Early Release

Perspective

• The Problem of Microbial Dark Matter in Neonatal Sepsis
  S. A. Sinnar and S. J. Schiff
• Two Pandemics, One Challenge—Leveraging Molecular Test Capacity of Tuberculosis Laboratories for Rapid COVID-19 Case-Finding
  S. Homolka et al. View Abstract Email this Article

  In many settings, the ongoing coronavirus (COVID-19) pandemic coincides with other major public health threats, in particular tuberculosis. Using tuberculosis (TB) molecular diagnostic infrastructure, which has substantially expanded worldwide in recent years, for COVID-19 case-finding might be warranted. We analyze the potential of using TB diagnostic and research infrastructures for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. We focused on quality control by adapting the 12 Quality System Essentials framework to the COVID-19 and TB context. We conclude that diagnostic infrastructures for TB can in principle be leveraged to scale-up SARS-CoV-2 testing, in particular in resource-poor settings. TB research infrastructures also can support sequencing of SARS-CoV-2 to study virus evolution and diversity globally. However, fundamental principles of quality management must be followed for both TB and SARS-CoV-2 testing to ensure valid results and to minimize biosafety hazards, and the continuity of TB diagnostic services must be guaranteed at all times.

Synopses

• Measuring Timeliness of Outbreak Detection, Notification, and Control in the WHO African Region, 2017–2019
  B. Impouma et al.
• Challenges to Achieving Measles Elimination, Republic of Georgia, 2013–2018
  N. Khetsuriani et al.

Research

• Three Patients with COVID-19 and Pulmonary Tuberculosis, Wuhan, China, January–February 2020
  Z. Yao et al. View Abstract Email this Article

  During January–February 2020, coronavirus disease (COVID-19) and tuberculosis were diagnosed for 3 patients in Wuhan, China. All 3 patients had COVID-19 pneumonia. One severely ill patient died after acute respiratory distress syndrome developed. Clinicians and public health officials should be aware of underlying chronic infections such as tuberculosis in COVID-19 patients.

• Validated Methods for Removing Select Agent Samples from Biosafety Level 3 Laboratories
  A. E. Kesterson et al.
• Epidemiology of COVID-19 Outbreak on Cruise Ship Quarantined at Yokohama, Japan, February 2020
  View Abstract Email this Article

  To improve understanding of coronavirus disease (COVID-19), we assessed the epidemiology of an outbreak on a cruise ship, February 5–24, 2020. The study population included persons on board on February 3 (2,666 passengers, 1,045 crew). Passengers had a mean age of 66.1 years and were 55% female; crew had a mean age of 36.6 years and were 81% male. Of passengers, 544 (20.4%) were infected, 314 (57.7%) asymptomatic. Attack rates were highest in 4-person cabins (30.0%; n = 18). Of crew, 143 (13.7%) were infected, 64 (44.8%) asymptomatic. Passenger cases peaked February 7, and 35 had onset before quarantine. Crew cases peaked on February 11 and 13. The median serial interval between cases in the same cabin was 2 days. This study shows that severe acute respiratory syndrome coronavirus 2 is infectious in closed settings, that subclinical infection is common, and that close contact is key for transmission.

• High Dengue Burden and Circulation of 4 Virus Serotypes among Children with Undifferentiated Fever, Kenya, 2014–2017
  M. M. Shah et al.
• Systematic Review and Meta-Analyses of Incidence for Group B Streptococcus Disease in Infants and Antimicrobial Resistance, China
  Y. Ding et al.
• Analysis of SARS-CoV-2 Transmission in Different Settings, Brunei
  L. Chaw et al.
• Modeling Treatment Strategies to Inform Yaws Eradication
  A. Holmes et al.
• Streptococcus pneumoniae Serotype 12F-CC4846 and Invasive Pneumococcal Disease after Introduction of 13-Valent Pneumococcal Conjugate Vaccine, Japan, 2017
  S. Nakano et al.
• Azithromycin to Prevent Pertussis in Household Contacts, Catalonia and Navarre, Spain, 2012–2013
  J. Alvarez et al.
• Case-Control Study of Use of Personal Protective Measures and Risk for Severe Acute Respiratory Syndrome Coronavirus 2 Infection, Thailand
  P. Doung-ngern et al. View Abstract Email this Article

