Early Release

Synopses

• 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.
• Transmission of Chikungunya Virus in a Brazilian Urban Slum
  R. O. Anjos et al.
• Public Health Role of Academic Medical Center in Community Outbreak of Hepatitis A, San Diego County, California, USA, 2016–2018
  M. Kang et al.

Research

• Identifying Locations with Possible Undetected Imported Severe Acute Respiratory Syndrome Coronavirus 2 Cases by Using Importation Predictions
  P. De Salazar et al. View Abstract Email this Article

  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 Coronavirus Disease 2019 Patients
  N. Okba et al. View Abstract Email this Article

  A new coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has recently emerged to cause a human pandemic. Although molecular diagnostic tests were rapidly developed, serologic assays are still lacking, yet urgently needed. Validated serologic assays are needed for contact tracing, identifying the viral reservoir, and epidemiologic studies. We developed serologic assays for detection of SARS-CoV-2 neutralizing, spike protein–specific, and nucleocapsid-specific antibodies. Using serum samples from patients with PCR-confirmed SARS-CoV-2 infections, other coronaviruses, or other respiratory pathogenic infections, we validated and tested various antigens in different in-house and commercial ELISAs. We demonstrated that most PCR-confirmed SARS-CoV-2–infected persons seroconverted by 2 weeks after disease onset. We found that commercial S1 IgG or IgA ELISAs were of lower specificity, and sensitivity varied between the 2 assays; the IgA ELISA showed higher sensitivity. Overall, the validated assays described can be instrumental for detection of SARS-CoV-2–specific antibodies for diagnostic, seroepidemiologic, and vaccine evaluation studies.

• Bat and Lyssavirus Exposure among Humans in Region that Celebrates a Bat Festival, Nigeria, 2010 and 2013
  N. M. Vora et al.
• High Contagiousness and Rapid Spread of Severe Acute Respiratory Syndrome Coronavirus 2
  S. Sanche et al. View Abstract Email this Article

  Severe acute respiratory syndrome coronavirus 2 is the causative agent of the 2019 novel coronavirus disease pandemic. Initial estimates of the early dynamics of the outbreak in Wuhan, China, suggested a doubling time of the number of infected persons of 6–7 days and a basic reproductive number (R₀) of 2.2–2.7. We collected extensive individual case reports across China and estimated key epidemiologic parameters, including the incubation period. We then designed 2 mathematical modeling approaches to infer the outbreak dynamics in Wuhan by using high-resolution domestic travel and infection data. Results show that the doubling time early in the epidemic in Wuhan was 2.3–3.3 days. Assuming a serial interval of 6–9 days, we calculated a median R₀ value of 5.7 (95% CI 3.8–8.9). We further show that active surveillance, contact tracing, quarantine, and early strong social distancing efforts are needed to stop transmission of the virus.

• Efficient Surveillance of Plasmodium knowlesi Genetic Subpopulations, Malaysian Borneo, 2000–2018
  P. C. Divis et al.
• Countrywide Outbreak of Invasive Listeriosis Associated with Blood Sausage Consumption, Germany, 2018–2019
  S. Halbedel et al.
• Rickettsioses as Major Etiologies of Unrecognized Acute Febrile Illness, Sabah, East Malaysia
  M. J. Grigg et al.
• Meningococcal W 135 Disease Vaccination Intent, the Netherlands, 2018–2019
  M. de Vries et al.
• Coccidioidomycosis Among Hispanic Farm Workers, California, USA, 2018
  S. A. McCurdy et al.
• Paradoxal Trends in Azole-Resistant Aspergillus fumigatus in a National Multicenter Surveillance Program, 2013–2018
  P. Lestrade et al.
• Burden and Cost of Hospitalization for Respiratory Syncytial Virus in Young Children, Singapore
  C. Tam et al.
• Human Adenovirus Type 55 Distribution, Regional Persistence, and Genetic Variability
  J. Hang et al.

Policy Review

• Policy Decisions and Use of Information Technology to Fight 2019 Novel Coronavirus Disease, Taiwan
  C. Lin et al. View Abstract Email this Article

  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.

