Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.
Volume 26, Number 5—May 2020
- Food Safety and Invasive Cronobacter Infections during Early Infancy, 1961–2018
- Clinical Outcomes of Patients Treated for Candida auris Infections in a Multisite Health System, Illinois, USA
- Mosquito Control Activities During Local Transmission of Zika Virus, Miami-Dade County, Florida, USA, 2016
- Epidemiology of Human Borreliosis Cases in Endemic Areas, Spain
- Emergence of Leprosy in Kiribati
- Biphasic Outbreak of Invasive Group A Streptococcus Disease in Eldercare Facility, New Zealand
- Sex Differences in Social Contact Patterns and Tuberculosis Transmission and Control
Effectiveness of Live Poultry Market Interventions on Human Infection with Avian Influenza A(H7N9) Virus, China
Various interventions for live poultry markets (LPMs) have emerged to control outbreaks of avian influenza A(H7N9) virus in mainland China since March 2013. We assessed the effectiveness of various LPM interventions in reducing transmission of H7N9 virus across 5 annual waves during 2013–2018, especially in the final wave. With the exception of waves 1 and 4, various LPM interventions reduced daily incidence rates significantly across waves. Four LPM interventions led to a mean reduction of 34%–98% in the daily number of infections in wave 5. Of these, permanent closure provided the most effective reduction in human infection with H7N9 virus, followed by long-period, short-period, and recursive closures in wave 5. The effectiveness of various LPM interventions changed with the type of intervention across epidemics. Permanent LPM closure should be considered to maintain sufficient effectiveness of interventions and prevent the recurrence of H7N9 epidemics.
- Zika Virus Circulation in Mali
- Epidemiologic and Clinical Progression of Lobomycosis among Kaiabi Indians, Brazil, 1965–2019
- Nationwide Monitoring for Plasmodium falciparum Drug-Resistance Alleles to Chloroquine, Sulfadoxine, and Pyrimethamine, Haiti, 2016–2017
- Possible Transmission Mechanisms of Mixed-Strain Mycobacterium tuberculosis in High HIV-Prevalence Country, Botswana
- Rhizopus microsporus Infections Associated with Surgical Procedures, Argentina, 2006–2014
- Blastomycosis in Minnesota, USA, 1999–2018
- Impact of Air Pollution and Other Environmental Exposures on Estimates of Severe Influenza Illness, Washington, USA
Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures
There were 3 influenza pandemics in the 20th century, and there has been 1 so far in the 21st century. Local, national, and international health authorities regularly update their plans for mitigating the next influenza pandemic in light of the latest available evidence on the effectiveness of various control measures in reducing transmission. Here, we review the evidence base on the effectiveness of nonpharmaceutical personal protective measures and environmental hygiene measures in nonhealthcare settings and discuss their potential inclusion in pandemic plans. Although mechanistic studies support the potential effect of hand hygiene or face masks, evidence from 14 randomized controlled trials of these measures did not support a substantial effect on transmission of laboratory-confirmed influenza. We similarly found limited evidence on the effectiveness of improved hygiene and environmental cleaning. We identified several major knowledge gaps requiring further research, most fundamentally an improved characterization of the modes of person-to-person transmission.
Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Social Distancing Measures
Influenza virus infections are believed to spread mostly by close contact in the community. Social distancing measures are essential components of the public health response to influenza pandemics. The objective of these mitigation measures is to reduce transmission, thereby delaying the epidemic peak, reducing the size of the epidemic peak, and spreading cases over a longer time to relieve pressure on the healthcare system. We conducted systematic reviews of the evidence base for effectiveness of multiple mitigation measures: isolating ill persons, contact tracing, quarantining exposed persons, school closures, workplace measures/closures, and avoiding crowding. Evidence supporting the effectiveness of these measures was obtained largely from observational studies and simulation studies. Voluntary isolation at home might be a more feasible social distancing measure, and pandemic plans should consider how to facilitate this measure. More drastic social distancing measures might be reserved for severe pandemics.
Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures
International travel–related nonpharmaceutical interventions (NPIs), which can include traveler screening, travel restrictions, and border closures, often are included in national influenza pandemic preparedness plans. We performed systematic reviews to identify evidence for their effectiveness. We found 15 studies in total. Some studies reported that NPIs could delay the introduction of influenza virus. However, no available evidence indicated that screening of inbound travelers would have a substantial effect on preventing spread of pandemic influenza, and no studies examining exit screening were found. Some studies reported that travel restrictions could delay the start of local transmission and slow international spread, and 1 study indicated that small Pacific islands were able to prevent importation of pandemic influenza during 1918–19 through complete border closure. This limited evidence base indicates that international travel-related NPIs would have limited effectiveness in controlling pandemic influenza and that these measures require considerable resources to implement.
- Women’s Awareness and Healthcare Provider Discussions about Zika Virus during Pregnancy, United States, 2016–2017
- A Neighbor-Based Approach to Identify Tuberculosis Exposure, Africa
- Genetic Characterization of Japanese Encephalitis Virus Genotype 5 Isolated from Patient, South Korea, 2015
- Candidatus Rickettsia xinyangensis as Cause of Spotted Fever Group Rickettsiosis, China
- Capybara and Brush Cutter Involvement in Q Fever Outbreak, Amazon Rain Forest, French Guiana, 2014
Update on Ebola Treatment Center Costs and Sustainability, United States, 2019
We surveyed 56 Ebola treatment centers (ETCs) in the United States and identified costs incurred since 2014 ($1.76 million/ETC) and sustainability strategies. ETCs reported heavy reliance on federal funding. It is uncertain if, or for how long, ETCs can maintain capabilities should federal funding expire in 2020.
- Species Distribution and Isolation Frequency of Nontuberculous Mycobacteria, Uruguay
- Out-of-Pocket Expenses for Presumptive Multidrug-Resistant Tuberculosis Patients, India, 2016–2017
- Antibodies against Crimean-Congo Hemorrhagic Fever Virus in Livestock, Corsica Island, France, 2014–2016
Risk for Transportation of 2019 Novel Coronavirus Disease from Wuhan to Other Cities in China
On January 23, 2020, China quarantined Wuhan to contain 2019 novel coronavirus disease (COVID-19). We estimated the probability of transportation of COVID-19 from Wuhan to 369 other cities in China before the quarantine. Expected COVID-19 risk is >50% in 130 (95% CI 89–190) cities and >99% in the 4 largest metropolitan areas.
- MDR Salmonella Serotype Anatum in Travelers and Seafood Imported from Asia, USA
- Average Hepatitis A Hospitalization Costs, United States, 2016
- Case of Babesia crassa-like Infection, Slovenia
Crimean-Congo Hemorrhagic Fever Virus Endemicity in United Arab Emirates, 2019
We conducted a cross-sectional survey of Crimean-Congo hemorrhagic fever virus (CCHFV) in dromedary camels and attached ticks at 3 locations in the United Arab Emirates. Results revealed a high prevalence of CCHFV-reactive antibodies in camels and viral RNA in ticks and camel serum, suggesting the virus is endemic in this country.
Serologic Detection of Middle East Respiratory Syndrome Coronavirus Functional Antibodies
We developed and validated 2 species-independent protein-based assays to detect Middle East respiratory syndrome coronavirus functional antibodies that can block virus receptor-binding or sialic acid-attachment. Antibody levels measured in both assays correlated strongly with virus-neutralizing antibody titers, proving their use for serologic confirmatory diagnosis of Middle East respiratory syndrome.
- Zika-Related Inquiries to the Centers for Disease Control and Prevention via the CDC-INFO system, December 2015–September 2017
- Rise in Murine Typhus in Galveston County, Texas, USA, 2018
Potential Presymptomatic Transmission of SARS-CoV-2, Zhejiang Province, China, 2020
We report a 2-family cluster of persons infected with severe acute respiratory syndrome coronavirus 2 in the city of Zhoushan, Zhejiang Province, China, during January 2020. The infections resulted from contact with an infected but potentially presymptomatic traveler from the city of Wuhan in Hubei Province.
