Early Release

Synopses

• Epidemiology of Legionnaires’ Disease, Hong Kong, China, 2005−2015
  Y. Leung et al. View Abstract Email this Article

  We reviewed findings of clinical, epidemiologic, and environmental investigations for 288 confirmed case-patients with Legionnaires’ disease reported in Hong Kong, China, during January 2005−December 2015. We found that chronic renal failure/impairment (adjusted odds ratio [aOR] 4.09), chronic pulmonary diseases (aOR 3.22), malignancy (aOR 3.04), and heart diseases (aOR 2.15) were independently associated with a higher risk for severe Legionnaires’ disease. However, patients with hyperlipidemia had a lower risk for severe outcome (aOR 0.17). Legionella positivity rate was 22% for 1,904 water samples collected. We found a higher positivity rate in summer months (28%−30%), which corroborated with months of highest rainfalls. Our novel finding that Legionnaires’ disease patients with hyperlipidemia had a lower risk for severe outcome deserves further study to confirm the observation and ascertain the underlying reason.

• 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, Washington, United States
  V. T. Chu et al. View Abstract Email this Article

  We describe the contact investigation for an early confirmed case of coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in the United States. Contacts of the case-patient were identified, actively monitored for symptoms, interviewed for a detailed exposure history, and tested for SARS-CoV-2 infection by real-time reverse transcription PCR (rRT-PCR) and ELISA. Fifty contacts were identified and 38 (76%) were interviewed, of whom 11 (29%) reported unprotected face-to-face interaction with the case-patient. Thirty-seven (74%) had respiratory specimens tested by rRT-PCR, and all tested negative. Twenty-three (46%) had ELISA performed on serum samples collected ≈6 weeks after exposure, and none had detectable antibodies to SARS-CoV-2. Among contacts who were tested, no secondary transmission was identified in this investigation, despite unprotected close interactions with the infectious case-patient.

• 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.

• Rise in Babesiosis Cases, Pennsylvania, USA, 2005–2018
  D. Ingram and T. Crook View Abstract Email this Article

  Babesiosis is an emerging infection in the state of Pennsylvania, and clinicians need to be made aware of its clinical manifestations as well as the risk factors associated with severe disease. Before 2010, our tertiary academic center in central Pennsylvania previously saw zero cases of babesiosis. We saw our first confirmed case of Babesia infection acquired in Pennsylvania in 2011; we recorded 2 confirmed cases in 2017 and 4 confirmed cases in 2018. All 4 cases from 2018 were thought to be acquired in southcentral Pennsylvania counties, whereas prior reports of cases were predominately in the southeast and northeast counties of the state.

• Association of Dengue Virus and Leptospira Co-Infections with Malaria Severity
  R. Mandage et al. View Abstract Email this Article

  Plasmodium infections are co-endemic with infections caused by other agents of acute febrile illnesses, such as dengue virus (DENV), chikungunya virus, Leptospira spp., and Orientia tsutsugamushi. However, co-infections may influence disease severity, treatment outcomes, and development of drug resistance. When we analyzed cases of acute febrile illness at the All India Institute of Medical Sciences, New Delhi, India, from July 2017 through September 2018, we found that most patients with malaria (77% of total infections) harbored co-infections (Plasmodium mixed species and other pathogens). DENV was the most common malaria co-infection (44% of total infections). DENV serotype 4 was associated with mild malaria, and Leptospira was associated with severe malaria. We also found the presence of P. knowlesi in our study population. Therefore, in areas with a large number of severe malaria cases, diagnostic screening for all 4 DENV serotypes, Leptospira, and all Plasmodium species should be performed.

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.

• 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. Park et al. View Abstract Email this Article

  CrAssphage is a recently discovered human gut–associated bacteriophage. To validate the potential use of crAssphage for detecting human fecal contamination on environmental surfaces and hands, we tested stool samples (n = 60), hand samples (n = 30), and environmental swab samples (n = 201) from 17 norovirus outbreaks for crAssphage by real-time PCR. In addition, we tested stool samples from healthy persons (n = 173), respiratory samples (n = 113), and animal fecal specimens (n = 68) and further sequenced positive samples. Overall, we detected crAssphage in 71.4% of outbreak stool samples, 48%–68.5% of stool samples from healthy persons, 56.2% of environmental swabs, and 60% of hand rinse samples, but not in human respiratory samples or animal fecal samples. CrAssphage sequences could be grouped into 2 major genetic clusters. Our data suggest that crAssphage could be used to detect human fecal contamination on environmental surfaces and hands.

• Virome Analysis for Detection of Segmented Flaviviruses in Wild Rodents, Pennsylvania, USA
  A. Kumar et al. View Abstract Email this Article

  Identifying viruses in synanthropic animals is necessary for understanding the origin of many viruses that can infect human hosts and developing strategies to prevent new zoonotic infections. The white-footed mouse, Peromyscus leucopus, is one of the most abundant rodent species in the northeastern United States. We characterized the serum virome of 978 free-ranging P. leucopus mice caught in Pennsylvania. We identified many new viruses from 26 different virus families. Among these viruses was a highly divergent segmented flavivirus whose genetic relatives were recently identified in ticks, mosquitos, and vertebrates, including febrile patients. The novel flavi-like segmented virus, isolated from ticks in Pennsylvania, shares ˂70% aa identity with known viruses in the highly conserved region of the viral polymerase. Our data will enable researchers to develop molecular reagents to further characterize this virus and its relatives infecting other hosts and to curtail their spread, if necessary.

