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Issue Cover for Volume 21, Number 11—November 2015

Volume 21, Number 11—November 2015

[PDF - 8.22 MB - 228 pages]

Perspective

Ebola in West Africa—CDC’s Role in Epidemic Detection, Control, and Prevention [PDF - 1.92 MB - 9 pages]
T. R. Frieden and I. K. Damon

Since Ebola virus disease was identified in West Africa on March 23, 2014, the Centers for Disease Control and Prevention (CDC) has undertaken the most intensive response in the agency’s history; >3,000 staff have been involved, including >1,200 deployed to West Africa for >50,000 person workdays. Efforts have included supporting incident management systems in affected countries; mobilizing partners; and strengthening laboratory, epidemiology, contact investigation, health care infection control, communication, and border screening in West Africa, Nigeria, Mali, Senegal, and the United States. All efforts were undertaken as part of national and global response activities with many partner organizations. CDC was able to support community, national, and international health and public health staff to prevent an even worse event. The Ebola virus disease epidemic highlights the need to strengthen national and international systems to detect, respond to, and prevent the spread of future health threats.

EID Frieden TR, Damon IK. Ebola in West Africa—CDC’s Role in Epidemic Detection, Control, and Prevention. Emerg Infect Dis. 2015;21(11):1897-1905. https://dx.doi.org/10.3201/eid2111.150949
AMA Frieden TR, Damon IK. Ebola in West Africa—CDC’s Role in Epidemic Detection, Control, and Prevention. Emerging Infectious Diseases. 2015;21(11):1897-1905. doi:10.3201/eid2111.150949.
APA Frieden, T. R., & Damon, I. K. (2015). Ebola in West Africa—CDC’s Role in Epidemic Detection, Control, and Prevention. Emerging Infectious Diseases, 21(11), 1897-1905. https://dx.doi.org/10.3201/eid2111.150949.
Synopses

Medscape CME Activity
Uncommon Candida Species Fungemia among Cancer Patients, Houston, Texas, USA [PDF - 940 KB - 9 pages]
D. Jung et al.

Many uncommon Candida species that cause bloodstream infections (BSIs) are not well-characterized. We investigated the epidemiology, antifungal use, susceptibility patterns, and factors associated with all-cause death among cancer patients in whom uncommon Candida spp. BSIs were diagnosed at a cancer treatment center during January 1998–September 2013. Of 1,395 Candida bloodstream isolates, 79 from 68 patients were uncommon Candida spp. The incidence density of uncommon Candida spp. BSIs and their proportion to all candidemia episodes substantively increased during the study period, and the rise was associated with increasing use of echinocandin antifungal drugs. Thirty-seven patients had breakthrough infections during therapy or prophylaxis with various systemic antifungal drugs for >7 consecutive days; 21 were receiving an echinocandin. C. kefyr (82%), and C. lusitaniae (21%) isolates frequently showed caspofungin MICs above the epidemiologic cutoff values. These findings support the need for institutional surveillance for uncommon Candida spp. among cancer patients.

EID Jung D, Farmakiotis D, Jiang Y, Tarrand JJ, Kontoyiannis DP. Uncommon Candida Species Fungemia among Cancer Patients, Houston, Texas, USA. Emerg Infect Dis. 2015;21(11):1942-1950. https://dx.doi.org/10.3201/eid2111.150404
AMA Jung D, Farmakiotis D, Jiang Y, et al. Uncommon Candida Species Fungemia among Cancer Patients, Houston, Texas, USA. Emerging Infectious Diseases. 2015;21(11):1942-1950. doi:10.3201/eid2111.150404.
APA Jung, D., Farmakiotis, D., Jiang, Y., Tarrand, J. J., & Kontoyiannis, D. P. (2015). Uncommon Candida Species Fungemia among Cancer Patients, Houston, Texas, USA. Emerging Infectious Diseases, 21(11), 1942-1950. https://dx.doi.org/10.3201/eid2111.150404.

Use of Internet Search Queries to Enhance Surveillance of Foodborne Illness [PDF - 730 KB - 8 pages]
G. Bahk et al.

As a supplement to or extension of methods used to determine trends in foodborne illness over time, we propose the use of Internet search metrics. We compared Internet query data for foodborne illness syndrome–related search terms from the most popular 5 Korean search engines using Health Insurance Review and Assessment Service inpatient stay data for 26 International Classification of Diseases, Tenth Revision, codes for foodborne illness in South Korea during 2010–2012. We used time-series analysis with Seasonal Autoregressive Integrated Moving Average (SARIMA) models. Internet search queries for “food poisoning” correlated most strongly with foodborne illness data (r = 0.70, p<0.001); furthermore, “food poisoning” queries correlated most strongly with the total number of inpatient stays related to foodborne illness during the next month (β = 0.069, SE 0.017, p<0.001). This approach, using the SARIMA model, could be used to effectively measure trends over time to enhance surveillance of foodborne illness in South Korea.

EID Bahk G, Kim Y, Park M. Use of Internet Search Queries to Enhance Surveillance of Foodborne Illness. Emerg Infect Dis. 2015;21(11):1906-1912. https://dx.doi.org/10.3201/eid2111.141834
AMA Bahk G, Kim Y, Park M. Use of Internet Search Queries to Enhance Surveillance of Foodborne Illness. Emerging Infectious Diseases. 2015;21(11):1906-1912. doi:10.3201/eid2111.141834.
APA Bahk, G., Kim, Y., & Park, M. (2015). Use of Internet Search Queries to Enhance Surveillance of Foodborne Illness. Emerging Infectious Diseases, 21(11), 1906-1912. https://dx.doi.org/10.3201/eid2111.141834.

Achievements in and Challenges of Tuberculosis Control in South Korea [PDF - 1.57 MB - 8 pages]
J. Kim and J. Yim

After the Korean War (1950–1953), nearly 6.5% of South Korea’s population had active tuberculosis (TB). In response, South Korea implemented the National Tuberculosis Program in 1962. From 1965 to 1995, the prevalence of bacteriologically confirmed pulmonary TB in South Korea decreased from 940 to 219 cases per 100,000 population. Astounding economic growth might have contributed to this result; however, TB incidence in South Korea remains the highest among high-income countries. The rate of decrease in TB incidence seems to have slowed over the past 15 years. A demographic shift toward an older population, many of whom have latent TB and various concurrent conditions, is challenging TB control efforts in South Korea. The increasing number of immigrants also plays a part in the prolonged battle against TB. A historical review of TB in South Korea provides an opportunity to understand national TB control efforts that are applicable to other parts of the world.

EID Kim J, Yim J. Achievements in and Challenges of Tuberculosis Control in South Korea. Emerg Infect Dis. 2015;21(11):1913-1920. https://dx.doi.org/10.3201/eid2111.141894
AMA Kim J, Yim J. Achievements in and Challenges of Tuberculosis Control in South Korea. Emerging Infectious Diseases. 2015;21(11):1913-1920. doi:10.3201/eid2111.141894.
APA Kim, J., & Yim, J. (2015). Achievements in and Challenges of Tuberculosis Control in South Korea. Emerging Infectious Diseases, 21(11), 1913-1920. https://dx.doi.org/10.3201/eid2111.141894.

Mycotic Infections Acquired outside Areas of Known Endemicity, United States [PDF - 579 KB - 6 pages]
K. Benedict et al.

In the United States, endemic mycoses—blastomycosis, coccidioidomycosis, and histoplasmosis—pose considerable clinical and public health challenges. Although the causative fungi typically exist within broadly defined geographic areas or ecologic niches, some evidence suggests that cases have occurred in humans and animals not exposed to these areas. We describe cases acquired outside regions of traditionally defined endemicity. These patients often have severe disease, but diagnosis may be delayed because of a low index of suspicion for mycotic disease, and many more cases probably go entirely undetected. Increased awareness of these diseases, with a specific focus on their potential occurrence in unusual areas, is needed. Continued interdisciplinary efforts to reevaluate and better describe areas of true endemicity are warranted, along with a more nuanced view of the notion of endemicity. The term “nonendemic” should be used with care; mycoses in such regions might more accurately be considered “not known to be endemic.”

EID Benedict K, Thompson GR, Deresinski S, Chiller TM. Mycotic Infections Acquired outside Areas of Known Endemicity, United States. Emerg Infect Dis. 2015;21(11):1935-1941. https://dx.doi.org/10.3201/eid2111.141950
AMA Benedict K, Thompson GR, Deresinski S, et al. Mycotic Infections Acquired outside Areas of Known Endemicity, United States. Emerging Infectious Diseases. 2015;21(11):1935-1941. doi:10.3201/eid2111.141950.
APA Benedict, K., Thompson, G. R., Deresinski, S., & Chiller, T. M. (2015). Mycotic Infections Acquired outside Areas of Known Endemicity, United States. Emerging Infectious Diseases, 21(11), 1935-1941. https://dx.doi.org/10.3201/eid2111.141950.

