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Issue Cover for Volume 5, Number 3—June 1999

Volume 5, Number 3—June 1999

[PDF - 4.58 MB - 180 pages]

Perspective

International Editors:Bacterial Resistance to Antimicrobial Agents: Selected Problems in France, 1996 to 1998 [PDF - 78 KB - 6 pages]
H. Aubry-Damon and P. Courvalin
EID Aubry-Damon H, Courvalin P. International Editors:Bacterial Resistance to Antimicrobial Agents: Selected Problems in France, 1996 to 1998. Emerg Infect Dis. 1999;5(3):315-320. https://dx.doi.org/10.3201/eid0503.990301
AMA Aubry-Damon H, Courvalin P. International Editors:Bacterial Resistance to Antimicrobial Agents: Selected Problems in France, 1996 to 1998. Emerging Infectious Diseases. 1999;5(3):315-320. doi:10.3201/eid0503.990301.
APA Aubry-Damon, H., & Courvalin, P. (1999). International Editors:Bacterial Resistance to Antimicrobial Agents: Selected Problems in France, 1996 to 1998. Emerging Infectious Diseases, 5(3), 315-320. https://dx.doi.org/10.3201/eid0503.990301.

The Cost Effectiveness of Vaccinating against Lyme Disease [PDF - 110 KB - 8 pages]
M. I. Meltzer et al.

To determine the cost effectiveness of vaccinating against Lyme disease, we used a decision tree to examine the impact on society of six key components. The main measure of outcome was the cost per case averted. Assuming a 0.80 probability of diagnosing and treating early Lyme disease, a 0.005 probability of contracting Lyme disease, and a vaccination cost of $50 per year, the mean cost of vaccination per case averted was $4,466. When we increased the probability of contracting Lyme disease to 0.03 and the cost of vaccination to $100 per year, the mean net savings per case averted was $3,377. Since few communities have average annual incidences of Lyme disease >0.005, economic benefits will be greatest when vaccination is used on the basis of individual risk, specifically, in persons whose probability of contracting Lyme disease is >0.01.

EID Meltzer MI, Dennis DT, Orloski KA. The Cost Effectiveness of Vaccinating against Lyme Disease. Emerg Infect Dis. 1999;5(3):321-328. https://dx.doi.org/10.3201/eid0503.990302
AMA Meltzer MI, Dennis DT, Orloski KA. The Cost Effectiveness of Vaccinating against Lyme Disease. Emerging Infectious Diseases. 1999;5(3):321-328. doi:10.3201/eid0503.990302.
APA Meltzer, M. I., Dennis, D. T., & Orloski, K. A. (1999). The Cost Effectiveness of Vaccinating against Lyme Disease. Emerging Infectious Diseases, 5(3), 321-328. https://dx.doi.org/10.3201/eid0503.990302.

Use of Antimicrobial Growth Promoters in Food Animals and Enterococcus faecium Resistance to Therapeutic Antimicrobial Drugs in Europe [PDF - 85 KB - 7 pages]
H. C. Wegener et al.

Supplementing animal feed with antimicrobial agents to enhance growth has been common practice for more than 30 years and is estimated to constitute more than half the total antimicrobial use worldwide. The potential public health consequences of this use have been debated; however, until recently, clear evidence of a health risk was not available. Accumulating evidence now indicates that the use of the glycopeptide avoparcin as a growth promoter has created in food animals a major reservoir of Enterococcus faecium, which contains the high level glycopeptide resistance determinant vanA, located on the Tn1546 transposon. Furthermore, glycopeptide-resistant strains, as well as resistance determinants, can be transmitted from animals to humans. Two antimicrobial classes expected to provide the future therapeutic options for treatment of infections with vancomycin-resistant enterococci have analogues among the growth promoters, and a huge animal reservoir of resistant E. faecium has already been created, posing a new public health problem.

EID Wegener HC, Aarestrup FM, Jensen LB, Hammerum AM, Bager F. Use of Antimicrobial Growth Promoters in Food Animals and Enterococcus faecium Resistance to Therapeutic Antimicrobial Drugs in Europe. Emerg Infect Dis. 1999;5(3):329-335. https://dx.doi.org/10.3201/eid0503.990303
AMA Wegener HC, Aarestrup FM, Jensen LB, et al. Use of Antimicrobial Growth Promoters in Food Animals and Enterococcus faecium Resistance to Therapeutic Antimicrobial Drugs in Europe. Emerging Infectious Diseases. 1999;5(3):329-335. doi:10.3201/eid0503.990303.
APA Wegener, H. C., Aarestrup, F. M., Jensen, L. B., Hammerum, A. M., & Bager, F. (1999). Use of Antimicrobial Growth Promoters in Food Animals and Enterococcus faecium Resistance to Therapeutic Antimicrobial Drugs in Europe. Emerging Infectious Diseases, 5(3), 329-335. https://dx.doi.org/10.3201/eid0503.990303.

Bacterial Vaccines and Serotype Replacement: Lessons from Haemophilus influenzae and Prospects for Streptococcus pneumoniae [PDF - 199 KB - 10 pages]
M. Lipsitch

Conjugate vaccines have reduced the incidence of invasive disease caused by Haemophilus influenzae, type b (Hib), in industrialized countries and may be highly effective against Streptococcus pneumoniae. However, the serotype specificity of these vaccines has led to concern that their use may increase carriage of and disease from serotypes not included in the vaccine. Replacement has not occurred with the use of Hib vaccines but has occurred in trials of pneumococcal vaccines. Mathematical models can be used to elucidate these contrasting outcomes, predict the conditions under which serotype replacement is likely, interpret the results of conjugate vaccine trials, design trials that will better detect serotype replacement (if it occurs), and suggest factors to consider in choosing the serotype composition of vaccines.

