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Issue Cover for Volume 28, Number 4—April 2022

Volume 28, Number 4—April 2022

[PDF - 61.35 MB - 220 pages]

Synopses

Citywide Integrated Aedes aegypti Mosquito Surveillance as Early Warning System for Arbovirus Transmission, Brazil [PDF - 2.68 MB - 10 pages]
A. S. Leandro et al.

Arbovirus epidemiology lacks efficient and timely surveillance systems with accurate outbreak alert signals. We devised a citywide integrated surveillance system combining entomologic, epidemiologic, and entomo-virologic data gathered during 2017–2020 in Foz do Iguaçu, Brazil. We installed 3,476 adult mosquito traps across the city and inspected traps every 2 months. We compared 5 entomologic indices: traditional house and Breteau indices for larval surveys and trap positivity, adult density, and mosquitoes per inhabitant indices for adult trapping. We screened for dengue, Zika, and chikungunya viruses in live adult Aedes aegypti mosquitoes collected from traps. Indices based on adult mosquito sampling had higher outbreak predictive values than larval indices, and we were able to build choropleth maps of infestation levels <36 h after each round of trap inspection. Locating naturally infected vectors provides a timely support tool for local public health managers to prioritize areas for intervention response to prevent virus outbreaks.

EID Leandro AS, de Castro W, Lopes RD, Delai RM, Villela D, de-Freitas R. Citywide Integrated Aedes aegypti Mosquito Surveillance as Early Warning System for Arbovirus Transmission, Brazil. Emerg Infect Dis. 2022;28(4):701-706. https://doi.org/10.3201/eid2804.211547
AMA Leandro AS, de Castro W, Lopes RD, et al. Citywide Integrated Aedes aegypti Mosquito Surveillance as Early Warning System for Arbovirus Transmission, Brazil. Emerging Infectious Diseases. 2022;28(4):701-706. doi:10.3201/eid2804.211547.
APA Leandro, A. S., de Castro, W., Lopes, R. D., Delai, R. M., Villela, D., & de-Freitas, R. (2022). Citywide Integrated Aedes aegypti Mosquito Surveillance as Early Warning System for Arbovirus Transmission, Brazil. Emerging Infectious Diseases, 28(4), 701-706. https://doi.org/10.3201/eid2804.211547.

Medscape CME Activity
Shewanella spp. Bloodstream Infections in Queensland, Australia [PDF - 1.07 MB - 6 pages]
K. B. Laupland et al.

The epidemiology of bloodstream infections caused by Shewanella spp. is not well defined. Our objective was to define the incidence and determinants of Shewanella spp. bloodstream infections by using population-based surveillance in Queensland, Australia during 2000‒2019. The incidence was 1.0 cases/1 million persons annually and was highest during summer and in the tropical Torres and Cape region. Older persons and male patients were at highest risk. At least 1 concurrent condition was documented in 75% of case-patients, and 30-day all cause case-fatality rate was 15%. Aging populations in warm climates might expect an increasing burden of these infections.

EID Laupland KB, Stewart AG, Edwards F, Paterson DL, Coulter S, Heney C, et al. Shewanella spp. Bloodstream Infections in Queensland, Australia. Emerg Infect Dis. 2022;28(4):701-706. https://doi.org/10.3201/eid2804.212193
AMA Laupland KB, Stewart AG, Edwards F, et al. Shewanella spp. Bloodstream Infections in Queensland, Australia. Emerging Infectious Diseases. 2022;28(4):701-706. doi:10.3201/eid2804.212193.
APA Laupland, K. B., Stewart, A. G., Edwards, F., Paterson, D. L., Coulter, S., Heney, C....Harris, P. (2022). Shewanella spp. Bloodstream Infections in Queensland, Australia. Emerging Infectious Diseases, 28(4), 701-706. https://doi.org/10.3201/eid2804.212193.

Increasing Antimicrobial Resistance in World Health Organization Eastern Mediterranean Region, 2017–2019 [PDF - 2.40 MB - 8 pages]
M. Talaat et al.

To better guide the regional response to antimicrobial resistance (AMR), we report the burden of AMR over time in countries in the World Health Organization Eastern Mediterranean Region. To assess the capacities of national infection prevention and control and antimicrobial stewardship programs, we analyzed data on bloodstream infections reported to the Global Antimicrobial Resistance Surveillance System during 2017–2019, data from 7 countries on nationally representative surveys of antimicrobial prescriptions, and data from 2 regional surveys. The median proportion of bloodstream infections was highest for carbapenem-resistant Acinetobacter spp. (70.3%) and lowest for carbapenem-resistant Escherichia coli (4.6%). Results of the regional assessments indicate that few countries have capacities for infection prevention and control and antimicrobial stewardship programs to prevent emergence and spread of AMR. Overall, the magnitude of the problem and the limited capacity to respond emphasize the need for regional political leadership in addressing AMR.

EID Talaat M, Zayed B, Tolba S, Abdou E, Gomaa M, Itani D, et al. Increasing Antimicrobial Resistance in World Health Organization Eastern Mediterranean Region, 2017–2019. Emerg Infect Dis. 2022;28(4):717-724. https://doi.org/10.3201/eid2804.211975
AMA Talaat M, Zayed B, Tolba S, et al. Increasing Antimicrobial Resistance in World Health Organization Eastern Mediterranean Region, 2017–2019. Emerging Infectious Diseases. 2022;28(4):717-724. doi:10.3201/eid2804.211975.
APA Talaat, M., Zayed, B., Tolba, S., Abdou, E., Gomaa, M., Itani, D....Hajjeh, R. (2022). Increasing Antimicrobial Resistance in World Health Organization Eastern Mediterranean Region, 2017–2019. Emerging Infectious Diseases, 28(4), 717-724. https://doi.org/10.3201/eid2804.211975.

Phylogenetic Analysis of Spread of Hepatitis C Virus Identified during HIV Outbreak Investigation, Unnao, India [PDF - 1.24 MB - 9 pages]
A. Mane et al.

An HIV outbreak investigation during 2017–2018 in Unnao District, Uttar Pradesh, India, unearthed high prevalence of hepatitis C virus (HCV) antibodies among the study participants. We investigated these HCV infections by analyzing NS5B and core regions. We observed no correlation between HIV–HCV viral loads and clustering of HCV sequences, regardless of HIV serostatus. All HCV isolates belonged to genotype 3a. Monophyletic clustering of isolates in NS5B phylogeny indicates emergence of the outbreak from a single isolate or its closely related descendants. The nucleotide substitution rate for NS5B was 6 × 10−3 and for core was 2 × 10−3 substitutions/site/year. Estimated time to most recent common ancestor of these isolates was 2012, aligning with the timeline of this outbreak, which might be attributable to unsafe injection practices while seeking healthcare. HIV–HCV co-infection underlines the need for integrated testing, surveillance, strengthening of healthcare systems, community empowerment, and molecular analyses as pragmatic public health tools.

EID Mane A, Kasibhatla S, Vidhate P, Saxena V, Patil S, Rao A, et al. Phylogenetic Analysis of Spread of Hepatitis C Virus Identified during HIV Outbreak Investigation, Unnao, India. Emerg Infect Dis. 2022;28(4):725-733. https://doi.org/10.3201/eid2804.211845
AMA Mane A, Kasibhatla S, Vidhate P, et al. Phylogenetic Analysis of Spread of Hepatitis C Virus Identified during HIV Outbreak Investigation, Unnao, India. Emerging Infectious Diseases. 2022;28(4):725-733. doi:10.3201/eid2804.211845.
APA Mane, A., Kasibhatla, S., Vidhate, P., Saxena, V., Patil, S., Rao, A....Panda, S. (2022). Phylogenetic Analysis of Spread of Hepatitis C Virus Identified during HIV Outbreak Investigation, Unnao, India. Emerging Infectious Diseases, 28(4), 725-733. https://doi.org/10.3201/eid2804.211845.
Research

SARS-CoV-2 IgG Seroprevalence among Blood Donors as a Monitor of the COVID-19 Epidemic, Brazil [PDF - 2.12 MB - 9 pages]
D. Chaves et al.

