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1.  Quantifying Reporting Timeliness to Improve Outbreak Control 
Emerging Infectious Diseases  2015;21(2):209-216.
In the Netherlands, reporting is timely for hepatitis A and B prevention but needs to be faster for measles, mumps, pertussis, and shigellosis prevention.
The extent to which reporting delays should be reduced to gain substantial improvement in outbreak control is unclear. We developed a model to quantitatively assess reporting timeliness. Using reporting speed data for 6 infectious diseases in the notification system in the Netherlands, we calculated the proportion of infections produced by index and secondary cases until the index case is reported. We assumed interventions that immediately stop transmission. Reporting delays render useful only those interventions that stop transmission from index and secondary cases. We found that current reporting delays are adequate for hepatitis A and B control. However, reporting delays should be reduced by a few days to improve measles and mumps control, by at least 10 days to improve shigellosis control, and by at least 5 weeks to substantially improve pertussis control. Our method provides quantitative insight into the required reporting delay reductions needed to achieve outbreak control and other transmission prevention goals.
PMCID: PMC4313625  PMID: 25625374
infectious disease; detection; notification; reporting; response; intervention; timeliness; bioterrorism and preparedness
2.  pH Level as a Marker for Predicting Death among Patients with Vibrio vulnificus Infection, South Korea, 2000–2011 
Emerging Infectious Diseases  2015;21(2):259-264.
Initial pH level at hospital admission was the most accurate and simple predictor of death.
Vibrio vulnificus infection can progress to necrotizing fasciitis and death. To improve the likelihood of patient survival, an early prognosis of patient outcome is clinically important for emergency/trauma department doctors. To identify an accurate and simple predictor for death among V. vulnificus–infected persons, we reviewed clinical data for 34 patients at a hospital in South Korea during 2000–2011; of the patients, 16 (47%) died and 18 (53%) survived. For nonsurvivors, median time from hospital admission to death was 15 h (range 4–70). For predicting death, the areas under the receiver operating characteristic curves of the Acute Physiology and Chronic Health Evaluation (APACHE) II score and initial pH were 0.746 and 0.972, respectively (p = 0.005). An optimal cutoff pH of <7.35 had a sensitivity of 100% and specificity of 83%. Compared with the APACHE II score, the initial arterial blood pH level in V. vulnificus-infected patients was a more accurate predictive marker for death.
PMCID: PMC4313626  PMID: 25627847
Vibrio vulnificus; mortality; death; predictive marker; pH; APACHE score; bacteria
3.  Evaluation of Border Entry Screening for Infectious Diseases in Humans 
Emerging Infectious Diseases  2015;21(2):197-201.
Outbreak-associated communications for travelers and clinicians may be a more effective approach to the international control of communicable diseases.
In response to the severe acute respiratory syndrome (SARS) pandemic of 2003 and the influenza pandemic of 2009, many countries instituted border measures as a means of stopping or slowing the spread of disease. The measures, usually consisting of a combination of border entry/exit screening, quarantine, isolation, and communications, were resource intensive, and modeling and observational studies indicate that border screening is not effective at detecting infectious persons. Moreover, border screening has high opportunity costs, financially and in terms of the use of scarce public health staff resources during a time of high need. We discuss the border-screening experiences with SARS and influenza and propose an approach to decision-making for future pandemics. We conclude that outbreak-associated communications for travelers at border entry points, together with effective communication with clinicians and more effective disease control measures in the community, may be a more effective approach to the international control of communicable diseases.
PMCID: PMC4313627  PMID: 25625224
influenza; 2009 influenza pandemic; influenza A(H1N1)pdm09; humans; SARS virus; severe acute respiratory syndrome; quarantine; patient isolation; border crossing; border entry; mass screening; pandemic; disease transmission; infectious; communicable diseases; disease control strategies; viruses; health communication
4.  Simulation Study of the Effect of Influenza and Influenza Vaccination on Risk of Acquiring Guillain-Barré Syndrome 
Emerging Infectious Diseases  2015;21(2):224-231.
