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Issue Cover for Volume 23, Number 7—July 2017

Volume 23, Number 7—July 2017

[PDF - 9.38 MB - 188 pages]

Perspective

Operational Research during the Ebola Emergency [PDF - 772 KB - 6 pages]
G. Fitzpatrick et al.

Operational research aims to identify interventions, strategies, or tools that can enhance the quality, effectiveness, or coverage of programs where the research is taking place. Médecins Sans Frontières admitted ≈5,200 patients with confirmed Ebola virus disease during the Ebola outbreak in West Africa and from the beginning nested operational research within its emergency response. This research covered critical areas, such as understanding how the virus spreads, clinical trials, community perceptions, challenges within Ebola treatment centers, and negative effects on non-Ebola healthcare. Importantly, operational research questions were decided to a large extent by returning volunteers who had first-hand knowledge of the immediate issues facing teams in the field. Such a method is appropriate for an emergency medical organization. Many challenges were also identified while carrying out operational research across 3 different countries, including the basic need for collecting data in standardized format to enable comparison of findings among treatment centers.

EID Fitzpatrick G, Decroo T, Draguez B, Crestani R, Ronsse A, Van den Bergh R, et al. Operational Research during the Ebola Emergency. Emerg Infect Dis. 2017;23(7):1057-1062. https://dx.doi.org/10.3201/eid2307.161389
AMA Fitzpatrick G, Decroo T, Draguez B, et al. Operational Research during the Ebola Emergency. Emerging Infectious Diseases. 2017;23(7):1057-1062. doi:10.3201/eid2307.161389.
APA Fitzpatrick, G., Decroo, T., Draguez, B., Crestani, R., Ronsse, A., Van den Bergh, R....Van Herp, M. (2017). Operational Research during the Ebola Emergency. Emerging Infectious Diseases, 23(7), 1057-1062. https://dx.doi.org/10.3201/eid2307.161389.
Synopses

Measles Outbreak with Unique Virus Genotyping, Ontario, Canada, 2015 [PDF - 573 KB - 7 pages]
S. Thomas et al.

The province of Ontario continues to experience measles virus transmissions despite the elimination of measles in Canada. We describe an unusual outbreak of measles in Ontario, Canada, in early 2015 that involved cases with a unique strain of virus and no known association among primary case-patients. A total of 18 cases of measles were reported from 4 public health units during the outbreak period (January 25–March 23, 2015); none of these cases occurred in persons who had recently traveled. Despite enhancements to case-patient interview methods and epidemiologic analyses, a source patient was not identified. However, the molecular epidemiologic analysis, which included extended sequencing, strongly suggested that all cases derived from a single importation of measles virus genotype D4. The use of timely genotype sequencing, rigorous epidemiologic investigation, and a better understanding of the gaps in surveillance are needed to maintain Ontario’s measles elimination status.

EID Thomas S, Hiebert J, Gubbay JB, Gournis E, Sharron J, Severini A, et al. Measles Outbreak with Unique Virus Genotyping, Ontario, Canada, 2015. Emerg Infect Dis. 2017;23(7):1063-1069. https://dx.doi.org/10.3201/eid2307.161145
AMA Thomas S, Hiebert J, Gubbay JB, et al. Measles Outbreak with Unique Virus Genotyping, Ontario, Canada, 2015. Emerging Infectious Diseases. 2017;23(7):1063-1069. doi:10.3201/eid2307.161145.
APA Thomas, S., Hiebert, J., Gubbay, J. B., Gournis, E., Sharron, J., Severini, A....Deeks, S. L. (2017). Measles Outbreak with Unique Virus Genotyping, Ontario, Canada, 2015. Emerging Infectious Diseases, 23(7), 1063-1069. https://dx.doi.org/10.3201/eid2307.161145.
Research

Case−Control Study of Risk Factors for Meningococcal Disease in Chile [PDF - 703 KB - 9 pages]
A. Olea et al.

An outbreak of meningococcal disease with a case-fatality rate of 30% and caused by predominantly serogroup W of Neisseria meningitidis began in Chile in 2012. This outbreak required a case−control study to assess determinants and risk factors for infection. We identified confirmed cases during January 2012−March 2013 and selected controls by random sampling of the population, matched for age and sex, resulting in 135 case-patients and 618 controls. Sociodemographic variables, habits, and previous illnesses were studied. Analyses yielded adjusted odds ratios as estimators of the probability of disease development. Results indicated that conditions of social vulnerability, such as low income and overcrowding, as well as familial history of this disease and clinical histories, especially chronic diseases and hospitalization for respiratory conditions, increased the probability of illness. Findings should contribute to direction of intersectoral public policies toward a highly vulnerable social group to enable them to improve their living conditions and health.

EID Olea A, Matute I, González C, Delgado I, Poffald L, Pedroni E, et al. Case−Control Study of Risk Factors for Meningococcal Disease in Chile. Emerg Infect Dis. 2017;23(7):1070-1078. https://dx.doi.org/10.3201/eid2307.160129
AMA Olea A, Matute I, González C, et al. Case−Control Study of Risk Factors for Meningococcal Disease in Chile. Emerging Infectious Diseases. 2017;23(7):1070-1078. doi:10.3201/eid2307.160129.
APA Olea, A., Matute, I., González, C., Delgado, I., Poffald, L., Pedroni, E....Aguilera, X. (2017). Case−Control Study of Risk Factors for Meningococcal Disease in Chile. Emerging Infectious Diseases, 23(7), 1070-1078. https://dx.doi.org/10.3201/eid2307.160129.

MERS-CoV Antibody Responses 1 Year after Symptom Onset, South Korea, 2015 [PDF - 1.17 MB - 6 pages]
P. Choe et al.

We investigated the kinetics of the Middle East respiratory syndrome coronavirus (MERS-CoV) neutralizing and spike protein antibody titers over the course of 1 year in 11 patients who were confirmed by reverse transcription PCR to have been infected during the outbreak in South Korea in 2015. Robust antibody responses were detected in all survivors who had severe disease; responses remained detectable, albeit with some waning, for <1 year. The duration of viral RNA detection (but not viral load) in sputum significantly correlated with the antibody response magnitude. The MERS S1 ELISA antibody titers correlated well with the neutralizing antibody response. Antibody titers in 4 of 6 patients who had mild illness were undetectable even though most had evidence of pneumonia. This finding implies that MERS-CoV seroepidemiologic studies markedly underestimate the extent of mild and asymptomatic infection. Obtaining convalescent-phase plasma with high antibody titers to treat MERS will be challenging.

EID Choe P, Perera R, Park W, Song K, Bang J, Kim E, et al. MERS-CoV Antibody Responses 1 Year after Symptom Onset, South Korea, 2015. Emerg Infect Dis. 2017;23(7):1079-1084. https://dx.doi.org/10.3201/eid2307.170310
AMA Choe P, Perera R, Park W, et al. MERS-CoV Antibody Responses 1 Year after Symptom Onset, South Korea, 2015. Emerging Infectious Diseases. 2017;23(7):1079-1084. doi:10.3201/eid2307.170310.
APA Choe, P., Perera, R., Park, W., Song, K., Bang, J., Kim, E....Oh, M. (2017). MERS-CoV Antibody Responses 1 Year after Symptom Onset, South Korea, 2015. Emerging Infectious Diseases, 23(7), 1079-1084. https://dx.doi.org/10.3201/eid2307.170310.

Competence of Aedes aegypti, Ae. albopictus, and Culex quinquefasciatus Mosquitoes as Zika Virus Vectors, China [PDF - 1.12 MB - 7 pages]
Z. Liu et al.

