Early Release

Synopses

• Epidemiology, Clinical Features, and Outcomes of Coccidioidomycosis in Utah, 2006–2015
  A. Carey et al.
• Epidemiology, Management, and Response to a COVID-19 Outbreak among Crew Members on a Cruise Ship, Nagasaki City, Japan, April 2020
  H. Maeda et al.
• Seroprevalence and Virologic Surveillance of Enterovirus 71 and Coxsackievirus A6, United Kingdom, 2006–2017
  E. Kamau et al.

Research

• Estimating the Impact of Statewide Policies to Reduce Spread of Severe Acute Respiratory Syndrome Coronavirus 2 in Real Time, Colorado, USA
  A. G. Buchwald et al. View Abstract Email this Article

  The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic necessitated rapid local public health response, but studies examining the impact of social distancing policies on SARS-CoV-2 transmission have struggled to capture regional-level dynamics. We developed a susceptible-exposed-infected-recovered transmission model, parameterized to Colorado, USA‒specific data, to estimate the impact of coronavirus disease‒related policy measures on mobility and SARS-CoV-2 transmission in real time. During March‒June 2020, we estimated unknown parameter values and generated scenario-based projections of future clinical care needs. Early coronavirus disease policy measures, including a stay-at-home order, were accompanied by substantial decreases in mobility and reduction of the effective reproductive number well below 1. When some restrictions were eased in late April, mobility increased to near baseline levels, but transmission remained low (effective reproductive number <1) through early June. Over time, our model was parameterized closer to reality in Colorado, leading to modest changes in estimates of intervention effects and more conservative long-term projections.

• Multicenter Epidemiologic Study of Coronavirus Disease–Associated Mucormycosis, India
  A. Patel et al. View Abstract Email this Article

  During September–December 2020, we conducted a multicenter retrospective study across India to compare epidemiology and outcomes among cases of coronavirus disease (COVID-19)–associated mucormycosis (CAM). Among 287 mucormycosis patients, 187 (65.2%) had CAM; CAM prevalence was 0.27% among hospitalized COVID-19 patients. We noted a 2.1-fold rise in mucormycosis during the study period compared with September–December 2019. Uncontrolled diabetes mellitus was the most common underlying disease among CAM and non-CAM patients. COVID-19 was the only underlying disease in 32.6% of CAM patients. COVID-19–related hypoxemia and improper glucocorticoid use independently were associated with CAM. The mucormycosis case-fatality rate at 12 weeks was 45.7% but was similar for CAM and non-CAM patients. Age, rhino-orbital-cerebral involvement, and intensive care unit admission were associated with increased mortality rates; sequential antifungal drug treatment improved mucormycosis survival. The COVID-19 pandemic has led to increases in mucormycosis in India, partly from inappropriate glucocorticoid use.

• Human and Porcine Transmission of Clostridioides difficile Ribotype 078, Europe
  G. Moloney et al. View Abstract Email this Article

  Genomic analysis of a diverse collection of Clostridioides difficile ribotype 078 isolates from Ireland and 9 countries in Europe provided evidence for complex regional and international patterns of dissemination that is not restricted to humans. These isolates are associated with C. difficile colonization and clinical illness in humans and pigs.

• Severe Acute Respiratory Syndrome Coronavirus 2 in Farmed Mink (Neovison vison), Poland
  L. Rabalski et al.
• Risk for Acquiring COVID-19 Illness among Emergency Medical Service Personnel Exposed to Aerosol-Generating Procedures
  A. Brown et al. View Abstract Email this Article

  We investigated the risk of coronavirus disease (COVID-19)­ patients transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to emergency medical service (EMS) providers, stratified by aerosol-generating procedures (AGP), in King County, Washington, USA, during February 16–July 31, 2020. We conducted a retrospective cohort investigation using a statewide COVID-19 registry and identified 1,115 encounters, 182 with ≥1 AGP. Overall, COVID-19 incidence among EMS personnel was 0.57 infections/10,000 person-days. Incidence per 10,000 person-days did not differ whether or not infection was attributed to a COVID-19 patient encounter (0.28 vs. 0.59; p>0.05). The 1 case attributed to a COVID-19 patient encounter occurred within an at-risk period and involved an AGP. We observed a very low risk for COVID-19 infection attributable to patient encounters among EMS first responders, supporting clinical strategies that maintain established practices for treating patients in emergency conditions.

• Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 to Close Contacts, China, January–February 2020
  Y. Li et al. View Abstract Email this Article

  We estimated the symptomatic, PCR-confirmed secondary attack rate (SAR) for 2,382 close contacts of 476 symptomatic persons with coronavirus disease in Yichang, Hubei Province, China, identified during January 23–February 25, 2020. The SAR among all close contacts was 6.5%; among close contacts who lived with an index case-patient, the SAR was 10.8%; among close-contact spouses of index case-patients, the SAR was 15.9%. The SAR varied by close contact age, from 3.0% for those <18 years of age to 12.5% for those >60 years of age. Multilevel logistic regression showed that factors significantly associated with increased SAR were living together, being a spouse, and being >60 years of age. Multilevel regression did not support SAR differing significantly by whether the most recent contact occurred before or after the index case-patient’s onset of illness (p = 0.66). The relatively high SAR for coronavirus disease suggests relatively high virus transmissibility.

• Patterns of Virus Exposure and Presumed Household Transmission among Persons with Coronavirus Disease, United States, January–April 2020
  R. M. Burke et al. View Abstract Email this Article

  We characterized common exposures reported by a convenience sample of 202 US patients with coronavirus disease during January–April 2020 and identified factors associated with presumed household transmission. The most commonly reported settings of known exposure were households and healthcare facilities; among case-patients who had known contact with a confirmed case-patient compared with those who did not, healthcare occupations were more common. Among case-patients without known contact, use of public transportation was more common. Within the household, presumed transmission was highest from older (>65 years) index case-patients and from children to parents, independent of index case-patient age. These findings may inform guidance for limiting transmission and emphasize the value of testing to identify community-acquired infections.

• Risk Factors for Middle East Respiratory Syndrome Coronavirus Infection among Camel Populations, Southern Jordan, 2014–2018
  P. Holloway et al. View Abstract Email this Article

  After the first detection of Middle East respiratory syndrome coronavirus (MERS-CoV) in camels in Jordan in 2013, we conducted 2 consecutive surveys in 2014–2015 and 2017–2018 investigating risk factors for MERS-CoV infection among camel populations in southern Jordan. Multivariate analysis to control for confounding demonstrated that borrowing of camels, particularly males, for breeding purposes was associated with increased MERS-CoV seroprevalence among receiving herds, suggesting a potential route of viral transmission between herds. Increasing age, herd size, and use of water troughs within herds were also associated with increased seroprevalence. Closed herd management practices were found to be protective. Future vaccination strategies among camel populations in Jordan could potentially prioritize breeding males, which are likely to be shared between herds. In addition, targeted management interventions with the potential to reduce transmission between herds should be considered; voluntary closed herd schemes offer a possible route to achieving disease-free herds.

• Geographically Targeted Interventions versus Mass Drug Administration to Control Taenia solium Cysticercosis, Peru
  S. E. O’Neal et al.
• Genomic Epidemiology of Azithromycin-Nonsusceptible Neisseria gonorrhoeae, Argentina, 2005–2019
  R. Gianecini et al.
• Evaluation of Risk Areas for Influenza A (H5) Environmental Contamination in Live Bird Markets, Dhaka, Bangladesh
  S. Chakma et al.
• Real-time Genomics for Tracking Severe Acute Respiratory Syndrome Coronavirus 2 Border Incursions after Virus Elimination, New Zealand
  J. Douglas et al.
• Perinatal Outcomes of Asynchronous Influenza Vaccination, Ceará, Brazil, 2013–2018
  J. Q. Filho et al.
• Development and Clinical Evaluation of a CRISPR-Based Diagnostic for Rapid Group B Streptococcus Screening
  L. Jiang et al.
• Reduction in Antimicrobial Use and Resistance in Broiler Chickens for Salmonella, Campylobacter, and Escherichia coli, Canada, 2013–2019
  L. Huber et al.
• Spatiotemporal Dynamics of Sporadic Shiga Toxin–Producing E. coli Enteritis, Ireland, 2013–2017
  E. Cleary et al.
• Maternal Carriage in Late-Onset Group B Streptococcus Disease, Italy
  A. Berardi et al.

