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Issue Cover for Volume 27, Number 1—January 2021

Volume 27, Number 1—January 2021

[PDF - 12.38 MB - 347 pages]

Synopses

Impact of Human Papillomavirus Vaccination, Rwanda and Bhutan [PDF - 787 KB - 9 pages]
I. Baussano et al.

Rwanda and Bhutan, 2 low- and middle-income countries, implemented primarily school-based national human papillomavirus (HPV) vaccination in 2011 (Rwanda) and 2010 (Bhutan). We estimated vaccination effectiveness through urine-based HPV prevalence surveys in schools in 2013–2014 and 2017. In Rwanda, 912 participants from baseline surveys and 1,087 from repeat surveys were included, and in Bhutan, 973 participants from baseline surveys and 909 from repeat surveys were included. The overall effectiveness against vaccine-targeted HPV types (i.e., HPV-6/11/16/18) was 78% (95% CI 51%–90%) in Rwanda, and 88% (6%–99%) in Bhutan and against other α-9 types was 58% (21–78) in Rwanda and 63% (27–82) in Bhutan. No effect against other HPV types was detectable. Prevalence of vaccine-targeted HPV types decreased significantly, as well as that of other α-9 types, suggesting cross-protection. These findings provide direct evidence from low- and middle-income countries of the marked effectiveness of high-coverage school-based, national HPV vaccination programs.

EID Baussano I, Sayinzoga F, Tshomo U, Tenet V, Vorsters A, Heideman D, et al. Impact of Human Papillomavirus Vaccination, Rwanda and Bhutan. Emerg Infect Dis. 2021;27(1):1-9. https://doi.org/10.3201/eid2701.191364
AMA Baussano I, Sayinzoga F, Tshomo U, et al. Impact of Human Papillomavirus Vaccination, Rwanda and Bhutan. Emerging Infectious Diseases. 2021;27(1):1-9. doi:10.3201/eid2701.191364.
APA Baussano, I., Sayinzoga, F., Tshomo, U., Tenet, V., Vorsters, A., Heideman, D....Clifford, G. M. (2021). Impact of Human Papillomavirus Vaccination, Rwanda and Bhutan. Emerging Infectious Diseases, 27(1), 1-9. https://doi.org/10.3201/eid2701.191364.

Nosocomial Coronavirus Disease Outbreak Containment, Hanoi, Vietnam, March–April 2020 [PDF - 1.43 MB - 8 pages]
C. Duy et al.

We report on the public health response generated by an outbreak of coronavirus disease (COVID-19) that occurred during March 2020 at Bach Mai Hospital (BMH) in Hanoi, northern Vietnam’s largest hospital complex. On March 18, a total of 3 distinct clusters of COVID-19 cases were identified at BMH. Diagnosis of the initial 3 COVID-19 cases led to contact tracing, symptom screening, and testing of 495 persons and limited quarantine of affected institutes or departments. When 27 staff members in the catering company tested positive for SARS-CoV-2, the entire BMH staff (7,664 persons) was put under quarantine. Contact tracing in the community resulted in an additional 52,239 persons being quarantined. After 3 weeks, the hospital outbreak was contained; no further spread occurred in the hospital. Rapid screening of cases, extensive testing, prompt quarantine, contact tracing, and social distancing contributed to prevent community transmission in Hanoi and northern Vietnam.

EID Duy C, Nong V, Van Ngo A, Doan T, Nguyen T, Truong P, et al. Nosocomial Coronavirus Disease Outbreak Containment, Hanoi, Vietnam, March–April 2020. Emerg Infect Dis. 2021;27(1):10-17. https://doi.org/10.3201/eid2701.202656
AMA Duy C, Nong V, Van Ngo A, et al. Nosocomial Coronavirus Disease Outbreak Containment, Hanoi, Vietnam, March–April 2020. Emerging Infectious Diseases. 2021;27(1):10-17. doi:10.3201/eid2701.202656.
APA Duy, C., Nong, V., Van Ngo, A., Doan, T., Nguyen, T., Truong, P....Larsson, M. (2021). Nosocomial Coronavirus Disease Outbreak Containment, Hanoi, Vietnam, March–April 2020. Emerging Infectious Diseases, 27(1), 10-17. https://doi.org/10.3201/eid2701.202656.

Aspergillosis Complicating Severe Coronavirus Disease [PDF - 1.82 MB - 8 pages]
K. A. Marr et al.

Aspergillosis complicating severe influenza infection has been increasingly detected worldwide. Recently, coronavirus disease–associated pulmonary aspergillosis (CAPA) has been detected through rapid reports, primarily from centers in Europe. We provide a case series of CAPA, adding 20 cases to the literature, with review of pathophysiology, diagnosis, and outcomes. The syndromes of pulmonary aspergillosis complicating severe viral infections are distinct from classic invasive aspergillosis, which is recognized most frequently in persons with neutropenia and in other immunocompromised persons. Combined with severe viral infection, aspergillosis comprises a constellation of airway-invasive and angio-invasive disease and results in risks associated with poor airway fungus clearance and killing, including virus- or inflammation-associated epithelial damage, systemic immunosuppression, and underlying lung disease. Radiologic abnormalities can vary, reflecting different pathologies. Prospective studies reporting poor outcomes in CAPA patients underscore the urgent need for strategies to improve diagnosis, prevention, and therapy.

EID Marr KA, Platt A, Tornheim JA, Zhang SX, Datta K, Cardozo C, et al. Aspergillosis Complicating Severe Coronavirus Disease. Emerg Infect Dis. 2021;27(1):18-25. https://doi.org/10.3201/eid2701.202896
AMA Marr KA, Platt A, Tornheim JA, et al. Aspergillosis Complicating Severe Coronavirus Disease. Emerging Infectious Diseases. 2021;27(1):18-25. doi:10.3201/eid2701.202896.
APA Marr, K. A., Platt, A., Tornheim, J. A., Zhang, S. X., Datta, K., Cardozo, C....Garcia-Vidal, C. (2021). Aspergillosis Complicating Severe Coronavirus Disease. Emerging Infectious Diseases, 27(1), 18-25. https://doi.org/10.3201/eid2701.202896.

Medscape CME Activity
Invasive Fusariosis in Nonneutropenic Patients, Spain, 2000–2015 [PDF - 565 KB - 10 pages]
E. Pérez-Nadales et al.

Invasive fusariosis (IF) is associated with severe neutropenia in patients with concurrent hematologic conditions. We conducted a retrospective observational study to characterize the epidemiology of IF in 18 Spanish hospitals during 2000–2015. In that time, the frequency of IF in nonneutropenic patients increased from 0.08 cases per 100,000 admissions in 2000–2009 to 0.22 cases per 100,000 admissions in 2010–2015. Nonneutropenic IF patients often had nonhematologic conditions, such as chronic cardiac or lung disease, rheumatoid arthritis, history of solid organ transplantation, or localized fusariosis. The 90-day death rate among nonneutropenic patients (28.6%) and patients with resolved neutropenia (38.1%) was similar. However, the death rate among patients with persistent neutropenia (91.3%) was significantly higher. We used a multivariate Cox regression analysis to characterize risk factors for death: persistent neutropenia was the only risk factor for death, regardless of antifungal therapy.

EID Pérez-Nadales E, Alastruey-Izquierdo A, Linares-Sicilia M, Soto-Debrán J, Abdala E, García-Rodríguez J, et al. Invasive Fusariosis in Nonneutropenic Patients, Spain, 2000–2015. Emerg Infect Dis. 2021;27(1):24-36. https://doi.org/10.3201/eid2701.190782
AMA Pérez-Nadales E, Alastruey-Izquierdo A, Linares-Sicilia M, et al. Invasive Fusariosis in Nonneutropenic Patients, Spain, 2000–2015. Emerging Infectious Diseases. 2021;27(1):24-36. doi:10.3201/eid2701.190782.
APA Pérez-Nadales, E., Alastruey-Izquierdo, A., Linares-Sicilia, M., Soto-Debrán, J., Abdala, E., García-Rodríguez, J....Nucci, M. (2021). Invasive Fusariosis in Nonneutropenic Patients, Spain, 2000–2015. Emerging Infectious Diseases, 27(1), 24-36. https://doi.org/10.3201/eid2701.190782.
Research

Differential Yellow Fever Susceptibility in New World Nonhuman Primates, Comparison with Humans, and Implications for Surveillance [PDF - 2.20 MB - 10 pages]
N. de Azevedo Fernandes et al.

A major outbreak of yellow fever (YF) occurred in Brazil during 2016–2018. Epizootics in New World nonhuman primates are sentinel events for YF virus circulation. However, genus-specific susceptibilities and suitability for YF surveillance remain poorly understood. We obtained and compared epidemiologic, histopathologic, immunohistochemical, and molecular results from 93 human and 1,752 primate cases submitted during the recent YF outbreak in Brazil (2017), with the support of the Brazilian National YF Surveillance Program. We detected heterogeneous YF-associated profiles among the various genera of primates we analyzed. Alouatta primates were the most reliable sentinel; Sapajus and Callicebus primates had higher viral loads but lower proportional mortality rates. Callithrix primates were the least sensitive, showing lower viral loads, lower proportional mortality rates, and no demonstrable YF virus antigen or extensive lesions in liver, despite detectable viral RNA. These differences in susceptibility, viral load, and mortality rates should be considered in strategic surveillance of epizootics and control measures for YF.

EID de Azevedo Fernandes N, Guerra JM, Díaz-Delgado J, Cunha MS, Saad L, Iglezias SD, et al. Differential Yellow Fever Susceptibility in New World Nonhuman Primates, Comparison with Humans, and Implications for Surveillance. Emerg Infect Dis. 2021;27(1):47-56. https://doi.org/10.3201/eid2701.191220
AMA de Azevedo Fernandes N, Guerra JM, Díaz-Delgado J, et al. Differential Yellow Fever Susceptibility in New World Nonhuman Primates, Comparison with Humans, and Implications for Surveillance. Emerging Infectious Diseases. 2021;27(1):47-56. doi:10.3201/eid2701.191220.
APA de Azevedo Fernandes, N., Guerra, J. M., Díaz-Delgado, J., Cunha, M. S., Saad, L., Iglezias, S. D....Catão-Dias, J. L. (2021). Differential Yellow Fever Susceptibility in New World Nonhuman Primates, Comparison with Humans, and Implications for Surveillance. Emerging Infectious Diseases, 27(1), 47-56. https://doi.org/10.3201/eid2701.191220.

Comparative Omics Analysis of Historic and Recent Isolates of Bordetella pertussis and Effects of Genome Rearrangements on Evolution [PDF - 3.00 MB - 12 pages]
A. Dienstbier et al.

Despite high vaccination coverage, pertussis is increasing in many industrialized countries, including the Czech Republic. To better understand Bordetella pertussis resurgence, we analyzed historic strains and recent clinical isolates by using a comparative omics approach. Whole-genome sequencing showed that historic and recent isolates of B. pertussis have substantial variation in genome organization and form separate phylogenetic clusters. Subsequent RNA sequence analysis and liquid chromatography with mass tandem spectrometry analyses showed that these variations translated into discretely separated transcriptomic and proteomic profiles. When compared with historic strains, recent isolates showed increased expression of flagellar genes and genes involved in lipopolysaccharide biosynthesis and decreased expression of polysaccharide capsule genes. Compared with reference strain Tohama I, all strains had increased expression and production of the type III secretion system apparatus. We detected the potential link between observed effects and insertion sequence element–induced changes in gene context only for a few genes.

