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Articles from Emerging Infectious Diseases

Perspective

Identifying and Interrupting Superspreading Events—Implications for Control of Severe Acute Respiratory Syndrome Coronavirus 2 [PDF - 334 KB - 8 pages]
T. R. Frieden and C. T. Lee

It appears inevitable that severe acute respiratory syndrome coronavirus 2 will continue to spread. Although we still have limited information on the epidemiology of this virus, there have been multiple reports of superspreading events (SSEs), which are associated with both explosive growth early in an outbreak and sustained transmission in later stages. Although SSEs appear to be difficult to predict and therefore difficult to prevent, core public health actions can prevent and reduce the number and impact of SSEs. To prevent and control of SSEs, speed is essential. Prevention and mitigation of SSEs depends, first and foremost, on quickly recognizing and understanding these events, particularly within healthcare settings. Better understanding transmission dynamics associated with SSEs, identifying and mitigating high-risk settings, strict adherence to healthcare infection prevention and control measures, and timely implementation of nonpharmaceutical interventions can help prevent and control severe acute respiratory syndrome coronavirus 2, as well as future infectious disease outbreaks.

EID Frieden TR, Lee CT. Identifying and Interrupting Superspreading Events—Implications for Control of Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis. 2020;26(6):1059-1066. https://dx.doi.org/10.3201/eid2606.200495
AMA Frieden TR, Lee CT. Identifying and Interrupting Superspreading Events—Implications for Control of Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases. 2020;26(6):1059-1066. doi:10.3201/eid2606.200495.
APA Frieden, T. R., & Lee, C. T. (2020). Identifying and Interrupting Superspreading Events—Implications for Control of Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases, 26(6), 1059-1066. https://dx.doi.org/10.3201/eid2606.200495.
Synopses

Risks Related to Chikungunya Infections among European Union Travelers, 2012–2018 [PDF - 1.95 MB - 10 pages]
C. M. Gossner et al.

Autochthonous outbreaks of chikungunya have occurred in the European Union (EU) after virus introduction by infected travelers. We reviewed the surveillance data of travel-related cases reported in the EU during 2012–2018 to document factors associated with increased infection rates among travelers and to assess how surveillance data could support preparedness against secondary transmission and timely control of outbreaks. Thirteen EU countries reported 2,616 travel-related chikungunya cases. We observed 3 successive epidemiologic periods; the highest number of cases (75%) occurred during 2014–2015, when most cases were associated with the Caribbean and South America. The highest infection rates among travelers were observed during the same phase. Although surveillance of travel-related cases is relevant for estimating the infection risk for travelers, we could not identify a relationship between the number of infected travelers and a higher likelihood of secondary transmission in the EU.

EID Gossner CM, Fournet N, Dias J, Martínez B, Del Manso M, Young JJ, et al. Risks Related to Chikungunya Infections among European Union Travelers, 2012–2018. Emerg Infect Dis. 2020;26(6):1067-1076. https://dx.doi.org/10.3201/eid2606.190490
AMA Gossner CM, Fournet N, Dias J, et al. Risks Related to Chikungunya Infections among European Union Travelers, 2012–2018. Emerging Infectious Diseases. 2020;26(6):1067-1076. doi:10.3201/eid2606.190490.
APA Gossner, C. M., Fournet, N., Dias, J., Martínez, B., Del Manso, M., Young, J. J....Coulombier, D. (2020). Risks Related to Chikungunya Infections among European Union Travelers, 2012–2018. Emerging Infectious Diseases, 26(6), 1067-1076. https://dx.doi.org/10.3201/eid2606.190490.

Medscape CME Activity
Manifestations of Toxic Shock Syndrome in Children, Columbus, Ohio, USA, 2010–2017 [PDF - 2.48 MB - 7 pages]
A. Cook et al.

Data are limited on the incidence and management of streptococcal toxic shock syndrome (TSS) and nonstreptococcal TSS in children. We aimed to define the clinical patterns of TSS at Nationwide Children’s Hospital in Ohio as they relate to published criteria, diagnostic decisions, and treatment options. Through retrospective chart reviews, we identified 58 patients with TSS (27 streptococcal, 31 nonstreptococcal) during January 2010–September 2017. We observed clinical and laboratory findings that are not part of TSS criteria, such as pyuria in streptococcal TSS (50% of patients) and pulmonary involvement (85%) and coagulopathy (92%) in nonstreptococcal TSS patients. Recommended treatment with clindamycin and intravenous immunoglobulin was delayed in streptococcal TSS patients without rash (3.37 days vs. 0.87 days in patients with rash), leading to prolonged hospitalization and complications. Incorporation of additional TSS signs and symptoms would be helpful in TSS diagnosis and management.

EID Cook A, Janse S, Watson JR, Erdem G. Manifestations of Toxic Shock Syndrome in Children, Columbus, Ohio, USA, 2010–2017. Emerg Infect Dis. 2020;26(6):1077-1083. https://dx.doi.org/10.3201/eid2606.190783
AMA Cook A, Janse S, Watson JR, et al. Manifestations of Toxic Shock Syndrome in Children, Columbus, Ohio, USA, 2010–2017. Emerging Infectious Diseases. 2020;26(6):1077-1083. doi:10.3201/eid2606.190783.
APA Cook, A., Janse, S., Watson, J. R., & Erdem, G. (2020). Manifestations of Toxic Shock Syndrome in Children, Columbus, Ohio, USA, 2010–2017. Emerging Infectious Diseases, 26(6), 1077-1083. https://dx.doi.org/10.3201/eid2606.190783.

Genomic Epidemiology of 2015–2016 Zika Virus Outbreak in Cape Verde [PDF - 1.54 MB - 7 pages]
O. Faye et al.

During 2015–2016, Cape Verde, an island nation off the coast of West Africa, experienced a Zika virus (ZIKV) outbreak involving 7,580 suspected Zika cases and 18 microcephaly cases. Analysis of the complete genomes of 3 ZIKV isolates from the outbreak indicated the strain was of the Asian (not African) lineage. The Cape Verde ZIKV sequences formed a distinct monophylogenetic group and possessed 1–2 (T659A, I756V) unique amino acid changes in the envelope protein. Phylogeographic and serologic evidence support earlier introduction of this lineage into Cape Verde, possibly from northeast Brazil, between June 2014 and August 2015, suggesting cryptic circulation of the virus before the initial wave of cases were detected in October 2015. These findings underscore the utility of genomic-scale epidemiology for outbreak investigations.

EID Faye O, de Lourdes Monteiro M, Vrancken B, Prot M, Lequime S, Diarra M, et al. Genomic Epidemiology of 2015–2016 Zika Virus Outbreak in Cape Verde. Emerg Infect Dis. 2020;26(6):1084-1090. https://dx.doi.org/10.3201/eid2606.190928
AMA Faye O, de Lourdes Monteiro M, Vrancken B, et al. Genomic Epidemiology of 2015–2016 Zika Virus Outbreak in Cape Verde. Emerging Infectious Diseases. 2020;26(6):1084-1090. doi:10.3201/eid2606.190928.
APA Faye, O., de Lourdes Monteiro, M., Vrancken, B., Prot, M., Lequime, S., Diarra, M....Simon-Loriere, E. (2020). Genomic Epidemiology of 2015–2016 Zika Virus Outbreak in Cape Verde. Emerging Infectious Diseases, 26(6), 1084-1090. https://dx.doi.org/10.3201/eid2606.190928.

Epidemiologic Changes of Scrub Typhus in China, 1952–2016 [PDF - 3.53 MB - 11 pages]
Z. Li et al.

Scrub typhus, a miteborne rickettsiosis, has emerged in many areas globally. We analyzed the incidence and spatial–temporal distribution of scrub typhus in China during 1952–1989 and 2006–2016 using national disease surveillance data. A total of 133,623 cases and 174 deaths were recorded. The average annual incidence was 0.13 cases/100,000 population during 1952–1989; incidence increased sharply from 0.09/100,000 population in 2006 to 1.60/100,000 population in 2016. The disease, historically endemic to southern China, has expanded to all the provinces across both rural and urban areas. We identified 3 distinct seasonal patterns nationwide; infections peaked in summer in the southwest, summer-autumn in the southeast, and autumn in the middle-east. Persons >40 years of age and in nonfarming occupations had a higher risk for death. The changing epidemiology of scrub typhus in China warrants an enhanced disease control and prevention program.

EID Li Z, Xin H, Sun J, Lai S, Zeng L, Zheng C, et al. Epidemiologic Changes of Scrub Typhus in China, 1952–2016. Emerg Infect Dis. 2020;26(6):1091-1101. https://dx.doi.org/10.3201/eid2606.191168
AMA Li Z, Xin H, Sun J, et al. Epidemiologic Changes of Scrub Typhus in China, 1952–2016. Emerging Infectious Diseases. 2020;26(6):1091-1101. doi:10.3201/eid2606.191168.
APA Li, Z., Xin, H., Sun, J., Lai, S., Zeng, L., Zheng, C....Gao, G. F. (2020). Epidemiologic Changes of Scrub Typhus in China, 1952–2016. Emerging Infectious Diseases, 26(6), 1091-1101. https://dx.doi.org/10.3201/eid2606.191168.

Pharmacologic Treatments and Supportive Care for Middle East Respiratory Syndrome [PDF - 605 KB - 11 pages]
T. Kain et al.

Available animal and cell line models have suggested that specific therapeutics might be effective in treating Middle East respiratory syndrome (MERS). We conducted a systematic review of evidence for treatment with pharmacologic and supportive therapies. We developed a protocol and searched 5 databases for studies describing treatment of MERS and deaths in MERS patients. Risk of bias (RoB) was assessed by using ROBINS-I tool. We retrieved 3,660 unique citations; 20 observational studies met eligibility, and we studied 13 therapies. Most studies were at serious or critical RoB; no studies were at low RoB. One study, at moderate RoB, showed reduced mortality rates in severe MERS patients with extracorporeal membrane oxygenation; no other studies showed a significant lifesaving benefit to any treatment. The existing literature on treatments for MERS is observational and at moderate to critical RoB. Clinical trials are needed to guide treatment decisions.

