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Issue Cover for Volume 26, Number 4—April 2020

Volume 26, Number 4—April 2020

[PDF - 37.83 MB - 198 pages]

Perspective

Stemming the Rising Tide of Human-Biting Ticks and Tickborne Diseases, United States [PDF - 1.27 MB - 7 pages]
L. Eisen

Ticks and tickborne diseases are increasingly problematic. There have been positive developments that should result in improved strategies and better tools to suppress ticks, reduce human tick bites, and roll back tickborne diseases. However, we equally need to address the question of who is responsible for implementing the solutions. The current model of individual responsibility for tick control evolved from a scenario in the 1990s focusing strongly on exposure to blacklegged ticks and Lyme disease spirochetes in peridomestic settings of the northeastern United States. Today, the threat posed by human-biting ticks is more widespread across the eastern United States, increasingly complex (multiple tick species and >10 notable tickborne pathogens), and, across tick species, more spatially diffuse (including backyards, neighborhood green spaces, and public recreation areas). To mitigate tick-associated negative societal effects, we must consider shifting the responsibility for tick control to include both individual persons and professionally staffed tick-management programs.

EID Eisen L. Stemming the Rising Tide of Human-Biting Ticks and Tickborne Diseases, United States. Emerg Infect Dis. 2020;26(4):641-647. https://dx.doi.org/10.3201/eid2604.191629
AMA Eisen L. Stemming the Rising Tide of Human-Biting Ticks and Tickborne Diseases, United States. Emerging Infectious Diseases. 2020;26(4):641-647. doi:10.3201/eid2604.191629.
APA Eisen, L. (2020). Stemming the Rising Tide of Human-Biting Ticks and Tickborne Diseases, United States. Emerging Infectious Diseases, 26(4), 641-647. https://dx.doi.org/10.3201/eid2604.191629.
Synopses

Medscape CME Activity
Ecology and Epidemiology of Tickborne Pathogens, Washington, USA, 2011–2016 [PDF - 2.68 MB - 10 pages]
E. A. Dykstra et al.

Tickborne diseases are rare in Washington, USA, and the ecology of these pathogens is poorly understood. We integrated surveillance data from humans and ticks to better describe their epidemiology and ecology. During 2011–2016, a total of 202 tickborne disease cases were reported in Washington residents. Of these, 68 (34%) were autochthonous, including cases of Lyme disease, Rocky Mountain spotted fever, tickborne relapsing fever, and tularemia. During May 2011–December 2016, we collected 977 host-seeking ticks, including Ixodes pacificus, I. angustus, I. spinipalpis, I. auritulus, Dermacentor andersoni, and D. variabilis ticks. The prevalence of Borrelia burgdorferi sensu stricto in I. pacificus ticks was 4.0%; of B. burgdorferi sensu lato, 3.8%; of B. miyamotoi, 4.4%; and of Anaplasma phagocytophilum, 1.9%. We did not detect Rickettsia rickettsii in either Dermacentor species. Case-patient histories and detection of pathogens in field-collected ticks indicate that several tickborne pathogens are endemic to Washington.

EID Dykstra EA, Oltean HN, Kangiser D, Marsden-Haug N, Rich SM, Xu G, et al. Ecology and Epidemiology of Tickborne Pathogens, Washington, USA, 2011–2016. Emerg Infect Dis. 2020;26(4):648-657. https://dx.doi.org/10.3201/eid2604.191382
AMA Dykstra EA, Oltean HN, Kangiser D, et al. Ecology and Epidemiology of Tickborne Pathogens, Washington, USA, 2011–2016. Emerging Infectious Diseases. 2020;26(4):648-657. doi:10.3201/eid2604.191382.
APA Dykstra, E. A., Oltean, H. N., Kangiser, D., Marsden-Haug, N., Rich, S. M., Xu, G....Eisen, R. J. (2020). Ecology and Epidemiology of Tickborne Pathogens, Washington, USA, 2011–2016. Emerging Infectious Diseases, 26(4), 648-657. https://dx.doi.org/10.3201/eid2604.191382.

Imported Arbovirus Infections in Spain, 2009–2018 [PDF - 962 KB - 9 pages]
F. F. Norman et al.

To determine the epidemiologic and clinical characteristics of patients in Spain with imported arbovirus infections, we analyzed 22,655 records from a collaborative network for January 2009–December 2018. Among 861 arbovirus infections, 845 were monoinfections (456 [53%] dengue, 280 [32.5%] chikungunya, 109 [12.7%] Zika) and 16 (1.8%) were co-infections. Most patients were travelers (56.3%) or immigrants returning to Spain after visiting friends or relatives (31.3%). Median patient age was 37 years; most (62.3%) were women and some (28.6%) had received pretravel advice. Only 12 patients were immunosuppressed. Six cases (all dengue monoinfections, none in immunosuppressed patients) were severe. Since 2014, nondengue arbovirus infections increased; until 2016, chikungunya and Zika were most common. Imported arbovirus infections (mostly dengue) were frequently diagnosed, although increased chikungunya and Zika virus infections coincided with their introduction and spread in the Americas. A large proportion of cases occurred in women of childbearing age, some despite receipt of pretravel advice.

EID Norman FF, Henríquez-Camacho C, Díaz-Menendez M, Chamorro S, Pou D, Molina I, et al. Imported Arbovirus Infections in Spain, 2009–2018. Emerg Infect Dis. 2020;26(4):658-666. https://dx.doi.org/10.3201/eid2604.190443
AMA Norman FF, Henríquez-Camacho C, Díaz-Menendez M, et al. Imported Arbovirus Infections in Spain, 2009–2018. Emerging Infectious Diseases. 2020;26(4):658-666. doi:10.3201/eid2604.190443.
APA Norman, F. F., Henríquez-Camacho, C., Díaz-Menendez, M., Chamorro, S., Pou, D., Molina, I....López-Velez, R. (2020). Imported Arbovirus Infections in Spain, 2009–2018. Emerging Infectious Diseases, 26(4), 658-666. https://dx.doi.org/10.3201/eid2604.190443.

Decreased Susceptibility to Azithromycin in Clinical Shigella Isolates Associated with HIV and Sexually Transmitted Bacterial Diseases, Minnesota, USA, 2012–2015 [PDF - 492 KB - 8 pages]
D. Eikmeier et al.

Shigellosis outbreaks caused by Shigella with decreased susceptibility to azithromycin (DSA-Shigella) among men who have sex with men (MSM) have been reported worldwide. We describe sexual health indicators and antimicrobial drug resistance for shigellosis cases in Minnesota, USA. We analyzed a sample of isolates received during 2012–2015 and cross-referenced cases with the Minnesota Department of Health Sexually Transmitted Disease Database to ascertain patients’ HIV status and recent chlamydia, gonorrhea, and syphilis infections. Of 691 Shigella isolates, 46 (7%) were DSA-Shigella; 91% of DSA-Shigella patients were men, of whom 60% were living with HIV. Among men, those with DSA-Shigella infection had greater odds of living with HIV, identifying as MSM, or having a recent diagnosis of a sexually transmitted disease. DSA-Shigella was associated with MSM, HIV infection, and recent sexually transmitted disease. To decrease spread of DSA-Shigella, interventions targeted at communities at high risk are needed.

EID Eikmeier D, Talley P, Bowen A, Leano F, Dobbins G, Jawahir S, et al. Decreased Susceptibility to Azithromycin in Clinical Shigella Isolates Associated with HIV and Sexually Transmitted Bacterial Diseases, Minnesota, USA, 2012–2015. Emerg Infect Dis. 2020;26(4):667-674. https://dx.doi.org/10.3201/eid2604.191031
AMA Eikmeier D, Talley P, Bowen A, et al. Decreased Susceptibility to Azithromycin in Clinical Shigella Isolates Associated with HIV and Sexually Transmitted Bacterial Diseases, Minnesota, USA, 2012–2015. Emerging Infectious Diseases. 2020;26(4):667-674. doi:10.3201/eid2604.191031.
APA Eikmeier, D., Talley, P., Bowen, A., Leano, F., Dobbins, G., Jawahir, S....Smith, K. (2020). Decreased Susceptibility to Azithromycin in Clinical Shigella Isolates Associated with HIV and Sexually Transmitted Bacterial Diseases, Minnesota, USA, 2012–2015. Emerging Infectious Diseases, 26(4), 667-674. https://dx.doi.org/10.3201/eid2604.191031.

