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Policy Review and Modeling Analysis of Mitigation Measures for Coronavirus Disease Epidemic Control, Health System, and Disease Burden, South Korea [PDF - 1.34 MB - 8 pages]
H. Kim et al.

We reviewed the timeline of key policies for control of the coronavirus disease epidemic and determined their impact on the epidemic and hospital burden in South Korea. Using a discrete stochastic transmission model, we estimated that multilevel policies, including extensive testing, contact tracing, and quarantine, reduced contact rates by 90% and rapidly decreased the epidemic in Daegu and nationwide during February‒March 2020. Absence of these prompt responses could have resulted in a >10-fold increase in infections, hospitalizations, and deaths by May 15, 2020, relative to the status quo. The model suggests that reallocation of persons who have mild or asymptomatic cases to community treatment centers helped avoid overwhelming hospital capacity and enabled healthcare workers to provide care for more severely and critically ill patients in hospital beds and negative-pressure intensive care units. As small outbreaks continue to occur, contact tracing and maintenance of hospital capacity are needed.

EID Kim H, Oh I, Lee J, Seon J, Jeon W, Park J, et al. Policy Review and Modeling Analysis of Mitigation Measures for Coronavirus Disease Epidemic Control, Health System, and Disease Burden, South Korea. Emerg Infect Dis. 2021;27(11):2753-2760. https://doi.org/10.3201/eid2711.203779
AMA Kim H, Oh I, Lee J, et al. Policy Review and Modeling Analysis of Mitigation Measures for Coronavirus Disease Epidemic Control, Health System, and Disease Burden, South Korea. Emerging Infectious Diseases. 2021;27(11):2753-2760. doi:10.3201/eid2711.203779.
APA Kim, H., Oh, I., Lee, J., Seon, J., Jeon, W., Park, J....Lee, S. (2021). Policy Review and Modeling Analysis of Mitigation Measures for Coronavirus Disease Epidemic Control, Health System, and Disease Burden, South Korea. Emerging Infectious Diseases, 27(11), 2753-2760. https://doi.org/10.3201/eid2711.203779.

Effectiveness of Abbott BinaxNOW Rapid Antigen Test for Detection of SARS-CoV-2 Infections in Outbreak among Horse Racetrack Workers, California, USA [PDF - 1.27 MB - 7 pages]
K. Surasi et al.

The Abbott BinaxNOW rapid antigen test is cheaper and faster than real-time reverse transcription PCR (rRT-PCR) for detecting severe acute respiratory syndrome coronavirus 2. We compared BinaxNOW with rRT-PCR in 769 paired specimens from 342 persons during a coronavirus disease outbreak among horse racetrack workers in California, USA. We found positive percent agreement was 43.3% (95% CI 34.6%–52.4%), negative percent agreement 100% (95% CI 99.4%–100%), positive predictive value 100% (95% CI 93.5%–100%), and negative predictive value 89.9% (95% CI 87.5%–92.0%). Among 127 rRT-PCR–positive specimens, the 55 with paired BinaxNOW-positive results had a lower mean cycle threshold than the 72 with paired BinaxNOW-negative results (17.8 vs. 28.5; p<0.001). Of 100 specimens with cycle threshold <30, a total of 51 resulted in positive virus isolation; 45 (88.2%) of those were BinaxNOW-positive. Our comparison supports immediate isolation for BinaxNOW-positive persons and confirmatory testing for negative persons.

EID Surasi K, Cummings KJ, Hanson C, Morris M, Salas M, Seftel D, et al. Effectiveness of Abbott BinaxNOW Rapid Antigen Test for Detection of SARS-CoV-2 Infections in Outbreak among Horse Racetrack Workers, California, USA. Emerg Infect Dis. 2021;27(11):2761-2767. https://doi.org/10.3201/eid2711.211449
AMA Surasi K, Cummings KJ, Hanson C, et al. Effectiveness of Abbott BinaxNOW Rapid Antigen Test for Detection of SARS-CoV-2 Infections in Outbreak among Horse Racetrack Workers, California, USA. Emerging Infectious Diseases. 2021;27(11):2761-2767. doi:10.3201/eid2711.211449.
APA Surasi, K., Cummings, K. J., Hanson, C., Morris, M., Salas, M., Seftel, D....Wadford, D. A. (2021). Effectiveness of Abbott BinaxNOW Rapid Antigen Test for Detection of SARS-CoV-2 Infections in Outbreak among Horse Racetrack Workers, California, USA. Emerging Infectious Diseases, 27(11), 2761-2767. https://doi.org/10.3201/eid2711.211449.

Medscape CME Activity
Ehrlichiosis and Anaplasmosis among Transfusion and Transplant Recipients in the United States [PDF - 1.10 MB - 8 pages]
S. J. Mowla et al.

Ehrlichiosis and anaplasmosis are emerging tickborne diseases that can also be transmitted through blood transfusions or organ transplants. Since 2000, ehrlichiosis and anaplasmosis cases in the United States have increased substantially, resulting in potential risk to transplant and transfusion recipients. We reviewed ehrlichiosis and anaplasmosis cases among blood transfusion and solid organ transplant recipients in the United States from peer-reviewed literature and Centers for Disease Control and Prevention investigations. We identified 132 cases during 1997–2020, 12 transfusion-associated cases and 120 cases in transplant recipients; 8 cases were donor-derived, and in 13 cases illness occurred <1 year after transplant. Disease in the remaining 99 cases occurred ≥1 year after transplant, suggesting donor-derived disease was unlikely. Severe illness or death were reported among 15 transfusion and transplant recipients. Clinicians should be alert for these possible infections among transfusion and transplant recipients to prevent severe complications or death by quickly treating them.

EID Mowla SJ, Drexler NA, Cherry CC, Annambholta PD, Kracalik IT, Basavaraju SV. Ehrlichiosis and Anaplasmosis among Transfusion and Transplant Recipients in the United States. Emerg Infect Dis. 2021;27(11):2768-2775. https://doi.org/10.3201/eid2711.211127
AMA Mowla SJ, Drexler NA, Cherry CC, et al. Ehrlichiosis and Anaplasmosis among Transfusion and Transplant Recipients in the United States. Emerging Infectious Diseases. 2021;27(11):2768-2775. doi:10.3201/eid2711.211127.
APA Mowla, S. J., Drexler, N. A., Cherry, C. C., Annambholta, P. D., Kracalik, I. T., & Basavaraju, S. V. (2021). Ehrlichiosis and Anaplasmosis among Transfusion and Transplant Recipients in the United States. Emerging Infectious Diseases, 27(11), 2768-2775. https://doi.org/10.3201/eid2711.211127.

Interventions to Disrupt Coronavirus Disease Transmission at a University, Wisconsin, USA, August–October 2020 [PDF - 2.48 MB - 10 pages]
D. W. Currie et al.

University settings have demonstrated potential for coronavirus disease (COVID-19) outbreaks; they combine congregate living, substantial social activity, and a young population predisposed to mild illness. Using genomic and epidemiologic data, we describe a COVID-19 outbreak at the University of Wisconsin–Madison, Madison, Wisconsin, USA. During August–October 2020, a total of 3,485 students, including 856/6,162 students living in dormitories, tested positive. Case counts began rising during move-in week, August 25–31, 2020, then rose rapidly during September 1–11, 2020. The university initiated multiple prevention efforts, including quarantining 2 dormitories; a subsequent decline in cases was observed. Genomic surveillance of cases from Dane County, in which the university is located, did not find evidence of transmission from a large cluster of cases in the 2 quarantined dorms during the outbreak. Coordinated implementation of prevention measures can reduce COVID-19 spread in university settings and may limit spillover to the surrounding community.

EID Currie DW, Moreno GK, Delahoy MJ, Pray IW, Jovaag A, Braun KM, et al. Interventions to Disrupt Coronavirus Disease Transmission at a University, Wisconsin, USA, August–October 2020. Emerg Infect Dis. 2021;27(11):2776-2785. https://doi.org/10.3201/eid2711.211306
AMA Currie DW, Moreno GK, Delahoy MJ, et al. Interventions to Disrupt Coronavirus Disease Transmission at a University, Wisconsin, USA, August–October 2020. Emerging Infectious Diseases. 2021;27(11):2776-2785. doi:10.3201/eid2711.211306.
APA Currie, D. W., Moreno, G. K., Delahoy, M. J., Pray, I. W., Jovaag, A., Braun, K. M....Killerby, M. E. (2021). Interventions to Disrupt Coronavirus Disease Transmission at a University, Wisconsin, USA, August–October 2020. Emerging Infectious Diseases, 27(11), 2776-2785. https://doi.org/10.3201/eid2711.211306.
Research

Probability-Based Estimates of Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence and Detection Fraction, Utah, USA [PDF - 2.26 MB - 9 pages]
M. H. Samore et al.

