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Issue Cover for Volume 27, Number 4—April 2021

Volume 27, Number 4—April 2021

[PDF - 10.47 MB - 266 pages]

Synopses

Medscape CME Activity
Systematic Review of Reported HIV Outbreaks, Pakistan, 2000–2019 [PDF - 1.14 MB - 8 pages]
E. M. Rabold et al.

Unsafe injection practices and injection drug use have been linked to multiple HIV outbreaks in Pakistan since 2003; however, few studies have systematically analyzed the causes of these outbreaks. We conducted a systematic review of published English-language literature indexed in bibliographic databases and search engines and a focused gray literature review to collate and analyze all reported HIV outbreaks in Pakistan during 2000–2019. Of 774 unique publications reviewed, we identified 25 eligible publications describing 7 outbreaks. More than half occurred during 2016–2019. The primary sources of transmission were iatrogenic transmission, affecting children, persons with chronic medical conditions, and the general population (4 outbreaks); injection drug use (2 outbreaks); and a combination of both (1 outbreak). In the absence of robust HIV testing and surveillance in Pakistan, timely and detailed outbreak reporting is important to understand the epidemiology of HIV in the country.

EID Rabold EM, Ali H, Fernandez D, Knuth M, Schenkel K, Asghar R, et al. Systematic Review of Reported HIV Outbreaks, Pakistan, 2000–2019. Emerg Infect Dis. 2021;27(4):1039-1047. https://doi.org/10.3201/eid2704.204205
AMA Rabold EM, Ali H, Fernandez D, et al. Systematic Review of Reported HIV Outbreaks, Pakistan, 2000–2019. Emerging Infectious Diseases. 2021;27(4):1039-1047. doi:10.3201/eid2704.204205.
APA Rabold, E. M., Ali, H., Fernandez, D., Knuth, M., Schenkel, K., Asghar, R....Morgan, O. (2021). Systematic Review of Reported HIV Outbreaks, Pakistan, 2000–2019. Emerging Infectious Diseases, 27(4), 1039-1047. https://doi.org/10.3201/eid2704.204205.

Animal Reservoirs and Hosts for Emerging Alphacoronaviruses and Betacoronaviruses [PDF - 1.99 MB - 8 pages]
R. R. Ghai et al.

The ongoing global pandemic caused by coronavirus disease has once again demonstrated the role of the family Coronaviridae in causing human disease outbreaks. Because severe acute respiratory syndrome coronavirus 2 was first detected in December 2019, information on its tropism, host range, and clinical manifestations in animals is limited. Given the limited information, data from other coronaviruses might be useful for informing scientific inquiry, risk assessment, and decision-making. We reviewed endemic and emerging infections of alphacoronaviruses and betacoronaviruses in wildlife, livestock, and companion animals and provide information on the receptor use, known hosts, and clinical signs associated with each host for 15 coronaviruses detected in humans and animals. This information can be used to guide implementation of a One Health approach that involves human health, animal health, environmental, and other relevant partners in developing strategies for preparedness, response, and control to current and future coronavirus disease threats.

EID Ghai RR, Carpenter A, Liew AY, Martin KB, Herring MK, Gerber SI, et al. Animal Reservoirs and Hosts for Emerging Alphacoronaviruses and Betacoronaviruses. Emerg Infect Dis. 2021;27(4):1015-1022. https://doi.org/10.3201/eid2704.203945
AMA Ghai RR, Carpenter A, Liew AY, et al. Animal Reservoirs and Hosts for Emerging Alphacoronaviruses and Betacoronaviruses. Emerging Infectious Diseases. 2021;27(4):1015-1022. doi:10.3201/eid2704.203945.
APA Ghai, R. R., Carpenter, A., Liew, A. Y., Martin, K. B., Herring, M. K., Gerber, S. I....Behravesh, C. (2021). Animal Reservoirs and Hosts for Emerging Alphacoronaviruses and Betacoronaviruses. Emerging Infectious Diseases, 27(4), 1015-1022. https://doi.org/10.3201/eid2704.203945.

Reemergence of Human Monkeypox and Declining Population Immunity in the Context of Urbanization, Nigeria, 2017–2020 [PDF - 1.53 MB - 8 pages]
P. Nguyen et al.

A monkeypox outbreak in Nigeria during 2017–2020 provides an illustrative case study for emerging zoonoses. We built a statistical model to simulate declining immunity from monkeypox at 2 levels: At the individual level, we used a constant rate of decline in immunity of 1.29% per year as smallpox vaccination rates fell. At the population level, the cohort of vaccinated residents decreased over time because of deaths and births. By 2016, only 10.1% of the total population in Nigeria was vaccinated against smallpox; the serologic immunity level was 25.7% among vaccinated persons and 2.6% in the overall population. The substantial resurgence of monkeypox in Nigeria in 2017 appears to have been driven by a combination of population growth, accumulation of unvaccinated cohorts, and decline in smallpox vaccine immunity. The expanding unvaccinated population means that entire households, not just children, are now more susceptible to monkeypox, increasing risk of human-to-human transmission.

EID Nguyen P, Ajisegiri W, Costantino V, Chughtai AA, MacIntyre C. Reemergence of Human Monkeypox and Declining Population Immunity in the Context of Urbanization, Nigeria, 2017–2020. Emerg Infect Dis. 2021;27(4):1007-1014. https://doi.org/10.3201/eid2704.203569
AMA Nguyen P, Ajisegiri W, Costantino V, et al. Reemergence of Human Monkeypox and Declining Population Immunity in the Context of Urbanization, Nigeria, 2017–2020. Emerging Infectious Diseases. 2021;27(4):1007-1014. doi:10.3201/eid2704.203569.
APA Nguyen, P., Ajisegiri, W., Costantino, V., Chughtai, A. A., & MacIntyre, C. (2021). Reemergence of Human Monkeypox and Declining Population Immunity in the Context of Urbanization, Nigeria, 2017–2020. Emerging Infectious Diseases, 27(4), 1007-1014. https://doi.org/10.3201/eid2704.203569.

Characteristics of SARS-CoV-2 Transmission among Meat Processing Workers in Nebraska, USA, and Effectiveness of Risk Mitigation Measures [PDF - 923 KB - 8 pages]
J. J. Herstein et al.

The coronavirus disease (COVID-19) pandemic has severely impacted the meat processing industry in the United States. We sought to detail demographics and outcomes of severe acute respiratory syndrome coronavirus 2 infections among workers in Nebraska meat processing facilities and determine the effects of initiating universal mask policies and installing physical barriers at 13 meat processing facilities. During April 1–July 31, 2020, COVID-19 was diagnosed in 5,002 Nebraska meat processing workers (attack rate 19%). After initiating both universal masking and physical barrier interventions, 8/13 facilities showed a statistically significant reduction in COVID-19 incidence in <10 days. Characteristics and incidence of confirmed cases aligned with many nationwide trends becoming apparent during this pandemic: specifically, high attack rates among meat processing industry workers, disproportionately high risk of adverse outcomes among ethnic and racial minority groups and men, and effectiveness of using multiple prevention and control interventions to reduce disease transmission.

EID Herstein JJ, Degarege A, Stover D, Austin C, Schwedhelm MM, Lawler JV, et al. Characteristics of SARS-CoV-2 Transmission among Meat Processing Workers in Nebraska, USA, and Effectiveness of Risk Mitigation Measures. Emerg Infect Dis. 2021;27(4):1032-1038. https://doi.org/10.3201/eid2704.204800
AMA Herstein JJ, Degarege A, Stover D, et al. Characteristics of SARS-CoV-2 Transmission among Meat Processing Workers in Nebraska, USA, and Effectiveness of Risk Mitigation Measures. Emerging Infectious Diseases. 2021;27(4):1032-1038. doi:10.3201/eid2704.204800.
APA Herstein, J. J., Degarege, A., Stover, D., Austin, C., Schwedhelm, M. M., Lawler, J. V....Donahue, M. (2021). Characteristics of SARS-CoV-2 Transmission among Meat Processing Workers in Nebraska, USA, and Effectiveness of Risk Mitigation Measures. Emerging Infectious Diseases, 27(4), 1032-1038. https://doi.org/10.3201/eid2704.204800.

Difficulties in Differentiating Coronaviruses from Subcellular Structures in Human Tissues by Electron Microscopy [PDF - 3.35 MB - 9 pages]
H. A. Bullock et al.

Efforts to combat the coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have placed a renewed focus on the use of transmission electron microscopy for identifying coronavirus in tissues. In attempts to attribute pathology of COVID-19 patients directly to tissue damage caused by SARS-CoV-2, investigators have inaccurately reported subcellular structures, including coated vesicles, multivesicular bodies, and vesiculating rough endoplasmic reticulum, as coronavirus particles. We describe morphologic features of coronavirus that distinguish it from subcellular structures, including particle size range (60–140 nm), intracellular particle location within membrane-bound vacuoles, and a nucleocapsid appearing in cross section as dense dots (6–12 nm) within the particles. In addition, although the characteristic spikes of coronaviruses may be visible on the virus surface, especially on extracellular particles, they are less evident in thin sections than in negative stain preparations.

EID Bullock HA, Goldsmith CS, Zaki SR, Martines RB, Miller SE. Difficulties in Differentiating Coronaviruses from Subcellular Structures in Human Tissues by Electron Microscopy. Emerg Infect Dis. 2021;27(4):1023-1031. https://doi.org/10.3201/eid2704.204337
AMA Bullock HA, Goldsmith CS, Zaki SR, et al. Difficulties in Differentiating Coronaviruses from Subcellular Structures in Human Tissues by Electron Microscopy. Emerging Infectious Diseases. 2021;27(4):1023-1031. doi:10.3201/eid2704.204337.
APA Bullock, H. A., Goldsmith, C. S., Zaki, S. R., Martines, R. B., & Miller, S. E. (2021). Difficulties in Differentiating Coronaviruses from Subcellular Structures in Human Tissues by Electron Microscopy. Emerging Infectious Diseases, 27(4), 1023-1031. https://doi.org/10.3201/eid2704.204337.

Medscape CME Activity
Blastomycosis Surveillance in 5 States, United States, 1987–2018 [PDF - 1.79 MB - 8 pages]
K. Benedict et al.

Blastomycosis is caused by inhalation of Blastomyces spp. fungi. Limited data are available on the incidence and geographic range of blastomycosis in the United States. To better characterize its epidemiologic features, we analyzed combined surveillance data from the 5 states in which blastomycosis is reportable: Arkansas, Louisiana, Michigan, Minnesota, and Wisconsin. Surveillance identified 4,441 cases during 1987–2018, a mean of 192 cases per year. The mean annual incidence was <1 case/100,000 population in most areas but >20 cases/100,000 population in some northern counties of Wisconsin. Median patient age was 46 years, 2,892 (65%) patients were male, 1,662 (57%) were hospitalized, and 278 (8%) died. The median time from symptom onset to diagnosis was 33 days. The severity of illness and diagnostic delays suggest that surveillance underestimates the true number of cases. More in-depth surveillance in additional states could elucidate blastomycosis incidence and inform efforts to increase awareness.

EID Benedict K, Gibbons-Burgener S, Kocharian A, Ireland M, Rothfeldt L, Christophe N, et al. Blastomycosis Surveillance in 5 States, United States, 1987–2018. Emerg Infect Dis. 2021;27(4):999-1006. https://doi.org/10.3201/eid2704.204078
AMA Benedict K, Gibbons-Burgener S, Kocharian A, et al. Blastomycosis Surveillance in 5 States, United States, 1987–2018. Emerging Infectious Diseases. 2021;27(4):999-1006. doi:10.3201/eid2704.204078.
APA Benedict, K., Gibbons-Burgener, S., Kocharian, A., Ireland, M., Rothfeldt, L., Christophe, N....Jackson, B. R. (2021). Blastomycosis Surveillance in 5 States, United States, 1987–2018. Emerging Infectious Diseases, 27(4), 999-1006. https://doi.org/10.3201/eid2704.204078.
Research

Medscape CME Activity
Infections with Tickborne Pathogens after Tick Bite, Austria, 2015–2018 [PDF - 1.18 MB - 9 pages]
M. Markowicz et al.

The aim of this prospective study was to assess the risk for tickborne infections after a tick bite. A total of 489 persons bitten by 1,295 ticks were assessed for occurrence of infections with Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum, Rickettsia spp., Babesia spp., Candidatus Neoehrlichia mikurensis, and relapsing fever borreliae. B. burgdorferi s.l. infection was found in 25 (5.1%) participants, of whom 15 had erythema migrans. Eleven (2.3%) participants were positive by PCR for Candidatus N. mikurensis. One asymptomatic participant infected with B. miyamotoi was identified. Full engorgement of the tick (odds ratio 9.52) and confirmation of B. burgdorferi s.l. in the tick by PCR (odds ratio 4.39) increased the risk for infection. Rickettsia helvetica was highly abundant in ticks but not pathogenic to humans. Knowledge about the outcome of tick bites is crucial because infections with emerging pathogens might be underestimated because of limited laboratory facilities.

EID Markowicz M, Schötta A, Höss D, Kundi M, Schray C, Stockinger H, et al. Infections with Tickborne Pathogens after Tick Bite, Austria, 2015–2018. Emerg Infect Dis. 2021;27(4):1048-1056. https://doi.org/10.3201/eid2704.203366
AMA Markowicz M, Schötta A, Höss D, et al. Infections with Tickborne Pathogens after Tick Bite, Austria, 2015–2018. Emerging Infectious Diseases. 2021;27(4):1048-1056. doi:10.3201/eid2704.203366.
APA Markowicz, M., Schötta, A., Höss, D., Kundi, M., Schray, C., Stockinger, H....Stanek, G. (2021). Infections with Tickborne Pathogens after Tick Bite, Austria, 2015–2018. Emerging Infectious Diseases, 27(4), 1048-1056. https://doi.org/10.3201/eid2704.203366.

Epidemiologic and Genomic Reidentification of Yaws, Liberia [PDF - 3.16 MB - 10 pages]
J. Timothy et al.

We confirmed endemicity and autochthonous transmission of yaws in Liberia after a population-based, community-led burden estimation (56,825 participants). Serologically confirmed yaws was rare and focal at population level (24 cases; 2.6 [95% CI 1.4–3.9] cases/10,000 population) with similar clinical epidemiology to other endemic countries in West Africa. Unsupervised classification of spatially referenced case finding data indicated that yaws was more likely to occur in hard-to-reach communities; healthcare-seeking was low among communities, and clinical awareness of yaws was low among healthcare workers. We recovered whole bacterial genomes from 12 cases and describe a monophyletic clade of Treponema pallidum subspecies pertenue, phylogenetically distinct from known TPE lineages, including those affecting neighboring nonhuman primate populations (Taï Forest, Côte d’Ivoire). Yaws is endemic in Liberia but exhibits low focal population prevalence with evidence of a historical genetic bottleneck and subsequent local expansion. Reporting gaps appear attributable to challenging epidemiology and low disease awareness.

EID Timothy J, Beale MA, Rogers E, Zaizay Z, Halliday KE, Mulbah T, et al. Epidemiologic and Genomic Reidentification of Yaws, Liberia. Emerg Infect Dis. 2021;27(4):1123-1132. https://doi.org/10.3201/eid2704.204442
AMA Timothy J, Beale MA, Rogers E, et al. Epidemiologic and Genomic Reidentification of Yaws, Liberia. Emerging Infectious Diseases. 2021;27(4):1123-1132. doi:10.3201/eid2704.204442.
APA Timothy, J., Beale, M. A., Rogers, E., Zaizay, Z., Halliday, K. E., Mulbah, T....Marks, M. (2021). Epidemiologic and Genomic Reidentification of Yaws, Liberia. Emerging Infectious Diseases, 27(4), 1123-1132. https://doi.org/10.3201/eid2704.204442.

Dynamic Public Perceptions of the Coronavirus Disease Crisis, the Netherlands, 2020 [PDF - 2.22 MB - 12 pages]
M. de Vries et al.

A key component of outbreak control is monitoring public perceptions and public response. To determine public perceptions and public responses during the first 3 months of the coronavirus disease (COVID-19) outbreak in the Netherlands, we conducted 6 repeated surveys of ≈3,000 persons. Generalized estimating equations analyses revealed changes over time as well as differences between groups at low and high risk. Overall, respondents perceived the risks associated with COVID-19 to be considerable, were positive about the mitigation measures, trusted the information and the measures from authorities, and adopted protective measures. Substantial increases were observed in risk perceptions and self-reported protective behavior in the first weeks of the outbreak. Individual differences were based mainly on participants’ age and health condition. We recommend that authorities constantly adjust their COVID-19 communication and mitigation strategies to fit public perceptions and public responses and that they tailor the information for different groups.

EID de Vries M, Claassen L, te Wierik M, van den Hof S, Brabers A, de Jong JD, et al. Dynamic Public Perceptions of the Coronavirus Disease Crisis, the Netherlands, 2020. Emerg Infect Dis. 2021;27(4):1098-1109. https://doi.org/10.3201/eid2704.203328
AMA de Vries M, Claassen L, te Wierik M, et al. Dynamic Public Perceptions of the Coronavirus Disease Crisis, the Netherlands, 2020. Emerging Infectious Diseases. 2021;27(4):1098-1109. doi:10.3201/eid2704.203328.
APA de Vries, M., Claassen, L., te Wierik, M., van den Hof, S., Brabers, A., de Jong, J. D....Timen, A. (2021). Dynamic Public Perceptions of the Coronavirus Disease Crisis, the Netherlands, 2020. Emerging Infectious Diseases, 27(4), 1098-1109. https://doi.org/10.3201/eid2704.203328.

Sexual Contact as Risk Factor for Campylobacter Infection, Denmark [PDF - 1.01 MB - 8 pages]
K. Kuhn et al.

Campylobacteriosis is a disease of worldwide importance, but aspects of its transmission dynamics, particularly risk factors, are still poorly understood. We used data from a matched case-control study of 4,269 men who have sex with men (MSM) and 26,215 controls, combined with national surveillance data on Campylobacter spp., Salmonella spp., and Shigella spp., to calculate matched odds ratios (mORs) for infection among MSM and controls. MSM had higher odds of Campylobacter (mOR 14, 95% CI 10–21) and Shigella (mOR 74, 95% CI 27–203) infections, but not Salmonella (mOR 0.2, 95% CI 0–13), and were less likely than controls to have acquired Campylobacter infection abroad (χ2 = 21; p<0.001). Our results confirm that sexual contact is a risk factor for campylobacteriosis and also suggest explanations for unique features of Campylobacter epidemiology. These findings provide a baseline for updating infection risk guidelines to the general population.

EID Kuhn K, Hvass A, Christiansen A, Ethelberg S, Cowan S. Sexual Contact as Risk Factor for Campylobacter Infection, Denmark. Emerg Infect Dis. 2021;27(4):1133-1140. https://doi.org/10.3201/eid2704.202337
AMA Kuhn K, Hvass A, Christiansen A, et al. Sexual Contact as Risk Factor for Campylobacter Infection, Denmark. Emerging Infectious Diseases. 2021;27(4):1133-1140. doi:10.3201/eid2704.202337.
APA Kuhn, K., Hvass, A., Christiansen, A., Ethelberg, S., & Cowan, S. (2021). Sexual Contact as Risk Factor for Campylobacter Infection, Denmark. Emerging Infectious Diseases, 27(4), 1133-1140. https://doi.org/10.3201/eid2704.202337.

COVID-19–Associated Pulmonary Aspergillosis, March–August 2020 [PDF - 1.47 MB - 10 pages]
J. Salmanton-García et al.

Pneumonia caused by severe acute respiratory syndrome coronavirus 2 emerged in China at the end of 2019. Because of the severe immunomodulation and lymphocyte depletion caused by this virus and the subsequent administration of drugs directed at the immune system, we anticipated that patients might experience fungal superinfection. We collected data from 186 patients who had coronavirus disease–associated pulmonary aspergillosis (CAPA) worldwide during March–August 2020. Overall, 182 patients were admitted to the intensive care unit (ICU), including 180 with acute respiratory distress syndrome and 175 who received mechanical ventilation. CAPA was diagnosed a median of 10 days after coronavirus disease diagnosis. Aspergillus fumigatus was identified in 80.3% of patient cultures, 4 of which were azole-resistant. Most (52.7%) patients received voriconazole. In total, 52.2% of patients died; of the deaths, 33.0% were attributed to CAPA. We found that the cumulative incidence of CAPA in the ICU ranged from 1.0% to 39.1%.

EID Salmanton-García J, Sprute R, Stemler J, Bartoletti M, Dupont D, Valerio M, et al. COVID-19–Associated Pulmonary Aspergillosis, March–August 2020. Emerg Infect Dis. 2021;27(4):1077-1086. https://doi.org/10.3201/eid2704.204895
AMA Salmanton-García J, Sprute R, Stemler J, et al. COVID-19–Associated Pulmonary Aspergillosis, March–August 2020. Emerging Infectious Diseases. 2021;27(4):1077-1086. doi:10.3201/eid2704.204895.
APA Salmanton-García, J., Sprute, R., Stemler, J., Bartoletti, M., Dupont, D., Valerio, M....Koehler, P. (2021). COVID-19–Associated Pulmonary Aspergillosis, March–August 2020. Emerging Infectious Diseases, 27(4), 1077-1086. https://doi.org/10.3201/eid2704.204895.

Genomic Surveillance of a Globally Circulating Distinct Group W Clonal Complex 11 Meningococcal Variant, New Zealand, 2013–2018 [PDF - 6.85 MB - 11 pages]
Z. Yang et al.

Genomic surveillance is an essential part of effective disease control, enabling identification of emerging and expanding strains and monitoring of subsequent interventions. Whole-genome sequencing was used to analyze the genomic diversity of all Neisseria meningitidis isolates submitted to the New Zealand Meningococcal Reference Laboratory during 2013–2018. Of the 347 isolates submitted for whole-genome sequencing, we identified 68 sequence types belonging to 18 clonal complexes (CC). The predominant CC was CC41/44; next in predominance was CC11. Comparison of the 45 New Zealand group W CC11 isolates with worldwide representatives of group W CC11 isolates revealed that the original UK strain, the 2013 UK strain, and a distinctive variant (the 2015 strain) were causing invasive group W meningococcal disease in New Zealand. The 2015 strain also demonstrated increased resistance to penicillin and has been circulating in Canada and several countries in Europe, highlighting that close monitoring is needed to prevent future outbreaks around the world.

EID Yang Z, Ren X, Davies H, Wood T, Lopez L, Sherwood J, et al. Genomic Surveillance of a Globally Circulating Distinct Group W Clonal Complex 11 Meningococcal Variant, New Zealand, 2013–2018. Emerg Infect Dis. 2021;27(4):1087-1097. https://doi.org/10.3201/eid2704.191716
AMA Yang Z, Ren X, Davies H, et al. Genomic Surveillance of a Globally Circulating Distinct Group W Clonal Complex 11 Meningococcal Variant, New Zealand, 2013–2018. Emerging Infectious Diseases. 2021;27(4):1087-1097. doi:10.3201/eid2704.191716.
APA Yang, Z., Ren, X., Davies, H., Wood, T., Lopez, L., Sherwood, J....Carter, P. E. (2021). Genomic Surveillance of a Globally Circulating Distinct Group W Clonal Complex 11 Meningococcal Variant, New Zealand, 2013–2018. Emerging Infectious Diseases, 27(4), 1087-1097. https://doi.org/10.3201/eid2704.191716.

Emergence of Burkholderia pseudomallei Sequence Type 562, Northern Australia [PDF - 3.60 MB - 11 pages]
E. M. Meumann et al.

Since 2005, the range of Burkholderia pseudomallei sequence type 562 (ST562) has expanded in northern Australia. During 2005–2019, ST562 caused melioidosis in 61 humans and 3 animals. Cases initially occurred in suburbs surrounding a creek before spreading across urban Darwin, Australia and a nearby island community. In urban Darwin, ST562 caused 12% (53/440) of melioidosis cases, a proportion that increased during the study period. We analyzed 2 clusters of cases with epidemiologic links and used genomic analysis to identify previously unassociated cases. We found that ST562 isolates from Hainan Province, China, and Pingtung County, Taiwan, were distantly related to ST562 strains from Australia. Temporal genomic analysis suggested a single ST562 introduction into the Darwin region in ≈1988. The origin and transmission mode of ST562 into Australia remain uncertain.

EID Meumann EM, Kaestli M, Mayo M, Ward L, Rachlin A, Webb JR, et al. Emergence of Burkholderia pseudomallei Sequence Type 562, Northern Australia. Emerg Infect Dis. 2021;27(4):1057-1067. https://doi.org/10.3201/eid2704.202716
AMA Meumann EM, Kaestli M, Mayo M, et al. Emergence of Burkholderia pseudomallei Sequence Type 562, Northern Australia. Emerging Infectious Diseases. 2021;27(4):1057-1067. doi:10.3201/eid2704.202716.
APA Meumann, E. M., Kaestli, M., Mayo, M., Ward, L., Rachlin, A., Webb, J. R....Currie, B. J. (2021). Emergence of Burkholderia pseudomallei Sequence Type 562, Northern Australia. Emerging Infectious Diseases, 27(4), 1057-1067. https://doi.org/10.3201/eid2704.202716.

Histopathological Characterization of Cases of Spontaneous Fatal Feline Severe Fever with Thrombocytopenia Syndrome, Japan [PDF - 7.74 MB - 9 pages]
Y. Sakai et al.

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging tickborne infectious disease caused by SFTS virus (SFTSV). We report 7 cases of spontaneous fatal SFTS in felines. Necropsies revealed characteristic lesions, including necrotizing lymphadenitis in 5 cases and necrotizing splenitis and SFTSV-positive blastic lymphocytes in all cases. We detected hemorrhagic lesions in the gastrointestinal tract in 6 cases and lungs in 3 cases, suggesting a more severe clinical course of SFTS in felids than in humans. We noted necrotic or ulcerative foci in the gastrointestinal tract in 3 cases, the lung in 2 cases, and the liver in 4 cases. We clarified that blastic lymphocytes are predominant targets of SFTSV and involved in induction of necrotic foci. We also found that thymic epithelial cells were additional targets of SFTSV. These results provide insights for diagnosing feline SFTS during pathological examination and demonstrate the similarity of feline and human SFTS cases.

EID Sakai Y, Kuwabara Y, Ishijima K, Kagimoto S, Mura S, Tatemoto K, et al. Histopathological Characterization of Cases of Spontaneous Fatal Feline Severe Fever with Thrombocytopenia Syndrome, Japan. Emerg Infect Dis. 2021;27(4):1068-1076. https://doi.org/10.3201/eid2704.204148
AMA Sakai Y, Kuwabara Y, Ishijima K, et al. Histopathological Characterization of Cases of Spontaneous Fatal Feline Severe Fever with Thrombocytopenia Syndrome, Japan. Emerging Infectious Diseases. 2021;27(4):1068-1076. doi:10.3201/eid2704.204148.
APA Sakai, Y., Kuwabara, Y., Ishijima, K., Kagimoto, S., Mura, S., Tatemoto, K....Maeda, K. (2021). Histopathological Characterization of Cases of Spontaneous Fatal Feline Severe Fever with Thrombocytopenia Syndrome, Japan. Emerging Infectious Diseases, 27(4), 1068-1076. https://doi.org/10.3201/eid2704.204148.