Ebola Virus Outbreak Investigation, Sierra Leone, September 28–November 11, 2014 [PDF - 1.45 MB - 7 pages]
H. Lu et al.

During 2014–2015, an outbreak of Ebola virus disease (EVD) swept across parts of West Africa. The China Mobile Laboratory Testing Team was dispatched to support response efforts; during September 28–November 11, 2014, they conducted PCR testing on samples from 1,635 suspected EVD patients. Of those patients, 50.4% were positive, of whom 84.6% lived within a 3-km zone along main roads connecting rural towns and densely populated cities. The median time from symptom onset to testing was 5 days. At testing, 75.7% of the confirmed patients had fever, and 94.1% reported at least 1 gastrointestinal symptom; all symptoms, except rash and hemorrhage, were more frequent in confirmed than nonconfirmed patients. Virus loads were significantly higher in EVD patients with fever, diarrhea, fatigue, or headache. The case-fatality rate was lower among patients 15–44 years of age and with virus loads of <100,000 RNA copies/mL. These findings are key for optimizing EVD control and treatment measures.

EID Lu H, Qian J, Kargbo D, Zhang X, Yang F, Hu Y, et al. Ebola Virus Outbreak Investigation, Sierra Leone, September 28–November 11, 2014. Emerg Infect Dis. 2015;21(11):1921-1927. https://dx.doi.org/10.3201/eid2111.150582
AMA Lu H, Qian J, Kargbo D, et al. Ebola Virus Outbreak Investigation, Sierra Leone, September 28–November 11, 2014. Emerging Infectious Diseases. 2015;21(11):1921-1927. doi:10.3201/eid2111.150582.
APA Lu, H., Qian, J., Kargbo, D., Zhang, X., Yang, F., Hu, Y....Jiang, J. (2015). Ebola Virus Outbreak Investigation, Sierra Leone, September 28–November 11, 2014. Emerging Infectious Diseases, 21(11), 1921-1927. https://dx.doi.org/10.3201/eid2111.150582.

Maternal Effects of Respiratory Syncytial Virus Infection during Pregnancy [PDF - 1.66 MB - 5 pages]
S. M. Wheeler et al.

Given the illness and deaths caused by respiratory syncytial virus (RSV) infection during the first year of life, preventing infant RSV infections through maternal vaccination is intriguing. However, little is known about the extent and maternal effects of RSV infection during pregnancy. We describe 3 cases of maternal RSV infection diagnosed at a US center during winter 2014. Case-patient 1 (26 years old, week 33 of gestation) received a diagnosis of RSV infection and required mechanical ventilation. Case-patient 2 (27 years old, week 34 of gestation) received a diagnosis of infection with influenza A(H1N1) virus and RSV and required mechanical ventilation. Case-patient 3 (21 years old, week 32 of gestation) received a diagnosis of group A streptococcus pharyngitis and RSV infection and was monitored as an outpatient. Clarifying the effects of maternal RSV infection could yield valuable insights into potential maternal and fetal benefits of an effective RSV vaccination program.

EID Wheeler SM, Dotters-Katz S, Heine R, Grotegut CA, Swamy GK. Maternal Effects of Respiratory Syncytial Virus Infection during Pregnancy. Emerg Infect Dis. 2015;21(11):1951-1955. https://dx.doi.org/10.3201/eid2111.150497
AMA Wheeler SM, Dotters-Katz S, Heine R, et al. Maternal Effects of Respiratory Syncytial Virus Infection during Pregnancy. Emerging Infectious Diseases. 2015;21(11):1951-1955. doi:10.3201/eid2111.150497.
APA Wheeler, S. M., Dotters-Katz, S., Heine, R., Grotegut, C. A., & Swamy, G. K. (2015). Maternal Effects of Respiratory Syncytial Virus Infection during Pregnancy. Emerging Infectious Diseases, 21(11), 1951-1955. https://dx.doi.org/10.3201/eid2111.150497.

Medscape CME Activity
Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E [PDF - 1.18 MB - 7 pages]
H. Perrin et al.

Neurologic disorders, mainly Guillain-Barré syndrome and Parsonage–Turner syndrome (PTS), have been described in patients with hepatitis E virus (HEV) infection in industrialized and developing countries. We report a wider range of neurologic disorders in nonimmunocompromised patients with acute HEV infection. Data from 15 French immunocompetent patients with acute HEV infection and neurologic disorders were retrospectively recorded from January 2006 through June 2013. The disorders could be divided into 4 main entities: mononeuritis multiplex, PTS, meningoradiculitis, and acute demyelinating neuropathy. HEV infection was treated with ribavirin in 3 patients (for PTS or mononeuritis multiplex). One patient was treated with corticosteroids (for mononeuropathy multiplex), and 5 others received intravenous immunoglobulin (for PTS, meningoradiculitis, Guillain-Barré syndrome, or Miller Fisher syndrome). We conclude that pleiotropic neurologic disorders are seen in HEV-infected immunocompetent patients. Patients with acute neurologic manifestations and aminotransferase abnormalities should be screened for HEV infection.

EID Perrin H, Cintas P, Abravanel F, Gérolami R, d'Alteroche L, Raynal J, et al. Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E. Emerg Infect Dis. 2015;21(11):1928-1934. https://dx.doi.org/10.3201/eid2111.141789
AMA Perrin H, Cintas P, Abravanel F, et al. Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E. Emerging Infectious Diseases. 2015;21(11):1928-1934. doi:10.3201/eid2111.141789.
APA Perrin, H., Cintas, P., Abravanel, F., Gérolami, R., d'Alteroche, L., Raynal, J....Peron, J. (2015). Neurologic Disorders in Immunocompetent Patients with Autochthonous Acute Hepatitis E. Emerging Infectious Diseases, 21(11), 1928-1934. https://dx.doi.org/10.3201/eid2111.141789.
Research

Contact Tracing Activities during the Ebola Virus Disease Epidemic in Kindia and Faranah, Guinea, 2014 [PDF - 1.23 MB - 8 pages]
M. G. Dixon et al.

The largest recorded Ebola virus disease epidemic began in March 2014; as of July 2015, it continued in 3 principally affected countries: Guinea, Liberia, and Sierra Leone. Control efforts include contact tracing to expedite identification of the virus in suspect case-patients. We examined contact tracing activities during September 20–December 31, 2014, in 2 prefectures of Guinea using national and local data about case-patients and their contacts. Results show less than one third of case-patients (28.3% and 31.1%) were registered as contacts before case identification; approximately two thirds (61.1% and 67.7%) had no registered contacts. Time to isolation of suspected case-patients was not immediate (median 5 and 3 days for Kindia and Faranah, respectively), and secondary attack rates varied by relationships of persons who had contact with the source case-patient and the type of case-patient to which a contact was exposed. More complete contact tracing efforts are needed to augment control of this epidemic.

EID Dixon MG, Taylor MM, Dee J, Hakim A, Cantey P, Lim T, et al. Contact Tracing Activities during the Ebola Virus Disease Epidemic in Kindia and Faranah, Guinea, 2014. Emerg Infect Dis. 2015;21(11):2022-2028. https://dx.doi.org/10.3201/eid2111.150684
AMA Dixon MG, Taylor MM, Dee J, et al. Contact Tracing Activities during the Ebola Virus Disease Epidemic in Kindia and Faranah, Guinea, 2014. Emerging Infectious Diseases. 2015;21(11):2022-2028. doi:10.3201/eid2111.150684.
APA Dixon, M. G., Taylor, M. M., Dee, J., Hakim, A., Cantey, P., Lim, T....Dahl, B. A. (2015). Contact Tracing Activities during the Ebola Virus Disease Epidemic in Kindia and Faranah, Guinea, 2014. Emerging Infectious Diseases, 21(11), 2022-2028. https://dx.doi.org/10.3201/eid2111.150684.

Role of Maternal Antibodies in Infants with Severe Diseases Related to Human Parechovirus Type 3 [PDF - 1.35 MB - 7 pages]
Y. Aizawa et al.

Human parechovirus type 3 (HPeV3) is an emerging pathogen that causes sepsis and meningoencephalitis in young infants. To test the hypothesis that maternal antibodies can protect this population, we measured neutralizing antibody titers (NATs) to HPeV3 and other genotypes (HPeV1 and HPeV6) in 175 cord blood samples in Japan. The seropositivity rate (>1:32) for HPeV3 was 61%, similar to that for the other genotypes, but decreased significantly as maternal age increased (p<0.001). Furthermore, during the 2014 HPeV3 epidemic, prospective measurement of NATs to HPeV3 in 45 patients with severe diseases caused by HPeV3 infection showed low NATs (<1:16) at onset and persistently high NATs (>1:512) until age 6 months. All intravenous immunoglobulin samples tested elicited high NATs to HPeV3. Our findings indicate that maternal antibodies to HPeV3 may help protect young infants from severe diseases related to HPeV3 and that antibody supplementation may benefit these patients.

