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Issue Cover for Volume 7, Number 5—October 2001

Volume 7, Number 5—October 2001

[PDF - 2.28 MB - 152 pages]

Perspective

Emerging Infectious Diseases in an Island Ecosystem: The New Zealand Perspective [PDF - 54 KB - 6 pages]
J. A. Crump et al.

Several unique features characterize infectious disease epidemiology in New Zealand. Historically, well-organized, government-run control programs have eliminated several zoonoses. More recently, however, communicable disease control has been mixed. Rates of rheumatic fever, tuberculosis, and enteric infectious are high, and rates of meningococcal disease are increasing. These diseases are over-represented in New Zealanders of Polynesian descent, who generally live in more deprived and overcrowded conditions than do those of European descent. Measles and pertussis epidemics are recurring because of inadequate vaccine coverage, despite a well-developed childhood immunization program. A progressive response to the HIV epidemic has resulted in relatively low rates of infection, particularly among injecting drug users; however, the response to other sexually transmitted infections has been poor. A key challenge for the future is to build on successful strategies and apply them to persisting and emerging infectious disease threats in a small, geographically isolated country with limited economic resources.

EID Crump JA, Murdoch DR, Baker MG. Emerging Infectious Diseases in an Island Ecosystem: The New Zealand Perspective. Emerg Infect Dis. 2001;7(5):767-772. https://doi.org/10.3201/eid0705.017501
AMA Crump JA, Murdoch DR, Baker MG. Emerging Infectious Diseases in an Island Ecosystem: The New Zealand Perspective. Emerging Infectious Diseases. 2001;7(5):767-772. doi:10.3201/eid0705.017501.
APA Crump, J. A., Murdoch, D. R., & Baker, M. G. (2001). Emerging Infectious Diseases in an Island Ecosystem: The New Zealand Perspective. Emerging Infectious Diseases, 7(5), 767-772. https://doi.org/10.3201/eid0705.017501.

Implementing a Network for Electronic Surveillance Reporting from Public Health Reference Laboratories: An International Perspective [PDF - 39 KB - 7 pages]
N. H. Bean and S. M. Martin

Electronic data reporting from public health laboratories to a central site provides a mechanism for public health officials to rapidly identify problems and take action to prevent further spread of disease. However, implementation of reference laboratory systems is much more complex than simply adopting new technology, especially in international settings. We describe three major areas to be considered by international organizations for successful implementation of electronic reporting systems from public health reference laboratories: benefits of electronic reporting, planning for system implementation (e.g., support, resources, data analysis, country sovereignty), and components of system initiation (e.g., authority, disease definition, feedback, site selection, assessing readiness, problem resolution). Our experience with implementation of electronic public health laboratory data management and reporting systems in the United States and working with international organizations to initiate similar efforts demonstrates that successful reference laboratory reporting can be implemented if surveillance issues and components are planned.

EID Bean NH, Martin SM. Implementing a Network for Electronic Surveillance Reporting from Public Health Reference Laboratories: An International Perspective. Emerg Infect Dis. 2001;7(5):773-779. https://doi.org/10.3201/eid0705.010502
AMA Bean NH, Martin SM. Implementing a Network for Electronic Surveillance Reporting from Public Health Reference Laboratories: An International Perspective. Emerging Infectious Diseases. 2001;7(5):773-779. doi:10.3201/eid0705.010502.
APA Bean, N. H., & Martin, S. M. (2001). Implementing a Network for Electronic Surveillance Reporting from Public Health Reference Laboratories: An International Perspective. Emerging Infectious Diseases, 7(5), 773-779. https://doi.org/10.3201/eid0705.010502.
Synopses

Potential Infectious Etiologies of Atherosclerosis: A Multifactorial Perspective [PDF - 94 KB - 9 pages]
S. O'Connor et al.

Coronary heart disease (CHD) contributes substantially to illness and death worldwide. Experimental studies demonstrate that infection can stimulate atherogenic processes. This review presents a spectrum of data regarding the link between CHD and infection. In addition, the need for improved diagnostic tools, the significance of multiple pathogens, and potential intervention strategies are discussed.

EID O'Connor S, Taylor C, Campbell L, Epstein S, Libby P. Potential Infectious Etiologies of Atherosclerosis: A Multifactorial Perspective. Emerg Infect Dis. 2001;7(5):780-788. https://doi.org/10.3201/eid0705.010503
AMA O'Connor S, Taylor C, Campbell L, et al. Potential Infectious Etiologies of Atherosclerosis: A Multifactorial Perspective. Emerging Infectious Diseases. 2001;7(5):780-788. doi:10.3201/eid0705.010503.
APA O'Connor, S., Taylor, C., Campbell, L., Epstein, S., & Libby, P. (2001). Potential Infectious Etiologies of Atherosclerosis: A Multifactorial Perspective. Emerging Infectious Diseases, 7(5), 780-788. https://doi.org/10.3201/eid0705.010503.

Changing Epidemiology of Q Fever in Germany, 1947-1999 [PDF - 106 KB - 8 pages]
W. Hellenbrand et al.

The epidemiology of Q fever in Germany was examined by reviewing relevant studies since 1947 and by analyzing available surveillance data since 1962. The average annual Q fever incidence nationwide from 1979 to 1989 was 0.8 per million and from 1990 to 1999, 1.4 per million. The mean annual incidence from 1979 to 1999 ranged from a minimum of 0.1 per million in several northern states to 3.1 per million in Baden-Württemberg, in the South. We identified 40 documented outbreaks since 1947; in 24 of these sheep were implicated as the source of transmission. The seasonality of community outbreaks has shifted from predominantly winter-spring to spring-summer, possibly because of changes in sheep husbandry. The location of recent outbreaks suggests that urbanization of rural areas may be contributing to the increase in Q fever. Prevention efforts should focus on reducing sheep-related exposures, particularly near urban areas.