Under typical conditions, such as influenza incidence rates of >5% and vaccine effectiveness >60%, vaccination reduced risk.
It is unclear whether seasonal influenza vaccination results in a net increase or decrease in the risk for Guillain-Barré syndrome (GBS). To assess the effect of seasonal influenza vaccination on the absolute risk of acquiring GBS, we used simulation models and published estimates of age- and sex-specific risks for GBS, influenza incidence, and vaccine effectiveness. For a hypothetical 45-year-old woman and 75-year-old man, excess GBS risk for influenza vaccination versus no vaccination was −0.36/1 million vaccinations (95% credible interval −1.22 to 0.28) and −0.42/1 million vaccinations (95% credible interval, –3.68 to 2.44), respectively. These numbers represent a small absolute reduction in GBS risk with vaccination. Under typical conditions (e.g. influenza incidence rates >5% and vaccine effectiveness >60%), vaccination reduced GBS risk. These findings should strengthen confidence in the safety of influenza vaccine and allow health professionals to better put GBS risk in context when discussing influenza vaccination with patients.
PMCID: PMC4313628  PMID: 25625590
seasonal influenza; influenza vaccination; Guillain-Barré syndrome; risk modeling; decision tree modeling; viruses; vaccination; influenza; modeling
5.  Ascariasis in Humans and Pigs on Small-Scale Farms, Maine, USA, 2010–2013 
Emerging Infectious Diseases  2015;21(2):332-334.
Ascaris is a genus of parasitic nematodes that can cause infections in humans and pigs. During 2010–2013, we identified 14 cases of ascariasis in persons who had contact with pigs in Maine, USA. Ascaris spp. are important zoonotic pathogens, and prevention measures are needed, including health education, farming practice improvements, and personal and food hygiene.
PMCID: PMC4313629  PMID: 25626125
Ascariasis; Ascaris lumbricoides; Ascaris suum; humans; pigs; Maine; USA; parasites; nematodes; helminths
6.  Refining Historical Limits Method to Improve Disease Cluster Detection, New York City, New York, USA 
Emerging Infectious Diseases  2015;21(2):265-272.
Our refinements corrected for major biases, preserved simplicity, and improved validity.
Since the early 2000s, the Bureau of Communicable Disease of the New York City Department of Health and Mental Hygiene has analyzed reportable infectious disease data weekly by using the historical limits method to detect unusual clusters that could represent outbreaks. This method typically produced too many signals for each to be investigated with available resources while possibly failing to signal during true disease outbreaks. We made method refinements that improved the consistency of case inclusion criteria and accounted for data lags and trends and aberrations in historical data. During a 12-week period in 2013, we prospectively assessed these refinements using actual surveillance data. The refined method yielded 74 signals, a 45% decrease from what the original method would have produced. Fewer and less biased signals included a true citywide increase in legionellosis and a localized campylobacteriosis cluster subsequently linked to live-poultry markets. Future evaluations using simulated data could complement this descriptive assessment.
PMCID: PMC4313630  PMID: 25625936
communicable disease; historical limits method; disease cluster detection; New York City; surveillance
7.  Outbreak-Associated Novel Avipoxvirus in Domestic Mallard Ducks, China 
Emerging Infectious Diseases  2015;21(2):372-373.
PMCID: PMC4313631  PMID: 25625217
Avipoxvirus; duck; outbreak; China; viruses; mallard
8.  Potentially Novel Ehrlichia Species in Horses, Nicaragua 
Emerging Infectious Diseases  2015;21(2):335-338.
Ehrlichia sp. DNA was amplified from 4 Ehrlichia-seroreactive horses from Mérida, Nicaragua. Sequencing of 16S rDNA, sodB, and groEL genes indicated that the bacterium is most likely a novel Ehrlichia species. The tick vector and the potential for canine and human infection remain unknown.
PMCID: PMC4313632  PMID: 25625228
bacteria; tickborne pathogen; Anaplasmataceae; Ehrlichia; equine; horse; PCR; DNA sequencing; Central America; Nicaragua
9.  Infectious Causes of Encephalitis and Meningoencephalitis in Thailand, 2003–2005 
Emerging Infectious Diseases  2015;21(2):280-289.
