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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 25, Number 3—March 2019


  • Global Systematic Review and Patient Meta-Analysis of Encouraging Treatment Outcomes for Children with Extensively Drug-Resistant Tuberculosis
    M. Osman et al.
  • University-Based Outbreaks of Meningococcal Disease Caused by Serogroup B, United States, 2013–2018
    H. M. Soeters et al.
        View Abstract

    We reviewed university-based outbreaks of meningococcal disease caused by serogroup B and vaccination responses in the United States in the years following serogroup B meningococcal (MenB) vaccine availability. Ten university-based outbreaks occurred in 7 states during 2013–2018, causing a total of 39 cases and 2 deaths. Outbreaks occurred at universities with 3,600–35,000 undergraduates. Outbreak case counts ranged from 2 to 9 cases; outbreak duration ranged from 0 to 376 days. All 10 universities implemented MenB vaccination: 3 primarily used MenB-FHbp and 7 used MenB-4C. Estimated first-dose vaccination coverage ranged from 14% to 98%. In 5 outbreaks, additional cases occurred 6–259 days following MenB vaccination initiation. Although it is difficult to predict outbreak trajectories and evaluate the effects of public health response measures, achieving high MenB vaccination coverage is crucial to help protect at-risk persons during outbreaks of meningococcal disease caused by this serogroup.

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  • Bacillus Calmette-Guérin Cases Reported to the National Tuberculosis Surveillance System, United States, 2004–2015
    Z. Wansaula et al.
  • Cross-Border Movement of Highly Drug-Resistant Mycobacterium tuberculosis from Papua New Guinea to Australia through Torres Strait Protected Zone, 2010–2015
    A. Bainomugisa et al.
        View Abstract

    In this retrospective study, we used whole-genome sequencing (WGS) to delineate transmission dynamics, characterize drug-resistance markers, and identify risk factors of transmission among Papua New Guinea residents of the Torres Strait Protected Zone (TSPZ) who had tuberculosis diagnoses during 2010–2015. Of 117 isolates collected, we could acquire WGS data for 100; 79 were Beijing sublineage, which was associated with active transmission (odds ratio 6.190, 95% CI 2.221–18.077). Strains were distributed widely throughout the TSPZ. Clustering occurred more often within than between villages (p = 0.0013). Including 4 multidrug-resistant tuberculosis isolates from Australia citizens epidemiologically linked to the TSPZ into the transmission network analysis revealed 2 probable cross-border transmission events. All multidrug-resistant isolates (33/104) belonged to Beijing sublineage and had high-level isoniazid and ethionamide co-resistance; 2 isolates were extensively drug resistant. Including WGS in regional surveillance could improve tuberculosis transmission tracking and control strategies within the TSPZ.

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  • Epidemiology of Extrapulmonary Tuberculosis among Inpatients, China, 2008–2017
    Y. Pang et al.
        View Abstract

    We investigated the epidemiology of extrapulmonary tuberculosis (TB) among patients admitted to Beijing Chest Hospital, Beijing, China, during January 2008–December 2017. Of 19,279 hospitalized TB patients, 33.4% (6,433) had extrapulmonary TB and 66.6% (12,846) had pulmonary TB. The most frequent forms of extrapulmonary TB observed were skeletal TB (41.1%) and pleural TB (26.0%). Younger, female patients from rural areas were more likely to have extrapulmonary TB. However, patients with diabetes mellitus were less likely to have extrapulmonary TB compared with patients without diabetes. A higher proportion of multidrug-resistant (MDR) TB was observed among patients with extrapulmonary TB than among patients with pulmonary TB. We observed a large increase in MDR TB, from 17.3% to 35.7%, for pleural TB cases. The increasing rate of drug resistance among extrapulmonary TB cases highlights the need for drug susceptibility testing and the formulation of more effective regimens for extrapulmonary TB treatment.

