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Issue Cover for Volume 9, Number 2—February 2003

Volume 9, Number 2—February 2003

[PDF - 15.49 MB - 139 pages]

Perspective

Preparing for a Bioterrorist Attack: Legal and Administrative Strategies [PDF - 175 KB - 5 pages]
R. E. Hoffman

This article proposes and discusses legal and administrative preparations for a bioterrorist attack. To perform the duties expected of public health agencies during a disease outbreak caused by bioterrorism, an agency must have a sufficient number of employees and providers at work and a good communications system between staff in the central offices of the public health agency and those in outlying or neighboring agencies and hospitals. The article proposes strategies for achieving these objectives as well as for removing legal barriers that discourage agencies, institutions, and persons from working together for the overall good of the community. Issues related to disease surveillance and special considerations regarding public health restrictive orders are discussed.

EID Hoffman RE. Preparing for a Bioterrorist Attack: Legal and Administrative Strategies. Emerg Infect Dis. 2003;9(2):241-245. https://dx.doi.org/10.3201/eid0902.020538
AMA Hoffman RE. Preparing for a Bioterrorist Attack: Legal and Administrative Strategies. Emerging Infectious Diseases. 2003;9(2):241-245. doi:10.3201/eid0902.020538.
APA Hoffman, R. E. (2003). Preparing for a Bioterrorist Attack: Legal and Administrative Strategies. Emerging Infectious Diseases, 9(2), 241-245. https://dx.doi.org/10.3201/eid0902.020538.
Synopses

B-Virus (Cercopithecine herpesvirus 1) Infection in Humans and Macaques: Potential for Zoonotic Disease [PDF - 172 KB - 5 pages]
J. L. Huff and P. A. Barry

Nonhuman primates are widely used in biomedical research because of their genetic, anatomic, and physiologic similarities to humans. In this setting, human contact directly with macaques or with their tissues and fluids sometimes occurs. Cercopithecine herpesvirus 1 (B virus), an alphaherpesvirus endemic in Asian macaques, is closely related to herpes simplex virus (HSV). Most macaques carry B virus without overt signs of disease. However, zoonotic infection with B virus in humans usually results in fatal encephalomyelitis or severe neurologic impairment. Although the incidence of human infection with B virus is low, a death rate of >70% before the availability of antiviral therapy makes this virus a serious zoonotic threat. Knowledge of the clinical signs and risk factors for human B-virus disease allows early initiation of antiviral therapy and prevents severe disease or death.

EID Huff JL, Barry PA. B-Virus (Cercopithecine herpesvirus 1) Infection in Humans and Macaques: Potential for Zoonotic Disease. Emerg Infect Dis. 2003;9(2):246-250. https://dx.doi.org/10.3201/eid0902.020272
AMA Huff JL, Barry PA. B-Virus (Cercopithecine herpesvirus 1) Infection in Humans and Macaques: Potential for Zoonotic Disease. Emerging Infectious Diseases. 2003;9(2):246-250. doi:10.3201/eid0902.020272.
APA Huff, J. L., & Barry, P. A. (2003). B-Virus (Cercopithecine herpesvirus 1) Infection in Humans and Macaques: Potential for Zoonotic Disease. Emerging Infectious Diseases, 9(2), 246-250. https://dx.doi.org/10.3201/eid0902.020272.
Research

Emerging Pattern of Rabies Deaths and Increased Viral Infectivity [PDF - 314 KB - 4 pages]
S. L. Messenger et al.

Most human rabies deaths in the United States can be attributed to unrecognized exposures to rabies viruses associated with bats, particularly those associated with two infrequently encountered bat species (Lasionycteris noctivagans and Pipistrellus subflavus). These human rabies cases tend to cluster in the southeastern and northwestern United States. In these regions, most rabies deaths associated with bats in nonhuman terrestrial mammals are also associated with virus variants specific to these two bat species rather than more common bat species; outside of these regions, more common bat rabies viruses contribute to most transmissions. The preponderance of rabies deaths connected with the two uncommon L. noctivagans and P. subflavus bat rabies viruses is best explained by their evolution of increased viral infectivity.

EID Messenger SL, Smith JS, Orciari LA, Yager PA, Rupprecht CE. Emerging Pattern of Rabies Deaths and Increased Viral Infectivity. Emerg Infect Dis. 2003;9(2):151-154. https://dx.doi.org/10.3201/eid0902.020083
AMA Messenger SL, Smith JS, Orciari LA, et al. Emerging Pattern of Rabies Deaths and Increased Viral Infectivity. Emerging Infectious Diseases. 2003;9(2):151-154. doi:10.3201/eid0902.020083.
APA Messenger, S. L., Smith, J. S., Orciari, L. A., Yager, P. A., & Rupprecht, C. E. (2003). Emerging Pattern of Rabies Deaths and Increased Viral Infectivity. Emerging Infectious Diseases, 9(2), 151-154. https://dx.doi.org/10.3201/eid0902.020083.

Araçatuba Virus: A Vaccinialike Virus Associated with Infection in Humans and Cattle [PDF - 1.32 MB - 6 pages]
G. Trindade et al.

We describe a vaccinialike virus, Araçatuba virus, associated with a cowpoxlike outbreak in a dairy herd and a related case of human infection. Diagnosis was based on virus growth characteristics, electron microscopy, and molecular biology techniques. Molecular characterization of the virus was done by using polymerase chain reaction amplification, cloning, and DNA sequencing of conserved orthopoxvirus genes such as the vaccinia growth factor (VGF), thymidine kinase (TK), and hemagglutinin. We used VGF-homologous and TK gene nucleotide sequences to construct a phylogenetic tree for comparison with other poxviruses. Gene sequences showed 99% homology with vaccinia virus genes and were clustered together with the isolated virus in the phylogenetic tree. Araçatuba virus is very similar to Cantagalo virus, showing the same signature deletion in the gene. Araçatuba virus could be a novel vaccinialike virus or could represent the spread of Cantagalo virus.