• Population Genomic Structure and Recent Evolution of Plasmodium knowlesi, Peninsular Malaysia
  S. E. Hocking et al. View Abstract Email this Article

  Most malaria in Malaysia is caused by Plasmodium knowlesi parasites through zoonotic infection from macaque reservoir hosts. We obtained genome sequences from 28 clinical infections in Peninsular Malaysia to clarify the emerging parasite population structure and test for evidence of recent adaptation. The parasites all belonged to a major genetic population of P. knowlesi (cluster 3) with high genomewide divergence from populations occurring in Borneo (clusters 1 and 2). We also observed unexpected local genetic subdivision; most parasites belonged to 2 subpopulations sharing a high level of diversity except at particular genomic regions, the largest being a region of chromosome 12, which showed evidence of recent directional selection. Surprisingly, we observed a third subpopulation comprising P. knowlesi infections that were almost identical to each other throughout most of the genome, indicating separately maintained transmission and recent genetic isolation. Each subpopulation could evolve and present a broader health challenge in Asia.

• Human Outbreak of Trichinellosis Caused by Trichinella papuae Nematodes, Central Kampong Thom Province, Cambodia
  Y. Caron et al. View Abstract Email this Article

  In September 2017, a severe trichinellosis outbreak occurred in Cambodia after persons consumed raw wild pig meat; 33 persons were infected and 8 died. We collected and analyzed the medical records for 25 patients. Clinical signs and symptoms included myalgia, facial or peripheral edema, asthenia, and fever. We observed increased levels of creatine phosphokinase and aspartate aminotransferase­, as well as eosinophilia. Histopathologic examination of muscle biopsy specimens showed nonencapsulated Trichinella larvae. A Trichinella excretory/secretory antigen ELISA identified Trichinella IgM and IgG. Biopsy samples were digested and larvae were isolated and counted. PCR for the 5S rDNA intergenic spacer region and a multiplex PCR, followed by sequencing identified the parasite as Trichinella papuae. This species was identified in Papua New Guinea during 1999 and in several outbreaks in humans in Thailand. Thus, we identified T. papuae nematodes in humans in Cambodia.

• Increased Sensitivity of Plasmodium falciparum to Artesunate/Amodiaquine Despite 14 Years as First-Line Malaria Treatment, Zanzibar
  M. Msellem et al. View Abstract Email this Article

  Artemisinin-based combination therapies (ACTs) are first-line treatments for uncomplicated Plasmodium falciparum malaria. ACT resistance is spreading in Asia but not yet in Africa. Reduced effects of ACT partner drugs have been reported but with little information regarding widely used artesunate/amodiaquine (ASAQ). We studied its efficacy in Zanzibar after 14 years as first-line treatment directly by an in vivo, single-armed trial and indirectly by prevalences of different genotypes in the P. falciparum chloroquine-resistance transporter, multidrug-resistance 1, and Kelch 13 propeller domain genes. In vivo efficacy was higher during 2017 (100%; 95% CI 97.4%–100%) than during 2002–2005 (94.7%; 95% CI 91.9%–96.7%) (p = 0.003). Molecular findings showed no artemisinin resistance–associated genotypes and major increases in genotypes associated with high sensitivity/efficacy for amodiaquine than before ASAQ was introduced. Thus, the efficacy of ASAQ is maintained and appears to be increased after long-term use in contrast to what is observed for other ACTs used in Africa.

• 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, most new cases, 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.

• Naturally Acquired Human Plasmodium cynomolgi and Plasmodium knowlesi Infections, Malaysian Borneo
  T. Raja et al.
• Linezolid-Associated Neurologic Adverse Events in Patients with Multidrug-Resistant Tuberculosis, France
  M. Jaspard et al. View Abstract Email this Article

  Linezolid is one of the most effective drugs for treating multidrug-resistant tuberculosis (MDR TB), but adverse effects remain problematic. We evaluated 57 MDR TB patients who had received >1 dose of linezolid during 2011–2016. Overall, patients received 600 mg/day of linezolid for a median of 13 months. In 33 (58%) patients, neurologic or ophthalmologic signs developed, and 18 (32%) had confirmed peripheral neuropathy, which for 78% was irreversible at 12 months after the end of TB treatment despite linezolid withdrawal. Among the 19 patients who underwent ophthalmologic evaluation, 14 patients had optic neuropathy that fully reversed for 2. A total of 16 (33%) of 49 patients had a linezolid trough concentration >2 mg/L, and among these, 14 (88%) experienced adverse effects. No significant association was found between trough concentration and neurologic toxicity. These findings suggest the need to closely monitor patients for neurologic signs and discuss optimal duration of linezolid treatment.

