Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Issue Cover for Volume 24, Number 4—April 2018

Volume 24, Number 4—April 2018

[PDF - 8.90 MB - 212 pages]

Synopses

Seroprevalence of Chikungunya Virus after Its Emergence in Brazil [PDF - 2.54 MB - 8 pages]
J. P. Dias et al.

Chikungunya has had a substantial impact on public health because of the magnitude of its epidemics and its highly debilitating symptoms. We estimated the seroprevalence, proportion of symptomatic cases, and proportion of chronic form of disease after introduction of chikungunya virus (CHIKV) in 2 cities in Brazil. We conducted the population-based study through household interviews and serologic surveys during October–December 2015. In Feira de Santana, we conducted a serologic survey of 385 persons; 57.1% were CHIKV-positive. Among them, 32.7% reported symptoms, and 68.1% contracted chronic chikungunya disease. A similar survey in Riachão do Jacuípe included 446 persons; 45.7% were CHIKV-positive, 41.2% reported symptoms, and 75.0% contracted the chronic form. Our data confirm intense CHIKV transmission during the continuing epidemic. Chronic pain developed in a high proportion of patients. We recommend training health professionals in management of chronic pain, which will improve the quality of life of chikungunya-affected persons.

EID Dias JP, Costa MN, Campos G, Paixão ES, Natividade MS, Barreto FR, et al. Seroprevalence of Chikungunya Virus after Its Emergence in Brazil. Emerg Infect Dis. 2018;24(4):617-624. https://dx.doi.org/10.3201/eid2404.171370
AMA Dias JP, Costa MN, Campos G, et al. Seroprevalence of Chikungunya Virus after Its Emergence in Brazil. Emerging Infectious Diseases. 2018;24(4):617-624. doi:10.3201/eid2404.171370.
APA Dias, J. P., Costa, M. N., Campos, G., Paixão, E. S., Natividade, M. S., Barreto, F. R....Teixeira, M. (2018). Seroprevalence of Chikungunya Virus after Its Emergence in Brazil. Emerging Infectious Diseases, 24(4), 617-624. https://dx.doi.org/10.3201/eid2404.171370.

Two Infants with Presumed Congenital Zika Syndrome, Brownsville, Texas, USA, 2016–2017 [PDF - 2.28 MB - 6 pages]
A. Howard et al.

Since 2007, Zika virus has spread through the Pacific Islands and the Americas. Beginning in 2016, women in Brownsville, Texas, USA, were identified as possibly being exposed to Zika virus during pregnancy. We identified 18 pregnant women during 2016–2017 who had supportive serologic or molecular test results indicating Zika virus or flavivirus infection. Two infants were evaluated for congenital Zika syndrome after identification of prenatal microcephaly. Despite standard of care testing of mothers and neonates, comparative results were unreliable for mothers and infants, which highlights the need for clinical and epidemiologic evidence for an accurate diagnosis. A high index of suspicion for congenital Zika syndrome for at-risk populations is useful because of current limitations of testing.

EID Howard A, Visintine J, Fergie J, Deleon M. Two Infants with Presumed Congenital Zika Syndrome, Brownsville, Texas, USA, 2016–2017. Emerg Infect Dis. 2018;24(4):625-630. https://dx.doi.org/10.3201/eid2404.171545
AMA Howard A, Visintine J, Fergie J, et al. Two Infants with Presumed Congenital Zika Syndrome, Brownsville, Texas, USA, 2016–2017. Emerging Infectious Diseases. 2018;24(4):625-630. doi:10.3201/eid2404.171545.
APA Howard, A., Visintine, J., Fergie, J., & Deleon, M. (2018). Two Infants with Presumed Congenital Zika Syndrome, Brownsville, Texas, USA, 2016–2017. Emerging Infectious Diseases, 24(4), 625-630. https://dx.doi.org/10.3201/eid2404.171545.

Medscape CME Activity
Reemergence of Intravenous Drug Use as Risk Factor for Candidemia, Massachusetts, USA [PDF - 1.37 MB - 7 pages]
N. Poowanawittayakom et al.

The epidemic of illicit intravenous drug use (IVDU) in the United States has been accompanied by a surge in drug overdose deaths and infectious sequelae. Candida albicans infections were associated with injection of contaminated impure brown heroin in the 1970s–1990s; however, candidiasis accompanying IVDU became considerably rarer as the purity of the heroin supply increased. We reviewed cases of candidemia occurring over a recent 7-year period in persons >14 years of age at a tertiary care hospital in central Massachusetts. Of the 198 patients with candidemia, 24 cases occurred in patients with a history of IVDU. Compared with non-IVDU patients, those with a history of IVDU were more likely to have non-albicans Candida, be co-infected with hepatitis C, and have end-organ involvement, including endocarditis and osteomyelitis. Thus, IVDU appears to be reemerging as a risk factor for invasive candidiasis.

EID Poowanawittayakom N, Dutta A, Stock S, Touray S, Ellison RT, Levitz SM. Reemergence of Intravenous Drug Use as Risk Factor for Candidemia, Massachusetts, USA. Emerg Infect Dis. 2018;24(4):631-637. https://dx.doi.org/10.3201/eid2404.171807
AMA Poowanawittayakom N, Dutta A, Stock S, et al. Reemergence of Intravenous Drug Use as Risk Factor for Candidemia, Massachusetts, USA. Emerging Infectious Diseases. 2018;24(4):631-637. doi:10.3201/eid2404.171807.
APA Poowanawittayakom, N., Dutta, A., Stock, S., Touray, S., Ellison, R. T., & Levitz, S. M. (2018). Reemergence of Intravenous Drug Use as Risk Factor for Candidemia, Massachusetts, USA. Emerging Infectious Diseases, 24(4), 631-637. https://dx.doi.org/10.3201/eid2404.171807.
Research

Medscape CME Activity
Rickettsial Illnesses as Important Causes of Febrile Illness in Chittagong, Bangladesh [PDF - 1.98 MB - 8 pages]
H. W. Kingston et al.

We conducted a yearlong prospective study of febrile patients admitted to a tertiary referral hospital in Chittagong, Bangladesh, to assess the proportion of patients with rickettsial illnesses and identify the causative pathogens, strain genotypes, and associated seasonality patterns. We diagnosed scrub typhus in 16.8% (70/416) and murine typhus in 5.8% (24/416) of patients; 2 patients had infections attributable to undifferentiated Rickettsia spp. and 2 had DNA sequence–confirmed R. felis infection. Orientia tsutsugamushi genotypes included Karp, Gilliam, Kato, and TA763-like strains, with a prominence of Karp-like strains. Scrub typhus admissions peaked in a biphasic pattern before and after the rainy season, whereas murine typhus more frequently occurred before the rainy season. Death occurred in 4% (18/416) of cases; case-fatality rates were 4% each for scrub typhus (3/70) and murine typhus (1/28). Overall, 23.1% (96/416) of patients had evidence of treatable rickettsial illnesses, providing important evidence toward optimizing empirical treatment strategies.

EID Kingston HW, Hossain M, Leopold S, Anantatat T, Tanganuchitcharnchai A, Sinha I, et al. Rickettsial Illnesses as Important Causes of Febrile Illness in Chittagong, Bangladesh. Emerg Infect Dis. 2018;24(4):638-645. https://dx.doi.org/10.3201/eid2404.170190
AMA Kingston HW, Hossain M, Leopold S, et al. Rickettsial Illnesses as Important Causes of Febrile Illness in Chittagong, Bangladesh. Emerging Infectious Diseases. 2018;24(4):638-645. doi:10.3201/eid2404.170190.
APA Kingston, H. W., Hossain, M., Leopold, S., Anantatat, T., Tanganuchitcharnchai, A., Sinha, I....Paris, D. H. (2018). Rickettsial Illnesses as Important Causes of Febrile Illness in Chittagong, Bangladesh. Emerging Infectious Diseases, 24(4), 638-645. https://dx.doi.org/10.3201/eid2404.170190.

Influence of Population Immunosuppression and Past Vaccination on Smallpox Reemergence [PDF - 3.01 MB - 8 pages]
C. MacIntyre et al.