EID Aizawa Y, Watanabe K, Oishi T, Hirano H, Hasegawa I, Saitoh A. Role of Maternal Antibodies in Infants with Severe Diseases Related to Human Parechovirus Type 3. Emerg Infect Dis. 2015;21(11):1966-1972. https://dx.doi.org/10.3201/eid2111.150267
AMA Aizawa Y, Watanabe K, Oishi T, et al. Role of Maternal Antibodies in Infants with Severe Diseases Related to Human Parechovirus Type 3. Emerging Infectious Diseases. 2015;21(11):1966-1972. doi:10.3201/eid2111.150267.
APA Aizawa, Y., Watanabe, K., Oishi, T., Hirano, H., Hasegawa, I., & Saitoh, A. (2015). Role of Maternal Antibodies in Infants with Severe Diseases Related to Human Parechovirus Type 3. Emerging Infectious Diseases, 21(11), 1966-1972. https://dx.doi.org/10.3201/eid2111.150267.

Molecular Epidemiology of Hospital Outbreak of Middle East Respiratory Syndrome, Riyadh, Saudi Arabia, 2014 [PDF - 1.55 MB - 8 pages]
S. F. Fagbo et al.

We investigated an outbreak of Middle East respiratory syndrome (MERS) at King Fahad Medical City (KFMC), Riyadh, Saudi Arabia, during March 29–May 21, 2014. This outbreak involved 45 patients: 8 infected outside KFMC, 13 long-term patients at KFMC, 23 health care workers, and 1 who had an indeterminate source of infection. Sequences of full-length MERS coronavirus (MERS-CoV) from 10 patients and a partial sequence of MERS-CoV from another patient, when compared with other MERS-CoV sequences, demonstrated that this outbreak was part of a larger outbreak that affected multiple health care facilities in Riyadh and possibly arose from a single zoonotic transmission event that occurred in December 2013 (95% highest posterior density interval November 8, 2013–February 10, 2014). This finding suggested continued health care–associated transmission for 5 months. Molecular epidemiology documented multiple external introductions in a seemingly contiguous outbreak and helped support or refute transmission pathways suspected through epidemiologic investigation.

EID Fagbo SF, Skakni L, Chu D, Garbati MA, Joseph M, Hakawi AM. Molecular Epidemiology of Hospital Outbreak of Middle East Respiratory Syndrome, Riyadh, Saudi Arabia, 2014. Emerg Infect Dis. 2015;21(11):1981-1988. https://dx.doi.org/10.3201/eid2111.150944
AMA Fagbo SF, Skakni L, Chu D, et al. Molecular Epidemiology of Hospital Outbreak of Middle East Respiratory Syndrome, Riyadh, Saudi Arabia, 2014. Emerging Infectious Diseases. 2015;21(11):1981-1988. doi:10.3201/eid2111.150944.
APA Fagbo, S. F., Skakni, L., Chu, D., Garbati, M. A., Joseph, M., & Hakawi, A. M. (2015). Molecular Epidemiology of Hospital Outbreak of Middle East Respiratory Syndrome, Riyadh, Saudi Arabia, 2014. Emerging Infectious Diseases, 21(11), 1981-1988. https://dx.doi.org/10.3201/eid2111.150944.

Association of Higher MERS-CoV Virus Load with Severe Disease and Death, Saudi Arabia, 2014 [PDF - 439 KB - 7 pages]
D. R. Feikin et al.

Middle East respiratory syndrome coronavirus (MERS-CoV) causes a spectrum of illness. We evaluated whether cycle threshold (Ct) values (which are inversely related to virus load) were associated with clinical severity in patients from Saudi Arabia whose nasopharyngeal specimens tested positive for this virus by real-time reverse transcription PCR. Among 102 patients, median Ct of 31.0 for the upstream of the E gene target for 41 (40%) patients who died was significantly lower than the median of 33.0 for 61 survivors (p = 0.0087). In multivariable regression analyses, risk factors for death were age >60 years), underlying illness, and decreasing Ct for each 1-point decrease in Ct). Results were similar for a composite severe outcome (death and/or intensive care unit admission). More data are needed to determine whether modulation of virus load by therapeutic agents affects clinical outcomes.

EID Feikin DR, Alraddadi BM, Qutub M, Shabouni O, Curns A, Oboho IK, et al. Association of Higher MERS-CoV Virus Load with Severe Disease and Death, Saudi Arabia, 2014. Emerg Infect Dis. 2015;21(11):2029-2035. https://dx.doi.org/10.3201/eid2111.150764
AMA Feikin DR, Alraddadi BM, Qutub M, et al. Association of Higher MERS-CoV Virus Load with Severe Disease and Death, Saudi Arabia, 2014. Emerging Infectious Diseases. 2015;21(11):2029-2035. doi:10.3201/eid2111.150764.
APA Feikin, D. R., Alraddadi, B. M., Qutub, M., Shabouni, O., Curns, A., Oboho, I. K....Madani, T. A. (2015). Association of Higher MERS-CoV Virus Load with Severe Disease and Death, Saudi Arabia, 2014. Emerging Infectious Diseases, 21(11), 2029-2035. https://dx.doi.org/10.3201/eid2111.150764.

Climatic Influences on Cryptococcus gattii Populations, Vancouver Island, Canada, 2002–2004 [PDF - 1.33 MB - 8 pages]
C. K. Uejio et al.

Vancouver Island, Canada, reports the world’s highest incidence of Cryptococcus gattii infection among humans and animals. To identify key biophysical factors modulating environmental concentrations, we evaluated monthly concentrations of C. gatti in air, soil, and trees over a 3-year period. The 2 study datasets were repeatedly measured plots and newly sampled plots. We used hierarchical generalized linear and mixed effect models to determine associations. Climate systematically influenced C. gattii concentrations in all environmental media tested; in soil and on trees, concentrations decreased when temperatures were warmer. Wind may be a key process that transferred C. gattii from soil into air and onto trees. C. gattii results for tree and air samples were more likely to be positive during periods of higher solar radiation. These results improve the understanding of the places and periods with the greatest C. gattii colonization. Refined risk projections may help susceptible persons avoid activities that disturb the topsoil during relatively cool summer days.

EID Uejio CK, Mak S, Manangan A, Luber G, Bartlett KH. Climatic Influences on Cryptococcus gattii Populations, Vancouver Island, Canada, 2002–2004. Emerg Infect Dis. 2015;21(11):1989-1996. https://dx.doi.org/10.3201/eid2111.141161
AMA Uejio CK, Mak S, Manangan A, et al. Climatic Influences on Cryptococcus gattii Populations, Vancouver Island, Canada, 2002–2004. Emerging Infectious Diseases. 2015;21(11):1989-1996. doi:10.3201/eid2111.141161.
APA Uejio, C. K., Mak, S., Manangan, A., Luber, G., & Bartlett, K. H. (2015). Climatic Influences on Cryptococcus gattii Populations, Vancouver Island, Canada, 2002–2004. Emerging Infectious Diseases, 21(11), 1989-1996. https://dx.doi.org/10.3201/eid2111.141161.

Coccidioidomycosis among Workers Constructing Solar Power Farms, California, USA, 2011–2014 [PDF - 1.73 MB - 9 pages]
J. A. Wilken et al.

Coccidioidomycosis is associated with soil-disruptive work in Coccidioides-endemic areas of the southwestern United States. Among 3,572 workers constructing 2 solar power–generating facilities in San Luis Obispo County, California, USA, we identified 44 patients with symptom onset during October 2011–April 2014 (attack rate 1.2 cases/100 workers). Of these 44 patients, 20 resided in California outside San Luis Obispo County and 10 resided in another state; 9 were hospitalized (median 3 days), 34 missed work (median 22 days), and 2 had disseminated disease. Of the 25 patients who frequently performed soil-disruptive work, 6 reported frequent use of respiratory protection. As solar farm construction in Coccidioides-endemic areas increases, additional workers will probably be exposed and infected unless awareness is emphasized and effective exposure reduction measures implemented, including limiting dust generation and providing respiratory protection. Medical providers, including those in non–Coccidioides-endemic areas, should suspect coccidioidomycosis in workers with compatible illness and report cases to their local health department.