• Factors Associated with Prescription of Antimicrobial Drugs for Dogs and Cats, United Kingdom, 2014–2016
  D. A. Singleton 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. View Abstract Email this Article

  Chagas disease is emerging in countries to which it is not endemic. Biomarkers for earlier therapeutic response assessment in patients with chronic Chagas disease are needed. We profiled plasma-derived extracellular vesicles from a heart transplant patient with chronic Chagas disease and showed the potential of this approach for discovering such biomarkers.

• 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.

• Spread of Multidrug-Resistant Bacteria by Moth Flies from Hospital Waste Water System
  T. Rupprecht et al. View Abstract Email this Article

  We documented and analyzed moth fly occurrence and spread of multidrug-resistant bacteria in a tertiary care hospital in Germany. The moth flies (Clogmia albipunctata) bred in the sewage system, then moved into the hospital, carrying biofilm and multidrug-resistant bacteria on their feet. Subsequently, the hospital developed a pest control protocol.

• Increasing Malaria Parasite Clearance Time after Chloroquine Therapy, South Korea, 2000–2016
  S. Park et al. View Abstract Email this Article

  We reviewed the clinical efficacy of chloroquine for Plasmodium vivax malaria, the changing trend of parasite clearance time, and fever clearance time during 2000–2016 in South Korea. Median parasite clearance time and fever clearance time increased significantly over the study period. Chloroquine was mostly underdosed when used to treat P. vivax malaria.

• 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. View Abstract Email this Article

  An immunocompetent child in Canada received a diagnosis of disseminated alveolar Echinococcus multilocularis infection. The case lacked typical features of liver involvement and was possibly related to a rare congenital portosystemic shunt. We summarize the rapidly evolving epidemiology of E. multilocularis parasites in Canada.

• SARS-CoV-2 Phylogenetic Analysis, Lazio Region, Italy, February–March 2020
  B. Bartolini et al. View Abstract Email this Article

  We report phylogenetic and mutational analysis of severe acute respiratory syndrome coronavirus 2 virus strains from the Lazio region of Italy and provide information about the dynamics of virus spread. Data suggest effective containment of clade V strains, but subsequently, multiple waves of clade G strains were circulating widely in Europe.

• Leishmania infantum in US-Born Dog
  M. E. de Almeida et al.
• Canine Dracunculus Worm Infection, Toledo, Spain
  I. Diekmann et al.
• Autochthonous Gnathostomiasis with Severe Ocular Infection, Madagascar, 2016
  A. Raharisoa et al.
• Doxycycline and Sitafloxacin Combination Therapy for Treating Highly Resistant Mycoplasma genitalium
  D. Durukan et al.
• Leishmania donovani Infection with Atypical Cutaneous Manifestations, Himachal Pradesh, India, 2014–2018
  L. Thakur et al. View Abstract Email this Article

  We conducted a molecular study of parasite sequences from a cohort of cutaneous leishmaniasis patients in Himachal Pradesh, India. Results revealed atypical cutaneous disease caused by Leishmania donovani parasites. L. donovani variants causing cutaneous manifestations in this region are different from those causing visceral leishmaniasis in northeastern India.

• Atypical Pathogenicity of Avian Influenza (H3N1) Virus Involved in Outbreak, Belgium, 2019
  M. Steensels et al. View Abstract Email this Article

  In 2019, an outbreak of avian influenza (H3N1) virus infection occurred among commercial poultry in Belgium. Full-genome phylogenetic analysis indicated a wild bird origin rather than recent circulation among poultry. Although classified as a nonnotifiable avian influenza virus, it was associated with reproductive tropism and substantial mortality in the field.

• Evolution and Antigenic Drift of Influenza A(H7N9) Viruses, China, 2019
  J. Zhang 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.

• mcr-Positive Escherichia coli ST131-H22 from Poultry Connected to International Isolates, Brazil
  A. S. Saidenberg et al. View Abstract Email this Article

  Escherichia coli sequence type (ST) 131 is of concern because it can acquire antimicrobial resistance and cause extraintestinal infections. E. coli ST131-H22 sublineage appears capable of being transmitted to humans through poultry. We report on multidrug-resistant ST131-H22 poultry isolates in Brazil closely related to international human and poultry isolates.

• 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. View Abstract Email this Article

  We explored the secondary attack rate in different types of contact with persons presymptomatic for coronavirus disease (COVID-19). Close contacts who lived with or had frequent contact with an index case-patient had a higher risk for COVID-19. Our findings provide population-based evidence for transmission from persons with presymptomatic COVID-19 infections.

• Visceral Leishmaniasis Caused by Leishmania donovani Zymodeme MON-37, Western Ghats, India
  P. Saini et al.
• Cryptosporidium baileyi Pulmonary Infection in Immunocompetent Woman with Benign Neoplasm
  Ż. Kopacz et al.

