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Issue Cover for Volume 25, Number 2—February 2019

Volume 25, Number 2—February 2019

[PDF - 11.08 MB - 200 pages]

Perspective

International Biological Reference Preparations for Epidemic Infectious Diseases [PDF - 387 KB - 7 pages]
T. Rampling et al.

Recent years have seen unprecedented investment in research and development for countermeasures for high-threat pathogens, including specific and ambitious objectives for development of diagnostics, therapeutics, and vaccines. The inadequate availability of biological reference materials for these pathogens poses a genuine obstacle in pursuit of these objectives, and the lack of a comprehensive and equitable framework for developing reference materials is a weakness. We outline the need for internationally standardized biological materials for high-threat pathogens as a core element of global health security. We also outline the key components of a framework for addressing this deficiency.

EID Rampling T, Page M, Horby P. International Biological Reference Preparations for Epidemic Infectious Diseases. Emerg Infect Dis. 2019;25(2):205-211. https://doi.org/10.3201/eid2502.180798
AMA Rampling T, Page M, Horby P. International Biological Reference Preparations for Epidemic Infectious Diseases. Emerging Infectious Diseases. 2019;25(2):205-211. doi:10.3201/eid2502.180798.
APA Rampling, T., Page, M., & Horby, P. (2019). International Biological Reference Preparations for Epidemic Infectious Diseases. Emerging Infectious Diseases, 25(2), 205-211. https://doi.org/10.3201/eid2502.180798.
Synopses

Atypical Cowpox Virus Infection in Smallpox-Vaccinated Patient, France [PDF - 2.40 MB - 8 pages]
J. Andreani et al.

We report a case of atypical cowpox virus infection in France in 2016. The patient sought care for thoracic lesions after injury from the sharp end of a metallic guardrail previously stored in the ground. We isolated a cowpox virus from the lesions and sequenced its whole genome. The patient reported that he had been previously vaccinated against smallpox. We describe an alternative route of cowpox virus infection and raise questions about the immunological status of smallpox-vaccinated patients for circulating orthopoxviruses.

EID Andreani J, Arnault J, Bou Khalil JY, Abrahão J, Tomei E, Vial E, et al. Atypical Cowpox Virus Infection in Smallpox-Vaccinated Patient, France. Emerg Infect Dis. 2019;25(2):212-219. https://doi.org/10.3201/eid2502.171433
AMA Andreani J, Arnault J, Bou Khalil JY, et al. Atypical Cowpox Virus Infection in Smallpox-Vaccinated Patient, France. Emerging Infectious Diseases. 2019;25(2):212-219. doi:10.3201/eid2502.171433.
APA Andreani, J., Arnault, J., Bou Khalil, J. Y., Abrahão, J., Tomei, E., Vial, E....La Scola, B. (2019). Atypical Cowpox Virus Infection in Smallpox-Vaccinated Patient, France. Emerging Infectious Diseases, 25(2), 212-219. https://doi.org/10.3201/eid2502.171433.

Trends of Human Plague, Madagascar, 1998–2016 [PDF - 1.19 MB - 9 pages]
V. Andrianaivoarimanana et al.

Madagascar is more seriously affected by plague, a zoonosis caused by Yersinia pestis, than any other country. The Plague National Control Program was established in 1993 and includes human surveillance. During 1998–2016, a total of 13,234 suspected cases were recorded, mainly from the central highlands; 27% were confirmed cases, and 17% were presumptive cases. Patients with bubonic plague (median age 13 years) represented 93% of confirmed and presumptive cases, and patients with pneumonic plague (median age 29 years) represented 7%. Deaths were associated with delay of consultation, pneumonic form, contact with other cases, occurrence after 2009, and not reporting dead rats. A seasonal pattern was observed with recrudescence during September–March. Annual cases peaked in 2004 and decreased to the lowest incidence in 2016. This overall reduction occurred primarily for suspected cases and might be caused by improved adherence to case criteria during widespread implementation of the F1 rapid diagnostic test in 2002.

EID Andrianaivoarimanana V, Piola P, Wagner DM, Rakotomanana F, Maheriniaina V, Andrianalimanana S, et al. Trends of Human Plague, Madagascar, 1998–2016. Emerg Infect Dis. 2019;25(2):220-228. https://doi.org/10.3201/eid2502.171974
AMA Andrianaivoarimanana V, Piola P, Wagner DM, et al. Trends of Human Plague, Madagascar, 1998–2016. Emerging Infectious Diseases. 2019;25(2):220-228. doi:10.3201/eid2502.171974.
APA Andrianaivoarimanana, V., Piola, P., Wagner, D. M., Rakotomanana, F., Maheriniaina, V., Andrianalimanana, S....Rajerison, M. (2019). Trends of Human Plague, Madagascar, 1998–2016. Emerging Infectious Diseases, 25(2), 220-228. https://doi.org/10.3201/eid2502.171974.

Medscape CME Activity
Human Pasteurellosis Health Risk for Elderly Persons Living with Companion Animals [PDF - 1.33 MB - 7 pages]
S. Körmöndi et al.
EID Körmöndi S, Terhes G, Pál Z, Varga E, Harmati M, Buzás K, et al. Human Pasteurellosis Health Risk for Elderly Persons Living with Companion Animals. Emerg Infect Dis. 2019;25(2):229-235. https://doi.org/10.3201/eid2502.180641
AMA Körmöndi S, Terhes G, Pál Z, et al. Human Pasteurellosis Health Risk for Elderly Persons Living with Companion Animals. Emerging Infectious Diseases. 2019;25(2):229-235. doi:10.3201/eid2502.180641.
APA Körmöndi, S., Terhes, G., Pál, Z., Varga, E., Harmati, M., Buzás, K....Urbán, E. (2019). Human Pasteurellosis Health Risk for Elderly Persons Living with Companion Animals. Emerging Infectious Diseases, 25(2), 229-235. https://doi.org/10.3201/eid2502.180641.

Lassa Fever in Travelers from West Africa, 1969–2016 [PDF - 322 KB - 4 pages]
A. Kofman et al.

Lassa virus is a rodentborne arenavirus responsible for human cases of Lassa fever, a viral hemorrhagic fever, in West Africa and in travelers arriving to non–Lassa-endemic countries from West Africa. We describe a retrospective review performed through literature search of clinical and epidemiologic characteristics of all imported Lassa fever cases worldwide during 1969–2016. Our findings demonstrate that approximately half of imported cases had distinctive clinical features (defined as fever and >1 of the following: pharyngitis, sore throat, tonsillitis, conjunctivitis, oropharyngeal ulcers, or proteinuria). Delays in clinical suspicion of this diagnosis were common. In addition, no secondary transmission of Lassa fever to contacts of patients with low-risk exposures occurred, and infection of high-risk contacts was rare. Future public health investigations of such cases should focus on timely recognition of distinctive clinical features, earlier treatment of patients, and targeted public health responses focused on high-risk contacts.

EID Kofman A, Choi MJ, Rollin PE. Lassa Fever in Travelers from West Africa, 1969–2016. Emerg Infect Dis. 2019;25(2):236-239. https://doi.org/10.3201/eid2502.180836
AMA Kofman A, Choi MJ, Rollin PE. Lassa Fever in Travelers from West Africa, 1969–2016. Emerging Infectious Diseases. 2019;25(2):236-239. doi:10.3201/eid2502.180836.
APA Kofman, A., Choi, M. J., & Rollin, P. E. (2019). Lassa Fever in Travelers from West Africa, 1969–2016. Emerging Infectious Diseases, 25(2), 236-239. https://doi.org/10.3201/eid2502.180836.

Ebola Virus Infection Associated with Transmission from Survivors [PDF - 865 KB - 7 pages]
S. Den Boon et al.