We aimed to generate an unbiased estimate of the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in 4 urban counties in Utah, USA. We used a multistage sampling design to randomly select community-representative participants >12 years of age. During May 4–June 30, 2020, we collected serum samples and survey responses from 8,108 persons belonging to 5,125 households. We used a qualitative chemiluminescent microparticle immunoassay to detect SARS-CoV-2 IgG in serum samples. We estimated the overall seroprevalence to be 0.8%. The estimated seroprevalence-to-case count ratio was 2.5, corresponding to a detection fraction of 40%. Only 0.2% of participants from whom we collected nasopharyngeal swab samples had SARS-CoV-2–positive reverse transcription PCR results. SARS-CoV-2 antibody prevalence during the study was low, and prevalence of PCR-positive cases was even lower. The comparatively high SARS-CoV-2 detection rate (40%) demonstrates the effectiveness of Utah’s testing strategy and public health response.

EID Samore MH, Looney A, Orleans B, Greene T, Seegert N, Delgado JC, et al. Probability-Based Estimates of Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence and Detection Fraction, Utah, USA. Emerg Infect Dis. 2021;27(11):2786-2794. https://doi.org/10.3201/eid2711.204435
AMA Samore MH, Looney A, Orleans B, et al. Probability-Based Estimates of Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence and Detection Fraction, Utah, USA. Emerging Infectious Diseases. 2021;27(11):2786-2794. doi:10.3201/eid2711.204435.
APA Samore, M. H., Looney, A., Orleans, B., Greene, T., Seegert, N., Delgado, J. C....Alder, S. C. (2021). Probability-Based Estimates of Severe Acute Respiratory Syndrome Coronavirus 2 Seroprevalence and Detection Fraction, Utah, USA. Emerging Infectious Diseases, 27(11), 2786-2794. https://doi.org/10.3201/eid2711.204435.

Seroprevalence of SARS-CoV-2–Specific Antibodies among Quarantined Close Contacts of COVID-19 Patients, Faroe Islands, 2020 [PDF - 1.04 MB - 7 pages]
M. Petersen et al.

Close contacts of coronavirus disease (COVID-19) patients are at high risk for severe acute respiratory syndrome 2 (SARS-CoV-2) infection. We assessed the seroprevalence of SARS-CoV-2–specific antibodies among quarantined close contacts of COVID-19 patients in the Faroe Islands. We invited quarantined close contacts of COVID-19 index patients identified during March 3–April 22, 2020, to participate in this study; 584 (81%) contacts consented and underwent serologic testing. Among the 584 participants, 32 (5.5%) were seropositive for total antibody against SARS-CoV-2. Household and young or elderly contacts had higher risk for seropositivity than other contacts. We found a secondary attack rate of 19.2%. Seroprevalence among close contacts was almost 10-fold higher than among the general population of the Faroe Islands. Regularly testing household close contacts of COVID-19 patients might help track the transmission of SARS-CoV-2.

EID Petersen M, Kristiansen M, Reinert H, Fjallsbak J, Christiansen D, Gaini S, et al. Seroprevalence of SARS-CoV-2–Specific Antibodies among Quarantined Close Contacts of COVID-19 Patients, Faroe Islands, 2020. Emerg Infect Dis. 2021;27(11):2795-2801. https://doi.org/10.3201/eid2711.204948
AMA Petersen M, Kristiansen M, Reinert H, et al. Seroprevalence of SARS-CoV-2–Specific Antibodies among Quarantined Close Contacts of COVID-19 Patients, Faroe Islands, 2020. Emerging Infectious Diseases. 2021;27(11):2795-2801. doi:10.3201/eid2711.204948.
APA Petersen, M., Kristiansen, M., Reinert, H., Fjallsbak, J., Christiansen, D., Gaini, S....Weihe, P. (2021). Seroprevalence of SARS-CoV-2–Specific Antibodies among Quarantined Close Contacts of COVID-19 Patients, Faroe Islands, 2020. Emerging Infectious Diseases, 27(11), 2795-2801. https://doi.org/10.3201/eid2711.204948.

Rapid Increase in SARS-CoV-2 P.1 Lineage Leading to Codominance with B.1.1.7 Lineage, British Columbia, Canada, January–April 2021 [PDF - 3.36 MB - 8 pages]
C. A. Hogan et al.

Several severe acute respiratory syndrome coronavirus 2 variants of concern (VOCs) emerged in late 2020; lineage B.1.1.7 initially dominated globally. However, lineages B.1.351 and P.1 represent potentially greater risk for transmission and immune escape. In British Columbia, Canada, B.1.1.7 and B.1.351 were first identified in December 2020 and P.1 in February 2021. We combined quantitative PCR and whole-genome sequencing to assess relative contribution of VOCs in nearly 67,000 infections during the first 16 weeks of 2021 in British Columbia. B.1.1.7 accounted for <10% of screened or sequenced specimens early on, increasing to >50% by week 8. P.1 accounted for <10% until week 10, increased rapidly to peak at week 12, and by week 13 codominated within 10% of rates of B.1.1.7. B.1.351 was a minority throughout. This rapid expansion of P.1 but suppression of B.1.351 expands our understanding of population-level VOC patterns and might provide clues to fitness determinants for emerging VOCs.

EID Hogan CA, Jassem AN, Sbihi H, Joffres Y, Tyson JR, Noftall K, et al. Rapid Increase in SARS-CoV-2 P.1 Lineage Leading to Codominance with B.1.1.7 Lineage, British Columbia, Canada, January–April 2021. Emerg Infect Dis. 2021;27(11):2802-2809. https://doi.org/10.3201/eid2711.211190
AMA Hogan CA, Jassem AN, Sbihi H, et al. Rapid Increase in SARS-CoV-2 P.1 Lineage Leading to Codominance with B.1.1.7 Lineage, British Columbia, Canada, January–April 2021. Emerging Infectious Diseases. 2021;27(11):2802-2809. doi:10.3201/eid2711.211190.
APA Hogan, C. A., Jassem, A. N., Sbihi, H., Joffres, Y., Tyson, J. R., Noftall, K....Hoang, L. (2021). Rapid Increase in SARS-CoV-2 P.1 Lineage Leading to Codominance with B.1.1.7 Lineage, British Columbia, Canada, January–April 2021. Emerging Infectious Diseases, 27(11), 2802-2809. https://doi.org/10.3201/eid2711.211190.

Changing Patterns of Disease Severity in Blastomyces dermatitidis Infection, Quebec, Canada [PDF - 901 KB - 7 pages]
A. Carignan et al.

This retrospective multicenter cohort study assessed temporal changes in the severity and mortality rate of blastomycosis in Quebec, Canada, and identified risk factors for death in patients with blastomycosis in 1988–2016. The primary outcome was 90-day all-cause deaths. Among 185 patients, 122 (66%) needed hospitalization and 30 (16%) died. We noted increases in the proportion of severe cases, in age at diagnosis and in the proportion of diabetic and immunocompromised patients over time. Independent risk factors for death were age (adjusted odds ratio [aOR] 1.04, 95% CI 1.00–1.07), immunosuppression (aOR 4.2, 95% CI 1.5–11.6), and involvement of >2 lung lobes (aOR 5.3, 95% CI 1.9–14.3). There was no association between the Blastomyces genotype group and all-cause mortality. The proportion of severe cases of blastomycosis has increased in Quebec over the past 30 years, partially explained by the higher number of immunosuppressed patients.

EID Carignan A, Boudhrioua C, Moreira S, Pelletier A, Dufour K, Pépin J, et al. Changing Patterns of Disease Severity in Blastomyces dermatitidis Infection, Quebec, Canada. Emerg Infect Dis. 2021;27(11):2810-2817. https://doi.org/10.3201/eid2711.210552
AMA Carignan A, Boudhrioua C, Moreira S, et al. Changing Patterns of Disease Severity in Blastomyces dermatitidis Infection, Quebec, Canada. Emerging Infectious Diseases. 2021;27(11):2810-2817. doi:10.3201/eid2711.210552.
APA Carignan, A., Boudhrioua, C., Moreira, S., Pelletier, A., Dufour, K., Pépin, J....Dufresne, P. J. (2021). Changing Patterns of Disease Severity in Blastomyces dermatitidis Infection, Quebec, Canada. Emerging Infectious Diseases, 27(11), 2810-2817. https://doi.org/10.3201/eid2711.210552.

Hepatitis A Virus Incidence Rates and Biomarker Dynamics for Plasma Donors, United States [PDF - 2.21 MB - 8 pages]
S. Schoch et al.

The United States is currently affected by widespread hepatitis A virus (HAV) outbreaks. We investigated HAV incidence rates among source plasma donors in the United States since 2016. Serial donations from HAV-positive frequent donors were analyzed for common biologic markers to obtain a detailed picture of the course of infection. We found a considerable increase in incidence rates with shifting outbreak hotspots over time. Although individual biomarker profiles were highly variable, HAV RNA typically had a high peak and a biphasic decrease and often remained detectable for several months. One donor had a biomarker pattern indicative of previous exposure. Our findings show that current HAV outbreaks have been spilling over into the plasma donor population. The detailed results presented improve our comprehension of HAV infection and related public health aspects. In addition, the capture of full RNA curves enables estimation of HAV doubling time.

