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Articles from Emerging Infectious Diseases

Perspective

Parallels and Mutual Lessons in Tuberculosis and COVID-19 Transmission, Prevention, and Control [PDF - 607 KB - 6 pages]
P. C. Hopewell et al.

The coronavirus disease (COVID-19) pandemic has had unprecedented negative effects on global health and economies, drawing attention and resources from many other public health services. To minimize negative effects, the parallels, lessons, and resources from existing public health programs need to be identified and used. Often underappreciated synergies relating to COVID-19 are with tuberculosis (TB). COVID-19 and TB share commonalities in transmission and public health response: case finding, contact identification, and evaluation. Data supporting interventions for either disease are, understandably, vastly different, given the diseases’ different histories. However, many of the evolving issues affecting these diseases are increasingly similar. As previously done for TB, all aspects of congregate investigations and preventive and therapeutic measures for COVID-19 must be prospectively studied for optimal evidence-based interventions. New attention garnered by the pandemic can ensure that knowledge and investment can benefit both COVID-19 response and traditional public health programs such as TB programs.

EID Hopewell PC, Reichman LB, Castro KG. Parallels and Mutual Lessons in Tuberculosis and COVID-19 Transmission, Prevention, and Control. Emerg Infect Dis. 2021;27(3):681-686. https://dx.doi.org/10.3201/eid2703.203456
AMA Hopewell PC, Reichman LB, Castro KG. Parallels and Mutual Lessons in Tuberculosis and COVID-19 Transmission, Prevention, and Control. Emerging Infectious Diseases. 2021;27(3):681-686. doi:10.3201/eid2703.203456.
APA Hopewell, P. C., Reichman, L. B., & Castro, K. G. (2021). Parallels and Mutual Lessons in Tuberculosis and COVID-19 Transmission, Prevention, and Control. Emerging Infectious Diseases, 27(3), 681-686. https://dx.doi.org/10.3201/eid2703.203456.
Synopses

Genomic Evidence of In-Flight Transmission of SARS-CoV-2 Despite Predeparture Testing [PDF - 1.21 MB - 7 pages]
T. Swadi et al.

Since the first wave of coronavirus disease in March 2020, citizens and permanent residents returning to New Zealand have been required to undergo managed isolation and quarantine (MIQ) for 14 days and mandatory testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As of October 20, 2020, of 62,698 arrivals, testing of persons in MIQ had identified 215 cases of SARS-CoV-2 infection. Among 86 passengers on a flight from Dubai, United Arab Emirates, that arrived in New Zealand on September 29, test results were positive for 7 persons in MIQ. These passengers originated from 5 different countries before a layover in Dubai; 5 had negative predeparture SARS-CoV-2 test results. To assess possible points of infection, we analyzed information about their journeys, disease progression, and virus genomic data. All 7 SARS-CoV-2 genomes were genetically identical, except for a single mutation in 1 sample. Despite predeparture testing, multiple instances of in-flight SARS-CoV-2 transmission are likely.

EID Swadi T, Geoghegan JL, Devine T, McElnay C, Sherwood J, Shoemack P, et al. Genomic Evidence of In-Flight Transmission of SARS-CoV-2 Despite Predeparture Testing. Emerg Infect Dis. 2021;27(3):687-693. https://dx.doi.org/10.3201/eid2703.204714
AMA Swadi T, Geoghegan JL, Devine T, et al. Genomic Evidence of In-Flight Transmission of SARS-CoV-2 Despite Predeparture Testing. Emerging Infectious Diseases. 2021;27(3):687-693. doi:10.3201/eid2703.204714.
APA Swadi, T., Geoghegan, J. L., Devine, T., McElnay, C., Sherwood, J., Shoemack, P....de Ligt, J. (2021). Genomic Evidence of In-Flight Transmission of SARS-CoV-2 Despite Predeparture Testing. Emerging Infectious Diseases, 27(3), 687-693. https://dx.doi.org/10.3201/eid2703.204714.

Systematic Review of Pooling Sputum as an Efficient Method for Xpert MTB/RIF Tuberculosis Testing during the COVID-19 Pandemic [PDF - 951 KB - 9 pages]
L. E. Cuevas et al.

GeneXpert-based testing with Xpert MTB/RIF or Ultra assays is essential for tuberculosis diagnosis. However, testing may be affected by cartridge and staff shortages. More efficient testing strategies could help, especially during the coronavirus disease pandemic. We searched the literature to systematically review whether GeneXpert-based testing of pooled sputum samples achieves sensitivity and specificity similar to testing individual samples; this method could potentially save time and preserve the limited supply of cartridges. From 6 publications, we found 2-sample pools using Xpert MTB/RIF had 87.5% and 96.0% sensitivity (average sensitivity 94%; 95% CI 89.0%–98.0%) (2 studies). Four-sample pools averaged 91% sensitivity with Xpert MTB/RIF (2 studies) and 98% with Ultra (2 studies); combining >4 samples resulted in lower sensitivity. Two studies reported that pooling achieved 99%–100% specificity and 27%–31% in cartridge savings. Our results show that pooling may improve efficiency of GeneXpert-based testing.

EID Cuevas LE, Santos VS, Lima S, Kontogianni K, Bimba JS, Iem V, et al. Systematic Review of Pooling Sputum as an Efficient Method for Xpert MTB/RIF Tuberculosis Testing during the COVID-19 Pandemic. Emerg Infect Dis. 2021;27(3):719-727. https://dx.doi.org/10.3201/eid2703.204090
AMA Cuevas LE, Santos VS, Lima S, et al. Systematic Review of Pooling Sputum as an Efficient Method for Xpert MTB/RIF Tuberculosis Testing during the COVID-19 Pandemic. Emerging Infectious Diseases. 2021;27(3):719-727. doi:10.3201/eid2703.204090.
APA Cuevas, L. E., Santos, V. S., Lima, S., Kontogianni, K., Bimba, J. S., Iem, V....Creswell, J. (2021). Systematic Review of Pooling Sputum as an Efficient Method for Xpert MTB/RIF Tuberculosis Testing during the COVID-19 Pandemic. Emerging Infectious Diseases, 27(3), 719-727. https://dx.doi.org/10.3201/eid2703.204090.

Evaluation of National Event-Based Surveillance, Nigeria, 2016–2018 [PDF - 660 KB - 9 pages]
K. Beebeejaun et al.

Nigeria Centres for Disease Control and Prevention established an event-based surveillance (EBS) system in 2016 to supplement traditional surveillance structures. The EBS system is comprised of an internet-based data mining tool and a call center. To evaluate the EBS system for usefulness, simplicity, acceptability, timeliness, and data quality, we performed a descriptive analysis of signals received during September 2017–June 2018. We used questionnaires, semistructured interviews, and direct observation to collect information from EBS staff. Amongst 43,631 raw signals detected, 138 (0.3%) were escalated; 63 (46%) of those were verified as events, including 25 Lassa fever outbreaks and 13 cholera outbreaks. Interviewees provided multiple examples of earlier outbreak detections but suggested notifications and logging could be improved to ensure action. EBS proved effective in detecting outbreaks, but we noted clear opportunities for efficiency gains. We recommend improving signal logging, standardizing processes, and revising outputs to ensure appropriate public health action.

EID Beebeejaun K, Elston J, Oliver I, Ihueze A, Ukenedo C, Aruna O, et al. Evaluation of National Event-Based Surveillance, Nigeria, 2016–2018. Emerg Infect Dis. 2021;27(3):694-702. https://dx.doi.org/10.3201/eid2703.200141
AMA Beebeejaun K, Elston J, Oliver I, et al. Evaluation of National Event-Based Surveillance, Nigeria, 2016–2018. Emerging Infectious Diseases. 2021;27(3):694-702. doi:10.3201/eid2703.200141.
APA Beebeejaun, K., Elston, J., Oliver, I., Ihueze, A., Ukenedo, C., Aruna, O....Ihekweazu, C. (2021). Evaluation of National Event-Based Surveillance, Nigeria, 2016–2018. Emerging Infectious Diseases, 27(3), 694-702. https://dx.doi.org/10.3201/eid2703.200141.

Use of US Public Health Travel Restrictions during COVID-19 Outbreak on Diamond Princess Ship, Japan, February–April 2020 [PDF - 1.61 MB - 9 pages]
A. M. Medley et al.

Public health travel restrictions (PHTR) are crucial measures during communicable disease outbreaks to prevent transmission during commercial airline travel and mitigate cross-border importation and spread. We evaluated PHTR implementation for US citizens on the Diamond Princess during its coronavirus disease (COVID-19) outbreak in Japan in February 2020 to explore how PHTR reduced importation of COVID-19 to the United States during the early phase of disease containment. Using PHTR required substantial collaboration among the US Centers for Disease Control and Prevention, other US government agencies, the cruise line, and public health authorities in Japan. Original US PHTR removal criteria were modified to reflect international testing protocols and enable removal of PHTR for persons who recovered from illness. The impact of PHTR on epidemic trajectory depends on the risk for transmission during travel and geographic spread of disease. Lessons learned from the Diamond Princess outbreak provide critical information for future PHTR use.

EID Medley AM, Marston BJ, Toda M, Kobayashi M, Weinberg M, Moriarty LF, et al. Use of US Public Health Travel Restrictions during COVID-19 Outbreak on Diamond Princess Ship, Japan, February–April 2020. Emerg Infect Dis. 2021;27(3):710-718. https://dx.doi.org/10.3201/eid2703.203820
AMA Medley AM, Marston BJ, Toda M, et al. Use of US Public Health Travel Restrictions during COVID-19 Outbreak on Diamond Princess Ship, Japan, February–April 2020. Emerging Infectious Diseases. 2021;27(3):710-718. doi:10.3201/eid2703.203820.
APA Medley, A. M., Marston, B. J., Toda, M., Kobayashi, M., Weinberg, M., Moriarty, L. F....Cetron, M. (2021). Use of US Public Health Travel Restrictions during COVID-19 Outbreak on Diamond Princess Ship, Japan, February–April 2020. Emerging Infectious Diseases, 27(3), 710-718. https://dx.doi.org/10.3201/eid2703.203820.

Clinical Features and Comparison of Kingella and Non–Kingella Endocarditis in Children, Israel [PDF - 1.76 MB - 7 pages]
A. Lowenthal et al.

