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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 2—February 2020

  • Middle East Respiratory Syndrome Coronavirus Transmission
    M. E. Killerby et al.

    Middle East respiratory syndrome coronavirus (MERS-CoV) infection causes a spectrum of respiratory illness, from asymptomatic to mild to fatal. MERS-CoV is transmitted sporadically from dromedary camels to humans and occasionally through human-to-human contact. Current epidemiologic evidence supports a major role in transmission for direct contact with live camels or humans with symptomatic MERS, but little evidence suggests the possibility of transmission from camel products or asymptomatic MERS cases. Because a proportion of case-patients do not report direct contact with camels or with persons who have symptomatic MERS, further research is needed to conclusively determine additional mechanisms of transmission, to inform public health practice, and to refine current precautionary recommendations.

  • Medscape CME Activity
    Acute Toxoplasmosis among Canadian Deer Hunters Associated with Consumption of Undercooked Deer Meat Hunted in the United States
    C. Gaulin et al.

    We conducted a recent investigation in Quebec, Canada, concerning Canadian deer hunters who went to the United States to hunt deer and returned with symptoms of fever, severe headache, myalgia, and articular pain of undetermined etiology. Further investigation identified that a group of 10 hunters from Quebec attended a hunting retreat in Illinois (USA) during November 22–December 4, 2018. Six of the 10 hunters had similar symptoms and illness onset dates. Serologic tests indicated a recent toxoplasmosis infection for all symptomatic hunters, and the risk factor identified was consumption of undercooked deer meat. Among asymptomatic hunters, 2 were already immune to toxoplasmosis, 1 was not immune, and the immune status of 1 remains unknown. Outbreaks of acute toxoplasmosis infection are rare in North America, but physicians should be aware that such outbreaks could become more common.

  • Public Health Program for Decreasing Risk for Ebola Virus Disease Resurgence from Survivors of the 2013–2016 Outbreak, Guinea
    M. Keita et al.

    At the end of the 2013–2016 Ebola virus disease outbreak in Guinea, we implemented an alert system for early detection of Ebola resurgence among survivors. Survivors were asked to report health alerts in their household and provide body fluid specimens for laboratory testing. During April–September 2016, a total of 1,075 (88%) of 1,215 survivors participated in the system; follow up occurred at a median of 16 months after discharge (interquartile range 14–18 months). Of these, 784 acted as focal points and reported 1,136 alerts (including 4 deaths among survivors). A total of 372 (91%) of 408 eligible survivors had >1 semen specimen tested; of 817 semen specimens, 5 samples from 4 survivors were positive up to 512 days after discharge. No lochia (0/7) or breast milk (0/69) specimens tested positive. Our findings underscore the importance of long-term monitoring of survivors’ semen samples in an Ebola-affected country.

  • Interspecies Transmission of Reassortant Swine Influenza A Virus Containing Genes from Swine Influenza A(H1N1)pdm09 and A(H1N2) Viruses
    H. E. Everett et al.

    Influenza A(H1N1)pdm09 (pH1N1) virus has become established in swine in the United Kingdom and currently co-circulates with previously enzootic swine influenza A virus (IAV) strains, including avian-like H1N1 and human-like H1N2 viruses. During 2010, a swine influenza A reassortant virus, H1N2r, which caused mild clinical disease in pigs in the United Kingdom, was isolated. This reassortant virus has a novel gene constellation, incorporating the internal gene cassette of pH1N1-origin viruses and hemagglutinin and neuraminidase genes of swine IAV H1N2 origin. We investigated the pathogenesis and infection dynamics of the H1N2r isolate in pigs (the natural host) and in ferrets, which represent a human model of infection. Clinical and virologic parameters were mild in both species and both intraspecies and interspecies transmission was observed when initiated from either infected pigs or infected ferrets. This novel reassortant virus has zoonotic and reverse zoonotic potential, but no apparent increased virulence or transmissibility, in comparison to pH1N1 viruses.

  • Neutralizing Antibodies against Enteroviruses in Patients with Hand, Foot and Mouth Disease
    L. Nguyet et al.

