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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.

Volume 26, Number 5—May 2020

  • Food Safety and Invasive Cronobacter Infections during Early Infancy, 1961–2018
    J. Strysko et al.
  • Clinical Outcomes of Patients Treated for Candida auris Infections in a Multisite Health System, Illinois, USA
    K. Arensman et al.
  • Mosquito Control Activities During Local Transmission of Zika Virus, Miami-Dade County, Florida, USA, 2016
    J. C. McAllister et al.
  • Epidemiology of Tick-Borne Relapsing Fever in Endemic Area, Spain
    M. Domínguez et al.

    Tick-borne relapsing fever (TBRF) is caused by spirochetes of Borrelia bacteria. We collected data on all TBRF cases in a TBRF-endemic area in southwest Spain during 1994–2016. We analyzed data from 98 patients in whom TBRF was diagnosed by light microscopy and analyzed the relationship between climatic data and TBRF incidence. Most cases occurred a rural environment during summer and autumn. We describe demographic, epidemiologic, clinical, and analytical characteristics, treatment, and occurrence of Jarisch-Herxheimer reaction. Most patients had fever and headache, and laboratory test results included elevated C-reactive protein, thrombocytopenia, and neutrophilia. No patients died, but 10.1% had Jarisch-Herxheimer reaction. B. hispanica was the infecting species in 12 cases with PCR results. Clinicians often do not suspect TBRF because clinical signs and symptoms vary; therefore, it is likely underdiagnosed, even in disease-endemic areas.

  • Surveillance of Leprosy in Kiribati, 1935–2017
    S. T. Chambers et al.

    In Kiribati, unlike most countries, high and increasing numbers of cases of leprosy have been reported despite the availability of multidrug therapy and efforts to improve case finding and management. Historic records show that 28 cases had been identified by 1925. A systematic population survey in 1997 identified 135 new cases; the mean incidence rate for 1993–1997 was 7.4/10,000 population. After administering mass chemoprophylaxis, the country reached the elimination threshold (prevalence <1/10,000), but case numbers have rebounded. The mean annualized rate of new cases in 2013–2017 was 15/10,000 population, with the highest new case rates (>20/10,000 population) in the main population centers of South Tarawa and Betio. Spread is expected to continue in areas where crowding and poor socioeconomic conditions persist and may accelerate as sea levels rise from climate change. New initiatives to improve social conditions are needed, and efforts such as postexposure chemoprophylaxis should be implemented to prevent spread.

  • Biphasic Outbreak of Invasive Group A Streptococcus Disease in Eldercare Facility, New Zealand
    K. A. Worthing et al.

    A 3-month outbreak of invasive group A Streptococcus disease at an eldercare facility, in which 5 persons died, was biphasic. Although targeted chemoprophylaxis contained the initial outbreak, a second phase of the outbreak occurred after infection control processes ended. To retrospectively investigate the genomic epidemiology of the biphasic outbreak, we used whole-genome sequencing and multiple bioinformatics approaches. Analysis of isolates from the outbreak and isolates prospectively collected during the outbreak response indicated a single S. pyogenes emm81 clone among residents and staff members. Outbreak isolates differed from nonoutbreak emm81 isolates by harboring an integrative conjugative genomic element that contained the macrolide resistance determinant erm(TR). This study shows how retrospective high-resolution genomic investigations identified rapid spread of a closed-facilty clonal outbreak that was controlled, but not readily cleared, by infection control management procedures.

  • Systematic Review and Meta-Analysis of Sex Differences in Social Contact Patterns and Implications for Tuberculosis Transmission and Control
    K. C. Horton et al.

    Social contact patterns might contribute to excess burden of tuberculosis in men. We conducted a study of social contact surveys to evaluate contact patterns relevant to tuberculosis transmission. Available data describe 21 surveys in 17 countries and show profound differences in sex-based and age-based patterns of contact. Adults reported more adult contacts than children. Children preferentially mixed with women in all surveys (median sex assortativity 58%, interquartile range [IQR] 57%–59% for boys, 61% [IQR 60%–63%] for girls). Men and women reported sex-assortative mixing in 80% and 95% of surveys (median sex assortativity 56% [IQR 54%–58%] for men, 59% [IQR 57%–63%] for women). Sex-specific patterns of contact with adults were similar at home and outside the home for children; adults reported greater sex assortativity outside the home in most surveys. Sex assortativity in adult contacts likely contributes to sex disparities in adult tuberculosis burden by amplifying incidence among men.

  • Effectiveness of Live Poultry Market Interventions on Human Infection with Avian Influenza A(H7N9) Virus, China
    W. Wang et al.