We built a SEIR (susceptible, exposed, infected, recovered) model of smallpox transmission for New York, New York, USA, and Sydney, New South Wales, Australia, that accounted for age-specific population immunosuppression and residual vaccine immunity and conducted sensitivity analyses to estimate the effect these parameters might have on smallpox reemergence. At least 19% of New York’s and 17% of Sydney’s population are immunosuppressed. The highest smallpox infection rates were in persons 0–19 years of age, but the highest death rates were in those >45 years of age. Because of the low level of residual vaccine immunity, immunosuppression was more influential than vaccination on death and infection rates in our model. Despite widespread smallpox vaccination until 1980 in New York, smallpox outbreak severity appeared worse in New York than in Sydney. Immunosuppression is highly prevalent and should be considered in future smallpox outbreak models because excluding this factor probably underestimates death and infection rates.

EID MacIntyre C, Costantino V, Chen X, Segelov E, Chughtai A, Kelleher A, et al. Influence of Population Immunosuppression and Past Vaccination on Smallpox Reemergence. Emerg Infect Dis. 2018;24(4):646-653. https://dx.doi.org/10.3201/eid2404.171233
AMA MacIntyre C, Costantino V, Chen X, et al. Influence of Population Immunosuppression and Past Vaccination on Smallpox Reemergence. Emerging Infectious Diseases. 2018;24(4):646-653. doi:10.3201/eid2404.171233.
APA MacIntyre, C., Costantino, V., Chen, X., Segelov, E., Chughtai, A., Kelleher, A....Lane, J. (2018). Influence of Population Immunosuppression and Past Vaccination on Smallpox Reemergence. Emerging Infectious Diseases, 24(4), 646-653. https://dx.doi.org/10.3201/eid2404.171233.

Emerging Coxsackievirus A6 Causing Hand, Foot and Mouth Disease, Vietnam [PDF - 2.67 MB - 9 pages]
N. Anh et al.

Hand, foot and mouth disease (HFMD) is a major public health issue in Asia and has global pandemic potential. Coxsackievirus A6 (CV-A6) was detected in 514/2,230 (23%) of HFMD patients admitted to 3 major hospitals in southern Vietnam during 2011–2015. Of these patients, 93 (18%) had severe HFMD. Phylogenetic analysis of 98 genome sequences revealed they belonged to cluster A and had been circulating in Vietnam for 2 years before emergence. CV-A6 movement among localities within Vietnam occurred frequently, whereas viral movement across international borders appeared rare. Skyline plots identified fluctuations in the relative genetic diversity of CV-A6 corresponding to large CV-A6–associated HFMD outbreaks worldwide. These data show that CV-A6 is an emerging pathogen and emphasize the necessity of active surveillance and understanding the mechanisms that shape the pathogen evolution and emergence, which is essential for development and implementation of intervention strategies.

EID Anh N, Nhu L, Van H, Hong N, Thanh T, Hang V, et al. Emerging Coxsackievirus A6 Causing Hand, Foot and Mouth Disease, Vietnam. Emerg Infect Dis. 2018;24(4):654-662. https://dx.doi.org/10.3201/eid2404.171298
AMA Anh N, Nhu L, Van H, et al. Emerging Coxsackievirus A6 Causing Hand, Foot and Mouth Disease, Vietnam. Emerging Infectious Diseases. 2018;24(4):654-662. doi:10.3201/eid2404.171298.
APA Anh, N., Nhu, L., Van, H., Hong, N., Thanh, T., Hang, V....Van Tan, L. (2018). Emerging Coxsackievirus A6 Causing Hand, Foot and Mouth Disease, Vietnam. Emerging Infectious Diseases, 24(4), 654-662. https://dx.doi.org/10.3201/eid2404.171298.

Genomic Surveillance of 4CMenB Vaccine Antigenic Variants among Disease-Causing Neisseria meningitidis Isolates, United Kingdom, 2010–2016 [PDF - 2.43 MB - 10 pages]
C. Rodrigues et al.

In September 2015, 4CMenB meningococcal vaccine was introduced into the United Kingdom infant immunization program without phase 3 trial information. Understanding the effect of this program requires enhanced surveillance of invasive meningococcal disease (IMD) Neisseria meningitidis isolates and comparison with prevaccination isolates. Bexsero Antigen Sequence Types (BASTs) were used to analyze whole-genome sequences of 3,073 prevaccine IMD N. meningitidis isolates obtained during 2010−2016. Isolates exhibited 803 BASTs among 31 clonal complexes. Frequencies of antigen peptide variants were factor H binding protein 1, 13.4%; Neisserial heparin-binding antigen 2, 13.8%; Neisseria adhesin A 8, 0.8%; and Porin A-VR2:P1.4,10.9%. In 2015−16, serogroup B isolates showed the highest proportion (35.7%) of exact matches to >1 Bexsero components. Serogroup W isolates showed the highest proportion (93.9%) of putatively cross-reactive variants of Bexsero antigens. Results highlighted the likely role of cross-reactive antigens. BAST surveillance of meningococcal whole-genome sequence data is rapid, scalable, and portable and enables international comparisons of isolates.

EID Rodrigues C, Lucidarme J, Borrow R, Smith A, Cameron J, Moxon E, et al. Genomic Surveillance of 4CMenB Vaccine Antigenic Variants among Disease-Causing Neisseria meningitidis Isolates, United Kingdom, 2010–2016. Emerg Infect Dis. 2018;24(4):673-682. https://dx.doi.org/10.3201/eid2404.171480
AMA Rodrigues C, Lucidarme J, Borrow R, et al. Genomic Surveillance of 4CMenB Vaccine Antigenic Variants among Disease-Causing Neisseria meningitidis Isolates, United Kingdom, 2010–2016. Emerging Infectious Diseases. 2018;24(4):673-682. doi:10.3201/eid2404.171480.
APA Rodrigues, C., Lucidarme, J., Borrow, R., Smith, A., Cameron, J., Moxon, E....Maiden, M. (2018). Genomic Surveillance of 4CMenB Vaccine Antigenic Variants among Disease-Causing Neisseria meningitidis Isolates, United Kingdom, 2010–2016. Emerging Infectious Diseases, 24(4), 673-682. https://dx.doi.org/10.3201/eid2404.171480.

Evolution of Sequence Type 4821 Clonal Complex Meningococcal Strains in China from Prequinolone to Quinolone Era, 1972–2013 [PDF - 1.37 MB - 8 pages]
Q. Guo et al.

The expansion of hypervirulent sequence type 4821 clonal complex (CC4821) lineage Neisseria meningitidis bacteria has led to a shift in meningococcal disease epidemiology in China, from serogroup A (MenA) to MenC. Knowledge of the evolution and genetic origin of the emergent MenC strains is limited. In this study, we subjected 76 CC4821 isolates collected across China during 1972–1977 and 2005–2013 to phylogenetic analysis, traditional genotyping, or both. We show that successive recombination events within genes encoding surface antigens and acquisition of quinolone resistance mutations possibly played a role in the emergence of CC4821 as an epidemic clone in China. MenC and MenB CC4821 strains have spread across China and have been detected in several countries in different continents. Capsular switches involving serogroups B and C occurred among epidemic strains, raising concerns regarding possible increases in MenB disease, given that vaccines in use in China do not protect against MenB.

EID Guo Q, Mustapha MM, Chen M, Qu D, Zhang X, Chen M, et al. Evolution of Sequence Type 4821 Clonal Complex Meningococcal Strains in China from Prequinolone to Quinolone Era, 1972–2013. Emerg Infect Dis. 2018;24(4):683-690. https://dx.doi.org/10.3201/eid2404.171744
AMA Guo Q, Mustapha MM, Chen M, et al. Evolution of Sequence Type 4821 Clonal Complex Meningococcal Strains in China from Prequinolone to Quinolone Era, 1972–2013. Emerging Infectious Diseases. 2018;24(4):683-690. doi:10.3201/eid2404.171744.
APA Guo, Q., Mustapha, M. M., Chen, M., Qu, D., Zhang, X., Chen, M....Harrison, L. H. (2018). Evolution of Sequence Type 4821 Clonal Complex Meningococcal Strains in China from Prequinolone to Quinolone Era, 1972–2013. Emerging Infectious Diseases, 24(4), 683-690. https://dx.doi.org/10.3201/eid2404.171744.