Kingella spp. have emerged as an important cause of invasive pediatric diseases. Data on Kingella infective endocarditis (KIE) in children are scarce. We compared the clinical features of pediatric KIE cases with those of Streptococcus species IE (StIE) and Staphylococcus aureus IE (SaIE). A total of 60 patients were included in the study. Throughout the study period, a rise in incidence of KIE was noted. KIE patients were significantly younger than those with StIE and SaIE, were predominately boys, and had higher temperature at admission, history of oral aphthae before IE diagnosis, and higher lymphocyte count (p<0.05). Pediatric KIE exhibits unique features compared with StIE and SaIE. Therefore, in young healthy children <36 months of age, especially boys, with or without a congenital heart defect, with a recent history of oral aphthae, and experiencing signs and symptoms compatible with endocarditis, Kingella should be suspected as the causative pathogen.

EID Lowenthal A, Weisblum-Neuman H, Birk E, Ashkenazi-Hoffnung L, Levy I, Ben-Zvi H, et al. Clinical Features and Comparison of Kingella and Non–Kingella Endocarditis in Children, Israel. Emerg Infect Dis. 2021;27(3):703-709. https://dx.doi.org/10.3201/eid2703.203022
AMA Lowenthal A, Weisblum-Neuman H, Birk E, et al. Clinical Features and Comparison of Kingella and Non–Kingella Endocarditis in Children, Israel. Emerging Infectious Diseases. 2021;27(3):703-709. doi:10.3201/eid2703.203022.
APA Lowenthal, A., Weisblum-Neuman, H., Birk, E., Ashkenazi-Hoffnung, L., Levy, I., Ben-Zvi, H....Scheuerman, O. (2021). Clinical Features and Comparison of Kingella and Non–Kingella Endocarditis in Children, Israel. Emerging Infectious Diseases, 27(3), 703-709. https://dx.doi.org/10.3201/eid2703.203022.

Decentralized Care for Rifampin-Resistant Tuberculosis, Western Cape, South Africa [PDF - 2.42 MB - 12 pages]
S. V. Leavitt et al.

In 2011, South Africa implemented a policy to decentralize treatment for rifampin-resistant tuberculosis (TB) to reduce durations of hospitalization and enable local treatment. We assessed policy implementation in Western Cape Province, where services expanded from 6 specialized TB hospitals to 406 facilities, by analyzing National Health Laboratory Service data on TB during 2012–2015. We calculated the percentage of patients who visited a TB hospital <1 year after rifampin-resistant TB diagnosis, the median duration of their hospitalizations, and the total distance between facilities visited. We assessed temporal changes with linear regression and stratified results by location. Of 2,878 patients, 65% were from Cape Town. In Cape Town, 29% visited a TB hospital; elsewhere, 68% visited a TB hospital. We found that hospitalizations and travel distances were shorter in Cape Town than in the surrounding areas.

EID Leavitt SV, Jacobson KR, Ragan EJ, Bor J, Hughes J, Bouton TC, et al. Decentralized Care for Rifampin-Resistant Tuberculosis, Western Cape, South Africa. Emerg Infect Dis. 2021;27(3):728-739. https://dx.doi.org/10.3201/eid2703.203204
AMA Leavitt SV, Jacobson KR, Ragan EJ, et al. Decentralized Care for Rifampin-Resistant Tuberculosis, Western Cape, South Africa. Emerging Infectious Diseases. 2021;27(3):728-739. doi:10.3201/eid2703.203204.
APA Leavitt, S. V., Jacobson, K. R., Ragan, E. J., Bor, J., Hughes, J., Bouton, T. C....Jenkins, H. E. (2021). Decentralized Care for Rifampin-Resistant Tuberculosis, Western Cape, South Africa. Emerging Infectious Diseases, 27(3), 728-739. https://dx.doi.org/10.3201/eid2703.203204.
Research

Severe Acute Respiratory Syndrome Coronavirus 2 Seropositivity among Healthcare Personnel in Hospitals and Nursing Homes, Rhode Island, USA, July–August 2020 [PDF - 2.02 MB - 12 pages]
L. J. Akinbami et al.

Healthcare personnel are recognized to be at higher risk for infection with severe acute respiratory syndrome coronavirus 2. We conducted a serologic survey in 15 hospitals and 56 nursing homes across Rhode Island, USA, during July 17–August 28, 2020. Overall seropositivity among 9,863 healthcare personnel was 4.6% (95% CI 4.2%–5.0%) but varied 4-fold between hospital personnel (3.1%, 95% CI 2.7%–3.5%) and nursing home personnel (13.1%, 95% CI 11.5%–14.9%). Within nursing homes, prevalence was highest among personnel working in coronavirus disease units (24.1%; 95% CI 20.6%–27.8%). Adjusted analysis showed that in hospitals, nurses and receptionists/medical assistants had a higher likelihood of seropositivity than physicians. In nursing homes, nursing assistants and social workers/case managers had higher likelihoods of seropositivity than occupational/physical/speech therapists. Nursing home personnel in all occupations had elevated seropositivity compared with hospital counterparts. Additional mitigation strategies are needed to protect nursing home personnel from infection, regardless of occupation.

EID Akinbami LJ, Chan PA, Vuong N, Sami S, Lewis D, Sheridan PE, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Seropositivity among Healthcare Personnel in Hospitals and Nursing Homes, Rhode Island, USA, July–August 2020. Emerg Infect Dis. 2021;27(3):823-834. https://dx.doi.org/10.3201/eid2703.204508
AMA Akinbami LJ, Chan PA, Vuong N, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Seropositivity among Healthcare Personnel in Hospitals and Nursing Homes, Rhode Island, USA, July–August 2020. Emerging Infectious Diseases. 2021;27(3):823-834. doi:10.3201/eid2703.204508.
APA Akinbami, L. J., Chan, P. A., Vuong, N., Sami, S., Lewis, D., Sheridan, P. E....Petersen, L. R. (2021). Severe Acute Respiratory Syndrome Coronavirus 2 Seropositivity among Healthcare Personnel in Hospitals and Nursing Homes, Rhode Island, USA, July–August 2020. Emerging Infectious Diseases, 27(3), 823-834. https://dx.doi.org/10.3201/eid2703.204508.

Population-Based Geospatial and Molecular Epidemiologic Study of Tuberculosis Transmission Dynamics, Botswana, 2012–2016 [PDF - 1.48 MB - 10 pages]
N. M. Zetola et al.

Tuberculosis (TB) elimination requires interrupting transmission of Mycobacterium tuberculosis. We used a multidisciplinary approach to describe TB transmission in 2 sociodemographically distinct districts in Botswana (Kopanyo Study). During August 2012–March 2016, all patients who had TB were enrolled, their sputum samples were cultured, and M. tuberculosis isolates were genotyped by using 24-locus mycobacterial interspersed repetitive units–variable number of tandem repeats. Of 5,515 TB patients, 4,331 (79%) were enrolled. Annualized TB incidence varied by geography (range 66–1,140 TB patients/100,000 persons). A total of 1,796 patient isolates had valid genotyping results and residential geocoordinates; 780 (41%) patients were involved in a localized TB transmission event. Residence in areas with a high burden of TB, age <24 years, being a current smoker, and unemployment were factors associated with localized transmission events. Patients with known HIV-positive status had lower odds of being involved in localized transmission.

EID Zetola NM, Moonan PK, Click E, Oeltmann JE, Basotli J, Wen X, et al. Population-Based Geospatial and Molecular Epidemiologic Study of Tuberculosis Transmission Dynamics, Botswana, 2012–2016. Emerg Infect Dis. 2021;27(3):835-844. https://dx.doi.org/10.3201/eid2703.203840
AMA Zetola NM, Moonan PK, Click E, et al. Population-Based Geospatial and Molecular Epidemiologic Study of Tuberculosis Transmission Dynamics, Botswana, 2012–2016. Emerging Infectious Diseases. 2021;27(3):835-844. doi:10.3201/eid2703.203840.
APA Zetola, N. M., Moonan, P. K., Click, E., Oeltmann, J. E., Basotli, J., Wen, X....Modongo, C. (2021). Population-Based Geospatial and Molecular Epidemiologic Study of Tuberculosis Transmission Dynamics, Botswana, 2012–2016. Emerging Infectious Diseases, 27(3), 835-844. https://dx.doi.org/10.3201/eid2703.203840.

Oral Human Papillomavirus Infection in Children during the First 6 Years of Life, Finland [PDF - 787 KB - 8 pages]
S. Syrjänen et al.

Human papillomavirus (HPV) infections are found in children, but transmission modes and outcomes are incompletely understood. We evaluated oral samples from 331 children in Finland who participated in the Finnish Family HPV Study from birth during 9 follow-up visits (mean time 51.9 months). We tested samples for 24 HPV genotypes. Oral HPV prevalence for children varied from 8.7% (at a 36-month visit) to 22.8% (at birth), and 18 HPV genotypes were identified. HPV16 was the most prevalent type to persist, followed by HPV18, HPV33, and HPV6. Persistent, oral, high-risk HPV infection for children was associated with oral HPV carriage of the mother at birth and seroconversion of the mother to high-risk HPV during follow-up (odds ratio 1.60–1.92, 95% CI 1.02–2.74). Children acquire their first oral HPV infection at an early age. The HPV status of the mother has a major impact on the outcome of oral HPV persistence for her offspring.

EID Syrjänen S, Rintala M, Sarkola M, Willberg J, Rautava J, Koskimaa H, et al. Oral Human Papillomavirus Infection in Children during the First 6 Years of Life, Finland. Emerg Infect Dis. 2021;27(3):759-766. https://dx.doi.org/10.3201/eid2703.202721
AMA Syrjänen S, Rintala M, Sarkola M, et al. Oral Human Papillomavirus Infection in Children during the First 6 Years of Life, Finland. Emerging Infectious Diseases. 2021;27(3):759-766. doi:10.3201/eid2703.202721.
APA Syrjänen, S., Rintala, M., Sarkola, M., Willberg, J., Rautava, J., Koskimaa, H....Louvanto, K. (2021). Oral Human Papillomavirus Infection in Children during the First 6 Years of Life, Finland. Emerging Infectious Diseases, 27(3), 759-766. https://dx.doi.org/10.3201/eid2703.202721.

Excess All-Cause Deaths during Coronavirus Disease Pandemic, Japan, January–May 2020 [PDF - 381 KB - 7 pages]
T. Kawashima et al.

To provide insight into the mortality burden of coronavirus disease (COVID-19) in Japan, we estimated the excess all-cause deaths for each week during the pandemic, January–May 2020, by prefecture and age group. We applied quasi-Poisson regression models to vital statistics data. Excess deaths were expressed as the range of differences between the observed and expected number of all-cause deaths and the 95% upper bound of the 1-sided prediction interval. A total of 208–4,322 all-cause excess deaths at the national level indicated a 0.03%–0.72% excess in the observed number of deaths. Prefecture and age structure consistency between the reported COVID-19 deaths and our estimates was weak, suggesting the need to use cause-specific analyses to distinguish between direct and indirect consequences of COVID-19.