    Various interventions for live poultry markets (LPMs) have emerged to control outbreaks of avian influenza A(H7N9) virus in mainland China since March 2013. We assessed the effectiveness of various LPM interventions in reducing transmission of H7N9 virus across 5 annual waves during 2013–2018, especially in the final wave. With the exception of waves 1 and 4, various LPM interventions reduced daily incidence rates significantly across waves. Four LPM interventions led to a mean reduction of 34%–98% in the daily number of infections in wave 5. Of these, permanent closure provided the most effective reduction in human infection with H7N9 virus, followed by long-period, short-period, and recursive closures in wave 5. The effectiveness of various LPM interventions changed with the type of intervention across epidemics. Permanent LPM closure should be considered to maintain sufficient effectiveness of interventions and prevent the recurrence of H7N9 epidemics.

  • Zika Virus Circulation in Mali
    I. Diarra et al.
  • Epidemiologic and Clinical Progression of Lobomycosis among Kaiabi Indians, Brazil, 1965–2019
    M. C. Florian et al.

    Lobomycosis is a rare granulomatous skin disease with a high prevalence in the Amazon region. The Kaiabi Indians are an especially affected group. We studied the current epidemiologic and clinical progression of lobomycosis among the Kaiabi in Brazil, from initial case reports in 1965 through 2019. A total of 60 lobomycosis cases had been reported among the Kaiabi, and we identified 3 new cases in our review. Of 550 cases of lobomycosis ever reported worldwide, 11.5% were among the Kaiabi. We note a high incidence among female Kaiabi and a precocious onset of disease in this indigenous population. Male Kaiabi frequently are infected with the multicentric form and women more frequently exhibit the localized form. Ulcerated lesions are observed more often in the multicentric form. The prevalence among this indigenous group could be explained by genetic susceptibility and lifestyle, which exposes them to a particular agent in the habitats in which they live.

  • Nationwide Monitoring for Plasmodium falciparum Drug-Resistance Alleles to Chloroquine, Sulfadoxine, and Pyrimethamine, Haiti, 2016–2017
    E. Rogier et al.

    Haiti is striving for zero local malaria transmission by the year 2025. Chloroquine remains the first-line treatment, and sulfadoxine/pyrimethamine (SP) has been used for mass drug-administration pilot programs. In March 2016, nationwide molecular surveillance was initiated to assess molecular resistance signatures for chloroquine and SP. For 778 samples collected through December 2017, we used Sanger sequencing to investigate putative resistance markers to chloroquine (Pfcrt codons 72, 74, 75, and 76), sulfadoxine (Pfdhps codons 436, 437, 540, 581, 613), and pyrimethamine (Pfdhfr codons 50, 51, 59, 108, 164). No parasites harbored Pfcrt point mutations. Prevalence of the Pfdhfr S108N single mutation was 47%, and we found the triple mutant Pfdhfr haplotype (108N, 51I, and 59R) in a single isolate. We observed no Pfdhps variants except in 1 isolate (A437G mutation). These data confirm the lack of highly resistant chloroquine and SP alleles in Haiti and support the continued use of chloroquine and SP.

  • Possible Transmission Mechanisms of Mixed-Strain Mycobacterium tuberculosis in High HIV-Prevalence Country, Botswana
    Y. Baik et al.
  • Rhizopus microsporus Infections Associated with Surgical Procedures, Argentina, 2006–2014
    J. R. Bowers et al.
  • Blastomycosis in Minnesota, USA, 1999–2018
    M. Ireland et al.
  • Effects of Air Pollution and Other Environmental Exposures on Estimates of Severe Influenza Illness, Washington, USA
    R. Somayaji et al.

    Ecologic models of influenza burden may be confounded by other exposures that share winter seasonality. We evaluated the effects of air pollution and other environmental exposures in ecologic models estimating influenza-associated hospitalizations. We linked hospitalization data, viral surveillance, and environmental data, including temperature, relative humidity, dew point, and fine particulate matter for 3 counties in Washington, USA, for 2001–2012. We used negative binomial regression models to estimate the incidence of influenza-associated respiratory and circulatory (RC) hospitalizations and to assess the effect of adjusting for environmental exposures on RC hospitalization estimates. The modeled overall incidence rate of influenza-associated RC hospitalizations was 31/100,000 person-years. The environmental parameters were statistically associated with RC hospitalizations but did not appreciably affect the event rate estimates. Modeled influenza-associated RC hospitalization rates were similar to published estimates, and inclusion of environmental covariates in the model did not have a clinically important effect on severe influenza estimates.

Policy Review
  • Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures
    J. Xiao et al.

