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Issue Cover for Volume 17, Number 11—November 2011

Volume 17, Number 11—November 2011

[PDF - 6.97 MB - 199 pages]

THEME ISSUE
CHOLERA IN HAITI
Synopses

Lessons Learned during Public Health Response to Cholera Epidemic in Haiti and the Dominican Republic [PDF - 295 KB - 7 pages]
J. W. Tappero and R. V. Tauxe

After epidemic cholera emerged in Haiti in October 2010, the disease spread rapidly in a country devastated by an earthquake earlier that year, in a population with a high proportion of infant deaths, poor nutrition, and frequent infectious diseases such as HIV infection, tuberculosis, and malaria. Many nations, multinational agencies, and nongovernmental organizations rapidly mobilized to assist Haiti. The US government provided emergency response through the Office of Foreign Disaster Assistance of the US Agency for International Development and the Centers for Disease Control and Prevention. This report summarizes the participation by the Centers and its partners. The efforts needed to reduce the spread of the epidemic and prevent deaths highlight the need for safe drinking water and basic medical care in such difficult circumstances and the need for rebuilding water, sanitation, and public health systems to prevent future epidemics.

EID Tappero JW, Tauxe RV. Lessons Learned during Public Health Response to Cholera Epidemic in Haiti and the Dominican Republic. Emerg Infect Dis. 2011;17(11):2087-2093. https://dx.doi.org/10.3201/eid1711.110827
AMA Tappero JW, Tauxe RV. Lessons Learned during Public Health Response to Cholera Epidemic in Haiti and the Dominican Republic. Emerging Infectious Diseases. 2011;17(11):2087-2093. doi:10.3201/eid1711.110827.
APA Tappero, J. W., & Tauxe, R. V. (2011). Lessons Learned during Public Health Response to Cholera Epidemic in Haiti and the Dominican Republic. Emerging Infectious Diseases, 17(11), 2087-2093. https://dx.doi.org/10.3201/eid1711.110827.

Rapid Development and Use of a Nationwide Training Program for Cholera Management, Haiti, 2010 [PDF - 315 KB - 5 pages]
R. V. Tauxe et al.

When epidemic cholera appeared in Haiti in October 2010, the medical community there had virtually no experience with the disease and needed rapid training as the epidemic spread throughout the country. We developed a set of training materials specific to Haiti and launched a cascading training effort. Through a training-of-trainers course in November 14–15, 2010, and department-level training conducted in French and Creole over the following 3 weeks, 521 persons were trained and equipped to further train staff at the institutions where they worked. After the training, the hospitalized cholera patients’ case-fatality rate dropped from 4% to <2% by mid-December and was <1% by January 2011. Continuing in-service training, monitoring and evaluation, and integration of cholera management into regular clinical training will help sustain this success.

EID Tauxe RV, Lynch M, Lambert Y, Sobel J, Domerçant JW, Khan A. Rapid Development and Use of a Nationwide Training Program for Cholera Management, Haiti, 2010. Emerg Infect Dis. 2011;17(11):2094-2098. https://dx.doi.org/10.3201/eid1711.110857
AMA Tauxe RV, Lynch M, Lambert Y, et al. Rapid Development and Use of a Nationwide Training Program for Cholera Management, Haiti, 2010. Emerging Infectious Diseases. 2011;17(11):2094-2098. doi:10.3201/eid1711.110857.
APA Tauxe, R. V., Lynch, M., Lambert, Y., Sobel, J., Domerçant, J. W., & Khan, A. (2011). Rapid Development and Use of a Nationwide Training Program for Cholera Management, Haiti, 2010. Emerging Infectious Diseases, 17(11), 2094-2098. https://dx.doi.org/10.3201/eid1711.110857.

Cholera—Modern Pandemic Disease of Ancient Lineage [PDF - 183 KB - 6 pages]
J. Morris

Cholera has affected humans for at least a millennium and persists as a major cause of illness and death worldwide, with recent epidemics in Zimbabwe (2008–2009) and Haiti (2010). Clinically, evidence exists of increasing severity of disease linked with emergence of atypical Vibrio cholerae organisms that have incorporated genetic material from classical biotype strains into an El Tor biotype background. A key element in transmission may be a recently recognized hyperinfectious phase, which persists for hours after passage in diarrheal feces. We propose a model of transmission in which environmental triggers (such as temperature) lead to increases in V. cholerae in environmental reservoirs, with spillover into human populations. However, once the microorganism is introduced into a human population, transmission occurs primary by “fast” transmission from person to person (taking advantage of the hyperinfectious state), without returning to the aquatic environment.

EID Morris J. Cholera—Modern Pandemic Disease of Ancient Lineage. Emerg Infect Dis. 2011;17(11):2099-2104. https://dx.doi.org/10.3201/eid1711.111109
AMA Morris J. Cholera—Modern Pandemic Disease of Ancient Lineage. Emerging Infectious Diseases. 2011;17(11):2099-2104. doi:10.3201/eid1711.111109.
APA Morris, J. (2011). Cholera—Modern Pandemic Disease of Ancient Lineage. Emerging Infectious Diseases, 17(11), 2099-2104. https://dx.doi.org/10.3201/eid1711.111109.

Considerations for Oral Cholera Vaccine Use during Outbreak after Earthquake in Haiti, 2010−2011 [PDF - 336 KB - 8 pages]
K. A. Date et al.

Oral cholera vaccines (OCVs) have been recommended in cholera-endemic settings and preemptively during outbreaks and complex emergencies. However, experience and guidelines for reactive use after an outbreak has started are limited. In 2010, after over a century without epidemic cholera, an outbreak was reported in Haiti after an earthquake. As intensive nonvaccine cholera control measures were initiated, the feasibility of OCV use was considered. We reviewed OCV characteristics and recommendations for their use and assessed global vaccine availability and capacity to implement a vaccination campaign. Real-time modeling was conducted to estimate vaccine impact. Ultimately, cholera vaccination was not implemented because of limited vaccine availability, complex logistical and operational challenges of a multidose regimen, and obstacles to conducting a campaign in a setting with population displacement and civil unrest. Use of OCVs is an option for cholera control; guidelines for their appropriate use in epidemic and emergency settings are urgently needed.

EID Date KA, Vicari A, Hyde TB, Mintz ED, Danovaro-Holliday MC, Henry A, et al. Considerations for Oral Cholera Vaccine Use during Outbreak after Earthquake in Haiti, 2010−2011. Emerg Infect Dis. 2011;17(11):2105-2112. https://dx.doi.org/10.3201/eid1711.110822
AMA Date KA, Vicari A, Hyde TB, et al. Considerations for Oral Cholera Vaccine Use during Outbreak after Earthquake in Haiti, 2010−2011. Emerging Infectious Diseases. 2011;17(11):2105-2112. doi:10.3201/eid1711.110822.
APA Date, K. A., Vicari, A., Hyde, T. B., Mintz, E. D., Danovaro-Holliday, M. C., Henry, A....Dietz, V. (2011). Considerations for Oral Cholera Vaccine Use during Outbreak after Earthquake in Haiti, 2010−2011. Emerging Infectious Diseases, 17(11), 2105-2112. https://dx.doi.org/10.3201/eid1711.110822.
Research

Comparative Genomics of Vibrio cholerae from Haiti, Asia, and Africa [PDF - 360 KB - 9 pages]
A. R. Reimer et al.

Cholera was absent from the island of Hispaniola at least a century before an outbreak that began in Haiti in the fall of 2010. Pulsed-field gel electrophoresis (PFGE) analysis of clinical isolates from the Haiti outbreak and recent global travelers returning to the United States showed indistinguishable PFGE fingerprints. To better explore the genetic ancestry of the Haiti outbreak strain, we acquired 23 whole-genome Vibrio cholerae sequences: 9 isolates obtained in Haiti or the Dominican Republic, 12 PFGE pattern-matched isolates linked to Asia or Africa, and 2 nonmatched outliers from the Western Hemisphere. Phylogenies for whole-genome sequences and core genome single-nucleotide polymorphisms showed that the Haiti outbreak strain is genetically related to strains originating in India and Cameroon. However, because no identical genetic match was found among sequenced contemporary isolates, a definitive genetic origin for the outbreak in Haiti remains speculative.

