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Issue Cover for Volume 22, Number 4—April 2016

Volume 22, Number 4—April 2016

[PDF - 9.93 MB - 200 pages]

Perspective

Determinants and Drivers of Infectious Disease Threat Events in Europe [PDF - 522 KB - 9 pages]
J. C. Semenza et al.

Infectious disease threat events (IDTEs) are increasing in frequency worldwide. We analyzed underlying drivers of 116 IDTEs detected in Europe during 2008–2013 by epidemic intelligence at the European Centre of Disease Prevention and Control. Seventeen drivers were identified and categorized into 3 groups: globalization and environment, sociodemographic, and public health systems. A combination of >2 drivers was responsible for most IDTEs. The driver category globalization and environment contributed to 61% of individual IDTEs, and the top 5 individual drivers of all IDTEs were travel and tourism, food and water quality, natural environment, global trade, and climate. Hierarchical cluster analysis of all drivers identified travel and tourism as a distinctly separate driver. Monitoring and modeling such disease drivers can help anticipate future IDTEs and strengthen control measures. More important, intervening directly on these underlying drivers can diminish the likelihood of the occurrence of an IDTE and reduce the associated human and economic costs.

EID Semenza JC, Lindgren E, Balkanyi L, Espinosa L, Almqvist MS, Penttinen P, et al. Determinants and Drivers of Infectious Disease Threat Events in Europe. Emerg Infect Dis. 2016;22(4):581-589. https://dx.doi.org/10.3201/eid2204.151073
AMA Semenza JC, Lindgren E, Balkanyi L, et al. Determinants and Drivers of Infectious Disease Threat Events in Europe. Emerging Infectious Diseases. 2016;22(4):581-589. doi:10.3201/eid2204.151073.
APA Semenza, J. C., Lindgren, E., Balkanyi, L., Espinosa, L., Almqvist, M. S., Penttinen, P....Rocklöv, J. (2016). Determinants and Drivers of Infectious Disease Threat Events in Europe. Emerging Infectious Diseases, 22(4), 581-589. https://dx.doi.org/10.3201/eid2204.151073.
Synopses

Shiga Toxin–Producing Escherichia coli O157, England and Wales, 1983–2012 [PDF - 640 KB - 8 pages]
N. L. Adams et al.

We evaluated clinical Shiga toxin–producing Escherichia coli O157 infections in England and Wales during 1983–2012 to describe changes in microbiological and surveillance methods. A strain replacement event was captured; phage type (PT) 2 decreased to account for just 3% of cases by 2012, whereas PT8 and PT21/28 strains concurrently emerged, constituting almost two thirds of cases by 2012. Despite interventions to control and reduce transmission, incidence remained constant. However, sources of infection changed over time; outbreaks caused by contaminated meat and milk declined, suggesting that interventions aimed at reducing meat cross-contamination were effective. Petting farm and school and nursery outbreaks increased, suggesting the emergence of other modes of transmission and potentially contributing to the sustained incidence over time. Studies assessing interventions and consideration of policies and guidance should be undertaken to reduce Shiga toxin–producing E. coli O157 infections in England and Wales in line with the latest epidemiologic findings.

EID Adams NL, Byrne L, Smith GA, Elson R, Harris JP, Salmon R, et al. Shiga Toxin–Producing Escherichia coli O157, England and Wales, 1983–2012. Emerg Infect Dis. 2016;22(4):590-597. https://dx.doi.org/10.3201/eid2204.151485
AMA Adams NL, Byrne L, Smith GA, et al. Shiga Toxin–Producing Escherichia coli O157, England and Wales, 1983–2012. Emerging Infectious Diseases. 2016;22(4):590-597. doi:10.3201/eid2204.151485.
APA Adams, N. L., Byrne, L., Smith, G. A., Elson, R., Harris, J. P., Salmon, R....Jenkins, C. (2016). Shiga Toxin–Producing Escherichia coli O157, England and Wales, 1983–2012. Emerging Infectious Diseases, 22(4), 590-597. https://dx.doi.org/10.3201/eid2204.151485.

Nosocomial Co-Transmission of Avian Influenza A(H7N9) and A(H1N1)pdm09 Viruses between 2 Patients with Hematologic Disorders [PDF - 588 KB - 10 pages]
H. Chen et al.

A nosocomial cluster induced by co-infections with avian influenza A(H7N9) and A(H1N1)pdm09 (pH1N1) viruses occurred in 2 patients at a hospital in Zhejiang Province, China, in January 2014. The index case-patient was a 57-year-old man with chronic lymphocytic leukemia who had been occupationally exposed to poultry. He had co-infection with H7N9 and pH1N1 viruses. A 71-year-old man with polycythemia vera who was in the same ward as the index case-patient for 6 days acquired infection with H7N9 and pH1N1 viruses. The incubation period for the second case-patient was estimated to be <4 days. Both case-patients died of multiple organ failure. Virus genetic sequences from the 2 case-patients were identical. Of 103 close contacts, none had acute respiratory symptoms; all were negative for H7N9 virus. Serum samples from both case-patients demonstrated strong proinflammatory cytokine secretion but incompetent protective immune responses. These findings strongly suggest limited nosocomial co-transmission of H7N9 and pH1N1 viruses from 1 immunocompromised patient to another.

EID Chen H, Liu S, Liu J, Chai C, Mao H, Yu Z, et al. Nosocomial Co-Transmission of Avian Influenza A(H7N9) and A(H1N1)pdm09 Viruses between 2 Patients with Hematologic Disorders. Emerg Infect Dis. 2016;22(4):598-607. https://dx.doi.org/10.3201/eid2204.151561
AMA Chen H, Liu S, Liu J, et al. Nosocomial Co-Transmission of Avian Influenza A(H7N9) and A(H1N1)pdm09 Viruses between 2 Patients with Hematologic Disorders. Emerging Infectious Diseases. 2016;22(4):598-607. doi:10.3201/eid2204.151561.
APA Chen, H., Liu, S., Liu, J., Chai, C., Mao, H., Yu, Z....Chen, E. (2016). Nosocomial Co-Transmission of Avian Influenza A(H7N9) and A(H1N1)pdm09 Viruses between 2 Patients with Hematologic Disorders. Emerging Infectious Diseases, 22(4), 598-607. https://dx.doi.org/10.3201/eid2204.151561.
Research

Quantifying Transmission of Clostridium difficile within and outside Healthcare Settings [PDF - 619 KB - 9 pages]
D. P. Durham et al.

To quantify the effect of hospital and community-based transmission and control measures on Clostridium difficile infection (CDI), we constructed a transmission model within and between hospital, community, and long-term care-facility settings. By parameterizing the model from national databases and calibrating it to C. difficile prevalence and CDI incidence, we found that hospitalized patients with CDI transmit C. difficile at a rate 15 (95% CI 7.2–32) times that of asymptomatic patients. Long-term care facility residents transmit at a rate of 27% (95% CI 13%–51%) that of hospitalized patients, and persons in the community at a rate of 0.1% (95% CI 0.062%–0.2%) that of hospitalized patients. Despite lower transmission rates for asymptomatic carriers and community sources, these transmission routes have a substantial effect on hospital-onset CDI because of the larger reservoir of hospitalized carriers and persons in the community. Asymptomatic carriers and community sources should be accounted for when designing and evaluating control interventions.

EID Durham DP, Olsen MA, Dubberke ER, Galvani AP, Townsend JP. Quantifying Transmission of Clostridium difficile within and outside Healthcare Settings. Emerg Infect Dis. 2016;22(4):608-616. https://dx.doi.org/10.3201/eid2204.150455
AMA Durham DP, Olsen MA, Dubberke ER, et al. Quantifying Transmission of Clostridium difficile within and outside Healthcare Settings. Emerging Infectious Diseases. 2016;22(4):608-616. doi:10.3201/eid2204.150455.
APA Durham, D. P., Olsen, M. A., Dubberke, E. R., Galvani, A. P., & Townsend, J. P. (2016). Quantifying Transmission of Clostridium difficile within and outside Healthcare Settings. Emerging Infectious Diseases, 22(4), 608-616. https://dx.doi.org/10.3201/eid2204.150455.

