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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 1—January 2019


  • Complexity of the Basic Reproduction Number (R0)
    P. L. Delamater et al.
        View Abstract

    The basic reproduction number (R0), also called the basic reproduction ratio or rate or the basic reproductive rate, is an epidemiologic metric used to describe the contagiousness or transmissibility of infectious agents. R0 is affected by numerous biological, sociobehavioral, and environmental factors that govern pathogen transmission and, therefore, is usually estimated with various types of complex mathematical models, which make R0 easily misrepresented, misinterpreted, and misapplied. R0 is not a biological constant for a pathogen, a rate over time, or a measure of disease severity, and R0 cannot be modified through vaccination campaigns. R0 is rarely measured directly, and modeled R0 values are dependent on model structures and assumptions. Some R0 values reported in the scientific literature are likely obsolete. R0 must be estimated, reported, and applied with great caution because this basic metric is far from simple.

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  • Clinical and Radiologic Characteristics of Human Metapneumovirus Infections in Adults, South Korea
    H. Koo et al.
        View Abstract

    Clinical features of human metapneumovirus (HMPV) infection have not been well documented for adults. We investigated clinical and radiologic features of HMPV infection in 849 adults in a tertiary hospital in South Korea. We classified patients into groups on the basis of underlying diseases: immunocompetent patients, solid tumor patients, solid organ transplantation recipients, hematopoietic stem cell transplant recipients, hematologic malignancy patients, and patients receiving long-term steroid treatment. Of 849 HMPV-infected patients, 756 had community-acquired infections, 579 had pneumonia, and 203 had infections with other pathogens. Mortality rates were highest in hematopoietic stem cell transplantation recipients (22% at 30 days). Older age, current smoking, and underlying disease were associated with HMPV pneumonia. Body mass index and an immunocompromised state were associated with 30-day mortality rates in HMPV-infected patients. Bronchial wall thickening, ground-glass opacity, and ill-defined centrilobular nodules were common computed tomography findings for HMPV pneumonia. Macronodules and consolidation were observed in <50% of patients.

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  • Enterovirus A71 Infection and Neurologic Disease, Madrid, Spain, 2016
    C. Taravilla et al.
  • Aeromedical Transfer of Patients with Viral Hemorrhagic Fever
    E. D. Nicol et al.
        View Abstract

    For >40 years, the British Royal Air Force has maintained an aeromedical evacuation facility, the Deployable Air Isolator Team (DAIT), to transport patients with possible or confirmed highly infectious diseases to the United Kingdom. Since 2012, the DAIT, a joint Department of Health and Ministry of Defence asset, has successfully transferred 1 case-patient with Crimean-Congo hemorrhagic fever, 5 case-patients with Ebola virus disease, and 5 case-patients with high-risk Ebola virus exposure. Currently, no UK-published guidelines exist on how to transfer such patients. Here we describe the DAIT procedures from collection at point of illness or exposure to delivery into a dedicated specialist center. We provide illustrations of the challenges faced and, where appropriate, the enhancements made to the process over time.

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  • Association of Increased Receptor-Binding Avidity of Influenza A(H9N2) Viruses with Escape from Antibody-Based Immunity and Enhanced Zoonotic Potential
    J. E. Sealy et al.
        View Abstract

    We characterized 55 influenza A(H9N2) viruses isolated in Pakistan during 2014–2016 and found that the hemagglutinin gene is of the G1 lineage and that internal genes have differentiated into a variety of novel genotypes. Some isolates had up to 4-fold reduction in hemagglutination inhibition titers compared with older viruses. Viruses with hemagglutinin A180T/V substitutions conveyed this antigenic diversity and also caused up to 3,500-fold greater binding to avian-like and >20-fold greater binding to human-like sialic acid receptor analogs. This enhanced binding avidity led to reduced virus replication in primary and continuous cell culture. We confirmed that altered receptor-binding avidity of H9N2 viruses, including enhanced binding to human-like receptors, results in antigenic variation in avian influenza viruses. Consequently, current vaccine formulations might not induce adequate protective immunity in poultry, and emergence of isolates with marked avidity for human-like receptors increases the zoonotic risk.

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  • Epidemiology of Imported Infectious Diseases, China, 2005–2016
    Y. Wang et al.
        View Abstract

    Imported infectious diseases are becoming a serious public health threat in China. However, limited information concerning the epidemiologic characteristics of imported infectious diseases is available. In this study, we collected data related to imported infectious diseases in mainland China from the National Information Reporting System of Infectious Diseases and analyzed demographic, temporal, and spatial distributions. The number of types of imported infectious diseases reported increased from 2 in 2005 to 11 in 2016. A total of 31,740 cases of infectious disease were imported to mainland China during 2005–2016; most of them were found in Yunnan Province. The cases were imported mainly from Africa and Asia. As a key and effective measure, pretravel education should be strengthened for all migrant workers and tourists in China, and border screening, cross-border international cooperation, and early warning should be further improved.