    Hand, foot and mouth disease (HFMD) is an emerging infection with pandemic potential. Knowledge of neutralizing antibody responses among its pathogens is essential to inform vaccine development and epidemiologic research. We used 120 paired-plasma samples collected at enrollment and >7 days after the onset of illness from HFMD patients infected with enterovirus A71 (EV-A71), coxsackievirus A (CVA) 6, CVA10, and CVA16 to study cross neutralization. For homotypic viruses, seropositivity increased from <60% at enrollment to 97%–100% at follow-up, corresponding to seroconversion rates of 57%–93%. Seroconversion for heterotypic viruses was recorded in only 3%–23% of patients. All plasma samples from patients infected with EV-A71 subgenogroup B5 could neutralize the emerging EV-A71 subgenogroup C4. Collectively, our results support previous reports about the potential benefit of EV-A71 vaccine but highlight the necessity of multivalent vaccines to control HFMD.

  • Cost-effectiveness of Screening Program for Chronic Q Fever, the Netherlands
    P. T. de Boer et al.

    In the aftermath of a large Q fever (QF) epidemic in the Netherlands during 2007–2010, new chronic QF (CQF) patients continue to be detected. We developed a health-economic decision model to evaluate the cost-effectiveness of a 1-time screening program for CQF 7 years after the epidemic. The model was parameterized with spatial data on QF notifications for the Netherlands, prevalence data from targeted screening studies, and clinical data from the national QF database. The cost-effectiveness of screening varied substantially among subpopulations and geographic areas. Screening that focused on cardiovascular risk patients in areas with high QF incidence during the epidemic ranged from cost-saving to €31,373 per quality-adjusted life year gained, depending on the method to estimate the prevalence of CQF. The cost per quality-adjusted life year of mass screening of all older adults was €70,000 in the most optimistic scenario.

  • Porcine Deltacoronavirus Infection and Transmission in Poultry, United States
    P. A. Boley et al.

    Coronaviruses cause respiratory and gastrointestinal diseases in diverse host species. Deltacoronaviruses (DCoVs) have been identified in various songbird species and in leopard cats in China. In 2009, porcine deltacoronavirus (PDCoV) was detected in fecal samples from pigs in Asia, but its etiologic role was not identified until 2014, when it caused major diarrhea outbreaks in swine in the United States. Studies have shown that PDCoV uses a conserved region of the aminopeptidase N protein to infect cell lines derived from multiple species, including humans, pigs, and chickens. Because PDCoV is a potential zoonotic pathogen, investigations of its prevalence in humans and its contribution to human disease continue. We report experimental PDCoV infection and subsequent transmission among poultry. In PDCoV-inoculated chicks and turkey poults, we observed diarrhea, persistent viral RNA titers from cloacal and tracheal samples, PDCoV-specific serum IgY antibody responses, and antigen-positive cells from intestines.

  • Medscape CME Activity
    Characteristics of Patients with Acute Flaccid Myelitis, United States, 2015–2018
    N. McLaren et al.

    Observed peaks of acute flaccid myelitis (AFM) cases have occurred biennially since 2014 in the United States. We aimed to determine if AFM etiology differed between peak and nonpeak years, considering that clinical features of AFM differ by virus etiology. We compared clinical and laboratory characteristics of AFM cases that occurred during peak (2016 and 2018, n = 366) and nonpeak (2015 and 2017, n = 50) years. AFM patients in peak years were younger (5.2 years) than those in nonpeak years (8.3 years). A higher percentage of patients in peak years than nonpeak years had pleocytosis (86% vs. 60%), upper extremity involvement (33% vs. 16%), and an illness preceding limb weakness (90% vs. 62%) and were positive for enterovirus or rhinovirus RNA (38% vs. 16%). Enterovirus D68 infection was associated with AFM only in peak years. Our findings suggest AFM etiology differs between peak and nonpeak years.

  • Multiplex Mediator Displacement Loop-Mediated Isothermal Amplification for Detection of Treponema pallidum and Haemophilus ducreyi
    L. Becherer et al.

    Yaws, a neglected tropical disease caused by the bacterium Treponema pallidum subspecies pertenue, manifests as ulcerative skin lesions. Nucleic acid amplification tests, like loop-mediated isothermal amplification (LAMP), are versatile tools to distinguish yaws from infections that cause similar skin lesions, primarily Haemophilus ducreyi. We developed a novel molecular test to simultaneously detect T. pallidum and H. ducreyi based on mediator displacement LAMP. We validated the T. pallidum and H. ducreyi LAMP (TPHD-LAMP) by testing 293 clinical samples from patients with yaws-like lesions. Compared with quantitative PCR, the TPHD-LAMP demonstrated high sensitivity and specificity for T. pallidum (84.7% sensitivity, 95.7% specificity) and H. ducreyi (91.6% sensitivity, 84.8% specificity). This novel assay provided rapid molecular confirmation of T. pallidum and H. ducreyi DNA and might be suitable for use at the point of care. TPHD-LAMP could support yaws eradication by improving access to molecular diagnostic tests at the district hospital level.