Microevolution of Monophasic Salmonella Typhimurium during Epidemic, United Kingdom, 2005–2010 [PDF - 2.48 MB - 8 pages]
L. Petrovska et al.

Microevolution associated with emergence and expansion of new epidemic clones of bacterial pathogens holds the key to epidemiologic success. To determine microevolution associated with monophasic Salmonella Typhimurium during an epidemic, we performed comparative whole-genome sequencing and phylogenomic analysis of isolates from the United Kingdom and Italy during 2005–2012. These isolates formed a single clade distinct from recent monophasic epidemic clones previously described from North America and Spain. The UK monophasic epidemic clones showed a novel genomic island encoding resistance to heavy metals and a composite transposon encoding antimicrobial drug resistance genes not present in other Salmonella Typhimurium isolates, which may have contributed to epidemiologic success. A remarkable amount of genotypic variation accumulated during clonal expansion that occurred during the epidemic, including multiple independent acquisitions of a novel prophage carrying the sopE gene and multiple deletion events affecting the phase II flagellin locus. This high level of microevolution may affect antigenicity, pathogenicity, and transmission.

EID Petrovska L, Mather AE, AbuOun M, Branchu P, Harris SR, Connor T, et al. Microevolution of Monophasic Salmonella Typhimurium during Epidemic, United Kingdom, 2005–2010. Emerg Infect Dis. 2016;22(4):617-624. https://dx.doi.org/10.3201/eid2204.150531
AMA Petrovska L, Mather AE, AbuOun M, et al. Microevolution of Monophasic Salmonella Typhimurium during Epidemic, United Kingdom, 2005–2010. Emerging Infectious Diseases. 2016;22(4):617-624. doi:10.3201/eid2204.150531.
APA Petrovska, L., Mather, A. E., AbuOun, M., Branchu, P., Harris, S. R., Connor, T....Kingsley, R. A. (2016). Microevolution of Monophasic Salmonella Typhimurium during Epidemic, United Kingdom, 2005–2010. Emerging Infectious Diseases, 22(4), 617-624. https://dx.doi.org/10.3201/eid2204.150531.

Molecular Typing and Epidemiology of Human Listeriosis Cases, Denmark, 2002–2012 [PDF - 656 KB - 9 pages]
A. Jensen et al.

Denmark has a high incidence of invasive listeriosis (0.9 cases/100,000 population in 2012). We analyzed patient data, clinical outcome, and trends in pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) of Listeria monocytogenes strains isolated in Denmark during 2002–2012. We performed 2-enzyme PFGE and serotyping on 559 isolates and MLST on 92 isolates and identified some correlation between molecular type and clinical outcome and patient characteristics. We found 178 different PFGE types, but isolates from 122 cases belonged to just 2 closely related PFGE types, clonal complex 8 and sequence type 8. These 2 types were the main cause of a peak in incidence of invasive listeriosis during 2005–2009, possibly representing an outbreak or the presence of a highly prevalent clone. However, current typing methods could not fully confirm these possibilities, highlighting the need for more refined discriminatory typing methods to identify outbreaks within frequently occurring L. monocytogenes PFGE types.

EID Jensen A, Björkman JT, Ethelberg S, Kiil K, Kemp M, Nielsen E. Molecular Typing and Epidemiology of Human Listeriosis Cases, Denmark, 2002–2012. Emerg Infect Dis. 2016;22(4):625-633. https://dx.doi.org/10.3201/eid2204.150998
AMA Jensen A, Björkman JT, Ethelberg S, et al. Molecular Typing and Epidemiology of Human Listeriosis Cases, Denmark, 2002–2012. Emerging Infectious Diseases. 2016;22(4):625-633. doi:10.3201/eid2204.150998.
APA Jensen, A., Björkman, J. T., Ethelberg, S., Kiil, K., Kemp, M., & Nielsen, E. (2016). Molecular Typing and Epidemiology of Human Listeriosis Cases, Denmark, 2002–2012. Emerging Infectious Diseases, 22(4), 625-633. https://dx.doi.org/10.3201/eid2204.150998.

Limited Dissemination of Extended-Spectrum β-Lactamase– and Plasmid-Encoded AmpC–Producing Escherichia coli from Food and Farm Animals, Sweden [PDF - 761 KB - 7 pages]
S. Börjesson et al.

Extended-spectrum β-lactamase (ESBL)– and plasmid-encoded ampC (pAmpC)–producing Enterobacteriaceae might spread from farm animals to humans through food. However, most studies have been limited in number of isolates tested and areas studied. We examined genetic relatedness of 716 isolates from 4,854 samples collected from humans, farm animals, and foods in Sweden to determine whether foods and farm animals might act as reservoirs and dissemination routes for ESBL/pAmpC-producing Escherichia coli. Results showed that clonal spread to humans appears unlikely. However, we found limited dissemination of genes encoding ESBL/pAmpC and plasmids carrying these genes from foods and farm animals to healthy humans and patients. Poultry and chicken meat might be a reservoir and dissemination route to humans. Although we found no evidence of clonal spread of ESBL/pAmpC-producing E. coli from farm animals or foods to humans, ESBL/pAmpC-producing E. coli with identical genes and plasmids were present in farm animals, foods, and humans.

EID Börjesson S, Ny S, Egervärn M, Bergström J, Rosengren Å, Englund S, et al. Limited Dissemination of Extended-Spectrum β-Lactamase– and Plasmid-Encoded AmpC–Producing Escherichia coli from Food and Farm Animals, Sweden. Emerg Infect Dis. 2016;22(4):634-640. https://dx.doi.org/10.3201/eid2204.151142
AMA Börjesson S, Ny S, Egervärn M, et al. Limited Dissemination of Extended-Spectrum β-Lactamase– and Plasmid-Encoded AmpC–Producing Escherichia coli from Food and Farm Animals, Sweden. Emerging Infectious Diseases. 2016;22(4):634-640. doi:10.3201/eid2204.151142.
APA Börjesson, S., Ny, S., Egervärn, M., Bergström, J., Rosengren, Å., Englund, S....Byfors, S. (2016). Limited Dissemination of Extended-Spectrum β-Lactamase– and Plasmid-Encoded AmpC–Producing Escherichia coli from Food and Farm Animals, Sweden. Emerging Infectious Diseases, 22(4), 634-640. https://dx.doi.org/10.3201/eid2204.151142.

Post-Ebola Syndrome, Sierra Leone [PDF - 837 KB - 6 pages]
J. T. Scott et al.

Thousands of persons have survived Ebola virus disease. Almost all survivors describe symptoms that persist or develop after hospital discharge. A cross-sectional survey of the symptoms of all survivors from the Ebola treatment unit (ETU) at 34th Regimental Military Hospital, Freetown, Sierra Leone (MH34), was conducted after discharge at their initial follow-up appointment within 3 weeks after their second negative PCR result. From its opening on December 1, 2014, through March 31, 2015, the MH34 ETU treated 84 persons (8–70 years of age) with PCR-confirmed Ebola virus disease, of whom 44 survived. Survivors reported musculoskeletal pain (70%), headache (48%), and ocular problems (14%). Those who reported headache had had lower admission cycle threshold Ebola PCR than did those who did not (p<0.03). This complete survivor cohort from 1 ETU enables analysis of the proportion of symptoms of post-Ebola syndrome. The Ebola epidemic is waning, but the effects of the disease will remain.