Dispatches

• Laboratory Exposures from an Unsuspected Case of Human Infection with Brucella canis
  J. Ahmed-Bentley et al.
• Ongoing High Incidence and Case Fatality of Invasive Listeriosis, Germany, 2010–2019
  H. Wilking et al.
• Predictors of Nonseroconversion after SARS-CoV-2 Infection
  W. Liu et al.
• Association of Dromedary Camels and Camel Ticks with Enzootic Transmission of Reassortant CCHFV, United Arab Emirates
  J. V. Camp et al.
• A Community-Adapted Approach to SARS-CoV-2 Testing for Medically Underserved Populations, Rhode Island, USA
  M. Murphy et al.
• Disseminated Cutaneous Leishmaniasis and Alcohol Misuse, Northeast Brazil, 2015–2018
  A. Q. Sousa et al.
• West Nile Virus Seroprevalence among Equids, Brazil
  E. F. de Oliveira-Filho et al.
• Predictors of Nonseroconversion after SARS-CoV-2 Infection
  W. Liu et al. View Abstract Email this Article

  Not all persons recovering from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection develop SARS-CoV-2–specific antibodies. We show that nonseroconversion is associated with younger age and higher reverse transcription PCR cycle threshold values and identify SARS-CoV-2 viral loads in the nasopharynx as a major correlate of the systemic antibody response.

• Hotspot of Crimean-Congo Hemorrhagic Fever Virus Seropositivity in Wildlife, Spain
  J. Espunyes et al.
• Bordetella hinzii Meningitis in a Transplant Patient, Virginia, USA
  J. Pechacek et al.
• Transmission of SARS-CoV-2 from Human to Domestic Ferret
  J. Račnik et al.

Research Letters

• Invasive Meningococcal Disease, 2011–2020, and Impact of the COVID-19 Pandemic, England
  S. Subbarao et al. View Abstract Email this Article

  Invasive meningococcal disease incidence in England declined from 1.93/100,000 persons (1,016 cases) in 2010–11 to 0.95/100,000 (530 cases) in 2018–19 and 0.74/100,000 in 2019–20 (419 cases). During national lockdown for the coronavirus disease pandemic (April–August 2020), incidence was 75% lower than during April–August 2019.

• SARS-CoV-2 Infection among Pregnant and Postpartum Women, Kenya, 2020–2021
  N. A. Otieno et al. View Abstract Email this Article

  We determined incidence of severe acute respiratory syndrome coronavirus 2 and influenza virus infections among pregnant and postpartum women and their infants in Kenya during 2020–2021. Incidence of severe acute respiratory syndrome coronavirus 2 was highest among pregnant women, followed by postpartum women and infants. No influenza virus infections were identified.

• Genomic Evolution of SARS-CoV-2 Virus in Immunocompromised Patient, Ireland
  M. Lynch et al. View Abstract Email this Article

  We examined virus genomic evolution in an immunocompromised patient with prolonged severe acute respiratory syndrome coronavirus 2 infection. Genomic sequencing revealed genetic variation during infection: 3 intrahost mutations and possible superinfection with a second strain of the virus. Prolonged infection in immunocompromised patients may lead to emergence of new virus variants.

• Prevalence of mcr-1 in Colonized Inpatients, China, 2011–2019
  C. Shen et al.
• Emergence of Haemophilus influenzae type a ST23, Northern Spain
  M. López-Olaizola et al.

Letters

• SARS-CoV-2 Superspread in Fitness Center, Hong Kong, China, March 2021
  L. C. Marr Email this Article
• Fecal Excretion of Mycobacterium leprae, Burkina Faso
  A. Singh et al.