EID Trindade G, Guimarães da Fonseca F, Marques JT, Nogueira ML, Mendes LC, Borges AS, et al. Araçatuba Virus: A Vaccinialike Virus Associated with Infection in Humans and Cattle. Emerg Infect Dis. 2003;9(2):155-160. https://dx.doi.org/10.3201/eid0902.020244
AMA Trindade G, Guimarães da Fonseca F, Marques JT, et al. Araçatuba Virus: A Vaccinialike Virus Associated with Infection in Humans and Cattle. Emerging Infectious Diseases. 2003;9(2):155-160. doi:10.3201/eid0902.020244.
APA Trindade, G., Guimarães da Fonseca, F., Marques, J. T., Nogueira, M. L., Mendes, L. C., Borges, A. S....Lima, M. (2003). Araçatuba Virus: A Vaccinialike Virus Associated with Infection in Humans and Cattle. Emerging Infectious Diseases, 9(2), 155-160. https://dx.doi.org/10.3201/eid0902.020244.

Equine Amplification and Virulence of Subtype IE Venezuelan Equine Encephalitis Viruses Isolated during the 1993 and 1996 Mexican Epizootics [PDF - 1.40 MB - 7 pages]
D. Gonzalez et al.

To assess the role of horses as amplification hosts during the 1993 and 1996 Mexican Venezuelan equine encephalitis (VEE) epizootics, we subcutaneously infected 10 horses by using four different equine isolates. Most horses showed little or no disease and low or nonexistent viremia. Neurologic disease developed in only 1 horse, and brain histopathologic examination showed meningeal lymphocytic infiltration, perivascular cuffing, and focalencephalitis. Three animals showed mild meningoencephalitis without clinical disease. Viral RNA was detected in the brain of several animals 12-14 days after infection. These data suggest that the duration and scope of the recent Mexican epizootics were limited by lack of equine amplification characteristic of previous, more extensive VEE outbreaks. The Mexican epizootics may have resulted from the circulation of a more equine-neurotropic, subtype IE virus strain or from increased transmission to horses due to amplification by other vertebrate hosts or transmission by more competent mosquito vectors.

EID Gonzalez D, Estrada-Franco JG, Carrara A, Aronson JF, Vasilakis N. Equine Amplification and Virulence of Subtype IE Venezuelan Equine Encephalitis Viruses Isolated during the 1993 and 1996 Mexican Epizootics. Emerg Infect Dis. 2003;9(2):162-168. https://dx.doi.org/10.3201/eid0902.020124
AMA Gonzalez D, Estrada-Franco JG, Carrara A, et al. Equine Amplification and Virulence of Subtype IE Venezuelan Equine Encephalitis Viruses Isolated during the 1993 and 1996 Mexican Epizootics. Emerging Infectious Diseases. 2003;9(2):162-168. doi:10.3201/eid0902.020124.
APA Gonzalez, D., Estrada-Franco, J. G., Carrara, A., Aronson, J. F., & Vasilakis, N. (2003). Equine Amplification and Virulence of Subtype IE Venezuelan Equine Encephalitis Viruses Isolated during the 1993 and 1996 Mexican Epizootics. Emerging Infectious Diseases, 9(2), 162-168. https://dx.doi.org/10.3201/eid0902.020124.

Elimination of Epidemic Methicillin-Resistant Staphylococcus aureus from a University Hospital and District Institutions, Finland [PDF - 325 KB - 7 pages]
P. Kotilainen et al.

From August 1991 to October 1992, two successive outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) occurred at a hospital in Finland. During and after these outbreaks, MRSA was diagnosed in 202 persons in our medical district; >100 cases involved epidemic MRSA. When control policies failed to stop the epidemic, more aggressive measures were taken, including continuous staff education, contact isolation for MRSA-positive patients, systematic screening for persons exposed to MRSA, cohort nursing of MRSA-positive and MRSA-exposed patients in epidemic situations, and perception of the 30 medical institutions in that district as one epidemiologic entity brought under surveillance and control of the infection control team of Turku University Hospital. Two major epidemic strains, as well as eight additional strains, were eliminated; we were also able to prevent nosocomial spread of other MRSA strains. Our data show that controlling MRSA is possible if strict measures are taken before the organism becomes endemic. Similar control policies may be successful for dealing with new strains of multiresistant bacteria, such as vancomycin-resistant strains of S. aureus.

EID Kotilainen P, Routamaa M, Peltonen R, Oksi J, Rintala E, Meurman O, et al. Elimination of Epidemic Methicillin-Resistant Staphylococcus aureus from a University Hospital and District Institutions, Finland. Emerg Infect Dis. 2003;9(2):169-175. https://dx.doi.org/10.3201/eid0902.020233
AMA Kotilainen P, Routamaa M, Peltonen R, et al. Elimination of Epidemic Methicillin-Resistant Staphylococcus aureus from a University Hospital and District Institutions, Finland. Emerging Infectious Diseases. 2003;9(2):169-175. doi:10.3201/eid0902.020233.
APA Kotilainen, P., Routamaa, M., Peltonen, R., Oksi, J., Rintala, E., Meurman, O....Rossi, T. (2003). Elimination of Epidemic Methicillin-Resistant Staphylococcus aureus from a University Hospital and District Institutions, Finland. Emerging Infectious Diseases, 9(2), 169-175. https://dx.doi.org/10.3201/eid0902.020233.

Annual Mycobacterium tuberculosis Infection Risk and Interpretation of Clustering Statistics [PDF - 376 KB - 8 pages]
E. Vynnycky et al.