EID Scott JT, Sesay FR, Massaquoi TA, Idriss BR, Sahr F, Semple MG. Post-Ebola Syndrome, Sierra Leone. Emerg Infect Dis. 2016;22(4):641-646. https://dx.doi.org/10.3201/eid2204.151302
AMA Scott JT, Sesay FR, Massaquoi TA, et al. Post-Ebola Syndrome, Sierra Leone. Emerging Infectious Diseases. 2016;22(4):641-646. doi:10.3201/eid2204.151302.
APA Scott, J. T., Sesay, F. R., Massaquoi, T. A., Idriss, B. R., Sahr, F., & Semple, M. G. (2016). Post-Ebola Syndrome, Sierra Leone. Emerging Infectious Diseases, 22(4), 641-646. https://dx.doi.org/10.3201/eid2204.151302.

Transmission of Middle East Respiratory Syndrome Coronavirus Infections in Healthcare Settings, Abu Dhabi [PDF - 2.35 MB - 10 pages]
J. C. Hunter et al.

Middle East respiratory syndrome coronavirus (MERS-CoV) infections sharply increased in the Arabian Peninsula during spring 2014. In Abu Dhabi, United Arab Emirates, these infections occurred primarily among healthcare workers and patients. To identify and describe epidemiologic and clinical characteristics of persons with healthcare-associated infection, we reviewed laboratory-confirmed MERS-CoV cases reported to the Health Authority of Abu Dhabi during January 1, 2013–May 9, 2014. Of 65 case-patients identified with MERS-CoV infection, 27 (42%) had healthcare-associated cases. Epidemiologic and genetic sequencing findings suggest that 3 healthcare clusters of MERS-CoV infection occurred, including 1 that resulted in 20 infected persons in 1 hospital. MERS-CoV in healthcare settings spread predominantly before MERS-CoV infection was diagnosed, underscoring the importance of increasing awareness and infection control measures at first points of entry to healthcare facilities.

EID Hunter JC, Nguyen DT, Aden B, Al Bandar Z, Al Dhaheri W, Abu Elkheir K, et al. Transmission of Middle East Respiratory Syndrome Coronavirus Infections in Healthcare Settings, Abu Dhabi. Emerg Infect Dis. 2016;22(4):647-656. https://dx.doi.org/10.3201/eid2204.151615
AMA Hunter JC, Nguyen DT, Aden B, et al. Transmission of Middle East Respiratory Syndrome Coronavirus Infections in Healthcare Settings, Abu Dhabi. Emerging Infectious Diseases. 2016;22(4):647-656. doi:10.3201/eid2204.151615.
APA Hunter, J. C., Nguyen, D. T., Aden, B., Al Bandar, Z., Al Dhaheri, W., Abu Elkheir, K....Al Hosani, F. (2016). Transmission of Middle East Respiratory Syndrome Coronavirus Infections in Healthcare Settings, Abu Dhabi. Emerging Infectious Diseases, 22(4), 647-656. https://dx.doi.org/10.3201/eid2204.151615.

Lassa Virus Seroprevalence in Sibirilia Commune, Bougouni District, Southern Mali [PDF - 475 KB - 7 pages]
N. Sogoba et al.

Lassa virus (LASV) is endemic to several nations in West Africa. In Mali, LASV was unknown until an exported case of Lassa fever was reported in 2009. Since that time, rodent surveys have found evidence of LASV-infected Mastomys natalensis rats in several communities in southern Mali, near the border with Côte d’Ivoire. Despite increased awareness, to date only a single case of Lassa fever has been confirmed in Mali. We conducted a survey to determine the prevalence of LASV exposure among persons in 3 villages in southern Mali where the presence of infected rodents has been documented. LASV IgG seroprevalence ranged from 14.5% to 44% per village. No sex bias was noted; however, seropositivity rates increased with participant age. These findings confirm human LASV exposure in Mali and suggest that LASV infection/Lassa fever is a potential public health concern in southern Mali.

EID Sogoba N, Rosenke K, Adjemian J, Diawara S, Maiga O, Keita M, et al. Lassa Virus Seroprevalence in Sibirilia Commune, Bougouni District, Southern Mali. Emerg Infect Dis. 2016;22(4):657-663. https://dx.doi.org/10.3201/eid2204.151814
AMA Sogoba N, Rosenke K, Adjemian J, et al. Lassa Virus Seroprevalence in Sibirilia Commune, Bougouni District, Southern Mali. Emerging Infectious Diseases. 2016;22(4):657-663. doi:10.3201/eid2204.151814.
APA Sogoba, N., Rosenke, K., Adjemian, J., Diawara, S., Maiga, O., Keita, M....Safronetz, D. (2016). Lassa Virus Seroprevalence in Sibirilia Commune, Bougouni District, Southern Mali. Emerging Infectious Diseases, 22(4), 657-663. https://dx.doi.org/10.3201/eid2204.151814.

Nipah Virus Transmission from Bats to Humans Associated with Drinking Traditional Liquor Made from Date Palm Sap, Bangladesh, 2011–2014 [PDF - 442 KB - 8 pages]
M. Islam et al.

Nipah virus (NiV) is a paramyxovirus, and Pteropus spp. bats are the natural reservoir. From December 2010 through March 2014, hospital-based encephalitis surveillance in Bangladesh identified 18 clusters of NiV infection. The source of infection for case-patients in 3 clusters in 2 districts was unknown. A team of epidemiologists and anthropologists investigated these 3 clusters comprising 14 case-patients, 8 of whom died. Among the 14 case-patients, 8 drank fermented date palm sap (tari) regularly before their illness, and 6 provided care to a person infected with NiV. The process of preparing date palm trees for tari production was similar to the process of collecting date palm sap for fresh consumption. Bat excreta was reportedly found inside pots used to make tari. These findings suggest that drinking tari is a potential pathway of NiV transmission. Interventions that prevent bat access to date palm sap might prevent tari-associated NiV infection.

EID Islam M, Sazzad H, Satter S, Sultana S, Hossain M, Hasan M, et al. Nipah Virus Transmission from Bats to Humans Associated with Drinking Traditional Liquor Made from Date Palm Sap, Bangladesh, 2011–2014. Emerg Infect Dis. 2016;22(4):664-670. https://dx.doi.org/10.3201/eid2204.151747
AMA Islam M, Sazzad H, Satter S, et al. Nipah Virus Transmission from Bats to Humans Associated with Drinking Traditional Liquor Made from Date Palm Sap, Bangladesh, 2011–2014. Emerging Infectious Diseases. 2016;22(4):664-670. doi:10.3201/eid2204.151747.
APA Islam, M., Sazzad, H., Satter, S., Sultana, S., Hossain, M., Hasan, M....Gurley, E. S. (2016). Nipah Virus Transmission from Bats to Humans Associated with Drinking Traditional Liquor Made from Date Palm Sap, Bangladesh, 2011–2014. Emerging Infectious Diseases, 22(4), 664-670. https://dx.doi.org/10.3201/eid2204.151747.

Evaluation of Viremia Frequencies of a Novel Human Pegivirus by Using Bioinformatic Screening and PCR [PDF - 622 KB - 8 pages]
D. Bonsall et al.

Next-generation sequencing has critical applications in virus discovery, diagnostics, and environmental surveillance. We used metagenomic sequence libraries for retrospective screening of plasma samples for the recently discovered human hepegivirus 1 (HHpgV-1). From a cohort of 150 hepatitis C virus (HCV)–positive case-patients, we identified 2 persons with HHpgV-1 viremia and a high frequency of human pegivirus (HPgV) viremia (14%). Detection of HHpgV-1 and HPgV was concordant with parallel PCR-based screening using conserved primers matching groups 1 (HPgV) and 2 (HHPgV-1) nonstructural 3 region sequences. PCR identified 1 HHPgV-1–positive person with viremia from a group of 195 persons with hemophilia who had been exposed to nonvirally inactivated factor VII/IX; 18 (9%) were HPgV-positive. Relative to HCV and HPgV, active infections with HHpgV-1 were infrequently detected in blood, even in groups that had substantial parenteral exposure. Our findings are consistent with lower transmissibility or higher rates of virus clearance for HHpgV-1 than for other bloodborne human flaviviruses.

