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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 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 Caused by Congenital Zika Virus Infection, Brazil, 2015
    M. C. Leal et al.
    View Summary

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

        View Abstract

    We summarize the characteristics of dysphagia in 9 infants in Brazil with microcephaly caused by congenital Zika virus infection. The Schedule for Oral Motor Assessment, fiberoptic endoscopic evaluation of swallowing, and the videofluoroscopic swallowing study were used as noninstrumental and instrumental assessments. All infants had a degree of neurologic damage and showed abnormalities in the oral phase. Of the 9 infants, 8 lacked oral and upper respiratory tract sensitivity, leading to delays in initiation of the pharyngeal phase of swallowing. Those delays, combined with marked oral dysfunction, increased the risk for aspiration of food, particularly liquid foods. Dysphagia resulting from congenital Zika virus syndrome microcephaly can develop in infants >3 months of age and is severe.

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  • 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.

  • Added Value of Next-Generation Sequencing for Multilocus Sequence Typing Analysis of a Pneumocystis jirovecii Pneumonia Outbreak
    E. Charpentier et al.
        View Abstract

    Pneumocystis jirovecii is a major threat for immunocompromised patients, and clusters of pneumocystis pneumonia (PCP) have been increasingly described in transplant units during the past decade. Exploring an outbreak transmission network requires complementary spatiotemporal and strain-typing approaches. We analyzed a PCP outbreak and demonstrated the added value of next-generation sequencing (NGS) for the multilocus sequence typing (MLST) study of P. jirovecii strains. Thirty-two PCP patients were included. Among the 12 solid organ transplant patients, 5 shared a major and unique genotype that was also found as a minor strain in a sixth patient. A transmission map analysis strengthened the suspicion of nosocomial acquisition of this strain for the 6 patients. NGS-MLST enables accurate determination of subpopulation, which allowed excluding other patients from the transmission network. NGS-MLST genotyping approach was essential to deciphering this outbreak. This innovative approach brings new insights for future epidemiologic studies on this uncultivable opportunistic fungus.

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  • 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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  • Human Infection with Highly Pathogenic Avian Influenza A(H7N9) Virus, China
    C. Ke et al.
        View Abstract

    The recent increase in zoonotic avian influenza A(H7N9) disease in China is a cause of public health concern. Most of the A(H7N9) viruses previously reported have been of low pathogenicity. We report the fatal case of a patient in China who was infected with an A(H7N9) virus having a polybasic amino acid sequence at its hemagglutinin cleavage site (PEVPKRKRTAR/GL), a sequence suggestive of high pathogenicity in birds. Its neuraminidase also had R292K, an amino acid change known to be associated with neuraminidase inhibitor resistance. Both of these molecular features might have contributed to the patient’s adverse clinical outcome. The patient had a history of exposure to sick and dying poultry, and his close contacts had no evidence of A(H7N9) disease, suggesting human-to-human transmission did not occur. Enhanced surveillance is needed to determine whether this highly pathogenic avian influenza A(H7N9) virus will continue to spread.

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  • 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.
        View Abstract

    Unprotected sexual intercourse between persons residing in or traveling from regions with Zika virus transmission is a risk factor for infection. To model risk for infection after sexual intercourse, we inoculated rhesus and cynomolgus macaques with Zika virus by intravaginal or intrarectal routes. In macaques inoculated intravaginally, we detected viremia and virus RNA in 50% of macaques, followed by seroconversion. In macaques inoculated intrarectally, we detected viremia, virus RNA, or both, in 100% of both species, followed by seroconversion. The magnitude and duration of infectious virus in blood of macaques suggest humans infected with Zika virus through sexual transmission will likely generate viremias sufficient to infect competent mosquito vectors. Our results indicate that transmission of Zika virus by sexual intercourse might serve as a virus maintenance mechanism in the absence of mosquito-to-human transmission and could increase the probability of establishment and spread of Zika virus in regions where this virus is not present.

