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Issue Cover for Volume 9, Number 1—January 2003

Volume 9, Number 1—January 2003

[PDF - 17.14 MB - 156 pages]

Perspective

Maintaining Fluoroquinolone Class Efficacy: Review of Influencing Factors [PDF - 224 KB - 9 pages]
W. M. Scheld

Previous experience with antimicrobial resistance has emphasized the importance of appropriate stewardship of these pharmacotherapeutic agents. The introduction of fluoroquinolones provided potent new drugs directed primarily against gram-negative pathogens, while the newer members of this class demonstrate more activity against gram-positive species, including Streptococcus pneumoniae. Although these agents are clinically effective against a broad range of infectious agents, emergence of resistance and associated clinical failures have prompted reexamination of their use. Appropriate use revolves around two key objectives: 1) only prescribing antimicrobial therapy when it is beneficial and 2) using the agents(s) with optimal activity against the expected pathogens(s). Pharmacodynamic principles and properties can be applied to achieve the latter objective when prescribing agents belonging to the fluoroquinolone class. A focused approach emphasizing “correct-spectrum” coverage may reduce development of antimicrobial resistance and maintain class efficacy.

EID Scheld WM. Maintaining Fluoroquinolone Class Efficacy: Review of Influencing Factors. Emerg Infect Dis. 2003;9(1):1-9. https://dx.doi.org/10.3201/eid0901.020277
AMA Scheld WM. Maintaining Fluoroquinolone Class Efficacy: Review of Influencing Factors. Emerging Infectious Diseases. 2003;9(1):1-9. doi:10.3201/eid0901.020277.
APA Scheld, W. M. (2003). Maintaining Fluoroquinolone Class Efficacy: Review of Influencing Factors. Emerging Infectious Diseases, 9(1), 1-9. https://dx.doi.org/10.3201/eid0901.020277.

Dead Bugs Don’t Mutate: Susceptibility Issues in the Emergence of Bacterial Resistance [PDF - 221 KB - 7 pages]
C. W. Stratton

The global emergence of antibacterial resistance among common and atypical respiratory pathogens in the last decade necessitates the strategic application of antibacterial agents. The use of bactericidal rather than bacteriostatic agents as first-line therapy is recommended because the eradication of microorganisms serves to curtail, although not avoid, the development of bacterial resistance. Bactericidal activity is achieved with specific classes of antimicrobial agents as well as by combination therapy. Newer classes of antibacterial agents, such as the fluoroquinolones and certain members of the macrolide/lincosamine/streptogramin class have increased bactericidal activity compared with traditional agents. More recently, the ketolides (novel, semisynthetic, erythromycin-A derivatives) have demonstrated potent bactericidal activity against key respiratory pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, Chlamydia pneumoniae, and Moraxella catarrhalis. Moreover, the ketolides are associated with a low potential for inducing resistance, making them promising first-line agents for respiratory tract infections.

EID Stratton CW. Dead Bugs Don’t Mutate: Susceptibility Issues in the Emergence of Bacterial Resistance. Emerg Infect Dis. 2003;9(1):10-16. https://dx.doi.org/10.3201/eid0901.020172
AMA Stratton CW. Dead Bugs Don’t Mutate: Susceptibility Issues in the Emergence of Bacterial Resistance. Emerging Infectious Diseases. 2003;9(1):10-16. doi:10.3201/eid0901.020172.
APA Stratton, C. W. (2003). Dead Bugs Don’t Mutate: Susceptibility Issues in the Emergence of Bacterial Resistance. Emerging Infectious Diseases, 9(1), 10-16. https://dx.doi.org/10.3201/eid0901.020172.

Geographic Translocation of Bats: Known and Potential Problems [PDF - 210 KB - 5 pages]
D. G. Constantine

Natural, accidental, and intentional translocation of bats, both intra- and intercontinentally, has been documented. Some bats have been translocated while incubating infectious diseases, including rabies or related lyssavirus infections; others have escaped confinement en route to or at their destinations, while others have been released deliberately. Known events and potential consequences of bat translocation are reviewed, including a proposed solution to the attendant problems.

EID Constantine DG. Geographic Translocation of Bats: Known and Potential Problems. Emerg Infect Dis. 2003;9(1):17-21. https://dx.doi.org/10.3201/eid0901.020104
AMA Constantine DG. Geographic Translocation of Bats: Known and Potential Problems. Emerging Infectious Diseases. 2003;9(1):17-21. doi:10.3201/eid0901.020104.
APA Constantine, D. G. (2003). Geographic Translocation of Bats: Known and Potential Problems. Emerging Infectious Diseases, 9(1), 17-21. https://dx.doi.org/10.3201/eid0901.020104.
Research

Foot and Mouth Disease in Livestock and Reduced Cryptosporidiosis in Humans, England and Wales [PDF - 321 KB - 7 pages]
W. J. Smerdon et al.

During the 2001 epidemic of foot and mouth disease (FMD) in livestock in England and Wales, we discovered a corresponding decrease in laboratory reports of cryptosporidiosis in humans. Using a regression model of laboratory reports of cryptosporidiosis, we found an estimated 35% (95% confidence interval [CI] 20% to 47%) reduction in reports during the weeks spanning the period from the first and last cases of FMD. The largest reduction occurred in northwest England, where the estimated decrease was 63% (95% CI 31% to 80%). Genotyping a subgroup of human isolates suggested that the proportion of Cryptosporidium genotype 2 strain (animal and human) was lower during the weeks of the FMD epidemic in 2001 compared with the same weeks in 2000. Our observations are consistent with livestock making a substantial contribution to Cryptosporidium infection in humans in England and Wales; our findings have implications for agriculture, visitors to rural areas, water companies, and regulators.

