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Issue Cover for Volume 26, Number 9—September 2020

Volume 26, Number 9—September 2020

[PDF - 14.46 MB - 344 pages]

Perspective

Disparate Effects of Invasive Group A Streptococcus on Native Americans [PDF - 364 KB - 7 pages]
R. M. Close and J. B. McAuley

Active surveillance of invasive group A Streptococcus (iGAS) disease indicates that its incidence in the US general population is low, but limited studies show rates for American Indians and Alaska Natives (AI/AN) are severalfold higher. Major disparities in rates of iGAS exist between Indigenous and non-Indigenous populations of Australia, New Zealand, and Canada, but much less is understood about iGAS among AI/AN in the United States. Although complex host–pathogen interactions influence the rates of iGAS, including strain variation and virulence, the number and type of concurrent conditions, and socioeconomic status, the relative contribution of each remains unclear. We highlight the poor correlation between the substantial effect of iGAS among Indigenous persons in industrialized countries and the current understanding of factors that influence iGAS disease in these populations. Prospective, large-scale, population-based studies of iGAS are needed that include AI/AN as a necessary first step to understanding the effects of iGAS.

EID Close RM, McAuley JB. Disparate Effects of Invasive Group A Streptococcus on Native Americans. Emerg Infect Dis. 2020;26(9):1971-1977. https://doi.org/10.3201/eid2609.181169
AMA Close RM, McAuley JB. Disparate Effects of Invasive Group A Streptococcus on Native Americans. Emerging Infectious Diseases. 2020;26(9):1971-1977. doi:10.3201/eid2609.181169.
APA Close, R. M., & McAuley, J. B. (2020). Disparate Effects of Invasive Group A Streptococcus on Native Americans. Emerging Infectious Diseases, 26(9), 1971-1977. https://doi.org/10.3201/eid2609.181169.

Seroepidemiologic Study Designs for Determining SARS-COV-2 Transmission and Immunity [PDF - 2.97 MB - 9 pages]
H. Clapham et al.

Serologic studies are crucial for clarifying dynamics of the coronavirus disease pandemic. Past work on serologic studies (e.g., during influenza pandemics) has made relevant contributions, but specific conditions of the current situation require adaptation. Although detection of antibodies to measure exposure, immunity, or both seems straightforward conceptually, numerous challenges exist in terms of sample collection, what the presence of antibodies actually means, and appropriate analysis and interpretation to account for test accuracy and sampling biases. Successful deployment of serologic studies depends on type and performance of serologic tests, population studied, use of adequate study designs, and appropriate analysis and interpretation of data. We highlight key questions that serologic studies can help answer at different times, review strengths and limitations of different assay types and study designs, and discuss methods for rapid sharing and analysis of serologic data to determine global transmission of severe acute respiratory syndrome coronavirus 2.

EID Clapham H, Hay J, Routledge I, Takahashi S, Choisy M, Cummings D, et al. Seroepidemiologic Study Designs for Determining SARS-COV-2 Transmission and Immunity. Emerg Infect Dis. 2020;26(9):1978-1986. https://doi.org/10.3201/eid2609.201840
AMA Clapham H, Hay J, Routledge I, et al. Seroepidemiologic Study Designs for Determining SARS-COV-2 Transmission and Immunity. Emerging Infectious Diseases. 2020;26(9):1978-1986. doi:10.3201/eid2609.201840.
APA Clapham, H., Hay, J., Routledge, I., Takahashi, S., Choisy, M., Cummings, D....Tam, C. C. (2020). Seroepidemiologic Study Designs for Determining SARS-COV-2 Transmission and Immunity. Emerging Infectious Diseases, 26(9), 1978-1986. https://doi.org/10.3201/eid2609.201840.
Synopses

Polyclonal Burkholderia cepacia Complex Outbreak in Peritoneal Dialysis Patients Caused by Contaminated Aqueous Chlorhexidine [PDF - 1.36 MB - 11 pages]
S. Wong et al.

Whether Burkholderia cepacia complex should be an objectionable organism in antiseptic solutions with acceptable total bacterial counts is controversial. By using next-generation sequencing, we documented a polyclonal B. cepacia complex outbreak affecting peritoneal dialysis patients in Hong Kong that was caused by contaminated chlorhexidine solutions. Epidemiologic investigations at a manufacturing site identified a semiautomated packaging machine as the probable source of contamination in some of the brands. Use of whole-genome sequencing differentiated the isolates into 3 brand-specific clonal types. Changes in exit site care recommendations, rapid recall of affected products, and tightening of regulatory control for chlorhexidine-containing skin antiseptics could prevent future similar outbreaks. Environmental opportunistic pathogens, including B. cepacia complex, might be included in regular surveillance as indicator organisms for monitoring environmental contamination.

EID Wong S, Wong S, Chen J, Poon R, Hung D, Chiu K, et al. Polyclonal Burkholderia cepacia Complex Outbreak in Peritoneal Dialysis Patients Caused by Contaminated Aqueous Chlorhexidine. Emerg Infect Dis. 2020;26(9):1987-1997. https://doi.org/10.3201/eid2609.191746
AMA Wong S, Wong S, Chen J, et al. Polyclonal Burkholderia cepacia Complex Outbreak in Peritoneal Dialysis Patients Caused by Contaminated Aqueous Chlorhexidine. Emerging Infectious Diseases. 2020;26(9):1987-1997. doi:10.3201/eid2609.191746.
APA Wong, S., Wong, S., Chen, J., Poon, R., Hung, D., Chiu, K....Cheng, V. (2020). Polyclonal Burkholderia cepacia Complex Outbreak in Peritoneal Dialysis Patients Caused by Contaminated Aqueous Chlorhexidine. Emerging Infectious Diseases, 26(9), 1987-1997. https://doi.org/10.3201/eid2609.191746.

Severe Acute Respiratory Syndrome Coronavirus 2 Prevalence, Seroprevalence, and Exposure among Evacuees from Wuhan, China, 2020 [PDF - 455 KB - 7 pages]
B. D. Hallowell et al.

To determine prevalence of, seroprevalence of, and potential exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among a cohort of evacuees returning to the United States from Wuhan, China, in January 2020, we conducted a cross-sectional study of quarantined evacuees from 1 repatriation flight. Overall, 193 of 195 evacuees completed exposure surveys and submitted upper respiratory or serum specimens or both at arrival in the United States. Nearly all evacuees had taken preventive measures to limit potential exposure while in Wuhan, and none had detectable SARS-CoV-2 in upper respiratory tract specimens, suggesting the absence of asymptomatic respiratory shedding among this group at the time of testing. Evidence of antibodies to SARS-CoV-2 was detected in 1 evacuee, who reported experiencing no symptoms or high-risk exposures in the previous 2 months. These findings demonstrated that this group of evacuees posed a low risk of introducing SARS-CoV-2 to the United States.

EID Hallowell BD, Carlson CM, Jacobs JR, Pomeroy M, Steinberg J, Tenforde MW, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Prevalence, Seroprevalence, and Exposure among Evacuees from Wuhan, China, 2020. Emerg Infect Dis. 2020;26(9):1998-2004. https://doi.org/10.3201/eid2609.201590
AMA Hallowell BD, Carlson CM, Jacobs JR, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Prevalence, Seroprevalence, and Exposure among Evacuees from Wuhan, China, 2020. Emerging Infectious Diseases. 2020;26(9):1998-2004. doi:10.3201/eid2609.201590.
APA Hallowell, B. D., Carlson, C. M., Jacobs, J. R., Pomeroy, M., Steinberg, J., Tenforde, M. W....Killerby, M. E. (2020). Severe Acute Respiratory Syndrome Coronavirus 2 Prevalence, Seroprevalence, and Exposure among Evacuees from Wuhan, China, 2020. Emerging Infectious Diseases, 26(9), 1998-2004. https://doi.org/10.3201/eid2609.201590.

Pathology and Pathogenesis of SARS-CoV-2 Associated with Fatal Coronavirus Disease, United States [PDF - 6.00 MB - 11 pages]
R. B. Martines et al.

An ongoing pandemic of coronavirus disease (COVID-19) is caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Characterization of the histopathology and cellular localization of SARS-CoV-2 in the tissues of patients with fatal COVID-19 is critical to further understand its pathogenesis and transmission and for public health prevention measures. We report clinicopathologic, immunohistochemical, and electron microscopic findings in tissues from 8 fatal laboratory-confirmed cases of SARS-CoV-2 infection in the United States. All cases except 1 were in residents of long-term care facilities. In these patients, SARS-CoV-2 infected epithelium of the upper and lower airways with diffuse alveolar damage as the predominant pulmonary pathology. SARS-CoV-2 was detectable by immunohistochemistry and electron microscopy in conducting airways, pneumocytes, alveolar macrophages, and a hilar lymph node but was not identified in other extrapulmonary tissues. Respiratory viral co-infections were identified in 3 cases; 3 cases had evidence of bacterial co-infection.

EID Martines RB, Ritter JM, Matkovic E, Gary J, Bollweg BC, Bullock H, et al. Pathology and Pathogenesis of SARS-CoV-2 Associated with Fatal Coronavirus Disease, United States. Emerg Infect Dis. 2020;26(9):2005-2015. https://doi.org/10.3201/eid2609.202095
AMA Martines RB, Ritter JM, Matkovic E, et al. Pathology and Pathogenesis of SARS-CoV-2 Associated with Fatal Coronavirus Disease, United States. Emerging Infectious Diseases. 2020;26(9):2005-2015. doi:10.3201/eid2609.202095.
APA Martines, R. B., Ritter, J. M., Matkovic, E., Gary, J., Bollweg, B. C., Bullock, H....Zaki, S. R. (2020). Pathology and Pathogenesis of SARS-CoV-2 Associated with Fatal Coronavirus Disease, United States. Emerging Infectious Diseases, 26(9), 2005-2015. https://doi.org/10.3201/eid2609.202095.

Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020 [PDF - 1.08 MB - 6 pages]
K. Benameur et al.

There are few detailed investigations of neurologic complications in severe acute respiratory syndrome coronavirus 2 infection. We describe 3 patients with laboratory-confirmed coronavirus disease who had encephalopathy and encephalitis develop. Neuroimaging showed nonenhancing unilateral, bilateral, and midline changes not readily attributable to vascular causes. All 3 patients had increased cerebrospinal fluid (CSF) levels of anti-S1 IgM. One patient who died also had increased levels of anti-envelope protein IgM. CSF analysis also showed markedly increased levels of interleukin (IL)-6, IL-8, and IL-10, but severe acute respiratory syndrome coronavirus 2 was not identified in any CSF sample. These changes provide evidence of CSF periinfectious/postinfectious inflammatory changes during coronavirus disease with neurologic complications.

EID Benameur K, Agarwal A, Auld SC, Butters MP, Webster AS, Ozturk T, et al. Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020. Emerg Infect Dis. 2020;26(9):2016-2021. https://doi.org/10.3201/eid2609.202122
AMA Benameur K, Agarwal A, Auld SC, et al. Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020. Emerging Infectious Diseases. 2020;26(9):2016-2021. doi:10.3201/eid2609.202122.
APA Benameur, K., Agarwal, A., Auld, S. C., Butters, M. P., Webster, A. S., Ozturk, T....Hu, W. T. (2020). Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020. Emerging Infectious Diseases, 26(9), 2016-2021. https://doi.org/10.3201/eid2609.202122.

Medscape CME Activity
Invasive Infections with Nannizziopsis obscura Species Complex in 9 Patients from West Africa, France, 2004–2020 [PDF - 1.59 MB - 9 pages]
D. Garcia-Hermoso et al.

Nine new human invasive infections caused by the keratinophilic fungi Nannizziopsis obscura have been reported in France since 2004. The patients had variable clinical manifestations, had frequent dissemination, were mainly T-cell immunocompromised, and all originated from sub-Saharan West Africa. Before collection of the isolates, the etiologies of these infections were often misidentified, underscoring the extent of microscopic and cultural polymorphisms. All isolates but 1 had low MICs for the 8 antifungal drugs tested. When treated, patients received mainly azole therapy. Two of 7 patients with a known outcome died. We performed multilocus sequence analysis of N. obscura clinical strains and several strains of Nannizziopsis spp. isolated from reptiles. The human strains were clearly differentiated from the animal strains. N. obscura might be endemic to West Africa and responsible for undetected infections, which might become reactivated when immunosuppression occurs. N. obscura infection is probably underestimated because only sequencing enables proper identification.

EID Garcia-Hermoso D, Hamane S, Fekkar A, Jabet A, Denis B, Siguier M, et al. Invasive Infections with Nannizziopsis obscura Species Complex in 9 Patients from West Africa, France, 2004–2020. Emerg Infect Dis. 2020;26(9):2022-2030. https://doi.org/10.3201/eid2609.200276
AMA Garcia-Hermoso D, Hamane S, Fekkar A, et al. Invasive Infections with Nannizziopsis obscura Species Complex in 9 Patients from West Africa, France, 2004–2020. Emerging Infectious Diseases. 2020;26(9):2022-2030. doi:10.3201/eid2609.200276.
APA Garcia-Hermoso, D., Hamane, S., Fekkar, A., Jabet, A., Denis, B., Siguier, M....Bretagne, S. (2020). Invasive Infections with Nannizziopsis obscura Species Complex in 9 Patients from West Africa, France, 2004–2020. Emerging Infectious Diseases, 26(9), 2022-2030. https://doi.org/10.3201/eid2609.200276.

Saprochaete clavata Outbreak Infecting Cancer Center through Dishwasher [PDF - 1.31 MB - 8 pages]
E. Menu et al.

