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Articles from Emerging Infectious Diseases

Synopses

Childcare Exposure to Severe Acute Respiratory Syndrome Coronavirus 2 for 4-Year-Old Presymptomatic Child, South Korea [PDF - 1.15 MB - 7 pages]
Y. Yoon et al.

Data on transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from preschool-age children to children and adults are limited. We investigated SARS-CoV-2 exposure at a childcare center in South Korea. A 4-year-old child, probably infected by his grandmother, attended the center during the presymptomatic period (February 19–21, 2020). Fever developed on February 22, and he was given a diagnosis SARS-CoV-2 infection on February 27. At the center, 190 persons (154 children and 36 adults) were identified as contacts; 44 (23.2%) were defined as close contacts (37 children and 7 adults). All 190 persons were negative for SARS-CoV-2 on days 8–9 after the last exposure. Two close contacts (1 child and 1 adult) showed development of symptoms on the last day of quarantine. However, subsequent test results were negative. This investigation adds indirect evidence of low potential infectivity in a childcare setting with exposure to a presymptomatic child.

EID Yoon Y, Choi G, Kim J, Kim K, Park H, Chun J, et al. Childcare Exposure to Severe Acute Respiratory Syndrome Coronavirus 2 for 4-Year-Old Presymptomatic Child, South Korea. Emerg Infect Dis. 2021;27(2):341-347. https://dx.doi.org/10.3201/eid2702.203189
AMA Yoon Y, Choi G, Kim J, et al. Childcare Exposure to Severe Acute Respiratory Syndrome Coronavirus 2 for 4-Year-Old Presymptomatic Child, South Korea. Emerging Infectious Diseases. 2021;27(2):341-347. doi:10.3201/eid2702.203189.
APA Yoon, Y., Choi, G., Kim, J., Kim, K., Park, H., Chun, J....Kim, Y. (2021). Childcare Exposure to Severe Acute Respiratory Syndrome Coronavirus 2 for 4-Year-Old Presymptomatic Child, South Korea. Emerging Infectious Diseases, 27(2), 341-347. https://dx.doi.org/10.3201/eid2702.203189.

Symptom Profiles and Progression in Hospitalized and Nonhospitalized Patients with Coronavirus Disease, Colorado, USA, 2020 [PDF - 1.75 MB - 11 pages]
G. M. Vahey et al.

To improve recognition of coronavirus disease (COVID-19) and inform clinical and public health guidance, we randomly selected 600 COVID-19 case-patients in Colorado. A telephone questionnaire captured symptoms experienced, when symptoms occurred, and how long each lasted. Among 128 hospitalized patients, commonly reported symptoms included fever (84%), fatigue (83%), cough (73%), and dyspnea (72%). Among 236 nonhospitalized patients, commonly reported symptoms included fatigue (90%), fever (83%), cough (83%), and myalgia (74%). The most commonly reported initial symptoms were cough (21%–25%) and fever (20%–25%). In multivariable analysis, vomiting, dyspnea, altered mental status, dehydration, and wheezing were significantly associated with hospitalization, whereas rhinorrhea, headache, sore throat, and anosmia or ageusia were significantly associated with nonhospitalization. General symptoms and upper respiratory symptoms occurred earlier in disease, and anosmia, ageusia, lower respiratory symptoms, and gastrointestinal symptoms occurred later. Symptoms should be considered alongside other epidemiologic factors in clinical and public health decisions regarding potential COVID-19 cases.

EID Vahey GM, Marshall KE, McDonald E, Martin SW, Tate JE, Midgley CM, et al. Symptom Profiles and Progression in Hospitalized and Nonhospitalized Patients with Coronavirus Disease, Colorado, USA, 2020. Emerg Infect Dis. 2021;27(2):385-395. https://dx.doi.org/10.3201/eid2702.203729
AMA Vahey GM, Marshall KE, McDonald E, et al. Symptom Profiles and Progression in Hospitalized and Nonhospitalized Patients with Coronavirus Disease, Colorado, USA, 2020. Emerging Infectious Diseases. 2021;27(2):385-395. doi:10.3201/eid2702.203729.
APA Vahey, G. M., Marshall, K. E., McDonald, E., Martin, S. W., Tate, J. E., Midgley, C. M....Staples, J. (2021). Symptom Profiles and Progression in Hospitalized and Nonhospitalized Patients with Coronavirus Disease, Colorado, USA, 2020. Emerging Infectious Diseases, 27(2), 385-395. https://dx.doi.org/10.3201/eid2702.203729.

Characteristics and Timing of Initial Virus Shedding in Severe Acute Respiratory Syndrome Coronavirus 2, Utah, USA [PDF - 1.89 MB - 8 pages]
N. M. Lewis et al.

Virus shedding in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can occur before onset of symptoms; less is known about symptom progression or infectiousness associated with initiation of viral shedding. We investigated household transmission in 5 households with daily specimen collection for 5 consecutive days starting a median of 4 days after symptom onset in index patients. Seven contacts across 2 households implementing no precautionary measures were infected. Of these 7, 2 tested positive for SARS-CoV-2 by reverse transcription PCR on day 3 of 5. Both had mild, nonspecific symptoms for 1–3 days preceding the first positive test. SARS-CoV-2 was cultured from the fourth-day specimen in 1 patient and from the fourth- and fifth-day specimens in the other. We also describe infection control measures taken in the households that had no transmission. Persons exposed to SARS-CoV-2 should self-isolate, including from household contacts, wear a mask, practice hand hygiene, and seek testing promptly.

EID Lewis NM, Duca LM, Marcenac P, Dietrich EA, Gregory CJ, Fields VL, et al. Characteristics and Timing of Initial Virus Shedding in Severe Acute Respiratory Syndrome Coronavirus 2, Utah, USA. Emerg Infect Dis. 2021;27(2):352-359. https://dx.doi.org/10.3201/eid2702.203517
AMA Lewis NM, Duca LM, Marcenac P, et al. Characteristics and Timing of Initial Virus Shedding in Severe Acute Respiratory Syndrome Coronavirus 2, Utah, USA. Emerging Infectious Diseases. 2021;27(2):352-359. doi:10.3201/eid2702.203517.
APA Lewis, N. M., Duca, L. M., Marcenac, P., Dietrich, E. A., Gregory, C. J., Fields, V. L....Kirking, H. L. (2021). Characteristics and Timing of Initial Virus Shedding in Severe Acute Respiratory Syndrome Coronavirus 2, Utah, USA. Emerging Infectious Diseases, 27(2), 352-359. https://dx.doi.org/10.3201/eid2702.203517.

Characteristics of Patients Co-infected with Severe Acute Respiratory Syndrome Coronavirus 2 and Dengue Virus, Buenos Aires, Argentina, March–June 2020 [PDF - 878 KB - 4 pages]
L. M. Carosella et al.

An epidemic of dengue virus and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) co-infections occurred in Argentina during 2020. We describe the clinical characteristics and outcomes in a cohort of patients hospitalized because of co-infection. We retrospectively identified 13 patients from different hospitals in Buenos Aires who had confirmed infection with SARS-CoV-2 and dengue virus and obtained clinical and laboratory data from clinical records. All patients had febrile disease when hospitalized. Headache was a common symptom. A total of 8 patients had respiratory symptoms, 5 had pneumonia, and 3 had rash. Nearly all patients had lymphopenia when hospitalized. No patients were admitted to an intensive care unit or died during follow up. Co-infection with SARS-CoV-2 and dengue virus can occur in patients living in areas in which both viruses are epidemic. The outcome of these patients did not seem to be worse than those having either SARS-CoV-2 or dengue infection alone.

EID Carosella LM, Pryluka D, Maranzana A, Barcan L, Cuini R, Freuler C, et al. Characteristics of Patients Co-infected with Severe Acute Respiratory Syndrome Coronavirus 2 and Dengue Virus, Buenos Aires, Argentina, March–June 2020. Emerg Infect Dis. 2021;27(2):348-351. https://dx.doi.org/10.3201/eid2702.203439
AMA Carosella LM, Pryluka D, Maranzana A, et al. Characteristics of Patients Co-infected with Severe Acute Respiratory Syndrome Coronavirus 2 and Dengue Virus, Buenos Aires, Argentina, March–June 2020. Emerging Infectious Diseases. 2021;27(2):348-351. doi:10.3201/eid2702.203439.
APA Carosella, L. M., Pryluka, D., Maranzana, A., Barcan, L., Cuini, R., Freuler, C....Stryjewski, M. E. (2021). Characteristics of Patients Co-infected with Severe Acute Respiratory Syndrome Coronavirus 2 and Dengue Virus, Buenos Aires, Argentina, March–June 2020. Emerging Infectious Diseases, 27(2), 348-351. https://dx.doi.org/10.3201/eid2702.203439.

Medscape CME Activity
Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018 [PDF - 2.56 MB - 12 pages]
A. Benavides-Lara et al.

After Zika virus (ZIKV) infection in Costa Rica was confirmed in January 2016, the national surveillance system was enhanced to monitor associated birth defects. To characterize the ZIKV outbreak among live-born infants during March 2016–March 2018, we conducted a descriptive analysis. Prevalence of ZIKV-associated birth defects was 15.3 cases/100,000 live births. Among 22 infants with ZIKV-associated birth defects, 11 were designated as confirmed (positive for ZIKV) and 11 were designated as probable cases (negative for ZIKV or not tested, but mother was expsed to ZIKV during pregnancy). A total of 91% had microcephaly (head circumference >2 SDs below mean for age and sex), 64% severe microcephaly (head circumference >3 SDs below mean for age and sex), 95% neurodevelopmental abnormalities, 82% brain anomalies, 41% eye abnormalities, and 9% hearing loss. Monitoring children for >1 year can increase identification of ZIKV-associated abnormalities in addition to microcephaly.

EID Benavides-Lara A, la Paz Barboza-Arguello Md, González-Elizondo M, Hernández-deMezerville M, Brenes-Chacón H, Ramírez-Rojas M, et al. Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018. Emerg Infect Dis. 2021;27(2):360-371. https://dx.doi.org/10.3201/eid2702.202047
AMA Benavides-Lara A, la Paz Barboza-Arguello Md, González-Elizondo M, et al. Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018. Emerging Infectious Diseases. 2021;27(2):360-371. doi:10.3201/eid2702.202047.
APA Benavides-Lara, A., la Paz Barboza-Arguello, M. d., González-Elizondo, M., Hernández-deMezerville, M., Brenes-Chacón, H., Ramírez-Rojas, M....Soriano-Fallas, A. (2021). Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018. Emerging Infectious Diseases, 27(2), 360-371. https://dx.doi.org/10.3201/eid2702.202047.

Medscape CME Activity
Plasmodium ovale wallikeri and P. ovale curtisi Infections and Diagnostic Approaches to Imported Malaria, France, 2013–2018 [PDF - 1.48 MB - 13 pages]
V. Joste et al.

We retrospectively analyzed epidemiologic, clinical, and biologic characteristics of 368 Plasmodium ovale wallikeri and 309 P. ovale curtisi infections treated in France during January 2013–December 2018. P. ovale wallikeri infections displayed deeper thrombocytopenia and shorter latency periods. Despite similar clinical manifestations, P. ovale wallikeri–infected patients were more frequently treated with artemisinin-based combination therapy. Although the difference was not statistically significant, P. ovale wallikeri–infected patients were 5 times more frequently hospitalized in intensive care or intermediate care and had a higher proportion of severe thrombocytopenia than P. ovale curtisi–infected patients. Rapid diagnostic tests that detect aldolase were more efficient than those detecting Plasmodium lactate dehydrogenase. Sequence analysis of the potra gene from 90 P. ovale isolates reveals an insufficient polymorphism for relapse typing.

EID Joste V, Bailly J, Hubert V, Pauc C, Gendrot M, Guillochon E, et al. Plasmodium ovale wallikeri and P. ovale curtisi Infections and Diagnostic Approaches to Imported Malaria, France, 2013–2018. Emerg Infect Dis. 2021;27(2):372-384. https://dx.doi.org/10.3201/eid2702.202143
AMA Joste V, Bailly J, Hubert V, et al. Plasmodium ovale wallikeri and P. ovale curtisi Infections and Diagnostic Approaches to Imported Malaria, France, 2013–2018. Emerging Infectious Diseases. 2021;27(2):372-384. doi:10.3201/eid2702.202143.
APA Joste, V., Bailly, J., Hubert, V., Pauc, C., Gendrot, M., Guillochon, E....Houzé, S. (2021). Plasmodium ovale wallikeri and P. ovale curtisi Infections and Diagnostic Approaches to Imported Malaria, France, 2013–2018. Emerging Infectious Diseases, 27(2), 372-384. https://dx.doi.org/10.3201/eid2702.202143.
Research

Addressing COVID-19 Misinformation on Social Media Preemptively and Responsively [PDF - 869 KB - 8 pages]
E. K. Vraga and L. Bode

Efforts to address misinformation on social media have special urgency with the emergence of coronavirus disease (COVID-19). In one effort, the World Health Organization (WHO) designed and publicized shareable infographics to debunk coronavirus myths. We used an experiment to test the efficacy of these infographics, depending on placement and source. We found that exposure to a corrective graphic on social media reduced misperceptions about the science of 1 false COVID-19 prevention strategy but did not affect misperceptions about prevention of COVID-19. Lowered misperceptions about the science persisted >1 week later. These effects were consistent when the graphic was shared by the World Health Organization or by an anonymous Facebook user and when the graphics were shared preemptively or in response to misinformation. Health organizations can and should create and promote shareable graphics to improve public knowledge.

EID Vraga EK, Bode L. Addressing COVID-19 Misinformation on Social Media Preemptively and Responsively. Emerg Infect Dis. 2021;27(2):396-403. https://dx.doi.org/10.3201/eid2702.203139
AMA Vraga EK, Bode L. Addressing COVID-19 Misinformation on Social Media Preemptively and Responsively. Emerging Infectious Diseases. 2021;27(2):396-403. doi:10.3201/eid2702.203139.
APA Vraga, E. K., & Bode, L. (2021). Addressing COVID-19 Misinformation on Social Media Preemptively and Responsively. Emerging Infectious Diseases, 27(2), 396-403. https://dx.doi.org/10.3201/eid2702.203139.

Universal Admission Screening for SARS-CoV-2 Infections among Hospitalized Patients, Switzerland, 2020 [PDF - 1.04 MB - 7 pages]
T. Scheier et al.

Switzerland began a national lockdown on March 16, 2020, in response to the rapid spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We assessed the prevalence of SARS-CoV-2 infection among patients admitted to 4 hospitals in the canton of Zurich, Switzerland, in April 2020. These 4 acute care hospitals screened 2,807 patients, including 2,278 (81.2%) who did not have symptoms of coronavirus disease (COVID-19). Overall, 529 (18.8%) persons had >1 symptom of COVID-19, of whom 60 (11.3%) tested positive for SARS-CoV-2. Eight asymptomatic persons (0.4%) also tested positive for SARS-CoV-2. Our findings indicate that screening on the basis of COVID-19 symptoms, regardless of clinical suspicion, can identify most SARS-CoV-2–positive persons in a low-prevalence setting.

EID Scheier T, Schibli A, Eich G, Rüegg C, Kube F, Schmid A, et al. Universal Admission Screening for SARS-CoV-2 Infections among Hospitalized Patients, Switzerland, 2020. Emerg Infect Dis. 2021;27(2):404-410. https://dx.doi.org/10.3201/eid2702.202318
AMA Scheier T, Schibli A, Eich G, et al. Universal Admission Screening for SARS-CoV-2 Infections among Hospitalized Patients, Switzerland, 2020. Emerging Infectious Diseases. 2021;27(2):404-410. doi:10.3201/eid2702.202318.
APA Scheier, T., Schibli, A., Eich, G., Rüegg, C., Kube, F., Schmid, A....Schreiber, P. W. (2021). Universal Admission Screening for SARS-CoV-2 Infections among Hospitalized Patients, Switzerland, 2020. Emerging Infectious Diseases, 27(2), 404-410. https://dx.doi.org/10.3201/eid2702.202318.

Excess Deaths during Influenza and Coronavirus Disease and Infection-Fatality Rate for Severe Acute Respiratory Syndrome Coronavirus 2, the Netherlands [PDF - 2.42 MB - 10 pages]
L. van Asten et al.

Since the 2009 influenza pandemic, the Netherlands has used a weekly death monitoring system to estimate deaths in excess of expectations. We present estimates of excess deaths during the ongoing coronavirus disease (COVID-19) epidemic and 10 previous influenza epidemics. Excess deaths per influenza epidemic averaged 4,000. The estimated 9,554 excess deaths (41% in excess) during the COVID-19 epidemic weeks 12–19 of 2020 appeared comparable to the 9,373 excess deaths (18%) during the severe influenza epidemic of 2017–18. However, these deaths occurred in a shorter time, had a higher peak, and were mitigated by nonpharmaceutical control measures. Excess deaths were 1.8-fold higher than reported laboratory-confirmed COVID-19 deaths (5,449). Based on excess deaths and preliminary results from seroepidemiologic studies, we estimated the infection-fatality rate to be 1%. Monitoring of excess deaths is crucial for timely estimates of disease burden for influenza and COVID-19. Our data complement laboratory-confirmed COVID-19 death reports and enable comparisons between epidemics.

EID van Asten L, Harmsen CN, Stoeldraijer L, Klinkenberg D, Teirlinck AC, de Lange M, et al. Excess Deaths during Influenza and Coronavirus Disease and Infection-Fatality Rate for Severe Acute Respiratory Syndrome Coronavirus 2, the Netherlands. Emerg Infect Dis. 2021;27(2):411-420. https://dx.doi.org/10.3201/eid2702.202999
AMA van Asten L, Harmsen CN, Stoeldraijer L, et al. Excess Deaths during Influenza and Coronavirus Disease and Infection-Fatality Rate for Severe Acute Respiratory Syndrome Coronavirus 2, the Netherlands. Emerging Infectious Diseases. 2021;27(2):411-420. doi:10.3201/eid2702.202999.
APA van Asten, L., Harmsen, C. N., Stoeldraijer, L., Klinkenberg, D., Teirlinck, A. C., de Lange, M....van der Hoek, W. (2021). Excess Deaths during Influenza and Coronavirus Disease and Infection-Fatality Rate for Severe Acute Respiratory Syndrome Coronavirus 2, the Netherlands. Emerging Infectious Diseases, 27(2), 411-420. https://dx.doi.org/10.3201/eid2702.202999.

Rapid Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in Detention Facility, Louisiana, USA, May–June, 2020 [PDF - 1.22 MB - 9 pages]
M. Wallace et al.

To assess transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a detention facility experiencing a coronavirus disease outbreak and evaluate testing strategies, we conducted a prospective cohort investigation in a facility in Louisiana, USA. We conducted SARS-CoV-2 testing for detained persons in 6 quarantined dormitories at various time points. Of 143 persons, 53 were positive at the initial test, and an additional 58 persons were positive at later time points (cumulative incidence 78%). In 1 dormitory, all 45 detained persons initially were negative; 18 days later, 40 (89%) were positive. Among persons who were SARS-CoV-2 positive, 47% (52/111) were asymptomatic at the time of specimen collection; 14 had replication-competent virus isolated. Serial SARS-CoV-2 testing might help interrupt transmission through medical isolation and quarantine. Testing in correctional and detention facilities will be most effective when initiated early in an outbreak, inclusive of all exposed persons, and paired with infection prevention and control.

EID Wallace M, James AE, Silver R, Koh M, Tobolowsky FA, Simonson S, et al. Rapid Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in Detention Facility, Louisiana, USA, May–June, 2020. Emerg Infect Dis. 2021;27(2):421-429. https://dx.doi.org/10.3201/eid2702.204158
AMA Wallace M, James AE, Silver R, et al. Rapid Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in Detention Facility, Louisiana, USA, May–June, 2020. Emerging Infectious Diseases. 2021;27(2):421-429. doi:10.3201/eid2702.204158.
APA Wallace, M., James, A. E., Silver, R., Koh, M., Tobolowsky, F. A., Simonson, S....Curran, K. G. (2021). Rapid Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in Detention Facility, Louisiana, USA, May–June, 2020. Emerging Infectious Diseases, 27(2), 421-429. https://dx.doi.org/10.3201/eid2702.204158.

Plasma MicroRNA Profiling of Plasmodium falciparum Biomass and Association with Severity of Malaria Disease [PDF - 1.94 MB - 13 pages]
H. Gupta et al.

Severe malaria (SM) is a major public health problem in malaria-endemic countries. Sequestration of Plasmodium falciparum–infected erythrocytes in vital organs and the associated inflammation leads to organ dysfunction. MicroRNAs (miRNAs), which are rapidly released from damaged tissues into the host fluids, constitute a promising biomarker for the prognosis of SM. We applied next-generation sequencing to evaluate the differential expression of miRNAs in SM and in uncomplicated malaria (UM) in children in Mozambique. Six miRNAs were associated with in vitro P. falciparum cytoadhesion, severity in children, and P. falciparum biomass. Relative expression of hsa-miR-4497 quantified by TaqMan-quantitative reverse transcription PCR was higher in plasma of children with SM than those with UM (p<0.048) and again correlated with P. falciparum biomass (p = 0.033). These findings suggest that different physiopathological processes in SM and UM lead to differential expression of miRNAs and suggest a pathway for assessing their prognostic value malaria.

EID Gupta H, Rubio M, Sitoe A, Varo R, Cisteró P, Madrid L, et al. Plasma MicroRNA Profiling of Plasmodium falciparum Biomass and Association with Severity of Malaria Disease. Emerg Infect Dis. 2021;27(2):430-442. https://dx.doi.org/10.3201/eid2702.191795
AMA Gupta H, Rubio M, Sitoe A, et al. Plasma MicroRNA Profiling of Plasmodium falciparum Biomass and Association with Severity of Malaria Disease. Emerging Infectious Diseases. 2021;27(2):430-442. doi:10.3201/eid2702.191795.
APA Gupta, H., Rubio, M., Sitoe, A., Varo, R., Cisteró, P., Madrid, L....Mayor, A. (2021). Plasma MicroRNA Profiling of Plasmodium falciparum Biomass and Association with Severity of Malaria Disease. Emerging Infectious Diseases, 27(2), 430-442. https://dx.doi.org/10.3201/eid2702.191795.

Increasing Incidence of Invasive Group A Streptococcus Disease in First Nations Population, Alberta, Canada, 2003–2017 [PDF - 1.04 MB - 9 pages]
G. J. Tyrrell et al.

The incidence of invasive group A Streptococcus (iGAS) disease in the general population in Alberta, Canada, has been steadily increasing. To determine whether rates for specific populations such as First Nations are also increasing, we investigated iGAS cases among First Nations persons in Alberta during 2003–2017. We identified cases by isolating GAS from a sterile site and performing emm typing. We collected demographic, social, behavioral, and clinical data for patients. During the study period, 669 cases of iGAS in First Nations persons were reported. Incidence increased from 10.0 cases/100,000 persons in 2003 to 52.2 cases/100,000 persons in 2017. The 2017 rate was 6 times higher for the First Nations population than for non–First Nations populations (8.7 cases/100,000 persons). The 5 most common emm types from First Nations patients were 59, 101, 82, 41, and 11. These data indicate that iGAS is severely affecting the First Nations population in Alberta, Canada.

EID Tyrrell GJ, Bell C, Bill L, Fathima S. Increasing Incidence of Invasive Group A Streptococcus Disease in First Nations Population, Alberta, Canada, 2003–2017. Emerg Infect Dis. 2021;27(2):443-451. https://dx.doi.org/10.3201/eid2702.201945
AMA Tyrrell GJ, Bell C, Bill L, et al. Increasing Incidence of Invasive Group A Streptococcus Disease in First Nations Population, Alberta, Canada, 2003–2017. Emerging Infectious Diseases. 2021;27(2):443-451. doi:10.3201/eid2702.201945.
APA Tyrrell, G. J., Bell, C., Bill, L., & Fathima, S. (2021). Increasing Incidence of Invasive Group A Streptococcus Disease in First Nations Population, Alberta, Canada, 2003–2017. Emerging Infectious Diseases, 27(2), 443-451. https://dx.doi.org/10.3201/eid2702.201945.

Effects of Social Distancing Measures during the First Epidemic Wave of Severe Acute Respiratory Syndrome Infection, Greece [PDF - 2.09 MB - 11 pages]
V. Sypsa et al.

Greece imposed a nationwide lockdown in March 2020 to mitigate transmission of severe acute respiratory syndrome coronavirus 2 during the first epidemic wave. We conducted a survey on age-specific social contact patterns to assess effects of physical distancing measures and used a susceptible-exposed-infectious-recovered model to simulate the epidemic. Because multiple distancing measures were implemented simultaneously, we assessed their overall effects and the contribution of each measure. Before measures were implemented, the estimated basic reproduction number (R0) was 2.38 (95% CI 2.01–2.80). During lockdown, daily contacts decreased by 86.9% and R0 decreased by 81.0% (95% credible interval [CrI] 71.8%–86.0%); each distancing measure decreased R0 by 10%–24%. By April 26, the attack rate in Greece was 0.12% (95% CrI 0.06%–0.26%), one of the lowest in Europe, and the infection fatality ratio was 1.12% (95% CrI 0.55%–2.31%). Multiple social distancing measures contained the first epidemic wave in Greece.

EID Sypsa V, Roussos S, Paraskevis D, Lytras T, Tsiodras S, Hatzakis A. Effects of Social Distancing Measures during the First Epidemic Wave of Severe Acute Respiratory Syndrome Infection, Greece. Emerg Infect Dis. 2021;27(2):452-462. https://dx.doi.org/10.3201/eid2702.203412
AMA Sypsa V, Roussos S, Paraskevis D, et al. Effects of Social Distancing Measures during the First Epidemic Wave of Severe Acute Respiratory Syndrome Infection, Greece. Emerging Infectious Diseases. 2021;27(2):452-462. doi:10.3201/eid2702.203412.
APA Sypsa, V., Roussos, S., Paraskevis, D., Lytras, T., Tsiodras, S., & Hatzakis, A. (2021). Effects of Social Distancing Measures during the First Epidemic Wave of Severe Acute Respiratory Syndrome Infection, Greece. Emerging Infectious Diseases, 27(2), 452-462. https://dx.doi.org/10.3201/eid2702.203412.

Role of Burkholderia pseudomallei–Specific IgG2 in Adults with Acute Melioidosis, Thailand [PDF - 923 KB - 8 pages]
P. Chaichana et al.

Melioidosis is a life-threatening infectious disease caused by the gram-negative bacillus Burkholderia pseudomallei. An effective vaccine is needed, but data on protective immune responses in human melioidosis are lacking. We used ELISA and an antibody-dependent cellular phagocytosis assay to identify the major features of protective antibodies in patients with acute melioidosis in Thailand. We found that high levels of B. pseudomallei–specific IgG2 are associated with protection against death in a multivariable logistic regression analysis adjusting for age, diabetes, renal disease, and neutrophil count. Serum from melioidosis survivors enhanced bacteria uptake into human monocytes expressing FcγRIIa-H/R131, an intermediate-affinity IgG2-receptor, compared with serum from nonsurvivors. We did not find this enhancement when using monocytes carrying the low IgG2–affinity FcγRIIa-R131 allele. The findings indicate the importance of IgG2 in protection against death in human melioidosis, a crucial finding for antibody-based therapeutics and vaccine development.

EID Chaichana P, Jenjaroen K, Chumseng S, Sumonwiriya M, Rongkard P, Kronsteiner B, et al. Role of Burkholderia pseudomallei–Specific IgG2 in Adults with Acute Melioidosis, Thailand. Emerg Infect Dis. 2021;27(2):463-470. https://dx.doi.org/10.3201/eid2702.200213
AMA Chaichana P, Jenjaroen K, Chumseng S, et al. Role of Burkholderia pseudomallei–Specific IgG2 in Adults with Acute Melioidosis, Thailand. Emerging Infectious Diseases. 2021;27(2):463-470. doi:10.3201/eid2702.200213.
APA Chaichana, P., Jenjaroen, K., Chumseng, S., Sumonwiriya, M., Rongkard, P., Kronsteiner, B....Dunachie, S. (2021). Role of Burkholderia pseudomallei–Specific IgG2 in Adults with Acute Melioidosis, Thailand. Emerging Infectious Diseases, 27(2), 463-470. https://dx.doi.org/10.3201/eid2702.200213.

Spread of Multidrug-Resistant Rhodococcus equi, United States [PDF - 2.97 MB - 9 pages]
S. Álvarez-Narváez et al.

Multidrug resistance has been detected in the animal and zoonotic human pathogen Rhodococcus equi after mass macrolide/rifampin antibioprophylaxis in endemically affected equine farms in the United States. Multidrug-resistant (MDR) R. equi emerged upon acquisition of pRERm46, a conjugative plasmid conferring resistance to macrolides, lincosamides, streptogramins, and, as we describe, tetracycline. Phylogenomic analyses indicate that the increasing prevalence of MDR R. equi since it was first documented in 2002 is caused by a clone, R. equi 2287, attributable to coselection of pRErm46 with a chromosomal rpoBS531F mutation driven by macrolide/rifampin therapy. pRErm46 spillover to other R. equi genotypes has given rise to a novel MDR clone, G2016, associated with a distinct rpoBS531Y mutation. Our findings illustrate that overuse of antimicrobial prophylaxis in animals can generate MDR pathogens with zoonotic potential. MDR R. equi and pRErm46-mediated resistance are currently disseminating in the United States and are likely to spread internationally through horse movements.

EID Álvarez-Narváez S, Giguère S, Cohen N, Slovis N, Vázquez-Boland JA. Spread of Multidrug-Resistant Rhodococcus equi, United States. Emerg Infect Dis. 2021;27(2):529-537. https://dx.doi.org/10.3201/eid2702.203030
AMA Álvarez-Narváez S, Giguère S, Cohen N, et al. Spread of Multidrug-Resistant Rhodococcus equi, United States. Emerging Infectious Diseases. 2021;27(2):529-537. doi:10.3201/eid2702.203030.
APA Álvarez-Narváez, S., Giguère, S., Cohen, N., Slovis, N., & Vázquez-Boland, J. A. (2021). Spread of Multidrug-Resistant Rhodococcus equi, United States. Emerging Infectious Diseases, 27(2), 529-537. https://dx.doi.org/10.3201/eid2702.203030.

Hepatitis C Virus Transmission Clusters in Public Health and Correctional Settings, Wisconsin, USA, 2016–2017 [PDF - 1.51 MB - 10 pages]
K. R. Hochstatter et al.

Ending the hepatitis C virus (HCV) epidemic requires stopping transmission among networks of persons who inject drugs. Identifying transmission networks by using genomic epidemiology may inform community responses that can quickly interrupt transmission. We retrospectively identified HCV RNA–positive specimens corresponding to 459 persons in settings that use the state laboratory, including correctional facilities and syringe services programs, in Wisconsin, USA, during 2016–2017. We conducted next-generation sequencing of HCV and analyzed it for phylogenetic linkage by using the Centers for Disease Control and Prevention Global Hepatitis Outbreak Surveillance Technology platform. Analysis showed that 126 persons were linked across 42 clusters. Phylogenetic clustering was higher in rural communities and associated with female sex and younger age among rural residents. These data highlight that HCV transmission could be reduced by expanding molecular-based surveillance strategies to rural communities affected by the opioid crisis.

EID Hochstatter KR, Tully DC, Power KA, Koepke R, Akhtar WZ, Prieve AF, et al. Hepatitis C Virus Transmission Clusters in Public Health and Correctional Settings, Wisconsin, USA, 2016–2017. Emerg Infect Dis. 2021;27(2):480-489. https://dx.doi.org/10.3201/eid2702.202957
AMA Hochstatter KR, Tully DC, Power KA, et al. Hepatitis C Virus Transmission Clusters in Public Health and Correctional Settings, Wisconsin, USA, 2016–2017. Emerging Infectious Diseases. 2021;27(2):480-489. doi:10.3201/eid2702.202957.
APA Hochstatter, K. R., Tully, D. C., Power, K. A., Koepke, R., Akhtar, W. Z., Prieve, A. F....Westergaard, R. P. (2021). Hepatitis C Virus Transmission Clusters in Public Health and Correctional Settings, Wisconsin, USA, 2016–2017. Emerging Infectious Diseases, 27(2), 480-489. https://dx.doi.org/10.3201/eid2702.202957.

Prolonged Maternal Zika Viremia as a Marker of Adverse Perinatal Outcomes [PDF - 2.10 MB - 9 pages]
L. Pomar et al.

Whether prolonged maternal viremia after Zika virus infection represents a risk factor for maternal–fetal transmission and subsequent adverse outcomes remains unclear. In this prospective cohort study in French Guiana, we enrolled Zika virus–infected pregnant women with a positive PCR result at inclusion and noninfected pregnant women; both groups underwent serologic testing in each trimester and at delivery during January–July 2016. Prolonged viremia was defined as ongoing virus detection >30 days postinfection. Adverse outcomes (fetal loss or neurologic anomalies) were more common in fetuses and neonates from mothers with prolonged viremia (40.0%) compared with those from infected mothers without prolonged viremia (5.3%, adjusted relative risk [aRR] 7.2 [95% CI 0.9–57.6]) or those from noninfected mothers (6.6%, aRR 6.7 [95% CI 3.0–15.1]). Congenital infections were confirmed more often in fetuses and neonates from mothers with prolonged viremia compared with the other 2 groups (60.0% vs. 26.3% vs. 0.0%, aRR 2.3 [95% CI 0.9–5.5]).

EID Pomar L, Lambert V, Matheus S, Pomar C, Hcini N, Carles G, et al. Prolonged Maternal Zika Viremia as a Marker of Adverse Perinatal Outcomes. Emerg Infect Dis. 2021;27(2):490-498. https://dx.doi.org/10.3201/eid2702.200684
AMA Pomar L, Lambert V, Matheus S, et al. Prolonged Maternal Zika Viremia as a Marker of Adverse Perinatal Outcomes. Emerging Infectious Diseases. 2021;27(2):490-498. doi:10.3201/eid2702.200684.
APA Pomar, L., Lambert, V., Matheus, S., Pomar, C., Hcini, N., Carles, G....Baud, D. (2021). Prolonged Maternal Zika Viremia as a Marker of Adverse Perinatal Outcomes. Emerging Infectious Diseases, 27(2), 490-498. https://dx.doi.org/10.3201/eid2702.200684.

Use of Commercial Claims Data for Evaluating Trends in Lyme Disease Diagnoses, United States, 2010–2018 [PDF - 1.17 MB - 9 pages]
A. M. Schwartz et al.

We evaluated MarketScan, a large commercial insurance claims database, for its potential use as a stable and consistent source of information on Lyme disease diagnoses in the United States. The age, sex, and geographic composition of the enrolled population during 2010–2018 remained proportionally stable, despite fluctuations in the number of enrollees. Annual incidence of Lyme disease diagnoses per 100,000 enrollees ranged from 49 to 88, ≈6–8 times higher than that observed for cases reported through notifiable disease surveillance. Age and sex distributions among Lyme disease diagnoses in MarketScan were similar to those of cases reported through surveillance, but proportionally more diagnoses occurred outside of peak summer months, among female enrollees, and outside high-incidence states. Misdiagnoses, particularly in low-incidence states, may account for some of the observed epidemiologic differences. Commercial claims provide a stable data source to monitor trends in Lyme disease diagnoses, but certain important characteristics warrant further investigation.

EID Schwartz AM, Kugeler KJ, Nelson CA, Marx GE, Hinckley AF. Use of Commercial Claims Data for Evaluating Trends in Lyme Disease Diagnoses, United States, 2010–2018. Emerg Infect Dis. 2021;27(2):499-507. https://dx.doi.org/10.3201/eid2702.202728
AMA Schwartz AM, Kugeler KJ, Nelson CA, et al. Use of Commercial Claims Data for Evaluating Trends in Lyme Disease Diagnoses, United States, 2010–2018. Emerging Infectious Diseases. 2021;27(2):499-507. doi:10.3201/eid2702.202728.
APA Schwartz, A. M., Kugeler, K. J., Nelson, C. A., Marx, G. E., & Hinckley, A. F. (2021). Use of Commercial Claims Data for Evaluating Trends in Lyme Disease Diagnoses, United States, 2010–2018. Emerging Infectious Diseases, 27(2), 499-507. https://dx.doi.org/10.3201/eid2702.202728.

Highly Pathogenic Avian Influenza A(H5N8) Virus Spread by Short- and Long-Range Transmission, France, 2016–17 [PDF - 2.27 MB - 9 pages]
F. Briand et al.

We detected 3 genotypes of highly pathogenic avian influenza A(H5N8) virus in France during winter 2016–17. Genotype A viruses caused dramatic economic losses in the domestic duck farm industry in southwestern France. Our phylogenetic analysis suggests that genotype A viruses formed 5 distinct geographic clusters in southwestern France. In some clusters, local secondary transmission might have been started by a single introduction. The intensity of the viral spread seems to correspond to the density of duck holdings in each production area. To avoid the introduction of disease into an unaffected area, it is crucial that authorities limit the movements of potentially infected birds.

EID Briand F, Niqueux E, Schmitz A, Martenot C, Cherbonnel M, Massin P, et al. Highly Pathogenic Avian Influenza A(H5N8) Virus Spread by Short- and Long-Range Transmission, France, 2016–17. Emerg Infect Dis. 2021;27(2):508-516. https://dx.doi.org/10.3201/eid2702.202920
AMA Briand F, Niqueux E, Schmitz A, et al. Highly Pathogenic Avian Influenza A(H5N8) Virus Spread by Short- and Long-Range Transmission, France, 2016–17. Emerging Infectious Diseases. 2021;27(2):508-516. doi:10.3201/eid2702.202920.
APA Briand, F., Niqueux, E., Schmitz, A., Martenot, C., Cherbonnel, M., Massin, P....Grasland, B. (2021). Highly Pathogenic Avian Influenza A(H5N8) Virus Spread by Short- and Long-Range Transmission, France, 2016–17. Emerging Infectious Diseases, 27(2), 508-516. https://dx.doi.org/10.3201/eid2702.202920.

Outbreak of Severe Vomiting in Dogs Associated with a Canine Enteric Coronavirus, United Kingdom [PDF - 3.42 MB - 12 pages]
A. D. Radford et al.

The lack of population health surveillance for companion animal populations leaves them vulnerable to the effects of novel diseases without means of early detection. We present evidence on the effectiveness of a system that enabled early detection and rapid response a canine gastroenteritis outbreak in the United Kingdom. In January 2020, prolific vomiting among dogs was sporadically reported in the United Kingdom. Electronic health records from a nationwide sentinel network of veterinary practices confirmed a significant increase in dogs with signs of gastroenteric disease. Male dogs and dogs living with other vomiting dogs were more likely to be affected. Diet and vaccination status were not associated with the disease; however, a canine enteric coronavirus was significantly associated with illness. The system we describe potentially fills a gap in surveillance in neglected populations and could provide a blueprint for other countries.

EID Radford AD, Singleton DA, Jewell C, Appleton C, Rowlingson B, Hale AC, et al. Outbreak of Severe Vomiting in Dogs Associated with a Canine Enteric Coronavirus, United Kingdom. Emerg Infect Dis. 2021;27(2):517-528. https://dx.doi.org/10.3201/eid2702.202452
AMA Radford AD, Singleton DA, Jewell C, et al. Outbreak of Severe Vomiting in Dogs Associated with a Canine Enteric Coronavirus, United Kingdom. Emerging Infectious Diseases. 2021;27(2):517-528. doi:10.3201/eid2702.202452.
APA Radford, A. D., Singleton, D. A., Jewell, C., Appleton, C., Rowlingson, B., Hale, A. C....Pinchbeck, G. L. (2021). Outbreak of Severe Vomiting in Dogs Associated with a Canine Enteric Coronavirus, United Kingdom. Emerging Infectious Diseases, 27(2), 517-528. https://dx.doi.org/10.3201/eid2702.202452.

Plasmodium falciparum Histidine-Rich Protein 2 and 3 Gene Deletions in Strains from Nigeria, Sudan, and South Sudan [PDF - 1.27 MB - 9 pages]
C. Prosser et al.

Deletion of histidine-rich protein genes pfhrp2/3 in Plasmodium falciparum causes infections to go undetected by HRP2-based malaria rapid diagnostic tests. We analyzed P. falciparum malaria cases imported to Australia (n = 210, collected 2010–2018) for their pfhrp2/3 status. We detected gene deletions in patients from 12 of 25 countries. We found >10% pfhrp2-deletion levels in those from Nigeria (13.3%, n = 30), Sudan (11.2%, n = 39), and South Sudan (17.7%, n = 17) and low levels of pfhrp3 deletion from Sudan (3.6%) and South Sudan (5.9%). No parasites with pfhrp2/3 double deletions were detected. Microsatellite typing of parasites from Nigeria, Sudan, and South Sudan revealed low relatedness among gene-deleted parasites, indicating independent emergences. The gene deletion proportions signify a risk of false-negative HRP2-RDT results. This study’s findings warrant surveillance to determine whether the prevalence of gene-deleted parasites justifies switching malaria rapid diagnostic tests in Nigeria, Sudan, and South Sudan.

EID Prosser C, Gresty K, Ellis J, Meyer W, Anderson K, Lee R, et al. Plasmodium falciparum Histidine-Rich Protein 2 and 3 Gene Deletions in Strains from Nigeria, Sudan, and South Sudan. Emerg Infect Dis. 2021;27(2):471-479. https://dx.doi.org/10.3201/eid2702.191410
AMA Prosser C, Gresty K, Ellis J, et al. Plasmodium falciparum Histidine-Rich Protein 2 and 3 Gene Deletions in Strains from Nigeria, Sudan, and South Sudan. Emerging Infectious Diseases. 2021;27(2):471-479. doi:10.3201/eid2702.191410.
APA Prosser, C., Gresty, K., Ellis, J., Meyer, W., Anderson, K., Lee, R....Cheng, Q. (2021). Plasmodium falciparum Histidine-Rich Protein 2 and 3 Gene Deletions in Strains from Nigeria, Sudan, and South Sudan. Emerging Infectious Diseases, 27(2), 471-479. https://dx.doi.org/10.3201/eid2702.191410.

Emergence of Lyme Disease on Treeless Islands, Scotland, United Kingdom [PDF - 1.40 MB - 9 pages]
C. Millins et al.

Lyme disease is usually associated with forested habitats but has recently emerged on treeless islands in the Western Isles of Scotland. The environmental and human components of Lyme disease risk in open habitats remain unknown. We quantified the environmental hazard and risk factors for human tick bite exposure among treeless islands with low and high Lyme disease incidence in the Western Isles. We found a higher prevalence of Borrelia burgdorferi sensu lato–infected ticks on high-incidence than on low-incidence islands (6.4% vs. 0.7%); we also found that residents of high-incidence islands reported increased tick bite exposure. Most tick bites (72.7%) occurred <1 km from the home, including many in home gardens. Residents of high Lyme disease incidence islands reported increasing problems with ticks; many suggested changing deer distribution as a potential driver. We highlight the benefits of an integrated approach in understanding the factors that contribute to Lyme disease emergence.

EID Millins C, Leo W, MacInnes I, Ferguson J, Charlesworth G, Nayar D, et al. Emergence of Lyme Disease on Treeless Islands, Scotland, United Kingdom. Emerg Infect Dis. 2021;27(2):538-546. https://dx.doi.org/10.3201/eid2702.203862
AMA Millins C, Leo W, MacInnes I, et al. Emergence of Lyme Disease on Treeless Islands, Scotland, United Kingdom. Emerging Infectious Diseases. 2021;27(2):538-546. doi:10.3201/eid2702.203862.
APA Millins, C., Leo, W., MacInnes, I., Ferguson, J., Charlesworth, G., Nayar, D....Biek, R. (2021). Emergence of Lyme Disease on Treeless Islands, Scotland, United Kingdom. Emerging Infectious Diseases, 27(2), 538-546. https://dx.doi.org/10.3201/eid2702.203862.
Dispatches

Murine Typhus in Canary Islands, Spain, 1999–2015 [PDF - 481 KB - 4 pages]
J. Robaina-Bordón et al.

To document the epidemiology, clinical features, and outcomes of murine typhus patients in the Canary Islands (Spain), we analyzed data that were retrospectively collected for 16 years for 221 patients. Murine typhus in the Canary Islands is characterized by a high rate of complications (31.6%), mainly liver, lung, kidney or central nervous system involvement.

EID Robaina-Bordón J, Carranza-Rodríguez C, Hernández-Cabrera M, Bolaños-Rivero M, Pisos-Álamo E, Jaén-Sánchez N, et al. Murine Typhus in Canary Islands, Spain, 1999–2015. Emerg Infect Dis. 2021;27(2):570-573. https://dx.doi.org/10.3201/eid2702.191695
AMA Robaina-Bordón J, Carranza-Rodríguez C, Hernández-Cabrera M, et al. Murine Typhus in Canary Islands, Spain, 1999–2015. Emerging Infectious Diseases. 2021;27(2):570-573. doi:10.3201/eid2702.191695.
APA Robaina-Bordón, J., Carranza-Rodríguez, C., Hernández-Cabrera, M., Bolaños-Rivero, M., Pisos-Álamo, E., Jaén-Sánchez, N....Pérez-Arellano, J. (2021). Murine Typhus in Canary Islands, Spain, 1999–2015. Emerging Infectious Diseases, 27(2), 570-573. https://dx.doi.org/10.3201/eid2702.191695.

Azithromycin-Resistant Salmonella enterica Serovar Typhi AcrB-R717Q/L, Singapore [PDF - 1.25 MB - 4 pages]
S. Octavia et al.

Global travel has led to intermittent importation of multidrug-resistant Salmonella enterica serovar Typhi into industrialized countries. We detected azithromycin-resistant Salmonella Typhi in Singapore, of which 2 isolates were likely locally acquired. Ongoing vigilance and surveillance to minimize the public health risk for this serious pathogen is needed.

EID Octavia S, Chew K, Lin RP, Teo JP. Azithromycin-Resistant Salmonella enterica Serovar Typhi AcrB-R717Q/L, Singapore. Emerg Infect Dis. 2021;27(2):624-627. https://dx.doi.org/10.3201/eid2702.203874
AMA Octavia S, Chew K, Lin RP, et al. Azithromycin-Resistant Salmonella enterica Serovar Typhi AcrB-R717Q/L, Singapore. Emerging Infectious Diseases. 2021;27(2):624-627. doi:10.3201/eid2702.203874.
APA Octavia, S., Chew, K., Lin, R. P., & Teo, J. P. (2021). Azithromycin-Resistant Salmonella enterica Serovar Typhi AcrB-R717Q/L, Singapore. Emerging Infectious Diseases, 27(2), 624-627. https://dx.doi.org/10.3201/eid2702.203874.

Evidence of Zika Virus Infection in Pigs and Mosquitoes, Mexico [PDF - 1.07 MB - 4 pages]
D. Nunez-Avellaneda et al.

Evidence suggests that pigs seroconvert after experimental exposure to Zika virus and are potential sentinels. We demonstrate that pigs are also susceptible to natural Zika virus infection, shown by the presence of antibodies in domestic pigs in Yucatan, Mexico. Zika virus RNA was detected in 5 species of mosquitoes collected inside pigpens.

EID Nunez-Avellaneda D, Cetina-Trejo R, Zamudio-Moreno E, Baak-Baak C, Cigarroa-Toledo N, Reyes-Solis G, et al. Evidence of Zika Virus Infection in Pigs and Mosquitoes, Mexico. Emerg Infect Dis. 2021;27(2):574-577. https://dx.doi.org/10.3201/eid2702.201452
AMA Nunez-Avellaneda D, Cetina-Trejo R, Zamudio-Moreno E, et al. Evidence of Zika Virus Infection in Pigs and Mosquitoes, Mexico. Emerging Infectious Diseases. 2021;27(2):574-577. doi:10.3201/eid2702.201452.
APA Nunez-Avellaneda, D., Cetina-Trejo, R., Zamudio-Moreno, E., Baak-Baak, C., Cigarroa-Toledo, N., Reyes-Solis, G....Machain-Williams, C. (2021). Evidence of Zika Virus Infection in Pigs and Mosquitoes, Mexico. Emerging Infectious Diseases, 27(2), 574-577. https://dx.doi.org/10.3201/eid2702.201452.

Non-Norovirus Viral Gastroenteritis Outbreaks Reported to the National Outbreak Reporting System, USA, 2009–2018 [PDF - 547 KB - 5 pages]
C. P. Mattison et al.

During 2009–2018, four adenovirus, 10 astrovirus, 123 rotavirus, and 107 sapovirus gastroenteritis outbreaks were reported to the US National Outbreak Reporting System (annual median 30 outbreaks). Most were attributable to person-to-person transmission in long-term care facilities, daycares, and schools. Investigations of norovirus-negative gastroenteritis outbreaks should include testing for these viruses.

EID Mattison CP, Dunn M, Wikswo ME, Kambhampati A, Calderwood L, Balachandran N, et al. Non-Norovirus Viral Gastroenteritis Outbreaks Reported to the National Outbreak Reporting System, USA, 2009–2018. Emerg Infect Dis. 2021;27(2):560-564. https://dx.doi.org/10.3201/eid2702.203943
AMA Mattison CP, Dunn M, Wikswo ME, et al. Non-Norovirus Viral Gastroenteritis Outbreaks Reported to the National Outbreak Reporting System, USA, 2009–2018. Emerging Infectious Diseases. 2021;27(2):560-564. doi:10.3201/eid2702.203943.
APA Mattison, C. P., Dunn, M., Wikswo, M. E., Kambhampati, A., Calderwood, L., Balachandran, N....Hall, A. J. (2021). Non-Norovirus Viral Gastroenteritis Outbreaks Reported to the National Outbreak Reporting System, USA, 2009–2018. Emerging Infectious Diseases, 27(2), 560-564. https://dx.doi.org/10.3201/eid2702.203943.

Novel Arterivirus Associated with Outbreak of Fatal Encephalitis in European Hedgehogs, England, 2019 [PDF - 723 KB - 4 pages]
A. Dastjerdi et al.

In the fall of 2019, a fatal encephalitis outbreak led to the deaths of >200 European hedgehogs (Erinaceus europaeus) in England. We used next-generation sequencing to identify a novel arterivirus with a genome coding sequence of only 43% similarity to existing GenBank arterivirus sequences.

EID Dastjerdi A, Inglese N, Partridge T, Karuna S, Everest DJ, Frossard J, et al. Novel Arterivirus Associated with Outbreak of Fatal Encephalitis in European Hedgehogs, England, 2019. Emerg Infect Dis. 2021;27(2):578-581. https://dx.doi.org/10.3201/eid2702.201962
AMA Dastjerdi A, Inglese N, Partridge T, et al. Novel Arterivirus Associated with Outbreak of Fatal Encephalitis in European Hedgehogs, England, 2019. Emerging Infectious Diseases. 2021;27(2):578-581. doi:10.3201/eid2702.201962.
APA Dastjerdi, A., Inglese, N., Partridge, T., Karuna, S., Everest, D. J., Frossard, J....Stidworthy, M. F. (2021). Novel Arterivirus Associated with Outbreak of Fatal Encephalitis in European Hedgehogs, England, 2019. Emerging Infectious Diseases, 27(2), 578-581. https://dx.doi.org/10.3201/eid2702.201962.

Early Transmission Dynamics, Spread, and Genomic Characterization of SARS-CoV-2 in Panama [PDF - 1.22 MB - 4 pages]
D. Franco et al.

We report an epidemiologic analysis of 4,210 cases of infection with severe acute respiratory syndrome coronavirus 2 and genetic analysis of 313 new near-complete virus genomes in Panama during March 9–April 16, 2020. Although containment measures reduced R0 and Rt, they did not interrupt virus spread in the country.

EID Franco D, Gonzalez C, Abrego LE, Carrera J, Diaz Y, Caicedo Y, et al. Early Transmission Dynamics, Spread, and Genomic Characterization of SARS-CoV-2 in Panama. Emerg Infect Dis. 2021;27(2):612-615. https://dx.doi.org/10.3201/eid2702.203767
AMA Franco D, Gonzalez C, Abrego LE, et al. Early Transmission Dynamics, Spread, and Genomic Characterization of SARS-CoV-2 in Panama. Emerging Infectious Diseases. 2021;27(2):612-615. doi:10.3201/eid2702.203767.
APA Franco, D., Gonzalez, C., Abrego, L. E., Carrera, J., Diaz, Y., Caicedo, Y....Martinez, A. A. (2021). Early Transmission Dynamics, Spread, and Genomic Characterization of SARS-CoV-2 in Panama. Emerging Infectious Diseases, 27(2), 612-615. https://dx.doi.org/10.3201/eid2702.203767.

Plasmodium cynomolgi Co-infections among Symptomatic Malaria Patients, Thailand [PDF - 461 KB - 4 pages]
C. Putaporntip et al.

Among 1,180 symptomatic malaria patients, 9 (0.76%) infected with Plasmodium cynomolgi were co-infected with P. vivax (n = 7), P. falciparum (n = 1), or P. vivax and P. knowlesi (n = 1). Patients were from Tak, Chanthaburi, Ubon Ratchathani, Yala, and Narathiwat Provinces, suggesting P. cynomolgi is widespread in this country.

EID Putaporntip C, Kuamsab N, Pattanawong U, Yanmanee S, Seethamchai S, Jongwutiwes S. Plasmodium cynomolgi Co-infections among Symptomatic Malaria Patients, Thailand. Emerg Infect Dis. 2021;27(2):590-593. https://dx.doi.org/10.3201/eid2702.191660
AMA Putaporntip C, Kuamsab N, Pattanawong U, et al. Plasmodium cynomolgi Co-infections among Symptomatic Malaria Patients, Thailand. Emerging Infectious Diseases. 2021;27(2):590-593. doi:10.3201/eid2702.191660.
APA Putaporntip, C., Kuamsab, N., Pattanawong, U., Yanmanee, S., Seethamchai, S., & Jongwutiwes, S. (2021). Plasmodium cynomolgi Co-infections among Symptomatic Malaria Patients, Thailand. Emerging Infectious Diseases, 27(2), 590-593. https://dx.doi.org/10.3201/eid2702.191660.

SARS-CoV-2 Transmission between Mink (Neovison vison) and Humans, Denmark [PDF - 1.15 MB - 5 pages]
A. Hammer et al.

Severe acute respiratory syndrome coronavirus 2 has caused a pandemic in humans. Farmed mink (Neovison vison) are also susceptible. In Denmark, this virus has spread rapidly among farmed mink, resulting in some respiratory disease. Full-length virus genome sequencing revealed novel virus variants in mink. These variants subsequently appeared within the local human community.

EID Hammer A, Quaade M, Rasmussen T, Fonager J, Rasmussen M, Mundbjerg K, et al. SARS-CoV-2 Transmission between Mink (Neovison vison) and Humans, Denmark. Emerg Infect Dis. 2021;27(2):547-551. https://dx.doi.org/10.3201/eid2702.203794
AMA Hammer A, Quaade M, Rasmussen T, et al. SARS-CoV-2 Transmission between Mink (Neovison vison) and Humans, Denmark. Emerging Infectious Diseases. 2021;27(2):547-551. doi:10.3201/eid2702.203794.
APA Hammer, A., Quaade, M., Rasmussen, T., Fonager, J., Rasmussen, M., Mundbjerg, K....Bøtner, A. (2021). SARS-CoV-2 Transmission between Mink (Neovison vison) and Humans, Denmark. Emerging Infectious Diseases, 27(2), 547-551. https://dx.doi.org/10.3201/eid2702.203794.

Estimating Transmission Parameters for COVID-19 Clusters by Using Symptom Onset Data, Singapore, January–April 2020 [PDF - 511 KB - 4 pages]
S. Ng et al.

We estimated the generation interval distribution for coronavirus disease on the basis of serial intervals of observed infector–infectee pairs from established clusters in Singapore. The short mean generation interval and consequent high prevalence of presymptomatic transmission requires public health control measures to be responsive to these characteristics of the epidemic.

EID Ng S, Kaur P, Kremer C, Tan W, Tan A, Hens N, et al. Estimating Transmission Parameters for COVID-19 Clusters by Using Symptom Onset Data, Singapore, January–April 2020. Emerg Infect Dis. 2021;27(2):582-585. https://dx.doi.org/10.3201/eid2702.203018
AMA Ng S, Kaur P, Kremer C, et al. Estimating Transmission Parameters for COVID-19 Clusters by Using Symptom Onset Data, Singapore, January–April 2020. Emerging Infectious Diseases. 2021;27(2):582-585. doi:10.3201/eid2702.203018.
APA Ng, S., Kaur, P., Kremer, C., Tan, W., Tan, A., Hens, N....Kannapiran, P. (2021). Estimating Transmission Parameters for COVID-19 Clusters by Using Symptom Onset Data, Singapore, January–April 2020. Emerging Infectious Diseases, 27(2), 582-585. https://dx.doi.org/10.3201/eid2702.203018.

Population-Based Serosurvey for Severe Acute Respiratory Syndrome Coronavirus 2 Transmission, Chennai, India [PDF - 623 KB - 4 pages]
S. Selvaraju et al.

We conducted a cross-sectional survey to estimate the seroprevalence of IgG against severe acute respiratory syndrome coronavirus 2 in Chennai, India. Among 12,405 serum samples tested, weighted seroprevalence was 18.4% (95% CI 14.8%–22.6%). These findings indicate most of the population of Chennai is still susceptible to this virus.

EID Selvaraju S, Kumar M, Thangaraj J, Bhatnagar T, Saravanakumar V, Kumar C, et al. Population-Based Serosurvey for Severe Acute Respiratory Syndrome Coronavirus 2 Transmission, Chennai, India. Emerg Infect Dis. 2021;27(2):586-589. https://dx.doi.org/10.3201/eid2702.203938
AMA Selvaraju S, Kumar M, Thangaraj J, et al. Population-Based Serosurvey for Severe Acute Respiratory Syndrome Coronavirus 2 Transmission, Chennai, India. Emerging Infectious Diseases. 2021;27(2):586-589. doi:10.3201/eid2702.203938.
APA Selvaraju, S., Kumar, M., Thangaraj, J., Bhatnagar, T., Saravanakumar, V., Kumar, C....Murhekar, M. (2021). Population-Based Serosurvey for Severe Acute Respiratory Syndrome Coronavirus 2 Transmission, Chennai, India. Emerging Infectious Diseases, 27(2), 586-589. https://dx.doi.org/10.3201/eid2702.203938.

Borrelia burgdorferi Sensu Stricto DNA in Field-Collected Haemaphysalis longicornis Ticks, Pennsylvania, United States [PDF - 483 KB - 4 pages]
K. J. Price et al.

We collected questing Haemaphysalis longicornis ticks from southeastern counties of Pennsylvania, USA. Of 263 ticks tested by PCR for pathogens, 1 adult female was positive for Borrelia burgdorferi sensu stricto, yielding a 0.4% infection rate. Continued monitoring of this invasive tick is essential to determine its public health role.

EID Price KJ, Graham CB, Witmier BJ, Chapman HA, Coder BL, Boyer CN, et al. Borrelia burgdorferi Sensu Stricto DNA in Field-Collected Haemaphysalis longicornis Ticks, Pennsylvania, United States. Emerg Infect Dis. 2021;27(2):608-611. https://dx.doi.org/10.3201/eid2702.201552
AMA Price KJ, Graham CB, Witmier BJ, et al. Borrelia burgdorferi Sensu Stricto DNA in Field-Collected Haemaphysalis longicornis Ticks, Pennsylvania, United States. Emerging Infectious Diseases. 2021;27(2):608-611. doi:10.3201/eid2702.201552.
APA Price, K. J., Graham, C. B., Witmier, B. J., Chapman, H. A., Coder, B. L., Boyer, C. N....Kyle, A. D. (2021). Borrelia burgdorferi Sensu Stricto DNA in Field-Collected Haemaphysalis longicornis Ticks, Pennsylvania, United States. Emerging Infectious Diseases, 27(2), 608-611. https://dx.doi.org/10.3201/eid2702.201552.

