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Articles from Emerging Infectious Diseases

Synopses

Epidemiology of Coronavirus Disease Outbreak among Crewmembers on Cruise Ship, Nagasaki City, Japan, April 2020 [PDF - 2.68 MB - 10 pages]
H. Maeda et al.

In April 2020, a coronavirus disease (COVID-19) outbreak occurred on the cruise ship Costa Atlantica in Nagasaki, Japan. Our outbreak investigation included 623 multinational crewmembers onboard on April 20. Median age was 31 years; 84% were men. Each crewmember was isolated or quarantined in a single room inside the ship, and monitoring of health status was supported by a remote health monitoring system. Crewmembers with more severe illness were hospitalized. The investigation found that the outbreak started in late March and peaked in late April, resulting in 149 laboratory-confirmed and 107 probable cases of infection with severe acute respiratory syndrome coronavirus 2. Six case-patients were hospitalized for COVID-19 pneumonia, including 1 in severe condition and 2 who required oxygen administration, but no deaths occurred. Although the virus can spread rapidly on a cruise ship, we describe how prompt isolation and quarantine combined with a sensitive syndromic surveillance system can control a COVID-19 outbreak.

EID Maeda H, Sando E, Toizumi M, Arima Y, Shimada T, Tanaka T, et al. Epidemiology of Coronavirus Disease Outbreak among Crewmembers on Cruise Ship, Nagasaki City, Japan, April 2020. Emerg Infect Dis. 2021;27(9):2251-2260. https://doi.org/10.3201/eid2709.204596
AMA Maeda H, Sando E, Toizumi M, et al. Epidemiology of Coronavirus Disease Outbreak among Crewmembers on Cruise Ship, Nagasaki City, Japan, April 2020. Emerging Infectious Diseases. 2021;27(9):2251-2260. doi:10.3201/eid2709.204596.
APA Maeda, H., Sando, E., Toizumi, M., Arima, Y., Shimada, T., Tanaka, T....Morimoto, K. (2021). Epidemiology of Coronavirus Disease Outbreak among Crewmembers on Cruise Ship, Nagasaki City, Japan, April 2020. Emerging Infectious Diseases, 27(9), 2251-2260. https://doi.org/10.3201/eid2709.204596.

Seroprevalence and Virologic Surveillance of Enterovirus 71 and Coxsackievirus A6, United Kingdom, 2006–2017 [PDF - 2.04 MB - 8 pages]
E. Kamau et al.

Enterovirus A71 (EV-A71) and coxsackievirus A6 (CVA6) cause hand, foot and mouth disease (HFMD) and are occasionally linked to severe neurologic complications and large outbreaks worldwide. We estimated EV-A71 and CVA6 seroprevalence using cross-sectional age-stratified samples collected in 2006, 2011, and 2017. Seroprevalences of EV-A71 and CVA6 increased from 32% and 54% at 6–11 months to >75% by 10 years of age. Antibody titers declined after 20 years, which could indicate infrequent re-exposure in older populations. Age profiles for acquiring infections and mean titers were comparable in the 3 testing years, despite the marked increase in incidence of CVA6-related HFMD from 2010. The uncoupling of changes in disease severity from the infection kinetics of CVA6 as we inferred from the seroprevalence data, rather than incidence of infection over the 11-year study period, provides further evidence for a change in its pathogenicity.

EID Kamau E, Nguyen D, Celma C, Blomqvist S, Horby P, Simmonds P, et al. Seroprevalence and Virologic Surveillance of Enterovirus 71 and Coxsackievirus A6, United Kingdom, 2006–2017. Emerg Infect Dis. 2021;27(9):2261-2268. https://doi.org/10.3201/eid2709.204915
AMA Kamau E, Nguyen D, Celma C, et al. Seroprevalence and Virologic Surveillance of Enterovirus 71 and Coxsackievirus A6, United Kingdom, 2006–2017. Emerging Infectious Diseases. 2021;27(9):2261-2268. doi:10.3201/eid2709.204915.
APA Kamau, E., Nguyen, D., Celma, C., Blomqvist, S., Horby, P., Simmonds, P....Harvala, H. (2021). Seroprevalence and Virologic Surveillance of Enterovirus 71 and Coxsackievirus A6, United Kingdom, 2006–2017. Emerging Infectious Diseases, 27(9), 2261-2268. https://doi.org/10.3201/eid2709.204915.

Epidemiology, Clinical Features, and Outcomes of Coccidioidomycosis, Utah, 2006–2015 [PDF - 1.28 MB - 9 pages]
A. Carey et al.

On the basis of a 1957 geographic Coccidioides seropositivity survey, 3 counties in southwestern Utah, USA, were considered coccidioidomycosis-endemic, but there has been a paucity of information on the disease burden in Utah since. We report findings from a recent clinical and epidemiologic study of coccidioidomycosis in Utah. To describe clinical characteristics, we identified all coccidioidomycosis cases in an integrated health system in the state during 2006–2015. For epidemiologic analysis, we used cases reported to the Utah Department of Health during 2009–2015. Mean state incidence was 1.83 cases/100,000 population/year. Washington County, in southwestern Utah, had the highest incidence, 17.2 cases/100,000 population/year. In a generalized linear model with time as a fixed effect, mean annual temperature, population, and new construction were associated with regional variations in incidence. Using these variables in a spatiotemporal model, we estimated the adjusted regional variation by county to predict areas where Coccidioides infections might increase.

EID Carey A, Gorris ME, Chiller T, Jackson B, Beadles W, Webb BJ. Epidemiology, Clinical Features, and Outcomes of Coccidioidomycosis, Utah, 2006–2015. Emerg Infect Dis. 2021;27(9):2269-2277. https://doi.org/10.3201/eid2709.210751
AMA Carey A, Gorris ME, Chiller T, et al. Epidemiology, Clinical Features, and Outcomes of Coccidioidomycosis, Utah, 2006–2015. Emerging Infectious Diseases. 2021;27(9):2269-2277. doi:10.3201/eid2709.210751.
APA Carey, A., Gorris, M. E., Chiller, T., Jackson, B., Beadles, W., & Webb, B. J. (2021). Epidemiology, Clinical Features, and Outcomes of Coccidioidomycosis, Utah, 2006–2015. Emerging Infectious Diseases, 27(9), 2269-2277. https://doi.org/10.3201/eid2709.210751.
Research

Medscape CME Activity
Maternal Carriage in Late-Onset Group B Streptococcus Disease, Italy [PDF - 1.04 MB - 9 pages]
A. Berardi et al.

We retrospectively investigated mother-to-infant transmission of group B Streptococcus (GBS) in 98 cases of late-onset disease reported during 2007–2018 by a network in Italy. Mothers with full assessment of vaginal/rectal carriage tested at prenatal screening and at time of late onset (ATLO) were included. Thirty-three mothers (33.7%) were never GBS colonized; 65 (66.3%) were vaginal/rectal colonized, of which 36 (36.7%) were persistently colonized. Mothers with vaginal/rectal colonization ATLO had high rates of GBS bacteriuria (33.9%) and positive breast milk culture (27.5%). GBS strains from mother–infant pairs were serotype III and possessed the surface protein antigen Rib. All but 1 strain belonged to clonal complex 17. GBS strains from 4 mother–infant pairs were indistinguishable through pulsed-field gel electrophoresis. At least two thirds of late-onset cases are transmitted from mothers, who often have vaginal/rectal carriage, positive breast milk culture, or GBS bacteriuria, which suggests heavy maternal colonization.

EID Berardi A, Spada C, Creti R, Auriti C, Gambini L, Rizzo V, et al. Maternal Carriage in Late-Onset Group B Streptococcus Disease, Italy. Emerg Infect Dis. 2021;27(9):2279-2287. https://doi.org/10.3201/eid2709.210049
AMA Berardi A, Spada C, Creti R, et al. Maternal Carriage in Late-Onset Group B Streptococcus Disease, Italy. Emerging Infectious Diseases. 2021;27(9):2279-2287. doi:10.3201/eid2709.210049.
APA Berardi, A., Spada, C., Creti, R., Auriti, C., Gambini, L., Rizzo, V....Lugli, L. (2021). Maternal Carriage in Late-Onset Group B Streptococcus Disease, Italy. Emerging Infectious Diseases, 27(9), 2279-2287. https://doi.org/10.3201/eid2709.210049.

Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 to Close Contacts, China, January–February 2020 [PDF - 1.41 MB - 6 pages]
Y. Li et al.

We estimated the symptomatic, PCR-confirmed secondary attack rate (SAR) for 2,382 close contacts of 476 symptomatic persons with coronavirus disease in Yichang, Hubei Province, China, identified during January 23–February 25, 2020. The SAR among all close contacts was 6.5%; among close contacts who lived with an index case-patient, the SAR was 10.8%; among close-contact spouses of index case-patients, the SAR was 15.9%. The SAR varied by close contact age, from 3.0% for those <18 years of age to 12.5% for those >60 years of age. Multilevel logistic regression showed that factors significantly associated with increased SAR were living together, being a spouse, and being >60 years of age. Multilevel regression did not support SAR differing significantly by whether the most recent contact occurred before or after the index case-patient’s onset of illness (p = 0.66). The relatively high SAR for coronavirus disease suggests relatively high virus transmissibility.