EID Kawashima T, Nomura S, Tanoue Y, Yoneoka D, Eguchi A, Ng C, et al. Excess All-Cause Deaths during Coronavirus Disease Pandemic, Japan, January–May 2020. Emerg Infect Dis. 2021;27(3):789-795. https://dx.doi.org/10.3201/eid2703.203925
AMA Kawashima T, Nomura S, Tanoue Y, et al. Excess All-Cause Deaths during Coronavirus Disease Pandemic, Japan, January–May 2020. Emerging Infectious Diseases. 2021;27(3):789-795. doi:10.3201/eid2703.203925.
APA Kawashima, T., Nomura, S., Tanoue, Y., Yoneoka, D., Eguchi, A., Ng, C....Hashizume, M. (2021). Excess All-Cause Deaths during Coronavirus Disease Pandemic, Japan, January–May 2020. Emerging Infectious Diseases, 27(3), 789-795. https://dx.doi.org/10.3201/eid2703.203925.

Genomic Characterization of hlyF-positive Shiga Toxin–Producing Escherichia coli, Italy and the Netherlands, 2000–2019 [PDF - 6.21 MB - 9 pages]
F. Gigliucci et al.

Shiga toxin–producing Escherichia coli (STEC) O80:H2 has emerged in Europe as a cause of hemolytic uremic syndrome associated with bacteremia. STEC O80:H2 harbors the mosaic plasmid pR444_A, which combines several virulence genes, including hlyF and antimicrobial resistance genes. pR444_A is found in some extraintestinal pathogenic E. coli (ExPEC) strains. We identified and characterized 53 STEC strains with ExPEC-associated virulence genes isolated in Italy and the Netherlands during 2000–2019. The isolates belong to 2 major populations: 1 belongs to sequence type 301 and harbors diverse stx2 subtypes, the intimin variant eae-ξ, and pO157-like and pR444_A plasmids; 1 consists of strains belonging to various sequence types, some of which lack the pO157 plasmid, the locus of enterocyte effacement, and the antimicrobial resistance–encoding region. Our results showed that STEC strains harboring ExPEC-associated virulence genes can include multiple serotypes and that the pR444_A plasmid can be acquired and mobilized by STEC strains.

EID Gigliucci F, van Hoek A, Chiani P, Knijn A, Minelli F, Scavia G, et al. Genomic Characterization of hlyF-positive Shiga Toxin–Producing Escherichia coli, Italy and the Netherlands, 2000–2019. Emerg Infect Dis. 2021;27(3):853-861. https://dx.doi.org/10.3201/eid2703.203110
AMA Gigliucci F, van Hoek A, Chiani P, et al. Genomic Characterization of hlyF-positive Shiga Toxin–Producing Escherichia coli, Italy and the Netherlands, 2000–2019. Emerging Infectious Diseases. 2021;27(3):853-861. doi:10.3201/eid2703.203110.
APA Gigliucci, F., van Hoek, A., Chiani, P., Knijn, A., Minelli, F., Scavia, G....Michelacci, V. (2021). Genomic Characterization of hlyF-positive Shiga Toxin–Producing Escherichia coli, Italy and the Netherlands, 2000–2019. Emerging Infectious Diseases, 27(3), 853-861. https://dx.doi.org/10.3201/eid2703.203110.

Foodborne Origin and Local and Global Spread of Staphylococcus saprophyticus Causing Human Urinary Tract Infections [PDF - 4.74 MB - 14 pages]
O. U. Lawal et al.

Staphylococcus saprophyticus is a primary cause of community-acquired urinary tract infections (UTIs) in young women. S. saprophyticus colonizes humans and animals but basic features of its molecular epidemiology are undetermined. We conducted a phylogenomic analysis of 321 S. saprophyticus isolates collected from human UTIs worldwide during 1997–2017 and 232 isolates from human UTIs and the pig-processing chain in a confined region during 2016–2017. We found epidemiologic and genomic evidence that the meat-production chain is a major source of S. saprophyticus causing human UTIs; human microbiota is another possible origin. Pathogenic S. saprophyticus belonged to 2 lineages with distinctive genetic features that are globally and locally disseminated. Pangenome-wide approaches identified a strong association between pathogenicity and antimicrobial resistance, phages, platelet binding proteins, and an increased recombination rate. Our study provides insight into the origin, transmission, and population structure of pathogenic S. saprophyticus and identifies putative new virulence factors.

EID Lawal OU, Fraqueza MJ, Bouchami O, Worning P, Bartels MD, Gonçalves ML, et al. Foodborne Origin and Local and Global Spread of Staphylococcus saprophyticus Causing Human Urinary Tract Infections. Emerg Infect Dis. 2021;27(3):880-893. https://dx.doi.org/10.3201/eid2703.200852
AMA Lawal OU, Fraqueza MJ, Bouchami O, et al. Foodborne Origin and Local and Global Spread of Staphylococcus saprophyticus Causing Human Urinary Tract Infections. Emerging Infectious Diseases. 2021;27(3):880-893. doi:10.3201/eid2703.200852.
APA Lawal, O. U., Fraqueza, M. J., Bouchami, O., Worning, P., Bartels, M. D., Gonçalves, M. L....Miragaia, M. (2021). Foodborne Origin and Local and Global Spread of Staphylococcus saprophyticus Causing Human Urinary Tract Infections. Emerging Infectious Diseases, 27(3), 880-893. https://dx.doi.org/10.3201/eid2703.200852.

Clusters of Drug-Resistant Mycobacterium tuberculosis Detected by Whole-Genome Sequence Analysis of Nationwide Sample, Thailand, 2014–2017 [PDF - 5.21 MB - 10 pages]
D. Nonghanphithak et al.

Multidrug-resistant tuberculosis (MDR TB), pre-extensively drug-resistant tuberculosis (pre-XDR TB), and extensively drug-resistant tuberculosis (XDR TB) complicate disease control. We analyzed whole-genome sequence data for 579 phenotypically drug-resistant M. tuberculosis isolates (28% of available MDR/pre-XDR and all culturable XDR TB isolates collected in Thailand during 2014–2017). Most isolates were from lineage 2 (n = 482; 83.2%). Cluster analysis revealed that 281/579 isolates (48.5%) formed 89 clusters, including 205 MDR TB, 46 pre-XDR TB, 19 XDR TB, and 11 poly–drug-resistant TB isolates based on genotypic drug resistance. Members of most clusters had the same subset of drug resistance-associated mutations, supporting potential primary resistance in MDR TB (n = 176/205; 85.9%), pre-XDR TB (n = 29/46; 63.0%), and XDR TB (n = 14/19; 73.7%). Thirteen major clades were significantly associated with geography (p<0.001). Clusters of clonal origin contribute greatly to the high prevalence of drug-resistant TB in Thailand.

EID Nonghanphithak D, Chaiprasert A, Smithtikarn S, Kamolwat P, Pungrassami P, Chongsuvivatwong V, et al. Clusters of Drug-Resistant Mycobacterium tuberculosis Detected by Whole-Genome Sequence Analysis of Nationwide Sample, Thailand, 2014–2017. Emerg Infect Dis. 2021;27(3):813-822. https://dx.doi.org/10.3201/eid2703.204364
AMA Nonghanphithak D, Chaiprasert A, Smithtikarn S, et al. Clusters of Drug-Resistant Mycobacterium tuberculosis Detected by Whole-Genome Sequence Analysis of Nationwide Sample, Thailand, 2014–2017. Emerging Infectious Diseases. 2021;27(3):813-822. doi:10.3201/eid2703.204364.
APA Nonghanphithak, D., Chaiprasert, A., Smithtikarn, S., Kamolwat, P., Pungrassami, P., Chongsuvivatwong, V....Faksri, K. (2021). Clusters of Drug-Resistant Mycobacterium tuberculosis Detected by Whole-Genome Sequence Analysis of Nationwide Sample, Thailand, 2014–2017. Emerging Infectious Diseases, 27(3), 813-822. https://dx.doi.org/10.3201/eid2703.204364.

Extrapulmonary Nontuberculous Mycobacteria Infections in Hospitalized Patients, United States, 2009–2014 [PDF - 940 KB - 8 pages]
E. E. Ricotta et al.

Nontuberculous mycobacteria (NTM) cause pulmonary and extrapulmonary infections in susceptible persons. To characterize the epidemiology of skin and soft tissue (SST) and disseminated extrapulmonary infections caused by NTM in the United States, we used a large electronic health record database to examine clinical, demographic, and laboratory data for hospitalized patients with NTM isolated from extrapulmonary sources during 2009–2014. Using all unique inpatients as the denominator, we estimated prevalence and summarized cases by key characteristics. Of 9,196,147 inpatients, 831 had confirmed extrapulmonary NTM. The 6-year prevalence was 11 cases/100,000 inpatients; source-specific prevalence was 4.4 SST infections/100,000 inpatients and 3.7 disseminated infections/100,000 inpatients. NTM species varied across geographic region; rapidly growing NTM were most prevalent in southern states. Infection with Mycobacterium avium complex was more common among patients with concurrent HIV and fungal infection, a relevant finding because treatment is more effective for M. avium complex than for other NTM infections.

EID Ricotta EE, Adjemian J, Blakney RA, Lai Y, Kadri SS, Prevots D. Extrapulmonary Nontuberculous Mycobacteria Infections in Hospitalized Patients, United States, 2009–2014. Emerg Infect Dis. 2021;27(3):845-852. https://dx.doi.org/10.3201/eid2703.201087
AMA Ricotta EE, Adjemian J, Blakney RA, et al. Extrapulmonary Nontuberculous Mycobacteria Infections in Hospitalized Patients, United States, 2009–2014. Emerging Infectious Diseases. 2021;27(3):845-852. doi:10.3201/eid2703.201087.
APA Ricotta, E. E., Adjemian, J., Blakney, R. A., Lai, Y., Kadri, S. S., & Prevots, D. (2021). Extrapulmonary Nontuberculous Mycobacteria Infections in Hospitalized Patients, United States, 2009–2014. Emerging Infectious Diseases, 27(3), 845-852. https://dx.doi.org/10.3201/eid2703.201087.

Medscape CME Activity
Fluconazole-Resistant Candida glabrata Bloodstream Isolates, South Korea, 2008–2018 [PDF - 730 KB - 10 pages]
E. Won et al.

