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Articles from Emerging Infectious Diseases

Perspective

Coordinated Strategy for a Model-Based Decision Support Tool for Coronavirus Disease, Utah, USA [PDF - 1.86 MB - 7 pages]
H. R. Meredith et al.

The coronavirus disease pandemic has highlighted the key role epidemiologic models play in supporting public health decision-making. In particular, these models provide estimates of outbreak potential when data are scarce and decision-making is critical and urgent. We document the integrated modeling response used in the US state of Utah early in the coronavirus disease pandemic, which brought together a diverse set of technical experts and public health and healthcare officials and led to an evidence-based response to the pandemic. We describe how we adapted a standard epidemiologic model; harmonized the outputs across modeling groups; and maintained a constant dialogue with policymakers at multiple levels of government to produce timely, evidence-based, and coordinated public health recommendations and interventions during the first wave of the pandemic. This framework continues to support the state’s response to ongoing outbreaks and can be applied in other settings to address unique public health challenges.

EID Meredith HR, Arehart E, Grantz KH, Beams A, Sheets T, Nelson R, et al. Coordinated Strategy for a Model-Based Decision Support Tool for Coronavirus Disease, Utah, USA. Emerg Infect Dis. 2021;27(5):1259-1265. https://doi.org/10.3201/eid2705.203075
AMA Meredith HR, Arehart E, Grantz KH, et al. Coordinated Strategy for a Model-Based Decision Support Tool for Coronavirus Disease, Utah, USA. Emerging Infectious Diseases. 2021;27(5):1259-1265. doi:10.3201/eid2705.203075.
APA Meredith, H. R., Arehart, E., Grantz, K. H., Beams, A., Sheets, T., Nelson, R....Keegan, L. T. (2021). Coordinated Strategy for a Model-Based Decision Support Tool for Coronavirus Disease, Utah, USA. Emerging Infectious Diseases, 27(5), 1259-1265. https://doi.org/10.3201/eid2705.203075.
Synopses

Coccidioidomycosis and COVID-19 Co-Infection, United States, 2020 [PDF - 1.13 MB - 8 pages]
A. K. Heaney et al.

We review the interaction between coronavirus disease (COVID-19) and coccidioidomycosis, a respiratory infection caused by inhalation of Coccidioides fungal spores in dust. We examine risk for co-infection among construction and agricultural workers, incarcerated persons, Black and Latino populations, and persons living in high dust areas. We further identify common risk factors for co-infection, including older age, diabetes, immunosuppression, racial or ethnic minority status, and smoking. Because these diseases cause similar symptoms, the COVID-19 pandemic might exacerbate delays in coccidioidomycosis diagnosis, potentially interfering with prompt administration of antifungal therapies. Finally, we examine the clinical implications of co-infection, including severe COVID-19 and reactivation of latent coccidioidomycosis. Physicians should consider coccidioidomycosis as a possible diagnosis when treating patients with respiratory symptoms. Preventive measures such as wearing face masks might mitigate exposure to dust and severe acute respiratory syndrome coronavirus 2, thereby protecting against both infections.

EID Heaney AK, Head JR, Broen K, Click K, Taylor J, Balmes JR, et al. Coccidioidomycosis and COVID-19 Co-Infection, United States, 2020. Emerg Infect Dis. 2021;27(5):1266-1273. https://doi.org/10.3201/eid2705.204661
AMA Heaney AK, Head JR, Broen K, et al. Coccidioidomycosis and COVID-19 Co-Infection, United States, 2020. Emerging Infectious Diseases. 2021;27(5):1266-1273. doi:10.3201/eid2705.204661.
APA Heaney, A. K., Head, J. R., Broen, K., Click, K., Taylor, J., Balmes, J. R....Remais, J. V. (2021). Coccidioidomycosis and COVID-19 Co-Infection, United States, 2020. Emerging Infectious Diseases, 27(5), 1266-1273. https://doi.org/10.3201/eid2705.204661.

Successful Control of an Onboard COVID-19 Outbreak Using the Cruise Ship as a Quarantine Facility, Western Australia, Australia [PDF - 3.17 MB - 9 pages]
T. A. Codreanu et al.

Onboard quarantining has been only partially effective to control outbreaks of coronavirus disease on cruise ships. We describe the successful use of the ship as a quarantine facility during the response to the outbreak on the MS Artania, which docked in Western Australia, Australia. The health-led 14-day quarantine regime was based on established principles of outbreak management and experiences of coronavirus disease outbreaks on cruise ships elsewhere. The attack rate in the crew was 3.3% (28/832) before quarantine commencement and 4.8% (21/441) during quarantine on board. No crew members became symptomatic after completion of quarantine. Infection surveillance involved telephone correspondence, face-to-face visits, and testing for severe acute respiratory syndrome coronavirus 2. No serious health issues were reported, no response staff became infected, and only 1 quarantine breach occurred among crew. Onboard quarantine could offer financial and operational advantages in outbreak response and provide reassurance to the shore-based wider community regarding risk for infection.

EID Codreanu TA, Ngeh S, Trewin A, Armstrong PK. Successful Control of an Onboard COVID-19 Outbreak Using the Cruise Ship as a Quarantine Facility, Western Australia, Australia. Emerg Infect Dis. 2021;27(5):1279-1287. https://doi.org/10.3201/eid2705.204142
AMA Codreanu TA, Ngeh S, Trewin A, et al. Successful Control of an Onboard COVID-19 Outbreak Using the Cruise Ship as a Quarantine Facility, Western Australia, Australia. Emerging Infectious Diseases. 2021;27(5):1279-1287. doi:10.3201/eid2705.204142.
APA Codreanu, T. A., Ngeh, S., Trewin, A., & Armstrong, P. K. (2021). Successful Control of an Onboard COVID-19 Outbreak Using the Cruise Ship as a Quarantine Facility, Western Australia, Australia. Emerging Infectious Diseases, 27(5), 1279-1287. https://doi.org/10.3201/eid2705.204142.

Case Series of Laboratory-Associated Zika Virus Disease, United States, 2016–2019 [PDF - 986 KB - 5 pages]
S. L. Hills et al.

Zika virus diagnostic testing and laboratory research increased considerably when Zika virus began spreading through the Americas in 2015, increasing the risk for potential Zika virus exposure of laboratory workers and biomedical researchers. We report 4 cases of laboratory-associated Zika virus disease in the United States during 2016–2019. Of these, 2 were associated with needlestick injuries; for the other 2 cases, the route of transmission was undetermined. In laboratories in which work with Zika virus is performed, good laboratory biosafety practices must be implemented and practiced to reduce the risk for infection among laboratory personnel.

EID Hills SL, Morrison A, Stuck S, Sandhu K, Mason KL, Stanek D, et al. Case Series of Laboratory-Associated Zika Virus Disease, United States, 2016–2019. Emerg Infect Dis. 2021;27(5):1296-1300. https://doi.org/10.3201/eid2705.203602
AMA Hills SL, Morrison A, Stuck S, et al. Case Series of Laboratory-Associated Zika Virus Disease, United States, 2016–2019. Emerging Infectious Diseases. 2021;27(5):1296-1300. doi:10.3201/eid2705.203602.
APA Hills, S. L., Morrison, A., Stuck, S., Sandhu, K., Mason, K. L., Stanek, D....Fischer, M. (2021). Case Series of Laboratory-Associated Zika Virus Disease, United States, 2016–2019. Emerging Infectious Diseases, 27(5), 1296-1300. https://doi.org/10.3201/eid2705.203602.

Clinical Laboratory Perspective on Streptococcus halichoeri, an Unusual Nonhemolytic, Lancefield Group B Streptococcus Causing Human Infections [PDF - 1.33 MB - 8 pages]
S. M. Shakir et al.

Streptococcus halichoeri is a relatively newly identified species of pyogenic streptococci that causes zoonotic infection in humans. S. halichoeri was first described in 2004 as indigenous to seals, and only 8 reports of human S. halichoeri infection have been published. S. halichoeri grows as small, white, nonhemolytic colonies and may be strongly catalase-positive on routine blood agar media, which can lead to isolates being misidentified as coagulase-negative staphylococci. S. halichoeri tests positive for Lancefield group B antigen, like S. agalactiae, but can be identified with matrix-assisted laser desorption/ionization time of flight mass spectrometry or partial 16S rRNA sequencing. We describe 3 cases of S. halichoeri bone and joint infections in patients in the United States with underlying health conditions. In addition, we examine the microbiologic characteristics of S. halichoeri and discuss the importance of fully identifying this organism that might otherwise be disregarded as a skin commensal.

EID Shakir SM, Gill R, Salberg J, Slechta E, Feldman M, Fritsche T, et al. Clinical Laboratory Perspective on Streptococcus halichoeri, an Unusual Nonhemolytic, Lancefield Group B Streptococcus Causing Human Infections. Emerg Infect Dis. 2021;27(5):1309-1316. https://doi.org/10.3201/eid2705.203428
AMA Shakir SM, Gill R, Salberg J, et al. Clinical Laboratory Perspective on Streptococcus halichoeri, an Unusual Nonhemolytic, Lancefield Group B Streptococcus Causing Human Infections. Emerging Infectious Diseases. 2021;27(5):1309-1316. doi:10.3201/eid2705.203428.
APA Shakir, S. M., Gill, R., Salberg, J., Slechta, E., Feldman, M., Fritsche, T....Fisher, M. A. (2021). Clinical Laboratory Perspective on Streptococcus halichoeri, an Unusual Nonhemolytic, Lancefield Group B Streptococcus Causing Human Infections. Emerging Infectious Diseases, 27(5), 1309-1316. https://doi.org/10.3201/eid2705.203428.

Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 during Border Quarantine and Air Travel, New Zealand (Aotearoa) [PDF - 1.87 MB - 5 pages]
N. Eichler et al.

The strategy in New Zealand (Aotearoa) to eliminate coronavirus disease requires that international arrivals undergo managed isolation and quarantine and mandatory testing for severe acute respiratory syndrome coronavirus 2. Combining genomic and epidemiologic data, we investigated the origin of an acute case of coronavirus disease identified in the community after the patient had spent 14 days in managed isolation and quarantine and had 2 negative test results. By combining genomic sequence analysis and epidemiologic investigations, we identified a multibranched chain of transmission of this virus, including on international and domestic flights, as well as a probable case of aerosol transmission without direct person-to-person contact. These findings show the power of integrating genomic and epidemiologic data to inform outbreak investigations.