  We evaluated effectiveness of personal protective measures against severe acute respiratory disease coronavirus 2 (SARS-CoV-2) infection. Our case-control study included 211 cases of coronavirus disease (COVID-19) and 839 controls in Thailand. Cases were defined as asymptomatic contacts of COVID-19 patients who later tested positive for SARS-CoV-2; controls were asymptomatic contacts who never tested positive. Wearing masks all the time during contact was independently associated with lower risk for SARS-CoV-2 infection compared with not wearing masks; wearing a mask sometimes during contact did not lower infection risk. We found the type of mask worn was not independently associated with infection and that contacts who always wore masks were more likely to practice social distancing. Maintaining >1 m distance from a person with COVID-19, having close contact for <15 minutes, and frequent handwashing were independently associated with lower risk for infection. Our findings support consistent wearing of masks, handwashing, and social distancing to protect against COVID-19.

• Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 During Long Flight
  N. Khanh et al. View Abstract Email this Article

  To assess the role of in-flight transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we investigated a cluster of cases among passengers on a 10-hour commercial flight. Affected persons were passengers, crew, and their close contacts. We traced 217 passengers and crew to their final destinations and interviewed, tested, and quarantined them. Among the 16 persons in whom SARS-CoV-2 infection was detected, 12 (75%) were passengers seated in business class along with the only symptomatic person (attack rate 62%). Seating proximity was strongly associated with increased infection risk (risk ratio 7.3, 95% CI 1.2–46.2). We found no strong evidence supporting alternative transmission scenarios. In-flight transmission that probably originated from 1 symptomatic passenger caused a large cluster of cases during a long flight. Guidelines for preventing SARS-CoV-2 infection among air passengers should consider individual passengers’ risk for infection, the number of passengers traveling, and flight duration.

• Endotheliopathy and Platelet Dysfunction as Hallmarks of Fatal Lassa Fever
  L. E. Horton et al.
• Phage-Mediated Immune Evasion and Transmission of Livestock-Associated Methicillin-Resistant Staphylococcus aureus in Humans
  R. N. Sieber et al.
• Nowcasting (Short-Term Forecasting) of Influenza Epidemics in Local Settings, Sweden, 2008–2019
  A. Spreco et al.

Dispatches

• Two New Cases of Pulmonary Infection by Mycobacterium shigaense
  S. Yoshida et al.
• Multiple Introductions of Salmonella Typhi H58 with Reduced Fluoroquinolone Susceptibility, Chile
  M. Maes et al.
• SARS-CoV-2 Virus Culture and Subgenomic RNA for Respiratory Specimens from Patients with Mild Coronavirus Disease
  R. Perera et al. View Abstract Email this Article

  We investigated 68 respiratory specimens from 35 coronavirus disease patients in Hong Kong, of whom 32 had mild disease. We found that severe acute respiratory syndrome coronavirus 2 and subgenomic RNA were rarely detectable beyond 8 days after onset of illness. However, virus RNA was detectable for many weeks by reverse transcription PCR.

• Chikungunya Virus Infection in Blood Donors and Patients with Acute Febrile Illness, Mandalay, Myanmar, 2019
  A. Kyaw et al.
• Asymptomatic Transmission of SARS-CoV-2 on Evacuation Flight
  S. Bae et al. View Abstract Email this Article

  We conducted a cohort study in a controlled environment to measure asymptomatic transmission of severe acute respiratory syndrome coronavirus 2 on a flight from Italy to South Korea. Our results suggest that stringent global regulations are necessary for the prevention of transmission of this virus on aircraft.

• Potential Role of Social Distancing in Mitigating Spread of Coronavirus Disease, South Korea
  S. Park et al. View Abstract Email this Article

  In South Korea, the coronavirus disease outbreak peaked at the end of February and subsided in mid-March. We analyzed the likely roles of social distancing in reducing transmission. Our analysis indicated that although transmission might persist in some regions, epidemics can be suppressed with less extreme measures than those taken by China.