Several recent studies have used proportions of tuberculosis cases sharing identical DNA fingerprint patterns (i.e., isolate clustering) to estimate the extent of disease attributable to recent transmission. Using a model of introduction and transmission of strains with different DNA fingerprint patterns, we show that the properties and interpretation of clustering statistics may differ substantially between settings. For some unindustrialized countries, where the annual risk for infection has changed little over time, 70% to 80% of all age groups may be clustered during a 3-year period, which underestimates the proportion of disease attributable to recent transmission. In contrast, for a typical industrialized setting (the Netherlands), clustering declines with increasing age (from 75% to 15% among young and old patients, respectively) and underestimates the extent of recent transmission only for young patients. We conclude that, in some settings, clustering is an unreliable indicator of the extent of recent transmission.

EID Vynnycky E, Borgdorff MW, van Soolingen D, Fine PE. Annual Mycobacterium tuberculosis Infection Risk and Interpretation of Clustering Statistics. Emerg Infect Dis. 2003;9(2):176-183. https://dx.doi.org/10.3201/eid0902.010530
AMA Vynnycky E, Borgdorff MW, van Soolingen D, et al. Annual Mycobacterium tuberculosis Infection Risk and Interpretation of Clustering Statistics. Emerging Infectious Diseases. 2003;9(2):176-183. doi:10.3201/eid0902.010530.
APA Vynnycky, E., Borgdorff, M. W., van Soolingen, D., & Fine, P. E. (2003). Annual Mycobacterium tuberculosis Infection Risk and Interpretation of Clustering Statistics. Emerging Infectious Diseases, 9(2), 176-183. https://dx.doi.org/10.3201/eid0902.010530.

Endemic Babesiosis in Another Eastern State: New Jersey [PDF - 1.19 MB - 5 pages]
B. L. Herwaldt et al.

In the United States, most reported cases of babesiosis have been caused by Babesia microti and acquired in the northeast. Although three cases of babesiosis acquired in New Jersey were recently described by others, babesiosis has not been widely known to be endemic in New Jersey. We describe a case of babesiosis acquired in New Jersey in 1999 in an otherwise healthy 53-year-old woman who developed life-threatening disease. We also provide composite data on 40 cases of babesiosis acquired from 1993 through 2001 in New Jersey. The 40 cases include the one we describe, the three cases previously described, and 36 other cases reported to public health agencies. The 40 cases were acquired in eight (38.1%) of the 21 counties in the state. Babesiosis, a potentially serious zoonosis, is endemic in New Jersey and should be considered in the differential diagnosis of patients with fever and hemolytic anemia, particularly in the spring, summer, and early fall.

EID Herwaldt BL, McGovern PC, Gerwel MP, Easton RM, MacGregor RR. Endemic Babesiosis in Another Eastern State: New Jersey. Emerg Infect Dis. 2003;9(2):184-188. https://dx.doi.org/10.3201/eid0902.020271
AMA Herwaldt BL, McGovern PC, Gerwel MP, et al. Endemic Babesiosis in Another Eastern State: New Jersey. Emerging Infectious Diseases. 2003;9(2):184-188. doi:10.3201/eid0902.020271.
APA Herwaldt, B. L., McGovern, P. C., Gerwel, M. P., Easton, R. M., & MacGregor, R. R. (2003). Endemic Babesiosis in Another Eastern State: New Jersey. Emerging Infectious Diseases, 9(2), 184-188. https://dx.doi.org/10.3201/eid0902.020271.

Molecular Typing of IberoAmerican Cryptococcus neoformans Isolates [PDF - 618 KB - 7 pages]
W. Meyer et al.

A network was established to acquire basic knowledge of Cryptococcus neoformans in IberoAmerican countries. To this effect, 340 clinical, veterinary, and environmental isolates from Argentina, Brazil, Chile, Colombia, Mexico, Peru, Venezuela, Guatemala, and Spain were typed by using M13 polymerase chain reaction-fingerprinting and orotidine monophosphate pyrophosphorylase (URA5) gene restriction fragment length polymorphsm analysis with HhaI and Sau96I in a double digest. Both techniques grouped all isolates into eight previously established molecular types. The majority of the isolates, 68.2% (n=232), were VNI (var. grubii, serotype A), which accords with the fact that this variety causes most human cryptococcal infections worldwide. A smaller proportion, 5.6% (n=19), were VNII (var. grubii, serotype A); 4.1% (n=14), VNIII (AD hybrid), with 9 isolates having a polymorphism in the URA5 gene; 1.8% (n=6), VNIV (var. neoformans, serotype D); 3.5% (n=12), VGI; 6.2% (n=21), VGII; 9.1% (n=31), VGIII, and 1.5% (n=5) VGIV, with all four VG types containing var. gattii serotypes B and C isolates.

EID Meyer W, Castañeda A, Jackson S, Huynh M, Castañeda E. Molecular Typing of IberoAmerican Cryptococcus neoformans Isolates. Emerg Infect Dis. 2003;9(2):189-195. https://dx.doi.org/10.3201/eid0902.020246
AMA Meyer W, Castañeda A, Jackson S, et al. Molecular Typing of IberoAmerican Cryptococcus neoformans Isolates. Emerging Infectious Diseases. 2003;9(2):189-195. doi:10.3201/eid0902.020246.
APA Meyer, W., Castañeda, A., Jackson, S., Huynh, M., & Castañeda, E. (2003). Molecular Typing of IberoAmerican Cryptococcus neoformans Isolates. Emerging Infectious Diseases, 9(2), 189-195. https://dx.doi.org/10.3201/eid0902.020246.

Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital Discharge [PDF - 855 KB - 8 pages]
E. N. Perencevich et al.

Although surgical site infections (SSIs) are known to cause substantial illness and costs during the index hospitalization, little information exists about the impact of infections diagnosed after discharge, which constitute the majority of SSIs. In this study, using patient questionnaire and administrative databases, we assessed the clinical outcomes and resource utilization in the 8-week postoperative period associated with SSIs recognized after discharge. SSI recognized after discharge was confirmed in 89 (1.9%) of 4,571 procedures from May 1997 to October 1998. Patients with SSI, but not controls, had a significant decline in SF-12 (Medical Outcomes Study 12-Item Short-Form Health Survey) mental health component scores after surgery (p=0.004). Patients required significantly more outpatient visits, emergency room visits, radiology services, readmissions, and home health aide services than did controls. Average total costs during the 8 weeks after discharge were US$5,155 for patients with SSI and $1,773 for controls (p<0.001).