EID Lipsitch M. Bacterial Vaccines and Serotype Replacement: Lessons from Haemophilus influenzae and Prospects for Streptococcus pneumoniae. Emerg Infect Dis. 1999;5(3):336-345. https://dx.doi.org/10.3201/eid0503.990304
AMA Lipsitch M. Bacterial Vaccines and Serotype Replacement: Lessons from Haemophilus influenzae and Prospects for Streptococcus pneumoniae. Emerging Infectious Diseases. 1999;5(3):336-345. doi:10.3201/eid0503.990304.
APA Lipsitch, M. (1999). Bacterial Vaccines and Serotype Replacement: Lessons from Haemophilus influenzae and Prospects for Streptococcus pneumoniae. Emerging Infectious Diseases, 5(3), 336-345. https://dx.doi.org/10.3201/eid0503.990304.

Iron Loading and Disease Surveillance [PDF - 68 KB - 7 pages]
E. D. Weinberg

Iron is an oxidant as well as a nutrient for invading microbial and neoplastic cells. Excessive iron in specific tissues and cells (iron loading) promotes development of infection, neoplasia, cardiomyopathy, arthropathy, and various endocrine and possibly neurodegenerative disorders. To contain and detoxify the metal, hosts have evolved an iron withholding defense system, but the system can be compromised by numerous factors. An array of behavioral, medical, and immunologic methods are in place or in development to strengthen iron withholding. Routine screening for iron loading could provide valuable information in epidemiologic, diagnostic, prophylactic, and therapeutic studies of emerging infectious diseases.

EID Weinberg ED. Iron Loading and Disease Surveillance. Emerg Infect Dis. 1999;5(3):346-352. https://dx.doi.org/10.3201/eid0503.990305
AMA Weinberg ED. Iron Loading and Disease Surveillance. Emerging Infectious Diseases. 1999;5(3):346-352. doi:10.3201/eid0503.990305.
APA Weinberg, E. D. (1999). Iron Loading and Disease Surveillance. Emerging Infectious Diseases, 5(3), 346-352. https://dx.doi.org/10.3201/eid0503.990305.
Synopses

Human Herpesvirus 6: An Emerging Pathogen [PDF - 527 KB - 14 pages]
G. Campadelli-Fiume et al.

Infections with human herpesvirus 6 (HHV-6), a ß-herpesvirus of which two variant groups (A and B) are recognized, is very common, approaching 100% in seroprevalence. Primary infection with HHV-6B causes roseola infantum or exanthem subitum, a common childhood disease that resolves spontaneously. After primary infection, the virus replicates in the salivary glands and is shed in saliva, the recognized route of transmission for variant B strains; it remains latent in lymphocytes and monocytes and persists at low levels in cells and tissues. Not usually associated with disease in the immunocompetent, HHV-6 infection is a major cause of opportunistic viral infections in the immunosuppressed, typically AIDS patients and transplant recipients, in whom HHV-6 infection/reactivation may culminate in rejection of transplanted organs and death. Other opportunistic viruses, human cytomegalovirus and HHV-7, also infect or reactivate in persons at risk. Another disease whose pathogenesis may be correlated with HHV-6 is multiple sclerosis. Data in favor of and against the correlation are discussed.

EID Campadelli-Fiume G, Mirandola P, Menotti L. Human Herpesvirus 6: An Emerging Pathogen. Emerg Infect Dis. 1999;5(3):353-366. https://dx.doi.org/10.3201/eid0503.990306
AMA Campadelli-Fiume G, Mirandola P, Menotti L. Human Herpesvirus 6: An Emerging Pathogen. Emerging Infectious Diseases. 1999;5(3):353-366. doi:10.3201/eid0503.990306.
APA Campadelli-Fiume, G., Mirandola, P., & Menotti, L. (1999). Human Herpesvirus 6: An Emerging Pathogen. Emerging Infectious Diseases, 5(3), 353-366. https://dx.doi.org/10.3201/eid0503.990306.

Emergence of a Unique Group of Necrotizing Mycobacterial Diseases [PDF - 617 KB - 12 pages]
K. M. Dobos et al.

Although most diseases due to pathogenic mycobacteria are caused by Mycobacterium tuberculosis, several other mycobacterial diseases—caused by M. ulcerans (Buruli ulcer), M. marinum, and M. haemophilum—have begun to emerge. We review the emergence of diseases caused by these three pathogens in the United States and around the world in the last decade. We examine the pathophysiologic similarities of the diseases (all three cause necrotizing skin lesions) and common reservoirs of infection (stagnant or slow-flowing water). Examination of the histologic and pathogenic characteristics of these mycobacteria suggests differences in the modes of transmission and pathogenesis, though no singular mechanism for either characteristic has been definitively described for any of these mycobacteria.

EID Dobos KM, Quinn FD, Ashford DA, Horsburgh CR, King CH. Emergence of a Unique Group of Necrotizing Mycobacterial Diseases. Emerg Infect Dis. 1999;5(3):367-378. https://dx.doi.org/10.3201/eid0503.990307
AMA Dobos KM, Quinn FD, Ashford DA, et al. Emergence of a Unique Group of Necrotizing Mycobacterial Diseases. Emerging Infectious Diseases. 1999;5(3):367-378. doi:10.3201/eid0503.990307.
APA Dobos, K. M., Quinn, F. D., Ashford, D. A., Horsburgh, C. R., & King, C. H. (1999). Emergence of a Unique Group of Necrotizing Mycobacterial Diseases. Emerging Infectious Diseases, 5(3), 367-378. https://dx.doi.org/10.3201/eid0503.990307.

Respiratory Diseases among U.S. Military Personnel: Countering Emerging Threats [PDF - 412 KB - 9 pages]
G. C. Gray et al.