EID Li Y, Liu J, Yang Z, Yu J, Xu C, Zhu A, et al. Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 to Close Contacts, China, January–February 2020. Emerg Infect Dis. 2021;27(9):2288-2293. https://doi.org/10.3201/eid2709.202035
AMA Li Y, Liu J, Yang Z, et al. Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 to Close Contacts, China, January–February 2020. Emerging Infectious Diseases. 2021;27(9):2288-2293. doi:10.3201/eid2709.202035.
APA Li, Y., Liu, J., Yang, Z., Yu, J., Xu, C., Zhu, A....Li, Z. (2021). Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 to Close Contacts, China, January–February 2020. Emerging Infectious Diseases, 27(9), 2288-2293. https://doi.org/10.3201/eid2709.202035.

Human and Porcine Transmission of Clostridioides difficile Ribotype 078, Europe [PDF - 2.82 MB - 7 pages]
G. Moloney et al.

Genomic analysis of a diverse collection of Clostridioides difficile ribotype 078 isolates from Ireland and 9 countries in Europe provided evidence for complex regional and international patterns of dissemination that are not restricted to humans. These isolates are associated with C. difficile colonization and clinical illness in humans and pigs.

EID Moloney G, Eyre DW, Mac Aogáin M, McElroy MC, Vaughan A, Peto T, et al. Human and Porcine Transmission of Clostridioides difficile Ribotype 078, Europe. Emerg Infect Dis. 2021;27(9):2294-2300. https://doi.org/10.3201/eid2709.203468
AMA Moloney G, Eyre DW, Mac Aogáin M, et al. Human and Porcine Transmission of Clostridioides difficile Ribotype 078, Europe. Emerging Infectious Diseases. 2021;27(9):2294-2300. doi:10.3201/eid2709.203468.
APA Moloney, G., Eyre, D. W., Mac Aogáin, M., McElroy, M. C., Vaughan, A., Peto, T....Rogers, T. R. (2021). Human and Porcine Transmission of Clostridioides difficile Ribotype 078, Europe. Emerging Infectious Diseases, 27(9), 2294-2300. https://doi.org/10.3201/eid2709.203468.

Risk Factors for Middle East Respiratory Syndrome Coronavirus Infection among Camel Populations, Southern Jordan, 2014–2018 [PDF - 1.81 MB - 11 pages]
P. Holloway et al.

After the first detection of Middle East respiratory syndrome coronavirus (MERS-CoV) in camels in Jordan in 2013, we conducted 2 consecutive surveys in 2014–2015 and 2017–2018 investigating risk factors for MERS-CoV infection among camel populations in southern Jordan. Multivariate analysis to control for confounding demonstrated that borrowing of camels, particularly males, for breeding purposes was associated with increased MERS-CoV seroprevalence among receiving herds, suggesting a potential route of viral transmission between herds. Increasing age, herd size, and use of water troughs within herds were also associated with increased seroprevalence. Closed herd management practices were found to be protective. Future vaccination strategies among camel populations in Jordan could potentially prioritize breeding males, which are likely to be shared between herds. In addition, targeted management interventions with the potential to reduce transmission between herds should be considered; voluntary closed herd schemes offer a possible route to achieving disease-free herds.

EID Holloway P, Gibson M, van Doremalen N, Nash S, Holloway T, Letko M, et al. Risk Factors for Middle East Respiratory Syndrome Coronavirus Infection among Camel Populations, Southern Jordan, 2014–2018. Emerg Infect Dis. 2021;27(9):2301-2311. https://doi.org/10.3201/eid2709.203508
AMA Holloway P, Gibson M, van Doremalen N, et al. Risk Factors for Middle East Respiratory Syndrome Coronavirus Infection among Camel Populations, Southern Jordan, 2014–2018. Emerging Infectious Diseases. 2021;27(9):2301-2311. doi:10.3201/eid2709.203508.
APA Holloway, P., Gibson, M., van Doremalen, N., Nash, S., Holloway, T., Letko, M....Guitian, J. (2021). Risk Factors for Middle East Respiratory Syndrome Coronavirus Infection among Camel Populations, Southern Jordan, 2014–2018. Emerging Infectious Diseases, 27(9), 2301-2311. https://doi.org/10.3201/eid2709.203508.

Estimating the Impact of Statewide Policies to Reduce Spread of Severe Acute Respiratory Syndrome Coronavirus 2 in Real Time, Colorado, USA [PDF - 2.94 MB - 11 pages]
A. G. Buchwald et al.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic necessitated rapid local public health response, but studies examining the impact of social distancing policies on SARS-CoV-2 transmission have struggled to capture regional-level dynamics. We developed a susceptible-exposed-infected-recovered transmission model, parameterized to Colorado, USA‒specific data, to estimate the impact of coronavirus disease‒related policy measures on mobility and SARS-CoV-2 transmission in real time. During March‒June 2020, we estimated unknown parameter values and generated scenario-based projections of future clinical care needs. Early coronavirus disease policy measures, including a stay-at-home order, were accompanied by substantial decreases in mobility and reduced the effective reproductive number well below 1. When some restrictions were eased in late April, mobility increased to near baseline levels, but transmission remained low (effective reproductive number <1) through early June. Over time, our model parameters were adjusted to more closely reflect reality in Colorado, leading to modest changes in estimates of intervention effects and more conservative long-term projections.

EID Buchwald AG, Bayham J, Adams J, Bortz D, Colborn K, Zarella O, et al. Estimating the Impact of Statewide Policies to Reduce Spread of Severe Acute Respiratory Syndrome Coronavirus 2 in Real Time, Colorado, USA. Emerg Infect Dis. 2021;27(9):2312-2322. https://doi.org/10.3201/eid2709.204167
AMA Buchwald AG, Bayham J, Adams J, et al. Estimating the Impact of Statewide Policies to Reduce Spread of Severe Acute Respiratory Syndrome Coronavirus 2 in Real Time, Colorado, USA. Emerging Infectious Diseases. 2021;27(9):2312-2322. doi:10.3201/eid2709.204167.
APA Buchwald, A. G., Bayham, J., Adams, J., Bortz, D., Colborn, K., Zarella, O....Carlton, E. J. (2021). Estimating the Impact of Statewide Policies to Reduce Spread of Severe Acute Respiratory Syndrome Coronavirus 2 in Real Time, Colorado, USA. Emerging Infectious Diseases, 27(9), 2312-2322. https://doi.org/10.3201/eid2709.204167.

Patterns of Virus Exposure and Presumed Household Transmission among Persons with Coronavirus Disease, United States, January–April 2020 [PDF - 1.59 MB - 10 pages]
R. M. Burke et al.

We characterized common exposures reported by a convenience sample of 202 US patients with coronavirus disease during January–April 2020 and identified factors associated with presumed household transmission. The most commonly reported settings of known exposure were households and healthcare facilities; among case-patients who had known contact with a confirmed case-patient compared with those who did not, healthcare occupations were more common. Among case-patients without known contact, use of public transportation was more common. Within the household, presumed transmission was highest from older (>65 years) index case-patients and from children to parents, independent of index case-patient age. These findings may inform guidance for limiting transmission and emphasize the value of testing to identify community-acquired infections.

EID Burke RM, Calderwood L, Killerby ME, Ashworth CE, Berns AL, Brennan S, et al. Patterns of Virus Exposure and Presumed Household Transmission among Persons with Coronavirus Disease, United States, January–April 2020. Emerg Infect Dis. 2021;27(9):2323-2332. https://doi.org/10.3201/eid2709.204577
AMA Burke RM, Calderwood L, Killerby ME, et al. Patterns of Virus Exposure and Presumed Household Transmission among Persons with Coronavirus Disease, United States, January–April 2020. Emerging Infectious Diseases. 2021;27(9):2323-2332. doi:10.3201/eid2709.204577.
APA Burke, R. M., Calderwood, L., Killerby, M. E., Ashworth, C. E., Berns, A. L., Brennan, S....Midgley, C. M. (2021). Patterns of Virus Exposure and Presumed Household Transmission among Persons with Coronavirus Disease, United States, January–April 2020. Emerging Infectious Diseases, 27(9), 2323-2332. https://doi.org/10.3201/eid2709.204577.

