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Issue Cover for Volume 28, Number 3—March 2022

Volume 28, Number 3—March 2022

[PDF - 31.73 MB - 276 pages]

Synopses

Airborne Transmission of SARS-CoV-2 Delta Variant within Tightly Monitored Isolation Facility, New Zealand (Aotearoa) [PDF - 3.68 MB - 9 pages]
A. Fox-Lewis et al.

In New Zealand, international arrivals are quarantined and undergo severe acute respiratory syndrome coronavirus 2 screening; those who test positive are transferred to a managed isolation facility (MIF). Solo traveler A and person E from a 5-person travel group (BCDEF) tested positive. After transfer to the MIF, person A and group BCDEF occupied rooms >2 meters apart across a corridor. Persons B, C, and D subsequently tested positive; viral sequences matched A and were distinct from E. The MIF was the only shared location of persons A and B, C, and D, and they had no direct contact. Security camera footage revealed 4 brief episodes of simultaneous door opening during person A’s infectious period. This public health investigation demonstrates transmission from A to B, C, and D while in the MIF, with airborne transmission the most plausible explanation. These findings are of global importance for coronavirus disease public health interventions and infection control practices.

EID Fox-Lewis A, Williamson F, Harrower J, Ren X, Sonder G, McNeill A, et al. Airborne Transmission of SARS-CoV-2 Delta Variant within Tightly Monitored Isolation Facility, New Zealand (Aotearoa). Emerg Infect Dis. 2022;28(3):501-509. https://doi.org/10.3201/eid2803.212318
AMA Fox-Lewis A, Williamson F, Harrower J, et al. Airborne Transmission of SARS-CoV-2 Delta Variant within Tightly Monitored Isolation Facility, New Zealand (Aotearoa). Emerging Infectious Diseases. 2022;28(3):501-509. doi:10.3201/eid2803.212318.
APA Fox-Lewis, A., Williamson, F., Harrower, J., Ren, X., Sonder, G., McNeill, A....Geoghegan, J. L. (2022). Airborne Transmission of SARS-CoV-2 Delta Variant within Tightly Monitored Isolation Facility, New Zealand (Aotearoa). Emerging Infectious Diseases, 28(3), 501-509. https://doi.org/10.3201/eid2803.212318.

Detection of SARS-CoV-2 in Neonatal Autopsy Tissues and Placenta [PDF - 3.61 MB - 8 pages]
S. Reagan-Steiner et al.

Severe coronavirus disease in neonates is rare. We analyzed clinical, laboratory, and autopsy findings from a neonate in the United States who was delivered at 25 weeks of gestation and died 4 days after birth; the mother had asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and preeclampsia. We observed severe diffuse alveolar damage and localized SARS-CoV-2 by immunohistochemistry, in situ hybridization, and electron microscopy of the lungs of the neonate. We localized SARS-CoV-2 RNA in neonatal heart and liver vascular endothelium by using in situ hybridization and detected SARS-CoV-2 RNA in neonatal and placental tissues by using reverse transcription PCR. Subgenomic reverse transcription PCR suggested viral replication in lung/airway, heart, and liver. These findings indicate that in utero SARS-CoV-2 transmission contributed to this neonatal death.

EID Reagan-Steiner S, Bhatnagar J, Martines RB, Milligan NS, Gisondo C, Williams FB, et al. Detection of SARS-CoV-2 in Neonatal Autopsy Tissues and Placenta. Emerg Infect Dis. 2022;28(3):510-517. https://doi.org/10.3201/eid2803.211735
AMA Reagan-Steiner S, Bhatnagar J, Martines RB, et al. Detection of SARS-CoV-2 in Neonatal Autopsy Tissues and Placenta. Emerging Infectious Diseases. 2022;28(3):510-517. doi:10.3201/eid2803.211735.
APA Reagan-Steiner, S., Bhatnagar, J., Martines, R. B., Milligan, N. S., Gisondo, C., Williams, F. B....Zaki, S. R. (2022). Detection of SARS-CoV-2 in Neonatal Autopsy Tissues and Placenta. Emerging Infectious Diseases, 28(3), 510-517. https://doi.org/10.3201/eid2803.211735.

Association of Healthcare and Aesthetic Procedures with Infections Caused by Nontuberculous Mycobacteria, France, 2012‒2020 [PDF - 1.55 MB - 9 pages]
C. Daniau et al.

We describe nontuberculous mycobacteria (NTM) infections during 2012–2020 associated with health care and aesthetic procedures in France. We obtained epidemiologic data from the national early warning response system for healtcare-associated infections and data on NTM isolates from the National Reference Center for Mycobacteria. We compared clinical and environmental isolates by using whole-genome sequencing. The 85 original cases were reported after surgery (48, 56%), other invasive procedures (28, 33%) and other procedures (9, 11%). NTM isolates belonged to rapidly growing (73, 86%) and slowly growing (10, 12%) species; in 2 cases, the species was not identified. We performed environmental investigations for 38 (45%) cases; results for 12 (32%) were positive for the same NTM species as for the infection. In 10 cases that had environmental and clinical samples whose genomes were similar, the infection source was probably the water used in the procedures. NTM infections could be preventable by using sterile water in all invasive procedures.

EID Daniau C, Lecorche E, Mougari F, Benmansour H, Bernet C, Blanchard H, et al. Association of Healthcare and Aesthetic Procedures with Infections Caused by Nontuberculous Mycobacteria, France, 2012‒2020. Emerg Infect Dis. 2022;28(3):518-526. https://doi.org/10.3201/eid2803.211791
AMA Daniau C, Lecorche E, Mougari F, et al. Association of Healthcare and Aesthetic Procedures with Infections Caused by Nontuberculous Mycobacteria, France, 2012‒2020. Emerging Infectious Diseases. 2022;28(3):518-526. doi:10.3201/eid2803.211791.
APA Daniau, C., Lecorche, E., Mougari, F., Benmansour, H., Bernet, C., Blanchard, H....Cambau, E. (2022). Association of Healthcare and Aesthetic Procedures with Infections Caused by Nontuberculous Mycobacteria, France, 2012‒2020. Emerging Infectious Diseases, 28(3), 518-526. https://doi.org/10.3201/eid2803.211791.

Medscape CME Activity
Rising Incidence of Legionnaires’ Disease and Associated Epidemiologic Patterns, United States, 1992–2018 [PDF - 3.45 MB - 12 pages]
A. E. Barskey et al.

Reported Legionnaires’ disease (LD) cases began increasing in the United States in 2003 after relatively stable numbers for >10 years; reasons for the rise are unclear. We compared epidemiologic patterns associated with cases reported to the Centers for Disease Control and Prevention before and during the rise. The age-standardized average incidence was 0.48 cases/100,000 population during 1992–2002 compared with 2.71 cases/100,000 in 2018. Reported LD incidence increased in nearly every demographic, but increases tended to be larger in demographic groups with higher incidence. During both periods, the largest number of cases occurred among White persons, but the highest incidence was in Black or African American persons. Incidence and increases in incidence were generally largest in the East North Central, Middle Atlantic, and New England divisions. Seasonality was more pronounced during 2003–2018, especially in the Northeast and Midwest. Rising incidence was most notably associated with increasing racial disparities, geographic focus, and seasonality.

EID Barskey AE, Derado G, Edens C. Rising Incidence of Legionnaires’ Disease and Associated Epidemiologic Patterns, United States, 1992–2018. Emerg Infect Dis. 2022;28(3):527-538. https://doi.org/10.3201/eid2803.211435
AMA Barskey AE, Derado G, Edens C. Rising Incidence of Legionnaires’ Disease and Associated Epidemiologic Patterns, United States, 1992–2018. Emerging Infectious Diseases. 2022;28(3):527-538. doi:10.3201/eid2803.211435.
APA Barskey, A. E., Derado, G., & Edens, C. (2022). Rising Incidence of Legionnaires’ Disease and Associated Epidemiologic Patterns, United States, 1992–2018. Emerging Infectious Diseases, 28(3), 527-538. https://doi.org/10.3201/eid2803.211435.
Research

Medscape CME Activity
Neutralizing Enterovirus D68 Antibodies in Children after 2014 Outbreak, Kansas City, Missouri, USA [PDF - 984 KB - 9 pages]
R. A. Livingston et al.

Enterovirus D68 (EV-D68) causes severe respiratory illness outbreaks among children, particularly those with asthma. We previously detected neutralizing antibodies against the predominant EV-D68 B1 clade in the 2014 outbreak in serum collected before the outbreak (2012–2013) from persons 24 months to 85 years of age. We recently detected neutralizing antibodies to the 2014 B1, B2, and D clade viruses in serum collected after the 2014 outbreak (April–May 2017) from 300 children 6 months to 18 years of age. B1 virus neutralizing antibodies were found in 100% of patients, even children born after 2014; B2 in 84.6%, and D in 99.6%. In 2017, titers increased with patient age and were higher than titers in 2012–2013 from comparably aged children. Rate of seronegativity was highest (15.3%) for B2 virus. Multivariate analysis revealed an association between asthma and higher titers against B2 and D viruses. EV-D68 seems to have circulated during 2014–2017.

