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Issue Cover for Volume 26, Number 2—February 2020

Volume 26, Number 2—February 2020

[PDF - 7.90 MB - 216 pages]

Perspective

Middle East Respiratory Syndrome Coronavirus Transmission [PDF - 442 KB - 8 pages]
M. E. Killerby et al.

Middle East respiratory syndrome coronavirus (MERS-CoV) infection causes a spectrum of respiratory illness, from asymptomatic to mild to fatal. MERS-CoV is transmitted sporadically from dromedary camels to humans and occasionally through human-to-human contact. Current epidemiologic evidence supports a major role in transmission for direct contact with live camels or humans with symptomatic MERS, but little evidence suggests the possibility of transmission from camel products or asymptomatic MERS cases. Because a proportion of case-patients do not report direct contact with camels or with persons who have symptomatic MERS, further research is needed to conclusively determine additional mechanisms of transmission, to inform public health practice, and to refine current precautionary recommendations.

EID Killerby ME, Biggs HM, Midgley CM, Gerber SI, Watson JT. Middle East Respiratory Syndrome Coronavirus Transmission. Emerg Infect Dis. 2020;26(2):191-198. https://dx.doi.org/10.3201/eid2602.190697
AMA Killerby ME, Biggs HM, Midgley CM, et al. Middle East Respiratory Syndrome Coronavirus Transmission. Emerging Infectious Diseases. 2020;26(2):191-198. doi:10.3201/eid2602.190697.
APA Killerby, M. E., Biggs, H. M., Midgley, C. M., Gerber, S. I., & Watson, J. T. (2020). Middle East Respiratory Syndrome Coronavirus Transmission. Emerging Infectious Diseases, 26(2), 191-198. https://dx.doi.org/10.3201/eid2602.190697.
Synopses

Medscape CME Activity
Acute Toxoplasmosis among Canadian Deer Hunters Associated with Consumption of Undercooked Deer Meat Hunted in the United States [PDF - 1.11 MB - 7 pages]
C. Gaulin et al.

We conducted a recent investigation in Quebec, Canada, concerning Canadian deer hunters who went to the United States to hunt deer and returned with symptoms of fever, severe headache, myalgia, and articular pain of undetermined etiology. Further investigation identified that a group of 10 hunters from Quebec attended a hunting retreat in Illinois (USA) during November 22–December 4, 2018. Six of the 10 hunters had similar symptoms and illness onset dates. Serologic tests indicated a recent toxoplasmosis infection for all symptomatic hunters, and the risk factor identified was consumption of undercooked deer meat. Among asymptomatic hunters, 2 were already immune to toxoplasmosis, 1 was not immune, and the immune status of 1 remains unknown. Outbreaks of acute toxoplasmosis infection are rare in North America, but physicians should be aware that such outbreaks could become more common.

EID Gaulin C, Ramsay D, Thivierge K, Tataryn J, Courville A, Martin C, et al. Acute Toxoplasmosis among Canadian Deer Hunters Associated with Consumption of Undercooked Deer Meat Hunted in the United States. Emerg Infect Dis. 2020;26(2):199-205. https://dx.doi.org/10.3201/eid2602.191218
AMA Gaulin C, Ramsay D, Thivierge K, et al. Acute Toxoplasmosis among Canadian Deer Hunters Associated with Consumption of Undercooked Deer Meat Hunted in the United States. Emerging Infectious Diseases. 2020;26(2):199-205. doi:10.3201/eid2602.191218.
APA Gaulin, C., Ramsay, D., Thivierge, K., Tataryn, J., Courville, A., Martin, C....Dion, R. (2020). Acute Toxoplasmosis among Canadian Deer Hunters Associated with Consumption of Undercooked Deer Meat Hunted in the United States. Emerging Infectious Diseases, 26(2), 199-205. https://dx.doi.org/10.3201/eid2602.191218.

Public Health Program for Decreasing Risk for Ebola Virus Disease Resurgence from Survivors of the 2013–2016 Outbreak, Guinea [PDF - 493 KB - 6 pages]
M. Keita et al.

At the end of the 2013–2016 Ebola virus disease outbreak in Guinea, we implemented an alert system for early detection of Ebola resurgence among survivors. Survivors were asked to report health alerts in their household and provide body fluid specimens for laboratory testing. During April–September 2016, a total of 1,075 (88%) of 1,215 survivors participated in the system; follow up occurred at a median of 16 months after discharge (interquartile range 14–18 months). Of these, 784 acted as focal points and reported 1,136 alerts (including 4 deaths among survivors). A total of 372 (91%) of 408 eligible survivors had >1 semen specimen tested; of 817 semen specimens, 5 samples from 4 survivors were positive up to 512 days after discharge. No lochia (0/7) or breast milk (0/69) specimens tested positive. Our findings underscore the importance of long-term monitoring of survivors’ semen samples in an Ebola-affected country.

EID Keita M, Keita S, Diallo B, Camara M, Mesfin S, Nebie K, et al. Public Health Program for Decreasing Risk for Ebola Virus Disease Resurgence from Survivors of the 2013–2016 Outbreak, Guinea. Emerg Infect Dis. 2020;26(2):206-211. https://dx.doi.org/10.3201/eid2602.191235
AMA Keita M, Keita S, Diallo B, et al. Public Health Program for Decreasing Risk for Ebola Virus Disease Resurgence from Survivors of the 2013–2016 Outbreak, Guinea. Emerging Infectious Diseases. 2020;26(2):206-211. doi:10.3201/eid2602.191235.
APA Keita, M., Keita, S., Diallo, B., Camara, M., Mesfin, S., Nebie, K....Subissi, L. (2020). Public Health Program for Decreasing Risk for Ebola Virus Disease Resurgence from Survivors of the 2013–2016 Outbreak, Guinea. Emerging Infectious Diseases, 26(2), 206-211. https://dx.doi.org/10.3201/eid2602.191235.
Research

Medscape CME Activity
Characteristics of Patients with Acute Flaccid Myelitis, United States, 2015–2018 [PDF - 671 KB - 3 pages]
N. McLaren et al.

Observed peaks of acute flaccid myelitis (AFM) cases have occurred biennially since 2014 in the United States. We aimed to determine if AFM etiology differed between peak and nonpeak years, considering that clinical features of AFM differ by virus etiology. We compared clinical and laboratory characteristics of AFM cases that occurred during peak (2016 and 2018, n = 366) and nonpeak (2015 and 2017, n = 50) years. AFM patients in peak years were younger (5.2 years) than those in nonpeak years (8.3 years). A higher percentage of patients in peak years than nonpeak years had pleocytosis (86% vs. 60%), upper extremity involvement (33% vs. 16%), and an illness preceding limb weakness (90% vs. 62%) and were positive for enterovirus or rhinovirus RNA (38% vs. 16%). Enterovirus D68 infection was associated with AFM only in peak years. Our findings suggest AFM etiology differs between peak and nonpeak years.

EID McLaren N, Lopez A, Kidd S, Zhang JX, Nix W, Link-Gelles R, et al. Characteristics of Patients with Acute Flaccid Myelitis, United States, 2015–2018. Emerg Infect Dis. 2020;26(2):212-219. https://dx.doi.org/10.3201/eid2602.191453
AMA McLaren N, Lopez A, Kidd S, et al. Characteristics of Patients with Acute Flaccid Myelitis, United States, 2015–2018. Emerging Infectious Diseases. 2020;26(2):212-219. doi:10.3201/eid2602.191453.
APA McLaren, N., Lopez, A., Kidd, S., Zhang, J. X., Nix, W., Link-Gelles, R....Routh, J. A. (2020). Characteristics of Patients with Acute Flaccid Myelitis, United States, 2015–2018. Emerging Infectious Diseases, 26(2), 212-219. https://dx.doi.org/10.3201/eid2602.191453.

Medscape CME Activity
Illness Severity in Hospitalized Influenza Patients by Virus Type and Subtype, Spain, 2010–2017 [PDF - 1.08 MB - 9 pages]
C. Delgado-Sanz et al.