EID Smerdon WJ, Nichols T, Chalmers RM, Heine H, Reacher M. Foot and Mouth Disease in Livestock and Reduced Cryptosporidiosis in Humans, England and Wales. Emerg Infect Dis. 2003;9(1):22-28. https://dx.doi.org/10.3201/eid0901.020512
AMA Smerdon WJ, Nichols T, Chalmers RM, et al. Foot and Mouth Disease in Livestock and Reduced Cryptosporidiosis in Humans, England and Wales. Emerging Infectious Diseases. 2003;9(1):22-28. doi:10.3201/eid0901.020512.
APA Smerdon, W. J., Nichols, T., Chalmers, R. M., Heine, H., & Reacher, M. (2003). Foot and Mouth Disease in Livestock and Reduced Cryptosporidiosis in Humans, England and Wales. Emerging Infectious Diseases, 9(1), 22-28. https://dx.doi.org/10.3201/eid0901.020512.

Congenital Transmission of Trypanosoma cruzi Infection in Argentina [PDF - 277 KB - 4 pages]
R. E. Gürtler et al.

Trypanosoma cruzi, the causative agent of Chagas disease, infects 10–18 million people and may be transmitted to the newborn. Using various data sources, we estimated that nearly 850 congenital cases occurred in Argentina in 1993, or 6.3 expected cases per each reported case in 1994 and in 1994–2001. The congenital transmission of T. cruzi constitutes a sizeable public health problem in the region.

EID Gürtler RE, Segura EL, Cohen JE. Congenital Transmission of Trypanosoma cruzi Infection in Argentina. Emerg Infect Dis. 2003;9(1):29-32. https://dx.doi.org/10.3201/eid0901.020274
AMA Gürtler RE, Segura EL, Cohen JE. Congenital Transmission of Trypanosoma cruzi Infection in Argentina. Emerging Infectious Diseases. 2003;9(1):29-32. doi:10.3201/eid0901.020274.
APA Gürtler, R. E., Segura, E. L., & Cohen, J. E. (2003). Congenital Transmission of Trypanosoma cruzi Infection in Argentina. Emerging Infectious Diseases, 9(1), 29-32. https://dx.doi.org/10.3201/eid0901.020274.

A Molecular Surveillance System for Global Patterns of Drug Resistance in Imported Malaria [PDF - 221 KB - 4 pages]
A. Labbé et al.

Analysis of imported malaria in travelers may represent a novel surveillance system for drug-resistant malaria. We analyzed consecutive falciparum malaria isolates from Canadian travelers from 1994 to 2000, for polymorphisms in pfcrt, dhfr, and dhps linked to chloroquine and pyrimethamine/sulfadoxine resistance. Forty percent of isolates possessed the K76 pfcrt allele, suggesting that many imported falciparum infections are still responsive to chloroquine. Travelers who had recently taken chloroquine had a significantly increased risk of harboring isolates with pfcrt resistance alleles (odds ratio = 4.47; p=0.03). The presence of two or more mutations in dhfr or dhps was found in 64.8% (95% confidence interval [CI] 54.6 to 73.9) and in 30.4% (95% CI 21.7 to 40.3) of isolates, respectively, and increased significantly over the course of the study. These molecular markers indicate that pyrimethamine/sulfadoxine resistance is increasing and is now too high to rely on this drug as a routine therapeutic agent to treat malaria in travelers.

EID Labbé A, Patel SN, Crandall I, Kain KC. A Molecular Surveillance System for Global Patterns of Drug Resistance in Imported Malaria. Emerg Infect Dis. 2003;9(1):33-36. https://dx.doi.org/10.3201/eid0901.020121
AMA Labbé A, Patel SN, Crandall I, et al. A Molecular Surveillance System for Global Patterns of Drug Resistance in Imported Malaria. Emerging Infectious Diseases. 2003;9(1):33-36. doi:10.3201/eid0901.020121.
APA Labbé, A., Patel, S. N., Crandall, I., & Kain, K. C. (2003). A Molecular Surveillance System for Global Patterns of Drug Resistance in Imported Malaria. Emerging Infectious Diseases, 9(1), 33-36. https://dx.doi.org/10.3201/eid0901.020121.

Texas Lifestyle Limits Transmission of Dengue Virus [PDF - 370 KB - 4 pages]
P. Reiter et al.

Urban dengue is common in most countries of the Americas, but has been rare in the United States for more than half a century. In 1999 we investigated an outbreak of the disease that affected Nuevo Laredo, Tamaulipas, Mexico, and Laredo, Texas, United States, contiguous cities that straddle the international border. The incidence of recent cases, indicated by immunoglobulin M antibody serosurvey, was higher in Nuevo Laredo, although the vector, Aedes aegypti, was more abundant in Laredo. Environmental factors that affect contact with mosquitoes, such as air-conditioning and human behavior, appear to account for this paradox. We conclude that the low prevalence of dengue in the United States is primarily due to economic, rather than climatic, factors.

EID Reiter P, Lathrop S, Bunning ML, Biggerstaff BJ, Singer D, Tiwari T, et al. Texas Lifestyle Limits Transmission of Dengue Virus. Emerg Infect Dis. 2003;9(1):86-89. https://dx.doi.org/10.3201/eid0901.020220
AMA Reiter P, Lathrop S, Bunning ML, et al. Texas Lifestyle Limits Transmission of Dengue Virus. Emerging Infectious Diseases. 2003;9(1):86-89. doi:10.3201/eid0901.020220.
APA Reiter, P., Lathrop, S., Bunning, M. L., Biggerstaff, B. J., Singer, D., Tiwari, T....Hayes, E. (2003). Texas Lifestyle Limits Transmission of Dengue Virus. Emerging Infectious Diseases, 9(1), 86-89. https://dx.doi.org/10.3201/eid0901.020220.