EID Schoch S, Wälti M, Schemmerer M, Alexander R, Keiner B, Kralicek C, et al. Hepatitis A Virus Incidence Rates and Biomarker Dynamics for Plasma Donors, United States. Emerg Infect Dis. 2021;27(11):2818-2824. https://doi.org/10.3201/eid2711.204642
AMA Schoch S, Wälti M, Schemmerer M, et al. Hepatitis A Virus Incidence Rates and Biomarker Dynamics for Plasma Donors, United States. Emerging Infectious Diseases. 2021;27(11):2818-2824. doi:10.3201/eid2711.204642.
APA Schoch, S., Wälti, M., Schemmerer, M., Alexander, R., Keiner, B., Kralicek, C....Widmer, E. (2021). Hepatitis A Virus Incidence Rates and Biomarker Dynamics for Plasma Donors, United States. Emerging Infectious Diseases, 27(11), 2818-2824. https://doi.org/10.3201/eid2711.204642.

Multidrug-Resistant Methicillin-Resistant Staphylococcus aureus Associated with Bacteremia and Monocyte Evasion, Rio de Janeiro, Brazil [PDF - 2.93 MB - 11 pages]
A. Viana et al.

We typed 600 methicillin-resistant Staphylococcus aureus (MRSA) isolates collected in 51 hospitals in the Rio de Janeiro, Brazil, metropolitan area during 2014–2017. We found that multiple new clonal complex (CC) 5 sequence types had replaced previously dominant MRSA lineages in hospitals. Whole-genome analysis of 208 isolates revealed an emerging sublineage of multidrug-resistant MRSA, sequence type 105, staphylococcal cassette chromosome mec II, spa t002, which we designated the Rio de Janeiro (RdJ) clone. Using molecular clock analysis, we hypothesized that this lineage began to expand in the Rio de Janeiro metropolitan area in 2009. Multivariate analysis supported an association between bloodstream infections and the CC5 lineage that includes the RdJ clone. Compared with other closely related isolates, representative isolates of the RdJ clone more effectively evaded immune function related to monocytic cells, as evidenced by decreased phagocytosis rate and increased numbers of viable unphagocytosed (free) bacteria after in vitro exposure to monocytes.

EID Viana A, Nunes Botelho A, Moustafa AM, Boge C, Pires Ferreira A, da Silva Carvalho M, et al. Multidrug-Resistant Methicillin-Resistant Staphylococcus aureus Associated with Bacteremia and Monocyte Evasion, Rio de Janeiro, Brazil. Emerg Infect Dis. 2021;27(11):2825-2835. https://doi.org/10.3201/eid2711.210097
AMA Viana A, Nunes Botelho A, Moustafa AM, et al. Multidrug-Resistant Methicillin-Resistant Staphylococcus aureus Associated with Bacteremia and Monocyte Evasion, Rio de Janeiro, Brazil. Emerging Infectious Diseases. 2021;27(11):2825-2835. doi:10.3201/eid2711.210097.
APA Viana, A., Nunes Botelho, A., Moustafa, A. M., Boge, C., Pires Ferreira, A., da Silva Carvalho, M....Planet, P. J. (2021). Multidrug-Resistant Methicillin-Resistant Staphylococcus aureus Associated with Bacteremia and Monocyte Evasion, Rio de Janeiro, Brazil. Emerging Infectious Diseases, 27(11), 2825-2835. https://doi.org/10.3201/eid2711.210097.

Population Genomics and Inference of Mycobacterium avium Complex Clusters in Cystic Fibrosis Care Centers, United States [PDF - 2.60 MB - 11 pages]
N. A. Hasan et al.

Mycobacterium avium complex (MAC) species constitute most mycobacteria infections in persons with cystic fibrosis (CF) in the United States, but little is known about their genomic diversity or transmission. During 2016–2020, we performed whole-genome sequencing on 364 MAC isolates from 186 persons with CF from 42 cystic fibrosis care centers (CFCCs) across 23 states. We compared isolate genomes to identify instances of shared strains between persons with CF. Among persons with multiple isolates sequenced, 15/56 (27%) had >1 MAC strain type. Genomic comparisons revealed 18 clusters of highly similar isolates; 8 of these clusters had patients who shared CFCCs, which included 27/186 (15%) persons with CF. We provide genomic evidence of highly similar MAC strains shared among patients at the same CFCCs. Polyclonal infections and high genetic similarity between MAC isolates are consistent with multiple modes of acquisition for persons with CF to acquire MAC infections.

EID Hasan NA, Davidson RM, Epperson L, Kammlade SM, Beagle S, Levin AR, et al. Population Genomics and Inference of Mycobacterium avium Complex Clusters in Cystic Fibrosis Care Centers, United States. Emerg Infect Dis. 2021;27(11):2836-2846. https://doi.org/10.3201/eid2711.210124
AMA Hasan NA, Davidson RM, Epperson L, et al. Population Genomics and Inference of Mycobacterium avium Complex Clusters in Cystic Fibrosis Care Centers, United States. Emerging Infectious Diseases. 2021;27(11):2836-2846. doi:10.3201/eid2711.210124.
APA Hasan, N. A., Davidson, R. M., Epperson, L., Kammlade, S. M., Beagle, S., Levin, A. R....Strong, M. (2021). Population Genomics and Inference of Mycobacterium avium Complex Clusters in Cystic Fibrosis Care Centers, United States. Emerging Infectious Diseases, 27(11), 2836-2846. https://doi.org/10.3201/eid2711.210124.

Genomic Profiling of Mycobacterium tuberculosis Strains, Myanmar [PDF - 1.98 MB - 9 pages]
H. Aung et al.

Multidrug resistance is a major threat to global elimination of tuberculosis (TB). We performed phenotypic drug-susceptibility testing and whole-genome sequencing for 309 isolates from 342 consecutive patients who were given a diagnosis of TB in Yangon, Myanmar, during July 2016‒June 2018. We identified isolates by using the GeneXpert platform to evaluate drug-resistance profiles. A total of 191 (62%) of 309 isolates had rifampin resistance; 168 (88%) of these rifampin-resistant isolates were not genomically related, indicating the repeated emergence of resistance in the population, rather than extensive local transmission. We did not detect resistance mutations to new oral drugs, including bedaquiline and pretomanid. The current GeneXpert MTB/RIF system needs to be modified by using the newly launched Xpert MTB/XDR cartridge or line-probe assay. Introducing new oral drugs to replace those currently used in treatment regimens for multidrug-resistant TB will also be useful for treating TB in Myanmar.

EID Aung H, Nyunt W, Fong Y, Biggs PJ, Winkworth RC, Lockhart PJ, et al. Genomic Profiling of Mycobacterium tuberculosis Strains, Myanmar. Emerg Infect Dis. 2021;27(11):2847-2855. https://doi.org/10.3201/eid2711.210726
AMA Aung H, Nyunt W, Fong Y, et al. Genomic Profiling of Mycobacterium tuberculosis Strains, Myanmar. Emerging Infectious Diseases. 2021;27(11):2847-2855. doi:10.3201/eid2711.210726.
APA Aung, H., Nyunt, W., Fong, Y., Biggs, P. J., Winkworth, R. C., Lockhart, P. J....Aung, S. (2021). Genomic Profiling of Mycobacterium tuberculosis Strains, Myanmar. Emerging Infectious Diseases, 27(11), 2847-2855. https://doi.org/10.3201/eid2711.210726.

Encephalitis and Death in Wild Mammals at a Rehabilitation Center after Infection with Highly Pathogenic Avian Influenza A(H5N8) Virus, United Kingdom [PDF - 1.83 MB - 8 pages]
T. Floyd et al.

We report a disease and mortality event involving swans, seals, and a fox at a wildlife rehabilitation center in the United Kingdom during late 2020. Five swans had onset of highly pathogenic avian influenza virus infection while in captivity. Subsequently, 5 seals and a fox died (or were euthanized) after onset of clinical disease. Avian-origin influenza A virus subtype H5N8 was retrospectively determined as the cause of disease. Infection in the seals manifested as seizures, and immunohistochemical and molecular testing on postmortem samples detected a neurologic distribution of viral products. The fox died overnight after sudden onset of inappetence, and postmortem tissues revealed neurologic and respiratory distribution of viral products. Live virus was isolated from the swans, seals, and the fox, and a single genetic change was detected as a potential adaptive mutation in the mammalian-derived viral sequences. No human influenza-like illness was reported in the weeks after the event.

