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Issue Cover for Volume 17, Number 12—December 2011

Volume 17, Number 12—December 2011

[PDF - 6.87 MB]

Perspective

Medscape CME Activity
Risk for Rabies Importation from North Africa [PDF - 273 KB - 7 pages]
P. Gautret et al.

A retrospective study conducted in France indicated that a large proportion of patients injured by potentially rabid animals while in North Africa did not seek pretravel advice, and some had not received proper rabies postexposure prophylaxis while in North Africa. As a result, imported human rabies cases are still being reported, and the need for postexposure prophylaxis after exposure in North Africa is not declining. Tourists are generally unaware of the danger of importing potentially rabid animals and of the rules governing the movement of pets. In France, for example, rabid dogs have frequently been imported from Morocco to France through Spain. This situation imposes heavy social and economic costs and impedes rabies control in Europe. Rabies surveillance and control should therefore be reinforced in North Africa, and travelers to North Africa should receive appropriate information about rabies risk and prevention.

EID Gautret P, Ribadeau-Dumas F, Parola P, Brouqui P, Bourhy H. Risk for Rabies Importation from North Africa. Emerg Infect Dis. 2011;17(12):2187-2193. https://dx.doi.org/10.3201/eid1712.110300
AMA Gautret P, Ribadeau-Dumas F, Parola P, et al. Risk for Rabies Importation from North Africa. Emerging Infectious Diseases. 2011;17(12):2187-2193. doi:10.3201/eid1712.110300.
APA Gautret, P., Ribadeau-Dumas, F., Parola, P., Brouqui, P., & Bourhy, H. (2011). Risk for Rabies Importation from North Africa. Emerging Infectious Diseases, 17(12), 2187-2193. https://dx.doi.org/10.3201/eid1712.110300.
Synopses

Medscape CME Activity
Worldwide Occurrence and Impact of Human Trichinellosis, 1986–2009 [PDF - 216 KB - 9 pages]
K. D. Murrell and E. Pozio

To assess the global incidence and clinical effects of human trichinellosis, we analyzed outbreak report data for 1986–2009. Searches of 6 international databases yielded 494 reports. After applying strict criteria for relevance and reliability, we selected 261 reports for data extraction. From 1986 through 2009, there were 65,818 cases and 42 deaths reported from 41 countries. The World Health Organization European Region accounted for 87% of cases; 50% of those occurred in Romania, mainly during 1990–1999. Incidence in the region ranged from 1.1 to 8.5 cases per 100,000 population. Trichinellosis affected primarily adults (median age 33.1 years) and about equally affected men (51%) and women. Major clinical effects, according to 5,377 well-described cases, were myalgia, diarrhea, fever, facial edema, and headaches. Pork was the major source of infection; wild game sources were also frequently reported. These data will be valuable for estimating the illness worldwide.

EID Murrell KD, Pozio E. Worldwide Occurrence and Impact of Human Trichinellosis, 1986–2009. Emerg Infect Dis. 2011;17(12):2194-2202. https://dx.doi.org/10.3201/eid1712.110896
AMA Murrell KD, Pozio E. Worldwide Occurrence and Impact of Human Trichinellosis, 1986–2009. Emerging Infectious Diseases. 2011;17(12):2194-2202. doi:10.3201/eid1712.110896.
APA Murrell, K. D., & Pozio, E. (2011). Worldwide Occurrence and Impact of Human Trichinellosis, 1986–2009. Emerging Infectious Diseases, 17(12), 2194-2202. https://dx.doi.org/10.3201/eid1712.110896.
Research

Sealpox Virus in Marine Mammal Rehabilitation Facilities, North America, 2007–2009 [PDF - 197 KB - 6 pages]
A. A. Roess et al.

Sealpox, a zoonotic disease affecting pinnipeds (seals and sea lions), can occur among captive and convalescing animals. We surveyed 1 worker each from 11 marine mammal centers and interviewed 31 other marine mammal workers to ascertain their knowledge of and experience with sealpox virus and to identify factors associated with sealpox virus outbreaks among pinnipeds in marine rehabilitation facilities. Demographic and health data were obtained for 1,423 pinnipeds at the 11 facilities. Among the 23 animals in which sealpox was clinically diagnosed, 4 arrived at the facility ill, 11 became ill <5 weeks after arrival, and 2 became ill >5 weeks after arrival; the timing of illness onset was unknown for 6 animals. Most infections occurred in pinnipeds <1 year of age. Nine affected animals were malnourished; 4 had additional illnesses. Sealpox had also occurred among workers at 2 facilities. Sealpox is a noteworthy zoonosis of rehabilitating convalescing pinnipeds; workplace education can help to minimize risks for human infection.

EID Roess AA, Levine RS, Barth L, Monroe B, Carroll DS, Damon IK, et al. Sealpox Virus in Marine Mammal Rehabilitation Facilities, North America, 2007–2009. Emerg Infect Dis. 2011;17(12):2203-2208. https://dx.doi.org/10.3201/eid1712.101945
AMA Roess AA, Levine RS, Barth L, et al. Sealpox Virus in Marine Mammal Rehabilitation Facilities, North America, 2007–2009. Emerging Infectious Diseases. 2011;17(12):2203-2208. doi:10.3201/eid1712.101945.
APA Roess, A. A., Levine, R. S., Barth, L., Monroe, B., Carroll, D. S., Damon, I. K....Reynolds, M. G. (2011). Sealpox Virus in Marine Mammal Rehabilitation Facilities, North America, 2007–2009. Emerging Infectious Diseases, 17(12), 2203-2208. https://dx.doi.org/10.3201/eid1712.101945.

Transmission of Guanarito and Pirital Viruses among Wild Rodents, Venezuela [PDF - 231 KB - 7 pages]
M. L. Milazzo et al.

Samples from rodents captured on a farm in Venezuela in February 1997 were tested for arenavirus, antibody against Guanarito virus (GTOV), and antibody against Pirital virus (PIRV). Thirty-one (48.4%) of 64 short-tailed cane mice (Zygodontomys brevicauda) were infected with GTOV, 1 Alston’s cotton rat (Sigmodon alstoni) was infected with GTOV, and 36 (64.3%) of 56 other Alston’s cotton rats were infected with PIRV. The results of analyses of field and laboratory data suggested that horizontal transmission is the dominant mode of GTOV transmission in Z. brevicauda mice and that vertical transmission is an important mode of PIRV transmission in S. alstoni rats. The results also suggested that bodily secretions and excretions from most GTOV-infected short-tailed cane mice and most PIRV-infected Alston’s cotton rats may transmit the viruses to humans.

EID Milazzo ML, Cajimat MN, Duno G, Duno F, Utrera A, Fulhorst CF. Transmission of Guanarito and Pirital Viruses among Wild Rodents, Venezuela. Emerg Infect Dis. 2011;17(12):2209-2215. https://dx.doi.org/10.3201/eid1712.110393
AMA Milazzo ML, Cajimat MN, Duno G, et al. Transmission of Guanarito and Pirital Viruses among Wild Rodents, Venezuela. Emerging Infectious Diseases. 2011;17(12):2209-2215. doi:10.3201/eid1712.110393.
APA Milazzo, M. L., Cajimat, M. N., Duno, G., Duno, F., Utrera, A., & Fulhorst, C. F. (2011). Transmission of Guanarito and Pirital Viruses among Wild Rodents, Venezuela. Emerging Infectious Diseases, 17(12), 2209-2215. https://dx.doi.org/10.3201/eid1712.110393.

Hepatitis E Virus in Rats, Los Angeles, California, USA [PDF - 258 KB - 7 pages]
R. H. Purcell et al.

The role of rats in human hepatitis E virus (HEV) infections remains controversial. A genetically distinct HEV was recently isolated from rats in Germany, and its genome was sequenced. We have isolated a genetically similar HEV from urban rats in Los Angeles, California, USA, and characterized its ability to infect laboratory rats and nonhuman primates. Two strains of HEV were isolated from serum samples of 134 wild rats that had a seroprevalence of antibodies against HEV of ≈80%. Virus was transmissible to seronegative Sprague-Dawley rats, but transmission was spotty and magnitude and duration of infection were not robust. Viremia was higher in nude rats. Serologic analysis and reverse transcription PCR were comparably sensitive in detecting infection. The sequence of the Los Angeles virus was virtually identical to that of isolates from Germany. Rat HEV was not transmissible to rhesus monkeys, suggesting that it is not a source of human infection.

EID Purcell RH, Engle RE, Rood MP, Kabrane-Lazizi Y, Nguyen HT, Govindarajan S, et al. Hepatitis E Virus in Rats, Los Angeles, California, USA. Emerg Infect Dis. 2011;17(12):2216-2222. https://dx.doi.org/10.3201/eid1712.110482
AMA Purcell RH, Engle RE, Rood MP, et al. Hepatitis E Virus in Rats, Los Angeles, California, USA. Emerging Infectious Diseases. 2011;17(12):2216-2222. doi:10.3201/eid1712.110482.
APA Purcell, R. H., Engle, R. E., Rood, M. P., Kabrane-Lazizi, Y., Nguyen, H. T., Govindarajan, S....Emerson, S. U. (2011). Hepatitis E Virus in Rats, Los Angeles, California, USA. Emerging Infectious Diseases, 17(12), 2216-2222. https://dx.doi.org/10.3201/eid1712.110482.

Enterovirus Co-infections and Onychomadesis after Hand, Foot, and Mouth Disease, Spain, 2008 [PDF - 360 KB - 9 pages]
M. A. Bracho et al.

