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Issue Cover for Volume 26, Number 5—May 2020

Volume 26, Number 5—May 2020

[PDF - 61.61 MB - 234 pages]

Synopses

Surveillance of Leprosy in Kiribati, 1935–2017 [PDF - 846 KB - 8 pages]
S. T. Chambers et al.

In Kiribati, unlike most countries, high and increasing numbers of cases of leprosy have been reported despite the availability of multidrug therapy and efforts to improve case finding and management. Historic records show that 28 cases had been identified by 1925. A systematic population survey in 1997 identified 135 new cases; the mean incidence rate for 1993–1997 was 7.4/10,000 population. After administering mass chemoprophylaxis, the country reached the elimination threshold (prevalence <1/10,000), but case numbers have rebounded. The mean annualized rate of new cases in 2013–2017 was 15/10,000 population, with the highest new case rates (>20/10,000 population) in the main population centers of South Tarawa and Betio. Spread is expected to continue in areas where crowding and poor socioeconomic conditions persist and may accelerate as sea levels rise from climate change. New initiatives to improve social conditions are needed, and efforts such as postexposure chemoprophylaxis should be implemented to prevent spread.

EID Chambers ST, Ioteba N, Timeon E, Rimon E, Murdoch H, Green J, et al. Surveillance of Leprosy in Kiribati, 1935–2017. Emerg Infect Dis. 2020;26(5):833-840. https://doi.org/10.3201/eid2605.181746
AMA Chambers ST, Ioteba N, Timeon E, et al. Surveillance of Leprosy in Kiribati, 1935–2017. Emerging Infectious Diseases. 2020;26(5):833-840. doi:10.3201/eid2605.181746.
APA Chambers, S. T., Ioteba, N., Timeon, E., Rimon, E., Murdoch, H., Green, J....Priest, P. (2020). Surveillance of Leprosy in Kiribati, 1935–2017. Emerging Infectious Diseases, 26(5), 833-840. https://doi.org/10.3201/eid2605.181746.

Biphasic Outbreak of Invasive Group A Streptococcus Disease in Eldercare Facility, New Zealand [PDF - 1.42 MB - 8 pages]
K. A. Worthing et al.

A 3-month outbreak of invasive group A Streptococcus disease at an eldercare facility, in which 5 persons died, was biphasic. Although targeted chemoprophylaxis contained the initial outbreak, a second phase of the outbreak occurred after infection control processes ended. To retrospectively investigate the genomic epidemiology of the biphasic outbreak, we used whole-genome sequencing and multiple bioinformatics approaches. Analysis of isolates from the outbreak and isolates prospectively collected during the outbreak response indicated a single S. pyogenes emm81 clone among residents and staff members. Outbreak isolates differed from nonoutbreak emm81 isolates by harboring an integrative conjugative genomic element that contained the macrolide resistance determinant erm(TR). This study shows how retrospective high-resolution genomic investigations identified rapid spread of a closed-facilty clonal outbreak that was controlled, but not readily cleared, by infection control management procedures.

EID Worthing KA, Werno A, Pink R, McIntyre L, Carter GP, Williamson DA, et al. Biphasic Outbreak of Invasive Group A Streptococcus Disease in Eldercare Facility, New Zealand. Emerg Infect Dis. 2020;26(5):841-848. https://doi.org/10.3201/eid2605.190131
AMA Worthing KA, Werno A, Pink R, et al. Biphasic Outbreak of Invasive Group A Streptococcus Disease in Eldercare Facility, New Zealand. Emerging Infectious Diseases. 2020;26(5):841-848. doi:10.3201/eid2605.190131.
APA Worthing, K. A., Werno, A., Pink, R., McIntyre, L., Carter, G. P., Williamson, D. A....Davies, M. R. (2020). Biphasic Outbreak of Invasive Group A Streptococcus Disease in Eldercare Facility, New Zealand. Emerging Infectious Diseases, 26(5), 841-848. https://doi.org/10.3201/eid2605.190131.

Epidemiology of Tick-Borne Relapsing Fever in Endemic Area, Spain [PDF - 1.06 MB - 8 pages]
M. Domínguez et al.

Tick-borne relapsing fever (TBRF) is caused by spirochetes of Borrelia bacteria. We collected data on all TBRF cases in a TBRF-endemic area in southwest Spain during 1994–2016. We analyzed data from 98 patients in whom TBRF was diagnosed by light microscopy and analyzed the relationship between climatic data and TBRF incidence. Most cases occurred a rural environment during summer and autumn. We describe demographic, epidemiologic, clinical, and analytical characteristics, treatment, and occurrence of Jarisch-Herxheimer reaction. Most patients had fever and headache, and laboratory test results included elevated C-reactive protein, thrombocytopenia, and neutrophilia. No patients died, but 10.1% had Jarisch-Herxheimer reaction. B. hispanica was the infecting species in 12 cases with PCR results. Clinicians often do not suspect TBRF because clinical signs and symptoms vary; therefore, it is likely underdiagnosed, even in disease-endemic areas.

EID Domínguez M, Vergara S, Gómez M, Roldán M. Epidemiology of Tick-Borne Relapsing Fever in Endemic Area, Spain. Emerg Infect Dis. 2020;26(5):849-856. https://doi.org/10.3201/eid2605.190745
AMA Domínguez M, Vergara S, Gómez M, et al. Epidemiology of Tick-Borne Relapsing Fever in Endemic Area, Spain. Emerging Infectious Diseases. 2020;26(5):849-856. doi:10.3201/eid2605.190745.
APA Domínguez, M., Vergara, S., Gómez, M., & Roldán, M. (2020). Epidemiology of Tick-Borne Relapsing Fever in Endemic Area, Spain. Emerging Infectious Diseases, 26(5), 849-856. https://doi.org/10.3201/eid2605.190745.

Medscape CME Activity
Food Safety and Invasive Cronobacter Infections during Early Infancy, 1961–2018 [PDF - 846 KB - 9 pages]
J. Strysko et al.

Invasive Cronobacter infections among infants are associated with severe neurologic disabilities and death. Early Cronobacter reports typically featured hospitalized and preterm infants and recognized contaminated powdered infant formula (PIF) as a transmission vehicle. To clarify recent epidemiology, we reviewed all cases of bloodstream infection or meningitis among infants that were reported to the Centers for Disease Control and Prevention and in the literature (1961–2018; n = 183). Most infants were neonates (100/150 [67%]); 38% (42/112) died, and 79% (81/102) had reported recent PIF consumption. In the final quarter of the study period (2004–2018), case counts were significantly higher (global average 8.7 cases/year); among US cases, significantly higher proportions occurred among full-term (56% [27/48]) and nonhospitalized (78% [42/54]) infants. PIF contamination, most commonly from opened containers, was identified in 30% (21/71) of investigations. Our findings reaffirm the need to promote safer alternatives for infant feeding, particularly among neonates.

EID Strysko J, Cope JR, Martin H, Tarr C, Hise K, Collier S, et al. Food Safety and Invasive Cronobacter Infections during Early Infancy, 1961–2018. Emerg Infect Dis. 2020;26(5):857-865. https://doi.org/10.3201/eid2605.190858
AMA Strysko J, Cope JR, Martin H, et al. Food Safety and Invasive Cronobacter Infections during Early Infancy, 1961–2018. Emerging Infectious Diseases. 2020;26(5):857-865. doi:10.3201/eid2605.190858.
APA Strysko, J., Cope, J. R., Martin, H., Tarr, C., Hise, K., Collier, S....Bowen, A. (2020). Food Safety and Invasive Cronobacter Infections during Early Infancy, 1961–2018. Emerging Infectious Diseases, 26(5), 857-865. https://doi.org/10.3201/eid2605.190858.

Clinical Outcomes of Patients Treated for Candida auris Infections in a Multisite Health System, Illinois, USA [PDF - 1.58 MB - 5 pages]
K. Arensman et al.

Candida auris is an emerging fungal pathogen that is typically resistant to fluconazole and is known to cause healthcare-associated outbreaks. We retrospectively reviewed 28 patients who had >1 positive culture for C. auris within a multisite health system in Illinois, USA, during May 2018–April 2019. Twelve of these patients were treated as inpatients for C. auris infections; 10 (83%) met criteria for clinical success, defined as absence of all-cause mortality, C. auris recurrence, and infection-related readmission at 30 days from the first positive culture. The other 2 patients (17%) died within 30 days. Most patients (92%) were empirically treated with micafungin. Four (14%) of 28 total isolates were resistant to fluconazole, 1 (3.6%) was resistant to amphotericin B, and 1 (3.6%) was resistant to echinocandins. Our findings describe low rates of antifungal resistance and favorable clinical outcomes for most C. auris patients.