Avirulent Bacillus anthracis Strain with Molecular Assay Targets as Surrogate for Irradiation-Inactivated Virulent Spores [PDF - 1.03 MB - 9 pages]
R. D. Plaut et al.

The revelation in May 2015 of the shipment of γ irradiation–inactivated wild-type Bacillus anthracis spore preparations containing a small number of live spores raised concern about the safety and security of these materials. The finding also raised doubts about the validity of the protocols and procedures used to prepare them. Such inactivated reference materials were used as positive controls in assays to detect suspected B. anthracis in samples because live agent cannot be shipped for use in field settings, in improvement of currently deployed detection methods or development of new methods, or for quality assurance and training activities. Hence, risk-mitigated B. anthracis strains are needed to fulfill these requirements. We constructed a genetically inactivated or attenuated strain containing relevant molecular assay targets and tested to compare assay performance using this strain to the historical data obtained using irradiation-inactivated virulent spores.

EID Plaut RD, Staab AB, Munson MA, Gebhardt JS, Klimko CP, Quirk AV, et al. Avirulent Bacillus anthracis Strain with Molecular Assay Targets as Surrogate for Irradiation-Inactivated Virulent Spores. Emerg Infect Dis. 2018;24(4):691-699. https://dx.doi.org/10.3201/eid2404.171646
AMA Plaut RD, Staab AB, Munson MA, et al. Avirulent Bacillus anthracis Strain with Molecular Assay Targets as Surrogate for Irradiation-Inactivated Virulent Spores. Emerging Infectious Diseases. 2018;24(4):691-699. doi:10.3201/eid2404.171646.
APA Plaut, R. D., Staab, A. B., Munson, M. A., Gebhardt, J. S., Klimko, C. P., Quirk, A. V....Sozhamannan, S. (2018). Avirulent Bacillus anthracis Strain with Molecular Assay Targets as Surrogate for Irradiation-Inactivated Virulent Spores. Emerging Infectious Diseases, 24(4), 691-699. https://dx.doi.org/10.3201/eid2404.171646.

Phenotypic and Genotypic Characterization of Enterobacteriaceae Producing Oxacillinase-48–Like Carbapenemases, United States [PDF - 788 KB - 10 pages]
J. D. Lutgring et al.

Oxacillinase (OXA)–48–like carbapenemases remain relatively uncommon in the United States. We performed phenotypic and genotypic characterization of 30 Enterobacteriaceae producing OXA-48–like carbapenemases that were recovered from patients during 2010–2014. Isolates were collected from 12 states and not associated with outbreaks, although we could not exclude limited local transmission. The alleles β-lactamase OXA-181 (blaOXA-181) (43%), blaOXA-232 (33%), and blaOXA-48 (23%) were found. All isolates were resistant to ertapenem and showed positive results for the ertapenem and meropenem modified Hodge test and the modified carbapenem inactivation method; 73% showed a positive result for the Carba Nordmann–Poirel test. Whole-genome sequencing identified extended-spectrum β-lactamase genes in 93% of isolates. In all blaOXA-232 isolates, the gene was on a ColKP3 plasmid. A total of 12 of 13 isolates harboring blaOXA-181 contained the insertion sequence ΔISEcp1. In all isolates with blaOXA-48, the gene was located on a TN1999 transposon; these isolates also carried IncL/M plasmids.

EID Lutgring JD, Zhu W, de Man T, Avillan JJ, Anderson KF, Lonsway DR, et al. Phenotypic and Genotypic Characterization of Enterobacteriaceae Producing Oxacillinase-48–Like Carbapenemases, United States. Emerg Infect Dis. 2018;24(4):700-709. https://dx.doi.org/10.3201/eid2404.171377
AMA Lutgring JD, Zhu W, de Man T, et al. Phenotypic and Genotypic Characterization of Enterobacteriaceae Producing Oxacillinase-48–Like Carbapenemases, United States. Emerging Infectious Diseases. 2018;24(4):700-709. doi:10.3201/eid2404.171377.
APA Lutgring, J. D., Zhu, W., de Man, T., Avillan, J. J., Anderson, K. F., Lonsway, D. R....Limbago, B. M. (2018). Phenotypic and Genotypic Characterization of Enterobacteriaceae Producing Oxacillinase-48–Like Carbapenemases, United States. Emerging Infectious Diseases, 24(4), 700-709. https://dx.doi.org/10.3201/eid2404.171377.

Bacterial Infections in Neonates, Madagascar, 2012–2014 [PDF - 1.10 MB - 8 pages]
B. Huynh et al.

Severe bacterial infections are a leading cause of death among neonates in low-income countries, which harbor several factors leading to emergence and spread of multidrug-resistant bacteria. Low-income countries should prioritize interventions to decrease neonatal infections; however, data are scarce, specifically from the community. To assess incidence, etiologies, and antimicrobial drug–resistance patterns of neonatal infections, during 2012–2014, we conducted a community-based prospective investigation of 981 newborns in rural and urban areas of Madagascar. The incidence of culture-confirmed severe neonatal infections was high: 17.7 cases/1,000 live births. Most (75%) occurred during the first week of life. The most common (81%) bacteria isolated were gram-negative. The incidence rate for multidrug-resistant neonatal infection was 7.7 cases/1,000 live births. In Madagascar, interventions to improve prevention, early diagnosis, and management of bacterial infections in neonates should be prioritized.

EID Huynh B, Kermorvant-Duchemin E, Herindrainy P, Padget M, Rakotoarimanana F, Feno H, et al. Bacterial Infections in Neonates, Madagascar, 2012–2014. Emerg Infect Dis. 2018;24(4):710-717. https://dx.doi.org/10.3201/eid2404.161977
AMA Huynh B, Kermorvant-Duchemin E, Herindrainy P, et al. Bacterial Infections in Neonates, Madagascar, 2012–2014. Emerging Infectious Diseases. 2018;24(4):710-717. doi:10.3201/eid2404.161977.
APA Huynh, B., Kermorvant-Duchemin, E., Herindrainy, P., Padget, M., Rakotoarimanana, F., Feno, H....Delarocque-Astagneau, E. (2018). Bacterial Infections in Neonates, Madagascar, 2012–2014. Emerging Infectious Diseases, 24(4), 710-717. https://dx.doi.org/10.3201/eid2404.161977.

Artemisinin-Resistant Plasmodium falciparum with High Survival Rates, Uganda, 2014–2016 [PDF - 1.51 MB - 9 pages]
M. Ikeda et al.

Because ≈90% of malaria cases occur in Africa, emergence of artemisinin-resistant Plasmodium falciparum in Africa poses a serious public health threat. To assess emergence of artemisinin-resistant parasites in Uganda during 2014–2016, we used the recently developed ex vivo ring-stage survival assay, which estimates ring-stage–specific P. falciparum susceptibility to artemisinin. We conducted 4 cross-sectional surveys to assess artemisinin sensitivity in Gulu, Uganda. Among 194 isolates, survival rates (ratio of viable drug-exposed parasites to drug-nonexposed controls) were high (>10%) for 4 isolates. Similar rates have been closely associated with delayed parasite clearance after drug treatment and are considered to be a proxy for the artemisinin-resistant phenotype. Of these, the PfKelch13 mutation was observed in only 1 isolate, A675V. Population genetics analysis suggested that these possibly artemisinin-resistant isolates originated in Africa. Large-scale surveillance of possibly artemisinin-resistant parasites in Africa would provide useful information about treatment outcomes and help regional malaria control.

