patient management included supportive care and combination therapy with ribavirin and favipiravir. Of 137 potential contacts, including friends, relatives, and healthcare and laboratory workers, none showed development of clinical symptoms of this disease.

EID Veliziotis I, Roman A, Martiny D, Schuldt G, Claus M, Dauby N, et al. Clinical Management of Argentine Hemorrhagic Fever using Ribavirin and Favipiravir, Belgium, 2020. Emerg Infect Dis. 2020;26(7):1562-1566. https://dx.doi.org/10.3201/eid2607.200275
AMA Veliziotis I, Roman A, Martiny D, et al. Clinical Management of Argentine Hemorrhagic Fever using Ribavirin and Favipiravir, Belgium, 2020. Emerging Infectious Diseases. 2020;26(7):1562-1566. doi:10.3201/eid2607.200275.
APA Veliziotis, I., Roman, A., Martiny, D., Schuldt, G., Claus, M., Dauby, N....Gérard, M. (2020). Clinical Management of Argentine Hemorrhagic Fever using Ribavirin and Favipiravir, Belgium, 2020. Emerging Infectious Diseases, 26(7), 1562-1566. https://dx.doi.org/10.3201/eid2607.200275.

Early Introduction of Severe Acute Respiratory Syndrome Coronavirus 2 into Europe [PDF - 1.07 MB - 4 pages]
S. J. Olsen et al.

Early infections with severe acute respiratory syndrome coronavirus 2 in Europe were detected in travelers from Wuhan, China, in January 2020. In 1 tour group, 5 of 30 members were ill; 3 cases were laboratory confirmed. In addition, a healthcare worker was infected. This event documents early importation and subsequent spread of the virus in Europe.

EID Olsen SJ, Chen M, Liu Y, Witschi M, Ardoin A, Calba C, et al. Early Introduction of Severe Acute Respiratory Syndrome Coronavirus 2 into Europe. Emerg Infect Dis. 2020;26(7):1567-1570. https://dx.doi.org/10.3201/eid2607.200359
AMA Olsen SJ, Chen M, Liu Y, et al. Early Introduction of Severe Acute Respiratory Syndrome Coronavirus 2 into Europe. Emerging Infectious Diseases. 2020;26(7):1567-1570. doi:10.3201/eid2607.200359.
APA Olsen, S. J., Chen, M., Liu, Y., Witschi, M., Ardoin, A., Calba, C....Pukkila, J. (2020). Early Introduction of Severe Acute Respiratory Syndrome Coronavirus 2 into Europe. Emerging Infectious Diseases, 26(7), 1567-1570. https://dx.doi.org/10.3201/eid2607.200359.

Surveillance and Testing for Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, March 2016–March 2019 [PDF - 753 KB - 4 pages]
A. Alzahrani et al.

During March 2016–March 2019, a total of 200,936 suspected cases of Middle East respiratory syndrome coronavirus infection were identified in Saudi Arabia; infections were confirmed in 698 cases (0.3% [0.7/100,000 population per year]). Continued surveillance is necessary for early case detection and timely infection control response.

EID Alzahrani A, Kujawski SA, Abedi GR, Tunkar S, Biggs HM, Alghawi N, et al. Surveillance and Testing for Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, March 2016–March 2019. Emerg Infect Dis. 2020;26(7):1571-1574. https://dx.doi.org/10.3201/eid2607.200437
AMA Alzahrani A, Kujawski SA, Abedi GR, et al. Surveillance and Testing for Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, March 2016–March 2019. Emerging Infectious Diseases. 2020;26(7):1571-1574. doi:10.3201/eid2607.200437.
APA Alzahrani, A., Kujawski, S. A., Abedi, G. R., Tunkar, S., Biggs, H. M., Alghawi, N....Watson, J. T. (2020). Surveillance and Testing for Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, March 2016–March 2019. Emerging Infectious Diseases, 26(7), 1571-1574. https://dx.doi.org/10.3201/eid2607.200437.

Community Responses during Early Phase of COVID-19 Epidemic, Hong Kong [PDF - 1.15 MB - 5 pages]
K. Kwok et al.

During the early phase of the coronavirus disease epidemic in Hong Kong, 1,715 survey respondents reported high levels of perceived risk, mild anxiety, and adoption of personal-hygiene, travel-avoidance, and social-distancing measures. Widely adopted individual precautionary measures, coupled with early government actions, might slow transmission early in the outbreak.