During epidemics, data from different sources can provide information on varying aspects of the epidemic process. Serology-based epidemiologic surveys could be used to compose a consistent epidemic scenario. We assessed the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG in serum samples collected from 7,837 blood donors in 7 cities of Brazil during March–December 2020. Based on our results, we propose a modification in a compartmental model that uses reported number of SARS-CoV-2 cases and serology results from blood donors as inputs and delivers estimates of hidden variables, such as daily values of SARS-CoV-2 transmission rates and cumulative incidence rate of reported and unreported SARS-CoV-2 cases. We concluded that the information about cumulative incidence of a disease in a city’s population can be obtained by testing serum samples collected from blood donors. Our proposed method also can be extended to surveillance of other infectious diseases.

EID Chaves D, Takahashi R, Campelo F, da Silva Malta M, de Oliveira I, Barbosa-Stancioli E, et al. SARS-CoV-2 IgG Seroprevalence among Blood Donors as a Monitor of the COVID-19 Epidemic, Brazil. Emerg Infect Dis. 2022;28(4):734-742. https://doi.org/10.3201/eid2804.211961
AMA Chaves D, Takahashi R, Campelo F, et al. SARS-CoV-2 IgG Seroprevalence among Blood Donors as a Monitor of the COVID-19 Epidemic, Brazil. Emerging Infectious Diseases. 2022;28(4):734-742. doi:10.3201/eid2804.211961.
APA Chaves, D., Takahashi, R., Campelo, F., da Silva Malta, M., de Oliveira, I., Barbosa-Stancioli, E....Martins, M. (2022). SARS-CoV-2 IgG Seroprevalence among Blood Donors as a Monitor of the COVID-19 Epidemic, Brazil. Emerging Infectious Diseases, 28(4), 734-742. https://doi.org/10.3201/eid2804.211961.

Diminishing Immune Responses against Variants of Concern in Dialysis Patients 4 Months after SARS-CoV-2 mRNA Vaccination [PDF - 1.22 MB - 8 pages]
A. Dulovic et al.

Patients undergoing chronic hemodialysis were among the first to receive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations because of their increased risk for severe coronavirus disease and high case-fatality rates. By using a previously reported cohort from Germany of at-risk hemodialysis patients and healthy donors, where antibody responses were examined 3 weeks after the second vaccination, we assessed systemic cellular and humoral immune responses in serum and saliva 4 months after vaccination with the Pfizer-BioNTech BNT162b2 vaccine using an interferon-γ release assay and multiplex-based IgG measurements. We further compared neutralization capacity of vaccination-induced IgG against 4 SARS-CoV-2 variants of concern (Alpha, Beta, Gamma, and Delta) by angiotensin-converting enzyme 2 receptor-binding domain competition assay. Sixteen weeks after second vaccination, compared with 3 weeks after, cellular and humoral responses against the original SARS-CoV-2 isolate and variants of concern were substantially reduced. Some dialysis patients even had no detectable B- or T-cell responses.

EID Dulovic A, Strengert M, Ramos G, Becker M, Griesbaum J, Junker D, et al. Diminishing Immune Responses against Variants of Concern in Dialysis Patients 4 Months after SARS-CoV-2 mRNA Vaccination. Emerg Infect Dis. 2022;28(4):743-750. https://doi.org/10.3201/eid2804.211907
AMA Dulovic A, Strengert M, Ramos G, et al. Diminishing Immune Responses against Variants of Concern in Dialysis Patients 4 Months after SARS-CoV-2 mRNA Vaccination. Emerging Infectious Diseases. 2022;28(4):743-750. doi:10.3201/eid2804.211907.
APA Dulovic, A., Strengert, M., Ramos, G., Becker, M., Griesbaum, J., Junker, D....Behrens, G. (2022). Diminishing Immune Responses against Variants of Concern in Dialysis Patients 4 Months after SARS-CoV-2 mRNA Vaccination. Emerging Infectious Diseases, 28(4), 743-750. https://doi.org/10.3201/eid2804.211907.

Genomic Epidemiology of Early SARS-CoV-2 Transmission Dynamics, Gujarat, India [PDF - 2.15 MB - 8 pages]
J. Raghwani et al.

Limited genomic sampling in many high-incidence countries has impeded studies of severe respiratory syndrome coronavirus 2 (SARS-CoV-2) genomic epidemiology. Consequently, critical questions remain about the generation and global distribution of virus genetic diversity. We investigated SARS-CoV-2 transmission dynamics in Gujarat, India, during the state’s first epidemic wave to shed light on spread of the virus in one of the regions hardest hit by the pandemic. By integrating case data and 434 whole-genome sequences sampled across 20 districts, we reconstructed the epidemic dynamics and spatial spread of SARS-CoV-2 in Gujarat. Our findings indicate global and regional connectivity and population density were major drivers of the Gujarat outbreak. We detected >100 virus lineage introductions, most of which appear to be associated with international travel. Within Gujarat, virus dissemination occurred predominantly from densely populated regions to geographically proximate locations that had low population density, suggesting that urban centers contributed disproportionately to virus spread.

EID Raghwani J, du Plessis L, McCrone JT, Hill SC, Parag KV, Thézé J, et al. Genomic Epidemiology of Early SARS-CoV-2 Transmission Dynamics, Gujarat, India. Emerg Infect Dis. 2022;28(4):751-758. https://doi.org/10.3201/eid2804.212053
AMA Raghwani J, du Plessis L, McCrone JT, et al. Genomic Epidemiology of Early SARS-CoV-2 Transmission Dynamics, Gujarat, India. Emerging Infectious Diseases. 2022;28(4):751-758. doi:10.3201/eid2804.212053.
APA Raghwani, J., du Plessis, L., McCrone, J. T., Hill, S. C., Parag, K. V., Thézé, J....Joshi, C. (2022). Genomic Epidemiology of Early SARS-CoV-2 Transmission Dynamics, Gujarat, India. Emerging Infectious Diseases, 28(4), 751-758. https://doi.org/10.3201/eid2804.212053.

Reassessing Reported Deaths and Estimated Infection Attack Rate during the First 6 Months of the COVID-19 Epidemic, Delhi, India [PDF - 1.15 MB - 7 pages]
M. Pons-Salort et al.

India reported >10 million coronavirus disease (COVID-19) cases and 149,000 deaths in 2020. To reassess reported deaths and estimate incidence rates during the first 6 months of the epidemic, we used a severe acute respiratory syndrome coronavirus 2 transmission model fit to data from 3 serosurveys in Delhi and time-series documentation of reported deaths. We estimated 48.7% (95% credible interval 22.1%–76.8%) cumulative infection in the population through the end of September 2020. Using an age-adjusted overall infection fatality ratio based on age-specific estimates from mostly high-income countries, we estimated that just 15.0% (95% credible interval 9.3%–34.0%) of COVID-19 deaths had been reported, indicating either substantial underreporting or lower age-specific infection-fatality ratios in India than in high-income countries. Despite the estimated high attack rate, additional epidemic waves occurred in late 2020 and April–May 2021. Future dynamics will depend on the duration of natural and vaccine-induced immunity and their effectiveness against new variants.

EID Pons-Salort M, John J, Watson OJ, Brazeau NF, Verity R, Kang G, et al. Reassessing Reported Deaths and Estimated Infection Attack Rate during the First 6 Months of the COVID-19 Epidemic, Delhi, India. Emerg Infect Dis. 2022;28(4):759-766. https://doi.org/10.3201/eid2804.210879
AMA Pons-Salort M, John J, Watson OJ, et al. Reassessing Reported Deaths and Estimated Infection Attack Rate during the First 6 Months of the COVID-19 Epidemic, Delhi, India. Emerging Infectious Diseases. 2022;28(4):759-766. doi:10.3201/eid2804.210879.
APA Pons-Salort, M., John, J., Watson, O. J., Brazeau, N. F., Verity, R., Kang, G....Grassly, N. C. (2022). Reassessing Reported Deaths and Estimated Infection Attack Rate during the First 6 Months of the COVID-19 Epidemic, Delhi, India. Emerging Infectious Diseases, 28(4), 759-766. https://doi.org/10.3201/eid2804.210879.

Mapping the Risk for West Nile Virus Transmission, Africa [PDF - 1.96 MB - 9 pages]
J. García-Carrasco et al.