EID Wilken JA, Sondermeyer G, Shusterman D, McNary J, Vugia D, McDowell A, et al. Coccidioidomycosis among Workers Constructing Solar Power Farms, California, USA, 2011–2014. Emerg Infect Dis. 2015;21(11):1997-2005. https://dx.doi.org/10.3201/eid2111.150129
AMA Wilken JA, Sondermeyer G, Shusterman D, et al. Coccidioidomycosis among Workers Constructing Solar Power Farms, California, USA, 2011–2014. Emerging Infectious Diseases. 2015;21(11):1997-2005. doi:10.3201/eid2111.150129.
APA Wilken, J. A., Sondermeyer, G., Shusterman, D., McNary, J., Vugia, D., McDowell, A....Materna, B. L. (2015). Coccidioidomycosis among Workers Constructing Solar Power Farms, California, USA, 2011–2014. Emerging Infectious Diseases, 21(11), 1997-2005. https://dx.doi.org/10.3201/eid2111.150129.

No Geographic Correlation between Lyme Disease and Death Due to 4 Neurodegenerative Disorders, United States, 2001–2010 [PDF - 1.24 MB - 4 pages]
J. D. Forrester et al.

Associations between Lyme disease and certain neurodegenerative diseases have been proposed, but supportive evidence for an association is lacking. Similar geographic distributions would be expected if 2 conditions were etiologically linked. Thus, we compared the distribution of Lyme disease cases in the United States with the distributions of deaths due to Alzheimer disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis (MS), and Parkinson disease; no geographic correlations were identified. Lyme disease incidence per US state was not correlated with rates of death due to ALS, MS, or Parkinson disease; however, an inverse correlation was detected between Lyme disease and Alzheimer disease. The absence of a positive correlation between the geographic distribution of Lyme disease and the distribution of deaths due to Alzheimer disease, ALS, MS, and Parkinson disease provides further evidence that Lyme disease is not associated with the development of these neurodegenerative conditions.

EID Forrester JD, Kugeler KJ, Perea AE, Pastula DM, Mead PS. No Geographic Correlation between Lyme Disease and Death Due to 4 Neurodegenerative Disorders, United States, 2001–2010. Emerg Infect Dis. 2015;21(11):2036-2039. https://dx.doi.org/10.3201/eid2111.150778
AMA Forrester JD, Kugeler KJ, Perea AE, et al. No Geographic Correlation between Lyme Disease and Death Due to 4 Neurodegenerative Disorders, United States, 2001–2010. Emerging Infectious Diseases. 2015;21(11):2036-2039. doi:10.3201/eid2111.150778.
APA Forrester, J. D., Kugeler, K. J., Perea, A. E., Pastula, D. M., & Mead, P. S. (2015). No Geographic Correlation between Lyme Disease and Death Due to 4 Neurodegenerative Disorders, United States, 2001–2010. Emerging Infectious Diseases, 21(11), 2036-2039. https://dx.doi.org/10.3201/eid2111.150778.

USA300 Methicillin-Resistant Staphylococcus aureus, United States, 2000–2013 [PDF - 2.25 MB - 8 pages]
M. Carrel et al.

In the United States, methicillin-resistant Staphylococcus aureus (MRSA) with the USA300 pulsed-field gel electrophoresis type causes most community-associated MRSA infections and is an increasingly common cause of health care–associated MRSA infections. USA300 probably emerged during the early 1990s. To assess the spatiotemporal diffusion of USA300 MRSA and USA100 MRSA throughout the United States, we systematically reviewed 354 articles for data on 33,543 isolates, of which 8,092 were classified as USA300 and 2,595 as USA100. Using the biomedical literature as a proxy for USA300 prevalence among genotyped MRSA samples, we found that USA300 was isolated during 2000 in several states, including California, Texas, and midwestern states. The geographic mean center of USA300 MRSA then shifted eastward from 2000 to 2013. Analyzing genotyping studies enabled us to track the emergence of a new, successful MRSA type in space and time across the country.

EID Carrel M, Perencevich EN, David MZ. USA300 Methicillin-Resistant Staphylococcus aureus, United States, 2000–2013. Emerg Infect Dis. 2015;21(11):1973-1980. https://dx.doi.org/10.3201/eid2111.150452
AMA Carrel M, Perencevich EN, David MZ. USA300 Methicillin-Resistant Staphylococcus aureus, United States, 2000–2013. Emerging Infectious Diseases. 2015;21(11):1973-1980. doi:10.3201/eid2111.150452.
APA Carrel, M., Perencevich, E. N., & David, M. Z. (2015). USA300 Methicillin-Resistant Staphylococcus aureus, United States, 2000–2013. Emerging Infectious Diseases, 21(11), 1973-1980. https://dx.doi.org/10.3201/eid2111.150452.

Serotype Changes and Drug Resistance in Invasive Pneumococcal Diseases in Adults after Vaccinations in Children, Japan, 2010–2013 [PDF - 1.32 MB - 10 pages]
K. Ubukata et al.

After 7-valent pneumococcal conjugate vaccine (PCV) for children was introduced in Japan in November 2010, we examined changes in Streptococcus pneumoniae serotypes and in genetic antimicrobial drug resistance of isolates from adults with invasive pneumococcal diseases. During April 2010–March 2013, a total of 715 isolates were collected from adults with invasive pneumococcal diseases. Seven-valent PCV serotypes in adults decreased from 43.3% to 23.8%, most noticeably for serotype 6B. Concomitantly, 23-valent pneumococcal polysaccharide vaccine (PPSV23) serotypes decreased from 82.2% to 72.2%; non-PPSV23 serotypes increased from 13.8% to 25.1%. Parallel with serotype changes, genotypic penicillin-resistant S. pneumoniae decreased from 32.4% to 21.1%, and 6 non-PPSV23 serotypes emerged (6D, 15A, 15C, 16F, 23A, and 35B). Respective vaccine coverage rates for 13-valent PCV and PPSV23 differed by disease: 73.9% and 84.3% for patients with pneumonia, 56.4% and 69.2% for patients with bacteremia and sepsis, and 45.7% and 69.3% for patients with meningitis.

EID Ubukata K, Chiba N, Hanada S, Morozumi M, Wajima T, Shouji M, et al. Serotype Changes and Drug Resistance in Invasive Pneumococcal Diseases in Adults after Vaccinations in Children, Japan, 2010–2013. Emerg Infect Dis. 2015;21(11):1956-1965. https://dx.doi.org/10.3201/eid2111.142029
AMA Ubukata K, Chiba N, Hanada S, et al. Serotype Changes and Drug Resistance in Invasive Pneumococcal Diseases in Adults after Vaccinations in Children, Japan, 2010–2013. Emerging Infectious Diseases. 2015;21(11):1956-1965. doi:10.3201/eid2111.142029.
APA Ubukata, K., Chiba, N., Hanada, S., Morozumi, M., Wajima, T., Shouji, M....Iwata, S. (2015). Serotype Changes and Drug Resistance in Invasive Pneumococcal Diseases in Adults after Vaccinations in Children, Japan, 2010–2013. Emerging Infectious Diseases, 21(11), 1956-1965. https://dx.doi.org/10.3201/eid2111.142029.

Shigella Infections in Household Contacts of Pediatric Shigellosis Patients in Rural Bangladesh [PDF - 440 KB - 8 pages]
C. George et al.

To examine rates of Shigella infections in household contacts of pediatric shigellosis patients, we followed contacts and controls prospectively for 1 week after the index patient obtained care. Household contacts of patients were 44 times more likely to develop a Shigella infection than were control contacts (odds ratio 44.7, 95% CI 5.5–361.6); 29 (94%) household contacts of shigellosis patients were infected with the same species and serotype as the index patient’s. Pulsed-field gel electrophoresis showed that 14 (88%) of 16 with infected contacts had strains that were indistinguishable from or closely related to the index patient’s strain. Latrine area fly counts were higher in patient households compared with control households, and 2 patient household water samples were positive for Shigella. We show high susceptibility of household contacts of shigellosis patients to Shigella infections and found environmental risk factors to be targeted in future interventions.

EID George C, Ahmed S, Talukder KA, Azmi IJ, Perin J, Sack R, et al. Shigella Infections in Household Contacts of Pediatric Shigellosis Patients in Rural Bangladesh. Emerg Infect Dis. 2015;21(11):2006-2013. https://dx.doi.org/10.3201/eid2111.150333
AMA George C, Ahmed S, Talukder KA, et al. Shigella Infections in Household Contacts of Pediatric Shigellosis Patients in Rural Bangladesh. Emerging Infectious Diseases. 2015;21(11):2006-2013. doi:10.3201/eid2111.150333.
APA George, C., Ahmed, S., Talukder, K. A., Azmi, I. J., Perin, J., Sack, R....Faruque, A. (2015). Shigella Infections in Household Contacts of Pediatric Shigellosis Patients in Rural Bangladesh. Emerging Infectious Diseases, 21(11), 2006-2013. https://dx.doi.org/10.3201/eid2111.150333.