EID Bonsall D, Gregory WF, Ip C, Donfield S, Iles J, Ansari M, et al. Evaluation of Viremia Frequencies of a Novel Human Pegivirus by Using Bioinformatic Screening and PCR. Emerg Infect Dis. 2016;22(4):671-678. https://dx.doi.org/10.3201/eid2204.151812
AMA Bonsall D, Gregory WF, Ip C, et al. Evaluation of Viremia Frequencies of a Novel Human Pegivirus by Using Bioinformatic Screening and PCR. Emerging Infectious Diseases. 2016;22(4):671-678. doi:10.3201/eid2204.151812.
APA Bonsall, D., Gregory, W. F., Ip, C., Donfield, S., Iles, J., Ansari, M....Simmonds, P. (2016). Evaluation of Viremia Frequencies of a Novel Human Pegivirus by Using Bioinformatic Screening and PCR. Emerging Infectious Diseases, 22(4), 671-678. https://dx.doi.org/10.3201/eid2204.151812.

Medscape CME Activity
Shiga Toxin 1–Producing Shigella sonnei Infections, California, United States, 2014–2015 [PDF - 558 KB - 8 pages]
K. Lamba et al.

Shiga toxins (Stx) are primarily associated with Shiga toxin–producing Escherichia coli and Shigella dysenteriae serotype 1. Stx production by other shigellae is uncommon, but in 2014, Stx1-producing S. sonnei infections were detected in California. Surveillance was enhanced to test S. sonnei isolates for the presence and expression of stx genes, perform DNA subtyping, describe clinical and epidemiologic characteristics of case-patients, and investigate for sources of infection. During June 2014–April 2015, we identified 56 cases of Stx1-producing S. sonnei, in 2 clusters. All isolates encoded stx1 and produced active Stx1. Multiple pulsed-field gel electrophoresis patterns were identified. Bloody diarrhea was reported by 71% of case-patients; none had hemolytic uremic syndrome. Some initial cases were epidemiologically linked to travel to Mexico, but subsequent infections were transmitted domestically. Continued surveillance of Stx1-producing S. sonnei in California is necessary to characterize its features and plan for reduction of its spread in the United States.

EID Lamba K, Nelson JA, Kimura AC, Poe A, Collins J, Kao AS, et al. Shiga Toxin 1–Producing Shigella sonnei Infections, California, United States, 2014–2015. Emerg Infect Dis. 2016;22(4):679-686. https://dx.doi.org/10.3201/eid2204.151825
AMA Lamba K, Nelson JA, Kimura AC, et al. Shiga Toxin 1–Producing Shigella sonnei Infections, California, United States, 2014–2015. Emerging Infectious Diseases. 2016;22(4):679-686. doi:10.3201/eid2204.151825.
APA Lamba, K., Nelson, J. A., Kimura, A. C., Poe, A., Collins, J., Kao, A. S....Vugia, D. (2016). Shiga Toxin 1–Producing Shigella sonnei Infections, California, United States, 2014–2015. Emerging Infectious Diseases, 22(4), 679-686. https://dx.doi.org/10.3201/eid2204.151825.
Dispatches

Adenovirus Type 7 Pneumonia in Children Who Died from Measles-Associated Pneumonia, Hanoi, Vietnam, 2014 [PDF - 395 KB - 4 pages]
L. Hai et al.

During a 2014 measles outbreak in Vietnam, postmortem pathologic examination of hospitalized children who died showed that adenovirus type 7 pneumonia was a contributory cause of death in children with measles-associated immune suppression. Adenovirus type 7 pneumonia should be recognized as a major cause of secondary infection after measles.

EID Hai L, Thach H, Tuan T, Nam D, Dien T, Sato Y, et al. Adenovirus Type 7 Pneumonia in Children Who Died from Measles-Associated Pneumonia, Hanoi, Vietnam, 2014. Emerg Infect Dis. 2016;22(4):687-690. https://dx.doi.org/10.3201/eid2204.151595
AMA Hai L, Thach H, Tuan T, et al. Adenovirus Type 7 Pneumonia in Children Who Died from Measles-Associated Pneumonia, Hanoi, Vietnam, 2014. Emerging Infectious Diseases. 2016;22(4):687-690. doi:10.3201/eid2204.151595.
APA Hai, L., Thach, H., Tuan, T., Nam, D., Dien, T., Sato, Y....Nakajima, N. (2016). Adenovirus Type 7 Pneumonia in Children Who Died from Measles-Associated Pneumonia, Hanoi, Vietnam, 2014. Emerging Infectious Diseases, 22(4), 687-690. https://dx.doi.org/10.3201/eid2204.151595.

Elevated Toxoplasma gondii Infection Rates for Retinas from Eye Banks, Southern Brazil [PDF - 327 KB - 3 pages]
A. G. Commodaro et al.

We found significantly higher incidence of Toxoplasma gondii DNA in eye bank specimens from Joinville in southern Brazil (13/15, 87%) than in São Paulo (3/42, 7%; p = 2.1 × 10E–8). PCR DNA sequence analysis was more sensitive at locus NTS2 than at locus B1; a high frequency of mixed co-infections was detected.

EID Commodaro AG, Chiasson M, Sundar N, Rizzo L, Belfort R, Grigg ME. Elevated Toxoplasma gondii Infection Rates for Retinas from Eye Banks, Southern Brazil. Emerg Infect Dis. 2016;22(4):691-693. https://dx.doi.org/10.3201/eid2204.141819
AMA Commodaro AG, Chiasson M, Sundar N, et al. Elevated Toxoplasma gondii Infection Rates for Retinas from Eye Banks, Southern Brazil. Emerging Infectious Diseases. 2016;22(4):691-693. doi:10.3201/eid2204.141819.
APA Commodaro, A. G., Chiasson, M., Sundar, N., Rizzo, L., Belfort, R., & Grigg, M. E. (2016). Elevated Toxoplasma gondii Infection Rates for Retinas from Eye Banks, Southern Brazil. Emerging Infectious Diseases, 22(4), 691-693. https://dx.doi.org/10.3201/eid2204.141819.

Arenavirus Diversity and Phylogeography of Mastomys natalensis Rodents, Nigeria [PDF - 451 KB - 4 pages]
A. Olayemi et al.

Mastomys natalensis rodents are natural hosts for Lassa virus (LASV). Detection of LASV in 2 mitochondrial phylogroups of the rodent near the Niger and Benue Rivers in Nigeria underlines the potential for LASV emergence in fresh phylogroups of this rodent. A Mobala-like sequence was also detected in eastern Nigeria.

EID Olayemi A, Obadare A, Oyeyiola A, Igbokwe J, Fasogbon A, Igbahenah F, et al. Arenavirus Diversity and Phylogeography of Mastomys natalensis Rodents, Nigeria. Emerg Infect Dis. 2016;22(4):694-697. https://dx.doi.org/10.3201/eid2204.150155
AMA Olayemi A, Obadare A, Oyeyiola A, et al. Arenavirus Diversity and Phylogeography of Mastomys natalensis Rodents, Nigeria. Emerging Infectious Diseases. 2016;22(4):694-697. doi:10.3201/eid2204.150155.
APA Olayemi, A., Obadare, A., Oyeyiola, A., Igbokwe, J., Fasogbon, A., Igbahenah, F....Fichet-Calvet, E. (2016). Arenavirus Diversity and Phylogeography of Mastomys natalensis Rodents, Nigeria. Emerging Infectious Diseases, 22(4), 694-697. https://dx.doi.org/10.3201/eid2204.150155.

Neisseria meningitidis Serogroup X in Sub-Saharan Africa [PDF - 514 KB - 4 pages]
A. Agnememel et al.