We investigated the clinical outcomes and molecular mechanisms of fluconazole-resistant (FR) Candida glabrata bloodstream infections. Among 1,158 isolates collected during multicenter studies in South Korea during 2008–2018, 5.7% were FR. For 64 patients with FR bloodstream infection isolates, the 30-day mortality rate was 60.9% and the 90-day mortality rate 78.2%; these rates were significantly higher than in patients with fluconazole-susceptible dose-dependent isolates (30-day mortality rate 36.4%, 90-day mortality rate 43.8%; p<0.05). For patients with FR isolates, appropriate antifungal therapy was the only independent protective factor associated with 30-day (hazard ratio 0.304) and 90-day (hazard ratio 0.310) mortality. Sequencing of pleiotropic drug-resistance transcription factor revealed that 1–2 additional Pdr1p amino acid substitutions (except genotype-specific Pdr1p amino acid substitutions) occurred in 98.5% of FR isolates but in only 0.9% of fluconazole-susceptible dose-dependent isolates. These results highlight the high mortality rate of patients infected with FR C. glabrata BSI isolates harboring Pdr1p mutations.

EID Won E, Choi MJ, Kim M, Yong D, Lee W, Uh Y, et al. Fluconazole-Resistant Candida glabrata Bloodstream Isolates, South Korea, 2008–2018. Emerg Infect Dis. 2021;27(3):779-788. https://dx.doi.org/10.3201/eid2703.203482
AMA Won E, Choi MJ, Kim M, et al. Fluconazole-Resistant Candida glabrata Bloodstream Isolates, South Korea, 2008–2018. Emerging Infectious Diseases. 2021;27(3):779-788. doi:10.3201/eid2703.203482.
APA Won, E., Choi, M. J., Kim, M., Yong, D., Lee, W., Uh, Y....Shin, J. (2021). Fluconazole-Resistant Candida glabrata Bloodstream Isolates, South Korea, 2008–2018. Emerging Infectious Diseases, 27(3), 779-788. https://dx.doi.org/10.3201/eid2703.203482.

Epidemiology and Clinical Course of First Wave Coronavirus Disease Cases, Faroe Islands [PDF - 2.67 MB - 10 pages]
M. F. Kristiansen et al.

The Faroe Islands was one of the first countries in the Western Hemisphere to eliminate coronavirus disease (COVID-19). During the first epidemic wave in the country, 187 cases were reported between March 3 and April 22, 2020. Large-scale testing and thorough contact tracing were implemented early on, along with lockdown measures. Transmission chains were mapped through patient history and knowledge of contact with prior cases. The most common reported COVID-19 symptoms were fever, headache, and cough, but 11.2% of cases were asymptomatic. Among 187 cases, 8 patients were admitted to hospitals but none were admitted to intensive care units and no deaths occurred. Superspreading was evident during the epidemic because most secondary cases were attributed to just 3 infectors. Even with the high incidence rate in early March, the Faroe Islands successfully eliminated the first wave of COVID-19 through the early use of contact tracing, quarantine, social distancing, and large-scale testing.

EID Kristiansen MF, Heimustovu BH, Borg S, Mohr T, Gislason H, Møller L, et al. Epidemiology and Clinical Course of First Wave Coronavirus Disease Cases, Faroe Islands. Emerg Infect Dis. 2021;27(3):749-758. https://dx.doi.org/10.3201/eid2703.202589
AMA Kristiansen MF, Heimustovu BH, Borg S, et al. Epidemiology and Clinical Course of First Wave Coronavirus Disease Cases, Faroe Islands. Emerging Infectious Diseases. 2021;27(3):749-758. doi:10.3201/eid2703.202589.
APA Kristiansen, M. F., Heimustovu, B. H., Borg, S., Mohr, T., Gislason, H., Møller, L....Gaini, S. (2021). Epidemiology and Clinical Course of First Wave Coronavirus Disease Cases, Faroe Islands. Emerging Infectious Diseases, 27(3), 749-758. https://dx.doi.org/10.3201/eid2703.202589.

Mycoplasma genitalium and Other Reproductive Tract Infections in Pregnant Women, Papua New Guinea, 2015–2017 [PDF - 1.21 MB - 11 pages]
M. Scoullar et al.

Much about the range of pathogens, frequency of coinfection, and clinical effects of reproductive tract infections (RTIs) among pregnant women remains unknown. We report on RTIs (Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Treponema pallidum subspecies pallidum, bacterial vaginosis, and vulvovaginal candidiasis) and other reproductive health indicators in 699 pregnant women in Papua New Guinea during 2015–2017. We found M. genitalium, an emerging pathogen in Papua New Guinea, in 12.5% of participants. These infections showed no evidence of macrolide resistance. In total, 74.1% of pregnant women had >1 RTI; most of these infections were treatable. We detected sexually transmitted infections (excluding syphilis) in 37.7% of women. Our findings showed that syndromic management of infections is greatly inadequate. In total, 98.4% of women had never used barrier contraception. These findings will inform efforts to improve reproductive healthcare in Papua New Guinea.

EID Scoullar M, Boeuf P, Peach E, Fidelis R, Tokmun K, Melepia P, et al. Mycoplasma genitalium and Other Reproductive Tract Infections in Pregnant Women, Papua New Guinea, 2015–2017. Emerg Infect Dis. 2021;27(3):894-904. https://dx.doi.org/10.3201/eid2703.201783
AMA Scoullar M, Boeuf P, Peach E, et al. Mycoplasma genitalium and Other Reproductive Tract Infections in Pregnant Women, Papua New Guinea, 2015–2017. Emerging Infectious Diseases. 2021;27(3):894-904. doi:10.3201/eid2703.201783.
APA Scoullar, M., Boeuf, P., Peach, E., Fidelis, R., Tokmun, K., Melepia, P....Beeson, J. G. (2021). Mycoplasma genitalium and Other Reproductive Tract Infections in Pregnant Women, Papua New Guinea, 2015–2017. Emerging Infectious Diseases, 27(3), 894-904. https://dx.doi.org/10.3201/eid2703.201783.

Medscape CME Activity
Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis, Karachi, Pakistan [PDF - 698 KB - 8 pages]
A. A. Malik et al.

In Karachi, Pakistan, a South Asian megacity with a high prevalence of tuberculosis (TB) and low HIV prevalence, we assessed the effectiveness of fluoroquinolone-based preventive therapy for drug-resistant (DR) TB exposure. During February 2016–March 2017, high-risk household contacts of DR TB patients began a 6-month course of preventive therapy with a fluoroquinolone-based, 2-drug regimen. We assessed effectiveness in this cohort by comparing the rate and risk for TB disease over 2 years to the rates and risks reported in the literature. Of 172 participants, TB occurred in 2 persons over 336 person-years of observation. TB disease incidence rate observed in the cohort was 6.0/1,000 person-years. The incidence rate ratio ranged from 0.29 (95% CI 0.04–1.3) to 0.50 (95% CI 0.06–2.8), with a pooled estimate of 0.35 (95% CI 0.14–0.87). Overall, fluoroquinolone-based preventive therapy for DR TB exposure reduced risk for TB disease by 65%.

EID Malik AA, Gandhi NR, Lash TL, Cranmer LM, Omer SB, Ahmed JF, et al. Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis, Karachi, Pakistan. Emerg Infect Dis. 2021;27(3):805-812. https://dx.doi.org/10.3201/eid2703.203916
AMA Malik AA, Gandhi NR, Lash TL, et al. Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis, Karachi, Pakistan. Emerging Infectious Diseases. 2021;27(3):805-812. doi:10.3201/eid2703.203916.
APA Malik, A. A., Gandhi, N. R., Lash, T. L., Cranmer, L. M., Omer, S. B., Ahmed, J. F....Becerra, M. C. (2021). Effectiveness of Preventive Therapy for Persons Exposed at Home to Drug-Resistant Tuberculosis, Karachi, Pakistan. Emerging Infectious Diseases, 27(3), 805-812. https://dx.doi.org/10.3201/eid2703.203916.

Decline of Tuberculosis Burden in Vietnam Measured by Consecutive National Surveys, 2007–2017 [PDF - 2.17 MB - 8 pages]
H. Nguyen et al.

Vietnam, a high tuberculosis (TB) burden country, conducted national TB prevalence surveys in 2007 and 2017. In both surveys participants were screened by using a questionnaire and chest radiograph; sputum samples were then collected to test for Mycobacterium tuberculosis by smear microscopy and Löwenstein-Jensen culture. Culture-positive, smear-positive, and smear-negative TB cases were defined by laboratory results, and the prevalence of tuberculosis was compared between the 2 surveys. The results showed prevalence of culture-positive TB decreased by 37% (95% CI 11.5%–55.4%), from 199 (95% CI 160–248) cases/100,000 adults in 2007 to 125 (95% CI 98–159) cases/100,000 adults in 2017. Prevalence of smear-positive TB dropped by 53% (95% CI 27.0%–69.7%), from 99 (95% CI 78–125) cases/100,000 adults to 46 (95% CI 32–68) cases/100,000 adults; smear-negative TB showed no substantial decrease. Replacing microscopy with molecular methods for primary diagnostics might enhance diagnosis of pulmonary TB cases and further lower TB burden.

EID Nguyen H, Nguyen H, Nguyen N, Cobelens F, Finlay A, Dao C, et al. Decline of Tuberculosis Burden in Vietnam Measured by Consecutive National Surveys, 2007–2017. Emerg Infect Dis. 2021;27(3):872-879. https://dx.doi.org/10.3201/eid2703.204253
AMA Nguyen H, Nguyen H, Nguyen N, et al. Decline of Tuberculosis Burden in Vietnam Measured by Consecutive National Surveys, 2007–2017. Emerging Infectious Diseases. 2021;27(3):872-879. doi:10.3201/eid2703.204253.
APA Nguyen, H., Nguyen, H., Nguyen, N., Cobelens, F., Finlay, A., Dao, C....Tiemersma, E. (2021). Decline of Tuberculosis Burden in Vietnam Measured by Consecutive National Surveys, 2007–2017. Emerging Infectious Diseases, 27(3), 872-879. https://dx.doi.org/10.3201/eid2703.204253.

Prevalence of SARS-CoV-2 Antibodies in First Responders and Public Safety Personnel, New York City, New York, USA, May–July 2020 [PDF - 1.09 MB - 9 pages]
S. Sami et al.

We conducted a serologic survey in public service agencies in New York City, New York, USA, during May–July 2020 to determine prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among first responders. Of 22,647 participants, 22.5% tested positive for SARS-CoV-2–specific antibodies. Seroprevalence for police and firefighters was similar to overall seroprevalence; seroprevalence was highest in correctional staff (39.2%) and emergency medical technicians (38.3%) and lowest in laboratory technicians (10.1%) and medicolegal death investigators (10.8%). Adjusted analyses demonstrated association between seropositivity and exposure to SARS-CoV-2–positive household members (adjusted odds ratio [aOR] 3.52 [95% CI 3.19–3.87]), non-Hispanic Black race or ethnicity (aOR 1.50 [95% CI 1.33–1.68]), and severe obesity (aOR 1.31 [95% CI 1.05–1.65]). Consistent glove use (aOR 1.19 [95% CI 1.06–1.33]) increased likelihood of seropositivity; use of other personal protective equipment had no association. Infection control measures, including vaccination, should be prioritized for frontline workers.