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  • Characterization of Fitzroy River Virus and Serologic Evidence of Human and Animal Infection
    C. A. Johansen et al.
        View Abstract

    In northern Western Australia in 2011 and 2012, surveillance detected a novel arbovirus in mosquitoes. Genetic and phenotypic analyses confirmed that the new flavivirus, named Fitzroy River virus, is related to Sepik virus and Wesselsbron virus, in the yellow fever virus group. Most (81%) isolates came from Aedes normanensis mosquitoes, providing circumstantial evidence of the probable vector. In cell culture, Fitzroy River virus replicated in mosquito (C6/36), mammalian (Vero, PSEK, and BSR), and avian (DF-1) cells. It also infected intraperitoneally inoculated weanling mice and caused mild clinical disease in 3 intracranially inoculated mice. Specific neutralizing antibodies were detected in sentinel horses (12.6%), cattle (6.6%), and chickens (0.5%) in the Northern Territory of Australia and in a subset of humans (0.8%) from northern Western Australia.

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  • Maguari Virus Associated with Human Disease
    A. Groseth et al.
        View Abstract

    Despite the lack of evidence for symptomatic human infection with Maguari virus (MAGV), its close relation to Cache Valley virus (CVV), which does infect humans, remains a concern. We sequenced the complete genome of a MAGV-like isolate (OBS 6657) obtained from a febrile patient in Pucallpa, Ucayali, Peru, in 1998. To facilitate its classification, we generated additional full-length sequences for the MAGV prototype strain, 3 additional MAGV-like isolates, and the closely related CVV (7 strains), Tlacotalpan (1 strain), Playas (3 strains), and Fort Sherman (1 strain) viruses. The OBS 6657 isolate is similar to the MAGV prototype, whereas 2 of the other MAGV-like isolates are located on a distinct branch and most likely warrant classification as a separate virus species and 1 is, in fact, a misclassified CVV strain. Our findings provide clear evidence that MAGV can cause human disease.

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  • Clinical Laboratory Values as Early Indicators of Ebola Virus Infection in Nonhuman Primates
    R. B. Reisler et al.
  • Lyme Borreliosis in Finland, 1995–2014
    E. Sajanti et al.
        View Abstract

    We investigated the epidemiology of Lyme borreliosis (LB) in Finland for the period 1995–2014 by using data from 3 different healthcare registers. We reviewed data on disseminated LB cases from the National Infectious Diseases Register (21,051 cases) and the National Hospital Discharge Register (10,402 cases) and data on primary LB (erythema migrans) cases from the Register for Primary Health Care Visits (11,793 cases). Incidence of microbiologically confirmed disseminated LB cases increased from 7/100,000 population in 1995 to 31/100,000 in 2014. Incidence of primary LB cases increased from 44/100,000 in 2011 to 61/100,000 in 2014. Overall, cases occurred predominantly in women, and we observed a bimodal age distribution in all 3 registers. Our results clearly demonstrate that the geographic distribution of LB has expanded in Finland and underscore the importance of LB as an increasing public health concern in Finland and in northern Europe in general.

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  • 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.
        View Abstract

    Tularemia in humans in northwestern Spain is associated with increases in vole populations. Prevalence of infection with Francisella tularensis in common voles increased to 33% during a vole population fluctuation. This finding confirms that voles are spillover agents for zoonotic outbreaks. Ecologic interactions associated with tularemia prevention should be considered.

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  • 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.
  • Preliminary Epidemiology of Human Infections with Highly Pathogenic Avian Influenza A(H7N9) Virus, China, 2017
    L. Zhou et al.
        View Abstract

    We compared the characteristics of cases of highly pathogenic avian influenza (HPAI) and low pathogenic avian influenza (LPAI) A(H7N9) virus infections in China. HPAI A(H7N9) case-patients were more likely to have had exposure to sick and dead poultry in rural areas and were hospitalized earlier than were LPAI A(H7N9) case-patients.