- Fatal Rodentborne Leptospirosis in Prison Inmates, South Africa, 2015
- Novel Ehrlichia Strain Infecting Cattle Tick Amblyomma neumanni, Argentina, 2018
- Diplorickettsia Bacteria in an Ixodes scapularis Tick, Vermont, USA
Books and Media
- Superbugs: the Race to Stop an Epidemic
Volume 26, Number 6—June 2020
Identifying and Interrupting Superspreading Events—Implications for Control of Severe Acute Respiratory Syndrome Coronavirus 2
It appears inevitable that severe acute respiratory syndrome coronavirus 2 will continue to spread. Although we still have limited information on the epidemiology of this virus, there have been multiple reports of superspreading events (SSEs), which are associated with both explosive growth early in an outbreak and sustained transmission in later stages. Although SSEs appear to be difficult to predict and therefore difficult to prevent, core public health actions can prevent and reduce the number and impact of SSEs. To prevent and control of SSEs, speed is essential. Prevention and mitigation of SSEs depends, first and foremost, on quickly recognizing and understanding these events, particularly within healthcare settings. Better understanding transmission dynamics associated with SSEs, identifying and mitigating high-risk settings, strict adherence to healthcare infection prevention and control measures, and timely implementation of nonpharmaceutical interventions can help prevent and control severe acute respiratory syndrome coronavirus 2, as well as future infectious disease outbreaks.
- Genomic Epidemiology of 2015–2016 Zika Virus Outbreak in Cape Verde
- Risks Related to Chikungunya Infections among European Union Travelers, 2012–2018
- Manifestations of Toxic Shock Syndrome in Children, Columbus, Ohio, USA, 2010–2017
Pharmacologic Treatments and Supportive Care for Middle East Respiratory Syndrome
Available animal and cell line models have suggested that specific therapeutics might be effective in treating Middle East respiratory syndrome (MERS). We conducted a systematic review of evidence for treatment with pharmacologic and supportive therapies. We developed a protocol and searched 5 databases for studies describing treatment of MERS and deaths in MERS patients. Risk of bias (RoB) was assessed by using ROBINS-I tool. We retrieved 3,660 unique citations; 20 observational studies met eligibility, and we studied 13 therapies. Most studies were at serious or critical RoB; no studies were at low RoB. One study, at moderate RoB, showed reduced mortality rates in severe MERS patients with extracorporeal membrane oxygenation; no other studies showed a significant lifesaving benefit to any treatment. The existing literature on treatments for MERS is observational and at moderate to critical RoB. Clinical trials are needed to guide treatment decisions.
- Endemic Chromoblastomycosis Caused Predominantly by Fonsecaea nubica, Madagascar
- Zoonotic Alphaviruses in Fatal and Neurologic Infections in Wildlife and Nonequine Domestic Animals, South Africa
- Invasive Group B Streptococcus Infections in Adults, England, 2015–2016
- Failures of 13-Valent Conjugated Pneumococcal Vaccine in Age-Appropriately Vaccinated Children 2–59 Months of Age
Severe Acute Respiratory Syndrome Coronavirus 2 from Patient with 2019 Novel Coronavirus Disease, United States
The etiologic agent of an outbreak of pneumonia in Wuhan, China, was identified as severe acute respiratory syndrome coronavirus 2 in January 2020. A patient in the United States was given a diagnosis of infection with this virus by the state of Washington and the US Centers for Disease Control and Prevention on January 20, 2020. We isolated virus from nasopharyngeal and oropharyngeal specimens from this patient and characterized the viral sequence, replication properties, and cell culture tropism. We found that the virus replicates to high titer in Vero-CCL81 cells and Vero E6 cells in the absence of trypsin. We also deposited the virus into 2 virus repositories, making it broadly available to the public health and research communities. We hope that open access to this reagent will expedite development of medical countermeasures.