EID Ikeda M, Kaneko M, Tachibana S, Balikagala B, Sakurai-Yatsushiro M, Yatsushiro S, et al. Artemisinin-Resistant Plasmodium falciparum with High Survival Rates, Uganda, 2014–2016. Emerg Infect Dis. 2018;24(4):718-726. https://dx.doi.org/10.3201/eid2404.170141
AMA Ikeda M, Kaneko M, Tachibana S, et al. Artemisinin-Resistant Plasmodium falciparum with High Survival Rates, Uganda, 2014–2016. Emerging Infectious Diseases. 2018;24(4):718-726. doi:10.3201/eid2404.170141.
APA Ikeda, M., Kaneko, M., Tachibana, S., Balikagala, B., Sakurai-Yatsushiro, M., Yatsushiro, S....Mita, T. (2018). Artemisinin-Resistant Plasmodium falciparum with High Survival Rates, Uganda, 2014–2016. Emerging Infectious Diseases, 24(4), 718-726. https://dx.doi.org/10.3201/eid2404.170141.

Carbapenem-Nonsusceptible Acinetobacter baumannii, 8 US Metropolitan Areas, 2012–2015 [PDF - 670 KB - 7 pages]
S. N. Bulens et al.

In healthcare settings, Acinetobacter spp. bacteria commonly demonstrate antimicrobial resistance, making them a major treatment challenge. Nearly half of Acinetobacter organisms from clinical cultures in the United States are nonsusceptible to carbapenem antimicrobial drugs. During 2012–2015, we conducted laboratory- and population-based surveillance in selected metropolitan areas in Colorado, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee to determine the incidence of carbapenem-nonsusceptible A. baumannii cultured from urine or normally sterile sites and to describe the demographic and clinical characteristics of patients and cases. We identified 621 cases in 537 patients; crude annual incidence was 1.2 cases/100,000 persons. Among 598 cases for which complete data were available, 528 (88.3%) occurred among patients with exposure to a healthcare facility during the preceding year; 506 (84.6%) patients had an indwelling device. Although incidence was lower than for other healthcare-associated pathogens, cases were associated with substantial illness and death.

EID Bulens SN, Yi SH, Walters MS, Jacob JT, Bower C, Reno J, et al. Carbapenem-Nonsusceptible Acinetobacter baumannii, 8 US Metropolitan Areas, 2012–2015. Emerg Infect Dis. 2018;24(4):727-734. https://dx.doi.org/10.3201/eid2404.171461
AMA Bulens SN, Yi SH, Walters MS, et al. Carbapenem-Nonsusceptible Acinetobacter baumannii, 8 US Metropolitan Areas, 2012–2015. Emerging Infectious Diseases. 2018;24(4):727-734. doi:10.3201/eid2404.171461.
APA Bulens, S. N., Yi, S. H., Walters, M. S., Jacob, J. T., Bower, C., Reno, J....Kallen, A. J. (2018). Carbapenem-Nonsusceptible Acinetobacter baumannii, 8 US Metropolitan Areas, 2012–2015. Emerging Infectious Diseases, 24(4), 727-734. https://dx.doi.org/10.3201/eid2404.171461.

Cooperative Recognition of Internationally Disseminated Ceftriaxone-Resistant Neisseria gonorrhoeae Strain [PDF - 703 KB - 9 pages]
M. M. Lahra et al.

Ceftriaxone remains a first-line treatment for patients infected by Neisseria gonorrhoeae in most settings. We investigated the possible spread of a ceftriaxone-resistant FC428 N. gonorrhoeae clone in Japan after recent isolation of similar strains in Denmark (GK124) and Canada (47707). We report 2 instances of the FC428 clone in Australia in heterosexual men traveling from Asia. Our bioinformatic analyses included core single-nucleotide variation phylogeny and in silico molecular typing; phylogenetic analysis showed close genetic relatedness among all 5 isolates. Results showed multilocus sequence type 1903; N. gonorrhoeae sequence typing for antimicrobial resistance (NG-STAR) 233; and harboring of mosaic penA allele encoding alterations A311V and T483S (penA-60.001), associated with ceftriaxone resistance. Our results provide further evidence of international transmission of ceftriaxone-resistant N. gonorrhoeae. We recommend increasing awareness of international spread of this drug-resistant strain, strengthening surveillance to include identifying treatment failures and contacts, and strengthening international sharing of data.

EID Lahra MM, Martin I, Demczuk W, Jennison AV, Lee K, Nakayama S, et al. Cooperative Recognition of Internationally Disseminated Ceftriaxone-Resistant Neisseria gonorrhoeae Strain. Emerg Infect Dis. 2018;24(4):735-743. https://dx.doi.org/10.3201/eid2404.171873
AMA Lahra MM, Martin I, Demczuk W, et al. Cooperative Recognition of Internationally Disseminated Ceftriaxone-Resistant Neisseria gonorrhoeae Strain. Emerging Infectious Diseases. 2018;24(4):735-743. doi:10.3201/eid2404.171873.
APA Lahra, M. M., Martin, I., Demczuk, W., Jennison, A. V., Lee, K., Nakayama, S....Whiley, D. (2018). Cooperative Recognition of Internationally Disseminated Ceftriaxone-Resistant Neisseria gonorrhoeae Strain. Emerging Infectious Diseases, 24(4), 735-743. https://dx.doi.org/10.3201/eid2404.171873.

Influenza A(H7N9) Virus Antibody Responses in Survivors 1 Year after Infection, China, 2017 [PDF - 2.34 MB - 10 pages]
M. Ma et al.

Avian influenza A(H7N9) virus has caused 5 epidemic waves in China since its emergence in 2013. We investigated the dynamic changes of antibody response to this virus over 1 year postinfection in 25 patients in Suzhou City, Jiangsu Province, China, who had laboratory-confirmed infections during the fifth epidemic wave, October 1, 2016–February 14, 2017. Most survivors had relatively robust antibody responses that decreased but remained detectable at 1 year. Antibody response was variable; several survivors had low or undetectable antibody titers. Hemagglutination inhibition titer was >1:40 for <40% of the survivors. Measured in vitro in infected mice, hemagglutination inhibition titer predicted serum protective ability. Our findings provide a helpful serologic guideline for identifying subclinical infections and for developing effective vaccines and therapeutics to counter H7N9 virus infections.

EID Ma M, Liu C, Wu M, Zhao T, Wang G, Yang Y, et al. Influenza A(H7N9) Virus Antibody Responses in Survivors 1 Year after Infection, China, 2017. Emerg Infect Dis. 2018;24(4):663-672. https://dx.doi.org/10.3201/eid2404.171995
AMA Ma M, Liu C, Wu M, et al. Influenza A(H7N9) Virus Antibody Responses in Survivors 1 Year after Infection, China, 2017. Emerging Infectious Diseases. 2018;24(4):663-672. doi:10.3201/eid2404.171995.
APA Ma, M., Liu, C., Wu, M., Zhao, T., Wang, G., Yang, Y....Cheng, L. (2018). Influenza A(H7N9) Virus Antibody Responses in Survivors 1 Year after Infection, China, 2017. Emerging Infectious Diseases, 24(4), 663-672. https://dx.doi.org/10.3201/eid2404.171995.
Dispatches

Imipenem Resistance in Clostridium difficile Ribotype 017, Portugal [PDF - 1.98 MB - 5 pages]
J. Isidro et al.

We describe imipenem-resistant and imipenem-susceptible clinical isolates of Clostridium difficile ribotype 017 in Portugal. All ribotype 017 isolates carried an extra penicillin-binding protein gene, pbp5, and the imipenem-resistant isolates had additional substitutions near the transpeptidase active sites of pbp1 and pbp3. These clones could disseminate and contribute to imipenem resistance.

EID Isidro J, Santos A, Nunes A, Borges V, Silva C, Vieira L, et al. Imipenem Resistance in Clostridium difficile Ribotype 017, Portugal. Emerg Infect Dis. 2018;24(4):741-745. https://dx.doi.org/10.3201/eid2404.170095
AMA Isidro J, Santos A, Nunes A, et al. Imipenem Resistance in Clostridium difficile Ribotype 017, Portugal. Emerging Infectious Diseases. 2018;24(4):741-745. doi:10.3201/eid2404.170095.
APA Isidro, J., Santos, A., Nunes, A., Borges, V., Silva, C., Vieira, L....Oleastro, M. (2018). Imipenem Resistance in Clostridium difficile Ribotype 017, Portugal. Emerging Infectious Diseases, 24(4), 741-745. https://dx.doi.org/10.3201/eid2404.170095.

