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Expedited Ahead-of-Print Articles

Articles from Emerging Infectious Diseases

Synopses

Outbreak of Nontuberculous Mycobacteria Joint Prosthesis Infections, Oregon, USA, 2010–2016 [PDF - 1.20 MB - 7 pages]
G. L. Buser et al.

We investigated a cluster of Mycobacterium fortuitum and M. goodii prosthetic joint surgical site infections occurring during 2010–2014. Cases were defined as culture-positive nontuberculous mycobacteria surgical site infections that had occurred within 1 year of joint replacement surgery performed on or after October 1, 2010. We identified 9 cases by case finding, chart review, interviews, surgical observations, matched case–control study, pulsed-field gel electrophoresis of isolates, and environmental investigation; 6 cases were diagnosed >90 days after surgery. Cases were associated with a surgical instrument vendor representative being in the operating room during surgery; other potential sources were ruled out. A tenth case occurred during 2016. This cluster of infections associated with a vendor reinforces that all personnel entering the operating suite should follow infection control guidelines; samples for mycobacterial culture should be collected early; and postoperative surveillance for <90 days can miss surgical site infections caused by slow-growing organisms requiring specialized cultures, like mycobacteria.

EID Buser GL, Laidler MR, Cassidy P, Moulton-Meissner H, Beldavs ZG, Cieslak PR. Outbreak of Nontuberculous Mycobacteria Joint Prosthesis Infections, Oregon, USA, 2010–2016. Emerg Infect Dis. 2019;25(5):849-855. https://dx.doi.org/10.3201/eid2505.181687
AMA Buser GL, Laidler MR, Cassidy P, et al. Outbreak of Nontuberculous Mycobacteria Joint Prosthesis Infections, Oregon, USA, 2010–2016. Emerging Infectious Diseases. 2019;25(5):849-855. doi:10.3201/eid2505.181687.
APA Buser, G. L., Laidler, M. R., Cassidy, P., Moulton-Meissner, H., Beldavs, Z. G., & Cieslak, P. R. (2019). Outbreak of Nontuberculous Mycobacteria Joint Prosthesis Infections, Oregon, USA, 2010–2016. Emerging Infectious Diseases, 25(5), 849-855. https://dx.doi.org/10.3201/eid2505.181687.
Research

Recurrent Cholera Outbreaks, Democratic Republic of the Congo, 2008–2017 [PDF - 8.14 MB - 9 pages]
B. Ingelbeen et al.

In 2017, the exacerbation of an ongoing countrywide cholera outbreak in the Democratic Republic of the Congo resulted in >53,000 reported cases and 1,145 deaths. To guide control measures, we analyzed the characteristics of cholera epidemiology in DRC on the basis of surveillance and cholera treatment center data for 2008–2017. The 2017 nationwide outbreak resulted from 3 distinct mechanisms: considerable increases in the number of cases in cholera-endemic areas, so-called hot spots, around the Great Lakes in eastern DRC; recurrent outbreaks progressing downstream along the Congo River; and spread along Congo River branches to areas that had been cholera-free for more than a decade. Case-fatality rates were higher in nonendemic areas and in the early phases of the outbreaks, possibly reflecting low levels of immunity and less appropriate prevention and treatment. Targeted use of oral cholera vaccine, soon after initial cases are diagnosed, could contribute to lower case-fatality rates.

EID Ingelbeen B, Hendrickx D, Miwanda B, van der Sande M, Mossoko M, Vochten H, et al. Recurrent Cholera Outbreaks, Democratic Republic of the Congo, 2008–2017. Emerg Infect Dis. 2019;25(5):856-864. https://dx.doi.org/10.3201/eid2505.181141
AMA Ingelbeen B, Hendrickx D, Miwanda B, et al. Recurrent Cholera Outbreaks, Democratic Republic of the Congo, 2008–2017. Emerging Infectious Diseases. 2019;25(5):856-864. doi:10.3201/eid2505.181141.
APA Ingelbeen, B., Hendrickx, D., Miwanda, B., van der Sande, M., Mossoko, M., Vochten, H....Muyembe, J. (2019). Recurrent Cholera Outbreaks, Democratic Republic of the Congo, 2008–2017. Emerging Infectious Diseases, 25(5), 856-864. https://dx.doi.org/10.3201/eid2505.181141.

Lassa Virus Targeting of Anterior Uvea and Endothelium of Cornea and Conjunctiva in Eye of Guinea Pig Model [PDF - 7.29 MB - 10 pages]
J. M. Gary et al.

Lassa virus (LASV), a hemorrhagic fever virus endemic to West Africa, causes conjunctivitis in patients with acute disease. To examine ocular manifestations of LASV, we histologically examined eyes from infected guinea pigs. In fatal disease, LASV immunostaining was most prominent in the anterior uvea, especially in the filtration angle, ciliary body, and iris and in and around vessels in the bulbar conjunctiva and peripheral cornea, where it co-localized with an endothelial marker (platelet endothelial cell adhesion molecule). Antigen was primarily associated with infiltration of T-lymphocytes around vessels in the anterior uvea and with new vessel formation at the peripheral cornea. In animals that exhibited clinical signs but survived infection, eyes had little to no inflammation and no LASV immunostaining 6 weeks after infection. Overall, in this model, LASV antigen was restricted to the anterior uvea and was associated with mild chronic inflammation in animals with severe disease but was not detected in survivors.

EID Gary JM, Welch SR, Ritter JM, Coleman-McCray J, Huynh T, Kainulainen MH, et al. Lassa Virus Targeting of Anterior Uvea and Endothelium of Cornea and Conjunctiva in Eye of Guinea Pig Model. Emerg Infect Dis. 2019;25(5):865-874. https://dx.doi.org/10.3201/eid2505.181254
AMA Gary JM, Welch SR, Ritter JM, et al. Lassa Virus Targeting of Anterior Uvea and Endothelium of Cornea and Conjunctiva in Eye of Guinea Pig Model. Emerging Infectious Diseases. 2019;25(5):865-874. doi:10.3201/eid2505.181254.
APA Gary, J. M., Welch, S. R., Ritter, J. M., Coleman-McCray, J., Huynh, T., Kainulainen, M. H....Spengler, J. R. (2019). Lassa Virus Targeting of Anterior Uvea and Endothelium of Cornea and Conjunctiva in Eye of Guinea Pig Model. Emerging Infectious Diseases, 25(5), 865-874. https://dx.doi.org/10.3201/eid2505.181254.

Medscape CME Activity
Age-Dependent Increase in Incidence of Staphylococcus aureus Bacteremia, Denmark, 2008–2015 [PDF - 1.04 MB - 8 pages]
L. Thorlacius-Ussing et al.

Staphylococcus aureus bacteremia (SAB) is a major cause of illness and death worldwide. We analyzed temporal trends of SAB incidence and death in Denmark during 2008–2015. SAB incidence increased 48%, from 20.76 to 30.37 per 100,000 person-years, during this period (p<0.001). The largest change in incidence was observed for persons >80 years of age: a 90% increase in the SAB rate (p<0.001). After adjusting for demographic changes, annual rates increased 4.0% (95% CI 3.0–5.0) for persons <80 years of age, 8.4% (95% CI 7.0–11.0) for persons 80–89 years of age, and 13.0% (95% CI 9.0–17.5) for persons >90 years of age. The 30-day case-fatality rate remained stable at 24%; crude population death rates increased by 53% during 2008–2015 (p<0.001). Specific causes and mechanisms for this rapid increase in SAB incidence among the elderly population remain to be clarified.

EID Thorlacius-Ussing L, Sandholdt H, Larsen A, Petersen A, Benfield T. Age-Dependent Increase in Incidence of Staphylococcus aureus Bacteremia, Denmark, 2008–2015. Emerg Infect Dis. 2019;25(5):875-882. https://dx.doi.org/10.3201/eid2505.181733
AMA Thorlacius-Ussing L, Sandholdt H, Larsen A, et al. Age-Dependent Increase in Incidence of Staphylococcus aureus Bacteremia, Denmark, 2008–2015. Emerging Infectious Diseases. 2019;25(5):875-882. doi:10.3201/eid2505.181733.
APA Thorlacius-Ussing, L., Sandholdt, H., Larsen, A., Petersen, A., & Benfield, T. (2019). Age-Dependent Increase in Incidence of Staphylococcus aureus Bacteremia, Denmark, 2008–2015. Emerging Infectious Diseases, 25(5), 875-882. https://dx.doi.org/10.3201/eid2505.181733.

