Early Release

Synopses

• Aspergillosis Complicating Severe Coronavirus Disease
  K. A. Marr et al. View Abstract Email this Article

  Aspergillosis complicating severe influenza infection has been increasingly detected worldwide. Recently, coronavirus disease–associated pulmonary aspergillosis (CAPA) has been detected through rapid reports, primarily from centers in Europe. We provide a case series of CAPA, adding 20 cases to the literature, with review of pathophysiology, diagnosis, and outcomes. The syndromes of pulmonary aspergillosis complicating severe viral infections are distinct from classic invasive aspergillosis, which is recognized most frequently in persons with neutropenia and in other immunocompromised persons. Combined with severe viral infection, aspergillosis comprises a constellation of airway-invasive and angio-invasive disease and results in risks associated with poor airway fungus clearance and killing, including virus- or inflammation-associated epithelial damage, systemic immunosuppression, and underlying lung disease. Radiologic abnormalities can vary, reflecting different pathologies. Prospective studies reporting poor outcomes in CAPA patients underscore the urgent need for strategies to improve diagnosis, prevention, and therapy.

• Nosocomial Coronavirus Disease Outbreak Containment, Hanoi, Vietnam, March–April 2020
  C. Duy et al. View Abstract Email this Article

  We report on the public health response generated by an outbreak of coronavirus disease (COVID-19) that occurred during March 2020 at Bach Mai Hospital (BMH) in Hanoi, northern Vietnam’s largest hospital complex. On March 18, a total of 3 distinct clusters of COVID-19 cases were identified at BMH. Diagnosis of the initial 3 COVID-19 cases led to contact tracing, symptom screening, and testing of 495 persons and limited quarantine of affected institutes or departments. When 27 staff members in the catering company tested positive for SARS-CoV-2, the entire BMH staff (7,664 persons) was put under quarantine. Contact tracing in the community resulted in an additional 52,239 persons being quarantined. After 3 weeks, the hospital outbreak was contained; no further spread occurred in the hospital. Rapid screening of cases, extensive testing, prompt quarantine, contact tracing, and social distancing contributed to prevent community transmission in Hanoi and northern Vietnam.

• Impact of Human Papillomavirus Vaccination, Rwanda and Bhutan
  I. Baussano et al. View Abstract Email this Article

  Rwanda and Bhutan, 2 low- and middle-income countries, implemented primarily school-based national human papillomavirus (HPV) vaccination in 2011 (Rwanda) and 2010 (Bhutan). We estimated vaccination effectiveness through urine-based HPV prevalence surveys in schools in 2013–2014 and 2017. In Rwanda, 912 participants from baseline surveys and 1,087 from repeat surveys were included, and in Bhutan, 973 participants from baseline surveys and 909 from repeat surveys were included. The overall effectiveness against vaccine-targeted HPV types (i.e., HPV-6/11/16/18) was 78% (95% CI 51%–90%) in Rwanda, and 88% (6%–99%) in Bhutan and against other α-9 types was 58% (21–78) in Rwanda and 63% (27–82) in Bhutan. No effect against other HPV types was detectable. Prevalence of vaccine-targeted HPV types decreased significantly, as well as that of other α-9 types, suggesting cross-protection. These findings provide direct evidence from low- and middle-income countries of the marked effectiveness of high-coverage school-based, national HPV vaccination programs.

• Invasive Fusariosis in Nonneutropenic Patients, Spain, 2000–2015
  E. Pérez-Nadales et al.

Research

• Comparative Omics Analysis of Historic and Recent Isolates of Bordetella pertussis and Effects of Genome Rearrangements on Evolution
  A. Dienstbier et al. View Abstract Email this Article

  Despite high vaccination coverage, pertussis is increasing in many industrialized countries, including the Czech Republic. To better understand Bordetella pertussis resurgence, we analyzed historic strains and recent clinical isolates by using a comparative omics approach. Whole-genome sequencing showed that historic and recent isolates of B. pertussis have substantial variation in genome organization and form separate phylogenetic clusters. Subsequent RNA sequence analysis and liquid chromatography with mass tandem spectrometry analyses showed that these variations translated into discretely separated transcriptomic and proteomic profiles. When compared with historic strains, recent isolates showed increased expression of flagellar genes and genes involved in lipopolysaccharide biosynthesis and decreased expression of polysaccharide capsule genes. Compared with reference strain Tohama I, all strains had increased expression and production of the type III secretion system apparatus. We detected the potential link between observed effects and insertion sequence element–induced changes in gene context only for a few genes.

• Estimate of Burden and Direct Healthcare Cost of Infectious Waterborne Disease in the United States
  S. A. Collier et al. View Abstract Email this Article

  Provision of safe drinking water in the United States is a great public health achievement. However, new waterborne disease challenges have emerged (e.g., aging infrastructure, chlorine-tolerant and biofilm-related pathogens, increased recreational water use). Comprehensive estimates of the health burden for all water exposure routes (ingestion, contact, inhalation) and sources (drinking, recreational, environmental) are needed. We estimated total illnesses, emergency department (ED) visits, hospitalizations, deaths, and direct healthcare costs for 17 waterborne infectious diseases. About 7.15 million waterborne illnesses occur annually (95% credible interval [CrI] 3.88 million–12.0 million), results in 601,000 ED visits (95% CrI 364,000–866,000), 118,000 hospitalizations (95% CrI 86,800–150,000), and 6,630 deaths (95% CrI 4,520–8,870) and incurring US $3.33 billion (95% CrI 1.37 billion–8.77 billion) in direct healthcare costs. Otitis externa and norovirus infection were the most common illnesses. Most hospitalizations and deaths were caused by biofilm-associated pathogens (nontuberculous mycobacteria, Pseudomonas, Legionella), costing US $2.39 billion annually.