EID Sami S, Akinbami LJ, Petersen LR, Crawley A, Lukacs SL, Weiss D, et al. Prevalence of SARS-CoV-2 Antibodies in First Responders and Public Safety Personnel, New York City, New York, USA, May–July 2020. Emerg Infect Dis. 2021;27(3):796-804. https://dx.doi.org/10.3201/eid2703.204340
AMA Sami S, Akinbami LJ, Petersen LR, et al. Prevalence of SARS-CoV-2 Antibodies in First Responders and Public Safety Personnel, New York City, New York, USA, May–July 2020. Emerging Infectious Diseases. 2021;27(3):796-804. doi:10.3201/eid2703.204340.
APA Sami, S., Akinbami, L. J., Petersen, L. R., Crawley, A., Lukacs, S. L., Weiss, D....Pathela, P. (2021). Prevalence of SARS-CoV-2 Antibodies in First Responders and Public Safety Personnel, New York City, New York, USA, May–July 2020. Emerging Infectious Diseases, 27(3), 796-804. https://dx.doi.org/10.3201/eid2703.204340.

Isolate-Based Surveillance of Bordetella pertussis, Austria, 2018–2020 [PDF - 2.17 MB - 10 pages]
A. Cabal et al.

Pertussis is a vaccine-preventable disease, and its recent resurgence might be attributable to the emergence of strains that differ genetically from the vaccine strain. We describe a novel pertussis isolate-based surveillance system and a core genome multilocus sequence typing scheme to assess Bordetella pertussis genetic variability and investigate the increased incidence of pertussis in Austria. During 2018–2020, we obtained 123 B. pertussis isolates and typed them with the new scheme (2,983 targets and preliminary cluster threshold of <6 alleles). B. pertussis isolates in Austria differed genetically from the vaccine strain, both in their core genomes and in their vaccine antigen genes; 31.7% of the isolates were pertactin-deficient. We detected 8 clusters, 1 of them with pertactin-deficient isolates and possibly part of a local outbreak. National expansion of the isolate-based surveillance system is needed to implement pertussis-control strategies.

EID Cabal A, Schmid D, Hell M, Chakeri A, Mustafa-Korninger E, Wojna A, et al. Isolate-Based Surveillance of Bordetella pertussis, Austria, 2018–2020. Emerg Infect Dis. 2021;27(3):862-871. https://dx.doi.org/10.3201/eid2703.202314
AMA Cabal A, Schmid D, Hell M, et al. Isolate-Based Surveillance of Bordetella pertussis, Austria, 2018–2020. Emerging Infectious Diseases. 2021;27(3):862-871. doi:10.3201/eid2703.202314.
APA Cabal, A., Schmid, D., Hell, M., Chakeri, A., Mustafa-Korninger, E., Wojna, A....Ruppitsch, W. (2021). Isolate-Based Surveillance of Bordetella pertussis, Austria, 2018–2020. Emerging Infectious Diseases, 27(3), 862-871. https://dx.doi.org/10.3201/eid2703.202314.

Daily Forecasting of Regional Epidemics of Coronavirus Disease with Bayesian Uncertainty Quantification, United States [PDF - 5.73 MB - 12 pages]
Y. Lin et al.

To increase situational awareness and support evidence-based policymaking, we formulated a mathematical model for coronavirus disease transmission within a regional population. This compartmental model accounts for quarantine, self-isolation, social distancing, a nonexponentially distributed incubation period, asymptomatic persons, and mild and severe forms of symptomatic disease. We used Bayesian inference to calibrate region-specific models for consistency with daily reports of confirmed cases in the 15 most populous metropolitan statistical areas in the United States. We also quantified uncertainty in parameter estimates and forecasts. This online learning approach enables early identification of new trends despite considerable variability in case reporting.

EID Lin Y, Neumann J, Miller EF, Posner RG, Mallela A, Safta C, et al. Daily Forecasting of Regional Epidemics of Coronavirus Disease with Bayesian Uncertainty Quantification, United States. Emerg Infect Dis. 2021;27(3):767-778. https://dx.doi.org/10.3201/eid2703.203364
AMA Lin Y, Neumann J, Miller EF, et al. Daily Forecasting of Regional Epidemics of Coronavirus Disease with Bayesian Uncertainty Quantification, United States. Emerging Infectious Diseases. 2021;27(3):767-778. doi:10.3201/eid2703.203364.
APA Lin, Y., Neumann, J., Miller, E. F., Posner, R. G., Mallela, A., Safta, C....Hlavacek, W. S. (2021). Daily Forecasting of Regional Epidemics of Coronavirus Disease with Bayesian Uncertainty Quantification, United States. Emerging Infectious Diseases, 27(3), 767-778. https://dx.doi.org/10.3201/eid2703.203364.

Local and Travel-Associated Transmission of Tuberculosis at Central Western Border of Brazil, 2014–2017 [PDF - 2.11 MB - 10 pages]
K. S. Walter et al.

International migrants are at heightened risk for tuberculosis (TB) disease. Intensified incarceration at international borders may compound population-wide TB risk. However, few studies have investigated the contributions of migration, local transmission, or prisons in driving incident TB at international borders. We conducted prospective population-based genomic surveillance in 3 cities along Brazil’s central western border from 2014–2017. Although most isolates (89/132; 67%) fell within genomic transmission clusters, genetically unique isolates disproportionately occurred among participants with recent international travel (17/42; 40.5%), suggesting that both local transmission and migration contribute to incident TB. Isolates from 40 participants with and 76 without an incarceration history clustered together throughout a maximum-likelihood phylogeny, indicating the close interrelatedness of prison and community epidemics. Our findings highlight the need for ongoing surveillance to control continued introductions of TB and reduce the disproportionate burden of TB in prisons at Brazil’s international borders.

EID Walter KS, Tatara M, Esther da Silva K, Moreira F, dos Santos P, de Melo Ferrari D, et al. Local and Travel-Associated Transmission of Tuberculosis at Central Western Border of Brazil, 2014–2017. Emerg Infect Dis. 2021;27(3):905-914. https://dx.doi.org/10.3201/eid2703.203839
AMA Walter KS, Tatara M, Esther da Silva K, et al. Local and Travel-Associated Transmission of Tuberculosis at Central Western Border of Brazil, 2014–2017. Emerging Infectious Diseases. 2021;27(3):905-914. doi:10.3201/eid2703.203839.
APA Walter, K. S., Tatara, M., Esther da Silva, K., Moreira, F., dos Santos, P., de Melo Ferrari, D....Croda, J. (2021). Local and Travel-Associated Transmission of Tuberculosis at Central Western Border of Brazil, 2014–2017. Emerging Infectious Diseases, 27(3), 905-914. https://dx.doi.org/10.3201/eid2703.203839.

Transmission of Antimicrobial-Resistant Staphylococcus aureus Clonal Complex 9 between Pigs and Humans, United States [PDF - 1.97 MB - 9 pages]
P. R. Randad et al.

Transmission of livestock-associated Staphylococcus aureus clonal complex 9 (LA-SA CC9) between pigs raised on industrial hog operations (IHOs) and humans in the United States is poorly understood. We analyzed whole-genome sequences from 32 international S. aureus CC9 isolates and 49 LA-SA CC9 isolates from IHO pigs and humans who work on or live near IHOs in 10 pig-producing counties in North Carolina, USA. Bioinformatic analysis of sequence data from the 81 isolates demonstrated 3 major LA-SA CC9 clades. North Carolina isolates all fell within a single clade (C3). High-resolution phylogenetic analysis of C3 revealed 2 subclades of intermingled IHO pig and human isolates differing by 0–34 single-nucleotide polymorphisms. Our findings suggest that LA-SA CC9 from pigs and humans share a common source and provide evidence of transmission of antimicrobial-resistant LA-SA CC9 between IHO pigs and humans who work on or live near IHOs in North Carolina.

EID Randad PR, Larsen J, Kaya H, Pisanic N, Ordak C, Price LB, et al. Transmission of Antimicrobial-Resistant Staphylococcus aureus Clonal Complex 9 between Pigs and Humans, United States. Emerg Infect Dis. 2021;27(3):740-748. https://dx.doi.org/10.3201/eid2703.191775
AMA Randad PR, Larsen J, Kaya H, et al. Transmission of Antimicrobial-Resistant Staphylococcus aureus Clonal Complex 9 between Pigs and Humans, United States. Emerging Infectious Diseases. 2021;27(3):740-748. doi:10.3201/eid2703.191775.
APA Randad, P. R., Larsen, J., Kaya, H., Pisanic, N., Ordak, C., Price, L. B....Heaney, C. D. (2021). Transmission of Antimicrobial-Resistant Staphylococcus aureus Clonal Complex 9 between Pigs and Humans, United States. Emerging Infectious Diseases, 27(3), 740-748. https://dx.doi.org/10.3201/eid2703.191775.
Dispatches

Bedaquiline as Treatment for Disseminated Nontuberculous Mycobacteria Infection in 2 Patients Co-Infected with HIV [PDF - 1.33 MB - 5 pages]
E. Gil et al.

Nontuberculous mycobacteria can cause disseminated infections in immunocompromised patients and are challenging to treat because of antimicrobial resistance and adverse effects of prolonged multidrug treatment. We report successful treatment with bedaquiline, a novel antimycobacterial drug, as part of combination therapy for 2 patients with disseminated nontuberculous mycobacteria co-infected with HIV.

EID Gil E, Sweeney N, Barrett V, Morris-Jones S, Miller RF, Johnston VJ, et al. Bedaquiline as Treatment for Disseminated Nontuberculous Mycobacteria Infection in 2 Patients Co-Infected with HIV. Emerg Infect Dis. 2021;27(3):944-948. https://dx.doi.org/10.3201/eid2703.202359
AMA Gil E, Sweeney N, Barrett V, et al. Bedaquiline as Treatment for Disseminated Nontuberculous Mycobacteria Infection in 2 Patients Co-Infected with HIV. Emerging Infectious Diseases. 2021;27(3):944-948. doi:10.3201/eid2703.202359.
APA Gil, E., Sweeney, N., Barrett, V., Morris-Jones, S., Miller, R. F., Johnston, V. J....Brown, M. (2021). Bedaquiline as Treatment for Disseminated Nontuberculous Mycobacteria Infection in 2 Patients Co-Infected with HIV. Emerging Infectious Diseases, 27(3), 944-948. https://dx.doi.org/10.3201/eid2703.202359.