EID Arensman K, Miller JL, Chiang A, Mai N, Levato J, LaChance E, et al. Clinical Outcomes of Patients Treated for Candida auris Infections in a Multisite Health System, Illinois, USA. Emerg Infect Dis. 2020;26(5):876-880. https://doi.org/10.3201/eid2605.191588
AMA Arensman K, Miller JL, Chiang A, et al. Clinical Outcomes of Patients Treated for Candida auris Infections in a Multisite Health System, Illinois, USA. Emerging Infectious Diseases. 2020;26(5):876-880. doi:10.3201/eid2605.191588.
APA Arensman, K., Miller, J. L., Chiang, A., Mai, N., Levato, J., LaChance, E....Dela Pena, J. (2020). Clinical Outcomes of Patients Treated for Candida auris Infections in a Multisite Health System, Illinois, USA. Emerging Infectious Diseases, 26(5), 876-880. https://doi.org/10.3201/eid2605.191588.

Mosquito Control Activities during Local Transmission of Zika Virus, Miami-Dade County, Florida, USA, 2016 [PDF - 3.05 MB - 10 pages]
J. C. McAllister et al.

In 2016, four clusters of local mosquitoborne Zika virus transmission were identified in Miami-Dade County, Florida, USA, generating “red zones” (areas into which pregnant women were advised against traveling). The Miami-Dade County Mosquito Control Division initiated intensive control activities, including property inspections, community education, and handheld sprayer applications of larvicides and adulticides. For the first time, the Mosquito Control Division used a combination of areawide ultralow-volume adulticide and low-volume larvicide spraying to effectively control Aedes aegypti mosquitoes, the primary Zika virus vector within the county. The number of mosquitoes rapidly decreased, and Zika virus transmission was interrupted within the red zones immediately after the combination of adulticide and larvicide spraying.

EID McAllister JC, Porcelli M, Medina JM, Delorey MJ, Connelly C, Godsey MS, et al. Mosquito Control Activities during Local Transmission of Zika Virus, Miami-Dade County, Florida, USA, 2016. Emerg Infect Dis. 2020;26(5):881-890. https://doi.org/10.3201/eid2605.191606
AMA McAllister JC, Porcelli M, Medina JM, et al. Mosquito Control Activities during Local Transmission of Zika Virus, Miami-Dade County, Florida, USA, 2016. Emerging Infectious Diseases. 2020;26(5):881-890. doi:10.3201/eid2605.191606.
APA McAllister, J. C., Porcelli, M., Medina, J. M., Delorey, M. J., Connelly, C., Godsey, M. S....Vasquez, C. (2020). Mosquito Control Activities during Local Transmission of Zika Virus, Miami-Dade County, Florida, USA, 2016. Emerging Infectious Diseases, 26(5), 881-890. https://doi.org/10.3201/eid2605.191606.
Research

Medscape CME Activity
Blastomycosis in Minnesota, USA, 1999–2018 [PDF - 2.59 MB - 10 pages]
M. Ireland et al.

Blastomycosis is a systemic disease caused by Blastomyces spp. fungi. To determine its epidemiology in blastomycosis-endemic Minnesota, USA, we evaluated all cases reported to public health officials during 1999–2018. We focused on time to diagnosis, exposure activities, and exposure location. A total of 671 cases and a median of 34 cases/year were reported. Median time to diagnosis was 31 days; 61% of patients were not tested for blastomycosis until they were hospitalized. The case-fatality rate was 10%, and patients who died were 5.3 times more likely to have a concurrent medical condition. Outdoor activities and soil exposure were reported by many patients, but no specific activity or exposure was common to most. Almost one third of patients were probably exposed in geographic areas other than their home county. Providers should consider alternative etiologies for patients with pneumonia not responding to antibacterial treatment, and public health officials should increase awareness in blastomycosis-endemic areas.

EID Ireland M, Klumb C, Smith K, Scheftel J. Blastomycosis in Minnesota, USA, 1999–2018. Emerg Infect Dis. 2020;26(5):866-875. https://doi.org/10.3201/eid2605.191074
AMA Ireland M, Klumb C, Smith K, et al. Blastomycosis in Minnesota, USA, 1999–2018. Emerging Infectious Diseases. 2020;26(5):866-875. doi:10.3201/eid2605.191074.
APA Ireland, M., Klumb, C., Smith, K., & Scheftel, J. (2020). Blastomycosis in Minnesota, USA, 1999–2018. Emerging Infectious Diseases, 26(5), 866-875. https://doi.org/10.3201/eid2605.191074.

Effectiveness of Live Poultry Market Interventions on Human Infection with Avian Influenza A(H7N9) Virus, China [PDF - 2.05 MB - 11 pages]
W. Wang et al.

Various interventions for live poultry markets (LPMs) have emerged to control outbreaks of avian influenza A(H7N9) virus in mainland China since March 2013. We assessed the effectiveness of various LPM interventions in reducing transmission of H7N9 virus across 5 annual waves during 2013–2018, especially in the final wave. With the exception of waves 1 and 4, various LPM interventions reduced daily incidence rates significantly across waves. Four LPM interventions led to a mean reduction of 34%–98% in the daily number of infections in wave 5. Of these, permanent closure provided the most effective reduction in human infection with H7N9 virus, followed by long-period, short-period, and recursive closures in wave 5. The effectiveness of various LPM interventions changed with the type of intervention across epidemics. Permanent LPM closure should be considered to maintain sufficient effectiveness of interventions and prevent the recurrence of H7N9 epidemics.

EID Wang W, Artois J, Wang X, Kucharski AJ, Pei Y, Tong X, et al. Effectiveness of Live Poultry Market Interventions on Human Infection with Avian Influenza A(H7N9) Virus, China. Emerg Infect Dis. 2020;26(5):891-901. https://doi.org/10.3201/eid2605.190390
AMA Wang W, Artois J, Wang X, et al. Effectiveness of Live Poultry Market Interventions on Human Infection with Avian Influenza A(H7N9) Virus, China. Emerging Infectious Diseases. 2020;26(5):891-901. doi:10.3201/eid2605.190390.
APA Wang, W., Artois, J., Wang, X., Kucharski, A. J., Pei, Y., Tong, X....Yu, H. (2020). Effectiveness of Live Poultry Market Interventions on Human Infection with Avian Influenza A(H7N9) Virus, China. Emerging Infectious Diseases, 26(5), 891-901. https://doi.org/10.3201/eid2605.190390.

Nationwide Monitoring for Plasmodium falciparum Drug-Resistance Alleles to Chloroquine, Sulfadoxine, and Pyrimethamine, Haiti, 2016–2017 [PDF - 1.44 MB - 8 pages]
E. Rogier et al.

Haiti is striving for zero local malaria transmission by the year 2025. Chloroquine remains the first-line treatment, and sulfadoxine/pyrimethamine (SP) has been used for mass drug-administration pilot programs. In March 2016, nationwide molecular surveillance was initiated to assess molecular resistance signatures for chloroquine and SP. For 778 samples collected through December 2017, we used Sanger sequencing to investigate putative resistance markers to chloroquine (Pfcrt codons 72, 74, 75, and 76), sulfadoxine (Pfdhps codons 436, 437, 540, 581, 613), and pyrimethamine (Pfdhfr codons 50, 51, 59, 108, 164). No parasites harbored Pfcrt point mutations. Prevalence of the Pfdhfr S108N single mutation was 47%, and we found the triple mutant Pfdhfr haplotype (108N, 51I, and 59R) in a single isolate. We observed no Pfdhps variants except in 1 isolate (A437G mutation). These data confirm the lack of highly resistant chloroquine and SP alleles in Haiti and support the continued use of chloroquine and SP.