High Incidence of Active Tuberculosis in Asylum Seekers from Eritrea and Somalia in the First 5 Years after Arrival in the Netherlands [PDF - 651 KB - 7 pages]
J. van den Boogaard et al.

Three quarters of tuberculosis (TB) patients in the Netherlands are foreign-born; 26% are from Eritrea or Somalia. We analyzed TB incidence rates in asylum seekers from Eritrea and Somalia in the first 5 years after arrival in the Netherlands (2013–2017) and performed survival analysis with Cox proportional hazards regression to analyze the effect of age and sex on the risk for TB. TB incidence remained high 5 years after arrival in asylum seekers from Eritrea (309 cases/100,000 person-years) and Somalia (81 cases/100,000 person-years). Age >18 years was associated with a higher risk for TB in asylum seekers from Eritrea (3.4 times higher) and Somalia (3.7 times higher), and male sex was associated with a 1.6 times higher risk for TB in asylum seekers from Eritrea. Screening and treating asylum seekers from high-incidence areas for latent TB infection upon arrival would further reduce TB incidence in the Netherlands.

EID van den Boogaard J, Slump E, Schimmel HJ, van der Hoek W, van den Hof S, de Vries G. High Incidence of Active Tuberculosis in Asylum Seekers from Eritrea and Somalia in the First 5 Years after Arrival in the Netherlands. Emerg Infect Dis. 2020;26(4):675-681. https://dx.doi.org/10.3201/eid2604.190123
AMA van den Boogaard J, Slump E, Schimmel HJ, et al. High Incidence of Active Tuberculosis in Asylum Seekers from Eritrea and Somalia in the First 5 Years after Arrival in the Netherlands. Emerging Infectious Diseases. 2020;26(4):675-681. doi:10.3201/eid2604.190123.
APA van den Boogaard, J., Slump, E., Schimmel, H. J., van der Hoek, W., van den Hof, S., & de Vries, G. (2020). High Incidence of Active Tuberculosis in Asylum Seekers from Eritrea and Somalia in the First 5 Years after Arrival in the Netherlands. Emerging Infectious Diseases, 26(4), 675-681. https://dx.doi.org/10.3201/eid2604.190123.

Severe Dengue Epidemic, Sri Lanka, 2017 [PDF - 2.19 MB - 9 pages]
H. A. Tissera et al.

In 2017, a dengue epidemic of unexpected magnitude occurred in Sri Lanka. A total of 186,101 suspected cases and 440 dengue-related deaths occurred. We conducted a comprehensive analysis of this epidemic by comparing national surveillance data for 2017 with data from the preceding 5 years. In all Sri Lanka districts, dengue incidence in 2017 increased significantly over incidence during the previous 5 years. Older schoolchildren and young adults were more clinically symptomatic than those at extremes of age. Limited virologic surveillance showed the dominant circulating variant was dengue virus type 2 cosmopolitan genotype in the most affected district. One quarter of total annual cases were reported 5 weeks after the southwest monsoon started. Changes in vector abundance were not predictive of the increased incidence. Direct government expenditures on dengue control activities in 2017 were US $12.7 million. The lessons learned from this outbreak are useful for other tropical nations facing increasing dengue incidence.

EID Tissera HA, Jayamanne B, Raut R, Janaki S, Tozan Y, Samaraweera PC, et al. Severe Dengue Epidemic, Sri Lanka, 2017. Emerg Infect Dis. 2020;26(4):682-691. https://dx.doi.org/10.3201/eid2604.190435
AMA Tissera HA, Jayamanne B, Raut R, et al. Severe Dengue Epidemic, Sri Lanka, 2017. Emerging Infectious Diseases. 2020;26(4):682-691. doi:10.3201/eid2604.190435.
APA Tissera, H. A., Jayamanne, B., Raut, R., Janaki, S., Tozan, Y., Samaraweera, P. C....Fernando, S. D. (2020). Severe Dengue Epidemic, Sri Lanka, 2017. Emerging Infectious Diseases, 26(4), 682-691. https://dx.doi.org/10.3201/eid2604.190435.

Severe Fever with Thrombocytopenia Syndrome, Japan, 2013–2017 [PDF - 680 KB - 8 pages]
Y. Kobayashi et al.

We conducted an epidemiologic study of severe fever with thrombocytopenia syndrome (SFTS) in Japan during 2013–2017. Of 303 cases reported during that period, 133 (44%) were included in this study. The median time between onset of illness and diagnosis of SFTS shortened, from 11.5 to 3.0 days, but the case-fatality rate remained high, at 27%. In 64 patients (48%), a close contact with companion animals was reported within 2 weeks of disease onset. Of these 64 patients, 40 were surveyed further, and we confirmed that 3 had direct contact with body fluids of ill companion animals; 2 had direct contact with the saliva of an ill feral cat or pet dog. These patients reported no history of tick bite, suggesting that ill companion animals might be a source of SFTS virus transmission. Direct contact with the body fluids of ill companion animals should be avoided.

EID Kobayashi Y, Kato H, Yamagishi T, Shimada T, Matsui T, Yoshikawa T, et al. Severe Fever with Thrombocytopenia Syndrome, Japan, 2013–2017. Emerg Infect Dis. 2020;26(4):692-699. https://dx.doi.org/10.3201/eid2604.191011
AMA Kobayashi Y, Kato H, Yamagishi T, et al. Severe Fever with Thrombocytopenia Syndrome, Japan, 2013–2017. Emerging Infectious Diseases. 2020;26(4):692-699. doi:10.3201/eid2604.191011.
APA Kobayashi, Y., Kato, H., Yamagishi, T., Shimada, T., Matsui, T., Yoshikawa, T....Oishi, K. (2020). Severe Fever with Thrombocytopenia Syndrome, Japan, 2013–2017. Emerging Infectious Diseases, 26(4), 692-699. https://dx.doi.org/10.3201/eid2604.191011.
Research

Comprehensive Profiling of Zika Virus Risk with Natural and Artificial Mitigating Strategies, United States [PDF - 5.24 MB - 11 pages]
M. J. Mina et al.

Zika virus is transitioning to become a long-term public health challenge, and countries should remain informed of the risk for emergence. We developed a stochastic epidemiologic model to profile risk for Zika virus emergence, including trimester-specific fetal risk across time, in all 3,208 counties in the United States, including Puerto Rico. Validation against known transmission in North America demonstrated accuracy to predict epidemic dynamics and absolute case counts across scales (R2 = 0.98). We found that, although sporadic single transmission events could occur in most US counties, outbreaks will likely be restricted to the Gulf Coast region and to late spring through autumn. Seasonal fluctuations in birth rates will confer natural population-level protection against early-trimester infections. Overall, outbreak control will be more effective and efficient than prevention, and vaccination will be most effective at >70% coverage. Our county-level risk profiles should serve as a critical resource for resource allocation.

EID Mina MJ, Guterman L, Allen KE, Omer SB. Comprehensive Profiling of Zika Virus Risk with Natural and Artificial Mitigating Strategies, United States. Emerg Infect Dis. 2020;26(4):700-710. https://dx.doi.org/10.3201/eid2604.181739
AMA Mina MJ, Guterman L, Allen KE, et al. Comprehensive Profiling of Zika Virus Risk with Natural and Artificial Mitigating Strategies, United States. Emerging Infectious Diseases. 2020;26(4):700-710. doi:10.3201/eid2604.181739.
APA Mina, M. J., Guterman, L., Allen, K. E., & Omer, S. B. (2020). Comprehensive Profiling of Zika Virus Risk with Natural and Artificial Mitigating Strategies, United States. Emerging Infectious Diseases, 26(4), 700-710. https://dx.doi.org/10.3201/eid2604.181739.

