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Articles from Emerging Infectious Diseases

Perspective

The Problem of Microbial Dark Matter in Neonatal Sepsis [PDF - 520 KB - 6 pages]
S. A. Sinnar and S. J. Schiff

Neonatal sepsis (NS) kills 750,000 infants every year. Effectively treating NS requires timely diagnosis and antimicrobial therapy matched to the causative pathogens, but most blood cultures for suspected NS do not recover a causative pathogen. We refer to these suspected but unidentified pathogens as microbial dark matter. Given these low culture recovery rates, many non–culture-based technologies are being explored to diagnose NS, including PCR, 16S amplicon sequencing, and whole metagenomic sequencing. However, few of these newer technologies are scalable or sustainable globally. To reduce worldwide deaths from NS, one possibility may be performing population-wide pathogen discovery. Because pathogen transmission patterns can vary across space and time, computational models can be built to predict the pathogens responsible for NS by region and season. This approach could help to optimally treat patients, decreasing deaths from NS and increasing antimicrobial stewardship until effective diagnostics that are scalable become available globally.

EID Sinnar SA, Schiff SJ. The Problem of Microbial Dark Matter in Neonatal Sepsis. Emerg Infect Dis. 2020;26(11):2543-2548. https://dx.doi.org/10.3201/eid2611.200004
AMA Sinnar SA, Schiff SJ. The Problem of Microbial Dark Matter in Neonatal Sepsis. Emerging Infectious Diseases. 2020;26(11):2543-2548. doi:10.3201/eid2611.200004.
APA Sinnar, S. A., & Schiff, S. J. (2020). The Problem of Microbial Dark Matter in Neonatal Sepsis. Emerging Infectious Diseases, 26(11), 2543-2548. https://dx.doi.org/10.3201/eid2611.200004.

Two Pandemics, One Challenge—Leveraging Molecular Test Capacity of Tuberculosis Laboratories for Rapid COVID-19 Case-Finding [PDF - 909 KB - 6 pages]
S. Homolka et al.

In many settings, the ongoing coronavirus disease (COVID-19) pandemic coincides with other major public health threats, in particular tuberculosis. Using tuberculosis (TB) molecular diagnostic infrastructure, which has substantially expanded worldwide in recent years, for COVID-19 case-finding might be warranted. We analyze the potential of using TB diagnostic and research infrastructures for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. We focused on quality control by adapting the 12 Quality System Essentials framework to the COVID-19 and TB context. We conclude that diagnostic infrastructures for TB can in principle be leveraged to scale-up SARS-CoV-2 testing, in particular in resource-poor settings. TB research infrastructures also can support sequencing of SARS-CoV-2 to study virus evolution and diversity globally. However, fundamental principles of quality management must be followed for both TB and SARS-CoV-2 testing to ensure valid results and to minimize biosafety hazards, and the continuity of TB diagnostic services must be guaranteed at all times.

EID Homolka S, Paulowski L, Andres S, Hillemann D, Jou R, Günther G, et al. Two Pandemics, One Challenge—Leveraging Molecular Test Capacity of Tuberculosis Laboratories for Rapid COVID-19 Case-Finding. Emerg Infect Dis. 2020;26(11):2549-2554. https://dx.doi.org/10.3201/eid2611.202602
AMA Homolka S, Paulowski L, Andres S, et al. Two Pandemics, One Challenge—Leveraging Molecular Test Capacity of Tuberculosis Laboratories for Rapid COVID-19 Case-Finding. Emerging Infectious Diseases. 2020;26(11):2549-2554. doi:10.3201/eid2611.202602.
APA Homolka, S., Paulowski, L., Andres, S., Hillemann, D., Jou, R., Günther, G....Maurer, F. P. (2020). Two Pandemics, One Challenge—Leveraging Molecular Test Capacity of Tuberculosis Laboratories for Rapid COVID-19 Case-Finding. Emerging Infectious Diseases, 26(11), 2549-2554. https://dx.doi.org/10.3201/eid2611.202602.
Synopses

Measuring Timeliness of Outbreak Response in the World Health Organization African Region, 2017–2019 [PDF - 2.49 MB - 10 pages]
B. Impouma et al.

Large-scale protracted outbreaks can be prevented through early detection, notification, and rapid control. We assessed trends in timeliness of detecting and responding to outbreaks in the African Region reported to the World Health Organization during 2017–2019. We computed the median time to each outbreak milestone and assessed the rates of change over time using univariable and multivariable Cox proportional hazard regression analyses. We selected 296 outbreaks from 348 public reported health events and evaluated 184 for time to detection, 232 for time to notification, and 201 for time to end. Time to detection and end decreased over time, whereas time to notification increased. Multiple factors can account for these findings, including scaling up support to member states after the World Health Organization established its Health Emergencies Programme and support given to countries from donors and partners to strengthen their core capacities for meeting International Health Regulations.

EID Impouma B, Roelens M, Williams G, Flahault A, Codeço C, Moussana F, et al. Measuring Timeliness of Outbreak Response in the World Health Organization African Region, 2017–2019. Emerg Infect Dis. 2020;26(11):2555-2564. https://dx.doi.org/10.3201/eid2611.191766
AMA Impouma B, Roelens M, Williams G, et al. Measuring Timeliness of Outbreak Response in the World Health Organization African Region, 2017–2019. Emerging Infectious Diseases. 2020;26(11):2555-2564. doi:10.3201/eid2611.191766.
APA Impouma, B., Roelens, M., Williams, G., Flahault, A., Codeço, C., Moussana, F....Keiser, O. (2020). Measuring Timeliness of Outbreak Response in the World Health Organization African Region, 2017–2019. Emerging Infectious Diseases, 26(11), 2555-2564. https://dx.doi.org/10.3201/eid2611.191766.

Challenges to Achieving Measles Elimination, Georgia, 2013–2018 [PDF - 4.70 MB - 13 pages]
N. Khetsuriani et al.

Controlling measles outbreaks in the country of Georgia and throughout Europe is crucial for achieving the measles elimination goal for the World Health Organization’s European Region. However, large-scale measles outbreaks occurred in Georgia during 2013–2015 and 2017–2018. The epidemiology of these outbreaks indicates widespread circulation and genetic diversity of measles viruses and reveals persistent gaps in population immunity across a wide age range that have not been sufficiently addressed thus far. Historic problems and recent challenges with the immunization program contributed to outbreaks. Addressing population susceptibility across all age groups is needed urgently. However, conducting large-scale mass immunization campaigns under the current health system is not feasible, so more selective response strategies are being implemented. Lessons from the measles outbreaks in Georgia could be useful for other countries that have immunization programs facing challenges related to health-system transitions and the presence of age cohorts with historically low immunization coverage.

EID Khetsuriani N, Sanadze K, Chlikadze R, Chitadze N, Dolakidze T, Komakhidze T, et al. Challenges to Achieving Measles Elimination, Georgia, 2013–2018. Emerg Infect Dis. 2020;26(11):2565-2577. https://dx.doi.org/10.3201/eid2611.200259
AMA Khetsuriani N, Sanadze K, Chlikadze R, et al. Challenges to Achieving Measles Elimination, Georgia, 2013–2018. Emerging Infectious Diseases. 2020;26(11):2565-2577. doi:10.3201/eid2611.200259.
APA Khetsuriani, N., Sanadze, K., Chlikadze, R., Chitadze, N., Dolakidze, T., Komakhidze, T....Hübschen, J. M. (2020). Challenges to Achieving Measles Elimination, Georgia, 2013–2018. Emerging Infectious Diseases, 26(11), 2565-2577. https://dx.doi.org/10.3201/eid2611.200259.
Research

Medscape CME Activity
Phage-Mediated Immune Evasion and Transmission of Livestock-Associated Methicillin-Resistant Staphylococcus aureus in Humans [PDF - 874 KB - 8 pages]
R. N. Sieber et al.

Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) can acquire phage-encoded immune modulators, such as the immune evasion cluster (IEC), which protects bacteria from components of the human innate immune system, and the enzyme TarP, which protects against antibody-mediated immune recognition. We used whole-genome sequencing and epidemiologic investigations to study the effects of IEC- and tarP-harboring phages on household transmission of LA-MRSA in North Denmark Region during 2004–2011. We reviewed information about all patients throughout Denmark who experienced LA-MRSA infection during 2007–2018 to determine whether IEC is associated with increased spread into the general population. Horizontal acquisition of IEC in the human host was associated with increased household transmission of LA-MRSA and spillover into the community and healthcare settings, whereas we found no evidence to suggest that IEC-positive LA-MRSA isolates have become self-sustainable in the general population. By contrast, TarP did not seem to influence household transmission of LA-MRSA.

EID Sieber RN, Urth TR, Petersen A, Møller CH, Price LB, Skov RL, et al. Phage-Mediated Immune Evasion and Transmission of Livestock-Associated Methicillin-Resistant Staphylococcus aureus in Humans. Emerg Infect Dis. 2020;26(11):2578-2585. https://dx.doi.org/10.3201/eid2611.201442
AMA Sieber RN, Urth TR, Petersen A, et al. Phage-Mediated Immune Evasion and Transmission of Livestock-Associated Methicillin-Resistant Staphylococcus aureus in Humans. Emerging Infectious Diseases. 2020;26(11):2578-2585. doi:10.3201/eid2611.201442.
APA Sieber, R. N., Urth, T. R., Petersen, A., Møller, C. H., Price, L. B., Skov, R. L....Larsen, J. (2020). Phage-Mediated Immune Evasion and Transmission of Livestock-Associated Methicillin-Resistant Staphylococcus aureus in Humans. Emerging Infectious Diseases, 26(11), 2578-2585. https://dx.doi.org/10.3201/eid2611.201442.