Medscape CME Activity
Novel Sequence Type in Bacillus cereus Strains Associated with Nosocomial Infections and Bacteremia, Japan [PDF - 2.53 MB - 8 pages]
R. Akamatsu et al.

Bacillus cereus is associated with foodborne illnesses characterized by vomiting and diarrhea. Although some B. cereus strains that cause severe extraintestinal infections and nosocomial infections are recognized as serious public health threats in healthcare settings, the genetic backgrounds of B. cereus strains causing such infections remain unknown. By conducting pulsed-field gel electrophoresis and multilocus sequence typing, we found that a novel sequence type (ST), newly registered as ST1420, was the dominant ST isolated from the cases of nosocomial infections that occurred in 3 locations in Japan in 2006, 2013, and 2016. Phylogenetic analysis showed that ST1420 strains belonged to the Cereus III lineage, which is much closer to the Anthracis lineage than to other Cereus lineages. Our results suggest that ST1420 is a prevalent ST in B. cereus strains that have caused recent nosocomial infections in Japan.

EID Akamatsu R, Suzuki M, Okinaka K, Sasahara T, Yamane K, Suzuki S, et al. Novel Sequence Type in Bacillus cereus Strains Associated with Nosocomial Infections and Bacteremia, Japan. Emerg Infect Dis. 2019;25(5):883-890. https://dx.doi.org/10.3201/eid2505.171890
AMA Akamatsu R, Suzuki M, Okinaka K, et al. Novel Sequence Type in Bacillus cereus Strains Associated with Nosocomial Infections and Bacteremia, Japan. Emerging Infectious Diseases. 2019;25(5):883-890. doi:10.3201/eid2505.171890.
APA Akamatsu, R., Suzuki, M., Okinaka, K., Sasahara, T., Yamane, K., Suzuki, S....Higashi, H. (2019). Novel Sequence Type in Bacillus cereus Strains Associated with Nosocomial Infections and Bacteremia, Japan. Emerging Infectious Diseases, 25(5), 883-890. https://dx.doi.org/10.3201/eid2505.171890.

Infectious Dose of African Swine Fever Virus When Consumed Naturally in Liquid or Feed [PDF - 1.10 MB - 7 pages]
M. C. Niederwerder et al.

African swine fever virus (ASFV) is a contagious, rapidly spreading, transboundary animal disease and a major threat to pork production globally. Although plant-based feed has been identified as a potential route for virus introduction onto swine farms, little is known about the risks for ASFV transmission in feed. We aimed to determine the minimum and median infectious doses of the Georgia 2007 strain of ASFV through oral exposure during natural drinking and feeding behaviors. The minimum infectious dose of ASFV in liquid was 100 50% tissue culture infectious dose (TCID50), compared with 104 TCID50 in feed. The median infectious dose was 101.0 TCID50 for liquid and 106.8 TCID50 for feed. Our findings demonstrate that ASFV Georgia 2007 can easily be transmitted orally, although higher doses are required for infection in plant-based feed. These data provide important information that can be incorporated into risk models for ASFV transmission.

EID Niederwerder MC, Stoian A, Rowland R, Dritz SS, Petrovan V, Constance LA, et al. Infectious Dose of African Swine Fever Virus When Consumed Naturally in Liquid or Feed. Emerg Infect Dis. 2019;25(5):891-897. https://dx.doi.org/10.3201/eid2505.181495
AMA Niederwerder MC, Stoian A, Rowland R, et al. Infectious Dose of African Swine Fever Virus When Consumed Naturally in Liquid or Feed. Emerging Infectious Diseases. 2019;25(5):891-897. doi:10.3201/eid2505.181495.
APA Niederwerder, M. C., Stoian, A., Rowland, R., Dritz, S. S., Petrovan, V., Constance, L. A....Hefley, T. J. (2019). Infectious Dose of African Swine Fever Virus When Consumed Naturally in Liquid or Feed. Emerging Infectious Diseases, 25(5), 891-897. https://dx.doi.org/10.3201/eid2505.181495.

Management of Central Nervous System Infections, Vientiane, Laos, 2003–2011 [PDF - 2.28 MB - 13 pages]
A. Dubot-Pérès et al.

During 2003–2011, we recruited 1,065 patients of all ages admitted to Mahosot Hospital (Vientiane, Laos) with suspected central nervous system (CNS) infection. Etiologies were laboratory confirmed for 42.3% of patients, who mostly had infections with emerging pathogens: viruses in 16.2% (mainly Japanese encephalitis virus [8.8%]); bacteria in 16.4% (including Orientia tsutsugamushi [2.9%], Leptospira spp. [2.3%], and Rickettsia spp. [2.3%]); and Cryptococcus spp. fungi in 6.6%. We observed no significant differences in distribution of clinical encephalitis and meningitis by bacterial or viral etiology. However, patients with bacterial CNS infection were more likely to have a history of diabetes than others. Death (26.3%) was associated with low Glasgow Coma Scale score, and the mortality rate was higher for patients with bacterial than viral infections. No clinical or laboratory variables could guide antibiotic selection. We conclude that high-dependency units and first-line treatment with ceftriaxone and doxycycline for suspected CNS infections could improve patient survival in Laos.

EID Dubot-Pérès A, Mayxay M, Phetsouvanh R, Lee SJ, Rattanavong S, Vongsouvath M, et al. Management of Central Nervous System Infections, Vientiane, Laos, 2003–2011. Emerg Infect Dis. 2019;25(5):898-910. https://dx.doi.org/10.3201/eid2505.180914
AMA Dubot-Pérès A, Mayxay M, Phetsouvanh R, et al. Management of Central Nervous System Infections, Vientiane, Laos, 2003–2011. Emerging Infectious Diseases. 2019;25(5):898-910. doi:10.3201/eid2505.180914.
APA Dubot-Pérès, A., Mayxay, M., Phetsouvanh, R., Lee, S. J., Rattanavong, S., Vongsouvath, M....Newton, P. N. (2019). Management of Central Nervous System Infections, Vientiane, Laos, 2003–2011. Emerging Infectious Diseases, 25(5), 898-910. https://dx.doi.org/10.3201/eid2505.180914.

Serologic Prevalence of Ebola Virus in Equatorial Africa [PDF - 1.24 MB - 8 pages]
I. Steffen et al.

We conducted a serologic survey of 2,430 serum samples collected during 1997–2012 for various studies to determine the prevalence of the hemorrhagic fever virus Ebola virus (EBOV) in equatorial Africa. We screened serum samples for neutralizing antibodies by using a pseudotype microneutralization assay and a newly developed luciferase immunoprecipitation system assay. Specimens seroreactive for EBOV were confirmed by using an ELISA. Our results suggest a serologic prevalence of 2%–3.5% in the Republic of the Congo and the Democratic Republic of the Congo, which have reported outbreaks of infection with EBOV. In addition we detected a seroprevalence of 1.3% in southern Cameroon, which indicated a low risk for exposure in this region.

EID Steffen I, Lu K, Yamamoto LK, Hoff NA, Mulembakani P, Wemakoy EO, et al. Serologic Prevalence of Ebola Virus in Equatorial Africa. Emerg Infect Dis. 2019;25(5):911-918. https://dx.doi.org/10.3201/eid2505.180115
AMA Steffen I, Lu K, Yamamoto LK, et al. Serologic Prevalence of Ebola Virus in Equatorial Africa. Emerging Infectious Diseases. 2019;25(5):911-918. doi:10.3201/eid2505.180115.
APA Steffen, I., Lu, K., Yamamoto, L. K., Hoff, N. A., Mulembakani, P., Wemakoy, E. O....Simmons, G. (2019). Serologic Prevalence of Ebola Virus in Equatorial Africa. Emerging Infectious Diseases, 25(5), 911-918. https://dx.doi.org/10.3201/eid2505.180115.