The epidemiology of meningococcal disease varies by geography and time. Whole-genome sequencing of Neisseria meningitidis serogroup X isolates from sub-Saharan Africa and Europe showed that serogroup X emergence in sub-Saharan Africa resulted from expansion of particular variants within clonal complex 181. Virulence of these isolates in experimental mouse models was high.

EID Agnememel A, Hong E, Giorgini D, Nuñez-Samudio V, Deghmane A, Taha M. Neisseria meningitidis Serogroup X in Sub-Saharan Africa. Emerg Infect Dis. 2016;22(4):698-702. https://dx.doi.org/10.3201/eid2204.150653
AMA Agnememel A, Hong E, Giorgini D, et al. Neisseria meningitidis Serogroup X in Sub-Saharan Africa. Emerging Infectious Diseases. 2016;22(4):698-702. doi:10.3201/eid2204.150653.
APA Agnememel, A., Hong, E., Giorgini, D., Nuñez-Samudio, V., Deghmane, A., & Taha, M. (2016). Neisseria meningitidis Serogroup X in Sub-Saharan Africa. Emerging Infectious Diseases, 22(4), 698-702. https://dx.doi.org/10.3201/eid2204.150653.

Cross-Neutralization between Human and African Bat Mumps Viruses [PDF - 441 KB - 4 pages]
H. Katoh et al.

Recently, a new paramyxovirus closely related to human mumps virus (MuV) was detected in bats. We generated recombinant MuVs carrying either or both of the fusion and hemagglutinin-neuraminidase bat virus glycoproteins. These viruses showed replication kinetics similar to human MuV in cultured cells and were neutralized efficiently by serum from healthy humans.

EID Katoh H, Kubota T, Ihara T, Maeda K, Takeda M, Kidokoro M. Cross-Neutralization between Human and African Bat Mumps Viruses. Emerg Infect Dis. 2016;22(4):703-706. https://dx.doi.org/10.3201/eid2204.151116
AMA Katoh H, Kubota T, Ihara T, et al. Cross-Neutralization between Human and African Bat Mumps Viruses. Emerging Infectious Diseases. 2016;22(4):703-706. doi:10.3201/eid2204.151116.
APA Katoh, H., Kubota, T., Ihara, T., Maeda, K., Takeda, M., & Kidokoro, M. (2016). Cross-Neutralization between Human and African Bat Mumps Viruses. Emerging Infectious Diseases, 22(4), 703-706. https://dx.doi.org/10.3201/eid2204.151116.

Definitive Hosts of Versteria Tapeworms (Cestoda: Taeniidae) Causing Fatal Infection in North America [PDF - 457 KB - 4 pages]
L. M. Lee et al.

We previously reported fatal infection of a captive Bornean orangutan with metacestodes of a novel taeniid tapeworm, Versteria sp. New data implicate mustelids as definitive hosts of these tapeworms in North America. At least 2 parasite genetic lineages circulate in North America, representing separate introductions from Eurasia.

EID Lee LM, Wallace RS, Clyde VL, Gendron-Fitzpatrick A, Sibley SD, Stuchin M, et al. Definitive Hosts of Versteria Tapeworms (Cestoda: Taeniidae) Causing Fatal Infection in North America. Emerg Infect Dis. 2016;22(4):707-710. https://dx.doi.org/10.3201/eid2204.151446
AMA Lee LM, Wallace RS, Clyde VL, et al. Definitive Hosts of Versteria Tapeworms (Cestoda: Taeniidae) Causing Fatal Infection in North America. Emerging Infectious Diseases. 2016;22(4):707-710. doi:10.3201/eid2204.151446.
APA Lee, L. M., Wallace, R. S., Clyde, V. L., Gendron-Fitzpatrick, A., Sibley, S. D., Stuchin, M....Goldberg, T. L. (2016). Definitive Hosts of Versteria Tapeworms (Cestoda: Taeniidae) Causing Fatal Infection in North America. Emerging Infectious Diseases, 22(4), 707-710. https://dx.doi.org/10.3201/eid2204.151446.

Effectiveness of a Mobile Short-Message-Service–Based Disease Outbreak Alert System in Kenya [PDF - 870 KB - 5 pages]
M. Toda et al.

We conducted a randomized, controlled trial to test the effectiveness of a text-messaging system used for notification of disease outbreaks in Kenya. Health facilities that used the system had more timely notifications than those that did not (19.2% vs. 2.6%), indicating that technology can enhance disease surveillance in resource-limited settings.

EID Toda M, Njeru I, Zurovac D, Tipo S, Kareko D, Mwau M, et al. Effectiveness of a Mobile Short-Message-Service–Based Disease Outbreak Alert System in Kenya. Emerg Infect Dis. 2016;22(4):711-715. https://dx.doi.org/10.3201/eid2204.151459
AMA Toda M, Njeru I, Zurovac D, et al. Effectiveness of a Mobile Short-Message-Service–Based Disease Outbreak Alert System in Kenya. Emerging Infectious Diseases. 2016;22(4):711-715. doi:10.3201/eid2204.151459.
APA Toda, M., Njeru, I., Zurovac, D., Tipo, S., Kareko, D., Mwau, M....Morita, K. (2016). Effectiveness of a Mobile Short-Message-Service–Based Disease Outbreak Alert System in Kenya. Emerging Infectious Diseases, 22(4), 711-715. https://dx.doi.org/10.3201/eid2204.151459.

Deletion Variants of Middle East Respiratory Syndrome Coronavirus from Humans, Jordan, 2015 [PDF - 584 KB - 4 pages]
M. M. Lamers et al.

We characterized Middle East respiratory syndrome coronaviruses from a hospital outbreak in Jordan in 2015. The viruses from Jordan were highly similar to isolates from Riyadh, Saudi Arabia, except for deletions in open reading frames 4a and 3. Transmissibility and pathogenicity of this strain remains to be determined.

EID Lamers MM, Raj V, Shafei M, Ali S, Abdallh SM, Gazo M, et al. Deletion Variants of Middle East Respiratory Syndrome Coronavirus from Humans, Jordan, 2015. Emerg Infect Dis. 2016;22(4):716-719. https://dx.doi.org/10.3201/eid2204.152065
AMA Lamers MM, Raj V, Shafei M, et al. Deletion Variants of Middle East Respiratory Syndrome Coronavirus from Humans, Jordan, 2015. Emerging Infectious Diseases. 2016;22(4):716-719. doi:10.3201/eid2204.152065.
APA Lamers, M. M., Raj, V., Shafei, M., Ali, S., Abdallh, S. M., Gazo, M....Haagmans, B. L. (2016). Deletion Variants of Middle East Respiratory Syndrome Coronavirus from Humans, Jordan, 2015. Emerging Infectious Diseases, 22(4), 716-719. https://dx.doi.org/10.3201/eid2204.152065.

Low-Cost National Media-Based Surveillance System for Public Health Events, Bangladesh [PDF - 328 KB - 3 pages]
T. T. Ao et al.

We assessed a media-based public health surveillance system in Bangladesh during 2010–2011. The system is a highly effective, low-cost, locally appropriate, and sustainable outbreak detection tool that could be used in other low-income, resource-poor settings to meet the capacity for surveillance outlined in the International Health Regulations 2005.

EID Ao TT, Rahman M, Haque F, Chakraborty A, Hossain M, Haider S, et al. Low-Cost National Media-Based Surveillance System for Public Health Events, Bangladesh. Emerg Infect Dis. 2016;22(4):720-722. https://dx.doi.org/10.3201/eid2204.150330
AMA Ao TT, Rahman M, Haque F, et al. Low-Cost National Media-Based Surveillance System for Public Health Events, Bangladesh. Emerging Infectious Diseases. 2016;22(4):720-722. doi:10.3201/eid2204.150330.
APA Ao, T. T., Rahman, M., Haque, F., Chakraborty, A., Hossain, M., Haider, S....Gurley, E. S. (2016). Low-Cost National Media-Based Surveillance System for Public Health Events, Bangladesh. Emerging Infectious Diseases, 22(4), 720-722. https://dx.doi.org/10.3201/eid2204.150330.

