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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.

Volume 23, Number 7—July 2017


  • Operational Research during the Ebola Emergency
    G. Fitzpatrick et al.
        View Abstract

    Operational research aims to identify interventions, strategies, or tools that can enhance the quality, effectiveness, or coverage of programs where the research is taking place. Médecins Sans Frontières admitted ≈5,200 patients with confirmed Ebola virus disease during the Ebola outbreak in West Africa and from the beginning nested operational research within its emergency response. This research covered critical areas, such as understanding how the virus spreads, clinical trials, community perceptions, challenges within Ebola treatment centers, and negative effects on non-Ebola healthcare. Importantly, operational research questions were decided to a large extent by returning volunteers who had first-hand knowledge of the immediate issues facing teams in the field. Such a method is appropriate for an emergency medical organization. Many challenges were also identified while carrying out operational research across 3 different countries, including the basic need for collecting data in standardized format to enable comparison of findings between treatment centers.

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  • 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

    A lesion specific to Ebola virus disease showed an anatomical distribution suggesting neuronal transmission.

        View Abstract

    We conducted a case–control study in Freetown, Sierra Leone, to investigate ocular signs in Ebola virus disease (EVD) survivors. A total of 82 EVD survivors with ocular symptoms and 105 controls from asymptomatic civilian and military personnel and symptomatic eye clinic attendees underwent ophthalmic examination, including widefield retinal imaging. Snellen visual acuity was <6/7.5 in 75.6% (97.5% CI 63%–85.7%) of EVD survivors and 75.5% (97.5% CI 59.1%–87.9%) of controls. Unilateral white cataracts were present in 7.4% (97.5% CI 2.4%–16.7%) of EVD survivors and no controls. Aqueous humor from 2 EVD survivors with cataract but no anterior chamber inflammation were PCR-negative for Zaire Ebola virus, permitting cataract surgery. A novel retinal lesion following the anatomic distribution of the optic nerve axons occurred in 14.6% (97.5% CI 7.1%–25.6%) of EVD survivors and no controls, suggesting neuronal transmission as a route of ocular entry.

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  • Case−Control Study of Risk Factors for Meningococcal Disease in Chile
    A. Olea et al.
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    An outbreak of meningococcal disease with a case-fatality rate of 30% and caused by predominantly serogroup W of Neisseria meningitidis began in Chile in 2012. This outbreak required a case−control study to assess determinants and risk factors for infection. We identified confirmed cases during January 2012−March 2013 and selected controls by random sampling of the population, matched for age and sex, resulting in 135 case-patients and 618 controls. Sociodemographic variables, habits, and previous illnesses were studied. Analyses yielded adjusted odds ratios as estimators of the probability of disease development. Results indicated that conditions of social vulnerability, such as low income and overcrowding, as well as familial history of this disease and clinical histories, especially chronic diseases and hospitalization for respiratory conditions, increased the probability of illness. Findings should contribute to direction of intersectoral public policies toward a highly vulnerable social group to enable them to improve their living conditions and health.

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  • 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 Mild and Severe Respiratory Illnesses in HIV-Infected and HIV-Uninfected Patients, South Africa, 2012–2016
    S. Tempia et al.
        View Abstract

    The attributable fraction (AF) of influenza virus detection to illness has not been described for patients in different age groups or with different HIV infection statuses. We compared the age group–specific prevalence of influenza virus infection among patients with influenza-like illness (ILI) or severe acute or chronic respiratory illness (SARI and SCRI, respectively) with that among controls, stratified by HIV serostatus. The overall AF for influenza virus detection to illness was 92.6% for ILI, 87.4% for SARI, and 86.2% for SCRI. Among HIV-uninfected patients, the AF for all syndromes was highest among persons <1 and >65 years of age and lowest among persons 25–44 years of age; this trend was not observed among HIV-infected patients. Overall, influenza viruses when detected in patients with ILI, SARI or SCRI are likely attributable to illness. This finding is particularly likely among children and the elderly irrespective of HIV serostatus and among HIV-infected persons irrespective of age.

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  • Competence of Aedes aegypti, Ae. albopictus, and Culex quinquefasciatus Mosquitoes as Zika Virus Vectors, China
    Z. Liu et al.
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    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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  • MERS-CoV Antibody Responses 1 Year after Symptom Onset, South Korea, 2015
    P. Choe et al.
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    We investigated the kinetics of the Middle East respiratory syndrome coronavirus (MERS-CoV) neutralizing and spike protein antibody titers over the course of 1 year in 11 patients who were confirmed by reverse transcription PCR to have been infected during the outbreak in South Korea in 2015. Robust antibody responses were detected in all survivors who had severe disease; responses remained detectable, albeit with some waning, for <1 year. The duration of viral RNA detection (but not viral load) in sputum significantly correlated with the antibody response magnitude. The MERS S1 ELISA antibody titers correlated well with the neutralizing antibody response. Antibody titers in 4 of 6 patients who had mild illness were undetectable even though most had evidence of pneumonia. This finding implies that MERS-CoV seroepidemiologic studies markedly underestimate the extent of mild and asymptomatic infection. Obtaining convalescent-phase plasma with high antibody titers to treat MERS will be challenging.

