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Articles from Emerging Infectious Diseases

Synopses

Localized Outbreaks of Epidemic Polyarthritis among Military Personnel Caused by Different Sublineages of Ross River Virus, Northeastern Australia, 2016–2017 [PDF - 1.88 MB - 9 pages]
W. Liu et al.

Two outbreaks of epidemic polyarthritis occurred among Australian Defence Force personnel during and following short military exercises in the Shoalwater Bay Training Area, northeastern Australia, in 2016 and 2017. Ross River virus (RRV) IgM was detected in acute-phase serum samples from most patients (28/28 in 2016 and 25/31 in 2017), and RRV was recovered from 4/38 serum samples assayed (1/21 in 2016 and 3/17 in 2017). Phylogenetic analyses of RRV envelope glycoprotein E2 and nonstructural protein nsP3 nucleotide sequences segregated the RRV isolates obtained in 2016 and 2017 outbreaks into 2 distinct sublineages, suggesting that each outbreak was caused by a different strain of RRV. The spatiotemporal characteristics of the 2016 outbreak suggested that some of the infections involved human-mosquito-human transmission without any intermediate host. These outbreaks highlight the importance of personal protective measures in preventing vectorborne diseases for which no vaccine or specific prophylaxis exists.

EID Liu W, Kizu JR, Le Grand LR, Moller CG, Carthew TL, Mitchell IR, et al. Localized Outbreaks of Epidemic Polyarthritis among Military Personnel Caused by Different Sublineages of Ross River Virus, Northeastern Australia, 2016–2017. Emerg Infect Dis. 2019;25(10):1793-1801. https://dx.doi.org/10.3201/eid2510.181610
AMA Liu W, Kizu JR, Le Grand LR, et al. Localized Outbreaks of Epidemic Polyarthritis among Military Personnel Caused by Different Sublineages of Ross River Virus, Northeastern Australia, 2016–2017. Emerging Infectious Diseases. 2019;25(10):1793-1801. doi:10.3201/eid2510.181610.
APA Liu, W., Kizu, J. R., Le Grand, L. R., Moller, C. G., Carthew, T. L., Mitchell, I. R....Aaskov, J. G. (2019). Localized Outbreaks of Epidemic Polyarthritis among Military Personnel Caused by Different Sublineages of Ross River Virus, Northeastern Australia, 2016–2017. Emerging Infectious Diseases, 25(10), 1793-1801. https://dx.doi.org/10.3201/eid2510.181610.

Transmissibility of MERS-CoV Infection in Closed Setting, Riyadh, Saudi Arabia, 2015 [PDF - 1.24 MB - 8 pages]
M. D. Van Kerkhove et al.

To investigate a cluster of Middle East respiratory syndrome (MERS) cases in a women-only dormitory in Riyadh, Saudi Arabia, in October 2015, we collected epidemiologic information, nasopharyngeal/oropharyngeal swab samples, and blood samples from 828 residents during November 2015 and December 2015–January 2016. We found confirmed infection for 19 (8 by reverse transcription PCR and 11 by serologic testing). Infection attack rates varied (2.7%–32.3%) by dormitory building. No deaths occurred. Independent risk factors for infection were direct contact with a confirmed case-patient and sharing a room with a confirmed case-patient; a protective factor was having an air conditioner in the bedroom. For 9 women from whom a second serum sample was collected, antibodies remained detectable at titers >1:20 by pseudoparticle neutralization tests (n = 8) and 90% plaque-reduction neutralization tests (n = 2). In closed high-contact settings, MERS coronavirus was highly infectious and pathogenicity was relatively low.

EID Van Kerkhove MD, Alaswad S, Assiri A, Perera R, Peiris M, El Bushra HE, et al. Transmissibility of MERS-CoV Infection in Closed Setting, Riyadh, Saudi Arabia, 2015. Emerg Infect Dis. 2019;25(10):1802-1809. https://dx.doi.org/10.3201/eid2510.190130
AMA Van Kerkhove MD, Alaswad S, Assiri A, et al. Transmissibility of MERS-CoV Infection in Closed Setting, Riyadh, Saudi Arabia, 2015. Emerging Infectious Diseases. 2019;25(10):1802-1809. doi:10.3201/eid2510.190130.
APA Van Kerkhove, M. D., Alaswad, S., Assiri, A., Perera, R., Peiris, M., El Bushra, H. E....BinSaeed, A. A. (2019). Transmissibility of MERS-CoV Infection in Closed Setting, Riyadh, Saudi Arabia, 2015. Emerging Infectious Diseases, 25(10), 1802-1809. https://dx.doi.org/10.3201/eid2510.190130.

Emergence and Containment of Canine Influenza Virus A(H3N2), Ontario, Canada, 2017–2018 [PDF - 1.45 MB - 7 pages]
J. Weese et al.

Canine influenza virus (CIV) A(H3N2) was identified in 104 dogs in Ontario, Canada, during December 28, 2017–October 30, 2018, in distinct epidemiologic clusters. High morbidity rates occurred within groups of dogs, and kennels and a veterinary clinic were identified as foci of infection. Death attributable to CIV infection occurred in 2 (2%) of 104 diagnosed cases. A combination of testing of suspected cases, contact tracing and testing, and 28-day isolation of infected dogs was used, and CIV transmission was contained in each outbreak. Dogs recently imported from Asia were implicated as the source of infection. CIV H3N2 spread rapidly within groups in this immunologically naive population; however, containment measures were apparently effective, demonstrating the potential value of prompt diagnosis and implementation of CIV control measures.

EID Weese J, Anderson M, Berhane Y, Doyle KF, Leutenegger C, Chan R, et al. Emergence and Containment of Canine Influenza Virus A(H3N2), Ontario, Canada, 2017–2018. Emerg Infect Dis. 2019;25(10):1810-1816. https://dx.doi.org/10.3201/eid2510.190196
AMA Weese J, Anderson M, Berhane Y, et al. Emergence and Containment of Canine Influenza Virus A(H3N2), Ontario, Canada, 2017–2018. Emerging Infectious Diseases. 2019;25(10):1810-1816. doi:10.3201/eid2510.190196.
APA Weese, J., Anderson, M., Berhane, Y., Doyle, K. F., Leutenegger, C., Chan, R....Ojkic, D. (2019). Emergence and Containment of Canine Influenza Virus A(H3N2), Ontario, Canada, 2017–2018. Emerging Infectious Diseases, 25(10), 1810-1816. https://dx.doi.org/10.3201/eid2510.190196.

Medscape CME Activity
Edwardsiella tarda Bacteremia, Okayama, Japan, 2005–2016 [PDF - 530 KB - 7 pages]
S. Kamiyama et al.

Edwardsiella tarda is primarily associated with gastrointestinal disease, but an increasing number of cases involving extraintestinal disease, especially E. tarda bacteremia, have been reported. Using clinical information of E. tarda bacteremia patients identified during January 2005–December 2016 in Japan, we characterized the clinical epidemiology of E. tarda bacteremia. A total of 182,668 sets of blood cultures were obtained during the study period; 40 (0.02%) sets from 26 patients were positive for E. tarda. The most common clinical manifestations were hepatobiliary infection, including cholangitis, liver abscess, and cholecystitis. Overall 30-day mortality for E. tarda bacteremia was 12%, and overall 90-day mortality was 27%. The incidence of E. tarda infection did not vary by season. We more frequently observed hepatobiliary infection in patients with E. tarda bacteremia than in patients with nonbacteremic E. tarda infections. E. tarda bacteremia is a rare entity that is not associated with high rates of death.

EID Kamiyama S, Kuriyama A, Hashimoto T. Edwardsiella tarda Bacteremia, Okayama, Japan, 2005–2016. Emerg Infect Dis. 2019;25(10):1817-1823. https://dx.doi.org/10.3201/eid2510.180518
AMA Kamiyama S, Kuriyama A, Hashimoto T. Edwardsiella tarda Bacteremia, Okayama, Japan, 2005–2016. Emerging Infectious Diseases. 2019;25(10):1817-1823. doi:10.3201/eid2510.180518.
APA Kamiyama, S., Kuriyama, A., & Hashimoto, T. (2019). Edwardsiella tarda Bacteremia, Okayama, Japan, 2005–2016. Emerging Infectious Diseases, 25(10), 1817-1823. https://dx.doi.org/10.3201/eid2510.180518.