Exportations of Symptomatic Cases of MERS-CoV Infection to Countries outside the Middle East [PDF - 319 KB - 3 pages]
C. Carias et al.

In 2012, an outbreak of infection with Middle East respiratory syndrome coronavirus (MERS-CoV), was detected in the Arabian Peninsula. Modeling can produce estimates of the expected annual number of symptomatic cases of MERS-CoV infection exported and the likelihood of exportation from source countries in the Middle East to countries outside the region.

EID Carias C, O’Hagan JJ, Jewett A, Gambhir M, Cohen NJ, Haber Y, et al. Exportations of Symptomatic Cases of MERS-CoV Infection to Countries outside the Middle East. Emerg Infect Dis. 2016;22(4):723-725. https://dx.doi.org/10.3201/eid2204.150976
AMA Carias C, O’Hagan JJ, Jewett A, et al. Exportations of Symptomatic Cases of MERS-CoV Infection to Countries outside the Middle East. Emerging Infectious Diseases. 2016;22(4):723-725. doi:10.3201/eid2204.150976.
APA Carias, C., O’Hagan, J. J., Jewett, A., Gambhir, M., Cohen, N. J., Haber, Y....Swerdlow, D. L. (2016). Exportations of Symptomatic Cases of MERS-CoV Infection to Countries outside the Middle East. Emerging Infectious Diseases, 22(4), 723-725. https://dx.doi.org/10.3201/eid2204.150976.

Nontyphoidal Salmonella Infection, Guangdong Province, China, 2012 [PDF - 386 KB - 4 pages]
X. Huang et al.

We used active and passive surveillance to estimate nontyphoidal Salmonella (NTS) infection during 2012 in Guangdong Province, China. Under passive surveillance, for every reported NTS infection, an estimated 414.8 cases occurred annually. Under active surveillance, an estimated 35.8 cases occurred. Active surveillance provides remarkable advantages in incidence estimate.

EID Huang X, Huang Q, Dun Z, Huang W, Wu S, Liang J, et al. Nontyphoidal Salmonella Infection, Guangdong Province, China, 2012. Emerg Infect Dis. 2016;22(4):726-729. https://dx.doi.org/10.3201/eid2204.151372
AMA Huang X, Huang Q, Dun Z, et al. Nontyphoidal Salmonella Infection, Guangdong Province, China, 2012. Emerging Infectious Diseases. 2016;22(4):726-729. doi:10.3201/eid2204.151372.
APA Huang, X., Huang, Q., Dun, Z., Huang, W., Wu, S., Liang, J....Zhang, Y. (2016). Nontyphoidal Salmonella Infection, Guangdong Province, China, 2012. Emerging Infectious Diseases, 22(4), 726-729. https://dx.doi.org/10.3201/eid2204.151372.

Severe Infections with Human Adenovirus 7d in 2 Adults in Family, Illinois, USA, 2014 [PDF - 490 KB - 4 pages]
A. E. Kajon and M. G. Ison

Human adenovirus 7d, a genomic variant with no reported circulation in the United States, was isolated from 2 adults with severe respiratory infections in Illinois. Molecular typing identified a close relationship with strains of the same genome type isolated from cases of respiratory disease in several provinces of China since 2009.

EID Kajon AE, Ison MG. Severe Infections with Human Adenovirus 7d in 2 Adults in Family, Illinois, USA, 2014. Emerg Infect Dis. 2016;22(4):730-733. https://dx.doi.org/10.3201/eid2204.151403
AMA Kajon AE, Ison MG. Severe Infections with Human Adenovirus 7d in 2 Adults in Family, Illinois, USA, 2014. Emerging Infectious Diseases. 2016;22(4):730-733. doi:10.3201/eid2204.151403.
APA Kajon, A. E., & Ison, M. G. (2016). Severe Infections with Human Adenovirus 7d in 2 Adults in Family, Illinois, USA, 2014. Emerging Infectious Diseases, 22(4), 730-733. https://dx.doi.org/10.3201/eid2204.151403.

Hypervirulent emm59 Clone in Invasive Group A Streptococcus Outbreak, Southwestern United States [PDF - 553 KB - 5 pages]
D. M. Engelthaler et al.

The hyper-virulent emm59 genotype of invasive group A Streptococcus was identified in northern Arizona in 2015. Eighteen isolates belonging to a genomic cluster grouped most closely with recently identified isolates in New Mexico. The continued transmission of emm59 in the southwestern United States poses a public health concern.

EID Engelthaler DM, Valentine M, Bowers J, Pistole J, Driebe EM, Terriquez J, et al. Hypervirulent emm59 Clone in Invasive Group A Streptococcus Outbreak, Southwestern United States. Emerg Infect Dis. 2016;22(4):734-738. https://dx.doi.org/10.3201/eid2204.151582
AMA Engelthaler DM, Valentine M, Bowers J, et al. Hypervirulent emm59 Clone in Invasive Group A Streptococcus Outbreak, Southwestern United States. Emerging Infectious Diseases. 2016;22(4):734-738. doi:10.3201/eid2204.151582.
APA Engelthaler, D. M., Valentine, M., Bowers, J., Pistole, J., Driebe, E. M., Terriquez, J....Keim, P. (2016). Hypervirulent emm59 Clone in Invasive Group A Streptococcus Outbreak, Southwestern United States. Emerging Infectious Diseases, 22(4), 734-738. https://dx.doi.org/10.3201/eid2204.151582.
Letters

Leishmania infantum Infection in Blood Donors, Northeastern Brazil [PDF - 305 KB - 2 pages]
D. Monteiro et al.
EID Monteiro D, Sousa AQ, Lima DM, Fontes RM, Praciano CC, Frutuoso MS, et al. Leishmania infantum Infection in Blood Donors, Northeastern Brazil. Emerg Infect Dis. 2016;22(4):739-740. https://dx.doi.org/10.3201/eid2204.150065
AMA Monteiro D, Sousa AQ, Lima DM, et al. Leishmania infantum Infection in Blood Donors, Northeastern Brazil. Emerging Infectious Diseases. 2016;22(4):739-740. doi:10.3201/eid2204.150065.
APA Monteiro, D., Sousa, A. Q., Lima, D. M., Fontes, R. M., Praciano, C. C., Frutuoso, M. S....Pompeu, M. (2016). Leishmania infantum Infection in Blood Donors, Northeastern Brazil. Emerging Infectious Diseases, 22(4), 739-740. https://dx.doi.org/10.3201/eid2204.150065.

Morbillivirus and Pilot Whale Deaths, Canary Islands, Spain, 2015 [PDF - 345 KB - 3 pages]
E. Sierra et al.
EID Sierra E, Fernández A, Suárez-Santana C, Xuriach A, Zucca D, Bernaldo de Quirós Y, et al. Morbillivirus and Pilot Whale Deaths, Canary Islands, Spain, 2015. Emerg Infect Dis. 2016;22(4):740-742. https://dx.doi.org/10.3201/eid2204.150954
AMA Sierra E, Fernández A, Suárez-Santana C, et al. Morbillivirus and Pilot Whale Deaths, Canary Islands, Spain, 2015. Emerging Infectious Diseases. 2016;22(4):740-742. doi:10.3201/eid2204.150954.
APA Sierra, E., Fernández, A., Suárez-Santana, C., Xuriach, A., Zucca, D., Bernaldo de Quirós, Y....Arbelo, M. (2016). Morbillivirus and Pilot Whale Deaths, Canary Islands, Spain, 2015. Emerging Infectious Diseases, 22(4), 740-742. https://dx.doi.org/10.3201/eid2204.150954.