EID Kwok K, Li K, Chan H, Yi Y, Tang A, Wei W, et al. Community Responses during Early Phase of COVID-19 Epidemic, Hong Kong. Emerg Infect Dis. 2020;26(7):1575-1579. https://dx.doi.org/10.3201/eid2607.200500
AMA Kwok K, Li K, Chan H, et al. Community Responses during Early Phase of COVID-19 Epidemic, Hong Kong. Emerging Infectious Diseases. 2020;26(7):1575-1579. doi:10.3201/eid2607.200500.
APA Kwok, K., Li, K., Chan, H., Yi, Y., Tang, A., Wei, W....Wong, S. (2020). Community Responses during Early Phase of COVID-19 Epidemic, Hong Kong. Emerging Infectious Diseases, 26(7), 1575-1579. https://dx.doi.org/10.3201/eid2607.200500.

Clinical Characteristics of Patients Hospitalized with Coronavirus Disease, Thailand [PDF - 1.71 MB - 6 pages]
W. A. Pongpirul et al.

Among 11 patients in Thailand infected with severe acute respiratory syndrome coronavirus 2, we detected viral RNA in upper respiratory specimens a median of 14 days after illness onset and 9 days after fever resolution. We identified viral co-infections and an asymptomatic person with detectable virus RNA in serial tests. We describe implications for surveillance.

EID Pongpirul WA, Mott JA, Woodring JV, Uyeki TM, MacArthur JR, Vachiraphan A, et al. Clinical Characteristics of Patients Hospitalized with Coronavirus Disease, Thailand. Emerg Infect Dis. 2020;26(7):1580-1585. https://dx.doi.org/10.3201/eid2607.200598
AMA Pongpirul WA, Mott JA, Woodring JV, et al. Clinical Characteristics of Patients Hospitalized with Coronavirus Disease, Thailand. Emerging Infectious Diseases. 2020;26(7):1580-1585. doi:10.3201/eid2607.200598.
APA Pongpirul, W. A., Mott, J. A., Woodring, J. V., Uyeki, T. M., MacArthur, J. R., Vachiraphan, A....Prasithsirikul, W. (2020). Clinical Characteristics of Patients Hospitalized with Coronavirus Disease, Thailand. Emerging Infectious Diseases, 26(7), 1580-1585. https://dx.doi.org/10.3201/eid2607.200598.

Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Wuhan, China, 2020 [PDF - 1.78 MB - 6 pages]
Z. Guo et al.

To determine distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards in Wuhan, China, we tested air and surface samples. Contamination was greater in intensive care units than general wards. Virus was widely distributed on floors, computer mice, trash cans, and sickbed handrails and was detected in air ≈4 m from patients.

EID Guo Z, Wang Z, Zhang S, Li X, Li L, Li C, et al. Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Wuhan, China, 2020. Emerg Infect Dis. 2020;26(7):1583-1591. https://dx.doi.org/10.3201/eid2607.200885
AMA Guo Z, Wang Z, Zhang S, et al. Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Wuhan, China, 2020. Emerging Infectious Diseases. 2020;26(7):1583-1591. doi:10.3201/eid2607.200885.
APA Guo, Z., Wang, Z., Zhang, S., Li, X., Li, L., Li, C....Chen, W. (2020). Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Wuhan, China, 2020. Emerging Infectious Diseases, 26(7), 1583-1591. https://dx.doi.org/10.3201/eid2607.200885.

Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 by WHO-Recommended Hand Rub Formulations and Alcohols [PDF - 728 KB - 4 pages]
A. Kratzel et al.

Infection control instructions call for use of alcohol-based hand rub solutions to inactivate severe acute respiratory syndrome coronavirus 2. We determined the virucidal activity of World Health Organization–recommended hand rub formulations, at full strength and multiple dilutions, and of the active ingredients. All disinfectants demonstrated efficient virus inactivation.

EID Kratzel A, Todt D, V’kovski P, Steiner S, Gultom M, Thao T, et al. Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 by WHO-Recommended Hand Rub Formulations and Alcohols. Emerg Infect Dis. 2020;26(7):1592-1595. https://dx.doi.org/10.3201/eid2607.200915
AMA Kratzel A, Todt D, V’kovski P, et al. Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 by WHO-Recommended Hand Rub Formulations and Alcohols. Emerging Infectious Diseases. 2020;26(7):1592-1595. doi:10.3201/eid2607.200915.
APA Kratzel, A., Todt, D., V’kovski, P., Steiner, S., Gultom, M., Thao, T....Pfaender, S. (2020). Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 by WHO-Recommended Hand Rub Formulations and Alcohols. Emerging Infectious Diseases, 26(7), 1592-1595. https://dx.doi.org/10.3201/eid2607.200915.