In China, the prevention and control of Zika virus disease has been a public health threat since the first imported case was reported in February 2016. To determine the vector competence of potential vector mosquito species, we experimentally infected Aedes aegypti, Ae. albopictus, and Culex quinquefasciatus mosquitoes and determined infection rates, dissemination rates, and transmission rates. We found the highest vector competence for the imported Zika virus in Ae. aegypti mosquitoes, some susceptibility of Ae. albopictus mosquitoes, but no transmission ability for Cx. quinquefasciatus mosquitoes. Considering that, in China, Ae. albopictus mosquitoes are widely distributed but Ae. aegypti mosquito distribution is limited, Ae. albopictus mosquitoes are a potential primary vector for Zika virus and should be targeted in vector control strategies.

EID Liu Z, Zhou T, Lai Z, Zhang Z, Jia Z, Zhou G, et al. Competence of Aedes aegypti, Ae. albopictus, and Culex quinquefasciatus Mosquitoes as Zika Virus Vectors, China. Emerg Infect Dis. 2017;23(7):1085-1091. https://dx.doi.org/10.3201/eid2307.161528
AMA Liu Z, Zhou T, Lai Z, et al. Competence of Aedes aegypti, Ae. albopictus, and Culex quinquefasciatus Mosquitoes as Zika Virus Vectors, China. Emerging Infectious Diseases. 2017;23(7):1085-1091. doi:10.3201/eid2307.161528.
APA Liu, Z., Zhou, T., Lai, Z., Zhang, Z., Jia, Z., Zhou, G....Chen, X. (2017). Competence of Aedes aegypti, Ae. albopictus, and Culex quinquefasciatus Mosquitoes as Zika Virus Vectors, China. Emerging Infectious Diseases, 23(7), 1085-1091. https://dx.doi.org/10.3201/eid2307.161528.

Medscape CME Activity
Clonal Clusters and Virulence Factors of Group C and G Streptococcus Causing Severe Infections, Manitoba, Canada, 2012–2014 [PDF - 3.17 MB - 10 pages]
S. A. Lother et al.

The incidence of group C and G Streptococcus (GCGS) bacteremia, which is associated with severe disease and death, is increasing. We characterized clinical features, outcomes, and genetic determinants of GCGS bacteremia for 89 patients in Winnipeg, Manitoba, Canada, who had GCGS bacteremia during 2012–2014. Of the 89 patients, 51% had bacteremia from skin and soft tissue, 70% had severe disease features, and 20% died. Whole-genome sequencing analysis was performed on isolates derived from 89 blood samples and 33 respiratory sample controls: 5 closely related genetic lineages were identified as being more likely to cause invasive disease than non-clade isolates (83% vs. 57%, p = 0.002). Virulence factors cbp, fbp, speG, sicG, gfbA, and bca clustered clonally into these clades. A clonal distribution of virulence factors may account for severe and fatal cases of bacteremia caused by invasive GCGS.

EID Lother SA, Demczuk W, Martin I, Mulvey MR, Dufault B, Lagacé-Wiens P, et al. Clonal Clusters and Virulence Factors of Group C and G Streptococcus Causing Severe Infections, Manitoba, Canada, 2012–2014. Emerg Infect Dis. 2017;23(7):1092-1101. https://dx.doi.org/10.3201/eid2307.161259
AMA Lother SA, Demczuk W, Martin I, et al. Clonal Clusters and Virulence Factors of Group C and G Streptococcus Causing Severe Infections, Manitoba, Canada, 2012–2014. Emerging Infectious Diseases. 2017;23(7):1092-1101. doi:10.3201/eid2307.161259.
APA Lother, S. A., Demczuk, W., Martin, I., Mulvey, M. R., Dufault, B., Lagacé-Wiens, P....Keynan, Y. (2017). Clonal Clusters and Virulence Factors of Group C and G Streptococcus Causing Severe Infections, Manitoba, Canada, 2012–2014. Emerging Infectious Diseases, 23(7), 1092-1101. https://dx.doi.org/10.3201/eid2307.161259.

Novel Retinal Lesion in Ebola Survivors, Sierra Leone, 2016 [PDF - 1.52 MB - 8 pages]
P. J. Steptoe et al.

We conducted a case–control study in Freetown, Sierra Leone, to investigate ocular signs in Ebola virus disease (EVD) survivors. A total of 82 EVD survivors with ocular symptoms and 105 controls from asymptomatic civilian and military personnel and symptomatic eye clinic attendees underwent ophthalmic examination, including widefield retinal imaging. Snellen visual acuity was <6/7.5 in 75.6% (97.5% CI 63%–85.7%) of EVD survivors and 75.5% (97.5% CI 59.1%–87.9%) of controls. Unilateral white cataracts were present in 7.4% (97.5% CI 2.4%–16.7%) of EVD survivors and no controls. Aqueous humor from 2 EVD survivors with cataract but no anterior chamber inflammation were PCR-negative for Zaire Ebola virus, permitting cataract surgery. A novel retinal lesion following the anatomic distribution of the optic nerve axons occurred in 14.6% (97.5% CI 7.1%–25.6%) of EVD survivors and no controls, suggesting neuronal transmission as a route of ocular entry.

EID Steptoe PJ, Scott JT, Baxter JM, Parkes CK, Dwivedi R, Czanner G, et al. Novel Retinal Lesion in Ebola Survivors, Sierra Leone, 2016. Emerg Infect Dis. 2017;23(7):1102-1109. https://dx.doi.org/10.3201/eid2307.161608
AMA Steptoe PJ, Scott JT, Baxter JM, et al. Novel Retinal Lesion in Ebola Survivors, Sierra Leone, 2016. Emerging Infectious Diseases. 2017;23(7):1102-1109. doi:10.3201/eid2307.161608.
APA Steptoe, P. J., Scott, J. T., Baxter, J. M., Parkes, C. K., Dwivedi, R., Czanner, G....Semple, M. G. (2017). Novel Retinal Lesion in Ebola Survivors, Sierra Leone, 2016. Emerging Infectious Diseases, 23(7), 1102-1109. https://dx.doi.org/10.3201/eid2307.161608.

Effects of Zika Virus Strain and Aedes Mosquito Species on Vector Competence [PDF - 1.12 MB - 8 pages]
A. T. Ciota et al.

In the Western Hemisphere, Zika virus is thought to be transmitted primarily by Aedes aegypti mosquitoes. To determine the extent to which Ae. albopictus mosquitoes from the United States are capable of transmitting Zika virus and the influence of virus dose, virus strain, and mosquito species on vector competence, we evaluated multiple doses of representative Zika virus strains in Ae. aegypti and Ae. albopictus mosquitoes. Virus preparation (fresh vs. frozen) significantly affected virus infectivity in mosquitoes. We calculated 50% infectious doses to be 6.1–7.5 log10 PFU/mL; minimum infective dose was 4.2 log10 PFU/mL. Ae. albopictus mosquitoes were more susceptible to infection than Ae. aegypti mosquitoes, but transmission efficiency was higher for Ae. aegypti mosquitoes, indicating a transmission barrier in Ae. albopictus mosquitoes. Results suggest that, although Zika virus transmission is relatively inefficient overall and dependent on virus strain and mosquito species, Ae. albopictus mosquitoes could become major vectors in the Americas.

EID Ciota AT, Bialosuknia SM, Zink SD, Brecher M, Ehrbar DJ, Morrissette MN, et al. Effects of Zika Virus Strain and Aedes Mosquito Species on Vector Competence. Emerg Infect Dis. 2017;23(7):1110-1117. https://dx.doi.org/10.3201/eid2307.161633
AMA Ciota AT, Bialosuknia SM, Zink SD, et al. Effects of Zika Virus Strain and Aedes Mosquito Species on Vector Competence. Emerging Infectious Diseases. 2017;23(7):1110-1117. doi:10.3201/eid2307.161633.
APA Ciota, A. T., Bialosuknia, S. M., Zink, S. D., Brecher, M., Ehrbar, D. J., Morrissette, M. N....Kramer, L. D. (2017). Effects of Zika Virus Strain and Aedes Mosquito Species on Vector Competence. Emerging Infectious Diseases, 23(7), 1110-1117. https://dx.doi.org/10.3201/eid2307.161633.