EID Eichler N, Thornley C, Swadi T, Devine T, McElnay C, Sherwood J, et al. Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 during Border Quarantine and Air Travel, New Zealand (Aotearoa). Emerg Infect Dis. 2021;27(5):1274-1278. https://doi.org/10.3201/eid2705.210514
AMA Eichler N, Thornley C, Swadi T, et al. Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 during Border Quarantine and Air Travel, New Zealand (Aotearoa). Emerging Infectious Diseases. 2021;27(5):1274-1278. doi:10.3201/eid2705.210514.
APA Eichler, N., Thornley, C., Swadi, T., Devine, T., McElnay, C., Sherwood, J....Geoghegan, J. L. (2021). Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 during Border Quarantine and Air Travel, New Zealand (Aotearoa). Emerging Infectious Diseases, 27(5), 1274-1278. https://doi.org/10.3201/eid2705.210514.

Epidemiologic Findings from Case Investigations and Contact Tracing for First 200 Cases of Coronavirus Disease, Santa Clara County, California, USA [PDF - 1021 KB - 8 pages]
N. Ortiz et al.

In January 2020, Santa Clara County, California, USA, began identifying laboratory-confirmed coronavirus disease among residents. County staff conducted case and contact investigations focused on households and collected detailed case demographic, occupation, exposure, and outcome information. We describe the first 200 test-positive cases during January 31–March 20, 2020, to inform future case and contact investigations. Probable infection sources included community transmission (104 cases), known close contact with a confirmed case-patient (66 cases), and travel (30 cases). Disease patterns across race and ethnicity, occupational, and household factors suggested multiple infection risk factors. Disproportionately high percentages of case-patients from racial and ethnic subgroups worked outside the home (Hispanic [86%] and Filipino [100%]); household transmission was more common among persons from Vietnam (53%). Even with the few initial cases, detailed case and contact investigations of household contacts capturing occupational and disaggregated race and ethnicity data helped identify at-risk groups and focused solutions for disease control.

EID Ortiz N, Villarino E, Lee JT, Bajema KL, Ricaldi JN, Smith S, et al. Epidemiologic Findings from Case Investigations and Contact Tracing for First 200 Cases of Coronavirus Disease, Santa Clara County, California, USA. Emerg Infect Dis. 2021;27(5):1301-1308. https://doi.org/10.3201/eid2705.204876
AMA Ortiz N, Villarino E, Lee JT, et al. Epidemiologic Findings from Case Investigations and Contact Tracing for First 200 Cases of Coronavirus Disease, Santa Clara County, California, USA. Emerging Infectious Diseases. 2021;27(5):1301-1308. doi:10.3201/eid2705.204876.
APA Ortiz, N., Villarino, E., Lee, J. T., Bajema, K. L., Ricaldi, J. N., Smith, S....Cody, S. H. (2021). Epidemiologic Findings from Case Investigations and Contact Tracing for First 200 Cases of Coronavirus Disease, Santa Clara County, California, USA. Emerging Infectious Diseases, 27(5), 1301-1308. https://doi.org/10.3201/eid2705.204876.

SARS-CoV-2 in Nursing Homes after 3 Months of Serial, Facilitywide Point Prevalence Testing, Connecticut, USA [PDF - 1.94 MB - 8 pages]
H. Y. Ehrlich et al.

Nursing homes house populations that are highly vulnerable to coronavirus disease. Point prevalence surveys (PPSs) provide information on the severe acute respiratory syndrome coronavirus 2 infection status of staff and residents in nursing homes and enable isolation of infectious persons to halt disease spread. We collected 16 weeks of public health surveillance data on a subset of nursing homes (34/212) in Connecticut, USA. We fit a Poisson regression model to evaluate the association between incidence and time since serial PPS onset, adjusting for decreasing community incidence and other factors. Nursing homes conducted a combined total of 205 PPSs in staff and 232 PPSs in residents. PPS was associated with 41%–80% reduction in incidence rate in nursing homes. Our findings provide support for the use of repeated PPSs in nursing home staff and residents, combined with strong infection prevention measures such as cohorting, in contributing to outbreak control.

EID Ehrlich HY, Harizaj A, Campbell L, Colt M, Yuan K, Rabatsky-Ehr T, et al. SARS-CoV-2 in Nursing Homes after 3 Months of Serial, Facilitywide Point Prevalence Testing, Connecticut, USA. Emerg Infect Dis. 2021;27(5):1288-1295. https://doi.org/10.3201/eid2705.204936
AMA Ehrlich HY, Harizaj A, Campbell L, et al. SARS-CoV-2 in Nursing Homes after 3 Months of Serial, Facilitywide Point Prevalence Testing, Connecticut, USA. Emerging Infectious Diseases. 2021;27(5):1288-1295. doi:10.3201/eid2705.204936.
APA Ehrlich, H. Y., Harizaj, A., Campbell, L., Colt, M., Yuan, K., Rabatsky-Ehr, T....Parikh, S. (2021). SARS-CoV-2 in Nursing Homes after 3 Months of Serial, Facilitywide Point Prevalence Testing, Connecticut, USA. Emerging Infectious Diseases, 27(5), 1288-1295. https://doi.org/10.3201/eid2705.204936.
Research

Use of Genomics to Track Coronavirus Disease Outbreaks, New Zealand [PDF - 3.66 MB - 6 pages]
J. L. Geoghegan et al.

Real-time genomic sequencing has played a major role in tracking the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), contributing greatly to disease mitigation strategies. In August 2020, after having eliminated the virus, New Zealand experienced a second outbreak. During that outbreak, New Zealand used genomic sequencing in a primary role, leading to a second elimination of the virus. We generated genomes from 78% of the laboratory-confirmed samples of SARS-CoV-2 from the second outbreak and compared them with the available global genomic data. Genomic sequencing rapidly identified that virus causing the second outbreak in New Zealand belonged to a single cluster, thus resulting from a single introduction. However, successful identification of the origin of this outbreak was impeded by substantial biases and gaps in global sequencing data. Access to a broader and more heterogenous sample of global genomic data would strengthen efforts to locate the source of any new outbreaks.

EID Geoghegan JL, Douglas J, Ren X, Storey M, Hadfield J, Silander OK, et al. Use of Genomics to Track Coronavirus Disease Outbreaks, New Zealand. Emerg Infect Dis. 2021;27(5):1317-1322. https://doi.org/10.3201/eid2705.204579
AMA Geoghegan JL, Douglas J, Ren X, et al. Use of Genomics to Track Coronavirus Disease Outbreaks, New Zealand. Emerging Infectious Diseases. 2021;27(5):1317-1322. doi:10.3201/eid2705.204579.
APA Geoghegan, J. L., Douglas, J., Ren, X., Storey, M., Hadfield, J., Silander, O. K....de Ligt, J. (2021). Use of Genomics to Track Coronavirus Disease Outbreaks, New Zealand. Emerging Infectious Diseases, 27(5), 1317-1322. https://doi.org/10.3201/eid2705.204579.

Clinical Evaluation of Roche SD Biosensor Rapid Antigen Test for SARS-CoV-2 in Municipal Health Service Testing Site, the Netherlands [PDF - 3.82 MB - 7 pages]
Z. Igloi et al.

Rapid detection of infection is essential for stopping the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The Roche SD Biosensor rapid antigen test for SARS-CoV-2 was evaluated in a nonhospitalized symptomatic population. We rapid-tested a sample onsite and compared results with those from reverse transcription PCR and virus culture. We analyzed date of onset and symptoms using data from a clinical questionnaire. Overall test sensitivity was 84.9% (95% CI 79.1–89.4) and specificity was 99.5% (95% CI 98.7–99.8). Sensitivity increased to 95.8% (95% CI 90.5–98.2) for persons who sought care within 7 days of symptom onset. Test band intensity and time to result correlated strongly with viral load; thus, strong positive results could be read before the recommended time. Approximately 98% of all viable specimens with cycle threshold <30 were detected. Rapid antigen tests can detect symptomatic SARS-CoV-2 infections in the early phase of disease, thereby identifying the most infectious persons.

EID Igloi Z, Velzing J, van Beek J, van de Vijver D, Aron G, Ensing R, et al. Clinical Evaluation of Roche SD Biosensor Rapid Antigen Test for SARS-CoV-2 in Municipal Health Service Testing Site, the Netherlands. Emerg Infect Dis. 2021;27(5):1323-1329. https://doi.org/10.3201/eid2705.204688
AMA Igloi Z, Velzing J, van Beek J, et al. Clinical Evaluation of Roche SD Biosensor Rapid Antigen Test for SARS-CoV-2 in Municipal Health Service Testing Site, the Netherlands. Emerging Infectious Diseases. 2021;27(5):1323-1329. doi:10.3201/eid2705.204688.
APA Igloi, Z., Velzing, J., van Beek, J., van de Vijver, D., Aron, G., Ensing, R....Molenkamp, R. (2021). Clinical Evaluation of Roche SD Biosensor Rapid Antigen Test for SARS-CoV-2 in Municipal Health Service Testing Site, the Netherlands. Emerging Infectious Diseases, 27(5), 1323-1329. https://doi.org/10.3201/eid2705.204688.

Prevalence and Clinical Profile of Severe Acute Respiratory Syndrome Coronavirus 2 Infection among Farmworkers, California, USA, June–November 2020 [PDF - 2.71 MB - 13 pages]
J. A. Lewnard et al.

During the ongoing coronavirus disease (COVID-19) pandemic, farmworkers in the United States are considered essential personnel and continue in-person work. We conducted prospective surveillance for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and antibody prevalence among farmworkers in Salinas Valley, California, during June 15–November 30, 2020. We observed 22.1% (1,514/6,864) positivity for SARS-CoV-2 infection among farmworkers compared with 17.2% (1,255/7,305) among other adults from the same communities (risk ratio 1.29, 95% CI 1.20–1.37). In a nested study enrolling 1,115 farmworkers, prevalence of current infection was 27.7% among farmworkers reporting >1 COVID-19 symptom and 7.2% among farmworkers without symptoms (adjusted odds ratio 4.16, 95% CI 2.85–6.06). Prevalence of SARS-CoV-2 antibodies increased from 10.5% (95% CI 6.0%–18.4%) during July 16–August 31 to 21.2% (95% CI 16.6%–27.4%) during November 1–30. High SARS-CoV-2 infection prevalence among farmworkers underscores the need for vaccination and other preventive interventions.