West Nile virus (WNV) is an emergent arthropodborne virus that is transmitted from bird to bird by mosquitoes. Spillover events occur when infected mosquitoes bite mammals. We created a geopositioned database of WNV presence in Africa and considered reports of the virus in all animal components: reservoirs, vectors, and nonhuman dead-end hosts. We built various biogeographic models to determine which drivers explain the distribution of WNV throughout Africa. Wetlands of international importance for birds accounted for the detection of WNV in all animal components, whereas human-related drivers played a key role in the epizootic cases. We combined these models to obtain an integrative and large-scale perspective of the areas at risk for WNV spillover. Understanding which areas pose the highest risk would enable us to address the management of this spreading disease and to comprehend the translocation of WNV outside Africa through avian migration routes.

EID García-Carrasco J, Muñoz A, Olivero J, Segura M, Real R. Mapping the Risk for West Nile Virus Transmission, Africa. Emerg Infect Dis. 2022;28(4):777-785. https://doi.org/10.3201/eid2804.211103
AMA García-Carrasco J, Muñoz A, Olivero J, et al. Mapping the Risk for West Nile Virus Transmission, Africa. Emerging Infectious Diseases. 2022;28(4):777-785. doi:10.3201/eid2804.211103.
APA García-Carrasco, J., Muñoz, A., Olivero, J., Segura, M., & Real, R. (2022). Mapping the Risk for West Nile Virus Transmission, Africa. Emerging Infectious Diseases, 28(4), 777-785. https://doi.org/10.3201/eid2804.211103.

Isolation of Heartland Virus from Lone Star Ticks, Georgia, USA, 2019 [PDF - 1.31 MB - 7 pages]
Y. Romer et al.

Report of a human death and exposure of white-tailed deer to Heartland virus (HRTV) in Georgia, USA, prompted the sampling of questing ticks during 2018–2019 in 26 sites near where seropositive deer were captured and the residence of the human case-patient. We processed 9,294 Amblyomma americanum ticks in pools by virus isolation in Vero E6 cells and reverse transcription PCR. Positive pools underwent whole-genome sequencing. Three pools were positive for HRTV (minimum infection rate 0.46/1,000 ticks) and none for Bourbon virus. Cell cultures confirmed HRTV presence in 2 pools. Genome sequencing, achieved for the 3 HRTV isolates, showed high similarity among samples but marked differences with previously sequenced HRTV isolates. The isolation and genomic characterization of HRTV from A. americanum ticks in Georgia confirm virus presence in the state. Clinicians and public health professionals should be aware of this emerging tickborne pathogen.

EID Romer Y, Adcock K, Wei Z, Mead DG, Kirstein O, Bellman S, et al. Isolation of Heartland Virus from Lone Star Ticks, Georgia, USA, 2019. Emerg Infect Dis. 2022;28(4):786-792. https://doi.org/10.3201/eid2804.211540
AMA Romer Y, Adcock K, Wei Z, et al. Isolation of Heartland Virus from Lone Star Ticks, Georgia, USA, 2019. Emerging Infectious Diseases. 2022;28(4):786-792. doi:10.3201/eid2804.211540.
APA Romer, Y., Adcock, K., Wei, Z., Mead, D. G., Kirstein, O., Bellman, S....Vazquez-Prokopec, G. M. (2022). Isolation of Heartland Virus from Lone Star Ticks, Georgia, USA, 2019. Emerging Infectious Diseases, 28(4), 786-792. https://doi.org/10.3201/eid2804.211540.

Increased Attack Rates and Decreased Incubation Periods in Raccoons with Chronic Wasting Disease Passaged through Meadow Voles [PDF - 2.81 MB - 9 pages]
S. J. Moore et al.

Chronic wasting disease (CWD) is a naturally-occurring neurodegenerative disease of cervids. Raccoons (Procyon lotor) and meadow voles (Microtus pennsylvanicus) have previously been shown to be susceptible to the CWD agent. To investigate the potential for transmission of the agent of CWD from white-tailed deer to voles and subsequently to raccoons, we intracranially inoculated raccoons with brain homogenate from a CWD-affected white-tailed deer (CWDWtd) or derivatives of this isolate after it had been passaged through voles 1 or 5 times. We found that passage of the CWDWtd isolate through voles led to a change in the biologic behavior of the CWD agent, including increased attack rates and decreased incubation periods in raccoons. A better understanding of the dynamics of cross-species transmission of CWD prions can provide insights into how these infectious proteins evolve in new hosts.

EID Moore SJ, Carlson CM, Schneider JR, Johnson CJ, Greenlee JJ. Increased Attack Rates and Decreased Incubation Periods in Raccoons with Chronic Wasting Disease Passaged through Meadow Voles. Emerg Infect Dis. 2022;28(4):793-801. https://doi.org/10.3201/eid2804.210271
AMA Moore SJ, Carlson CM, Schneider JR, et al. Increased Attack Rates and Decreased Incubation Periods in Raccoons with Chronic Wasting Disease Passaged through Meadow Voles. Emerging Infectious Diseases. 2022;28(4):793-801. doi:10.3201/eid2804.210271.
APA Moore, S. J., Carlson, C. M., Schneider, J. R., Johnson, C. J., & Greenlee, J. J. (2022). Increased Attack Rates and Decreased Incubation Periods in Raccoons with Chronic Wasting Disease Passaged through Meadow Voles. Emerging Infectious Diseases, 28(4), 793-801. https://doi.org/10.3201/eid2804.210271.

Fatal Human Alphaherpesvirus 1 Infection in Free-Ranging Black-Tufted Marmosets in Anthropized Environments, Brazil, 2012–2019 [PDF - 5.71 MB - 10 pages]
T. M. Wilson et al.

Human alphaherpesvirus 1 (HuAHV1) causes fatal neurologic infections in captive New World primates. To determine risks for interspecies transmission, we examined data for 13 free-ranging, black-tufted marmosets (Callithrix penicillata) that died of HuAHV1 infection and had been in close contact with humans in anthropized areas in Brazil during 2012–2019. We evaluated pathologic changes in the marmosets, localized virus and antigen, and assessed epidemiologic features. The main clinical findings were neurologic signs, necrotizing meningoencephalitis, and ulcerative glossitis; 1 animal had necrotizing hepatitis. Transmission electron microscopy revealed intranuclear herpetic inclusions, and immunostaining revealed HuAHV1 and herpesvirus particles in neurons, glial cells, tongue mucosal epithelium, and hepatocytes. PCR confirmed HuAHV1 infection. These findings illustrate how disruption of the One Health equilibrium in anthropized environments poses risks for interspecies virus transmission with potential spillover not only from animals to humans but also from humans to free-ranging nonhuman primates or other animals.

EID Wilson TM, Ritter JM, Martines RB, Bullock HA, Fair P, Radford KW, et al. Fatal Human Alphaherpesvirus 1 Infection in Free-Ranging Black-Tufted Marmosets in Anthropized Environments, Brazil, 2012–2019. Emerg Infect Dis. 2022;28(4):802-811. https://doi.org/10.3201/eid2804.212334
AMA Wilson TM, Ritter JM, Martines RB, et al. Fatal Human Alphaherpesvirus 1 Infection in Free-Ranging Black-Tufted Marmosets in Anthropized Environments, Brazil, 2012–2019. Emerging Infectious Diseases. 2022;28(4):802-811. doi:10.3201/eid2804.212334.
APA Wilson, T. M., Ritter, J. M., Martines, R. B., Bullock, H. A., Fair, P., Radford, K. W....Castro, M. B. (2022). Fatal Human Alphaherpesvirus 1 Infection in Free-Ranging Black-Tufted Marmosets in Anthropized Environments, Brazil, 2012–2019. Emerging Infectious Diseases, 28(4), 802-811. https://doi.org/10.3201/eid2804.212334.

Molecular Surveillance for Imported Antimicrobial Resistant Plasmodium falciparum, Ontario, Canada [PDF - 640 KB - 8 pages]
R. Kariyawasam et al.