Cost Effectiveness of a Potential Vaccine for Human papillomavirus [PDF - 389 KB - 12 pages]
G. D. Sanders and A. V. Taira

Human papillomavirus (HPV) infection, usually a sexually transmitted disease, is a risk factor for cervical cancer. Given the substantial disease and death associated with HPV and cervical cancer, development of a prophylactic HPV vaccine is a public health priority. We evaluated the cost-effectiveness of vaccinating adolescent girls for high-risk HPV infections relative to current practice. A vaccine with a 75% probability of immunity against high-risk HPV infection resulted in a life-expectancy gain of 2.8 days or 4.0 quality-adjusted life days at a cost of $246 relative to current practice (incremental cost effectiveness of $22,755/quality-adjusted life year [QALY]). If all 12-year-old girls currently living in the United States were vaccinated, >1,300 deaths from cervical cancer would be averted during their lifetimes. Vaccination of girls against high-risk HPV is relatively cost effective even when vaccine efficacy is low. If the vaccine efficacy rate is 35%, the cost effectiveness increases to $52,398/QALY. Although gains in life expectancy may be modest at the individual level, population benefits are substantial.

EID Sanders GD, Taira AV. Cost Effectiveness of a Potential Vaccine for Human papillomavirus. Emerg Infect Dis. 2003;9(1):37-48. https://dx.doi.org/10.3201/eid0901.020168
AMA Sanders GD, Taira AV. Cost Effectiveness of a Potential Vaccine for Human papillomavirus. Emerging Infectious Diseases. 2003;9(1):37-48. doi:10.3201/eid0901.020168.
APA Sanders, G. D., & Taira, A. V. (2003). Cost Effectiveness of a Potential Vaccine for Human papillomavirus. Emerging Infectious Diseases, 9(1), 37-48. https://dx.doi.org/10.3201/eid0901.020168.

Natural Enzootic Vectors of Venezuelan equine encephalitis virus in the Magdalena Valley, Colombia [PDF - 268 KB - 6 pages]
C. Ferro et al.

To characterize the transmission cycle of enzootic Venezuelan equine encephalitis virus (VEEV) strains believed to represent an epizootic progenitor, we identified natural vectors in a sylvatic focus in the middle Magdalena Valley of Colombia. Hamster-baited traps were placed into an active forest focus, and mosquitoes collected from each trap in which a hamster became infected were sorted by species and assayed for virus. In 18 cases, a single, initial, high-titered mosquito pool representing the vector species was identified. These vectors included Culex (Melanoconion) vomerifer (11 transmission events), Cx. (Mel.) pedroi (5 transmissions) and Cx. (Mel.) adamesi (2 transmissions). These results extend the number of proven enzootic VEEV vectors to 7, all of which are members of the Spissipes section of the subgenus Melanoconion. Our findings contrast with previous studies, which have indicated that a single species usually serves as the principal enzootic VEEV vector at a given location.

EID Ferro C, Boshell J, Moncayo AC, Gonzalez M, Ahumada ML, Kang W, et al. Natural Enzootic Vectors of Venezuelan equine encephalitis virus in the Magdalena Valley, Colombia. Emerg Infect Dis. 2003;9(1):49-54. https://dx.doi.org/10.3201/eid0901.020136
AMA Ferro C, Boshell J, Moncayo AC, et al. Natural Enzootic Vectors of Venezuelan equine encephalitis virus in the Magdalena Valley, Colombia. Emerging Infectious Diseases. 2003;9(1):49-54. doi:10.3201/eid0901.020136.
APA Ferro, C., Boshell, J., Moncayo, A. C., Gonzalez, M., Ahumada, M. L., Kang, W....Vasilakis, N. (2003). Natural Enzootic Vectors of Venezuelan equine encephalitis virus in the Magdalena Valley, Colombia. Emerging Infectious Diseases, 9(1), 49-54. https://dx.doi.org/10.3201/eid0901.020136.

Highly Endemic, Waterborne Toxoplasmosis in North Rio de Janeiro State, Brazil [PDF - 255 KB - 8 pages]
L. M. Bahia-Oliveira et al.

In Campos dos Goytacazes, northern Rio de Janeiro state, Brazil, reports of uveitis consistent with toxoplasmosis led to a survey of the prevalence and risk factors for Toxoplasma gondii infection in 1997–1999. The survey population was selected randomly from schools, randomly chosen communities, and an army battalion. Serum samples from 1,436 persons were tested. With results adjusted for age, 84% of the population in the lower socioeconomic group was seropositive, compared with 62% and 23% of the middle and upper socioeconomic groups, respectively (p<0.001). When multivariate analysis was performed, drinking unfiltered water was found to increase the risk of seropositivity for the lower socioeconomic (odds ratio [OR]: 3.0, 95% confidence interval [CI] 1.3 to 6.9) and middle socioeconomic (OR: 1.7, 95% CI 1.2 to 2.3) populations. We also found a high T. gondii seroprevalence in this Brazilian community. Drinking unfiltered water increased the risk of T. gondii seropositivity, indicating the potential importance of oocyst transmission in water in this region.

EID Bahia-Oliveira LM, Jones JL, Azevedo-Silva J, Alves CC, Oréfice F, Addiss DG. Highly Endemic, Waterborne Toxoplasmosis in North Rio de Janeiro State, Brazil. Emerg Infect Dis. 2003;9(1):55-62. https://dx.doi.org/10.3201/eid0901.020160
AMA Bahia-Oliveira LM, Jones JL, Azevedo-Silva J, et al. Highly Endemic, Waterborne Toxoplasmosis in North Rio de Janeiro State, Brazil. Emerging Infectious Diseases. 2003;9(1):55-62. doi:10.3201/eid0901.020160.
APA Bahia-Oliveira, L. M., Jones, J. L., Azevedo-Silva, J., Alves, C. C., Oréfice, F., & Addiss, D. G. (2003). Highly Endemic, Waterborne Toxoplasmosis in North Rio de Janeiro State, Brazil. Emerging Infectious Diseases, 9(1), 55-62. https://dx.doi.org/10.3201/eid0901.020160.

Seasonal Dynamics of Anaplasma phagocytophila in a Rodent-Tick (Ixodes trianguliceps) System, United Kingdom [PDF - 988 KB - 8 pages]
K. J. Bown et al.