• Estimating the Force of Infection for Dengue Virus Using Repeated Serosurveys, Ouagadougou, Burkina Faso
  J. K. Lim et al. View Abstract Email this Article

  Because of limited data on dengue virus in Burkina Faso, we conducted 4 consecutive age-stratified longitudinal serologic surveys, ≈6 months apart, among persons 1–55 years of age, during June 2015–March 2017, which included a 2016 outbreak. The seroconversion rate before the serosurvey enrollment was estimated by binomial regression, taking age as the duration of exposure, and assuming constant force of infection (FOI) over age and calendar time. We calculated FOI between consecutive surveys and rate ratios for potentially associated characteristics based on seroconversion using the duration of intervals. Among 2,897 persons at enrollment, 66.3% were IgG-positive, and estimated annual FOI was 5.95%. Of 1,269 enrollees participating in all 4 serosurveys, 438 were IgG-negative at enrollment. The annualized FOI ranged from 10% to 20% (during the 2016 outbreak). Overall, we observed high FOI for dengue. These results could support decision-making about control and preventive measures.

• Performance of Nucleic Acid Amplification Tests for Detection of Severe Acute Respiratory Syndrome Coronavirus 2 in Prospectively Pooled Specimens
  H. Wang et al. View Abstract Email this Article

  Pooled nucleic acid amplification tests for severe acute respiratory syndrome coronavirus 2 could increase availability of testing at decreased cost. However, the effect of dilution on analytical sensitivity through sample pooling has not been well characterized. We tested 1,648 prospectively pooled specimens by using 3 nucleic acid amplification tests for severe acute respiratory syndrome coronavirus 2: a laboratory-developed real-time reverse transcription PCR targeting the envelope gene, and 2 commercially available Panther System assays targeting open reading frame 1ab. Positive percent agreement (PPA) of pooled versus individual testing ranged from 71.7% to 82.6% for pools of 8 and from 82.9% to 100.0% for pools of 4. We developed and validated an independent stochastic simulation model to estimate effects of dilution on PPA and efficiency of a 2-stage pooled real-time reverse transcription PCR testing algorithm. PPA was dependent on the proportion of tests with positive results, cycle threshold distribution, and assay limit of detection.

• Intrafamilial Exposure to SARS-CoV-2 Associated with Cellular Immune Response without Seroconversion, France
  F. Gallais et al. View Abstract Email this Article

  We investigated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–specific antibodies and T-cell responses against SARS-CoV-2 and human coronavirus (HCoV) 229E and OC43 in 11 SARS-CoV-2 serodiscordant couples in Strausbourg, France, in which 1 partner had evidence of mild coronavirus disease (COVID-19) and in 10 unexposed healthy controls. Patients with confirmed COVID-19 were considered index patients and their partners close contacts. All index patients displayed positive SARS-CoV-2–specific antibody and T-cell responses that lasted up to 102 days after symptom onset. All contacts remained seronegative for SARS-CoV-2; however, 6 reported COVID-19 symptoms within a median of 7 days after their partners, and 4 of those showed a positive SARS-CoV-2–specific T-cell response against 3 or 4 SARS-CoV-2 antigens that lasted up to 93 days after symptom onset. The 11 couples and controls displayed positive T-cell responses against HCoV-229E or HCoV-OC43. These data suggest that exposure to SARS-CoV-2 can induce virus-specific T-cell responses without seroconversion.

• Differential Yellow Fever Susceptibility in New World Nonhuman Primates, Comparison with Humans, and Implications for Surveillance
  N. A. Fernandes et al.
• Attribution of Illnesses Transmitted by Food and Water to Comprehensive Transmission Pathways Using Structured Expert Judgment, United States
  E. Beshearse et al. View Abstract Email this Article

  Illnesses transmitted by food and water cause a major disease burden in the United States despite advancements in food safety, water treatment, and sanitation. We report estimates from a structured expert judgment study using 48 experts who applied Cooke’s classical model of the proportion of disease attributable to 5 major transmission pathways (foodborne, waterborne, person-to-person, animal contact, and environmental) and 6 subpathways (food handler–related, under foodborne; recreational, drinking, and nonrecreational/nondrinking, under waterborne; and presumed person-to-person-associated and presumed animal contact-associated, under environmental). Estimates for 33 pathogens were elicited, including bacteria such as Salmonella enterica, Campylobacter spp., Legionella spp., and Pseudomonas spp.; protozoa such as Acanthamoeba spp., Cyclospora cayetanensis, and Naegleria fowleri; and viruses such as norovirus, rotavirus, and hepatitis A virus. The results highlight the importance of multiple pathways in the transmission of the included pathogens and can be used to guide prioritization of public health interventions.