Dispatches

• Early Introduction of Severe Acute Respiratory Syndrome Coronavirus 2 into Europe
  S. J. Olsen et al. View Abstract Email this Article

  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 Coronavirus Disease, Thailand
  W. A. Pongpirul et al. View Abstract Email this Article

  Among 11 patients in Thailand infected with severe acute respiratory syndrome coronavirus 2, we detected viral RNA in upper respiratory specimens a median of 14 days after illness onset and 9 days after fever resolution. We identified viral co-infections and an asymptomatic person with detectable virus RNA in serial tests. We describe implications for surveillance.

• Clinical Management of Argentine Hemorrhagic Fever using Ribavirin and Favipiravir, Belgium, 2020
  I. Veliziotis et al. View Abstract Email this Article

  We report a case of Argentine hemorrhagic fever diagnosed in a woman in Belgium who traveled from a disease-endemic area. Patient management included supportive care and combination therapy with ribavirin and favipiravir. Of 137 potential contacts, including friends, relatives, and healthcare and laboratory workers, none showed development of clinical symptoms of this disease.

• Sub-Saharan Africa and Eurasia Ancestry of Reassortant Highly Pathogenic Avian Influenza A (H5N8) Virus, Europe, December 2019
  E. Świętoń et al.
• Inactivation of Severe Acute Respiratory Syndrome Coronavirus 2 by WHO-Recommended Hand Rub Formulations and Alcohols
  A. Kratzel et al. View Abstract Email this Article

  Infection control instructions call for use of alcohol-based hand rub solutions to inactivate severe acute respiratory syndrome coronavirus 2. We determined the virucidal activity of World Health Organization–recommended hand rub formulations, at full strength and multiple dilutions, and of the active ingredients. All disinfectants demonstrated efficient virus inactivation.

• Aerosol and Surface Distribution of Severe Acute Respiratory Syndrome Coronavirus 2 in Hospital Wards, Wuhan, China, 2020
  Z. Guo et al. View Abstract Email this Article

  To determine distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards in Wuhan, China, we tested air and surface samples. Contamination was greater in intensive care units than general wards. Virus was widely distributed on floors, computer mice, trash cans, and sickbed handrails and was detected in air ≈4 m from patients.

• Severe Acute Respiratory Syndrome Coronavirus 2 Infection among Returnees to Japan from Wuhan, China, 2020
  Y. Arima et al. View Abstract Email this Article

  In early 2020, Japan repatriated 566 nationals from China. Universal laboratory testing and 14-day monitoring of returnees detected 12 cases of severe acute respiratory syndrome coronavirus 2 infection; initial screening results were negative for 5. Common outcomes were remaining asymptomatic (n = 4) and pneumonia (n = 6). Overall, screening performed poorly.

• Carbapenem Resistance Conferred by OXA-48 in K2-ST86 Hypervirulent Klebsiella pneumoniae, France
  R. Beyrouthy et al.
• Possible Bat Origin of Severe Acute Respiratory Syndrome Coronavirus 2
  S. Lau et al. View Abstract Email this Article

  We showed that severe acute respiratory syndrome coronavirus 2 is probably a novel recombinant virus. Its genome is closest to that of severe acute respiratory syndrome–related coronaviruses from horseshoe bats, and its receptor-binding domain is closest to that of pangolin viruses. Its origin and direct ancestral viruses have not been identified.

• Serologic Evidence of Severe Fever with Thrombocytopenia Syndrome Virus and Related Viruses in Pakistan
  A. Zohaib et al.
• Surveillance and Testing for Middle East Respiratory Syndrome Coronavirus, Saudi Arabia, March 2016–March 2019
  A. Alzahrani et al.
• Community Responses during Early Phase of COVID-19 Epidemic, Hong Kong
  K. Kwok et al. View Abstract Email this Article

  During the early phase of the coronavirus disease epidemic in Hong Kong, 1,715 survey respondents reported high levels of perceived risk, mild anxiety, and adoption of personal-hygiene, travel-avoidance, and social-distancing measures. Widely adopted individual precautionary measures, coupled with early government actions, might slow transmission early in the outbreak.