EID Reimer AR, Van Domselaar G, Stroika S, Walker M, Kent H, Tarr C, et al. Comparative Genomics of Vibrio cholerae from Haiti, Asia, and Africa. Emerg Infect Dis. 2011;17(11):2113-2121. https://dx.doi.org/10.3201/eid1711.110794
AMA Reimer AR, Van Domselaar G, Stroika S, et al. Comparative Genomics of Vibrio cholerae from Haiti, Asia, and Africa. Emerging Infectious Diseases. 2011;17(11):2113-2121. doi:10.3201/eid1711.110794.
APA Reimer, A. R., Van Domselaar, G., Stroika, S., Walker, M., Kent, H., Tarr, C....Gerner-Smidt, P. (2011). Comparative Genomics of Vibrio cholerae from Haiti, Asia, and Africa. Emerging Infectious Diseases, 17(11), 2113-2121. https://dx.doi.org/10.3201/eid1711.110794.

Characterization of Toxigenic Vibrio cholerae from Haiti, 2010–2011 [PDF - 248 KB - 8 pages]
D. Talkington et al.

In October 2010, the US Centers for Disease Control and Prevention received reports of cases of severe watery diarrhea in Haiti. The cause was confirmed to be toxigenic Vibrio cholerae, serogroup O1, serotype Ogawa, biotype El Tor. We characterized 122 isolates from Haiti and compared them with isolates from other countries. Antimicrobial drug susceptibility was tested by disk diffusion and broth microdilution. Analyses included identification of rstR and VC2346 genes, sequencing of ctxAB and tcpA genes, and pulsed-field gel electrophoresis with SfiI and NotI enzymes. All isolates were susceptible to doxycycline and azithromycin. One pulsed-field gel electrophoresis pattern predominated, and ctxB sequence of all isolates matched the B-7 allele. We identified the tcpETCIRS allele, which is also present in Bangladesh strain CIRS 101. These data show that the isolates from Haiti are clonally and genetically similar to isolates originating in Africa and southern Asia and that ctxB-7 and tcpETCIRS alleles are undergoing global dissemination.

EID Talkington D, Bopp C, Tarr C, Parsons MB, Dahourou G, Freeman M, et al. Characterization of Toxigenic Vibrio cholerae from Haiti, 2010–2011. Emerg Infect Dis. 2011;17(11):2122-2129. https://dx.doi.org/10.3201/eid1711.110805
AMA Talkington D, Bopp C, Tarr C, et al. Characterization of Toxigenic Vibrio cholerae from Haiti, 2010–2011. Emerging Infectious Diseases. 2011;17(11):2122-2129. doi:10.3201/eid1711.110805.
APA Talkington, D., Bopp, C., Tarr, C., Parsons, M. B., Dahourou, G., Freeman, M....Gerner-Smidt, P. (2011). Characterization of Toxigenic Vibrio cholerae from Haiti, 2010–2011. Emerging Infectious Diseases, 17(11), 2122-2129. https://dx.doi.org/10.3201/eid1711.110805.
Historical Reviews

Cholera in Haiti and Other Caribbean Regions, 19th Century [PDF - 180 KB - 6 pages]
D. Jenson and V. Szabo

Medical journals and other sources do not show evidence that cholera occurred in Haiti before 2010, despite the devastating effect of this disease in the Caribbean region in the 19th century. Cholera occurred in Cuba in 1833–1834; in Jamaica, Cuba, Puerto Rico, St. Thomas, St. Lucia, St. Kitts, Nevis, Trinidad, the Bahamas, St. Vincent, Granada, Anguilla, St. John, Tortola, the Turks and Caicos, the Grenadines (Carriacou and Petite Martinique), and possibly Antigua in 1850–1856; and in Guadeloupe, Cuba, St. Thomas, the Dominican Republic, Dominica, Martinique, and Marie Galante in 1865–1872. Conditions associated with slavery and colonial military control were absent in independent Haiti. Clustered populations, regular influx of new persons, and close quarters of barracks living contributed to spread of cholera in other Caribbean locations. We provide historical accounts of the presence and spread of cholera epidemics in Caribbean islands.

EID Jenson D, Szabo V. Cholera in Haiti and Other Caribbean Regions, 19th Century. Emerg Infect Dis. 2011;17(11):2130-2135. https://dx.doi.org/10.3201/eid1711.110958
AMA Jenson D, Szabo V. Cholera in Haiti and Other Caribbean Regions, 19th Century. Emerging Infectious Diseases. 2011;17(11):2130-2135. doi:10.3201/eid1711.110958.
APA Jenson, D., & Szabo, V. (2011). Cholera in Haiti and Other Caribbean Regions, 19th Century. Emerging Infectious Diseases, 17(11), 2130-2135. https://dx.doi.org/10.3201/eid1711.110958.
Dispatches

Risk Factors Early in the 2010 Cholera Epidemic, Haiti [PDF - 186 KB - 3 pages]
K. A. O’Connor et al.

During the early weeks of the cholera outbreak that began in Haiti in October 2010, we conducted a case–control study to identify risk factors. Drinking treated water was strongly protective against illness. Our results highlight the effectiveness of safe water in cholera control.

EID O’Connor KA, Cartwright E, Loharikar A, Routh J, Gaines J, Fouché MB, et al. Risk Factors Early in the 2010 Cholera Epidemic, Haiti. Emerg Infect Dis. 2011;17(11):2136-2138. https://dx.doi.org/10.3201/eid1711.110810
AMA O’Connor KA, Cartwright E, Loharikar A, et al. Risk Factors Early in the 2010 Cholera Epidemic, Haiti. Emerging Infectious Diseases. 2011;17(11):2136-2138. doi:10.3201/eid1711.110810.
APA O’Connor, K. A., Cartwright, E., Loharikar, A., Routh, J., Gaines, J., Fouché, M. B....Mahon, B. E. (2011). Risk Factors Early in the 2010 Cholera Epidemic, Haiti. Emerging Infectious Diseases, 17(11), 2136-2138. https://dx.doi.org/10.3201/eid1711.110810.

Rapid Assessment of Cholera-related Deaths, Artibonite Department, Haiti, 2010 [PDF - 273 KB - 4 pages]
J. A. Routh et al.

We evaluated a high (6%) cholera case-fatality rate in Haiti. Of 39 community decedents, only 23% consumed oral rehydration salts at home, and 59% did not seek care, whereas 54% of 48 health facility decedents died after overnight admission. Early in the cholera epidemic, care was inadequate or nonexistent.

EID Routh JA, Loharikar A, Fouché MB, Cartwright EJ, Roy SL, Ailes E, et al. Rapid Assessment of Cholera-related Deaths, Artibonite Department, Haiti, 2010. Emerg Infect Dis. 2011;17(11):2139-2142. https://dx.doi.org/10.3201/eid1711.110747
AMA Routh JA, Loharikar A, Fouché MB, et al. Rapid Assessment of Cholera-related Deaths, Artibonite Department, Haiti, 2010. Emerging Infectious Diseases. 2011;17(11):2139-2142. doi:10.3201/eid1711.110747.
APA Routh, J. A., Loharikar, A., Fouché, M. B., Cartwright, E. J., Roy, S. L., Ailes, E....Quick, R. E. (2011). Rapid Assessment of Cholera-related Deaths, Artibonite Department, Haiti, 2010. Emerging Infectious Diseases, 17(11), 2139-2142. https://dx.doi.org/10.3201/eid1711.110747.

Epidemic Cholera in a Crowded Urban Environment, Port-au-Prince, Haiti [PDF - 181 KB - 4 pages]
S. E. Dunkle et al.

We conducted a case–control study to investigate factors associated with epidemic cholera. Water treatment and handwashing may have been protective, highlighting the need for personal hygiene for cholera prevention in contaminated urban environments. We also found a diverse diet, a possible proxy for improved nutrition, was protective against cholera.

EID Dunkle SE, Mba-Jonas A, Loharikar A, Fouché B, Peck M, Ayers T, et al. Epidemic Cholera in a Crowded Urban Environment, Port-au-Prince, Haiti. Emerg Infect Dis. 2011;17(11):2143-2146. https://dx.doi.org/10.3201/eid1711.110772
AMA Dunkle SE, Mba-Jonas A, Loharikar A, et al. Epidemic Cholera in a Crowded Urban Environment, Port-au-Prince, Haiti. Emerging Infectious Diseases. 2011;17(11):2143-2146. doi:10.3201/eid1711.110772.
APA Dunkle, S. E., Mba-Jonas, A., Loharikar, A., Fouché, B., Peck, M., Ayers, T....Quick, R. E. (2011). Epidemic Cholera in a Crowded Urban Environment, Port-au-Prince, Haiti. Emerging Infectious Diseases, 17(11), 2143-2146. https://dx.doi.org/10.3201/eid1711.110772.

