Early Release

Perspective

• Reflections on 40 Years of AIDS
  K. M. De Cock et al. View Abstract Email this Article

  June 2021 marks the 40th anniversary of the first description of AIDS. On the 30th anniversary, we defined priorities as improving use of existing interventions, clarifying optimal use of HIV testing and antiretroviral therapy for prevention and treatment, continuing research, and ensuring sustainability of the response. Despite scientific and programmatic progress, the end of AIDS is not in sight. Other major epidemics over the past decade have included Ebola, arbovirus infections, and coronavirus disease (COVID-19). A benchmark against which to compare other global interventions is the HIV/AIDS response in terms of funding, coordination, and solidarity. Lessons from Ebola and HIV/AIDS are pertinent to the COVID-19 response. The fifth decade of AIDS will have to position HIV/AIDS in the context of enhanced preparedness and capacity to respond to other potential pandemics and transnational health threats.

Synopses

• Pertactin-Deficient Bordetella pertussis, Vaccine-Driven Evolution, and Reemergence of Pertussis
  L. Ma et al. View Abstract Email this Article

  Recent reemergence of pertussis (whooping cough) in highly vaccinated populations and rapid expansion of Bordetella pertussis strains lacking pertactin (PRN), a common acellular vaccine antigen, have raised the specter of vaccine-driven evolution and potential return of what was once the major killer of children. The discovery that most circulating B. pertussis strains in the United States have acquired new and independent disruptive mutations in PRN is compelling evidence of strong selective pressure. However, the other 4 antigens included in acellular vaccines do not appear to be selected against so rapidly. We consider 3 aspects of PRN that distinguish it from other vaccine antigens, which might, individually or collectively, explain why only this antigen is being precipitously eliminated. An understanding of the increase in PRN-deficient strains should provide useful information for the current search for new protective antigens and provide broader lessons for the design of improved subunit vaccines.

• Rocky Mountain Spotted Fever in a Large Metropolitan Center, Mexico–United States Border, 2009–2019
  O. E. Zazueta et al.

Research

• Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 IgG in Juba, South Sudan, 2020
  K. E. Wiens et al. View Abstract Email this Article

  Relatively few coronavirus disease cases and deaths have been reported from sub-Saharan Africa, although the extent of its spread remains unclear. During August 10–September 11, 2020, we recruited 2,214 participants for a representative household-based cross-sectional serosurvey in Juba, South Sudan. We found 22.3% of participants had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor binding domain IgG titers above prepandemic levels. After accounting for waning antibody levels, age, and sex, we estimated that 38.3% (95% credible interval 31.8%–46.5%) of the population had been infected with SARS-CoV-2. At this rate, for each PCR–confirmed SARS-CoV-2 infection reported by the Ministry of Health, 103 (95% credible interval 86–126) infections would have been unreported, meaning SARS-CoV-2 has likely spread extensively within Juba. We also found differences in background reactivity in Juba compared with Boston, Massachusetts, USA, where the immunoassay was validated. Our findings underscore the need to validate serologic tests in sub-Saharan Africa populations.

• Molecular Epidemiology and Evolutionary Trajectory of Emerging Echovirus 30, Europe
  K. Benschop et al. View Abstract Email this Article

  In 2018, an upsurge in echovirus 30 (E30) infections was reported in Europe. We conducted a large-scale epidemiologic and evolutionary study of 1,329 E30 strains collected in 22 countries in Europe during 2016–2018. Most E30 cases affected persons 0–4 years of age (29%) and 25–34 years of age (27%). Sequences were divided into 6 genetic clades (G1–G6). Most (53%) sequences belonged to G1, followed by G6 (23%), G2 (17%), G4 (4%), G3 (0.3%), and G5 (0.2%). Each clade encompassed unique individual recombinant forms; G1 and G4 displayed >2 unique recombinant forms. Rapid turnover of new clades and recombinant forms occurred over time. Clades G1 and G6 dominated in 2018, suggesting the E30 upsurge was caused by emergence of 2 distinct clades circulating in Europe. Investigation into the mechanisms behind the rapid turnover of E30 is crucial for clarifying the epidemiology and evolution of these enterovirus infections.

