Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link

Early Release

Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.

Issues Available

Volume 27, Number 4—April 2021

  • Systematic Review of Reported HIV Outbreaks, Pakistan, 2000–2019
    E. M. Rabold et al.
  • Animal Reservoirs and Hosts for Emerging Alphacoronaviruses and Betacoronaviruses
    R. R. Ghai et al.

    The ongoing global pandemic caused by coronavirus disease has once again demonstrated the role of the family Coronaviridae in causing human disease outbreaks. Because severe acute respiratory syndrome coronavirus 2 was first detected in December 2019, information on its tropism, host range, and clinical manifestations in animals is limited. Given the limited information, data from other coronaviruses might be useful for informing scientific inquiry, risk assessment, and decision-making. We reviewed endemic and emerging infections of alphacoronaviruses and betacoronaviruses in wildlife, livestock, and companion animals and provide information on the receptor use, known hosts, and clinical signs associated with each host for 15 coronaviruses detected in humans and animals. This information can be used to guide implementation of a One Health approach that involves human health, animal health, environmental, and other relevant partners in developing strategies for preparedness, response, and control to current and future coronavirus disease threats.

  • Reemergence of Human Monkeypox and Declining Population Immunity in the Context of Urbanization, Nigeria, 2017–2020
    P. Nguyen et al.

    A monkeypox outbreak in Nigeria during 2017–2020 provides an illustrative case study for emerging zoonoses. We built a statistical model to simulate declining immunity from monkeypox at 2 levels: At the individual level, we used a constant rate of decline in immunity of 1.29% per year as smallpox vaccination rates fell. At the population level, the cohort of vaccinated residents decreased over time because of deaths and births. By 2016, only 10.1% of the total population in Nigeria was vaccinated against smallpox; the serologic immunity level was 25.7% among vaccinated persons and 2.6% in the overall population. The substantial resurgence of monkeypox in Nigeria in 2017 appears to have been driven by a combination of population growth, accumulation of unvaccinated cohorts, and decline in smallpox vaccine immunity. The expanding unvaccinated population means that entire households, not just children, are now more susceptible to monkeypox, increasing risk of human-to-human transmission.

  • Characteristics of SARS-CoV-2 Transmission among Meat Processing Workers in Nebraska, USA, and Effectiveness of Risk Mitigation Measures
    J. J. Herstein et al.

    The coronavirus disease (COVID-19) pandemic has severely impacted the meat processing industry in the United States. We sought to detail demographics and outcomes of severe acute respiratory syndrome coronavirus 2 infections among workers in Nebraska meat processing facilities and determine the effects of initiating universal mask policies and installing physical barriers at 13 meat processing facilities. During April 1–July 31, 2020, COVID-19 was diagnosed in 5,002 Nebraska meat processing workers (attack rate 19%). After initiating both universal masking and physical barrier interventions, 8/13 facilities showed a statistically significant reduction in COVID-19 incidence in <10 days. Characteristics and incidence of confirmed cases aligned with many nationwide trends becoming apparent during this pandemic: specifically, high attack rates among meat processing industry workers, disproportionately high risk of adverse outcomes among ethnic and racial minority groups and men, and effectiveness of using multiple prevention and control interventions to reduce disease transmission.

  • Blastomycosis Surveillance in 5 States, United States, 1987–2018
    K. Benedict et al.
  • Difficulties in Differentiating Coronaviruses from Subcellular Structures in Human Tissues by Electron Microscopy
    H. A. Bullock et al.

    Efforts to combat the coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have placed a renewed focus on the use of transmission electron microscopy for identifying coronavirus in tissues. In attempts to attribute pathology of COVID-19 patients directly to tissue damage caused by SARS-CoV-2, investigators have inaccurately reported subcellular structures, including coated vesicles, multivesicular bodies, and vesiculating rough endoplasmic reticulum, as coronavirus particles. We describe morphologic features of coronavirus that distinguish it from subcellular structures, including particle size range (60–140 nm), intracellular particle location within membrane-bound vacuoles, and a nucleocapsid appearing in cross section as dense dots (6–12 nm) within the particles. In addition, although the characteristic spikes of coronaviruses may be visible on the virus surface, especially on extracellular particles, they are less evident in thin sections than in negative stain preparations.

  • Infections with Tickborne Pathogens after Tick Bite, Austria, 2015–2018
    M. Markowicz et al.
  • Epidemiologic and Genomic Reidentification of Yaws, Liberia
    J. Timothy et al.
  • Dynamic Public Perceptions of the Coronavirus Disease Crisis, the Netherlands, 2020
    M. de Vries et al.

