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Ahead of Print / In Press

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 24, Number 1—January 2018


  • Increased Severity and Spread of Mycobacterium ulcerans, Southeastern Australia
    A. Tai et al.
        View Abstract

    Reported cases of Mycobacterium ulcerans disease (Buruli ulcer) have been increasing in southeastern Australia and spreading into new geographic areas. We analyzed 426 cases of M. ulcerans disease during January 1998–May 2017 in the established disease-endemic region of the Bellarine Peninsula and the emerging endemic region of the Mornington Peninsula. A total of 20.4% of cases-patients had severe disease. Over time, there has been an increase in the number of cases managed per year and the proportion associated with severe disease. Risk factors associated with severe disease included age, time period (range of years of diagnosis), and location of lesions over a joint. We highlight the changing epidemiology and pathogenicity of M. ulcerans disease in Australia. Further research, including genomic studies of emergent strains with increased pathogenicity, are urgently needed to improve the understanding of disease to facilitate implementation of effective public health measures to halt its spread.

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  • Japanese Encephalitis Virus Transmitted Via Blood Transfusion, Hong Kong, China
    V. Cheng et al.
        View Abstract

    Japanese encephalitis virus (JEV) is a mosquitoborne virus endemic to China and Southeast Asia that causes severe encephalitis in <1% of infected persons. Transmission of JEV via blood transfusion has not been reported. We report transmission of JEV via blood donation products from an asymptomatic viremic donor to 2 immunocompromised recipients. One recipient on high-dose immunosuppressive drugs received JEV-positive packed red blood cells after a double lung transplant; severe encephalitis and a poor clinical outcome resulted. JEV RNA was detected in serum, cerebrospinal fluid, and bronchoalveolar lavage fluid specimens. The second recipient had leukemia and received platelets after undergoing chemotherapy. This patient was asymptomatic; JEV infection was confirmed in this person by IgM seroconversion. This study illustrates that, consistent with other pathogenic flaviviruses, JEV can be transmitted via blood products. Targeted donor screening and pathogen reduction technologies could be used to prevent transfusion-transmitted JEV infection in highly JEV-endemic areas.

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  • Sensitivity and Specificity of Suspected Case Definition Used during West Africa Ebola Epidemic
    C. H. Hsu et al.
        View Abstract

    Rapid early detection and control of Ebola virus disease (EVD) is contingent on accurate case definitions. Using an epidemic surveillance dataset from Guinea, we analyzed an EVD case definition developed by the World Health Organization (WHO) and used in Guinea. We used the surveillance dataset (March–October 2014; n = 2,847 persons) to identify patients that satisfied or did not satisfy case definition criteria. Laboratory confirmation determined cases from noncases, and we calculates sensitivity, specificity and predictive values. The sensitivity of the defintion was 68.9%, and the specificity of the definition was 49.6%. The presence of epidemiologic risk factors (i.e., recent contact with a known or suspected EVD case-patient) had the highest sensitivity (74.7%), and unexplained deaths had the highest specificity (92.8%). Results for case definition analyses were statistically significant (p<0.05 by χ2 test). Multiple components of the EVD case definition used in Guinea contributed to improved overall sensitivity and specificity.

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  • Drug-Resistant Polymorphisms and Copy Numbers in Plasmodium falciparum, Mozambique, 2015
    H. Gupta et al.
        View Abstract

    One of the fundamental steps toward malaria control is the use of antimalarial drugs. The success of antimalarial treatment can be affected by the presence of drug-resistant populations of Plasmodium falciparum. To assess resistance, we used molecular methods to examine 351 P. falciparum isolates collected from 4 sentinel sites in Mozambique for K13, pfmdr1, pfcrt, and pfdhps polymorphisms and for plasmepsin2 (pfpm2) and pfmdr1 copy numbers. We found multiple copies of pfpm2 in 1.1% of isolates. All isolates carried K13 wild-type alleles (3D7-like), except 4 novel polymorphisms (Leu619Leu, Phe656Ile, Val666Val, Gly690Gly). Prevalence of isolates with pfcrt mutant (K76T) allele was low (2.3%). Prevalence of isolates with pfdhps mutant alleles (A437G and K540E) was >80%, indicating persistence of sulfadoxine/pyrimethamine resistance; however, markers of artemisinin were absent, and markers of piperaquine resistance were low. Piperaquine resistance isolates may spread in Mozambique as dihydroartemisinin/piperaquine drug pressure increases.