  • Chronic Human Pegivirus 2 without Hepatitis C Virus Co-infection
    K. E. Coller et al.

    Most human pegivirus 2 (HPgV-2) infections are associated with past or current hepatitis C virus (HCV) infection. HPgV-2 is thought to be a bloodborne virus: higher prevalence of active infection has been found in populations with a history of parenteral exposure to viruses. We evaluated longitudinally collected blood samples obtained from injection drug users (IDUs) for active and resolved HPgV-2 infections using a combination of HPgV-2–specific molecular and serologic tests. We found evidence of HPgV-2 infection in 11.2% (22/197) of past or current HCV-infected IDUs, compared with 1.9% (4/205) of an HCV-negative IDU population. Testing of available longitudinal blood samples from HPgV-2–positive participants identified 5 with chronic infection (>6 months viremia in >3 timepoints); 2 were identified among the HCV-positive IDUs and 3 among the HCV-negative IDUs. Our findings indicate that HPgV-2 can establish chronic infection and replicate in the absence of HCV.

  • Medscape CME Activity
    Illness Severity in Hospitalized Influenza Patients by Virus Type and Subtype, Spain, 2010–2017
    C. Delgado-Sanz et al.

    We conducted a retrospective cohort study to assess the effect of influenza virus type and subtype on disease severity among hospitalized influenza patients in Spain. We analyzed the cases of 8,985 laboratory-confirmed case-patients hospitalized for severe influenza by using data from a national surveillance system for the period 2010–2017. Hospitalized patients with influenza A(H1N1)pdm09 virus were significantly younger, more frequently had class III obesity, and had a higher risk for pneumonia or acute respiratory distress syndrome than patients infected with influenza A(H3N2) or B (p<0.05). Hospitalized patients with influenza A(H1N1)pdm09 also had a higher risk for intensive care unit admission, death, or both than patients with influenza A(H3N2) or B, independent of other factors. Determining the patterns of influenza-associated severity and how they might differ by virus type and subtype can help guide planning and implementation of adequate control and preventive measures during influenza epidemics.

  • Novel Subclone of Carbapenem-Resistant Klebsiella pneumoniae Sequence Type 11 with Enhanced Virulence and Transmissibility, China
    K. Zhou et al.

    We aimed to clarify the epidemiologic and clinical importance of evolutionary events that occurred in carbapenem-resistant Klebsiella pneumoniae (CRKP). We collected 203 CRKP causing bloodstream infections in a tertiary hospital in China during 2013–2017. We detected a subclonal shift in the dominant clone sequence type (ST) 11 CRKP in which the previously prevalent capsular loci (KL) 47 had been replaced by KL64 since 2016. Patients infected with ST11-KL64 CRKP had a significantly higher 30-day mortality rate than other CRKP-infected patients. Enhanced virulence was further evidenced by phenotypic tests. Phylogenetic reconstruction demonstrated that ST11-KL64 is derived from an ST11-KL47–like ancestor through recombination. We identified a pLVPK-like virulence plasmid carrying rmpA and peg-344 in ST11-KL64 exclusively from 2016 onward. The pLVPK-like–positive ST11-KL64 isolates exhibited enhanced environmental survival. Retrospective screening of a national collection identified ST11-KL64 in multiple regions. Targeted surveillance of this high-risk CRKP clone is urgently needed.

  • Exposure to Ebola Virus and Risk for Infection with Malaria Parasites, Rural Gabon
    J. L. Abbate et al.

    An association between malaria and risk for death among patients with Ebola virus disease has suggested within-host interactions between Plasmodium falciparum parasites and Ebola virus. To determine whether such an interaction might also influence the probability of acquiring either infection, we used a large snapshot surveillance study from rural Gabon to test if past exposure to Ebola virus is associated with current infection with Plasmodium spp. during nonepidemic conditions. We found a strong positive association, on population and individual levels, between seropositivity for antibodies against Ebola virus and the presence of Plasmodium parasites in the blood. According to a multiple regression model accounting for other key variables, antibodies against Ebola virus emerged as the strongest individual-level risk factor for acquiring malaria. Our results suggest that within-host interactions between malaria parasites and Ebola virus may underlie epidemiologic associations.