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  • Donor-Derived Genotype 4 Hepatitis E Virus Infection, Hong Kong, China, 2018
    S. Sridhar et al.
        View Abstract

    Hepatitis E virus (HEV) genotype 4 (HEV-4) is an emerging cause of acute hepatitis in China. Less is known about the clinical characteristics and natural history of HEV-4 than HEV genotype 3 infections in immunocompromised patients. We report transmission of HEV-4 from a deceased organ donor to 5 transplant recipients. The donor had been viremic but HEV IgM and IgG seronegative, and liver function test results were within reference ranges. After a mean of 52 days after transplantation, hepatitis developed in all 5 recipients; in the liver graft recipient, disease was severe and with progressive portal hypertension. Despite reduced immunosuppression, all HEV-4 infections progressed to persistent hepatitis. Four patients received ribavirin and showed evidence of response after 2 months. This study highlights the role of organ donation in HEV transmission, provides additional data on the natural history of HEV-4 infection, and points out differences between genotype 3 and 4 infections in immunocompromised patients.

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  • Case Investigations of Infectious Diseases Occurring in Workplaces, United States, 2006–2015
    C. Su et al.
        View Abstract

    Workers in specific settings and activities are at increased risk for certain infectious diseases. When an infectious disease case occurs in a worker, investigators need to understand the mechanisms of disease propagation in the workplace. Few publications have explored these factors in the United States; a literature search yielded 66 investigations of infectious disease occurring in US workplaces from 2006–2015. Reported cases appear to be concentrated in specific industries and occupations, especially the healthcare industry, laboratory workers, animal workers, and public service workers. A hierarchy-of-controls approach can help determine how to implement effective preventive measures in workplaces. Consideration of occupational risk factors and control of occupational exposures will help prevent disease transmission in the workplace and protect workers’ health.

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  • Utility of Whole-Genome Sequencing to Ascertain Locally Acquired Cases of Coccidioidomycosis, Washington, USA
    H. N. Oltean et al.
        View Abstract

    Coccidioidomycosis is an emerging fungal infection in Washington, USA, and the epidemiology of the disease in this state is poorly understood. We used whole-genome sequencing to differentiate locally acquired cases in Washington on the basis of the previously identified phylogeographic population structure of Coccidioides spp. Clinical isolates from coccidioidomycosis cases involving possible Washington soil exposure were included. Of 17 human infections with epidemiologic evidence of possible local acquisition, 4 were likely locally acquired infections and 13 were likely acquired outside Washington. Isolates from locally acquired cases clustered within the previously established Washington clade of C. immitis. Genetic differences among these strains suggest multiple environmental reservoirs of C. immitis in the state.

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  • Increased Risk for Invasive Group A Streptococcus Disease for Household Contacts of Scarlet Fever Cases, England, 2011–2016
    V. Watts et al.
        View Abstract

    The incidence of scarlet fever in England and Wales is at its highest in 50 years. We estimated secondary household risk for invasive group A Streptococcus (iGAS) disease within 60 days after onset of scarlet fever. Reports of scarlet fever in England during 2011–2016 were matched by residential address to persons with laboratory-confirmed iGAS infections. We identified 11 iGAS cases in ≈189,684 household contacts and a 60-day incidence rate of 35.3 cases/100,000 person-years, which was 12.2-fold higher than the background rate (2.89). Infants and contacts >75 years of age were at highest risk. Three cases were fatal; sepsis and cellulitis were the most common manifestations. Typing for 6 iGAS cases identified emm 1.0 (n = 4), emm 4.0 (n = 1), and emm 12.0 (n = 1). Although absolute risk in household contacts was low, clinicians assessing household contacts should be aware of the risk to expedite diagnosis and initiate life-saving treatment.