Concurrent Infection with Hepatitis C Virus and Streptococcus pneumoniae [PDF - 508 KB - 6 pages]
T. J. Marrie et al.

Little is known about concurrent infection with hepatitis C virus (HCV) and Streptococcus pneumoniae, which causes invasive pneumococcal disease (IPD). We hypothesized that co-infection with HCV and S. pneumoniae would increase risk for death and complications. We captured sociodemographic and serologic data for adults with IPD in a population-based cohort study in northern Alberta, Canada, during 2000–2014. IPD patients infected with HCV were compared with IPD patients not infected with HCV for risk of in-hospital deaths and complications by using multivariable logistic regression. A total of 355 of 3,251 patients with IPD were co-infected with HCV. The in-hospital mortality rate was higher for IPD patients infected with HCV. Prevalence of most IPD-related complications (e.g., cellulitis, acute kidney injury, mechanical ventilation) was also higher in HCV-infected patients. Infection with HCV is common in patients with IPD, and HCV is independently associated with an increased risk for serious illness and death.

EID Marrie TJ, Tyrrell GJ, Majumdar SR, Eurich DT. Concurrent Infection with Hepatitis C Virus and Streptococcus pneumoniae. Emerg Infect Dis. 2017;23(7):1118-1123. https://dx.doi.org/10.3201/eid2307.161858
AMA Marrie TJ, Tyrrell GJ, Majumdar SR, et al. Concurrent Infection with Hepatitis C Virus and Streptococcus pneumoniae. Emerging Infectious Diseases. 2017;23(7):1118-1123. doi:10.3201/eid2307.161858.
APA Marrie, T. J., Tyrrell, G. J., Majumdar, S. R., & Eurich, D. T. (2017). Concurrent Infection with Hepatitis C Virus and Streptococcus pneumoniae. Emerging Infectious Diseases, 23(7), 1118-1123. https://dx.doi.org/10.3201/eid2307.161858.

Attributable Fraction of Influenza Virus Detection to Mild and Severe Respiratory Illnesses in HIV-Infected and HIV-Uninfected Patients, South Africa, 2012–2016 [PDF - 698 KB - 9 pages]
S. Tempia et al.

The attributable fraction (AF) of influenza virus detection to illness has not been described for patients in different age groups or with different HIV infection statuses. We compared the age group–specific prevalence of influenza virus infection among patients with influenza-like illness (ILI) or severe acute or chronic respiratory illness (SARI and SCRI, respectively) with that among controls, stratified by HIV serostatus. The overall AF for influenza virus detection to illness was 92.6% for ILI, 87.4% for SARI, and 86.2% for SCRI. Among HIV-uninfected patients, the AF for all syndromes was highest among persons <1 and >65 years of age and lowest among persons 25–44 years of age; this trend was not observed among HIV-infected patients. Overall, influenza viruses when detected in patients with ILI, SARI, or SCRI are likely attributable to illness. This finding is particularly likely among children and the elderly irrespective of HIV serostatus and among HIV-infected persons irrespective of age.

EID Tempia S, Walaza S, Moyes J, Cohen AL, von Mollendorf C, McMorrow ML, et al. Attributable Fraction of Influenza Virus Detection to Mild and Severe Respiratory Illnesses in HIV-Infected and HIV-Uninfected Patients, South Africa, 2012–2016. Emerg Infect Dis. 2017;23(7):1124-1132. https://dx.doi.org/10.3201/eid2307.161959
AMA Tempia S, Walaza S, Moyes J, et al. Attributable Fraction of Influenza Virus Detection to Mild and Severe Respiratory Illnesses in HIV-Infected and HIV-Uninfected Patients, South Africa, 2012–2016. Emerging Infectious Diseases. 2017;23(7):1124-1132. doi:10.3201/eid2307.161959.
APA Tempia, S., Walaza, S., Moyes, J., Cohen, A. L., von Mollendorf, C., McMorrow, M. L....Cohen, C. (2017). Attributable Fraction of Influenza Virus Detection to Mild and Severe Respiratory Illnesses in HIV-Infected and HIV-Uninfected Patients, South Africa, 2012–2016. Emerging Infectious Diseases, 23(7), 1124-1132. https://dx.doi.org/10.3201/eid2307.161959.

Phylogeography of Burkholderia pseudomallei Isolates, Western Hemisphere [PDF - 426 KB - 6 pages]
J. E. Gee et al.

The bacterium Burkholderia pseudomallei causes melioidosis, which is mainly associated with tropical areas. We analyzed single-nucleotide polymorphisms (SNPs) among genome sequences from isolates of B. pseudomallei that originated in the Western Hemisphere by comparing them with genome sequences of isolates that originated in the Eastern Hemisphere. Analysis indicated that isolates from the Western Hemisphere form a distinct clade, which supports the hypothesis that these isolates were derived from a constricted seeding event from Africa. Subclades have been resolved that are associated with specific regions within the Western Hemisphere and suggest that isolates might be correlated geographically with cases of melioidosis. One isolate associated with a former World War II prisoner of war was believed to represent illness 62 years after exposure in Southeast Asia. However, analysis suggested the isolate originated in Central or South America.

EID Gee JE, Gulvik CA, Elrod MG, Batra D, Rowe LA, Sheth M, et al. Phylogeography of Burkholderia pseudomallei Isolates, Western Hemisphere. Emerg Infect Dis. 2017;23(7):1133-1138. https://dx.doi.org/10.3201/eid2307.161978
AMA Gee JE, Gulvik CA, Elrod MG, et al. Phylogeography of Burkholderia pseudomallei Isolates, Western Hemisphere. Emerging Infectious Diseases. 2017;23(7):1133-1138. doi:10.3201/eid2307.161978.
APA Gee, J. E., Gulvik, C. A., Elrod, M. G., Batra, D., Rowe, L. A., Sheth, M....Hoffmaster, A. R. (2017). Phylogeography of Burkholderia pseudomallei Isolates, Western Hemisphere. Emerging Infectious Diseases, 23(7), 1133-1138. https://dx.doi.org/10.3201/eid2307.161978.

Nontuberculous Mycobacteria Infections at a Provincial Reference Hospital, Cambodia [PDF - 595 KB - 9 pages]
M. Bonnet et al.

Prevalence of nontuberculous mycobacteria (NTM) disease is poorly documented in countries with high prevalence of tuberculosis (TB). We describe prevalence, risk factors, and TB program implications for NTM isolates and disease in Cambodia. A prospective cohort of 1,183 patients with presumptive TB underwent epidemiologic, clinical, radiologic, and microbiologic evaluation, including >12-months of follow-up for patients with NTM isolates. Prevalence of NTM isolates was 10.8% and of disease was 0.9%; 217 (18.3%) patients had TB. Of 197 smear-positive patients, 171 (86.8%) had TB confirmed (167 by culture and 4 by Xpert MTB/RIF assay only) and 11 (5.6%) had NTM isolates. HIV infection and past TB were independently associated with having NTM isolates. Improved detection of NTM isolates in Cambodia might require more systematic use of mycobacterial culture and the use of Xpert MTB/RIF to confirm smear-positive TB cases, especially in patients with HIV infection or a history of TB.