Medscape CME Activity
Case Studies and Literature Review of Pneumococcal Septic Arthritis in Adults [PDF - 928 KB - 10 pages]
A. Dernoncourt et al.

We conducted a retrospective study on all cases of pneumococcal septic arthritis (SA) in patients >18 years of age reported to the Picardie Regional Pneumococcal Network in France during 2005–2016. Among 1,062 cases of invasive pneumococcal disease, we observed 16 (1.5%) SA cases. Although SA is uncommon in adult patients, the prevalence of pneumococcal SA in the Picardie region increased from 0.69% during 2005–2010 to 2.47% during 2011–2016 after introduction of the pneumococcal 13-valent conjugate vaccine. We highlight the emergence of SA cases caused by the 23B serotype, which is not covered in the vaccine.

EID Dernoncourt A, El Samad Y, Schmidt J, Emond J, Gouraud C, Brocard A, et al. Case Studies and Literature Review of Pneumococcal Septic Arthritis in Adults. Emerg Infect Dis. 2019;25(10):1824-1833. https://dx.doi.org/10.3201/eid2510.181695
AMA Dernoncourt A, El Samad Y, Schmidt J, et al. Case Studies and Literature Review of Pneumococcal Septic Arthritis in Adults. Emerging Infectious Diseases. 2019;25(10):1824-1833. doi:10.3201/eid2510.181695.
APA Dernoncourt, A., El Samad, Y., Schmidt, J., Emond, J., Gouraud, C., Brocard, A....Hamdad, F. (2019). Case Studies and Literature Review of Pneumococcal Septic Arthritis in Adults. Emerging Infectious Diseases, 25(10), 1824-1833. https://dx.doi.org/10.3201/eid2510.181695.

Global Epidemiology of Diphtheria, 2000–2017 [PDF - 1.27 MB - 9 pages]
K. Clarke et al.

In 2017, a total of 8,819 cases of diphtheria were reported worldwide, the most since 2004. However, recent diphtheria epidemiology has not been well described. We analyzed incidence data and data from the literature to describe diphtheria epidemiology. World Health Organization surveillance data were 81% complete; completeness varied by region, indicating underreporting. As national diphtheria–tetanus–pertussis (DTP) 3 coverage increased, the proportion of case-patients <15 years of age decreased, indicating increased protection of young children. In countries with higher case counts, 66% of case-patients were unvaccinated and 63% were <15 years of age. In countries with sporadic cases, 32% of case-patients were unvaccinated and 66% were >15 years of age, consistent with waning vaccine immunity. Global DTP3 coverage is suboptimal. Attaining high DTP3 coverage and implementing recommended booster doses are necessary to decrease diphtheria incidence. Collection and use of data on subnational and booster dose coverage, enhanced laboratory capacity, and case-based surveillance would improve data quality.

EID Clarke K, MacNeil A, Hadler S, Scott C, Tiwari T, Cherian T. Global Epidemiology of Diphtheria, 2000–2017. Emerg Infect Dis. 2019;25(10):1834-1842. https://dx.doi.org/10.3201/eid2510.190271
AMA Clarke K, MacNeil A, Hadler S, et al. Global Epidemiology of Diphtheria, 2000–2017. Emerging Infectious Diseases. 2019;25(10):1834-1842. doi:10.3201/eid2510.190271.
APA Clarke, K., MacNeil, A., Hadler, S., Scott, C., Tiwari, T., & Cherian, T. (2019). Global Epidemiology of Diphtheria, 2000–2017. Emerging Infectious Diseases, 25(10), 1834-1842. https://dx.doi.org/10.3201/eid2510.190271.
Research

VAR2CSA Serology to Detect Plasmodium falciparum Transmission Patterns in Pregnancy [PDF - 7.09 MB - 10 pages]
A. Fonseca et al.

Pregnant women constitute a promising sentinel group for continuous monitoring of malaria transmission. To identify antibody signatures of recent Plasmodium falciparum exposure during pregnancy, we dissected IgG responses against VAR2CSA, the parasite antigen that mediates placental sequestration. We used a multiplex peptide-based suspension array in 2,354 samples from pregnant women from Mozambique, Benin, Kenya, Gabon, Tanzania, and Spain. Two VAR2CSA peptides of limited polymorphism were immunogenic and targeted by IgG responses readily boosted during infection and with estimated half-lives of <2 years. Seroprevalence against these peptides reflected declines and rebounds of transmission in southern Mozambique during 2004–2012, reduced exposure associated with use of preventive measures during pregnancy, and local clusters of transmission that were missed by detection of P. falciparum infections. These data suggest that VAR2CSA serology can provide a useful adjunct for the fine-scale estimation of the malaria burden among pregnant women over time and space.

EID Fonseca A, González R, Bardají A, Jairoce C, Rupérez M, Jiménez A, et al. VAR2CSA Serology to Detect Plasmodium falciparum Transmission Patterns in Pregnancy. Emerg Infect Dis. 2019;25(10):1851-1860. https://dx.doi.org/10.3201/eid2510.181177
AMA Fonseca A, González R, Bardají A, et al. VAR2CSA Serology to Detect Plasmodium falciparum Transmission Patterns in Pregnancy. Emerging Infectious Diseases. 2019;25(10):1851-1860. doi:10.3201/eid2510.181177.
APA Fonseca, A., González, R., Bardají, A., Jairoce, C., Rupérez, M., Jiménez, A....Mayor, A. (2019). VAR2CSA Serology to Detect Plasmodium falciparum Transmission Patterns in Pregnancy. Emerging Infectious Diseases, 25(10), 1851-1860. https://dx.doi.org/10.3201/eid2510.181177.

Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa, Zhejiang Province, China [PDF - 1.41 MB - 7 pages]
Y. Hu et al.

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a public health concern worldwide, but comprehensive analysis of risk factors for CRPA remains limited in China. We conducted a retrospective observational study of carbapenem resistance in 71,880 P. aeruginosa isolates collected in Zhejiang Province during 2015–2017. We analyzed risk factors for CRPA, including the type of clinical specimen; the year, season, and region in which it was collected; patient information, including age, whether they were an outpatient or inpatient, and whether inpatients were in the intensive care unit or general ward; and the level of hospital submitting isolates. We found CRPA was more prevalent among isolates from patients >60 years of age and in inpatients, especially in intensive care units. In addition, specimen types and seasons in which they were collected were associated with higher rates of CRPA. Our findings can help hospitals reduce the spread of P. aeruginosa and optimize antimicrobial drug use.

EID Hu Y, Cao J, Yang Q, Chen S, Lv H, Zhou H, et al. Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa, Zhejiang Province, China. Emerg Infect Dis. 2019;25(10):1861-1867. https://dx.doi.org/10.3201/eid2510.181699
AMA Hu Y, Cao J, Yang Q, et al. Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa, Zhejiang Province, China. Emerging Infectious Diseases. 2019;25(10):1861-1867. doi:10.3201/eid2510.181699.
APA Hu, Y., Cao, J., Yang, Q., Chen, S., Lv, H., Zhou, H....Zhang, R. (2019). Risk Factors for Carbapenem-Resistant Pseudomonas aeruginosa, Zhejiang Province, China. Emerging Infectious Diseases, 25(10), 1861-1867. https://dx.doi.org/10.3201/eid2510.181699.

Sensitive and Specific Detection of Low-Level Antibody Responses in Mild Middle East Respiratory Syndrome Coronavirus Infections [PDF - 1.96 MB - 10 pages]
N. Okba et al.

Middle East respiratory syndrome coronavirus (MERS-CoV) infections in humans can cause asymptomatic to fatal lower respiratory lung disease. Despite posing a probable risk for virus transmission, asymptomatic to mild infections can go unnoticed; a lack of seroconversion among some PCR-confirmed cases has been reported. We found that a MERS-CoV spike S1 protein–based ELISA, routinely used in surveillance studies, showed low sensitivity in detecting infections among PCR-confirmed patients with mild clinical symptoms and cross-reactivity of human coronavirus OC43–positive serum samples. Using in-house S1 ELISA and protein microarray, we demonstrate that most PCR-confirmed MERS-CoV case-patients with mild infections seroconverted; nonetheless, some of these samples did not have detectable levels of virus-neutralizing antibodies. The use of a sensitive and specific serologic S1-based assay can be instrumental in the accurate estimation of MERS-CoV prevalence.