Genomic Insight into the Spread of Meropenem-Resistant Streptococcus pneumoniae Spain-ST81, Taiwan [PDF - 1.11 MB - 10 pages]
Y. Chen et al.

Incidence of invasive pneumococcal disease caused by antimicrobial-resistant Streptococcus pneumoniae types not included in pneumococcal conjugate vaccines has increased, including a penicillin- and meropenem-resistant serotype 15A-ST63 clone in Japan. During 2013–2017, we collected 206 invasive pneumococcal isolates in Taiwan for penicillin and meropenem susceptibility testing. We found serotypes 15B/C-ST83 and 15A-ST63 were the most prevalent penicillin- and meropenem-resistant clones. A transformation study confirmed that penicillin-binding protein (PBP) 2b was the primary meropenem resistance determinant, and PBP1a was essential for high-level resistance. The rate of serotype 15B/C-ST83 increased during the study. All 15B/C-ST83 isolates showed an ermB macrolide resistance genotype. Prediction analysis of recombination sites revealed 12 recombination regions in 15B/C-ST83 compared with the S. pneumoniae Spain23F-ST81 genome. Pneumococcal clones rapidly recombine to acquire survival advantages and undergo local expansion under the selective pressure exerted by vaccines and antimicrobial drugs. The spread of 15B/C-ST83 is alarming for countries with high antimicrobial pressure.

EID Chen Y, Hsieh Y, Gong Y, Liao W, Li S, Chang I, et al. Genomic Insight into the Spread of Meropenem-Resistant Streptococcus pneumoniae Spain23F-ST81, Taiwan. Emerg Infect Dis. 2020;26(4):711-720. https://dx.doi.org/10.3201/eid2604.190717
AMA Chen Y, Hsieh Y, Gong Y, et al. Genomic Insight into the Spread of Meropenem-Resistant Streptococcus pneumoniae Spain23F-ST81, Taiwan. Emerging Infectious Diseases. 2020;26(4):711-720. doi:10.3201/eid2604.190717.
APA Chen, Y., Hsieh, Y., Gong, Y., Liao, W., Li, S., Chang, I....Huang, Y. (2020). Genomic Insight into the Spread of Meropenem-Resistant Streptococcus pneumoniae Spain23F-ST81, Taiwan. Emerging Infectious Diseases, 26(4), 711-720. https://dx.doi.org/10.3201/eid2604.190717.

Isolation of Drug-Resistant Gallibacterium anatis from Calves with Unresponsive Bronchopneumonia, Belgium [PDF - 1.56 MB - 10 pages]
L. Van Driessche et al.

Gallibacterium anatis is an opportunistic pathogen, previously associated with deaths in poultry, domestic birds, and occasionally humans. We obtained G. anatis isolates from bronchoalveolar lavage samples of 10 calves with bronchopneumonia unresponsive to antimicrobial therapy. Collected isolates were multidrug-resistant to extensively drug-resistant, exhibiting resistance against 5–7 classes of antimicrobial drugs. Whole-genome sequencing revealed 24 different antimicrobial-resistance determinants, including genes not previously described in the Gallibacterium genus or even the Pasteurellaceae family, such as aadA23, blaCARB-8, tet(Y), and qnrD1. Some resistance genes were closely linked in resistance gene cassettes with either transposases in close proximity or situated on putative mobile elements or predicted plasmids. Single-nucleotide polymorphism genotyping revealed large genetic variation between the G. anatis isolates, including isolates retrieved from the same farm. G. anatis might play a hitherto unrecognized role as a respiratory pathogen and resistance gene reservoir in cattle and has unknown zoonotic potential.

EID Van Driessche L, Vanneste K, Bogaerts B, De Keersmaecker S, Roosens NH, Haesebrouck F, et al. Isolation of Drug-Resistant Gallibacterium anatis from Calves with Unresponsive Bronchopneumonia, Belgium. Emerg Infect Dis. 2020;26(4):721-730. https://dx.doi.org/10.3201/eid2604.190962
AMA Van Driessche L, Vanneste K, Bogaerts B, et al. Isolation of Drug-Resistant Gallibacterium anatis from Calves with Unresponsive Bronchopneumonia, Belgium. Emerging Infectious Diseases. 2020;26(4):721-730. doi:10.3201/eid2604.190962.
APA Van Driessche, L., Vanneste, K., Bogaerts, B., De Keersmaecker, S., Roosens, N. H., Haesebrouck, F....Boyen, F. (2020). Isolation of Drug-Resistant Gallibacterium anatis from Calves with Unresponsive Bronchopneumonia, Belgium. Emerging Infectious Diseases, 26(4), 721-730. https://dx.doi.org/10.3201/eid2604.190962.

Guaroa Virus and Plasmodium vivax Co-Infections, Peruvian Amazon [PDF - 848 KB - 7 pages]
C. Siles et al.

During April–June 2014 in a malaria-endemic rural community close to the city of Iquitos in Peru, we detected evidence of Guaroa virus (GROV) infection in 14 febrile persons, of whom 6 also had evidence of Plasmodium vivax malaria. Cases were discovered through a long-term febrile illness surveillance network at local participating health facilities. GROV cases were identified by using a combination of seroconversion and virus isolation, and malaria was diagnosed by thick smear and PCR. GROV mono-infections manifested as nonspecific febrile illness and were clinically indistinguishable from GROV and P. vivax co-infections. This cluster of cases highlights the potential for GROV transmission in the rural Peruvian Amazon, particularly in areas where malaria is endemic. Further study of similar areas of the Amazon may provide insights into the extent of GROV transmission in the Amazon basin.

EID Siles C, Elson WH, Vilcarromero S, Morrison AC, Hontz RD, Alava F, et al. Guaroa Virus and Plasmodium vivax Co-Infections, Peruvian Amazon. Emerg Infect Dis. 2020;26(4):731-737. https://dx.doi.org/10.3201/eid2604.191104
AMA Siles C, Elson WH, Vilcarromero S, et al. Guaroa Virus and Plasmodium vivax Co-Infections, Peruvian Amazon. Emerging Infectious Diseases. 2020;26(4):731-737. doi:10.3201/eid2604.191104.
APA Siles, C., Elson, W. H., Vilcarromero, S., Morrison, A. C., Hontz, R. D., Alava, F....Ampuero, J. S. (2020). Guaroa Virus and Plasmodium vivax Co-Infections, Peruvian Amazon. Emerging Infectious Diseases, 26(4), 731-737. https://dx.doi.org/10.3201/eid2604.191104.

Intensified Short Symptom Screening Program for Dengue Infection during Pregnancy, India [PDF - 440 KB - 5 pages]
S. Naik et al.

Mosquitoborne diseases (e.g., malaria, dengue, and chikungunya) are endemic to India and pose diagnostic challenges during pregnancy. We evaluated an intensified short symptom screening program in India to diagnose dengue during pregnancy. During October 2017–January 2018, we screened pregnant women during antenatal surveillance for symptoms of mosquitoborne diseases (fever only, fever with conjunctivitis, fever with rash, or all 3 symptoms) within the previous 15 days. Of 5,843 pregnant women screened, 52 were enrolled and tested for dengue, chikungunya, and Zika viruses by using a Trioplex real-time reverse transcription PCR. Of 49 who had complete results, 7 (14%) were dengue positive. Of these ocular pain was seen in 4 (57%) and conjunctivitis in 7 (100%). Intensified symptom screening using conjunctivitis, in addition to rash, in pregnant women with fever might improve dengue case detection and can be included in routine symptom screening during pregnancy.