    A key component of outbreak control is monitoring public perceptions and public response. To determine public perceptions and public responses during the first 3 months of the coronavirus disease (COVID-19) outbreak in the Netherlands, we conducted 6 repeated surveys of ≈3,000 persons. Generalized estimating equations analyses revealed changes over time as well as differences between groups at low and high risk. Overall, respondents perceived the risks associated with COVID-19 to be considerable, were positive about the mitigation measures, trusted the information and the measures from authorities, and adopted protective measures. Substantial increases were observed in risk perceptions and self-reported protective behavior in the first weeks of the outbreak. Individual differences were based mainly on participants’ age and health condition. We recommend that authorities constantly adjust their COVID-19 communication and mitigation strategies to fit public perceptions and public responses and that they tailor the information for different groups.

  • Identifying Sexual Contact as a Risk Factor for Campylobacter Infection
    K. Kuhn et al.
  • COVID-19–Associated Pulmonary Aspergillosis, March–August 2020
    J. Salmanton-García et al.

    Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Because of the severe immunomodulation and lymphocyte depletion caused by this virus and the subsequent administration of drugs directed at the immune system, we anticipated that patients might experience fungal superinfection. We collected data from 186 patients who had coronavirus disease–associated pulmonary aspergillosis (CAPA) worldwide during March–August 2020. Overall, 182 patients were admitted to the intensive care unit (ICU), including 180 with acute respiratory distress syndrome and 175 who received mechanical ventilation. CAPA was diagnosed a median of 10 days after coronavirus disease diagnosis. Aspergillus fumigatus was identified in 80.3% of patient cultures, 4 of which were azole-resistant. Most (52.7%) patients received voriconazole. In total, 52.2% of patients died; of the deaths, 33.0% were attributed to CAPA. We found that the cumulative incidence of CAPA in the ICU ranged from 1.0% to 39.1%.

  • Genomic Surveillance of a Globally Circulating Distinct Serogroup W Clonal Complex 11 Meningococcal Variant, New Zealand, 2013–2018
    Z. Yang et al.
  • Emergence of Burkholderia pseudomallei Sequence Type 562, Northern Australia
    E. M. Meumann et al.
  • Histopathological Characterization of Cases of Spontaneous Fatal Feline Severe Fever with Thrombocytopenia Syndrome, Japan
    Y. Sakai et al.

    Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tickborne infectious disease caused by SFTS virus (SFTSV). We report 7 cases of spontaneous fatal SFTS in felines. Necropsies revealed characteristic lesions, including necrotizing lymphadenitis in 5 cases and necrotizing splenitis and SFTSV-positive blastic lymphocytes in all cases. We detected hemorrhagic lesions in the gastrointestinal tract in 6 cases and lungs in 3 cases, suggesting a more severe clinical course of SFTS in felids than in humans. We noted necrotic or ulcerative foci in the gastrointestinal tract in 3 cases, the lung in 2 cases, and the liver in 4 cases. We clarified that blastic lymphocytes are predominant targets of SFTSV and involved in induction of necrotic foci. We also found that thymic epithelial cells were additional targets of SFTSV. These results provide insights for diagnosing feline SFTS during pathological examination and demonstrate the similarity of feline and human SFTS cases.

  • Improving Treatment and Outcomes for Melioidosis in Children, Northern Cambodia, 2009–2018
    A. Chandna et al.
  • Characteristics and Risk Factors of Hospitalized and Nonhospitalized COVID-19 Patients, Atlanta, Georgia, USA, March–April 2020
    K. Pettrone et al.

    We compared the characteristics of hospitalized and nonhospitalized patients who had coronavirus disease in Atlanta, Georgia, USA. We found that risk for hospitalization increased with a patient’s age and number of concurrent conditions. We also found a potential association between hospitalization and high hemoglobin A1c levels in persons with diabetes.

  • Rare Norovirus GIV Foodborne Outbreak, Wisconsin, USA
    L. Barclay et al.
  • Venezuelan Equine Encephalitis Complex Alphavirus in Bats, French Guiana
    C. Fischer et al.
  • Post-Vaccination COVID-19 among Healthcare Workers, Israel
    S. Amit et al.

    Coronavirus disease (COVID-19) symptoms can be mistaken for vaccine-related side effects during initial days after immunization. Among 4,081 vaccinated healthcare workers in Israel, 22 (0.54%) developed COVID-19 from 1–10 days (median 3.5 days) after immunization. Clinicians should not dismiss postvaccination symptoms as vaccine-related and should promptly test for COVID-19.