• Macrolide-Resistant Mycoplasma pneumoniae Infections in Children, Ohio, USA
  M. M. Lanata et al. View Abstract Email this Article

  Emergence of macrolide-resistant Mycoplasma pneumoniae (MRMp) challenges empiric macrolide therapy. Our goal was to determine MRMp rates and define characteristics of children infected with macrolide-sensitive M. pneumoniae (MSMp) versus MRMp in Ohio, USA. We cultured PCR-positive M. pneumoniae specimens and sequenced M. pneumoniae–positive cultures to detect macrolide resistance mutations. We reviewed medical records to compare characteristics of both groups. We identified 14 (2.8%) MRMp and 485 (97.2%) MSMp samples. Patients in these groups had similar demographics and clinical characteristics, but patients with MRMp had longer hospitalizations, were more likely to have received previous macrolides, and were more likely to have switched to alternative antimicrobial drugs. MRMp-infected patients also had ≈5-fold greater odds of pediatric intensive care unit admission. Rates of MRMp infections in children in central Ohio are low, but clinicians should remain aware of the risk for severe illness caused by these pathogens.

• Precision Tracing of Household Dengue Spread Using Inter- and Intra-Host Viral Variation Data, Kamphaeng Phet, Thailand
  I. Berry et al. View Abstract Email this Article

  Dengue control approaches are best informed by granular spatial epidemiology of these viruses, yet reconstruction of inter- and intra-household transmissions is limited when analyzing case count, serologic, or genomic consensus sequence data. To determine viral spread on a finer spatial scale, we extended phylogenomic discrete trait analyses to reconstructions of house-to-house transmissions within a prospective cluster study in Kamphaeng Phet, Thailand. For additional resolution and transmission confirmation, we mapped dengue intra-host single nucleotide variants on the taxa of these time-scaled phylogenies. This approach confirmed 19 household transmissions and revealed that dengue disperses an average of 70 m per day between households in these communities. We describe an evolutionary biology framework for the resolution of dengue transmissions that cannot be differentiated based on epidemiologic and consensus genome data alone. This framework can be used as a public health tool to inform control approaches and enable precise tracing of dengue transmissions.

• Association between Birth Region and Time to Tuberculosis Diagnosis among Non–US-Born Persons Entering the United States
  A. Talwar et al.
• Neurologic Disease After Yellow Fever Vaccination, São Paulo, Brazil, 2017–2018
  A. Ribeiro et al.
• HIV Infection as Risk Factor for Death among Hospitalized Persons with Candidemia, South Africa, 2012–2017
  N. P. Govender et al.
• Twenty-Year Public Health Impact of 7- and 13-Valent Pneumococcal Conjugate Vaccines in US Children
  M. Wasserman et al. View Abstract Email this Article

  Pneumococcal conjugate vaccines (PCVs) have been used in the United States since 2000. To assess the cumulative 20-year effect of PCVs on invasive pneumococcal disease (IPD) incidence among children <5 years of age, we analyzed Active Bacterial Core Surveillance data, conducted a literature review, and modeled expected and observed disease. We found that PCVs have averted >282,000 cases of IPD, including ≈16,000 meningitis, ≈172,000 bacteremia, and ≈55,000 bacteremic pneumonia cases. In addition, vaccination has prevented 97 million healthcare visits for otitis media, 438,914–706,345 hospitalizations for pneumonia, and 2,780 total deaths. IPD cases declined 91%, from 15,707 in 1997 to 1,382 in 2019. Average annual visits for otitis media declined 41%, from 78 visits/100 children before PCV introduction to 46 visits/100 children after PCV13 introduction. Annual pneumonia hospitalizations declined 66%–79%, from 110,000–175,000 in 1997 to 37,000 in 2019. These findings confirm the substantial benefits of PCVs for preventing IPD in children.

• Case–Control Study of Risk Factors for Acquired Hepatitis E Virus Infections in Blood Donors, United Kingdom, 2018–2019
  I. Smith et al. View Abstract Email this Article

  Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in England. Substantial yearly increases of autochthonous infections were observed during 2003–2016 and again during 2017–2019. Previous studies associated acute HEV cases with consumption of processed pork products, we investigated risk factors for autochthonous HEV infections in the blood donor population in England. Study participants were 117 HEV RNA–positive blood donors and 564 HEV RNA–negative blood donors. No persons with positive results were vegetarian; 97.4% of persons with positive results reported eating pork products. Consuming bacon (OR 3.0, 95% CI 1.7–5.5; p<0.0001), cured pork meats (OR 3.5, 95% CI 2.2–5.4; p<0.0001), and pigs’ liver (OR 2.9, 95% CI 1.0–8.3; p = 0.04) were significantly associated with HEV infection. Our findings confirm previous links to pork products and suggest that appropriate animal husbandry is essential to reduce the risk for HEV infection.