We investigated the reservoir role of European wild rodents for Anaplasma phagocytophila using polymerase chain reaction (PCR) analysis of blood collected from individually tagged rodents captured monthly over 2 years. The only tick species observed in the woodland study site was Ixodes trianguliceps, and ruminant reservoir hosts were not known to occur. A. phagocytophila infections were detected in both bank voles and wood mice but were restricted to periods of peak nymphal and adult tick activity. Most PCR-positive rodents were positive only once, suggesting that rodent infections are generally short-lived and that ticks rather than rodents may maintain the infection over winter. Bank voles were more likely to be PCR positive than wood mice, possibly because detectable infections are longer lived in bank voles. This study confirms that woodland rodents can maintain A. phagocytophila in Great Britain in the absence of other reservoir hosts and suggests that I. trianguliceps is a competent vector.

EID Bown KJ, Begon M, Bennett M, Woldehiwet Z, Ogden NH. Seasonal Dynamics of Anaplasma phagocytophila in a Rodent-Tick (Ixodes trianguliceps) System, United Kingdom. Emerg Infect Dis. 2003;9(1):63-70. https://dx.doi.org/10.3201/eid0901.020169
AMA Bown KJ, Begon M, Bennett M, et al. Seasonal Dynamics of Anaplasma phagocytophila in a Rodent-Tick (Ixodes trianguliceps) System, United Kingdom. Emerging Infectious Diseases. 2003;9(1):63-70. doi:10.3201/eid0901.020169.
APA Bown, K. J., Begon, M., Bennett, M., Woldehiwet, Z., & Ogden, N. H. (2003). Seasonal Dynamics of Anaplasma phagocytophila in a Rodent-Tick (Ixodes trianguliceps) System, United Kingdom. Emerging Infectious Diseases, 9(1), 63-70. https://dx.doi.org/10.3201/eid0901.020169.

Two Epidemiologic Patterns of Norovirus Outbreaks: Surveillance in England and Wales, 1992–2000 [PDF - 938 KB - 7 pages]
B. Lopman et al.

In the period 1992–2000, the Public Health Laboratory Service Communicable Disease Surveillance Centre collected standardized epidemiologic data on 1,877 general outbreaks of Norovirus (formerly “Norwalk-like virus”) infection in England and Wales. Seventy-nine percent of general outbreaks occurred in health-care institutions, i.e., hospitals (40%) and residential-care facilities (39%). When compared with outbreaks in other settings, those in health-care institutions were unique in exhibiting a winter peak (p<0.0001); these outbreaks were also associated with significantly higher death rates and prolonged duration but were smaller in size and less likely to be foodborne. These data suggest that Norovirus infection has considerable impact on the health service and the vulnerable populations residing in institutions such as hospitals and residential homes. A distinct outbreak pattern in health-care institutions suggests a combination of host, virologic, and environmental factors that mediate these divergent epidemiologic patterns.

EID Lopman B, Adak G, Reacher M, Brown DW. Two Epidemiologic Patterns of Norovirus Outbreaks: Surveillance in England and Wales, 1992–2000. Emerg Infect Dis. 2003;9(1):71-77. https://dx.doi.org/10.3201/eid0901.020175
AMA Lopman B, Adak G, Reacher M, et al. Two Epidemiologic Patterns of Norovirus Outbreaks: Surveillance in England and Wales, 1992–2000. Emerging Infectious Diseases. 2003;9(1):71-77. doi:10.3201/eid0901.020175.
APA Lopman, B., Adak, G., Reacher, M., & Brown, D. W. (2003). Two Epidemiologic Patterns of Norovirus Outbreaks: Surveillance in England and Wales, 1992–2000. Emerging Infectious Diseases, 9(1), 71-77. https://dx.doi.org/10.3201/eid0901.020175.

Viral Gastroenteritis Outbreaks in Europe, 1995–2000 [PDF - 412 KB - 7 pages]
B. Lopman et al.

To gain understanding of surveillance and epidemiology of viral gastroenteritis outbreaks in Europe, we compiled data from 10 surveillance systems in the Foodborne Viruses in Europe network. Established surveillance systems found Norovirus to be responsible for >85% (N=3,714) of all nonbacterial outbreaks of gastroenteritis reported from 1995 to 2000. However, the absolute number and population-based rates of viral gastroenteritis outbreaks differed markedly among European surveillance systems. A wide range of estimates of the importance of foodborne transmission were also found. We review these differences within the context of the sources of outbreak surveillance information, clinical definitions, and structures of the outbreak surveillance systems.

EID Lopman B, Reacher M, van Duijnhoven Y, Hanon F, Brown D, Koopmans M. Viral Gastroenteritis Outbreaks in Europe, 1995–2000. Emerg Infect Dis. 2003;9(1):90-96. https://dx.doi.org/10.3201/eid0901.020184
AMA Lopman B, Reacher M, van Duijnhoven Y, et al. Viral Gastroenteritis Outbreaks in Europe, 1995–2000. Emerging Infectious Diseases. 2003;9(1):90-96. doi:10.3201/eid0901.020184.
APA Lopman, B., Reacher, M., van Duijnhoven, Y., Hanon, F., Brown, D., & Koopmans, M. (2003). Viral Gastroenteritis Outbreaks in Europe, 1995–2000. Emerging Infectious Diseases, 9(1), 90-96. https://dx.doi.org/10.3201/eid0901.020184.

The U.S.-Mexico Border Infectious Disease Surveillance Project: Establishing Binational Border Surveillance [PDF - 318 KB - 6 pages]
M. Weinberg et al.

In 1997, the Centers for Disease Control and Prevention, the Mexican Secretariat of Health, and border health officials began the development of the Border Infectious Disease Surveillance (BIDS) project, a surveillance system for infectious diseases along the U.S.-Mexico border. During a 3-year period, a binational team implemented an active, sentinel surveillance system for hepatitis and febrile exanthems at 13 clinical sites. The network developed surveillance protocols, trained nine surveillance coordinators, established serologic testing at four Mexican border laboratories, and created agreements for data sharing and notification of selected diseases and outbreaks. BIDS facilitated investigations of dengue fever in Texas-Tamaulipas and measles in California–Baja California. BIDS demonstrates that a binational effort with local, state, and federal participation can create a regional surveillance system that crosses an international border. Reducing administrative, infrastructure, and political barriers to cross-border public health collaboration will enhance the effectiveness of disease prevention projects such as BIDS.