EID Naik S, Robinson ML, Alexander M, Chandanwale A, Sambarey P, Kinikar A, et al. Intensified Short Symptom Screening Program for Dengue Infection during Pregnancy, India. Emerg Infect Dis. 2020;26(4):738-743. https://dx.doi.org/10.3201/eid2604.191476
AMA Naik S, Robinson ML, Alexander M, et al. Intensified Short Symptom Screening Program for Dengue Infection during Pregnancy, India. Emerging Infectious Diseases. 2020;26(4):738-743. doi:10.3201/eid2604.191476.
APA Naik, S., Robinson, M. L., Alexander, M., Chandanwale, A., Sambarey, P., Kinikar, A....Mathad, J. (2020). Intensified Short Symptom Screening Program for Dengue Infection during Pregnancy, India. Emerging Infectious Diseases, 26(4), 738-743. https://dx.doi.org/10.3201/eid2604.191476.
Dispatches

Prevalence of Antibodies to Crimean-Congo Hemorrhagic Fever Virus in Ruminants, Nigeria, 2015 [PDF - 1.07 MB - 4 pages]
D. Oluwayelu et al.

Crimean-Congo hemorrhagic fever virus (CCHFV) is a highly transmissible human pathogen. Infection is often misdiagnosed, in part because of poor availability of data in disease-endemic areas. We sampled 150 apparently healthy ruminants throughout Nigeria for virus seropositivity and detected virus-specific IgG in cattle (24%) and goats (2%), highlighting the need for further investigations.

EID Oluwayelu D, Afrough B, Adebiyi A, Varghese A, Eun-Sil P, Fukushi S, et al. Prevalence of Antibodies to Crimean-Congo Hemorrhagic Fever Virus in Ruminants, Nigeria, 2015. Emerg Infect Dis. 2020;26(4):744-747. https://dx.doi.org/10.3201/eid2604.190354
AMA Oluwayelu D, Afrough B, Adebiyi A, et al. Prevalence of Antibodies to Crimean-Congo Hemorrhagic Fever Virus in Ruminants, Nigeria, 2015. Emerging Infectious Diseases. 2020;26(4):744-747. doi:10.3201/eid2604.190354.
APA Oluwayelu, D., Afrough, B., Adebiyi, A., Varghese, A., Eun-Sil, P., Fukushi, S....Tomori, O. (2020). Prevalence of Antibodies to Crimean-Congo Hemorrhagic Fever Virus in Ruminants, Nigeria, 2015. Emerging Infectious Diseases, 26(4), 744-747. https://dx.doi.org/10.3201/eid2604.190354.

Recurrent Herpes Simplex Virus 2 Lymphocytic Meningitis in Patient with IgG Subclass 2 Deficiency [PDF - 837 KB - 3 pages]
T. Goyal and I. Ali

We report a case of a patient with a lifetime history of 8 episodes of recurrent lymphocytic meningitis. Our findings suggest that susceptibility to recurrent lymphocytic meningitis might be caused by low serum IgG subclass 2 immunodeficiency.

EID Goyal T, Ali I. Recurrent Herpes Simplex Virus 2 Lymphocytic Meningitis in Patient with IgG Subclass 2 Deficiency. Emerg Infect Dis. 2020;26(4):748-750. https://dx.doi.org/10.3201/eid2604.190406
AMA Goyal T, Ali I. Recurrent Herpes Simplex Virus 2 Lymphocytic Meningitis in Patient with IgG Subclass 2 Deficiency. Emerging Infectious Diseases. 2020;26(4):748-750. doi:10.3201/eid2604.190406.
APA Goyal, T., & Ali, I. (2020). Recurrent Herpes Simplex Virus 2 Lymphocytic Meningitis in Patient with IgG Subclass 2 Deficiency. Emerging Infectious Diseases, 26(4), 748-750. https://dx.doi.org/10.3201/eid2604.190406.

Health-Related Quality of Life after Dengue Fever, Morelos, Mexico, 2016–2017 [PDF - 549 KB - 5 pages]
A. Schulte et al.

We adapted the EQ-5D-3L questionnaire and visual analog scale to assess health-related quality of life (HRQOL) and persistent symptoms in 79 patients with laboratory-confirmed dengue in Morelos, Mexico. The lowest HRQOLs were 0.53 and 38.1 (febrile phase). Patients recovered baseline HRQOL in ≈2 months.

EID Schulte A, Weber I, Tiga-Loza D, Amaya Larios IY, Shepard DS, Tschampl CA, et al. Health-Related Quality of Life after Dengue Fever, Morelos, Mexico, 2016–2017. Emerg Infect Dis. 2020;26(4):751-755. https://dx.doi.org/10.3201/eid2604.190729
AMA Schulte A, Weber I, Tiga-Loza D, et al. Health-Related Quality of Life after Dengue Fever, Morelos, Mexico, 2016–2017. Emerging Infectious Diseases. 2020;26(4):751-755. doi:10.3201/eid2604.190729.
APA Schulte, A., Weber, I., Tiga-Loza, D., Amaya Larios, I. Y., Shepard, D. S., Tschampl, C. A....Ramos-Castañeda, J. (2020). Health-Related Quality of Life after Dengue Fever, Morelos, Mexico, 2016–2017. Emerging Infectious Diseases, 26(4), 751-755. https://dx.doi.org/10.3201/eid2604.190729.

Person-to-Person Transmission of Andes Virus in Hantavirus Pulmonary Syndrome, Argentina, 2014 [PDF - 674 KB - 4 pages]
D. O. Alonso et al.

Andes virus is unique among hantaviruses because it can be transmitted from person to person. This mechanism was previously supported by epidemiologic data and genetic evidence based only on partial sequences. We used full-length virus sequencing to confirm person-to-person transmission of this virus in a cluster of 3 cases in Argentina in 2014.

EID Alonso DO, Pérez-Sautu U, Bellomo CM, Prieto K, Iglesias A, Coelho R, et al. Person-to-Person Transmission of Andes Virus in Hantavirus Pulmonary Syndrome, Argentina, 2014. Emerg Infect Dis. 2020;26(4):756-759. https://dx.doi.org/10.3201/eid2604.190799
AMA Alonso DO, Pérez-Sautu U, Bellomo CM, et al. Person-to-Person Transmission of Andes Virus in Hantavirus Pulmonary Syndrome, Argentina, 2014. Emerging Infectious Diseases. 2020;26(4):756-759. doi:10.3201/eid2604.190799.
APA Alonso, D. O., Pérez-Sautu, U., Bellomo, C. M., Prieto, K., Iglesias, A., Coelho, R....Martinez, V. P. (2020). Person-to-Person Transmission of Andes Virus in Hantavirus Pulmonary Syndrome, Argentina, 2014. Emerging Infectious Diseases, 26(4), 756-759. https://dx.doi.org/10.3201/eid2604.190799.

Ebola Virus Neutralizing Antibodies in Dogs from Sierra Leone, 2017 [PDF - 559 KB - 4 pages]
K. Fischer et al.

Ebola virus (EBOV) is a highly pathogenic zoonotic virus for which the reservoir host has not been identified. To study the role of dogs as potential hosts, we screened 300 serum samples from dogs in Sierra Leone and found EBOV neutralizing antibodies in 12, suggesting their susceptibility to natural infection.

EID Fischer K, Suluku R, Fehling S, Jabaty J, Koroma B, Strecker T, et al. Ebola Virus Neutralizing Antibodies in Dogs from Sierra Leone, 2017. Emerg Infect Dis. 2020;26(4):760-763. https://dx.doi.org/10.3201/eid2604.190802
AMA Fischer K, Suluku R, Fehling S, et al. Ebola Virus Neutralizing Antibodies in Dogs from Sierra Leone, 2017. Emerging Infectious Diseases. 2020;26(4):760-763. doi:10.3201/eid2604.190802.
APA Fischer, K., Suluku, R., Fehling, S., Jabaty, J., Koroma, B., Strecker, T....Diederich, S. (2020). Ebola Virus Neutralizing Antibodies in Dogs from Sierra Leone, 2017. Emerging Infectious Diseases, 26(4), 760-763. https://dx.doi.org/10.3201/eid2604.190802.

