Dozens sickened amid 'unusual' outbreak in NYC

The New York City Health Department is investigating a deadly new outbreak of Legionnaires' Disease, a particularly severe form of pneumonia, which has already killed two people in the Bronx.

Some 31 new cases have been reported since July 10, but health officials have yet to determine a source of the outbreak, according to a Health Department press release.

Dozens sickened amid 'unusual' outbreak in NYC

Ahead of Print -Influenza A(H6N1) Virus in Dogs, Taiwan - Volume 21, Number 12—December 2015 - Emerging Infectious Disease journal - CDC

We determined the prevalence of influenza A virus in dogs in Taiwan and isolated A/canine/Taiwan/E01/2014. Molecular analysis indicated that this isolate was closely related to influenza A(H6N1) viruses circulating in Taiwan and harbored the E627K substitution in the polymerase basic 2 protein, which indicated its ability to replicate in mammalian species.



Ahead of Print -Influenza A(H6N1) Virus in Dogs, Taiwan - Volume 21, Number 12—December 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Workplace Safety Concerns among Co-workers of Responder Returning from Ebola-Affected Country - Volume 21, Number 11—November 2015 - Emerging Infectious Disease journal - CDC

We surveyed public health co-workers regarding attitudes toward a physician who returned to New Hampshire after volunteering in the West African Ebola outbreak. An unexpectedly large (18.0%) proportion of staff expressed discomfort with the Ebola responder returning to work. Employers should take proactive steps to address employee fears and concerns.



Ahead of Print -Workplace Safety Concerns among Co-workers of Responder Returning from Ebola-Affected Country - Volume 21, Number 11—November 2015 - Emerging Infectious Disease journal - CDC

World's first malaria vaccine, backed by Bill Gates, gets green light - Jul. 24, 2015

The world's first malaria vaccine, backed by Bill Gates, has received a green light for future use in babies in sub-Saharan Africa.



The European Medicines Agency gave the Mosquirix vaccine a favorable review after 30 years of research by GlaxoSmithKline (GLAXF) and the PATH Malaria Vaccine Initiative.



World's first malaria vaccine, backed by Bill Gates, gets green light - Jul. 24, 2015

Ahead of Print -Genetic Characterization of Highly Pathogenic Avian Influenza A(H5N6) Virus, Guangdong, China - Volume 21, Number 12—December 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Genetic Characterization of Highly Pathogenic Avian Influenza A(H5N6) Virus, Guangdong, China - Volume 21, Number 12—December 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Infection Risk for Persons Exposed to Highly Pathogenic Avian Influenza A H5 Virus–Infected Birds, United States, December 2014–March 2015 - Volume 21, Number 12—December 2015 - Emerging Infectious Disease journal - CDC

Newly emerged highly pathogenic avian influenza (HPAI) A H5 viruses have caused outbreaks among birds in the United States. These viruses differ genetically from HPAI H5 viruses that previously caused human illness, most notably in Asia and Africa. To assess the risk for animal-to-human HPAI H5 virus transmission in the United States, we determined the number of persons with self-reported exposure to infected birds, the number with an acute respiratory infection (ARI) during a 10-day postexposure period, and the number with ARI who tested positive for influenza by real-time reverse transcription PCR or serologic testing for each outbreak during December 15, 2014–March 31, 2015. During 60 outbreaks in 13 states, a total of 164 persons were exposed to infected birds. ARI developed in 5 of these persons within 10 days of exposure. H5 influenza virus infection was not identified in any persons with ARI, suggesting a low risk for animal-to-human HPAI H5 virus transmission.



Ahead of Print -Infection Risk for Persons Exposed to Highly Pathogenic Avian Influenza A H5 Virus–Infected Birds, United States, December 2014–March 2015 - Volume 21, Number 12—December 2015 - Emerging Infectious Disease journal - CDC

Major frozen chicken recall after salmonella illnesses - Jul. 17, 2015

Several million pounds of frozen chicken are being recalled after between 10 and 11 people got sick from salmonella.



