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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 1—January 2020

  • Candidatus Mycoplasma haemohominis in Human, Japan
    N. Hattori et al.
  • Spatial Epidemiologic Trends and Hotspots of Leishmaniasis, Sri Lanka, 2001–2018
    N. D. Karunaweera et al.
  • Nutritional Care for Patients with Ebola Virus Disease
    M. Ververs and M. Gabra

    During the Ebola virus disease (EVD) outbreak of 2014–2016 in West Africa, practitioners faced challenges providing nutritional care for patients in Ebola treatment units (ETUs). The current EVD outbreak in the Democratic Republic of the Congo demonstrates the need to understand lessons learned from previous outbreaks and to update nutritional guidelines. We conducted a literature review to identify articles that included nutrition as an integral part of supportive care. We found little information on the specific nutritional care or practical challenges within an ETU. This review showed that nutritional care for EVD patients is poorly described, and therefore the optimal composition and implementation of nutritional care remain unknown. We recommend that researchers and practitioners share specific and practical details of their experiences in providing nutrition support within ETUs to expand the knowledge base and ultimately improve the nutritional care for an increasingly prevalent patient population.

  • Paid Leave and Access to Telework as Work Attendance Determinants during Acute Respiratory Illness, United States, 2017–2018
    F. Ahmed et al.
  • Elephant Endotheliotropic Herpesvirus Hemorrhagic Disease in Asian Elephant Calves in Logging Camps, Myanmar
    Z. Oo et al.

    In recent years, an alarming number of cases of lethal acute hemorrhagic disease have occurred in Asian elephant calves raised in logging camps in Myanmar. To determine whether these deaths were associated with infection by elephant endotheliotropic herpesvirus (EEHV), we conducted diagnostic PCR subtype DNA sequencing analysis on necropsy tissue samples collected from 3 locations. We found that EEHV DNA from 7 PCR loci was present at high levels in all 3 calves and was the same EEHV1A virus type that has been described in North America, Europe, and other parts of Asia. However, when analyzed over 5,610 bp, the strains showed major differences from each other and from all previously characterized EEHV1A strains. We conclude that these 3 elephant calves in Myanmar died from the same herpesvirus disease that has afflicted young Asian elephants in other countries over the past 20 years.

  • High Azole Resistance in Aspergillus fumigatus Isolates from Strawberry Fields, China, 2018
    Y. Chen et al.

    In 2018, we conducted a cross-sectional study to investigate azole resistance in environmental Aspergillus fumigatus isolates obtained from different agricultural fields in China. Using 63 soil cores, we cultured for azole-resistant A. fumigatus and characterized isolates by their cyp51A gene type, short tandem repeat genotype, and mating type. Of 206 A. fumigatus isolates, 21 (10.2%) were azole resistant. Nineteen of 21 had mutations in their cyp51A gene (5 TR34/L98H, 8 TR34/L98H/S297T/F495I, 6 TR46/Y121F/T289A). Eighteen were cultured from soil samples acquired from strawberry fields, suggesting this soil type is a potential hotspot for azole resistance selection. Twenty resistant isolates were mating type MAT1-1, suggesting asexual sporulation contributed to their evolution. Prochloraz, difenoconazole, and tebuconazole were the most frequently detected fungicides in soil samples with azole-resistant fungus. Our study results suggest that managing the fungicides used in agriculture will help contain the problem of antifungal drug resistance in clinics.

  • High Pathogenicity Nipah Virus in Pteropus lylei Fruit Bats, Cambodia
    M. Gaudino et al.
  • Tick-Borne Encephalitis Virus, United Kingdom
    M. Holding et al.

    During February 2018–January 2019, we conducted large-scale surveillance for the presence and prevalence of tick-borne encephalitis virus (TBEV) and louping ill virus (LIV) in sentinel animals and ticks in the United Kingdom. Serum was collected from 1,309 deer culled across England and Scotland. Overall, 4% of samples were ELISA-positive for the TBEV serocomplex. A focus in the Thetford Forest area had the highest proportion (47.7%) of seropositive samples. Engorged ticks collected from culled deer within seropositive regions were tested for viral RNA; 5 of 2,041 ticks tested positive by LIV/TBEV real-time reverse transcription PCR, all from within the Thetford Forest area. From 1 tick, we identified a full-length genomic sequence of TBEV. Thus, using deer as sentinels revealed a potential TBEV focus in the United Kingdom. This detection of TBEV genomic sequence in UK ticks has important public health implications, especially for undiagnosed encephalitis.