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  • Emergence of Vaccine-Derived Polioviruses during Ebola Virus Disease Outbreak, Guinea, 2014–2015
    M. Fernandez-Garcia et al.
  • Nipah Virus Contamination of Hospital Surfaces during Outbreaks, Bangladesh, 2013–2014
    M. Hassan et al.
        View Abstract

    Nipah virus (NiV) has been transmitted from patient to caregivers in Bangladesh presumably through oral secretions. We aimed to detect whether NiV-infected patients contaminate hospital surfaces with the virus. During December 2013–April 2014, we collected 1 swab sample from 5 surfaces near NiV-infected patients and tested surface and oral swab samples by real-time reverse transcription PCR for NiV RNA. We identified 16 Nipah patients; 12 cases were laboratory-confirmed and 4 probable. Of the 12 laboratory-confirmed cases, 10 showed NiV RNA in oral swab specimens. We obtained surface swab samples for 6 Nipah patients; 5 had evidence of NiV RNA on >1 surface: 4 patients contaminated towels, 3 bed sheets, and 1 the bed rail. Patients with NiV RNA in oral swab samples were significantly more likely than other Nipah patients to die. To reduce the risk for fomite transmission of NiV, infection control should target hospital surfaces.

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  • Detection and Circulation of a Novel Rabbit Hemorrhagic Disease Virus in Australia
    J. E. Mahar et al.
        View Abstract

    The highly virulent rabbit hemorrhagic disease virus (RHDV) has been widely used in Australia and New Zealand since the mid-1990s to control wild rabbits, an invasive vertebrate pest in these countries. In January 2014, an exotic RHDV was detected in Australia, and 8 additional outbreaks were reported in both domestic and wild rabbits in the 15 months following its detection. Full-length genomic analysis revealed that this virus is a recombinant containing an RHDVa capsid gene and nonstructural genes most closely related to nonpathogenic rabbit caliciviruses. Nationwide monitoring efforts need to be expanded to assess if the increasing number of different RHDV variants circulating in the Australian environment will affect biological control of rabbits. At the same time, updated vaccines and vaccination protocols are urgently needed to protect pet and farmed rabbits from these novel rabbit caliciviruses.

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  • Changing Geographic Patterns and Risk Factors for Avian Influenza A(H7N9) Infections in Humans, China
    J. Artois et al.
        View Abstract

    The fifth epidemic wave of avian influenza A(H7N9) virus in China during 2016–2017 demonstrated a geographic range expansion and caused more human cases than any previous wave. The factors that may explain the recent range expansion and surge in incidence remain unknown. We investigated the effect of anthropogenic, poultry, and wetland variables on all epidemic waves. Poultry predictor variables became much more important in the last 2 epidemic waves than they were previously, supporting the assumption of much wider H7N9 transmission in the chicken reservoir. We show that the future range expansion of H7N9 to northern China may increase the risk of H7N9 epidemic peaks coinciding in time and space with those of seasonal influenza, leading to a higher risk of reassortments than before, although the risk is still low so far.

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Historical Review

  • Dangers of Noncritical Use of Historical Plague Data
    J. Roosen and D. R. Curtis
        View Abstract

    Researchers have published several articles using historical data sets on plague epidemics using impressive digital databases that contain thousands of recorded outbreaks across Europe over the past several centuries. Through the digitization of preexisting data sets, scholars have unprecedented access to the historical record of plague occurrences. However, although these databases offer new research opportunities, noncritical use and reproduction of preexisting data sets can also limit our understanding of how infectious diseases evolved. Many scholars have performed investigations using Jean-Noël Biraben’s data, which contains information on mentions of plague from various kinds of sources, many of which were not cited. When scholars fail to apply source criticism or do not reflect on the content of the data they use, the reliability of their results becomes highly questionable. Researchers using these databases going forward need to verify and restrict content spatially and temporally, and historians should be encouraged to compile the work.

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  • Pneumonic Plague in Johannesburg, South Africa, 1904
    C. M. Evans et al.
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    Plague is a potentially dangerous reemerging disease. Because modern outbreaks are relatively infrequent, data for epidemiologic study are best found in historical accounts. In 1905, the Rand Plague Committee published a report describing an explosive outbreak of 113 cases of pneumonic plague that occurred in Johannesburg, South Africa, in 1904. Using these data, we investigated social, spatial, and temporal dynamics and quantified transmissibility as measured by the time-varying reproduction number. Risk for transmission was highest when friends, family members, and caregivers approached the sick. Reproduction numbers were 2–4. Transmission rates rapidly diminished after implementation of control measures, including isolation and safer burial practices. A contemporaneous smaller bubonic plague outbreak associated with a low-key epizootic of rats also occurred. Clusters of cases of pneumonic plague were mostly limited to the Indian community; cases of bubonic plague were mostly associated with white communities and their black African servants.

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Research Letters


Books and Media

About the Cover



Volume 24, Number 2—February 2018


  • Hypervirulent Klebsiella pneumoniae in Cryptogenic Liver Abscesses, Paris, France
    B. Rossi et al.
    View Summary

    France and Europe might have an epidemic of this bacteria as did Asia in the early 2000s.