EID Hellenbrand W, Breuer T, Petersen L. Changing Epidemiology of Q Fever in Germany, 1947-1999. Emerg Infect Dis. 2001;7(5):789-796. https://doi.org/10.3201/eid0705.010504
AMA Hellenbrand W, Breuer T, Petersen L. Changing Epidemiology of Q Fever in Germany, 1947-1999. Emerging Infectious Diseases. 2001;7(5):789-796. doi:10.3201/eid0705.010504.
APA Hellenbrand, W., Breuer, T., & Petersen, L. (2001). Changing Epidemiology of Q Fever in Germany, 1947-1999. Emerging Infectious Diseases, 7(5), 789-796. https://doi.org/10.3201/eid0705.010504.

Cost-Effectiveness of a Potential Vaccine for Coccidioides immitis [PDF - 127 KB - 8 pages]
A. E. Barnato et al.

Coccidioidomycosis, a systemic fungal infection, affects Americans living in the Southwest. We evaluated the cost- effectiveness of a potential vaccine against Coccidioides immitis. Using a decision model we developed, we estimate that among children, vaccination would saved 1.9 quality-adjusted life days (QALD) and $33 per person. Among adults, screening followed by vaccination would save 0.5 QALD per person and cost $62,000 per quality adjusted life year gained over no vaccination. If the birth cohort in highly endemic counties of California and Arizona were immunized in 2001, 11 deaths would be averted and $3 million would be saved (in net present value) over the lifetime of these infants. Vaccination of adults to prevent disseminated coccidioidomycosis would provide a modest health benefit similar in magnitude to other vaccines but would increase net expenditures. Vaccination of children in highly endemic regions would provide a larger health benefit and would reduce total health care expenditures.

EID Barnato AE, Sanders GD, Owens DK. Cost-Effectiveness of a Potential Vaccine for Coccidioides immitis. Emerg Infect Dis. 2001;7(5):797-806. https://doi.org/10.3201/eid0705.010505
AMA Barnato AE, Sanders GD, Owens DK. Cost-Effectiveness of a Potential Vaccine for Coccidioides immitis. Emerging Infectious Diseases. 2001;7(5):797-806. doi:10.3201/eid0705.010505.
APA Barnato, A. E., Sanders, G. D., & Owens, D. K. (2001). Cost-Effectiveness of a Potential Vaccine for Coccidioides immitis. Emerging Infectious Diseases, 7(5), 797-806. https://doi.org/10.3201/eid0705.010505.
Research

First Isolation of La Crosse Virus from Naturally Infected Aedes albopictus [PDF - 70 KB - 5 pages]
R. R. Gerhardt et al.

La Crosse (LAC) virus, a California serogroup bunyavirus, is the leading cause of pediatric arboviral encephalitis in the United States and an emerging disease in Tennessee, West Virginia, and North Carolina. Human cases of LAC encephalitis in Tennessee and North Carolina have increased above endemic levels during 1997 to 1999 and may represent an expansion of a new southeastern endemic focus. This report describes the isolation of LAC virus from the exotic mosquito Aedes albopictus. The discovery of LAC virus in wild populations of Ae. albopictus, coupled with its expanding distribution in the southeastern United States, suggests that this mosquito may become an important accessory vector, potentially increasing the number of human cases in endemic foci or expanding the range of the disease.

EID Gerhardt RR, Gottfried KL, Apperson CS, Davis BS, Erwin PC, Smith A, et al. First Isolation of La Crosse Virus from Naturally Infected Aedes albopictus. Emerg Infect Dis. 2001;7(5):807-811. https://doi.org/10.3201/eid0705.017506
AMA Gerhardt RR, Gottfried KL, Apperson CS, et al. First Isolation of La Crosse Virus from Naturally Infected Aedes albopictus. Emerging Infectious Diseases. 2001;7(5):807-811. doi:10.3201/eid0705.017506.
APA Gerhardt, R. R., Gottfried, K. L., Apperson, C. S., Davis, B. S., Erwin, P. C., Smith, A....Nasci, R. S. (2001). First Isolation of La Crosse Virus from Naturally Infected Aedes albopictus. Emerging Infectious Diseases, 7(5), 807-811. https://doi.org/10.3201/eid0705.017506.

Factors Contributing to the Emergence of Escherichia coli O157 in Africa [PDF - 145 KB - 8 pages]
P. Effler et al.

In 1992, a large outbreak of bloody diarrhea caused by Escherichia coli O157 infections occurred in southern Africa. In Swaziland, 40,912 physician visits for diarrhea in persons ages >5 years were reported during October through November 1992. This was a sevenfold increase over the same period during 1990-91. The attack rate was 42% among 778 residents we surveyed. Female gender and consuming beef and untreated water were significant risks for illness. E. coli O157:NM was recovered from seven affected foci in Swaziland and South Africa; 27 of 31 patient and environmental isolates had indistinguishable pulsed-field gel electrophoresis patterns. Compared with previous years, a fivefold increase in cattle deaths occurred in October 1992. The first heavy rains fell that same month (36 mm), following 3 months of drought. Drought, carriage of E. coli O157 by cattle, and heavy rains with contamination of surface water appear to be important factors contributing to this outbreak.

EID Effler P, Isaäcson M, Arntzen L, Heenan R, Canter P, Barrett T, et al. Factors Contributing to the Emergence of Escherichia coli O157 in Africa. Emerg Infect Dis. 2001;7(5):812-819. https://doi.org/10.3201/eid0705.017507
AMA Effler P, Isaäcson M, Arntzen L, et al. Factors Contributing to the Emergence of Escherichia coli O157 in Africa. Emerging Infectious Diseases. 2001;7(5):812-819. doi:10.3201/eid0705.017507.
APA Effler, P., Isaäcson, M., Arntzen, L., Heenan, R., Canter, P., Barrett, T....Griffin, P. M. (2001). Factors Contributing to the Emergence of Escherichia coli O157 in Africa. Emerging Infectious Diseases, 7(5), 812-819. https://doi.org/10.3201/eid0705.017507.