Ebola virus (EBOV) can persist in immunologically protected body sites in survivors of Ebola virus disease, creating the potential to initiate new chains of transmission. From the outbreak in West Africa during 2014–2016, we identified 13 possible events of viral persistence–derived transmission of EBOV (VPDTe) and applied predefined criteria to classify transmission events based on the strength of evidence for VPDTe and source and route of transmission. For 8 events, a recipient case was identified; possible source cases were identified for 5 of these 8. For 5 events, a recipient case or chain of transmission could not be confidently determined. Five events met our criteria for sexual transmission (male-to-female). One VPDTe event led to at least 4 generations of cases; transmission was limited after the other events. VPDTe has increased the importance of Ebola survivor services and sustained surveillance and response capacity in regions with previously widespread transmission.

EID Den Boon S, Marston BJ, Nyenswah TG, Jambai A, Barry M, Keita S, et al. Ebola Virus Infection Associated with Transmission from Survivors. Emerg Infect Dis. 2019;25(2):240-246. https://doi.org/10.3201/eid2502.181011
AMA Den Boon S, Marston BJ, Nyenswah TG, et al. Ebola Virus Infection Associated with Transmission from Survivors. Emerging Infectious Diseases. 2019;25(2):240-246. doi:10.3201/eid2502.181011.
APA Den Boon, S., Marston, B. J., Nyenswah, T. G., Jambai, A., Barry, M., Keita, S....Dye, C. (2019). Ebola Virus Infection Associated with Transmission from Survivors. Emerging Infectious Diseases, 25(2), 240-246. https://doi.org/10.3201/eid2502.181011.

Medscape CME Activity
Zika Virus Epidemic in Pregnant Women, Dominican Republic, 2016–2017 [PDF - 2.59 MB - 9 pages]
F. Peña et al.

Zika virus infection during pregnancy may result in birth defects and pregnancy complications. We describe the Zika virus outbreak in pregnant women in the Dominican Republic during 2016–2017. We conducted multinomial logistic regression to identify factors associated with fetal losses and preterm birth. The Ministry of Health identified 1,282 pregnant women with suspected Zika virus infection, a substantial proportion during their first trimester. Fetal loss was reported for ≈10% of the reported pregnancies, and 3 cases of fetal microcephaly were reported. Women infected during the first trimester were more likely to have early fetal loss (adjusted odds ratio 5.9, 95% CI 3.5–10.0). Experiencing fever during infection was associated with increased odds of premature birth (adjusted odds ratio 1.65, 95% CI 1.03–2.65). There was widespread morbidity during the epidemic. Our findings strengthen the evidence for a broad range of adverse pregnancy outcomes resulting from Zika virus infection.

EID Peña F, Pimentel R, Khosla S, Mehta SD, Brito MO. Zika Virus Epidemic in Pregnant Women, Dominican Republic, 2016–2017. Emerg Infect Dis. 2019;25(2):247-255. https://doi.org/10.3201/eid2502.181054
AMA Peña F, Pimentel R, Khosla S, et al. Zika Virus Epidemic in Pregnant Women, Dominican Republic, 2016–2017. Emerging Infectious Diseases. 2019;25(2):247-255. doi:10.3201/eid2502.181054.
APA Peña, F., Pimentel, R., Khosla, S., Mehta, S. D., & Brito, M. O. (2019). Zika Virus Epidemic in Pregnant Women, Dominican Republic, 2016–2017. Emerging Infectious Diseases, 25(2), 247-255. https://doi.org/10.3201/eid2502.181054.
Research

Medscape CME Activity
Acute and Delayed Deaths after West Nile Virus Infection, Texas, USA, 2002–2012 [PDF - 1.21 MB - 9 pages]
D. Philpott et al.

Infection with West Nile virus (WNV) has a well-characterized acute disease process. However, long-term consequences are less understood. We searched death records for 4,142 residents of Texas, USA, infected with WNV during 2002–2012 and identified 557 (13%) deaths. We analyzed all-cause and cause-specific deaths after WNV infection by calculating standardized mortality ratios and using statewide mortality data. Acute-phase deaths (<90 days after symptom onset) occurred in 289 (7%) of case-patients; of those deaths, 289 (92%) were cases of West Nile neuroinvasive disease (WNND). Convalescent-phase deaths (>90 days after symptom onset) occurred in 268 (7%) of the remaining 3,853 case-patients; 210 (78%) of these deaths occurred in patients with WNND. Convalescent-phase WNND case-patients showed excess deaths from infectious and renal causes; case-patients <60 years of age had increased risk for all-cause death, specifically from renal, infectious, digestive, and circulatory causes. We provide population-level evidence of increased risk for death after WNV infection resulting in WNND.

EID Philpott D, Nolan MS, Evert N, Mayes B, Hesalroad D, Fonken E, et al. Acute and Delayed Deaths after West Nile Virus Infection, Texas, USA, 2002–2012. Emerg Infect Dis. 2019;25(2):256-264. https://doi.org/10.3201/eid2502.181250
AMA Philpott D, Nolan MS, Evert N, et al. Acute and Delayed Deaths after West Nile Virus Infection, Texas, USA, 2002–2012. Emerging Infectious Diseases. 2019;25(2):256-264. doi:10.3201/eid2502.181250.
APA Philpott, D., Nolan, M. S., Evert, N., Mayes, B., Hesalroad, D., Fonken, E....Murray, K. O. (2019). Acute and Delayed Deaths after West Nile Virus Infection, Texas, USA, 2002–2012. Emerging Infectious Diseases, 25(2), 256-264. https://doi.org/10.3201/eid2502.181250.

Echinococcus multilocularis Infection, Southern Ontario, Canada [PDF - 1.48 MB - 8 pages]
J. D. Kotwa et al.

Alveolar echinococcosis, the disease caused by infection with the intermediate stage of the Echinococcus multilocularis tapeworm, is typically fatal in humans and dogs when left untreated. Since 2012, alveolar echinococcosis has been diagnosed in 5 dogs, 3 lemurs, and 1 chipmunk in southern Ontario, Canada, a region previously considered free of these tapeworms. Because of human and animal health concerns, we estimated prevalence of infection in wild canids across southern Ontario. During 2015–2017, we collected fecal samples from 460 wild canids (416 coyotes, 44 foxes) during postmortem examination and analyzed them by using a semiautomated magnetic capture probe DNA extraction and real-time PCR method for E. multilocularis DNA. Surprisingly, 23% (95% CI 20%–27%) of samples tested positive. By using a spatial scan test, we identified an infection cluster (relative risk 2.26; p = 0.002) in the western-central region of the province. The cluster encompasses areas of dense human population, suggesting zoonotic transmission.

EID Kotwa JD, Isaksson M, Jardine CM, Campbell G, Berke O, Pearl DL, et al. Echinococcus multilocularis Infection, Southern Ontario, Canada. Emerg Infect Dis. 2019;25(2):265-272. https://doi.org/10.3201/eid2502.180299
AMA Kotwa JD, Isaksson M, Jardine CM, et al. Echinococcus multilocularis Infection, Southern Ontario, Canada. Emerging Infectious Diseases. 2019;25(2):265-272. doi:10.3201/eid2502.180299.
APA Kotwa, J. D., Isaksson, M., Jardine, C. M., Campbell, G., Berke, O., Pearl, D. L....Peregrine, A. S. (2019). Echinococcus multilocularis Infection, Southern Ontario, Canada. Emerging Infectious Diseases, 25(2), 265-272. https://doi.org/10.3201/eid2502.180299.

Oasis Malaria, Northern Mauritania [PDF - 951 KB - 8 pages]
J. Deida et al.