Single-nucleotide polymorphisms at several loci have been correlated with Plasmodium falciparum drug resistance. We examined the prevalence of resistance markers in P. falciparum from imported malaria cases in Canada during 3 time periods, 2008–2009, 2013–2014, and 2017–2018. We evaluated single-nucleotide polymorphisms at atpase6 (pfATPase6), pfcrt (chloroquine resistance transporter), cytb (cytochrome b), dhfr (dihydrofolate reductase), dhps (dihydropteroate synthetase), mdr1 (multidrug resistance protein) and mdr1 copy number, and kelch13 (kelch protein gene on chromosome 13). Over time, we observed increasing mutant genotypes for dhfr S108N and dhps A613T and decreasing mutant genotypes for mdr1 N86Y, D1246Y, pfcrt K76T, and pfcrt 74–75; we identified no kelch13 mutations. We observed fewer mutations indicative of chloroquine resistance over time, which may reflect reduced chloroquine pressure in specimens from travelers to Africa. Mutations conferring proguanil resistance increased over time. Minor genotypes confirm the heterogeneous nature of infection and may affect treatment success.

EID Kariyawasam R, Lau R, Shao E, Tan K, Showler A, Ralevski F, et al. Molecular Surveillance for Imported Antimicrobial Resistant Plasmodium falciparum, Ontario, Canada. Emerg Infect Dis. 2022;28(4):812-819. https://doi.org/10.3201/eid2804.210533
AMA Kariyawasam R, Lau R, Shao E, et al. Molecular Surveillance for Imported Antimicrobial Resistant Plasmodium falciparum, Ontario, Canada. Emerging Infectious Diseases. 2022;28(4):812-819. doi:10.3201/eid2804.210533.
APA Kariyawasam, R., Lau, R., Shao, E., Tan, K., Showler, A., Ralevski, F....Boggild, A. K. (2022). Molecular Surveillance for Imported Antimicrobial Resistant Plasmodium falciparum, Ontario, Canada. Emerging Infectious Diseases, 28(4), 812-819. https://doi.org/10.3201/eid2804.210533.

Decrease in Tuberculosis Cases during COVID-19 Pandemic as Reflected by Outpatient Pharmacy Data, United States, 2020 [PDF - 996 KB - 8 pages]
K. Winglee et al.

We analyzed a pharmacy dataset to assess the 20% decline in tuberculosis (TB) cases reported to the US National Tuberculosis Surveillance System (NTSS) during the coronavirus disease pandemic in 2020 compared with the 2016–2019 average. We examined the correlation between TB medication dispensing data to TB case counts in NTSS and used a seasonal autoregressive integrated moving average model to predict expected 2020 counts. Trends in the TB medication data were correlated with trends in NTSS data during 2006–2019. There were fewer prescriptions and cases in 2020 than would be expected on the basis of previous trends. This decrease was particularly large during April–May 2020. These data are consistent with NTSS data, suggesting that underreporting is not occurring but not ruling out underdiagnosis or actual decline. Understanding the mechanisms behind the 2020 decline in reported TB cases will help TB programs better prepare for postpandemic cases.

EID Winglee K, Hill AN, Langer AJ, Self JL. Decrease in Tuberculosis Cases during COVID-19 Pandemic as Reflected by Outpatient Pharmacy Data, United States, 2020. Emerg Infect Dis. 2022;28(4):820-827. https://doi.org/10.3201/eid2804.212014
AMA Winglee K, Hill AN, Langer AJ, et al. Decrease in Tuberculosis Cases during COVID-19 Pandemic as Reflected by Outpatient Pharmacy Data, United States, 2020. Emerging Infectious Diseases. 2022;28(4):820-827. doi:10.3201/eid2804.212014.
APA Winglee, K., Hill, A. N., Langer, A. J., & Self, J. L. (2022). Decrease in Tuberculosis Cases during COVID-19 Pandemic as Reflected by Outpatient Pharmacy Data, United States, 2020. Emerging Infectious Diseases, 28(4), 820-827. https://doi.org/10.3201/eid2804.212014.

Medscape CME Activity
Unique Clinical, Immune, and Genetic Signature in Patients with Borrelial Meningoradiculoneuritis [PDF - 2.53 MB - 11 pages]
K. Ogrinc et al.

Lyme neuroborreliosis (LNB) in Europe may manifest with painful meningoradiculoneuritis (also known as Bannwarth syndrome) or lymphocytic meningitis with or without cranial neuritis (peripheral facial palsy). We assessed host immune responses and the prevalence of TLR1 (toll-like receptor 1)–1805GG polymorphism to gain insights into the pathophysiology of these conditions. Regardless of LNB manifestation, most mediators associated with innate and adaptive immune responses were concentrated in cerebrospinal fluid; serum levels were unremarkable. When stratified by specific clinical manifestation, patients with meningoradiculoneuritis had higher levels of B-cell chemoattractants CXC motif chemokine ligand (CXCL) 12 and CXCL13 and T-cell–associated mediators CXCL9, CXCL10, and interleukin 17, compared with those without radicular pain. Moreover, these patients had a higher frequency of TLR1–1805GG polymorphism and more constitutional symptoms. These findings demonstrate that meningoradiculoneuritis is a distinct clinical entity with unique immune and genetic pathophysiology, providing new considerations for the study of LNB and borrelial meningoradiculitis.

EID Ogrinc K, Hernández SA, Korva M, Bogovič P, Rojko T, Lusa L, et al. Unique Clinical, Immune, and Genetic Signature in Patients with Borrelial Meningoradiculoneuritis. Emerg Infect Dis. 2022;28(4):766-776. https://doi.org/10.3201/eid2804.211831
AMA Ogrinc K, Hernández SA, Korva M, et al. Unique Clinical, Immune, and Genetic Signature in Patients with Borrelial Meningoradiculoneuritis. Emerging Infectious Diseases. 2022;28(4):766-776. doi:10.3201/eid2804.211831.
APA Ogrinc, K., Hernández, S. A., Korva, M., Bogovič, P., Rojko, T., Lusa, L....Strle, K. (2022). Unique Clinical, Immune, and Genetic Signature in Patients with Borrelial Meningoradiculoneuritis. Emerging Infectious Diseases, 28(4), 766-776. https://doi.org/10.3201/eid2804.211831.
Dispatches

Durability of Antibody Response and Frequency of SARS-CoV-2 Infection 6 Months after COVID-19 Vaccination in Healthcare Workers [PDF - 1.06 MB - 5 pages]
E. D. Laing et al.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies decay but persist 6 months postvaccination; lower levels of neutralizing titers persist against Delta than wild-type virus. Of 227 vaccinated healthcare workers tested, only 2 experienced outpatient symptomatic breakthrough infections, despite 59/227 exhibiting serologic evidence of SARS-CoV-2 infection, defined as presence of nucleocapsid protein antibodies.

EID Laing ED, Weiss CD, Samuels EC, Coggins SA, Wang W, Wang R, et al. Durability of Antibody Response and Frequency of SARS-CoV-2 Infection 6 Months after COVID-19 Vaccination in Healthcare Workers. Emerg Infect Dis. 2022;28(4):828-832. https://doi.org/10.3201/eid2804.212037
AMA Laing ED, Weiss CD, Samuels EC, et al. Durability of Antibody Response and Frequency of SARS-CoV-2 Infection 6 Months after COVID-19 Vaccination in Healthcare Workers. Emerging Infectious Diseases. 2022;28(4):828-832. doi:10.3201/eid2804.212037.
APA Laing, E. D., Weiss, C. D., Samuels, E. C., Coggins, S. A., Wang, W., Wang, R....Mitre, E. (2022). Durability of Antibody Response and Frequency of SARS-CoV-2 Infection 6 Months after COVID-19 Vaccination in Healthcare Workers. Emerging Infectious Diseases, 28(4), 828-832. https://doi.org/10.3201/eid2804.212037.

SARS-CoV-2 Outbreak among Malayan Tigers and Humans, Tennessee, USA, 2020 [PDF - 1013 KB - 4 pages]
H. N. Grome et al.

We report an outbreak of severe acute respiratory syndrome coronavirus 2 involving 3 Malayan tigers (Panthera tigris jacksoni) at a zoo in Tennessee, USA. Investigation identified naturally occurring tiger-to-tiger transmission; genetic sequence change occurred with viral passage. We provide epidemiologic, environmental, and genomic sequencing data for animal and human infections.

