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Medscape CME Activity
Healthcare-Associated Legionnaires’ Disease, Europe, 2008−2017 [PDF - 1.77 MB - 10 pages]
J. Beauté et al.

Healthcare-associated Legionnaires’ disease (HCA LD) can cause nosocomial outbreaks with high death rates. We compared community-acquired LD cases with HCA LD cases in Europe during 2008−2017 using data from The European Surveillance System. A total of 29 countries reported 40,411 community-acquired and 4,315 HCA LD cases. Of the HCA LD cases, 2,937 (68.1%) were hospital-acquired and 1,378 (31.9%) were linked to other healthcare facilities. The odds of having HCA LD were higher for women, children and persons <20 years of age, and persons >60 years of age. Out of the cases caused by Legionella pneumophila with a known serotype, community-acquired LD was more likely to be caused by L. pneumophila serogroup 1 (92.3%) than was HCA LD (85.1%). HCA LD patients were more likely to die. HCA LD is associated with specific patient demographics, causative strains, and outcomes. Healthcare facilities should consider these characteristics when designing HCA LD prevention strategies.

EID Beauté J, Plachouras D, Sandin S, Giesecke J, Sparén P. Healthcare-Associated Legionnaires’ Disease, Europe, 2008−2017. Emerg Infect Dis. 2020;26(10):2309-2318. https://dx.doi.org/10.3201/eid2610.181889
AMA Beauté J, Plachouras D, Sandin S, et al. Healthcare-Associated Legionnaires’ Disease, Europe, 2008−2017. Emerging Infectious Diseases. 2020;26(10):2309-2318. doi:10.3201/eid2610.181889.
APA Beauté, J., Plachouras, D., Sandin, S., Giesecke, J., & Sparén, P. (2020). Healthcare-Associated Legionnaires’ Disease, Europe, 2008−2017. Emerging Infectious Diseases, 26(10), 2309-2318. https://dx.doi.org/10.3201/eid2610.181889.

Medscape CME Activity
Lessons Learned from a Decade of Investigations of Shiga Toxin–Producing Escherichia coli Outbreaks Linked to Leafy Greens, United States and Canada [PDF - 1.41 MB - 10 pages]
K. E. Marshall et al.

Shiga toxin–producing Escherichia coli (STEC) cause substantial and costly illnesses. Leafy greens are the second most common source of foodborne STEC O157 outbreaks. We examined STEC outbreaks linked to leafy greens during 2009–2018 in the United States and Canada. We identified 40 outbreaks, 1,212 illnesses, 77 cases of hemolytic uremic syndrome, and 8 deaths. More outbreaks were linked to romaine lettuce (54%) than to any other type of leafy green. More outbreaks occurred in the fall (45%) and spring (28%) than in other seasons. Barriers in epidemiologic and traceback investigations complicated identification of the ultimate outbreak source. Research on the seasonality of leafy green outbreaks and vulnerability to STEC contamination and bacterial survival dynamics by leafy green type are warranted. Improvements in traceability of leafy greens are also needed. Federal and state health partners, researchers, the leafy green industry, and retailers can work together on interventions to reduce STEC contamination.

EID Marshall KE, Hexemer A, Seelman SL, Fatica MK, Blessington T, Hajmeer M, et al. Lessons Learned from a Decade of Investigations of Shiga Toxin–Producing Escherichia coli Outbreaks Linked to Leafy Greens, United States and Canada. Emerg Infect Dis. 2020;26(10):2319-2328. https://dx.doi.org/10.3201/eid2610.191418
AMA Marshall KE, Hexemer A, Seelman SL, et al. Lessons Learned from a Decade of Investigations of Shiga Toxin–Producing Escherichia coli Outbreaks Linked to Leafy Greens, United States and Canada. Emerging Infectious Diseases. 2020;26(10):2319-2328. doi:10.3201/eid2610.191418.
APA Marshall, K. E., Hexemer, A., Seelman, S. L., Fatica, M. K., Blessington, T., Hajmeer, M....Gieraltowski, L. (2020). Lessons Learned from a Decade of Investigations of Shiga Toxin–Producing Escherichia coli Outbreaks Linked to Leafy Greens, United States and Canada. Emerging Infectious Diseases, 26(10), 2319-2328. https://dx.doi.org/10.3201/eid2610.191418.

Operating Protocols of a Community Treatment Center for Isolation of Patients with Coronavirus Disease, South Korea [PDF - 1.20 MB - 9 pages]
E. Kang et al.

Most persons with confirmed coronavirus disease (COVID-19) have no or mild symptoms. During the COVID-19 pandemic, communities need efficient methods to monitor asymptomatic patients to reduce transmission. We describe the structure and operating protocols of a community treatment center (CTC) run by Seoul National University Hospital (SNUH) in South Korea. SNUH converted an existing facility into a CTC to isolate patients who had confirmed COVID-19 but mild or no symptoms. Patients reported self-measured vital signs and symptoms twice a day by using a smartphone application. Medical staff in a remote monitoring center at SNUH reviewed patient vital signs and provided video consultation to patients twice daily. The CTC required few medical staff to perform medical tests, monitor patients, and respond to emergencies. During March 5–26, 2020, we admitted and treated 113 patients at this center. CTCs could be an alternative to hospital admission for isolating patients and preventing community transmission.

EID Kang E, Lee S, Jung H, Kim M, Cho B, Kim Y. Operating Protocols of a Community Treatment Center for Isolation of Patients with Coronavirus Disease, South Korea. Emerg Infect Dis. 2020;26(10):2329-2337. https://dx.doi.org/10.3201/eid2610.201460
AMA Kang E, Lee S, Jung H, et al. Operating Protocols of a Community Treatment Center for Isolation of Patients with Coronavirus Disease, South Korea. Emerging Infectious Diseases. 2020;26(10):2329-2337. doi:10.3201/eid2610.201460.
APA Kang, E., Lee, S., Jung, H., Kim, M., Cho, B., & Kim, Y. (2020). Operating Protocols of a Community Treatment Center for Isolation of Patients with Coronavirus Disease, South Korea. Emerging Infectious Diseases, 26(10), 2329-2337. https://dx.doi.org/10.3201/eid2610.201460.

Community Treatment Centers for Isolation of Asymptomatic and Mildly Symptomatic Patients with Coronavirus Disease, South Korea [PDF - 1.42 MB - 7 pages]
W. Choi et al.

As a part of measures to decrease spikes in coronavirus disease (COVID-19) cases and deaths outside of hospitals, the government of South Korea introduced a plan for community treatment centers (CTCs) to isolate and monitor patients with mild COVID-19 symptoms. We assessed outcomes of 568 patients admitted to 3 CTCs near Daegu. More (64.6%) women than men (35.4%) were admitted, and the mean age of patients was 36.0 years (SD +15.0 years). Among all patients, 75.7% remained asymptomatic while at the CTCs. The mean time patients remained at CTCs was 19.6 days (SD +5.8 days) from the day of diagnosis until our study ended on March 23, 2020. Because they offer appropriate clinical triaging and daily monitoring for patients, CTCs are a safe alternative to medical institutions for asymptomatic or mildly symptomatic patients with COVID-19.

EID Choi W, Kim H, Kim B, Nam S, Sohn J. Community Treatment Centers for Isolation of Asymptomatic and Mildly Symptomatic Patients with Coronavirus Disease, South Korea. Emerg Infect Dis. 2020;26(10):2338-2345. https://dx.doi.org/10.3201/eid2610.201539
AMA Choi W, Kim H, Kim B, et al. Community Treatment Centers for Isolation of Asymptomatic and Mildly Symptomatic Patients with Coronavirus Disease, South Korea. Emerging Infectious Diseases. 2020;26(10):2338-2345. doi:10.3201/eid2610.201539.
APA Choi, W., Kim, H., Kim, B., Nam, S., & Sohn, J. (2020). Community Treatment Centers for Isolation of Asymptomatic and Mildly Symptomatic Patients with Coronavirus Disease, South Korea. Emerging Infectious Diseases, 26(10), 2338-2345. https://dx.doi.org/10.3201/eid2610.201539.

Clinical Course of Asymptomatic and Mildly Symptomatic Patients with Coronavirus Disease Admitted to Community Treatment Centers, South Korea [PDF - 1022 KB - 7 pages]
Y. Lee et al.

We evaluated the clinical course of asymptomatic and mildly symptomatic patients with laboratory-confirmed coronavirus disease (COVID-19) admitted to community treatment centers (CTCs) for isolation in South Korea. Of 632 patients, 75 (11.9%) had symptoms at admission, 186 (29.4%) were asymptomatic at admission but developed symptoms during their stay, and 371 (58.7%) remained asymptomatic during their entire clinical course. Nineteen (3.0%) patients were transferred to hospitals, but 94.3% (573/613) of the remaining patients were discharged from CTCs upon virologic remission. The mean virologic remission period was 20.1 days (SD + 7.7 days). Nearly 20% of patients remained in the CTCs for 4 weeks after diagnosis. The virologic remission period was longer in symptomatic patients than in asymptomatic patients. In mildly symptomatic patients, the mean duration from symptom onset to virologic remission was 11.7 days (SD + 8.2 days). These data could help in planning for isolation centers and formulating self-isolation guidelines.

EID Lee Y, Hong C, Kim D, Lee T, Lee J. Clinical Course of Asymptomatic and Mildly Symptomatic Patients with Coronavirus Disease Admitted to Community Treatment Centers, South Korea. Emerg Infect Dis. 2020;26(10):2346-2352. https://dx.doi.org/10.3201/eid2610.201620
AMA Lee Y, Hong C, Kim D, et al. Clinical Course of Asymptomatic and Mildly Symptomatic Patients with Coronavirus Disease Admitted to Community Treatment Centers, South Korea. Emerging Infectious Diseases. 2020;26(10):2346-2352. doi:10.3201/eid2610.201620.
APA Lee, Y., Hong, C., Kim, D., Lee, T., & Lee, J. (2020). Clinical Course of Asymptomatic and Mildly Symptomatic Patients with Coronavirus Disease Admitted to Community Treatment Centers, South Korea. Emerging Infectious Diseases, 26(10), 2346-2352. https://dx.doi.org/10.3201/eid2610.201620.

Nationwide External Quality Assessment of SARS-CoV-2 Molecular Testing, South Korea [PDF - 1.26 MB - 8 pages]
H. Sung et al.

External quality assessment (EQA) is essential for ensuring reliable test results, especially when laboratories are using assays authorized for emergency use for newly emerging pathogens. We developed an EQA panel to assess the quality of real-time reverse transcription PCR assays being used in South Korea to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). With the participation of 23 public health organization laboratories and 95 nongovernmental laboratories involved in SARS-CoV-2 testing, we conducted qualitative and semiquantitative performance assessments by using pooled respiratory samples containing different viral loads of SARS-CoV-2 or human coronavirus OC43. A total of 110 (93.2%) laboratories reported correct results for all qualitative tests; 29 (24.6%) laboratories had >1 outliers according to cycle threshold values. Our EQA panel identified the potential weaknesses of currently available commercial reagent kits. The methodology we used can provide practical experience for those planning to conduct evaluations for testing of SARS-CoV-2 and other emerging pathogens in the future.