Carbapenem-Resistant Enterobacteriaceae in Children, United States, 1999–2012 [PDF - 910 KB - 8 pages]
L. K. Logan et al.

The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) infections is increasing in the United States. However, few studies have addressed their epidemiology in children. To phenotypically identify CRE isolates cultured from patients 1–17 years of age, we used antimicrobial susceptibilities of Enterobacteriaceae reported to 300 laboratories participating in The Surveillance Network–USA database during January 1999–July 2012. Of 316,253 isolates analyzed, 266 (0.08%) were identified as CRE. CRE infection rate increases were highest for Enterobacter species, blood culture isolates, and isolates from intensive care units, increasing from 0.0% in 1999–2000 to 5.2%, 4.5%, and 3.2%, respectively, in 2011–2012. CRE occurrence in children is increasing but remains low and is less common than that for extended-spectrum β-lactamase–producing Enterobacteriaceae. The molecular characterization of CRE isolates from children and clinical epidemiology of infection are essential for development of effective prevention strategies.

EID Logan LK, Renschler JP, Gandra S, Weinstein RA, Laxminarayan R. Carbapenem-Resistant Enterobacteriaceae in Children, United States, 1999–2012. Emerg Infect Dis. 2015;21(11):2014-2021. https://dx.doi.org/10.3201/eid2111.150548
AMA Logan LK, Renschler JP, Gandra S, et al. Carbapenem-Resistant Enterobacteriaceae in Children, United States, 1999–2012. Emerging Infectious Diseases. 2015;21(11):2014-2021. doi:10.3201/eid2111.150548.
APA Logan, L. K., Renschler, J. P., Gandra, S., Weinstein, R. A., & Laxminarayan, R. (2015). Carbapenem-Resistant Enterobacteriaceae in Children, United States, 1999–2012. Emerging Infectious Diseases, 21(11), 2014-2021. https://dx.doi.org/10.3201/eid2111.150548.
Dispatches

Fosfomycin Resistance in Escherichia coli, Pennsylvania, USA [PDF - 1.12 MB - 3 pages]
H. Alrowais et al.

Fosfomycin resistance in Escherichia coli is rare in the United States. An extended-spectrum β-lactamase–producing E. coli clinical strain identified in Pennsylvania, USA, showed high-level fosfomycin resistance caused by the fosA3 gene. The IncFII plasmid carrying this gene had a structure similar to those found in China, where fosfomycin resistance is commonly described.

EID Alrowais H, McElheny CL, Spychala CN, Sastry S, Guo Q, Butt AA, et al. Fosfomycin Resistance in Escherichia coli, Pennsylvania, USA. Emerg Infect Dis. 2015;21(11):2045-2047. https://dx.doi.org/10.3201/eid2111.150750
AMA Alrowais H, McElheny CL, Spychala CN, et al. Fosfomycin Resistance in Escherichia coli, Pennsylvania, USA. Emerging Infectious Diseases. 2015;21(11):2045-2047. doi:10.3201/eid2111.150750.
APA Alrowais, H., McElheny, C. L., Spychala, C. N., Sastry, S., Guo, Q., Butt, A. A....Doi, Y. (2015). Fosfomycin Resistance in Escherichia coli, Pennsylvania, USA. Emerging Infectious Diseases, 21(11), 2045-2047. https://dx.doi.org/10.3201/eid2111.150750.

Invasive Pneumococcal Disease 3 Years after Introduction of 10-Valent Pneumococcal Conjugate Vaccine, the Netherlands [PDF - 1.71 MB - 5 pages]
M. J. Knol et al.

Three years after a 7-valent pneumococcal conjugate vaccine was replaced by a 10-valent pneumococcal conjugate vaccine in the Netherlands, we observed a decrease in incidence of invasive pneumococcal disease caused by Streptococcus pneumoniae serotypes 1, 5, and 7F. Our data do not support or exclude cross-protection against serotype 19A.

EID Knol MJ, Wagenvoort G, Sanders E, Elberse K, Vlaminckx BJ, de Melker HE, et al. Invasive Pneumococcal Disease 3 Years after Introduction of 10-Valent Pneumococcal Conjugate Vaccine, the Netherlands. Emerg Infect Dis. 2015;21(11):2040-2044. https://dx.doi.org/10.3201/eid2111.140780
AMA Knol MJ, Wagenvoort G, Sanders E, et al. Invasive Pneumococcal Disease 3 Years after Introduction of 10-Valent Pneumococcal Conjugate Vaccine, the Netherlands. Emerging Infectious Diseases. 2015;21(11):2040-2044. doi:10.3201/eid2111.140780.
APA Knol, M. J., Wagenvoort, G., Sanders, E., Elberse, K., Vlaminckx, B. J., de Melker, H. E....van der Ende, A. (2015). Invasive Pneumococcal Disease 3 Years after Introduction of 10-Valent Pneumococcal Conjugate Vaccine, the Netherlands. Emerging Infectious Diseases, 21(11), 2040-2044. https://dx.doi.org/10.3201/eid2111.140780.

Workplace Safety Concerns among Co-workers of Responder Returning from Ebola-Affected Country [PDF - 356 KB - 3 pages]
B. P. Chan et al.

We surveyed public health co-workers regarding attitudes toward a physician who returned to New Hampshire after volunteering in the West African Ebola outbreak. An unexpectedly large (18.0%) proportion of staff expressed discomfort with the Ebola responder returning to work. Employers should take proactive steps to address employee fears and concerns.

EID Chan BP, Daly ER, Talbot EA. Workplace Safety Concerns among Co-workers of Responder Returning from Ebola-Affected Country. Emerg Infect Dis. 2015;21(11):2077-2079. https://dx.doi.org/10.3201/eid2111.150780
AMA Chan BP, Daly ER, Talbot EA. Workplace Safety Concerns among Co-workers of Responder Returning from Ebola-Affected Country. Emerging Infectious Diseases. 2015;21(11):2077-2079. doi:10.3201/eid2111.150780.
APA Chan, B. P., Daly, E. R., & Talbot, E. A. (2015). Workplace Safety Concerns among Co-workers of Responder Returning from Ebola-Affected Country. Emerging Infectious Diseases, 21(11), 2077-2079. https://dx.doi.org/10.3201/eid2111.150780.

Mortality Risk Factors for Middle East Respiratory Syndrome Outbreak, South Korea, 2015 [PDF - 352 KB - 3 pages]
M. S. Majumder et al.

As of July 15, 2015, the South Korean Ministry of Health and Welfare had reported 186 case-patients with Middle East respiratory syndrome in South Korea. For 159 case-patients with known outcomes and complete case histories, we found that older age and preexisting concurrent health conditions were risk factors for death.

EID Majumder MS, Kluberg SA, Mekaru SR, Brownstein JS. Mortality Risk Factors for Middle East Respiratory Syndrome Outbreak, South Korea, 2015. Emerg Infect Dis. 2015;21(11):2088-2090. https://dx.doi.org/10.3201/eid2111.151231
AMA Majumder MS, Kluberg SA, Mekaru SR, et al. Mortality Risk Factors for Middle East Respiratory Syndrome Outbreak, South Korea, 2015. Emerging Infectious Diseases. 2015;21(11):2088-2090. doi:10.3201/eid2111.151231.
APA Majumder, M. S., Kluberg, S. A., Mekaru, S. R., & Brownstein, J. S. (2015). Mortality Risk Factors for Middle East Respiratory Syndrome Outbreak, South Korea, 2015. Emerging Infectious Diseases, 21(11), 2088-2090. https://dx.doi.org/10.3201/eid2111.151231.

Pneumococcal Infection among Children before Introduction of 13-Valent Pneumococcal Conjugate Vaccine, Cambodia [PDF - 904 KB - 4 pages]
P. Turner et al.

Vaccination of children with pneumococcal conjugate vaccine (PCV13) was initiated in Cambodia in 2015. To determine baseline data, we collected samples from children in 2013 and 2014. PCV13 serotypes accounted for 62.7% of colonizing organisms in outpatients and 88.4% of invasive pneumococci overall; multidrug resistance was common. Thus, effectiveness of vaccination should be high.

