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Disclaimer: Ahead of print articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.

Issues Available

Volume 23, Number 6—June 2017


  • Sporadic Creutzfeldt-Jakob Disease in 2 Plasma Product Recipients, United Kingdom,
    P. Urwin et al.
    View Summary

    Two cases of sporadic CJD with clotting disorders have been identified, but this may represent a chance event.



  • Distribution and Quantitative Estimates of Variant Creutzfeldt-Jakob Disease Prions in Tissues of Clinical and Asymptomatic Patients
    J. Y. Douet et al.
        View Abstract

    In the United-Kingdom, ≈1 of 2,000 persons could be infected with variant Creutzfeldt-Jakob disease (vCJD). Therefore, risk of transmission of vCJD by medical procedures remains a major concern for public health authorities. In this study, we used in vitro amplification of prions by protein misfolding cyclic amplification (PMCA) to estimate distribution and level of the vCJD agent in 21 tissues from 4 patients who died of clinical vCJD and from 1 asymptomatic person with vCJD. PMCA identified major levels of vCJD prions in a range of tissues, including liver, salivary gland, kidney, lung, and bone marrow. Bioassays confirmed that the quantitative estimate of levels of vCJD prion accumulation provided by PMCA are indicative of vCJD infectivity levels in tissues. Findings provide critical data for the design of measures to minimize risk for iatrogenic transmission of vCJD.

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  • Disease Burden Associated with the Consumption of Unpasteurized Cow’s Milk and Cheese, United States, 2009–2014
    S. Costard et al.
  • Relative Risk for Ehrlichiosis and Lyme Disease in an Area Where Vectors for Both are Sympatric, New Jersey, USA
    A. Egizi et al.
    View Summary

    Ehrlichiosis may be grossly underreported or misreported in the northeast United States, and many infections may be asymptomatic.

  • Invasive Serotype 35B Pneumococci and Identification of Expanding Serotype Switch Lineage, United States, 2015–2016
    S. Chochua et al.
  • Hospital Outbreaks of Middle East Respiratory Syndrome, Daejeon, South Korea, 2015
    J. Park et al.
        View Abstract

    From May through July 2015, a total of 26 cases of Middle East Respiratory Syndrome were reported from 2 hospitals in Daejeon, South Korea, including 1 index case and 25 new cases. We examined the epidemiologic features of these cases and found an estimated median incubation period of 6.1 days (8.8 days in hospital A and 4.6 days in hospital B). The overall attack rate was 3.7% (4.7% in hospital A and 3.0% in hospital B), and the attack rates among inpatients and caregivers in the same ward were 12.3% and 22.5%, respectively. The overall case-fatality rate was 44.0% (28.6% in hospital A and 63.6% in hospital B). The use of cohort quarantine may have played a role in preventing community spread, but additional transmission occurred among members of the hospital cohort quarantined together. Caregivers may have contributed in part to the transmission.

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  • Stockpiling Ventilators for Influenza Pandemics
    H. Huang et al.
        View Abstract

    In preparing for influenza pandemics, public health agencies stockpile critical medical resources. Determining appropriate quantities and locations for such resources can be challenging, given the considerable uncertainty in the timing and severity of future pandemics. We introduce a method for optimizing stockpiles of mechanical ventilators, which are critical for treating hospitalized influenza patients in respiratory failure. As a case study, we consider the US state of Texas during mild, moderate, and severe pandemics. Optimal allocations prioritize local over central storage, even though the latter can be deployed adaptively, on the basis of real-time needs. This prioritization stems from high geographic correlations and the slightly lower treatment success assumed for centrally stockpiled ventilators. We developed our model and analysis in collaboration with academic researchers and a state public health agency and incorporated it into a Web-based decision-support tool for pandemic preparedness and response.