EID Rogier E, Herman C, Huber CS, Hamre K, Pierre B, Mace KE, et al. Nationwide Monitoring for Plasmodium falciparum Drug-Resistance Alleles to Chloroquine, Sulfadoxine, and Pyrimethamine, Haiti, 2016–2017. Emerg Infect Dis. 2020;26(5):902-909. https://doi.org/10.3201/eid2605.190556
AMA Rogier E, Herman C, Huber CS, et al. Nationwide Monitoring for Plasmodium falciparum Drug-Resistance Alleles to Chloroquine, Sulfadoxine, and Pyrimethamine, Haiti, 2016–2017. Emerging Infectious Diseases. 2020;26(5):902-909. doi:10.3201/eid2605.190556.
APA Rogier, E., Herman, C., Huber, C. S., Hamre, K., Pierre, B., Mace, K. E....Chang, M. A. (2020). Nationwide Monitoring for Plasmodium falciparum Drug-Resistance Alleles to Chloroquine, Sulfadoxine, and Pyrimethamine, Haiti, 2016–2017. Emerging Infectious Diseases, 26(5), 902-909. https://doi.org/10.3201/eid2605.190556.

Systematic Review and Meta-Analysis of Sex Differences in Social Contact Patterns and Implications for Tuberculosis Transmission and Control [PDF - 1.69 MB - 10 pages]
K. C. Horton et al.

Social contact patterns might contribute to excess burden of tuberculosis in men. We conducted a study of social contact surveys to evaluate contact patterns relevant to tuberculosis transmission. Available data describe 21 surveys in 17 countries and show profound differences in sex-based and age-based patterns of contact. Adults reported more adult contacts than children. Children preferentially mixed with women in all surveys (median sex assortativity 58%, interquartile range [IQR] 57%–59% for boys, 61% [IQR 60%–63%] for girls). Men and women reported sex-assortative mixing in 80% and 95% of surveys (median sex assortativity 56% [IQR 54%–58%] for men, 59% [IQR 57%–63%] for women). Sex-specific patterns of contact with adults were similar at home and outside the home for children; adults reported greater sex assortativity outside the home in most surveys. Sex assortativity in adult contacts likely contributes to sex disparities in adult tuberculosis burden by amplifying incidence among men.

EID Horton KC, Hoey AL, Béraud G, Corbett EL, White RG. Systematic Review and Meta-Analysis of Sex Differences in Social Contact Patterns and Implications for Tuberculosis Transmission and Control. Emerg Infect Dis. 2020;26(5):910-919. https://doi.org/10.3201/eid2605.190574
AMA Horton KC, Hoey AL, Béraud G, et al. Systematic Review and Meta-Analysis of Sex Differences in Social Contact Patterns and Implications for Tuberculosis Transmission and Control. Emerging Infectious Diseases. 2020;26(5):910-919. doi:10.3201/eid2605.190574.
APA Horton, K. C., Hoey, A. L., Béraud, G., Corbett, E. L., & White, R. G. (2020). Systematic Review and Meta-Analysis of Sex Differences in Social Contact Patterns and Implications for Tuberculosis Transmission and Control. Emerging Infectious Diseases, 26(5), 910-919. https://doi.org/10.3201/eid2605.190574.

Effects of Air Pollution and Other Environmental Exposures on Estimates of Severe Influenza Illness, Washington, USA [PDF - 1.50 MB - 10 pages]
R. Somayaji et al.

Ecologic models of influenza burden may be confounded by other exposures that share winter seasonality. We evaluated the effects of air pollution and other environmental exposures in ecologic models estimating influenza-associated hospitalizations. We linked hospitalization data, viral surveillance, and environmental data, including temperature, relative humidity, dew point, and fine particulate matter for 3 counties in Washington, USA, for 2001–2012. We used negative binomial regression models to estimate the incidence of influenza-associated respiratory and circulatory (RC) hospitalizations and to assess the effect of adjusting for environmental exposures on RC hospitalization estimates. The modeled overall incidence rate of influenza-associated RC hospitalizations was 31/100,000 person-years. The environmental parameters were statistically associated with RC hospitalizations but did not appreciably affect the event rate estimates. Modeled influenza-associated RC hospitalization rates were similar to published estimates, and inclusion of environmental covariates in the model did not have a clinically important effect on severe influenza estimates.

EID Somayaji R, Neradilek MB, Szpiro AA, Lofy KH, Jackson ML, Goss CH, et al. Effects of Air Pollution and Other Environmental Exposures on Estimates of Severe Influenza Illness, Washington, USA. Emerg Infect Dis. 2020;26(5):920-929. https://doi.org/10.3201/eid2605.190599
AMA Somayaji R, Neradilek MB, Szpiro AA, et al. Effects of Air Pollution and Other Environmental Exposures on Estimates of Severe Influenza Illness, Washington, USA. Emerging Infectious Diseases. 2020;26(5):920-929. doi:10.3201/eid2605.190599.
APA Somayaji, R., Neradilek, M. B., Szpiro, A. A., Lofy, K. H., Jackson, M. L., Goss, C. H....Ortiz, J. R. (2020). Effects of Air Pollution and Other Environmental Exposures on Estimates of Severe Influenza Illness, Washington, USA. Emerging Infectious Diseases, 26(5), 920-929. https://doi.org/10.3201/eid2605.190599.

Epidemiologic and Clinical Progression of Lobomycosis among Kaiabi Indians, Brazil, 1965–2019 [PDF - 1.40 MB - 7 pages]
M. C. Florian et al.

Lobomycosis is a rare granulomatous skin disease with a high prevalence in the Amazon region. The Kaiabi Indians are an especially affected group. We studied the current epidemiologic and clinical progression of lobomycosis among the Kaiabi in Brazil, from initial case reports in 1965 through 2019. A total of 60 lobomycosis cases had been reported among the Kaiabi, and we identified 3 new cases in our review. Of 550 cases of lobomycosis ever reported worldwide, 11.5% were among the Kaiabi. We note a high incidence among female Kaiabi and a precocious onset of disease in this indigenous population. Male Kaiabi frequently are infected with the multicentric form and women more frequently exhibit the localized form. Ulcerated lesions are observed more often in the multicentric form. The prevalence among this indigenous group could be explained by genetic susceptibility and lifestyle, which exposes them to a particular agent in the habitats in which they live.

EID Florian MC, Rodrigues DA, de Mendonça S, Colombo AL, Tomimori J. Epidemiologic and Clinical Progression of Lobomycosis among Kaiabi Indians, Brazil, 1965–2019. Emerg Infect Dis. 2020;26(5):930-936. https://doi.org/10.3201/eid2605.190958
AMA Florian MC, Rodrigues DA, de Mendonça S, et al. Epidemiologic and Clinical Progression of Lobomycosis among Kaiabi Indians, Brazil, 1965–2019. Emerging Infectious Diseases. 2020;26(5):930-936. doi:10.3201/eid2605.190958.
APA Florian, M. C., Rodrigues, D. A., de Mendonça, S., Colombo, A. L., & Tomimori, J. (2020). Epidemiologic and Clinical Progression of Lobomycosis among Kaiabi Indians, Brazil, 1965–2019. Emerging Infectious Diseases, 26(5), 930-936. https://doi.org/10.3201/eid2605.190958.

Rhizopus microsporus Infections Associated with Surgical Procedures, Argentina, 2006–2014 [PDF - 1.25 MB - 8 pages]
J. R. Bowers et al.

Rhizopus spp. fungi are ubiquitous in the environment and a rare but substantial cause of infection in immunosuppressed persons and surgery patients. During 2005–2017, an abnormally high number of Rhizopus infections in surgery patients, with no apparent epidemiologic links, were reported in Argentina. To determine the likelihood of a common source of the cluster, we performed whole-genome sequencing on samples collected during 2006–2014. Most isolates were separated by >60 single-nucleotide polymorphisms, and we found no evidence for recombination or nonneutral mutation accumulation; these findings do not support common source or patient-to-patient transmission. Assembled genomes of most isolates were ≈25 Mbp, and multiple isolates had substantially larger assembled genomes (43–51 Mbp), indicative of infections with strain types that underwent genome expansion. Whole-genome sequencing has become an essential tool for studying epidemiology of fungal infections. Less discriminatory techniques may miss true relationships, possibly resulting in inappropriate attribution of point source.