EID Weinberg M, Waterman S, Lucas CA, Falcon VC, Morales PK, Lopez LA, et al. The U.S.-Mexico Border Infectious Disease Surveillance Project: Establishing Binational Border Surveillance. Emerg Infect Dis. 2003;9(1):97-102. https://dx.doi.org/10.3201/eid0901.020047
AMA Weinberg M, Waterman S, Lucas CA, et al. The U.S.-Mexico Border Infectious Disease Surveillance Project: Establishing Binational Border Surveillance. Emerging Infectious Diseases. 2003;9(1):97-102. doi:10.3201/eid0901.020047.
APA Weinberg, M., Waterman, S., Lucas, C. A., Falcon, V. C., Morales, P. K., Lopez, L. A....Cetron, M. S. (2003). The U.S.-Mexico Border Infectious Disease Surveillance Project: Establishing Binational Border Surveillance. Emerging Infectious Diseases, 9(1), 97-102. https://dx.doi.org/10.3201/eid0901.020047.

Shiga Toxin–Producing Escherichia coli Infections Associated with Hemolytic Uremic Syndrome, Italy, 1988–2000 [PDF - 240 KB - 3 pages]
A. E. Tozzi et al.

The mean annual incidence of hemolytic uremic syndrome in persons <15 years of age in Italy from 1988 to 2000 was 0.28 per 100,000 population. Laboratory investigations showed that Shiga toxin–producing Escherichia coli (STEC) infection occurred in 73.1% of patients. STEC O157 was the most common serotype, but a considerable number of cases were from infections by non-O157 STEC.

EID Tozzi AE, Caprioli A, Minelli F, Gianviti A, De Petris L, Edefonti A, et al. Shiga Toxin–Producing Escherichia coli Infections Associated with Hemolytic Uremic Syndrome, Italy, 1988–2000. Emerg Infect Dis. 2003;9(1):106-108. https://dx.doi.org/10.3201/eid0901.020266
AMA Tozzi AE, Caprioli A, Minelli F, et al. Shiga Toxin–Producing Escherichia coli Infections Associated with Hemolytic Uremic Syndrome, Italy, 1988–2000. Emerging Infectious Diseases. 2003;9(1):106-108. doi:10.3201/eid0901.020266.
APA Tozzi, A. E., Caprioli, A., Minelli, F., Gianviti, A., De Petris, L., Edefonti, A....Rizzoni, G. (2003). Shiga Toxin–Producing Escherichia coli Infections Associated with Hemolytic Uremic Syndrome, Italy, 1988–2000. Emerging Infectious Diseases, 9(1), 106-108. https://dx.doi.org/10.3201/eid0901.020266.

Epidemic Hand, Foot and Mouth Disease Caused by Human Enterovirus 71, Singapore [PDF - 1.21 MB - 8 pages]
K. P. Chan et al.

Singapore experienced a large epidemic of hand, foot and mouth disease (HFMD) in 2000. After reviewing HFMD notifications from doctors and child-care centers, we found that the incidence of HFMD rose in September and declined at the end of October. During this period, 3,790 cases were reported. We performed enteroviral cultures on 311 and 157 specimens from 175 HFMD patients and 107 non-HFMD patients, respectively; human enterovirus 71 (HEV71) was the most frequently isolated virus from both groups. Most of the HFMD patients were <4 years of age. Three HFMD and two non-HFMD patients died. Specimens from two HFMD and both non-HFMD patients were culture positive for HEV71; a third patient was possibly associated with the virus. Autopsies performed on all three HFMD and one of the non-HFMD case-patients showed encephalitis, interstitial pneumonitis, and myocarditis. A preparedness plan for severe HFMD outbreaks provided for the prompt, coordinated actions needed to control the epidemic.

EID Chan KP, Goh K, Chong C, Teo ES, Lau G, Ling AE. Epidemic Hand, Foot and Mouth Disease Caused by Human Enterovirus 71, Singapore. Emerg Infect Dis. 2003;9(1):78-85. https://dx.doi.org/10.3201/eid0901.020112
AMA Chan KP, Goh K, Chong C, et al. Epidemic Hand, Foot and Mouth Disease Caused by Human Enterovirus 71, Singapore. Emerging Infectious Diseases. 2003;9(1):78-85. doi:10.3201/eid0901.020112.
APA Chan, K. P., Goh, K., Chong, C., Teo, E. S., Lau, G., & Ling, A. E. (2003). Epidemic Hand, Foot and Mouth Disease Caused by Human Enterovirus 71, Singapore. Emerging Infectious Diseases, 9(1), 78-85. https://dx.doi.org/10.3201/eid0901.020112.
Dispatches

Chagas Disease in a Domestic Transmission Cycle in Southern Texas, USA [PDF - 1010 KB - 3 pages]
C. B. Beard et al.

After three dogs died from acute Chagas cardiomyopathy at one location, an investigation was conducted of the home, garage, and grounds of the owner. A serologic study was conducted on stray dogs, and an ecologic niche model was developed to predict areas where the vector Triatoma gerstaeckeri might be expected.

EID Beard CB, Pye G, Steurer FJ, Rodriguez R, Campman R, Peterson AT, et al. Chagas Disease in a Domestic Transmission Cycle in Southern Texas, USA. Emerg Infect Dis. 2003;9(1):103-105. https://dx.doi.org/10.3201/eid0901.020217
AMA Beard CB, Pye G, Steurer FJ, et al. Chagas Disease in a Domestic Transmission Cycle in Southern Texas, USA. Emerging Infectious Diseases. 2003;9(1):103-105. doi:10.3201/eid0901.020217.
APA Beard, C. B., Pye, G., Steurer, F. J., Rodriguez, R., Campman, R., Peterson, A. T....Robinson, L. E. (2003). Chagas Disease in a Domestic Transmission Cycle in Southern Texas, USA. Emerging Infectious Diseases, 9(1), 103-105. https://dx.doi.org/10.3201/eid0901.020217.