EID Bonnet M, San K, Pho Y, Sok C, Dousset J, Brant W, et al. Nontuberculous Mycobacteria Infections at a Provincial Reference Hospital, Cambodia. Emerg Infect Dis. 2017;23(7):1139-1147. https://dx.doi.org/10.3201/eid2307.170060
AMA Bonnet M, San K, Pho Y, et al. Nontuberculous Mycobacteria Infections at a Provincial Reference Hospital, Cambodia. Emerging Infectious Diseases. 2017;23(7):1139-1147. doi:10.3201/eid2307.170060.
APA Bonnet, M., San, K., Pho, Y., Sok, C., Dousset, J., Brant, W....Hewison, C. (2017). Nontuberculous Mycobacteria Infections at a Provincial Reference Hospital, Cambodia. Emerging Infectious Diseases, 23(7), 1139-1147. https://dx.doi.org/10.3201/eid2307.170060.

Medscape CME Activity
Risk Factors for Legionella longbeachae Legionnaires’ Disease, New Zealand [PDF - 645 KB - 7 pages]
E. Kenagy et al.

Legionella longbeachae, found in soil and compost-derived products, is a globally underdiagnosed cause of Legionnaires’ disease. We conducted a case–control study of L. longbeachae Legionnaires’ disease in Canterbury, New Zealand. Case-patients were persons hospitalized with L. longbeachae pneumonia, and controls were persons randomly sampled from the electoral roll for the area served by the participating hospital. Among 31 cases and 172 controls, risk factors for Legionnaires’ disease were chronic obstructive pulmonary disease, history of smoking >10 years, and exposure to compost or potting mix. Gardening behaviors associated with L. longbeachae disease included having unwashed hands near the face after exposure to or tipping and troweling compost or potting mix. Mask or glove use was not protective among persons exposed to compost-derived products. Precautions against inhaling compost and attention to hand hygiene might effectively prevent L. longbeachae disease. Long-term smokers and those with chronic obstructive pulmonary disease should be particularly careful.

EID Kenagy E, Priest PC, Cameron CM, Smith D, Scott P, Cho V, et al. Risk Factors for Legionella longbeachae Legionnaires’ Disease, New Zealand. Emerg Infect Dis. 2017;23(7):1148-1154. https://dx.doi.org/10.3201/eid2307.161429
AMA Kenagy E, Priest PC, Cameron CM, et al. Risk Factors for Legionella longbeachae Legionnaires’ Disease, New Zealand. Emerging Infectious Diseases. 2017;23(7):1148-1154. doi:10.3201/eid2307.161429.
APA Kenagy, E., Priest, P. C., Cameron, C. M., Smith, D., Scott, P., Cho, V....Murdoch, D. R. (2017). Risk Factors for Legionella longbeachae Legionnaires’ Disease, New Zealand. Emerging Infectious Diseases, 23(7), 1148-1154. https://dx.doi.org/10.3201/eid2307.161429.
Dispatches

Environmental Factors as Key Determinants for Visceral Leishmaniasis in Solid Organ Transplant Recipients, Madrid, Spain [PDF - 1.59 MB - 5 pages]
N. Carrasco-Antón et al.

During a visceral leishmaniasis outbreak in an area of Madrid, Spain, the incidence of disease among solid organ transplant recipients was 10.3% (7/68). Being a black person from sub-Saharan Africa, undergoing transplantation during the outbreak, and residing <1,000 m from the epidemic focus were risk factors for posttransplant visceral leishmaniasis.

EID Carrasco-Antón N, López-Medrano F, Fernández-Ruiz M, Carrillo E, Moreno J, García-Reyne A, et al. Environmental Factors as Key Determinants for Visceral Leishmaniasis in Solid Organ Transplant Recipients, Madrid, Spain. Emerg Infect Dis. 2017;23(7):1155-1159. https://dx.doi.org/10.3201/eid2307.151251
AMA Carrasco-Antón N, López-Medrano F, Fernández-Ruiz M, et al. Environmental Factors as Key Determinants for Visceral Leishmaniasis in Solid Organ Transplant Recipients, Madrid, Spain. Emerging Infectious Diseases. 2017;23(7):1155-1159. doi:10.3201/eid2307.151251.
APA Carrasco-Antón, N., López-Medrano, F., Fernández-Ruiz, M., Carrillo, E., Moreno, J., García-Reyne, A....Aguado, J. (2017). Environmental Factors as Key Determinants for Visceral Leishmaniasis in Solid Organ Transplant Recipients, Madrid, Spain. Emerging Infectious Diseases, 23(7), 1155-1159. https://dx.doi.org/10.3201/eid2307.151251.

Locally Acquired mcr-1 in Escherichia coli, Australia, 2011 and 2013 [PDF - 1.37 MB - 4 pages]
J. A. Ellem et al.

We identified discrete importation events of the mcr-1 gene on incompatibility group IncI2 plasmids in Escherichia coli isolated from patients in New South Wales, Australia, in 2011 and 2013. mcr-1 is present in a small minority of colistin-resistant Enterobacteriaceae and appears not to be established locally.

EID Ellem JA, Ginn AN, Chen S, Ferguson J, Partridge SR, Iredell JR. Locally Acquired mcr-1 in Escherichia coli, Australia, 2011 and 2013. Emerg Infect Dis. 2017;23(7):1160-1163. https://dx.doi.org/10.3201/eid2307.161638
AMA Ellem JA, Ginn AN, Chen S, et al. Locally Acquired mcr-1 in Escherichia coli, Australia, 2011 and 2013. Emerging Infectious Diseases. 2017;23(7):1160-1163. doi:10.3201/eid2307.161638.
APA Ellem, J. A., Ginn, A. N., Chen, S., Ferguson, J., Partridge, S. R., & Iredell, J. R. (2017). Locally Acquired mcr-1 in Escherichia coli, Australia, 2011 and 2013. Emerging Infectious Diseases, 23(7), 1160-1163. https://dx.doi.org/10.3201/eid2307.161638.

Postmortem Findings for 7 Neonates with Congenital Zika Virus Infection [PDF - 2.66 MB - 4 pages]
A. Q. Sousa et al.

Postmortem examination of 7 neonates with congenital Zika virus infection in Brazil revealed microcephaly, ventriculomegaly, dystrophic calcifications, and severe cortical neuronal depletion in all and arthrogryposis in 6. Other findings were leptomeningeal and brain parenchymal inflammation and pulmonary hypoplasia and lymphocytic infiltration in liver and lungs. Findings confirmed virus neurotropism and multiple organ infection.

EID Sousa AQ, Cavalcante D, Franco LM, Araújo F, Sousa ET, Valença-Junior J, et al. Postmortem Findings for 7 Neonates with Congenital Zika Virus Infection. Emerg Infect Dis. 2017;23(7):1164-1167. https://dx.doi.org/10.3201/eid2307.162019
AMA Sousa AQ, Cavalcante D, Franco LM, et al. Postmortem Findings for 7 Neonates with Congenital Zika Virus Infection. Emerging Infectious Diseases. 2017;23(7):1164-1167. doi:10.3201/eid2307.162019.
APA Sousa, A. Q., Cavalcante, D., Franco, L. M., Araújo, F., Sousa, E. T., Valença-Junior, J....Pompeu, M. (2017). Postmortem Findings for 7 Neonates with Congenital Zika Virus Infection. Emerging Infectious Diseases, 23(7), 1164-1167. https://dx.doi.org/10.3201/eid2307.162019.

Porcine Hemagglutinating Encephalomyelitis Virus and Respiratory Disease in Exhibition Swine, Michigan, USA, 2015 [PDF - 1.33 MB - 4 pages]
J. N. Lorbach et al.

Acute outbreaks of respiratory disease in swine at agricultural fairs in Michigan, USA, in 2015 raised concern for potential human exposure to influenza A virus. Testing ruled out influenza A virus and identified porcine hemagglutinating encephalomyelitis virus as the cause of influenza-like illness in the affected swine.