EID Okba N, Raj V, Widjaja I, GeurtsvanKessel CH, de Bruin E, Chandler FD, et al. Sensitive and Specific Detection of Low-Level Antibody Responses in Mild Middle East Respiratory Syndrome Coronavirus Infections. Emerg Infect Dis. 2019;25(10):1868-1877. https://dx.doi.org/10.3201/eid2510.190051
AMA Okba N, Raj V, Widjaja I, et al. Sensitive and Specific Detection of Low-Level Antibody Responses in Mild Middle East Respiratory Syndrome Coronavirus Infections. Emerging Infectious Diseases. 2019;25(10):1868-1877. doi:10.3201/eid2510.190051.
APA Okba, N., Raj, V., Widjaja, I., GeurtsvanKessel, C. H., de Bruin, E., Chandler, F. D....Haagmans, B. L. (2019). Sensitive and Specific Detection of Low-Level Antibody Responses in Mild Middle East Respiratory Syndrome Coronavirus Infections. Emerging Infectious Diseases, 25(10), 1868-1877. https://dx.doi.org/10.3201/eid2510.190051.

Comparison of Serologic Assays for Middle East Respiratory Syndrome Coronavirus [PDF - 816 KB - 6 pages]
R. Harvey et al.

Middle East respiratory syndrome coronavirus (MERS-CoV) was detected in humans in 2012. Since then, sporadic outbreaks with primary transmission through dromedary camels to humans and outbreaks in healthcare settings have shown that MERS-CoV continues to pose a threat to human health. Several serologic assays for MERS-CoV have been developed globally. We describe a collaborative study to investigate the comparability of serologic assays for MERS-CoV and assess any benefit associated with the introduction of a standard reference reagent for MERS-CoV serology. Our study findings indicate that, when possible, laboratories should use a testing algorithm including >2 tests to ensure correct diagnosis of MERS-CoV. We also demonstrate that the use of a reference reagent greatly improves the agreement between assays, enabling more consistent and therefore more meaningful comparisons between results.

EID Harvey R, Mattiuzzo G, Hassall M, Sieberg A, Müller MA, Drosten C, et al. Comparison of Serologic Assays for Middle East Respiratory Syndrome Coronavirus. Emerg Infect Dis. 2019;25(10):1878-1883. https://dx.doi.org/10.3201/eid2510.190497
AMA Harvey R, Mattiuzzo G, Hassall M, et al. Comparison of Serologic Assays for Middle East Respiratory Syndrome Coronavirus. Emerging Infectious Diseases. 2019;25(10):1878-1883. doi:10.3201/eid2510.190497.
APA Harvey, R., Mattiuzzo, G., Hassall, M., Sieberg, A., Müller, M. A., Drosten, C....Oxenford, C. J. (2019). Comparison of Serologic Assays for Middle East Respiratory Syndrome Coronavirus. Emerging Infectious Diseases, 25(10), 1878-1883. https://dx.doi.org/10.3201/eid2510.190497.

Prevalence of Tuberculosis in Children After Natural Disasters, Bohol, Philippines [PDF - 1.83 MB - 8 pages]
K. O. Murray et al.

In 2013, a severe earthquake and typhoon affected Bohol, Philippines. To assess the postdisaster risk for emergence of Mycobacterium tuberculosis infection in children, we conducted a cross-sectional multistage cluster study to estimate the prevalence of tuberculin skin test (TST) positivity and tuberculosis (TB) in children from 200 villages in heavily affected and less affected disaster areas. Of the 5,476 children we enrolled, 355 were TST-positive (weighted prevalence 6.4%); 16 children had active TB. Fourteen (7%) villages had >20% TST-positive prevalence. Although prevalence did not differ significantly between heavily affected and less affected areas, living in a shelter with >25 persons approached significance. TST positivity was independently associated with older age, prior TB treatment, known contact with a person with TB, and living on a geographically isolated island. We found a high TST-positive prevalence, suggesting that national programs should consider the differential vulnerability of children and the role of geographically isolated communities in TB emergence.

EID Murray KO, Castillo-Carandang NT, Mandalakas AM, Cruz AT, Leining LM, Gatchalian SR. Prevalence of Tuberculosis in Children After Natural Disasters, Bohol, Philippines. Emerg Infect Dis. 2019;25(10):1884-1892. https://dx.doi.org/10.3201/eid2510.190619
AMA Murray KO, Castillo-Carandang NT, Mandalakas AM, et al. Prevalence of Tuberculosis in Children After Natural Disasters, Bohol, Philippines. Emerging Infectious Diseases. 2019;25(10):1884-1892. doi:10.3201/eid2510.190619.
APA Murray, K. O., Castillo-Carandang, N. T., Mandalakas, A. M., Cruz, A. T., Leining, L. M., & Gatchalian, S. R. (2019). Prevalence of Tuberculosis in Children After Natural Disasters, Bohol, Philippines. Emerging Infectious Diseases, 25(10), 1884-1892. https://dx.doi.org/10.3201/eid2510.190619.

Sporotrichosis in the Highlands of Madagascar, 2013–2017 [PDF - 1.81 MB - 10 pages]
T. Rasamoelina et al.

Sporotrichosis is a saprozoonotic fungal infection found mostly in tropical and subtropical areas. Few case reports in Madagascar have been published. To document sporotrichosis epidemiology in Madagascar, we conducted a cross-sectional study. During March 2013–June 2017, we recruited from select hospitals in Madagascar patients with chronic cutaneous lesions suggestive of dermatomycosis. Sporotrichosis was diagnosed for 63 (42.5%) of 148 patients. All but 1 patient came from the central highlands, where the prevalence was 0.21 cases/100,000 inhabitants. Frequency was high (64.7%) among patients <18 years of age. Sporotrichosis was diagnosed for 73.8% of patients with arm lesions, 32.3% with leg lesions, and 15.4% with lesions at other sites. Molecular identification identified 53 Sporothrix schenckii isolates. Among the 32 patients who were followed up, response to itraconazole was complete or major for 15 and minor for 17. Overall, endemicity of sporotrichosis in Madagascar was high, concentrated in the highlands.

EID Rasamoelina T, Maubon D, Raharolahy O, Razanakoto H, Rakotozandrindrainy N, Rakotomalala F, et al. Sporotrichosis in the Highlands of Madagascar, 2013–2017. Emerg Infect Dis. 2019;25(10):1893-1902. https://dx.doi.org/10.3201/eid2510.190700
AMA Rasamoelina T, Maubon D, Raharolahy O, et al. Sporotrichosis in the Highlands of Madagascar, 2013–2017. Emerging Infectious Diseases. 2019;25(10):1893-1902. doi:10.3201/eid2510.190700.
APA Rasamoelina, T., Maubon, D., Raharolahy, O., Razanakoto, H., Rakotozandrindrainy, N., Rakotomalala, F....Cornet, M. (2019). Sporotrichosis in the Highlands of Madagascar, 2013–2017. Emerging Infectious Diseases, 25(10), 1893-1902. https://dx.doi.org/10.3201/eid2510.190700.

Medscape CME Activity
Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA, 2002–2015 [PDF - 1.00 MB - 8 pages]
E. Mosites et al.

The risk for invasive streptococcal infection has not been clearly quantified among persons experiencing homelessness (PEH). We compared the incidence of detected cases of invasive group A Streptococcus infection, group B Streptococcus infection, and Streptococcus pneumoniae (pneumococcal) infection among PEH with that among the general population in Anchorage, Alaska, USA, during 2002–2015. We used data from the Centers for Disease Control and Prevention’s Arctic Investigations Program surveillance system, the US Census, and the Anchorage Point-in-Time count (a yearly census of PEH). We detected a disproportionately high incidence of invasive streptococcal disease in Anchorage among PEH. Compared with the general population, PEH were 53.3 times as likely to have invasive group A Streptococcus infection, 6.9 times as likely to have invasive group B Streptococcus infection, and 36.3 times as likely to have invasive pneumococcal infection. Infection control in shelters, pneumococcal vaccination, and infection monitoring could help protect the health of this vulnerable group.