Aspen Foods is recalling nearly two million pounds of frozen chicken after three people became ill in Minnesota, according to the U.S. Department of Agriculture. That brings the USDA's tally to 11, after taking into account the eight people who became recently became ill with salmonella in Minnesota and Wisconsin leading to a frozen chicken recall by Barber Foods.



Major frozen chicken recall after salmonella illnesses - Jul. 17, 2015

Ahead of Print -Medscape CME Activity - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Medscape CME Activity - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Human–Bat Interactions in Rural West Africa - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

Because some bats host viruses with zoonotic potential, we investigated human–bat interactions in rural Ghana during 2011–2012. Nearly half (46.6%) of respondents regularly visited bat caves; 37.4% had been bitten, scratched, or exposed to bat urine; and 45.6% ate bat meat. Human–bat interactions in rural Ghana are frequent and diverse.



Ahead of Print -Human–Bat Interactions in Rural West Africa - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Geographic Distribution and Expansion of Human Lyme Disease, United States - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

Lyme disease occurs in specific geographic regions of the United States. We present a method for defining high-risk counties based on observed versus expected number of reported human Lyme disease cases. Applying this method to successive periods shows substantial geographic expansion of counties at high risk for Lyme disease.



Ahead of Print -Geographic Distribution and Expansion of Human Lyme Disease, United States - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Macrolide-Resistant Mycoplasma pneumoniae, United States1 - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

Macrolide-resistant Mycoplasma pneumoniae (MRMP) is highly prevalent in Asia and is now being reported from Europe. Few data on MRMP are available in the United States. Using genotypic and phenotypic methods, we detected high-level MRMP in 13.2% of 91 M. pneumoniae­–positive specimens from 6 US locations.



Ahead of Print -Macrolide-Resistant Mycoplasma pneumoniae, United States1 - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Decreased Ebola Transmission after Rapid Response to Outbreaks in Remote Areas, Liberia, 2014 - Volume 21, Number 10—October 2015 - Emerging Infectious Disease journal - CDC

We measured the reproduction number before and after interventions were implemented to reduce Ebola transmission in 9 outbreaks in Liberia during 2014. We evaluated risk factors for secondary cases and the association between patient admission to an Ebola treatment unit (ETU) and survival. The reproduction number declined 94% from 1.7 (95% CI 1.1–2.6) to 0.1 (95% CI 0.02–0.6) after interventions began. The risk for secondary infections was 90% lower for patients admitted to an ETU (risk ratio 0.1, 95% CI 0.04–0.3) than for those who died in the community. The case-fatality rate was 68% (95% CI 60–74), and ETU admission was associated with a 50% reduction in death (hazard ratio 0.5, 95% CI 0.4–0.8). Isolation and treatment of Ebola patients had the dual benefit of interrupting community transmission and improving survival.



Ahead of Print -Decreased Ebola Transmission after Rapid Response to Outbreaks in Remote Areas, Liberia, 2014 - Volume 21, Number 10—October 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Socioeconomic Disparities and Influenza Hospitalizations, Tennessee, USA - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

We examined population-based surveillance data from the Tennessee Emerging Infections Program to determine whether neighborhood socioeconomic status was associated with influenza hospitalization rates. Hospitalization data collected during October 2007–April 2014 were geocoded (N = 1,743) and linked to neighborhood socioeconomic data. We calculated age-standardized annual incidence rates, relative index of inequality, and concentration curves for socioeconomic variables. Influenza hospitalizations increased with increased percentages of persons who lived in poverty, had female-headed households, lived in crowded households, and lived in population-dense areas. Influenza hospitalizations decreased with increased percentages of persons who were college educated, were employed, and had health insurance. Higher incidence of influenza hospitalization was also associated with lower neighborhood socioeconomic status when data were stratified by race.



Ahead of Print -Socioeconomic Disparities and Influenza Hospitalizations, Tennessee, USA - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Putative Lineage of Novel African Usutu Virus, Central Europe - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

We characterized the complete genome of a putative novel Usutu virus (USUV) strain (Usutu-BONN) detected in a dead blackbird from Germany. Genomic analysis revealed several unique amino acid substitutions among the polyprotein gene. Phylogenetic analyses demonstrated that Usutu-BONN constitutes a putative novel African USUV lineage, which was probably recently introduced to central Europe.



