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Issue Cover for Volume 22, Number 6—June 2016

Volume 22, Number 6—June 2016

[PDF - 8.14 MB - 208 pages]

Perspective

Debate Regarding Oseltamivir Use for Seasonal and Pandemic Influenza [PDF - 1.10 MB - 7 pages]
A. C. Hurt and H. Kelly

A debate about the market-leading influenza antiviral medication, oseltamivir, which initially focused on treatment for generally mild illness, has been expanded to question the wisdom of stockpiling for use in future influenza pandemics. Although randomized controlled trial evidence confirms that oseltamivir will reduce symptom duration by 17–25 hours among otherwise healthy adolescents and adults with community-managed disease, no randomized controlled trials have examined the effectiveness of oseltamivir against more serious outcomes. Observational studies, although criticized on methodologic grounds, suggest that oseltamivir given early can reduce the risk for death by half among persons hospitalized with confirmed infection caused by influenza A(H1N1)pdm09 and influenza A(H5N1) viruses. However, available randomized controlled trial data may not be able to capture the effect of oseltamivir use among hospitalized patients with severe disease. We assert that data on outpatients with relatively mild disease should not form the basis for policies on the management of more severe disease.

EID Hurt AC, Kelly H. Debate Regarding Oseltamivir Use for Seasonal and Pandemic Influenza. Emerg Infect Dis. 2016;22(6):949-955. https://dx.doi.org/10.3201/eid2206.151037
AMA Hurt AC, Kelly H. Debate Regarding Oseltamivir Use for Seasonal and Pandemic Influenza. Emerging Infectious Diseases. 2016;22(6):949-955. doi:10.3201/eid2206.151037.
APA Hurt, A. C., & Kelly, H. (2016). Debate Regarding Oseltamivir Use for Seasonal and Pandemic Influenza. Emerging Infectious Diseases, 22(6), 949-955. https://dx.doi.org/10.3201/eid2206.151037.

Perspectives on West Africa Ebola Virus Disease Outbreak, 2013–2016 [PDF - 2.38 MB - 8 pages]
J. R. Spengler et al.

The variety of factors that contributed to the initial undetected spread of Ebola virus disease in West Africa during 2013–2016 and the difficulty controlling the outbreak once the etiology was identified highlight priorities for disease prevention, detection, and response. These factors include occurrence in a region recovering from civil instability and lacking experience with Ebola response; inadequate surveillance, recognition of suspected cases, and Ebola diagnosis; mobile populations and extensive urban transmission; and the community’s insufficient general understanding about the disease. The magnitude of the outbreak was not attributable to a substantial change of the virus. Continued efforts during the outbreak and in preparation for future outbreak response should involve identifying the reservoir, improving in-country detection and response capacity, conducting survivor studies and supporting survivors, engaging in culturally appropriate public education and risk communication, building productive interagency relationships, and continuing support for basic research.

EID Spengler JR, Ervin E, Towner JS, Rollin PE, Nichol ST. Perspectives on West Africa Ebola Virus Disease Outbreak, 2013–2016. Emerg Infect Dis. 2016;22(6):956-963. https://dx.doi.org/10.3201/eid2206.160021
AMA Spengler JR, Ervin E, Towner JS, et al. Perspectives on West Africa Ebola Virus Disease Outbreak, 2013–2016. Emerging Infectious Diseases. 2016;22(6):956-963. doi:10.3201/eid2206.160021.
APA Spengler, J. R., Ervin, E., Towner, J. S., Rollin, P. E., & Nichol, S. T. (2016). Perspectives on West Africa Ebola Virus Disease Outbreak, 2013–2016. Emerging Infectious Diseases, 22(6), 956-963. https://dx.doi.org/10.3201/eid2206.160021.
Synopses

Medscape CME Activity
Human Infection with Influenza A(H7N9) Virus during 3 Major Epidemic Waves, China, 2013–2015 [PDF - 2.99 MB - 9 pages]
P. Wu et al.

Since March 2013, a novel influenza A(H7N9) virus has caused 3 epidemic waves of human infection in mainland China. We analyzed data from patients with laboratory-confirmed influenza A(H7N9) virus infection to estimate the risks for severe outcomes after hospitalization across the 3 waves. We found that hospitalized patients with confirmed infections in waves 2 and 3 were younger and more likely to be residing in small cities and rural areas than were patients in wave 1; they also had a higher risk for death, after adjustment for age and underlying medical conditions. Risk for death among hospitalized patients during waves 2 and 3 was lower in Jiangxi and Fujian Provinces than in eastern and southern provinces. The variation in risk for death among hospitalized case-patients in different areas across 3 epidemic waves might be associated with differences in case ascertainment, changes in clinical management, or virus genetic diversity.

EID Wu P, Peng Z, Fang VJ, Feng L, Tsang TK, Jiang H, et al. Human Infection with Influenza A(H7N9) Virus during 3 Major Epidemic Waves, China, 2013–2015. Emerg Infect Dis. 2016;22(6):964-972. https://dx.doi.org/10.3201/eid2206.151752
AMA Wu P, Peng Z, Fang VJ, et al. Human Infection with Influenza A(H7N9) Virus during 3 Major Epidemic Waves, China, 2013–2015. Emerging Infectious Diseases. 2016;22(6):964-972. doi:10.3201/eid2206.151752.
APA Wu, P., Peng, Z., Fang, V. J., Feng, L., Tsang, T. K., Jiang, H....Cowling, B. J. (2016). Human Infection with Influenza A(H7N9) Virus during 3 Major Epidemic Waves, China, 2013–2015. Emerging Infectious Diseases, 22(6), 964-972. https://dx.doi.org/10.3201/eid2206.151752.

Integration of Genomic and Other Epidemiologic Data to Investigate and Control a Cross-Institutional Outbreak of Streptococcus pyogenes [PDF - 1.13 MB - 8 pages]
V. J. Chalker et al.

Single-strain outbreaks of Streptococcus pyogenes infections are common and often go undetected. In 2013, two clusters of invasive group A Streptococcus (iGAS) infection were identified in independent but closely located care homes in Oxfordshire, United Kingdom. Investigation included visits to each home, chart review, staff survey, microbiologic sampling, and genome sequencing. S. pyogenes emm type 1.0, the most common circulating type nationally, was identified from all cases yielding GAS isolates. A tailored whole-genome reference population comprising epidemiologically relevant contemporaneous isolates and published isolates was assembled. Data were analyzed independently using whole-genome multilocus sequencing and single-nucleotide polymorphism analyses. Six isolates from staff and residents of the homes formed a single cluster that was separated from the reference population by both analytical approaches. No further cases occurred after mass chemoprophylaxis and enhanced infection control. Our findings demonstrate the ability of 2 independent analytical approaches to enable robust conclusions from nonstandardized whole-genome analysis to support public health practice.

EID Chalker VJ, Smith A, Al-Shahib A, Botchway S, Macdonald E, Daniel R, et al. Integration of Genomic and Other Epidemiologic Data to Investigate and Control a Cross-Institutional Outbreak of Streptococcus pyogenes. Emerg Infect Dis. 2016;22(6):973-980. https://dx.doi.org/10.3201/eid2206.142050
AMA Chalker VJ, Smith A, Al-Shahib A, et al. Integration of Genomic and Other Epidemiologic Data to Investigate and Control a Cross-Institutional Outbreak of Streptococcus pyogenes. Emerging Infectious Diseases. 2016;22(6):973-980. doi:10.3201/eid2206.142050.
APA Chalker, V. J., Smith, A., Al-Shahib, A., Botchway, S., Macdonald, E., Daniel, R....McCarthy, N. (2016). Integration of Genomic and Other Epidemiologic Data to Investigate and Control a Cross-Institutional Outbreak of Streptococcus pyogenes. Emerging Infectious Diseases, 22(6), 973-980. https://dx.doi.org/10.3201/eid2206.142050.