Clinical Consequences and Cost of Limiting Use of Vancomycin for Perioperative Prophylaxis: Example of Coronary Artery Bypass Surgery [PDF - 76 KB - 8 pages]
G. Zanetti et al.

Routine us of vancomycin for perioperative prophylaxis is discouraged, principally to minimize microbial resistance to it. However, outcomes and costs of this recommendation have not been assessed. We used decision-analytic models to compare clinical results and cost-effectiveness of no prophylaxis, cefazolin, and vancomycin, in coronary artery bypass graft surgery. In the base case, vancomycin resulted in 7% fewer surgical site infections and 1% lower all-cause mortality and saved $117 per procedure, compared with cefazolin. Cefazolin, in turn, resulted in substantially fewer infections and deaths and lower costs than no prophylaxis. We conclude that perioperative antibiotic prophylaxis with vancomycin is usually more effective and less expensive than cefazolin. Data on vancomycin's impact on resistance are needed to quantify the trade-off between individual patients' improved clinical outcomes and lower costs and the future long-term consequences to society.

EID Zanetti G, Goldie SJ, Platt R. Clinical Consequences and Cost of Limiting Use of Vancomycin for Perioperative Prophylaxis: Example of Coronary Artery Bypass Surgery. Emerg Infect Dis. 2001;7(5):820-827. https://doi.org/10.3201/eid0705.010508
AMA Zanetti G, Goldie SJ, Platt R. Clinical Consequences and Cost of Limiting Use of Vancomycin for Perioperative Prophylaxis: Example of Coronary Artery Bypass Surgery. Emerging Infectious Diseases. 2001;7(5):820-827. doi:10.3201/eid0705.010508.
APA Zanetti, G., Goldie, S. J., & Platt, R. (2001). Clinical Consequences and Cost of Limiting Use of Vancomycin for Perioperative Prophylaxis: Example of Coronary Artery Bypass Surgery. Emerging Infectious Diseases, 7(5), 820-827. https://doi.org/10.3201/eid0705.010508.

Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery [PDF - 36 KB - 4 pages]
G. Zanetti et al.

Intraoperative redosing of prophylactic antibiotics is recommended for prolonged surgical procedures, although its efficacy has not been assessed. We retrospectively compared the risk of surgical site infections in 1,548 patients who underwent cardiac surgery lasting >240 min after preoperative administration of cefazolin prophylaxis. The overall risk of surgical site infection was similar among patients with (43 [9.4%] of 459) and without (101 [9.3%] of 1,089) intraoperative redosing (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.70-1.47). However, redosing was beneficial in procedures lasting >400 min: infection occurred in 14 (7.7%) of 182 patients with redosing and in 32 (16.0%) of 200 patients without (adjusted OR 0.44, 95% CI 0.23-0.86). Intraoperative redosing of cefazolin was associated with a 16% reduction in the overall risk for surgical site infection after cardiac surgery, including procedures lasting <240 min.

EID Zanetti G, Giardina R, Platt R. Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery. Emerg Infect Dis. 2001;7(5):828-831. https://doi.org/10.3201/eid0705.017509
AMA Zanetti G, Giardina R, Platt R. Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery. Emerging Infectious Diseases. 2001;7(5):828-831. doi:10.3201/eid0705.017509.
APA Zanetti, G., Giardina, R., & Platt, R. (2001). Intraoperative Redosing of Cefazolin and Risk for Surgical Site Infection in Cardiac Surgery. Emerging Infectious Diseases, 7(5), 828-831. https://doi.org/10.3201/eid0705.017509.

Pneumococcal Surface Protein A of Invasive Streptococcus pneumoniae Isolates from Colombian Children [PDF - 29 KB - 5 pages]
M. Coral et al.

Pneumococcal surface protein A (PspA) elicits protection in mice against fatal bacteremia and sepsis caused by genetically diverse pneumococci and protects against carriage and lung infection. We determined the PspA families of invasive isolates of Streptococcus pneumoniae recovered from Colombian children <5 years of age. That 97.5% of Colombian isolates belong to PspA families 1 and 2 supports the hypothesis that a human PspA vaccine covering a few PspA families could be broadly effective.

EID Coral M, Fonseca N, Castañeda E, Di Fabio J, Hollingshead SK, Briles DE. Pneumococcal Surface Protein A of Invasive Streptococcus pneumoniae Isolates from Colombian Children. Emerg Infect Dis. 2001;7(5):832-836. https://doi.org/10.3201/eid0705.017510
AMA Coral M, Fonseca N, Castañeda E, et al. Pneumococcal Surface Protein A of Invasive Streptococcus pneumoniae Isolates from Colombian Children. Emerging Infectious Diseases. 2001;7(5):832-836. doi:10.3201/eid0705.017510.
APA Coral, M., Fonseca, N., Castañeda, E., Di Fabio, J., Hollingshead, S. K., & Briles, D. E. (2001). Pneumococcal Surface Protein A of Invasive Streptococcus pneumoniae Isolates from Colombian Children. Emerging Infectious Diseases, 7(5), 832-836. https://doi.org/10.3201/eid0705.017510.

Epidemiology of and Surveillance for Postpartum Infections [PDF - 54 KB - 5 pages]
D. S. Yokoe et al.

We screened automated ambulatory medical records, hospital and emergency room claims, and pharmacy records of 2,826 health maintenance organization (HMO) members who gave birth over a 30-month period. Full-text ambulatory records were reviewed for the 30-day postpartum period to confirm infection status for a weighted sample of cases. The overall postpartum infection rate was 6.0%, with rates of 7.4% following cesarean section and 5.5% following vaginal delivery. Rehospitalization; cesarean delivery; antistaphylococcal antibiotics; diagnosis codes for mastitis, endometritis, and wound infection; and ambulatory blood or wound cultures were important predictors of infection. Use of automated information routinely collected by HMOs and insurers allows efficient identification of postpartum infections not detected by conventional surveillance.