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  • Genomic Analysis of Salmonella enterica Serovar Typhimurium DT160 Associated with 14-Year Outbreak, New Zealand, 1998–2012
    S. J. Bloomfield et al.
  • Serologic and Molecular Evidence of Vaccinia Virus Circulation among Small Mammals from Different Biomes, Brazil
    J. B. Miranda et al.
        View Abstract

    Vaccinia virus (VACV) is a zoonotic agent that causes a disease called bovine vaccinia, which is detected mainly in milking cattle and humans in close contact with these animals. Even though many aspects of VACV infection have been described, much is still unknown about its circulation in the environment and its natural hosts/reservoirs. To investigate the presence of Orthopoxvirus antibodies or VACV DNA, we captured small rodents and marsupials in 3 areas of Minas Gerais state, Brazil, and tested their samples in a laboratory. A total of 336 animals were tested; positivity ranged from 18.1% to 25.5% in the 3 studied regions located in different biomes, including the Atlantic Forest and the Cerrado. Analysis of nucleotide sequences indicated co-circulation of VACV groups I and II. Our findings reinforce the possible role played by rodents and marsupials in VACV maintenance and its transmission chain.

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  • Autochthonous Case of Eosinophilic Meningitis Caused by Angiostrongylus cantonensis, France, 2016
    Y. Nguyen et al.
  • Congenital Malformations of Calves Infected with Shamonda Virus, Southern Japan
    Y. Hirashima et al.
  • Domestic Pig Unlikely Reservoir for MERS-CoV
    E. de Wit et al.
        View Abstract

    We tested the suitability of the domestic pig as a model for Middle East respiratory syndrome coronavirus (MERS-CoV) infection. Inoculation did not cause disease, but a low level of virus replication, shedding, and seroconversion were observed. Pigs do not recapitulate human MERS-CoV and are unlikely to constitute a reservoir in nature.

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  • Severe Neurologic Disorders in 2 Fetuses with Zika Virus Infection, Colombia
    J. Acosta-Reyes et al.
        View Abstract

    We report the results of pathologic examinations of 2 fetuses from women in Colombia with Zika virus infection during pregnancy that revealed severe central nervous system defects and potential associated abnormalities of the eye, spleen, and placenta. Amniotic fluid and tissues from multiple fetal organs tested positive for Zika virus.

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  • Seoul Virus Infection in Humans, France, 2014–2016
    J. Reynes et al.
        View Abstract

    We report detection of Seoul virus in 3 patients in France over a 2-year period. These patients accounted for 3 of the 4 Seoul virus infections among 434 hantavirus infections (1.7%) reported during this time. More attention should be given to this virus in Europe where surveillance has been focused mostly on Puumala and Dobrava-Belgrade hantaviruses.

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  • Central Nervous System Brucellosis Granuloma and White Matter Disease in Immunocompromised Patient
    M. Alqwaifly et al.
        View Abstract

    Brucellosis is a multisystem zoonotic disease. We report an unusual case of neurobrucellosis with seizures in an immunocompromised patient in Saudi Arabia who underwent renal transplantation. Magnetic resonance imaging of the brain showed diffuse white matter lesions. Serum and cerebrospinal fluid were positive for Brucella sp. Granuloma was detected in a brain biopsy specimen.

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  • Crimean-Congo Hemorrhagic Fever in Migrant Worker Returning from Muscat, Oman, to India, 2016
    P. D. Yadav et al.
  • Clinical and Molecular Characteristics of Human Rotavirus G8P[8] Outbreak Strain, Japan, 2014
    K. Kondo et al.
        View Abstract

    During March–July 2014, rotavirus G8P[8] emerged as the predominant cause of rotavirus gastroenteritis among children in Hokkaido Prefecture, Japan. Clinical characteristics were similar for infections caused by G8 and non-G8 strains. Sequence and phylogenetic analyses suggest the strains were generated by multiple reassortment events between DS-1–like P[8] strains and bovine strains from Asia.

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  • High Rates of Neutralizing Antibodies to Toscana and Sandfly Fever Sicilian Viruses in Livestock, Kosovo
    N. Ayhan et al.
  • Brucella neotomae Infection in Humans, Costa Rica
    M. Suárez-Esquivel et al.
  • Penicillin Resistance of Nonvaccine Type Pneumococcus before and after PCV13 Introduction, United States
    C. P. Andam et al.
        View Abstract

    Introduction of 13-valent pneumococcal conjugate vaccine in the United States was not associated with a significant change in prevalence of penicillin resistance in nonvaccine type serotypes because of the variable success of highly resistant serotypes. Differences in regional serotype distribution and serotype-specific resistance contributed to geographic heterogeneity of penicillin resistance.