Formaldehyde and Glutaraldehyde Inactivation of Bacterial Tier 1 Select Agents in Tissues [PDF - 2.22 MB - 8 pages]
J. Chua et al.

For safety, designated Select Agents in tissues must be inactivated and viability tested before the tissue undergoes further processing and analysis. In response to the shipping of samples of “inactivated” Bacillus anthracis that inadvertently contained live spores to nonregulated entities and partners worldwide, the Federal Register now mandates in-house validation of inactivation procedures and standardization of viability testing to detect live organisms in samples containing Select Agents that have undergone an inactivation process. We tested and validated formaldehyde and glutaraldehyde inactivation procedures for animal tissues infected with virulent B. anthracis, Burkholderia pseudomallei, Francisella tularensis, and Yersinia pestis. We confirmed that our fixation procedures for tissues containing these Tier 1 Select Agents resulted in complete inactivation and that our validated viability testing methods do not interfere with detection of live organisms. Institutions may use this work as a guide to develop and conduct their own testing to comply with the policy.

EID Chua J, Bozue JA, Klimko CP, Shoe JL, Ruiz SI, Jensen CL, et al. Formaldehyde and Glutaraldehyde Inactivation of Bacterial Tier 1 Select Agents in Tissues. Emerg Infect Dis. 2019;25(5):919-926. https://dx.doi.org/10.3201/eid2505.180928
AMA Chua J, Bozue JA, Klimko CP, et al. Formaldehyde and Glutaraldehyde Inactivation of Bacterial Tier 1 Select Agents in Tissues. Emerging Infectious Diseases. 2019;25(5):919-926. doi:10.3201/eid2505.180928.
APA Chua, J., Bozue, J. A., Klimko, C. P., Shoe, J. L., Ruiz, S. I., Jensen, C. L....Cote, C. K. (2019). Formaldehyde and Glutaraldehyde Inactivation of Bacterial Tier 1 Select Agents in Tissues. Emerging Infectious Diseases, 25(5), 919-926. https://dx.doi.org/10.3201/eid2505.180928.

Risk Factors for MERS-CoV Seropositivity among Animal Market and Slaughterhouse Workers, Abu Dhabi, United Arab Emirates, 2014–2017 [PDF - 872 KB - 9 pages]
A. Khudhair et al.

Camel contact is a recognized risk factor for Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Because specific camel exposures associated with MERS-CoV seropositivity are not fully understood, we investigated worker–camel interactions and MERS-CoV seroprevalence. We assessed worker seroprevalence in 2 slaughterhouses and 1 live-animal market in Abu Dhabi, United Arab Emirates, during 2014–2017 and administered an epidemiologic survey in 2016 and 2017. Across 3 sampling rounds during 2014–2017, we sampled 100–235 workers, and 6%–19% were seropositive for MERS-CoV at each sampling round. One (1.4%) of 70 seronegative workers tested at multiple rounds seroconverted. On multivariable analyses, working as a camel salesman, handling live camels or their waste, and having diabetes were associated with seropositivity among all workers, whereas handling live camels and either administering medications or cleaning equipment was associated with seropositivity among market workers. Characterization of high-risk exposures is critical for implementation of preventive measures.

EID Khudhair A, Killerby ME, Al Mulla M, Abou Elkheir K, Ternanni W, Bandar Z, et al. Risk Factors for MERS-CoV Seropositivity among Animal Market and Slaughterhouse Workers, Abu Dhabi, United Arab Emirates, 2014–2017. Emerg Infect Dis. 2019;25(5):927-935. https://dx.doi.org/10.3201/eid2505.181728
AMA Khudhair A, Killerby ME, Al Mulla M, et al. Risk Factors for MERS-CoV Seropositivity among Animal Market and Slaughterhouse Workers, Abu Dhabi, United Arab Emirates, 2014–2017. Emerging Infectious Diseases. 2019;25(5):927-935. doi:10.3201/eid2505.181728.
APA Khudhair, A., Killerby, M. E., Al Mulla, M., Abou Elkheir, K., Ternanni, W., Bandar, Z....Hall, A. J. (2019). Risk Factors for MERS-CoV Seropositivity among Animal Market and Slaughterhouse Workers, Abu Dhabi, United Arab Emirates, 2014–2017. Emerging Infectious Diseases, 25(5), 927-935. https://dx.doi.org/10.3201/eid2505.181728.

Outcomes of Bedaquiline Treatment in Patients with Multidrug-Resistant Tuberculosis [PDF - 1.25 MB - 8 pages]
L. Mbuagbaw et al.

Bedaquiline is recommended by the World Health Organization for the treatment of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis (TB). We pooled data from 5 cohorts of patients treated with bedaquiline in France, Georgia, Armenia, and South Africa and in a multicountry study. The rate of culture conversion to negative at 6 months (by the end of 6 months of treatment) was 78% (95% CI 73.5%–81.9%), and the treatment success rate was 65.8% (95% CI 59.9%–71.3%). Death rate was 11.7% (95% CI 7.0%–19.1%). Up to 91.1% (95% CI 82.2%–95.8%) of the patients experienced >1 adverse event, and 11.2% (95% CI 5.0%–23.2%) experienced a serious adverse event. Lung cavitations were consistently associated with unfavorable outcomes. The use of bedaquiline in MDR and XDR TB treatment regimens appears to be effective and safe across different settings, although the certainty of evidence was assessed as very low.

EID Mbuagbaw L, Guglielmetti L, Hewison C, Bakare N, Bastard M, Caumes E, et al. Outcomes of Bedaquiline Treatment in Patients with Multidrug-Resistant Tuberculosis. Emerg Infect Dis. 2019;25(5):936-943. https://dx.doi.org/10.3201/eid2505.181823
AMA Mbuagbaw L, Guglielmetti L, Hewison C, et al. Outcomes of Bedaquiline Treatment in Patients with Multidrug-Resistant Tuberculosis. Emerging Infectious Diseases. 2019;25(5):936-943. doi:10.3201/eid2505.181823.
APA Mbuagbaw, L., Guglielmetti, L., Hewison, C., Bakare, N., Bastard, M., Caumes, E....Lienhardt, C. (2019). Outcomes of Bedaquiline Treatment in Patients with Multidrug-Resistant Tuberculosis. Emerging Infectious Diseases, 25(5), 936-943. https://dx.doi.org/10.3201/eid2505.181823.
Dispatches

Phylogenetic Analysis of Francisella tularensis Group A.II Isolates from 5 Patients with Tularemia, Arizona, USA, 2015–2017 [PDF - 753 KB - 3 pages]
D. N. Birdsell et al.

We examined 5 tularemia cases in Arizona, USA, during 2015–2017. All were caused by Francisella tularensis group A.II. Genetically similar isolates were found across large spatial and temporal distances, suggesting that group A.II strains are dispersed across long distances by wind and exhibit low replication rates in the environment.

EID Birdsell DN, Yaglom H, Rodriguez E, Engelthaler DM, Maurer M, Gaither M, et al. Phylogenetic Analysis of Francisella tularensis Group A.II Isolates from 5 Patients with Tularemia, Arizona, USA, 2015–2017. Emerg Infect Dis. 2019;25(5):944-946. https://dx.doi.org/10.3201/eid2505.180363
AMA Birdsell DN, Yaglom H, Rodriguez E, et al. Phylogenetic Analysis of Francisella tularensis Group A.II Isolates from 5 Patients with Tularemia, Arizona, USA, 2015–2017. Emerging Infectious Diseases. 2019;25(5):944-946. doi:10.3201/eid2505.180363.
APA Birdsell, D. N., Yaglom, H., Rodriguez, E., Engelthaler, D. M., Maurer, M., Gaither, M....Wagner, D. M. (2019). Phylogenetic Analysis of Francisella tularensis Group A.II Isolates from 5 Patients with Tularemia, Arizona, USA, 2015–2017. Emerging Infectious Diseases, 25(5), 944-946. https://dx.doi.org/10.3201/eid2505.180363.

Anthrax Epizootic in Wildlife, Bwabwata National Park, Namibia, 2017 [PDF - 1.37 MB - 4 pages]
C. M. Cossaboom et al.