EID Lewnard JA, Mora AM, Nkwocha O, Kogut K, Rauch SA, Morga N, et al. Prevalence and Clinical Profile of Severe Acute Respiratory Syndrome Coronavirus 2 Infection among Farmworkers, California, USA, June–November 2020. Emerg Infect Dis. 2021;27(5):1330-1342. https://doi.org/10.3201/eid2705.204949
AMA Lewnard JA, Mora AM, Nkwocha O, et al. Prevalence and Clinical Profile of Severe Acute Respiratory Syndrome Coronavirus 2 Infection among Farmworkers, California, USA, June–November 2020. Emerging Infectious Diseases. 2021;27(5):1330-1342. doi:10.3201/eid2705.204949.
APA Lewnard, J. A., Mora, A. M., Nkwocha, O., Kogut, K., Rauch, S. A., Morga, N....Eskenazi, B. (2021). Prevalence and Clinical Profile of Severe Acute Respiratory Syndrome Coronavirus 2 Infection among Farmworkers, California, USA, June–November 2020. Emerging Infectious Diseases, 27(5), 1330-1342. https://doi.org/10.3201/eid2705.204949.

Herd Immunity against Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 10 Communities, Qatar [PDF - 1.44 MB - 10 pages]
A. Jeremijenko et al.

We investigated what proportion of the population acquired severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and whether the herd immunity threshold has been reached in 10 communities in Qatar. The study included 4,970 participants during June 21–September 9, 2020. Antibodies against SARS-CoV-2 were detected by using an electrochemiluminescence immunoassay. Seropositivity ranged from 54.9% (95% CI 50.2%–59.4%) to 83.8% (95% CI 79.1%–87.7%) across communities and showed a pooled mean of 66.1% (95% CI 61.5%–70.6%). A range of other epidemiologic measures indicated that active infection is rare, with limited if any sustainable infection transmission for clusters to occur. Only 5 infections were ever severe and 1 was critical in these young communities; infection severity rate of 0.2% (95% CI 0.1%–0.4%). Specific communities in Qatar have or nearly reached herd immunity for SARS-CoV-2 infection: 65%–70% of the population has been infected.

EID Jeremijenko A, Chemaitelly H, Ayoub HH, Alishaq M, Abou-Samra A, Al Ajmi J, et al. Herd Immunity against Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 10 Communities, Qatar. Emerg Infect Dis. 2021;27(5):1343-1352. https://doi.org/10.3201/eid2705.204365
AMA Jeremijenko A, Chemaitelly H, Ayoub HH, et al. Herd Immunity against Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 10 Communities, Qatar. Emerging Infectious Diseases. 2021;27(5):1343-1352. doi:10.3201/eid2705.204365.
APA Jeremijenko, A., Chemaitelly, H., Ayoub, H. H., Alishaq, M., Abou-Samra, A., Al Ajmi, J....Abu-Raddad, L. J. (2021). Herd Immunity against Severe Acute Respiratory Syndrome Coronavirus 2 Infection in 10 Communities, Qatar. Emerging Infectious Diseases, 27(5), 1343-1352. https://doi.org/10.3201/eid2705.204365.

Symptom Diary–Based Analysis of Disease Course among Patients with Mild Coronavirus Disease, Germany, 2020 [PDF - 2.82 MB - 9 pages]
P. Wiegele et al.

Limited information is available on the clinical course of outpatients with mild coronavirus disease (COVID-19). This information is critically important to inform public health prevention strategies and to provide anticipatory guidance to patients, primary care providers, and employers. We retrospectively assessed the daily prevalence of symptoms in 313 COVID-19 outpatients for the first 20 days of illness. Generalized estimating equations were used to assess the probability of symptom occurrence over time. Fatigue (91%), cough (85%), and headache (78%) were the most common symptoms and occurred a median of 1 day from symptom onset. Neurologic symptoms, such as loss of taste (66%) and anosmia (62%), and dyspnea (51%) occurred considerably later (median 3–4 days after symptom onset). Symptoms of COVID-19 are similar to those of other respiratory pathogens, so symptomatic patients should be tested more frequently for severe acute respiratory syndrome coronavirus 2 during influenza season to prevent further spread of COVID-19.

EID Wiegele P, Kabar I, Kerschke L, Froemmel C, Hüsing-Kabar A, Schmidt H, et al. Symptom Diary–Based Analysis of Disease Course among Patients with Mild Coronavirus Disease, Germany, 2020. Emerg Infect Dis. 2021;27(5):1353-1361. https://doi.org/10.3201/eid2705.204507
AMA Wiegele P, Kabar I, Kerschke L, et al. Symptom Diary–Based Analysis of Disease Course among Patients with Mild Coronavirus Disease, Germany, 2020. Emerging Infectious Diseases. 2021;27(5):1353-1361. doi:10.3201/eid2705.204507.
APA Wiegele, P., Kabar, I., Kerschke, L., Froemmel, C., Hüsing-Kabar, A., Schmidt, H....Tepasse, P. (2021). Symptom Diary–Based Analysis of Disease Course among Patients with Mild Coronavirus Disease, Germany, 2020. Emerging Infectious Diseases, 27(5), 1353-1361. https://doi.org/10.3201/eid2705.204507.

Serologic Screening of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Cats and Dogs during First Coronavirus Disease Wave, the Netherlands [PDF - 2.42 MB - 9 pages]
S. Zhao et al.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can infect many animal species, including minks, cats, and dogs. To gain insights into SARS-CoV-2 infections in cats and dogs, we developed and validated a set of serologic assays, including ELISA and virus neutralization. Evaluation of samples from animals before they acquired coronavirus disease and samples from cats roaming SARS-CoV-2–positive mink farms confirmed the suitability of these assays for specific antibody detection. Furthermore, our findings exclude SARS-CoV-2 nucleocapsid protein as an antigen for serologic screening of cat and dog samples. We analyzed 500 serum samples from domestic cats and dogs in the Netherlands during April–May 2020. We showed 0.4% of cats and 0.2% of dogs were seropositive. Although seroprevalence in cats and dogs that had unknown SARS-CoV-2 exposure was low during the first coronavirus disease wave, our data stress the need for development of continuous serosurveillance for SARS-CoV-2 in these 2 animal species.

EID Zhao S, Schuurman N, Li W, Wang C, Smit L, Broens EM, et al. Serologic Screening of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Cats and Dogs during First Coronavirus Disease Wave, the Netherlands. Emerg Infect Dis. 2021;27(5):1362-1370. https://doi.org/10.3201/eid2705.204055
AMA Zhao S, Schuurman N, Li W, et al. Serologic Screening of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Cats and Dogs during First Coronavirus Disease Wave, the Netherlands. Emerging Infectious Diseases. 2021;27(5):1362-1370. doi:10.3201/eid2705.204055.
APA Zhao, S., Schuurman, N., Li, W., Wang, C., Smit, L., Broens, E. M....Egberink, H. (2021). Serologic Screening of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Cats and Dogs during First Coronavirus Disease Wave, the Netherlands. Emerging Infectious Diseases, 27(5), 1362-1370. https://doi.org/10.3201/eid2705.204055.

Active Case Finding of Current Bornavirus Infections in Human Encephalitis Cases of Unknown Etiology, Germany, 2018–2020 [PDF - 2.36 MB - 9 pages]
P. Eisermann et al.

Human bornavirus encephalitis is a severe and often fatal infection caused by variegated squirrel bornavirus 1 (VSBV-1) and Borna disease virus 1 (BoDV-1). We conducted a prospective study of bornavirus etiology of encephalitis cases in Germany during 2018–2020 by using a serologic testing scheme applied along proposed graded case definitions for VSBV-1, BoDV-1, and unspecified bornavirus encephalitis. Of 103 encephalitis cases of unknown etiology, 4 bornavirus infections were detected serologically. One chronic case was caused by VSBV-1 after occupational-related contact of a person with exotic squirrels, and 3 acute cases were caused by BoDV-1 in virus-endemic areas. All 4 case-patients died. Bornavirus etiology could be confirmed by molecular methods. Serologic testing for these cases was virus specific, discriminatory, and a practical diagnostic option for living patients if no brain tissue samples are available. This testing should be guided by clinical and epidemiologic suspicions, such as residence in virus-endemic areas and animal exposure.

EID Eisermann P, Rubbenstroth D, Cadar D, Thomé-Bolduan C, Eggert P, Schlaphof A, et al. Active Case Finding of Current Bornavirus Infections in Human Encephalitis Cases of Unknown Etiology, Germany, 2018–2020. Emerg Infect Dis. 2021;27(5):1371-1379. https://doi.org/10.3201/eid2705.204490
AMA Eisermann P, Rubbenstroth D, Cadar D, et al. Active Case Finding of Current Bornavirus Infections in Human Encephalitis Cases of Unknown Etiology, Germany, 2018–2020. Emerging Infectious Diseases. 2021;27(5):1371-1379. doi:10.3201/eid2705.204490.
APA Eisermann, P., Rubbenstroth, D., Cadar, D., Thomé-Bolduan, C., Eggert, P., Schlaphof, A....Tappe, D. (2021). Active Case Finding of Current Bornavirus Infections in Human Encephalitis Cases of Unknown Etiology, Germany, 2018–2020. Emerging Infectious Diseases, 27(5), 1371-1379. https://doi.org/10.3201/eid2705.204490.

Susceptibility to SARS-CoV-2 of Cell Lines and Substrates Commonly Used to Diagnose and Isolate Influenza and Other Viruses [PDF - 4.18 MB - 13 pages]
L. Wang et al.