Hand, foot, and mouth disease (HFMD), a common disease caused by enteroviruses (EVs), usually affects children. Clustered and sporadic HFMD cases, followed by onychomadesis (nail shedding), occurred during summer and fall 2008 in Valencia, Spain. Fecal samples from onychomadesis patients, who did or did not have previous HFMD, and from healthy children exposed to onychomadesis patients tested positive for EV. The complete viral protein 1 capsid gene sequence was obtained for typing and phylogenetic analysis. Two EV serotypes, coxsackievirus A10 and coxsackievirus B1 (CVB1), were mainly detected as a monoinfection or co-infection in a childcare center where an onychomadesis outbreak occurred. On the basis of our results, and detection of CVB1 in 2 other contemporary onychomadesis outbreaks in childcare centers in Spain, we propose that mixed infection of an EV serotype that causes HFMD, plus the serotype CVB1, could explain the emergence after HFMD of onychomadesis, a rare and late complication.

EID Bracho MA, González-Candelas F, Valero A, Córdoba J, Salazar A. Enterovirus Co-infections and Onychomadesis after Hand, Foot, and Mouth Disease, Spain, 2008. Emerg Infect Dis. 2011;17(12):2223-2231. https://dx.doi.org/10.3201/eid1712.110395
AMA Bracho MA, González-Candelas F, Valero A, et al. Enterovirus Co-infections and Onychomadesis after Hand, Foot, and Mouth Disease, Spain, 2008. Emerging Infectious Diseases. 2011;17(12):2223-2231. doi:10.3201/eid1712.110395.
APA Bracho, M. A., González-Candelas, F., Valero, A., Córdoba, J., & Salazar, A. (2011). Enterovirus Co-infections and Onychomadesis after Hand, Foot, and Mouth Disease, Spain, 2008. Emerging Infectious Diseases, 17(12), 2223-2231. https://dx.doi.org/10.3201/eid1712.110395.

Experimental Infection of Horses with Hendra Virus/Australia/Horse/2008/Redlands [PDF - 470 KB - 7 pages]
G. A. Marsh et al.

Hendra virus (HeV) is a highly pathogenic zoonotic paramyxovirus harbored by Australian flying foxes with sporadic spillovers directly to horses. Although the mode and critical control points of HeV spillover to horses from flying foxes, and the risk for transmission from infected horses to other horses and humans, are poorly understood, we successfully established systemic HeV disease in 3 horses exposed to Hendra virus/Australia/Horse/2008/Redlands by the oronasal route, a plausible route for natural infection. In 2 of the 3 animals, HeV RNA was detected continually in nasal swabs from as early as 2 days postexposure, indicating that systemic spread of the virus may be preceded by local viral replication in the nasal cavity or nasopharynx. Our data suggest that a critical factor for reducing HeV exposure risk to humans includes early consideration of HeV in the differential diagnosis and institution of appropriate infection control procedures.

EID Marsh GA, Haining J, Hancock TJ, Robinson R, Foord A, Barr JA, et al. Experimental Infection of Horses with Hendra Virus/Australia/Horse/2008/Redlands. Emerg Infect Dis. 2011;17(12):2232-2238. https://dx.doi.org/10.3201/eid1712.111162
AMA Marsh GA, Haining J, Hancock TJ, et al. Experimental Infection of Horses with Hendra Virus/Australia/Horse/2008/Redlands. Emerging Infectious Diseases. 2011;17(12):2232-2238. doi:10.3201/eid1712.111162.
APA Marsh, G. A., Haining, J., Hancock, T. J., Robinson, R., Foord, A., Barr, J. A....Middleton, D. (2011). Experimental Infection of Horses with Hendra Virus/Australia/Horse/2008/Redlands. Emerging Infectious Diseases, 17(12), 2232-2238. https://dx.doi.org/10.3201/eid1712.111162.

Lineage and Virulence of Streptococcus suis Serotype 2 Isolates from North America [PDF - 234 KB - 6 pages]
N. Fittipaldi et al.

We performed multilocus sequence typing of 64 North American Streptococcus suis serotype 2 porcine isolates. Strains were sequence type (ST) 28 (51%), ST25 (44%), and ST1 (5%). We identified nonrandom associations between STs and expression of the virulence markers suilysin (SLY), muramidase-relased protein (MRP), and extracellular factor (EF). Expression of pili encoded by the srtF and srtG pilus clusters was also nonrandomly associated with STs. ST1 strains were SLY+ EF+ MRP+ srtF pilus+ srtG pilus−. ST25 strains were SLY− EF− MRP− srtF pilus− srtG pilus+, and most ST28 strains were SLY− MRP+ EF− srtF pilus+ srtG pilus+. ST28 isolates proved essentially nonvirulent in a mouse infection model; ST25 strains showed moderate virulence and ST1 isolates were highly virulent. ST1 is responsible for a high proportion of S. suis disease in humans worldwide. Its presence in North America indicates that potential zoonotic S. suis outbreaks in this continent cannot be disregarded.

EID Fittipaldi N, Xu J, Lacouture S, Tharavichitkul P, Osaki M, Sekizaki T, et al. Lineage and Virulence of Streptococcus suis Serotype 2 Isolates from North America. Emerg Infect Dis. 2011;17(12):2239-2244. https://dx.doi.org/10.3201/eid1712.110609
AMA Fittipaldi N, Xu J, Lacouture S, et al. Lineage and Virulence of Streptococcus suis Serotype 2 Isolates from North America. Emerging Infectious Diseases. 2011;17(12):2239-2244. doi:10.3201/eid1712.110609.
APA Fittipaldi, N., Xu, J., Lacouture, S., Tharavichitkul, P., Osaki, M., Sekizaki, T....Gottschalk, M. (2011). Lineage and Virulence of Streptococcus suis Serotype 2 Isolates from North America. Emerging Infectious Diseases, 17(12), 2239-2244. https://dx.doi.org/10.3201/eid1712.110609.

West Nile Virus Infection of Birds, Mexico [PDF - 387 KB - 8 pages]
S. Guerrero-Sánchez et al.

West Nile virus (WNV) has caused disease in humans, equids, and birds at lower frequency in Mexico than in the United States. We hypothesized that the seemingly reduced virulence in Mexico was caused by attenuation of the Tabasco strain from southeastern Mexico, resulting in lower viremia than that caused by the Tecate strain from the more northern location of Baja California. During 2006–2008, we tested this hypothesis in candidate avian amplifying hosts: domestic chickens, rock pigeons, house sparrows, great-tailed grackles, and clay-colored thrushes. Only great-tailed grackles and house sparrows were competent amplifying hosts for both strains, and deaths occurred in each species. Tecate strain viremia levels were higher for thrushes. Both strains produced low-level viremia in pigeons and chickens. Our results suggest that certain avian hosts within Mexico are competent for efficient amplification of both northern and southern WNV strains and that both strains likely contribute to bird deaths.

EID Guerrero-Sánchez S, Cuevas-Romero S, Nemeth NM, Trujillo-Olivera MT, Worwa G, Dupuis A, et al. West Nile Virus Infection of Birds, Mexico. Emerg Infect Dis. 2011;17(12):2245-2252. https://dx.doi.org/10.3201/eid1712.110294
AMA Guerrero-Sánchez S, Cuevas-Romero S, Nemeth NM, et al. West Nile Virus Infection of Birds, Mexico. Emerging Infectious Diseases. 2011;17(12):2245-2252. doi:10.3201/eid1712.110294.
APA Guerrero-Sánchez, S., Cuevas-Romero, S., Nemeth, N. M., Trujillo-Olivera, M. T., Worwa, G., Dupuis, A....Estrada-Franco, J. G. (2011). West Nile Virus Infection of Birds, Mexico. Emerging Infectious Diseases, 17(12), 2245-2252. https://dx.doi.org/10.3201/eid1712.110294.

Isolation of Prion with BSE Properties from Farmed Goat [PDF - 633 KB - 9 pages]
J. Spiropoulos et al.

Transmissible spongiform encephalopathies are fatal neurodegenerative diseases that include variant Creutzfeldt-Jakob disease in humans, scrapie in small ruminants, and bovine spongiform encephalopathy (BSE) in cattle. Scrapie is not considered a public health risk, but BSE has been linked to variant Creutzfeldt-Jakob disease. Small ruminants are susceptible to BSE, and in 2005 BSE was identified in a farmed goat in France. We confirm another BSE case in a goat in which scrapie was originally diagnosed and retrospectively identified as suspected BSE. The prion strain in this case was further characterized by mouse bioassay after extraction from formaldehyde-fixed brain tissue embedded in paraffin blocks. Our data show that BSE can infect small ruminants under natural conditions and could be misdiagnosed as scrapie. Surveillance should continue so that another outbreak of this zoonotic transmissible spongiform encephalopathy can be prevented and public health safeguarded.

EID Spiropoulos J, Lockey R, Sallis RE, Terry LA, Thorne L, Holder TM, et al. Isolation of Prion with BSE Properties from Farmed Goat. Emerg Infect Dis. 2011;17(12):2253-2261. https://dx.doi.org/10.3201/eid1712.110333
AMA Spiropoulos J, Lockey R, Sallis RE, et al. Isolation of Prion with BSE Properties from Farmed Goat. Emerging Infectious Diseases. 2011;17(12):2253-2261. doi:10.3201/eid1712.110333.
APA Spiropoulos, J., Lockey, R., Sallis, R. E., Terry, L. A., Thorne, L., Holder, T. M....Simmons, M. M. (2011). Isolation of Prion with BSE Properties from Farmed Goat. Emerging Infectious Diseases, 17(12), 2253-2261. https://dx.doi.org/10.3201/eid1712.110333.