    There were 3 influenza pandemics in the 20th century, and there has been 1 so far in the 21st century. Local, national, and international health authorities regularly update their plans for mitigating the next influenza pandemic in light of the latest available evidence on the effectiveness of various control measures in reducing transmission. Here, we review the evidence base on the effectiveness of nonpharmaceutical personal protective measures and environmental hygiene measures in nonhealthcare settings and discuss their potential inclusion in pandemic plans. Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza. We similarly found limited evidence on the effectiveness of improved hygiene and environmental cleaning. We identified several major knowledge gaps requiring further research, most fundamentally an improved characterization of the modes of person-to-person transmission.

  • Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Social Distancing Measures
    M. W. Fong et al.

    Influenza virus infections are believed to spread mostly by close contact in the community. Social distancing measures are essential components of the public health response to influenza pandemics. The objective of these mitigation measures is to reduce transmission, thereby delaying the epidemic peak, reducing the size of the epidemic peak, and spreading cases over a longer time to relieve pressure on the healthcare system. We conducted systematic reviews of the evidence base for effectiveness of multiple mitigation measures: isolating ill persons, contact tracing, quarantining exposed persons, school closures, workplace measures/closures, and avoiding crowding. Evidence supporting the effectiveness of these measures was obtained largely from observational studies and simulation studies. Voluntary isolation at home might be a more feasible social distancing measure, and pandemic plans should consider how to facilitate this measure. More drastic social distancing measures might be reserved for severe pandemics.

  • Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures
    S. Ryu et al.

    International travel–related nonpharmaceutical interventions (NPIs), which can include traveler screening, travel restrictions, and border closures, often are included in national influenza pandemic preparedness plans. We performed systematic reviews to identify evidence for their effectiveness. We found 15 studies in total. Some studies reported that NPIs could delay the introduction of influenza virus. However, no available evidence indicated that screening of inbound travelers would have a substantial effect on preventing spread of pandemic influenza, and no studies examining exit screening were found. Some studies reported that travel restrictions could delay the start of local transmission and slow international spread, and 1 study indicated that small Pacific islands were able to prevent importation of pandemic influenza during 1918–19 through complete border closure. This limited evidence base indicates that international travel-related NPIs would have limited effectiveness in controlling pandemic influenza and that these measures require considerable resources to implement.

  • Women’s Awareness and Healthcare Provider Discussions about Zika Virus during Pregnancy, United States, 2016–2017
    L. Williams et al.
  • A Neighbor-Based Approach to Identify Tuberculosis Exposure, Africa
    P. K. Moonan et al.
  • Genetic Characterization of Japanese Encephalitis Virus Genotype 5 Isolated from Patient, South Korea, 2015
    J. Woo et al.
  • Candidatus Rickettsia xinyangensis as Cause of Spotted Fever Group Rickettsiosis, Xinyang, China, 2015
    H. Li et al.

    In 2015, we evaluated 221 patients with undifferentiated fever and tick bite or animal exposure in Xinyang, China, for Rickettsia infection. Three with mild disease were infected with Candidatus R. xinyangensis, which clustered with R. fournieri and R. vini in phylogenetic analyses. Field investigations suggest Haemaphysalis longicornis ticks might be involved in transmission.

  • Capybara and Brush Cutter Involvement in Q Fever Outbreak in Remote Area of Amazon Rain Forest, French Guiana, 2014
    J. Christen et al.

    We investigated a Q fever outbreak that occurred in an isolated area of the Amazon Rain Forest in French Guiana in 2014. Capybara fecal samples were positive for Coxiella burnetii DNA. Being near brush cutters in use was associated with disease development. Capybaras are a putative reservoir for C. burnetii.

  • Update on Ebola Treatment Center Costs and Sustainability, United States, 2019
    J. J. Herstein et al.

    We surveyed 56 Ebola treatment centers (ETCs) in the United States and identified costs incurred since 2014 ($1.76 million/ETC) and sustainability strategies. ETCs reported heavy reliance on federal funding. It is uncertain if, or for how long, ETCs can maintain capabilities should federal funding expire in 2020.

  • Species Distribution and Isolation Frequency of Nontuberculous Mycobacteria, Uruguay
    G. Greif et al.
  • Pretreatment Out-of-Pocket Expenses for Presumptive Multidrug-Resistant Tuberculosis Patients, India, 2016–2017
    P. Rathi et al.

    In India, under the National Tuberculosis Elimination Programme, the government provides free treatment for multidrug-resistant tuberculosis; however, many patients seek care elsewhere, which is costly. To determine those out-of-pocket expenses, we interviewed 40 presumptive patients and found that they spent more than their median annual income before registering for the government program.

