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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 23, Number 5—May 2017


  • Risk for Hantavirus Pulmonary Syndrome, United States, 1993–2015


  • Control of Malaria Vector Mosquitoes by Insecticide-Treated Combinations of Window Screens and Eave Baffles
    G. F. Killeen et al.
        View Abstract

    We assessed window screens and eave baffles (WSEBs), which enable mosquitoes to enter but not exit houses, as an alternative to indoor residual spraying (IRS) for malaria vector control. WSEBs treated with water, the pyrethroid lambda-cyhalothrin, or the organophosphate pirimiphos-methyl, with and without a binding agent for increasing insecticide persistence on netting, were compared with IRS in experimental huts. Compared with IRS containing the same insecticide, WSEBs killed similar proportions of Anopheles funestus mosquitoes that were resistant to pyrethroids, carbamates and organochlorines and greater proportions of pyrethroid-resistant, early exiting An. arabiensis mosquitoes. WSEBs with pirimiphos-methyl killed greater proportions of both vectors than lambda-cyhalothrin or lambda-cyhalothrin plus pirimiphos-methyl and were equally efficacious when combined with binding agent. WSEBs required far less insecticide than IRS, and binding agents might enhance durability. WSEBs might enable affordable deployment of insecticide combinations to mitigate against physiologic insecticide resistance and improve control of behaviorally resistant, early exiting vectors.

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  • Insecticide-Treated Nets and Protection against Insecticide-Resistant Malaria Vectors in Western Kenya
    E. Ochomo et al.
        View Abstract

    Insecticide resistance might reduce the efficacy of malaria vector control. In 2013 and 2014, malaria vectors for 50 villages, of varying pyrethroid resistance, in western Kenya were assayed for resistance to deltamethrin. Long-lasting insecticide-treated nets (LLIN) were distributed to households at universal coverage. Children were recruited into 2 cohorts, cleared of malaria-causing parasites, and tested every 2 weeks for reinfection. Infection incidence rates for the 2 cohorts were 2.2 (95% CI 1.9–2.5) infections/person-year and 2.8 (95% CI 2.5–3.0) infections/person-year. LLIN users had lower infection rates than non-LLIN users in both low-resistance (rate ratio 0.61, 95% CI 0.42–0.88) and high-resistance (rate ratio 0.55, 95% CI 0.35–0.87) villages (p = 0.63). The association between insecticide resistance and infection incidence was not significant (p = 0.99). Although the incidence of infection was high among net users, LLINs provided significant protection (p = 0.01) against infection with malaria parasite regardless of vector insecticide resistance.

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  • Prevention of Chronic Hepatitis B after 3 Decades of Escalating Vaccination Policy, China
    F. Cui et al.
        View Abstract

    China’s hepatitis B virus (HBV) prevention policy has been evaluated through nationally representative serologic surveys conducted in 1992 and 2006. We report results of a 2014 serologic survey and reanalysis of the 1992 and 2006 surveys in the context of program policy. The 2014 survey used a 2-stage sample strategy in which townships were selected from 160 longstanding, nationally representative, county-level disease surveillance points, and persons 1–29 years of age were invited to participate. The 2014 sample size was 31,713; the response rate was 83.3%. Compared with the 1992 pre–recombinant vaccine survey, HBV surface antigen prevalence declined 46% by 2006 and by 52% by 2014. Among children <5 years of age, the decline was 97%. China’s HBV prevention program, targeted toward interrupting perinatal transmission, has been highly successful and increasingly effective. However, this progress must be sustained for decades to come, and elimination of HBV transmission will require augmented strategies.

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  • Increased Neurotropic Threat from Burkholderia pseudomallei Strains with a B. mallei–like Variation in the bimA Motility Gene, Australia
    J. L. Morris et al.
    View Summary

    These strains have heightened pathogenic potential for rapid dissemination to multiple tissues, including the central nervous system.

  • Population Genomics of Legionella longbeachae and Hidden Complexities of Infection Source Attribution
    R. Bacigalupe et al.
        View Abstract

    Legionella longbeachae is the primary cause of legionellosis in Australasia and Southeast Asia and an emerging pathogen in Europe and the United States; however, our understanding of the population diversity of L. longbeachae from patient and environmental sources is limited. We analyzed the genomes of 64 L. longbeachae isolates, of which 29 were from a cluster of legionellosis cases linked to commercial growing media in Scotland in 2013 and 41 were non–outbreak-associated isolates from Scotland and other countries. We identified extensive genetic diversity across the L. longbeachae species, associated with intraspecies and interspecies gene flow, and a wide geographic distribution of closely related genotypes. Of note, we observed a highly diverse pool of L. longbeachae genotypes within compost samples that precluded the genetic establishment of an infection source. These data represent a view of the genomic diversity of L. longbeachae that will inform strategies for investigating future outbreaks.

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  • Lack of Durable Cross-Neutralizing Antibodies Against Zika Virus from Dengue Virus Infection
    M. H. Collins et al.
        View Abstract

    Cross-reactive antibodies elicited by dengue virus (DENV) infection might affect Zika virus infection and confound serologic tests. Recent data demonstrate neutralization of Zika virus by monoclonal antibodies or human serum collected early after DENV infection. Whether this finding is true in late DENV convalescence (>6 months after infection) is unknown. We studied late convalescent serum samples from persons with prior DENV or Zika virus exposure. Despite extensive cross-reactivity in IgG binding, Zika virus neutralization was not observed among primary DENV infections. We observed low-frequency (23%) Zika virus cross-neutralization in repeat DENV infections. DENV-immune persons who had Zika virus as a secondary infection had distinct populations of antibodies that neutralized DENVs and Zika virus, as shown by DENV-reactive antibody depletion experiments. These data suggest that most DENV infections do not induce durable, high-level Zika virus cross-neutralizing antibodies. Zika virus–specific antibody populations develop after Zika virus infection irrespective of prior DENV immunity.

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  • Use of Blood Donor Screening Data to Estimate Zika Virus Incidence, Puerto Rico, April–August 2016
    M. S. Chevalier et al.
        View Abstract

    Puerto Rico has been heavily impacted by Zika virus, a mosquitoborne flavivirus that emerged in the Americas during 2015. Although most persons with Zika virus show no symptoms, the virus can cause neurologic and other complications, including fetal microcephaly. Local Zika virus transmission in Puerto Rico has been reported since December 2015. To prevent transfusion-associated transmission, local blood collection ceased in March 2016 but resumed in April 2016 after Zika virus screening of blood donations became available. Using data from screening of blood donations collected by the 2 largest blood centers in Puerto Rico during April 3–August 12, 2016, and assuming a 9.9-day duration of viremia, we estimated that 469,321 persons in Puerto Rico were infected during this period, for an estimated cumulative incidence of 12.9%. Results from blood donation screening during arboviral outbreaks can supplement routine clinical and surveillance data for improved targeting of prevention efforts.

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Historical Review

  • Anthrax Cases Associated with Animal-Hair Shaving Brushes
    C. M. Szablewski et al.


  • Exposure Risk for Infection and Lack of Human-to-Human Transmission of Mycobacterium ulcerans Disease, Australia
    D. P. O’Brien et al.
        View Abstract

    We conducted epidemiologic and genetic analyses of family clusters of Mycobacterium ulcerans (Buruli ulcer) disease in southeastern Australia. We found that the incidence of M. ulcerans disease in family members was increased. However, the risk for exposure appeared short-term and not related to human-human transmission.

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  • Amoxicillin and Ceftriaxone as Treatment Alternatives to Penicillin for Maternal Syphilis
    Y. Katanami et al.
  • Increasing Macrolide and Fluoroquinolone Resistance in Mycoplasma genitalium
    G. L. Murray et al.
        View Abstract

    Escalating resistance to azithromycin and moxifloxacin is being reported for Mycoplasma genitalium in the Asia-Pacific region. Analyzing 140 infections, we found pretreatment fluoroquinolone-resistance mutations in parC (13.6%) and gyrA (5%). ParC S83 changes were associated with moxifloxacin failure. Combined macrolide/fluoroquinolone-resistance mutations were in 8.6% of specimens, for which recommended therapies would be ineffective.

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  • Reassortant Clade Avian Influenza A(H5N6) Virus in a Wild Mandarin Duck, South Korea, 2016
    J. Kwon et al.
        View Abstract

    A reassortant clade avian influenza A(H5N6) virus was isolated from a fecal sample of a Mandarin duck (Aix galericulata) in South Korea during October 2016. This virus was genetically similar to H5N6 subtype virus isolates from China, Vietnam, Laos, and Hong Kong, including human isolates.

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  • Regional Transmission of Salmonella Paratyphi A, China, 1998–2012
    X. Lu et al.
        View Abstract

    To explore transmission patterns and genetic relationships of Salmonella enterica serovar Paratyphi A in China, we conducted a genome-wide single-nucleotide polymorphism analysis on the strains in the 4 provinces in which incidence was highest during 1998–2012. Markedly phylogeographic clustering suggested regional virus circulation after introduction from areas in southeastern China.

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  • Survey of Treponemal Infections in Free-Ranging and Captive Macaques, 1999–2012
    A. R. Klegarth et al.
  • Neisseria gonorrhoeae Isolates with Azithromycin Resistance and Decreased in vitro Susceptibility to Ceftriaxone, Hawaii
    J. R. Papp et al.
  • Estimated Incubation Period for Zika Virus Disease
    E. R. Krow-Lucal et al.
        View Abstract

    Information about incubation is needed for identifying local and alternative modes of Zika virus transmission. Data from 2015–2016 for 197 symptomatic travelers with recent Zika virus disease indicated an estimated incubation period of 3–14 days. For persons in whom symptoms develop >2 weeks after travel, transmission might not be travel associated.

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  • Phenotypic and Genotypic Shifts in Hepatitis B Virus in Treatment-Naive Patients, Taiwan, 2008–2012
    C. Yeh et al.
  • Population Responses during the Pandemic Phase of the Influenza A(H1N1)pdm09 Epidemic, Hong Kong, China
    N. Yeung et al.
        View Abstract

    During August 2009–July 2010, we conducted 7 longitudinal telephone surveys among 503 adults in Hong Kong, China, to explore changes in their behavioral and psychological responses to the influenza A(H1N1)pdm09 virus epidemic. Trends were examined using generalized estimating equations models. Findings showed that responses varied with the course of the pandemic.

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Another Dimension

  • The Discovery of Penicillin—New Insights After More Than 75 Years of Clinical Use
    R. Gaynes
        View Abstract

    After just over 75 years of penicillin’s clinical use, the world can see that its impact was immediate and profound. In 1928, a chance event in Alexander Fleming’s London laboratory changed the course of medicine. However, the purification and first clinical use of penicillin would take more than a decade. Unprecedented United States/Great Britain cooperation to produce penicillin was incredibly successful by 1943. This success overshadowed efforts to produce penicillin during World War II in Europe, particularly in the Netherlands. Information about these efforts, available only in the last 10–15 years, provides new insights into the story of the first antibiotic. Researchers in the Netherlands produced penicillin using their own production methods and marketed it in 1946, which eventually increased the penicillin supply and decreased the price. The unusual serendipity involved in the discovery of penicillin demonstrates the difficulties in finding new antibiotics and should remind health professionals to expertly manage these extraordinary medicines.

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Research Letters

  • Management of Bartonella Prosthetic Valve Endocarditis without Cardiac Surgery
    P. Papineni et al.
        View Abstract

    Two cases of Bartonella prosthetic valve endocarditis were cured when treated for 2 weeks with gentamicin and 3 months with doxycycline. Clinical cure correlated with decreased Bartonella antibody titers. This report suggests a strategy to monitor, treat, and cure Bartonella prosthetic valve endocarditis.

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  • Persistence of Zika Virus in Breast Milk after Infection in Late Stage of Pregnancy
    J. R. Sotelo et al.
        View Abstract

    We detected Zika virus in breast milk of a woman in Brazil infected with the virus during the 36th week of pregnancy. Virus was detected 33 days after onset of signs and symptoms and 9 days after delivery. No abnormalities were found during fetal assessment or after birth of the infant.

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  • Colistin Resistance in ESBL-Producing Klebsiella pneumoniae, France
    Y. Caspar et al.
  • Borrelia turicatae Infection in Febrile Soldier, Texas, USA
    A. M. Christensen et al.
  • Severe MRSA Enterocolitis Caused by a Strain Harboring Enterotoxins D, G, and I
    M. Bergevin et al.
        View Abstract

    We describe a case of methicillin-resistant Staphylococcus aureus (MRSA) enterocolitis in a healthy adult with previous antibiotic exposure. Colonoscopy revealed diffuse colitis and mild ileitis without ulceration. Stool cultures demonstrated abundant growth of MRSA and absent normal flora. Oral vancomycin treatment was effective and seems to be the consensus choice for therapy.

