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Issue Cover for Volume 25, Number 3—March 2019

Volume 25, Number 3—March 2019

[PDF - 13.14 MB - 236 pages]

Synopses

Case Investigations of Infectious Diseases Occurring in Workplaces, United States, 2006–2015 [PDF - 895 KB - 9 pages]
C. Su et al.

Workers in specific settings and activities are at increased risk for certain infectious diseases. When an infectious disease case occurs in a worker, investigators need to understand the mechanisms of disease propagation in the workplace. Few publications have explored these factors in the United States; a literature search yielded 66 investigations of infectious disease occurring in US workplaces during 2006–2015. Reported cases appear to be concentrated in specific industries and occupations, especially the healthcare industry, laboratory workers, animal workers, and public service workers. A hierarchy-of-controls approach can help determine how to implement effective preventive measures in workplaces. Consideration of occupational risk factors and control of occupational exposures will help prevent disease transmission in the workplace and protect workers’ health.

EID Su C, de Perio MA, Cummings KJ, McCague A, Luckhaupt SE, Sweeney M. Case Investigations of Infectious Diseases Occurring in Workplaces, United States, 2006–2015. Emerg Infect Dis. 2019;25(3):397-405. https://dx.doi.org/10.3201/eid2503.180708
AMA Su C, de Perio MA, Cummings KJ, et al. Case Investigations of Infectious Diseases Occurring in Workplaces, United States, 2006–2015. Emerging Infectious Diseases. 2019;25(3):397-405. doi:10.3201/eid2503.180708.
APA Su, C., de Perio, M. A., Cummings, K. J., McCague, A., Luckhaupt, S. E., & Sweeney, M. (2019). Case Investigations of Infectious Diseases Occurring in Workplaces, United States, 2006–2015. Emerging Infectious Diseases, 25(3), 397-405. https://dx.doi.org/10.3201/eid2503.180708.

Cross-Border Movement of Highly Drug-Resistant Mycobacterium tuberculosis from Papua New Guinea to Australia through Torres Strait Protected Zone, 2010–2015 [PDF - 1.89 MB - 10 pages]
A. Bainomugisa et al.

In this retrospective study, we used whole-genome sequencing (WGS) to delineate transmission dynamics, characterize drug-resistance markers, and identify risk factors of transmission among Papua New Guinea residents of the Torres Strait Protected Zone (TSPZ) who had tuberculosis diagnoses during 2010–2015. Of 117 isolates collected, we could acquire WGS data for 100; 79 were Beijing sublineage 2.2.1.1, which was associated with active transmission (odds ratio 6.190, 95% CI 2.221–18.077). Strains were distributed widely throughout the TSPZ. Clustering occurred more often within than between villages (p = 0.0013). Including 4 multidrug-resistant tuberculosis isolates from Australia citizens epidemiologically linked to the TSPZ into the transmission network analysis revealed 2 probable cross-border transmission events. All multidrug-resistant isolates (33/104) belonged to Beijing sublineage 2.2.1.1 and had high-level isoniazid and ethionamide co-resistance; 2 isolates were extensively drug resistant. Including WGS in regional surveillance could improve tuberculosis transmission tracking and control strategies within the TSPZ.

EID Bainomugisa A, Pandey S, Donnan E, Simpson G, Foster J, Lavu E, et al. Cross-Border Movement of Highly Drug-Resistant Mycobacterium tuberculosis from Papua New Guinea to Australia through Torres Strait Protected Zone, 2010–2015. Emerg Infect Dis. 2019;25(3):406-415. https://dx.doi.org/10.3201/eid2503.181003
AMA Bainomugisa A, Pandey S, Donnan E, et al. Cross-Border Movement of Highly Drug-Resistant Mycobacterium tuberculosis from Papua New Guinea to Australia through Torres Strait Protected Zone, 2010–2015. Emerging Infectious Diseases. 2019;25(3):406-415. doi:10.3201/eid2503.181003.
APA Bainomugisa, A., Pandey, S., Donnan, E., Simpson, G., Foster, J., Lavu, E....Coulter, C. (2019). Cross-Border Movement of Highly Drug-Resistant Mycobacterium tuberculosis from Papua New Guinea to Australia through Torres Strait Protected Zone, 2010–2015. Emerging Infectious Diseases, 25(3), 406-415. https://dx.doi.org/10.3201/eid2503.181003.

Donor-Derived Genotype 4 Hepatitis E Virus Infection, Hong Kong, China, 2018 [PDF - 1.42 MB - 9 pages]
S. Sridhar et al.

Hepatitis E virus (HEV) genotype 4 (HEV-4) is an emerging cause of acute hepatitis in China. Less is known about the clinical characteristics and natural history of HEV-4 than HEV genotype 3 infections in immunocompromised patients. We report transmission of HEV-4 from a deceased organ donor to 5 transplant recipients. The donor had been viremic but HEV IgM and IgG seronegative, and liver function test results were within reference ranges. After a mean of 52 days after transplantation, hepatitis developed in all 5 recipients; in the liver graft recipient, disease was severe and with progressive portal hypertension. Despite reduced immunosuppression, all HEV-4 infections progressed to persistent hepatitis. Four patients received ribavirin and showed evidence of response after 2 months. This study highlights the role of organ donation in HEV transmission, provides additional data on the natural history of HEV-4 infection, and points out differences between genotype 3 and 4 infections in immunocompromised patients.

EID Sridhar S, Cheng V, Wong S, Yip C, Wu S, Lo A, et al. Donor-Derived Genotype 4 Hepatitis E Virus Infection, Hong Kong, China, 2018. Emerg Infect Dis. 2019;25(3):425-433. https://dx.doi.org/10.3201/eid2503.181563
AMA Sridhar S, Cheng V, Wong S, et al. Donor-Derived Genotype 4 Hepatitis E Virus Infection, Hong Kong, China, 2018. Emerging Infectious Diseases. 2019;25(3):425-433. doi:10.3201/eid2503.181563.
APA Sridhar, S., Cheng, V., Wong, S., Yip, C., Wu, S., Lo, A....Yuen, K. (2019). Donor-Derived Genotype 4 Hepatitis E Virus Infection, Hong Kong, China, 2018. Emerging Infectious Diseases, 25(3), 425-433. https://dx.doi.org/10.3201/eid2503.181563.

University-Based Outbreaks of Meningococcal Disease Caused by Serogroup B, United States, 2013–2018 [PDF - 597 KB - 7 pages]
H. M. Soeters et al.

We reviewed university-based outbreaks of meningococcal disease caused by serogroup B and vaccination responses in the United States in the years following serogroup B meningococcal (MenB) vaccine availability. Ten university-based outbreaks occurred in 7 states during 2013–2018, causing a total of 39 cases and 2 deaths. Outbreaks occurred at universities with 3,600–35,000 undergraduates. Outbreak case counts ranged from 2 to 9 cases; outbreak duration ranged from 0 to 376 days. All 10 universities implemented MenB vaccination: 3 primarily used MenB-FHbp and 7 used MenB-4C. Estimated first-dose vaccination coverage ranged from 14% to 98%. In 5 outbreaks, additional cases occurred 6–259 days following MenB vaccination initiation. Although it is difficult to predict outbreak trajectories and evaluate the effects of public health response measures, achieving high MenB vaccination coverage is crucial to help protect at-risk persons during outbreaks of meningococcal disease caused by this serogroup.

EID Soeters HM, McNamara LA, Blain AE, Whaley M, MacNeil JR, Hariri S, et al. University-Based Outbreaks of Meningococcal Disease Caused by Serogroup B, United States, 2013–2018. Emerg Infect Dis. 2019;25(3):434-440. https://dx.doi.org/10.3201/eid2503.181574
AMA Soeters HM, McNamara LA, Blain AE, et al. University-Based Outbreaks of Meningococcal Disease Caused by Serogroup B, United States, 2013–2018. Emerging Infectious Diseases. 2019;25(3):434-440. doi:10.3201/eid2503.181574.
APA Soeters, H. M., McNamara, L. A., Blain, A. E., Whaley, M., MacNeil, J. R., Hariri, S....Mbaeyi, S. A. (2019). University-Based Outbreaks of Meningococcal Disease Caused by Serogroup B, United States, 2013–2018. Emerging Infectious Diseases, 25(3), 434-440. https://dx.doi.org/10.3201/eid2503.181574.

Medscape CME Activity
Treatment Outcomes in Global Systematic Review and Patient Meta-Analysis of Children with Extensively Drug-Resistant Tuberculosis [PDF - 965 KB - 10 pages]
M. Osman et al.

Extensively drug-resistant tuberculosis (XDR TB) has extremely poor treatment outcomes in adults. Limited data are available for children. We report on clinical manifestations, treatment, and outcomes for 37 children (<15 years of age) with bacteriologically confirmed XDR TB in 11 countries. These patients were managed during 1999–2013. For the 37 children, median age was 11 years, 32 (87%) had pulmonary TB, and 29 had a recorded HIV status; 7 (24%) were infected with HIV. Median treatment duration was 7.0 months for the intensive phase and 12.2 months for the continuation phase. Thirty (81%) children had favorable treatment outcomes. Four (11%) died, 1 (3%) failed treatment, and 2 (5%) did not complete treatment. We found a high proportion of favorable treatment outcomes among children, with mortality rates markedly lower than for adults. Regimens and duration of treatment varied considerably. Evaluation of new regimens in children is required.