Research Letters
  • Antibodies against Crimean-Congo Hemorrhagic Fever Virus in Livestock, Corsica Island, France, 2014–2016
    S. Grech-Angelini et al.
  • Risk for Transportation of 2019 Novel Coronavirus Disease from Wuhan to Other Cities in China
    Z. Du et al.

    On January 23, 2020, China quarantined Wuhan to contain 2019 novel coronavirus disease (COVID-19). We estimated the probability of transportation of COVID-19 from Wuhan to 369 other cities in China before the quarantine. Expected COVID-19 risk is >50% in 130 (95% CI 89–190) cities and >99% in the 4 largest metropolitan areas.

  • MDR Salmonella Serotype Anatum in Travelers and Seafood Imported from Asia, USA
    B. E. Karp et al.
  • Average Hepatitis A Hospitalization Costs, United States, 2016
    M. G. Hofmeister et al.
  • Case of Babesia crassa-like Infection, Slovenia
    K. Smrdel et al.
  • Crimean-Congo Hemorrhagic Fever Virus Endemicity in United Arab Emirates, 2019
    J. V. Camp et al.

    We conducted a cross-sectional survey of Crimean-Congo hemorrhagic fever virus (CCHFV) in dromedary camels and attached ticks at 3 locations in the United Arab Emirates. Results revealed a high prevalence of CCHFV-reactive antibodies in camels and viral RNA in ticks and camel serum, suggesting the virus is endemic in this country.

  • Serologic Detection of Middle East Respiratory Syndrome Coronavirus Functional Antibodies
    N. Okba et al.

    We developed and validated 2 species-independent protein-based assays to detect Middle East respiratory syndrome coronavirus functional antibodies that can block virus receptor-binding or sialic acid-attachment. Antibody levels measured in both assays correlated strongly with virus-neutralizing antibody titers, proving their use for serologic confirmatory diagnosis of Middle East respiratory syndrome.

  • Zika Inquiries Made to the CDC-INFO System, December 2015–September 2017
    T. Sell et al.

    We examined Zika-related inquiries to CDC-INFO, the national contact center for the Centers for Disease Control and Prevention, to identify potential communication gaps. The most frequently asked questions related to travel or geographic location of Zika (42% of all inquiries), information about laboratory testing (13%), or acquiring a Zika test (11%).

  • Rise in Murine Typhus in Galveston County, Texas, USA, 2018
    K. Ruiz et al.
  • Potential Presymptomatic Transmission of SARS-CoV-2, Zhejiang Province, China, 2020
    Z. Tong et al.

    We report a 2-family cluster of persons infected with severe acute respiratory syndrome coronavirus 2 in the city of Zhoushan, Zhejiang Province, China, during January 2020. The infections resulted from contact with an infected but potentially presymptomatic traveler from the city of Wuhan in Hubei Province.

  • Fatal Rodentborne Leptospirosis in Prison Inmates, South Africa, 2015
    K. Naidoo et al.
  • Novel Ehrlichia Strain Infecting Cattle Tick Amblyomma neumanni, Argentina, 2018
    L. Fargnoli et al.

    In 2018, we detected a novel Ehrlichia strain infecting Amblyomma neumanni ticks in Argentina. The novel strain is phylogenetically related to the ruminant pathogen E. ruminantium and represents a potential risk for veterinary and public health because A. neumanni ticks parasitize domestic and wild ruminants and bite humans.

  • Diplorickettsia Bacteria in an Ixodes scapularis Tick, Vermont, USA
    C. Merenstein et al.
Books and Media
  • Superbugs: the Race to Stop an Epidemic
    A. Read


Volume 26, Number 6—June 2020

  • Identifying and Interrupting Superspreading Events—Implications for Control of Severe Acute Respiratory Syndrome Coronavirus 2
    T. R. Frieden and C. T. Lee

    It appears inevitable that severe acute respiratory syndrome coronavirus 2 will continue to spread. Although we still have limited information on the epidemiology of this virus, there have been multiple reports of superspreading events (SSEs), which are associated with both explosive growth early in an outbreak and sustained transmission in later stages. Although SSEs appear to be difficult to predict and therefore difficult to prevent, core public health actions can prevent and reduce the number and impact of SSEs. To prevent and control of SSEs, speed is essential. Prevention and mitigation of SSEs depends, first and foremost, on quickly recognizing and understanding these events, particularly within healthcare settings. Better understanding transmission dynamics associated with SSEs, identifying and mitigating high-risk settings, strict adherence to healthcare infection prevention and control measures, and timely implementation of nonpharmaceutical interventions can help prevent and control severe acute respiratory syndrome coronavirus 2, as well as future infectious disease outbreaks.