Severe Acute Respiratory Syndrome Coronavirus 2 Infection among Returnees to Japan from Wuhan, China, 2020 [PDF - 1.09 MB - 5 pages]
Y. Arima et al.

In early 2020, Japan repatriated 566 nationals from China. Universal laboratory testing and 14-day monitoring of returnees detected 12 cases of severe acute respiratory syndrome coronavirus 2 infection; initial screening results were negative for 5. Common outcomes were remaining asymptomatic (n = 4) and pneumonia (n = 6). Overall, screening performed poorly.

EID Arima Y, Kutsuna S, Shimada T, Suzuki M, Suzuki T, Kobayashi Y, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Infection among Returnees to Japan from Wuhan, China, 2020. Emerg Infect Dis. 2020;26(7):1596-1600. https://dx.doi.org/10.3201/eid2607.200994
AMA Arima Y, Kutsuna S, Shimada T, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Infection among Returnees to Japan from Wuhan, China, 2020. Emerging Infectious Diseases. 2020;26(7):1596-1600. doi:10.3201/eid2607.200994.
APA Arima, Y., Kutsuna, S., Shimada, T., Suzuki, M., Suzuki, T., Kobayashi, Y....Wakita, T. (2020). Severe Acute Respiratory Syndrome Coronavirus 2 Infection among Returnees to Japan from Wuhan, China, 2020. Emerging Infectious Diseases, 26(7), 1596-1600. https://dx.doi.org/10.3201/eid2607.200994.
Research Letters

Zika Virus Detection with 2013 Serosurvey, Mombasa, Kenya [PDF - 317 KB - 3 pages]
E. Hunsperger et al.

Acute Zika virus (ZIKV) infection has not been confirmed in Kenya. In 2018, we used specimens collected in a 2013 dengue serosurvey study in Mombasa to test for ZIKV IgM. We confirmed specific ZIKV IgM positivity in 5 persons. These results suggest recent ZIKV transmission in the coastal region of Kenya.

EID Hunsperger E, Odhiambo D, Makio A, Alando M, Ochieng M, Omballa V, et al. Zika Virus Detection with 2013 Serosurvey, Mombasa, Kenya. Emerg Infect Dis. 2020;26(7):1603-1605. https://dx.doi.org/10.3201/eid2607.191363
AMA Hunsperger E, Odhiambo D, Makio A, et al. Zika Virus Detection with 2013 Serosurvey, Mombasa, Kenya. Emerging Infectious Diseases. 2020;26(7):1603-1605. doi:10.3201/eid2607.191363.
APA Hunsperger, E., Odhiambo, D., Makio, A., Alando, M., Ochieng, M., Omballa, V....Widdowson, M. (2020). Zika Virus Detection with 2013 Serosurvey, Mombasa, Kenya. Emerging Infectious Diseases, 26(7), 1603-1605. https://dx.doi.org/10.3201/eid2607.191363.

Mycobacterium bovis Pulmonary Tuberculosis after Ritual Sheep Sacrifice in Tunisia [PDF - 622 KB - 3 pages]
J. Saad et al.

A woman in France was diagnosed with pulmonary tuberculosis caused by Mycobacterium bovis after a ritual sheep sacrifice in her home country of Tunisia. This investigation sheds light on ritual sacrifice of sheep as a circumstance in which religious tradition and practices can expose millions of Muslims worldwide to this disease.

EID Saad J, Baron S, Lagier J, Drancourt M, Gautret P. Mycobacterium bovis Pulmonary Tuberculosis after Ritual Sheep Sacrifice in Tunisia. Emerg Infect Dis. 2020;26(7):1605-1607. https://dx.doi.org/10.3201/eid2607.191597
AMA Saad J, Baron S, Lagier J, et al. Mycobacterium bovis Pulmonary Tuberculosis after Ritual Sheep Sacrifice in Tunisia. Emerging Infectious Diseases. 2020;26(7):1605-1607. doi:10.3201/eid2607.191597.
APA Saad, J., Baron, S., Lagier, J., Drancourt, M., & Gautret, P. (2020). Mycobacterium bovis Pulmonary Tuberculosis after Ritual Sheep Sacrifice in Tunisia. Emerging Infectious Diseases, 26(7), 1605-1607. https://dx.doi.org/10.3201/eid2607.191597.