EID Lorbach JN, Wang L, Nolting JM, Benjamin MG, Killian M, Zhang Y, et al. Porcine Hemagglutinating Encephalomyelitis Virus and Respiratory Disease in Exhibition Swine, Michigan, USA, 2015. Emerg Infect Dis. 2017;23(7):1168-1171. https://dx.doi.org/10.3201/eid2307.170019
AMA Lorbach JN, Wang L, Nolting JM, et al. Porcine Hemagglutinating Encephalomyelitis Virus and Respiratory Disease in Exhibition Swine, Michigan, USA, 2015. Emerging Infectious Diseases. 2017;23(7):1168-1171. doi:10.3201/eid2307.170019.
APA Lorbach, J. N., Wang, L., Nolting, J. M., Benjamin, M. G., Killian, M., Zhang, Y....Bowman, A. S. (2017). Porcine Hemagglutinating Encephalomyelitis Virus and Respiratory Disease in Exhibition Swine, Michigan, USA, 2015. Emerging Infectious Diseases, 23(7), 1168-1171. https://dx.doi.org/10.3201/eid2307.170019.

Norovirus GII.P16/GII.2–Associated Gastroenteritis, China, 2016 [PDF - 2.33 MB - 4 pages]
Y. Ao et al.

During October–December 2016, the number of norovirus outbreaks in China increased sharply from the same period during the previous 4 years. We identified a recombinant norovirus strain, GII.P16-GII.2, as the cause of 44 (79%) of the 56 outbreaks, signaling that this strain could replace the predominant GII.4 viruses.

EID Ao Y, Wang J, Ling H, He Y, Dong X, Wang X, et al. Norovirus GII.P16/GII.2–Associated Gastroenteritis, China, 2016. Emerg Infect Dis. 2017;23(7):1172-1175. https://dx.doi.org/10.3201/eid2307.170034
AMA Ao Y, Wang J, Ling H, et al. Norovirus GII.P16/GII.2–Associated Gastroenteritis, China, 2016. Emerging Infectious Diseases. 2017;23(7):1172-1175. doi:10.3201/eid2307.170034.
APA Ao, Y., Wang, J., Ling, H., He, Y., Dong, X., Wang, X....Duan, Z. (2017). Norovirus GII.P16/GII.2–Associated Gastroenteritis, China, 2016. Emerging Infectious Diseases, 23(7), 1172-1175. https://dx.doi.org/10.3201/eid2307.170034.

Novel Pestivirus Species in Pigs, Austria, 2015 [PDF - 2.71 MB - 4 pages]
B. Lamp et al.

A novel pestivirus species was discovered in a piglet-producing farm in Austria during virologic examinations of congenital tremor cases. The emergence of this novel pestivirus species, provisionally termed Linda virus, in domestic pigs may have implications for classical swine fever virus surveillance and porcine health management.

EID Lamp B, Schwarz L, Högler S, Riedel C, Sinn L, Rebel-Bauder B, et al. Novel Pestivirus Species in Pigs, Austria, 2015. Emerg Infect Dis. 2017;23(7):1176-1179. https://dx.doi.org/10.3201/eid2307.170163
AMA Lamp B, Schwarz L, Högler S, et al. Novel Pestivirus Species in Pigs, Austria, 2015. Emerging Infectious Diseases. 2017;23(7):1176-1179. doi:10.3201/eid2307.170163.
APA Lamp, B., Schwarz, L., Högler, S., Riedel, C., Sinn, L., Rebel-Bauder, B....Rümenapf, T. (2017). Novel Pestivirus Species in Pigs, Austria, 2015. Emerging Infectious Diseases, 23(7), 1176-1179. https://dx.doi.org/10.3201/eid2307.170163.

Recombinant GII.P16-GII.2 Norovirus, Taiwan, 2016 [PDF - 1.54 MB - 4 pages]
L. Liu et al.

In Taiwan, acute gastroenteritis outbreaks caused by a new norovirus genotype GII.2 increased sharply toward the end of 2016. Unlike previous outbreaks, which often involved restaurants, GII.2 outbreaks mainly occurred in schools. Phylogenetic analysis indicates that these noroviruses are recombinant GII.P16-GII.2 strains.

EID Liu L, Kuo T, Wu C, Liao W, Hall AJ, Wu F. Recombinant GII.P16-GII.2 Norovirus, Taiwan, 2016. Emerg Infect Dis. 2017;23(7):1180-1183. https://dx.doi.org/10.3201/eid2307.170212
AMA Liu L, Kuo T, Wu C, et al. Recombinant GII.P16-GII.2 Norovirus, Taiwan, 2016. Emerging Infectious Diseases. 2017;23(7):1180-1183. doi:10.3201/eid2307.170212.
APA Liu, L., Kuo, T., Wu, C., Liao, W., Hall, A. J., & Wu, F. (2017). Recombinant GII.P16-GII.2 Norovirus, Taiwan, 2016. Emerging Infectious Diseases, 23(7), 1180-1183. https://dx.doi.org/10.3201/eid2307.170212.

Emergency Meningococcal ACWY Vaccination Program for Teenagers to Control Group W Meningococcal Disease, England, 2015–2016 [PDF - 714 KB - 4 pages]
H. Campbell et al.

During the first 12 months of an emergency meningococcal ACWY vaccination program for teenagers in England, coverage among persons who left school in 2015, the first cohort to be vaccinated, was 36.6%. There were 69% fewer group W meningococcal cases than predicted by trend analysis and no cases in vaccinated teenagers.

EID Campbell H, Edelstein M, Andrews N, Borrow R, Ramsay M, Ladhani S. Emergency Meningococcal ACWY Vaccination Program for Teenagers to Control Group W Meningococcal Disease, England, 2015–2016. Emerg Infect Dis. 2017;23(7):1184-1187. https://dx.doi.org/10.3201/eid2307.170236
AMA Campbell H, Edelstein M, Andrews N, et al. Emergency Meningococcal ACWY Vaccination Program for Teenagers to Control Group W Meningococcal Disease, England, 2015–2016. Emerging Infectious Diseases. 2017;23(7):1184-1187. doi:10.3201/eid2307.170236.
APA Campbell, H., Edelstein, M., Andrews, N., Borrow, R., Ramsay, M., & Ladhani, S. (2017). Emergency Meningococcal ACWY Vaccination Program for Teenagers to Control Group W Meningococcal Disease, England, 2015–2016. Emerging Infectious Diseases, 23(7), 1184-1187. https://dx.doi.org/10.3201/eid2307.170236.

Association of GII.P16-GII.2 Recombinant Norovirus Strain with Increased Norovirus Outbreaks, Guangdong, China, 2016 [PDF - 1.18 MB - 3 pages]
J. Lu et al.

An unusual prevalence of recombinant GII.2 noroviruses (GII.P16-GII.2) in Guangdong, China, at the end of 2016 caused a sharp increase in outbreaks of acute gastroenteritis. This event was another non-GII.4 epidemic that emerged after the GII.17 viruses in 2014 and 2015 and warrants global surveillance.

EID Lu J, Fang L, Sun L, Zeng H, Li Y, Zheng H, et al. Association of GII.P16-GII.2 Recombinant Norovirus Strain with Increased Norovirus Outbreaks, Guangdong, China, 2016. Emerg Infect Dis. 2017;23(7):1188-1190. https://dx.doi.org/10.3201/eid2307.170333
AMA Lu J, Fang L, Sun L, et al. Association of GII.P16-GII.2 Recombinant Norovirus Strain with Increased Norovirus Outbreaks, Guangdong, China, 2016. Emerging Infectious Diseases. 2017;23(7):1188-1190. doi:10.3201/eid2307.170333.
APA Lu, J., Fang, L., Sun, L., Zeng, H., Li, Y., Zheng, H....Li, H. (2017). Association of GII.P16-GII.2 Recombinant Norovirus Strain with Increased Norovirus Outbreaks, Guangdong, China, 2016. Emerging Infectious Diseases, 23(7), 1188-1190. https://dx.doi.org/10.3201/eid2307.170333.