EID Mosites E, Zulz T, Bruden D, Nolen L, Frick A, Castrodale L, et al. Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA, 2002–2015. Emerg Infect Dis. 2019;25(10):1903-1910. https://dx.doi.org/10.3201/eid2510.181408
AMA Mosites E, Zulz T, Bruden D, et al. Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA, 2002–2015. Emerging Infectious Diseases. 2019;25(10):1903-1910. doi:10.3201/eid2510.181408.
APA Mosites, E., Zulz, T., Bruden, D., Nolen, L., Frick, A., Castrodale, L....Bruce, M. G. (2019). Risk for Invasive Streptococcal Infections among Adults Experiencing Homelessness, Anchorage, Alaska, USA, 2002–2015. Emerging Infectious Diseases, 25(10), 1903-1910. https://dx.doi.org/10.3201/eid2510.181408.

Early Diagnosis of Tularemia by Flow Cytometry, Czech Republic, 2003–2015 [PDF - 1.22 MB - 9 pages]
A. Chrdle et al.

We retrospectively assessed the utility of a flow cytometry–based test quantifying the percentage of CD3+ T cells with the CD4–/CD8– phenotype for predicting tularemia diagnoses in 64 probable and confirmed tularemia patients treated during 2003–2015 and 342 controls with tularemia-like illnesses treated during 2012–2015 in the Czech Republic. The median percentage of CD3+/CD4–/CD8– T cells in peripheral blood was higher in tularemia patients (19%, 95% CI 17%–22%) than in controls (3%, 95% CI 2%–3%). When we used 8% as the cutoff, this test’s sensitivity was 0.953 and specificity 0.895 for distinguishing cases from controls. The CD3+/CD4–/CD8– T cells increased a median of 7 days before tularemia serologic test results became positive. This test supports early presumptive diagnosis of tularemia for clinically suspected cases 7–14 days before diagnosis can be confirmed by serologic testing in regions with low prevalences of tularemia-like illnesses.

EID Chrdle A, Tinavská P, Dvořáčková O, Filipová P, Hnetilová V, Žampach P, et al. Early Diagnosis of Tularemia by Flow Cytometry, Czech Republic, 2003–2015. Emerg Infect Dis. 2019;25(10):1919-1927. https://dx.doi.org/10.3201/eid2510.181875
AMA Chrdle A, Tinavská P, Dvořáčková O, et al. Early Diagnosis of Tularemia by Flow Cytometry, Czech Republic, 2003–2015. Emerging Infectious Diseases. 2019;25(10):1919-1927. doi:10.3201/eid2510.181875.
APA Chrdle, A., Tinavská, P., Dvořáčková, O., Filipová, P., Hnetilová, V., Žampach, P....Beeching, N. J. (2019). Early Diagnosis of Tularemia by Flow Cytometry, Czech Republic, 2003–2015. Emerging Infectious Diseases, 25(10), 1919-1927. https://dx.doi.org/10.3201/eid2510.181875.

Economic Burden of West Nile Virus Disease, Quebec, Canada, 2012–2013 [PDF - 508 KB - 8 pages]
N. Ouhoummane et al.

The economic burden of West Nile virus (WNV) infection is not known for Canada. We sought to describe the direct and indirect costs of WNV infection in the province of Quebec, Canada, up to 2 years after onset of signs and symptoms. We conducted a retrospective cohort study that included WNV cases reported during 2012 and 2013. For 90 persons infected with WNV, persons with encephalitis accounted for the largest proportion of total cost: a median cost of $21,332 per patient compared with $8,124 for West Nile meningitis (p = 0.0004) and $192 for West Nile fever (p<0.0001). When results were extrapolated to all reported WNV patients, the estimated total cost for 124 symptomatic cases was ≈$1.7 million for 2012 and that for 31 symptomatic cases was ≈$430,000 for 2013. Our study provides information for the government to make informed decisions regarding public health policies and infectious diseases prevention and control programs.

EID Ouhoummane N, Tchouaket E, Lowe A, Fortin A, Kairy D, Vibien A, et al. Economic Burden of West Nile Virus Disease, Quebec, Canada, 2012–2013. Emerg Infect Dis. 2019;25(10):1943-1950. https://dx.doi.org/10.3201/eid2510.181608
AMA Ouhoummane N, Tchouaket E, Lowe A, et al. Economic Burden of West Nile Virus Disease, Quebec, Canada, 2012–2013. Emerging Infectious Diseases. 2019;25(10):1943-1950. doi:10.3201/eid2510.181608.
APA Ouhoummane, N., Tchouaket, E., Lowe, A., Fortin, A., Kairy, D., Vibien, A....Milord, F. (2019). Economic Burden of West Nile Virus Disease, Quebec, Canada, 2012–2013. Emerging Infectious Diseases, 25(10), 1943-1950. https://dx.doi.org/10.3201/eid2510.181608.

Serologic Evidence of Exposure to Highly Pathogenic Avian Influenza H5 Viruses in Migratory Shorebirds, Australia [PDF - 1.72 MB - 8 pages]
M. Wille et al.

Highly pathogenic avian influenza (HPAI) H5Nx viruses of the goose/Guangdong/96 lineage continue to cause outbreaks in poultry and wild birds globally. Shorebirds, known reservoirs of avian influenza viruses, migrate from Siberia to Australia along the East-Asian-Australasian Flyway. We examined whether migrating shorebirds spending nonbreeding seasons in Australia were exposed to HPAI H5 viruses. We compared those findings with those for a resident duck species. We screened >1,500 blood samples for nucleoprotein antibodies and tested positive samples for specific antibodies against 7 HPAI H5 virus antigens and 2 low pathogenicity avian influenza H5 virus antigens. We demonstrated the presence of hemagglutinin inhibitory antibodies against HPAI H5 virus clade 2.3.4.4 in the red-necked stint (Calidris ruficolis). We did not find hemagglutinin inhibitory antibodies in resident Pacific black ducks (Anas superciliosa). Our study highlights the potential role of long-distance migratory shorebirds in intercontinental spread of HPAI H5 viruses.

EID Wille M, Lisovski S, Risely A, Ferenczi M, Roshier D, Wong F, et al. Serologic Evidence of Exposure to Highly Pathogenic Avian Influenza H5 Viruses in Migratory Shorebirds, Australia. Emerg Infect Dis. 2019;25(10):1903-1910. https://dx.doi.org/10.3201/eid2510.190699
AMA Wille M, Lisovski S, Risely A, et al. Serologic Evidence of Exposure to Highly Pathogenic Avian Influenza H5 Viruses in Migratory Shorebirds, Australia. Emerging Infectious Diseases. 2019;25(10):1903-1910. doi:10.3201/eid2510.190699.
APA Wille, M., Lisovski, S., Risely, A., Ferenczi, M., Roshier, D., Wong, F....Hurt, A. C. (2019). Serologic Evidence of Exposure to Highly Pathogenic Avian Influenza H5 Viruses in Migratory Shorebirds, Australia. Emerging Infectious Diseases, 25(10), 1903-1910. https://dx.doi.org/10.3201/eid2510.190699.
Dispatches

Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit [PDF - 833 KB - 4 pages]
A. Chamieh et al.

We decreased antimicrobial drug consumption in an intensive care unit in Lebanon by changing to colistin monotherapy for extensively drug-resistant Acinetobacter baumanii infections. We saw a 78% decrease of A. baumanii in sputum and near-elimination of blaoxa-23-carrying sequence type 2 clone over the 1-year study. Non–A. baumanii multidrug-resistant infections remained stable.

EID Chamieh A, Nawfal T, Ballouz T, Afif C, Juvelekian G, Hlais S, et al. Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit. Emerg Infect Dis. 2019;25(10):1928-1931. https://dx.doi.org/10.3201/eid2510.181626
AMA Chamieh A, Nawfal T, Ballouz T, et al. Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit. Emerging Infectious Diseases. 2019;25(10):1928-1931. doi:10.3201/eid2510.181626.
APA Chamieh, A., Nawfal, T., Ballouz, T., Afif, C., Juvelekian, G., Hlais, S....Azar, E. (2019). Control and Elimination of Extensively Drug-Resistant Acinetobacter baumanii in an Intensive Care Unit. Emerging Infectious Diseases, 25(10), 1928-1931. https://dx.doi.org/10.3201/eid2510.181626.

Antigenic Variation of Avian Influenza A(H5N6) Viruses, Guangdong Province, China, 2014–2018 [PDF - 2.71 MB - 4 pages]
R. Bai et al.

