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Volume 17, Number 11—November 2011

Volume 17, Number 11—November 2011   PDF Version [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 Version [PDF - 295 KB - 7 pages]
    J. W. Tappero and R. V. Tauxe
    View Summary

    Safe water and sewage systems must be constructed to prevent future epidemics.

        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 315 KB - 5 pages]
    R. V. Tauxe et al.
    View Summary

    Rapid training of health care staff was followed by lower death rates.

        View Abstract

    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.

        Cite This Article
    EID Tauxe RV, Lynch M, Lambert Y, Sobel J, Domerçant JW, Khan A, et al. 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 Version [PDF - 183 KB - 6 pages]
    J. Morris
    View Summary

    Cholera is a wily opponent. The cholera organism can live indefinitely in water and can survive in a changing environment by evolving genetically. And as it evolves, it is becoming more capable of causing severe disease. Recently, researchers found that the organism passed in diarrhea from an infected person is more capable of causing disease for several hours, during which time fast transmission from person to person can occur. Although the key to ultimate cholera control is good sanitation, prevention efforts should also focus on household transmission during the short period when it is more infectious.

        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 336 KB - 8 pages]
    K. A. Date et al.
    View Summary

    Many logistical and operational challenges prevented implementation of a vaccination campaign.

        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 360 KB - 9 pages]
    A. R. Reimer et al.
    View Summary

    A strain from Haiti shares genetic ancestry with those from Asia and Africa.

        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 248 KB - 8 pages]
    D. Talkington et al.
    View Summary

    A virulent clone from Africa or southern Asia was likely introduced at a single time point.

        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 180 KB - 6 pages]
    D. Jenson and V. Szabo
    View Summary

    Epidemic cholera did not occur in Haiti before 2010.

        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 186 KB - 3 pages]
    K. A. O’Connor et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 273 KB - 4 pages]
    J. A. Routh et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 181 KB - 4 pages]
    S. E. Dunkle et al.
    View Summary

    Cholera is a problem in areas where sanitation is poor and clean water is scarce. Such were the conditions in Port-au-Prince, Haiti, after the January 2010 earthquake destroyed the city’s vital water and sanitation infrastructure. By the time the cholera epidemic hit, >1 million people were living in camps or crowded slums, where poverty, poor nutrition, and inadequate water and sanitation were the norm. A recent study conducted in Port-au-Prince identified 3 actions that seemed to protect some persons from cholera: disinfecting drinking water, washing hands, and eating a diverse diet. The protective effects of clean water and handwashing are well known but the effects of the diverse diet might reflect higher socioeconomic status (more access to a variety of foods) or higher nutritional content (and subsequent health benefits), which may have helped prevent persons from getting sick.

        View Abstract

    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.

        Cite This Article
    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. (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 Version [PDF - 192 KB - 4 pages]
    V. R. Hill et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 276 KB - 4 pages]
    M. Sjölund-Karlsson et al.
    View Summary

    Drug-resistant cholera is a global health concern; infections with drug-resistant strains can be more difficult to treat. Although the main treatment for cholera is replacing the fluid lost through diarrhea, the volume and duration of diarrhea can be reduced with antimicrobial drugs. Resistance to these drugs, however, has been emerging and has been found in the cholera strain that caused the outbreak in Haiti. A study of the genetic mechanisms behind this resistance showed that the Haiti strain carries several drug-resistance genes. Continued monitoring of resistance in the cholera bacteria in Haiti is necessary to know if further resistance develops and to guide antimicrobial drug–use policy if it does.

        View Abstract

    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.

        Cite This Article
    EID Sjölund-Karlsson M, Reimer AR, Folster JP, Walker M, Dahourou G, Batra DG, 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. G....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 Version [PDF - 189 KB - 3 pages]
    S. Ernst et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 209 KB - 4 pages]
    V. E. De Rochars et al.
        View Abstract

    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%.

