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Articles from Emerging Infectious Diseases

Perspective

Antimicrobial Resistance in Africa—How to Relieve the Burden on Family Farmers [PDF - 2.04 MB - 6 pages]
C. Ducrot et al.

Although currently available data indicate that Africa has the lowest usage of antimicrobials in animals in the world (adjusted by animal biomass), data show a high prevalence of antimicrobial resistance in foodborne pathogens isolated from animals and animal products. Apart from the lack of solid data on antimicrobial use in many countries in Africa, different hypotheses could explain this situation. Qualitative interviews of farmers show a lack of knowledge and uninformed use of antimicrobials. Considering the development of animal farming to meet an increasing demand for proteins, this deficiency represents a serious public health issue. We advocate for policies that consider the specific challenges faced by family farmers in Africa, to simultaneously improve access to veterinary drugs while strengthening the regulation of their use. We propose a global approach targeting the agri-food system, offering innovative social and technical interventions on antimicrobial usage, adapted to family farmers.

EID Ducrot C, Hobeika A, Lienhardt C, Wieland B, Dehays C, Delabouglise A, et al. Antimicrobial Resistance in Africa—How to Relieve the Burden on Family Farmers. Emerg Infect Dis. 2021;27(10):2515-2520. https://doi.org/10.3201/eid2710.210076
AMA Ducrot C, Hobeika A, Lienhardt C, et al. Antimicrobial Resistance in Africa—How to Relieve the Burden on Family Farmers. Emerging Infectious Diseases. 2021;27(10):2515-2520. doi:10.3201/eid2710.210076.
APA Ducrot, C., Hobeika, A., Lienhardt, C., Wieland, B., Dehays, C., Delabouglise, A....Roger, F. (2021). Antimicrobial Resistance in Africa—How to Relieve the Burden on Family Farmers. Emerging Infectious Diseases, 27(10), 2515-2520. https://doi.org/10.3201/eid2710.210076.
Synopses

Characteristics, Comorbidities, and Data Gaps for Coronavirus Disease Deaths, Tennessee, USA [PDF - 1015 KB - 8 pages]
J. Parker et al.

As of March 2021, coronavirus disease (COVID-19) had led to >500,000 deaths in the United States, and the state of Tennessee had the fifth highest number of cases per capita. We reviewed the Tennessee Department of Health COVID-19 surveillance and chart-abstraction data during March 15‒August 15, 2020. Patients who died from COVID-19 were more likely to be older, male, and Black and to have underlying conditions (hereafter comorbidities) than case-patients who survived. We found 30.4% of surviving case-patients and 20.3% of deceased patients had no comorbidity information recorded. Chart-abstraction captured a higher proportion of deceased case-patients with >1 comorbidity (96.3%) compared with standard surveillance deaths (79.0%). Chart-abstraction detected higher rates of each comorbidity except for diabetes, which had similar rates among standard surveillance and chart-abstraction. Investing in public health data collection infrastructure will be beneficial for the COVID-19 pandemic and future disease outbreaks.

EID Parker J, Octaria R, Smith MD, Chao SJ, Davis M, Goodson C, et al. Characteristics, Comorbidities, and Data Gaps for Coronavirus Disease Deaths, Tennessee, USA. Emerg Infect Dis. 2021;27(10):2521-2528. https://doi.org/10.3201/eid2710.211070
AMA Parker J, Octaria R, Smith MD, et al. Characteristics, Comorbidities, and Data Gaps for Coronavirus Disease Deaths, Tennessee, USA. Emerging Infectious Diseases. 2021;27(10):2521-2528. doi:10.3201/eid2710.211070.
APA Parker, J., Octaria, R., Smith, M. D., Chao, S. J., Davis, M., Goodson, C....Fill, M. A. (2021). Characteristics, Comorbidities, and Data Gaps for Coronavirus Disease Deaths, Tennessee, USA. Emerging Infectious Diseases, 27(10), 2521-2528. https://doi.org/10.3201/eid2710.211070.

Fatal Exacerbations of Systemic Capillary Leak Syndrome Complicating Coronavirus Disease [PDF - 829 KB - 6 pages]
P. C. Cheung et al.

We report 2 fatal exacerbations of systemic capillary leak syndrome (SCLS), also known as Clarkson disease, associated with coronavirus disease (COVID-19) in the United States. One patient carried an established diagnosis of SCLS and the other sought treatment for new-onset hypotensive shock, hemoconcentration, and anasarca, classic symptoms indicative of an SCLS flare. Both patients had only mild-to-moderate symptoms of COVID-19. This clinical picture suggests that these patients succumbed to complications of SCLS induced by infection with severe acute respiratory syndrome coronavirus 2. Persons with known or suspected SCLS may be at increased risk for developing a disease flare in the setting of mild-to-moderate COVID-19 infection.

EID Cheung PC, Eisch A, Maleque N, Polly DM, Auld SC, Druey KM. Fatal Exacerbations of Systemic Capillary Leak Syndrome Complicating Coronavirus Disease. Emerg Infect Dis. 2021;27(10):2529-2534. https://doi.org/10.3201/eid2710.211155
AMA Cheung PC, Eisch A, Maleque N, et al. Fatal Exacerbations of Systemic Capillary Leak Syndrome Complicating Coronavirus Disease. Emerging Infectious Diseases. 2021;27(10):2529-2534. doi:10.3201/eid2710.211155.
APA Cheung, P. C., Eisch, A., Maleque, N., Polly, D. M., Auld, S. C., & Druey, K. M. (2021). Fatal Exacerbations of Systemic Capillary Leak Syndrome Complicating Coronavirus Disease. Emerging Infectious Diseases, 27(10), 2529-2534. https://doi.org/10.3201/eid2710.211155.

Distribution and Characteristics of Human Plague Cases and Yersinia pestis Isolates from 4 Marmota Plague Foci, China, 1950–2019 [PDF - 3.02 MB - 10 pages]
Z. He et al.

We analyzed epidemiologic characteristics and distribution of 1,067 human plague cases and 5,958 Yersinia pestis isolates collected from humans, host animals, and insect vectors during 1950–2019 in 4 Marmota plague foci in China. The case-fatality rate for plague in humans was 68.88%; the overall trend slowly decreased over time but fluctuated greatly. Most human cases (98.31%) and isolates (82.06%) identified from any source were from the Marmota himalayana plague focus. The tendency among human cases could be divided into 3 stages: 1950–1969, 1970–2003, and 2004–2019. The Marmota sibirica plague focus has not had identified human cases nor isolates since 1926. However, in the other 3 foci, Y. pestis continues to circulate among animal hosts; ecologic factors might affect local Y. pestis activity. Marmota plague foci are active in China, and the epidemic boundary is constantly expanding, posing a potential threat to domestic and global public health.

EID He Z, Wei B, Zhang Y, Liu J, Xi J, Ciren D, et al. Distribution and Characteristics of Human Plague Cases and Yersinia pestis Isolates from 4 Marmota Plague Foci, China, 1950–2019. Emerg Infect Dis. 2021;27(10):2544-2553. https://doi.org/10.3201/eid2710.202239
AMA He Z, Wei B, Zhang Y, et al. Distribution and Characteristics of Human Plague Cases and Yersinia pestis Isolates from 4 Marmota Plague Foci, China, 1950–2019. Emerging Infectious Diseases. 2021;27(10):2544-2553. doi:10.3201/eid2710.202239.
APA He, Z., Wei, B., Zhang, Y., Liu, J., Xi, J., Ciren, D....Wang, X. (2021). Distribution and Characteristics of Human Plague Cases and Yersinia pestis Isolates from 4 Marmota Plague Foci, China, 1950–2019. Emerging Infectious Diseases, 27(10), 2544-2553. https://doi.org/10.3201/eid2710.202239.

Severe Acute Respiratory Syndrome Coronavirus 2 and Pregnancy Outcomes According to Gestational Age at Time of Infection [PDF - 1.48 MB - 9 pages]
D. A. Badr et al.

We conducted an international multicenter retrospective cohort study, PregOuTCOV, to examine the effect of gestational age at time of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on obstetric and neonatal outcomes. We included all singleton pregnancies with a live fetus at 10 weeks’ gestation in which pregnancy outcomes were known. The exposed group consisted of patients infected with SARS-CoV-2, whereas the unexposed group consisted of all remaining patients during the same period. Primary outcomes were defined as composite adverse obstetric outcomes and composite adverse neonatal outcomes. Of 10,925 pregnant women, 393 (3.60%) were infected with SARS-CoV-2 (exposed group). After matching for possible confounders, we identified statistically significant increases in the exposed group of composite adverse obstetric outcomes at >20 weeks’ gestation and of composite adverse neonatal outcomes at >26 weeks’ gestation (p<0.001). Vaccination programs should target women early in pregnancy or before conception, if possible.