  • Genomic Epidemiology of 2015–2016 Zika Virus Outbreak in Cape Verde
    O. Faye et al.
  • Risks Related to Chikungunya Infections among European Union Travelers, 2012–2018
    C. M. Gossner et al.
  • Manifestations of Toxic Shock Syndrome in Children, Columbus, Ohio, USA, 2010–2017
    A. Cook et al.
  • Pharmacologic Treatments and Supportive Care for Middle East Respiratory Syndrome
    T. Kain et al.

    Available animal and cell line models have suggested that specific therapeutics might be effective in treating Middle East respiratory syndrome (MERS). We conducted a systematic review of evidence for treatment with pharmacologic and supportive therapies. We developed a protocol and searched 5 databases for studies describing treatment of MERS and deaths in MERS patients. Risk of bias (RoB) was assessed by using ROBINS-I tool. We retrieved 3,660 unique citations; 20 observational studies met eligibility, and we studied 13 therapies. Most studies were at serious or critical RoB; no studies were at low RoB. One study, at moderate RoB, showed reduced mortality rates in severe MERS patients with extracorporeal membrane oxygenation; no other studies showed a significant lifesaving benefit to any treatment. The existing literature on treatments for MERS is observational and at moderate to critical RoB. Clinical trials are needed to guide treatment decisions.

  • Endemic Chromoblastomycosis Caused Predominantly by Fonsecaea nubica, Madagascar
    T. Rasamoelina et al.
  • Zoonotic Alphaviruses in Fatal and Neurologic Infections in Wildlife and Nonequine Domestic Animals, South Africa
    J. Steyn et al.
  • Invasive Group B Streptococcus Infections in Adults, England, 2015–2016
    S. M. Collin et al.
  • Failures of 13-Valent Conjugated Pneumococcal Vaccine in Age-Appropriately Vaccinated Children 2–59 Months of Age
    S. Hernández et al.
  • Severe Acute Respiratory Syndrome Coronavirus 2 from Patient with 2019 Novel Coronavirus Disease, United States
    J. Harcourt et al.

    The etiologic agent of an outbreak of pneumonia in Wuhan, China, was identified as severe acute respiratory syndrome coronavirus 2 in January 2020. A patient in the United States was given a diagnosis of infection with this virus by the state of Washington and the US Centers for Disease Control and Prevention on January 20, 2020. We isolated virus from nasopharyngeal and oropharyngeal specimens from this patient and characterized the viral sequence, replication properties, and cell culture tropism. We found that the virus replicates to high titer in Vero-CCL81 cells and Vero E6 cells in the absence of trypsin. We also deposited the virus into 2 virus repositories, making it broadly available to the public health and research communities. We hope that open access to this reagent will expedite development of medical countermeasures.

  • Estimating Risk for Death from 2019 Novel Coronavirus Disease, China, January–February 2020
    K. Mizumoto and G. Chowell

    Since December 2019, when the first case of 2019 novel coronavirus disease (COVID-19) was identified in the city of Wuhan in the Hubei Province of China, the epidemic has generated tens of thousands of cases throughout China. As of February 28, 2020, the cumulative number of reported deaths in China was 2,858. We estimated the time-delay adjusted risk for death from COVID-19 in Wuhan, as well as for China excluding Wuhan, to assess the severity of the epidemic in the country. Our estimates of the risk for death in Wuhan reached values as high as 12% in the epicenter of the epidemic and ≈1% in other, more mildly affected areas. The elevated death risk estimates are probably associated with a breakdown of the healthcare system, indicating that enhanced public health interventions, including social distancing and movement restrictions, should be implemented to bring the COVID-19 epidemic under control.

  • Epidemiology of 2019 Novel Coronavirus Disease-19 in Gansu Province, China, 2020
    J. Fan et al.

    To determine the epidemiology of 2019 novel coronavirus disease (COVID-19) in a remote region of China, far from Wuhan, we analyzed the epidemiology of COVID-19 in Gansu Province. From January 23 through February 3, 2020, a total of 35 (64.8%) of 54 reported cases were imported from COVID-19–epidemic areas. Characteristics that differed significantly during the first and second waves of illness in Gansu Province were mean patient age, occupation, having visited epidemic areas, and mode of transportation. Time from infection to illness onset for family clusters was shorter in Gansu Province than in Wuhan, consistent with shortened durations from onset to first medical visit or hospitalization. Spatial distribution pattern analysis indicated hot spots and spatial outliers in Gansu Province. As a result of adequate interventions, transmission of the COVID-19 virus in Gansu Province is decreasing.