EID Grome HN, Meyer B, Read E, Buchanan M, Cushing A, Sawatzki K, et al. SARS-CoV-2 Outbreak among Malayan Tigers and Humans, Tennessee, USA, 2020. Emerg Infect Dis. 2022;28(4):833-836. https://doi.org/10.3201/eid2804.212219
AMA Grome HN, Meyer B, Read E, et al. SARS-CoV-2 Outbreak among Malayan Tigers and Humans, Tennessee, USA, 2020. Emerging Infectious Diseases. 2022;28(4):833-836. doi:10.3201/eid2804.212219.
APA Grome, H. N., Meyer, B., Read, E., Buchanan, M., Cushing, A., Sawatzki, K....Dunn, J. (2022). SARS-CoV-2 Outbreak among Malayan Tigers and Humans, Tennessee, USA, 2020. Emerging Infectious Diseases, 28(4), 833-836. https://doi.org/10.3201/eid2804.212219.

Zika Virus after the Public Health Emergency of International Concern Period, Brazil [PDF - 1.24 MB - 4 pages]
L. Yakob

More than 100,000 Zika virus cases have been reported in Brazil since the Public Health Emergency of International Concern period ended in 2016. We analyzed cases in Brazil during 2017–2021 to identify transmission trends and forecast future infection hotspots. Our results can be used for targeted interventions to reduce transmission.

EID Yakob L. Zika Virus after the Public Health Emergency of International Concern Period, Brazil. Emerg Infect Dis. 2022;28(4):837-840. https://doi.org/10.3201/eid2804.211949
AMA Yakob L. Zika Virus after the Public Health Emergency of International Concern Period, Brazil. Emerging Infectious Diseases. 2022;28(4):837-840. doi:10.3201/eid2804.211949.
APA Yakob, L. (2022). Zika Virus after the Public Health Emergency of International Concern Period, Brazil. Emerging Infectious Diseases, 28(4), 837-840. https://doi.org/10.3201/eid2804.211949.

Vehicle Windshield Wiper Fluid as Potential Source of Sporadic Legionnaires’ Disease in Commercial Truck Drivers [PDF - 289 KB - 3 pages]
J. Politi et al.

Sporadic Legionnaires’ disease is frequently detected in commercial truck drivers. We report 2 sporadic cases of this disease in Barcelona, Spain, that occurred during December 2019 and September 2020. Laboratory findings were consistent with windshield wiper fluid without added screen wash as a possible source of infection for both cases.

EID Politi J, Queralt A, Valero N, Martín-Gómez MT, Durán R, Parra E, et al. Vehicle Windshield Wiper Fluid as Potential Source of Sporadic Legionnaires’ Disease in Commercial Truck Drivers. Emerg Infect Dis. 2022;28(4):841-843. https://doi.org/10.3201/eid2804.210814
AMA Politi J, Queralt A, Valero N, et al. Vehicle Windshield Wiper Fluid as Potential Source of Sporadic Legionnaires’ Disease in Commercial Truck Drivers. Emerging Infectious Diseases. 2022;28(4):841-843. doi:10.3201/eid2804.210814.
APA Politi, J., Queralt, A., Valero, N., Martín-Gómez, M. T., Durán, R., Parra, E....Álamo-Junquera, D. (2022). Vehicle Windshield Wiper Fluid as Potential Source of Sporadic Legionnaires’ Disease in Commercial Truck Drivers. Emerging Infectious Diseases, 28(4), 841-843. https://doi.org/10.3201/eid2804.210814.

Bordetella hinzii Pneumonia in Patient with SARS-CoV-2 Infection [PDF - 908 KB - 4 pages]
H. Ben Lakhal et al.

Patients infected with severe acute respiratory syndrome coronavirus 2 might have bacterial and fungal superinfections develop. We describe a clinical case of coronavirus disease with pulmonary aspergillosis associated with Bordetella hinzii pneumonia in an immunocompetent patient in France. B. hinzii infections are rare in humans and develop secondary to immunosuppression or debilitating diseases.

EID Ben Lakhal H, Cachinho J, Kalfon P, Naas T, Benseddik Z. Bordetella hinzii Pneumonia in Patient with SARS-CoV-2 Infection. Emerg Infect Dis. 2022;28(4):844-847. https://doi.org/10.3201/eid2804.212564
AMA Ben Lakhal H, Cachinho J, Kalfon P, et al. Bordetella hinzii Pneumonia in Patient with SARS-CoV-2 Infection. Emerging Infectious Diseases. 2022;28(4):844-847. doi:10.3201/eid2804.212564.
APA Ben Lakhal, H., Cachinho, J., Kalfon, P., Naas, T., & Benseddik, Z. (2022). Bordetella hinzii Pneumonia in Patient with SARS-CoV-2 Infection. Emerging Infectious Diseases, 28(4), 844-847. https://doi.org/10.3201/eid2804.212564.

Coccidioidomycosis Cases at a Regional Referral Center, West Texas, USA, 2013–2019 [PDF - 868 KB - 4 pages]
C. Peterson et al.

We describe 73 patients with coccidioidomycosis diagnosed or treated at a regional referral center in West Texas, USA. Patients most at risk worked in oil production or agriculture; the most-associated health factors were smoking and diabetes. Patient demographics suggest that access to care may affect coccidioidomycosis diagnosis in this region.

EID Peterson C, Chu V, Lovelace J, Almekdash M, Lacy M. Coccidioidomycosis Cases at a Regional Referral Center, West Texas, USA, 2013–2019. Emerg Infect Dis. 2022;28(4):848-851. https://doi.org/10.3201/eid2804.211912
AMA Peterson C, Chu V, Lovelace J, et al. Coccidioidomycosis Cases at a Regional Referral Center, West Texas, USA, 2013–2019. Emerging Infectious Diseases. 2022;28(4):848-851. doi:10.3201/eid2804.211912.
APA Peterson, C., Chu, V., Lovelace, J., Almekdash, M., & Lacy, M. (2022). Coccidioidomycosis Cases at a Regional Referral Center, West Texas, USA, 2013–2019. Emerging Infectious Diseases, 28(4), 848-851. https://doi.org/10.3201/eid2804.211912.

In Vitro Confirmation of Artemisinin Resistance in Plasmodium falciparum from Patient Isolates, Southern Rwanda, 2019 [PDF - 1.03 MB - 4 pages]
W. van Loon et al.

Artemisinin resistance in Plasmodium falciparum is conferred by mutations in the kelch 13 (K13) gene. In Rwanda, K13 mutations have increased over the past decade, including mutations associated with delayed parasite clearance. We document artemisinin resistance in P. falciparum patient isolates from Rwanda carrying K13 R561H, A675V, and C469F mutations.

EID van Loon W, Oliveira R, Bergmann C, Habarugira F, Ndoli J, Sendegeya A, et al. In Vitro Confirmation of Artemisinin Resistance in Plasmodium falciparum from Patient Isolates, Southern Rwanda, 2019. Emerg Infect Dis. 2022;28(4):852-855. https://doi.org/10.3201/eid2804.212269
AMA van Loon W, Oliveira R, Bergmann C, et al. In Vitro Confirmation of Artemisinin Resistance in Plasmodium falciparum from Patient Isolates, Southern Rwanda, 2019. Emerging Infectious Diseases. 2022;28(4):852-855. doi:10.3201/eid2804.212269.
APA van Loon, W., Oliveira, R., Bergmann, C., Habarugira, F., Ndoli, J., Sendegeya, A....Mockenhaupt, F. P. (2022). In Vitro Confirmation of Artemisinin Resistance in Plasmodium falciparum from Patient Isolates, Southern Rwanda, 2019. Emerging Infectious Diseases, 28(4), 852-855. https://doi.org/10.3201/eid2804.212269.

Rigidoporus corticola Colonization and Invasive Fungal Disease in Immunocompromised Patients, United States [PDF - 1.96 MB - 4 pages]
A. C. Laga et al.

We report 2 cases of Rigidoporus corticola (Oxyporus corticola) infection in humans in the United States. Clinical manifestations consisted of angioinvasive fungal sinusitis in 1 patient and pulmonary intracavitary fungus ball in the other patient. These cases illustrate previously undescribed clinicopathologic manifestations of infection by this filamentous basidiomycete in humans.

