Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.
Volume 26, Number 1—January 2020
- Candidatus Mycoplasma haemohominis in Human, Japan
- Spatial Epidemiologic Trends and Hotspots of Leishmaniasis, Sri Lanka, 2001–2018
Nutritional Care for Patients with Ebola Virus Disease
During the Ebola virus disease (EVD) outbreak of 2014–2016 in West Africa, practitioners faced challenges providing nutritional care for patients in Ebola treatment units (ETUs). The current EVD outbreak in the Democratic Republic of the Congo demonstrates the need to understand lessons learned from previous outbreaks and to update nutritional guidelines. We conducted a literature review to identify articles that included nutrition as an integral part of supportive care. We found little information on the specific nutritional care or practical challenges within an ETU. This review showed that nutritional care for EVD patients is poorly described, and therefore the optimal composition and implementation of nutritional care remain unknown. We recommend that researchers and practitioners share specific and practical details of their experiences in providing nutrition support within ETUs to expand the knowledge base and ultimately improve the nutritional care for an increasingly prevalent patient population.
- Paid Leave and Access to Telework as Work Attendance Determinants during Acute Respiratory Illness, United States, 2017–2018
Elephant Endotheliotropic Herpesvirus Hemorrhagic Disease in Asian Elephant Calves in Logging Camps, Myanmar
In recent years, an alarming number of cases of lethal acute hemorrhagic disease have occurred in Asian elephant calves raised in logging camps in Myanmar. To determine whether these deaths were associated with infection by elephant endotheliotropic herpesvirus (EEHV), we conducted diagnostic PCR subtype DNA sequencing analysis on necropsy tissue samples collected from 3 locations. We found that EEHV DNA from 7 PCR loci was present at high levels in all 3 calves and was the same EEHV1A virus type that has been described in North America, Europe, and other parts of Asia. However, when analyzed over 5,610 bp, the strains showed major differences from each other and from all previously characterized EEHV1A strains. We conclude that these 3 elephant calves in Myanmar died from the same herpesvirus disease that has afflicted young Asian elephants in other countries over the past 20 years.
High Azole Resistance in Aspergillus fumigatus Isolates from Strawberry Fields, China, 2018
In 2018, we conducted a cross-sectional study to investigate azole resistance in environmental Aspergillus fumigatus isolates obtained from different agricultural fields in China. Using 63 soil cores, we cultured for azole-resistant A. fumigatus and characterized isolates by their cyp51A gene type, short tandem repeat genotype, and mating type. Of 206 A. fumigatus isolates, 21 (10.2%) were azole resistant. Nineteen of 21 had mutations in their cyp51A gene (5 TR34/L98H, 8 TR34/L98H/S297T/F495I, 6 TR46/Y121F/T289A). Eighteen were cultured from soil samples acquired from strawberry fields, suggesting this soil type is a potential hotspot for azole resistance selection. Twenty resistant isolates were mating type MAT1-1, suggesting asexual sporulation contributed to their evolution. Prochloraz, difenoconazole, and tebuconazole were the most frequently detected fungicides in soil samples with azole-resistant fungus. Our study results suggest that managing the fungicides used in agriculture will help contain the problem of antifungal drug resistance in clinics.
- High Pathogenicity Nipah Virus in Pteropus lylei Fruit Bats, Cambodia
Tick-Borne Encephalitis Virus, United Kingdom
During February 2018–January 2019, we conducted large-scale surveillance for the presence and prevalence of tick-borne encephalitis virus (TBEV) and louping ill virus (LIV) in sentinel animals and ticks in the United Kingdom. Serum was collected from 1,309 deer culled across England and Scotland. Overall, 4% of samples were ELISA-positive for the TBEV serocomplex. A focus in the Thetford Forest area had the highest proportion (47.7%) of seropositive samples. Engorged ticks collected from culled deer within seropositive regions were tested for viral RNA; 5 of 2,041 ticks tested positive by LIV/TBEV real-time reverse transcription PCR, all from within the Thetford Forest area. From 1 tick, we identified a full-length genomic sequence of TBEV. Thus, using deer as sentinels revealed a potential TBEV focus in the United Kingdom. This detection of TBEV genomic sequence in UK ticks has important public health implications, especially for undiagnosed encephalitis.