EID Yokoe DS, Christiansen CL, Johnson R, Sands K, Livingston J, Shtatland ES, et al. Epidemiology of and Surveillance for Postpartum Infections. Emerg Infect Dis. 2001;7(5):837-841. https://doi.org/10.3201/eid0705.010511
AMA Yokoe DS, Christiansen CL, Johnson R, et al. Epidemiology of and Surveillance for Postpartum Infections. Emerging Infectious Diseases. 2001;7(5):837-841. doi:10.3201/eid0705.010511.
APA Yokoe, D. S., Christiansen, C. L., Johnson, R., Sands, K., Livingston, J., Shtatland, E. S....Platt, R. (2001). Epidemiology of and Surveillance for Postpartum Infections. Emerging Infectious Diseases, 7(5), 837-841. https://doi.org/10.3201/eid0705.010511.

Molecular Identification of Streptomycin Monoresistant Mycobacterium tuberculosis Related to Multidrug-Resistant W Strain [PDF - 135 KB - 7 pages]
P. Bifani et al.

A distinct branch of the Mycobacterium tuberculosis W phylogenetic lineage (W14 group) has been identified and characterized by various genotyping techniques. The W14 group comprises three strain variants: W14, W23, and W26, which accounted for 26 clinical isolates from the New York City metropolitan area. The W14 group shares a unique IS6110 hybridizing banding motif as well as distinct polymorphic GC-rich repetitive sequence and variable number tandem repeat patterns. All W14 group members have high levels of streptomycin resistance. When the streptomycin resistance rpsL target gene was sequenced, all members of this strain family had an identical mutation in codon 43. Patients infected with the W14 group were primarily of non-Hispanic black origin (77%); all were US-born. Including HIV positivity, 84% of the patients had at least one known risk factor for tuberculosis.

EID Bifani P, Mathema B, Campo M, Moghazeh S, Nivin B, Shashkina E, et al. Molecular Identification of Streptomycin Monoresistant Mycobacterium tuberculosis Related to Multidrug-Resistant W Strain. Emerg Infect Dis. 2001;7(5):842-848. https://doi.org/10.3201/eid0705.010512
AMA Bifani P, Mathema B, Campo M, et al. Molecular Identification of Streptomycin Monoresistant Mycobacterium tuberculosis Related to Multidrug-Resistant W Strain. Emerging Infectious Diseases. 2001;7(5):842-848. doi:10.3201/eid0705.010512.
APA Bifani, P., Mathema, B., Campo, M., Moghazeh, S., Nivin, B., Shashkina, E....Kreiswirth, B. N. (2001). Molecular Identification of Streptomycin Monoresistant Mycobacterium tuberculosis Related to Multidrug-Resistant W Strain. Emerging Infectious Diseases, 7(5), 842-848. https://doi.org/10.3201/eid0705.010512.

Clonal Expansion of Sequence Type (ST-)5 and Emergence of ST-7 in Serogroup A Meningococci, Africa [PDF - 50 KB - 6 pages]
P. Nicolas et al.

One hundred four serogroup A meningococci in our collection, isolated in Africa from 1988 to 1999, were characterized by multilocus sequence typing (MLST). Our results and data from the Internet indicate that sequence type 5 (ST-5) strains were responsible for most of African outbreaks and sporadic cases during this period. In 1995, a new clone, characterized by ST-7 sequence, emerged and was responsible for severe outbreaks in Chad (1998) and Sudan (1999). MLST and epidemiologic data indicate that ST-5 and ST-7 represent two virulent clones. These two STs, which belong to subgroup III, differ only in the pgm locus: allele pgm3 is characteristic for ST-5 and allele pgm19 for ST-7. Subgroup III strains were responsible for two pandemics in the 1960s and 1980s. Our data show that the third subgroup III pandemic has now reached Africa.

EID Nicolas P, Décousset L, Riglet V, Castelli P, Stor R, Blanchet G. Clonal Expansion of Sequence Type (ST-)5 and Emergence of ST-7 in Serogroup A Meningococci, Africa. Emerg Infect Dis. 2001;7(5):849-854. https://doi.org/10.3201/eid0705.010513
AMA Nicolas P, Décousset L, Riglet V, et al. Clonal Expansion of Sequence Type (ST-)5 and Emergence of ST-7 in Serogroup A Meningococci, Africa. Emerging Infectious Diseases. 2001;7(5):849-854. doi:10.3201/eid0705.010513.
APA Nicolas, P., Décousset, L., Riglet, V., Castelli, P., Stor, R., & Blanchet, G. (2001). Clonal Expansion of Sequence Type (ST-)5 and Emergence of ST-7 in Serogroup A Meningococci, Africa. Emerging Infectious Diseases, 7(5), 849-854. https://doi.org/10.3201/eid0705.010513.

Multidrug-Resistant Tuberculosis in Prison Inmates, Azerbaijan [PDF - 169 KB - 7 pages]
G. E. Pfyffer et al.

In a tuberculosis (TB) program in the Central Penitentiary Hospital of Azerbaijan, we analyzed 65 isolates of Mycobacterium tuberculosis by IS6110-based restriction fragment-length polymorphism (RFLP) and spoligotyping. From 11 clusters associated with 33 patients, 31 isolates had an IS6110-based banding pattern characteristic of the Beijing genotype of M. tuberculosis. In addition, 15 M. tuberculosis isolates with similar RFLP patterns constituted a single group by spoligotyping, matching the Beijing genotype. Multidrug resistance, always involving isoniazid and rifampin, was seen in 34 (52.3%) of 65 isolates, with 28 belonging to the Beijing genotype.