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  • Window Period Prophylaxis for Children Exposed to Tuberculosis, Houston, Texas, USA, 2007–2017
    A. T. Cruz and J. R. Starke
        View Abstract

    In this retrospective study, we assessed the safety of window period prophylaxis and proportion of tuberculin skin test (TST) conversions in children <5 years of age who were exposed to an adult with tuberculosis disease during 2007–2017. Children included in this study had unremarkable examination and chest radiograph findings and negative test results for TB infection. In total, 752 children (41% cohabitating with the index patient) received prophylaxis during the window period, usually directly observed therapy with isoniazid. Hepatotoxicity and tuberculosis disease did not develop in any child. TST conversion occurred in 37 (4.9%) children and was associated with the index patient being the child’s parent (odds ratio 3.2, 95% CI 1.2–8.2). TST conversion was not associated with sputum smear results, culture positivity, or cohabitation. Thresholds for initiation of window prophylaxis in exposed young children should be low given the safety of medication and difficulties with risk stratification.

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  • Emergence and Spread of Cephalosporin-Resistant Neisseria gonorrhoeae with Mosaic penA Alleles, South Korea, 2012–2017
    H. Lee et al.
        View Abstract

    In South Korea, surveillance of antimicrobial drug resistance in Neisseria gonorrhoeae is extremely limited. We describe the emergence and subsequent national spread of N. gonorrhoeae strains with mosaic penA alleles associated with decreased susceptibility and resistance to extended-spectrum cephalosporins. From 2012 through 2017, the proportion of mosaic penA alleles in gonococcal-positive nucleic acid amplification test (NAAT) specimens across South Korea increased from 1.1% to 23.9%. Gonococcal strains with mosaic penA alleles emerged in the international hubs of Seoul in Gyeonggi Province and Busan in South Gyeongsang Province and subsequently spread across South Korea. Most common was mosaic penA-10.001 (n = 572 isolates; 94.7%), which is associated with cefixime resistance. We also identified mosaic penA-34.001 and penA-60.001, both of which are associated with multidrug-resistant gonococcal strains and spread of cefixime and ceftriaxone resistance. Implementation of molecular resistance prediction from N. gonorrhoeae–positive nucleic acid amplification test specimens is imperative in South Korea and internationally.

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  • Mycobacterium avium in Community and Household Water, Suburban Philadelphia, Pennsylvania, USA, 20102012
    L. Lande et al.
        View Abstract

    Attention to environmental sources of Mycobacterium avium complex (MAC) infection is a vital component of disease prevention and control. We investigated MAC colonization of household plumbing in suburban Philadelphia, Pennsylvania, USA. We used variable-number tandem-repeat genotyping and whole-genome sequencing with core genome single-nucleotide variant analysis to compare M. avium from household plumbing biofilms with M. avium isolates from patient respiratory specimens. M. avium was recovered from 30 (81.1%) of 37 households, including 19 (90.5%) of 21 M. avium patient households. For 11 (52.4%) of 21 patients with M. avium disease, isolates recovered from their respiratory and household samples were of the same genotype. Within the same community, 18 (85.7%) of 21 M. avium respiratory isolates genotypically matched household plumbing isolates. Six predominant genotypes were recovered across multiple households and respiratory specimens. M. avium colonizing municipal water and household plumbing may be a substantial source of MAC pulmonary infection.

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  • SNP-IT Tool for Identifying Subspecies and Associated Lineages of Mycobacterium tuberculosis Complex
    S. Lipworth et al.
        View Abstract

    The clinical phenotype of zoonotic tuberculosis and its contribution to the global burden of disease are poorly understood and probably underestimated. This shortcoming is partly because of the inability of currently available laboratory and in silico tools to accurately identify all subspecies of the Mycobacterium tuberculosis complex (MTBC). We present SNPs to Identify TB (SNP-IT), a single-nucleotide polymorphism–based tool to identify all members of MTBC, including animal clades. By applying SNP-IT to a collection of clinical genomes from a UK reference laboratory, we detected an unexpectedly high number of M. orygis isolates. M. orygis is seen at a similar rate to M. bovis, yet M. orygis cases have not been previously described in the United Kingdom. From an international perspective, it is possible that M. orygis is an underestimated zoonosis. Accurate identification will enable study of the clinical phenotype, host range, and transmission mechanisms of all subspecies of MTBCin greater detail.