Medscape CME Activity
Infectious Disease Risk Associated with Contaminated Propofol Anesthesia, 1989–2014 [PDF - 1.14 MB - 12 pages]
A. Zorrilla-Vaca et al.

Administration of propofol, the most frequently used intravenous anesthetic worldwide, has been associated with several iatrogenic infections despite its relative safety. Little is known regarding the global epidemiology of propofol-related outbreaks and the effectiveness of existing preventive strategies. In this overview of the evidence of propofol as a source of infection and appraisal of preventive strategies, we identified 58 studies through a literature search in PubMed, Embase, and Lilacs for propofol-related infections during 1989–2014. Twenty propofol-related outbreaks have been reported, affecting 144 patients and resulting in 10 deaths. Related factors included reuse of syringes for multiple patients and prolonged exposure to the environment when vials were left open. The addition of antimicrobial drugs to the emulsion has been instituted in some countries, but outbreaks have still occurred. There remains a lack of comprehensive information on the effectiveness of measures to prevent future outbreaks.

EID Zorrilla-Vaca A, Arevalo JJ, Escandón-Vargas K, Soltanifar D, Mirski MA. Infectious Disease Risk Associated with Contaminated Propofol Anesthesia, 1989–2014. Emerg Infect Dis. 2016;22(6):981-992. https://dx.doi.org/10.3201/eid2206.150376
AMA Zorrilla-Vaca A, Arevalo JJ, Escandón-Vargas K, et al. Infectious Disease Risk Associated with Contaminated Propofol Anesthesia, 1989–2014. Emerging Infectious Diseases. 2016;22(6):981-992. doi:10.3201/eid2206.150376.
APA Zorrilla-Vaca, A., Arevalo, J. J., Escandón-Vargas, K., Soltanifar, D., & Mirski, M. A. (2016). Infectious Disease Risk Associated with Contaminated Propofol Anesthesia, 1989–2014. Emerging Infectious Diseases, 22(6), 981-992. https://dx.doi.org/10.3201/eid2206.150376.

Improved Global Capacity for Influenza Surveillance [PDF - 1.51 MB - 9 pages]
L. S. Polansky et al.

During 2004–2009, the Centers for Disease Control and Prevention (CDC) partnered with 39 national governments to strengthen global influenza surveillance. Using World Health Organization data and program evaluation indicators collected by CDC in 2013, we retrospectively evaluated progress made 4–9 years after the start of influenza surveillance capacity strengthening in the countries. Our results showed substantial increases in laboratory and sentinel surveillance capacities, which are essential for knowing which influenza strains circulate globally, detecting emergence of novel influenza, identifying viruses for vaccine selection, and determining the epidemiology of respiratory illness. Twenty-eight of 35 countries responding to a 2013 questionnaire indicated that they have leveraged routine influenza surveillance platforms to detect other pathogens. This additional surveillance illustrates increased health-system strengthening. Furthermore, 34 countries reported an increased ability to use data in decision making; data-driven decisions are critical for improving local prevention and control of influenza around the world.

EID Polansky LS, Outin-Blenman S, Moen AC. Improved Global Capacity for Influenza Surveillance. Emerg Infect Dis. 2016;22(6):993-1001. https://dx.doi.org/10.3201/eid2206.151521
AMA Polansky LS, Outin-Blenman S, Moen AC. Improved Global Capacity for Influenza Surveillance. Emerging Infectious Diseases. 2016;22(6):993-1001. doi:10.3201/eid2206.151521.
APA Polansky, L. S., Outin-Blenman, S., & Moen, A. C. (2016). Improved Global Capacity for Influenza Surveillance. Emerging Infectious Diseases, 22(6), 993-1001. https://dx.doi.org/10.3201/eid2206.151521.

Reemergence of Dengue in Southern Texas, 2013 [PDF - 1.85 MB - 6 pages]
D. Thomas et al.

During a dengue epidemic in northern Mexico, enhanced surveillance identified 53 laboratory-positive cases in southern Texas; 26 (49%) patients acquired the infection locally, and 29 (55%) were hospitalized. Of 83 patient specimens that were initially IgM negative according to ELISA performed at a commercial laboratory, 14 (17%) were dengue virus positive by real-time reverse transcription PCR performed at the Centers for Disease Control and Prevention. Dengue virus types 1 and 3 were identified, and molecular phylogenetic analysis demonstrated close identity with viruses that had recently circulated in Mexico and Central America. Of 51 household members of 22 dengue case-patients who participated in household investigations, 6 (12%) had been recently infected with a dengue virus and reported no recent travel, suggesting intrahousehold transmission. One household member reported having a recent illness consistent with dengue. This outbreak reinforces emergence of dengue in southern Texas, particularly when incidence is high in northern Mexico.

EID Thomas D, Santiago GA, Abeyta R, Hinojosa S, Torres-Velasquez B, Adam JK, et al. Reemergence of Dengue in Southern Texas, 2013. Emerg Infect Dis. 2016;22(6):1002-1007. https://dx.doi.org/10.3201/eid2206.152000
AMA Thomas D, Santiago GA, Abeyta R, et al. Reemergence of Dengue in Southern Texas, 2013. Emerging Infectious Diseases. 2016;22(6):1002-1007. doi:10.3201/eid2206.152000.
APA Thomas, D., Santiago, G. A., Abeyta, R., Hinojosa, S., Torres-Velasquez, B., Adam, J. K....Sharp, T. M. (2016). Reemergence of Dengue in Southern Texas, 2013. Emerging Infectious Diseases, 22(6), 1002-1007. https://dx.doi.org/10.3201/eid2206.152000.
Research

Transmission of Mycobacterium chimaera from Heater–Cooler Units during Cardiac Surgery despite an Ultraclean Air Ventilation System [PDF - 1.60 MB - 6 pages]
R. Sommerstein et al.

Heater–cooler units (HCUs) were recently identified as a source of Mycobacterium chimaera causing surgical site infections. We investigated transmission of this bacterium from HCUs to the surgical field by using a thermic anemometer and particle counter, videotape of an operating room equipped with an ultraclean laminar airflow ventilation system, and bacterial culture sedimentation plates in a nonventilated room. Smoke from the HCU reached the surgical field in 23 s by merging with ultraclean air. The HCU produced on average 5.2, 139, and 14.8 particles/min in the surgical field at positions Off, On/oriented toward, and On/oriented away, respectively. Culture plates were positive for M. chimaera <5 m from the HCU in the test room. These experiments confirm airborne transmission of M. chimaera aerosols from a contaminated HCU to an open surgical field despite ultraclean air ventilation. Efforts to mitigate infectious risks during surgery should consider contamination from water sources and airflow-generating devices.

EID Sommerstein R, Rüegg C, Kohler P, Bloemberg GV, Kuster SP, Sax H. Transmission of Mycobacterium chimaera from Heater–Cooler Units during Cardiac Surgery despite an Ultraclean Air Ventilation System. Emerg Infect Dis. 2016;22(6):1008-1013. https://dx.doi.org/10.3201/eid2206.160045
AMA Sommerstein R, Rüegg C, Kohler P, et al. Transmission of Mycobacterium chimaera from Heater–Cooler Units during Cardiac Surgery despite an Ultraclean Air Ventilation System. Emerging Infectious Diseases. 2016;22(6):1008-1013. doi:10.3201/eid2206.160045.
APA Sommerstein, R., Rüegg, C., Kohler, P., Bloemberg, G. V., Kuster, S. P., & Sax, H. (2016). Transmission of Mycobacterium chimaera from Heater–Cooler Units during Cardiac Surgery despite an Ultraclean Air Ventilation System. Emerging Infectious Diseases, 22(6), 1008-1013. https://dx.doi.org/10.3201/eid2206.160045.

Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo [PDF - 2.24 MB - 8 pages]
L. Nolen et al.

A >600% increase in monkeypox cases occurred in the Bokungu Health Zone of the Democratic Republic of the Congo during the second half of 2013; this increase prompted an outbreak investigation. A total of 104 possible cases were reported from this health zone; among 60 suspected cases that were tested, 50 (48.1%) cases were confirmed by laboratory testing, and 10 (9.6%) tested negative for monkeypox virus (MPXV) infection. The household attack rate (i.e., rate of persons living with an infected person that develop symptoms of MPXV infection) was 50%. Nine families showed >1 transmission event, and >6 transmission events occurred within this health zone. Mean incubation period was 8 days (range 4–14 days). The high attack rate and transmission observed in this study reinforce the importance of surveillance and rapid identification of monkeypox cases. Community education and training are needed to prevent transmission of MPXV infection during outbreaks.

EID Nolen L, Osadebe L, Katomba J, Likofata J, Mukadi D, Monroe B, et al. Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo. Emerg Infect Dis. 2016;22(6):1014-1021. https://dx.doi.org/10.3201/eid2206.150579
AMA Nolen L, Osadebe L, Katomba J, et al. Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo. Emerging Infectious Diseases. 2016;22(6):1014-1021. doi:10.3201/eid2206.150579.
APA Nolen, L., Osadebe, L., Katomba, J., Likofata, J., Mukadi, D., Monroe, B....Reynolds, M. G. (2016). Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo. Emerging Infectious Diseases, 22(6), 1014-1021. https://dx.doi.org/10.3201/eid2206.150579.

Use of Population Genetics to Assess the Ecology, Evolution, and Population Structure of Coccidioides [PDF - 1.55 MB - 9 pages]
M. M. Teixeira and B. M. Barker

During the past 20 years, a general picture of the genetic diversity and population structure of Coccidioides, the causal agent of coccidioidomycosis (Valley fever), has emerged. The genus consists of 2 genetically diverse species, C. immitis and C. posadasii, each of which contains 1 or more distinct populations with limited gene flow. Genotypic data indicate that C. immitis is divided into 2 subpopulations (central and southern California populations) and C. posadasii is divided into 3 subpopulations (Arizona, Mexico, and Texas/South America populations). However, admixture within and among these populations and the current paucity of environmental isolates limit our understanding of the population genetics of Coccidioides. We assessed population structure of Coccidioides in Arizona by analyzing 495 clinical and environmental isolates. Our findings confirm the population structure as previously described and indicate a finer scale population structure in Arizona. Environmental isolates appear to have higher genetic diversity than isolates from human patients.

EID Teixeira MM, Barker BM. Use of Population Genetics to Assess the Ecology, Evolution, and Population Structure of Coccidioides. Emerg Infect Dis. 2016;22(6):1022-1030. https://dx.doi.org/10.3201/eid2206.151565
AMA Teixeira MM, Barker BM. Use of Population Genetics to Assess the Ecology, Evolution, and Population Structure of Coccidioides. Emerging Infectious Diseases. 2016;22(6):1022-1030. doi:10.3201/eid2206.151565.
APA Teixeira, M. M., & Barker, B. M. (2016). Use of Population Genetics to Assess the Ecology, Evolution, and Population Structure of Coccidioides. Emerging Infectious Diseases, 22(6), 1022-1030. https://dx.doi.org/10.3201/eid2206.151565.

Infection, Replication, and Transmission of Middle East Respiratory Syndrome Coronavirus in Alpacas [PDF - 1.74 MB - 7 pages]
D. R. Adney et al.

Middle East respiratory syndrome coronavirus is a recently emerged pathogen associated with severe human disease. Zoonotic spillover from camels appears to play a major role in transmission. Because of logistic difficulties in working with dromedaries in containment, a more manageable animal model would be desirable. We report shedding and transmission of this virus in experimentally infected alpacas (n = 3) or those infected by contact (n = 3). Infectious virus was detected in all infected animals and in 2 of 3 in-contact animals. All alpacas seroconverted and were rechallenged 70 days after the original infection. Experimentally infected animals were protected against reinfection, and those infected by contact were partially protected. Necropsy specimens from immunologically naive animals (n = 3) obtained on day 5 postinfection showed virus in the upper respiratory tract. These data demonstrate efficient virus replication and animal-to-animal transmission and indicate that alpacas might be useful surrogates for camels in laboratory studies.

EID Adney DR, Bielefeldt-Ohmann H, Hartwig AE, Bowen RA. Infection, Replication, and Transmission of Middle East Respiratory Syndrome Coronavirus in Alpacas. Emerg Infect Dis. 2016;22(6):1031-1037. https://dx.doi.org/10.3201/eid2206.160192
AMA Adney DR, Bielefeldt-Ohmann H, Hartwig AE, et al. Infection, Replication, and Transmission of Middle East Respiratory Syndrome Coronavirus in Alpacas. Emerging Infectious Diseases. 2016;22(6):1031-1037. doi:10.3201/eid2206.160192.
APA Adney, D. R., Bielefeldt-Ohmann, H., Hartwig, A. E., & Bowen, R. A. (2016). Infection, Replication, and Transmission of Middle East Respiratory Syndrome Coronavirus in Alpacas. Emerging Infectious Diseases, 22(6), 1031-1037. https://dx.doi.org/10.3201/eid2206.160192.

Rapid Detection of Polymyxin Resistance in Enterobacteriaceae [PDF - 1.57 MB - 6 pages]
P. Nordmann et al.

For identification of polymyxin resistance in Enterobacteriaceae, we developed a rapid test that detects glucose metabolization associated with bacterial growth in the presence of a defined concentration of colistin or polymyxin B. Formation of acid metabolites is evidenced by a color change (orange to yellow) of a pH indicator (red phenol). To evaluate the test, we used bacterial colonies of 135 isolates expressing various mechanisms of colistin resistance (intrinsic, chromosomally encoded, and plasmid-mediated MCR-1) and 65 colistin-susceptible isolates. Sensitivity and specificity were 99.3% and 95.4%, respectively, compared with the standard broth microdilution method. This new test is inexpensive, easy to perform, sensitive, specific, and can be completed in <2 hours. It could be useful in countries facing endemic spread of carbapenemase producers and for which polymyxins are last-resort drugs.

EID Nordmann P, Jayol A, Poirel L. Rapid Detection of Polymyxin Resistance in Enterobacteriaceae. Emerg Infect Dis. 2016;22(6):1038-1043. https://dx.doi.org/10.3201/eid2206.151840
AMA Nordmann P, Jayol A, Poirel L. Rapid Detection of Polymyxin Resistance in Enterobacteriaceae. Emerging Infectious Diseases. 2016;22(6):1038-1043. doi:10.3201/eid2206.151840.
APA Nordmann, P., Jayol, A., & Poirel, L. (2016). Rapid Detection of Polymyxin Resistance in Enterobacteriaceae. Emerging Infectious Diseases, 22(6), 1038-1043. https://dx.doi.org/10.3201/eid2206.151840.

Human Adenovirus Associated with Severe Respiratory Infection, Oregon, USA, 2013–2014 [PDF - 1.76 MB - 8 pages]
M. Scott et al.