EID Badr DA, Picone O, Bevilacqua E, Carlin A, Meli F, Sibiude J, et al. Severe Acute Respiratory Syndrome Coronavirus 2 and Pregnancy Outcomes According to Gestational Age at Time of Infection. Emerg Infect Dis. 2021;27(10):2535-2543. https://doi.org/10.3201/eid2710.211394
AMA Badr DA, Picone O, Bevilacqua E, et al. Severe Acute Respiratory Syndrome Coronavirus 2 and Pregnancy Outcomes According to Gestational Age at Time of Infection. Emerging Infectious Diseases. 2021;27(10):2535-2543. doi:10.3201/eid2710.211394.
APA Badr, D. A., Picone, O., Bevilacqua, E., Carlin, A., Meli, F., Sibiude, J....Vivanti, A. J. (2021). Severe Acute Respiratory Syndrome Coronavirus 2 and Pregnancy Outcomes According to Gestational Age at Time of Infection. Emerging Infectious Diseases, 27(10), 2535-2543. https://doi.org/10.3201/eid2710.211394.

Novel Outbreak-Associated Food Vehicles, United States [PDF - 880 KB - 6 pages]
H. K. Whitham et al.

Novel outbreak-associated food vehicles (i.e., foods not implicated in past outbreaks) can emerge as a result of evolving pathogens and changing consumption trends. To identify these foods, we examined data from the Centers for Disease Control and Prevention Foodborne Disease Outbreak Surveillance System and found 14,216 reported outbreaks with information on implicated foods. We compared foods implicated in outbreaks during 2007–2016 with those implicated in outbreaks during 1973–2006. We identified 28 novel food vehicles, of which the most common types were fish, nuts, fruits, and vegetables; one third were imported. Compared with other outbreaks, those associated with novel food vehicles were more likely to involve illnesses in multiple states and food recalls and were larger in terms of cases, hospitalizations, and deaths. Two thirds of novel foods did not require cooking after purchase. Prevention efforts targeting novel foods cannot rely solely on consumer education but require industry preventive measures.

EID Whitham HK, Sundararaman P, Dewey-Mattia D, Manikonda K, Marshall KE, Griffin PM, et al. Novel Outbreak-Associated Food Vehicles, United States. Emerg Infect Dis. 2021;27(10):2554-2559. https://doi.org/10.3201/eid2710.204080
AMA Whitham HK, Sundararaman P, Dewey-Mattia D, et al. Novel Outbreak-Associated Food Vehicles, United States. Emerging Infectious Diseases. 2021;27(10):2554-2559. doi:10.3201/eid2710.204080.
APA Whitham, H. K., Sundararaman, P., Dewey-Mattia, D., Manikonda, K., Marshall, K. E., Griffin, P. M....Crowe, S. J. (2021). Novel Outbreak-Associated Food Vehicles, United States. Emerging Infectious Diseases, 27(10), 2554-2559. https://doi.org/10.3201/eid2710.204080.
Research

Bloodstream Infection Risk, Incidence, and Deaths for Hospitalized Patients during Coronavirus Disease Pandemic [PDF - 1.22 MB - 7 pages]
B. S. Shukla et al.

Hospital-acquired infections are emerging major concurrent conditions during the coronavirus disease (COVID-19) pandemic. We conducted a retrospective review of hospitalizations during March‒October 2020 of adults tested by reverse transcription PCR for severe acute respiratory syndrome coronavirus 2. We evaluated associations of COVID-19 diagnosis with risk for laboratory-confirmed bloodstream infections (LCBIs, primary outcome), time to LCBI, and risk for death by using logistic and competing risks regression with adjustment for relevant covariates. A total of 10,848 patients were included in the analysis: 918 (8.5%) were given a diagnosis of COVID-19, and 232 (2.1%) had LCBIs during their hospitalization. Of these patients, 58 (25%) were classified as having central line‒associated bloodstream infections. After adjusting for covariates, COVID-19‒positive status was associated with higher risk for LCBI and death. Reinforcement of infection control practices should be implemented in COVID-19 wards, and review of superiority and inferiority ranking methods by National Healthcare Safety Network criteria might be needed.

EID Shukla BS, Warde PR, Knott E, Arenas S, Pronty D, Ramirez R, et al. Bloodstream Infection Risk, Incidence, and Deaths for Hospitalized Patients during Coronavirus Disease Pandemic. Emerg Infect Dis. 2021;27(10):2588-2594. https://doi.org/10.3201/eid2710.210538
AMA Shukla BS, Warde PR, Knott E, et al. Bloodstream Infection Risk, Incidence, and Deaths for Hospitalized Patients during Coronavirus Disease Pandemic. Emerging Infectious Diseases. 2021;27(10):2588-2594. doi:10.3201/eid2710.210538.
APA Shukla, B. S., Warde, P. R., Knott, E., Arenas, S., Pronty, D., Ramirez, R....Gershengorn, H. B. (2021). Bloodstream Infection Risk, Incidence, and Deaths for Hospitalized Patients during Coronavirus Disease Pandemic. Emerging Infectious Diseases, 27(10), 2588-2594. https://doi.org/10.3201/eid2710.210538.

Direct and Indirect Effectiveness of mRNA Vaccination against Severe Acute Respiratory Syndrome Coronavirus 2 in Long-Term Care Facilities, Spain [PDF - 1.19 MB - 9 pages]
S. Monge et al.

We conducted a registries-based cohort study of long-term care facility residents >65 years of age offered vaccination against severe acute respiratory syndrome coronavirus 2 before March 10, 2021, in Spain. Risk for infection in vaccinated and nonvaccinated persons was compared with risk in the same persons in a period before the vaccination campaign, adjusted by daily-varying incidence and reproduction number. We selected 299,209 persons; 99.0% had >1 dose, 92.6% had 2 doses, and 99.8% of vaccines were Pfizer/BioNTech (BNT162b2). For vaccinated persons with no previous infection, vaccine effectiveness was 81.8% (95% CI 81.0%–82.7%), and 11.6 (95% CI 11.3–11.9) cases were prevented per 10,000 vaccinated/day. In those with previous infection, effectiveness was 56.8% (95% CI 47.1%–67.7%). In nonvaccinated residents with no previous infection, risk decreased by up to 81.4% (95% CI 73.3%–90.3%). Our results confirm vaccine effectiveness in this population and suggest indirect protection in nonvaccinated persons.

EID Monge S, Olmedo C, Alejos B, Lapeña MF, Sierra M, Limia A. Direct and Indirect Effectiveness of mRNA Vaccination against Severe Acute Respiratory Syndrome Coronavirus 2 in Long-Term Care Facilities, Spain. Emerg Infect Dis. 2021;27(10):2595-2603. https://doi.org/10.3201/eid2710.211184
AMA Monge S, Olmedo C, Alejos B, et al. Direct and Indirect Effectiveness of mRNA Vaccination against Severe Acute Respiratory Syndrome Coronavirus 2 in Long-Term Care Facilities, Spain. Emerging Infectious Diseases. 2021;27(10):2595-2603. doi:10.3201/eid2710.211184.
APA Monge, S., Olmedo, C., Alejos, B., Lapeña, M. F., Sierra, M., & Limia, A. (2021). Direct and Indirect Effectiveness of mRNA Vaccination against Severe Acute Respiratory Syndrome Coronavirus 2 in Long-Term Care Facilities, Spain. Emerging Infectious Diseases, 27(10), 2595-2603. https://doi.org/10.3201/eid2710.211184.

Predictors of Test Positivity, Mortality, and Seropositivity during the Early Coronavirus Disease Epidemic, Orange County, California, USA [PDF - 8.19 MB - 15 pages]
D. M. Parker et al.

We conducted a detailed analysis of coronavirus disease in a large population center in southern California, USA (Orange County, population 3.2 million), to determine heterogeneity in risks for infection, test positivity, and death. We used a combination of datasets, including a population-representative seroprevalence survey, to assess the actual burden of disease and testing intensity, test positivity, and mortality. In the first month of the local epidemic (March 2020), case incidence clustered in high-income areas. This pattern quickly shifted, and cases next clustered in much higher rates in the north-central area of the county, which has a lower socioeconomic status. Beginning in April 2020, a concentration of reported cases, test positivity, testing intensity, and seropositivity in a north-central area persisted. At the individual level, several factors (e.g., age, race or ethnicity, and ZIP codes with low educational attainment) strongly affected risk for seropositivity and death.

EID Parker DM, Bruckner T, Vieira VM, Medina C, Minin VN, Felgner PL, et al. Predictors of Test Positivity, Mortality, and Seropositivity during the Early Coronavirus Disease Epidemic, Orange County, California, USA. Emerg Infect Dis. 2021;27(10):2604-2618. https://doi.org/10.3201/eid2710.210103
AMA Parker DM, Bruckner T, Vieira VM, et al. Predictors of Test Positivity, Mortality, and Seropositivity during the Early Coronavirus Disease Epidemic, Orange County, California, USA. Emerging Infectious Diseases. 2021;27(10):2604-2618. doi:10.3201/eid2710.210103.
APA Parker, D. M., Bruckner, T., Vieira, V. M., Medina, C., Minin, V. N., Felgner, P. L....Boden-Albala, B. (2021). Predictors of Test Positivity, Mortality, and Seropositivity during the Early Coronavirus Disease Epidemic, Orange County, California, USA. Emerging Infectious Diseases, 27(10), 2604-2618. https://doi.org/10.3201/eid2710.210103.

