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Issue Cover for Volume 24, Number 10—October 2018

Volume 24, Number 10—October 2018

[PDF - 6.99 MB - 196 pages]

Synopses

Medscape CME Activity
Human Pegivirus in Patients with Encephalitis of Unclear Etiology, Poland [PDF - 3.00 MB - 10 pages]
I. Bukowska-Ośko et al.

Human pegivirus (HPgV), previously called hepatitis G virus or GB virus C, is a lymphotropic virus with undefined pathology. Because many viruses from the family Flaviviridae, to which HPgV belongs, are neurotropic, we studied whether HPgV could infect the central nervous system. We tested serum and cerebrospinal fluid samples from 96 patients with a diagnosis of encephalitis for a variety of pathogens by molecular methods and serology; we also tested for autoantibodies against neuronal antigens. We found HPgV in serum and cerebrospinal fluid from 3 patients who had encephalitis of unclear origin; that is, all the markers that had been tested were negative. Single-strand confirmation polymorphism and next-generation sequencing analysis revealed differences between the serum and cerebrospinal fluid–derived viral sequences, which is compatible with the presence of a separate HPgV compartment in the central nervous system. It is unclear whether HPgV was directly responsible for encephalitis in these patients.

EID Bukowska-Ośko I, Perlejewski K, Pawełczyk A, Rydzanicz M, Pollak A, Popiel M, et al. Human Pegivirus in Patients with Encephalitis of Unclear Etiology, Poland. Emerg Infect Dis. 2018;24(10):1785-1794. https://dx.doi.org/10.3201/eid2410.180161
AMA Bukowska-Ośko I, Perlejewski K, Pawełczyk A, et al. Human Pegivirus in Patients with Encephalitis of Unclear Etiology, Poland. Emerging Infectious Diseases. 2018;24(10):1785-1794. doi:10.3201/eid2410.180161.
APA Bukowska-Ośko, I., Perlejewski, K., Pawełczyk, A., Rydzanicz, M., Pollak, A., Popiel, M....Laskus, T. (2018). Human Pegivirus in Patients with Encephalitis of Unclear Etiology, Poland. Emerging Infectious Diseases, 24(10), 1785-1794. https://dx.doi.org/10.3201/eid2410.180161.
Research

Molecular Evolution, Diversity, and Adaptation of Influenza A(H7N9) Viruses in China [PDF - 3.25 MB - 11 pages]
J. Lu et al.

The substantial increase in prevalence and emergence of antigenically divergent or highly pathogenic influenza A(H7N9) viruses during 2016–17 raises concerns about the epizootic potential of these viruses. We investigated the evolution and adaptation of H7N9 viruses by analyzing available data and newly generated virus sequences isolated in Guangdong Province, China, during 2015–2017. Phylogenetic analyses showed that circulating H7N9 viruses belong to distinct lineages with differing spatial distributions. Hemagglutination inhibition assays performed on serum samples from patients infected with these viruses identified 3 antigenic clusters for 16 strains of different virus lineages. We used ancestral sequence reconstruction to identify parallel amino acid changes on multiple separate lineages. We inferred that mutations in hemagglutinin occur primarily at sites involved in receptor recognition or antigenicity. Our results indicate that highly pathogenic strains likely emerged from viruses circulating in eastern Guangdong Province during March 2016 and are associated with a high rate of adaptive molecular evolution.

EID Lu J, Raghwani J, Pryce R, Bowden TA, Thézé J, Huang S, et al. Molecular Evolution, Diversity, and Adaptation of Influenza A(H7N9) Viruses in China. Emerg Infect Dis. 2018;24(10):1795-1805. https://dx.doi.org/10.3201/eid2410.171063
AMA Lu J, Raghwani J, Pryce R, et al. Molecular Evolution, Diversity, and Adaptation of Influenza A(H7N9) Viruses in China. Emerging Infectious Diseases. 2018;24(10):1795-1805. doi:10.3201/eid2410.171063.
APA Lu, J., Raghwani, J., Pryce, R., Bowden, T. A., Thézé, J., Huang, S....Ke, C. (2018). Molecular Evolution, Diversity, and Adaptation of Influenza A(H7N9) Viruses in China. Emerging Infectious Diseases, 24(10), 1795-1805. https://dx.doi.org/10.3201/eid2410.171063.

Tuberculosis Treatment Monitoring by Video Directly Observed Therapy in 5 Health Districts, California, USA [PDF - 1.11 MB - 10 pages]
R. S. Garfein et al.

We assessed video directly observed therapy (VDOT) for monitoring tuberculosis treatment in 5 health districts in California, USA, to compare adherence between 274 patients using VDOT and 159 patients using in-person directly observed therapy (DOT). Multivariable linear regression analyses identified participant-reported sociodemographics, risk behaviors, and treatment experience associated with adherence. Median participant age was 44 (range 18–87) years; 61% of participants were male. Median fraction of expected doses observed (FEDO) among VDOT participants was higher (93.0% [interquartile range (IQR) 83.4%–97.1%]) than among patients receiving DOT (66.4% [IQR 55.1%–89.3%]). Most participants (96%) would recommend VDOT to others; 90% preferred VDOT over DOT. Lower FEDO was independently associated with US or Mexico birth, shorter VDOT duration, finding VDOT difficult, frequently taking medications while away from home, and having video-recording problems (p<0.05). VDOT cost 32% (range 6%–46%) less than DOT. VDOT was feasible, acceptable, and achieved high adherence at lower cost than DOT.

EID Garfein RS, Liu L, Cuevas-Mota J, Collins K, Muñoz F, Catanzaro DG, et al. Tuberculosis Treatment Monitoring by Video Directly Observed Therapy in 5 Health Districts, California, USA. Emerg Infect Dis. 2018;24(10):1806-1815. https://dx.doi.org/10.3201/eid2410.180459
AMA Garfein RS, Liu L, Cuevas-Mota J, et al. Tuberculosis Treatment Monitoring by Video Directly Observed Therapy in 5 Health Districts, California, USA. Emerging Infectious Diseases. 2018;24(10):1806-1815. doi:10.3201/eid2410.180459.
APA Garfein, R. S., Liu, L., Cuevas-Mota, J., Collins, K., Muñoz, F., Catanzaro, D. G....Raab, F. (2018). Tuberculosis Treatment Monitoring by Video Directly Observed Therapy in 5 Health Districts, California, USA. Emerging Infectious Diseases, 24(10), 1806-1815. https://dx.doi.org/10.3201/eid2410.180459.

Candida auris in Healthcare Facilities, New York, USA, 2013–2017 [PDF - 1.11 MB - 9 pages]
E. Adams et al.

Candida auris is an emerging yeast that causes healthcare-associated infections. It can be misidentified by laboratories and often is resistant to antifungal medications. We describe an outbreak of C. auris infections in healthcare facilities in New York City, New York, USA. The investigation included laboratory surveillance, record reviews, site visits, contact tracing with cultures, and environmental sampling. We identified 51 clinical case-patients and 61 screening case-patients. Epidemiologic links indicated a large, interconnected web of affected healthcare facilities throughout New York City. Of the 51 clinical case-patients, 23 (45%) died within 90 days and isolates were resistant to fluconazole for 50 (98%). Of screening cultures performed for 572 persons (1,136 total cultures), results were C. auris positive for 61 (11%) persons. Environmental cultures were positive for samples from 15 of 20 facilities. Colonization was frequently identified during contact investigations; environmental contamination was also common.

EID Adams E, Quinn M, Tsay S, Poirot E, Chaturvedi S, Southwick K, et al. Candida auris in Healthcare Facilities, New York, USA, 2013–2017. Emerg Infect Dis. 2018;24(10):1816-1824. https://dx.doi.org/10.3201/eid2410.180649
AMA Adams E, Quinn M, Tsay S, et al. Candida auris in Healthcare Facilities, New York, USA, 2013–2017. Emerging Infectious Diseases. 2018;24(10):1816-1824. doi:10.3201/eid2410.180649.
APA Adams, E., Quinn, M., Tsay, S., Poirot, E., Chaturvedi, S., Southwick, K....Workgroup, C. (2018). Candida auris in Healthcare Facilities, New York, USA, 2013–2017. Emerging Infectious Diseases, 24(10), 1816-1824. https://dx.doi.org/10.3201/eid2410.180649.