Saprochaete clavata is a pathogenic yeast responsible for rare outbreaks involving immunocompromised patients, especially those with hematologic malignancies. During February 2016–December 2017, we diagnosed S. clavata infections in 9 patients (8 with fungemia), including 3 within 1 month, at a cancer center in Marseille, France. The patients (median age 58 years), 4 of 9 of whom had acute myeloid leukemia, were hospitalized in 3 different wards. Ten environmental samples, including from 2 dishwashers and 4 pitchers, grew S. clavata, but no contaminated food was discovered. The outbreak ended after contaminated utensils and appliances were discarded. Whole-genome sequencing analysis demonstrated that all clinical and environmental isolates belonged to the same phylogenetic clade, which was unrelated to clades from previous S. clavata outbreaks in France. We identified a dishwasher with a deficient heating system as the vector of contamination.

EID Menu E, Criscuolo A, Desnos-Ollivier M, Cassagne C, D’Incan E, Furst S, et al. Saprochaete clavata Outbreak Infecting Cancer Center through Dishwasher. Emerg Infect Dis. 2020;26(9):2031-2038. https://doi.org/10.3201/eid2609.200341
AMA Menu E, Criscuolo A, Desnos-Ollivier M, et al. Saprochaete clavata Outbreak Infecting Cancer Center through Dishwasher. Emerging Infectious Diseases. 2020;26(9):2031-2038. doi:10.3201/eid2609.200341.
APA Menu, E., Criscuolo, A., Desnos-Ollivier, M., Cassagne, C., D’Incan, E., Furst, S....Dromer, F. (2020). Saprochaete clavata Outbreak Infecting Cancer Center through Dishwasher. Emerging Infectious Diseases, 26(9), 2031-2038. https://doi.org/10.3201/eid2609.200341.

Medscape CME Activity
Q Fever Osteoarticular Infection in Children [PDF - 1.15 MB - 7 pages]
H. Dabaja-Younis et al.

Q fever osteoarticular infection in children is an underestimated disease. We report 3 cases of Q fever osteomyelitis in children and review all cases reported in the literature through March 2018. A high index of suspicion is encouraged in cases of an unusual manifestation, prolonged course, relapsing symptoms, nonresolving or slowly resolving osteomyelitis, culture-negative osteomyelitis, or bone histopathology demonstrating granulomatous changes. Urban residence or lack of direct exposure to animals does not rule out infection. Diagnosis usually requires use of newer diagnostic modalities. Optimal antimicrobial therapy has not been well established; some case-patients may improve spontaneously or during treatment with a β-lactam. The etiology of treatment failure and relapse is not well understood, and tools for follow-up are lacking. Clinicians should be aware of these infections in children to guide optimal treatment, including choice of antimicrobial drugs, duration of therapy, and methods of monitoring response to treatment..

EID Dabaja-Younis H, Meir M, Ilivizki A, Militianu D, Eidelman M, Kassis I, et al. Q Fever Osteoarticular Infection in Children. Emerg Infect Dis. 2020;26(9):2039-2045. https://doi.org/10.3201/eid2609.191360
AMA Dabaja-Younis H, Meir M, Ilivizki A, et al. Q Fever Osteoarticular Infection in Children. Emerging Infectious Diseases. 2020;26(9):2039-2045. doi:10.3201/eid2609.191360.
APA Dabaja-Younis, H., Meir, M., Ilivizki, A., Militianu, D., Eidelman, M., Kassis, I....Shachor-Meyouhas, Y. (2020). Q Fever Osteoarticular Infection in Children. Emerging Infectious Diseases, 26(9), 2039-2045. https://doi.org/10.3201/eid2609.191360.

Web-Based Interactive Tool to Identify Facilities at Risk of Receiving Patients with Multidrug-Resistant Organisms [PDF - 1.56 MB - 8 pages]
R. Octaria et al.

To identify facilities at risk of receiving patients colonized or infected with multidrug-resistant organisms (MDROs), we developed an interactive web-based interface for visualization of patient-sharing networks among healthcare facilities in Tennessee, USA. Using hospital discharge data and the Centers for Medicare and Medicaid Services’ claims and Minimum Data Set, we constructed networks among hospitals and skilled nursing facilities. Networks included direct and indirect transfers, which accounted for <365 days in the community outside of facility admissions. Authorized users can visualize a facility of interest and tailor visualizations by year, network dataset, length of time in the community, and minimum number of transfers. The interface visualizes the facility of interest with its connected facilities that receive or send patients, the number of interfacility transfers, and facilities at risk of receiving transfers from the facility of interest. This tool will help other health departments enhance their MDRO outbreak responses.

EID Octaria R, Chan A, Wolford H, Devasia R, Moon TD, Zhu Y, et al. Web-Based Interactive Tool to Identify Facilities at Risk of Receiving Patients with Multidrug-Resistant Organisms. Emerg Infect Dis. 2020;26(9):2046-2053. https://doi.org/10.3201/eid2609.191691
AMA Octaria R, Chan A, Wolford H, et al. Web-Based Interactive Tool to Identify Facilities at Risk of Receiving Patients with Multidrug-Resistant Organisms. Emerging Infectious Diseases. 2020;26(9):2046-2053. doi:10.3201/eid2609.191691.
APA Octaria, R., Chan, A., Wolford, H., Devasia, R., Moon, T. D., Zhu, Y....Kainer, M. A. (2020). Web-Based Interactive Tool to Identify Facilities at Risk of Receiving Patients with Multidrug-Resistant Organisms. Emerging Infectious Diseases, 26(9), 2046-2053. https://doi.org/10.3201/eid2609.191691.
Research

Isolation, Sequence, Infectivity, and Replication Kinetics of Severe Acute Respiratory Syndrome Coronavirus 2 [PDF - 3.64 MB - 10 pages]
A. Banerjee et al.

Since its emergence in Wuhan, China, in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected ≈6 million persons worldwide. As SARS-CoV-2 spreads across the planet, we explored the range of human cells that can be infected by this virus. We isolated SARS-CoV-2 from 2 infected patients in Toronto, Canada; determined the genomic sequences; and identified single-nucleotide changes in representative populations of our virus stocks. We also tested a wide range of human immune cells for productive infection with SARS-CoV-2. We confirm that human primary peripheral blood mononuclear cells are not permissive for SARS-CoV-2. As SARS-CoV-2 continues to spread globally, it is essential to monitor single-nucleotide polymorphisms in the virus and to continue to isolate circulating viruses to determine viral genotype and phenotype by using in vitro and in vivo infection models.

EID Banerjee A, Nasir JA, Budylowski P, Yip L, Aftanas P, Christie N, et al. Isolation, Sequence, Infectivity, and Replication Kinetics of Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis. 2020;26(9):2054-2063. https://doi.org/10.3201/eid2609.201495
AMA Banerjee A, Nasir JA, Budylowski P, et al. Isolation, Sequence, Infectivity, and Replication Kinetics of Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases. 2020;26(9):2054-2063. doi:10.3201/eid2609.201495.
APA Banerjee, A., Nasir, J. A., Budylowski, P., Yip, L., Aftanas, P., Christie, N....Mubareka, S. (2020). Isolation, Sequence, Infectivity, and Replication Kinetics of Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases, 26(9), 2054-2063. https://doi.org/10.3201/eid2609.201495.

Evaluation of World Health Organization–Recommended Hand Hygiene Formulations [PDF - 689 KB - 5 pages]
M. Suchomel et al.

As a result of the coronavirus disease pandemic, commercial hand hygiene products have become scarce and World Health Organization (WHO) alcohol-based hand rub formulations containing ethanol or isopropanol are being produced for hospitals worldwide. Neither WHO formulation meets European Norm 12791, the basis for approval as a surgical hand preparation, nor satisfies European Norm 1500, the basis for approval as a hygienic hand rub. We evaluated the efficacy of modified formulations with alcohol concentrations in mass instead of volume percentage and glycerol concentrations of 0.5% instead of 1.45%. Both modified formulations met standard requirements for a 3-minute surgical hand preparation, the usual duration of surgical hand treatment in most hospitals in Europe. Contrary to the originally proposed WHO hand rub formulations, both modified formulations are appropriate for surgical hand preparation after 3 minutes when alcohol concentrations of 80% wt/wt ethanol or 75% wt/wt isopropanol along with reduced glycerol concentration (0.5%) are used.

EID Suchomel M, Eggers M, Maier S, Kramer A, Dancer SJ, Pittet D. Evaluation of World Health Organization–Recommended Hand Hygiene Formulations. Emerg Infect Dis. 2020;26(9):2064-2068. https://doi.org/10.3201/eid2609.201761
AMA Suchomel M, Eggers M, Maier S, et al. Evaluation of World Health Organization–Recommended Hand Hygiene Formulations. Emerging Infectious Diseases. 2020;26(9):2064-2068. doi:10.3201/eid2609.201761.
APA Suchomel, M., Eggers, M., Maier, S., Kramer, A., Dancer, S. J., & Pittet, D. (2020). Evaluation of World Health Organization–Recommended Hand Hygiene Formulations. Emerging Infectious Diseases, 26(9), 2064-2068. https://doi.org/10.3201/eid2609.201761.

Retrospective Description of Pregnant Women Infected with Severe Acute Respiratory Syndrome Coronavirus 2, France [PDF - 566 KB - 8 pages]
A. J. Vivanti et al.

Fix data are available on the management of pregnant women infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We conducted a retrospective study of 100 pregnant women with SARS-CoV-2 infection in 4 obstetric units in the Paris metropolitan area of France during March 12–April 13, 2020. Among patients, 52 (52%) were hospitalized, 10 (10%) in intensive care units (ICUs). Women with higher body mass indexes (BMIs; median 30.7 kg/m2) were more likely to be hospitalized in ICUs than other women (median BMI 26.2 kg/m2). Women hospitalized in ICUs had lower lymphocyte count at diagnosis (median 0.77 × 109 cells/L) than women not hospitalized in ICUs (median lymphocyte count 1.15 × 109 cells/L). All women requiring oxygen >5 L/min were intubated. Clinical and laboratory evaluation of SARS-CoV–2−positive pregnant women at the time of diagnosis can identify patients at risk for ICU hospitalization.

EID Vivanti AJ, Mattern J, Vauloup-Fellous C, Jani J, Rigonnot L, El Hachem L, et al. Retrospective Description of Pregnant Women Infected with Severe Acute Respiratory Syndrome Coronavirus 2, France. Emerg Infect Dis. 2020;26(9):2069-2076. https://doi.org/10.3201/eid2609.202144
AMA Vivanti AJ, Mattern J, Vauloup-Fellous C, et al. Retrospective Description of Pregnant Women Infected with Severe Acute Respiratory Syndrome Coronavirus 2, France. Emerging Infectious Diseases. 2020;26(9):2069-2076. doi:10.3201/eid2609.202144.
APA Vivanti, A. J., Mattern, J., Vauloup-Fellous, C., Jani, J., Rigonnot, L., El Hachem, L....Cordier, A. (2020). Retrospective Description of Pregnant Women Infected with Severe Acute Respiratory Syndrome Coronavirus 2, France. Emerging Infectious Diseases, 26(9), 2069-2076. https://doi.org/10.3201/eid2609.202144.

Heterogeneity of Dengue Illness in Community-Based Prospective Study, Iquitos, Peru [PDF - 3.03 MB - 10 pages]
W. H. Elson et al.

Measuring heterogeneity of dengue illness is necessary to define suitable endpoints in dengue vaccine and therapeutic trials and will help clarify behavioral responses to illness. To quantify heterogeneity in dengue illness, including milder cases, we developed the Dengue Illness Perceptions Response (IPR) survey, which captured detailed symptom data, including intensity, duration, and character, and change in routine activities caused by illness. During 2016–2019, we collected IPR data daily during the acute phase of illness for 79 persons with a positive reverse transcription PCR result for dengue virus RNA. Most participants had mild ambulatory disease. However, we measured substantial heterogeneity in illness experience, symptom duration, and maximum reported intensity of individual symptoms. Symptom intensity was a more valuable predicter of major activity change during dengue illness than symptom presence or absence alone. These data suggest that the IPR measures clinically useful heterogeneity in dengue illness experience and its relation to altered human behavior.

EID Elson WH, Reiner RC, Siles C, Bazan I, Vilcarromero S, Riley-Powell AR, et al. Heterogeneity of Dengue Illness in Community-Based Prospective Study, Iquitos, Peru. Emerg Infect Dis. 2020;26(9):2077-2086. https://doi.org/10.3201/eid2609.191472
AMA Elson WH, Reiner RC, Siles C, et al. Heterogeneity of Dengue Illness in Community-Based Prospective Study, Iquitos, Peru. Emerging Infectious Diseases. 2020;26(9):2077-2086. doi:10.3201/eid2609.191472.
APA Elson, W. H., Reiner, R. C., Siles, C., Bazan, I., Vilcarromero, S., Riley-Powell, A. R....Paz-Soldan, V. A. (2020). Heterogeneity of Dengue Illness in Community-Based Prospective Study, Iquitos, Peru. Emerging Infectious Diseases, 26(9), 2077-2086. https://doi.org/10.3201/eid2609.191472.

Association of Biosecurity and Hygiene Practices with Environmental Contamination with Influenza A Viruses in Live Bird Markets, Bangladesh [PDF - 891 KB - 10 pages]
S. Chowdhury et al.