EID Sung H, Han M, Yoo C, Lee S, Chung Y, Park J, et al. Nationwide External Quality Assessment of SARS-CoV-2 Molecular Testing, South Korea. Emerg Infect Dis. 2020;26(10):2353-2360. https://dx.doi.org/10.3201/eid2610.202551
AMA Sung H, Han M, Yoo C, et al. Nationwide External Quality Assessment of SARS-CoV-2 Molecular Testing, South Korea. Emerging Infectious Diseases. 2020;26(10):2353-2360. doi:10.3201/eid2610.202551.
APA Sung, H., Han, M., Yoo, C., Lee, S., Chung, Y., Park, J....Min, W. (2020). Nationwide External Quality Assessment of SARS-CoV-2 Molecular Testing, South Korea. Emerging Infectious Diseases, 26(10), 2353-2360. https://dx.doi.org/10.3201/eid2610.202551.
Research

Impact of Social Distancing Measures on Coronavirus Disease Healthcare Demand, Central Texas, USA [PDF - 1.43 MB - 9 pages]
X. Wang et al.

Social distancing orders have been enacted worldwide to slow the coronavirus disease (COVID-19) pandemic, reduce strain on healthcare systems, and prevent deaths. To estimate the impact of the timing and intensity of such measures, we built a mathematical model of COVID-19 transmission that incorporates age-stratified risks and contact patterns and projects numbers of hospitalizations, patients in intensive care units, ventilator needs, and deaths within US cities. Focusing on the Austin metropolitan area of Texas, we found that immediate and extensive social distancing measures were required to ensure that COVID-19 cases did not exceed local hospital capacity by early May 2020. School closures alone hardly changed the epidemic curve. A 2-week delay in implementation was projected to accelerate the timing of peak healthcare needs by 4 weeks and cause a bed shortage in intensive care units. This analysis informed the Stay Home-Work Safe order enacted by Austin on March 24, 2020.

EID Wang X, Pasco RF, Du Z, Petty M, Fox SJ, Galvani AP, et al. Impact of Social Distancing Measures on Coronavirus Disease Healthcare Demand, Central Texas, USA. Emerg Infect Dis. 2020;26(10):2361-2369. https://dx.doi.org/10.3201/eid2610.201702
AMA Wang X, Pasco RF, Du Z, et al. Impact of Social Distancing Measures on Coronavirus Disease Healthcare Demand, Central Texas, USA. Emerging Infectious Diseases. 2020;26(10):2361-2369. doi:10.3201/eid2610.201702.
APA Wang, X., Pasco, R. F., Du, Z., Petty, M., Fox, S. J., Galvani, A. P....Meyers, L. (2020). Impact of Social Distancing Measures on Coronavirus Disease Healthcare Demand, Central Texas, USA. Emerging Infectious Diseases, 26(10), 2361-2369. https://dx.doi.org/10.3201/eid2610.201702.

Multicenter Prevalence Study Comparing Molecular and Toxin Assays for Clostridioides difficile Surveillance, Switzerland [PDF - 2.59 MB - 8 pages]
A. F. Widmer et al.

Public health authorities in the United States and Europe recommend surveillance for Clostridioides difficile infections among hospitalized patients, but differing diagnostic algorithms can hamper comparisons between institutions and countries. We compared surveillance based on detection of C. difficile by PCR or enzyme immunoassay (EIA) in a nationwide C. difficile prevalence study in Switzerland. We included all routinely collected stool samples from hospitalized patients with diarrhea in 76 hospitals in Switzerland on 2 days, 1 in winter and 1 in summer, in 2015. EIA C. difficile detection rates were 6.4 cases/10,000 patient bed-days in winter and 5.7 cases/10,000 patient bed-days in summer. PCR detection rates were 11.4 cases/10,000 patient bed-days in winter and 7.1 cases/10,000 patient bed-days in summer. We found PCR used alone increased reported C. difficile prevalence rates by <80% compared with a 2-stage EIA-based algorithm.

EID Widmer AF, Frei R, Kuijper EJ, Wilcox MH, Schindler R, Spaniol V, et al. Multicenter Prevalence Study Comparing Molecular and Toxin Assays for Clostridioides difficile Surveillance, Switzerland. Emerg Infect Dis. 2020;26(10):2370-2377. https://dx.doi.org/10.3201/eid2610.190804
AMA Widmer AF, Frei R, Kuijper EJ, et al. Multicenter Prevalence Study Comparing Molecular and Toxin Assays for Clostridioides difficile Surveillance, Switzerland. Emerging Infectious Diseases. 2020;26(10):2370-2377. doi:10.3201/eid2610.190804.
APA Widmer, A. F., Frei, R., Kuijper, E. J., Wilcox, M. H., Schindler, R., Spaniol, V....Tschudin-Sutter, S. (2020). Multicenter Prevalence Study Comparing Molecular and Toxin Assays for Clostridioides difficile Surveillance, Switzerland. Emerging Infectious Diseases, 26(10), 2370-2377. https://dx.doi.org/10.3201/eid2610.190804.

Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine against Invasive Pneumococcal Disease in Adults, Japan, 2013–2017 [PDF - 599 KB - 9 pages]
R. Shimbashi et al.

The decline in the proportion of pneumococcal conjugate vaccine (PCV)–covered serotypes among adult invasive pneumococcal disease (IPD) patients might change the overall effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) because its effectiveness differs according to serotype. Using the indirect cohort method, we calculated the effectiveness of PPSV23 against IPD among adults in Japan to assess the impact of the national pediatric PCV program. Clinical and epidemiologic information and pneumococcal isolates were collected from IPD patients >20 years of age through enhanced IPD surveillance during April 2013–December 2017. Adjusted effectiveness against PPSV23-serotype IPD was 42.2%. Despite a substantial decline in the proportion of 13-valent PCV serotypes during the study period (45% to 31%), the change in effectiveness for PPSV23-serotype IPD was limited (47.1% to 39.3%) and only marginal in the elderly population (39.9% to 39.4%). The pediatric PCV program had limited impact on PPSV23 effectiveness against IPD in adults.

EID Shimbashi R, Suzuki M, Chang B, Watanabe H, Tanabe Y, Kuronuma K, et al. Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine against Invasive Pneumococcal Disease in Adults, Japan, 2013–2017. Emerg Infect Dis. 2020;26(10):2378-2386. https://dx.doi.org/10.3201/eid2610.191531
AMA Shimbashi R, Suzuki M, Chang B, et al. Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine against Invasive Pneumococcal Disease in Adults, Japan, 2013–2017. Emerging Infectious Diseases. 2020;26(10):2378-2386. doi:10.3201/eid2610.191531.
APA Shimbashi, R., Suzuki, M., Chang, B., Watanabe, H., Tanabe, Y., Kuronuma, K....Oishi, K. (2020). Effectiveness of 23-Valent Pneumococcal Polysaccharide Vaccine against Invasive Pneumococcal Disease in Adults, Japan, 2013–2017. Emerging Infectious Diseases, 26(10), 2378-2386. https://dx.doi.org/10.3201/eid2610.191531.

Sequential Acquisition of Human Papillomavirus Infection at Genital and Anal Sites, Liuzhou, China [PDF - 1.39 MB - 7 pages]
F. Wei et al.

Little is known about the risk for acquiring a concordant human papillomavirus (HPV) infection in a genital (or anal) site after an anal (or genital) HPV infection. We collected 3 sets of anogenital specimens at 6-month intervals from 2,309 men and 2,378 women in Liuzhou, China, and tested these specimens for HPV. The risk for sequential anal HPV infection in participants with a previous genital HPV infection was higher than for participants without an infection (hazard ratio [HR] 4.4, 95% CI 3.4–5.8 for women and HR 2.6, 95% CI 1.4–4.6 for men). For sequential genital HPV infection, women with a previous anal infection had a higher risk (HR 1.9, 95% CI 1.2–3.1), but no major difference was found for men (HR 0.7, 95% CI 0.2–1.9). Our study indicates that autoinoculation might play a major role in anogenital HPV transmission, in addition to direct sexual intercourse, especially for anal infection in women.

EID Wei F, Su Y, Cui X, Yu X, Li Y, Song Q, et al. Sequential Acquisition of Human Papillomavirus Infection at Genital and Anal Sites, Liuzhou, China. Emerg Infect Dis. 2020;26(10):2387-2393. https://dx.doi.org/10.3201/eid2610.191646
AMA Wei F, Su Y, Cui X, et al. Sequential Acquisition of Human Papillomavirus Infection at Genital and Anal Sites, Liuzhou, China. Emerging Infectious Diseases. 2020;26(10):2387-2393. doi:10.3201/eid2610.191646.
APA Wei, F., Su, Y., Cui, X., Yu, X., Li, Y., Song, Q....Xia, N. (2020). Sequential Acquisition of Human Papillomavirus Infection at Genital and Anal Sites, Liuzhou, China. Emerging Infectious Diseases, 26(10), 2387-2393. https://dx.doi.org/10.3201/eid2610.191646.

Association between Shiga Toxin–Producing Escherichia coli O157:H7 stx Gene Subtype and Disease Severity, England, 2009–2019 [PDF - 678 KB - 7 pages]
L. Byrne et al.

Signs and symptoms of Shiga toxin–producing Escherichia coli (STEC) serogroup O157:H7 infection range from mild gastrointestinal to bloody diarrhea and hemolytic uremic syndrome (HUS). We assessed the association between Shiga toxin gene (stx) subtype and disease severity for »3,000 patients with STEC O157:H7 in England during 2009–2019. Odds of bloody diarrhea, HUS, or both, were significantly higher for patients infected with STEC O157:H7 possessing stx2a only or stx2a combined with other stx subtypes. Odds of severe signs/symptoms were significantly higher for isolates encoding stx2a only and belonging to sublineage Ic and lineage I/II than for those encoding stx2a only and belonging to sublineage IIb, indicating that stx2a is not the only driver causing HUS. Strains of STEC O157:H7 that had stx1a were also significantly more associated with severe disease than strains with stx2c only. This finding confounds public health risk assessment algorithms based on detection of stx2 as a predictor of severe disease.