Candidate Cell Substrates, Vaccine Production, and Transmissible Spongiform Encephalopathies [PDF - 371 KB - 8 pages]
P. Piccardo et al.

Transmissible spongiform encephalopathy (TSE) agents have contaminated human tissue–derived medical products, human blood components, and animal vaccines. The objective of this study was to determine the potential susceptibility to infection of 5 cell lines used or proposed for manufacture of biological products, as well as other lines. Cell lines were exposed to the infectious agents of sporadic and variant Creutzfeldt-Jakob disease and bovine spongiform encephalopathy (BSE). Exposed cultures were tested for TSE-associated prion protein (PrPTSE) and TSE infectivity by assay in rodents and nonhuman primates. No PrPTSE or infectivity has been detected in any exposed cell line under study so far. Animals inoculated with BSE brain homogenate developed typical spongiform encephalopathy. In contrast, animals inoculated with cells exposed to the BSE agent remained asymptomatic. All cell lines we studied resisted infection with 3 TSE agents, including the BSE agent.

EID Piccardo P, Cervenakova L, Vasilyeva I, Yakovleva O, Bacik I, Cervenak J, et al. Candidate Cell Substrates, Vaccine Production, and Transmissible Spongiform Encephalopathies. Emerg Infect Dis. 2011;17(12):2262-2269. https://dx.doi.org/10.3201/eid1712.110607
AMA Piccardo P, Cervenakova L, Vasilyeva I, et al. Candidate Cell Substrates, Vaccine Production, and Transmissible Spongiform Encephalopathies. Emerging Infectious Diseases. 2011;17(12):2262-2269. doi:10.3201/eid1712.110607.
APA Piccardo, P., Cervenakova, L., Vasilyeva, I., Yakovleva, O., Bacik, I., Cervenak, J....Asher, D. M. (2011). Candidate Cell Substrates, Vaccine Production, and Transmissible Spongiform Encephalopathies. Emerging Infectious Diseases, 17(12), 2262-2269. https://dx.doi.org/10.3201/eid1712.110607.

Molecular Epidemiology of Rift Valley Fever Virus [PDF - 338 KB - 7 pages]
A. A. Grobbelaar et al.

Phylogenetic relationships were examined for 198 Rift Valley fever virus isolates and 5 derived strains obtained from various sources in Saudi Arabia and 16 countries in Africa during a 67-year period (1944–2010). A maximum-likelihood tree prepared with sequence data for a 490-nt section of the Gn glycoprotein gene showed that 95 unique sequences sorted into 15 lineages. A 2010 isolate from a patient in South Africa potentially exposed to co-infection with live animal vaccine and wild virus was a reassortant. The potential influence of large-scale use of live animal vaccine on evolution of Rift Valley fever virus is discussed.

EID Grobbelaar AA, Weyer J, Leman PA, Kemp A, Paweska JT, Swanepoel R. Molecular Epidemiology of Rift Valley Fever Virus. Emerg Infect Dis. 2011;17(12):2270-2276. https://dx.doi.org/10.3201/eid1712.111035
AMA Grobbelaar AA, Weyer J, Leman PA, et al. Molecular Epidemiology of Rift Valley Fever Virus. Emerging Infectious Diseases. 2011;17(12):2270-2276. doi:10.3201/eid1712.111035.
APA Grobbelaar, A. A., Weyer, J., Leman, P. A., Kemp, A., Paweska, J. T., & Swanepoel, R. (2011). Molecular Epidemiology of Rift Valley Fever Virus. Emerging Infectious Diseases, 17(12), 2270-2276. https://dx.doi.org/10.3201/eid1712.111035.

Novel Multiplexed HIV/Simian Immunodeficiency Virus Antibody Detection Assay [PDF - 418 KB - 10 pages]
S. Ahuka-Mundeke et al.

Like most emerging infectious disease viruses, HIV is also of zoonotic origin. To assess the risk for cross-species transmission of simian immunodeficiency viruses (SIVs) from nonhuman primates to humans in the Democratic Republic of Congo, we collected 330 samples derived from nonhuman primate bushmeat at 3 remote forest sites. SIV prevalences were estimated by using a novel high-throughput assay that included 34 HIV and SIV antigens in a single well. Overall, 19% of nonhuman primate bushmeat was infected with SIVs, and new SIV lineages were identified. Highest SIV prevalences were seen in red-tailed guenons (25%) and Tshuapa red colobus monkeys (24%), representing the most common hunted primate species, thus increasing the likelihood for cross-species transmission. Additional studies are needed to determine whether other SIVs crossed the species barrier. With the newly developed assay, large-scale screening against many antigens is now easier and faster.

EID Ahuka-Mundeke S, Ayouba A, Mbala-Kingebeni P, Liegeois F, Esteban A, Lunguya-Metila O, et al. Novel Multiplexed HIV/Simian Immunodeficiency Virus Antibody Detection Assay. Emerg Infect Dis. 2011;17(12):2277-2286. https://dx.doi.org/10.3201/eid1712.110783
AMA Ahuka-Mundeke S, Ayouba A, Mbala-Kingebeni P, et al. Novel Multiplexed HIV/Simian Immunodeficiency Virus Antibody Detection Assay. Emerging Infectious Diseases. 2011;17(12):2277-2286. doi:10.3201/eid1712.110783.
APA Ahuka-Mundeke, S., Ayouba, A., Mbala-Kingebeni, P., Liegeois, F., Esteban, A., Lunguya-Metila, O....Peeters, M. (2011). Novel Multiplexed HIV/Simian Immunodeficiency Virus Antibody Detection Assay. Emerging Infectious Diseases, 17(12), 2277-2286. https://dx.doi.org/10.3201/eid1712.110783.

Astroviruses in Rabbits [PDF - 320 KB - 7 pages]
V. Martella et al.

By screening rabbits with enterocolitis or enteritis complex and asymptomatic rabbits, we identified a novel astrovirus. The virus was distantly related (19.3%–23.7% aa identity) in the capsid precursor to other mammalian astroviruses within the Mamastrovirus genus. By using real-time reverse transcription PCR, with specific primers and probes and targeting a conserved stretch in open reading frame 1b, we found rabbit astrovirus in 10 (43%) of 23 samples from animals with enteric disease and in 25 (18%) of 139 samples from asymptomatic animals in Italy during 2005–2008. The mean and median titers in the positive animals were 102× and 103× greater, respectively, in the symptomatic animals than in the asymptomatic animals. These findings support the idea that rabbit astroviruses should be included in the diagnostic algorithm of rabbit enteric disease and animal experiments to increase information obtained about their epidemiology and potential pathogenic role.

EID Martella V, Moschidou P, Pinto P, Catella C, Desario C, Larocca V, et al. Astroviruses in Rabbits. Emerg Infect Dis. 2011;17(12):2287-2293. https://dx.doi.org/10.3201/eid1712.110967
AMA Martella V, Moschidou P, Pinto P, et al. Astroviruses in Rabbits. Emerging Infectious Diseases. 2011;17(12):2287-2293. doi:10.3201/eid1712.110967.
APA Martella, V., Moschidou, P., Pinto, P., Catella, C., Desario, C., Larocca, V....Buonavoglia, C. (2011). Astroviruses in Rabbits. Emerging Infectious Diseases, 17(12), 2287-2293. https://dx.doi.org/10.3201/eid1712.110967.

A Pilot Study of Host Genetic Variants Associated with Influenza-associated Deaths among Children and Young Adults [PDF - 210 KB - 9 pages]
J. M. Ferdinands et al.

We compared the prevalence of 8 polymorphisms in the tumor necrosis factor and mannose-binding lectin genes among 105 children and young adults with fatal influenza with US population estimates and determined in subanalyses whether these polymorphisms were associated with sudden death and bacterial co-infection among persons with fatal influenza. No differences were observed in genotype prevalence or minor allele frequencies between persons with fatal influenza and the reference sample. Fatal cases with low-producing MBL2 genotypes had a 7-fold increased risk for invasive methicillin-resistant Staphylococcus aureus (MRSA) co-infection compared with fatal cases with high- and intermediate-producing MBL2 genotypes (odds ratio 7.1, 95% confidence interval 1.6–32.1). Limited analysis of 2 genes important to the innate immune response found no association between genetic variants and fatal influenza infection. Among children and young adults who died of influenza, low-producing MBL2 genotypes may have increased risk for MRSA co-infection.

EID Ferdinands JM, Denison AM, Dowling NF, Jost HA, Gwinn ML, Liu L, et al. A Pilot Study of Host Genetic Variants Associated with Influenza-associated Deaths among Children and Young Adults. Emerg Infect Dis. 2011;17(12):2294-2302. https://dx.doi.org/10.3201/eid1712.111002
AMA Ferdinands JM, Denison AM, Dowling NF, et al. A Pilot Study of Host Genetic Variants Associated with Influenza-associated Deaths among Children and Young Adults. Emerging Infectious Diseases. 2011;17(12):2294-2302. doi:10.3201/eid1712.111002.
APA Ferdinands, J. M., Denison, A. M., Dowling, N. F., Jost, H. A., Gwinn, M. L., Liu, L....Shay, D. K. (2011). A Pilot Study of Host Genetic Variants Associated with Influenza-associated Deaths among Children and Young Adults. Emerging Infectious Diseases, 17(12), 2294-2302. https://dx.doi.org/10.3201/eid1712.111002.
Dispatches

Severe Human Bocavirus Infection, Germany [PDF - 229 KB]
R. W. Körner et al.