EID Osman M, Harausz EP, Garcia-Prats AJ, Schaaf H, Moore BK, Hicks RM, et al. Treatment Outcomes in Global Systematic Review and Patient Meta-Analysis of Children with Extensively Drug-Resistant Tuberculosis. Emerg Infect Dis. 2019;25(3):441-450. https://dx.doi.org/10.3201/eid2503.180852
AMA Osman M, Harausz EP, Garcia-Prats AJ, et al. Treatment Outcomes in Global Systematic Review and Patient Meta-Analysis of Children with Extensively Drug-Resistant Tuberculosis. Emerging Infectious Diseases. 2019;25(3):441-450. doi:10.3201/eid2503.180852.
APA Osman, M., Harausz, E. P., Garcia-Prats, A. J., Schaaf, H., Moore, B. K., Hicks, R. M....Hesseling, A. C. (2019). Treatment Outcomes in Global Systematic Review and Patient Meta-Analysis of Children with Extensively Drug-Resistant Tuberculosis. Emerging Infectious Diseases, 25(3), 441-450. https://dx.doi.org/10.3201/eid2503.180852.

Medscape CME Activity
Bacillus Calmette-Guérin Cases Reported to the National Tuberculosis Surveillance System, United States, 2004–2015 [PDF - 1.01 MB - 6 pages]
Z. Wansaula et al.

Mycobacterium bovis bacillus Calmette-Guérin (BCG) is used as a vaccine to protect against disseminated tuberculosis (TB) and as a treatment for bladder cancer. We describe characteristics of US TB patients reported to the National Tuberculosis Surveillance System (NTSS) whose disease was attributed to BCG. We identified 118 BCG cases and 91,065 TB cases reported to NTSS during 2004–2015. Most patients with BCG were US-born (86%), older (median age 75 years), and non-Hispanic white (81%). Only 17% of BCG cases had pulmonary involvement, in contrast with 84% of TB cases. Epidemiologic features of BCG cases differed from TB cases. Clinicians can use clinical history to discern probable BCG cases from TB cases, enabling optimal clinical management. Public health agencies can use this information to quickly identify probable BCG cases to avoid inappropriately reporting BCG cases to NTSS or expending resources on unnecessary public health interventions.

EID Wansaula Z, Wortham JM, Mindra G, Haddad MB, Salinas JL, Ashkin D, et al. Bacillus Calmette-Guérin Cases Reported to the National Tuberculosis Surveillance System, United States, 2004–2015. Emerg Infect Dis. 2019;25(3):451-456. https://dx.doi.org/10.3201/eid2503.180686
AMA Wansaula Z, Wortham JM, Mindra G, et al. Bacillus Calmette-Guérin Cases Reported to the National Tuberculosis Surveillance System, United States, 2004–2015. Emerging Infectious Diseases. 2019;25(3):451-456. doi:10.3201/eid2503.180686.
APA Wansaula, Z., Wortham, J. M., Mindra, G., Haddad, M. B., Salinas, J. L., Ashkin, D....Langer, A. J. (2019). Bacillus Calmette-Guérin Cases Reported to the National Tuberculosis Surveillance System, United States, 2004–2015. Emerging Infectious Diseases, 25(3), 451-456. https://dx.doi.org/10.3201/eid2503.180686.

Epidemiology of Extrapulmonary Tuberculosis among Inpatients, China, 2008–2017 [PDF - 991 KB - 8 pages]
Y. Pang et al.

We investigated the epidemiology of extrapulmonary tuberculosis (TB) among patients admitted to Beijing Chest Hospital, Beijing, China, during January 2008–December 2017. Of 19,279 hospitalized TB patients, 33.4% (6,433) had extrapulmonary TB and 66.6% (12,846) had pulmonary TB. The most frequent forms of extrapulmonary TB observed were skeletal TB (41.1%) and pleural TB (26.0%). Younger, female patients from rural areas were more likely to have extrapulmonary TB. However, patients with diabetes mellitus were less likely to have extrapulmonary TB compared with patients without diabetes. A higher proportion of multidrug-resistant (MDR) TB was observed among patients with extrapulmonary TB than among patients with pulmonary TB. We observed a large increase in MDR TB, from 17.3% to 35.7%, for pleural TB cases. The increasing rate of drug resistance among extrapulmonary TB cases highlights the need for drug susceptibility testing and the formulation of more effective regimens for extrapulmonary TB treatment.

EID Pang Y, An J, Shu W, Huo F, Chu N, Gao M, et al. Epidemiology of Extrapulmonary Tuberculosis among Inpatients, China, 2008–2017. Emerg Infect Dis. 2019;25(3):457-464. https://dx.doi.org/10.3201/eid2503.180572
AMA Pang Y, An J, Shu W, et al. Epidemiology of Extrapulmonary Tuberculosis among Inpatients, China, 2008–2017. Emerging Infectious Diseases. 2019;25(3):457-464. doi:10.3201/eid2503.180572.
APA Pang, Y., An, J., Shu, W., Huo, F., Chu, N., Gao, M....Xu, S. (2019). Epidemiology of Extrapulmonary Tuberculosis among Inpatients, China, 2008–2017. Emerging Infectious Diseases, 25(3), 457-464. https://dx.doi.org/10.3201/eid2503.180572.
Research

Emergence and Spread of Cephalosporin-Resistant Neisseria gonorrhoeae with Mosaic penA Alleles, South Korea, 2012–2017 [PDF - 1.03 MB - 9 pages]
H. Lee et al.

In South Korea, surveillance of antimicrobial drug resistance in Neisseria gonorrhoeae is extremely limited. We describe the emergence and subsequent national spread of N. gonorrhoeae strains with mosaic penA alleles associated with decreased susceptibility and resistance to extended-spectrum cephalosporins. From 2012 through 2017, the proportion of mosaic penA alleles in gonococcal-positive nucleic acid amplification test (NAAT) specimens across South Korea increased from 1.1% to 23.9%. Gonococcal strains with mosaic penA alleles emerged in the international hubs of Seoul in Gyeonggi Province and Busan in South Gyeongsang Province and subsequently spread across South Korea. Most common was mosaic penA-10.001 (n = 572 isolates; 94.7%), which is associated with cefixime resistance. We also identified mosaic penA-34.001 and penA-60.001, both of which are associated with multidrug-resistant gonococcal strains and spread of cefixime and ceftriaxone resistance. Implementation of molecular resistance prediction from N. gonorrhoeae–positive nucleic acid amplification test specimens is imperative in South Korea and internationally.

EID Lee H, Suh Y, Lee S, Kim Y, Han M, Bae H, et al. Emergence and Spread of Cephalosporin-Resistant Neisseria gonorrhoeae with Mosaic penA Alleles, South Korea, 2012–2017. Emerg Infect Dis. 2019;25(3):416-424. https://dx.doi.org/10.3201/eid2503.181503
AMA Lee H, Suh Y, Lee S, et al. Emergence and Spread of Cephalosporin-Resistant Neisseria gonorrhoeae with Mosaic penA Alleles, South Korea, 2012–2017. Emerging Infectious Diseases. 2019;25(3):416-424. doi:10.3201/eid2503.181503.
APA Lee, H., Suh, Y., Lee, S., Kim, Y., Han, M., Bae, H....Lee, K. (2019). Emergence and Spread of Cephalosporin-Resistant Neisseria gonorrhoeae with Mosaic penA Alleles, South Korea, 2012–2017. Emerging Infectious Diseases, 25(3), 416-424. https://dx.doi.org/10.3201/eid2503.181503.

Reassortments among Avian Influenza A(H5N1) Viruses Circulating in Indonesia, 2015–2016 [PDF - 3.69 MB - 8 pages]
D. Karo-karo et al.

Highly pathogenic avian influenza (HPAI) A(H5N1) viruses have been circulating since 2003 in Indonesia, with major impacts on poultry health, severe economic losses, and 168 fatal laboratory-confirmed human cases. We performed phylogenetic analysis on 39 full-genome H5N1 virus samples collected during outbreaks among poultry in 2015–2016 in West Java and compared them with recently published sequences from Indonesia. Phylogenetic analysis revealed that the hemagglutinin gene of all samples belonged to 2 genetic groups in clade 2.3.2.1c. We also observed these groups for the neuraminidase, nucleoprotein, polymerase, and polymerase basic 1 genes. Matrix, nonstructural protein, and polymerase basic 2 genes of some HPAI were most closely related to clade 2.1.3 instead of clade 2.3.2.1c, and a polymerase basic 2 gene was most closely related to Eurasian low pathogenicity avian influenza. Our results detected a total of 13 reassortment types among HPAI in Indonesia, mostly in backyard chickens in Indramayu.