Urogenital Schistosomiasis in Fisherman, Nepal, 2019 [PDF - 3.53 MB - 3 pages]
R. Sah et al.

We report a case of urogenital schistosomiasis in a 34-year-old male patient in Nepal and summarize additional case reports. These cases provide putative evidence for the potential existence of human-pathogenic (most likely zoonotic) schistosome species on the Indian subcontinent.

EID Sah R, Utzinger J, Neumayr A. Urogenital Schistosomiasis in Fisherman, Nepal, 2019. Emerg Infect Dis. 2020;26(7):1607-1609. https://dx.doi.org/10.3201/eid2607.191828
AMA Sah R, Utzinger J, Neumayr A. Urogenital Schistosomiasis in Fisherman, Nepal, 2019. Emerging Infectious Diseases. 2020;26(7):1607-1609. doi:10.3201/eid2607.191828.
APA Sah, R., Utzinger, J., & Neumayr, A. (2020). Urogenital Schistosomiasis in Fisherman, Nepal, 2019. Emerging Infectious Diseases, 26(7), 1607-1609. https://dx.doi.org/10.3201/eid2607.191828.

Detection and Characterization of New Coronavirus in Bottlenose Dolphin, United States, 2019 [PDF - 723 KB - 3 pages]
L. Wang et al.

We characterized novel coronaviruses detected in US bottlenose dolphins (BdCoVs) with diarrhea. These viruses are closely related to the other 2 known cetacean coronaviruses, Hong Kong BdCoV and beluga whale CoV. A deletion in the spike gene and insertions in the membrane gene and untranslated regions were found in US BdCoVs (unrelated to severe acute respiratory syndrome coronavirus 2).

EID Wang L, Maddox C, Terio K, Lanka S, Fredrickson R, Novick B, et al. Detection and Characterization of New Coronavirus in Bottlenose Dolphin, United States, 2019. Emerg Infect Dis. 2020;26(7):1610-1612. https://dx.doi.org/10.3201/eid2607.200093
AMA Wang L, Maddox C, Terio K, et al. Detection and Characterization of New Coronavirus in Bottlenose Dolphin, United States, 2019. Emerging Infectious Diseases. 2020;26(7):1610-1612. doi:10.3201/eid2607.200093.
APA Wang, L., Maddox, C., Terio, K., Lanka, S., Fredrickson, R., Novick, B....Ross, K. (2020). Detection and Characterization of New Coronavirus in Bottlenose Dolphin, United States, 2019. Emerging Infectious Diseases, 26(7), 1610-1612. https://dx.doi.org/10.3201/eid2607.200093.

Human Case of Severe Fever with Thrombocytopenia Syndrome Virus Infection, Taiwan, 2019 [PDF - 317 KB - 3 pages]
S. Peng et al.

We report on a 70-year-old man with fever, leukopenia, thrombocytopenia, vomiting, malaise, dyspnea, and consciousness disturbance who was infected with severe fever with thrombocytopenia syndrome virus in northern Taiwan, 2019. This autochthonous case was confirmed by reverse transcription PCR, virus isolation, and genomic sequencing.

EID Peng S, Yang S, Tang S, Wang T, Hsu T, Su C, et al. Human Case of Severe Fever with Thrombocytopenia Syndrome Virus Infection, Taiwan, 2019. Emerg Infect Dis. 2020;26(7):1612-1614. https://dx.doi.org/10.3201/eid2607.200104
AMA Peng S, Yang S, Tang S, et al. Human Case of Severe Fever with Thrombocytopenia Syndrome Virus Infection, Taiwan, 2019. Emerging Infectious Diseases. 2020;26(7):1612-1614. doi:10.3201/eid2607.200104.
APA Peng, S., Yang, S., Tang, S., Wang, T., Hsu, T., Su, C....Shu, P. (2020). Human Case of Severe Fever with Thrombocytopenia Syndrome Virus Infection, Taiwan, 2019. Emerging Infectious Diseases, 26(7), 1612-1614. https://dx.doi.org/10.3201/eid2607.200104.

Lesions of Mycobacterium avium spp. hominissuis Infection Resembling M. bovis Lesions in a Wild Mule Deer, Canada [PDF - 595 KB - 3 pages]
K. Frayne et al.