Toxigenic Vibrio cholerae O1 in Water and Seafood, Haiti [PDF - 192 KB - 4 pages]
V. R. Hill et al.

During the 2010 cholera outbreak in Haiti, water and seafood samples were collected to detect Vibrio cholerae. The outbreak strain of toxigenic V. cholerae O1 serotype Ogawa was isolated from freshwater and seafood samples. The cholera toxin gene was detected in harbor water samples.

EID Hill VR, Cohen NJ, Kahler AM, Jones JL, Bopp CA, Marano N, et al. Toxigenic Vibrio cholerae O1 in Water and Seafood, Haiti. Emerg Infect Dis. 2011;17(11):2147-2150. https://dx.doi.org/10.3201/eid1711.110748
AMA Hill VR, Cohen NJ, Kahler AM, et al. Toxigenic Vibrio cholerae O1 in Water and Seafood, Haiti. Emerging Infectious Diseases. 2011;17(11):2147-2150. doi:10.3201/eid1711.110748.
APA Hill, V. R., Cohen, N. J., Kahler, A. M., Jones, J. L., Bopp, C. A., Marano, N....Tauxe, R. V. (2011). Toxigenic Vibrio cholerae O1 in Water and Seafood, Haiti. Emerging Infectious Diseases, 17(11), 2147-2150. https://dx.doi.org/10.3201/eid1711.110748.

Drug-Resistance Mechanisms in Vibrio cholerae O1 Outbreak Strain, Haiti, 2010 [PDF - 276 KB - 4 pages]
M. Sjölund-Karlsson et al.

To increase understanding of drug-resistant Vibrio cholerae, we studied selected molecular mechanisms of antimicrobial drug resistance in the 2010 Haiti V. cholerae outbreak strain. Most resistance resulted from acquired genes located on an integrating conjugative element showing high homology to an integrating conjugative element identified in a V. cholerae isolate from India.

EID Sjölund-Karlsson M, Reimer AR, Folster JP, Walker M, Dahourou G, Batra D, et al. Drug-Resistance Mechanisms in Vibrio cholerae O1 Outbreak Strain, Haiti, 2010. Emerg Infect Dis. 2011;17(11):2151-2154. https://dx.doi.org/10.3201/eid1711.110720
AMA Sjölund-Karlsson M, Reimer AR, Folster JP, et al. Drug-Resistance Mechanisms in Vibrio cholerae O1 Outbreak Strain, Haiti, 2010. Emerging Infectious Diseases. 2011;17(11):2151-2154. doi:10.3201/eid1711.110720.
APA Sjölund-Karlsson, M., Reimer, A. R., Folster, J. P., Walker, M., Dahourou, G., Batra, D....Gilmour, M. W. (2011). Drug-Resistance Mechanisms in Vibrio cholerae O1 Outbreak Strain, Haiti, 2010. Emerging Infectious Diseases, 17(11), 2151-2154. https://dx.doi.org/10.3201/eid1711.110720.

Cholera Management and Prevention at Hôpital Albert Schweitzer, Haiti [PDF - 189 KB - 3 pages]
S. Ernst et al.

In October 2010, Hôpital Albert Schweitzer Haiti treated some of the first patients with cholera in Haiti. Over the following 10 months, a strategic plan was developed and implemented to improve the management of cases at the hospital level and to address the underlying risk factors at the community level.

EID Ernst S, Weinrobe C, Bien-Aime C, Rawson I. Cholera Management and Prevention at Hôpital Albert Schweitzer, Haiti. Emerg Infect Dis. 2011;17(11):2155-2157. https://dx.doi.org/10.3201/eid1711.110815
AMA Ernst S, Weinrobe C, Bien-Aime C, et al. Cholera Management and Prevention at Hôpital Albert Schweitzer, Haiti. Emerging Infectious Diseases. 2011;17(11):2155-2157. doi:10.3201/eid1711.110815.
APA Ernst, S., Weinrobe, C., Bien-Aime, C., & Rawson, I. (2011). Cholera Management and Prevention at Hôpital Albert Schweitzer, Haiti. Emerging Infectious Diseases, 17(11), 2155-2157. https://dx.doi.org/10.3201/eid1711.110815.

Knowledge, Attitudes, and Practices Related to Treatment and Prevention of Cholera, Haiti, 2010 [PDF - 209 KB - 4 pages]
V. E. De Rochars et al.

In response to the recent cholera outbreak, a public health response targeted high-risk communities, including resource-poor communities in Port-au-Prince, Haiti. A survey covering knowledge and practices indicated that hygiene messages were received and induced behavior change, specifically related to water treatment practices. Self-reported household water treatment increased from 30.3% to 73.9%.

EID De Rochars VE, Tipret J, Patrick M, Jacobson L, Barbour KE, Berendes D, et al. Knowledge, Attitudes, and Practices Related to Treatment and Prevention of Cholera, Haiti, 2010. Emerg Infect Dis. 2011;17(11):2158-2161. https://dx.doi.org/10.3201/eid1711.110818
AMA De Rochars VE, Tipret J, Patrick M, et al. Knowledge, Attitudes, and Practices Related to Treatment and Prevention of Cholera, Haiti, 2010. Emerging Infectious Diseases. 2011;17(11):2158-2161. doi:10.3201/eid1711.110818.
APA De Rochars, V. E., Tipret, J., Patrick, M., Jacobson, L., Barbour, K. E., Berendes, D....Handzel, T. (2011). Knowledge, Attitudes, and Practices Related to Treatment and Prevention of Cholera, Haiti, 2010. Emerging Infectious Diseases, 17(11), 2158-2161. https://dx.doi.org/10.3201/eid1711.110818.

Cholera Prevention Training Materials for Community Health Workers, Haiti, 2010–2011 [PDF - 222 KB - 4 pages]
A. Rajasingham et al.

Stopping the spread of the cholera epidemic in Haiti required engaging community health workers (CHWs) in prevention and treatment activities. The Centers for Disease Control and Prevention collaborated with the Haitian Ministry of Public Health and Population to develop CHW educational materials, train >1,100 CHWs, and evaluate training efforts.

EID Rajasingham A, Bowen A, O’Reilly C, Sholtes K, Schilling K, Hough C, et al. Cholera Prevention Training Materials for Community Health Workers, Haiti, 2010–2011. Emerg Infect Dis. 2011;17(11):2162-2165. https://dx.doi.org/10.3201/eid1711.110806
AMA Rajasingham A, Bowen A, O’Reilly C, et al. Cholera Prevention Training Materials for Community Health Workers, Haiti, 2010–2011. Emerging Infectious Diseases. 2011;17(11):2162-2165. doi:10.3201/eid1711.110806.
APA Rajasingham, A., Bowen, A., O’Reilly, C., Sholtes, K., Schilling, K., Hough, C....Person, B. (2011). Cholera Prevention Training Materials for Community Health Workers, Haiti, 2010–2011. Emerging Infectious Diseases, 17(11), 2162-2165. https://dx.doi.org/10.3201/eid1711.110806.

Cholera in United States Associated with Epidemic in Hispaniola [PDF - 173 KB - 3 pages]
A. E. Newton et al.

Cholera is rare in the United States (annual average 6 cases). Since epidemic cholera began in Hispaniola in 2010, a total of 23 cholera cases caused by toxigenic Vibrio cholerae O1 have been confirmed in the United States. Twenty-two case-patients reported travel to Hispaniola and 1 reported consumption of seafood from Haiti.

EID Newton AE, Heiman KE, Schmitz A, Török T, Apostolou A, Hanson H, et al. Cholera in United States Associated with Epidemic in Hispaniola. Emerg Infect Dis. 2011;17(11):2166-2168. https://dx.doi.org/10.3201/eid1711.110808
AMA Newton AE, Heiman KE, Schmitz A, et al. Cholera in United States Associated with Epidemic in Hispaniola. Emerging Infectious Diseases. 2011;17(11):2166-2168. doi:10.3201/eid1711.110808.
APA Newton, A. E., Heiman, K. E., Schmitz, A., Török, T., Apostolou, A., Hanson, H....Mintz, E. D. (2011). Cholera in United States Associated with Epidemic in Hispaniola. Emerging Infectious Diseases, 17(11), 2166-2168. https://dx.doi.org/10.3201/eid1711.110808.

Travel Health Alert Notices and Haiti Cholera Outbreak, Florida, USA, 2011 [PDF - 246 KB - 3 pages]
M. U. Selent et al.