EID Livingston RA, Harrison CJ, Selvarangan R. Neutralizing Enterovirus D68 Antibodies in Children after 2014 Outbreak, Kansas City, Missouri, USA. Emerg Infect Dis. 2022;28(3):539-547. https://doi.org/10.3201/eid2803.211467
AMA Livingston RA, Harrison CJ, Selvarangan R. Neutralizing Enterovirus D68 Antibodies in Children after 2014 Outbreak, Kansas City, Missouri, USA. Emerging Infectious Diseases. 2022;28(3):539-547. doi:10.3201/eid2803.211467.
APA Livingston, R. A., Harrison, C. J., & Selvarangan, R. (2022). Neutralizing Enterovirus D68 Antibodies in Children after 2014 Outbreak, Kansas City, Missouri, USA. Emerging Infectious Diseases, 28(3), 539-547. https://doi.org/10.3201/eid2803.211467.

High-Dose Convalescent Plasma for Treatment of Severe COVID-19 [PDF - 1.39 MB - 8 pages]
G. C. De Santis et al.

To assess whether high-dose coronavirus disease (COVID-19) convalescent plasma (CCP) transfusion may benefit patients with severe COVID-19, we conducted a multicenter randomized trial in Brazil. Patients with severe COVID-19 who were within 10 days of initial symptom onset were eligible. Patients in the CCP group received 3 daily doses of CCP (600 mL/d) in addition to standard treatment; control patients received standard treatment only. Primary outcomes were death rates at days 30 and 60 of study randomization. Secondary outcomes were ventilator-free days and hospital-free days. We enrolled 107 patients: 36 CCP and 71 control. At day 30, death rates were 22% for CCP and 25% for the control group; at day 60, rates were 31% for CCP and 35% for control. Needs for invasive mechanical ventilation and durations of hospital stay were similar between groups. We conclude that high-dose CCP transfused within 10 days of symptom onset provided no benefit for patients with severe COVID-19.

EID De Santis GC, Oliveira L, Garibaldi P, Almado C, Croda J, Arcanjo G, et al. High-Dose Convalescent Plasma for Treatment of Severe COVID-19. Emerg Infect Dis. 2022;28(3):548-555. https://doi.org/10.3201/eid2803.212299
AMA De Santis GC, Oliveira L, Garibaldi P, et al. High-Dose Convalescent Plasma for Treatment of Severe COVID-19. Emerging Infectious Diseases. 2022;28(3):548-555. doi:10.3201/eid2803.212299.
APA De Santis, G. C., Oliveira, L., Garibaldi, P., Almado, C., Croda, J., Arcanjo, G....Calado, R. T. (2022). High-Dose Convalescent Plasma for Treatment of Severe COVID-19. Emerging Infectious Diseases, 28(3), 548-555. https://doi.org/10.3201/eid2803.212299.

SARS-CoV-2 Period Seroprevalence and Related Factors, Hillsborough County, Florida, USA, October 2020–March 2021 [PDF - 915 KB - 8 pages]
A. R. Giuliano et al.

Estimating the actual extent of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is challenging because virus test positivity data undercount the actual number and proportion of persons infected. SARS-CoV-2 seroprevalence is a marker of past SARS-CoV-2 infection regardless of presence or severity of symptoms and therefore is a robust biomarker of infection period prevalence. We estimated SARS-CoV-2 seroprevalence among residents of Hillsborough County, Florida, USA, to determine factors independently associated with SARS-CoV-2 antibody status overall and among asymptomatic antibody-positive persons. Among 867 participants, SARS-CoV-2 period prevalence (October 2020–March 2021) was 19.5% (asymptomatic seroprevalence was 8%). Seroprevalence was 2-fold higher than reported SARS-CoV-2 virus test positivity. Factors related to social distancing (e.g., essential worker status, not practicing social distancing, contact with a virus-positive person, and length of contact exposure time) were consistently associated with seroprevalence but did not differ by time since suspected or known infection (<6 months vs. >6 months).

EID Giuliano AR, Pilon-Thomas S, Schell MJ, Abrahamsen M, Islam JY, Isaacs-Soriano K, et al. SARS-CoV-2 Period Seroprevalence and Related Factors, Hillsborough County, Florida, USA, October 2020–March 2021. Emerg Infect Dis. 2022;28(3):556-563. https://doi.org/10.3201/eid2803.211495
AMA Giuliano AR, Pilon-Thomas S, Schell MJ, et al. SARS-CoV-2 Period Seroprevalence and Related Factors, Hillsborough County, Florida, USA, October 2020–March 2021. Emerging Infectious Diseases. 2022;28(3):556-563. doi:10.3201/eid2803.211495.
APA Giuliano, A. R., Pilon-Thomas, S., Schell, M. J., Abrahamsen, M., Islam, J. Y., Isaacs-Soriano, K....Yang, Y. (2022). SARS-CoV-2 Period Seroprevalence and Related Factors, Hillsborough County, Florida, USA, October 2020–March 2021. Emerging Infectious Diseases, 28(3), 556-563. https://doi.org/10.3201/eid2803.211495.

Nowcasting (Short-Term Forecasting) of COVID-19 Hospitalizations Using Syndromic Healthcare Data, Sweden, 2020 [PDF - 1.27 MB - 8 pages]
A. Spreco et al.

We report on local nowcasting (short-term forecasting) of coronavirus disease (COVID-19) hospitalizations based on syndromic (symptom) data recorded in regular healthcare routines in Östergötland County (population ≈465,000), Sweden, early in the pandemic, when broad laboratory testing was unavailable. Daily nowcasts were supplied to the local healthcare management based on analyses of the time lag between telenursing calls with the chief complaints (cough by adult or fever by adult) and COVID-19 hospitalization. The complaint cough by adult showed satisfactory performance (Pearson correlation coefficient r>0.80; mean absolute percentage error <20%) in nowcasting the incidence of daily COVID-19 hospitalizations 14 days in advance until the incidence decreased to <1.5/100,000 population, whereas the corresponding performance for fever by adult was unsatisfactory. Our results support local nowcasting of hospitalizations on the basis of symptom data recorded in routine healthcare during the initial stage of a pandemic.

EID Spreco A, Jöud A, Eriksson O, Soltesz K, Källström R, Dahlström Ö, et al. Nowcasting (Short-Term Forecasting) of COVID-19 Hospitalizations Using Syndromic Healthcare Data, Sweden, 2020. Emerg Infect Dis. 2022;28(3):564-571. https://doi.org/10.3201/eid2803.210267
AMA Spreco A, Jöud A, Eriksson O, et al. Nowcasting (Short-Term Forecasting) of COVID-19 Hospitalizations Using Syndromic Healthcare Data, Sweden, 2020. Emerging Infectious Diseases. 2022;28(3):564-571. doi:10.3201/eid2803.210267.
APA Spreco, A., Jöud, A., Eriksson, O., Soltesz, K., Källström, R., Dahlström, Ö....Timpka, T. (2022). Nowcasting (Short-Term Forecasting) of COVID-19 Hospitalizations Using Syndromic Healthcare Data, Sweden, 2020. Emerging Infectious Diseases, 28(3), 564-571. https://doi.org/10.3201/eid2803.210267.

Infection Control Measures and Prevalence of SARS-CoV-2 IgG among 4,554 University Hospital Employees, Munich, Germany [PDF - 2.98 MB - 10 pages]
J. Erber et al.

Hospital staff are at high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the coronavirus disease (COVID-19) pandemic. This cross-sectional study aimed to determine the prevalence of SARS-CoV-2 infection in hospital staff at the University Hospital rechts der Isar in Munich, Germany, and identify modulating factors. Overall seroprevalence of SARS-CoV-2-IgG in 4,554 participants was 2.4%. Staff engaged in direct patient care, including those working in COVID-19 units, had a similar probability of being seropositive as non–patient-facing staff. Increased probability of infection was observed in staff reporting interactions with SARS-CoV-2‒infected coworkers or private contacts or exposure to COVID-19 patients without appropriate personal protective equipment. Analysis of spatiotemporal trajectories identified that distinct hotspots for SARS-CoV-2‒positive staff and patients only partially overlap. Patient-facing work in a healthcare facility during the SARS-CoV-2 pandemic might be safe as long as adequate personal protective equipment is used and infection prevention practices are followed inside and outside the hospital

EID Erber J, Kappler V, Haller B, Mijočević H, Galhoz A, Prazeres da Costa C, et al. Infection Control Measures and Prevalence of SARS-CoV-2 IgG among 4,554 University Hospital Employees, Munich, Germany. Emerg Infect Dis. 2022;28(3):572-581. https://doi.org/10.3201/eid2803.204436
AMA Erber J, Kappler V, Haller B, et al. Infection Control Measures and Prevalence of SARS-CoV-2 IgG among 4,554 University Hospital Employees, Munich, Germany. Emerging Infectious Diseases. 2022;28(3):572-581. doi:10.3201/eid2803.204436.
APA Erber, J., Kappler, V., Haller, B., Mijočević, H., Galhoz, A., Prazeres da Costa, C....Lingor, P. (2022). Infection Control Measures and Prevalence of SARS-CoV-2 IgG among 4,554 University Hospital Employees, Munich, Germany. Emerging Infectious Diseases, 28(3), 572-581. https://doi.org/10.3201/eid2803.204436.