EID Dienstbier A, Amman F, Petráčková D, Štipl D, Čapek J, Zavadilová J, et al. Comparative Omics Analysis of Historic and Recent Isolates of Bordetella pertussis and Effects of Genome Rearrangements on Evolution. Emerg Infect Dis. 2021;27(1):57-68. https://doi.org/10.3201/eid2701.191541
AMA Dienstbier A, Amman F, Petráčková D, et al. Comparative Omics Analysis of Historic and Recent Isolates of Bordetella pertussis and Effects of Genome Rearrangements on Evolution. Emerging Infectious Diseases. 2021;27(1):57-68. doi:10.3201/eid2701.191541.
APA Dienstbier, A., Amman, F., Petráčková, D., Štipl, D., Čapek, J., Zavadilová, J....Večerek, B. (2021). Comparative Omics Analysis of Historic and Recent Isolates of Bordetella pertussis and Effects of Genome Rearrangements on Evolution. Emerging Infectious Diseases, 27(1), 57-68. https://doi.org/10.3201/eid2701.191541.

Hospitalization for Invasive Pneumococcal Diseases in Young Children before Use of 13-Valent Pneumococcal Conjugate Vaccine, Suzhou, China [PDF - 1.25 MB - 7 pages]
K. Chen et al.

A 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease (IPD) was introduced in China in April 2017. We describe 105 children <5 years of age who were hospitalized for IPD at Soochow University Affiliated Children’s Hospital in Suzhou, China, during January 2010–December 2017. We calculated the incidence of hospitalization for IPD as 14.55/100,000 children in Suzhou. We identified 8 different capsular serotypes: 6B (28.4% of cases), 14 (18.9% of cases), 19A (18.9% of cases), 19F (12.2% of cases), 23F (10.8% of cases), 20 (4.1% of cases), 9V (4.1% of cases), and 15B/C (2.7% of cases). These results provide baseline data of IPD before the introduction of this vaccine in China, enabling researchers to better understand its effects on IPD incidence.

EID Chen K, Zhang X, Tao Y, Wang Y, Xue J, Liu C, et al. Hospitalization for Invasive Pneumococcal Diseases in Young Children before Use of 13-Valent Pneumococcal Conjugate Vaccine, Suzhou, China. Emerg Infect Dis. 2021;27(1):69-75. https://doi.org/10.3201/eid2701.181415
AMA Chen K, Zhang X, Tao Y, et al. Hospitalization for Invasive Pneumococcal Diseases in Young Children before Use of 13-Valent Pneumococcal Conjugate Vaccine, Suzhou, China. Emerging Infectious Diseases. 2021;27(1):69-75. doi:10.3201/eid2701.181415.
APA Chen, K., Zhang, X., Tao, Y., Wang, Y., Xue, J., Liu, C....Zhang, T. (2021). Hospitalization for Invasive Pneumococcal Diseases in Young Children before Use of 13-Valent Pneumococcal Conjugate Vaccine, Suzhou, China. Emerging Infectious Diseases, 27(1), 69-75. https://doi.org/10.3201/eid2701.181415.

Human Diversity of Killer Cell Immunoglobulin-Like Receptors and Human Leukocyte Antigen Class I Alleles and Ebola Virus Disease Outcomes [PDF - 968 KB - 9 pages]
T. Wawina-Bokalanga et al.

We investigated the genetic profiles of killer cell immunoglobulin-like receptors (KIRs) in Ebola virus–infected patients. We studied the relationship between KIR–human leukocyte antigen (HLA) combinations and the clinical outcomes of patients with Ebola virus disease (EVD). We genotyped KIRs and HLA class I alleles using DNA from uninfected controls, EVD survivors, and persons who died of EVD. The activating 2DS4–003 and inhibitory 2DL5 genes were significantly more common among persons who died of EVD; 2DL2 was more common among survivors. We used logistic regression analysis and Bayesian modeling to identify 2DL2, 2DL5, 2DS4–003, HLA-B-Bw4-Thr, and HLA-B-Bw4-Ile as probably having a significant relationship with disease outcome. Our findings highlight the importance of innate immune response against Ebola virus and show the association between KIRs and the clinical outcome of EVD.

EID Wawina-Bokalanga T, Vanmechelen B, Lhermitte V, Martí-Carreras J, Vergote V, Koundouno F, et al. Human Diversity of Killer Cell Immunoglobulin-Like Receptors and Human Leukocyte Antigen Class I Alleles and Ebola Virus Disease Outcomes. Emerg Infect Dis. 2021;27(1):76-84. https://doi.org/10.3201/eid2701.202177
AMA Wawina-Bokalanga T, Vanmechelen B, Lhermitte V, et al. Human Diversity of Killer Cell Immunoglobulin-Like Receptors and Human Leukocyte Antigen Class I Alleles and Ebola Virus Disease Outcomes. Emerging Infectious Diseases. 2021;27(1):76-84. doi:10.3201/eid2701.202177.
APA Wawina-Bokalanga, T., Vanmechelen, B., Lhermitte, V., Martí-Carreras, J., Vergote, V., Koundouno, F....Maes, P. (2021). Human Diversity of Killer Cell Immunoglobulin-Like Receptors and Human Leukocyte Antigen Class I Alleles and Ebola Virus Disease Outcomes. Emerging Infectious Diseases, 27(1), 76-84. https://doi.org/10.3201/eid2701.202177.

IgG Seroconversion and Pathophysiology in Severe Acute Respiratory Syndrome Coronavirus 2 Infection [PDF - 917 KB - 7 pages]
H. M. Staines et al.

We investigated the dynamics of seroconversion in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. During March 29–May 22, 2020, we collected serum samples and associated clinical data from 177 persons in London, UK, who had SARS-CoV-2 infection. We measured IgG against SARS-CoV-2 and compared antibody levels with patient outcomes, demographic information, and laboratory characteristics. We found that 2.0%–8.5% of persons did not seroconvert 3–6 weeks after infection. Persons who seroconverted were older, were more likely to have concurrent conditions, and had higher levels of inflammatory markers. Non-White persons had higher antibody concentrations than those who identified as White; these concentrations did not decline during follow-up. Serologic assay results correlated with disease outcome, race, and other risk factors for severe SARS-CoV-2 infection. Serologic assays can be used in surveillance to clarify the duration and protective nature of humoral responses to SARS-CoV-2 infection.

EID Staines HM, Kirwan DE, Clark DJ, Adams ER, Augustin Y, Byrne RL, et al. IgG Seroconversion and Pathophysiology in Severe Acute Respiratory Syndrome Coronavirus 2 Infection. Emerg Infect Dis. 2021;27(1):85-91. https://doi.org/10.3201/eid2701.203074
AMA Staines HM, Kirwan DE, Clark DJ, et al. IgG Seroconversion and Pathophysiology in Severe Acute Respiratory Syndrome Coronavirus 2 Infection. Emerging Infectious Diseases. 2021;27(1):85-91. doi:10.3201/eid2701.203074.
APA Staines, H. M., Kirwan, D. E., Clark, D. J., Adams, E. R., Augustin, Y., Byrne, R. L....Planche, T. (2021). IgG Seroconversion and Pathophysiology in Severe Acute Respiratory Syndrome Coronavirus 2 Infection. Emerging Infectious Diseases, 27(1), 85-91. https://doi.org/10.3201/eid2701.203074.

Performance of Nucleic Acid Amplification Tests for Detection of Severe Acute Respiratory Syndrome Coronavirus 2 in Prospectively Pooled Specimens [PDF - 3.73 MB - 12 pages]
H. Wang et al.

Pooled nucleic acid amplification tests for severe acute respiratory syndrome coronavirus 2 could increase availability of testing at decreased cost. However, the effect of dilution on analytical sensitivity through sample pooling has not been well characterized. We tested 1,648 prospectively pooled specimens by using 3 nucleic acid amplification tests for severe acute respiratory syndrome coronavirus 2: a laboratory-developed real-time reverse transcription PCR targeting the envelope gene, and 2 commercially available Panther System assays targeting open reading frame 1ab. Positive percent agreement (PPA) of pooled versus individual testing ranged from 71.7% to 82.6% for pools of 8 and from 82.9% to 100.0% for pools of 4. We developed and validated an independent stochastic simulation model to estimate effects of dilution on PPA and efficiency of a 2-stage pooled real-time reverse transcription PCR testing algorithm. PPA was dependent on the proportion of tests with positive results, cycle threshold distribution, and assay limit of detection.

EID Wang H, Hogan CA, Miller JA, Sahoo MK, Huang C, Mfuh KO, et al. Performance of Nucleic Acid Amplification Tests for Detection of Severe Acute Respiratory Syndrome Coronavirus 2 in Prospectively Pooled Specimens. Emerg Infect Dis. 2021;27(1):92-103. https://doi.org/10.3201/eid2701.203379
AMA Wang H, Hogan CA, Miller JA, et al. Performance of Nucleic Acid Amplification Tests for Detection of Severe Acute Respiratory Syndrome Coronavirus 2 in Prospectively Pooled Specimens. Emerging Infectious Diseases. 2021;27(1):92-103. doi:10.3201/eid2701.203379.
APA Wang, H., Hogan, C. A., Miller, J. A., Sahoo, M. K., Huang, C., Mfuh, K. O....Pinsky, B. A. (2021). Performance of Nucleic Acid Amplification Tests for Detection of Severe Acute Respiratory Syndrome Coronavirus 2 in Prospectively Pooled Specimens. Emerging Infectious Diseases, 27(1), 92-103. https://doi.org/10.3201/eid2701.203379.

Susceptibility of Domestic Swine to Experimental Infection with Severe Acute Respiratory Syndrome Coronavirus 2 [PDF - 1.15 MB - 9 pages]
B. S. Pickering et al.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the agent that causes coronavirus disease, has been shown to infect several species. The role of domestic livestock and associated risks for humans in close contact with food production animals remains unknown for many species. Determining the susceptibility of pigs to SARS-CoV-2 is critical to a One Health approach to manage potential risk for zoonotic transmission. We found that pigs are susceptible to SARS-CoV-2 after oronasal inoculation. Among 16 animals, we detected viral RNA in group oral fluids and in nasal wash from 2 pigs, but live virus was isolated from only 1 pig. Antibodies also were detected in only 2 animals at 11 and 13 days postinoculation but were detected in oral fluid samples at 6 days postinoculation, indicating antibody secretion. These data highlight the need for additional livestock assessment to determine the potential role of domestic animals in the SARS-CoV-2 pandemic.

EID Pickering BS, Smith G, Pinette MM, Embury-Hyatt C, Moffat E, Marszal P, et al. Susceptibility of Domestic Swine to Experimental Infection with Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis. 2021;27(1):104-112. https://doi.org/10.3201/eid2701.203399
AMA Pickering BS, Smith G, Pinette MM, et al. Susceptibility of Domestic Swine to Experimental Infection with Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases. 2021;27(1):104-112. doi:10.3201/eid2701.203399.
APA Pickering, B. S., Smith, G., Pinette, M. M., Embury-Hyatt, C., Moffat, E., Marszal, P....Lewis, C. E. (2021). Susceptibility of Domestic Swine to Experimental Infection with Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases, 27(1), 104-112. https://doi.org/10.3201/eid2701.203399.

Intrafamilial Exposure to SARS-CoV-2 Associated with Cellular Immune Response without Seroconversion, France [PDF - 1.71 MB - 9 pages]
F. Gallais et al.

We investigated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–specific antibodies and T-cell responses against SARS-CoV-2 and human coronavirus (HCoV) 229E and OC43 in 11 SARS-CoV-2 serodiscordant couples in Strasbourg, France, in which 1 partner had evidence of mild coronavirus disease (COVID-19) and in 10 unexposed healthy controls. Patients with confirmed COVID-19 were considered index patients and their partners close contacts. All index patients displayed positive SARS-CoV-2–specific antibody and T-cell responses that lasted up to 102 days after symptom onset. All contacts remained seronegative for SARS-CoV-2; however, 6 reported COVID-19 symptoms within a median of 7 days after their partners, and 4 of those showed a positive SARS-CoV-2–specific T-cell response against 3 or 4 SARS-CoV-2 antigens that lasted up to 93 days after symptom onset. The 11 couples and controls displayed positive T-cell responses against HCoV-229E or HCoV-OC43. These data suggest that exposure to SARS-CoV-2 can induce virus-specific T-cell responses without seroconversion.