Implementation of an Animal Sporotrichosis Surveillance and Control Program, Southeastern Brazil [PDF - 685 KB - 4 pages]
S. M. Moreira et al.

We report the implementation of an animal sporotrichosis surveillance and control program that evaluates strategies to identify suspected and infected cats in a municipality in southeastern Brazil. All adopted measures reinforced the program, although strategies had different abilities to detect the presence of infection.

EID Moreira SM, Andrade E, Paiva MT, Zibaoui HM, Salvato LA, Azevedo MI, et al. Implementation of an Animal Sporotrichosis Surveillance and Control Program, Southeastern Brazil. Emerg Infect Dis. 2021;27(3):949-952. https://dx.doi.org/10.3201/eid2703.202863
AMA Moreira SM, Andrade E, Paiva MT, et al. Implementation of an Animal Sporotrichosis Surveillance and Control Program, Southeastern Brazil. Emerging Infectious Diseases. 2021;27(3):949-952. doi:10.3201/eid2703.202863.
APA Moreira, S. M., Andrade, E., Paiva, M. T., Zibaoui, H. M., Salvato, L. A., Azevedo, M. I....Bastos, C. V. (2021). Implementation of an Animal Sporotrichosis Surveillance and Control Program, Southeastern Brazil. Emerging Infectious Diseases, 27(3), 949-952. https://dx.doi.org/10.3201/eid2703.202863.

Extraintestinal Seeding of Salmonella enterica Serotype Typhi, Pakistan [PDF - 402 KB - 3 pages]
S. Irfan et al.

We evaluated Salmonella enterica serotype Typhi strains isolated from all body sites in Pakistan during 2013–2018. Despite an increase in overall number of localized, extensively drug-resistant Salmonella Typhi in organ infections during 2018, there was no increase in the proportion of such isolates in comparison with non–extensively drug-resistant isolates.

EID Irfan S, Zeeshan M, Rattani S, Farooqi J, Shakoor S, Hasan R, et al. Extraintestinal Seeding of Salmonella enterica Serotype Typhi, Pakistan. Emerg Infect Dis. 2021;27(3):936-938. https://dx.doi.org/10.3201/eid2703.200464
AMA Irfan S, Zeeshan M, Rattani S, et al. Extraintestinal Seeding of Salmonella enterica Serotype Typhi, Pakistan. Emerging Infectious Diseases. 2021;27(3):936-938. doi:10.3201/eid2703.200464.
APA Irfan, S., Zeeshan, M., Rattani, S., Farooqi, J., Shakoor, S., Hasan, R....Zafar, A. (2021). Extraintestinal Seeding of Salmonella enterica Serotype Typhi, Pakistan. Emerging Infectious Diseases, 27(3), 936-938. https://dx.doi.org/10.3201/eid2703.200464.

Human Infection with Eurasian Avian-Like Swine Influenza A(H1N1) Virus, the Netherlands, September 2019 [PDF - 1.59 MB - 5 pages]
A. Parys et al.

We report a zoonotic infection of a pig farmer in the Netherlands with a Eurasian avian-like swine influenza A(H1N1) virus that was also detected in the farmed pigs. Both viruses were antigenically and genetically characterized. Continued surveillance of swine influenza A viruses is needed for risk assessment in humans and swine.

EID Parys A, Vandoorn E, King J, Graaf A, Pohlmann A, Beer M, et al. Human Infection with Eurasian Avian-Like Swine Influenza A(H1N1) Virus, the Netherlands, September 2019. Emerg Infect Dis. 2021;27(3):939-943. https://dx.doi.org/10.3201/eid2703.201863
AMA Parys A, Vandoorn E, King J, et al. Human Infection with Eurasian Avian-Like Swine Influenza A(H1N1) Virus, the Netherlands, September 2019. Emerging Infectious Diseases. 2021;27(3):939-943. doi:10.3201/eid2703.201863.
APA Parys, A., Vandoorn, E., King, J., Graaf, A., Pohlmann, A., Beer, M....Van Reeth, K. (2021). Human Infection with Eurasian Avian-Like Swine Influenza A(H1N1) Virus, the Netherlands, September 2019. Emerging Infectious Diseases, 27(3), 939-943. https://dx.doi.org/10.3201/eid2703.201863.

Antibody Responses 8 Months after Asymptomatic or Mild SARS-CoV-2 Infection [PDF - 344 KB - 4 pages]
P. Choe et al.

Waning humoral immunity in coronavirus disease patients has raised concern over usefulness of serologic testing. We investigated antibody responses of 58 persons 8 months after asymptomatic or mildly symptomatic infection with severe acute respiratory syndrome coronavirus 2. For 3 of 4 immunoassays used, seropositivity rates were high (69.0%–91.4%).

EID Choe P, Kim K, Kang C, Suh H, Kang E, Lee S, et al. Antibody Responses 8 Months after Asymptomatic or Mild SARS-CoV-2 Infection. Emerg Infect Dis. 2021;27(3):928-931. https://dx.doi.org/10.3201/eid2703.204543
AMA Choe P, Kim K, Kang C, et al. Antibody Responses 8 Months after Asymptomatic or Mild SARS-CoV-2 Infection. Emerging Infectious Diseases. 2021;27(3):928-931. doi:10.3201/eid2703.204543.
APA Choe, P., Kim, K., Kang, C., Suh, H., Kang, E., Lee, S....Oh, M. (2021). Antibody Responses 8 Months after Asymptomatic or Mild SARS-CoV-2 Infection. Emerging Infectious Diseases, 27(3), 928-931. https://dx.doi.org/10.3201/eid2703.204543.

Addressing Reemergence of Diphtheria among Adolescents through Program Integration in India [PDF - 488 KB - 4 pages]
K. Maramraj et al.

We report a diphtheria outbreak mostly among children (median 12 years; range 4–26 years) of a religious minority in urban India. Case-fatality rate (15%, 19/124) was higher among unimmunized patients (relative risk 4.1, 95% CI 1.5–11.7). We recommend mandating and integrating immunization into school health programs to prevent reemergence.

EID Maramraj K, Latha M, Reddy R, Sodha SV, Kaur S, Dikid T, et al. Addressing Reemergence of Diphtheria among Adolescents through Program Integration in India. Emerg Infect Dis. 2021;27(3):953-956. https://dx.doi.org/10.3201/eid2703.203205
AMA Maramraj K, Latha M, Reddy R, et al. Addressing Reemergence of Diphtheria among Adolescents through Program Integration in India. Emerging Infectious Diseases. 2021;27(3):953-956. doi:10.3201/eid2703.203205.
APA Maramraj, K., Latha, M., Reddy, R., Sodha, S. V., Kaur, S., Dikid, T....Singh, S. (2021). Addressing Reemergence of Diphtheria among Adolescents through Program Integration in India. Emerging Infectious Diseases, 27(3), 953-956. https://dx.doi.org/10.3201/eid2703.203205.

Familial Clusters of Coronavirus Disease in 10 Prefectures, Japan, February−May 2020 [PDF - 369 KB - 4 pages]
R. Miyahara et al.

The overall coronavirus disease secondary attack rate (SAR) in family members was 19.0% in 10 prefectures of Japan during February 22–May 31, 2020. The SAR was lower for primary cases diagnosed early, within 2 days after symptom onset. The SAR of asymptomatic primary cases was 11.8%.

EID Miyahara R, Tsuchiya N, Yasuda I, Ko YK, Furuse Y, Sando E, et al. Familial Clusters of Coronavirus Disease in 10 Prefectures, Japan, February−May 2020. Emerg Infect Dis. 2021;27(3):915-918. https://dx.doi.org/10.3201/eid2703.203882
AMA Miyahara R, Tsuchiya N, Yasuda I, et al. Familial Clusters of Coronavirus Disease in 10 Prefectures, Japan, February−May 2020. Emerging Infectious Diseases. 2021;27(3):915-918. doi:10.3201/eid2703.203882.
APA Miyahara, R., Tsuchiya, N., Yasuda, I., Ko, Y. K., Furuse, Y., Sando, E....Oshitani, H. (2021). Familial Clusters of Coronavirus Disease in 10 Prefectures, Japan, February−May 2020. Emerging Infectious Diseases, 27(3), 915-918. https://dx.doi.org/10.3201/eid2703.203882.

COVID-19 Outbreak in a Large Penitentiary Complex, April–June 2020, Brazil [PDF - 773 KB - 4 pages]
F. A. Gouvea-Reis et al.

An outbreak of coronavirus disease began in a large penitentiary complex in Brazil on April 1, 2020. By June 12, there were 1,057 confirmed cases among inmates and staff. Nine patients were hospitalized, and 3 died. Mean serial interval was ≈2.5 days; reproduction number range was 1.0–2.3.

EID Gouvea-Reis FA, Oliveira PD, Silva D, Borja LS, Percio J, Souza FS, et al. COVID-19 Outbreak in a Large Penitentiary Complex, April–June 2020, Brazil. Emerg Infect Dis. 2021;27(3):924-927. https://dx.doi.org/10.3201/eid2703.204079
AMA Gouvea-Reis FA, Oliveira PD, Silva D, et al. COVID-19 Outbreak in a Large Penitentiary Complex, April–June 2020, Brazil. Emerging Infectious Diseases. 2021;27(3):924-927. doi:10.3201/eid2703.204079.
APA Gouvea-Reis, F. A., Oliveira, P. D., Silva, D., Borja, L. S., Percio, J., Souza, F. S....de Moraes, C. (2021). COVID-19 Outbreak in a Large Penitentiary Complex, April–June 2020, Brazil. Emerging Infectious Diseases, 27(3), 924-927. https://dx.doi.org/10.3201/eid2703.204079.

Lung Pathology of Mutually Exclusive Co-infection with SARS-CoV-2 and Streptococcus pneumoniae [PDF - 2.82 MB - 5 pages]
T. Tsukamoto et al.

Postmortem lung pathology of a patient in Japan with severe acute respiratory syndrome coronavirus 2 infection showed diffuse alveolar damage as well as bronchopneumonia caused by Streptococcus pneumoniae infection. The distribution of each pathogen and the accompanying histopathology suggested the infections progressed in a mutually exclusive manner within the lung, resulting in fatal respiratory failure.