  • Phenotypic and Genotypic Correlates of Penicillin Susceptibility in Nontoxigenic Corynebacterium diphtheriae, British Columbia, 2015–2018
    J. Zou et al.
  • Preclinical Detection of Prions in Blood of Nonhuman Primates Infected with Variant Creutzfeldt-Jakob Disease
    L. Concha-Marambio et al.

    Variant Creutzfeldt-Jakob disease (vCJD) is caused by prion infection with bovine spongiform encephalopathy and can be transmitted by blood transfusion. Protein misfolding cyclic amplification (PMCA) can detect prions in blood from vCJD patients with 100% sensitivity and specificity. To determine whether PMCA enables prion detection in blood during the preclinical stage of infection, we performed a blind study using blood samples longitudinally collected from 28 control macaques and 3 macaques peripherally infected with vCJD. Our results demonstrate that PMCA consistently detected prions in blood during the entire preclinical stage in all infected macaques, without false positives from noninfected animals, when using the optimized conditions for amplification of macaque prions. Strikingly, prions were detected as early as 2 months postinoculation (>750 days before disease onset). These findings suggest that PMCA has the potential to detect vCJD prions in blood from asymptomatic carriers during the preclinical phase of the disease.

  • Effects of Acute Illness on Contact Patterns, Malawi, 2017
    J. R. Glynn et al.
  • Outbreak of Peste des Petits Ruminants among Critically Endangered Mongolian Saiga and Other Wild Ungulates, Mongolia, 2016–2017
    M. Pruvot et al.

    The 2016–2017 introduction of peste des petits ruminants virus (PPRV) into livestock in Mongolia was followed by mass mortality of the critically endangered Mongolian saiga antelope and other rare wild ungulates. To assess the nature and population effects of this outbreak among wild ungulates, we collected clinical, histopathologic, epidemiologic, and ecological evidence. Molecular characterization confirmed that the causative agent was PPRV lineage IV. The spatio-temporal patterns of cases among wildlife were similar to those among livestock affected by the PPRV outbreak, suggesting spillover of virus from livestock at multiple locations and time points and subsequent spread among wild ungulates. Estimates of saiga abundance suggested a population decline of 80%, raising substantial concerns for the species’ survival. Consideration of the entire ungulate community (wild and domestic) is essential for elucidating the epidemiology of PPRV in Mongolia, addressing the threats to wild ungulate conservation, and achieving global PPRV eradication.

  • Effect of Pediatric Influenza Vaccination on Antibiotic Resistance, England and Wales
    C. Chae et al.

    Vaccines against viral infections have been proposed to reduce prescribing of antibiotics and thereby help control resistant bacterial infections. However, by combining published data sources, we predict that pediatric live attenuated influenza vaccination in England and Wales will not substantially reduce antibiotic consumption or adverse health outcomes associated with antibiotic resistance.

  • Varicella in Adult Foreigners at a Referral Hospital, Central Tokyo, Japan, 2012–2016
    S. Takaya et al.
  • Distribution of Japanese Encephalitis Virus, Japan and Southeast Asia, 2016–2018
    R. Kuwata et al.

    During 2016–2018, we conducted surveillance for Japanese encephalitis virus (JEV) in mosquitoes and pigs in Japan, Thailand, the Philippines, and Indonesia. Phylogenetic analyses demonstrated that our isolates (genotypes Ia, Ib, III, IV) were related to JEV isolates obtained from the same regions many years ago. Indigenous JEV strains persist in Asia.

  • Geographic Distribution and Incidence of Melioidosis, Panama
    A. B. Araúz et al.

    Melioidosis is an infection caused by Burkholderia pseudomallei. Most cases occur in Southeast Asia and northern Australia; <100 cases have been reported in the Americas. We conducted a retrospective study and identified 12 melioidosis cases in Panama during 2007–2017, suggesting possible endemicity and increased need for surveillance.

  • Novel Reassortant Highly Pathogenic Avian Influenza A(H5N2) Virus in Broiler Chickens, Egypt
    K. E. Hassan et al.

    We detected a novel reassortant highly pathogenic avian influenza A(H5N2) virus in 3 poultry farms in Egypt. The virus carried genome segments of a pigeon H9N2 influenza virus detected in 2014, a nucleoprotein segment of contemporary chicken H9N2 viruses from Egypt, and hemagglutinin derived from the H5N8 virus clade.

  • Infectivity of Norovirus GI and GII from Bottled Mineral Water during a Waterborne Outbreak, Spain
    S. Guix et al.

    During a waterborne outbreak of norovirus in Spain, we estimated 50% illness doses for a group of exposed (secretor) persons to be 556 (95% CI 319–957) genome copies/day for norovirus GI and 2,934 (95% CI 1,683–5,044) genome copies/day for norovirus GII. Use of a propidium monoazide viability assay reduced these values.