EID Gallais F, Velay A, Nazon C, Wendling M, Partisani M, Sibilia J, et al. Intrafamilial Exposure to SARS-CoV-2 Associated with Cellular Immune Response without Seroconversion, France. Emerg Infect Dis. 2021;27(1):113-121. https://doi.org/10.3201/eid2701.203611
AMA Gallais F, Velay A, Nazon C, et al. Intrafamilial Exposure to SARS-CoV-2 Associated with Cellular Immune Response without Seroconversion, France. Emerging Infectious Diseases. 2021;27(1):113-121. doi:10.3201/eid2701.203611.
APA Gallais, F., Velay, A., Nazon, C., Wendling, M., Partisani, M., Sibilia, J....Fafi-Kremer, S. (2021). Intrafamilial Exposure to SARS-CoV-2 Associated with Cellular Immune Response without Seroconversion, France. Emerging Infectious Diseases, 27(1), 113-121. https://doi.org/10.3201/eid2701.203611.

Cellular Immunity in COVID-19 Convalescents with PCR-Confirmed Infection but with Undetectable SARS-CoV-2–Specific IgG [PDF - 1.05 MB - 8 pages]
S. Schwarzkopf et al.

We investigated immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among a group of convalescent, potential blood donors in Germany who had PCR-confirmed SARS-CoV-2 infection. Sixty days after onset of symptoms, 13/78 (17%) study participants had borderline or negative results to an ELISA detecting IgG against the S1 protein of SARS-CoV-2. We analyzed participants with PCR-confirmed infection who had strong antibody responses (ratio >3) as positive controls and participants without symptoms of SARS-CoV-2 infection and without household contact with infected patients as negative controls. Using interferon-γ ELISpot, we observed that 78% of PCR-positive volunteers with undetectable antibodies showed T cell immunity against SARS-CoV-2. We observed a similar frequency (80%) of T-cell immunity in convalescent donors with strong antibody responses but did not detect immunity in negative controls. We concluded that, in convalescent patients with undetectable SARS-CoV-2 IgG, immunity may be mediated through T cells.

EID Schwarzkopf S, Krawczyk A, Knop D, Klump H, Heinold A, Heinemann FM, et al. Cellular Immunity in COVID-19 Convalescents with PCR-Confirmed Infection but with Undetectable SARS-CoV-2–Specific IgG. Emerg Infect Dis. 2021;27(1):122-129. https://doi.org/10.3201/eid2701.203772
AMA Schwarzkopf S, Krawczyk A, Knop D, et al. Cellular Immunity in COVID-19 Convalescents with PCR-Confirmed Infection but with Undetectable SARS-CoV-2–Specific IgG. Emerging Infectious Diseases. 2021;27(1):122-129. doi:10.3201/eid2701.203772.
APA Schwarzkopf, S., Krawczyk, A., Knop, D., Klump, H., Heinold, A., Heinemann, F. M....Lindemann, M. (2021). Cellular Immunity in COVID-19 Convalescents with PCR-Confirmed Infection but with Undetectable SARS-CoV-2–Specific IgG. Emerging Infectious Diseases, 27(1), 122-129. https://doi.org/10.3201/eid2701.203772.

Estimating the Force of Infection for Dengue Virus Using Repeated Serosurveys, Ouagadougou, Burkina Faso [PDF - 1.37 MB - 10 pages]
J. K. Lim et al.

Because of limited data on dengue virus in Burkina Faso, we conducted 4 consecutive age-stratified longitudinal serologic surveys, ≈6 months apart, among persons 1–55 years of age, during June 2015–March 2017, which included a 2016 outbreak. The seroconversion rate before the serosurvey enrollment was estimated by binomial regression, taking age as the duration of exposure, and assuming constant force of infection (FOI) over age and calendar time. We calculated FOI between consecutive surveys and rate ratios for potentially associated characteristics based on seroconversion using the duration of intervals. Among 2,897 persons at enrollment, 66.3% were IgG-positive, and estimated annual FOI was 5.95%. Of 1,269 enrollees participating in all 4 serosurveys, 438 were IgG-negative at enrollment. The annualized FOI ranged from 10% to 20% (during the 2016 outbreak). Overall, we observed high FOI for dengue. These results could support decision-making about control and preventive measures for dengue.

EID Lim JK, Carabali M, Edwards T, Barro A, Lee J, Dahourou D, et al. Estimating the Force of Infection for Dengue Virus Using Repeated Serosurveys, Ouagadougou, Burkina Faso. Emerg Infect Dis. 2021;27(1):130-139. https://doi.org/10.3201/eid2701.191650
AMA Lim JK, Carabali M, Edwards T, et al. Estimating the Force of Infection for Dengue Virus Using Repeated Serosurveys, Ouagadougou, Burkina Faso. Emerging Infectious Diseases. 2021;27(1):130-139. doi:10.3201/eid2701.191650.
APA Lim, J. K., Carabali, M., Edwards, T., Barro, A., Lee, J., Dahourou, D....Seydou, Y. (2021). Estimating the Force of Infection for Dengue Virus Using Repeated Serosurveys, Ouagadougou, Burkina Faso. Emerging Infectious Diseases, 27(1), 130-139. https://doi.org/10.3201/eid2701.191650.

Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States [PDF - 493 KB - 10 pages]
S. A. Collier et al.

Provision of safe drinking water in the United States is a great public health achievement. However, new waterborne disease challenges have emerged (e.g., aging infrastructure, chlorine-tolerant and biofilm-related pathogens, increased recreational water use). Comprehensive estimates of the health burden for all water exposure routes (ingestion, contact, inhalation) and sources (drinking, recreational, environmental) are needed. We estimated total illnesses, emergency department (ED) visits, hospitalizations, deaths, and direct healthcare costs for 17 waterborne infectious diseases. About 7.15 million waterborne illnesses occur annually (95% credible interval [CrI] 3.88 million–12.0 million), results in 601,000 ED visits (95% CrI 364,000–866,000), 118,000 hospitalizations (95% CrI 86,800–150,000), and 6,630 deaths (95% CrI 4,520–8,870) and incurring US $3.33 billion (95% CrI 1.37 billion–8.77 billion) in direct healthcare costs. Otitis externa and norovirus infection were the most common illnesses. Most hospitalizations and deaths were caused by biofilm-associated pathogens (nontuberculous mycobacteria, Pseudomonas, Legionella), costing US $2.39 billion annually.

EID Collier SA, Deng L, Adam EA, Benedict KM, Beshearse EM, Blackstock AJ, et al. Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States. Emerg Infect Dis. 2021;27(1):140-149. https://doi.org/10.3201/eid2701.190676
AMA Collier SA, Deng L, Adam EA, et al. Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States. Emerging Infectious Diseases. 2021;27(1):140-149. doi:10.3201/eid2701.190676.
APA Collier, S. A., Deng, L., Adam, E. A., Benedict, K. M., Beshearse, E. M., Blackstock, A. J....Beach, M. J. (2021). Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States. Emerging Infectious Diseases, 27(1), 140-149. https://doi.org/10.3201/eid2701.190676.

Post–13-Valent Pneumococcal Conjugate Vaccine Dynamics in Young Children of Serotypes Included in Candidate Extended-Spectrum Conjugate Vaccines [PDF - 3.39 MB - 11 pages]
S. Ben-Shimol et al.

After worldwide implementation of 10-valent and 13-valent pneumococcal conjugate vaccines (PCV10/PCV13), a 20-valent PCV (PCV20) was developed. We assessed dynamics of non-PCV13 additional PCV20 serotypes (VT20–13), compared with all other non-VT20 serotypes, in children <2 years of age in late PCV13 (2015–2017) and early PCV (2009–2011) periods. Our prospective population-based multifaceted surveillance included isolates from carriage in healthy children, children requiring chest radiography for lower respiratory tract infections (LRTIs), and children with non-LRTI illness, as well as isolates from acute conjunctivitis, otitis media (OM), and invasive pneumococcal disease (IPD). After PCV13 implementation, VT20–13 increased disproportionally in OM, IPD, and carriage in LRTI. VT20–13/non-VT20 prevalence ratio range was 0.26–1.40. VT20–13 serotypes were more frequently antimicrobial-nonsusceptible than non-VT20 serotypes. The disproportionate increase of VT20–13 in respiratory infections and IPD points to their higher disease potential compared with all other non-VT20 as a group.

EID Ben-Shimol S, Givon-Lavi N, Kotler L, Adriaan van der Beek B, Greenberg D, Dagan R. Post–13-Valent Pneumococcal Conjugate Vaccine Dynamics in Young Children of Serotypes Included in Candidate Extended-Spectrum Conjugate Vaccines. Emerg Infect Dis. 2021;27(1):150-160. https://doi.org/10.3201/eid2701.201178
AMA Ben-Shimol S, Givon-Lavi N, Kotler L, et al. Post–13-Valent Pneumococcal Conjugate Vaccine Dynamics in Young Children of Serotypes Included in Candidate Extended-Spectrum Conjugate Vaccines. Emerging Infectious Diseases. 2021;27(1):150-160. doi:10.3201/eid2701.201178.
APA Ben-Shimol, S., Givon-Lavi, N., Kotler, L., Adriaan van der Beek, B., Greenberg, D., & Dagan, R. (2021). Post–13-Valent Pneumococcal Conjugate Vaccine Dynamics in Young Children of Serotypes Included in Candidate Extended-Spectrum Conjugate Vaccines. Emerging Infectious Diseases, 27(1), 150-160. https://doi.org/10.3201/eid2701.201178.

Precise Species Identification by Whole-Genome Sequencing of Enterobacter Bloodstream Infection, China [PDF - 595 KB - 9 pages]
W. Wu et al.

The clinical importance of Enterobacter spp. remains unclear because phenotype-based Enterobacter species identification is unreliable. We performed a genomic study on 48 cases of Enterobacter-caused bloodstream infection by using in silico DNA–DNA hybridization to identify precise species. Strains belonged to 12 species; Enterobacter xiangfangensis (n = 21) and an unnamed species (taxon 1, n = 8) were dominant. Most (63.5%) Enterobacter strains (n = 349) with genomes in GenBank from human blood are E. xiangfangensis; taxon 1 (19.8%) was next most common. E. xiangfangensis and taxon 1 were associated with increased deaths (20.7% vs. 15.8%), lengthier hospitalizations (median 31 d vs. 19.5 d), and higher resistance to aztreonam, cefepime, ceftriaxone, piperacillin-tazobactam, and tobramycin. Strains belonged to 37 sequence types (STs); ST171 (E. xiangfangensis) was most common (n = 6). Four ST171 strains belonged to a defined clone. Precise species identification has greater implications for epidemiology and infection control than treatment.

EID Wu W, Wei L, Feng Y, Xie Y, Zong Z. Precise Species Identification by Whole-Genome Sequencing of Enterobacter Bloodstream Infection, China. Emerg Infect Dis. 2021;27(1):161-169. https://doi.org/10.3201/eid2701.190154
AMA Wu W, Wei L, Feng Y, et al. Precise Species Identification by Whole-Genome Sequencing of Enterobacter Bloodstream Infection, China. Emerging Infectious Diseases. 2021;27(1):161-169. doi:10.3201/eid2701.190154.
APA Wu, W., Wei, L., Feng, Y., Xie, Y., & Zong, Z. (2021). Precise Species Identification by Whole-Genome Sequencing of Enterobacter Bloodstream Infection, China. Emerging Infectious Diseases, 27(1), 161-169. https://doi.org/10.3201/eid2701.190154.

Delineating and Analyzing Locality-Level Determinants of Cholera, Haiti [PDF - 4.59 MB - 12 pages]
K. Griffiths et al.