Fatal Cowpox Virus Infection in Human Fetus, France, 2017 [PDF - 2.20 MB - 8 pages]
A. Ferrier et al.

Cowpox virus (CPXV) has an animal reservoir and is typically transmitted to humans by contact with infected animals. In 2017, CPXV infection of a pregnant woman in France led to the death of her fetus. Fetal death after maternal orthopoxvirus (smallpox) vaccination has been reported; however, this patient had not been vaccinated. Investigation of the patient’s domestic animals failed to demonstrate prevalence of CPXV infection among them. The patient’s diagnosis was confirmed by identifying CPXV DNA in all fetal and maternal biopsy samples and infectious CPXV in biopsy but not plasma samples. This case of fetal death highlights the risk for complications of orthopoxvirus infection during pregnancy. Among orthopoxviruses, fetal infection has been reported for variola virus and vaccinia virus; our findings suggest that CPXV poses the same threats for infection complications as vaccinia virus.

EID Ferrier A, Frenois-Veyrat G, Schvoerer E, Henard S, Jarjaval F, Drouet I, et al. Fatal Cowpox Virus Infection in Human Fetus, France, 2017. Emerg Infect Dis. 2021;27(10):2570-2577. https://doi.org/10.3201/eid2710.204818
AMA Ferrier A, Frenois-Veyrat G, Schvoerer E, et al. Fatal Cowpox Virus Infection in Human Fetus, France, 2017. Emerging Infectious Diseases. 2021;27(10):2570-2577. doi:10.3201/eid2710.204818.
APA Ferrier, A., Frenois-Veyrat, G., Schvoerer, E., Henard, S., Jarjaval, F., Drouet, I....Ferraris, O. (2021). Fatal Cowpox Virus Infection in Human Fetus, France, 2017. Emerging Infectious Diseases, 27(10), 2570-2577. https://doi.org/10.3201/eid2710.204818.

Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in Georgia, USA, February 1–July 13, 2020 [PDF - 3.58 MB - 10 pages]
Y. Wang et al.

The serial interval and effective reproduction number for coronavirus disease (COVID-19) are heterogenous, varying by demographic characteristics, region, and period. During February 1–July 13, 2020, we identified 4,080 transmission pairs in Georgia, USA, by using contact tracing information from COVID-19 cases reported to the Georgia Department of Public Health. We examined how various transmission characteristics were affected by symptoms, demographics, and period (during shelter-in-place and after subsequent reopening) and estimated the time course of reproduction numbers for all 159 Georgia counties. Transmission varied by time and place but also by persons’ sex and race. The mean serial interval decreased from 5.97 days in February–April to 4.40 days in June–July. Younger adults (20–50 years of age) were involved in most transmission events occurring during or after reopening. The shelter-in-place period was not long enough to prevent sustained virus transmission in densely populated urban areas connected by major transportation links.

EID Wang Y, Siesel C, Chen Y, Lopman B, Edison L, Thomas M, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in Georgia, USA, February 1–July 13, 2020. Emerg Infect Dis. 2021;27(10):2578-2587. https://doi.org/10.3201/eid2710.210061
AMA Wang Y, Siesel C, Chen Y, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in Georgia, USA, February 1–July 13, 2020. Emerging Infectious Diseases. 2021;27(10):2578-2587. doi:10.3201/eid2710.210061.
APA Wang, Y., Siesel, C., Chen, Y., Lopman, B., Edison, L., Thomas, M....Teunis, P. (2021). Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in Georgia, USA, February 1–July 13, 2020. Emerging Infectious Diseases, 27(10), 2578-2587. https://doi.org/10.3201/eid2710.210061.

Risk Assessment for Highly Pathogenic Avian Influenza A(H5N6/H5N8) Clade 2.3.4.4 Viruses [PDF - 1.26 MB - 9 pages]
C. Bui et al.

The numerous global outbreaks and continuous reassortments of highly pathogenic avian influenza (HPAI) A(H5N6/H5N8) clade 2.3.4.4 viruses in birds pose a major risk to the public health. We investigated the tropism and innate host responses of 5 recent HPAI A(H5N6/H5N8) avian isolates of clades 2.3.4.4b, e, and h in human airway organoids and primary human alveolar epithelial cells. The HPAI A(H5N6/H5N8) avian isolates replicated productively but with lower competence than the influenza A(H1N1)pdm09, HPAI A(H5N1), and HPAI A(H5N6) isolates from humans in both or either models. They showed differential cellular tropism in human airway organoids; some infected all 4 major epithelial cell types: ciliated cells, club cells, goblet cells, and basal cells. Our results suggest zoonotic potential but low transmissibility of the HPAI A(H5N6/H5N8) avian isolates among humans. These viruses induced low levels of proinflammatory cytokines/chemokines, which are unlikely to contribute to the pathogenesis of severe disease.

EID Bui C, Kuok D, Yeung HW, Ng K, Chu D, Webby RJ, et al. Risk Assessment for Highly Pathogenic Avian Influenza A(H5N6/H5N8) Clade 2.3.4.4 Viruses. Emerg Infect Dis. 2021;27(10):2619-2627. https://doi.org/10.3201/eid2710.210297
AMA Bui C, Kuok D, Yeung HW, et al. Risk Assessment for Highly Pathogenic Avian Influenza A(H5N6/H5N8) Clade 2.3.4.4 Viruses. Emerging Infectious Diseases. 2021;27(10):2619-2627. doi:10.3201/eid2710.210297.
APA Bui, C., Kuok, D., Yeung, H. W., Ng, K., Chu, D., Webby, R. J....Chan, M. (2021). Risk Assessment for Highly Pathogenic Avian Influenza A(H5N6/H5N8) Clade 2.3.4.4 Viruses. Emerging Infectious Diseases, 27(10), 2619-2627. https://doi.org/10.3201/eid2710.210297.

Medscape CME Activity
Population-Based Study of Bloodstream Infection Incidence and Mortality Rates, Finland, 2004–2018 [PDF - 2.78 MB - 10 pages]
K. Kontula et al.

We evaluated the incidence, outcomes, and causative agents of bloodstream infections (BSI) in Finland during 2004–2018 by using data from the national registries. We identified a total of 173,715 BSIs; annual incidence increased from 150 to 309 cases/100,000 population. BSI incidence rose most sharply among persons >80 years of age. The 1-month case-fatality rate decreased from 13.0% to 12.6%, but the 1-month all-cause mortality rate rose from 20 to 39 deaths/100,000 population. BSIs caused by Escherichia coli increased from 26% to 30% of all BSIs. BSIs caused by multidrug-resistant microbes rose from 0.4% to 2.8%, mostly caused by extended-spectrum β-lactamase-producing E. coli. We observed an increase in community-acquired BSIs, from 67% to 78%. The proportion of patients with severe underlying conditions rose from 14% to 23%. Additional public health and healthcare prevention efforts are needed to curb the increasing trend in community-acquired BSIs and antimicrobial drug–resistant E. coli.

EID Kontula K, Skogberg K, Ollgren J, Järvinen A, Lyytikäinen O. Population-Based Study of Bloodstream Infection Incidence and Mortality Rates, Finland, 2004–2018. Emerg Infect Dis. 2021;27(10):2560-2569. https://doi.org/10.3201/eid2710.204826
AMA Kontula K, Skogberg K, Ollgren J, et al. Population-Based Study of Bloodstream Infection Incidence and Mortality Rates, Finland, 2004–2018. Emerging Infectious Diseases. 2021;27(10):2560-2569. doi:10.3201/eid2710.204826.
APA Kontula, K., Skogberg, K., Ollgren, J., Järvinen, A., & Lyytikäinen, O. (2021). Population-Based Study of Bloodstream Infection Incidence and Mortality Rates, Finland, 2004–2018. Emerging Infectious Diseases, 27(10), 2560-2569. https://doi.org/10.3201/eid2710.204826.

New Delhi Metallo-β-Lactamase–Producing Enterobacterales Bacteria, Switzerland, 2019–2020 [PDF - 2.49 MB - 10 pages]
J. Findlay et al.