Severe Acute Respiratory Syndrome Coronavirus 2 in Farmed Mink (Neovison vison), Poland [PDF - 1.56 MB - 7 pages]
L. Rabalski et al.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of coronavirus disease and has been spreading worldwide since December 2019. The virus can infect different animal species under experimental conditions, and mink on fur farms in Europe and other areas are susceptible to SARS-CoV-2 infection. We investigated SARS-CoV-2 infection in 91 mink from a farm in northern Poland. Using reverse transcription PCR, antigen detection, and next-generation sequencing, we confirmed that 15 animals were positive for SARS-CoV-2. We verified this finding by sequencing full viral genomes and confirmed a virus variant that has sporadic mutations through the full genome sequence in the spike protein (G75V and C1247F). We were unable to find other SARS-CoV-2 sequences simultaneously containing these 2 mutations. Country-scale monitoring by veterinary inspection should be implemented to detect SARS-CoV-2 in other mink farms.

EID Rabalski L, Kosinski M, Smura T, Aaltonen K, Kant R, Sironen T, et al. Severe Acute Respiratory Syndrome Coronavirus 2 in Farmed Mink (Neovison vison), Poland. Emerg Infect Dis. 2021;27(9):2333-2339. https://doi.org/10.3201/eid2709.210286
AMA Rabalski L, Kosinski M, Smura T, et al. Severe Acute Respiratory Syndrome Coronavirus 2 in Farmed Mink (Neovison vison), Poland. Emerging Infectious Diseases. 2021;27(9):2333-2339. doi:10.3201/eid2709.210286.
APA Rabalski, L., Kosinski, M., Smura, T., Aaltonen, K., Kant, R., Sironen, T....Grzybek, M. (2021). Severe Acute Respiratory Syndrome Coronavirus 2 in Farmed Mink (Neovison vison), Poland. Emerging Infectious Diseases, 27(9), 2333-2339. https://doi.org/10.3201/eid2709.210286.

Risk for Acquiring Coronavirus Disease Illness among Emergency Medical Service Personnel Exposed to Aerosol-Generating Procedures [PDF - 1.60 MB - 9 pages]
A. Brown et al.

We investigated the risk of coronavirus disease (COVID-19)­ patients transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to emergency medical service (EMS) providers, stratified by aerosol-generating procedures (AGP), in King County, Washington, USA, during February 16–July 31, 2020. We conducted a retrospective cohort investigation using a statewide COVID-19 registry and identified 1,115 encounters, 182 with ≥1 AGP. Overall, COVID-19 incidence among EMS personnel was 0.57 infections/10,000 person-days. Incidence per 10,000 person-days did not differ whether or not infection was attributed to a COVID-19 patient encounter (0.28 vs. 0.59; p>0.05). The 1 case attributed to a COVID-19 patient encounter occurred within an at-risk period and involved an AGP. We observed a very low risk for COVID-19 infection attributable to patient encounters among EMS first responders, supporting clinical strategies that maintain established practices for treating patients in emergency conditions.

EID Brown A, Schwarcz L, Counts CR, Barnard LM, Yang BY, Emert JM, et al. Risk for Acquiring Coronavirus Disease Illness among Emergency Medical Service Personnel Exposed to Aerosol-Generating Procedures. Emerg Infect Dis. 2021;27(9):2340-2348. https://doi.org/10.3201/eid2709.210363
AMA Brown A, Schwarcz L, Counts CR, et al. Risk for Acquiring Coronavirus Disease Illness among Emergency Medical Service Personnel Exposed to Aerosol-Generating Procedures. Emerging Infectious Diseases. 2021;27(9):2340-2348. doi:10.3201/eid2709.210363.
APA Brown, A., Schwarcz, L., Counts, C. R., Barnard, L. M., Yang, B. Y., Emert, J. M....Rea, T. (2021). Risk for Acquiring Coronavirus Disease Illness among Emergency Medical Service Personnel Exposed to Aerosol-Generating Procedures. Emerging Infectious Diseases, 27(9), 2340-2348. https://doi.org/10.3201/eid2709.210363.

Multicenter Epidemiologic Study of Coronavirus Disease–Associated Mucormycosis, India [PDF - 2.32 MB - 11 pages]
A. Patel et al.

During September–December 2020, we conducted a multicenter retrospective study across India to evaluate epidemiology and outcomes among cases of coronavirus disease (COVID-19)–associated mucormycosis (CAM). Among 287 mucormycosis patients, 187 (65.2%) had CAM; CAM prevalence was 0.27% among hospitalized COVID-19 patients. We noted a 2.1-fold rise in mucormycosis during the study period compared with September–December 2019. Uncontrolled diabetes mellitus was the most common underlying disease among CAM and non-CAM patients. COVID-19 was the only underlying disease in 32.6% of CAM patients. COVID-19–related hypoxemia and improper glucocorticoid use independently were associated with CAM. The mucormycosis case-fatality rate at 12 weeks was 45.7% but was similar for CAM and non-CAM patients. Age, rhino-orbital-cerebral involvement, and intensive care unit admission were associated with increased mortality rates; sequential antifungal drug treatment improved mucormycosis survival. The COVID-19 pandemic has led to increases in mucormycosis in India, partly from inappropriate glucocorticoid use.

EID Patel A, Agarwal R, Rudramurthy SM, Shevkani M, Xess I, Sharma R, et al. Multicenter Epidemiologic Study of Coronavirus Disease–Associated Mucormycosis, India. Emerg Infect Dis. 2021;27(9):2349-2359. https://doi.org/10.3201/eid2709.210934
AMA Patel A, Agarwal R, Rudramurthy SM, et al. Multicenter Epidemiologic Study of Coronavirus Disease–Associated Mucormycosis, India. Emerging Infectious Diseases. 2021;27(9):2349-2359. doi:10.3201/eid2709.210934.
APA Patel, A., Agarwal, R., Rudramurthy, S. M., Shevkani, M., Xess, I., Sharma, R....Chakrabarti, A. (2021). Multicenter Epidemiologic Study of Coronavirus Disease–Associated Mucormycosis, India. Emerging Infectious Diseases, 27(9), 2349-2359. https://doi.org/10.3201/eid2709.210934.

Real-Time Genomics for Tracking Severe Acute Respiratory Syndrome Coronavirus 2 Border Incursions after Virus Elimination, New Zealand [PDF - 1.64 MB - 8 pages]
J. Douglas et al.

Since severe acute respiratory syndrome coronavirus 2 was first eliminated in New Zealand in May 2020, a total of 13 known coronavirus disease (COVID-19) community outbreaks have occurred, 2 of which led health officials to issue stay-at-home orders. These outbreaks originated at the border via isolating returnees, airline workers, and cargo vessels. Because a public health system was informed by real-time viral genomic sequencing and complete genomes typically were available within 12 hours of community-based positive COVID-19 test results, every outbreak was well-contained. A total of 225 community cases resulted in 3 deaths. Real-time genomics were essential for establishing links between cases when epidemiologic data could not do so and for identifying when concurrent outbreaks had different origins.

EID Douglas J, Geoghegan JL, Hadfield J, Bouckaert R, Storey M, Ren X, et al. Real-Time Genomics for Tracking Severe Acute Respiratory Syndrome Coronavirus 2 Border Incursions after Virus Elimination, New Zealand. Emerg Infect Dis. 2021;27(9):2361-2368. https://doi.org/10.3201/eid2709.211097
AMA Douglas J, Geoghegan JL, Hadfield J, et al. Real-Time Genomics for Tracking Severe Acute Respiratory Syndrome Coronavirus 2 Border Incursions after Virus Elimination, New Zealand. Emerging Infectious Diseases. 2021;27(9):2361-2368. doi:10.3201/eid2709.211097.
APA Douglas, J., Geoghegan, J. L., Hadfield, J., Bouckaert, R., Storey, M., Ren, X....Welch, D. (2021). Real-Time Genomics for Tracking Severe Acute Respiratory Syndrome Coronavirus 2 Border Incursions after Virus Elimination, New Zealand. Emerging Infectious Diseases, 27(9), 2361-2368. https://doi.org/10.3201/eid2709.211097.

Genomic Epidemiology of Azithromycin-Nonsusceptible Neisseria gonorrhoeae, Argentina, 2005–2019 [PDF - 2.36 MB - 10 pages]
R. Gianecini et al.

Azithromycin-nonsusceptible Neisseria gonorrhoeae strains are an emerging global public health threat. During 2015–2018, the prevalence of azithromycin-nonsusceptible gonococcal infection increased significantly in Argentina. To investigate the genomic epidemiology and resistance mechanisms of these strains, we sequenced 96 nonsusceptible isolates collected in Argentina during 2005–2019. Phylogenomic analysis revealed 2 main clades, which were characterized by a limited geographic distribution, circulating during January 2015–November 2019. These clades included the internationally spreading multilocus sequence types (STs) 1580 and 9363. The ST1580 isolates, which had MICs of 2–4 μg/mL, had mutations in the 23S rRNA. The ST9363 isolates, which had MICs of 2–4 or >256 μg/mL, had mutations in the 23S rRNA, a mosaic mtr locus, or both. Identifying the geographic dissemination and characteristics of these predominant clones will guide public health policies to control the spread of azithromycin-nonsusceptible N. gonorrhoeae in Argentina.