Overseas Treatment of Latent Tuberculosis Infection in US–Bound Immigrants [PDF - 1.40 MB - 9 pages]
A. Khan et al.

Seventy percent of tuberculosis (TB) cases in the United States occur among non–US-born persons; cases usually result from reactivation of latent TB infection (LTBI) likely acquired before the person’s US arrival. We conducted a prospective study among US immigrant visa applicants undergoing the required overseas medical examination in Vietnam. Consenting applicants >15 years of age were offered an interferon-γ release assay (IGRA); those 12–14 years of age received an IGRA as part of the required examination. Eligible participants were offered LTBI treatment with 12 doses of weekly isoniazid and rifapentine. Of 5,311 immigrant visa applicants recruited, 2,438 (46%) consented to participate; 2,276 had an IGRA processed, and 484 (21%) tested positive. Among 452 participants eligible for treatment, 304 (67%) initiated treatment, and 268 (88%) completed treatment. We demonstrated that using the overseas medical examination to provide voluntary LTBI testing and treatment should be considered to advance US TB elimination efforts.

EID Khan A, Phares CR, Phuong H, Trinh D, Phan H, Merrifield C, et al. Overseas Treatment of Latent Tuberculosis Infection in US–Bound Immigrants. Emerg Infect Dis. 2022;28(3):582-590. https://doi.org/10.3201/eid2803.212131
AMA Khan A, Phares CR, Phuong H, et al. Overseas Treatment of Latent Tuberculosis Infection in US–Bound Immigrants. Emerging Infectious Diseases. 2022;28(3):582-590. doi:10.3201/eid2803.212131.
APA Khan, A., Phares, C. R., Phuong, H., Trinh, D., Phan, H., Merrifield, C....Oeltmann, J. E. (2022). Overseas Treatment of Latent Tuberculosis Infection in US–Bound Immigrants. Emerging Infectious Diseases, 28(3), 582-590. https://doi.org/10.3201/eid2803.212131.

Effectiveness of 3 COVID-19 Vaccines in Preventing SARS-CoV-2 Infections, January–May 2021, Aragon, Spain [PDF - 1.15 MB - 8 pages]
A. del Cura-Bilbao et al.

Reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is a worldwide challenge; widespread vaccination could be one strategy for control. We conducted a prospective, population-based cohort study of 964,258 residents of Aragon, Spain, during December 2020–May 2021. We used the Cox proportional-hazards model with vaccination status as the exposure condition to estimate the effectiveness of 3 coronavirus disease vaccines in preventing SARS-CoV-2 infection. Pfizer-BioNTech had 20.8% (95% CI 11.6%–29.0%) vaccine effectiveness (VE) against infection after 1 dose and 70.0% (95% CI 65.3%–74.1%) after 2 doses, Moderna had 52.8% (95% CI 30.7%–67.8%) VE after 1 dose and 70.3% (95% CI 52.2%–81.5%) after 2 doses, and Oxford-AstraZeneca had 40.3% (95% CI 31.8%–47.7%) VE after 1 dose. All estimates were lower than those from previous studies. Results imply that, although high vaccination coverage remains critical to protect people from disease, it will be difficult to effectively minimize transmission opportunities.

EID del Cura-Bilbao A, López-Mendoza H, Chaure-Pardos A, Vergara-Ugarriza A, Guimbao-Bescós J. Effectiveness of 3 COVID-19 Vaccines in Preventing SARS-CoV-2 Infections, January–May 2021, Aragon, Spain. Emerg Infect Dis. 2022;28(3):591-598. https://doi.org/10.3201/eid2803.212027
AMA del Cura-Bilbao A, López-Mendoza H, Chaure-Pardos A, et al. Effectiveness of 3 COVID-19 Vaccines in Preventing SARS-CoV-2 Infections, January–May 2021, Aragon, Spain. Emerging Infectious Diseases. 2022;28(3):591-598. doi:10.3201/eid2803.212027.
APA del Cura-Bilbao, A., López-Mendoza, H., Chaure-Pardos, A., Vergara-Ugarriza, A., & Guimbao-Bescós, J. (2022). Effectiveness of 3 COVID-19 Vaccines in Preventing SARS-CoV-2 Infections, January–May 2021, Aragon, Spain. Emerging Infectious Diseases, 28(3), 591-598. https://doi.org/10.3201/eid2803.212027.

Case–Control Study of Clostridium innocuum Infection, Taiwan [PDF - 1.25 MB - 9 pages]
Y. Chen et al.

Vancomycin-resistant Clostridium innocuum was recently identified as an etiologic agent for antibiotic-associated diarrhea in humans. We conducted a case–control study involving 152 C. innocuum-infected patients during 2014–2019 in Taiwan, using 304 cases of Clostridioides difficile infection (CDI) matched by diagnosis year, age (+2 years), and sex as controls. The baseline characteristics were similar between the 2 groups. C. innocuum–infected patients experienced more extraintestinal clostridial infection and gastrointestinal tract–related complications than did patients with CDI. The 30-day mortality rate among C. innocuum–infected patients was 14.5%, and the overall rate was 23.0%. Chronic kidney disease, solid tumor, intensive care unit admission, and shock status were 4 independent risk factors for death. C. innocuum identified from clinical specimens should be recognized as a pathogen requiring treatment, and because of its intrinsic vancomycin resistance, precise identification is necessary to guide appropriate and timely antimicrobial therapy.

EID Chen Y, Kuo Y, Chen M, Zhang Y, Chen C, Le P, et al. Case–Control Study of Clostridium innocuum Infection, Taiwan. Emerg Infect Dis. 2022;28(3):599-607. https://doi.org/10.3201/eid2803.204421
AMA Chen Y, Kuo Y, Chen M, et al. Case–Control Study of Clostridium innocuum Infection, Taiwan. Emerging Infectious Diseases. 2022;28(3):599-607. doi:10.3201/eid2803.204421.
APA Chen, Y., Kuo, Y., Chen, M., Zhang, Y., Chen, C., Le, P....Chiu, C. (2022). Case–Control Study of Clostridium innocuum Infection, Taiwan. Emerging Infectious Diseases, 28(3), 599-607. https://doi.org/10.3201/eid2803.204421.

Plasmodium falciparum pfhrp2 and pfhrp3 Gene Deletions from Persons with Symptomatic Malaria Infection in Ethiopia, Kenya, Madagascar, and Rwanda [PDF - 1.57 MB - 9 pages]
E. Rogier et al.

Histidine-rich protein 2 (HRP2)–based rapid diagnostic tests detect Plasmodium falciparum malaria and are used throughout sub-Saharan Africa. However, deletions in the pfhrp2 and related pfhrp3 (pfhrp2/3) genes threaten use of these tests. Therapeutic efficacy studies (TESs) enroll persons with symptomatic P. falciparum infection. We screened TES samples collected during 2016–2018 in Ethiopia, Kenya, Rwanda, and Madagascar for HRP2/3, pan-Plasmodium lactate dehydrogenase, and pan-Plasmodium aldolase antigen levels and selected samples with low levels of HRP2/3 for pfhrp2/3 genotyping. We observed deletion of pfhrp3 in samples from all countries except Kenya. Single-gene deletions in pfhrp2 were observed in 1.4% (95% CI 0.2%–4.8%) of Ethiopia samples and in 0.6% (95% CI 0.2%–1.6%) of Madagascar samples, and dual pfhrp2/3 deletions were noted in 2.0% (95% CI 0.4%–5.9%) of Ethiopia samples. Although this study was not powered for precise prevalence estimates, evaluating TES samples revealed a low prevalence of pfhrp2/3 deletions in most sites.