Evolution of Sequence Type 4821 Clonal Complex Hyperinvasive and Quinolone-Resistant Meningococci [PDF - 7.20 MB - 13 pages]
M. Chen et al.

Expansion of quinolone-resistant Neisseria meningitidis clone ChinaCC4821-R1-C/B from sequence type (ST) 4821 clonal complex (CC4821) caused a serogroup shift from serogroup A to serogroup C invasive meningococcal disease (IMD) in China. To determine the relationship among globally distributed CC4821 meningococci, we analyzed whole-genome sequence data from 173 CC4821 meningococci isolated from 4 continents during 1972–2019. These meningococci clustered into 4 sublineages (1–4); sublineage 1 primarily comprised of IMD isolates (41/50, 82%). Most isolates from outside China (40/49, 81.6%) formed a distinct sublineage, the Europe–USA cluster, with the typical strain designation B:P1.17-6,23:F3-36:ST-3200(CC4821), harboring mutations in penicillin-binding protein 2. These data show that the quinolone-resistant clone ChinaCC4821-R1-C/B has expanded to other countries. The increasing distribution worldwide of serogroup B CC4821 raises the concern that CC4821 has the potential to cause a pandemic that would be challenging to control, despite indirect evidence that the Trumenba vaccine might afford some protection.

EID Chen M, Harrison OB, Bratcher HB, Bo Z, Jolley KA, Rodrigues C, et al. Evolution of Sequence Type 4821 Clonal Complex Hyperinvasive and Quinolone-Resistant Meningococci. Emerg Infect Dis. 2021;27(4):1110-1122. https://doi.org/10.3201/eid2704.203612
AMA Chen M, Harrison OB, Bratcher HB, et al. Evolution of Sequence Type 4821 Clonal Complex Hyperinvasive and Quinolone-Resistant Meningococci. Emerging Infectious Diseases. 2021;27(4):1110-1122. doi:10.3201/eid2704.203612.
APA Chen, M., Harrison, O. B., Bratcher, H. B., Bo, Z., Jolley, K. A., Rodrigues, C....Maiden, M. (2021). Evolution of Sequence Type 4821 Clonal Complex Hyperinvasive and Quinolone-Resistant Meningococci. Emerging Infectious Diseases, 27(4), 1110-1122. https://doi.org/10.3201/eid2704.203612.
Dispatches

Improving Treatment and Outcomes for Melioidosis in Children, Northern Cambodia, 2009–2018 [PDF - 793 KB - 4 pages]
A. Chandna et al.

We report trends in manifestations, treatment, and outcomes of 355 children with culture-confirmed melioidosis over 10 years at a pediatric hospital in northern Cambodia. Bacteremia and presentation with pneumonia were risk factors for death. A total of 39 children recovered after being given only oral antimicrobial drug treatment.

EID Chandna A, Bonhoeffer M, Miliya T, Suy K, Sao S, Turner P. Improving Treatment and Outcomes for Melioidosis in Children, Northern Cambodia, 2009–2018. Emerg Infect Dis. 2021;27(4):1169-1172. https://doi.org/10.3201/eid2704.201683
AMA Chandna A, Bonhoeffer M, Miliya T, et al. Improving Treatment and Outcomes for Melioidosis in Children, Northern Cambodia, 2009–2018. Emerging Infectious Diseases. 2021;27(4):1169-1172. doi:10.3201/eid2704.201683.
APA Chandna, A., Bonhoeffer, M., Miliya, T., Suy, K., Sao, S., & Turner, P. (2021). Improving Treatment and Outcomes for Melioidosis in Children, Northern Cambodia, 2009–2018. Emerging Infectious Diseases, 27(4), 1169-1172. https://doi.org/10.3201/eid2704.201683.

Characteristics and Risk Factors of Hospitalized and Nonhospitalized COVID-19 Patients, Atlanta, Georgia, USA, March–April 2020 [PDF - 1.14 MB - 5 pages]
K. Pettrone et al.

We compared the characteristics of hospitalized and nonhospitalized patients who had coronavirus disease in Atlanta, Georgia, USA. We found that risk for hospitalization increased with a patient’s age and number of concurrent conditions. We also found a potential association between hospitalization and high hemoglobin A1c levels in persons with diabetes.

EID Pettrone K, Burnett E, Link-Gelles R, Haight SC, Schrodt C, England L, et al. Characteristics and Risk Factors of Hospitalized and Nonhospitalized COVID-19 Patients, Atlanta, Georgia, USA, March–April 2020. Emerg Infect Dis. 2021;27(4):1164-1168. https://doi.org/10.3201/eid2704.204709
AMA Pettrone K, Burnett E, Link-Gelles R, et al. Characteristics and Risk Factors of Hospitalized and Nonhospitalized COVID-19 Patients, Atlanta, Georgia, USA, March–April 2020. Emerging Infectious Diseases. 2021;27(4):1164-1168. doi:10.3201/eid2704.204709.
APA Pettrone, K., Burnett, E., Link-Gelles, R., Haight, S. C., Schrodt, C., England, L....Killerby, M. E. (2021). Characteristics and Risk Factors of Hospitalized and Nonhospitalized COVID-19 Patients, Atlanta, Georgia, USA, March–April 2020. Emerging Infectious Diseases, 27(4), 1164-1168. https://doi.org/10.3201/eid2704.204709.

Rare Norovirus GIV Foodborne Outbreak, Wisconsin, USA [PDF - 1.36 MB - 4 pages]
L. Barclay et al.

We report a norovirus GIV outbreak in the United States, 15 years after the last reported outbreak. During May 2016 in Wisconsin, 53 persons, including 4 food handlers, reported being ill. The outbreak was linked to individually prepared fruit consumed as a fruit salad. The virus was phylogenetically classified as a novel GIV genotype.

EID Barclay L, Davis T, Vinjé J. Rare Norovirus GIV Foodborne Outbreak, Wisconsin, USA. Emerg Infect Dis. 2021;27(4):1151-1154. https://doi.org/10.3201/eid2704.204521
AMA Barclay L, Davis T, Vinjé J. Rare Norovirus GIV Foodborne Outbreak, Wisconsin, USA. Emerging Infectious Diseases. 2021;27(4):1151-1154. doi:10.3201/eid2704.204521.
APA Barclay, L., Davis, T., & Vinjé, J. (2021). Rare Norovirus GIV Foodborne Outbreak, Wisconsin, USA. Emerging Infectious Diseases, 27(4), 1151-1154. https://doi.org/10.3201/eid2704.204521.

Venezuelan Equine Encephalitis Complex Alphavirus in Bats, French Guiana [PDF - 1.87 MB - 5 pages]
C. Fischer et al.

Although essential for control strategies, knowledge about transmission cycles is limited for Venezuelan equine encephalitis complex alphaviruses (VEEVs). After testing 1,398 bats from French Guiana for alphaviruses, we identified and isolated a new strain of the encephalitogenic VEEV species Tonate virus (TONV). Bats may contribute to TONV spread in Latin America.


Postvaccination COVID-19 among Healthcare Workers, Israel [PDF - 1004 KB - 3 pages]
S. Amit et al.

Coronavirus disease (COVID-19) symptoms can be mistaken for vaccine-related side effects during initial days after immunization. Among 4,081 vaccinated healthcare workers in Israel, 22 (0.54%) developed COVID-19 from 1–10 days (median 3.5 days) after immunization. Clinicians should not dismiss postvaccination symptoms as vaccine-related and should promptly test for COVID-19.

EID Amit S, Beni S, Biber A, Grinberg A, Leshem E, Regev-Yochay G. Postvaccination COVID-19 among Healthcare Workers, Israel. Emerg Infect Dis. 2021;27(4):1220-1222. https://doi.org/10.3201/eid2704.210016
AMA Amit S, Beni S, Biber A, et al. Postvaccination COVID-19 among Healthcare Workers, Israel. Emerging Infectious Diseases. 2021;27(4):1220-1222. doi:10.3201/eid2704.210016.
APA Amit, S., Beni, S., Biber, A., Grinberg, A., Leshem, E., & Regev-Yochay, G. (2021). Postvaccination COVID-19 among Healthcare Workers, Israel. Emerging Infectious Diseases, 27(4), 1220-1222. https://doi.org/10.3201/eid2704.210016.

SARS-CoV-2 Seropositivity among US Marine Recruits Attending Basic Training, United States, Spring–Fall 2020 [PDF - 2.02 MB - 5 pages]
A. G. Letizia et al.

In a study of US Marine recruits, seroprevalence of severe acute respiratory syndrome coronavirus 2 IgG was 9.0%. Hispanic and non-Hispanic Black participants and participants from states affected earlier in the pandemic had higher seropositivity rates. These results suggest the need for targeted public health strategies among young adults at increased risk for infection.