Serogroup-specific Seasonality of Verotoxigenic Escherichia coli, Ireland [PDF - 378 KB - 3 pages]
P. Garvey et al.
EID Garvey P, Carroll A, McNamara E, Charlett A, Danis K, McKeown PJ. Serogroup-specific Seasonality of Verotoxigenic Escherichia coli, Ireland. Emerg Infect Dis. 2016;22(4):742-744. https://dx.doi.org/10.3201/eid2204.151160
AMA Garvey P, Carroll A, McNamara E, et al. Serogroup-specific Seasonality of Verotoxigenic Escherichia coli, Ireland. Emerging Infectious Diseases. 2016;22(4):742-744. doi:10.3201/eid2204.151160.
APA Garvey, P., Carroll, A., McNamara, E., Charlett, A., Danis, K., & McKeown, P. J. (2016). Serogroup-specific Seasonality of Verotoxigenic Escherichia coli, Ireland. Emerging Infectious Diseases, 22(4), 742-744. https://dx.doi.org/10.3201/eid2204.151160.

New Delhi Metallo-β-Lactamase-1–Producing Klebsiella pneumoniae, Florida, USA [PDF - 293 KB - 3 pages]
J. Li et al.
EID Li J, Munoz-Price L, Spychala CN, DePascale D, Doi Y. New Delhi Metallo-β-Lactamase-1–Producing Klebsiella pneumoniae, Florida, USA. Emerg Infect Dis. 2016;22(4):744-746. https://dx.doi.org/10.3201/eid2204.151176
AMA Li J, Munoz-Price L, Spychala CN, et al. New Delhi Metallo-β-Lactamase-1–Producing Klebsiella pneumoniae, Florida, USA. Emerging Infectious Diseases. 2016;22(4):744-746. doi:10.3201/eid2204.151176.
APA Li, J., Munoz-Price, L., Spychala, C. N., DePascale, D., & Doi, Y. (2016). New Delhi Metallo-β-Lactamase-1–Producing Klebsiella pneumoniae, Florida, USA. Emerging Infectious Diseases, 22(4), 744-746. https://dx.doi.org/10.3201/eid2204.151176.

Ritual Slaughter as Overlooked Risk Factor for Brucellosis [PDF - 311 KB - 3 pages]
I. Fuchs et al.
EID Fuchs I, Osyntsov L, Refaely Y, Ciobotaro P, Zimhony O. Ritual Slaughter as Overlooked Risk Factor for Brucellosis. Emerg Infect Dis. 2016;22(4):746-748. https://dx.doi.org/10.3201/eid2204.151192
AMA Fuchs I, Osyntsov L, Refaely Y, et al. Ritual Slaughter as Overlooked Risk Factor for Brucellosis. Emerging Infectious Diseases. 2016;22(4):746-748. doi:10.3201/eid2204.151192.
APA Fuchs, I., Osyntsov, L., Refaely, Y., Ciobotaro, P., & Zimhony, O. (2016). Ritual Slaughter as Overlooked Risk Factor for Brucellosis. Emerging Infectious Diseases, 22(4), 746-748. https://dx.doi.org/10.3201/eid2204.151192.

Follow-up of Ebola Patient, 2014–2015 [PDF - 294 KB - 3 pages]
V. Srinivas et al.
EID Srinivas V, Yadav PD, Mittal V, Chaubal G, Chhabra M, Mattoo S, et al. Follow-up of Ebola Patient, 2014–2015. Emerg Infect Dis. 2016;22(4):748-750. https://dx.doi.org/10.3201/eid2204.151405
AMA Srinivas V, Yadav PD, Mittal V, et al. Follow-up of Ebola Patient, 2014–2015. Emerging Infectious Diseases. 2016;22(4):748-750. doi:10.3201/eid2204.151405.
APA Srinivas, V., Yadav, P. D., Mittal, V., Chaubal, G., Chhabra, M., Mattoo, S....Mourya, D. T. (2016). Follow-up of Ebola Patient, 2014–2015. Emerging Infectious Diseases, 22(4), 748-750. https://dx.doi.org/10.3201/eid2204.151405.

Sustained Elevated Cytokine Levels during Recovery Phase of Mayaro Virus Infection [PDF - 339 KB - 3 pages]
D. Tappe et al.
EID Tappe D, Pérez-Girón J, Just-Nübling G, Schuster G, Gómez-Medina S, Günther S, et al. Sustained Elevated Cytokine Levels during Recovery Phase of Mayaro Virus Infection. Emerg Infect Dis. 2016;22(4):750-752. https://dx.doi.org/10.3201/eid2204.151502
AMA Tappe D, Pérez-Girón J, Just-Nübling G, et al. Sustained Elevated Cytokine Levels during Recovery Phase of Mayaro Virus Infection. Emerging Infectious Diseases. 2016;22(4):750-752. doi:10.3201/eid2204.151502.
APA Tappe, D., Pérez-Girón, J., Just-Nübling, G., Schuster, G., Gómez-Medina, S., Günther, S....Schmidt-Chanasit, J. (2016). Sustained Elevated Cytokine Levels during Recovery Phase of Mayaro Virus Infection. Emerging Infectious Diseases, 22(4), 750-752. https://dx.doi.org/10.3201/eid2204.151502.

Enterovirus A71 Genogroups C and E in Children with Acute Flaccid Paralysis, West Africa [PDF - 358 KB - 3 pages]
M. D. Fernandez-Garcia et al.
EID Fernandez-Garcia MD, Kebe O, Fall AD, Dia H, Diop OM, Delpeyroux F, et al. Enterovirus A71 Genogroups C and E in Children with Acute Flaccid Paralysis, West Africa. Emerg Infect Dis. 2016;22(4):753-755. https://dx.doi.org/10.3201/eid2204.151588
AMA Fernandez-Garcia MD, Kebe O, Fall AD, et al. Enterovirus A71 Genogroups C and E in Children with Acute Flaccid Paralysis, West Africa. Emerging Infectious Diseases. 2016;22(4):753-755. doi:10.3201/eid2204.151588.
APA Fernandez-Garcia, M. D., Kebe, O., Fall, A. D., Dia, H., Diop, O. M., Delpeyroux, F....Ndiaye, K. (2016). Enterovirus A71 Genogroups C and E in Children with Acute Flaccid Paralysis, West Africa. Emerging Infectious Diseases, 22(4), 753-755. https://dx.doi.org/10.3201/eid2204.151588.

Hepatitis E Virus Prevalence among Blood Donors, Ouagadougou, Burkina Faso [PDF - 315 KB - 3 pages]
K. A. Traoré et al.
EID Traoré KA, Ouoba J, Rouamba H, Nébié YK, Dahourou H, Rossetto F, et al. Hepatitis E Virus Prevalence among Blood Donors, Ouagadougou, Burkina Faso. Emerg Infect Dis. 2016;22(4):755-757. https://dx.doi.org/10.3201/eid2204.151728
AMA Traoré KA, Ouoba J, Rouamba H, et al. Hepatitis E Virus Prevalence among Blood Donors, Ouagadougou, Burkina Faso. Emerging Infectious Diseases. 2016;22(4):755-757. doi:10.3201/eid2204.151728.
APA Traoré, K. A., Ouoba, J., Rouamba, H., Nébié, Y. K., Dahourou, H., Rossetto, F....Roques, P. (2016). Hepatitis E Virus Prevalence among Blood Donors, Ouagadougou, Burkina Faso. Emerging Infectious Diseases, 22(4), 755-757. https://dx.doi.org/10.3201/eid2204.151728.