EID Gianecini R, Poklepovich T, Golparian D, Cuenca N, Tuduri E, Unemo M, et al. Genomic Epidemiology of Azithromycin-Nonsusceptible Neisseria gonorrhoeae, Argentina, 2005–2019. Emerg Infect Dis. 2021;27(9):2369-2378. https://doi.org/10.3201/eid2709.204843
AMA Gianecini R, Poklepovich T, Golparian D, et al. Genomic Epidemiology of Azithromycin-Nonsusceptible Neisseria gonorrhoeae, Argentina, 2005–2019. Emerging Infectious Diseases. 2021;27(9):2369-2378. doi:10.3201/eid2709.204843.
APA Gianecini, R., Poklepovich, T., Golparian, D., Cuenca, N., Tuduri, E., Unemo, M....Galarza, P. (2021). Genomic Epidemiology of Azithromycin-Nonsusceptible Neisseria gonorrhoeae, Argentina, 2005–2019. Emerging Infectious Diseases, 27(9), 2369-2378. https://doi.org/10.3201/eid2709.204843.

Development and Clinical Evaluation of a CRISPR-Based Diagnostic for Rapid Group B Streptococcus Screening [PDF - 3.14 MB - 10 pages]
L. Jiang et al.

Vertical transmission of group B Streptococcus (GBS) is among the leading causes of neonatal illness and death. Colonization with GBS usually is screened weeks before delivery during pregnancy, on the basis of which preventive measures, such as antibiotic prophylaxis, were taken. However, the accuracy of such an antenatal screening strategy has been questionable because of the intermittent nature of GBS carriage. We developed a simple-to-use, rapid, CRISPR-based assay for GBS detection. We conducted studies in a prospective cohort of 412 pregnant women and a retrospective validation cohort to evaluate its diagnostic performance. We demonstrated that CRISPR-GBS is highly sensitive and offered shorter turnaround times and lower instrument demands than PCR-based assays. This novel GBS test exhibited an overall improved diagnostic performance over culture and PCR-based assays and represents a novel diagnostic for potential rapid, point-of-care GBS screening.

EID Jiang L, Zeng W, Wu W, Deng Y, He F, Liang W, et al. Development and Clinical Evaluation of a CRISPR-Based Diagnostic for Rapid Group B Streptococcus Screening. Emerg Infect Dis. 2021;27(9):2379-2388. https://doi.org/10.3201/eid2709.200091
AMA Jiang L, Zeng W, Wu W, et al. Development and Clinical Evaluation of a CRISPR-Based Diagnostic for Rapid Group B Streptococcus Screening. Emerging Infectious Diseases. 2021;27(9):2379-2388. doi:10.3201/eid2709.200091.
APA Jiang, L., Zeng, W., Wu, W., Deng, Y., He, F., Liang, W....Xu, T. (2021). Development and Clinical Evaluation of a CRISPR-Based Diagnostic for Rapid Group B Streptococcus Screening. Emerging Infectious Diseases, 27(9), 2379-2388. https://doi.org/10.3201/eid2709.200091.

Geographically Targeted Interventions versus Mass Drug Administration to Control Taenia solium Cysticercosis, Peru [PDF - 1.28 MB - 10 pages]
S. E. O’Neal et al.

Optimal control strategies for Taenia solium taeniasis and cysticercosis have not been determined. We conducted a 2-year cluster randomized trial in Peru by assigning 23 villages to 1 of 3 geographically targeted intervention approaches. For ring screening (RS), participants living near pigs with cysticercosis were screened for taeniasis; identified cases were treated with niclosamide. In ring treatment (RT), participants living near pigs with cysticercosis received presumptive treatment with niclosamide. In mass treatment (MT), participants received niclosamide treatment every 6 months regardless of location. In each approach, half the villages received targeted or mass oxfendazole for pigs (6 total study arms). We noted significant reductions in seroincidence among pigs in all approaches (67.1% decrease in RS, 69.3% in RT, 64.7% in MT; p<0.001), despite a smaller proportion of population treated by targeted approaches (RS 1.4%, RT 19.3%, MT 88.5%). Our findings suggest multiple approaches can achieve rapid control of T. solium transmission.

EID O’Neal SE, Pray IW, Vilchez P, Gamboa R, Muro C, Moyano L, et al. Geographically Targeted Interventions versus Mass Drug Administration to Control Taenia solium Cysticercosis, Peru. Emerg Infect Dis. 2021;27(9):2389-2398. https://doi.org/10.3201/eid2709.203349
AMA O’Neal SE, Pray IW, Vilchez P, et al. Geographically Targeted Interventions versus Mass Drug Administration to Control Taenia solium Cysticercosis, Peru. Emerging Infectious Diseases. 2021;27(9):2389-2398. doi:10.3201/eid2709.203349.
APA O’Neal, S. E., Pray, I. W., Vilchez, P., Gamboa, R., Muro, C., Moyano, L....Garcia, H. H. (2021). Geographically Targeted Interventions versus Mass Drug Administration to Control Taenia solium Cysticercosis, Peru. Emerging Infectious Diseases, 27(9), 2389-2398. https://doi.org/10.3201/eid2709.203349.

Risk Areas for Influenza A(H5) Environmental Contamination in Live Bird Markets, Dhaka, Bangladesh [PDF - 1.99 MB - 10 pages]
S. Chakma et al.

We evaluated the presence of influenza A(H5) virus environmental contamination in live bird markets (LBMs) in Dhaka, Bangladesh. By using Bernoulli generalized linear models and multinomial logistic regression models, we quantified LBM-level factors associated with market work zone–specific influenza A(H5) virus contamination patterns. Results showed higher environmental contamination in LBMs that have wholesale and retail operations compared with retail-only markets (relative risk 0.69, 95% 0.51–0.93; p = 0.012) and in March compared with January (relative risk 2.07, 95% CI 1.44–2.96; p<0.001). Influenza A(H5) environmental contamination remains a public health problem in most LBMs in Dhaka, which underscores the need to implement enhanced biosecurity interventions in LBMs in Bangladesh.

EID Chakma S, Osmani MG, Akwar H, Hasan Z, Nasrin T, Karim M, et al. Risk Areas for Influenza A(H5) Environmental Contamination in Live Bird Markets, Dhaka, Bangladesh. Emerg Infect Dis. 2021;27(9):2399-2408. https://doi.org/10.3201/eid2709.204447
AMA Chakma S, Osmani MG, Akwar H, et al. Risk Areas for Influenza A(H5) Environmental Contamination in Live Bird Markets, Dhaka, Bangladesh. Emerging Infectious Diseases. 2021;27(9):2399-2408. doi:10.3201/eid2709.204447.
APA Chakma, S., Osmani, M. G., Akwar, H., Hasan, Z., Nasrin, T., Karim, M....Magalhães, R. (2021). Risk Areas for Influenza A(H5) Environmental Contamination in Live Bird Markets, Dhaka, Bangladesh. Emerging Infectious Diseases, 27(9), 2399-2408. https://doi.org/10.3201/eid2709.204447.

Perinatal Outcomes of Asynchronous Influenza Vaccination, Ceará, Brazil, 2013–2018 [PDF - 3.91 MB - 12 pages]
J. Q. Filho et al.

In Ceará, Brazil, seasonal influenza transmission begins before national annual vaccination campaigns commence. To assess the perinatal consequences of this misalignment, we tracked severe acute respiratory infection (SARI), influenza, and influenza immunizations during 2013–2018. Among 3,297 SARI cases, 145 (4.4%) occurred in pregnant women. Statewide vaccination coverage was >80%; however, national vaccination campaigns began during or after peak influenza season. Thirty to forty weeks after peak influenza season, birthweights decreased by 40 g, and rates of prematurity increased from 10.7% to 15.5%. We identified 61 children born to mothers with SARI during pregnancy; they weighed 10% less at birth and were more likely to be premature than 122 newborn controls. Mistiming of influenza vaccination campaigns adversely effects perinatal outcomes in Ceará. Because Ceará is the presumptive starting point for north-to-south seasonal influenza transmission in Brazil, earlier national immunization campaigns would provide greater protection for pregnant women and their fetuses in Ceará and beyond.

EID Filho JQ, Junior FS Junior, Lima T, Viana V, Burgoa J, Soares AM, et al. Perinatal Outcomes of Asynchronous Influenza Vaccination, Ceará, Brazil, 2013–2018. Emerg Infect Dis. 2021;27(9):2409-2420. https://doi.org/10.3201/eid2709.203791
AMA Filho JQ, Junior FS Junior, Lima T, et al. Perinatal Outcomes of Asynchronous Influenza Vaccination, Ceará, Brazil, 2013–2018. Emerging Infectious Diseases. 2021;27(9):2409-2420. doi:10.3201/eid2709.203791.
APA Filho, J. Q., Junior, F. S., Junior., Lima, T., Viana, V., Burgoa, J., Soares, A. M....Lima, A. (2021). Perinatal Outcomes of Asynchronous Influenza Vaccination, Ceará, Brazil, 2013–2018. Emerging Infectious Diseases, 27(9), 2409-2420. https://doi.org/10.3201/eid2709.203791.