A malaria survey was conducted in Atar, the northernmost oasis city in Mauritania, during 2015–2016. All febrile patients in whom malaria was suspected were screened for malaria by using rapid diagnostic testing and microscopic examination of blood smears and later confirmed by PCR. Of 453 suspected malaria cases, 108 (23.8%) were positive by rapid diagnostic testing, 154 (34.0%) by microscopic examination, and 162 (35.7%) by PCR. Malaria cases were observed throughout the year and among all age groups. Plasmodium vivax was present in 120/162 (74.1%) cases, P. falciparum in 4/162 (2.4%), and mixed P. falciparumP. vivax in 38/162 (23.4%). Malaria is endemic in northern Mauritania and could be spreading farther north in the Sahara, possibly because of human-driven environmental changes. Further entomologic and parasitologic studies and monitoring are needed to relate these findings to major Anopheles mosquito vectors and to design and implement strategies for malaria prevention and control.

EID Deida J, Tahar R, Khalef Y, Lekweiry K, Hmeyade A, Khairy M, et al. Oasis Malaria, Northern Mauritania. Emerg Infect Dis. 2019;25(2):273-280. https://doi.org/10.3201/eid2502.180732
AMA Deida J, Tahar R, Khalef Y, et al. Oasis Malaria, Northern Mauritania. Emerging Infectious Diseases. 2019;25(2):273-280. doi:10.3201/eid2502.180732.
APA Deida, J., Tahar, R., Khalef, Y., Lekweiry, K., Hmeyade, A., Khairy, M....Boukhary, A. (2019). Oasis Malaria, Northern Mauritania. Emerging Infectious Diseases, 25(2), 273-280. https://doi.org/10.3201/eid2502.180732.

Epidemiologic and Ecologic Investigations of Monkeypox, Likouala Department, Republic of the Congo, 2017 [PDF - 781 KB - 9 pages]
R. H. Doshi et al.

Monkeypox, caused by a zoonotic orthopoxvirus, is endemic in Central and West Africa. Monkeypox has been sporadically reported in the Republic of the Congo. During March 22–April 5, 2017, we investigated 43 suspected human monkeypox cases. We interviewed suspected case-patients and collected dried blood strips and vesicular and crust specimens (active lesions), which we tested for orthopoxvirus antibodies by ELISA and monkeypox virus and varicella zoster virus DNA by PCR. An ecologic investigation was conducted around Manfouété, and specimens from 105 small mammals were tested for anti-orthopoxvirus antibodies or DNA. Among the suspected human cases, 22 met the confirmed, probable, and possible case definitions. Only 18 patients had available dried blood strips; 100% were IgG positive, and 88.9% (16/18) were IgM positive. Among animals, only specimens from Cricetomys giant pouched rats showed presence of orthopoxvirus antibodies, adding evidence to this species’ involvement in the transmission and maintenance of monkeypox virus in nature.

EID Doshi RH, Guagliardo SJ, Doty JB, Babeaux A, Matheny A, Burgado J, et al. Epidemiologic and Ecologic Investigations of Monkeypox, Likouala Department, Republic of the Congo, 2017. Emerg Infect Dis. 2019;25(2):281-289. https://doi.org/10.3201/eid2502.181222
AMA Doshi RH, Guagliardo SJ, Doty JB, et al. Epidemiologic and Ecologic Investigations of Monkeypox, Likouala Department, Republic of the Congo, 2017. Emerging Infectious Diseases. 2019;25(2):281-289. doi:10.3201/eid2502.181222.
APA Doshi, R. H., Guagliardo, S. J., Doty, J. B., Babeaux, A., Matheny, A., Burgado, J....Petersen, B. W. (2019). Epidemiologic and Ecologic Investigations of Monkeypox, Likouala Department, Republic of the Congo, 2017. Emerging Infectious Diseases, 25(2), 281-289. https://doi.org/10.3201/eid2502.181222.

Macrophage Activation Marker Soluble CD163 Associated with Fatal and Severe Ebola Virus Disease in Humans [PDF - 2.99 MB - 9 pages]
A. K. McElroy et al.

Ebola virus disease (EVD) is associated with elevated cytokine levels, and hypercytokinemia is more pronounced in fatal cases. This type of hyperinflammatory state is reminiscent of 2 rheumatologic disorders known as macrophage activation syndrome and hemophagocytic lymphohistiocytosis, which are characterized by macrophage and T-cell activation. An evaluation of 2 cohorts of patients with EVD revealed that a marker of macrophage activation (sCD163) but not T-cell activation (sCD25) was associated with severe and fatal EVD. Furthermore, substantial immunoreactivity of host tissues to a CD163-specific antibody, predominantly in areas of extensive immunostaining for Ebola virus antigens, was observed in fatal cases. These data suggest that host macrophage activation contributes to EVD pathogenesis and that directed antiinflammatory therapies could be beneficial in the treatment of EVD.

EID McElroy AK, Shrivastava-Ranjan P, Harmon JR, Martines RB, Silva-Flannery L, Flietstra TD, et al. Macrophage Activation Marker Soluble CD163 Associated with Fatal and Severe Ebola Virus Disease in Humans. Emerg Infect Dis. 2019;25(2):290-298. https://doi.org/10.3201/eid2502.181326
AMA McElroy AK, Shrivastava-Ranjan P, Harmon JR, et al. Macrophage Activation Marker Soluble CD163 Associated with Fatal and Severe Ebola Virus Disease in Humans. Emerging Infectious Diseases. 2019;25(2):290-298. doi:10.3201/eid2502.181326.
APA McElroy, A. K., Shrivastava-Ranjan, P., Harmon, J. R., Martines, R. B., Silva-Flannery, L., Flietstra, T. D....Spiropoulou, C. F. (2019). Macrophage Activation Marker Soluble CD163 Associated with Fatal and Severe Ebola Virus Disease in Humans. Emerging Infectious Diseases, 25(2), 290-298. https://doi.org/10.3201/eid2502.181326.

Zika Virus IgM Detection and Neutralizing Antibody Profiles 12–19 Months after Illness Onset [PDF - 437 KB - 5 pages]
I. Griffin et al.

Data on the duration of detectable Zika virus–specific IgM in infected persons are limited. Neutralizing antibody cross-reactivity occurs between Zika virus and related flaviviruses, but the degree to which this confounds diagnosis is uncertain. We tested serum specimens collected 12–19 months after illness onset from patients with confirmed Zika virus disease for Zika virus IgM and Zika virus and dengue virus neutralizing antibodies. Among 62 participants, 45 (73%) had detectable Zika virus IgM and 12 (19%) had an equivocal result. Although all patients tested had Zika virus neutralizing antibodies, 39 (63%) also had neutralizing antibodies against dengue virus; of those, 12 (19%) had <4-fold difference between Zika virus and dengue virus titers, and 5 (8%) had dengue virus titer >4-fold higher than Zika virus titer. Prolonged detection of IgM and neutralizing antibody cross-reactivity make it difficult to determine the timing of Zika virus infection and differentiate between related flaviviruses.

EID Griffin I, Martin SW, Fischer M, Chambers TV, Kosoy O, Falise A, et al. Zika Virus IgM Detection and Neutralizing Antibody Profiles 12–19 Months after Illness Onset. Emerg Infect Dis. 2019;25(2):299-303. https://doi.org/10.3201/eid2502.181286
AMA Griffin I, Martin SW, Fischer M, et al. Zika Virus IgM Detection and Neutralizing Antibody Profiles 12–19 Months after Illness Onset. Emerging Infectious Diseases. 2019;25(2):299-303. doi:10.3201/eid2502.181286.
APA Griffin, I., Martin, S. W., Fischer, M., Chambers, T. V., Kosoy, O., Falise, A....Jean, R. (2019). Zika Virus IgM Detection and Neutralizing Antibody Profiles 12–19 Months after Illness Onset. Emerging Infectious Diseases, 25(2), 299-303. https://doi.org/10.3201/eid2502.181286.
Historical Review

Killing Clothes Lice by Holding Infested Clothes Away from Hosts for 10 Days to Control Louseborne Relapsing Fever, Bahir Dah, Ethiopia [PDF - 2.64 MB - 7 pages]
S. C. Barker and D. Barker

Louseborne relapsing fever (LBRF) was once a cosmopolitan disease, but it now occurs only in the Horn of Africa. Recent cases in refugees to Europe made LBRF topical again. Crowded boarding houses and church dwellings in Ethiopia are analogous to the crowded air-raid shelters of World War II. Thus, we might learn from experiments the London School of Tropical Hygiene and Medicine conducted during World War II. When the vector of Borrelia recurrentis (Pediculus humanus lice) was held away from the host for 10 days, 100% of nymphal and adult lice starved to death and 100% of eggs did not hatch. We hypothesize that holding infested clothes away from hosts in plastic shopping bags will kill enough lice to control LBRF in Ethiopia. Owning 2 sets of clothes might be useful; 1 set might be held in a plastic shopping bag for 10 days to kill lice and their eggs.