In late September 2017, Bwabwata National Park in Namibia experienced a sudden die-off of hippopotamuses and Cape buffalo. A multiorganizational response was initiated, involving several ministries within Namibia and the US Centers for Disease Control and Prevention. Rapid interventions resulted in zero human or livestock cases associated with this epizootic.

EID Cossaboom CM, Khaiseb S, Haufiku B, Katjiuanjo P, Kannyinga A, Mbai K, et al. Anthrax Epizootic in Wildlife, Bwabwata National Park, Namibia, 2017. Emerg Infect Dis. 2019;25(5):947-950. https://dx.doi.org/10.3201/eid2505.180867
AMA Cossaboom CM, Khaiseb S, Haufiku B, et al. Anthrax Epizootic in Wildlife, Bwabwata National Park, Namibia, 2017. Emerging Infectious Diseases. 2019;25(5):947-950. doi:10.3201/eid2505.180867.
APA Cossaboom, C. M., Khaiseb, S., Haufiku, B., Katjiuanjo, P., Kannyinga, A., Mbai, K....Walke, H. (2019). Anthrax Epizootic in Wildlife, Bwabwata National Park, Namibia, 2017. Emerging Infectious Diseases, 25(5), 947-950. https://dx.doi.org/10.3201/eid2505.180867.

Zika Virus in Rectal Swab Samples [PDF - 1.24 MB - 4 pages]
C. Bôtto-Menezes et al.

We detected Zika virus RNA in rectal swab samples from 10 patients by using real-time reverse transcription PCR, and we isolated the virus from 1 patient. The longest interval from symptom onset to detection was 14 days. These findings are applicable to diagnosis and infection prevention recommendations.

EID Bôtto-Menezes C, Neto A, Calvet G, Kara E, Lacerda M, Castilho M, et al. Zika Virus in Rectal Swab Samples. Emerg Infect Dis. 2019;25(5):951-954. https://dx.doi.org/10.3201/eid2505.180904
AMA Bôtto-Menezes C, Neto A, Calvet G, et al. Zika Virus in Rectal Swab Samples. Emerging Infectious Diseases. 2019;25(5):951-954. doi:10.3201/eid2505.180904.
APA Bôtto-Menezes, C., Neto, A., Calvet, G., Kara, E., Lacerda, M., Castilho, M....Franca, R. (2019). Zika Virus in Rectal Swab Samples. Emerging Infectious Diseases, 25(5), 951-954. https://dx.doi.org/10.3201/eid2505.180904.

Bombali Virus in Mops condylurus Bat, Kenya [PDF - 1.25 MB - 3 pages]
K. M. Forbes et al.

Bombali virus (genus Ebolavirus) was identified in organs and excreta of an Angolan free-tailed bat (Mops condylurus) in Kenya. Complete genome analysis revealed 98% nucleotide sequence similarity to the prototype virus from Sierra Leone. No Ebola virus–specific RNA or antibodies were detected from febrile humans in the area who reported contact with bats.

EID Forbes KM, Webala PW, Jääskeläinen AJ, Abdurahman S, Ogola J, Masika MM, et al. Bombali Virus in Mops condylurus Bat, Kenya. Emerg Infect Dis. 2019;25(5):955-957. https://dx.doi.org/10.3201/eid2505.181666
AMA Forbes KM, Webala PW, Jääskeläinen AJ, et al. Bombali Virus in Mops condylurus Bat, Kenya. Emerging Infectious Diseases. 2019;25(5):955-957. doi:10.3201/eid2505.181666.
APA Forbes, K. M., Webala, P. W., Jääskeläinen, A. J., Abdurahman, S., Ogola, J., Masika, M. M....Sironen, T. (2019). Bombali Virus in Mops condylurus Bat, Kenya. Emerging Infectious Diseases, 25(5), 955-957. https://dx.doi.org/10.3201/eid2505.181666.

Genetic Characterization of Middle East Respiratory Syndrome Coronavirus, South Korea, 2018 [PDF - 1.83 MB - 5 pages]
Y. Chung et al.

We evaluated genetic variation in Middle East respiratory syndrome coronavirus (MERS-CoV) imported to South Korea in 2018 using specimens from a patient and isolates from infected Caco-2 cells. The MERS-CoV strain in this study was genetically similar to a strain isolated in Riyadh, Saudi Arabia, in 2017.

EID Chung Y, Kim J, Man Kim H, Park K, Lee A, Lee N, et al. Genetic Characterization of Middle East Respiratory Syndrome Coronavirus, South Korea, 2018. Emerg Infect Dis. 2019;25(5):958-962. https://dx.doi.org/10.3201/eid2505.181534
AMA Chung Y, Kim J, Man Kim H, et al. Genetic Characterization of Middle East Respiratory Syndrome Coronavirus, South Korea, 2018. Emerging Infectious Diseases. 2019;25(5):958-962. doi:10.3201/eid2505.181534.
APA Chung, Y., Kim, J., Man Kim, H., Park, K., Lee, A., Lee, N....Kang, C. (2019). Genetic Characterization of Middle East Respiratory Syndrome Coronavirus, South Korea, 2018. Emerging Infectious Diseases, 25(5), 958-962. https://dx.doi.org/10.3201/eid2505.181534.

Novel Picornavirus in Lambs with Severe Encephalomyelitis [PDF - 2.27 MB - 4 pages]
L. F. Forth et al.

Using metagenomic analysis, we identified a novel picornavirus in young preweaned lambs with neurologic signs associated with severe nonsuppurative encephalitis and sensory ganglionitis in 2016 and 2017 in the United Kingdom. In situ hybridization demonstrated intralesional neuronotropism of this virus, which was also detected in archived samples of similarly affected lambs (1998–2014).

EID Forth LF, Scholes S, Pesavento PA, Jackson K, Mackintosh A, Carson A, et al. Novel Picornavirus in Lambs with Severe Encephalomyelitis. Emerg Infect Dis. 2019;25(5):963-967. https://dx.doi.org/10.3201/eid2505.181573
AMA Forth LF, Scholes S, Pesavento PA, et al. Novel Picornavirus in Lambs with Severe Encephalomyelitis. Emerging Infectious Diseases. 2019;25(5):963-967. doi:10.3201/eid2505.181573.
APA Forth, L. F., Scholes, S., Pesavento, P. A., Jackson, K., Mackintosh, A., Carson, A....Beer, M. (2019). Novel Picornavirus in Lambs with Severe Encephalomyelitis. Emerging Infectious Diseases, 25(5), 963-967. https://dx.doi.org/10.3201/eid2505.181573.

Severe Myasthenic Manifestation of Leptospirosis Associated with New Sequence Type of Leptospira interrogans [PDF - 1.79 MB - 4 pages]
M. Tomschik et al.

We report the rapid development of a myasthenic crisis as the first-time manifestation of myasthenia gravis. The symptoms developed in the course of acute leptospirosis associated with a new sequence type of Leptospira interrogans. Antibiotic treatment led to rapid amelioration of myasthenia.

EID Tomschik M, Koneczny I, Schötta A, Scharer S, Smajlhodzic M, Rosenegger P, et al. Severe Myasthenic Manifestation of Leptospirosis Associated with New Sequence Type of Leptospira interrogans. Emerg Infect Dis. 2019;25(5):968-971. https://dx.doi.org/10.3201/eid2505.181591
AMA Tomschik M, Koneczny I, Schötta A, et al. Severe Myasthenic Manifestation of Leptospirosis Associated with New Sequence Type of Leptospira interrogans. Emerging Infectious Diseases. 2019;25(5):968-971. doi:10.3201/eid2505.181591.
APA Tomschik, M., Koneczny, I., Schötta, A., Scharer, S., Smajlhodzic, M., Rosenegger, P....Markowicz, M. (2019). Severe Myasthenic Manifestation of Leptospirosis Associated with New Sequence Type of Leptospira interrogans. Emerging Infectious Diseases, 25(5), 968-971. https://dx.doi.org/10.3201/eid2505.181591.

Neonatal Conjunctivitis Caused by Neisseria meningitidis US Urethritis Clade, New York, USA, August 2017 [PDF - 712 KB - 4 pages]
C. B. Kretz et al.