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  • Multicenter Study of Cronobacter sakazakii Infections in Humans, Europe, 2017
    S. Lepuschitz et al.
        View Abstract

    Cronobacter sakazakii has been documented as a cause of life-threating infections, predominantly in neonates. We conducted a multicenter study to assess the occurrence of C. sakazakii across Europe and the extent of clonality for outbreak detection. National coordinators representing 24 countries in Europe were requested to submit all human C. sakazakii isolates collected during 2017 to a study center in Austria. Testing at the center included species identification by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, subtyping by whole-genome sequencing (WGS), and determination of antimicrobial resistance. Eleven countries sent 77 isolates, including 36 isolates from 2017 and 41 historical isolates. Fifty-nine isolates were confirmed as C. sakazakii by WGS, highlighting the challenge of correctly identifying Cronobacter spp. WGS-based typing revealed high strain diversity, indicating absence of multinational outbreaks in 2017, but identified 4 previously unpublished historical outbreaks. WGS is the recommended method for accurate identification, typing, and detection of this pathogen.

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  • Reassortments Among Avian Influenza A(H5N1) Viruses Circulating in Indonesia, 2015–2016
    D. Karo-karo et al.
        View Abstract

    Highly pathogenic avian influenza (HPAI) A(H5N1) viruses have been circulating since 2003 in Indonesia, with major impacts on poultry health, severe economic losses, and 168 fatal laboratory-confirmed human cases. We performed phylogenetic analysis on 39 full-genome H5N1 virus samples collected during outbreaks among poultry in 2015–2016 in West Java and compared them with recently published sequences from Indonesia. Phylogenetic analysis revealed that the hemagglutinin gene of all samples belonged to 2 genetic groups in clade We also observed these groups for the neuraminidase, nucleoprotein, polymerase, and polymerase basic 1 genes. Matrix, nonstructural protein, and polymerase basic 2 genes of some HPAI were most closely related to clade 2.1.3 instead of clade, and, a polymerase basic 2 gene was most closely related to Eurasian low pathogenicity avian influenza. Our results detected a total of 13 reassortment types among HPAI in Indonesia, mostly in backyard chickens in Indramayu.

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  • Use of Genomics to Investigate Historical Importation of Shiga Toxin–Producing Escherichia coli Serogroup O26 and Nontoxigenic Variants into New Zealand
    A. Browne et al.
        View Abstract

    Shiga toxin–producing Escherichia coli serogroup O26 is an important public health pathogen. Phylogenetic bacterial lineages in a country can be associated with the level and timing of international imports of live cattle, the main reservoir. We sequenced the genomes of 152 E. coli O26 isolates from New Zealand and compared them with 252 E. coli O26 genomes from 14 other countries. Gene variation among isolates from humans, animals, and food was strongly associated with country of origin and stx toxin profile but not isolation source. Time of origin estimates indicate serogroup O26 sequence type 21 was introduced at least 3 times into New Zealand from the 1920s to the 1980s, whereas nonvirulent O26 sequence type 29 strains were introduced during the early 2000s. New Zealand’s remarkably fewer introductions of Shiga toxin–producing Escherichia coli O26 compared with other countries (such as Japan) might be related to patterns of trade in live cattle.

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  • Simplified Model to Survey Tuberculosis Transmission in Countries Without Systematic Molecular Epidemiology Programs
    J. Domínguez et al.
        View Abstract

    Systematic molecular/genomic epidemiology studies for tuberculosis surveillance cannot be implemented in many countries. We selected Panama as a model for an alternative strategy. Mycobacterial interspersed repetitive unit–variable-number tandem-repeat (MIRU-VNTR) analysis revealed a high proportion (50%) of Mycobacterium tuberculosis isolates included in 6 clusters (A–F) in 2 provinces (Panama and Colon). Cluster A corresponded to the Beijing sublineage. Whole-genome sequencing (WGS) differentiated clusters due to active recent transmission, with low single-nucleotide polymorphism–based diversity (cluster C), from clusters involving long-term prevalent strains with higher diversity (clusters A, B). Prospective application in Panama of 3 tailored strain–specific PCRs targeting marker single-nucleotide polymorphisms identified from WGS data revealed that 31.4% of incident cases involved strains A–C and that the Beijing strain was highly represented and restricted mainly to Colon. Rational integration of MIRU-VNTR, WGS, and tailored strain–specific PCRs could be a new model for tuberculosis surveillance in countries without molecular/genomic epidemiology programs.