EID Letizia AG, Ge Y, Goforth CW, Weir DL, Lizewski R, Lizewski S, et al. SARS-CoV-2 Seropositivity among US Marine Recruits Attending Basic Training, United States, Spring–Fall 2020. Emerg Infect Dis. 2021;27(4):1188-1192. https://doi.org/10.3201/eid2704.204732
AMA Letizia AG, Ge Y, Goforth CW, et al. SARS-CoV-2 Seropositivity among US Marine Recruits Attending Basic Training, United States, Spring–Fall 2020. Emerging Infectious Diseases. 2021;27(4):1188-1192. doi:10.3201/eid2704.204732.
APA Letizia, A. G., Ge, Y., Goforth, C. W., Weir, D. L., Lizewski, R., Lizewski, S....Ramos, I. (2021). SARS-CoV-2 Seropositivity among US Marine Recruits Attending Basic Training, United States, Spring–Fall 2020. Emerging Infectious Diseases, 27(4), 1188-1192. https://doi.org/10.3201/eid2704.204732.

High Case-Fatality Rate for Human Anthrax, Northern Ghana, 2005–2016 [PDF - 1.33 MB - 4 pages]
J. K. Blackburn et al.

The human cutaneous anthrax case-fatality rate is ≈1% when treated, 5%–20% when untreated. We report high case-fatality rates (median 35.0%; 95% CI 21.1%–66.7%) during 2005–2016 linked to livestock handling in northern Ghana, where veterinary resources are limited. Livestock vaccination and access to human treatment should be evaluated.

EID Blackburn JK, Kenu E, Asiedu-Bekoe F, Sarkodie B, Kracalik IT, Bower WA, et al. High Case-Fatality Rate for Human Anthrax, Northern Ghana, 2005–2016. Emerg Infect Dis. 2021;27(4):1216-1219. https://doi.org/10.3201/eid2704.204496
AMA Blackburn JK, Kenu E, Asiedu-Bekoe F, et al. High Case-Fatality Rate for Human Anthrax, Northern Ghana, 2005–2016. Emerging Infectious Diseases. 2021;27(4):1216-1219. doi:10.3201/eid2704.204496.
APA Blackburn, J. K., Kenu, E., Asiedu-Bekoe, F., Sarkodie, B., Kracalik, I. T., Bower, W. A....Traxler, R. M. (2021). High Case-Fatality Rate for Human Anthrax, Northern Ghana, 2005–2016. Emerging Infectious Diseases, 27(4), 1216-1219. https://doi.org/10.3201/eid2704.204496.

Genomic Analysis of Novel Poxvirus Brazilian Porcupinepox Virus, Brazil, 2019 [PDF - 1.88 MB - 4 pages]
A. S. Hora et al.

We obtained the complete sequence of a novel poxvirus, tentatively named Brazilian porcupinepox virus, from a wild porcupine (Coendou prehensilis) in Brazil that had skin and internal lesions characteristic of poxvirus infection. The impact of this lethal poxvirus on the survival of this species and its potential zoonotic importance remain to be investigated.

EID Hora AS, Taniwaki SA, Martins NB, Pinto N, Schlemper AE, Santos A, et al. Genomic Analysis of Novel Poxvirus Brazilian Porcupinepox Virus, Brazil, 2019. Emerg Infect Dis. 2021;27(4):1177-1180. https://doi.org/10.3201/eid2704.203818
AMA Hora AS, Taniwaki SA, Martins NB, et al. Genomic Analysis of Novel Poxvirus Brazilian Porcupinepox Virus, Brazil, 2019. Emerging Infectious Diseases. 2021;27(4):1177-1180. doi:10.3201/eid2704.203818.
APA Hora, A. S., Taniwaki, S. A., Martins, N. B., Pinto, N., Schlemper, A. E., Santos, A....Brandão, P. E. (2021). Genomic Analysis of Novel Poxvirus Brazilian Porcupinepox Virus, Brazil, 2019. Emerging Infectious Diseases, 27(4), 1177-1180. https://doi.org/10.3201/eid2704.203818.

Surveillance of COVID-19–Associated Multisystem Inflammatory Syndrome in Children, South Korea [PDF - 1.55 MB - 5 pages]
Y. Choe et al.

A concerning development during the coronavirus disease pandemic has been multisystem inflammatory syndrome in children. Reports of this condition in East Asia have been limited. In South Korea, 3 cases were reported to the national surveillance system for multisystem inflammatory syndrome in children. All case-patients were hospitalized and survived with no major disease sequelae.

EID Choe Y, Choi E, Choi J, Eun B, Eun L, Kim Y, et al. Surveillance of COVID-19–Associated Multisystem Inflammatory Syndrome in Children, South Korea. Emerg Infect Dis. 2021;27(4):1196-1200. https://doi.org/10.3201/eid2704.210026
AMA Choe Y, Choi E, Choi J, et al. Surveillance of COVID-19–Associated Multisystem Inflammatory Syndrome in Children, South Korea. Emerging Infectious Diseases. 2021;27(4):1196-1200. doi:10.3201/eid2704.210026.
APA Choe, Y., Choi, E., Choi, J., Eun, B., Eun, L., Kim, Y....Lee, S. (2021). Surveillance of COVID-19–Associated Multisystem Inflammatory Syndrome in Children, South Korea. Emerging Infectious Diseases, 27(4), 1196-1200. https://doi.org/10.3201/eid2704.210026.

Fatal Case of Crimean-Congo Hemorrhagic Fever Caused by Reassortant Virus, Spain, 2018 [PDF - 1.10 MB - 5 pages]
A. Negredo et al.

In August 2018, a fatal autochthonous case of Crimean-Congo hemorrhagic fever was confirmed in western Spain. The complete sequence of the viral genome revealed circulation of a new virus because the genotype differs from that of the virus responsible for another case in 2016. Practitioners should be alert to possible new cases.

EID Negredo A, Sánchez-Arroyo R, Díez-Fuertes F, de Ory F, Budiño M, Vázquez A, et al. Fatal Case of Crimean-Congo Hemorrhagic Fever Caused by Reassortant Virus, Spain, 2018. Emerg Infect Dis. 2021;27(4):1211-1215. https://doi.org/10.3201/eid2704.203462
AMA Negredo A, Sánchez-Arroyo R, Díez-Fuertes F, et al. Fatal Case of Crimean-Congo Hemorrhagic Fever Caused by Reassortant Virus, Spain, 2018. Emerging Infectious Diseases. 2021;27(4):1211-1215. doi:10.3201/eid2704.203462.
APA Negredo, A., Sánchez-Arroyo, R., Díez-Fuertes, F., de Ory, F., Budiño, M., Vázquez, A....Sánchez-Seco, P. (2021). Fatal Case of Crimean-Congo Hemorrhagic Fever Caused by Reassortant Virus, Spain, 2018. Emerging Infectious Diseases, 27(4), 1211-1215. https://doi.org/10.3201/eid2704.203462.

Stability of SARS-CoV-2 RNA in Nonsupplemented Saliva [PDF - 1.35 MB - 5 pages]
I. M. Ott et al.

The expense of saliva collection devices designed to stabilize severe acute respiratory syndrome coronavirus 2 RNA is prohibitive to mass testing. However, virus RNA in nonsupplemented saliva is stable for extended periods and at elevated temperatures. Simple plastic tubes for saliva collection will make large-scale testing and continued surveillance easier.

EID Ott IM, Strine MS, Watkins AE, Boot M, Kalinich CC, Harden CA, et al. Stability of SARS-CoV-2 RNA in Nonsupplemented Saliva. Emerg Infect Dis. 2021;27(4):1146-1150. https://doi.org/10.3201/eid2704.204199
AMA Ott IM, Strine MS, Watkins AE, et al. Stability of SARS-CoV-2 RNA in Nonsupplemented Saliva. Emerging Infectious Diseases. 2021;27(4):1146-1150. doi:10.3201/eid2704.204199.
APA Ott, I. M., Strine, M. S., Watkins, A. E., Boot, M., Kalinich, C. C., Harden, C. A....Wyllie, A. L. (2021). Stability of SARS-CoV-2 RNA in Nonsupplemented Saliva. Emerging Infectious Diseases, 27(4), 1146-1150. https://doi.org/10.3201/eid2704.204199.

Increased SARS-CoV-2 Testing Capacity with Pooled Saliva Samples [PDF - 1.75 MB - 4 pages]
A. E. Watkins et al.

We analyzed feasibility of pooling saliva samples for severe acute respiratory syndrome coronavirus 2 testing and found that sensitivity decreased according to pool size: 5 samples/pool, 7.4% reduction; 10 samples/pool, 11.1%; and 20 samples/pool, 14.8%. When virus prevalence is >2.6%, pools of 5 require fewer tests; when <0.6%, pools of 20 support screening strategies.


Persistence of SARS-CoV-2 N-Antibody Response in Healthcare Workers, London, UK [PDF - 1.52 MB - 4 pages]
M. Shrotri et al.