We used molecular analyses to confirm Mycobacterium avium spp. hominissuis infection in lung granulomas and pyogranulomas in the tracheobronchial lymph node in a wild mule deer in Banff, Canada. These lesions are similar to those found in M. bovis–infected animals, emphasizing the critical need for disease surveillance in wildlife populations.

EID Frayne K, Chappell BR, Davies JL, Macbeth BJ, Ngeleka M, Rothenburger JL. Lesions of Mycobacterium avium spp. hominissuis Infection Resembling M. bovis Lesions in a Wild Mule Deer, Canada. Emerg Infect Dis. 2020;26(7):1614-1616. https://dx.doi.org/10.3201/eid2607.200187
AMA Frayne K, Chappell BR, Davies JL, et al. Lesions of Mycobacterium avium spp. hominissuis Infection Resembling M. bovis Lesions in a Wild Mule Deer, Canada. Emerging Infectious Diseases. 2020;26(7):1614-1616. doi:10.3201/eid2607.200187.
APA Frayne, K., Chappell, B. R., Davies, J. L., Macbeth, B. J., Ngeleka, M., & Rothenburger, J. L. (2020). Lesions of Mycobacterium avium spp. hominissuis Infection Resembling M. bovis Lesions in a Wild Mule Deer, Canada. Emerging Infectious Diseases, 26(7), 1614-1616. https://dx.doi.org/10.3201/eid2607.200187.

Public Mental Health Crisis during COVID-19 Pandemic, China [PDF - 235 KB - 3 pages]
L. Dong and J. Bouey

The 2019 novel coronavirus disease emerged in China in late 2019–early 2020 and spread rapidly. China has been implementing emergency psychological crisis interventions to reduce the negative psychosocial impact on public mental health, but challenges exist. Public mental health interventions should be formally integrated into public health preparedness and emergency response plans.

EID Dong L, Bouey J. Public Mental Health Crisis during COVID-19 Pandemic, China. Emerg Infect Dis. 2020;26(7):1616-1618. https://dx.doi.org/10.3201/eid2607.200407
AMA Dong L, Bouey J. Public Mental Health Crisis during COVID-19 Pandemic, China. Emerging Infectious Diseases. 2020;26(7):1616-1618. doi:10.3201/eid2607.200407.
APA Dong, L., & Bouey, J. (2020). Public Mental Health Crisis during COVID-19 Pandemic, China. Emerging Infectious Diseases, 26(7), 1616-1618. https://dx.doi.org/10.3201/eid2607.200407.

Rhabdomyolysis as Potential Late Complication Associated with COVID-19 [PDF - 605 KB - 3 pages]
M. Jin and Q. Tong

We describe a patient in Wuhan, China, with severe acute respiratory syndrome coronavirus 2 infection who had progressive pulmonary lesions and rhabdomyolysis with manifestations of lower limb pain and fatigue. Rapid clinical recognition of rhabdomyolysis symptoms in patients with severe acute respiratory syndrome coronavirus 2 infection can be lifesaving.

EID Jin M, Tong Q. Rhabdomyolysis as Potential Late Complication Associated with COVID-19. Emerg Infect Dis. 2020;26(7):1618-1620. https://dx.doi.org/10.3201/eid2607.200445
AMA Jin M, Tong Q. Rhabdomyolysis as Potential Late Complication Associated with COVID-19. Emerging Infectious Diseases. 2020;26(7):1618-1620. doi:10.3201/eid2607.200445.
APA Jin, M., & Tong, Q. (2020). Rhabdomyolysis as Potential Late Complication Associated with COVID-19. Emerging Infectious Diseases, 26(7), 1618-1620. https://dx.doi.org/10.3201/eid2607.200445.

Detection of Influenza A(H3N2) Virus RNA in Donated Blood [PDF - 1.00 MB - 3 pages]
R. dos Santos Bezerra et al.

Influenza A virus infection has rarely been documented to cause viremia. In 28 blood donations in Brazil that were deferred because of postdonation information, we identified influenza A(H3N2) virus RNA in 1 donation using metagenomic analysis. Our finding implies theoretical risk for viremia and transfusion transmission.