To enhance the timeliness of medical evaluation for cholera-like illness during the 2011 cholera outbreak in Hispaniola, printed Travel Health Alert Notices (T-HANs) were distributed to travelers from Haiti to the United States. Evaluation of the T-HANs’ influence on travelers’ health care–seeking behavior suggested T-HANs might positively influence health care–seeking behavior.

EID Selent MU, McWhorter A, De Rochars VM, Myers R, Hunter DW, Brown CM, et al. Travel Health Alert Notices and Haiti Cholera Outbreak, Florida, USA, 2011. Emerg Infect Dis. 2011;17(11):2169-2171. https://dx.doi.org/10.3201/eid1711.110721
AMA Selent MU, McWhorter A, De Rochars VM, et al. Travel Health Alert Notices and Haiti Cholera Outbreak, Florida, USA, 2011. Emerging Infectious Diseases. 2011;17(11):2169-2171. doi:10.3201/eid1711.110721.
APA Selent, M. U., McWhorter, A., De Rochars, V. M., Myers, R., Hunter, D. W., Brown, C. M....Marano, N. (2011). Travel Health Alert Notices and Haiti Cholera Outbreak, Florida, USA, 2011. Emerging Infectious Diseases, 17(11), 2169-2171. https://dx.doi.org/10.3201/eid1711.110721.

Multinational Cholera Outbreak after Wedding in the Dominican Republic [PDF - 146 KB - 3 pages]
M. L. Jiménez et al.

We conducted a case–control study of a cholera outbreak after a wedding in the Dominican Republic, January 22, 2011. Ill persons were more likely to report having consumed shrimp on ice (odds ratio 8.50) and ice cubes in beverages (odds ratio 3.62). Travelers to cholera-affected areas should avoid consuming uncooked seafood and untreated water.

EID Jiménez ML, Apostolou A, Suarez AJ, Meyer L, Hiciano S, Newton A, et al. Multinational Cholera Outbreak after Wedding in the Dominican Republic. Emerg Infect Dis. 2011;17(11):2172-2174. https://dx.doi.org/10.3201/eid1711.111263
AMA Jiménez ML, Apostolou A, Suarez AJ, et al. Multinational Cholera Outbreak after Wedding in the Dominican Republic. Emerging Infectious Diseases. 2011;17(11):2172-2174. doi:10.3201/eid1711.111263.
APA Jiménez, M. L., Apostolou, A., Suarez, A. J., Meyer, L., Hiciano, S., Newton, A....Pimentel, R. (2011). Multinational Cholera Outbreak after Wedding in the Dominican Republic. Emerging Infectious Diseases, 17(11), 2172-2174. https://dx.doi.org/10.3201/eid1711.111263.
Commentaries

Haiti in the Context of the Current Global Cholera Pandemic [PDF - 186 KB - 2 pages]
E. T. Ryan
EID Ryan ET. Haiti in the Context of the Current Global Cholera Pandemic. Emerg Infect Dis. 2011;17(11):2175-2176. https://dx.doi.org/10.3201/eid1711.110849
AMA Ryan ET. Haiti in the Context of the Current Global Cholera Pandemic. Emerging Infectious Diseases. 2011;17(11):2175-2176. doi:10.3201/eid1711.110849.
APA Ryan, E. T. (2011). Haiti in the Context of the Current Global Cholera Pandemic. Emerging Infectious Diseases, 17(11), 2175-2176. https://dx.doi.org/10.3201/eid1711.110849.
Letters

Preparing Health Care Workers for a Cholera Epidemic, Dominican Republic, 2010 [PDF - 96 KB - 2 pages]
C. Mendoza et al.
EID Mendoza C, Meites E, Briere E, Gernay J, Morgan O, Monegro NR. Preparing Health Care Workers for a Cholera Epidemic, Dominican Republic, 2010. Emerg Infect Dis. 2011;17(11):2177-2178. https://dx.doi.org/10.3201/eid1711.110703
AMA Mendoza C, Meites E, Briere E, et al. Preparing Health Care Workers for a Cholera Epidemic, Dominican Republic, 2010. Emerging Infectious Diseases. 2011;17(11):2177-2178. doi:10.3201/eid1711.110703.
APA Mendoza, C., Meites, E., Briere, E., Gernay, J., Morgan, O., & Monegro, N. R. (2011). Preparing Health Care Workers for a Cholera Epidemic, Dominican Republic, 2010. Emerging Infectious Diseases, 17(11), 2177-2178. https://dx.doi.org/10.3201/eid1711.110703.

Understanding the Cholera Epidemic, Haiti [PDF - 161 KB - 3 pages]
S. B. Pun
EID Pun SB. Understanding the Cholera Epidemic, Haiti. Emerg Infect Dis. 2011;17(11):2178-2180. https://dx.doi.org/10.3201/eid1711.110981
AMA Pun SB. Understanding the Cholera Epidemic, Haiti. Emerging Infectious Diseases. 2011;17(11):2178-2180. doi:10.3201/eid1711.110981.
APA Pun, S. B. (2011). Understanding the Cholera Epidemic, Haiti. Emerging Infectious Diseases, 17(11), 2178-2180. https://dx.doi.org/10.3201/eid1711.110981.
Etymologia

Etymologia: Cholera [PDF - 135 KB - 1 page]
N. Männikkö
EID Männikkö N. Etymologia: Cholera. Emerg Infect Dis. 2011;17(11):2104. https://dx.doi.org/10.3201/eid1711.et1711
AMA Männikkö N. Etymologia: Cholera. Emerging Infectious Diseases. 2011;17(11):2104. doi:10.3201/eid1711.et1711.
APA Männikkö, N. (2011). Etymologia: Cholera. Emerging Infectious Diseases, 17(11), 2104. https://dx.doi.org/10.3201/eid1711.et1711.
Conference Summaries

Academic Consortia: Untapped Resources for Preparedness, Response, and Recovery—Examining the Cholera Outbreak in Haiti
L. M. Gargano et al.
EID Gargano LM, Gallagher PF, Freeman AS, Morris J, Cookson ST, Greenwald I, et al. Academic Consortia: Untapped Resources for Preparedness, Response, and Recovery—Examining the Cholera Outbreak in Haiti. Emerg Infect Dis. 2011;17(11):2182. https://dx.doi.org/10.3201/eid1711.110727
AMA Gargano LM, Gallagher PF, Freeman AS, et al. Academic Consortia: Untapped Resources for Preparedness, Response, and Recovery—Examining the Cholera Outbreak in Haiti. Emerging Infectious Diseases. 2011;17(11):2182. doi:10.3201/eid1711.110727.
APA Gargano, L. M., Gallagher, P. F., Freeman, A. S., Morris, J., Cookson, S. T., Greenwald, I....Hughes, J. M. (2011). Academic Consortia: Untapped Resources for Preparedness, Response, and Recovery—Examining the Cholera Outbreak in Haiti. Emerging Infectious Diseases, 17(11), 2182. https://dx.doi.org/10.3201/eid1711.110727.
About the Cover

Persistence of Memory and the Comma Bacillus [PDF - 133 KB - 2 pages]
P. Potter
EID Potter P. Persistence of Memory and the Comma Bacillus. Emerg Infect Dis. 2011;17(11):2181-2182. https://dx.doi.org/10.3201/eid1711.ac1711
AMA Potter P. Persistence of Memory and the Comma Bacillus. Emerging Infectious Diseases. 2011;17(11):2181-2182. doi:10.3201/eid1711.ac1711.
APA Potter, P. (2011). Persistence of Memory and the Comma Bacillus. Emerging Infectious Diseases, 17(11), 2181-2182. https://dx.doi.org/10.3201/eid1711.ac1711.
Volume 17, Number 11—November 2011 - Continued

Research

Medscape CME Activity
Deaths Associated with Pandemic (H1N1) 2009 among Children, Japan, 2009–2010 [PDF - 253 KB - 8 pages]
A. Okumura et al.

To clarify the cause of deaths associated with pandemic (H1N1) 2009 among children in Japan, we retrospectively studied 41 patients <20 years of age who had died of pandemic (H1N1) 2009 through March 31, 2010. Data were collected through interviews with attending physicians and chart reviews. Median age of patients was 59 months; one third had a preexisting condition. Cause of death was categorized as unexpected cardiopulmonary arrest for 15 patients, encephalopathy for 15, and respiratory failure for 6. Preexisting respiratory or neurologic disorders were more frequent in patients with respiratory failure and less frequent in patients with unexpected cardiopulmonary arrest. The leading causes of death among children with pandemic (H1N1) 2009 in Japan were encephalopathy and unexpected cardiopulmonary arrest. Deaths associated with respiratory failure were infrequent and occurred primarily among children with preexisting conditions. Vaccine use and public education are necessary for reducing influenza-associated illness and death.