• Cellular Immunity in COVID-19 Convalescents with PCR-Confirmed Infection but with Undetectable SARS-CoV-2–Specific IgG
  S. Schwarzkopf et al. View Abstract Email this Article

  We investigated immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among a group of convalescent, potential blood donors in Germany who had PCR-confirmed SARS-CoV-2 infection. Sixty days after onset of symptoms, 13/78 (17%) study participants had borderline or negative results to an ELISA detecting IgG against the S1 protein of SARS-CoV-2. We analyzed participants with PCR-confirmed infection who had strong antibody responses (ratio >3) as positive controls and participants without symptoms of SARS-CoV-2 infection and without household contact with infected patients as negative controls. Using interferon-γ ELISpot, we observed that 78% of PCR-positive volunteers with undetectable antibodies showed T cell immunity against SARS-CoV-2. We observed a similar frequency (80%) of T-cell immunity in convalescent donors with strong antibody responses but did not detect immunity in negative controls. We concluded that, in convalescent patients with undetectable SARS-CoV-2 IgG, immunity may be mediated through T cells.

• Human Diversity of Killer Cell Immunoglobulin-Like Receptors and Human Leukocyte Antigen Class I Alleles and Ebola Virus Disease Outcomes
  T. Wawina-Bokalanga et al. View Abstract Email this Article

  We investigated the genetic profiles of killer cell immunoglobulin-like receptors (KIRs) in Ebola virus–infected patients. We studied the relationship between KIR–human leukocyte antigen (HLA) combinations and the clinical outcomes of patients with Ebola virus disease (EVD). We genotyped KIRs and HLA class I alleles using DNA from uninfected controls, EVD survivors, and persons who died of EVD. The activating 2DS4–003 and inhibitory 2DL5 genes were significantly more common among persons who died of EVD; 2DL2 was more common among survivors. We used logistic regression analysis and Bayesian modeling to identify 2DL2, 2DL5, 2DS4–003, HLA-B-Bw4-Thr, and HLA-B-Bw4-Ile as probably having a significant relationship with disease outcome. Our findings highlight the importance of innate immune response against Ebola virus and show the association between KIRs and the clinical outcome of EVD.

• IgG Seroconversion and Pathophysiology in Severe Acute Respiratory Syndrome Coronavirus 2 Infection
  H. M. Staines et al. View Abstract Email this Article

  We investigated the dynamics of seroconversion in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. During March 29–May 22, 2020, we collected serum samples and associated clinical data from 177 persons in London, UK, who had SARS-CoV-2 infection. We measured IgG against SARS-CoV-2 and compared antibody levels with patient outcomes, demographic information, and laboratory characteristics. We found that 2.0%–8.5% of persons did not seroconvert 3–6 weeks after infection. Persons who seroconverted were older, were more likely to have concurrent conditions, and had higher levels of inflammatory markers. Non-White persons had higher antibody concentrations than those who identified as White; these concentrations did not decline during follow-up. Serologic assay results correlated with disease outcome, race, and other risk factors for severe SARS-CoV-2 infection. Serologic assays can be used in surveillance to clarify the duration and protective nature of humoral responses to SARS-CoV-2 infection.

• Hospitalization for Invasive Pneumococcal Diseases in Young Children before Use of 13-Valent Pneumococcal Conjugate Vaccine, Suzhou, China
  K. Chen et al. View Abstract Email this Article

  A 13-valent pneumococcal conjugate vaccine against invasive pneumococcal disease (IPD) was introduced in China in April 2017. We describe 105 children <5 years of age who were hospitalized for IPD at Soochow University Affiliated Children’s Hospital in Suzhou, China, during January 2010–December 2017. We calculated the incidence of hospitalization for IPD as 14.55/100,000 children in Suzhou. We identified 8 different capsular serotypes: 6B (28.4% of cases), 14 (18.9% of cases), 19A (18.9% of cases), 19F (12.2% of cases), 23F (10.8% of cases), 20 (4.1% of cases), 9V (4.1% of cases), and 15B/C (2.7% of cases). These results provide baseline data of IPD before the introduction of this vaccine in China, enabling researchers to better understand its effects on IPD incidence.

• Susceptibility of Domestic Swine to Experimental Infection with Severe Acute Respiratory Syndrome Coronavirus 2
  B. S. Pickering et al.
• Prevalence of Acute Rheumatic Fever and Rheumatic Heart Disease among Ethnic Groups, New Zealand, 2000–2018
  J. Bennett et al.
• Post–13-Valent Pneumococcal Conjugate Vaccine Dynamics in Young Children of Serotypes Included in Candidate Extended-Spectrum Conjugate Vaccines
  S. Ben-Shimol et al. View Abstract Email this Article

  After worldwide implementation of 10-valent and 13-valent pneumococcal conjugate vaccines (PCV10/PCV13), a 20-valent PCV (PCV20) was developed. We assessed dynamics of non-PCV13 additional PCV20 serotypes (VT20–13), compared with all other non-VT20 serotypes, in children <2 years of age in late PCV13 (2015–2017) and early PCV (2009–2011) periods. Our prospective population-based multifaceted surveillance included isolates from carriage in healthy children, children requiring chest radiography for lower respiratory tract infections (LRTIs), and children with non-LRTI illness, as well as isolates from acute conjunctivitis, otitis media (OM), and invasive pneumococcal disease (IPD). After PCV13 implementation, VT20–13 increased disproportionally in OM, IPD, and carriage in LRTI. VT20–13/non-VT20 prevalence ratio range was 0.26–1.40. VT20–13 serotypes were more frequently antimicrobial-nonsusceptible than non-VT20 serotypes. The disproportionate increase of VT20–13 in respiratory infections and IPD points to their higher disease potential compared with all other non-VT20 as a group.