Enhanced Replication of Highly Pathogenic Influenza A(H7N9) Virus in Humans [PDF - 2.73 MB - 5 pages]
S. Yamayoshi et al.

To clarify the threat posed by emergence of highly pathogenic influenza A(H7N9) virus infection among humans, we characterized the viral polymerase complex. Polymerase basic 2–482R, polymerase basic 2–588V, and polymerase acidic–497R individually or additively enhanced virus polymerase activity, indicating that multiple replication-enhancing mutations in 1 isolate may contribute to virulence.

EID Yamayoshi S, Kiso M, Yasuhara A, Ito M, Shu Y, Kawaoka Y. Enhanced Replication of Highly Pathogenic Influenza A(H7N9) Virus in Humans. Emerg Infect Dis. 2018;24(4):746-750. https://dx.doi.org/10.3201/eid2404.171509
AMA Yamayoshi S, Kiso M, Yasuhara A, et al. Enhanced Replication of Highly Pathogenic Influenza A(H7N9) Virus in Humans. Emerging Infectious Diseases. 2018;24(4):746-750. doi:10.3201/eid2404.171509.
APA Yamayoshi, S., Kiso, M., Yasuhara, A., Ito, M., Shu, Y., & Kawaoka, Y. (2018). Enhanced Replication of Highly Pathogenic Influenza A(H7N9) Virus in Humans. Emerging Infectious Diseases, 24(4), 746-750. https://dx.doi.org/10.3201/eid2404.171509.

Multidrug-Resistant Salmonella enterica 4,[5],12:i:- Sequence Type 34, New South Wales, Australia, 2016–2017 [PDF - 1.50 MB - 3 pages]
A. Arnott et al.

Multidrug- and colistin-resistant Salmonella enterica serotype 4,[5],12:i:- sequence type 34 is present in Europe and Asia. Using genomic surveillance, we determined that this sequence type is also endemic to Australia. Our findings highlight the public health benefits of genome sequencing–guided surveillance for monitoring the spread of multidrug-resistant mobile genes and isolates.

EID Arnott A, Wang Q, Bachmann N, Sadsad R, Biswas C, Sotomayor C, et al. Multidrug-Resistant Salmonella enterica 4,[5],12:i:- Sequence Type 34, New South Wales, Australia, 2016–2017. Emerg Infect Dis. 2018;24(4):751-753. https://dx.doi.org/10.3201/eid2404.171619
AMA Arnott A, Wang Q, Bachmann N, et al. Multidrug-Resistant Salmonella enterica 4,[5],12:i:- Sequence Type 34, New South Wales, Australia, 2016–2017. Emerging Infectious Diseases. 2018;24(4):751-753. doi:10.3201/eid2404.171619.
APA Arnott, A., Wang, Q., Bachmann, N., Sadsad, R., Biswas, C., Sotomayor, C....Sintchenko, V. (2018). Multidrug-Resistant Salmonella enterica 4,[5],12:i:- Sequence Type 34, New South Wales, Australia, 2016–2017. Emerging Infectious Diseases, 24(4), 751-753. https://dx.doi.org/10.3201/eid2404.171619.

Genetic Characterization of Enterovirus A71 Circulating in Africa [PDF - 1.32 MB - 4 pages]
M. Fernandez-Garcia et al.

We analyzed whole-genome sequences of 8 enterovirus A71 isolates (EV-A71). We confirm the circulation of genogroup C and the new genogroup E in West Africa. Our analysis demonstrates wide geographic circulation and describes genetic exchanges between EV-A71 and autochthonous EV-A that might contribute to the emergence of pathogenic lineages.

EID Fernandez-Garcia M, Volle R, Joffret M, Sadeuh-Mba S, Gouandjika-Vasilache I, Kebe O, et al. Genetic Characterization of Enterovirus A71 Circulating in Africa. Emerg Infect Dis. 2018;24(4):754-757. https://dx.doi.org/10.3201/eid2404.171783
AMA Fernandez-Garcia M, Volle R, Joffret M, et al. Genetic Characterization of Enterovirus A71 Circulating in Africa. Emerging Infectious Diseases. 2018;24(4):754-757. doi:10.3201/eid2404.171783.
APA Fernandez-Garcia, M., Volle, R., Joffret, M., Sadeuh-Mba, S., Gouandjika-Vasilache, I., Kebe, O....Bessaud, M. (2018). Genetic Characterization of Enterovirus A71 Circulating in Africa. Emerging Infectious Diseases, 24(4), 754-757. https://dx.doi.org/10.3201/eid2404.171783.

Emergomyces canadensis, a Dimorphic Fungus Causing Fatal Systemic Human Disease in North America [PDF - 1.26 MB - 4 pages]
I. S. Schwartz et al.

We report 4 patients in North America with disease caused by Emergomyces canadensis, a newly proposed species of pathogenic dimorphic fungus. Affected persons were immunocompromised; lived in Saskatchewan, Colorado, and New Mexico; and had systemic disease involving blood, skin, cervix, lung, and lymph node. Two cases were fatal.

EID Schwartz IS, Sanche S, Wiederhold NP, Patterson TF, Sigler L. Emergomyces canadensis, a Dimorphic Fungus Causing Fatal Systemic Human Disease in North America. Emerg Infect Dis. 2018;24(4):758-761. https://dx.doi.org/10.3201/eid2404.171765
AMA Schwartz IS, Sanche S, Wiederhold NP, et al. Emergomyces canadensis, a Dimorphic Fungus Causing Fatal Systemic Human Disease in North America. Emerging Infectious Diseases. 2018;24(4):758-761. doi:10.3201/eid2404.171765.
APA Schwartz, I. S., Sanche, S., Wiederhold, N. P., Patterson, T. F., & Sigler, L. (2018). Emergomyces canadensis, a Dimorphic Fungus Causing Fatal Systemic Human Disease in North America. Emerging Infectious Diseases, 24(4), 758-761. https://dx.doi.org/10.3201/eid2404.171765.

mcr-1 in Carbapenemase-Producing Klebsiella pneumoniae with Hospitalized Patients, Portugal, 2016–2017 [PDF - 2.52 MB - 5 pages]
A. Mendes et al.

We describe a hospital-based outbreak caused by multidrug-resistant, Klebsiella pneumoniae carbapenemase 3–producing, mcr-1–positive K. pneumoniae sequence type 45 in Portugal. mcr-1 was located in an IncX4 plasmid. Our data highlight the urgent need for systematic surveillance of mcr-1 to support adequate therapeutic choices in the nosocomial setting.

EID Mendes A, Novais Â, Campos J, Rodrigues C, Santos C, Antunes P, et al. mcr-1 in Carbapenemase-Producing Klebsiella pneumoniae with Hospitalized Patients, Portugal, 2016–2017. Emerg Infect Dis. 2018;24(4):762-766. https://dx.doi.org/10.3201/eid2404.171787
AMA Mendes A, Novais Â, Campos J, et al. mcr-1 in Carbapenemase-Producing Klebsiella pneumoniae with Hospitalized Patients, Portugal, 2016–2017. Emerging Infectious Diseases. 2018;24(4):762-766. doi:10.3201/eid2404.171787.
APA Mendes, A., Novais, Â., Campos, J., Rodrigues, C., Santos, C., Antunes, P....Peixe, L. (2018). mcr-1 in Carbapenemase-Producing Klebsiella pneumoniae with Hospitalized Patients, Portugal, 2016–2017. Emerging Infectious Diseases, 24(4), 762-766. https://dx.doi.org/10.3201/eid2404.171787.

Bimodal Seasonality and Alternating Predominance of Norovirus GII.4 and Non-GII.4, Hong Kong, China, 2014–2017 [PDF - 857 KB - 3 pages]
M. Chan et al.