Co-infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other viruses has been reported. We evaluated cell lines commonly used to isolate viruses and diagnose related diseases for their susceptibility to SARS-CoV-2. Although multiple kidney cell lines from monkeys were susceptible to SARS-CoV-2, we found many cell types derived from humans, dogs, minks, cats, mice, and chicken were not. We analyzed MDCK cells, which are most commonly used for surveillance and study of influenza viruses, and found that they were not susceptible to SARS-CoV-2. The low expression level of the angiotensin converting enzyme 2 receptor and lower receptor affinity to SARS-CoV-2 spike, which could be overcome by overexpression of canine angiotensin converting enzyme 2 in trans, strengthened the cellular barrier to productive infection. Moreover, a D614G mutation in the spike protein did not appear to affect SARS-CoV-2 cell tropism. Our findings should help avert inadvertent propagation of SARS-CoV-2 from diagnostic cell lines.

EID Wang L, Fan X, Bonenfant G, Cui D, Hossain J, Jiang N, et al. Susceptibility to SARS-CoV-2 of Cell Lines and Substrates Commonly Used to Diagnose and Isolate Influenza and Other Viruses. Emerg Infect Dis. 2021;27(5):1380-1392. https://doi.org/10.3201/eid2705.210023
AMA Wang L, Fan X, Bonenfant G, et al. Susceptibility to SARS-CoV-2 of Cell Lines and Substrates Commonly Used to Diagnose and Isolate Influenza and Other Viruses. Emerging Infectious Diseases. 2021;27(5):1380-1392. doi:10.3201/eid2705.210023.
APA Wang, L., Fan, X., Bonenfant, G., Cui, D., Hossain, J., Jiang, N....Zhou, B. (2021). Susceptibility to SARS-CoV-2 of Cell Lines and Substrates Commonly Used to Diagnose and Isolate Influenza and Other Viruses. Emerging Infectious Diseases, 27(5), 1380-1392. https://doi.org/10.3201/eid2705.210023.

Epidemiologic History and Genetic Diversity Origins of Chikungunya and Dengue Viruses, Paraguay [PDF - 4.22 MB - 12 pages]
T. Gräf et al.

Paraguay has been severely affected by emergent Zika and chikungunya viruses, and dengue virus is endemic. To learn more about the origins of genetic diversity and epidemiologic history of these viruses in Paraguay, we deployed portable sequencing technologies to strengthen genomic surveillance and determine the evolutionary and epidemic history of arthropod-borne viruses (arboviruses). Samples stored at the Paraguay National Central Laboratory were sequenced and subjected to phylogenetic analysis. Among 33 virus genomes generated, we identified 2 genotypes of chikungunya and 2 serotypes of dengue virus that circulated in Paraguay during 2014–2018; the main source of these virus lineages was estimated to be Brazil. The evolutionary history inferred by our analyses precisely matched the available travel history of the patients. The genomic surveillance approach used was valuable for describing the epidemiologic history of arboviruses and can be used to determine the origins and evolution of future arbovirus outbreaks.

EID Gräf T, Vazquez C, Giovanetti M, de Bruycker-Nogueira F, Fonseca V, Claro I, et al. Epidemiologic History and Genetic Diversity Origins of Chikungunya and Dengue Viruses, Paraguay. Emerg Infect Dis. 2021;27(5):1393-1404. https://doi.org/10.3201/eid2705.204244
AMA Gräf T, Vazquez C, Giovanetti M, et al. Epidemiologic History and Genetic Diversity Origins of Chikungunya and Dengue Viruses, Paraguay. Emerging Infectious Diseases. 2021;27(5):1393-1404. doi:10.3201/eid2705.204244.
APA Gräf, T., Vazquez, C., Giovanetti, M., de Bruycker-Nogueira, F., Fonseca, V., Claro, I....Alcantara, L. (2021). Epidemiologic History and Genetic Diversity Origins of Chikungunya and Dengue Viruses, Paraguay. Emerging Infectious Diseases, 27(5), 1393-1404. https://doi.org/10.3201/eid2705.204244.

Monitoring SARS-CoV-2 Circulation and Diversity through Community Wastewater Sequencing, the Netherlands and Belgium [PDF - 2.42 MB - 11 pages]
R. Izquierdo-Lara et al.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly become a major global health problem, and public health surveillance is crucial to monitor and prevent virus spread. Wastewater-based epidemiology has been proposed as an addition to disease-based surveillance because virus is shed in the feces of ≈40% of infected persons. We used next-generation sequencing of sewage samples to evaluate the diversity of SARS-CoV-2 at the community level in the Netherlands and Belgium. Phylogenetic analysis revealed the presence of the most prevalent clades (19A, 20A, and 20B) and clustering of sewage samples with clinical samples from the same region. We distinguished multiple clades within a single sewage sample by using low-frequency variant analysis. In addition, several novel mutations in the SARS-CoV-2 genome were detected. Our results illustrate how wastewater can be used to investigate the diversity of SARS-CoV-2 viruses circulating in a community and identify new outbreaks.

EID Izquierdo-Lara R, Elsinga G, Heijnen L, Munnink B, Schapendonk C, Nieuwenhuijse D, et al. Monitoring SARS-CoV-2 Circulation and Diversity through Community Wastewater Sequencing, the Netherlands and Belgium. Emerg Infect Dis. 2021;27(5):1405-1415. https://doi.org/10.3201/eid2705.204410
AMA Izquierdo-Lara R, Elsinga G, Heijnen L, et al. Monitoring SARS-CoV-2 Circulation and Diversity through Community Wastewater Sequencing, the Netherlands and Belgium. Emerging Infectious Diseases. 2021;27(5):1405-1415. doi:10.3201/eid2705.204410.
APA Izquierdo-Lara, R., Elsinga, G., Heijnen, L., Munnink, B., Schapendonk, C., Nieuwenhuijse, D....de Graaf, M. (2021). Monitoring SARS-CoV-2 Circulation and Diversity through Community Wastewater Sequencing, the Netherlands and Belgium. Emerging Infectious Diseases, 27(5), 1405-1415. https://doi.org/10.3201/eid2705.204410.

Medscape CME Activity
Characteristics and Clinical Implications of Carbapenemase-Producing Klebsiella pneumoniae Colonization and Infection, Italy [PDF - 2.70 MB - 11 pages]
M. Rossi et al.

Klebsiella pneumoniae carbapenemase–producing K. pneumoniae (KPC-Kp) has been endemic in Italy since 2013. In a multicenter cohort study, we investigated various aspects of KPC-Kp among patients, including 15-day mortality rates and delays in adequate therapy. Most (77%) KPC-Kp strains were sequence type (ST) ST512 or ST307. During 2017, KPC-Kp prevalence was 3.26 cases/1,000 hospitalized patients. Cumulative incidence of KPC-Kp acquired >48 hours after hospital admission was 0.68% but varied widely between centers. Among patients with mild infections and noninfected colonized patients, 15-day mortality rates were comparable, but rates were much higher among patients with severe infections. Delays of >4 days in receiving adequate therapy more frequently occurred among patients with mild infections than those with severe infections, and delays were less common for patients with known previous KPC-Kp colonization. Italy urgently needs a concerted surveillance system to control the spread of KPC-Kp.

EID Rossi M, Chatenoud L, Gona F, Sala I, Nattino G, D'Antonio A, et al. Characteristics and Clinical Implications of Carbapenemase-Producing Klebsiella pneumoniae Colonization and Infection, Italy. Emerg Infect Dis. 2021;27(5):1416-1426. https://doi.org/10.3201/eid2705.203662
AMA Rossi M, Chatenoud L, Gona F, et al. Characteristics and Clinical Implications of Carbapenemase-Producing Klebsiella pneumoniae Colonization and Infection, Italy. Emerging Infectious Diseases. 2021;27(5):1416-1426. doi:10.3201/eid2705.203662.
APA Rossi, M., Chatenoud, L., Gona, F., Sala, I., Nattino, G., D'Antonio, A....Gori, A. (2021). Characteristics and Clinical Implications of Carbapenemase-Producing Klebsiella pneumoniae Colonization and Infection, Italy. Emerging Infectious Diseases, 27(5), 1416-1426. https://doi.org/10.3201/eid2705.203662.

Engineered NS1 for Sensitive, Specific Zika Virus Diagnosis from Patient Serology [PDF - 1.92 MB - 11 pages]
T. Yap et al.

Dengue virus (DENV) and Zika virus (ZIKV) belong to the Flaviviridae family of viruses spread by Aedes aegypti mosquitoes in tropical and subtropical areas. Accurate diagnostic tests to differentiate the 2 infections are necessary for patient management and disease control. Using characterized ZIKV and DENV patient plasma in a blind manner, we validated an ELISA and a rapid immunochromatographic test for ZIKV detection. We engineered the ZIKV nonstructural protein 1 (NS1) for sensitive serologic detection with low cross reactivity against dengue and developed monoclonal antibodies specific for the ZIKV NS1 antigen. As expected, the serologic assays performed better with convalescent than acute plasma samples; the sensitivity ranged from 71% to 88%, depending on the performance of individual tests (IgM/IgG/NS1). Although serologic tests were generally less sensitive with acute samples, our ZIKV NS1 antibodies were able to complement the serologic tests to achieve greater sensitivity for detecting early infections.

EID Yap T, Hong S, Soh J, Ravichandraprabhu L, Lim V, Chan H, et al. Engineered NS1 for Sensitive, Specific Zika Virus Diagnosis from Patient Serology. Emerg Infect Dis. 2021;27(5):1427-1437. https://doi.org/10.3201/eid2705.190121
AMA Yap T, Hong S, Soh J, et al. Engineered NS1 for Sensitive, Specific Zika Virus Diagnosis from Patient Serology. Emerging Infectious Diseases. 2021;27(5):1427-1437. doi:10.3201/eid2705.190121.
APA Yap, T., Hong, S., Soh, J., Ravichandraprabhu, L., Lim, V., Chan, H....Sun, W. (2021). Engineered NS1 for Sensitive, Specific Zika Virus Diagnosis from Patient Serology. Emerging Infectious Diseases, 27(5), 1427-1437. https://doi.org/10.3201/eid2705.190121.

Global Trends in Norovirus Genotype Distribution among Children with Acute Gastroenteritis [PDF - 1.60 MB - 8 pages]
J. L. Cannon et al.