Spatiotemporal Dynamics of Sporadic Shiga Toxin–Producing Escherichia coli Enteritis, Ireland, 2013–2017 [PDF - 5.34 MB - 13 pages]
E. Cleary et al.

The Republic of Ireland regularly reports the highest annual crude incidence rates of Shiga toxin–producing Escherichia coli (STEC) enteritis in the European Union, ≈10 times the average. We investigated spatiotemporal patterns of STEC enteritis in Ireland using multiple statistical tools. Overall, we georeferenced 2,755 cases of infection during January 2013–December 2017; we found >1 case notified in 2,340 (12.6%) of 18,641 Census Small Areas. We encountered the highest case numbers in children 0–5 years of age (n = 1,101, 39.6%) and associated with serogroups O26 (n = 800, 29%) and O157 (n = 638, 23.2%). Overall, we identified 17 space-time clusters, ranging from 2 (2014) to 5 (2017) clusters of sporadic infection per year; we detected recurrent clustering in 3 distinct geographic regions in the west and mid-west, all of which are primarily rural. Our findings can be used to enable targeted epidemiologic intervention and surveillance.

EID Cleary E, Boudou M, Garvey P, Aiseadha CO, McKeown P, O’Dwyer J, et al. Spatiotemporal Dynamics of Sporadic Shiga Toxin–Producing Escherichia coli Enteritis, Ireland, 2013–2017. Emerg Infect Dis. 2021;27(9):2421-2433. https://doi.org/10.3201/eid2709.204021
AMA Cleary E, Boudou M, Garvey P, et al. Spatiotemporal Dynamics of Sporadic Shiga Toxin–Producing Escherichia coli Enteritis, Ireland, 2013–2017. Emerging Infectious Diseases. 2021;27(9):2421-2433. doi:10.3201/eid2709.204021.
APA Cleary, E., Boudou, M., Garvey, P., Aiseadha, C. O., McKeown, P., O’Dwyer, J....Hynds, P. (2021). Spatiotemporal Dynamics of Sporadic Shiga Toxin–Producing Escherichia coli Enteritis, Ireland, 2013–2017. Emerging Infectious Diseases, 27(9), 2421-2433. https://doi.org/10.3201/eid2709.204021.

Reduction in Antimicrobial Use and Resistance to Salmonella, Campylobacter, and Escherichia coli in Broiler Chickens, Canada, 2013–2019 [PDF - 3.32 MB - 11 pages]
L. Huber et al.

Antimicrobial use contributes to the global rise of antimicrobial resistance (AMR). In 2014, the poultry industry in Canada initiated its Antimicrobial Use Reduction Strategy to mitigate AMR in the poultry sector. We monitored trends in antimicrobial use and AMR of foodborne bacteria (Salmonella, Escherichia coli, and Campylobacter) in broiler chickens during 2013 and 2019. We quantified the effect of antimicrobial use and management factors on AMR by using LASSO regression and generalized mixed-effect models. AMR in broiler chickens declined by 6%–38% after the decrease in prophylactic antimicrobial use. However, the withdrawal of individual compounds, such as cephalosporins and fluoroquinolones, prompted an increase in use of and resistance levels for other drug classes, such as aminoglycosides. Canada’s experience with antimicrobial use reduction illustrates the potential for progressive transitions from conventional antimicrobial-dependent broiler production to more sustainable production with respect to antimicrobial use.

EID Huber L, Agunos A, Gow SP, Carson CA, Van Boeckel TP. Reduction in Antimicrobial Use and Resistance to Salmonella, Campylobacter, and Escherichia coli in Broiler Chickens, Canada, 2013–2019. Emerg Infect Dis. 2021;27(9):2434-2444. https://doi.org/10.3201/eid2709.204395
AMA Huber L, Agunos A, Gow SP, et al. Reduction in Antimicrobial Use and Resistance to Salmonella, Campylobacter, and Escherichia coli in Broiler Chickens, Canada, 2013–2019. Emerging Infectious Diseases. 2021;27(9):2434-2444. doi:10.3201/eid2709.204395.
APA Huber, L., Agunos, A., Gow, S. P., Carson, C. A., & Van Boeckel, T. P. (2021). Reduction in Antimicrobial Use and Resistance to Salmonella, Campylobacter, and Escherichia coli in Broiler Chickens, Canada, 2013–2019. Emerging Infectious Diseases, 27(9), 2434-2444. https://doi.org/10.3201/eid2709.204395.
Dispatches

A Community-Adapted Approach to SARS-CoV-2 Testing for Medically Underserved Populations, Rhode Island, USA [PDF - 1.13 MB - 5 pages]
M. Murphy et al.

We developed a testing program for severe acute respiratory syndrome coronavirus 2 in an urban Latinx neighborhood in Providence, Rhode Island, USA. Approximately 11% of Latinx participants (n = 180) tested positive. Culturally tailored, community-based programs that reduce barriers to testing help identify persons at highest risk for coronavirus disease.

EID Murphy M, Dhrolia I, Zanowick-Marr A, Tao J, Coats C, Napoleon S, et al. A Community-Adapted Approach to SARS-CoV-2 Testing for Medically Underserved Populations, Rhode Island, USA. Emerg Infect Dis. 2021;27(9):2445-2449. https://doi.org/10.3201/eid2709.204874
AMA Murphy M, Dhrolia I, Zanowick-Marr A, et al. A Community-Adapted Approach to SARS-CoV-2 Testing for Medically Underserved Populations, Rhode Island, USA. Emerging Infectious Diseases. 2021;27(9):2445-2449. doi:10.3201/eid2709.204874.
APA Murphy, M., Dhrolia, I., Zanowick-Marr, A., Tao, J., Coats, C., Napoleon, S....Nunn, A. (2021). A Community-Adapted Approach to SARS-CoV-2 Testing for Medically Underserved Populations, Rhode Island, USA. Emerging Infectious Diseases, 27(9), 2445-2449. https://doi.org/10.3201/eid2709.204874.

Transmission of SARS-CoV-2 from Human to Domestic Ferret [PDF - 2.15 MB - 4 pages]
J. Račnik et al.

We report a case of natural infection with severe acute respiratory syndrome coronavirus 2 transmitted from an owner to a pet ferret in the same household in Slovenia. The ferret had onset of gastroenteritis with severe dehydration. Whole-genome sequencing of the viruses isolated from the owner and ferret revealed a 2-nt difference.

EID Račnik J, Kočevar A, Slavec B, Korva M, Rus K, Zakotnik S, et al. Transmission of SARS-CoV-2 from Human to Domestic Ferret. Emerg Infect Dis. 2021;27(9):2450-2453. https://doi.org/10.3201/eid2709.210774
AMA Račnik J, Kočevar A, Slavec B, et al. Transmission of SARS-CoV-2 from Human to Domestic Ferret. Emerging Infectious Diseases. 2021;27(9):2450-2453. doi:10.3201/eid2709.210774.
APA Račnik, J., Kočevar, A., Slavec, B., Korva, M., Rus, K., Zakotnik, S....Županc, T. (2021). Transmission of SARS-CoV-2 from Human to Domestic Ferret. Emerging Infectious Diseases, 27(9), 2450-2453. https://doi.org/10.3201/eid2709.210774.

Predictors of Nonseroconversion after SARS-CoV-2 Infection [PDF - 1.39 MB - 5 pages]
W. Liu et al.

Not all persons recovering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection develop SARS-CoV-2–specific antibodies. We show that nonseroconversion is associated with younger age and higher reverse transcription PCR cycle threshold values and identify SARS-CoV-2 viral loads in the nasopharynx as a major correlate of the systemic antibody response.

EID Liu W, Russell RM, Bibollet-Ruche F, Skelly AN, Sherrill-Mix S, Freeman DA, et al. Predictors of Nonseroconversion after SARS-CoV-2 Infection. Emerg Infect Dis. 2021;27(9):2454-2458. https://doi.org/10.3201/eid2709.211042
AMA Liu W, Russell RM, Bibollet-Ruche F, et al. Predictors of Nonseroconversion after SARS-CoV-2 Infection. Emerging Infectious Diseases. 2021;27(9):2454-2458. doi:10.3201/eid2709.211042.
APA Liu, W., Russell, R. M., Bibollet-Ruche, F., Skelly, A. N., Sherrill-Mix, S., Freeman, D. A....Hahn, B. H. (2021). Predictors of Nonseroconversion after SARS-CoV-2 Infection. Emerging Infectious Diseases, 27(9), 2454-2458. https://doi.org/10.3201/eid2709.211042.

Bordetella hinzii Meningitis in Patient with History of Kidney Transplant, Virginia, USA [PDF - 688 KB - 3 pages]
J. Pechacek et al.

A patient in Virginia, USA, who had previously undergone multiple kidney transplantations showed signs of Bordetella hinzii bacteremia and meningitis. This emerging pathogen has been increasingly identified as a clinically significant pathogen in immunosuppressed and, less frequently, immunocompetent patients. This patient was treated and recovered without further issue.