Validated Methods for Removing Select Agent Samples from Biosafety Level 3 Laboratories [PDF - 704 KB - 5 pages]
A. E. Kesterson et al.

The Federal Select Agent Program dictates that all research entities in the United States must rigorously assess laboratory protocols to sterilize samples being removed from containment areas. We validated procedures using sterile filtration and methanol to remove the following select agents: Francisella tularensis, Burkholderia pseudomallei, B. mallei, Yersinia pestis, and Bacillus anthracis. We validated methanol treatment for B. pseudomallei. These validations reaffirm safety protocols that enable researchers to keep samples sufficiently intact when samples are transferred between laboratories.

EID Kesterson AE, Craig JE, Chuvala LJ, Heine HS. Validated Methods for Removing Select Agent Samples from Biosafety Level 3 Laboratories. Emerg Infect Dis. 2020;26(11):2586-2590. https://dx.doi.org/10.3201/eid2611.191630
AMA Kesterson AE, Craig JE, Chuvala LJ, et al. Validated Methods for Removing Select Agent Samples from Biosafety Level 3 Laboratories. Emerging Infectious Diseases. 2020;26(11):2586-2590. doi:10.3201/eid2611.191630.
APA Kesterson, A. E., Craig, J. E., Chuvala, L. J., & Heine, H. S. (2020). Validated Methods for Removing Select Agent Samples from Biosafety Level 3 Laboratories. Emerging Infectious Diseases, 26(11), 2586-2590. https://dx.doi.org/10.3201/eid2611.191630.

Epidemiology of COVID-19 Outbreak on Cruise Ship Quarantined at Yokohama, Japan, February 2020 [PDF - 1.88 MB - 7 pages]

To improve understanding of coronavirus disease (COVID-19), we assessed the epidemiology of an outbreak on a cruise ship, February 5–24, 2020. The study population included persons on board on February 3 (2,666 passengers, 1,045 crew). Passengers had a mean age of 66.1 years and were 55% female; crew had a mean age of 36.6 years and were 81% male. Of passengers, 544 (20.4%) were infected, 314 (57.7%) asymptomatic. Attack rates were highest in 4-person cabins (30.0%; n = 18). Of crew, 143 (13.7%) were infected, 64 (44.8%) asymptomatic. Passenger cases peaked February 7, and 35 had onset before quarantine. Crew cases peaked on February 11 and 13. The median serial interval between cases in the same cabin was 2 days. This study shows that severe acute respiratory syndrome coronavirus 2 is infectious in closed settings, that subclinical infection is common, and that close contact is key for transmission.

EID Epidemiology of COVID-19 Outbreak on Cruise Ship Quarantined at Yokohama, Japan, February 2020. Emerg Infect Dis. 2020;26(11):2591-2597. https://dx.doi.org/10.3201/eid2611.201165
AMA Epidemiology of COVID-19 Outbreak on Cruise Ship Quarantined at Yokohama, Japan, February 2020. Emerging Infectious Diseases. 2020;26(11):2591-2597. doi:10.3201/eid2611.201165.
APA (2020). Epidemiology of COVID-19 Outbreak on Cruise Ship Quarantined at Yokohama, Japan, February 2020. Emerging Infectious Diseases, 26(11), 2591-2597. https://dx.doi.org/10.3201/eid2611.201165.

Analysis of SARS-CoV-2 Transmission in Different Settings, Brunei [PDF - 1.33 MB - 9 pages]
L. Chaw et al.

We report the transmission dynamics of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) across different settings in Brunei. An initial cluster of SARS-CoV-2 cases arose from 19 persons who had attended the Tablighi Jama’at gathering in Malaysia, resulting in 52 locally transmitted cases. The highest nonprimary attack rates (14.8%) were observed from a subsequent religious gathering in Brunei and in households of attendees (10.6%). Household attack rates from symptomatic case-patients were higher (14.4%) than from asymptomatic (4.4%) or presymptomatic (6.1%) case-patients. Workplace and social settings had attack rates of <1%. Our analyses highlight that transmission of SARS-CoV-2 varies depending on environmental, behavioral, and host factors. We identify red flags for potential superspreading events, specifically densely populated gatherings with prolonged exposure in enclosed settings, persons with recent travel history to areas with active SARS-CoV-2 infections, and group behaviors. We propose differentiated testing strategies to account for differing transmission risk.

EID Chaw L, Koh W, Jamaludin S, Naing L, Alikhan M, Wong J. Analysis of SARS-CoV-2 Transmission in Different Settings, Brunei. Emerg Infect Dis. 2020;26(11):2598-2606. https://dx.doi.org/10.3201/eid2611.202263
AMA Chaw L, Koh W, Jamaludin S, et al. Analysis of SARS-CoV-2 Transmission in Different Settings, Brunei. Emerging Infectious Diseases. 2020;26(11):2598-2606. doi:10.3201/eid2611.202263.
APA Chaw, L., Koh, W., Jamaludin, S., Naing, L., Alikhan, M., & Wong, J. (2020). Analysis of SARS-CoV-2 Transmission in Different Settings, Brunei. Emerging Infectious Diseases, 26(11), 2598-2606. https://dx.doi.org/10.3201/eid2611.202263.

Case-Control Study of Use of Personal Protective Measures and Risk for SARS-CoV 2 Infection, Thailand [PDF - 1.74 MB - 10 pages]
P. Doung-ngern et al.

We evaluated effectiveness of personal protective measures against severe acute respiratory disease coronavirus 2 (SARS-CoV-2) infection. Our case-control study included 211 cases of coronavirus disease (COVID-19) and 839 controls in Thailand. Cases were defined as asymptomatic contacts of COVID-19 patients who later tested positive for SARS-CoV-2; controls were asymptomatic contacts who never tested positive. Wearing masks all the time during contact was independently associated with lower risk for SARS-CoV-2 infection compared with not wearing masks; wearing a mask sometimes during contact did not lower infection risk. We found the type of mask worn was not independently associated with infection and that contacts who always wore masks were more likely to practice social distancing. Maintaining >1 m distance from a person with COVID-19, having close contact for <15 minutes, and frequent handwashing were independently associated with lower risk for infection. Our findings support consistent wearing of masks, handwashing, and social distancing to protect against COVID-19.

EID Doung-ngern P, Suphanchaimat R, Panjangampatthana A, Janekrongtham C, Ruampoom D, Daochaeng N, et al. Case-Control Study of Use of Personal Protective Measures and Risk for SARS-CoV 2 Infection, Thailand. Emerg Infect Dis. 2020;26(11):2607-2616. https://dx.doi.org/10.3201/eid2611.203003
AMA Doung-ngern P, Suphanchaimat R, Panjangampatthana A, et al. Case-Control Study of Use of Personal Protective Measures and Risk for SARS-CoV 2 Infection, Thailand. Emerging Infectious Diseases. 2020;26(11):2607-2616. doi:10.3201/eid2611.203003.
APA Doung-ngern, P., Suphanchaimat, R., Panjangampatthana, A., Janekrongtham, C., Ruampoom, D., Daochaeng, N....Limmathurotsakul, D. (2020). Case-Control Study of Use of Personal Protective Measures and Risk for SARS-CoV 2 Infection, Thailand. Emerging Infectious Diseases, 26(11), 2607-2616. https://dx.doi.org/10.3201/eid2611.203003.

Transmission of SARS-CoV 2 During Long-Haul Flight [PDF - 970 KB - 8 pages]
N. Khanh et al.

To assess the role of in-flight transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we investigated a cluster of cases among passengers on a 10-hour commercial flight. Affected persons were passengers, crew, and their close contacts. We traced 217 passengers and crew to their final destinations and interviewed, tested, and quarantined them. Among the 16 persons in whom SARS-CoV-2 infection was detected, 12 (75%) were passengers seated in business class along with the only symptomatic person (attack rate 62%). Seating proximity was strongly associated with increased infection risk (risk ratio 7.3, 95% CI 1.2–46.2). We found no strong evidence supporting alternative transmission scenarios. In-flight transmission that probably originated from 1 symptomatic passenger caused a large cluster of cases during a long flight. Guidelines for preventing SARS-CoV-2 infection among air passengers should consider individual passengers’ risk for infection, the number of passengers traveling, and flight duration.

EID Khanh N, Thai P, Quach H, Thi N, Dinh P, Duong T, et al. Transmission of SARS-CoV 2 During Long-Haul Flight. Emerg Infect Dis. 2020;26(11):2617-2624. https://dx.doi.org/10.3201/eid2611.203299
AMA Khanh N, Thai P, Quach H, et al. Transmission of SARS-CoV 2 During Long-Haul Flight. Emerging Infectious Diseases. 2020;26(11):2617-2624. doi:10.3201/eid2611.203299.
APA Khanh, N., Thai, P., Quach, H., Thi, N., Dinh, P., Duong, T....Anh, D. (2020). Transmission of SARS-CoV 2 During Long-Haul Flight. Emerging Infectious Diseases, 26(11), 2617-2624. https://dx.doi.org/10.3201/eid2611.203299.

Endotheliopathy and Platelet Dysfunction as Hallmarks of Fatal Lassa Fever [PDF - 2.71 MB - 13 pages]
L. E. Horton et al.