EID Laga AC, Crothers JW, Cañete-Gibas CF, Wiederhold NP, Solomon IH. Rigidoporus corticola Colonization and Invasive Fungal Disease in Immunocompromised Patients, United States. Emerg Infect Dis. 2022;28(4):856-859. https://doi.org/10.3201/eid2804.211987
AMA Laga AC, Crothers JW, Cañete-Gibas CF, et al. Rigidoporus corticola Colonization and Invasive Fungal Disease in Immunocompromised Patients, United States. Emerging Infectious Diseases. 2022;28(4):856-859. doi:10.3201/eid2804.211987.
APA Laga, A. C., Crothers, J. W., Cañete-Gibas, C. F., Wiederhold, N. P., & Solomon, I. H. (2022). Rigidoporus corticola Colonization and Invasive Fungal Disease in Immunocompromised Patients, United States. Emerging Infectious Diseases, 28(4), 856-859. https://doi.org/10.3201/eid2804.211987.

Zoonotic Pathogens in Wildlife Traded in Markets for Human Consumption, Laos [PDF - 571 KB - 5 pages]
P. Nawtaisong et al.

We tested animals from wildlife trade sites in Laos for the presence of zoonotic pathogens. Leptospira spp. were the most frequently detected infectious agents, found in 20.1% of animals. Rickettsia typhi and R. felis were also detected. These findings suggest a substantial risk for exposure through handling and consumption of wild animal meat.

EID Nawtaisong P, Robinson MT, Khammavong K, Milavong P, Rachlin A, Dittrich S, et al. Zoonotic Pathogens in Wildlife Traded in Markets for Human Consumption, Laos. Emerg Infect Dis. 2022;28(4):860-864. https://doi.org/10.3201/eid2804.210249
AMA Nawtaisong P, Robinson MT, Khammavong K, et al. Zoonotic Pathogens in Wildlife Traded in Markets for Human Consumption, Laos. Emerging Infectious Diseases. 2022;28(4):860-864. doi:10.3201/eid2804.210249.
APA Nawtaisong, P., Robinson, M. T., Khammavong, K., Milavong, P., Rachlin, A., Dittrich, S....Newton, P. N. (2022). Zoonotic Pathogens in Wildlife Traded in Markets for Human Consumption, Laos. Emerging Infectious Diseases, 28(4), 860-864. https://doi.org/10.3201/eid2804.210249.

Infectious Toscana Virus in Seminal Fluid of Young Man Returning from Elba Island, Italy [PDF - 1.31 MB - 5 pages]
G. Matusali et al.

We report detecting infectious Toscana virus in the seminal fluid of a 25-year-old man from Italy returning from Elba Island. The presence of infectious virus in human semen adds Toscana virus to the long list of viruses detected in this genital fluid and indicates a potential for sexual transmission.

EID Matusali G, D’Abramo A, Terrosi C, Carletti F, Colavita F, Vairo F, et al. Infectious Toscana Virus in Seminal Fluid of Young Man Returning from Elba Island, Italy. Emerg Infect Dis. 2022;28(4):865-869. https://doi.org/10.3201/eid2804.211920
AMA Matusali G, D’Abramo A, Terrosi C, et al. Infectious Toscana Virus in Seminal Fluid of Young Man Returning from Elba Island, Italy. Emerging Infectious Diseases. 2022;28(4):865-869. doi:10.3201/eid2804.211920.
APA Matusali, G., D’Abramo, A., Terrosi, C., Carletti, F., Colavita, F., Vairo, F....Nicastri, E. (2022). Infectious Toscana Virus in Seminal Fluid of Young Man Returning from Elba Island, Italy. Emerging Infectious Diseases, 28(4), 865-869. https://doi.org/10.3201/eid2804.211920.
Research Letters

Multisystem Inflammatory Syndrome in Adult after First Dose of mRNA Vaccine [PDF - 670 KB - 3 pages]
Y. Miyazato et al.

A 32-year-old man in Japan experienced respiratory failure after receiving the first dose of coronavirus disease (COVID-19) vaccine. He was treated with noninvasive ventilation and corticosteroids. Serologic test results suggested previous COVID-19; therefore, he received a diagnosis of multisystem inflammatory syndrome. COVID-19 vaccination could be a trigger for this condition.

EID Miyazato Y, Yamamoto K, Yamada G, Kubota S, Ishikane M, Sugiyama M, et al. Multisystem Inflammatory Syndrome in Adult after First Dose of mRNA Vaccine. Emerg Infect Dis. 2022;28(4):870-872. https://doi.org/10.3201/eid2804.212585
AMA Miyazato Y, Yamamoto K, Yamada G, et al. Multisystem Inflammatory Syndrome in Adult after First Dose of mRNA Vaccine. Emerging Infectious Diseases. 2022;28(4):870-872. doi:10.3201/eid2804.212585.
APA Miyazato, Y., Yamamoto, K., Yamada, G., Kubota, S., Ishikane, M., Sugiyama, M....Ohmagari, N. (2022). Multisystem Inflammatory Syndrome in Adult after First Dose of mRNA Vaccine. Emerging Infectious Diseases, 28(4), 870-872. https://doi.org/10.3201/eid2804.212585.

Recurrent SARS-CoV-2 RNA Detection after COVID-19 Illness Onset during Pregnancy [PDF - 784 KB - 4 pages]
I. Griffin et al.

The Surveillance for Emerging Threats to Mothers and Babies Network conducts longitudinal surveillance of pregnant persons in the United States with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection during pregnancy. Of 6,551 infected pregnant persons in this analysis, 142 (2.2%) had positive RNA tests >90 days and up to 416 days after infection.

EID Griffin I, Woodworth KR, Galang RR, Burkel VK, Neelam V, Siebman S, et al. Recurrent SARS-CoV-2 RNA Detection after COVID-19 Illness Onset during Pregnancy. Emerg Infect Dis. 2022;28(4):873-876. https://doi.org/10.3201/eid2804.212354
AMA Griffin I, Woodworth KR, Galang RR, et al. Recurrent SARS-CoV-2 RNA Detection after COVID-19 Illness Onset during Pregnancy. Emerging Infectious Diseases. 2022;28(4):873-876. doi:10.3201/eid2804.212354.
APA Griffin, I., Woodworth, K. R., Galang, R. R., Burkel, V. K., Neelam, V., Siebman, S....Tong, V. T. (2022). Recurrent SARS-CoV-2 RNA Detection after COVID-19 Illness Onset during Pregnancy. Emerging Infectious Diseases, 28(4), 873-876. https://doi.org/10.3201/eid2804.212354.

Hantavirus Pulmonary Syndrome in a COVID-19 Patient, Argentina, 2020 [PDF - 568 KB - 3 pages]
R. M. Coelho et al.

We describe a patient in Argentina with severe acute respiratory syndrome coronavirus 2 infection and hantavirus pulmonary syndrome (HPS). Although both coronavirus disease and HPS can be fatal when not diagnosed and treated promptly, HPS is much more lethal. This case report may contribute to improved detection of co-infections in HPS-endemic regions.

EID Coelho RM, Periolo N, Duhalde C, Alonso DO, Bellomo CM, Corazza M, et al. Hantavirus Pulmonary Syndrome in a COVID-19 Patient, Argentina, 2020. Emerg Infect Dis. 2022;28(4):876-878. https://doi.org/10.3201/eid2804.211837
AMA Coelho RM, Periolo N, Duhalde C, et al. Hantavirus Pulmonary Syndrome in a COVID-19 Patient, Argentina, 2020. Emerging Infectious Diseases. 2022;28(4):876-878. doi:10.3201/eid2804.211837.
APA Coelho, R. M., Periolo, N., Duhalde, C., Alonso, D. O., Bellomo, C. M., Corazza, M....Martinez, V. P. (2022). Hantavirus Pulmonary Syndrome in a COVID-19 Patient, Argentina, 2020. Emerging Infectious Diseases, 28(4), 876-878. https://doi.org/10.3201/eid2804.211837.

Early Circulation of SARS-CoV-2, Congo, 2020 [PDF - 409 KB - 3 pages]
N. Bonguili et al.

To determine when severe acute respiratory syndrome coronavirus 2 arrived in Congo, we retrospectively antibody tested 937 blood samples collected during September 2019–February 2020. Seropositivity significantly increased from 1% in December 2019 to 5.3% in February 2020, before the first officially reported case in March 2020, suggesting unexpected early virus circulation.