EID Byrne L, Adams N, Jenkins C. Association between Shiga Toxin–Producing Escherichia coli O157:H7 stx Gene Subtype and Disease Severity, England, 2009–2019. Emerg Infect Dis. 2020;26(10):2394-2400. https://dx.doi.org/10.3201/eid2610.200319
AMA Byrne L, Adams N, Jenkins C. Association between Shiga Toxin–Producing Escherichia coli O157:H7 stx Gene Subtype and Disease Severity, England, 2009–2019. Emerging Infectious Diseases. 2020;26(10):2394-2400. doi:10.3201/eid2610.200319.
APA Byrne, L., Adams, N., & Jenkins, C. (2020). Association between Shiga Toxin–Producing Escherichia coli O157:H7 stx Gene Subtype and Disease Severity, England, 2009–2019. Emerging Infectious Diseases, 26(10), 2394-2400. https://dx.doi.org/10.3201/eid2610.200319.
Dispatches

Rapid, Sensitive, Full-Genome Sequencing of Severe Acute Respiratory Syndrome Coronavirus 2 [PDF - 1.30 MB - 5 pages]
C. R. Paden et al.

We describe validated protocols for generating high-quality, full-length severe acute respiratory syndrome coronavirus 2 genomes from primary samples. One protocol uses multiplex reverse transcription PCR, followed by MinION or MiSeq sequencing; the other uses singleplex, nested reverse transcription PCR and Sanger sequencing. These protocols enable sensitive virus sequencing in different laboratory environments.

EID Paden CR, Tao Y, Queen K, Zhang J, Li Y, Uehara A, et al. Rapid, Sensitive, Full-Genome Sequencing of Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis. 2020;26(10):2401-2405. https://dx.doi.org/10.3201/eid2610.201800
AMA Paden CR, Tao Y, Queen K, et al. Rapid, Sensitive, Full-Genome Sequencing of Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases. 2020;26(10):2401-2405. doi:10.3201/eid2610.201800.
APA Paden, C. R., Tao, Y., Queen, K., Zhang, J., Li, Y., Uehara, A....Tong, S. (2020). Rapid, Sensitive, Full-Genome Sequencing of Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases, 26(10), 2401-2405. https://dx.doi.org/10.3201/eid2610.201800.

Effect of Nonpharmaceutical Interventions on Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, South Korea, 2020 [PDF - 1.50 MB - 5 pages]
S. Ryu et al.

We analyzed transmission of coronavirus disease outside of the Daegu-Gyeongsangbuk provincial region in South Korea. We estimated that nonpharmaceutical measures reduced transmissibility by a maximum of 34% without resorting to a strict lockdown strategy. To optimize epidemic control, continuous efforts to monitor the transmissibility are needed.

EID Ryu S, Ali S, Jang C, Kim B, Cowling BJ. Effect of Nonpharmaceutical Interventions on Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, South Korea, 2020. Emerg Infect Dis. 2020;26(10):2406-2410. https://dx.doi.org/10.3201/eid2610.201886
AMA Ryu S, Ali S, Jang C, et al. Effect of Nonpharmaceutical Interventions on Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, South Korea, 2020. Emerging Infectious Diseases. 2020;26(10):2406-2410. doi:10.3201/eid2610.201886.
APA Ryu, S., Ali, S., Jang, C., Kim, B., & Cowling, B. J. (2020). Effect of Nonpharmaceutical Interventions on Transmission of Severe Acute Respiratory Syndrome Coronavirus 2, South Korea, 2020. Emerging Infectious Diseases, 26(10), 2406-2410. https://dx.doi.org/10.3201/eid2610.201886.

Main Routes of Entry and Genomic Diversity of SARS-CoV-2, Uganda [PDF - 1.32 MB - 5 pages]
D. Bugembe et al.

We established rapid local viral sequencing to document the genomic diversity of severe acute respiratory syndrome coronavirus 2 entering Uganda. Virus lineages closely followed the travel origins of infected persons. Our sequence data provide an important baseline for tracking any further transmission of the virus throughout the country and region.

EID Bugembe D, Kayiwa J, Phan M, Tushabe P, Balinandi S, Dhaala B, et al. Main Routes of Entry and Genomic Diversity of SARS-CoV-2, Uganda. Emerg Infect Dis. 2020;26(10):2411-2415. https://dx.doi.org/10.3201/eid2610.202575
AMA Bugembe D, Kayiwa J, Phan M, et al. Main Routes of Entry and Genomic Diversity of SARS-CoV-2, Uganda. Emerging Infectious Diseases. 2020;26(10):2411-2415. doi:10.3201/eid2610.202575.
APA Bugembe, D., Kayiwa, J., Phan, M., Tushabe, P., Balinandi, S., Dhaala, B....Cotten, M. (2020). Main Routes of Entry and Genomic Diversity of SARS-CoV-2, Uganda. Emerging Infectious Diseases, 26(10), 2411-2415. https://dx.doi.org/10.3201/eid2610.202575.

High Proportion of Asymptomatic SARS-CoV-2 Infections in 9 Long-Term Care Facilities, Pasadena, California, USA, April 2020 [PDF - 324 KB - 4 pages]
M. Feaster and Y. Goh

Our analysis of coronavirus disease prevalence in 9 long-term care facilities demonstrated a high proportion (40.7%) of asymptomatic infections among residents and staff members. Infection control measures in congregate settings should include mass testing–based strategies in concert with symptom screening for greater effectiveness in preventing the spread of severe acute respiratory syndrome coronavirus 2.

EID Feaster M, Goh Y. High Proportion of Asymptomatic SARS-CoV-2 Infections in 9 Long-Term Care Facilities, Pasadena, California, USA, April 2020. Emerg Infect Dis. 2020;26(10):2416-2419. https://dx.doi.org/10.3201/eid2610.202694
AMA Feaster M, Goh Y. High Proportion of Asymptomatic SARS-CoV-2 Infections in 9 Long-Term Care Facilities, Pasadena, California, USA, April 2020. Emerging Infectious Diseases. 2020;26(10):2416-2419. doi:10.3201/eid2610.202694.
APA Feaster, M., & Goh, Y. (2020). High Proportion of Asymptomatic SARS-CoV-2 Infections in 9 Long-Term Care Facilities, Pasadena, California, USA, April 2020. Emerging Infectious Diseases, 26(10), 2416-2419. https://dx.doi.org/10.3201/eid2610.202694.

Tickborne Relapsing Fever, Jerusalem, Israel, 2004–2018 [PDF - 1.11 MB - 4 pages]
S. Hashavya et al.

To compare tickborne relapsing fever (TBRF) in children and adults in Jerusalem, Israel, we collected data from the medical records of all 92 patients with TBRF during 2004–2018. The 30 children with TBRF had more episodes of fever and lower inflammatory markers than adult patients.

EID Hashavya S, Gross I, Gross M, Hurvitz N, Weiser G, Temper V, et al. Tickborne Relapsing Fever, Jerusalem, Israel, 2004–2018. Emerg Infect Dis. 2020;26(10):2420-2423. https://dx.doi.org/10.3201/eid2610.181988
AMA Hashavya S, Gross I, Gross M, et al. Tickborne Relapsing Fever, Jerusalem, Israel, 2004–2018. Emerging Infectious Diseases. 2020;26(10):2420-2423. doi:10.3201/eid2610.181988.
APA Hashavya, S., Gross, I., Gross, M., Hurvitz, N., Weiser, G., Temper, V....Megged, O. (2020). Tickborne Relapsing Fever, Jerusalem, Israel, 2004–2018. Emerging Infectious Diseases, 26(10), 2420-2423. https://dx.doi.org/10.3201/eid2610.181988.

Seawater-Associated Highly Pathogenic Francisella hispaniensis Infections Causing Multiple Organ Failure [PDF - 1.37 MB - 5 pages]
H. Zhou et al.

A rare case of Francisella hispaniensis infection associated with seawater exposure occurred in a deep-sea diving fisherman in Zhejiang, China. He had skin and soft tissue infection that progressed to bacteremia and multiple organ failure. Moxifloxacin treatment cleared the infections, but the patient suffered a sequela of heart damage.

EID Zhou H, Yang Q, Shen L, Yao Y, Xu J, Ye J, et al. Seawater-Associated Highly Pathogenic Francisella hispaniensis Infections Causing Multiple Organ Failure. Emerg Infect Dis. 2020;26(10):2424-2428. https://dx.doi.org/10.3201/eid2610.190844
AMA Zhou H, Yang Q, Shen L, et al. Seawater-Associated Highly Pathogenic Francisella hispaniensis Infections Causing Multiple Organ Failure. Emerging Infectious Diseases. 2020;26(10):2424-2428. doi:10.3201/eid2610.190844.
APA Zhou, H., Yang, Q., Shen, L., Yao, Y., Xu, J., Ye, J....Yang, S. (2020). Seawater-Associated Highly Pathogenic Francisella hispaniensis Infections Causing Multiple Organ Failure. Emerging Infectious Diseases, 26(10), 2424-2428. https://dx.doi.org/10.3201/eid2610.190844.

Basic Reproduction Number of Chikungunya Virus Transmitted by Aedes Mosquitoes [PDF - 331 KB - 3 pages]
N. Haider et al.

We estimated the weighted mean basic reproduction number (R0) of chikungunya virus based on outbreak size. R0 was 3.4 (95% CI 2.4–4.2) and varied for 2 primary chikungunya mosquito vectors: 4.1 (95% CI 1.5–6.6) for Aedes aegypti and 2.8 (95% CI 1.8–3.8) for Ae. albopictus.

EID Haider N, Vairo F, Ippolito G, Zumla A, Kock RA. Basic Reproduction Number of Chikungunya Virus Transmitted by Aedes Mosquitoes. Emerg Infect Dis. 2020;26(10):2429-2431. https://dx.doi.org/10.3201/eid2610.190957
AMA Haider N, Vairo F, Ippolito G, et al. Basic Reproduction Number of Chikungunya Virus Transmitted by Aedes Mosquitoes. Emerging Infectious Diseases. 2020;26(10):2429-2431. doi:10.3201/eid2610.190957.
APA Haider, N., Vairo, F., Ippolito, G., Zumla, A., & Kock, R. A. (2020). Basic Reproduction Number of Chikungunya Virus Transmitted by Aedes Mosquitoes. Emerging Infectious Diseases, 26(10), 2429-2431. https://dx.doi.org/10.3201/eid2610.190957.

Deaths Associated with Pneumonic Plague, 1946–2017 [PDF - 331 KB - 3 pages]
A. P. Salam et al.
EID Salam AP, Rojek A, Cai E, Raberahona M, Horby P. Deaths Associated with Pneumonic Plague, 1946–2017. Emerg Infect Dis. 2020;26(10):2432-2434. https://dx.doi.org/10.3201/eid2610.191270
AMA Salam AP, Rojek A, Cai E, et al. Deaths Associated with Pneumonic Plague, 1946–2017. Emerging Infectious Diseases. 2020;26(10):2432-2434. doi:10.3201/eid2610.191270.
APA Salam, A. P., Rojek, A., Cai, E., Raberahona, M., & Horby, P. (2020). Deaths Associated with Pneumonic Plague, 1946–2017. Emerging Infectious Diseases, 26(10), 2432-2434. https://dx.doi.org/10.3201/eid2610.191270.