Lassa fever (LF) causes multisystem disease and has a fatality rate <70%. Severe cases exhibit abnormal coagulation, endothelial barrier disruption, and dysfunctional platelet aggregation but the underlying mechanisms remain poorly understood. In Sierra Leone during 2015–2018, we assessed LF patients’ day-of-admission plasma samples for levels of proteins necessary for coagulation, fibrinolysis, and platelet function. P-selectin, soluble endothelial protein C receptor, soluble thrombomodulin, plasminogen activator inhibitor 1, ADAMTS-13, von Willebrand factor, tissue factor, soluble intercellular adhesion molecule 1, and vascular cell adhesion molecule 1 were more elevated in LF patients than in controls. Endothelial protein C receptor, thrombomodulin, intercellular adhesion molecule 1, plasminogen activator inhibitor 1, D-dimer, and hepatocyte growth factor were higher in fatal than nonfatal LF cases. Platelet disaggregation occurred only in samples from fatal LF cases. The impaired homeostasis and platelet dysfunction implicate alterations in the protein C pathway, which might contribute to the loss of endothelial barrier function in fatal infections.

EID Horton LE, Cross RW, Hartnett JN, Engel EJ, Sakabe S, Goba A, et al. Endotheliopathy and Platelet Dysfunction as Hallmarks of Fatal Lassa Fever. Emerg Infect Dis. 2020;26(11):2625-2637. https://dx.doi.org/10.3201/eid2611.191694
AMA Horton LE, Cross RW, Hartnett JN, et al. Endotheliopathy and Platelet Dysfunction as Hallmarks of Fatal Lassa Fever. Emerging Infectious Diseases. 2020;26(11):2625-2637. doi:10.3201/eid2611.191694.
APA Horton, L. E., Cross, R. W., Hartnett, J. N., Engel, E. J., Sakabe, S., Goba, A....Sullivan, B. M. (2020). Endotheliopathy and Platelet Dysfunction as Hallmarks of Fatal Lassa Fever. Emerging Infectious Diseases, 26(11), 2625-2637. https://dx.doi.org/10.3201/eid2611.191694.

High Dengue Burden and Circulation of 4 Virus Serotypes among Children with Undifferentiated Fever, Kenya, 2014–2017 [PDF - 4.48 MB - 13 pages]
M. M. Shah et al.

Little is known about the extent and serotypes of dengue viruses circulating in Africa. We evaluated the presence of dengue viremia during 4 years of surveillance (2014–2017) among children with febrile illness in Kenya. Acutely ill febrile children were recruited from 4 clinical sites in western and coastal Kenya, and 1,022 participant samples were tested by using a highly sensitive real-time reverse transcription PCR. A complete case analysis with genomic sequencing and phylogenetic analyses was conducted to characterize the presence of dengue viremia among participants during 2014–2017. Dengue viremia was detected in 41.9% (361/862) of outpatient children who had undifferentiated febrile illness in Kenya. Of children with confirmed dengue viremia, 51.5% (150/291) had malaria parasitemia. All 4 dengue virus serotypes were detected, and phylogenetic analyses showed several viruses from novel lineages. Our results suggests high levels of dengue virus infection among children with undifferentiated febrile illness in Kenya.

EID Shah MM, Ndenga BA, Mutuku FM, Vu DM, Grossi-Soyster EN, Okuta V, et al. High Dengue Burden and Circulation of 4 Virus Serotypes among Children with Undifferentiated Fever, Kenya, 2014–2017. Emerg Infect Dis. 2020;26(11):2638-2650. https://dx.doi.org/10.3201/eid2611.200960
AMA Shah MM, Ndenga BA, Mutuku FM, et al. High Dengue Burden and Circulation of 4 Virus Serotypes among Children with Undifferentiated Fever, Kenya, 2014–2017. Emerging Infectious Diseases. 2020;26(11):2638-2650. doi:10.3201/eid2611.200960.
APA Shah, M. M., Ndenga, B. A., Mutuku, F. M., Vu, D. M., Grossi-Soyster, E. N., Okuta, V....LaBeaud, A. (2020). High Dengue Burden and Circulation of 4 Virus Serotypes among Children with Undifferentiated Fever, Kenya, 2014–2017. Emerging Infectious Diseases, 26(11), 2638-2650. https://dx.doi.org/10.3201/eid2611.200960.

Systematic Review and Meta-Analyses of Incidence for Group B Streptococcus Disease in Infants and Antimicrobial Resistance, China [PDF - 1.02 MB - 9 pages]
Y. Ding et al.

We performed a systematic review and meta-analysis of the incidence, case-fatality rate (CFR), isolate antimicrobial resistance patterns, and serotype and sequence type distributions for invasive group B Streptococcus (GBS) disease in infants <1–89 days of age in China. We searched the PubMed/Medline, Embase, Wanfang, and China National Knowledge Infrastructure databases for research published during January 1, 2000–March 16, 2018, and identified 64 studies. Quality of included studies was assessed by using Cochrane tools. Incidence and CFR were estimated by using random-effects meta-analyses. Overall incidence was 0.55 (95% CI 0.35–0.74) cases/1,000 live births, and the CFR was 5% (95% CI 3%–6%). Incidence of GBS in young infants in China was higher than the estimated global incidence (0.49 cases/1,000 live births) and higher than previous estimates for Asia (0.3 cases/1,000 live births). Our findings suggest that implementation of additional GBS prevention efforts in China, including maternal vaccination, could be beneficial.

EID Ding Y, Wang Y, Hsia Y, Russell N, Heath PT. Systematic Review and Meta-Analyses of Incidence for Group B Streptococcus Disease in Infants and Antimicrobial Resistance, China. Emerg Infect Dis. 2020;26(11):2651-2659. https://dx.doi.org/10.3201/eid2611.181414
AMA Ding Y, Wang Y, Hsia Y, et al. Systematic Review and Meta-Analyses of Incidence for Group B Streptococcus Disease in Infants and Antimicrobial Resistance, China. Emerging Infectious Diseases. 2020;26(11):2651-2659. doi:10.3201/eid2611.181414.
APA Ding, Y., Wang, Y., Hsia, Y., Russell, N., & Heath, P. T. (2020). Systematic Review and Meta-Analyses of Incidence for Group B Streptococcus Disease in Infants and Antimicrobial Resistance, China. Emerging Infectious Diseases, 26(11), 2651-2659. https://dx.doi.org/10.3201/eid2611.181414.

Streptococcus pneumoniae Serotype 12F-CC4846 and Invasive Pneumococcal Disease after Introduction of 13-Valent Pneumococcal Conjugate Vaccine, Japan, 2015–2017 [PDF - 1.60 MB - 9 pages]
S. Nakano et al.

To prevent invasive pneumococcal disease (IPD), pneumococcal conjugate vaccines (PCVs) have been implemented in many countries; however, many cases of IPD still occur and can be attributable to nonvaccine serotypes of Streptococcus pneumoniae. In Japan, the number of IPD cases attributable to serotype 12F increased from 4.4% in 2015 to 24.6% in 2017 after 13-valent PCV was introduced. To clarify the associated genetic characteristics, we conducted whole-genome sequencing of 75 serotype 12F isolates. We identified 2 sequence types (STs) among the isolates: ST4846, which was the major type, and ST6945. Bayesian analysis suggested that these types diverged in »1942. Among serotype 12F-ST4846, we identified a major cluster, PC-JP12F, whose time of most recent common ancestor was estimated to be »2012. A phylogeographic analysis demonstrated that PC-JP12F isolates spread from the Kanto region, the most populated region in Japan, to other local regions.

EID Nakano S, Fujisawa T, Ito Y, Chang B, Matsumura Y, Yamamoto M, et al. Streptococcus pneumoniae Serotype 12F-CC4846 and Invasive Pneumococcal Disease after Introduction of 13-Valent Pneumococcal Conjugate Vaccine, Japan, 2015–2017. Emerg Infect Dis. 2020;26(11):2660-2668. https://dx.doi.org/10.3201/eid2611.200087
AMA Nakano S, Fujisawa T, Ito Y, et al. Streptococcus pneumoniae Serotype 12F-CC4846 and Invasive Pneumococcal Disease after Introduction of 13-Valent Pneumococcal Conjugate Vaccine, Japan, 2015–2017. Emerging Infectious Diseases. 2020;26(11):2660-2668. doi:10.3201/eid2611.200087.
APA Nakano, S., Fujisawa, T., Ito, Y., Chang, B., Matsumura, Y., Yamamoto, M....Nagao, M. (2020). Streptococcus pneumoniae Serotype 12F-CC4846 and Invasive Pneumococcal Disease after Introduction of 13-Valent Pneumococcal Conjugate Vaccine, Japan, 2015–2017. Emerging Infectious Diseases, 26(11), 2660-2668. https://dx.doi.org/10.3201/eid2611.200087.

Nowcasting (Short-Term Forecasting) of Influenza Epidemics in Local Settings, Sweden, 2008–2019 [PDF - 1.50 MB - 9 pages]
A. Spreco et al.

The timing of influenza case incidence during epidemics can differ between regions within nations and states. We conducted a prospective 10-year evaluation (January 2008–February 2019) of a local influenza nowcasting (short-term forecasting) method in 3 urban counties in Sweden with independent public health administrations by using routine health information system data. Detection-of-epidemic-start (detection), peak timing, and peak intensity were nowcasted. Detection displayed satisfactory performance in 2 of the 3 counties for all nonpandemic influenza seasons and in 6 of 9 seasons for the third county. Peak-timing prediction showed satisfactory performance from the influenza season 2011–12 onward. Peak-intensity prediction also was satisfactory for influenza seasons in 2 of the counties but poor in 1 county. Local influenza nowcasting was satisfactory for seasonal influenza in 2 of 3 counties. The less satisfactory performance in 1 of the study counties might be attributable to population mixing with a neighboring metropolitan area.

