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Issue Cover for Volume 27, Number 6—June 2021

Volume 27, Number 6—June 2021

[PDF - 10.86 MB - 222 pages]

Perspective

Reflections on 40 Years of AIDS [PDF - 698 KB - 8 pages]
K. M. De Cock et al.

June 2021 marks the 40th anniversary of the first description of AIDS. On the 30th anniversary, we defined priorities as improving use of existing interventions, clarifying optimal use of HIV testing and antiretroviral therapy for prevention and treatment, continuing research, and ensuring sustainability of the response. Despite scientific and programmatic progress, the end of AIDS is not in sight. Other major epidemics over the past decade have included Ebola, arbovirus infections, and coronavirus disease (COVID-19). A benchmark against which to compare other global interventions is the HIV/AIDS response in terms of funding, coordination, and solidarity. Lessons from Ebola and HIV/AIDS are pertinent to the COVID-19 response. The fifth decade of AIDS will have to position HIV/AIDS in the context of enhanced preparedness and capacity to respond to other potential pandemics and transnational health threats.

EID De Cock KM, Jaffe HW, Curran JW. Reflections on 40 Years of AIDS. Emerg Infect Dis. 2021;27(6):1553-1560. https://doi.org/10.3201/eid2706.210284
AMA De Cock KM, Jaffe HW, Curran JW. Reflections on 40 Years of AIDS. Emerging Infectious Diseases. 2021;27(6):1553-1560. doi:10.3201/eid2706.210284.
APA De Cock, K. M., Jaffe, H. W., & Curran, J. W. (2021). Reflections on 40 Years of AIDS. Emerging Infectious Diseases, 27(6), 1553-1560. https://doi.org/10.3201/eid2706.210284.
Synopses

Pertactin-Deficient Bordetella pertussis, Vaccine-Driven Evolution, and Reemergence of Pertussis [PDF - 1.04 MB - 6 pages]
L. Ma et al.

Recent reemergence of pertussis (whooping cough) in highly vaccinated populations and rapid expansion of Bordetella pertussis strains lacking pertactin (PRN), a common acellular vaccine antigen, have raised the specter of vaccine-driven evolution and potential return of what was once the major killer of children. The discovery that most circulating B. pertussis strains in the United States have acquired new and independent disruptive mutations in PRN is compelling evidence of strong selective pressure. However, the other 4 antigens included in acellular vaccines do not appear to be selected against so rapidly. We consider 3 aspects of PRN that distinguish it from other vaccine antigens, which might, individually or collectively, explain why only this antigen is being precipitously eliminated. An understanding of the increase in PRN-deficient strains should provide useful information for the current search for new protective antigens and provide broader lessons for the design of improved subunit vaccines.

EID Ma L, Caulfield A, Dewan KK, Harvill ET. Pertactin-Deficient Bordetella pertussis, Vaccine-Driven Evolution, and Reemergence of Pertussis. Emerg Infect Dis. 2021;27(6):1561-1566. https://doi.org/10.3201/eid2706.203850
AMA Ma L, Caulfield A, Dewan KK, et al. Pertactin-Deficient Bordetella pertussis, Vaccine-Driven Evolution, and Reemergence of Pertussis. Emerging Infectious Diseases. 2021;27(6):1561-1566. doi:10.3201/eid2706.203850.
APA Ma, L., Caulfield, A., Dewan, K. K., & Harvill, E. T. (2021). Pertactin-Deficient Bordetella pertussis, Vaccine-Driven Evolution, and Reemergence of Pertussis. Emerging Infectious Diseases, 27(6), 1561-1566. https://doi.org/10.3201/eid2706.203850.

Medscape CME Activity
Rocky Mountain Spotted Fever in a Large Metropolitan Center, Mexico–United States Border, 2009–2019 [PDF - 1.68 MB - 10 pages]
O. E. Zazueta et al.

Epidemic levels of Rocky Mountain spotted fe­­­ver (RMSF) have persisted in Mexicali, Mexico, since the initial outbreak was first reported in December 2008. We compared clinical and epidemiologic data of cases in Mexicali during 2009–2019 between patients with an IgG titer reactive with Rickettsia rickettsii bacteria by indirect immunofluorescence antibody (IFA) assay and those who demonstrated DNA of R. rickettsii in a whole blood sample when tested by PCR. We identified 4,290 patients with clinical and epidemiologic features compatible with RMSF; of these, 9.74% tested positive by IFA and 8.41% by PCR. Overall, 140 patients died (11-year case-fatality rate 17.97%). Substantial differences in the frequency of commonly recognized clinical characteristics of RMSF were identified between PCR-positive and IFA-positive cases. The Mexicali epidemic is unique in its size and urban centralization. Cases confirmed by PCR most accurately reflect the clinical profile of RMSF.

EID Zazueta OE, Armstrong PA, Márquez-Elguea A, Hernández Milán N, Peterson AE, Ovalle-Marroquín DF, et al. Rocky Mountain Spotted Fever in a Large Metropolitan Center, Mexico–United States Border, 2009–2019. Emerg Infect Dis. 2021;27(6):1567-1576. https://doi.org/10.3201/eid2706.191662
AMA Zazueta OE, Armstrong PA, Márquez-Elguea A, et al. Rocky Mountain Spotted Fever in a Large Metropolitan Center, Mexico–United States Border, 2009–2019. Emerging Infectious Diseases. 2021;27(6):1567-1576. doi:10.3201/eid2706.191662.
APA Zazueta, O. E., Armstrong, P. A., Márquez-Elguea, A., Hernández Milán, N., Peterson, A. E., Ovalle-Marroquín, D. F....Paddock, C. D. (2021). Rocky Mountain Spotted Fever in a Large Metropolitan Center, Mexico–United States Border, 2009–2019. Emerging Infectious Diseases, 27(6), 1567-1576. https://doi.org/10.3201/eid2706.191662.
Research

Medscape CME Activity
Neurologic Disease after Yellow Fever Vaccination, São Paulo, Brazil, 2017–2018 [PDF - 1.40 MB - 11 pages]
A. Ribeiro et al.

Yellow fever (YF) vaccine can cause neurologic complications. We examined YF vaccine–associated neurologic disease reported from 3 tertiary referral centers in São Paulo, Brazil, during 2017–2018 and compared the performance of criteria established by the Yellow Fever Vaccine Working Group/Centers for Disease Control and Prevention and the Brighton Collaboration. Among 50 patients who met inclusion criteria, 32 had meningoencephalitis (14 with reactive YF IgM in cerebrospinal fluid), 2 died, and 1 may have transmitted infection to an infant through breast milk. Of 7 cases of autoimmune neurologic disease after YF vaccination, 2 were acute disseminated encephalomyelitis, 2 myelitis, and 3 Guillain-Barré syndrome. Neurologic disease can follow fractional vaccine doses, and novel potential vaccine-associated syndromes include autoimmune encephalitis, opsoclonus-myoclonus-ataxia syndrome, optic neuritis, and ataxia. Although the Brighton Collaboration criteria lack direct vaccine causal assessment, they are more inclusive than the Centers for Disease Control and Prevention criteria.

EID Ribeiro A, Guedes B, Sulleiman J, de Oliveira F, de Souza I, Nogueira J, et al. Neurologic Disease after Yellow Fever Vaccination, São Paulo, Brazil, 2017–2018. Emerg Infect Dis. 2021;27(6):1577-1587. https://doi.org/10.3201/eid2706.204170
AMA Ribeiro A, Guedes B, Sulleiman J, et al. Neurologic Disease after Yellow Fever Vaccination, São Paulo, Brazil, 2017–2018. Emerging Infectious Diseases. 2021;27(6):1577-1587. doi:10.3201/eid2706.204170.
APA Ribeiro, A., Guedes, B., Sulleiman, J., de Oliveira, F., de Souza, I., Nogueira, J....de Oliveira, A. (2021). Neurologic Disease after Yellow Fever Vaccination, São Paulo, Brazil, 2017–2018. Emerging Infectious Diseases, 27(6), 1577-1587. https://doi.org/10.3201/eid2706.204170.

Macrolide-Resistant Mycoplasma pneumoniae Infections in Children, Ohio, USA [PDF - 1.81 MB - 10 pages]
M. M. Lanata et al.