We conducted a retrospective cohort study to assess the effect of influenza virus type and subtype on disease severity among hospitalized influenza patients in Spain. We analyzed the cases of 8,985 laboratory-confirmed case-patients hospitalized for severe influenza by using data from a national surveillance system for the period 2010–2017. Hospitalized patients with influenza A(H1N1)pdm09 virus were significantly younger, more frequently had class III obesity, and had a higher risk for pneumonia or acute respiratory distress syndrome than patients infected with influenza A(H3N2) or B (p<0.05). Hospitalized patients with influenza A(H1N1)pdm09 also had a higher risk for intensive care unit admission, death, or both than patients with influenza A(H3N2) or B, independent of other factors. Determining the patterns of influenza-associated severity and how they might differ by virus type and subtype can help guide planning and implementation of adequate control and preventive measures during influenza epidemics.

EID Delgado-Sanz C, Mazagatos-Ateca C, Oliva J, Gherasim A, Larrauri A. Illness Severity in Hospitalized Influenza Patients by Virus Type and Subtype, Spain, 2010–2017. Emerg Infect Dis. 2020;26(2):220-228. https://dx.doi.org/10.3201/eid2602.181732
AMA Delgado-Sanz C, Mazagatos-Ateca C, Oliva J, et al. Illness Severity in Hospitalized Influenza Patients by Virus Type and Subtype, Spain, 2010–2017. Emerging Infectious Diseases. 2020;26(2):220-228. doi:10.3201/eid2602.181732.
APA Delgado-Sanz, C., Mazagatos-Ateca, C., Oliva, J., Gherasim, A., & Larrauri, A. (2020). Illness Severity in Hospitalized Influenza Patients by Virus Type and Subtype, Spain, 2010–2017. Emerging Infectious Diseases, 26(2), 220-228. https://dx.doi.org/10.3201/eid2602.181732.

Exposure to Ebola Virus and Risk for Infection with Malaria Parasites, Rural Gabon [PDF - 905 KB - 9 pages]
J. L. Abbate et al.

An association between malaria and risk for death among patients with Ebola virus disease has suggested within-host interactions between Plasmodium falciparum parasites and Ebola virus. To determine whether such an interaction might also influence the probability of acquiring either infection, we used a large snapshot surveillance study from rural Gabon to test if past exposure to Ebola virus is associated with current infection with Plasmodium spp. during nonepidemic conditions. We found a strong positive association, on population and individual levels, between seropositivity for antibodies against Ebola virus and the presence of Plasmodium parasites in the blood. According to a multiple regression model accounting for other key variables, antibodies against Ebola virus emerged as the strongest individual-level risk factor for acquiring malaria. Our results suggest that within-host interactions between malaria parasites and Ebola virus may underlie epidemiologic associations.

EID Abbate JL, Becquart P, Leroy E, Ezenwa VO, Roche B. Exposure to Ebola Virus and Risk for Infection with Malaria Parasites, Rural Gabon. Emerg Infect Dis. 2020;26(2):229-237. https://dx.doi.org/10.3201/eid2602.181120
AMA Abbate JL, Becquart P, Leroy E, et al. Exposure to Ebola Virus and Risk for Infection with Malaria Parasites, Rural Gabon. Emerging Infectious Diseases. 2020;26(2):229-237. doi:10.3201/eid2602.181120.
APA Abbate, J. L., Becquart, P., Leroy, E., Ezenwa, V. O., & Roche, B. (2020). Exposure to Ebola Virus and Risk for Infection with Malaria Parasites, Rural Gabon. Emerging Infectious Diseases, 26(2), 229-237. https://dx.doi.org/10.3201/eid2602.181120.

Cost-effectiveness of Screening Program for Chronic Q Fever, the Netherlands [PDF - 2.59 MB - 9 pages]
P. T. de Boer et al.

In the aftermath of a large Q fever (QF) epidemic in the Netherlands during 2007–2010, new chronic QF (CQF) patients continue to be detected. We developed a health-economic decision model to evaluate the cost-effectiveness of a 1-time screening program for CQF 7 years after the epidemic. The model was parameterized with spatial data on QF notifications for the Netherlands, prevalence data from targeted screening studies, and clinical data from the national QF database. The cost-effectiveness of screening varied substantially among subpopulations and geographic areas. Screening that focused on cardiovascular risk patients in areas with high QF incidence during the epidemic ranged from cost-saving to €31,373 per quality-adjusted life year gained, depending on the method to estimate the prevalence of CQF. The cost per quality-adjusted life year of mass screening of all older adults was €70,000 in the most optimistic scenario.

EID de Boer PT, de Lange M, Wielders C, Dijkstra F, van Roeden SE, Bleeker-Rovers CP, et al. Cost-effectiveness of Screening Program for Chronic Q Fever, the Netherlands. Emerg Infect Dis. 2020;26(2):238-246. https://dx.doi.org/10.3201/eid2602.181772
AMA de Boer PT, de Lange M, Wielders C, et al. Cost-effectiveness of Screening Program for Chronic Q Fever, the Netherlands. Emerging Infectious Diseases. 2020;26(2):238-246. doi:10.3201/eid2602.181772.
APA de Boer, P. T., de Lange, M., Wielders, C., Dijkstra, F., van Roeden, S. E., Bleeker-Rovers, C. P....van der Hoek, W. (2020). Cost-effectiveness of Screening Program for Chronic Q Fever, the Netherlands. Emerging Infectious Diseases, 26(2), 238-246. https://dx.doi.org/10.3201/eid2602.181772.

Unique Clindamycin-Resistant Clostridioides difficile Strain Related to Fluoroquinolone-Resistant Epidemic BI/RT027 Strain [PDF - 1.16 MB - 8 pages]
A. M. Skinner et al.

During a surveillance study of patients in a long-term care facility and the affiliated acute care hospital in the United States, we identified a Clostridioides difficile strain related to the epidemic PCR ribotype (RT) 027 strain associated with hospital outbreaks of severe disease. Fifteen patients were infected with this strain, characterized as restriction endonuclease analysis group DQ and RT591. Like RT027, DQ/RT591 contained genes for toxin B and binary toxin CDT and a tcdC gene of identical sequence. Whole-genome sequencing and multilocus sequence typing showed that DQ/RT591 is a member of the same multilocus sequence typing clade 2 as RT027 but in a separate cluster. DQ/RT591 produced a similar cytopathic effect as RT027 but showed delayed toxin production in vitro. DQ/RT591 was susceptible to moxifloxacin but highly resistant to clindamycin. Continued surveillance is warranted for this clindamycin-resistant strain that is related to the fluoroquinolone-resistant epidemic RT027 strain.

EID Skinner AM, Petrella L, Siddiqui F, Sambol SP, Gulvik CA, Gerding DN, et al. Unique Clindamycin-Resistant Clostridioides difficile Strain Related to Fluoroquinolone-Resistant Epidemic BI/RT027 Strain. Emerg Infect Dis. 2020;26(2):247-254. https://dx.doi.org/10.3201/eid2602.181965
AMA Skinner AM, Petrella L, Siddiqui F, et al. Unique Clindamycin-Resistant Clostridioides difficile Strain Related to Fluoroquinolone-Resistant Epidemic BI/RT027 Strain. Emerging Infectious Diseases. 2020;26(2):247-254. doi:10.3201/eid2602.181965.
APA Skinner, A. M., Petrella, L., Siddiqui, F., Sambol, S. P., Gulvik, C. A., Gerding, D. N....Johnson, S. (2020). Unique Clindamycin-Resistant Clostridioides difficile Strain Related to Fluoroquinolone-Resistant Epidemic BI/RT027 Strain. Emerging Infectious Diseases, 26(2), 247-254. https://dx.doi.org/10.3201/eid2602.181965.

Porcine Deltacoronavirus Infection and Transmission in Poultry, United States [PDF - 1.43 MB - 11 pages]
P. A. Boley et al.