EID Kain T, Lindsay PJ, Adhikari N, Arabi YM, Van Kerkhove MD, Fowler RA. Pharmacologic Treatments and Supportive Care for Middle East Respiratory Syndrome. Emerg Infect Dis. 2020;26(6):1102-1112. https://dx.doi.org/10.3201/eid2606.200037
AMA Kain T, Lindsay PJ, Adhikari N, et al. Pharmacologic Treatments and Supportive Care for Middle East Respiratory Syndrome. Emerging Infectious Diseases. 2020;26(6):1102-1112. doi:10.3201/eid2606.200037.
APA Kain, T., Lindsay, P. J., Adhikari, N., Arabi, Y. M., Van Kerkhove, M. D., & Fowler, R. A. (2020). Pharmacologic Treatments and Supportive Care for Middle East Respiratory Syndrome. Emerging Infectious Diseases, 26(6), 1102-1112. https://dx.doi.org/10.3201/eid2606.200037.
Research

Distribution of Streptococcal Pharyngitis and Acute Rheumatic Fever, Auckland, New Zealand, 2010–2016 [PDF - 951 KB - 9 pages]
J. Oliver et al.

Group A Streptococcus (GAS) pharyngitis is a key initiator of acute rheumatic fever (ARF). In New Zealand, ARF cases occur more frequently among persons of certain ethnic and socioeconomic groups. We compared GAS pharyngitis estimates (1,257,058 throat swab samples) with ARF incidence (792 hospitalizations) in Auckland during 2010–2016. Among children 5–14 years of age in primary healthcare clinics, GAS pharyngitis was detected in similar proportions across ethnic groups (≈19%). Relative risk for GAS pharyngitis was moderately elevated among children of Pacific Islander and Māori ethnicities compared with those of European/other ethnicities, but risk for ARF was highly elevated for children of Pacific Islander and Māori ethnicity compared with those of European/other ethnicity. That ethnic disparities are much higher among children with ARF than among those with GAS pharyngitis implies that ARF is driven by factors other than rate of GAS pharyngitis alone.

EID Oliver J, Upton A, Jack SJ, Pierse N, Williamson DA, Baker MG. Distribution of Streptococcal Pharyngitis and Acute Rheumatic Fever, Auckland, New Zealand, 2010–2016. Emerg Infect Dis. 2020;26(6):1113-1121. https://dx.doi.org/10.3201/eid2606.181462
AMA Oliver J, Upton A, Jack SJ, et al. Distribution of Streptococcal Pharyngitis and Acute Rheumatic Fever, Auckland, New Zealand, 2010–2016. Emerging Infectious Diseases. 2020;26(6):1113-1121. doi:10.3201/eid2606.181462.
APA Oliver, J., Upton, A., Jack, S. J., Pierse, N., Williamson, D. A., & Baker, M. G. (2020). Distribution of Streptococcal Pharyngitis and Acute Rheumatic Fever, Auckland, New Zealand, 2010–2016. Emerging Infectious Diseases, 26(6), 1113-1121. https://dx.doi.org/10.3201/eid2606.181462.

Temporary Fertility Decline after Large Rubella Outbreak, Japan [PDF - 1.66 MB - 8 pages]
K. Mizumoto and G. Chowell

Japan experienced 2 large rubella epidemics in 2004 and 2012–2014. Because of suboptimal immunization levels, the country has been experiencing a third major outbreak during 2018–2020. We conducted time series analyses to evaluate the effect of the 2012–2014 nationwide rubella epidemic on prefecture-level natality in Japan. We identified a statistically significant decline in fertility rates associated with rubella epidemic activity and increased Google searches for the term “rubella.” We noted that the timing of fertility declines in 2014 occurred 9–13 months after peak rubella incidence months in 2013 in 4 prefectures with the highest rubella incidence. Public health interventions should focus on enhancing vaccination campaigns against rubella, not only to protect pregnant women from infection but also to mitigate declines in population size and birth rates.

EID Mizumoto K, Chowell G. Temporary Fertility Decline after Large Rubella Outbreak, Japan. Emerg Infect Dis. 2020;26(6):1122-1129. https://dx.doi.org/10.3201/eid2606.181718
AMA Mizumoto K, Chowell G. Temporary Fertility Decline after Large Rubella Outbreak, Japan. Emerging Infectious Diseases. 2020;26(6):1122-1129. doi:10.3201/eid2606.181718.
APA Mizumoto, K., & Chowell, G. (2020). Temporary Fertility Decline after Large Rubella Outbreak, Japan. Emerging Infectious Diseases, 26(6), 1122-1129. https://dx.doi.org/10.3201/eid2606.181718.

Radical Change in Zoonotic Abilities of Atypical BSE Prion Strains as Evidenced by Crossing of Sheep Species Barrier in Transgenic Mice [PDF - 1.33 MB - 10 pages]
A. Marín-Moreno et al.

Classical bovine spongiform encephalopathy (BSE) is the only zoonotic prion disease described to date. Although the zoonotic potential of atypical BSE prions have been partially studied, an extensive analysis is still needed. We conducted a systematic study by inoculating atypical BSE isolates from different countries in Europe into transgenic mice overexpressing human prion protein (PrP): TgMet129, TgMet/Val129, and TgVal129. L-type BSE showed a higher zoonotic potential in TgMet129 mice than classical BSE, whereas Val129-PrP variant was a strong molecular protector against L-type BSE prions, even in heterozygosis. H-type BSE could not be transmitted to any of the mice. We also adapted 1 H- and 1 L-type BSE isolate to sheep-PrP transgenic mice and inoculated them into human-PrP transgenic mice. Atypical BSE prions showed a modification in their zoonotic ability after adaptation to sheep-PrP producing agents able to infect TgMet129 and TgVal129, bearing features that make them indistinguishable of sporadic Creutzfeldt-Jakob disease prions.

EID Marín-Moreno A, Huor A, Espinosa J, Douet J, Aguilar-Calvo P, Aron N, et al. Radical Change in Zoonotic Abilities of Atypical BSE Prion Strains as Evidenced by Crossing of Sheep Species Barrier in Transgenic Mice. Emerg Infect Dis. 2020;26(6):1130-1139. https://dx.doi.org/10.3201/eid2606.181790
AMA Marín-Moreno A, Huor A, Espinosa J, et al. Radical Change in Zoonotic Abilities of Atypical BSE Prion Strains as Evidenced by Crossing of Sheep Species Barrier in Transgenic Mice. Emerging Infectious Diseases. 2020;26(6):1130-1139. doi:10.3201/eid2606.181790.
APA Marín-Moreno, A., Huor, A., Espinosa, J., Douet, J., Aguilar-Calvo, P., Aron, N....Torres, J. (2020). Radical Change in Zoonotic Abilities of Atypical BSE Prion Strains as Evidenced by Crossing of Sheep Species Barrier in Transgenic Mice. Emerging Infectious Diseases, 26(6), 1130-1139. https://dx.doi.org/10.3201/eid2606.181790.

Characterization of Sporadic Creutzfeldt-Jakob Disease and History of Neurosurgery to Identify Potential Iatrogenic Cases [PDF - 1.55 MB - 7 pages]
T. Hamaguchi et al.

We previously reported a phenotype of Creutzfeldt-Jakob disease (CJD), CJD-MMiK, that could help identify iatrogenic CJD. To find cases mimicking CJD-MMiK, we investigated clinical features and pathology of 1,155 patients with diagnosed sporadic CJD or unclassified CJD with and without history of neurosurgery. Patients with history of neurosurgery more frequently had an absence of periodic sharp-wave complexes on electroencephalogram than patients without a history of neurosurgery. Among 27 patients with history of neurosurgery, 5 had no periodic sharp-wave complexes on electroencephalogram. We confirmed 1 case of CJD-MMiK and suspected another. Both had methionine homozygosity at codon 129 of the prion protein gene and hyperintensity lesions in the thalamus on magnetic resonance images of the brain, which might be a clinical marker of CJD-MMiK. A subgroup with a history of neurosurgery and clinical features mimicking dura mater graft-associated CJD might have been infected during neurosurgery and had symptoms develop after many years.

EID Hamaguchi T, Sakai K, Kobayashi A, Kitamoto T, Ae R, Nakamura Y, et al. Characterization of Sporadic Creutzfeldt-Jakob Disease and History of Neurosurgery to Identify Potential Iatrogenic Cases. Emerg Infect Dis. 2020;26(6):1140-1146. https://dx.doi.org/10.3201/eid2606.181969
AMA Hamaguchi T, Sakai K, Kobayashi A, et al. Characterization of Sporadic Creutzfeldt-Jakob Disease and History of Neurosurgery to Identify Potential Iatrogenic Cases. Emerging Infectious Diseases. 2020;26(6):1140-1146. doi:10.3201/eid2606.181969.
APA Hamaguchi, T., Sakai, K., Kobayashi, A., Kitamoto, T., Ae, R., Nakamura, Y....Yamada, M. (2020). Characterization of Sporadic Creutzfeldt-Jakob Disease and History of Neurosurgery to Identify Potential Iatrogenic Cases. Emerging Infectious Diseases, 26(6), 1140-1146. https://dx.doi.org/10.3201/eid2606.181969.

Failures of 13-Valent Conjugated Pneumococcal Vaccine in Age-Appropriately Vaccinated Children 2–59 Months of Age, Spain [PDF - 460 KB - 9 pages]
S. Hernández et al.