EID dos Santos Bezerra R, de Melo Jorge D, Castro Í, Moretto E, Scalon de Oliveira L, Ubiali E, et al. Detection of Influenza A(H3N2) Virus RNA in Donated Blood. Emerg Infect Dis. 2020;26(7):1621-1623. https://dx.doi.org/10.3201/eid2607.200549
AMA dos Santos Bezerra R, de Melo Jorge D, Castro Í, et al. Detection of Influenza A(H3N2) Virus RNA in Donated Blood. Emerging Infectious Diseases. 2020;26(7):1621-1623. doi:10.3201/eid2607.200549.
APA dos Santos Bezerra, R., de Melo Jorge, D., Castro, Í., Moretto, E., Scalon de Oliveira, L., Ubiali, E....Slavov, S. (2020). Detection of Influenza A(H3N2) Virus RNA in Donated Blood. Emerging Infectious Diseases, 26(7), 1621-1623. https://dx.doi.org/10.3201/eid2607.200549.

Severe Acute Respiratory Syndrome Coronavirus 2 Shedding by Travelers, Vietnam, 2020 [PDF - 343 KB - 3 pages]
T. Le et al.

We analyzed 2 clusters of 12 patients in Vietnam with severe acute respiratory syndrome coronavirus 2 infection during January–February 2020. Analysis indicated virus transmission from a traveler from China. One asymptomatic patient demonstrated virus shedding, indicating potential virus transmission in the absence of clinical signs and symptoms.

EID Le T, Takemura T, Moi M, Nabeshima T, Nguyen L, Hoang V, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Shedding by Travelers, Vietnam, 2020. Emerg Infect Dis. 2020;26(7):1624-1626. https://dx.doi.org/10.3201/eid2607.200591
AMA Le T, Takemura T, Moi M, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Shedding by Travelers, Vietnam, 2020. Emerging Infectious Diseases. 2020;26(7):1624-1626. doi:10.3201/eid2607.200591.
APA Le, T., Takemura, T., Moi, M., Nabeshima, T., Nguyen, L., Hoang, V....Dang, D. (2020). Severe Acute Respiratory Syndrome Coronavirus 2 Shedding by Travelers, Vietnam, 2020. Emerging Infectious Diseases, 26(7), 1624-1626. https://dx.doi.org/10.3201/eid2607.200591.

Asymptomatic and Human-to-Human Transmission of SARS-CoV-2 in a 2-Family Cluster, Xuzhou, China [PDF - 616 KB - 3 pages]
C. Li et al.

We report epidemiologic, laboratory, and clinical findings for 7 patients with 2019 novel coronavirus disease in a 2-family cluster. Our study confirms asymptomatic and human-to-human transmission through close contacts in familial and hospital settings. These findings might also serve as a practical reference for clinical diagnosis and medical treatment.

EID Li C, Ji F, Wang L, Wang L, Hao J, Dai M, et al. Asymptomatic and Human-to-Human Transmission of SARS-CoV-2 in a 2-Family Cluster, Xuzhou, China. Emerg Infect Dis. 2020;26(7):1626-1628. https://dx.doi.org/10.3201/eid2607.200718
AMA Li C, Ji F, Wang L, et al. Asymptomatic and Human-to-Human Transmission of SARS-CoV-2 in a 2-Family Cluster, Xuzhou, China. Emerging Infectious Diseases. 2020;26(7):1626-1628. doi:10.3201/eid2607.200718.
APA Li, C., Ji, F., Wang, L., Wang, L., Hao, J., Dai, M....Gu, B. (2020). Asymptomatic and Human-to-Human Transmission of SARS-CoV-2 in a 2-Family Cluster, Xuzhou, China. Emerging Infectious Diseases, 26(7), 1626-1628. https://dx.doi.org/10.3201/eid2607.200718.

COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020 [PDF - 988 KB - 4 pages]
J. Lu et al.

During January 26–February 10, 2020, an outbreak of 2019 novel coronavirus disease in an air-conditioned restaurant in Guangzhou, China, involved 3 family clusters. The airflow direction was consistent with droplet transmission. To prevent the spread of the virus in restaurants, we recommend increasing the distance between tables and improving ventilation.

EID Lu J, Gu J, Li K, Xu C, Su W, Lai Z, et al. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerg Infect Dis. 2020;26(7):1628-1631. https://dx.doi.org/10.3201/eid2607.200764
AMA Lu J, Gu J, Li K, et al. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerging Infectious Diseases. 2020;26(7):1628-1631. doi:10.3201/eid2607.200764.
APA Lu, J., Gu, J., Li, K., Xu, C., Su, W., Lai, Z....Yang, Z. (2020). COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerging Infectious Diseases, 26(7), 1628-1631. https://dx.doi.org/10.3201/eid2607.200764.