Frequent Genetic Mismatch between Vaccine Strains and Circulating Seasonal Influenza Viruses, Hong Kong, China, 1996–2012 [PDF - 2.91 MB - 10 pages]
M. Chan et al.

The World Health Organization selects influenza vaccine compositions biannually to cater to peaks in temperate regions. In tropical and subtropical regions, where influenza seasonality varies and epidemics can occur year-round, the choice of vaccine remains uncertain. Our 17-year molecular epidemiologic survey showed that most influenza A(H3N2) (9/11) and B (6/7) vaccine strains had circulated in East Asia >1 year before inclusion into vaccines. Northern Hemisphere vaccine strains and circulating strains in East Asia were closely matched in 7 (20.6%) of 34 seasons for H3N2 and 5 (14.7%) of 34 seasons for B. Southern Hemisphere vaccines also had a low probability of matching (H3N2, 14.7%; B, 11.1%). Strain drift among seasons was common (H3N2, 41.2%; B, 35.3%), and biannual vaccination strategy (Northern Hemisphere vaccines in November followed by Southern Hemisphere vaccines in May) did not improve matching. East Asia is an important contributor to influenza surveillance but often has mismatch between vaccine and contemporarily circulating strains.

EID Chan M, Wang MH, Chen Z, Hui D, Kwok AK, Yeung A, et al. Frequent Genetic Mismatch between Vaccine Strains and Circulating Seasonal Influenza Viruses, Hong Kong, China, 1996–2012. Emerg Infect Dis. 2018;24(10):1825-1834. https://dx.doi.org/10.3201/eid2410.180652
AMA Chan M, Wang MH, Chen Z, et al. Frequent Genetic Mismatch between Vaccine Strains and Circulating Seasonal Influenza Viruses, Hong Kong, China, 1996–2012. Emerging Infectious Diseases. 2018;24(10):1825-1834. doi:10.3201/eid2410.180652.
APA Chan, M., Wang, M. H., Chen, Z., Hui, D., Kwok, A. K., Yeung, A....Chan, P. (2018). Frequent Genetic Mismatch between Vaccine Strains and Circulating Seasonal Influenza Viruses, Hong Kong, China, 1996–2012. Emerging Infectious Diseases, 24(10), 1825-1834. https://dx.doi.org/10.3201/eid2410.180652.

Mapping Histoplasma capsulatum Exposure, United States [PDF - 1.55 MB - 5 pages]
A. W. Maiga et al.

Maps of Histoplasma capsulatum infection prevalence were created 50 years ago; since then, the environment, climate, and anthropogenic land use have changed drastically. Recent outbreaks of acute disease in Montana and Nebraska, USA, suggest shifts in geographic distribution, necessitating updated prevalence maps. To create a weighted overlay geographic suitability model for Histoplasma, we used a geographic information system to combine satellite imagery integrating land cover use (70%), distance to water (20%), and soil pH (10%). We used logistic regression modeling to compare our map with state-level histoplasmosis incidence data from a 5% sample from the Centers for Medicare and Medicaid Services. When compared with the state-based Centers data, the predictive accuracy of the suitability score–predicted states with high and mid-to-high histoplasmosis incidence was moderate. Preferred soil environments for Histoplasma have migrated into the upper Missouri River basin. Suitability score mapping may be applicable to other geographically specific infectious vectors.

EID Maiga AW, Deppen S, Scaffidi B, Baddley J, Aldrich MC, Dittus RS, et al. Mapping Histoplasma capsulatum Exposure, United States. Emerg Infect Dis. 2018;24(10):1835-1839. https://dx.doi.org/10.3201/eid2410.180032
AMA Maiga AW, Deppen S, Scaffidi B, et al. Mapping Histoplasma capsulatum Exposure, United States. Emerging Infectious Diseases. 2018;24(10):1835-1839. doi:10.3201/eid2410.180032.
APA Maiga, A. W., Deppen, S., Scaffidi, B., Baddley, J., Aldrich, M. C., Dittus, R. S....Grogan, E. L. (2018). Mapping Histoplasma capsulatum Exposure, United States. Emerging Infectious Diseases, 24(10), 1835-1839. https://dx.doi.org/10.3201/eid2410.180032.

Transmission Dynamics of Highly Pathogenic Avian Influenza Virus A(H5Nx) Clade 2.3.4.4, North America, 2014–2015 [PDF - 2.12 MB - 9 pages]
D. Lee et al.

Eurasia highly pathogenic avian influenza virus (HPAIV) H5 clade 2.3.4.4 emerged in North America at the end of 2014 and caused outbreaks affecting >50 million poultry in the United States before eradication in June 2015. We investigated the underlying ecologic and epidemiologic processes associated with this viral spread by performing a comparative genomic study using 268 full-length genome sequences and data from outbreak investigations. Reassortant HPAIV H5N2 circulated in wild birds along the Pacific flyway before several spillover events transmitting the virus to poultry farms. Our analysis suggests that >3 separate introductions of HPAIV H5N2 into Midwest states occurred during March–June 2015; transmission to Midwest poultry farms from Pacific wild birds occurred ≈1.7–2.4 months before detection. Once established in poultry, the virus rapidly spread between turkey and chicken farms in neighboring states. Enhanced biosecurity is required to prevent the introduction and dissemination of HPAIV across the poultry industry.

EID Lee D, Torchetti M, Hicks J, Killian M, Bahl J, Pantin-Jackwood M, et al. Transmission Dynamics of Highly Pathogenic Avian Influenza Virus A(H5Nx) Clade 2.3.4.4, North America, 2014–2015. Emerg Infect Dis. 2018;24(10):1840-1848. https://dx.doi.org/10.3201/eid2410.171891
AMA Lee D, Torchetti M, Hicks J, et al. Transmission Dynamics of Highly Pathogenic Avian Influenza Virus A(H5Nx) Clade 2.3.4.4, North America, 2014–2015. Emerging Infectious Diseases. 2018;24(10):1840-1848. doi:10.3201/eid2410.171891.
APA Lee, D., Torchetti, M., Hicks, J., Killian, M., Bahl, J., Pantin-Jackwood, M....Swayne, D. E. (2018). Transmission Dynamics of Highly Pathogenic Avian Influenza Virus A(H5Nx) Clade 2.3.4.4, North America, 2014–2015. Emerging Infectious Diseases, 24(10), 1840-1848. https://dx.doi.org/10.3201/eid2410.171891.

Zika Virus Infection during Pregnancy and Effects on Early Childhood Development, French Polynesia, 2013–2016 [PDF - 878 KB - 9 pages]
L. Subissi et al.

Congenital Zika virus syndrome consists of a large spectrum of neurologic abnormalities seen in infants infected with Zika virus in utero. However, little is known about the effects of Zika virus intrauterine infection on the neurocognitive development of children born without birth defects. Using a case-control study design, we investigated the temporal association of a cluster of congenital defects with Zika virus infection. In a nested study, we also assessed the early childhood development of children recruited in the initial study as controls who were born without known birth defects,. We found evidence for an association of congenital defects with both maternal Zika virus seropositivity (time of infection unknown) and symptomatic Zika virus infection during pregnancy. Although the early childhood development assessment found no excess burden of developmental delay associated with maternal Zika virus infection, larger, longer-term studies are needed.

EID Subissi L, Dub T, Besnard M, Mariteragi-Helle T, Nhan T, Lutringer-Magnin D, et al. Zika Virus Infection during Pregnancy and Effects on Early Childhood Development, French Polynesia, 2013–2016. Emerg Infect Dis. 2018;24(10):1850-1858. https://dx.doi.org/10.3201/eid2410.172079
AMA Subissi L, Dub T, Besnard M, et al. Zika Virus Infection during Pregnancy and Effects on Early Childhood Development, French Polynesia, 2013–2016. Emerging Infectious Diseases. 2018;24(10):1850-1858. doi:10.3201/eid2410.172079.
APA Subissi, L., Dub, T., Besnard, M., Mariteragi-Helle, T., Nhan, T., Lutringer-Magnin, D....Mallet, H. (2018). Zika Virus Infection during Pregnancy and Effects on Early Childhood Development, French Polynesia, 2013–2016. Emerging Infectious Diseases, 24(10), 1850-1858. https://dx.doi.org/10.3201/eid2410.172079.