Carbapenemase-producing Enterobacterales (CPE) bacteria are a critical global health concern; New Delhi metallo-β-lactamase (NDM) enzymes account for >25% of all CPE found in Switzerland. We characterized NDM-positive CPE submitted to the Swiss National Reference Center for Emerging Antibiotic Resistance during a 2-year period (January 2019–December 2020) phenotypically and by using whole-genome sequencing. Most isolates were either Klebsiella pneumoniae (59/141) or Escherichia coli (52/141), and >50% were obtained from screening swabs. Among the 108 sequenced isolates, NDM-1 was the most prevalent variant, occurring in 56 isolates, mostly K. pneumoniae (34/56); the next most prevalent was NDM-5, which occurred in 49 isolates, mostly E. coli (40/49). Fourteen isolates coproduced a second carbapenemase, predominantly an OXA-48-like enzyme, and almost one third of isolates produced a 16S rRNA methylase conferring panresistance to aminoglycosides. We identified successful plasmids and global lineages as major factors contributing to the increasing prevalence of NDMs in Switzerland.

EID Findlay J, Poirel L, Kessler J, Kronenberg A, Nordmann P. New Delhi Metallo-β-Lactamase–Producing Enterobacterales Bacteria, Switzerland, 2019–2020. Emerg Infect Dis. 2021;27(10):2628-2637. https://doi.org/10.3201/eid2710.211265
AMA Findlay J, Poirel L, Kessler J, et al. New Delhi Metallo-β-Lactamase–Producing Enterobacterales Bacteria, Switzerland, 2019–2020. Emerging Infectious Diseases. 2021;27(10):2628-2637. doi:10.3201/eid2710.211265.
APA Findlay, J., Poirel, L., Kessler, J., Kronenberg, A., & Nordmann, P. (2021). New Delhi Metallo-β-Lactamase–Producing Enterobacterales Bacteria, Switzerland, 2019–2020. Emerging Infectious Diseases, 27(10), 2628-2637. https://doi.org/10.3201/eid2710.211265.

New Perspective on the Geographic Distribution and Evolution of Lymphocytic Choriomeningitis Virus, Central Europe [PDF - 3.01 MB - 10 pages]
A. Fornůsková et al.

Lymphocytic choriomeningitis virus (LCMV) is an Old World mammarenavirus found worldwide because of its association with the house mouse. When LCMV spills over to immunocompetent humans, the virus can cause aseptic meningitis; in immunocompromised persons, systemic infection and death can occur. Central Europe is a strategic location for the study of LCMV evolutionary history and host specificity because of the presence of a hybrid zone (genetic barrier) between 2 house mouse subspecies, Mus musculus musculus and M. musculus domesticus. We report LCMV prevalence in natural mouse populations from a Czech Republic–Germany transect and genomic characterization of 2 new LCMV variants from the Czech Republic. We demonstrate that the main division in the LCMV phylogenetic tree corresponds to mouse host subspecies and, when the virus is found in human hosts, the mouse subspecies found at the spillover location. Therefore, LCMV strains infecting humans can be predicted by the genetic structure of house mice.

EID Fornůsková A, Hiadlovská Z, Macholán M, Piálek J, de Bellocq J. New Perspective on the Geographic Distribution and Evolution of Lymphocytic Choriomeningitis Virus, Central Europe. Emerg Infect Dis. 2021;27(10):2638-2647. https://doi.org/10.3201/eid2710.210224
AMA Fornůsková A, Hiadlovská Z, Macholán M, et al. New Perspective on the Geographic Distribution and Evolution of Lymphocytic Choriomeningitis Virus, Central Europe. Emerging Infectious Diseases. 2021;27(10):2638-2647. doi:10.3201/eid2710.210224.
APA Fornůsková, A., Hiadlovská, Z., Macholán, M., Piálek, J., & de Bellocq, J. (2021). New Perspective on the Geographic Distribution and Evolution of Lymphocytic Choriomeningitis Virus, Central Europe. Emerging Infectious Diseases, 27(10), 2638-2647. https://doi.org/10.3201/eid2710.210224.

Burden of Influenza-Associated Respiratory Hospitalizations, Vietnam, 2014–2016 [PDF - 1.92 MB - 10 pages]
N. Khanh et al.

Influenza burden estimates are essential to informing prevention and control policies. To complement recent influenza vaccine production capacity in Vietnam, we used acute respiratory infection (ARI) hospitalization data, severe acute respiratory infection (SARI) surveillance data, and provincial population data from 4 provinces representing Vietnam’s major regions during 2014–2016 to calculate provincial and national influenza-associated ARI and SARI hospitalization rates. We determined the proportion of ARI admissions meeting the World Health Organization SARI case definition through medical record review. The mean influenza-associated hospitalization rates per 100,000 population were 218 (95% uncertainty interval [UI] 197–238) for ARI and 134 (95% UI 119–149) for SARI. Influenza-associated SARI hospitalization rates per 100,000 population were highest among children <5 years of age (1,123; 95% UI 946–1,301) and adults >65 years of age (207; 95% UI 186–227), underscoring the need for prevention and control measures, such as vaccination, in these at-risk populations.

EID Khanh N, Fowlkes AL, Nghia N, Duong T, Tu N, Tu T, et al. Burden of Influenza-Associated Respiratory Hospitalizations, Vietnam, 2014–2016. Emerg Infect Dis. 2021;27(10):2648-2657. https://doi.org/10.3201/eid2710.204765
AMA Khanh N, Fowlkes AL, Nghia N, et al. Burden of Influenza-Associated Respiratory Hospitalizations, Vietnam, 2014–2016. Emerging Infectious Diseases. 2021;27(10):2648-2657. doi:10.3201/eid2710.204765.
APA Khanh, N., Fowlkes, A. L., Nghia, N., Duong, T., Tu, N., Tu, T....Iuliano, A. (2021). Burden of Influenza-Associated Respiratory Hospitalizations, Vietnam, 2014–2016. Emerging Infectious Diseases, 27(10), 2648-2657. https://doi.org/10.3201/eid2710.204765.
Dispatches

Widespread Disease in Hedgehogs (Erinaceus europaeus) Caused by Toxigenic Corynebacterium ulcerans [PDF - 3.04 MB - 5 pages]
A. Martel et al.

Toxin-producing Corynebacterium ulcerans, a causative agent of diphtheria in humans, was isolated from 53 hedgehogs in Belgium during the spring of 2020. Isolates showed low levels of acquired antimicrobial drug resistance. Strain diversity suggests emergence from an endemic situation. These findings stress the need for raising public awareness and improved wildlife disease surveillance.

EID Martel A, Boyen F, Rau J, Eisenberg T, Sing A, Berger A, et al. Widespread Disease in Hedgehogs (Erinaceus europaeus) Caused by Toxigenic Corynebacterium ulcerans. Emerg Infect Dis. 2021;27(10):2686-2690. https://doi.org/10.3201/eid2710.203335
AMA Martel A, Boyen F, Rau J, et al. Widespread Disease in Hedgehogs (Erinaceus europaeus) Caused by Toxigenic Corynebacterium ulcerans. Emerging Infectious Diseases. 2021;27(10):2686-2690. doi:10.3201/eid2710.203335.
APA Martel, A., Boyen, F., Rau, J., Eisenberg, T., Sing, A., Berger, A....Pasmans, F. (2021). Widespread Disease in Hedgehogs (Erinaceus europaeus) Caused by Toxigenic Corynebacterium ulcerans. Emerging Infectious Diseases, 27(10), 2686-2690. https://doi.org/10.3201/eid2710.203335.

Genetic Diversity of SARS-CoV-2 among Travelers Arriving in Hong Kong [PDF - 675 KB - 3 pages]
H. Gu et al.

We sequenced 10% of imported severe acute respiratory syndrome coronavirus 2 infections detected in travelers to Hong Kong and revealed the genomic diversity of regions of origin, including lineages not previously reported from those countries. Our results suggest that international or regional travel hubs might be useful surveillance sites to monitor sequence diversity.

EID Gu H, Chu D, Chang L, Cheuk S, Gurung S, Krishnan P, et al. Genetic Diversity of SARS-CoV-2 among Travelers Arriving in Hong Kong. Emerg Infect Dis. 2021;27(10):2666-2668. https://doi.org/10.3201/eid2710.211028
AMA Gu H, Chu D, Chang L, et al. Genetic Diversity of SARS-CoV-2 among Travelers Arriving in Hong Kong. Emerging Infectious Diseases. 2021;27(10):2666-2668. doi:10.3201/eid2710.211028.
APA Gu, H., Chu, D., Chang, L., Cheuk, S., Gurung, S., Krishnan, P....Poon, L. (2021). Genetic Diversity of SARS-CoV-2 among Travelers Arriving in Hong Kong. Emerging Infectious Diseases, 27(10), 2666-2668. https://doi.org/10.3201/eid2710.211028.

Point-of-Care Antigen Test for SARS-CoV-2 in Asymptomatic College Students [PDF - 1.67 MB - 4 pages]
S. C. Tinker et al.

We used the BinaxNOW COVID-19 Ag Card to screen 1,540 asymptomatic college students for severe acute respiratory syndrome coronavirus 2 in a low-prevalence setting. Compared with reverse transcription PCR, BinaxNOW showed 20% overall sensitivity; among participants with culturable virus, sensitivity was 60%. BinaxNOW provides point-of-care screening but misses many infections.