In Bangladesh, live bird market environments are frequently contaminated with avian influenza viruses. Shop-level biosecurity practices might increase risk for environmental contamination. We sought to determine which shop-level biosecurity practices were associated with environmental contamination. We surveyed 800 poultry shops to describe biosecurity practices and collect environmental samples. Samples from 205 (26%) shops were positive for influenza A viral RNA, 108 (14%) for H9, and 60 (8%) for H5. Shops that slaughtered poultry, kept poultry overnight, remained open without rest days, had uneven muddy floors, held poultry on the floor, and housed sick and healthy poultry together were more frequently positive for influenza A viruses. Reported monthly cleaning seemed protective, but disinfection practices were not otherwise associated with influenza A virus detection. Slaughtering, keeping poultry overnight, weekly rest days, infrastructure, and disinfection practices could be targets for interventions to reduce environmental contamination.

EID Chowdhury S, Azziz-Baumgartner E, Kile JC, Hoque M, Rahman MZ, Hossain M, et al. Association of Biosecurity and Hygiene Practices with Environmental Contamination with Influenza A Viruses in Live Bird Markets, Bangladesh. Emerg Infect Dis. 2020;26(9):2087-2096. https://doi.org/10.3201/eid2609.191029
AMA Chowdhury S, Azziz-Baumgartner E, Kile JC, et al. Association of Biosecurity and Hygiene Practices with Environmental Contamination with Influenza A Viruses in Live Bird Markets, Bangladesh. Emerging Infectious Diseases. 2020;26(9):2087-2096. doi:10.3201/eid2609.191029.
APA Chowdhury, S., Azziz-Baumgartner, E., Kile, J. C., Hoque, M., Rahman, M. Z., Hossain, M....Gurley, E. S. (2020). Association of Biosecurity and Hygiene Practices with Environmental Contamination with Influenza A Viruses in Live Bird Markets, Bangladesh. Emerging Infectious Diseases, 26(9), 2087-2096. https://doi.org/10.3201/eid2609.191029.

Costs Associated with Nontuberculous Mycobacteria Infection, Ontario, Canada, 2001–2012 [PDF - 1.37 MB - 11 pages]
L. C. Ramsay et al.

To determine incidence-based healthcare costs attributable to nontuberculous mycobacterial (NTM) pulmonary disease (PD) and NTM pulmonary isolation (PI), from the healthcare payer perspective, we conducted a population-based matched cohort study in Ontario, Canada. We established cohorts of patients with incident NTM-PD and NTM-PI during 2001–2012 by using individually linked laboratory data and health administrative data, matched to unexposed persons from the general population. To estimate attributable costs for acute and long-term illness, we used a phase-of-care approach. Costs were stratified by age, sex, and healthcare resource, and reported in 2018 Canadian dollars (CAD) and US dollars (USD), standardized to 10 days. Costs were highest during the before-death phase (NTM-PD CAD $1,352 [USD $1,044]; NTM-PI CAD $731 [USD $565]). The cumulative mean attributable 1-year costs were CAD $14,953 (USD $11,541) for NTM-PD and CAD $8,729 (USD $6,737) for NTM-PI. Costs for patients with NTM-PD and NTM-PI were higher than those for unexposed persons.

EID Ramsay LC, Shing E, Wang J, Marras TK, Kwong JC, Brode SK, et al. Costs Associated with Nontuberculous Mycobacteria Infection, Ontario, Canada, 2001–2012. Emerg Infect Dis. 2020;26(9):2097-2107. https://doi.org/10.3201/eid2609.190524
AMA Ramsay LC, Shing E, Wang J, et al. Costs Associated with Nontuberculous Mycobacteria Infection, Ontario, Canada, 2001–2012. Emerging Infectious Diseases. 2020;26(9):2097-2107. doi:10.3201/eid2609.190524.
APA Ramsay, L. C., Shing, E., Wang, J., Marras, T. K., Kwong, J. C., Brode, S. K....Sander, B. (2020). Costs Associated with Nontuberculous Mycobacteria Infection, Ontario, Canada, 2001–2012. Emerging Infectious Diseases, 26(9), 2097-2107. https://doi.org/10.3201/eid2609.190524.

No Change in Risk for Antibiotic-Resistant Salmonellosis from Beef, United States, 2002–2010 [PDF - 1.14 MB - 10 pages]
S. Costard et al.

Restricting antibiotic use in food production animals is a target for reducing antimicrobial drug–resistant infections in humans. We used US surveillance data to estimate the probability of antibiotic-resistant nontyphoidal salmonellosis per meal made with beef during 2002–2010. Applying data for nontyphoidal Salmonella in raised-without-antibiotics cattle, we tested the effect of removing antibiotic use from all beef cattle production. We found an average of 1.2 (95% credible interval 0.6–4.2) antibiotic-resistant nontyphoidal salmonellosis cases per 1 million beef meals made with beef initially contaminated with antibiotic-resistant nontyphoidal Salmonella at slaughter or retail and 0.031 (95% credible interval 0.00018–0.14) cases per 1 million meals irrespective of beef contamination status. Neither outcome showed sustained change except for increases in 2003 and 2009 (>98% confidence) when larger or more outbreaks occurred. Switching all beef production to a raised-without-antibiotics system may not have a significant effect on antibiotic-resistant nontyphoidal salmonellosis (94.3% confidence).

EID Costard S, Pouzou JG, Belk KE, Morley PS, Schmidt JW, Wheeler TL, et al. No Change in Risk for Antibiotic-Resistant Salmonellosis from Beef, United States, 2002–2010. Emerg Infect Dis. 2020;26(9):2108-2117. https://doi.org/10.3201/eid2609.190922
AMA Costard S, Pouzou JG, Belk KE, et al. No Change in Risk for Antibiotic-Resistant Salmonellosis from Beef, United States, 2002–2010. Emerging Infectious Diseases. 2020;26(9):2108-2117. doi:10.3201/eid2609.190922.
APA Costard, S., Pouzou, J. G., Belk, K. E., Morley, P. S., Schmidt, J. W., Wheeler, T. L....Zagmutt, F. J. (2020). No Change in Risk for Antibiotic-Resistant Salmonellosis from Beef, United States, 2002–2010. Emerging Infectious Diseases, 26(9), 2108-2117. https://doi.org/10.3201/eid2609.190922.

Detection of H1 Swine Influenza A Virus Antibodies in Human Serum Samples by Age Group [PDF - 1.58 MB - 11 pages]
E. Vandoorn et al.

Most H1 influenza A viruses (IAVs) of swine are derived from past human viruses. As human population immunity against these IAVs gradually decreases, the risk of reintroduction to humans increases. We examined 549 serum samples from persons 0–97 years of age collected in Belgium during 2017–2018 for hemagglutination inhibiting and virus neutralizing antibodies against 7 major H1 swine IAV (swIAV) clades and 3 human progenitor IAVs. Seroprevalence (titers >40) rates were >50% for classical swine and European human-like swIAVs, >24% for North American human-like δ1a and Asian avian-like swIAVs, and <10% for North American human-like δ1b and European avian-like swIAVs, but rates were age-dependent. Antibody titers against human-like swIAVs and supposed human precursor IAVs correlated with correlation coefficients of 0.30–0.86. Our serologic findings suggest that European avian-like, clade 1C.2.1, and North American human-like δ1b, clade 1B.2.2.2, H1 swIAVs pose the highest pandemic risk.

EID Vandoorn E, Leroux-Roels I, Leroux-Roels G, Parys A, Vincent A, Van Reeth K. Detection of H1 Swine Influenza A Virus Antibodies in Human Serum Samples by Age Group. Emerg Infect Dis. 2020;26(9):2118-2128. https://doi.org/10.3201/eid2609.191796
AMA Vandoorn E, Leroux-Roels I, Leroux-Roels G, et al. Detection of H1 Swine Influenza A Virus Antibodies in Human Serum Samples by Age Group. Emerging Infectious Diseases. 2020;26(9):2118-2128. doi:10.3201/eid2609.191796.
APA Vandoorn, E., Leroux-Roels, I., Leroux-Roels, G., Parys, A., Vincent, A., & Van Reeth, K. (2020). Detection of H1 Swine Influenza A Virus Antibodies in Human Serum Samples by Age Group. Emerging Infectious Diseases, 26(9), 2118-2128. https://doi.org/10.3201/eid2609.191796.

Incidence and Seroprevalence of Avian Influenza in a Cohort of Backyard Poultry Growers, Egypt, August 2015–March 2019 [PDF - 391 KB - 8 pages]
M. R. Gomaa et al.

Currently enzootic avian influenza H5N1, H9N2, and H5N8 viruses were introduced into poultry in Egypt in 2006, 2011, and 2016, respectively. Infections with H5N1 and H9N2 were reported among poultry-exposed humans. We followed 2,402 persons from households raising backyard poultry from 5 villages in Egypt during August 2015–March 2019. We collected demographic, exposure, and health condition data and annual serum samples from each participant and obtained swab samples from participants reporting influenza-like illness symptoms. We performed serologic and molecular analyses and detected 4 cases of infection with H5N1 and 3 cases with H9N2. We detected very low seroprevalence of H5N1 antibodies and no H5N8 antibodies among the cohort; up to 11% had H9 antibodies. None of the exposure, health status, or demographic variables were related to being seropositive. Our findings indicate that avian influenza remains a public health risk in Eqypt, but infections may go undetected because of their mild or asymptomatic nature.

EID Gomaa MR, El Rifay AS, Abu Zeid D, Elabd MA, Elabd E, Kandeil A, et al. Incidence and Seroprevalence of Avian Influenza in a Cohort of Backyard Poultry Growers, Egypt, August 2015–March 2019. Emerg Infect Dis. 2020;26(9):2129-2136. https://doi.org/10.3201/eid2609.200266
AMA Gomaa MR, El Rifay AS, Abu Zeid D, et al. Incidence and Seroprevalence of Avian Influenza in a Cohort of Backyard Poultry Growers, Egypt, August 2015–March 2019. Emerging Infectious Diseases. 2020;26(9):2129-2136. doi:10.3201/eid2609.200266.
APA Gomaa, M. R., El Rifay, A. S., Abu Zeid, D., Elabd, M. A., Elabd, E., Kandeil, A....Kayali, G. (2020). Incidence and Seroprevalence of Avian Influenza in a Cohort of Backyard Poultry Growers, Egypt, August 2015–March 2019. Emerging Infectious Diseases, 26(9), 2129-2136. https://doi.org/10.3201/eid2609.200266.

Risk-Based Estimate of Human Fungal Disease Burden, China [PDF - 1.59 MB - 11 pages]
L. Zhou et al.

We conducted a systematic literature review to obtain risk population–based fungal disease incidence or prevalence data from China. Data were categorized by risk factors and extrapolated by using most recent demographic figures. A total of 71,316,101 cases (5.0% of the population) were attributed to 12 risk factors and 17 fungal diseases. Excluding recurrent Candida vaginitis (4,057/100,000 women) and onychomycosis (2,600/100,000 persons), aspergillosis (317/100,000 persons) was the most common problem; prevalence exceeded that in most other countries. Cryptococcal meningitis, an opportunistic infection, occurs in immunocompetent persons almost twice as often as AIDS. The pattern of fungal infections also varies geographically; Talaromyces marneffei is distributed mainly in the Pearl River Basin, and the Yangtze River bears the greatest histoplasmosis burden. New host populations, new endemic patterns, and high fungal burdens in China, which caused a huge impact on public health, underscore the urgent need for building diagnostic and therapeutic capacity.

EID Zhou L, Jiang Y, Li R, Huang L, Yip C, Denning DW, et al. Risk-Based Estimate of Human Fungal Disease Burden, China. Emerg Infect Dis. 2020;26(9):2137-2147. https://doi.org/10.3201/eid2609.200016
AMA Zhou L, Jiang Y, Li R, et al. Risk-Based Estimate of Human Fungal Disease Burden, China. Emerging Infectious Diseases. 2020;26(9):2137-2147. doi:10.3201/eid2609.200016.
APA Zhou, L., Jiang, Y., Li, R., Huang, L., Yip, C., Denning, D. W....Zhu, L. (2020). Risk-Based Estimate of Human Fungal Disease Burden, China. Emerging Infectious Diseases, 26(9), 2137-2147. https://doi.org/10.3201/eid2609.200016.

Molecular Description of a Novel Orientia Species Causing Scrub Typhus in Chile [PDF - 1.91 MB - 9 pages]
K. Abarca et al.

Scrub typhus is a potentially fatal rickettsiosis caused by Orientia species intracellular bacteria of the genus Orientia. Although considered to be restricted to the Asia Pacific region, scrub typhus has recently been discovered in southern Chile. We analyzed Orientia gene sequences of 16S rRNA (rrs) and 47-kDa (htrA) from 18 scrub typhus patients from Chile. Sequences were ≥99.7% identical among the samples for both amplified genes. Their diversity was 3.1%–3.5% for rrs and 11.2%–11.8% for htrA compared with O. tsusugamushi and 3.0% for rrs and 14.8% for htrA compared with Candidatus Orientia chuto. Phylogenetic analyses of both genes grouped the specimens from Chile in a different clade from other Orientia species. Our results indicate that Orientia isolates from Chile constitute a novel species, which, until they are cultivated and fully characterized, we propose to designate as Candidatus Orientia chiloensis, after the Chiloé Archipelago where the pathogen was identified.