• Delineating and Analyzing Locality-Level Determinants of Cholera, Haiti
  K. Griffiths et al. View Abstract Email this Article

  Centre Department, Haiti, was the origin of a major cholera epidemic during 2010–2019. Although no fine-scale spatial delineation is officially available, we aimed to analyze determinants of cholera at the local level and identify priority localities in need of interventions. After estimating the likely boundaries of 1,730 localities by using Voronoi polygons, we mapped 5,322 suspected cholera cases reported during January 2015–September 2016 by locality alongside environmental and socioeconomic variables. A hierarchical clustering on principal components highlighted 2 classes with high cholera risk: localities close to rivers and unimproved water sources (standardized incidence ratio 1.71, 95% CI 1.02–2.87; p = 0.04) and urban localities with markets (standardized incidence ratio 1.69, 95% CI 1.25–2.29; p = 0.0006). Our analyses helped identify and characterize areas where efforts should be focused to reduce vulnerability to cholera and other waterborne diseases; these methods could be used in other contexts.

• Territory-Wide Study of Early Coronavirus Disease Outbreak, Hong Kong, China
  K. Leung et al. View Abstract Email this Article

  Initial cases of coronavirus disease in Hong Kong were imported from mainland China. A dramatic increase in case numbers was seen in February 2020. Most case-patients had no recent travel history, suggesting the presence of transmission chains in the local community. We collected demographic, clinical, and epidemiologic data from 50 patients, who accounted for 53.8% of total reported case-patients as of February 28, 2020. We performed whole-genome sequencing to determine phylogenetic relationship and transmission dynamics of severe acute respiratory syndrome coronavirus 2 infections. By using phylogenetic analysis, we attributed the community outbreak to 2 lineages; 1 harbored a common mutation, Orf3a-G251V, and accounted for 88.0% of the cases in our study. The estimated time to the most recent common ancestor of local coronavirus disease outbreak was December 24, 2019, with an evolutionary rate of 3.04 × 10⁻³ substitutions/site/year. The reproduction number was 1.84, indicating ongoing community spread.

• Recency-Weighted Statistical Modeling Approach to Attribute Illnesses Caused by 4 Pathogens to Food Sources Using Outbreak Data, United States
  M. B. Batz et al. View Abstract Email this Article

  Foodborne illness source attribution is foundational to a risk-based food safety system. We describe a method for attributing US foodborne illnesses caused by nontyphoidal Salmonella enterica, Escherichia coli O157, Listeria monocytogenes, and Campylobacter to 17 food categories using statistical modeling of outbreak data. This method adjusts for epidemiologic factors associated with outbreak size, down-weights older outbreaks, and estimates credibility intervals. On the basis of 952 reported outbreaks and 32,802 illnesses during 1998–2012, we attribute 77% of foodborne Salmonella illnesses to 7 food categories (seeded vegetables, eggs, chicken, other produce, pork, beef, and fruits), 82% of E. coli O157 illnesses to beef and vegetable row crops, 81% of L. monocytogenes illnesses to fruits and dairy, and 74% of Campylobacter illnesses to dairy and chicken. However, because Campylobacter outbreaks probably overrepresent dairy as a source of nonoutbreak campylobacteriosis, we caution against using these Campylobacter attribution estimates without further adjustment.

• Precise Species Identification by Whole-Genome Sequencing of Enterobacter Bloodstream Infection, China
  W. Wu et al. View Abstract Email this Article

  The clinical importance of Enterobacter spp. remains unclear because phenotype-based Enterobacter species identification is unreliable. We performed a genomic study on 48 cases of Enterobacter-caused bloodstream infection by using in silico DNA–DNA hybridization to identify precise species. Strains belonged to 12 species; Enterobacter xiangfangensis (n = 21) and an unnamed species (taxon 1, n = 8) were dominant. Most (63.5%) Enterobacter strains (n = 349) with genomes in GenBank from human blood are E. xiangfangensis; taxon 1 (19.8%) was next most common. E. xiangfangensis and taxon 1 were associated with increased deaths (20.7% vs. 15.8%), lengthier hospitalizations (median 31 d vs. 19.5 d), and higher resistance to aztreonam, cefepime, ceftriaxone, piperacillin-tazobactam, and tobramycin. Strains belonged to 37 sequence types (STs); ST171 (E. xiangfangensis) was most common (n = 6). Four ST171 strains belonged to a defined clone. Precise species identification has greater implications for epidemiology and infection control than treatment.

• Viral Metagenomic Analysis of Cerebrospinal Fluid from Patients with Acute Central Nervous System Infections of Unknown Origin, Vietnam
  N. T. Anh et al.

Historical Review

• Hannibal’s Ophthalmia—A New Answer to An Ancient Question
  J. T. Denholm and P. N. Hunt View Abstract Email this Article

  In the spring of 217 bce, shortly after Hannibal’s famous elephantborne crossing of the Alps, the general was afflicted by an acute, painful eye condition that has never been adequately explained and that led to permanent unilateral loss of vision in 1 eye. In modern times, scant attention has been given to understanding this condition. We review the historical and geographic evidence and considers possible infective explanations for Hannibal's condition, including elephant-associated zoonoses. Ultimately, we suggest that a keratitis from waterborne organisms, such as Pseudomonas spp. or Acanthamoeba spp., might provide the best answer to this ancient enigma.

Dispatches

• Geographic Range of Recreational Water-Associated Primary Amebic Meningoencephalitis, United States, 1978–2018
  R. Gharpure et al. View Abstract Email this Article

  Naegleria fowleri is a free-living ameba that causes primary amebic meningoencephalitis (PAM), a rare but usually fatal disease. We analyzed trends in recreational water exposures associated with PAM cases reported during 1978–2018 in the United States. Although PAM incidence remained stable, the geographic range of exposure locations expanded northward.

• In Vivo Observation of Cutaneous Larva Migrans by Fluorescence-Advanced Videodermatoscopy
  A. Ramondetta et al.
• Ocular Filariasis in Human Caused by Breinlia (Johnstonema) annulipapillata Nematode, Australia
  A. V. Koehler et al. View Abstract Email this Article

  We report a human case of ocular filariasis, caused by a species of Breinlia nematode, from Queensland, Australia. Morphological and molecular evidence indicated that the nematode Breinlia (Johnstonema) annulipapillata, or a closely related taxon, likely transmitted from a macropodid marsupial host was involved, which might represent an accidental finding or an emerging zoonosis.

• Listeriosis Caused by Persistence of Listeria monocytogenes Serotype 4b Sequence Type 6 in Cheese Production Environment
  M. Nüesch-Inderbinen et al.
• Fatal Case of Chronic Jamestown Canyon Virus Encephalitis Diagnosed by Metagenomic Sequencing in Patient Receiving Rituximab
  I. H. Solomon et al. View Abstract Email this Article

  A 56-year-old man receiving rituximab who had months of neurologic symptoms was found to have Jamestown Canyon virus in cerebrospinal fluid by clinical metagenomic sequencing. The patient died, and postmortem examination revealed extensive neuropathologic abnormalities. Deep sequencing enabled detailed characterization of viral genomes from the cerebrospinal fluid, cerebellum, and cerebral cortex.

• Prevalence of SARS-CoV-2, Verona, Italy, April–May 2020
  M. Guerriero et al. View Abstract Email this Article

  We used random sampling to estimate the prevalence of severe acute respiratory syndrome coronavirus 2 infection in Verona, Italy. Of 1,515 participants, 2.6% tested positive by serologic assay and 0.7% by reverse transcription PCR. We used latent class analysis to estimate a 3.0% probability of infection and 2.0% death rate.

• Severe Human Bocavirus–Associated Pneumonia in Adults at a Referral Hospital, Seoul, South Korea
  S. Choi et al. View Abstract Email this Article

  We report a case series of severe human bocavirus–associated pneumonia in adults in Seoul, South Korea. The virus accounted for 0.5% of all severe pneumonia cases. Structural lung disease and hematologic malignancy were common underlying diseases. Overall death rate was 54.5%. Higher death rates were associated with co-infection (83.3%) and immunocompromise (80.0%).

• Large-Scale Testing of Asymptomatic Healthcare Personnel for Severe Acute Respiratory Syndrome Coronavirus 2
  C. A. Hogan et al. View Abstract Email this Article

  Large-scale, 1-time testing of >12,000 asymptomatic healthcare personnel in California, USA, during April–June 2020 showed that prevalence of severe acute respiratory syndrome coronavirus 2 was low (<1%). Testing might identify asymptomatic and presymptomatic persons, including some with high viral burden, enabling prompt implementation of measures to limit nosocomial spread.

• Economic Burden of Legionnaires’ Disease, United States, 2014
  M. Baker-Goering et al. View Abstract Email this Article

  Through the use of published estimates of medical costs and new calculations of productivity losses, we estimate the lifetime economic burden of 2014 Legionnaires’ disease cases in the United States at ≈$835 million. This total includes $21 million in productivity losses caused by absenteeism and $412 million in productivity losses caused by premature deaths.

• Coronavirus Disease among Workers in Food Processing, Food Manufacturing, and Agriculture Workplaces
  M. A. Waltenburg et al. View Abstract Email this Article

  We describe coronavirus disease (COVID-19) among US food manufacturing and agriculture workers and provide updated information on meat and poultry processing workers. Among 742 food and agriculture workplaces in 30 states, 8,978 workers had confirmed COVID-19; 55 workers died. Racial and ethnic minority workers could be disproportionately affected by COVID-19.

• Impact of a Nationwide Lockdown on SARS-CoV-2 Transmissibility, Italy
  G. Guzzetta et al. View Abstract Email this Article

  On March 11, 2020, Italy imposed a national lockdown to curtail the spread of severe acute respiratory syndrome coronavirus 2. We estimate that, 14 days after lockdown, the net reproduction number had dropped below 1 and remained stable at »0.76 (95% CI 0.67–0.85) in all regions for >3 of the following weeks.

• Limited Specificity of Serologic Tests for SARS-CoV-2 Antibody Detection, Benin
  A. Yadouleton et al. View Abstract Email this Article

  We used commercially available ELISAs to test 68 samples from coronavirus disease cases and prepandemic controls from Benin. We noted <25% false-positive results among controls, likely due to unspecific immune responses elicited by acute malaria. Serologic tests must be carefully evaluated to assess coronavirus disease spread and immunity in tropical regions.