Letters

• Intact Mycobacterium leprae Isolated from Placenta of a Pregnant Woman, China
  A. Singh et al. Email this Article
• 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 Email this Article

Books and Media

• Human Parasitic Diseases: A Diagnostic Atlas
  T. Crook

Etymologia

• Etymologia: Acanthamoeba
  N. Pradhan Email this Article

Perspective

• Seroepidemiologic Study Designs for Determining SARS-COV-2 Transmission and Immunity
  H. Clapham et al. View Abstract Email this Article

  Serologic studies are crucial for clarifying dynamics of the coronavirus disease pandemic. Past work on serologic studies (e.g., during influenza pandemics) has made relevant contributions, but specific conditions of the current situation require adaptation. Although detection of antibodies to measure exposure, immunity, or both seems straightforward conceptually, numerous challenges exist in terms of sample collection, what the presence of antibodies actually means, and appropriate analysis and interpretation to account for test accuracy and sampling biases. Successful deployment of serologic studies depends on type and performance of serologic tests, population studied, use of adequate study designs, and appropriate analysis and interpretation of data. We highlight key questions that serologic studies can help answer at different times, review strengths and limitations of different assay types and study designs, and discuss methods for rapid sharing and analysis of serologic data to determine global transmission of severe acute respiratory syndrome coronavirus 2.

• Disparate Effects of Invasive Group A Streptococcus on Native Americans
  R. M. Close and J. B. McAuley

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.

• Severe Acute Respiratory Syndrome Coronavirus 2 Prevalence, Seroprevalence, and Exposure Among Evacuees from Wuhan, China, 2020
  B. D. Hallowell et al. View Abstract Email this Article

  To determine prevalence of, seroprevalence of, and potential exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among a cohort of evacuees returning to the United States from Wuhan, China, in January 2020, we conducted a cross-sectional study of quarantined evacuees from 1 repatriation flight. Overall, 193 of 195 evacuees completed exposure surveys and submitted upper respiratory or serum specimens or both at arrival in the United States. Nearly all evacuees had taken preventive measures to limit potential exposure while in Wuhan, and none had detectable SARS-CoV-2 in upper respiratory tract specimens, suggesting the absence of asymptomatic respiratory shedding among this group at the time of testing. Evidence of antibodies to SARS-CoV-2 was detected in 1 evacuee, who reported experiencing no symptoms or high-risk exposures in the previous 2 months. These findings demonstrated that this group of evacuees posed a low risk of introducing SARS-CoV-2 to the United States.

• Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020
  K. Benameur et al. View Abstract Email this Article

  Few detailed investigations of neurologic complications in severe acute respiratory syndrome coronavirus 2 infection have been conducted. We describe 3 patients with laboratory-confirmed coronavirus disease who showed development of encephalopathy and encephalitis. Neuroimaging showed nonenhancing unilateral, bilateral, and midline changes not readily attributable to vascular causes. All 3 patients had increased cerebrospinal fluid (CSF) levels of anti-S1 IgM. One patient who died also had increased levels of anti–envelope protein IgM. CSF analysis also showed markedly increased levels of interleukin (IL) 6, IL-8, and IL-10, but severe acute respiratory syndrome coronavirus 2 was not identified in any CSF sample. These changes provide evidence of CSF periinfectious/postinfectious inflammatory changes during coronavirus disease with neurologic complications.

• Outbreak of Saprochaete clavata Infections through Dishwashers in a Cancer Center
  E. Menu et al.
• Q-Fever Osteoarticular Infection in Children
  H. Dabaja-Younis et al.

Research

• Association of Biosecurity and Hygiene Practices with Environmental Contamination with Influenza A Viruses in Live Bird Markets, Bangladesh
  S. Chowdhury et al.
• Risk-Based Estimate of Human Fungal Disease Burden, China
  L. Zhou et al.
• Molecular Description of a Novel Orientia Species Causing Scrub Typhus in South America
  K. Abarca et al.
• Evaluation of World Health Organization–Recommended Hand Hygiene Formulations
  M. Suchomel et al. View Abstract Email this Article

  As a result of the coronavirus disease pandemic, commercial hand hygiene products have become scarce and World Health Organization (WHO) alcohol-based hand rub formulations containing ethanol or isopropanol are being produced for hospitals worldwide. Neither WHO formulation meets European Norm 12791, the basis for approval as a surgical hand preparation, nor satisfies European Norm 1500, the basis for approval as a hygienic hand rub. We evaluated the efficacy of modified formulations with alcohol concentrations in mass instead of volume percentage and glycerol concentrations of 0.5% instead of 1.45%. Both modified formulations met standard requirements for a 3-minute surgical hand preparation, the usual duration of surgical hand treatment in most hospitals in Europe. Contrary to the originally proposed WHO hand rub formulations, both modified formulations are appropriate for surgical hand preparation after 3 minutes when alcohol concentrations of 80% wt/wt ethanol or 75% wt/wt isopropanol along with reduced glycerol concentration (0.5%) are used.