Emergence of macrolide-resistant Mycoplasma pneumoniae (MRMp) challenges empiric macrolide therapy. Our goal was to determine MRMp rates and define characteristics of children infected with macrolide-sensitive M. pneumoniae (MSMp) versus MRMp in Ohio, USA. We cultured PCR-positive M. pneumoniae specimens and sequenced M. pneumoniae–positive cultures to detect macrolide resistance mutations. We reviewed medical records to compare characteristics of both groups. We identified 14 (2.8%) MRMp and 485 (97.2%) MSMp samples. Patients in these groups had similar demographics and clinical characteristics, but patients with MRMp had longer hospitalizations, were more likely to have received previous macrolides, and were more likely to have switched to alternative antimicrobial drugs. MRMp-infected patients also had ≈5-fold greater odds of pediatric intensive care unit admission. Rates of MRMp infections in children in central Ohio are low, but clinicians should remain aware of the risk for severe illness caused by these pathogens.

EID Lanata MM, Wang H, Everhart K, Moore-Clingenpeel M, Ramilo O, Leber A. Macrolide-Resistant Mycoplasma pneumoniae Infections in Children, Ohio, USA. Emerg Infect Dis. 2021;27(6):1588-1597. https://doi.org/10.3201/eid2706.203206
AMA Lanata MM, Wang H, Everhart K, et al. Macrolide-Resistant Mycoplasma pneumoniae Infections in Children, Ohio, USA. Emerging Infectious Diseases. 2021;27(6):1588-1597. doi:10.3201/eid2706.203206.
APA Lanata, M. M., Wang, H., Everhart, K., Moore-Clingenpeel, M., Ramilo, O., & Leber, A. (2021). Macrolide-Resistant Mycoplasma pneumoniae Infections in Children, Ohio, USA. Emerging Infectious Diseases, 27(6), 1588-1597. https://doi.org/10.3201/eid2706.203206.

Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 IgG in Juba, South Sudan, 2020 [PDF - 1006 KB - 9 pages]
K. E. Wiens et al.

Relatively few coronavirus disease cases and deaths have been reported from sub-Saharan Africa, although the extent of its spread remains unclear. During August 10–September 11, 2020, we recruited 2,214 participants for a representative household-based cross-sectional serosurvey in Juba, South Sudan. We found 22.3% of participants had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) receptor binding domain IgG titers above prepandemic levels. After accounting for waning antibody levels, age, and sex, we estimated that 38.3% (95% credible interval 31.8%–46.5%) of the population had been infected with SARS-CoV-2. At this rate, for each PCR–confirmed SARS-CoV-2 infection reported by the Ministry of Health, 103 (95% credible interval 86–126) infections would have been unreported, meaning SARS-CoV-2 has likely spread extensively within Juba. We also found differences in background reactivity in Juba compared with Boston, Massachusetts, USA, where the immunoassay was validated. Our findings underscore the need to validate serologic tests in sub-Saharan Africa populations.

EID Wiens KE, Mawien P, Rumunu J, Slater D, Jones FK, Moheed S, et al. Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 IgG in Juba, South Sudan, 2020. Emerg Infect Dis. 2021;27(6):1598-1606. https://doi.org/10.3201/eid2706.210568
AMA Wiens KE, Mawien P, Rumunu J, et al. Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 IgG in Juba, South Sudan, 2020. Emerging Infectious Diseases. 2021;27(6):1598-1606. doi:10.3201/eid2706.210568.
APA Wiens, K. E., Mawien, P., Rumunu, J., Slater, D., Jones, F. K., Moheed, S....Wamala, J. F. (2021). Seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 IgG in Juba, South Sudan, 2020. Emerging Infectious Diseases, 27(6), 1598-1606. https://doi.org/10.3201/eid2706.210568.

Medscape CME Activity
HIV Infection as Risk Factor for Death among Hospitalized Persons with Candidemia, South Africa, 2012–2017 [PDF - 1.02 MB - 9 pages]
N. P. Govender et al.

We determined the effect of HIV infection on deaths among persons >18 months of age with culture-confirmed candidemia at 29 sentinel hospitals in South Africa during 2012–2017. Of 1,040 case-patients with documented HIV status and in-hospital survival data, 426 (41%) were HIV-seropositive. The in-hospital case-fatality rate was 54% (228/426) for HIV-seropositive participants and 37% (230/614) for HIV-seronegative participants (crude odds ratio [OR] 1.92, 95% CI 1.50–2.47; p<0.001). After adjusting for relevant confounders (n = 907), mortality rates were 1.89 (95% CI 1.38–2.60) times higher among HIV-seropositive participants than HIV-seronegative participants (p<0.001). Compared with HIV-seronegative persons, the stratum-specific adjusted mortality OR was higher among HIV-seropositive persons not managed in intensive care units (OR 2.27, 95% CI 1.47–3.52; p<0.001) than among persons who were (OR 1.56, 95% CI 1.00–2.43; p = 0.05). Outcomes among HIV-seropositive persons with candidemia might be improved with intensive care.

EID Govender NP, Todd J, Nel J, Mer M, Karstaedt A, Cohen C. HIV Infection as Risk Factor for Death among Hospitalized Persons with Candidemia, South Africa, 2012–2017. Emerg Infect Dis. 2021;27(6):1607-1615. https://doi.org/10.3201/eid2706.210128
AMA Govender NP, Todd J, Nel J, et al. HIV Infection as Risk Factor for Death among Hospitalized Persons with Candidemia, South Africa, 2012–2017. Emerging Infectious Diseases. 2021;27(6):1607-1615. doi:10.3201/eid2706.210128.
APA Govender, N. P., Todd, J., Nel, J., Mer, M., Karstaedt, A., & Cohen, C. (2021). HIV Infection as Risk Factor for Death among Hospitalized Persons with Candidemia, South Africa, 2012–2017. Emerging Infectious Diseases, 27(6), 1607-1615. https://doi.org/10.3201/eid2706.210128.

Molecular Epidemiology and Evolutionary Trajectory of Emerging Echovirus 30, Europe [PDF - 3.31 MB - 11 pages]
K. Benschop et al.

In 2018, an upsurge in echovirus 30 (E30) infections was reported in Europe. We conducted a large-scale epidemiologic and evolutionary study of 1,329 E30 strains collected in 22 countries in Europe during 2016–2018. Most E30 cases affected persons 0–4 years of age (29%) and 25–34 years of age (27%). Sequences were divided into 6 genetic clades (G1–G6). Most (53%) sequences belonged to G1, followed by G6 (23%), G2 (17%), G4 (4%), G3 (0.3%), and G5 (0.2%). Each clade encompassed unique individual recombinant forms; G1 and G4 displayed >2 unique recombinant forms. Rapid turnover of new clades and recombinant forms occurred over time. Clades G1 and G6 dominated in 2018, suggesting the E30 upsurge was caused by emergence of 2 distinct clades circulating in Europe. Investigation into the mechanisms behind the rapid turnover of E30 is crucial for clarifying the epidemiology and evolution of these enterovirus infections.

EID Benschop K, Broberg EK, Hodcroft E, Schmitz D, Albert J, Baicus A, et al. Molecular Epidemiology and Evolutionary Trajectory of Emerging Echovirus 30, Europe. Emerg Infect Dis. 2021;27(6):1616-1626. https://doi.org/10.3201/eid2706.203096
AMA Benschop K, Broberg EK, Hodcroft E, et al. Molecular Epidemiology and Evolutionary Trajectory of Emerging Echovirus 30, Europe. Emerging Infectious Diseases. 2021;27(6):1616-1626. doi:10.3201/eid2706.203096.
APA Benschop, K., Broberg, E. K., Hodcroft, E., Schmitz, D., Albert, J., Baicus, A....Simmonds, P. (2021). Molecular Epidemiology and Evolutionary Trajectory of Emerging Echovirus 30, Europe. Emerging Infectious Diseases, 27(6), 1616-1626. https://doi.org/10.3201/eid2706.203096.

Twenty-Year Public Health Impact of 7- and 13-Valent Pneumococcal Conjugate Vaccines in US Children [PDF - 3.02 MB - 10 pages]
M. Wasserman et al.

Pneumococcal conjugate vaccines (PCVs) have been used in the United States since 2000. To assess the cumulative 20-year effect of PCVs on invasive pneumococcal disease (IPD) incidence among children <5 years of age, we analyzed Active Bacterial Core Surveillance data, conducted a literature review, and modeled expected and observed disease. We found that PCVs have averted >282,000 cases of IPD, including ≈16,000 meningitis, ≈172,000 bacteremia, and ≈55,000 bacteremic pneumonia cases. In addition, vaccination has prevented 97 million healthcare visits for otitis media, 438,914–706,345 hospitalizations for pneumonia, and 2,780 total deaths. IPD cases declined 91%, from 15,707 in 1997 to 1,382 in 2019. Average annual visits for otitis media declined 41%, from 78 visits/100 children before PCV introduction to 46 visits/100 children after PCV13 introduction. Annual pneumonia hospitalizations declined 66%–79%, from 110,000–175,000 in 1997 to 37,000 in 2019. These findings confirm the substantial benefits of PCVs for preventing IPD in children.

EID Wasserman M, Chapman R, Lapidot R, Sutton K, Dillon-Murphy D, Patel S, et al. Twenty-Year Public Health Impact of 7- and 13-Valent Pneumococcal Conjugate Vaccines in US Children. Emerg Infect Dis. 2021;27(6):1627-1636. https://doi.org/10.3201/eid2706.204238
AMA Wasserman M, Chapman R, Lapidot R, et al. Twenty-Year Public Health Impact of 7- and 13-Valent Pneumococcal Conjugate Vaccines in US Children. Emerging Infectious Diseases. 2021;27(6):1627-1636. doi:10.3201/eid2706.204238.
APA Wasserman, M., Chapman, R., Lapidot, R., Sutton, K., Dillon-Murphy, D., Patel, S....Pelton, S. (2021). Twenty-Year Public Health Impact of 7- and 13-Valent Pneumococcal Conjugate Vaccines in US Children. Emerging Infectious Diseases, 27(6), 1627-1636. https://doi.org/10.3201/eid2706.204238.

Precision Tracing of Household Dengue Spread Using Inter- and Intra-Host Viral Variation Data, Kamphaeng Phet, Thailand [PDF - 1.05 MB - 8 pages]
I. Berry et al.

Dengue control approaches are best informed by granular spatial epidemiology of these viruses, yet reconstruction of inter- and intra-household transmissions is limited when analyzing case count, serologic, or genomic consensus sequence data. To determine viral spread on a finer spatial scale, we extended phylogenomic discrete trait analyses to reconstructions of house-to-house transmissions within a prospective cluster study in Kamphaeng Phet, Thailand. For additional resolution and transmission confirmation, we mapped dengue intra-host single nucleotide variants on the taxa of these time-scaled phylogenies. This approach confirmed 19 household transmissions and revealed that dengue disperses an average of 70 m per day between households in these communities. We describe an evolutionary biology framework for the resolution of dengue transmissions that cannot be differentiated based on epidemiologic and consensus genome data alone. This framework can be used as a public health tool to inform control approaches and enable precise tracing of dengue transmissions.

EID Berry I, Melendrez MC, Pollett S, Figueroa K, Buddhari D, Klungthong C, et al. Precision Tracing of Household Dengue Spread Using Inter- and Intra-Host Viral Variation Data, Kamphaeng Phet, Thailand. Emerg Infect Dis. 2021;27(6):1637-1644. https://doi.org/10.3201/eid2706.204323
AMA Berry I, Melendrez MC, Pollett S, et al. Precision Tracing of Household Dengue Spread Using Inter- and Intra-Host Viral Variation Data, Kamphaeng Phet, Thailand. Emerging Infectious Diseases. 2021;27(6):1637-1644. doi:10.3201/eid2706.204323.
APA Berry, I., Melendrez, M. C., Pollett, S., Figueroa, K., Buddhari, D., Klungthong, C....Jarman, R. G. (2021). Precision Tracing of Household Dengue Spread Using Inter- and Intra-Host Viral Variation Data, Kamphaeng Phet, Thailand. Emerging Infectious Diseases, 27(6), 1637-1644. https://doi.org/10.3201/eid2706.204323.

Association between Birth Region and Time to Tuberculosis Diagnosis among Non–US-Born Persons in the United States [PDF - 2.39 MB - 9 pages]
A. Talwar et al.

Approximately 90% of tuberculosis (TB) cases among non–US-born persons in the United States are attributable to progression of latent TB infection to TB disease. Using survival analysis, we investigated whether birthplace is associated with time to disease progression among non–US-born persons in whom TB disease developed. We derived a Cox regression model comparing differences in time to TB diagnosis after US entry among 19 birth regions, adjusting for sex, birth year, and age at entry. After adjusting for age at entry and birth year, the median time to TB diagnosis was lowest among persons from Middle Africa, 128 months (95% CI 116–146 months) for male persons and 121 months (95% CI 108–136 months) for female persons. We found time to TB diagnosis among non–US-born persons varied by birth region, which represents a prognostic indicator for progression of latent TB infection to TB disease.

EID Talwar A, Li R, Langer AJ. Association between Birth Region and Time to Tuberculosis Diagnosis among Non–US-Born Persons in the United States. Emerg Infect Dis. 2021;27(6):1645-1653. https://doi.org/10.3201/eid2706.203663
AMA Talwar A, Li R, Langer AJ. Association between Birth Region and Time to Tuberculosis Diagnosis among Non–US-Born Persons in the United States. Emerging Infectious Diseases. 2021;27(6):1645-1653. doi:10.3201/eid2706.203663.
APA Talwar, A., Li, R., & Langer, A. J. (2021). Association between Birth Region and Time to Tuberculosis Diagnosis among Non–US-Born Persons in the United States. Emerging Infectious Diseases, 27(6), 1645-1653. https://doi.org/10.3201/eid2706.203663.

Case–Control Study of Risk Factors for Acquired Hepatitis E Virus Infections in Blood Donors, United Kingdom, 2018–2019 [PDF - 918 KB - 8 pages]
I. Smith et al.

Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in England. Substantial yearly increases of autochthonous infections were observed during 2003–2016 and again during 2017–2019. Previous studies associated acute HEV cases with consumption of processed pork products, we investigated risk factors for autochthonous HEV infections in the blood donor population in England. Study participants were 117 HEV RNA–positive blood donors and 564 HEV RNA–negative blood donors. No persons with positive results were vegetarian; 97.4% of persons with positive results reported eating pork products. Consuming bacon (OR 3.0, 95% CI 1.7–5.5; p<0.0001), cured pork meats (OR 3.5, 95% CI 2.2–5.4; p<0.0001), and pigs’ liver (OR 2.9, 95% CI 1.0–8.3; p = 0.04) were significantly associated with HEV infection. Our findings confirm previous links to pork products and suggest that appropriate animal husbandry is essential to reduce the risk for HEV infection.

EID Smith I, Said B, Vaughan A, Haywood B, Ijaz S, Reynolds C, et al. Case–Control Study of Risk Factors for Acquired Hepatitis E Virus Infections in Blood Donors, United Kingdom, 2018–2019. Emerg Infect Dis. 2021;27(6):1654-1661. https://doi.org/10.3201/eid2706.203964
AMA Smith I, Said B, Vaughan A, et al. Case–Control Study of Risk Factors for Acquired Hepatitis E Virus Infections in Blood Donors, United Kingdom, 2018–2019. Emerging Infectious Diseases. 2021;27(6):1654-1661. doi:10.3201/eid2706.203964.
APA Smith, I., Said, B., Vaughan, A., Haywood, B., Ijaz, S., Reynolds, C....Morgan, D. (2021). Case–Control Study of Risk Factors for Acquired Hepatitis E Virus Infections in Blood Donors, United Kingdom, 2018–2019. Emerging Infectious Diseases, 27(6), 1654-1661. https://doi.org/10.3201/eid2706.203964.

Increased Incidence of Antimicrobial-Resistant Nontyphoidal Salmonella Infections, United States, 2004–2016 [PDF - 2.54 MB - 11 pages]
F. Medalla et al.

Salmonella is a major cause of foodborne illness in the United States, and antimicrobial-resistant strains pose a serious threat to public health. We used Bayesian hierarchical models of culture-confirmed infections during 2004–2016 from 2 Centers for Disease Control and Prevention surveillance systems to estimate changes in the national incidence of resistant nontyphoidal Salmonella infections. Extrapolating to the United States population and accounting for unreported infections, we estimated a 40% increase in the annual incidence of infections with clinically important resistance (resistance to ampicillin or ceftriaxone or nonsusceptibility to ciprofloxacin) during 2015–2016 (≈222,000 infections) compared with 2004–2008 (≈159,000 infections). Changes in the incidence of resistance varied by serotype. Serotypes I 4,[5],12:i:- and Enteritidis were responsible for two thirds of the increased incidence of clinically important resistance during 2015–2016. Ciprofloxacin-nonsusceptible infections accounted for more than half of the increase. These estimates can help in setting targets and priorities for prevention.

EID Medalla F, Gu W, Friedman CR, Judd M, Folster J, Griffin PM, et al. Increased Incidence of Antimicrobial-Resistant Nontyphoidal Salmonella Infections, United States, 2004–2016. Emerg Infect Dis. 2021;27(6):1662-1672. https://doi.org/10.3201/eid2706.204486
AMA Medalla F, Gu W, Friedman CR, et al. Increased Incidence of Antimicrobial-Resistant Nontyphoidal Salmonella Infections, United States, 2004–2016. Emerging Infectious Diseases. 2021;27(6):1662-1672. doi:10.3201/eid2706.204486.
APA Medalla, F., Gu, W., Friedman, C. R., Judd, M., Folster, J., Griffin, P. M....Hoekstra, R. M. (2021). Increased Incidence of Antimicrobial-Resistant Nontyphoidal Salmonella Infections, United States, 2004–2016. Emerging Infectious Diseases, 27(6), 1662-1672. https://doi.org/10.3201/eid2706.204486.
Dispatches

Rapid Detection of SARS-CoV-2 Variants of Concern, Including B.1.1.28/P.1, British Columbia, Canada [PDF - 752 KB - 4 pages]
N. Matic et al.

To screen all severe acute respiratory syndrome coronavirus 2–positive samples in Vancouver, British Columbia, Canada, and determine whether they represented variants of concern, we implemented a real-time reverse transcription PCR–based algorithm. We rapidly identified 77 samples with variants: 57 with B.1.1.7, 7 with B.1.351, and an epidemiologic cluster of 13 with B.1.1.28/P.1.

EID Matic N, Lowe CF, Ritchie G, Stefanovic A, Lawson T, Jang W, et al. Rapid Detection of SARS-CoV-2 Variants of Concern, Including B.1.1.28/P.1, British Columbia, Canada. Emerg Infect Dis. 2021;27(6):1673-1676. https://doi.org/10.3201/eid2706.210532
AMA Matic N, Lowe CF, Ritchie G, et al. Rapid Detection of SARS-CoV-2 Variants of Concern, Including B.1.1.28/P.1, British Columbia, Canada. Emerging Infectious Diseases. 2021;27(6):1673-1676. doi:10.3201/eid2706.210532.
APA Matic, N., Lowe, C. F., Ritchie, G., Stefanovic, A., Lawson, T., Jang, W....Romney, M. G. (2021). Rapid Detection of SARS-CoV-2 Variants of Concern, Including B.1.1.28/P.1, British Columbia, Canada. Emerging Infectious Diseases, 27(6), 1673-1676. https://doi.org/10.3201/eid2706.210532.

Epidemiologic Evidence for Airborne Transmission of SARS-CoV-2 during Church Singing, Australia, 2020 [PDF - 80 KB - 2 pages]
A. L. Katelaris et al.

An outbreak of severe acute respiratory syndrome coronavirus 2 infection occurred among church attendees after an infectious chorister sang at multiple services. We detected 12 secondary case-patients. Video recordings of the services showed that case-patients were seated in the same section, up to 15 m from the primary case-patient, without close physical contact, suggesting airborne transmission.

EID Katelaris AL, Wells J, Clark P, Norton S, Rockett R, Arnott A, et al. Epidemiologic Evidence for Airborne Transmission of SARS-CoV-2 during Church Singing, Australia, 2020. Emerg Infect Dis. 2021;27(6):1677-1680. https://doi.org/10.3201/eid2706.210465
AMA Katelaris AL, Wells J, Clark P, et al. Epidemiologic Evidence for Airborne Transmission of SARS-CoV-2 during Church Singing, Australia, 2020. Emerging Infectious Diseases. 2021;27(6):1677-1680. doi:10.3201/eid2706.210465.
APA Katelaris, A. L., Wells, J., Clark, P., Norton, S., Rockett, R., Arnott, A....Bag, S. K. (2021). Epidemiologic Evidence for Airborne Transmission of SARS-CoV-2 during Church Singing, Australia, 2020. Emerging Infectious Diseases, 27(6), 1677-1680. https://doi.org/10.3201/eid2706.210465.

Ebola Virus IgG Seroprevalence in Southern Mali [PDF - 1.49 MB - 4 pages]
S. Bane et al.

Mali had 2 reported introductions of Ebola virus (EBOV) during the 2013–2016 West Africa epidemic. Previously, no evidence for EBOV circulation was reported in Mali. We performed an EBOV serosurvey study in southern Mali. We found low seroprevalence in the population, indicating local exposure to EBOV or closely related ebola viruses.

EID Bane S, Rosenke K, Maiga O, Feldmann F, Meade-White K, Callison J, et al. Ebola Virus IgG Seroprevalence in Southern Mali. Emerg Infect Dis. 2021;27(6):1681-1684. https://doi.org/10.3201/eid2706.203510
AMA Bane S, Rosenke K, Maiga O, et al. Ebola Virus IgG Seroprevalence in Southern Mali. Emerging Infectious Diseases. 2021;27(6):1681-1684. doi:10.3201/eid2706.203510.
APA Bane, S., Rosenke, K., Maiga, O., Feldmann, F., Meade-White, K., Callison, J....Feldmann, H. (2021). Ebola Virus IgG Seroprevalence in Southern Mali. Emerging Infectious Diseases, 27(6), 1681-1684. https://doi.org/10.3201/eid2706.203510.

Trends in Viral Respiratory Infections During COVID-19 Pandemic, South Korea [PDF - 2.21 MB - 4 pages]
S. Yum et al.

We compared weekly positivity rates of 8 respiratory viruses in South Korea during 2010–2019 and 2020. The overall mean positivity rate for these viruses decreased from 54.7% in 2010–2019 to 39.1% in 2020. Pandemic control measures might have reduced the incidence of many, but not all, viral respiratory infections.

EID Yum S, Hong K, Sohn S, Kim J, Chun B. Trends in Viral Respiratory Infections During COVID-19 Pandemic, South Korea. Emerg Infect Dis. 2021;27(6):1685-1688. https://doi.org/10.3201/eid2706.210135
AMA Yum S, Hong K, Sohn S, et al. Trends in Viral Respiratory Infections During COVID-19 Pandemic, South Korea. Emerging Infectious Diseases. 2021;27(6):1685-1688. doi:10.3201/eid2706.210135.
APA Yum, S., Hong, K., Sohn, S., Kim, J., & Chun, B. (2021). Trends in Viral Respiratory Infections During COVID-19 Pandemic, South Korea. Emerging Infectious Diseases, 27(6), 1685-1688. https://doi.org/10.3201/eid2706.210135.

Serotype-Switch Variant of Multidrug-Resistant Streptococcus pneumoniae Sequence Type 271 [PDF - 1.15 MB - 4 pages]
E. M. Scherer et al.

We discovered 3 invasive, multidrug-resistant Streptococcus pneumoniae isolates of vaccine-refractory capsular serotype 3 that recently arose within the successful sequence type 271 complex through a serotype switch recombination event. Mapping genomic recombination sites within the serotype 3/sequence type 271 progeny revealed a 55.9-kb donated fragment that encompassed cps3, pbp1a, and additional virulence factors.

EID Scherer EM, Beall B, Metcalf B. Serotype-Switch Variant of Multidrug-Resistant Streptococcus pneumoniae Sequence Type 271. Emerg Infect Dis. 2021;27(6):1689-1692. https://doi.org/10.3201/eid2706.203629
AMA Scherer EM, Beall B, Metcalf B. Serotype-Switch Variant of Multidrug-Resistant Streptococcus pneumoniae Sequence Type 271. Emerging Infectious Diseases. 2021;27(6):1689-1692. doi:10.3201/eid2706.203629.
APA Scherer, E. M., Beall, B., & Metcalf, B. (2021). Serotype-Switch Variant of Multidrug-Resistant Streptococcus pneumoniae Sequence Type 271. Emerging Infectious Diseases, 27(6), 1689-1692. https://doi.org/10.3201/eid2706.203629.

Reemergence of Scabies Driven by Adolescents and Young Adults, Germany, 2009–2018 [PDF - 1.18 MB - 4 pages]
F. Reichert et al.

To validate anecdotal evidence on scabies infestations, we analyzed inpatient and outpatient claims data in Germany. Scabies diagnoses increased 9-fold and treatment failure 4-fold during 2009–2018, driven mainly by persons 15–24 years of age. Prevention and control in young adults appear key because of these persons’ high mobility and social connectivity.

EID Reichert F, Schulz M, Mertens E, Lachmann R, Aebischer A. Reemergence of Scabies Driven by Adolescents and Young Adults, Germany, 2009–2018. Emerg Infect Dis. 2021;27(6):1693-1696. https://doi.org/10.3201/eid2706.203681
AMA Reichert F, Schulz M, Mertens E, et al. Reemergence of Scabies Driven by Adolescents and Young Adults, Germany, 2009–2018. Emerging Infectious Diseases. 2021;27(6):1693-1696. doi:10.3201/eid2706.203681.
APA Reichert, F., Schulz, M., Mertens, E., Lachmann, R., & Aebischer, A. (2021). Reemergence of Scabies Driven by Adolescents and Young Adults, Germany, 2009–2018. Emerging Infectious Diseases, 27(6), 1693-1696. https://doi.org/10.3201/eid2706.203681.

Role of Anopheles stephensi Mosquitoes in Malaria Outbreak, Djibouti, 2019 [PDF - 1.95 MB - 4 pages]
V. Pommier de Santi et al.

Anopheles stephensi mosquitoes share urban breeding sites with Aedes aegypti and Culex quinquefasciatus mosquitoes in the Republic of Djibouti. We present evidence that A. stephensi mosquitoes might be responsible for an increase in malaria incidence in this country. We also document resistance of Plasmodium falciparum to dihydroartemisinin/piperaquine.

EID Pommier de Santi V, Khaireh B, Chiniard T, Pradines B, Taudon N, Larréché S, et al. Role of Anopheles stephensi Mosquitoes in Malaria Outbreak, Djibouti, 2019. Emerg Infect Dis. 2021;27(6):1697-1700. https://doi.org/10.3201/eid2706.204557
AMA Pommier de Santi V, Khaireh B, Chiniard T, et al. Role of Anopheles stephensi Mosquitoes in Malaria Outbreak, Djibouti, 2019. Emerging Infectious Diseases. 2021;27(6):1697-1700. doi:10.3201/eid2706.204557.
APA Pommier de Santi, V., Khaireh, B., Chiniard, T., Pradines, B., Taudon, N., Larréché, S....Briolant, S. (2021). Role of Anopheles stephensi Mosquitoes in Malaria Outbreak, Djibouti, 2019. Emerging Infectious Diseases, 27(6), 1697-1700. https://doi.org/10.3201/eid2706.204557.

Recurrent Swelling and Microfilaremia Caused by Dirofilaria repens Infection after Travel to India [PDF - 1.90 MB - 4 pages]
L. Huebl et al.

Human subcutaneous dirofilariasis is an emerging mosquitoborne zoonosis. A traveler returning to Germany from India experienced Dirofilaria infection with concomitant microfilaremia. Molecular analysis indicated Dirofilaria repens nematodes of an Asian genotype. Microfilaremia showed no clear periodicity. Presence of Wolbachia endosymbionts enabled successful treatment with doxycycline.

EID Huebl L, Tappe D, Giese M, Mempel S, Tannich E, Kreuels B, et al. Recurrent Swelling and Microfilaremia Caused by Dirofilaria repens Infection after Travel to India. Emerg Infect Dis. 2021;27(6):1701-1704. https://doi.org/10.3201/eid2706.210592
AMA Huebl L, Tappe D, Giese M, et al. Recurrent Swelling and Microfilaremia Caused by Dirofilaria repens Infection after Travel to India. Emerging Infectious Diseases. 2021;27(6):1701-1704. doi:10.3201/eid2706.210592.
APA Huebl, L., Tappe, D., Giese, M., Mempel, S., Tannich, E., Kreuels, B....Jochum, J. (2021). Recurrent Swelling and Microfilaremia Caused by Dirofilaria repens Infection after Travel to India. Emerging Infectious Diseases, 27(6), 1701-1704. https://doi.org/10.3201/eid2706.210592.

Melioidosis in Children, Brazil, 1989–2019 [PDF - 972 KB - 4 pages]
R. Lima and D. Rolim

We studied 20 confirmed or suspected cases of melioidosis in children in Ceará, Brazil, during 1989–2019. We observed a high death rate, severe signs and symptoms, and substantial environmental exposure. These data suggest that childhood melioidosis might be more severe in Brazil than in other regions.

EID Lima R, Rolim D. Melioidosis in Children, Brazil, 1989–2019. Emerg Infect Dis. 2021;27(6):1705-1708. https://doi.org/10.3201/eid2706.200154
AMA Lima R, Rolim D. Melioidosis in Children, Brazil, 1989–2019. Emerging Infectious Diseases. 2021;27(6):1705-1708. doi:10.3201/eid2706.200154.
APA Lima, R., & Rolim, D. (2021). Melioidosis in Children, Brazil, 1989–2019. Emerging Infectious Diseases, 27(6), 1705-1708. https://doi.org/10.3201/eid2706.200154.

Seroepidemiologic Survey of Crimean-Congo Hemorrhagic Fever Virus in Logging Communities, Myanmar [PDF - 862 KB - 5 pages]
T. Evans et al.

Crimean-Congo hemorrhagic fever virus (CCHFV) is endemic in Asia, infecting many animal hosts, but CCHFV has not been reported in Myanmar. We conducted a seroepidemiologic survey of logging communities in Myanmar and found CCHFV exposure was common (9.8%) and exposure to wild animal blood and body fluids was associated with seropositivity.

EID Evans T, Myat T, Hom N, Ricks K, Maw M, Oo Z, et al. Seroepidemiologic Survey of Crimean-Congo Hemorrhagic Fever Virus in Logging Communities, Myanmar. Emerg Infect Dis. 2021;27(6):1709-1713. https://doi.org/10.3201/eid2706.203223
AMA Evans T, Myat T, Hom N, et al. Seroepidemiologic Survey of Crimean-Congo Hemorrhagic Fever Virus in Logging Communities, Myanmar. Emerging Infectious Diseases. 2021;27(6):1709-1713. doi:10.3201/eid2706.203223.
APA Evans, T., Myat, T., Hom, N., Ricks, K., Maw, M., Oo, Z....Thu, H. (2021). Seroepidemiologic Survey of Crimean-Congo Hemorrhagic Fever Virus in Logging Communities, Myanmar. Emerging Infectious Diseases, 27(6), 1709-1713. https://doi.org/10.3201/eid2706.203223.

Cutaneous Leishmaniasis Caused by an Unknown Leishmania Strain, Arizona, USA [PDF - 1.05 MB - 4 pages]
M. de Almeida et al.

We investigated an autochthonous case of cutaneous leishmaniasis caused by a genetically different Leishmania sp. in a patient in Arizona, USA. This parasite was classified into the subgenus Leishmania on the basis of multilocus DNA sequence and phylogenetic analyses of the rRNA locus and 11 reference genes.