Books and Media

• People Count: Contact-Tracing Apps and Public Health
  I. Fung and B. B. Chan

Online Report

• SARS-CoV-2 Wastewater Surveillance for Public Health Action
  J. S. McClary-Gutierrez et al. View Abstract Email this Article

  Wastewater surveillance for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has garnered extensive public attention during the coronavirus disease pandemic as a proposed complement to existing disease surveillance systems. Over the past year, methods for detection and quantification of SARS-CoV-2 viral RNA in untreated sewage have advanced, and concentrations in wastewater have been shown to correlate with trends in reported cases. Despite the promise of wastewater surveillance, for these measurements to translate into useful public health tools, bridging the communication and knowledge gaps between researchers and public health responders is needed. We describe the key uses, barriers, and applicability of SARS-CoV-2 wastewater surveillance for supporting public health decisions and actions, including establishing ethics consideration for monitoring. Although wastewater surveillance to assess community infections is not a new idea, the coronavirus disease pandemic might be the initiating event to make this emerging public health tool a sustainable nationwide surveillance system, provided that these barriers are addressed.

Perspective

• Antimicrobial Resistance in Africa: How to Relieve the Burden on Family Farmers
  C. Ducrot et al.

Synopses

• Characteristics, Comorbidities, and Data Gaps for Coronavirus Disease Deaths, Tennessee, USA
  J. J. Parker et al.
• Fatal Exacerbations of Systemic Capillary Leak Syndrome Complicating Coronavirus Disease
  P. C. Cheung et al. View Abstract Email this Article

  We report 2 fatal exacerbations of systemic capillary leak syndrome (SCLS), also known as Clarkson disease, associated with coronavirus disease (COVID-19) in the United States. One patient carried an established diagnosis of SCLS and the other sought treatment for new-onset hypotensive shock, hemoconcentration, and anasarca, classic symptoms indicative of an SCLS flare. Both patients had only mild-to-moderate symptoms of COVID-19. This clinical picture suggests that these patients succumbed to complications of SCLS induced by infection with severe acute respiratory syndrome coronavirus 2. Persons with known or suspected SCLS may be at increased risk for developing a disease flare in the setting of mild-to-moderate COVID-19 infection.

• Distribution and Characteristics of Human Plague Cases and Yersinia pestis Isolates from 4 Marmota Plague Foci, China, 1950–2019
  Z. He et al.
• Novel Outbreak-Associated Food Vehicles and Outbreak Investigation, Prevention, and Communications Needs, United States
  H. K. Whitham et al.
• Severe Acute Respiratory Syndrome Coronavirus 2 and Pregnancy Outcomes according to Gestational Age at Time of Infection
  D. A. Badr et al.

Research

• Bloodstream Infection Risk, Incidence, and Deaths for Hospitalized Patients During Coronavirus Disease Pandemic
  B. S. Shukla et al.
• Direct and Indirect Effectiveness of mRNA Vaccination against Severe Acute Respiratory Syndrome Coronavirus 2 in Long-Term Care Facilities, Spain
  S. Monge et al. View Abstract Email this Article

  We conducted a registries-based cohort study of long-term care facility residents >65 years of age offered vaccination against severe acute respiratory syndrome coronavirus 2 before March 10, 2021, in Spain. Risk for infection in vaccinated and nonvaccinated persons was compared with risk in the same persons in a period before the vaccination campaign, adjusted by daily-varying incidence and reproduction number. We selected 299,209 persons; 99.0% had >1 dose, 92.6% had 2 doses, and 99.8% of vaccines were Pfizer/BioNTech (BNT162b2). For vaccinated persons with no previous infection, vaccine effectiveness was 81.8% (95% CI 81.0%–82.7%), and 11.6 (95% CI 11.3–11.9) cases were prevented per 10,000 vaccinated/day. In those with previous infection, effectiveness was 56.8% (95% CI 47.1%–67.7%). In nonvaccinated residents with no previous infection, risk decreased by up to 81.4% (95% CI 73.3%–90.3%). Our results confirm vaccine effectiveness in this population and suggest indirect protection in nonvaccinated persons.

• Epidemiology of the Early COVID-19 Epidemic in Orange County, California, USA
  D. M. Parker et al.
• Fatal Cowpox Virus Infection in Human Fetus, France, 2017
  A. Ferrier et al.
• Severe Acute Respiratory Syndrome Coronavirus 2 Transmission in Georgia, USA, February 1–July 13, 2020
  Y. Wang et al.
• Risk Assessment for Highly Pathogenic Avian Influenza A(H5Nx) Clade 2.3.4.4 Viruses
  C. Bui et al.