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  • Multiple Introductions of Domestic Feline Leukemia Virus in Endangered Florida Panthers
    E. S. Chiu et al.
        View Abstract

    The endangered Florida panther (Puma concolor coryi) had an outbreak of infection with feline leukemia virus (FeLV) in the early 2000s that resulted in the deaths of 3 animals. A vaccination campaign was instituted during 2003–2007 and no additional cases were recorded until 2010. During 2010–2016, six additional FeLV cases were documented. We characterized FeLV genomes isolated from Florida panthers from both outbreaks and compared them with full-length genomes of FeLVs isolated from contemporary Florida domestic cats. Phylogenetic analyses identified >2 circulating FeLV strains in panthers, which represent separate introductions from domestic cats. The original FeLV virus outbreak strain is either still circulating or another domestic cat transmission event has occurred with a closely related variant. We also report a case of a cross-species transmission event of an oncogenic FeLV recombinant (FeLV-B). Evidence of multiple FeLV strains and detection of FeLV-B indicate Florida panthers are at high risk for FeLV infection.

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  • Prescription of Antibacterial Drugs for HIV-Exposed Noninfected Infants, Malawi, 2004–2010
    A. C. Ewing et al.
  • Variable Protease-Sensitive Prionopathy Transmission to Bank Voles
    R. Nonno et al.
        View Abstract

    Variably protease-sensitive prionopathy (VPSPr), a recently described human sporadic prion disease, features a protease-resistant, disease-related prion protein (resPrPD) displaying 5 fragments reminiscent of Gerstmann-Sträussler-Scheinker disease. Experimental VPSPr transmission to human PrP–expressing transgenic mice, although replication of the VPSPr resPrPD profile succeeded, has been incomplete because of second passage failure. We bioassayed VPSPr in bank voles, which are susceptible to human prion strains. Transmission was complete; first-passage attack rates were 5%–35%, and second-passage rates reached 100% and survival times were 50% shorter. We observed 3 distinct phenotypes and resPrPD profiles; 2 imitated sporadic Creutzfeldt-Jakob disease resPrPD, and 1 resembled Gerstmann-Sträussler-Scheinker disease resPrPD. The first 2 phenotypes may be related to the presence of minor PrPD components in VPSPr. Full VPSPr transmission confirms permissiveness of bank voles to human prions and suggests that bank vole PrP may efficiently reveal an underrepresented native strain but does not replicate the complex VPSPr PrPD profile.

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  • Risk Factors for Elizabethkingia Acquisition and Clinical Characteristics of Patients, South Korea
    M. Choi et al.
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    Elizabethkingia infections are difficult to treat because of intrinsic antimicrobial resistance, and their incidence has recently increased. We conducted a propensity score–matched case–control study during January 2016–June 2017 in South Korea and retrospectively studied data from patients who were culture positive for Elizabethkingia species during January 2009–June 2017. Furthermore, we conducted epidemiologic studies of the hospital environment and mosquitoes. The incidence of Elizabethkingia increased significantly, by 432.1%, for 2016–2017 over incidence for 2009–2015. Mechanical ventilation was associated with the acquisition of Elizabethkingia species. Because Elizabethkingia infection has a high case-fatality rate and is difficult to eliminate, intensive prevention of contamination is needed.

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  • Effects of Antibiotic Cycling Policy on Incidence of Healthcare-Associated MRSA and Clostridioides difficile Infection in Secondary Healthcare Settings
    G. Conlon-Bingham et al.
        View Abstract

    This quasi-experimental study investigated the effect of an antibiotic cycling policy based on time-series analysis of epidemiologic data, which identified antimicrobial drugs and time periods for restriction. Cyclical restrictions of amoxicillin/clavulanic acid, piperacillin/tazobactam, and clarithromycin were undertaken over a 2-year period in the intervention hospital. We used segmented regression analysis to compare the effect on the incidence of healthcare-associated Clostridioides difficile infection (HA-CDI), healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA), and new extended-spectrum β-lactamase (ESBL) isolates and on changes in resistance patterns of the HA-MRSA and ESBL organisms between the intervention and control hospitals. HA-CDI incidence did not change. HA-MRSA incidence increased significantly in the intervention hospital. The resistance of new ESBL isolates to amoxicillin/clavulanic acid and piperacillin/tazobactam decreased significantly in the intervention hospital; however, resistance to piperacillin/tazobactam increased after a return to the standard policy. The results question the value of antibiotic cycling to antibiotic stewardship.