- Phenotypic and Genotypic Correlates of Penicillin Susceptibility in Nontoxigenic Corynebacterium diphtheriae, British Columbia, 2015–2018
Preclinical Detection of Prions in Blood of Nonhuman Primates Infected with Variant Creutzfeldt-Jakob Disease
Variant Creutzfeldt-Jakob disease (vCJD) is caused by prion infection with bovine spongiform encephalopathy and can be transmitted by blood transfusion. Protein misfolding cyclic amplification (PMCA) can detect prions in blood from vCJD patients with 100% sensitivity and specificity. To determine whether PMCA enables prion detection in blood during the preclinical stage of infection, we performed a blind study using blood samples longitudinally collected from 28 control macaques and 3 macaques peripherally infected with vCJD. Our results demonstrate that PMCA consistently detected prions in blood during the entire preclinical stage in all infected macaques, without false positives from noninfected animals, when using the optimized conditions for amplification of macaque prions. Strikingly, prions were detected as early as 2 months postinoculation (>750 days before disease onset). These findings suggest that PMCA has the potential to detect vCJD prions in blood from asymptomatic carriers during the preclinical phase of the disease.
- Effects of Acute Illness on Contact Patterns, Malawi, 2017
Outbreak of Peste des Petits Ruminants among Critically Endangered Mongolian Saiga and Other Wild Ungulates, Mongolia, 2016–2017
The 2016–2017 introduction of peste des petits ruminants virus (PPRV) into livestock in Mongolia was followed by mass mortality of the critically endangered Mongolian saiga antelope and other rare wild ungulates. To assess the nature and population effects of this outbreak among wild ungulates, we collected clinical, histopathologic, epidemiologic, and ecological evidence. Molecular characterization confirmed that the causative agent was PPRV lineage IV. The spatio-temporal patterns of cases among wildlife were similar to those among livestock affected by the PPRV outbreak, suggesting spillover of virus from livestock at multiple locations and time points and subsequent spread among wild ungulates. Estimates of saiga abundance suggested a population decline of 80%, raising substantial concerns for the species’ survival. Consideration of the entire ungulate community (wild and domestic) is essential for elucidating the epidemiology of PPRV in Mongolia, addressing the threats to wild ungulate conservation, and achieving global PPRV eradication.
Effect of Pediatric Influenza Vaccination on Antibiotic Resistance, England and Wales
Vaccines against viral infections have been proposed to reduce prescribing of antibiotics and thereby help control resistant bacterial infections. However, by combining published data sources, we predict that pediatric live attenuated influenza vaccination in England and Wales will not substantially reduce antibiotic consumption or adverse health outcomes associated with antibiotic resistance.
- Varicella in Adult Foreigners at a Referral Hospital, Central Tokyo, Japan, 2012–2016
Distribution of Japanese Encephalitis Virus, Japan and Southeast Asia, 2016–2018
During 2016–2018, we conducted surveillance for Japanese encephalitis virus (JEV) in mosquitoes and pigs in Japan, Thailand, the Philippines, and Indonesia. Phylogenetic analyses demonstrated that our isolates (genotypes Ia, Ib, III, IV) were related to JEV isolates obtained from the same regions many years ago. Indigenous JEV strains persist in Asia.
Geographic Distribution and Incidence of Melioidosis, Panama
Melioidosis is an infection caused by Burkholderia pseudomallei. Most cases occur in Southeast Asia and northern Australia; <100 cases have been reported in the Americas. We conducted a retrospective study and identified 12 melioidosis cases in Panama during 2007–2017, suggesting possible endemicity and increased need for surveillance.
Novel Reassortant Highly Pathogenic Avian Influenza A(H5N2) Virus in Broiler Chickens, Egypt
We detected a novel reassortant highly pathogenic avian influenza A(H5N2) virus in 3 poultry farms in Egypt. The virus carried genome segments of a pigeon H9N2 influenza virus detected in 2014, a nucleoprotein segment of contemporary chicken H9N2 viruses from Egypt, and hemagglutinin derived from the 184.108.40.206b H5N8 virus clade.