• Identification of a Novel α-herpesvirus Associated with Ulcerative Stomatitis in Donkeys
  V. Martella et al.
• Multidrug-Resistant Hypervirulent Group B Streptococcus in Neonatal Invasive Infections, France, 2007–2019
  C. Plainvert et al.
• Multidrug-Resistant Candida auris Infections in Critically Ill Coronavirus Disease Patients, India, April–July 2020
  A. Chowdhary et al. View Abstract Email this Article

  In New Delhi, India, candidemia affected 15 critically ill coronavirus disease patients admitted to an intensive care unit during April–July 2020. Candida auris accounted for two thirds of cases; case-fatality rate was high (60%). Hospital-acquired C. auris infections in coronavirus disease patients may lead to adverse outcomes and additional strain on healthcare resources.

• Worldwide Effects of Coronavirus Disease Pandemic on Tuberculosis Services, January–April 2020
  G. Migliori et al. View Abstract Email this Article

  Coronavirus disease has disrupted tuberculosis services globally. Data from 33 centers in 16 countries on 5 continents showed that attendance at tuberculosis centers was lower during the first 4 months of the pandemic in 2020 than for the same period in 2019. Resources are needed to ensure tuberculosis care continuity during the pandemic.

• Surveillance of Pneumonia and Influenza Mortality to Distinguish Thresholds versus Anomaly Detection
  T. L. Wiemken et al.
• Preventing Vector-Borne Transmission of Zika Virus Infection During Pregnancy, Puerto Rico, USA, 2016–2017
  K. Kortsmit et al.
• In-Flight Transmission of Severe Acute Respiratory Syndrome Coronavirus 2
  E. M. Choi et al. View Abstract Email this Article

  Four persons with severe acute respiratory syndrome coronavirus 2 infection had traveled on the same flight from Boston, Massachusetts, USA, to Hong Kong, China. Their virus genetic sequences are identical, unique, and belong to a clade not previously identified in Hong Kong, which strongly suggests that the virus can be transmitted during air travel.

• KPC-3–Producing Serratia marcescens Outbreak between Acute and Long-Term Care Facilities, Florida, USA
  A. Jimenez et al.

Research Letters

• Four Patients with COVID-19 and Tuberculosis, Singapore, April–May 2020
  S. Tham et al. View Abstract Email this Article

  Coronavirus disease (COVID-19) and tuberculosis (TB) developed in 4 foreign workers living in dormitories in Singapore during April–May 2020. Clinical manifestations and atypical radiographic features of COVID-19 led to the diagnosis of TB through positive interferon-gamma release assay and culture results. During the COVID-19 pandemic, TB should not be overlooked.

• Seroprevalence of SARS-CoV-2–Specific Antibodies, Faroe Islands
  M. Petersen et al. View Abstract Email this Article

  We conducted a nationwide study of the prevalence of severe acute respiratory syndrome coronavirus 2 infection in the Faroe Islands. Of 1,075 randomly selected participants, 6 (0.6%) tested seropositive for antibodies to the virus. Adjustment for test sensitivity and specificity yielded a 0.7% prevalence. Our findings will help us evaluate our public health response.

• Detection of SARS-CoV-2 in Hemodialysis Effluent of Patient with COVID-19 Pneumonia, Japan
  A. Okuhama et al.
• Seroprevalence of SARS-CoV-2 and Infection Fatality Ratio, Orleans and Jefferson Parishes, Louisiana, USA, May 2020
  A. K. Feehan et al. View Abstract Email this Article

  Using a novel recruitment method and paired molecular and antibody testing for severe acute respiratory syndrome coronavirus 2 infection, we determined seroprevalence in a racially diverse municipality in Louisiana, USA. Infections were highly variable by ZIP code and differed by race/ethnicity. Overall census-weighted seroprevalence was 6.9%, and the calculated infection fatality ratio was 1.63%.

• Detection of SARS-CoV-2 in Hemodialysis Effluent of Patient with COVID-19 Pneumonia, Japan
  A. Okuhama et al. View Abstract Email this Article

  We report detection of severe acute respiratory syndrome coronavirus 2 RNA in hemodialysis effluent from a patient in Japan with coronavirus disease and prolonged inflammation. Healthcare workers should observe strict standard and contact precautions and use appropriate personal protective equipment when handling hemodialysis circuitry from patients with diagnosed coronavirus disease.