Emerging respiratory disease agents, increased antibiotic resistance, and the loss of effective vaccines threaten to increase the incidence of respiratory disease in military personnel. We examine six respiratory pathogens (adenoviruses, influenza viruses, Streptococcus pneumoniae, Streptococcus pyogenes, Mycoplasma pneumoniae, and Bordetella pertussis) and review the impact of the diseases they cause, past efforts to control these diseases in U.S. military personnel, as well as current treatment and surveillance strategies, limitations in diagnostic testing, and vaccine needs.

EID Gray GC, Callahan JD, Hawksworth AW, Fisher CA, Gaydos JC. Respiratory Diseases among U.S. Military Personnel: Countering Emerging Threats. Emerg Infect Dis. 1999;5(3):379-387. https://dx.doi.org/10.3201/eid0503.990308
AMA Gray GC, Callahan JD, Hawksworth AW, et al. Respiratory Diseases among U.S. Military Personnel: Countering Emerging Threats. Emerging Infectious Diseases. 1999;5(3):379-387. doi:10.3201/eid0503.990308.
APA Gray, G. C., Callahan, J. D., Hawksworth, A. W., Fisher, C. A., & Gaydos, J. C. (1999). Respiratory Diseases among U.S. Military Personnel: Countering Emerging Threats. Emerging Infectious Diseases, 5(3), 379-387. https://dx.doi.org/10.3201/eid0503.990308.

Q Fever in Bulgaria and Slovakia [PDF - 84 KB - 7 pages]
V. Serbezov et al.

As a result of dramatic political and economic changes in the beginning of the 1990s, Q-fever epidemiology in Bulgaria has changed. The number of goats almost tripled; contact between goat owners (and their families) and goats, as well as goats and other animals, increased; consumption of raw goat milk and its products increased; and goats replaced cattle and sheep as the main source of human Coxiella burnetii infections. Hundreds of overt, serologically confirmed human cases of acute Q fever have occurred. Chronic forms of Q fever manifesting as endocarditis were also observed. In contrast, in Slovakia, Q fever does not pose a serious public health problem, and the chronic form of infection has not been found either in follow-ups of a Q-fever epidemic connected with goats imported from Bulgaria and other previous Q-fever outbreaks or in a serologic survey. Serologic diagnosis as well as control and prevention of Q fever are discussed.

EID Serbezov V, Kazár J, Novkirishki V, Gatcheva N, Kovácová E, Voynova V. Q Fever in Bulgaria and Slovakia. Emerg Infect Dis. 1999;5(3):388-394. https://dx.doi.org/10.3201/eid0503.990309
AMA Serbezov V, Kazár J, Novkirishki V, et al. Q Fever in Bulgaria and Slovakia. Emerging Infectious Diseases. 1999;5(3):388-394. doi:10.3201/eid0503.990309.
APA Serbezov, V., Kazár, J., Novkirishki, V., Gatcheva, N., Kovácová, E., & Voynova, V. (1999). Q Fever in Bulgaria and Slovakia. Emerging Infectious Diseases, 5(3), 388-394. https://dx.doi.org/10.3201/eid0503.990309.

Adhesins as Targets for Vaccine Development [PDF - 189 KB - 9 pages]
T. M. Wizemann et al.

Blocking the primary stages of infection, namely bacterial attachment to host cell receptors and colonization of the mucosal surface, may be the most effective strategy to prevent bacterial infections. Bacterial attachment usually involves an interaction between a bacterial surface protein called an adhesin and the host cell receptor. Recent preclinical vaccine studies with the FimH adhesin (derived from uropathogenic Escherichia coli) have confirmed that antibodies elicited against an adhesin can impede colonization, block infection, and prevent disease. The studies indicate that prophylactic vaccination with adhesins can block bacterial infections. With recent advances in the identification, characterization, and isolation of other adhesins, similar approaches are being explored to prevent infections, from otitis media and dental caries to pneumonia and sepsis.

EID Wizemann TM, Adamou JE, Langermann S. Adhesins as Targets for Vaccine Development. Emerg Infect Dis. 1999;5(3):395-403. https://dx.doi.org/10.3201/eid0503.990310
AMA Wizemann TM, Adamou JE, Langermann S. Adhesins as Targets for Vaccine Development. Emerging Infectious Diseases. 1999;5(3):395-403. doi:10.3201/eid0503.990310.
APA Wizemann, T. M., Adamou, J. E., & Langermann, S. (1999). Adhesins as Targets for Vaccine Development. Emerging Infectious Diseases, 5(3), 395-403. https://dx.doi.org/10.3201/eid0503.990310.
Research

Tuberculosis in the Caribbean: Using Spacer Oligonucleotide Typing to Understand Strain Origin and Transmission [PDF - 408 KB - 11 pages]
C. Sola et al.

We used direct repeat (DR)-based spacer oligonucleotide typing (spoligotyping) (in association with double-repetitive element–polymerase chain reaction, IS6110-restriction fragment length polymorphism [RFLP], and sometimes DR-RFLP and polymorphic GC-rich sequence-RFLP) to detect epidemiologic links and transmission patterns of Mycobacterium tuberculosis on Martinique, Guadeloupe, and French Guiana. In more than a third of the 218 strains we typed from this region, clusters and isolates shared genetic identity, which suggests epidemiologic links. However, because of limited epidemiologic information, only 14.2% of the strains could be directly linked. When spoligotyping patterns shared by two or more isolates were pooled with 392 spoligotypes from other parts of the world, new matches were detected, which suggests imported transmission. Persisting foci of endemic disease and increased active transmission due to high population flux and HIV-coinfection may be linked to the recent reemergence of tuberculosis in the Caribbean. We also found that several distinct families of spoligotypes are overrepresented in this region.