EID Barker SC, Barker D. Killing Clothes Lice by Holding Infested Clothes Away from Hosts for 10 Days to Control Louseborne Relapsing Fever, Bahir Dah, Ethiopia. Emerg Infect Dis. 2019;25(2):304-310. https://doi.org/10.3201/eid2502.181226
AMA Barker SC, Barker D. Killing Clothes Lice by Holding Infested Clothes Away from Hosts for 10 Days to Control Louseborne Relapsing Fever, Bahir Dah, Ethiopia. Emerging Infectious Diseases. 2019;25(2):304-310. doi:10.3201/eid2502.181226.
APA Barker, S. C., & Barker, D. (2019). Killing Clothes Lice by Holding Infested Clothes Away from Hosts for 10 Days to Control Louseborne Relapsing Fever, Bahir Dah, Ethiopia. Emerging Infectious Diseases, 25(2), 304-310. https://doi.org/10.3201/eid2502.181226.
Dispatches

Differential Shedding and Antibody Kinetics of Zika and Chikungunya Viruses, Brazil [PDF - 1.67 MB - 5 pages]
F. A. Bozza et al.

In seroconversion panels obtained from patients from Brazil, diagnostic testing for Zika virus infection was improved by combining multiple antibody isotypes, techniques, and antigens, but sensitivity remained suboptimal. In contrast, chikungunya virus diagnostic testing was unambiguous. Recurrent recent arbovirus infections suggested by serologic data and unspecific symptoms highlight the need for exhaustive virologic testing.

EID Bozza FA, Moreira-Soto A, Rockstroh A, Fischer C, Nascimento AD, Calheiros AS, et al. Differential Shedding and Antibody Kinetics of Zika and Chikungunya Viruses, Brazil. Emerg Infect Dis. 2019;25(2):311-315. https://doi.org/10.3201/eid2502.180166
AMA Bozza FA, Moreira-Soto A, Rockstroh A, et al. Differential Shedding and Antibody Kinetics of Zika and Chikungunya Viruses, Brazil. Emerging Infectious Diseases. 2019;25(2):311-315. doi:10.3201/eid2502.180166.
APA Bozza, F. A., Moreira-Soto, A., Rockstroh, A., Fischer, C., Nascimento, A. D., Calheiros, A. S....Drexler, J. (2019). Differential Shedding and Antibody Kinetics of Zika and Chikungunya Viruses, Brazil. Emerging Infectious Diseases, 25(2), 311-315. https://doi.org/10.3201/eid2502.180166.

Clinical Manifestations, Antimicrobial Drug Susceptibility Patterns, and Outcomes in Melioidosis Cases, India [PDF - 1.68 MB - 5 pages]
M. Koshy et al.

We studied the clinical manifestations and outcomes of 114 patients with culture-confirmed melioidosis treated at a tertiary hospital in southern India. Diabetes mellitus is the main risk factor, and chronic melioidosis mimicking tuberculosis was more common than acute disease. Septicemia and respiratory involvement were associated with poor outcomes.

EID Koshy M, Jagannati M, Ralph R, Victor P, David T, Sathyendra S, et al. Clinical Manifestations, Antimicrobial Drug Susceptibility Patterns, and Outcomes in Melioidosis Cases, India. Emerg Infect Dis. 2019;25(2):316-320. https://doi.org/10.3201/eid2502.170745
AMA Koshy M, Jagannati M, Ralph R, et al. Clinical Manifestations, Antimicrobial Drug Susceptibility Patterns, and Outcomes in Melioidosis Cases, India. Emerging Infectious Diseases. 2019;25(2):316-320. doi:10.3201/eid2502.170745.
APA Koshy, M., Jagannati, M., Ralph, R., Victor, P., David, T., Sathyendra, S....Varghese, G. M. (2019). Clinical Manifestations, Antimicrobial Drug Susceptibility Patterns, and Outcomes in Melioidosis Cases, India. Emerging Infectious Diseases, 25(2), 316-320. https://doi.org/10.3201/eid2502.170745.

Crimean-Congo Hemorrhagic Fever, Kosovo, 2013–2016 [PDF - 855 KB - 4 pages]
S. Ahmeti et al.

During 2013–2016, a total of 32 patients were treated for Crimean-Congo hemorrhagic fever in Prishtina, Kosovo; 11 died. In the 11 patients who died, findings included viral loads >1 × 108.5/mL, lactate dehydrogenase >2,700 U/mL, bleeding, and impaired consciousness. Ribavirin therapy had no noticeable effect in this small patient sample.

EID Ahmeti S, Berisha L, Halili B, Ahmeti F, von Possel R, Thomé-Bolduan C, et al. Crimean-Congo Hemorrhagic Fever, Kosovo, 2013–2016. Emerg Infect Dis. 2019;25(2):321-324. https://doi.org/10.3201/eid2502.171999
AMA Ahmeti S, Berisha L, Halili B, et al. Crimean-Congo Hemorrhagic Fever, Kosovo, 2013–2016. Emerging Infectious Diseases. 2019;25(2):321-324. doi:10.3201/eid2502.171999.
APA Ahmeti, S., Berisha, L., Halili, B., Ahmeti, F., von Possel, R., Thomé-Bolduan, C....Emmerich, P. (2019). Crimean-Congo Hemorrhagic Fever, Kosovo, 2013–2016. Emerging Infectious Diseases, 25(2), 321-324. https://doi.org/10.3201/eid2502.171999.

Cumulative Incidence of West Nile Virus Infection, Continental United States, 1999–2016 [PDF - 833 KB - 3 pages]
S. E. Ronca et al.

Using reported case data from ArboNET and previous seroprevalence data stratified by age and sex, we conservatively estimate that ≈7 million persons in the United States have been infected with West Nile virus since its introduction in 1999. Our data support the need for public health interventions and improved surveillance.

EID Ronca SE, Murray KO, Nolan MS. Cumulative Incidence of West Nile Virus Infection, Continental United States, 1999–2016. Emerg Infect Dis. 2019;25(2):325-327. https://doi.org/10.3201/eid2502.180765
AMA Ronca SE, Murray KO, Nolan MS. Cumulative Incidence of West Nile Virus Infection, Continental United States, 1999–2016. Emerging Infectious Diseases. 2019;25(2):325-327. doi:10.3201/eid2502.180765.
APA Ronca, S. E., Murray, K. O., & Nolan, M. S. (2019). Cumulative Incidence of West Nile Virus Infection, Continental United States, 1999–2016. Emerging Infectious Diseases, 25(2), 325-327. https://doi.org/10.3201/eid2502.180765.

Lyme Disease Emergence after Invasion of the Blacklegged Tick, Ixodes scapularis, Ontario, Canada, 2010–2016 [PDF - 2.66 MB - 5 pages]
M. A. Kulkarni et al.

Analysis of surveillance data for 2010–2016 in eastern Ontario, Canada, demonstrates the rapid northward spread of Ixodes scapularis ticks and Borrelia burgdorferi, followed by increasing human Lyme disease incidence. Most spread occurred during 2011–2013. Continued monitoring is essential to identify emerging risk areas in this region.