EID Karo-karo D, Bodewes R, Wibawa H, Artika M, Pribadi E, Diyantoro D, et al. Reassortments among Avian Influenza A(H5N1) Viruses Circulating in Indonesia, 2015–2016. Emerg Infect Dis. 2019;25(3):465-472. https://dx.doi.org/10.3201/eid2503.180167
AMA Karo-karo D, Bodewes R, Wibawa H, et al. Reassortments among Avian Influenza A(H5N1) Viruses Circulating in Indonesia, 2015–2016. Emerging Infectious Diseases. 2019;25(3):465-472. doi:10.3201/eid2503.180167.
APA Karo-karo, D., Bodewes, R., Wibawa, H., Artika, M., Pribadi, E., Diyantoro, D....Koch, G. (2019). Reassortments among Avian Influenza A(H5N1) Viruses Circulating in Indonesia, 2015–2016. Emerging Infectious Diseases, 25(3), 465-472. https://dx.doi.org/10.3201/eid2503.180167.

Mycobacterium avium in Community and Household Water, Suburban Philadelphia, Pennsylvania, USA, 20102012 [PDF - 1.03 MB - 9 pages]
L. Lande et al.

Attention to environmental sources of Mycobacterium avium complex (MAC) infection is a vital component of disease prevention and control. We investigated MAC colonization of household plumbing in suburban Philadelphia, Pennsylvania, USA. We used variable-number tandem-repeat genotyping and whole-genome sequencing with core genome single-nucleotide variant analysis to compare M. avium from household plumbing biofilms with M. avium isolates from patient respiratory specimens. M. avium was recovered from 30 (81.1%) of 37 households, including 19 (90.5%) of 21 M. avium patient households. For 11 (52.4%) of 21 patients with M. avium disease, isolates recovered from their respiratory and household samples were of the same genotype. Within the same community, 18 (85.7%) of 21 M. avium respiratory isolates genotypically matched household plumbing isolates. Six predominant genotypes were recovered across multiple households and respiratory specimens. M. avium colonizing municipal water and household plumbing may be a substantial source of MAC pulmonary infection.

EID Lande L, Alexander DC, Wallace RJ, Kwait R, Iakhiaeva E, Williams M, et al. Mycobacterium avium in Community and Household Water, Suburban Philadelphia, Pennsylvania, USA, 2010–2012. Emerg Infect Dis. 2019;25(3):473-481. https://dx.doi.org/10.3201/eid2503.180336
AMA Lande L, Alexander DC, Wallace RJ, et al. Mycobacterium avium in Community and Household Water, Suburban Philadelphia, Pennsylvania, USA, 2010–2012. Emerging Infectious Diseases. 2019;25(3):473-481. doi:10.3201/eid2503.180336.
APA Lande, L., Alexander, D. C., Wallace, R. J., Kwait, R., Iakhiaeva, E., Williams, M....Falkinham, J. O. (2019). Mycobacterium avium in Community and Household Water, Suburban Philadelphia, Pennsylvania, USA, 2010–2012. Emerging Infectious Diseases, 25(3), 473-481. https://dx.doi.org/10.3201/eid2503.180336.

SNP-IT Tool for Identifying Subspecies and Associated Lineages of Mycobacterium tuberculosis Complex [PDF - 784 KB - 7 pages]
S. Lipworth et al.

The clinical phenotype of zoonotic tuberculosis and its contribution to the global burden of disease are poorly understood and probably underestimated. This shortcoming is partly because of the inability of currently available laboratory and in silico tools to accurately identify all subspecies of the Mycobacterium tuberculosis complex (MTBC). We present SNPs to Identify TB (SNP-IT), a single-nucleotide polymorphism–based tool to identify all members of MTBC, including animal clades. By applying SNP-IT to a collection of clinical genomes from a UK reference laboratory, we detected an unexpectedly high number of M. orygis isolates. M. orygis is seen at a similar rate to M. bovis, yet M. orygis cases have not been previously described in the United Kingdom. From an international perspective, it is possible that M. orygis is an underestimated zoonosis. Accurate identification will enable study of the clinical phenotype, host range, and transmission mechanisms of all subspecies of MTBC in greater detail.

EID Lipworth S, Jajou R, de Neeling A, Bradley P, van der Hoek W, Maphalala G, et al. SNP-IT Tool for Identifying Subspecies and Associated Lineages of Mycobacterium tuberculosis Complex. Emerg Infect Dis. 2019;25(3):482-488. https://dx.doi.org/10.3201/eid2503.180894
AMA Lipworth S, Jajou R, de Neeling A, et al. SNP-IT Tool for Identifying Subspecies and Associated Lineages of Mycobacterium tuberculosis Complex. Emerging Infectious Diseases. 2019;25(3):482-488. doi:10.3201/eid2503.180894.
APA Lipworth, S., Jajou, R., de Neeling, A., Bradley, P., van der Hoek, W., Maphalala, G....van Soolingen, D. (2019). SNP-IT Tool for Identifying Subspecies and Associated Lineages of Mycobacterium tuberculosis Complex. Emerging Infectious Diseases, 25(3), 482-488. https://dx.doi.org/10.3201/eid2503.180894.

Use of Genomics to Investigate Historical Importation of Shiga Toxin–Producing Escherichia coli Serogroup O26 and Nontoxigenic Variants into New Zealand [PDF - 6.07 MB - 12 pages]
A. Browne et al.

Shiga toxin–producing Escherichia coli serogroup O26 is an important public health pathogen. Phylogenetic bacterial lineages in a country can be associated with the level and timing of international imports of live cattle, the main reservoir. We sequenced the genomes of 152 E. coli O26 isolates from New Zealand and compared them with 252 E. coli O26 genomes from 14 other countries. Gene variation among isolates from humans, animals, and food was strongly associated with country of origin and stx toxin profile but not isolation source. Time of origin estimates indicate serogroup O26 sequence type 21 was introduced at least 3 times into New Zealand from the 1920s to the 1980s, whereas nonvirulent O26 sequence type 29 strains were introduced during the early 2000s. New Zealand’s remarkably fewer introductions of Shiga toxin–producing Escherichia coli O26 compared with other countries (such as Japan) might be related to patterns of trade in live cattle.

EID Browne A, Biggs PJ, Wilkinson DA, Cookson AL, Midwinter AC, Bloomfield SJ, et al. Use of Genomics to Investigate Historical Importation of Shiga Toxin–Producing Escherichia coli Serogroup O26 and Nontoxigenic Variants into New Zealand. Emerg Infect Dis. 2019;25(3):489-500. https://dx.doi.org/10.3201/eid2503.180899
AMA Browne A, Biggs PJ, Wilkinson DA, et al. Use of Genomics to Investigate Historical Importation of Shiga Toxin–Producing Escherichia coli Serogroup O26 and Nontoxigenic Variants into New Zealand. Emerging Infectious Diseases. 2019;25(3):489-500. doi:10.3201/eid2503.180899.
APA Browne, A., Biggs, P. J., Wilkinson, D. A., Cookson, A. L., Midwinter, A. C., Bloomfield, S. J....French, N. P. (2019). Use of Genomics to Investigate Historical Importation of Shiga Toxin–Producing Escherichia coli Serogroup O26 and Nontoxigenic Variants into New Zealand. Emerging Infectious Diseases, 25(3), 489-500. https://dx.doi.org/10.3201/eid2503.180899.

Utility of Whole-Genome Sequencing to Ascertain Locally Acquired Cases of Coccidioidomycosis, Washington, USA [PDF - 717 KB - 6 pages]
H. N. Oltean et al.

Coccidioidomycosis is an emerging fungal infection in Washington, USA, and the epidemiology of the disease in this state is poorly understood. We used whole-genome sequencing to differentiate locally acquired cases in Washington on the basis of the previously identified phylogeographic population structure of Coccidioides spp. Clinical isolates from coccidioidomycosis cases involving possible Washington soil exposure were included. Of 17 human infections with epidemiologic evidence of possible local acquisition, 4 were likely locally acquired infections and 13 were likely acquired outside Washington. Isolates from locally acquired cases clustered within the previously established Washington clade of C. immitis. Genetic differences among these strains suggest multiple environmental reservoirs of C. immitis in the state.

EID Oltean HN, Etienne KA, Roe CC, Gade L, McCotter OZ, Engelthaler DM, et al. Utility of Whole-Genome Sequencing to Ascertain Locally Acquired Cases of Coccidioidomycosis, Washington, USA. Emerg Infect Dis. 2019;25(3):501-506. https://dx.doi.org/10.3201/eid2503.181155
AMA Oltean HN, Etienne KA, Roe CC, et al. Utility of Whole-Genome Sequencing to Ascertain Locally Acquired Cases of Coccidioidomycosis, Washington, USA. Emerging Infectious Diseases. 2019;25(3):501-506. doi:10.3201/eid2503.181155.
APA Oltean, H. N., Etienne, K. A., Roe, C. C., Gade, L., McCotter, O. Z., Engelthaler, D. M....Litvintseva, A. P. (2019). Utility of Whole-Genome Sequencing to Ascertain Locally Acquired Cases of Coccidioidomycosis, Washington, USA. Emerging Infectious Diseases, 25(3), 501-506. https://dx.doi.org/10.3201/eid2503.181155.