EID Perencevich EN, Sands KE, Cosgrove SE, Guadagnoli E, Meara E, Platt R. Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital Discharge. Emerg Infect Dis. 2003;9(2):196-203. https://dx.doi.org/10.3201/eid0902.020232
AMA Perencevich EN, Sands KE, Cosgrove SE, et al. Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital Discharge. Emerging Infectious Diseases. 2003;9(2):196-203. doi:10.3201/eid0902.020232.
APA Perencevich, E. N., Sands, K. E., Cosgrove, S. E., Guadagnoli, E., Meara, E., & Platt, R. (2003). Health and Economic Impact of Surgical Site Infections Diagnosed after Hospital Discharge. Emerging Infectious Diseases, 9(2), 196-203. https://dx.doi.org/10.3201/eid0902.020232.

Applying Network Theory to Epidemics: Control Measures for Mycoplasma pneumoniae Outbreaks [PDF - 445 KB - 7 pages]
L. Meyers et al.

We introduce a novel mathematical approach to investigating the spread and control of communicable infections in closed communities. Mycoplasma pneumoniae is a major cause of bacterial pneumonia in the United States. Outbreaks of illness attributable to mycoplasma commonly occur in closed or semi-closed communities. These outbreaks are difficult to contain because of delays in outbreak detection, the long incubation period of the bacterium, and an incomplete understanding of the effectiveness of infection control strategies. Our model explicitly captures the patterns of interactions among patients and caregivers in an institution with multiple wards. Analysis of this contact network predicts that, despite the relatively low prevalence of mycoplasma pneumonia found among caregivers, the patterns of caregiver activity and the extent to which they are protected against infection may be fundamental to the control and prevention of mycoplasma outbreaks. In particular, the most effective interventions are those that reduce the diversity of interactions between caregivers and patients.

EID Meyers L, Newman M, Martin M, Schrag S. Applying Network Theory to Epidemics: Control Measures for Mycoplasma pneumoniae Outbreaks. Emerg Infect Dis. 2003;9(2):204-210. https://dx.doi.org/10.3201/eid0902.020188
AMA Meyers L, Newman M, Martin M, et al. Applying Network Theory to Epidemics: Control Measures for Mycoplasma pneumoniae Outbreaks. Emerging Infectious Diseases. 2003;9(2):204-210. doi:10.3201/eid0902.020188.
APA Meyers, L., Newman, M., Martin, M., & Schrag, S. (2003). Applying Network Theory to Epidemics: Control Measures for Mycoplasma pneumoniae Outbreaks. Emerging Infectious Diseases, 9(2), 204-210. https://dx.doi.org/10.3201/eid0902.020188.

Using Hospital Antibiogram Data To Assess Regional Pneumococcal Resistance to Antibiotics [PDF - 284 KB - 6 pages]
C. R. Stein et al.

Antimicrobial resistance to penicillin and macrolides in Streptococcus pneumoniae has increased in the United States over the past decade. Considerable geographic variation in susceptibility necessitates regional resistance tracking. Traditional active surveillance is labor intensive and costly. We collected antibiogram reports from North Carolina hospitals and assessed pneumococcal susceptibility to multiple agents from 1996 through 2000. Susceptibility in North Carolina was consistently lower than the national average. Aggregating antibiogram data is a feasible and timely method of monitoring regional susceptibility patterns and may also prove beneficial in measuring the effects of interventions to decrease antimicrobial resistance.

EID Stein CR, Weber DJ, Kelley M. Using Hospital Antibiogram Data To Assess Regional Pneumococcal Resistance to Antibiotics. Emerg Infect Dis. 2003;9(2):211-216. https://dx.doi.org/10.3201/eid0902.020123
AMA Stein CR, Weber DJ, Kelley M. Using Hospital Antibiogram Data To Assess Regional Pneumococcal Resistance to Antibiotics. Emerging Infectious Diseases. 2003;9(2):211-216. doi:10.3201/eid0902.020123.
APA Stein, C. R., Weber, D. J., & Kelley, M. (2003). Using Hospital Antibiogram Data To Assess Regional Pneumococcal Resistance to Antibiotics. Emerging Infectious Diseases, 9(2), 211-216. https://dx.doi.org/10.3201/eid0902.020123.

Influence of Role Models and Hospital Design on the Hand Hygiene of Health-Care Workers [PDF - 896 KB - 7 pages]
M. G. Lankford et al.

We assessed the effect of medical staff role models and the number of health-care worker sinks on hand-hygiene compliance before and after construction of a new hospital designed for increased access to handwashing sinks. We observed health-care worker hand hygiene in four nursing units that provided similar patient care in both the old and new hospitals: medical and surgical intensive care, hematology/oncology, and solid organ transplant units. Of 721 hand-hygiene opportunities, 304 (42%) were observed in the old hospital and 417 (58%) in the new hospital. Hand-hygiene compliance was significantly better in the old hospital (161/304; 53%) compared to the new hospital (97/417; 23.3%) (p<0.001). Health-care workers in a room with a senior (e.g., higher ranking) medical staff person or peer who did not wash hands were significantly less likely to wash their own hands (odds ratio 0.2; confidence interval 0.1 to 0.5); p<0.001). Our results suggest that health-care worker hand-hygiene compliance is influenced significantly by the behavior of other health-care workers. An increased number of hand-washing sinks, as a sole measure, did not increase hand-hygiene compliance.