Outbreak of Dirkmeia churashimaensis Fungemia in a Neonatal Intensive Care Unit, India [PDF - 572 KB - 5 pages]
A. Chowdhary et al.

Bloodstream infections caused by uncommon or novel fungal species are challenging to identify and treat. We report a series of cases of fungemia due to a rare basidiomycete yeast, Dirkmeia churashimaensis, in neonatal patients in India. Whole-genome sequence typing demonstrated that the patient isolates were genetically indistinguishable, indicating a single-source infection.

EID Chowdhary A, Sharada K, Singh P, Bhagwani D, Kumar N, de Groot T, et al. Outbreak of Dirkmeia churashimaensis Fungemia in a Neonatal Intensive Care Unit, India. Emerg Infect Dis. 2020;26(4):764-768. https://dx.doi.org/10.3201/eid2604.190847
AMA Chowdhary A, Sharada K, Singh P, et al. Outbreak of Dirkmeia churashimaensis Fungemia in a Neonatal Intensive Care Unit, India. Emerging Infectious Diseases. 2020;26(4):764-768. doi:10.3201/eid2604.190847.
APA Chowdhary, A., Sharada, K., Singh, P., Bhagwani, D., Kumar, N., de Groot, T....Meis, J. F. (2020). Outbreak of Dirkmeia churashimaensis Fungemia in a Neonatal Intensive Care Unit, India. Emerging Infectious Diseases, 26(4), 764-768. https://dx.doi.org/10.3201/eid2604.190847.

Rift Valley Fever Outbreak, Mayotte, France, 2018–2019 [PDF - 1.14 MB - 4 pages]
H. Youssouf et al.

From November 2018 through July 2019, an outbreak of Rift Valley fever in humans occurred in Mayotte, France; 142 cases were confirmed. Exposure to animals or their biological fluid was reported by 73% of patients. Health authorities have been implementing control measures, including veterinary surveys, vector control interventions, and prevention measures.

EID Youssouf H, Subiros M, Dennetiere G, Collet L, Dommergues L, Pauvert A, et al. Rift Valley Fever Outbreak, Mayotte, France, 2018–2019. Emerg Infect Dis. 2020;26(4):769-772. https://dx.doi.org/10.3201/eid2604.191147
AMA Youssouf H, Subiros M, Dennetiere G, et al. Rift Valley Fever Outbreak, Mayotte, France, 2018–2019. Emerging Infectious Diseases. 2020;26(4):769-772. doi:10.3201/eid2604.191147.
APA Youssouf, H., Subiros, M., Dennetiere, G., Collet, L., Dommergues, L., Pauvert, A....Larsen, C. (2020). Rift Valley Fever Outbreak, Mayotte, France, 2018–2019. Emerging Infectious Diseases, 26(4), 769-772. https://dx.doi.org/10.3201/eid2604.191147.

Crimean-Congo Hemorrhagic Fever Virus in Humans and Livestock, Pakistan, 2015–2017 [PDF - 2.37 MB - 7 pages]
A. Zohaib et al.

We detected Crimean-Congo hemorrhagic fever virus infections in 4 provinces of Pakistan during 2017–2018. Overall, seroprevalence was 2.7% in humans and 36.2% in domestic livestock. Antibody prevalence in humans was highest in rural areas, where increased contact with animals is likely.

EID Zohaib A, Saqib M, Athar MA, Hussain MH, Sial A, Tayyab MH, et al. Crimean-Congo Hemorrhagic Fever Virus in Humans and Livestock, Pakistan, 2015–2017. Emerg Infect Dis. 2020;26(4):773-777. https://dx.doi.org/10.3201/eid2604.191154
AMA Zohaib A, Saqib M, Athar MA, et al. Crimean-Congo Hemorrhagic Fever Virus in Humans and Livestock, Pakistan, 2015–2017. Emerging Infectious Diseases. 2020;26(4):773-777. doi:10.3201/eid2604.191154.
APA Zohaib, A., Saqib, M., Athar, M. A., Hussain, M. H., Sial, A., Tayyab, M. H....Shi, Z. (2020). Crimean-Congo Hemorrhagic Fever Virus in Humans and Livestock, Pakistan, 2015–2017. Emerging Infectious Diseases, 26(4), 773-777. https://dx.doi.org/10.3201/eid2604.191154.

Detection of Zoonotic Bartonella Pathogens in Rabbit Fleas, Colorado, USA [PDF - 563 KB - 4 pages]
S. Sato et al.

We detected 3 Bartonella species in wild rabbit fleas from Colorado, USA: B. vinsonii subsp. berkhoffii (n = 16), B. alsatica (n = 5), and B. rochalimae (n = 1). Our results support the establishment of the zoonotic agent B. alsatica in North America.

EID Sato S, Brinkerhoff R, Hollis E, Funada S, Shannon AB, Maruyama S. Detection of Zoonotic Bartonella Pathogens in Rabbit Fleas, Colorado, USA. Emerg Infect Dis. 2020;26(4):778-781. https://dx.doi.org/10.3201/eid2604.191161
AMA Sato S, Brinkerhoff R, Hollis E, et al. Detection of Zoonotic Bartonella Pathogens in Rabbit Fleas, Colorado, USA. Emerging Infectious Diseases. 2020;26(4):778-781. doi:10.3201/eid2604.191161.
APA Sato, S., Brinkerhoff, R., Hollis, E., Funada, S., Shannon, A. B., & Maruyama, S. (2020). Detection of Zoonotic Bartonella Pathogens in Rabbit Fleas, Colorado, USA. Emerging Infectious Diseases, 26(4), 778-781. https://dx.doi.org/10.3201/eid2604.191161.

Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018 [PDF - 307 KB - 4 pages]
A. Vaughan et al.

In September 2018, monkeypox virus was transmitted from a patient to a healthcare worker in the United Kingdom. Transmission was probably through contact with contaminated bedding. Infection control precautions for contacts (vaccination, daily monitoring, staying home from work) were implemented. Of 134 potential contacts, 4 became ill; all patients survived.

EID Vaughan A, Aarons E, Astbury J, Brooks T, Chand M, Flegg P, et al. Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018. Emerg Infect Dis. 2020;26(4):782-785. https://dx.doi.org/10.3201/eid2604.191164
AMA Vaughan A, Aarons E, Astbury J, et al. Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018. Emerging Infectious Diseases. 2020;26(4):782-785. doi:10.3201/eid2604.191164.
APA Vaughan, A., Aarons, E., Astbury, J., Brooks, T., Chand, M., Flegg, P....Dunning, J. (2020). Human-to-Human Transmission of Monkeypox Virus, United Kingdom, October 2018. Emerging Infectious Diseases, 26(4), 782-785. https://dx.doi.org/10.3201/eid2604.191164.

Whole-Genome Analysis of Salmonella enterica Serovar Enteritidis Isolates in Outbreak Linked to Online Food Delivery, Shenzhen, China, 2018 [PDF - 1.07 MB - 4 pages]
M. Jiang et al.

In July 2018, an outbreak of 10 cases of Salmonella enterica serovar Enteritidis infection occurred in Shenzhen, China. Outbreak investigation complemented by whole-genome sequencing traced the source to food ordered online. Our investigation highlights the role of online food delivery platforms as a new mode of foodborne disease transmission.