Severe Acute Respiratory Syndrome Coronavirus 2 RNA Detected in Blood Donations [PDF - 373 KB - 3 pages]
L. Chang et al.

Because of high rates of 2019 novel coronavirus disease in Wuhan, China, Wuhan Blood Center began screening for severe acute respiratory syndrome coronavirus 2 RNA on January 25, 2020. We screened donations in real-time and retrospectively and found plasma samples positive for viral RNA from 4 asymptomatic donors.

EID Chang L, Zhao L, Gong H, Wang L, Wang L. Severe Acute Respiratory Syndrome Coronavirus 2 RNA Detected in Blood Donations. Emerg Infect Dis. 2020;26(7):1631-1633. https://dx.doi.org/10.3201/eid2607.200839
AMA Chang L, Zhao L, Gong H, et al. Severe Acute Respiratory Syndrome Coronavirus 2 RNA Detected in Blood Donations. Emerging Infectious Diseases. 2020;26(7):1631-1633. doi:10.3201/eid2607.200839.
APA Chang, L., Zhao, L., Gong, H., Wang, L., & Wang, L. (2020). Severe Acute Respiratory Syndrome Coronavirus 2 RNA Detected in Blood Donations. Emerging Infectious Diseases, 26(7), 1631-1633. https://dx.doi.org/10.3201/eid2607.200839.

Triplex Real-Time RT-PCR for Severe Acute Respiratory Syndrome Coronavirus 2 [PDF - 275 KB - 3 pages]
J. J. Waggoner et al.

Most reverse transcription PCR protocols for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) include 2–3 targets for detection. We developed a triplex, real-time reverse transcription PCR for SARS-CoV-2 that maintained clinical performance compared with singleplex assays. This protocol could streamline detection and decrease reagent use during current high SARS-CoV-2 testing demands.

EID Waggoner JJ, Stittleburg V, Pond R, Saklawi Y, Sahoo MK, Babiker A, et al. Triplex Real-Time RT-PCR for Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis. 2020;26(7):1633-1635. https://dx.doi.org/10.3201/eid2607.201285
AMA Waggoner JJ, Stittleburg V, Pond R, et al. Triplex Real-Time RT-PCR for Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases. 2020;26(7):1633-1635. doi:10.3201/eid2607.201285.
APA Waggoner, J. J., Stittleburg, V., Pond, R., Saklawi, Y., Sahoo, M. K., Babiker, A....Rouphael, N. (2020). Triplex Real-Time RT-PCR for Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases, 26(7), 1633-1635. https://dx.doi.org/10.3201/eid2607.201285.

Fatal Invasive Aspergillosis and Coronavirus Disease in an Immunocompetent Patient [PDF - 369 KB - 2 pages]
M. Blaize et al.

Invasive pulmonary aspergillosis is a complication in critically ill patients with acute respiratory distress syndrome, especially those with severe influenza pneumonia. We report a fatal case of invasive pulmonary aspergillosis in an immunocompetent patient in France who had severe coronavirus disease–associated pneumonia.

EID Blaize M, Mayaux J, Nabet C, Lampros A, Marcelin A, Thellier M, et al. Fatal Invasive Aspergillosis and Coronavirus Disease in an Immunocompetent Patient. Emerg Infect Dis. 2020;26(7):1636-1637. https://dx.doi.org/10.3201/eid2607.201603
AMA Blaize M, Mayaux J, Nabet C, et al. Fatal Invasive Aspergillosis and Coronavirus Disease in an Immunocompetent Patient. Emerging Infectious Diseases. 2020;26(7):1636-1637. doi:10.3201/eid2607.201603.
APA Blaize, M., Mayaux, J., Nabet, C., Lampros, A., Marcelin, A., Thellier, M....Fekkar, A. (2020). Fatal Invasive Aspergillosis and Coronavirus Disease in an Immunocompetent Patient. Emerging Infectious Diseases, 26(7), 1636-1637. https://dx.doi.org/10.3201/eid2607.201603.
Letters