EID Tinker SC, Szablewski CM, Litvintseva AP, Drenzek C, Voccio GE, Hunter MA, et al. Point-of-Care Antigen Test for SARS-CoV-2 in Asymptomatic College Students. Emerg Infect Dis. 2021;27(10):2662-2665. https://doi.org/10.3201/eid2710.210080
AMA Tinker SC, Szablewski CM, Litvintseva AP, et al. Point-of-Care Antigen Test for SARS-CoV-2 in Asymptomatic College Students. Emerging Infectious Diseases. 2021;27(10):2662-2665. doi:10.3201/eid2710.210080.
APA Tinker, S. C., Szablewski, C. M., Litvintseva, A. P., Drenzek, C., Voccio, G. E., Hunter, M. A....Honein, M. A. (2021). Point-of-Care Antigen Test for SARS-CoV-2 in Asymptomatic College Students. Emerging Infectious Diseases, 27(10), 2662-2665. https://doi.org/10.3201/eid2710.210080.

Medscape CME Activity
Recurrence of Human Babesiosis Caused by Reinfection [PDF - 721 KB - 4 pages]
J. Ho et al.

Babesiosis developed in a 62-year-old immunocompetent physician, who had an uneventful recovery after receiving atovaquone and azithromycin. Three years later, babesiosis developed again, and he was again successfully given treatment. Clinical and laboratory evidence were highly supportive of Babesia reinfection. Healthcare professionals should be aware that reinfection might occur in babesiosis.

EID Ho J, Carey E, Carey DE, Krause PJ. Recurrence of Human Babesiosis Caused by Reinfection. Emerg Infect Dis. 2021;27(10):2658-2661. https://doi.org/10.3201/eid2710.211240
AMA Ho J, Carey E, Carey DE, et al. Recurrence of Human Babesiosis Caused by Reinfection. Emerging Infectious Diseases. 2021;27(10):2658-2661. doi:10.3201/eid2710.211240.
APA Ho, J., Carey, E., Carey, D. E., & Krause, P. J. (2021). Recurrence of Human Babesiosis Caused by Reinfection. Emerging Infectious Diseases, 27(10), 2658-2661. https://doi.org/10.3201/eid2710.211240.

Breakthrough Infections of SARS-CoV-2 Gamma Variant in Fully Vaccinated Gold Miners, French Guiana, 2021 [PDF - 785 KB - 4 pages]
N. Vignier et al.

An outbreak of severe acute respiratory syndrome coronavirus 2 caused by the Gamma variant of concern infected 24/44 (55%) employees of a gold mine in French Guiana (87% symptomatic, no severe forms). The attack rate was 60% (15/25) among fully vaccinated miners and 75% (3/4) among unvaccinated miners without a history of infection.

EID Vignier N, Bérot V, Bonnave N, Peugny S, Ballet M, Jacoud E, et al. Breakthrough Infections of SARS-CoV-2 Gamma Variant in Fully Vaccinated Gold Miners, French Guiana, 2021. Emerg Infect Dis. 2021;27(10):2673-2676. https://doi.org/10.3201/eid2710.211427
AMA Vignier N, Bérot V, Bonnave N, et al. Breakthrough Infections of SARS-CoV-2 Gamma Variant in Fully Vaccinated Gold Miners, French Guiana, 2021. Emerging Infectious Diseases. 2021;27(10):2673-2676. doi:10.3201/eid2710.211427.
APA Vignier, N., Bérot, V., Bonnave, N., Peugny, S., Ballet, M., Jacoud, E....Epelboin, L. (2021). Breakthrough Infections of SARS-CoV-2 Gamma Variant in Fully Vaccinated Gold Miners, French Guiana, 2021. Emerging Infectious Diseases, 27(10), 2673-2676. https://doi.org/10.3201/eid2710.211427.

Seoul Virus Associated with Pet Rats, Scotland, UK, 2019 [PDF - 898 KB - 4 pages]
J. G. Shepherd et al.

We describe a case of hemorrhagic fever with renal syndrome caused by Seoul virus in a woman in Scotland, UK. Whole-genome sequencing showed the virus belonged to a lineage characterized by recent international expansion, probably driven by trade in pet rats.

EID Shepherd JG, Blunsum AE, Carmichael S, Smollett K, Maxwell-Scott H, Farmer E, et al. Seoul Virus Associated with Pet Rats, Scotland, UK, 2019. Emerg Infect Dis. 2021;27(10):2677-2680. https://doi.org/10.3201/eid2710.211298
AMA Shepherd JG, Blunsum AE, Carmichael S, et al. Seoul Virus Associated with Pet Rats, Scotland, UK, 2019. Emerging Infectious Diseases. 2021;27(10):2677-2680. doi:10.3201/eid2710.211298.
APA Shepherd, J. G., Blunsum, A. E., Carmichael, S., Smollett, K., Maxwell-Scott, H., Farmer, E....Thomson, E. C. (2021). Seoul Virus Associated with Pet Rats, Scotland, UK, 2019. Emerging Infectious Diseases, 27(10), 2677-2680. https://doi.org/10.3201/eid2710.211298.

Natural Plasmodium inui Infections in Humans and Anopheles cracens Mosquito, Malaysia [PDF - 1.07 MB - 4 pages]
J. Liew et al.

We detected 2 natural, asymptomatic Plasmodium inui monoinfections in humans in Malaysia by using nested PCR on concentrated high-volume blood samples. We found a P. inui–positive Anopheles cracens mosquito in the same site as the human infections. Investigators should use ultrasensitive detection methods to identify simian malaria parasite transmission in humans.

EID Liew J, Bukhari F, Jeyaprakasam N, Phang W, Vythilingam I, Lau Y. Natural Plasmodium inui Infections in Humans and Anopheles cracens Mosquito, Malaysia. Emerg Infect Dis. 2021;27(10):2700-2703. https://doi.org/10.3201/eid2710.210412
AMA Liew J, Bukhari F, Jeyaprakasam N, et al. Natural Plasmodium inui Infections in Humans and Anopheles cracens Mosquito, Malaysia. Emerging Infectious Diseases. 2021;27(10):2700-2703. doi:10.3201/eid2710.210412.
APA Liew, J., Bukhari, F., Jeyaprakasam, N., Phang, W., Vythilingam, I., & Lau, Y. (2021). Natural Plasmodium inui Infections in Humans and Anopheles cracens Mosquito, Malaysia. Emerging Infectious Diseases, 27(10), 2700-2703. https://doi.org/10.3201/eid2710.210412.

Outbreak of Oropouche Virus in French Guiana [PDF - 2.06 MB - 4 pages]
M. Gaillet et al.

Oropouche fever is a zoonotic dengue-like syndrome caused by Oropouche virus. In August–September 2020, dengue-like syndrome developed in 41 patients in a remote rainforest village in French Guiana. By PCR or microneutralization, 23 (82.1%) of 28 tested patients were positive for Oropouche virus, documenting its emergence in French Guiana.

EID Gaillet M, Pichard C, Restrepo J, Lavergne A, Perez L, Enfissi A, et al. Outbreak of Oropouche Virus in French Guiana. Emerg Infect Dis. 2021;27(10):2711-2714. https://doi.org/10.3201/eid2710.204760
AMA Gaillet M, Pichard C, Restrepo J, et al. Outbreak of Oropouche Virus in French Guiana. Emerging Infectious Diseases. 2021;27(10):2711-2714. doi:10.3201/eid2710.204760.
APA Gaillet, M., Pichard, C., Restrepo, J., Lavergne, A., Perez, L., Enfissi, A....Rousset, D. (2021). Outbreak of Oropouche Virus in French Guiana. Emerging Infectious Diseases, 27(10), 2711-2714. https://doi.org/10.3201/eid2710.204760.

Rapid Increase in Lymphogranuloma Venereum among HIV-Negative Men Who Have Sex with Men, England, 2019 [PDF - 1.09 MB - 5 pages]
M. Prochazka et al.

Incidence of lymphogranuloma venereum increased in England during 2018–2019, after a period of decline. Our retrospective analysis of national surveillance data identified a rapid increase in diagnoses among HIV-negative men who have sex with men. These findings indicate a need for sustained surveillance and targeted public health action.

EID Prochazka M, Charles H, Allen H, Cole M, Hughes G, Sinka K. Rapid Increase in Lymphogranuloma Venereum among HIV-Negative Men Who Have Sex with Men, England, 2019. Emerg Infect Dis. 2021;27(10):2695-2699. https://doi.org/10.3201/eid2710.210309
AMA Prochazka M, Charles H, Allen H, et al. Rapid Increase in Lymphogranuloma Venereum among HIV-Negative Men Who Have Sex with Men, England, 2019. Emerging Infectious Diseases. 2021;27(10):2695-2699. doi:10.3201/eid2710.210309.
APA Prochazka, M., Charles, H., Allen, H., Cole, M., Hughes, G., & Sinka, K. (2021). Rapid Increase in Lymphogranuloma Venereum among HIV-Negative Men Who Have Sex with Men, England, 2019. Emerging Infectious Diseases, 27(10), 2695-2699. https://doi.org/10.3201/eid2710.210309.