EID Jiang M, Zhu F, Yang C, Deng Y, Kwan P, Li Y, et al. Whole-Genome Analysis of Salmonella enterica Serovar Enteritidis Isolates in Outbreak Linked to Online Food Delivery, Shenzhen, China, 2018. Emerg Infect Dis. 2020;26(4):789-792. https://dx.doi.org/10.3201/eid2604.191446
AMA Jiang M, Zhu F, Yang C, et al. Whole-Genome Analysis of Salmonella enterica Serovar Enteritidis Isolates in Outbreak Linked to Online Food Delivery, Shenzhen, China, 2018. Emerging Infectious Diseases. 2020;26(4):789-792. doi:10.3201/eid2604.191446.
APA Jiang, M., Zhu, F., Yang, C., Deng, Y., Kwan, P., Li, Y....Hu, Q. (2020). Whole-Genome Analysis of Salmonella enterica Serovar Enteritidis Isolates in Outbreak Linked to Online Food Delivery, Shenzhen, China, 2018. Emerging Infectious Diseases, 26(4), 789-792. https://dx.doi.org/10.3201/eid2604.191446.

Pruritic Cutaneous Nematodiasis Caused by Avian Eyeworm Oxyspirura Larvae, Vietnam [PDF - 1.34 MB - 3 pages]
D. T. Dung et al.

A 41-year-old man from Son La Province, Vietnam, sought care for disseminated prurigo-like skin lesions from which nematode larvae were emerging. We morphologically and molecularly identified the larvae as Oxyspirura sp. Our findings confirm this nematode species as a zoonotic pathogen for emerging disease.

Research Letters

Novel Rapid Test for Detecting Carbapenemase [PDF - 776 KB - 3 pages]
Y. Feng et al.

We developed a carbapenemase test based on the ability of imipenem to inhibit noncarbapenemase β-lactamases. The test uses bacterial isolates with a fluorescent β-lactamase substrate, producing objective results with 100% sensitivity and specificity in 10 minutes. The assay is inexpensive and consists of only 1 mixing step.

EID Feng Y, Palanisami A, Kuriakose J, Pigula M, Ashraf S, Hasan T. Novel Rapid Test for Detecting Carbapenemase. Emerg Infect Dis. 2020;26(4):793-795. https://dx.doi.org/10.3201/eid2604.181655
AMA Feng Y, Palanisami A, Kuriakose J, et al. Novel Rapid Test for Detecting Carbapenemase. Emerging Infectious Diseases. 2020;26(4):793-795. doi:10.3201/eid2604.181655.
APA Feng, Y., Palanisami, A., Kuriakose, J., Pigula, M., Ashraf, S., & Hasan, T. (2020). Novel Rapid Test for Detecting Carbapenemase. Emerging Infectious Diseases, 26(4), 793-795. https://dx.doi.org/10.3201/eid2604.181655.

Arthritis Caused by MRSA CC398 in a Patient without Animal Contact, Japan [PDF - 274 KB - 3 pages]
H. Nakaminami et al.

Clonal complex 398 methicillin-resistant Staphylococcus aureus (MRSA) is a typical lineage of livestock-associated MRSA. We report a case of intractable arthritis of the shoulder joint caused by a multidrug-resistant Panton-Valentine leukocidin–positive livestock-associated MRSA clonal complex 398 sequence type 1232 clone in a patient in Japan who had no animal contact.

EID Nakaminami H, Hirai Y, Nishimura H, Takadama S, Noguchi N. Arthritis Caused by MRSA CC398 in a Patient without Animal Contact, Japan. Emerg Infect Dis. 2020;26(4):795-797. https://dx.doi.org/10.3201/eid2604.190376
AMA Nakaminami H, Hirai Y, Nishimura H, et al. Arthritis Caused by MRSA CC398 in a Patient without Animal Contact, Japan. Emerging Infectious Diseases. 2020;26(4):795-797. doi:10.3201/eid2604.190376.
APA Nakaminami, H., Hirai, Y., Nishimura, H., Takadama, S., & Noguchi, N. (2020). Arthritis Caused by MRSA CC398 in a Patient without Animal Contact, Japan. Emerging Infectious Diseases, 26(4), 795-797. https://dx.doi.org/10.3201/eid2604.190376.

Detection of Rocio Virus SPH 34675 during Dengue Epidemics, Brazil, 2011–2013 [PDF - 343 KB - 3 pages]
M. V. Saivish et al.

Recent seroprevalence studies in animals detected Rocio virus in regions of Brazil, indicating risk for re-emergence of this pathogen. We identified Rocio virus RNA in samples from 2 human patients for whom dengue fever was clinically suspected but ruled out by laboratory findings. Testing for infrequent flavivirus infections should expedite diagnoses.

EID Saivish MV, da Costa VG, Rodrigues RL, Féres V, Montoya-Diaz E, Moreli ML. Detection of Rocio Virus SPH 34675 during Dengue Epidemics, Brazil, 2011–2013. Emerg Infect Dis. 2020;26(4):797-799. https://dx.doi.org/10.3201/eid2604.190487
AMA Saivish MV, da Costa VG, Rodrigues RL, et al. Detection of Rocio Virus SPH 34675 during Dengue Epidemics, Brazil, 2011–2013. Emerging Infectious Diseases. 2020;26(4):797-799. doi:10.3201/eid2604.190487.
APA Saivish, M. V., da Costa, V. G., Rodrigues, R. L., Féres, V., Montoya-Diaz, E., & Moreli, M. L. (2020). Detection of Rocio Virus SPH 34675 during Dengue Epidemics, Brazil, 2011–2013. Emerging Infectious Diseases, 26(4), 797-799. https://dx.doi.org/10.3201/eid2604.190487.

Epidemiology of Lassa Fever and Factors Associated with Deaths, Bauchi State, Nigeria, 2015–2018 [PDF - 304 KB - 11 pages]
M. A. Abdulkarim et al.

We report the epidemiology of Lassa fever in Bauchi State, a disease-endemic region, in Nigeria. Since 2015, major increases in Lassa fever attack rate and in the case-fatality rate have occurred in this state. A delay in seeking care by a case-patient for >7 days after symptom onset was the major predictor of death.

EID Abdulkarim MA, Babale SM, Umeokonkwo CD, Bamgboye EA, Bashorun AT, Usman AA, et al. Epidemiology of Lassa Fever and Factors Associated with Deaths, Bauchi State, Nigeria, 2015–2018. Emerg Infect Dis. 2020;26(4):799-801. https://dx.doi.org/10.3201/eid2604.190678
AMA Abdulkarim MA, Babale SM, Umeokonkwo CD, et al. Epidemiology of Lassa Fever and Factors Associated with Deaths, Bauchi State, Nigeria, 2015–2018. Emerging Infectious Diseases. 2020;26(4):799-801. doi:10.3201/eid2604.190678.
APA Abdulkarim, M. A., Babale, S. M., Umeokonkwo, C. D., Bamgboye, E. A., Bashorun, A. T., Usman, A. A....Balogun, M. S. (2020). Epidemiology of Lassa Fever and Factors Associated with Deaths, Bauchi State, Nigeria, 2015–2018. Emerging Infectious Diseases, 26(4), 799-801. https://dx.doi.org/10.3201/eid2604.190678.

Plague Epizootic Dynamics in Chipmunk Fleas, Sierra Nevada Mountains, California, USA, 2013–2015 [PDF - 444 KB - 4 pages]
T. T. Hammond et al.

We describe Yersinia pestis minimum infection prevalence in fleas collected from Tamias spp. chipmunks in the Sierra Nevadas (California, USA) during 2013–2015. Y. pestis–positive fleas were detected only in 2015 (year of plague epizootic), mostly in T. speciosus chipmunks at high-elevation sites. Plague surveillance should include testing vectors for Y. pestis.