EID Turner P, Turner C, Suy K, Soeng S, Ly S, Miliya T, et al. Pneumococcal Infection among Children before Introduction of 13-Valent Pneumococcal Conjugate Vaccine, Cambodia. Emerg Infect Dis. 2015;21(11):2080-2083. https://dx.doi.org/10.3201/eid2111.150914
AMA Turner P, Turner C, Suy K, et al. Pneumococcal Infection among Children before Introduction of 13-Valent Pneumococcal Conjugate Vaccine, Cambodia. Emerging Infectious Diseases. 2015;21(11):2080-2083. doi:10.3201/eid2111.150914.
APA Turner, P., Turner, C., Suy, K., Soeng, S., Ly, S., Miliya, T....Day, N. (2015). Pneumococcal Infection among Children before Introduction of 13-Valent Pneumococcal Conjugate Vaccine, Cambodia. Emerging Infectious Diseases, 21(11), 2080-2083. https://dx.doi.org/10.3201/eid2111.150914.

RmtC and RmtF 16S rRNA Methyltransferase in NDM-1–Producing Pseudomonas aeruginosa [PDF - 1.05 MB - 4 pages]
M. Rahman et al.

We investigated 16S rRNA methyltransferases in 38 blaNDM-1–positive Pseudomonas aeruginosa isolates and found RmtC in 3 isolates, 1 of which also harbored RmtF. The isolates were clonally unrelated; rmtC and rmtF genes were located on a chromosome with the blaNDM-1 gene. Strategies are needed to limit the spread of such isolates.

EID Rahman M, Prasad K, Pathak A, Pati B, Singh A, Ovejero CM, et al. RmtC and RmtF 16S rRNA Methyltransferase in NDM-1–Producing Pseudomonas aeruginosa. Emerg Infect Dis. 2015;21(11):2059-2062. https://dx.doi.org/10.3201/eid2111.150271
AMA Rahman M, Prasad K, Pathak A, et al. RmtC and RmtF 16S rRNA Methyltransferase in NDM-1–Producing Pseudomonas aeruginosa. Emerging Infectious Diseases. 2015;21(11):2059-2062. doi:10.3201/eid2111.150271.
APA Rahman, M., Prasad, K., Pathak, A., Pati, B., Singh, A., Ovejero, C. M....Gonzalez-Zorn, B. (2015). RmtC and RmtF 16S rRNA Methyltransferase in NDM-1–Producing Pseudomonas aeruginosa. Emerging Infectious Diseases, 21(11), 2059-2062. https://dx.doi.org/10.3201/eid2111.150271.

Encephalitis-Associated Human Metapneumovirus Pneumonia in Adult, Australia [PDF - 876 KB - 3 pages]
A. Fok et al.

Human metapneumovirus pneumonia, most commonly found in children, was diagnosed in an adult with encephalitis. This case suggests that testing for human metapneumovirus RNA in nasopharyngeal aspirate and cerebrospinal fluid samples should be considered in adults with encephalitis who have a preceding respiratory infection,

EID Fok A, Mateevici C, Lin B, Chandra RV, Chong V. Encephalitis-Associated Human Metapneumovirus Pneumonia in Adult, Australia. Emerg Infect Dis. 2015;21(11):2074-2076. https://dx.doi.org/10.3201/eid2111.150608
AMA Fok A, Mateevici C, Lin B, et al. Encephalitis-Associated Human Metapneumovirus Pneumonia in Adult, Australia. Emerging Infectious Diseases. 2015;21(11):2074-2076. doi:10.3201/eid2111.150608.
APA Fok, A., Mateevici, C., Lin, B., Chandra, R. V., & Chong, V. (2015). Encephalitis-Associated Human Metapneumovirus Pneumonia in Adult, Australia. Emerging Infectious Diseases, 21(11), 2074-2076. https://dx.doi.org/10.3201/eid2111.150608.

Middle East Respiratory Syndrome in 3 Persons, South Korea, 2015 [PDF - 1.50 MB - 4 pages]
J. Yang et al.

In May 2015, Middle East respiratory syndrome coronavirus infection was laboratory confirmed in South Korea. Patients were a man who had visited the Middle East, his wife, and a man who shared a hospital room with the index patient. Rapid laboratory confirmation will facilitate subsequent prevention and control for imported cases.

EID Yang J, Park S, Kim Y, Kang H, Kim H, Han Y, et al. Middle East Respiratory Syndrome in 3 Persons, South Korea, 2015. Emerg Infect Dis. 2015;21(11):2084-2087. https://dx.doi.org/10.3201/eid2111.151016
AMA Yang J, Park S, Kim Y, et al. Middle East Respiratory Syndrome in 3 Persons, South Korea, 2015. Emerging Infectious Diseases. 2015;21(11):2084-2087. doi:10.3201/eid2111.151016.
APA Yang, J., Park, S., Kim, Y., Kang, H., Kim, H., Han, Y....Kim, S. (2015). Middle East Respiratory Syndrome in 3 Persons, South Korea, 2015. Emerging Infectious Diseases, 21(11), 2084-2087. https://dx.doi.org/10.3201/eid2111.151016.

Serogroup W Meningitis Outbreak at the Subdistrict Level, Burkina Faso, 2012 [PDF - 1.05 MB - 4 pages]
L. Cibrelus et al.

In 2012, Neisseria meningitidis serogroup W caused a widespread meningitis epidemic in Burkina Faso. We describe the dynamic of the epidemic at the subdistrict level. Disease detection at this scale allows for a timelier response, which is critical in the new epidemiologic landscape created in Africa by the N. meningitidis A conjugate vaccine.

EID Cibrelus L, Medah I, Koussoubé D, Yélbeogo D, Fernandez K, Lingani C, et al. Serogroup W Meningitis Outbreak at the Subdistrict Level, Burkina Faso, 2012. Emerg Infect Dis. 2015;21(11):2063-2066. https://dx.doi.org/10.3201/eid2111.150304
AMA Cibrelus L, Medah I, Koussoubé D, et al. Serogroup W Meningitis Outbreak at the Subdistrict Level, Burkina Faso, 2012. Emerging Infectious Diseases. 2015;21(11):2063-2066. doi:10.3201/eid2111.150304.
APA Cibrelus, L., Medah, I., Koussoubé, D., Yélbeogo, D., Fernandez, K., Lingani, C....Hugonnet, S. (2015). Serogroup W Meningitis Outbreak at the Subdistrict Level, Burkina Faso, 2012. Emerging Infectious Diseases, 21(11), 2063-2066. https://dx.doi.org/10.3201/eid2111.150304.

Epidemiology of Primary Multidrug-Resistant Tuberculosis, Vladimir Region, Russia [PDF - 1.85 MB - 4 pages]
J. Ershova et al.

We studied the epidemiology of drug-resistant tuberculosis (TB) in Vladimir Region, Russia, in 2012. Most cases of multidrug-resistant TB (MDR TB) were caused by transmission of drug-resistant strains, and >33% were in patients referred for testing after mass radiographic screening. Early diagnosis of drug resistance is essential for preventing transmission of MDR TB.

EID Ershova J, Volchenkov GV, Kaminski DA, Somova TR, Kuznetsova TA, Kaunetis NV, et al. Epidemiology of Primary Multidrug-Resistant Tuberculosis, Vladimir Region, Russia. Emerg Infect Dis. 2015;21(11):2048-2051. https://dx.doi.org/10.3201/eid2111.150813
AMA Ershova J, Volchenkov GV, Kaminski DA, et al. Epidemiology of Primary Multidrug-Resistant Tuberculosis, Vladimir Region, Russia. Emerging Infectious Diseases. 2015;21(11):2048-2051. doi:10.3201/eid2111.150813.
APA Ershova, J., Volchenkov, G. V., Kaminski, D. A., Somova, T. R., Kuznetsova, T. A., Kaunetis, N. V....Kurbatova, E. V. (2015). Epidemiology of Primary Multidrug-Resistant Tuberculosis, Vladimir Region, Russia. Emerging Infectious Diseases, 21(11), 2048-2051. https://dx.doi.org/10.3201/eid2111.150813.

Rotavirus P[8] Infections in Persons with Secretor and Nonsecretor Phenotypes, Tunisia [PDF - 933 KB - 4 pages]
S. Ayouni et al.

To determine whether rotavirus infections are linked to secretor status, we studied samples from children in Tunisia with gastroenteritis. We phenotyped saliva for human blood group antigens and tested feces for rotavirus. Rotavirus was detected in 32/114 patients. Secretor genotyping showed that P[8] rotavirus infected secretors and nonsecretors, and infection correlated with presence of Lewis antigen.