EID Lankford MG, Zembower TR, Trick WE, Hacek DM, Noskin GA, Peterson LR. Influence of Role Models and Hospital Design on the Hand Hygiene of Health-Care Workers. Emerg Infect Dis. 2003;9(2):217-223. https://dx.doi.org/10.3201/eid0902.020249
AMA Lankford MG, Zembower TR, Trick WE, et al. Influence of Role Models and Hospital Design on the Hand Hygiene of Health-Care Workers. Emerging Infectious Diseases. 2003;9(2):217-223. doi:10.3201/eid0902.020249.
APA Lankford, M. G., Zembower, T. R., Trick, W. E., Hacek, D. M., Noskin, G. A., & Peterson, L. R. (2003). Influence of Role Models and Hospital Design on the Hand Hygiene of Health-Care Workers. Emerging Infectious Diseases, 9(2), 217-223. https://dx.doi.org/10.3201/eid0902.020249.

Aeromonas Isolates from Human Diarrheic Stool and Groundwater Compared by Pulsed-Field Gel Electrophoresis [PDF - 439 KB - 5 pages]
M. A. Borchardt et al.

Gastrointestinal infections of Aeromonas species are generally considered waterborne; for this reason, Aeromonas hydrophila has been placed on the United States Environmental Protection Agency Contaminant Candidate List of emerging pathogens in drinking water. In this study, we compared pulsed-field gel electrophoresis patterns of Aeromonas isolates from stool specimens of patients with diarrhea with Aeromonas isolates from patients’ drinking water. Among 2,565 diarrheic stool specimens submitted to a Wisconsin clinical reference laboratory, 17 (0.66%) tested positive for Aeromonas. Groundwater isolates of Aeromonas were obtained from private wells throughout Wisconsin and the drinking water of Aeromonas-positive patients. The analysis showed that the stool and drinking water isolates were genetically unrelated, suggesting that in this population Aeromonas gastrointestinal infections were not linked with groundwater exposures.

EID Borchardt MA, Stemper ME, Standridge JH. Aeromonas Isolates from Human Diarrheic Stool and Groundwater Compared by Pulsed-Field Gel Electrophoresis. Emerg Infect Dis. 2003;9(2):224-228. https://dx.doi.org/10.3201/eid0902.020031
AMA Borchardt MA, Stemper ME, Standridge JH. Aeromonas Isolates from Human Diarrheic Stool and Groundwater Compared by Pulsed-Field Gel Electrophoresis. Emerging Infectious Diseases. 2003;9(2):224-228. doi:10.3201/eid0902.020031.
APA Borchardt, M. A., Stemper, M. E., & Standridge, J. H. (2003). Aeromonas Isolates from Human Diarrheic Stool and Groundwater Compared by Pulsed-Field Gel Electrophoresis. Emerging Infectious Diseases, 9(2), 224-228. https://dx.doi.org/10.3201/eid0902.020031.

Risk Factors for Sporadic Giardiasis: a Case-Control Study in Southwestern England [PDF - 201 KB - 5 pages]
J. M. Stuart et al.

To investigate risk factors for sporadic infection with Giardia lamblia acquired in the United Kingdom, we conducted a matched case-control study in southwest England in 1998 and 1999. Response rates to a postal questionnaire were 84% (232/276) for cases and 69% (574/828) for controls. In multivariable analysis, swallowing water while swimming (p<0.0001, odds ratio [OR] 6.2, 95% confidence intervals [CI] 2.3 to 16.6), recreational fresh water contact (p=0.001, OR 5.5, 95% CI 1.9 to 15.9), drinking treated tap water (p<0.0001, OR 1.3, 95% CI 1.1 to 1.5 for each additional glass per day), and eating lettuce (p=0.01, OR 2.2, 95% CI 1.2 to 4.3) had positive and independent associations with infection. Although case-control studies are prone to bias and the risk of Giardia infection is minimized by water treatment processes, the possibility that treated tap water is a source of sporadic giardiasis warrants further investigation.

EID Stuart JM, Orr HJ, Warburton F, Jeyakanth S, Pugh C, Morris I, et al. Risk Factors for Sporadic Giardiasis: a Case-Control Study in Southwestern England. Emerg Infect Dis. 2003;9(2):229-233. https://dx.doi.org/10.3201/eid0902.010488
AMA Stuart JM, Orr HJ, Warburton F, et al. Risk Factors for Sporadic Giardiasis: a Case-Control Study in Southwestern England. Emerging Infectious Diseases. 2003;9(2):229-233. doi:10.3201/eid0902.010488.
APA Stuart, J. M., Orr, H. J., Warburton, F., Jeyakanth, S., Pugh, C., Morris, I....Nichols, G. (2003). Risk Factors for Sporadic Giardiasis: a Case-Control Study in Southwestern England. Emerging Infectious Diseases, 9(2), 229-233. https://dx.doi.org/10.3201/eid0902.010488.

Viral Encephalitis in England, 1989–1998: What Did We Miss? [PDF - 267 KB - 7 pages]
K. L. Davison et al.

We analyzed hospitalizations in England from April 1, 1989, to March 31, 1998, and identified approximately 700 cases, 46 fatal, from viral encephalitis that occurred during each year; most (60%) were of unknown etiology. Of cases with a diagnosis, the largest proportion was herpes simplex encephalitis. Using normal and Poisson regression, we identified six possible clusters of unknown etiology. Over 75% of hospitalizations are not reported through the routine laboratory and clinical notification systems, resulting in underdiagnosis of viral encephalitis in England. Current surveillance greatly underascertains incidence of the disease and existence of clusters; in general, outbreaks are undetected. Surveillance systems must be adapted to detect major changes in epidemiology so that timely control measures can be implemented.