Enterovirus A71 Infection and Neurologic Disease, Madrid, Spain, 2016 [PDF - 392 KB - 1 page]
P. Del Giudice
EID Del Giudice P. Enterovirus A71 Infection and Neurologic Disease, Madrid, Spain, 2016. Emerg Infect Dis. 2020;26(7):1638. https://dx.doi.org/10.3201/eid2607.190037
AMA Del Giudice P. Enterovirus A71 Infection and Neurologic Disease, Madrid, Spain, 2016. Emerging Infectious Diseases. 2020;26(7):1638. doi:10.3201/eid2607.190037.
APA Del Giudice, P. (2020). Enterovirus A71 Infection and Neurologic Disease, Madrid, Spain, 2016. Emerging Infectious Diseases, 26(7), 1638. https://dx.doi.org/10.3201/eid2607.190037.
Another Dimension

A Critique of Coronavirus [PDF - 222 KB - 2 pages]
E. R. Osen
EID Osen ER. A Critique of Coronavirus. Emerg Infect Dis. 2020;26(7):1601-1602. https://dx.doi.org/10.3201/eid2607.201426
AMA Osen ER. A Critique of Coronavirus. Emerging Infectious Diseases. 2020;26(7):1601-1602. doi:10.3201/eid2607.201426.
APA Osen, E. R. (2020). A Critique of Coronavirus. Emerging Infectious Diseases, 26(7), 1601-1602. https://dx.doi.org/10.3201/eid2607.201426.
Books and Media

The Poison Squad: One Chemist’s Single-Minded Crusade for Food Safety at the Turn of the Twentieth Century [PDF - 391 KB - 1 page]
M. C. Bazaco
EID Bazaco MC. The Poison Squad: One Chemist’s Single-Minded Crusade for Food Safety at the Turn of the Twentieth Century. Emerg Infect Dis. 2020;26(7):1639. https://dx.doi.org/10.3201/eid2607.200184
AMA Bazaco MC. The Poison Squad: One Chemist’s Single-Minded Crusade for Food Safety at the Turn of the Twentieth Century. Emerging Infectious Diseases. 2020;26(7):1639. doi:10.3201/eid2607.200184.
APA Bazaco, M. C. (2020). The Poison Squad: One Chemist’s Single-Minded Crusade for Food Safety at the Turn of the Twentieth Century. Emerging Infectious Diseases, 26(7), 1639. https://dx.doi.org/10.3201/eid2607.200184.
About the Cover

Intricacy, Symmetry, Diversity [PDF - 721 KB - 2 pages]
B. Breedlove
EID Breedlove B. Intricacy, Symmetry, Diversity. Emerg Infect Dis. 2020;26(7):1640-1641. https://dx.doi.org/10.3201/eid2607.ac2607
AMA Breedlove B. Intricacy, Symmetry, Diversity. Emerging Infectious Diseases. 2020;26(7):1640-1641. doi:10.3201/eid2607.ac2607.
APA Breedlove, B. (2020). Intricacy, Symmetry, Diversity. Emerging Infectious Diseases, 26(7), 1640-1641. https://dx.doi.org/10.3201/eid2607.ac2607.
Etymologia

Etymologia: Rhabdomyolysis [PDF - 485 KB - 1 page]
R. Henry
EID Henry R. Etymologia: Rhabdomyolysis. Emerg Infect Dis. 2020;26(7):1620. https://dx.doi.org/10.3201/eid2607.et2607
AMA Henry R. Etymologia: Rhabdomyolysis. Emerging Infectious Diseases. 2020;26(7):1620. doi:10.3201/eid2607.et2607.
APA Henry, R. (2020). Etymologia: Rhabdomyolysis. Emerging Infectious Diseases, 26(7), 1620. https://dx.doi.org/10.3201/eid2607.et2607.
Online Reports

Evidence Supporting Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 While Presymptomatic or Asymptomatic [PDF - 333 KB - 6 pages]
N. W. Furukawa et al.

Recent epidemiologic, virologic, and modeling reports support the possibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission from persons who are presymptomatic (SARS-CoV-2 detected before symptom onset) or asymptomatic (SARS-CoV-2 detected but symptoms never develop). SARS-CoV-2 transmission in the absence of symptoms reinforces the value of measures that prevent the spread of SARS-CoV-2 by infected persons who may not exhibit illness despite being infectious. Critical knowledge gaps include the relative incidence of asymptomatic and symptomatic SARS-CoV-2 infection, the public health interventions that prevent asymptomatic transmission, and the question of whether asymptomatic SARS-CoV-2 infection confers protective immunity.

Page created: June 11, 2020
Page updated: June 26, 2020
Page reviewed: June 26, 2020
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