Ahead of Print -Putative Lineage of Novel African Usutu Virus, Central Europe - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Socioeconomic Status and Foodborne Pathogens in Connecticut, USA, 2000–20111 - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Foodborne pathogens cause >9 million illnesses annually. Food safety efforts address the entire food chain, but an essential strategy for preventing foodborne disease is educating consumers and food preparers. To better understand the epidemiology of foodborne disease and to direct prevention efforts, we examined incidence of Salmonella infection, Shiga toxin–producing Escherichia coli infection, and hemolytic uremic syndrome by census tract–level socioeconomic status (SES) in the Connecticut Foodborne Diseases Active Surveillance Network site for 2000–2011. Addresses of case-patients were geocoded to census tracts and linked to census tract–level SES data. Higher census tract–level SES was associated with Shiga toxin–producing Escherichia coli, regardless of serotype; hemolytic uremic syndrome; salmonellosis in persons ≥5 years of age; and some Salmonella serotypes. A reverse association was found for salmonellosis in children <5 years of age and for 1 Salmonella serotype. These findings will inform education and prevention efforts as well as further research.



Ahead of Print -Socioeconomic Status and Foodborne Pathogens in Connecticut, USA, 2000–20111 - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Emerging Infections Program—20 Years of Achievements and Future Prospects - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Emerging Infections Program—20 Years of Achievements and Future Prospects - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Deadly new squirrel virus may have killed 3 men | Fox News

Squirrel breeding is a real job—and apparently a very dangerous one if you're dealing with the wrong kind of squirrel. After the mysterious deaths of three German men who all worked as breeders of variegated squirrels—a kind of squirrel native to Central America that's sometimes kept as an exotic pet—researchers have identified a new virus that had apparently jumped from the squirrels to the men, LiveScience reports.



Deadly new squirrel virus may have killed 3 men | Fox News

Chairman Roberts Holds Hearing on Avian Flu Challenges, Response, Paths ...

Ahead of Print -Schistosomiasis Screening of Travelers from Italy with Possible Exposure in Corsica, France - Volume 21, Number 10—October 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Schistosomiasis Screening of Travelers from Italy with Possible Exposure in Corsica, France - Volume 21, Number 10—October 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Local and International Implications of Schistosomiasis Acquired in Corsica, France - Volume 21, Number 10—October 2015 - Emerging Infectious Disease journal - CDC

We report 11 cases of schistosomiasis in international travelers who had bathed in rivers in Corsica, France, during 2012–2014. The infections were diagnosed in 2014 and reported to the GeoSentinel Surveillance Network and European Travel Medicine Network. Travelers can be sentinels for emerging infections; thus, this situation warrants a concerted human and veterinary epidemiologic response.



Ahead of Print -Local and International Implications of Schistosomiasis Acquired in Corsica, France - Volume 21, Number 10—October 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Utility of Oral Swab Sampling for Ebola Virus Detection in Guinea Pig Model - Volume 21, Number 10—October 2015 - Emerging Infectious Disease journal - CDC

To determine the utility of oral swabs for diagnosing infection with Ebola virus, we used a guinea pig model and obtained daily antemortem and postmortem swab samples. According to quantitative reverse transcription PCR analysis, the diagnostic value was poor for antemortem swab samples but excellent for postmortem samples.