EID Floyd T, Banyard AC, Lean F, Byrne A, Fullick E, Whittard E, et al. Encephalitis and Death in Wild Mammals at a Rehabilitation Center after Infection with Highly Pathogenic Avian Influenza A(H5N8) Virus, United Kingdom. Emerg Infect Dis. 2021;27(11):2856-2863. https://doi.org/10.3201/eid2711.211225
AMA Floyd T, Banyard AC, Lean F, et al. Encephalitis and Death in Wild Mammals at a Rehabilitation Center after Infection with Highly Pathogenic Avian Influenza A(H5N8) Virus, United Kingdom. Emerging Infectious Diseases. 2021;27(11):2856-2863. doi:10.3201/eid2711.211225.
APA Floyd, T., Banyard, A. C., Lean, F., Byrne, A., Fullick, E., Whittard, E....Brown, I. H. (2021). Encephalitis and Death in Wild Mammals at a Rehabilitation Center after Infection with Highly Pathogenic Avian Influenza A(H5N8) Virus, United Kingdom. Emerging Infectious Diseases, 27(11), 2856-2863. https://doi.org/10.3201/eid2711.211225.
Dispatches

Co-infection with Legionella and SARS-CoV-2, France, March 2020 [PDF - 1.52 MB - 5 pages]
C. Allam et al.

We describe a March 2020 co-occurrence of Legionnaires’ disease (LD) and coronavirus disease in France. Severe acute respiratory syndrome coronavirus 2 co-infections were identified in 7 of 49 patients from LD case notifications. Most were elderly men with underlying conditions who had contracted severe pneumonia, illustrating the relevance of co-infection screening.

EID Allam C, Gaymard A, Descours G, Ginevra C, Josset L, Bouscambert M, et al. Co-infection with Legionella and SARS-CoV-2, France, March 2020. Emerg Infect Dis. 2021;27(11):2864-2868. https://doi.org/10.3201/eid2711.202150
AMA Allam C, Gaymard A, Descours G, et al. Co-infection with Legionella and SARS-CoV-2, France, March 2020. Emerging Infectious Diseases. 2021;27(11):2864-2868. doi:10.3201/eid2711.202150.
APA Allam, C., Gaymard, A., Descours, G., Ginevra, C., Josset, L., Bouscambert, M....Jarraud, S. (2021). Co-infection with Legionella and SARS-CoV-2, France, March 2020. Emerging Infectious Diseases, 27(11), 2864-2868. https://doi.org/10.3201/eid2711.202150.

Epidemiologic Analysis of Efforts to Achieve and Sustain Malaria Elimination along the China–Myanmar Border [PDF - 1.70 MB - 5 pages]
F. Huang et al.

Malaria cases have dramatically declined in China along the Myanmar border, attributed mainly to adoption of the 1-3-7 surveillance and response approach. No indigenous cases have been reported in China since 2017. Counties in the middle and southern part of the border area have a higher risk for malaria importation and reestablishment after elimination.

EID Huang F, Zhang L, Tu H, Cui Y, Zhou S, Xia Z, et al. Epidemiologic Analysis of Efforts to Achieve and Sustain Malaria Elimination along the China–Myanmar Border. Emerg Infect Dis. 2021;27(11):2869-2873. https://doi.org/10.3201/eid2711.204428
AMA Huang F, Zhang L, Tu H, et al. Epidemiologic Analysis of Efforts to Achieve and Sustain Malaria Elimination along the China–Myanmar Border. Emerging Infectious Diseases. 2021;27(11):2869-2873. doi:10.3201/eid2711.204428.
APA Huang, F., Zhang, L., Tu, H., Cui, Y., Zhou, S., Xia, Z....Zhou, H. (2021). Epidemiologic Analysis of Efforts to Achieve and Sustain Malaria Elimination along the China–Myanmar Border. Emerging Infectious Diseases, 27(11), 2869-2873. https://doi.org/10.3201/eid2711.204428.

Socioeconomic Patterns of COVID-19 Clusters in Low-Incidence City, Hong Kong [PDF - 725 KB - 4 pages]
G. Chung et al.

Although coronavirus disease (COVID-19) outbreaks have been relatively well controlled in Hong Kong, containment remains challenging among socioeconomically disadvantaged persons. They are at higher risk for widespread COVID-19 transmission through sizable clustering, probably because of exposure to social settings in which existing mitigation policies had differential socioeconomic effects.

EID Chung G, Chan S, Chan Y, Woo J, Wong H, Wong SY, et al. Socioeconomic Patterns of COVID-19 Clusters in Low-Incidence City, Hong Kong. Emerg Infect Dis. 2021;27(11):2874-2877. https://doi.org/10.3201/eid2711.204840
AMA Chung G, Chan S, Chan Y, et al. Socioeconomic Patterns of COVID-19 Clusters in Low-Incidence City, Hong Kong. Emerging Infectious Diseases. 2021;27(11):2874-2877. doi:10.3201/eid2711.204840.
APA Chung, G., Chan, S., Chan, Y., Woo, J., Wong, H., Wong, S. Y....Chung, R. Y. (2021). Socioeconomic Patterns of COVID-19 Clusters in Low-Incidence City, Hong Kong. Emerging Infectious Diseases, 27(11), 2874-2877. https://doi.org/10.3201/eid2711.204840.

Prevalence of SARS-CoV-2 Antibodies after First 6 Months of COVID-19 Pandemic, Portugal [PDF - 832 KB - 4 pages]
L. Canto e Castro et al.

In September 2020, we tested 13,398 persons in Portugal for antibodies against severe acute respiratory syndrome coronavirus 2 by using a quota sample stratified by age and population density. We found a seroprevalence of 2.2%, 3–4 times larger than the official number of cases at the end of the first wave of the pandemic.

EID Canto e Castro L, Pereira A, Ribeiro R, Alves C, Veloso L, Vicente V, et al. Prevalence of SARS-CoV-2 Antibodies after First 6 Months of COVID-19 Pandemic, Portugal. Emerg Infect Dis. 2021;27(11):2878-2881. https://doi.org/10.3201/eid2711.210636
AMA Canto e Castro L, Pereira A, Ribeiro R, et al. Prevalence of SARS-CoV-2 Antibodies after First 6 Months of COVID-19 Pandemic, Portugal. Emerging Infectious Diseases. 2021;27(11):2878-2881. doi:10.3201/eid2711.210636.
APA Canto e Castro, L., Pereira, A., Ribeiro, R., Alves, C., Veloso, L., Vicente, V....Ribeiro, R. M. (2021). Prevalence of SARS-CoV-2 Antibodies after First 6 Months of COVID-19 Pandemic, Portugal. Emerging Infectious Diseases, 27(11), 2878-2881. https://doi.org/10.3201/eid2711.210636.

Association of Shared Living Spaces and COVID-19 in University Students, Wisconsin, USA, 2020 [PDF - 660 KB - 5 pages]
J. Bigouette et al.

We describe characteristics associated with having coronavirus disease (COVID-19) among students residing on a university campus. Of 2,187 students, 528 (24.1%) received a COVID-19 diagnosis during fall semester 2020. Students sharing a bedroom or suite had approximately twice the odds of contracting COVID-19 as those living alone.

EID Bigouette J, Ford L, Segaloff HE, Langolf K, Kahrs J, Zochert T, et al. Association of Shared Living Spaces and COVID-19 in University Students, Wisconsin, USA, 2020. Emerg Infect Dis. 2021;27(11):2882-2886. https://doi.org/10.3201/eid2711.211000
AMA Bigouette J, Ford L, Segaloff HE, et al. Association of Shared Living Spaces and COVID-19 in University Students, Wisconsin, USA, 2020. Emerging Infectious Diseases. 2021;27(11):2882-2886. doi:10.3201/eid2711.211000.
APA Bigouette, J., Ford, L., Segaloff, H. E., Langolf, K., Kahrs, J., Zochert, T....Killerby, M. E. (2021). Association of Shared Living Spaces and COVID-19 in University Students, Wisconsin, USA, 2020. Emerging Infectious Diseases, 27(11), 2882-2886. https://doi.org/10.3201/eid2711.211000.

Correlation of SARS-CoV-2 Subgenomic RNA with Antigen Detection in Nasal Midturbinate Swab Specimens [PDF - 1.49 MB - 5 pages]
K. Immergluck et al.

Among symptomatic outpatients, subgenomic RNA of severe acute respiratory syndrome coronavirus 2 in nasal midturbinate swab specimens was concordant with antigen detection but remained detectable in 13 (82.1%) of 16 nasopharyngeal swab specimens from antigen-negative persons. Subgenomic RNA in midturbinate swab specimens might be useful for routine diagnostics to identify active virus replication.

EID Immergluck K, Gonzalez MD, Frediani JK, Levy JM, Figueroa J, Wood A, et al. Correlation of SARS-CoV-2 Subgenomic RNA with Antigen Detection in Nasal Midturbinate Swab Specimens. Emerg Infect Dis. 2021;27(11):2887-2891. https://doi.org/10.3201/eid2711.211135
AMA Immergluck K, Gonzalez MD, Frediani JK, et al. Correlation of SARS-CoV-2 Subgenomic RNA with Antigen Detection in Nasal Midturbinate Swab Specimens. Emerging Infectious Diseases. 2021;27(11):2887-2891. doi:10.3201/eid2711.211135.
APA Immergluck, K., Gonzalez, M. D., Frediani, J. K., Levy, J. M., Figueroa, J., Wood, A....Waggoner, J. J. (2021). Correlation of SARS-CoV-2 Subgenomic RNA with Antigen Detection in Nasal Midturbinate Swab Specimens. Emerging Infectious Diseases, 27(11), 2887-2891. https://doi.org/10.3201/eid2711.211135.