Coronaviruses cause respiratory and gastrointestinal diseases in diverse host species. Deltacoronaviruses (DCoVs) have been identified in various songbird species and in leopard cats in China. In 2009, porcine deltacoronavirus (PDCoV) was detected in fecal samples from pigs in Asia, but its etiologic role was not identified until 2014, when it caused major diarrhea outbreaks in swine in the United States. Studies have shown that PDCoV uses a conserved region of the aminopeptidase N protein to infect cell lines derived from multiple species, including humans, pigs, and chickens. Because PDCoV is a potential zoonotic pathogen, investigations of its prevalence in humans and its contribution to human disease continue. We report experimental PDCoV infection and subsequent transmission among poultry. In PDCoV-inoculated chicks and turkey poults, we observed diarrhea, persistent viral RNA titers from cloacal and tracheal samples, PDCoV-specific serum IgY antibody responses, and antigen-positive cells from intestines.

EID Boley PA, Alhamo MA, Lossie G, Yadav K, Vasquez-Lee M, Saif LJ, et al. Porcine Deltacoronavirus Infection and Transmission in Poultry, United States. Emerg Infect Dis. 2020;26(2):255-265. https://dx.doi.org/10.3201/eid2602.190346
AMA Boley PA, Alhamo MA, Lossie G, et al. Porcine Deltacoronavirus Infection and Transmission in Poultry, United States. Emerging Infectious Diseases. 2020;26(2):255-265. doi:10.3201/eid2602.190346.
APA Boley, P. A., Alhamo, M. A., Lossie, G., Yadav, K., Vasquez-Lee, M., Saif, L. J....Kenney, S. P. (2020). Porcine Deltacoronavirus Infection and Transmission in Poultry, United States. Emerging Infectious Diseases, 26(2), 255-265. https://dx.doi.org/10.3201/eid2602.190346.

Chronic Human Pegivirus 2 without Hepatitis C Virus Co-infection [PDF - 564 KB - 8 pages]
K. E. Coller et al.

Most human pegivirus 2 (HPgV-2) infections are associated with past or current hepatitis C virus (HCV) infection. HPgV-2 is thought to be a bloodborne virus: higher prevalence of active infection has been found in populations with a history of parenteral exposure to viruses. We evaluated longitudinally collected blood samples obtained from injection drug users (IDUs) for active and resolved HPgV-2 infections using a combination of HPgV-2–specific molecular and serologic tests. We found evidence of HPgV-2 infection in 11.2% (22/197) of past or current HCV-infected IDUs, compared with 1.9% (4/205) of an HCV-negative IDU population. Testing of available longitudinal blood samples from HPgV-2–positive participants identified 5 with chronic infection (>6 months viremia in >3 timepoints); 2 were identified among the HCV-positive IDUs and 3 among the HCV-negative IDUs. Our findings indicate that HPgV-2 can establish chronic infection and replicate in the absence of HCV.

EID Coller KE, Bruce V, Cassidy M, Gersch J, Frankel MB, Vallari A, et al. Chronic Human Pegivirus 2 without Hepatitis C Virus Co-infection. Emerg Infect Dis. 2020;26(2):265-272. https://dx.doi.org/10.3201/eid2602.190434
AMA Coller KE, Bruce V, Cassidy M, et al. Chronic Human Pegivirus 2 without Hepatitis C Virus Co-infection. Emerging Infectious Diseases. 2020;26(2):265-272. doi:10.3201/eid2602.190434.
APA Coller, K. E., Bruce, V., Cassidy, M., Gersch, J., Frankel, M. B., Vallari, A....Dawson, G. J. (2020). Chronic Human Pegivirus 2 without Hepatitis C Virus Co-infection. Emerging Infectious Diseases, 26(2), 265-272. https://dx.doi.org/10.3201/eid2602.190434.

Interspecies Transmission of Reassortant Swine Influenza A Virus Containing Genes from Swine Influenza A(H1N1)pdm09 and A(H1N2) Viruses [PDF - 1.57 MB - 9 pages]
H. E. Everett et al.

Influenza A(H1N1)pdm09 (pH1N1) virus has become established in swine in the United Kingdom and currently co-circulates with previously enzootic swine influenza A virus (IAV) strains, including avian-like H1N1 and human-like H1N2 viruses. During 2010, a swine influenza A reassortant virus, H1N2r, which caused mild clinical disease in pigs in the United Kingdom, was isolated. This reassortant virus has a novel gene constellation, incorporating the internal gene cassette of pH1N1-origin viruses and hemagglutinin and neuraminidase genes of swine IAV H1N2 origin. We investigated the pathogenesis and infection dynamics of the H1N2r isolate in pigs (the natural host) and in ferrets, which represent a human model of infection. Clinical and virologic parameters were mild in both species and both intraspecies and interspecies transmission was observed when initiated from either infected pigs or infected ferrets. This novel reassortant virus has zoonotic and reverse zoonotic potential, but no apparent increased virulence or transmissibility, in comparison to pH1N1 viruses.

EID Everett HE, Nash B, Londt BZ, Kelly MD, Coward V, Nunez A, et al. Interspecies Transmission of Reassortant Swine Influenza A Virus Containing Genes from Swine Influenza A(H1N1)pdm09 and A(H1N2) Viruses. Emerg Infect Dis. 2020;26(2):273-281. https://dx.doi.org/10.3201/eid2602.190486
AMA Everett HE, Nash B, Londt BZ, et al. Interspecies Transmission of Reassortant Swine Influenza A Virus Containing Genes from Swine Influenza A(H1N1)pdm09 and A(H1N2) Viruses. Emerging Infectious Diseases. 2020;26(2):273-281. doi:10.3201/eid2602.190486.
APA Everett, H. E., Nash, B., Londt, B. Z., Kelly, M. D., Coward, V., Nunez, A....Brookes, S. M. (2020). Interspecies Transmission of Reassortant Swine Influenza A Virus Containing Genes from Swine Influenza A(H1N1)pdm09 and A(H1N2) Viruses. Emerging Infectious Diseases, 26(2), 273-281. https://dx.doi.org/10.3201/eid2602.190486.

Multiplex Mediator Displacement Loop-Mediated Isothermal Amplification for Detection of Treponema pallidum and Haemophilus ducreyi [PDF - 1.80 MB - 7 pages]
L. Becherer et al.

Yaws, a neglected tropical disease caused by the bacterium Treponema pallidum subspecies pertenue, manifests as ulcerative skin lesions. Nucleic acid amplification tests, like loop-mediated isothermal amplification (LAMP), are versatile tools to distinguish yaws from infections that cause similar skin lesions, primarily Haemophilus ducreyi. We developed a novel molecular test to simultaneously detect T. pallidum and H. ducreyi based on mediator displacement LAMP. We validated the T. pallidum and H. ducreyi LAMP (TPHD-LAMP) by testing 293 clinical samples from patients with yaws-like lesions. Compared with quantitative PCR, the TPHD-LAMP demonstrated high sensitivity and specificity for T. pallidum (84.7% sensitivity, 95.7% specificity) and H. ducreyi (91.6% sensitivity, 84.8% specificity). This novel assay provided rapid molecular confirmation of T. pallidum and H. ducreyi DNA and might be suitable for use at the point of care. TPHD-LAMP could support yaws eradication by improving access to molecular diagnostic tests at the district hospital level.

EID Becherer L, Knauf S, Marks M, Lueert S, Frischmann S, Borst N, et al. Multiplex Mediator Displacement Loop-Mediated Isothermal Amplification for Detection of Treponema pallidum and Haemophilus ducreyi. Emerg Infect Dis. 2020;26(2):282-288. https://dx.doi.org/10.3201/eid2602.190505
AMA Becherer L, Knauf S, Marks M, et al. Multiplex Mediator Displacement Loop-Mediated Isothermal Amplification for Detection of Treponema pallidum and Haemophilus ducreyi. Emerging Infectious Diseases. 2020;26(2):282-288. doi:10.3201/eid2602.190505.
APA Becherer, L., Knauf, S., Marks, M., Lueert, S., Frischmann, S., Borst, N....Bakheit, M. (2020). Multiplex Mediator Displacement Loop-Mediated Isothermal Amplification for Detection of Treponema pallidum and Haemophilus ducreyi. Emerging Infectious Diseases, 26(2), 282-288. https://dx.doi.org/10.3201/eid2602.190505.