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  • 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.
        View Abstract

    Highly pathogenic avian influenza A(H5N8) clade virus emerged in 2016 and spread to Russia, Europe, and Africa. Our analysis of viruses from domestic ducks at Tanguar haor, Bangladesh, showed genetic similarities with other viruses from wild birds in central Asia, suggesting their potential role in the genesis of A(H5N8).

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  • Global Spread of Norovirus GII.17 Kawasaki 308, 2014–2016
    M. Chan et al.
        View Abstract

    Analysis of complete capsid sequences of the emerging norovirus GII.17 Kawasaki 308 from 13 countries demonstrated that they originated from a single haplotype since the initial emergence in China in late 2014. Global spread of a sublineage SL2 was identified. A new sublineage SL3 emerged in China in 2016.

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  • Clonal Expansion of New Penicillin-Resistant Clade of Neisseria meningitidis Serogroup W Clonal Complex 11, Australia
    S. Mowlaboccus et al.
        View Abstract

    In Western Australia, Neisseria meningitidis serogroup W clonal complex 11 became the predominant cause of invasive meningococcal disease in 2016. We used core-genome analysis to show emergence of a penicillin-resistant clade that had the penA_253 allele. This new penicillin-resistant clade might affect treatment regimens for this disease.

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  • Opiate Injection–Associated Skin, Soft Tissue, and Vascular Infections, England, UK, 1997–2016
    D. Lewer et al.
  • Influenza D Virus in Animal Species in Guangdong Province, Southern China
    S. Zhai et al.

Research Letters

  • Outcomes for 2 Children after Peripartum Acquisition of Zika Virus Infection, French Polynesia, 2013–2014
    M. Besnard et al.
        View Abstract

    Congenital Zika virus infection is associated with severe brain anomalies and impaired function. To determine outcomes, we followed 2 affected children for ≈30 months. For 1 who was symptomatic at birth, transient hepatitis developed. However, neurodevelopment for both children was age appropriate.

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  • Scrub Typhus Outbreak in a Remote Primary School, Bhutan, 2014
    T. Tshokey et al.
  • Mucus-Activatable Shiga Toxin Genotype stx2d in Escherichia coli O157:H7
    S. Sánchez et al.
  • mcr-1 and bla in Escherichia coli ST744 after Meropenem and Colistin Therapy, Portugal
    M. Tacão et al.
  • Effects of Influenza Strain Label on Worry and Behavioral Intentions
    A. M. Scherer et al.
        View Abstract

    Persons who read information about a hypothetical influenza strain with scientific (H11N3 influenza) or exotic-sounding (Yarraman flu) name reported higher worry and vaccination intentions than did those who read about strains named after an animal reservoir (horse flu). These findings suggest that terms used for influenza in public communications can influence reactions.

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  • Early Evidence for Zika Virus Circulation among Aedes aegypti Mosquitoes, Rio de Janeiro, Brazil
    T. Ayllón et al.
        View Abstract

    During 2014–2016, we conducted mosquito-based Zika virus surveillance in Rio de Janeiro, Brazil. Results suggest that Zika virus was probably introduced into the area during May–November 2013 via multiple in-country sources. Furthermore, our results strengthen the hypothesis that Zika virus in the Americas originated in Brazil during October 2012–May 2013.

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  • Candidatus Dirofilaria hongkongensis as Causative Agent of Human Ocular Filariosis after Travel to India
    S. Winkler et al.
  • Zika Virus Screening among Spanish Team Members After 2016 Rio de Janeiro, Brazil, Olympic Games
    N. Rodriguez-Valero et al.
        View Abstract

    We evaluated the risk for the Spanish Olympic Team acquiring Zika virus in Rio de Janeiro, Brazil, during 2016. We recruited 117 team members, and all tested negative for Zika virus. Lack of cases in this cohort supports the minimum risk estimates made before the Games.