Human bocavirus (HBoV), discovered in 2005, can cause respiratory disease or no symptoms at all. We confirmed HBoV infection in an 8-month-old girl with hypoxia, respiratory distress, wheezing, cough, and fever. This case demonstrates that lower respiratory tract infection caused by HBoV can lead to severe and life-threatening disease.

EID Körner RW, Söderlund-Venermo M, van Koningsbruggen-Rietschel S, Kaiser R, Malecki M, Schildgen O. Severe Human Bocavirus Infection, Germany. Emerg Infect Dis. 2011;17(12):2303-2305. https://dx.doi.org/10.3201/eid1712.110574
AMA Körner RW, Söderlund-Venermo M, van Koningsbruggen-Rietschel S, et al. Severe Human Bocavirus Infection, Germany. Emerging Infectious Diseases. 2011;17(12):2303-2305. doi:10.3201/eid1712.110574.
APA Körner, R. W., Söderlund-Venermo, M., van Koningsbruggen-Rietschel, S., Kaiser, R., Malecki, M., & Schildgen, O. (2011). Severe Human Bocavirus Infection, Germany. Emerging Infectious Diseases, 17(12), 2303-2305. https://dx.doi.org/10.3201/eid1712.110574.

Continuing Threat of Influenza (H5N1) Virus Circulation in Egypt [PDF - 168 KB - 3 pages]
M. Oh et al.

Reservoirs for the continuing influenza (H5N1) outbreaks in Egypt are ill-defined. Through active surveillance, we detected highly pathogenic influenza subtype H5 viruses in all poultry sectors; incidence was 5%. No other subtypes were found. Continued circulation of influenza (H5N1) viruses in various regions and poultry sectors perpetuates human exposure in Egypt.

EID Oh M, El-Shesheny R, Kutkat MA, Kandeil A, Mostafa A, Ducatez MF, et al. Continuing Threat of Influenza (H5N1) Virus Circulation in Egypt. Emerg Infect Dis. 2011;17(12):2306-2308. https://dx.doi.org/10.3201/eid1712.110683
AMA Oh M, El-Shesheny R, Kutkat MA, et al. Continuing Threat of Influenza (H5N1) Virus Circulation in Egypt. Emerging Infectious Diseases. 2011;17(12):2306-2308. doi:10.3201/eid1712.110683.
APA Oh, M., El-Shesheny, R., Kutkat, M. A., Kandeil, A., Mostafa, A., Ducatez, M. F....Ali, M. A. (2011). Continuing Threat of Influenza (H5N1) Virus Circulation in Egypt. Emerging Infectious Diseases, 17(12), 2306-2308. https://dx.doi.org/10.3201/eid1712.110683.

Hepatitis E Virus Antibodies in Blood Donors, France [PDF - 219 KB - 4 pages]
J. Mansuy et al.

Using a validated sensitive assay, we found hepatitis E virus (HEV) IgG in 52.5% of voluntary blood donors in southwestern France. This finding suggests HEV is highly endemic to this region. The high HEV prevalence may reflect local dietary practices, such as eating uncooked pork and game products.

EID Mansuy J, Bendall R, Legrand-Abravanel F, Sauné K, Miédouge M, Ellis V, et al. Hepatitis E Virus Antibodies in Blood Donors, France. Emerg Infect Dis. 2011;17(12):2309-2312. https://dx.doi.org/10.3201/eid1712.110371
AMA Mansuy J, Bendall R, Legrand-Abravanel F, et al. Hepatitis E Virus Antibodies in Blood Donors, France. Emerging Infectious Diseases. 2011;17(12):2309-2312. doi:10.3201/eid1712.110371.
APA Mansuy, J., Bendall, R., Legrand-Abravanel, F., Sauné, K., Miédouge, M., Ellis, V....Izopet, J. (2011). Hepatitis E Virus Antibodies in Blood Donors, France. Emerging Infectious Diseases, 17(12), 2309-2312. https://dx.doi.org/10.3201/eid1712.110371.

Human Cardioviruses, Meningitis, and Sudden Infant Death Syndrome in Children [PDF - 206 KB - 3 pages]
A. Bispo de Filippis et al.

Cardioviruses cause myocarditis and encephalomyelitis in rodents; human cardioviruses have not been ascribed to any disease. We screened 6,854 cerebrospinal fluid and 10 myocardium specimens from children and adults. A genotype 2 cardiovirus was detected from a child who died of sudden infant death syndrome, and 2 untypeable cardioviruses were detected from 2 children with meningitis.

EID Bispo de Filippis A, Baumgarte S, Eschbach-Bludau M, Simon A, Kemen C, Bode U, et al. Human Cardioviruses, Meningitis, and Sudden Infant Death Syndrome in Children. Emerg Infect Dis. 2011;17(12):2313-2315. https://dx.doi.org/10.3201/eid1712.111037
AMA Bispo de Filippis A, Baumgarte S, Eschbach-Bludau M, et al. Human Cardioviruses, Meningitis, and Sudden Infant Death Syndrome in Children. Emerging Infectious Diseases. 2011;17(12):2313-2315. doi:10.3201/eid1712.111037.
APA Bispo de Filippis, A., Baumgarte, S., Eschbach-Bludau, M., Simon, A., Kemen, C., Bode, U....Drosten, C. (2011). Human Cardioviruses, Meningitis, and Sudden Infant Death Syndrome in Children. Emerging Infectious Diseases, 17(12), 2313-2315. https://dx.doi.org/10.3201/eid1712.111037.

Seroprevalence of Alkhurma and Other Hemorrhagic Fever Viruses, Saudi Arabia [PDF - 161 KB]
Z. A. Memish et al.

A 2009 deployment of military units from several Saudi Arabian provinces to Jazan Province, Saudi Arabia, enabled us to evaluate exposure to Alkhurma, Crimean-Congo, dengue, and Rift Valley hemorrhagic fever viruses. Seroprevalence to all viruses was low; however, Alkhurma virus seroprevalence was higher (1.3%) and less geographically restricted than previously thought.

EID Memish ZA, Albarrak A, Almazroa MA, Al-Omar I, Alhakeem R, Assiri AM, et al. Seroprevalence of Alkhurma and Other Hemorrhagic Fever Viruses, Saudi Arabia. Emerg Infect Dis. 2011;17(12):2316-2318. https://dx.doi.org/10.3201/eid1712.110658
AMA Memish ZA, Albarrak A, Almazroa MA, et al. Seroprevalence of Alkhurma and Other Hemorrhagic Fever Viruses, Saudi Arabia. Emerging Infectious Diseases. 2011;17(12):2316-2318. doi:10.3201/eid1712.110658.
APA Memish, Z. A., Albarrak, A., Almazroa, M. A., Al-Omar, I., Alhakeem, R., Assiri, A. M....Stephens, G. (2011). Seroprevalence of Alkhurma and Other Hemorrhagic Fever Viruses, Saudi Arabia. Emerging Infectious Diseases, 17(12), 2316-2318. https://dx.doi.org/10.3201/eid1712.110658.

Knowledge of Avian Influenza (H5N1) among Poultry Workers, Hong Kong, China [PDF - 294 KB - 3 pages]
J. H. Kim et al.

In 2009, a cross-sectional survey of 360 poultry workers in Hong Kong, China, showed that workers had inadequate levels of avian influenza (H5N1) risk knowledge, preventive behavior, and outbreak preparedness. The main barriers to preventive practices were low perceived benefits and interference with work. Poultry workers require occupation-specific health promotion.

EID Kim JH, Lo FK, Cheuk KK, Kwong MS, Goggins WB, Cai YS, et al. Knowledge of Avian Influenza (H5N1) among Poultry Workers, Hong Kong, China. Emerg Infect Dis. 2011;17(12):2319-2321. https://dx.doi.org/10.3201/eid1712.110321
AMA Kim JH, Lo FK, Cheuk KK, et al. Knowledge of Avian Influenza (H5N1) among Poultry Workers, Hong Kong, China. Emerging Infectious Diseases. 2011;17(12):2319-2321. doi:10.3201/eid1712.110321.
APA Kim, J. H., Lo, F. K., Cheuk, K. K., Kwong, M. S., Goggins, W. B., Cai, Y. S....Griffiths, S. (2011). Knowledge of Avian Influenza (H5N1) among Poultry Workers, Hong Kong, China. Emerging Infectious Diseases, 17(12), 2319-2321. https://dx.doi.org/10.3201/eid1712.110321.

Risk for Human African Trypanosomiasis, Central Africa, 2000–2009 [PDF - 221 KB - 3 pages]
P. P. Simarro et al.

Comprehensive georeference records for human African trypanosomiasis in Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, and Gabon were combined with human population layers to estimate a kernel-smoothed relative risk function. Five risk categories were mapped, and ≈3.5 million persons were estimated to be at risk for this disease.

EID Simarro PP, Cecchi G, Franco JR, Paone M, Fèvre EM, Diarra A, et al. Risk for Human African Trypanosomiasis, Central Africa, 2000–2009. Emerg Infect Dis. 2011;17(12):2322-2324. https://dx.doi.org/10.3201/eid1712.110921
AMA Simarro PP, Cecchi G, Franco JR, et al. Risk for Human African Trypanosomiasis, Central Africa, 2000–2009. Emerging Infectious Diseases. 2011;17(12):2322-2324. doi:10.3201/eid1712.110921.
APA Simarro, P. P., Cecchi, G., Franco, J. R., Paone, M., Fèvre, E. M., Diarra, A....Jannin, J. G. (2011). Risk for Human African Trypanosomiasis, Central Africa, 2000–2009. Emerging Infectious Diseases, 17(12), 2322-2324. https://dx.doi.org/10.3201/eid1712.110921.