Noroviruses are a leading cause of acute gastroenteritis (AGE) among adults and children worldwide. NoroSurv is a global network for norovirus strain surveillance among children <5 years of age with AGE. Participants in 16 countries across 6 continents used standardized protocols for dual typing (genotype and polymerase type) and uploaded 1,325 dual-typed sequences to the NoroSurv web portal during 2016–2020. More than 50% of submitted sequences were GII.4 Sydney[P16] or GII.4 Sydney[P31] strains. Other common strains included GII.2[P16], GII.3[P12], GII.6[P7], and GI.3[P3] viruses. In total, 22 genotypes and 36 dual types, including GII.3 and GII.20 viruses with rarely reported polymerase types, were detected, reflecting high strain diversity. Surveillance data captured in NoroSurv enables the monitoring of trends in norovirus strains associated childhood AGE throughout the world on a near real-time basis.

EID Cannon JL, Bonifacio J, Bucardo F, Buesa J, Bruggink L, Chan M, et al. Global Trends in Norovirus Genotype Distribution among Children with Acute Gastroenteritis. Emerg Infect Dis. 2021;27(5):1438-1445. https://doi.org/10.3201/eid2705.204756
AMA Cannon JL, Bonifacio J, Bucardo F, et al. Global Trends in Norovirus Genotype Distribution among Children with Acute Gastroenteritis. Emerging Infectious Diseases. 2021;27(5):1438-1445. doi:10.3201/eid2705.204756.
APA Cannon, J. L., Bonifacio, J., Bucardo, F., Buesa, J., Bruggink, L., Chan, M....Vinjé, J. (2021). Global Trends in Norovirus Genotype Distribution among Children with Acute Gastroenteritis. Emerging Infectious Diseases, 27(5), 1438-1445. https://doi.org/10.3201/eid2705.204756.

Genetic Evidence and Host Immune Response in Persons Reinfected with SARS-CoV-2, Brazil [PDF - 1.75 MB - 8 pages]
N. Fintelman-Rodrigues et al.

The dynamics underlying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinfection remain poorly understood. We identified a small cluster of patients in Brazil who experienced 2 episodes of coronavirus disease (COVID-19) in March and late May 2020. In the first episode, patients manifested an enhanced innate response compared with healthy persons, but neutralizing humoral immunity was not fully achieved. The second episode was associated with different SARS-CoV-2 strains, higher viral loads, and clinical symptoms. Our finding that persons with mild COVID-19 may have controlled SARS-CoV-2 replication without developing detectable humoral immunity suggests that reinfection is more frequent than supposed, but this hypothesis is not well documented.

EID Fintelman-Rodrigues N, da Silva A, dos Santos M, Saraiva FB, Ferreira MA, Gesto J, et al. Genetic Evidence and Host Immune Response in Persons Reinfected with SARS-CoV-2, Brazil. Emerg Infect Dis. 2021;27(5):1446-1453. https://doi.org/10.3201/eid2705.204912
AMA Fintelman-Rodrigues N, da Silva A, dos Santos M, et al. Genetic Evidence and Host Immune Response in Persons Reinfected with SARS-CoV-2, Brazil. Emerging Infectious Diseases. 2021;27(5):1446-1453. doi:10.3201/eid2705.204912.
APA Fintelman-Rodrigues, N., da Silva, A., dos Santos, M., Saraiva, F. B., Ferreira, M. A., Gesto, J....Souza, T. L. (2021). Genetic Evidence and Host Immune Response in Persons Reinfected with SARS-CoV-2, Brazil. Emerging Infectious Diseases, 27(5), 1446-1453. https://doi.org/10.3201/eid2705.204912.
Dispatches

COVID-19–Associated Mold Infection in Critically Ill Patients, Chile [PDF - 616 KB - 3 pages]
R. Rabagliati et al.

Patients with severe coronavirus disease (COVID-19) may have COVID-19–associated invasive mold infection (CAIMI) develop. We report 16 cases of CAIMI among 146 nonimmunocompromised patients with severe COVID-19 at an academic hospital in Santiago, Chile. These rates correspond to a CAIMI incidence of 11%; the mortality rate for these patients was 31.2%.

EID Rabagliati R, Rodríguez N, Núñez C, Huete A, Bravo S, Garcia P. COVID-19–Associated Mold Infection in Critically Ill Patients, Chile. Emerg Infect Dis. 2021;27(5):1454-1456. https://doi.org/10.3201/eid2705.204412
AMA Rabagliati R, Rodríguez N, Núñez C, et al. COVID-19–Associated Mold Infection in Critically Ill Patients, Chile. Emerging Infectious Diseases. 2021;27(5):1454-1456. doi:10.3201/eid2705.204412.
APA Rabagliati, R., Rodríguez, N., Núñez, C., Huete, A., Bravo, S., & Garcia, P. (2021). COVID-19–Associated Mold Infection in Critically Ill Patients, Chile. Emerging Infectious Diseases, 27(5), 1454-1456. https://doi.org/10.3201/eid2705.204412.

Multisystem Inflammatory Syndrome in Children, Chile, May–August 2020 [PDF - 2.63 MB - 5 pages]
C. Niño-Taravilla et al.

We describe 26 children with multisystem inflammatory syndrome associated with coronavirus disease in the pediatric intensive care unit of Roberto del Río Hospital (Santiago, Chile). In total, 10 (38.5%) children required mechanical ventilation; 13 (50.0%) required inotropic support. In addition, 18 (69.2%) patients had echocardiographic abnormalities. No patients died.

EID Niño-Taravilla C, Otaola-Arca H, Lara-Aguilera N, Zuleta-Morales Y, Ortiz-Fritz P. Multisystem Inflammatory Syndrome in Children, Chile, May–August 2020. Emerg Infect Dis. 2021;27(5):1457-1461. https://doi.org/10.3201/eid2705.204591
AMA Niño-Taravilla C, Otaola-Arca H, Lara-Aguilera N, et al. Multisystem Inflammatory Syndrome in Children, Chile, May–August 2020. Emerging Infectious Diseases. 2021;27(5):1457-1461. doi:10.3201/eid2705.204591.
APA Niño-Taravilla, C., Otaola-Arca, H., Lara-Aguilera, N., Zuleta-Morales, Y., & Ortiz-Fritz, P. (2021). Multisystem Inflammatory Syndrome in Children, Chile, May–August 2020. Emerging Infectious Diseases, 27(5), 1457-1461. https://doi.org/10.3201/eid2705.204591.

Medscape CME Activity
Prescribing Antimicrobial Drugs for Acute Gastroenteritis, Primary Care, Australia, 2013–2018 [PDF - 1.54 MB - 6 pages]
W. He et al.

During 2013–2018, antimicrobial drugs were prescribed for 6.8% of cases of acute gastroenteritis encountered in general practice in Australia, including 35.7% of Salmonella infections and 54.1% of Campylobacter infections. During that time, prescriptions for acute gastroenteritis decreased by 2.0%. Managing infectious gastroenteritis in general practice will require greater antimicrobial stewardship.

EID He W, Kirk MD, Hall J, Liu B. Prescribing Antimicrobial Drugs for Acute Gastroenteritis, Primary Care, Australia, 2013–2018. Emerg Infect Dis. 2021;27(5):1462-1467. https://doi.org/10.3201/eid2705.203692
AMA He W, Kirk MD, Hall J, et al. Prescribing Antimicrobial Drugs for Acute Gastroenteritis, Primary Care, Australia, 2013–2018. Emerging Infectious Diseases. 2021;27(5):1462-1467. doi:10.3201/eid2705.203692.
APA He, W., Kirk, M. D., Hall, J., & Liu, B. (2021). Prescribing Antimicrobial Drugs for Acute Gastroenteritis, Primary Care, Australia, 2013–2018. Emerging Infectious Diseases, 27(5), 1462-1467. https://doi.org/10.3201/eid2705.203692.

Epidemiology of Confirmed COVID-19 Deaths in Adults, England, March–December 2020 [PDF - 1.13 MB - 4 pages]
A. E. Brown et al.

Of the 58,186 coronavirus deaths among adults in England during March–December 2020, 77% occurred in hospitals, 93% were in patients >60 years, and 91% occurred within 28 days of positive specimen. Cumulative mortality rates were highest among persons of Black, Asian, other, or mixed ethnicities and in socioeconomically deprived areas.

EID Brown AE, Heinsbroek E, Kall MM, Allen H, Beebeejaun K, Blomquist P, et al. Epidemiology of Confirmed COVID-19 Deaths in Adults, England, March–December 2020. Emerg Infect Dis. 2021;27(5):1468-1471. https://doi.org/10.3201/eid2705.203524
AMA Brown AE, Heinsbroek E, Kall MM, et al. Epidemiology of Confirmed COVID-19 Deaths in Adults, England, March–December 2020. Emerging Infectious Diseases. 2021;27(5):1468-1471. doi:10.3201/eid2705.203524.
APA Brown, A. E., Heinsbroek, E., Kall, M. M., Allen, H., Beebeejaun, K., Blomquist, P....Dabrera, G. (2021). Epidemiology of Confirmed COVID-19 Deaths in Adults, England, March–December 2020. Emerging Infectious Diseases, 27(5), 1468-1471. https://doi.org/10.3201/eid2705.203524.

Longevity of Middle East Respiratory Syndrome Coronavirus Antibody Responses in Humans, Saudi Arabia [PDF - 1019 KB - 5 pages]
A. N. Alshukairi et al.

Understanding the immune response to Middle East respiratory syndrome coronavirus (MERS-CoV) is crucial for disease prevention and vaccine development. We studied the antibody responses in 48 human MERS-CoV infection survivors who had variable disease severity in Saudi Arabia. MERS-CoV–specific neutralizing antibodies were detected for 6 years postinfection.

EID Alshukairi AN, Zhao J, Al-Mozaini MA, Wang Y, Dada A, Baharoon SA, et al. Longevity of Middle East Respiratory Syndrome Coronavirus Antibody Responses in Humans, Saudi Arabia. Emerg Infect Dis. 2021;27(5):1472-1476. https://doi.org/10.3201/eid2705.204056
AMA Alshukairi AN, Zhao J, Al-Mozaini MA, et al. Longevity of Middle East Respiratory Syndrome Coronavirus Antibody Responses in Humans, Saudi Arabia. Emerging Infectious Diseases. 2021;27(5):1472-1476. doi:10.3201/eid2705.204056.
APA Alshukairi, A. N., Zhao, J., Al-Mozaini, M. A., Wang, Y., Dada, A., Baharoon, S. A....Memish, Z. A. (2021). Longevity of Middle East Respiratory Syndrome Coronavirus Antibody Responses in Humans, Saudi Arabia. Emerging Infectious Diseases, 27(5), 1472-1476. https://doi.org/10.3201/eid2705.204056.