EID Bonguili N, Fritz M, Lenguiya L, Mayengue P, Koukouikila-Koussounda F, Dossou-Yovo L, et al. Early Circulation of SARS-CoV-2, Congo, 2020. Emerg Infect Dis. 2022;28(4):878-880. https://doi.org/10.3201/eid2804.212476
AMA Bonguili N, Fritz M, Lenguiya L, et al. Early Circulation of SARS-CoV-2, Congo, 2020. Emerging Infectious Diseases. 2022;28(4):878-880. doi:10.3201/eid2804.212476.
APA Bonguili, N., Fritz, M., Lenguiya, L., Mayengue, P., Koukouikila-Koussounda, F., Dossou-Yovo, L....Niama, F. R. (2022). Early Circulation of SARS-CoV-2, Congo, 2020. Emerging Infectious Diseases, 28(4), 878-880. https://doi.org/10.3201/eid2804.212476.

Amplification Artifact in SARS-CoV-2 Omicron Sequences Carrying P681R Mutation, New York, USA [PDF - 510 KB - 3 pages]
A. Heguy et al.

Of 379 severe acute respiratory syndrome coronavirus 2 samples collected in New York, USA, we detected 86 Omicron variant sequences containing Delta variant mutation P681R. Probable explanations were co-infection with 2 viruses or contamination/amplification artifact. Repeated library preparation with fewer cycles showed the P681R calls were artifactual. Unusual mutations should be interpreted with caution.

EID Heguy A, Dimartino D, Marier C, Zappile P, Guzman E, Duerr R, et al. Amplification Artifact in SARS-CoV-2 Omicron Sequences Carrying P681R Mutation, New York, USA. Emerg Infect Dis. 2022;28(4):881-883. https://doi.org/10.3201/eid2804.220146
AMA Heguy A, Dimartino D, Marier C, et al. Amplification Artifact in SARS-CoV-2 Omicron Sequences Carrying P681R Mutation, New York, USA. Emerging Infectious Diseases. 2022;28(4):881-883. doi:10.3201/eid2804.220146.
APA Heguy, A., Dimartino, D., Marier, C., Zappile, P., Guzman, E., Duerr, R....St. George, K. (2022). Amplification Artifact in SARS-CoV-2 Omicron Sequences Carrying P681R Mutation, New York, USA. Emerging Infectious Diseases, 28(4), 881-883. https://doi.org/10.3201/eid2804.220146.

Tularemia Transmission to Humans, the Netherlands, 2011–2021 [PDF - 319 KB - 3 pages]
J. M. Rijks et al.

We used national registry data on human cases of Francisella tularensis subspecies holarctica infection to assess transmission modes among all 26 autochthonous cases in the Netherlands since 2011. The results indicate predominance of terrestrial over aquatic animal transmission sources. We recommend targeting disease-risk communication toward hunters, recreationists, and outdoor professionals.

EID Rijks JM, Tulen AD, Notermans DW, Reubsaet F, de Vries MC, Koene M, et al. Tularemia Transmission to Humans, the Netherlands, 2011–2021. Emerg Infect Dis. 2022;28(4):883-885. https://doi.org/10.3201/eid2804.211913
AMA Rijks JM, Tulen AD, Notermans DW, et al. Tularemia Transmission to Humans, the Netherlands, 2011–2021. Emerging Infectious Diseases. 2022;28(4):883-885. doi:10.3201/eid2804.211913.
APA Rijks, J. M., Tulen, A. D., Notermans, D. W., Reubsaet, F., de Vries, M. C., Koene, M....Maas, M. (2022). Tularemia Transmission to Humans, the Netherlands, 2011–2021. Emerging Infectious Diseases, 28(4), 883-885. https://doi.org/10.3201/eid2804.211913.

Streptobacillus notomytis Bacteremia after Exposure to Rat Feces [PDF - 632 KB - 3 pages]
A. Kawashima et al.

To determine the source of Streptobacillus notomytis bacteremia in a woman in Japan with signs of rat-bite fever, we examined rat feces from her home. After culture and PCR failed to identify the causative organism in the feces, next-generation sequencing detected Streptobacillus spp., illustrating this procedure’s value for identifying causative environmental organisms.

EID Kawashima A, Kutsuna S, Shimomura A, Sato L, Ando H, Tanikawa T, et al. Streptobacillus notomytis Bacteremia after Exposure to Rat Feces. Emerg Infect Dis. 2022;28(4):886-888. https://doi.org/10.3201/eid2804.204965
AMA Kawashima A, Kutsuna S, Shimomura A, et al. Streptobacillus notomytis Bacteremia after Exposure to Rat Feces. Emerging Infectious Diseases. 2022;28(4):886-888. doi:10.3201/eid2804.204965.
APA Kawashima, A., Kutsuna, S., Shimomura, A., Sato, L., Ando, H., Tanikawa, T....Ohmagari, N. (2022). Streptobacillus notomytis Bacteremia after Exposure to Rat Feces. Emerging Infectious Diseases, 28(4), 886-888. https://doi.org/10.3201/eid2804.204965.

Autochthonous Leishmania infantum in Dogs, Zambia, 2021 [PDF - 806 KB - 3 pages]
D. Squarre et al.

Leishmaniases are neglected tropical diseases of humans and animals. We detected Leishmania infantum in 3 mixed-breed dogs in Zambia that had no travel history outside the country. Our findings suggest presence of and probable emergence of leishmaniasis in Zambia, indicating the need for physicians and veterinarians to consider the disease during diagnosis.

EID Squarre D, Chambaro HM, Hayashida K, Moonga LC, Qiu Y, Goto Y, et al. Autochthonous Leishmania infantum in Dogs, Zambia, 2021. Emerg Infect Dis. 2022;28(4):888-890. https://doi.org/10.3201/eid2804.212378
AMA Squarre D, Chambaro HM, Hayashida K, et al. Autochthonous Leishmania infantum in Dogs, Zambia, 2021. Emerging Infectious Diseases. 2022;28(4):888-890. doi:10.3201/eid2804.212378.
APA Squarre, D., Chambaro, H. M., Hayashida, K., Moonga, L. C., Qiu, Y., Goto, Y....Fandamu, P. (2022). Autochthonous Leishmania infantum in Dogs, Zambia, 2021. Emerging Infectious Diseases, 28(4), 888-890. https://doi.org/10.3201/eid2804.212378.

Pseudo-Outbreak of Bordetella parapertussis Caused by Contaminated Swabs in the Netherlands [PDF - 700 KB - 3 pages]
J. Flipse et al.

An increase in positive Bordetella parapertussis tests among patients in a teaching hospital in the Netherlands resulted in enhanced infection control and microbiological surveillance. Further analysis revealed that batches of contaminated nasopharyngeal swabs were associated with a pseudo-outbreak, resulting in incorrect diagnoses, antimicrobial treatments, isolation precautions, and public health notifications.

EID Flipse J, Tromp AT, Bosman J, ten Hove C, Beks H, Kortbeek T, et al. Pseudo-Outbreak of Bordetella parapertussis Caused by Contaminated Swabs in the Netherlands. Emerg Infect Dis. 2022;28(4):890-892. https://doi.org/10.3201/eid2804.212097
AMA Flipse J, Tromp AT, Bosman J, et al. Pseudo-Outbreak of Bordetella parapertussis Caused by Contaminated Swabs in the Netherlands. Emerging Infectious Diseases. 2022;28(4):890-892. doi:10.3201/eid2804.212097.
APA Flipse, J., Tromp, A. T., Bosman, J., ten Hove, C., Beks, H., Kortbeek, T....Mascini, E. M. (2022). Pseudo-Outbreak of Bordetella parapertussis Caused by Contaminated Swabs in the Netherlands. Emerging Infectious Diseases, 28(4), 890-892. https://doi.org/10.3201/eid2804.212097.

High Prevalence and Low Diversity of Rickettsia in Dermacentor reticulatus Ticks, Central Europe [PDF - 565 KB - 3 pages]
A. Balážová et al.

We collected 1,671 Dermacentor reticulatus ticks from 17 locations in the Czech Republic, Slovakia, and Hungary. We found 47.9% overall prevalence of Rickettsia species in ticks over all locations. Sequence analysis confirmed that all tested samples belonged to R. raoultii, the causative agent of tick-borne lymphadenopathy.