EID Okumura A, Nakagawa S, Kawashima H, Muguruma T, Saito O, Fujimoto J, et al. Deaths Associated with Pandemic (H1N1) 2009 among Children, Japan, 2009–2010. Emerg Infect Dis. 2011;17(11):1993-2000. https://dx.doi.org/10.3201/eid1711.110649
AMA Okumura A, Nakagawa S, Kawashima H, et al. Deaths Associated with Pandemic (H1N1) 2009 among Children, Japan, 2009–2010. Emerging Infectious Diseases. 2011;17(11):1993-2000. doi:10.3201/eid1711.110649.
APA Okumura, A., Nakagawa, S., Kawashima, H., Muguruma, T., Saito, O., Fujimoto, J....Morishima, T. (2011). Deaths Associated with Pandemic (H1N1) 2009 among Children, Japan, 2009–2010. Emerging Infectious Diseases, 17(11), 1993-2000. https://dx.doi.org/10.3201/eid1711.110649.

Medscape CME Activity
Global Distribution and Epidemiologic Associations of Escherichia coli Clonal Group A, 1998–2007 [PDF - 308 KB - 9 pages]
J. R. Johnson et al.

Escherichia coli clonal group A (CGA) was first reported in 2001 as an emerging multidrug-resistant extraintestinal pathogen. Because CGA has considerable implications for public health, we examined the trends of its global distribution, clinical associations, and temporal prevalence for the years 1998–2007. We characterized 2,210 E. coli extraintestinal clinical isolates from 32 centers on 6 continents by CGA status for comparison with trimethoprim/sulfamethoxazole (TMP/SMZ) phenotype, specimen type, inpatient/outpatient source, and adult/child host; we adjusted for clustering by center. CGA prevalence varied greatly by center and continent, was strongly associated with TMP/SMZ resistance but not with other epidemiologic variables, and exhibited no temporal prevalence trend. Our findings indicate that CGA is a prominent, primarily TMP/SMZ-resistant extraintestinal pathogen concentrated within the Western world, with considerable pathogenic versatility. The stable prevalence of CGA over time suggests full emergence by the late 1990s, followed by variable endemicity worldwide as an antimicrobial drug–resistant public health threat.

EID Johnson JR, Menard ME, Lauderdale T, Kosmidis C, Gordon D, Collignon P, et al. Global Distribution and Epidemiologic Associations of Escherichia coli Clonal Group A, 1998–2007. Emerg Infect Dis. 2011;17(11):2001-2009. https://dx.doi.org/10.3201/eid1711.110488
AMA Johnson JR, Menard ME, Lauderdale T, et al. Global Distribution and Epidemiologic Associations of Escherichia coli Clonal Group A, 1998–2007. Emerging Infectious Diseases. 2011;17(11):2001-2009. doi:10.3201/eid1711.110488.
APA Johnson, J. R., Menard, M. E., Lauderdale, T., Kosmidis, C., Gordon, D., Collignon, P....Kuskowski, M. A. (2011). Global Distribution and Epidemiologic Associations of Escherichia coli Clonal Group A, 1998–2007. Emerging Infectious Diseases, 17(11), 2001-2009. https://dx.doi.org/10.3201/eid1711.110488.

Group A Streptococcus emm Gene Types in Pharyngeal Isolates, Ontario, Canada, 2002–2010 [PDF - 361 KB - 8 pages]
P. R. Shea et al.

Group A Streptococcus (GAS) is a human-adapted pathogen that causes a variety of diseases, including pharyngitis and invasive infections. GAS strains are categorized by variation in the nucleotide sequence of the gene (emm) that encodes the M protein. To identify the emm types of GAS strains causing pharyngitis in Ontario, Canada, we sequenced the hypervariable region of the emm gene in 4,635 pharyngeal GAS isolates collected during 2002–2010. The most prevalent emm types varied little from year to year. In contrast, fine-scale geographic analysis identified inter-site variability in the most common emm types. Additionally, we observed fluctuations in yearly frequency of emm3 strains from pharyngitis patients that coincided with peaks of emm3 invasive infections. We also discovered a striking increase in frequency of emm89 strains among isolates from patients with pharyngitis and invasive disease. These findings about the epidemiology of GAS are potentially useful for vaccine research.

EID Shea PR, Ewbank AL, Gonzalez-Lugo JH, Martagon-Rosado AJ, Martinez-Gutierrez JC, Rehman HA, et al. Group A Streptococcus emm Gene Types in Pharyngeal Isolates, Ontario, Canada, 2002–2010. Emerg Infect Dis. 2011;17(11):2010-2017. https://dx.doi.org/10.3201/eid1711.110159
AMA Shea PR, Ewbank AL, Gonzalez-Lugo JH, et al. Group A Streptococcus emm Gene Types in Pharyngeal Isolates, Ontario, Canada, 2002–2010. Emerging Infectious Diseases. 2011;17(11):2010-2017. doi:10.3201/eid1711.110159.
APA Shea, P. R., Ewbank, A. L., Gonzalez-Lugo, J. H., Martagon-Rosado, A. J., Martinez-Gutierrez, J. C., Rehman, H. A....Musser, J. M. (2011). Group A Streptococcus emm Gene Types in Pharyngeal Isolates, Ontario, Canada, 2002–2010. Emerging Infectious Diseases, 17(11), 2010-2017. https://dx.doi.org/10.3201/eid1711.110159.

Medscape CME Activity
Close Similarity between Sequences of Hepatitis E Virus Recovered from Humans and Swine, France, 2008−2009 [PDF - 433 KB - 8 pages]
J. Bouquet et al.

Frequent zoonotic transmission of hepatitis E virus (HEV) has been suspected, but data supporting the animal origin of autochthonous cases are still sparse. We assessed the genetic identity of HEV strains found in humans and swine during an 18-month period in France. HEV sequences identified in patients with autochthonous hepatitis E infection (n = 106) were compared with sequences amplified from swine livers collected in slaughterhouses (n = 43). Phylogenetic analysis showed the same proportions of subtypes 3f (73.8%), 3c (13.4%), and 3e (4.7%) in human and swine populations. Furthermore, similarity of >99% was found between HEV sequences of human and swine origins. These results indicate that consumption of some pork products, such as raw liver, is a major source of exposure for autochthonous HEV infection.

EID Bouquet J, Tessé S, Lunazzi A, Eloit M, Rose N, Nicand E, et al. Close Similarity between Sequences of Hepatitis E Virus Recovered from Humans and Swine, France, 2008−2009. Emerg Infect Dis. 2011;17(11):2018-2025. https://dx.doi.org/10.3201/eid1711.110616
AMA Bouquet J, Tessé S, Lunazzi A, et al. Close Similarity between Sequences of Hepatitis E Virus Recovered from Humans and Swine, France, 2008−2009. Emerging Infectious Diseases. 2011;17(11):2018-2025. doi:10.3201/eid1711.110616.
APA Bouquet, J., Tessé, S., Lunazzi, A., Eloit, M., Rose, N., Nicand, E....Pavio, N. (2011). Close Similarity between Sequences of Hepatitis E Virus Recovered from Humans and Swine, France, 2008−2009. Emerging Infectious Diseases, 17(11), 2018-2025. https://dx.doi.org/10.3201/eid1711.110616.

Dynamics of Cholera Outbreaks in Great Lakes Region of Africa, 1978–2008 [PDF - 877 KB - 9 pages]
D. B. Nkoko et al.

Cholera outbreaks have occurred in Burundi, Rwanda, Democratic Republic of Congo, Tanzania, Uganda, and Kenya almost every year since 1977–1978, when the disease emerged in these countries. We used a multiscale, geographic information system–based approach to assess the link between cholera outbreaks, climate, and environmental variables. We performed time-series analyses and field investigations in the main affected areas. Results showed that cholera greatly increased during El Niño warm events (abnormally warm El Niños) but decreased or remained stable between these events. Most epidemics occurred in a few hotspots in lakeside areas, where the weekly incidence of cholera varied by season, rainfall, fluctuations of plankton, and fishing activities. During lull periods, persistence of cholera was explained by outbreak dynamics, which suggested a metapopulation pattern, and by endemic foci around the lakes. These links between cholera outbreaks, climate, and lake environments need additional, multidisciplinary study.