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  • Rise in Group W Meningococcal Carriage in University Students, United Kingdom
    N. J. Oldfield et al.
        View Abstract

    MenACWY conjugate vaccination was recently introduced in the United Kingdom for adolescents and young adults to reduce disease from infection by Neisseria meningitidis group W. We conducted a cross-sectional meningococcal carriage study in first-year UK university students. Despite 71% MenACWY vaccine coverage, carriage of group W increased substantially.

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  • Febrile Respiratory Illness Associated with Human Adenovirus Type 55 in South Korea Military, 2014–2016
    H. Yoo et al.
        View Abstract

    An outbreak of febrile respiratory illness associated with human adenovirus (HAdV) occurred in the South Korea military during the 2014–15 influenza season and thereafter. Molecular typing and phylogenetic analysis of patient samples identified HAdV type 55 as the causative agent. Emergence of this novel HAdV necessitates continued surveillance in military and civilian populations.

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  • Stockpiling Ventilators for Influenza Pandemics
    M. I. Meltzer and A. Patel

Research Letters

Volume 23, Number 7—July 2017


  • Risk Factors for Legionella longbeachae Legionnaires’ Disease, New Zealand
    E. Kenagy et al.
    View Summary

    Gardeners, persons with chronic obstructive pulmonary diesease, and, particularly, long-term smokers should take precautions against inhaling compost and pay attention to hand hygiene to prevent Legionelle longbeachae Legionnaires’ disease.

  • Novel Retinal Lesion in Ebola Survivors, Sierra Leone, 2016
    P. J. Steptoe et al.
    View Summary

    Our study detected a retinal lesion specific to Ebola virus disease with an anatomical distribution suggesting neuronal transmission.

  • Case−Control Study of Risk Factors for Meningococcal Disease in Chile
    A. N. Olea et al.
  • Phylogeography of Burkholderia pseudomallei Isolates, Western Hemisphere
    J. E. Gee et al.
  • Effects of Zika Virus Strain and Aedes Mosquito Species on Vector Competence
    A. T. Ciota et al.
        View Abstract

    In the Western Hemisphere, Zika virus is thought to be transmitted primarily by Aedes aegypti mosquitoes. To determine the extent to which Ae. albopictus mosquitoes from the United States are capable of transmitting Zika virus and the influence of virus dose, virus strain, and mosquito species on vector competence, we evaluated multiple doses of representative Zika virus strains in Ae. aegypti and Ae. albopictus mosquitoes. Virus preparation (fresh vs. frozen) significantly affected virus infectivity in mosquitoes. We calculated 50% infectious doses to be 6.1–7.5 log10 PFU/mL; minimum infective dose was 4.2 log10 PFU/mL. Ae. albopictus mosquitoes were more susceptible to infection than Ae. aegypti mosquitoes, but transmission efficiency was higher for Ae. aegypti mosquitoes, indicating a transmission barrier in Ae. albopictus mosquitoes. Results suggest that, although Zika virus transmission is relatively inefficient overall and dependent on virus strain and mosquito species, Ae. albopictus mosquitoes could become major vectors in the Americas.

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  • Clonal Clusters and Virulence Factors of Group C and G Streptococci Causing Severe Infections, Manitoba, Canada, 2012–2014
    S. A. Lother et al.
  • Attributable Fraction of Influenza Virus Detection to Illness in HIV-Infected and HIV-Uninfected Patients, South Africa, 2012–2016
  • Competence of Aedes aegypti, Ae. albopictus, and Culex quinquefasciatus Mosquitoes as Zika Virus Vectors, China
    Z. Liu et al.
        View Abstract

    In China, the prevention and control of Zika virus disease has been a public health threat since the first imported case was reported in February 2016. To determine the vector competence of potential vector mosquito species, we experimentally infected Aedes aegypti, Ae. albopictus, and Culex quinquefasciatus mosquitoes and determined infection rates, dissemination rates, and transmission rates. We found the highest vector competence for the imported Zika virus in Ae. aegypti mosquitoes, some susceptibility of Ae. albopictus mosquitoes, but no transmission ability for Cx. quinquefasciatus mosquitoes. Considering that, in China, Ae. albopictus mosquitoes are widely distributed but Ae. aegypti mosquito distribution is limited, Ae. albopictus mosquitoes are a potential primary vector for Zika virus and should be targeted in vector control strategies.