EID Bowers JR, Monroy-Nieto J, Gade L, Travis J, Refojo N, Abrantes R, et al. Rhizopus microsporus Infections Associated with Surgical Procedures, Argentina, 2006–2014. Emerg Infect Dis. 2020;26(5):937-944. https://doi.org/10.3201/eid2605.191045
AMA Bowers JR, Monroy-Nieto J, Gade L, et al. Rhizopus microsporus Infections Associated with Surgical Procedures, Argentina, 2006–2014. Emerging Infectious Diseases. 2020;26(5):937-944. doi:10.3201/eid2605.191045.
APA Bowers, J. R., Monroy-Nieto, J., Gade, L., Travis, J., Refojo, N., Abrantes, R....Engelthaler, D. M. (2020). Rhizopus microsporus Infections Associated with Surgical Procedures, Argentina, 2006–2014. Emerging Infectious Diseases, 26(5), 937-944. https://doi.org/10.3201/eid2605.191045.

Zika Virus Circulation in Mali [PDF - 2.06 MB - 8 pages]
I. Diarra et al.

The circulation of Zika virus (ZIKV) in Mali has not been clearly characterized. Therefore, we conducted a serologic survey of 793 asymptomatic volunteers >15 years of age (2016), and 637 blood donors (2013) to assess the seroprevalence of ZIKV infection in 2 ecoclimatic regions of Mali, tropical savannah and warm semiarid region, using ELISA and seroneutralization assays. The overall seroprevalence was ≈12% and increased with age, with no statistical difference between male and female participants. In the warm semiarid study sites we detected immunological markers of an outbreak that occurred in the late 1990s in 18% (95% CI 13%–23%) of participants. In tropical savannah sites, we estimated a low rate of endemic transmission, with 2.5% (95% CI 2.0%–3.1%) of population infected by ZIKV annually. These data demonstrate the circulation of ZIKV in Mali and provide evidence of a previously unidentified outbreak that occurred in the late 1990s.

EID Diarra I, Nurtop E, Sangaré A, Sagara I, Pastorino B, Sacko S, et al. Zika Virus Circulation in Mali. Emerg Infect Dis. 2020;26(5):945-952. https://doi.org/10.3201/eid2605.191383
AMA Diarra I, Nurtop E, Sangaré A, et al. Zika Virus Circulation in Mali. Emerging Infectious Diseases. 2020;26(5):945-952. doi:10.3201/eid2605.191383.
APA Diarra, I., Nurtop, E., Sangaré, A., Sagara, I., Pastorino, B., Sacko, S....Doumbo, O. K. (2020). Zika Virus Circulation in Mali. Emerging Infectious Diseases, 26(5), 945-952. https://doi.org/10.3201/eid2605.191383.

Possible Transmission Mechanisms of Mixed Mycobacterium tuberculosis Infection in High HIV Prevalence Country, Botswana [PDF - 1.51 MB - 8 pages]
Y. Baik et al.

Tuberculosis caused by concurrent infection with multiple Mycobacterium tuberculosis strains (i.e., mixed infection) challenges clinical and epidemiologic paradigms. We explored possible transmission mechanisms of mixed infection in a population-based, molecular epidemiology study in Botswana during 2012–2016. We defined mixed infection as multiple repeats of alleles at >2 loci within a discrete mycobacterial interspersed repetitive unit–variable-number tandem-repeat (MIRU-VNTR) result. We compared mixed infection MIRU-VNTR results with all study MIRU-VNTR results by considering all permutations at each multiple allele locus; matched MIRU-VNTR results were considered evidence of recently acquired strains and nonmatched to any other results were considered evidence of remotely acquired strains. Among 2,051 patients, 34 (1.7%) had mixed infection, of which 23 (68%) had recently and remotely acquired strains. This finding might support the mixed infection mechanism of recent transmission and simultaneous remote reactivation. Further exploration is needed to determine proportions of transmission mechanisms in settings where mixed infections are prevalent.

EID Baik Y, Modongo C, Moonan PK, Click ES, Tobias JL, Boyd R, et al. Possible Transmission Mechanisms of Mixed Mycobacterium tuberculosis Infection in High HIV Prevalence Country, Botswana. Emerg Infect Dis. 2020;26(5):953-960. https://doi.org/10.3201/eid2605.191638
AMA Baik Y, Modongo C, Moonan PK, et al. Possible Transmission Mechanisms of Mixed Mycobacterium tuberculosis Infection in High HIV Prevalence Country, Botswana. Emerging Infectious Diseases. 2020;26(5):953-960. doi:10.3201/eid2605.191638.
APA Baik, Y., Modongo, C., Moonan, P. K., Click, E. S., Tobias, J. L., Boyd, R....Zetola, N. M. (2020). Possible Transmission Mechanisms of Mixed Mycobacterium tuberculosis Infection in High HIV Prevalence Country, Botswana. Emerging Infectious Diseases, 26(5), 953-960. https://doi.org/10.3201/eid2605.191638.
Policy Review

Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures [PDF - 418 KB - 6 pages]
S. Ryu et al.

International travel–related nonpharmaceutical interventions (NPIs), which can include traveler screening, travel restrictions, and border closures, often are included in national influenza pandemic preparedness plans. We performed systematic reviews to identify evidence for their effectiveness. We found 15 studies in total. Some studies reported that NPIs could delay the introduction of influenza virus. However, no available evidence indicated that screening of inbound travelers would have a substantial effect on preventing spread of pandemic influenza, and no studies examining exit screening were found. Some studies reported that travel restrictions could delay the start of local transmission and slow international spread, and 1 study indicated that small Pacific islands were able to prevent importation of pandemic influenza during 1918–19 through complete border closure. This limited evidence base indicates that international travel-related NPIs would have limited effectiveness in controlling pandemic influenza and that these measures require considerable resources to implement.

EID Ryu S, Gao H, Wong JY, Shiu E, Xiao J, Fong M, et al. Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures. Emerg Infect Dis. 2020;26(5):961-966. https://doi.org/10.3201/eid2605.190993
AMA Ryu S, Gao H, Wong JY, et al. Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures. Emerging Infectious Diseases. 2020;26(5):961-966. doi:10.3201/eid2605.190993.
APA Ryu, S., Gao, H., Wong, J. Y., Shiu, E., Xiao, J., Fong, M....Cowling, B. J. (2020). Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures. Emerging Infectious Diseases, 26(5), 961-966. https://doi.org/10.3201/eid2605.190993.

Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures [PDF - 914 KB - 9 pages]
J. Xiao et al.

There were 3 influenza pandemics in the 20th century, and there has been 1 so far in the 21st century. Local, national, and international health authorities regularly update their plans for mitigating the next influenza pandemic in light of the latest available evidence on the effectiveness of various control measures in reducing transmission. Here, we review the evidence base on the effectiveness of nonpharmaceutical personal protective measures and environmental hygiene measures in nonhealthcare settings and discuss their potential inclusion in pandemic plans. Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza. We similarly found limited evidence on the effectiveness of improved hygiene and environmental cleaning. We identified several major knowledge gaps requiring further research, most fundamentally an improved characterization of the modes of person-to-person transmission.

EID Xiao J, Shiu E, Gao H, Wong JY, Fong MW, Ryu S, et al. Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures. Emerg Infect Dis. 2020;26(5):967-975. https://doi.org/10.3201/eid2605.190994
AMA Xiao J, Shiu E, Gao H, et al. Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures. Emerging Infectious Diseases. 2020;26(5):967-975. doi:10.3201/eid2605.190994.
APA Xiao, J., Shiu, E., Gao, H., Wong, J. Y., Fong, M. W., Ryu, S....Cowling, B. J. (2020). Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures. Emerging Infectious Diseases, 26(5), 967-975. https://doi.org/10.3201/eid2605.190994.

Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Social Distancing Measures [PDF - 1.08 MB - 9 pages]
M. W. Fong et al.

Influenza virus infections are believed to spread mostly by close contact in the community. Social distancing measures are essential components of the public health response to influenza pandemics. The objective of these mitigation measures is to reduce transmission, thereby delaying the epidemic peak, reducing the size of the epidemic peak, and spreading cases over a longer time to relieve pressure on the healthcare system. We conducted systematic reviews of the evidence base for effectiveness of multiple mitigation measures: isolating ill persons, contact tracing, quarantining exposed persons, school closures, workplace measures/closures, and avoiding crowding. Evidence supporting the effectiveness of these measures was obtained largely from observational studies and simulation studies. Voluntary isolation at home might be a more feasible social distancing measure, and pandemic plans should consider how to facilitate this measure. More drastic social distancing measures might be reserved for severe pandemics.