We report emerging subtropical bimodal seasonality and alternating predominance of norovirus GII.4 and non-GII.4 genotypes in Hong Kong. GII.4 predominated in summer and autumn months and affected young children, whereas emergent non-GII.4 genotypes predominated in winter months and affected all age groups. This highly dynamic epidemiology should inform vaccination strategies.

EID Chan M, Kwok K, Zhang L, Mohammad KN, Lee N, Lui G, et al. Bimodal Seasonality and Alternating Predominance of Norovirus GII.4 and Non-GII.4, Hong Kong, China, 2014–2017. Emerg Infect Dis. 2018;24(4):767-769. https://dx.doi.org/10.3201/eid2404.171791
AMA Chan M, Kwok K, Zhang L, et al. Bimodal Seasonality and Alternating Predominance of Norovirus GII.4 and Non-GII.4, Hong Kong, China, 2014–2017. Emerging Infectious Diseases. 2018;24(4):767-769. doi:10.3201/eid2404.171791.
APA Chan, M., Kwok, K., Zhang, L., Mohammad, K. N., Lee, N., Lui, G....Chan, P. (2018). Bimodal Seasonality and Alternating Predominance of Norovirus GII.4 and Non-GII.4, Hong Kong, China, 2014–2017. Emerging Infectious Diseases, 24(4), 767-769. https://dx.doi.org/10.3201/eid2404.171791.

Novel Highly Pathogenic Avian Influenza A(H5N6) Virus in the Netherlands, December 2017 [PDF - 885 KB - 4 pages]
N. Beerens et al.

A novel highly pathogenic avian influenza A(H5N6) virus affecting wild birds and commercial poultry was detected in the Netherlands in December 2017. Phylogenetic analysis demonstrated that the virus is a reassortant of H5N8 clade 2.3.4.4 viruses and not related to the Asian H5N6 viruses that caused human infections.

EID Beerens N, Koch G, Heutink R, Harders F, Vries D, Ho C, et al. Novel Highly Pathogenic Avian Influenza A(H5N6) Virus in the Netherlands, December 2017. Emerg Infect Dis. 2018;24(4):770-773. https://dx.doi.org/10.3201/eid2404.172124
AMA Beerens N, Koch G, Heutink R, et al. Novel Highly Pathogenic Avian Influenza A(H5N6) Virus in the Netherlands, December 2017. Emerging Infectious Diseases. 2018;24(4):770-773. doi:10.3201/eid2404.172124.
APA Beerens, N., Koch, G., Heutink, R., Harders, F., Vries, D., Ho, C....Elbers, A. (2018). Novel Highly Pathogenic Avian Influenza A(H5N6) Virus in the Netherlands, December 2017. Emerging Infectious Diseases, 24(4), 770-773. https://dx.doi.org/10.3201/eid2404.172124.

Importation of Mumps Virus Genotype K to China from Vietnam [PDF - 896 KB - 5 pages]
W. Cao et al.

During May–August 2016, mumps virus genotype K was detected in 12 Vietnam citizens who entered China at the Shuikou border crossing and 1 girl from China. We provide evidence that mumps genotype K is circulating in Vietnam and was imported to China from Vietnam.

EID Cao W, Deng L, Lin X, Wang X, Ma Y, Deng Q, et al. Importation of Mumps Virus Genotype K to China from Vietnam. Emerg Infect Dis. 2018;24(4):774-778. https://dx.doi.org/10.3201/eid2404.170591
AMA Cao W, Deng L, Lin X, et al. Importation of Mumps Virus Genotype K to China from Vietnam. Emerging Infectious Diseases. 2018;24(4):774-778. doi:10.3201/eid2404.170591.
APA Cao, W., Deng, L., Lin, X., Wang, X., Ma, Y., Deng, Q....Jin, L. (2018). Importation of Mumps Virus Genotype K to China from Vietnam. Emerging Infectious Diseases, 24(4), 774-778. https://dx.doi.org/10.3201/eid2404.170591.

Testing for Coccidioidomycosis among Community-Acquired Pneumonia Patients, Southern California, USA [PDF - 570 KB - 3 pages]
S. Y. Tartof et al.

We conducted a cohort study to identify characteristics associated with testing for, and testing positive for, coccidioidomycosis among patients with community-acquired pneumonia in southern California, USA. Limited and delayed testing probably leads to underdiagnosis among non-Hispanic black, Filipino, or Hispanic patients and among high-risk groups, including persons in whom antimicrobial drug therapy has failed.

EID Tartof SY, Benedict K, Xie F, Rieg GK, Yu KC, Contreras R, et al. Testing for Coccidioidomycosis among Community-Acquired Pneumonia Patients, Southern California, USA. Emerg Infect Dis. 2018;24(4):779-781. https://dx.doi.org/10.3201/eid2404.161568
AMA Tartof SY, Benedict K, Xie F, et al. Testing for Coccidioidomycosis among Community-Acquired Pneumonia Patients, Southern California, USA. Emerging Infectious Diseases. 2018;24(4):779-781. doi:10.3201/eid2404.161568.
APA Tartof, S. Y., Benedict, K., Xie, F., Rieg, G. K., Yu, K. C., Contreras, R....Mody, R. K. (2018). Testing for Coccidioidomycosis among Community-Acquired Pneumonia Patients, Southern California, USA. Emerging Infectious Diseases, 24(4), 779-781. https://dx.doi.org/10.3201/eid2404.161568.

Lyssavirus in Japanese Pipistrelle, Taiwan [PDF - 612 KB - 4 pages]
S. Hu et al.

A putative new lyssavirus was found in 2 Japanese pipistrelles (Pipistrellus abramus) in Taiwan in 2016 and 2017. The concatenated coding regions of the virus showed 62.9%–75.1% nucleotide identities to the other 16 species of lyssavirus, suggesting that it may be representative of a new species of this virus.

EID Hu S, Hsu C, Lee M, Tu Y, Chang J, Wu C, et al. Lyssavirus in Japanese Pipistrelle, Taiwan. Emerg Infect Dis. 2018;24(4):782-785. https://dx.doi.org/10.3201/eid2404.171696
AMA Hu S, Hsu C, Lee M, et al. Lyssavirus in Japanese Pipistrelle, Taiwan. Emerging Infectious Diseases. 2018;24(4):782-785. doi:10.3201/eid2404.171696.
APA Hu, S., Hsu, C., Lee, M., Tu, Y., Chang, J., Wu, C....Hsu, W. (2018). Lyssavirus in Japanese Pipistrelle, Taiwan. Emerging Infectious Diseases, 24(4), 782-785. https://dx.doi.org/10.3201/eid2404.171696.

Direct Whole-Genome Sequencing of Cutaneous Strains of Haemophilus ducreyi [PDF - 1.26 MB - 4 pages]
M. Marks et al.

Haemophilus ducreyi, which causes chancroid, has emerged as a cause of pediatric skin disease. Isolation of H. ducreyi in low-income settings is challenging, limiting phylogenetic investigation. Next-generation sequencing demonstrates that cutaneous strains arise from class I and II H. ducreyi clades and that class II may represent a distinct subspecies.

EID Marks M, Fookes M, Wagner J, Ghinai R, Sokana O, Sarkodie Y, et al. Direct Whole-Genome Sequencing of Cutaneous Strains of Haemophilus ducreyi. Emerg Infect Dis. 2018;24(4):786-789. https://dx.doi.org/10.3201/eid2404.171726
AMA Marks M, Fookes M, Wagner J, et al. Direct Whole-Genome Sequencing of Cutaneous Strains of Haemophilus ducreyi. Emerging Infectious Diseases. 2018;24(4):786-789. doi:10.3201/eid2404.171726.
APA Marks, M., Fookes, M., Wagner, J., Ghinai, R., Sokana, O., Sarkodie, Y....Thomson, N. R. (2018). Direct Whole-Genome Sequencing of Cutaneous Strains of Haemophilus ducreyi. Emerging Infectious Diseases, 24(4), 786-789. https://dx.doi.org/10.3201/eid2404.171726.

Region-Specific, Life-Threatening Diseases among International Travelers from Israel, 2004–2015 [PDF - 550 KB - 1 page]
C. Avni et al.