Novel Subclone of Carbapenem-Resistant Klebsiella pneumoniae Sequence Type 11 with Enhanced Virulence and Transmissibility, China [PDF - 1.06 MB - 9 pages]
K. Zhou et al.

We aimed to clarify the epidemiologic and clinical importance of evolutionary events that occurred in carbapenem-resistant Klebsiella pneumoniae (CRKP). We collected 203 CRKP causing bloodstream infections in a tertiary hospital in China during 2013–2017. We detected a subclonal shift in the dominant clone sequence type (ST) 11 CRKP in which the previously prevalent capsular loci (KL) 47 had been replaced by KL64 since 2016. Patients infected with ST11-KL64 CRKP had a significantly higher 30-day mortality rate than other CRKP-infected patients. Enhanced virulence was further evidenced by phenotypic tests. Phylogenetic reconstruction demonstrated that ST11-KL64 is derived from an ST11-KL47–like ancestor through recombination. We identified a pLVPK-like virulence plasmid carrying rmpA and peg-344 in ST11-KL64 exclusively from 2016 onward. The pLVPK-like–positive ST11-KL64 isolates exhibited enhanced environmental survival. Retrospective screening of a national collection identified ST11-KL64 in multiple regions. Targeted surveillance of this high-risk CRKP clone is urgently needed.

EID Zhou K, Xiao T, David S, Wang Q, Zhou Y, Guo L, et al. Novel Subclone of Carbapenem-Resistant Klebsiella pneumoniae Sequence Type 11 with Enhanced Virulence and Transmissibility, China. Emerg Infect Dis. 2020;26(2):289-297. https://dx.doi.org/10.3201/eid2602.190594
AMA Zhou K, Xiao T, David S, et al. Novel Subclone of Carbapenem-Resistant Klebsiella pneumoniae Sequence Type 11 with Enhanced Virulence and Transmissibility, China. Emerging Infectious Diseases. 2020;26(2):289-297. doi:10.3201/eid2602.190594.
APA Zhou, K., Xiao, T., David, S., Wang, Q., Zhou, Y., Guo, L....Xiao, Y. (2020). Novel Subclone of Carbapenem-Resistant Klebsiella pneumoniae Sequence Type 11 with Enhanced Virulence and Transmissibility, China. Emerging Infectious Diseases, 26(2), 289-297. https://dx.doi.org/10.3201/eid2602.190594.

Neutralizing Antibodies against Enteroviruses in Patients with Hand, Foot and Mouth Disease [PDF - 724 KB - 9 pages]
L. Nguyet et al.

Hand, foot and mouth disease (HFMD) is an emerging infection with pandemic potential. Knowledge of neutralizing antibody responses among its pathogens is essential to inform vaccine development and epidemiologic research. We used 120 paired-plasma samples collected at enrollment and >7 days after the onset of illness from HFMD patients infected with enterovirus A71 (EV-A71), coxsackievirus A (CVA) 6, CVA10, and CVA16 to study cross neutralization. For homotypic viruses, seropositivity increased from <60% at enrollment to 97%–100% at follow-up, corresponding to seroconversion rates of 57%–93%. Seroconversion for heterotypic viruses was recorded in only 3%–23% of patients. All plasma samples from patients infected with EV-A71 subgenogroup B5 could neutralize the emerging EV-A71 subgenogroup C4. Collectively, our results support previous reports about the potential benefit of EV-A71 vaccine but highlight the necessity of multivalent vaccines to control HFMD.

EID Nguyet L, Thanh T, Nhan L, Hong N, Nhu L, Van H, et al. Neutralizing Antibodies against Enteroviruses in Patients with Hand, Foot and Mouth Disease. Emerg Infect Dis. 2020;26(2):298-306. https://dx.doi.org/10.3201/eid2602.190721
AMA Nguyet L, Thanh T, Nhan L, et al. Neutralizing Antibodies against Enteroviruses in Patients with Hand, Foot and Mouth Disease. Emerging Infectious Diseases. 2020;26(2):298-306. doi:10.3201/eid2602.190721.
APA Nguyet, L., Thanh, T., Nhan, L., Hong, N., Nhu, L., Van, H....Tan, L. (2020). Neutralizing Antibodies against Enteroviruses in Patients with Hand, Foot and Mouth Disease. Emerging Infectious Diseases, 26(2), 298-306. https://dx.doi.org/10.3201/eid2602.190721.
Dispatches

Emergence of Chikungunya Virus, Pakistan, 2016–2017 [PDF - 1.54 MB - 4 pages]
N. Badar et al.

During December 2016–May 2017, an outbreak of chikungunya virus infection occurred across Pakistan. The East/Central/South African genotype was predominant. This study provides baseline data on the virus strain and emphasizes the need for active surveillance and implementation of preventive interventions to contain future outbreaks.

EID Badar N, Salman M, Ansari J, Aamir U, Alam M, Arshad Y, et al. Emergence of Chikungunya Virus, Pakistan, 2016–2017. Emerg Infect Dis. 2020;26(2):307-310. https://dx.doi.org/10.3201/eid2602.171636
AMA Badar N, Salman M, Ansari J, et al. Emergence of Chikungunya Virus, Pakistan, 2016–2017. Emerging Infectious Diseases. 2020;26(2):307-310. doi:10.3201/eid2602.171636.
APA Badar, N., Salman, M., Ansari, J., Aamir, U., Alam, M., Arshad, Y....Qazi, J. (2020). Emergence of Chikungunya Virus, Pakistan, 2016–2017. Emerging Infectious Diseases, 26(2), 307-310. https://dx.doi.org/10.3201/eid2602.171636.

Influence of Rainfall on Leptospira Infection and Disease in a Tropical Urban Setting, Brazil [PDF - 611 KB - 4 pages]
K. P. Hacker et al.

The incidence of hospitalized leptospirosis patients was positively associated with increased precipitation in Salvador, Brazil. However, Leptospira infection risk among a cohort of city residents was inversely associated with rainfall. These findings indicate that, although heavy rainfall may increase severe illness, Leptospira exposures can occur year-round.

EID Hacker KP, Sacramento GA, Cruz JS, de Oliveira D, Nery N, Lindow JC, et al. Influence of Rainfall on Leptospira Infection and Disease in a Tropical Urban Setting, Brazil. Emerg Infect Dis. 2020;26(2):311-314. https://dx.doi.org/10.3201/eid2602.190102
AMA Hacker KP, Sacramento GA, Cruz JS, et al. Influence of Rainfall on Leptospira Infection and Disease in a Tropical Urban Setting, Brazil. Emerging Infectious Diseases. 2020;26(2):311-314. doi:10.3201/eid2602.190102.
APA Hacker, K. P., Sacramento, G. A., Cruz, J. S., de Oliveira, D., Nery, N., Lindow, J. C....Costa, F. (2020). Influence of Rainfall on Leptospira Infection and Disease in a Tropical Urban Setting, Brazil. Emerging Infectious Diseases, 26(2), 311-314. https://dx.doi.org/10.3201/eid2602.190102.

Systematic Hospital-Based Travel Screening to Assess Exposure to Zika Virus [PDF - 781 KB - 5 pages]
A. Iqbal et al.

We queried hospital patients about international travel in the previous 30 days to assess potential importation of emerging infections. We used 12 months of deidentified data to analyze patient demographics, travel destinations, and diagnoses for exposure to Zika virus. Our approach could be used to analyze potential infectious disease exposures.

EID Iqbal A, Colgrove R, Iacoviello V, Blair BM, Chen LH. Systematic Hospital-Based Travel Screening to Assess Exposure to Zika Virus. Emerg Infect Dis. 2020;26(2):315-319. https://dx.doi.org/10.3201/eid2602.190292
AMA Iqbal A, Colgrove R, Iacoviello V, et al. Systematic Hospital-Based Travel Screening to Assess Exposure to Zika Virus. Emerging Infectious Diseases. 2020;26(2):315-319. doi:10.3201/eid2602.190292.
APA Iqbal, A., Colgrove, R., Iacoviello, V., Blair, B. M., & Chen, L. H. (2020). Systematic Hospital-Based Travel Screening to Assess Exposure to Zika Virus. Emerging Infectious Diseases, 26(2), 315-319. https://dx.doi.org/10.3201/eid2602.190292.

Elizabethkingia anophelis Infection in Infants, Cambodia, 2012–2018 [PDF - 341 KB - 2 pages]
T. Reed et al.

We describe 6 clinical isolates of Elizabethkingia anophelis from a pediatric referral hospital in Cambodia, along with 1 isolate reported from Thailand. Improving diagnostic microbiological methods in resource-limited settings will increase the frequency of reporting for this pathogen. Consensus on therapeutic options is needed, especially for resource-limited settings.

EID Reed T, Watson G, Kheng C, Tan P, Roberts T, Ling CL, et al. Elizabethkingia anophelis Infection in Infants, Cambodia, 2012–2018. Emerg Infect Dis. 2020;26(2):320-322. https://dx.doi.org/10.3201/eid2602.190345
AMA Reed T, Watson G, Kheng C, et al. Elizabethkingia anophelis Infection in Infants, Cambodia, 2012–2018. Emerging Infectious Diseases. 2020;26(2):320-322. doi:10.3201/eid2602.190345.
APA Reed, T., Watson, G., Kheng, C., Tan, P., Roberts, T., Ling, C. L....Turner, P. (2020). Elizabethkingia anophelis Infection in Infants, Cambodia, 2012–2018. Emerging Infectious Diseases, 26(2), 320-322. https://dx.doi.org/10.3201/eid2602.190345.

Global Expansion of Pacific Northwest Vibrio parahaemolyticus Sequence Type 36 [PDF - 2.75 MB - 4 pages]
M. Abanto et al.

We report transcontinental expansion of Vibrio parahaemolyticus sequence type 36 into Lima, Peru. From national collections, we identified 7 isolates from 2 different Pacific Northwest complex lineages that surfaced during 2011–2016. Sequence type 36 is likely established in environmental reservoirs. Systematic surveillance enabled detection of these epidemic isolates.

EID Abanto M, Gavilan RG, Baker-Austin C, Gonzalez-Escalona N, Martinez-Urtaza J. Global Expansion of Pacific Northwest Vibrio parahaemolyticus Sequence Type 36. Emerg Infect Dis. 2020;26(2):323-326. https://dx.doi.org/10.3201/eid2602.190362
AMA Abanto M, Gavilan RG, Baker-Austin C, et al. Global Expansion of Pacific Northwest Vibrio parahaemolyticus Sequence Type 36. Emerging Infectious Diseases. 2020;26(2):323-326. doi:10.3201/eid2602.190362.
APA Abanto, M., Gavilan, R. G., Baker-Austin, C., Gonzalez-Escalona, N., & Martinez-Urtaza, J. (2020). Global Expansion of Pacific Northwest Vibrio parahaemolyticus Sequence Type 36. Emerging Infectious Diseases, 26(2), 323-326. https://dx.doi.org/10.3201/eid2602.190362.

Surge in Anaplasmosis Cases in Maine, USA, 2013–2017 [PDF - 1.03 MB - 5 pages]
S. P. Elias et al.

Incidence of human granulocytic anaplasmosis is rising in Maine, USA. This increase may be explained in part by adoption of tick panels as a frequent diagnostic test in persons with febrile illness and in part by range expansion of Ixodes scapularis ticks and zoonotic amplification of Anaplasma phagocytophilum.

EID Elias SP, Bonthius J, Robinson S, Robich RM, Lubelczyk CB, Smith RP. Surge in Anaplasmosis Cases in Maine, USA, 2013–2017. Emerg Infect Dis. 2020;26(2):327-331. https://dx.doi.org/10.3201/eid2602.190529
AMA Elias SP, Bonthius J, Robinson S, et al. Surge in Anaplasmosis Cases in Maine, USA, 2013–2017. Emerging Infectious Diseases. 2020;26(2):327-331. doi:10.3201/eid2602.190529.
APA Elias, S. P., Bonthius, J., Robinson, S., Robich, R. M., Lubelczyk, C. B., & Smith, R. P. (2020). Surge in Anaplasmosis Cases in Maine, USA, 2013–2017. Emerging Infectious Diseases, 26(2), 327-331. https://dx.doi.org/10.3201/eid2602.190529.

Mycoplasma genitalium Antimicrobial Resistance in Community and Sexual Health Clinic Patients, Auckland, New Zealand [PDF - 508 KB - 4 pages]
A. Vesty et al.

Our retrospective study compared genotypic antimicrobial resistance in Mycoplasma genitalium–positive specimens collected from 48 community and 33 sexual health clinic (SHC) patients. Macrolide resistance was similar in community (75%) and SHC (76%) patients. We observed no significant difference in fluoroquinolone resistance between community (19%) and SHC (27%) patients (p = 0.66).

EID Vesty A, McAuliffe G, Roberts S, Henderson G, Basu I. Mycoplasma genitalium Antimicrobial Resistance in Community and Sexual Health Clinic Patients, Auckland, New Zealand. Emerg Infect Dis. 2020;26(2):332-335. https://dx.doi.org/10.3201/eid2602.190533
AMA Vesty A, McAuliffe G, Roberts S, et al. Mycoplasma genitalium Antimicrobial Resistance in Community and Sexual Health Clinic Patients, Auckland, New Zealand. Emerging Infectious Diseases. 2020;26(2):332-335. doi:10.3201/eid2602.190533.
APA Vesty, A., McAuliffe, G., Roberts, S., Henderson, G., & Basu, I. (2020). Mycoplasma genitalium Antimicrobial Resistance in Community and Sexual Health Clinic Patients, Auckland, New Zealand. Emerging Infectious Diseases, 26(2), 332-335. https://dx.doi.org/10.3201/eid2602.190533.

Early Detection of Public Health Emergencies of International Concern through Undiagnosed Disease Reports in ProMED-Mail [PDF - 964 KB - 4 pages]
C. Rolland et al.

We conducted a retrospective analysis of all reports in ProMED-mail that were initially classified as undiagnosed diseases during 2007–2018. We identified 371 cases reported in ProMED-mail; 34% were later diagnosed. ProMED-mail could be used to supplement other undiagnosed disease surveillance systems worldwide.

EID Rolland C, Lazarus C, Giese C, Monate B, Travert A, Salomon J. Early Detection of Public Health Emergencies of International Concern through Undiagnosed Disease Reports in ProMED-Mail. Emerg Infect Dis. 2020;26(2):336-339. https://dx.doi.org/10.3201/eid2602.191043
AMA Rolland C, Lazarus C, Giese C, et al. Early Detection of Public Health Emergencies of International Concern through Undiagnosed Disease Reports in ProMED-Mail. Emerging Infectious Diseases. 2020;26(2):336-339. doi:10.3201/eid2602.191043.
APA Rolland, C., Lazarus, C., Giese, C., Monate, B., Travert, A., & Salomon, J. (2020). Early Detection of Public Health Emergencies of International Concern through Undiagnosed Disease Reports in ProMED-Mail. Emerging Infectious Diseases, 26(2), 336-339. https://dx.doi.org/10.3201/eid2602.191043.

Ocular Spiroplasma ixodetis in Newborns, France [PDF - 3.12 MB - 5 pages]
A. Matet et al.

Cataract and uveitis are rare in newborns but potentially blinding. Three newborns with cataract and severe anterior uveitis underwent cataract surgery. Spiroplasma ixodetis was detected in lens aspirates using bacterial 16S-rRNA PCR and transmission electron microscopy. These findings, which suggest maternal–fetal infection, are consistent with previous experimental Spiroplasma-induced cataract and uveitis.

EID Matet A, Le Flèche-Matéos A, Doz F, Dureau P, Cassoux N. Ocular Spiroplasma ixodetis in Newborns, France. Emerg Infect Dis. 2020;26(2):340-344. https://dx.doi.org/10.3201/eid2602.191097
AMA Matet A, Le Flèche-Matéos A, Doz F, et al. Ocular Spiroplasma ixodetis in Newborns, France. Emerging Infectious Diseases. 2020;26(2):340-344. doi:10.3201/eid2602.191097.
APA Matet, A., Le Flèche-Matéos, A., Doz, F., Dureau, P., & Cassoux, N. (2020). Ocular Spiroplasma ixodetis in Newborns, France. Emerging Infectious Diseases, 26(2), 340-344. https://dx.doi.org/10.3201/eid2602.191097.