EID Nkoko DB, Giraudoux P, Plisnier P, Tinda AM, Piarroux M, Sudre B, et al. Dynamics of Cholera Outbreaks in Great Lakes Region of Africa, 1978–2008. Emerg Infect Dis. 2011;17(11):2026-2034. https://dx.doi.org/10.3201/eid1711.110170
AMA Nkoko DB, Giraudoux P, Plisnier P, et al. Dynamics of Cholera Outbreaks in Great Lakes Region of Africa, 1978–2008. Emerging Infectious Diseases. 2011;17(11):2026-2034. doi:10.3201/eid1711.110170.
APA Nkoko, D. B., Giraudoux, P., Plisnier, P., Tinda, A. M., Piarroux, M., Sudre, B....Piarroux, R. (2011). Dynamics of Cholera Outbreaks in Great Lakes Region of Africa, 1978–2008. Emerging Infectious Diseases, 17(11), 2026-2034. https://dx.doi.org/10.3201/eid1711.110170.
Dispatches

International Spread of MDR TB from Tugela Ferry, South Africa [PDF - 148 KB - 3 pages]
G. S. Cooke et al.

We describe a death associated with multidrug-resistant tuberculosis and HIV infection outside Africa that can be linked to Tugela Ferry (KwaZulu-Natal, South Africa), the town most closely associated with the regional epidemic of drug-resistant tuberculosis. This case underscores the international relevance of this regional epidemic, particularly among health care workers.

EID Cooke GS, Beaton RK, Lessells RJ, John L, Ashworth S, Kon OM, et al. International Spread of MDR TB from Tugela Ferry, South Africa. Emerg Infect Dis. 2011;17(11):2035-2037. https://dx.doi.org/10.3201/eid1711.110291
AMA Cooke GS, Beaton RK, Lessells RJ, et al. International Spread of MDR TB from Tugela Ferry, South Africa. Emerging Infectious Diseases. 2011;17(11):2035-2037. doi:10.3201/eid1711.110291.
APA Cooke, G. S., Beaton, R. K., Lessells, R. J., John, L., Ashworth, S., Kon, O. M....Pym, A. S. (2011). International Spread of MDR TB from Tugela Ferry, South Africa. Emerging Infectious Diseases, 17(11), 2035-2037. https://dx.doi.org/10.3201/eid1711.110291.

Seasonal Influenza A Virus in Feces of Hospitalized Adults [PDF - 599 KB - 5 pages]
M. Chan et al.

In a cohort of hospitalized adults with seasonal influenza A in Hong Kong, viral RNA was frequently (47%) detected in stool specimens. Viable virus was rarely isolated. Viral RNA positivity had little correlation with gastrointestinal symptoms and outcomes. In vitro studies suggested low potential for seasonal influenza viruses to cause direct intestinal infections.

EID Chan M, Lee N, Chan P, To K, Wong R, Ho W, et al. Seasonal Influenza A Virus in Feces of Hospitalized Adults. Emerg Infect Dis. 2011;17(11):2038-2042. https://dx.doi.org/10.3201/eid1711.110205
AMA Chan M, Lee N, Chan P, et al. Seasonal Influenza A Virus in Feces of Hospitalized Adults. Emerging Infectious Diseases. 2011;17(11):2038-2042. doi:10.3201/eid1711.110205.
APA Chan, M., Lee, N., Chan, P., To, K., Wong, R., Ho, W....Sung, J. (2011). Seasonal Influenza A Virus in Feces of Hospitalized Adults. Emerging Infectious Diseases, 17(11), 2038-2042. https://dx.doi.org/10.3201/eid1711.110205.

Influenza B Viruses with Mutation in the Neuraminidase Active Site, North Carolina, USA, 2010–11 [PDF - 303 KB - 4 pages]
K. Sleeman et al.

Oseltamivir is 1 of 2 antiviral medications available for the treatment of influenza B virus infections. We describe and characterize a cluster of influenza B viruses circulating in North Carolina with a mutation in the neuraminidase active site that may reduce susceptibility to oseltamivir and the investigational drug peramivir but not to zanamivir.

EID Sleeman K, Sheu TG, Moore Z, Kilpatrick S, Garg S, Fry AM, et al. Influenza B Viruses with Mutation in the Neuraminidase Active Site, North Carolina, USA, 2010–11. Emerg Infect Dis. 2011;17(11):2043-2046. https://dx.doi.org/10.3201/eid1711.110787
AMA Sleeman K, Sheu TG, Moore Z, et al. Influenza B Viruses with Mutation in the Neuraminidase Active Site, North Carolina, USA, 2010–11. Emerging Infectious Diseases. 2011;17(11):2043-2046. doi:10.3201/eid1711.110787.
APA Sleeman, K., Sheu, T. G., Moore, Z., Kilpatrick, S., Garg, S., Fry, A. M....Gubareva, L. V. (2011). Influenza B Viruses with Mutation in the Neuraminidase Active Site, North Carolina, USA, 2010–11. Emerging Infectious Diseases, 17(11), 2043-2046. https://dx.doi.org/10.3201/eid1711.110787.

Hepatitis E Virus in Rabbits, Virginia, USA [PDF - 166 KB - 3 pages]
C. M. Cossaboom et al.

We identified hepatitis E virus (HEV) in rabbits in Virginia, USA. HEV RNA was detected in 14 (16%) of 85 serum samples and 13 (15%) of 85 fecal samples. Antibodies against HEV were detected in 31 (36%) of 85 serum samples. Sequence analyses showed that HEV from rabbits is closely related to genotype 3.

EID Cossaboom CM, Córdoba L, Dryman BA, Meng X. Hepatitis E Virus in Rabbits, Virginia, USA. Emerg Infect Dis. 2011;17(11):2047-2049. https://dx.doi.org/10.3201/eid1711.110428
AMA Cossaboom CM, Córdoba L, Dryman BA, et al. Hepatitis E Virus in Rabbits, Virginia, USA. Emerging Infectious Diseases. 2011;17(11):2047-2049. doi:10.3201/eid1711.110428.
APA Cossaboom, C. M., Córdoba, L., Dryman, B. A., & Meng, X. (2011). Hepatitis E Virus in Rabbits, Virginia, USA. Emerging Infectious Diseases, 17(11), 2047-2049. https://dx.doi.org/10.3201/eid1711.110428.

Astrovirus MLB2 Viremia in Febrile Child [PDF - 238 KB - 3 pages]
L. R. Holtz et al.

Astroviruses cause diarrhea, but it is not known whether they circulate in human plasma. Astrovirus MLB2 was recently discovered in diarrhea samples from children. We detected MLB2 in the plasma of a febrile child, which suggests that MLB2 has broader tropism than expected and disease potential beyond the gastrointestinal tract.

EID Holtz LR, Wylie KM, Sodergren E, Jiang Y, Franz CJ, Weinstock GM, et al. Astrovirus MLB2 Viremia in Febrile Child. Emerg Infect Dis. 2011;17(11):2050-2052. https://dx.doi.org/10.3201/eid1711.110496
AMA Holtz LR, Wylie KM, Sodergren E, et al. Astrovirus MLB2 Viremia in Febrile Child. Emerging Infectious Diseases. 2011;17(11):2050-2052. doi:10.3201/eid1711.110496.
APA Holtz, L. R., Wylie, K. M., Sodergren, E., Jiang, Y., Franz, C. J., Weinstock, G. M....Wang, D. (2011). Astrovirus MLB2 Viremia in Febrile Child. Emerging Infectious Diseases, 17(11), 2050-2052. https://dx.doi.org/10.3201/eid1711.110496.

New Dengue Virus Type 1 Genotype in Colombo, Sri Lanka [PDF - 237 KB - 3 pages]
H. A. Tissera et al.

The number of cases and severity of disease associated with dengue infection in Sri Lanka has been increasing since 1989, when the first epidemic of dengue hemorrhagic fever was recorded. We identified a new dengue virus 1 strain circulating in Sri Lanka that coincided with the 2009 dengue epidemic.