Centre Department, Haiti, was the origin of a major cholera epidemic during 2010–2019. Although no fine-scale spatial delineation is officially available, we aimed to analyze determinants of cholera at the local level and identify priority localities in need of interventions. After estimating the likely boundaries of 1,730 localities by using Voronoi polygons, we mapped 5,322 suspected cholera cases reported during January 2015–September 2016 by locality alongside environmental and socioeconomic variables. A hierarchical clustering on principal components highlighted 2 classes with high cholera risk: localities close to rivers and unimproved water sources (standardized incidence ratio 1.71, 95% CI 1.02–2.87; p = 0.04) and urban localities with markets (standardized incidence ratio 1.69, 95% CI 1.25–2.29; p = 0.0006). Our analyses helped identify and characterize areas where efforts should be focused to reduce vulnerability to cholera and other waterborne diseases; these methods could be used in other contexts.

EID Griffiths K, Moise K, Piarroux M, Gaudart J, Beaulieu S, Bulit G, et al. Delineating and Analyzing Locality-Level Determinants of Cholera, Haiti. Emerg Infect Dis. 2021;27(1):170-181. https://doi.org/10.3201/eid2701.191787
AMA Griffiths K, Moise K, Piarroux M, et al. Delineating and Analyzing Locality-Level Determinants of Cholera, Haiti. Emerging Infectious Diseases. 2021;27(1):170-181. doi:10.3201/eid2701.191787.
APA Griffiths, K., Moise, K., Piarroux, M., Gaudart, J., Beaulieu, S., Bulit, G....Rebaudet, S. (2021). Delineating and Analyzing Locality-Level Determinants of Cholera, Haiti. Emerging Infectious Diseases, 27(1), 170-181. https://doi.org/10.3201/eid2701.191787.

Attribution of Illnesses Transmitted by Food and Water to Comprehensive Transmission Pathways Using Structured Expert Judgment, United States [PDF - 1.63 MB - 14 pages]
E. Beshearse et al.

Illnesses transmitted by food and water cause a major disease burden in the United States despite advancements in food safety, water treatment, and sanitation. We report estimates from a structured expert judgment study using 48 experts who applied Cooke’s classical model of the proportion of disease attributable to 5 major transmission pathways (foodborne, waterborne, person-to-person, animal contact, and environmental) and 6 subpathways (food handler–related, under foodborne; recreational, drinking, and nonrecreational/nondrinking, under waterborne; and presumed person-to-person-associated and presumed animal contact-associated, under environmental). Estimates for 33 pathogens were elicited, including bacteria such as Salmonella enterica, Campylobacter spp., Legionella spp., and Pseudomonas spp.; protozoa such as Acanthamoeba spp., Cyclospora cayetanensis, and Naegleria fowleri; and viruses such as norovirus, rotavirus, and hepatitis A virus. The results highlight the importance of multiple pathways in the transmission of the included pathogens and can be used to guide prioritization of public health interventions.

EID Beshearse E, Bruce BB, Nane GF, Cooke RM, Aspinall W, Hald T, et al. Attribution of Illnesses Transmitted by Food and Water to Comprehensive Transmission Pathways Using Structured Expert Judgment, United States. Emerg Infect Dis. 2021;27(1):182-195. https://doi.org/10.3201/eid2701.200316
AMA Beshearse E, Bruce BB, Nane GF, et al. Attribution of Illnesses Transmitted by Food and Water to Comprehensive Transmission Pathways Using Structured Expert Judgment, United States. Emerging Infectious Diseases. 2021;27(1):182-195. doi:10.3201/eid2701.200316.
APA Beshearse, E., Bruce, B. B., Nane, G. F., Cooke, R. M., Aspinall, W., Hald, T....Havelaar, A. H. (2021). Attribution of Illnesses Transmitted by Food and Water to Comprehensive Transmission Pathways Using Structured Expert Judgment, United States. Emerging Infectious Diseases, 27(1), 182-195. https://doi.org/10.3201/eid2701.200316.

Territorywide Study of Early Coronavirus Disease Outbreak, Hong Kong, China [PDF - 1.11 MB - 9 pages]
K. Leung et al.

Initial cases of coronavirus disease in Hong Kong were imported from mainland China. A dramatic increase in case numbers was seen in February 2020. Most case-patients had no recent travel history, suggesting the presence of transmission chains in the local community. We collected demographic, clinical, and epidemiologic data from 50 patients, who accounted for 53.8% of total reported case-patients as of February 28, 2020. We performed whole-genome sequencing to determine phylogenetic relationship and transmission dynamics of severe acute respiratory syndrome coronavirus 2 infections. By using phylogenetic analysis, we attributed the community outbreak to 2 lineages; 1 harbored a common mutation, Orf3a-G251V, and accounted for 88.0% of the cases in our study. The estimated time to the most recent common ancestor of local coronavirus disease outbreak was December 24, 2019, with an evolutionary rate of 3.04 × 10−3 substitutions/site/year. The reproduction number was 1.84, indicating ongoing community spread.

EID Leung K, Ng T, Wu A, Yau M, Lao H, Choi M, et al. Territorywide Study of Early Coronavirus Disease Outbreak, Hong Kong, China. Emerg Infect Dis. 2021;27(1):196-204. https://doi.org/10.3201/eid2701.201543
AMA Leung K, Ng T, Wu A, et al. Territorywide Study of Early Coronavirus Disease Outbreak, Hong Kong, China. Emerging Infectious Diseases. 2021;27(1):196-204. doi:10.3201/eid2701.201543.
APA Leung, K., Ng, T., Wu, A., Yau, M., Lao, H., Choi, M....Siu, G. (2021). Territorywide Study of Early Coronavirus Disease Outbreak, Hong Kong, China. Emerging Infectious Diseases, 27(1), 196-204. https://doi.org/10.3201/eid2701.201543.

Viral Metagenomic Analysis of Cerebrospinal Fluid from Patients with Acute Central Nervous System Infections of Unknown Origin, Vietnam [PDF - 1.78 MB - 9 pages]
N. T. Anh et al.

Central nervous system (CNS) infection is a serious neurologic condition, although the etiology remains unknown in >50% of patients. We used metagenomic next-generation sequencing to detect viruses in 204 cerebrospinal fluid (CSF) samples from patients with acute CNS infection who were enrolled from Vietnam hospitals during 2012–2016. We detected 8 viral species in 107/204 (52.4%) of CSF samples. After virus-specific PCR confirmation, the detection rate was lowered to 30/204 (14.7%). Enteroviruses were the most common viruses detected (n = 23), followed by hepatitis B virus (3), HIV (2), molluscum contagiosum virus (1), and gemycircularvirus (1). Analysis of enterovirus sequences revealed the predominance of echovirus 30 (9). Phylogenetically, the echovirus 30 strains belonged to genogroup V and VIIb. Our results expanded knowledge about the clinical burden of enterovirus in Vietnam and underscore the challenges of identifying a plausible viral pathogen in CSF of patients with CNS infections.

EID Anh NT, Nhu L, Hong N, Phuc TM, Tam P, Huong D, et al. Viral Metagenomic Analysis of Cerebrospinal Fluid from Patients with Acute Central Nervous System Infections of Unknown Origin, Vietnam. Emerg Infect Dis. 2021;27(1):205-213. https://doi.org/10.3201/eid2701.202723
AMA Anh NT, Nhu L, Hong N, et al. Viral Metagenomic Analysis of Cerebrospinal Fluid from Patients with Acute Central Nervous System Infections of Unknown Origin, Vietnam. Emerging Infectious Diseases. 2021;27(1):205-213. doi:10.3201/eid2701.202723.
APA Anh, N. T., Nhu, L., Hong, N., Phuc, T. M., Tam, P., Huong, D....Van Tan, L. (2021). Viral Metagenomic Analysis of Cerebrospinal Fluid from Patients with Acute Central Nervous System Infections of Unknown Origin, Vietnam. Emerging Infectious Diseases, 27(1), 205-213. https://doi.org/10.3201/eid2701.202723.

Recency-Weighted Statistical Modeling Approach to Attribute Illnesses Caused by 4 Pathogens to Food Sources Using Outbreak Data, United States [PDF - 911 KB - 9 pages]
M. B. Batz et al.

Foodborne illness source attribution is foundational to a risk-based food safety system. We describe a method for attributing US foodborne illnesses caused by nontyphoidal Salmonella enterica, Escherichia coli O157, Listeria monocytogenes, and Campylobacter to 17 food categories using statistical modeling of outbreak data. This method adjusts for epidemiologic factors associated with outbreak size, down-weights older outbreaks, and estimates credibility intervals. On the basis of 952 reported outbreaks and 32,802 illnesses during 1998–2012, we attribute 77% of foodborne Salmonella illnesses to 7 food categories (seeded vegetables, eggs, chicken, other produce, pork, beef, and fruits), 82% of E. coli O157 illnesses to beef and vegetable row crops, 81% of L. monocytogenes illnesses to fruits and dairy, and 74% of Campylobacter illnesses to dairy and chicken. However, because Campylobacter outbreaks probably overrepresent dairy as a source of nonoutbreak campylobacteriosis, we caution against using these Campylobacter attribution estimates without further adjustment.

EID Batz MB, Richardson LC, Bazaco MC, Parker C, Chirtel SJ, Cole D, et al. Recency-Weighted Statistical Modeling Approach to Attribute Illnesses Caused by 4 Pathogens to Food Sources Using Outbreak Data, United States. Emerg Infect Dis. 2021;27(1):214-222. https://doi.org/10.3201/eid2701.203832
AMA Batz MB, Richardson LC, Bazaco MC, et al. Recency-Weighted Statistical Modeling Approach to Attribute Illnesses Caused by 4 Pathogens to Food Sources Using Outbreak Data, United States. Emerging Infectious Diseases. 2021;27(1):214-222. doi:10.3201/eid2701.203832.
APA Batz, M. B., Richardson, L. C., Bazaco, M. C., Parker, C., Chirtel, S. J., Cole, D....Hoekstra, R. (2021). Recency-Weighted Statistical Modeling Approach to Attribute Illnesses Caused by 4 Pathogens to Food Sources Using Outbreak Data, United States. Emerging Infectious Diseases, 27(1), 214-222. https://doi.org/10.3201/eid2701.203832.

Medscape CME Activity
Rising Ethnic Inequalities in Acute Rheumatic Fever and Rheumatic Heart Disease, New Zealand, 2000–2018 [PDF - 1.75 MB - 11 pages]
J. Bennett et al.

We describe trends in acute rheumatic fever (ARF), rheumatic heart disease (RHD), and RHD deaths among population groups in New Zealand. We analyzed initial primary ARF and RHD hospitalizations during 2000–2018 and RHD mortality rates during 2000–2016. We found elevated rates of initial ARF hospitalizations for persons of Māori (adjusted rate ratio [aRR] 11.8, 95% CI 10.0–14.0) and Pacific Islander (aRR 23.6, 95% CI 19.9–27.9) ethnicity compared with persons of European/other ethnicity. We also noted higher rates of initial RHD hospitalization for Māori (aRR 3.2, 95% CI 2.9–3.5) and Pacific Islander (aRR 4.6, 95% CI 4.2–5.1) groups and RHD deaths among these groups (Māori aRR 12.3, 95% CI 10.3–14.6, and Pacific Islanders aRR 11.2, 95% CI 9.1–13.8). Rates also were higher in socioeconomically disadvantaged neighborhoods. To curb high rates of ARF and RHD, New Zealand must address increasing social and ethnic inequalities.