Racial and Ethnic Disparities in Incidence of SARS-CoV-2 Infection, 22 US States and DC, January 1–October 1, 2020 [PDF - 2.30 MB - 5 pages]
N. D. Hollis et al.

We examined disparities in cumulative incidence of severe acute respiratory syndrome coronavirus 2 by race/ethnicity, age, and sex in the United States during January 1–October 1, 2020. Hispanic/Latino and non-Hispanic Black, American Indian/Alaskan Native, and Native Hawaiian/other Pacific Islander persons had a substantially higher incidence of infection than non-Hispanic White persons.

EID Hollis ND, Li W, Van Dyke ME, Njie GJ, Scobie HM, Parker EM, et al. Racial and Ethnic Disparities in Incidence of SARS-CoV-2 Infection, 22 US States and DC, January 1–October 1, 2020. Emerg Infect Dis. 2021;27(5):1477-1481. https://doi.org/10.3201/eid2705.204523
AMA Hollis ND, Li W, Van Dyke ME, et al. Racial and Ethnic Disparities in Incidence of SARS-CoV-2 Infection, 22 US States and DC, January 1–October 1, 2020. Emerging Infectious Diseases. 2021;27(5):1477-1481. doi:10.3201/eid2705.204523.
APA Hollis, N. D., Li, W., Van Dyke, M. E., Njie, G. J., Scobie, H. M., Parker, E. M....Clarke, K. (2021). Racial and Ethnic Disparities in Incidence of SARS-CoV-2 Infection, 22 US States and DC, January 1–October 1, 2020. Emerging Infectious Diseases, 27(5), 1477-1481. https://doi.org/10.3201/eid2705.204523.

Emergence of Toscana Virus, Romania, 2017–2018 [PDF - 2.23 MB - 4 pages]
C. P. Popescu et al.

We describe a series of severe neuroinvasive infections caused by Toscana virus, identified by real-time reverse transcription PCR testing, in 8 hospitalized patients in Bucharest, Romania, during the summer seasons of 2017 and 2018. Of 8 patients, 5 died. Sequencing showed that the circulating virus belonged to lineage A.

EID Popescu CP, Cotar AI, Dinu S, Zaharia M, Tardei G, Ceausu E, et al. Emergence of Toscana Virus, Romania, 2017–2018. Emerg Infect Dis. 2021;27(5):1482-1485. https://doi.org/10.3201/eid2705.204598
AMA Popescu CP, Cotar AI, Dinu S, et al. Emergence of Toscana Virus, Romania, 2017–2018. Emerging Infectious Diseases. 2021;27(5):1482-1485. doi:10.3201/eid2705.204598.
APA Popescu, C. P., Cotar, A. I., Dinu, S., Zaharia, M., Tardei, G., Ceausu, E....Florescu, S. A. (2021). Emergence of Toscana Virus, Romania, 2017–2018. Emerging Infectious Diseases, 27(5), 1482-1485. https://doi.org/10.3201/eid2705.204598.

SARS-CoV-2 Serial Interval Variation, Montana, USA, March 1–July 31, 2020 [PDF - 1.47 MB - 6 pages]
I. G. Reed et al.

We report mean severe acute respiratory syndrome coronavirus 2 serial intervals for Montana, USA, from 583 transmission pairs; infectors’ symptom onset dates occurred during March 1–July 31, 2020. Our estimate was 5.68 (95% CI 5.27–6.08) days, SD 4.77 (95% CI 4.33–5.19) days. Subperiod estimates varied temporally by nonpharmaceutical intervention type and fluctuating incidence.

EID Reed IG, Walker ES, Landguth EL. SARS-CoV-2 Serial Interval Variation, Montana, USA, March 1–July 31, 2020. Emerg Infect Dis. 2021;27(5):1486-1491. https://doi.org/10.3201/eid2705.204663
AMA Reed IG, Walker ES, Landguth EL. SARS-CoV-2 Serial Interval Variation, Montana, USA, March 1–July 31, 2020. Emerging Infectious Diseases. 2021;27(5):1486-1491. doi:10.3201/eid2705.204663.
APA Reed, I. G., Walker, E. S., & Landguth, E. L. (2021). SARS-CoV-2 Serial Interval Variation, Montana, USA, March 1–July 31, 2020. Emerging Infectious Diseases, 27(5), 1486-1491. https://doi.org/10.3201/eid2705.204663.

Introduction of ORF3a-Q57H SARS-CoV-2 Variant Causing Fourth Epidemic Wave of COVID-19, Hong Kong, China [PDF - 1.40 MB - 4 pages]
D. Chu et al.

We describe an introduction of clade GH severe acute respiratory syndrome coronavirus 2 causing a fourth wave of coronavirus disease in Hong Kong. The virus has an ORF3a-Q57H mutation, causing truncation of ORF3b. This virus evades induction of cytokine, chemokine, and interferon-stimulated gene expression in primary human respiratory cells.

EID Chu D, Hui K, Gu H, Ko R, Krishnan P, Ng D, et al. Introduction of ORF3a-Q57H SARS-CoV-2 Variant Causing Fourth Epidemic Wave of COVID-19, Hong Kong, China. Emerg Infect Dis. 2021;27(5):1492-1495. https://doi.org/10.3201/eid2705.210015
AMA Chu D, Hui K, Gu H, et al. Introduction of ORF3a-Q57H SARS-CoV-2 Variant Causing Fourth Epidemic Wave of COVID-19, Hong Kong, China. Emerging Infectious Diseases. 2021;27(5):1492-1495. doi:10.3201/eid2705.210015.
APA Chu, D., Hui, K., Gu, H., Ko, R., Krishnan, P., Ng, D....Poon, L. (2021). Introduction of ORF3a-Q57H SARS-CoV-2 Variant Causing Fourth Epidemic Wave of COVID-19, Hong Kong, China. Emerging Infectious Diseases, 27(5), 1492-1495. https://doi.org/10.3201/eid2705.210015.

Detecting Rapid Spread of SARS-CoV-2 Variants, France, January 26–February 16, 2021 [PDF - 1.32 MB - 4 pages]
S. Haim-Boukobza et al.

Variants of severe acute respiratory syndrome coronavirus 2 raise concerns regarding the control of coronavirus disease epidemics. We analyzed 40,000 specific reverse transcription PCR tests performed on positive samples during January 26–February 16, 2021, in France. We found high transmission advantage of variants and more advanced spread than anticipated.

EID Haim-Boukobza S, Roquebert B, Trombert-Paolantoni S, Lecorche E, Verdurme L, Foulongne V, et al. Detecting Rapid Spread of SARS-CoV-2 Variants, France, January 26–February 16, 2021. Emerg Infect Dis. 2021;27(5):1496-1499. https://doi.org/10.3201/eid2705.210397
AMA Haim-Boukobza S, Roquebert B, Trombert-Paolantoni S, et al. Detecting Rapid Spread of SARS-CoV-2 Variants, France, January 26–February 16, 2021. Emerging Infectious Diseases. 2021;27(5):1496-1499. doi:10.3201/eid2705.210397.
APA Haim-Boukobza, S., Roquebert, B., Trombert-Paolantoni, S., Lecorche, E., Verdurme, L., Foulongne, V....Alizon, S. (2021). Detecting Rapid Spread of SARS-CoV-2 Variants, France, January 26–February 16, 2021. Emerging Infectious Diseases, 27(5), 1496-1499. https://doi.org/10.3201/eid2705.210397.

Detecting COVID-19 Clusters at High Spatiotemporal Resolution, New York City, New York, USA, June–July 2020 [PDF - 238 KB - 5 pages]
S. K. Greene et al.

A surveillance system that uses census tract resolution and the SaTScan prospective space-time scan statistic detected clusters of increasing severe acute respiratory syndrome coronavirus 2 test percent positivity in New York City, NY, USA. Clusters included one in which patients attended the same social gathering and another that led to targeted testing and outreach.

EID Greene SK, Peterson ER, Balan D, Jones L, Culp GM, Fine AD, et al. Detecting COVID-19 Clusters at High Spatiotemporal Resolution, New York City, New York, USA, June–July 2020. Emerg Infect Dis. 2021;27(5):1500-1504. https://doi.org/10.3201/eid2705.203583
AMA Greene SK, Peterson ER, Balan D, et al. Detecting COVID-19 Clusters at High Spatiotemporal Resolution, New York City, New York, USA, June–July 2020. Emerging Infectious Diseases. 2021;27(5):1500-1504. doi:10.3201/eid2705.203583.
APA Greene, S. K., Peterson, E. R., Balan, D., Jones, L., Culp, G. M., Fine, A. D....Kulldorff, M. (2021). Detecting COVID-19 Clusters at High Spatiotemporal Resolution, New York City, New York, USA, June–July 2020. Emerging Infectious Diseases, 27(5), 1500-1504. https://doi.org/10.3201/eid2705.203583.

Evaluating Differences in Whole Blood, Serum, and Urine Screening Tests for Zika Virus, Puerto Rico, USA, 2016 [PDF - 755 KB - 4 pages]
A. Y. Rosinger et al.

We evaluated nucleic acid amplification testing (NAAT) for Zika virus on whole-blood specimens compared with NAAT on serum and urine specimens among asymptomatic pregnant women during the 2015–2016 Puerto Rico Zika outbreak. Using NAAT, more infections were detected in serum and urine than in whole blood specimens.