Emerging Sand Fly–Borne Phlebovirus in China [PDF - 1.64 MB - 4 pages]
J. Wang et al.

We isolated 17 viral strains capable of causing cytopathic effects in mammalian cells and death in neonatal mice from sand flies in China. Phylogenetic analysis showed that these strains belonged to the genus Phlebovirus. These findings highlight the need to control this potentially emerging virus to help safeguard public health.

EID Wang J, Fu S, Xu Z, Cheng J, Shi M, Fan N, et al. Emerging Sand Fly–Borne Phlebovirus in China. Emerg Infect Dis. 2020;26(10):2435-2438. https://dx.doi.org/10.3201/eid2610.191374
AMA Wang J, Fu S, Xu Z, et al. Emerging Sand Fly–Borne Phlebovirus in China. Emerging Infectious Diseases. 2020;26(10):2435-2438. doi:10.3201/eid2610.191374.
APA Wang, J., Fu, S., Xu, Z., Cheng, J., Shi, M., Fan, N....Liang, G. (2020). Emerging Sand Fly–Borne Phlebovirus in China. Emerging Infectious Diseases, 26(10), 2435-2438. https://dx.doi.org/10.3201/eid2610.191374.

Drug Resistance Spread in 6 Metropolitan Regions, Germany, 2001–2018 [PDF - 1.29 MB - 5 pages]
M. Stecher et al.

We analyzed 1,397 HIV-1 pol sequences of antiretroviral therapy–naive patients in a total of 7 university hospitals in Bonn, Cologne, Frankfurt, Hamburg, Hannover, and Munich, Germany. Phylogenetic and network analysis elucidated numerous cases of shared drug resistance mutations among genetically linked patients; K103N was the most frequently shared mutation.

EID Stecher M, Chaillon A, Stephan C, Knops E, Kohmer N, Lehmann C, et al. Drug Resistance Spread in 6 Metropolitan Regions, Germany, 2001–2018. Emerg Infect Dis. 2020;26(10):2439-2443. https://dx.doi.org/10.3201/eid2610.191506
AMA Stecher M, Chaillon A, Stephan C, et al. Drug Resistance Spread in 6 Metropolitan Regions, Germany, 2001–2018. Emerging Infectious Diseases. 2020;26(10):2439-2443. doi:10.3201/eid2610.191506.
APA Stecher, M., Chaillon, A., Stephan, C., Knops, E., Kohmer, N., Lehmann, C....Hoenigl, M. (2020). Drug Resistance Spread in 6 Metropolitan Regions, Germany, 2001–2018. Emerging Infectious Diseases, 26(10), 2439-2443. https://dx.doi.org/10.3201/eid2610.191506.

Human Adenovirus B7d–Associated Urethritis after Suspected Sexual Transmission, Japan [PDF - 1.03 MB - 4 pages]
N. Hanaoka et al.

Outbreaks of acute respiratory disease associated with human adenovirus (HAdV) B7d have been reported, including fatal cases in the United States. In 2018, we detected HAdV-B7d in a patient with urethritis, probably transmitted through sexual contact. Infectious HAdV-B7d was excreted in urine and gargle for >10 days after the disappearance of symptoms.

EID Hanaoka N, Ito S, Nojiri N, Konagaya M, Yasuda M, Deguchi T, et al. Human Adenovirus B7d–Associated Urethritis after Suspected Sexual Transmission, Japan. Emerg Infect Dis. 2020;26(10):2444-2447. https://dx.doi.org/10.3201/eid2610.191538
AMA Hanaoka N, Ito S, Nojiri N, et al. Human Adenovirus B7d–Associated Urethritis after Suspected Sexual Transmission, Japan. Emerging Infectious Diseases. 2020;26(10):2444-2447. doi:10.3201/eid2610.191538.
APA Hanaoka, N., Ito, S., Nojiri, N., Konagaya, M., Yasuda, M., Deguchi, T....Fujimoto, T. (2020). Human Adenovirus B7d–Associated Urethritis after Suspected Sexual Transmission, Japan. Emerging Infectious Diseases, 26(10), 2444-2447. https://dx.doi.org/10.3201/eid2610.191538.

Polyester Vascular Graft Material and Risk for Intracavitary Thoracic Vascular Graft Infection [PDF - 885 KB - 5 pages]
T. A. Schweizer et al.

Prosthetic vascular graft infections of the thoracic aorta are rare but can be fatal. Our comparison of collagen- and gelatin-coated grafts showed that collagen-coated grafts were associated with increased biofilm formation and bacterial adherence in vitro and with higher rates of perioperative vascular graft infections in vivo.

EID Schweizer TA, Shambat S, Haunreiter V, Mestres CA, Weber A, Maisano F, et al. Polyester Vascular Graft Material and Risk for Intracavitary Thoracic Vascular Graft Infection. Emerg Infect Dis. 2020;26(10):2448-2452. https://dx.doi.org/10.3201/eid2610.191711
AMA Schweizer TA, Shambat S, Haunreiter V, et al. Polyester Vascular Graft Material and Risk for Intracavitary Thoracic Vascular Graft Infection. Emerging Infectious Diseases. 2020;26(10):2448-2452. doi:10.3201/eid2610.191711.
APA Schweizer, T. A., Shambat, S., Haunreiter, V., Mestres, C. A., Weber, A., Maisano, F....Hasse, B. (2020). Polyester Vascular Graft Material and Risk for Intracavitary Thoracic Vascular Graft Infection. Emerging Infectious Diseases, 26(10), 2448-2452. https://dx.doi.org/10.3201/eid2610.191711.

Silent Circulation of Rift Valley Fever in Humans, Botswana, 2013–2014 [PDF - 1.24 MB - 4 pages]
C. E. Sanderson et al.

We evaluated the prevalence of Rift Valley fever virus IgG and IgM in human serum samples (n = 1,276) collected in 2013–2014 in northern Botswana. Our findings provide evidence of active circulation of this virus in humans in the absence of clinical disease in this region.

EID Sanderson CE, Jori F, Moolla N, Paweska JT, Oumer N, Alexander KA. Silent Circulation of Rift Valley Fever in Humans, Botswana, 2013–2014. Emerg Infect Dis. 2020;26(10):2453-2456. https://dx.doi.org/10.3201/eid2610.191837
AMA Sanderson CE, Jori F, Moolla N, et al. Silent Circulation of Rift Valley Fever in Humans, Botswana, 2013–2014. Emerging Infectious Diseases. 2020;26(10):2453-2456. doi:10.3201/eid2610.191837.
APA Sanderson, C. E., Jori, F., Moolla, N., Paweska, J. T., Oumer, N., & Alexander, K. A. (2020). Silent Circulation of Rift Valley Fever in Humans, Botswana, 2013–2014. Emerging Infectious Diseases, 26(10), 2453-2456. https://dx.doi.org/10.3201/eid2610.191837.

Limitations of Ribotyping as Genotyping Method for Corynebacterium ulcerans [PDF - 447 KB - 3 pages]
T. Sekizuka et al.

We conducted molecular typing of a Corynebacterium ulcerans isolate from a woman who died in Japan in 2016. Genomic DNA modification might have affected the isolate’s ribotyping profile. Multilocus sequence typing results (sequence type 337) were more accurate. Whole-genome sequencing had greater ability to discriminate lineages at high resolution.

EID Sekizuka T, Katsukawa C, Kuroda M, Shibayama K, Otsuji K, Saito M, et al. Limitations of Ribotyping as Genotyping Method for Corynebacterium ulcerans. Emerg Infect Dis. 2020;26(10):2457-2459. https://dx.doi.org/10.3201/eid2610.200086
AMA Sekizuka T, Katsukawa C, Kuroda M, et al. Limitations of Ribotyping as Genotyping Method for Corynebacterium ulcerans. Emerging Infectious Diseases. 2020;26(10):2457-2459. doi:10.3201/eid2610.200086.
APA Sekizuka, T., Katsukawa, C., Kuroda, M., Shibayama, K., Otsuji, K., Saito, M....Iwaki, M. (2020). Limitations of Ribotyping as Genotyping Method for Corynebacterium ulcerans. Emerging Infectious Diseases, 26(10), 2457-2459. https://dx.doi.org/10.3201/eid2610.200086.

Seoul Orthohantavirus in Wild Black Rats, Senegal, 2012–2013 [PDF - 1.13 MB - 5 pages]
M. M. Diagne et al.

Hantaviruses cause hemorrhagic fever in humans worldwide. However, few hantavirus surveillance campaigns occur in Africa. We detected Seoul orthohantavirus in black rats in Senegal, although we did not find serologic evidence of this disease in humans. These findings highlight the need for increased surveillance of hantaviruses in this region.

EID Diagne MM, Dieng I, Granjon L, Lucaccioni H, Sow A, Ndiaye O, et al. Seoul Orthohantavirus in Wild Black Rats, Senegal, 2012–2013. Emerg Infect Dis. 2020;26(10):2460-2464. https://dx.doi.org/10.3201/eid2610.201306
AMA Diagne MM, Dieng I, Granjon L, et al. Seoul Orthohantavirus in Wild Black Rats, Senegal, 2012–2013. Emerging Infectious Diseases. 2020;26(10):2460-2464. doi:10.3201/eid2610.201306.
APA Diagne, M. M., Dieng, I., Granjon, L., Lucaccioni, H., Sow, A., Ndiaye, O....Sall, A. A. (2020). Seoul Orthohantavirus in Wild Black Rats, Senegal, 2012–2013. Emerging Infectious Diseases, 26(10), 2460-2464. https://dx.doi.org/10.3201/eid2610.201306.

Contact Tracing during Coronavirus Disease Outbreak, South Korea, 2020 [PDF - 546 KB - 4 pages]
Y. Park et al.

We analyzed reports for 59,073 contacts of 5,706 coronavirus disease (COVID-19) index patients reported in South Korea during January 20–March 27, 2020. Of 10,592 household contacts, 11.8% had COVID-19. Of 48,481 nonhousehold contacts, 1.9% had COVID-19. Use of personal protective measures and social distancing reduces the likelihood of transmission.

EID Park Y, Choe Y, Park O, Park S, Kim Y, Kim J, et al. Contact Tracing during Coronavirus Disease Outbreak, South Korea, 2020. Emerg Infect Dis. 2020;26(10):2465-2468. https://dx.doi.org/10.3201/eid2610.201315
AMA Park Y, Choe Y, Park O, et al. Contact Tracing during Coronavirus Disease Outbreak, South Korea, 2020. Emerging Infectious Diseases. 2020;26(10):2465-2468. doi:10.3201/eid2610.201315.
APA Park, Y., Choe, Y., Park, O., Park, S., Kim, Y., Kim, J....Jeong, E. (2020). Contact Tracing during Coronavirus Disease Outbreak, South Korea, 2020. Emerging Infectious Diseases, 26(10), 2465-2468. https://dx.doi.org/10.3201/eid2610.201315.