EID Rogier E, McCaffery JN, Nace D, Svigel S, Assefa A, Hwang J, et al. Plasmodium falciparum pfhrp2 and pfhrp3 Gene Deletions from Persons with Symptomatic Malaria Infection in Ethiopia, Kenya, Madagascar, and Rwanda. Emerg Infect Dis. 2022;28(3):608-616. https://doi.org/10.3201/eid2803.211499
AMA Rogier E, McCaffery JN, Nace D, et al. Plasmodium falciparum pfhrp2 and pfhrp3 Gene Deletions from Persons with Symptomatic Malaria Infection in Ethiopia, Kenya, Madagascar, and Rwanda. Emerging Infectious Diseases. 2022;28(3):608-616. doi:10.3201/eid2803.211499.
APA Rogier, E., McCaffery, J. N., Nace, D., Svigel, S., Assefa, A., Hwang, J....Halsey, E. S. (2022). Plasmodium falciparum pfhrp2 and pfhrp3 Gene Deletions from Persons with Symptomatic Malaria Infection in Ethiopia, Kenya, Madagascar, and Rwanda. Emerging Infectious Diseases, 28(3), 608-616. https://doi.org/10.3201/eid2803.211499.

Genomic and Phenotypic Insights for Toxigenic Clinical Vibrio cholerae O141 [PDF - 2.55 MB - 8 pages]
Y. Hounmanou et al.

Vibrio cholerae remains a major public health threat worldwide, causing millions of cholera cases each year. Although much is known about the evolution and pathogenicity of the O1/O139 serogroups of V. cholerae, information is lacking on the molecular epidemiology of non‒O1/O139 strains isolated from patients who have diarrheal illnesses. We performed whole-genome sequence analysis and in vivo infections to investigate characteristics of V. cholerae O141 isolated from sporadic diarrheal cases in 4 countries. The strains formed a distinct phylogenetic clade distinguishable from other serogroups and a unique multilocus sequence type 42, but interstrain variation suggests that O141 isolates are not clonal. These isolates encode virulence factors including cholera toxin and the toxin-coregulated pilus, as well as a type 3 secretion system. They had widely variable capacities for intestinal colonization in the infant mouse model. We propose that O141 isolates comprise a distinct clade of V. cholerae non‒O1/O139, and their continued surveillance is warranted.

EID Hounmanou Y, Sit B, Fakoya B, Waldor MK, Dalsgaard A. Genomic and Phenotypic Insights for Toxigenic Clinical Vibrio cholerae O141. Emerg Infect Dis. 2022;28(3):617-624. https://doi.org/10.3201/eid2803.210715
AMA Hounmanou Y, Sit B, Fakoya B, et al. Genomic and Phenotypic Insights for Toxigenic Clinical Vibrio cholerae O141. Emerging Infectious Diseases. 2022;28(3):617-624. doi:10.3201/eid2803.210715.
APA Hounmanou, Y., Sit, B., Fakoya, B., Waldor, M. K., & Dalsgaard, A. (2022). Genomic and Phenotypic Insights for Toxigenic Clinical Vibrio cholerae O141. Emerging Infectious Diseases, 28(3), 617-624. https://doi.org/10.3201/eid2803.210715.

Development and Evaluation of Statewide Prospective Spatiotemporal Legionellosis Cluster Surveillance, New Jersey, USA [PDF - 748 KB - 6 pages]
J. A. Gleason and K. M. Ross

Incidence of Legionnaires’ disease is increasing, particularly in the Mid-Atlantic states in the United States; since 2015, New Jersey has documented ≈250–350 legionellosis cases per year. We used SaTScan software to develop a semiautomated surveillance tool for prospectively detecting legionellosis clusters in New Jersey. We varied temporal window size and baseline period to evaluate optimal parameter selections. The surveillance system detected 3 community clusters of Legionnaires’ disease that were subsequently investigated. Other, smaller clusters were detected, but standard epidemiologic data did not identify common sources or new cases. The semiautomated processing is straightforward and replicable in other jurisdictions, likely by persons with even basic programming skills.

EID Gleason JA, Ross KM. Development and Evaluation of Statewide Prospective Spatiotemporal Legionellosis Cluster Surveillance, New Jersey, USA. Emerg Infect Dis. 2022;28(3):625-630. https://doi.org/10.3201/eid2803.211147
AMA Gleason JA, Ross KM. Development and Evaluation of Statewide Prospective Spatiotemporal Legionellosis Cluster Surveillance, New Jersey, USA. Emerging Infectious Diseases. 2022;28(3):625-630. doi:10.3201/eid2803.211147.
APA Gleason, J. A., & Ross, K. M. (2022). Development and Evaluation of Statewide Prospective Spatiotemporal Legionellosis Cluster Surveillance, New Jersey, USA. Emerging Infectious Diseases, 28(3), 625-630. https://doi.org/10.3201/eid2803.211147.

COVID-19 Vaccination Coverage, Behaviors, and Intentions among Adults with Previous Diagnosis, United States [PDF - 852 KB - 8 pages]
K. H. Nguyen et al.

To determine the extent of gaps in coronavirus disease (COVID-19) vaccine coverage among those in the United States with and without previous COVID-19 diagnoses, we used July 21–August 2, 2021, data from a large, nationally representative survey (Household Pulse Survey). We analyzed vaccine receipt (≥1 dose and full vaccination) and intention to be vaccinated for 63,266 persons. Vaccination receipt was lower among those who had a prior diagnosis of COVID-19 compared to those without: >1 dose: 73% and 85%, respectively, p<0.001; full vaccination: 69% and 82%, respectively, p<0.001). Reluctance to be vaccinated was higher among those with a previous COVID-19 diagnosis (14%) than among those without (9%). These findings suggest the need to focus educational and confidence-building interventions on adults when they receive a COVID-19 diagnosis, during clinic visits, or at the time of discharge if hospitalized and to better educate the public about the value of being vaccinated, regardless of previous COVID-19 status.

EID Nguyen KH, Huang J, Mansfield K, Corlin L, Allen JD. COVID-19 Vaccination Coverage, Behaviors, and Intentions among Adults with Previous Diagnosis, United States. Emerg Infect Dis. 2022;28(3):631-638. https://doi.org/10.3201/eid2803.211561
AMA Nguyen KH, Huang J, Mansfield K, et al. COVID-19 Vaccination Coverage, Behaviors, and Intentions among Adults with Previous Diagnosis, United States. Emerging Infectious Diseases. 2022;28(3):631-638. doi:10.3201/eid2803.211561.
APA Nguyen, K. H., Huang, J., Mansfield, K., Corlin, L., & Allen, J. D. (2022). COVID-19 Vaccination Coverage, Behaviors, and Intentions among Adults with Previous Diagnosis, United States. Emerging Infectious Diseases, 28(3), 631-638. https://doi.org/10.3201/eid2803.211561.

Higher Viral Stability and Ethanol Resistance of Avian Influenza A(H5N1) Virus on Human Skin [PDF - 2.82 MB - 11 pages]
R. Bandou et al.

Evaluating the stability of highly pathogenic avian influenza viruses on human skin and measuring the effectiveness of disinfectants are crucial for preventing contact disease transmission. We constructed an evaluation model using autopsy skin samples and evaluated factors that affect the stability and disinfectant effectiveness for various subtypes. The survival time of the avian influenza A(H5N1) virus on plastic surfaces was ≈26 hours and on skin surfaces ≈4.5 hours, >2.5-fold longer than other subtypes. The effectiveness of a relatively low ethanol concentration (32%–36% wt/wt) against the H5N1 subtype was substantially reduced compared with other subtypes. Moreover, recombinant viruses with the neuraminidase gene of H5N1 survived longer on plastic and skin surfaces than other recombinant viruses and were resistant to ethanol. Our results imply that the H5N1 subtype poses a higher contact transmission risk because of its higher stability and ethanol resistance, which might depend on the neuraminidase protein.

EID Bandou R, Hirose R, Nakaya T, Miyazaki H, Watanabe N, Yoshida T, et al. Higher Viral Stability and Ethanol Resistance of Avian Influenza A(H5N1) Virus on Human Skin. Emerg Infect Dis. 2022;28(3):639-649. https://doi.org/10.3201/eid2803.211752
AMA Bandou R, Hirose R, Nakaya T, et al. Higher Viral Stability and Ethanol Resistance of Avian Influenza A(H5N1) Virus on Human Skin. Emerging Infectious Diseases. 2022;28(3):639-649. doi:10.3201/eid2803.211752.
APA Bandou, R., Hirose, R., Nakaya, T., Miyazaki, H., Watanabe, N., Yoshida, T....Ikegaya, H. (2022). Higher Viral Stability and Ethanol Resistance of Avian Influenza A(H5N1) Virus on Human Skin. Emerging Infectious Diseases, 28(3), 639-649. https://doi.org/10.3201/eid2803.211752.

Spatiotemporal Analyses of 2 Co-Circulating SARS-CoV-2 Variants, New York State, USA [PDF - 3.34 MB - 10 pages]
A. Russell et al.