Animal Diseases Caused by Orbiviruses, Algeria [PDF - 179 KB - 3 pages]
H. Madani et al.

Antibodies against bluetongue virus were detected in cattle, sheep, goats, and camels in Algeria in 2008. Antibodies against epizootic hemorrhagic disease virus were detected in cattle, but antibodies against African horse sickness virus were not detected in horses and mules. Epizootic hemorrhagic disease in northern Africa poses a major risk for the European Union.

EID Madani H, Casal J, Alba A, Allepuz A, Cêtre-Sossah C, Hafsi L, et al. Animal Diseases Caused by Orbiviruses, Algeria. Emerg Infect Dis. 2011;17(12):2325-2327. https://dx.doi.org/10.3201/eid1712.110928
AMA Madani H, Casal J, Alba A, et al. Animal Diseases Caused by Orbiviruses, Algeria. Emerging Infectious Diseases. 2011;17(12):2325-2327. doi:10.3201/eid1712.110928.
APA Madani, H., Casal, J., Alba, A., Allepuz, A., Cêtre-Sossah, C., Hafsi, L....Napp, S. (2011). Animal Diseases Caused by Orbiviruses, Algeria. Emerging Infectious Diseases, 17(12), 2325-2327. https://dx.doi.org/10.3201/eid1712.110928.

Genogroup I and II Picobirnaviruses in Respiratory Tracts of Pigs [PDF - 180 KB - 3 pages]
S. L. Smits et al.

Sequence-independent amplification and specific reverse transcription PCRs identified genogroup I and II picobirnaviruses in respiratory tracts of pigs. These data expand knowledge of picobirnavirus diversity and tropism. Genetic relationships between porcine respiratory and human enteric picobirnaviruses suggest cross-species transmission of picobirnaviruses between pigs and humans.

EID Smits SL, Poon LL, van Leeuwen M, Lau P, Perera HK, Peiris JS, et al. Genogroup I and II Picobirnaviruses in Respiratory Tracts of Pigs. Emerg Infect Dis. 2011;17(12):2328-2330. https://dx.doi.org/10.3201/eid1712.110934
AMA Smits SL, Poon LL, van Leeuwen M, et al. Genogroup I and II Picobirnaviruses in Respiratory Tracts of Pigs. Emerging Infectious Diseases. 2011;17(12):2328-2330. doi:10.3201/eid1712.110934.
APA Smits, S. L., Poon, L. L., van Leeuwen, M., Lau, P., Perera, H. K., Peiris, J. S....Osterhaus, A. (2011). Genogroup I and II Picobirnaviruses in Respiratory Tracts of Pigs. Emerging Infectious Diseases, 17(12), 2328-2330. https://dx.doi.org/10.3201/eid1712.110934.

High Prevalence of Human Liver Infection by Amphimerus spp. Flukes, Ecuador [PDF - 363 KB - 4 pages]
M. Calvopiña et al.

Amphimerus spp. flukes are known to infect mammals, but human infections have not been confirmed. Microscopy of fecal samples from 397 persons from Ecuador revealed Opisthorchiidae eggs in 71 (24%) persons. Light microscopy of adult worms and scanning electron microscopy of eggs were compatible with descriptions of Amphimerus spp. This pathogen was only observed in communities that consumed undercooked fish.

EID Calvopiña M, Cevallos W, Kumazawa H, Eisenberg J. High Prevalence of Human Liver Infection by Amphimerus spp. Flukes, Ecuador. Emerg Infect Dis. 2011;17(12):2331-2334. https://dx.doi.org/10.3201/eid1712.110373
AMA Calvopiña M, Cevallos W, Kumazawa H, et al. High Prevalence of Human Liver Infection by Amphimerus spp. Flukes, Ecuador. Emerging Infectious Diseases. 2011;17(12):2331-2334. doi:10.3201/eid1712.110373.
APA Calvopiña, M., Cevallos, W., Kumazawa, H., & Eisenberg, J. (2011). High Prevalence of Human Liver Infection by Amphimerus spp. Flukes, Ecuador. Emerging Infectious Diseases, 17(12), 2331-2334. https://dx.doi.org/10.3201/eid1712.110373.

Aedes aegypti Mosquitoes Imported into the Netherlands, 2010 [PDF - 395 KB - 3 pages]
J. E. Brown et al.

During summer 2010, Aedes aegypti mosquitoes were discovered in the Netherlands. Using genetic markers, we tracked the origin of these mosquitoes to a tire shipment from Miami, Florida, USA. Surveillance of tire exports from the United States should be included as part of a comprehensive surveillance system.

EID Brown JE, Scholte E, Dik M, Den Hartog W, Beeuwkes J, Powell JR. Aedes aegypti Mosquitoes Imported into the Netherlands, 2010. Emerg Infect Dis. 2011;17(12):2335-2337. https://dx.doi.org/10.3201/eid1712.110992
AMA Brown JE, Scholte E, Dik M, et al. Aedes aegypti Mosquitoes Imported into the Netherlands, 2010. Emerging Infectious Diseases. 2011;17(12):2335-2337. doi:10.3201/eid1712.110992.
APA Brown, J. E., Scholte, E., Dik, M., Den Hartog, W., Beeuwkes, J., & Powell, J. R. (2011). Aedes aegypti Mosquitoes Imported into the Netherlands, 2010. Emerging Infectious Diseases, 17(12), 2335-2337. https://dx.doi.org/10.3201/eid1712.110992.

Fatal Outbreak of Mycoplasma capricolum Pneumonia in Endangered Markhors [PDF - 394 KB]
S. Ostrowski et al.

A pneumonia outbreak reduced the numbers of a wild population of endangered markhors (Capra falconeri) in Tajikistan in 2010. The infection was diagnosed by histologic examination and bacteriologic testing. Mycoplasma capricolum subsp. capricolum was the sole infectious agent detected. Cross-species transmission from domestic goats may have occurred.

EID Ostrowski S, Thiaucourt F, Amirbekov M, Mahmadshoev A, Manso-Silván L, Dupuy V, et al. Fatal Outbreak of Mycoplasma capricolum Pneumonia in Endangered Markhors. Emerg Infect Dis. 2011;17(12):2338-2341. https://dx.doi.org/10.3201/eid1712.110187
AMA Ostrowski S, Thiaucourt F, Amirbekov M, et al. Fatal Outbreak of Mycoplasma capricolum Pneumonia in Endangered Markhors. Emerging Infectious Diseases. 2011;17(12):2338-2341. doi:10.3201/eid1712.110187.
APA Ostrowski, S., Thiaucourt, F., Amirbekov, M., Mahmadshoev, A., Manso-Silván, L., Dupuy, V....Michel, S. (2011). Fatal Outbreak of Mycoplasma capricolum Pneumonia in Endangered Markhors. Emerging Infectious Diseases, 17(12), 2338-2341. https://dx.doi.org/10.3201/eid1712.110187.

Characterization of African Swine Fever Virus Caucasus Isolate in European Wild Boars [PDF - 293 KB - 4 pages]
C. Gabriel et al.

Since 2007, African swine fever has spread from the Caucasus region. To learn more about the dynamics of the disease in wild boars (Sus scrofa), we conducted experiments by using European wild boars. We found high virulence of Caucasus isolates limited potential for establishment of endemicity.

EID Gabriel C, Blome S, Malogolovkin A, Parilov S, Kolbasov D, Teifke JP, et al. Characterization of African Swine Fever Virus Caucasus Isolate in European Wild Boars. Emerg Infect Dis. 2011;17(12):2342-2345. https://dx.doi.org/10.3201/eid1712.110430
AMA Gabriel C, Blome S, Malogolovkin A, et al. Characterization of African Swine Fever Virus Caucasus Isolate in European Wild Boars. Emerging Infectious Diseases. 2011;17(12):2342-2345. doi:10.3201/eid1712.110430.
APA Gabriel, C., Blome, S., Malogolovkin, A., Parilov, S., Kolbasov, D., Teifke, J. P....Beer, M. (2011). Characterization of African Swine Fever Virus Caucasus Isolate in European Wild Boars. Emerging Infectious Diseases, 17(12), 2342-2345. https://dx.doi.org/10.3201/eid1712.110430.

Novel Sylvatic Rabies Virus Variant in Endangered Golden Palm Civet, Sri Lanka [PDF - 342 KB - 4 pages]
T. Matsumoto et al.

Information is scarce about sylvatic rabies virus in Asia and about rabies in palm civets. We report a novel sylvatic rabies virus variant detected in a golden palm civet in Sri Lanka. Evolutionary analysis suggests the virus diverged from canine rabies viruses in Sri Lanka in ≈1933 (range 1886–1963).