EID de Almeida M, Zheng Y, Nascimento FS, Bishop H, Cama VA, Batra D, et al. Cutaneous Leishmaniasis Caused by an Unknown Leishmania Strain, Arizona, USA. Emerg Infect Dis. 2021;27(6):1714-1717. https://doi.org/10.3201/eid2706.204198
AMA de Almeida M, Zheng Y, Nascimento FS, et al. Cutaneous Leishmaniasis Caused by an Unknown Leishmania Strain, Arizona, USA. Emerging Infectious Diseases. 2021;27(6):1714-1717. doi:10.3201/eid2706.204198.
APA de Almeida, M., Zheng, Y., Nascimento, F. S., Bishop, H., Cama, V. A., Batra, D....Donovan, F. M. (2021). Cutaneous Leishmaniasis Caused by an Unknown Leishmania Strain, Arizona, USA. Emerging Infectious Diseases, 27(6), 1714-1717. https://doi.org/10.3201/eid2706.204198.

Molecular Characterization and Antimicrobial Resistance in Neisseria gonorrhoeae, Nunavut Region of Inuit Nunangat, Canada, 2018–2019 [PDF - 3.25 MB - 5 pages]
A. E. Singh et al.

We assessed antimicrobial resistance (AMR) in Neisseria gonorrhoeae in Nunavut, Canada, using remnant gonorrhea nucleic acid amplification test–positive urine specimens. This study confirms the feasibility of conducting N. gonorrhoeae AMR surveillance and highlights the diversity of gonococcal sequence types and geographic variation of AMR patterns in the territory.

EID Singh AE, Pawa J, Kulleperuma K, Prasad E, Marchand S, Dionne K, et al. Molecular Characterization and Antimicrobial Resistance in Neisseria gonorrhoeae, Nunavut Region of Inuit Nunangat, Canada, 2018–2019. Emerg Infect Dis. 2021;27(6):1718-1722. https://doi.org/10.3201/eid2706.204407
AMA Singh AE, Pawa J, Kulleperuma K, et al. Molecular Characterization and Antimicrobial Resistance in Neisseria gonorrhoeae, Nunavut Region of Inuit Nunangat, Canada, 2018–2019. Emerging Infectious Diseases. 2021;27(6):1718-1722. doi:10.3201/eid2706.204407.
APA Singh, A. E., Pawa, J., Kulleperuma, K., Prasad, E., Marchand, S., Dionne, K....Martin, I. (2021). Molecular Characterization and Antimicrobial Resistance in Neisseria gonorrhoeae, Nunavut Region of Inuit Nunangat, Canada, 2018–2019. Emerging Infectious Diseases, 27(6), 1718-1722. https://doi.org/10.3201/eid2706.204407.

Leishmaniases in the European Union and Neighboring Countries [PDF - 1.84 MB - 5 pages]
E. Berriatua et al.

A questionnaire survey of animal and human health authorities in Europe revealed that leishmaniases are not notifiable in all countries with autochthonous cases. Few countries implement surveillance and control targeting both animal and human infections. Leishmaniases are considered emergent diseases in most countries, and lack of resources is a challenge for control.

EID Berriatua E, Maia C, Conceição C, Özbel Y, Töz S, Baneth G, et al. Leishmaniases in the European Union and Neighboring Countries. Emerg Infect Dis. 2021;27(6):1723-1727. https://doi.org/10.3201/eid2706.210239
AMA Berriatua E, Maia C, Conceição C, et al. Leishmaniases in the European Union and Neighboring Countries. Emerging Infectious Diseases. 2021;27(6):1723-1727. doi:10.3201/eid2706.210239.
APA Berriatua, E., Maia, C., Conceição, C., Özbel, Y., Töz, S., Baneth, G....Gossner, C. M. (2021). Leishmaniases in the European Union and Neighboring Countries. Emerging Infectious Diseases, 27(6), 1723-1727. https://doi.org/10.3201/eid2706.210239.

Brucellosis Outbreak Traced to Commercially Sold Camel Milk through Whole-Genome Sequencing, Israel [PDF - 1.15 MB - 4 pages]
S. Bardenstein et al.

Brucellosis, a neglected zoonotic disease acquired from contaminated food products, remains a public health concern worldwide. We describe an outbreak in which commercially sold camel milk containing Brucella melitensis was distributed across Israel. Whole-genome sequencing linked patients infected with B. melitensis to wholesale camel milk and unregulated livestock trade.

EID Bardenstein S, Gibbs RE, Yagel Y, Motro Y, Moran-Gilad J. Brucellosis Outbreak Traced to Commercially Sold Camel Milk through Whole-Genome Sequencing, Israel. Emerg Infect Dis. 2021;27(6):1728-1731. https://doi.org/10.3201/eid2706.204902
AMA Bardenstein S, Gibbs RE, Yagel Y, et al. Brucellosis Outbreak Traced to Commercially Sold Camel Milk through Whole-Genome Sequencing, Israel. Emerging Infectious Diseases. 2021;27(6):1728-1731. doi:10.3201/eid2706.204902.
APA Bardenstein, S., Gibbs, R. E., Yagel, Y., Motro, Y., & Moran-Gilad, J. (2021). Brucellosis Outbreak Traced to Commercially Sold Camel Milk through Whole-Genome Sequencing, Israel. Emerging Infectious Diseases, 27(6), 1728-1731. https://doi.org/10.3201/eid2706.204902.
Research Letters

Highly Pathogenic Avian Influenza A(H5N8) Virus in Swans, China, 2020 [PDF - 1.27 MB - 3 pages]
X. Li et al.

In October 2020, highly pathogenic avian influenza A(H5N8) viruses were detected in 2 dead swans in Inner Mongolia, China. Genetic analysis showed that the H5N8 isolates belong to clade 2.3.4.4b and that the isolates cluster with the H5N8 viruses isolated in Eurasia in the fall of 2020.

EID Li X, Lv X, Li Y, Peng P, Zhou R, Qin S, et al. Highly Pathogenic Avian Influenza A(H5N8) Virus in Swans, China, 2020. Emerg Infect Dis. 2021;27(6):1732-1734. https://doi.org/10.3201/eid2706.204727
AMA Li X, Lv X, Li Y, et al. Highly Pathogenic Avian Influenza A(H5N8) Virus in Swans, China, 2020. Emerging Infectious Diseases. 2021;27(6):1732-1734. doi:10.3201/eid2706.204727.
APA Li, X., Lv, X., Li, Y., Peng, P., Zhou, R., Qin, S....Chai, H. (2021). Highly Pathogenic Avian Influenza A(H5N8) Virus in Swans, China, 2020. Emerging Infectious Diseases, 27(6), 1732-1734. https://doi.org/10.3201/eid2706.204727.

Rapid Antigen Test for Postmortem Evaluation of SARS-CoV-2 Carriage [PDF - 1.08 MB - 4 pages]
M. Zacharias et al.

Detecting severe acute respiratory syndrome coronavirus 2 in deceased patients is key when considering appropriate safety measures to prevent infection during postmortem examinations. A prospective cohort study comparing a rapid antigen test with quantitative reverse transcription PCR showed the rapid test’s usability as a tool to guide autopsy practice.

EID Zacharias M, Stangl V, Thüringer A, Loibner M, Wurm P, Wolfgruber S, et al. Rapid Antigen Test for Postmortem Evaluation of SARS-CoV-2 Carriage. Emerg Infect Dis. 2021;27(6):1734-1737. https://doi.org/10.3201/eid2706.210226
AMA Zacharias M, Stangl V, Thüringer A, et al. Rapid Antigen Test for Postmortem Evaluation of SARS-CoV-2 Carriage. Emerging Infectious Diseases. 2021;27(6):1734-1737. doi:10.3201/eid2706.210226.
APA Zacharias, M., Stangl, V., Thüringer, A., Loibner, M., Wurm, P., Wolfgruber, S....Gorkiewicz, G. (2021). Rapid Antigen Test for Postmortem Evaluation of SARS-CoV-2 Carriage. Emerging Infectious Diseases, 27(6), 1734-1737. https://doi.org/10.3201/eid2706.210226.

Respiratory Viral Shedding in Healthcare Workers Reinfected with SARS-CoV-2, Brazil, 2020 [PDF - 896 KB - 4 pages]
M. R. Amorim et al.

We documented 4 cases of severe acute respiratory syndrome coronavirus 2 reinfection by non–variant of concern strains among healthcare workers in Campinas, Brazil. We isolated infectious particles from nasopharyngeal secretions during both infection episodes. Improved and continued protection measures are necessary to mitigate the risk for reinfection among healthcare workers.