The emergence of novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants in late 2020 and early 2021 raised alarm worldwide because of their potential for increased transmissibility and immune evasion. Elucidating the evolutionary and epidemiologic dynamics among novel SARS-CoV-2 variants is essential for understanding the trajectory of the coronavirus disease pandemic. We describe the interplay between B.1.1.7 (Alpha) and B.1.526 (Iota) variants in New York State, USA, during December 2020–April 2021 through phylogeographic analyses, space-time scan statistics, and cartographic visualization. Our results indicate that B.1.526 probably evolved in New York City, where it was displaced as the dominant lineage by B.1.1.7 months after its initial appearance. In contrast, B.1.1.7 became dominant earlier in regions with fewer B.1.526 infections. These results suggest that B.1.526 might have delayed the initial spread of B.1.1.7 in New York City. Our combined spatiotemporal methodologies can help disentangle the complexities of shifting SARS-CoV-2 variant landscapes.

EID Russell A, O’Connor C, Lasek-Nesselquist E, Plitnick J, Kelly JP, Lamson DM, et al. Spatiotemporal Analyses of 2 Co-Circulating SARS-CoV-2 Variants, New York State, USA. Emerg Infect Dis. 2022;28(3):650-659. https://doi.org/10.3201/eid2803.211972
AMA Russell A, O’Connor C, Lasek-Nesselquist E, et al. Spatiotemporal Analyses of 2 Co-Circulating SARS-CoV-2 Variants, New York State, USA. Emerging Infectious Diseases. 2022;28(3):650-659. doi:10.3201/eid2803.211972.
APA Russell, A., O’Connor, C., Lasek-Nesselquist, E., Plitnick, J., Kelly, J. P., Lamson, D. M....St. George, K. (2022). Spatiotemporal Analyses of 2 Co-Circulating SARS-CoV-2 Variants, New York State, USA. Emerging Infectious Diseases, 28(3), 650-659. https://doi.org/10.3201/eid2803.211972.

Treatment Outcomes of Childhood Tuberculous Meningitis in a Real-World Retrospective Cohort, Bandung, Indonesia [PDF - 1.17 MB - 12 pages]
H. M. Nataprawira et al.

We retrospectively evaluated clinical features and outcomes in children treated for tuberculous meningitis (TBM) at Hasan Sadikin Hospital, Bandung, Indonesia, during 2011–2020. Among 283 patients, 153 (54.1%) were <5 years of age, and 226 (79.9%) had stage II or III TBM. Predictors of in-hospital death (n = 44 [15.5%]) were stage III TBM, hydrocephalus, male sex, low-income parents, seizures at admission, and lack of bacillus Calmette-Guérin vaccination. Predictors of postdischarge death (n = 18 [6.4%]) were hydrocephalus, tuberculoma, and lack of bacillus Calmette-Guérin vaccination. At treatment completion, 91 (32.1%) patients were documented to have survived, of whom 33 (36.3%) had severe neurologic sequelae and 118 (41.7%) had unknown outcomes. Predictors of severe neurologic sequelae were baseline temperature >38°C, stage III TBM, and baseline motor deficit. Despite treatment, childhood TBM in Indonesia causes substantial neurologic sequelae and death, highlighting the importance of improved early diagnosis, better tuberculosis prevention, and optimized TBM management strategies.

EID Nataprawira HM, Gafar F, Risan NA, Wulandari DA, Sudarwati S, Marais BJ, et al. Treatment Outcomes of Childhood Tuberculous Meningitis in a Real-World Retrospective Cohort, Bandung, Indonesia. Emerg Infect Dis. 2022;28(3):660-671. https://doi.org/10.3201/eid2803.212230
AMA Nataprawira HM, Gafar F, Risan NA, et al. Treatment Outcomes of Childhood Tuberculous Meningitis in a Real-World Retrospective Cohort, Bandung, Indonesia. Emerging Infectious Diseases. 2022;28(3):660-671. doi:10.3201/eid2803.212230.
APA Nataprawira, H. M., Gafar, F., Risan, N. A., Wulandari, D. A., Sudarwati, S., Marais, B. J....Ruslami, R. (2022). Treatment Outcomes of Childhood Tuberculous Meningitis in a Real-World Retrospective Cohort, Bandung, Indonesia. Emerging Infectious Diseases, 28(3), 660-671. https://doi.org/10.3201/eid2803.212230.

Evaluation of Commercially Available High-Throughput SARS-CoV-2 Serologic Assays for Serosurveillance and Related Applications [PDF - 2.82 MB - 12 pages]
M. Stone et al.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurveys can estimate cumulative incidence for monitoring epidemics, requiring assessment of serologic assays to inform testing algorithm development and interpretation of results. We conducted a multilaboratory evaluation of 21 commercial high-throughput SARS-CoV-2 serologic assays using blinded panels of 1,000 highly characterized specimens. Assays demonstrated a range of sensitivities (96%–63%), specificities (99%–96%), and precision (intraclass correlation coefficient 0.55–0.99). Durability of antibody detection was dependent on antigen and immunoglobulin targets; antispike and total Ig assays demonstrated more stable longitudinal reactivity than antinucleocapsid and IgG assays. Assays with high sensitivity, specificity, and durable antibody detection are ideal for serosurveillance, but assays demonstrating waning reactivity are appropriate for other applications, including correlation with neutralizing activity and detection of anamnestic boosting by reinfections. Assay performance must be evaluated in context of intended use, particularly in the context of widespread vaccination and circulation of SARS-CoV-2 variants.

EID Stone M, Grebe E, Sulaeman H, Di Germanio C, Dave H, Kelly K, et al. Evaluation of Commercially Available High-Throughput SARS-CoV-2 Serologic Assays for Serosurveillance and Related Applications. Emerg Infect Dis. 2022;28(3):672-683. https://doi.org/10.3201/eid2803.211885
AMA Stone M, Grebe E, Sulaeman H, et al. Evaluation of Commercially Available High-Throughput SARS-CoV-2 Serologic Assays for Serosurveillance and Related Applications. Emerging Infectious Diseases. 2022;28(3):672-683. doi:10.3201/eid2803.211885.
APA Stone, M., Grebe, E., Sulaeman, H., Di Germanio, C., Dave, H., Kelly, K....Busch, M. P. (2022). Evaluation of Commercially Available High-Throughput SARS-CoV-2 Serologic Assays for Serosurveillance and Related Applications. Emerging Infectious Diseases, 28(3), 672-683. https://doi.org/10.3201/eid2803.211885.

Retrospective Cohort Study of Effects of the COVID-19 Pandemic on Tuberculosis Notifications, Vietnam, 2020 [PDF - 2.95 MB - 9 pages]
T. Hasan et al.

We evaluated the effects of the coronavirus disease pandemic on diagnosis of and treatment for tuberculosis (TB) in Vietnam. We obtained quarterly notifications for TB and multidrug-resistant/rifampin-resistant (MDR/RR) TB from 2015–2020 and evaluated changes in monthly TB case notifications. We used an interrupted time series to assess the change in notifications and treatment outcomes. Overall, TB case notifications were 8% lower in 2020 than in 2019; MDR/RR TB notifications were 1% lower. TB case notifications decreased by 364 (95% CI −1,236 to 508) notifications per quarter and MDR/RR TB by 1 (95% CI −129 to 132) notification per quarter. The proportion of successful TB treatment outcomes decreased by 0.1% per quarter (95% CI −1.1% to 0.8%) in 2020 compared with previous years. Our study suggests that Vietnam was able to maintain its TB response in 2020, despite the pandemic.

EID Hasan T, Nguyen V, Nguyen H, Nguyen T, Le H, Pham CD, et al. Retrospective Cohort Study of Effects of the COVID-19 Pandemic on Tuberculosis Notifications, Vietnam, 2020. Emerg Infect Dis. 2022;28(3):684-692. https://doi.org/10.3201/eid2803.211919
AMA Hasan T, Nguyen V, Nguyen H, et al. Retrospective Cohort Study of Effects of the COVID-19 Pandemic on Tuberculosis Notifications, Vietnam, 2020. Emerging Infectious Diseases. 2022;28(3):684-692. doi:10.3201/eid2803.211919.
APA Hasan, T., Nguyen, V., Nguyen, H., Nguyen, T., Le, H., Pham, C. D....Fox, G. J. (2022). Retrospective Cohort Study of Effects of the COVID-19 Pandemic on Tuberculosis Notifications, Vietnam, 2020. Emerging Infectious Diseases, 28(3), 684-692. https://doi.org/10.3201/eid2803.211919.

Novel Hendra Virus Variant Detected by Sentinel Surveillance of Horses in Australia [PDF - 5.02 MB - 12 pages]
E. J. Annand et al.

We identified and isolated a novel Hendra virus (HeV) variant not detected by routine testing from a horse in Queensland, Australia, that died from acute illness with signs consistent with HeV infection. Using whole-genome sequencing and phylogenetic analysis, we determined the variant had ≈83% nt identity with prototypic HeV. In silico and in vitro comparisons of the receptor-binding protein with prototypic HeV support that the human monoclonal antibody m102.4 used for postexposure prophylaxis and current equine vaccine will be effective against this variant. An updated quantitative PCR developed for routine surveillance resulted in subsequent case detection. Genetic sequence consistency with virus detected in grey-headed flying foxes suggests the variant circulates at least among this species. Studies are needed to determine infection kinetics, pathogenicity, reservoir-species associations, viral-host coevolution, and spillover dynamics for this virus. Surveillance and biosecurity practices should be updated to acknowledge HeV spillover risk across all regions frequented by flying foxes.