  • Locally Acquired Human Infection with Swine-Origin Influenza A(H3N2) Variant Virus, Australia, 2018
    Y. Deng et al.

    In 2018, a 15-year-old female adolescent in Australia was infected with swine influenza A(H3N2) variant virus. The virus contained hemagglutinin and neuraminidase genes derived from 1990s-like human seasonal viruses and internal protein genes from influenza A(H1N1)pdm09 virus, highlighting the potential risk that swine influenza A virus poses to human health in Australia.

  • Shigella Bacteremia, Georgia, USA, 2002–2012
    M. Tobin-D’Angelo et al.

    Shigella commonly causes gastroenteritis but rarely spreads to the blood. During 2002–2012, we identified 11,262 Shigella infections through population-based active surveillance in Georgia; 72 (0.64%) were isolated from blood. Bacteremia was associated with age >18 years, black race, and S. flexneri. More than half of patients with bacteremia were HIV-infected.

Research Letters
  • Syphilitic bilateral papillitis mimicking papilloedema
    A. Gonzalez-Martinez et al.
  • Emergence of Vibrio cholerae O1 Sequence Type 75 in Taiwan
    Y. Tu et al.
  • Influenza A Virus Infections among Dromedary Camels, Nigeria and Ethiopia, 2015–2016
    D. Chu et al.
  • Autochthonous Human Fascioliasis, Belgium
    S. Milas et al.

    We report 2 cases of human fascioliasis (HF) in Belgium, likely caused by consumption of vegetables from a garden that was flooded by pasture runoff. Because autochthonous HF is rare and the route of transmission was unusual, HF was not diagnosed until 6 months after symptom onset in both cases.

  • Risk Factors and Seroprevalence of Tickborne Zoonoses among Livestock Owners, Kazakhstan
    J. R. Head et al.
  • Training for Foodborne Outbreak Investigations by Using Structured Learning Experience
    F. Burckhardt and E. Kissling

    We created a free and interactive training activity based on playing cards (disease detective cards) that introduces foodborne outbreak investigations to public health professionals and students. Competencies taught cover-selected descriptive and analytic epidemiologic topics, such as case definition, epidemic curve, 2-by-2 tables, relative risks, attack rates, stratification, and confounding.

  • Hantavirus Pulmonary Syndrome in Traveler Returning from Nepal to Spain
    E. Sulleiro et al.

    Most human hantavirus infections occur in Asia, but some cases have been described in Europe in travelers returning from Asia. We describe a case of hantavirus pulmonary syndrome in a previously healthy traveler occurring shortly after he returned to Spain from Nepal. Serologic tests suggested a Puumala virus–like infection.

  • Legionella pneumophila as Cause of Severe Community-Acquired Pneumonia, China
    H. Yi et al.

    We report a case of community-acquired pneumonia in a patient in China. We verified Legionella pneumophila infection through next-generation sequencing of blood, sputum, and pleural effusion samples. Our results show the usefulness of next-generation sequencing and of testing different samples early in the course of illness to identify this bacterium.

  • Detection of Bovine Kobuvirus in Cattle with Diarrhea, United States
    L. Wang et al.
  • Diabetes Mellitus, Hypertension, and Death for 32 Patients with MERS-CoV Infection, Saudi Arabia
    K. H. Alanazi et al.
  • Rare Case of Enteric Ancylostoma caninum Infection, South Korea
    B. Jung et al.
  • Influenza D Virus of New Phylogenetic Lineage, Japan
    S. Murakami et al.
  • Recombinant Nontypeable Genotype II Human Noroviruses in the Americas
    K. Tohma et al.

    We report multiple nontypeable genotype II noroviruses circulating in South America; nucleotides differed by >25% from those of other genotypes. These viruses have been circulating in the Americas for ≈20 years and show recombination with other genotypes. Clues to norovirus natural history can guide development of treatment and prevention plans.

  • Use of Ambulance Dispatch Calls for Surveillance of Severe Acute Respiratory Infections
    S. Monge et al.

    Ambulance dispatches for respiratory syndromes reflect incidence of influenza-like illness in primary care. Associations are highest in children (15%–34% of respiratory calls attributable to influenza), out-of-office hours (9%), and highest urgency-level calls (9%–11%). Ambulance dispatches might be an additional source of data for severe influenza surveillance.

  • Visceral Leishmaniasis, Northern Somalia, 2013–2019
    M. Aalto et al.