Use of Surveillance Outbreak Response Management and Analysis System for Human Monkeypox Outbreak, Nigeria, 2017–2019 [PDF - 1.42 MB - 5 pages]
B. C. Silenou et al.

In November 2017, the mobile digital Surveillance Outbreak Response Management and Analysis System was deployed in 30 districts in Nigeria in response to an outbreak of monkeypox. Adaptation and activation of the system took 14 days, and its use improved timeliness, completeness, and overall capacity of the response.

EID Silenou BC, Tom-Aba D, Adeoye O, Arinze CC, Oyiri F, Suleman AK, et al. Use of Surveillance Outbreak Response Management and Analysis System for Human Monkeypox Outbreak, Nigeria, 2017–2019. Emerg Infect Dis. 2020;26(2):345-349. https://dx.doi.org/10.3201/eid2602.191139
AMA Silenou BC, Tom-Aba D, Adeoye O, et al. Use of Surveillance Outbreak Response Management and Analysis System for Human Monkeypox Outbreak, Nigeria, 2017–2019. Emerging Infectious Diseases. 2020;26(2):345-349. doi:10.3201/eid2602.191139.
APA Silenou, B. C., Tom-Aba, D., Adeoye, O., Arinze, C. C., Oyiri, F., Suleman, A. K....Krause, G. (2020). Use of Surveillance Outbreak Response Management and Analysis System for Human Monkeypox Outbreak, Nigeria, 2017–2019. Emerging Infectious Diseases, 26(2), 345-349. https://dx.doi.org/10.3201/eid2602.191139.

Human Norovirus Infection in Dogs, Thailand [PDF - 1.49 MB - 4 pages]
K. Charoenkul et al.

In July 2018, recombinant norovirus GII.Pe-GII.4 Sydney was detected in dogs who had diarrhea in a kennel and in children living on the same premises in Thailand. Whole-genome sequencing and phylogenetic analysis of 4 noroviruses from Thailand showed that the canine norovirus was closely related to human norovirus GII.Pe-GII.4 Sydney, suggesting human-to-canine transmission.

EID Charoenkul K, Nasamran C, Janetanakit T, Tangwangvivat R, Bunpapong N, Boonyapisitsopa S, et al. Human Norovirus Infection in Dogs, Thailand. Emerg Infect Dis. 2020;26(2):350-353. https://dx.doi.org/10.3201/eid2602.191151
AMA Charoenkul K, Nasamran C, Janetanakit T, et al. Human Norovirus Infection in Dogs, Thailand. Emerging Infectious Diseases. 2020;26(2):350-353. doi:10.3201/eid2602.191151.
APA Charoenkul, K., Nasamran, C., Janetanakit, T., Tangwangvivat, R., Bunpapong, N., Boonyapisitsopa, S....Amonsin, A. (2020). Human Norovirus Infection in Dogs, Thailand. Emerging Infectious Diseases, 26(2), 350-353. https://dx.doi.org/10.3201/eid2602.191151.

Hepatitis E Virus in Pigs from Slaughterhouses, United States, 2017–2019 [PDF - 766 KB - 4 pages]
H. Sooryanarain et al.

Hepatitis E virus (HEV) RNA was detected in 6.3% and HEV IgG in 40% of 5,033 serum samples from market-weight pigs at 25 slaughterhouses in 10 US states. The prevalent HEV genotype was zoonotic genotype 3, group 2. Blood of HEV-viremic pigs from slaughterhouses may contaminate pork supply chains.

EID Sooryanarain H, Heffron CL, Hill DE, Fredericks J, Rosenthal BM, Werre SR, et al. Hepatitis E Virus in Pigs from Slaughterhouses, United States, 2017–2019. Emerg Infect Dis. 2020;26(2):354-357. https://dx.doi.org/10.3201/eid2602.191348
AMA Sooryanarain H, Heffron CL, Hill DE, et al. Hepatitis E Virus in Pigs from Slaughterhouses, United States, 2017–2019. Emerging Infectious Diseases. 2020;26(2):354-357. doi:10.3201/eid2602.191348.
APA Sooryanarain, H., Heffron, C. L., Hill, D. E., Fredericks, J., Rosenthal, B. M., Werre, S. R....Meng, X. (2020). Hepatitis E Virus in Pigs from Slaughterhouses, United States, 2017–2019. Emerging Infectious Diseases, 26(2), 354-357. https://dx.doi.org/10.3201/eid2602.191348.

Rapid Nanopore Whole-Genome Sequencing for Anthrax Emergency Preparedness [PDF - 822 KB - 4 pages]
H. P. McLaughlin et al.

Human anthrax cases necessitate rapid response. We completed Bacillus anthracis nanopore whole-genome sequencing in our high-containment laboratory from a human anthrax isolate hours after receipt. The de novo assembled genome showed no evidence of known antimicrobial resistance genes or introduced plasmid(s). Same-day genomic characterization enhances public health emergency response.

EID McLaughlin HP, Bugrysheva JV, Conley AB, Gulvik CA, Cherney B, Kolton CB, et al. Rapid Nanopore Whole-Genome Sequencing for Anthrax Emergency Preparedness. Emerg Infect Dis. 2020;26(2):358-361. https://dx.doi.org/10.3201/eid2602.191351
AMA McLaughlin HP, Bugrysheva JV, Conley AB, et al. Rapid Nanopore Whole-Genome Sequencing for Anthrax Emergency Preparedness. Emerging Infectious Diseases. 2020;26(2):358-361. doi:10.3201/eid2602.191351.
APA McLaughlin, H. P., Bugrysheva, J. V., Conley, A. B., Gulvik, C. A., Cherney, B., Kolton, C. B....Sue, D. (2020). Rapid Nanopore Whole-Genome Sequencing for Anthrax Emergency Preparedness. Emerging Infectious Diseases, 26(2), 358-361. https://dx.doi.org/10.3201/eid2602.191351.
Research Letters

Rickettsia mongolitimonae Encephalitis, Southern France, 2018 [PDF - 1.06 MB - 3 pages]
M. Loarte et al.

We report a case of Rickettsia sibirica mongolitimonae infection, an emerging tickborne rickettsiosis, with associated encephalitis in a 66-year-old man. Diagnosis was rapidly confirmed by quantitative PCR obtained from an eschar swab sample. The patient was successfully treated with oral doxycycline.

EID Loarte M, Melenotte C, Cassir N, Cammilleri S, Dory-Lautrec P, Raoult D, et al. Rickettsia mongolitimonae Encephalitis, Southern France, 2018. Emerg Infect Dis. 2020;26(2):362-364. https://dx.doi.org/10.3201/eid2602.181667
AMA Loarte M, Melenotte C, Cassir N, et al. Rickettsia mongolitimonae Encephalitis, Southern France, 2018. Emerging Infectious Diseases. 2020;26(2):362-364. doi:10.3201/eid2602.181667.
APA Loarte, M., Melenotte, C., Cassir, N., Cammilleri, S., Dory-Lautrec, P., Raoult, D....Parola, P. (2020). Rickettsia mongolitimonae Encephalitis, Southern France, 2018. Emerging Infectious Diseases, 26(2), 362-364. https://dx.doi.org/10.3201/eid2602.181667.

Human Alveolar Echinococcosis, Croatia [PDF - 658 KB - 3 pages]
D. Dušek et al.

Alveolar echinococcosis is a parasitic disease caused by the tapeworm larval stage of Echinococcus multilocularis. This zoonotic disease has not been known to occur in Croatia. We report a confirmed case of human alveolar echinococcosis in a patient in Croatia who had never visited a known E. multilocularis–endemic area.