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Historical Review

  • Tuberculosis Surveillance and Control, Puerto Rico, 1898–2015
    E. Dirlikov et al.
        View Abstract

    The World Health Organization recognizes Puerto Rico as an area of low tuberculosis (TB) incidence, where TB elimination is possible by 2035. To clarify the current low incidence of reported cases, provide key lessons learned, and detect areas that may affect progress, we systematically reviewed the literature about the history of TB surveillance and control in Puerto Rico and supplemented this information with additional references and epidemiologic data. We reviewed 3 periods: 1898–1946 (public health efforts before the advent of TB chemotherapy); 1947–1992 (control and surveillance after the introduction of TB chemotherapy); and 1993–2015 (expanded TB control and surveillance). Although sustained surveillance, continued care, and use of newly developed strategies occurred concomitantly with decreased reported TB incidence and mortality rates, factors that may affect progress remain poorly understood and include potential delayed diagnosis and underreporting, the effects of government debt and Hurricane Maria, and poverty.

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Research Letters

Books and Media

About the Cover


Online Report

  • Survey on Implementation of One Health Approach for MERS-CoV Preparedness and Control in Gulf Cooperation Council and Middle East Countries
    E. Farag et al.
        View Abstract

    In 2015, a One Health Working Group was established in Qatar to conduct a survey in the Gulf Cooperation Council countries, Egypt, and Jordan to monitor preparedness of public health and veterinary health authorities in response to the Middle East respiratory syndrome coronavirus epidemic. All but 1 country indicated they established joint One Health policy teams for investigation and response. However, the response to the questionnaires was largely limited to veterinary authorities. Critical barriers and limitations were identified. National and regional leaders, policy makers, and stakeholders should be prompted to advocate and enhance adoption of the One Health framework to mitigate the risk for Middle East respiratory syndrome and other emerging zoonotic diseases.

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Volume 25, Number 4—April 2019


  • Resurgence of Vaccine-Preventable Diseases in Venezuela as a Regional Public Health Threat in the Americas
    A. E. Paniz-Mondolfi et al.
        View Abstract

    Venezuela’s tumbling economy and authoritarian rule have precipitated an unprecedented humanitarian crisis. Hyperinflation rates now exceed 45,000%, and Venezuela’s health system is in free fall. The country is experiencing a massive exodus of biomedical scientists and qualified healthcare professionals. Reemergence of arthropod-borne and vaccine-preventable diseases has sparked serious epidemics that also affect neighboring countries. In this article, we discuss the ongoing epidemics of measles and diphtheria in Venezuela and their disproportionate impact on indigenous populations. We also discuss the potential for reemergence of poliomyelitis and conclude that action to halt the spread of vaccine-preventable diseases within Venezuela is a matter of urgency for the country and the region. We further provide specific recommendations for addressing this crisis.

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  • Mucosal Leishmaniasis in Travelers with L. braziliensis Complex Returning to Israel
    M. Solomon et al.
  • Lobomycosis in Soldiers, Colombia
    C. M. Arenas et al.
  • Tickborne Relapsing Fever in the White Mountains, Arizona, 2013–2018
    N. Mafi et al.
  • Clinical Manifestation and Molecular Diagnosis of Scrub Typhus and Murine Typhus, Vietnam, 2015–2017
    N. Trung et al.