• Laboratory-Acquired Dengue Virus Infection, United States, 2018
  T. M. Sharp et al.
• Linking Epidemiology and Whole-Genome Sequencing to Investigate Salmonella Outbreak, Massachusetts, USA, 2018
  E. L. Vaughn et al.
• Heartland Virus in Humans and Ticks, Illinois, USA, 2018–2019
  H. Tuten et al.
• Survey of Parental Use of Antimicrobial Drugs for Common Childhood Infections, China
  L. Lin 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 View Abstract Email this Article

  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 View Abstract Email this Article

  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. View Abstract Email this Article

  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. View Abstract Email this Article

  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. View Abstract Email this Article

  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. View Abstract Email this Article

  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.

• Lesions of Mycobacterium avium spp. hominissuis infection in a wild mule deer resemble Mycobacterium bovis
  K. Frayne et al.
• Triplex Real-Time RT-PCR for Severe Acute Respiratory Syndrome Coronavirus 2
  J. J. Waggoner et al. View Abstract Email this Article

  Most reverse transcription PCR protocols for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) include 2–3 targets for detection. We developed a triplex, real-time reverse transcription PCR for SARS-CoV-2 that maintained clinical performance compared with singleplex assays. This protocol could streamline detection and decrease reagent use during current high SARS-CoV-2 testing demands.

• Detection of Influenza A(H3N2) Virus RNA in Donated Blood
  R. dos Santos Bezerra et al. View Abstract Email this Article

  Influenza A virus infection has rarely been documented to cause viremia. In 28 blood donations in Brazil that were deferred because of postdonation information, we identified influenza A(H3N2) virus RNA in 1 donation using metagenomic analysis. Our finding implies theoretical risk for viremia and transfusion transmission.

• Fatal Invasive Aspergillosis and Coronavirus Disease in an Immunocompetent Patient
  M. Blaize et al. View Abstract Email this Article

  Invasive pulmonary aspergillosis is a complication in critically ill patients with acute respiratory distress syndrome, especially those with severe influenza pneumonia. We report a fatal case of invasive pulmonary aspergillosis in an immunocompetent patient in France who had severe coronavirus disease–associated pneumonia.

• Urogenital Schistosomiasis in Fisherman, Nepal, 2019
  R. Sah et al.

Letter

• Enterovirus A71 Infection and Neurologic Disease, Madrid, Spain, 2016
  P. Del Giudice

Another Dimension

• A Critique of Coronavirus
  E. R. Osen

Books and Media

• The Poison Squad: One Chemist’s Single-Minded Crusade for Food Safety at the Turn of the Twentieth Century
  M. C. Bazaco

Online Report

• Evidence Supporting Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 While Presymptomatic or Asymptomatic
  N. W. Furukawa et al. View Abstract Email this Article

  Recent epidemiologic, virologic, and modeling reports support the possibility of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission from persons who are presymptomatic (SARS-CoV-2 detected before symptom onset) or asymptomatic (SARS-CoV-2 detected but symptoms never develop). SARS-CoV-2 transmission in the absence of symptoms reinforces the value of measures that prevent the spread of SARS-CoV-2 by infected persons who may not exhibit illness despite being infectious. Critical knowledge gaps include the relative incidence of asymptomatic and symptomatic SARS-CoV-2 infection, the public health interventions that prevent asymptomatic transmission, and the question of whether asymptomatic SARS-CoV-2 infection confers protective immunity.