• Heterogeneity of Dengue Illness in Community-Based Prospective Study, Iquitos, Peru
  W. H. Elson et al.
• Isolation, Sequence, Infectivity, and Replication Kinetics of Severe Acute Respiratory Syndrome Coronavirus 2
  A. Banerjee et al. View Abstract Email this Article

  Since its emergence in Wuhan, China, in December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected ≈6 million persons worldwide. As SARS-CoV-2 spreads across the planet, we explored the range of human cells that can be infected by this virus. We isolated SARS-CoV-2 from 2 infected patients in Toronto, Canada; determined the genomic sequences; and identified single-nucleotide changes in representative populations of our virus stocks. We also tested a wide range of human immune cells for productive infection with SARS-CoV-2. We confirm that human primary peripheral blood mononuclear cells are not permissive for SARS-CoV-2. As SARS-CoV-2 continues to spread globally, it is essential to monitor single-nucleotide polymorphisms in the virus and to continue to isolate circulating viruses to determine viral genotype and phenotype by using in vitro and in vivo infection models.

• Incidence and Seroprevalence of Avian Influenza among a Cohort of Backyard Poultry Growers, Egypt, August 2015–March 2019
  M. R. Gomaa et al.
• Retrospective Description of Pregnant Women Infected with Severe Acute Respiratory Syndrome Coronavirus 2, France
  A. J. Vivanti 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.

• Carbapenemase-Producing Gram Negative Bacteria in Andalusia, Spain, 2014–2018
  I. Lopez-Hernandez et al.
• Enterovirus D68 Subclade B3 in Children with Acute Flaccid Paralysis in West Africa, 2016
  A. Fall et al.
• Role of Wildlife in Emergence of Ebola Virus, Kaigbono (Likati), Democratic Republic of the Congo, 2017
  S. Gryseels et al.
• Emergence of pstS-Null Vancomycin-Resistant Enterococcus faecium clone ST1478, Canada, 2013–2018
  M. McCracken et al.
• Clusters of Coronavirus Disease in Communities, Japan, January–April 2020
  Y. Furuse et al. View Abstract Email this Article

  We analyzed 3,184 cases of coronavirus disease in Japan and identified 61 case-clusters in healthcare and other care facilities, restaurants and bars, workplaces, and music events. We also identified 22 probable primary case-patients for the clusters; most were 20–39 years of age and presymptomatic or asymptomatic at virus transmission.

• Sequence Type Changes Associated with Decreasing Macrolide-Resistant Mycoplasma pneumoniae, Japan
  M. Morozumi et al.
• Mycobacterial Testing Trends, United States, 2009–2015
  S. G. Dean et al.
• Persistence of Severe Acute Respiratory Syndrome Coronavirus 2 in Aerosol Suspensions
  A. C. Fears et al. View Abstract Email this Article

  We aerosolized severe acute respiratory syndrome coronavirus 2 and determined that its dynamic aerosol efficiency surpassed those of severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome. Although we performed experiment only once across several laboratories, our findings suggest retained infectivity and virion integrity for up to 16 hours in respirable-sized aerosols.

• Updated Estimates of Chronic Conditions Affecting Risk for Complications from Coronavirus Disease, United States
  M. L. Adams et al. View Abstract Email this Article

  We updated estimates of adults at risk for coronavirus disease complications on the basis of data for China by using recent US hospitalization data. This update to our previous publication substitutes obesity for cancer as an underlying condition and increases adults reporting any of the conditions from 45.4% to 56.0%.

• Oxacillinase-181 Carbapenemase-Producing Klebsiella pneumoniae in Neonatal Intensive Care Unit, Ghana, 2017–2019
  A. Labi et al.
• Fatal Measles Inclusion-Body Encephalitis in an Adult with Untreated AIDS, France
  C. Rodriguez et al.

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
• Clostridioides 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 Clostridioides 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. View Abstract Email this Article

  We describe 2 cases in coronavirus disease patients in France involving presumed thrombotic stroke that occurred during ongoing anticoagulation treatment for atrial fibrillation stroke prophylaxis; 1 patient had positive antiphospholipid antibodies. These cases highlight the severe and unique consequences of coronavirus disease–associated stroke.

• SARS-CoV-2 RNA Detection on Disposable Wooden Chopsticks, Hong Kong
  G. Lui et al. View Abstract Email this Article

  We detected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA on disposable wooden chopsticks used by 5 consecutive asymptomatic and postsymptomatic patients admitted for isolation and care at our hospital. Although we did not assess virus viability, our findings may suggest potential for transmission through shared eating utensils.

• Parotitis-Like Symptoms Associated with COVID-19, France, March–April 2020
  J. R. Lechien et al. View Abstract Email this Article

  We report the clinical features of 3 patients in France who had parotitis (inflammation of the parotid salivary glands) as a clinical manifestation of confirmed coronavirus disease. Results from magnetic resonance imaging support the occurrence of intraparotid lymphadenitis, leading to a parotitis-like clinical picture.

• Effectiveness of N95 Respirator Decontamination and Reuse against SARS-CoV-2 Virus
  R. J. Fischer et al. View Abstract Email this Article

  The coronavirus pandemic has created worldwide shortages of N95 respirators. We analyzed 4 decontamination methods for effectiveness in deactivating severe acute respiratory syndrome coronavirus 2 virus and effect on respirator function. Our results indicate that N95 respirators can be decontaminated and reused, but the integrity of respirator fit and seal must be maintained.