EID Pfyffer GE, Strässle A, van Gorkum T, Portaels F, Rigouts L, Mathieu C, et al. Multidrug-Resistant Tuberculosis in Prison Inmates, Azerbaijan. Emerg Infect Dis. 2001;7(5):855-861. https://doi.org/10.3201/eid0705.017514
AMA Pfyffer GE, Strässle A, van Gorkum T, et al. Multidrug-Resistant Tuberculosis in Prison Inmates, Azerbaijan. Emerging Infectious Diseases. 2001;7(5):855-861. doi:10.3201/eid0705.017514.
APA Pfyffer, G. E., Strässle, A., van Gorkum, T., Portaels, F., Rigouts, L., Mathieu, C....van Embden, J. (2001). Multidrug-Resistant Tuberculosis in Prison Inmates, Azerbaijan. Emerging Infectious Diseases, 7(5), 855-861. https://doi.org/10.3201/eid0705.017514.

Rapid Emergence of Ciprofloxacin-Resistant Enterobacteriaceae Containing Multiple Gentamicin Resistance-Associated Integrons, the Netherlands [PDF - 85 KB - 10 pages]
A. van Belkum et al.

In a hematology unit in the Netherlands, the incidence of ciprofloxacin-resistant Enterobacter cloacae and Escherichia coli increased from <0.5% to 20.7% and <0.5% to 64%, respectively, from 1996 to 1999. Clonal spread of single genotypes of both ciprofloxacin-resistant E. coli and Enterobacter cloacae from patient to patient was documented by pulsed-field gel electrophoresis and random amplification of polymorphic DNA. In addition, genetically heterogeneous strains were isolated regularly. Integrons associated with gentamicin resistance were detected in Enterobacter cloacae and E. coli strains. Integron-containing E. coli were detected in all hematology wards. In contrast, in Enterobacter cloacae strains two integron types were encountered only in the isolates from one ward. Although in all patients identical antibiotic regimens were used for selective decontamination, we documented clear differences with respect to the nosocomial emergence of ciprofloxacin-resistant bacterial strains and gentamicin resistance-associated integrons.

EID van Belkum A, Goessens W, van der Schee C, Lemmens-den Toom N, Vos MC, Cornelissen J, et al. Rapid Emergence of Ciprofloxacin-Resistant Enterobacteriaceae Containing Multiple Gentamicin Resistance-Associated Integrons, the Netherlands. Emerg Infect Dis. 2001;7(5):862-871. https://doi.org/10.3201/eid0705.017515
AMA van Belkum A, Goessens W, van der Schee C, et al. Rapid Emergence of Ciprofloxacin-Resistant Enterobacteriaceae Containing Multiple Gentamicin Resistance-Associated Integrons, the Netherlands. Emerging Infectious Diseases. 2001;7(5):862-871. doi:10.3201/eid0705.017515.
APA van Belkum, A., Goessens, W., van der Schee, C., Lemmens-den Toom, N., Vos, M. C., Cornelissen, J....Endtz, H. (2001). Rapid Emergence of Ciprofloxacin-Resistant Enterobacteriaceae Containing Multiple Gentamicin Resistance-Associated Integrons, the Netherlands. Emerging Infectious Diseases, 7(5), 862-871. https://doi.org/10.3201/eid0705.017515.

Topical Insecticide Treatments to Protect Dogs from Sand Fly Vectors of Leishmaniasis [PDF - 75 KB - 5 pages]
R. Reithinger et al.

We compared the susceptibility of sand fly vectors to four topical insecticide treatments applied to domestic dogs, a reservoir of human leishmaniasis. Dogs were exposed to sand flies pretreatment and at 1 week, 1 month, and 2 months posttreatment. Sand fly bloodfeeding and survival rate of both fed and unfed flies were significantly reduced by the permethrin, deltamethrin, and fenthion treatments, but diazinon had no effect. The survival rate of bloodfed sand flies was reduced by up to 86% with deltamethrin collars. The antifeeding effect suggests that deltamethrin collars may be recommended to dog owners to protect their pets from sandfly-borne diseases. The combined effects on sand fly feeding and survival indicate that epidemiologic, community-based trials are warranted to test whether deltamethrin collars could reduce the incidence of canine and, hence, human leishmaniasis.

EID Reithinger R, Teodoro U, Davies CR. Topical Insecticide Treatments to Protect Dogs from Sand Fly Vectors of Leishmaniasis. Emerg Infect Dis. 2001;7(5):872-876. https://doi.org/10.3201/eid0705.017516
AMA Reithinger R, Teodoro U, Davies CR. Topical Insecticide Treatments to Protect Dogs from Sand Fly Vectors of Leishmaniasis. Emerging Infectious Diseases. 2001;7(5):872-876. doi:10.3201/eid0705.017516.
APA Reithinger, R., Teodoro, U., & Davies, C. R. (2001). Topical Insecticide Treatments to Protect Dogs from Sand Fly Vectors of Leishmaniasis. Emerging Infectious Diseases, 7(5), 872-876. https://doi.org/10.3201/eid0705.017516.
Dispatches

Ehrlichia-Infected Ticks on Migrating Birds [PDF - 21 KB - 3 pages]
A. Bjöersdorff et al.

During the spring of 1996, an estimated 581,395 Ehrlichia-infected ticks were imported into Sweden by migrating birds. Ehrlichia gene sequences found in ticks collected from these migrating birds were identical to those of granulocytic ehrlichiosis found in domestic animals and humans in Sweden. These findings support the idea that birds may play a role in dispersing Ehrlichia.

EID Bjöersdorff A, Bergström S, Massung RF, Haemig PD, Olsen B. Ehrlichia-Infected Ticks on Migrating Birds. Emerg Infect Dis. 2001;7(5):877-879. https://doi.org/10.3201/eid0705.017517
AMA Bjöersdorff A, Bergström S, Massung RF, et al. Ehrlichia-Infected Ticks on Migrating Birds. Emerging Infectious Diseases. 2001;7(5):877-879. doi:10.3201/eid0705.017517.
APA Bjöersdorff, A., Bergström, S., Massung, R. F., Haemig, P. D., & Olsen, B. (2001). Ehrlichia-Infected Ticks on Migrating Birds. Emerging Infectious Diseases, 7(5), 877-879. https://doi.org/10.3201/eid0705.017517.