EID Pechacek J, Raybould J, Morales M. Bordetella hinzii Meningitis in Patient with History of Kidney Transplant, Virginia, USA. Emerg Infect Dis. 2021;27(9):2459-2461. https://doi.org/10.3201/eid2709.210350
AMA Pechacek J, Raybould J, Morales M. Bordetella hinzii Meningitis in Patient with History of Kidney Transplant, Virginia, USA. Emerging Infectious Diseases. 2021;27(9):2459-2461. doi:10.3201/eid2709.210350.
APA Pechacek, J., Raybould, J., & Morales, M. (2021). Bordetella hinzii Meningitis in Patient with History of Kidney Transplant, Virginia, USA. Emerging Infectious Diseases, 27(9), 2459-2461. https://doi.org/10.3201/eid2709.210350.

Disseminated Cutaneous Leishmaniasis and Alcohol Misuse, Northeast Brazil, 2015–2018 [PDF - 1.82 MB - 4 pages]
A. Q. Sousa et al.

Disseminated cutaneous leishmaniasis (DCL) is an uncommon form of Leishmania braziliensis infection. It remains unknown why some people develop this clinical condition. We describe 14 DCL patients in Northeast Brazil during 2015–2018. These patients regularly drank large amounts of alcohol, possibly increasing their risk for DCL.

EID Sousa AQ, Filho P, Cavalcante D, Frutuoso MS, Pereira FF, Lima J, et al. Disseminated Cutaneous Leishmaniasis and Alcohol Misuse, Northeast Brazil, 2015–2018. Emerg Infect Dis. 2021;27(9):2462-2465. https://doi.org/10.3201/eid2709.203714
AMA Sousa AQ, Filho P, Cavalcante D, et al. Disseminated Cutaneous Leishmaniasis and Alcohol Misuse, Northeast Brazil, 2015–2018. Emerging Infectious Diseases. 2021;27(9):2462-2465. doi:10.3201/eid2709.203714.
APA Sousa, A. Q., Filho, P., Cavalcante, D., Frutuoso, M. S., Pereira, F. F., Lima, J....Pompeu, M. (2021). Disseminated Cutaneous Leishmaniasis and Alcohol Misuse, Northeast Brazil, 2015–2018. Emerging Infectious Diseases, 27(9), 2462-2465. https://doi.org/10.3201/eid2709.203714.

Ecologic Determinants of West Nile Virus Seroprevalence among Equids, Brazil [PDF - 1.62 MB - 5 pages]
E. F. de Oliveira-Filho et al.

Among 713 equids sampled in northeastern Brazil during 2013–2018, West Nile virus seroprevalence was 4.5% (95% CI 3.1%–6.3%). Mathematical modeling substantiated higher seroprevalence adjacent to an avian migratory route and in areas characterized by forest loss, implying increased risk for zoonotic infections in disturbed areas.

EID de Oliveira-Filho EF, Fischer C, Berneck B, Carneiro IO, Kühne A, de Almeida Campos AC, et al. Ecologic Determinants of West Nile Virus Seroprevalence among Equids, Brazil. Emerg Infect Dis. 2021;27(9):2466-2470. https://doi.org/10.3201/eid2709.204706
AMA de Oliveira-Filho EF, Fischer C, Berneck B, et al. Ecologic Determinants of West Nile Virus Seroprevalence among Equids, Brazil. Emerging Infectious Diseases. 2021;27(9):2466-2470. doi:10.3201/eid2709.204706.
APA de Oliveira-Filho, E. F., Fischer, C., Berneck, B., Carneiro, I. O., Kühne, A., de Almeida Campos, A. C....Drexler, J. (2021). Ecologic Determinants of West Nile Virus Seroprevalence among Equids, Brazil. Emerging Infectious Diseases, 27(9), 2466-2470. https://doi.org/10.3201/eid2709.204706.

Association of Dromedary Camels and Camel Ticks with Reassortant Crimean-Congo Hemorrhagic Fever Virus, United Arab Emirates [PDF - 965 KB - 4 pages]
J. V. Camp et al.

We previously detected a potentially novel reassortant of Crimean-Congo hemorrhagic fever virus in camels at the largest livestock market in the United Arab Emirates. A broader survey of large mammals at the site indicated zoonotic transmission is associated with dromedaries and camel ticks. Seroprevalence in cattle, sheep, and goats is minimal.

EID Camp JV, Weidinger P, Ramaswamy S, Kannan DO, Osman B, Kolodziejek J, et al. Association of Dromedary Camels and Camel Ticks with Reassortant Crimean-Congo Hemorrhagic Fever Virus, United Arab Emirates. Emerg Infect Dis. 2021;27(9):2471-2474. https://doi.org/10.3201/eid2709.210299
AMA Camp JV, Weidinger P, Ramaswamy S, et al. Association of Dromedary Camels and Camel Ticks with Reassortant Crimean-Congo Hemorrhagic Fever Virus, United Arab Emirates. Emerging Infectious Diseases. 2021;27(9):2471-2474. doi:10.3201/eid2709.210299.
APA Camp, J. V., Weidinger, P., Ramaswamy, S., Kannan, D. O., Osman, B., Kolodziejek, J....Nowotny, N. (2021). Association of Dromedary Camels and Camel Ticks with Reassortant Crimean-Congo Hemorrhagic Fever Virus, United Arab Emirates. Emerging Infectious Diseases, 27(9), 2471-2474. https://doi.org/10.3201/eid2709.210299.

Gram-Negative Bacteria Harboring Multiple Carbapenemase Genes, United States, 2012–2019 [PDF - 1.27 MB - 5 pages]
D. Ham et al.

Reports of organisms harboring multiple carbapenemase genes have increased since 2010. During October 2012–April 2019, the Centers for Disease Control and Prevention documented 151 of these isolates from 100 patients in the United States. Possible risk factors included recent history of international travel, international inpatient healthcare, and solid organ or bone marrow transplantation.

EID Ham D, Mahon G, Bhaurla SK, Horwich-Scholefield S, Klein L, Dotson N, et al. Gram-Negative Bacteria Harboring Multiple Carbapenemase Genes, United States, 2012–2019. Emerg Infect Dis. 2021;27(9):2475-2479. https://doi.org/10.3201/eid2709.210456
AMA Ham D, Mahon G, Bhaurla SK, et al. Gram-Negative Bacteria Harboring Multiple Carbapenemase Genes, United States, 2012–2019. Emerging Infectious Diseases. 2021;27(9):2475-2479. doi:10.3201/eid2709.210456.
APA Ham, D., Mahon, G., Bhaurla, S. K., Horwich-Scholefield, S., Klein, L., Dotson, N....Walters, M. (2021). Gram-Negative Bacteria Harboring Multiple Carbapenemase Genes, United States, 2012–2019. Emerging Infectious Diseases, 27(9), 2475-2479. https://doi.org/10.3201/eid2709.210456.

Ongoing High Incidence and Case-Fatality Rates for Invasive Listeriosis, Germany, 2010–2019 [PDF - 1.47 MB - 4 pages]
H. Wilking et al.

We used 10 years of surveillance data to describe listeriosis frequency in Germany. Altogether, 5,576 cases were reported, 91% not pregnancy associated; case counts increased over time. Case-fatality rate was 13% in non–pregnancy-associated cases, most in adults ≥65 years of age. Detecting, investigating, and ending outbreaks might have the greatest effect on incidence

EID Wilking H, Lachmann R, Holzer A, Halbedel S, Flieger A, Stark K. Ongoing High Incidence and Case-Fatality Rates for Invasive Listeriosis, Germany, 2010–2019. Emerg Infect Dis. 2021;27(9):2485-2488. https://doi.org/10.3201/eid2709.210068
AMA Wilking H, Lachmann R, Holzer A, et al. Ongoing High Incidence and Case-Fatality Rates for Invasive Listeriosis, Germany, 2010–2019. Emerging Infectious Diseases. 2021;27(9):2485-2488. doi:10.3201/eid2709.210068.
APA Wilking, H., Lachmann, R., Holzer, A., Halbedel, S., Flieger, A., & Stark, K. (2021). Ongoing High Incidence and Case-Fatality Rates for Invasive Listeriosis, Germany, 2010–2019. Emerging Infectious Diseases, 27(9), 2485-2488. https://doi.org/10.3201/eid2709.210068.

Laboratory Exposures from an Unsuspected Case of Human Infection with Brucella canis [PDF - 1.05 MB - 3 pages]
J. Ahmed-Bentley et al.

We report a case of human infection with a Brucella canis isolate in an adult in Canada who was receiving a biologic immunomodulating medication. We detail subsequent investigations, which showed that 17 clinical microbiology staff had high-risk exposures to the isolate, 1 of whom had a positive result for B. canis.