• Effects of Proactive Social Distancing on COVID-19 Outbreaks in 58 Cities, China
  Z. Du et al. View Abstract Email this Article

  Cities across China implemented stringent social distancing measures in early 2020 to curb coronavirus disease outbreaks. We estimated the speed with which these measures contained transmission in cities. A 1-day delay in implementing social distancing resulted in a containment delay of 2.41 (95% CI 0.97–3.86) days.

• Effect of Environmental Conditions on SARS-CoV-2 Stability in Human Nasal Mucus and Sputum
  M. Matson et al. View Abstract Email this Article

  We found that environmental conditions affect the stability of severe acute respiratory syndrome coronavirus 2 in nasal mucus and sputum. The virus is more stable at low-temperature and low-humidity conditions, whereas warmer temperature and higher humidity shortened half-life. Although infectious virus was undetectable after 48 hours, viral RNA remained detectable for 7 days.

• Severe Acute Respiratory Syndrome Coronavirus 2 among Asymptomatic Workers Screened for Work Resumption, China
  X. Han et al. View Abstract Email this Article

  After the outbreak in Wuhan, China, we assessed 29,299 workers screened for severe acute respiratory syndrome coronavirus 2 by reverse transcription PCR. We noted 18 (0.061%) cases of asymptomatic infection; 13 turned negative within 8.0 days, and 41 close contacts tested negative. Among 6 contacts who had serologic tests, none were positive.

• Putative Conjugative Plasmids with tcdB and cdtAB Genes in Clostridioides difficile
  G. Ramírez-Vargas and C. Rodríguez
• Methemoglobinemia in Patient with G6PD Deficiency and SARS-CoV-2 Infection
  K. Palmer et al. View Abstract Email this Article

  We report a case of intravascular hemolysis and methemoglobinemia, precipitated by severe acute respiratory syndrome coronavirus 2 infection, in a patient with undiagnosed glucose-6-phosphate dehydrogenase deficiency. Clinicians should be aware of this complication of coronavirus disease as a cause of error in pulse oximetry and a potential risk for drug-induced hemolysis.

• Prolonged Infectivity of SARS-CoV-2 in Fomites
  B. Pastorino et al. View Abstract Email this Article

  We spotted severe acute respiratory syndrome coronavirus 2 on polystyrene plastic, aluminum, and glass for 96 hours with and without bovine serum albumin (3 g/L). We observed a steady infectivity (<1 log₁₀ drop) on plastic, a 3.5 log₁₀ decrease on glass, and a 6 log₁₀ drop on aluminum. The presence of proteins noticeably prolonged infectivity.

• Asymptomatic SARS-CoV-2 Infection in Nursing Homes, Barcelona, Spain, April 2020
  B. Borras-Bermejo et al. View Abstract Email this Article

  During the coronavirus disease pandemic in Spain, from April 10–24, 2020, a total of 5,869 persons were screened for severe acute respiratory syndrome coronavirus 2 at nursing homes. Among residents, 768 (23.9%) tested positive; among staff, 403 (15.2%). Of those testing positive, 69.7% of residents and 55.8% of staff were asymptomatic.

• Large SARS-CoV-2 Outbreak Caused by Asymptomatic Traveler, China
  J. Liu et al. View Abstract Email this Article

  An asymptomatic person infected with severe acute respiratory syndrome coronavirus 2 returned to Heilongjiang Province, China, after international travel. The traveler’s neighbor became infected and generated a cluster of >71 cases, including cases in 2 hospitals. Genome sequences of the virus were distinct from viral genomes previously circulating in China.

• Antibody Responses after Classroom Exposure to Teacher with Coronavirus Disease, March 2020
  N. E. Brown et al. View Abstract Email this Article

  After returning from Europe to the United States, on March 1, 2020, a symptomatic teacher received positive test results for severe acute respiratory syndrome coronavirus 2. Of the 21 students exposed to the teacher in the classroom, serologic results suggested past infection for 2. Classroom contact may result in virus transmission.

• Buying Time with COVID-19 Outbreak Response, Israel
  E. Leshem et al. View Abstract Email this Article

  Israel's response during the containment phase of the COVID-19 outbreak in early 2020 led to a delay in sustained community transmission and effective mitigation. During February–April 2020, a total of 15,981 confirmed cases resulted in 223 deaths. A total of 179,003 persons reported electronically to self-quarantine and were entitled to paid sick leave.