Synopses

• Epidemiology of Legionnaires’ Disease, Hong Kong, China, 2005−2015
  Y. Leung et al.
• Coronavirus Disease Outbreak in Call Center, South Korea
  S. Park et al. View Abstract Email this Article

  We describe the epidemiology of a coronavirus disease (COVID-19) outbreak in a call center in South Korea. We obtained information on demographic characteristics by using standardized epidemiologic investigation forms. We performed descriptive analyses and reported the results as frequencies and proportions for categoric variables. Of 1,143 persons who were tested for COVID-19, a total of 97 (8.5%, 95% CI 7.0%–10.3%) had confirmed cases. Of these, 94 were working in an 11th-floor call center with 216 employees, translating to an attack rate of 43.5% (95% CI 36.9%–50.4%). The household secondary attack rate among symptomatic case-patients was 16.2% (95% CI 11.6%– 22.0%). Of the 97 persons with confirmed COVID-19, only 4 (1.9%) remained asymptomatic within 14 days of quarantine, and none of their household contacts acquired secondary infections. Extensive contact tracing, testing all contacts, and early quarantine blocked further transmission and might be effective for containing rapid outbreaks in crowded work settings.

• Tuberculosis in Internationally Displaced Children Resettling in Harris County, Texas, USA, 2010–2015
  G. S. Lamb et al.
• Investigation and Serologic Follow-Up of Contacts of an Early Confirmed Case-Patient with COVID-19, United States
  V. T. Chu et al.
• US CDC Real-Time Reverse Transcription PCR Panel for Detection of Severe Acute Respiratory Syndrome Coronavirus 2
  X. Lu et al. View Abstract Email this Article

  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the etiologic agent associated with coronavirus disease, which emerged in late 2019. In response, we developed a diagnostic panel consisting of 3 real-time reverse transcription PCR assays targeting the nucleocapsid gene and evaluated use of these assays for detecting SARS-CoV-2 infection. All assays demonstrated a linear dynamic range of 8 orders of magnitude and an analytical limit of detection of 5 copies/reaction of quantified RNA transcripts and 1 x 10^−1.5 50% tissue culture infectious dose/mL of cell-cultured SARS-CoV-2. All assays performed comparably with nasopharyngeal and oropharyngeal secretions, serum, and fecal specimens spiked with cultured virus. We obtained no false-positive amplifications with other human coronaviruses or common respiratory pathogens. Results from all 3 assays were highly correlated during clinical specimen testing. On February 4, 2020, the Food and Drug Administration issued an Emergency Use Authorization to enable emergency use of this panel.

• Characteristics and Outcomes of Coronavirus Disease Patients under Nonsurge Conditions, Northern California, USA, March–April 2020
  J. Ferguson et al. View Abstract Email this Article

  Limited data are available on the clinical presentation and outcomes of coronavirus disease (COVID-19) patients in the United States hospitalized under normal-caseload or nonsurge conditions. We retrospectively studied 72 consecutive adult patients hospitalized with COVID-19 in 2 hospitals in the San Francisco Bay area, California, USA, during March 13–April 11, 2020. The death rate for all hospitalized COVID-19 patients was 8.3%, and median length of hospitalization was 7.5 days. Of the 21 (29% of total) intensive care unit patients, 3 (14.3% died); median length of intensive care unit stay was 12 days. Of the 72 patients, 43 (59.7%) had underlying cardiovascular disease and 19 (26.4%) had underlying pulmonary disease. In this study, death rates were lower than those reported from regions of the United States experiencing a high volume of COVID-19 patients.

Research

• Analysis of MarketScan Data for Immunosuppressive Conditions and Hospitalizations for Acute Respiratory Illness, United States
  M. Patel et al. View Abstract Email this Article

  Increasing use of immunosuppressive biologic therapies poses a challenge for infectious diseases. Immunosuppressed patients have a high risk for influenza complications and an impaired immune response to vaccines. The total burden of immunosuppressive conditions in the United States, including those receiving emerging biologic therapies, remains unknown. We used the national claims database MarketScan to estimate the prevalence of immunosuppressive conditions and risk for acute respiratory illnesses (ARIs). We studied 47.2 million unique enrollees, representing 115 million person-years of observation during 2012–2017, and identified immunosuppressive conditions in 6.2% adults 18–64 years of age and 2.6% of children <18 years of age. Among 542,105 ARI hospitalizations, 32% of patients had immunosuppressive conditions. The risk for ARI hospitalizations was higher among enrollees with immunosuppression than among nonimmunosuppressed enrollees. Future efforts should focus on developing improved strategies, including vaccines, for preventing influenza in immunosuppressed patients, who are an increasing population in the United States.