EID Davison KL, Crowcroft NS, Ramsay ME, Brown DW, Andrews N. Viral Encephalitis in England, 1989–1998: What Did We Miss?. Emerg Infect Dis. 2003;9(2):234-240. https://dx.doi.org/10.3201/eid0902.020218
AMA Davison KL, Crowcroft NS, Ramsay ME, et al. Viral Encephalitis in England, 1989–1998: What Did We Miss?. Emerging Infectious Diseases. 2003;9(2):234-240. doi:10.3201/eid0902.020218.
APA Davison, K. L., Crowcroft, N. S., Ramsay, M. E., Brown, D. W., & Andrews, N. (2003). Viral Encephalitis in England, 1989–1998: What Did We Miss?. Emerging Infectious Diseases, 9(2), 234-240. https://dx.doi.org/10.3201/eid0902.020218.
Dispatches

Photorhabdus Species: Bioluminescent Bacteria as Human Pathogens? [PDF - 1.13 MB - 4 pages]
J. G. Gerrard et al.

We report two Australian patients with soft tissue infections due to Photorhabdus species. Recognized as important insect pathogens, Photorhabdus spp. are bioluminescent gram-negative bacilli. Bacteria belonging to the genus are emerging as a cause of both localized soft tissue and disseminated infections in humans in the United States and Australia. The source of infection in humans remains unknown.

EID Gerrard JG, McNevin S, Alfredson D, Forgan-Smith R, Fraser N. Photorhabdus Species: Bioluminescent Bacteria as Human Pathogens?. Emerg Infect Dis. 2003;9(2):251-254. https://dx.doi.org/10.3201/eid0902.020222
AMA Gerrard JG, McNevin S, Alfredson D, et al. Photorhabdus Species: Bioluminescent Bacteria as Human Pathogens?. Emerging Infectious Diseases. 2003;9(2):251-254. doi:10.3201/eid0902.020222.
APA Gerrard, J. G., McNevin, S., Alfredson, D., Forgan-Smith, R., & Fraser, N. (2003). Photorhabdus Species: Bioluminescent Bacteria as Human Pathogens?. Emerging Infectious Diseases, 9(2), 251-254. https://dx.doi.org/10.3201/eid0902.020222.

Life-Threatening Infantile Diarrhea from Fluoroquinolone-Resistant Salmonella enteric Typhimurium with Mutations in Both gyrA and parC [PDF - 226 KB - 3 pages]
H. Nakaya et al.

Salmonella Typhimurium DT12, isolated from a 35-day-old infant with diarrhea, was highly resistant to ampicillin, tetracycline, chloramphenicol, streptomycin, gentamycin, sulfamethoxazole/trimethoprim, nalidixic acid, and fluoroquinolones. The patient responded to antibiotic therapy with fosfomycin. Multidrug-resistance may become prevalent in Salmonella infections in Japan, as shown in this first case of a patient infected with fluoroquinolone-resistant Salmonella.

EID Nakaya H, Yasuhara A, Yoshimura K, Oshihoi Y, Izumiya H, Watanabe H. Life-Threatening Infantile Diarrhea from Fluoroquinolone-Resistant Salmonella enteric Typhimurium with Mutations in Both gyrA and parC. Emerg Infect Dis. 2003;9(2):255-257. https://dx.doi.org/10.3201/eid0902.020185
AMA Nakaya H, Yasuhara A, Yoshimura K, et al. Life-Threatening Infantile Diarrhea from Fluoroquinolone-Resistant Salmonella enteric Typhimurium with Mutations in Both gyrA and parC. Emerging Infectious Diseases. 2003;9(2):255-257. doi:10.3201/eid0902.020185.
APA Nakaya, H., Yasuhara, A., Yoshimura, K., Oshihoi, Y., Izumiya, H., & Watanabe, H. (2003). Life-Threatening Infantile Diarrhea from Fluoroquinolone-Resistant Salmonella enteric Typhimurium with Mutations in Both gyrA and parC. Emerging Infectious Diseases, 9(2), 255-257. https://dx.doi.org/10.3201/eid0902.020185.

Invasive Type e Haemophilus influenzae Disease in Italy [PDF - 347 KB - 4 pages]
M. Cerquetti et al.

We describe the first reported cases of invasive type e Haemophilus influenzae disease in Italy. All five cases occurred in adults. The isolates were susceptible to ampicillin and eight other antimicrobial agents. Molecular analysis showed two distinct type e strains circulating in Italy, both containing a single copy of the capsulation locus.

EID Cerquetti M, degli Atti ML, Cardines R, Salmaso S, Renna G, Mastrantonio P. Invasive Type e Haemophilus influenzae Disease in Italy. Emerg Infect Dis. 2003;9(2):258-261. https://dx.doi.org/10.3201/eid0902.020142
AMA Cerquetti M, degli Atti ML, Cardines R, et al. Invasive Type e Haemophilus influenzae Disease in Italy. Emerging Infectious Diseases. 2003;9(2):258-261. doi:10.3201/eid0902.020142.
APA Cerquetti, M., degli Atti, M. L., Cardines, R., Salmaso, S., Renna, G., & Mastrantonio, P. (2003). Invasive Type e Haemophilus influenzae Disease in Italy. Emerging Infectious Diseases, 9(2), 258-261. https://dx.doi.org/10.3201/eid0902.020142.

Public Health Surveillance for Australian bat lyssavirus in Queensland, Australia, 2000–2001 [PDF - 206 KB - 3 pages]
D. Warrilow et al.

From February 1, 2000, to December 4, 2001, a total of 119 bats (85 Megachiroptera and 34 Microchiroptera) were tested for Australian bat lyssavirus (ABLV) infection. Eight Megachiroptera were positive by immunofluorescence assay that used cross-reactive antibodies to rabies nucleocapsid protein. A case study of cross-species transmission of ABLV supports the conclusion that a bat reservoir exists for ABLV in which the virus circulates across Megachiroptera species within mixed communities.

EID Warrilow D, Harrower B, Smith IL, Field HE, Taylor R, Walker GC, et al. Public Health Surveillance for Australian bat lyssavirus in Queensland, Australia, 2000–2001. Emerg Infect Dis. 2003;9(2):262-264. https://dx.doi.org/10.3201/eid0902.020264
AMA Warrilow D, Harrower B, Smith IL, et al. Public Health Surveillance for Australian bat lyssavirus in Queensland, Australia, 2000–2001. Emerging Infectious Diseases. 2003;9(2):262-264. doi:10.3201/eid0902.020264.
APA Warrilow, D., Harrower, B., Smith, I. L., Field, H. E., Taylor, R., Walker, G. C....Smith, G. A. (2003). Public Health Surveillance for Australian bat lyssavirus in Queensland, Australia, 2000–2001. Emerging Infectious Diseases, 9(2), 262-264. https://dx.doi.org/10.3201/eid0902.020264.