Infectivity of Norovirus GI and GII from Bottled Mineral Water during a Waterborne Outbreak, Spain
During a waterborne outbreak of norovirus in Spain, we estimated 50% illness doses for a group of exposed (secretor) persons to be 556 (95% CI 319–957) genome copies/day for norovirus GI and 2,934 (95% CI 1,683–5,044) genome copies/day for norovirus GII. Use of a propidium monoazide viability assay reduced these values.
Locally Acquired Human Infection with Swine-Origin Influenza A(H3N2) Variant Virus, Australia, 2018
In 2018, a 15-year-old female adolescent in Australia was infected with swine influenza A(H3N2) variant virus. The virus contained hemagglutinin and neuraminidase genes derived from 1990s-like human seasonal viruses and internal protein genes from influenza A(H1N1)pdm09 virus, highlighting the potential risk that swine influenza A virus poses to human health in Australia.
Shigella Bacteremia, Georgia, USA, 2002–2012
Shigella commonly causes gastroenteritis but rarely spreads to the blood. During 2002–2012, we identified 11,262 Shigella infections through population-based active surveillance in Georgia; 72 (0.64%) were isolated from blood. Bacteremia was associated with age >18 years, black race, and S. flexneri. More than half of patients with bacteremia were HIV-infected.
- Syphilitic bilateral papillitis mimicking papilloedema
- Emergence of Vibrio cholerae O1 Sequence Type 75 in Taiwan
- Influenza A Virus Infections among Dromedary Camels, Nigeria and Ethiopia, 2015–2016
Autochthonous Human Fascioliasis, Belgium
We report 2 cases of human fascioliasis (HF) in Belgium, likely caused by consumption of vegetables from a garden that was flooded by pasture runoff. Because autochthonous HF is rare and the route of transmission was unusual, HF was not diagnosed until 6 months after symptom onset in both cases.
- Risk Factors and Seroprevalence of Tickborne Zoonoses among Livestock Owners, Kazakhstan
Training for Foodborne Outbreak Investigations by Using Structured Learning Experience
We created a free and interactive training activity based on playing cards (disease detective cards) that introduces foodborne outbreak investigations to public health professionals and students. Competencies taught cover-selected descriptive and analytic epidemiologic topics, such as case definition, epidemic curve, 2-by-2 tables, relative risks, attack rates, stratification, and confounding.
Hantavirus Pulmonary Syndrome in Traveler Returning from Nepal to Spain
Most human hantavirus infections occur in Asia, but some cases have been described in Europe in travelers returning from Asia. We describe a case of hantavirus pulmonary syndrome in a previously healthy traveler occurring shortly after he returned to Spain from Nepal. Serologic tests suggested a Puumala virus–like infection.
Legionella pneumophila as Cause of Severe Community-Acquired Pneumonia, China
We report a case of community-acquired pneumonia in a patient in China. We verified Legionella pneumophila infection through next-generation sequencing of blood, sputum, and pleural effusion samples. Our results show the usefulness of next-generation sequencing and of testing different samples early in the course of illness to identify this bacterium.
- Detection of Bovine Kobuvirus in Cattle with Diarrhea, United States
- Diabetes Mellitus, Hypertension, and Death for 32 Patients with MERS-CoV Infection, Saudi Arabia
- Rare Case of Enteric Ancylostoma caninum Infection, South Korea
- Influenza D Virus of New Phylogenetic Lineage, Japan
Recombinant Nontypeable Genotype II Human Noroviruses in the Americas
We report multiple nontypeable genotype II noroviruses circulating in South America; nucleotides differed by >25% from those of other genotypes. These viruses have been circulating in the Americas for ≈20 years and show recombination with other genotypes. Clues to norovirus natural history can guide development of treatment and prevention plans.