  • Unique Clindamycin-Resistant Clostridioides difficile Strain Related to Fluoroquinolone-Resistant Epidemic BI/RT027 Strain
    A. M. Skinner et al.

    During a surveillance study of patients in a long-term care facility and the affiliated acute care hospital in the United States, we identified a Clostridioides difficile strain related to the epidemic PCR ribotype (RT) 027 strain associated with hospital outbreaks of severe disease. Fifteen patients were infected with this strain, characterized as restriction endonuclease analysis group DQ and RT591. Like RT027, DQ/RT591 contained genes for toxin B and binary toxin CDT and a tcdC gene of identical sequence. Whole-genome sequencing and multilocus sequence typing showed that DQ/RT591 is a member of the same multilocus sequence typing clade 2 as RT027 but in a separate cluster. DQ/RT591 produced a similar cytopathic effect as RT027 but showed delayed toxin production in vitro. DQ/RT591 was susceptible to moxifloxacin but highly resistant to clindamycin. Continued surveillance is warranted for this clindamycin-resistant strain that is related to the fluoroquinolone-resistant epidemic RT027 strain.

  • Global Expansion of Pacific Northwest Vibrio parahaemolyticus Sequence Type 36
    M. Abanto et al.

    We report transcontinental expansion of Vibrio parahaemolyticus sequence type 36 into Lima, Peru. From national collections, we identified 7 isolates from 2 different Pacific Northwest complex lineages that surfaced during 2011–2016. Sequence type 36 is likely established in environmental reservoirs. Systematic surveillance enabled detection of these epidemic isolates.

  • Systematic Hospital-Based Travel Screening to Assess Exposure to Zika Virus
    A. Iqbal et al.

    We queried hospital patients about international travel in the previous 30 days to assess potential importation of emerging infections. We used 12 months of deidentified data to analyze patient demographics, travel destinations, and diagnoses for exposure to Zika virus. Our approach could be used to analyze potential infectious disease exposures.

  • Human Norovirus Infection in Dogs, Thailand
    K. Charoenkul et al.

    In July 2018, recombinant norovirus GII.Pe-GII.4 Sydney was detected in dogs who had diarrhea in a kennel and in children living on the same premises in Thailand. Whole-genome sequencing and phylogenetic analysis of 4 noroviruses from Thailand showed that the canine norovirus was closely related to human norovirus GII.Pe-GII.4 Sydney, suggesting human-to-canine transmission.

  • Emergence of Chikungunya Virus, Pakistan, 2016–2017
    N. Badar et al.

    During December 2016–May 2017, an outbreak of chikungunya virus infection occurred across Pakistan. The East/Central/South African genotype was predominant. This study provides baseline data on the virus strain and emphasizes the need for active surveillance and implementation of preventive interventions to contain future outbreaks.

  • Surge in Anaplasmosis Cases in Maine, USA, 2013–2017
    S. P. Elias et al.

    Incidence of human granulocytic anaplasmosis is rising in Maine, USA. This increase may be explained in part by adoption of tick panels as a frequent diagnostic test in persons with febrile illness and in part by range expansion of Ixodes scapularis ticks and zoonotic amplification of Anaplasma phagocytophilum.

  • Early Detection of Public Health Emergencies of International Concern through Undiagnosed Disease Reports in ProMED-Mail
    C. Rolland et al.

    We conducted a retrospective analysis of all reports in ProMED-mail that were initially classified as undiagnosed diseases during 2007–2018. We identified 371 cases reported in ProMED-mail; 34% were later diagnosed. ProMED-mail could be used to supplement other undiagnosed disease surveillance systems worldwide.

  • 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.

    The incidence of hospitalized leptospirosis patients was positively associated with increased precipitation in Salvador, Brazil. However, Leptospira infection risk among a cohort of city residents was inversely associated with rainfall. These findings indicate that, although heavy rainfall may increase severe illness, Leptospira exposures can occur year-round.

  • Elizabethkingia anophelis Infection in Infants, Cambodia, 2012–2018
    T. Reed et al.