• Evaluating the Effectiveness of Social Distancing Interventions to Delay or Flatten the Epidemic Curve of Coronavirus Disease
  L. Matrajt and T. Leung View Abstract Email this Article

  By April 2, 2020, >1 million persons worldwide were infected with severe acute respiratory syndrome coronavirus 2. We used a mathematical model to investigate the effectiveness of social distancing interventions in a mid-sized city. Interventions reduced contacts of adults >60 years of age, adults 20–59 years of age, and children <19 years of age for 6 weeks. Our results suggest interventions started earlier in the epidemic delay the epidemic curve and interventions started later flatten the epidemic curve. We noted that, while social distancing interventions were in place, 20% of new cases and most hospitalizations and deaths were averted, even with modest reductions in contact among adults. However, when interventions ended, the epidemic rebounded. Our models suggest that social distancing can provide crucial time to increase healthcare capacity but must occur in conjunction with testing and contact tracing of all suspected cases to mitigate virus transmission.

• Sporadic Creutzfeldt-Jakob Disease among Physicians, Germany, 1993–2018
  P. Hermann et al.
• Characterizing Norovirus Transmission from Outbreak Data, United States
  M. K. Steele et al.
• CrAssphage as a Novel Tool to Detect Human Fecal Contamination on Environmental Surfaces and Hands
  G. W. Park et al.
• Virome Analysis of Wild Rodents Reveals the Presence of Segmented Flaviviruses in North America
  A. Kumar et al.
• Population Genomic Structure and Recent Evolution of Plasmodium knowlesi, Peninsular Malaysia
  S. E. Hocking et al.
• Human Outbreak of Trichinellosis Caused by Trichinella papuae, Central Kampong Thom Province, Cambodia
  Y. Caron et al.

Dispatches

• Genotypic heterogeneity of Orientia tsutsugamushi in scrub typhus patients and coinfection with thrombocytopenia syndrome virus, Myanmar
  A. Win et al.
• Population-Based Estimates of Chronic Conditions Affecting Risk for Complications from Coronavirus Disease, United States
  M. L. Adams et al. View Abstract Email this Article

  We estimated that 45.4% of US adults are at increased risk for complications from coronavirus disease because of cardiovascular disease, diabetes, respiratory disease, hypertension, or cancer. Rates increased by age, from 19.8% for persons 18–29 years of age to 80.7% for persons >80 years of age, and varied by state, race/ethnicity, health insurance status, and employment.

• Prolonged Persistence of SARS-CoV-2 RNA in Body Fluids
  J. Sun et al. View Abstract Email this Article

  We prospectively assessed 49 coronavirus disease cases in Guangdong, China, to estimate the frequency and duration of detectable severe acute respiratory syndrome coronavirus 2 RNA in human body fluids. The prolonged persistence of virus RNA in various body fluids may guide the clinical diagnosis and prevention of onward virus transmission.

• Plasma-Derived Extracellular Vesicles as Potential Biomarkers in Heart Transplant Patient with Chronic Chagas Disease
  N. Cortes-Serra et al.
• Imported Monkeypox, Singapore
  S. Yong et al. View Abstract Email this Article

  In May 2019, we investigated monkeypox in a traveler from Nigeria to Singapore. The public health response included rapid identification of contacts, use of quarantine, and postexposure smallpox vaccination. No secondary cases were identified. Countries should develop surveillance systems to detect emerging infectious diseases globally.

• Moth flies in the hospital distribute multidrug resistant bacteria from the waste water system
  T. Rupprecht et al.
• Increasing Malaria Parasite Clearance Time following Chloroquine Therapy in the Republic of Korea, 2000–2016
  S. Park et al.
• Prognostic Value of Leukocytosis and Lymphopenia for Coronavirus Disease Severity
  G. Huang et al. View Abstract Email this Article

  To evaluate lymphopenia as a marker for coronavirus disease severity, we conducted a meta-analysis of 10 studies. Severe illness was associated with lower lymphocyte and higher leukocyte counts. Using these markers for early identification of patients with severe disease may help healthcare providers prioritize the need to obtain therapy.