EID Abarca K, Martínez-Valdebenito C, Angulo J, Jiang J, Farris CM, Richards AL, et al. Molecular Description of a Novel Orientia Species Causing Scrub Typhus in Chile. Emerg Infect Dis. 2020;26(9):2148-2156. https://doi.org/10.3201/eid2609.200918
AMA Abarca K, Martínez-Valdebenito C, Angulo J, et al. Molecular Description of a Novel Orientia Species Causing Scrub Typhus in Chile. Emerging Infectious Diseases. 2020;26(9):2148-2156. doi:10.3201/eid2609.200918.
APA Abarca, K., Martínez-Valdebenito, C., Angulo, J., Jiang, J., Farris, C. M., Richards, A. L....Weitzel, T. (2020). Molecular Description of a Novel Orientia Species Causing Scrub Typhus in Chile. Emerging Infectious Diseases, 26(9), 2148-2156. https://doi.org/10.3201/eid2609.200918.
Dispatches

Clinicopathologic and Immunohistochemical Findings from Autopsy of Patient with COVID-19, Japan [PDF - 1.60 MB - 5 pages]
T. Adachi et al.

An autopsy of a patient in Japan with coronavirus disease indicated pneumonia lung pathology, manifested as diffuse alveolar damage. We detected severe acute respiratory syndrome coronavirus 2 antigen in alveolar epithelial cells and macrophages. Coronavirus disease is essentially a lower respiratory tract disease characterized by direct viral injury of alveolar epithelial cells.

EID Adachi T, Chong J, Nakajima N, Sano M, Yamazaki J, Miyamoto I, et al. Clinicopathologic and Immunohistochemical Findings from Autopsy of Patient with COVID-19, Japan. Emerg Infect Dis. 2020;26(9):2157-2161. https://doi.org/10.3201/eid2609.201353
AMA Adachi T, Chong J, Nakajima N, et al. Clinicopathologic and Immunohistochemical Findings from Autopsy of Patient with COVID-19, Japan. Emerging Infectious Diseases. 2020;26(9):2157-2161. doi:10.3201/eid2609.201353.
APA Adachi, T., Chong, J., Nakajima, N., Sano, M., Yamazaki, J., Miyamoto, I....Suzuki, T. (2020). Clinicopathologic and Immunohistochemical Findings from Autopsy of Patient with COVID-19, Japan. Emerging Infectious Diseases, 26(9), 2157-2161. https://doi.org/10.3201/eid2609.201353.

Detection of Severe Acute Respiratory Syndrome Coronavirus 2 RNA on Surfaces in Quarantine Rooms [PDF - 340 KB - 3 pages]
F. Jiang et al.

We investigated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination in 2 rooms of a quarantine hotel after 2 presymptomatic persons who stayed there were laboratory-confirmed as having coronavirus disease. We detected SARS-CoV-2 RNA on 8 (36%) of 22 surfaces, as well as on the pillow cover, sheet, and duvet cover.

EID Jiang F, Jiang X, Wang Z, Meng Z, Shao S, Anderson BD, et al. Detection of Severe Acute Respiratory Syndrome Coronavirus 2 RNA on Surfaces in Quarantine Rooms. Emerg Infect Dis. 2020;26(9):2162-2164. https://doi.org/10.3201/eid2609.201435
AMA Jiang F, Jiang X, Wang Z, et al. Detection of Severe Acute Respiratory Syndrome Coronavirus 2 RNA on Surfaces in Quarantine Rooms. Emerging Infectious Diseases. 2020;26(9):2162-2164. doi:10.3201/eid2609.201435.
APA Jiang, F., Jiang, X., Wang, Z., Meng, Z., Shao, S., Anderson, B. D....Ma, M. (2020). Detection of Severe Acute Respiratory Syndrome Coronavirus 2 RNA on Surfaces in Quarantine Rooms. Emerging Infectious Diseases, 26(9), 2162-2164. https://doi.org/10.3201/eid2609.201435.

Large Outbreak of Coronavirus Disease among Wedding Attendees, Jordan [PDF - 295 KB - 3 pages]
D. Yusef et al.

In March 2020, a wedding in Jordan led to a large outbreak of coronavirus disease (COVID-19). We collected data on 350 wedding attendees, 76 who of whom developed COVID-19. Our study shows high communicability of COVID-19 and the enormous risk for severe acute respiratory syndrome 2 virus transmission during mass gatherings.

EID Yusef D, Hayajneh W, Awad S, Momany S, Khassawneh B, Samrah S, et al. Large Outbreak of Coronavirus Disease among Wedding Attendees, Jordan. Emerg Infect Dis. 2020;26(9):2165-2167. https://doi.org/10.3201/eid2609.201469
AMA Yusef D, Hayajneh W, Awad S, et al. Large Outbreak of Coronavirus Disease among Wedding Attendees, Jordan. Emerging Infectious Diseases. 2020;26(9):2165-2167. doi:10.3201/eid2609.201469.
APA Yusef, D., Hayajneh, W., Awad, S., Momany, S., Khassawneh, B., Samrah, S....Qdaisat, R. (2020). Large Outbreak of Coronavirus Disease among Wedding Attendees, Jordan. Emerging Infectious Diseases, 26(9), 2165-2167. https://doi.org/10.3201/eid2609.201469.

Persistence of Severe Acute Respiratory Syndrome Coronavirus 2 in Aerosol Suspensions [PDF - 459 KB - 4 pages]
A. C. Fears et al.

We aerosolized severe acute respiratory syndrome coronavirus 2 and determined that its dynamic aerosol efficiency surpassed those of severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome. Although we performed experiment only once across several laboratories, our findings suggest retained infectivity and virion integrity for up to 16 hours in respirable-sized aerosols.

EID Fears AC, Klimstra WB, Duprex P, Hartman A, Weaver SC, Plante KS, et al. Persistence of Severe Acute Respiratory Syndrome Coronavirus 2 in Aerosol Suspensions. Emerg Infect Dis. 2020;26(9):2168-2171. https://doi.org/10.3201/eid2609.201806
AMA Fears AC, Klimstra WB, Duprex P, et al. Persistence of Severe Acute Respiratory Syndrome Coronavirus 2 in Aerosol Suspensions. Emerging Infectious Diseases. 2020;26(9):2168-2171. doi:10.3201/eid2609.201806.
APA Fears, A. C., Klimstra, W. B., Duprex, P., Hartman, A., Weaver, S. C., Plante, K. S....Roy, C. J. (2020). Persistence of Severe Acute Respiratory Syndrome Coronavirus 2 in Aerosol Suspensions. Emerging Infectious Diseases, 26(9), 2168-2171. https://doi.org/10.3201/eid2609.201806.

Updated Estimates of Chronic Conditions Affecting Risk for Complications from Coronavirus Disease, United States [PDF - 1.44 MB - 4 pages]
M. L. Adams et al.

We updated estimates of adults at risk for coronavirus disease complications on the basis of data for China by using recent US hospitalization data. This update to our previous publication substitutes obesity for cancer as an underlying condition and increases adults reporting any of the conditions from 45.4% to 56.0%.

EID Adams ML, Katz DL, Grandpre J. Updated Estimates of Chronic Conditions Affecting Risk for Complications from Coronavirus Disease, United States. Emerg Infect Dis. 2020;26(9):2172-2175. https://doi.org/10.3201/eid2609.202117
AMA Adams ML, Katz DL, Grandpre J. Updated Estimates of Chronic Conditions Affecting Risk for Complications from Coronavirus Disease, United States. Emerging Infectious Diseases. 2020;26(9):2172-2175. doi:10.3201/eid2609.202117.
APA Adams, M. L., Katz, D. L., & Grandpre, J. (2020). Updated Estimates of Chronic Conditions Affecting Risk for Complications from Coronavirus Disease, United States. Emerging Infectious Diseases, 26(9), 2172-2175. https://doi.org/10.3201/eid2609.202117.

Clusters of Coronavirus Disease in Communities, Japan, January–April 2020 [PDF - 1.06 MB - 4 pages]
Y. Furuse et al.

We analyzed 3,184 cases of coronavirus disease in Japan and identified 61 case-clusters in healthcare and other care facilities, restaurants and bars, workplaces, and music events. We also identified 22 probable primary case-patients for the clusters; most were 20–39 years of age and presymptomatic or asymptomatic at virus transmission.

EID Furuse Y, Sando E, Tsuchiya N, Miyahara R, Yasuda I, Ko YK, et al. Clusters of Coronavirus Disease in Communities, Japan, January–April 2020. Emerg Infect Dis. 2020;26(9):2176-2179. https://doi.org/10.3201/eid2609.202272
AMA Furuse Y, Sando E, Tsuchiya N, et al. Clusters of Coronavirus Disease in Communities, Japan, January–April 2020. Emerging Infectious Diseases. 2020;26(9):2176-2179. doi:10.3201/eid2609.202272.
APA Furuse, Y., Sando, E., Tsuchiya, N., Miyahara, R., Yasuda, I., Ko, Y. K....Oshitani, H. (2020). Clusters of Coronavirus Disease in Communities, Japan, January–April 2020. Emerging Infectious Diseases, 26(9), 2176-2179. https://doi.org/10.3201/eid2609.202272.

Toxigenic Corynebacterium diphtheriae–Associated Genital Ulceration [PDF - 283 KB - 2 pages]
F. Fuchs et al.

In October 2016, an adolescent boy sought care for acute genital ulceration in Cologne, Germany. We presumed a sexually transmitted infection, but initial diagnostic procedures yielded negative results. He was hospitalized because swab samples from the lesion grew toxigenic Corynebacterium diphtheriae, leading to the diagnosis of possibly sexually transmitted cutaneous diphtheria.

EID Fuchs F, Markert D, Wagner IV, Liebau MC, Berger A, Dangel A, et al. Toxigenic Corynebacterium diphtheriae–Associated Genital Ulceration. Emerg Infect Dis. 2020;26(9):2180-2181. https://doi.org/10.3201/eid2609.180830
AMA Fuchs F, Markert D, Wagner IV, et al. Toxigenic Corynebacterium diphtheriae–Associated Genital Ulceration. Emerging Infectious Diseases. 2020;26(9):2180-2181. doi:10.3201/eid2609.180830.
APA Fuchs, F., Markert, D., Wagner, I. V., Liebau, M. C., Berger, A., Dangel, A....Plum, G. (2020). Toxigenic Corynebacterium diphtheriae–Associated Genital Ulceration. Emerging Infectious Diseases, 26(9), 2180-2181. https://doi.org/10.3201/eid2609.180830.

Duration of Carbapenemase-Producing Enterobacteriaceae Carriage in Hospital Patients [PDF - 875 KB - 4 pages]
Y. Mo et al.

To determine the duration of carbapenemase-producing Enterobacteriaceae (CPE) carriage, we studied 21 CPE carriers for »1 year. Mean carriage duration was 86 days; probability of decolonization in 1 year was 98.5%, suggesting that CPE-carriers’ status can be reviewed yearly. Prolonged carriage was associated with use of antimicrobial drugs.

EID Mo Y, Hernandez-Koutoucheva A, Musicha P, Bertrand D, Lye D, Ng O, et al. Duration of Carbapenemase-Producing Enterobacteriaceae Carriage in Hospital Patients. Emerg Infect Dis. 2020;26(9):2182-2185. https://doi.org/10.3201/eid2609.190592
AMA Mo Y, Hernandez-Koutoucheva A, Musicha P, et al. Duration of Carbapenemase-Producing Enterobacteriaceae Carriage in Hospital Patients. Emerging Infectious Diseases. 2020;26(9):2182-2185. doi:10.3201/eid2609.190592.
APA Mo, Y., Hernandez-Koutoucheva, A., Musicha, P., Bertrand, D., Lye, D., Ng, O....Marimuthu, K. (2020). Duration of Carbapenemase-Producing Enterobacteriaceae Carriage in Hospital Patients. Emerging Infectious Diseases, 26(9), 2182-2185. https://doi.org/10.3201/eid2609.190592.

Chromobacterium haemolyticum Pneumonia Associated with Near-Drowning and River Water, Japan [PDF - 1.72 MB - 4 pages]
H. Kanamori et al.

We report a severe case of Chromobacterium haemolyticum pneumonia associated with near-drowning and detail the investigation of the pathogen and river water. Our genomic and environmental investigation demonstrated that river water in a temperate region can be a source of C. haemolyticum causing human infections.

EID Kanamori H, Aoyagi T, Kuroda M, Sekizuka T, Katsumi M, Ishikawa K, et al. Chromobacterium haemolyticum Pneumonia Associated with Near-Drowning and River Water, Japan. Emerg Infect Dis. 2020;26(9):2186-2189. https://doi.org/10.3201/eid2609.190670
AMA Kanamori H, Aoyagi T, Kuroda M, et al. Chromobacterium haemolyticum Pneumonia Associated with Near-Drowning and River Water, Japan. Emerging Infectious Diseases. 2020;26(9):2186-2189. doi:10.3201/eid2609.190670.
APA Kanamori, H., Aoyagi, T., Kuroda, M., Sekizuka, T., Katsumi, M., Ishikawa, K....Kaku, M. (2020). Chromobacterium haemolyticum Pneumonia Associated with Near-Drowning and River Water, Japan. Emerging Infectious Diseases, 26(9), 2186-2189. https://doi.org/10.3201/eid2609.190670.

Anicteric Leptospirosis-Associated Meningitis in a Tropical Urban Environment, Brazil [PDF - 347 KB - 3 pages]
S. A. Nabity et al.

While studying aseptic meningitis in Salvador, Brazil, we diagnosed anicteric leptospirosis in 1.7% (5/295) of patients hospitalized for aseptic meningitis. Leptospirosis-associated meningitis patients had lower mean cerebrospinal fluid cell counts and protein than other-cause aseptic meningitis (p<0.05). Clinicians must consider leptospirosis-associated meningitis in appropriate clinical-epidemiologic contexts.