EID Matsumoto T, Ahmed K, Wimalaratne O, Nanayakkara S, Perera D, Karunanayake D, et al. Novel Sylvatic Rabies Virus Variant in Endangered Golden Palm Civet, Sri Lanka. Emerg Infect Dis. 2011;17(12):2346-2349. https://dx.doi.org/10.3201/eid1712.110811
AMA Matsumoto T, Ahmed K, Wimalaratne O, et al. Novel Sylvatic Rabies Virus Variant in Endangered Golden Palm Civet, Sri Lanka. Emerging Infectious Diseases. 2011;17(12):2346-2349. doi:10.3201/eid1712.110811.
APA Matsumoto, T., Ahmed, K., Wimalaratne, O., Nanayakkara, S., Perera, D., Karunanayake, D....Nishizono, A. (2011). Novel Sylvatic Rabies Virus Variant in Endangered Golden Palm Civet, Sri Lanka. Emerging Infectious Diseases, 17(12), 2346-2349. https://dx.doi.org/10.3201/eid1712.110811.

Rickettsia parkeri in Amblyomma maculatum Ticks, North Carolina, USA, 2009–2010 [PDF - 408 KB - 4 pages]
A. S. Varela-Stokes et al.

We detected Rickettsia parkeri in 20%−33% of Amblyomma maculatum ticks sampled in North Carolina. Results highlight the high frequencies of R. parkeri–infected ticks in the state with the highest annual incidence of Rocky Mountain spotted fever. Epidemiologic studies are needed to definitively link R. parkeri to cases of spotted fever rickettsiosis.

EID Varela-Stokes AS, Paddock CD, Engber B, Toliver M. Rickettsia parkeri in Amblyomma maculatum Ticks, North Carolina, USA, 2009–2010. Emerg Infect Dis. 2011;17(12):2350-2353. https://dx.doi.org/10.3201/eid1712.110789
AMA Varela-Stokes AS, Paddock CD, Engber B, et al. Rickettsia parkeri in Amblyomma maculatum Ticks, North Carolina, USA, 2009–2010. Emerging Infectious Diseases. 2011;17(12):2350-2353. doi:10.3201/eid1712.110789.
APA Varela-Stokes, A. S., Paddock, C. D., Engber, B., & Toliver, M. (2011). Rickettsia parkeri in Amblyomma maculatum Ticks, North Carolina, USA, 2009–2010. Emerging Infectious Diseases, 17(12), 2350-2353. https://dx.doi.org/10.3201/eid1712.110789.

Japanese Encephalitis Virus Genotype Replacement, Taiwan, 2009–2010 [PDF - 202 KB - 3 pages]
Y. Chen et al.

Genotype I of Japanese encephalitis virus first appeared in Taiwan in 2008. Phylogenetic analysis of 37 viruses from pig farms in 2009–2010 classified these viruses into 2 unique subclusters of genotype I viruses and suggested multiple introductions and swift replacement of genotype III by genotype I virus in Taiwan.

EID Chen Y, Fan Y, Tu W, Chang R, Shih C, Lu I, et al. Japanese Encephalitis Virus Genotype Replacement, Taiwan, 2009–2010. Emerg Infect Dis. 2011;17(12):2354-2356. https://dx.doi.org/10.3201/eid1712.110914
AMA Chen Y, Fan Y, Tu W, et al. Japanese Encephalitis Virus Genotype Replacement, Taiwan, 2009–2010. Emerging Infectious Diseases. 2011;17(12):2354-2356. doi:10.3201/eid1712.110914.
APA Chen, Y., Fan, Y., Tu, W., Chang, R., Shih, C., Lu, I....Chiou, S. (2011). Japanese Encephalitis Virus Genotype Replacement, Taiwan, 2009–2010. Emerging Infectious Diseases, 17(12), 2354-2356. https://dx.doi.org/10.3201/eid1712.110914.

Altitude-dependent Bartonella quintana Genotype C in Head Lice, Ethiopia [PDF - 194 KB - 3 pages]
E. Angelakis et al.

To determine the presence of Bartonella quintana in head and body lice from persons in different locations in Ethiopia, we used molecular methods. B. quintana was found in 19 (7%) genotype C head lice and in 76 (18%) genotype A body lice. B. quintana in head lice was positively linked to altitude (p = 0.014).

EID Angelakis E, Diatta G, Abdissa A, Trape J, Mediannikov O, Richet H, et al. Altitude-dependent Bartonella quintana Genotype C in Head Lice, Ethiopia. Emerg Infect Dis. 2011;17(12):2357-2359. https://dx.doi.org/10.3201/eid1712.110453
AMA Angelakis E, Diatta G, Abdissa A, et al. Altitude-dependent Bartonella quintana Genotype C in Head Lice, Ethiopia. Emerging Infectious Diseases. 2011;17(12):2357-2359. doi:10.3201/eid1712.110453.
APA Angelakis, E., Diatta, G., Abdissa, A., Trape, J., Mediannikov, O., Richet, H....Raoult, D. (2011). Altitude-dependent Bartonella quintana Genotype C in Head Lice, Ethiopia. Emerging Infectious Diseases, 17(12), 2357-2359. https://dx.doi.org/10.3201/eid1712.110453.

Proximity to Goat Farms and Coxiella burnetii Seroprevalence among Pregnant Women [PDF - 266 KB - 4 pages]
W. van der Hoek et al.

During 2007–2009, we tested serum samples from 2,004 pregnant women living in an area of high Q fever incidence in the Netherlands. Results confirmed that presence of antibodies against Coxiella burnetii is related to proximity to infected dairy goat farms. Pregnant women and patients with certain cardiovascular conditions should avoid these farms.

EID van der Hoek W, Meekelenkamp JC, Dijkstra F, Notermans D, Bom B, Vellema P, et al. Proximity to Goat Farms and Coxiella burnetii Seroprevalence among Pregnant Women. Emerg Infect Dis. 2011;17(12):2360-2363. https://dx.doi.org/10.3201/eid1712.110738
AMA van der Hoek W, Meekelenkamp JC, Dijkstra F, et al. Proximity to Goat Farms and Coxiella burnetii Seroprevalence among Pregnant Women. Emerging Infectious Diseases. 2011;17(12):2360-2363. doi:10.3201/eid1712.110738.
APA van der Hoek, W., Meekelenkamp, J. C., Dijkstra, F., Notermans, D., Bom, B., Vellema, P....Leenders, A. C. (2011). Proximity to Goat Farms and Coxiella burnetii Seroprevalence among Pregnant Women. Emerging Infectious Diseases, 17(12), 2360-2363. https://dx.doi.org/10.3201/eid1712.110738.
Commentaries

In Memoriam: Washington C. (Wash) Winn Jr. (1941–2011) [PDF - 182 KB - 2 pages]
D. H. Walker et al.
EID Walker DH, LaSala R, Pritt B, Koneman E, Miller JM. In Memoriam: Washington C. (Wash) Winn Jr. (1941–2011). Emerg Infect Dis. 2011;17(12):2400-2401. https://dx.doi.org/10.3201/eid1712.im1712
AMA Walker DH, LaSala R, Pritt B, et al. In Memoriam: Washington C. (Wash) Winn Jr. (1941–2011). Emerging Infectious Diseases. 2011;17(12):2400-2401. doi:10.3201/eid1712.im1712.
APA Walker, D. H., LaSala, R., Pritt, B., Koneman, E., & Miller, J. M. (2011). In Memoriam: Washington C. (Wash) Winn Jr. (1941–2011). Emerging Infectious Diseases, 17(12), 2400-2401. https://dx.doi.org/10.3201/eid1712.im1712.
Photo Quizzes

Photo Quiz [PDF - 180 KB - 3 pages]
M. G. Schultz and P. Schantz
EID Schultz MG, Schantz P. Photo Quiz. Emerg Infect Dis. 2011;17(12):2365-2367. https://dx.doi.org/10.3201/eid1712.110484
AMA Schultz MG, Schantz P. Photo Quiz. Emerging Infectious Diseases. 2011;17(12):2365-2367. doi:10.3201/eid1712.110484.
APA Schultz, M. G., & Schantz, P. (2011). Photo Quiz. Emerging Infectious Diseases, 17(12), 2365-2367. https://dx.doi.org/10.3201/eid1712.110484.
Letters

Q Fever in Woolsorters, Belgium [PDF - 133 KB]
P. Wattiau et al.
EID Wattiau P, Boldisova E, Toman R, Van Esbroeck M, Quoilin S, Hammadi S, et al. Q Fever in Woolsorters, Belgium. Emerg Infect Dis. 2011;17(12):2368-2369. https://dx.doi.org/10.3201/eid1712.101786
AMA Wattiau P, Boldisova E, Toman R, et al. Q Fever in Woolsorters, Belgium. Emerging Infectious Diseases. 2011;17(12):2368-2369. doi:10.3201/eid1712.101786.
APA Wattiau, P., Boldisova, E., Toman, R., Van Esbroeck, M., Quoilin, S., Hammadi, S....Fretin, D. (2011). Q Fever in Woolsorters, Belgium. Emerging Infectious Diseases, 17(12), 2368-2369. https://dx.doi.org/10.3201/eid1712.101786.

Coxiella burnetii Infection in Roe Deer during Q Fever Epidemic, the Netherlands [PDF - 171 KB - 3 pages]
J. M. Rijks et al.
EID Rijks JM, Roest HI, van Tulden PW, Kik MJ, IJzer J, Gröne A. Coxiella burnetii Infection in Roe Deer during Q Fever Epidemic, the Netherlands. Emerg Infect Dis. 2011;17(12):2369-2371. https://dx.doi.org/10.3201/eid1712.110580
AMA Rijks JM, Roest HI, van Tulden PW, et al. Coxiella burnetii Infection in Roe Deer during Q Fever Epidemic, the Netherlands. Emerging Infectious Diseases. 2011;17(12):2369-2371. doi:10.3201/eid1712.110580.
APA Rijks, J. M., Roest, H. I., van Tulden, P. W., Kik, M. J., IJzer, J., & Gröne, A. (2011). Coxiella burnetii Infection in Roe Deer during Q Fever Epidemic, the Netherlands. Emerging Infectious Diseases, 17(12), 2369-2371. https://dx.doi.org/10.3201/eid1712.110580.