    We describe 6 clinical isolates of Elizabethkingia anophelis from a pediatric referral hospital in Cambodia, along with 1 isolate reported from Thailand. Improving diagnostic microbiological methods in resource-limited settings will increase the frequency of reporting for this pathogen. Consensus on therapeutic options is needed, especially for resource-limited settings.

  • Rapid Nanopore Whole-Genome Sequencing for Anthrax Emergency Preparedness
    H. P. McLaughlin et al.

    Human anthrax cases necessitate rapid response. We completed Bacillus anthracis nanopore whole-genome sequencing in our high-containment laboratory from a human anthrax isolate hours after receipt. The de novo assembled genome showed no evidence of known antimicrobial resistance genes or introduced plasmid(s). Same-day genomic characterization enhances public health emergency response.

  • Hepatitis E Virus in Pigs from Slaughterhouses, United States, 2017–2019
    H. Sooryanarain et al.

    Hepatitis E virus (HEV) RNA was detected in 6.3% and HEV IgG in 40% of 5,033 serum samples from market-weight pigs at 25 slaughterhouses in 10 US states. The prevalent HEV genotype was zoonotic genotype 3, group 2. Blood of HEV-viremic pigs from slaughterhouses may contaminate pork supply chains.

  • Antimicrobial Resistance in Mycoplasma genitalium in Community and Sexual Health Clinic Patients, Auckland, New Zealand
    A. Vesty et al.

    Our retrospective study compared genotypic antimicrobial resistance in Mycoplasma genitalium–positive specimens collected from 48 community and 33 sexual health clinic (SHC) patients. Macrolide resistance was similar in community (75%) and SHC (76%) patients. We observed no significant difference in fluoroquinolone resistance between community (19%) and SHC (27%) patients (p = 0.66).

  • Use of Surveillance Outbreak Response Management and Analysis System for Human Monkeypox Outbreak, Nigeria, 2017–2019
    B. C. Silenou et al.

    In November 2017, the mobile digital Surveillance Outbreak Response Management and Analysis System was deployed in 30 districts in Nigeria in response to an outbreak of monkeypox. Adaptation and activation of the system took 14 days, and its use improved timeliness, completeness, and overall capacity of the response.

Research Letters
  • New Delhi Metallo-β-Lactamase-5–Producing Escherichia coli in Companion Animals, United States
    S. D. Cole et al.

    We report isolation of a New Delhi metallo-β-lactamase-5–producing carbapenem-resistant Escherichia coli sequence type 167 from companion animals in the United States. Reports of carbapenem-resistant Enterobacteriaceae in companion animals are rare. We describe a unique cluster of blaNDM-5–producing E. coli in a veterinary hospital.

  • Human Alveolar Echinococcosis, Croatia
    D. Dušek et al.

    Alveolar echinococcosis is a parasitic disease caused by the tapeworm larval stage of Echinococcus multilocularis. This zoonotic disease has not been known to occur in Croatia. We report a confirmed case of human alveolar echinococcosis in a patient in Croatia who had never visited a known E. multilocularis–endemic area.

  • Rickettsia mongolitimonae Encephalitis, Southern France, 2018
    M. Loarte et al.

    We report a case of Rickettsia sibirica mongolitimonae infection, an emerging tickborne rickettsiosis, with associated encephalitis in a 66-year-old man. Diagnosis was rapidly confirmed by quantitative PCR obtained from an eschar swab sample. The patient was successfully treated with oral doxycycline.

  • Astrovirus in White-Tailed Deer, United States, 2018
    L. Wang et al.

    We report the identification of astrovirus WI65268 in a white-tailed deer with respiratory disease in the United States in 2018. This virus is a recombinant of Kagoshima1-7 and Kagoshima2-3-2 (both bovine astroviruses from Japan) and was characterized as a potential new genotype. Further surveillance of deer might help identify related isolates.

  • Actinomycetoma Caused by Actinomadura mexicana, A Neglected Entity in the Caribbean
    S. Bessis et al.

    Mycetoma is a chronic infection that is slow to develop and heal. It can be caused by fungi (eumycetoma) or bacteria (actinomycetoma). We describe a case of actinomycetoma caused by Actinomadura mexicana in the Caribbean region.

  • Persistence of Crimean-Congo Hemorrhagic Fever Virus RNA
    L. Mathengtheng et al.