EID Sola C, Devallois A, Horgen L, Maïsetti J, Filliol I, Legrand E, et al. Tuberculosis in the Caribbean: Using Spacer Oligonucleotide Typing to Understand Strain Origin and Transmission. Emerg Infect Dis. 1999;5(3):404-411. https://dx.doi.org/10.3201/eid0503.990311
AMA Sola C, Devallois A, Horgen L, et al. Tuberculosis in the Caribbean: Using Spacer Oligonucleotide Typing to Understand Strain Origin and Transmission. Emerging Infectious Diseases. 1999;5(3):404-411. doi:10.3201/eid0503.990311.
APA Sola, C., Devallois, A., Horgen, L., Maïsetti, J., Filliol, I., Legrand, E....Rastogi, N. (1999). Tuberculosis in the Caribbean: Using Spacer Oligonucleotide Typing to Understand Strain Origin and Transmission. Emerging Infectious Diseases, 5(3), 404-411. https://dx.doi.org/10.3201/eid0503.990311.

Human Rabies Postexposure Prophylaxis during a Raccoon Rabies Epizootic in New York, 1993 and 1994 [PDF - 359 KB - 8 pages]
J. D. Wyatt et al.

We describe the epidemiology of human rabies postexposure prophylaxis (PEP) in four upstate New York counties during the 1st and 2nd year of a raccoon rabies epizootic. We obtained data from records of 1,173 persons whose rabies PEP was reported to local health departments in 1993 and 1994. Mean annual PEP incidence rates were highest in rural counties, in summer, and in patients 10 to 14 and 35 to 44 years of age. PEP given after bites was primarily associated with unvaccinated dogs and cats, but most (70%) was not attributable to bites. Although pet vaccination and stray animal control, which target direct exposure, remain the cornerstones of human rabies prevention, the risk for rabies by the nonbite route (e.g., raccoon saliva on pet dogs' and cats' fur) should also be considered.

EID Wyatt JD, Barker WH, Bennett NM, Hanlon CA. Human Rabies Postexposure Prophylaxis during a Raccoon Rabies Epizootic in New York, 1993 and 1994. Emerg Infect Dis. 1999;5(3):415-423. https://dx.doi.org/10.3201/eid0503.990312
AMA Wyatt JD, Barker WH, Bennett NM, et al. Human Rabies Postexposure Prophylaxis during a Raccoon Rabies Epizootic in New York, 1993 and 1994. Emerging Infectious Diseases. 1999;5(3):415-423. doi:10.3201/eid0503.990312.
APA Wyatt, J. D., Barker, W. H., Bennett, N. M., & Hanlon, C. A. (1999). Human Rabies Postexposure Prophylaxis during a Raccoon Rabies Epizootic in New York, 1993 and 1994. Emerging Infectious Diseases, 5(3), 415-423. https://dx.doi.org/10.3201/eid0503.990312.
Dispatches

Factory Outbreak of Escherichia coli O157:H7 Infection in Japan [PDF - 74 KB - 5 pages]
Y. Watanabe et al.

To determine the cause of a July 1996 outbreak of Escherichia coli O157:H7 among factory workers in Kyoto, Japan, we conducted cohort and case-control studies. Eating radish sprout salad during lunch at the factory cafeteria had been linked to illness. The sprouts were traced to four growers in Japan; one had been associated with an outbreak of E. coli O157:H7 among 6,000 schoolchildren in Sakai earlier in July.

EID Watanabe Y, Ozasa K, Mermin JH, Griffin PM, Masuda K, Imashuku S, et al. Factory Outbreak of Escherichia coli O157:H7 Infection in Japan. Emerg Infect Dis. 1999;5(3):424-428. https://dx.doi.org/10.3201/eid0503.990313
AMA Watanabe Y, Ozasa K, Mermin JH, et al. Factory Outbreak of Escherichia coli O157:H7 Infection in Japan. Emerging Infectious Diseases. 1999;5(3):424-428. doi:10.3201/eid0503.990313.
APA Watanabe, Y., Ozasa, K., Mermin, J. H., Griffin, P. M., Masuda, K., Imashuku, S....Sawada, T. (1999). Factory Outbreak of Escherichia coli O157:H7 Infection in Japan. Emerging Infectious Diseases, 5(3), 424-428. https://dx.doi.org/10.3201/eid0503.990313.

First Case of Yellow Fever in French Guiana since 1902 [PDF - 67 KB - 4 pages]
J. Heraud et al.

The first case of yellow fever in French Guiana since 1902 was reported in March 1998. The yellow fever virus genome was detected in postmortem liver biopsies by seminested polymerase chain reaction. Sequence analysis showed that this strain was most closely related to strains from Brazil and Ecuador.

EID Heraud J, Hommel D, Hulin A, Deubel V, Poveda J, Sarthou J, et al. First Case of Yellow Fever in French Guiana since 1902. Emerg Infect Dis. 1999;5(3):429-432. https://dx.doi.org/10.3201/eid0503.990314
AMA Heraud J, Hommel D, Hulin A, et al. First Case of Yellow Fever in French Guiana since 1902. Emerging Infectious Diseases. 1999;5(3):429-432. doi:10.3201/eid0503.990314.
APA Heraud, J., Hommel, D., Hulin, A., Deubel, V., Poveda, J., Sarthou, J....Talarmin, A. (1999). First Case of Yellow Fever in French Guiana since 1902. Emerging Infectious Diseases, 5(3), 429-432. https://dx.doi.org/10.3201/eid0503.990314.

Risk for Rabies Transmission from Encounters with Bats, Colorado, 1977–1996 [PDF - 57 KB - 5 pages]
W. J. Pape et al.