Mutations Associated with SARS-CoV-2 Variants of Concern, Benin, Early 2021 [PDF - 1.11 MB - 5 pages]
A. Sander et al.

Intense transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Africa might promote emergence of variants. We describe 10 SARS-CoV-2 lineages in Benin during early 2021 that harbored mutations associated with variants of concern. Benin-derived SARS-CoV-2 strains were more efficiently neutralized by antibodies derived from vaccinees than patients, warranting accelerated vaccination in Africa.

EID Sander A, Yadouleton A, de Oliveira Filho EF, Tchibozo C, Hounkanrin G, Badou Y, et al. Mutations Associated with SARS-CoV-2 Variants of Concern, Benin, Early 2021. Emerg Infect Dis. 2021;27(11):2889-2903. https://doi.org/10.3201/eid2711.211353
AMA Sander A, Yadouleton A, de Oliveira Filho EF, et al. Mutations Associated with SARS-CoV-2 Variants of Concern, Benin, Early 2021. Emerging Infectious Diseases. 2021;27(11):2889-2903. doi:10.3201/eid2711.211353.
APA Sander, A., Yadouleton, A., de Oliveira Filho, E. F., Tchibozo, C., Hounkanrin, G., Badou, Y....Drexler, J. (2021). Mutations Associated with SARS-CoV-2 Variants of Concern, Benin, Early 2021. Emerging Infectious Diseases, 27(11), 2889-2903. https://doi.org/10.3201/eid2711.211353.

Multinational Observational Cohort Study of COVID-19–Associated Pulmonary Aspergillosis [PDF - 1015 KB - 7 pages]
N. Janssen et al.

We performed an observational study to investigate intensive care unit incidence, risk factors, and outcomes of coronavirus disease–associated pulmonary aspergillosis (CAPA). We found 10%–15% CAPA incidence among 823 patients in 2 cohorts. Several factors were independently associated with CAPA in 1 cohort and mortality rates were 43%–52%.

EID Janssen N, Nyga R, Vanderbeke L, Jacobs C, Ergün M, Buil JB, et al. Multinational Observational Cohort Study of COVID-19–Associated Pulmonary Aspergillosis. Emerg Infect Dis. 2021;27(11):2892-2898. https://doi.org/10.3201/eid2711.211174
AMA Janssen N, Nyga R, Vanderbeke L, et al. Multinational Observational Cohort Study of COVID-19–Associated Pulmonary Aspergillosis. Emerging Infectious Diseases. 2021;27(11):2892-2898. doi:10.3201/eid2711.211174.
APA Janssen, N., Nyga, R., Vanderbeke, L., Jacobs, C., Ergün, M., Buil, J. B....Verweij, P. E. (2021). Multinational Observational Cohort Study of COVID-19–Associated Pulmonary Aspergillosis. Emerging Infectious Diseases, 27(11), 2892-2898. https://doi.org/10.3201/eid2711.211174.

Bordetella hinzii Pneumonia and Bacteremia in a Patient with SARS-CoV-2 Infection [PDF - 1.42 MB - 4 pages]
M. Maison-Fomotar and G. Sivasubramanian

Patients with severe acute respiratory syndrome coronavirus 2 infection may have bacterial co-infections, including pneumonia and bacteremia. Bordetella hinzii infections are rare, may be associated with exposure to poultry, and have been reported mostly among immunocompromised patients. We describe B. hinzii pneumonia and bacteremia in a severe acute respiratory syndrome coronavirus 2 patient.

EID Maison-Fomotar M, Sivasubramanian G. Bordetella hinzii Pneumonia and Bacteremia in a Patient with SARS-CoV-2 Infection. Emerg Infect Dis. 2021;27(11):2904-2907. https://doi.org/10.3201/eid2711.211468
AMA Maison-Fomotar M, Sivasubramanian G. Bordetella hinzii Pneumonia and Bacteremia in a Patient with SARS-CoV-2 Infection. Emerging Infectious Diseases. 2021;27(11):2904-2907. doi:10.3201/eid2711.211468.
APA Maison-Fomotar, M., & Sivasubramanian, G. (2021). Bordetella hinzii Pneumonia and Bacteremia in a Patient with SARS-CoV-2 Infection. Emerging Infectious Diseases, 27(11), 2904-2907. https://doi.org/10.3201/eid2711.211468.

COVID-19 Vaccination Coverage, Intent, Knowledge, Attitudes, and Beliefs among Essential Workers, United States [PDF - 1.45 MB - 6 pages]
K. H. Nguyen et al.

We assessed coronavirus disease vaccination and intent and knowledge, attitudes, and beliefs among essential workers during March–June 2021. Coverage was 67%; 18% reported no intent to get vaccinated. Primary concerns were potential side effects, safety, and lack of trust in vaccines, highlighting the importance of increasing vaccine confidence in this population.

EID Nguyen KH, Yankey D, Coy KC, Brookmeyer KA, Abad N, Guerin R, et al. COVID-19 Vaccination Coverage, Intent, Knowledge, Attitudes, and Beliefs among Essential Workers, United States. Emerg Infect Dis. 2021;27(11):2908-2913. https://doi.org/10.3201/eid2711.211557
AMA Nguyen KH, Yankey D, Coy KC, et al. COVID-19 Vaccination Coverage, Intent, Knowledge, Attitudes, and Beliefs among Essential Workers, United States. Emerging Infectious Diseases. 2021;27(11):2908-2913. doi:10.3201/eid2711.211557.
APA Nguyen, K. H., Yankey, D., Coy, K. C., Brookmeyer, K. A., Abad, N., Guerin, R....Singleton, J. A. (2021). COVID-19 Vaccination Coverage, Intent, Knowledge, Attitudes, and Beliefs among Essential Workers, United States. Emerging Infectious Diseases, 27(11), 2908-2913. https://doi.org/10.3201/eid2711.211557.

Fatal Multisystem Inflammatory Syndrome in Adult after SARS-CoV-2 Natural Infection and COVID-19 Vaccination [PDF - 2.30 MB - 5 pages]
H. N. Grome et al.

We describe a fatal case of multisystem inflammatory syndrome in an adult with onset 22 days after a second dose of mRNA coronavirus disease vaccine. Serologic and clinical findings indicated severe acute respiratory syndrome coronavirus 2 infection occurred before vaccination. The immunopathology of this syndrome, regardless of vaccination status, remains poorly understood.

EID Grome HN, Threlkeld M, Threlkeld S, Newman C, Martines R, Reagan-Steiner S, et al. Fatal Multisystem Inflammatory Syndrome in Adult after SARS-CoV-2 Natural Infection and COVID-19 Vaccination. Emerg Infect Dis. 2021;27(11):2914-2918. https://doi.org/10.3201/eid2711.211612
AMA Grome HN, Threlkeld M, Threlkeld S, et al. Fatal Multisystem Inflammatory Syndrome in Adult after SARS-CoV-2 Natural Infection and COVID-19 Vaccination. Emerging Infectious Diseases. 2021;27(11):2914-2918. doi:10.3201/eid2711.211612.
APA Grome, H. N., Threlkeld, M., Threlkeld, S., Newman, C., Martines, R., Reagan-Steiner, S....Dunn, J. (2021). Fatal Multisystem Inflammatory Syndrome in Adult after SARS-CoV-2 Natural Infection and COVID-19 Vaccination. Emerging Infectious Diseases, 27(11), 2914-2918. https://doi.org/10.3201/eid2711.211612.

Effectiveness of BNT162b2 Vaccine in Adolescents during Outbreak of SARS-CoV-2 Delta Variant Infection, Israel, 2021 [PDF - 1.46 MB - 4 pages]
A. Glatman-Freedman et al.

In Israel, the BNT162b2 vaccine against severe acute respiratory syndrome coronavirus 2 was approved for use in adolescents in June 2021, shortly before an outbreak of B.1.617.2 (Delta) variant–dominant infection. We evaluated short-term vaccine effectiveness and found the vaccine to be highly effective among this population in this setting.