Porcine Deltacoronavirus, Thailand, 2015 [PDF - 300 KB - 3 pages]
T. Janetanakit et al.
EID Janetanakit T, Lumyai M, Bunpapong N, Boonyapisitsopa S, Chaiyawong S, Nonthabenjawan N, et al. Porcine Deltacoronavirus, Thailand, 2015. Emerg Infect Dis. 2016;22(4):757-759. https://dx.doi.org/10.3201/eid2204.151852
AMA Janetanakit T, Lumyai M, Bunpapong N, et al. Porcine Deltacoronavirus, Thailand, 2015. Emerging Infectious Diseases. 2016;22(4):757-759. doi:10.3201/eid2204.151852.
APA Janetanakit, T., Lumyai, M., Bunpapong, N., Boonyapisitsopa, S., Chaiyawong, S., Nonthabenjawan, N....Amonsin, A. (2016). Porcine Deltacoronavirus, Thailand, 2015. Emerging Infectious Diseases, 22(4), 757-759. https://dx.doi.org/10.3201/eid2204.151852.

Ebola Virus in Breast Milk in an Ebola Virus–Positive Mother with Twin Babies, Guinea, 2015 [PDF - 281 KB - 2 pages]
H. Nordenstedt et al.
EID Nordenstedt H, Bah E, de la Vega M, Barry M, N’Faly M, Barry M, et al. Ebola Virus in Breast Milk in an Ebola Virus–Positive Mother with Twin Babies, Guinea, 2015. Emerg Infect Dis. 2016;22(4):759-760. https://dx.doi.org/10.3201/eid2204.151880
AMA Nordenstedt H, Bah E, de la Vega M, et al. Ebola Virus in Breast Milk in an Ebola Virus–Positive Mother with Twin Babies, Guinea, 2015. Emerging Infectious Diseases. 2016;22(4):759-760. doi:10.3201/eid2204.151880.
APA Nordenstedt, H., Bah, E., de la Vega, M., Barry, M., N’Faly, M., Barry, M....Ingelbeen, B. (2016). Ebola Virus in Breast Milk in an Ebola Virus–Positive Mother with Twin Babies, Guinea, 2015. Emerging Infectious Diseases, 22(4), 759-760. https://dx.doi.org/10.3201/eid2204.151880.

Chronic Infection of Domestic Cats with Feline Morbillivirus, United States [PDF - 403 KB - 3 pages]
C. R. Sharp et al.
EID Sharp CR, Nambulli S, Acciardo AS, Rennick LJ, Drexler J, Rima BK, et al. Chronic Infection of Domestic Cats with Feline Morbillivirus, United States. Emerg Infect Dis. 2016;22(4):760-762. https://dx.doi.org/10.3201/eid2204.151921
AMA Sharp CR, Nambulli S, Acciardo AS, et al. Chronic Infection of Domestic Cats with Feline Morbillivirus, United States. Emerging Infectious Diseases. 2016;22(4):760-762. doi:10.3201/eid2204.151921.
APA Sharp, C. R., Nambulli, S., Acciardo, A. S., Rennick, L. J., Drexler, J., Rima, B. K....Duprex, W. (2016). Chronic Infection of Domestic Cats with Feline Morbillivirus, United States. Emerging Infectious Diseases, 22(4), 760-762. https://dx.doi.org/10.3201/eid2204.151921.

Difficulties in Schistosomiasis Assessment, Corsica, France [PDF - 402 KB - 4 pages]
H. Moné et al.
EID Moné H, Holtfreter MC, Mouahid G, Richter J. Difficulties in Schistosomiasis Assessment, Corsica, France. Emerg Infect Dis. 2016;22(4):762-765. https://dx.doi.org/10.3201/eid2204.160110
AMA Moné H, Holtfreter MC, Mouahid G, et al. Difficulties in Schistosomiasis Assessment, Corsica, France. Emerging Infectious Diseases. 2016;22(4):762-765. doi:10.3201/eid2204.160110.
APA Moné, H., Holtfreter, M. C., Mouahid, G., & Richter, J. (2016). Difficulties in Schistosomiasis Assessment, Corsica, France. Emerging Infectious Diseases, 22(4), 762-765. https://dx.doi.org/10.3201/eid2204.160110.
Books and Media

Immunity [PDF - 208 KB - 1 page]
T. M. Lee
EID Lee TM. Immunity. Emerg Infect Dis. 2016;22(4):766. https://dx.doi.org/10.3201/eid2204.151858
AMA Lee TM. Immunity. Emerging Infectious Diseases. 2016;22(4):766. doi:10.3201/eid2204.151858.
APA Lee, T. M. (2016). Immunity. Emerging Infectious Diseases, 22(4), 766. https://dx.doi.org/10.3201/eid2204.151858.

One Health: People, Animals, and the Environment [PDF - 281 KB - 2 pages]
C. Behravesh
EID Behravesh C. One Health: People, Animals, and the Environment. Emerg Infect Dis. 2016;22(4):766-767. https://dx.doi.org/10.3201/eid2204.151887
AMA Behravesh C. One Health: People, Animals, and the Environment. Emerging Infectious Diseases. 2016;22(4):766-767. doi:10.3201/eid2204.151887.
APA Behravesh, C. (2016). One Health: People, Animals, and the Environment. Emerging Infectious Diseases, 22(4), 766-767. https://dx.doi.org/10.3201/eid2204.151887.
In Memoriam

In Memoriam: Sandy Ford (1950–2015) [PDF - 429 KB - 2 pages]
M. G. Schultz and A. B. Bloch
EID Schultz MG, Bloch AB. In Memoriam: Sandy Ford (1950–2015). Emerg Infect Dis. 2016;22(4):764-765. https://dx.doi.org/10.3201/eid2204.151336
AMA Schultz MG, Bloch AB. In Memoriam: Sandy Ford (1950–2015). Emerging Infectious Diseases. 2016;22(4):764-765. doi:10.3201/eid2204.151336.
APA Schultz, M. G., & Bloch, A. B. (2016). In Memoriam: Sandy Ford (1950–2015). Emerging Infectious Diseases, 22(4), 764-765. https://dx.doi.org/10.3201/eid2204.151336.
About the Cover

From Farm to Fable [PDF - 308 KB - 2 pages]
B. Breedlove
EID Breedlove B. From Farm to Fable. Emerg Infect Dis. 2016;22(4):768-769. https://dx.doi.org/10.3201/eid2204.ac2204
AMA Breedlove B. From Farm to Fable. Emerging Infectious Diseases. 2016;22(4):768-769. doi:10.3201/eid2204.ac2204.
APA Breedlove, B. (2016). From Farm to Fable. Emerging Infectious Diseases, 22(4), 768-769. https://dx.doi.org/10.3201/eid2204.ac2204.
Etymologia

Etymologia: Listeria [PDF - 332 KB - 1 page]
EID Etymologia: Listeria. Emerg Infect Dis. 2016;22(4):633. https://dx.doi.org/10.3201/eid2204.et2204
AMA Etymologia: Listeria. Emerging Infectious Diseases. 2016;22(4):633. doi:10.3201/eid2204.et2204.
APA (2016). Etymologia: Listeria. Emerging Infectious Diseases, 22(4), 633. https://dx.doi.org/10.3201/eid2204.et2204.
Conference Summaries

Enteric Fever and Invasive Nontyphoidal Salmonellosis—9th International Conference on Typhoid and Invasive NTS Disease, Bali, Indonesia, April 30–May 3, 2015
M. Khan et al.
Corrections

Correction: Vol. 21, No. 11 [PDF - 353 KB - 1 page]
EID Correction: Vol. 21, No. 11. Emerg Infect Dis. 2016;22(4):763. https://dx.doi.org/10.3201/eid2204.c12204
AMA Correction: Vol. 21, No. 11. Emerging Infectious Diseases. 2016;22(4):763. doi:10.3201/eid2204.c12204.
APA (2016). Correction: Vol. 21, No. 11. Emerging Infectious Diseases, 22(4), 763. https://dx.doi.org/10.3201/eid2204.c12204.
Page created: December 01, 2016
Page updated: December 01, 2016
Page reviewed: December 01, 2016
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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