To assess the risk for rabies transmission to humans by bats, we analyzed the prevalence of rabies in bats that encountered humans from 1977 to 1996 and characterized the bat-human encounters. Rabies was diagnosed in 685 (15%) of 4,470 bats tested. The prevalence of rabies in bats that bit humans was 2.1 times higher than in bats that did not bite humans. At least a third of the encounters were preventable.

EID Pape WJ, Fitzsimmons TD, Hoffman RE. Risk for Rabies Transmission from Encounters with Bats, Colorado, 1977–1996. Emerg Infect Dis. 1999;5(3):433-437. https://dx.doi.org/10.3201/eid0503.990315
AMA Pape WJ, Fitzsimmons TD, Hoffman RE. Risk for Rabies Transmission from Encounters with Bats, Colorado, 1977–1996. Emerging Infectious Diseases. 1999;5(3):433-437. doi:10.3201/eid0503.990315.
APA Pape, W. J., Fitzsimmons, T. D., & Hoffman, R. E. (1999). Risk for Rabies Transmission from Encounters with Bats, Colorado, 1977–1996. Emerging Infectious Diseases, 5(3), 433-437. https://dx.doi.org/10.3201/eid0503.990315.

Australian Bat Lyssavirus Infection in a Captive Juvenile Black Flying Fox [PDF - 46 KB - 3 pages]
H. E. Field et al.

The newly emerging Australian bat lyssavirus causes rabieslike disease in bats and humans. A captive juvenile black flying fox exhibited progressive neurologic signs, including sudden aggression, vocalization, dysphagia, and paresis over 9 days and then died. At necropsy, lyssavirus infection was diagnosed by fluorescent antibody test, immunoperoxidase staining, polymerase chain reaction, and virus isolation. Eight human contacts received postexposure vaccination.

EID Field HE, McCall B, Barrett J. Australian Bat Lyssavirus Infection in a Captive Juvenile Black Flying Fox. Emerg Infect Dis. 1999;5(3):438-440. https://dx.doi.org/10.3201/eid0503.990316
AMA Field HE, McCall B, Barrett J. Australian Bat Lyssavirus Infection in a Captive Juvenile Black Flying Fox. Emerging Infectious Diseases. 1999;5(3):438-440. doi:10.3201/eid0503.990316.
APA Field, H. E., McCall, B., & Barrett, J. (1999). Australian Bat Lyssavirus Infection in a Captive Juvenile Black Flying Fox. Emerging Infectious Diseases, 5(3), 438-440. https://dx.doi.org/10.3201/eid0503.990316.

Bordetella holmesii-Like Organisms Isolated from Massachusetts Patients with Pertussis-Like Symptoms [PDF - 51 KB - 3 pages]
W. K. Yih et al.

We isolated Bordetella holmesii, generally associated with septicemia in patients with underlying conditions, from nasopharyngeal specimens of otherwise healthy young persons with a cough. The proportion of B. holmesii- positive specimens submitted to the Massachusetts State Laboratory Institute increased from 1995 to 1998.

EID Yih WK, Silva EA, Ida J, Harrington N, Lett SM, George H. Bordetella holmesii-Like Organisms Isolated from Massachusetts Patients with Pertussis-Like Symptoms. Emerg Infect Dis. 1999;5(3):441-443. https://dx.doi.org/10.3201/eid0503.990317
AMA Yih WK, Silva EA, Ida J, et al. Bordetella holmesii-Like Organisms Isolated from Massachusetts Patients with Pertussis-Like Symptoms. Emerging Infectious Diseases. 1999;5(3):441-443. doi:10.3201/eid0503.990317.
APA Yih, W. K., Silva, E. A., Ida, J., Harrington, N., Lett, S. M., & George, H. (1999). Bordetella holmesii-Like Organisms Isolated from Massachusetts Patients with Pertussis-Like Symptoms. Emerging Infectious Diseases, 5(3), 441-443. https://dx.doi.org/10.3201/eid0503.990317.

New Cryptosporidium Genotypes in HIV-Infected Persons [PDF - 162 KB - 6 pages]
N. J. Pieniazek et al.

Using DNA sequencing and phylogenetic analysis, we identified four distinct Cryptosporidium genotypes in HIV-infected patients: genotype 1 (human), genotype 2 (bovine) Cryptosporidium parvum, a genotype identical to C. felis, and one identical to a Cryptosporidium sp. isolate from a dog. This is the first identification of human infection with the latter two genotypes.

EID Pieniazek NJ, Bornay-Llinares FJ, Slemenda SB, da Silva AJ, Moura IN, Arrowood MJ, et al. New Cryptosporidium Genotypes in HIV-Infected Persons. Emerg Infect Dis. 1999;5(3):444-449. https://dx.doi.org/10.3201/eid0503.990318
AMA Pieniazek NJ, Bornay-Llinares FJ, Slemenda SB, et al. New Cryptosporidium Genotypes in HIV-Infected Persons. Emerging Infectious Diseases. 1999;5(3):444-449. doi:10.3201/eid0503.990318.
APA Pieniazek, N. J., Bornay-Llinares, F. J., Slemenda, S. B., da Silva, A. J., Moura, I. N., Arrowood, M. J....Addiss, D. G. (1999). New Cryptosporidium Genotypes in HIV-Infected Persons. Emerging Infectious Diseases, 5(3), 444-449. https://dx.doi.org/10.3201/eid0503.990318.

Fatal Case Due to Methicillin-Resistant Staphylococcus aureus Small Colony Variants in an AIDS Patient [PDF - 98 KB - 4 pages]
H. Seifert et al.