  • Temporary Fertility Decline after a Large Rubella Outbreak, Japan
    K. Mizumoto and G. Chowell
  • Characterization of Sporadic Creutzfeldt-Jakob Disease and History of Neurosurgery to Identify Potential Iatrogenic Cases
    T. Hamaguchi et al.
  • Statin Use and Influenza Vaccine Effectiveness in Persons >65 Years of Age, Taiwan
    L. Tsai et al.
  • Unexpected Genetic Diversity and Emergence of New Non-CG258 High-Risk Clones among KPC-Producing Klebsiella pneumoniae, France
    R. A. Bonnin et al.
  • Increased Risk for Carbapenem-Resistant Enterobacteriaceae Colonization in Intensive Care Units
    M. Salomão et al.
  • Antimicrobial Resistance in Salmonella enterica Serovar Paratyphi B Variant Java in Poultry from Europe and Latin America
    L. Castellanos et al.
  • Multihost Transmission of Schistosoma mansoni in Senegal
    S. Catalano et al.
  • Distribution of Group A Streptococcus Pharyngitis and Acute Rheumatic Fever, Auckland, New Zealand, 2010–2016
    J. Oliver et al.
  • Ectoparasites and Vectorborne Zoonotic Pathogens of Dogs and Cats in Asia, 2017–2018
    V. Colella et al.
  • Radical Change in Zoonotic Abilities of Atypical BSE Prion Strains as Evidenced by Crossing of Sheep Species Barrier in Transgenic Mice
    A. Marín-Moreno et al.
Historical Review
  • Syphilis in Maria Salviati (1499–1543), Wife of Giovanni de’ Medici of the Black Bands
    A. Fornaciari et al.
  • Leishmania infantum in Tigers and Sand Flies from a Leishmaniasis-Endemic Area, Southern Italy
    R. Iatta et al.
  • Melioidosis in a Resident of Texas with No Recent Travel History, United States
    C. M. Cossaboom et al.
  • High Prevalence of Escherichia albertii in Raccoons (Procyon lotor), Japan
    A. Hinenoya et al.
  • Cannabis Use and Fungal Infections in a Commercially Insured Population, United States, 2016
    K. Benedict et al.
  • Origin of 3 Rabid Terrestrial Animals in Raccoon Rabies-Free Zone, Long Island, New York, USA, 2016–2017
    S. Brunt et al.
  • Community Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, Shenzhen, China, 2020
    J. Liu et al.

    Since early January 2020, after the outbreak of 2019 novel coronavirus infection in Wuhan, China, ≈365 confirmed cases have been reported in Shenzhen, China. The mode of community and intrafamily transmission is threatening residents in Shenzhen. Strategies to strengthen prevention and interruption of these transmissions should be urgently addressed.

  • No Adaption of the Prion Strain in a Heterozygous Case of Variant Creutzfeldt-Jakob Disease
    A. Boyle et al.
  • Yaws Disease Caused by Treponema pallidum subsp. pertenue in Wild chimpanzee (Pan troglodytes verus), Guinea, 2019
    B. Mubemba et al.
Research Letters
  • Serial Interval of COVID-19 among Publicly Reported Confirmed Cases
    Z. Du et al.

    We estimate the distribution of serial intervals for 468 confirmed cases of 2019 novel coronavirus disease reported in China as of February 8, 2020. The mean interval was 3.96 days (95% CI 3.53–4.39 days), SD 4.75 days (95% CI 4.46–5.07 days); 12.6% of case reports indicated presymptomatic transmission.

  • COVID-19 in 2 Persons with Mild Upper Respiratory Tract Symptoms on a Cruise Ship, Japan
    T. Arashiro et al.

    We describe 2 cases of COVID-19 in patients with mild upper respiratory symptoms. Both patients worked on a cruise ship quarantined off the coast of Japan. One patient had persistent, low-grade upper respiratory tract symptoms without fever. The other patient had rapid symptom cessation but persistent viral RNA detection.

  • Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China
    Y. Li et al.

    A woman with 2019 novel coronavirus disease in her 35th week of pregnancy delivered an infant by cesarean section in a negative-pressure operating room. The infant was negative for severe acute respiratory coronavirus 2. This case suggests that mother-to-child transmission is unlikely for this virus.

  • Detection of Novel Coronavirus by RT-PCR in Stool Specimen from Asymptomatic Child, China
    A. Tang et al.

    We report an asymptomatic child who was positive for a 2019 novel coronavirus by reverse transcription PCR in a stool specimen 17 days after the last virus exposure. The child was virus positive in stool specimens for at least an additional 9 days. Respiratory tract specimens were negative by reverse transcription PCR.