Dispatches

• Widespread Disease in Hedgehogs (Erinaceus europaeus) Caused by Toxigenic Corynebacterium ulcerans
  A. Martel et al.
• Genetic Diversity of SARS-CoV-2 in Travelers Arriving in Hong Kong
  H. Gu et al.
• Point-of-Care Antigen Test for SARS-CoV-2 in Asymptomatic College Students
  S. C. Tinker et al.
• Human Babesiosis Reinfection
  J. Ho et al.
• Breakthrough Infections of SARS-CoV-2 Gamma Variant in Fully Vaccinated Gold Miners, French Guiana, 2021
  N. Vignier et al. View Abstract Email this Article

  An outbreak of severe acute respiratory syndrome coronavirus 2 caused by the Gamma variant of concern infected 24/44 (55%) employees of a gold mine in French Guiana (87% symptomatic, no severe forms). The attack rate was 60% (15/25) among fully vaccinated miners and 75% (3/4) among unvaccinated miners without a history of infection.

• Seoul Virus Associated with Pet Rats, Scotland, United Kingdom, 2019
  J. G. Shepherd et al.
• Natural Plasmodium inui Infections among Humans and Anopheles cracens Mosquitoes, Malaysia
  J. K. Liew et al.
• Outbreak of Oropouche Virus in French Guiana
  M. Gaillet et al.
• Rapid Increase in Lymphogranuloma Venereum among HIV-Negative Men Who Have Sex with Men, England, 2019
  M. Prochazka et al.
• Genomic Sequencing of SARS-CoV-2 E484K Variant B.1.243.1, Arizona, USA
  P. T. Skidmore et al.
• Multiple Transmission Chains within COVID-19 Cluster, Connecticut, USA, 2020
  S. M. Bart et al.

Research Letters

• Case of Rickettsia slovaca Infection in Russia
  R. F. Sayfullin et al.
• Indoor and Outdoor Rodent Hosts of Orientia tsutsugamushi, Shandong Province, China
  F. Li et al.
• SARS-CoV-2 Neutralization Resistance Mutations in Patient with HIV/AIDS, California, USA
  S. A. Hoffman et al. View Abstract Email this Article

  We report persistent severe acute respiratory syndrome coronavirus 2 infection in a patient with HIV/AIDS; the virus developed spike N terminal domain and receptor binding domain neutralization resistance mutations. Our findings suggest that immunocompromised patients can harbor emerging variants of severe acute respiratory syndrome coronavirus 2.

• Emergence of SARS-COV-2 Spike Protein Escape Mutation Q493R after Treatment for COVID-19
  D. Focosi et al. View Abstract Email this Article

  We report in vivo selection of a severe acute respiratory syndrome coronavirus 2 spike mutation (Q493R) conferring simultaneous resistance to bamlanivimab and etesivimab. This mutation was isolated from a patient who had coronavirus disease and was treated with these drugs.

• SARS-CoV-2 Delta Variant among Asiatic Lions, India
  A. Mishra et al.
• SARS-Co2v-2 Variants in Immunocompromised Patient Given Antibody Monotherapy
  A. Truffot et al.
• Effects of COVID-19 Pandemic on Reported Lyme Disease, United States, 2020
  D. W. McCormick et al.

Letter

• Antimicrobial-Resistant Nontyphoidal Salmonella Infections, United States, 2004–2016
  A. Bharat et al.

Synopsis

• Policy Review and Modeling Analysis of Mitigation Measures for Coronavirus Disease Epidemic Control, Health System, and Disease Burden, South Korea
  H. Kim et al.

Research

• Genomic Profiling of Mycobacterium tuberculosis Strains, Myanmar
  H. Aung et al.
• Incidence Rates for Hepatitis A Virus and Biomarker Dynamics in Plasma Donors, United States
  S. Schoch et al.

Research Letter

• Real-Time Genomic Surveillance for SARS-CoV-2 Variants of Concern, Uruguay
  N. Rego et al.