EID Nabity SA, Araújo GC, Hagan JE, Damião AO, Reis MG, Ko AI, et al. Anicteric Leptospirosis-Associated Meningitis in a Tropical Urban Environment, Brazil. Emerg Infect Dis. 2020;26(9):2190-2192. https://doi.org/10.3201/eid2609.191001
AMA Nabity SA, Araújo GC, Hagan JE, et al. Anicteric Leptospirosis-Associated Meningitis in a Tropical Urban Environment, Brazil. Emerging Infectious Diseases. 2020;26(9):2190-2192. doi:10.3201/eid2609.191001.
APA Nabity, S. A., Araújo, G. C., Hagan, J. E., Damião, A. O., Reis, M. G., Ko, A. I....Ribeiro, G. S. (2020). Anicteric Leptospirosis-Associated Meningitis in a Tropical Urban Environment, Brazil. Emerging Infectious Diseases, 26(9), 2190-2192. https://doi.org/10.3201/eid2609.191001.

Lyme Borreliosis with Scalp Eschar Mimicking Rickettsial Infection, Austria [PDF - 1.00 MB - 3 pages]
M. Markowicz et al.

We report on a patient in Austria with scalp eschar and neck lymphadenopathy. Rickettsial etiology was excluded by culture, PCR, and serologic tests. Borrelia afzelii was identified from the eschar swab by PCR. Lyme borreliosis can mimic rickettsiosis; appropriate tests should be included in the diagnostic workup of patients with eschars.

EID Markowicz M, Schötta A, Wijnveld M, Stanek G. Lyme Borreliosis with Scalp Eschar Mimicking Rickettsial Infection, Austria. Emerg Infect Dis. 2020;26(9):2193-2195. https://doi.org/10.3201/eid2609.191256
AMA Markowicz M, Schötta A, Wijnveld M, et al. Lyme Borreliosis with Scalp Eschar Mimicking Rickettsial Infection, Austria. Emerging Infectious Diseases. 2020;26(9):2193-2195. doi:10.3201/eid2609.191256.
APA Markowicz, M., Schötta, A., Wijnveld, M., & Stanek, G. (2020). Lyme Borreliosis with Scalp Eschar Mimicking Rickettsial Infection, Austria. Emerging Infectious Diseases, 26(9), 2193-2195. https://doi.org/10.3201/eid2609.191256.

Assessing 3 Outbreak Detection Algorithms in an Electronic Syndromic Surveillance System in a Resource-Limited Setting [PDF - 1023 KB - 5 pages]
E. Alsentzer et al.

We evaluated the performance of X-bar chart, exponentially weighted moving average, and C3 cumulative sums aberration detection algorithms for acute diarrheal disease syndromic surveillance at naval sites in Peru during 2007–2011. The 3 algorithms’ detection sensitivity was 100%, specificity was 97%–99%, and positive predictive value was 27%–46%.

EID Alsentzer E, Ballard S, Neyra J, Vera DM, Osorio VB, Quispe J, et al. Assessing 3 Outbreak Detection Algorithms in an Electronic Syndromic Surveillance System in a Resource-Limited Setting. Emerg Infect Dis. 2020;26(9):2196-2200. https://doi.org/10.3201/eid2609.191315
AMA Alsentzer E, Ballard S, Neyra J, et al. Assessing 3 Outbreak Detection Algorithms in an Electronic Syndromic Surveillance System in a Resource-Limited Setting. Emerging Infectious Diseases. 2020;26(9):2196-2200. doi:10.3201/eid2609.191315.
APA Alsentzer, E., Ballard, S., Neyra, J., Vera, D. M., Osorio, V. B., Quispe, J....Loayza, L. (2020). Assessing 3 Outbreak Detection Algorithms in an Electronic Syndromic Surveillance System in a Resource-Limited Setting. Emerging Infectious Diseases, 26(9), 2196-2200. https://doi.org/10.3201/eid2609.191315.

Human Borrelia miyamotoi Infection, Austria [PDF - 1.45 MB - 4 pages]
S. Tobudic et al.

We report a human case of Borrelia miyamotoi infection diagnosed in Austria. Spirochetes were detected in Giemsa-stained blood smears. The presence of B. miyamotoi in the patient’s blood was confirmed by PCR, and phylogenetic analysis identified an infection with a strain from Europe.

EID Tobudic S, Burgmann H, Stanek G, Winkler S, Schötta A, Obermüller M, et al. Human Borrelia miyamotoi Infection, Austria. Emerg Infect Dis. 2020;26(9):2201-2204. https://doi.org/10.3201/eid2609.191501
AMA Tobudic S, Burgmann H, Stanek G, et al. Human Borrelia miyamotoi Infection, Austria. Emerging Infectious Diseases. 2020;26(9):2201-2204. doi:10.3201/eid2609.191501.
APA Tobudic, S., Burgmann, H., Stanek, G., Winkler, S., Schötta, A., Obermüller, M....Lagler, H. (2020). Human Borrelia miyamotoi Infection, Austria. Emerging Infectious Diseases, 26(9), 2201-2204. https://doi.org/10.3201/eid2609.191501.

Role of Wildlife in Emergence of Ebola Virus in Kaigbono (Likati), Democratic Republic of the Congo, 2017 [PDF - 1.44 MB - 5 pages]
S. Gryseels et al.

After the 2017 Ebola virus (EBOV) outbreak in Likati, a district in northern Democratic Republic of the Congo, we sampled small mammals from the location where the primary case-patient presumably acquired the infection. None tested positive for EBOV RNA or antibodies against EBOV, highlighting the ongoing challenge in detecting animal reservoirs for EBOV.

EID Gryseels S, Mbala-Kingebeni P, Akonda I, Angoyo R, Ayouba A, Baelo P, et al. Role of Wildlife in Emergence of Ebola Virus in Kaigbono (Likati), Democratic Republic of the Congo, 2017. Emerg Infect Dis. 2020;26(9):2205-2209. https://doi.org/10.3201/eid2609.191552
AMA Gryseels S, Mbala-Kingebeni P, Akonda I, et al. Role of Wildlife in Emergence of Ebola Virus in Kaigbono (Likati), Democratic Republic of the Congo, 2017. Emerging Infectious Diseases. 2020;26(9):2205-2209. doi:10.3201/eid2609.191552.
APA Gryseels, S., Mbala-Kingebeni, P., Akonda, I., Angoyo, R., Ayouba, A., Baelo, P....Ahuka-Mundeke, S. (2020). Role of Wildlife in Emergence of Ebola Virus in Kaigbono (Likati), Democratic Republic of the Congo, 2017. Emerging Infectious Diseases, 26(9), 2205-2209. https://doi.org/10.3201/eid2609.191552.

Sequence Type Changes Associated with Decreasing Macrolide-Resistant Mycoplasma pneumoniae, Japan [PDF - 1.16 MB - 4 pages]
M. Morozumi et al.

We compared sequence types (STs) of Mycoplasma pneumoniae isolates from Japan during 2002–2019. ST3 and ST14 dominated during 2002–2016, and ST7 and ST33 dominated during 2018–2019. These STs were associated with a decrease in macrolide-resistant strains after an epidemic of infection with M. pneumoniae during 2011–2012.

EID Morozumi M, Tajima T, Sakuma M, Shouji M, Meguro H, Saito K, et al. Sequence Type Changes Associated with Decreasing Macrolide-Resistant Mycoplasma pneumoniae, Japan. Emerg Infect Dis. 2020;26(9):2210-2213. https://doi.org/10.3201/eid2609.191575
AMA Morozumi M, Tajima T, Sakuma M, et al. Sequence Type Changes Associated with Decreasing Macrolide-Resistant Mycoplasma pneumoniae, Japan. Emerging Infectious Diseases. 2020;26(9):2210-2213. doi:10.3201/eid2609.191575.
APA Morozumi, M., Tajima, T., Sakuma, M., Shouji, M., Meguro, H., Saito, K....Ubukata, K. (2020). Sequence Type Changes Associated with Decreasing Macrolide-Resistant Mycoplasma pneumoniae, Japan. Emerging Infectious Diseases, 26(9), 2210-2213. https://doi.org/10.3201/eid2609.191575.

Hepatitis E Virus Genotype 7 RNA and Antibody Kinetics in Naturally Infected Dromedary Calves, United Arab Emirates [PDF - 1.32 MB - 4 pages]
V. M. Corman et al.

Orthohepevirus A genotype 7 is a novel zoonotic variant of hepatitis E virus. To clarify infection in the animal reservoir, we virologically monitored 11 dromedary dam–calf pairs. All calves became infected during the first 6 months of life and cleared the virus after an average of 2 months. Dams did not become infected.

EID Corman VM, Nagy P, Ostermann S, Arloth J, Liljander A, Barua R, et al. Hepatitis E Virus Genotype 7 RNA and Antibody Kinetics in Naturally Infected Dromedary Calves, United Arab Emirates. Emerg Infect Dis. 2020;26(9):2214-2217. https://doi.org/10.3201/eid2609.191758
AMA Corman VM, Nagy P, Ostermann S, et al. Hepatitis E Virus Genotype 7 RNA and Antibody Kinetics in Naturally Infected Dromedary Calves, United Arab Emirates. Emerging Infectious Diseases. 2020;26(9):2214-2217. doi:10.3201/eid2609.191758.
APA Corman, V. M., Nagy, P., Ostermann, S., Arloth, J., Liljander, A., Barua, R....Drosten, C. (2020). Hepatitis E Virus Genotype 7 RNA and Antibody Kinetics in Naturally Infected Dromedary Calves, United Arab Emirates. Emerging Infectious Diseases, 26(9), 2214-2217. https://doi.org/10.3201/eid2609.191758.

Carbapenemase-Producing Gram-Negative Bacteria in Andalusia, Spain, 2014–2018 [PDF - 966 KB - 5 pages]
I. López-Hernández et al.

The emergence and spread of carbapenemase-producing gram-negative bacteria is a major public health concern. We used data collected from microbiology laboratories as part of the PIRASOA program during 2014–2018 to study the epidemiology of carbapenemase-producing bacteria in Andalusia, Spain. Our findings highlight the importance of ongoing surveillance and epidemiologic studies for these bacteria.

EID López-Hernández I, Delgado-Valverde M, Fernández-Cuenca F, López-Cerero L, Machuca J, Pascual Á. Carbapenemase-Producing Gram-Negative Bacteria in Andalusia, Spain, 2014–2018. Emerg Infect Dis. 2020;26(9):2218-2222. https://doi.org/10.3201/eid2609.191772
AMA López-Hernández I, Delgado-Valverde M, Fernández-Cuenca F, et al. Carbapenemase-Producing Gram-Negative Bacteria in Andalusia, Spain, 2014–2018. Emerging Infectious Diseases. 2020;26(9):2218-2222. doi:10.3201/eid2609.191772.
APA López-Hernández, I., Delgado-Valverde, M., Fernández-Cuenca, F., López-Cerero, L., Machuca, J., & Pascual, Á. (2020). Carbapenemase-Producing Gram-Negative Bacteria in Andalusia, Spain, 2014–2018. Emerging Infectious Diseases, 26(9), 2218-2222. https://doi.org/10.3201/eid2609.191772.

Identification of Streptococcus suis Meningitis by Direct Triplex Real-Time PCR, Burkina Faso [PDF - 1.07 MB - 4 pages]
M. Ouattara et al.

Meningitis confirmation in Burkina Faso uses PCR for detecting Streptococcus pneumoniae, Neisseria meningitidis, or Hemophilus influenzae. We identified 38 cases of meningitis among 590 that were PCR-positive for 3 nonpneumococcal streptococcal pathogens, including 21 cases of Streptococcus suis. Among the country’s 13 regions, 10 had S. suis–positive cases.

EID Ouattara M, Tamboura M, Kambire D, Sanou M, Ouattara K, Congo M, et al. Identification of Streptococcus suis Meningitis by Direct Triplex Real-Time PCR, Burkina Faso. Emerg Infect Dis. 2020;26(9):2223-2226. https://doi.org/10.3201/eid2609.200203
AMA Ouattara M, Tamboura M, Kambire D, et al. Identification of Streptococcus suis Meningitis by Direct Triplex Real-Time PCR, Burkina Faso. Emerging Infectious Diseases. 2020;26(9):2223-2226. doi:10.3201/eid2609.200203.
APA Ouattara, M., Tamboura, M., Kambire, D., Sanou, M., Ouattara, K., Congo, M....Beall, B. (2020). Identification of Streptococcus suis Meningitis by Direct Triplex Real-Time PCR, Burkina Faso. Emerging Infectious Diseases, 26(9), 2223-2226. https://doi.org/10.3201/eid2609.200203.

Enterovirus D68 Subclade B3 in Children with Acute Flaccid Paralysis in West Africa, 2016 [PDF - 1.38 MB - 4 pages]
A. Fall et al.

We tested for enterovirus D68 in fecal samples collected during June–September 2016 from 567 patients with acute flaccid paralysis in 7 West Africa nations. Children <5 years old comprised 64.3% of enterovirus D68 positive patients. Our findings emphasize the need for active surveillance for acute flaccid myelitis.