Pooling Upper Respiratory Specimens for Rapid Mass Screening of COVID-19 by Real-Time RT-PCR [PDF - 635 KB - 4 pages]
S. Kim et al.

To validate the specimen-pooling strategy for real-time reverse transcription PCR detection of severe acute respiratory syndrome coronavirus 2, we generated different pools including positive specimens, reflecting the distribution of cycle threshold values at initial diagnosis. Cumulative sensitivities of tested pool sizes suggest pooling of <6 specimens for surveillance by this method.

EID Kim S, Lee J, Sung H, Lee H, Han M, Yoo C, et al. Pooling Upper Respiratory Specimens for Rapid Mass Screening of COVID-19 by Real-Time RT-PCR. Emerg Infect Dis. 2020;26(10):2469-2472. https://dx.doi.org/10.3201/eid2610.201955
AMA Kim S, Lee J, Sung H, et al. Pooling Upper Respiratory Specimens for Rapid Mass Screening of COVID-19 by Real-Time RT-PCR. Emerging Infectious Diseases. 2020;26(10):2469-2472. doi:10.3201/eid2610.201955.
APA Kim, S., Lee, J., Sung, H., Lee, H., Han, M., Yoo, C....Hong, K. (2020). Pooling Upper Respiratory Specimens for Rapid Mass Screening of COVID-19 by Real-Time RT-PCR. Emerging Infectious Diseases, 26(10), 2469-2472. https://dx.doi.org/10.3201/eid2610.201955.

Coronavirus Disease among Persons with Sickle Cell Disease, United States, March 20–May 21, 2020 [PDF - 308 KB - 4 pages]
J. A. Panepinto et al.

Sickle cell disease (SCD) disproportionately affects Black or African American persons in the United States and can cause multisystem organ damage and reduced lifespan. Among 178 persons with SCD in the United States who were reported to an SCD–coronavirus disease case registry, 122 (69%) were hospitalized and 13 (7%) died.

EID Panepinto JA, Brandow A, Mucalo L, Yusuf F, Singh A, Taylor B, et al. Coronavirus Disease among Persons with Sickle Cell Disease, United States, March 20–May 21, 2020. Emerg Infect Dis. 2020;26(10):2473-2476. https://dx.doi.org/10.3201/eid2610.202792
AMA Panepinto JA, Brandow A, Mucalo L, et al. Coronavirus Disease among Persons with Sickle Cell Disease, United States, March 20–May 21, 2020. Emerging Infectious Diseases. 2020;26(10):2473-2476. doi:10.3201/eid2610.202792.
APA Panepinto, J. A., Brandow, A., Mucalo, L., Yusuf, F., Singh, A., Taylor, B....Schieve, L. A. (2020). Coronavirus Disease among Persons with Sickle Cell Disease, United States, March 20–May 21, 2020. Emerging Infectious Diseases, 26(10), 2473-2476. https://dx.doi.org/10.3201/eid2610.202792.
Research Letters

Eliminating Spiked Bovine Spongiform Encephalopathy Agent Activity from Heparin [PDF - 280 KB - 3 pages]
C. Bett et al.

US manufacturers, concerned about bovine spongiform encephalopathy (BSE), ceased marketing bovine heparin in the 1990s. Recent short supplies of safe porcine heparin suggest that reintroducing bovine heparin might benefit public health. We purified heparin from crude bovine extract spiked with BSE agent, removing substantial infectivity and abnormal prion proteins (PrPTSE).

EID Bett C, Andrews O, Asher DM, Pilant T, Keire D, Gregori L. Eliminating Spiked Bovine Spongiform Encephalopathy Agent Activity from Heparin. Emerg Infect Dis. 2020;26(10):2478-2480. https://dx.doi.org/10.3201/eid2610.200142
AMA Bett C, Andrews O, Asher DM, et al. Eliminating Spiked Bovine Spongiform Encephalopathy Agent Activity from Heparin. Emerging Infectious Diseases. 2020;26(10):2478-2480. doi:10.3201/eid2610.200142.
APA Bett, C., Andrews, O., Asher, D. M., Pilant, T., Keire, D., & Gregori, L. (2020). Eliminating Spiked Bovine Spongiform Encephalopathy Agent Activity from Heparin. Emerging Infectious Diseases, 26(10), 2478-2480. https://dx.doi.org/10.3201/eid2610.200142.

Undetected Circulation of African Swine Fever in Wild Boar, Asia [PDF - 822 KB - 3 pages]
T. Vergne et al.

African swine fever is a growing threat to the livestock industry. We examined data indicating that in most countries in Asia, most notified events were related to farm outbreaks; meanwhile, only a few wild boar cases were reported. We hypothesize the virus circulates unnoticed in wild boar populations in Asia.

EID Vergne T, Guinat C, Pfeiffer DU. Undetected Circulation of African Swine Fever in Wild Boar, Asia. Emerg Infect Dis. 2020;26(10):2480-2482. https://dx.doi.org/10.3201/eid2610.200608
AMA Vergne T, Guinat C, Pfeiffer DU. Undetected Circulation of African Swine Fever in Wild Boar, Asia. Emerging Infectious Diseases. 2020;26(10):2480-2482. doi:10.3201/eid2610.200608.
APA Vergne, T., Guinat, C., & Pfeiffer, D. U. (2020). Undetected Circulation of African Swine Fever in Wild Boar, Asia. Emerging Infectious Diseases, 26(10), 2480-2482. https://dx.doi.org/10.3201/eid2610.200608.

Review of Mental Health Response to COVID-19, China [PDF - 268 KB - 3 pages]
A. Miu et al.

Public mental health response to coronavirus disease is essential. After reviewing systemic and local efforts in China, we found efficient coordination and human resources. We recommend better symptom assessment, monitoring of organizations, and basic needs protection. This recommendation can inform how other countries can overcome mental health challenges during this pandemic.

EID Miu A, Cao H, Zhang B, Zhang H. Review of Mental Health Response to COVID-19, China. Emerg Infect Dis. 2020;26(10):2482-2484. https://dx.doi.org/10.3201/eid2610.201113
AMA Miu A, Cao H, Zhang B, et al. Review of Mental Health Response to COVID-19, China. Emerging Infectious Diseases. 2020;26(10):2482-2484. doi:10.3201/eid2610.201113.
APA Miu, A., Cao, H., Zhang, B., & Zhang, H. (2020). Review of Mental Health Response to COVID-19, China. Emerging Infectious Diseases, 26(10), 2482-2484. https://dx.doi.org/10.3201/eid2610.201113.

Antibody Responses to SARS-CoV-2 at 8 Weeks Postinfection in Asymptomatic Patients [PDF - 344 KB - 4 pages]
P. Choe et al.

We compared levels of severe acute respiratory syndrome coronavirus 2 neutralizing antibodies in recovery plasma from 7 completely asymptomatic coronavirus disease patients with those in symptomatic patients in South Korea. We found that serologic diagnostic testing was positive for 71% (5/7) of completely asymptomatic patients, but neutralizing antibody response occurred in all 7 patients.

EID Choe P, Kang C, Suh H, Jung J, Kang E, Lee S, et al. Antibody Responses to SARS-CoV-2 at 8 Weeks Postinfection in Asymptomatic Patients. Emerg Infect Dis. 2020;26(10):2484-2487. https://dx.doi.org/10.3201/eid2610.202211
AMA Choe P, Kang C, Suh H, et al. Antibody Responses to SARS-CoV-2 at 8 Weeks Postinfection in Asymptomatic Patients. Emerging Infectious Diseases. 2020;26(10):2484-2487. doi:10.3201/eid2610.202211.
APA Choe, P., Kang, C., Suh, H., Jung, J., Kang, E., Lee, S....Oh, M. (2020). Antibody Responses to SARS-CoV-2 at 8 Weeks Postinfection in Asymptomatic Patients. Emerging Infectious Diseases, 26(10), 2484-2487. https://dx.doi.org/10.3201/eid2610.202211.

Retrospective Screening for SARS-CoV-2 RNA in California, USA, Late 2019 [PDF - 242 KB - 2 pages]
C. A. Hogan et al.

To investigate the possibility of earlier cases of severe acute respiratory syndrome coronavirus 2 infection than previously recognized, we retrospectively tested pooled samples from 1,700 persons with respiratory signs/symptoms seen at Stanford Health Care, Palo Alto, California, USA, during the last 2 months of 2019. We found no evidence of earlier infection.

EID Hogan CA, Garamani N, Sahoo MK, Huang C, Zehnder J, Pinsky BA. Retrospective Screening for SARS-CoV-2 RNA in California, USA, Late 2019. Emerg Infect Dis. 2020;26(10):2487-2488. https://dx.doi.org/10.3201/eid2610.202296
AMA Hogan CA, Garamani N, Sahoo MK, et al. Retrospective Screening for SARS-CoV-2 RNA in California, USA, Late 2019. Emerging Infectious Diseases. 2020;26(10):2487-2488. doi:10.3201/eid2610.202296.
APA Hogan, C. A., Garamani, N., Sahoo, M. K., Huang, C., Zehnder, J., & Pinsky, B. A. (2020). Retrospective Screening for SARS-CoV-2 RNA in California, USA, Late 2019. Emerging Infectious Diseases, 26(10), 2487-2488. https://dx.doi.org/10.3201/eid2610.202296.

Using Virus Sequencing to Determine Source of SARS-CoV-2 Transmission for Healthcare Worker [PDF - 1.08 MB - 3 pages]
N. Safdar et al.

Whether a healthcare worker’s severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is community or hospital acquired affects prevention practices. We used virus sequencing to determine that infection of a healthcare worker who cared for 2 SARS-CoV-2–infected patients was probably community acquired. Appropriate personal protective equipment may have protected against hospital-acquired infection.

EID Safdar N, Moreno GK, Braun KM, Friedrich TC, O’Connor DH. Using Virus Sequencing to Determine Source of SARS-CoV-2 Transmission for Healthcare Worker. Emerg Infect Dis. 2020;26(10):2489-2491. https://dx.doi.org/10.3201/eid2610.202322
AMA Safdar N, Moreno GK, Braun KM, et al. Using Virus Sequencing to Determine Source of SARS-CoV-2 Transmission for Healthcare Worker. Emerging Infectious Diseases. 2020;26(10):2489-2491. doi:10.3201/eid2610.202322.
APA Safdar, N., Moreno, G. K., Braun, K. M., Friedrich, T. C., & O’Connor, D. H. (2020). Using Virus Sequencing to Determine Source of SARS-CoV-2 Transmission for Healthcare Worker. Emerging Infectious Diseases, 26(10), 2489-2491. https://dx.doi.org/10.3201/eid2610.202322.