EID Fong MW, Gao H, Wong JY, Xiao J, Shiu E, Ryu S, et al. Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Social Distancing Measures. Emerg Infect Dis. 2020;26(5):976-984. https://doi.org/10.3201/eid2605.190995
AMA Fong MW, Gao H, Wong JY, et al. Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Social Distancing Measures. Emerging Infectious Diseases. 2020;26(5):976-984. doi:10.3201/eid2605.190995.
APA Fong, M. W., Gao, H., Wong, J. Y., Xiao, J., Shiu, E., Ryu, S....Cowling, B. J. (2020). Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Social Distancing Measures. Emerging Infectious Diseases, 26(5), 976-984. https://doi.org/10.3201/eid2605.190995.
Dispatches

Candidatus Rickettsia xinyangensis as Cause of Spotted Fever Group Rickettsiosis, Xinyang, China, 2015 [PDF - 524 KB - 4 pages]
H. Li et al.

In 2015, we evaluated 221 patients with undifferentiated fever and tick bite or animal exposure in Xinyang, China, for Rickettsia infection. Three with mild disease were infected with Candidatus R. xinyangensis, which clustered with R. fournieri and R. vini in phylogenetic analyses. Field investigations suggest Haemaphysalis longicornis ticks might be involved in transmission.

EID Li H, Li X, Du J, Zhang X, Cui N, Yang Z, et al. Candidatus Rickettsia xinyangensis as Cause of Spotted Fever Group Rickettsiosis, Xinyang, China, 2015. Emerg Infect Dis. 2020;26(5):985-988. https://doi.org/10.3201/eid2605.170294
AMA Li H, Li X, Du J, et al. Candidatus Rickettsia xinyangensis as Cause of Spotted Fever Group Rickettsiosis, Xinyang, China, 2015. Emerging Infectious Diseases. 2020;26(5):985-988. doi:10.3201/eid2605.170294.
APA Li, H., Li, X., Du, J., Zhang, X., Cui, N., Yang, Z....Liu, W. (2020). Candidatus Rickettsia xinyangensis as Cause of Spotted Fever Group Rickettsiosis, Xinyang, China, 2015. Emerging Infectious Diseases, 26(5), 985-988. https://doi.org/10.3201/eid2605.170294.

Pretreatment Out-of-Pocket Expenses for Presumptive Multidrug-Resistant Tuberculosis Patients, India, 2016–2017 [PDF - 435 KB - 4 pages]
P. Rathi et al.

In India, under the National Tuberculosis Elimination Programme, the government provides free treatment for multidrug-resistant tuberculosis; however, many patients seek care elsewhere, which is costly. To determine those out-of-pocket expenses, we interviewed 40 presumptive patients and found that they spent more than their median annual income before registering for the government program.

EID Rathi P, Shringarpure K, Unnikrishnan B, Chadha V, Acharya V, Nair A, et al. Pretreatment Out-of-Pocket Expenses for Presumptive Multidrug-Resistant Tuberculosis Patients, India, 2016–2017. Emerg Infect Dis. 2020;26(5):989-992. https://doi.org/10.3201/eid2605.181992
AMA Rathi P, Shringarpure K, Unnikrishnan B, et al. Pretreatment Out-of-Pocket Expenses for Presumptive Multidrug-Resistant Tuberculosis Patients, India, 2016–2017. Emerging Infectious Diseases. 2020;26(5):989-992. doi:10.3201/eid2605.181992.
APA Rathi, P., Shringarpure, K., Unnikrishnan, B., Chadha, V., Acharya, V., Nair, A....Shastri, S. (2020). Pretreatment Out-of-Pocket Expenses for Presumptive Multidrug-Resistant Tuberculosis Patients, India, 2016–2017. Emerging Infectious Diseases, 26(5), 989-992. https://doi.org/10.3201/eid2605.181992.

Capybara and Brush Cutter Involvement in Q Fever Outbreak in Remote Area of Amazon Rain Forest, French Guiana, 2014 [PDF - 1.95 MB - 5 pages]
J. Christen et al.

We investigated a Q fever outbreak that occurred in an isolated area of the Amazon Rain Forest in French Guiana in 2014. Capybara fecal samples were positive for Coxiella burnetii DNA. Being near brush cutters in use was associated with disease development. Capybaras are a putative reservoir for C. burnetii.

EID Christen J, Edouard S, Lamour T, Martinez E, Rousseau C, de Laval F, et al. Capybara and Brush Cutter Involvement in Q Fever Outbreak in Remote Area of Amazon Rain Forest, French Guiana, 2014. Emerg Infect Dis. 2020;26(5):993-997. https://doi.org/10.3201/eid2605.190242
AMA Christen J, Edouard S, Lamour T, et al. Capybara and Brush Cutter Involvement in Q Fever Outbreak in Remote Area of Amazon Rain Forest, French Guiana, 2014. Emerging Infectious Diseases. 2020;26(5):993-997. doi:10.3201/eid2605.190242.
APA Christen, J., Edouard, S., Lamour, T., Martinez, E., Rousseau, C., de Laval, F....Epelboin, L. (2020). Capybara and Brush Cutter Involvement in Q Fever Outbreak in Remote Area of Amazon Rain Forest, French Guiana, 2014. Emerging Infectious Diseases, 26(5), 993-997. https://doi.org/10.3201/eid2605.190242.

Women’s Awareness and Healthcare Provider Discussions about Zika Virus during Pregnancy, United States, 2016–2017 [PDF - 326 KB - 4 pages]
L. Williams et al.

We surveyed women with a recent live birth who resided in 16 US states and 1 city during the 2016 Zika outbreak. We found high awareness about the risk of Zika virus infection during pregnancy and about advisories to avoid travel to affected areas but moderate levels of discussions with healthcare providers.

EID Williams L, D’Angelo DV, Bauman B, Dieke AC, Ellington SR, Shapiro-Mendoza CK, et al. Women’s Awareness and Healthcare Provider Discussions about Zika Virus during Pregnancy, United States, 2016–2017. Emerg Infect Dis. 2020;26(5):998-1001. https://doi.org/10.3201/eid2605.190727
AMA Williams L, D’Angelo DV, Bauman B, et al. Women’s Awareness and Healthcare Provider Discussions about Zika Virus during Pregnancy, United States, 2016–2017. Emerging Infectious Diseases. 2020;26(5):998-1001. doi:10.3201/eid2605.190727.
APA Williams, L., D’Angelo, D. V., Bauman, B., Dieke, A. C., Ellington, S. R., Shapiro-Mendoza, C. K....Warner, L. (2020). Women’s Awareness and Healthcare Provider Discussions about Zika Virus during Pregnancy, United States, 2016–2017. Emerging Infectious Diseases, 26(5), 998-1001. https://doi.org/10.3201/eid2605.190727.

Genetic Characterization of Japanese Encephalitis Virus Genotype 5 Isolated from Patient, South Korea, 2015 [PDF - 868 KB - 5 pages]
J. Woo et al.

We isolated Japanese encephalitis virus genotype 5 from human specimens in South Korea. Whole-genome analysis showed 90.4% identity with other genotype 5 viruses from humans. This virus had a unique insertion in the NS4A gene. However, the envelope protein contained Lys 84, which was specific to strains of genotype 5 viruses from South Korea.

EID Woo J, Jeong Y, Jo J, Shim S, Ryou J, Kim K, et al. Genetic Characterization of Japanese Encephalitis Virus Genotype 5 Isolated from Patient, South Korea, 2015. Emerg Infect Dis. 2020;26(5):1002-1006. https://doi.org/10.3201/eid2605.190977
AMA Woo J, Jeong Y, Jo J, et al. Genetic Characterization of Japanese Encephalitis Virus Genotype 5 Isolated from Patient, South Korea, 2015. Emerging Infectious Diseases. 2020;26(5):1002-1006. doi:10.3201/eid2605.190977.
APA Woo, J., Jeong, Y., Jo, J., Shim, S., Ryou, J., Kim, K....Lee, J. (2020). Genetic Characterization of Japanese Encephalitis Virus Genotype 5 Isolated from Patient, South Korea, 2015. Emerging Infectious Diseases, 26(5), 1002-1006. https://doi.org/10.3201/eid2605.190977.

Update on Ebola Treatment Center Costs and Sustainability, United States, 2019 [PDF - 359 KB - 3 pages]
J. J. Herstein et al.