EID Bennett J, Zhang J, Leung W, Jack S, Oliver J, Webb R, et al. Rising Ethnic Inequalities in Acute Rheumatic Fever and Rheumatic Heart Disease, New Zealand, 2000–2018. Emerg Infect Dis. 2021;27(1):36-46. https://doi.org/10.3201/eid2701.191791
AMA Bennett J, Zhang J, Leung W, et al. Rising Ethnic Inequalities in Acute Rheumatic Fever and Rheumatic Heart Disease, New Zealand, 2000–2018. Emerging Infectious Diseases. 2021;27(1):36-46. doi:10.3201/eid2701.191791.
APA Bennett, J., Zhang, J., Leung, W., Jack, S., Oliver, J., Webb, R....Baker, M. G. (2021). Rising Ethnic Inequalities in Acute Rheumatic Fever and Rheumatic Heart Disease, New Zealand, 2000–2018. Emerging Infectious Diseases, 27(1), 36-46. https://doi.org/10.3201/eid2701.191791.
Historical Review

Hannibal’s Ophthalmia—A New Answer to An Ancient Question [PDF - 299 KB - 3 pages]
J. T. Denholm and P. N. Hunt

In the spring of 217 bce, shortly after Hannibal’s famous elephantborne crossing of the Alps, the general was afflicted by an acute, painful eye condition that has never been adequately explained and that led to permanent unilateral loss of vision in 1 eye. In modern times, scant attention has been given to understanding this condition. We review the historical and geographic evidence and consider possible infective explanations for Hannibal's condition, including elephant-associated zoonoses. Ultimately, we suggest that a keratitis from waterborne organisms, such as Pseudomonas spp. or Acanthamoeba spp., might provide the best answer to this ancient enigma.

EID Denholm JT, Hunt PN. Hannibal’s Ophthalmia—A New Answer to An Ancient Question. Emerg Infect Dis. 2021;27(1):223-225. https://doi.org/10.3201/eid2701.191696
AMA Denholm JT, Hunt PN. Hannibal’s Ophthalmia—A New Answer to An Ancient Question. Emerging Infectious Diseases. 2021;27(1):223-225. doi:10.3201/eid2701.191696.
APA Denholm, J. T., & Hunt, P. N. (2021). Hannibal’s Ophthalmia—A New Answer to An Ancient Question. Emerging Infectious Diseases, 27(1), 223-225. https://doi.org/10.3201/eid2701.191696.
Dispatches

Severe Human Bocavirus–Associated Pneumonia in Adults at a Referral Hospital, Seoul, South Korea [PDF - 234 KB - 3 pages]
S. Choi et al.

We report a case series of severe human bocavirus–associated pneumonia in adults in Seoul, South Korea. The virus accounted for 0.5% of all severe pneumonia cases. Structural lung disease and hematologic malignancy were common underlying diseases. Overall death rate was 54.5%. Higher death rates were associated with co-infection (83.3%) and immunocompromise (80.0%).

EID Choi S, Huh J, Hong S, Jung J, Kim M, Chong Y, et al. Severe Human Bocavirus–Associated Pneumonia in Adults at a Referral Hospital, Seoul, South Korea. Emerg Infect Dis. 2021;27(1):226-228. https://doi.org/10.3201/eid2701.202061
AMA Choi S, Huh J, Hong S, et al. Severe Human Bocavirus–Associated Pneumonia in Adults at a Referral Hospital, Seoul, South Korea. Emerging Infectious Diseases. 2021;27(1):226-228. doi:10.3201/eid2701.202061.
APA Choi, S., Huh, J., Hong, S., Jung, J., Kim, M., Chong, Y....Koh, Y. (2021). Severe Human Bocavirus–Associated Pneumonia in Adults at a Referral Hospital, Seoul, South Korea. Emerging Infectious Diseases, 27(1), 226-228. https://doi.org/10.3201/eid2701.202061.

Prevalence of SARS-CoV-2, Verona, Italy, April–May 2020 [PDF - 525 KB - 4 pages]
M. Guerriero et al.

We used random sampling to estimate the prevalence of severe acute respiratory syndrome coronavirus 2 infection in Verona, Italy. Of 1,515 participants, 2.6% tested positive by serologic assay and 0.7% by reverse transcription PCR. We used latent class analysis to estimate a 3.0% probability of infection and 2.0% death rate.

EID Guerriero M, Bisoffi Z, Poli A, Micheletto C, Conti A, Pomari C. Prevalence of SARS-CoV-2, Verona, Italy, April–May 2020. Emerg Infect Dis. 2021;27(1):229-232. https://doi.org/10.3201/eid2701.202740
AMA Guerriero M, Bisoffi Z, Poli A, et al. Prevalence of SARS-CoV-2, Verona, Italy, April–May 2020. Emerging Infectious Diseases. 2021;27(1):229-232. doi:10.3201/eid2701.202740.
APA Guerriero, M., Bisoffi, Z., Poli, A., Micheletto, C., Conti, A., & Pomari, C. (2021). Prevalence of SARS-CoV-2, Verona, Italy, April–May 2020. Emerging Infectious Diseases, 27(1), 229-232. https://doi.org/10.3201/eid2701.202740.

Limited Specificity of Serologic Tests for SARS-CoV-2 Antibody Detection, Benin [PDF - 1.38 MB - 5 pages]
A. Yadouleton et al.

We used commercially available ELISAs to test 68 samples from coronavirus disease cases and prepandemic controls from Benin. We noted <25% false-positive results among controls, likely due to unspecific immune responses elicited by acute malaria. Serologic tests must be carefully evaluated to assess coronavirus disease spread and immunity in tropical regions.

EID Yadouleton A, Sander A, Moreira-Soto A, Tchibozo C, Hounkanrin G, Badou Y, et al. Limited Specificity of Serologic Tests for SARS-CoV-2 Antibody Detection, Benin. Emerg Infect Dis. 2021;27(1):233-237. https://doi.org/10.3201/eid2701.203281
AMA Yadouleton A, Sander A, Moreira-Soto A, et al. Limited Specificity of Serologic Tests for SARS-CoV-2 Antibody Detection, Benin. Emerging Infectious Diseases. 2021;27(1):233-237. doi:10.3201/eid2701.203281.
APA Yadouleton, A., Sander, A., Moreira-Soto, A., Tchibozo, C., Hounkanrin, G., Badou, Y....Drexler, J. (2021). Limited Specificity of Serologic Tests for SARS-CoV-2 Antibody Detection, Benin. Emerging Infectious Diseases, 27(1), 233-237. https://doi.org/10.3201/eid2701.203281.

Fatal Case of Chronic Jamestown Canyon Virus Encephalitis Diagnosed by Metagenomic Sequencing in Patient Receiving Rituximab [PDF - 2.12 MB - 5 pages]
I. H. Solomon et al.

A 56-year-old man receiving rituximab who had months of neurologic symptoms was found to have Jamestown Canyon virus in cerebrospinal fluid by clinical metagenomic sequencing. The patient died, and postmortem examination revealed extensive neuropathologic abnormalities. Deep sequencing enabled detailed characterization of viral genomes from the cerebrospinal fluid, cerebellum, and cerebral cortex.

EID Solomon IH, Ganesh VS, Yu G, Deng X, Wilson MR, Miller S, et al. Fatal Case of Chronic Jamestown Canyon Virus Encephalitis Diagnosed by Metagenomic Sequencing in Patient Receiving Rituximab. Emerg Infect Dis. 2021;27(1):238-242. https://doi.org/10.3201/eid2701.203448
AMA Solomon IH, Ganesh VS, Yu G, et al. Fatal Case of Chronic Jamestown Canyon Virus Encephalitis Diagnosed by Metagenomic Sequencing in Patient Receiving Rituximab. Emerging Infectious Diseases. 2021;27(1):238-242. doi:10.3201/eid2701.203448.
APA Solomon, I. H., Ganesh, V. S., Yu, G., Deng, X., Wilson, M. R., Miller, S....Piantadosi, A. (2021). Fatal Case of Chronic Jamestown Canyon Virus Encephalitis Diagnosed by Metagenomic Sequencing in Patient Receiving Rituximab. Emerging Infectious Diseases, 27(1), 238-242. https://doi.org/10.3201/eid2701.203448.

Coronavirus Disease among Workers in Food Processing, Food Manufacturing, and Agriculture Workplaces [PDF - 961 KB - 7 pages]
M. A. Waltenburg et al.

We describe coronavirus disease (COVID-19) among US food manufacturing and agriculture workers and provide updated information on meat and poultry processing workers. Among 742 food and agriculture workplaces in 30 states, 8,978 workers had confirmed COVID-19; 55 workers died. Racial and ethnic minority workers could be disproportionately affected by COVID-19.

EID Waltenburg MA, Rose CE, Victoroff T, Butterfield M, Dillaha JA, Heinzerling A, et al. Coronavirus Disease among Workers in Food Processing, Food Manufacturing, and Agriculture Workplaces. Emerg Infect Dis. 2021;27(1):243-249. https://doi.org/10.3201/eid2701.203821
AMA Waltenburg MA, Rose CE, Victoroff T, et al. Coronavirus Disease among Workers in Food Processing, Food Manufacturing, and Agriculture Workplaces. Emerging Infectious Diseases. 2021;27(1):243-249. doi:10.3201/eid2701.203821.
APA Waltenburg, M. A., Rose, C. E., Victoroff, T., Butterfield, M., Dillaha, J. A., Heinzerling, A....Honein, M. A. (2021). Coronavirus Disease among Workers in Food Processing, Food Manufacturing, and Agriculture Workplaces. Emerging Infectious Diseases, 27(1), 243-249. https://doi.org/10.3201/eid2701.203821.

Large-Scale Testing of Asymptomatic Healthcare Personnel for Severe Acute Respiratory Syndrome Coronavirus 2 [PDF - 762 KB - 5 pages]
C. A. Hogan et al.

Large-scale, 1-time testing of >12,000 asymptomatic healthcare personnel in California, USA, during April–June 2020 showed that prevalence of severe acute respiratory syndrome coronavirus 2 was low (<1%). Testing might identify asymptomatic and presymptomatic persons, including some with high viral burden, enabling prompt implementation of measures to limit nosocomial spread.

EID Hogan CA, Gombar S, Wang H, Röltgen K, Shi R, Holubar M, et al. Large-Scale Testing of Asymptomatic Healthcare Personnel for Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis. 2021;27(1):250-254. https://doi.org/10.3201/eid2701.203892
AMA Hogan CA, Gombar S, Wang H, et al. Large-Scale Testing of Asymptomatic Healthcare Personnel for Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases. 2021;27(1):250-254. doi:10.3201/eid2701.203892.
APA Hogan, C. A., Gombar, S., Wang, H., Röltgen, K., Shi, R., Holubar, M....Pinsky, B. A. (2021). Large-Scale Testing of Asymptomatic Healthcare Personnel for Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases, 27(1), 250-254. https://doi.org/10.3201/eid2701.203892.

Economic Burden of Legionnaires’ Disease, United States, 2014 [PDF - 325 KB - 3 pages]
M. Baker-Goering et al.

Through the use of published estimates of medical costs and new calculations of productivity losses, we estimate the lifetime economic burden of 2014 Legionnaires’ disease cases in the United States at ≈$835 million. This total includes $21 million in productivity losses caused by absenteeism and $412 million in productivity losses caused by premature deaths.

EID Baker-Goering M, Roy K, Edens C, Collier S. Economic Burden of Legionnaires’ Disease, United States, 2014. Emerg Infect Dis. 2021;27(1):255-257. https://doi.org/10.3201/eid2701.191198
AMA Baker-Goering M, Roy K, Edens C, et al. Economic Burden of Legionnaires’ Disease, United States, 2014. Emerging Infectious Diseases. 2021;27(1):255-257. doi:10.3201/eid2701.191198.
APA Baker-Goering, M., Roy, K., Edens, C., & Collier, S. (2021). Economic Burden of Legionnaires’ Disease, United States, 2014. Emerging Infectious Diseases, 27(1), 255-257. https://doi.org/10.3201/eid2701.191198.

Optimization of Notification Criteria for Shiga Toxin–Producing Escherichia coli Surveillance, the Netherlands [PDF - 719 KB - 4 pages]
I. Friesema et al.

We describe the consequences of 2 major changes in notification criteria for Shiga toxin–producing Escherichia coli surveillance in the Netherlands. The change to reporting acute, more severe infections appears to be a good compromise between workload, redundancy, and public health relevance, provided isolates remain available for typing and sequencing.