EID Tsukamoto T, Nakajima N, Sakurai A, Nakajima M, Sakurai E, Sato Y, et al. Lung Pathology of Mutually Exclusive Co-infection with SARS-CoV-2 and Streptococcus pneumoniae. Emerg Infect Dis. 2021;27(3):919-923. https://dx.doi.org/10.3201/eid2703.204024
AMA Tsukamoto T, Nakajima N, Sakurai A, et al. Lung Pathology of Mutually Exclusive Co-infection with SARS-CoV-2 and Streptococcus pneumoniae. Emerging Infectious Diseases. 2021;27(3):919-923. doi:10.3201/eid2703.204024.
APA Tsukamoto, T., Nakajima, N., Sakurai, A., Nakajima, M., Sakurai, E., Sato, Y....Suzuki, T. (2021). Lung Pathology of Mutually Exclusive Co-infection with SARS-CoV-2 and Streptococcus pneumoniae. Emerging Infectious Diseases, 27(3), 919-923. https://dx.doi.org/10.3201/eid2703.204024.

Trends in Untreated Tuberculosis in Large Municipalities, Brazil, 2008–2017 [PDF - 1.07 MB - 4 pages]
M. H. Chitwood et al.

We adapted a mathematical modeling approach to estimate tuberculosis (TB) incidence and fraction treated for 101 municipalities of Brazil during 2008–2017. We found the average TB incidence rate decreased annually (0.95%), and fraction treated increased (0.30%). We estimated that 9% of persons with TB did not receive treatment in 2017.

EID Chitwood MH, Pelissari DM, Marques da Silva G, Bartholomay P, Rocha M, Arakaki-Sanchez D, et al. Trends in Untreated Tuberculosis in Large Municipalities, Brazil, 2008–2017. Emerg Infect Dis. 2021;27(3):957-960. https://dx.doi.org/10.3201/eid2703.204094
AMA Chitwood MH, Pelissari DM, Marques da Silva G, et al. Trends in Untreated Tuberculosis in Large Municipalities, Brazil, 2008–2017. Emerging Infectious Diseases. 2021;27(3):957-960. doi:10.3201/eid2703.204094.
APA Chitwood, M. H., Pelissari, D. M., Marques da Silva, G., Bartholomay, P., Rocha, M., Arakaki-Sanchez, D....Menzies, N. A. (2021). Trends in Untreated Tuberculosis in Large Municipalities, Brazil, 2008–2017. Emerging Infectious Diseases, 27(3), 957-960. https://dx.doi.org/10.3201/eid2703.204094.

Tropheryma whipplei in Feces of Patients with Diarrhea in 3 Locations on Different Continents [PDF - 460 KB - 4 pages]
G. E. Feurle et al.

We examined fecal specimens of patients with diarrhea from 3 continents for Tropheryma whipplei and enteropathogens. T. whipplei was most common in South Africa, followed by Singapore and Germany. Its presence was associated with the presence of other pathogens. An independent causative role in diarrhea appears unlikely.

EID Feurle GE, Moos V, Landt O, Corcoran C, Reischl U, Maiwald M. Tropheryma whipplei in Feces of Patients with Diarrhea in 3 Locations on Different Continents. Emerg Infect Dis. 2021;27(3):932-935. https://dx.doi.org/10.3201/eid2703.200182
AMA Feurle GE, Moos V, Landt O, et al. Tropheryma whipplei in Feces of Patients with Diarrhea in 3 Locations on Different Continents. Emerging Infectious Diseases. 2021;27(3):932-935. doi:10.3201/eid2703.200182.
APA Feurle, G. E., Moos, V., Landt, O., Corcoran, C., Reischl, U., & Maiwald, M. (2021). Tropheryma whipplei in Feces of Patients with Diarrhea in 3 Locations on Different Continents. Emerging Infectious Diseases, 27(3), 932-935. https://dx.doi.org/10.3201/eid2703.200182.
Research Letters

Validity of Diagnosis Code–Based Claims to Identify Pulmonary NTM Disease in Bronchiectasis Patients [PDF - 452 KB - 4 pages]
J. H. Ku et al.

Nontuberculous mycobacteria infection is increasing in incidence and can lead to chronic, debilitating pulmonary disease. We investigated the accuracy of diagnosis code–based nontuberculous mycobacteria lung disease claims among Medicare beneficiaries in the United States. We observed that these claims have moderate validity, but given their low sensitivity, incidence might be underestimated.

EID Ku JH, Henkle EM, Carlson KF, Marino M, Winthrop KL. Validity of Diagnosis Code–Based Claims to Identify Pulmonary NTM Disease in Bronchiectasis Patients. Emerg Infect Dis. 2021;27(3):982-985. https://dx.doi.org/10.3201/eid2703.203124
AMA Ku JH, Henkle EM, Carlson KF, et al. Validity of Diagnosis Code–Based Claims to Identify Pulmonary NTM Disease in Bronchiectasis Patients. Emerging Infectious Diseases. 2021;27(3):982-985. doi:10.3201/eid2703.203124.
APA Ku, J. H., Henkle, E. M., Carlson, K. F., Marino, M., & Winthrop, K. L. (2021). Validity of Diagnosis Code–Based Claims to Identify Pulmonary NTM Disease in Bronchiectasis Patients. Emerging Infectious Diseases, 27(3), 982-985. https://dx.doi.org/10.3201/eid2703.203124.

Autochthonous Case of Pulmonary Histoplasmosis, Switzerland [PDF - 1.20 MB - 4 pages]
Y. Schmiedel et al.

In Europe, pulmonary histoplasmosis is rarely diagnosed except in travelers. We report a probable autochthonous case of severe chronic pulmonary histoplasmosis in an immunocompetent man in Switzerland without travel history outside of Europe. Diagnosis was achieved by histopathology, fungal culture, and serology, but the source of the infection remains speculative.

EID Schmiedel Y, Büchi AE, Berezowska S, Pöllinger A, Mühlethaler K, Funke-Chambour M. Autochthonous Case of Pulmonary Histoplasmosis, Switzerland. Emerg Infect Dis. 2021;27(3):966-969. https://dx.doi.org/10.3201/eid2703.191831
AMA Schmiedel Y, Büchi AE, Berezowska S, et al. Autochthonous Case of Pulmonary Histoplasmosis, Switzerland. Emerging Infectious Diseases. 2021;27(3):966-969. doi:10.3201/eid2703.191831.
APA Schmiedel, Y., Büchi, A. E., Berezowska, S., Pöllinger, A., Mühlethaler, K., & Funke-Chambour, M. (2021). Autochthonous Case of Pulmonary Histoplasmosis, Switzerland. Emerging Infectious Diseases, 27(3), 966-969. https://dx.doi.org/10.3201/eid2703.191831.

Severe Pulmonary Disease Caused by Mycolicibacter kumamotonensis [PDF - 715 KB - 3 pages]
K. Manika et al.

Severe Mycolicibacter kumamotonensis-pulmonary disease was diagnosed in a 68-year-old immunocompetent woman in Greece; the disease was initially treated as tuberculosis. The patient responded favorably to a new treatment regimen of azithromycin, amikacin, moxifloxacin, and linezolid. Complete symptom resolution and radiologic improvement resulted.

EID Manika K, Kontos F, Papavasileiou A, Papaventsis D, Sionidou M, Kioumis I. Severe Pulmonary Disease Caused by Mycolicibacter kumamotonensis. Emerg Infect Dis. 2021;27(3):962-964. https://dx.doi.org/10.3201/eid2703.191648
AMA Manika K, Kontos F, Papavasileiou A, et al. Severe Pulmonary Disease Caused by Mycolicibacter kumamotonensis. Emerging Infectious Diseases. 2021;27(3):962-964. doi:10.3201/eid2703.191648.
APA Manika, K., Kontos, F., Papavasileiou, A., Papaventsis, D., Sionidou, M., & Kioumis, I. (2021). Severe Pulmonary Disease Caused by Mycolicibacter kumamotonensis. Emerging Infectious Diseases, 27(3), 962-964. https://dx.doi.org/10.3201/eid2703.191648.

Limited Capability for Testing Mycobacterium tuberculosis for Susceptibility to New Drugs [PDF - 631 KB - 3 pages]
H. Z. Farooq et al.

We surveyed availability of phenotypic drug susceptibility testing for drug-resistant Mycobacterium tuberculosis in Europe. Of 27 laboratories, 17 tested for linezolid, 11 for clofazimine, 9 for bedaquiline, and 6 for delamanid during 2019. Our findings indicate that testing capacity for newer and repurposed tuberculosis drugs exists, but its availability is limited.


COVID-19–Associated Fusobacterium nucleatum Bacteremia, Belgium [PDF - 345 KB - 3 pages]
L. Wolff et al.

We report 4 cases of Fusobacterium nucleatum bacteremia associated with coronavirus disease (COVID-19). Three cases occurred concomitantly with COVID-19 diagnosis; 1 occurred on day 15 of intensive care. None of the patients had known risk factors for F. nucleatum bacteremia. F. nucleatum infection could represent a possible complication of COVID-19.

EID Wolff L, Martiny D, Deyi V, Maillart E, Clevenbergh P, Dauby N. COVID-19–Associated Fusobacterium nucleatum Bacteremia, Belgium. Emerg Infect Dis. 2021;27(3):975-977. https://dx.doi.org/10.3201/eid2703.202284
AMA Wolff L, Martiny D, Deyi V, et al. COVID-19–Associated Fusobacterium nucleatum Bacteremia, Belgium. Emerging Infectious Diseases. 2021;27(3):975-977. doi:10.3201/eid2703.202284.
APA Wolff, L., Martiny, D., Deyi, V., Maillart, E., Clevenbergh, P., & Dauby, N. (2021). COVID-19–Associated Fusobacterium nucleatum Bacteremia, Belgium. Emerging Infectious Diseases, 27(3), 975-977. https://dx.doi.org/10.3201/eid2703.202284.

Misidentification of Burkholderia pseudomallei, China [PDF - 763 KB - 3 pages]
B. Wu et al.

We report a case of melioidosis in China and offer a comparison of 5 commercial detection systems for Burkholderia pseudomallei. The organism was misidentified by the VITEK 2 Compact, Phoenix, VITEK mass spectrometry, and API 20NE systems but was eventually identified by the Bruker Biotyper system and 16S rRNA sequencing.

EID Wu B, Tong X, He H, Yang Y, Chen H, Yang X, et al. Misidentification of Burkholderia pseudomallei, China. Emerg Infect Dis. 2021;27(3):964-966. https://dx.doi.org/10.3201/eid2703.191769
AMA Wu B, Tong X, He H, et al. Misidentification of Burkholderia pseudomallei, China. Emerging Infectious Diseases. 2021;27(3):964-966. doi:10.3201/eid2703.191769.
APA Wu, B., Tong, X., He, H., Yang, Y., Chen, H., Yang, X....Xu, B. (2021). Misidentification of Burkholderia pseudomallei, China. Emerging Infectious Diseases, 27(3), 964-966. https://dx.doi.org/10.3201/eid2703.191769.

Genomic and Pathologic Findings for Prototheca cutis Infection in Cat [PDF - 1.83 MB - 4 pages]
G. Maboni et al.