Although many causes were identified, most remain unknown.
Acute encephalitis is a severe neurologic syndrome. Determining etiology from among ≈100 possible agents is difficult. To identify infectious etiologies of encephalitis in Thailand, we conducted surveillance in 7 hospitals during July 2003–August 2005 and selected patients with acute onset of brain dysfunction with fever or hypothermia and with abnormalities seen on neuroimages or electroencephalograms or with cerebrospinal fluid pleocytosis. Blood and cerebrospinal fluid were tested for >30 pathogens. Among 149 case-patients, median age was 12 (range 0–83) years, 84 (56%) were male, and 15 (10%) died. Etiology was confirmed or probable for 54 (36%) and possible or unknown for 95 (64%). Among confirmed or probable etiologies, the leading pathogens were Japanese encephalitis virus, enteroviruses, and Orientia tsutsugamushi. No samples were positive for chikungunya, Nipah, or West Nile viruses; Bartonella henselae; or malaria parasites. Although a broad range of infectious agents was identified, the etiology of most cases remains unknown.
PMCID: PMC4313633  PMID: 25627940
encephalitis; etiology; brain diseases; tropical medicine; Thailand; viruses; bacteria
10.  Use of Insecticide-Treated House Screens to Reduce Infestations of Dengue Virus Vectors, Mexico 
Emerging Infectious Diseases  2015;21(2):308-311.
Dengue prevention efforts rely on control of virus vectors. We investigated use of insecticide-treated screens permanently affixed to windows and doors in Mexico and found that the screens significantly reduced infestations of Aedes aegypti mosquitoes in treated houses. Our findings demonstrate the value of this method for dengue virus vector control.
PMCID: PMC4313634  PMID: 25625483
viruses; dengue; arbovirus; mosquitoes; Aedes aegypti; vector; control; prevention; outbreak; epidemic; net; LLIS; vector-borne infections; Mexico; screens; insecticide; Suggested citation for this article: Manrique-Saide P; Che-Mendoza A; Barrera-Perez M; Guillermo-May G; Herrera-Bojorquez J; Dzul-Manzanilla F; et al. Use of insecticide-treated house screens to reduce infestations of dengue virus vectors; Mexico. Emerg Infect Dis [Internet]. 2015 Feb [date cited].
11.  Evidence for Elizabethkingia anophelis Transmission from Mother to Infant, Hong Kong 
Emerging Infectious Diseases  2015;21(2):232-241.
Genome sequencing can provide rapid insights on transmission and pathogenesis of emerging pathogens.
Elizabethkingia anophelis, recently discovered from mosquito gut, is an emerging bacterium associated with neonatal meningitis and nosocomial outbreaks. However, its transmission route remains unknown. We use rapid genome sequencing to investigate 3 cases of E. anophelis sepsis involving 2 neonates who had meningitis and 1 neonate’s mother who had chorioamnionitis. Comparative genomics revealed evidence for perinatal vertical transmission from a mother to her neonate; the 2 isolates from these patients, HKU37 and HKU38, shared essentially identical genome sequences. In contrast, the strain from another neonate (HKU36) was genetically divergent, showing only 78.6% genome sequence identity to HKU37 and HKU38, thus excluding a clonal outbreak. Comparison to genomes from mosquito strains revealed potential metabolic adaptations in E. anophelis under different environments. Maternal infection, not mosquitoes, is most likely the source of neonatal E. anophelis infections. Our findings highlight the power of genome sequencing in gaining rapid insights on transmission and pathogenesis of emerging pathogens.
PMCID: PMC4313635  PMID: 25625669
Elizabethkingia anophelis; neonatal; meningitis; sepsis; vertical; transmission; maternal; bacteria; genome; mother; child; Hong Kong; sequencing
12.  Comparative Analysis of African Swine Fever Virus Genotypes and Serogroups 
Emerging Infectious Diseases  2015;21(2):312-315.
African swine fever virus (ASFV) causes highly lethal hemorrhagic disease among pigs, and ASFV’s extreme antigenic diversity hinders vaccine development. We show that p72 ASFV phylogenetic analysis does not accurately define ASFV hemadsorption inhibition assay serogroups. Thus, conventional ASFV genotyping cannot discriminate between viruses of different virulence or predict efficacy of a specific ASFV vaccine.
PMCID: PMC4313636  PMID: 25625574
African swine fever virus; genotypes; phylogenetic analysis; serogroups; hemadsorption inhibition assay; viruses; vaccine development; swine; domestic pigs; cross-protective responses; antigenic diversity
13.  Naturally Acquired Antibodies against Haemophilus influenzae Type a in Aboriginal Adults, Canada 
Emerging Infectious Diseases  2015;21(2):273-279.
High prevalence of invasive Hia disease among North American Aboriginal populations is more likely related to exposure than to inadequate immunity.
In the post-Haemophilus influenzae type b (Hib) vaccine era that began in the 1980's, H. influenzae type a (Hia) emerged as a prominent cause of invasive disease in North American Aboriginal populations. To test whether a lack of naturally acquired antibodies may underlie increased rates of invasive Hia disease, we compared serum bactericidal activity against Hia and Hib and IgG and IgM against capsular polysaccharide between Canadian Aboriginal and non-Aboriginal healthy and immunocompromised adults. Both healthy and immunocompromised Aboriginal adults exhibited significantly higher bactericidal antibody titers against Hia than did non-Aboriginal adults (p = 0.042 and 0.045 respectively), with no difference in functional antibody activity against Hib. IgM concentrations against Hia were higher than IgG in most study groups; the inverse was true for antibody concentrations against Hib. Our results indicate that Aboriginal adults possess substantial serum bactericidal activity against Hia that is mostly due to IgM antibodies. The presence of sustained IgM against Hia suggests recent Hia exposure.
PMCID: PMC4313637  PMID: 25626129
Antibody; IgM; IgG; bacteria; bactericidal; Haemophilus influenzae type a; Hia; polysaccharide antibodies; vaccine; indigenous; Aboriginal; Aborigine; antibody functional activity; secondary immunodeficiency; North America; Canada
14.  Neisseria meningitidis ST-11 Clonal Complex, Chile 2012 
Emerging Infectious Diseases  2015;21(2):339-341.
Serogroup W Neisseria meningitidis was the main cause of invasive meningococcal disease in Chile during 2012. The case-fatality rate for this disease was higher than in previous years. Genotyping of meningococci isolated from case-patients identified the hypervirulent lineage W:P1.5,2:ST-11, which contained allele 22 of the fHbp gene.
PMCID: PMC4313638  PMID: 25625322
Neisseria meningitidis; bacteria; serogroup W; invasive meningococcal disease; ST-11; sequence type; hyperinvasive lineage; clonal complex; Chile
15.  Microbiota That Affect Risk for Shigellosis in Children in Low-Income Countries 
Emerging Infectious Diseases  2015;21(2):242-250.
Co-infection with Shigella spp. and other microbes modifies diarrhea risk.
Pathogens in the gastrointestinal tract exist within a vast population of microbes. We examined associations between pathogens and composition of gut microbiota as they relate to Shigella spp./enteroinvasive Escherichia coli infection. We analyzed 3,035 stool specimens (1,735 nondiarrheal and 1,300 moderate-to-severe diarrheal) from the Global Enteric Multicenter Study for 9 enteropathogens. Diarrheal specimens had a higher number of enteropathogens (diarrheal mean 1.4, nondiarrheal mean 0.95; p<0.0001). Rotavirus showed a negative association with Shigella spp. in cases of diarrhea (odds ratio 0.31, 95% CI 0.17–0.55) and had a large combined effect on moderate-to-severe diarrhea (odds ratio 29, 95% CI 3.8–220). In 4 Lactobacillus taxa identified by 16S rRNA gene sequencing, the association between pathogen and disease was decreased, which is consistent with the possibility that Lactobacillus spp. are protective against Shigella spp.–induced diarrhea. Bacterial diversity of gut microbiota was associated with diarrhea status, not high levels of the Shigella spp. ipaH gene.
PMCID: PMC4313639  PMID: 25625766
shigellosis; Shigella; bacteria; polymicrobial infection; Escherichia coli; enteroinvasive E. coli; EIEC; Lactobacillus; rotavirus; viruses; co-occurring pathogens; enteropathogens; microbiota; ipaH gene; diarrhea; children; low-income countries
16.  Molecular Diagnosis of Cause of Anisakiasis in Humans, South Korea 
Emerging Infectious Diseases  2015;21(2):342-344.
Anisakiasis in humans in South Korea has been considered to be caused exclusively by the larvae of Anisakis simplex sensu stricto and Pseudoterranova decipiens. Recently, however, DNA sequencing of larvae from 15 of 16 anisakiasis patients confirmed the cause to be Anisakis pegreffii infection. Molecular analysis should be performed for all extracted larvae.
PMCID: PMC4313640  PMID: 25625427
Anisakis pegreffii; Anisakis simplex sensu stricto; anisakiasis; human; fish; Korea
17.  Murine Typhus, Reunion, France, 2011–2013 
Emerging Infectious Diseases  2015;21(2):316-319.
Murine typhus case was initially identified in Reunion, France, in 2012 in a tourist. Our investigation confirmed 8 autochthonous cases that occurred during January 2011–January 2013 in Reunion. Murine typhus should be considered in local patients and in travelers returning from Reunion who have fevers of unknown origin.
PMCID: PMC4313641  PMID: 25625653
Fleas; murine typhus; Reunion; rodents; bacteria; zoonoses; vector-borne infections; France
18.  Orientia tsutsugamushi in Lung of Patient with Acute Respiratory Distress Syndrome, France, 2013 
Emerging Infectious Diseases  2015;21(2):373-375.
PMCID: PMC4313642  PMID: 25625312
Orientia tsutsugamushi; bronchoalveolar lavage; acute respiratory distress syndrome; France; Laos; lung; scrub typhus
19.  Timing of Influenza A(H5N1) in Poultry and Humans and Seasonal Influenza Activity Worldwide, 2004–2013 
Emerging Infectious Diseases  2015;21(2):202-208.
Co-circulation of H5N1 in poultry and humans during seasonal influenza epidemic periods signals the need for enhanced surveillance and biosafety measures.
Co-circulation of influenza A(H5N1) and seasonal influenza viruses among humans and animals could lead to co-infections, reassortment, and emergence of novel viruses with pandemic potential. We assessed the timing of subtype H5N1 outbreaks among poultry, human H5N1 cases, and human seasonal influenza in 8 countries that reported 97% of all human H5N1 cases and 90% of all poultry H5N1 outbreaks. In these countries, most outbreaks among poultry (7,001/11,331, 62%) and half of human cases (313/625, 50%) occurred during January–March. Human H5N1 cases occurred in 167 (45%) of 372 months during which outbreaks among poultry occurred, compared with 59 (10%) of 574 months that had no outbreaks among poultry. Human H5N1 cases also occurred in 59 (22%) of 267 months during seasonal influenza periods. To reduce risk for co-infection, surveillance and control of H5N1 should be enhanced during January–March, when H5N1 outbreaks typically occur and overlap with seasonal influenza virus circulation.
PMCID: PMC4313643  PMID: 25625302
H5N1; poultry; human; seasonal influenza; global; influenza; viruses; outbreaks; surveillance; biosafety
20.  Streptococcus suis Infection in Hospitalized Patients, Nakhon Phanom Province, Thailand 
Emerging Infectious Diseases  2015;21(2):345-348.
In Nakhon Phanom, Thailand, we identified 38 hospitalized patients with Streptococcus suis infection during 2006–2012. Deafness developed in 12 patients; none died. Thirty-five reported recent exposure to pigs/pork. Annual incidence was 0.1–2.2 cases/100,000 population (0.2–3.2 in persons >20 years of age). Clinicians should consider S. suis infection in areas where pig exposure is common.