Mycobacterium tuberculosis Beijing Genotype Strains Associated with Febrile Response to Treatment [PDF - 70 KB - 4 pages]
R. van Crevel et al.

DNA fingerprinting has demonstrated predominance of the Beijing genotype among Mycobacterium tuberculosis strains isolated in Southeast Asia. We prospectively examined the occurrence of Beijing genotype strains in tuberculosis patients in Indonesia. Early in treatment, patients infected with Beijing genotype strains more often had fever unrelated to disease severity, toxicity, or drug resistance, indicating that Beijing genotype strains may have specific pathogenic properties.

EID van Crevel R, Nelwan R, de Lenne W, Veeraragu Y, van der Zanden AG, Amin Z, et al. Mycobacterium tuberculosis Beijing Genotype Strains Associated with Febrile Response to Treatment. Emerg Infect Dis. 2001;7(5):880-883. https://doi.org/10.3201/eid0705.017518
AMA van Crevel R, Nelwan R, de Lenne W, et al. Mycobacterium tuberculosis Beijing Genotype Strains Associated with Febrile Response to Treatment. Emerging Infectious Diseases. 2001;7(5):880-883. doi:10.3201/eid0705.017518.
APA van Crevel, R., Nelwan, R., de Lenne, W., Veeraragu, Y., van der Zanden, A. G., Amin, Z....van Soolingen, D. (2001). Mycobacterium tuberculosis Beijing Genotype Strains Associated with Febrile Response to Treatment. Emerging Infectious Diseases, 7(5), 880-883. https://doi.org/10.3201/eid0705.017518.

Lactococcus lactis subsp. lactis Infection in Waterfowl: First Confirmation in Animals [PDF - 43 KB - 3 pages]
J. Goyache et al.

We report the first description, confirmed by bacteriologic and molecular (polymerase chain reaction and pulsed-field gel electrophoresis) analysis, of an infection in animals caused by Lactococcus lactis subsp. lactis, affecting waterfowl.

EID Goyache J, Vela AI, Gibello A, Blanco MM, Briones V, González S, et al. Lactococcus lactis subsp. lactis Infection in Waterfowl: First Confirmation in Animals. Emerg Infect Dis. 2001;7(5):884-886. https://doi.org/10.3201/eid0705.017519
AMA Goyache J, Vela AI, Gibello A, et al. Lactococcus lactis subsp. lactis Infection in Waterfowl: First Confirmation in Animals. Emerging Infectious Diseases. 2001;7(5):884-886. doi:10.3201/eid0705.017519.
APA Goyache, J., Vela, A. I., Gibello, A., Blanco, M. M., Briones, V., González, S....Fernández-Garayzábal, J. F. (2001). Lactococcus lactis subsp. lactis Infection in Waterfowl: First Confirmation in Animals. Emerging Infectious Diseases, 7(5), 884-886. https://doi.org/10.3201/eid0705.017519.

First Epidemic of Echovirus 16 Meningitis in Cuba [PDF - 36 KB - 3 pages]
L. Sarmiento et al.

From April to September 2000, an epidemic of aseptic meningitis spread throughout Cuba, with 16,943 reported cases. Virologic studies identified echovirus 16 as the cause of this epidemic. This is the first reported isolate of echovirus 16 from patients with viral meningitis in Cuba.

EID Sarmiento L, Mas P, Goyenechea A, Palomera R, Morier L, Capó V, et al. First Epidemic of Echovirus 16 Meningitis in Cuba. Emerg Infect Dis. 2001;7(5):887-889. https://doi.org/10.3201/eid0705.017520
AMA Sarmiento L, Mas P, Goyenechea A, et al. First Epidemic of Echovirus 16 Meningitis in Cuba. Emerging Infectious Diseases. 2001;7(5):887-889. doi:10.3201/eid0705.017520.
APA Sarmiento, L., Mas, P., Goyenechea, A., Palomera, R., Morier, L., Capó, V....Santin, M. (2001). First Epidemic of Echovirus 16 Meningitis in Cuba. Emerging Infectious Diseases, 7(5), 887-889. https://doi.org/10.3201/eid0705.017520.

Expanding Global Distribution of Rotavirus Serotype G9: Detection in Libya, Kenya, and Cuba [PDF - 21 KB - 3 pages]
N. A. Cunliffe et al.

Serotype G9 may be the fifth most common human rotavirus serotype, after serotypes G1 to G4. In three cross-sectional studies of childhood diarrhea, we have detected serotype G9 rotaviruses for the first time in Libya, Kenya, and Cuba. Serotype G9 constituted 27% of all rotaviruses identified, emphasizing the reemergence of serotype G9 and suggesting that future human rotavirus vaccines will need to protect against disease caused by this serotype.

EID Cunliffe NA, Dove W, Bunn J, Ben Ramadam M, Nyangao J, Riveron RL, et al. Expanding Global Distribution of Rotavirus Serotype G9: Detection in Libya, Kenya, and Cuba. Emerg Infect Dis. 2001;7(5):890-892. https://doi.org/10.3201/eid0705.017521
AMA Cunliffe NA, Dove W, Bunn J, et al. Expanding Global Distribution of Rotavirus Serotype G9: Detection in Libya, Kenya, and Cuba. Emerging Infectious Diseases. 2001;7(5):890-892. doi:10.3201/eid0705.017521.
APA Cunliffe, N. A., Dove, W., Bunn, J., Ben Ramadam, M., Nyangao, J., Riveron, R. L....Hart, C. (2001). Expanding Global Distribution of Rotavirus Serotype G9: Detection in Libya, Kenya, and Cuba. Emerging Infectious Diseases, 7(5), 890-892. https://doi.org/10.3201/eid0705.017521.

Human Herpesvirus-8 and Other Viral Infections, Papua New Guinea [PDF - 22 KB - 3 pages]
G. Rezza et al.