EID Annand EJ, Horsburgh BA, Xu K, Reid PA, Poole B, de Kantzow MC, et al. Novel Hendra Virus Variant Detected by Sentinel Surveillance of Horses in Australia. Emerg Infect Dis. 2022;28(3):693-704. https://doi.org/10.3201/eid2803.211245
AMA Annand EJ, Horsburgh BA, Xu K, et al. Novel Hendra Virus Variant Detected by Sentinel Surveillance of Horses in Australia. Emerging Infectious Diseases. 2022;28(3):693-704. doi:10.3201/eid2803.211245.
APA Annand, E. J., Horsburgh, B. A., Xu, K., Reid, P. A., Poole, B., de Kantzow, M. C....Eden, J. (2022). Novel Hendra Virus Variant Detected by Sentinel Surveillance of Horses in Australia. Emerging Infectious Diseases, 28(3), 693-704. https://doi.org/10.3201/eid2803.211245.
Dispatches

Encephalitozoon cuniculi and Extraintestinal Microsporidiosis in Bird Owners [PDF - 1.19 MB - 4 pages]
M. Kicia et al.

We identified Encephalitozoon cuniculi genotype II parasites as a cause of extraintestinal microsporidiosis in 2 owners of birds also infected with E. cuniculi. Patients experienced long-lasting nonspecific symptoms; the disease course was more progressive in a patient with diabetes. Our findings suggest direct bird-to-human transmission of this pathogen.

EID Kicia M, Zajączkowska Ż, Kváč M, Cebulski K, Holubová N, Wencel P, et al. Encephalitozoon cuniculi and Extraintestinal Microsporidiosis in Bird Owners. Emerg Infect Dis. 2022;28(3):705-708. https://doi.org/10.3201/eid2803.211556
AMA Kicia M, Zajączkowska Ż, Kváč M, et al. Encephalitozoon cuniculi and Extraintestinal Microsporidiosis in Bird Owners. Emerging Infectious Diseases. 2022;28(3):705-708. doi:10.3201/eid2803.211556.
APA Kicia, M., Zajączkowska, Ż., Kváč, M., Cebulski, K., Holubová, N., Wencel, P....Sak, B. (2022). Encephalitozoon cuniculi and Extraintestinal Microsporidiosis in Bird Owners. Emerging Infectious Diseases, 28(3), 705-708. https://doi.org/10.3201/eid2803.211556.

Epidemiology of COVID-19 after Emergence of SARS-CoV-2 Gamma Variant, Brazilian Amazon, 2020–2021 [PDF - 1.27 MB - 4 pages]
V. C. Nicolete et al.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Gamma variant has been hypothesized to cause more severe illness than previous variants, especially in children. Successive SARS-CoV-2 IgG serosurveys in the Brazilian Amazon showed that age-specific attack rates and proportions of symptomatic SARS-CoV-2 infections were similar before and after Gamma variant emergence.

EID Nicolete VC, Rodrigues PT, Fernandes A, Corder RM, Tonini J, Buss LF, et al. Epidemiology of COVID-19 after Emergence of SARS-CoV-2 Gamma Variant, Brazilian Amazon, 2020–2021. Emerg Infect Dis. 2022;28(3):709-712. https://doi.org/10.3201/eid2803.211993
AMA Nicolete VC, Rodrigues PT, Fernandes A, et al. Epidemiology of COVID-19 after Emergence of SARS-CoV-2 Gamma Variant, Brazilian Amazon, 2020–2021. Emerging Infectious Diseases. 2022;28(3):709-712. doi:10.3201/eid2803.211993.
APA Nicolete, V. C., Rodrigues, P. T., Fernandes, A., Corder, R. M., Tonini, J., Buss, L. F....Ferreira, M. U. (2022). Epidemiology of COVID-19 after Emergence of SARS-CoV-2 Gamma Variant, Brazilian Amazon, 2020–2021. Emerging Infectious Diseases, 28(3), 709-712. https://doi.org/10.3201/eid2803.211993.

Return of Norovirus and Rotavirus Activity in Winter 2020‒21 in City with Strict COVID-19 Control Strategy, China [PDF - 1.65 MB - 4 pages]
M. Chan

A rapid decrease in viral gastroenteritis during winter 2019–20 and a return of norovirus and rotavirus activity during winter 2020–21 were observed while multiple nonpharmaceutical interventions for coronavirus disease were in effect in Hong Kong. The initial collateral benefit of coronavirus disease countermeasures that reduced the viral gastroenteritis burden is not sustainable.

EID Chan M. Return of Norovirus and Rotavirus Activity in Winter 2020‒21 in City with Strict COVID-19 Control Strategy, China. Emerg Infect Dis. 2022;28(3):713-716. https://doi.org/10.3201/eid2803.212117
AMA Chan M. Return of Norovirus and Rotavirus Activity in Winter 2020‒21 in City with Strict COVID-19 Control Strategy, China. Emerging Infectious Diseases. 2022;28(3):713-716. doi:10.3201/eid2803.212117.
APA Chan, M. (2022). Return of Norovirus and Rotavirus Activity in Winter 2020‒21 in City with Strict COVID-19 Control Strategy, China. Emerging Infectious Diseases, 28(3), 713-716. https://doi.org/10.3201/eid2803.212117.

Relationship of SARS-CoV-2 Antigen and Reverse Transcription PCR Positivity for Viral Cultures [PDF - 699 KB - 4 pages]
D. W. Currie et al.

We assessed the relationship between antigen and reverse transcription PCR (RT-PCR) test positivity and successful virus isolation. We found that antigen test results were more predictive of virus recovery than RT-PCR results. However, virus was isolated from some antigen-negative and RT-PCR‒positive paired specimens, providing support for the Centers for Disease Control and Prevention antigen testing algorithm.

EID Currie DW, Shah MM, Salvatore PP, Ford L, Whaley MJ, Meece J, et al. Relationship of SARS-CoV-2 Antigen and Reverse Transcription PCR Positivity for Viral Cultures. Emerg Infect Dis. 2022;28(3):717-720. https://doi.org/10.3201/eid2803.211747
AMA Currie DW, Shah MM, Salvatore PP, et al. Relationship of SARS-CoV-2 Antigen and Reverse Transcription PCR Positivity for Viral Cultures. Emerging Infectious Diseases. 2022;28(3):717-720. doi:10.3201/eid2803.211747.
APA Currie, D. W., Shah, M. M., Salvatore, P. P., Ford, L., Whaley, M. J., Meece, J....Tate, J. E. (2022). Relationship of SARS-CoV-2 Antigen and Reverse Transcription PCR Positivity for Viral Cultures. Emerging Infectious Diseases, 28(3), 717-720. https://doi.org/10.3201/eid2803.211747.

Disseminated Histoplasmosis in Persons with HIV/AIDS, Southern Brazil, 2010–2019 [PDF - 904 KB - 4 pages]
R. Basso et al.

We evaluated disseminated histoplasmosis (DH) in HIV patients over 10 years in southern Brazil. The incidence was 12 cases/1,000 hospitalizations (2010–2019); the mortality rate was 35%. Tuberculosis frequently obscured the diagnosis of DH. We emphasize the need in our region to suspect and investigate DH using more sensitive methods.

EID Basso R, Poester V, Benelli J, Stevens DA, Xavier M. Disseminated Histoplasmosis in Persons with HIV/AIDS, Southern Brazil, 2010–2019. Emerg Infect Dis. 2022;28(3):721-724. https://doi.org/10.3201/eid2803.212150
AMA Basso R, Poester V, Benelli J, et al. Disseminated Histoplasmosis in Persons with HIV/AIDS, Southern Brazil, 2010–2019. Emerging Infectious Diseases. 2022;28(3):721-724. doi:10.3201/eid2803.212150.
APA Basso, R., Poester, V., Benelli, J., Stevens, D. A., & Xavier, M. (2022). Disseminated Histoplasmosis in Persons with HIV/AIDS, Southern Brazil, 2010–2019. Emerging Infectious Diseases, 28(3), 721-724. https://doi.org/10.3201/eid2803.212150.

Transovarial Transmission of Heartland Virus by Invasive Asian Longhorned Ticks under Laboratory Conditions [PDF - 913 KB - 4 pages]
W. R. Raney et al.

We demonstrated experimental acquisition and transmission of Heartland bandavirus by Haemaphysalis longicornis ticks. Virus was detected in tick salivary gland and midgut tissues. A total of 80% of mice exposed to 1 infected tick seroconverted, suggesting horizontal transmission. H. longicornis ticks can transmit the virus in the transovarial mode.