Prospective serosurveillance of severe acute respiratory syndrome coronavirus 2 in 1,069 healthcare workers in London, UK, demonstrated that nucleocapsid antibody titers were stable and sustained for <12 weeks in 312 seropositive participants. This finding was consistent across demographic and clinical variables and contrasts with reports of short-term antibody waning.

EID Shrotri M, Harris RJ, Rodger A, Planche T, Sanderson F, Mahungu T, et al. Persistence of SARS-CoV-2 N-Antibody Response in Healthcare Workers, London, UK. Emerg Infect Dis. 2021;27(4):1155-1158. https://doi.org/10.3201/eid2704.204554
AMA Shrotri M, Harris RJ, Rodger A, et al. Persistence of SARS-CoV-2 N-Antibody Response in Healthcare Workers, London, UK. Emerging Infectious Diseases. 2021;27(4):1155-1158. doi:10.3201/eid2704.204554.
APA Shrotri, M., Harris, R. J., Rodger, A., Planche, T., Sanderson, F., Mahungu, T....Chand, M. (2021). Persistence of SARS-CoV-2 N-Antibody Response in Healthcare Workers, London, UK. Emerging Infectious Diseases, 27(4), 1155-1158. https://doi.org/10.3201/eid2704.204554.

Highly Pathogenic Avian Influenza Clade 2.3.4.4 Subtype H5N6 Viruses Isolated from Wild Whooper Swans, Mongolia, 2020 [PDF - 769 KB - 3 pages]
S. Jeong et al.

We identified clade 2.3.4.4 highly pathogenic avian influenza A(H5N6) viruses from whooper swans (Cygnus cygnus) found dead in Mongolia. The identification of these infections in wild birds in this area is of concern because of the potential for virus dissemination during fall migration.

EID Jeong S, Otgontogtokh N, Lee D, Davganyam B, Lee S, Cho AY, et al. Highly Pathogenic Avian Influenza Clade 2.3.4.4 Subtype H5N6 Viruses Isolated from Wild Whooper Swans, Mongolia, 2020. Emerg Infect Dis. 2021;27(4):1181-1183. https://doi.org/10.3201/eid2704.203859
AMA Jeong S, Otgontogtokh N, Lee D, et al. Highly Pathogenic Avian Influenza Clade 2.3.4.4 Subtype H5N6 Viruses Isolated from Wild Whooper Swans, Mongolia, 2020. Emerging Infectious Diseases. 2021;27(4):1181-1183. doi:10.3201/eid2704.203859.
APA Jeong, S., Otgontogtokh, N., Lee, D., Davganyam, B., Lee, S., Cho, A. Y....Song, C. (2021). Highly Pathogenic Avian Influenza Clade 2.3.4.4 Subtype H5N6 Viruses Isolated from Wild Whooper Swans, Mongolia, 2020. Emerging Infectious Diseases, 27(4), 1181-1183. https://doi.org/10.3201/eid2704.203859.

Low-Level Middle East Respiratory Syndrome Coronavirus among Camel Handlers, Kenya, 2019 [PDF - 1.55 MB - 5 pages]
P. M. Munyua et al.

Although seroprevalence of Middle East respiratory coronavirus syndrome is high among camels in Africa, researchers have not detected zoonotic transmission in Kenya. We followed a cohort of 262 camel handlers in Kenya during April 2018–March 2020. We report PCR-confirmed Middle East respiratory coronavirus syndrome in 3 asymptomatic handlers.

EID Munyua PM, Ngere I, Hunsperger E, Kochi A, Amoth P, Mwasi L, et al. Low-Level Middle East Respiratory Syndrome Coronavirus among Camel Handlers, Kenya, 2019. Emerg Infect Dis. 2021;27(4):1201-1205. https://doi.org/10.3201/eid2704.204458
AMA Munyua PM, Ngere I, Hunsperger E, et al. Low-Level Middle East Respiratory Syndrome Coronavirus among Camel Handlers, Kenya, 2019. Emerging Infectious Diseases. 2021;27(4):1201-1205. doi:10.3201/eid2704.204458.
APA Munyua, P. M., Ngere, I., Hunsperger, E., Kochi, A., Amoth, P., Mwasi, L....Njenga, M. (2021). Low-Level Middle East Respiratory Syndrome Coronavirus among Camel Handlers, Kenya, 2019. Emerging Infectious Diseases, 27(4), 1201-1205. https://doi.org/10.3201/eid2704.204458.

Emergence and Polyclonal Dissemination of OXA-244–Producing Escherichia coli, France [PDF - 2.67 MB - 5 pages]
C. Emeraud et al.

Since 2016, OXA-244–producing Escherichia coli has been increasingly isolated in France. We sequenced 97 OXA-244–producing E. coli isolates and found a wide diversity of sequence types and a high prevalence of sequence type 38. Long-read sequencing demonstrated the chromosomal location of blaOXA-244 inside the entire or truncated Tn51098.

EID Emeraud C, Girlich D, Bonnin RA, Jousset AB, Naas T, Dortet L. Emergence and Polyclonal Dissemination of OXA-244–Producing Escherichia coli, France. Emerg Infect Dis. 2021;27(4):1206-1210. https://doi.org/10.3201/eid2704.204459
AMA Emeraud C, Girlich D, Bonnin RA, et al. Emergence and Polyclonal Dissemination of OXA-244–Producing Escherichia coli, France. Emerging Infectious Diseases. 2021;27(4):1206-1210. doi:10.3201/eid2704.204459.
APA Emeraud, C., Girlich, D., Bonnin, R. A., Jousset, A. B., Naas, T., & Dortet, L. (2021). Emergence and Polyclonal Dissemination of OXA-244–Producing Escherichia coli, France. Emerging Infectious Diseases, 27(4), 1206-1210. https://doi.org/10.3201/eid2704.204459.

Analysis of Asymptomatic and Presymptomatic Transmission in SARS-CoV-2 Outbreak, Germany, 2020 [PDF - 2.67 MB - 5 pages]
J. K. Bender et al.

We determined secondary attack rates (SAR) among close contacts of 59 asymptomatic and symptomatic coronavirus disease case-patients by presymptomatic and symptomatic exposure. We observed no transmission from asymptomatic case-patients and highest SAR through presymptomatic exposure. Rapid quarantine of close contacts with or without symptoms is needed to prevent presymptomatic transmission.


Eastern Equine Encephalitis Virus in Mexican Wolf Pups at Zoo, Michigan, USA [PDF - 1.43 MB - 4 pages]
K. A. Thompson et al.

During the 2019 Eastern equine encephalitis virus (EEEV) outbreak in Michigan, two 2-month old Mexican wolf pups experienced neurologic signs, lymphohistiocytic neutrophilic meningoencephalitis with neuronal necrosis and neuronophagia, and acute death. We identified EEEV by reverse transcription real-time PCR and in situ hybridization. Vector mosquitoes were trapped at the zoo.

EID Thompson KA, Henderson E, Fitzgerald SD, Walker ED, Kiupel M. Eastern Equine Encephalitis Virus in Mexican Wolf Pups at Zoo, Michigan, USA. Emerg Infect Dis. 2021;27(4):1173-1176. https://doi.org/10.3201/eid2704.202400
AMA Thompson KA, Henderson E, Fitzgerald SD, et al. Eastern Equine Encephalitis Virus in Mexican Wolf Pups at Zoo, Michigan, USA. Emerging Infectious Diseases. 2021;27(4):1173-1176. doi:10.3201/eid2704.202400.
APA Thompson, K. A., Henderson, E., Fitzgerald, S. D., Walker, E. D., & Kiupel, M. (2021). Eastern Equine Encephalitis Virus in Mexican Wolf Pups at Zoo, Michigan, USA. Emerging Infectious Diseases, 27(4), 1173-1176. https://doi.org/10.3201/eid2704.202400.

Genomic Characterizations of Clade III Lineage of Candida auris, California, USA [PDF - 1.40 MB - 5 pages]
T. K. Price et al.

Candida auris is an emerging multidrug-resistant yeast. We describe an ongoing C. auris outbreak that began in October 2019 in Los Angeles, California, USA. We used genomic analysis to determine that isolates from 5 of 6 patients belonged to clade III; 4 isolates were closely related.

EID Price TK, Mirasol R, Ward KW, Dayo AJ, Hilt EE, Chandrasekaran S, et al. Genomic Characterizations of Clade III Lineage of Candida auris, California, USA. Emerg Infect Dis. 2021;27(4):1223-1227. https://doi.org/10.3201/eid2704.204361
AMA Price TK, Mirasol R, Ward KW, et al. Genomic Characterizations of Clade III Lineage of Candida auris, California, USA. Emerging Infectious Diseases. 2021;27(4):1223-1227. doi:10.3201/eid2704.204361.
APA Price, T. K., Mirasol, R., Ward, K. W., Dayo, A. J., Hilt, E. E., Chandrasekaran, S....Yang, S. (2021). Genomic Characterizations of Clade III Lineage of Candida auris, California, USA. Emerging Infectious Diseases, 27(4), 1223-1227. https://doi.org/10.3201/eid2704.204361.
Research Letters

Increased Likelihood of Detecting Ebola Virus RNA in Semen by Using Sample Pelleting [PDF - 686 KB - 3 pages]
C. M. Bozman et al.