We characterized a case of neonatal conjunctivitis in New York, USA, caused by Neisseria meningitidis by using whole-genome sequencing. The case was a rare occurrence, and the isolate obtained belonged to an emerging clade (N. meningitidis US nongroupable urethritis) associated with an increase in cases of urethritis since 2015.

EID Kretz CB, Bergeron G, Aldrich M, Bloch D, Del Rosso PE, Halse TA, et al. Neonatal Conjunctivitis Caused by Neisseria meningitidis US Urethritis Clade, New York, USA, August 2017. Emerg Infect Dis. 2019;25(5):972-975. https://dx.doi.org/10.3201/eid2505.181631
AMA Kretz CB, Bergeron G, Aldrich M, et al. Neonatal Conjunctivitis Caused by Neisseria meningitidis US Urethritis Clade, New York, USA, August 2017. Emerging Infectious Diseases. 2019;25(5):972-975. doi:10.3201/eid2505.181631.
APA Kretz, C. B., Bergeron, G., Aldrich, M., Bloch, D., Del Rosso, P. E., Halse, T. A....Rakeman, J. L. (2019). Neonatal Conjunctivitis Caused by Neisseria meningitidis US Urethritis Clade, New York, USA, August 2017. Emerging Infectious Diseases, 25(5), 972-975. https://dx.doi.org/10.3201/eid2505.181631.

Fatal Meningitis in Patient with X-Linked Chronic Granulomatous Disease Caused by Virulent Granulibacter bethesdensis [PDF - 1.28 MB - 4 pages]
M. Rebelo et al.

Granulibacter bethesdensis is a pathogen reported to cause recurrent lymphadenitis exclusively in persons with chronic granulomatous disease. We report a case of fatal meningitis caused by a highly virulent G. bethesdensis strain in an adolescent in Europe who had chronic granulomatous disease.

EID Rebelo M, Ding L, Cordeiro A, Neves C, Simões M, Zelazny AM, et al. Fatal Meningitis in Patient with X-Linked Chronic Granulomatous Disease Caused by Virulent Granulibacter bethesdensis. Emerg Infect Dis. 2019;25(5):976-979. https://dx.doi.org/10.3201/eid2505.181505
AMA Rebelo M, Ding L, Cordeiro A, et al. Fatal Meningitis in Patient with X-Linked Chronic Granulomatous Disease Caused by Virulent Granulibacter bethesdensis. Emerging Infectious Diseases. 2019;25(5):976-979. doi:10.3201/eid2505.181505.
APA Rebelo, M., Ding, L., Cordeiro, A., Neves, C., Simões, M., Zelazny, A. M....Neves, J. (2019). Fatal Meningitis in Patient with X-Linked Chronic Granulomatous Disease Caused by Virulent Granulibacter bethesdensis. Emerging Infectious Diseases, 25(5), 976-979. https://dx.doi.org/10.3201/eid2505.181505.

Diagnosis of Imported Monkeypox, Israel, 2018 [PDF - 3.76 MB - 4 pages]
N. Erez et al.

We report a case of monkeypox in a man who returned from Nigeria to Israel in 2018. Virus was detected in pustule swabs by transmission electron microscopy and PCR and confirmed by immunofluorescence assay, tissue culture, and ELISA. The West Africa monkeypox outbreak calls for increased awareness by public health authorities worldwide.

EID Erez N, Achdout H, Milrot E, Schwartz Y, Wiener-Well Y, Paran N, et al. Diagnosis of Imported Monkeypox, Israel, 2018. Emerg Infect Dis. 2019;25(5):980-983. https://dx.doi.org/10.3201/eid2505.190076
AMA Erez N, Achdout H, Milrot E, et al. Diagnosis of Imported Monkeypox, Israel, 2018. Emerging Infectious Diseases. 2019;25(5):980-983. doi:10.3201/eid2505.190076.
APA Erez, N., Achdout, H., Milrot, E., Schwartz, Y., Wiener-Well, Y., Paran, N....Schwartz, E. (2019). Diagnosis of Imported Monkeypox, Israel, 2018. Emerging Infectious Diseases, 25(5), 980-983. https://dx.doi.org/10.3201/eid2505.190076.

Population-Based Estimate of Melioidosis, Kenya [PDF - 848 KB - 4 pages]
E. M. Muthumbi et al.

Melioidosis is thought to be endemic, although underdiagnosed, in Africa. We identified 5 autochthonous cases of Burkholderia pseudomallei infection in a case series in Kenya. Incidence of B. pseudomallei bacteremia in Kenya’s Kilifi County is low, at 1.5 cases per million person-years, but this result might be an underestimate.

EID Muthumbi EM, Gordon NC, Mochamah G, Nyongesa S, Odipo E, Mwarumba S, et al. Population-Based Estimate of Melioidosis, Kenya. Emerg Infect Dis. 2019;25(5):984-987. https://dx.doi.org/10.3201/eid2505.180545
AMA Muthumbi EM, Gordon NC, Mochamah G, et al. Population-Based Estimate of Melioidosis, Kenya. Emerging Infectious Diseases. 2019;25(5):984-987. doi:10.3201/eid2505.180545.
APA Muthumbi, E. M., Gordon, N. C., Mochamah, G., Nyongesa, S., Odipo, E., Mwarumba, S....Morpeth, S. C. (2019). Population-Based Estimate of Melioidosis, Kenya. Emerging Infectious Diseases, 25(5), 984-987. https://dx.doi.org/10.3201/eid2505.180545.

Novel Method for Rapid Detection of Spatiotemporal HIV Clusters Potentially Warranting Intervention [PDF - 1.44 MB - 4 pages]
A. G. Fitzmaurice et al.

Rapid detection of increases in HIV transmission enables targeted outbreak response efforts to reduce the number of new infections. We analyzed US HIV surveillance data and identified spatiotemporal clusters of diagnoses. This systematic method can help target timely investigations and preventive interventions for maximum public health benefit.

EID Fitzmaurice AG, Linley L, Zhang C, Watson M, France A, Oster AM. Novel Method for Rapid Detection of Spatiotemporal HIV Clusters Potentially Warranting Intervention. Emerg Infect Dis. 2019;25(5):988-991. https://dx.doi.org/10.3201/eid2505.180776
AMA Fitzmaurice AG, Linley L, Zhang C, et al. Novel Method for Rapid Detection of Spatiotemporal HIV Clusters Potentially Warranting Intervention. Emerging Infectious Diseases. 2019;25(5):988-991. doi:10.3201/eid2505.180776.
APA Fitzmaurice, A. G., Linley, L., Zhang, C., Watson, M., France, A., & Oster, A. M. (2019). Novel Method for Rapid Detection of Spatiotemporal HIV Clusters Potentially Warranting Intervention. Emerging Infectious Diseases, 25(5), 988-991. https://dx.doi.org/10.3201/eid2505.180776.

Rickettsia japonica and Novel Rickettsia Species in Ticks, China [PDF - 798 KB - 4 pages]
X. Qin et al.

PCR amplification indicated the minimum infection rate of Rickettsia spp. was 0.66% in Haemaphysalis longicornis ticks collected from Shandong Province, China. Phylogenetic analysis based on the rrs, gltA, ompA, and ompB genes indicated that the ticks carried R. japonica, Candidatus Rickettsia longicornii, and a novel Rickettsia species related to R. canadensis.

EID Qin X, Han H, Han F, Zhao F, Zhang Z, Xue Z, et al. Rickettsia japonica and Novel Rickettsia Species in Ticks, China. Emerg Infect Dis. 2019;25(5):992-995. https://dx.doi.org/10.3201/eid2505.171745
AMA Qin X, Han H, Han F, et al. Rickettsia japonica and Novel Rickettsia Species in Ticks, China. Emerging Infectious Diseases. 2019;25(5):992-995. doi:10.3201/eid2505.171745.
APA Qin, X., Han, H., Han, F., Zhao, F., Zhang, Z., Xue, Z....Yu, X. (2019). Rickettsia japonica and Novel Rickettsia Species in Ticks, China. Emerging Infectious Diseases, 25(5), 992-995. https://dx.doi.org/10.3201/eid2505.171745.