Rabbit Hepatitis E Virus Infections in Humans, France [PDF - 515 KB - 3 pages]
F. Abravanel et al.

Hepatitis E virus (HEV) has been detected in rabbits, but whether rabbit HEV strains can be transmitted to humans is not known. Of 919 HEV-infected patients in France during 2015–2016, five were infected with a rabbit HEV strain. None of the patients had direct contact with rabbits, suggesting foodborne or waterborne infections.

EID Abravanel F, Lhomme S, El Costa H, Schvartz B, Peron J, Kamar N, et al. Rabbit Hepatitis E Virus Infections in Humans, France. Emerg Infect Dis. 2017;23(7):1191-1193. https://dx.doi.org/10.3201/eid2307.170318
AMA Abravanel F, Lhomme S, El Costa H, et al. Rabbit Hepatitis E Virus Infections in Humans, France. Emerging Infectious Diseases. 2017;23(7):1191-1193. doi:10.3201/eid2307.170318.
APA Abravanel, F., Lhomme, S., El Costa, H., Schvartz, B., Peron, J., Kamar, N....Izopet, J. (2017). Rabbit Hepatitis E Virus Infections in Humans, France. Emerging Infectious Diseases, 23(7), 1191-1193. https://dx.doi.org/10.3201/eid2307.170318.

Detection and Genetic Characterization of Adenovirus Type 14 Strain in Students with Influenza-Like Illness, New York, USA, 2014–2015 [PDF - 846 KB - 7 pages]
D. M. Lamson et al.

During the 2014–15 influenza season, 13/168 respiratory samples from students with influenza-like illness (ILI) at a college in New York, USA, were positive for human adenovirus (HAdV); 4/13 samples were positive for HAdV-B14p1. During influenza season, HAdV should be included in the differential diagnostic panel used to determine the etiology of ILI.

EID Lamson DM, Kajon AE, Shudt M, Girouard G, St. George K. Detection and Genetic Characterization of Adenovirus Type 14 Strain in Students with Influenza-Like Illness, New York, USA, 2014–2015. Emerg Infect Dis. 2017;23(7):1194-1197. https://dx.doi.org/10.3201/eid2307.161730
AMA Lamson DM, Kajon AE, Shudt M, et al. Detection and Genetic Characterization of Adenovirus Type 14 Strain in Students with Influenza-Like Illness, New York, USA, 2014–2015. Emerging Infectious Diseases. 2017;23(7):1194-1197. doi:10.3201/eid2307.161730.
APA Lamson, D. M., Kajon, A. E., Shudt, M., Girouard, G., & St. George, K. (2017). Detection and Genetic Characterization of Adenovirus Type 14 Strain in Students with Influenza-Like Illness, New York, USA, 2014–2015. Emerging Infectious Diseases, 23(7), 1194-1197. https://dx.doi.org/10.3201/eid2307.161730.

Francisella tularensis ssp. holarctica in Ringtail Possums, Australia [PDF - 1.31 MB - 4 pages]
J. Eden et al.

The occurrence of Francisella tularensis outside of endemic areas, such as North America and Eurasia, has been enigmatic. We report the metagenomic discovery and isolation of F. tularensis ssp. holarctica biovar japonica from diseased ringtail possums in Sydney, Australia. This finding confirms the presence of F. tularensis in the Southern Hemisphere.

EID Eden J, Rose K, Ng J, Shi M, Wang Q, Sintchenko V, et al. Francisella tularensis ssp. holarctica in Ringtail Possums, Australia. Emerg Infect Dis. 2017;23(7):1198-1201. https://dx.doi.org/10.3201/eid2307.161863
AMA Eden J, Rose K, Ng J, et al. Francisella tularensis ssp. holarctica in Ringtail Possums, Australia. Emerging Infectious Diseases. 2017;23(7):1198-1201. doi:10.3201/eid2307.161863.
APA Eden, J., Rose, K., Ng, J., Shi, M., Wang, Q., Sintchenko, V....Holmes, E. C. (2017). Francisella tularensis ssp. holarctica in Ringtail Possums, Australia. Emerging Infectious Diseases, 23(7), 1198-1201. https://dx.doi.org/10.3201/eid2307.161863.
Research Letters

Mycobacterium gordonae in Patient with Facial Ulcers, Nosebleeds, and Positive T-SPOT.TB Test, China [PDF - 1.57 MB - 3 pages]
Y. Chen et al.

Mycobacterium gordonae is often regarded as a weak pathogen that only occasionally causes overt disease. We report a case of M. gordonae infection in the facial skin, nasal mucosa, and paranasal sinus in an immunocompetent patient and review previous cases. The T-SPOT.TB test might be useful in diagnosing such cases.

EID Chen Y, Jiang J, Jiang H, Chen J, Wang X, Liu W, et al. Mycobacterium gordonae in Patient with Facial Ulcers, Nosebleeds, and Positive T-SPOT.TB Test, China. Emerg Infect Dis. 2017;23(7):1204-1206. https://dx.doi.org/10.3201/eid2307.162033
AMA Chen Y, Jiang J, Jiang H, et al. Mycobacterium gordonae in Patient with Facial Ulcers, Nosebleeds, and Positive T-SPOT.TB Test, China. Emerging Infectious Diseases. 2017;23(7):1204-1206. doi:10.3201/eid2307.162033.
APA Chen, Y., Jiang, J., Jiang, H., Chen, J., Wang, X., Liu, W....Wang, H. (2017). Mycobacterium gordonae in Patient with Facial Ulcers, Nosebleeds, and Positive T-SPOT.TB Test, China. Emerging Infectious Diseases, 23(7), 1204-1206. https://dx.doi.org/10.3201/eid2307.162033.

Norovirus GII.17 as Major Epidemic Strain in Italy, Winter 2015–16 [PDF - 557 KB - 3 pages]
G. Giammanco et al.

In winter 2015–16, norovirus GII.17 Kawasaki 2014 emerged as a cause of sporadic gastroenteritis in children in Italy. Median patient age was higher for those with GII.17 than GII.4 infection (55 vs. 24 months), suggesting limited cross-protection for older children.

EID Giammanco G, De Grazia S, Bonura F, Cappa V, Muli S, Pepe A, et al. Norovirus GII.17 as Major Epidemic Strain in Italy, Winter 2015–16. Emerg Infect Dis. 2017;23(7):1206-1208. https://dx.doi.org/10.3201/eid2307.161255
AMA Giammanco G, De Grazia S, Bonura F, et al. Norovirus GII.17 as Major Epidemic Strain in Italy, Winter 2015–16. Emerging Infectious Diseases. 2017;23(7):1206-1208. doi:10.3201/eid2307.161255.
APA Giammanco, G., De Grazia, S., Bonura, F., Cappa, V., Muli, S., Pepe, A....Martella, V. (2017). Norovirus GII.17 as Major Epidemic Strain in Italy, Winter 2015–16. Emerging Infectious Diseases, 23(7), 1206-1208. https://dx.doi.org/10.3201/eid2307.161255.

Disseminated Mycobacterium genavense Infection in Patient with Adult-Onset Immunodeficiency [PDF - 340 KB - 3 pages]
T. Asakura et al.

We report a case of disseminated Mycobacterium genavense infection resulting from neutralizing anti–interferon-γ autoantibodies in the patient. We identified M. genavense targeting the hsp65 gene in an aspiration specimen of the lymph node. Adult-onset immunodeficiency caused by neutralizing anti–interferon-γ autoantibodies, in addition to HIV infection, can lead to disseminated nontuberculous mycobacterial infection.