Estimating Risk for Death from 2019 Novel Coronavirus Disease, China, January–February 2020
Since December 2019, when the first case of 2019 novel coronavirus disease (COVID-19) was identified in the city of Wuhan in the Hubei Province of China, the epidemic has generated tens of thousands of cases throughout China. As of February 28, 2020, the cumulative number of reported deaths in China was 2,858. We estimated the time-delay adjusted risk for death from COVID-19 in Wuhan, as well as for China excluding Wuhan, to assess the severity of the epidemic in the country. Our estimates of the risk for death in Wuhan reached values as high as 12% in the epicenter of the epidemic and ≈1% in other, more mildly affected areas. The elevated death risk estimates are probably associated with a breakdown of the healthcare system, indicating that enhanced public health interventions, including social distancing and movement restrictions, should be implemented to bring the COVID-19 epidemic under control.
Epidemiology of 2019 Novel Coronavirus Disease-19 in Gansu Province, China, 2020
To determine the epidemiology of 2019 novel coronavirus disease (COVID-19) in a remote region of China, far from Wuhan, we analyzed the epidemiology of COVID-19 in Gansu Province. From January 23 through February 3, 2020, a total of 35 (64.8%) of 54 reported cases were imported from COVID-19–epidemic areas. Characteristics that differed significantly during the first and second waves of illness in Gansu Province were mean patient age, occupation, having visited epidemic areas, and mode of transportation. Time from infection to illness onset for family clusters was shorter in Gansu Province than in Wuhan, consistent with shortened durations from onset to first medical visit or hospitalization. Spatial distribution pattern analysis indicated hot spots and spatial outliers in Gansu Province. As a result of adequate interventions, transmission of the COVID-19 virus in Gansu Province is decreasing.
- Temporary Fertility Decline after a Large Rubella Outbreak, Japan
- Characterization of Sporadic Creutzfeldt-Jakob Disease and History of Neurosurgery to Identify Potential Iatrogenic Cases
- Statin Use and Influenza Vaccine Effectiveness in Persons >65 Years of Age, Taiwan
- Unexpected Genetic Diversity and Emergence of New Non-CG258 High-Risk Clones among KPC-Producing Klebsiella pneumoniae, France
- Increased Risk for Carbapenem-Resistant Enterobacteriaceae Colonization in Intensive Care Units
- Antimicrobial Resistance in Salmonella enterica Serovar Paratyphi B Variant Java in Poultry from Europe and Latin America
- Multihost Transmission of Schistosoma mansoni in Senegal
- Distribution of Group A Streptococcus Pharyngitis and Acute Rheumatic Fever, Auckland, New Zealand, 2010–2016
- Ectoparasites and Vectorborne Zoonotic Pathogens of Dogs and Cats in Asia, 2017–2018
- Syphilis in Maria Salviati (1499–1543), Wife of Giovanni de’ Medici of the Black Bands
- Leishmania infantum in Tigers and Sand Flies from a Leishmaniasis-Endemic Area, Southern Italy
- Melioidosis in a Resident of Texas with No Recent Travel History, United States
- High Prevalence of Escherichia albertii in Raccoons (Procyon lotor), Japan
- Cannabis Use and Fungal Infections in a Commercially Insured Population, United States, 2016
- Origin of 3 Rabid Terrestrial Animals in Raccoon Rabies-Free Zone, Long Island, New York, USA, 2016–2017
Community Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, Shenzhen, China, 2020
Since early January 2020, after the outbreak of 2019 novel coronavirus infection in Wuhan, China, ≈365 confirmed cases have been reported in Shenzhen, China. The mode of community and intrafamily transmission is threatening residents in Shenzhen. Strategies to strengthen prevention and interruption of these transmissions should be urgently addressed.
- No Adaption of the Prion Strain in a Heterozygous Case of Variant Creutzfeldt-Jakob Disease
- Yaws Disease Caused by Treponema pallidum subsp. pertenue in Wild chimpanzee (Pan troglodytes verus), Guinea, 2019
Serial Interval of COVID-19 among Publicly Reported Confirmed Cases
We estimate the distribution of serial intervals for 468 confirmed cases of 2019 novel coronavirus disease reported in China as of February 8, 2020. The mean interval was 3.96 days (95% CI 3.53–4.39 days), SD 4.75 days (95% CI 4.46–5.07 days); 12.6% of case reports indicated presymptomatic transmission.