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  • California Serogroup Virus Infection Associated with Encephalitis and Cognitive Decline, Canada, 2015
  • Detection of Elizabethkingia spp. in Culicoides Biting Midges, Australia
    P. T. Mee et al.
  • Scrub Typhus as a Cause of Acute Encephalitis Syndrome, Gorakhpur, Uttar Pradesh, India
    M. Mittal et al.


  • Acute Encephalitis Syndrome and Scrub Typhus in India
    M. V. Murhekar

Volume 23, Number 9—September 2017


  • Bioinformatic Analyses of Whole-Genome Sequence Data in a Public Health Laboratory
    K. F. Oakeson et al.


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

    During 2015–2016, we evaluated the performance of whole-genome sequencing (WGS) as a routine typing tool. Its added value for microbiological and epidemiologic surveillance of listeriosis was compared with that for pulsed-field gel electrophoresis (PFGE), the current standard method. A total of 2,743 Listeria monocytogenes isolates collected as part of routine surveillance were characterized in parallel by PFGE and core genome multilocus sequence typing (cgMLST) extracted from WGS. We investigated PFGE and cgMLST clusters containing human isolates. Discrimination of isolates was significantly higher by cgMLST than by PFGE (p<0.001). cgMLST discriminated unrelated isolates that shared identical PFGE profiles and phylogenetically closely related isolates with distinct PFGE profiles. This procedure also refined epidemiologic investigations to include only phylogenetically closely related isolates, improved source identification, and facilitated epidemiologic investigations, enabling identification of more outbreaks at earlier stages. WGS-based typing should replace PFGE as the primary typing method for L. monocytogenes.

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  • Prevalence of Yersinia enterocolitica Bioserotype 3/O:3 in Children with Diarrhea, China
    R. Duan et al.
  • Convergence of Humans, Bats, Trees, and Culture in Nipah Virus Transmission, Bangladesh
    E. S. Gurley et al.
  • Estimated Annual Numbers of Foodborne Pathogen–Associated Illnesses, Hospitalizations, and Deaths, France, 2008–2013
    D. Van Cauteren et al.
  • Epidemiology of Salmonella enterica Serotype Dublin Infections among Humans, United States, 1968–2013
    R. Harvey et al.
    View Summary

    Infection incidence and antimicrobial drug resistance are increasing.

  • Phylogeographic Analysis of Rabies Virus Incursions across US/Canada Border
    H. Trewby et al.
  • The Role of Food Insecurity in an Outbreak of Anthrax among Humans and Hippopotamuses Living in a Game Reserve Area, Rural Zambia


  • Group A Rotavirus Associated with Encephalitis in Red Fox
  • Cost of Nosocomial Outbreak Caused by NDM-1–Containing Klebsiella pneumoniae in the Netherlands, 2015–2016
    M. Mollers et al.
  • Imported Infections with Mansonella perstans Nematodes, Italy
    F. Gobbi et al.
  • Microcephaly Caused by Lymphocytic Choriomeningitis Virus
    M. Delaine et al.
  • Epidemiology of Neisseria gonorrhoeae Gyrase A Genotype, Los Angeles, California, USA
    A. A. Bhatti et al.
  • Emergence of Plasmid-Mediated Fosfomycin Resistance Genes among Escherichia coli Isolates, France
    Y. Benzerara et al.

Research Letters

  • Identification of Clade E Avipoxvirus, Mozambique, Africa, 2016
    L. P. Mapaco et al.
  • Carbapenemase-Producing Enterobacteriaceae and Nonfermentative Bacteria, the Philippines, 2013–2016

Volume 23, Number 10—October 2017


  • Off-Label Use of Bedaquiline in Children and Adolescents with Drug-Resistant Tuberculosis
  • Bedaquiline and Delamanid Combination Treatment for Pulmonary Multidrug-Resistant Tuberculosis, Europe and India
    A. Maryandyshev et al.

Research Letter

  • Multidrug-Resistant Tuberculosis in Pregnant Woman on Bedaquiline and Linezolid
    M. Jaspard et al.