Evaluation of Effectiveness of a Community-Based Intervention for Control of Dengue Virus Vector, Ouagadougou, Burkina Faso [PDF - 2.13 MB - 9 pages]
S. Ouédraogo et al.

We evaluated the effectiveness of a community-based intervention for dengue vector control in Ouagadougou, the capital city of Burkina Faso. Households in the intervention (n = 287) and control (n = 289) neighborhoods were randomly sampled and the outcomes collected before the intervention (October 2015) and after the intervention (October 2016). The intervention reduced residents’ exposure to dengue vector bites (vector saliva biomarker difference −0.08 [95% CI −0.11 to −0.04]). The pupae index declined in the intervention neighborhood (from 162.14 to 99.03) and increased in the control neighborhood (from 218.72 to 255.67). Residents in the intervention neighborhood were less likely to associate dengue with malaria (risk ratio 0.70 [95% CI 0.58–0.84]) and had increased knowledge about dengue symptoms (risk ratio 1.44 [95% CI 1.22–1.69]). Our study showed that well-planned, evidence/community-based interventions that control exposure to dengue vectors are feasible and effective in urban settings in Africa that have limited resources.

EID Ouédraogo S, Benmarhnia T, Bonnet E, Somé P, Barro AS, Kafando Y, et al. Evaluation of Effectiveness of a Community-Based Intervention for Control of Dengue Virus Vector, Ouagadougou, Burkina Faso. Emerg Infect Dis. 2018;24(10):1859-1867. https://dx.doi.org/10.3201/eid2410.180069
AMA Ouédraogo S, Benmarhnia T, Bonnet E, et al. Evaluation of Effectiveness of a Community-Based Intervention for Control of Dengue Virus Vector, Ouagadougou, Burkina Faso. Emerging Infectious Diseases. 2018;24(10):1859-1867. doi:10.3201/eid2410.180069.
APA Ouédraogo, S., Benmarhnia, T., Bonnet, E., Somé, P., Barro, A. S., Kafando, Y....Ridde, V. (2018). Evaluation of Effectiveness of a Community-Based Intervention for Control of Dengue Virus Vector, Ouagadougou, Burkina Faso. Emerging Infectious Diseases, 24(10), 1859-1867. https://dx.doi.org/10.3201/eid2410.180069.

Evaluation of Nowcasting for Detecting and Predicting Local Influenza Epidemics, Sweden, 2009–2014 [PDF - 1008 KB - 6 pages]
A. Spreco et al.

The growing availability of big data in healthcare and public health opens possibilities for infectious disease control in local settings. We prospectively evaluated a method for integrated local detection and prediction (nowcasting) of influenza epidemics over 5 years, using the total population in Östergötland County, Sweden. We used routine health information system data on influenza-diagnosis cases and syndromic telenursing data for July 2009–June 2014 to evaluate epidemic detection, peak-timing prediction, and peak-intensity prediction. Detection performance was satisfactory throughout the period, except for the 2011–12 influenza A(H3N2) season, which followed a season with influenza B and pandemic influenza A(H1N1)pdm09 virus activity. Peak-timing prediction performance was satisfactory for the 4 influenza seasons but not the pandemic. Peak-intensity levels were correctly categorized for the pandemic and 2 of 4 influenza seasons. We recommend using versions of this method modified with regard to local use context for further evaluations using standard methods.

EID Spreco A, Eriksson O, Dahlström Ö, Cowling B, Timpka T. Evaluation of Nowcasting for Detecting and Predicting Local Influenza Epidemics, Sweden, 2009–2014. Emerg Infect Dis. 2018;24(10):1868-1873. https://dx.doi.org/10.3201/eid2410.171940
AMA Spreco A, Eriksson O, Dahlström Ö, et al. Evaluation of Nowcasting for Detecting and Predicting Local Influenza Epidemics, Sweden, 2009–2014. Emerging Infectious Diseases. 2018;24(10):1868-1873. doi:10.3201/eid2410.171940.
APA Spreco, A., Eriksson, O., Dahlström, Ö., Cowling, B., & Timpka, T. (2018). Evaluation of Nowcasting for Detecting and Predicting Local Influenza Epidemics, Sweden, 2009–2014. Emerging Infectious Diseases, 24(10), 1868-1873. https://dx.doi.org/10.3201/eid2410.171940.

Rapid Increase in Carriage Rates of Enterobacteriaceae Producing Extended-Spectrum β-Lactamases in Healthy Preschool Children, Sweden [PDF - 1.14 MB - 8 pages]
J. Kaarme et al.

By collecting and analyzing diapers, we identified a >6-fold increase in carriage of extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae for healthy preschool children in Sweden (p<0.0001). For 6 of the 50 participating preschools, the carriage rate was >40%. We analyzed samples from 334 children and found 56 containing >1 ESBL producer. The prevalence in the study population increased from 2.6% in 2010 to 16.8% in 2016 (p<0.0001), and for 6 of the 50 participating preschools, the carriage rate was >40%. Furthermore, 58% of the ESBL producers were multidrug resistant, and transmission of ESBL-producing and non–ESBL-producing strains was observed at several of the preschools. Toddlers appear to be major carriers of ESBL producers in Sweden.

EID Kaarme J, Riedel H, Schaal W, Yin H, Nevéus T, Melhus Å. Rapid Increase in Carriage Rates of Enterobacteriaceae Producing Extended-Spectrum β-Lactamases in Healthy Preschool Children, Sweden. Emerg Infect Dis. 2018;24(10):1874-1881. https://dx.doi.org/10.3201/eid2410.171842
AMA Kaarme J, Riedel H, Schaal W, et al. Rapid Increase in Carriage Rates of Enterobacteriaceae Producing Extended-Spectrum β-Lactamases in Healthy Preschool Children, Sweden. Emerging Infectious Diseases. 2018;24(10):1874-1881. doi:10.3201/eid2410.171842.
APA Kaarme, J., Riedel, H., Schaal, W., Yin, H., Nevéus, T., & Melhus, Å. (2018). Rapid Increase in Carriage Rates of Enterobacteriaceae Producing Extended-Spectrum β-Lactamases in Healthy Preschool Children, Sweden. Emerging Infectious Diseases, 24(10), 1874-1881. https://dx.doi.org/10.3201/eid2410.171842.

Medscape CME Activity
Influenza Transmission Dynamics in Urban Households, Managua, Nicaragua, 2012–2014 [PDF - 686 KB - 7 pages]
A. Gordon et al.

During August 2012–November 2014, we conducted a case ascertainment study to investigate household transmission of influenza virus in Managua, Nicaragua. We collected up to 5 respiratory swab samples from each of 536 household contacts of 133 influenza virus–infected persons and assessed for evidence of influenza virus transmission. The overall risk for influenza virus infection of household contacts was 15.7% (95% CI 12.7%–19.0%). Oseltamivir treatment of index patients did not appear to reduce household transmission. The mean serial interval for within-household transmission was 3.1 (95% CI 1.6–8.4) days. We found the transmissibility of influenza B virus to be higher than that of influenza A virus among children. Compared with households with <4 household contacts, those with >4 household contacts appeared to have a reduced risk for infection. Further research is needed to model household influenza virus transmission and design interventions for these settings.