Market surveillance showed continuing circulation of avian influenza A(H5N6) virus in live poultry markets in Guangdong Province in 2017, despite compulsory vaccination for avian influenza A(H5Nx) and A(H7N9). We analyzed H5N6 viruses from 2014–2018 from Guangdong Province, revealing antigenic drift and decreased antibody response against the vaccine strain in vaccinated chickens.

EID Bai R, Sikkema RS, Li C, Munnink BB, Wu J, Zou L, et al. Antigenic Variation of Avian Influenza A(H5N6) Viruses, Guangdong Province, China, 2014–2018. Emerg Infect Dis. 2019;25(10):1932-1935. https://dx.doi.org/10.3201/eid2510.190274
AMA Bai R, Sikkema RS, Li C, et al. Antigenic Variation of Avian Influenza A(H5N6) Viruses, Guangdong Province, China, 2014–2018. Emerging Infectious Diseases. 2019;25(10):1932-1935. doi:10.3201/eid2510.190274.
APA Bai, R., Sikkema, R. S., Li, C., Munnink, B. B., Wu, J., Zou, L....Ke, C. (2019). Antigenic Variation of Avian Influenza A(H5N6) Viruses, Guangdong Province, China, 2014–2018. Emerging Infectious Diseases, 25(10), 1932-1935. https://dx.doi.org/10.3201/eid2510.190274.

Plasmodium cynomolgi as Cause of Malaria in Tourist to Southeast Asia, 2018 [PDF - 1.62 MB - 4 pages]
G. N. Hartmeyer et al.

We report human infection with simian Plasmodium cynomolgi in a tourist from Denmark who had visited forested areas in peninsular Malaysia and Thailand in August and September 2018. Because P. cynomolgi may go unnoticed by standard malaria diagnostics, this malaria species may be more common in humans than was previously thought.

EID Hartmeyer GN, Stensvold CR, Fabricius T, Marmolin ES, Hoegh SV, Nielsen HV, et al. Plasmodium cynomolgi as Cause of Malaria in Tourist to Southeast Asia, 2018. Emerg Infect Dis. 2019;25(10):1936-1939. https://dx.doi.org/10.3201/eid2510.190448
AMA Hartmeyer GN, Stensvold CR, Fabricius T, et al. Plasmodium cynomolgi as Cause of Malaria in Tourist to Southeast Asia, 2018. Emerging Infectious Diseases. 2019;25(10):1936-1939. doi:10.3201/eid2510.190448.
APA Hartmeyer, G. N., Stensvold, C. R., Fabricius, T., Marmolin, E. S., Hoegh, S. V., Nielsen, H. V....Vestergaard, L. S. (2019). Plasmodium cynomolgi as Cause of Malaria in Tourist to Southeast Asia, 2018. Emerging Infectious Diseases, 25(10), 1936-1939. https://dx.doi.org/10.3201/eid2510.190448.

Bidirectional Human–Swine Transmission of Seasonal Influenza A(H1N1)pdm09 Virus in Pig Herd, France, 2018 [PDF - 598 KB - 4 pages]
A. Chastagner et al.

In 2018, a veterinarian became sick shortly after swabbing sows exhibiting respiratory syndrome on a farm in France. Epidemiologic data and genetic analyses revealed consecutive human-to-swine and swine-to-human influenza A(H1N1)pdm09 virus transmission, which occurred despite some biosecurity measures. Providing pig industry workers the annual influenza vaccine might reduce transmission risk.

EID Chastagner A, Enouf V, Peroz D, Hervé S, Lucas P, Quéguiner S, et al. Bidirectional Human–Swine Transmission of Seasonal Influenza A(H1N1)pdm09 Virus in Pig Herd, France, 2018. Emerg Infect Dis. 2019;25(10):1940-1943. https://dx.doi.org/10.3201/eid2510.190068
AMA Chastagner A, Enouf V, Peroz D, et al. Bidirectional Human–Swine Transmission of Seasonal Influenza A(H1N1)pdm09 Virus in Pig Herd, France, 2018. Emerging Infectious Diseases. 2019;25(10):1940-1943. doi:10.3201/eid2510.190068.
APA Chastagner, A., Enouf, V., Peroz, D., Hervé, S., Lucas, P., Quéguiner, S....Simon, G. (2019). Bidirectional Human–Swine Transmission of Seasonal Influenza A(H1N1)pdm09 Virus in Pig Herd, France, 2018. Emerging Infectious Diseases, 25(10), 1940-1943. https://dx.doi.org/10.3201/eid2510.190068.

Tick-Borne Encephalitis in Auvergne-Rhône-Alpes Region, France, 2017–2018 [PDF - 4.25 MB - 5 pages]
E. Botelho-Nevers et al.

Three autochthonous cases of tick-borne encephalitis (TBE) acquired in rural areas of France where Lyme borreliosis, but not TBE, is endemic highlight the emergence of TBE in new areas. For patients with neurologic involvement who have been in regions where Ixodes ticks circulate, clinicians should test for TBE virus and other tickborne viruses.

EID Botelho-Nevers E, Gagneux-Brunon A, Velay A, Guerbois-Galla M, Grard G, Bretagne C, et al. Tick-Borne Encephalitis in Auvergne-Rhône-Alpes Region, France, 2017–2018. Emerg Infect Dis. 2019;25(10):1944-1948. https://dx.doi.org/10.3201/eid2510.181923
AMA Botelho-Nevers E, Gagneux-Brunon A, Velay A, et al. Tick-Borne Encephalitis in Auvergne-Rhône-Alpes Region, France, 2017–2018. Emerging Infectious Diseases. 2019;25(10):1944-1948. doi:10.3201/eid2510.181923.
APA Botelho-Nevers, E., Gagneux-Brunon, A., Velay, A., Guerbois-Galla, M., Grard, G., Bretagne, C....Pillet, S. (2019). Tick-Borne Encephalitis in Auvergne-Rhône-Alpes Region, France, 2017–2018. Emerging Infectious Diseases, 25(10), 1944-1948. https://dx.doi.org/10.3201/eid2510.181923.

Factoring Prior Treatment into Tuberculosis Infection Prevalence Estimates, United States, 2011–2012 [PDF - 430 KB - 3 pages]
L. A. Vonnahme et al.

To refine estimates of how many persons in the United States are candidates for treatment of latent tuberculosis, we removed from analysis persons who self-reported prior treatment on the National Health and Nutrition Examination Survey 2011–2012. We estimate that 12.6 million persons could benefit from treatment to prevent active tuberculosis.

EID Vonnahme LA, Haddad MB, Navin TR. Factoring Prior Treatment into Tuberculosis Infection Prevalence Estimates, United States, 2011–2012. Emerg Infect Dis. 2019;25(10):1949-1951. https://dx.doi.org/10.3201/eid2510.190439
AMA Vonnahme LA, Haddad MB, Navin TR. Factoring Prior Treatment into Tuberculosis Infection Prevalence Estimates, United States, 2011–2012. Emerging Infectious Diseases. 2019;25(10):1949-1951. doi:10.3201/eid2510.190439.
APA Vonnahme, L. A., Haddad, M. B., & Navin, T. R. (2019). Factoring Prior Treatment into Tuberculosis Infection Prevalence Estimates, United States, 2011–2012. Emerging Infectious Diseases, 25(10), 1949-1951. https://dx.doi.org/10.3201/eid2510.190439.

Melioidosis after Hurricanes Irma and Maria, St. Thomas/St. John District, US Virgin Islands, October 2017 [PDF - 929 KB - 4 pages]
I. Guendel et al.

We report 2 cases of melioidosis in women with diabetes admitted to an emergency department in the US Virgin Islands during October 2017. These cases emerged after Hurricanes Irma and Maria and did not have a definitively identified source. Poor outcomes were observed when septicemia and pulmonary involvement were present.