Infection of Cultured Human and Monkey Cell Lines with Extract of Penaeid Shrimp Infected with Taura Syndrome Virus [PDF - 476 KB - 2 pages]
J. Audelo-del-Valle et al.

Taura syndrome virus (TSV) affects shrimp cultured for human consumption. Although TSV is related to the Cricket Paralysis virus, it belongs to the “picornavirus superfamily,” the most common cause of viral illnesses. Here we demonstrate that TSV also infects human cell lines, which may suggest that Penaeus is a potential reservoir of this virus.

EID Audelo-del-Valle J, Clement-Mellado O, Magaña-Hernández A, Flisser A, Montiel-Aguirre F, Briseño-García B. Infection of Cultured Human and Monkey Cell Lines with Extract of Penaeid Shrimp Infected with Taura Syndrome Virus. Emerg Infect Dis. 2003;9(2):265-266. https://dx.doi.org/10.3201/eid0902.020181
AMA Audelo-del-Valle J, Clement-Mellado O, Magaña-Hernández A, et al. Infection of Cultured Human and Monkey Cell Lines with Extract of Penaeid Shrimp Infected with Taura Syndrome Virus. Emerging Infectious Diseases. 2003;9(2):265-266. doi:10.3201/eid0902.020181.
APA Audelo-del-Valle, J., Clement-Mellado, O., Magaña-Hernández, A., Flisser, A., Montiel-Aguirre, F., & Briseño-García, B. (2003). Infection of Cultured Human and Monkey Cell Lines with Extract of Penaeid Shrimp Infected with Taura Syndrome Virus. Emerging Infectious Diseases, 9(2), 265-266. https://dx.doi.org/10.3201/eid0902.020181.

Fluoroquinolone Resistance in Campylobacter jejuni Isolates in Travelers Returning to Finland: Association of Ciprofloxacin Resistance to Travel Destination [PDF - 789 KB - 4 pages]
A. Hakanen et al.

Ciprofloxacin resistance was analyzed in 354 Campylobacter jejuni isolates collected during two study periods (1995–1997 and 1998–2000) from travelers returning to Finland. The increase in resistance between the two periods was significant among all isolates (40% vs. 60%; p<0.01), as well as among those from Asia alone (45% vs. 72%; p<0.01).

EID Hakanen A, Jousimies-Somer H, Siitonen A, Huovinen P, Kotilainen P. Fluoroquinolone Resistance in Campylobacter jejuni Isolates in Travelers Returning to Finland: Association of Ciprofloxacin Resistance to Travel Destination. Emerg Infect Dis. 2003;9(2):267-270. https://dx.doi.org/10.3201/eid0902.020227
AMA Hakanen A, Jousimies-Somer H, Siitonen A, et al. Fluoroquinolone Resistance in Campylobacter jejuni Isolates in Travelers Returning to Finland: Association of Ciprofloxacin Resistance to Travel Destination. Emerging Infectious Diseases. 2003;9(2):267-270. doi:10.3201/eid0902.020227.
APA Hakanen, A., Jousimies-Somer, H., Siitonen, A., Huovinen, P., & Kotilainen, P. (2003). Fluoroquinolone Resistance in Campylobacter jejuni Isolates in Travelers Returning to Finland: Association of Ciprofloxacin Resistance to Travel Destination. Emerging Infectious Diseases, 9(2), 267-270. https://dx.doi.org/10.3201/eid0902.020227.
Letters

Streptomyces bikiniensis Bacteremia [PDF - 176 KB - 2 pages]
W. J. Moss et al.
EID Moss WJ, Sager JA, Dick JD, Ruff A. Streptomyces bikiniensis Bacteremia. Emerg Infect Dis. 2003;9(2):273-274. https://dx.doi.org/10.3201/eid0902.020275
AMA Moss WJ, Sager JA, Dick JD, et al. Streptomyces bikiniensis Bacteremia. Emerging Infectious Diseases. 2003;9(2):273-274. doi:10.3201/eid0902.020275.
APA Moss, W. J., Sager, J. A., Dick, J. D., & Ruff, A. (2003). Streptomyces bikiniensis Bacteremia. Emerging Infectious Diseases, 9(2), 273-274. https://dx.doi.org/10.3201/eid0902.020275.

Drug-Resistant Mycobacterium tuberculosis among New Tuberculosis Patients, Yangon, Myanmar [PDF - 184 KB - 3 pages]
S. Phyu et al.
EID Phyu S, Ti T, Jureen R, Hmun T, Myint H, Htun A, et al. Drug-Resistant Mycobacterium tuberculosis among New Tuberculosis Patients, Yangon, Myanmar. Emerg Infect Dis. 2003;9(2):274-276. https://dx.doi.org/10.3201/eid0902.020128
AMA Phyu S, Ti T, Jureen R, et al. Drug-Resistant Mycobacterium tuberculosis among New Tuberculosis Patients, Yangon, Myanmar. Emerging Infectious Diseases. 2003;9(2):274-276. doi:10.3201/eid0902.020128.
APA Phyu, S., Ti, T., Jureen, R., Hmun, T., Myint, H., Htun, A....Bjorvatn, B. (2003). Drug-Resistant Mycobacterium tuberculosis among New Tuberculosis Patients, Yangon, Myanmar. Emerging Infectious Diseases, 9(2), 274-276. https://dx.doi.org/10.3201/eid0902.020128.