    Crimean-Congo hemorrhagic fever virus (CCHFV) causes severe disease with fatalities. Awareness of potential sources of infection is important to reduce risk to healthcare workers and contacts. We detected CCHFV RNA in formalin-fixed, paraffin-embedded tissues from a spontaneous abortion that were submitted for histology 9 weeks after a suspected CCHFV infection in the mother.

  • Hantavirus Infection with Renal Failure and Proteinuria, Colorado, USA, 2019
    S. Chand et al.

    In North America, hantaviruses commonly cause hantavirus pulmonary syndrome (HPS). Clinical descriptions of hantavirus-associated renal disease in the Americas are scarce. Herein, we discuss the case of a 61-year-old man whose predominant manifestations were acute kidney injury and proteinuria. Clinical recognition of renal signs in hantavirus infections can reduce risk for death.

  • Two Cases of Newly Characterized Neisseria Species, Brazil
    M. M. Mustapha et al.

    We describe 2 human cases of infection with a new Neisseria species (putatively N. brasiliensis), 1 of which involved bacteremia. Genomic analyses found that both isolates were distinct strains of the same species, were closely related to N. iguanae, and contained a capsule synthesis operon similar to N. meningitidis.

  • Antigenic Variant of Highly Pathogenic Avian Influenza A(H7N9) Virus, China, 2019
    W. Jiang et al.

    In China, influenza A(H7N9) virus appeared in 2013, then mutated into a highly pathogenic virus, causing outbreaks among poultry and cases in humans. Since September 2017, extensive use of the corresponding vaccine, H7-Re1, successfully reduced virus prevalence. However, in 2019, a novel antigenic variant emerged, posing considerable economic and public health threats.

  • Hepatitis A Virus Genotype IB Outbreak among Internally Displaced Persons, Syria
    M. Kaddoura et al.

    In 2018, a hepatitis A virus outbreak was identified among internally displaced persons in Syria. Sequence analysis based on the viral protein 1/2 junction revealed that the causative virus belonged to genotype IB. A high displacement rate, deteriorated sanitary and health conditions, and poor water quality likely contributed to this outbreak.

  • Rickettsia parkeri and Candidatus Rickettsia andeanae in Amblyomma maculatum Group Ticks
    B. H. Noden et al.

    We determined prevalence of Rickettsia spp. in 172 ticks of the Amblyomma maculatum group collected from 16 urban sites in Oklahoma City, Oklahoma, USA, during 2017 and 2018. Most ticks (59.3%) were collected from 1 site; 4 (2.3%) were infected with Rickettsia parkeri and 118 (68.6%) with Candidatus Rickettsia andeanae.

Another Dimension
  • Social Responses to Epidemics Depicted by Cinema
    Q. Han and D. R. Curtis

    Films illustrate 2 ways that epidemics can affect societies: fear leading to a breakdown in sociability and fear stimulating preservation of tightly held social norms. The first response is often informed by concern over perceived moral failings within society, the second response by the application of arbitrary or excessive controls from outside the community.