• Emerging Human Metapneumovirus Gene Duplication Variants in Patients with Severe Acute Respiratory Infection, China, 2017–2019
  Z. Xie et al. View Abstract Email this Article

  We detected human metapneumovirus (HMPV) in 72 (7.1%) of 1,021 patients hospitalized with severe acute respiratory infection in Luohe, China, during 2017–2019. We detected HMPV most frequently in young children and less often in adults. HMPV genotype A2c variants 111 nt and 180 nt duplications predominated, demonstrating their continuing geographic spread.

• Increase in Kelch13 Polymorphisms in Plasmodium falciparum, Southern Rwanda
  C. Bergmann et al.
• Fatal 3-Nitropropionic Acid Poisoning after Consuming Coconut Water
  T. Birkelund et al. View Abstract Email this Article

  We describe the fatal course of a patient with initial symptoms of vomiting and nausea who developed symptoms of dystonia, encephalopathy, and coma. The cause of death was poisoning with 3-nitropropionic acid from coconut water spoiled with the fungus Arthrinium saccharicola. We present the clinical findings and forensic analysis.

• Detection of Norovirus Variant GII.4 Hong Kong in Asia and Europe, 2017−2019
  M. Chan et al.
• Optimization of Notification Criteria for Shiga Toxin–Producing Escherichia coli Surveillance, the Netherlands
  I. Friesema et al. View Abstract Email this Article

  We describe the consequences of 2 major changes in notification criteria for Shiga toxin–producing Escherichia coli surveillance in the Netherlands. The change to reporting acute, more severe infections appears to be a good compromise between workload, redundancy, and public health relevance, provided isolates remain available for typing and sequencing.

• Seventh Pandemic Vibrio cholerae O1 Sublineages, Central African Republic
  S. Breurec et al. View Abstract Email this Article

  Four cholera outbreaks were reported in the Central African Republic during 1997–2016. We show that the outbreak isolates were Vibrio cholerae O1 serotype Inaba from 3 seventh pandemic El Tor sublineages originating from West Africa (sublineages T7 and T9) or the African Great Lakes Region (T10).

Research Letters

• Risk for SARS-CoV-2 Infection in Healthcare Workers, Turin, Italy
  A. Calcagno et al. View Abstract Email this Article

  We measured severe acute respiratory syndrome coronavirus 2 spike protein subunits S1/S2 antibodies by using capillary electrophoresis and a chemiluminescence immunoassay for 5,444 active healthcare workers in Italy. Seroprevalence was 6.9% and higher among participants having contact with patients. Seroconversion was not observed in 37/213 previously infected participants.

• Waning Antibody Responses in Asymptomatic and Symptomatic SARS-CoV-2 Infection
  P. Choe et al. View Abstract Email this Article

  We investigated the kinetics of severe acute respiratory syndrome coronavirus 2 neutralizing antibodies in 7 asymptomatic persons and 11 patients with pneumonia. The geometric mean titer of neutralizing antibodies declined from 219.4 at 2 months to 143.7 at 5 months after infection, indicating a waning antibody response.

• Attitudes about COVID-19 Lockdown among General Population, France, March 2020
  P. Peretti-Watel et al. View Abstract Email this Article

  Because the effectiveness of a coronavirus disease lockdown in curbing coronavirus disease spread depends on public support, acquiring real-time information about the way populations reacted to the lockdown is crucial. In France, such public support remained fragile among low-income persons, probably because the lockdown exacerbated preexisting social inequalities and conflicts.

• Etiology of Severe Acute Respiratory Infections, Bangladesh, 2017
  M. R. Rahaman et al. View Abstract Email this Article

  In April 2017, surveillance detected a surge in severe acute respiratory infections (SARI) in Bangladesh. We collected specimens from SARI patients and asymptomatic controls for analysis with multipathogen diagnostic tests. Influenza A(H1N1)pdm09 was associated with the SARI epidemic, suggesting that introducing vaccines and empiric antiviral drugs could be beneficial.

• SARS-CoV-2 Cluster in Nursery, Poland
  M. Okarska-Napierała et al. View Abstract Email this Article

  We report a cluster of surprisingly high spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated with a single nursery in Poland. Our findings contrast with the presumed negligible role of children in driving the SARS-CoV-2 pandemic. Children 1–2 years of age might be effective SARS-CoV-2 spreaders.

• Nonpolio Enterovirus Activity during the COVID-19 Pandemic, Taiwan, 2020
  S. Kuo et al. View Abstract Email this Article

  In Taiwan, lower nonpolio enterovirus activity during the coronavirus disease pandemic in 2020 compared with 2014–2019 might be attributable to adherence to nonpharmaceutical interventions. The preventable fraction among unexposed persons indicated that 90% of nonpolio enterovirus activity might have been prevented during 2014–2019 by adopting the same measures enforced in 2020.

• Superspreading Event of SARS-CoV-2 Infection at a Bar, Ho Chi Minh City, Vietnam
  N. Chau et al. View Abstract Email this Article

  We report a superspreading event of severe acute respiratory syndrome coronavirus 2 infection initiated at a bar in Vietnam with evidence of symptomatic and asymptomatic transmission, based on ministry of health reports, patient interviews, and whole-genome sequence analysis. Crowds in enclosed indoor settings with poor ventilation may be considered at high risk for transmission.

• Absence of SARS-CoV-2 Transmission from Children in Isolation to Guardians, South Korea
  E. Lee et al. View Abstract Email this Article

  We explored transmission of severe acute respiratory syndrome coronavirus 2 among 12 children and their uninfected guardians in hospital isolation rooms in South Korea. We found that, even with close frequent contact, guardians who used appropriate personal protective equipment were not infected by children with diagnosed coronavirus disease.