EID Rosinger AY, Olson SM, Ellington SR, Perez-Padilla J, Simeone RM, Pedati CS, et al. Evaluating Differences in Whole Blood, Serum, and Urine Screening Tests for Zika Virus, Puerto Rico, USA, 2016. Emerg Infect Dis. 2021;27(5):1505-1508. https://doi.org/10.3201/eid2705.203960
AMA Rosinger AY, Olson SM, Ellington SR, et al. Evaluating Differences in Whole Blood, Serum, and Urine Screening Tests for Zika Virus, Puerto Rico, USA, 2016. Emerging Infectious Diseases. 2021;27(5):1505-1508. doi:10.3201/eid2705.203960.
APA Rosinger, A. Y., Olson, S. M., Ellington, S. R., Perez-Padilla, J., Simeone, R. M., Pedati, C. S....Shapiro-Mendoza, C. K. (2021). Evaluating Differences in Whole Blood, Serum, and Urine Screening Tests for Zika Virus, Puerto Rico, USA, 2016. Emerging Infectious Diseases, 27(5), 1505-1508. https://doi.org/10.3201/eid2705.203960.

Whole-Genome Sequencing of Shiga Toxin–Producing Escherichia coli OX18 from a Fatal Hemolytic Uremic Syndrome Case [PDF - 1.31 MB - 4 pages]
K. Lee et al.

We report a fatal case of hemolytic uremic syndrome with urinary tract infection in Japan caused by Shiga toxin–producing Escherichia coli. We genotypically identified the isolate as OX18:H2. Whole-genome sequencing revealed 3 potentially pathogenic lineages (OX18:H2, H19, and H34) that have been continuously isolated in Japan.

EID Lee K, Iguchi A, Uda K, Matsumura S, Miyairi I, Ishikura K, et al. Whole-Genome Sequencing of Shiga Toxin–Producing Escherichia coli OX18 from a Fatal Hemolytic Uremic Syndrome Case. Emerg Infect Dis. 2021;27(5):1509-1512. https://doi.org/10.3201/eid2705.204162
AMA Lee K, Iguchi A, Uda K, et al. Whole-Genome Sequencing of Shiga Toxin–Producing Escherichia coli OX18 from a Fatal Hemolytic Uremic Syndrome Case. Emerging Infectious Diseases. 2021;27(5):1509-1512. doi:10.3201/eid2705.204162.
APA Lee, K., Iguchi, A., Uda, K., Matsumura, S., Miyairi, I., Ishikura, K....Iyoda, S. (2021). Whole-Genome Sequencing of Shiga Toxin–Producing Escherichia coli OX18 from a Fatal Hemolytic Uremic Syndrome Case. Emerging Infectious Diseases, 27(5), 1509-1512. https://doi.org/10.3201/eid2705.204162.

Coordinated Response to Imported Vaccine-Derived Poliovirus Infection, Barcelona, Spain, 2019–2020 [PDF - 1.94 MB - 4 pages]
D. Álamo-Junquera et al.

In 2019, the Public Health Agency of Barcelona, Spain, was notified of a vaccine-derived poliovirus infection. The patient had an underlying common variable immunodeficiency and no signs of acute flaccid paralysis. We describe the ongoing coordinated response to contain the infection, which included compassionate-use treatment with pocapavir.

EID Álamo-Junquera D, Politi J, Simón P, Dieli-Crimi R, Borrell R, Colobran R, et al. Coordinated Response to Imported Vaccine-Derived Poliovirus Infection, Barcelona, Spain, 2019–2020. Emerg Infect Dis. 2021;27(5):1513-1516. https://doi.org/10.3201/eid2705.204675
AMA Álamo-Junquera D, Politi J, Simón P, et al. Coordinated Response to Imported Vaccine-Derived Poliovirus Infection, Barcelona, Spain, 2019–2020. Emerging Infectious Diseases. 2021;27(5):1513-1516. doi:10.3201/eid2705.204675.
APA Álamo-Junquera, D., Politi, J., Simón, P., Dieli-Crimi, R., Borrell, R., Colobran, R....Rius, C. (2021). Coordinated Response to Imported Vaccine-Derived Poliovirus Infection, Barcelona, Spain, 2019–2020. Emerging Infectious Diseases, 27(5), 1513-1516. https://doi.org/10.3201/eid2705.204675.
Research Letters

Intersecting Paths of Emerging and Reemerging Infectious Diseases [PDF - 2.03 MB - 3 pages]
T. M. Wilson et al.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) shares common clinicopathologic features with other severe pulmonary illnesses. Hantavirus pulmonary syndrome was diagnosed in 2 patients in Arizona, USA, suspected of dying from infection with SARS-CoV-2. Differential diagnoses and possible co-infections should be considered for cases of respiratory distress during the SARS-CoV-2 pandemic.

EID Wilson TM, Paddock CD, Reagan-Steiner S, Bhatnagar J, Martines RB, Wiens AL, et al. Intersecting Paths of Emerging and Reemerging Infectious Diseases. Emerg Infect Dis. 2021;27(5):1517-1519. https://doi.org/10.3201/eid2705.204779
AMA Wilson TM, Paddock CD, Reagan-Steiner S, et al. Intersecting Paths of Emerging and Reemerging Infectious Diseases. Emerging Infectious Diseases. 2021;27(5):1517-1519. doi:10.3201/eid2705.204779.
APA Wilson, T. M., Paddock, C. D., Reagan-Steiner, S., Bhatnagar, J., Martines, R. B., Wiens, A. L....Zaki, S. R. (2021). Intersecting Paths of Emerging and Reemerging Infectious Diseases. Emerging Infectious Diseases, 27(5), 1517-1519. https://doi.org/10.3201/eid2705.204779.

Novel Mutation of SARS-CoV-2, Vietnam, July 2020 [PDF - 1.15 MB - 3 pages]
H. Phuong et al.

A cluster of severe acute respiratory syndrome coronavirus 2 infections in Danang, Vietnam, began July 25, 2020, and resulted in 551 confirmed cases and 35 deaths as of February 2021. We analyzed 26 sequences from this cluster and identified a novel shared mutation in nonstructural protein 9, suggesting a single introduction into Vietnam.

EID Phuong H, Tung T, Trang U, Hang N, Son NV, Hien P, et al. Novel Mutation of SARS-CoV-2, Vietnam, July 2020. Emerg Infect Dis. 2021;27(5):1519-1521. https://doi.org/10.3201/eid2705.210013
AMA Phuong H, Tung T, Trang U, et al. Novel Mutation of SARS-CoV-2, Vietnam, July 2020. Emerging Infectious Diseases. 2021;27(5):1519-1521. doi:10.3201/eid2705.210013.
APA Phuong, H., Tung, T., Trang, U., Hang, N., Son, N. V., Hien, P....Mai, L. (2021). Novel Mutation of SARS-CoV-2, Vietnam, July 2020. Emerging Infectious Diseases, 27(5), 1519-1521. https://doi.org/10.3201/eid2705.210013.

Genomic Evidence of SARS-CoV-2 Reinfection Involving E484K Spike Mutation, Brazil [PDF - 1.29 MB - 3 pages]
C. V. Nonaka et al.

Uncertainty remains about how long the protective immune responses against severe acute respiratory syndrome coronavirus 2 persists, and suspected reinfection in recovered patients has been reported. We describe a case of reinfection from distinct virus lineages in Brazil harboring the E484K mutation, a variant associated with escape from neutralizing antibodies.

EID Nonaka CV, Franco M, Gräf T, de Lorenzo Barcia C, de Ávila Mendonça R, de Sousa K, et al. Genomic Evidence of SARS-CoV-2 Reinfection Involving E484K Spike Mutation, Brazil. Emerg Infect Dis. 2021;27(5):1522-1524. https://doi.org/10.3201/eid2705.210191
AMA Nonaka CV, Franco M, Gräf T, et al. Genomic Evidence of SARS-CoV-2 Reinfection Involving E484K Spike Mutation, Brazil. Emerging Infectious Diseases. 2021;27(5):1522-1524. doi:10.3201/eid2705.210191.
APA Nonaka, C. V., Franco, M., Gräf, T., de Lorenzo Barcia, C., de Ávila Mendonça, R., de Sousa, K....de Freitas Souza, B. (2021). Genomic Evidence of SARS-CoV-2 Reinfection Involving E484K Spike Mutation, Brazil. Emerging Infectious Diseases, 27(5), 1522-1524. https://doi.org/10.3201/eid2705.210191.

Upper Respiratory Infections in Schools and Childcare Centers Reopening after COVID-19 Dismissals, Hong Kong [PDF - 1.18 MB - 3 pages]
M. Fong et al.

A large number of common cold outbreaks in Hong Kong schools and childcare centers during October–November 2020 led to territorywide school dismissals. Increased susceptibility to rhinoviruses during prolonged school closures and dismissals for coronavirus disease and varying effectiveness of nonpharmaceutical interventions may have heightened transmission of cold-causing viruses after school attendance resumed.

EID Fong M, Leung N, Cowling BJ, Wu P. Upper Respiratory Infections in Schools and Childcare Centers Reopening after COVID-19 Dismissals, Hong Kong. Emerg Infect Dis. 2021;27(5):1525-1527. https://doi.org/10.3201/eid2705.210277
AMA Fong M, Leung N, Cowling BJ, et al. Upper Respiratory Infections in Schools and Childcare Centers Reopening after COVID-19 Dismissals, Hong Kong. Emerging Infectious Diseases. 2021;27(5):1525-1527. doi:10.3201/eid2705.210277.
APA Fong, M., Leung, N., Cowling, B. J., & Wu, P. (2021). Upper Respiratory Infections in Schools and Childcare Centers Reopening after COVID-19 Dismissals, Hong Kong. Emerging Infectious Diseases, 27(5), 1525-1527. https://doi.org/10.3201/eid2705.210277.

Risk for International Importations of Variant SARS-CoV-2 Originating in the United Kingdom [PDF - 1.20 MB - 3 pages]
Z. Du et al.

A fast-spreading severe acute respiratory syndrome coronavirus 2 variant identified in the United Kingdom in December 2020 has raised international alarm. We analyzed data from 15 countries and estimated that the chance that this variant was imported into these countries by travelers from the United Kingdom by December 7 is >50%.