EID Kulkarni MA, Narula I, Slatculescu AM, Russell C. Lyme Disease Emergence after Invasion of the Blacklegged Tick, Ixodes scapularis, Ontario, Canada, 2010–2016. Emerg Infect Dis. 2019;25(2):328-332. https://doi.org/10.3201/eid2502.180771
AMA Kulkarni MA, Narula I, Slatculescu AM, et al. Lyme Disease Emergence after Invasion of the Blacklegged Tick, Ixodes scapularis, Ontario, Canada, 2010–2016. Emerging Infectious Diseases. 2019;25(2):328-332. doi:10.3201/eid2502.180771.
APA Kulkarni, M. A., Narula, I., Slatculescu, A. M., & Russell, C. (2019). Lyme Disease Emergence after Invasion of the Blacklegged Tick, Ixodes scapularis, Ontario, Canada, 2010–2016. Emerging Infectious Diseases, 25(2), 328-332. https://doi.org/10.3201/eid2502.180771.

Bat Influenza A(HL18NL11) Virus in Fruit Bats, Brazil [PDF - 1.52 MB - 5 pages]
A. Campos et al.

Screening of 533 bats for influenza A viruses showed subtype HL18NL11 in intestines of 2 great fruit-eating bats (Artibeus lituratus). High concentrations suggested fecal shedding. Genomic characterizations revealed conservation of viral genes across different host species, countries, and sampling years, suggesting a conserved cellular receptor and wide-ranging occurrence of bat influenza A viruses.

EID Campos A, Góes L, Moreira-Soto A, de Carvalho C, Ambar G, Sander A, et al. Bat Influenza A(HL18NL11) Virus in Fruit Bats, Brazil. Emerg Infect Dis. 2019;25(2):333-337. https://doi.org/10.3201/eid2502.181246
AMA Campos A, Góes L, Moreira-Soto A, et al. Bat Influenza A(HL18NL11) Virus in Fruit Bats, Brazil. Emerging Infectious Diseases. 2019;25(2):333-337. doi:10.3201/eid2502.181246.
APA Campos, A., Góes, L., Moreira-Soto, A., de Carvalho, C., Ambar, G., Sander, A....Drexler, J. (2019). Bat Influenza A(HL18NL11) Virus in Fruit Bats, Brazil. Emerging Infectious Diseases, 25(2), 333-337. https://doi.org/10.3201/eid2502.181246.

Rift Valley Fever Reemergence after 7 Years of Quiescence, South Africa, May 2018 [PDF - 831 KB - 4 pages]
P. Jansen van Vuren et al.

Phylogenetic analysis of Rift Valley fever virus partial genomic sequences from a patient infected in South Africa in May 2018 suggests reemergence of an endemic lineage different from that of the epidemic in South Africa during 2010–2011. Surveillance during interepidemic periods should be intensified to better predict future epidemics.

EID Jansen van Vuren P, Kgaladi J, Msimang V, Paweska JT. Rift Valley Fever Reemergence after 7 Years of Quiescence, South Africa, May 2018. Emerg Infect Dis. 2019;25(2):338-341. https://doi.org/10.3201/eid2502.181289
AMA Jansen van Vuren P, Kgaladi J, Msimang V, et al. Rift Valley Fever Reemergence after 7 Years of Quiescence, South Africa, May 2018. Emerging Infectious Diseases. 2019;25(2):338-341. doi:10.3201/eid2502.181289.
APA Jansen van Vuren, P., Kgaladi, J., Msimang, V., & Paweska, J. T. (2019). Rift Valley Fever Reemergence after 7 Years of Quiescence, South Africa, May 2018. Emerging Infectious Diseases, 25(2), 338-341. https://doi.org/10.3201/eid2502.181289.

Tick-Borne Encephalitis Virus Antibodies in Roe Deer, the Netherlands [PDF - 1.25 MB - 4 pages]
J. M. Rijks et al.

To increase knowledge of tick-borne encephalitis virus (TBEV) circulation in the Netherlands, we conducted serosurveillance in roe deer (Capreolus capreolus) during 2017 and compared results with those obtained during 2010. Results corroborate a more widespread occurrence of the virus in 2017. Additional precautionary public health measures have been taken.

EID Rijks JM, Montizaan M, Bakker N, de Vries A, Van Gucht S, Swaan C, et al. Tick-Borne Encephalitis Virus Antibodies in Roe Deer, the Netherlands. Emerg Infect Dis. 2019;25(2):342-345. https://doi.org/10.3201/eid2502.181386
AMA Rijks JM, Montizaan M, Bakker N, et al. Tick-Borne Encephalitis Virus Antibodies in Roe Deer, the Netherlands. Emerging Infectious Diseases. 2019;25(2):342-345. doi:10.3201/eid2502.181386.
APA Rijks, J. M., Montizaan, M., Bakker, N., de Vries, A., Van Gucht, S., Swaan, C....Sprong, H. (2019). Tick-Borne Encephalitis Virus Antibodies in Roe Deer, the Netherlands. Emerging Infectious Diseases, 25(2), 342-345. https://doi.org/10.3201/eid2502.181386.

Vector Competence of Aedes caspius and Ae. albopictus Mosquitoes for Zika Virus, Spain [PDF - 400 KB - 3 pages]
R. Gutiérrez-López et al.

We assessed the vector competence of Aedes caspius and Aedes albopictus mosquitoes in Spain for the transmission of Zika virus. Whereas Ae. albopictus mosquitoes were a competent vector, Ae. caspius mosquitoes were unable to transmit Zika virus. We also identified high levels of vertical transmission of Zika virus in Ae. albopictus mosquitoes.

EID Gutiérrez-López R, Bialosuknia SM, Ciota AT, Montalvo T, Martínez-de la Puente J, Gangoso L, et al. Vector Competence of Aedes caspius and Ae. albopictus Mosquitoes for Zika Virus, Spain. Emerg Infect Dis. 2019;25(2):346-348. https://doi.org/10.3201/eid2502.171123
AMA Gutiérrez-López R, Bialosuknia SM, Ciota AT, et al. Vector Competence of Aedes caspius and Ae. albopictus Mosquitoes for Zika Virus, Spain. Emerging Infectious Diseases. 2019;25(2):346-348. doi:10.3201/eid2502.171123.
APA Gutiérrez-López, R., Bialosuknia, S. M., Ciota, A. T., Montalvo, T., Martínez-de la Puente, J., Gangoso, L....Kramer, L. D. (2019). Vector Competence of Aedes caspius and Ae. albopictus Mosquitoes for Zika Virus, Spain. Emerging Infectious Diseases, 25(2), 346-348. https://doi.org/10.3201/eid2502.171123.

Submicroscopic Malaria in Migrants from Sub-Saharan Africa, Spain [PDF - 529 KB - 4 pages]
J. Pousibet-Puerto et al.

In a screening program, we detected submicroscopic malaria in 8.9% of recent migrants to Spain from sub-Saharan Africa. Hemoglobinopathies and filarial infection occurred more frequently in newly arrived migrants with submicroscopic malaria than in those without. Our findings could justify systematic screening in immigrants and recent travelers from malaria-endemic areas.

EID Pousibet-Puerto J, Cabezas-Fernández M, Lozano-Serrano AB, Vázquez-Villegas J, Soriano-Pérez MJ, Cabeza-Barrera I, et al. Submicroscopic Malaria in Migrants from Sub-Saharan Africa, Spain. Emerg Infect Dis. 2019;25(2):349-352. https://doi.org/10.3201/eid2502.180717
AMA Pousibet-Puerto J, Cabezas-Fernández M, Lozano-Serrano AB, et al. Submicroscopic Malaria in Migrants from Sub-Saharan Africa, Spain. Emerging Infectious Diseases. 2019;25(2):349-352. doi:10.3201/eid2502.180717.
APA Pousibet-Puerto, J., Cabezas-Fernández, M., Lozano-Serrano, A. B., Vázquez-Villegas, J., Soriano-Pérez, M. J., Cabeza-Barrera, I....Salas-Coronas, J. (2019). Submicroscopic Malaria in Migrants from Sub-Saharan Africa, Spain. Emerging Infectious Diseases, 25(2), 349-352. https://doi.org/10.3201/eid2502.180717.