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  • One-Year Follow-Up Antibody Responses in Patients Infected with MERS-CoV, South Korea, 2015
    P. Choe et al.
  • Concurrent Infection with Hepatitis C Virus and Streptococcus pneumoniae, Alberta, Canada
    T. J. Marrie et al.


  • Emergency Meningococcal ACWY Vaccination Program for Teenagers to Control Group W Meningococcal Disease, England, 2015–2016
    H. Campbell et al.
        View Abstract

    During the first 12 months of an emergency meningococcal ACWY vaccination program for teenagers in England, coverage among persons who left school in 2015, the first cohort to be vaccinated, was 36.6%. There were 69% fewer group W meningococcal cases than predicted by trend analysis and no cases in vaccinated teenagers.

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  • Francisella tularensis ssp. holarctica in Australian Ringtail Possums
    J. Eden et al.
  • Environmental Factors as Key Determinants for Visceral Leishmaniasis in Solid Organ Transplant Recipients, Madrid, Spain
    N. Carrasco-Antón et al.
  • Rabbit Hepatitis E Virus Infections in Humans, France
    F. Abravanel et al.
  • Detection and Genetic Characterization of Human Adenovirus 14 Strain in Students with Influenza-Like Illness, New York, 2014–2015
    D. M. Lamson et al.
  • Norovirus GII.P16/GII.2–Associated Gastroenteritis, China, 2016
    Y. Ao et al.
        View Abstract

    During October–December 2016, the number of norovirus outbreaks in China increased sharply from the same period during the previous 4 years. We identified a recombinant norovirus strain, GII.P16-GII.2, as the cause of 44 (79%) of the 56 outbreaks, signaling that this strain could replace the predominant GII.4 viruses.

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  • Association of GII.P16-GII.2 Recombinant Norovirus Strain with Increased Norovirus Outbreaks, Guangdong, China, 2016
    J. Lu et al.
        View Abstract

    An unusual prevalence of recombinant GII.2 noroviruses (GII.P16-GII.2) in Guangdong, China, at the end of 2016 caused a sharp increase in outbreaks of acute gastroenteritis. This event was another non-GII.4 epidemic that emerged after the GII.17 viruses in 2014 and 2015 and warrants global surveillance.

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  • Escherichia coli Isolates with mcr-1 Gene, Australia, 2011 and 2013
    J. A. Ellem et al.

Research Letters

  • Live Cell Therapy as Potential Risk Factor for Q Fever
    M. George et al.
        View Abstract

    During an outbreak of Q fever in Germany, we identified an infected sheep flock from which animals were routinely used as a source for life cell therapy (LCT), the injection of fetal cells or cell extracts from sheep into humans. Q fever developed in 7 LCT recipients from Canada, Germany, and the United States.

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  • Mycobacterium gordonae in Patient with Facial Ulcer, Nosebleeds, and Positive T-SPOT.TB Test, China
    Y. Chen et al.
  • Rickettsia sibirica mongolitimonae Infection, Turkey, 2016
    F. Kuscu et al.

Volume 23, Number 8—August 2017


  • Genomic Characterization of Recrudescent Plasmodium malariae after Treatment with Artemether/Lumefantrine
    G. G. Rutledge et al.
        View Abstract

    Plasmodium malariae is the only human malaria parasite species with a 72-hour intraerythrocytic cycle and the ability to persist in the host for life. We present a case of a P. malariae infection with clinical recrudescence after directly observed administration of artemether/lumefantrine. By using whole-genome sequencing, we show that the initial infection was polyclonal and the recrudescent isolate was a single clone present at low density in the initial infection. Haplotypic analysis of the clones in the initial infection revealed that they were all closely related and were presumably recombinant progeny originating from the same infective mosquito bite. We review possible explanations for the P. malariae treatment failure and conclude that a 3-day artemether/lumefantrine regimen is suboptimal for this species because of its long asexual lifecycle.

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  • Real-Time Evolution of Zika Virus Disease Outbreak, Roatán, Honduras
    T. Brooks et al.