EID Du Z, Wang L, Yang B, Ali S, Tsang TK, Shan S, et al. Risk for International Importations of Variant SARS-CoV-2 Originating in the United Kingdom. Emerg Infect Dis. 2021;27(5):1527-1529. https://doi.org/10.3201/eid2705.210050
AMA Du Z, Wang L, Yang B, et al. Risk for International Importations of Variant SARS-CoV-2 Originating in the United Kingdom. Emerging Infectious Diseases. 2021;27(5):1527-1529. doi:10.3201/eid2705.210050.
APA Du, Z., Wang, L., Yang, B., Ali, S., Tsang, T. K., Shan, S....Meyers, L. (2021). Risk for International Importations of Variant SARS-CoV-2 Originating in the United Kingdom. Emerging Infectious Diseases, 27(5), 1527-1529. https://doi.org/10.3201/eid2705.210050.

Severe Case of Rickettsiosis Identified by Metagenomic Sequencing, China [PDF - 798 KB - 3 pages]
Z. Teng et al.

A case of Rickettsia sibirica subspecies sibirica BJ-90 infection in China was identified by metagenomic analysis of an eschar biopsy specimen and confirmed by nested PCR. Seroprevalence of spotted fever group Rickettsia was ≈17.4% among the local population. This report highlights the threat of rickettsioses to public health in the Qinghai–Tibet Plateau.

EID Teng Z, Shi Y, Peng Y, Zhang H, Luo X, Lun X, et al. Severe Case of Rickettsiosis Identified by Metagenomic Sequencing, China. Emerg Infect Dis. 2021;27(5):1530-1532. https://doi.org/10.3201/eid2705.203265
AMA Teng Z, Shi Y, Peng Y, et al. Severe Case of Rickettsiosis Identified by Metagenomic Sequencing, China. Emerging Infectious Diseases. 2021;27(5):1530-1532. doi:10.3201/eid2705.203265.
APA Teng, Z., Shi, Y., Peng, Y., Zhang, H., Luo, X., Lun, X....Qin, A. (2021). Severe Case of Rickettsiosis Identified by Metagenomic Sequencing, China. Emerging Infectious Diseases, 27(5), 1530-1532. https://doi.org/10.3201/eid2705.203265.

Eosinophilic Meningitis and Intraocular Infection Caused by Dirofilaria sp. Genotype Hongkong [PDF - 898 KB - 3 pages]
A. S. Jyotsna et al.

Eosinophilic meningitis caused by human diroflarial infection is rare. We report a case of eosinophilic meningitis and concomitant intraocular dirofilarial infection in India. Sequencing of the mitochondrial genome identified the worm as Dirofilaria sp. genotype Hongkong, a close relative of D. repens nematodes.

EID Jyotsna AS, Vinayan K, Biswas L, Haridas S, Roy AG, Suresh P, et al. Eosinophilic Meningitis and Intraocular Infection Caused by Dirofilaria sp. Genotype Hongkong. Emerg Infect Dis. 2021;27(5):1532-1534. https://doi.org/10.3201/eid2705.203599
AMA Jyotsna AS, Vinayan K, Biswas L, et al. Eosinophilic Meningitis and Intraocular Infection Caused by Dirofilaria sp. Genotype Hongkong. Emerging Infectious Diseases. 2021;27(5):1532-1534. doi:10.3201/eid2705.203599.
APA Jyotsna, A. S., Vinayan, K., Biswas, L., Haridas, S., Roy, A. G., Suresh, P....Kumar, A. (2021). Eosinophilic Meningitis and Intraocular Infection Caused by Dirofilaria sp. Genotype Hongkong. Emerging Infectious Diseases, 27(5), 1532-1534. https://doi.org/10.3201/eid2705.203599.

COVID-19 Co-infection with Legionella pneumophila in 2 Tertiary-Care Hospitals, Germany [PDF - 702 KB - 3 pages]
H. L. Verhasselt et al.

We describe screening results for detection of co-infections with Legionella pneumophila in patients infected with severe acute respiratory syndrome coronavirus 2. In total, 93 patients were tested; 1 was positive (1.1%) for L. pneumophila serogroup 1. Co-infections with L. pneumophila occur in coronavirus disease patients and should not be missed.

EID Verhasselt HL, Buer J, Dedy J, Ziegler R, Steinmann J, Herbstreit F, et al. COVID-19 Co-infection with Legionella pneumophila in 2 Tertiary-Care Hospitals, Germany. Emerg Infect Dis. 2021;27(5):1535-1537. https://doi.org/10.3201/eid2705.203388
AMA Verhasselt HL, Buer J, Dedy J, et al. COVID-19 Co-infection with Legionella pneumophila in 2 Tertiary-Care Hospitals, Germany. Emerging Infectious Diseases. 2021;27(5):1535-1537. doi:10.3201/eid2705.203388.
APA Verhasselt, H. L., Buer, J., Dedy, J., Ziegler, R., Steinmann, J., Herbstreit, F....Rath, P. (2021). COVID-19 Co-infection with Legionella pneumophila in 2 Tertiary-Care Hospitals, Germany. Emerging Infectious Diseases, 27(5), 1535-1537. https://doi.org/10.3201/eid2705.203388.

Temporal Variations in Respiratory Syncytial Virus Epidemics, by Virus Subtype, 4 Countries [PDF - 1.01 MB - 4 pages]
L. Staadegaard et al.

Temporal variation of respiratory syncytial virus (RSV) epidemics was recently reported to be determined by the dominant RSV subtype. However, when we repeated the analysis for 4 countries in the Northern and Southern Hemispheres, the dominant subtype did not seem to affect temporal variation of RSV epidemics.

EID Staadegaard L, Meijer A, Rodrigues A, Huang S, Cohen C, Demont C, et al. Temporal Variations in Respiratory Syncytial Virus Epidemics, by Virus Subtype, 4 Countries. Emerg Infect Dis. 2021;27(5):1537-1540. https://doi.org/10.3201/eid2705.204615
AMA Staadegaard L, Meijer A, Rodrigues A, et al. Temporal Variations in Respiratory Syncytial Virus Epidemics, by Virus Subtype, 4 Countries. Emerging Infectious Diseases. 2021;27(5):1537-1540. doi:10.3201/eid2705.204615.
APA Staadegaard, L., Meijer, A., Rodrigues, A., Huang, S., Cohen, C., Demont, C....Paget, J. (2021). Temporal Variations in Respiratory Syncytial Virus Epidemics, by Virus Subtype, 4 Countries. Emerging Infectious Diseases, 27(5), 1537-1540. https://doi.org/10.3201/eid2705.204615.

Novel SARS-CoV-2 Variant Derived from Clade 19B, France [PDF - 1.29 MB - 4 pages]
S. Fourati et al.

We report a novel severe acute respiratory syndrome coronavirus 2 variant derived from clade 19B (HMN.19B variant or Henri Mondor variant). This variant is characterized by the presence of 18 amino acid substitutions, including 7–8 substitutions in the spike protein and 2 deletions. These variants actively circulate in different regions of France.

EID Fourati S, Decousser J, Khouider S, N’Debi M, Demontant V, Trawinski E, et al. Novel SARS-CoV-2 Variant Derived from Clade 19B, France. Emerg Infect Dis. 2021;27(5):1540-1543. https://doi.org/10.3201/eid2705.210324
AMA Fourati S, Decousser J, Khouider S, et al. Novel SARS-CoV-2 Variant Derived from Clade 19B, France. Emerging Infectious Diseases. 2021;27(5):1540-1543. doi:10.3201/eid2705.210324.
APA Fourati, S., Decousser, J., Khouider, S., N’Debi, M., Demontant, V., Trawinski, E....Rodriguez, C. (2021). Novel SARS-CoV-2 Variant Derived from Clade 19B, France. Emerging Infectious Diseases, 27(5), 1540-1543. https://doi.org/10.3201/eid2705.210324.

Undocumented Migrants Reintroducing COVID-19, Yunnan Province, China [PDF - 954 KB - 3 pages]
M. Zhang et al.

To limit the spread of severe acute respiratory syndrome coronavirus 2, the government of China has been monitoring infected travelers and minimizing cold-chain contamination. However, other factors might contribute to recurring outbreaks. We analyze the role of undocumented migrants as potential transmitters of severe acute respiratory syndrome coronavirus 2 in China.

EID Zhang M, Zhou J, Jia S, Zhao X, Chen Y, Sun Y, et al. Undocumented Migrants Reintroducing COVID-19, Yunnan Province, China. Emerg Infect Dis. 2021;27(5):1543-1545. https://doi.org/10.3201/eid2705.204944
AMA Zhang M, Zhou J, Jia S, et al. Undocumented Migrants Reintroducing COVID-19, Yunnan Province, China. Emerging Infectious Diseases. 2021;27(5):1543-1545. doi:10.3201/eid2705.204944.
APA Zhang, M., Zhou, J., Jia, S., Zhao, X., Chen, Y., Sun, Y....Fu, X. (2021). Undocumented Migrants Reintroducing COVID-19, Yunnan Province, China. Emerging Infectious Diseases, 27(5), 1543-1545. https://doi.org/10.3201/eid2705.204944.
Books and Media

Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live [PDF - 609 KB - 1 page]
N. M. M’ikanatha and C. E. Carr
EID M’ikanatha NM, Carr CE. Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live. Emerg Infect Dis. 2021;27(5):1546. https://doi.org/10.3201/eid2705.210381
AMA M’ikanatha NM, Carr CE. Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live. Emerging Infectious Diseases. 2021;27(5):1546. doi:10.3201/eid2705.210381.
APA M’ikanatha, N. M., & Carr, C. E. (2021). Apollo’s Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live. Emerging Infectious Diseases, 27(5), 1546. https://doi.org/10.3201/eid2705.210381.
About the Cover

Ancient Methods Deliver a Current Message [PDF - 1.66 MB - 2 pages]
B. Breedlove
Corrections

Correction: Vol. 27, No. 3 [PDF - 564 KB - 1 page]
EID Correction: Vol. 27, No. 3. Emerg Infect Dis. 2021;27(5):1545. https://doi.org/10.3201/eid2705.c12705
AMA Correction: Vol. 27, No. 3. Emerging Infectious Diseases. 2021;27(5):1545. doi:10.3201/eid2705.c12705.
APA (2021). Correction: Vol. 27, No. 3. Emerging Infectious Diseases, 27(5), 1545. https://doi.org/10.3201/eid2705.c12705.
Page created: April 22, 2021
Page updated: April 27, 2021
Page reviewed: April 27, 2021
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