Ebola virus RNA can reside for months or years in semen of survivors of Ebola virus disease and is probably associated with increased risk for cryptic sexual transmission of the virus. A modified protocol resulted in increased detection of Ebola virus RNA in semen and improved disease surveillance.

EID Bozman CM, Fallah M, Sneller MC, Freeman C, Fakoli LS, Shobayo BI, et al. Increased Likelihood of Detecting Ebola Virus RNA in Semen by Using Sample Pelleting. Emerg Infect Dis. 2021;27(4):1239-1241. https://doi.org/10.3201/eid2704.204175
AMA Bozman CM, Fallah M, Sneller MC, et al. Increased Likelihood of Detecting Ebola Virus RNA in Semen by Using Sample Pelleting. Emerging Infectious Diseases. 2021;27(4):1239-1241. doi:10.3201/eid2704.204175.
APA Bozman, C. M., Fallah, M., Sneller, M. C., Freeman, C., Fakoli, L. S., Shobayo, B. I....Hensley, L. E. (2021). Increased Likelihood of Detecting Ebola Virus RNA in Semen by Using Sample Pelleting. Emerging Infectious Diseases, 27(4), 1239-1241. https://doi.org/10.3201/eid2704.204175.

Experimental SARS-CoV-2 Infection of Bank Voles [PDF - 1.02 MB - 3 pages]
L. Ulrich et al.

After experimental inoculation, severe acute respiratory syndrome coronavirus 2 infection was confirmed in bank voles by seroconversion within 8 days and detection of viral RNA in nasal tissue for up to 21 days. However, transmission to contact animals was not detected. Thus, bank voles are unlikely to establish effective transmission cycles in nature.

EID Ulrich L, Michelitsch A, Halwe N, Wernike K, Hoffmann D, Beer M. Experimental SARS-CoV-2 Infection of Bank Voles. Emerg Infect Dis. 2021;27(4):1193-1195. https://doi.org/10.3201/eid2704.204945
AMA Ulrich L, Michelitsch A, Halwe N, et al. Experimental SARS-CoV-2 Infection of Bank Voles. Emerging Infectious Diseases. 2021;27(4):1193-1195. doi:10.3201/eid2704.204945.
APA Ulrich, L., Michelitsch, A., Halwe, N., Wernike, K., Hoffmann, D., & Beer, M. (2021). Experimental SARS-CoV-2 Infection of Bank Voles. Emerging Infectious Diseases, 27(4), 1193-1195. https://doi.org/10.3201/eid2704.204945.

Inguinal Ulceroglandular Tularemia Caused by Francisella tularensis Subspecies holarctica, Canada [PDF - 666 KB - 2 pages]
C. Boodman et al.

Tularemia is a zoonotic disease caused by the gram-negative coccobacillus Francisella tularensis, a Biosafety Level 3 pathogen and potential agent of bioterrorism. We describe 2 cases of perigenital ulcer disease caused by Francisella tularensis subspecies holarctica in Manitoba, Canada. These cases caused inadvertent exposure among laboratory personnel.

EID Boodman C, Richert Q, Lother S, Kasper K, Fanella S, Lagacé-Wiens P, et al. Inguinal Ulceroglandular Tularemia Caused by Francisella tularensis Subspecies holarctica, Canada. Emerg Infect Dis. 2021;27(4):1228-1229. https://doi.org/10.3201/eid2704.203262
AMA Boodman C, Richert Q, Lother S, et al. Inguinal Ulceroglandular Tularemia Caused by Francisella tularensis Subspecies holarctica, Canada. Emerging Infectious Diseases. 2021;27(4):1228-1229. doi:10.3201/eid2704.203262.
APA Boodman, C., Richert, Q., Lother, S., Kasper, K., Fanella, S., Lagacé-Wiens, P....Keynan, Y. (2021). Inguinal Ulceroglandular Tularemia Caused by Francisella tularensis Subspecies holarctica, Canada. Emerging Infectious Diseases, 27(4), 1228-1229. https://doi.org/10.3201/eid2704.203262.

Risk for Fomite-Mediated Transmission of SARS-CoV-2 in Child Daycares, Schools, Nursing Homes, and Offices [PDF - 1.02 MB - 3 pages]
A. Kraay et al.

Severe acute respiratory syndrome coronavirus 2 can persist on surfaces, suggesting possible surface-mediated transmission of this pathogen. We found that fomites might be a substantial source of transmission risk, particularly in schools and child daycares. Combining surface cleaning and decontamination with mask wearing can help mitigate this risk.

EID Kraay A, Hayashi M, Berendes DM, Sobolik JS, Leon JS, Lopman BA. Risk for Fomite-Mediated Transmission of SARS-CoV-2 in Child Daycares, Schools, Nursing Homes, and Offices. Emerg Infect Dis. 2021;27(4):1229-1231. https://doi.org/10.3201/eid2704.203631
AMA Kraay A, Hayashi M, Berendes DM, et al. Risk for Fomite-Mediated Transmission of SARS-CoV-2 in Child Daycares, Schools, Nursing Homes, and Offices. Emerging Infectious Diseases. 2021;27(4):1229-1231. doi:10.3201/eid2704.203631.
APA Kraay, A., Hayashi, M., Berendes, D. M., Sobolik, J. S., Leon, J. S., & Lopman, B. A. (2021). Risk for Fomite-Mediated Transmission of SARS-CoV-2 in Child Daycares, Schools, Nursing Homes, and Offices. Emerging Infectious Diseases, 27(4), 1229-1231. https://doi.org/10.3201/eid2704.203631.

Novel SARS-CoV-2 Variant in Travelers from Brazil to Japan [PDF - 656 KB - 3 pages]
T. Fujino et al.

Multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with higher transmission potential have been emerging globally, including SARS-CoV-2 variants from the United Kingdom and South Africa. We report 4 travelers from Brazil to Japan in January 2021 infected with a novel SARS-CoV-2 variant with an additional set of mutations.


Imported SARS-CoV-2 Variant P.1 in Traveler Returning from Brazil to Italy [PDF - 812 KB - 3 pages]
F. Maggi et al.

We report an imported case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant P.1 detected in an asymptomatic traveler who arrived in Italy on an indirect flight from Brazil. This case shows the risk for introduction of SARS-CoV-2 variants from indirect flights and the need for continued SARS-CoV-2 surveillance.

EID Maggi F, Novazzi F, Genoni A, Baj A, Spezia P, Focosi D, et al. Imported SARS-CoV-2 Variant P.1 in Traveler Returning from Brazil to Italy. Emerg Infect Dis. 2021;27(4):1249-1251. https://doi.org/10.3201/eid2704.210183
AMA Maggi F, Novazzi F, Genoni A, et al. Imported SARS-CoV-2 Variant P.1 in Traveler Returning from Brazil to Italy. Emerging Infectious Diseases. 2021;27(4):1249-1251. doi:10.3201/eid2704.210183.
APA Maggi, F., Novazzi, F., Genoni, A., Baj, A., Spezia, P., Focosi, D....Bonelli, G. (2021). Imported SARS-CoV-2 Variant P.1 in Traveler Returning from Brazil to Italy. Emerging Infectious Diseases, 27(4), 1249-1251. https://doi.org/10.3201/eid2704.210183.

Rapid Spread and Control of Multidrug-Resistant Gram-Negative Bacteria in COVID-19 Patient Care Units [PDF - 1013 KB - 4 pages]
A. Patel et al.

We describe rapid spread of multidrug-resistant gram-negative bacteria among patients in dedicated coronavirus disease care units in a hospital in Maryland, USA, during May–June 2020. Critical illness, high antibiotic use, double occupancy of single rooms, and modified infection prevention practices were key contributing factors. Surveillance culturing aided in outbreak recognition and control.

EID Patel A, Emerick M, Cabunoc MK, Williams MH, Preas M, Schrank G, et al. Rapid Spread and Control of Multidrug-Resistant Gram-Negative Bacteria in COVID-19 Patient Care Units. Emerg Infect Dis. 2021;27(4):1234-1237. https://doi.org/10.3201/eid2704.204036
AMA Patel A, Emerick M, Cabunoc MK, et al. Rapid Spread and Control of Multidrug-Resistant Gram-Negative Bacteria in COVID-19 Patient Care Units. Emerging Infectious Diseases. 2021;27(4):1234-1237. doi:10.3201/eid2704.204036.
APA Patel, A., Emerick, M., Cabunoc, M. K., Williams, M. H., Preas, M., Schrank, G....Leekha, S. (2021). Rapid Spread and Control of Multidrug-Resistant Gram-Negative Bacteria in COVID-19 Patient Care Units. Emerging Infectious Diseases, 27(4), 1234-1237. https://doi.org/10.3201/eid2704.204036.

Polyresistant Mycobacterium bovis Infection in Human and Sympatric Sheep, Spain, 2017–2018 [PDF - 789 KB - 3 pages]
B. de Val et al.

The main etiologic agent of tuberculosis (TB) in livestock is Mycobacterium bovis; human TB cases caused by M. bovis are rare. Analysis of a TB outbreak caused by polyresistant M. bovis involving a human and sympatric sheep in Spain suggests local circulation of drug-resistant M. bovis strains among livestock.