We studied residents of remote villages and the capital (Port Moresby) of Papua New Guinea to determine the distribution of human herpesvirus-8 (HHV-8) infection. Our data suggest that HHV-8 has been endemic on the island for a long time and that the epidemiologic pattern of HHV-8 is more similar to that of herpes simplex virus-2 than hepatitis C virus.

EID Rezza G, Danaya RT, Wagner TM, Sarmati L, Owen IL, Monini P, et al. Human Herpesvirus-8 and Other Viral Infections, Papua New Guinea. Emerg Infect Dis. 2001;7(5):893-895. https://doi.org/10.3201/eid0705.017522
AMA Rezza G, Danaya RT, Wagner TM, et al. Human Herpesvirus-8 and Other Viral Infections, Papua New Guinea. Emerging Infectious Diseases. 2001;7(5):893-895. doi:10.3201/eid0705.017522.
APA Rezza, G., Danaya, R. T., Wagner, T. M., Sarmati, L., Owen, I. L., Monini, P....Pozio, E. (2001). Human Herpesvirus-8 and Other Viral Infections, Papua New Guinea. Emerging Infectious Diseases, 7(5), 893-895. https://doi.org/10.3201/eid0705.017522.

A Unique Mycobacterium Species Isolated from an Epizootic of Striped Bass (Morone saxatilis) [PDF - 75 KB - 4 pages]
M. W. Rhodes et al.

We isolated a Mycobacterium sp. resembling Mycobacterium marinum and M. ulcerans from diseased striped bass (Morone saxatilis) during an epizootic of mycobacteriosis in the Chesapeake Bay. This isolate may represent an undescribed Mycobacterium species, based on phenotypic characteristics and comparative 16S rRNA gene sequence.

EID Rhodes MW, Kator H, Kotob S, van Berkum P, Kaattari I, Vogelbein W, et al. A Unique Mycobacterium Species Isolated from an Epizootic of Striped Bass (Morone saxatilis). Emerg Infect Dis. 2001;7(5):896-899. https://doi.org/10.3201/eid0705.017523
AMA Rhodes MW, Kator H, Kotob S, et al. A Unique Mycobacterium Species Isolated from an Epizootic of Striped Bass (Morone saxatilis). Emerging Infectious Diseases. 2001;7(5):896-899. doi:10.3201/eid0705.017523.
APA Rhodes, M. W., Kator, H., Kotob, S., van Berkum, P., Kaattari, I., Vogelbein, W....Shotts, E. (2001). A Unique Mycobacterium Species Isolated from an Epizootic of Striped Bass (Morone saxatilis). Emerging Infectious Diseases, 7(5), 896-899. https://doi.org/10.3201/eid0705.017523.

Wind-Blown Mosquitoes and Introduction of Japanese Encephalitis into Australia [PDF - 95 KB - 9 pages]
S. A. Ritchie and W. Rochester

Backtrack simulation analysis indicates that wind-blown mosquitoes could have traveled from New Guinea to Australia, potentially introducing Japanese encephalitis virus. Large incursions of the virus in 1995 and 1998 were linked with low-pressure systems that sustained strong northerly winds from New Guinea to the Cape York Peninsula.

EID Ritchie SA, Rochester W. Wind-Blown Mosquitoes and Introduction of Japanese Encephalitis into Australia. Emerg Infect Dis. 2001;7(5):900-908. https://doi.org/10.3201/eid0705.017524
AMA Ritchie SA, Rochester W. Wind-Blown Mosquitoes and Introduction of Japanese Encephalitis into Australia. Emerging Infectious Diseases. 2001;7(5):900-908. doi:10.3201/eid0705.017524.
APA Ritchie, S. A., & Rochester, W. (2001). Wind-Blown Mosquitoes and Introduction of Japanese Encephalitis into Australia. Emerging Infectious Diseases, 7(5), 900-908. https://doi.org/10.3201/eid0705.017524.

Perceived Etiology of Foodborne Illness among Public Health Personnel [PDF - 17 KB - 2 pages]
T. F. Jones and D. Gerber

Few data exist about perceptions regarding the etiology of foodborne illness. Among public health staff throughout Tennessee, the three pathogens most commonly believed to cause foodborne illness in the United States actually account for only 12% of disease. Fewer than 3% of respondents correctly identified the leading cause of foodborne illness.

EID Jones TF, Gerber D. Perceived Etiology of Foodborne Illness among Public Health Personnel. Emerg Infect Dis. 2001;7(5):904-905. https://doi.org/10.3201/eid0705.010525
AMA Jones TF, Gerber D. Perceived Etiology of Foodborne Illness among Public Health Personnel. Emerging Infectious Diseases. 2001;7(5):904-905. doi:10.3201/eid0705.010525.
APA Jones, T. F., & Gerber, D. (2001). Perceived Etiology of Foodborne Illness among Public Health Personnel. Emerging Infectious Diseases, 7(5), 904-905. https://doi.org/10.3201/eid0705.010525.

Fluoroquinolone Resistance among Streptococcus pneumoniae in Hong Kong Linked to the Spanish 23F Clone [PDF - 40 KB - 3 pages]
P. Ho et al.

Serotypes 6A/B, 19F, and 23F accounted for 73% of 140 mucosal isolates of Streptococcus pneumoniae from Hong Kong. In pulsed-field gel electrophoresis analysis, a group of related patterns was shared by 14 of 15 ciprofloxacin-resistant and 12 of 16 ciprofloxacin-susceptible isolates. These strains exhibited capsular switching and were highly similar to the Spanish 23F clone.