Volume 26, Number 3—March 2020

  • Epidemiology of Cryptosporidiosis in New York City, New York, USA, 1995–2018
    L. Alleyne et al.
  • Mycobacterium tuberculosis Complex Lineage 3 as Causative Agent of Pulmonary Tuberculosis, Eastern Sudan
    Y. A. Shuaib et al.
  • Public Health Response to Tuberculosis Outbreak among Persons Experiencing Homelessness, Minneapolis, Minnesota, USA, 2017
    K. K. Tibbetts et al.
  • Clinical Characteristics of Disseminated Strongyloidiasis, Japan, 1975–2017
    M. Mukaigawara et al.
  • Norovirus Outbreak Surveillance, China, 2016–2018
    M. Jin et al.
  • Long-Term Rodent Surveillance after Outbreak of Hantavirus Infection in Yosemite National Park, California, United States, 2012
    M. E. Danforth et al.
  • Risk Factors for Complicated Lymphadenitis Caused by Nontuberculous Mycobacteria in Children
    M. Kuntz et al.
  • Genomic and Phenotypic Variability of Antimicrobial–Susceptible Neisseria gonorrhoeae, England
    K. Town et al.
  • Hypervirulent Carbapenem-Resistant Klebsiella pneumoniae with blaKPC-2 Gene, Singapore, 2010–2015
    Y. Chen et al.
  • Methicillin-Resistant Staphylococcus aureus Bloodstream Infections and Injection Drug Use, Tennessee, USA, 2015–2017
    M. P. Parikh et al.
  • High Prevalence of and Risk Factors for Latent Tuberculosis among Prisoners, Tianjin, China
    G. Zhang et al.
  • Randomized Trial of 2 Meningococcal B Vaccine Schedules in Adolescents and Young Adults, Canada
    J. M. Langley et al.
  • Pregnancy Outcomes among Women Vaccinated with rVSVΔ-ZEBOV-GP Ebola Vaccine during the Sierra Leone Trial to Introduce a Vaccine against Ebola (STRIVE)
    J. K. Legardy-Williams et al.
  • Human Immune Responses to Melioidosis and Cross-Reactivity to Low-Virulence Burkholderia Species
    P. Rongkard et al.
  • Role of Live-Duck Movement Networks in Shaping Avian Influenza Transmission, France, 2016–17
    C. Guinat et al.
  • Multidrug- and Extensively Drug-Resistant Mycobacterium tuberculosis Beijing Clades, Ukraine, 2015
    M. Merker et al.
  • Stable and Local Reservoirs of Mycobacterium ulcerans Inferred from the Nonrandom Distribution of Bacterial Genotypes, Benin
    C. Coudereau et al.
  • Use of Whole-Genome Sequencing to Detect Campylobacter jejuni Infection Outbreak Sources, Denmark, 2015–2017
    K. G. Joensen et al.
  • US Tuberculosis Rates among Persons Born Outside the United States Compared with Rates in their Countries of Birth, 2012–2016
    C. A. Tsang et al.
  • Beijing Lineage and Risk for Tuberculosis in Child Household Contacts, Peru
    C. Huang et al.
  • Suspected Locally Acquired Coccidioidomycosis in Human, Spokane, Washington, USA
    H. N. Oltean et al.

    The full geographic range of coccidioidomycosis is unknown, although it is most likely expanding with environmental change. We report an apparently autochthonous coccidioidomycosis patient from Spokane, Washington, USA, a location to which Coccidioides spp. are not known to be endemic.

  • Avian Influenza Virus Detection Rates in Poultry and Environment at Live Poultry Markets, Guangdong, China
    K. Cheng et al.

    We report the use of environmental samples to assess avian influenza virus activity in chickens at live poultry markets in China. Results of environmental and chicken samples correlate moderately well. However, collection of multiple environmental samples from holding, processing, and selling areas is recommended to detect viruses expected to have low prevalence.

  • Diphtheria outbreaks in schools in highland districts of Central Vietnam, 2015–2018
    N. Kitamura et al.
  • Human Exposure to Hantaviruses Associated with Rodents of the Murinae Subfamily, Madagascar
    H. Rabemananjara et al.
  • Progressive Vaccinia in a Patient with HIV/AIDS Acquired through Zoonotic Transmission, Colombia
    K. Laiton-Donato et al.
Research Letters
  • Novel Techniques for Detection of Mycobacterium bovis Infection in a Cheetah
    T. J. Kerr et al.
  • Geographic Expansion of Sporotrichosis, Brazil
    I. Gremião et al.
  • Three New Cases of Melioidosis, Guadeloupe, French West Indies
    B. Melot et al.
  • Chlamydia abortus in a Pregnant Woman with Acute Respiratory Distress Syndrome
    N. Pichon et al.
  • Low Prevalence of Mycobacterium bovis in Pulmonary Tuberculosis Patients, Ethiopia
    M. Getahun et al.
  • Need for BCG Vaccination to Prevent TB in High-Incidence Countries and Populations
    S. Pooransingh and S. Sakhamuri

    An estimated one quarter of persons worldwide are infected with Mycobacterium tuberculosis. In 2018, the World Health Organization issued revised guidance on BCG vaccine for high-risk groups. The World Health Organization should consider guiding countries on a case-by-case basis in developing appropriate BCG policies to deliver equitable healthcare and protect public health.