EID de Val B, Romero B, Tórtola M, León L, Pozo P, Mercader I, et al. Polyresistant Mycobacterium bovis Infection in Human and Sympatric Sheep, Spain, 2017–2018. Emerg Infect Dis. 2021;27(4):1241-1243. https://doi.org/10.3201/eid2704.204467
AMA de Val B, Romero B, Tórtola M, et al. Polyresistant Mycobacterium bovis Infection in Human and Sympatric Sheep, Spain, 2017–2018. Emerging Infectious Diseases. 2021;27(4):1241-1243. doi:10.3201/eid2704.204467.
APA de Val, B., Romero, B., Tórtola, M., León, L., Pozo, P., Mercader, I....Vidal, E. (2021). Polyresistant Mycobacterium bovis Infection in Human and Sympatric Sheep, Spain, 2017–2018. Emerging Infectious Diseases, 27(4), 1241-1243. https://doi.org/10.3201/eid2704.204467.

Tula Virus as Causative Agent of Hantavirus Disease in Immunocompetent Person, Germany [PDF - 743 KB - 3 pages]
J. Hofmann et al.

We report molecular evidence of Tula virus infection in an immunocompetent patient from Germany who had typical signs of hantavirus disease. Accumulating evidence indicates that Tula virus infection, although often considered nonpathogenic, represents a threat to human health.

EID Hofmann J, Kramer S, Herrlinger KR, Jeske K, Kuhns M, Weiss S, et al. Tula Virus as Causative Agent of Hantavirus Disease in Immunocompetent Person, Germany. Emerg Infect Dis. 2021;27(4):1234-1237. https://doi.org/10.3201/eid2704.203996
AMA Hofmann J, Kramer S, Herrlinger KR, et al. Tula Virus as Causative Agent of Hantavirus Disease in Immunocompetent Person, Germany. Emerging Infectious Diseases. 2021;27(4):1234-1237. doi:10.3201/eid2704.203996.
APA Hofmann, J., Kramer, S., Herrlinger, K. R., Jeske, K., Kuhns, M., Weiss, S....Krüger, D. H. (2021). Tula Virus as Causative Agent of Hantavirus Disease in Immunocompetent Person, Germany. Emerging Infectious Diseases, 27(4), 1234-1237. https://doi.org/10.3201/eid2704.203996.

Cetacean Morbillivirus and Toxoplasma gondii Co-infection in Mediterranean Monk Seal Pup, Italy [PDF - 1.13 MB - 3 pages]
A. Petrella et al.

A Mediterranean monk seal (Monachus monachus) pup from the southern Adriatic coast of Italy showed cetacean morbillivirus (CeMV) and disseminated Toxoplasma gondii co-infection, which probably resulted from CeMV-induced immunosuppression. These findings are of concern for the conservation of this critically endangered species.

EID Petrella A, Mazzariol S, Padalino I, Di Francesco G, Casalone C, Grattarola C, et al. Cetacean Morbillivirus and Toxoplasma gondii Co-infection in Mediterranean Monk Seal Pup, Italy. Emerg Infect Dis. 2021;27(4):1237-1239. https://doi.org/10.3201/eid2704.204131
AMA Petrella A, Mazzariol S, Padalino I, et al. Cetacean Morbillivirus and Toxoplasma gondii Co-infection in Mediterranean Monk Seal Pup, Italy. Emerging Infectious Diseases. 2021;27(4):1237-1239. doi:10.3201/eid2704.204131.
APA Petrella, A., Mazzariol, S., Padalino, I., Di Francesco, G., Casalone, C., Grattarola, C....Gili, C. (2021). Cetacean Morbillivirus and Toxoplasma gondii Co-infection in Mediterranean Monk Seal Pup, Italy. Emerging Infectious Diseases, 27(4), 1237-1239. https://doi.org/10.3201/eid2704.204131.

Isolation of Rickettsia rickettsii in Rocky Mountain Spotted Fever Outbreak, Panama [PDF - 660 KB - 3 pages]
Y. Zaldívar et al.

We report new cases of Rocky Mountain spotted fever in patients from Kinkantu, Ngäbe-Bugle indigenous comarca, Panama. We isolated Rickettsia rickettsii in cell culture after intraperitoneal inoculation of guinea pigs with tissues from a deceased patient. Our results indicate that Rocky Mountain spotted fever is emerging in this region.

EID Zaldívar Y, Hernández M, Domínguez L, Saénz L, Montilla S, de Antinori M, et al. Isolation of Rickettsia rickettsii in Rocky Mountain Spotted Fever Outbreak, Panama. Emerg Infect Dis. 2021;27(4):1245-1247. https://doi.org/10.3201/eid2704.201606
AMA Zaldívar Y, Hernández M, Domínguez L, et al. Isolation of Rickettsia rickettsii in Rocky Mountain Spotted Fever Outbreak, Panama. Emerging Infectious Diseases. 2021;27(4):1245-1247. doi:10.3201/eid2704.201606.
APA Zaldívar, Y., Hernández, M., Domínguez, L., Saénz, L., Montilla, S., de Antinori, M....Bermúdez, S. (2021). Isolation of Rickettsia rickettsii in Rocky Mountain Spotted Fever Outbreak, Panama. Emerging Infectious Diseases, 27(4), 1245-1247. https://doi.org/10.3201/eid2704.201606.

Co-infection with Severe Fever with Thrombocytopenia Syndrome Virus and Rickettsia japonica after Tick Bite, Japan [PDF - 906 KB - 3 pages]
T. Fujikawa et al.

Severe fever with thrombocytopenia syndrome was diagnosed in a febrile woman in Japan after a tick bite. However, Rickettsia japonica DNA was retrospectively detected in the eschar specimen, suggesting co-infection from the bite. Establishment of the severe fever with thrombocytopenia syndrome virus infection might have overpowered the R. japonica infection.

EID Fujikawa T, Yoshikawa T, Kurosu T, Shimojima M, Saijo M, Yokota K. Co-infection with Severe Fever with Thrombocytopenia Syndrome Virus and Rickettsia japonica after Tick Bite, Japan. Emerg Infect Dis. 2021;27(4):1247-1249. https://doi.org/10.3201/eid2704.203610
AMA Fujikawa T, Yoshikawa T, Kurosu T, et al. Co-infection with Severe Fever with Thrombocytopenia Syndrome Virus and Rickettsia japonica after Tick Bite, Japan. Emerging Infectious Diseases. 2021;27(4):1247-1249. doi:10.3201/eid2704.203610.
APA Fujikawa, T., Yoshikawa, T., Kurosu, T., Shimojima, M., Saijo, M., & Yokota, K. (2021). Co-infection with Severe Fever with Thrombocytopenia Syndrome Virus and Rickettsia japonica after Tick Bite, Japan. Emerging Infectious Diseases, 27(4), 1247-1249. https://doi.org/10.3201/eid2704.203610.
Books and Media

Understanding Coronavirus [PDF - 707 KB - 1 page]
X. Yin and N. M. Hackman
EID Yin X, Hackman NM. Understanding Coronavirus. Emerg Infect Dis. 2021;27(4):1252. https://doi.org/10.3201/eid2704.210152
AMA Yin X, Hackman NM. Understanding Coronavirus. Emerging Infectious Diseases. 2021;27(4):1252. doi:10.3201/eid2704.210152.
APA Yin, X., & Hackman, N. M. (2021). Understanding Coronavirus. Emerging Infectious Diseases, 27(4), 1252. https://doi.org/10.3201/eid2704.210152.
About the Cover

An Interesting and Horribly Wondrous Sight [PDF - 1.40 MB - 2 pages]
B. Breedlove
EID Breedlove B. An Interesting and Horribly Wondrous Sight. Emerg Infect Dis. 2021;27(4):1253-1254. https://doi.org/10.3201/eid2704.ac2704
AMA Breedlove B. An Interesting and Horribly Wondrous Sight. Emerging Infectious Diseases. 2021;27(4):1253-1254. doi:10.3201/eid2704.ac2704.
APA Breedlove, B. (2021). An Interesting and Horribly Wondrous Sight. Emerging Infectious Diseases, 27(4), 1253-1254. https://doi.org/10.3201/eid2704.ac2704.
Etymologia

Etymologia: Treponema [PDF - 1002 KB - 1 page]
F. C. Pogliani and R. D. Ollhoff
EID Pogliani FC, Ollhoff RD. Etymologia: Treponema. Emerg Infect Dis. 2021;27(4):1006. https://doi.org/10.3201/eid2704.et2704
AMA Pogliani FC, Ollhoff RD. Etymologia: Treponema. Emerging Infectious Diseases. 2021;27(4):1006. doi:10.3201/eid2704.et2704.
APA Pogliani, F. C., & Ollhoff, R. D. (2021). Etymologia: Treponema. Emerging Infectious Diseases, 27(4), 1006. https://doi.org/10.3201/eid2704.et2704.
Page created: March 11, 2021
Page updated: April 06, 2021
Page reviewed: April 06, 2021
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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