We describe the first known case of a fatal infection with small colony variants of methicillin-resistant Staphylococcus aureus in a patient with AIDS. Recovered from three blood cultures as well as from a deep hip abscess, these variants may have resulted from long-term antimicrobial therapy with trimethoprim/sulfamethoxazole for prophylaxis of Pneumocystis carinii pneumonia.

EID Seifert H, von Eiff C, Fätkenheuer G. Fatal Case Due to Methicillin-Resistant Staphylococcus aureus Small Colony Variants in an AIDS Patient. Emerg Infect Dis. 1999;5(3):450-453. https://dx.doi.org/10.3201/eid0503.990319
AMA Seifert H, von Eiff C, Fätkenheuer G. Fatal Case Due to Methicillin-Resistant Staphylococcus aureus Small Colony Variants in an AIDS Patient. Emerging Infectious Diseases. 1999;5(3):450-453. doi:10.3201/eid0503.990319.
APA Seifert, H., von Eiff, C., & Fätkenheuer, G. (1999). Fatal Case Due to Methicillin-Resistant Staphylococcus aureus Small Colony Variants in an AIDS Patient. Emerging Infectious Diseases, 5(3), 450-453. https://dx.doi.org/10.3201/eid0503.990319.

Application of Data Mining to Intensive Care Unit Microbiologic Data [PDF - 56 KB - 4 pages]
S. A. Moser et al.

We describe refinements to and new experimental applications of the Data Mining Surveillance System (DMSS), which uses a large electronic health-care database for monitoring emerging infections and antimicrobial resistance. For example, information from DMSS can indicate potentially important shifts in infection and antimicrobial resistance patterns in the intensive care units of a single health-care facility.

EID Moser SA, Jones WT, Brossette SE. Application of Data Mining to Intensive Care Unit Microbiologic Data. Emerg Infect Dis. 1999;5(3):454-457. https://dx.doi.org/10.3201/eid0503.990320
AMA Moser SA, Jones WT, Brossette SE. Application of Data Mining to Intensive Care Unit Microbiologic Data. Emerging Infectious Diseases. 1999;5(3):454-457. doi:10.3201/eid0503.990320.
APA Moser, S. A., Jones, W. T., & Brossette, S. E. (1999). Application of Data Mining to Intensive Care Unit Microbiologic Data. Emerging Infectious Diseases, 5(3), 454-457. https://dx.doi.org/10.3201/eid0503.990320.

Sentinel Surveillance for Enterovirus 71, Taiwan, 1998 [PDF - 71 KB - 3 pages]
T. Wu et al.

Outbreaks of enterovirus 71 have been reported around the world since 1969. The most recent outbreak occurred in Taiwan during April-July 1998. This hand, foot, and mouth disease epidemic was detected by a sentinel surveillance system in April at the beginning of the outbreak, and the public was alerted.

EID Wu T, Tsai S, Li S, Lee T, Huang T, Wang M, et al. Sentinel Surveillance for Enterovirus 71, Taiwan, 1998. Emerg Infect Dis. 1999;5(3):458-460. https://dx.doi.org/10.3201/eid0503.990321
AMA Wu T, Tsai S, Li S, et al. Sentinel Surveillance for Enterovirus 71, Taiwan, 1998. Emerging Infectious Diseases. 1999;5(3):458-460. doi:10.3201/eid0503.990321.
APA Wu, T., Tsai, S., Li, S., Lee, T., Huang, T., Wang, M....Shen, C. (1999). Sentinel Surveillance for Enterovirus 71, Taiwan, 1998. Emerging Infectious Diseases, 5(3), 458-460. https://dx.doi.org/10.3201/eid0503.990321.

Chlorine Inactivation of Escherichia coli O157:H7 [PDF - 47 KB - 3 pages]
E. W. Rice et al.

We analyzed isolates of Escherichia coli O157:H7 (which has recently caused waterborne outbreaks) and wild-type E. coli to determine their sensitivity to chlorination. Both pathogenic and nonpathogenic strains were significantly reduced within 1 minute of exposure to free chlorine. Results indicate that chlorine levels typically maintained in water systems are sufficient to inactivate these organisms.

EID Rice EW, Clark RM, Johnson CH. Chlorine Inactivation of Escherichia coli O157:H7. Emerg Infect Dis. 1999;5(3):461-463. https://dx.doi.org/10.3201/eid0503.990322
AMA Rice EW, Clark RM, Johnson CH. Chlorine Inactivation of Escherichia coli O157:H7. Emerging Infectious Diseases. 1999;5(3):461-463. doi:10.3201/eid0503.990322.
APA Rice, E. W., Clark, R. M., & Johnson, C. H. (1999). Chlorine Inactivation of Escherichia coli O157:H7. Emerging Infectious Diseases, 5(3), 461-463. https://dx.doi.org/10.3201/eid0503.990322.

Fulminant Meningococcal Supraglottitis: An Emerging Infectious Syndrome? [PDF - 51 KB - 4 pages]
E. Schwam and J. Cox

We report a case of fulminant supraglottitis with dramatic external cervical swelling due to associated cellulitis. Blood cultures were positive for Neisseria meningitidis. The patient recovered completely after emergency fiberoptic intubation and appropriate antibiotic therapy. We summarize five other cases of meningococcal supraglottitis, all reported since 1995, and discuss possible pathophysiologic mechanisms

EID Schwam E, Cox J. Fulminant Meningococcal Supraglottitis: An Emerging Infectious Syndrome?. Emerg Infect Dis. 1999;5(3):464-467. https://dx.doi.org/10.3201/eid0503.990323
AMA Schwam E, Cox J. Fulminant Meningococcal Supraglottitis: An Emerging Infectious Syndrome?. Emerging Infectious Diseases. 1999;5(3):464-467. doi:10.3201/eid0503.990323.
APA Schwam, E., & Cox, J. (1999). Fulminant Meningococcal Supraglottitis: An Emerging Infectious Syndrome?. Emerging Infectious Diseases, 5(3), 464-467. https://dx.doi.org/10.3201/eid0503.990323.