  • SARS-CoV-2 Seropositivity among US Marine Recruits Attending Basic Training, United States, Spring–Fall 2020
    A. G. Letizia et al.

    In a study of US Marine recruits, seroprevalence of severe acute respiratory syndrome coronavirus 2 IgG was 9.0%. Hispanic and non-Hispanic Black participants and participants from states affected earlier in the pandemic had higher seropositivity rates. These results suggest the need for targeted public health strategies among young adults at increased risk for infection.

  • High Human Anthrax Case Fatality Rate in Northern Ghana, 2005–2016
    J. K. Blackburn et al.
  • Genomic Analysis of Novel Poxvirus Brazilian Porcupinepox Virus, Brazil, 2019
    A. S. Hora et al.
  • Surveillance of COVID-19–Associated Multisystem Inflammatory Syndrome in Children, South Korea
    Y. Choe et al.

    A concerning development during the coronavirus disease pandemic has been multisystem inflammatory syndrome in children. Reports of this condition in East Asia have been limited. In South Korea, 3 cases were reported to the national surveillance system for multisystem inflammatory syndrome in children. All case-patients were hospitalized and survived with no major disease sequelae.

  • Fatal Case of Crimean-Congo Hemorrhagic Fever Caused by Reassortant Virus, Spain, 2018
    A. Negredo et al.
  • Stability of SARS-CoV-2 RNA in Nonsupplemented Saliva
    I. M. Ott et al.

    The expense of saliva collection devices designed to stabilize severe acute respiratory syndrome coronavirus 2 RNA is prohibitive to mass testing. However, virus RNA in nonsupplemented saliva is stable for extended periods and at elevated temperatures. Simple plastic tubes for saliva collection will make large-scale testing and continued surveillance easier.

  • Increasing SARS-CoV-2 Testing Capacity with Pooled Saliva Samples
    A. E. Watkins et al.

    We analyzed feasibility of pooling saliva samples for severe acute respiratory syndrome coronavirus 2 testing and found that sensitivity decreased according to pool size: 5 samples/pool, 7.4% reduction; 10 samples/pool, 11.1%; and 20 samples/pool, 14.8%. When virus prevalence is >2.6%, pools of 5 require fewer tests; when <0.6%, pools of 20 support screening strategies.

  • Persistence of SARS-CoV-2 N-Antibody Response in Healthcare Workers, London, UK
    M. Shrotri et al.
  • Highly Pathogenic Avian Influenza Clade Subtype H5N6 Viruses Isolated from Wild Whooper Swans, Mongolia, 2020
    S. Jeong et al.
  • Low-Level Middle East Respiratory Coronavirus Syndrome among Camel Handlers, Kenya, 2019
    P. M. Munyua et al.
  • Emergence and Polyclonal Dissemination of OXA-244–Producing Escherichia coli, France
    C. Emeraud et al.
  • Analysis of Asymptomatic and Presymptomatic Transmission in SARS-CoV-2 Outbreak, Germany, 2020
    J. K. Bender et al.

    We determined secondary attack rates (SAR) among close contacts of 59 asymptomatic and symptomatic coronavirus disease case-patients by presymptomatic and symptomatic exposure. We observed no transmission from asymptomatic case-patients and highest SAR through presymptomatic exposure. Rapid quarantine of close contacts with or without symptoms is needed to prevent presymptomatic transmission.

Research Letters
  • Increased Likelihood of Detecting Ebola Virus RNA in Semen by Using Sample Pelleting
    C. M. Bozman et al.
  • Experimental SARS-CoV-2 Infection of Bank Voles
    L. Ulrich et al.
  • Inguinal Ulceroglandular Tularemia Caused by Francisella tularensis Subspecies holarctica, Canada
    C. Boodman et al.

    Tularemia is a zoonotic disease caused by the gram-negative coccobacillus Francisella tularensis, a Biosafety Level 3 pathogen and potential agent of bioterrorism. We describe 2 cases of perigenital ulcer disease caused by Francisella tularensis subspecies holarctica in Manitoba, Canada. These cases caused inadvertent exposure among laboratory personnel.

  • Risk for Fomite-Mediated Transmission of SARS-CoV-2 in Child Daycares, Schools, Nursing Homes, and Offices
    A. Kraay et al.

    Severe acute respiratory syndrome coronavirus 2 can persist on surfaces, suggesting possible surface-mediated transmission of this pathogen. We found that fomites might be a substantial source of transmission risk, particularly in schools and child daycares. Combining surface cleaning and decontamination with mask wearing can help mitigate this risk.

  • Novel SARS-CoV-2 Variant Identified in Travelers from Brazil to Japan
    T. Fujino et al.

    Multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with higher transmission potential have been emerging globally, including SARS-CoV-2 variants from the United Kingdom and South Africa. We report 4 travelers from Brazil to Japan in January 2021 infected with a novel SARS-CoV-2 variant with an additional set of mutations.

  • Imported SARS-COV-2 Variant P.1 Detected in Traveler Returning from Brazil to Italy
    F. Maggi et al.

    We report an imported case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant P.1 detected in an asymptomatic traveler who arrived in Italy on an indirect flight from Brazil. This case shows the risk for introduction of SARS-CoV-2 variants from indirect flights and the need for continued SARS-CoV-2 surveillance.

  • Rapid Spread and Control of Multidrug-Resistant Gram-Negative Bacteria in COVID-19 Patient Care Units
    A. Patel et al.

    We describe rapid spread of multidrug-resistant gram-negative bacteria among patients in dedicated coronavirus disease care units in a hospital in Maryland, USA, during May–June 2020. Critical illness, high antibiotic use, double occupancy of single rooms, and modified infection prevention practices were key contributing factors. Surveillance culturing aided in outbreak recognition and control.

  • Polydrug-Resistant Mycobacterium bovis Infection in Human and Sympatric Sheep, Spain, 2017–2018
    B. de Val et al.
  • Tula Virus as the Causative Agent of Hantavirus Disease in an Immunocompetent Person, Germany
    J. Hofmann et al.
Books and Media
  • Understanding Coronavirus
    X. Yin and N. Hackman


Volume 27, Number 5—May 2021

  • Active Case Finding of Current Bornavirus Infections in Human Encephalitis Cases of Unknown Etiology, Germany, 2018–2020
    P. Eisermann et al.
  • Serologic Screening of Severe Acute Respiratory Syndrome Coronavirus 2 Infection in Cats and Dogs during First Coronavirus Disease Wave, the Netherlands
    S. Zhao et al.
  • SARS-CoV-2 Susceptibility of Cell Lines and Substrates Commonly Used in Diagnosis and Isolation of Influenza and Other Viruses
    L. Wang et al.
  • Symptom Diary–Based Analysis of COVID-19 Disease Course, Germany, 2020
    P. Wiegele et al.
  • Longevity of Middle East Respiratory Syndrome Coronavirus Antibody Responses in Patients, Saudi Arabia
    A. N. Alshukairi et al.
  • Whole-Genome Sequencing of Shiga Toxin–Producing Escherichia coli OX18 from a Fatal Hemolytic Uremic Syndrome Case
    K. Lee et al.
  • Introduction of ORF3a-Q57H SARS-CoV-2 Variant Causing Fourth Epidemic Wave of COVID-19, Hong Kong, China
    D. Chu et al.
Research Letters
  • Upper Respiratory Infections in Schools and Childcare Centers Reopening after COVID-19 Dismissals, Hong Kong
    M. Fong et al.

    A large number of common cold outbreaks in Hong Kong schools and childcare centers during October–November 2020 led to territorywide school dismissals. Increased susceptibility to rhinoviruses during prolonged school closures and dismissals for coronavirus disease and varying effectiveness of nonpharmaceutical interventions may have heightened transmission of cold-causing viruses after school attendance resumed.

  • Undocumented Migrants Reintroducing COVID-19, Yunnan Province, China
    M. Zhang et al.
  • Genomic Evidence of SARS-CoV-2 Reinfection Involving E484K Spike Mutation, Brazil
    C. V. Nonaka et al.

    Uncertainty remains about how long the protective immune responses against severe acute respiratory syndrome coronavirus 2 persists, and suspected reinfection in recovered patients has been reported. We describe a case of reinfection from distinct virus lineages in Brazil harboring the E484K mutation, a variant associated with escape from neutralizing antibodies.

  • Eosinophilic Meningitis and Intraocular Infection Caused by Dirofilaria sp. Genotype Hongkong
    A. Jyotsna et al.


Volume 27, Number 6—June 2021

  • Molecular Characterization and Antimicrobial Resistance in Neisseria gonorrhoeae, Nunavut Region of Inuit Nunangat, Canada, 2018–2019
    A. E. Singh et al.


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.
edit_01 ScholarOne Submission Portal
Issue Select

Subscribe and Get Email Updates

Sign up at EID Subscriptions to receive email notifications for the table of contents, expedited articles, podcasts, CME credits, and specific article types and disease topics.

To receive email updates about this page, enter your email address:

Email Address
What's this?



Get Email Updates

To receive email updates about this page, enter your email address: