Inhalation anthrax occurred in a man who vacationed in 4 US states where anthrax is enzootic. Despite an extensive multi-agency investigation, the specific source was not detected, and no additional related human or animal cases were found. Although rare, inhalation anthrax can occur naturally in the United States.
anthrax; epidemiology; zoonoses; Bacillus anthracis; bacteria; United States
Clinical recommendations for the prevention and treatment of anthrax among pregnant women are updated.
In August 2012, the Centers for Disease Control and Prevention, in partnership with the Association of Maternal and Child Health Programs, convened a meeting of national subject matter experts to review key clinical elements of anthrax prevention and treatment for pregnant, postpartum, and lactating (P/PP/L) women. National experts in infectious disease, obstetrics, maternal fetal medicine, neonatology, pediatrics, and pharmacy attended the meeting, as did representatives from professional organizations and national, federal, state, and local agencies. The meeting addressed general principles of prevention and treatment for P/PP/L women, vaccines, antimicrobial prophylaxis and treatment, clinical considerations and critical care issues, antitoxin, delivery concerns, infection control measures, and communication. The purpose of this meeting summary is to provide updated clinical information to health care providers and public health professionals caring for P/PP/L women in the setting of a bioterrorist event involving anthrax.
Bacillus anthracis; anthrax; antibacterial agents; antimicrobial drugs; pregnancy; postpartum period; lactation; breast-feeding; bacteria; women; treatment; antibiotics; antitoxins; PEP; postexposure prophylaxis; vaccine; vaccination; Suggested citation for this article: Meaney-Delman D, Zotti ME, Creanga AA, Misegades LK, Wako E, Treadwell TA, et al; Workgroup on Anthrax in Pregnant and Postpartum Women. Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women. Emerg Infect Dis [Internet]. 2014 Feb [date cited]. http://dx.doi.org/10.3201/eid2002.130611
NDM-1; Enterobacteriaceae; Providencia rettgeri; Raoultella ornithinolytica; bacteria; China; New Delhi metallo-β-lactamase-1–producing strains
The Centers for Disease Control and Prevention convened panels of anthrax experts to review and update guidelines for anthrax postexposure prophylaxis and treatment. The panels included civilian and military anthrax experts and clinicians with experience treating anthrax patients. Specialties represented included internal medicine, pediatrics, obstetrics, infectious disease, emergency medicine, critical care, pulmonology, hematology, and nephrology. Panelists discussed recent patients with systemic anthrax; reviews of published, unpublished, and proprietary data regarding antimicrobial drugs and anthrax antitoxins; and critical care measures of potential benefit to patients with anthrax. This article updates antimicrobial postexposure prophylaxis and antimicrobial and antitoxin treatment options and describes potentially beneficial critical care measures for persons with anthrax, including clinical procedures for infected nonpregnant adults. Changes from previous guidelines include an expanded discussion of critical care and clinical procedures and additional antimicrobial choices, including preferred antimicrobial drug treatment for possible anthrax meningitis.
anthrax; Bacillus anthracis; bacteria; bioterrorism and preparedness; antitoxin; raxibacumab; expert panel meeting; prevention; treatment; adults; Centers for Disease Control and Prevention
A Rift Valley fever (RVF) outbreak in humans and animals occurred in Mauritania in 2010. Thirty cases of RVF in humans and 3 deaths were identified. RVFV isolates were recovered from humans, camels, sheep, goats, and Culex antennatus mosquitoes. Phylogenetic analysis of isolates indicated a virus origin from western Africa.
Rift Valley fever; Rift Valley fever viruses; viruses; outbreak; virus lineage; reemergence; field investigations; human; animals; mosquitoes; Mauritania
Rabies; Greece; rabies diagnostic; RT-PCR; molecular epidemiology; phylogenetic analysis; viruses; zoonoses; animal rabies
Replicative capacity of Middle East respiratory syndrome coronavirus (MERS-CoV) was assessed in cell lines derived from livestock and peridomestic small mammals on the Arabian Peninsula. Only cell lines originating from goats and camels showed efficient replication of MERS-CoV. These results provide direction in the search for the intermediate host of MERS-CoV.
Middle East respiratory syndrome; MERS; coronavirus; livestock; intermediate host; zoonosis; zoonotic; zoonoses; viruses; cell culture; goats; camels; Arabian Peninsula
Rift Valley Fever Outbreak, Mauritania, 2012
After a period of heavy rainfall, an outbreak of Rift Valley fever occurred in southern Mauritania during September–November 2012. A total of 41 human cases were confirmed, including 13 deaths, and 12 Rift Valley fever virus strains were isolated. Moudjeria and Temchecket Departments were the most affected areas.
Rift Valley fever; outbreak; re-emergence; field investigation; Mauritania; viruses; RVFV; Rift Valley fever virus; Suggested citation for this article: Sow A; Faye Om; Ba Y; Ba H; Diallo D; Faye Os; et al. Rift Valley fever outbreak; southern Mauritania; 2012. Emerg Infect Dis [Internet]. 2014 Feb [date cited]. http://dx.doi.org/10.3201/eid2002.131000
Bacillus anthracis; anthrax; heroin users; single nucleotide polymorphism; Germany; Trans-Eurasian clade; phylogeny; bacteria; Europe; injectional anthrax; humans
bunyavirus; phlebovirus; Heartland virus; severe fever with thrombocytopenia syndrome virus; sftsv; animals; infection; viruses; Minnesota; USA; large mammals; novel bunyavirus
bunyavirus; phlebovirus; Heartland virus; Heartland-like virus; hrtv; severe fever with thrombocytopenia syndrome virus; sftsv; animals; infection; zoonoses; viruses; Minnesota; USA; large mammals; novel bunyavirus
We report a case of congenital rubella syndrome in a child born to a vaccinated New Jersey woman who had not traveled internationally. Although rubella and congenital rubella syndrome have been eliminated from the United States, clinicians should remain vigilant and immediately notify public health authorities when either is suspected.
Rubella syndrome; congenital rubella syndrome; rubella; viruses; congenital; vaccination; contact tracing; case reports; New Jersey; USA
Immunosuppression is a risk factor for serious infection in humans.
The insect microsporidian Anncaliia algerae was first described in 2004 as a cause of fatal myositis in an immunosuppressed person from Pennsylvania, USA. Two cases were subsequently reported, and we detail 2 additional cases, including the only nonfatal case. We reviewed all 5 case histories with respect to clinical characteristics, diagnosis, and management and summarized organism life cycle and epidemiology. Before infection, all case-patients were using immunosuppressive medications for rheumatoid arthritis or solid-organ transplantation. Four of the 5 case-patients were from Australia. All diagnoses were confirmed by skeletal muscle biopsy; however, peripheral nerves and other tissues may be infected. The surviving patient received albendazole and had a reduction of immunosuppressive medications and measures to prevent complications. Although insects are the natural hosts for A. algerae, human contact with water contaminated by spores may be a mode of transmission. A. algerae has emerged as a cause of myositis, particularly in coastal Australia.
microporidia; insects; myositis; infection; arthritis rheumatoid; solid-organ transplantation; Anncaliia algerae; Australia
Understanding host antibody response is crucial for predicting disease severity and for vaccine development. We investigated antibody responses against influenza A(H7N9) virus in 48 serum samples from 21 patients, including paired samples from 15 patients. IgG against subtype H7 and neutralizing antibodies (NAbs) were not detected in acute-phase samples, but ELISA geometric mean titers increased in convalescent-phase samples; NAb titers were 20–80 (geometric mean titer 40). Avidity to IgG against subtype H7 was significantly lower than that against H1 and H3. IgG against H3 was boosted after infection with influenza A(H7N9) virus, and its level in acute-phase samples correlated with that against H7 in convalescent-phase samples. A correlation was also found between hemagglutinin inhibition and NAb titers and between hemagglutinin inhibition and IgG titers against H7. Because of the relatively weak protective antibody response to influenza A(H7N9), multiple vaccinations might be needed to achieve protective immunity.
avian influenza virus; H7N9; antibody responses; neutralizing antibody; hemagglutination inhibition assay; avidity; viruses; influenza; human
Such surveillance can provide an early warning for emergence of this disease and measure disease underreporting.
Human babesiosis is an emerging tick-borne disease caused by the intraerythrocytic protozoan Babesia microti. Its geographic distribution is more limited than that of Lyme disease, despite sharing the same tick vector and reservoir hosts. The geographic range of babesiosis is expanding, but knowledge of its range is incomplete and relies exclusively on reports of human cases. We evaluated the utility of tick-based surveillance for monitoring disease expansion by comparing the ratios of the 2 infections in humans and ticks in areas with varying B. microti endemicity. We found a close association between human disease and tick infection ratios in long-established babesiosis-endemic areas but a lower than expected incidence of human babesiosis on the basis of tick infection rates in new disease-endemic areas. This finding suggests that babesiosis at emerging sites is underreported. Vector-based surveillance can provide an early warning system for the emergence of human babesiosis.
Ixodes scapularis; Borrelia burgdorferi; Babesia microti; tick-borne pathogens; Lyme disease; human babesiosis; parasites; piroplasm; infection prevalence; incidence ratio; emergence; New England; Connecticut; Massachusetts
Fungal endophthalmitis is a rare but serious infection. In March 2012, several cases of probable and laboratory-confirmed fungal endophthalmitis occurring after invasive ocular procedures were reported nationwide. We identified 47 cases in 9 states: 21 patients had been exposed to the intraocular dye Brilliant Blue G (BBG) during retinal surgery, and the other 26 had received an intravitreal injection containing triamcinolone acetonide. Both drugs were produced by Franck’s Compounding Lab (Ocala, FL, USA). Fusarium incarnatum-equiseti species complex mold was identified in specimens from BBG-exposed case-patients and an unopened BBG vial. Bipolaris hawaiiensis mold was identified in specimens from triamcinolone-exposed case-patients. Exposure to either product was the only factor associated with case status. Of 40 case-patients for whom data were available, 39 (98%) lost vision. These concurrent outbreaks, associated with 1 compounding pharmacy, resulted in a product recall. Ensuring safety and integrity of compounded medications is critical for preventing further outbreaks associated with compounded products.