Ranavirosis in Invasive Bullfrogs, Belgium [PDF - 135 KB]
M. Sharifian-Fard et al.
EID Sharifian-Fard M, Pasmans F, Adriaensen C, Devisscher S, Adriaens T, Louette G, et al. Ranavirosis in Invasive Bullfrogs, Belgium. Emerg Infect Dis. 2011;17(12):2371-2372. https://dx.doi.org/10.3201/eid1712.110236
AMA Sharifian-Fard M, Pasmans F, Adriaensen C, et al. Ranavirosis in Invasive Bullfrogs, Belgium. Emerging Infectious Diseases. 2011;17(12):2371-2372. doi:10.3201/eid1712.110236.
APA Sharifian-Fard, M., Pasmans, F., Adriaensen, C., Devisscher, S., Adriaens, T., Louette, G....Martel, A. (2011). Ranavirosis in Invasive Bullfrogs, Belgium. Emerging Infectious Diseases, 17(12), 2371-2372. https://dx.doi.org/10.3201/eid1712.110236.

Rift Valley and West Nile Virus Antibodies in Camels, North Africa [PDF - 142 KB]
M. El-Harrak et al.
EID El-Harrak M, Martín-Folgar R, Llorente F, Fernández-Pacheco P, Brun A, Figuerola J, et al. Rift Valley and West Nile Virus Antibodies in Camels, North Africa. Emerg Infect Dis. 2011;17(12):2372-2374. https://dx.doi.org/10.3201/eid1712.110587
AMA El-Harrak M, Martín-Folgar R, Llorente F, et al. Rift Valley and West Nile Virus Antibodies in Camels, North Africa. Emerging Infectious Diseases. 2011;17(12):2372-2374. doi:10.3201/eid1712.110587.
APA El-Harrak, M., Martín-Folgar, R., Llorente, F., Fernández-Pacheco, P., Brun, A., Figuerola, J....Jiménez-Clavero, M. (2011). Rift Valley and West Nile Virus Antibodies in Camels, North Africa. Emerging Infectious Diseases, 17(12), 2372-2374. https://dx.doi.org/10.3201/eid1712.110587.

Brucellosis, Taiwan, 2011 [PDF - 134 KB]
Y. Chuang et al.
EID Chuang Y, Chen S, Mu J, Lin H, Chang C, Yang W, et al. Brucellosis, Taiwan, 2011. Emerg Infect Dis. 2011;17(12):2374-2375. https://dx.doi.org/10.3201/eid1712.110739
AMA Chuang Y, Chen S, Mu J, et al. Brucellosis, Taiwan, 2011. Emerging Infectious Diseases. 2011;17(12):2374-2375. doi:10.3201/eid1712.110739.
APA Chuang, Y., Chen, S., Mu, J., Lin, H., Chang, C., Yang, W....Hsueh, P. (2011). Brucellosis, Taiwan, 2011. Emerging Infectious Diseases, 17(12), 2374-2375. https://dx.doi.org/10.3201/eid1712.110739.

Hemoptysis Associated with Leptospirosis Acquired in Hawaii, USA [PDF - 136 KB]
C. A. DuPlessis et al.
EID DuPlessis CA, Sklar MJ, Maves RC, Spichler A, Hale B, Johnson M, et al. Hemoptysis Associated with Leptospirosis Acquired in Hawaii, USA. Emerg Infect Dis. 2011;17(12):2375-2377. https://dx.doi.org/10.3201/eid1712.110700
AMA DuPlessis CA, Sklar MJ, Maves RC, et al. Hemoptysis Associated with Leptospirosis Acquired in Hawaii, USA. Emerging Infectious Diseases. 2011;17(12):2375-2377. doi:10.3201/eid1712.110700.
APA DuPlessis, C. A., Sklar, M. J., Maves, R. C., Spichler, A., Hale, B., Johnson, M....Vinetz, J. M. (2011). Hemoptysis Associated with Leptospirosis Acquired in Hawaii, USA. Emerging Infectious Diseases, 17(12), 2375-2377. https://dx.doi.org/10.3201/eid1712.110700.

Salmonella enterica in Pinnipeds, Chile [PDF - 133 KB]
N. Sturm et al.
EID Sturm N, Abalos P, Fernandez A, Rodriguez G, Oviedo P, Arroyo V, et al. Salmonella enterica in Pinnipeds, Chile. Emerg Infect Dis. 2011;17(12):2377-2378. https://dx.doi.org/10.3201/eid1712.111103
AMA Sturm N, Abalos P, Fernandez A, et al. Salmonella enterica in Pinnipeds, Chile. Emerging Infectious Diseases. 2011;17(12):2377-2378. doi:10.3201/eid1712.111103.
APA Sturm, N., Abalos, P., Fernandez, A., Rodriguez, G., Oviedo, P., Arroyo, V....Retamal, P. (2011). Salmonella enterica in Pinnipeds, Chile. Emerging Infectious Diseases, 17(12), 2377-2378. https://dx.doi.org/10.3201/eid1712.111103.

Changing Perception of Avian Influenza Risk, Hong Kong, 2006–2010 [PDF - 131 KB]
Q. Liao et al.
EID Liao Q, Cowling BJ, Lam WT, Fielding R. Changing Perception of Avian Influenza Risk, Hong Kong, 2006–2010. Emerg Infect Dis. 2011;17(12):2379-2380. https://dx.doi.org/10.3201/eid1712.110298
AMA Liao Q, Cowling BJ, Lam WT, et al. Changing Perception of Avian Influenza Risk, Hong Kong, 2006–2010. Emerging Infectious Diseases. 2011;17(12):2379-2380. doi:10.3201/eid1712.110298.
APA Liao, Q., Cowling, B. J., Lam, W. T., & Fielding, R. (2011). Changing Perception of Avian Influenza Risk, Hong Kong, 2006–2010. Emerging Infectious Diseases, 17(12), 2379-2380. https://dx.doi.org/10.3201/eid1712.110298.

Bat Rabies and Human Postexposure Prophylaxis, New York, USA [PDF - 199 KB]
M. Eidson et al.
EID Eidson M, Hagiwara Y, Rudd RJ, McNutt L. Bat Rabies and Human Postexposure Prophylaxis, New York, USA. Emerg Infect Dis. 2011;17(12):2380-2383. https://dx.doi.org/10.3201/eid1712.102024
AMA Eidson M, Hagiwara Y, Rudd RJ, et al. Bat Rabies and Human Postexposure Prophylaxis, New York, USA. Emerging Infectious Diseases. 2011;17(12):2380-2383. doi:10.3201/eid1712.102024.
APA Eidson, M., Hagiwara, Y., Rudd, R. J., & McNutt, L. (2011). Bat Rabies and Human Postexposure Prophylaxis, New York, USA. Emerging Infectious Diseases, 17(12), 2380-2383. https://dx.doi.org/10.3201/eid1712.102024.

Chrysosporium sp. Infection in Eastern Massasauga Rattlesnakes [PDF - 214 KB]
M. C. Allender et al.
EID Allender MC, Dreslik M, Wylie S, Phillips C, Wylie DB, Maddox C, et al. Chrysosporium sp. Infection in Eastern Massasauga Rattlesnakes. Emerg Infect Dis. 2011;17(12):2383-2384. https://dx.doi.org/10.3201/eid1712.110240
AMA Allender MC, Dreslik M, Wylie S, et al. Chrysosporium sp. Infection in Eastern Massasauga Rattlesnakes. Emerging Infectious Diseases. 2011;17(12):2383-2384. doi:10.3201/eid1712.110240.
APA Allender, M. C., Dreslik, M., Wylie, S., Phillips, C., Wylie, D. B., Maddox, C....Kinsel, M. J. (2011). Chrysosporium sp. Infection in Eastern Massasauga Rattlesnakes. Emerging Infectious Diseases, 17(12), 2383-2384. https://dx.doi.org/10.3201/eid1712.110240.

Cutaneous Myiasis in Traveler Returning from Ethiopia [PDF - 179 KB - 2 pages]
P. Hannam et al.
EID Hannam P, Khairnar K, Downey J, Powis J, Ralevski F, Pillai DR. Cutaneous Myiasis in Traveler Returning from Ethiopia. Emerg Infect Dis. 2011;17(12):2385-2386. https://dx.doi.org/10.3201/eid1712.111062
AMA Hannam P, Khairnar K, Downey J, et al. Cutaneous Myiasis in Traveler Returning from Ethiopia. Emerging Infectious Diseases. 2011;17(12):2385-2386. doi:10.3201/eid1712.111062.
APA Hannam, P., Khairnar, K., Downey, J., Powis, J., Ralevski, F., & Pillai, D. R. (2011). Cutaneous Myiasis in Traveler Returning from Ethiopia. Emerging Infectious Diseases, 17(12), 2385-2386. https://dx.doi.org/10.3201/eid1712.111062.