• In Vivo Observation of Trombiculosis with Fluorescence–Advanced Videodermatoscopy
  A. Ramondetta et al.
• Disseminated Echinococcus multilocularis Infection without Liver Involvement in Child, Canada, 2018
  J. Joyce et al.
• SARS-CoV-2 Phylogenetic Analysis, Lazio Region, Italy, February–March 2020
  B. Bartolini et al.
• Leishmania infantum in US-Born Dog
  M. E. de Almeida et al.

Research Letters

• Dengue Virus Type 1 Infection in Traveler Returning from Benin to France, 2019
  T. Fourié et al.
• Outbreak of Human Metapneumovirus Infection in Zoo, Slovenia
  T. Uršič et al.
• Panton-Valentine Leukocidin–Secreting Staphylococcus aureus Pneumonia Complicating COVID-19
  C. Duployez et al. View Abstract Email this Article

  Necrotizing pneumonia induced by Panton-Valentine leukocidin–secreting Staphylococcus aureus is a rare but life-threatening infection that has been described in patients after they had influenza. We report a fatal case of this superinfection in a young adult who had coronavirus disease.

• Decreased Influenza Incidence under COVID-19 Control Measures, Singapore
  R. Soo et al. View Abstract Email this Article

  We compared indicators of influenza activity in 2020 before and after public health measures were taken to reduce coronavirus disease (COVID-19) with the corresponding indicators from 3 preceding years. Influenza activity declined substantially, suggesting that the measures taken for COVID-19 were effective in reducing spread of other viral respiratory diseases.

• Connection to retail meat and international human isolates of Escherichia coli ST131-H22 from Brazilian poultry
  A. S. Saidenberg et al.
• Doubling Time of the COVID-19 Epidemic by Province, China
  K. Muniz-Rodriguez et al. View Abstract Email this Article

  In China, the doubling time of the coronavirus disease epidemic by province increased during January 20–February 9, 2020. Doubling time estimates ranged from 1.4 (95% CI 1.2–2.0) days for Hunan Province to 3.1 (95% CI 2.1–4.8) days for Xinjiang Province. The estimate for Hubei Province was 2.5 (95% CI 2.4–2.6) days.

• Estimation of Coronavirus Disease Case-Fatality Risk in Real Time
  Y. Ge and S. Sun View Abstract Email this Article

  We ran a simulation comparing 3 methods to calculate case-fatality risk for coronavirus disease using parameters described in previous studies. Case-fatality risk calculated from these methods all are biased at the early stage of the epidemic. When comparing real-time case-fatality risk, the current trajectory of the epidemic should be considered.

• Severe Acute Respiratory Syndrome Coronavirus 2 Transmission Potential, Iran, 2020
  K. Muniz-Rodriguez et al. View Abstract Email this Article

  To determine the transmission potential of severe acute respiratory syndrome coronavirus 2 in Iran in 2020, we estimated the reproduction number as 4.4 (95% CI 3.9–4.9) by using a generalized growth model and 3.5 (95% CI 1.3–8.1) by using epidemic doubling time. The reproduction number decreased to 1.55 after social distancing interventions were implemented.

• Asymptomatic SARS-CoV-2 Infection in Household Contacts of a Healthcare Provider, Wuhan, China
  Y. Luo et al. View Abstract Email this Article

  We found that all 5 asymptomatic household contacts of a Wuhan, China, physician with coronavirus disease had severe acute respiratory syndrome coronavirus 2 detected by PCR. The index patient and 2 contacts also had abnormal chest computed tomography scans. Asymptomatic infected household contacts of healthcare workers with coronavirus disease might be underrecognized.

• Collateral Benefit of COVID-19 Control Measures on Influenza Activity, Taiwan
  S. Kuo et al. View Abstract Email this Article

  Taiwan has strictly followed infection control measures to prevent spread of coronavirus disease. Meanwhile, nationwide surveillance data revealed drastic decreases in influenza diagnoses in outpatient departments, positivity rates of clinical specimens, and confirmed severe cases during the first 12 weeks of 2020 compared with the same period of 2019.