We surveyed 56 Ebola treatment centers (ETCs) in the United States and identified costs incurred since 2014 ($1.76 million/ETC) and sustainability strategies. ETCs reported heavy reliance on federal funding. It is uncertain if, or for how long, ETCs can maintain capabilities should federal funding expire in 2020.

EID Herstein JJ, Le AB, McNulty LA, Buehler SA, Biddinger PD, Hewlett AL, et al. Update on Ebola Treatment Center Costs and Sustainability, United States, 2019. Emerg Infect Dis. 2020;26(5):1007-1009. https://doi.org/10.3201/eid2605.191245
AMA Herstein JJ, Le AB, McNulty LA, et al. Update on Ebola Treatment Center Costs and Sustainability, United States, 2019. Emerging Infectious Diseases. 2020;26(5):1007-1009. doi:10.3201/eid2605.191245.
APA Herstein, J. J., Le, A. B., McNulty, L. A., Buehler, S. A., Biddinger, P. D., Hewlett, A. L....Gibbs, S. G. (2020). Update on Ebola Treatment Center Costs and Sustainability, United States, 2019. Emerging Infectious Diseases, 26(5), 1007-1009. https://doi.org/10.3201/eid2605.191245.

A Neighbor-Based Approach to Identify Tuberculosis Exposure, the Kopanyo Study [PDF - 461 KB - 4 pages]
P. K. Moonan et al.

Contact investigation is one public health measure used to prevent tuberculosis by identifying and treating persons exposed to Mycobacterium tuberculosis. Contact investigations are a major tenet of global tuberculosis elimination efforts, but for many reasons remain ineffective. We describe a novel neighbor-based approach to reframe contact investigations.

EID Moonan PK, Zetola NM, Tobias JL, Basotli J, Boyd R, Click ES, et al. A Neighbor-Based Approach to Identify Tuberculosis Exposure, the Kopanyo Study. Emerg Infect Dis. 2020;26(5):1010-1013. https://doi.org/10.3201/eid2605.191568
AMA Moonan PK, Zetola NM, Tobias JL, et al. A Neighbor-Based Approach to Identify Tuberculosis Exposure, the Kopanyo Study. Emerging Infectious Diseases. 2020;26(5):1010-1013. doi:10.3201/eid2605.191568.
APA Moonan, P. K., Zetola, N. M., Tobias, J. L., Basotli, J., Boyd, R., Click, E. S....Oeltmann, J. E. (2020). A Neighbor-Based Approach to Identify Tuberculosis Exposure, the Kopanyo Study. Emerging Infectious Diseases, 26(5), 1010-1013. https://doi.org/10.3201/eid2605.191568.

Species Distribution and Isolation Frequency of Nontuberculous Mycobacteria, Uruguay [PDF - 973 KB - 5 pages]
G. Greif et al.

Nontuberculous mycobacteria (NTM) increasingly are recognized as opportunistic pathogens of humans. NTM species distribution is well documented in Europe and North America, but data from other regions are scarce. We assessed NTM isolation frequency and species distribution in Uruguay during 2006–2018.

EID Greif G, Coitinho C, van Ingen J, Robello C. Species Distribution and Isolation Frequency of Nontuberculous Mycobacteria, Uruguay. Emerg Infect Dis. 2020;26(5):1014-1018. https://doi.org/10.3201/eid2605.191631
AMA Greif G, Coitinho C, van Ingen J, et al. Species Distribution and Isolation Frequency of Nontuberculous Mycobacteria, Uruguay. Emerging Infectious Diseases. 2020;26(5):1014-1018. doi:10.3201/eid2605.191631.
APA Greif, G., Coitinho, C., van Ingen, J., & Robello, C. (2020). Species Distribution and Isolation Frequency of Nontuberculous Mycobacteria, Uruguay. Emerging Infectious Diseases, 26(5), 1014-1018. https://doi.org/10.3201/eid2605.191631.
Research Letters

Crimean-Congo Hemorrhagic Fever Virus Endemicity in United Arab Emirates, 2019 [PDF - 1.34 MB - 3 pages]
J. V. Camp et al.

We conducted a cross-sectional survey of Crimean-Congo hemorrhagic fever virus (CCHFV) in dromedary camels and attached ticks at 3 locations in the United Arab Emirates. Results revealed a high prevalence of CCHFV-reactive antibodies in camels and viral RNA in ticks and camel serum, suggesting the virus is endemic in this country.

EID Camp JV, Kannan DO, Osman B, Shah M, Howarth B, Khafaga T, et al. Crimean-Congo Hemorrhagic Fever Virus Endemicity in United Arab Emirates, 2019. Emerg Infect Dis. 2020;26(5):1019-1021. https://doi.org/10.3201/eid2605.191414
AMA Camp JV, Kannan DO, Osman B, et al. Crimean-Congo Hemorrhagic Fever Virus Endemicity in United Arab Emirates, 2019. Emerging Infectious Diseases. 2020;26(5):1019-1021. doi:10.3201/eid2605.191414.
APA Camp, J. V., Kannan, D. O., Osman, B., Shah, M., Howarth, B., Khafaga, T....Nowotny, N. (2020). Crimean-Congo Hemorrhagic Fever Virus Endemicity in United Arab Emirates, 2019. Emerging Infectious Diseases, 26(5), 1019-1021. https://doi.org/10.3201/eid2605.191414.

Zika Inquiries Made to the CDC-INFO System, December 2015–September 2017 [PDF - 304 KB - 3 pages]
T. Sell et al.

We examined Zika-related inquiries to CDC-INFO, the national contact center for the Centers for Disease Control and Prevention, to identify potential communication gaps. The most frequently asked questions related to travel or geographic location of Zika (42% of all inquiries), information about laboratory testing (13%), or acquiring a Zika test (11%).

EID Sell T, Watson C, Meyer D, Snyder MR, Ravi SJ, McGinty EE, et al. Zika Inquiries Made to the CDC-INFO System, December 2015–September 2017. Emerg Infect Dis. 2020;26(5):1022-1024. https://doi.org/10.3201/eid2605.181694
AMA Sell T, Watson C, Meyer D, et al. Zika Inquiries Made to the CDC-INFO System, December 2015–September 2017. Emerging Infectious Diseases. 2020;26(5):1022-1024. doi:10.3201/eid2605.181694.
APA Sell, T., Watson, C., Meyer, D., Snyder, M. R., Ravi, S. J., McGinty, E. E....Lubell, K. M. (2020). Zika Inquiries Made to the CDC-INFO System, December 2015–September 2017. Emerging Infectious Diseases, 26(5), 1022-1024. https://doi.org/10.3201/eid2605.181694.

Serologic Detection of Middle East Respiratory Syndrome Coronavirus Functional Antibodies [PDF - 1.34 MB - 4 pages]
N. Okba et al.

We developed and validated 2 species-independent protein-based assays to detect Middle East respiratory syndrome coronavirus functional antibodies that can block virus receptor-binding or sialic acid-attachment. Antibody levels measured in both assays correlated strongly with virus-neutralizing antibody titers, proving their use for serologic confirmatory diagnosis of Middle East respiratory syndrome.

EID Okba N, Widjaja I, Li W, GeurtsvanKessel CH, Farag E, Al-Hajri M, et al. Serologic Detection of Middle East Respiratory Syndrome Coronavirus Functional Antibodies. Emerg Infect Dis. 2020;26(5):1024-1027. https://doi.org/10.3201/eid2605.190921
AMA Okba N, Widjaja I, Li W, et al. Serologic Detection of Middle East Respiratory Syndrome Coronavirus Functional Antibodies. Emerging Infectious Diseases. 2020;26(5):1024-1027. doi:10.3201/eid2605.190921.
APA Okba, N., Widjaja, I., Li, W., GeurtsvanKessel, C. H., Farag, E., Al-Hajri, M....Haagmans, B. L. (2020). Serologic Detection of Middle East Respiratory Syndrome Coronavirus Functional Antibodies. Emerging Infectious Diseases, 26(5), 1024-1027. https://doi.org/10.3201/eid2605.190921.

Novel Ehrlichia Strain Infecting Cattle Tick Amblyomma neumanni, Argentina, 2018 [PDF - 792 KB - 4 pages]
L. Fargnoli et al.