EID Raney WR, Perry JB, Hermance ME. Transovarial Transmission of Heartland Virus by Invasive Asian Longhorned Ticks under Laboratory Conditions. Emerg Infect Dis. 2022;28(3):726-729. https://doi.org/10.3201/eid2803.210973
AMA Raney WR, Perry JB, Hermance ME. Transovarial Transmission of Heartland Virus by Invasive Asian Longhorned Ticks under Laboratory Conditions. Emerging Infectious Diseases. 2022;28(3):726-729. doi:10.3201/eid2803.210973.
APA Raney, W. R., Perry, J. B., & Hermance, M. E. (2022). Transovarial Transmission of Heartland Virus by Invasive Asian Longhorned Ticks under Laboratory Conditions. Emerging Infectious Diseases, 28(3), 726-729. https://doi.org/10.3201/eid2803.210973.

Long-Term Symptoms among COVID-19 Survivors in Prospective Cohort Study, Brazil [PDF - 1.00 MB - 4 pages]
L. P. Bonifácio et al.

We conducted a prospective cohort study in a population with diverse ethnic backgrounds from Brazil to assess clinically meaningful symptoms after surviving coronavirus disease. For most of the 175 patients in the study, clinically meaningful symptoms, including fatigue, dyspnea, cough, headache, and muscle weakness, persisted for >120 days after disease onset.

EID Bonifácio LP, Csizmar V, Barbosa-Júnior F, Pereira A, Koenigkam-Santos M, Wada DT, et al. Long-Term Symptoms among COVID-19 Survivors in Prospective Cohort Study, Brazil. Emerg Infect Dis. 2022;28(3):730-733. https://doi.org/10.3201/eid2803.212020
AMA Bonifácio LP, Csizmar V, Barbosa-Júnior F, et al. Long-Term Symptoms among COVID-19 Survivors in Prospective Cohort Study, Brazil. Emerging Infectious Diseases. 2022;28(3):730-733. doi:10.3201/eid2803.212020.
APA Bonifácio, L. P., Csizmar, V., Barbosa-Júnior, F., Pereira, A., Koenigkam-Santos, M., Wada, D. T....Bellissimo-Rodrigues, F. (2022). Long-Term Symptoms among COVID-19 Survivors in Prospective Cohort Study, Brazil. Emerging Infectious Diseases, 28(3), 730-733. https://doi.org/10.3201/eid2803.212020.

Ebola Virus Glycoprotein IgG Seroprevalence in Community Previously Affected by Ebola, Sierra Leone [PDF - 1.05 MB - 5 pages]
D. Manno et al.

We explored the association of Ebola virus antibody seropositivity and concentration with potential risk factors for infection. Among 1,282 adults and children from a community affected by the 2014–2016 Ebola outbreak in Sierra Leone, 8% were seropositive for virus antibodies but never experienced disease symptoms. Antibody concentration increased with age.

EID Manno D, Ayieko P, Ishola D, Afolabi MO, Rogers B, Baiden F, et al. Ebola Virus Glycoprotein IgG Seroprevalence in Community Previously Affected by Ebola, Sierra Leone. Emerg Infect Dis. 2022;28(3):734-738. https://doi.org/10.3201/eid2803.211496
AMA Manno D, Ayieko P, Ishola D, et al. Ebola Virus Glycoprotein IgG Seroprevalence in Community Previously Affected by Ebola, Sierra Leone. Emerging Infectious Diseases. 2022;28(3):734-738. doi:10.3201/eid2803.211496.
APA Manno, D., Ayieko, P., Ishola, D., Afolabi, M. O., Rogers, B., Baiden, F....Watson-Jones, D. (2022). Ebola Virus Glycoprotein IgG Seroprevalence in Community Previously Affected by Ebola, Sierra Leone. Emerging Infectious Diseases, 28(3), 734-738. https://doi.org/10.3201/eid2803.211496.

Effects of COVID-19 Pandemic Response on Service Provision for Sexually Transmitted Infections, HIV, and Viral Hepatitis, England [PDF - 1019 KB - 4 pages]
H. D. Mitchell et al.

Since the coronavirus disease pandemic response began in March 2020, tests, vaccinations, diagnoses, and treatment initiations for sexual health, HIV, and viral hepatitis in England have declined. The shift towards online and outreach services happened rapidly during 2020 and highlights the need to evaluate the effects of these strategies on health inequalities.

EID Mitchell HD, Vilaplana T, Mandal S, Ratna N, Glancy M, Shah A, et al. Effects of COVID-19 Pandemic Response on Service Provision for Sexually Transmitted Infections, HIV, and Viral Hepatitis, England. Emerg Infect Dis. 2022;28(3):739-742. https://doi.org/10.3201/eid2803.211998
AMA Mitchell HD, Vilaplana T, Mandal S, et al. Effects of COVID-19 Pandemic Response on Service Provision for Sexually Transmitted Infections, HIV, and Viral Hepatitis, England. Emerging Infectious Diseases. 2022;28(3):739-742. doi:10.3201/eid2803.211998.
APA Mitchell, H. D., Vilaplana, T., Mandal, S., Ratna, N., Glancy, M., Shah, A....Hughes, G. (2022). Effects of COVID-19 Pandemic Response on Service Provision for Sexually Transmitted Infections, HIV, and Viral Hepatitis, England. Emerging Infectious Diseases, 28(3), 739-742. https://doi.org/10.3201/eid2803.211998.
Photo Quizzes

Photo Quiz [PDF - 1.15 MB - 4 pages]
D. Orsini and M. Martini
EID Orsini D, Martini M. Photo Quiz. Emerg Infect Dis. 2022;28(3):743-746. https://doi.org/10.3201/eid2803.204699
AMA Orsini D, Martini M. Photo Quiz. Emerging Infectious Diseases. 2022;28(3):743-746. doi:10.3201/eid2803.204699.
APA Orsini, D., & Martini, M. (2022). Photo Quiz. Emerging Infectious Diseases, 28(3), 743-746. https://doi.org/10.3201/eid2803.204699.
Research Letters

Mycobacterium leprae Infection in a Wild Nine-Banded Armadillo, Nuevo León, Mexico [PDF - 1.98 MB - 3 pages]
L. Vera-Cabrera et al.

Nine-banded armadillos (Dasypus novemcinctus) are naturally infected with Mycobacterium leprae and are implicated in the zoonotic transmission of leprosy in the United States. In Mexico, the existence of such a reservoir remains to be characterized. We describe a wild armadillo infected by M. leprae in the state of Nuevo León, Mexico.

EID Vera-Cabrera L, Ramos-Cavazos CJ, Youssef NA, Pearce CM, Molina-Torres CA, Avalos-Ramirez R, et al. Mycobacterium leprae Infection in a Wild Nine-Banded Armadillo, Nuevo León, Mexico. Emerg Infect Dis. 2022;28(3):747-749. https://doi.org/10.3201/eid2803.211295
AMA Vera-Cabrera L, Ramos-Cavazos CJ, Youssef NA, et al. Mycobacterium leprae Infection in a Wild Nine-Banded Armadillo, Nuevo León, Mexico. Emerging Infectious Diseases. 2022;28(3):747-749. doi:10.3201/eid2803.211295.
APA Vera-Cabrera, L., Ramos-Cavazos, C. J., Youssef, N. A., Pearce, C. M., Molina-Torres, C. A., Avalos-Ramirez, R....Avanzi, C. (2022). Mycobacterium leprae Infection in a Wild Nine-Banded Armadillo, Nuevo León, Mexico. Emerging Infectious Diseases, 28(3), 747-749. https://doi.org/10.3201/eid2803.211295.

Sensitivity of Mycobacterium leprae to Telacebec [PDF - 1.05 MB - 3 pages]
R. Lahiri et al.

The treatment of leprosy is long and complex, benefiting from the development of sterilizing, rapidly-acting drugs. Reductive evolution made Mycobacterium leprae exquisitely sensitive to Telacebec, a phase 2 drug candidate for tuberculosis. The unprecedented potency of Telacebec against M. leprae warrants further validation in clinical trials.

EID Lahiri R, Adams LB, Thomas S, Pethe K. Sensitivity of Mycobacterium leprae to Telacebec. Emerg Infect Dis. 2022;28(3):749-751. https://doi.org/10.3201/eid2803.210394
AMA Lahiri R, Adams LB, Thomas S, et al. Sensitivity of Mycobacterium leprae to Telacebec. Emerging Infectious Diseases. 2022;28(3):749-751. doi:10.3201/eid2803.210394.
APA Lahiri, R., Adams, L. B., Thomas, S., & Pethe, K. (2022). Sensitivity of Mycobacterium leprae to Telacebec. Emerging Infectious Diseases, 28(3), 749-751. https://doi.org/10.3201/eid2803.210394.