• Heartland Virus in Lone Star Ticks, Alabama, USA
  B. C. Newman et al.
• Pulmonary Embolism and Increased Levels of d-Dimer in Patients with Coronavirus Disease
  D. O. Griffin et al. View Abstract Email this Article

  We report 3 patients with coronavirus disease who had a decline in respiratory status during their hospital course that responded well to intravenous steroids and interleukin-6 receptor antagonist therapy. These patients later showed development of persistent hypoxia with increased levels of d-dimer levels and were given a diagnosis of pulmonary embolisms.

• COVID-19 and Acute Pulmonary Embolism in Postpartum Patient
  Z. Khodamoradi et al. View Abstract Email this Article

  We report a 36-year-old woman in Iran who sought care for left shoulder pain and cough 5 days after a scheduled cesarean section. Acute pulmonary embolism and coronavirus disease were diagnosed. Physicians should be aware of the potential for these concurrent conditions in postpartum women.

• Cluster of Coronavirus Disease Associated with Fitness Dance Classes, South Korea
  S. Jang et al. View Abstract Email this Article

  During 24 days in Cheonan, South Korea, 112 persons were infected with severe acute respiratory syndrome coronavirus 2 associated with fitness dance classes at 12 sports facilities. Intense physical exercise in densely populated sports facilities could increase risk for infection. Vigorous exercise in confined spaces should be minimized during outbreaks.

• Abdominal Visceral Infarction in 3 Patients with COVID-19
  G. Besutti et al. View Abstract Email this Article

  A high incidence of thrombotic events has been reported in patients with coronavirus disease (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. We report 3 clinical cases of patients in Italy with COVID-19 who developed abdominal viscera infarction, demonstrated by computed tomography.

• Delayed Laboratory Response to COVID-19 Caused by Molecular Diagnostic Contamination
  R. Mögling et al. View Abstract Email this Article

  The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) created an exceptional situation in which numerous laboratories in Europe simultaneously implemented SARS-CoV-2 diagnostics. These laboratories reported in February 2020 that commercial primer and probe batches for SARS-CoV-2 detection were contaminated with synthetic control material, causing delays of regional testing roll-out in various countries.

• SARS-CoV-2 Transmission from Presymptomatic Meeting Attendee, Germany
  D. Hijnen et al. View Abstract Email this Article

  During a meeting in Munich, Germany, a presymptomatic attendee with severe acute respiratory syndrome coronavirus 2 infected at least 11 of 13 other participants. Although 5 participants had no or mild symptoms, 6 had typical coronavirus disease, without dyspnea. Our findings suggest hand shaking and face-to-face contact as possible modes of transmission.

• Infectious SARS-CoV-2 in Feces of Patient with Severe COVID-19
  F. Xiao et al. View Abstract Email this Article

  Severe acute respiratory syndrome coronavirus 2 was isolated from feces of a patient in China with coronavirus disease who died. Confirmation of infectious virus in feces affirms the potential for fecal–oral or fecal–respiratory transmission and warrants further study.

• Secondary Transmission of Coronavirus Disease from Presymptomatic Persons, China
  W. Zhang et al.

Letters

• Intact Mycobacterium leprae Isolated from Placenta of a Pregnant Woman, China
  A. Singh et al.
• The Practice of Wearing Surgical Masks during the COVID-19 Pandemic
  C. Chiang et al. Email this Article
• Infections among Contacts of Patients with Nipah Virus, India
  C. Tan and K. Wong

Synopses

• Polyclonal Burkholderia cepacia Complex Outbreak in Peritoneal Dialysis Patients Caused by Contaminated Aqueous Chlorhexidine and Documented by Genomic Sequencing
  S. Wong et al.
• Pathology and Pathogenesis of SARS-CoV-2 Associated with Fatal Coronavirus Disease, United States
  R. B. Martines et al. View Abstract Email this Article