EID Spreco A, Eriksson O, Dahlström Ö, Cowling B, Biggerstaff M, Ljunggren G, et al. Nowcasting (Short-Term Forecasting) of Influenza Epidemics in Local Settings, Sweden, 2008–2019. Emerg Infect Dis. 2020;26(11):2669-2677. https://dx.doi.org/10.3201/eid2611.200448
AMA Spreco A, Eriksson O, Dahlström Ö, et al. Nowcasting (Short-Term Forecasting) of Influenza Epidemics in Local Settings, Sweden, 2008–2019. Emerging Infectious Diseases. 2020;26(11):2669-2677. doi:10.3201/eid2611.200448.
APA Spreco, A., Eriksson, O., Dahlström, Ö., Cowling, B., Biggerstaff, M., Ljunggren, G....Timpka, T. (2020). Nowcasting (Short-Term Forecasting) of Influenza Epidemics in Local Settings, Sweden, 2008–2019. Emerging Infectious Diseases, 26(11), 2669-2677. https://dx.doi.org/10.3201/eid2611.200448.

Azithromycin to Prevent Pertussis in Household Contacts, Catalonia and Navarre, Spain, 2012–2013 [PDF - 1.27 MB - 7 pages]
J. Alvarez et al.

We retrospectively assessed the effectiveness of azithromycin in preventing transmission of pertussis to a patient’s household contacts. We also considered the duration between symptom onset in the primary patient and azithromycin administration. We categorized contacts into 4 groups: those treated within <7 days, 8–14 days, 15–21 days, and >21 days after illness onset in the primary patient. We studied 476 primary index patients and their 1,975 household contacts, of whom 4.5% were later identified as having pertussis. When contacts started chemoprophylaxis within <21 days after the primary patient’s symptom onset, the treatment was 43.9% effective. Chemoprophylaxis started >14 days after primary patient’s symptom onset was less effective. We recommend that contacts of persons with pertussis begin chemoprophylaxis within <14 days after primary patient’s symptom onset.

EID Alvarez J, Godoy P, Plans-Rubio P, Camps N, Carol M, Carmona G, et al. Azithromycin to Prevent Pertussis in Household Contacts, Catalonia and Navarre, Spain, 2012–2013. Emerg Infect Dis. 2020;26(11):2678-2684. https://dx.doi.org/10.3201/eid2611.181418
AMA Alvarez J, Godoy P, Plans-Rubio P, et al. Azithromycin to Prevent Pertussis in Household Contacts, Catalonia and Navarre, Spain, 2012–2013. Emerging Infectious Diseases. 2020;26(11):2678-2684. doi:10.3201/eid2611.181418.
APA Alvarez, J., Godoy, P., Plans-Rubio, P., Camps, N., Carol, M., Carmona, G....Dominguez, A. (2020). Azithromycin to Prevent Pertussis in Household Contacts, Catalonia and Navarre, Spain, 2012–2013. Emerging Infectious Diseases, 26(11), 2678-2684. https://dx.doi.org/10.3201/eid2611.181418.

Modeling Treatment Strategies to Inform Yaws Eradication [PDF - 1.92 MB - 9 pages]
A. Holmes et al.

Yaws is a neglected tropical disease targeted for eradication by 2030. To achieve eradication, finding and treating asymptomatic infections as well as clinical cases is crucial. The proposed plan, the Morges strategy, involves rounds of total community treatment (i.e., treating the whole population) and total targeted treatment (TTT) (i.e., treating clinical cases and contacts). However, modeling and empirical work suggests asymptomatic infections often are not found in the same households as clinical cases, reducing the utility of household-based contact tracing for a TTT strategy. We use a model fitted to data from the Solomon Islands to predict the likelihood of elimination of transmission under different intervention schemes and levels of systematic nontreatment resulting from the intervention. Our results indicate that implementing additional treatment rounds through total community treatment is more effective than conducting additional rounds of treatment of at-risk persons through TTT.

EID Holmes A, Tildesley MJ, Solomon AW, Mabey D, Sokana O, Marks M, et al. Modeling Treatment Strategies to Inform Yaws Eradication. Emerg Infect Dis. 2020;26(11):2685-2693. https://dx.doi.org/10.3201/eid2611.191491
AMA Holmes A, Tildesley MJ, Solomon AW, et al. Modeling Treatment Strategies to Inform Yaws Eradication. Emerging Infectious Diseases. 2020;26(11):2685-2693. doi:10.3201/eid2611.191491.
APA Holmes, A., Tildesley, M. J., Solomon, A. W., Mabey, D., Sokana, O., Marks, M....Dyson, L. (2020). Modeling Treatment Strategies to Inform Yaws Eradication. Emerging Infectious Diseases, 26(11), 2685-2693. https://dx.doi.org/10.3201/eid2611.191491.

Three Patients with COVID-19 and Pulmonary Tuberculosis, Wuhan, China, January–February 2020 [PDF - 302 KB - 4 pages]
Z. Yao et al.

During January–February 2020, coronavirus disease (COVID-19) and tuberculosis were diagnosed for 3 patients in Wuhan, China. All 3 patients had COVID-19 pneumonia. One severely ill patient died after acute respiratory distress syndrome developed. Clinicians and public health officials should be aware of underlying chronic infections such as tuberculosis in COVID-19 patients.

EID Yao Z, Chen J, Wang Q, Liu W, Zhang Q, Nan J, et al. Three Patients with COVID-19 and Pulmonary Tuberculosis, Wuhan, China, January–February 2020. Emerg Infect Dis. 2020;26(11):2754-2757. https://dx.doi.org/10.3201/eid2611.201536
AMA Yao Z, Chen J, Wang Q, et al. Three Patients with COVID-19 and Pulmonary Tuberculosis, Wuhan, China, January–February 2020. Emerging Infectious Diseases. 2020;26(11):2754-2757. doi:10.3201/eid2611.201536.
APA Yao, Z., Chen, J., Wang, Q., Liu, W., Zhang, Q., Nan, J....Yu, H. (2020). Three Patients with COVID-19 and Pulmonary Tuberculosis, Wuhan, China, January–February 2020. Emerging Infectious Diseases, 26(11), 2754-2757. https://dx.doi.org/10.3201/eid2611.201536.
Dispatches

Multidrug-Resistant Candida auris Infections in Critically Ill Coronavirus Disease Patients, India, April–July 2020 [PDF - 285 KB - 3 pages]
A. Chowdhary et al.

In New Delhi, India, candidemia affected 15 critically ill coronavirus disease patients admitted to an intensive care unit during April–July 2020. Candida auris accounted for two thirds of cases; case-fatality rate was high (60%). Hospital-acquired C. auris infections in coronavirus disease patients may lead to adverse outcomes and additional strain on healthcare resources.

EID Chowdhary A, Tarai B, Singh A, Sharma A. Multidrug-Resistant Candida auris Infections in Critically Ill Coronavirus Disease Patients, India, April–July 2020. Emerg Infect Dis. 2020;26(11):2694-2696. https://dx.doi.org/10.3201/eid2611.203504
AMA Chowdhary A, Tarai B, Singh A, et al. Multidrug-Resistant Candida auris Infections in Critically Ill Coronavirus Disease Patients, India, April–July 2020. Emerging Infectious Diseases. 2020;26(11):2694-2696. doi:10.3201/eid2611.203504.
APA Chowdhary, A., Tarai, B., Singh, A., & Sharma, A. (2020). Multidrug-Resistant Candida auris Infections in Critically Ill Coronavirus Disease Patients, India, April–July 2020. Emerging Infectious Diseases, 26(11), 2694-2696. https://dx.doi.org/10.3201/eid2611.203504.

Potential Role of Social Distancing in Mitigating Spread of Coronavirus Disease, South Korea [PDF - 1.77 MB - 4 pages]
S. Park et al.

In South Korea, the coronavirus disease outbreak peaked at the end of February and subsided in mid-March. We analyzed the likely roles of social distancing in reducing transmission. Our analysis indicated that although transmission might persist in some regions, epidemics can be suppressed with less extreme measures than those taken by China.

EID Park S, Sun K, Viboud C, Grenfell BT, Dushoff J. Potential Role of Social Distancing in Mitigating Spread of Coronavirus Disease, South Korea. Emerg Infect Dis. 2020;26(11):2697-2700. https://dx.doi.org/10.3201/eid2611.201099
AMA Park S, Sun K, Viboud C, et al. Potential Role of Social Distancing in Mitigating Spread of Coronavirus Disease, South Korea. Emerging Infectious Diseases. 2020;26(11):2697-2700. doi:10.3201/eid2611.201099.
APA Park, S., Sun, K., Viboud, C., Grenfell, B. T., & Dushoff, J. (2020). Potential Role of Social Distancing in Mitigating Spread of Coronavirus Disease, South Korea. Emerging Infectious Diseases, 26(11), 2697-2700. https://dx.doi.org/10.3201/eid2611.201099.

SARS-CoV-2 Virus Culture and Subgenomic RNA for Respiratory Specimens from Patients with Mild Coronavirus Disease [PDF - 1.09 MB - 4 pages]
R. Perera et al.

We investigated 68 respiratory specimens from 35 coronavirus disease patients in Hong Kong, of whom 32 had mild disease. We found that severe acute respiratory syndrome coronavirus 2 and subgenomic RNA were rarely detectable beyond 8 days after onset of illness. However, virus RNA was detectable for many weeks by reverse transcription PCR.

EID Perera R, Tso E, Tsang O, Tsang D, Fung K, Leung Y, et al. SARS-CoV-2 Virus Culture and Subgenomic RNA for Respiratory Specimens from Patients with Mild Coronavirus Disease. Emerg Infect Dis. 2020;26(11):2701-2704. https://dx.doi.org/10.3201/eid2611.203219
AMA Perera R, Tso E, Tsang O, et al. SARS-CoV-2 Virus Culture and Subgenomic RNA for Respiratory Specimens from Patients with Mild Coronavirus Disease. Emerging Infectious Diseases. 2020;26(11):2701-2704. doi:10.3201/eid2611.203219.
APA Perera, R., Tso, E., Tsang, O., Tsang, D., Fung, K., Leung, Y....Peiris, M. (2020). SARS-CoV-2 Virus Culture and Subgenomic RNA for Respiratory Specimens from Patients with Mild Coronavirus Disease. Emerging Infectious Diseases, 26(11), 2701-2704. https://dx.doi.org/10.3201/eid2611.203219.