Simplified Model to Survey Tuberculosis Transmission in Countries Without Systematic Molecular Epidemiology Programs [PDF - 924 KB - 8 pages]
J. Domínguez et al.

Systematic molecular/genomic epidemiology studies for tuberculosis surveillance cannot be implemented in many countries. We selected Panama as a model for an alternative strategy. Mycobacterial interspersed repetitive unit–variable-number tandem-repeat (MIRU-VNTR) analysis revealed a high proportion (50%) of Mycobacterium tuberculosis isolates included in 6 clusters (A–F) in 2 provinces (Panama and Colon). Cluster A corresponded to the Beijing sublineage. Whole-genome sequencing (WGS) differentiated clusters due to active recent transmission, with low single-nucleotide polymorphism–based diversity (cluster C), from clusters involving long-term prevalent strains with higher diversity (clusters A, B). Prospective application in Panama of 3 tailored strain–specific PCRs targeting marker single-nucleotide polymorphisms identified from WGS data revealed that 31.4% of incident cases involved strains A–C and that the Beijing strain was highly represented and restricted mainly to Colon. Rational integration of MIRU-VNTR, WGS, and tailored strain–specific PCRs could be a new model for tuberculosis surveillance in countries without molecular/genomic epidemiology programs.

EID Domínguez J, Acosta F, Pérez-Lago L, Sambrano D, Batista V, De La Guardia C, et al. Simplified Model to Survey Tuberculosis Transmission in Countries Without Systematic Molecular Epidemiology Programs. Emerg Infect Dis. 2019;25(3):507-514. https://dx.doi.org/10.3201/eid2503.181593
AMA Domínguez J, Acosta F, Pérez-Lago L, et al. Simplified Model to Survey Tuberculosis Transmission in Countries Without Systematic Molecular Epidemiology Programs. Emerging Infectious Diseases. 2019;25(3):507-514. doi:10.3201/eid2503.181593.
APA Domínguez, J., Acosta, F., Pérez-Lago, L., Sambrano, D., Batista, V., De La Guardia, C....García de Viedma, D. (2019). Simplified Model to Survey Tuberculosis Transmission in Countries Without Systematic Molecular Epidemiology Programs. Emerging Infectious Diseases, 25(3), 507-514. https://dx.doi.org/10.3201/eid2503.181593.

Multicenter Study of Cronobacter sakazakii Infections in Humans, Europe, 2017 [PDF - 1.67 MB - 8 pages]
S. Lepuschitz et al.

Cronobacter sakazakii has been documented as a cause of life-threating infections, predominantly in neonates. We conducted a multicenter study to assess the occurrence of C. sakazakii across Europe and the extent of clonality for outbreak detection. National coordinators representing 24 countries in Europe were requested to submit all human C. sakazakii isolates collected during 2017 to a study center in Austria. Testing at the center included species identification by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, subtyping by whole-genome sequencing (WGS), and determination of antimicrobial resistance. Eleven countries sent 77 isolates, including 36 isolates from 2017 and 41 historical isolates. Fifty-nine isolates were confirmed as C. sakazakii by WGS, highlighting the challenge of correctly identifying Cronobacter spp. WGS-based typing revealed high strain diversity, indicating absence of multinational outbreaks in 2017, but identified 4 previously unpublished historical outbreaks. WGS is the recommended method for accurate identification, typing, and detection of this pathogen.

EID Lepuschitz S, Ruppitsch W, Pekard-Amenitsch S, Forsythe SJ, Cormican M, Mach RL, et al. Multicenter Study of Cronobacter sakazakii Infections in Humans, Europe, 2017. Emerg Infect Dis. 2019;25(3):515-522. https://dx.doi.org/10.3201/eid2503.181652
AMA Lepuschitz S, Ruppitsch W, Pekard-Amenitsch S, et al. Multicenter Study of Cronobacter sakazakii Infections in Humans, Europe, 2017. Emerging Infectious Diseases. 2019;25(3):515-522. doi:10.3201/eid2503.181652.
APA Lepuschitz, S., Ruppitsch, W., Pekard-Amenitsch, S., Forsythe, S. J., Cormican, M., Mach, R. L....Allerberger, F. (2019). Multicenter Study of Cronobacter sakazakii Infections in Humans, Europe, 2017. Emerging Infectious Diseases, 25(3), 515-522. https://dx.doi.org/10.3201/eid2503.181652.

Window Period Prophylaxis for Children Exposed to Tuberculosis, Houston, Texas, USA, 2007–2017 [PDF - 398 KB - 6 pages]
A. T. Cruz and J. R. Starke

In this retrospective study, we assessed the safety of window period prophylaxis and proportion of tuberculin skin test (TST) conversions in children <5 years of age who were exposed to an adult with tuberculosis disease during 2007–2017. Children included in this study had unremarkable examination and chest radiograph findings and negative test results for TB infection. In total, 752 children (41% cohabitating with the index patient) received prophylaxis during the window period, usually directly observed therapy with isoniazid. Hepatotoxicity and tuberculosis disease did not develop in any child. TST conversion occurred in 37 (4.9%) children and was associated with the index patient being the child’s parent (odds ratio 3.2, 95% CI 1.2–8.2). TST conversion was not associated with sputum smear results, culture positivity, or cohabitation. Thresholds for initiation of window prophylaxis in exposed young children should be low given the safety of medication and difficulties with risk stratification.

EID Cruz AT, Starke JR. Window Period Prophylaxis for Children Exposed to Tuberculosis, Houston, Texas, USA, 2007–2017. Emerg Infect Dis. 2019;25(3):523-528. https://dx.doi.org/10.3201/eid2503.181596
AMA Cruz AT, Starke JR. Window Period Prophylaxis for Children Exposed to Tuberculosis, Houston, Texas, USA, 2007–2017. Emerging Infectious Diseases. 2019;25(3):523-528. doi:10.3201/eid2503.181596.
APA Cruz, A. T., & Starke, J. R. (2019). Window Period Prophylaxis for Children Exposed to Tuberculosis, Houston, Texas, USA, 2007–2017. Emerging Infectious Diseases, 25(3), 523-528. https://dx.doi.org/10.3201/eid2503.181596.

Increased Risk for Invasive Group A Streptococcus Disease for Household Contacts of Scarlet Fever Cases, England, 2011–2016 [PDF - 968 KB - 9 pages]
V. Watts et al.

The incidence of scarlet fever in England and Wales is at its highest in 50 years. We estimated secondary household risk for invasive group A Streptococcus (iGAS) disease within 60 days after onset of scarlet fever. Reports of scarlet fever in England during 2011–2016 were matched by residential address to persons with laboratory-confirmed iGAS infections. We identified 11 iGAS cases in ≈189,684 household contacts and a 60-day incidence rate of 35.3 cases/100,000 person-years, which was 12.2-fold higher than the background rate (2.89). Infants and contacts >75 years of age were at highest risk. Three cases were fatal; sepsis and cellulitis were the most common manifestations. Typing for 6 iGAS cases identified emm 1.0 (n = 4), emm 4.0 (n = 1), and emm 12.0 (n = 1). Although absolute risk in household contacts was low, clinicians assessing household contacts should be aware of the risk to expedite diagnosis and initiate life-saving treatment.

EID Watts V, Balasegaram S, Brown CS, Mathew S, Mearkle R, Ready D, et al. Increased Risk for Invasive Group A Streptococcus Disease for Household Contacts of Scarlet Fever Cases, England, 2011–2016. Emerg Infect Dis. 2019;25(3):529-537. https://dx.doi.org/10.3201/eid2503.181518
AMA Watts V, Balasegaram S, Brown CS, et al. Increased Risk for Invasive Group A Streptococcus Disease for Household Contacts of Scarlet Fever Cases, England, 2011–2016. Emerging Infectious Diseases. 2019;25(3):529-537. doi:10.3201/eid2503.181518.
APA Watts, V., Balasegaram, S., Brown, C. S., Mathew, S., Mearkle, R., Ready, D....Lamagni, T. (2019). Increased Risk for Invasive Group A Streptococcus Disease for Household Contacts of Scarlet Fever Cases, England, 2011–2016. Emerging Infectious Diseases, 25(3), 529-537. https://dx.doi.org/10.3201/eid2503.181518.
Historical Review

Tuberculosis Surveillance and Control, Puerto Rico, 1898–2015 [PDF - 1.19 MB - 9 pages]
E. Dirlikov et al.

The World Health Organization recognizes Puerto Rico as an area of low tuberculosis (TB) incidence, where TB elimination is possible by 2035. To describe the current low incidence of reported cases, provide key lessons learned, and detect areas that may affect progress, we systematically reviewed the literature about the history of TB surveillance and control in Puerto Rico and supplemented this information with additional references and epidemiologic data. We reviewed 3 periods: 1898–1946 (public health efforts before the advent of TB chemotherapy); 1947–1992 (control and surveillance after the introduction of TB chemotherapy); and 1993–2015 (expanded TB control and surveillance). Although sustained surveillance, continued care, and use of newly developed strategies occurred concomitantly with decreased incidence of reported TB cases and mortality rates, factors that may affect progress remain poorly understood and include potential delayed diagnosis and underreporting, the effects of government debt and Hurricane Maria, and poverty.

EID Dirlikov E, Thomas D, Yost D, Tejada-Vera B, Bermudez M, Joglar O, et al. Tuberculosis Surveillance and Control, Puerto Rico, 1898–2015. Emerg Infect Dis. 2019;25(3):538-546. https://dx.doi.org/10.3201/eid2503.181157
AMA Dirlikov E, Thomas D, Yost D, et al. Tuberculosis Surveillance and Control, Puerto Rico, 1898–2015. Emerging Infectious Diseases. 2019;25(3):538-546. doi:10.3201/eid2503.181157.
APA Dirlikov, E., Thomas, D., Yost, D., Tejada-Vera, B., Bermudez, M., Joglar, O....Chorba, T. (2019). Tuberculosis Surveillance and Control, Puerto Rico, 1898–2015. Emerging Infectious Diseases, 25(3), 538-546. https://dx.doi.org/10.3201/eid2503.181157.
Dispatches

Whole-Genome Sequencing of Drug-Resistant Mycobacterium tuberculosis Strains, Tunisia, 2012–2016 [PDF - 1000 KB - 9 pages]
I. Bouzouita et al.

To investigate transmission of drug-resistant strains of Mycobacterium tuberculosis in Tunisia, we performed whole-genome sequencing on 46 multidrug-resistant strains isolated during 2012–2016. Core-genome multilocus sequence typing grouped 30 strains (65.2%) into 3 clusters, indicating extensive recent transmission and Haarlem clone predominance. Whole-genome sequencing might help public health services undertake appropriate control actions.

EID Bouzouita I, Cabibbe A, Trovato A, Daroui H, Ghariani A, Midouni B, et al. Whole-Genome Sequencing of Drug-Resistant Mycobacterium tuberculosis Strains, Tunisia, 2012–2016. Emerg Infect Dis. 2019;25(3):547-550. https://dx.doi.org/10.3201/eid2503.181370
AMA Bouzouita I, Cabibbe A, Trovato A, et al. Whole-Genome Sequencing of Drug-Resistant Mycobacterium tuberculosis Strains, Tunisia, 2012–2016. Emerging Infectious Diseases. 2019;25(3):547-550. doi:10.3201/eid2503.181370.
APA Bouzouita, I., Cabibbe, A., Trovato, A., Daroui, H., Ghariani, A., Midouni, B....Saidi, L. (2019). Whole-Genome Sequencing of Drug-Resistant Mycobacterium tuberculosis Strains, Tunisia, 2012–2016. Emerging Infectious Diseases, 25(3), 547-550. https://dx.doi.org/10.3201/eid2503.181370.

Role of Backyard Flocks in Transmission Dynamics of Highly Pathogenic Avian Influenza A(H5N8) Clade 2.3.4.4, France, 2016–2017 [PDF - 2.96 MB - 4 pages]
M. Souvestre et al.

Highly pathogenic avian influenza A(H5N8) clade 2.3.4.4 spread in France during 2016–2017. We assessed the biosecurity and avian influenza virus infection status of 70 backyard flocks near H5N8-infected commercial farms. One flock was seropositive for clade 2.3.4.4. Backyard flocks linked to commercial farms had elevated risk for H5 infection.

EID Souvestre M, Guinat C, Niqueux E, Robertet L, Croville G, Paul M, et al. Role of Backyard Flocks in Transmission Dynamics of Highly Pathogenic Avian Influenza A(H5N8) Clade 2.3.4.4, France, 2016–2017. Emerg Infect Dis. 2019;25(3):551-554. https://dx.doi.org/10.3201/eid2503.181040
AMA Souvestre M, Guinat C, Niqueux E, et al. Role of Backyard Flocks in Transmission Dynamics of Highly Pathogenic Avian Influenza A(H5N8) Clade 2.3.4.4, France, 2016–2017. Emerging Infectious Diseases. 2019;25(3):551-554. doi:10.3201/eid2503.181040.
APA Souvestre, M., Guinat, C., Niqueux, E., Robertet, L., Croville, G., Paul, M....Guérin, J. (2019). Role of Backyard Flocks in Transmission Dynamics of Highly Pathogenic Avian Influenza A(H5N8) Clade 2.3.4.4, France, 2016–2017. Emerging Infectious Diseases, 25(3), 551-554. https://dx.doi.org/10.3201/eid2503.181040.

Longitudinal Outbreak of Multidrug-Resistant Tuberculosis in a Hospital Setting, Serbia [PDF - 1.46 MB - 4 pages]
I. Arandjelović et al.

A retrospective population-based molecular epidemiologic study of multidrug-resistant Mycobacterium tuberculosis complex strains in Serbia (2008–2014) revealed an outbreak of TUR genotype strains in a psychiatric hospital starting around 1990. Drug unavailability, poor infection control, and schizophrenia likely fueled acquisition of additional resistance and bacterial fitness–related mutations over 2 decades.

EID Arandjelović I, Merker M, Richter E, Kohl TA, Savić B, Soldatović I, et al. Longitudinal Outbreak of Multidrug-Resistant Tuberculosis in a Hospital Setting, Serbia. Emerg Infect Dis. 2019;25(3):555-558. https://dx.doi.org/10.3201/eid2503.181220
AMA Arandjelović I, Merker M, Richter E, et al. Longitudinal Outbreak of Multidrug-Resistant Tuberculosis in a Hospital Setting, Serbia. Emerging Infectious Diseases. 2019;25(3):555-558. doi:10.3201/eid2503.181220.
APA Arandjelović, I., Merker, M., Richter, E., Kohl, T. A., Savić, B., Soldatović, I....Niemann, S. (2019). Longitudinal Outbreak of Multidrug-Resistant Tuberculosis in a Hospital Setting, Serbia. Emerging Infectious Diseases, 25(3), 555-558. https://dx.doi.org/10.3201/eid2503.181220.

Genomic Analysis of Cardiac Surgery–Associated Mycobacterium chimaera Infections, United States [PDF - 1.85 MB - 5 pages]
N. A. Hasan et al.

A surgical heater–cooler unit has been implicated as the source for Mycobacterium chimaera infections among cardiac surgery patients in several countries. We isolated M. chimaera from heater–cooler units and patient infections in the United States. Whole-genome sequencing corroborated a risk for these units acting as a reservoir for this pathogen.

EID Hasan NA, Epperson L, Lawsin A, Rodger RR, Perkins KM, Halpin A, et al. Genomic Analysis of Cardiac Surgery–Associated Mycobacterium chimaera Infections, United States. Emerg Infect Dis. 2019;25(3):559-563. https://dx.doi.org/10.3201/eid2503.181282
AMA Hasan NA, Epperson L, Lawsin A, et al. Genomic Analysis of Cardiac Surgery–Associated Mycobacterium chimaera Infections, United States. Emerging Infectious Diseases. 2019;25(3):559-563. doi:10.3201/eid2503.181282.
APA Hasan, N. A., Epperson, L., Lawsin, A., Rodger, R. R., Perkins, K. M., Halpin, A....Strong, M. (2019). Genomic Analysis of Cardiac Surgery–Associated Mycobacterium chimaera Infections, United States. Emerging Infectious Diseases, 25(3), 559-563. https://dx.doi.org/10.3201/eid2503.181282.

Drug-Resistant Tuberculosis, Lebanon, 2016 – 2017 [PDF - 1.45 MB - 5 pages]
S. El Achkar et al.

In a 12-month nationwide study on the prevalence of drug-resistant tuberculosis (TB) in Lebanon, we identified 3 multidrug-resistant cases and 3 extensively drug-resistant TB cases in refugees, migrants, and 1 Lebanon resident. Enhanced diagnostics, particularly in major destinations for refugees, asylum seekers, and migrant workers, can inform treatment decisions and may help prevent the spread of drug-resistant TB.

EID El Achkar S, Demanche C, Osman M, Rafei R, Ismail M, Yaacoub H, et al. Drug-Resistant Tuberculosis, Lebanon, 2016 – 2017. Emerg Infect Dis. 2019;25(3):564-568. https://dx.doi.org/10.3201/eid2503.181375
AMA El Achkar S, Demanche C, Osman M, et al. Drug-Resistant Tuberculosis, Lebanon, 2016 – 2017. Emerging Infectious Diseases. 2019;25(3):564-568. doi:10.3201/eid2503.181375.
APA El Achkar, S., Demanche, C., Osman, M., Rafei, R., Ismail, M., Yaacoub, H....Supply, P. (2019). Drug-Resistant Tuberculosis, Lebanon, 2016 – 2017. Emerging Infectious Diseases, 25(3), 564-568. https://dx.doi.org/10.3201/eid2503.181375.

Epidemiology of Nontuberculous Mycobacterial Infection, South Korea, 2007–2016 [PDF - 974 KB - 4 pages]
H. Lee et al.

The prevalence and incidence of nontuberculous mycobacterial (NTM) infections increased in South Korea from 2007 to 2016. Annual prevalence of NTM infection increased to 39.6 cases/100,000 population in 2016 and annual incidence to 19.0 cases/100,000 population. Overall prevalence for the study period was higher in the elderly, in females, and in cities.

EID Lee H, Myung W, Koh W, Moon S, Jhun B. Epidemiology of Nontuberculous Mycobacterial Infection, South Korea, 2007–2016. Emerg Infect Dis. 2019;25(3):569-572. https://dx.doi.org/10.3201/eid2503.181597
AMA Lee H, Myung W, Koh W, et al. Epidemiology of Nontuberculous Mycobacterial Infection, South Korea, 2007–2016. Emerging Infectious Diseases. 2019;25(3):569-572. doi:10.3201/eid2503.181597.
APA Lee, H., Myung, W., Koh, W., Moon, S., & Jhun, B. (2019). Epidemiology of Nontuberculous Mycobacterial Infection, South Korea, 2007–2016. Emerging Infectious Diseases, 25(3), 569-572. https://dx.doi.org/10.3201/eid2503.181597.

Acute Flaccid Myelitis Associated with Enterovirus D68 in Children, Argentina, 2016 [PDF - 468 KB - 4 pages]
C. M. Carballo et al.

After a 2014 outbreak of severe respiratory illness caused by enterovirus D68 in the United States, sporadic cases of acute flaccid myelitis have been reported worldwide. We describe a cluster of acute flaccid myelitis cases in Argentina in 2016, adding data to the evidence of association between enterovirus D68 and this polio-like illness.

EID Carballo CM, Erro M, Sordelli N, Vazquez G, Mistchenko AS, Cejas C, et al. Acute Flaccid Myelitis Associated with Enterovirus D68 in Children, Argentina, 2016. Emerg Infect Dis. 2019;25(3):573-576. https://dx.doi.org/10.3201/eid2503.170897
AMA Carballo CM, Erro M, Sordelli N, et al. Acute Flaccid Myelitis Associated with Enterovirus D68 in Children, Argentina, 2016. Emerging Infectious Diseases. 2019;25(3):573-576. doi:10.3201/eid2503.170897.
APA Carballo, C. M., Erro, M., Sordelli, N., Vazquez, G., Mistchenko, A. S., Cejas, C....Lopez, E. L. (2019). Acute Flaccid Myelitis Associated with Enterovirus D68 in Children, Argentina, 2016. Emerging Infectious Diseases, 25(3), 573-576. https://dx.doi.org/10.3201/eid2503.170897.

In Vivo Selection of a Unique Tandem Repeat Mediated Azole Resistance Mechanism (TR120) in Aspergillus fumigatus cyp51A, Denmark [PDF - 903 KB - 4 pages]
R. K. Hare et al.

We report a fatal aspergillosis case in which STRAf typing and whole-genome sequencing substantiated in vivo emergence of an azole-resistant Aspergillus fumigatus with a 120-bp tandem repeat in the promoter region of cyp51A. This event, previously restricted to the environment, challenges current understanding of azole resistance development in A. fumigatus.

EID Hare RK, Gertsen JB, Astvad K, Degn KB, Løkke A, Stegger M, et al. In Vivo Selection of a Unique Tandem Repeat Mediated Azole Resistance Mechanism (TR120) in Aspergillus fumigatus cyp51A, Denmark. Emerg Infect Dis. 2019;25(3):577-580. https://dx.doi.org/10.3201/eid2503.180297
AMA Hare RK, Gertsen JB, Astvad K, et al. In Vivo Selection of a Unique Tandem Repeat Mediated Azole Resistance Mechanism (TR120) in Aspergillus fumigatus cyp51A, Denmark. Emerging Infectious Diseases. 2019;25(3):577-580. doi:10.3201/eid2503.180297.
APA Hare, R. K., Gertsen, J. B., Astvad, K., Degn, K. B., Løkke, A., Stegger, M....Arendrup, M. C. (2019). In Vivo Selection of a Unique Tandem Repeat Mediated Azole Resistance Mechanism (TR120) in Aspergillus fumigatus cyp51A, Denmark. Emerging Infectious Diseases, 25(3), 577-580. https://dx.doi.org/10.3201/eid2503.180297.

Listeria monocytogenes Associated with Pasteurized Chocolate Milk, Ontario, Canada [PDF - 889 KB - 4 pages]
H. Hanson et al.

In an investigation of a listeriosis outbreak in Ontario, Canada, during November 2015–June 2016, pasteurized chocolate milk was identified as the source. Because listeriosis outbreaks associated with pasteurized milk are rare in North America, these findings highlight that dairy products can be contaminated after pasteurization.

EID Hanson H, Whitfield Y, Lee C, Badiani T, Minielly C, Fenik J, et al. Listeria monocytogenes Associated with Pasteurized Chocolate Milk, Ontario, Canada. Emerg Infect Dis. 2019;25(3):581-584. https://dx.doi.org/10.3201/eid2503.180742
AMA Hanson H, Whitfield Y, Lee C, et al. Listeria monocytogenes Associated with Pasteurized Chocolate Milk, Ontario, Canada. Emerging Infectious Diseases. 2019;25(3):581-584. doi:10.3201/eid2503.180742.
APA Hanson, H., Whitfield, Y., Lee, C., Badiani, T., Minielly, C., Fenik, J....Warshawsky, B. (2019). Listeria monocytogenes Associated with Pasteurized Chocolate Milk, Ontario, Canada. Emerging Infectious Diseases, 25(3), 581-584. https://dx.doi.org/10.3201/eid2503.180742.

Neutralizing Antibody against Enterovirus D68 in Children and Adults before 2014 Outbreak, Kansas City, Missouri, USA [PDF - 1.02 MB - 4 pages]
C. J. Harrison et al.

We evaluated enterovirus D68 seroprevalence in Kansas City, Missouri, USA, from samples obtained during 2012–2013. Neutralizing antibodies against Fermon and the dominant 2014 Missouri isolate were universally detected. Titers increased with age. Widespread circulation of enterovirus D68 occurred before the 2014 outbreak. Research is needed to determine a surrogate of protection.

EID Harrison CJ, Weldon WC, Pahud BA, Jackson M, Oberste M, Selvarangan R. Neutralizing Antibody against Enterovirus D68 in Children and Adults before 2014 Outbreak, Kansas City, Missouri, USA. Emerg Infect Dis. 2019;25(3):585-588. https://dx.doi.org/10.3201/eid2503.180960
AMA Harrison CJ, Weldon WC, Pahud BA, et al. Neutralizing Antibody against Enterovirus D68 in Children and Adults before 2014 Outbreak, Kansas City, Missouri, USA. Emerging Infectious Diseases. 2019;25(3):585-588. doi:10.3201/eid2503.180960.
APA Harrison, C. J., Weldon, W. C., Pahud, B. A., Jackson, M., Oberste, M., & Selvarangan, R. (2019). Neutralizing Antibody against Enterovirus D68 in Children and Adults before 2014 Outbreak, Kansas City, Missouri, USA. Emerging Infectious Diseases, 25(3), 585-588. https://dx.doi.org/10.3201/eid2503.180960.

Prospective Whole-Genome Sequencing in Tuberculosis Outbreak Investigation, France, 2017–2018 [PDF - 1.13 MB - 4 pages]
C. Genestet et al.

During June 2017–April 2018, active tuberculosis with Beijing SIT1 isolates was diagnosed in 14 persons living in 4 distant cities in France. Whole-genome sequencing indicated that these patients belonged to a single transmission chain. Whole-genome sequencing–based laboratory investigations enabled prompt tracing of linked cases to improve tuberculosis control.

EID Genestet C, Tatai C, Berland J, Claude J, Westeel E, Hodille E, et al. Prospective Whole-Genome Sequencing in Tuberculosis Outbreak Investigation, France, 2017–2018. Emerg Infect Dis. 2019;25(3):589-592. https://dx.doi.org/10.3201/eid2503.181124
AMA Genestet C, Tatai C, Berland J, et al. Prospective Whole-Genome Sequencing in Tuberculosis Outbreak Investigation, France, 2017–2018. Emerging Infectious Diseases. 2019;25(3):589-592. doi:10.3201/eid2503.181124.
APA Genestet, C., Tatai, C., Berland, J., Claude, J., Westeel, E., Hodille, E....Dumitrescu, O. (2019). Prospective Whole-Genome Sequencing in Tuberculosis Outbreak Investigation, France, 2017–2018. Emerging Infectious Diseases, 25(3), 589-592. https://dx.doi.org/10.3201/eid2503.181124.

Response to Isoniazid-Resistant Tuberculosis in Homeless Shelters, Georgia, USA, 2015–2017 [PDF - 458 KB - 3 pages]
D. P. Holland et al.

In 2008, an outbreak of isoniazid-resistant tuberculosis was identified among residents of homeless shelters in Atlanta, Georgia, USA. When initial control efforts involving standard targeted testing failed, a comprehensive approach that involved all providers of services for the homeless successfully interrupted the outbreak.

EID Holland DP, Alexander S, Onwubiko U, Goswami ND, Yamin A, Mohamed O, et al. Response to Isoniazid-Resistant Tuberculosis in Homeless Shelters, Georgia, USA, 2015–2017. Emerg Infect Dis. 2019;25(3):593-595. https://dx.doi.org/10.3201/eid2503.181678
AMA Holland DP, Alexander S, Onwubiko U, et al. Response to Isoniazid-Resistant Tuberculosis in Homeless Shelters, Georgia, USA, 2015–2017. Emerging Infectious Diseases. 2019;25(3):593-595. doi:10.3201/eid2503.181678.
APA Holland, D. P., Alexander, S., Onwubiko, U., Goswami, N. D., Yamin, A., Mohamed, O....Toomey, K. E. (2019). Response to Isoniazid-Resistant Tuberculosis in Homeless Shelters, Georgia, USA, 2015–2017. Emerging Infectious Diseases, 25(3), 593-595. https://dx.doi.org/10.3201/eid2503.181678.
Research Letters

Exportation of MDR TB to Europe from Setting with Actively Transmitted Persistent Strains in Peru [PDF - 425 KB - 3 pages]
F. Acosta et al.

We performed a cross-border molecular epidemiology analysis of multidrug-resistant tuberculosis in Peru, Spain, and Italy. This analysis revealed frequent transmission in Peru and exportation of a strain that recreated similar levels of transmission in Europe during 2007–2017. Transnational efforts are needed to control transmission of multidrug-resistant tuberculosis globally.

EID Acosta F, Agapito J, Cabibbe A, Cáceres T, Sola C, Pérez-Lago L, et al. Exportation of MDR TB to Europe from Setting with Actively Transmitted Persistent Strains in Peru. Emerg Infect Dis. 2019;25(3):596-598. https://dx.doi.org/10.3201/eid2503.180574
AMA Acosta F, Agapito J, Cabibbe A, et al. Exportation of MDR TB to Europe from Setting with Actively Transmitted Persistent Strains in Peru. Emerging Infectious Diseases. 2019;25(3):596-598. doi:10.3201/eid2503.180574.
APA Acosta, F., Agapito, J., Cabibbe, A., Cáceres, T., Sola, C., Pérez-Lago, L....García de Viedma, D. (2019). Exportation of MDR TB to Europe from Setting with Actively Transmitted Persistent Strains in Peru. Emerging Infectious Diseases, 25(3), 596-598. https://dx.doi.org/10.3201/eid2503.180574.

Rectal Lymphogranuloma Venereum, Buenos Aires, Argentina [PDF - 350 KB - 2 pages]
L. López et al.

Among 34 men with proctitis in Buenos Aires, Argentina, 16 (47%) had Chlamydia trachomatis infection, 11 (68.8%) of which were biovar lymphogranuloma venereum. The outbreak was probably local, as in Europe. In Argentina, lymphogranuloma venereum should be a suspected cause of proctitis in HIV-infected men who have had unprotected anal sex with men.

EID López L, La Rosa L, Entrocassi A, Caffarena D, Santos B, Fermepin M. Rectal Lymphogranuloma Venereum, Buenos Aires, Argentina. Emerg Infect Dis. 2019;25(3):598-599. https://dx.doi.org/10.3201/eid2503.180600
AMA López L, La Rosa L, Entrocassi A, et al. Rectal Lymphogranuloma Venereum, Buenos Aires, Argentina. Emerging Infectious Diseases. 2019;25(3):598-599. doi:10.3201/eid2503.180600.
APA López, L., La Rosa, L., Entrocassi, A., Caffarena, D., Santos, B., & Fermepin, M. (2019). Rectal Lymphogranuloma Venereum, Buenos Aires, Argentina. Emerging Infectious Diseases, 25(3), 598-599. https://dx.doi.org/10.3201/eid2503.180600.

Confirmed Case of Buruli Ulcer, Senegal, 2018 [PDF - 331 KB - 2 pages]
G. Turner et al.

Buruli ulcer is a necrotizing skin disease caused by Mycobacterium ulcerans and is usually associated with tropical climates and exposure to slow-moving or stagnant water. We report a case of Buruli ulcer that may have originated in an urban semiarid area of Senegal.

EID Turner G, Seck A, Dieng A, Diadie S, Ndiaye B, van Imeerzeel TD, et al. Confirmed Case of Buruli Ulcer, Senegal, 2018. Emerg Infect Dis. 2019;25(3):600-601. https://dx.doi.org/10.3201/eid2503.180707
AMA Turner G, Seck A, Dieng A, et al. Confirmed Case of Buruli Ulcer, Senegal, 2018. Emerging Infectious Diseases. 2019;25(3):600-601. doi:10.3201/eid2503.180707.
APA Turner, G., Seck, A., Dieng, A., Diadie, S., Ndiaye, B., van Imeerzeel, T. D....Boye, C. (2019). Confirmed Case of Buruli Ulcer, Senegal, 2018. Emerging Infectious Diseases, 25(3), 600-601. https://dx.doi.org/10.3201/eid2503.180707.

Management of Patients with Candida auris Fungemia at Community Hospital, Brooklyn, New York, USA, 2016–2018 [PDF - 297 KB - 2 pages]
J. Park et al.

Candida auris is an emerging fungus that can cause invasive infections. It is associated with high mortality rates and resistance to multiple classes of antifungal drugs and is difficult to identify with standard laboratory methods. We describe the management and outcomes of 9 patients with C. auris fungemia in Brooklyn, New York, USA.

EID Park J, Bradley N, Brooks S, Burney S, Wassner C. Management of Patients with Candida auris Fungemia at Community Hospital, Brooklyn, New York, USA, 2016–2018. Emerg Infect Dis. 2019;25(3):601-602. https://dx.doi.org/10.3201/eid2503.180927
AMA Park J, Bradley N, Brooks S, et al. Management of Patients with Candida auris Fungemia at Community Hospital, Brooklyn, New York, USA, 2016–2018. Emerging Infectious Diseases. 2019;25(3):601-602. doi:10.3201/eid2503.180927.
APA Park, J., Bradley, N., Brooks, S., Burney, S., & Wassner, C. (2019). Management of Patients with Candida auris Fungemia at Community Hospital, Brooklyn, New York, USA, 2016–2018. Emerging Infectious Diseases, 25(3), 601-602. https://dx.doi.org/10.3201/eid2503.180927.

Helicobacter cinaedi Hepatic Cyst Infection with Bacteremia [PDF - 419 KB - 2 pages]
T. Suzuki et al.

Helicobacter cinaedi is an enterohepatic bacillus that causes infections of various manifestations. We report a novel case of hepatic cyst infection with bacteremia caused by H. cinaedi in an immunocompetent woman in Japan. Further research is warranted to identify the epidemiologic and clinical features of H. cinaedi infection.

EID Suzuki T, Kutsuna S, Tsuboi M, Ota M, Hayakawa K, Ohmagari N. Helicobacter cinaedi Hepatic Cyst Infection with Bacteremia. Emerg Infect Dis. 2019;25(3):603-604. https://dx.doi.org/10.3201/eid2503.180936
AMA Suzuki T, Kutsuna S, Tsuboi M, et al. Helicobacter cinaedi Hepatic Cyst Infection with Bacteremia. Emerging Infectious Diseases. 2019;25(3):603-604. doi:10.3201/eid2503.180936.
APA Suzuki, T., Kutsuna, S., Tsuboi, M., Ota, M., Hayakawa, K., & Ohmagari, N. (2019). Helicobacter cinaedi Hepatic Cyst Infection with Bacteremia. Emerging Infectious Diseases, 25(3), 603-604. https://dx.doi.org/10.3201/eid2503.180936.

Mycobacterium tuberculosis RD-Rio Strain in Kazakhstan [PDF - 454 KB - 3 pages]
I. Mokrousov

Mycobacterium tuberculosis RD-Rio strains are still rare in the former Soviet Union countries and Asia. We describe a strain in Kazakhstan that belongs to the RD-Rio secondary branch, which is endemic to northwest Russia and eastern Europe. Although RD-Rio strains are frequently multidrug resistant, this heterogeneous branch included only drug-susceptible isolates.

EID Mokrousov I. Mycobacterium tuberculosis RD-Rio Strain in Kazakhstan. Emerg Infect Dis. 2019;25(3):604-606. https://dx.doi.org/10.3201/eid2503.181179
AMA Mokrousov I. Mycobacterium tuberculosis RD-Rio Strain in Kazakhstan. Emerging Infectious Diseases. 2019;25(3):604-606. doi:10.3201/eid2503.181179.
APA Mokrousov, I. (2019). Mycobacterium tuberculosis RD-Rio Strain in Kazakhstan. Emerging Infectious Diseases, 25(3), 604-606. https://dx.doi.org/10.3201/eid2503.181179.

Detection of Influenza C Virus Infection among Hospitalized Patients, Cameroon [PDF - 926 KB - 3 pages]
R. Njouom et al.

We report 3 cases of influenza C virus in children hospitalized with severe acute respiratory infection in Cameroon. Two of these case-patients had grave clinical manifestations, but all 3 recovered. The lack of specific antiviral drugs for influenza C virus highlights the need to identify and describe cases involving this virus.

EID Njouom R, Monamele G, Ermetal B, Tchatchouang S, Moyo-Tetang S, McCauley JW, et al. Detection of Influenza C Virus Infection among Hospitalized Patients, Cameroon. Emerg Infect Dis. 2019;25(3):607-609. https://dx.doi.org/10.3201/eid2503.181213
AMA Njouom R, Monamele G, Ermetal B, et al. Detection of Influenza C Virus Infection among Hospitalized Patients, Cameroon. Emerging Infectious Diseases. 2019;25(3):607-609. doi:10.3201/eid2503.181213.
APA Njouom, R., Monamele, G., Ermetal, B., Tchatchouang, S., Moyo-Tetang, S., McCauley, J. W....Daniels, R. S. (2019). Detection of Influenza C Virus Infection among Hospitalized Patients, Cameroon. Emerging Infectious Diseases, 25(3), 607-609. https://dx.doi.org/10.3201/eid2503.181213.

Healthcare Provider Discrimination toward Pregnant Women with Rifampin-Resistant Tuberculosis [PDF - 263 KB - 2 pages]
M. Loveday et al.

Little is known about the treatment experiences of pregnant women with rifampin-resistant tuberculosis. We conducted qualitative interviews with 10 women who had this condition; 9 reported facing discrimination from healthcare providers. Our findings underscore an urgent need to ensure a human-rights–based, patient-centered approach for women with rifampin-resistant tuberculosis who are pregnant.

EID Loveday M, Hlangu S, Furin J. Healthcare Provider Discrimination toward Pregnant Women with Rifampin-Resistant Tuberculosis. Emerg Infect Dis. 2019;25(3):609-610. https://dx.doi.org/10.3201/eid2503.181571
AMA Loveday M, Hlangu S, Furin J. Healthcare Provider Discrimination toward Pregnant Women with Rifampin-Resistant Tuberculosis. Emerging Infectious Diseases. 2019;25(3):609-610. doi:10.3201/eid2503.181571.
APA Loveday, M., Hlangu, S., & Furin, J. (2019). Healthcare Provider Discrimination toward Pregnant Women with Rifampin-Resistant Tuberculosis. Emerging Infectious Diseases, 25(3), 609-610. https://dx.doi.org/10.3201/eid2503.181571.

Mycobacterium chimaera Pulmonary Disease in Cystic Fibrosis Patients, France, 2010–2017 [PDF - 468 KB - 3 pages]
R. Larcher et al.

We report Mycobacterium chimaera pulmonary disease in 4 patients given a diagnosis of cystic fibrosis in a university hospital in Montpellier, France. All patients had M. chimaera–positive expectorated sputum specimens, clinical symptoms of pulmonary exacerbation, or a decrease in spirometry test results that improved after specific treatment.

EID Larcher R, Lounnas M, Dumont Y, Michon A, Bonzon L, Chiron R, et al. Mycobacterium chimaera Pulmonary Disease in Cystic Fibrosis Patients, France, 2010–2017. Emerg Infect Dis. 2019;25(3):611-613. https://dx.doi.org/10.3201/eid2503.181590
AMA Larcher R, Lounnas M, Dumont Y, et al. Mycobacterium chimaera Pulmonary Disease in Cystic Fibrosis Patients, France, 2010–2017. Emerging Infectious Diseases. 2019;25(3):611-613. doi:10.3201/eid2503.181590.
APA Larcher, R., Lounnas, M., Dumont, Y., Michon, A., Bonzon, L., Chiron, R....Godreuil, S. (2019). Mycobacterium chimaera Pulmonary Disease in Cystic Fibrosis Patients, France, 2010–2017. Emerging Infectious Diseases, 25(3), 611-613. https://dx.doi.org/10.3201/eid2503.181590.

Biomphalaria pfeifferi Snails and Intestinal Schistosomiasis, Lake Malawi, Africa, 2017–2018 [PDF - 1.32 MB - 3 pages]
M. H. Alharbi et al.

Two surveys conducted in 2017 and 2018 demonstrated Biomphalaria pfeifferi snails in Lake Malawi in Africa. Epidemiologic examination of 175 local children at 3 primary schools confirmed emergence of intestinal schistosomiasis. These findings highlight autochthonous transmission of Schistosoma mansoni flukes in Lake Malawi and the need to revise international travel advice.

EID Alharbi MH, Condemine C, Christiansen R, LaCourse E, Makaula P, Stanton MC, et al. Biomphalaria pfeifferi Snails and Intestinal Schistosomiasis, Lake Malawi, Africa, 2017–2018. Emerg Infect Dis. 2019;25(3):613-615. https://dx.doi.org/10.3201/eid2503.181601
AMA Alharbi MH, Condemine C, Christiansen R, et al. Biomphalaria pfeifferi Snails and Intestinal Schistosomiasis, Lake Malawi, Africa, 2017–2018. Emerging Infectious Diseases. 2019;25(3):613-615. doi:10.3201/eid2503.181601.
APA Alharbi, M. H., Condemine, C., Christiansen, R., LaCourse, E., Makaula, P., Stanton, M. C....Stothard, J. (2019). Biomphalaria pfeifferi Snails and Intestinal Schistosomiasis, Lake Malawi, Africa, 2017–2018. Emerging Infectious Diseases, 25(3), 613-615. https://dx.doi.org/10.3201/eid2503.181601.
Books and Media

Infectious Diseases: A Geographic Guide, Second Edition [PDF - 379 KB - 1 page]
J. W. Tang
EID Tang JW. Infectious Diseases: A Geographic Guide, Second Edition. Emerg Infect Dis. 2019;25(3):616. https://dx.doi.org/10.3201/eid2503.181500
AMA Tang JW. Infectious Diseases: A Geographic Guide, Second Edition. Emerging Infectious Diseases. 2019;25(3):616. doi:10.3201/eid2503.181500.
APA Tang, J. W. (2019). Infectious Diseases: A Geographic Guide, Second Edition. Emerging Infectious Diseases, 25(3), 616. https://dx.doi.org/10.3201/eid2503.181500.
About the Cover

Romanticism, Mycobacterium, and the Myth of the Muse [PDF - 1.24 MB - 2 pages]
D. Mahoney and T. Chorba
EID Mahoney D, Chorba T. Romanticism, Mycobacterium, and the Myth of the Muse. Emerg Infect Dis. 2019;25(3):617-618. https://dx.doi.org/10.3201/eid2503.ac2503
AMA Mahoney D, Chorba T. Romanticism, Mycobacterium, and the Myth of the Muse. Emerging Infectious Diseases. 2019;25(3):617-618. doi:10.3201/eid2503.ac2503.
APA Mahoney, D., & Chorba, T. (2019). Romanticism, Mycobacterium, and the Myth of the Muse. Emerging Infectious Diseases, 25(3), 617-618. https://dx.doi.org/10.3201/eid2503.ac2503.
Etymologia

Etymologia: Streptomycin [PDF - 504 KB - 1 page]
R. Henry
EID Henry R. Etymologia: Streptomycin. Emerg Infect Dis. 2019;25(3):450. https://dx.doi.org/10.3201/eid2503.et2503
AMA Henry R. Etymologia: Streptomycin. Emerging Infectious Diseases. 2019;25(3):450. doi:10.3201/eid2503.et2503.
APA Henry, R. (2019). Etymologia: Streptomycin. Emerging Infectious Diseases, 25(3), 450. https://dx.doi.org/10.3201/eid2503.et2503.
Online Reports

Survey on Implementation of One Health Approach for MERS-CoV Preparedness and Control in Gulf Cooperation Council and Middle East Countries [PDF - 612 KB - 6 pages]
E. Farag et al.

In 2015, a One Health Working Group was established in Qatar to conduct a survey in the Gulf Cooperation Council countries, Egypt, and Jordan to monitor preparedness of public health and veterinary health authorities in response to the Middle East respiratory syndrome coronavirus epidemic. All but 1 country indicated they established joint One Health policy teams for investigation and response. However, the response to the questionnaires was largely limited to veterinary authorities. Critical barriers and limitations were identified. National and regional leaders, policy makers, and stakeholders should be prompted to advocate and enhance adoption of the One Health framework to mitigate the risk for Middle East respiratory syndrome and other emerging zoonotic diseases.

Page created: February 20, 2019
Page updated: February 20, 2019
Page reviewed: February 20, 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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