Disappearance of SARS-CoV-2 Antibodies in Infants Born to Women with COVID-19, Wuhan, China [PDF - 736 KB - 4 pages]
J. Gao et al.

We report the detection and decline over time of severe acute respiratory syndrome coronavirus 2 antibodies in infants born to women with coronavirus disease. Among 11 infants tested at birth, all had detectable IgG and 5 had detectable IgM. IgG titers with positive IgM declined more slowly than those without.

EID Gao J, Li W, Hu X, Wei Y, Wu J, Luo X, et al. Disappearance of SARS-CoV-2 Antibodies in Infants Born to Women with COVID-19, Wuhan, China. Emerg Infect Dis. 2020;26(10):2491-2494. https://dx.doi.org/10.3201/eid2610.202328
AMA Gao J, Li W, Hu X, et al. Disappearance of SARS-CoV-2 Antibodies in Infants Born to Women with COVID-19, Wuhan, China. Emerging Infectious Diseases. 2020;26(10):2491-2494. doi:10.3201/eid2610.202328.
APA Gao, J., Li, W., Hu, X., Wei, Y., Wu, J., Luo, X....Chen, L. (2020). Disappearance of SARS-CoV-2 Antibodies in Infants Born to Women with COVID-19, Wuhan, China. Emerging Infectious Diseases, 26(10), 2491-2494. https://dx.doi.org/10.3201/eid2610.202328.

Culture-Competent SARS-CoV-2 in Nasopharynx of Symptomatic Neonates, Children, and Adolescents [PDF - 338 KB - 4 pages]
A. G. L’Huillier et al.

Children do not seem to drive transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We isolated culture-competent virus in vitro from 12 (52%) of 23 SARS-CoV-2–infected children; the youngest was 7 days old. Our findings show that symptomatic neonates, children, and teenagers shed infectious SARS-CoV-2, suggesting that transmission from them is plausible.

EID L’Huillier AG, Torriani G, Pigny F, Kaiser L, Eckerle I. Culture-Competent SARS-CoV-2 in Nasopharynx of Symptomatic Neonates, Children, and Adolescents. Emerg Infect Dis. 2020;26(10):2494-2497. https://dx.doi.org/10.3201/eid2610.202403
AMA L’Huillier AG, Torriani G, Pigny F, et al. Culture-Competent SARS-CoV-2 in Nasopharynx of Symptomatic Neonates, Children, and Adolescents. Emerging Infectious Diseases. 2020;26(10):2494-2497. doi:10.3201/eid2610.202403.
APA L’Huillier, A. G., Torriani, G., Pigny, F., Kaiser, L., & Eckerle, I. (2020). Culture-Competent SARS-CoV-2 in Nasopharynx of Symptomatic Neonates, Children, and Adolescents. Emerging Infectious Diseases, 26(10), 2494-2497. https://dx.doi.org/10.3201/eid2610.202403.

Viral RNA Load in Mildly Symptomatic and Asymptomatic Children with COVID-19, Seoul, South Korea [PDF - 492 KB - 3 pages]
M. Han et al.

Along with positive SARS-CoV-2 RNA in nasopharyngeal swabs, viral RNA was detectable at high concentration for >3 weeks in fecal samples from 12 mildly symptomatic and asymptomatic children with COVID-19 in Seoul, South Korea. Saliva also tested positive during the early phase of infection. If proven infectious, feces and saliva could serve as transmission sources.

EID Han M, Seong M, Kim N, Shin S, Cho S, Park H, et al. Viral RNA Load in Mildly Symptomatic and Asymptomatic Children with COVID-19, Seoul, South Korea. Emerg Infect Dis. 2020;26(10):2497-2499. https://dx.doi.org/10.3201/eid2610.202449
AMA Han M, Seong M, Kim N, et al. Viral RNA Load in Mildly Symptomatic and Asymptomatic Children with COVID-19, Seoul, South Korea. Emerging Infectious Diseases. 2020;26(10):2497-2499. doi:10.3201/eid2610.202449.
APA Han, M., Seong, M., Kim, N., Shin, S., Cho, S., Park, H....Choi, E. (2020). Viral RNA Load in Mildly Symptomatic and Asymptomatic Children with COVID-19, Seoul, South Korea. Emerging Infectious Diseases, 26(10), 2497-2499. https://dx.doi.org/10.3201/eid2610.202449.

Coronavirus Disease Exposure and Spread from Nightclubs, South Korea [PDF - 712 KB - 3 pages]
C. Kang et al.

At least 246 cases of coronavirus disease (COVID-19) have been linked to nightclubs in Seoul, South Korea. During the April 30–May 5 holiday, young adults from across the country who visited nightclubs in Seoul contracted COVID-19 and spread it nationally. Nightclubs were temporarily closed to limit COVID-19 spread.

EID Kang C, Lee J, Park Y, Huh I, Ham H, Han J, et al. Coronavirus Disease Exposure and Spread from Nightclubs, South Korea. Emerg Infect Dis. 2020;26(10):2499-2501. https://dx.doi.org/10.3201/eid2610.202573
AMA Kang C, Lee J, Park Y, et al. Coronavirus Disease Exposure and Spread from Nightclubs, South Korea. Emerging Infectious Diseases. 2020;26(10):2499-2501. doi:10.3201/eid2610.202573.
APA Kang, C., Lee, J., Park, Y., Huh, I., Ham, H., Han, J....Na, B. (2020). Coronavirus Disease Exposure and Spread from Nightclubs, South Korea. Emerging Infectious Diseases, 26(10), 2499-2501. https://dx.doi.org/10.3201/eid2610.202573.

Rapid Screening Evaluation of SARS-CoV-2 IgG Assays Using Z-Scores to Standardize Results [PDF - 737 KB - 3 pages]
M. K. Das et al.

Many serologic tests are now available for measuring severe acute respiratory syndrome coronavirus 2 antibodies to evaluate potential protective immunity and for seroprevalence studies. We describe an approach to standardizing positivity thresholds and quantitative values for different assays that uses z-scores to enable rapid and efficient comparison of serologic test performance.

EID Das MK, Chaudhary A, Bryan A, Wener MH, Fink SL, Morishima C. Rapid Screening Evaluation of SARS-CoV-2 IgG Assays Using Z-Scores to Standardize Results. Emerg Infect Dis. 2020;26(10):2501-2503. https://dx.doi.org/10.3201/eid2610.202632
AMA Das MK, Chaudhary A, Bryan A, et al. Rapid Screening Evaluation of SARS-CoV-2 IgG Assays Using Z-Scores to Standardize Results. Emerging Infectious Diseases. 2020;26(10):2501-2503. doi:10.3201/eid2610.202632.
APA Das, M. K., Chaudhary, A., Bryan, A., Wener, M. H., Fink, S. L., & Morishima, C. (2020). Rapid Screening Evaluation of SARS-CoV-2 IgG Assays Using Z-Scores to Standardize Results. Emerging Infectious Diseases, 26(10), 2501-2503. https://dx.doi.org/10.3201/eid2610.202632.

Relative Bradycardia in Patients with Mild-to-Moderate Coronavirus Disease, Japan [PDF - 364 KB - 3 pages]
K. Ikeuchi et al.

Coronavirus disease is reported to affect the cardiovascular system. We showed that relative bradycardia was a common characteristic for 54 patients with PCR-confirmed mild-to-moderate coronavirus disease in Japan. This clinical sign could help clinicians to diagnose this disease.

EID Ikeuchi K, Saito M, Yamamoto S, Nagai H, Adachi E. Relative Bradycardia in Patients with Mild-to-Moderate Coronavirus Disease, Japan. Emerg Infect Dis. 2020;26(10):2504-2506. https://dx.doi.org/10.3201/eid2610.202648
AMA Ikeuchi K, Saito M, Yamamoto S, et al. Relative Bradycardia in Patients with Mild-to-Moderate Coronavirus Disease, Japan. Emerging Infectious Diseases. 2020;26(10):2504-2506. doi:10.3201/eid2610.202648.
APA Ikeuchi, K., Saito, M., Yamamoto, S., Nagai, H., & Adachi, E. (2020). Relative Bradycardia in Patients with Mild-to-Moderate Coronavirus Disease, Japan. Emerging Infectious Diseases, 26(10), 2504-2506. https://dx.doi.org/10.3201/eid2610.202648.

Effect of COVID-19 on Tuberculosis Notification, South Korea [PDF - 449 KB - 3 pages]
N. Kwak et al.

After South Korea raised its infectious disease alert to the highest level in response to coronavirus disease emergence, tuberculosis notification during the first 18 weeks of 2020 decreased significantly from the same period for each year during 2015–2019. Adequate measures to diagnose, control, and prevent tuberculosis need to be maintained.

EID Kwak N, Hwang S, Yim J. Effect of COVID-19 on Tuberculosis Notification, South Korea. Emerg Infect Dis. 2020;26(10):2506-2508. https://dx.doi.org/10.3201/eid2610.202782
AMA Kwak N, Hwang S, Yim J. Effect of COVID-19 on Tuberculosis Notification, South Korea. Emerging Infectious Diseases. 2020;26(10):2506-2508. doi:10.3201/eid2610.202782.
APA Kwak, N., Hwang, S., & Yim, J. (2020). Effect of COVID-19 on Tuberculosis Notification, South Korea. Emerging Infectious Diseases, 26(10), 2506-2508. https://dx.doi.org/10.3201/eid2610.202782.

Effects of COVID-19 Prevention Measures on Other Common Infections, Taiwan [PDF - 1.22 MB - 3 pages]
H. Lee and S. Lin

To determine whether policies to limit transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) hinder spread of other infectious diseases, we analyzed the National Health Insurance database in Taiwan. Rates of other infections were significantly lower after SARS-CoV-2 prevention measures were announced. This finding can be applied to cost-effectiveness of SARS-CoV-2 prevention.

EID Lee H, Lin S. Effects of COVID-19 Prevention Measures on Other Common Infections, Taiwan. Emerg Infect Dis. 2020;26(10):2509-2511. https://dx.doi.org/10.3201/eid2610.203193
AMA Lee H, Lin S. Effects of COVID-19 Prevention Measures on Other Common Infections, Taiwan. Emerging Infectious Diseases. 2020;26(10):2509-2511. doi:10.3201/eid2610.203193.
APA Lee, H., & Lin, S. (2020). Effects of COVID-19 Prevention Measures on Other Common Infections, Taiwan. Emerging Infectious Diseases, 26(10), 2509-2511. https://dx.doi.org/10.3201/eid2610.203193.

Macrolide-Resistant Bordetella pertussis, Vietnam, 2016−2017 [PDF - 344 KB - 3 pages]
K. Kamachi et al.