Several human adenoviruses (HAdVs) can cause respiratory infections, some severe. HAdV-B7, which can cause severe respiratory disease, has not been recently reported in the United States but is reemerging in Asia. During October 2013–July 2014, Oregon health authorities identified 198 persons with respiratory symptoms and an HAdV-positive respiratory tract specimen. Among 136 (69%) hospitalized persons, 31% were admitted to the intensive care unit and 18% required mechanical ventilation; 5 patients died. Molecular typing of 109 specimens showed that most (59%) were HAdV-B7, followed by HAdVs-C1, -C2, -C5 (26%); HAdVs-B3, -B21 (15%); and HAdV-E4 (1%). Molecular analysis of 7 HAdV-B7 isolates identified the virus as genome type d, a strain previously identified only among strains circulating in Asia. Patients with HAdV-B7 were significantly more likely than those without HAdV-B7 to be adults and to have longer hospital stays. HAdV-B7 might be reemerging in the United States, and clinicians should consider HAdV in persons with severe respiratory infection.

EID Scott M, Chommanard C, Lu X, Appelgate D, Grenz L, Schneider E, et al. Human Adenovirus Associated with Severe Respiratory Infection, Oregon, USA, 2013–2014. Emerg Infect Dis. 2016;22(6):1044-1051. https://dx.doi.org/10.3201/eid2206.151898
AMA Scott M, Chommanard C, Lu X, et al. Human Adenovirus Associated with Severe Respiratory Infection, Oregon, USA, 2013–2014. Emerging Infectious Diseases. 2016;22(6):1044-1051. doi:10.3201/eid2206.151898.
APA Scott, M., Chommanard, C., Lu, X., Appelgate, D., Grenz, L., Schneider, E....Thomas, A. (2016). Human Adenovirus Associated with Severe Respiratory Infection, Oregon, USA, 2013–2014. Emerging Infectious Diseases, 22(6), 1044-1051. https://dx.doi.org/10.3201/eid2206.151898.

Heterogeneous and Dynamic Prevalence of Asymptomatic Influenza Virus Infections [PDF - 651 KB - 5 pages]
L. Furuya-Kanamori et al.

Influenza infection manifests in a wide spectrum of severity, including symptomless pathogen carriers. We conducted a systematic review and meta-analysis of 55 studies to elucidate the proportional representation of these asymptomatic infected persons. We observed extensive heterogeneity among these studies. The prevalence of asymptomatic carriage (total absence of symptoms) ranged from 5.2% to 35.5% and subclinical cases (illness that did not meet the criteria for acute respiratory or influenza-like illness) from 25.4% to 61.8%. Statistical analysis showed that the heterogeneity could not be explained by the type of influenza, the laboratory tests used to detect the virus, the year of the study, or the location of the study. Projections of infection spread and strategies for disease control require that we identify the proportional representation of these insidious spreaders early on in the emergence of new influenza subtypes or strains and track how this rate evolves over time and space.

EID Furuya-Kanamori L, Cox M, Milinovich GJ, Magalhaes RJ, Mackay IM, Yakob L. Heterogeneous and Dynamic Prevalence of Asymptomatic Influenza Virus Infections. Emerg Infect Dis. 2016;22(6):1052-1056. https://dx.doi.org/10.3201/eid2206.151080
AMA Furuya-Kanamori L, Cox M, Milinovich GJ, et al. Heterogeneous and Dynamic Prevalence of Asymptomatic Influenza Virus Infections. Emerging Infectious Diseases. 2016;22(6):1052-1056. doi:10.3201/eid2206.151080.
APA Furuya-Kanamori, L., Cox, M., Milinovich, G. J., Magalhaes, R. J., Mackay, I. M., & Yakob, L. (2016). Heterogeneous and Dynamic Prevalence of Asymptomatic Influenza Virus Infections. Emerging Infectious Diseases, 22(6), 1052-1056. https://dx.doi.org/10.3201/eid2206.151080.

High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus [PDF - 1.52 MB - 10 pages]
R. San-Juan et al.

We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011–June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 μg/mL and 0.5 μg/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2–5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1–5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications.

EID San-Juan R, Viedma E, Chaves F, Lalueza A, Fortún J, Loza E, et al. High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus. Emerg Infect Dis. 2016;22(6):1057-1066. https://dx.doi.org/10.3201/eid2206.151709
AMA San-Juan R, Viedma E, Chaves F, et al. High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus. Emerging Infectious Diseases. 2016;22(6):1057-1066. doi:10.3201/eid2206.151709.
APA San-Juan, R., Viedma, E., Chaves, F., Lalueza, A., Fortún, J., Loza, E....Aguado, J. (2016). High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus. Emerging Infectious Diseases, 22(6), 1057-1066. https://dx.doi.org/10.3201/eid2206.151709.
Dispatches

Population-Level Effect of Cholera Vaccine on Displaced Populations, South Sudan, 2014 [PDF - 1.55 MB - 4 pages]
A. S. Azman et al.

Following mass population displacements in South Sudan, preventive cholera vaccination campaigns were conducted in displaced persons camps before a 2014 cholera outbreak. We compare cholera transmission in vaccinated and unvaccinated areas and show vaccination likely halted transmission within vaccinated areas, illustrating the potential for oral cholera vaccine to stop cholera transmission in vulnerable populations.

EID Azman AS, Rumunu J, Abubakar A, West H, Ciglenecki I, Helderman T, et al. Population-Level Effect of Cholera Vaccine on Displaced Populations, South Sudan, 2014. Emerg Infect Dis. 2016;22(6):1067-1070. https://dx.doi.org/10.3201/eid2206.151592
AMA Azman AS, Rumunu J, Abubakar A, et al. Population-Level Effect of Cholera Vaccine on Displaced Populations, South Sudan, 2014. Emerging Infectious Diseases. 2016;22(6):1067-1070. doi:10.3201/eid2206.151592.
APA Azman, A. S., Rumunu, J., Abubakar, A., West, H., Ciglenecki, I., Helderman, T....Luquero, F. J. (2016). Population-Level Effect of Cholera Vaccine on Displaced Populations, South Sudan, 2014. Emerging Infectious Diseases, 22(6), 1067-1070. https://dx.doi.org/10.3201/eid2206.151592.

Experimental Infection and Response to Rechallenge of Alpacas with Middle East Respiratory Syndrome Coronavirus [PDF - 736 KB - 4 pages]
G. Crameri et al.

We conducted a challenge/rechallenge trial in which 3 alpacas were infected with Middle East respiratory syndrome coronavirus. The alpacas shed virus at challenge but were refractory to further shedding at rechallenge on day 21. The trial indicates that alpacas may be suitable models for infection and shedding dynamics of this virus.

EID Crameri G, Durr PA, Klein R, Foord A, Yu M, Riddell S, et al. Experimental Infection and Response to Rechallenge of Alpacas with Middle East Respiratory Syndrome Coronavirus. Emerg Infect Dis. 2016;22(6):1071-1074. https://dx.doi.org/10.3201/eid2206.160007
AMA Crameri G, Durr PA, Klein R, et al. Experimental Infection and Response to Rechallenge of Alpacas with Middle East Respiratory Syndrome Coronavirus. Emerging Infectious Diseases. 2016;22(6):1071-1074. doi:10.3201/eid2206.160007.
APA Crameri, G., Durr, P. A., Klein, R., Foord, A., Yu, M., Riddell, S....Wang, L. (2016). Experimental Infection and Response to Rechallenge of Alpacas with Middle East Respiratory Syndrome Coronavirus. Emerging Infectious Diseases, 22(6), 1071-1074. https://dx.doi.org/10.3201/eid2206.160007.

Scarlet Fever Upsurge in England and Molecular-Genetic Analysis in North-West London, 2014 [PDF - 1.90 MB - 4 pages]
C. E. Turner et al.

Scarlet fever notifications surged across the United Kingdom in spring 2014. Molecular epidemiologic investigation of Streptococcus pyogenes infections in North-West London highlighted increased emm4 and emm3 infections coincident with the upsurge. Unlike outbreaks in other countries, antimicrobial resistance was uncommon, highlighting an urgent need to better understand the drivers of scarlet fever activity.