EID Guendel I, Ekpo L, Hinkle MK, Harrison CJ, Blaney DD, Gee JE, et al. Melioidosis after Hurricanes Irma and Maria, St. Thomas/St. John District, US Virgin Islands, October 2017. Emerg Infect Dis. 2019;25(10):1952-1955. https://dx.doi.org/10.3201/eid2510.180959
AMA Guendel I, Ekpo L, Hinkle MK, et al. Melioidosis after Hurricanes Irma and Maria, St. Thomas/St. John District, US Virgin Islands, October 2017. Emerging Infectious Diseases. 2019;25(10):1952-1955. doi:10.3201/eid2510.180959.
APA Guendel, I., Ekpo, L., Hinkle, M. K., Harrison, C. J., Blaney, D. D., Gee, J. E....Ellis, E. M. (2019). Melioidosis after Hurricanes Irma and Maria, St. Thomas/St. John District, US Virgin Islands, October 2017. Emerging Infectious Diseases, 25(10), 1952-1955. https://dx.doi.org/10.3201/eid2510.180959.

Possible Prognostic Value of Serial Brain MRIs in Powassan Virus Encephalitis [PDF - 1.39 MB - 3 pages]
J. Allgaier et al.

Powassan virus (POWV) encephalitis is a rare tickborne illness. We describe the clinical course, laboratory findings, and imaging for a patient with POWV in Massachusetts, USA. Clinical presentation and laboratory findings were nonspecific. Improvement on brain magnetic resonance imaging after 2 weeks preceded clinical improvement by months, suggesting possible prognostic value.

EID Allgaier J, Quarles R, Skiest D. Possible Prognostic Value of Serial Brain MRIs in Powassan Virus Encephalitis. Emerg Infect Dis. 2019;25(10):1956-1958. https://dx.doi.org/10.3201/eid2510.181262
AMA Allgaier J, Quarles R, Skiest D. Possible Prognostic Value of Serial Brain MRIs in Powassan Virus Encephalitis. Emerging Infectious Diseases. 2019;25(10):1956-1958. doi:10.3201/eid2510.181262.
APA Allgaier, J., Quarles, R., & Skiest, D. (2019). Possible Prognostic Value of Serial Brain MRIs in Powassan Virus Encephalitis. Emerging Infectious Diseases, 25(10), 1956-1958. https://dx.doi.org/10.3201/eid2510.181262.

Rapid Screening of Aedes aegypti Mosquitoes for Susceptibility to Insecticides as Part of Zika Emergency Response, Puerto Rico [PDF - 683 KB - 3 pages]
R. R. Hemme et al.

In response to the 2016 Zika outbreak, Aedes aegypti mosquitoes from 38 locations across Puerto Rico were screened using Centers for Disease Control and Prevention bottle bioassays for sensitivity to insecticides used for mosquito control. All populations were resistant to pyrethroids. Naled, an organophosphate, was the most effective insecticide, killing all mosquitoes tested.

EID Hemme RR, Vizcaino L, Harris AF, Felix G, Kavanaugh M, Kenney JL, et al. Rapid Screening of Aedes aegypti Mosquitoes for Susceptibility to Insecticides as Part of Zika Emergency Response, Puerto Rico. Emerg Infect Dis. 2019;25(10):1959-1961. https://dx.doi.org/10.3201/eid2510.181847
AMA Hemme RR, Vizcaino L, Harris AF, et al. Rapid Screening of Aedes aegypti Mosquitoes for Susceptibility to Insecticides as Part of Zika Emergency Response, Puerto Rico. Emerging Infectious Diseases. 2019;25(10):1959-1961. doi:10.3201/eid2510.181847.
APA Hemme, R. R., Vizcaino, L., Harris, A. F., Felix, G., Kavanaugh, M., Kenney, J. L....Lenhart, A. (2019). Rapid Screening of Aedes aegypti Mosquitoes for Susceptibility to Insecticides as Part of Zika Emergency Response, Puerto Rico. Emerging Infectious Diseases, 25(10), 1959-1961. https://dx.doi.org/10.3201/eid2510.181847.

New Exposure Location for Hantavirus Pulmonary Syndrome Case, California, USA, 2018 [PDF - 655 KB - 3 pages]
A. M. Kjemtrup et al.

We describe a case of hantavirus pulmonary syndrome in a patient exposed to Sin Nombre virus in a coastal county in California, USA, that had no previous record of human cases. Environmental evaluation coupled with genotypic analysis of virus isolates from the case-patient and locally trapped rodents identified the likely exposure location.

EID Kjemtrup AM, Messenger S, Meza AM, Feiszli T, Yoshimizu M, Padgett K, et al. New Exposure Location for Hantavirus Pulmonary Syndrome Case, California, USA, 2018. Emerg Infect Dis. 2019;25(10):1962-1964. https://dx.doi.org/10.3201/eid2510.190058
AMA Kjemtrup AM, Messenger S, Meza AM, et al. New Exposure Location for Hantavirus Pulmonary Syndrome Case, California, USA, 2018. Emerging Infectious Diseases. 2019;25(10):1962-1964. doi:10.3201/eid2510.190058.
APA Kjemtrup, A. M., Messenger, S., Meza, A. M., Feiszli, T., Yoshimizu, M., Padgett, K....Singh, S. (2019). New Exposure Location for Hantavirus Pulmonary Syndrome Case, California, USA, 2018. Emerging Infectious Diseases, 25(10), 1962-1964. https://dx.doi.org/10.3201/eid2510.190058.

Two Cases of Borrelia miyamotoi Meningitis, Sweden, 2018 [PDF - 691 KB - 4 pages]
A. J. Henningsson et al.

We report 2 human cases of Borrelia miyamotoi disease diagnosed in Sweden, including 1 case of meningitis in an apparently immunocompetent patient. The diagnoses were confirmed by 3 different independent PCR assays and DNA sequencing from cerebrospinal fluid, supplemented by serologic analyses.

EID Henningsson AJ, Asgeirsson H, Hammas B, Karlsson E, Parke Å, Hoornstra D, et al. Two Cases of Borrelia miyamotoi Meningitis, Sweden, 2018. Emerg Infect Dis. 2019;25(10):1965-1968. https://dx.doi.org/10.3201/eid2510.190416
AMA Henningsson AJ, Asgeirsson H, Hammas B, et al. Two Cases of Borrelia miyamotoi Meningitis, Sweden, 2018. Emerging Infectious Diseases. 2019;25(10):1965-1968. doi:10.3201/eid2510.190416.
APA Henningsson, A. J., Asgeirsson, H., Hammas, B., Karlsson, E., Parke, Å., Hoornstra, D....Hovius, J. W. (2019). Two Cases of Borrelia miyamotoi Meningitis, Sweden, 2018. Emerging Infectious Diseases, 25(10), 1965-1968. https://dx.doi.org/10.3201/eid2510.190416.

Susceptibility of Influenza A, B, C, and D Viruses to Baloxavir [PDF - 700 KB - 4 pages]
V. P. Mishin et al.

Baloxavir showed broad-spectrum in vitro replication inhibition of 4 types of influenza viruses (90% effective concentration range 1.2–98.3 nmol/L); susceptibility pattern was influenza A ˃ B ˃ C ˃ D. This drug also inhibited influenza A viruses of avian and swine origin, including viruses that have pandemic potential and those resistant to neuraminidase inhibitors.

EID Mishin VP, Patel MC, Chesnokov A, De La Cruz J, Nguyen HT, Lollis L, et al. Susceptibility of Influenza A, B, C, and D Viruses to Baloxavir. Emerg Infect Dis. 2019;25(10):1969-1972. https://dx.doi.org/10.3201/eid2510.190607
AMA Mishin VP, Patel MC, Chesnokov A, et al. Susceptibility of Influenza A, B, C, and D Viruses to Baloxavir. Emerging Infectious Diseases. 2019;25(10):1969-1972. doi:10.3201/eid2510.190607.
APA Mishin, V. P., Patel, M. C., Chesnokov, A., De La Cruz, J., Nguyen, H. T., Lollis, L....Gubareva, L. V. (2019). Susceptibility of Influenza A, B, C, and D Viruses to Baloxavir. Emerging Infectious Diseases, 25(10), 1969-1972. https://dx.doi.org/10.3201/eid2510.190607.

Genetic Characterization and Zoonotic Potential of Highly Pathogenic Avian Influenza Virus A(H5N6/H5N5), Germany, 2017–2018 [PDF - 3.71 MB - 4 pages]
A. Pohlmann et al.

We genetically characterized highly pathogenic avian influenza virus A(H5N6) clade 2.3.4.4b isolates found in Germany in 2017–2018 and assessed pathogenicity of representative H5N5 and H5N6 viruses in ferrets. These viruses had low pathogenicity; however, continued characterization of related isolates is warranted because of their high potential for reassortment.