Macrolide-resistant Bordetella pertussis emerged in Vietnam during 2016−2017. Direct analyses of swab samples from 10 patients with pertussis revealed a macrolide-resistant mutation, A2047G, in the 23S rRNA. We identified the MT104 genotype of macrolide-resistant B. pertussis (which is prevalent in mainland China) and its variants in these patients.

EID Kamachi K, Duong HT, Dang AD, Hai T, Do D, Koide K, et al. Macrolide-Resistant Bordetella pertussis, Vietnam, 2016−2017. Emerg Infect Dis. 2020;26(10):2511-2513. https://dx.doi.org/10.3201/eid2610.201035
AMA Kamachi K, Duong HT, Dang AD, et al. Macrolide-Resistant Bordetella pertussis, Vietnam, 2016−2017. Emerging Infectious Diseases. 2020;26(10):2511-2513. doi:10.3201/eid2610.201035.
APA Kamachi, K., Duong, H. T., Dang, A. D., Hai, T., Do, D., Koide, K....Hoang, H. (2020). Macrolide-Resistant Bordetella pertussis, Vietnam, 2016−2017. Emerging Infectious Diseases, 26(10), 2511-2513. https://dx.doi.org/10.3201/eid2610.201035.

COVID-19 in Patient with Sarcoidosis Receiving Long-Term Hydroxychloroquine Treatment, France, 2020 [PDF - 576 KB - 3 pages]
F. Bénézit et al.

Because of in vitro studies, hydroxychloroquine has been evaluated as a preexposure or postexposure prophylaxis for coronavirus disease (COVID-19) and as a possible COVID-19 curative treatment. We report a case of COVID-19 in a patient with sarcoidosis who was receiving long-term hydroxychloroquine treatment and contracted COVID-19 despite adequate plasma concentrations.

EID Bénézit F, Le Bot A, Jouneau S, Lemaître F, Pronier C, Lentz P, et al. COVID-19 in Patient with Sarcoidosis Receiving Long-Term Hydroxychloroquine Treatment, France, 2020. Emerg Infect Dis. 2020;26(10):2513-2515. https://dx.doi.org/10.3201/eid2610.201816
AMA Bénézit F, Le Bot A, Jouneau S, et al. COVID-19 in Patient with Sarcoidosis Receiving Long-Term Hydroxychloroquine Treatment, France, 2020. Emerging Infectious Diseases. 2020;26(10):2513-2515. doi:10.3201/eid2610.201816.
APA Bénézit, F., Le Bot, A., Jouneau, S., Lemaître, F., Pronier, C., Lentz, P....Tattevin, P. (2020). COVID-19 in Patient with Sarcoidosis Receiving Long-Term Hydroxychloroquine Treatment, France, 2020. Emerging Infectious Diseases, 26(10), 2513-2515. https://dx.doi.org/10.3201/eid2610.201816.

Inappropriate Administration of Rabies Postexposure Prophylaxis, Cook County, Illinois, USA [PDF - 283 KB - 3 pages]
H. D. Steinberg et al.

Administration of rabies postexposure prophylaxis (PEP) is expensive and time-consuming. In suburban Cook County, Illinois, USA, administration of 55.5% of PEP treatments did not follow Advisory Committee on Immunization Practices guidelines. Health department consultation lowered the odds of inappropriate PEP administration by 87%. Providers should consult their health department before prescribing PEP.

EID Steinberg HD, Bemis K, Frias MM, Christiansen D. Inappropriate Administration of Rabies Postexposure Prophylaxis, Cook County, Illinois, USA. Emerg Infect Dis. 2020;26(10):2515-2517. https://dx.doi.org/10.3201/eid2610.200232
AMA Steinberg HD, Bemis K, Frias MM, et al. Inappropriate Administration of Rabies Postexposure Prophylaxis, Cook County, Illinois, USA. Emerging Infectious Diseases. 2020;26(10):2515-2517. doi:10.3201/eid2610.200232.
APA Steinberg, H. D., Bemis, K., Frias, M. M., & Christiansen, D. (2020). Inappropriate Administration of Rabies Postexposure Prophylaxis, Cook County, Illinois, USA. Emerging Infectious Diseases, 26(10), 2515-2517. https://dx.doi.org/10.3201/eid2610.200232.

Mycobacterium leprae on Palatine Tonsils and Adenoids of Asymptomatic Patients, Brazil [PDF - 358 KB - 3 pages]
M. Morgado de Abreu et al.

We investigated palatine tonsil and adenoid specimens excised from otorhinolaryngological patients in a leprosy-endemic region of Brazil. Fite-Faraco staining identified Mycobacterium spp. in 9 of 397 specimen blocks. Immunohistochemistry and molecular analysis confirmed the presence of Mycobacterium leprae, indicating that these organs can house M. leprae in persons inhabiting a leprosy-endemic region.

EID Morgado de Abreu M, Nai G, Molina J, Gomes R, Natalia de Paula A. Mycobacterium leprae on Palatine Tonsils and Adenoids of Asymptomatic Patients, Brazil. Emerg Infect Dis. 2020;26(10):2518-2520. https://dx.doi.org/10.3201/eid2610.191267
AMA Morgado de Abreu M, Nai G, Molina J, et al. Mycobacterium leprae on Palatine Tonsils and Adenoids of Asymptomatic Patients, Brazil. Emerging Infectious Diseases. 2020;26(10):2518-2520. doi:10.3201/eid2610.191267.
APA Morgado de Abreu, M., Nai, G., Molina, J., Gomes, R., & Natalia de Paula, A. (2020). Mycobacterium leprae on Palatine Tonsils and Adenoids of Asymptomatic Patients, Brazil. Emerging Infectious Diseases, 26(10), 2518-2520. https://dx.doi.org/10.3201/eid2610.191267.

Fatal Chlamydia avium Infection in Captive Picazuro Pigeons, the Netherlands [PDF - 664 KB - 2 pages]
M. Kik et al.

In 2016, an outbreak of Chlamydia avium infection occurred among Picazuro pigeons (Patagioenas picazuro) living in an aviary in the Netherlands. Molecular typing revealed a unique strain of C. avium. Our findings show that C. avium infection, which usually causes subclinical infection, can cause fatal disease in pigeons.

EID Kik M, Heijne M, IJzer J, Grinwis G, Pannekoek Y, Gröne A. Fatal Chlamydia avium Infection in Captive Picazuro Pigeons, the Netherlands. Emerg Infect Dis. 2020;26(10):2520-2522. https://dx.doi.org/10.3201/eid2610.191412
AMA Kik M, Heijne M, IJzer J, et al. Fatal Chlamydia avium Infection in Captive Picazuro Pigeons, the Netherlands. Emerging Infectious Diseases. 2020;26(10):2520-2522. doi:10.3201/eid2610.191412.
APA Kik, M., Heijne, M., IJzer, J., Grinwis, G., Pannekoek, Y., & Gröne, A. (2020). Fatal Chlamydia avium Infection in Captive Picazuro Pigeons, the Netherlands. Emerging Infectious Diseases, 26(10), 2520-2522. https://dx.doi.org/10.3201/eid2610.191412.

Streptococcus equi Subspecies zooepidemicus and Sudden Deaths in Swine, Canada [PDF - 955 KB - 3 pages]
M. O. Costa and B. Lage

Historically described as a commensal of the swine upper respiratory tract, Streptococcus equi subspecies zooepidemicus was previously reported as an important swine pathogen only in Asia. Here we report the isolation and whole genome characterization of S. equi subsp. zooepidemicus associated with a sudden death outbreak in pigs in Canada.

EID Costa MO, Lage B. Streptococcus equi Subspecies zooepidemicus and Sudden Deaths in Swine, Canada. Emerg Infect Dis. 2020;26(10):2522-2524. https://dx.doi.org/10.3201/eid2610.191485
AMA Costa MO, Lage B. Streptococcus equi Subspecies zooepidemicus and Sudden Deaths in Swine, Canada. Emerging Infectious Diseases. 2020;26(10):2522-2524. doi:10.3201/eid2610.191485.
APA Costa, M. O., & Lage, B. (2020). Streptococcus equi Subspecies zooepidemicus and Sudden Deaths in Swine, Canada. Emerging Infectious Diseases, 26(10), 2522-2524. https://dx.doi.org/10.3201/eid2610.191485.

Pulmonary Infection Related to Mimivirus in Patient with Primary Ciliary Dyskinesia [PDF - 661 KB - 3 pages]
F. Sakhaee et al.

Primary ciliary dyskinesia is a rare autosomal recessive disorder that causes oto-sino-pulmonary disease. We report a case of pulmonary infection related to mimivirus in a 10-year-old boy with primary ciliary dyskinesia that was identified using molecular techniques. Our findings indicate that the lineage C of mimivirus may cause pneumonia in humans.

EID Sakhaee F, Vaziri F, Bahramali G, Siadat S, Fateh A. Pulmonary Infection Related to Mimivirus in Patient with Primary Ciliary Dyskinesia. Emerg Infect Dis. 2020;26(10):2524-2526. https://dx.doi.org/10.3201/eid2610.191613
AMA Sakhaee F, Vaziri F, Bahramali G, et al. Pulmonary Infection Related to Mimivirus in Patient with Primary Ciliary Dyskinesia. Emerging Infectious Diseases. 2020;26(10):2524-2526. doi:10.3201/eid2610.191613.
APA Sakhaee, F., Vaziri, F., Bahramali, G., Siadat, S., & Fateh, A. (2020). Pulmonary Infection Related to Mimivirus in Patient with Primary Ciliary Dyskinesia. Emerging Infectious Diseases, 26(10), 2524-2526. https://dx.doi.org/10.3201/eid2610.191613.

Q Fever Endocarditis and a New Genotype of Coxiella burnetii, Greece [PDF - 1.01 MB - 3 pages]
I. Karageorgou et al.

Underdiagnosis of Coxiella burnetii infections in Greece is possible because of lack of awareness by physicians, and most suspected cases are in patients with no bovine contact. We found serologic evidence of C. burnetii infection throughout Greece and identified a new C. burnetii genotype in the aortic valve of a patient with Q fever endocarditis.

EID Karageorgou I, Kogerakis N, Labropoulou S, Hatzianastasiou S, Mentis A, Stavridis G, et al. Q Fever Endocarditis and a New Genotype of Coxiella burnetii, Greece. Emerg Infect Dis. 2020;26(10):2527-2529. https://dx.doi.org/10.3201/eid2610.191616
AMA Karageorgou I, Kogerakis N, Labropoulou S, et al. Q Fever Endocarditis and a New Genotype of Coxiella burnetii, Greece. Emerging Infectious Diseases. 2020;26(10):2527-2529. doi:10.3201/eid2610.191616.
APA Karageorgou, I., Kogerakis, N., Labropoulou, S., Hatzianastasiou, S., Mentis, A., Stavridis, G....Angelakis, E. (2020). Q Fever Endocarditis and a New Genotype of Coxiella burnetii, Greece. Emerging Infectious Diseases, 26(10), 2527-2529. https://dx.doi.org/10.3201/eid2610.191616.