• Racial and Workplace Disparities in Seroprevalence of SARS-CoV-2, Baton Rouge, Louisiana, USA
  A. K. Feehan et al. View Abstract Email this Article

  By using paired molecular and antibody testing for severe acute respiratory syndrome coronavirus 2 infection, we determined point prevalence and seroprevalence in Louisiana, USA, during the second phase of reopening. Infections were highly variable by race and ethnicity, work environment, and ZIP code. Census-weighted seroprevalence was 3.6%, and point prevalence was 3.0%.

• Novel 6-Month Treatment for Drug-Resistant Tuberculosis, United States
  C. A. Haley et al. View Abstract Email this Article

  The US Food and Drug Administration approved a 6-month regimen of pretomanid, bedaquiline, and linezolid for extensively drug-resistant or multidrug-intolerant tuberculosis after a trial in South Africa demonstrated 90% effectiveness 6 months posttreatment. We report on a patient who completed the regimen using a lower linezolid dose.

• Developing Endemicity of Schistosomiasis, Corsica, France
  C. Rothe et al. View Abstract Email this Article

  Urogenital schistosomiasis was diagnosed in a man from Germany who had never traveled outside Europe. He likely acquired the infection in Corsica, France, but did not swim in the Cavu River, which was linked to a previous outbreak. This case highlights that transmission of schistosomiasis in Corsica is ongoing.

• Relapsing Fever Group Borreliae in Human-Biting Soft Ticks, Brazil
  S. Muñoz-Leal et al. View Abstract Email this Article

  We conducted a molecular survey for Borrelia spp. in Ornithodoros ticks previously reported as biting humans. We collected specimens in natural ecosystems and inside human dwellings in 6 states in Brazil. Phylogenetic analyses unveiled the occurrence of 4 putatively new species of relapsing fever group borreliae.

• Postmortem Stability of SARS-CoV-2 in Nasopharyngeal Mucosa
  F. Heinrich et al. View Abstract Email this Article

  Analyses of infection chains have demonstrated that severe acute respiratory syndrome coronavirus 2 is highly transmissive. However, data on postmortem stability and infectivity are lacking. Our finding of nasopharyngeal viral RNA stability in 79 corpses showed no time-dependent decrease. Maintained infectivity is supported by virus isolation up to 35 hours postmortem.

Letters

• Large-Scale Isolation Facilities and Potential for Secondary Infectious Disease Outbreak
  S. D. Lim and H. Tey Email this Article
• Relative Bradycardia in Patients with Mild-to-Moderate Coronavirus Disease, Japan
  G. Yan et al. Email this Article

About the Cover

• A Final Voyage Framed by Balance and Contrast
  B. Breedlove Email this Article

Synopses

• Childcare Exposure to Severe Acute Respiratory Syndrome Coronavirus 2 for 4-Year-Old Presymptomatic Child, South Korea
  Y. Yoon et al. View Abstract Email this Article

  Data on transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from preschool-age children to children and adults are limited. We investigated SARS-CoV-2 exposure at a childcare center in South Korea. A 4-year-old child, probably infected by his grandmother, attended the center during the presymptomatic period (February 19–21, 2020). Fever developed on February 22, and he was given a diagnosis SARS-CoV-2 infection on February 27. At the center, 190 persons (154 children and 36 adults) were identified as contacts; 44 (23.2%) were defined as close contacts (37 children and 7 adults). All 190 persons were negative for SARS-CoV-2 on days 8–9 after the last exposure. Two close contacts (1 child and 1 adult) showed development of symptoms on the last day of quarantine. However, subsequent test results were negative. This investigation adds indirect evidence of low potential infectivity in a childcare setting with exposure to a presymptomatic child.

• Symptom Onset and Progression in Hospitalized and Nonhospitalized Patients with Coronavirus Disease, Colorado, USA
  G. M. Vahey et al.
• Characteristics and Timing of Initial Virus Shedding in Severe Acute Respiratory Syndrome Coronavirus 2, Utah, USA
  N. M. Lewis et al. View Abstract Email this Article

  Virus shedding in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can occur before onset of symptoms; less is known about symptom progression or infectiousness associated with initiation of viral shedding. We investigated household transmission in 5 households with daily specimen collection for 5 consecutive days starting a median of 4 days after symptom onset in index patients. Seven contacts across 2 households implementing no precautionary measures were infected. Of these 7, 2 tested positive for SARS-CoV-2 by reverse transcription PCR on day 3 of 5. Both had mild, nonspecific symptoms for 1–3 days preceding the first positive test. SARS-CoV-2 was cultured from the fourth-day specimen in 1 patient and from the fourth- and fifth-day specimens in the other. We also describe infection control measures taken in the households that had no transmission. Persons exposed to SARS-CoV-2 should self-isolate, including from household contacts, wear a mask, practice hand hygiene, and seek testing promptly.

• Clinical Characteristics of Patients Co-infected with Severe Acute Respiratory Syndrome Coronavirus 2 and Dengue Virus, Buenos Aires, Argentina, March–June 2020
  L. M. Carosella et al.
• Zika Virus–Associated Birth Defects, Costa Rica, 2016–2018
  A. Benavides-Lara et al.