  • Pulmonary Nocardia ignorata Infection in Gardener from Iran, 2017
    H. Rahdar et al.
  • Mycobacterium senegalense Infection after Implant-Based Breast Reconstruction, Spain
    O. Carretero et al.
  • Coccidioidomycosis Skin Testing in a Commercially-Insured Population, United States, 2014–2017
    K. Benedict et al.
  • Invasive Candida bovina Infection, France
    K. Brunet et al.
  • Global Health Estimate of Invasive Mycobacterium chimaera Infections Associated with Heater–Cooler Devices in Cardiac Surgery
    T. Lamagni et al.
  • Authors’ Reply: A Global Health Estimate of the Burden of the Worldwide Epidemic with Invasive Mycobacterium chimaera Infections Associated with Heater-Cooler Devices in Cardiac Surgery
    R. Sommerstein et al.
Online Report
  • Improving Quality of Patient Data for Treatment of Multidrug- or Rifampin-Resistant Tuberculosis
    J. R. Campbell et al.

    International policy for treatment of multidrug- and rifampin-resistant tuberculosis (MDR/RR TB) relies largely on individual patient data (IPD) from observational studies of patients treated under routine conditions. We prepared guidance on which data to collect and what measures could improve consistency and utility for future evidence-based recommendations. We highlight critical stages in data collection at which improvements to uniformity, accuracy, and completeness could add value to IPD quality. Through a repetitive development process, we suggest essential patient- and treatment-related characteristics that should be collected by prospective contributors of observational IPD in MDR/RR TB.

Conference Summary
  • Communications Challenges in Emerging Infectious Disease management, Val-de-Grâce School 2019 Seminar
    P. Le Turnier et al.


Volume 26, Number 4—April 2020

  • Stemming the Increase in Human-Biting Ticks and Tickborne Diseases, United States
    L. Eisen
  • Decreased Susceptibility to Azithromycin in Clinical Shigella Isolates Associated with HIV and Sexually Transmitted Bacterial Diseases, Minnesota, USA, 2012–2015
    D. Eikmeier et al.
  • Ecology and Epidemiology of Tickborne Pathogens, Washington State, USA, 2011–2016
    E. A. Dykstra et al.
  • Comprehensive Profiling of Zika Virus Risk with Natural and Artificial Mitigating Strategies, United States
    M. J. Mina et al.
  • Intensified Short Symptom Screening Program for Dengue Infection during Pregnancy, India
    S. Naik et al.
  • Genomic Insight into the Spread of Meropenem-Resistant Streptococcus pneumoniae Spain-ST81, Taiwan
    Y. Chen et al.
  • Isolation of Drug-Resistant Gallibacterium anatis from Calves with Unresponsive Bronchopneumonia
    L. Van Driessche et al.
  • Prevalence of Antibodies to Crimean-Congo Hemorrhagic Fever Virus in Ruminants, Nigeria, 2015
    D. Oluwayelu et al.
  • Confirmation of Person-to-Person Transmission of Andes Virus in Persons with Hantavirus Pulmonary Syndrome, Argentina, 2014
    D. O. Alonso et al.
  • Detection of Zoonotic Bartonella Pathogens in Rabbit Fleas, Colorado, USA
    S. Sato et al.
  • Tickborne Crimean-Congo Hemorrhagic Fever Virus in Humans and Livestock, Pakistan
    A. Zohaib et al.
  • Outbreak of Dirkmeia churashimaensis Fungemia in a Neonatal Intensive Care Unit, India
    A. Chowdhary et al.
  • Pruritic Cutaneous Nematodiasis Caused by Avian Eyeworm Oxyspirura Larvae, Vietnam
    T. Dung et al.
Research Letters
  • Plague Epizootic Dynamics in Chipmunk Fleas, Sierra Nevada Mountains, California, USA, 2013–2015
    T. T. Hammond et al.

    We describe Yersina pestis minimum infection prevalence in fleas collected from Tamias spp. chipmunks in the Sierra Nevadas (California, USA) during 2013–2015. Y. pestis–positive fleas were detected only in 2015 (year of plague epizootic), mostly in T. speciosus chipmunks at high-elevation sites. Plague surveillance should include testing vectors for Y. pestis.

  • Crimean-Congo Hemorrhagic Fever, Mauritania
    B. Boushab et al.
  • MRSA CC398 in a Patient without Animal Contact, Japan
    H. Nakaminami et al.
  • Epidemiology of Lassa Fever and Factors Associated with Deaths, Bauchi State, Nigeria, 2015–2018
    M. A. Abdulkarim et al.
  • Needlestick-Associated Rocky Mountain Spotted Fever, Brazil
    S. Vilges de Oliveira et al.


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