Use of Ambulance Dispatch Calls for Surveillance of Severe Acute Respiratory Infections
Ambulance dispatches for respiratory syndromes reflect incidence of influenza-like illness in primary care. Associations are highest in children (15%–34% of respiratory calls attributable to influenza), out-of-office hours (9%), and highest urgency-level calls (9%–11%). Ambulance dispatches might be an additional source of data for severe influenza surveillance.
Visceral Leishmaniasis, Northern Somalia, 2013–2019
We identified visceral leishmaniasis caused by Leishmania donovani in a previously unknown focus in northern Somalia. Clinical and epidemiologic characteristics of 118 cases during 2013–2019 in Bosaso, the region’s commercial capital, have raised suspicion of visceral leishmaniasis endemicity status there.
Plans for Nationwide Serosurveillance Network in Vietnam
In recent years, serosurveillance has gained momentum as way of determining disease transmission and immunity in populations, particularly with respect to vaccine-preventable diseases. At the end of 2017, the Oxford University Clinical Research Unit and the National Institute of Hygiene and Epidemiology held a meeting in Vietnam with national policy makers, researchers, and international experts to discuss current seroepidemiologic projects in Vietnam and future needs and plans for nationwide serosurveillance. This report summarizes the meeting and the plans that were discussed to set up nationwide serosurveillance in Vietnam.
Volume 26, Number 2—February 2020
- Acute Toxoplasmosis among Canadian Deer Hunters Associated with Consumption of Undercooked Deer Meat Hunted in the United States
- Interspecies Transmission of Swine Reassortant Influenza A Virus Containing Genes from Influenza A(H1N1)pdm09 and Swine Influenza A(H1N2) Viruses
- Neutralizing Antibodies against Enterovirus and Coxsackieviruses in Patients with Hand, Foot and Mouth Disease
- Cost-Effectiveness of Screening Program for Chronic Q Fever, the Netherlands
- Infection and Transmission of Porcine Deltacoronavirus in Commercial Poultry, United States
- Characteristics of Patients with Acute Flaccid Myelitis, USA, 2015–2018
- Multiplex Mediator Displacement LAMP for Detection of Treponema pallidum and Haemophilus ducreyi in Clinical Samples
- Chronic Human Pegivirus-2 and Hepatitis C Virus Co-infection
- Global Expansion of Pacific Northwest Vibrio parahaemolyticus Sequence Type 36
- Systematic Hospital-Based Travel Screening to Assess Exposure to Zika Virus
- Human Norovirus Infection in Dogs, Thailand
- Emergence of Chikungunya Virus, Pakistan, 2016–2017
- Surge in Anaplasmosis Cases in Maine, USA, 2013–2017
- Early Detection of Public Health Emergencies of International Concern through Undiagnosed Disease Reports in ProMED-mail
Ocular Spiroplasma ixodetis in Newborns, France
Cataract and uveitis are rare in newborns but potentially blinding. Three newborns with cataract and severe anterior uveitis underwent cataract surgery. Spiroplasma ixodetis was detected in lens aspirates using bacterial 16S-rRNA PCR and transmission electron microscopy. These findings, which suggest maternal–fetal infection, are consistent with previous experimental Spiroplasma-induced cataract and uveitis.
- Influence of Rainfall on Leptospira Infection and Disease in a Tropical Urban Setting, Brazil
- Elizabethkingia anophelis Infection in Infants, Cambodia, 2012–2018
- New Delhi Metallo-β-Lactamase-5–Producing Escherichia coli in Companion Animals, United States
- Human Alveolar Echinococcosis, Croatia
- Rickettsia mongolitimonae Encephalitis, Southern France, 2018
- Astrovirus in White-Tailed Deer, United States, 2018
- Actinomycetoma caused by Actinomadura mexicana, a neglected entity in the Caribbean
- Persistence of Crimean-Congo Hemorrhagic Fever Virus RNA
- Hantavirus Infection with Renal Failure and Proteinuria, Colorado, United States, 2019
- Non-Leishmania Parasite in Fatal Visceral Leishmaniasis–like Disease, Brazil
Volume 26, Number 3—March 2020
- Improving Quality of Patient Data for Treatment of Multidrug- or Rifampin-Resistant Tuberculosis