EID Friesema I, Kuiling S, Igloi Z, Franz E. Optimization of Notification Criteria for Shiga Toxin–Producing Escherichia coli Surveillance, the Netherlands. Emerg Infect Dis. 2021;27(1):258-261. https://doi.org/10.3201/eid2701.200339
AMA Friesema I, Kuiling S, Igloi Z, et al. Optimization of Notification Criteria for Shiga Toxin–Producing Escherichia coli Surveillance, the Netherlands. Emerging Infectious Diseases. 2021;27(1):258-261. doi:10.3201/eid2701.200339.
APA Friesema, I., Kuiling, S., Igloi, Z., & Franz, E. (2021). Optimization of Notification Criteria for Shiga Toxin–Producing Escherichia coli Surveillance, the Netherlands. Emerging Infectious Diseases, 27(1), 258-261. https://doi.org/10.3201/eid2701.200339.

Seventh Pandemic Vibrio cholerae O1 Sublineages, Central African Republic [PDF - 1.26 MB - 5 pages]
S. Breurec et al.

Four cholera outbreaks were reported in the Central African Republic during 1997–2016. We show that the outbreak isolates were Vibrio cholerae O1 serotype Inaba from 3 seventh pandemic El Tor sublineages originating from West Africa (sublineages T7 and T9) or the African Great Lakes Region (T10).

EID Breurec S, Franck T, Njamkepo E, Mbecko J, Rauzier J, Sanke-Waïgana H, et al. Seventh Pandemic Vibrio cholerae O1 Sublineages, Central African Republic. Emerg Infect Dis. 2021;27(1):262-266. https://doi.org/10.3201/eid2701.200375
AMA Breurec S, Franck T, Njamkepo E, et al. Seventh Pandemic Vibrio cholerae O1 Sublineages, Central African Republic. Emerging Infectious Diseases. 2021;27(1):262-266. doi:10.3201/eid2701.200375.
APA Breurec, S., Franck, T., Njamkepo, E., Mbecko, J., Rauzier, J., Sanke-Waïgana, H....Weill, F. (2021). Seventh Pandemic Vibrio cholerae O1 Sublineages, Central African Republic. Emerging Infectious Diseases, 27(1), 262-266. https://doi.org/10.3201/eid2701.200375.

Impact of a Nationwide Lockdown on SARS-CoV-2 Transmissibility, Italy [PDF - 847 KB - 4 pages]
G. Guzzetta et al.

On March 11, 2020, Italy imposed a national lockdown to curtail the spread of severe acute respiratory syndrome coronavirus 2. We estimate that, 14 days after lockdown, the net reproduction number had dropped below 1 and remained stable at »0.76 (95% CI 0.67–0.85) in all regions for >3 of the following weeks.

EID Guzzetta G, Riccardo F, Marziano V, Poletti P, Trentini F, Bella A, et al. Impact of a Nationwide Lockdown on SARS-CoV-2 Transmissibility, Italy. Emerg Infect Dis. 2021;27(1):267-270. https://doi.org/10.3201/eid2701.202114
AMA Guzzetta G, Riccardo F, Marziano V, et al. Impact of a Nationwide Lockdown on SARS-CoV-2 Transmissibility, Italy. Emerging Infectious Diseases. 2021;27(1):267-270. doi:10.3201/eid2701.202114.
APA Guzzetta, G., Riccardo, F., Marziano, V., Poletti, P., Trentini, F., Bella, A....Merler, S. (2021). Impact of a Nationwide Lockdown on SARS-CoV-2 Transmissibility, Italy. Emerging Infectious Diseases, 27(1), 267-270. https://doi.org/10.3201/eid2701.202114.

Geographic Range of Recreational Water–Associated Primary Amebic Meningoencephalitis, United States, 1978–2018 [PDF - 1.11 MB - 4 pages]
R. Gharpure et al.

Naegleria fowleri is a free-living ameba that causes primary amebic meningoencephalitis (PAM), a rare but usually fatal disease. We analyzed trends in recreational water exposures associated with PAM cases reported during 1978–2018 in the United States. Although PAM incidence remained stable, the geographic range of exposure locations expanded northward.

EID Gharpure R, Gleason M, Salah Z, Blackstock AJ, Hess-Homeier D, Yoder JS, et al. Geographic Range of Recreational Water–Associated Primary Amebic Meningoencephalitis, United States, 1978–2018. Emerg Infect Dis. 2021;27(1):271-274. https://doi.org/10.3201/eid2701.202119
AMA Gharpure R, Gleason M, Salah Z, et al. Geographic Range of Recreational Water–Associated Primary Amebic Meningoencephalitis, United States, 1978–2018. Emerging Infectious Diseases. 2021;27(1):271-274. doi:10.3201/eid2701.202119.
APA Gharpure, R., Gleason, M., Salah, Z., Blackstock, A. J., Hess-Homeier, D., Yoder, J. S....Cope, J. R. (2021). Geographic Range of Recreational Water–Associated Primary Amebic Meningoencephalitis, United States, 1978–2018. Emerging Infectious Diseases, 27(1), 271-274. https://doi.org/10.3201/eid2701.202119.

Emerging Human Metapneumovirus Gene Duplication Variants in Patients with Severe Acute Respiratory Infection, China, 2017–2019 [PDF - 501 KB - 3 pages]
Z. Xie et al.

We detected human metapneumovirus (HMPV) in 72 (7.1%) of 1,021 patients hospitalized with severe acute respiratory infection in Luohe, China, during 2017–2019. We detected HMPV most frequently in young children and less often in adults. HMPV genotype A2c variants 111 nt and 180 nt duplications predominated, demonstrating their continuing geographic spread.

EID Xie Z, Xu J, Ren Y, Cui A, Wang H, Song J, et al. Emerging Human Metapneumovirus Gene Duplication Variants in Patients with Severe Acute Respiratory Infection, China, 2017–2019. Emerg Infect Dis. 2021;27(1):275-277. https://doi.org/10.3201/eid2701.201043
AMA Xie Z, Xu J, Ren Y, et al. Emerging Human Metapneumovirus Gene Duplication Variants in Patients with Severe Acute Respiratory Infection, China, 2017–2019. Emerging Infectious Diseases. 2021;27(1):275-277. doi:10.3201/eid2701.201043.
APA Xie, Z., Xu, J., Ren, Y., Cui, A., Wang, H., Song, J....Zhang, Y. (2021). Emerging Human Metapneumovirus Gene Duplication Variants in Patients with Severe Acute Respiratory Infection, China, 2017–2019. Emerging Infectious Diseases, 27(1), 275-277. https://doi.org/10.3201/eid2701.201043.

Fatal 3-Nitropropionic Acid Poisoning after Consuming Coconut Water [PDF - 841 KB - 3 pages]
T. Birkelund et al.

We describe the fatal course of a patient with initial symptoms of vomiting and nausea who developed symptoms of dystonia, encephalopathy, and coma. The cause of death was poisoning with 3-nitropropionic acid from coconut water spoiled with the fungus Arthrinium saccharicola. We present the clinical findings and forensic analysis.

EID Birkelund T, Johansen RF, Illum DG, Dyrskog S, Østergaard JA, Falconer TM, et al. Fatal 3-Nitropropionic Acid Poisoning after Consuming Coconut Water. Emerg Infect Dis. 2021;27(1):278-280. https://doi.org/10.3201/eid2701.202222
AMA Birkelund T, Johansen RF, Illum DG, et al. Fatal 3-Nitropropionic Acid Poisoning after Consuming Coconut Water. Emerging Infectious Diseases. 2021;27(1):278-280. doi:10.3201/eid2701.202222.
APA Birkelund, T., Johansen, R. F., Illum, D. G., Dyrskog, S., Østergaard, J. A., Falconer, T. M....Jensen, J. S. (2021). Fatal 3-Nitropropionic Acid Poisoning after Consuming Coconut Water. Emerging Infectious Diseases, 27(1), 278-280. https://doi.org/10.3201/eid2701.202222.

In Vivo Observation of Cutaneous Larva Migrans by Fluorescence-Advanced Videodermatoscopy [PDF - 2.08 MB - 3 pages]
A. Ramondetta et al.

Fluorescence-advanced videodermatoscopy is not a widespread diagnostic technique. Its application in dermatology can facilitate the diagnosis of diseases such as cutaneous larva migrans by enabling us to recognize the precise position of larva in vivo on the skin. Using this noninvasive technique, we detected a case of cutaneous larva migrans in a patient.

EID Ramondetta A, Ribero S, Quaglino P, Broganelli P. In Vivo Observation of Cutaneous Larva Migrans by Fluorescence-Advanced Videodermatoscopy. Emerg Infect Dis. 2021;27(1):281-283. https://doi.org/10.3201/eid2701.203137
AMA Ramondetta A, Ribero S, Quaglino P, et al. In Vivo Observation of Cutaneous Larva Migrans by Fluorescence-Advanced Videodermatoscopy. Emerging Infectious Diseases. 2021;27(1):281-283. doi:10.3201/eid2701.203137.
APA Ramondetta, A., Ribero, S., Quaglino, P., & Broganelli, P. (2021). In Vivo Observation of Cutaneous Larva Migrans by Fluorescence-Advanced Videodermatoscopy. Emerging Infectious Diseases, 27(1), 281-283. https://doi.org/10.3201/eid2701.203137.

Listeriosis Caused by Persistence of Listeria monocytogenes Serotype 4b Sequence Type 6 in Cheese Production Environment [PDF - 951 KB - 5 pages]
M. Nüesch-Inderbinen et al.

A nationwide outbreak of human listeriosis in Switzerland was traced to persisting environmental contamination of a cheese dairy with Listeria monocytogenes serotype 4b, sequence type 6, cluster type 7488. Whole-genome sequencing was used to match clinical isolates to a cheese sample and to samples from numerous sites within the production environment.

EID Nüesch-Inderbinen M, Bloemberg GV, Müller A, Stevens M, Cernela N, Kollöffel B, et al. Listeriosis Caused by Persistence of Listeria monocytogenes Serotype 4b Sequence Type 6 in Cheese Production Environment. Emerg Infect Dis. 2021;27(1):284-288. https://doi.org/10.3201/eid2701.203266
AMA Nüesch-Inderbinen M, Bloemberg GV, Müller A, et al. Listeriosis Caused by Persistence of Listeria monocytogenes Serotype 4b Sequence Type 6 in Cheese Production Environment. Emerging Infectious Diseases. 2021;27(1):284-288. doi:10.3201/eid2701.203266.
APA Nüesch-Inderbinen, M., Bloemberg, G. V., Müller, A., Stevens, M., Cernela, N., Kollöffel, B....Stephan, R. (2021). Listeriosis Caused by Persistence of Listeria monocytogenes Serotype 4b Sequence Type 6 in Cheese Production Environment. Emerging Infectious Diseases, 27(1), 284-288. https://doi.org/10.3201/eid2701.203266.

Detection of Norovirus Variant GII.4 Hong Kong in Asia and Europe, 2017−2019 [PDF - 1.19 MB - 5 pages]
M. Chan et al.

We report a new norovirus GII.4 variant, GII.4 Hong Kong, with low-level circulation in 4 Eurasia countries since mid-2017. Amino acid substitutions in key residues on the virus capsid associated with the emergence of pandemic noroviruses suggest that GII.4 Hong Kong has the potential to become the next pandemic variant.

EID Chan M, Roy S, Bonifacio J, Zhang L, Chhabra P, Chan J, et al. Detection of Norovirus Variant GII.4 Hong Kong in Asia and Europe, 2017−2019. Emerg Infect Dis. 2021;27(1):289-293. https://doi.org/10.3201/eid2701.203351
AMA Chan M, Roy S, Bonifacio J, et al. Detection of Norovirus Variant GII.4 Hong Kong in Asia and Europe, 2017−2019. Emerging Infectious Diseases. 2021;27(1):289-293. doi:10.3201/eid2701.203351.
APA Chan, M., Roy, S., Bonifacio, J., Zhang, L., Chhabra, P., Chan, J....de Graaf, M. (2021). Detection of Norovirus Variant GII.4 Hong Kong in Asia and Europe, 2017−2019. Emerging Infectious Diseases, 27(1), 289-293. https://doi.org/10.3201/eid2701.203351.