Confirmation of Rickettsia conorii Subspecies indica Infection by Next-Generation Sequencing, Shandong, China [PDF - 1.23 MB - 4 pages]
N. Xu et al.

We describe 3 similar cases of rickettsial disease that occurred after tick bites in a mountainous rural area of Shandong Province, China. Next-generation sequencing indicated the etiologic agent of 1 patient was Rickettsia conorii subspecies indica. This agent may be more widely distributed across China than previously thought.

EID Xu N, Gai W, Zhang Y, Wang W, Wang G, Dasch GA, et al. Confirmation of Rickettsia conorii Subspecies indica Infection by Next-Generation Sequencing, Shandong, China. Emerg Infect Dis. 2021;27(10):2691-2694. https://doi.org/10.3201/eid2710.204764
AMA Xu N, Gai W, Zhang Y, et al. Confirmation of Rickettsia conorii Subspecies indica Infection by Next-Generation Sequencing, Shandong, China. Emerging Infectious Diseases. 2021;27(10):2691-2694. doi:10.3201/eid2710.204764.
APA Xu, N., Gai, W., Zhang, Y., Wang, W., Wang, G., Dasch, G. A....Eremeeva, M. E. (2021). Confirmation of Rickettsia conorii Subspecies indica Infection by Next-Generation Sequencing, Shandong, China. Emerging Infectious Diseases, 27(10), 2691-2694. https://doi.org/10.3201/eid2710.204764.

Relapsing Fever Infection Manifesting as Aseptic Meningitis
L. Ellis et al.

Genetic Characterization of Seoul Virus in the Seaport of Cotonou, Benin [PDF - 650 KB - 3 pages]
G. Castel et al.

Seoul virus is a zoonotic pathogen carried by the brown rat Rattus norvegicus. Information on its circulation in Africa is limited. In this study, the virus was detected in 37.5% of brown rats captured in the Autonomous Port of Cotonou, Benin. Phylogenetic analyses place this virus in Seoul virus lineage 7.

EID Castel G, Kant R, Badou S, Etougbétché J, Dossou H, Gauthier P, et al. Genetic Characterization of Seoul Virus in the Seaport of Cotonou, Benin. Emerg Infect Dis. 2021;27(10):2704-2706. https://doi.org/10.3201/eid2710.210268
AMA Castel G, Kant R, Badou S, et al. Genetic Characterization of Seoul Virus in the Seaport of Cotonou, Benin. Emerging Infectious Diseases. 2021;27(10):2704-2706. doi:10.3201/eid2710.210268.
APA Castel, G., Kant, R., Badou, S., Etougbétché, J., Dossou, H., Gauthier, P....Dobigny, G. (2021). Genetic Characterization of Seoul Virus in the Seaport of Cotonou, Benin. Emerging Infectious Diseases, 27(10), 2704-2706. https://doi.org/10.3201/eid2710.210268.

Multiple Transmission Chains within COVID-19 Cluster, Connecticut, USA, 2020 [PDF - 1.28 MB - 4 pages]
S. M. Bart et al.

In fall 2020, a coronavirus disease cluster comprising 16 cases occurred in Connecticut, USA. Epidemiologic and genomic evidence supported transmission among persons at a school and fitness center but not a workplace. The multiple transmission chains identified within this cluster highlight the necessity of a combined investigatory approach.

EID Bart SM, Flaherty E, Alpert T, Carlson S, Fasulo L, Earnest R, et al. Multiple Transmission Chains within COVID-19 Cluster, Connecticut, USA, 2020. Emerg Infect Dis. 2021;27(10):2669-2672. https://doi.org/10.3201/eid2710.211196
AMA Bart SM, Flaherty E, Alpert T, et al. Multiple Transmission Chains within COVID-19 Cluster, Connecticut, USA, 2020. Emerging Infectious Diseases. 2021;27(10):2669-2672. doi:10.3201/eid2710.211196.
APA Bart, S. M., Flaherty, E., Alpert, T., Carlson, S., Fasulo, L., Earnest, R....Sosa, L. E. (2021). Multiple Transmission Chains within COVID-19 Cluster, Connecticut, USA, 2020. Emerging Infectious Diseases, 27(10), 2669-2672. https://doi.org/10.3201/eid2710.211196.

Therapeutic Efficacy of Human Monoclonal Antibodies against Andes Virus Infection in Syrian Hamsters [PDF - 1.34 MB - 4 pages]
B. N. Williamson et al.

Andes virus, an orthohantavirus endemic to South America, causes severe hantavirus cardiopulmonary syndrome associated with human-to-human transmission. No approved treatments or vaccines against this virus are available. We show that a combined treatment with 2 monoclonal antibodies protected Syrian hamsters when administered at midstage or late-stage disease.

EID Williamson BN, Prescott J, Garrido JL, Alvarez RA, Feldmann H, Barría MI. Therapeutic Efficacy of Human Monoclonal Antibodies against Andes Virus Infection in Syrian Hamsters. Emerg Infect Dis. 2021;27(10):2707-2710. https://doi.org/10.3201/eid2710.210735
AMA Williamson BN, Prescott J, Garrido JL, et al. Therapeutic Efficacy of Human Monoclonal Antibodies against Andes Virus Infection in Syrian Hamsters. Emerging Infectious Diseases. 2021;27(10):2707-2710. doi:10.3201/eid2710.210735.
APA Williamson, B. N., Prescott, J., Garrido, J. L., Alvarez, R. A., Feldmann, H., & Barría, M. I. (2021). Therapeutic Efficacy of Human Monoclonal Antibodies against Andes Virus Infection in Syrian Hamsters. Emerging Infectious Diseases, 27(10), 2707-2710. https://doi.org/10.3201/eid2710.210735.

Genomic Sequencing of SARS-CoV-2 E484K Variant B.1.243.1, Arizona, USA [PDF - 972 KB - 3 pages]
P. T. Skidmore et al.

Genomic surveillance can provide early insights into new circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants. While conducting genomic surveillance (1,663 cases) from December 2020–April 2021 in Arizona, USA, we detected an emergent E484K-harboring variant, B.1.243.1. This finding demonstrates the importance of real-time SARS-CoV-2 surveillance to better inform public health responses.

EID Skidmore PT, Kaelin EA, Holland LA, Maqsood R, Wu LI, Mellor NJ, et al. Genomic Sequencing of SARS-CoV-2 E484K Variant B.1.243.1, Arizona, USA. Emerg Infect Dis. 2021;27(10):2718-2720. https://doi.org/10.3201/eid2710.211189
AMA Skidmore PT, Kaelin EA, Holland LA, et al. Genomic Sequencing of SARS-CoV-2 E484K Variant B.1.243.1, Arizona, USA. Emerging Infectious Diseases. 2021;27(10):2718-2720. doi:10.3201/eid2710.211189.
APA Skidmore, P. T., Kaelin, E. A., Holland, L. A., Maqsood, R., Wu, L. I., Mellor, N. J....Lim, E. S. (2021). Genomic Sequencing of SARS-CoV-2 E484K Variant B.1.243.1, Arizona, USA. Emerging Infectious Diseases, 27(10), 2718-2720. https://doi.org/10.3201/eid2710.211189.
Research Letters

Autochthonous Case of Rickettsia slovaca Infection in Russia [PDF - 1.31 MB - 3 pages]
R. F. Sayfullin et al.

We describe an autochthonous case of Rickettsia slovaca infection in a man 35 years of age from Russia who had tickborne lymphadenopathy. We used ELISA and quantitative PCR testing to further identify DNA and confirm diagnosis. Physicians in Russia should consider similar diseases in differential diagnoses after tick bites.

EID Sayfullin RF, Perekopskaya NE, Karan LS, Zvereva NN, Sayfullin MA. Autochthonous Case of Rickettsia slovaca Infection in Russia. Emerg Infect Dis. 2021;27(10):2736-2738. https://doi.org/10.3201/eid2710.204621
AMA Sayfullin RF, Perekopskaya NE, Karan LS, et al. Autochthonous Case of Rickettsia slovaca Infection in Russia. Emerging Infectious Diseases. 2021;27(10):2736-2738. doi:10.3201/eid2710.204621.
APA Sayfullin, R. F., Perekopskaya, N. E., Karan, L. S., Zvereva, N. N., & Sayfullin, M. A. (2021). Autochthonous Case of Rickettsia slovaca Infection in Russia. Emerging Infectious Diseases, 27(10), 2736-2738. https://doi.org/10.3201/eid2710.204621.

Indoor and Outdoor Rodent Hosts of Orientia tsutsugamushi, Shandong Province, China [PDF - 1006 KB - 3 pages]
F. Li et al.