Pneumocystis carinii versus Pneumocystis jiroveci: Another Misnomer (Response to Stringer et al.) [PDF - 176 KB - 2 pages]
W. T. Hughes
EID Hughes WT. Pneumocystis carinii versus Pneumocystis jiroveci: Another Misnomer (Response to Stringer et al.). Emerg Infect Dis. 2003;9(2):276-277. https://dx.doi.org/10.3201/eid0902.020602
AMA Hughes WT. Pneumocystis carinii versus Pneumocystis jiroveci: Another Misnomer (Response to Stringer et al.). Emerging Infectious Diseases. 2003;9(2):276-277. doi:10.3201/eid0902.020602.
APA Hughes, W. T. (2003). Pneumocystis carinii versus Pneumocystis jiroveci: Another Misnomer (Response to Stringer et al.). Emerging Infectious Diseases, 9(2), 276-277. https://dx.doi.org/10.3201/eid0902.020602.

Dual Infection by Dengue Virus and Shigella sonnei in Patient Returning from India [PDF - 166 KB - 1 page]
R. N. Charrel et al.
EID Charrel RN, Abboud M, Durand JP, Brouqui P, De Lamballerie X. Dual Infection by Dengue Virus and Shigella sonnei in Patient Returning from India. Emerg Infect Dis. 2003;9(2):271. https://dx.doi.org/10.3201/eid0902.020026
AMA Charrel RN, Abboud M, Durand JP, et al. Dual Infection by Dengue Virus and Shigella sonnei in Patient Returning from India. Emerging Infectious Diseases. 2003;9(2):271. doi:10.3201/eid0902.020026.
APA Charrel, R. N., Abboud, M., Durand, J. P., Brouqui, P., & De Lamballerie, X. (2003). Dual Infection by Dengue Virus and Shigella sonnei in Patient Returning from India. Emerging Infectious Diseases, 9(2), 271. https://dx.doi.org/10.3201/eid0902.020026.

St. Louis Encephalitis in Argentina: the First Case Reported in the Last Seventeen Years [PDF - 182 KB - 3 pages]
L. Spinsanti et al.
EID Spinsanti L, Basquiera AL, Bulacio S, Somale V, Kim SC, Ré V, et al. St. Louis Encephalitis in Argentina: the First Case Reported in the Last Seventeen Years. Emerg Infect Dis. 2003;9(2):271-273. https://dx.doi.org/10.3201/eid0902.020301
AMA Spinsanti L, Basquiera AL, Bulacio S, et al. St. Louis Encephalitis in Argentina: the First Case Reported in the Last Seventeen Years. Emerging Infectious Diseases. 2003;9(2):271-273. doi:10.3201/eid0902.020301.
APA Spinsanti, L., Basquiera, A. L., Bulacio, S., Somale, V., Kim, S. C., Ré, V....Palacio, S. (2003). St. Louis Encephalitis in Argentina: the First Case Reported in the Last Seventeen Years. Emerging Infectious Diseases, 9(2), 271-273. https://dx.doi.org/10.3201/eid0902.020301.

A New Name (Pneumocystis jiroveci) for Pneumocystis from Humans (Response to Hughes)
J. R. Stringer et al.
EID Stringer JR, Ben Beard C, Miller RF, Cushion MT. A New Name (Pneumocystis jiroveci) for Pneumocystis from Humans (Response to Hughes). Emerg Infect Dis. 2003;9(2):276-277. https://dx.doi.org/10.3201/eid0902.020711
AMA Stringer JR, Ben Beard C, Miller RF, et al. A New Name (Pneumocystis jiroveci) for Pneumocystis from Humans (Response to Hughes). Emerging Infectious Diseases. 2003;9(2):276-277. doi:10.3201/eid0902.020711.
APA Stringer, J. R., Ben Beard, C., Miller, R. F., & Cushion, M. T. (2003). A New Name (Pneumocystis jiroveci) for Pneumocystis from Humans (Response to Hughes). Emerging Infectious Diseases, 9(2), 276-277. https://dx.doi.org/10.3201/eid0902.020711.
Books and Media

Field Epidemiology, 2nd edition [PDF - 132 KB - 1 page]
M. A. Strassburg
EID Strassburg MA. Field Epidemiology, 2nd edition. Emerg Infect Dis. 2003;9(2):280. https://dx.doi.org/10.3201/eid0902.020697
AMA Strassburg MA. Field Epidemiology, 2nd edition. Emerging Infectious Diseases. 2003;9(2):280. doi:10.3201/eid0902.020697.
APA Strassburg, M. A. (2003). Field Epidemiology, 2nd edition. Emerging Infectious Diseases, 9(2), 280. https://dx.doi.org/10.3201/eid0902.020697.
About the Cover

Frida Kahlo (1910–1954). Self-Portrait with Monkey (1938) [PDF - 15.49 MB - 1 page]
P. Potter
EID Potter P. Frida Kahlo (1910–1954). Self-Portrait with Monkey (1938). Emerg Infect Dis. 2003;9(2):281. https://dx.doi.org/10.3201/eid0902.ac0902
AMA Potter P. Frida Kahlo (1910–1954). Self-Portrait with Monkey (1938). Emerging Infectious Diseases. 2003;9(2):281. doi:10.3201/eid0902.ac0902.
APA Potter, P. (2003). Frida Kahlo (1910–1954). Self-Portrait with Monkey (1938). Emerging Infectious Diseases, 9(2), 281. https://dx.doi.org/10.3201/eid0902.ac0902.
Corrections

Correction, Vol. 9, No. 1
EID Correction, Vol. 9, No. 1. Emerg Infect Dis. 2003;9(2):279. https://dx.doi.org/10.3201/eid0902.c10902
AMA Correction, Vol. 9, No. 1. Emerging Infectious Diseases. 2003;9(2):279. doi:10.3201/eid0902.c10902.
APA (2003). Correction, Vol. 9, No. 1. Emerging Infectious Diseases, 9(2), 279. https://dx.doi.org/10.3201/eid0902.c10902.
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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