    We identified visceral leishmaniasis caused by Leishmania donovani in a previously unknown focus in northern Somalia. Clinical and epidemiologic characteristics of 118 cases during 2013–2019 in Bosaso, the region’s commercial capital, have raised suspicion of visceral leishmaniasis endemicity status there.

In Memoriam
Online Report
  • Plans for Nationwide Serosurveillance Network in Vietnam
    D. Anh et al.

    In recent years, serosurveillance has gained momentum as way of determining disease transmission and immunity in populations, particularly with respect to vaccine-preventable diseases. At the end of 2017, the Oxford University Clinical Research Unit and the National Institute of Hygiene and Epidemiology held a meeting in Vietnam with national policy makers, researchers, and international experts to discuss current seroepidemiologic projects in Vietnam and future needs and plans for nationwide serosurveillance. This report summarizes the meeting and the plans that were discussed to set up nationwide serosurveillance in Vietnam.


Volume 26, Number 2—February 2020

  • Acute Toxoplasmosis among Canadian Deer Hunters Associated with Consumption of Undercooked Deer Meat Hunted in the United States
    C. Gaulin et al.
  • Interspecies Transmission of Swine Reassortant Influenza A Virus Containing Genes from Influenza A(H1N1)pdm09 and Swine Influenza A(H1N2) Viruses
    H. E. Everett et al.
  • Neutralizing Antibodies against Enterovirus and Coxsackieviruses in Patients with Hand, Foot and Mouth Disease
    L. A. Nguyet et al.
  • Cost-Effectiveness of Screening Program for Chronic Q Fever, the Netherlands
    P. T. de Boer et al.
  • Infection and Transmission of Porcine Deltacoronavirus in Commercial Poultry, United States
    P. A. Boley et al.
  • Characteristics of Patients with Acute Flaccid Myelitis, USA, 2015–2018
    N. McLaren et al.
  • Multiplex Mediator Displacement LAMP for Detection of Treponema pallidum and Haemophilus ducreyi in Clinical Samples
    L. Becherer et al.
  • Chronic Human Pegivirus-2 and Hepatitis C Virus Co-infection
    K. E. Coller et al.
  • Global Expansion of Pacific Northwest Vibrio parahaemolyticus Sequence Type 36
    M. Abanto et al.
  • Systematic Hospital-Based Travel Screening to Assess Exposure to Zika Virus
    A. Iqbal et al.
  • Human Norovirus Infection in Dogs, Thailand
    K. Charoenkul et al.
  • Emergence of Chikungunya Virus, Pakistan, 2016–2017
    N. Badar et al.
  • Surge in Anaplasmosis Cases in Maine, USA, 2013–2017
    S. P. Elias et al.
  • Early Detection of Public Health Emergencies of International Concern through Undiagnosed Disease Reports in ProMED-mail
    C. Rolland et al.
  • Ocular Spiroplasma ixodetis in Newborns, France
    A. Matet et al.

    Cataract and uveitis are rare in newborns but potentially blinding. Three newborns with cataract and severe anterior uveitis underwent cataract surgery. Spiroplasma ixodetis was detected in lens aspirates using bacterial 16S-rRNA PCR and transmission electron microscopy. These findings, which suggest maternal–fetal infection, are consistent with previous experimental Spiroplasma-induced cataract and uveitis.

  • Influence of Rainfall on Leptospira Infection and Disease in a Tropical Urban Setting, Brazil
    K. P. Hacker et al.
  • Elizabethkingia anophelis Infection in Infants, Cambodia, 2012–2018
    T. Reed et al.
Research Letters
  • New Delhi Metallo-β-Lactamase-5–Producing Escherichia coli in Companion Animals, United States
    S. D. Cole et al.
  • Human Alveolar Echinococcosis, Croatia
    D. Dušek et al.
  • Rickettsia mongolitimonae Encephalitis, Southern France, 2018
    M. Loarte et al.
  • Astrovirus in White-Tailed Deer, United States, 2018
    L. Wang et al.
  • Actinomycetoma caused by Actinomadura mexicana, a neglected entity in the Caribbean
    S. Bessis et al.
  • Persistence of Crimean-Congo Hemorrhagic Fever Virus RNA
    L. Mathengtheng et al.
  • Hantavirus Infection with Renal Failure and Proteinuria, Colorado, United States, 2019
    S. Chand et al.
  • Non-Leishmania Parasite in Fatal Visceral Leishmaniasis–like Disease, Brazil
    M. Domagalska and J. Dujardin


Volume 26, Number 3—March 2020

Online Report
  • Improving Quality of Patient Data for Treatment of Multidrug- or Rifampin-Resistant Tuberculosis
    J. R. Campbell et al.


Volume 26, Number 4—April 2020


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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