EID Ahmed-Bentley J, Roman S, Mirzanejad Y, Fraser E, Hoang L, Young EJ, et al. Laboratory Exposures from an Unsuspected Case of Human Infection with Brucella canis. Emerg Infect Dis. 2021;27(9):2489-2491. https://doi.org/10.3201/eid2709.204701
AMA Ahmed-Bentley J, Roman S, Mirzanejad Y, et al. Laboratory Exposures from an Unsuspected Case of Human Infection with Brucella canis. Emerging Infectious Diseases. 2021;27(9):2489-2491. doi:10.3201/eid2709.204701.
APA Ahmed-Bentley, J., Roman, S., Mirzanejad, Y., Fraser, E., Hoang, L., Young, E. J....Deans, G. (2021). Laboratory Exposures from an Unsuspected Case of Human Infection with Brucella canis. Emerging Infectious Diseases, 27(9), 2489-2491. https://doi.org/10.3201/eid2709.204701.

Highly Pathogenic Avian Influenza A(H5N6) Virus Clade 2.3.4.4h in Wild Birds and Live Poultry Markets, Bangladesh [PDF - 615 KB - 3 pages]
J. Turner et al.

Migratory birds play a major role in spreading influenza viruses over long distances. We report highly pathogenic avian influenza A(H5N6) viruses in migratory and resident ducks in Bangladesh. The viruses were genetically similar to viruses detected in wild birds in China and Mongolia, suggesting migration-associated dissemination of these zoonotic pathogens.

EID Turner J, Barman S, Feeroz MM, Hasan M, Akhtar S, Jeevan T, et al. Highly Pathogenic Avian Influenza A(H5N6) Virus Clade 2.3.4.4h in Wild Birds and Live Poultry Markets, Bangladesh. Emerg Infect Dis. 2021;27(9):2492-2494. https://doi.org/10.3201/eid2709.210819
AMA Turner J, Barman S, Feeroz MM, et al. Highly Pathogenic Avian Influenza A(H5N6) Virus Clade 2.3.4.4h in Wild Birds and Live Poultry Markets, Bangladesh. Emerging Infectious Diseases. 2021;27(9):2492-2494. doi:10.3201/eid2709.210819.
APA Turner, J., Barman, S., Feeroz, M. M., Hasan, M., Akhtar, S., Jeevan, T....Webby, R. J. (2021). Highly Pathogenic Avian Influenza A(H5N6) Virus Clade 2.3.4.4h in Wild Birds and Live Poultry Markets, Bangladesh. Emerging Infectious Diseases, 27(9), 2492-2494. https://doi.org/10.3201/eid2709.210819.

Hotspot of Crimean-Congo Hemorrhagic Fever Virus Seropositivity in Wildlife, Northeastern Spain [PDF - 2.48 MB - 5 pages]
J. Espunyes et al.

We conducted a serosurvey for Crimean-Congo hemorrhagic fever virus antibodies in various wildlife species in Catalonia, northeastern Spain. We detected high seroprevalence in southern Catalonia, close to the Ebro Delta wetland, a key stopover for birds migrating from Africa. Our findings could indicate that competent virus vectors are present in the region.

EID Espunyes J, Cabezón O, Pailler-García L, Dias-Alves A, Lobato-Bailón L, Marco I, et al. Hotspot of Crimean-Congo Hemorrhagic Fever Virus Seropositivity in Wildlife, Northeastern Spain. Emerg Infect Dis. 2021;27(9):2480-2484. https://doi.org/10.3201/eid2709.211105
AMA Espunyes J, Cabezón O, Pailler-García L, et al. Hotspot of Crimean-Congo Hemorrhagic Fever Virus Seropositivity in Wildlife, Northeastern Spain. Emerging Infectious Diseases. 2021;27(9):2480-2484. doi:10.3201/eid2709.211105.
APA Espunyes, J., Cabezón, O., Pailler-García, L., Dias-Alves, A., Lobato-Bailón, L., Marco, I....Napp, S. (2021). Hotspot of Crimean-Congo Hemorrhagic Fever Virus Seropositivity in Wildlife, Northeastern Spain. Emerging Infectious Diseases, 27(9), 2480-2484. https://doi.org/10.3201/eid2709.211105.
Research Letters

Invasive Meningococcal Disease, 2011–2020, and Impact of the COVID-19 Pandemic, England [PDF - 878 KB - 3 pages]
S. Subbarao et al.

Invasive meningococcal disease incidence in England declined from 1.93/100,000 persons (1,016 cases) in 2010–11 to 0.95/100,000 (530 cases) in 2018–19 and 0.74/100,000 in 2019–20 (419 cases). During national lockdown for the coronavirus disease pandemic (April–August 2020), incidence was 75% lower than during April–August 2019.

EID Subbarao S, Campbell H, Ribeiro S, Clark SA, Lucidarme J, Ramsay M, et al. Invasive Meningococcal Disease, 2011–2020, and Impact of the COVID-19 Pandemic, England. Emerg Infect Dis. 2021;27(9):2495-2497. https://doi.org/10.3201/eid2709.204866
AMA Subbarao S, Campbell H, Ribeiro S, et al. Invasive Meningococcal Disease, 2011–2020, and Impact of the COVID-19 Pandemic, England. Emerging Infectious Diseases. 2021;27(9):2495-2497. doi:10.3201/eid2709.204866.
APA Subbarao, S., Campbell, H., Ribeiro, S., Clark, S. A., Lucidarme, J., Ramsay, M....Ladhani, S. (2021). Invasive Meningococcal Disease, 2011–2020, and Impact of the COVID-19 Pandemic, England. Emerging Infectious Diseases, 27(9), 2495-2497. https://doi.org/10.3201/eid2709.204866.

SARS-CoV-2 Infection among Pregnant and Postpartum Women, Kenya, 2020–2021 [PDF - 804 KB - 3 pages]
N. A. Otieno et al.

We determined incidence of severe acute respiratory syndrome coronavirus 2 and influenza virus infections among pregnant and postpartum women and their infants in Kenya during 2020–2021. Incidence of severe acute respiratory syndrome coronavirus 2 was highest among pregnant women, followed by postpartum women and infants. No influenza virus infections were identified.

EID Otieno NA, Azziz-Baumgartner E, Nyawanda BO, Oreri E, Ellington S, Onyango C, et al. SARS-CoV-2 Infection among Pregnant and Postpartum Women, Kenya, 2020–2021. Emerg Infect Dis. 2021;27(9):2497-2499. https://doi.org/10.3201/eid2709.210849
AMA Otieno NA, Azziz-Baumgartner E, Nyawanda BO, et al. SARS-CoV-2 Infection among Pregnant and Postpartum Women, Kenya, 2020–2021. Emerging Infectious Diseases. 2021;27(9):2497-2499. doi:10.3201/eid2709.210849.
APA Otieno, N. A., Azziz-Baumgartner, E., Nyawanda, B. O., Oreri, E., Ellington, S., Onyango, C....Emukule, G. O. (2021). SARS-CoV-2 Infection among Pregnant and Postpartum Women, Kenya, 2020–2021. Emerging Infectious Diseases, 27(9), 2497-2499. https://doi.org/10.3201/eid2709.210849.

Genomic Evolution of SARS-CoV-2 Virus in Immunocompromised Patient, Ireland [PDF - 858 KB - 3 pages]
M. Lynch et al.

We examined virus genomic evolution in an immunocompromised patient with prolonged severe acute respiratory syndrome coronavirus 2 infection. Genomic sequencing revealed genetic variation during infection: 3 intrahost mutations and possible superinfection with a second strain of the virus. Prolonged infection in immunocompromised patients may lead to emergence of new virus variants.

EID Lynch M, Macori G, Fanning S, O’Regan E, Hunt E, O’Callaghan D, et al. Genomic Evolution of SARS-CoV-2 Virus in Immunocompromised Patient, Ireland. Emerg Infect Dis. 2021;27(9):2499-2501. https://doi.org/10.3201/eid2709.211159
AMA Lynch M, Macori G, Fanning S, et al. Genomic Evolution of SARS-CoV-2 Virus in Immunocompromised Patient, Ireland. Emerging Infectious Diseases. 2021;27(9):2499-2501. doi:10.3201/eid2709.211159.
APA Lynch, M., Macori, G., Fanning, S., O’Regan, E., Hunt, E., O’Callaghan, D....Fortune, A. (2021). Genomic Evolution of SARS-CoV-2 Virus in Immunocompromised Patient, Ireland. Emerging Infectious Diseases, 27(9), 2499-2501. https://doi.org/10.3201/eid2709.211159.

Prevalence of mcr-1 in Colonized Inpatients, China, 2011–2019 [PDF - 1.07 MB - 3 pages]
C. Shen et al.

In response to the spread of colistin resistance gene mcr-1, China banned the use of colistin in livestock fodders. We used a time-series analysis of inpatient colonization data from 2011–2019 to accurately reveal the associated fluctuations of mcr-1 that occurred in inpatients in response to the ban.