• Sporotrichosis Cases in Commercial Insurance Data, United States, 2012–2018
  K. Benedict and B. R. Jackson
• Burkholderia pseudomallei in Soil, US Virgin Islands, 2019
  N. E. Stone et al.
• Saliva Alternative to Upper Respiratory Swabs for SARS-CoV-2 Diagnosis
  R. L. Byrne et al. View Abstract Email this Article

  PCR of upper respiratory specimens is the diagnostic standard for severe acute respiratory syndrome coronavirus 2 infection. However, saliva sampling is an easy alternative to nasal and throat swabbing. We found similar viral loads in saliva samples and in nasal and throat swab samples from 110 patients with coronavirus disease.

• Abrupt Subsidence of Seasonal Influenza after Coronavirus Disease Outbreak, Hong Kong, China
  N. Wong et al. View Abstract Email this Article

  The onset of the 2019–20 winter influenza season in Hong Kong coincided with the emergence of the coronavirus disease epidemic in neighboring mainland China. After widespread adoption of large-scale social distancing interventions in response to the impending coronavirus disease outbreak, the influenza season ended abruptly with a decrease to a low trough.

• Nontuberculous Mycobacterial Pulmonary Disease Caused by Mycobacterium hassiacum, Austria
  H. Salzer et al.
• Large outbreak of Guillain-Barré Syndrome, Peru, 2019
  C. V. Munayco et al.
• Osteomyelitis Due to Mycobacterium goodii in an Adolescent, United States
  A. Diaz et al.
• COVID-19 Outbreak, Senegal, 2020
  N. Dia et al.
• Sociodemographic Predictors of SARS-CoV-2 Infection in Obstetric Patients, Georgia
  N. T. Joseph et al.

Letters

• Pulmonary Nocardia ignorata Infection in Gardener, Iran, 2017
  V. A. Muggia and Y. A. Puius
• COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020
  A. M. Rule Email this Article
• COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020
  J. Lu and Z. Yang Email this Article

Another Dimension

• Isolation Cocoon, May 2020
  R. Louie

Online Report

• Early Insights from Statistical and Mathematical Modeling of Key Epidemiologic Parameters of COVID-19
  M. Biggerstaff et al. View Abstract Email this Article

  We report key epidemiologic parameter estimates for coronavirus disease identified in peer-reviewed publications, preprint articles, and online reports. Range estimates for incubation period were 1.8–6.9 days, serial interval 4.0–7.5 days, and doubling time 2.3–7.4 days. The effective reproductive number varied widely, with reductions attributable to interventions. Case burden and infection fatality ratios increased with patient age. Implementation of combined interventions could reduce cases and delay epidemic peak up to 1 month. These parameters for transmission, disease severity, and intervention effectiveness are critical for guiding policy decisions. Estimates will likely change as new information becomes available.

Synopses

• Outbreak of Anthrax Associated with Handling and Eating Meat from a Cow, Uganda, 2018
  E. Kisaakye et al.
• Animal Rabies Surveillance, China, 2004–2018
  Y. Feng et al.

Research

• Small Particle Aerosol Exposure of African Green Monkeys to MERS-CoV as a Model for Highly Pathogenic Coronavirus Infection
  A. Totura et al. View Abstract Email this Article

  Emerging coronaviruses are a global public health threat because of the potential for person-to-person transmission and high mortality rates. Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in 2012, causing lethal respiratory disease in »35% of cases. Primate models of coronavirus disease are needed to support development of therapeutics, but few models exist that recapitulate severe disease. For initial development of a MERS-CoV primate model, 12 African green monkeys were exposed to 10³, 10⁴, or 10⁵ PFU target doses of aerosolized MERS-CoV. We observed a dose-dependent increase of respiratory disease signs, although all 12 monkeys survived for the 28-day duration of the study. This study describes dose-dependent effects of MERS-CoV infection of primates and uses a route of infection with potential relevance to MERS-CoV transmission. Aerosol exposure of African green monkeys might provide a platform approach for the development of primate models of novel coronavirus diseases.