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  • Zoonotic Source Attribution of Salmonella enterica Serotype Typhimurium Using Genomic Surveillance Data, United States
    S. Zhang et al.
        View Abstract

    Increasingly, routine surveillance and monitoring of foodborne pathogens using whole-genome sequencing is creating opportunities to study foodborne illness epidemiology beyond routine outbreak investigations and case–control studies. Using a global phylogeny of Salmonella enterica serotype Typhimurium, we found that major livestock sources of the pathogen in the United States can be predicted through whole-genome sequencing data. Relatively steady rates of sequence divergence in livestock lineages enabled the inference of their recent origins. Elevated accumulation of lineage-specific pseudogenes after divergence from generalist populations and possible metabolic acclimation in a representative swine isolate indicates possible emergence of host adaptation. We developed and retrospectively applied a machine learning Random Forest classifier for genomic source prediction of Salmonella Typhimurium that correctly attributed 7 of 8 major zoonotic outbreaks in the United States during 1998–2013. We further identified 50 key genetic features that were sufficient for robust livestock source prediction.

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Research Letters

Books and Media

In Memoriam

About the Cover


Volume 25, Number 2—February 2019


  • International Biologic Reference Preparations for Epidemic Infectious Diseases
    T. Rampling et al.


  • Trends of Human Plague, Madagascar, 1998–2016
    V. Andrianaivoarimanana et al.
  • Human Pasteurellosis, Health Risk for Elderly Persons Living with Companion Animals
    S. Körmöndi et al.
  • Ebola Virus Infection Associated with Transmission from Survivors
    S. Den Boon et al.
        View Abstract

    Ebola virus (EBOV) can persist in immunologically protected body sites in survivors of Ebola virus disease, creating the potential to initiate new chains of transmission. From the outbreak in West Africa during 2014–2016, we identified 13 possible events of viral persistence–derived transmission of EBOV (VPDTe) and applied predefined criteria to classify transmission events based on the strength of evidence for VPDTe and source and route of transmission. For 8 events, a recipient case was identified; possible source cases were identified for 5 of these 8. For 5 events, a recipient case or chain of transmission could not be confidently determined. Five events met our criteria for sexual transmission (male-to-female). One VPDTe event led to at least 4 generations of cases; transmission was limited after the other events. VPDTe has increased the importance of Ebola survivor services and sustained surveillance and response capacity in regions with previously widespread transmission.

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  • Atypical Cowpox Virus Infection in Smallpox-Vaccinated Patient, France
    J. Andreani et al.
  • Zika Virus Epidemic in Pregnant Women, Dominican Republic, 2016–2017
    F. Peña et al.
  • Lassa Fever in Travelers Arriving from West Africa, 1969–2016
    A. Kofman et al.


  • Acute and Delayed Deaths after West Nile Virus Infection, Texas, USA, 2002–2012
    D. Philpott et al.
  • Macrophage Activation Marker sCD163 Associated with Fatal and Severe Ebola Virus Disease in Humans
    A. K. McElroy et al.
  • Epidemiologic and Ecologic Investigations of Monkeypox, Likouala Department, Republic of the Congo, 2017
    R. H. Doshi et al.
  • Zika Virus-Specific IgM Antibody Detection and Neutralizing Antibody Profiles 12–19 Months after Illness Onset
    I. Griffin et al.
  • Oasis Malaria, Northern Mauritania
    J. Deida et al.
  • Echinococcus multilocularis, Southern Ontario, Canada
    J. D. Kotwa et al.

Historical Review

  • Killing Clothes Lice by Holding Infested Clothes away from Hosts for 10 Days to Control Louseborne Relapsing Fever, Bahir Dah, Ethiopia
    S. C. Barker and D. Barker


  • Identification of Leishmania Species in Naturally Infected Sand Flies from Refugee Camps, Greece
    E. A. Fotakis et al.
        View Abstract

    High infection rates of Leishmania donovani and L. tropica were detected in Phlebotomus spp. sand flies collected from refugee camps in Greece, indicating increased risk of infection among local populations. Detection and treatment of leishmaniasis, community education, and vector control are essential measures to prevent pathogen transmission and protect public health.

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  • Seroprevalence of Heartland Virus Antibodies in Blood Donors, Northwestern Missouri, USA
    N. P. Lindsey et al.
        View Abstract

    We estimated the seroprevalence of Heartland virus antibodies to be 0.9% (95% CI 0.4%–4.2%) in a convenience sample of blood donors from northwestern Missouri, USA, where human cases and infected ticks have been identified. Although these findings suggest that some past human infections were undetected, the estimated prevalence is low.