In 2018, we detected a novel Ehrlichia strain infecting Amblyomma neumanni ticks in Argentina. The novel strain is phylogenetically related to the ruminant pathogen E. ruminantium and represents a potential risk for veterinary and public health because A. neumanni ticks parasitize domestic and wild ruminants and bite humans.

EID Fargnoli L, Fernandez C, Monje LD. Novel Ehrlichia Strain Infecting Cattle Tick Amblyomma neumanni, Argentina, 2018. Emerg Infect Dis. 2020;26(5):1027-1030. https://doi.org/10.3201/eid2605.190940
AMA Fargnoli L, Fernandez C, Monje LD. Novel Ehrlichia Strain Infecting Cattle Tick Amblyomma neumanni, Argentina, 2018. Emerging Infectious Diseases. 2020;26(5):1027-1030. doi:10.3201/eid2605.190940.
APA Fargnoli, L., Fernandez, C., & Monje, L. D. (2020). Novel Ehrlichia Strain Infecting Cattle Tick Amblyomma neumanni, Argentina, 2018. Emerging Infectious Diseases, 26(5), 1027-1030. https://doi.org/10.3201/eid2605.190940.

Multidrug-Resistant Salmonella Serotype Anatum in Travelers and Seafood from Asia, United States [PDF - 1.50 MB - 4 pages]
B. E. Karp et al.

A multidrug-resistant Salmonella enterica serotype Anatum strain reported in Taiwan was isolated in the United States from patients and from seafood imported from Asia. Isolates harbored 11 resistance determinants, including quinolone and inducible cephalosporin resistance genes. Most patients had traveled to Asia. These findings underscore the need for global One Health resistance surveillance.

EID Karp BE, Leeper MM, Chen JC, Tagg KA, Francois Watkins LK, Friedman CR. Multidrug-Resistant Salmonella Serotype Anatum in Travelers and Seafood from Asia, United States. Emerg Infect Dis. 2020;26(5):1030-1033. https://doi.org/10.3201/eid2605.190992
AMA Karp BE, Leeper MM, Chen JC, et al. Multidrug-Resistant Salmonella Serotype Anatum in Travelers and Seafood from Asia, United States. Emerging Infectious Diseases. 2020;26(5):1030-1033. doi:10.3201/eid2605.190992.
APA Karp, B. E., Leeper, M. M., Chen, J. C., Tagg, K. A., Francois Watkins, L. K., & Friedman, C. R. (2020). Multidrug-Resistant Salmonella Serotype Anatum in Travelers and Seafood from Asia, United States. Emerging Infectious Diseases, 26(5), 1030-1033. https://doi.org/10.3201/eid2605.190992.

Fatal Rodentborne Leptospirosis in Prison Inmates, South Africa, 2015 [PDF - 553 KB - 3 pages]
K. Naidoo et al.

Leptospirosis is a neglected zoonotic disease. In 2015, leptospirosis was diagnosed in 2 prison inmates in South Africa. Using real-time PCR and DNA sequencing, we identified Leptospira interrogans serogroup Icterohaemorrhagiae in rodents and water samples within the prison. Leptospirosis might be frequently underdiagnosed in South Africa.

EID Naidoo K, Moseley M, McCarthy K, Chingonzoh R, Lawrence C, Setshedi GM, et al. Fatal Rodentborne Leptospirosis in Prison Inmates, South Africa, 2015. Emerg Infect Dis. 2020;26(5):1033-1035. https://doi.org/10.3201/eid2605.191132
AMA Naidoo K, Moseley M, McCarthy K, et al. Fatal Rodentborne Leptospirosis in Prison Inmates, South Africa, 2015. Emerging Infectious Diseases. 2020;26(5):1033-1035. doi:10.3201/eid2605.191132.
APA Naidoo, K., Moseley, M., McCarthy, K., Chingonzoh, R., Lawrence, C., Setshedi, G. M....Rossouw, J. (2020). Fatal Rodentborne Leptospirosis in Prison Inmates, South Africa, 2015. Emerging Infectious Diseases, 26(5), 1033-1035. https://doi.org/10.3201/eid2605.191132.

Diplorickettsia Bacteria in an Ixodes scapularis Tick, Vermont, USA [PDF - 468 KB - 3 pages]
C. Merenstein et al.

An unexpected Diplorickettsia species closely related to the tickborne pathogen D. massieliensis was found in the microbiome of an Ixodes scapularis tick in Vermont, USA. This evidence of Diplorickettsia in North American ticks suggests a need for disease surveillance using molecular screening of ticks and serologic studies of humans.

EID Merenstein C, Ward J, Allen D. Diplorickettsia Bacteria in an Ixodes scapularis Tick, Vermont, USA. Emerg Infect Dis. 2020;26(5):1036-1038. https://doi.org/10.3201/eid2605.191135
AMA Merenstein C, Ward J, Allen D. Diplorickettsia Bacteria in an Ixodes scapularis Tick, Vermont, USA. Emerging Infectious Diseases. 2020;26(5):1036-1038. doi:10.3201/eid2605.191135.
APA Merenstein, C., Ward, J., & Allen, D. (2020). Diplorickettsia Bacteria in an Ixodes scapularis Tick, Vermont, USA. Emerging Infectious Diseases, 26(5), 1036-1038. https://doi.org/10.3201/eid2605.191135.

Case of Babesia crassa–Like Infection, Slovenia, 2014 [PDF - 657 KB - 3 pages]
K. Strasek-Smrdel et al.

We report a case of Babesia crassa–like infection in an asplenic patient in Slovenia in 2014. We diagnosed the infection using microscopy, 18S rRNA sequencing, and serology and monitored parasitemia using digital PCR. With its increasing occurrence, babesiosis should be included in differential diagnoses for immunocompromised patients displaying fever.

EID Strasek-Smrdel K, Korva M, Pal E, Rajter M, Skvarc M, Avsic-Zupanc T. Case of Babesia crassa–Like Infection, Slovenia, 2014. Emerg Infect Dis. 2020;26(5):1038-1040. https://doi.org/10.3201/eid2605.191201
AMA Strasek-Smrdel K, Korva M, Pal E, et al. Case of Babesia crassa–Like Infection, Slovenia, 2014. Emerging Infectious Diseases. 2020;26(5):1038-1040. doi:10.3201/eid2605.191201.
APA Strasek-Smrdel, K., Korva, M., Pal, E., Rajter, M., Skvarc, M., & Avsic-Zupanc, T. (2020). Case of Babesia crassa–Like Infection, Slovenia, 2014. Emerging Infectious Diseases, 26(5), 1038-1040. https://doi.org/10.3201/eid2605.191201.

Hepatitis A Hospitalization Costs, United States, 2017 [PDF - 229 KB - 2 pages]
M. G. Hofmeister et al.

The United States is in the midst of unprecedented person-to-person hepatitis A outbreaks. By using Healthcare Cost and Utilization Project data, we estimated the average costs per hepatitis A–related hospitalization in 2017. These estimates can guide investment in outbreak prevention efforts to stop the spread of this vaccine-preventable disease.

EID Hofmeister MG, Yin S, Aslam MV, Teshale EH, Spradling PR. Hepatitis A Hospitalization Costs, United States, 2017. Emerg Infect Dis. 2020;26(5):1040-1041. https://doi.org/10.3201/eid2605.191224
AMA Hofmeister MG, Yin S, Aslam MV, et al. Hepatitis A Hospitalization Costs, United States, 2017. Emerging Infectious Diseases. 2020;26(5):1040-1041. doi:10.3201/eid2605.191224.
APA Hofmeister, M. G., Yin, S., Aslam, M. V., Teshale, E. H., & Spradling, P. R. (2020). Hepatitis A Hospitalization Costs, United States, 2017. Emerging Infectious Diseases, 26(5), 1040-1041. https://doi.org/10.3201/eid2605.191224.

Crimean-Congo Hemorrhagic Fever Virus Antibodies among Livestock on Corsica, France, 2014–2016 [PDF - 1.30 MB - 4 pages]
S. Grech-Angelini et al.

We conducted a serologic survey for Crimean-Congo hemorrhagic fever virus antibodies in livestock (cattle, sheep, and goats; N = 3,890) on Corsica (island of France) during 2014–2016. Overall, 9.1% of animals were seropositive, suggesting this virus circulates on Corsica. However, virus identification is needed to confirm these results.