PMCID: PMC4313644  PMID: 25625540
Streptococcus suis; meningitis; sepsis; Thailand; bacteria; zoonoses
21.  Optimizing Distribution of Pandemic Influenza Antiviral Drugs 
Emerging Infectious Diseases  2015;21(2):251-258.
Effective distribution of these drugs will reduce illness and death in underinsured populations.
We provide a data-driven method for optimizing pharmacy-based distribution of antiviral drugs during an influenza pandemic in terms of overall access for a target population and apply it to the state of Texas, USA. We found that during the 2009 influenza pandemic, the Texas Department of State Health Services achieved an estimated statewide access of 88% (proportion of population willing to travel to the nearest dispensing point). However, access reached only 34.5% of US postal code (ZIP code) areas containing <1,000 underinsured persons. Optimized distribution networks increased expected access to 91% overall and 60% in hard-to-reach regions, and 2 or 3 major pharmacy chains achieved near maximal coverage in well-populated areas. Independent pharmacies were essential for reaching ZIP code areas containing <1,000 underinsured persons. This model was developed during a collaboration between academic researchers and public health officials and is available as a decision support tool for Texas Department of State Health Services at a Web-based interface.
PMCID: PMC4313645  PMID: 25625858
antiviral drugs; influenza; influenza virus; viruses; 2009 pandemic; influenza A(H1N1)pdm09 virus; pandemic influenza; optimization; control; pharmacies; pharmacy-based drug distribution; underinsured populations; ZIP codes; Texas
22.  Awareness and Support of Release of Genetically Modified “Sterile” Mosquitoes, Key West, Florida, USA 
Emerging Infectious Diseases  2015;21(2):320-324.
After a dengue outbreak in Key West, Florida, during 2009–2010, authorities, considered conducting the first US release of male Aedes aegypti mosquitoes genetically modified to prevent reproduction. Despite outreach and media attention, only half of the community was aware of the proposal; half of those were supportive. Novel public health strategies require community engagement.
PMCID: PMC4313646  PMID: 25625795
dengue; Aedes aegypti; OX513A; mosquitoes; dengue; viruses; genetically modified; sterile; awareness; support; Key West; Florida
23.  Meningococcal Disease in US Military Personnel before and After Adoption of Conjugate Vaccine 
Emerging Infectious Diseases  2015;21(2):377-379.
PMCID: PMC4313647  PMID: 25625525
US military; meningococcal disease; vaccine; bacteria
24.  Melioidosis Diagnostic Workshop, 20131 
Emerging Infectious Diseases  2015;21(2):e141045.
Melioidosis is a severe disease that can be difficult to diagnose because of its diverse clinical manifestations and a lack of adequate diagnostic capabilities for suspected cases. There is broad interest in improving detection and diagnosis of this disease not only in melioidosis-endemic regions but also outside these regions because melioidosis may be underreported and poses a potential bioterrorism challenge for public health authorities. Therefore, a workshop of academic, government, and private sector personnel from around the world was convened to discuss the current state of melioidosis diagnostics, diagnostic needs, and future directions.
PMCID: PMC4313648  PMID: 25626057
melioidosis; Burkholderia pseudomallei; diagnosis; bacteria
25.  Novel Candidatus Rickettsia Species Detected in Nostril Tick from Human, Gabon, 2014 
Emerging Infectious Diseases  2015;21(2):325-327.
We report the identification of a nymphal nostril tick (Amblyomma sp.) from a national park visitor in Gabon and subsequent molecular detection and characterization of tickborne bacteria. Our findings provide evidence of a potentially new Rickettsia sp. circulating in Africa and indicate that tick bites may pose a risk to persons visiting parks in the region.
PMCID: PMC4313649  PMID: 25625886
Amblyomma sp.; Rickettsia; Candidatus Rickettsia davousti; nostril tick; tick; Gabon; Africa; bacteria; Africa; novel; tickborne diseases; Candidatus Rickettsia species

Results 1-25 (7730)