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  • Concurrent Infection with Hepatitis C Virus and Streptococcus pneumoniae
    T. J. Marrie et al.
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    Little is known about concurrent infection with hepatitis C virus (HCV) and Streptococcus pneumoniae, which causes invasive pneumococcal disease (IPD). We hypothesized that co-infection with HCV and S. pneumoniae would increase risk for death and complications. We captured sociodemographic and serologic data for adults with IPD in a population-based cohort study in northern Alberta, Canada, during 2000–2014. IPD patients infected with HCV were compared with IPD patients not infected with HCV for risk of in-hospital deaths and complications by using multivariable logistic regression. A total of 355 of 3,251 patients with IPD were co-infected with HCV. The in-hospital mortality rate was higher for IPD patients infected with HCV. Prevalence of most IPD-related complications (e.g., cellulitis, acute kidney injury, mechanical ventilation) was also higher in HCV-infected patients. Infection with HCV is common in patients with IPD, and HCV is independently associated with an increased risk for serious illness and death.

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  • Nontuberculous Mycobacteria Infections at a Provincial Reference Hospital, Cambodia
    M. Bonnet et al.
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    Prevalence of nontuberculous mycobacteria (NTM) disease is poorly documented in countries with high prevalence of tuberculosis (TB). We describe prevalence, risk factors, and TB program implications for NTM isolates and disease in Cambodia. A prospective cohort of 1,183 patients with presumptive TB underwent epidemiologic, clinical, radiologic, and microbiologic evaluation, including >12-months of follow-up for patients with NTM isolates. Prevalence of NTM isolates was 10.8% and of disease was 0.9%; 217 (18.3%) patients had TB. Of 197 smear-positive patients, 171 (86.8%) had TB confirmed (167 by culture and 4 by Xpert MTB/RIF assay only) and 11 (5.6%) had NTM isolates. HIV infection and past TB were independently associated with having NTM isolates. Improved detection of NTM isolates in Cambodia might require more systematic use of mycobacterial culture and the use of Xpert MTB/RIF to confirm smear-positive TB cases, especially in patients with HIV infection or a history of TB.

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Another Dimension

Research Letters

Books and Media

Volume 23, Number 8—August 2017


  • Zika Virus Infection in Patient with No Known Risk Factors, Utah, USA, 2016
    E. R. Krow-Lucal et al.
  • Characteristics of Dysphagia in Infants with Microcephaly due to Congenital Zika Virus Infection
    M. C. Leal et al.
    View Summary

    Oral motor dysfunction begins after 3 months of age and is severe.

  • Bartonella quintana, an Unrecognized Cause of Infective Endocarditis in Children in Ethiopia
    D. Tasher et al.
    View Summary

    Infection is probably not uncommon in those with heart defects, and diagnosis should be considered for patients with culture-negative endocarditis.



  • Genomic Characterization of Recrudescent Plasmodium malariae after Treatment with Artemether/Lumefantrine
    G. G. Rutledge et al.
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    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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  • Human Infection with Highly Pathogenic Avian Influenza A Virus (H7N9), China
    C. Ke et al.
  • Molecular Characterization of Corynebacterium diphtheriae Outbreak Isolates, South Africa, March–June 2015
    M. du Plessis et al.
  • High Infection Rates for Adult Macaques after Intravaginal or Intrarectal Inoculation with Zika Virus
    A. D. Haddow et al.
  • Characterization of Fitzroy River Virus and Serologic Evidence of Human and Animal Infection
    C. A. Johansen et al.
  • Maguari Virus Associated with Human Disease
    A. Groseth et al.


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

    A Zika virus disease outbreak occurred in Roatán, Honduras, during September 2015–July 2016. Blood samples and clinical information were obtained from 183 patients given a clinical diagnosis of suspected dengue virus infection. A total of 79 patients were positive for Zika virus, 13 for chikungunya virus, and 6 for dengue virus.

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  • Serologic Evidence of Powassan Virus Infection in Patients with Suspected Lyme Disease
    H. M. Frost et al.
  • Density-Dependent Prevalence of Francisella tularensis in Fluctuating Vole Populations, Northwestern Spain
    R. Rodríguez-Pastor et al.
  • Occupational Exposures to Ebola Virus in Ebola Treatment Center, Conakry, Guinea
    H. Savini et al.
  • Serologic Evidence of Scrub Typhus in the Peruvian Amazon
    C. Kocher et al.
  • Seroprevalence of Baylisascaris procyonis Infection in Humans, Santa Barbara County, California, USA, 2014–2016
    S. B. Weinstein et al.
  • Epidemiologic Characteristics of Human Infections with Highly Pathogenic Avian Influenza A(H7N9) Virus, China, 2017
    L. Zhou et al.
  • West Nile Virus Outbreak in Houston and Harris County, Texas, 2014
    D. Martinez et al.
  • Genesis of Influenza A(H5N8) Viruses
    R. El-Shesheny et al.

Research Letters

Volume 23, Number 9—September 2017


  • Real-Time Whole-Genome Sequencing for Surveillance of Listeria monocytogenes, France
    A. Moura et al.


  • Group A Rotavirus Associated with Encephalitis in Red Fox