Ahead of Print -Utility of Oral Swab Sampling for Ebola Virus Detection in Guinea Pig Model - Volume 21, Number 10—October 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Measles Reemergence in Ceará, Northeast Brazil, 15 Years after Elimination - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Measles Reemergence in Ceará, Northeast Brazil, 15 Years after Elimination - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Improved Phenotype-Based Definition for Identifying Carbapenemase Producers among Carbapenem-Resistant Enterobacteriaceae - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Preventing transmission of carbapenemase-producing, carbapenem-resistant Enterobacteriaceae (CP-CRE) is a public health priority. A phenotype-based definition that reliably identifies CP-CRE while minimizing misclassification of non–CP-CRE could help prevention efforts. To assess possible definitions, we evaluated enterobacterial isolates that had been tested and deemed nonsusceptible to >1 carbapenem at US Emerging Infections Program sites. We determined the number of non-CP isolates that met (false positives) and CP isolates that did not meet (false negatives) the Centers for Disease Control and Prevention CRE definition in use during our study: 30% (94/312) of CRE had carbapenemase genes, and 21% (14/67) of Klebsiella pneumoniae carbapenemase–producing Klebsiella isolates had been misclassified as non-CP. A new definition requiring resistance to 1 carbapenem rarely missed CP strains, but 55% of results were false positive; adding the modified Hodge test to the definition decreased false positives to 12%. This definition should be considered for use in carbapenemase-producing CRE surveillance and prevention.



Ahead of Print -Improved Phenotype-Based Definition for Identifying Carbapenemase Producers among Carbapenem-Resistant Enterobacteriaceae - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Emerging Infections Program—State Health Department Perspective - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

The Emerging Infections Program (EIP) is a collaboration between the Centers for Disease Control and Prevention and 10 state health departments working with academic partners to conduct active population-based surveillance and special studies for several emerging infectious disease issues determined to need special attention. The Centers for Disease Control and Prevention funds the 10 EIP sites through cooperative agreements. Our objective was to highlight 1) what being an EIP site has meant for participating health departments and associated academic centers, including accomplishments and challenges, and 2) the synergy between the state and federal levels that has resulted from the collaborative relationship. Sharing these experiences should provide constructive insight to other public health programs and other countries contemplating a collaborative federal–local approach to collective public health challenges.



Ahead of Print -Emerging Infections Program—State Health Department Perspective - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Randomness of Dengue Outbreaks on the Equator - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

A simple mathematical model without seasonality indicated that the apparently chaotic dengue epidemics in Singapore have characteristics similar to epidemics resulting from chance. Randomness as a sufficient condition for patterns of dengue epidemics in equatorial regions calls into question existing explanations for dengue outbreaks there.



Ahead of Print -Randomness of Dengue Outbreaks on the Equator - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Fatal Accelerated Cirrhosis after Imported HEV Genotype 4 Infection - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Fatal Accelerated Cirrhosis after Imported HEV Genotype 4 Infection - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Etymologia: Surveillance - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Etymologia: Surveillance - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Correction: Vol. 21, No. 4 - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Correction: Vol. 21, No. 4 - Volume 21, Number 8—August 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Chikungunya Virus in Macaques, Malaysia - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Chikungunya Virus in Macaques, Malaysia - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Monitoring Effect of Human Papillomavirus Vaccines in US Population, Emerging Infections Program, 2008–2012 - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

In 2007, five Emerging Infections Program (EIP) sites were funded to determine the feasibility of establishing a population-based surveillance system for monitoring the effect of human papillomavirus (HPV) vaccine on pre-invasive cervical lesions. The project involved active population-based surveillance of cervical intraepithelial neoplasia grades 2 and 3 and adenocarcinoma in situ as well as associated HPV types in women >18 years of age residing in defined catchment areas; collecting relevant clinical information and detailed HPV vaccination histories for women 18–39 years of age; and estimating the annual rate of cervical cancer screening among the catchment area population. The first few years of the project provided key information, including data on HPV type distribution, before expected effect of vaccine introduction. The project’s success exemplifies the flexibility of EIP’s network to expand core activities to include emerging surveillance needs beyond acute infectious diseases. Project results contribute key information regarding the impact of HPV vaccination in the United States.



Ahead of Print -Monitoring Effect of Human Papillomavirus Vaccines in US Population, Emerging Infections Program, 2008–2012 - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Improving Accuracy of Influenza-Associated Hospitalization Rate Estimates - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Diagnostic test sensitivity affects rate estimates for laboratory-confirmed influenza–associated hospitalizations. We used data from FluSurv-NET, a national population-based surveillance system for laboratory-confirmed influenza hospitalizations, to capture diagnostic test type by patient age and influenza season. We calculated observed rates by age group and adjusted rates by test sensitivity. Test sensitivity was lowest in adults >65 years of age. For all ages, reverse transcription PCR was the most sensitive test, and use increased from <10% during 2003–2008 to ≈70% during 2009–2013. Observed hospitalization rates per 100,000 persons varied by season: 7.3–50.5 for children <18 years of age, 3.0–30.3 for adults 18–64 years, and 13.6–181.8 for adults >65 years. After 2009, hospitalization rates adjusted by test sensitivity were ≈15% higher for children <18 years, ≈20% higher for adults 18–64 years, and ≈55% for adults >65 years of age. Test sensitivity adjustments improve the accuracy of hospitalization rate estimates.