  An ongoing pandemic of coronavirus disease (COVID-19) is caused by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Characterization of the histopathology and cellular localization of SARS-CoV-2 in the tissues of patients with fatal COVID-19 is critical to further understand its pathogenesis and transmission and for public health prevention measures. We report clinicopathologic, immunohistochemical, and electron microscopic findings in tissues from 8 fatal laboratory-confirmed cases of SARS-CoV-2 infection in the United States. All cases except 1 were in residents of long-term care facilities. In these patients, SARS-CoV-2 infected epithelium of the upper and lower airways with diffuse alveolar damage as the predominant pulmonary pathology. SARS-CoV-2 was detectable by immunohistochemistry and electron microscopy in conducting airways, pneumocytes, alveolar macrophages, and a hilar lymph node but was not identified in other extrapulmonary tissues. Respiratory viral co-infections were identified in 3 cases; 3 cases had evidence of bacterial co-infection.

Research

• Association of Biosecurity and Hygiene Practices with Environmental Contamination with Influenza A Viruses in Live Bird Markets, Bangladesh
  S. Chowdhury et al.

Dispatches

• Hepatitis E Virus Genotype 7 RNA and Antibody Kinetics in Naturally Infected Dromedary Calves, United Arab Emirates
  V. M. Corman et al.
• Detection of Severe Acute Respiratory Syndrome Coronavirus 2 RNA on Surfaces in Quarantine Rooms
  F. Jiang et al. View Abstract Email this Article

  We investigated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination in 2 rooms of a quarantine hotel after 2 presymptomatic persons who stayed there were laboratory-confirmed as having coronavirus disease. We detected SARS-CoV-2 RNA on 8 (36%) of 22 surfaces, as well as on the pillow cover, sheet, and duvet cover.

• Clinicopathologic and Immunohistochemical Findings from Autopsy of Patient with COVID-19, Japan
  T. Adachi et al. View Abstract Email this Article

  An autopsy of a patient in Japan with coronavirus disease indicated pneumonia lung pathology, manifested as diffuse alveolar damage. We detected severe acute respiratory syndrome coronavirus 2 antigen in alveolar epithelial cells and macrophages. Coronavirus disease is essentially a lower respiratory tract disease characterized by direct viral injury of alveolar epithelial cells.

• Lyme Borreliosis with Scalp Eschar Mimicking Rickettsial Infection
  M. Markowicz et al.
• Large Outbreak of Coronavirus Disease among Wedding Attendees, Jordan
  D. Yusef et al. View Abstract Email this Article

  In March 2020, a wedding in Jordan led to a large outbreak of coronavirus disease (COVID-19). We collected data on 350 wedding attendees, 76 who of whom developed COVID-19. Our study shows high communicability of COVID-19 and the enormous risk for severe acute respiratory syndrome 2 virus transmission during mass gatherings.

Research Letters

• Latent Tuberculosis Screening Using Electronic Health Record Data
  J. D. Jenks et al.
• Typhus Group Rickettsiosis, Brazilian Amazon
  A. Minervino et al.
• Information-Accessing Behavior During Zika Virus Outbreak, United States, 2016
  R. Piltch-Loeb and D. Abramson
• Clostridiodes difficile in COVID-19 Patients, Detroit, Michigan, USA, March–April 2020
  A. Sandhu et al. View Abstract Email this Article

  We describe 9 patients at a medical center in Detroit, Michigan, USA, with severe acute respiratory syndrome coronavirus 2 and Clostridiodes difficile. Both infections can manifest as digestive symptoms and merit screening when assessing patients with diarrhea during the coronavirus disease pandemic. These co-infections also highlight the continued importance of antimicrobial stewardship.

• Acute Cerebral Stroke with Multiple Infarctions and COVID-19, France, 2020
  S. Zayet et al.

Letter

• Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures
  J. Pannu

Research Letter

• COVID-19 in Patient with Sarcoidosis Receiving Long-Term Hydroxychloroquine Treatment, France, 2020
  F. Bénézit et al.