EID Turner CE, Pyzio M, Song B, Lamagni T, Meltzer M, Chow J, et al. Scarlet Fever Upsurge in England and Molecular-Genetic Analysis in North-West London, 2014. Emerg Infect Dis. 2016;22(6):1075-1078. https://dx.doi.org/10.3201/eid2206.151726
AMA Turner CE, Pyzio M, Song B, et al. Scarlet Fever Upsurge in England and Molecular-Genetic Analysis in North-West London, 2014. Emerging Infectious Diseases. 2016;22(6):1075-1078. doi:10.3201/eid2206.151726.
APA Turner, C. E., Pyzio, M., Song, B., Lamagni, T., Meltzer, M., Chow, J....Sriskandan, S. (2016). Scarlet Fever Upsurge in England and Molecular-Genetic Analysis in North-West London, 2014. Emerging Infectious Diseases, 22(6), 1075-1078. https://dx.doi.org/10.3201/eid2206.151726.

Possible Case of Novel Spotted Fever Group Rickettsiosis in Traveler Returning to Japan from India [PDF - 1.86 MB - 4 pages]
I. Takajo et al.

A 60-year-old woman experienced fever, headache, rash, and altered vision after returning to Japan from India. Testing detected elevated antibody titers to spotted fever group rickettsia; PCR on blood yielded positive results for the rickettsial outer membrane protein A gene. We isolated a unique rickettsial agent and performed a full-genome analysis.

EID Takajo I, Sekizuka T, Fujita H, Kawano A, Kawaguchi T, Matsuda M, et al. Possible Case of Novel Spotted Fever Group Rickettsiosis in Traveler Returning to Japan from India. Emerg Infect Dis. 2016;22(6):1079-1082. https://dx.doi.org/10.3201/eid2206.151985
AMA Takajo I, Sekizuka T, Fujita H, et al. Possible Case of Novel Spotted Fever Group Rickettsiosis in Traveler Returning to Japan from India. Emerging Infectious Diseases. 2016;22(6):1079-1082. doi:10.3201/eid2206.151985.
APA Takajo, I., Sekizuka, T., Fujita, H., Kawano, A., Kawaguchi, T., Matsuda, M....Ando, S. (2016). Possible Case of Novel Spotted Fever Group Rickettsiosis in Traveler Returning to Japan from India. Emerging Infectious Diseases, 22(6), 1079-1082. https://dx.doi.org/10.3201/eid2206.151985.

Shigella Antimicrobial Drug Resistance Mechanisms, 2004–2014 [PDF - 834 KB - 3 pages]
M. Nüesch-Inderbinen et al.

To determine antimicrobial drug resistance mechanisms of Shigella spp., we analyzed 344 isolates collected in Switzerland during 2004–2014. Overall, 78.5% of isolates were multidrug resistant; 10.5% were ciprofloxacin resistant; and 2% harbored mph(A), a plasmid-mediated gene that confers reduced susceptibility to azithromycin, a last-resort antimicrobial agent for shigellosis.

EID Nüesch-Inderbinen M, Heini N, Zurfluh K, Althaus D, Hächler H, Stephan R. Shigella Antimicrobial Drug Resistance Mechanisms, 2004–2014. Emerg Infect Dis. 2016;22(6):1083-1085. https://dx.doi.org/10.3201/eid2206.152088
AMA Nüesch-Inderbinen M, Heini N, Zurfluh K, et al. Shigella Antimicrobial Drug Resistance Mechanisms, 2004–2014. Emerging Infectious Diseases. 2016;22(6):1083-1085. doi:10.3201/eid2206.152088.
APA Nüesch-Inderbinen, M., Heini, N., Zurfluh, K., Althaus, D., Hächler, H., & Stephan, R. (2016). Shigella Antimicrobial Drug Resistance Mechanisms, 2004–2014. Emerging Infectious Diseases, 22(6), 1083-1085. https://dx.doi.org/10.3201/eid2206.152088.

MERS-CoV Antibodies in Humans, Africa, 2013–2014 [PDF - 884 KB - 4 pages]
A. M. Liljander et al.

Dromedaries in Africa and elsewhere carry the Middle East respiratory syndrome coronavirus (MERS-CoV). To search for evidence of autochthonous MERS-CoV infection in humans, we tested archived serum from livestock handlers in Kenya for MERS-CoV antibodies. Serologic evidence of infection was confirmed for 2 persons sampled in 2013 and 2014.

EID Liljander AM, Meyer B, Jores J, Müller MA, Lattwein E, Njeru I, et al. MERS-CoV Antibodies in Humans, Africa, 2013–2014. Emerg Infect Dis. 2016;22(6):1086-1089. https://dx.doi.org/10.3201/eid2206.160064
AMA Liljander AM, Meyer B, Jores J, et al. MERS-CoV Antibodies in Humans, Africa, 2013–2014. Emerging Infectious Diseases. 2016;22(6):1086-1089. doi:10.3201/eid2206.160064.
APA Liljander, A. M., Meyer, B., Jores, J., Müller, M. A., Lattwein, E., Njeru, I....Corman, V. (2016). MERS-CoV Antibodies in Humans, Africa, 2013–2014. Emerging Infectious Diseases, 22(6), 1086-1089. https://dx.doi.org/10.3201/eid2206.160064.

Microcephaly in Infants, Pernambuco State, Brazil, 2015 [PDF - 969 KB - 4 pages]

We studied the clinical characteristics for 104 infants born with microcephaly in the delivery hospitals of Pernambuco State, Brazil, during 2015. Testing is ongoing to exclude known infectious causes. However, microcephaly peaked in October and demonstrated central nervous system abnormalities with brain dysgenesis and intracranial calcifications consistent with an intrauterine infection.

EID Microcephaly in Infants, Pernambuco State, Brazil, 2015. Emerg Infect Dis. 2016;22(6):1090-1093. https://dx.doi.org/10.3201/eid2206.160062
AMA Microcephaly in Infants, Pernambuco State, Brazil, 2015. Emerging Infectious Diseases. 2016;22(6):1090-1093. doi:10.3201/eid2206.160062.
APA (2016). Microcephaly in Infants, Pernambuco State, Brazil, 2015. Emerging Infectious Diseases, 22(6), 1090-1093. https://dx.doi.org/10.3201/eid2206.160062.

Prospective Validation of Cessation of Contact Precautions for Extended-Spectrum β-Lactamase–Producing Escherichia coli [PDF - 1.06 MB - 4 pages]
S. Tschudin-Sutter et al.

After contact precautions were discontinued, we determined nosocomial transmission of extended-spectrum β-lactamase (ESBL)–producing Escherichia coli by screening hospital patients who shared rooms with ESBL-producing E. coli–infected or –colonized patients. Transmission rates were 2.6% and 8.8% at an acute-care and a geriatric/rehabilitation hospital, respectively. Prolonged contact was associated with increased transmission.

EID Tschudin-Sutter S, Frei R, Schwahn F, Tomic M, Conzelmann M, Stranden A, et al. Prospective Validation of Cessation of Contact Precautions for Extended-Spectrum β-Lactamase–Producing Escherichia coli. Emerg Infect Dis. 2016;22(6):1094-1097. https://dx.doi.org/10.3201/eid2206.150554
AMA Tschudin-Sutter S, Frei R, Schwahn F, et al. Prospective Validation of Cessation of Contact Precautions for Extended-Spectrum β-Lactamase–Producing Escherichia coli. Emerging Infectious Diseases. 2016;22(6):1094-1097. doi:10.3201/eid2206.150554.
APA Tschudin-Sutter, S., Frei, R., Schwahn, F., Tomic, M., Conzelmann, M., Stranden, A....Widmer, A. F. (2016). Prospective Validation of Cessation of Contact Precautions for Extended-Spectrum β-Lactamase–Producing Escherichia coli. Emerging Infectious Diseases, 22(6), 1094-1097. https://dx.doi.org/10.3201/eid2206.150554.