We characterized posttravel hospitalizations of citizens returning to Israel by summarizing the returning traveler hospitalization dataset of the national referral Center for Travel Medicine and Tropical Diseases at Sheba Medical Center in Israel. Of 722 hospitalizations, 181 (25%) infections were life-threatening; most would have been preventable by chemoprophylaxis and pretravel vaccination.

EID Avni C, Stienlauf S, Meltzer E, Sidi Y, Schwartz E, Leshem E. Region-Specific, Life-Threatening Diseases among International Travelers from Israel, 2004–2015. Emerg Infect Dis. 2018;24(4):790-793. https://dx.doi.org/10.3201/eid2404.171542
AMA Avni C, Stienlauf S, Meltzer E, et al. Region-Specific, Life-Threatening Diseases among International Travelers from Israel, 2004–2015. Emerging Infectious Diseases. 2018;24(4):790-793. doi:10.3201/eid2404.171542.
APA Avni, C., Stienlauf, S., Meltzer, E., Sidi, Y., Schwartz, E., & Leshem, E. (2018). Region-Specific, Life-Threatening Diseases among International Travelers from Israel, 2004–2015. Emerging Infectious Diseases, 24(4), 790-793. https://dx.doi.org/10.3201/eid2404.171542.
Research Letters

Intensive Care Admissions for Severe Chikungunya Virus Infection, French Polynesia [PDF - 297 KB - 3 pages]
A. Koeltz et al.

During the 2014–2015 chikungunya outbreak in French Polynesia, 64 patients with confirmed chikungunya virus infection were admitted into intensive care. Sixty-three were nonpregnant adults; 11 had an atypical form, 21 had severe sepsis or septic shock, and 18 died. These findings indicate that critical illness frequently complicates the course of chikungunya virus infection.

EID Koeltz A, Lastere S, Jean-Baptiste S. Intensive Care Admissions for Severe Chikungunya Virus Infection, French Polynesia. Emerg Infect Dis. 2018;24(4):794-796. https://dx.doi.org/10.3201/eid2404.161536
AMA Koeltz A, Lastere S, Jean-Baptiste S. Intensive Care Admissions for Severe Chikungunya Virus Infection, French Polynesia. Emerging Infectious Diseases. 2018;24(4):794-796. doi:10.3201/eid2404.161536.
APA Koeltz, A., Lastere, S., & Jean-Baptiste, S. (2018). Intensive Care Admissions for Severe Chikungunya Virus Infection, French Polynesia. Emerging Infectious Diseases, 24(4), 794-796. https://dx.doi.org/10.3201/eid2404.161536.

African Swine Fever Virus, Siberia, Russia, 2017 [PDF - 397 KB - 3 pages]
D. Kolbasov et al.

African swine fever (ASF) is arguably the most dangerous and emerging swine disease worldwide. ASF is a serious problem for the swine industry. The first case of ASF in Russia was reported in 2007. We report an outbreak of ASF in Siberia, Russia, in 2017.

EID Kolbasov D, Titov I, Tsybanov S, Gogin A, Malogolovkin A. African Swine Fever Virus, Siberia, Russia, 2017. Emerg Infect Dis. 2018;24(4):796-798. https://dx.doi.org/10.3201/eid2404.171238
AMA Kolbasov D, Titov I, Tsybanov S, et al. African Swine Fever Virus, Siberia, Russia, 2017. Emerging Infectious Diseases. 2018;24(4):796-798. doi:10.3201/eid2404.171238.
APA Kolbasov, D., Titov, I., Tsybanov, S., Gogin, A., & Malogolovkin, A. (2018). African Swine Fever Virus, Siberia, Russia, 2017. Emerging Infectious Diseases, 24(4), 796-798. https://dx.doi.org/10.3201/eid2404.171238.

Classical Swine Fever Outbreak after Modified Live LOM Strain Vaccination in Naive Pigs, South Korea [PDF - 764 KB - 3 pages]
S. H. Je et al.

We report classical swine fever outbreaks occurring in naive pig herds on Jeju Island, South Korea, after the introduction of the LOM vaccine strain. Two isolates from sick pigs had >99% identity with the vaccine stain. LOM strain does not appear safe; its use in the vaccine should be reconsidered.

EID Je SH, Kwon T, Yoo SJ, Lee D, Lee S, Richt JA, et al. Classical Swine Fever Outbreak after Modified Live LOM Strain Vaccination in Naive Pigs, South Korea. Emerg Infect Dis. 2018;24(4):798-800. https://dx.doi.org/10.3201/eid2404.171319
AMA Je SH, Kwon T, Yoo SJ, et al. Classical Swine Fever Outbreak after Modified Live LOM Strain Vaccination in Naive Pigs, South Korea. Emerging Infectious Diseases. 2018;24(4):798-800. doi:10.3201/eid2404.171319.
APA Je, S. H., Kwon, T., Yoo, S. J., Lee, D., Lee, S., Richt, J. A....Lyoo, Y. S. (2018). Classical Swine Fever Outbreak after Modified Live LOM Strain Vaccination in Naive Pigs, South Korea. Emerging Infectious Diseases, 24(4), 798-800. https://dx.doi.org/10.3201/eid2404.171319.

Imported Congenital Rubella Syndrome, United States, 2017 [PDF - 326 KB - 2 pages]
R. Al Hammoud et al.

Although transmission of rubella virus within the United States is rare, the risk for imported cases persists. We describe a rubella case in a newborn, conceived in Saudi Arabia, in Texas during 2017, highlighting the importance of active surveillance and early diagnosis of this disease.

EID Al Hammoud R, Murphy JR, Pérez N. Imported Congenital Rubella Syndrome, United States, 2017. Emerg Infect Dis. 2018;24(4):800-801. https://dx.doi.org/10.3201/eid2404.171540
AMA Al Hammoud R, Murphy JR, Pérez N. Imported Congenital Rubella Syndrome, United States, 2017. Emerging Infectious Diseases. 2018;24(4):800-801. doi:10.3201/eid2404.171540.
APA Al Hammoud, R., Murphy, J. R., & Pérez, N. (2018). Imported Congenital Rubella Syndrome, United States, 2017. Emerging Infectious Diseases, 24(4), 800-801. https://dx.doi.org/10.3201/eid2404.171540.

Candida auris Infection Leading to Nosocomial Transmission, Israel, 2017 [PDF - 555 KB - 4 pages]
A. Belkin et al.

A patient transferred from South Africa to Israel acquired a Candida auris infection. Phylogenetic analysis showed resemblance of C. auris to isolates from South Africa but not Israel, suggesting travel-associated infection. C. auris infection occurred weeks later in another patient at the same hospital, suggesting prolonged environmental persistence.

EID Belkin A, Gazit Z, Keller N, Ben-Ami R, Wieder-Finesod A, Novikov A, et al. Candida auris Infection Leading to Nosocomial Transmission, Israel, 2017. Emerg Infect Dis. 2018;24(4):801-804. https://dx.doi.org/10.3201/eid2404.171715
AMA Belkin A, Gazit Z, Keller N, et al. Candida auris Infection Leading to Nosocomial Transmission, Israel, 2017. Emerging Infectious Diseases. 2018;24(4):801-804. doi:10.3201/eid2404.171715.
APA Belkin, A., Gazit, Z., Keller, N., Ben-Ami, R., Wieder-Finesod, A., Novikov, A....Brosh-Nissimov, T. (2018). Candida auris Infection Leading to Nosocomial Transmission, Israel, 2017. Emerging Infectious Diseases, 24(4), 801-804. https://dx.doi.org/10.3201/eid2404.171715.

Cephalosporin-Resistant Neisseria gonorrhoeae Clone, China [PDF - 331 KB - 3 pages]
S. Chen et al.

Cephalosporin-resistant Neisseria gonorrhoeae is a major public health concern. N. gonorrhoeae of multiantigen sequence type G1407 and multilocus sequence type 1901 is an internationally spreading cephalosporin-resistant clone. We detected 4 cases of infection with this clone in China and analyzed resistance determinants by using N. gonorrhoeae sequence typing for antimicrobial resistance.