  • Co-infection with SARS-CoV-2 and Influenza A Virus in Patient with Pneumonia, China
    X. Wu et al.

    We report co-infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza A virus in a patient with pneumonia in China. The case highlights possible co-detection of known respiratory viruses. We noted low sensitivity of upper respiratory specimens for SARS-CoV-2, which could further complicate recognition of the full extent of disease.

  • Case-Fatality Risk Estimates for COVID-19 Calculated by Using a Lag Time for Fatality
    N. Wilson et al.

    We estimated the case-fatality risk for 2019 novel coronavirus disease cases in China (3.5%); China, excluding Hubei Province (0.8%); 82 countries, territories, and areas (4.2%); and on a cruise ship (0.6%). Lower estimates might be closest to the true value, but a broad range of 0.25%–3.0% probably should be considered.

  • Indirect Virus Transmission in Cluster of COVID-19 Cases, Wenzhou, China, 2020
    J. Cai et al.

    To determine possible modes of virus transmission, we investigated a cluster of COVID-19 cases associated with a shopping mall in Wenzhou, China. Data indicated that indirect transmission of the causative virus occurred, perhaps resulting from virus contamination of common objects, virus aerosolization in a confined space, or spread from asymptomatic infected persons.

  • Donor-Derived Transmission of Cryptococcus gattii sensu lato in Kidney Transplant Tecipients
    D. Santos et al.
  • Sabiá-like Mammarenavirus in Patient with Fatal Hemorrhagic Fever, Brazil, 2020
    F. de Mello Malta et al.
  • Incursions of Candida auris into Australia, 2018
    C. R. Lane et al.

    Candida auris is an emerging global healthcare-associated pathogen. During July–December 2018, four patients with C. auris were identified in Victoria, Australia, all with previous overseas hospitalization. Phylogenetic analysis revealed putative transmission between 2 patients and suspected overseas acquisition in the others. Vigilant screening of at-risk patients is required.

Books and Media
  • The Pandemic Century: One Hundred Years of Panic, Hysteria, and Hubris
    N. M. M’ikanatha


Volume 26, Number 7—July 2020

  • Case Manifestations and Public Health Response for Outbreak of Meningococcal W Disease, Central Australia
    E. L. Sudbury et al.
  • Macrolide-Resistant Mycoplasma pneumoniae Infections in Pediatric Community-Acquired Pneumonia
    Y. Chen et al.
  • Identifying Locations with Possible Undetected Imported Severe Acute Respiratory Syndrome Coronavirus 2 Cases by Using Importation Predictions
    P. De Salazar et al.

    Cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection exported from mainland China could lead to self-sustained outbreaks in other countries. By February 2020, several countries were reporting imported SARS-CoV-2 cases. To contain the virus, early detection of imported SARS-CoV-2 cases is critical. We used air travel volume estimates from Wuhan, China, to international destinations and a generalized linear regression model to identify locations that could have undetected imported cases. Our model can be adjusted to account for exportation of cases from other locations as the virus spreads and more information on importations and transmission becomes available. Early detection and appropriate control measures can reduce the risk for transmission in all locations.

  • Atypical Manifestations of Cat-Scratch Disease, United States, 2005–2014
    C. C. Nawrocki et al.
  • Severe Acute Respiratory Syndrome Coronavirus 2−Specific Antibody Responses in 2019 Novel Coronavirus Disease Patients
    N. Okba et al.
  • Bat and Lyssavirus Exposure among Humans in Region that Celebrates a Bat Festival, Nigeria, 2010 and 2013
    N. M. Vora et al.
  • Higher than Initially Estimated Transmission Potential of Severe Acute Respiratory Syndrome Coronavirus 2
    S. Sanche et al.
Policy Review
  • Policy Decisions and Use of Information Technology to Fight 2019 Novel Coronavirus Disease, Taiwan
    C. Lin et al.

    Because of its proximity to and frequent travelers to and from China, Taiwan faces complex challenges in preventing 2019 novel coronavirus disease (COVID-19). As soon as China reported the unidentified outbreak to the World Health Organization on December 31, 2019, Taiwan assembled a taskforce and began health checks onboard flights from Wuhan. Taiwan’s rapid implementation of disease prevention measures helped detect and isolate the country’s first COVID-19 case on January 20, 2020. Laboratories in Taiwan developed 4-hour test kits and isolated 2 strains of the coronavirus before February. Taiwan effectively delayed and contained community transmission by leveraging experience from the 2003 severe acute respiratory syndrome outbreak, prevalent public awareness, a robust public health network, support from healthcare industries, cross-departmental collaborations, and advanced information technology capacity. We analyze use of the National Health Insurance database and critical policy decisions made by Taiwan’s government during the first 50 days of the COVID-19 outbreak.