Value of PCR, Serology, and Blood Smears for Human Granulocytic Anaplasmosis Diagnosis, France [PDF - 443 KB - 3 pages]
Y. Hansmann et al.

We prospectively examined the effectiveness of diagnostic tests for anaplasmosis using patients with suspected diagnoses in France. PCR (sensitivity 0.74, specificity 1) was the best-suited test. Serology had a lower specificity but higher sensitivity when testing acute and convalescent samples. PCR and serology should be used in combination for anaplasmosis diagnosis.

EID Hansmann Y, Jaulhac B, Kieffer P, Martinot M, Wurtz E, Dukic R, et al. Value of PCR, Serology, and Blood Smears for Human Granulocytic Anaplasmosis Diagnosis, France. Emerg Infect Dis. 2019;25(5):996-998. https://dx.doi.org/10.3201/eid2505.171751
AMA Hansmann Y, Jaulhac B, Kieffer P, et al. Value of PCR, Serology, and Blood Smears for Human Granulocytic Anaplasmosis Diagnosis, France. Emerging Infectious Diseases. 2019;25(5):996-998. doi:10.3201/eid2505.171751.
APA Hansmann, Y., Jaulhac, B., Kieffer, P., Martinot, M., Wurtz, E., Dukic, R....De Martino, S. (2019). Value of PCR, Serology, and Blood Smears for Human Granulocytic Anaplasmosis Diagnosis, France. Emerging Infectious Diseases, 25(5), 996-998. https://dx.doi.org/10.3201/eid2505.171751.

Lassa and Crimean-Congo Hemorrhagic Fever Viruses, Mali [PDF - 884 KB - 4 pages]
J. Baumann et al.

We report detection of Lassa virus and Crimean-Congo hemorrhagic fever virus infections in the area of Bamako, the capital of Mali. Our investigation found 2 cases of infection with each of these viruses. These results show the potential for both of these viruses to be endemic to Mali.

EID Baumann J, Knüpfer M, Ouedraogo J, Traoré BY, Heitzer A, Kané B, et al. Lassa and Crimean-Congo Hemorrhagic Fever Viruses, Mali. Emerg Infect Dis. 2019;25(5):999-1002. https://dx.doi.org/10.3201/eid2505.181047
AMA Baumann J, Knüpfer M, Ouedraogo J, et al. Lassa and Crimean-Congo Hemorrhagic Fever Viruses, Mali. Emerging Infectious Diseases. 2019;25(5):999-1002. doi:10.3201/eid2505.181047.
APA Baumann, J., Knüpfer, M., Ouedraogo, J., Traoré, B. Y., Heitzer, A., Kané, B....Wölfel, R. (2019). Lassa and Crimean-Congo Hemorrhagic Fever Viruses, Mali. Emerging Infectious Diseases, 25(5), 999-1002. https://dx.doi.org/10.3201/eid2505.181047.

Nipah Virus Sequences from Humans and Bats during Nipah Outbreak, Kerala, India, 2018 [PDF - 1.40 MB - 4 pages]
P. D. Yadav et al.

We retrieved Nipah virus (NiV) sequences from 4 human and 3 fruit bat (Pteropus medius) samples from a 2018 outbreak in Kerala, India. Phylogenetic analysis demonstrated that NiV from humans was 96.15% similar to a Bangladesh strain but 99.7%–100% similar to virus from Pteropus spp. bats, indicating bats were the source of the outbreak.

EID Yadav PD, Shete AM, Kumar G, Sarkale P, Sahay RR, Radhakrishnan C, et al. Nipah Virus Sequences from Humans and Bats during Nipah Outbreak, Kerala, India, 2018. Emerg Infect Dis. 2019;25(5):1003-1006. https://dx.doi.org/10.3201/eid2505.181076
AMA Yadav PD, Shete AM, Kumar G, et al. Nipah Virus Sequences from Humans and Bats during Nipah Outbreak, Kerala, India, 2018. Emerging Infectious Diseases. 2019;25(5):1003-1006. doi:10.3201/eid2505.181076.
APA Yadav, P. D., Shete, A. M., Kumar, G., Sarkale, P., Sahay, R. R., Radhakrishnan, C....Mourya, D. T. (2019). Nipah Virus Sequences from Humans and Bats during Nipah Outbreak, Kerala, India, 2018. Emerging Infectious Diseases, 25(5), 1003-1006. https://dx.doi.org/10.3201/eid2505.181076.

Infections among Contacts of Patients with Nipah Virus, India [PDF - 640 KB - 4 pages]
C. Kumar et al.

We conducted a serosurvey of 155 healthcare workers and 124 household and community members who had close contact with 18 patients who had laboratory-confirmed Nipah virus infections in Kerala, India. We detected 3 subclinical infections; 2 persons had IgM and IgG and 1 only IgM against Nipah virus.

EID Kumar C, Sugunan AP, Yadav P, Kurup K, Aarathee R, Manickam P, et al. Infections among Contacts of Patients with Nipah Virus, India. Emerg Infect Dis. 2019;25(5):1007-1010. https://dx.doi.org/10.3201/eid2505.181352
AMA Kumar C, Sugunan AP, Yadav P, et al. Infections among Contacts of Patients with Nipah Virus, India. Emerging Infectious Diseases. 2019;25(5):1007-1010. doi:10.3201/eid2505.181352.
APA Kumar, C., Sugunan, A. P., Yadav, P., Kurup, K., Aarathee, R., Manickam, P....Murhekar, M. V. (2019). Infections among Contacts of Patients with Nipah Virus, India. Emerging Infectious Diseases, 25(5), 1007-1010. https://dx.doi.org/10.3201/eid2505.181352.

Estimating Risk to Responders Exposed to Avian Influenza A H5 and H7 Viruses in Poultry, United States, 2014–2017 [PDF - 1007 KB - 4 pages]
S. J. Olsen et al.

In the United States, outbreaks of avian influenza H5 and H7 virus infections in poultry have raised concern about the risk for infections in humans. We reviewed the data collected during 2014–2017 and found no human infections among 4,555 exposed responders who were wearing protection.

EID Olsen SJ, Rooney JA, Blanton L, Rolfes MA, Nelson DI, Gomez TM, et al. Estimating Risk to Responders Exposed to Avian Influenza A H5 and H7 Viruses in Poultry, United States, 2014–2017. Emerg Infect Dis. 2019;25(5):1011-1014. https://dx.doi.org/10.3201/eid2505.181253
AMA Olsen SJ, Rooney JA, Blanton L, et al. Estimating Risk to Responders Exposed to Avian Influenza A H5 and H7 Viruses in Poultry, United States, 2014–2017. Emerging Infectious Diseases. 2019;25(5):1011-1014. doi:10.3201/eid2505.181253.
APA Olsen, S. J., Rooney, J. A., Blanton, L., Rolfes, M. A., Nelson, D. I., Gomez, T. M....Fry, A. M. (2019). Estimating Risk to Responders Exposed to Avian Influenza A H5 and H7 Viruses in Poultry, United States, 2014–2017. Emerging Infectious Diseases, 25(5), 1011-1014. https://dx.doi.org/10.3201/eid2505.181253.
Research Letters

Mycobacterium obuense Bacteremia in a Patient with Pneumonia [PDF - 401 KB - 2 pages]
B. Luis et al.

Mycobacterium obuense is a pigmented, rapidly growing mycobacterium. Because it has been considered nonpathogenic, M. obuense is being investigated in clinical trials of cancer immunotherapy and bioremediation. We report a case of bacteremia caused by M. obuense in a patient with pneumonia, showing its potential pathogenicity.

EID Luis B, Díaz-Lomelí P, Gómez-Albarrán L, Martínez-Gamboa A, Ponce-de-León A. Mycobacterium obuense Bacteremia in a Patient with Pneumonia. Emerg Infect Dis. 2019;25(5):1015-1016. https://dx.doi.org/10.3201/eid2505.180208
AMA Luis B, Díaz-Lomelí P, Gómez-Albarrán L, et al. Mycobacterium obuense Bacteremia in a Patient with Pneumonia. Emerging Infectious Diseases. 2019;25(5):1015-1016. doi:10.3201/eid2505.180208.
APA Luis, B., Díaz-Lomelí, P., Gómez-Albarrán, L., Martínez-Gamboa, A., & Ponce-de-León, A. (2019). Mycobacterium obuense Bacteremia in a Patient with Pneumonia. Emerging Infectious Diseases, 25(5), 1015-1016. https://dx.doi.org/10.3201/eid2505.180208.