EID Pohlmann A, Hoffmann D, Grund C, Koethe S, Hüssy D, Meier SM, et al. Genetic Characterization and Zoonotic Potential of Highly Pathogenic Avian Influenza Virus A(H5N6/H5N5), Germany, 2017–2018. Emerg Infect Dis. 2019;25(10):1973-1976. https://dx.doi.org/10.3201/eid2510.181931
AMA Pohlmann A, Hoffmann D, Grund C, et al. Genetic Characterization and Zoonotic Potential of Highly Pathogenic Avian Influenza Virus A(H5N6/H5N5), Germany, 2017–2018. Emerging Infectious Diseases. 2019;25(10):1973-1976. doi:10.3201/eid2510.181931.
APA Pohlmann, A., Hoffmann, D., Grund, C., Koethe, S., Hüssy, D., Meier, S. M....Beer, M. (2019). Genetic Characterization and Zoonotic Potential of Highly Pathogenic Avian Influenza Virus A(H5N6/H5N5), Germany, 2017–2018. Emerging Infectious Diseases, 25(10), 1973-1976. https://dx.doi.org/10.3201/eid2510.181931.
Research Letters

Lassa Virus in Pygmy Mice, Benin, 2016–2017 [PDF - 551 KB - 3 pages]
A. Yadouleton et al.

Lassa virus has been identified in 3 pygmy mice, Mus baoulei, in central Benin. The glycoprotein and nucleoprotein sequences cluster with the Togo strain. These mice may be a new reservoir for Lassa virus in Ghana, Togo, and Benin.

EID Yadouleton A, Agolinou A, Kourouma F, Saizonou R, Pahlmann M, Bedié S, et al. Lassa Virus in Pygmy Mice, Benin, 2016–2017. Emerg Infect Dis. 2019;25(10):1977-1979. https://dx.doi.org/10.3201/eid2510.180523
AMA Yadouleton A, Agolinou A, Kourouma F, et al. Lassa Virus in Pygmy Mice, Benin, 2016–2017. Emerging Infectious Diseases. 2019;25(10):1977-1979. doi:10.3201/eid2510.180523.
APA Yadouleton, A., Agolinou, A., Kourouma, F., Saizonou, R., Pahlmann, M., Bedié, S....Fichet-Calvet, E. (2019). Lassa Virus in Pygmy Mice, Benin, 2016–2017. Emerging Infectious Diseases, 25(10), 1977-1979. https://dx.doi.org/10.3201/eid2510.180523.

Genomic Characterization of Rift Valley Fever Virus, South Africa, 2018 [PDF - 603 KB - 3 pages]
A. van Schalkwyk and M. Romito

An isolated Rift Valley fever (RVF) outbreak was reported in 2018 in Free State Province, South Africa. Phylogenetic analyses based on complete genome sequences of 3 RVF viruses from blood and tissue samples indicated that they were related to a virus isolated in 2016 from a man returning to China from Angola.

EID van Schalkwyk A, Romito M. Genomic Characterization of Rift Valley Fever Virus, South Africa, 2018. Emerg Infect Dis. 2019;25(10):1979-1981. https://dx.doi.org/10.3201/eid2510.181748
AMA van Schalkwyk A, Romito M. Genomic Characterization of Rift Valley Fever Virus, South Africa, 2018. Emerging Infectious Diseases. 2019;25(10):1979-1981. doi:10.3201/eid2510.181748.
APA van Schalkwyk, A., & Romito, M. (2019). Genomic Characterization of Rift Valley Fever Virus, South Africa, 2018. Emerging Infectious Diseases, 25(10), 1979-1981. https://dx.doi.org/10.3201/eid2510.181748.

Estimated Incubation Period and Serial Interval for Human-to-Human Influenza A(H7N9) Virus Transmission [PDF - 293 KB - 2 pages]
L. Zhou et al.

We estimated the incubation period and serial interval for human-to-human–transmitted avian influenza A(H7N9) virus infection using case-patient clusters from epidemics in China during 2013–2017. The median incubation period was 4 days and serial interval 9 days. China’s 10-day monitoring period for close contacts of case-patients should detect most secondary infections.

EID Zhou L, Li Q, Uyeki TM. Estimated Incubation Period and Serial Interval for Human-to-Human Influenza A(H7N9) Virus Transmission. Emerg Infect Dis. 2019;25(10):1982-1983. https://dx.doi.org/10.3201/eid2510.190117
AMA Zhou L, Li Q, Uyeki TM. Estimated Incubation Period and Serial Interval for Human-to-Human Influenza A(H7N9) Virus Transmission. Emerging Infectious Diseases. 2019;25(10):1982-1983. doi:10.3201/eid2510.190117.
APA Zhou, L., Li, Q., & Uyeki, T. M. (2019). Estimated Incubation Period and Serial Interval for Human-to-Human Influenza A(H7N9) Virus Transmission. Emerging Infectious Diseases, 25(10), 1982-1983. https://dx.doi.org/10.3201/eid2510.190117.

Pulmonary Infection Associated with Mycobacterium canariasense in Suspected Tuberculosis Patient, Iran [PDF - 690 KB - 3 pages]
F. Sakhaee et al.

Mycobacterium canariasense had only been isolated in humans from blood and contaminated catheters. We report a case of pulmonary disease associated with M. canariasense infection that was identified by multilocus sequence analysis; the illness was initially ascribed to M. tuberculosis. M. canariasense should be considered a cause of respiratory infection.

EID Sakhaee F, Vaziri F, Bahramali G, Taremian K, Siadat S, Fateh A. Pulmonary Infection Associated with Mycobacterium canariasense in Suspected Tuberculosis Patient, Iran. Emerg Infect Dis. 2019;25(10):1984-1986. https://dx.doi.org/10.3201/eid2510.190156
AMA Sakhaee F, Vaziri F, Bahramali G, et al. Pulmonary Infection Associated with Mycobacterium canariasense in Suspected Tuberculosis Patient, Iran. Emerging Infectious Diseases. 2019;25(10):1984-1986. doi:10.3201/eid2510.190156.
APA Sakhaee, F., Vaziri, F., Bahramali, G., Taremian, K., Siadat, S., & Fateh, A. (2019). Pulmonary Infection Associated with Mycobacterium canariasense in Suspected Tuberculosis Patient, Iran. Emerging Infectious Diseases, 25(10), 1984-1986. https://dx.doi.org/10.3201/eid2510.190156.

Mycobacterium conceptionense Pneumonitis in Patient with HIV/AIDS [PDF - 342 KB - 3 pages]
S. M. Michienzi et al.

Approximately 21 human cases of infection with Mycobacterium conceptionense have been reported. However, most cases were outside the United States, and optimal treatment remains uncertain. We report a case of M. conceptionense pneumonitis in a patient with HIV/AIDS in the United States. The patient was cured with azithromycin and doxycycline.

EID Michienzi SM, Burgos RM, Novak RM. Mycobacterium conceptionense Pneumonitis in Patient with HIV/AIDS. Emerg Infect Dis. 2019;25(10):1986-1988. https://dx.doi.org/10.3201/eid2510.190444
AMA Michienzi SM, Burgos RM, Novak RM. Mycobacterium conceptionense Pneumonitis in Patient with HIV/AIDS. Emerging Infectious Diseases. 2019;25(10):1986-1988. doi:10.3201/eid2510.190444.
APA Michienzi, S. M., Burgos, R. M., & Novak, R. M. (2019). Mycobacterium conceptionense Pneumonitis in Patient with HIV/AIDS. Emerging Infectious Diseases, 25(10), 1986-1988. https://dx.doi.org/10.3201/eid2510.190444.

Emergence of Influenza A(H7N4) Virus, Cambodia [PDF - 1.14 MB - 4 pages]
D. Vijaykrishna et al.

Active surveillance in high-risk sites in Cambodia has identified multiple low-pathogenicity influenza A(H7) viruses, mainly in ducks. None fall within the A/Anhui/1/2013(H7N9) lineage; however, some A(H7) viruses from 2018 show temporal and phylogenetic similarity to the H7N4 virus that caused a nonfatal infection in Jiangsu Province, China, in December 2017.