Genetic Evidence of Dobrava Virus in Apodemus agrarius in Hungary [PDF - 80 KB - 3 pages]
J. J. Scharninghausen et al.

Using nested polymerase chain reaction, we sequenced Dobrava virus (DOB) from the rodent Apodemus agrarius in Hungary. The samples we isolated group with DOB samples previously isolated from A. flavicollis. This grouping may indicate host switching.

EID Scharninghausen JJ, Meyer H, Pfeffer M, Davis DS, Honeycutt RL. Genetic Evidence of Dobrava Virus in Apodemus agrarius in Hungary. Emerg Infect Dis. 1999;5(3):468-470. https://dx.doi.org/10.3201/eid0503.990324
AMA Scharninghausen JJ, Meyer H, Pfeffer M, et al. Genetic Evidence of Dobrava Virus in Apodemus agrarius in Hungary. Emerging Infectious Diseases. 1999;5(3):468-470. doi:10.3201/eid0503.990324.
APA Scharninghausen, J. J., Meyer, H., Pfeffer, M., Davis, D. S., & Honeycutt, R. L. (1999). Genetic Evidence of Dobrava Virus in Apodemus agrarius in Hungary. Emerging Infectious Diseases, 5(3), 468-470. https://dx.doi.org/10.3201/eid0503.990324.

Bacterial Resistance to Ciprofloxacin in Greece: Results from the National Electronic Surveillance System [PDF - 108 KB - 6 pages]
A. Vatopoulos et al.

According to 1997 susceptibility data from the National Electronic System for the Surveillance of Antimicrobial Resistance, Greece has high rates of ciprofloxacin resistance. For most species, the frequency of ciprofloxacin- resistant isolates (from highest to lowest, by patient setting) was as follows: intensive care unit > surgical > medical > outpatient. Most ciprofloxacin-resistant strains were multidrug resistant.

EID Vatopoulos A, Network G, Legakis N. Bacterial Resistance to Ciprofloxacin in Greece: Results from the National Electronic Surveillance System. Emerg Infect Dis. 1999;5(3):471-476. https://dx.doi.org/10.3201/eid0503.990325
AMA Vatopoulos A, Network G, Legakis N. Bacterial Resistance to Ciprofloxacin in Greece: Results from the National Electronic Surveillance System. Emerging Infectious Diseases. 1999;5(3):471-476. doi:10.3201/eid0503.990325.
APA Vatopoulos, A., Network, G., & Legakis, N. (1999). Bacterial Resistance to Ciprofloxacin in Greece: Results from the National Electronic Surveillance System. Emerging Infectious Diseases, 5(3), 471-476. https://dx.doi.org/10.3201/eid0503.990325.

Emergence of Related Nontoxigenic Corynebacterium diphtheriae Biotype mitis Strains in Western Europe [PDF - 83 KB - 4 pages]
G. Funke et al.

We report on 17 isolates of Corynebacterium diphtheriae biotype mitis with related ribotypes from Switzerland, Germany, and France. Isolates came from skin and subcutaneous infections of injecting drug users, homeless persons, prisoners, and elderly orthopedic patients with joint prostheses or primary joint infections. Such isolates had only been observed in Switzerland.

EID Funke G, Altwegg M, Frommelt L, von Graevenitz A. Emergence of Related Nontoxigenic Corynebacterium diphtheriae Biotype mitis Strains in Western Europe. Emerg Infect Dis. 1999;5(3):477-480. https://dx.doi.org/10.3201/eid0503.990326
AMA Funke G, Altwegg M, Frommelt L, et al. Emergence of Related Nontoxigenic Corynebacterium diphtheriae Biotype mitis Strains in Western Europe. Emerging Infectious Diseases. 1999;5(3):477-480. doi:10.3201/eid0503.990326.
APA Funke, G., Altwegg, M., Frommelt, L., & von Graevenitz, A. (1999). Emergence of Related Nontoxigenic Corynebacterium diphtheriae Biotype mitis Strains in Western Europe. Emerging Infectious Diseases, 5(3), 477-480. https://dx.doi.org/10.3201/eid0503.990326.
Letters

First Case of Human Ehrlichiosis in Mexico [PDF - 51 KB - 1 page]
R. A. Gongóra-Biachi et al.
EID Gongóra-Biachi RA, Zavala-Velázquez J, Castro-Sansores CJ, González-Martínez P. First Case of Human Ehrlichiosis in Mexico. Emerg Infect Dis. 1999;5(3):481. https://dx.doi.org/10.3201/eid0503.990327
AMA Gongóra-Biachi RA, Zavala-Velázquez J, Castro-Sansores CJ, et al. First Case of Human Ehrlichiosis in Mexico. Emerging Infectious Diseases. 1999;5(3):481. doi:10.3201/eid0503.990327.
APA Gongóra-Biachi, R. A., Zavala-Velázquez, J., Castro-Sansores, C. J., & González-Martínez, P. (1999). First Case of Human Ehrlichiosis in Mexico. Emerging Infectious Diseases, 5(3), 481. https://dx.doi.org/10.3201/eid0503.990327.