Asymptomatic Transmission of SARS-CoV-2 on Evacuation Flight [PDF - 1.33 MB - 4 pages]
S. Bae et al.

We conducted a cohort study in a controlled environment to measure asymptomatic transmission of severe acute respiratory syndrome coronavirus 2 on a flight from Italy to South Korea. Our results suggest that stringent global regulations are necessary for the prevention of transmission of this virus on aircraft.

EID Bae S, Shin H, Koo H, Lee S, Yang J, Yon D. Asymptomatic Transmission of SARS-CoV-2 on Evacuation Flight. Emerg Infect Dis. 2020;26(11):2705-2708. https://dx.doi.org/10.3201/eid2611.203353
AMA Bae S, Shin H, Koo H, et al. Asymptomatic Transmission of SARS-CoV-2 on Evacuation Flight. Emerging Infectious Diseases. 2020;26(11):2705-2708. doi:10.3201/eid2611.203353.
APA Bae, S., Shin, H., Koo, H., Lee, S., Yang, J., & Yon, D. (2020). Asymptomatic Transmission of SARS-CoV-2 on Evacuation Flight. Emerging Infectious Diseases, 26(11), 2705-2708. https://dx.doi.org/10.3201/eid2611.203353.

Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January–April 2020 [PDF - 869 KB - 4 pages]
G. Migliori et al.

Coronavirus disease has disrupted tuberculosis services globally. Data from 33 centers in 16 countries on 5 continents showed that attendance at tuberculosis centers was lower during the first 4 months of the pandemic in 2020 than for the same period in 2019. Resources are needed to ensure tuberculosis care continuity during the pandemic.

EID Migliori G, Thong P, Akkerman O, Alffenaar J, Álvarez-Navascués F, Assao-Neino M, et al. Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January–April 2020. Emerg Infect Dis. 2020;26(11):2709-2712. https://dx.doi.org/10.3201/eid2611.203163
AMA Migliori G, Thong P, Akkerman O, et al. Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January–April 2020. Emerging Infectious Diseases. 2020;26(11):2709-2712. doi:10.3201/eid2611.203163.
APA Migliori, G., Thong, P., Akkerman, O., Alffenaar, J., Álvarez-Navascués, F., Assao-Neino, M....Goletti, D. (2020). Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January–April 2020. Emerging Infectious Diseases, 26(11), 2709-2712. https://dx.doi.org/10.3201/eid2611.203163.

In-Flight Transmission of SARS-CoV-2 [PDF - 601 KB - 4 pages]
E. M. Choi et al.

Four persons with severe acute respiratory syndrome coronavirus 2 infection had traveled on the same flight from Boston, Massachusetts, USA, to Hong Kong, China. Their virus genetic sequences are identical, unique, and belong to a clade not previously identified in Hong Kong, which strongly suggests that the virus can be transmitted during air travel.

EID Choi EM, Chu D, Cheng P, Tsang D, Peiris M, Bausch DG, et al. In-Flight Transmission of SARS-CoV-2. Emerg Infect Dis. 2020;26(11):2713-2716. https://dx.doi.org/10.3201/eid2611.203254
AMA Choi EM, Chu D, Cheng P, et al. In-Flight Transmission of SARS-CoV-2. Emerging Infectious Diseases. 2020;26(11):2713-2716. doi:10.3201/eid2611.203254.
APA Choi, E. M., Chu, D., Cheng, P., Tsang, D., Peiris, M., Bausch, D. G....Watson-Jones, D. (2020). In-Flight Transmission of SARS-CoV-2. Emerging Infectious Diseases, 26(11), 2713-2716. https://dx.doi.org/10.3201/eid2611.203254.

Preventing Vector-Borne Transmission of Zika Virus Infection During Pregnancy, Puerto Rico, USA, 2016–2017 [PDF - 370 KB - 4 pages]
K. Kortsmit et al.

We examined pregnant women’s use of personal protective measures to prevent mosquito bites during the 2016–2017 Zika outbreak in Puerto Rico. Healthcare provider counseling on recommended measures was associated with increased use of insect repellent among pregnant women but not with wearing protective clothing.

EID Kortsmit K, Salvesen von Essen B, Warner L, D’Angelo DV, Smith RA, Shapiro-Mendoza CK, et al. Preventing Vector-Borne Transmission of Zika Virus Infection During Pregnancy, Puerto Rico, USA, 2016–2017. Emerg Infect Dis. 2020;26(11):2717-2720. https://dx.doi.org/10.3201/eid2611.201614
AMA Kortsmit K, Salvesen von Essen B, Warner L, et al. Preventing Vector-Borne Transmission of Zika Virus Infection During Pregnancy, Puerto Rico, USA, 2016–2017. Emerging Infectious Diseases. 2020;26(11):2717-2720. doi:10.3201/eid2611.201614.
APA Kortsmit, K., Salvesen von Essen, B., Warner, L., D’Angelo, D. V., Smith, R. A., Shapiro-Mendoza, C. K....Bernal, M. (2020). Preventing Vector-Borne Transmission of Zika Virus Infection During Pregnancy, Puerto Rico, USA, 2016–2017. Emerging Infectious Diseases, 26(11), 2717-2720. https://dx.doi.org/10.3201/eid2611.201614.

Multidrug-Resistant Hypervirulent Group B Streptococcus in Neonatal Invasive Infections, France, 2007–2019 [PDF - 762 KB - 4 pages]
C. Plainvert et al.

We analyzed group B Streptococcus (GBS) neonatal invasive infections reported during 2007–2019 in France. The hypervirulent clonal complex (CC) 17 GBS was responsible for 66% (827/1,262) of cases. The role of CC17 GBS increased over time (p for trend = 0.0001), together with the emergence of a multidrug-resistant CC17 GBS sublineage.

EID Plainvert C, Hays C, Touak G, Joubrel-Guyot C, Dmytruk N, Frigo A, et al. Multidrug-Resistant Hypervirulent Group B Streptococcus in Neonatal Invasive Infections, France, 2007–2019. Emerg Infect Dis. 2020;26(11):2721-2724. https://dx.doi.org/10.3201/eid2611.201669
AMA Plainvert C, Hays C, Touak G, et al. Multidrug-Resistant Hypervirulent Group B Streptococcus in Neonatal Invasive Infections, France, 2007–2019. Emerging Infectious Diseases. 2020;26(11):2721-2724. doi:10.3201/eid2611.201669.
APA Plainvert, C., Hays, C., Touak, G., Joubrel-Guyot, C., Dmytruk, N., Frigo, A....Tazi, A. (2020). Multidrug-Resistant Hypervirulent Group B Streptococcus in Neonatal Invasive Infections, France, 2007–2019. Emerging Infectious Diseases, 26(11), 2721-2724. https://dx.doi.org/10.3201/eid2611.201669.

Epileptic Seizure after Use of Moxifloxacin in Man with Legionella longbeachae Pneumonia [PDF - 605 KB - 3 pages]
J. Wang et al.

Legionellosis caused by Legionella longbeachae is diagnosed mainly by PCR. We report a case of L. longbeachae infection in mainland China, which was diagnosed by metagenomic next-generation sequencing, in a man who developed an epileptic seizure after using moxifloxacin. Metagenomic next-generation sequencing may be a useful tool to detect Legionella spp.

EID Wang J, Li X, Chen J, Tong B. Epileptic Seizure after Use of Moxifloxacin in Man with Legionella longbeachae Pneumonia. Emerg Infect Dis. 2020;26(11):2725-2727. https://dx.doi.org/10.3201/eid2611.191815
AMA Wang J, Li X, Chen J, et al. Epileptic Seizure after Use of Moxifloxacin in Man with Legionella longbeachae Pneumonia. Emerging Infectious Diseases. 2020;26(11):2725-2727. doi:10.3201/eid2611.191815.
APA Wang, J., Li, X., Chen, J., & Tong, B. (2020). Epileptic Seizure after Use of Moxifloxacin in Man with Legionella longbeachae Pneumonia. Emerging Infectious Diseases, 26(11), 2725-2727. https://dx.doi.org/10.3201/eid2611.191815.

Two New Cases of Pulmonary Infection by Mycobacterium shigaense, Japan [PDF - 1.74 MB - 5 pages]
S. Yoshida et al.

We report 2 case-patients in Japan with Mycobacterium shigaense pulmonary infections. One patient was given aggressive treatment and the other conservative treatment, according to distinctive radiologic evidence. A close phylogenetic relationship based on whole-genome sequencing was found between strain from the conservatively treated patient and a reference strain of cutaneous origin.

EID Yoshida S, Iwamoto T, Kobayashi T, Nomoto R, Inoue Y, Tsuyuguchi K, et al. Two New Cases of Pulmonary Infection by Mycobacterium shigaense, Japan. Emerg Infect Dis. 2020;26(11):2728-2732. https://dx.doi.org/10.3201/eid2611.200315
AMA Yoshida S, Iwamoto T, Kobayashi T, et al. Two New Cases of Pulmonary Infection by Mycobacterium shigaense, Japan. Emerging Infectious Diseases. 2020;26(11):2728-2732. doi:10.3201/eid2611.200315.
APA Yoshida, S., Iwamoto, T., Kobayashi, T., Nomoto, R., Inoue, Y., Tsuyuguchi, K....Suzuki, K. (2020). Two New Cases of Pulmonary Infection by Mycobacterium shigaense, Japan. Emerging Infectious Diseases, 26(11), 2728-2732. https://dx.doi.org/10.3201/eid2611.200315.