• Equine-Like H3 Avian Influenza Viruses in Wild Birds, Chile
  N. Bravo-Vasquez et al.
• Trends in Population Dynamics of Escherichia coli Sequence Type 131, 2006–2016
  G. Peirano et al.
• Risk for Hepatitis E Virus Transmission by Solvent/Detergent–Treated Plasma
  P. Gallian et al.
• SARS-CoV-2 Seroprevalence among Healthcare, First Response, and Public Safety Personnel, Detroit Metropolitan Area, Michigan, USA, May–June 2020
  L. J. Akinbami et al. View Abstract Email this Article

  To estimate seroprevalence of severe acute respiratory syndrome 2 (SARS-CoV-2) among healthcare, first response, and public safety personnel, antibody testing was conducted in emergency medical service agencies and 27 hospitals in the Detroit, Michigan, USA, metropolitan area during May–June 2020. Of 16,403 participants, 6.9% had SARS-CoV-2 antibodies. In adjusted analyses, seropositivity was associated with exposure to SARS-CoV-2–positive household members (adjusted odds ratio [aOR] 6.18, 95% CI 4.81–7.93) and working within 15 km of Detroit (aOR 5.60, 95% CI 3.98–7.89). Nurse assistants (aOR 1.88, 95% CI 1.24–2.83) and nurses (aOR 1.52, 95% CI 1.18–1.95) had higher likelihood of seropositivity than physicians. Working in a hospital emergency department increased the likelihood of seropositivity (aOR 1.16, 95% CI 1.002–1.35). Consistently using N95 respirators (aOR 0.83, 95% CI 0.72–0.95) and surgical facemasks (aOR 0.86, 95% CI 0.75–0.98) decreased the likelihood of seropositivity.

• HIV-Associated Tuberculosis Among Children and Adolescents in High HIV/TB Settings
  A. M. Mandalakas et al.
• Game Animal Density, Climate, and Tick-borne Encephalitis in Finland, 2007–2017
  T. Dub et al.

Dispatches

• Coyotes as Reservoirs for Onchocerca lupi, United States, 2015–2018
  C. C. Roe et al.
• Direct Transmission of Severe Fever with Thrombocytopenia Syndrome Virus from Domestic Cat to Veterinary Personnel
  A. Yamanaka et al.
• Differential Tropism of SARS-CoV and SARS-CoV-2 in Bat Cells
  S. Lau et al. View Abstract Email this Article

  Severe acute respiratory syndrome coronavirus 2 did not replicate efficiently in 13 bat cell lines, whereas severe acute respiratory syndrome coronavirus replicated efficiently in kidney cells of its ancestral host, the Rhinolophus sinicus bat, suggesting different evolutionary origins. Structural modeling showed that RBD/RsACE2 binding may contribute to the differential cellular tropism.

• Novel Rickettsia Species Infecting Dogs, United States
  J. M. Wilson et al.
• Zoonotic Pathogens in Ticks from Migratory Birds, Italy
  E. Battisti et al.
• Lymphocytic Choriomeningitis Virus Infections and Seroprevalence, Southern Iraq
  H. Alburkat et al.
• Characterization and Source Investigation of Multidrug-Resistant Salmonella Anatum from a Sustained Outbreak, Taiwan
  Y. Feng et al. View Abstract Email this Article

  An ongoing outbreak of multidrug-resistant Salmonella enterica serovar Anatum began in Taiwan in 2015. Pork and poultry were identified as vehicles for transmission. Contaminated meat contributed to the high rate of infections among children. Nearly identical Salmonella Anatum strains have been identified in the United Kingdom, the United States, and the Philippines.

• Shedding of Marburg Virus in Naturally Infected Egyptian Rousette Bats, South Africa, 2017
  J. T. Pawęska et al.
• High-Pathogenicity Avian Influenza A(H7N3) Virus in Poultry, United States, 2020
  S. Youk et al.
• Endovascular Infection with Kingella kingae Complicated by Septic Arthritis in Immunocompromised Adult Patient
  M. Mustafa-Hellou et al.
• Human Rickettsiosis Caused by Rickettsia parkeri Strain Atlantic Rainforest, Urabá, Colombia
  M. Arboleda et al.
• Unusual Outbreak of Rift Valley Fever in Sudan, 2019
  A. Ahmed et al.
• Antibody Profiles According to Mild or Severe SARS-CoV-2 Infection, Atlanta, Georgia, USA, 2020
  W. T. Hu et al. View Abstract Email this Article

  Among patients with coronavirus disease (COVID-19), IgM levels increased early after symptom onset for those with mild and severe disease, but IgG levels increased early only in those with severe disease. A similar pattern was observed in a separate serosurveillance cohort. Mild COVID-19 should be investigated separately from severe COVID-19.