EID Chen S, Yin Y, Chen X. Cephalosporin-Resistant Neisseria gonorrhoeae Clone, China. Emerg Infect Dis. 2018;24(4):804-806. https://dx.doi.org/10.3201/eid2404.171817
AMA Chen S, Yin Y, Chen X. Cephalosporin-Resistant Neisseria gonorrhoeae Clone, China. Emerging Infectious Diseases. 2018;24(4):804-806. doi:10.3201/eid2404.171817.
APA Chen, S., Yin, Y., & Chen, X. (2018). Cephalosporin-Resistant Neisseria gonorrhoeae Clone, China. Emerging Infectious Diseases, 24(4), 804-806. https://dx.doi.org/10.3201/eid2404.171817.

Chlamydia trachomatis in Cervical Lymph Node of Man with Lymphogranuloma Venereum, Croatia, 2014 [PDF - 346 KB - 3 pages]
B. Gjurašin et al.

We report an HIV-infected person who was treated for lymphogranuloma venereum cervical lymphadenopathy and proctitis in Croatia in 2014. Infection with a variant L2b genovar of Chlamydia trachomatis was detected in a cervical lymph node aspirate. A prolonged course of doxycycline was required to cure the infection.

EID Gjurašin B, Lepej S, Cole MJ, Pitt R, Begovac J. Chlamydia trachomatis in Cervical Lymph Node of Man with Lymphogranuloma Venereum, Croatia, 2014. Emerg Infect Dis. 2018;24(4):806-808. https://dx.doi.org/10.3201/eid2404.171872
AMA Gjurašin B, Lepej S, Cole MJ, et al. Chlamydia trachomatis in Cervical Lymph Node of Man with Lymphogranuloma Venereum, Croatia, 2014. Emerging Infectious Diseases. 2018;24(4):806-808. doi:10.3201/eid2404.171872.
APA Gjurašin, B., Lepej, S., Cole, M. J., Pitt, R., & Begovac, J. (2018). Chlamydia trachomatis in Cervical Lymph Node of Man with Lymphogranuloma Venereum, Croatia, 2014. Emerging Infectious Diseases, 24(4), 806-808. https://dx.doi.org/10.3201/eid2404.171872.

Zika Virus MB16-23 in Mosquitoes, Miami-Dade County, Florida, USA, 2016 [PDF - 573 KB - 3 pages]
J. Mutebi et al.

We isolated a strain of Zika virus, MB16-23, from Aedes aegypti mosquitoes collected in Miami Beach, Florida, USA, on September 2, 2016. Phylogenetic analysis suggests that MB16-23 most likely originated from the Caribbean region.

EID Mutebi J, Hughes HR, Burkhalter KL, Kothera L, Vasquez C, Kenney JL. Zika Virus MB16-23 in Mosquitoes, Miami-Dade County, Florida, USA, 2016. Emerg Infect Dis. 2018;24(4):808-810. https://dx.doi.org/10.3201/eid2404.171919
AMA Mutebi J, Hughes HR, Burkhalter KL, et al. Zika Virus MB16-23 in Mosquitoes, Miami-Dade County, Florida, USA, 2016. Emerging Infectious Diseases. 2018;24(4):808-810. doi:10.3201/eid2404.171919.
APA Mutebi, J., Hughes, H. R., Burkhalter, K. L., Kothera, L., Vasquez, C., & Kenney, J. L. (2018). Zika Virus MB16-23 in Mosquitoes, Miami-Dade County, Florida, USA, 2016. Emerging Infectious Diseases, 24(4), 808-810. https://dx.doi.org/10.3201/eid2404.171919.

Identification of Wild Boar–Habitat Epidemiologic Cycle in African Swine Fever Epizootic [PDF - 896 KB - 3 pages]
E. Chenais et al.

The African swine fever epizootic in central and eastern European Union member states has a newly identified component involving virus transmission by wild boar and virus survival in the environment. Insights led to an update of the 3 accepted African swine fever transmission models to include a fourth cycle: wild boar–habitat.

EID Chenais E, Ståhl K, Guberti V, Depner K. Identification of Wild Boar–Habitat Epidemiologic Cycle in African Swine Fever Epizootic. Emerg Infect Dis. 2018;24(4):810-812. https://dx.doi.org/10.3201/eid2404.172127
AMA Chenais E, Ståhl K, Guberti V, et al. Identification of Wild Boar–Habitat Epidemiologic Cycle in African Swine Fever Epizootic. Emerging Infectious Diseases. 2018;24(4):810-812. doi:10.3201/eid2404.172127.
APA Chenais, E., Ståhl, K., Guberti, V., & Depner, K. (2018). Identification of Wild Boar–Habitat Epidemiologic Cycle in African Swine Fever Epizootic. Emerging Infectious Diseases, 24(4), 810-812. https://dx.doi.org/10.3201/eid2404.172127.

Two Cases of Dengue Fever Imported from Egypt to Russia, 2017 [PDF - 667 KB - 2 pages]
M. A. Saifullin et al.

In 2017, two cases of dengue fever were imported from Hurghada, Egypt, where dengue fever was not considered endemic, to Moscow. These cases show how emergence of dengue fever in popular resort regions on the coast of the Red Sea can spread infection to countries where it is not endemic.

EID Saifullin MA, Laritchev VP, Grigorieva YE, Zvereva NN, Domkina AM, Saifullin RF, et al. Two Cases of Dengue Fever Imported from Egypt to Russia, 2017. Emerg Infect Dis. 2018;24(4):813-814. https://dx.doi.org/10.3201/eid2404.172131
AMA Saifullin MA, Laritchev VP, Grigorieva YE, et al. Two Cases of Dengue Fever Imported from Egypt to Russia, 2017. Emerging Infectious Diseases. 2018;24(4):813-814. doi:10.3201/eid2404.172131.
APA Saifullin, M. A., Laritchev, V. P., Grigorieva, Y. E., Zvereva, N. N., Domkina, A. M., Saifullin, R. F....Butenko, A. M. (2018). Two Cases of Dengue Fever Imported from Egypt to Russia, 2017. Emerging Infectious Diseases, 24(4), 813-814. https://dx.doi.org/10.3201/eid2404.172131.
About the Cover

“No Water, No Life. No Blue, No Green” [PDF - 1.36 MB - 2 pages]
B. Breedlove and J. Weber
EID Breedlove B, Weber J. “No Water, No Life. No Blue, No Green”. Emerg Infect Dis. 2018;24(4):815-816. https://dx.doi.org/10.3201/eid2404.ac2404
AMA Breedlove B, Weber J. “No Water, No Life. No Blue, No Green”. Emerging Infectious Diseases. 2018;24(4):815-816. doi:10.3201/eid2404.ac2404.
APA Breedlove, B., & Weber, J. (2018). “No Water, No Life. No Blue, No Green”. Emerging Infectious Diseases, 24(4), 815-816. https://dx.doi.org/10.3201/eid2404.ac2404.
Etymologia

Etymologia: TEM [PDF - 322 KB - 1 page]
J. Ruiz
EID Ruiz J. Etymologia: TEM. Emerg Infect Dis. 2018;24(4):709. https://dx.doi.org/10.3201/eid2404.et2404
AMA Ruiz J. Etymologia: TEM. Emerging Infectious Diseases. 2018;24(4):709. doi:10.3201/eid2404.et2404.
APA Ruiz, J. (2018). Etymologia: TEM. Emerging Infectious Diseases, 24(4), 709. https://dx.doi.org/10.3201/eid2404.et2404.
Page created: July 31, 2018
Page updated: July 31, 2018
Page reviewed: July 31, 2018
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.
edit_01 Submit ManuscriptExternal Link
Issue Select
GO
GO

Notice to Readers

Emerging Infectious Diseases will no longer print copies of the journal after Volume 25. Printable PDF versions of issues, and articles, will still be available online. Visit EID Subscriptions to sign up for monthly email notifications for the table of contents, and for specific article types and disease topics.

Get Email Updates

To receive email updates about this page, enter your email address:

file_external