EID Dušek D, Vince A, Kurelac I, Papić N, Višković K, Deplazes P, et al. Human Alveolar Echinococcosis, Croatia. Emerg Infect Dis. 2020;26(2):364-366. https://dx.doi.org/10.3201/eid2602.181826
AMA Dušek D, Vince A, Kurelac I, et al. Human Alveolar Echinococcosis, Croatia. Emerging Infectious Diseases. 2020;26(2):364-366. doi:10.3201/eid2602.181826.
APA Dušek, D., Vince, A., Kurelac, I., Papić, N., Višković, K., Deplazes, P....Beck, R. (2020). Human Alveolar Echinococcosis, Croatia. Emerging Infectious Diseases, 26(2), 364-366. https://dx.doi.org/10.3201/eid2602.181826.

Two Cases of Newly Characterized Neisseria Species, Brazil [PDF - 816 KB - 4 pages]
M. M. Mustapha et al.

We describe 2 human cases of infection with a new Neisseria species (putatively N. brasiliensis), 1 of which involved bacteremia. Genomic analyses found that both isolates were distinct strains of the same species, were closely related to N. iguanae, and contained a capsule synthesis operon similar to N. meningitidis.

EID Mustapha MM, Lemos AS, Griffith MP, Evans DR, Marx R, Coltro E, et al. Two Cases of Newly Characterized Neisseria Species, Brazil. Emerg Infect Dis. 2020;26(2):366-369. https://dx.doi.org/10.3201/eid2602.190191
AMA Mustapha MM, Lemos AS, Griffith MP, et al. Two Cases of Newly Characterized Neisseria Species, Brazil. Emerging Infectious Diseases. 2020;26(2):366-369. doi:10.3201/eid2602.190191.
APA Mustapha, M. M., Lemos, A. S., Griffith, M. P., Evans, D. R., Marx, R., Coltro, E....Sacchi, C. T. (2020). Two Cases of Newly Characterized Neisseria Species, Brazil. Emerging Infectious Diseases, 26(2), 366-369. https://dx.doi.org/10.3201/eid2602.190191.

Hepatitis A Virus Genotype IB Outbreak among Internally Displaced Persons, Syria [PDF - 302 KB - 3 pages]
M. Kaddoura et al.

In 2018, a hepatitis A virus outbreak was identified among internally displaced persons in Syria. Sequence analysis based on the viral protein 1/2A junction revealed that the causative virus belonged to genotype IB. A high displacement rate, deteriorated sanitary and health conditions, and poor water quality likely contributed to this outbreak.

EID Kaddoura M, Allaham R, Abubakar A, Ezzeddine A, Barakat A, Mala P, et al. Hepatitis A Virus Genotype IB Outbreak among Internally Displaced Persons, Syria. Emerg Infect Dis. 2020;26(2):369-371. https://dx.doi.org/10.3201/eid2602.190652
AMA Kaddoura M, Allaham R, Abubakar A, et al. Hepatitis A Virus Genotype IB Outbreak among Internally Displaced Persons, Syria. Emerging Infectious Diseases. 2020;26(2):369-371. doi:10.3201/eid2602.190652.
APA Kaddoura, M., Allaham, R., Abubakar, A., Ezzeddine, A., Barakat, A., Mala, P....Zaraket, H. (2020). Hepatitis A Virus Genotype IB Outbreak among Internally Displaced Persons, Syria. Emerging Infectious Diseases, 26(2), 369-371. https://dx.doi.org/10.3201/eid2602.190652.

Rickettsia parkeri and Candidatus Rickettsia andeanae in Amblyomma maculatum Group Ticks [PDF - 797 KB - 4 pages]
B. H. Noden et al.

We determined prevalence of Rickettsia spp. in 172 ticks of the Amblyomma maculatum group collected from 16 urban sites in Oklahoma City, Oklahoma, USA, during 2017 and 2018. Most ticks (59.3%) were collected from 1 site; 4 (2.3%) were infected with Rickettsia parkeri and 118 (68.6%) with Candidatus Rickettsia andeanae.

EID Noden BH, Roselli MA, Loss SR. Rickettsia parkeri and Candidatus Rickettsia andeanae in Amblyomma maculatum Group Ticks. Emerg Infect Dis. 2020;26(2):371-374. https://dx.doi.org/10.3201/eid2602.190664
AMA Noden BH, Roselli MA, Loss SR. Rickettsia parkeri and Candidatus Rickettsia andeanae in Amblyomma maculatum Group Ticks. Emerging Infectious Diseases. 2020;26(2):371-374. doi:10.3201/eid2602.190664.
APA Noden, B. H., Roselli, M. A., & Loss, S. R. (2020). Rickettsia parkeri and Candidatus Rickettsia andeanae in Amblyomma maculatum Group Ticks. Emerging Infectious Diseases, 26(2), 371-374. https://dx.doi.org/10.3201/eid2602.190664.

Astrovirus in White-Tailed Deer, United States, 2018 [PDF - 1.36 MB - 3 pages]
L. Wang et al.

We report the identification of astrovirus WI65268 in a white-tailed deer with respiratory disease in the United States in 2018. This virus is a recombinant of Kagoshima1-7 and Kagoshima2-3-2 (both bovine astroviruses from Japan) and was characterized as a potential new genotype. Further surveillance of deer might help identify related isolates.

EID Wang L, Shen H, Zheng Y, Schumacher L, Li G. Astrovirus in White-Tailed Deer, United States, 2018. Emerg Infect Dis. 2020;26(2):374-376. https://dx.doi.org/10.3201/eid2602.190878
AMA Wang L, Shen H, Zheng Y, et al. Astrovirus in White-Tailed Deer, United States, 2018. Emerging Infectious Diseases. 2020;26(2):374-376. doi:10.3201/eid2602.190878.
APA Wang, L., Shen, H., Zheng, Y., Schumacher, L., & Li, G. (2020). Astrovirus in White-Tailed Deer, United States, 2018. Emerging Infectious Diseases, 26(2), 374-376. https://dx.doi.org/10.3201/eid2602.190878.

Actinomycetoma Caused by Actinomadura mexicana, A Neglected Entity in the Caribbean [PDF - 273 KB - 3 pages]
S. Bessis et al.

Mycetoma is a chronic infection that is slow to develop and heal. It can be caused by fungi (eumycetoma) or bacteria (actinomycetoma). We describe a case of actinomycetoma caused by Actinomadura mexicana in the Caribbean region.

EID Bessis S, Noussair L, Rodriguez-Nava V, Jousset C, Duran C, Beresteanu A, et al. Actinomycetoma Caused by Actinomadura mexicana, A Neglected Entity in the Caribbean. Emerg Infect Dis. 2020;26(2):376-378. https://dx.doi.org/10.3201/eid2602.191005
AMA Bessis S, Noussair L, Rodriguez-Nava V, et al. Actinomycetoma Caused by Actinomadura mexicana, A Neglected Entity in the Caribbean. Emerging Infectious Diseases. 2020;26(2):376-378. doi:10.3201/eid2602.191005.
APA Bessis, S., Noussair, L., Rodriguez-Nava, V., Jousset, C., Duran, C., Beresteanu, A....Dinh, A. (2020). Actinomycetoma Caused by Actinomadura mexicana, A Neglected Entity in the Caribbean. Emerging Infectious Diseases, 26(2), 376-378. https://dx.doi.org/10.3201/eid2602.191005.

Antigenic Variant of Highly Pathogenic Avian Influenza A(H7N9) Virus, China, 2019 [PDF - 273 KB - 2 pages]
W. Jiang et al.

In China, influenza A(H7N9) virus appeared in 2013, then mutated into a highly pathogenic virus, causing outbreaks among poultry and cases in humans. Since September 2017, extensive use of the corresponding vaccine, H7-Re1, successfully reduced virus prevalence. However, in 2019, a novel antigenic variant emerged, posing considerable economic and public health threats.