• Outbreaks of H5N6 Highly Pathogenic Avian Influenza Virus Subclade 2.3.4.4h in Swans, Xinjiang, Western China, 2020
  Y. Li et al.
• Human Monocytic Ehrlichiosis, Mexico City, Mexico
  V. E. Alcántara-Rodríguez et al.
• SARS-CoV-2 in Cattle
  L. Ulrich et al.
• Sensitive Detection of SARS-CoV-2–Specific Antibodies in Dried Blood Spot Samples
  G. L. Morley et al.

Research Letters

• Pathogenic New World relapsing fever Borrelia in a Myotis bat, Eastern China, 2015
  H. Han et al.
• One-Year Retrospective Review of Psychiatric Consultations in Lassa Fever, Southern Nigeria
  E. O. Okogbenin et al.
• SARS-CoV-2 Natural Transmission from Human to Cat, Belgium, March 2020
  M. Garigliany et al. View Abstract Email this Article

  In March 2020, a severe respiratory syndrome developed in a cat, 1 week after its owner received positive test results for severe acute respiratory syndrome coronavirus 2. Viral RNA was detected in the cat’s nasopharyngeal swab samples and vomitus or feces; immunoglobulin against the virus was found in convalescent-phase serum. Human-to-cat transmission is suspected.

• Autochthonous Rat-Borne Seoul Virus Infection with Acute Kidney Injury, Germany, 2018
  J. Hofmann et al.
• Effects of Cocooning on Coronavirus Disease Rates after Relaxing Social Distancing
  X. Wang et al. View Abstract Email this Article

  As coronavirus disease spreads throughout the United States, policymakers are contemplating reinstatement and relaxation of shelter-in-place orders. By using a model capturing high-risk populations and transmission rates estimated from hospitalization data, we found that postponing relaxation will only delay future disease waves. Cocooning vulnerable populations can prevent overwhelming medical surges.

• SARS-CoV-2 in Quarantined Domestic Cats from COVID-19 Households or Close Contacts, Hong Kong, China
  V. R. Barrs et al. View Abstract Email this Article

  We tested 50 cats from coronavirus disease households or close contacts in Hong Kong, China, for severe acute respiratory syndrome coronavirus 2 RNA in respiratory and fecal samples. We found 6 cases of apparent human-to-feline transmission involving healthy cats. Virus genomes sequenced from 1 cat and its owner were identical.

• Pediatric Lyme Disease Biobank, United States, 2015–2020
  L. E. Nigrovic et al.
• Serologic Responses in Healthy Adult with SARS-CoV-2 Reinfection, Hong Kong, August, 2020
  P. Chan et al.

Letters

• Buruli Ulcer
  T. M. Korman et al.
• Proactive Case-Finding and Isolation Are Crucial for Preventing Large SARS-CoV-2 Outbreaks
  A. R. Akhmetzhanov

Research

• Comparative Omics Analysis of Historic and Recent Isolates of Bordetella pertussis and Effects of Genome Rearrangements on Evolution
  A. Dienstbier et al.
• Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States
  S. A. Collier et al.

Dispatches

• Primary Amebic Meningoencephalitis Associated with Recreational Aquatic Exposures, USA, 1978–2018
  R. Gharpure et al.
• In Vivo Observation of Cutaneous Larva Migrans by Fluorescence-Advanced Videodermatoscopy
  A. Ramondetta et al.
• Ocular Filariasis in Human Caused by Breinlia (Johnstonema) annulipapillata, Australia
  A. V. Koehler et al.

Research Letter

• Risk for SARS-CoV-2 Infection in Healthcare Workers, Turin, Italy
  A. Calcagno et al.