EID Gordon A, Tsang TK, Cowling BJ, Kuan G, Ojeda S, Sanchez N, et al. Influenza Transmission Dynamics in Urban Households, Managua, Nicaragua, 2012–2014. Emerg Infect Dis. 2018;24(10):1882-1888. https://dx.doi.org/10.3201/eid2410.161258
AMA Gordon A, Tsang TK, Cowling BJ, et al. Influenza Transmission Dynamics in Urban Households, Managua, Nicaragua, 2012–2014. Emerging Infectious Diseases. 2018;24(10):1882-1888. doi:10.3201/eid2410.161258.
APA Gordon, A., Tsang, T. K., Cowling, B. J., Kuan, G., Ojeda, S., Sanchez, N....Harris, E. (2018). Influenza Transmission Dynamics in Urban Households, Managua, Nicaragua, 2012–2014. Emerging Infectious Diseases, 24(10), 1882-1888. https://dx.doi.org/10.3201/eid2410.161258.

Non-cyp51A Azole-Resistant Aspergillus fumigatus Isolates with Mutation in HMG-CoA Reductase [PDF - 2.67 MB - 9 pages]
D. Hagiwara et al.

The recent increase in azole-resistant Aspergillus fumigatus is a global concern. Identifying the mutations that confer azole resistance is essential for developing novel methods for prompt diagnosis and effective drug treatment. We screened A. fumigatus clinical isolates for novel mutations conferring azole resistance. We compared the genomic sequences of susceptible and resistant isolates without mutations in cyp51A (non-cyp51A) and found mutations in hmg1 and erg6 involved in ergosterol biosynthesis. We also found the novel mutations in these genes in azole-resistant isolates with different genetic backgrounds. The resistant isolates with mutations in hmg1 showed increased intracellular ergosterol levels compared with susceptible isolates. This finding supports the concept that the ergosterol level is a determinant for resistance to any class of azoles. Multiple isolates with increased resistance to azole possessed a mutation in hmg1, indicating that this mutation is widely present in non-cyp51A azole-resistant A. fumigatus.

EID Hagiwara D, Arai T, Takahashi H, Kusuya Y, Watanabe A, Kamei K. Non-cyp51A Azole-Resistant Aspergillus fumigatus Isolates with Mutation in HMG-CoA Reductase. Emerg Infect Dis. 2018;24(10):1889-1897. https://dx.doi.org/10.3201/eid2410.180730
AMA Hagiwara D, Arai T, Takahashi H, et al. Non-cyp51A Azole-Resistant Aspergillus fumigatus Isolates with Mutation in HMG-CoA Reductase. Emerging Infectious Diseases. 2018;24(10):1889-1897. doi:10.3201/eid2410.180730.
APA Hagiwara, D., Arai, T., Takahashi, H., Kusuya, Y., Watanabe, A., & Kamei, K. (2018). Non-cyp51A Azole-Resistant Aspergillus fumigatus Isolates with Mutation in HMG-CoA Reductase. Emerging Infectious Diseases, 24(10), 1889-1897. https://dx.doi.org/10.3201/eid2410.180730.
Dispatches

Multilocus Sequence Typing of Mycoplasma pneumoniae, Japan, 2002–2016 [PDF - 800 KB - 7 pages]
M. Ando et al.

In Japan, Mycoplasma pneumoniae resistance to macrolides is high. To compare sequence types (STs) of susceptible and resistant isolates, we performed multilocus sequence typing for 417 isolates obtained in Japan during 2002–2016. The most prevalent ST overall was ST3, for macrolide-resistant was ST19, and for macrolide-susceptible were ST14 and ST7.

EID Ando M, Morozumi M, Adachi Y, Ubukata K, Iwata S. Multilocus Sequence Typing of Mycoplasma pneumoniae, Japan, 2002–2016. Emerg Infect Dis. 2018;24(10):1895-1901. https://dx.doi.org/10.3201/eid2410.171194
AMA Ando M, Morozumi M, Adachi Y, et al. Multilocus Sequence Typing of Mycoplasma pneumoniae, Japan, 2002–2016. Emerging Infectious Diseases. 2018;24(10):1895-1901. doi:10.3201/eid2410.171194.
APA Ando, M., Morozumi, M., Adachi, Y., Ubukata, K., & Iwata, S. (2018). Multilocus Sequence Typing of Mycoplasma pneumoniae, Japan, 2002–2016. Emerging Infectious Diseases, 24(10), 1895-1901. https://dx.doi.org/10.3201/eid2410.171194.

Emerging Enteroviruses Causing Hand, Foot and Mouth Disease, China, 2010–2016 [PDF - 1.01 MB - 5 pages]
Y. Li et al.

Coxsackievirus A6 emerged as one of the predominant causative agents of hand, foot and mouth disease epidemics in many provinces of China in 2013 and 2015. This virus strain accounted for 25.9% of mild and 15.2% of severe cases in 2013 and 25.8% of mild and 16.9% of severe cases in 2015.

EID Li Y, Chang Z, Wu P, Liao Q, Liu F, Zheng Y, et al. Emerging Enteroviruses Causing Hand, Foot and Mouth Disease, China, 2010–2016. Emerg Infect Dis. 2018;24(10):1902-1906. https://dx.doi.org/10.3201/eid2410.171953
AMA Li Y, Chang Z, Wu P, et al. Emerging Enteroviruses Causing Hand, Foot and Mouth Disease, China, 2010–2016. Emerging Infectious Diseases. 2018;24(10):1902-1906. doi:10.3201/eid2410.171953.
APA Li, Y., Chang, Z., Wu, P., Liao, Q., Liu, F., Zheng, Y....Cowling, B. J. (2018). Emerging Enteroviruses Causing Hand, Foot and Mouth Disease, China, 2010–2016. Emerging Infectious Diseases, 24(10), 1902-1906. https://dx.doi.org/10.3201/eid2410.171953.

Cronobacter spp. in Common Breast Milk Substitutes, Bogotá, Colombia [PDF - 2.03 MB - 3 pages]
M. Morato-Rodríguez et al.

In Bogotá, Colombia, a large number of babies are fed with breast milk substitutes made from corn and plantain starch. We found 34.3% of tested samples to be contaminated with Cronobacter spp.; C. sakazakii was the most recovered species. Our findings underscore the risk for contamination of breast milk substitutes.

EID Morato-Rodríguez M, Velandia-Rodríguez D, Castañeda S, Crosby M, Vera H. Cronobacter spp. in Common Breast Milk Substitutes, Bogotá, Colombia. Emerg Infect Dis. 2018;24(10):1907-1909. https://dx.doi.org/10.3201/eid2410.172021
AMA Morato-Rodríguez M, Velandia-Rodríguez D, Castañeda S, et al. Cronobacter spp. in Common Breast Milk Substitutes, Bogotá, Colombia. Emerging Infectious Diseases. 2018;24(10):1907-1909. doi:10.3201/eid2410.172021.
APA Morato-Rodríguez, M., Velandia-Rodríguez, D., Castañeda, S., Crosby, M., & Vera, H. (2018). Cronobacter spp. in Common Breast Milk Substitutes, Bogotá, Colombia. Emerging Infectious Diseases, 24(10), 1907-1909. https://dx.doi.org/10.3201/eid2410.172021.

Effectiveness of Whole, Inactivated, Low Pathogenicity Influenza A(H7N9) Vaccine against Antigenically Distinct, Highly Pathogenic H7N9 Virus [PDF - 2.61 MB - 4 pages]
M. Hatta et al.

The recent emergence of highly pathogenic influenza A(H7N9) variants poses a great risk to humans. We show that ferrets vaccinated with low pathogenicity H7N9 virus vaccine do not develop severe symptoms after infection with an antigenically distinct, highly pathogenic H7N9 virus. These results demonstrate the protective benefits of this H7N9 vaccine.

EID Hatta M, Zhong G, Chiba S, Lopes T, Neumann G, Kawaoka Y. Effectiveness of Whole, Inactivated, Low Pathogenicity Influenza A(H7N9) Vaccine against Antigenically Distinct, Highly Pathogenic H7N9 Virus. Emerg Infect Dis. 2018;24(10):1910-1913. https://dx.doi.org/10.3201/eid2410.180403
AMA Hatta M, Zhong G, Chiba S, et al. Effectiveness of Whole, Inactivated, Low Pathogenicity Influenza A(H7N9) Vaccine against Antigenically Distinct, Highly Pathogenic H7N9 Virus. Emerging Infectious Diseases. 2018;24(10):1910-1913. doi:10.3201/eid2410.180403.
APA Hatta, M., Zhong, G., Chiba, S., Lopes, T., Neumann, G., & Kawaoka, Y. (2018). Effectiveness of Whole, Inactivated, Low Pathogenicity Influenza A(H7N9) Vaccine against Antigenically Distinct, Highly Pathogenic H7N9 Virus. Emerging Infectious Diseases, 24(10), 1910-1913. https://dx.doi.org/10.3201/eid2410.180403.