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  • Reemergence of African Swine Fever in Zimbabwe, 2015
    J. van Heerden et al.
        View Abstract

    Zimbabwe is the only country in southern Africa with no reported African swine fever (ASF) outbreaks during 1993–2014. However, the 2015 discovery of genotype II ASF virus in Zimbabwe indicates the reemergence of ASF in this country and suggests that this viral genotype may be spreading through eastern and southern Africa.

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  • Serogroup B Meningococcal Disease Outbreak and Vaccination at a University, New Jersey, 2016
    H. M. Soeters et al.
  • Carbapenem-Resistant Enterobacteriaceae in US Veterans Administration Patients, 2006–2015
  • Zika Virus Infection and Prolonged Viremia in Whole-Blood Specimens
    J. Mansuy et al.
        View Abstract

    We tested whole-blood and plasma samples from immunocompetent patients who had had benign Zika virus infections and found that Zika virus RNA persisted in whole blood substantially longer than in plasma. This finding may have implications for diagnosis of acute symptomatic and asymptomatic infections and for testing of blood donations.

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  • Clinical Manifestations of Punta Toro Species Complex Infections, Panama, 2009
    N. D. Gundacker et al.
  • Chromosomal 16S Ribosomal RNA Methyltransferase RmtE1 in Escherichia coli Sequence Type 448
    B. Li et al.
  • Vertical Transmission of Zika Virus by Aedes aegypti and Ae. albopictus Mosquitoes
    A. T. Ciota et al.
        View Abstract

    To determine the potential role of vertical transmission in Zika virus expansion, we evaluated larval pools of perorally infected Aedes. aegypti and Ae. albopictus adult female mosquitoes; ≈1/84 larvae tested were Zika virus–positive; and rates varied among mosquito populations. Thus, vertical transmission may play a role in Zika virus spread and maintenance.

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  • No Such Thing as Chronic Q Fever
    M. Million and D. Raoult
        View Abstract

    Modern diagnostic methods enable clinicians to look beyond a diagnosis of chronic Q fever and discern whether patients instead have persistent focalized Coxiella burnetii infection(s). Use of these methods and development of criteria to define and treat such infections, especially cardiovascular infections, will improve the prognosis for patients previously thought to have chronic Q fever.

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  • ESBL- and Carbapenemase-Producing Enterobacteriaceae in Patients with Sepsis, Yangon, Myanmar, 2014
    T. O. Myat et al.
        View Abstract

    Among 42 gram-negative bloodstream isolates from inpatients in 3 hospitals in Yangon, Myanmar, admitted during July–December 2014, 16 (38%) were extended-spectrum β-lactamase–producing Enterobacteriaceae and 6 (14%) produced carbapenemase. The high prevalence of multidrug-resistant gram-negative bacteria raises concerns about the empiric treatment of patients with sepsis in Yangon.

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  • Meningococci of Serogroup X Clonal Complex 181 in Refugee Camps, Italy
    P. Stefanelli et al.
        View Abstract

    Four cases of infection with serogroup X meningococci (MenX) (1 in 2015 and 3 in 2016) occurred in migrants living in refugee camps or reception centers in Italy. All MenX isolates were identified as clonal complex 181. Our report suggests that serogroup X represents an emerging health threat for persons arriving from African countries.

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  • CTX-M-27–Producing Escherichia coli of Sequence Type 131 and Clade C1-M27 in France
    A. Birgy et al.
  • Antimicrobial Drug Resistance Among Refugees from Syria, Jordan
    A. Abbara et al.

Online Report

  • Translating Real-Time Infectious Disease Modeling into Routine Public Health Practice
    D. J. Muscatello et al.

Volume 23, Number 6—June 2017


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


  • 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.
  • Central Nervous System Brucellosis Granuloma and White Matter Disease in Immunocompromised Patient
    M. Alqwaifly et al.
  • Crimean-Congo Hemorrhagic Fever in Migrant Worker Returning from Muscat, Oman, to India, 2016
    P. D. Yadav et al.

Research Letter

  • Enterocytozoon bieneusi Microsporidiosis in Stem Cell Transplant Recipients Treated with Fumagillin

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.


Research Letter

Volume 23, Number 8—August 2017