• Antimicrobial-Resistant Nontyphoidal Salmonella Infections, United States, 2004–2016
  F. Medalla et al.

Dispatches

• Molecular Characterization and Antimicrobial Resistance in Neisseria gonorrhoeae, Nunavut Region of Inuit Nunangat, Canada, 2018–2019
  A. E. Singh et al.
• Cutaneous Leishmaniasis Caused by an Unknown Leishmania Strain in the Subgenus Leishmania (Leishmania), Arizona, USA
  M. de Almeida et al.
• Reemergence of Scabies Driven by Adolescents and Young Adults, Germany, 2009–2018
  F. Reichert et al. View Abstract Email this Article

  To validate anecdotal evidence on scabies infestations, we analyzed inpatient and outpatient claims data in Germany. Scabies diagnoses increased 9-fold and treatment failure 4-fold during 2009–2018, driven mainly by persons 15–24 years of age. Prevention and control in young adults appear key because of these persons’ high mobility and social connectivity.

• Melioidosis in Children, Brazil, 1989–2019
  R. Lima and D. Rolim View Abstract Email this Article

  We studied 20 confirmed or suspected cases of melioidosis in children in Ceará, Brazil, during 1989–2019. We observed a high death rate, severe signs and symptoms, and substantial environmental exposure. These data suggest that childhood melioidosis might be more severe in Brazil than in other regions.

• Epidemiologic Evidence for Airborne Transmission of SARS-CoV-2 during Church Singing, Australia, 2020
  A. L. Katelaris et al. View Abstract Email this Article

  An outbreak of severe acute respiratory syndrome coronavirus 2 infection occurred among church attendees after an infectious chorister sang at multiple services. We detected 12 secondary case-patients. Video recordings of the services showed that case-patients were seated in the same section, up to 15 m from the primary case-patient, without close physical contact, suggesting airborne transmission.

• Rapid Detection of SARS-CoV-2 Variants of Concern, Including B.1.1.28/P.1, in British Columbia, Canada
  N. Matic et al. View Abstract Email this Article

  To screen all severe acute respiratory syndrome coronavirus 2–positive samples in British Columbia, Canada, and determine whether they represented variants of concern, we implemented a real-time reverse transcription PCR–based algorithm. We rapidly identified 77 samples with variants: 57 with B.1.1.7, 7 with B.1.351, and an epidemiologic cluster of 13 with B.1.1.28/P.1.

• Brucellosis Outbreak Traced to Commercially Sold Camel Milk through Whole-Genome Sequencing, Israel
  S. Bardenstein et al.
• Seroepidemiologic Survey of Crimean-Congo Hemorrhagic Fever Virus in Logging Communities, Myanmar
  T. Evans et al. View Abstract Email this Article

  Crimean-Congo hemorrhagic fever virus (CCHFV) is endemic in Asia, infecting many animal hosts, but CCHFV has not been reported in Myanmar. We conducted a seroepidemiologic survey of logging communities in Myanmar and found CCHFV exposure was common (9.8%) and exposure to wild animal blood and body fluids was associated with seropositivity.

• Role of Anopheles stephensi in Malaria Outbreak, Djibouti, 2019
  V. de Santi et al.
• Recurrent Swelling and Microfilaremia Caused by Dirofilaria repens Infection after Travel to India
  L. Huebl et al.
• Serotype-Switch Variant of Multidrug-Resistant Streptococcus pneumoniae Sequence Type 271
  E. M. Scherer et al. View Abstract Email this Article

  We discovered 3 invasive, multidrug-resistant Streptococcus pneumoniae isolates of vaccine-refractory capsular serotype 3 that recently arose within the successful sequence type 271 complex through a serotype switch recombination event. Mapping genomic recombination sites within the serotype 3/sequence type 271 progeny revealed a 55.9-kb donated fragment that encompassed cps3, pbp1a, and additional virulence factors.

• Trends in Viral Respiratory Infections During COVID-19 Pandemic, South Korea
  S. Yum et al. View Abstract Email this Article

  We compared weekly positivity rates of 8 respiratory viruses in South Korea during 2010–2019 and 2020. The overall mean positivity rate for these viruses decreased from 54.7% in 2010–2019 to 39.1% in 2020. Pandemic control measures might have reduced the incidence of many, but not all, viral respiratory infections.