During December 2012–July 2016, we tested small indoor and outdoor mammals in Qingdao, China, for Orientia tsutsugamushi infection. We found that outdoor Apodemus agrarius mice, Cricetulus barabensis hamsters, and Niviventer confucianus rats, as well as indoor Mus musculus mice, tested positive for O. tsutsugamushi by PCR.

EID Li F, Zhang Z, Fang L, Yu H, Qin X, Yu X. Indoor and Outdoor Rodent Hosts of Orientia tsutsugamushi, Shandong Province, China. Emerg Infect Dis. 2021;27(10):2731-2734. https://doi.org/10.3201/eid2710.210393
AMA Li F, Zhang Z, Fang L, et al. Indoor and Outdoor Rodent Hosts of Orientia tsutsugamushi, Shandong Province, China. Emerging Infectious Diseases. 2021;27(10):2731-2734. doi:10.3201/eid2710.210393.
APA Li, F., Zhang, Z., Fang, L., Yu, H., Qin, X., & Yu, X. (2021). Indoor and Outdoor Rodent Hosts of Orientia tsutsugamushi, Shandong Province, China. Emerging Infectious Diseases, 27(10), 2731-2734. https://doi.org/10.3201/eid2710.210393.

SARS-CoV-2 Neutralization Resistance Mutations in Patient with HIV/AIDS, California, USA [PDF - 835 KB - 4 pages]
S. A. Hoffman et al.

We report persistent severe acute respiratory syndrome coronavirus 2 infection in a patient with HIV/AIDS; the virus developed spike N terminal domain and receptor binding domain neutralization resistance mutations. Our findings suggest that immunocompromised patients can harbor emerging variants of severe acute respiratory syndrome coronavirus 2.

EID Hoffman SA, Costales C, Sahoo MK, Palanisamy S, Yamamoto F, Huang C, et al. SARS-CoV-2 Neutralization Resistance Mutations in Patient with HIV/AIDS, California, USA. Emerg Infect Dis. 2021;27(10):2720-2723. https://doi.org/10.3201/eid2710.211461
AMA Hoffman SA, Costales C, Sahoo MK, et al. SARS-CoV-2 Neutralization Resistance Mutations in Patient with HIV/AIDS, California, USA. Emerging Infectious Diseases. 2021;27(10):2720-2723. doi:10.3201/eid2710.211461.
APA Hoffman, S. A., Costales, C., Sahoo, M. K., Palanisamy, S., Yamamoto, F., Huang, C....Pinsky, B. A. (2021). SARS-CoV-2 Neutralization Resistance Mutations in Patient with HIV/AIDS, California, USA. Emerging Infectious Diseases, 27(10), 2720-2723. https://doi.org/10.3201/eid2710.211461.

Emergence of SARS-COV-2 Spike Protein Escape Mutation Q493R after Treatment for COVID-19 [PDF - 1.12 MB - 4 pages]
D. Focosi et al.

We report in vivo selection of a severe acute respiratory syndrome coronavirus 2 spike mutation (Q493R) conferring simultaneous resistance to bamlanivimab and etesivimab. This mutation was isolated from a patient who had coronavirus disease and was treated with these drugs.

EID Focosi D, Novazzi F, Genoni A, Dentali F, Gasperina D, Baj A, et al. Emergence of SARS-COV-2 Spike Protein Escape Mutation Q493R after Treatment for COVID-19. Emerg Infect Dis. 2021;27(10):2728-2731. https://doi.org/10.3201/eid2710.211538
AMA Focosi D, Novazzi F, Genoni A, et al. Emergence of SARS-COV-2 Spike Protein Escape Mutation Q493R after Treatment for COVID-19. Emerging Infectious Diseases. 2021;27(10):2728-2731. doi:10.3201/eid2710.211538.
APA Focosi, D., Novazzi, F., Genoni, A., Dentali, F., Gasperina, D., Baj, A....Maggi, F. (2021). Emergence of SARS-COV-2 Spike Protein Escape Mutation Q493R after Treatment for COVID-19. Emerging Infectious Diseases, 27(10), 2728-2731. https://doi.org/10.3201/eid2710.211538.

SARS-CoV-2 Variants in Immunocompromised Patient Given Antibody Monotherapy [PDF - 2.45 MB - 4 pages]
A. Truffot et al.

A 72-year-old immunocompromised man infected with severe acute respiratory syndrome coronavirus 2 received bamlanivimab monotherapy. Viral evolution was monitored in nasopharyngeal and blood samples by melting curve analysis of single-nucleotide polymorphisms and whole-genome sequencing. Rapid emergence of spike receptor binding domain mutations was found, associated with a compartmentalization of viral populations.

EID Truffot A, Andréani J, Le Maréchal M, Caporossi A, Epaulard O, Germi R, et al. SARS-CoV-2 Variants in Immunocompromised Patient Given Antibody Monotherapy. Emerg Infect Dis. 2021;27(10):2725-2728. https://doi.org/10.3201/eid2710.211509
AMA Truffot A, Andréani J, Le Maréchal M, et al. SARS-CoV-2 Variants in Immunocompromised Patient Given Antibody Monotherapy. Emerging Infectious Diseases. 2021;27(10):2725-2728. doi:10.3201/eid2710.211509.
APA Truffot, A., Andréani, J., Le Maréchal, M., Caporossi, A., Epaulard, O., Germi, R....Larrat, S. (2021). SARS-CoV-2 Variants in Immunocompromised Patient Given Antibody Monotherapy. Emerging Infectious Diseases, 27(10), 2725-2728. https://doi.org/10.3201/eid2710.211509.

Effects of COVID-19 Pandemic on Reported Lyme Disease, United States, 2020 [PDF - 835 KB - 3 pages]
D. W. McCormick et al.

Surveys indicate US residents spent more time outdoors in 2020 than in 2019, but fewer tick bite–related emergency department visits and Lyme disease laboratory tests were reported. Despite ongoing exposure, Lyme disease case reporting for 2020 might be artificially reduced due to coronavirus disease–associated changes in healthcare-seeking behavior.

EID McCormick DW, Kugeler KJ, Marx GE, Jayanthi P, Dietz S, Mead P, et al. Effects of COVID-19 Pandemic on Reported Lyme Disease, United States, 2020. Emerg Infect Dis. 2021;27(10):2715-2717. https://doi.org/10.3201/eid2710.210903
AMA McCormick DW, Kugeler KJ, Marx GE, et al. Effects of COVID-19 Pandemic on Reported Lyme Disease, United States, 2020. Emerging Infectious Diseases. 2021;27(10):2715-2717. doi:10.3201/eid2710.210903.
APA McCormick, D. W., Kugeler, K. J., Marx, G. E., Jayanthi, P., Dietz, S., Mead, P....Hinckley, A. F. (2021). Effects of COVID-19 Pandemic on Reported Lyme Disease, United States, 2020. Emerging Infectious Diseases, 27(10), 2715-2717. https://doi.org/10.3201/eid2710.210903.

Equine Herpesvirus 1 Variant and New Marker for Epidemiologic Surveillance, Europe, 2021 [PDF - 616 KB - 2 pages]
G. Sutton et al.

Equine herpesvirus 1 isolates from a 2021 outbreak of neurologic disease in Europe have a mutation, A713G, in open reading frame 11 not detected in 249 other sequences from equine herpesvirus 1 isolates. This single-nucleotide polymorphism could help identify horses infected with the virus strain linked to this outbreak.

EID Sutton G, Normand C, Carnet F, Couroucé A, Garvey M, Castagnet S, et al. Equine Herpesvirus 1 Variant and New Marker for Epidemiologic Surveillance, Europe, 2021. Emerg Infect Dis. 2021;27(10):2738-2739. https://doi.org/10.3201/eid2710.210704
AMA Sutton G, Normand C, Carnet F, et al. Equine Herpesvirus 1 Variant and New Marker for Epidemiologic Surveillance, Europe, 2021. Emerging Infectious Diseases. 2021;27(10):2738-2739. doi:10.3201/eid2710.210704.
APA Sutton, G., Normand, C., Carnet, F., Couroucé, A., Garvey, M., Castagnet, S....Pronost, S. (2021). Equine Herpesvirus 1 Variant and New Marker for Epidemiologic Surveillance, Europe, 2021. Emerging Infectious Diseases, 27(10), 2738-2739. https://doi.org/10.3201/eid2710.210704.

Nocardiosis in Immunocompromised Patients on Alternative Pneumocystis Prophylaxis [PDF - 877 KB - 3 pages]
A. G. Puing et al.

Prophylactic trimethoprim/sulfamethoxazole (TMP/SMX) prevents Pneumocystis jirovecii pneumonia and nocardiosis in immunocompromised patients but sometimes is avoided because of purported allergies or side effects. Of 25 immunocompromised patients receiving alternative prophylaxis in whom nocardiosis developed, 16 subsequently tolerated TMP/SMX treatment. Clinicians should consider TMP/SMX allergy evaluation and rechallenging to assess patient tolerance.

EID Puing AG, Epstein DJ, Banaei N, Subramanian AK, Liu AY. Nocardiosis in Immunocompromised Patients on Alternative Pneumocystis Prophylaxis. Emerg Infect Dis. 2021;27(10):2734-2736. https://doi.org/10.3201/eid2710.210620
AMA Puing AG, Epstein DJ, Banaei N, et al. Nocardiosis in Immunocompromised Patients on Alternative Pneumocystis Prophylaxis. Emerging Infectious Diseases. 2021;27(10):2734-2736. doi:10.3201/eid2710.210620.
APA Puing, A. G., Epstein, D. J., Banaei, N., Subramanian, A. K., & Liu, A. Y. (2021). Nocardiosis in Immunocompromised Patients on Alternative Pneumocystis Prophylaxis. Emerging Infectious Diseases, 27(10), 2734-2736. https://doi.org/10.3201/eid2710.210620.

Emergomyces orientalis Emergomycosis Diagnosed by Metagenomic Next-Generation Sequencing [PDF - 1.38 MB - 3 pages]
D. He et al.

Emergomyces is a newly described dimorphic fungus genus; it may cause fatal infections in immunocompromised patients, but diagnosis is often delayed. We report a case of disseminated emergomycosis caused by the novel species Emergomyces orientalis in a kidney transplant recipient from Tibet. Infection was diagnosed early by metagenomic next-generation sequencing.

EID He D, Quan M, Zhong H, Chen Z, Wang X, He F, et al. Emergomyces orientalis Emergomycosis Diagnosed by Metagenomic Next-Generation Sequencing. Emerg Infect Dis. 2021;27(10):2740-2742. https://doi.org/10.3201/eid2710.210769
AMA He D, Quan M, Zhong H, et al. Emergomyces orientalis Emergomycosis Diagnosed by Metagenomic Next-Generation Sequencing. Emerging Infectious Diseases. 2021;27(10):2740-2742. doi:10.3201/eid2710.210769.
APA He, D., Quan, M., Zhong, H., Chen, Z., Wang, X., He, F....Zong, Z. (2021). Emergomyces orientalis Emergomycosis Diagnosed by Metagenomic Next-Generation Sequencing. Emerging Infectious Diseases, 27(10), 2740-2742. https://doi.org/10.3201/eid2710.210769.

Human Infection with Avian Influenza A(H9N2) Virus, Cambodia, February 2021 [PDF - 1.33 MB - 4 pages]
S. Um et al.

In February 2021, routine sentinel surveillance for influenza-like illness in Cambodia detected a human avian influenza A(H9N2) virus infection. Investigations identified no recent H9N2 virus infections in 43 close contacts. One chicken sample from the infected child’s house was positive for H9N2 virus and genetically similar to the human virus.

EID Um S, Siegers JY, Sar B, Chin S, Patel S, Bunnary S, et al. Human Infection with Avian Influenza A(H9N2) Virus, Cambodia, February 2021. Emerg Infect Dis. 2021;27(10):2742-2745. https://doi.org/10.3201/eid2710.211039
AMA Um S, Siegers JY, Sar B, et al. Human Infection with Avian Influenza A(H9N2) Virus, Cambodia, February 2021. Emerging Infectious Diseases. 2021;27(10):2742-2745. doi:10.3201/eid2710.211039.
APA Um, S., Siegers, J. Y., Sar, B., Chin, S., Patel, S., Bunnary, S....Karlsson, E. A. (2021). Human Infection with Avian Influenza A(H9N2) Virus, Cambodia, February 2021. Emerging Infectious Diseases, 27(10), 2742-2745. https://doi.org/10.3201/eid2710.211039.

SARS-CoV-2 Delta Variant among Asiatic Lions, India [PDF - 1.23 MB - 3 pages]
A. Mishra et al.

In May 2021, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was detected in Asiatic lions in a zoological park in India. Sequence and phylogenetic analyses showed the SARS-CoV-2 strains were the B.1.617.2 (Delta) variant. To reduce transmission of variants of concern, surveillance of SARS-CoV-2 in wild animal populations should be increased.

EID Mishra A, Kumar N, Bhatia S, Aasdev A, Kanniappan S, Sekhar A, et al. SARS-CoV-2 Delta Variant among Asiatic Lions, India. Emerg Infect Dis. 2021;27(10):2723-2725. https://doi.org/10.3201/eid2710.211500
AMA Mishra A, Kumar N, Bhatia S, et al. SARS-CoV-2 Delta Variant among Asiatic Lions, India. Emerging Infectious Diseases. 2021;27(10):2723-2725. doi:10.3201/eid2710.211500.
APA Mishra, A., Kumar, N., Bhatia, S., Aasdev, A., Kanniappan, S., Sekhar, A....Singh, V. (2021). SARS-CoV-2 Delta Variant among Asiatic Lions, India. Emerging Infectious Diseases, 27(10), 2723-2725. https://doi.org/10.3201/eid2710.211500.
Letters

Antimicrobial-Resistant Nontyphoidal Salmonella Infections, United States, 2004–2016 [PDF - 633 KB - 1 page]
A. Bharat et al.
EID Bharat A, Murphy CP, Mulvey MR, Hussain S, Carson CA, Reid-Smith RJ. Antimicrobial-Resistant Nontyphoidal Salmonella Infections, United States, 2004–2016. Emerg Infect Dis. 2021;27(10):2746. https://doi.org/10.3201/eid2710.211339
AMA Bharat A, Murphy CP, Mulvey MR, et al. Antimicrobial-Resistant Nontyphoidal Salmonella Infections, United States, 2004–2016. Emerging Infectious Diseases. 2021;27(10):2746. doi:10.3201/eid2710.211339.
APA Bharat, A., Murphy, C. P., Mulvey, M. R., Hussain, S., Carson, C. A., & Reid-Smith, R. J. (2021). Antimicrobial-Resistant Nontyphoidal Salmonella Infections, United States, 2004–2016. Emerging Infectious Diseases, 27(10), 2746. https://doi.org/10.3201/eid2710.211339.
About the Cover

Revisiting the Island of Doctor Moreau [PDF - 1.68 MB - 2 pages]
B. Breedlove
EID Breedlove B. Revisiting the Island of Doctor Moreau. Emerg Infect Dis. 2021;27(10):2747-2748. https://doi.org/10.3201/eid2710.ac2710
AMA Breedlove B. Revisiting the Island of Doctor Moreau. Emerging Infectious Diseases. 2021;27(10):2747-2748. doi:10.3201/eid2710.ac2710.
APA Breedlove, B. (2021). Revisiting the Island of Doctor Moreau. Emerging Infectious Diseases, 27(10), 2747-2748. https://doi.org/10.3201/eid2710.ac2710.
Online Reports

Proactive Engagement of the Expert Meeting in Managing the Early Phase of the COVID-19 Epidemic, Japan, February–June 2020 [PDF - 895 KB - 9 pages]
T. Saito et al.

To deal with the risk of emerging diseases with many unknowns, close and timely collaboration and communication between science experts and policymakers are crucial to developing and implementing an effective science-based intervention strategy. The Expert Meeting, an ad hoc medical advisory body, was established in February 2020 to advise Japan’s COVID-19 Response Headquarters. The group played an important role in the policymaking process, promoting timely situation awareness and developing science-based proposals on interventions that were promptly reflected in government actions. However, this expert group may have been overly proactive in taking on the government’s role in crisis management. For the next stage of managing the coronavirus disease pandemic and future pandemics, the respective roles of the government and its advisory bodies need to be clearly defined. Leadership and strategic risk communication by the government are key.

EID Saito T, Muto K, Tanaka M, Okabe N, Oshitani H, Kamayachi S, et al. Proactive Engagement of the Expert Meeting in Managing the Early Phase of the COVID-19 Epidemic, Japan, February–June 2020. Emerg Infect Dis. 2021;27(10):1-9. https://doi.org/10.3201/eid2710.204685
AMA Saito T, Muto K, Tanaka M, et al. Proactive Engagement of the Expert Meeting in Managing the Early Phase of the COVID-19 Epidemic, Japan, February–June 2020. Emerging Infectious Diseases. 2021;27(10):1-9. doi:10.3201/eid2710.204685.
APA Saito, T., Muto, K., Tanaka, M., Okabe, N., Oshitani, H., Kamayachi, S....Wakita, T. (2021). Proactive Engagement of the Expert Meeting in Managing the Early Phase of the COVID-19 Epidemic, Japan, February–June 2020. Emerging Infectious Diseases, 27(10), 1-9. https://doi.org/10.3201/eid2710.204685.
Conference Summaries

US–Japan Cooperative Medical Sciences Program’s Virtual Workshop on COVID-19
Y. Doi et al.
Page created: September 19, 2021
Page updated: September 19, 2021
Page reviewed: September 19, 2021
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