EID Fall A, Ndiaye N, Messacar K, Kebe O, Jallow M, Harouna H, et al. Enterovirus D68 Subclade B3 in Children with Acute Flaccid Paralysis in West Africa, 2016. Emerg Infect Dis. 2020;26(9):2227-2230. https://doi.org/10.3201/eid2609.200312
AMA Fall A, Ndiaye N, Messacar K, et al. Enterovirus D68 Subclade B3 in Children with Acute Flaccid Paralysis in West Africa, 2016. Emerging Infectious Diseases. 2020;26(9):2227-2230. doi:10.3201/eid2609.200312.
APA Fall, A., Ndiaye, N., Messacar, K., Kebe, O., Jallow, M., Harouna, H....Dia, N. (2020). Enterovirus D68 Subclade B3 in Children with Acute Flaccid Paralysis in West Africa, 2016. Emerging Infectious Diseases, 26(9), 2227-2230. https://doi.org/10.3201/eid2609.200312.

Fatal Measles Inclusion-Body Encephalitis in Adult with Untreated AIDS, France [PDF - 1.44 MB - 4 pages]
C. Rodriguez et al.

We report a fatal case of measles inclusion-body encephalitis occurring in a woman from Romania with AIDS. After an extensive but unsuccessful diagnostic evaluation, a pan-pathogen shotgun metagenomic approach revealed a measles virus infection. We identified no mutations previously associated with neurovirulence.

EID Rodriguez C, Gouilh M, Weiss N, Stroer S, Mokhtari K, Seilhean D, et al. Fatal Measles Inclusion-Body Encephalitis in Adult with Untreated AIDS, France. Emerg Infect Dis. 2020;26(9):2231-2234. https://doi.org/10.3201/eid2609.200366
AMA Rodriguez C, Gouilh M, Weiss N, et al. Fatal Measles Inclusion-Body Encephalitis in Adult with Untreated AIDS, France. Emerging Infectious Diseases. 2020;26(9):2231-2234. doi:10.3201/eid2609.200366.
APA Rodriguez, C., Gouilh, M., Weiss, N., Stroer, S., Mokhtari, K., Seilhean, D....Burrel, S. (2020). Fatal Measles Inclusion-Body Encephalitis in Adult with Untreated AIDS, France. Emerging Infectious Diseases, 26(9), 2231-2234. https://doi.org/10.3201/eid2609.200366.

Oxacillinase-181 Carbapenemase-Producing Klebsiella pneumoniae in Neonatal Intensive Care Unit, Ghana, 2017–2019 [PDF - 1.12 MB - 4 pages]
A. Labi et al.

We sequenced 29 carbapenemase-producing Klebsiella pneumoniae isolates from a neonatal intensive care unit in Ghana. Twenty-eight isolates were sequence type 17 with blaOXA-181 and differed by 0–32 single-nucleotide polymorphisms. Improved surveillance and infection control are needed to characterize and curb the spread of multidrug-resistant organisms in sub-Saharan Africa.

EID Labi A, Nielsen KL, Marvig RL, Bjerrum S, Enweronu-Laryea C, Bennedbæk M, et al. Oxacillinase-181 Carbapenemase-Producing Klebsiella pneumoniae in Neonatal Intensive Care Unit, Ghana, 2017–2019. Emerg Infect Dis. 2020;26(9):2235-2238. https://doi.org/10.3201/eid2609.200562
AMA Labi A, Nielsen KL, Marvig RL, et al. Oxacillinase-181 Carbapenemase-Producing Klebsiella pneumoniae in Neonatal Intensive Care Unit, Ghana, 2017–2019. Emerging Infectious Diseases. 2020;26(9):2235-2238. doi:10.3201/eid2609.200562.
APA Labi, A., Nielsen, K. L., Marvig, R. L., Bjerrum, S., Enweronu-Laryea, C., Bennedbæk, M....Kurtzhals, J. (2020). Oxacillinase-181 Carbapenemase-Producing Klebsiella pneumoniae in Neonatal Intensive Care Unit, Ghana, 2017–2019. Emerging Infectious Diseases, 26(9), 2235-2238. https://doi.org/10.3201/eid2609.200562.

Japanese Encephalitis Virus as Cause of Acute Encephalitis, Bhutan [PDF - 986 KB - 4 pages]
S. Wangchuk et al.

In 2011, Bhutan’s Royal Centre for Disease Control began Japanese encephalitis (JE) surveillance at 5 sentinel hospitals throughout Bhutan. During 2011–2018, a total of 20 JE cases were detected, indicating JE virus causes encephalitis in Bhutan. Maintaining JE surveillance will help improve understanding of JE epidemiology in this country.

EID Wangchuk S, Tamang T, Darnal J, Pelden S, Lhazeen K, Mynak M, et al. Japanese Encephalitis Virus as Cause of Acute Encephalitis, Bhutan. Emerg Infect Dis. 2020;26(9):2239-2242. https://doi.org/10.3201/eid2609.200620
AMA Wangchuk S, Tamang T, Darnal J, et al. Japanese Encephalitis Virus as Cause of Acute Encephalitis, Bhutan. Emerging Infectious Diseases. 2020;26(9):2239-2242. doi:10.3201/eid2609.200620.
APA Wangchuk, S., Tamang, T., Darnal, J., Pelden, S., Lhazeen, K., Mynak, M....Hills, S. L. (2020). Japanese Encephalitis Virus as Cause of Acute Encephalitis, Bhutan. Emerging Infectious Diseases, 26(9), 2239-2242. https://doi.org/10.3201/eid2609.200620.

Mycobacterial Testing Trends, United States, 2009–2015 [PDF - 776 KB - 4 pages]
S. G. Dean et al.

We studied 31 US healthcare facilities to characterize trends in mycobacterial testing. During 2009–2015, testing for acid-fast bacilli increased 3.2% annually, and prevalence of pathogenic nontuberculous mycobacteria increased 4.5% annually. These increases were highest for subpopulations at high risk of infection, including older women, Asians, and patients with concurrent conditions.

EID Dean SG, Ricotta EE, Fintzi J, Lai Y, Kadri SS, Olivier KN, et al. Mycobacterial Testing Trends, United States, 2009–2015. Emerg Infect Dis. 2020;26(9):2243-2246. https://doi.org/10.3201/eid2609.200749
AMA Dean SG, Ricotta EE, Fintzi J, et al. Mycobacterial Testing Trends, United States, 2009–2015. Emerging Infectious Diseases. 2020;26(9):2243-2246. doi:10.3201/eid2609.200749.
APA Dean, S. G., Ricotta, E. E., Fintzi, J., Lai, Y., Kadri, S. S., Olivier, K. N....Prevots, D. (2020). Mycobacterial Testing Trends, United States, 2009–2015. Emerging Infectious Diseases, 26(9), 2243-2246. https://doi.org/10.3201/eid2609.200749.

Emergence of pstS-Null Vancomycin-Resistant Enterococcus faecium Clone ST1478, Canada, 2013–2018 [PDF - 594 KB - 4 pages]
M. McCracken et al.

Rates of vancomycin-resistant enterococci bloodstream infections have remained relatively low in Canada. We recently observed an increase of 113% in these infections rates, which coincided with emergence of Enterococcus faecium pstS-null sequence type 1478. The proportion of this sequence type increased from 2.7% to 38.7% for all tested isolates from 2013–2018.

EID McCracken M, Mitchell R, Smith S, Hota S, Conly J, Du T, et al. Emergence of pstS-Null Vancomycin-Resistant Enterococcus faecium Clone ST1478, Canada, 2013–2018. Emerg Infect Dis. 2020;26(9):2247-2250. https://doi.org/10.3201/eid2609.201576
AMA McCracken M, Mitchell R, Smith S, et al. Emergence of pstS-Null Vancomycin-Resistant Enterococcus faecium Clone ST1478, Canada, 2013–2018. Emerging Infectious Diseases. 2020;26(9):2247-2250. doi:10.3201/eid2609.201576.
APA McCracken, M., Mitchell, R., Smith, S., Hota, S., Conly, J., Du, T....Golding, G. (2020). Emergence of pstS-Null Vancomycin-Resistant Enterococcus faecium Clone ST1478, Canada, 2013–2018. Emerging Infectious Diseases, 26(9), 2247-2250. https://doi.org/10.3201/eid2609.201576.
Research Letters

Buying Time with COVID-19 Outbreak Response, Israel [PDF - 872 KB - 3 pages]
E. Leshem et al.

Israel's response during the containment phase of the COVID-19 outbreak in early 2020 led to a delay in sustained community transmission and effective mitigation. During February–April 2020, a total of 15,981 confirmed cases resulted in 223 deaths. A total of 179,003 persons reported electronically to self-quarantine and were entitled to paid sick leave.

EID Leshem E, Afek A, Kreiss Y. Buying Time with COVID-19 Outbreak Response, Israel. Emerg Infect Dis. 2020;26(9):2251-2253. https://doi.org/10.3201/eid2609.201476
AMA Leshem E, Afek A, Kreiss Y. Buying Time with COVID-19 Outbreak Response, Israel. Emerging Infectious Diseases. 2020;26(9):2251-2253. doi:10.3201/eid2609.201476.
APA Leshem, E., Afek, A., & Kreiss, Y. (2020). Buying Time with COVID-19 Outbreak Response, Israel. Emerging Infectious Diseases, 26(9), 2251-2253. https://doi.org/10.3201/eid2609.201476.

Effectiveness of N95 Respirator Decontamination and Reuse against SARS-CoV-2 Virus [PDF - 1.22 MB - 3 pages]
R. J. Fischer et al.

The coronavirus pandemic has created worldwide shortages of N95 respirators. We analyzed 4 decontamination methods for effectiveness in deactivating severe acute respiratory syndrome coronavirus 2 virus and effect on respirator function. Our results indicate that N95 respirators can be decontaminated and reused, but the integrity of respirator fit and seal must be maintained.

EID Fischer RJ, Morris DH, van Doremalen N, Sarchette S, Matson M, Bushmaker T, et al. Effectiveness of N95 Respirator Decontamination and Reuse against SARS-CoV-2 Virus. Emerg Infect Dis. 2020;26(9):2253-2255. https://doi.org/10.3201/eid2609.201524
AMA Fischer RJ, Morris DH, van Doremalen N, et al. Effectiveness of N95 Respirator Decontamination and Reuse against SARS-CoV-2 Virus. Emerging Infectious Diseases. 2020;26(9):2253-2255. doi:10.3201/eid2609.201524.
APA Fischer, R. J., Morris, D. H., van Doremalen, N., Sarchette, S., Matson, M., Bushmaker, T....Munster, V. J. (2020). Effectiveness of N95 Respirator Decontamination and Reuse against SARS-CoV-2 Virus. Emerging Infectious Diseases, 26(9), 2253-2255. https://doi.org/10.3201/eid2609.201524.

Prolonged Infectivity of SARS-CoV-2 in Fomites [PDF - 561 KB - 2 pages]
B. Pastorino et al.

We spotted severe acute respiratory syndrome coronavirus 2 on polystyrene plastic, aluminum, and glass for 96 hours with and without bovine serum albumin (3 g/L). We observed a steady infectivity (<1 log10 drop) on plastic, a 3.5 log10 decrease on glass, and a 6 log10 drop on aluminum. The presence of proteins noticeably prolonged infectivity.

EID Pastorino B, Touret F, Gilles M, de Lamballerie X, Charrel RN. Prolonged Infectivity of SARS-CoV-2 in Fomites. Emerg Infect Dis. 2020;26(9):2256-2257. https://doi.org/10.3201/eid2609.201788
AMA Pastorino B, Touret F, Gilles M, et al. Prolonged Infectivity of SARS-CoV-2 in Fomites. Emerging Infectious Diseases. 2020;26(9):2256-2257. doi:10.3201/eid2609.201788.
APA Pastorino, B., Touret, F., Gilles, M., de Lamballerie, X., & Charrel, R. N. (2020). Prolonged Infectivity of SARS-CoV-2 in Fomites. Emerging Infectious Diseases, 26(9), 2256-2257. https://doi.org/10.3201/eid2609.201788.

Acute Cerebral Stroke with Multiple Infarctions and COVID-19, France, 2020 [PDF - 831 KB - 3 pages]
S. Zayet et al.

We describe 2 cases in coronavirus disease patients in France involving presumed thrombotic stroke that occurred during ongoing anticoagulation treatment for atrial fibrillation stroke prophylaxis; 1 patient had positive antiphospholipid antibodies. These cases highlight the severe and unique consequences of coronavirus disease–associated stroke.

EID Zayet S, Klopfenstein T, Kovẚcs R, Stancescu S, Hagenkötter B. Acute Cerebral Stroke with Multiple Infarctions and COVID-19, France, 2020. Emerg Infect Dis. 2020;26(9):2258-2260. https://doi.org/10.3201/eid2609.201791
AMA Zayet S, Klopfenstein T, Kovẚcs R, et al. Acute Cerebral Stroke with Multiple Infarctions and COVID-19, France, 2020. Emerging Infectious Diseases. 2020;26(9):2258-2260. doi:10.3201/eid2609.201791.
APA Zayet, S., Klopfenstein, T., Kovẚcs, R., Stancescu, S., & Hagenkötter, B. (2020). Acute Cerebral Stroke with Multiple Infarctions and COVID-19, France, 2020. Emerging Infectious Diseases, 26(9), 2258-2260. https://doi.org/10.3201/eid2609.201791.

Large SARS-CoV-2 Outbreak Caused by Asymptomatic Traveler, China [PDF - 575 KB - 4 pages]
J. Liu et al.

An asymptomatic person infected with severe acute respiratory syndrome coronavirus 2 returned to Heilongjiang Province, China, after international travel. The traveler’s neighbor became infected and generated a cluster of >71 cases, including cases in 2 hospitals. Genome sequences of the virus were distinct from viral genomes previously circulating in China.