Cytauxzoon felis Infection in Domestic Cats, Yunnan Province, China, 2016 [PDF - 380 KB - 2 pages]
F. Zou et al.

We performed a molecular survey for Cytauxzoon felis infection in 311 domestic cats in Yunnan Province, China, in 2016 and found a prevalence of 21.5%. C. felis infection in domestic and wild cats in other provinces should be investigated to determine parasite prevalence and genetic diversity among cats throughout China.

EID Zou F, Li Z, Yang J, Chang J, Liu G, Lv Y, et al. Cytauxzoon felis Infection in Domestic Cats, Yunnan Province, China, 2016. Emerg Infect Dis. 2019;25(2):353-354. https://doi.org/10.3201/eid2502.181182
AMA Zou F, Li Z, Yang J, et al. Cytauxzoon felis Infection in Domestic Cats, Yunnan Province, China, 2016. Emerging Infectious Diseases. 2019;25(2):353-354. doi:10.3201/eid2502.181182.
APA Zou, F., Li, Z., Yang, J., Chang, J., Liu, G., Lv, Y....Zhu, X. (2019). Cytauxzoon felis Infection in Domestic Cats, Yunnan Province, China, 2016. Emerging Infectious Diseases, 25(2), 353-354. https://doi.org/10.3201/eid2502.181182.

Molecular Detection and Species Determination of Malaria Parasites, Venezuela [PDF - 698 KB - 3 pages]
C. Pacheco et al.

In southeastern Venezuela, malaria cases have increased since 2013. We found that 46% of 352 blood samples from symptomatic patients in 1 municipality tested positive for Plasmodium spp. In addition, the number of cases increased by 10 times in 4 years (2014–2017) and by 3 times in 1 year (2016–2017).

EID Pacheco C, Moreno J, Herrera F. Molecular Detection and Species Determination of Malaria Parasites, Venezuela. Emerg Infect Dis. 2019;25(2):355-357. https://doi.org/10.3201/eid2502.181279
AMA Pacheco C, Moreno J, Herrera F. Molecular Detection and Species Determination of Malaria Parasites, Venezuela. Emerging Infectious Diseases. 2019;25(2):355-357. doi:10.3201/eid2502.181279.
APA Pacheco, C., Moreno, J., & Herrera, F. (2019). Molecular Detection and Species Determination of Malaria Parasites, Venezuela. Emerging Infectious Diseases, 25(2), 355-357. https://doi.org/10.3201/eid2502.181279.

Seroprevalence of Heartland Virus Antibodies in Blood Donors, Northwestern Missouri, USA [PDF - 473 KB - 3 pages]
N. P. Lindsey et al.

We estimated the seroprevalence of Heartland virus antibodies to be 0.9% (95% CI 0.4%–4.2%) in a convenience sample of blood donors from northwestern Missouri, USA, where human cases and infected ticks have been identified. Although these findings suggest that some past human infections were undetected, the estimated prevalence is low.

EID Lindsey NP, Menitove JE, Biggerstaff BJ, Turabelidze G, Parton P, Peck K, et al. Seroprevalence of Heartland Virus Antibodies in Blood Donors, Northwestern Missouri, USA. Emerg Infect Dis. 2019;25(2):358-360. https://doi.org/10.3201/eid2502.181288
AMA Lindsey NP, Menitove JE, Biggerstaff BJ, et al. Seroprevalence of Heartland Virus Antibodies in Blood Donors, Northwestern Missouri, USA. Emerging Infectious Diseases. 2019;25(2):358-360. doi:10.3201/eid2502.181288.
APA Lindsey, N. P., Menitove, J. E., Biggerstaff, B. J., Turabelidze, G., Parton, P., Peck, K....Staples, J. (2019). Seroprevalence of Heartland Virus Antibodies in Blood Donors, Northwestern Missouri, USA. Emerging Infectious Diseases, 25(2), 358-360. https://doi.org/10.3201/eid2502.181288.

Identification of Leishmania Species in Naturally Infected Sand Flies from Refugee Camps, Greece [PDF - 672 KB - 4 pages]
E. A. Fotakis et al.

High infection rates of Leishmania donovani and L. tropica were detected in Phlebotomus spp. sand flies collected from refugee camps in Greece, indicating increased risk of infection among local populations. Detection and treatment of leishmaniasis, community education, and vector control are essential measures to prevent pathogen transmission and protect public health.

EID Fotakis EA, Giantsis IA, Avgerinou A, Kourtidis S, Agathaggelidou E, Kapoula C, et al. Identification of Leishmania Species in Naturally Infected Sand Flies from Refugee Camps, Greece. Emerg Infect Dis. 2019;25(2):361-364. https://doi.org/10.3201/eid2502.181359
AMA Fotakis EA, Giantsis IA, Avgerinou A, et al. Identification of Leishmania Species in Naturally Infected Sand Flies from Refugee Camps, Greece. Emerging Infectious Diseases. 2019;25(2):361-364. doi:10.3201/eid2502.181359.
APA Fotakis, E. A., Giantsis, I. A., Avgerinou, A., Kourtidis, S., Agathaggelidou, E., Kapoula, C....Chaskopoulou, A. (2019). Identification of Leishmania Species in Naturally Infected Sand Flies from Refugee Camps, Greece. Emerging Infectious Diseases, 25(2), 361-364. https://doi.org/10.3201/eid2502.181359.
Research Letters

Schistosoma haematobiumSchistosoma mansoni Hybrid Parasite in Migrant Boy, France, 2017 [PDF - 1.71 MB - 3 pages]
Y. Le Govic et al.

Schistosomiasis is frequently detected in persons entering Europe. In 2017, we detected a Schistosoma mansoniSchistosoma haematobium hybrid parasite infection in a migrant boy from Côte d’Ivoire entering France. Because such parasites might be established in Europe, as illustrated by an outbreak on Corsica Island, vectors of these parasites should be investigated.

EID Le Govic Y, Kincaid-Smith J, Allienne J, Rey O, de Gentile L, Boissier J. Schistosoma haematobium–Schistosoma mansoni Hybrid Parasite in Migrant Boy, France, 2017. Emerg Infect Dis. 2019;25(2):365-367. https://doi.org/10.3201/eid2502.172028
AMA Le Govic Y, Kincaid-Smith J, Allienne J, et al. Schistosoma haematobium–Schistosoma mansoni Hybrid Parasite in Migrant Boy, France, 2017. Emerging Infectious Diseases. 2019;25(2):365-367. doi:10.3201/eid2502.172028.
APA Le Govic, Y., Kincaid-Smith, J., Allienne, J., Rey, O., de Gentile, L., & Boissier, J. (2019). Schistosoma haematobium–Schistosoma mansoni Hybrid Parasite in Migrant Boy, France, 2017. Emerging Infectious Diseases, 25(2), 365-367. https://doi.org/10.3201/eid2502.172028.

West Nile Virus Infection in Travelers Returning to United Kingdom from South Africa [PDF - 328 KB - 3 pages]
V. Parkash et al.

West Nile virus (WNV) is an arthropod-transmitted flavivirus that causes West Nile fever and may infrequently cause neuroinvasive disease in humans. We present 2 cases of confirmed WNV infection, 1 of severe encephalitis and 1 of mild febrile illness, in a couple returning to the United Kingdom from South Africa.