EID Amorim MR, Souza WM, Barros A, Toledo-Teixeira DA, dos-Santos K, Simeoni CL, et al. Respiratory Viral Shedding in Healthcare Workers Reinfected with SARS-CoV-2, Brazil, 2020. Emerg Infect Dis. 2021;27(6):1737-1740. https://doi.org/10.3201/eid2706.210558
AMA Amorim MR, Souza WM, Barros A, et al. Respiratory Viral Shedding in Healthcare Workers Reinfected with SARS-CoV-2, Brazil, 2020. Emerging Infectious Diseases. 2021;27(6):1737-1740. doi:10.3201/eid2706.210558.
APA Amorim, M. R., Souza, W. M., Barros, A., Toledo-Teixeira, D. A., dos-Santos, K., Simeoni, C. L....Proenca-Modena, J. (2021). Respiratory Viral Shedding in Healthcare Workers Reinfected with SARS-CoV-2, Brazil, 2020. Emerging Infectious Diseases, 27(6), 1737-1740. https://doi.org/10.3201/eid2706.210558.

Multisystem Inflammatory Syndrome in Adults after Mild SARS-CoV-2 Infection, Japan [PDF - 659 KB - 3 pages]
Y. Yamada et al.

In Japan, a 51-year-old man had minimally symptomatic severe acute respiratory syndrome coronavirus 2 infection. Multisystem inflammatory syndrome was diagnosed ≈5 weeks later; characteristics included severe inflammation, cardiac dysfunction, and IgG positivity. Clinicians should obtain detailed history and examine IgG levels for cases of inflammatory disease with unexplained cardiac decompensation.

EID Yamada Y, Fujinami K, Eguchi T, Takefuji H, Mori N. Multisystem Inflammatory Syndrome in Adults after Mild SARS-CoV-2 Infection, Japan. Emerg Infect Dis. 2021;27(6):1740-1742. https://doi.org/10.3201/eid2706.210728
AMA Yamada Y, Fujinami K, Eguchi T, et al. Multisystem Inflammatory Syndrome in Adults after Mild SARS-CoV-2 Infection, Japan. Emerging Infectious Diseases. 2021;27(6):1740-1742. doi:10.3201/eid2706.210728.
APA Yamada, Y., Fujinami, K., Eguchi, T., Takefuji, H., & Mori, N. (2021). Multisystem Inflammatory Syndrome in Adults after Mild SARS-CoV-2 Infection, Japan. Emerging Infectious Diseases, 27(6), 1740-1742. https://doi.org/10.3201/eid2706.210728.

Changing Molecular Epidemiology of Hepatitis A Virus Infection, United States, 1996–2019 [PDF - 1.12 MB - 4 pages]
S. Ramachandran et al.

Hepatitis A virus (HAV) genotype IA was most common among strains tested in US outbreak investigations and surveillance during 1996–2015. However, HAV genotype IB gained prominence during 2016–2019 person-to-person multistate outbreaks. Detection of previously uncommon strains highlights the changing molecular epidemiology of HAV infection in the United States.

EID Ramachandran S, Xia G, Dimitrova Z, Lin Y, Montgomery M, Augustine R, et al. Changing Molecular Epidemiology of Hepatitis A Virus Infection, United States, 1996–2019. Emerg Infect Dis. 2021;27(6):1742-1745. https://doi.org/10.3201/eid2706.203036
AMA Ramachandran S, Xia G, Dimitrova Z, et al. Changing Molecular Epidemiology of Hepatitis A Virus Infection, United States, 1996–2019. Emerging Infectious Diseases. 2021;27(6):1742-1745. doi:10.3201/eid2706.203036.
APA Ramachandran, S., Xia, G., Dimitrova, Z., Lin, Y., Montgomery, M., Augustine, R....Khudyakov, Y. (2021). Changing Molecular Epidemiology of Hepatitis A Virus Infection, United States, 1996–2019. Emerging Infectious Diseases, 27(6), 1742-1745. https://doi.org/10.3201/eid2706.203036.

Molecular Typing of Burkholderia mallei Isolates from Equids with Glanders, India [PDF - 1.45 MB - 4 pages]
H. Singha et al.

We collected 10 Burkholderia mallei isolates from equids in 9 districts in India during glanders outbreaks in 2013–2016. Multilocus variable-number tandem-repeat analysis showed 7 outbreak area–related genotypes. The study highlights the utility of this analysis for epidemiologically tracing of specific B. mallei isolates during outbreaks.

EID Singha H, Elschner MC, Malik P, Saini S, Tripathi BN, Mertens-Scholz K, et al. Molecular Typing of Burkholderia mallei Isolates from Equids with Glanders, India. Emerg Infect Dis. 2021;27(6):1745-1748. https://doi.org/10.3201/eid2706.203232
AMA Singha H, Elschner MC, Malik P, et al. Molecular Typing of Burkholderia mallei Isolates from Equids with Glanders, India. Emerging Infectious Diseases. 2021;27(6):1745-1748. doi:10.3201/eid2706.203232.
APA Singha, H., Elschner, M. C., Malik, P., Saini, S., Tripathi, B. N., Mertens-Scholz, K....Neubauer, H. (2021). Molecular Typing of Burkholderia mallei Isolates from Equids with Glanders, India. Emerging Infectious Diseases, 27(6), 1745-1748. https://doi.org/10.3201/eid2706.203232.

Atypical Brucella inopinata–Like Species in 2 Marine Toads [PDF - 854 KB - 3 pages]
R. A. Glabman et al.

We describe the isolation of atypical Brucella inopinata–like species and unique clinicopathologic findings in 2 adult marine toads (Rhinella marina), including oophoritis in 1 toad. These findings represent a novel emerging disease in toads and a possible zoonotic pathogen.

EID Glabman RA, Thompson KA, Mani R, Colburn R, Agnew DW. Atypical Brucella inopinata–Like Species in 2 Marine Toads. Emerg Infect Dis. 2021;27(6):1748-1750. https://doi.org/10.3201/eid2706.204001
AMA Glabman RA, Thompson KA, Mani R, et al. Atypical Brucella inopinata–Like Species in 2 Marine Toads. Emerging Infectious Diseases. 2021;27(6):1748-1750. doi:10.3201/eid2706.204001.
APA Glabman, R. A., Thompson, K. A., Mani, R., Colburn, R., & Agnew, D. W. (2021). Atypical Brucella inopinata–Like Species in 2 Marine Toads. Emerging Infectious Diseases, 27(6), 1748-1750. https://doi.org/10.3201/eid2706.204001.

Incursion of Novel Highly Pathogenic Avian Influenza A(H5N8) Virus, the Netherlands, October 2020 [PDF - 1.31 MB - 4 pages]
N. Beerens et al.

Highly pathogenic avian influenza A(H5N8) virus was detected in mute swans in the Netherlands during October 2020. The virus shares a common ancestor with clade 2.3.4.4b viruses detected in Egypt during 2018–2019 and has similar genetic composition. The virus is not directly related to H5N8 viruses from Europe detected in the first half of 2020.

EID Beerens N, Heutink R, Harders F, Roose M, Pritz-Verschuren S, Germeraad EA, et al. Incursion of Novel Highly Pathogenic Avian Influenza A(H5N8) Virus, the Netherlands, October 2020. Emerg Infect Dis. 2021;27(6):1750-1753. https://doi.org/10.3201/eid2706.204464
AMA Beerens N, Heutink R, Harders F, et al. Incursion of Novel Highly Pathogenic Avian Influenza A(H5N8) Virus, the Netherlands, October 2020. Emerging Infectious Diseases. 2021;27(6):1750-1753. doi:10.3201/eid2706.204464.
APA Beerens, N., Heutink, R., Harders, F., Roose, M., Pritz-Verschuren, S., Germeraad, E. A....Engelsma, M. (2021). Incursion of Novel Highly Pathogenic Avian Influenza A(H5N8) Virus, the Netherlands, October 2020. Emerging Infectious Diseases, 27(6), 1750-1753. https://doi.org/10.3201/eid2706.204464.

Retrospective Identification of Early Autochthonous Case of Crimean-Congo Hemorrhagic Fever, Spain, 2013 [PDF - 902 KB - 3 pages]
A. Negredo et al.