Gordonia bronchialis–Associated Endophthalmitis, Oregon, USA [PDF - 550 KB - 3 pages]
R. Choi et al.

Gordonia bronchialis is an aerobic actinomycetes that rarely causes infections in humans. Few reports describe Gordonia spp. causing eye-related infections. We report a case of chronic infectious endophthalmitis in Oregon, USA, associated with infection by G. bronchialis.

EID Choi R, Strnad L, Flaxel CJ, Lauer AK, Suhler EB. Gordonia bronchialis–Associated Endophthalmitis, Oregon, USA. Emerg Infect Dis. 2019;25(5):1017-1019. https://dx.doi.org/10.3201/eid2505.180340
AMA Choi R, Strnad L, Flaxel CJ, et al. Gordonia bronchialis–Associated Endophthalmitis, Oregon, USA. Emerging Infectious Diseases. 2019;25(5):1017-1019. doi:10.3201/eid2505.180340.
APA Choi, R., Strnad, L., Flaxel, C. J., Lauer, A. K., & Suhler, E. B. (2019). Gordonia bronchialis–Associated Endophthalmitis, Oregon, USA. Emerging Infectious Diseases, 25(5), 1017-1019. https://dx.doi.org/10.3201/eid2505.180340.

Rickettsiales in Ticks Removed from Outdoor Workers, Southwest Georgia and Northwest Florida, USA [PDF - 384 KB - 3 pages]
E. R. Gleim et al.

We determined the prevalence of selected Rickettsiales in 362 ticks removed from outdoor workers in southwest Georgia and northwest Florida, USA. Persons submitted an average of 1.1 ticks/month. We found Ehrlichia chaffeensis in an Amblyomma maculatum tick, and Panola Mountain Ehrlichia sp. in 2 A. maculatum ticks and 1 Dermacentor variabilis tick.

EID Gleim ER, Conner L, Zemtsova GE, Levin ML, Wong P, Pfaff MA, et al. Rickettsiales in Ticks Removed from Outdoor Workers, Southwest Georgia and Northwest Florida, USA. Emerg Infect Dis. 2019;25(5):1019-1021. https://dx.doi.org/10.3201/eid2505.180438
AMA Gleim ER, Conner L, Zemtsova GE, et al. Rickettsiales in Ticks Removed from Outdoor Workers, Southwest Georgia and Northwest Florida, USA. Emerging Infectious Diseases. 2019;25(5):1019-1021. doi:10.3201/eid2505.180438.
APA Gleim, E. R., Conner, L., Zemtsova, G. E., Levin, M. L., Wong, P., Pfaff, M. A....Yabsley, M. J. (2019). Rickettsiales in Ticks Removed from Outdoor Workers, Southwest Georgia and Northwest Florida, USA. Emerging Infectious Diseases, 25(5), 1019-1021. https://dx.doi.org/10.3201/eid2505.180438.

Hepatic Brucelloma Diagnosis and Long-Term Treatment, France [PDF - 360 KB - 3 pages]
M. Amsilli et al.

We report a case of hepatic brucelloma in France. This diagnosis may be suspected in any patient who has a liver abscess after traveling to a brucellosis-endemic area. Brucella spp. may be detected by PCR in the liver tissue or suppuration. Abscess drainage and prolonged antimicrobial therapy help achieve healing.

EID Amsilli M, Epaulard O, Brion J, Pavese P, Letoublon C, Pelloux I, et al. Hepatic Brucelloma Diagnosis and Long-Term Treatment, France. Emerg Infect Dis. 2019;25(5):1021-1023. https://dx.doi.org/10.3201/eid2505.180613
AMA Amsilli M, Epaulard O, Brion J, et al. Hepatic Brucelloma Diagnosis and Long-Term Treatment, France. Emerging Infectious Diseases. 2019;25(5):1021-1023. doi:10.3201/eid2505.180613.
APA Amsilli, M., Epaulard, O., Brion, J., Pavese, P., Letoublon, C., Pelloux, I....Maurin, M. (2019). Hepatic Brucelloma Diagnosis and Long-Term Treatment, France. Emerging Infectious Diseases, 25(5), 1021-1023. https://dx.doi.org/10.3201/eid2505.180613.

Human Monkeypox in Sierra Leone after 44-Year Absence of Reported Cases [PDF - 523 KB - 3 pages]
M. G. Reynolds et al.

We note the reemergence of human monkeypox in Sierra Leone following a 44-year absence of reported disease. The persons affected were an 11-month-old boy and, several years later, a 35-year-old man. The reappearance of monkeypox in this country suggests a need for renewed vigilance and awareness of the disease and its manifestations.

EID Reynolds MG, Wauquier N, Li Y, Satheshkumar P, Kanneh LD, Monroe B, et al. Human Monkeypox in Sierra Leone after 44-Year Absence of Reported Cases. Emerg Infect Dis. 2019;25(5):1023-1025. https://dx.doi.org/10.3201/eid2505.180832
AMA Reynolds MG, Wauquier N, Li Y, et al. Human Monkeypox in Sierra Leone after 44-Year Absence of Reported Cases. Emerging Infectious Diseases. 2019;25(5):1023-1025. doi:10.3201/eid2505.180832.
APA Reynolds, M. G., Wauquier, N., Li, Y., Satheshkumar, P., Kanneh, L. D., Monroe, B....Moses, L. M. (2019). Human Monkeypox in Sierra Leone after 44-Year Absence of Reported Cases. Emerging Infectious Diseases, 25(5), 1023-1025. https://dx.doi.org/10.3201/eid2505.180832.

Increase in Lassa Fever Cases in Nigeria, January–March 2018 [PDF - 454 KB - 2 pages]
E. A. Ilori et al.

We reviewed data pertaining to the massive wave of Lassa fever cases that occurred in Nigeria in 2018. No new virus strains were detected, but in 2018, the outbreak response was intensified, additional diagnostic support was available, and surveillance sensitivity increased. These factors probably contributed to the high case count.

EID Ilori EA, Frank C, Dan-Nwafor CC, Ipadeola O, Krings A, Ukponu W, et al. Increase in Lassa Fever Cases in Nigeria, January–March 2018. Emerg Infect Dis. 2019;25(5):1026-1027. https://dx.doi.org/10.3201/eid2505.181247
AMA Ilori EA, Frank C, Dan-Nwafor CC, et al. Increase in Lassa Fever Cases in Nigeria, January–March 2018. Emerging Infectious Diseases. 2019;25(5):1026-1027. doi:10.3201/eid2505.181247.
APA Ilori, E. A., Frank, C., Dan-Nwafor, C. C., Ipadeola, O., Krings, A., Ukponu, W....Ihekweazu, C. (2019). Increase in Lassa Fever Cases in Nigeria, January–March 2018. Emerging Infectious Diseases, 25(5), 1026-1027. https://dx.doi.org/10.3201/eid2505.181247.

Rabies Acquired through Mucosal Exposure, China, 2013 [PDF - 301 KB - 2 pages]
H. Zhao et al.

In China in 2013, a man acquired rabies after sucking wounds of his son, who had been bitten by a stray dog. The man declined postexposure prophylaxis (hyperimmunoglobulin and vaccine) and died; the son accepted prophylaxis and survived. Physicians should be aware of rabies transmission through mucosal exposure and encourage postexposure prophylaxis.

EID Zhao H, Zhang J, Cheng C, Zhou Y. Rabies Acquired through Mucosal Exposure, China, 2013. Emerg Infect Dis. 2019;25(5):1028-1029. https://dx.doi.org/10.3201/eid2505.181413
AMA Zhao H, Zhang J, Cheng C, et al. Rabies Acquired through Mucosal Exposure, China, 2013. Emerging Infectious Diseases. 2019;25(5):1028-1029. doi:10.3201/eid2505.181413.
APA Zhao, H., Zhang, J., Cheng, C., & Zhou, Y. (2019). Rabies Acquired through Mucosal Exposure, China, 2013. Emerging Infectious Diseases, 25(5), 1028-1029. https://dx.doi.org/10.3201/eid2505.181413.