Foot and Mouth Disease and Cryptosporidiosis: Possible Interaction between Two Emerging Infectious Diseases [PDF - 1.08 MB - 4 pages]
P. R. Hunter et al.

During 2001, a large outbreak of foot and mouth disease occurred in the United Kingdom, during which approximately 2,030 confirmed cases of the disease were reported, >6 million animals were slaughtered, and strict restrictions on access to the countryside were imposed. We report a dramatic decline in the reported incidence of human cryptosporidiosis in northwest England during weeks 13–38 in 2001, compared with the previous 11 years. This decline coincided with the period of foot and mouth restrictions. No similar reduction occurred in the other 26 weeks of the year. We also noted a substantial decline in the proportion of human infections caused by the bovine strain (genotype 2) of Cryptosporidium parvum during weeks 13–38 that year but not during the other weeks.

EID Hunter PR, Chalmers RM, Syed Q, Hughes LS, Woodhouse S, Swift L. Foot and Mouth Disease and Cryptosporidiosis: Possible Interaction between Two Emerging Infectious Diseases. Emerg Infect Dis. 2003;9(1):109-112. https://dx.doi.org/10.3201/eid0901.020265
AMA Hunter PR, Chalmers RM, Syed Q, et al. Foot and Mouth Disease and Cryptosporidiosis: Possible Interaction between Two Emerging Infectious Diseases. Emerging Infectious Diseases. 2003;9(1):109-112. doi:10.3201/eid0901.020265.
APA Hunter, P. R., Chalmers, R. M., Syed, Q., Hughes, L. S., Woodhouse, S., & Swift, L. (2003). Foot and Mouth Disease and Cryptosporidiosis: Possible Interaction between Two Emerging Infectious Diseases. Emerging Infectious Diseases, 9(1), 109-112. https://dx.doi.org/10.3201/eid0901.020265.

Enteropathogenic Escherichia coli O157 Strains from Brazil [PDF - 836 KB - 3 pages]
T. E. Blank et al.

We describe two serogroup O157 Escherichia coli strains from Brazilian infants with diarrhea. A variety of assays indicate that these strains belong to the enteropathogenic, not the enterohemorrhagic, pathotype. These strains possess a novel bfpA allele encoding the type IV pilin characteristic of typical enteropathogenic E. coli strains. Our results emphasize the pitfalls of classifying pathogenic E. coli by serogroup.

EID Blank TE, Lacher DW, Scaletsky IC, Zhong H, Whittam TS, Donnenberg MS. Enteropathogenic Escherichia coli O157 Strains from Brazil. Emerg Infect Dis. 2003;9(1):113-115. https://dx.doi.org/10.3201/eid0901.020072
AMA Blank TE, Lacher DW, Scaletsky IC, et al. Enteropathogenic Escherichia coli O157 Strains from Brazil. Emerging Infectious Diseases. 2003;9(1):113-115. doi:10.3201/eid0901.020072.
APA Blank, T. E., Lacher, D. W., Scaletsky, I. C., Zhong, H., Whittam, T. S., & Donnenberg, M. S. (2003). Enteropathogenic Escherichia coli O157 Strains from Brazil. Emerging Infectious Diseases, 9(1), 113-115. https://dx.doi.org/10.3201/eid0901.020072.

Transfusion-Associated Babesiosis after Heart Transplant [PDF - 1.19 MB - 4 pages]
J. Z. Lux et al.

We describe a 54-year-old spleen-intact man with transfusion-associated Babesia microti infection after a heart transplant. Adult respiratory distress syndrome developed in the patient, and he required mechanical ventilation. Our experiences with this patient suggest that babesiosis should be considered in the differential diagnosis of transplant patients who have fever and hemolytic anemia.

EID Lux JZ, Weiss D, Linden JV, Kessler D, Herwaldt BL, Wong SJ, et al. Transfusion-Associated Babesiosis after Heart Transplant. Emerg Infect Dis. 2003;9(1):116-119. https://dx.doi.org/10.3201/eid0901.020149
AMA Lux JZ, Weiss D, Linden JV, et al. Transfusion-Associated Babesiosis after Heart Transplant. Emerging Infectious Diseases. 2003;9(1):116-119. doi:10.3201/eid0901.020149.
APA Lux, J. Z., Weiss, D., Linden, J. V., Kessler, D., Herwaldt, B. L., Wong, S. J....Scully, B. E. (2003). Transfusion-Associated Babesiosis after Heart Transplant. Emerging Infectious Diseases, 9(1), 116-119. https://dx.doi.org/10.3201/eid0901.020149.

Household Contamination with Salmonella enterica [PDF - 227 KB - 3 pages]
D. H. Rice et al.

Household contamination with Salmonella enterica increases when occupational exposure exists (cattle farms with known salmonellosis in cattle, a salmonella research laboratory, or a veterinary clinic experiencing an outbreak of salmonellosis). Fifteen of 55 (27.2%) vacuum cleaner bags from households with occupational exposure to S. enterica were positive versus 1 of 24 (4.2% without known exposure. Use of a carpet cleaner and several cleaners/disinfectants reduced, but failed to eliminate, S. enterica from artificially contaminated carpet.

EID Rice DH, Hancock DD, Roozen PM, Szymanski MH, Scheenstra BC, Cady KM, et al. Household Contamination with Salmonella enterica1. Emerg Infect Dis. 2003;9(1):120-122. https://dx.doi.org/10.3201/eid0901.020214
AMA Rice DH, Hancock DD, Roozen PM, et al. Household Contamination with Salmonella enterica1. Emerging Infectious Diseases. 2003;9(1):120-122. doi:10.3201/eid0901.020214.
APA Rice, D. H., Hancock, D. D., Roozen, P. M., Szymanski, M. H., Scheenstra, B. C., Cady, K. M....Chudek, P. A. (2003). Household Contamination with Salmonella enterica1. Emerging Infectious Diseases, 9(1), 120-122. https://dx.doi.org/10.3201/eid0901.020214.