EID Hammond TT, Liebman KA, Payne R, Pigage HK, Padgett KA. Plague Epizootic Dynamics in Chipmunk Fleas, Sierra Nevada Mountains, California, USA, 2013–2015. Emerg Infect Dis. 2020;26(4):801-804. https://dx.doi.org/10.3201/eid2604.190733
AMA Hammond TT, Liebman KA, Payne R, et al. Plague Epizootic Dynamics in Chipmunk Fleas, Sierra Nevada Mountains, California, USA, 2013–2015. Emerging Infectious Diseases. 2020;26(4):801-804. doi:10.3201/eid2604.190733.
APA Hammond, T. T., Liebman, K. A., Payne, R., Pigage, H. K., & Padgett, K. A. (2020). Plague Epizootic Dynamics in Chipmunk Fleas, Sierra Nevada Mountains, California, USA, 2013–2015. Emerging Infectious Diseases, 26(4), 801-804. https://dx.doi.org/10.3201/eid2604.190733.

Brucella melitensis in Asian Badgers, Northwestern China [PDF - 889 KB - 3 pages]
X. Liu et al.

We isolated Brucella melitensis biovar 3 from the spleen of an Asian badger (Meles leucurus) in Nilka County, northwestern China. Our investigation showed that this isolate had a common multilocus variable-number tandem-repeat analysis 16 genotype, similar to bacterial isolates from local aborted sheep fetuses.

EID Liu X, Yang M, Song S, Liu G, Zhao S, Liu G, et al. Brucella melitensis in Asian Badgers, Northwestern China. Emerg Infect Dis. 2020;26(4):804-806. https://dx.doi.org/10.3201/eid2604.190833
AMA Liu X, Yang M, Song S, et al. Brucella melitensis in Asian Badgers, Northwestern China. Emerging Infectious Diseases. 2020;26(4):804-806. doi:10.3201/eid2604.190833.
APA Liu, X., Yang, M., Song, S., Liu, G., Zhao, S., Liu, G....Jiang, H. (2020). Brucella melitensis in Asian Badgers, Northwestern China. Emerging Infectious Diseases, 26(4), 804-806. https://dx.doi.org/10.3201/eid2604.190833.

Knowledge of Infectious Disease Specialists Regarding Aspergillosis Complicating Influenza, United States [PDF - 278 KB - 3 pages]
M. Toda et al.

In an online survey, we found that nearly one fifth of physicians in the United States who responded had seen or heard about a case of invasive pulmonary aspergillosis after severe influenza at their institution. However, <10% routinely used galactomannan testing to test for this fungus in patients with severe influenza.

EID Toda M, Beekmann SE, Polgreen PM, Chiller TM, Jackson BR, Beer KD. Knowledge of Infectious Disease Specialists Regarding Aspergillosis Complicating Influenza, United States. Emerg Infect Dis. 2020;26(4):809-811. https://dx.doi.org/10.3201/eid2604.190953
AMA Toda M, Beekmann SE, Polgreen PM, et al. Knowledge of Infectious Disease Specialists Regarding Aspergillosis Complicating Influenza, United States. Emerging Infectious Diseases. 2020;26(4):809-811. doi:10.3201/eid2604.190953.
APA Toda, M., Beekmann, S. E., Polgreen, P. M., Chiller, T. M., Jackson, B. R., & Beer, K. D. (2020). Knowledge of Infectious Disease Specialists Regarding Aspergillosis Complicating Influenza, United States. Emerging Infectious Diseases, 26(4), 809-811. https://dx.doi.org/10.3201/eid2604.190953.

West Nile Virus in Farmed Crocodiles, Zambia, 2019 [PDF - 498 KB - 4 pages]
E. Simulundu et al.

We detected West Nile virus (WNV) nucleic acid in crocodiles (Crocodylus niloticus) in Zambia. Phylogenetically, the virus belonged to lineage 1a, which is predominant in the Northern Hemisphere. These data provide evidence that WNV is circulating in crocodiles in Africa and increases the risk for animal and human transmission.

EID Simulundu E, Ndashe K, Chambaro HM, Squarre D, Reilly P, Chitanga S, et al. West Nile Virus in Farmed Crocodiles, Zambia, 2019. Emerg Infect Dis. 2020;26(4):811-814. https://dx.doi.org/10.3201/eid2604.190954
AMA Simulundu E, Ndashe K, Chambaro HM, et al. West Nile Virus in Farmed Crocodiles, Zambia, 2019. Emerging Infectious Diseases. 2020;26(4):811-814. doi:10.3201/eid2604.190954.
APA Simulundu, E., Ndashe, K., Chambaro, H. M., Squarre, D., Reilly, P., Chitanga, S....Sawa, H. (2020). West Nile Virus in Farmed Crocodiles, Zambia, 2019. Emerging Infectious Diseases, 26(4), 811-814. https://dx.doi.org/10.3201/eid2604.190954.

Needlestick-Associated Rocky Mountain Spotted Fever, Brazil [PDF - 292 KB - 2 pages]
S. Vilges de Oliveira et al.

We report a fatal case of Rocky Mountain spotted fever (RMSF) in a man in Brazil without recent history of tick bites or environmental exposure. He received an accidental needlestick while working as a nurse. The nurse and his patient died. Both cases were confirmed as RMSF by molecular methods.

EID Vilges de Oliveira S, Faccini-Martínez ÁA, Adelino T, de Lima Duré A, Barbieri A, Labruna MB. Needlestick-Associated Rocky Mountain Spotted Fever, Brazil. Emerg Infect Dis. 2020;26(4):815-816. https://dx.doi.org/10.3201/eid2604.191251
AMA Vilges de Oliveira S, Faccini-Martínez ÁA, Adelino T, et al. Needlestick-Associated Rocky Mountain Spotted Fever, Brazil. Emerging Infectious Diseases. 2020;26(4):815-816. doi:10.3201/eid2604.191251.
APA Vilges de Oliveira, S., Faccini-Martínez, Á. A., Adelino, T., de Lima Duré, A., Barbieri, A., & Labruna, M. B. (2020). Needlestick-Associated Rocky Mountain Spotted Fever, Brazil. Emerging Infectious Diseases, 26(4), 815-816. https://dx.doi.org/10.3201/eid2604.191251.

Crimean-Congo Hemorrhagic Fever, Mauritania [PDF - 396 KB - 2 pages]
B. Boushab et al.

The distribution of Crimean-Congo hemorrhagic fever (CCHF), a tickborne arboviral disease, is not well known in West Africa. We report 2 recent human cases of CCHF with infectious syndrome and severe bleeding in Mauritania. CCHF was diagnosed by ELISA and real time reverse transcription PCR. No secondary CCHF cases were found.

EID Boushab B, Kelly M, Kébé H, Bollahi M, Basco LK. Crimean-Congo Hemorrhagic Fever, Mauritania. Emerg Infect Dis. 2020;26(4):817-818. https://dx.doi.org/10.3201/eid2604.191292
AMA Boushab B, Kelly M, Kébé H, et al. Crimean-Congo Hemorrhagic Fever, Mauritania. Emerging Infectious Diseases. 2020;26(4):817-818. doi:10.3201/eid2604.191292.
APA Boushab, B., Kelly, M., Kébé, H., Bollahi, M., & Basco, L. K. (2020). Crimean-Congo Hemorrhagic Fever, Mauritania. Emerging Infectious Diseases, 26(4), 817-818. https://dx.doi.org/10.3201/eid2604.191292.

Trombiculiasis in a Dog with Severe Neurologic Disorders, Spain [PDF - 673 KB - 2 pages]
P. Santibáñez et al.

Chiggers, the larvae of trombiculid mites, parasitize a wide variety of terrestrial vertebrates worldwide. Their bites cause seasonal trombiculiasis in humans and animals. Affected canines can have a variety of digestive and systemic clinical signs. We describe a case of canine trombiculiasis in a dog exhibiting severe neurologic symptoms.