Strand-Specific Reverse Transcription PCR for Detection of Replicating SARS-CoV-2 [PDF - 1.77 MB - 4 pages]
C. A. Hogan et al.

We developed an assay that detects minus-strand RNA as a surrogate for actively replicating severe acute respiratory syndrome coronavirus 2. We detected minus-strand RNA in 41 persons with coronavirus disease up to 30 days after symptom onset. This assay might inform clinical decision-making about patient infectiousness.

EID Hogan CA, Huang C, Sahoo MK, Wang H, Jiang B, Sibai M, et al. Strand-Specific Reverse Transcription PCR for Detection of Replicating SARS-CoV-2. Emerg Infect Dis. 2021;27(2):632-635. https://dx.doi.org/10.3201/eid2702.204168
AMA Hogan CA, Huang C, Sahoo MK, et al. Strand-Specific Reverse Transcription PCR for Detection of Replicating SARS-CoV-2. Emerging Infectious Diseases. 2021;27(2):632-635. doi:10.3201/eid2702.204168.
APA Hogan, C. A., Huang, C., Sahoo, M. K., Wang, H., Jiang, B., Sibai, M....Pinsky, B. A. (2021). Strand-Specific Reverse Transcription PCR for Detection of Replicating SARS-CoV-2. Emerging Infectious Diseases, 27(2), 632-635. https://dx.doi.org/10.3201/eid2702.204168.

Vaccine-Derived Polioviruses, Central African Republic, 2019 [PDF - 1.70 MB - 4 pages]
M. Joffret et al.

Since May 2019, the Central African Republic has experienced a poliomyelitis outbreak caused by type 2 vaccine-derived polioviruses (VDPV-2s). The outbreak affected Bangui, the capital city, and 10 districts across the country. The outbreak resulted from several independent emergence events of VDPV-2s featuring recombinant genomes with complex mosaic genomes. The low number of mutations (<20) in the viral capsid protein 1–encoding region compared with the vaccine strain suggests that VDPV-2 had been circulating for a relatively short time (probably <3 years) before being isolated. Environmental surveillance, which relies on a limited number of sampling sites in the Central African Republic and does not cover the whole country, failed to detect the circulation of VDPV-2s before some had induced poliomyelitis in children.

EID Joffret M, Doté J, Gumede N, Vignuzzi M, Bessaud M, Gouandjika-Vasilache I. Vaccine-Derived Polioviruses, Central African Republic, 2019. Emerg Infect Dis. 2021;27(2):620-623. https://dx.doi.org/10.3201/eid2702.203173
AMA Joffret M, Doté J, Gumede N, et al. Vaccine-Derived Polioviruses, Central African Republic, 2019. Emerging Infectious Diseases. 2021;27(2):620-623. doi:10.3201/eid2702.203173.
APA Joffret, M., Doté, J., Gumede, N., Vignuzzi, M., Bessaud, M., & Gouandjika-Vasilache, I. (2021). Vaccine-Derived Polioviruses, Central African Republic, 2019. Emerging Infectious Diseases, 27(2), 620-623. https://dx.doi.org/10.3201/eid2702.203173.

COVID-19 and Fatal Sepsis Caused by Hypervirulent Klebsiella pneumoniae, Japan, 2020 [PDF - 1.76 MB - 4 pages]
T. Hosoda et al.

A patient in Japan with coronavirus disease and hypervirulent Klebsiella pneumoniae K2 sequence type 86 infection died of respiratory failure. Bacterial and fungal co-infections caused by region-endemic pathogens, including hypervirulent K. pneumoniae in eastern Asia, should be included in the differential diagnosis of coronavirus disease patients with acutely deteriorating condition.

EID Hosoda T, Harada S, Okamoto K, Ishino S, Kaneko M, Suzuki M, et al. COVID-19 and Fatal Sepsis Caused by Hypervirulent Klebsiella pneumoniae, Japan, 2020. Emerg Infect Dis. 2021;27(2):556-559. https://dx.doi.org/10.3201/eid2702.204662
AMA Hosoda T, Harada S, Okamoto K, et al. COVID-19 and Fatal Sepsis Caused by Hypervirulent Klebsiella pneumoniae, Japan, 2020. Emerging Infectious Diseases. 2021;27(2):556-559. doi:10.3201/eid2702.204662.
APA Hosoda, T., Harada, S., Okamoto, K., Ishino, S., Kaneko, M., Suzuki, M....Mizoguchi, M. (2021). COVID-19 and Fatal Sepsis Caused by Hypervirulent Klebsiella pneumoniae, Japan, 2020. Emerging Infectious Diseases, 27(2), 556-559. https://dx.doi.org/10.3201/eid2702.204662.

SARS-CoV-2 Infections among Recent Organ Recipients, March–May 2020, United States [PDF - 739 KB - 4 pages]
J. M. Jones et al.

We conducted public health investigations of 8 organ transplant recipients who tested positive for severe acute respiratory syndrome coronavirus 2 infection. Findings suggest the most likely source of transmission was community or healthcare exposure, not the organ donor. Transplant centers should educate transplant candidates and recipients about infection prevention recommendations.

EID Jones JM, Kracalik I, Rana MM, Nguyen A, Keller BC, Mishkin A, et al. SARS-CoV-2 Infections among Recent Organ Recipients, March–May 2020, United States. Emerg Infect Dis. 2021;27(2):552-555. https://dx.doi.org/10.3201/eid2702.204046
AMA Jones JM, Kracalik I, Rana MM, et al. SARS-CoV-2 Infections among Recent Organ Recipients, March–May 2020, United States. Emerging Infectious Diseases. 2021;27(2):552-555. doi:10.3201/eid2702.204046.
APA Jones, J. M., Kracalik, I., Rana, M. M., Nguyen, A., Keller, B. C., Mishkin, A....Basavaraju, S. V. (2021). SARS-CoV-2 Infections among Recent Organ Recipients, March–May 2020, United States. Emerging Infectious Diseases, 27(2), 552-555. https://dx.doi.org/10.3201/eid2702.204046.

Shuni Virus in Cases of Neurologic Disease in Humans, South Africa [PDF - 635 KB - 5 pages]
T. P. Motlou and M. Venter

We describe Shuni virus (SHUV) detection in human neurologic disease cases in South Africa. SHUV RNA was identified in 5% of cerebrospinal fluid specimens collected during the arbovirus season from public sector hospitals. This finding suggests that SHUV may be a previously unrecognized cause of human neurologic infections in Africa.

EID Motlou TP, Venter M. Shuni Virus in Cases of Neurologic Disease in Humans, South Africa. Emerg Infect Dis. 2021;27(2):565-569. https://dx.doi.org/10.3201/eid2702.191551
AMA Motlou TP, Venter M. Shuni Virus in Cases of Neurologic Disease in Humans, South Africa. Emerging Infectious Diseases. 2021;27(2):565-569. doi:10.3201/eid2702.191551.
APA Motlou, T. P., & Venter, M. (2021). Shuni Virus in Cases of Neurologic Disease in Humans, South Africa. Emerging Infectious Diseases, 27(2), 565-569. https://dx.doi.org/10.3201/eid2702.191551.

Combined Epidemiologic and Entomologic Survey to Detect Urban Malaria Transmission, Guinea, 2018 [PDF - 1.03 MB - 4 pages]
D. Sayre et al.

Malaria incidence is generally lower in cities than rural areas. However, reported urban malaria incidence may not accurately reflect the level of ongoing transmission, which has potentially large implications for prevention efforts. To guide mosquito net distribution, we assessed the extent of malaria transmission in Conakry, Guinea, in 2018. We found evidence of active malaria transmission.

EID Sayre D, Camara A, Barry Y, Deen T, Camara D, Dioubaté M, et al. Combined Epidemiologic and Entomologic Survey to Detect Urban Malaria Transmission, Guinea, 2018. Emerg Infect Dis. 2021;27(2):599-602. https://dx.doi.org/10.3201/eid2702.191701
AMA Sayre D, Camara A, Barry Y, et al. Combined Epidemiologic and Entomologic Survey to Detect Urban Malaria Transmission, Guinea, 2018. Emerging Infectious Diseases. 2021;27(2):599-602. doi:10.3201/eid2702.191701.
APA Sayre, D., Camara, A., Barry, Y., Deen, T., Camara, D., Dioubaté, M....Plucinski, M. (2021). Combined Epidemiologic and Entomologic Survey to Detect Urban Malaria Transmission, Guinea, 2018. Emerging Infectious Diseases, 27(2), 599-602. https://dx.doi.org/10.3201/eid2702.191701.

Human Tacheng Tick Virus 2 Infection, China, 2019 [PDF - 1.72 MB - 5 pages]
Z. Dong et al.

We used metagenomic analysis to identify Tacheng tick virus 2 infection in a patient with a history of tick bite in northwestern China. We confirmed the virus with reverse transcription-PCR, virus isolation, and genomic analysis. We detected viral RNA in 9.6% of ticks collected from the same region.

EID Dong Z, Yang M, Wang Z, Zhao S, Xie S, Yang Y, et al. Human Tacheng Tick Virus 2 Infection, China, 2019. Emerg Infect Dis. 2021;27(2):594-598. https://dx.doi.org/10.3201/eid2702.191486
AMA Dong Z, Yang M, Wang Z, et al. Human Tacheng Tick Virus 2 Infection, China, 2019. Emerging Infectious Diseases. 2021;27(2):594-598. doi:10.3201/eid2702.191486.
APA Dong, Z., Yang, M., Wang, Z., Zhao, S., Xie, S., Yang, Y....Wang, Y. (2021). Human Tacheng Tick Virus 2 Infection, China, 2019. Emerging Infectious Diseases, 27(2), 594-598. https://dx.doi.org/10.3201/eid2702.191486.

Estimating the Frequency of Lyme Disease Diagnoses, United States, 2010–2018 [PDF - 650 KB - 4 pages]
K. J. Kugeler et al.

By using commercial insurance claims data, we estimated that Lyme disease was diagnosed and treated in ≈476,000 patients in the United States annually during 2010–2018. Our results underscore the need for accurate diagnosis and improved prevention.

EID Kugeler KJ, Schwartz AM, Delorey MJ, Mead PS, Hinckley AF. Estimating the Frequency of Lyme Disease Diagnoses, United States, 2010–2018. Emerg Infect Dis. 2021;27(2):616-619. https://dx.doi.org/10.3201/eid2702.202731
AMA Kugeler KJ, Schwartz AM, Delorey MJ, et al. Estimating the Frequency of Lyme Disease Diagnoses, United States, 2010–2018. Emerging Infectious Diseases. 2021;27(2):616-619. doi:10.3201/eid2702.202731.
APA Kugeler, K. J., Schwartz, A. M., Delorey, M. J., Mead, P. S., & Hinckley, A. F. (2021). Estimating the Frequency of Lyme Disease Diagnoses, United States, 2010–2018. Emerging Infectious Diseases, 27(2), 616-619. https://dx.doi.org/10.3201/eid2702.202731.

Prevalence of SARS-CoV-2–Specific Antibodies, Japan, June 2020 [PDF - 432 KB - 4 pages]
T. Yoshiyama et al.

We used 2 commercially available antibody tests to estimate seroprevalence of severe acute respiratory syndrome coronavirus 2 infection in Japan during June 2020. Of 7,950 samples, 8 were positive by both assays. Using 2 reliable antibody tests in conjunction is an effective method for estimating seroprevalence in low prevalence settings.

EID Yoshiyama T, Saito Y, Masuda K, Nakanishi Y, Kido Y, Uchimura K, et al. Prevalence of SARS-CoV-2–Specific Antibodies, Japan, June 2020. Emerg Infect Dis. 2021;27(2):628-631. https://dx.doi.org/10.3201/eid2702.204088
AMA Yoshiyama T, Saito Y, Masuda K, et al. Prevalence of SARS-CoV-2–Specific Antibodies, Japan, June 2020. Emerging Infectious Diseases. 2021;27(2):628-631. doi:10.3201/eid2702.204088.
APA Yoshiyama, T., Saito, Y., Masuda, K., Nakanishi, Y., Kido, Y., Uchimura, K....Kato, K. (2021). Prevalence of SARS-CoV-2–Specific Antibodies, Japan, June 2020. Emerging Infectious Diseases, 27(2), 628-631. https://dx.doi.org/10.3201/eid2702.204088.