Thresholds versus Anomaly Detection for Surveillance of Pneumonia and Influenza Mortality [PDF - 1.15 MB - 3 pages]
T. L. Wiemken et al.

Computational surveillance of pneumonia and influenza mortality in the United States using FluView uses epidemic thresholds to identify high mortality rates but is limited by statistical issues such as seasonality and autocorrelation. We used time series anomaly detection to improve recognition of high mortality rates. Results suggest that anomaly detection can complement mortality reporting.

EID Wiemken TL, Rutschman A, Niemotka SL, Hoft D. Thresholds versus Anomaly Detection for Surveillance of Pneumonia and Influenza Mortality. Emerg Infect Dis. 2020;26(11):2733-2735. https://dx.doi.org/10.3201/eid2611.200706
AMA Wiemken TL, Rutschman A, Niemotka SL, et al. Thresholds versus Anomaly Detection for Surveillance of Pneumonia and Influenza Mortality. Emerging Infectious Diseases. 2020;26(11):2733-2735. doi:10.3201/eid2611.200706.
APA Wiemken, T. L., Rutschman, A., Niemotka, S. L., & Hoft, D. (2020). Thresholds versus Anomaly Detection for Surveillance of Pneumonia and Influenza Mortality. Emerging Infectious Diseases, 26(11), 2733-2735. https://dx.doi.org/10.3201/eid2611.200706.

Chikungunya Virus Infection in Blood Donors and Patients During Outbreak, Mandalay, Myanmar, 2019 [PDF - 1.37 MB - 5 pages]
A. Kyaw et al.

In 2019, an outbreak of chikungunya virus infection occurred in Mandalay, Myanmar, and 3.2% of blood donors and 20.5% of patients who were children were confirmed as being infected. The prevalence rate was up to 6.3% among blood donors. The East Central/South African genotype was predominantly circulating during this outbreak.

EID Kyaw A, Tun M, Nabeshima T, Soe A, Thida T, Aung T, et al. Chikungunya Virus Infection in Blood Donors and Patients During Outbreak, Mandalay, Myanmar, 2019. Emerg Infect Dis. 2020;26(11):2741-2745. https://dx.doi.org/10.3201/eid2611.201824
AMA Kyaw A, Tun M, Nabeshima T, et al. Chikungunya Virus Infection in Blood Donors and Patients During Outbreak, Mandalay, Myanmar, 2019. Emerging Infectious Diseases. 2020;26(11):2741-2745. doi:10.3201/eid2611.201824.
APA Kyaw, A., Tun, M., Nabeshima, T., Soe, A., Thida, T., Aung, T....Morita, K. (2020). Chikungunya Virus Infection in Blood Donors and Patients During Outbreak, Mandalay, Myanmar, 2019. Emerging Infectious Diseases, 26(11), 2741-2745. https://dx.doi.org/10.3201/eid2611.201824.

KPC-3–Producing Serratia marcescens Outbreak between Acute and Long-Term Care Facilities, Florida, USA [PDF - 10.77 MB - 5 pages]
A. Jimenez et al.

We describe an outbreak caused by Serratia marcescens carrying blaKPC-3 that was sourced to a long-term care facility in Florida, USA. Whole-genome sequencing and plasmid profiling showed involvement of 3 clonal lineages of S. marcescens and 2 blaKPC-3-carrying plasmids. Determining the resistance mechanism is critical for timely implementation of infection control measures.

EID Jimenez A, Abbo LM, Martinez O, Shukla B, Sposato K, Iovleva A, et al. KPC-3–Producing Serratia marcescens Outbreak between Acute and Long-Term Care Facilities, Florida, USA. Emerg Infect Dis. 2020;26(11):2746-2750. https://dx.doi.org/10.3201/eid2611.202203
AMA Jimenez A, Abbo LM, Martinez O, et al. KPC-3–Producing Serratia marcescens Outbreak between Acute and Long-Term Care Facilities, Florida, USA. Emerging Infectious Diseases. 2020;26(11):2746-2750. doi:10.3201/eid2611.202203.
APA Jimenez, A., Abbo, L. M., Martinez, O., Shukla, B., Sposato, K., Iovleva, A....Doi, Y. (2020). KPC-3–Producing Serratia marcescens Outbreak between Acute and Long-Term Care Facilities, Florida, USA. Emerging Infectious Diseases, 26(11), 2746-2750. https://dx.doi.org/10.3201/eid2611.202203.

Multiple Introductions of Salmonella enterica Serovar Typhi H58 with Reduced Fluoroquinolone Susceptibility into Chile [PDF - 1.53 MB - 5 pages]
M. Maes et al.

Salmonella enterica serovar Typhi H58, an antimicrobial-resistant lineage, is globally disseminated but has not been reported in Latin America. Genomic analysis revealed 3 independent introductions of Salmonella Typhi H58 with reduced fluoroquinolone susceptibility into Chile. Our findings highlight the utility of enhanced genomic surveillance for typhoid fever in this region.

EID Maes M, Dyson ZA, Higginson EE, Fernandez A, Araya P, Tennant SM, et al. Multiple Introductions of Salmonella enterica Serovar Typhi H58 with Reduced Fluoroquinolone Susceptibility into Chile. Emerg Infect Dis. 2020;26(11):2736-2740. https://dx.doi.org/10.3201/eid2611.201676
AMA Maes M, Dyson ZA, Higginson EE, et al. Multiple Introductions of Salmonella enterica Serovar Typhi H58 with Reduced Fluoroquinolone Susceptibility into Chile. Emerging Infectious Diseases. 2020;26(11):2736-2740. doi:10.3201/eid2611.201676.
APA Maes, M., Dyson, Z. A., Higginson, E. E., Fernandez, A., Araya, P., Tennant, S. M....Dougan, G. (2020). Multiple Introductions of Salmonella enterica Serovar Typhi H58 with Reduced Fluoroquinolone Susceptibility into Chile. Emerging Infectious Diseases, 26(11), 2736-2740. https://dx.doi.org/10.3201/eid2611.201676.
Research Letters

Abrupt Subsidence of Seasonal Influenza after COVID-19 Outbreak, Hong Kong, China [PDF - 814 KB - 3 pages]
N. Wong et al.

The onset of the 2019–20 winter influenza season in Hong Kong coincided with the emergence of the coronavirus disease epidemic in neighboring mainland China. After widespread adoption of large-scale social distancing interventions in response to the impending coronavirus disease outbreak, the influenza season ended abruptly with a decrease to a low trough.

EID Wong N, Leung C, Lee S. Abrupt Subsidence of Seasonal Influenza after COVID-19 Outbreak, Hong Kong, China. Emerg Infect Dis. 2020;26(11):2752-2754. https://dx.doi.org/10.3201/eid2611.200861
AMA Wong N, Leung C, Lee S. Abrupt Subsidence of Seasonal Influenza after COVID-19 Outbreak, Hong Kong, China. Emerging Infectious Diseases. 2020;26(11):2752-2754. doi:10.3201/eid2611.200861.
APA Wong, N., Leung, C., & Lee, S. (2020). Abrupt Subsidence of Seasonal Influenza after COVID-19 Outbreak, Hong Kong, China. Emerging Infectious Diseases, 26(11), 2752-2754. https://dx.doi.org/10.3201/eid2611.200861.

Detection of SARS-CoV-2 in Hemodialysis Effluent of Patient with COVID-19 Pneumonia, Japan [PDF - 558 KB - 4 pages]
A. Okuhama et al.

We report detection of severe acute respiratory syndrome coronavirus 2 RNA in hemodialysis effluent from a patient in Japan with coronavirus disease and prolonged inflammation. Healthcare workers should observe strict standard and contact precautions and use appropriate personal protective equipment when handling hemodialysis circuitry from patients with diagnosed coronavirus disease.

EID Okuhama A, Ishikane M, Katagiri D, Kanda K, Nakamoto T, Kinoshita N, et al. Detection of SARS-CoV-2 in Hemodialysis Effluent of Patient with COVID-19 Pneumonia, Japan. Emerg Infect Dis. 2020;26(11):2757-2760. https://dx.doi.org/10.3201/eid2611.201956
AMA Okuhama A, Ishikane M, Katagiri D, et al. Detection of SARS-CoV-2 in Hemodialysis Effluent of Patient with COVID-19 Pneumonia, Japan. Emerging Infectious Diseases. 2020;26(11):2757-2760. doi:10.3201/eid2611.201956.
APA Okuhama, A., Ishikane, M., Katagiri, D., Kanda, K., Nakamoto, T., Kinoshita, N....Hinoshita, F. (2020). Detection of SARS-CoV-2 in Hemodialysis Effluent of Patient with COVID-19 Pneumonia, Japan. Emerging Infectious Diseases, 26(11), 2757-2760. https://dx.doi.org/10.3201/eid2611.201956.

Seroprevalence of SARS-CoV-2–Specific Antibodies, Faroe Islands [PDF - 323 KB - 3 pages]
M. Petersen et al.

We conducted a nationwide study of the prevalence of severe acute respiratory syndrome coronavirus 2 infection in the Faroe Islands. Of 1,075 randomly selected participants, 6 (0.6%) tested seropositive for antibodies to the virus. Adjustment for test sensitivity and specificity yielded a 0.7% prevalence. Our findings will help us evaluate our public health response.