EID Liu J, Huang J, Xiang D. Large SARS-CoV-2 Outbreak Caused by Asymptomatic Traveler, China. Emerg Infect Dis. 2020;26(9):2260-2263. https://doi.org/10.3201/eid2609.201798
AMA Liu J, Huang J, Xiang D. Large SARS-CoV-2 Outbreak Caused by Asymptomatic Traveler, China. Emerging Infectious Diseases. 2020;26(9):2260-2263. doi:10.3201/eid2609.201798.
APA Liu, J., Huang, J., & Xiang, D. (2020). Large SARS-CoV-2 Outbreak Caused by Asymptomatic Traveler, China. Emerging Infectious Diseases, 26(9), 2260-2263. https://doi.org/10.3201/eid2609.201798.

Antibody Responses after Classroom Exposure to Teacher with Coronavirus Disease, March 2020 [PDF - 284 KB - 3 pages]
N. E. Brown et al.

After returning from Europe to the United States, on March 1, 2020, a symptomatic teacher received positive test results for severe acute respiratory syndrome coronavirus 2. Of the 21 students exposed to the teacher in the classroom, serologic results suggested past infection for 2. Classroom contact may result in virus transmission.

EID Brown NE, Bryant-Genevier J, Bandy U, Browning CA, Berns AL, Dott M, et al. Antibody Responses after Classroom Exposure to Teacher with Coronavirus Disease, March 2020. Emerg Infect Dis. 2020;26(9):2263-2265. https://doi.org/10.3201/eid2609.201802
AMA Brown NE, Bryant-Genevier J, Bandy U, et al. Antibody Responses after Classroom Exposure to Teacher with Coronavirus Disease, March 2020. Emerging Infectious Diseases. 2020;26(9):2263-2265. doi:10.3201/eid2609.201802.
APA Brown, N. E., Bryant-Genevier, J., Bandy, U., Browning, C. A., Berns, A. L., Dott, M....Watson, J. (2020). Antibody Responses after Classroom Exposure to Teacher with Coronavirus Disease, March 2020. Emerging Infectious Diseases, 26(9), 2263-2265. https://doi.org/10.3201/eid2609.201802.

Severe Acute Respiratory Syndrome Coronavirus 2 among Asymptomatic Workers Screened for Work Resumption, China [PDF - 320 KB - 3 pages]
X. Han et al.

After the outbreak in Wuhan, China, we assessed 29,299 workers screened for severe acute respiratory syndrome coronavirus 2 by reverse transcription PCR. We noted 18 (0.061%) cases of asymptomatic infection; 13 turned negative within 8.0 days, and 41 close contacts tested negative. Among 6 contacts who had serologic tests, none were positive.

EID Han X, Wei X, Alwalid O, Cao Y, Li Y, Wang L, et al. Severe Acute Respiratory Syndrome Coronavirus 2 among Asymptomatic Workers Screened for Work Resumption, China. Emerg Infect Dis. 2020;26(9):2265-2267. https://doi.org/10.3201/eid2609.201848
AMA Han X, Wei X, Alwalid O, et al. Severe Acute Respiratory Syndrome Coronavirus 2 among Asymptomatic Workers Screened for Work Resumption, China. Emerging Infectious Diseases. 2020;26(9):2265-2267. doi:10.3201/eid2609.201848.
APA Han, X., Wei, X., Alwalid, O., Cao, Y., Li, Y., Wang, L....Shi, H. (2020). Severe Acute Respiratory Syndrome Coronavirus 2 among Asymptomatic Workers Screened for Work Resumption, China. Emerging Infectious Diseases, 26(9), 2265-2267. https://doi.org/10.3201/eid2609.201848.

Effects of Proactive Social Distancing on COVID-19 Outbreaks in 58 Cities, China [PDF - 711 KB - 3 pages]
Z. Du et al.

Cities across China implemented stringent social distancing measures in early 2020 to curb coronavirus disease outbreaks. We estimated the speed with which these measures contained transmission in cities. A 1-day delay in implementing social distancing resulted in a containment delay of 2.41 (95% CI 0.97–3.86) days.

EID Du Z, Xu X, Wang L, Fox SJ, Cowling BJ, Galvani AP, et al. Effects of Proactive Social Distancing on COVID-19 Outbreaks in 58 Cities, China. Emerg Infect Dis. 2020;26(9):2267-2269. https://doi.org/10.3201/eid2609.201932
AMA Du Z, Xu X, Wang L, et al. Effects of Proactive Social Distancing on COVID-19 Outbreaks in 58 Cities, China. Emerging Infectious Diseases. 2020;26(9):2267-2269. doi:10.3201/eid2609.201932.
APA Du, Z., Xu, X., Wang, L., Fox, S. J., Cowling, B. J., Galvani, A. P....Meyers, L. (2020). Effects of Proactive Social Distancing on COVID-19 Outbreaks in 58 Cities, China. Emerging Infectious Diseases, 26(9), 2267-2269. https://doi.org/10.3201/eid2609.201932.

Parotitis-Like Symptoms Associated with COVID-19, France, March–April 2020 [PDF - 284 KB - 1 page]
J. R. Lechien et al.

We report the clinical features of 3 patients in France who had parotitis (inflammation of the parotid salivary glands) as a clinical manifestation of confirmed coronavirus disease. Results from magnetic resonance imaging support the occurrence of intraparotid lymphadenitis, leading to a parotitis-like clinical picture.

EID Lechien JR, Chetrit A, Chekkoury-Idrissi Y, Distinguin L, Circiu M, Saussez S, et al. Parotitis-Like Symptoms Associated with COVID-19, France, March–April 2020. Emerg Infect Dis. 2020;26(9):2270-2271. https://doi.org/10.3201/eid2609.202059
AMA Lechien JR, Chetrit A, Chekkoury-Idrissi Y, et al. Parotitis-Like Symptoms Associated with COVID-19, France, March–April 2020. Emerging Infectious Diseases. 2020;26(9):2270-2271. doi:10.3201/eid2609.202059.
APA Lechien, J. R., Chetrit, A., Chekkoury-Idrissi, Y., Distinguin, L., Circiu, M., Saussez, S....Carlier, R. (2020). Parotitis-Like Symptoms Associated with COVID-19, France, March–April 2020. Emerging Infectious Diseases, 26(9), 2270-2271. https://doi.org/10.3201/eid2609.202059.

Clostridioides difficile in COVID-19 Patients, Detroit, Michigan, USA, March–April 2020 [PDF - 338 KB - 3 pages]
A. Sandhu et al.

We describe 9 patients at a medical center in Detroit, Michigan, USA, with severe acute respiratory syndrome coronavirus 2 and Clostridioides difficile. Both infections can manifest as digestive symptoms and merit screening when assessing patients with diarrhea during the coronavirus disease pandemic. These co-infections also highlight the continued importance of antimicrobial stewardship.

EID Sandhu A, Tillotson G, Polistico J, Salimnia H, Cranis M, Moshos J, et al. Clostridioides difficile in COVID-19 Patients, Detroit, Michigan, USA, March–April 2020. Emerg Infect Dis. 2020;26(9):2272-2274. https://doi.org/10.3201/eid2609.202126
AMA Sandhu A, Tillotson G, Polistico J, et al. Clostridioides difficile in COVID-19 Patients, Detroit, Michigan, USA, March–April 2020. Emerging Infectious Diseases. 2020;26(9):2272-2274. doi:10.3201/eid2609.202126.
APA Sandhu, A., Tillotson, G., Polistico, J., Salimnia, H., Cranis, M., Moshos, J....Chopra, T. (2020). Clostridioides difficile in COVID-19 Patients, Detroit, Michigan, USA, March–April 2020. Emerging Infectious Diseases, 26(9), 2272-2274. https://doi.org/10.3201/eid2609.202126.

SARS-CoV-2 RNA Detection on Disposable Wooden Chopsticks, Hong Kong [PDF - 582 KB - 3 pages]
G. Lui et al.

We detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA on disposable wooden chopsticks used by 5 consecutive asymptomatic and postsymptomatic patients admitted for isolation and care at our hospital. Although we did not assess virus viability, our findings may suggest potential for transmission through shared eating utensils.

EID Lui G, Lai C, Chen Z, Tong S, Ho W, Yeung A, et al. SARS-CoV-2 RNA Detection on Disposable Wooden Chopsticks, Hong Kong. Emerg Infect Dis. 2020;26(9):2274-2276. https://doi.org/10.3201/eid2609.202135
AMA Lui G, Lai C, Chen Z, et al. SARS-CoV-2 RNA Detection on Disposable Wooden Chopsticks, Hong Kong. Emerging Infectious Diseases. 2020;26(9):2274-2276. doi:10.3201/eid2609.202135.
APA Lui, G., Lai, C., Chen, Z., Tong, S., Ho, W., Yeung, A....Chan, P. (2020). SARS-CoV-2 RNA Detection on Disposable Wooden Chopsticks, Hong Kong. Emerging Infectious Diseases, 26(9), 2274-2276. https://doi.org/10.3201/eid2609.202135.

Effect of Environmental Conditions on SARS-CoV-2 Stability in Human Nasal Mucus and Sputum [PDF - 970 KB - 3 pages]
M. Matson et al.

We found that environmental conditions affect the stability of severe acute respiratory syndrome coronavirus 2 in nasal mucus and sputum. The virus is more stable at low-temperature and low-humidity conditions, whereas warmer temperature and higher humidity shortened half-life. Although infectious virus was undetectable after 48 hours, viral RNA remained detectable for 7 days.

EID Matson M, Yinda C, Seifert SN, Bushmaker T, Fischer RJ, van Doremalen N, et al. Effect of Environmental Conditions on SARS-CoV-2 Stability in Human Nasal Mucus and Sputum. Emerg Infect Dis. 2020;26(9):2276-2278. https://doi.org/10.3201/eid2609.202267
AMA Matson M, Yinda C, Seifert SN, et al. Effect of Environmental Conditions on SARS-CoV-2 Stability in Human Nasal Mucus and Sputum. Emerging Infectious Diseases. 2020;26(9):2276-2278. doi:10.3201/eid2609.202267.
APA Matson, M., Yinda, C., Seifert, S. N., Bushmaker, T., Fischer, R. J., van Doremalen, N....Munster, V. J. (2020). Effect of Environmental Conditions on SARS-CoV-2 Stability in Human Nasal Mucus and Sputum. Emerging Infectious Diseases, 26(9), 2276-2278. https://doi.org/10.3201/eid2609.202267.

Methemoglobinemia in Patient with G6PD Deficiency and SARS-CoV-2 Infection [PDF - 450 KB - 3 pages]
K. Palmer et al.

We report a case of intravascular hemolysis and methemoglobinemia, precipitated by severe acute respiratory syndrome coronavirus 2 infection, in a patient with undiagnosed glucose-6-phosphate dehydrogenase deficiency. Clinicians should be aware of this complication of coronavirus disease as a cause of error in pulse oximetry and a potential risk for drug-induced hemolysis.

EID Palmer K, Dick J, French W, Floro L, Ford M. Methemoglobinemia in Patient with G6PD Deficiency and SARS-CoV-2 Infection. Emerg Infect Dis. 2020;26(9):2279-2281. https://doi.org/10.3201/eid2609.202353
AMA Palmer K, Dick J, French W, et al. Methemoglobinemia in Patient with G6PD Deficiency and SARS-CoV-2 Infection. Emerging Infectious Diseases. 2020;26(9):2279-2281. doi:10.3201/eid2609.202353.
APA Palmer, K., Dick, J., French, W., Floro, L., & Ford, M. (2020). Methemoglobinemia in Patient with G6PD Deficiency and SARS-CoV-2 Infection. Emerging Infectious Diseases, 26(9), 2279-2281. https://doi.org/10.3201/eid2609.202353.

Asymptomatic SARS-CoV-2 Infection in Nursing Homes, Barcelona, Spain, April 2020 [PDF - 332 KB - 3 pages]
B. Borras-Bermejo et al.

During the coronavirus disease pandemic in Spain, from April 10–24, 2020, a total of 5,869 persons were screened for severe acute respiratory syndrome coronavirus 2 at nursing homes. Among residents, 768 (23.9%) tested positive; among staff, 403 (15.2%). Of those testing positive, 69.7% of residents and 55.8% of staff were asymptomatic.

EID Borras-Bermejo B, Martínez-Gómez X, San Miguel M, Esperalba J, Antón A, Martin E, et al. Asymptomatic SARS-CoV-2 Infection in Nursing Homes, Barcelona, Spain, April 2020. Emerg Infect Dis. 2020;26(9):2281-2283. https://doi.org/10.3201/eid2609.202603
AMA Borras-Bermejo B, Martínez-Gómez X, San Miguel M, et al. Asymptomatic SARS-CoV-2 Infection in Nursing Homes, Barcelona, Spain, April 2020. Emerging Infectious Diseases. 2020;26(9):2281-2283. doi:10.3201/eid2609.202603.
APA Borras-Bermejo, B., Martínez-Gómez, X., San Miguel, M., Esperalba, J., Antón, A., Martin, E....Almirante, B. (2020). Asymptomatic SARS-CoV-2 Infection in Nursing Homes, Barcelona, Spain, April 2020. Emerging Infectious Diseases, 26(9), 2281-2283. https://doi.org/10.3201/eid2609.202603.

Leuconostoc lactis and Staphylococcus nepalensis Bacteremia, Japan [PDF - 826 KB - 3 pages]
S. Hosoya et al.