EID Ho P, Yam W, Cheung T, Ng W, Que T, Tsang D, et al. Fluoroquinolone Resistance among Streptococcus pneumoniae in Hong Kong Linked to the Spanish 23F Clone. Emerg Infect Dis. 2001;7(5):906-908. https://doi.org/10.3201/eid0705.010526
AMA Ho P, Yam W, Cheung T, et al. Fluoroquinolone Resistance among Streptococcus pneumoniae in Hong Kong Linked to the Spanish 23F Clone. Emerging Infectious Diseases. 2001;7(5):906-908. doi:10.3201/eid0705.010526.
APA Ho, P., Yam, W., Cheung, T., Ng, W., Que, T., Tsang, D....Seto, W. (2001). Fluoroquinolone Resistance among Streptococcus pneumoniae in Hong Kong Linked to the Spanish 23F Clone. Emerging Infectious Diseases, 7(5), 906-908. https://doi.org/10.3201/eid0705.010526.
Letters

First Documentation of Rickettsia conorii Infection (Strain Indian Tick Typhus) in a Traveler [PDF - 20 KB - 2 pages]
P. Parola et al.
EID Parola P, Fenollar F, Badiaga S, Brouqui P, Raoult D. First Documentation of Rickettsia conorii Infection (Strain Indian Tick Typhus) in a Traveler. Emerg Infect Dis. 2001;7(5):909-910. https://doi.org/10.3201/eid0705.017527
AMA Parola P, Fenollar F, Badiaga S, et al. First Documentation of Rickettsia conorii Infection (Strain Indian Tick Typhus) in a Traveler. Emerging Infectious Diseases. 2001;7(5):909-910. doi:10.3201/eid0705.017527.
APA Parola, P., Fenollar, F., Badiaga, S., Brouqui, P., & Raoult, D. (2001). First Documentation of Rickettsia conorii Infection (Strain Indian Tick Typhus) in a Traveler. Emerging Infectious Diseases, 7(5), 909-910. https://doi.org/10.3201/eid0705.017527.

Multidrug-Resistant Pseudomonas aeruginosa Producing PER-1 Extended-Spectrum Serine-β-Lactamase and VIM-2 Metallo-β-Lactamase [PDF - 20 KB - 2 pages]
J. Docquier et al.
EID Docquier J, Luzzaro F, Amicosante G, Toniolo A, Rossolini G. Multidrug-Resistant Pseudomonas aeruginosa Producing PER-1 Extended-Spectrum Serine-β-Lactamase and VIM-2 Metallo-β-Lactamase. Emerg Infect Dis. 2001;7(5):910-911. https://doi.org/10.3201/eid0705.010528
AMA Docquier J, Luzzaro F, Amicosante G, et al. Multidrug-Resistant Pseudomonas aeruginosa Producing PER-1 Extended-Spectrum Serine-β-Lactamase and VIM-2 Metallo-β-Lactamase. Emerging Infectious Diseases. 2001;7(5):910-911. doi:10.3201/eid0705.010528.
APA Docquier, J., Luzzaro, F., Amicosante, G., Toniolo, A., & Rossolini, G. (2001). Multidrug-Resistant Pseudomonas aeruginosa Producing PER-1 Extended-Spectrum Serine-β-Lactamase and VIM-2 Metallo-β-Lactamase. Emerging Infectious Diseases, 7(5), 910-911. https://doi.org/10.3201/eid0705.010528.

Jamestown Canyon Virus: Seroprevalence in Connecticut [PDF - 20 KB - 2 pages]
D. Mayo et al.
EID Mayo D, Karabatsos N, Scarano FJ, Brennan T, Buck D, Fiorentino T, et al. Jamestown Canyon Virus: Seroprevalence in Connecticut. Emerg Infect Dis. 2001;7(5):911-912. https://doi.org/10.3201/eid0705.017529
AMA Mayo D, Karabatsos N, Scarano FJ, et al. Jamestown Canyon Virus: Seroprevalence in Connecticut. Emerging Infectious Diseases. 2001;7(5):911-912. doi:10.3201/eid0705.017529.
APA Mayo, D., Karabatsos, N., Scarano, F. J., Brennan, T., Buck, D., Fiorentino, T....Tran, S. (2001). Jamestown Canyon Virus: Seroprevalence in Connecticut. Emerging Infectious Diseases, 7(5), 911-912. https://doi.org/10.3201/eid0705.017529.

A Newly Discovered Variant of a Hantavirus in Apodemus peninsulae, Far Eastern Russia [PDF - 22 KB - 2 pages]
L. Yashina et al.
EID Yashina L, Mishin VP, Zdanovskaya N, Schmaljohn C, Ivanov L. A Newly Discovered Variant of a Hantavirus in Apodemus peninsulae, Far Eastern Russia. Emerg Infect Dis. 2001;7(5):912-913. https://doi.org/10.3201/eid0705.017530
AMA Yashina L, Mishin VP, Zdanovskaya N, et al. A Newly Discovered Variant of a Hantavirus in Apodemus peninsulae, Far Eastern Russia. Emerging Infectious Diseases. 2001;7(5):912-913. doi:10.3201/eid0705.017530.
APA Yashina, L., Mishin, V. P., Zdanovskaya, N., Schmaljohn, C., & Ivanov, L. (2001). A Newly Discovered Variant of a Hantavirus in Apodemus peninsulae, Far Eastern Russia. Emerging Infectious Diseases, 7(5), 912-913. https://doi.org/10.3201/eid0705.017530.
About the Cover

The Arrival of the Maoris in New Zealand, 1898 [PDF - 30 KB - 1 page]
R. Blackley
EID Blackley R. The Arrival of the Maoris in New Zealand, 1898. Emerg Infect Dis. 2001;7(5):914. https://doi.org/10.3201/eid0705.ac0705
AMA Blackley R. The Arrival of the Maoris in New Zealand, 1898. Emerging Infectious Diseases. 2001;7(5):914. doi:10.3201/eid0705.ac0705.
APA Blackley, R. (2001). The Arrival of the Maoris in New Zealand, 1898. Emerging Infectious Diseases, 7(5), 914. https://doi.org/10.3201/eid0705.ac0705.
Page created: April 26, 2012
Page updated: April 26, 2012
Page reviewed: April 26, 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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