Letters

• Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures
  J. Pannu Email this Article
• Zika Virus Infection, Philippines, 2012
  C. Buerano et al.
• Clostridiodes difficile in COVID-19 Patients, Detroit, Michigan, USA, March–April 2020
  S. Lakkasani et al. Email this Article
• Rhabdomyolysis as Potential Late Complication Associated with COVID-19
  Y. He and F. Chen
• COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020
  F. W. Moses et al. Email this Article

Etymologia

• Etymologia: Dermatophyte
  A. E. Santana and F. P. Sellera Email this Article

Synopses

• Operating Protocols of a Community Treatment Center for Isolation of Patients with Coronavirus Disease, South Korea
  E. Kang et al. View Abstract Email this Article

  Most persons with confirmed coronavirus disease (COVID-19) have no or mild symptoms. During the COVID-19 pandemic, communities need efficient methods to monitor asymptomatic patients to reduce transmission. We describe the structure and operating protocols of a community treatment center (CTC) run by Seoul National University Hospital (SNUH) in South Korea. SNUH converted an existing facility into a CTC to isolate patients who had confirmed COVID-19 but mild or no symptoms. Patients reported self-measured vital signs and symptoms twice a day by using a smartphone application. Medical staff in a remote monitoring center at SNUH reviewed patient vital signs and provided video consultation to patients twice daily. The CTC required few medical staff to perform medical tests, monitor patients, and respond to emergencies. During March 5–26, 2020, we admitted and treated 113 patients at this center. CTCs could be an alternative to hospital admission for isolating patients and preventing community transmission.

• Community Treatment Centers for Isolation of Asymptomatic and Mildly Symptomatic Patients with Coronavirus Disease, South Korea
  W. Choi et al. View Abstract Email this Article

  As a part of measures to decrease spikes in coronavirus disease (COVID-19) cases and deaths outside of hospitals, the government of South Korea introduced a plan for community treatment centers (CTCs) to isolate and monitor patients with mild COVID-19 symptoms. We assessed outcomes of 568 patients admitted to 3 CTCs near Daegu. More (64.6%) women than men (35.4%) were admitted, and the mean age of patients was 36.0 years (SD +15.0 years). Among all patients, 75.7% remained asymptomatic while at the CTCs. The mean time patients remained at CTCs was 19.6 days (SD +5.8 days) from the day of diagnosis until our study ended on March 23, 2020. Because they offer appropriate clinical triaging and daily monitoring for patients, CTCs are a safe alternative to medical institutions for asymptomatic or mildly symptomatic patients with COVID-19.

• Clinical Course of Asymptomatic and Mildly Symptomatic Patients with Coronavirus Disease Admitted to Community Treatment Centers, South Korea
  Y. Lee et al. View Abstract Email this Article

  We evaluated the clinical course of asymptomatic and mildly symptomatic patients with laboratory-confirmed coronavirus disease (COVID-19) admitted to community treatment centers (CTCs) for isolation in South Korea. Of 632 patients, 75 (11.9%) had symptoms at admission, 186 (29.4%) were asymptomatic at admission but developed symptoms during their stay, and 371 (58.7%) remained asymptomatic during their entire clinical course. Nineteen (3.0%) patients were transferred to hospitals, but 94.3% (573/613) of the remaining patients were discharged from CTCs upon virologic remission. The mean virologic remission period was 20.1 days (SD + 7.7 days). Nearly 20% of patients remained in the CTCs for 4 weeks after diagnosis. The virologic remission period was longer in symptomatic patients than in asymptomatic patients. In mildly symptomatic patients, the mean duration from symptom onset to virologic remission was 11.7 days (SD + 8.2 days). These data could help in planning for isolation centers and formulating self-isolation guidelines.

• Investigations of Shiga Toxin-Producing Escherichia coli Outbreaks Linked to Leafy Greens, United States and Canada, 2009–2018
  K. E. Marshall et al.

Research

• Sequential Acquisition of Human Papillomavirus Infection at Genital and Anal Sites, Liuzhou, China
  F. Wei et al.

Dispatches

• Effect of Nonpharmaceutical Interventions on Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, South Korea, 2020
  S. Ryu et al. View Abstract Email this Article

  We analyzed transmission of coronavirus disease outside of the Daegu-Gyeongsangbuk provincial region in South Korea. We estimated that nonpharmaceutical measures reduced transmissibility by a maximum of 33% without resorting to a strict lockdown strategy. To optimize epidemic control, continuous efforts to monitor the transmissibility are needed.

• Rapid, Sensitive, Full-Genome Sequencing of Severe Acute Respiratory Syndrome Coronavirus 2
  C. R. Paden et al. View Abstract Email this Article

  We describe validated protocols for generating high-quality, full-length severe acute respiratory syndrome coronavirus 2 genomes from primary samples. One protocol uses multiplex reverse transcription PCR, followed by MinION or MiSeq sequencing; the other uses singleplex, nested reverse transcription PCR and Sanger sequencing. These protocols enable sensitive virus sequencing in different laboratory environments.

• Seoul Orthohantavirus in Wild Black Rats, Senegal, 2012–2013
  M. M. Diagne et al.
• Emerging Sandfly-borne Phlebovirus in China
  J. Wang et al.
• Silent Circulation of Rift Valley Fever in Humans in Botswana
  C. E. Sanderson et al.
• Contact Tracing during Coronavirus Disease Outbreak, South Korea, 2020
  Y. Park et al.
• Main Routes of Entry and Genomic Diversity of SARS-CoV-2, Uganda
  D. Bugembe et al. View Abstract Email this Article

  We established rapid local viral sequencing to document the genomic diversity of severe acute respiratory syndrome coronavirus 2 entering Uganda. Virus lineages closely followed the travel origins of infected persons. Our sequence data provide an important baseline for tracking any further transmission of the virus throughout the country and region.