  • Differences in Neuropathogenesis of California Serogroup Viruses
    A. B. Evans et al.
  • Staphylococcus aureus Bacteremia in Children of Rural Gambia, 2008–2015
    O. Aderonke et al.
  • MERS-CoV Infection Dynamics and Antibody Responses among Clinically Diverse Patients, Saudi Arabia
    H. M. Al-Abdely et al.
  • Pneumonia-Specific Escherichia coli Isolates with Distinct Phylogenetic and Virulence Profiles
    B. La Combe et al.
  • Co-infections in Persons with Early Lyme Disease, New York, USA
    G. P. Wormser et al.
  • Francisella tularensis Transmission by Solid Organ Transplantation, 2017
    C. A. Nelson et al.
        View Abstract

    In July 2017, fever and sepsis developed in 3 recipients of solid organs (1 heart and 2 kidneys) from a common donor in the United States; 1 of the kidney recipients died. Tularemia was suspected only after blood cultures from the surviving kidney recipient grew Francisella species. The organ donor, a middle-aged man from the southwestern United States, had been hospitalized for acute alcohol withdrawal syndrome, pneumonia, and multiorgan failure. F. tularensis subsp. tularensis (clade A2) was cultured from archived spleen tissue from the donor and blood from both kidney recipients. Whole-genome multilocus sequence typing indicated that the isolated strains were indistinguishable. The heart recipient remained seronegative with negative blood cultures but had been receiving antimicrobial drugs for a medical device infection before transplant. Two lagomorph carcasses collected near the donor’s residence were positive by PCR for F. tularensis subsp. tularensis (clade A2). This investigation documents F. tularensis transmission by solid organ transplantation.

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  • Sandfly-Associated Phlebovirus with Evidence of Neutralizing Antibodies in Humans, Kenya
    D. P. Tchouassi et al.
  • Human-Origin Influenza A(H3N2) Reassortant Viruses in Swine, Southeast Mexico
    M. I. Nelson et al.
        View Abstract

    The genetic diversity of influenza A viruses circulating in swine in Mexico complicates control efforts in animals and presents a threat to humans, as shown by influenza A(H1N1)pdm09 virus. To describe evolution of swine influenza A viruses in Mexico and evaluate strains for vaccine development, we sequenced the genomes of 59 viruses and performed antigenic cartography on strains from 5 regions. We found that genetic and antigenic diversity were particularly high in southeast Mexico because of repeated introductions of viruses from humans and swine in other regions in Mexico. We identified novel reassortant H3N2 viruses with genome segments derived from 2 different viruses that were independently introduced from humans into swine: pandemic H1N1 viruses and seasonal H3N2 viruses. The Mexico swine viruses are antigenically distinct from US swine lineages. Protection against these viruses is unlikely to be afforded by US virus vaccines and would require development of new vaccines specifically targeting these diverse strains.

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  • Cost-Effectiveness of Latent Tuberculosis Infection Screening before Immigration to Low-Incidence Countries
    J. R. Campbell et al.
  • Klebsiella pneumoniae ST307 with blaOXA-181, South Africa, 2014–2016
    M. Lowe et al.


  • Seroprevalence of Borrelia burgdorferi, Borrelia miyamotoi, and Powassan Virus in Residents Bitten by Ixodes Ticks, Maine, USA
    R. P. Smith et al.
  • Distribution, Host-Seeking Phenology, and Host and Habitat Associations of Haemaphysalis longicornis Ticks, Staten Island, New York, USA
    D. M. Tufts et al.
        View Abstract

    Haemaphysalis longicornis, an invasive Ixodid tick, was recently reported in the eastern United States. The emergence of these ticks represents a potential threat for livestock, wildlife, and human health. We describe the distribution, host-seeking phenology, and host and habitat associations of these ticks on Staten Island, New York, a borough of New York City.

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  • Pneumonic Plague in Dog with Widespread Potential Human Exposure in Veterinary Teaching Hospital
    P. A. Schaffer et al.
  • Prolonged Shedding of Zika Virus RNA in Vaginal Secretions, Nicaragua
    Y. Reyes et al.
  • Enterovirus A71 Phenotypes Causing Hand, Foot, and Mouth Disease, Vietnam
    H. Van et al.
  • Aerosol Transmission of Aspergillus fumigatus in Cystic Fibrosis Patients, the Netherlands
    T. Engel et al.
  • Self-Flagellation as Possible Route of Human T-Cell Lymphotropic Virus Transmission
    A. R. Tang et al.
  • Seroprevalence of Zika and Dengue Virus Antibodies among Migrant Workers, Taiwan, 2017
    G. Perng et al.
  • Anopheles sundaicus as a Vector for Plasmodium knowlesi, Andaman and Nicobar Islands
    P. Vidhya et al.
  • Genomic Survey of Bordetella pertussis Diversity, United States, 2000–2013
    M. R. Weigand et al.

Research Letters

  • Cytokine Response to Zika Virus in Peripheral Plasma and Semen of Humans
    J. M. Mansuy et al.
  • Prior Vaccination and Effectiveness of Communication Strategies Used to Describe Infectious Diseases
    T. S. Valley et al.
  • Effects of Political Instability in Venezuela on Malaria Resurgence at Ecuador–Peru Border, 2018
    R. Jaramillo-Ochoa et al.
        View Abstract

    Mass migration from Venezuela has increased malaria resurgence risk across South America. During 2018, migrants from Venezuela constituted 96% of imported malaria cases along the Ecuador–Peru border. Plasmodium vivax predominated (96%). Autochthonous malaria cases emerged in areas previously malaria-free. Heightened malaria control and a response to this humanitarian crisis are imperative.

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  • Detection of Epizootic Hemorrhagic Disease Virus Serotype 1, Israel
    N. Golender and V. Y. Bumbarov
  • Ross River Virus Antibody Prevalence, Fiji Islands, 2013–2015
    M. Aubry et al.
  • Epizootic Hemorrhagic Disease in White-Tailed Deer, Canada
    S. E. Allen et al.
  • Malignant Aspergillus flavus Otitis Externa with Jugular Thrombosis
    M. Moniot et al.
  • Reduced Susceptibility to Neuraminidase Inhibitors in Influenza B Virus from Immunocompromised Woman, Canada
    Y. Abed et al.

Books and Media

  • The Task Force for Child Survival: Secrets of Successful Coalitions, 1st Edition
    J. M. Gould

Volume 25, Number 5—May 2019


  • Novel Sequence Type in Bacillus cereus Strains Associated with Nosocomial Infections and Bacteremia, Japan
    R. Akamatsu et al.
  • Formaldehyde and Glutaraldehyde Inactivation of Bacterial Tier I Select Agents in Tissues
    J. Chua et al.
        View Abstract

    For safety, Select Agents in tissues must be inactivated and viability tested before the tissue undergoes further processing and analysis. In response to the shipping of samples of “inactivated” Bacillus anthracis that inadvertently contained live spores to nonregulated entities and partners worldwide, the Federal Register now mandates in-house validation of inactivation procedures and standardization of viability testing to detect live organisms in samples containing Select Agents that have undergone an inactivation process. We tested and validated formaldehyde and glutaraldehyde inactivation procedures for animal tissues infected with virulent B. anthracis, Burkholderia pseudomallei, Francisella tularensis, and Yersinia pestis. We confirmed that our fixation procedures for tissues containing these Tier I Select Agents resulted in complete inactivation and that our validated viability testing methods do not interfere with detection of live organisms. Institutions may use this work as a guide to develop and conduct their own testing to comply with the policy.

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  • Infectious Dose of African Swine Fever Virus When Consumed Naturally in Liquid or Feed
    M. C. Niederwerder et al.
        View Abstract

    African swine fever virus (ASFV) is a contagious, rapidly spreading, transboundary animal disease and a major threat to pork production globally. Although plant-based feed has been identified as a potential route for virus introduction onto swine farms, little is known about the risks for ASFV transmission in feed. We aimed to determine the minimum and median infectious doses of the Georgia 2007 strain of ASFV through oral exposure during natural drinking and feeding behaviors. The minimum infectious dose of ASFV in liquid was 100 50% tissue culture infectious dose (TCID50), compared with 104 TCID50 in feed. The median infectious dose was 101.0 TCID50 for liquid and 106.8 TCID50 for feed. Our findings demonstrate that ASFV Georgia 2007 can easily be transmitted orally, although higher doses are required for infection in plant-based feed. These data provide important information that can be incorporated into risk models for ASFV transmission.

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  • Serologic Prevalence of Ebola Virus in Equatorial Africa
    I. Steffen et al.
  • Management of Central Nervous System Infections, Vientiane, Laos, 2003–2011
    A. Dubot-Pérès et al.


  • Neonatal Conjunctivitis Caused by Neisseria meningitidis of US Urethritis Clade, New York City, New York, USA, August 2017
    C. B. Kretz et al.
  • Estimating Risk to Responders Exposed to Avian Influenza A H5 and H7 Viruses in Poultry, United States, 2014–2017
    S. J. Olsen et al.
        View Abstract

    In the United States, outbreaks of avian influenza H5 and H7 virus infections in poultry have raised concern about the risk for infections in humans. We reviewed the data collected during 2014–2017 and found no human infections among 4,555 exposed responders who were wearing protection.

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  • Genetic Characterization of Middle East Respiratory Syndrome Coronavirus, South Korea, 2018
    Y. Chung et al.
        View Abstract

    We evaluated genetic variation in Middle East respiratory syndrome coronavirus (MERS-CoV) imported to South Korea in 2018 using specimens from a patient and isolates from infected Caco-2 cells. The MERS-CoV strain in this study was genetically similar to a strain isolated in Riyadh, Saudi Arabia, in 2017.

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  • Anthrax Epizootic in Wildlife, Bwabwata National Park, Namibia, 2017
    C. M. Cossaboom et al.
  • Phylogenetic Analysis of Francisella tularensis Group A.II Isolates from 5 Human Tularemia Cases, Arizona, USA, 2015–2017
    D. N. Birdsell et al.
  • Value of PCR, Serology, and Blood Smears for Human Granulocytic Anaplasmosis Diagnosis, France
    Y. Hansmann et al.

Research Letters

  • Gordonia bronchialis–Associated Endophthalmitis
    R. Choi et al.
  • Human Monkeypox in Sierra Leone after 44-Year Absence of Reported Cases
    M. G. Reynolds et al.
        View Abstract

    We note the reemergence of human monkeypox in Sierra Leone following a 44-year absence of reported disease. The persons affected were an 11-month-old boy and, several years later, a 35-year-old man. The reappearance of monkeypox in this country suggests a need for renewed vigilance and awareness of the disease and its manifestations.

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  • Rickettsiales in Ticks Removed from Outdoor Workers, Southwest Georgia and Northwest Florida, USA
    E. R. Gleim et al.
  • Need for Aeromedical Evacuation High-Level Containment Transport Guidelines
    S. G. Gibbs et al.
        View Abstract

    Circumstances exist that call for the aeromedical evacuation high-level containment transport (AE-HLCT) of patients with highly hazardous communicable diseases. A small number of organizations maintain AE-HLCT capabilities, and little is publicly available regarding the practices. The time is ripe for the development of standards and consensus guidelines involving AE-HLCT.

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  • Increase in Lassa Fever Cases in Nigeria, January–March 2018
    E. A. Ilori et al.

Online Report

  • Southeast Asia Strategic Multilateral Dialogue on Biosecurity
    A. Cicero et al.

Volume 25, Number 6—June 2019


  • New Delhi Metallo-β-Lactamase 5–Producing Klebsiella pneumoniae Sequence Type 258, Southwest China, 2017
    X. Zhang et al.

Research Letter

  • Hepatitis E Virus Infection in European Brown Hares, Germany 2007–2014
    V. Corman et al.