Whole-Genome Analysis of Cryptococcus gattii, Southeastern United States [PDF - 652 KB - 4 pages]
S. R. Lockhart et al.

Cryptococcus gattii is a recognized pathogenic fungus along the Pacific coast of the United States from California to Washington. Here we report that C. gattii may also be endemic to the southeastern United States and has probably been present there longer than in the Pacific Northwest.

EID Lockhart SR, Roe CC, Engelthaler DM. Whole-Genome Analysis of Cryptococcus gattii, Southeastern United States. Emerg Infect Dis. 2016;22(6):1098-1101. https://dx.doi.org/10.3201/eid2206.151455
AMA Lockhart SR, Roe CC, Engelthaler DM. Whole-Genome Analysis of Cryptococcus gattii, Southeastern United States. Emerging Infectious Diseases. 2016;22(6):1098-1101. doi:10.3201/eid2206.151455.
APA Lockhart, S. R., Roe, C. C., & Engelthaler, D. M. (2016). Whole-Genome Analysis of Cryptococcus gattii, Southeastern United States. Emerging Infectious Diseases, 22(6), 1098-1101. https://dx.doi.org/10.3201/eid2206.151455.

Prevalence of Nontuberculous Mycobacterial Pulmonary Disease, Germany, 2009–2014 [PDF - 479 KB - 4 pages]
F. C. Ringshausen et al.

We analyzed routine statutory health insurance claim data to determine prevalence of nontuberculous mycobacterial pulmonary disease in Germany. Documented prevalence rates of this nonnotifiable disease increased from 2.3 to 3.3 cases/100,000 population from 2009 to 2014. Prevalence showed a strong association with advanced age and chronic obstructive pulmonary disease.

EID Ringshausen FC, Wagner D, de Roux A, Diel R, Hohmann D, Hickstein L, et al. Prevalence of Nontuberculous Mycobacterial Pulmonary Disease, Germany, 2009–2014. Emerg Infect Dis. 2016;22(6):1102-1105. https://dx.doi.org/10.3201/eid2206.151642
AMA Ringshausen FC, Wagner D, de Roux A, et al. Prevalence of Nontuberculous Mycobacterial Pulmonary Disease, Germany, 2009–2014. Emerging Infectious Diseases. 2016;22(6):1102-1105. doi:10.3201/eid2206.151642.
APA Ringshausen, F. C., Wagner, D., de Roux, A., Diel, R., Hohmann, D., Hickstein, L....Rademacher, J. (2016). Prevalence of Nontuberculous Mycobacterial Pulmonary Disease, Germany, 2009–2014. Emerging Infectious Diseases, 22(6), 1102-1105. https://dx.doi.org/10.3201/eid2206.151642.

Post-Ebola Measles Outbreak in Lola, Guinea, January–June 2015 [PDF - 438 KB - 3 pages]
J. E. Suk et al.

During public health crises such as the recent outbreaks of Ebola virus disease in West Africa, breakdowns in public health systems can lead to epidemics of vaccine-preventable diseases. We report here on an outbreak of measles in the prefecture of Lola, Guinea, which started in January 2015.

EID Suk JE, Jimenez A, Kourouma M, Derrough T, Baldé M, Honomou P, et al. Post-Ebola Measles Outbreak in Lola, Guinea, January–June 2015. Emerg Infect Dis. 2016;22(6):1106-1108. https://dx.doi.org/10.3201/eid2206.151652
AMA Suk JE, Jimenez A, Kourouma M, et al. Post-Ebola Measles Outbreak in Lola, Guinea, January–June 2015. Emerging Infectious Diseases. 2016;22(6):1106-1108. doi:10.3201/eid2206.151652.
APA Suk, J. E., Jimenez, A., Kourouma, M., Derrough, T., Baldé, M., Honomou, P....Prikazsky, V. (2016). Post-Ebola Measles Outbreak in Lola, Guinea, January–June 2015. Emerging Infectious Diseases, 22(6), 1106-1108. https://dx.doi.org/10.3201/eid2206.151652.

Changes in Childhood Pneumonia Hospitalizations by Race and Sex Associated with Pneumococcal Conjugate Vaccines [PDF - 1.16 MB - 4 pages]
A. D. Wiese et al.

Introduction of pneumococcal conjugate vaccines in the childhood immunization schedule was associated with decreases in all-cause pneumonia hospitalizations among black and white children in Tennessee, USA. Although racial disparities that existed before introduction of these vaccines have been substantially reduced, rates remain higher in boys than in girls among young children.

EID Wiese AD, Grijalva CG, Zhu Y, Mitchel EF, Griffin MR. Changes in Childhood Pneumonia Hospitalizations by Race and Sex Associated with Pneumococcal Conjugate Vaccines. Emerg Infect Dis. 2016;22(6):1109-1112. https://dx.doi.org/10.3201/eid2206.152023
AMA Wiese AD, Grijalva CG, Zhu Y, et al. Changes in Childhood Pneumonia Hospitalizations by Race and Sex Associated with Pneumococcal Conjugate Vaccines. Emerging Infectious Diseases. 2016;22(6):1109-1112. doi:10.3201/eid2206.152023.
APA Wiese, A. D., Grijalva, C. G., Zhu, Y., Mitchel, E. F., & Griffin, M. R. (2016). Changes in Childhood Pneumonia Hospitalizations by Race and Sex Associated with Pneumococcal Conjugate Vaccines. Emerging Infectious Diseases, 22(6), 1109-1112. https://dx.doi.org/10.3201/eid2206.152023.

Antibody Response and Disease Severity in Healthcare Worker MERS Survivors [PDF - 464 KB - 3 pages]
A. N. Alshukairi et al.

We studied antibody response in 9 healthcare workers in Jeddah, Saudi Arabia, who survived Middle East respiratory syndrome, by using serial ELISA and indirect immunofluorescence assay testing. Among patients who had experienced severe pneumonia, antibody was detected for >18 months after infection. Antibody longevity was more variable in patients who had experienced milder disease.

EID Alshukairi AN, Khalid I, Ahmed WA, Dada AM, Bayumi DT, Malic LS, et al. Antibody Response and Disease Severity in Healthcare Worker MERS Survivors. Emerg Infect Dis. 2016;22(6):1113-1115. https://dx.doi.org/10.3201/eid2206.160010
AMA Alshukairi AN, Khalid I, Ahmed WA, et al. Antibody Response and Disease Severity in Healthcare Worker MERS Survivors. Emerging Infectious Diseases. 2016;22(6):1113-1115. doi:10.3201/eid2206.160010.
APA Alshukairi, A. N., Khalid, I., Ahmed, W. A., Dada, A. M., Bayumi, D. T., Malic, L. S....Perlman, S. (2016). Antibody Response and Disease Severity in Healthcare Worker MERS Survivors. Emerging Infectious Diseases, 22(6), 1113-1115. https://dx.doi.org/10.3201/eid2206.160010.
Letters

Epidemiology of Pulmonary Nontuberculous Mycobacterial Disease, Japan [PDF - 309 KB - 2 pages]
H. Namkoong et al.
EID Namkoong H, Kurashima A, Morimoto K, Hoshino Y, Hasegawa N, Ato M, et al. Epidemiology of Pulmonary Nontuberculous Mycobacterial Disease, Japan. Emerg Infect Dis. 2016;22(6):1116-1117. https://dx.doi.org/10.3201/eid2206.151086
AMA Namkoong H, Kurashima A, Morimoto K, et al. Epidemiology of Pulmonary Nontuberculous Mycobacterial Disease, Japan. Emerging Infectious Diseases. 2016;22(6):1116-1117. doi:10.3201/eid2206.151086.
APA Namkoong, H., Kurashima, A., Morimoto, K., Hoshino, Y., Hasegawa, N., Ato, M....Mitarai, S. (2016). Epidemiology of Pulmonary Nontuberculous Mycobacterial Disease, Japan. Emerging Infectious Diseases, 22(6), 1116-1117. https://dx.doi.org/10.3201/eid2206.151086.