EID Asakura T, Namkoong H, Sakagami T, Hasegawa N, Ohkusu K, Nakamura A. Disseminated Mycobacterium genavense Infection in Patient with Adult-Onset Immunodeficiency. Emerg Infect Dis. 2017;23(7):1208-1210. https://dx.doi.org/10.3201/eid2307.161677
AMA Asakura T, Namkoong H, Sakagami T, et al. Disseminated Mycobacterium genavense Infection in Patient with Adult-Onset Immunodeficiency. Emerging Infectious Diseases. 2017;23(7):1208-1210. doi:10.3201/eid2307.161677.
APA Asakura, T., Namkoong, H., Sakagami, T., Hasegawa, N., Ohkusu, K., & Nakamura, A. (2017). Disseminated Mycobacterium genavense Infection in Patient with Adult-Onset Immunodeficiency. Emerging Infectious Diseases, 23(7), 1208-1210. https://dx.doi.org/10.3201/eid2307.161677.

Live Cell Therapy as Potential Risk Factor for Q Fever [PDF - 321 KB - 3 pages]
M. George et al.

During an outbreak of Q fever in Germany, we identified an infected sheep flock from which animals were routinely used as a source for life cell therapy (LCT), the injection of fetal cells or cell extracts from sheep into humans. Q fever developed in 7 LCT recipients from Canada, Germany, and the United States.

EID George M, Reich A, Cussler K, Jehl H, Burckhardt F. Live Cell Therapy as Potential Risk Factor for Q Fever. Emerg Infect Dis. 2017;23(7):1210-1212. https://dx.doi.org/10.3201/eid2307.161693
AMA George M, Reich A, Cussler K, et al. Live Cell Therapy as Potential Risk Factor for Q Fever. Emerging Infectious Diseases. 2017;23(7):1210-1212. doi:10.3201/eid2307.161693.
APA George, M., Reich, A., Cussler, K., Jehl, H., & Burckhardt, F. (2017). Live Cell Therapy as Potential Risk Factor for Q Fever. Emerging Infectious Diseases, 23(7), 1210-1212. https://dx.doi.org/10.3201/eid2307.161693.

Novel Avulaviruses in Penguins, Antarctica [PDF - 498 KB - 3 pages]
V. Neira et al.

We identified 3 novel and distinct avulaviruses from Gentoo penguins sampled in Antarctica. We isolated these viruses and sequenced their complete genomes; serologic assays demonstrated that the viruses do not have cross-reactivity between them. Our findings suggest that these 3 new viruses represent members of 3 novel avulavirus species.

EID Neira V, Tapia R, Verdugo C, Barriga G, Mor S, Ng T, et al. Novel Avulaviruses in Penguins, Antarctica. Emerg Infect Dis. 2017;23(7):1212-1214. https://dx.doi.org/10.3201/eid2307.170054
AMA Neira V, Tapia R, Verdugo C, et al. Novel Avulaviruses in Penguins, Antarctica. Emerging Infectious Diseases. 2017;23(7):1212-1214. doi:10.3201/eid2307.170054.
APA Neira, V., Tapia, R., Verdugo, C., Barriga, G., Mor, S., Ng, T....González-Acuña, D. (2017). Novel Avulaviruses in Penguins, Antarctica. Emerging Infectious Diseases, 23(7), 1212-1214. https://dx.doi.org/10.3201/eid2307.170054.

Rickettsia sibirica mongolitimonae Infection, Turkey, 2016 [PDF - 331 KB - 3 pages]
F. Kuscu et al.

In 2016, Rickettsia sibirica mongolitimonae was diagnosed for a man in Turkey. He had been bitten by a Hyalomma marginatum tick, from which PCR detected rickettsial DNA. Sequence analysis of the DNA identified R. sibirica mongolitimonae. Immunofluorescence assay of patient serum indicated R. conorii, which cross-reacts. PCR is recommended for rickettsiosis diagnoses.

EID Kuscu F, Orkun O, Ulu A, Kurtaran B, Komur S, Inal A, et al. Rickettsia sibirica mongolitimonae Infection, Turkey, 2016. Emerg Infect Dis. 2017;23(7):1214-1216. https://dx.doi.org/10.3201/eid2307.170188
AMA Kuscu F, Orkun O, Ulu A, et al. Rickettsia sibirica mongolitimonae Infection, Turkey, 2016. Emerging Infectious Diseases. 2017;23(7):1214-1216. doi:10.3201/eid2307.170188.
APA Kuscu, F., Orkun, O., Ulu, A., Kurtaran, B., Komur, S., Inal, A....Aksu, H. (2017). Rickettsia sibirica mongolitimonae Infection, Turkey, 2016. Emerging Infectious Diseases, 23(7), 1214-1216. https://dx.doi.org/10.3201/eid2307.170188.

Contaminated Stream Water as Source for Escherichia coli O157 Illness in Children [PDF - 441 KB - 3 pages]
W. S. Probert et al.

In May 2016, an outbreak of Shiga toxin–producing Escherichia coli O157 infections occurred among children who had played in a stream flowing through a park. Analysis of E. coli isolates from the patients, stream water, and deer and coyote scat showed that feces from deer were the most likely source of contamination.

EID Probert WS, Miller GM, Ledin KE. Contaminated Stream Water as Source for Escherichia coli O157 Illness in Children. Emerg Infect Dis. 2017;23(7):1216-1218. https://dx.doi.org/10.3201/eid2307.170226
AMA Probert WS, Miller GM, Ledin KE. Contaminated Stream Water as Source for Escherichia coli O157 Illness in Children. Emerging Infectious Diseases. 2017;23(7):1216-1218. doi:10.3201/eid2307.170226.
APA Probert, W. S., Miller, G. M., & Ledin, K. E. (2017). Contaminated Stream Water as Source for Escherichia coli O157 Illness in Children. Emerging Infectious Diseases, 23(7), 1216-1218. https://dx.doi.org/10.3201/eid2307.170226.

Diphtheria in Mayotte, 2007–2015 [PDF - 565 KB - 3 pages]
E. Belchior et al.

Epidemiology of diphtheria in the southwestern Indian Ocean is poorly documented. We analyzed 14 cases of infection with toxigenic Corynebacterium diphtheriae reported during 2007–2015 in Mayotte, a French department located in this region. Local control of diphtheria is needed to minimize the risk for importation of the bacterium into disease-free areas.

EID Belchior E, Henry S, Badell E, Collet L, Benoit-Cattin T, de Montera A, et al. Diphtheria in Mayotte, 2007–2015. Emerg Infect Dis. 2017;23(7):1218-1220. https://dx.doi.org/10.3201/eid2307.170262
AMA Belchior E, Henry S, Badell E, et al. Diphtheria in Mayotte, 2007–2015. Emerging Infectious Diseases. 2017;23(7):1218-1220. doi:10.3201/eid2307.170262.
APA Belchior, E., Henry, S., Badell, E., Collet, L., Benoit-Cattin, T., de Montera, A....Olivier, S. (2017). Diphtheria in Mayotte, 2007–2015. Emerging Infectious Diseases, 23(7), 1218-1220. https://dx.doi.org/10.3201/eid2307.170262.

Haemophilus influenzae Type a Meningitis in Immunocompetent Child, Oman, 2015 [PDF - 393 KB - 3 pages]
K. P. Sawardekar

Meningitis caused by Haemophilus influenzae type b (Hib) was eliminated in Oman after the introduction of Hib vaccine in 2001. However, a case of H. influenzae type a meningitis was diagnosed in a child from Oman in 2015, which highlights the need to monitor the incidence of invasive non-Hib H. influenzae disease.