EID Glatman-Freedman A, Hershkovitz Y, Kaufman Z, Dichtiar R, Keinan-Boker L, Bromberg M. Effectiveness of BNT162b2 Vaccine in Adolescents during Outbreak of SARS-CoV-2 Delta Variant Infection, Israel, 2021. Emerg Infect Dis. 2021;27(11):2919-2922. https://doi.org/10.3201/eid2711.211886
AMA Glatman-Freedman A, Hershkovitz Y, Kaufman Z, et al. Effectiveness of BNT162b2 Vaccine in Adolescents during Outbreak of SARS-CoV-2 Delta Variant Infection, Israel, 2021. Emerging Infectious Diseases. 2021;27(11):2919-2922. doi:10.3201/eid2711.211886.
APA Glatman-Freedman, A., Hershkovitz, Y., Kaufman, Z., Dichtiar, R., Keinan-Boker, L., & Bromberg, M. (2021). Effectiveness of BNT162b2 Vaccine in Adolescents during Outbreak of SARS-CoV-2 Delta Variant Infection, Israel, 2021. Emerging Infectious Diseases, 27(11), 2919-2922. https://doi.org/10.3201/eid2711.211886.

Influenza and SARS-CoV-2 Co-infections in California, USA, September 2020–April 2021 [PDF - 999 KB - 4 pages]
K. R. Rizzo et al.

During September 1, 2020–April 30, 2021, the California Department of Public Health, Richmond, California, USA, received 255 positive influenza molecular test results that matched with severe acute respiratory syndrome coronavirus 2 molecular test results; 58 (23%) persons were co-infected. Influenza activity was minimal in California, and co-infections were sporadic.

EID Rizzo KR, Hoover C, Jain S, Sun M, Myers JF, Bregman B, et al. Influenza and SARS-CoV-2 Co-infections in California, USA, September 2020–April 2021. Emerg Infect Dis. 2021;27(11):2923-2926. https://doi.org/10.3201/eid2711.211129
AMA Rizzo KR, Hoover C, Jain S, et al. Influenza and SARS-CoV-2 Co-infections in California, USA, September 2020–April 2021. Emerging Infectious Diseases. 2021;27(11):2923-2926. doi:10.3201/eid2711.211129.
APA Rizzo, K. R., Hoover, C., Jain, S., Sun, M., Myers, J. F., Bregman, B....Murray, E. L. (2021). Influenza and SARS-CoV-2 Co-infections in California, USA, September 2020–April 2021. Emerging Infectious Diseases, 27(11), 2923-2926. https://doi.org/10.3201/eid2711.211129.

Emergence of Vibrio cholerae O1 Sequence Type 75, South Africa, 2018–2020 [PDF - 1.97 MB - 5 pages]
A. M. Smith et al.

We describe the molecular epidemiology of cholera in South Africa during 2018–2020. Vibrio cholerae O1 sequence type (ST) 75 recently emerged and became more prevalent than the V. cholerae O1 biotype El Tor pandemic clone. ST75 isolates were found across large spatial and temporal distances, suggesting local ST75 spread.

EID Smith AM, Weill F, Njamkepo E, Ngomane HM, Ramalwa N, Sekwadi P, et al. Emergence of Vibrio cholerae O1 Sequence Type 75, South Africa, 2018–2020. Emerg Infect Dis. 2021;27(11):2927-2931. https://doi.org/10.3201/eid2711.211144
AMA Smith AM, Weill F, Njamkepo E, et al. Emergence of Vibrio cholerae O1 Sequence Type 75, South Africa, 2018–2020. Emerging Infectious Diseases. 2021;27(11):2927-2931. doi:10.3201/eid2711.211144.
APA Smith, A. M., Weill, F., Njamkepo, E., Ngomane, H. M., Ramalwa, N., Sekwadi, P....Thomas, J. (2021). Emergence of Vibrio cholerae O1 Sequence Type 75, South Africa, 2018–2020. Emerging Infectious Diseases, 27(11), 2927-2931. https://doi.org/10.3201/eid2711.211144.

Toward Cholera Elimination, Haiti [PDF - 2.83 MB - 5 pages]
S. Rebaudet et al.

This study describes the apparent discontinuation of cholera transmission in Haiti since February 2019. Because vulnerabilities persist and vaccination remains limited, our findings suggest that case-area targeted interventions conducted by rapid response teams played a key role. We question the presence of environmental reservoirs in Haiti and discuss progress toward elimination.

EID Rebaudet S, Dély P, Boncy J, Henrys J, Piarroux R. Toward Cholera Elimination, Haiti. Emerg Infect Dis. 2021;27(11):2932-2936. https://doi.org/10.3201/eid2711.203372
AMA Rebaudet S, Dély P, Boncy J, et al. Toward Cholera Elimination, Haiti. Emerging Infectious Diseases. 2021;27(11):2932-2936. doi:10.3201/eid2711.203372.
APA Rebaudet, S., Dély, P., Boncy, J., Henrys, J., & Piarroux, R. (2021). Toward Cholera Elimination, Haiti. Emerging Infectious Diseases, 27(11), 2932-2936. https://doi.org/10.3201/eid2711.203372.

Acute Chagas Disease Manifesting as Orbital Cellulitis, Texas, USA [PDF - 925 KB - 3 pages]
F. Hudson et al.

We report a case of acute, vectorborne Chagas disease, acquired locally in central Texas, USA, manifesting as Romaña’s sign, which was initially mistaken for orbital cellulitis. After the infection failed to respond to antibiotics, DNA-based next generation sequencing on plasma yielded high levels of Trypanasoma cruzi; results were confirmed by PCR.

EID Hudson F, Homer N, Epstein A, Mondy K. Acute Chagas Disease Manifesting as Orbital Cellulitis, Texas, USA. Emerg Infect Dis. 2021;27(11):2937-2939. https://doi.org/10.3201/eid2711.203698
AMA Hudson F, Homer N, Epstein A, et al. Acute Chagas Disease Manifesting as Orbital Cellulitis, Texas, USA. Emerging Infectious Diseases. 2021;27(11):2937-2939. doi:10.3201/eid2711.203698.
APA Hudson, F., Homer, N., Epstein, A., & Mondy, K. (2021). Acute Chagas Disease Manifesting as Orbital Cellulitis, Texas, USA. Emerging Infectious Diseases, 27(11), 2937-2939. https://doi.org/10.3201/eid2711.203698.

Genetically Divergent Highly Pathogenic Avian Influenza A(H5N8) Viruses in Wild Birds, Eastern China [PDF - 834 KB - 4 pages]
G. He et al.

In late 2020, we detected 32 highly pathogenic avian influenza A(H5N8) viruses in migratory ducks in Shanghai, China. Phylogenetic analysis of 5 representative isolates identified 2 sublineages of clade 2.3.4.4b. Each sublineage formed separate clusters with isolates from East Asia and Europe.

EID He G, Ming L, Li X, Song Y, Tang L, Ma M, et al. Genetically Divergent Highly Pathogenic Avian Influenza A(H5N8) Viruses in Wild Birds, Eastern China. Emerg Infect Dis. 2021;27(11):2940-2943. https://doi.org/10.3201/eid2711.204893
AMA He G, Ming L, Li X, et al. Genetically Divergent Highly Pathogenic Avian Influenza A(H5N8) Viruses in Wild Birds, Eastern China. Emerging Infectious Diseases. 2021;27(11):2940-2943. doi:10.3201/eid2711.204893.
APA He, G., Ming, L., Li, X., Song, Y., Tang, L., Ma, M....Wang, T. (2021). Genetically Divergent Highly Pathogenic Avian Influenza A(H5N8) Viruses in Wild Birds, Eastern China. Emerging Infectious Diseases, 27(11), 2940-2943. https://doi.org/10.3201/eid2711.204893.

Isolation of Novel Mycobacterium Species from Skin Infection in an Immunocompromised Person [PDF - 1.22 MB - 4 pages]
Y. Mei et al.

We investigated a case of cutaneous infection in an immunocompromised patient in China that was caused by a novel species within the Mycobacterium gordonae complex. Results of whole-genome sequencing indicated that some strains considered to be M. gordonae complex are actually polyphyletic and should be designated as closely related species.

EID Mei Y, Zhang Q, Zhang W, Jiang H, Shi Y, Xiong J, et al. Isolation of Novel Mycobacterium Species from Skin Infection in an Immunocompromised Person. Emerg Infect Dis. 2021;27(11):2944-2947. https://doi.org/10.3201/eid2711.210426
AMA Mei Y, Zhang Q, Zhang W, et al. Isolation of Novel Mycobacterium Species from Skin Infection in an Immunocompromised Person. Emerging Infectious Diseases. 2021;27(11):2944-2947. doi:10.3201/eid2711.210426.
APA Mei, Y., Zhang, Q., Zhang, W., Jiang, H., Shi, Y., Xiong, J....Wang, H. (2021). Isolation of Novel Mycobacterium Species from Skin Infection in an Immunocompromised Person. Emerging Infectious Diseases, 27(11), 2944-2947. https://doi.org/10.3201/eid2711.210426.
Research Letters

Co-Infection with 4 Species of Mycobacteria Identified by Using Next-Generation Sequencing [PDF - 1.18 MB - 3 pages]
L. Wang et al.

We identified co-infection with 4 species of mycobacteria in a woman in New York, New York, USA, by using next-generation sequencing. This procedure is useful for identifying co-infections with multiple mycobacteria, tracing the geographic origin of strains, investigating transmission dynamics in susceptible populations, and gaining insight into prevention and control.