EID Balážová A, Földvári G, Bilbija B, Nosková E, Široký P. High Prevalence and Low Diversity of Rickettsia in Dermacentor reticulatus Ticks, Central Europe. Emerg Infect Dis. 2022;28(4):893-895. https://doi.org/10.3201/eid2804.211267
AMA Balážová A, Földvári G, Bilbija B, et al. High Prevalence and Low Diversity of Rickettsia in Dermacentor reticulatus Ticks, Central Europe. Emerging Infectious Diseases. 2022;28(4):893-895. doi:10.3201/eid2804.211267.
APA Balážová, A., Földvári, G., Bilbija, B., Nosková, E., & Široký, P. (2022). High Prevalence and Low Diversity of Rickettsia in Dermacentor reticulatus Ticks, Central Europe. Emerging Infectious Diseases, 28(4), 893-895. https://doi.org/10.3201/eid2804.211267.

Spread of SARS-CoV-2 Variants on Réunion Island, France, 2021 [PDF - 810 KB - 4 pages]
A. Mercier et al.

In January 2021, after detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, genomic surveillance was established on Réunion Island to track the introduction and spread of SARS-CoV-2 lineages and variants of concern. This system identified 22 SARS-CoV-2 lineages, 71% of which were attributed to the Beta variant

EID Mercier A, Wilkinson DA, Lebarbenchon C, Mavingui P, Yemadje-Menudier L. Spread of SARS-CoV-2 Variants on Réunion Island, France, 2021. Emerg Infect Dis. 2022;28(4):895-898. https://doi.org/10.3201/eid2804.212243
AMA Mercier A, Wilkinson DA, Lebarbenchon C, et al. Spread of SARS-CoV-2 Variants on Réunion Island, France, 2021. Emerging Infectious Diseases. 2022;28(4):895-898. doi:10.3201/eid2804.212243.
APA Mercier, A., Wilkinson, D. A., Lebarbenchon, C., Mavingui, P., & Yemadje-Menudier, L. (2022). Spread of SARS-CoV-2 Variants on Réunion Island, France, 2021. Emerging Infectious Diseases, 28(4), 895-898. https://doi.org/10.3201/eid2804.212243.

Community Transmission of SARS-CoV-2 Omicron Variant, South Korea, 2021 [PDF - 370 KB - 3 pages]
E. Kim et al.

In South Korea, a November 2021 outbreak caused by severe acute respiratory syndrome coronavirus 2 Omicron variant originated from 1 person with an imported case and spread to households, kindergartens, workplaces, restaurants, and hospitals, resulting in 11 clusters within 3 weeks. An epidemiologic curve indicated rapid community transmission of the Omicron variant.

EID Kim E, Choe Y, Park H, Jeong H, Chung J, Yu J, et al. Community Transmission of SARS-CoV-2 Omicron Variant, South Korea, 2021. Emerg Infect Dis. 2022;28(4):898-900. https://doi.org/10.3201/eid2804.220006
AMA Kim E, Choe Y, Park H, et al. Community Transmission of SARS-CoV-2 Omicron Variant, South Korea, 2021. Emerging Infectious Diseases. 2022;28(4):898-900. doi:10.3201/eid2804.220006.
APA Kim, E., Choe, Y., Park, H., Jeong, H., Chung, J., Yu, J....Park, Y. (2022). Community Transmission of SARS-CoV-2 Omicron Variant, South Korea, 2021. Emerging Infectious Diseases, 28(4), 898-900. https://doi.org/10.3201/eid2804.220006.

Time from Exposure to Diagnosis among Quarantined Close Contacts of SARS-CoV-2 Omicron Variant Index Case-Patients, South Korea [PDF - 652 KB - 3 pages]
H. Lee et al.

To determine optimal quarantine duration, we evaluated time from exposure to diagnosis for 107 close contacts of severe acute respiratory syndrome coronavirus 2 Omicron variant case-patients. Average time from exposure to diagnosis was 3.7 days; 70% of diagnoses were made on day 5 and 99.1% by day 10, suggesting 10-day quarantine.

EID Lee H, Choe Y, Jang E, Kim J, Lee J, Lee H, et al. Time from Exposure to Diagnosis among Quarantined Close Contacts of SARS-CoV-2 Omicron Variant Index Case-Patients, South Korea. Emerg Infect Dis. 2022;28(4):901-903. https://doi.org/10.3201/eid2804.220153
AMA Lee H, Choe Y, Jang E, et al. Time from Exposure to Diagnosis among Quarantined Close Contacts of SARS-CoV-2 Omicron Variant Index Case-Patients, South Korea. Emerging Infectious Diseases. 2022;28(4):901-903. doi:10.3201/eid2804.220153.
APA Lee, H., Choe, Y., Jang, E., Kim, J., Lee, J., Lee, H....Park, Y. (2022). Time from Exposure to Diagnosis among Quarantined Close Contacts of SARS-CoV-2 Omicron Variant Index Case-Patients, South Korea. Emerging Infectious Diseases, 28(4), 901-903. https://doi.org/10.3201/eid2804.220153.

Legionella pneumophila Subspecies fraseri Infection after Allogeneic Hematopoietic Stem Cell Transplant, China [PDF - 532 KB - 3 pages]
X. Wang et al.

We describe an immunosuppressed patient with bacteremia and pneumonia caused by Legionella pneumophila subspecies fraseri in China. We confirmed this diagnosis by using nanopore sequencing of positive blood cultures and subsequent recovery from buffered-charcoal yeast extract culture. Nanopore sequencing is an effective tool for early diagnosis of atypical infections.

EID Wang X, Guo Y, Zhang Y, Wang Q, Yang S, Yang H, et al. Legionella pneumophila Subspecies fraseri Infection after Allogeneic Hematopoietic Stem Cell Transplant, China. Emerg Infect Dis. 2022;28(4):903-905. https://doi.org/10.3201/eid2804.211433
AMA Wang X, Guo Y, Zhang Y, et al. Legionella pneumophila Subspecies fraseri Infection after Allogeneic Hematopoietic Stem Cell Transplant, China. Emerging Infectious Diseases. 2022;28(4):903-905. doi:10.3201/eid2804.211433.
APA Wang, X., Guo, Y., Zhang, Y., Wang, Q., Yang, S., Yang, H....Wang, H. (2022). Legionella pneumophila Subspecies fraseri Infection after Allogeneic Hematopoietic Stem Cell Transplant, China. Emerging Infectious Diseases, 28(4), 903-905. https://doi.org/10.3201/eid2804.211433.

Vaccine-Associated Measles Encephalitis in Immunocompromised Child, California, USA [PDF - 1001 KB - 3 pages]
C. Costales et al.

We report a fatal case of vaccine-associated measles encephalitis in an immunocompromised child in California, USA. The infection was confirmed by whole-genome RNA sequencing of measles virus from brain tissue. We observed biased matrix-gene hypermutation consistent with persistent measles virus central nervous system infection.

EID Costales C, Sahoo MK, Huang C, Guimaraes CV, Born D, Kushner L, et al. Vaccine-Associated Measles Encephalitis in Immunocompromised Child, California, USA. Emerg Infect Dis. 2022;28(4):906-908. https://doi.org/10.3201/eid2804.212357
AMA Costales C, Sahoo MK, Huang C, et al. Vaccine-Associated Measles Encephalitis in Immunocompromised Child, California, USA. Emerging Infectious Diseases. 2022;28(4):906-908. doi:10.3201/eid2804.212357.
APA Costales, C., Sahoo, M. K., Huang, C., Guimaraes, C. V., Born, D., Kushner, L....Pinsky, B. A. (2022). Vaccine-Associated Measles Encephalitis in Immunocompromised Child, California, USA. Emerging Infectious Diseases, 28(4), 906-908. https://doi.org/10.3201/eid2804.212357.
About the Cover

A Dizzying, Complex Spectacle [PDF - 3.84 MB - 2 pages]
B. Breedlove
EID Breedlove B. A Dizzying, Complex Spectacle. Emerg Infect Dis. 2022;28(4):909-910. https://doi.org/10.3201/eid2804.ac2804
AMA Breedlove B. A Dizzying, Complex Spectacle. Emerging Infectious Diseases. 2022;28(4):909-910. doi:10.3201/eid2804.ac2804.
APA Breedlove, B. (2022). A Dizzying, Complex Spectacle. Emerging Infectious Diseases, 28(4), 909-910. https://doi.org/10.3201/eid2804.ac2804.
Page created: March 19, 2022
Page updated: March 28, 2022
Page reviewed: March 28, 2022
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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