EID Ayouni S, Sdiri-Loulizi K, de Rougemont A, Estienney M, Ambert-Balay K, Aho S, et al. Rotavirus P[8] Infections in Persons with Secretor and Nonsecretor Phenotypes, Tunisia. Emerg Infect Dis. 2015;21(11):2055-2058. https://dx.doi.org/10.3201/eid2111.141901
AMA Ayouni S, Sdiri-Loulizi K, de Rougemont A, et al. Rotavirus P[8] Infections in Persons with Secretor and Nonsecretor Phenotypes, Tunisia. Emerging Infectious Diseases. 2015;21(11):2055-2058. doi:10.3201/eid2111.141901.
APA Ayouni, S., Sdiri-Loulizi, K., de Rougemont, A., Estienney, M., Ambert-Balay, K., Aho, S....Belliot, G. (2015). Rotavirus P[8] Infections in Persons with Secretor and Nonsecretor Phenotypes, Tunisia. Emerging Infectious Diseases, 21(11), 2055-2058. https://dx.doi.org/10.3201/eid2111.141901.

Use of Whole-Genome Sequencing to Link Burkholderia pseudomallei from Air Sampling to Mediastinal Melioidosis, Australia [PDF - 802 KB - 3 pages]
B. J. Currie et al.

The frequency with which melioidosis results from inhalation rather than percutaneous inoculation or ingestion is unknown. We recovered Burkholderia pseudomallei from air samples at the residence of a patient with presumptive inhalational melioidosis and used whole-genome sequencing to link the environmental bacteria to B. pseudomallei recovered from the patient.

EID Currie BJ, Price EP, Mayo M, Kaestli M, Theobald V, Harrington I, et al. Use of Whole-Genome Sequencing to Link Burkholderia pseudomallei from Air Sampling to Mediastinal Melioidosis, Australia. Emerg Infect Dis. 2015;21(11):2052-2054. https://dx.doi.org/10.3201/eid2111.141802
AMA Currie BJ, Price EP, Mayo M, et al. Use of Whole-Genome Sequencing to Link Burkholderia pseudomallei from Air Sampling to Mediastinal Melioidosis, Australia. Emerging Infectious Diseases. 2015;21(11):2052-2054. doi:10.3201/eid2111.141802.
APA Currie, B. J., Price, E. P., Mayo, M., Kaestli, M., Theobald, V., Harrington, I....Sarovich, D. (2015). Use of Whole-Genome Sequencing to Link Burkholderia pseudomallei from Air Sampling to Mediastinal Melioidosis, Australia. Emerging Infectious Diseases, 21(11), 2052-2054. https://dx.doi.org/10.3201/eid2111.141802.

Economic Costs of Measles Outbreak in the Netherlands, 2013–2014 [PDF - 792 KB - 3 pages]
A. Suijkerbuijk et al.

In 2013 and 2014, the Netherlands experienced a measles outbreak in orthodox Protestant communities with low measles–mumps–rubella vaccination coverage. Assessing total outbreak costs is needed for public health outbreak preparedness and control. Total costs of this outbreak were an estimated $4.7 million.

EID Suijkerbuijk A, Woudenberg T, Hahné S, Nic Lochlainn L, de Melker HE, Ruijs W, et al. Economic Costs of Measles Outbreak in the Netherlands, 2013–2014. Emerg Infect Dis. 2015;21(11):2067-2069. https://dx.doi.org/10.3201/eid2111.150410
AMA Suijkerbuijk A, Woudenberg T, Hahné S, et al. Economic Costs of Measles Outbreak in the Netherlands, 2013–2014. Emerging Infectious Diseases. 2015;21(11):2067-2069. doi:10.3201/eid2111.150410.
APA Suijkerbuijk, A., Woudenberg, T., Hahné, S., Nic Lochlainn, L., de Melker, H. E., Ruijs, W....Lugnér, A. K. (2015). Economic Costs of Measles Outbreak in the Netherlands, 2013–2014. Emerging Infectious Diseases, 21(11), 2067-2069. https://dx.doi.org/10.3201/eid2111.150410.

Chikungunya Virus as Cause of Febrile Illness Outbreak, Chiapas, Mexico, 2014 [PDF - 656 KB - 4 pages]
T. F. Kautz et al.

Since chikungunya virus (CHIKV) was introduced into the Americas in 2013, its geographic distribution has rapidly expanded. Of 119 serum samples collected in 2014 from febrile patients in southern Mexico, 79% were positive for CHIKV or IgM against CHIKV. Sequencing results confirmed CHIKV strains closely related to Caribbean isolates.

EID Kautz TF, Díaz-González EE, Erasmus JH, Malo-García IR, Langsjoen RM, Patterson EI, et al. Chikungunya Virus as Cause of Febrile Illness Outbreak, Chiapas, Mexico, 2014. Emerg Infect Dis. 2015;21(11):2070-2073. https://dx.doi.org/10.3201/eid2111.150546
AMA Kautz TF, Díaz-González EE, Erasmus JH, et al. Chikungunya Virus as Cause of Febrile Illness Outbreak, Chiapas, Mexico, 2014. Emerging Infectious Diseases. 2015;21(11):2070-2073. doi:10.3201/eid2111.150546.
APA Kautz, T. F., Díaz-González, E. E., Erasmus, J. H., Malo-García, I. R., Langsjoen, R. M., Patterson, E. I....Fernández-Salas, I. (2015). Chikungunya Virus as Cause of Febrile Illness Outbreak, Chiapas, Mexico, 2014. Emerging Infectious Diseases, 21(11), 2070-2073. https://dx.doi.org/10.3201/eid2111.150546.
Letters

Divergent Gemycircularvirus in HIV-Positive Blood, France [PDF - 527 KB - 3 pages]
R. Uch et al.
EID Uch R, Fournier P, Robert C, Blanc-Tailleur C, Galicher V, Barre R, et al. Divergent Gemycircularvirus in HIV-Positive Blood, France. Emerg Infect Dis. 2015;21(11):2096-2098. https://dx.doi.org/10.3201/eid2111.150486
AMA Uch R, Fournier P, Robert C, et al. Divergent Gemycircularvirus in HIV-Positive Blood, France. Emerging Infectious Diseases. 2015;21(11):2096-2098. doi:10.3201/eid2111.150486.
APA Uch, R., Fournier, P., Robert, C., Blanc-Tailleur, C., Galicher, V., Barre, R....Biagini, P. (2015). Divergent Gemycircularvirus in HIV-Positive Blood, France. Emerging Infectious Diseases, 21(11), 2096-2098. https://dx.doi.org/10.3201/eid2111.150486.

G2P[4]-RotaTeq Reassortant Rotavirus in Vaccinated Child, United States [PDF - 398 KB - 2 pages]
S. Roy et al.
EID Roy S, Rungsrisuriyachai K, Esona MD, Boom JA, Sahni LC, Rench MA, et al. G2P[4]-RotaTeq Reassortant Rotavirus in Vaccinated Child, United States. Emerg Infect Dis. 2015;21(11):2103-2104. https://dx.doi.org/10.3201/eid2111.150850
AMA Roy S, Rungsrisuriyachai K, Esona MD, et al. G2P[4]-RotaTeq Reassortant Rotavirus in Vaccinated Child, United States. Emerging Infectious Diseases. 2015;21(11):2103-2104. doi:10.3201/eid2111.150850.
APA Roy, S., Rungsrisuriyachai, K., Esona, M. D., Boom, J. A., Sahni, L. C., Rench, M. A....Bowen, M. D. (2015). G2P[4]-RotaTeq Reassortant Rotavirus in Vaccinated Child, United States. Emerging Infectious Diseases, 21(11), 2103-2104. https://dx.doi.org/10.3201/eid2111.150850.

Human Infection with Sporolactobacillus laevolacticus, Marseille, France [PDF - 1.58 MB - 3 pages]
C. Abat et al.
EID Abat C, Kerbaj J, Dubourg G, Garcia V, Rolain J. Human Infection with Sporolactobacillus laevolacticus, Marseille, France. Emerg Infect Dis. 2015;21(11):2106-2108. https://dx.doi.org/10.3201/eid2111.151197
AMA Abat C, Kerbaj J, Dubourg G, et al. Human Infection with Sporolactobacillus laevolacticus, Marseille, France. Emerging Infectious Diseases. 2015;21(11):2106-2108. doi:10.3201/eid2111.151197.
APA Abat, C., Kerbaj, J., Dubourg, G., Garcia, V., & Rolain, J. (2015). Human Infection with Sporolactobacillus laevolacticus, Marseille, France. Emerging Infectious Diseases, 21(11), 2106-2108. https://dx.doi.org/10.3201/eid2111.151197.