EID Tissera HA, Ooi EE, Gubler DJ, Tan Y, Logendra B, Wahala WM, et al. New Dengue Virus Type 1 Genotype in Colombo, Sri Lanka. Emerg Infect Dis. 2011;17(11):2053-2055. https://dx.doi.org/10.3201/eid1711.101893
AMA Tissera HA, Ooi EE, Gubler DJ, et al. New Dengue Virus Type 1 Genotype in Colombo, Sri Lanka. Emerging Infectious Diseases. 2011;17(11):2053-2055. doi:10.3201/eid1711.101893.
APA Tissera, H. A., Ooi, E. E., Gubler, D. J., Tan, Y., Logendra, B., Wahala, W. M....De Silva, A. D. (2011). New Dengue Virus Type 1 Genotype in Colombo, Sri Lanka. Emerging Infectious Diseases, 17(11), 2053-2055. https://dx.doi.org/10.3201/eid1711.101893.

Ultrastructural Characterization of Pandemic (H1N1) 2009 Virus [PDF - 498 KB - 4 pages]
C. S. Goldsmith et al.

We evaluated pandemic influenza A (H1N1) 2009 virus isolates and respiratory tissues collected at autopsy by electron microscopy. Many morphologic characteristics were similar to those previously described for influenza virus. One of the distinctive features was dense tubular structures in the nuclei of infected cells.

EID Goldsmith CS, Metcalfe MG, Rollin DC, Shieh W, Paddock CD, Xu X, et al. Ultrastructural Characterization of Pandemic (H1N1) 2009 Virus. Emerg Infect Dis. 2011;17(11):2056-2059. https://dx.doi.org/10.3201/eid1711.110258
AMA Goldsmith CS, Metcalfe MG, Rollin DC, et al. Ultrastructural Characterization of Pandemic (H1N1) 2009 Virus. Emerging Infectious Diseases. 2011;17(11):2056-2059. doi:10.3201/eid1711.110258.
APA Goldsmith, C. S., Metcalfe, M. G., Rollin, D. C., Shieh, W., Paddock, C. D., Xu, X....Zaki, S. R. (2011). Ultrastructural Characterization of Pandemic (H1N1) 2009 Virus. Emerging Infectious Diseases, 17(11), 2056-2059. https://dx.doi.org/10.3201/eid1711.110258.

Molecular Subtyping in Cholera Outbreak, Laos, 2010 [PDF - 231 KB - 3 pages]
N. Sithivong et al.

A cholera outbreak in Laos in July 2010 involved 237 cases, including 4 deaths. Molecular subtyping indicated relatedness between the Vibrio cholerae isolates in this and in a 2007 outbreak, uncovering a clonal group of V. cholerae circulating in the Mekong basin. Our finding suggests the subtyping methods will affect this relatedness.

EID Sithivong N, Morita-Ishihara T, Vongdouangchanh A, Phouthavane T, Chomlasak K, Sisavath L, et al. Molecular Subtyping in Cholera Outbreak, Laos, 2010. Emerg Infect Dis. 2011;17(11):2060-2062. https://dx.doi.org/10.3201/eid1711.110280
AMA Sithivong N, Morita-Ishihara T, Vongdouangchanh A, et al. Molecular Subtyping in Cholera Outbreak, Laos, 2010. Emerging Infectious Diseases. 2011;17(11):2060-2062. doi:10.3201/eid1711.110280.
APA Sithivong, N., Morita-Ishihara, T., Vongdouangchanh, A., Phouthavane, T., Chomlasak, K., Sisavath, L....Izumiya, H. (2011). Molecular Subtyping in Cholera Outbreak, Laos, 2010. Emerging Infectious Diseases, 17(11), 2060-2062. https://dx.doi.org/10.3201/eid1711.110280.

Clonal Origins of Vibrio cholerae O1 El Tor Strains, Papua New Guinea, 2009–2011 [PDF - 150 KB - 3 pages]
P. F. Horwood et al.

We used multilocus sequence typing and variable number tandem repeat analysis to determine the clonal origins of Vibrio cholerae O1 El Tor strains from an outbreak of cholera that began in 2009 in Papua New Guinea. The epidemic is ongoing, and transmission risk is elevated within the Pacific region.

EID Horwood PF, Collins D, Jonduo MH, Rosewell A, Dutta SR, Dagina R, et al. Clonal Origins of Vibrio cholerae O1 El Tor Strains, Papua New Guinea, 2009–2011. Emerg Infect Dis. 2011;17(11):2063-2065. https://dx.doi.org/10.3201/eid1711.110782
AMA Horwood PF, Collins D, Jonduo MH, et al. Clonal Origins of Vibrio cholerae O1 El Tor Strains, Papua New Guinea, 2009–2011. Emerging Infectious Diseases. 2011;17(11):2063-2065. doi:10.3201/eid1711.110782.
APA Horwood, P. F., Collins, D., Jonduo, M. H., Rosewell, A., Dutta, S. R., Dagina, R....Greenhill, A. R. (2011). Clonal Origins of Vibrio cholerae O1 El Tor Strains, Papua New Guinea, 2009–2011. Emerging Infectious Diseases, 17(11), 2063-2065. https://dx.doi.org/10.3201/eid1711.110782.
Letters

Fatal Infectious Diseases during Pandemic (H1N1) 2009 Outbreak [PDF - 137 KB - 2 pages]
D. M. Blau et al.
EID Blau DM, Denison AM, Bhatnagar J, DeLeon-Carnes M, Drew C, Paddock CD, et al. Fatal Infectious Diseases during Pandemic (H1N1) 2009 Outbreak. Emerg Infect Dis. 2011;17(11):2069-2070. https://dx.doi.org/10.3201/eid1711.110429
AMA Blau DM, Denison AM, Bhatnagar J, et al. Fatal Infectious Diseases during Pandemic (H1N1) 2009 Outbreak. Emerging Infectious Diseases. 2011;17(11):2069-2070. doi:10.3201/eid1711.110429.
APA Blau, D. M., Denison, A. M., Bhatnagar, J., DeLeon-Carnes, M., Drew, C., Paddock, C. D....Zaki, S. R. (2011). Fatal Infectious Diseases during Pandemic (H1N1) 2009 Outbreak. Emerging Infectious Diseases, 17(11), 2069-2070. https://dx.doi.org/10.3201/eid1711.110429.

Epidemic Meningococcal Meningitis, Cameroon [PDF - 189 KB - 3 pages]
D. Massenet et al.
EID Massenet D, Vohod D, Hamadicko H, Caugant D. Epidemic Meningococcal Meningitis, Cameroon. Emerg Infect Dis. 2011;17(11):2070-2072. https://dx.doi.org/10.3201/eid1711.110468
AMA Massenet D, Vohod D, Hamadicko H, et al. Epidemic Meningococcal Meningitis, Cameroon. Emerging Infectious Diseases. 2011;17(11):2070-2072. doi:10.3201/eid1711.110468.
APA Massenet, D., Vohod, D., Hamadicko, H., & Caugant, D. (2011). Epidemic Meningococcal Meningitis, Cameroon. Emerging Infectious Diseases, 17(11), 2070-2072. https://dx.doi.org/10.3201/eid1711.110468.

Foodborne-associated Shigella sonnei, India, 2009 and 2010 [PDF - 365 KB - 3 pages]
S. Nandy et al.
EID Nandy S, Dutta S, Ghosh S, Ganai A, Rajahamsan J, Theodore RB, et al. Foodborne-associated Shigella sonnei, India, 2009 and 2010. Emerg Infect Dis. 2011;17(11):2072-2074. https://dx.doi.org/10.3201/eid1711.110403
AMA Nandy S, Dutta S, Ghosh S, et al. Foodborne-associated Shigella sonnei, India, 2009 and 2010. Emerging Infectious Diseases. 2011;17(11):2072-2074. doi:10.3201/eid1711.110403.
APA Nandy, S., Dutta, S., Ghosh, S., Ganai, A., Rajahamsan, J., Theodore, R. B....Sheikh, N. K. (2011). Foodborne-associated Shigella sonnei, India, 2009 and 2010. Emerging Infectious Diseases, 17(11), 2072-2074. https://dx.doi.org/10.3201/eid1711.110403.

Mosquito-associated Dengue Virus, Key West, Florida, USA, 2010 [PDF - 155 KB - 2 pages]
A. S. Graham et al.
EID Graham AS, Pruszynski CA, Hribar LJ, DeMay DJ, Tambasco AN, Hartley AE, et al. Mosquito-associated Dengue Virus, Key West, Florida, USA, 2010. Emerg Infect Dis. 2011;17(11):2074-2075. https://dx.doi.org/10.3201/eid1711.110419
AMA Graham AS, Pruszynski CA, Hribar LJ, et al. Mosquito-associated Dengue Virus, Key West, Florida, USA, 2010. Emerging Infectious Diseases. 2011;17(11):2074-2075. doi:10.3201/eid1711.110419.
APA Graham, A. S., Pruszynski, C. A., Hribar, L. J., DeMay, D. J., Tambasco, A. N., Hartley, A. E....Isern, S. (2011). Mosquito-associated Dengue Virus, Key West, Florida, USA, 2010. Emerging Infectious Diseases, 17(11), 2074-2075. https://dx.doi.org/10.3201/eid1711.110419.