  • Early Introduction of Severe Acute Respiratory Syndrome Coronavirus 2 into Europe
    S. J. Olsen et al.

    Early infections with severe acute respiratory syndrome coronavirus 2 in Europe were detected in travelers from Wuhan, China, in January 2020. In 1 tour group, 5 of 30 members were ill; 3 cases were laboratory confirmed. In addition, a healthcare worker was infected. This event documents early importation and subsequent spread of the virus in Europe.

  • Shuni Virus in Wildlife and Nonequine Domestic Animals, South Africa
    J. Steyn et al.
  • Approach to Cataract in an Ebola Virus Disease Survivor with Prior Ocular Viral Persistence: Phacoemulsification Surgery, Lens Biopsy, and Laboratory Analyses
    J. R. Wells et al.
  • Transmission of Legionnaires’ Disease through Toilet Flushing
    J. Couturier et al.
  • Clinical Characteristics of Patients Hospitalized with 2019 Novel Coronavirus Disease, Thailand
    W. A. Pongpirul et al.
  • Clinical Management Using Ribavirin and Favipiravir for Containment of Argentine Hemorrhagic Fever, Belgium, 2020
    I. Veliziotis et al.
Research Letters
  • Zika Virus Detection with 2013 Serosurvey, Mombasa, Kenya
    E. Hunsperger et al.
  • Rhabdomyolysis as Potential Late Complication Associated with COVID-19
    M. Jin and Q. Tong

    We describe a patient in Wuhan, China, with severe acute respiratory syndrome coronavirus 2 infection who had progressive pulmonary lesions and rhabdomyolysis with manifestations of lower limb pain and fatigue. Rapid clinical recognition of rhabdomyolysis symptoms in patients with severe acute respiratory syndrome coronavirus 2 infection can be lifesaving.

  • Human Case of Severe Fever with Thrombocytopenia Syndrome Virus Infection, Taiwan, 2019
    S. Peng et al.
  • Public Mental Health Crisis during COVID-19 Pandemic, China
    L. Dong and J. Bouey

    The 2019 novel coronavirus disease emerged in China in late 2019–early 2020 and spread rapidly. China has been implementing emergency psychological crisis interventions to reduce the negative psychosocial impact on public mental health, but challenges exist. Public mental health interventions should be formally integrated into public health preparedness and emergency response plans.

  • Mycobacterium bovis Pulmonary Tuberculosis following Ritual Sheep Sacrifice, Tunisia
    J. Saad et al.
  • Asymptomatic and Human-to-Human Transmission of SARS-CoV-2 in a 2-Family Cluster, Xuzhou, China
    C. Li et al.

    We report epidemiologic, laboratory, and clinical findings for 7 patients with 2019 novel coronavirus disease in a 2-family cluster. Our study confirms asymptomatic and human-to-human transmission through close contacts in familial and hospital settings. These findings might also serve as a practical reference for clinical diagnosis and medical treatment.

  • Detection and Characterization of New Coronavirus in Bottlenose Dolphin, United States, 2019
    L. Wang et al.
  • Severe Acute Respiratory Syndrome Coronavirus 2 RNA Detected in Blood Donations
    L. Chang et al.

    Because of high rates of 2019 novel coronavirus disease in Wuhan, China, Wuhan Blood Center began screening for severe acute respiratory syndrome coronavirus 2 RNA on January 25, 2020. We screened donations in real-time and retrospectively and found plasma samples positive for viral RNA from 4 asymptomatic donors.

  • Severe Acute Respiratory Syndrome Coronavirus 2 Shedding by Travelers, Vietnam, 2020
    T. Le et al.

    We analyzed 2 clusters of 12 patients in Vietnam with severe acute respiratory syndrome coronavirus 2 infection during January–February 2020. Analysis indicated virus transmission from a traveler from China. One asymptomatic patient demonstrated virus shedding, indicating potential virus transmission in the absence of clinical signs and symptoms.

  • COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020
    J. Lu et al.

    During January 26–February 10, 2020, an outbreak of 2019 novel coronavirus disease in an air-conditioned restaurant in Guangzhou, China, involved 3 family clusters. The airflow direction was consistent with droplet transmission. To prevent the spread of the virus in restaurants, we recommend increasing the distance between tables and improving ventilation.


Volume 26, Number 8—August 2020

  • Epidemiology of Legionnaires’ Disease, Hong Kong, China, 2005−2015
    Y. Leung 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.
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