  • Adenovirus Type 4 Respiratory Infections among Civilians, Northeastern United States, 2011–2015
    A. E. Kajon et al.
  • Increase in Ocular Syphilis Cases at an Ophthalmologic Reference Center, France, 2012–2015
  • Ecologic Features of Plague Outbreak Areas, Democratic Republic of the Congo, 2004–2014
    A. Abedi et al.


  • Environmental Risk Factors for and Spatial Distribution of Typhoid Fever in Fiji
    R. de Alwis et al.
  • Trends in Infectious Disease Deaths, South Korea, 1983–2015
    Y. Choe et al.
  • Lethal Respiratory Disease Associated with Human Rhinovirus C in Wild Chimpanzees, Uganda, 2013
    E. J. Scully et al.
  • Multiplex PCR−Based Next-Generation Sequencing and Global Diversity of Seoul Virus in Humans and Rats
    W. Kim et al.
  • Spread of Meropenem-Resistant Streptococcus pneumoniae Serotype 15A-ST63 Clone in Japan, 2012–2014
    S. Nakano et al.
  • Borrelia miyamotoi Infections in Humans and Ticks, Northeastern China
    B. Jiang et al.
  • Use of Pristinamycin for Macrolide-Resistant Mycoplasma genitalium Infection
    T. Read et al.
  • New Parvovirus Associated with Serum Hepatitis in Horses After inoculation of Common Biological Product
    T. J. Divers et al.
  • Potential Reservoir for Yersinia pestis Survival and Replication in Phagocytic Amebae Colonies
    D. W. Markman et al.


  • Ceftriaxone-Resistant Neisseria gonorrhoeae, Canada, 2017
    B. Lefebvre et al.
        View Abstract

    We identified a ceftriaxone-resistant Neisseria gonorrhoeae isolate in a patient in Canada. This isolate carried the penA-60 allele, which differs substantially from its closest relative, mosaic penA XXVII (80% nucleotide identity). Epidemiologic and genomic data suggest spread from Asia. Antimicrobial susceptibility surveillance helps prevent spread of highly resistant N. gonorrhoeae strains.

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  • Containment of Highly Pathogenic Avian Influenza A(H5N1) Virus, Lebanon, 2016
    Z. E. Farah et al.
  • Clusters of Human Infection and Human-to-Human Transmission of Avian Influenza A(H7N9) Virus, 2013–2017
    L. Zhou et al.
        View Abstract

    To detect changes in human-to-human transmission of influenza A(H7N9) virus, we analyzed characteristics of 40 clusters of case-patients during 5 epidemics in China in 2013–2017. Similarities in number and size of clusters and proportion of clusters with probable human-to-human transmission across all epidemics suggest no change in human-to-human transmission risk.

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  • Co-circulation of Influenza A/H5N1, H7, and H9 Viruses and Evidence of Co-infected Poultry in Live Bird Markets, Cambodia
    P. F. Horwood et al.
  • Effects of Culling on Leptospira interrogans Carriage by Rats
    M. J. Lee et al.
  • Epidemic Varicella Zoster Virus among University Students, India
    J. Meyers et al.
  • Emergomyces africanus in Soil, South Africa
    I. S. Schwartz et al.

Research Letters

  • Novel Sequence Type ST834 Streptococcus suis among Humans on Pig Farms, Madagascar
    M. Raberahona et al.
  • Influenza D Virus in Cattle, Ireland
    O. Flynn et al.
  • Human African Trypanosomiasis in a Chinese Emigrant Returning from Gabon in 2017
    X. Wang et al.
  • Cronobacter sakazakii Infection from Expressed Breast Milk, Australia
    R. McMullan et al.
  • Dengue-Associated Posterior Reversible Encephalopathy Syndrome, Vietnam
    N. Mai et al.
  • Cerebral Syphilitic Gumma in Immunocompetent Man, Japan
    T. Kodama et al.

Books and Media

  • In the Company of Microbes: Ten Years of Small Things Considered
    R. Danila

Volume 24, Number 3—March 2018


  • Epidemiology of Recurrent Hand, Foot and Mouth Disease, China, 2008–2015
    J. Huang et al.


  • Major Threat to Malaria Control Programs by Plasmodium falciparum Lacking Histidine-Rich Protein 2, Eritrea
    A. Berhane et al.
  • Incidence and Preventable Burden of Childhood Tuberculosis, Kenya
    A. J. Brent et al.


  • Molecular and Epidemiologic Analysis of Reemergent Salmonella enterica Serovar Napoli, Italy, 2011–2015
    M. Sabbatucci et al.