Leuconostoc lactis is a glycopeptide-resistant, gram-positive, facultative anaerobic coccus isolated from dairy products, whereas Staphylococcus nepalensis is coagulase-negative coccus that has not been identified as human pathogen. We report an instructive case of L. lactis and S. nepalensis bacteremia in a 71-year-old man who experienced Boerhaave syndrome after a meal.

EID Hosoya S, Kutsuna S, Shiojiri D, Tamura S, Isaka E, Wakimoto Y, et al. Leuconostoc lactis and Staphylococcus nepalensis Bacteremia, Japan. Emerg Infect Dis. 2020;26(9):2283-2285. https://doi.org/10.3201/eid2609.191123
AMA Hosoya S, Kutsuna S, Shiojiri D, et al. Leuconostoc lactis and Staphylococcus nepalensis Bacteremia, Japan. Emerging Infectious Diseases. 2020;26(9):2283-2285. doi:10.3201/eid2609.191123.
APA Hosoya, S., Kutsuna, S., Shiojiri, D., Tamura, S., Isaka, E., Wakimoto, Y....Ohmagari, N. (2020). Leuconostoc lactis and Staphylococcus nepalensis Bacteremia, Japan. Emerging Infectious Diseases, 26(9), 2283-2285. https://doi.org/10.3201/eid2609.191123.

Latent Tuberculosis Screening Using Electronic Health Record Data [PDF - 335 KB - 3 pages]
J. D. Jenks et al.

Screening for latent tuberculosis infection is recommended for foreign-born persons in the United States. We used proxy data from electronic health records to determine that 17.5% of foreign-born outpatients attending the UC San Diego Health clinic (San Diego, CA, USA) underwent screening. Ending the global tuberculosis epidemic requires improved screening.

EID Jenks JD, Garfein RS, Zhu W, Hogarth M. Latent Tuberculosis Screening Using Electronic Health Record Data. Emerg Infect Dis. 2020;26(9):2285-2287. https://doi.org/10.3201/eid2609.191391
AMA Jenks JD, Garfein RS, Zhu W, et al. Latent Tuberculosis Screening Using Electronic Health Record Data. Emerging Infectious Diseases. 2020;26(9):2285-2287. doi:10.3201/eid2609.191391.
APA Jenks, J. D., Garfein, R. S., Zhu, W., & Hogarth, M. (2020). Latent Tuberculosis Screening Using Electronic Health Record Data. Emerging Infectious Diseases, 26(9), 2285-2287. https://doi.org/10.3201/eid2609.191391.

Putative Conjugative Plasmids with tcdB and cdtAB Genes in Clostridioides difficile [PDF - 1.53 MB - 4 pages]
G. Ramírez-Vargas and C. Rodríguez

The major toxins of Clostridioides difficile (TcdA, TcdB, CDT) are chromosomally encoded in nearly all known strains. Following up on previous findings, we identified 5 examples of a family of putative conjugative plasmids with tcdB and cdtAB in clinical C. difficile isolates from multilocus sequence typing clades C-I, 2, and 4.

EID Ramírez-Vargas G, Rodríguez C. Putative Conjugative Plasmids with tcdB and cdtAB Genes in Clostridioides difficile. Emerg Infect Dis. 2020;26(9):2287-2290. https://doi.org/10.3201/eid2609.191447
AMA Ramírez-Vargas G, Rodríguez C. Putative Conjugative Plasmids with tcdB and cdtAB Genes in Clostridioides difficile. Emerging Infectious Diseases. 2020;26(9):2287-2290. doi:10.3201/eid2609.191447.
APA Ramírez-Vargas, G., & Rodríguez, C. (2020). Putative Conjugative Plasmids with tcdB and cdtAB Genes in Clostridioides difficile. Emerging Infectious Diseases, 26(9), 2287-2290. https://doi.org/10.3201/eid2609.191447.

Information-Accessing Behavior during Zika Virus Outbreak, United States, 2016 [PDF - 385 KB - 3 pages]
R. Piltch-Loeb and D. Abramson

We used latent class analysis to examine Zika virus–related information-accessing behavior of US residents during the 2016 international outbreak. We characterized 3 classes of information-accessing behavior patterns: universalists, media seekers, and passive recipients. Understanding these patterns is crucial to planning risk communication during an emerging health threat.

EID Piltch-Loeb R, Abramson D. Information-Accessing Behavior during Zika Virus Outbreak, United States, 2016. Emerg Infect Dis. 2020;26(9):2290-2292. https://doi.org/10.3201/eid2609.191519
AMA Piltch-Loeb R, Abramson D. Information-Accessing Behavior during Zika Virus Outbreak, United States, 2016. Emerging Infectious Diseases. 2020;26(9):2290-2292. doi:10.3201/eid2609.191519.
APA Piltch-Loeb, R., & Abramson, D. (2020). Information-Accessing Behavior during Zika Virus Outbreak, United States, 2016. Emerging Infectious Diseases, 26(9), 2290-2292. https://doi.org/10.3201/eid2609.191519.

Severe Fever with Thrombocytopenia Syndrome Virus in Ticks and SFTS Incidence in Humans, South Korea [PDF - 666 KB - 3 pages]
J. Yoo et al.

During 2016–2018, we collected 3,193 ticks from rural areas in South Korea to investigate the prevalence of severe fever with thrombocytopenia syndrome virus (SFTSV). We detected SFTSV in ticks at an infection rate (IR) of 11.1%. We noted increases in the human IR associated with the monthly SFTSV IR in ticks.

EID Yoo J, Heo S, Song S, Bae S, Lee S, Choi S, et al. Severe Fever with Thrombocytopenia Syndrome Virus in Ticks and SFTS Incidence in Humans, South Korea. Emerg Infect Dis. 2020;26(9):2292-2294. https://doi.org/10.3201/eid2609.200065
AMA Yoo J, Heo S, Song S, et al. Severe Fever with Thrombocytopenia Syndrome Virus in Ticks and SFTS Incidence in Humans, South Korea. Emerging Infectious Diseases. 2020;26(9):2292-2294. doi:10.3201/eid2609.200065.
APA Yoo, J., Heo, S., Song, S., Bae, S., Lee, S., Choi, S....Lee, K. (2020). Severe Fever with Thrombocytopenia Syndrome Virus in Ticks and SFTS Incidence in Humans, South Korea. Emerging Infectious Diseases, 26(9), 2292-2294. https://doi.org/10.3201/eid2609.200065.

Typhus Group Rickettsiosis, Brazilian Amazon [PDF - 783 KB - 3 pages]
A. Minervino et al.

Rickettsia rickettsii infection is the only rickettsiosis included in the list of reportable diseases in Brazil, where typhus group rickettsioses, mainly murine typhus, have been underreported. We report a case of typhus group rickettsiosis with unique ecologic particularities in a patient from the Brazilian Amazon, where, to our knowledge, rickettsioses have not been reported.

EID Minervino A, Labruna MB, Dias SR, Costa FB, Martins TF, da Silva P, et al. Typhus Group Rickettsiosis, Brazilian Amazon. Emerg Infect Dis. 2020;26(9):2294-2296. https://doi.org/10.3201/eid2609.201305
AMA Minervino A, Labruna MB, Dias SR, et al. Typhus Group Rickettsiosis, Brazilian Amazon. Emerging Infectious Diseases. 2020;26(9):2294-2296. doi:10.3201/eid2609.201305.
APA Minervino, A., Labruna, M. B., Dias, S. R., Costa, F. B., Martins, T. F., da Silva, P....Faccini-Martínez, Á. A. (2020). Typhus Group Rickettsiosis, Brazilian Amazon. Emerging Infectious Diseases, 26(9), 2294-2296. https://doi.org/10.3201/eid2609.201305.
Letters

Rhabdomyolysis as Potential Late Complication Associated with COVID-19 [PDF - 321 KB - 2 pages]
Y. He and F. Chen
EID He Y, Chen F. Rhabdomyolysis as Potential Late Complication Associated with COVID-19. Emerg Infect Dis. 2020;26(9):2297-2298. https://doi.org/10.3201/eid2609.201463
AMA He Y, Chen F. Rhabdomyolysis as Potential Late Complication Associated with COVID-19. Emerging Infectious Diseases. 2020;26(9):2297-2298. doi:10.3201/eid2609.201463.
APA He, Y., & Chen, F. (2020). Rhabdomyolysis as Potential Late Complication Associated with COVID-19. Emerging Infectious Diseases, 26(9), 2297-2298. https://doi.org/10.3201/eid2609.201463.

COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020 [PDF - 245 KB - 1 page]
F. W. Moses et al.
EID Moses FW, Gonzalez-Rothi R, Schmidt G. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerg Infect Dis. 2020;26(9):2298. https://doi.org/10.3201/eid2609.201749
AMA Moses FW, Gonzalez-Rothi R, Schmidt G. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerging Infectious Diseases. 2020;26(9):2298. doi:10.3201/eid2609.201749.
APA Moses, F. W., Gonzalez-Rothi, R., & Schmidt, G. (2020). COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerging Infectious Diseases, 26(9), 2298. https://doi.org/10.3201/eid2609.201749.

Clostridiodes difficile in COVID-19 Patients, Detroit, Michigan, USA, March–April 2020 [PDF - 278 KB - 2 pages]
S. Lakkasani et al.
EID Lakkasani S, Chan K, Shaaban HS. Clostridiodes difficile in COVID-19 Patients, Detroit, Michigan, USA, March–April 2020. Emerg Infect Dis. 2020;26(9):2299-2300. https://doi.org/10.3201/eid2609.202505
AMA Lakkasani S, Chan K, Shaaban HS. Clostridiodes difficile in COVID-19 Patients, Detroit, Michigan, USA, March–April 2020. Emerging Infectious Diseases. 2020;26(9):2299-2300. doi:10.3201/eid2609.202505.
APA Lakkasani, S., Chan, K., & Shaaban, H. S. (2020). Clostridiodes difficile in COVID-19 Patients, Detroit, Michigan, USA, March–April 2020. Emerging Infectious Diseases, 26(9), 2299-2300. https://doi.org/10.3201/eid2609.202505.

Zika Virus Infection, Philippines, 2012 [PDF - 532 KB - 2 pages]
C. Buerano et al.
EID Buerano C, Pangilinan L, Dimamay M, Mapua C, Dimamay M, Matias R, et al. Zika Virus Infection, Philippines, 2012. Emerg Infect Dis. 2020;26(9):2300-2301. https://doi.org/10.3201/eid2609.190896
AMA Buerano C, Pangilinan L, Dimamay M, et al. Zika Virus Infection, Philippines, 2012. Emerging Infectious Diseases. 2020;26(9):2300-2301. doi:10.3201/eid2609.190896.
APA Buerano, C., Pangilinan, L., Dimamay, M., Mapua, C., Dimamay, M., Matias, R....Moi, M. (2020). Zika Virus Infection, Philippines, 2012. Emerging Infectious Diseases, 26(9), 2300-2301. https://doi.org/10.3201/eid2609.190896.

Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures [PDF - 277 KB - 2 pages]
J. Pannu
EID Pannu J. Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures. Emerg Infect Dis. 2020;26(9):2298-2299. https://doi.org/10.3201/eid2609.201990
AMA Pannu J. Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures. Emerging Infectious Diseases. 2020;26(9):2298-2299. doi:10.3201/eid2609.201990.
APA Pannu, J. (2020). Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures. Emerging Infectious Diseases, 26(9), 2298-2299. https://doi.org/10.3201/eid2609.201990.
About the Cover

The Concept of the Crown and Its Potential Role in the Downfall of Coronavirus [PDF - 3.88 MB - 2 pages]
T. Chorba
EID Chorba T. The Concept of the Crown and Its Potential Role in the Downfall of Coronavirus. Emerg Infect Dis. 2020;26(9):2302-2305. https://doi.org/10.3201/eid2609.ac2609
AMA Chorba T. The Concept of the Crown and Its Potential Role in the Downfall of Coronavirus. Emerging Infectious Diseases. 2020;26(9):2302-2305. doi:10.3201/eid2609.ac2609.
APA Chorba, T. (2020). The Concept of the Crown and Its Potential Role in the Downfall of Coronavirus. Emerging Infectious Diseases, 26(9), 2302-2305. https://doi.org/10.3201/eid2609.ac2609.
Etymologia

Etymologia: Dermatophyte [PDF - 720 KB - 1 page]
A. E. Santana and F. P. Sellera
EID Santana AE, Sellera FP. Etymologia: Dermatophyte. Emerg Infect Dis. 2020;26(9):2156. https://doi.org/10.3201/eid2609.et2609
AMA Santana AE, Sellera FP. Etymologia: Dermatophyte. Emerging Infectious Diseases. 2020;26(9):2156. doi:10.3201/eid2609.et2609.
APA Santana, A. E., & Sellera, F. P. (2020). Etymologia: Dermatophyte. Emerging Infectious Diseases, 26(9), 2156. https://doi.org/10.3201/eid2609.et2609.
Corrections

Correction: Vol. 26, No. 7 [PDF - 462 KB - 1 page]
EID Correction: Vol. 26, No. 7. Emerg Infect Dis. 2020;26(9):2301. https://doi.org/10.3201/eid2609.c12609
AMA Correction: Vol. 26, No. 7. Emerging Infectious Diseases. 2020;26(9):2301. doi:10.3201/eid2609.c12609.
APA (2020). Correction: Vol. 26, No. 7. Emerging Infectious Diseases, 26(9), 2301. https://doi.org/10.3201/eid2609.c12609.
Page created: August 11, 2020
Page updated: August 26, 2020
Page reviewed: August 26, 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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