        Cite This Article
    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 Version [PDF - 222 KB - 4 pages]
    A. Rajasingham et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 173 KB - 3 pages]
    A. E. Newton et al.
    View Summary

    Sometimes history really does repeat itself. In the 1990s, increases in cholera in Latin America led to increasing numbers of cases in the United States. So, when the Haiti cholera epidemic began in 2010, experts expected to see an uptick in US cases. And they did. Since the Haiti epidemic began, 23 cases of imported cholera have been reported among those living in 8 US states—nearly 4 times the annual average in recent years. All but 1 patient had travelled to Haiti or the Dominican Republic, including 9 who attended a wedding in the Dominican Republic. (The nontraveler ate contaminated seafood brought back from Haiti by a relative). Most of the 23 US cholera patients had gone to Hispaniola to visit friends or relatives. Although the risk of spreading cholera to others in the United States is low, this study underscores the need to educate those visiting friends or relatives about steps they should take to prevent infection and importation of disease into the United States.

        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 246 KB - 3 pages]
    M. U. Selent et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 146 KB - 3 pages]
    M. L. Jiménez et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 186 KB - 2 pages]
    E. T. Ryan
            Cite This Article
    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 Version [PDF - 96 KB - 2 pages]
    C. Mendoza et al.
            Cite This Article
    EID Mendoza C, Meites E, Briere EC, Gernay J, Morgan O, Monegro NR, et al. 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 EC, 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. C., 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 Version [PDF - 161 KB - 3 pages]
    S. B. Pun
            Cite This Article
    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 Version [PDF - 135 KB - 1 page]
    N. Männikkö
            Cite This Article
    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.
            Cite This Article
    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 Version [PDF - 133 KB - 2 pages]
    P. Potter
            Cite This Article
    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 Version [PDF - 253 KB - 8 pages]
    A. Okumura et al.
    View Summary

    Encephalopathy and unexpected cardiopulmonary arrest were the leading causes of death.

        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 308 KB - 9 pages]
    J. R. Johnson et al.
    View Summary

    This group was associated with the Western world, trimethoprim/sulfamethoxazole resistance, and diverse hosts/specimens.

        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 361 KB - 8 pages]
    P. R. Shea et al.
    View Summary

    Determination of emm variations may help improve vaccine design.

        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 433 KB - 8 pages]
    J. Bouquet et al.
    View Summary

    Autochthonous human infection may result from consumption of pork products such as raw liver.

        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 877 KB - 9 pages]
    D. B. Nkoko et al.
    View Summary

    Outbreaks fluctuate on the basis of season, rainfall, plankton bloom, and fishing activities.

        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 148 KB - 3 pages]
    G. S. Cooke et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 599 KB - 5 pages]
    M. Chan et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 303 KB - 4 pages]
    K. Sleeman et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 166 KB - 3 pages]
    C. M. Cossaboom et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 238 KB - 3 pages]
    L. R. Holtz et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 237 KB - 3 pages]
    H. A. Tissera et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 498 KB - 4 pages]
    C. S. Goldsmith et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 231 KB - 3 pages]
    N. Sithivong et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 150 KB - 3 pages]
    P. F. Horwood et al.
        View Abstract

    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.

        Cite This Article
    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 Version [PDF - 137 KB - 2 pages]
    D. M. Blau et al.
            Cite This Article
    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 Version [PDF - 189 KB - 3 pages]
    D. Massenet et al.
            Cite This Article
    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 Version [PDF - 365 KB - 3 pages]
    S. Nandy et al.
            Cite This Article
    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 Version [PDF - 155 KB - 2 pages]
    A. S. Graham et al.
            Cite This Article
    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 Version [PDF - 225 KB - 3 pages]
    A. C. Pettit et al.
            Cite This Article
    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 Version [PDF - 226 KB - 2 pages]
    Y. Kuo et al.
            Cite This Article
    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 Version [PDF - 160 KB - 3 pages]
    O. Barraud et al.
            Cite This Article
    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 Version [PDF - 151 KB - 3 pages]
    A. K. Owusu-Ofori et al.
            Cite This Article
    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 Version [PDF - 147 KB - 2 pages]
    J. Ramiandrisoa et al.
            Cite This Article
    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 Version [PDF - 147 KB - 2 pages]
    M. J. Mimica
            Cite This Article
    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 Version [PDF - 205 KB - 2 pages]
    P. A. Small
            Cite This Article
    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 Version [PDF - 130 KB - 1 page]
            Cite This Article
    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

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