Histoplasmosis in HIV-Infected Persons, Yaoundé, Cameroon [PDF - 284 KB - 3 pages]
C. E. Mandengue et al.
EID Mandengue CE, Ngandjio A, Atangana P. Histoplasmosis in HIV-Infected Persons, Yaoundé, Cameroon. Emerg Infect Dis. 2015;21(11):2094-2096. https://dx.doi.org/10.3201/eid2111.150278
AMA Mandengue CE, Ngandjio A, Atangana P. Histoplasmosis in HIV-Infected Persons, Yaoundé, Cameroon. Emerging Infectious Diseases. 2015;21(11):2094-2096. doi:10.3201/eid2111.150278.
APA Mandengue, C. E., Ngandjio, A., & Atangana, P. (2015). Histoplasmosis in HIV-Infected Persons, Yaoundé, Cameroon. Emerging Infectious Diseases, 21(11), 2094-2096. https://dx.doi.org/10.3201/eid2111.150278.

Multidrug-Resistant Tuberculosis in Child Successfully Treated with 9-Month Drug Regimen [PDF - 275 KB - 2 pages]
J. Achar et al.
EID Achar J, Berry C, Herboczek K, Parpieva N, Tillyashaykhov MN, Tigay ZN, et al. Multidrug-Resistant Tuberculosis in Child Successfully Treated with 9-Month Drug Regimen. Emerg Infect Dis. 2015;21(11):2105-2106. https://dx.doi.org/10.3201/eid2111.151119
AMA Achar J, Berry C, Herboczek K, et al. Multidrug-Resistant Tuberculosis in Child Successfully Treated with 9-Month Drug Regimen. Emerging Infectious Diseases. 2015;21(11):2105-2106. doi:10.3201/eid2111.151119.
APA Achar, J., Berry, C., Herboczek, K., Parpieva, N., Tillyashaykhov, M. N., Tigay, Z. N....du Cros, P. (2015). Multidrug-Resistant Tuberculosis in Child Successfully Treated with 9-Month Drug Regimen. Emerging Infectious Diseases, 21(11), 2105-2106. https://dx.doi.org/10.3201/eid2111.151119.

Mycobacterium sherrisii Pulmonary Disease, Burkina Faso [PDF - 304 KB - 2 pages]
E. Borroni et al.
EID Borroni E, Badoum G, Cirillo D, Matteelli A, Moyenga I, Ouedraogo M, et al. Mycobacterium sherrisii Pulmonary Disease, Burkina Faso. Emerg Infect Dis. 2015;21(11):2093-2094. https://dx.doi.org/10.3201/eid2111.141809
AMA Borroni E, Badoum G, Cirillo D, et al. Mycobacterium sherrisii Pulmonary Disease, Burkina Faso. Emerging Infectious Diseases. 2015;21(11):2093-2094. doi:10.3201/eid2111.141809.
APA Borroni, E., Badoum, G., Cirillo, D., Matteelli, A., Moyenga, I., Ouedraogo, M....Tortoli, E. (2015). Mycobacterium sherrisii Pulmonary Disease, Burkina Faso. Emerging Infectious Diseases, 21(11), 2093-2094. https://dx.doi.org/10.3201/eid2111.141809.

Co-infection with Drug-Susceptible and Reactivated Latent Multidrug-Resistant Mycobacterium tuberculosis [PDF - 849 KB - 3 pages]
L. Pérez-Lago et al.
EID Pérez-Lago L, Lirola M, Navarro Y, Herranz M, Ruiz-Serrano M, Bouza E, et al. Co-infection with Drug-Susceptible and Reactivated Latent Multidrug-Resistant Mycobacterium tuberculosis. Emerg Infect Dis. 2015;21(11):2098-2100. https://dx.doi.org/10.3201/eid2111.150683
AMA Pérez-Lago L, Lirola M, Navarro Y, et al. Co-infection with Drug-Susceptible and Reactivated Latent Multidrug-Resistant Mycobacterium tuberculosis. Emerging Infectious Diseases. 2015;21(11):2098-2100. doi:10.3201/eid2111.150683.
APA Pérez-Lago, L., Lirola, M., Navarro, Y., Herranz, M., Ruiz-Serrano, M., Bouza, E....García-de-Viedma, D. (2015). Co-infection with Drug-Susceptible and Reactivated Latent Multidrug-Resistant Mycobacterium tuberculosis. Emerging Infectious Diseases, 21(11), 2098-2100. https://dx.doi.org/10.3201/eid2111.150683.

Sensitivity to Polymyxin B in El Tor Vibrio cholerae O1 Strain, Kolkata, India [PDF - 567 KB - 3 pages]
P. Samanta et al.
EID Samanta P, Ghosh P, Chowdhury G, Ramamurthy T, Mukhopadhyay AK. Sensitivity to Polymyxin B in El Tor Vibrio cholerae O1 Strain, Kolkata, India. Emerg Infect Dis. 2015;21(11):2100-2102. https://dx.doi.org/10.3201/eid2111.150762
AMA Samanta P, Ghosh P, Chowdhury G, et al. Sensitivity to Polymyxin B in El Tor Vibrio cholerae O1 Strain, Kolkata, India. Emerging Infectious Diseases. 2015;21(11):2100-2102. doi:10.3201/eid2111.150762.
APA Samanta, P., Ghosh, P., Chowdhury, G., Ramamurthy, T., & Mukhopadhyay, A. K. (2015). Sensitivity to Polymyxin B in El Tor Vibrio cholerae O1 Strain, Kolkata, India. Emerging Infectious Diseases, 21(11), 2100-2102. https://dx.doi.org/10.3201/eid2111.150762.
Another Dimension

Liberia—Moving Beyond “Ebola Free” [PDF - 443 KB - 2 pages]
H. Keys et al.
EID Keys H, Midturi J, Chambers-Kersch L. Liberia—Moving Beyond “Ebola Free”. Emerg Infect Dis. 2015;21(11):2091-2092. https://dx.doi.org/10.3201/eid2111.151322
AMA Keys H, Midturi J, Chambers-Kersch L. Liberia—Moving Beyond “Ebola Free”. Emerging Infectious Diseases. 2015;21(11):2091-2092. doi:10.3201/eid2111.151322.
APA Keys, H., Midturi, J., & Chambers-Kersch, L. (2015). Liberia—Moving Beyond “Ebola Free”. Emerging Infectious Diseases, 21(11), 2091-2092. https://dx.doi.org/10.3201/eid2111.151322.
Books and Media

The Fantastic Laboratory of Dr. Weigl: How Two Brave Scientists Battled Typhus and Sabotaged the Nazis [PDF - 374 KB - 1 page]
C. Teo
EID Teo C. The Fantastic Laboratory of Dr. Weigl: How Two Brave Scientists Battled Typhus and Sabotaged the Nazis. Emerg Infect Dis. 2015;21(11):2109. https://dx.doi.org/10.3201/eid2111.150926
AMA Teo C. The Fantastic Laboratory of Dr. Weigl: How Two Brave Scientists Battled Typhus and Sabotaged the Nazis. Emerging Infectious Diseases. 2015;21(11):2109. doi:10.3201/eid2111.150926.
APA Teo, C. (2015). The Fantastic Laboratory of Dr. Weigl: How Two Brave Scientists Battled Typhus and Sabotaged the Nazis. Emerging Infectious Diseases, 21(11), 2109. https://dx.doi.org/10.3201/eid2111.150926.
About the Cover

Celebrating the Fabric of Commonplace Society [PDF - 2.57 MB - 2 pages]
B. Breedlove and N. M. M’ikanatha
EID Breedlove B, M’ikanatha NM. Celebrating the Fabric of Commonplace Society. Emerg Infect Dis. 2015;21(11):2110-2111. https://dx.doi.org/10.3201/eid2111.ac2111
AMA Breedlove B, M’ikanatha NM. Celebrating the Fabric of Commonplace Society. Emerging Infectious Diseases. 2015;21(11):2110-2111. doi:10.3201/eid2111.ac2111.
APA Breedlove, B., & M’ikanatha, N. M. (2015). Celebrating the Fabric of Commonplace Society. Emerging Infectious Diseases, 21(11), 2110-2111. https://dx.doi.org/10.3201/eid2111.ac2111.
Etymologia

Etymologia: Ebola [PDF - 1.59 MB - 1 page]
EID Etymologia: Ebola. Emerg Infect Dis. 2015;21(11):1905. https://dx.doi.org/10.3201/eid2111.et2111
AMA Etymologia: Ebola. Emerging Infectious Diseases. 2015;21(11):1905. doi:10.3201/eid2111.et2111.
APA (2015). Etymologia: Ebola. Emerging Infectious Diseases, 21(11), 1905. https://dx.doi.org/10.3201/eid2111.et2111.
Conference Summaries

Invasive Salmonella Discussed in Africa Consensus Meeting 2014, Blantyre, Malawi
R. S. Heyderman and J. A. Crump
Page created: November 18, 2015
Page updated: November 18, 2015
Page reviewed: November 18, 2015
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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