EID Grech-Angelini S, Lancelot R, Ferraris O, Peyrefitte C, Vachiery N, Pédarrieu A, et al. Crimean-Congo Hemorrhagic Fever Virus Antibodies among Livestock on Corsica, France, 2014–2016. Emerg Infect Dis. 2020;26(5):1041-1044. https://doi.org/10.3201/eid2605.191465
AMA Grech-Angelini S, Lancelot R, Ferraris O, et al. Crimean-Congo Hemorrhagic Fever Virus Antibodies among Livestock on Corsica, France, 2014–2016. Emerging Infectious Diseases. 2020;26(5):1041-1044. doi:10.3201/eid2605.191465.
APA Grech-Angelini, S., Lancelot, R., Ferraris, O., Peyrefitte, C., Vachiery, N., Pédarrieu, A....Vial, L. (2020). Crimean-Congo Hemorrhagic Fever Virus Antibodies among Livestock on Corsica, France, 2014–2016. Emerging Infectious Diseases, 26(5), 1041-1044. https://doi.org/10.3201/eid2605.191465.

Rise in Murine Typhus in Galveston County, Texas, USA, 2018 [PDF - 330 KB - 3 pages]
K. Ruiz et al.

Murine typhus, an undifferentiated febrile illness caused by Rickettsia typhi, is increasing in prevalence and distribution throughout Texas. In 2018, a total of 40 cases of murine typhus were reported in Galveston County. This increase, unprecedented since the 1940s, highlights the importance of awareness by physicians and public health officials.

EID Ruiz K, Valcin R, Keiser P, Blanton LS. Rise in Murine Typhus in Galveston County, Texas, USA, 2018. Emerg Infect Dis. 2020;26(5):1044-1046. https://doi.org/10.3201/eid2605.191505
AMA Ruiz K, Valcin R, Keiser P, et al. Rise in Murine Typhus in Galveston County, Texas, USA, 2018. Emerging Infectious Diseases. 2020;26(5):1044-1046. doi:10.3201/eid2605.191505.
APA Ruiz, K., Valcin, R., Keiser, P., & Blanton, L. S. (2020). Rise in Murine Typhus in Galveston County, Texas, USA, 2018. Emerging Infectious Diseases, 26(5), 1044-1046. https://doi.org/10.3201/eid2605.191505.

Human Adenovirus 7d Strains Associated with Influenza-Like Illness, New York, USA, 2017–2019 [PDF - 378 KB - 3 pages]
D. M. Lamson et al.

Human adenovirus 7d is a respiratory pathogen capable of causing acute respiratory disease of variable severity. Phylogenetic analysis of whole-genome sequences of 15 strains isolated from cases of influenza-like-illness during 2017–2019 demonstrated the circulation of 2 distinct clades of genomic variant 7d in colleges in New York, USA.

EID Lamson DM, Kajon A, Popowich M, Fuschino M, St. George K. Human Adenovirus 7d Strains Associated with Influenza-Like Illness, New York, USA, 2017–2019. Emerg Infect Dis. 2020;26(5):1047-1049. https://doi.org/10.3201/eid2605.200116
AMA Lamson DM, Kajon A, Popowich M, et al. Human Adenovirus 7d Strains Associated with Influenza-Like Illness, New York, USA, 2017–2019. Emerging Infectious Diseases. 2020;26(5):1047-1049. doi:10.3201/eid2605.200116.
APA Lamson, D. M., Kajon, A., Popowich, M., Fuschino, M., & St. George, K. (2020). Human Adenovirus 7d Strains Associated with Influenza-Like Illness, New York, USA, 2017–2019. Emerging Infectious Diseases, 26(5), 1047-1049. https://doi.org/10.3201/eid2605.200116.

Risk for Transportation of Coronavirus Disease from Wuhan to Other Cities in China [PDF - 779 KB - 4 pages]
Z. Du et al.

On January 23, 2020, China quarantined Wuhan to contain coronavirus disease (COVID-19). We estimated the probability of transportation of COVID-19 from Wuhan to 369 other cities in China before the quarantine. Expected COVID-19 risk is >50% in 130 (95% CI 89–190) cities and >99% in the 4 largest metropolitan areas.

EID Du Z, Wang L, Cauchemez S, Xu X, Wang X, Cowling BJ, et al. Risk for Transportation of Coronavirus Disease from Wuhan to Other Cities in China. Emerg Infect Dis. 2020;26(5):1049-1052. https://doi.org/10.3201/eid2605.200146
AMA Du Z, Wang L, Cauchemez S, et al. Risk for Transportation of Coronavirus Disease from Wuhan to Other Cities in China. Emerging Infectious Diseases. 2020;26(5):1049-1052. doi:10.3201/eid2605.200146.
APA Du, Z., Wang, L., Cauchemez, S., Xu, X., Wang, X., Cowling, B. J....Meyers, L. (2020). Risk for Transportation of Coronavirus Disease from Wuhan to Other Cities in China. Emerging Infectious Diseases, 26(5), 1049-1052. https://doi.org/10.3201/eid2605.200146.

Potential Presymptomatic Transmission of SARS-CoV-2, Zhejiang Province, China, 2020 [PDF - 2.35 MB - 3 pages]
Z. Tong et al.

We report a 2-family cluster of persons infected with severe acute respiratory syndrome coronavirus 2 in the city of Zhoushan, Zhejiang Province, China, during January 2020. The infections resulted from contact with an infected but potentially presymptomatic traveler from the city of Wuhan in Hubei Province.

EID Tong Z, Tang A, Li K, Li P, Wang H, Yi J, et al. Potential Presymptomatic Transmission of SARS-CoV-2, Zhejiang Province, China, 2020. Emerg Infect Dis. 2020;26(5):1052-1054. https://doi.org/10.3201/eid2605.200198
AMA Tong Z, Tang A, Li K, et al. Potential Presymptomatic Transmission of SARS-CoV-2, Zhejiang Province, China, 2020. Emerging Infectious Diseases. 2020;26(5):1052-1054. doi:10.3201/eid2605.200198.
APA Tong, Z., Tang, A., Li, K., Li, P., Wang, H., Yi, J....Yan, J. (2020). Potential Presymptomatic Transmission of SARS-CoV-2, Zhejiang Province, China, 2020. Emerging Infectious Diseases, 26(5), 1052-1054. https://doi.org/10.3201/eid2605.200198.
Books and Media

Superbugs: The Race to Stop an Epidemic [PDF - 325 KB - 1 page]
A. F. Read
EID Read AF. Superbugs: The Race to Stop an Epidemic. Emerg Infect Dis. 2020;26(5):1055. https://doi.org/10.3201/eid2605.191717
AMA Read AF. Superbugs: The Race to Stop an Epidemic. Emerging Infectious Diseases. 2020;26(5):1055. doi:10.3201/eid2605.191717.
APA Read, A. F. (2020). Superbugs: The Race to Stop an Epidemic. Emerging Infectious Diseases, 26(5), 1055. https://doi.org/10.3201/eid2605.191717.
About the Cover

Auspicious Symbols of Rank and Status [PDF - 2.28 MB - 2 pages]
B. Breedlove and I. Fung
EID Breedlove B, Fung I. Auspicious Symbols of Rank and Status. Emerg Infect Dis. 2020;26(5):1056-1057. https://doi.org/10.3201/eid2605.ac2605
AMA Breedlove B, Fung I. Auspicious Symbols of Rank and Status. Emerging Infectious Diseases. 2020;26(5):1056-1057. doi:10.3201/eid2605.ac2605.
APA Breedlove, B., & Fung, I. (2020). Auspicious Symbols of Rank and Status. Emerging Infectious Diseases, 26(5), 1056-1057. https://doi.org/10.3201/eid2605.ac2605.
Etymologia

Etymologia: Coronavirus [PDF - 507 KB - 1 page]
R. Henry
EID Henry R. Etymologia: Coronavirus. Emerg Infect Dis. 2020;26(5):1027. https://doi.org/10.3201/eid2605.et2605
AMA Henry R. Etymologia: Coronavirus. Emerging Infectious Diseases. 2020;26(5):1027. doi:10.3201/eid2605.et2605.
APA Henry, R. (2020). Etymologia: Coronavirus. Emerging Infectious Diseases, 26(5), 1027. https://doi.org/10.3201/eid2605.et2605.
Page created: May 11, 2020
Page updated: May 11, 2020
Page reviewed: May 11, 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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