• High Proportion of Asymptomatic SARS-CoV-2 Infections in 9 Long-Term Care Facilities, Pasadena, California, USA, April 2020
  M. Feaster and Y. Goh View Abstract Email this Article

  Our analysis of coronavirus disease prevalence in 9 long-term care facilities demonstrated a high proportion (40.7%) of asymptomatic infections among residents and staff members. Infection control measures in congregate settings should include mass testing-based strategies in concert with symptom screening for greater effectiveness in preventing the spread of severe acute respiratory syndrome coronavirus 2.

Research Letters

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

  Because of in vitro studies, hydroxychloroquine is under evaluation as a preexposure or postexposure prophylaxis for coronavirus disease (COVID-19) and as a possible COVID-19 curative treatment. We report a case of COVID-19 in a patient with sarcoidosis who was receiving long-term hydroxychloroquine treatment, despite adequate plasma concentrations.

• Prevalence of African Swine Fever in Wild Boar, Asia
  T. Vergne et al.
• Review of Mental Health Response to COVID-19, China
  A. Miu et al. View Abstract Email this Article

  Public mental health response to coronavirus disease is essential. After reviewing systemic and local efforts in China, we found efficient coordination and human resources. We recommend better symptom assessment, monitoring of organizations, and basic needs protection. This recommendation can inform how other countries can overcome mental health challenges during this pandemic.

• Viral RNA Load in Mildly Symptomatic and Asymptomatic Children with COVID-19, Seoul
  M. Han et al. View Abstract Email this Article

  Along with positive SARS-CoV-2 RNA in nasopharyngeal swabs, viral RNA was detectable at high concentration for >3 weeks in fecal samples from 12 mildly symptomatic and asymptomatic children with COVID-19. Saliva also tested positive during the early phase of infection. If proven infectious, feces and saliva could serve as transmission sources.

• Q Fever Endocarditis and a New Genotype of Coxiella burnetii, Greece
  I. Karageorgou et al.
• Antibody Responses to SARS-CoV-2 at 8 Weeks Postinfection in Asymptomatic Patients
  P. Choe et al. View Abstract Email this Article

  We compared levels of severe acute respiratory syndrome coronavirus 2 neutralizing antibodies in recovery plasma from 7 completely asymptomatic coronavirus disease patients with those in symptomatic patients in South Korea. We found that serologic diagnostic testing was positive for 71% (5/7) of completely asymptomatic patients, but neutralizing antibody response occurred in all 7 patients.

• Disappearance of SARS-CoV-2 Antibodies in Infants Born to Women with COVID-19, Wuhan, China
  J. Gao et al. View Abstract Email this Article

  We report the detection and decline over time of severe acute respiratory syndrome coronavirus 2 antibodies in infants born to women with coronavirus disease. Among 11 infants tested at birth, all had detectable IgG and 5 had detectable IgM. IgG titers with positive IgM declined more slowly than those without.

• Relative Bradycardia in Patients with Mild-to-Moderate Coronavirus Disease, Japan
  K. Ikeuchi et al. View Abstract Email this Article

  Coronavirus disease is reported to affect the cardiovascular system. We showed that relative bradycardia was a common characteristic for 54 patients with PCR-confirmed mild-to-moderate coronavirus disease in Japan. This clinical sign could help clinicians to diagnose this disease.

• Culture-Competent SARS-CoV-2 in Nasopharynx of Symptomatic Neonates, Children, and Adolescents
  A. G. L’Huillier et al. View Abstract Email this Article

  Children do not seem to drive transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We isolated culture-competent virus in vitro from 12 (52%) of 23 SARS-CoV-2–infected children; the youngest was 7 days old. Our findings show that symptomatic neonates, children, and teenagers shed infectious SARS-CoV-2, suggesting that transmission from them is plausible.

• Retrospective Screening for SARS-CoV-2 RNA in California, USA, Late 2019
  C. A. Hogan et al. View Abstract Email this Article

  To investigate the possibility of earlier cases of severe acute respiratory syndrome coronavirus 2 infection than previously recognized, we retrospectively tested pooled samples from 1,700 persons with respiratory signs/symptoms seen at Stanford Health Care, Palo Alto, California, USA, during the last 2 months of 2019. We found no evidence of earlier infection.

• Coronavirus Disease Exposure and Spread from Nightclubs, South Korea
  C. Kang et al.

Letters

• Pulmonary Embolism and Increased Levels of d-Dimer in Patients with Coronavirus Disease
  K. Chan et al. Email this Article
• Rhabdomyolysis as Potential Late Complication Associated with COVID-19
  K. Chan and J. Slim Email this Article

Research Letter

• Pathogenic New World relapsing fever Borrelia in a Myotis bat, Eastern China, 2015
  H. Han et al.