Severe nasal Prototheca cutis infection was diagnosed postmortem for an immunocompetent cat with respiratory signs. Pathologic examination and whole-genome sequencing identified this species of algae, and susceptibility testing determined antimicrobial resistance patterns. P. cutis infection should be a differential diagnosis for soft tissue infections of mammals.

EID Maboni G, Elbert JA, Stilwell JM, Sanchez S. Genomic and Pathologic Findings for Prototheca cutis Infection in Cat. Emerg Infect Dis. 2021;27(3):979-982. https://dx.doi.org/10.3201/eid2703.202941
AMA Maboni G, Elbert JA, Stilwell JM, et al. Genomic and Pathologic Findings for Prototheca cutis Infection in Cat. Emerging Infectious Diseases. 2021;27(3):979-982. doi:10.3201/eid2703.202941.
APA Maboni, G., Elbert, J. A., Stilwell, J. M., & Sanchez, S. (2021). Genomic and Pathologic Findings for Prototheca cutis Infection in Cat. Emerging Infectious Diseases, 27(3), 979-982. https://dx.doi.org/10.3201/eid2703.202941.

SARS-CoV-2 Exposure in Escaped Mink, Utah, USA [PDF - 348 KB - 3 pages]
S. A. Shriner et al.

In August 2020, outbreaks of coronavirus disease were confirmed on mink farms in Utah, USA. We surveyed mammals captured on and around farms for evidence of infection or exposure. Free-ranging mink, presumed domestic escapees, exhibited high antibody titers, suggesting a potential severe acute respiratory syndrome coronavirus 2 transmission pathway to native wildlife.

EID Shriner SA, Ellis JW, Root J, Roug A, Stopak SR, Wiscomb GW, et al. SARS-CoV-2 Exposure in Escaped Mink, Utah, USA. Emerg Infect Dis. 2021;27(3):988-990. https://dx.doi.org/10.3201/eid2703.204444
AMA Shriner SA, Ellis JW, Root J, et al. SARS-CoV-2 Exposure in Escaped Mink, Utah, USA. Emerging Infectious Diseases. 2021;27(3):988-990. doi:10.3201/eid2703.204444.
APA Shriner, S. A., Ellis, J. W., Root, J., Roug, A., Stopak, S. R., Wiscomb, G. W....DeLiberto, T. J. (2021). SARS-CoV-2 Exposure in Escaped Mink, Utah, USA. Emerging Infectious Diseases, 27(3), 988-990. https://dx.doi.org/10.3201/eid2703.204444.

Drug-Resistant Tuberculosis in Pet Ring-Tailed Lemur, Madagascar [PDF - 579 KB - 3 pages]
M. LaFleur et al.

We diagnosed tuberculosis in an illegally wild-captured pet ring-tailed lemur manifesting lethargy, anorexia, and cervical lymphadenopathy. Whole-genome sequencing confirmed the Mycobacterium tuberculosis isolate belonged to lineage 3 and harbored streptomycin resistance. We recommend reverse zoonosis prevention and determination of whether lemurs are able to maintain M. tuberculosis infection.

EID LaFleur M, Reuter KE, Hall MB, Rasoanaivo HH, McKernan S, Ranaivomanana P, et al. Drug-Resistant Tuberculosis in Pet Ring-Tailed Lemur, Madagascar. Emerg Infect Dis. 2021;27(3):977-979. https://dx.doi.org/10.3201/eid2703.202924
AMA LaFleur M, Reuter KE, Hall MB, et al. Drug-Resistant Tuberculosis in Pet Ring-Tailed Lemur, Madagascar. Emerging Infectious Diseases. 2021;27(3):977-979. doi:10.3201/eid2703.202924.
APA LaFleur, M., Reuter, K. E., Hall, M. B., Rasoanaivo, H. H., McKernan, S., Ranaivomanana, P....Lapierre, S. (2021). Drug-Resistant Tuberculosis in Pet Ring-Tailed Lemur, Madagascar. Emerging Infectious Diseases, 27(3), 977-979. https://dx.doi.org/10.3201/eid2703.202924.

Local Transmission of SARS-CoV-2 Lineage B.1.1.7, Brazil, December 2020 [PDF - 616 KB - 3 pages]
I. Claro et al.

In December 2020, research surveillance detected the B.1.1.7 lineage of severe acute respiratory syndrome coronavirus 2 in São Paulo, Brazil. Rapid genomic sequencing and phylogenetic analysis revealed 2 distinct introductions of the lineage. One patient reported no international travel. There may be more infections with this lineage in Brazil than reported.

EID Claro I, da Silva Sales F, Ramundo M, Candido DS, Silva C, de Jesus J, et al. Local Transmission of SARS-CoV-2 Lineage B.1.1.7, Brazil, December 2020. Emerg Infect Dis. 2021;27(3):970-972. https://dx.doi.org/10.3201/eid2703.210038
AMA Claro I, da Silva Sales F, Ramundo M, et al. Local Transmission of SARS-CoV-2 Lineage B.1.1.7, Brazil, December 2020. Emerging Infectious Diseases. 2021;27(3):970-972. doi:10.3201/eid2703.210038.
APA Claro, I., da Silva Sales, F., Ramundo, M., Candido, D. S., Silva, C., de Jesus, J....Levi, J. (2021). Local Transmission of SARS-CoV-2 Lineage B.1.1.7, Brazil, December 2020. Emerging Infectious Diseases, 27(3), 970-972. https://dx.doi.org/10.3201/eid2703.210038.

Mycobacterium bovis Infection in Free-Ranging African Elephants [PDF - 343 KB - 3 pages]
M. A. Miller et al.

Mycobacterium bovis infection in wildlife species occurs worldwide. However, few cases of M. bovis infection in captive elephants have been reported. We describe 2 incidental cases of bovine tuberculosis in free-ranging African elephants (Loxodonta africana) from a tuberculosis-endemic national park in South Africa and the epidemiologic implications of these infections.

EID Miller MA, Kerr TJ, de Waal CR, Goosen WJ, Streicher EM, Hausler G, et al. Mycobacterium bovis Infection in Free-Ranging African Elephants. Emerg Infect Dis. 2021;27(3):990-992. https://dx.doi.org/10.3201/eid2703.204729
AMA Miller MA, Kerr TJ, de Waal CR, et al. Mycobacterium bovis Infection in Free-Ranging African Elephants. Emerging Infectious Diseases. 2021;27(3):990-992. doi:10.3201/eid2703.204729.
APA Miller, M. A., Kerr, T. J., de Waal, C. R., Goosen, W. J., Streicher, E. M., Hausler, G....Buss, P. E. (2021). Mycobacterium bovis Infection in Free-Ranging African Elephants. Emerging Infectious Diseases, 27(3), 990-992. https://dx.doi.org/10.3201/eid2703.204729.

Mycobacterium bovis Pulmonary Tuberculosis, Algeria [PDF - 410 KB - 3 pages]
F. Tazerart et al.

We analyzed 98 Mycobacterium tuberculosis complex isolates collected in 2 regions of Algeria in 2015–2018 from 93 cases of pulmonary tuberculosis. We identified 93/98 isolates as M. tuberculosis lineage 4 and 1 isolate as M. tuberculosis lineage 2 (Beijing). We confirmed 4 isolates as M. bovis by whole-genome sequencing.

EID Tazerart F, Saad J, Niar A, Sahraoui N, Drancourt M. Mycobacterium bovis Pulmonary Tuberculosis, Algeria. Emerg Infect Dis. 2021;27(3):972-974. https://dx.doi.org/10.3201/eid2703.191823
AMA Tazerart F, Saad J, Niar A, et al. Mycobacterium bovis Pulmonary Tuberculosis, Algeria. Emerging Infectious Diseases. 2021;27(3):972-974. doi:10.3201/eid2703.191823.
APA Tazerart, F., Saad, J., Niar, A., Sahraoui, N., & Drancourt, M. (2021). Mycobacterium bovis Pulmonary Tuberculosis, Algeria. Emerging Infectious Diseases, 27(3), 972-974. https://dx.doi.org/10.3201/eid2703.191823.
Another Dimension

Without Mercy [PDF - 203 KB - 1 page]
J. Casabona
EID Casabona J. Without Mercy. Emerg Infect Dis. 2021;27(3):961. https://dx.doi.org/10.3201/eid2703.203690
AMA Casabona J. Without Mercy. Emerging Infectious Diseases. 2021;27(3):961. doi:10.3201/eid2703.203690.
APA Casabona, J. (2021). Without Mercy. Emerging Infectious Diseases, 27(3), 961. https://dx.doi.org/10.3201/eid2703.203690.
Books and Media

Bats and Viruses: Current Research and Future Trends [PDF - 309 KB - 1 page]
D. Hewitt
EID Hewitt D. Bats and Viruses: Current Research and Future Trends. Emerg Infect Dis. 2021;27(3):993. https://dx.doi.org/10.3201/eid2703.204561
AMA Hewitt D. Bats and Viruses: Current Research and Future Trends. Emerging Infectious Diseases. 2021;27(3):993. doi:10.3201/eid2703.204561.
APA Hewitt, D. (2021). Bats and Viruses: Current Research and Future Trends. Emerging Infectious Diseases, 27(3), 993. https://dx.doi.org/10.3201/eid2703.204561.
About the Cover

Strange Case of a Sojourn in Saranac [PDF - 784 KB - 2 pages]
T. Chorba
EID Chorba T. Strange Case of a Sojourn in Saranac. Emerg Infect Dis. 2021;27(3):994-995. https://dx.doi.org/10.3201/eid2703.ac2703
AMA Chorba T. Strange Case of a Sojourn in Saranac. Emerging Infectious Diseases. 2021;27(3):994-995. doi:10.3201/eid2703.ac2703.
APA Chorba, T. (2021). Strange Case of a Sojourn in Saranac. Emerging Infectious Diseases, 27(3), 994-995. https://dx.doi.org/10.3201/eid2703.ac2703.
Etymologia

Etymologia: Histoplasma capsulatum [PDF - 447 KB - 1 page]
M. Mahajan
EID Mahajan M. Etymologia: Histoplasma capsulatum. Emerg Infect Dis. 2021;27(3):969. https://dx.doi.org/10.3201/eid2703.et2703
AMA Mahajan M. Etymologia: Histoplasma capsulatum. Emerging Infectious Diseases. 2021;27(3):969. doi:10.3201/eid2703.et2703.
APA Mahajan, M. (2021). Etymologia: Histoplasma capsulatum. Emerging Infectious Diseases, 27(3), 969. https://dx.doi.org/10.3201/eid2703.et2703.
Page created: February 10, 2021
Page updated: March 05, 2021
Page reviewed: March 05, 2021
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