Anopheles stephensi Mosquitoes as Vectors of Plasmodium vivax and falciparum, Horn of Africa, 2019 [PDF - 771 KB - 5 pages]
F. G. Tadesse et al.

Anopheles stephensi mosquitoes, efficient vectors in parts of Asia and Africa, were found in 75.3% of water sources surveyed and contributed to 80.9% of wild-caught Anopheles mosquitoes in Awash Sebat Kilo, Ethiopia. High susceptibility of these mosquitoes to Plasmodium falciparum and vivax infection presents a challenge for malaria control in the Horn of Africa.

EID Tadesse FG, Ashine T, Teka H, Esayas E, Messenger LA, Chali W, et al. Anopheles stephensi Mosquitoes as Vectors of Plasmodium vivax and falciparum, Horn of Africa, 2019. Emerg Infect Dis. 2021;27(2):603-607. https://dx.doi.org/10.3201/eid2702.200019
AMA Tadesse FG, Ashine T, Teka H, et al. Anopheles stephensi Mosquitoes as Vectors of Plasmodium vivax and falciparum, Horn of Africa, 2019. Emerging Infectious Diseases. 2021;27(2):603-607. doi:10.3201/eid2702.200019.
APA Tadesse, F. G., Ashine, T., Teka, H., Esayas, E., Messenger, L. A., Chali, W....Bousema, T. (2021). Anopheles stephensi Mosquitoes as Vectors of Plasmodium vivax and falciparum, Horn of Africa, 2019. Emerging Infectious Diseases, 27(2), 603-607. https://dx.doi.org/10.3201/eid2702.200019.
Research Letters

Potential Association between Zika Infection and Microcephaly during 2007 Fever Outbreak, Gabon [PDF - 702 KB - 3 pages]
C. Koumavor et al.

Although Zika virus (ZIKV) circulates in sub-Saharan Africa, no case of ZIKV-associated microcephaly has thus far been reported. Here, we report evidence of a possible association between a 2007 outbreak of febrile illness and an increase in microcephaly and possibly ZIKV infection in Gabon.

EID Koumavor C, Elguero E, Leroy EM. Potential Association between Zika Infection and Microcephaly during 2007 Fever Outbreak, Gabon. Emerg Infect Dis. 2021;27(2):672-674. https://dx.doi.org/10.3201/eid2702.202987
AMA Koumavor C, Elguero E, Leroy EM. Potential Association between Zika Infection and Microcephaly during 2007 Fever Outbreak, Gabon. Emerging Infectious Diseases. 2021;27(2):672-674. doi:10.3201/eid2702.202987.
APA Koumavor, C., Elguero, E., & Leroy, E. M. (2021). Potential Association between Zika Infection and Microcephaly during 2007 Fever Outbreak, Gabon. Emerging Infectious Diseases, 27(2), 672-674. https://dx.doi.org/10.3201/eid2702.202987.

Seroprevalence of SARS-CoV-2 in Guilan Province, Iran, April 2020 [PDF - 272 KB - 3 pages]
M. Shakiba et al.

We determined the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in an affected area in northern Iran in April 2020. Antibodies to SARS-CoV-2 were detected in 528 persons by using rapid tests. Adjusted prevalence of SARS-CoV-2 seropositivity was 22.2% (95% CI 16.4%–28.5%).

EID Shakiba M, Nazemipour M, Salari A, Mehrabian F, Nazari SH, Rezvani S, et al. Seroprevalence of SARS-CoV-2 in Guilan Province, Iran, April 2020. Emerg Infect Dis. 2021;27(2):636-638. https://dx.doi.org/10.3201/eid2702.201960
AMA Shakiba M, Nazemipour M, Salari A, et al. Seroprevalence of SARS-CoV-2 in Guilan Province, Iran, April 2020. Emerging Infectious Diseases. 2021;27(2):636-638. doi:10.3201/eid2702.201960.
APA Shakiba, M., Nazemipour, M., Salari, A., Mehrabian, F., Nazari, S. H., Rezvani, S....Mansournia, M. (2021). Seroprevalence of SARS-CoV-2 in Guilan Province, Iran, April 2020. Emerging Infectious Diseases, 27(2), 636-638. https://dx.doi.org/10.3201/eid2702.201960.

COVID-19–Related Misinformation among Parents of Patients with Pediatric Cancer [PDF - 779 KB - 3 pages]
J. Guidry et al.

We conducted a survey among 735 parents to determine differences in endorsement of misinformation related to the coronavirus disease pandemic between parents of children in cancer treatment and those with children who had no cancer history. Parents of children with cancer were more likely to believe misinformation than parents of children without cancer.

EID Guidry J, Miller CA, Ksinan AJ, Rohan JM, Winter MA, Carlyle KE, et al. COVID-19–Related Misinformation among Parents of Patients with Pediatric Cancer. Emerg Infect Dis. 2021;27(2):650-652. https://dx.doi.org/10.3201/eid2702.203285
AMA Guidry J, Miller CA, Ksinan AJ, et al. COVID-19–Related Misinformation among Parents of Patients with Pediatric Cancer. Emerging Infectious Diseases. 2021;27(2):650-652. doi:10.3201/eid2702.203285.
APA Guidry, J., Miller, C. A., Ksinan, A. J., Rohan, J. M., Winter, M. A., Carlyle, K. E....Fuemmeler, B. F. (2021). COVID-19–Related Misinformation among Parents of Patients with Pediatric Cancer. Emerging Infectious Diseases, 27(2), 650-652. https://dx.doi.org/10.3201/eid2702.203285.

Intrauterine Transmission of SARS-CoV-2 [PDF - 963 KB - 4 pages]
E. S. Stonoga et al.

We documented fetal death associated with intrauterine transmission of severe acute respiratory syndrome coronavirus 2. We found chronic histiocytic intervillositis, maternal and fetal vascular malperfusion, microglial hyperplasia, and lymphocytic infiltrate in muscle in the placenta and fetal tissue. Placenta and umbilical cord blood tested positive for the virus by PCR, confirming transplacental transmission.

EID Stonoga ES, de Almeida Lanzoni L, Rebutini P, Permegiani de Oliveira A, Chiste J, Fugaça C, et al. Intrauterine Transmission of SARS-CoV-2. Emerg Infect Dis. 2021;27(2):638-641. https://dx.doi.org/10.3201/eid2702.203824
AMA Stonoga ES, de Almeida Lanzoni L, Rebutini P, et al. Intrauterine Transmission of SARS-CoV-2. Emerging Infectious Diseases. 2021;27(2):638-641. doi:10.3201/eid2702.203824.
APA Stonoga, E. S., de Almeida Lanzoni, L., Rebutini, P., Permegiani de Oliveira, A., Chiste, J., Fugaça, C....Raboni, S. (2021). Intrauterine Transmission of SARS-CoV-2. Emerging Infectious Diseases, 27(2), 638-641. https://dx.doi.org/10.3201/eid2702.203824.

Protective Immunity and Persistent Lung Sequelae in Domestic Cats after SARS-CoV-2 Infection [PDF - 1.51 MB - 4 pages]
S. Chiba et al.

Severe acute respiratory syndrome coronavirus 2 readily transmits between domestic cats. We found that domestic cats that recover from an initial infection might be protected from reinfection. However, we found long-term persistence of inflammation and other lung lesions after infection, despite a lack of clinical symptoms and limited viral replication in the lungs.

EID Chiba S, Halfmann PJ, Hatta M, Maemura T, Fan S, Armbrust T, et al. Protective Immunity and Persistent Lung Sequelae in Domestic Cats after SARS-CoV-2 Infection. Emerg Infect Dis. 2021;27(2):660-663. https://dx.doi.org/10.3201/eid2702.203884
AMA Chiba S, Halfmann PJ, Hatta M, et al. Protective Immunity and Persistent Lung Sequelae in Domestic Cats after SARS-CoV-2 Infection. Emerging Infectious Diseases. 2021;27(2):660-663. doi:10.3201/eid2702.203884.
APA Chiba, S., Halfmann, P. J., Hatta, M., Maemura, T., Fan, S., Armbrust, T....Kawaoka, Y. (2021). Protective Immunity and Persistent Lung Sequelae in Domestic Cats after SARS-CoV-2 Infection. Emerging Infectious Diseases, 27(2), 660-663. https://dx.doi.org/10.3201/eid2702.203884.

Puumala Virus Infection in Family, Switzerland [PDF - 485 KB - 3 pages]
P. Vetter et al.

We report 3 cases of Puumala virus infection in a family in Switzerland in January 2019. Clinical manifestations of the infection ranged from mild influenza-like illness to fatal disease. This cluster illustrates the wide range of clinical manifestations of Old World hantavirus infections and the challenge of diagnosing travel-related hemorrhagic fevers.

EID Vetter P, L’Huillier AG, Montalbano MF, Pigny F, Eckerle I, Torriani G, et al. Puumala Virus Infection in Family, Switzerland. Emerg Infect Dis. 2021;27(2):658-660. https://dx.doi.org/10.3201/eid2702.203770
AMA Vetter P, L’Huillier AG, Montalbano MF, et al. Puumala Virus Infection in Family, Switzerland. Emerging Infectious Diseases. 2021;27(2):658-660. doi:10.3201/eid2702.203770.
APA Vetter, P., L’Huillier, A. G., Montalbano, M. F., Pigny, F., Eckerle, I., Torriani, G....Schibler, M. (2021). Puumala Virus Infection in Family, Switzerland. Emerging Infectious Diseases, 27(2), 658-660. https://dx.doi.org/10.3201/eid2702.203770.

Long-Term Humoral Immune Response in Persons with Asymptomatic or Mild SARS-CoV-2 Infection, Vietnam [PDF - 543 KB - 4 pages]
H. Mai et al.

Antibody response against nucleocapsid and spike proteins of SARS-CoV-2 in 11 persons with mild or asymptomatic infection rapidly increased after infection. At weeks 18–30 after diagnosis, all remained seropositive but spike protein–targeting antibody titers declined. These data may be useful for vaccine development.

EID Mai H, Trieu N, Long T, Thanh H, Luong N, Huy L, et al. Long-Term Humoral Immune Response in Persons with Asymptomatic or Mild SARS-CoV-2 Infection, Vietnam. Emerg Infect Dis. 2021;27(2):663-666. https://dx.doi.org/10.3201/eid2702.204226
AMA Mai H, Trieu N, Long T, et al. Long-Term Humoral Immune Response in Persons with Asymptomatic or Mild SARS-CoV-2 Infection, Vietnam. Emerging Infectious Diseases. 2021;27(2):663-666. doi:10.3201/eid2702.204226.
APA Mai, H., Trieu, N., Long, T., Thanh, H., Luong, N., Huy, L....Hung, D. (2021). Long-Term Humoral Immune Response in Persons with Asymptomatic or Mild SARS-CoV-2 Infection, Vietnam. Emerging Infectious Diseases, 27(2), 663-666. https://dx.doi.org/10.3201/eid2702.204226.

Genomic Diversity of Burkholderia pseudomallei Isolates, Colombia [PDF - 551 KB - 4 pages]
C. Duarte et al.

We report an analysis of the genomic diversity of isolates of Burkholderia pseudomallei, the cause of melioidosis, recovered in Colombia from routine surveillance during 2016–2017. B. pseudomallei appears genetically diverse, suggesting it is well established and has spread across the region.

EID Duarte C, Montufar F, Moreno J, Sánchez D, Rodríguez J, Torres AG, et al. Genomic Diversity of Burkholderia pseudomallei Isolates, Colombia. Emerg Infect Dis. 2021;27(2):655-658. https://dx.doi.org/10.3201/eid2702.202824
AMA Duarte C, Montufar F, Moreno J, et al. Genomic Diversity of Burkholderia pseudomallei Isolates, Colombia. Emerging Infectious Diseases. 2021;27(2):655-658. doi:10.3201/eid2702.202824.
APA Duarte, C., Montufar, F., Moreno, J., Sánchez, D., Rodríguez, J., Torres, A. G....Gee, J. E. (2021). Genomic Diversity of Burkholderia pseudomallei Isolates, Colombia. Emerging Infectious Diseases, 27(2), 655-658. https://dx.doi.org/10.3201/eid2702.202824.

COVID-19 Infection Control Measures in Long-Term Care Facility, Pennsylvania, USA [PDF - 225 KB - 2 pages]
S. T. Shimotsu et al.

Residents of long-term care facilities are at risk for coronavirus disease. We report a surveillance exercise at such a facility in Pennsylvania, USA. After introduction of a testing strategy and other measures, this facility had a 17-fold lower coronavirus disease case rate than neighboring facilities.

EID Shimotsu ST, Johnson A, Berke EM, Griffin DO. COVID-19 Infection Control Measures in Long-Term Care Facility, Pennsylvania, USA. Emerg Infect Dis. 2021;27(2):644-645. https://dx.doi.org/10.3201/eid2702.204265
AMA Shimotsu ST, Johnson A, Berke EM, et al. COVID-19 Infection Control Measures in Long-Term Care Facility, Pennsylvania, USA. Emerging Infectious Diseases. 2021;27(2):644-645. doi:10.3201/eid2702.204265.
APA Shimotsu, S. T., Johnson, A., Berke, E. M., & Griffin, D. O. (2021). COVID-19 Infection Control Measures in Long-Term Care Facility, Pennsylvania, USA. Emerging Infectious Diseases, 27(2), 644-645. https://dx.doi.org/10.3201/eid2702.204265.

Severe Acute Respiratory Syndrome Coronavirus 2 Outbreak Related to a Nightclub, Germany, 2020 [PDF - 572 KB - 4 pages]
N. Muller et al.

We report an outbreak of coronavirus disease with 74 cases related to a nightclub in Germany in March 2020. Staff members were particularly affected (attack rate 56%) and likely caused sustained viral transmission after an event at the club. This outbreak illustrates the potential for superspreader events and corroborates current club closures.

EID Muller N, Kunze M, Steitz F, Saad NJ, Mühlemann B, Beheim-Schwarzbach JI, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Outbreak Related to a Nightclub, Germany, 2020. Emerg Infect Dis. 2021;27(2):645-648. https://dx.doi.org/10.3201/eid2702.204443
AMA Muller N, Kunze M, Steitz F, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Outbreak Related to a Nightclub, Germany, 2020. Emerging Infectious Diseases. 2021;27(2):645-648. doi:10.3201/eid2702.204443.
APA Muller, N., Kunze, M., Steitz, F., Saad, N. J., Mühlemann, B., Beheim-Schwarzbach, J. I....Corman, V. M. (2021). Severe Acute Respiratory Syndrome Coronavirus 2 Outbreak Related to a Nightclub, Germany, 2020. Emerging Infectious Diseases, 27(2), 645-648. https://dx.doi.org/10.3201/eid2702.204443.

COVID-19 and Infant Hospitalizations for Seasonal Respiratory Virus Infections, New Zealand, 2020 [PDF - 434 KB - 3 pages]
A. Trenholme et al.

In March 2020, a national elimination strategy for coronavirus disease was introduced in New Zealand. Since then, hospitalizations for lower respiratory tract infection among infants <2 years of age and cases of respiratory syncytial or influenza virus infection have dramatically decreased. These findings indicate additional benefits of coronavirus disease control strategies.

EID Trenholme A, Webb R, Lawrence S, Arrol S, Taylor S, Ameratunga S, et al. COVID-19 and Infant Hospitalizations for Seasonal Respiratory Virus Infections, New Zealand, 2020. Emerg Infect Dis. 2021;27(2):641-643. https://dx.doi.org/10.3201/eid2702.204041
AMA Trenholme A, Webb R, Lawrence S, et al. COVID-19 and Infant Hospitalizations for Seasonal Respiratory Virus Infections, New Zealand, 2020. Emerging Infectious Diseases. 2021;27(2):641-643. doi:10.3201/eid2702.204041.
APA Trenholme, A., Webb, R., Lawrence, S., Arrol, S., Taylor, S., Ameratunga, S....Byrnes, C. A. (2021). COVID-19 and Infant Hospitalizations for Seasonal Respiratory Virus Infections, New Zealand, 2020. Emerging Infectious Diseases, 27(2), 641-643. https://dx.doi.org/10.3201/eid2702.204041.

Evidence of SARS-CoV-2 RNA in an Oropharyngeal Swab Specimen, Milan, Italy, Early December 2019 [PDF - 233 KB - 3 pages]
A. Amendola et al.

We identified severe acute respiratory syndrome coronavirus 2 RNA in an oropharyngeal swab specimen collected from a child with suspected measles in early December 2019, ≈3 months before the first identified coronavirus disease case in Italy. This finding expands our knowledge on timing and mapping of novel coronavirus transmission pathways.

EID Amendola A, Bianchi S, Gori M, Colzani D, Canuti M, Borghi E, et al. Evidence of SARS-CoV-2 RNA in an Oropharyngeal Swab Specimen, Milan, Italy, Early December 2019. Emerg Infect Dis. 2021;27(2):648-650. https://dx.doi.org/10.3201/eid2702.204632
AMA Amendola A, Bianchi S, Gori M, et al. Evidence of SARS-CoV-2 RNA in an Oropharyngeal Swab Specimen, Milan, Italy, Early December 2019. Emerging Infectious Diseases. 2021;27(2):648-650. doi:10.3201/eid2702.204632.
APA Amendola, A., Bianchi, S., Gori, M., Colzani, D., Canuti, M., Borghi, E....Tanzi, E. (2021). Evidence of SARS-CoV-2 RNA in an Oropharyngeal Swab Specimen, Milan, Italy, Early December 2019. Emerging Infectious Diseases, 27(2), 648-650. https://dx.doi.org/10.3201/eid2702.204632.

SARS-CoV-2 Infection and Mitigation Efforts among Office Workers, Washington, DC, USA [PDF - 580 KB - 4 pages]
S. Sami et al.

Despite mitigation efforts, 2 coronavirus disease outbreaks were identified among office workers in Washington, DC. Moderate adherence to workplace mitigation efforts was reported in a serologic survey; activities outside of the workplace were associated with infection. Adherence to safety measures are critical for returning to work during the pandemic.

EID Sami S, Vuong N, Miller H, Priestley R, Payne M, Licata-Portentoso G, et al. SARS-CoV-2 Infection and Mitigation Efforts among Office Workers, Washington, DC, USA. Emerg Infect Dis. 2021;27(2):669-672. https://dx.doi.org/10.3201/eid2702.204529
AMA Sami S, Vuong N, Miller H, et al. SARS-CoV-2 Infection and Mitigation Efforts among Office Workers, Washington, DC, USA. Emerging Infectious Diseases. 2021;27(2):669-672. doi:10.3201/eid2702.204529.
APA Sami, S., Vuong, N., Miller, H., Priestley, R., Payne, M., Licata-Portentoso, G....Petersen, L. R. (2021). SARS-CoV-2 Infection and Mitigation Efforts among Office Workers, Washington, DC, USA. Emerging Infectious Diseases, 27(2), 669-672. https://dx.doi.org/10.3201/eid2702.204529.

Prevalence and Time Trend of SARS-CoV-2 Infection in Puducherry, India, August–October 2020 [PDF - 572 KB - 4 pages]
S. Kar et al.

We conducted 3 population-based cross-sectional surveys, at 1-month intervals, to estimate the prevalence and time-trend of severe acute respiratory syndrome coronavirus 2 infection in Puducherry, India. Seropositivity rate increased from 4.9% to 34.5% over 2 months and was 20-fold higher than the number of diagnosed cases of infection.

EID Kar S, Sarkar S, Murali S, Dhodapkar R, Joseph N, Aggarwal R. Prevalence and Time Trend of SARS-CoV-2 Infection in Puducherry, India, August–October 2020. Emerg Infect Dis. 2021;27(2):666-669. https://dx.doi.org/10.3201/eid2702.204480
AMA Kar S, Sarkar S, Murali S, et al. Prevalence and Time Trend of SARS-CoV-2 Infection in Puducherry, India, August–October 2020. Emerging Infectious Diseases. 2021;27(2):666-669. doi:10.3201/eid2702.204480.
APA Kar, S., Sarkar, S., Murali, S., Dhodapkar, R., Joseph, N., & Aggarwal, R. (2021). Prevalence and Time Trend of SARS-CoV-2 Infection in Puducherry, India, August–October 2020. Emerging Infectious Diseases, 27(2), 666-669. https://dx.doi.org/10.3201/eid2702.204480.

Rift Valley Fever and Crimean-Congo Hemorrhagic Fever Viruses in Ruminants, Jordan [PDF - 593 KB - 3 pages]
M. M. Obaidat et al.

The epidemiology of Rift Valley fever virus (RVFV) and Crimean-Congo hemorrhagic fever virus (CCHFV) in Jordan is unknown. Our investigation showed 3% of 989 tested dairy cattle, sheep, and goats were RVFV seropositive and 14% were CCHFV seropositive. Ongoing surveillance is needed to assess risk to humans and protect public health.

EID Obaidat MM, Graziano JC, Morales-Betoulle M, Brown SM, Chiang C, Klena JD. Rift Valley Fever and Crimean-Congo Hemorrhagic Fever Viruses in Ruminants, Jordan. Emerg Infect Dis. 2021;27(2):653-655. https://dx.doi.org/10.3201/eid2702.203713
AMA Obaidat MM, Graziano JC, Morales-Betoulle M, et al. Rift Valley Fever and Crimean-Congo Hemorrhagic Fever Viruses in Ruminants, Jordan. Emerging Infectious Diseases. 2021;27(2):653-655. doi:10.3201/eid2702.203713.
APA Obaidat, M. M., Graziano, J. C., Morales-Betoulle, M., Brown, S. M., Chiang, C., & Klena, J. D. (2021). Rift Valley Fever and Crimean-Congo Hemorrhagic Fever Viruses in Ruminants, Jordan. Emerging Infectious Diseases, 27(2), 653-655. https://dx.doi.org/10.3201/eid2702.203713.
Books and Media

The Rules of Contagion: Why Things Spread—and Why They Stop [PDF - 321 KB - 1 page]
V. J. Morley
EID Morley VJ. The Rules of Contagion: Why Things Spread—and Why They Stop. Emerg Infect Dis. 2021;27(2):675. https://dx.doi.org/10.3201/eid2702.204255
AMA Morley VJ. The Rules of Contagion: Why Things Spread—and Why They Stop. Emerging Infectious Diseases. 2021;27(2):675. doi:10.3201/eid2702.204255.
APA Morley, V. J. (2021). The Rules of Contagion: Why Things Spread—and Why They Stop. Emerging Infectious Diseases, 27(2), 675. https://dx.doi.org/10.3201/eid2702.204255.
About the Cover

Public Health Posters Take Aim against Bloodthirsty Ann [PDF - 638 KB - 2 pages]
B. Breedlove
EID Breedlove B. Public Health Posters Take Aim against Bloodthirsty Ann. Emerg Infect Dis. 2021;27(2):676-677. https://dx.doi.org/10.3201/eid2702.ac2702
AMA Breedlove B. Public Health Posters Take Aim against Bloodthirsty Ann. Emerging Infectious Diseases. 2021;27(2):676-677. doi:10.3201/eid2702.ac2702.
APA Breedlove, B. (2021). Public Health Posters Take Aim against Bloodthirsty Ann. Emerging Infectious Diseases, 27(2), 676-677. https://dx.doi.org/10.3201/eid2702.ac2702.
Etymologia

Etymologia: Falciparum [PDF - 429 KB - 1 page]
A. Tiwari and A. Sinha
EID Tiwari A, Sinha A. Etymologia: Falciparum. Emerg Infect Dis. 2021;27(2):470. https://dx.doi.org/10.3201/eid2702.et2702
AMA Tiwari A, Sinha A. Etymologia: Falciparum. Emerging Infectious Diseases. 2021;27(2):470. doi:10.3201/eid2702.et2702.
APA Tiwari, A., & Sinha, A. (2021). Etymologia: Falciparum. Emerging Infectious Diseases, 27(2), 470. https://dx.doi.org/10.3201/eid2702.et2702.
Page created: January 20, 2021
Page updated: January 24, 2021
Page reviewed: January 24, 2021
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