Mycobacterium doricum Osteomyelitis and Soft Tissue Infection [PDF - 225 KB - 3 pages]
A. C. Pettit et al.
EID Pettit AC, Jahangir AA, Wright PW. Mycobacterium doricum Osteomyelitis and Soft Tissue Infection. Emerg Infect Dis. 2011;17(11):2075-2077. https://dx.doi.org/10.3201/eid1711.110460
AMA Pettit AC, Jahangir AA, Wright PW. Mycobacterium doricum Osteomyelitis and Soft Tissue Infection. Emerging Infectious Diseases. 2011;17(11):2075-2077. doi:10.3201/eid1711.110460.
APA Pettit, A. C., Jahangir, A. A., & Wright, P. W. (2011). Mycobacterium doricum Osteomyelitis and Soft Tissue Infection. Emerging Infectious Diseases, 17(11), 2075-2077. https://dx.doi.org/10.3201/eid1711.110460.

Disseminated Mycobacterium abscessus Infection and Showerheads, Taiwan [PDF - 226 KB - 2 pages]
Y. Kuo et al.
EID Kuo Y, Cheng A, Wu P, Hsieh S, Hsieh S, Hsueh P, et al. Disseminated Mycobacterium abscessus Infection and Showerheads, Taiwan. Emerg Infect Dis. 2011;17(11):2077-2078. https://dx.doi.org/10.3201/eid1711.110050
AMA Kuo Y, Cheng A, Wu P, et al. Disseminated Mycobacterium abscessus Infection and Showerheads, Taiwan. Emerging Infectious Diseases. 2011;17(11):2077-2078. doi:10.3201/eid1711.110050.
APA Kuo, Y., Cheng, A., Wu, P., Hsieh, S., Hsieh, S., Hsueh, P....Yu, C. (2011). Disseminated Mycobacterium abscessus Infection and Showerheads, Taiwan. Emerging Infectious Diseases, 17(11), 2077-2078. https://dx.doi.org/10.3201/eid1711.110050.

Antimicrobial Drug Resistance in Corynebacterium diphtheriae mitis [PDF - 160 KB - 3 pages]
O. Barraud et al.
EID Barraud O, Badell E, Denis F, Guiso N, Ploy M. Antimicrobial Drug Resistance in Corynebacterium diphtheriae mitis. Emerg Infect Dis. 2011;17(11):2078-2080. https://dx.doi.org/10.3201/eid1711.110282
AMA Barraud O, Badell E, Denis F, et al. Antimicrobial Drug Resistance in Corynebacterium diphtheriae mitis. Emerging Infectious Diseases. 2011;17(11):2078-2080. doi:10.3201/eid1711.110282.
APA Barraud, O., Badell, E., Denis, F., Guiso, N., & Ploy, M. (2011). Antimicrobial Drug Resistance in Corynebacterium diphtheriae mitis. Emerging Infectious Diseases, 17(11), 2078-2080. https://dx.doi.org/10.3201/eid1711.110282.

Transfusion-transmitted Syphilis in Teaching Hospital, Ghana [PDF - 151 KB - 3 pages]
A. K. Owusu-Ofori et al.
EID Owusu-Ofori AK, Parry CM, Bates I. Transfusion-transmitted Syphilis in Teaching Hospital, Ghana. Emerg Infect Dis. 2011;17(11):2080-2082. https://dx.doi.org/10.3201/eid1711.110985
AMA Owusu-Ofori AK, Parry CM, Bates I. Transfusion-transmitted Syphilis in Teaching Hospital, Ghana. Emerging Infectious Diseases. 2011;17(11):2080-2082. doi:10.3201/eid1711.110985.
APA Owusu-Ofori, A. K., Parry, C. M., & Bates, I. (2011). Transfusion-transmitted Syphilis in Teaching Hospital, Ghana. Emerging Infectious Diseases, 17(11), 2080-2082. https://dx.doi.org/10.3201/eid1711.110985.

Congenital Syphilis, Réunion Island, 2010 [PDF - 147 KB - 2 pages]
J. Ramiandrisoa et al.
EID Ramiandrisoa J, Aubert L, Lespine EB, Alessandri J, Robillard P, Bertsch M, et al. Congenital Syphilis, Réunion Island, 2010. Emerg Infect Dis. 2011;17(11):2082-2083. https://dx.doi.org/10.3201/eid1711.101925
AMA Ramiandrisoa J, Aubert L, Lespine EB, et al. Congenital Syphilis, Réunion Island, 2010. Emerging Infectious Diseases. 2011;17(11):2082-2083. doi:10.3201/eid1711.101925.
APA Ramiandrisoa, J., Aubert, L., Lespine, E. B., Alessandri, J., Robillard, P., Bertsch, M....D’Ortenzio, E. (2011). Congenital Syphilis, Réunion Island, 2010. Emerging Infectious Diseases, 17(11), 2082-2083. https://dx.doi.org/10.3201/eid1711.101925.

Reduced Susceptibility to Vancomycin in Staphylococcus aureus [PDF - 147 KB - 2 pages]
M. J. Mimica
EID Mimica MJ. Reduced Susceptibility to Vancomycin in Staphylococcus aureus. Emerg Infect Dis. 2011;17(11):2083-2084. https://dx.doi.org/10.3201/eid1711.110799
AMA Mimica MJ. Reduced Susceptibility to Vancomycin in Staphylococcus aureus. Emerging Infectious Diseases. 2011;17(11):2083-2084. doi:10.3201/eid1711.110799.
APA Mimica, M. J. (2011). Reduced Susceptibility to Vancomycin in Staphylococcus aureus. Emerging Infectious Diseases, 17(11), 2083-2084. https://dx.doi.org/10.3201/eid1711.110799.
Books and Media

Smallpox: The Death of a Disease and 
House on Fire: The Fight to Eradicate Smallpox [PDF - 205 KB - 2 pages]
P. A. Small
EID Small PA. Smallpox: The Death of a Disease and 
House on Fire: The Fight to Eradicate Smallpox. Emerg Infect Dis. 2011;17(11):2085-2086. https://dx.doi.org/10.3201/eid1711.111229
AMA Small PA. Smallpox: The Death of a Disease and 
House on Fire: The Fight to Eradicate Smallpox. Emerging Infectious Diseases. 2011;17(11):2085-2086. doi:10.3201/eid1711.111229.
APA Small, P. A. (2011). Smallpox: The Death of a Disease and 
House on Fire: The Fight to Eradicate Smallpox. Emerging Infectious Diseases, 17(11), 2085-2086. https://dx.doi.org/10.3201/eid1711.111229.
Corrections

Correction: Vol. 16, No. 11 [PDF - 130 KB - 1 page]
EID Correction: Vol. 16, No. 11. Emerg Infect Dis. 2011;17(11):2180. https://dx.doi.org/10.3201/eid1711.c11711
AMA Correction: Vol. 16, No. 11. Emerging Infectious Diseases. 2011;17(11):2180. doi:10.3201/eid1711.c11711.
APA (2011). Correction: Vol. 16, No. 11. Emerging Infectious Diseases, 17(11), 2180. https://dx.doi.org/10.3201/eid1711.c11711.
News and Notes

In Memoriam: David Judson Sencer, A Public Health Giant [PDF - 241 KB - 3 pages]
J. P. Koplan
EID Koplan JP. In Memoriam: David Judson Sencer, A Public Health Giant. Emerg Infect Dis. 2011;17(11):2066-2068. https://dx.doi.org/10.3201/eid1711.im1711
AMA Koplan JP. In Memoriam: David Judson Sencer, A Public Health Giant. Emerging Infectious Diseases. 2011;17(11):2066-2068. doi:10.3201/eid1711.im1711.
APA Koplan, J. P. (2011). In Memoriam: David Judson Sencer, A Public Health Giant. Emerging Infectious Diseases, 17(11), 2066-2068. https://dx.doi.org/10.3201/eid1711.im1711.
Page created: February 16, 2012
Page updated: May 18, 2012
Page reviewed: May 18, 2012
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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