HIV-1 Subtype F in Single and Dual Infections in Puerto Rico: A Potential Sentinel Site for Monitoring Novel Genetic HIV Variants in North America [PDF - 59 KB - 3 pages]
I. Flores et al.
EID Flores I, Pieniazek D, Morán N, Soler A, Rodríguez N, Alegría M, et al. HIV-1 Subtype F in Single and Dual Infections in Puerto Rico: A Potential Sentinel Site for Monitoring Novel Genetic HIV Variants in North America. Emerg Infect Dis. 1999;5(3):481-483. https://dx.doi.org/10.3201/eid0503.990328
AMA Flores I, Pieniazek D, Morán N, et al. HIV-1 Subtype F in Single and Dual Infections in Puerto Rico: A Potential Sentinel Site for Monitoring Novel Genetic HIV Variants in North America. Emerging Infectious Diseases. 1999;5(3):481-483. doi:10.3201/eid0503.990328.
APA Flores, I., Pieniazek, D., Morán, N., Soler, A., Rodríguez, N., Alegría, M....Yamamura, Y. (1999). HIV-1 Subtype F in Single and Dual Infections in Puerto Rico: A Potential Sentinel Site for Monitoring Novel Genetic HIV Variants in North America. Emerging Infectious Diseases, 5(3), 481-483. https://dx.doi.org/10.3201/eid0503.990328.

Paratyphoid Fever in India: An Emerging Problem [PDF - 56 KB - 3 pages]
S. Sood et al.
EID Sood S, Kapil A, Dash N, Das BK, Goel V, Seth P. Paratyphoid Fever in India: An Emerging Problem. Emerg Infect Dis. 1999;5(3):483-485. https://dx.doi.org/10.3201/eid0503.990329
AMA Sood S, Kapil A, Dash N, et al. Paratyphoid Fever in India: An Emerging Problem. Emerging Infectious Diseases. 1999;5(3):483-485. doi:10.3201/eid0503.990329.
APA Sood, S., Kapil, A., Dash, N., Das, B. K., Goel, V., & Seth, P. (1999). Paratyphoid Fever in India: An Emerging Problem. Emerging Infectious Diseases, 5(3), 483-485. https://dx.doi.org/10.3201/eid0503.990329.

Hepatitis C Virus RNA Viremia in Central Africa [PDF - 55 KB - 3 pages]
N. Cancré et al.
EID Cancré N, Grésenguet G, Mbopi-Kéou F, Kozemaka A, Mohamed AS, Matta M, et al. Hepatitis C Virus RNA Viremia in Central Africa. Emerg Infect Dis. 1999;5(3):484-486. https://dx.doi.org/10.3201/eid0503.990330
AMA Cancré N, Grésenguet G, Mbopi-Kéou F, et al. Hepatitis C Virus RNA Viremia in Central Africa. Emerging Infectious Diseases. 1999;5(3):484-486. doi:10.3201/eid0503.990330.
APA Cancré, N., Grésenguet, G., Mbopi-Kéou, F., Kozemaka, A., Mohamed, A. S., Matta, M....Bélec, L. (1999). Hepatitis C Virus RNA Viremia in Central Africa. Emerging Infectious Diseases, 5(3), 484-486. https://dx.doi.org/10.3201/eid0503.990330.

Immunization of Peacekeeping Forces [PDF - 55 KB - 2 pages]
R. Steffen
EID Steffen R. Immunization of Peacekeeping Forces. Emerg Infect Dis. 1999;5(3):485-486. https://dx.doi.org/10.3201/eid0503.990331
AMA Steffen R. Immunization of Peacekeeping Forces. Emerging Infectious Diseases. 1999;5(3):485-486. doi:10.3201/eid0503.990331.
APA Steffen, R. (1999). Immunization of Peacekeeping Forces. Emerging Infectious Diseases, 5(3), 485-486. https://dx.doi.org/10.3201/eid0503.990331.

Sexually Transmitted Diseases in Ukraine [PDF - 50 KB - 2 pages]
D. I. Ivanov
EID Ivanov DI. Sexually Transmitted Diseases in Ukraine. Emerg Infect Dis. 1999;5(3):486-487. https://dx.doi.org/10.3201/eid0503.9903332
AMA Ivanov DI. Sexually Transmitted Diseases in Ukraine. Emerging Infectious Diseases. 1999;5(3):486-487. doi:10.3201/eid0503.9903332.
APA Ivanov, D. I. (1999). Sexually Transmitted Diseases in Ukraine. Emerging Infectious Diseases, 5(3), 486-487. https://dx.doi.org/10.3201/eid0503.9903332.

Yellow Fever Vaccine [PDF - 53 KB - 2 pages]
S. C. Arya
EID Arya SC. Yellow Fever Vaccine. Emerg Infect Dis. 1999;5(3):487-488. https://dx.doi.org/10.3201/eid0503.990333
AMA Arya SC. Yellow Fever Vaccine. Emerging Infectious Diseases. 1999;5(3):487-488. doi:10.3201/eid0503.990333.
APA Arya, S. C. (1999). Yellow Fever Vaccine. Emerging Infectious Diseases, 5(3), 487-488. https://dx.doi.org/10.3201/eid0503.990333.

Yellow Fever Vaccine—Reply to S. Arya [PDF - 52 KB - 2 pages]
T. Monath et al.
EID Monath T, Giesberg J, Fierros E. Yellow Fever Vaccine—Reply to S. Arya. Emerg Infect Dis. 1999;5(3):488-489. https://dx.doi.org/10.3201/eid0503.990334
AMA Monath T, Giesberg J, Fierros E. Yellow Fever Vaccine—Reply to S. Arya. Emerging Infectious Diseases. 1999;5(3):488-489. doi:10.3201/eid0503.990334.
APA Monath, T., Giesberg, J., & Fierros, E. (1999). Yellow Fever Vaccine—Reply to S. Arya. Emerging Infectious Diseases, 5(3), 488-489. https://dx.doi.org/10.3201/eid0503.990334.
About the Cover

A Mosaic from Louis Pasteur’s Crypt
Page created: January 23, 2012
Page updated: January 23, 2012
Page reviewed: January 23, 2012
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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