EID Petersen M, Strøm M, Christiansen D, Fjallsbak J, Eliasen E, Johansen M, et al. Seroprevalence of SARS-CoV-2–Specific Antibodies, Faroe Islands. Emerg Infect Dis. 2020;26(11):2760-2762. https://dx.doi.org/10.3201/eid2611.202736
AMA Petersen M, Strøm M, Christiansen D, et al. Seroprevalence of SARS-CoV-2–Specific Antibodies, Faroe Islands. Emerging Infectious Diseases. 2020;26(11):2760-2762. doi:10.3201/eid2611.202736.
APA Petersen, M., Strøm, M., Christiansen, D., Fjallsbak, J., Eliasen, E., Johansen, M....Weihe, P. (2020). Seroprevalence of SARS-CoV-2–Specific Antibodies, Faroe Islands. Emerging Infectious Diseases, 26(11), 2760-2762. https://dx.doi.org/10.3201/eid2611.202736.

Four Patients with COVID-19 and Tuberculosis, Singapore, April–May 2020 [PDF - 442 KB - 3 pages]
S. Tham et al.

Coronavirus disease (COVID-19) and tuberculosis (TB) developed in 4 foreign workers living in dormitories in Singapore during April–May 2020. Clinical manifestations and atypical radiographic features of COVID-19 led to the diagnosis of TB through positive interferon-gamma release assay and culture results. During the COVID-19 pandemic, TB should not be overlooked.

EID Tham S, Lim W, Lee C, Loh J, Premkumar A, Yan B, et al. Four Patients with COVID-19 and Tuberculosis, Singapore, April–May 2020. Emerg Infect Dis. 2020;26(11):2763-2765. https://dx.doi.org/10.3201/eid2611.202752
AMA Tham S, Lim W, Lee C, et al. Four Patients with COVID-19 and Tuberculosis, Singapore, April–May 2020. Emerging Infectious Diseases. 2020;26(11):2763-2765. doi:10.3201/eid2611.202752.
APA Tham, S., Lim, W., Lee, C., Loh, J., Premkumar, A., Yan, B....Yan, G. (2020). Four Patients with COVID-19 and Tuberculosis, Singapore, April–May 2020. Emerging Infectious Diseases, 26(11), 2763-2765. https://dx.doi.org/10.3201/eid2611.202752.

Seroprevalence of SARS-CoV-2 and Infection Fatality Ratio, Orleans and Jefferson Parishes, Louisiana, USA, May 2020 [PDF - 1.41 MB - 4 pages]
A. K. Feehan et al.

Using a novel recruitment method and paired molecular and antibody testing for severe acute respiratory syndrome coronavirus 2 infection, we determined seroprevalence in a racially diverse municipality in Louisiana, USA. Infections were highly variable by ZIP code and differed by race/ethnicity. Overall census-weighted seroprevalence was 6.9%, and the calculated infection fatality ratio was 1.63%.

EID Feehan AK, Fort D, Garcia-Diaz J, Price-Haywood EG, Velasco C, Sapp E, et al. Seroprevalence of SARS-CoV-2 and Infection Fatality Ratio, Orleans and Jefferson Parishes, Louisiana, USA, May 2020. Emerg Infect Dis. 2020;26(11):2765-2768. https://dx.doi.org/10.3201/eid2611.203029
AMA Feehan AK, Fort D, Garcia-Diaz J, et al. Seroprevalence of SARS-CoV-2 and Infection Fatality Ratio, Orleans and Jefferson Parishes, Louisiana, USA, May 2020. Emerging Infectious Diseases. 2020;26(11):2765-2768. doi:10.3201/eid2611.203029.
APA Feehan, A. K., Fort, D., Garcia-Diaz, J., Price-Haywood, E. G., Velasco, C., Sapp, E....Seoane, L. (2020). Seroprevalence of SARS-CoV-2 and Infection Fatality Ratio, Orleans and Jefferson Parishes, Louisiana, USA, May 2020. Emerging Infectious Diseases, 26(11), 2765-2768. https://dx.doi.org/10.3201/eid2611.203029.

Saliva Alternative to Upper Respiratory Swabs for SARS-CoV-2 Diagnosis [PDF - 353 KB - 2 pages]
R. L. Byrne et al.

PCR of upper respiratory specimens is the diagnostic standard for severe acute respiratory syndrome coronavirus 2 infection. However, saliva sampling is an easy alternative to nasal and throat swabbing. We found similar viral loads in saliva samples and in nasal and throat swab samples from 110 patients with coronavirus disease.

EID Byrne RL, Kay GA, Kontogianni K, Aljayyoussi G, Brown L, Collins AM, et al. Saliva Alternative to Upper Respiratory Swabs for SARS-CoV-2 Diagnosis. Emerg Infect Dis. 2020;26(11):2769-2770. https://dx.doi.org/10.3201/eid2611.203283
AMA Byrne RL, Kay GA, Kontogianni K, et al. Saliva Alternative to Upper Respiratory Swabs for SARS-CoV-2 Diagnosis. Emerging Infectious Diseases. 2020;26(11):2769-2770. doi:10.3201/eid2611.203283.
APA Byrne, R. L., Kay, G. A., Kontogianni, K., Aljayyoussi, G., Brown, L., Collins, A. M....Cubas-Atienzar, A. I. (2020). Saliva Alternative to Upper Respiratory Swabs for SARS-CoV-2 Diagnosis. Emerging Infectious Diseases, 26(11), 2769-2770. https://dx.doi.org/10.3201/eid2611.203283.

COVID-19 Outbreak, Senegal, 2020 [PDF - 1.57 MB - 3 pages]
N. Dia et al.

The spread of severe acute respiratory syndrome coronavirus 2 began later in Africa than in Asia and Europe. Senegal confirmed its first case of coronavirus disease on March 2, 2020. By March 4, a total of 4 cases had been confirmed, all in patients who traveled from Europe.

EID Dia N, Lakh N, Diagne M, Mbaye K, Taieb F, Fall N, et al. COVID-19 Outbreak, Senegal, 2020. Emerg Infect Dis. 2020;26(11):2771-2773. https://dx.doi.org/10.3201/eid2611.202615
AMA Dia N, Lakh N, Diagne M, et al. COVID-19 Outbreak, Senegal, 2020. Emerging Infectious Diseases. 2020;26(11):2771-2773. doi:10.3201/eid2611.202615.
APA Dia, N., Lakh, N., Diagne, M., Mbaye, K., Taieb, F., Fall, N....Seydi, M. (2020). COVID-19 Outbreak, Senegal, 2020. Emerging Infectious Diseases, 26(11), 2771-2773. https://dx.doi.org/10.3201/eid2611.202615.

Burkholderia pseudomallei in Soil, US Virgin Islands, 2019 [PDF - 1023 KB - 3 pages]
N. E. Stone et al.

The distribution of Burkholderia pseudomallei in the Caribbean is poorly understood. We isolated B. pseudomallei from US Virgin Islands soil. The soil isolate was genetically similar to other isolates from the Caribbean, suggesting that B. pseudomallei might have been introduced to the islands multiple times through severe weather events.

EID Stone NE, Hall CM, Browne A, Sahl JW, Hutton SM, Santana-Propper E, et al. Burkholderia pseudomallei in Soil, US Virgin Islands, 2019. Emerg Infect Dis. 2020;26(11):2773-2775. https://dx.doi.org/10.3201/eid2611.191577
AMA Stone NE, Hall CM, Browne A, et al. Burkholderia pseudomallei in Soil, US Virgin Islands, 2019. Emerging Infectious Diseases. 2020;26(11):2773-2775. doi:10.3201/eid2611.191577.
APA Stone, N. E., Hall, C. M., Browne, A., Sahl, J. W., Hutton, S. M., Santana-Propper, E....Wagner, D. M. (2020). Burkholderia pseudomallei in Soil, US Virgin Islands, 2019. Emerging Infectious Diseases, 26(11), 2773-2775. https://dx.doi.org/10.3201/eid2611.191577.

Nontuberculous Mycobacterial Pulmonary Disease from Mycobacterium hassiacum, Austria [PDF - 713 KB - 3 pages]
H. Salzer et al.

The clinical relevance of newly described nontuberculous mycobacteria is often unclear. We report a case of pulmonary infection caused by Mycobacterium hassiacum in an immunocompetent patient in Austria who had chronic obstructive pulmonary disease. Antimicrobial drug susceptibility testing showed low MICs for macrolides, aminoglycosides, fluoroquinolones, tetracyclines, imipenem, and linezolid.

EID Salzer H, Chitechi B, Hillemann D, Mandl M, Paar C, Mitterhumer M, et al. Nontuberculous Mycobacterial Pulmonary Disease from Mycobacterium hassiacum, Austria. Emerg Infect Dis. 2020;26(11):2776-2778. https://dx.doi.org/10.3201/eid2611.191718
AMA Salzer H, Chitechi B, Hillemann D, et al. Nontuberculous Mycobacterial Pulmonary Disease from Mycobacterium hassiacum, Austria. Emerging Infectious Diseases. 2020;26(11):2776-2778. doi:10.3201/eid2611.191718.
APA Salzer, H., Chitechi, B., Hillemann, D., Mandl, M., Paar, C., Mitterhumer, M....Maurer, F. P. (2020). Nontuberculous Mycobacterial Pulmonary Disease from Mycobacterium hassiacum, Austria. Emerging Infectious Diseases, 26(11), 2776-2778. https://dx.doi.org/10.3201/eid2611.191718.

Large Outbreak of Guillain-Barré Syndrome, Peru, 2019 [PDF - 401 KB - 3 pages]
C. V. Munayco et al.

Outbreaks of Guillain-Barré syndrome (GBS) are uncommon. In May 2019, national surveillance in Peru detected an increase in GBS cases in excess of the expected incidence of 1.2 cases/100,000 population. Several clinical and epidemiologic findings call into question the suggested association between this GBS outbreak and Campylobacter.