Vaccination with the 13-valent conjugated pneumococcal disease (PCV13) has reduced invasive pneumococcal disease (IPD), but there have been reports of vaccine failures. We performed a prospective study in children aged 2–59 months who received diagnoses of IPD during January 2012–June 2016 in 3 pediatric hospitals in Catalonia, Spain, a region with a PCV13 vaccination coverage of 63%. We analyzed patients who had been age-appropriately vaccinated but who developed IPD caused by PCV13 serotypes. We detected 24 vaccine failure cases. The serotypes involved were 3 (16 cases); 19A (5 cases); and 1, 6B, and 14 (1 case each). Cases were associated with children without underlying conditions, with complicated pneumonia (OR 6.65, 95% CI 1.91–23.21), and with diagnosis by PCR (OR 5.18, 95% CI 1.84–14.59). Vaccination coverage should be increased to reduce the circulation of vaccine serotypes. Continuous surveillance of cases of IPD using both culture and PCR to characterize vaccine failures is necessary.

EID Hernández S, Moraga-Llop F, Díaz A, de Sevilla MF, Ciruela P, Muñoz-Almagro C, et al. Failures of 13-Valent Conjugated Pneumococcal Vaccine in Age-Appropriately Vaccinated Children 2–59 Months of Age, Spain. Emerg Infect Dis. 2020;26(6):1147-1155. https://dx.doi.org/10.3201/eid2606.190951
AMA Hernández S, Moraga-Llop F, Díaz A, et al. Failures of 13-Valent Conjugated Pneumococcal Vaccine in Age-Appropriately Vaccinated Children 2–59 Months of Age, Spain. Emerging Infectious Diseases. 2020;26(6):1147-1155. doi:10.3201/eid2606.190951.
APA Hernández, S., Moraga-Llop, F., Díaz, A., de Sevilla, M. F., Ciruela, P., Muñoz-Almagro, C....Domínguez, Á. (2020). Failures of 13-Valent Conjugated Pneumococcal Vaccine in Age-Appropriately Vaccinated Children 2–59 Months of Age, Spain. Emerging Infectious Diseases, 26(6), 1147-1155. https://dx.doi.org/10.3201/eid2606.190951.

Increased Risk for Carbapenem-Resistant Enterobacteriaceae Colonization in Intensive Care Units after Hospitalization in Emergency Department [PDF - 1.95 MB - 8 pages]
M. Salomão et al.

Carbapenem-resistant Enterobacteriaceae (CRE) colonization is common in hospital patients admitted to intensive care units (ICU) from the emergency department. We evaluated the effect of previous hospitalization in the emergency department on CRE colonization at ICU admission. Our case–control study included 103 cases and 201 controls; cases were patients colonized by CRE at admission to ICU and controls were patients admitted to ICU and not colonized. Risk factors were emergency department stay, use of carbapenem, Simplified Acute Physiology Score, upper digestive endoscopy, and transfer from another hospital. We found that ED stay before ICU admission was associated with CRE colonization at admission to the ICU. Our findings indicate that addressing infection control problems in EDs will help to control carbapenem resistance in ICUs.

EID Salomão M, Freire M, Boszczowski I, Raymundo SF, Guedes A, Levin AS. Increased Risk for Carbapenem-Resistant Enterobacteriaceae Colonization in Intensive Care Units after Hospitalization in Emergency Department. Emerg Infect Dis. 2020;26(6):1156-1163. https://dx.doi.org/10.3201/eid2606.190965
AMA Salomão M, Freire M, Boszczowski I, et al. Increased Risk for Carbapenem-Resistant Enterobacteriaceae Colonization in Intensive Care Units after Hospitalization in Emergency Department. Emerging Infectious Diseases. 2020;26(6):1156-1163. doi:10.3201/eid2606.190965.
APA Salomão, M., Freire, M., Boszczowski, I., Raymundo, S. F., Guedes, A., & Levin, A. S. (2020). Increased Risk for Carbapenem-Resistant Enterobacteriaceae Colonization in Intensive Care Units after Hospitalization in Emergency Department. Emerging Infectious Diseases, 26(6), 1156-1163. https://dx.doi.org/10.3201/eid2606.190965.

Antimicrobial Resistance in Salmonella enterica Serovar Paratyphi B Variant Java in Poultry from Europe and Latin America [PDF - 1.99 MB - 10 pages]
L. Castellanos et al.

Salmonella enterica serovar Paratyphi B variant Java sequence type 28 is prevalent in poultry and poultry meat. We investigated the evolutionary relatedness between sequence type 28 strains from Europe and Latin America using time-resolved phylogeny and principal component analysis. We sequenced isolates from Colombia, Guatemala, Costa Rica, and the Netherlands and complemented them with publicly available genomes from Europe, Africa, and the Middle East. Phylogenetic time trees and effective population sizes (Ne) showed separate clustering of strains from Latin America and Europe. The separation is estimated to have occurred during the 1980s. Ne of strains increased sharply in Europe around 1995 and in Latin America around 2005. Principal component analysis on noncore genes showed a clear distinction between strains from Europe and Latin America, whereas the plasmid gene content was similar. Regardless of the evolutionary separation, similar features of resistance to β-lactams and quinolones/fluoroquinolones indicated parallel evolution of antimicrobial resistance in both regions.

EID Castellanos L, van der Graaf-van Bloois L, Donado-Godoy P, Veldman K, Duarte F, Acuña MT, et al. Antimicrobial Resistance in Salmonella enterica Serovar Paratyphi B Variant Java in Poultry from Europe and Latin America. Emerg Infect Dis. 2020;26(6):1164-1173. https://dx.doi.org/10.3201/eid2606.191121
AMA Castellanos L, van der Graaf-van Bloois L, Donado-Godoy P, et al. Antimicrobial Resistance in Salmonella enterica Serovar Paratyphi B Variant Java in Poultry from Europe and Latin America. Emerging Infectious Diseases. 2020;26(6):1164-1173. doi:10.3201/eid2606.191121.
APA Castellanos, L., van der Graaf-van Bloois, L., Donado-Godoy, P., Veldman, K., Duarte, F., Acuña, M. T....Zomer, A. L. (2020). Antimicrobial Resistance in Salmonella enterica Serovar Paratyphi B Variant Java in Poultry from Europe and Latin America. Emerging Infectious Diseases, 26(6), 1164-1173. https://dx.doi.org/10.3201/eid2606.191121.

Invasive Group B Streptococcus Infections in Adults, England, 2015–2016 [PDF - 1.05 MB - 8 pages]
S. M. Collin et al.

During 2015–2016, a total of 3,156 episodes of invasive group B Streptococcus (iGBS) infection in adults (>15 years of age) were recorded in England, corresponding to an annual incidence of 3.48/100,000 population. iGBS incidence was highest in older patients and women of childbearing age. The 493 pregnancy-related iGBS episodes correspond to a rate of 1.34/10,000 live births. In adults up to 60–69 years of age and in pregnant women, iGBS incidence increased with higher levels of socioeconomic deprivation. Hospital admissions associated with iGBS were predominantly emergency admissions (73% [2,260/3,099]); only 7% of nonpregnancy iGBS diagnoses were made >48 hours after admission. Underlying conditions were highly prevalent in nonpregnant adult case-patients, including cardiovascular (57%), lung (43%), and kidney (45%) disease and diabetes (40%). Post-iGBS episode 30-day and 12-month all-cause mortality rates in nonpregnant adults were 12% and 24%, respectively. No pregnancy-related iGBS deaths were identified.

EID Collin SM, Shetty N, Lamagni T. Invasive Group B Streptococcus Infections in Adults, England, 2015–2016. Emerg Infect Dis. 2020;26(6):1174-1181. https://dx.doi.org/10.3201/eid2606.191141
AMA Collin SM, Shetty N, Lamagni T. Invasive Group B Streptococcus Infections in Adults, England, 2015–2016. Emerging Infectious Diseases. 2020;26(6):1174-1181. doi:10.3201/eid2606.191141.
APA Collin, S. M., Shetty, N., & Lamagni, T. (2020). Invasive Group B Streptococcus Infections in Adults, England, 2015–2016. Emerging Infectious Diseases, 26(6), 1174-1181. https://dx.doi.org/10.3201/eid2606.191141.

Zoonotic Alphaviruses in Fatal and Neurologic Infections in Wildlife and Nonequine Domestic Animals, South Africa [PDF - 1.73 MB - 9 pages]
J. Steyn et al.

Alphaviruses from Africa, such as Middelburg virus (MIDV), and Sindbis virus (SINV), were detected in horses with neurologic disease in South Africa, but their host ranges remain unknown. We investigated the contribution of alphaviruses to neurologic infections and death in wildlife and domestic animals in this country. During 2010–2018, a total of 608 clinical samples from wildlife and nonequine domestic animals that had febrile, neurologic signs or unexplained deaths were tested for alphaviruses. We identified 32 (5.5%) of 608 alphavirus infections (9 SINV and 23 MIDV), mostly in neurotissue of wildlife, domestic animals, and birds. Phylogenetic analysis of the RNA-dependent RNA polymerase gene confirmed either SINV or MIDV. This study implicates MIDV and SINV as potential causes of neurologic disease in wildlife and nonequine domestic species in Africa and suggests a wide host range and pathogenic potential.

EID Steyn J, Fourie I, Steyl J, Williams J, Stivaktas V, Botha E, et al. Zoonotic Alphaviruses in Fatal and Neurologic Infections in Wildlife and Nonequine Domestic Animals, South Africa. Emerg Infect Dis. 2020;26(6):1182-1191. https://dx.doi.org/10.3201/eid2606.191179
AMA Steyn J, Fourie I, Steyl J, et al. Zoonotic Alphaviruses in Fatal and Neurologic Infections in Wildlife and Nonequine Domestic Animals, South Africa. Emerging Infectious Diseases. 2020;26(6):1182-1191. doi:10.3201/eid2606.191179.
APA Steyn, J., Fourie, I., Steyl, J., Williams, J., Stivaktas, V., Botha, E....Venter, M. (2020). Zoonotic Alphaviruses in Fatal and Neurologic Infections in Wildlife and Nonequine Domestic Animals, South Africa. Emerging Infectious Diseases, 26(6), 1182-1191. https://dx.doi.org/10.3201/eid2606.191179.