• Ebola Virus IgG Seroprevalence in Southern Mali
  S. Bane et al. View Abstract Email this Article

  Mali had 2 reported introductions of Ebola virus (EBOV) during the 2013–2016 West Africa epidemic. Previously, no evidence for EBOV circulation was reported in Mali. We performed an EBOV serosurvey study in southern Mali. We found low seroprevalence in the population, indicating local exposure to EBOV or closely related viruses.

• Leishmaniases in the European Union and Neighboring Countries
  E. Berriatua et al.

Research Letters

• Changing Molecular Epidemiology of Hepatitis A Virus Infection, United States, 1996–2019
  S. Ramachandran et al. View Abstract Email this Article

  Hepatitis A virus (HAV) genotype IA was most common among strains tested in US outbreak investigations and surveillance during 1996–2015. However, HAV genotype IB gained prominence during 2016–2019 person-to-person multistate outbreaks. Detection of previously uncommon strains highlights the changing molecular epidemiology of HAV infection in the United States.

• Evidence of Oropouche orthobunyavirus Infection, Colombia, 2017
  D. E. Gómez-Camargo et al.
• Highly Pathogenic Avian Influenza A(H5N8) Virus in Swans, China, 2020
  X. Li et al. View Abstract Email this Article

  In October 2020, highly pathogenic avian influenza A(H5N8) viruses were detected in 2 dead swans in Inner Mongolia, China. Genetic analysis showed that the H5N8 isolates belong to clade 2.3.4.4b and that the isolates cluster with the H5N8 viruses isolated in Eurasia in the fall of 2020.

• Multisystem Inflammatory Syndrome in Adults after Mild SARS-CoV-2 Infection, Japan
  Y. Yamada et al. View Abstract Email this Article

  In Japan, a 51-year-old man had minimally symptomatic severe acute respiratory syndrome coronavirus 2 infection. Multisystem inflammatory syndrome was diagnosed ≈5 weeks later; characteristics included severe inflammation, cardiac dysfunction, and IgG positivity. Clinicians should obtain detailed history and examine IgG levels for cases of inflammatory disease with unexplained cardiac decompensation.

• Rapid Antigen Test for Postmortem Evaluation of SARS-CoV-2 Carriage
  M. Zacharias et al. View Abstract Email this Article

  Detecting severe acute respiratory syndrome coronavirus 2 in deceased patients is key when considering appropriate safety measures to prevent infection during postmortem examinations. A prospective cohort study comparing a rapid antigen test with quantitative reverse transcription PCR showed the rapid test’s usability as a tool to guide autopsy practice.

• Novel Incursion of Highly Pathogenic Avian Influenza A(H5N8) Virus, the Netherlands, October 2020
  N. Beerens et al.
• Respiratory Viral Shedding in Healthcare Workers Reinfected with SARS-CoV-2, Brazil, 2020
  M. R. Amorim et al. View Abstract Email this Article

  We documented 4 cases of severe acute respiratory syndrome coronavirus 2 reinfection by non–variant of concern strains among healthcare workers in Campinas, Brazil. We isolated infectious particles from nasopharyngeal secretions during both infection episodes. Improved and continued protection measures are necessary to mitigate the risk for reinfection among healthcare workers.

• Retrospective Identification of Early Autochthonous Case of Crimean-Congo Hemorrhagic Fever, Spain, 2013
  A. Negredo et al.
• Molecular Typing of Burkholderia mallei Isolates from Equids with Glanders, India
  H. Singha et al. View Abstract Email this Article

  We collected 10 Burkholderia mallei isolates from equids in 9 districts in India during glanders outbreaks in 2013–2016. Multilocus variable-number tandem-repeat analysis showed 7 outbreak area–related genotypes. The study highlights the utility of this analysis for epidemiologically tracing of specific B. mallei isolates during outbreaks.

• Atypical Brucella inopinata-like Species in 2 Marine Toads
  R. A. Glabman et al.

Letter

• Postvaccination COVID-19 among Healthcare Workers, Israel
  Z. Yousaf and K. Mushtaq Email this Article

Etymologia

• Etymologia: Enterocytozoon bieneusi
  M. Moniot et al. Email this Article

Online Report

• Proposal for Human Respiratory Syncytial Virus Nomenclature below the Species Level
  V. Salimi et al.