EID Santibáñez P, Gallo E, Palomar AM, Portillo A, Carrillo JA, Oteo JA. Trombiculiasis in a Dog with Severe Neurologic Disorders, Spain. Emerg Infect Dis. 2020;26(4):819-820. https://dx.doi.org/10.3201/eid2604.191313
AMA Santibáñez P, Gallo E, Palomar AM, et al. Trombiculiasis in a Dog with Severe Neurologic Disorders, Spain. Emerging Infectious Diseases. 2020;26(4):819-820. doi:10.3201/eid2604.191313.
APA Santibáñez, P., Gallo, E., Palomar, A. M., Portillo, A., Carrillo, J. A., & Oteo, J. A. (2020). Trombiculiasis in a Dog with Severe Neurologic Disorders, Spain. Emerging Infectious Diseases, 26(4), 819-820. https://dx.doi.org/10.3201/eid2604.191313.

Tick-Borne Relapsing Fever Caused by Borrelia persica in Traveler to Central Asia, 2019 [PDF - 484 KB - 3 pages]
V. Muigg et al.

We report a case of tick-borne relapsing fever caused by Borrelia persica in a traveler returning to Switzerland from central Asia. After the disease was diagnosed by blood smear microscopy, the causative Borrelia species was confirmed by shotgun metagenomics sequencing. PCR and sequencing techniques provide highly sensitive diagnostic tools superior to microscopy.

EID Muigg V, Seth-Smith H, Goldenberger D, Egli A, Nickel B, Dürig R, et al. Tick-Borne Relapsing Fever Caused by Borrelia persica in Traveler to Central Asia, 2019. Emerg Infect Dis. 2020;26(4):824-826. https://dx.doi.org/10.3201/eid2604.191771
AMA Muigg V, Seth-Smith H, Goldenberger D, et al. Tick-Borne Relapsing Fever Caused by Borrelia persica in Traveler to Central Asia, 2019. Emerging Infectious Diseases. 2020;26(4):824-826. doi:10.3201/eid2604.191771.
APA Muigg, V., Seth-Smith, H., Goldenberger, D., Egli, A., Nickel, B., Dürig, R....Neumayr, A. (2020). Tick-Borne Relapsing Fever Caused by Borrelia persica in Traveler to Central Asia, 2019. Emerging Infectious Diseases, 26(4), 824-826. https://dx.doi.org/10.3201/eid2604.191771.

Imported Human Babesiosis, Singapore, 2018 [PDF - 767 KB - 3 pages]
P. Lim et al.

In 2018, Babesia microti infection was diagnosed for a 37-year-old man in Singapore who acquired the infection in the United States. This case highlights the recent rise of tickborne infections in the United States and the risk for their spread, because of increasing global interconnectivity, to regions where they are not endemic.

EID Lim P, Chavatte J, Vasoo S, Yang J. Imported Human Babesiosis, Singapore, 2018. Emerg Infect Dis. 2020;26(4):826-828. https://dx.doi.org/10.3201/eid2604.200025
AMA Lim P, Chavatte J, Vasoo S, et al. Imported Human Babesiosis, Singapore, 2018. Emerging Infectious Diseases. 2020;26(4):826-828. doi:10.3201/eid2604.200025.
APA Lim, P., Chavatte, J., Vasoo, S., & Yang, J. (2020). Imported Human Babesiosis, Singapore, 2018. Emerging Infectious Diseases, 26(4), 826-828. https://dx.doi.org/10.3201/eid2604.200025.

Multicenter Study of Azole-Resistant Aspergillus fumigatus Clinical Isolates, Taiwan [PDF - 1.41 MB - 3 pages]
C. Wu et al.

In a multicenter study, we determined a prevalence rate of 4% for azole-resistant Aspergillus fumigatus in Taiwan. Resistance emerged mainly from the environment (TR34/L98H, TR34/L98H/S297T/F495I, and TR46/Y121F/T289A mutations) but occasionally during azole treatment. A high mortality rate observed for azole-resistant aspergillosis necessitates diagnostic stewardship in healthcare and antifungal stewardship in the environment.

EID Wu C, Liu W, Lai C, Chao C, Ko W, Wang H, et al. Multicenter Study of Azole-Resistant Aspergillus fumigatus Clinical Isolates, Taiwan. Emerg Infect Dis. 2020;26(4):804-806. https://dx.doi.org/10.3201/eid2604.190840
AMA Wu C, Liu W, Lai C, et al. Multicenter Study of Azole-Resistant Aspergillus fumigatus Clinical Isolates, Taiwan. Emerging Infectious Diseases. 2020;26(4):804-806. doi:10.3201/eid2604.190840.
APA Wu, C., Liu, W., Lai, C., Chao, C., Ko, W., Wang, H....Chen, Y. (2020). Multicenter Study of Azole-Resistant Aspergillus fumigatus Clinical Isolates, Taiwan. Emerging Infectious Diseases, 26(4), 804-806. https://dx.doi.org/10.3201/eid2604.190840.

Geographic Distribution of Raccoon Roundworm, Baylisascaris procyonis, Germany and Luxembourg [PDF - 1.68 MB - 3 pages]
M. Heddergott et al.

Infestation with Baylisascaris procyonis, a gastrointestinal nematode of the raccoon, can cause fatal disease in humans. We found that the parasite is widespread in central Germany and can pose a public health risk. The spread of B. procyonis roundworms into nematode-free raccoon populations needs to be monitored.

EID Heddergott M, Steinbach P, Schwarz S, Anheyer-Behmenburg HE, Sutor A, Schliephake A, et al. Geographic Distribution of Raccoon Roundworm, Baylisascaris procyonis, Germany and Luxembourg. Emerg Infect Dis. 2020;26(4):821-823. https://dx.doi.org/10.3201/eid2604.191670
AMA Heddergott M, Steinbach P, Schwarz S, et al. Geographic Distribution of Raccoon Roundworm, Baylisascaris procyonis, Germany and Luxembourg. Emerging Infectious Diseases. 2020;26(4):821-823. doi:10.3201/eid2604.191670.
APA Heddergott, M., Steinbach, P., Schwarz, S., Anheyer-Behmenburg, H. E., Sutor, A., Schliephake, A....Frantz, A. C. (2020). Geographic Distribution of Raccoon Roundworm, Baylisascaris procyonis, Germany and Luxembourg. Emerging Infectious Diseases, 26(4), 821-823. https://dx.doi.org/10.3201/eid2604.191670.
About the Cover

Different Angles, Changing Perspectives [PDF - 2.37 MB - 2 pages]
B. Breedlove and R. Tucker
EID Breedlove B, Tucker R. Different Angles, Changing Perspectives. Emerg Infect Dis. 2020;26(4):829-830. https://dx.doi.org/10.3201/eid2604.ac2604
AMA Breedlove B, Tucker R. Different Angles, Changing Perspectives. Emerging Infectious Diseases. 2020;26(4):829-830. doi:10.3201/eid2604.ac2604.
APA Breedlove, B., & Tucker, R. (2020). Different Angles, Changing Perspectives. Emerging Infectious Diseases, 26(4), 829-830. https://dx.doi.org/10.3201/eid2604.ac2604.
Etymologia

Etymologia: Trombiculiasis [PDF - 359 KB - 1 page]
R. Henry
EID Henry R. Etymologia: Trombiculiasis. Emerg Infect Dis. 2020;26(4):821. https://dx.doi.org/10.3201/eid2604.et2604
AMA Henry R. Etymologia: Trombiculiasis. Emerging Infectious Diseases. 2020;26(4):821. doi:10.3201/eid2604.et2604.
APA Henry, R. (2020). Etymologia: Trombiculiasis. Emerging Infectious Diseases, 26(4), 821. https://dx.doi.org/10.3201/eid2604.et2604.
Conference Summaries

Workshop Report on Global Harmonization of Enterovirus Vaccines
T. Weng et al.
Page created: March 23, 2020
Page updated: March 23, 2020
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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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