Mycobacterium mageritense Lymphadenitis in Child [PDF - 654 KB - 2 pages]
M. García-Boyano et al.

Although human infections caused by Mycobacterium mageritense are rare, there are some case reports involving sinusitis, pneumonia, and hospital-acquired infections in adults. We report a case of lymphadenitis caused by M. mageritense in a child in Spain.

EID García-Boyano M, Baquero-Artigao F, Toro C, Alguacil-Guillén M, Lázaro-Perona F, Calvo C. Mycobacterium mageritense Lymphadenitis in Child. Emerg Infect Dis. 2022;28(3):752-753. https://doi.org/10.3201/eid2803.211486
AMA García-Boyano M, Baquero-Artigao F, Toro C, et al. Mycobacterium mageritense Lymphadenitis in Child. Emerging Infectious Diseases. 2022;28(3):752-753. doi:10.3201/eid2803.211486.
APA García-Boyano, M., Baquero-Artigao, F., Toro, C., Alguacil-Guillén, M., Lázaro-Perona, F., & Calvo, C. (2022). Mycobacterium mageritense Lymphadenitis in Child. Emerging Infectious Diseases, 28(3), 752-753. https://doi.org/10.3201/eid2803.211486.

SARS-CoV-2 Breakthrough Infections after introduction of 4 COVID-19 Vaccines, South Korea, 2021 [PDF - 821 KB - 4 pages]
S. Yi et al.

We conducted a nationwide retrospective cohort study to estimate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) breakthrough infection among recipients of 4 different vaccines in South Korea. Age-adjusted breakthrough infection rate per month was highest for Janssen (42.6/100,000 population), followed by AstraZeneca (21.7/100,000 population), Pfizer-BioNTech (8.5/100,000 population), and Moderna (1.8/100,000 population).

EID Yi S, Choe Y, Kim J, Kim Y, Kim R, Jang E, et al. SARS-CoV-2 Breakthrough Infections after introduction of 4 COVID-19 Vaccines, South Korea, 2021. Emerg Infect Dis. 2022;28(3):753-756. https://doi.org/10.3201/eid2803.212210
AMA Yi S, Choe Y, Kim J, et al. SARS-CoV-2 Breakthrough Infections after introduction of 4 COVID-19 Vaccines, South Korea, 2021. Emerging Infectious Diseases. 2022;28(3):753-756. doi:10.3201/eid2803.212210.
APA Yi, S., Choe, Y., Kim, J., Kim, Y., Kim, R., Jang, E....Park, Y. (2022). SARS-CoV-2 Breakthrough Infections after introduction of 4 COVID-19 Vaccines, South Korea, 2021. Emerging Infectious Diseases, 28(3), 753-756. https://doi.org/10.3201/eid2803.212210.

Serial Intervals and Household Transmission of SARS-CoV-2 Omicron Variant, South Korea, 2021 [PDF - 729 KB - 4 pages]
J. S. Song et al.

To clarify transmissibility of the severe acute respiratory syndrome coronavirus 2 Omicron variant, we determined serial intervals and secondary attack rates among household contacts in South Korea. Mean serial interval for 12 transmission pairs was 2.9 days, and secondary attack rate among 25 households was 50.0%, raising concern about a rapid surge in cases.

EID Song JS, Lee J, Kim M, Jeong H, Kim MS, Kim S, et al. Serial Intervals and Household Transmission of SARS-CoV-2 Omicron Variant, South Korea, 2021. Emerg Infect Dis. 2022;28(3):756-759. https://doi.org/10.3201/eid2803.212607
AMA Song JS, Lee J, Kim M, et al. Serial Intervals and Household Transmission of SARS-CoV-2 Omicron Variant, South Korea, 2021. Emerging Infectious Diseases. 2022;28(3):756-759. doi:10.3201/eid2803.212607.
APA Song, J. S., Lee, J., Kim, M., Jeong, H., Kim, M. S., Kim, S....Park, Y. (2022). Serial Intervals and Household Transmission of SARS-CoV-2 Omicron Variant, South Korea, 2021. Emerging Infectious Diseases, 28(3), 756-759. https://doi.org/10.3201/eid2803.212607.

Restaurant-Based Measures to Control Community Transmission of COVID-19, Hong Kong [PDF - 1.12 MB - 3 pages]
F. Ho et al.

Controlling transmission in restaurants is an important component of public health and social measures for coronavirus disease. We examined the effects of restaurant measures in Hong Kong. Our findings indicate that shortening operating hours did not have an effect on time-varying effective reproduction number when capacity was already reduced.

EID Ho F, Tsang TK, Gao H, Xiao J, Lau E, Wong JY, et al. Restaurant-Based Measures to Control Community Transmission of COVID-19, Hong Kong. Emerg Infect Dis. 2022;28(3):759-761. https://doi.org/10.3201/eid2803.211015
AMA Ho F, Tsang TK, Gao H, et al. Restaurant-Based Measures to Control Community Transmission of COVID-19, Hong Kong. Emerging Infectious Diseases. 2022;28(3):759-761. doi:10.3201/eid2803.211015.
APA Ho, F., Tsang, T. K., Gao, H., Xiao, J., Lau, E., Wong, J. Y....Cowling, B. J. (2022). Restaurant-Based Measures to Control Community Transmission of COVID-19, Hong Kong. Emerging Infectious Diseases, 28(3), 759-761. https://doi.org/10.3201/eid2803.211015.

Subcutaneous Nodules Caused by Tropheryma whipplei Infection [PDF - 1.29 MB - 3 pages]
L. Wang et al.

To help clarify the clinical manifestations, diagnosis, and treatment for Whipple disease, we report a case of a man in China infected with Tropheryma whipplei. The patient had multiple subcutaneous nodules as the only manifestation, which was not consistent with the typical symptoms of T. whipplei infection.

EID Wang L, Su P, Song L, Sai L. Subcutaneous Nodules Caused by Tropheryma whipplei Infection. Emerg Infect Dis. 2022;28(3):761-763. https://doi.org/10.3201/eid2803.211989
AMA Wang L, Su P, Song L, et al. Subcutaneous Nodules Caused by Tropheryma whipplei Infection. Emerging Infectious Diseases. 2022;28(3):761-763. doi:10.3201/eid2803.211989.
APA Wang, L., Su, P., Song, L., & Sai, L. (2022). Subcutaneous Nodules Caused by Tropheryma whipplei Infection. Emerging Infectious Diseases, 28(3), 761-763. https://doi.org/10.3201/eid2803.211989.
Letters

Addendum to Proposal for Human Respiratory Syncytial Virus Nomenclature below the Species Level [PDF - 691 KB - 1 page]
I. G. Barr et al.
EID Barr IG, Williams TC, Salimi V, Buchholz UJ. Addendum to Proposal for Human Respiratory Syncytial Virus Nomenclature below the Species Level. Emerg Infect Dis. 2022;28(3):764. https://doi.org/10.3201/eid2803.212438
AMA Barr IG, Williams TC, Salimi V, et al. Addendum to Proposal for Human Respiratory Syncytial Virus Nomenclature below the Species Level. Emerging Infectious Diseases. 2022;28(3):764. doi:10.3201/eid2803.212438.
APA Barr, I. G., Williams, T. C., Salimi, V., & Buchholz, U. J. (2022). Addendum to Proposal for Human Respiratory Syncytial Virus Nomenclature below the Species Level. Emerging Infectious Diseases, 28(3), 764. https://doi.org/10.3201/eid2803.212438.
About the Cover

When a Touch of Gold Was Used to Heal the King’s Evil [PDF - 2.58 MB - 3 pages]
J. Krugman and T. Chorba
EID Krugman J, Chorba T. When a Touch of Gold Was Used to Heal the King’s Evil. Emerg Infect Dis. 2022;28(3):765-767. https://doi.org/10.3201/eid2803.ac2803
AMA Krugman J, Chorba T. When a Touch of Gold Was Used to Heal the King’s Evil. Emerging Infectious Diseases. 2022;28(3):765-767. doi:10.3201/eid2803.ac2803.
APA Krugman, J., & Chorba, T. (2022). When a Touch of Gold Was Used to Heal the King’s Evil. Emerging Infectious Diseases, 28(3), 765-767. https://doi.org/10.3201/eid2803.ac2803.
Etymologia

Schizophyllum commune [PDF - 1.23 MB - 1 page]
M. Mahajan
EID Mahajan M. Schizophyllum commune. Emerg Infect Dis. 2022;28(3):725. https://doi.org/10.3201/eid2803.211051
AMA Mahajan M. Schizophyllum commune. Emerging Infectious Diseases. 2022;28(3):725. doi:10.3201/eid2803.211051.
APA Mahajan, M. (2022). Schizophyllum commune. Emerging Infectious Diseases, 28(3), 725. https://doi.org/10.3201/eid2803.211051.
Page created: February 21, 2022
Page updated: February 22, 2022
Page reviewed: February 22, 2022
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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