Endemic Severe Fever with Thrombocytopenia Syndrome, Vietnam [PDF - 357 KB - 3 pages]
X. Tran et al.

Severe fever with thrombocytopenia syndrome (SFTS), a tickborne viral disease, has been identified in China, South Korea, and Japan since 2009. We found retrospective evidence of SFTS virus (SFTSV) infection in Vietnam, which suggests that SFTSV infections also occur in Vietnam, where the virus has not been known to be endemic.

EID Tran X, Yun Y, Van An L, Kim S, Thao NT, Man PC, et al. Endemic Severe Fever with Thrombocytopenia Syndrome, Vietnam. Emerg Infect Dis. 2019;25(5):1029-1031. https://dx.doi.org/10.3201/eid2505.181463
AMA Tran X, Yun Y, Van An L, et al. Endemic Severe Fever with Thrombocytopenia Syndrome, Vietnam. Emerging Infectious Diseases. 2019;25(5):1029-1031. doi:10.3201/eid2505.181463.
APA Tran, X., Yun, Y., Van An, L., Kim, S., Thao, N. T., Man, P. C....Lee, K. (2019). Endemic Severe Fever with Thrombocytopenia Syndrome, Vietnam. Emerging Infectious Diseases, 25(5), 1029-1031. https://dx.doi.org/10.3201/eid2505.181463.

Mixed Mycobacterium tuberculosis Lineage Infection in 2 Elephants, Nepal [PDF - 344 KB - 2 pages]
S. Paudel et al.

Tuberculosis in elephants is primarily caused by Mycobacterium tuberculosis. We identified mixed M. tuberculosis lineage infection in 2 captive elephants in Nepal by using spoligotyping and large sequence polymorphism. One elephant was infected with Indo-Oceanic and East African–Indian (CAS-Delhi) lineages; the other was infected with Indo-Oceanic and East Asian (Beijing) lineages.

EID Paudel S, Nakajima C, Mikota SK, Gairhe KP, Maharjan B, Subedi S, et al. Mixed Mycobacterium tuberculosis Lineage Infection in 2 Elephants, Nepal. Emerg Infect Dis. 2019;25(5):1031-1032. https://dx.doi.org/10.3201/eid2505.181898
AMA Paudel S, Nakajima C, Mikota SK, et al. Mixed Mycobacterium tuberculosis Lineage Infection in 2 Elephants, Nepal. Emerging Infectious Diseases. 2019;25(5):1031-1032. doi:10.3201/eid2505.181898.
APA Paudel, S., Nakajima, C., Mikota, S. K., Gairhe, K. P., Maharjan, B., Subedi, S....Tsubota, T. (2019). Mixed Mycobacterium tuberculosis Lineage Infection in 2 Elephants, Nepal. Emerging Infectious Diseases, 25(5), 1031-1032. https://dx.doi.org/10.3201/eid2505.181898.

Need for Aeromedical Evacuation High-Level Containment Transport Guidelines [PDF - 284 KB - 2 pages]
S. G. Gibbs et al.

Circumstances exist that call for the aeromedical evacuation high-level containment transport (AE-HLCT) of patients with highly hazardous communicable diseases. A small number of organizations maintain AE-HLCT capabilities, and little is publicly available regarding the practices. The time is ripe for the development of standards and consensus guidelines involving AE-HLCT.

EID Gibbs SG, Herstein JJ, Le AB, Beam EL, Cieslak TJ, Lawler JV, et al. Need for Aeromedical Evacuation High-Level Containment Transport Guidelines. Emerg Infect Dis. 2019;25(5):1033-1034. https://dx.doi.org/10.3201/eid2505.181948
AMA Gibbs SG, Herstein JJ, Le AB, et al. Need for Aeromedical Evacuation High-Level Containment Transport Guidelines. Emerging Infectious Diseases. 2019;25(5):1033-1034. doi:10.3201/eid2505.181948.
APA Gibbs, S. G., Herstein, J. J., Le, A. B., Beam, E. L., Cieslak, T. J., Lawler, J. V....Lowe, J. J. (2019). Need for Aeromedical Evacuation High-Level Containment Transport Guidelines. Emerging Infectious Diseases, 25(5), 1033-1034. https://dx.doi.org/10.3201/eid2505.181948.
About the Cover

Consequences of Failing to Investigate [PDF - 1.52 MB - 2 pages]
B. Breedlove
EID Breedlove B. Consequences of Failing to Investigate. Emerg Infect Dis. 2019;25(5):1035-1036. https://dx.doi.org/10.3201/eid2505.ac2505
AMA Breedlove B. Consequences of Failing to Investigate. Emerging Infectious Diseases. 2019;25(5):1035-1036. doi:10.3201/eid2505.ac2505.
APA Breedlove, B. (2019). Consequences of Failing to Investigate. Emerging Infectious Diseases, 25(5), 1035-1036. https://dx.doi.org/10.3201/eid2505.ac2505.
Etymologia

Etymologia: Nipah Virus [PDF - 554 KB - 1 page]
R. Henry
EID Henry R. Etymologia: Nipah Virus. Emerg Infect Dis. 2019;25(5):1010. https://dx.doi.org/10.3201/eid2505.et2505
AMA Henry R. Etymologia: Nipah Virus. Emerging Infectious Diseases. 2019;25(5):1010. doi:10.3201/eid2505.et2505.
APA Henry, R. (2019). Etymologia: Nipah Virus. Emerging Infectious Diseases, 25(5), 1010. https://dx.doi.org/10.3201/eid2505.et2505.
Online Reports

Biosafety Level 4 Laboratory User Training Program, China [PDF - 1006 KB - 4 pages]
H. Xia et al.

Experienced, qualified personnel certified to work in high-level biocontainment laboratories contribute to the safe operation of these facilities. China began a training program for laboratory users after establishing its first Biosafety Level 4 laboratory, the Wuhan National Biosafety Laboratory (Level 4) of the Chinese Academy of Sciences. We provide an overview of the content of this training program, which can serve as a reference for developing national norms for high-containment laboratory training.


Southeast Asia Strategic Multilateral Dialogue on Biosecurity [PDF - 1.24 MB - 6 pages]
A. Cicero et al.

A strategic multilateral dialogue related to biosecurity risks in Southeast Asia, established in 2014, now includes participants from Singapore, Malaysia, Indonesia, Thailand, Philippines, and the United States. This dialogue is conducted at the nonministerial level, enabling participants to engage without the constraints of operating in their official capacities. Participants reflect on mechanisms to detect, mitigate, and respond to biosecurity risks and highlight biosecurity issues for national leadership. Participants have also identified factors to improve regional and global biosecurity, including improved engagement and collaboration across relevant ministries and agencies, sustainable funding for biosecurity programs, enhanced information sharing for communicable diseases, and increased engagement in international biosecurity forums.

Corrections

Correction: Vol. 25, No. 2 [PDF - 241 KB - 1 page]
EID Correction: Vol. 25, No. 2. Emerg Infect Dis. 2019;25(5):1034. https://dx.doi.org/10.3201/eid2505.c22505
AMA Correction: Vol. 25, No. 2. Emerging Infectious Diseases. 2019;25(5):1034. doi:10.3201/eid2505.c22505.
APA (2019). Correction: Vol. 25, No. 2. Emerging Infectious Diseases, 25(5), 1034. https://dx.doi.org/10.3201/eid2505.c22505.

Correction: Vol. 24, No. 10 [PDF - 241 KB - 1 page]
EID Correction: Vol. 24, No. 10. Emerg Infect Dis. 2019;25(5):1034. https://dx.doi.org/10.3201/eid2505.c12505
AMA Correction: Vol. 24, No. 10. Emerging Infectious Diseases. 2019;25(5):1034. doi:10.3201/eid2505.c12505.
APA (2019). Correction: Vol. 24, No. 10. Emerging Infectious Diseases, 25(5), 1034. https://dx.doi.org/10.3201/eid2505.c12505.
Page created: April 18, 2019
Page updated: April 18, 2019
Page reviewed: April 18, 2019
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