EID Munayco CV, Gavilan RG, Ramirez G, Loayza M, Miraval ML, Whitehouse E, et al. Large Outbreak of Guillain-Barré Syndrome, Peru, 2019. Emerg Infect Dis. 2020;26(11):2778-2780. https://dx.doi.org/10.3201/eid2611.200127
AMA Munayco CV, Gavilan RG, Ramirez G, et al. Large Outbreak of Guillain-Barré Syndrome, Peru, 2019. Emerging Infectious Diseases. 2020;26(11):2778-2780. doi:10.3201/eid2611.200127.
APA Munayco, C. V., Gavilan, R. G., Ramirez, G., Loayza, M., Miraval, M. L., Whitehouse, E....Sejvar, J. (2020). Large Outbreak of Guillain-Barré Syndrome, Peru, 2019. Emerging Infectious Diseases, 26(11), 2778-2780. https://dx.doi.org/10.3201/eid2611.200127.

Osteomyelitis Due to Mycobacterium goodii in an Adolescent, United States [PDF - 392 KB - 3 pages]
A. Diaz et al.

Osteomyelitis is a rare clinical manifestation of infection with nontuberculous mycobacteria (NTM). We report an adolescent with femoral osteomyelitis associated with prosthetic material due to an emerging pathogen, Mycobacterium goodii. Application of secA1 and 16S ribosomal RNA gene sequencing reliably determined the NTM species, enabling targeted antimicrobial therapy.

EID Diaz A, Ardura MI, Wang H, Antonara S, Ouellette CP. Osteomyelitis Due to Mycobacterium goodii in an Adolescent, United States. Emerg Infect Dis. 2020;26(11):2781-2783. https://dx.doi.org/10.3201/eid2611.200206
AMA Diaz A, Ardura MI, Wang H, et al. Osteomyelitis Due to Mycobacterium goodii in an Adolescent, United States. Emerging Infectious Diseases. 2020;26(11):2781-2783. doi:10.3201/eid2611.200206.
APA Diaz, A., Ardura, M. I., Wang, H., Antonara, S., & Ouellette, C. P. (2020). Osteomyelitis Due to Mycobacterium goodii in an Adolescent, United States. Emerging Infectious Diseases, 26(11), 2781-2783. https://dx.doi.org/10.3201/eid2611.200206.

Sporotrichosis Cases in Commercial Insurance Data, United States, 2012–2018 [PDF - 482 KB - 3 pages]
K. Benedict and B. R. Jackson

The geographic distribution of sporotrichosis in the United States is largely unknown. In a large commercial health insurance database, sporotrichosis was rare but most frequently occurred in southern and south-central states. Knowledge about where sporotrichosis is most likely to occur is essential for increasing clinician awareness of this rare fungal disease.

EID Benedict K, Jackson BR. Sporotrichosis Cases in Commercial Insurance Data, United States, 2012–2018. Emerg Infect Dis. 2020;26(11):2783-2785. https://dx.doi.org/10.3201/eid2611.201693
AMA Benedict K, Jackson BR. Sporotrichosis Cases in Commercial Insurance Data, United States, 2012–2018. Emerging Infectious Diseases. 2020;26(11):2783-2785. doi:10.3201/eid2611.201693.
APA Benedict, K., & Jackson, B. R. (2020). Sporotrichosis Cases in Commercial Insurance Data, United States, 2012–2018. Emerging Infectious Diseases, 26(11), 2783-2785. https://dx.doi.org/10.3201/eid2611.201693.

Sociodemographic Predictors of SARS-CoV-2 Infection in Obstetric Patients, Georgia, USA [PDF - 325 KB - 3 pages]
N. T. Joseph et al.

We conducted a cohort study to determine sociodemographic risk factors for severe acute respiratory syndrome coronavirus 2 infection among obstetric patients in 2 urban hospitals in Atlanta, Georgia, USA. Prevalence of infection was highest among women who were Hispanic, were uninsured, or lived in high-density neighborhoods.

EID Joseph NT, Stanhope KK, Badell ML, Horton JP, Boulet SL, Jamieson DJ. Sociodemographic Predictors of SARS-CoV-2 Infection in Obstetric Patients, Georgia, USA. Emerg Infect Dis. 2020;26(11):2786-2788. https://dx.doi.org/10.3201/eid2611.203091
AMA Joseph NT, Stanhope KK, Badell ML, et al. Sociodemographic Predictors of SARS-CoV-2 Infection in Obstetric Patients, Georgia, USA. Emerging Infectious Diseases. 2020;26(11):2786-2788. doi:10.3201/eid2611.203091.
APA Joseph, N. T., Stanhope, K. K., Badell, M. L., Horton, J. P., Boulet, S. L., & Jamieson, D. J. (2020). Sociodemographic Predictors of SARS-CoV-2 Infection in Obstetric Patients, Georgia, USA. Emerging Infectious Diseases, 26(11), 2786-2788. https://dx.doi.org/10.3201/eid2611.203091.
Letters

Nocardia ignorata Infection in Heart Transplant Patient [PDF - 602 KB - 2 pages]
V. A. Muggia and Y. A. Puius
EID Muggia VA, Puius YA. Nocardia ignorata Infection in Heart Transplant Patient. Emerg Infect Dis. 2020;26(11):2788-2789. https://dx.doi.org/10.3201/eid2611.202756
AMA Muggia VA, Puius YA. Nocardia ignorata Infection in Heart Transplant Patient. Emerging Infectious Diseases. 2020;26(11):2788-2789. doi:10.3201/eid2611.202756.
APA Muggia, V. A., & Puius, Y. A. (2020). Nocardia ignorata Infection in Heart Transplant Patient. Emerging Infectious Diseases, 26(11), 2788-2789. https://dx.doi.org/10.3201/eid2611.202756.

COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020 [PDF - 812 KB - 3 pages]
J. Lu and Z. Yang
EID Lu J, Yang Z. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerg Infect Dis. 2020;26(11):2789-2791. https://dx.doi.org/10.3201/eid2611.203774
AMA Lu J, Yang Z. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerging Infectious Diseases. 2020;26(11):2789-2791. doi:10.3201/eid2611.203774.
APA Lu, J., & Yang, Z. (2020). COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerging Infectious Diseases, 26(11), 2789-2791. https://dx.doi.org/10.3201/eid2611.203774.

COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020 [PDF - 450 KB - 1 page]
A. M. Rule
EID Rule AM. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerg Infect Dis. 2020;26(11):2790. https://dx.doi.org/10.3201/eid2611.202948
AMA Rule AM. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerging Infectious Diseases. 2020;26(11):2790. doi:10.3201/eid2611.202948.
APA Rule, A. M. (2020). COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerging Infectious Diseases, 26(11), 2790. https://dx.doi.org/10.3201/eid2611.202948.
Another Dimension

Isolation Cocoon, May 2020—After Zhuangzi’s Butterfly Dream [PDF - 212 KB - 1 page]
R. Louie
EID Louie R. Isolation Cocoon, May 2020—After Zhuangzi’s Butterfly Dream. Emerg Infect Dis. 2020;26(11):2750. https://dx.doi.org/10.3201/eid2611.202993
AMA Louie R. Isolation Cocoon, May 2020—After Zhuangzi’s Butterfly Dream. Emerging Infectious Diseases. 2020;26(11):2750. doi:10.3201/eid2611.202993.
APA Louie, R. (2020). Isolation Cocoon, May 2020—After Zhuangzi’s Butterfly Dream. Emerging Infectious Diseases, 26(11), 2750. https://dx.doi.org/10.3201/eid2611.202993.
About the Cover

Social Distancing and Artful Pandemic Survival [PDF - 623 KB - 2 pages]
T. Chorba
EID Chorba T. Social Distancing and Artful Pandemic Survival. Emerg Infect Dis. 2020;26(11):2793-2794. https://dx.doi.org/10.3201/eid2611.ac2611
AMA Chorba T. Social Distancing and Artful Pandemic Survival. Emerging Infectious Diseases. 2020;26(11):2793-2794. doi:10.3201/eid2611.ac2611.
APA Chorba, T. (2020). Social Distancing and Artful Pandemic Survival. Emerging Infectious Diseases, 26(11), 2793-2794. https://dx.doi.org/10.3201/eid2611.ac2611.
Etymologia

Etymologia: Nocardia [PDF - 527 KB - 1 page]
C. J. Opperman
EID Opperman CJ. Etymologia: Nocardia. Emerg Infect Dis. 2020;26(11):2789. https://dx.doi.org/10.3201/eid2611.et2611
AMA Opperman CJ. Etymologia: Nocardia. Emerging Infectious Diseases. 2020;26(11):2789. doi:10.3201/eid2611.et2611.
APA Opperman, C. J. (2020). Etymologia: Nocardia. Emerging Infectious Diseases, 26(11), 2789. https://dx.doi.org/10.3201/eid2611.et2611.
Online Reports

Early Insights from Statistical and Mathematical Modeling of Key Epidemiologic Parameters of COVID-19
M. Biggerstaff et al.

We report key epidemiologic parameter estimates for coronavirus disease identified in peer-reviewed publications, preprint articles, and online reports. Range estimates for incubation period were 1.8–6.9 days, serial interval 4.0–7.5 days, and doubling time 2.3–7.4 days. The effective reproductive number varied widely, with reductions attributable to interventions. Case burden and infection fatality ratios increased with patient age. Implementation of combined interventions could reduce cases and delay epidemic peak up to 1 month. These parameters for transmission, disease severity, and intervention effectiveness are critical for guiding policy decisions. Estimates will likely change as new information becomes available.

Page created: October 20, 2020
Page updated: October 20, 2020
Page reviewed: October 20, 2020
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