Persistence of W135 Neisseria meningitidis Carriage in Returning Hajj Pilgrims: Risk for Early and Late Transmission to Household Contacts [PDF - 1.16 MB - 4 pages]
A. Wilder-Smith et al.

After an outbreak of meningococcal disease caused by Neisseria meningitidis W135, associated with the Hajj pilgrimage in 2001, 15% of returning vaccinated pilgrims carried a single W135 clone, and 55% were still carriers 6 months later. Transmission to 8% of their unvaccinated household contacts occurred within a few weeks, but no late transmission took place. Public health interventions are needed to protect household contacts.

EID Wilder-Smith A, Barkham TM, Ravindran S, Earnest A, Paton NI. Persistence of W135 Neisseria meningitidis Carriage in Returning Hajj Pilgrims: Risk for Early and Late Transmission to Household Contacts. Emerg Infect Dis. 2003;9(1):123-126. https://dx.doi.org/10.3201/eid0901.020131
AMA Wilder-Smith A, Barkham TM, Ravindran S, et al. Persistence of W135 Neisseria meningitidis Carriage in Returning Hajj Pilgrims: Risk for Early and Late Transmission to Household Contacts. Emerging Infectious Diseases. 2003;9(1):123-126. doi:10.3201/eid0901.020131.
APA Wilder-Smith, A., Barkham, T. M., Ravindran, S., Earnest, A., & Paton, N. I. (2003). Persistence of W135 Neisseria meningitidis Carriage in Returning Hajj Pilgrims: Risk for Early and Late Transmission to Household Contacts. Emerging Infectious Diseases, 9(1), 123-126. https://dx.doi.org/10.3201/eid0901.020131.

Single Multiplex Polymerase Chain Reaction To Detect Diverse Loci Associated with Diarrheagenic Escherichia coli [PDF - 738 KB - 5 pages]
C. López-Saucedo et al.

We developed and tested a single multiplex polymerase chain reaction (PCR) that detects enterotoxigenic, enteropathogenic, enteroinvasive, and Shiga-toxin–producing Escherichia coli. This PCR is specific, sensitive, and rapid in detecting target isolates in stool and food. Because of its simplicity, economy, and efficiency, this protocol warrants further evaluation in large, prospective studies of polymicrobial substances.

EID López-Saucedo C, Cerna JF, Villegas-Sepulveda N, Thompson R, Velazquez FR, Torres J, et al. Single Multiplex Polymerase Chain Reaction To Detect Diverse Loci Associated with Diarrheagenic Escherichia coli. Emerg Infect Dis. 2003;9(1):127-131. https://dx.doi.org/10.3201/eid0901.010507
AMA López-Saucedo C, Cerna JF, Villegas-Sepulveda N, et al. Single Multiplex Polymerase Chain Reaction To Detect Diverse Loci Associated with Diarrheagenic Escherichia coli. Emerging Infectious Diseases. 2003;9(1):127-131. doi:10.3201/eid0901.010507.
APA López-Saucedo, C., Cerna, J. F., Villegas-Sepulveda, N., Thompson, R., Velazquez, F. R., Torres, J....Estrada-García, T. (2003). Single Multiplex Polymerase Chain Reaction To Detect Diverse Loci Associated with Diarrheagenic Escherichia coli. Emerging Infectious Diseases, 9(1), 127-131. https://dx.doi.org/10.3201/eid0901.010507.

Risk for Pneumocystis carinii Transmission among Patients with Pneumonia: a Molecular Epidemiology Study [PDF - 332 KB - 3 pages]
E. S. Manoloff et al.

We report a molecular typing and epidemiologic analysis of Pneumocystis carinii pneumonia (PCP) cases diagnosed in our geographic area from 1990 to 2000. Our analysis suggests that transmission from patients with active PCP to susceptible persons caused only a few, if any, PCP cases in our setting.

EID Manoloff ES, Francioli P, Taffé P, van Melle G, Bille J, Hauser PM. Risk for Pneumocystis carinii Transmission among Patients with Pneumonia: a Molecular Epidemiology Study. Emerg Infect Dis. 2003;9(1):132-134. https://dx.doi.org/10.3201/eid0901.020141
AMA Manoloff ES, Francioli P, Taffé P, et al. Risk for Pneumocystis carinii Transmission among Patients with Pneumonia: a Molecular Epidemiology Study. Emerging Infectious Diseases. 2003;9(1):132-134. doi:10.3201/eid0901.020141.
APA Manoloff, E. S., Francioli, P., Taffé, P., van Melle, G., Bille, J., & Hauser, P. M. (2003). Risk for Pneumocystis carinii Transmission among Patients with Pneumonia: a Molecular Epidemiology Study. Emerging Infectious Diseases, 9(1), 132-134. https://dx.doi.org/10.3201/eid0901.020141.
Letters

Granulomatous Lymphadenitis as a Manifestation of Q Fever [PDF - 171 KB - 2 pages]
P. Tattevin et al.
EID Tattevin P, Arvieux C, Dupont M, Guggenbuhl P, Lemeur A, Michelet C. Granulomatous Lymphadenitis as a Manifestation of Q Fever. Emerg Infect Dis. 2003;9(1):137-138. https://dx.doi.org/10.3201/eid0901.020211
AMA Tattevin P, Arvieux C, Dupont M, et al. Granulomatous Lymphadenitis as a Manifestation of Q Fever. Emerging Infectious Diseases. 2003;9(1):137-138. doi:10.3201/eid0901.020211.
APA Tattevin, P., Arvieux, C., Dupont, M., Guggenbuhl, P., Lemeur, A., & Michelet, C. (2003). Granulomatous Lymphadenitis as a Manifestation of Q Fever. Emerging Infectious Diseases, 9(1), 137-138. https://dx.doi.org/10.3201/eid0901.020211.