EID Shen C, Zhong L, Zhong Z, Doi Y, Shen J, Wang Y, et al. Prevalence of mcr-1 in Colonized Inpatients, China, 2011–2019. Emerg Infect Dis. 2021;27(9):2502-2504. https://doi.org/10.3201/eid2709.203642
AMA Shen C, Zhong L, Zhong Z, et al. Prevalence of mcr-1 in Colonized Inpatients, China, 2011–2019. Emerging Infectious Diseases. 2021;27(9):2502-2504. doi:10.3201/eid2709.203642.
APA Shen, C., Zhong, L., Zhong, Z., Doi, Y., Shen, J., Wang, Y....Tian, G. (2021). Prevalence of mcr-1 in Colonized Inpatients, China, 2011–2019. Emerging Infectious Diseases, 27(9), 2502-2504. https://doi.org/10.3201/eid2709.203642.

Haemophilus influenzae Type a Sequence Type 23, Northern Spain [PDF - 894 KB - 3 pages]
M. López-Olaizola et al.

Two consecutive cases of Haemophilus influenzae type a sequence type 23 invasive infection in 2 children attending the same daycare in 2019 triggered epidemiologic surveillance of H. influenzae infections in northern Spain. Despite the invasiveness potential of this virus strain, we detected no additional cases for 2013–2020.

EID López-Olaizola M, Aguirre-Quiñonero A, Canut A, Barrios J, Cilla G, Vicente D, et al. Haemophilus influenzae Type a Sequence Type 23, Northern Spain. Emerg Infect Dis. 2021;27(9):2504-2506. https://doi.org/10.3201/eid2709.204247
AMA López-Olaizola M, Aguirre-Quiñonero A, Canut A, et al. Haemophilus influenzae Type a Sequence Type 23, Northern Spain. Emerging Infectious Diseases. 2021;27(9):2504-2506. doi:10.3201/eid2709.204247.
APA López-Olaizola, M., Aguirre-Quiñonero, A., Canut, A., Barrios, J., Cilla, G., Vicente, D....Marimón, J. (2021). Haemophilus influenzae Type a Sequence Type 23, Northern Spain. Emerging Infectious Diseases, 27(9), 2504-2506. https://doi.org/10.3201/eid2709.204247.
Letters

Fecal Excretion of Mycobacterium leprae, Burkina Faso [PDF - 633 KB - 2 pages]
A. Singh et al.
EID Singh A, Yadav R, Pawar H, Chauhan D. Fecal Excretion of Mycobacterium leprae, Burkina Faso. Emerg Infect Dis. 2021;27(9):2507-2508. https://doi.org/10.3201/eid2709.211262
AMA Singh A, Yadav R, Pawar H, et al. Fecal Excretion of Mycobacterium leprae, Burkina Faso. Emerging Infectious Diseases. 2021;27(9):2507-2508. doi:10.3201/eid2709.211262.
APA Singh, A., Yadav, R., Pawar, H., & Chauhan, D. (2021). Fecal Excretion of Mycobacterium leprae, Burkina Faso. Emerging Infectious Diseases, 27(9), 2507-2508. https://doi.org/10.3201/eid2709.211262.

SARS-CoV-2 Superspread in Fitness Center, Hong Kong, China, March 2021 [PDF - 630 KB - 1 page]
L. C. Marr
EID Marr LC. SARS-CoV-2 Superspread in Fitness Center, Hong Kong, China, March 2021. Emerg Infect Dis. 2021;27(9):2507. https://doi.org/10.3201/eid2709.211177
AMA Marr LC. SARS-CoV-2 Superspread in Fitness Center, Hong Kong, China, March 2021. Emerging Infectious Diseases. 2021;27(9):2507. doi:10.3201/eid2709.211177.
APA Marr, L. C. (2021). SARS-CoV-2 Superspread in Fitness Center, Hong Kong, China, March 2021. Emerging Infectious Diseases, 27(9), 2507. https://doi.org/10.3201/eid2709.211177.
Books and Media

People Count: Contact-Tracing Apps and Public Health [PDF - 751 KB - 1 page]
I. Fung and B. Chan
EID Fung I, Chan B. People Count: Contact-Tracing Apps and Public Health. Emerg Infect Dis. 2021;27(9):2509. https://doi.org/10.3201/eid2709.210754
AMA Fung I, Chan B. People Count: Contact-Tracing Apps and Public Health. Emerging Infectious Diseases. 2021;27(9):2509. doi:10.3201/eid2709.210754.
APA Fung, I., & Chan, B. (2021). People Count: Contact-Tracing Apps and Public Health. Emerging Infectious Diseases, 27(9), 2509. https://doi.org/10.3201/eid2709.210754.
About the Cover

Considering Mycological Rarities [PDF - 1.91 MB - 2 pages]
B. Breedlove
EID Breedlove B. Considering Mycological Rarities. Emerg Infect Dis. 2021;27(9):2510-2511. https://doi.org/10.3201/eid2709.ac2709
AMA Breedlove B. Considering Mycological Rarities. Emerging Infectious Diseases. 2021;27(9):2510-2511. doi:10.3201/eid2709.ac2709.
APA Breedlove, B. (2021). Considering Mycological Rarities. Emerging Infectious Diseases, 27(9), 2510-2511. https://doi.org/10.3201/eid2709.ac2709.
Etymologia

Talaromyces marneffei [PDF - 1.38 MB - 1 page]
M. Mahajan
EID Mahajan M. Talaromyces marneffei. Emerg Infect Dis. 2021;27(9):2278. https://doi.org/10.3201/eid2709.210318
AMA Mahajan M. Talaromyces marneffei. Emerging Infectious Diseases. 2021;27(9):2278. doi:10.3201/eid2709.210318.
APA Mahajan, M. (2021). Talaromyces marneffei. Emerging Infectious Diseases, 27(9), 2278. https://doi.org/10.3201/eid2709.210318.

Paracoccidioides [PDF - 1.10 MB - 1 page]
L. Oliveira and P. de Sousa Lima
EID Oliveira L, de Sousa Lima P. Paracoccidioides. Emerg Infect Dis. 2021;27(9):2360. https://doi.org/10.3201/eid2709.210461
AMA Oliveira L, de Sousa Lima P. Paracoccidioides. Emerging Infectious Diseases. 2021;27(9):2360. doi:10.3201/eid2709.210461.
APA Oliveira, L., & de Sousa Lima, P. (2021). Paracoccidioides. Emerging Infectious Diseases, 27(9), 2360. https://doi.org/10.3201/eid2709.210461.
Online Reports

SARS-CoV-2 Wastewater Surveillance for Public Health Action [PDF - 677 KB - 9 pages]
J. S. McClary-Gutierrez et al.

Wastewater surveillance for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has garnered extensive public attention during the coronavirus disease pandemic as a proposed complement to existing disease surveillance systems. Over the past year, methods for detection and quantification of SARS-CoV-2 viral RNA in untreated sewage have advanced, and concentrations in wastewater have been shown to correlate with trends in reported cases. Despite the promise of wastewater surveillance, for these measurements to translate into useful public health tools, bridging the communication and knowledge gaps between researchers and public health responders is needed. We describe the key uses, barriers, and applicability of SARS-CoV-2 wastewater surveillance for supporting public health decisions and actions, including establishing ethics consideration for monitoring. Although wastewater surveillance to assess community infections is not a new idea, the coronavirus disease pandemic might be the initiating event to make this emerging public health tool a sustainable nationwide surveillance system, provided that these barriers are addressed.

EID McClary-Gutierrez JS, Mattioli MC, Marcenac P, Silverman AI, Boehm AB, Bibby K, et al. SARS-CoV-2 Wastewater Surveillance for Public Health Action. Emerg Infect Dis. 2021;27(9):1-8. https://doi.org/10.3201/eid2709.210753
AMA McClary-Gutierrez JS, Mattioli MC, Marcenac P, et al. SARS-CoV-2 Wastewater Surveillance for Public Health Action. Emerging Infectious Diseases. 2021;27(9):1-8. doi:10.3201/eid2709.210753.
APA McClary-Gutierrez, J. S., Mattioli, M. C., Marcenac, P., Silverman, A. I., Boehm, A. B., Bibby, K....McLellan, S. L. (2021). SARS-CoV-2 Wastewater Surveillance for Public Health Action. Emerging Infectious Diseases, 27(9), 1-8. https://doi.org/10.3201/eid2709.210753.
Corrections

Correction: Vol. 26, No. 6 [PDF - 561 KB - 1 page]
EID Correction: Vol. 26, No. 6. Emerg Infect Dis. 2021;27(9):2508. https://doi.org/10.3201/eid2709.c12706
AMA Correction: Vol. 26, No. 6. Emerging Infectious Diseases. 2021;27(9):2508. doi:10.3201/eid2709.c12706.
APA (2021). Correction: Vol. 26, No. 6. Emerging Infectious Diseases, 27(9), 2508. https://doi.org/10.3201/eid2709.c12706.
Page created: August 24, 2021
Page updated: August 25, 2021
Page reviewed: August 25, 2021
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