EID Vijaykrishna D, Deng Y, Grau ML, Kay M, Suttie A, Horwood PF, et al. Emergence of Influenza A(H7N4) Virus, Cambodia. Emerg Infect Dis. 2019;25(10):1988-1991. https://dx.doi.org/10.3201/eid2510.190506
AMA Vijaykrishna D, Deng Y, Grau ML, et al. Emergence of Influenza A(H7N4) Virus, Cambodia. Emerging Infectious Diseases. 2019;25(10):1988-1991. doi:10.3201/eid2510.190506.
APA Vijaykrishna, D., Deng, Y., Grau, M. L., Kay, M., Suttie, A., Horwood, P. F....Karlsson, E. A. (2019). Emergence of Influenza A(H7N4) Virus, Cambodia. Emerging Infectious Diseases, 25(10), 1988-1991. https://dx.doi.org/10.3201/eid2510.190506.

Mycobacterium marseillense Infection in Human Skin, China, 2018 [PDF - 1.06 MB - 3 pages]
B. Xie et al.

We describe a case of facial skin infection and sinusitis caused by Mycobacterium marseillense in an immunocompetent woman in China in 2018. The infection was cleared with clarithromycin, moxifloxacin, and amikacin. Antimicrobial drug treatments could not be predicted by genetic analyses; further genetic characterization would be required to do so.

EID Xie B, Chen Y, Wang J, Gao W, Jiang H, Sun J, et al. Mycobacterium marseillense Infection in Human Skin, China, 2018. Emerg Infect Dis. 2019;25(10):1991-1993. https://dx.doi.org/10.3201/eid2510.190695
AMA Xie B, Chen Y, Wang J, et al. Mycobacterium marseillense Infection in Human Skin, China, 2018. Emerging Infectious Diseases. 2019;25(10):1991-1993. doi:10.3201/eid2510.190695.
APA Xie, B., Chen, Y., Wang, J., Gao, W., Jiang, H., Sun, J....Wang, H. (2019). Mycobacterium marseillense Infection in Human Skin, China, 2018. Emerging Infectious Diseases, 25(10), 1991-1993. https://dx.doi.org/10.3201/eid2510.190695.

Geospatial Variation in Rotavirus Vaccination in Infants, United States, 2010–2017 [PDF - 1.37 MB - 3 pages]
M. Rogers et al.

We evaluated rotavirus vaccination rates in the United States by using records from a nationwide health database. From data on 519,697 infants, we found 68.6% received the entire rotavirus vaccine series. We noted pockets of undervaccination in many states, particularly in the Northeast and in some western states.

EID Rogers M, Kim C, Hofstetter AM. Geospatial Variation in Rotavirus Vaccination in Infants, United States, 2010–2017. Emerg Infect Dis. 2019;25(10):1993-1995. https://dx.doi.org/10.3201/eid2510.190874
AMA Rogers M, Kim C, Hofstetter AM. Geospatial Variation in Rotavirus Vaccination in Infants, United States, 2010–2017. Emerging Infectious Diseases. 2019;25(10):1993-1995. doi:10.3201/eid2510.190874.
APA Rogers, M., Kim, C., & Hofstetter, A. M. (2019). Geospatial Variation in Rotavirus Vaccination in Infants, United States, 2010–2017. Emerging Infectious Diseases, 25(10), 1993-1995. https://dx.doi.org/10.3201/eid2510.190874.
Letters

Databases for Research and Development [PDF - 287 KB - 1 page]
M. G. Head
EID Head MG. Databases for Research and Development. Emerg Infect Dis. 2019;25(10):1996. https://dx.doi.org/10.3201/eid2510.181411
AMA Head MG. Databases for Research and Development. Emerging Infectious Diseases. 2019;25(10):1996. doi:10.3201/eid2510.181411.
APA Head, M. G. (2019). Databases for Research and Development. Emerging Infectious Diseases, 25(10), 1996. https://dx.doi.org/10.3201/eid2510.181411.

Self-Flagellation as Possible Route of Human T-Cell Lymphotropic Virus Type 1 Transmission [PDF - 534 KB - 2 pages]
C. E. Styles et al.
EID Styles CE, Hoad VC, Denham-Ricks P, Brown D, Seed CR. Self-Flagellation as Possible Route of Human T-Cell Lymphotropic Virus Type 1 Transmission. Emerg Infect Dis. 2019;25(10):1996-1997. https://dx.doi.org/10.3201/eid2510.190484
AMA Styles CE, Hoad VC, Denham-Ricks P, et al. Self-Flagellation as Possible Route of Human T-Cell Lymphotropic Virus Type 1 Transmission. Emerging Infectious Diseases. 2019;25(10):1996-1997. doi:10.3201/eid2510.190484.
APA Styles, C. E., Hoad, V. C., Denham-Ricks, P., Brown, D., & Seed, C. R. (2019). Self-Flagellation as Possible Route of Human T-Cell Lymphotropic Virus Type 1 Transmission. Emerging Infectious Diseases, 25(10), 1996-1997. https://dx.doi.org/10.3201/eid2510.190484.
Books and Media

Flu Hunter: Unlocking the Secrets of a Virus [PDF - 531 KB - 1 page]
S. W. Boktor and S. Ostroff
EID Boktor SW, Ostroff S. Flu Hunter: Unlocking the Secrets of a Virus. Emerg Infect Dis. 2019;25(10):1998. https://dx.doi.org/10.3201/eid2510.190880
AMA Boktor SW, Ostroff S. Flu Hunter: Unlocking the Secrets of a Virus. Emerging Infectious Diseases. 2019;25(10):1998. doi:10.3201/eid2510.190880.
APA Boktor, S. W., & Ostroff, S. (2019). Flu Hunter: Unlocking the Secrets of a Virus. Emerging Infectious Diseases, 25(10), 1998. https://dx.doi.org/10.3201/eid2510.190880.
About the Cover

A Study in Stillness and Symmetry [PDF - 2.42 MB - 2 pages]
B. Breedlove
EID Breedlove B. A Study in Stillness and Symmetry. Emerg Infect Dis. 2019;25(10):1999-2000. https://dx.doi.org/10.3201/eid2510.ac2510
AMA Breedlove B. A Study in Stillness and Symmetry. Emerging Infectious Diseases. 2019;25(10):1999-2000. doi:10.3201/eid2510.ac2510.
APA Breedlove, B. (2019). A Study in Stillness and Symmetry. Emerging Infectious Diseases, 25(10), 1999-2000. https://dx.doi.org/10.3201/eid2510.ac2510.
Etymologia

Etymologia: Edwardsiella tarda [PDF - 498 KB - 1 page]
R. Henry
EID Henry R. Etymologia: Edwardsiella tarda. Emerg Infect Dis. 2019;25(10):1833. https://dx.doi.org/10.3201/eid2510.et2510
AMA Henry R. Etymologia: Edwardsiella tarda. Emerging Infectious Diseases. 2019;25(10):1833. doi:10.3201/eid2510.et2510.
APA Henry, R. (2019). Etymologia: Edwardsiella tarda. Emerging Infectious Diseases, 25(10), 1833. https://dx.doi.org/10.3201/eid2510.et2510.
Corrections

Correction: Vol. 25, No. 3 [PDF - 483 KB - 1 page]
EID Correction: Vol. 25, No. 3. Emerg Infect Dis. 2019;25(10):1996. https://dx.doi.org/10.3201/eid2510.c12510
AMA Correction: Vol. 25, No. 3. Emerging Infectious Diseases. 2019;25(10):1996. doi:10.3201/eid2510.c12510.
APA (2019). Correction: Vol. 25, No. 3. Emerging Infectious Diseases, 25(10), 1996. https://dx.doi.org/10.3201/eid2510.c12510.

Correction: Vol. 25, No. 9 [PDF - 483 KB - 1 page]
EID Correction: Vol. 25, No. 9. Emerg Infect Dis. 2019;25(10):1996. https://dx.doi.org/10.3201/eid2510.c22510
AMA Correction: Vol. 25, No. 9. Emerging Infectious Diseases. 2019;25(10):1996. doi:10.3201/eid2510.c22510.
APA (2019). Correction: Vol. 25, No. 9. Emerging Infectious Diseases, 25(10), 1996. https://dx.doi.org/10.3201/eid2510.c22510.
Page created: September 17, 2019
Page updated: September 17, 2019
Page reviewed: September 17, 2019
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