EID Parkash V, Woods K, Kafetzopoulou L, Osborne J, Aarons E, Cartwright K. West Nile Virus Infection in Travelers Returning to United Kingdom from South Africa. Emerg Infect Dis. 2019;25(2):367-369. https://doi.org/10.3201/eid2502.172101
AMA Parkash V, Woods K, Kafetzopoulou L, et al. West Nile Virus Infection in Travelers Returning to United Kingdom from South Africa. Emerging Infectious Diseases. 2019;25(2):367-369. doi:10.3201/eid2502.172101.
APA Parkash, V., Woods, K., Kafetzopoulou, L., Osborne, J., Aarons, E., & Cartwright, K. (2019). West Nile Virus Infection in Travelers Returning to United Kingdom from South Africa. Emerging Infectious Diseases, 25(2), 367-369. https://doi.org/10.3201/eid2502.172101.

East/Central/South African Genotype in a Chikungunya Outbreak, Dhaka, Bangladesh, 2017 [PDF - 727 KB - 3 pages]
M. Rahman et al.

In 2017, an unprecedented increase in febrile illness was observed in Dhaka, Bangladesh. Real-time reverse transcription PCR confirmed that 603 (40.2%) of 1,500 cases were chikungunya fever. Phylogenetic analysis revealed circulation of the non-A226V East/Central/South African genotype of chikungunya virus in Bangladesh.

EID Rahman M, Yamagishi J, Rahim R, Hasan A, Sobhan A. East/Central/South African Genotype in a Chikungunya Outbreak, Dhaka, Bangladesh, 2017. Emerg Infect Dis. 2019;25(2):370-372. https://doi.org/10.3201/eid2502.180188
AMA Rahman M, Yamagishi J, Rahim R, et al. East/Central/South African Genotype in a Chikungunya Outbreak, Dhaka, Bangladesh, 2017. Emerging Infectious Diseases. 2019;25(2):370-372. doi:10.3201/eid2502.180188.
APA Rahman, M., Yamagishi, J., Rahim, R., Hasan, A., & Sobhan, A. (2019). East/Central/South African Genotype in a Chikungunya Outbreak, Dhaka, Bangladesh, 2017. Emerging Infectious Diseases, 25(2), 370-372. https://doi.org/10.3201/eid2502.180188.

Dolphin Morbillivirus in Eurasian Otters, Italy [PDF - 784 KB - 3 pages]
I. Padalino et al.

We report biomolecular evidence of dolphin morbillivirus in 4 wild Eurasian otters (Lutra lutra) from southern Italy; 2 animals showed simultaneous immunohistochemical reactivity against morbilliviral antigen. These cases add further concern and support to the progressively expanding host range of dolphin morbillivirus in the western Mediterranean Sea.

EID Padalino I, Di Guardo G, Carbone A, Troiano P, Parisi A, Galante D, et al. Dolphin Morbillivirus in Eurasian Otters, Italy. Emerg Infect Dis. 2019;25(2):372-374. https://doi.org/10.3201/eid2502.180256
AMA Padalino I, Di Guardo G, Carbone A, et al. Dolphin Morbillivirus in Eurasian Otters, Italy. Emerging Infectious Diseases. 2019;25(2):372-374. doi:10.3201/eid2502.180256.
APA Padalino, I., Di Guardo, G., Carbone, A., Troiano, P., Parisi, A., Galante, D....Petrella, A. (2019). Dolphin Morbillivirus in Eurasian Otters, Italy. Emerging Infectious Diseases, 25(2), 372-374. https://doi.org/10.3201/eid2502.180256.

Little Evidence of Zika Virus Infection in Wild Long-Tailed Macaques, Peninsular Malaysia [PDF - 349 KB - 3 pages]
C. Chua et al.

We tested a sample of 234 wild long-tailed macaques (Macaca fascicularis) trapped in Peninsular Malaysia in 2009, 2010, and 2016 for Zika virus RNA and antibodies. None were positive for RNA, and only 1.3% were seropositive for neutralizing antibodies. Long-tailed macaques are unlikely to be reservoirs for Zika virus in Malaysia.

EID Chua C, Chan Y, Andu E, Rovie-Ryan JJ, Sitam F, Verasahib K, et al. Little Evidence of Zika Virus Infection in Wild Long-Tailed Macaques, Peninsular Malaysia. Emerg Infect Dis. 2019;25(2):374-376. https://doi.org/10.3201/eid2502.180258
AMA Chua C, Chan Y, Andu E, et al. Little Evidence of Zika Virus Infection in Wild Long-Tailed Macaques, Peninsular Malaysia. Emerging Infectious Diseases. 2019;25(2):374-376. doi:10.3201/eid2502.180258.
APA Chua, C., Chan, Y., Andu, E., Rovie-Ryan, J. J., Sitam, F., Verasahib, K....Sam, I. (2019). Little Evidence of Zika Virus Infection in Wild Long-Tailed Macaques, Peninsular Malaysia. Emerging Infectious Diseases, 25(2), 374-376. https://doi.org/10.3201/eid2502.180258.

Severe Fever with Thrombocytopenia Syndrome Virus in Dogs, South Korea [PDF - 471 KB - 3 pages]
J. Kang et al.

Of 103 serum samples collected from dogs in South Korea, 3 (2.9%) were positive for severe fever with thrombocytopenia syndrome virus (SFTSV) and 22 (21.4%) were positive for antibodies against SFTSV. A dog-derived isolate of SFTSV clustered with many South Korea SFTSV strains in the Japanese clade.

EID Kang J, Cho Y, Jo Y, Chae J, Joo Y, Park K, et al. Severe Fever with Thrombocytopenia Syndrome Virus in Dogs, South Korea. Emerg Infect Dis. 2019;25(2):376-378. https://doi.org/10.3201/eid2502.180859
AMA Kang J, Cho Y, Jo Y, et al. Severe Fever with Thrombocytopenia Syndrome Virus in Dogs, South Korea. Emerging Infectious Diseases. 2019;25(2):376-378. doi:10.3201/eid2502.180859.
APA Kang, J., Cho, Y., Jo, Y., Chae, J., Joo, Y., Park, K....Chae, J. (2019). Severe Fever with Thrombocytopenia Syndrome Virus in Dogs, South Korea. Emerging Infectious Diseases, 25(2), 376-378. https://doi.org/10.3201/eid2502.180859.

Pin-Site Myiasis Caused by Screwworm Fly in Nonhealed Wound, Colombia [PDF - 705 KB - 2 pages]
W. E. Villamil-Gómez et al.

Pin-site myiasis is an underreported complication of surgical interventions. We present a case of myiasis caused by the New World screwworm fly (Cochliomyia hominivorax) in a pin site of a chronic nonhealed wound 12 years after the intervention. This infection apparently was the result of poor perfusion of the leg.

EID Villamil-Gómez WE, Cardona-Ospina JA, Prado-Ojeda J, Hernández-Prado H, Figueroa M, Causil-Morales PN, et al. Pin-Site Myiasis Caused by Screwworm Fly in Nonhealed Wound, Colombia. Emerg Infect Dis. 2019;25(2):379-380. https://doi.org/10.3201/eid2502.181053
AMA Villamil-Gómez WE, Cardona-Ospina JA, Prado-Ojeda J, et al. Pin-Site Myiasis Caused by Screwworm Fly in Nonhealed Wound, Colombia. Emerging Infectious Diseases. 2019;25(2):379-380. doi:10.3201/eid2502.181053.
APA Villamil-Gómez, W. E., Cardona-Ospina, J. A., Prado-Ojeda, J., Hernández-Prado, H., Figueroa, M., Causil-Morales, P. N....Rodríguez-Morales, A. J. (2019). Pin-Site Myiasis Caused by Screwworm Fly in Nonhealed Wound, Colombia. Emerging Infectious Diseases, 25(2), 379-380. https://doi.org/10.3201/eid2502.181053.

Oropouche Virus–Associated Aseptic Meningoencephalitis, Southeastern Brazil [PDF - 601 KB - 3 pages]
S. Vernal et al.

Oropouche fever is a neglected arthropodborne disease and zoonosis responsible for several outbreaks of a febrile disease in Central and South America. We present a clinical case of aseptic meningoencephalitis in an immunocompetent patient that resulted from Oropouche virus acquired in northern Brazil but diagnosed in a nonendemic region.