Ahead of Print -Improving Accuracy of Influenza-Associated Hospitalization Rate Estimates - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Third Wave of Influenza A(H7N9) Virus from Poultry, Guangdong Province, China, 2014–2015 - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Fourteen influenza A(H7N9) viruses were isolated from poultry or the environment in live poultry markets in Guangdong Province, China during 2014−2015. Phylogenetic analysis showed that all viruses were descended from viruses of the second wave of influenza A(H7N9) virus infections during 2013. These viruses can be divided into 2 branches.



Ahead of Print -Third Wave of Influenza A(H7N9) Virus from Poultry, Guangdong Province, China, 2014–2015 - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Training in Infectious Disease Epidemiology through the Emerging Infections Program Sites - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

One objective of the Emerging Infections Program (EIP) of the US Centers for Disease Control and Prevention is to provide training opportunities in infectious disease epidemiology. To determine the extent of training performed since the program's inception in 1995, we reviewed training efforts at the 10 EIP sites. By 2015, all sites hosted trainees (most were graduate public health students and physicians) who worked on a variety of infectious disease surveillance and epidemiologic projects. Trainee projects at all sites were used for graduate student theses or practicums. Numerous projects resulted in conference presentations and publications in peer-reviewed journals. Local public health and health care partners have also benefitted from EIP presentations and training. Consideration should be given to standardizing and documenting EIP training and to sharing useful training initiatives with other state and local health departments and academic institutions.



Ahead of Print -Training in Infectious Disease Epidemiology through the Emerging Infections Program Sites - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Tracking Pertussis and Evaluating Control Measures through Enhanced Pertussis Surveillance, Emerging Infections Program, United States - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Despite high coverage with pertussis-containing vaccines, pertussis remains endemic to the United States. There have been increases in reported cases in recent years, punctuated by striking epidemics and shifting epidemiology, both of which raise questions about current policies regarding its prevention and control. Limited data on pertussis reported through the National Notifiable Disease Surveillance System have proved insufficient to answer these questions. To address shortcomings of national pertussis data, the Emerging Infections Program at the US Centers for Disease Control and Prevention launched Enhanced Pertussis Surveillance (EPS), which is characterized by systematic case ascertainment, augmented data collection, and collection of Bordetella pertussis isolates. Data collected through EPS have been instrumental in clarifying the rapidly evolving epidemiology and molecular epidemiology of pertussis and have contributed essential information regarding pertussis vaccines. EPS also serves as a platform for conducting critical and timely evaluations of pertussis prevention and control strategies, including targeting of vaccinations and antimicrobial prophylaxis.



Ahead of Print -Tracking Pertussis and Evaluating Control Measures through Enhanced Pertussis Surveillance, Emerging Infections Program, United States - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Increase in Lymphadenitis Cases after Shift in BCG Vaccine Strain - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Increase in Lymphadenitis Cases after Shift in BCG Vaccine Strain - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Ahead of Print -Enhancing Lyme Disease Surveillance by Using Administrative Claims Data, Tennessee, USA - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC

Lyme disease is underreported in the United States. We used insurance administrative claims data to determine the value of such data in enhancing case ascertainment in Tennessee during January 2011–June 2013. Although we identified ≈20% more cases of Lyme disease (5/year), the method was resource intensive and not sustainable in this low-incidence state.



Ahead of Print -Enhancing Lyme Disease Surveillance by Using Administrative Claims Data, Tennessee, USA - Volume 21, Number 9—September 2015 - Emerging Infectious Disease journal - CDC