Has Coxiella burnetii (Q fever) Been Introduced into New Zealand? [PDF - 201 KB - 3 pages]
E. Greenslade et al.
EID Greenslade E, Beasley R, Jennings L, Woodward A, Weinstein P. Has Coxiella burnetii (Q fever) Been Introduced into New Zealand?. Emerg Infect Dis. 2003;9(1):138-140. https://dx.doi.org/10.3201/eid0901.010305
AMA Greenslade E, Beasley R, Jennings L, et al. Has Coxiella burnetii (Q fever) Been Introduced into New Zealand?. Emerging Infectious Diseases. 2003;9(1):138-140. doi:10.3201/eid0901.010305.
APA Greenslade, E., Beasley, R., Jennings, L., Woodward, A., & Weinstein, P. (2003). Has Coxiella burnetii (Q fever) Been Introduced into New Zealand?. Emerging Infectious Diseases, 9(1), 138-140. https://dx.doi.org/10.3201/eid0901.010305.

First Isolation of Rickettsia slovaca from a Patient, France [PDF - 162 KB - 1 page]
C. Cazorla et al.
EID Cazorla C, Enea M, Lucht F, Raoult D. First Isolation of Rickettsia slovaca from a Patient, France. Emerg Infect Dis. 2003;9(1):135. https://dx.doi.org/10.3201/eid0901.020192
AMA Cazorla C, Enea M, Lucht F, et al. First Isolation of Rickettsia slovaca from a Patient, France. Emerging Infectious Diseases. 2003;9(1):135. doi:10.3201/eid0901.020192.
APA Cazorla, C., Enea, M., Lucht, F., & Raoult, D. (2003). First Isolation of Rickettsia slovaca from a Patient, France. Emerging Infectious Diseases, 9(1), 135. https://dx.doi.org/10.3201/eid0901.020192.

Enteropathogenic Klebsiella pneumoniae HIV-Infected Adults, Africa [PDF - 180 KB - 3 pages]
P. L. Thi et al.
EID Thi PL, Yassibanda S, Aidara A, Le Bouguénec C, Germani Y. Enteropathogenic Klebsiella pneumoniae HIV-Infected Adults, Africa. Emerg Infect Dis. 2003;9(1):135-137. https://dx.doi.org/10.3201/eid0901.020138
AMA Thi PL, Yassibanda S, Aidara A, et al. Enteropathogenic Klebsiella pneumoniae HIV-Infected Adults, Africa. Emerging Infectious Diseases. 2003;9(1):135-137. doi:10.3201/eid0901.020138.
APA Thi, P. L., Yassibanda, S., Aidara, A., Le Bouguénec, C., & Germani, Y. (2003). Enteropathogenic Klebsiella pneumoniae HIV-Infected Adults, Africa. Emerging Infectious Diseases, 9(1), 135-137. https://dx.doi.org/10.3201/eid0901.020138.
Books and Media

Polymicrobial Diseases [PDF - 171 KB - 1 page]
H. W. Haverkos
EID Haverkos HW. Polymicrobial Diseases. Emerg Infect Dis. 2003;9(1):141. https://dx.doi.org/10.3201/eid0901.020487
AMA Haverkos HW. Polymicrobial Diseases. Emerging Infectious Diseases. 2003;9(1):141. doi:10.3201/eid0901.020487.
APA Haverkos, H. W. (2003). Polymicrobial Diseases. Emerging Infectious Diseases, 9(1), 141. https://dx.doi.org/10.3201/eid0901.020487.

Manual of Commercial Methods in Clinical Microbiology [PDF - 245 KB - 2 pages]
W. J. Martin
EID Martin WJ. Manual of Commercial Methods in Clinical Microbiology. Emerg Infect Dis. 2003;9(1):141-142. https://dx.doi.org/10.3201/eid0901.020623
AMA Martin WJ. Manual of Commercial Methods in Clinical Microbiology. Emerging Infectious Diseases. 2003;9(1):141-142. doi:10.3201/eid0901.020623.
APA Martin, W. J. (2003). Manual of Commercial Methods in Clinical Microbiology. Emerging Infectious Diseases, 9(1), 141-142. https://dx.doi.org/10.3201/eid0901.020623.
About the Cover

Aaron Douglas (1899–1979). Noah's Ark, 1927 [PDF - 365 KB - 1 page]
M. Smalls and P. Potter
EID Smalls M, Potter P. Aaron Douglas (1899–1979). Noah's Ark, 1927. Emerg Infect Dis. 2003;9(1):143. https://dx.doi.org/10.3201/eid0901.ac0901
AMA Smalls M, Potter P. Aaron Douglas (1899–1979). Noah's Ark, 1927. Emerging Infectious Diseases. 2003;9(1):143. doi:10.3201/eid0901.ac0901.
APA Smalls, M., & Potter, P. (2003). Aaron Douglas (1899–1979). Noah's Ark, 1927. Emerging Infectious Diseases, 9(1), 143. https://dx.doi.org/10.3201/eid0901.ac0901.
Corrections

Correction, Vol. 8, No. 12 [PDF - 142 KB - 1 page]
EID Correction, Vol. 8, No. 12. Emerg Infect Dis. 2003;9(1):140. https://dx.doi.org/10.3201/eid0901.c10901
AMA Correction, Vol. 8, No. 12. Emerging Infectious Diseases. 2003;9(1):140. doi:10.3201/eid0901.c10901.
APA (2003). Correction, Vol. 8, No. 12. Emerging Infectious Diseases, 9(1), 140. https://dx.doi.org/10.3201/eid0901.c10901.

Correction, Vol. 8, No. 10 [PDF - 142 KB - 1 page]
EID Correction, Vol. 8, No. 10. Emerg Infect Dis. 2003;9(1):140. https://dx.doi.org/10.3201/eid0901.c20901
AMA Correction, Vol. 8, No. 10. Emerging Infectious Diseases. 2003;9(1):140. doi:10.3201/eid0901.c20901.
APA (2003). Correction, Vol. 8, No. 10. Emerging Infectious Diseases, 9(1), 140. https://dx.doi.org/10.3201/eid0901.c20901.
Page created: July 10, 2012
Page updated: July 10, 2012
Page reviewed: July 10, 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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