EID Jiang W, Hou G, Li J, Peng C, Wang S, Liu S, et al. Antigenic Variant of Highly Pathogenic Avian Influenza A(H7N9) Virus, China, 2019. Emerg Infect Dis. 2020;26(2):379-380. https://dx.doi.org/10.3201/eid2602.191105
AMA Jiang W, Hou G, Li J, et al. Antigenic Variant of Highly Pathogenic Avian Influenza A(H7N9) Virus, China, 2019. Emerging Infectious Diseases. 2020;26(2):379-380. doi:10.3201/eid2602.191105.
APA Jiang, W., Hou, G., Li, J., Peng, C., Wang, S., Liu, S....Liu, H. (2020). Antigenic Variant of Highly Pathogenic Avian Influenza A(H7N9) Virus, China, 2019. Emerging Infectious Diseases, 26(2), 379-380. https://dx.doi.org/10.3201/eid2602.191105.

New Delhi Metallo-β-Lactamase-5–Producing Escherichia coli in Companion Animals, United States [PDF - 334 KB - 3 pages]
S. D. Cole et al.

We report isolation of a New Delhi metallo-β-lactamase-5–producing carbapenem-resistant Escherichia coli sequence type 167 from companion animals in the United States. Reports of carbapenem-resistant Enterobacteriaceae in companion animals are rare. We describe a unique cluster of blaNDM-5–producing E. coli in a veterinary hospital.

EID Cole SD, Peak L, Tyson GH, Reimschuessel R, Ceric O, Rankin SC. New Delhi Metallo-β-Lactamase-5–Producing Escherichia coli in Companion Animals, United States. Emerg Infect Dis. 2020;26(2):381-383. https://dx.doi.org/10.3201/eid2602.191221
AMA Cole SD, Peak L, Tyson GH, et al. New Delhi Metallo-β-Lactamase-5–Producing Escherichia coli in Companion Animals, United States. Emerging Infectious Diseases. 2020;26(2):381-383. doi:10.3201/eid2602.191221.
APA Cole, S. D., Peak, L., Tyson, G. H., Reimschuessel, R., Ceric, O., & Rankin, S. C. (2020). New Delhi Metallo-β-Lactamase-5–Producing Escherichia coli in Companion Animals, United States. Emerging Infectious Diseases, 26(2), 381-383. https://dx.doi.org/10.3201/eid2602.191221.

Hantavirus Infection with Renal Failure and Proteinuria, Colorado, USA, 2019 [PDF - 361 KB - 3 pages]
S. Chand et al.

In North America, hantaviruses commonly cause hantavirus pulmonary syndrome (HPS). Clinical descriptions of hantavirus-associated renal disease in the Americas are scarce. Herein, we discuss the case of a 61-year-old man whose predominant manifestations were acute kidney injury and proteinuria. Clinical recognition of renal signs in hantavirus infections can reduce risk for death.

EID Chand S, Thapa S, Kon S, Johnson SC, Poeschla EM, Franco-Paredes C, et al. Hantavirus Infection with Renal Failure and Proteinuria, Colorado, USA, 2019. Emerg Infect Dis. 2020;26(2):383-385. https://dx.doi.org/10.3201/eid2602.191349
AMA Chand S, Thapa S, Kon S, et al. Hantavirus Infection with Renal Failure and Proteinuria, Colorado, USA, 2019. Emerging Infectious Diseases. 2020;26(2):383-385. doi:10.3201/eid2602.191349.
APA Chand, S., Thapa, S., Kon, S., Johnson, S. C., Poeschla, E. M., Franco-Paredes, C....Henao-Martínez, A. F. (2020). Hantavirus Infection with Renal Failure and Proteinuria, Colorado, USA, 2019. Emerging Infectious Diseases, 26(2), 383-385. https://dx.doi.org/10.3201/eid2602.191349.

Persistence of Crimean-Congo Hemorrhagic Fever Virus RNA [PDF - 350 KB - 3 pages]
L. Mathengtheng et al.

Crimean-Congo hemorrhagic fever virus (CCHFV) causes severe disease with fatalities. Awareness of potential sources of infection is important to reduce risk to healthcare workers and contacts. We detected CCHFV RNA in formalin-fixed, paraffin-embedded tissues from a spontaneous abortion that were submitted for histology 9 weeks after a suspected CCHFV infection in the mother.

EID Mathengtheng L, Goedhals D, Bester PA, Goedhals J, Burt FJ. Persistence of Crimean-Congo Hemorrhagic Fever Virus RNA. Emerg Infect Dis. 2020;26(2):385-387. https://dx.doi.org/10.3201/eid2602.191460
AMA Mathengtheng L, Goedhals D, Bester PA, et al. Persistence of Crimean-Congo Hemorrhagic Fever Virus RNA. Emerging Infectious Diseases. 2020;26(2):385-387. doi:10.3201/eid2602.191460.
APA Mathengtheng, L., Goedhals, D., Bester, P. A., Goedhals, J., & Burt, F. J. (2020). Persistence of Crimean-Congo Hemorrhagic Fever Virus RNA. Emerging Infectious Diseases, 26(2), 385-387. https://dx.doi.org/10.3201/eid2602.191460.
Letters

Non-Leishmania Parasite in Fatal Visceral Leishmaniasis–like Disease, Brazil [PDF - 206 KB - 1 page]
M. Domagalska and J. Dujardin
EID Domagalska M, Dujardin J. Non-Leishmania Parasite in Fatal Visceral Leishmaniasis–like Disease, Brazil. Emerg Infect Dis. 2020;26(2):388. https://dx.doi.org/10.3201/eid2602.191428
AMA Domagalska M, Dujardin J. Non-Leishmania Parasite in Fatal Visceral Leishmaniasis–like Disease, Brazil. Emerging Infectious Diseases. 2020;26(2):388. doi:10.3201/eid2602.191428.
APA Domagalska, M., & Dujardin, J. (2020). Non-Leishmania Parasite in Fatal Visceral Leishmaniasis–like Disease, Brazil. Emerging Infectious Diseases, 26(2), 388. https://dx.doi.org/10.3201/eid2602.191428.
Another Dimension

Social Responses to Epidemics Depicted by Cinema [PDF - 272 KB - 6 pages]
Q. Han and D. R. Curtis

Films illustrate 2 ways that epidemics can affect societies: fear leading to a breakdown in sociability and fear stimulating preservation of tightly held social norms. The first response is often informed by concern over perceived moral failings within society, the second response by the application of arbitrary or excessive controls from outside the community.

EID Han Q, Curtis DR. Social Responses to Epidemics Depicted by Cinema. Emerg Infect Dis. 2020;26(2):389-394. https://dx.doi.org/10.3201/eid2602.181022
AMA Han Q, Curtis DR. Social Responses to Epidemics Depicted by Cinema. Emerging Infectious Diseases. 2020;26(2):389-394. doi:10.3201/eid2602.181022.
APA Han, Q., & Curtis, D. R. (2020). Social Responses to Epidemics Depicted by Cinema. Emerging Infectious Diseases, 26(2), 389-394. https://dx.doi.org/10.3201/eid2602.181022.
About the Cover

Veiled Dangers in an Idyllic Setting [PDF - 830 KB - 2 pages]
B. Breedlove
EID Breedlove B. Veiled Dangers in an Idyllic Setting. Emerg Infect Dis. 2020;26(2):395-396. https://dx.doi.org/10.3201/eid2602.ac2602
AMA Breedlove B. Veiled Dangers in an Idyllic Setting. Emerging Infectious Diseases. 2020;26(2):395-396. doi:10.3201/eid2602.ac2602.
APA Breedlove, B. (2020). Veiled Dangers in an Idyllic Setting. Emerging Infectious Diseases, 26(2), 395-396. https://dx.doi.org/10.3201/eid2602.ac2602.
Etymologia

Etymologia: Pegivirus [PDF - 271 KB - 1 page]
R. Henry
EID Henry R. Etymologia: Pegivirus. Emerg Infect Dis. 2020;26(2):272. https://dx.doi.org/10.3201/eid2602.et2602
AMA Henry R. Etymologia: Pegivirus. Emerging Infectious Diseases. 2020;26(2):272. doi:10.3201/eid2602.et2602.
APA Henry, R. (2020). Etymologia: Pegivirus. Emerging Infectious Diseases, 26(2), 272. https://dx.doi.org/10.3201/eid2602.et2602.
Page created: January 20, 2020
Page updated: January 20, 2020
Page reviewed: January 20, 2020
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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