EID Sawardekar KP. Haemophilus influenzae Type a Meningitis in Immunocompetent Child, Oman, 2015. Emerg Infect Dis. 2017;23(7):1221-1223. https://dx.doi.org/10.3201/eid2307.170311
AMA Sawardekar KP. Haemophilus influenzae Type a Meningitis in Immunocompetent Child, Oman, 2015. Emerging Infectious Diseases. 2017;23(7):1221-1223. doi:10.3201/eid2307.170311.
APA Sawardekar, K. P. (2017). Haemophilus influenzae Type a Meningitis in Immunocompetent Child, Oman, 2015. Emerging Infectious Diseases, 23(7), 1221-1223. https://dx.doi.org/10.3201/eid2307.170311.

Importation of Zika Virus from Vietnam to Japan, November 2016 [PDF - 526 KB - 3 pages]
T. Hashimoto et al.

We report a case of Zika virus infection that was imported to Japan by a traveler returning from Vietnam. We detected Zika virus RNA in the patient’s saliva, urine, and whole blood. In the Zika virus strain isolated from the urine, we found clearly smaller plaques than in previous strains.

EID Hashimoto T, Kutsuna S, Tajima S, Nakayama E, Maeki T, Taniguchi S, et al. Importation of Zika Virus from Vietnam to Japan, November 2016. Emerg Infect Dis. 2017;23(7):1223-1225. https://dx.doi.org/10.3201/eid2307.170519
AMA Hashimoto T, Kutsuna S, Tajima S, et al. Importation of Zika Virus from Vietnam to Japan, November 2016. Emerging Infectious Diseases. 2017;23(7):1223-1225. doi:10.3201/eid2307.170519.
APA Hashimoto, T., Kutsuna, S., Tajima, S., Nakayama, E., Maeki, T., Taniguchi, S....Ohmagari, N. (2017). Importation of Zika Virus from Vietnam to Japan, November 2016. Emerging Infectious Diseases, 23(7), 1223-1225. https://dx.doi.org/10.3201/eid2307.170519.

Case of Nigeria-Acquired Human African Trypanosomiasis in United Kingdom, 2016 [PDF - 330 KB - 3 pages]
A. Luintel et al.

Human African trypanosomiasis has not been reported in Nigeria since 2012. Nevertheless, limitations of current surveillance programs mean that undetected infections may persist. We report a recent case of stage 2 trypanosomiasis caused by Trypanosoma brucei gambiense acquired in Nigeria and imported into the United Kingdom.

EID Luintel A, Lowe P, Cooper A, MacLeod A, Büscher P, Brooks T, et al. Case of Nigeria-Acquired Human African Trypanosomiasis in United Kingdom, 2016. Emerg Infect Dis. 2017;23(7):1225-1227. https://dx.doi.org/10.3201/eid2307.170695
AMA Luintel A, Lowe P, Cooper A, et al. Case of Nigeria-Acquired Human African Trypanosomiasis in United Kingdom, 2016. Emerging Infectious Diseases. 2017;23(7):1225-1227. doi:10.3201/eid2307.170695.
APA Luintel, A., Lowe, P., Cooper, A., MacLeod, A., Büscher, P., Brooks, T....Brown, M. (2017). Case of Nigeria-Acquired Human African Trypanosomiasis in United Kingdom, 2016. Emerging Infectious Diseases, 23(7), 1225-1227. https://dx.doi.org/10.3201/eid2307.170695.
Letters

Mycobacterium chimaera Isolates from Heater–Cooler Units, United Kingdom [PDF - 304 KB - 1 page]
J. Hedge et al.
EID Hedge J, Lamagni T, Moore G, Walker J, Crook D, Chand M. Mycobacterium chimaera Isolates from Heater–Cooler Units, United Kingdom. Emerg Infect Dis. 2017;23(7):1227. https://dx.doi.org/10.3201/eid2307.170442
AMA Hedge J, Lamagni T, Moore G, et al. Mycobacterium chimaera Isolates from Heater–Cooler Units, United Kingdom. Emerging Infectious Diseases. 2017;23(7):1227. doi:10.3201/eid2307.170442.
APA Hedge, J., Lamagni, T., Moore, G., Walker, J., Crook, D., & Chand, M. (2017). Mycobacterium chimaera Isolates from Heater–Cooler Units, United Kingdom. Emerging Infectious Diseases, 23(7), 1227. https://dx.doi.org/10.3201/eid2307.170442.
Another Dimension

The Summer of Seventy-Six—Legionella pneumophila Monologue [PDF - 1.23 MB - 2 pages]
A. Valavane and R. Chaudhry
EID Valavane A, Chaudhry R. The Summer of Seventy-Six—Legionella pneumophila Monologue. Emerg Infect Dis. 2017;23(7):1202-1203. https://dx.doi.org/10.3201/eid2307.160546
AMA Valavane A, Chaudhry R. The Summer of Seventy-Six—Legionella pneumophila Monologue. Emerging Infectious Diseases. 2017;23(7):1202-1203. doi:10.3201/eid2307.160546.
APA Valavane, A., & Chaudhry, R. (2017). The Summer of Seventy-Six—Legionella pneumophila Monologue. Emerging Infectious Diseases, 23(7), 1202-1203. https://dx.doi.org/10.3201/eid2307.160546.
Books and Media

Outbreaks and Surveys: A Dilogy [PDF - 293 KB - 1 page]
J. S. Keystone
EID Keystone JS. Outbreaks and Surveys: A Dilogy. Emerg Infect Dis. 2017;23(7):1228. https://dx.doi.org/10.3201/eid2307.170315
AMA Keystone JS. Outbreaks and Surveys: A Dilogy. Emerging Infectious Diseases. 2017;23(7):1228. doi:10.3201/eid2307.170315.
APA Keystone, J. S. (2017). Outbreaks and Surveys: A Dilogy. Emerging Infectious Diseases, 23(7), 1228. https://dx.doi.org/10.3201/eid2307.170315.
About the Cover

Elaborate Details, Hidden Surprises [PDF - 736 KB - 2 pages]
B. Breedlove and T. Chorba
EID Breedlove B, Chorba T. Elaborate Details, Hidden Surprises. Emerg Infect Dis. 2017;23(7):1229-1230. https://dx.doi.org/10.3201/eid2307.ac2307
AMA Breedlove B, Chorba T. Elaborate Details, Hidden Surprises. Emerging Infectious Diseases. 2017;23(7):1229-1230. doi:10.3201/eid2307.ac2307.
APA Breedlove, B., & Chorba, T. (2017). Elaborate Details, Hidden Surprises. Emerging Infectious Diseases, 23(7), 1229-1230. https://dx.doi.org/10.3201/eid2307.ac2307.
Etymologia

Etymologia: Meningococcal Disease [PDF - 425 KB - 1 page]
R. Henry
EID Henry R. Etymologia: Meningococcal Disease. Emerg Infect Dis. 2017;23(7):1187. https://dx.doi.org/10.3201/eid2307.et2307
AMA Henry R. Etymologia: Meningococcal Disease. Emerging Infectious Diseases. 2017;23(7):1187. doi:10.3201/eid2307.et2307.
APA Henry, R. (2017). Etymologia: Meningococcal Disease. Emerging Infectious Diseases, 23(7), 1187. https://dx.doi.org/10.3201/eid2307.et2307.
Corrections

Correction: Vol. 23, No. 4 [PDF - 293 KB - 1 page]
EID Correction: Vol. 23, No. 4. Emerg Infect Dis. 2017;23(7):1228. https://dx.doi.org/10.3201/eid2307.c12307
AMA Correction: Vol. 23, No. 4. Emerging Infectious Diseases. 2017;23(7):1228. doi:10.3201/eid2307.c12307.
APA (2017). Correction: Vol. 23, No. 4. Emerging Infectious Diseases, 23(7), 1228. https://dx.doi.org/10.3201/eid2307.c12307.
Page created: June 20, 2017
Page updated: June 20, 2017
Page reviewed: June 20, 2017
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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