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  • Incidence and Prevalence of West Nile Virus Infections, Continental United States, 1999–2016
    S. E. Ronca et al.
  • Rift Valley Fever Reemergence after 7 Years of Quiescence, South Africa, 2018
    P. Jansen van Vuren et al.
  • Cytauxzoon felis Infection in Domestic Cats, Yunnan Province, China, 2016
    F. Zou et al.
  • Tick-Borne Encephalitis Virus in Roe Deer, the Netherlands
    J. M. Rijks et al.
  • Vector Competence of Aedes caspius and Aedes albopictus Mosquitoes for Zika Virus, Spain
    R. Gutiérrez-López et al.
  • Crimean Congo Hemorrhagic Fever, Kosovo, 2013–2016
    S. Ahmeti et al.
  • Bat Influenza A HL18NL11 Virus in Fruit Bats, Brazil
    A. Campos et al.
  • Differential Shedding and Antibody Kinetics of Zika Virus and Chikungunya Virus, Brazil
    F. A. Bozza et al.
  • Submicroscopic Malaria in Migrants from Sub-Saharan Africa, Spain
    J. Pousibet-Puerto et al.
  • Molecular Detection and Species Determination of Malaria Parasites, Venezuela
    C. Pacheco et al.
  • Clinical Manifestations, Antimicrobial Drug Susceptibility Patterns, and Outcomes of Melioidosis, India
    M. Koshy et al.
  • Lyme Disease Emergence after Invasion of the Blacklegged Tick, Ixodes scapularis, Ontario, Canada, 2010–2016
    M. A. Kulkarni et al.

Research Letters

  • No Evidence of Zika Virus Exposure in Wild Long-Tailed Macaques, Peninsular Malaysia
    C. Chua et al.
  • Clinical Characteristics of Ratborne Seoul Hantavirus Disease
    J. Clement et al.
  • Severe Respiratory Illness Associated with Human Metapneumovirus in Nursing Home, New Mexico, USA
    S. A. Peña et al.
  • Schistosoma haematobiumSchistosoma mansoni Hybrid Parasite in Migrant Boy, France, 2017
    Y. Le Govic et al.
        View Abstract

    Schistosomiasis is frequently detected in persons entering Europe. In 2017, we detected a Schistosoma mansoniSchistosoma haematobium hybrid parasite infection in a migrant boy from Côte d’Ivoire entering France. Because such parasites might be established in Europe, as illustrated by an outbreak on Corsica Island, vectors of these parasites should be investigated.

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  • West Nile Virus Infection in Travelers Returning to United Kingdom from South Africa
    V. Parkash et al.
  • Dolphin Morbillivirus in Eurasian Otters, Italy
    I. Padalino et al.
  • Pin-Site Myiasis Caused by Screwworm Fly in Nonhealed Wound, Colombia
    W. E. Villamil-Gómez et al.
  • Severe Fever with Thrombocytopenia Syndrome Virus in Dogs, Republic of Korea
    J. Kang et al.
  • Oropouche Virus–Associated Aseptic Meningoencephalitis, Southeastern Brazil
    S. Vernal et al.
  • Zoonotic Leishmaniasis, Bosnia and Herzegovina
    V. Colella et al.
        View Abstract

    Leishmania infantum causes potentially life-threatening disease in humans. To determine the extent of the animal reservoir for this pathogen in Bosnia and Herzegovina, we tested dogs and cats. We found that a large proportion of dogs were exposed to or infected with L. infantum, indicating endemicity in dogs and zoonotic risk for humans.

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  • East/Central/South African Genotype in a Chikungunya Outbreak, Dhaka City, Bangladesh, 2017
    M. Rahman et al.


  • Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas
    G. Sharma and V. Sharma

Online Report

  • Public Health–Driven Research and Innovation for Influenza Vaccines, European Union
    A. Navarro-Torné et al.

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 Serogroup B Meningococcal Disease Outbreaks, United States, 2013–2018
    H. M. Soeters et al.
  • Bacillus Calmette-Guérin Cases Reported to the National Tuberculosis Surveillance System, United States, 2004–2015
    Z. Wansaula et al.


  • Utility of Whole-Genome Sequencing to Ascertain Locally Acquired Cases of Coccidioidomycosis, Washington, USA
    H. N. Oltean et al.
  • Increased Risk for Invasive Group A Streptococcal Disease for Household Contacts of Persons with Scarlet Fever, England, 2011–2016
    V. Watts et al.

Research Letters

  • Exportation of Multidrug-Resistant Tuberculosis from Peru to Europe
    F. Acosta et al.
  • Confirmed Case of Buruli Ulcer, Senegal, 2018
    G. Turner et al.

Volume 25, Number 4—April 2019


  • Seroprevalence of Borrelia burgdorferi, Borrelia miyamotoi, and Powassan Virus in Residents Bitten by Ixodes Ticks, Maine, USA
    R. P. Smith et al.