Elevated Pertussis Reporting in Response to 2011–2012 Outbreak, New York City, New York, USA [PDF - 307 KB - 3 pages]
R. J. Arciuolo et al.
EID Arciuolo RJ, Rosen JB, Zucker JR. Elevated Pertussis Reporting in Response to 2011–2012 Outbreak, New York City, New York, USA. Emerg Infect Dis. 2016;22(6):1117-1119. https://dx.doi.org/10.3201/eid2206.151514
AMA Arciuolo RJ, Rosen JB, Zucker JR. Elevated Pertussis Reporting in Response to 2011–2012 Outbreak, New York City, New York, USA. Emerging Infectious Diseases. 2016;22(6):1117-1119. doi:10.3201/eid2206.151514.
APA Arciuolo, R. J., Rosen, J. B., & Zucker, J. R. (2016). Elevated Pertussis Reporting in Response to 2011–2012 Outbreak, New York City, New York, USA. Emerging Infectious Diseases, 22(6), 1117-1119. https://dx.doi.org/10.3201/eid2206.151514.

Hemophagocytic Lymphohistiocytosis and Progressive Disseminated Histoplasmosis [PDF - 347 KB - 3 pages]
K. Ferguson-Paul et al.
EID Ferguson-Paul K, Mangum S, Porter A, Leventaki V, Campbell P, Wolf J. Hemophagocytic Lymphohistiocytosis and Progressive Disseminated Histoplasmosis. Emerg Infect Dis. 2016;22(6):1119-1121. https://dx.doi.org/10.3201/eid2206.151682
AMA Ferguson-Paul K, Mangum S, Porter A, et al. Hemophagocytic Lymphohistiocytosis and Progressive Disseminated Histoplasmosis. Emerging Infectious Diseases. 2016;22(6):1119-1121. doi:10.3201/eid2206.151682.
APA Ferguson-Paul, K., Mangum, S., Porter, A., Leventaki, V., Campbell, P., & Wolf, J. (2016). Hemophagocytic Lymphohistiocytosis and Progressive Disseminated Histoplasmosis. Emerging Infectious Diseases, 22(6), 1119-1121. https://dx.doi.org/10.3201/eid2206.151682.

Novel Avian Influenza A(H5N8) Viruses in Migratory Birds, China, 2013–2014 [PDF - 832 KB - 3 pages]
L. Zhou et al.
EID Zhou L, Liu J, Pei E, Xue W, Lyu J, Cai Y, et al. Novel Avian Influenza A(H5N8) Viruses in Migratory Birds, China, 2013–2014. Emerg Infect Dis. 2016;22(6):1121-1123. https://dx.doi.org/10.3201/eid2206.151754
AMA Zhou L, Liu J, Pei E, et al. Novel Avian Influenza A(H5N8) Viruses in Migratory Birds, China, 2013–2014. Emerging Infectious Diseases. 2016;22(6):1121-1123. doi:10.3201/eid2206.151754.
APA Zhou, L., Liu, J., Pei, E., Xue, W., Lyu, J., Cai, Y....Wang, T. (2016). Novel Avian Influenza A(H5N8) Viruses in Migratory Birds, China, 2013–2014. Emerging Infectious Diseases, 22(6), 1121-1123. https://dx.doi.org/10.3201/eid2206.151754.

Interferon-γ Autoantibodies as Predisposing Factor for Nontuberculous Mycobacterial Infection [PDF - 356 KB - 3 pages]
F. Valour et al.
EID Valour F, Perpoint T, Sénéchal A, Kong X, Bustamante J, Ferry T, et al. Interferon-γ Autoantibodies as Predisposing Factor for Nontuberculous Mycobacterial Infection. Emerg Infect Dis. 2016;22(6):1124-1126. https://dx.doi.org/10.3201/eid2206.151860
AMA Valour F, Perpoint T, Sénéchal A, et al. Interferon-γ Autoantibodies as Predisposing Factor for Nontuberculous Mycobacterial Infection. Emerging Infectious Diseases. 2016;22(6):1124-1126. doi:10.3201/eid2206.151860.
APA Valour, F., Perpoint, T., Sénéchal, A., Kong, X., Bustamante, J., Ferry, T....Ader, F. (2016). Interferon-γ Autoantibodies as Predisposing Factor for Nontuberculous Mycobacterial Infection. Emerging Infectious Diseases, 22(6), 1124-1126. https://dx.doi.org/10.3201/eid2206.151860.

Loss of 89K Pathogenicity Island in Epidemic Streptococcus suis, China [PDF - 286 KB - 2 pages]
X. Shi et al.
EID Shi X, Ye H, Wang J, Li Z, Wang J, Chen B, et al. Loss of 89K Pathogenicity Island in Epidemic Streptococcus suis, China. Emerg Infect Dis. 2016;22(6):1126-1127. https://dx.doi.org/10.3201/eid2206.152010
AMA Shi X, Ye H, Wang J, et al. Loss of 89K Pathogenicity Island in Epidemic Streptococcus suis, China. Emerging Infectious Diseases. 2016;22(6):1126-1127. doi:10.3201/eid2206.152010.
APA Shi, X., Ye, H., Wang, J., Li, Z., Wang, J., Chen, B....Feng, Y. (2016). Loss of 89K Pathogenicity Island in Epidemic Streptococcus suis, China. Emerging Infectious Diseases, 22(6), 1126-1127. https://dx.doi.org/10.3201/eid2206.152010.

Next-Generation Sequencing of Mycobacterium tuberculosis [PDF - 460 KB - 3 pages]
I. Mokrousov et al.
EID Mokrousov I, Chernyaeva E, Vyazovaya A, Sinkov V, Zhuravlev V, Narvskaya O. Next-Generation Sequencing of Mycobacterium tuberculosis. Emerg Infect Dis. 2016;22(6):1127-1129. https://dx.doi.org/10.3201/eid2206.152051
AMA Mokrousov I, Chernyaeva E, Vyazovaya A, et al. Next-Generation Sequencing of Mycobacterium tuberculosis. Emerging Infectious Diseases. 2016;22(6):1127-1129. doi:10.3201/eid2206.152051.
APA Mokrousov, I., Chernyaeva, E., Vyazovaya, A., Sinkov, V., Zhuravlev, V., & Narvskaya, O. (2016). Next-Generation Sequencing of Mycobacterium tuberculosis. Emerging Infectious Diseases, 22(6), 1127-1129. https://dx.doi.org/10.3201/eid2206.152051.

MERS-CoV Infection of Alpaca in a Region Where MERS-CoV is Endemic [PDF - 360 KB - 3 pages]
C. Reusken et al.
EID Reusken C, Schilp C, Raj V, De Bruin E, Kohl R, Farag E, et al. MERS-CoV Infection of Alpaca in a Region Where MERS-CoV is Endemic. Emerg Infect Dis. 2016;22(6):1129-1131. https://dx.doi.org/10.3201/eid2206.152113
AMA Reusken C, Schilp C, Raj V, et al. MERS-CoV Infection of Alpaca in a Region Where MERS-CoV is Endemic. Emerging Infectious Diseases. 2016;22(6):1129-1131. doi:10.3201/eid2206.152113.
APA Reusken, C., Schilp, C., Raj, V., De Bruin, E., Kohl, R., Farag, E....Koopmans, M. (2016). MERS-CoV Infection of Alpaca in a Region Where MERS-CoV is Endemic. Emerging Infectious Diseases, 22(6), 1129-1131. https://dx.doi.org/10.3201/eid2206.152113.