EID Wang L, Liu D, Yung L, Rodriguez G, Prasad N, Segal-Maurer S, et al. Co-Infection with 4 Species of Mycobacteria Identified by Using Next-Generation Sequencing. Emerg Infect Dis. 2021;27(11):2948-2950. https://doi.org/10.3201/eid2711.203458
AMA Wang L, Liu D, Yung L, et al. Co-Infection with 4 Species of Mycobacteria Identified by Using Next-Generation Sequencing. Emerging Infectious Diseases. 2021;27(11):2948-2950. doi:10.3201/eid2711.203458.
APA Wang, L., Liu, D., Yung, L., Rodriguez, G., Prasad, N., Segal-Maurer, S....Rodgers, W. (2021). Co-Infection with 4 Species of Mycobacteria Identified by Using Next-Generation Sequencing. Emerging Infectious Diseases, 27(11), 2948-2950. https://doi.org/10.3201/eid2711.203458.

Fatal Co-infections with SARS-CoV-2 and Legionella pneumophila, England [PDF - 637 KB - 3 pages]
V. J. Chalker et al.

Both Legionella pneumophila and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause pneumonia. L. pneumophila is acquired from water sources, sometimes in healthcare settings. We report 2 fatal cases of L. pneumophila and SARS-CoV-2 co-infection in England. Clinicians should be aware of possible L. pneumophila infections among SARS-CoV-2 patients.

EID Chalker VJ, Adler H, Ball R, Naik F, Day J, Afshar B, et al. Fatal Co-infections with SARS-CoV-2 and Legionella pneumophila, England. Emerg Infect Dis. 2021;27(11):2950-2952. https://doi.org/10.3201/eid2711.204121
AMA Chalker VJ, Adler H, Ball R, et al. Fatal Co-infections with SARS-CoV-2 and Legionella pneumophila, England. Emerging Infectious Diseases. 2021;27(11):2950-2952. doi:10.3201/eid2711.204121.
APA Chalker, V. J., Adler, H., Ball, R., Naik, F., Day, J., Afshar, B....Amin, A. K. (2021). Fatal Co-infections with SARS-CoV-2 and Legionella pneumophila, England. Emerging Infectious Diseases, 27(11), 2950-2952. https://doi.org/10.3201/eid2711.204121.

Invasive Malaria Vector Anopheles stephensi Mosquitoes in Sudan, 2016–2018 [PDF - 1.18 MB - 3 pages]
A. Ahmed et al.

Anopheles stephensi mosquitoes are urban malaria vectors in Asia that have recently invaded the Horn of Africa. We detected emergence of An. stephensi mosquitoes in 2 noncontiguous states of eastern Sudan. Results of mitochondrial DNA sequencing suggest the possibility of distinct invasions, potentially from a neighboring country.

EID Ahmed A, Pignatelli P, Elaagip A, Abdel Hamid MM, Alrahman O, Weetman D. Invasive Malaria Vector Anopheles stephensi Mosquitoes in Sudan, 2016–2018. Emerg Infect Dis. 2021;27(11):2952-2954. https://doi.org/10.3201/eid2711.210040
AMA Ahmed A, Pignatelli P, Elaagip A, et al. Invasive Malaria Vector Anopheles stephensi Mosquitoes in Sudan, 2016–2018. Emerging Infectious Diseases. 2021;27(11):2952-2954. doi:10.3201/eid2711.210040.
APA Ahmed, A., Pignatelli, P., Elaagip, A., Abdel Hamid, M. M., Alrahman, O., & Weetman, D. (2021). Invasive Malaria Vector Anopheles stephensi Mosquitoes in Sudan, 2016–2018. Emerging Infectious Diseases, 27(11), 2952-2954. https://doi.org/10.3201/eid2711.210040.

Nonclonal Burkholderia pseudomallei Population in Melioidosis Case Cluster, Sri Lanka [PDF - 972 KB - 3 pages]
H. S. Jayasinghearachchi et al.

A melioidosis case cluster of 10 blood culture–positive patients occurred in eastern Sri Lanka after an extreme weather event. Four infections were caused by Burkholderia pseudomallei isolates of sequence type 594. Whole-genome analysis showed that the isolates were genetically diverse and the case cluster was nonclonal.

EID Jayasinghearachchi HS, Francis VR, Sathkumara HD, Krishnananthasivam S, Masakorala J, Muthugama T, et al. Nonclonal Burkholderia pseudomallei Population in Melioidosis Case Cluster, Sri Lanka. Emerg Infect Dis. 2021;27(11):2955-2957. https://doi.org/10.3201/eid2711.210219
AMA Jayasinghearachchi HS, Francis VR, Sathkumara HD, et al. Nonclonal Burkholderia pseudomallei Population in Melioidosis Case Cluster, Sri Lanka. Emerging Infectious Diseases. 2021;27(11):2955-2957. doi:10.3201/eid2711.210219.
APA Jayasinghearachchi, H. S., Francis, V. R., Sathkumara, H. D., Krishnananthasivam, S., Masakorala, J., Muthugama, T....Corea, E. M. (2021). Nonclonal Burkholderia pseudomallei Population in Melioidosis Case Cluster, Sri Lanka. Emerging Infectious Diseases, 27(11), 2955-2957. https://doi.org/10.3201/eid2711.210219.

Real-Time Genomic Surveillance for SARS-CoV-2 Variants of Concern, Uruguay [PDF - 1.07 MB - 4 pages]
N. Rego et al.

We developed a genomic surveillance program for real-time monitoring of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOCs) in Uruguay. We report on a PCR method for SARS-CoV-2 VOCs, the surveillance workflow, and multiple independent introductions and community transmission of the SARS-CoV-2 P.1 VOC in Uruguay.

EID Rego N, Costábile A, Paz M, Salazar C, Perbolianachis P, Spangenberg L, et al. Real-Time Genomic Surveillance for SARS-CoV-2 Variants of Concern, Uruguay. Emerg Infect Dis. 2021;27(11):2957-2960. https://doi.org/10.3201/eid2711.211198
AMA Rego N, Costábile A, Paz M, et al. Real-Time Genomic Surveillance for SARS-CoV-2 Variants of Concern, Uruguay. Emerging Infectious Diseases. 2021;27(11):2957-2960. doi:10.3201/eid2711.211198.
APA Rego, N., Costábile, A., Paz, M., Salazar, C., Perbolianachis, P., Spangenberg, L....Moreno, P. (2021). Real-Time Genomic Surveillance for SARS-CoV-2 Variants of Concern, Uruguay. Emerging Infectious Diseases, 27(11), 2957-2960. https://doi.org/10.3201/eid2711.211198.

Highly Pathogenic Avian Influenza A(H5N1) Virus in Wild Red Foxes, the Netherlands, 2021 [PDF - 1011 KB - 3 pages]
J. M. Rijks et al.

We detected infection with highly pathogenic avian influenza A(H5N1) virus clade 2.3.4.4b in 2 red fox (Vulpes vulpes) cubs found in the wild with neurologic signs in the Netherlands. The virus is related to avian influenza viruses found in wild birds in the same area.

EID Rijks JM, Hesselink H, Lollinga P, Wesselman R, Prins P, Weesendorp E, et al. Highly Pathogenic Avian Influenza A(H5N1) Virus in Wild Red Foxes, the Netherlands, 2021. Emerg Infect Dis. 2021;27(11):2960-2962. https://doi.org/10.3201/eid2711.211281
AMA Rijks JM, Hesselink H, Lollinga P, et al. Highly Pathogenic Avian Influenza A(H5N1) Virus in Wild Red Foxes, the Netherlands, 2021. Emerging Infectious Diseases. 2021;27(11):2960-2962. doi:10.3201/eid2711.211281.
APA Rijks, J. M., Hesselink, H., Lollinga, P., Wesselman, R., Prins, P., Weesendorp, E....Beerens, N. (2021). Highly Pathogenic Avian Influenza A(H5N1) Virus in Wild Red Foxes, the Netherlands, 2021. Emerging Infectious Diseases, 27(11), 2960-2962. https://doi.org/10.3201/eid2711.211281.

Online Registry of COVID-19–Associated Mucormycosis Cases, India, 2021 [PDF - 1005 KB - 3 pages]
S. Arora et al.

We established an online registry of coronavirus disease–associated mucormycosis cases in India. We analyzed data from 65 cases diagnosed during April–June 2021, when the Delta variant predominated, and found that patients frequently received antibacterial drugs and zinc supplementation. Online registries rapidly provide relevant data for emerging infections.