Two Community Clusters of Legionnaires’ Disease Directly Linked to a Biologic Wastewater Treatment Plant, the Netherlands [PDF - 1.70 MB - 5 pages]
A. D. Loenenbach et al.

A biologic wastewater treatment plant was identified as a common source for 2 consecutive Legionnaires’ disease clusters in the Netherlands in 2016 and 2017. Sequence typing and transmission modeling indicated direct and long-distance transmission of Legionella, indicating this source type should also be investigated in sporadic Legionnaires’ disease cases.

EID Loenenbach AD, Beulens C, Euser SM, van Leuken J, Bom B, van der Hoek W, et al. Two Community Clusters of Legionnaires’ Disease Directly Linked to a Biologic Wastewater Treatment Plant, the Netherlands. Emerg Infect Dis. 2018;24(10):1914-1918. https://dx.doi.org/10.3201/eid2410.180906
AMA Loenenbach AD, Beulens C, Euser SM, et al. Two Community Clusters of Legionnaires’ Disease Directly Linked to a Biologic Wastewater Treatment Plant, the Netherlands. Emerging Infectious Diseases. 2018;24(10):1914-1918. doi:10.3201/eid2410.180906.
APA Loenenbach, A. D., Beulens, C., Euser, S. M., van Leuken, J., Bom, B., van der Hoek, W....Brandsema, P. S. (2018). Two Community Clusters of Legionnaires’ Disease Directly Linked to a Biologic Wastewater Treatment Plant, the Netherlands. Emerging Infectious Diseases, 24(10), 1914-1918. https://dx.doi.org/10.3201/eid2410.180906.

Rapid Spread of Pneumococcal Nonvaccine Serotype 7C Previously Associated with Vaccine Serotype 19F, England and Wales [PDF - 790 KB - 4 pages]
A. Makwana et al.

We observed a sudden and rapid increase in rare invasive pneumococcal disease serotype 7C, from an annual average of 3 cases during 2000–01 through 2015–16 to 29 cases in 2016–17. The increase was caused almost entirely by clonal expansion of sequence type 177, previously associated with vaccine serotype 19F.

EID Makwana A, Ladhani SN, Kapatai G, Campion E, Fry NK, Sheppard C. Rapid Spread of Pneumococcal Nonvaccine Serotype 7C Previously Associated with Vaccine Serotype 19F, England and Wales. Emerg Infect Dis. 2018;24(10):1919-1922. https://dx.doi.org/10.3201/eid2410.180114
AMA Makwana A, Ladhani SN, Kapatai G, et al. Rapid Spread of Pneumococcal Nonvaccine Serotype 7C Previously Associated with Vaccine Serotype 19F, England and Wales. Emerging Infectious Diseases. 2018;24(10):1919-1922. doi:10.3201/eid2410.180114.
APA Makwana, A., Ladhani, S. N., Kapatai, G., Campion, E., Fry, N. K., & Sheppard, C. (2018). Rapid Spread of Pneumococcal Nonvaccine Serotype 7C Previously Associated with Vaccine Serotype 19F, England and Wales. Emerging Infectious Diseases, 24(10), 1919-1922. https://dx.doi.org/10.3201/eid2410.180114.

Acute Encephalitis with Atypical Presentation of Rubella in Family Cluster, India [PDF - 507 KB - 3 pages]
S. D. Bharadwaj et al.

We report 3 atypical rubella cases in a family cluster in India. The index case-patient showed only mild febrile illness, whereas the other 2 patients showed acute encephalitis and died of the disease. We confirmed rubella in the index and third cases using next-generation sequencing and IgM.

EID Bharadwaj SD, Sahay RR, Yadav PD, Dhanawade S, Basu A, Meena VK, et al. Acute Encephalitis with Atypical Presentation of Rubella in Family Cluster, India. Emerg Infect Dis. 2018;24(10):1923-1925. https://dx.doi.org/10.3201/eid2410.180053
AMA Bharadwaj SD, Sahay RR, Yadav PD, et al. Acute Encephalitis with Atypical Presentation of Rubella in Family Cluster, India. Emerging Infectious Diseases. 2018;24(10):1923-1925. doi:10.3201/eid2410.180053.
APA Bharadwaj, S. D., Sahay, R. R., Yadav, P. D., Dhanawade, S., Basu, A., Meena, V. K....Sapkal, G. N. (2018). Acute Encephalitis with Atypical Presentation of Rubella in Family Cluster, India. Emerging Infectious Diseases, 24(10), 1923-1925. https://dx.doi.org/10.3201/eid2410.180053.

Influenza C Virus in Cattle with Respiratory Disease, United States, 2016–2018 [PDF - 830 KB - 4 pages]
H. Zhang et al.

We identified influenza C virus (ICV) in samples from US cattle with bovine respiratory disease through real-time PCR testing and sequencing. Bovine ICV isolates had high nucleotide identities (≈98%) with each other and were closely related to human ICV strains (≈95%). Further research is needed to determine bovine ICV’s zoonotic potential.

EID Zhang H, Porter E, Lohman M, Lu N, Peddireddi L, Hanzlicek G, et al. Influenza C Virus in Cattle with Respiratory Disease, United States, 2016–2018. Emerg Infect Dis. 2018;24(10):1926-1929. https://dx.doi.org/10.3201/eid2410.180589
AMA Zhang H, Porter E, Lohman M, et al. Influenza C Virus in Cattle with Respiratory Disease, United States, 2016–2018. Emerging Infectious Diseases. 2018;24(10):1926-1929. doi:10.3201/eid2410.180589.
APA Zhang, H., Porter, E., Lohman, M., Lu, N., Peddireddi, L., Hanzlicek, G....Bai, J. (2018). Influenza C Virus in Cattle with Respiratory Disease, United States, 2016–2018. Emerging Infectious Diseases, 24(10), 1926-1929. https://dx.doi.org/10.3201/eid2410.180589.

Simple Estimates for Local Prevalence of Latent Tuberculosis Infection, United States, 2011–2015 [PDF - 1.58 MB - 4 pages]
M. B. Haddad et al.

We used tuberculosis genotyping results to derive estimates of prevalence of latent tuberculosis infection in the United States. We estimated <1% prevalence in 1,981 US counties, 1%–<3% in 785 counties, and >3% in 377 counties. This method for estimating prevalence could be applied in any jurisdiction with an established tuberculosis surveillance system.

EID Haddad MB, Raz KM, Lash TL, Hill AN, Kammerer J, Winston CA, et al. Simple Estimates for Local Prevalence of Latent Tuberculosis Infection, United States, 2011–2015. Emerg Infect Dis. 2018;24(10):1930-1933. https://dx.doi.org/10.3201/eid2410.180716
AMA Haddad MB, Raz KM, Lash TL, et al. Simple Estimates for Local Prevalence of Latent Tuberculosis Infection, United States, 2011–2015. Emerging Infectious Diseases. 2018;24(10):1930-1933. doi:10.3201/eid2410.180716.
APA Haddad, M. B., Raz, K. M., Lash, T. L., Hill, A. N., Kammerer, J., Winston, C. A....Navin, T. R. (2018). Simple Estimates for Local Prevalence of Latent Tuberculosis Infection, United States, 2011–2015. Emerging Infectious Diseases, 24(10), 1930-1933. https://dx.doi.org/10.3201/eid2410.180716.

Invasive Pneumococcal Disease in Refugee Children, Germany [PDF - 774 KB - 3 pages]
S. Perniciaro et al.

Refugee children in Germany are not routinely given a pneumococcal conjugate vaccine. Cases of invasive pneumococcal disease (IPD) in 21 refugee children were compared with those in 405 Germany-born children for 3 pneumococcal seasons. Refugee children had significantly higher odds of vaccine-type IPD and multidrug-resistant IPD than did Germany-born children.

EID Perniciaro S, Imöhl M, van der Linden M. Invasive Pneumococcal Disease in Refugee Children, Germany. Emerg Infect Dis. 2018;24(10):1934-1936. https://dx.doi.org/10.3201/eid2410.180253
AMA Perniciaro S, Imöhl M, van der Linden M. Invasive Pneumococcal Disease in Refugee Children, Germany. Emerging Infectious Diseases. 2018;24(10):1934-1936. doi:10.3201/eid2410.180253.
APA Perniciaro, S., Imöhl, M., & van der Linden, M. (2018). Invasive Pneumococcal Disease in Refugee Children, Germany. Emerging Infectious Diseases, 24(10), 1934-1936. https://dx.doi.org/10.3201/eid2410.180253.

Mycobacterium caprae Infection in Captive Borneo Elephant, Japan [PDF - 1.69 MB - 4 pages]
S. Yoshida et al.

In 2016, disseminated tuberculosis caused by Mycobacterium caprae was diagnosed in a captive Borneo elephant in Japan. The bacterium was initially identified from clinical isolates. An isolate collected during a relapse showed isoniazid monoresistance and a codon 315 katG mutation.

EID Yoshida S, Suga S, Ishikawa S, Mukai Y, Tsuyuguchi K, Inoue Y, et al. Mycobacterium caprae Infection in Captive Borneo Elephant, Japan. Emerg Infect Dis. 2018;24(10):1937-1940. https://dx.doi.org/10.3201/eid2410.180018
AMA Yoshida S, Suga S, Ishikawa S, et al. Mycobacterium caprae Infection in Captive Borneo Elephant, Japan. Emerging Infectious Diseases. 2018;24(10):1937-1940. doi:10.3201/eid2410.180018.
APA Yoshida, S., Suga, S., Ishikawa, S., Mukai, Y., Tsuyuguchi, K., Inoue, Y....Wada, T. (2018). Mycobacterium caprae Infection in Captive Borneo Elephant, Japan. Emerging Infectious Diseases, 24(10), 1937-1940. https://dx.doi.org/10.3201/eid2410.180018.
Research Letters

Genetic Diversity and Antimicrobial Drug Resistance of Serotype VI Group B Streptococcus, Canada [PDF - 318 KB - 2 pages]
A. Neemuchwala et al.

Two genetically dissimilar sequence type 1 clades dominate the serotype VI group B Streptococcus population of strains causing invasive disease in Canada. Isolates of this rare serotype, recovered mainly from adult patients, were all susceptible to penicillin and vancomycin. However, we observed resistance to erythromycin and clindamycin.

EID Neemuchwala A, Teatero S, Liang L, Martin I, Demzcuk W, McGeer A, et al. Genetic Diversity and Antimicrobial Drug Resistance of Serotype VI Group B Streptococcus, Canada. Emerg Infect Dis. 2018;24(10):1941-1942. https://dx.doi.org/10.3201/eid2410.171711
AMA Neemuchwala A, Teatero S, Liang L, et al. Genetic Diversity and Antimicrobial Drug Resistance of Serotype VI Group B Streptococcus, Canada. Emerging Infectious Diseases. 2018;24(10):1941-1942. doi:10.3201/eid2410.171711.
APA Neemuchwala, A., Teatero, S., Liang, L., Martin, I., Demzcuk, W., McGeer, A....Fittipaldi, N. (2018). Genetic Diversity and Antimicrobial Drug Resistance of Serotype VI Group B Streptococcus, Canada. Emerging Infectious Diseases, 24(10), 1941-1942. https://dx.doi.org/10.3201/eid2410.171711.

Psychrobacter sanguinis Wound Infection Associated with Marine Environment Exposure, Washington, USA [PDF - 373 KB - 3 pages]
J. Bonwitt et al.

We report a 26-year-old man with Psychrobacter sanguinis cellulitis of a wound sustained during ocean fishing in Washington, USA, in 2017. Psychrobacter spp. are opportunistic pathogens found in a wide range of environments. Clinicians should be aware of Psychrobacter spp. and perform 16S rRNA sequencing if this pathogen is suspected.

EID Bonwitt J, Tran M, Droz A, Gonzalez A, Glover WA. Psychrobacter sanguinis Wound Infection Associated with Marine Environment Exposure, Washington, USA. Emerg Infect Dis. 2018;24(10):1942-1944. https://dx.doi.org/10.3201/eid2410.171821
AMA Bonwitt J, Tran M, Droz A, et al. Psychrobacter sanguinis Wound Infection Associated with Marine Environment Exposure, Washington, USA. Emerging Infectious Diseases. 2018;24(10):1942-1944. doi:10.3201/eid2410.171821.
APA Bonwitt, J., Tran, M., Droz, A., Gonzalez, A., & Glover, W. A. (2018). Psychrobacter sanguinis Wound Infection Associated with Marine Environment Exposure, Washington, USA. Emerging Infectious Diseases, 24(10), 1942-1944. https://dx.doi.org/10.3201/eid2410.171821.

Diagnosis of Haemophilus influenzae Pneumonia by Nanopore 16S Amplicon Sequencing of Sputum [PDF - 681 KB - 3 pages]
J. Moon et al.

We used deep sequencing of the 16S rRNA gene from sputum to identify Haemophilus influenza in a patient with community-acquired pneumonia. This method may be more effective than conventional diagnostic tests in pneumonia patients because of its speed and sensitivity.

EID Moon J, Jang Y, Kim N, Park W, Park K, Lee S, et al. Diagnosis of Haemophilus influenzae Pneumonia by Nanopore 16S Amplicon Sequencing of Sputum. Emerg Infect Dis. 2018;24(10):1944-1946. https://dx.doi.org/10.3201/eid2410.180234
AMA Moon J, Jang Y, Kim N, et al. Diagnosis of Haemophilus influenzae Pneumonia by Nanopore 16S Amplicon Sequencing of Sputum. Emerging Infectious Diseases. 2018;24(10):1944-1946. doi:10.3201/eid2410.180234.
APA Moon, J., Jang, Y., Kim, N., Park, W., Park, K., Lee, S....Chu, K. (2018). Diagnosis of Haemophilus influenzae Pneumonia by Nanopore 16S Amplicon Sequencing of Sputum. Emerging Infectious Diseases, 24(10), 1944-1946. https://dx.doi.org/10.3201/eid2410.180234.

Revisiting Influenza Vaccination Exemption [PDF - 345 KB - 2 pages]
M. Ryan et al.

Serious adverse events after immunizations are rare. We review the case of a man who, 50 years earlier, experienced a serious adverse neurologic event 2 weeks after receiving influenza vaccine. He had received no subsequent seasonal influenza vaccinations, but after the risks and benefits were considered, he was vaccinated without adverse event that season.

EID Ryan M, Duran L, Lee R, Wu S. Revisiting Influenza Vaccination Exemption. Emerg Infect Dis. 2018;24(10):1947-1948. https://dx.doi.org/10.3201/eid2410.180304
AMA Ryan M, Duran L, Lee R, et al. Revisiting Influenza Vaccination Exemption. Emerging Infectious Diseases. 2018;24(10):1947-1948. doi:10.3201/eid2410.180304.
APA Ryan, M., Duran, L., Lee, R., & Wu, S. (2018). Revisiting Influenza Vaccination Exemption. Emerging Infectious Diseases, 24(10), 1947-1948. https://dx.doi.org/10.3201/eid2410.180304.

Fatal Cronobacter sakazakii Sequence Type 494 Meningitis in a Newborn, Brazil [PDF - 479 KB - 3 pages]
C. Chaves et al.

We describe a case of infection with Cronobacter sakazakii sequence type 494 causing bacteremia and meningitis in a hospitalized late premature infant in Brazil. We conducted microbiological analyses on samples of powdered infant formula from the same batch as formula ingested by the infant but could not identify the source of contamination.

EID Chaves C, Brandão M, Lacerda M, Rocha C, Leone de Oliveira S, Parpinelli T, et al. Fatal Cronobacter sakazakii Sequence Type 494 Meningitis in a Newborn, Brazil. Emerg Infect Dis. 2018;24(10):1948-1950. https://dx.doi.org/10.3201/eid2410.180373
AMA Chaves C, Brandão M, Lacerda M, et al. Fatal Cronobacter sakazakii Sequence Type 494 Meningitis in a Newborn, Brazil. Emerging Infectious Diseases. 2018;24(10):1948-1950. doi:10.3201/eid2410.180373.
APA Chaves, C., Brandão, M., Lacerda, M., Rocha, C., Leone de Oliveira, S., Parpinelli, T....Paniago, A. (2018). Fatal Cronobacter sakazakii Sequence Type 494 Meningitis in a Newborn, Brazil. Emerging Infectious Diseases, 24(10), 1948-1950. https://dx.doi.org/10.3201/eid2410.180373.

Introduction of Eurasian-Origin Influenza A(H8N4) Virus into North America by Migratory Birds [PDF - 585 KB - 4 pages]
A. M. Ramey et al.

We identified a Eurasian-origin influenza A(H8N4) virus in North America by sampling wild birds in western Alaska, USA. Evidence for repeated introductions of influenza A viruses into North America by migratory birds suggests that intercontinental dispersal might not be exceedingly rare and that our understanding of viral establishment is incomplete.

EID Ramey AM, Reeves AB, Donnelly T, Poulson RL, Stallknecht DE. Introduction of Eurasian-Origin Influenza A(H8N4) Virus into North America by Migratory Birds. Emerg Infect Dis. 2018;24(10):1950-1953. https://dx.doi.org/10.3201/eid2410.180447
AMA Ramey AM, Reeves AB, Donnelly T, et al. Introduction of Eurasian-Origin Influenza A(H8N4) Virus into North America by Migratory Birds. Emerging Infectious Diseases. 2018;24(10):1950-1953. doi:10.3201/eid2410.180447.
APA Ramey, A. M., Reeves, A. B., Donnelly, T., Poulson, R. L., & Stallknecht, D. E. (2018). Introduction of Eurasian-Origin Influenza A(H8N4) Virus into North America by Migratory Birds. Emerging Infectious Diseases, 24(10), 1950-1953. https://dx.doi.org/10.3201/eid2410.180447.

New Reassortant Clade 2.3.4.4b Avian Influenza A(H5N6) Virus in Wild Birds, South Korea, 2017–18 [PDF - 675 KB - 3 pages]
J. Kwon et al.

We isolated new reassortant avian influenza A(H5N6) viruses from feces of wild waterfowl in South Korea during 2017–18. Phylogenetic analysis suggested that reassortment occurred between clade 2.3.4.4b H5N8 and Eurasian low pathogenicity avian influenza viruses circulating in wild birds. Dissemination to South Korea during the 2017 fall migratory season followed.

EID Kwon J, Jeong S, Lee D, Swayne DE, Kim Y, Lee S, et al. New Reassortant Clade 2.3.4.4b Avian Influenza A(H5N6) Virus in Wild Birds, South Korea, 2017–18. Emerg Infect Dis. 2018;24(10):1953-1955. https://dx.doi.org/10.3201/eid2410.180461
AMA Kwon J, Jeong S, Lee D, et al. New Reassortant Clade 2.3.4.4b Avian Influenza A(H5N6) Virus in Wild Birds, South Korea, 2017–18. Emerging Infectious Diseases. 2018;24(10):1953-1955. doi:10.3201/eid2410.180461.
APA Kwon, J., Jeong, S., Lee, D., Swayne, D. E., Kim, Y., Lee, S....Song, C. (2018). New Reassortant Clade 2.3.4.4b Avian Influenza A(H5N6) Virus in Wild Birds, South Korea, 2017–18. Emerging Infectious Diseases, 24(10), 1953-1955. https://dx.doi.org/10.3201/eid2410.180461.

Clinical Isolation and Identification of Haematospirillum jordaniae [PDF - 328 KB - 2 pages]
G. Hovan and A. Hollinger

A clinical case study involving a man (35–49 years of age) with wounds to his lower right extremity. An isolate was sent to the Delaware Public Health Laboratory for confirmatory testing by genetic analysis of the 16S gene. Testing identified the isolate as a novel genus and species, Haematospirillum jordaniae.

EID Hovan G, Hollinger A. Clinical Isolation and Identification of Haematospirillum jordaniae. Emerg Infect Dis. 2018;24(10):1955-1956. https://dx.doi.org/10.3201/eid2410.180548
AMA Hovan G, Hollinger A. Clinical Isolation and Identification of Haematospirillum jordaniae. Emerging Infectious Diseases. 2018;24(10):1955-1956. doi:10.3201/eid2410.180548.
APA Hovan, G., & Hollinger, A. (2018). Clinical Isolation and Identification of Haematospirillum jordaniae. Emerging Infectious Diseases, 24(10), 1955-1956. https://dx.doi.org/10.3201/eid2410.180548.

Molecular Typing and Antifungal Susceptibility of Candida viswanathii, India [PDF - 359 KB - 3 pages]
S. A. Shankarnarayan et al.

We report invasive candidiasis caused by Candida viswanathii over 2 time periods during 2013–2015 in a tertiary care hospital in Chandigarh, India. Molecular typing revealed multiple clusters of the isolates. We detected high MICs for fluconazole in the second time period.

EID Shankarnarayan SA, Rudramurthy SM, Chakrabarti A, Shaw D, Paul S, Sethuraman N, et al. Molecular Typing and Antifungal Susceptibility of Candida viswanathii, India. Emerg Infect Dis. 2018;24(10):1956-1958. https://dx.doi.org/10.3201/eid2410.180801
AMA Shankarnarayan SA, Rudramurthy SM, Chakrabarti A, et al. Molecular Typing and Antifungal Susceptibility of Candida viswanathii, India. Emerging Infectious Diseases. 2018;24(10):1956-1958. doi:10.3201/eid2410.180801.
APA Shankarnarayan, S. A., Rudramurthy, S. M., Chakrabarti, A., Shaw, D., Paul, S., Sethuraman, N....Ghosh, A. K. (2018). Molecular Typing and Antifungal Susceptibility of Candida viswanathii, India. Emerging Infectious Diseases, 24(10), 1956-1958. https://dx.doi.org/10.3201/eid2410.180801.

Community-Acquired Staphylococcus argenteus Sequence Type 2250 Bone and Joint Infection, France, 2017 [PDF - 426 KB - 4 pages]
J. Rigaill et al.

We report a rare case of Staphylococcus argenteus bone and joint infection in a 9-year-old boy in France. His finger arthritis was complicated by osteitis 5 weeks later, which resulted in a secondary intervention. This case indicates the virulence of S. argenteus, an emerging pathogen whose clinical effects are poorly described.

EID Rigaill J, Grattard F, Grange S, Forest F, Haddad E, Carricajo A, et al. Community-Acquired Staphylococcus argenteus Sequence Type 2250 Bone and Joint Infection, France, 2017. Emerg Infect Dis. 2018;24(10):1958-1961. https://dx.doi.org/10.3201/eid2410.180727
AMA Rigaill J, Grattard F, Grange S, et al. Community-Acquired Staphylococcus argenteus Sequence Type 2250 Bone and Joint Infection, France, 2017. Emerging Infectious Diseases. 2018;24(10):1958-1961. doi:10.3201/eid2410.180727.
APA Rigaill, J., Grattard, F., Grange, S., Forest, F., Haddad, E., Carricajo, A....Verhoeven, P. O. (2018). Community-Acquired Staphylococcus argenteus Sequence Type 2250 Bone and Joint Infection, France, 2017. Emerging Infectious Diseases, 24(10), 1958-1961. https://dx.doi.org/10.3201/eid2410.180727.

Circulation of Influenza A(H5N8) Virus, Saudi Arabia [PDF - 843 KB - 4 pages]
H. Al-Ghadeer et al.

Highly pathogenic avian influenza A(H5N8) viruses have been detected in several continents. However, limited viral sequence data are available from countries in the Middle East. We report full-genome analyses of highly pathogenic H5N8 viruses recently detected in different provinces in Saudi Arabia.

EID Al-Ghadeer H, Chu D, Rihan E, Abd-Allah EM, Gu H, Chin A, et al. Circulation of Influenza A(H5N8) Virus, Saudi Arabia. Emerg Infect Dis. 2018;24(10):1961-1964. https://dx.doi.org/10.3201/eid2410.180846
AMA Al-Ghadeer H, Chu D, Rihan E, et al. Circulation of Influenza A(H5N8) Virus, Saudi Arabia. Emerging Infectious Diseases. 2018;24(10):1961-1964. doi:10.3201/eid2410.180846.
APA Al-Ghadeer, H., Chu, D., Rihan, E., Abd-Allah, E. M., Gu, H., Chin, A....Poon, L. (2018). Circulation of Influenza A(H5N8) Virus, Saudi Arabia. Emerging Infectious Diseases, 24(10), 1961-1964. https://dx.doi.org/10.3201/eid2410.180846.

Severe Respiratory Illness Outbreak Associated with Human Coronavirus NL63 in a Long-Term Care Facility [PDF - 336 KB - 3 pages]
J. Hand et al.

We describe an outbreak of severe respiratory illness associated with human coronavirus NL63 in a long-term care facility in Louisiana in November 2017. Six of 20 case-patients were hospitalized with pneumonia, and 3 of 20 died. Clinicians should consider human coronavirus NL63 for patients in similar settings with respiratory disease.

EID Hand J, Rose E, Salinas A, Lu X, Sakthivel SK, Schneider E, et al. Severe Respiratory Illness Outbreak Associated with Human Coronavirus NL63 in a Long-Term Care Facility. Emerg Infect Dis. 2018;24(10):1964-1966. https://dx.doi.org/10.3201/eid2410.180862
AMA Hand J, Rose E, Salinas A, et al. Severe Respiratory Illness Outbreak Associated with Human Coronavirus NL63 in a Long-Term Care Facility. Emerging Infectious Diseases. 2018;24(10):1964-1966. doi:10.3201/eid2410.180862.
APA Hand, J., Rose, E., Salinas, A., Lu, X., Sakthivel, S. K., Schneider, E....Watson, J. T. (2018). Severe Respiratory Illness Outbreak Associated with Human Coronavirus NL63 in a Long-Term Care Facility. Emerging Infectious Diseases, 24(10), 1964-1966. https://dx.doi.org/10.3201/eid2410.180862.
Letters

External Quality Assessment for Zika Virus Molecular Diagnostic Testing, Brazil [PDF - 290 KB - 1 page]
S. A. Baylis and J. Blümel
EID Baylis SA, Blümel J. External Quality Assessment for Zika Virus Molecular Diagnostic Testing, Brazil. Emerg Infect Dis. 2018;24(10):1966. https://dx.doi.org/10.3201/eid2410.180360
AMA Baylis SA, Blümel J. External Quality Assessment for Zika Virus Molecular Diagnostic Testing, Brazil. Emerging Infectious Diseases. 2018;24(10):1966. doi:10.3201/eid2410.180360.
APA Baylis, S. A., & Blümel, J. (2018). External Quality Assessment for Zika Virus Molecular Diagnostic Testing, Brazil. Emerging Infectious Diseases, 24(10), 1966. https://dx.doi.org/10.3201/eid2410.180360.
Books and Media

The Fears of the Rich, the Needs of the Poor: My Years at the CDC [PDF - 494 KB - 1 page]
L. Robinson and C. Vinoya-Chung
EID Robinson L, Vinoya-Chung C. The Fears of the Rich, the Needs of the Poor: My Years at the CDC. Emerg Infect Dis. 2018;24(10):1967. https://dx.doi.org/10.3201/eid2410.180687
AMA Robinson L, Vinoya-Chung C. The Fears of the Rich, the Needs of the Poor: My Years at the CDC. Emerging Infectious Diseases. 2018;24(10):1967. doi:10.3201/eid2410.180687.
APA Robinson, L., & Vinoya-Chung, C. (2018). The Fears of the Rich, the Needs of the Poor: My Years at the CDC. Emerging Infectious Diseases, 24(10), 1967. https://dx.doi.org/10.3201/eid2410.180687.
About the Cover

Concurrent Conflicts—the Great War and the 1918 Influenza Pandemic [PDF - 1.60 MB - 2 pages]
T. Chorba and B. Breedlove
EID Chorba T, Breedlove B. Concurrent Conflicts—the Great War and the 1918 Influenza Pandemic. Emerg Infect Dis. 2018;24(10):1968-1969. https://dx.doi.org/10.3201/eid2410.ac2410
AMA Chorba T, Breedlove B. Concurrent Conflicts—the Great War and the 1918 Influenza Pandemic. Emerging Infectious Diseases. 2018;24(10):1968-1969. doi:10.3201/eid2410.ac2410.
APA Chorba, T., & Breedlove, B. (2018). Concurrent Conflicts—the Great War and the 1918 Influenza Pandemic. Emerging Infectious Diseases, 24(10), 1968-1969. https://dx.doi.org/10.3201/eid2410.ac2410.
Etymologia

Etymologia: Hemagglutinin and Neuraminidase [PDF - 632 KB - 1 page]
R. Henry and F. A. Murphy
EID Henry R, Murphy FA. Etymologia: Hemagglutinin and Neuraminidase. Emerg Infect Dis. 2018;24(10):1849. https://dx.doi.org/10.3201/eid2410.et2410
AMA Henry R, Murphy FA. Etymologia: Hemagglutinin and Neuraminidase. Emerging Infectious Diseases. 2018;24(10):1849. doi:10.3201/eid2410.et2410.
APA Henry, R., & Murphy, F. A. (2018). Etymologia: Hemagglutinin and Neuraminidase. Emerging Infectious Diseases, 24(10), 1849. https://dx.doi.org/10.3201/eid2410.et2410.
Online Reports

Protective Measures for Humans against Avian Influenza A(H5N8) Outbreaks in 22 European Union/European Economic Area Countries and Israel, 2016–17 [PDF - 1.40 MB - 8 pages]
C. Adlhoch et al.

We sought to better understand national approaches for managing potential human health risks during outbreaks of infection with avian influenza A(H5N8) virus during 2016–17. Twenty-three countries in the Union/European Economic Area and Israel participated in this study. Risk to the general public was assessed as low in 18 countries and medium in 1 country. Of 524 exposed persons identified, 274 were passively monitored and 250 were actively monitored. Of 29 persons tested, all were negative for H5N8 virus. Vaccination and antiviral drug recommendations varied across countries. A high level of personal protection was recommended although a low risk was assessed. No transmission of this virus to humans was identified.

EID Adlhoch C, Dabrera G, Penttinen P, Pebody R. Protective Measures for Humans against Avian Influenza A(H5N8) Outbreaks in 22 European Union/European Economic Area Countries and Israel, 2016–17. Emerg Infect Dis. 2018;24(10):1-8. https://dx.doi.org/10.3201/eid2410.180269
AMA Adlhoch C, Dabrera G, Penttinen P, et al. Protective Measures for Humans against Avian Influenza A(H5N8) Outbreaks in 22 European Union/European Economic Area Countries and Israel, 2016–17. Emerging Infectious Diseases. 2018;24(10):1-8. doi:10.3201/eid2410.180269.
APA Adlhoch, C., Dabrera, G., Penttinen, P., & Pebody, R. (2018). Protective Measures for Humans against Avian Influenza A(H5N8) Outbreaks in 22 European Union/European Economic Area Countries and Israel, 2016–17. Emerging Infectious Diseases, 24(10), 1-8. https://dx.doi.org/10.3201/eid2410.180269.
Conference Summaries

VisiEAU 2018—A Vision for Water in Haiti, 2018
J. M. Widmer et al.
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Page updated: September 18, 2018
Page reviewed: September 18, 2018
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