Correction

• Correction: Vol. 26, No. 12
  Email this Article

Synopses

• Industry Sectors Highly Affected by Worksite Outbreaks of Coronavirus Disease, Los Angeles County, California, USA, March 19–September 30, 2020
  Z. Contreras et al.
• Risks and Preventive Strategies for Clostridioides difficile Transmission to Household or Community Contacts during Transition in Healthcare Settings
  R. Asgary et al.

Research

• Severe Acute Respiratory Syndrome Coronavirus 2 P.2 Lineage Associated with Reinfection Case, Brazil, June–October 2020
  P. Resende et al. View Abstract Email this Article

  A 37-year-old healthcare worker from the northeastern region of Brazil experienced 2 clinical episodes of coronavirus disease. Infection with severe acute respiratory syndrome coronavirus 2 was confirmed by reverse transcription PCR in samples collected 116 days apart. Whole-genome sequencing revealed that the 2 infections were caused by the most prevalent lineage in Brazil, B.1.1.33, and the emerging lineage P.2. The first infection occurred in June 2020; Bayesian analysis suggests reinfection at some point during September 14–October 11, 2020, a few days before the second episode of coronavirus disease. Of note, P.2 corresponds to an emergent viral lineage in Brazil that contains the mutation E484K in the spike protein. The P.2 lineage was initially detected in the state of Rio de Janeiro, and since then it has been found throughout the country. Our findings suggest not only a reinfection case but also geographic dissemination of the emerging Brazil clade P.2.

• Novel Morbillivirus as a Putative Cause of Fetal Death and Encephalitis among Swine
  B. Arruda et al.
• Seroprevalence of SARS-CoV-2 among Blood Donors and Changes after Introduction of Public Health and Social Measures, London, England
  G. Amirthalingam et al.
• Whole Genome Analysis of Streptococcus pneumoniae Serotype 4 Causing an Outbreak of Invasive Pneumococcal Disease, Alberta, Canada
  J. D. Kellner et al.
• Triclabendazole Treatment Failure for Fasciola hepatica Infection among Preschool and School-Age Children, Cusco, Peru
  M. L. Morales et al.
• Plasmodium falciparum Kelch 13 Mutations, 9 Countries in Africa, 2014–2018
  S. E. Schmedes et al.
• Susceptibility to SARS-CoV-2 of Well-Differentiated Airway Epithelial Cell Cultures from Domestic and Wild Animals
  M. Gultom et al.
• Effects of Coronavirus Disease Pandemic on Tuberculosis Notifications, Malawi
  R. M. Burke et al.

Dispatches

• COVID-19 Outbreak on a Passenger Ship and Assessment of Response Measures, Greece, 2020
  S. Hatzianastasiou et al.
• Polymicrobial Infections Among Patients with Vascular Q Fever, France, 2014–2020
  M. Puges et al.
• Anthrenus sp. and an Uncommon Cluster of Dermatitis
  L. Simon et al.
• Assessing Community Vulnerability over 3 Waves of COVID-19 Pandemic, Hong Kong, China
  Q. Liao et al.
• Pneumococcal Disease Outbreak at State Prison, Alabama, USA, September 1–October 10, 2018
  G. V. Sanchez et al.
• Cluster of Oseltamivir-Resistant and HA Antigenically Drifted Influenza A(H1N1)pdm09 Viruses, Texas, USA, January 2020
  T. Mohan et al.
• Cross-Sectional Serosurvey of Companion Animals Housed with SARS-CoV-2–Infected Owners, Italy
  B. Colitti et al.
• Prevalence of Middle East Respiratory Coronavirus in Dromedary Camels, Tunisia
  S. Eckstein et al.

Research Letters

• Possible Human-to-Dog Transmission of SARS-CoV-2, Italy, 2020
  N. Decaro et al.
• Outbreak of Rabbit Hemorrhagic Disease Virus 2, Ghana
  A. Ambagala et al.
• Confirmed Cases of Ophidiomycosis in Museum Specimens from as Early as 1945, United States
  J. M. Lorch et al.
• Murine Piroplasm Parasite Anthemosoma garnhami Causing Recrudescing Infection in an HIV-Infected Man from Zimbabwe in South Africa
  D. Stead et al.
• Prolonged SARS-CoV-2 RNA Shedding from Therapy Cat after Cluster Outbreak in Retirement Home
  C. Schulz et al.