Effectiveness and Tolerability of Oral Amoxicillin in Pregnant Women with Active Syphilis, Japan, 2010–2018 [PDF - 844 KB - 9 pages]
T. Nishijima et al.

We conducted a nationwide retrospective study in Japan to evaluate the effectiveness of oral amoxicillin or ampicillin as alternatives to injectable benzathine penicillin G for treating pregnant women with syphilis and preventing congenital syphilis (CS). We investigated 80 pregnant women with active syphilis treated with amoxicillin or ampicillin during 2010–2018. Overall, 21% (15/71) had pregnancies resulting in CS cases, and 3.8% (3/80) changed therapies because of side effects. Among 26 patients with early syphilis, no CS cases occurred, but among 45 with late syphilis, 15 (33%) CS cases occurred. Among 57 patients who started treatment >60 days before delivery, 8 (14%) had CS pregnancy outcomes. We found oral amoxicillin potentially ineffective for preventing CS cases among pregnant women with late syphilis but potentially effective in those with early syphilis. Prospective studies are needed to definitively evaluate the efficacy of amoxicillin for the treatment of pregnant women with syphilis to prevent CS.

EID Nishijima T, Kawana K, Fukasawa I, Ishikawa N, Taylor MM, Mikamo H, et al. Effectiveness and Tolerability of Oral Amoxicillin in Pregnant Women with Active Syphilis, Japan, 2010–2018. Emerg Infect Dis. 2020;26(6):1192-1200. https://dx.doi.org/10.3201/eid2606.191300
AMA Nishijima T, Kawana K, Fukasawa I, et al. Effectiveness and Tolerability of Oral Amoxicillin in Pregnant Women with Active Syphilis, Japan, 2010–2018. Emerging Infectious Diseases. 2020;26(6):1192-1200. doi:10.3201/eid2606.191300.
APA Nishijima, T., Kawana, K., Fukasawa, I., Ishikawa, N., Taylor, M. M., Mikamo, H....Fujii, T. (2020). Effectiveness and Tolerability of Oral Amoxicillin in Pregnant Women with Active Syphilis, Japan, 2010–2018. Emerging Infectious Diseases, 26(6), 1192-1200. https://dx.doi.org/10.3201/eid2606.191300.

Endemic Chromoblastomycosis Caused Predominantly by Fonsecaea nubica, Madagascar [PDF - 2.57 MB - 11 pages]
T. Rasamoelina et al.

Chromoblastomycosis is an implantation fungal infection. Twenty years ago, Madagascar was recognized as the leading focus of this disease. We recruited patients in Madagascar who had chronic subcutaneous lesions suggestive of dermatomycosis during March 2013–June 2017. Chromoblastomycosis was diagnosed in 50 (33.8%) of 148 patients. The highest prevalence was in northeastern (1.47 cases/100,000 persons) and southern (0.8 cases/100,000 persons) Madagascar. Patients with chromoblastomycosis were older (47.9 years) than those without (37.5 years) (p = 0.0005). Chromoblastomycosis was 3 times more likely to consist of leg lesions (p = 0.003). Molecular analysis identified Fonsecaea nubica in 23 cases and Cladophialophora carrionii in 7 cases. Of 27 patients who underwent follow-up testing, none were completely cured. We highlight the persistence of a high level of chromoblastomycosis endemicity, which was even greater at some locations than 20 years ago. We used molecular tools to identify the Fonsecaea sp. strains isolated from patients as F. nubica.

EID Rasamoelina T, Maubon D, Andrianarison M, Ranaivo I, Sendrasoa F, Rakotozandrindrainy N, et al. Endemic Chromoblastomycosis Caused Predominantly by Fonsecaea nubica, Madagascar. Emerg Infect Dis. 2020;26(6):1201-1211. https://dx.doi.org/10.3201/eid2606.191498
AMA Rasamoelina T, Maubon D, Andrianarison M, et al. Endemic Chromoblastomycosis Caused Predominantly by Fonsecaea nubica, Madagascar. Emerging Infectious Diseases. 2020;26(6):1201-1211. doi:10.3201/eid2606.191498.
APA Rasamoelina, T., Maubon, D., Andrianarison, M., Ranaivo, I., Sendrasoa, F., Rakotozandrindrainy, N....Ramarozatovo, L. S. (2020). Endemic Chromoblastomycosis Caused Predominantly by Fonsecaea nubica, Madagascar. Emerging Infectious Diseases, 26(6), 1201-1211. https://dx.doi.org/10.3201/eid2606.191498.

Emergence of New Non–Clonal Group 258 High-Risk Clones among Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae Isolates, France [PDF - 2.15 MB - 9 pages]
R. A. Bonnin et al.

The worldwide spread of Klebsiella pneumoniae carbapenemase–producing Klebsiella pneumoniae (KPC-Kp) isolates was reported to be caused by dissemination of 1 clonal complex (i.e., clonal group [CG] 258, which includes sequence types [STs] 258 and 512). We conducted whole-genome sequencing and epidemiologic analysis of all KPC-Kp isolates in France in 2018 and found that new successful high-risk clones of ST147, ST307, ST231, and ST383 are now the main drivers of blaKPC genes. The blaKPC genes were mostly carried by Tn4401a and Tn4401d structures and a new non–Tn4401 element. Our epidemiologic investigations showed that the emergence of these non-CG258 KPC-Kp isolates in France was linked to dissemination of these clones from Portugal. Thus, KPC-Kp epidemiology has changed in Europe, at least in several non–KPC-endemic countries of western Europe, such as France and Portugal, where CG258 is not the most prevalent clone.

EID Bonnin RA, Jousset AB, Chiarelli A, Emeraud C, Glaser P, Naas T, et al. Emergence of New Non–Clonal Group 258 High-Risk Clones among Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae Isolates, France. Emerg Infect Dis. 2020;26(6):1212-1220. https://dx.doi.org/10.3201/eid2606.191517
AMA Bonnin RA, Jousset AB, Chiarelli A, et al. Emergence of New Non–Clonal Group 258 High-Risk Clones among Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae Isolates, France. Emerging Infectious Diseases. 2020;26(6):1212-1220. doi:10.3201/eid2606.191517.
APA Bonnin, R. A., Jousset, A. B., Chiarelli, A., Emeraud, C., Glaser, P., Naas, T....Dortet, L. (2020). Emergence of New Non–Clonal Group 258 High-Risk Clones among Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae Isolates, France. Emerging Infectious Diseases, 26(6), 1212-1220. https://dx.doi.org/10.3201/eid2606.191517.

Zoonotic Vectorborne Pathogens and Ectoparasites of Dogs and Cats in Eastern and Southeast Asia [PDF - 4.50 MB - 3 pages]
V. Colella et al.

To provide data that can be used to inform treatment and prevention strategies for zoonotic pathogens in animal and human populations, we assessed the occurrence of zoonotic pathogens and their vectors on 2,381 client-owned dogs and cats living in metropolitan areas of 8 countries in eastern and Southeast Asia during 2017–2018. Overall exposure to ectoparasites was 42.4% in dogs and 31.3% in cats. Our data cover a wide geographic distribution of several pathogens, including Leishmania infantum and zoonotic species of filariae, and of animals infested with arthropods known to be vectors of zoonotic pathogens. Because dogs and cats share a common environment with humans, they are likely to be key reservoirs of pathogens that infect persons in the same environment. These results will help epidemiologists and policy makers provide tailored recommendations for future surveillance and prevention strategies.

EID Colella V, Nguyen VL, Tan DY, Lu N, Fang F, Zhijuan Y, et al. Zoonotic Vectorborne Pathogens and Ectoparasites of Dogs and Cats in Eastern and Southeast Asia. Emerg Infect Dis. 2020;26(6):1221-1233. https://dx.doi.org/10.3201/eid2606.191832
AMA Colella V, Nguyen VL, Tan DY, et al. Zoonotic Vectorborne Pathogens and Ectoparasites of Dogs and Cats in Eastern and Southeast Asia. Emerging Infectious Diseases. 2020;26(6):1221-1233. doi:10.3201/eid2606.191832.
APA Colella, V., Nguyen, V. L., Tan, D. Y., Lu, N., Fang, F., Zhijuan, Y....Halos, L. (2020). Zoonotic Vectorborne Pathogens and Ectoparasites of Dogs and Cats in Eastern and Southeast Asia. Emerging Infectious Diseases, 26(6), 1221-1233. https://dx.doi.org/10.3201/eid2606.191832.

Multihost Transmission of Schistosoma mansoni in Senegal, 2015–2018 [PDF - 737 KB - 9 pages]
S. Catalano et al.

In West Africa, Schistosoma spp. are capable of infecting multiple definitive hosts, a lifecycle feature that may complicate schistosomiasis control. We characterized the evolutionary relationships among multiple Schistosoma mansoni isolates collected from snails (intermediate hosts), humans (definitive hosts), and rodents (definitive hosts) in Senegal. On a local scale, diagnosis of S. mansoni infection ranged 3.8%–44.8% in school-aged children, 1.7%–52.6% in Mastomys huberti mice, and 1.8%–7.1% in Biomphalaria pfeifferi snails. Our phylogenetic framework confirmed the presence of multiple S. mansoni lineages that could infect both humans and rodents; divergence times of these lineages varied (0.13–0.02 million years ago). We propose that extensive movement of persons across West Africa might have contributed to the establishment of these various multihost S. mansoni clades. High S. mansoni prevalence in rodents at transmission sites frequented by humans further highlights the implications that alternative hosts could have on future public health interventions.

EID Catalano S, Léger E, Fall CB, Borlase A, Diop SD, Berger D, et al. Multihost Transmission of Schistosoma mansoni in Senegal, 2015–2018. Emerg Infect Dis. 2020;26(6):1234-1242. https://dx.doi.org/10.3201/eid2606.200107
AMA Catalano S, Léger E, Fall CB, et al. Multihost Transmission of Schistosoma mansoni in Senegal, 2015–2018. Emerging Infectious Diseases. 2020;26(6):1234-1242. doi:10.3201/eid2606.200107.
APA Catalano, S., Léger, E., Fall, C. B., Borlase, A., Diop, S. D., Berger, D....Webster, J. P. (2020). Multihost Transmission of Schistosoma mansoni in Senegal, 2015–2018. Emerging Infectious Diseases, 26(6), 1234-1242. https://dx.doi.org/10.3201/eid2606.200107.

Medscape CME Activity
Statin Use and Influenza Vaccine Effectiveness in Persons ≥ 65 Years of Age, Taiwan [PDF - 1.08 MB - 8 pages]
L. Tsai et al.

Debates on whether statin use reduces the effectiveness of influenza vaccines against critical illness and death among persons >65 years of age continue. We conducted a study of 9,427,392 persons >65 years of age who did and did not receive influenza vaccinations during 12 consecutive influenza seasons, 2000–01 through 2011–12. Using data from Taiwan’s National Health Insurance Research Database, we performed propensity score-matching to compare vaccinated persons with unvaccinated controls. After propensity score-matching, the vaccinated group had lower risks for in-hospital death from influenza and pneumonia and for hospitalization for pneumonia and influenza, circulatory conditions, and critical illnesses compared with the unvaccinated group. We stratified the 2 groups by statin use and analyzed data by interaction analysis and saw no statistically significant difference. We found that influenza vaccine effectively reduced risks for hospitalization and death in persons >65 years of age, regardless of statin use.

EID Tsai L, Chen Y, Shih C, Ou S, Chao P, Lo S. Statin Use and Influenza Vaccine Effectiveness in Persons ≥ 65 Years of Age, Taiwan. Emerg Infect Dis. 2020;26(6):1243-1250. https://dx.doi.org/10.3201/eid2606.190646
AMA Tsai L, Chen Y, Shih C, et al. Statin Use and Influenza Vaccine Effectiveness in Persons ≥ 65 Years of Age, Taiwan. Emerging Infectious Diseases. 2020;26(6):1243-1250. doi:10.3201/eid2606.190646.
APA Tsai, L., Chen, Y., Shih, C., Ou, S., Chao, P., & Lo, S. (2020). Statin Use and Influenza Vaccine Effectiveness in Persons ≥ 65 Years of Age, Taiwan. Emerging Infectious Diseases, 26(6), 1243-1250. https://dx.doi.org/10.3201/eid2606.190646.

Estimating Risk for Death from Coronavirus Disease, China, January–February 2020 [PDF - 696 KB - 6 pages]
K. Mizumoto and G. Chowell

Since December 2019, when the first case of coronavirus disease (COVID-19) was identified in the city of Wuhan in the Hubei Province of China, the epidemic has generated tens of thousands of cases throughout China. As of February 28, 2020, the cumulative number of reported deaths in China was 2,858. We estimated the time-delay adjusted risk for death from COVID-19 in Wuhan, as well as for China excluding Wuhan, to assess the severity of the epidemic in the country. Our estimates of the risk for death in Wuhan reached values as high as 12% in the epicenter of the epidemic and ≈1% in other, more mildly affected areas. The elevated death risk estimates are probably associated with a breakdown of the healthcare system, indicating that enhanced public health interventions, including social distancing and movement restrictions, should be implemented to bring the COVID-19 epidemic under control.

EID Mizumoto K, Chowell G. Estimating Risk for Death from Coronavirus Disease, China, January–February 2020. Emerg Infect Dis. 2020;26(6):1251-1256. https://dx.doi.org/10.3201/eid2606.200233
AMA Mizumoto K, Chowell G. Estimating Risk for Death from Coronavirus Disease, China, January–February 2020. Emerging Infectious Diseases. 2020;26(6):1251-1256. doi:10.3201/eid2606.200233.
APA Mizumoto, K., & Chowell, G. (2020). Estimating Risk for Death from Coronavirus Disease, China, January–February 2020. Emerging Infectious Diseases, 26(6), 1251-1256. https://dx.doi.org/10.3201/eid2606.200233.

Epidemiology of Coronavirus Disease in Gansu Province, China, 2020 [PDF - 2.23 MB - 9 pages]
J. Fan et al.

To determine the epidemiology of coronavirus disease (COVID-19) in a remote region of China, far from Wuhan, we analyzed the epidemiology of COVID-19 in Gansu Province. From January 23 through February 3, 2020, a total of 35 (64.8%) of 54 reported cases were imported from COVID-19–epidemic areas. Characteristics that differed significantly during the first and second waves of illness in Gansu Province were mean patient age, occupation, having visited epidemic areas, and mode of transportation. Time from infection to illness onset for family clusters was shorter in Gansu Province than in Wuhan, consistent with shortened durations from onset to first medical visit or hospitalization. Spatial distribution pattern analysis indicated hot spots and spatial outliers in Gansu Province. As a result of adequate interventions, transmission of the COVID-19 virus in Gansu Province is decreasing.

EID Fan J, Liu X, Pan W, Douglas MW, Bao S. Epidemiology of Coronavirus Disease in Gansu Province, China, 2020. Emerg Infect Dis. 2020;26(6):1257-1265. https://dx.doi.org/10.3201/eid2606.200251
AMA Fan J, Liu X, Pan W, et al. Epidemiology of Coronavirus Disease in Gansu Province, China, 2020. Emerging Infectious Diseases. 2020;26(6):1257-1265. doi:10.3201/eid2606.200251.
APA Fan, J., Liu, X., Pan, W., Douglas, M. W., & Bao, S. (2020). Epidemiology of Coronavirus Disease in Gansu Province, China, 2020. Emerging Infectious Diseases, 26(6), 1257-1265. https://dx.doi.org/10.3201/eid2606.200251.

Severe Acute Respiratory Syndrome Coronavirus 2 from Patient with Coronavirus Disease, United States [PDF - 2.78 MB - 8 pages]
J. Harcourt et al.

The etiologic agent of an outbreak of pneumonia in Wuhan, China, was identified as severe acute respiratory syndrome coronavirus 2 in January 2020. A patient in the United States was given a diagnosis of infection with this virus by the state of Washington and the US Centers for Disease Control and Prevention on January 20, 2020. We isolated virus from nasopharyngeal and oropharyngeal specimens from this patient and characterized the viral sequence, replication properties, and cell culture tropism. We found that the virus replicates to high titer in Vero-CCL81 cells and Vero E6 cells in the absence of trypsin. We also deposited the virus into 2 virus repositories, making it broadly available to the public health and research communities. We hope that open access to this reagent will expedite development of medical countermeasures.

EID Harcourt J, Tamin A, Lu X, Kamili S, Sakthivel SK, Murray J, et al. Severe Acute Respiratory Syndrome Coronavirus 2 from Patient with Coronavirus Disease, United States. Emerg Infect Dis. 2020;26(6):1266-1273. https://dx.doi.org/10.3201/eid2606.200516
AMA Harcourt J, Tamin A, Lu X, et al. Severe Acute Respiratory Syndrome Coronavirus 2 from Patient with Coronavirus Disease, United States. Emerging Infectious Diseases. 2020;26(6):1266-1273. doi:10.3201/eid2606.200516.
APA Harcourt, J., Tamin, A., Lu, X., Kamili, S., Sakthivel, S. K., Murray, J....Thornburg, N. J. (2020). Severe Acute Respiratory Syndrome Coronavirus 2 from Patient with Coronavirus Disease, United States. Emerging Infectious Diseases, 26(6), 1266-1273. https://dx.doi.org/10.3201/eid2606.200516.
Historical Review

Syphilis in Maria Salviati (1499–1543), Wife of Giovanni de’ Medici of the Black Bands [PDF - 4.82 MB - 9 pages]
A. Fornaciari et al.

Researchers from the Division of Paleopathology of Pisa University (Pisa, Italy) exhumed the well-preserved skeleton of Maria Salviati (1499–1543), wife of Giovanni de’ Medici, named “Giovanni of the Black Bands,” in Florence in 2012. Many lytic lesions had affected the skull of Maria on the frontal bone and on the parietal bones. These lesions are pathognomonic for syphilis. An ancient diagnosis of syphilis for Maria Salviati does not emerge from the historical sources, although the symptoms manifested in her last years of life are compatible with a colorectal localization, including severe hemorrhages, caused by syphilitic infection. The case of Maria Salviati can be compared with those of other famous Italian noblewomen of the Renaissance, such as Isabella of Aragon (1470–1524) and Maria of Aragon (1503–1568). Paleopathology made it possible to directly observe a “secret illness” to which noblewomen were susceptible as a result of the sexual conduct of their husbands.

EID Fornaciari A, Gaeta R, Minozzi S, Giuffra V. Syphilis in Maria Salviati (1499–1543), Wife of Giovanni de’ Medici of the Black Bands. Emerg Infect Dis. 2020;26(6):1274-1282. https://dx.doi.org/10.3201/eid2606.180786
AMA Fornaciari A, Gaeta R, Minozzi S, et al. Syphilis in Maria Salviati (1499–1543), Wife of Giovanni de’ Medici of the Black Bands. Emerging Infectious Diseases. 2020;26(6):1274-1282. doi:10.3201/eid2606.180786.
APA Fornaciari, A., Gaeta, R., Minozzi, S., & Giuffra, V. (2020). Syphilis in Maria Salviati (1499–1543), Wife of Giovanni de’ Medici of the Black Bands. Emerging Infectious Diseases, 26(6), 1274-1282. https://dx.doi.org/10.3201/eid2606.180786.
Dispatches

Yaws Disease Caused by Treponema pallidum subspecies pertenue in Wild Chimpanzee, Guinea, 2019 [PDF - 2.22 MB - 4 pages]
B. Mubemba et al.

Yaws-like lesions are widely reported in wild African great apes, yet the causative agent has not been confirmed in affected animals. We describe yaws-like lesions in a wild chimpanzee in Guinea for which we demonstrate infection with Treponema pallidum subsp. pertenue. Assessing the conservation implications of this pathogen requires further research.

EID Mubemba B, Chanove E, Mätz-Rensing K, Gogarten JF, Düx A, Merkel K, et al. Yaws Disease Caused by Treponema pallidum subspecies pertenue in Wild Chimpanzee, Guinea, 2019. Emerg Infect Dis. 2020;26(6):1283-1286. https://dx.doi.org/10.3201/eid2606.191713
AMA Mubemba B, Chanove E, Mätz-Rensing K, et al. Yaws Disease Caused by Treponema pallidum subspecies pertenue in Wild Chimpanzee, Guinea, 2019. Emerging Infectious Diseases. 2020;26(6):1283-1286. doi:10.3201/eid2606.191713.
APA Mubemba, B., Chanove, E., Mätz-Rensing, K., Gogarten, J. F., Düx, A., Merkel, K....Leendertz, F. H. (2020). Yaws Disease Caused by Treponema pallidum subspecies pertenue in Wild Chimpanzee, Guinea, 2019. Emerging Infectious Diseases, 26(6), 1283-1286. https://dx.doi.org/10.3201/eid2606.191713.

Fatal Encephalitis Caused by Cristoli Virus, an Emerging Orthobunyavirus, France [PDF - 700 KB - 4 pages]
C. Rodriguez et al.

We report the discovery of a new orthobunyavirus, Cristoli virus, by means of shotgun metagenomics. The virus was identified in an immunodepressed patient with fatal encephalitis. Full-length genome sequencing revealed high-level expression of a virulence factor, possibly explaining the severity of the infection. The patient’s recent history suggests circulation in France.

EID Rodriguez C, Gricourt G, Ndebi M, Demontant V, Poiteau L, Burrel S, et al. Fatal Encephalitis Caused by Cristoli Virus, an Emerging Orthobunyavirus, France. Emerg Infect Dis. 2020;26(6):1287-1290. https://dx.doi.org/10.3201/eid2606.191431
AMA Rodriguez C, Gricourt G, Ndebi M, et al. Fatal Encephalitis Caused by Cristoli Virus, an Emerging Orthobunyavirus, France. Emerging Infectious Diseases. 2020;26(6):1287-1290. doi:10.3201/eid2606.191431.
APA Rodriguez, C., Gricourt, G., Ndebi, M., Demontant, V., Poiteau, L., Burrel, S....Pawlotsky, J. (2020). Fatal Encephalitis Caused by Cristoli Virus, an Emerging Orthobunyavirus, France. Emerging Infectious Diseases, 26(6), 1287-1290. https://dx.doi.org/10.3201/eid2606.191431.

Increased Community-Associated Clostridioides difficile Infections in Quebec, Canada, 2008–2015 [PDF - 817 KB - 4 pages]
V. Zanichelli et al.

The annual incidence rate of community-associated Clostridioides difficile infections in Quebec, Canada, has increased by 33.3%, from 0.51 (2008) to 0.68 (2015) cases/100,000 population, while incidence of healthcare-associated cases remained relatively stable. Possible causes include increased disease severity, increased antimicrobial drug use, emergence of virulent strains, and heightened physician awareness.

EID Zanichelli V, Garenc C, Villeneuve J, Moisan D, Frenette C, Loo V, et al. Increased Community-Associated Clostridioides difficile Infections in Quebec, Canada, 2008–2015. Emerg Infect Dis. 2020;26(6):1291-1294. https://dx.doi.org/10.3201/eid2606.190233
AMA Zanichelli V, Garenc C, Villeneuve J, et al. Increased Community-Associated Clostridioides difficile Infections in Quebec, Canada, 2008–2015. Emerging Infectious Diseases. 2020;26(6):1291-1294. doi:10.3201/eid2606.190233.
APA Zanichelli, V., Garenc, C., Villeneuve, J., Moisan, D., Frenette, C., Loo, V....Longtin, Y. (2020). Increased Community-Associated Clostridioides difficile Infections in Quebec, Canada, 2008–2015. Emerging Infectious Diseases, 26(6), 1291-1294. https://dx.doi.org/10.3201/eid2606.190233.

Melioidosis in a Resident of Texas with No Recent Travel History, United States [PDF - 1.83 MB - 5 pages]
C. M. Cossaboom et al.

To our knowledge, environmental isolation of Burkholderia pseudomallei, the causative agent of melioidosis, from the continental United States has not been reported. We report a case of melioidosis in a Texas resident. Genomic analysis indicated that the isolate groups with B. pseudomallei isolates from patients in the same region, suggesting possible endemicity to this region.

EID Cossaboom CM, Marinova-Petkova A, Strysko J, Rodriguez G, Maness T, Ocampo J, et al. Melioidosis in a Resident of Texas with No Recent Travel History, United States. Emerg Infect Dis. 2020;26(6):1295-1299. https://dx.doi.org/10.3201/eid2606.190975
AMA Cossaboom CM, Marinova-Petkova A, Strysko J, et al. Melioidosis in a Resident of Texas with No Recent Travel History, United States. Emerging Infectious Diseases. 2020;26(6):1295-1299. doi:10.3201/eid2606.190975.
APA Cossaboom, C. M., Marinova-Petkova, A., Strysko, J., Rodriguez, G., Maness, T., Ocampo, J....Kieffer, A. (2020). Melioidosis in a Resident of Texas with No Recent Travel History, United States. Emerging Infectious Diseases, 26(6), 1295-1299. https://dx.doi.org/10.3201/eid2606.190975.

No Adaptation of the Prion Strain in a Heterozygous Case of Variant Creutzfeldt-Jakob Disease [PDF - 1.57 MB - 4 pages]
A. Boyle et al.

We investigated a clinical case of variant Creutzfeldt-Jakob Disease in a person heterozygous for methionine/valine at codon 129 of the prion protein gene and identified the same strain properties in variant Creutzfeldt-Jakob disease in methionine homozygous persons and in bovine spongiform encephalopathy. These results indicate no adaptation of the agent in a different genetic background.

EID Boyle A, Plinston C, Laing F, Mackenzie G, Will RG, Manson JC, et al. No Adaptation of the Prion Strain in a Heterozygous Case of Variant Creutzfeldt-Jakob Disease. Emerg Infect Dis. 2020;26(6):1300-1303. https://dx.doi.org/10.3201/eid2606.191116
AMA Boyle A, Plinston C, Laing F, et al. No Adaptation of the Prion Strain in a Heterozygous Case of Variant Creutzfeldt-Jakob Disease. Emerging Infectious Diseases. 2020;26(6):1300-1303. doi:10.3201/eid2606.191116.
APA Boyle, A., Plinston, C., Laing, F., Mackenzie, G., Will, R. G., Manson, J. C....Diack, A. B. (2020). No Adaptation of the Prion Strain in a Heterozygous Case of Variant Creutzfeldt-Jakob Disease. Emerging Infectious Diseases, 26(6), 1300-1303. https://dx.doi.org/10.3201/eid2606.191116.

Prevalence of Escherichia albertii in Raccoons (Procyon lotor), Japan [PDF - 845 KB - 4 pages]
A. Hinenoya et al.

Natural reservoirs of Escherichia albertii remain unclear. In this study, we detected E. albertii by PCR in 248 (57.7%) of 430 raccoons from Osaka, Japan, and isolated 143 E. albertii strains from the 62 PCR-positive samples. These data indicate that raccoons could be a natural reservoir of E. albertii in Japan.

EID Hinenoya A, Nagano K, Awasthi SP, Hatanaka N, Yamasaki S. Prevalence of Escherichia albertii in Raccoons (Procyon lotor), Japan. Emerg Infect Dis. 2020;26(6):1304-1307. https://dx.doi.org/10.3201/eid2606.191436
AMA Hinenoya A, Nagano K, Awasthi SP, et al. Prevalence of Escherichia albertii in Raccoons (Procyon lotor), Japan. Emerging Infectious Diseases. 2020;26(6):1304-1307. doi:10.3201/eid2606.191436.
APA Hinenoya, A., Nagano, K., Awasthi, S. P., Hatanaka, N., & Yamasaki, S. (2020). Prevalence of Escherichia albertii in Raccoons (Procyon lotor), Japan. Emerging Infectious Diseases, 26(6), 1304-1307. https://dx.doi.org/10.3201/eid2606.191436.

Cannabis Use and Fungal Infections in a Commercially Insured Population, United States, 2016 [PDF - 296 KB - 3 pages]
K. Benedict et al.

Case reports have identified invasive fungal diseases in persons who use cannabis, and fungal contamination of cannabis has been described. In a large health insurance claims database, persons who used cannabis were 3.5 (95% CI 2.6–4.8) times more likely than persons who did not use cannabis to have a fungal infection in 2016.

EID Benedict K, Thompson GR, Jackson BR. Cannabis Use and Fungal Infections in a Commercially Insured Population, United States, 2016. Emerg Infect Dis. 2020;26(6):1308-1310. https://dx.doi.org/10.3201/eid2606.191570
AMA Benedict K, Thompson GR, Jackson BR. Cannabis Use and Fungal Infections in a Commercially Insured Population, United States, 2016. Emerging Infectious Diseases. 2020;26(6):1308-1310. doi:10.3201/eid2606.191570.
APA Benedict, K., Thompson, G. R., & Jackson, B. R. (2020). Cannabis Use and Fungal Infections in a Commercially Insured Population, United States, 2016. Emerging Infectious Diseases, 26(6), 1308-1310. https://dx.doi.org/10.3201/eid2606.191570.

Leishmania infantum in Tigers and Sand Flies from a Leishmaniasis-Endemic Area, Southern Italy [PDF - 1.45 MB - 4 pages]
R. Iatta et al.

We detected Leishmania infantum infection in 45% of tigers and 5.3% of sand flies tested at a zoo in southern Italy in 2019. These infections in tigers and the abundance of Phlebotomus perniciosus sand flies represent a potential risk to other animals and humans living in or visiting the zoo.

EID Iatta R, Zatelli A, Laricchiuta P, Legrottaglie M, Modry D, Dantas-Torres F, et al. Leishmania infantum in Tigers and Sand Flies from a Leishmaniasis-Endemic Area, Southern Italy. Emerg Infect Dis. 2020;26(6):1311-1314. https://dx.doi.org/10.3201/eid2606.191668
AMA Iatta R, Zatelli A, Laricchiuta P, et al. Leishmania infantum in Tigers and Sand Flies from a Leishmaniasis-Endemic Area, Southern Italy. Emerging Infectious Diseases. 2020;26(6):1311-1314. doi:10.3201/eid2606.191668.
APA Iatta, R., Zatelli, A., Laricchiuta, P., Legrottaglie, M., Modry, D., Dantas-Torres, F....Otranto, D. (2020). Leishmania infantum in Tigers and Sand Flies from a Leishmaniasis-Endemic Area, Southern Italy. Emerging Infectious Diseases, 26(6), 1311-1314. https://dx.doi.org/10.3201/eid2606.191668.

Origin of 3 Rabid Terrestrial Animals in Raccoon Rabies Virus–Free Zone, Long Island, New York, USA, 2016–2017 [PDF - 2.14 MB - 5 pages]
S. Brunt et al.

During 2016–2017, three rabid terrestrial animals were discovered in the raccoon rabies virus–free zone of Long Island, New York, USA. Whole-genome sequencing and phylogenetic analyses revealed the likely origins of the viruses, enabling the rabies outbreak response (often costly and time-consuming) to be done less expensively and more efficiently.

EID Brunt S, Solomon H, Leavitt H, Lasek-Nesselquist E, LaPierre P, Shudt M, et al. Origin of 3 Rabid Terrestrial Animals in Raccoon Rabies Virus–Free Zone, Long Island, New York, USA, 2016–2017. Emerg Infect Dis. 2020;26(6):1315-1319. https://dx.doi.org/10.3201/eid2606.191700
AMA Brunt S, Solomon H, Leavitt H, et al. Origin of 3 Rabid Terrestrial Animals in Raccoon Rabies Virus–Free Zone, Long Island, New York, USA, 2016–2017. Emerging Infectious Diseases. 2020;26(6):1315-1319. doi:10.3201/eid2606.191700.
APA Brunt, S., Solomon, H., Leavitt, H., Lasek-Nesselquist, E., LaPierre, P., Shudt, M....Davis, A. D. (2020). Origin of 3 Rabid Terrestrial Animals in Raccoon Rabies Virus–Free Zone, Long Island, New York, USA, 2016–2017. Emerging Infectious Diseases, 26(6), 1315-1319. https://dx.doi.org/10.3201/eid2606.191700.

Community Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, Shenzhen, China, 2020 [PDF - 1.34 MB - 4 pages]
J. Liu et al.

Since early January 2020, after the outbreak of coronavirus infection in Wuhan, China, ≈365 confirmed cases have been reported in Shenzhen, China. The mode of community and intrafamily transmission is threatening residents in Shenzhen. Strategies to strengthen prevention and interruption of these transmissions should be urgently addressed.

EID Liu J, Liao X, Qian S, Yuan J, Wang F, Liu Y, et al. Community Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, Shenzhen, China, 2020. Emerg Infect Dis. 2020;26(6):1320-1323. https://dx.doi.org/10.3201/eid2606.200239
AMA Liu J, Liao X, Qian S, et al. Community Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, Shenzhen, China, 2020. Emerging Infectious Diseases. 2020;26(6):1320-1323. doi:10.3201/eid2606.200239.
APA Liu, J., Liao, X., Qian, S., Yuan, J., Wang, F., Liu, Y....Zhang, Z. (2020). Community Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, Shenzhen, China, 2020. Emerging Infectious Diseases, 26(6), 1320-1323. https://dx.doi.org/10.3201/eid2606.200239.
Research Letters

Co-infection with SARS-CoV-2 and Influenza A Virus in Patient with Pneumonia, China [PDF - 458 KB - 3 pages]
X. Wu et al.

We report co-infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza A virus in a patient with pneumonia in China. The case highlights possible co-detection of known respiratory viruses. We noted low sensitivity of upper respiratory specimens for SARS-CoV-2, which could further complicate recognition of the full extent of disease.

EID Wu X, Cai Y, Huang X, Yu X, Zhao L, Wang F, et al. Co-infection with SARS-CoV-2 and Influenza A Virus in Patient with Pneumonia, China. Emerg Infect Dis. 2020;26(6):1324-1326. https://dx.doi.org/10.3201/eid2606.200299
AMA Wu X, Cai Y, Huang X, et al. Co-infection with SARS-CoV-2 and Influenza A Virus in Patient with Pneumonia, China. Emerging Infectious Diseases. 2020;26(6):1324-1326. doi:10.3201/eid2606.200299.
APA Wu, X., Cai, Y., Huang, X., Yu, X., Zhao, L., Wang, F....Zhan, Q. (2020). Co-infection with SARS-CoV-2 and Influenza A Virus in Patient with Pneumonia, China. Emerging Infectious Diseases, 26(6), 1324-1326. https://dx.doi.org/10.3201/eid2606.200299.

Incursions of Candida auris into Australia, 2018 [PDF - 722 KB - 3 pages]
C. R. Lane et al.

Candida auris is an emerging global healthcare-associated pathogen. During July–December 2018, four patients with C. auris were identified in Victoria, Australia, all with previous overseas hospitalization. Phylogenetic analysis revealed putative transmission between 2 patients and suspected overseas acquisition in the others. Vigilant screening of at-risk patients is required.

EID Lane CR, Seemann T, Worth LJ, Easton M, Pitchers W, Wong J, et al. Incursions of Candida auris into Australia, 2018. Emerg Infect Dis. 2020;26(6):1326-1328. https://dx.doi.org/10.3201/eid2606.190936
AMA Lane CR, Seemann T, Worth LJ, et al. Incursions of Candida auris into Australia, 2018. Emerging Infectious Diseases. 2020;26(6):1326-1328. doi:10.3201/eid2606.190936.
APA Lane, C. R., Seemann, T., Worth, L. J., Easton, M., Pitchers, W., Wong, J....Williamson, D. A. (2020). Incursions of Candida auris into Australia, 2018. Emerging Infectious Diseases, 26(6), 1326-1328. https://dx.doi.org/10.3201/eid2606.190936.

Donor-Derived Transmission of Cryptococcus gattii sensu lato in Kidney Transplant Recipients [PDF - 709 KB - 3 pages]
D. Santos et al.

We describe cases of donor-derived transmission of Cryptococcus deuterogattii in 2 kidney transplant recipients in Brazil and published information on other cases. Prompt reduction of immunosuppression and initiation of antifungal therapy was required to successfully control the fungal infections and preserve engraftment.

EID Santos D, Hagen F, Meis JF, Cristelli MP, Viana LA, Bernardi F, et al. Donor-Derived Transmission of Cryptococcus gattii sensu lato in Kidney Transplant Recipients. Emerg Infect Dis. 2020;26(6):1329-1331. https://dx.doi.org/10.3201/eid2606.191765
AMA Santos D, Hagen F, Meis JF, et al. Donor-Derived Transmission of Cryptococcus gattii sensu lato in Kidney Transplant Recipients. Emerging Infectious Diseases. 2020;26(6):1329-1331. doi:10.3201/eid2606.191765.
APA Santos, D., Hagen, F., Meis, J. F., Cristelli, M. P., Viana, L. A., Bernardi, F....Colombo, A. L. (2020). Donor-Derived Transmission of Cryptococcus gattii sensu lato in Kidney Transplant Recipients. Emerging Infectious Diseases, 26(6), 1329-1331. https://dx.doi.org/10.3201/eid2606.191765.

Sabiá Virus–Like Mammarenavirus in Patient with Fatal Hemorrhagic Fever, Brazil, 2020 [PDF - 1.21 MB - 3 pages]
F. de Mello Malta et al.

New World arenaviruses can cause chronic infection in rodents and hemorrhagic fever in humans. We identified a Sabiá virus–like mammarenavirus in a patient with fatal hemorrhagic fever from São Paulo, Brazil. The virus was detected through virome enrichment and metagenomic next-generation sequencing technology.

EID de Mello Malta F, Amgarten D, Nastri A, Ho Y, Boas Casadio L, Basqueira M, et al. Sabiá Virus–Like Mammarenavirus in Patient with Fatal Hemorrhagic Fever, Brazil, 2020. Emerg Infect Dis. 2020;26(6):1332-1334. https://dx.doi.org/10.3201/eid2606.200099
AMA de Mello Malta F, Amgarten D, Nastri A, et al. Sabiá Virus–Like Mammarenavirus in Patient with Fatal Hemorrhagic Fever, Brazil, 2020. Emerging Infectious Diseases. 2020;26(6):1332-1334. doi:10.3201/eid2606.200099.
APA de Mello Malta, F., Amgarten, D., Nastri, A., Ho, Y., Boas Casadio, L., Basqueira, M....Pinho, J. (2020). Sabiá Virus–Like Mammarenavirus in Patient with Fatal Hemorrhagic Fever, Brazil, 2020. Emerging Infectious Diseases, 26(6), 1332-1334. https://dx.doi.org/10.3201/eid2606.200099.

Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China [PDF - 395 KB - 2 pages]
Y. Li et al.

A woman with coronavirus disease in her 35th week of pregnancy delivered an infant by cesarean section in a negative-pressure operating room. The infant was negative for severe acute respiratory coronavirus 2. This case suggests that mother-to-child transmission is unlikely for this virus.

EID Li Y, Zhao R, Zheng S, Chen X, Wang J, Sheng X, et al. Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China. Emerg Infect Dis. 2020;26(6):1335-1336. https://dx.doi.org/10.3201/eid2606.200287
AMA Li Y, Zhao R, Zheng S, et al. Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China. Emerging Infectious Diseases. 2020;26(6):1335-1336. doi:10.3201/eid2606.200287.
APA Li, Y., Zhao, R., Zheng, S., Chen, X., Wang, J., Sheng, X....Sheng, J. (2020). Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China. Emerging Infectious Diseases, 26(6), 1335-1336. https://dx.doi.org/10.3201/eid2606.200287.

Detection of Novel Coronavirus by RT-PCR in Stool Specimen from Asymptomatic Child, China [PDF - 509 KB - 3 pages]
A. Tang et al.

We report an asymptomatic child who was positive for a coronavirus by reverse transcription PCR in a stool specimen 17 days after the last virus exposure. The child was virus positive in stool specimens for at least an additional 9 days. Respiratory tract specimens were negative by reverse transcription PCR.

EID Tang A, Tong Z, Wang H, Dai Y, Li K, Liu J, et al. Detection of Novel Coronavirus by RT-PCR in Stool Specimen from Asymptomatic Child, China. Emerg Infect Dis. 2020;26(6):1337-1339. https://dx.doi.org/10.3201/eid2606.200301
AMA Tang A, Tong Z, Wang H, et al. Detection of Novel Coronavirus by RT-PCR in Stool Specimen from Asymptomatic Child, China. Emerging Infectious Diseases. 2020;26(6):1337-1339. doi:10.3201/eid2606.200301.
APA Tang, A., Tong, Z., Wang, H., Dai, Y., Li, K., Liu, J....Yan, J. (2020). Detection of Novel Coronavirus by RT-PCR in Stool Specimen from Asymptomatic Child, China. Emerging Infectious Diseases, 26(6), 1337-1339. https://dx.doi.org/10.3201/eid2606.200301.

Case-Fatality Risk Estimates for COVID-19 Calculated by Using a Lag Time for Fatality [PDF - 286 KB - 3 pages]
N. Wilson et al.

We estimated the case-fatality risk for coronavirus disease cases in China (3.5%); China, excluding Hubei Province (0.8%); 82 countries, territories, and areas (4.2%); and on a cruise ship (0.6%). Lower estimates might be closest to the true value, but a broad range of 0.25%–3.0% probably should be considered.

EID Wilson N, Kvalsvig A, Barnard L, Baker MG. Case-Fatality Risk Estimates for COVID-19 Calculated by Using a Lag Time for Fatality. Emerg Infect Dis. 2020;26(6):1339-1441. https://dx.doi.org/10.3201/eid2606.200320
AMA Wilson N, Kvalsvig A, Barnard L, et al. Case-Fatality Risk Estimates for COVID-19 Calculated by Using a Lag Time for Fatality. Emerging Infectious Diseases. 2020;26(6):1339-1441. doi:10.3201/eid2606.200320.
APA Wilson, N., Kvalsvig, A., Barnard, L., & Baker, M. G. (2020). Case-Fatality Risk Estimates for COVID-19 Calculated by Using a Lag Time for Fatality. Emerging Infectious Diseases, 26(6), 1339-1441. https://dx.doi.org/10.3201/eid2606.200320.

Serial Interval of COVID-19 among Publicly Reported Confirmed Cases [PDF - 405 KB - 3 pages]
Z. Du et al.

We estimate the distribution of serial intervals for 468 confirmed cases of coronavirus disease reported in China as of February 8, 2020. The mean interval was 3.96 days (95% CI 3.53–4.39 days), SD 4.75 days (95% CI 4.46–5.07 days); 12.6% of case reports indicated presymptomatic transmission.

EID Du Z, Xu X, Wu Y, Wang L, Cowling BJ, Meyers L. Serial Interval of COVID-19 among Publicly Reported Confirmed Cases. Emerg Infect Dis. 2020;26(6):1341-1343. https://dx.doi.org/10.3201/eid2606.200357
AMA Du Z, Xu X, Wu Y, et al. Serial Interval of COVID-19 among Publicly Reported Confirmed Cases. Emerging Infectious Diseases. 2020;26(6):1341-1343. doi:10.3201/eid2606.200357.
APA Du, Z., Xu, X., Wu, Y., Wang, L., Cowling, B. J., & Meyers, L. (2020). Serial Interval of COVID-19 among Publicly Reported Confirmed Cases. Emerging Infectious Diseases, 26(6), 1341-1343. https://dx.doi.org/10.3201/eid2606.200357.

Indirect Virus Transmission in Cluster of COVID-19 Cases, Wenzhou, China, 2020 [PDF - 911 KB - 3 pages]
J. Cai et al.

To determine possible modes of virus transmission, we investigated a cluster of coronavirus disease cases associated with a shopping mall in Wenzhou, China. Data indicated that indirect transmission of the causative virus occurred, perhaps resulting from virus contamination of common objects, virus aerosolization in a confined space, or spread from asymptomatic infected persons.

EID Cai J, Sun W, Huang J, Gamber M, Wu J, He G. Indirect Virus Transmission in Cluster of COVID-19 Cases, Wenzhou, China, 2020. Emerg Infect Dis. 2020;26(6):1343-1345. https://dx.doi.org/10.3201/eid2606.200412
AMA Cai J, Sun W, Huang J, et al. Indirect Virus Transmission in Cluster of COVID-19 Cases, Wenzhou, China, 2020. Emerging Infectious Diseases. 2020;26(6):1343-1345. doi:10.3201/eid2606.200412.
APA Cai, J., Sun, W., Huang, J., Gamber, M., Wu, J., & He, G. (2020). Indirect Virus Transmission in Cluster of COVID-19 Cases, Wenzhou, China, 2020. Emerging Infectious Diseases, 26(6), 1343-1345. https://dx.doi.org/10.3201/eid2606.200412.

COVID-19 in 2 Persons with Mild Upper Respiratory Tract Symptoms on a Cruise Ship, Japan [PDF - 976 KB - 4 pages]
T. Arashiro et al.

We describe 2 cases of coronavirus disease in patients with mild upper respiratory symptoms. Both patients worked on a cruise ship quarantined off the coast of Japan. One patient had persistent, low-grade upper respiratory tract symptoms without fever. The other patient had rapid symptom cessation but persistent viral RNA detection.

EID Arashiro T, Furukawa K, Nakamura A. COVID-19 in 2 Persons with Mild Upper Respiratory Tract Symptoms on a Cruise Ship, Japan. Emerg Infect Dis. 2020;26(6):1345-1348. https://dx.doi.org/10.3201/eid2606.200452
AMA Arashiro T, Furukawa K, Nakamura A. COVID-19 in 2 Persons with Mild Upper Respiratory Tract Symptoms on a Cruise Ship, Japan. Emerging Infectious Diseases. 2020;26(6):1345-1348. doi:10.3201/eid2606.200452.
APA Arashiro, T., Furukawa, K., & Nakamura, A. (2020). COVID-19 in 2 Persons with Mild Upper Respiratory Tract Symptoms on a Cruise Ship, Japan. Emerging Infectious Diseases, 26(6), 1345-1348. https://dx.doi.org/10.3201/eid2606.200452.
Books and Media

The Pandemic Century: One Hundred Years of Panic, Hysteria and Hubris [PDF - 330 KB - 1 page]
N. M. M’ikanatha
EID M’ikanatha NM. The Pandemic Century: One Hundred Years of Panic, Hysteria and Hubris. Emerg Infect Dis. 2020;26(6):1349. https://dx.doi.org/10.3201/eid2606.191739
AMA M’ikanatha NM. The Pandemic Century: One Hundred Years of Panic, Hysteria and Hubris. Emerging Infectious Diseases. 2020;26(6):1349. doi:10.3201/eid2606.191739.
APA M’ikanatha, N. M. (2020). The Pandemic Century: One Hundred Years of Panic, Hysteria and Hubris. Emerging Infectious Diseases, 26(6), 1349. https://dx.doi.org/10.3201/eid2606.191739.
About the Cover

About the Cover [PDF - 598 KB - 1 page]
EID About the Cover. Emerg Infect Dis. 2020;26(6):1350. https://dx.doi.org/10.3201/eid2606.ac2606
AMA About the Cover. Emerging Infectious Diseases. 2020;26(6):1350. doi:10.3201/eid2606.ac2606.
APA (2020). About the Cover. Emerging Infectious Diseases, 26(6), 1350. https://dx.doi.org/10.3201/eid2606.ac2606.
Etymologia

Etymologia: Scrapie [PDF - 484 KB - 1 page]
R. Henry and L. B. Schonburger
EID Henry R, Schonburger LB. Etymologia: Scrapie. Emerg Infect Dis. 2020;26(6):1139. https://dx.doi.org/10.3201/eid2606.et2606
AMA Henry R, Schonburger LB. Etymologia: Scrapie. Emerging Infectious Diseases. 2020;26(6):1139. doi:10.3201/eid2606.et2606.
APA Henry, R., & Schonburger, L. B. (2020). Etymologia: Scrapie. Emerging Infectious Diseases, 26(6), 1139. https://dx.doi.org/10.3201/eid2606.et2606.
Page created: May 19, 2020
Page updated: May 19, 2020
Page reviewed: May 19, 2020
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