High Prevalence of Rickettsia raoultii and Associated Pathogens in Canine Ticks, South Korea [PDF - 683 KB - 3 pages]
M. Seo et al.

We studied the prevalence of tickborne pathogens in canine ticks, South Korea, during 2010–2015. Results revealed a high prevalence of the emerging pathogen Rickettsia raoultii. Dog ticks may be maintenance hosts for tickborne pathogens, suggesting the need to continually evaluate the potential public health threat posed by R. raoultii–infected ticks.

EID Seo M, Kwon O, Kwak D. High Prevalence of Rickettsia raoultii and Associated Pathogens in Canine Ticks, South Korea. Emerg Infect Dis. 2020;26(10):2530-2532. https://dx.doi.org/10.3201/eid2610.191649
AMA Seo M, Kwon O, Kwak D. High Prevalence of Rickettsia raoultii and Associated Pathogens in Canine Ticks, South Korea. Emerging Infectious Diseases. 2020;26(10):2530-2532. doi:10.3201/eid2610.191649.
APA Seo, M., Kwon, O., & Kwak, D. (2020). High Prevalence of Rickettsia raoultii and Associated Pathogens in Canine Ticks, South Korea. Emerging Infectious Diseases, 26(10), 2530-2532. https://dx.doi.org/10.3201/eid2610.191649.
Letters

Pulmonary Embolism and Increased Levels of d-Dimer in Patients with Coronavirus Disease [PDF - 243 KB - 2 pages]
K. Chan et al.
EID Chan K, Slim J, Shaaban HS. Pulmonary Embolism and Increased Levels of d-Dimer in Patients with Coronavirus Disease. Emerg Infect Dis. 2020;26(10):2532-2533. https://dx.doi.org/10.3201/eid2610.202127
AMA Chan K, Slim J, Shaaban HS. Pulmonary Embolism and Increased Levels of d-Dimer in Patients with Coronavirus Disease. Emerging Infectious Diseases. 2020;26(10):2532-2533. doi:10.3201/eid2610.202127.
APA Chan, K., Slim, J., & Shaaban, H. S. (2020). Pulmonary Embolism and Increased Levels of d-Dimer in Patients with Coronavirus Disease. Emerging Infectious Diseases, 26(10), 2532-2533. https://dx.doi.org/10.3201/eid2610.202127.

Work Environment Surrounding COVID-19 Outbreak in Call Center, South Korea [PDF - 233 KB - 1 page]
T. Kim
EID Kim T. Work Environment Surrounding COVID-19 Outbreak in Call Center, South Korea. Emerg Infect Dis. 2020;26(10):2533-2534. https://dx.doi.org/10.3201/eid2610.202647
AMA Kim T. Work Environment Surrounding COVID-19 Outbreak in Call Center, South Korea. Emerging Infectious Diseases. 2020;26(10):2533-2534. doi:10.3201/eid2610.202647.
APA Kim, T. (2020). Work Environment Surrounding COVID-19 Outbreak in Call Center, South Korea. Emerging Infectious Diseases, 26(10), 2533-2534. https://dx.doi.org/10.3201/eid2610.202647.

Stemming the Rising Tide of Human-Biting Ticks and Tickborne Diseases, United States [PDF - 257 KB - 2 pages]
A. Egizi and R. A. Jordan
EID Egizi A, Jordan RA. Stemming the Rising Tide of Human-Biting Ticks and Tickborne Diseases, United States. Emerg Infect Dis. 2020;26(10):2534-2535. https://dx.doi.org/10.3201/eid2610.201271
AMA Egizi A, Jordan RA. Stemming the Rising Tide of Human-Biting Ticks and Tickborne Diseases, United States. Emerging Infectious Diseases. 2020;26(10):2534-2535. doi:10.3201/eid2610.201271.
APA Egizi, A., & Jordan, R. A. (2020). Stemming the Rising Tide of Human-Biting Ticks and Tickborne Diseases, United States. Emerging Infectious Diseases, 26(10), 2534-2535. https://dx.doi.org/10.3201/eid2610.201271.

Rhabdomyolysis as Potential Late Complication Associated with COVID-19 [PDF - 234 KB - 1 page]
K. Chan and J. Slim
EID Chan K, Slim J. Rhabdomyolysis as Potential Late Complication Associated with COVID-19. Emerg Infect Dis. 2020;26(10):2535. https://dx.doi.org/10.3201/eid2610.202225
AMA Chan K, Slim J. Rhabdomyolysis as Potential Late Complication Associated with COVID-19. Emerging Infectious Diseases. 2020;26(10):2535. doi:10.3201/eid2610.202225.
APA Chan, K., & Slim, J. (2020). Rhabdomyolysis as Potential Late Complication Associated with COVID-19. Emerging Infectious Diseases, 26(10), 2535. https://dx.doi.org/10.3201/eid2610.202225.
Another Dimension

The Last Plague or Before the Graying [PDF - 248 KB - 1 page]
R. O. Valdiserri
EID Valdiserri RO. The Last Plague or Before the Graying. Emerg Infect Dis. 2020;26(10):2477. https://dx.doi.org/10.3201/eid2610.202788
AMA Valdiserri RO. The Last Plague or Before the Graying. Emerging Infectious Diseases. 2020;26(10):2477. doi:10.3201/eid2610.202788.
APA Valdiserri, R. O. (2020). The Last Plague or Before the Graying. Emerging Infectious Diseases, 26(10), 2477. https://dx.doi.org/10.3201/eid2610.202788.
Books and Media

The Mosquito: A Human History of Our Deadliest Predator [PDF - 292 KB - 1 page]
T. Snyder
EID Snyder T. The Mosquito: A Human History of Our Deadliest Predator. Emerg Infect Dis. 2020;26(10):2536. https://dx.doi.org/10.3201/eid2610.202806
AMA Snyder T. The Mosquito: A Human History of Our Deadliest Predator. Emerging Infectious Diseases. 2020;26(10):2536. doi:10.3201/eid2610.202806.
APA Snyder, T. (2020). The Mosquito: A Human History of Our Deadliest Predator. Emerging Infectious Diseases, 26(10), 2536. https://dx.doi.org/10.3201/eid2610.202806.
About the Cover

“All Bookshelves Are Magical” [PDF - 1.47 MB - 2 pages]
B. Breedlove
EID Breedlove B. “All Bookshelves Are Magical”. Emerg Infect Dis. 2020;26(10):2537-2538. https://dx.doi.org/10.3201/eid2610.ac2610
AMA Breedlove B. “All Bookshelves Are Magical”. Emerging Infectious Diseases. 2020;26(10):2537-2538. doi:10.3201/eid2610.ac2610.
APA Breedlove, B. (2020). “All Bookshelves Are Magical”. Emerging Infectious Diseases, 26(10), 2537-2538. https://dx.doi.org/10.3201/eid2610.ac2610.
Etymologia

Etymologia: Mimivirus [PDF - 546 KB - 1 page]
C. Partin
EID Partin C. Etymologia: Mimivirus. Emerg Infect Dis. 2020;26(10):2527. https://dx.doi.org/10.3201/eid2610.et2610
AMA Partin C. Etymologia: Mimivirus. Emerging Infectious Diseases. 2020;26(10):2527. doi:10.3201/eid2610.et2610.
APA Partin, C. (2020). Etymologia: Mimivirus. Emerging Infectious Diseases, 26(10), 2527. https://dx.doi.org/10.3201/eid2610.et2610.
Online Reports

Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2 [PDF - 323 KB - 5 pages]
A. A. Chughtai et al.

Cloth masks have been used in healthcare and community settings to protect the wearer from respiratory infections. The use of cloth masks during the coronavirus disease (COVID-19) pandemic is under debate. The filtration effectiveness of cloth masks is generally lower than that of medical masks and respirators; however, cloth masks may provide some protection if well designed and used correctly. Multilayer cloth masks, designed to fit around the face and made of water-resistant fabric with a high number of threads and finer weave, may provide reasonable protection. Until a cloth mask design is proven to be equally effective as a medical or N95 mask, wearing cloth masks should not be mandated for healthcare workers. In community settings, however, cloth masks may be used to prevent community spread of infections by sick or asymptomatically infected persons, and the public should be educated about their correct use.

EID Chughtai AA, Seale H, Macintyre C. Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2. Emerg Infect Dis. 2020;26(10):1-5. https://dx.doi.org/10.3201/eid2610.200948
AMA Chughtai AA, Seale H, Macintyre C. Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases. 2020;26(10):1-5. doi:10.3201/eid2610.200948.
APA Chughtai, A. A., Seale, H., & Macintyre, C. (2020). Effectiveness of Cloth Masks for Protection Against Severe Acute Respiratory Syndrome Coronavirus 2. Emerging Infectious Diseases, 26(10), 1-5. https://dx.doi.org/10.3201/eid2610.200948.

Enterovirus D68–Associated Acute Flaccid Myelitis, United States, 2020 [PDF - 438 KB - 8 pages]
S. Kidd et al.

Acute flaccid myelitis (AFM) is a serious neurologic condition that causes limb weakness or paralysis in previously healthy children. Since clusters of cases were first reported in 2014, nationwide surveillance has demonstrated sharp increases in AFM cases in the United States every 2 years, most occurring during late summer and early fall. Given this current biennial pattern, another peak AFM season is expected during fall 2020 in the United States. Scientific understanding of the etiology and the factors driving the biennial increases in AFM has advanced rapidly in the past few years, although areas of uncertainty remain. The Centers for Disease Control and Prevention and AFM partners are focused on answering key questions about AFM epidemiology and mechanisms of disease. This article summarizes the current understanding of AFM etiology and outlines priorities for surveillance and research as we prepare for a likely surge in cases in 2020.

EID Kidd S, Lopez AS, Konopka-Anstadt JL, Nix W, Routh JA, Oberste M. Enterovirus D68–Associated Acute Flaccid Myelitis, United States, 2020. Emerg Infect Dis. 2020;26(10):6-12. https://dx.doi.org/10.3201/eid2610.201630
AMA Kidd S, Lopez AS, Konopka-Anstadt JL, et al. Enterovirus D68–Associated Acute Flaccid Myelitis, United States, 2020. Emerging Infectious Diseases. 2020;26(10):6-12. doi:10.3201/eid2610.201630.
APA Kidd, S., Lopez, A. S., Konopka-Anstadt, J. L., Nix, W., Routh, J. A., & Oberste, M. (2020). Enterovirus D68–Associated Acute Flaccid Myelitis, United States, 2020. Emerging Infectious Diseases, 26(10), 6-12. https://dx.doi.org/10.3201/eid2610.201630.
Page created: September 14, 2020
Page updated: September 17, 2020
Page reviewed: September 17, 2020
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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