Increase in Kelch 13 Polymorphisms in Plasmodium falciparum, Southern Rwanda [PDF - 343 KB - 3 pages]
C. Bergmann et al.

Artemisinin resistance in Plasmodium falciparum is associated with nonsynonymous mutations in the Kelch 13 (K13) propeller domain. We found that 12.1% (8/66) of clinical P. falciparum isolates from Huye district, Rwanda, exhibited K13 mutations, including R561H, a validated resistance marker. K13 mutations appear to be increasing in this region.

EID Bergmann C, van Loon W, Habarugira F, Tacoli C, Jäger JC, Savelsberg D, et al. Increase in Kelch 13 Polymorphisms in Plasmodium falciparum, Southern Rwanda. Emerg Infect Dis. 2021;27(1):294-296. https://doi.org/10.3201/eid2701.203527
AMA Bergmann C, van Loon W, Habarugira F, et al. Increase in Kelch 13 Polymorphisms in Plasmodium falciparum, Southern Rwanda. Emerging Infectious Diseases. 2021;27(1):294-296. doi:10.3201/eid2701.203527.
APA Bergmann, C., van Loon, W., Habarugira, F., Tacoli, C., Jäger, J. C., Savelsberg, D....Mockenhaupt, F. P. (2021). Increase in Kelch 13 Polymorphisms in Plasmodium falciparum, Southern Rwanda. Emerging Infectious Diseases, 27(1), 294-296. https://doi.org/10.3201/eid2701.203527.

Ocular Filariasis in Human Caused by Breinlia (Johnstonema) annulipapillata Nematode, Australia [PDF - 1011 KB - 4 pages]
A. V. Koehler et al.

We report a human case of ocular filariasis, caused by a species of Breinlia nematode, from Queensland, Australia. Morphological and molecular evidence indicated that the nematode Breinlia (Johnstonema) annulipapillata, or a closely related taxon, likely transmitted from a macropodid marsupial host was involved, which might represent an accidental finding or an emerging zoonosis.

EID Koehler AV, Robson J, Spratt DM, Hann J, Beveridge I, Walsh M, et al. Ocular Filariasis in Human Caused by Breinlia (Johnstonema) annulipapillata Nematode, Australia. Emerg Infect Dis. 2021;27(1):297-300. https://doi.org/10.3201/eid2701.203585
AMA Koehler AV, Robson J, Spratt DM, et al. Ocular Filariasis in Human Caused by Breinlia (Johnstonema) annulipapillata Nematode, Australia. Emerging Infectious Diseases. 2021;27(1):297-300. doi:10.3201/eid2701.203585.
APA Koehler, A. V., Robson, J., Spratt, D. M., Hann, J., Beveridge, I., Walsh, M....Gasser, R. B. (2021). Ocular Filariasis in Human Caused by Breinlia (Johnstonema) annulipapillata Nematode, Australia. Emerging Infectious Diseases, 27(1), 297-300. https://doi.org/10.3201/eid2701.203585.
Research Letters

Attitudes about COVID-19 Lockdown among General Population, France, March 2020 [PDF - 275 KB - 3 pages]
P. Peretti-Watel et al.

Because the effectiveness of a coronavirus disease lockdown in curbing coronavirus disease spread depends on public support, acquiring real-time information about the way populations reacted to the lockdown is crucial. In France, such public support remained fragile among low-income persons, probably because the lockdown exacerbated preexisting social inequalities and conflicts.

EID Peretti-Watel P, Seror V, Cortaredona S, Launay O, Raude J, Verger P, et al. Attitudes about COVID-19 Lockdown among General Population, France, March 2020. Emerg Infect Dis. 2021;27(1):301-303. https://doi.org/10.3201/eid2701.201377
AMA Peretti-Watel P, Seror V, Cortaredona S, et al. Attitudes about COVID-19 Lockdown among General Population, France, March 2020. Emerging Infectious Diseases. 2021;27(1):301-303. doi:10.3201/eid2701.201377.
APA Peretti-Watel, P., Seror, V., Cortaredona, S., Launay, O., Raude, J., Verger, P....Longitudinale, E. (2021). Attitudes about COVID-19 Lockdown among General Population, France, March 2020. Emerging Infectious Diseases, 27(1), 301-303. https://doi.org/10.3201/eid2701.201377.

Risk for SARS-CoV-2 Infection in Healthcare Workers, Turin, Italy [PDF - 336 KB - 3 pages]
A. Calcagno et al.

We measured severe acute respiratory syndrome coronavirus 2 spike protein subunits S1/S2 antibodies by using capillary electrophoresis and a chemiluminescence immunoassay for 5,444 active healthcare workers in Italy. Seroprevalence was 6.9% and higher among participants having contact with patients. Seroconversion was not observed in 37/213 previously infected participants.

EID Calcagno A, Ghisetti V, Emanuele T, Trunfio M, Faraoni S, Boglione L, et al. Risk for SARS-CoV-2 Infection in Healthcare Workers, Turin, Italy. Emerg Infect Dis. 2021;27(1):303-305. https://doi.org/10.3201/eid2701.203027
AMA Calcagno A, Ghisetti V, Emanuele T, et al. Risk for SARS-CoV-2 Infection in Healthcare Workers, Turin, Italy. Emerging Infectious Diseases. 2021;27(1):303-305. doi:10.3201/eid2701.203027.
APA Calcagno, A., Ghisetti, V., Emanuele, T., Trunfio, M., Faraoni, S., Boglione, L....Di Perri, G. (2021). Risk for SARS-CoV-2 Infection in Healthcare Workers, Turin, Italy. Emerging Infectious Diseases, 27(1), 303-305. https://doi.org/10.3201/eid2701.203027.

Nonpolio Enterovirus Activity during the COVID-19 Pandemic, Taiwan, 2020 [PDF - 809 KB - 3 pages]
S. Kuo et al.

In Taiwan, lower nonpolio enterovirus activity during the coronavirus disease pandemic in 2020 compared with 2014–2019 might be attributable to adherence to nonpharmaceutical interventions. The preventable fraction among unexposed persons indicated that 90% of nonpolio enterovirus activity might have been prevented during 2014–2019 by adopting the same measures enforced in 2020.

EID Kuo S, Tsou H, Wu H, Hsu Y, Lee F, Shih S, et al. Nonpolio Enterovirus Activity during the COVID-19 Pandemic, Taiwan, 2020. Emerg Infect Dis. 2021;27(1):306-308. https://doi.org/10.3201/eid2701.203394
AMA Kuo S, Tsou H, Wu H, et al. Nonpolio Enterovirus Activity during the COVID-19 Pandemic, Taiwan, 2020. Emerging Infectious Diseases. 2021;27(1):306-308. doi:10.3201/eid2701.203394.
APA Kuo, S., Tsou, H., Wu, H., Hsu, Y., Lee, F., Shih, S....Chen, W. J. (2021). Nonpolio Enterovirus Activity during the COVID-19 Pandemic, Taiwan, 2020. Emerging Infectious Diseases, 27(1), 306-308. https://doi.org/10.3201/eid2701.203394.

Absence of SARS-CoV-2 Transmission from Children in Isolation to Guardians, South Korea [PDF - 307 KB - 3 pages]
E. Lee et al.

We explored transmission of severe acute respiratory syndrome coronavirus 2 among 12 children and their uninfected guardians in hospital isolation rooms in South Korea. We found that, even with close frequent contact, guardians who used appropriate personal protective equipment were not infected by children with diagnosed coronavirus disease.

EID Lee E, Kim D, Chang S, Suh S, Lee J, Lee H, et al. Absence of SARS-CoV-2 Transmission from Children in Isolation to Guardians, South Korea. Emerg Infect Dis. 2021;27(1):308-310. https://doi.org/10.3201/eid2701.203450
AMA Lee E, Kim D, Chang S, et al. Absence of SARS-CoV-2 Transmission from Children in Isolation to Guardians, South Korea. Emerging Infectious Diseases. 2021;27(1):308-310. doi:10.3201/eid2701.203450.
APA Lee, E., Kim, D., Chang, S., Suh, S., Lee, J., Lee, H....Han, M. (2021). Absence of SARS-CoV-2 Transmission from Children in Isolation to Guardians, South Korea. Emerging Infectious Diseases, 27(1), 308-310. https://doi.org/10.3201/eid2701.203450.

Superspreading Event of SARS-CoV-2 Infection at a Bar, Ho Chi Minh City, Vietnam [PDF - 922 KB - 5 pages]
N. Chau et al.

We report a superspreading event of severe acute respiratory syndrome coronavirus 2 infection initiated at a bar in Vietnam with evidence of symptomatic and asymptomatic transmission, based on ministry of health reports, patient interviews, and whole-genome sequence analysis. Crowds in enclosed indoor settings with poor ventilation may be considered at high risk for transmission.

EID Chau N, Hong N, Ngoc NM, Thanh T, Khanh P, Nguyet L, et al. Superspreading Event of SARS-CoV-2 Infection at a Bar, Ho Chi Minh City, Vietnam. Emerg Infect Dis. 2021;27(1):310-314. https://doi.org/10.3201/eid2701.203480
AMA Chau N, Hong N, Ngoc NM, et al. Superspreading Event of SARS-CoV-2 Infection at a Bar, Ho Chi Minh City, Vietnam. Emerging Infectious Diseases. 2021;27(1):310-314. doi:10.3201/eid2701.203480.
APA Chau, N., Hong, N., Ngoc, N. M., Thanh, T., Khanh, P., Nguyet, L....Van Tan, L. (2021). Superspreading Event of SARS-CoV-2 Infection at a Bar, Ho Chi Minh City, Vietnam. Emerging Infectious Diseases, 27(1), 310-314. https://doi.org/10.3201/eid2701.203480.

Racial and Workplace Disparities in Seroprevalence of SARS-CoV-2, Baton Rouge, Louisiana, USA [PDF - 904 KB - 4 pages]
A. K. Feehan et al.

By using paired molecular and antibody testing for severe acute respiratory syndrome coronavirus 2 infection, we determined point prevalence and seroprevalence in Louisiana, USA, during the second phase of reopening. Infections were highly variable by race and ethnicity, work environment, and ZIP code. Census-weighted seroprevalence was 3.6%, and point prevalence was 3.0%.

EID Feehan AK, Velasco C, Fort D, Burton JH, Price-Haywood EG, Katzmarzyk PT, et al. Racial and Workplace Disparities in Seroprevalence of SARS-CoV-2, Baton Rouge, Louisiana, USA. Emerg Infect Dis. 2021;27(1):314-317. https://doi.org/10.3201/eid2701.203808
AMA Feehan AK, Velasco C, Fort D, et al. Racial and Workplace Disparities in Seroprevalence of SARS-CoV-2, Baton Rouge, Louisiana, USA. Emerging Infectious Diseases. 2021;27(1):314-317. doi:10.3201/eid2701.203808.
APA Feehan, A. K., Velasco, C., Fort, D., Burton, J. H., Price-Haywood, E. G., Katzmarzyk, P. T....Seoane, L. (2021). Racial and Workplace Disparities in Seroprevalence of SARS-CoV-2, Baton Rouge, Louisiana, USA. Emerging Infectious Diseases, 27(1), 314-317. https://doi.org/10.3201/eid2701.203808.

SARS-CoV-2 Cluster in Nursery, Poland [PDF - 486 KB - 3 pages]
M. Okarska-Napierała et al.

We report a cluster of surprisingly high spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated with a single nursery in Poland. Our findings contrast with the presumed negligible role of children in driving the SARS-CoV-2 pandemic. Children 1–2 years of age might be effective SARS-CoV-2 spreaders.