EID Arora S, Hemmige VS, Mandke C, Chansoria M, Rawat S, Dravid A, et al. Online Registry of COVID-19–Associated Mucormycosis Cases, India, 2021. Emerg Infect Dis. 2021;27(11):2963-2965. https://doi.org/10.3201/eid2711.211322
AMA Arora S, Hemmige VS, Mandke C, et al. Online Registry of COVID-19–Associated Mucormycosis Cases, India, 2021. Emerging Infectious Diseases. 2021;27(11):2963-2965. doi:10.3201/eid2711.211322.
APA Arora, S., Hemmige, V. S., Mandke, C., Chansoria, M., Rawat, S., Dravid, A....Puius, Y. A. (2021). Online Registry of COVID-19–Associated Mucormycosis Cases, India, 2021. Emerging Infectious Diseases, 27(11), 2963-2965. https://doi.org/10.3201/eid2711.211322.

Spontaneous Bacterial Peritonitis Caused by Bordetella hinzii [PDF - 1.49 MB - 3 pages]
G. C. Wang et al.

Although Bordetella hinzii coccobacilli is most commonly identified in respiratory tracts of birds and rodents, this organism has occasionally been isolated in human infections. We describe a case of B. hinzii spontaneous bacterial peritonitis in Missouri, USA. Whole-genome sequencing of blood and peritoneal fluid isolates confirmed B. hinzii infection.

EID Wang GC, Wallace MJ, Krishnan G, Olson PD, Carlson AL, Dantas G, et al. Spontaneous Bacterial Peritonitis Caused by Bordetella hinzii. Emerg Infect Dis. 2021;27(11):2966-2968. https://doi.org/10.3201/eid2711.211428
AMA Wang GC, Wallace MJ, Krishnan G, et al. Spontaneous Bacterial Peritonitis Caused by Bordetella hinzii. Emerging Infectious Diseases. 2021;27(11):2966-2968. doi:10.3201/eid2711.211428.
APA Wang, G. C., Wallace, M. J., Krishnan, G., Olson, P. D., Carlson, A. L., Dantas, G....Fleckenstein, J. M. (2021). Spontaneous Bacterial Peritonitis Caused by Bordetella hinzii. Emerging Infectious Diseases, 27(11), 2966-2968. https://doi.org/10.3201/eid2711.211428.

Resurgence of Respiratory Syncytial Virus Infections during COVID-19 Pandemic, Tokyo, Japan [PDF - 606 KB - 2 pages]
M. Ujiie et al.

More than a year into the coronavirus-19 pandemic, intensified infection control measures have controlled most viral respiratory infections in Tokyo, Japan. As of July 2021, however, an unusually high number of respiratory syncytial virus infections were reported in Tokyo. This resurgence may have resulted from restarting social activities for children.

EID Ujiie M, Tsuzuki S, Nakamoto T, Iwamoto N. Resurgence of Respiratory Syncytial Virus Infections during COVID-19 Pandemic, Tokyo, Japan. Emerg Infect Dis. 2021;27(11):2969-2970. https://doi.org/10.3201/eid2711.211565
AMA Ujiie M, Tsuzuki S, Nakamoto T, et al. Resurgence of Respiratory Syncytial Virus Infections during COVID-19 Pandemic, Tokyo, Japan. Emerging Infectious Diseases. 2021;27(11):2969-2970. doi:10.3201/eid2711.211565.
APA Ujiie, M., Tsuzuki, S., Nakamoto, T., & Iwamoto, N. (2021). Resurgence of Respiratory Syncytial Virus Infections during COVID-19 Pandemic, Tokyo, Japan. Emerging Infectious Diseases, 27(11), 2969-2970. https://doi.org/10.3201/eid2711.211565.

Tracing the Origin, Spread, and Molecular Evolution of Zika Virus in Puerto Rico, 2016–2017 [PDF - 1.14 MB - 3 pages]
G. A. Santiago et al.

We reconstructed the 2016–2017 Zika virus epidemic in Puerto Rico by using complete genomes to uncover the epidemic’s origin, spread, and evolutionary dynamics. Our study revealed that the epidemic was propelled by multiple introductions that spread across the island, intricate evolutionary patterns, and ≈10 months of cryptic transmission.

EID Santiago GA, Kalinich CC, Cruz-López F, González GL, Flores B, Hentoff A, et al. Tracing the Origin, Spread, and Molecular Evolution of Zika Virus in Puerto Rico, 2016–2017. Emerg Infect Dis. 2021;27(11):2971-2973. https://doi.org/10.3201/eid2711.211575
AMA Santiago GA, Kalinich CC, Cruz-López F, et al. Tracing the Origin, Spread, and Molecular Evolution of Zika Virus in Puerto Rico, 2016–2017. Emerging Infectious Diseases. 2021;27(11):2971-2973. doi:10.3201/eid2711.211575.
APA Santiago, G. A., Kalinich, C. C., Cruz-López, F., González, G. L., Flores, B., Hentoff, A....Muñoz-Jordán, J. L. (2021). Tracing the Origin, Spread, and Molecular Evolution of Zika Virus in Puerto Rico, 2016–2017. Emerging Infectious Diseases, 27(11), 2971-2973. https://doi.org/10.3201/eid2711.211575.

Fatal Systemic Capillary Leak Syndrome after SARS-CoV-2 Vaccination in Patient with Multiple Myeloma [PDF - 669 KB - 3 pages]
G. Choi et al.

A young man with smoldering multiple myeloma died of hypotensive shock 2.5 days after severe acute respiratory syndrome coronavirus 2 vaccination. Clinical findings suggested systemic capillary leak syndrome (SCLS); the patient had experienced a previous suspected flare episode. History of SCLS may indicate higher risk for SCLS after receiving this vaccine.

EID Choi G, Baek SH, Kim J, Kim JH, Kwon G, Kim D, et al. Fatal Systemic Capillary Leak Syndrome after SARS-CoV-2 Vaccination in Patient with Multiple Myeloma. Emerg Infect Dis. 2021;27(11):2973-2975. https://doi.org/10.3201/eid2711.211723
AMA Choi G, Baek SH, Kim J, et al. Fatal Systemic Capillary Leak Syndrome after SARS-CoV-2 Vaccination in Patient with Multiple Myeloma. Emerging Infectious Diseases. 2021;27(11):2973-2975. doi:10.3201/eid2711.211723.
APA Choi, G., Baek, S. H., Kim, J., Kim, J. H., Kwon, G., Kim, D....Kim, S. (2021). Fatal Systemic Capillary Leak Syndrome after SARS-CoV-2 Vaccination in Patient with Multiple Myeloma. Emerging Infectious Diseases, 27(11), 2973-2975. https://doi.org/10.3201/eid2711.211723.
Books and Media

The COVID Catastrophe: What’s Gone Wrong and How To Stop It Happening Again, 2nd Edition [PDF - 688 KB - 1 page]
D. Hong et al.
EID Hong D, Yin X, Shi L. The COVID Catastrophe: What’s Gone Wrong and How To Stop It Happening Again, 2nd Edition. Emerg Infect Dis. 2021;27(11):2976. https://doi.org/10.3201/eid2711.211257
AMA Hong D, Yin X, Shi L. The COVID Catastrophe: What’s Gone Wrong and How To Stop It Happening Again, 2nd Edition. Emerging Infectious Diseases. 2021;27(11):2976. doi:10.3201/eid2711.211257.
APA Hong, D., Yin, X., & Shi, L. (2021). The COVID Catastrophe: What’s Gone Wrong and How To Stop It Happening Again, 2nd Edition. Emerging Infectious Diseases, 27(11), 2976. https://doi.org/10.3201/eid2711.211257.
About the Cover

Yet Another Potential Age-Old Nonpharmaceutical Intervention [PDF - 1.59 MB - 2 pages]
K. Gensheimer and B. Breedlove
EID Gensheimer K, Breedlove B. Yet Another Potential Age-Old Nonpharmaceutical Intervention. Emerg Infect Dis. 2021;27(11):2977-2978. https://doi.org/10.3201/eid2711.ac2711
AMA Gensheimer K, Breedlove B. Yet Another Potential Age-Old Nonpharmaceutical Intervention. Emerging Infectious Diseases. 2021;27(11):2977-2978. doi:10.3201/eid2711.ac2711.
APA Gensheimer, K., & Breedlove, B. (2021). Yet Another Potential Age-Old Nonpharmaceutical Intervention. Emerging Infectious Diseases, 27(11), 2977-2978. https://doi.org/10.3201/eid2711.ac2711.
Etymologia

Etymologia: Prototheca [PDF - 950 KB - 1 page]
R. D. Ollhoff et al.
EID Ollhoff RD, Sellera FP, Pogliani FC. Etymologia: Prototheca. Emerg Infect Dis. 2021;27(11):2891. https://doi.org/10.3201/eid2711.211554
AMA Ollhoff RD, Sellera FP, Pogliani FC. Etymologia: Prototheca. Emerging Infectious Diseases. 2021;27(11):2891. doi:10.3201/eid2711.211554.
APA Ollhoff, R. D., Sellera, F. P., & Pogliani, F. C. (2021). Etymologia: Prototheca. Emerging Infectious Diseases, 27(11), 2891. https://doi.org/10.3201/eid2711.211554.
Page created: October 13, 2021
Page updated: October 19, 2021
Page reviewed: October 19, 2021
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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