EID Vernal S, Martini C, da Fonseca B. Oropouche Virus–Associated Aseptic Meningoencephalitis, Southeastern Brazil. Emerg Infect Dis. 2019;25(2):380-382. https://doi.org/10.3201/eid2502.181189
AMA Vernal S, Martini C, da Fonseca B. Oropouche Virus–Associated Aseptic Meningoencephalitis, Southeastern Brazil. Emerging Infectious Diseases. 2019;25(2):380-382. doi:10.3201/eid2502.181189.
APA Vernal, S., Martini, C., & da Fonseca, B. (2019). Oropouche Virus–Associated Aseptic Meningoencephalitis, Southeastern Brazil. Emerging Infectious Diseases, 25(2), 380-382. https://doi.org/10.3201/eid2502.181189.

Severe Respiratory Illness Associated with Human Metapneumovirus in Nursing Home, New Mexico, USA [PDF - 387 KB - 2 pages]
S. A. Peña et al.

Human metapneumovirus is an emerging pathogen that causes upper and lower respiratory illness. Nursing home outbreaks of infection with this virus can cause severe illness and lead to poor patient outcomes. We report an outbreak investigation in a nursing home during 2018 and infection control guidelines to assist in disease control.

EID Peña SA, Davis S, Lu X, Sakthivel SK, Peret T, Rose E, et al. Severe Respiratory Illness Associated with Human Metapneumovirus in Nursing Home, New Mexico, USA. Emerg Infect Dis. 2019;25(2):383-384. https://doi.org/10.3201/eid2502.181298
AMA Peña SA, Davis S, Lu X, et al. Severe Respiratory Illness Associated with Human Metapneumovirus in Nursing Home, New Mexico, USA. Emerging Infectious Diseases. 2019;25(2):383-384. doi:10.3201/eid2502.181298.
APA Peña, S. A., Davis, S., Lu, X., Sakthivel, S. K., Peret, T., Rose, E....Watson, J. (2019). Severe Respiratory Illness Associated with Human Metapneumovirus in Nursing Home, New Mexico, USA. Emerging Infectious Diseases, 25(2), 383-384. https://doi.org/10.3201/eid2502.181298.

Zoonotic Leishmaniasis, Bosnia and Herzegovina [PDF - 371 KB - 2 pages]
V. Colella et al.

Leishmania infantum causes potentially life-threatening disease in humans. To determine the extent of the animal reservoir for this pathogen in Bosnia and Herzegovina, we tested dogs and cats. We found that a large proportion of dogs were exposed to or infected with L. infantum, indicating endemicity in dogs and zoonotic risk for humans.

EID Colella V, Hodžić A, Iatta R, Baneth G, Alić A, Otranto D. Zoonotic Leishmaniasis, Bosnia and Herzegovina. Emerg Infect Dis. 2019;25(2):385-386. https://doi.org/10.3201/eid2502.181481
AMA Colella V, Hodžić A, Iatta R, et al. Zoonotic Leishmaniasis, Bosnia and Herzegovina. Emerging Infectious Diseases. 2019;25(2):385-386. doi:10.3201/eid2502.181481.
APA Colella, V., Hodžić, A., Iatta, R., Baneth, G., Alić, A., & Otranto, D. (2019). Zoonotic Leishmaniasis, Bosnia and Herzegovina. Emerging Infectious Diseases, 25(2), 385-386. https://doi.org/10.3201/eid2502.181481.

Clinical Characteristics of Ratborne Seoul Hantavirus Disease [PDF - 281 KB - 2 pages]
J. Clement et al.

Although Seoul orthohantavirus is the only globally spread hantavirus pathogen, few confirmed human infections with this virus have been reported in Western countries, suggesting lower medical awareness of the milder, transient, and often chameleon-like symptoms of this zoonosis. We describe lesser known clinical and laboratory characteristics to help improve underreporting of this virus.

EID Clement J, LeDuc JW, McElhinney LM, Reynes J, Van Ranst M, Calisher CH. Clinical Characteristics of Ratborne Seoul Hantavirus Disease. Emerg Infect Dis. 2019;25(2):387-388. https://doi.org/10.3201/eid2502.181643
AMA Clement J, LeDuc JW, McElhinney LM, et al. Clinical Characteristics of Ratborne Seoul Hantavirus Disease. Emerging Infectious Diseases. 2019;25(2):387-388. doi:10.3201/eid2502.181643.
APA Clement, J., LeDuc, J. W., McElhinney, L. M., Reynes, J., Van Ranst, M., & Calisher, C. H. (2019). Clinical Characteristics of Ratborne Seoul Hantavirus Disease. Emerging Infectious Diseases, 25(2), 387-388. https://doi.org/10.3201/eid2502.181643.
Letters

Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas [PDF - 546 KB - 2 pages]
G. Sharma and V. Sharma
EID Sharma G, Sharma V. Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas. Emerg Infect Dis. 2019;25(2):389-390. https://doi.org/10.3201/eid2502.171895
AMA Sharma G, Sharma V. Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas. Emerging Infectious Diseases. 2019;25(2):389-390. doi:10.3201/eid2502.171895.
APA Sharma, G., & Sharma, V. (2019). Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas. Emerging Infectious Diseases, 25(2), 389-390. https://doi.org/10.3201/eid2502.171895.
About the Cover

Malaria Elimination―Not Just a Bunch of Hocus-Pocus [PDF - 2.42 MB - 2 pages]
B. Breedlove and P. M. Arguin
EID Breedlove B, Arguin PM. Malaria Elimination―Not Just a Bunch of Hocus-Pocus. Emerg Infect Dis. 2019;25(2):391-392. https://doi.org/10.3201/eid2502.ac2502
AMA Breedlove B, Arguin PM. Malaria Elimination―Not Just a Bunch of Hocus-Pocus. Emerging Infectious Diseases. 2019;25(2):391-392. doi:10.3201/eid2502.ac2502.
APA Breedlove, B., & Arguin, P. M. (2019). Malaria Elimination―Not Just a Bunch of Hocus-Pocus. Emerging Infectious Diseases, 25(2), 391-392. https://doi.org/10.3201/eid2502.ac2502.
Etymologia

Etymologia: Cochliomyia hominivorax [PDF - 486 KB - 1 page]
R. Henry
EID Henry R. Etymologia: Cochliomyia hominivorax. Emerg Infect Dis. 2019;25(2):389. https://doi.org/10.3201/eid2502.et2502
AMA Henry R. Etymologia: Cochliomyia hominivorax. Emerging Infectious Diseases. 2019;25(2):389. doi:10.3201/eid2502.et2502.
APA Henry, R. (2019). Etymologia: Cochliomyia hominivorax. Emerging Infectious Diseases, 25(2), 389. https://doi.org/10.3201/eid2502.et2502.
Online Reports

Public Health–Driven Research and Innovation for Next-Generation Influenza Vaccines, European Union [PDF - 679 KB - 8 pages]
A. Navarro-Torné et al.

Influenza virus infections are a major public health threat. Vaccination is available, but unpredictable antigenic changes in circulating strains require annual modification of seasonal influenza vaccines. Vaccine effectiveness has proven limited, particularly in certain groups, such as the elderly. Moreover, preparedness for upcoming pandemics is challenging because we can predict neither the strain that will cause the next pandemic nor the severity of the pandemic. The European Union fosters research and innovation to develop novel vaccines that evoke broadly protective and long-lasting immune responses against both seasonal and pandemic influenza, underpinned by a political commitment to global public health.

Corrections

Correction: Vol. 25, No. 1

Correction: Vol. 25, No. 1

Correction: Vol. 24, No. 12

Correction: Vol. 25, No. 1
Page created: January 18, 2019
Page updated: January 18, 2019
Page reviewed: January 18, 2019
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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