Before this report, 7 autochthonous human cases of Crimean-Congo hemorrhagic fever had been reported in Spain, all occurring since 2016. We describe the retrospective identification of an eighth case dating back to 2013. This study highlights that the earliest cases of an emerging disease are often difficult to recognize.

EID Negredo A, Sánchez-Ledesma M, Llorente F, Pérez-Olmeda M, Belhassen-García M, González-Calle D, et al. Retrospective Identification of Early Autochthonous Case of Crimean-Congo Hemorrhagic Fever, Spain, 2013. Emerg Infect Dis. 2021;27(6):1754-1756. https://doi.org/10.3201/eid2706.204643
AMA Negredo A, Sánchez-Ledesma M, Llorente F, et al. Retrospective Identification of Early Autochthonous Case of Crimean-Congo Hemorrhagic Fever, Spain, 2013. Emerging Infectious Diseases. 2021;27(6):1754-1756. doi:10.3201/eid2706.204643.
APA Negredo, A., Sánchez-Ledesma, M., Llorente, F., Pérez-Olmeda, M., Belhassen-García, M., González-Calle, D....Jiménez-Clavero, M. (2021). Retrospective Identification of Early Autochthonous Case of Crimean-Congo Hemorrhagic Fever, Spain, 2013. Emerging Infectious Diseases, 27(6), 1754-1756. https://doi.org/10.3201/eid2706.204643.

Evidence of Oropouche Orthobunyavirus Infection, Colombia, 2017 [PDF - 1.48 MB - 3 pages]
D. E. Gómez-Camargo et al.

We describe an Oropouche orthobunyavirus infection in a women 28 years of age in Colombia. We confirmed the diagnosis by viral isolation, quantitative reverse transcription PCR, and phylogenetic analysis of the small, medium, and large genomic segments. The virus is related to a strain isolated in Ecuador in 2016.

EID Gómez-Camargo DE, Egurrola-Pedraza JA, Cruz CD, Popuche D, Ochoa-Díaz MM, Guevara C, et al. Evidence of Oropouche Orthobunyavirus Infection, Colombia, 2017. Emerg Infect Dis. 2021;27(6):1756-1758. https://doi.org/10.3201/eid2706.204405
AMA Gómez-Camargo DE, Egurrola-Pedraza JA, Cruz CD, et al. Evidence of Oropouche Orthobunyavirus Infection, Colombia, 2017. Emerging Infectious Diseases. 2021;27(6):1756-1758. doi:10.3201/eid2706.204405.
APA Gómez-Camargo, D. E., Egurrola-Pedraza, J. A., Cruz, C. D., Popuche, D., Ochoa-Díaz, M. M., Guevara, C....Ampuero, J. S. (2021). Evidence of Oropouche Orthobunyavirus Infection, Colombia, 2017. Emerging Infectious Diseases, 27(6), 1756-1758. https://doi.org/10.3201/eid2706.204405.

Fecal Excretion of Mycobacterium leprae, Burkina Faso [PDF - 1.06 MB - 3 pages]
A. Millogo et al.

Mycobacterium leprae was detected by optical microscopy, fluorescent in situ hybridization, and molecular detection in feces collected for the diagnosis of Entamoeba coli enteritis in a leprosy patient in Burkina Faso. This observation raises questions about the role of fecal excretion of M. leprae in the natural history and diagnosis of leprosy.

EID Millogo A, Loukil A, L’Ollivier C, Djibougou D, Godreuil S, Drancourt M. Fecal Excretion of Mycobacterium leprae, Burkina Faso. Emerg Infect Dis. 2021;27(6):1758-1760. https://doi.org/10.3201/eid2706.200748
AMA Millogo A, Loukil A, L’Ollivier C, et al. Fecal Excretion of Mycobacterium leprae, Burkina Faso. Emerging Infectious Diseases. 2021;27(6):1758-1760. doi:10.3201/eid2706.200748.
APA Millogo, A., Loukil, A., L’Ollivier, C., Djibougou, D., Godreuil, S., & Drancourt, M. (2021). Fecal Excretion of Mycobacterium leprae, Burkina Faso. Emerging Infectious Diseases, 27(6), 1758-1760. https://doi.org/10.3201/eid2706.200748.
Letters

Postvaccination COVID-19 among Healthcare Workers, Israel [PDF - 572 KB - 1 page]
Z. Yousaf and K. Mushtaq
EID Yousaf Z, Mushtaq K. Postvaccination COVID-19 among Healthcare Workers, Israel. Emerg Infect Dis. 2021;27(6):1761. https://doi.org/10.3201/eid2706.210410
AMA Yousaf Z, Mushtaq K. Postvaccination COVID-19 among Healthcare Workers, Israel. Emerging Infectious Diseases. 2021;27(6):1761. doi:10.3201/eid2706.210410.
APA Yousaf, Z., & Mushtaq, K. (2021). Postvaccination COVID-19 among Healthcare Workers, Israel. Emerging Infectious Diseases, 27(6), 1761. https://doi.org/10.3201/eid2706.210410.
About the Cover

Fluid Motion and Frozen Time [PDF - 2.00 MB - 2 pages]
B. Breedlove
EID Breedlove B. Fluid Motion and Frozen Time. Emerg Infect Dis. 2021;27(6):1762-1763. https://doi.org/10.3201/eid2706.ac2706
AMA Breedlove B. Fluid Motion and Frozen Time. Emerging Infectious Diseases. 2021;27(6):1762-1763. doi:10.3201/eid2706.ac2706.
APA Breedlove, B. (2021). Fluid Motion and Frozen Time. Emerging Infectious Diseases, 27(6), 1762-1763. https://doi.org/10.3201/eid2706.ac2706.
Etymologia

Etymologia: Enterocytozoon bieneusi [PDF - 785 KB - 1 page]
M. Moniot et al.
EID Moniot M, Poirier P, Nourrisson C. Etymologia: Enterocytozoon bieneusi. Emerg Infect Dis. 2021;27(6):1587. https://doi.org/10.3201/eid2706.et2706
AMA Moniot M, Poirier P, Nourrisson C. Etymologia: Enterocytozoon bieneusi. Emerging Infectious Diseases. 2021;27(6):1587. doi:10.3201/eid2706.et2706.
APA Moniot, M., Poirier, P., & Nourrisson, C. (2021). Etymologia: Enterocytozoon bieneusi. Emerging Infectious Diseases, 27(6), 1587. https://doi.org/10.3201/eid2706.et2706.
Online Reports

Proposal for Human Respiratory Syncytial Virus Nomenclature below the Species Level [PDF - 2.13 MB - 9 pages]
V. Salimi et al.

Human respiratory syncytial virus (HRSV) is the leading viral cause of serious pediatric respiratory disease, and lifelong reinfections are common. Its 2 major subgroups, A and B, exhibit some antigenic variability, enabling HRSV to circulate annually. Globally, research has increased the number of HRSV genomic sequences available. To ensure accurate molecular epidemiology analyses, we propose a uniform nomenclature for HRSV-positive samples and isolates, and HRSV sequences, namely: HRSV/subgroup identifier/geographic identifier/unique sequence identifier/year of sampling. We also propose a template for submitting associated metadata. Universal nomenclature would help researchers retrieve and analyze sequence data to better understand the evolution of this virus.

EID Salimi V, Viegas M, Trento A, Agoti CN, Anderson LJ, Avadhanula V, et al. Proposal for Human Respiratory Syncytial Virus Nomenclature below the Species Level. Emerg Infect Dis. 2021;27(6):1-9. https://doi.org/10.3201/eid2706.204608
AMA Salimi V, Viegas M, Trento A, et al. Proposal for Human Respiratory Syncytial Virus Nomenclature below the Species Level. Emerging Infectious Diseases. 2021;27(6):1-9. doi:10.3201/eid2706.204608.
APA Salimi, V., Viegas, M., Trento, A., Agoti, C. N., Anderson, L. J., Avadhanula, V....Buchholz, U. J. (2021). Proposal for Human Respiratory Syncytial Virus Nomenclature below the Species Level. Emerging Infectious Diseases, 27(6), 1-9. https://doi.org/10.3201/eid2706.204608.
Page created: May 10, 2021
Page updated: May 20, 2021
Page reviewed: May 20, 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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