EID Okarska-Napierała M, Mańdziuk J, Kuchar E. SARS-CoV-2 Cluster in Nursery, Poland. Emerg Infect Dis. 2021;27(1):317-319. https://doi.org/10.3201/eid2701.203849
AMA Okarska-Napierała M, Mańdziuk J, Kuchar E. SARS-CoV-2 Cluster in Nursery, Poland. Emerging Infectious Diseases. 2021;27(1):317-319. doi:10.3201/eid2701.203849.
APA Okarska-Napierała, M., Mańdziuk, J., & Kuchar, E. (2021). SARS-CoV-2 Cluster in Nursery, Poland. Emerging Infectious Diseases, 27(1), 317-319. https://doi.org/10.3201/eid2701.203849.

Developing Endemicity of Schistosomiasis, Corsica, France [PDF - 722 KB - 3 pages]
C. Rothe et al.

Urogenital schistosomiasis was diagnosed in a man from Germany who had never traveled outside Europe. He likely acquired the infection in Corsica, France, but did not swim in the Cavu River, which was linked to a previous outbreak. This case highlights that transmission of schistosomiasis in Corsica is ongoing.

EID Rothe C, Zimmer T, Schunk M, Wallrauch C, Helfrich K, Gültekin F, et al. Developing Endemicity of Schistosomiasis, Corsica, France. Emerg Infect Dis. 2021;27(1):319-321. https://doi.org/10.3201/eid2701.204391
AMA Rothe C, Zimmer T, Schunk M, et al. Developing Endemicity of Schistosomiasis, Corsica, France. Emerging Infectious Diseases. 2021;27(1):319-321. doi:10.3201/eid2701.204391.
APA Rothe, C., Zimmer, T., Schunk, M., Wallrauch, C., Helfrich, K., Gültekin, F....Boissier, J. (2021). Developing Endemicity of Schistosomiasis, Corsica, France. Emerging Infectious Diseases, 27(1), 319-321. https://doi.org/10.3201/eid2701.204391.

Relapsing Fever Group Borreliae in Human-Biting Soft Ticks, Brazil [PDF - 850 KB - 4 pages]
S. Muñoz-Leal et al.

We conducted a molecular survey for Borrelia spp. in Ornithodoros ticks previously reported as biting humans. We collected specimens in natural ecosystems and inside human dwellings in 6 states in Brazil. Phylogenetic analyses unveiled the occurrence of 4 putatively new species of relapsing fever group borreliae.

EID Muñoz-Leal S, Faccini-Martínez ÁA, Teixeira BM, Martins M, Serpa MA, Oliveira G, et al. Relapsing Fever Group Borreliae in Human-Biting Soft Ticks, Brazil. Emerg Infect Dis. 2021;27(1):322-324. https://doi.org/10.3201/eid2701.200349
AMA Muñoz-Leal S, Faccini-Martínez ÁA, Teixeira BM, et al. Relapsing Fever Group Borreliae in Human-Biting Soft Ticks, Brazil. Emerging Infectious Diseases. 2021;27(1):322-324. doi:10.3201/eid2701.200349.
APA Muñoz-Leal, S., Faccini-Martínez, Á. A., Teixeira, B. M., Martins, M., Serpa, M. A., Oliveira, G....Labruna, M. B. (2021). Relapsing Fever Group Borreliae in Human-Biting Soft Ticks, Brazil. Emerging Infectious Diseases, 27(1), 322-324. https://doi.org/10.3201/eid2701.200349.

Etiology of Severe Acute Respiratory Infections, Bangladesh, 2017 [PDF - 580 KB - 3 pages]
M. R. Rahaman et al.

In April 2017, surveillance detected a surge in severe acute respiratory infections (SARI) in Bangladesh. We collected specimens from SARI patients and asymptomatic controls for analysis with multipathogen diagnostic tests. Influenza A(H1N1)pdm09 was associated with the SARI epidemic, suggesting that introducing vaccines and empiric antiviral drugs could be beneficial.

EID Rahaman MR, Alroy KA, Van Beneden CA, Friedman MS, Kennedy ED, Rahman M, et al. Etiology of Severe Acute Respiratory Infections, Bangladesh, 2017. Emerg Infect Dis. 2021;27(1):324-326. https://doi.org/10.3201/eid2701.201347
AMA Rahaman MR, Alroy KA, Van Beneden CA, et al. Etiology of Severe Acute Respiratory Infections, Bangladesh, 2017. Emerging Infectious Diseases. 2021;27(1):324-326. doi:10.3201/eid2701.201347.
APA Rahaman, M. R., Alroy, K. A., Van Beneden, C. A., Friedman, M. S., Kennedy, E. D., Rahman, M....Azziz-Baumgartner, E. (2021). Etiology of Severe Acute Respiratory Infections, Bangladesh, 2017. Emerging Infectious Diseases, 27(1), 324-326. https://doi.org/10.3201/eid2701.201347.

Waning Antibody Responses in Asymptomatic and Symptomatic SARS-CoV-2 Infection [PDF - 494 KB - 3 pages]
P. Choe et al.

We investigated the kinetics of severe acute respiratory syndrome coronavirus 2 neutralizing antibodies in 7 asymptomatic persons and 11 patients with pneumonia. The geometric mean titer of neutralizing antibodies declined from 219.4 at 2 months to 143.7 at 5 months after infection, indicating a waning antibody response.

EID Choe P, Kang C, Suh H, Jung J, Song K, Bang J, et al. Waning Antibody Responses in Asymptomatic and Symptomatic SARS-CoV-2 Infection. Emerg Infect Dis. 2021;27(1):327-329. https://doi.org/10.3201/eid2701.203515
AMA Choe P, Kang C, Suh H, et al. Waning Antibody Responses in Asymptomatic and Symptomatic SARS-CoV-2 Infection. Emerging Infectious Diseases. 2021;27(1):327-329. doi:10.3201/eid2701.203515.
APA Choe, P., Kang, C., Suh, H., Jung, J., Song, K., Bang, J....Oh, M. (2021). Waning Antibody Responses in Asymptomatic and Symptomatic SARS-CoV-2 Infection. Emerging Infectious Diseases, 27(1), 327-329. https://doi.org/10.3201/eid2701.203515.

Postmortem Stability of SARS-CoV-2 in Nasopharyngeal Mucosa [PDF - 457 KB - 3 pages]
F. Heinrich et al.

Analyses of infection chains have demonstrated that severe acute respiratory syndrome coronavirus 2 is highly transmissive. However, data on postmortem stability and infectivity are lacking. Our finding of nasopharyngeal viral RNA stability in 79 corpses showed no time-dependent decrease. Maintained infectivity is supported by virus isolation up to 35 hours postmortem.

EID Heinrich F, Meißner K, Langenwalder F, Püschel K, Nörz D, Hoffmann A, et al. Postmortem Stability of SARS-CoV-2 in Nasopharyngeal Mucosa. Emerg Infect Dis. 2021;27(1):329-331. https://doi.org/10.3201/eid2701.203112
AMA Heinrich F, Meißner K, Langenwalder F, et al. Postmortem Stability of SARS-CoV-2 in Nasopharyngeal Mucosa. Emerging Infectious Diseases. 2021;27(1):329-331. doi:10.3201/eid2701.203112.
APA Heinrich, F., Meißner, K., Langenwalder, F., Püschel, K., Nörz, D., Hoffmann, A....Heinemann, A. (2021). Postmortem Stability of SARS-CoV-2 in Nasopharyngeal Mucosa. Emerging Infectious Diseases, 27(1), 329-331. https://doi.org/10.3201/eid2701.203112.

Novel 6-Month Treatment for Drug-Resistant Tuberculosis, United States [PDF - 616 KB - 3 pages]
C. A. Haley et al.

The US Food and Drug Administration approved a 6-month regimen of pretomanid, bedaquiline, and linezolid for extensively drug-resistant or multidrug-intolerant tuberculosis after a trial in South Africa demonstrated 90% effectiveness 6 months posttreatment. We report on a patient who completed the regimen using a lower linezolid dose.

EID Haley CA, Macias P, Jasuja S, Jones BA, Rowlinson M, Jaimon R, et al. Novel 6-Month Treatment for Drug-Resistant Tuberculosis, United States. Emerg Infect Dis. 2021;27(1):332-334. https://doi.org/10.3201/eid2701.203766
AMA Haley CA, Macias P, Jasuja S, et al. Novel 6-Month Treatment for Drug-Resistant Tuberculosis, United States. Emerging Infectious Diseases. 2021;27(1):332-334. doi:10.3201/eid2701.203766.
APA Haley, C. A., Macias, P., Jasuja, S., Jones, B. A., Rowlinson, M., Jaimon, R....Goswami, N. D. (2021). Novel 6-Month Treatment for Drug-Resistant Tuberculosis, United States. Emerging Infectious Diseases, 27(1), 332-334. https://doi.org/10.3201/eid2701.203766.
Letters

Large-Scale Isolation Facilities and Potential for Secondary Infectious Disease Outbreak [PDF - 527 KB - 2 pages]
S. D. Lim and H. Tey
EID Lim SD, Tey H. Large-Scale Isolation Facilities and Potential for Secondary Infectious Disease Outbreak. Emerg Infect Dis. 2021;27(1):334-335. https://doi.org/10.3201/eid2701.203127
AMA Lim SD, Tey H. Large-Scale Isolation Facilities and Potential for Secondary Infectious Disease Outbreak. Emerging Infectious Diseases. 2021;27(1):334-335. doi:10.3201/eid2701.203127.
APA Lim, S. D., & Tey, H. (2021). Large-Scale Isolation Facilities and Potential for Secondary Infectious Disease Outbreak. Emerging Infectious Diseases, 27(1), 334-335. https://doi.org/10.3201/eid2701.203127.

Relative Bradycardia in Patients with Mild-to-Moderate Coronavirus Disease, Japan [PDF - 194 KB - 1 page]
G. Yan et al.
EID Yan G, Ang A, Tham S, Ng A, Chew K. Relative Bradycardia in Patients with Mild-to-Moderate Coronavirus Disease, Japan. Emerg Infect Dis. 2021;27(1):335. https://doi.org/10.3201/eid2701.203312
AMA Yan G, Ang A, Tham S, et al. Relative Bradycardia in Patients with Mild-to-Moderate Coronavirus Disease, Japan. Emerging Infectious Diseases. 2021;27(1):335. doi:10.3201/eid2701.203312.
APA Yan, G., Ang, A., Tham, S., Ng, A., & Chew, K. (2021). Relative Bradycardia in Patients with Mild-to-Moderate Coronavirus Disease, Japan. Emerging Infectious Diseases, 27(1), 335. https://doi.org/10.3201/eid2701.203312.
About the Cover

A Final Voyage Framed by Balance and Contrast [PDF - 819 KB - 2 pages]
B. Breedlove
EID Breedlove B. A Final Voyage Framed by Balance and Contrast. Emerg Infect Dis. 2021;27(1):336-337. https://doi.org/10.3201/eid2701.ac2701
AMA Breedlove B. A Final Voyage Framed by Balance and Contrast. Emerging Infectious Diseases. 2021;27(1):336-337. doi:10.3201/eid2701.ac2701.
APA Breedlove, B. (2021). A Final Voyage Framed by Balance and Contrast. Emerging Infectious Diseases, 27(1), 336-337. https://doi.org/10.3201/eid2701.ac2701.
Etymologia

Etymologia: Petri Dish [PDF - 454 KB - 1 page]
M. Mahajan
EID Mahajan M. Etymologia: Petri Dish. Emerg Infect Dis. 2021;27(1):261. https://doi.org/10.3201/eid2701.et2701
AMA Mahajan M. Etymologia: Petri Dish. Emerging Infectious Diseases. 2021;27(1):261. doi:10.3201/eid2701.et2701.
APA Mahajan, M. (2021). Etymologia: Petri Dish. Emerging Infectious Diseases, 27(1), 261. https://doi.org/10.3201/eid2701.et2701.
Page created: December 23, 2020
Page updated: January 27, 2021
Page reviewed: January 27, 2021
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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