Cryptococcus gattii VGIIb-like Variant in White-Tailed Deer, Nova Scotia, Canada [PDF - 985 KB - 3 pages]
D. P. Overy et al.
EID Overy DP, McBurney S, Muckle A, Lund L, Lewis P, Strang R. Cryptococcus gattii VGIIb-like Variant in White-Tailed Deer, Nova Scotia, Canada. Emerg Infect Dis. 2016;22(6):1131-1133. https://dx.doi.org/10.3201/eid2206.160081
AMA Overy DP, McBurney S, Muckle A, et al. Cryptococcus gattii VGIIb-like Variant in White-Tailed Deer, Nova Scotia, Canada. Emerging Infectious Diseases. 2016;22(6):1131-1133. doi:10.3201/eid2206.160081.
APA Overy, D. P., McBurney, S., Muckle, A., Lund, L., Lewis, P., & Strang, R. (2016). Cryptococcus gattii VGIIb-like Variant in White-Tailed Deer, Nova Scotia, Canada. Emerging Infectious Diseases, 22(6), 1131-1133. https://dx.doi.org/10.3201/eid2206.160081.

Zika Virus in a Traveler Returning to China from Caracas, Venezuela, February 2016 [PDF - 535 KB - 4 pages]
J. Li et al.
EID Li J, Xiong Y, Wu W, Liu X, Qu J, Zhao X, et al. Zika Virus in a Traveler Returning to China from Caracas, Venezuela, February 2016. Emerg Infect Dis. 2016;22(6):1133-1136. https://dx.doi.org/10.3201/eid2206.160273
AMA Li J, Xiong Y, Wu W, et al. Zika Virus in a Traveler Returning to China from Caracas, Venezuela, February 2016. Emerging Infectious Diseases. 2016;22(6):1133-1136. doi:10.3201/eid2206.160273.
APA Li, J., Xiong, Y., Wu, W., Liu, X., Qu, J., Zhao, X....Li, D. (2016). Zika Virus in a Traveler Returning to China from Caracas, Venezuela, February 2016. Emerging Infectious Diseases, 22(6), 1133-1136. https://dx.doi.org/10.3201/eid2206.160273.

Pericarditis Caused by Hyperinvasive Strain of Neisseria meningitidis, Sardinia, Italy, 2015 [PDF - 298 KB - 2 pages]
C. Fazio et al.
EID Fazio C, Castiglia P, Piana A, Neri A, Mura MS, Caruana G, et al. Pericarditis Caused by Hyperinvasive Strain of Neisseria meningitidis, Sardinia, Italy, 2015. Emerg Infect Dis. 2016;22(6):1136-1137. https://dx.doi.org/10.3201/eid2206.160160
AMA Fazio C, Castiglia P, Piana A, et al. Pericarditis Caused by Hyperinvasive Strain of Neisseria meningitidis, Sardinia, Italy, 2015. Emerging Infectious Diseases. 2016;22(6):1136-1137. doi:10.3201/eid2206.160160.
APA Fazio, C., Castiglia, P., Piana, A., Neri, A., Mura, M. S., Caruana, G....Stefanelli, P. (2016). Pericarditis Caused by Hyperinvasive Strain of Neisseria meningitidis, Sardinia, Italy, 2015. Emerging Infectious Diseases, 22(6), 1136-1137. https://dx.doi.org/10.3201/eid2206.160160.

Ecologic Study of Meningococcal B Vaccine and Neisseria gonorrhoeae Infection, Norway [PDF - 419 KB - 3 pages]
J. Whelan et al.
EID Whelan J, Kløvstad H, Haugen I, Holle M, Storsaeter J. Ecologic Study of Meningococcal B Vaccine and Neisseria gonorrhoeae Infection, Norway. Emerg Infect Dis. 2016;22(6):1137-1139. https://dx.doi.org/10.3201/eid2206.151093
AMA Whelan J, Kløvstad H, Haugen I, et al. Ecologic Study of Meningococcal B Vaccine and Neisseria gonorrhoeae Infection, Norway. Emerging Infectious Diseases. 2016;22(6):1137-1139. doi:10.3201/eid2206.151093.
APA Whelan, J., Kløvstad, H., Haugen, I., Holle, M., & Storsaeter, J. (2016). Ecologic Study of Meningococcal B Vaccine and Neisseria gonorrhoeae Infection, Norway. Emerging Infectious Diseases, 22(6), 1137-1139. https://dx.doi.org/10.3201/eid2206.151093.

Neisseria gonorrhoeae Resistant to Ceftriaxone and Cefixime, Argentina [PDF - 692 KB - 3 pages]
R. Gianecini et al.
EID Gianecini R, Oviedo C, Stafforini G, Galarza P. Neisseria gonorrhoeae Resistant to Ceftriaxone and Cefixime, Argentina. Emerg Infect Dis. 2016;22(6):1139-1141. https://dx.doi.org/10.3201/eid2206.152091
AMA Gianecini R, Oviedo C, Stafforini G, et al. Neisseria gonorrhoeae Resistant to Ceftriaxone and Cefixime, Argentina. Emerging Infectious Diseases. 2016;22(6):1139-1141. doi:10.3201/eid2206.152091.
APA Gianecini, R., Oviedo, C., Stafforini, G., & Galarza, P. (2016). Neisseria gonorrhoeae Resistant to Ceftriaxone and Cefixime, Argentina. Emerging Infectious Diseases, 22(6), 1139-1141. https://dx.doi.org/10.3201/eid2206.152091.
Books and Media

Microbial Biofilms, Second Edition [PDF - 252 KB - 1 page]
R. M. Donlan
EID Donlan RM. Microbial Biofilms, Second Edition. Emerg Infect Dis. 2016;22(6):1142. https://dx.doi.org/10.3201/eid2206.160282
AMA Donlan RM. Microbial Biofilms, Second Edition. Emerging Infectious Diseases. 2016;22(6):1142. doi:10.3201/eid2206.160282.
APA Donlan, R. M. (2016). Microbial Biofilms, Second Edition. Emerging Infectious Diseases, 22(6), 1142. https://dx.doi.org/10.3201/eid2206.160282.
About the Cover

Perspective and Surprise in the Floating World [PDF - 4.17 MB - 2 pages]
B. Breedlove and J. Friedberg
EID Breedlove B, Friedberg J. Perspective and Surprise in the Floating World. Emerg Infect Dis. 2016;22(6):1143-1144. https://dx.doi.org/10.3201/eid2206.ac2206
AMA Breedlove B, Friedberg J. Perspective and Surprise in the Floating World. Emerging Infectious Diseases. 2016;22(6):1143-1144. doi:10.3201/eid2206.ac2206.
APA Breedlove, B., & Friedberg, J. (2016). Perspective and Surprise in the Floating World. Emerging Infectious Diseases, 22(6), 1143-1144. https://dx.doi.org/10.3201/eid2206.ac2206.
Etymologia

Etymologia: Neisseria [PDF - 599 KB - 1 page]
EID Etymologia: Neisseria. Emerg Infect Dis. 2016;22(6):1141. https://dx.doi.org/10.3201/eid2206.et2206
AMA Etymologia: Neisseria. Emerging Infectious Diseases. 2016;22(6):1141. doi:10.3201/eid2206.et2206.
APA (2016). Etymologia: Neisseria. Emerging Infectious Diseases, 22(6), 1141. https://dx.doi.org/10.3201/eid2206.et2206.
Page created: August 18, 2016
Page updated: August 18, 2016
Page reviewed: August 18, 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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