eye infections; fungal; mold; endophthalmitis; disease outbreaks; Franck’s; Fusarium incarnatum-equiseti; Bipolaris hawaiiensis; fungi; compounding
During follow-up of a 2012 US outbreak of lymphocytic choriomeningitis virus (LCMV), we conducted a trace-forward investigation. LCMV-infected feeder mice originating from a US rodent breeding facility had been distributed to >500 locations in 21 states. All mice from the facility were euthanized, and no additional persons tested positive for LCMV infection.
animals; mice; humans; lymphocytic choriomeningitis virus; arenavirus; zoonoses; viruses; multistate outbreaks
Careful monitoring of vaccines against common bacterial colonizers is needed.
Seven-valent pneumococcal conjugate vaccine (PCV-7) is effective against vaccine serotype disease and carriage. Nevertheless, shifts in colonization and disease toward nonvaccine serotypes and other potential pathogens have been described. To understand the extent of these shifts, we analyzed nasopharyngeal microbial profiles of 97 PCV-7–vaccinated infants and 103 control infants participating in a randomized controlled trial in the Netherlands. PCV-7 immunization resulted in a temporary shift in microbial community composition and increased bacterial diversity. Immunization also resulted in decreased presence of the pneumococcal vaccine serotype and an increase in the relative abundance and presence of nonpneumococcal streptococci and anaerobic bacteria. Furthermore, the abundance of Haemophilus and Staphylococcus bacteria in vaccinees was increased over that in controls. This study illustrates the much broader effect of vaccination with PCV-7 on the microbial community than currently assumed, and highlights the need for careful monitoring when implementing vaccines directed against common colonizers.
seven-valent pneumococcal conjugate vaccine; PCV-7; pneumococcal conjugate vaccine; pneumococcal conjugate vaccination; pneumococci; bacteria; respiratory tract; colonization; randomized controlled trial; nasopharyngeal microbiota; children
high-consequence pathogens; high mortality; anthrax; orthopoxviruses; hemorrhagic fevers; filoviruses; monkeypox; pathology; infectious disease pathology; viruses; bacteria; zoonoses
etymologia; Dirofilaria immitis; heartworm; worm; nematode
outbreaks; pandemics; viruses; drug-resistant parasites; malaria; West Nile virus; Legionnaires disease; medical detectives
We identified 10 patients in Thailand with culture-confirmed melioidosis who had Burkholderia pseudomallei isolated from their drinking water. The multilocus sequence type of B. pseudomallei from clinical specimens and water samples were identical for 2 patients. This finding suggests that drinking water is a preventable source of B. pseudomallei infection.
melioidosis; Burkholderia pseudomallei; bacteria; drinking water; genotyping; Thailand
Health authorities should be vigilant for this rapidly evolving virus.
Monkeypox virus is a zoonotic virus endemic to Central Africa. Although active disease surveillance has assessed monkeypox disease prevalence and geographic range, information about virus diversity is lacking. We therefore assessed genome diversity of viruses in 60 samples obtained from humans with primary and secondary cases of infection from 2005 through 2007. We detected 4 distinct lineages and a deletion that resulted in gene loss in 10 (16.7%) samples and that seemed to correlate with human-to-human transmission (p = 0.0544). The data suggest a high frequency of spillover events from the pool of viruses in nonhuman animals, active selection through genomic destabilization and gene loss, and increased disease transmissibility and severity. The potential for accelerated adaptation to humans should be monitored through improved surveillance.
Monkeypox virus; genomic diversity; emerging infectious disease; genomic reduction; gene loss; Democratic Republic of the Congo; viruses
The cause of diphyllobothriosis in 5 persons in Harbin and Shanghai, China, during 2008–2011, initially attributed to the tapeworm Diphyllobothrium latum, was confirmed as D. nihonkaiense by using molecular analysis of expelled proglottids. The use of morphologic characteristics alone to identify this organism was inadequate and led to misidentification of the species.
cestodiasis; diphyllobothrium; diphyllobothrium infection; nihonkaiense; latum; diphyllobothriosis; tapeworm; proglottid; plerocoercoid; strobila; parasite; China
Seroprevalence of Crimean-Congo hemorrhagic fever virus (CCHFV) is high in some regions of Greece, but only 1 case of disease has been reported. We used 4 methods to test 118 serum samples that were positive for CCHFV IgG by commercial ELISA and confirmed the positive results. A nonpathogenic or low-pathogenicity strain may be circulating.
Crimean-Congo hemorrhagic fever virus; CCHFV; viruses; ELISA; immunofluorescence assay; neutralization test; Greece; vector-borne infections; ticks; seroprevalence