Brucella suis Infection in Dogs, Georgia, USA [PDF - 136 KB]
S. Ramamoorthy et al.
EID Ramamoorthy S, Woldemeskel M, Ligett A, Snider R, Cobb R, Rajeev S. Brucella suis Infection in Dogs, Georgia, USA. Emerg Infect Dis. 2011;17(12):2386-2387. https://dx.doi.org/10.3201/eid1712.111127
AMA Ramamoorthy S, Woldemeskel M, Ligett A, et al. Brucella suis Infection in Dogs, Georgia, USA. Emerging Infectious Diseases. 2011;17(12):2386-2387. doi:10.3201/eid1712.111127.
APA Ramamoorthy, S., Woldemeskel, M., Ligett, A., Snider, R., Cobb, R., & Rajeev, S. (2011). Brucella suis Infection in Dogs, Georgia, USA. Emerging Infectious Diseases, 17(12), 2386-2387. https://dx.doi.org/10.3201/eid1712.111127.

Iridovirus Infection in Chinese Giant Salamanders, China, 2010 [PDF - 267 KB - 2 pages]
W. Dong et al.
EID Dong W, Zhang X, Yang C, An J, Qin J, Song F, et al. Iridovirus Infection in Chinese Giant Salamanders, China, 2010. Emerg Infect Dis. 2011;17(12):2388-2389. https://dx.doi.org/10.3201/eid1712.101758
AMA Dong W, Zhang X, Yang C, et al. Iridovirus Infection in Chinese Giant Salamanders, China, 2010. Emerging Infectious Diseases. 2011;17(12):2388-2389. doi:10.3201/eid1712.101758.
APA Dong, W., Zhang, X., Yang, C., An, J., Qin, J., Song, F....Zeng, W. (2011). Iridovirus Infection in Chinese Giant Salamanders, China, 2010. Emerging Infectious Diseases, 17(12), 2388-2389. https://dx.doi.org/10.3201/eid1712.101758.

Vertical Transmission of Avian Bornavirus in Psittacines [PDF - 142 KB]
M. Lierz et al.
EID Lierz M, Piepenbring A, Herden C, Oberhäuser K, Heffels-Redmann U, Enderlein D. Vertical Transmission of Avian Bornavirus in Psittacines. Emerg Infect Dis. 2011;17(12):2390-2391. https://dx.doi.org/10.3201/eid1712.111317
AMA Lierz M, Piepenbring A, Herden C, et al. Vertical Transmission of Avian Bornavirus in Psittacines. Emerging Infectious Diseases. 2011;17(12):2390-2391. doi:10.3201/eid1712.111317.
APA Lierz, M., Piepenbring, A., Herden, C., Oberhäuser, K., Heffels-Redmann, U., & Enderlein, D. (2011). Vertical Transmission of Avian Bornavirus in Psittacines. Emerging Infectious Diseases, 17(12), 2390-2391. https://dx.doi.org/10.3201/eid1712.111317.

Novel Astroviruses in Children, Egypt [PDF - 180 KB]
S. F. Ahmed et al.
EID Ahmed SF, Sebeny PJ, Klena JD, Pimentel G, Mansour A, Naguib AM, et al. Novel Astroviruses in Children, Egypt. Emerg Infect Dis. 2011;17(12):2391-2393. https://dx.doi.org/10.3201/eid1712.110909
AMA Ahmed SF, Sebeny PJ, Klena JD, et al. Novel Astroviruses in Children, Egypt. Emerging Infectious Diseases. 2011;17(12):2391-2393. doi:10.3201/eid1712.110909.
APA Ahmed, S. F., Sebeny, P. J., Klena, J. D., Pimentel, G., Mansour, A., Naguib, A. M....Wang, D. (2011). Novel Astroviruses in Children, Egypt. Emerging Infectious Diseases, 17(12), 2391-2393. https://dx.doi.org/10.3201/eid1712.110909.

Humans as Source of Mycobacterium tuberculosis Infection in Cattle, Spain [PDF - 139 KB - 3 pages]
B. Romero et al.
EID Romero B, Rodríguez S, Bezos J, Díaz R, Copano MF, Merediz I, et al. Humans as Source of Mycobacterium tuberculosis Infection in Cattle, Spain. Emerg Infect Dis. 2011;17(12):2393-2395. https://dx.doi.org/10.3201/eid1712.101476
AMA Romero B, Rodríguez S, Bezos J, et al. Humans as Source of Mycobacterium tuberculosis Infection in Cattle, Spain. Emerging Infectious Diseases. 2011;17(12):2393-2395. doi:10.3201/eid1712.101476.
APA Romero, B., Rodríguez, S., Bezos, J., Díaz, R., Copano, M. F., Merediz, I....de Juan, L. (2011). Humans as Source of Mycobacterium tuberculosis Infection in Cattle, Spain. Emerging Infectious Diseases, 17(12), 2393-2395. https://dx.doi.org/10.3201/eid1712.101476.

Porcine and Human Community Reservoirs of Enterococcus faecalis, Denmark [PDF - 124 KB - 3 pages]
J. Larsen et al.
EID Larsen J, Schønheyder HC, Singh KV, Lester CH, Olsen SS, Porsbo LJ, et al. Porcine and Human Community Reservoirs of Enterococcus faecalis, Denmark. Emerg Infect Dis. 2011;17(12):2395-2397. https://dx.doi.org/10.3201/eid1712.101584
AMA Larsen J, Schønheyder HC, Singh KV, et al. Porcine and Human Community Reservoirs of Enterococcus faecalis, Denmark. Emerging Infectious Diseases. 2011;17(12):2395-2397. doi:10.3201/eid1712.101584.
APA Larsen, J., Schønheyder, H. C., Singh, K. V., Lester, C. H., Olsen, S. S., Porsbo, L. J....Hammerum, A. M. (2011). Porcine and Human Community Reservoirs of Enterococcus faecalis, Denmark. Emerging Infectious Diseases, 17(12), 2395-2397. https://dx.doi.org/10.3201/eid1712.101584.

West Nile Fever Outbreak in Horses and Humans, Spain, 2010 [PDF - 183 KB]
I. García-Bocanegra et al.
EID García-Bocanegra I, Jaén-Téllez JA, Napp S, Arenas-Montes A, Fernández-Morente M, Fernández-Molera V, et al. West Nile Fever Outbreak in Horses and Humans, Spain, 2010. Emerg Infect Dis. 2011;17(12):2397-2399. https://dx.doi.org/10.3201/eid1712.110651
AMA García-Bocanegra I, Jaén-Téllez JA, Napp S, et al. West Nile Fever Outbreak in Horses and Humans, Spain, 2010. Emerging Infectious Diseases. 2011;17(12):2397-2399. doi:10.3201/eid1712.110651.
APA García-Bocanegra, I., Jaén-Téllez, J. A., Napp, S., Arenas-Montes, A., Fernández-Morente, M., Fernández-Molera, V....Arenas, A. (2011). West Nile Fever Outbreak in Horses and Humans, Spain, 2010. Emerging Infectious Diseases, 17(12), 2397-2399. https://dx.doi.org/10.3201/eid1712.110651.
Another Dimension

The Life and Death of Anaplasma [PDF - 157 KB - 1 page]
S. Vora
EID Vora S. The Life and Death of Anaplasma. Emerg Infect Dis. 2011;17(12):2364. https://dx.doi.org/10.3201/eid1712.ad1712
AMA Vora S. The Life and Death of Anaplasma. Emerging Infectious Diseases. 2011;17(12):2364. doi:10.3201/eid1712.ad1712.
APA Vora, S. (2011). The Life and Death of Anaplasma. Emerging Infectious Diseases, 17(12), 2364. https://dx.doi.org/10.3201/eid1712.ad1712.
About the Cover

When snouted wild-boars routing tender corn / Anger our huntsman [PDF - 48 KB - 2 pages]
P. Potter
EID Potter P. When snouted wild-boars routing tender corn / Anger our huntsman. Emerg Infect Dis. 2011;17(12):2402-2403. https://dx.doi.org/10.3201/eid1712.ac1712
AMA Potter P. When snouted wild-boars routing tender corn / Anger our huntsman. Emerging Infectious Diseases. 2011;17(12):2402-2403. doi:10.3201/eid1712.ac1712.
APA Potter, P. (2011). When snouted wild-boars routing tender corn / Anger our huntsman. Emerging Infectious Diseases, 17(12), 2402-2403. https://dx.doi.org/10.3201/eid1712.ac1712.
Etymologia

Etymologia: Q Fever [PDF - 106 KB - 1 page]
N. Männikkö
EID Männikkö N. Etymologia: Q Fever. Emerg Infect Dis. 2011;17(12):2359. https://dx.doi.org/10.3201/eid1712.et1712
AMA Männikkö N. Etymologia: Q Fever. Emerging Infectious Diseases. 2011;17(12):2359. doi:10.3201/eid1712.et1712.
APA Männikkö, N. (2011). Etymologia: Q Fever. Emerging Infectious Diseases, 17(12), 2359. https://dx.doi.org/10.3201/eid1712.et1712.
Corrections

Correction: Vol. 17, No. 11 [PDF - 183 KB - 2 pages]
EID Correction: Vol. 17, No. 11. Emerg Infect Dis. 2011;17(12):2399. https://dx.doi.org/10.3201/eid1712.c11712
AMA Correction: Vol. 17, No. 11. Emerging Infectious Diseases. 2011;17(12):2399. doi:10.3201/eid1712.c11712.
APA (2011). Correction: Vol. 17, No. 11. Emerging Infectious Diseases, 17(12), 2399. https://dx.doi.org/10.3201/eid1712.c11712.
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Page updated: February 06, 2018
Page reviewed: February 06, 2018
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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