COVID-19 in 2 Persons with Mild Upper Respiratory Tract Symptoms on a Cruise Ship, Japan
We describe 2 cases of COVID-19 in patients with mild upper respiratory symptoms. Both patients worked on a cruise ship quarantined off the coast of Japan. One patient had persistent, low-grade upper respiratory tract symptoms without fever. The other patient had rapid symptom cessation but persistent viral RNA detection.
Lack of Vertical Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, China
A woman with 2019 novel coronavirus disease in her 35th week of pregnancy delivered an infant by cesarean section in a negative-pressure operating room. The infant was negative for severe acute respiratory coronavirus 2. This case suggests that mother-to-child transmission is unlikely for this virus.
Detection of Novel Coronavirus by RT-PCR in Stool Specimen from Asymptomatic Child, China
We report an asymptomatic child who was positive for a 2019 novel coronavirus by reverse transcription PCR in a stool specimen 17 days after the last virus exposure. The child was virus positive in stool specimens for at least an additional 9 days. Respiratory tract specimens were negative by reverse transcription PCR.
Co-infection with SARS-CoV-2 and Influenza A Virus in Patient with Pneumonia, China
We report co-infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza A virus in a patient with pneumonia in China. The case highlights possible co-detection of known respiratory viruses. We noted low sensitivity of upper respiratory specimens for SARS-CoV-2, which could further complicate recognition of the full extent of disease.
Case-Fatality Risk Estimates for COVID-19 Calculated by Using a Lag Time for Fatality
We estimated the case-fatality risk for 2019 novel coronavirus disease cases in China (3.5%); China, excluding Hubei Province (0.8%); 82 countries, territories, and areas (4.2%); and on a cruise ship (0.6%). Lower estimates might be closest to the true value, but a broad range of 0.25%–3.0% probably should be considered.
Indirect Virus Transmission in Cluster of COVID-19 Cases, Wenzhou, China, 2020
To determine possible modes of virus transmission, we investigated a cluster of COVID-19 cases associated with a shopping mall in Wenzhou, China. Data indicated that indirect transmission of the causative virus occurred, perhaps resulting from virus contamination of common objects, virus aerosolization in a confined space, or spread from asymptomatic infected persons.
- Donor-Derived Transmission of Cryptococcus gattii sensu lato in Kidney Transplant Tecipients
- Sabiá-like Mammarenavirus in Patient with Fatal Hemorrhagic Fever, Brazil, 2020
Incursions of Candida auris into Australia, 2018
Candida auris is an emerging global healthcare-associated pathogen. During July–December 2018, four patients with C. auris were identified in Victoria, Australia, all with previous overseas hospitalization. Phylogenetic analysis revealed putative transmission between 2 patients and suspected overseas acquisition in the others. Vigilant screening of at-risk patients is required.
Books and Media
- The Pandemic Century: One Hundred Years of Panic, Hysteria, and Hubris
Volume 26, Number 7—July 2020
Identifying Locations with Possible Undetected Imported Severe Acute Respiratory Syndrome Coronavirus 2 Cases by Using Importation Predictions
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
- Severe Acute Respiratory Syndrome Coronavirus 2−Specific Antibody Responses in 2019 Novel Coronavirus Disease Patients
- Bat and Lyssavirus Exposure among Humans in Region that Celebrates a Bat Festival, Nigeria, 2010 and 2013
- Policy Decisions and Use of Information Technology to Fight 2019 Novel Coronavirus Disease, Taiwan
Early Introduction of Severe Acute Respiratory Syndrome Coronavirus 2 into Europe
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
- Approach to Cataract in an Ebola Virus Disease Survivor with Prior Ocular Viral Persistence: Phacoemulsification Surgery, Lens Biopsy, and Laboratory Analyses
- Zika Virus Detection with 2013 Serosurvey, Mombasa, Kenya
Rhabdomyolysis as Potential Late Complication Associated with COVID-19
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
Public Mental Health Crisis during COVID-19 Pandemic, China
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
- Asymptomatic and Human-to-Human Transmission of SARS-CoV-2 in a 2-Family Cluster, Xuzhou, China