Research

• Addressing COVID-19 Misinformation on Social Media Preemptively and Responsively
  E. K. Vraga and L. Bode
• Rapid Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in Detention Facility, Louisiana, USA, May–June, 2020
  M. Wallace et al.
• Nationwide Outbreak of Severe Vomiting in Dogs Associated with a Canine Enteric Coronavirus, United Kingdom
  A. D. Radford et al.
• Excess Deaths during Influenza and Coronavirus Disease and Infection-Fatality Rate for Severe Acute Respiratory Syndrome Coronavirus 2, the Netherlands
  L. van Asten et al.
• Universal Admission Screening for SARS-CoV-2 Infections among Hospitalized Patients, Switzerland, 2020
  T. Scheier et al.
• Highly Pathogenic Avian Influenza A(H5N8) Virus Spread by Short- and Long-Range Transmission, France, 2016–17
  F. Briand et al.
• Increasing Incidence of Invasive Group A Streptococcal Disease in First Nations Population, Alberta, Canada, 2003–2017
  G. J. Tyrrell et al.
• Transmission Clusters of Hepatitis C Virus in Public Health and Correctional Settings, Wisconsin, USA, 2016–2017
  K. R. Hochstatter et al.
• Spread of Multidrug-Resistant Rhodococcus equi, United States
  S. Álvarez-Narváez et al.
• Plasma MicroRNA Profiling of Plasmodium falciparum Biomass and Association with Severity of Malaria Disease
  H. Gupta et al.
• Prolonged Maternal Zika Viremia as a Marker of Adverse Perinatal Outcomes
  L. Pomar et al.
• Use of Commercial Claims Data for Evaluating Trends in Lyme Disease Diagnosis, United States
  A. M. Schwartz et al.
• Role of Burkholderia pseudomallei–Specific IgG2 Antibodies in Adults with Acute Melioidosis, Thailand
  P. Chaichana et al.
• Effects of Social Distancing Measures during the First Epidemic Wave of Severe Acute Respiratory Syndrome Coronavirus 2, Greece
  V. Sypsa et al.

Dispatches

• Murine Typhus in Canary Islands, Spain, 1999–2015
  J. Robaina-Bordón et al.
• Salmonella enterica Serovar Typhi AcrB-R717Q/L Azithromycin-Resistant Isolates, Singapore
  S. Octavia et al.
• Evidence of Zika Virus Infection in Pigs and Mosquitoes, Mexico
  D. Nunez-Avellaneda et al.
• Prevalence of SARS-CoV-2–Specific Antibodies, Japan, June 2020
  T. Yoshiyama et al.
• Novel Arterivirus Associated with Outbreak of Fatal Encephalitis in European Hedgehogs, England
  A. Dastjerdi et al.
• Early Transmission Dynamics, Spread, and Genomic Characterization of SARS-CoV-2 in Panama
  D. Franco et al.
• Plasmodium cynomolgi Coinfections among Symptomatic Malaria Patients, Thailand
  C. Putaporntip et al.
• SARS-CoV-2 Transmission between Mink (Neovison vison) and Humans, Denmark
  A. Hammer et al. View Abstract Email this Article

  Severe acute respiratory syndrome coronavirus 2 has caused a pandemic in humans. Farmed mink (Neovison vison) are also susceptible. In Denmark, this virus has spread rapidly among farmed mink, resulting in some respiratory disease. Full-length virus genome sequencing revealed novel virus variants in mink. These variants subsequently appeared within the local human community.

• Estimating Transmission Parameters for COVID-19 Clusters by Using Symptom Onset Data, Singapore, January–April 2020
  S. Ng et al.
• Population-Based Serosurvey for Severe Acute Respiratory Syndrome Coronavirus 2 Transmission, India
  S. Selvaraju et al.
• Detection of Borrelia burgdorferi sensu stricto DNA in field-collected Haemaphysalis longicornis, United States
  K. J. Price et al.
• Strand-Specific PCR for Detection of Replicating SARS-CoV-2
  C. A. Hogan et al.
• Vaccine-Derived Polioviruses, Central African Republic, 2019
  M. Joffret et al.
• COVID-19 and Fatal Sepsis Caused by Hypervirulent Klebsiella pneumoniae, Japan, 2020
  T. Hosoda et al. View Abstract Email this Article

  A patient in Japan with coronavirus disease and hypervirulent Klebsiella pneumoniae K2 sequence type 86 infection died of respiratory failure. Bacterial and fungal co-infections caused by region-endemic pathogens, including hypervirulent K. pneumoniae in eastern Asia, should be included in the differential diagnosis of coronavirus disease patients with acutely deteriorating condition.

• SARS-CoV-2 Infections among Recent Organ Recipients, March–May 2020, United States
  J. M. Jones et al. View Abstract Email this Article

  We conducted public health investigations of 8 organ transplant recipients who tested positive for severe acute respiratory syndrome coronavirus 2 infection. Findings suggest the most likely source of transmission was community or healthcare exposure, not the organ donor. Transplant centers should educate transplant candidates and recipients about infection prevention recommendations.

• Detection of Shuni Virus in Cases of Neurologic Disease in Humans, South Africa
  T. P. Motlou and M. Venter
• Combined Epidemiologic and Entomologic Survey to Detect Urban Malaria Transmission, Guinea, 2018
  D. Sayre et al.

Research Letters

• Potential Association between Zika Infection and Microcephaly during 2007 Fever Outbreak, Gabon
  C. K. Koumavor et al.
• Seroprevalence of SARS-CoV-2 in Guilan Province, Iran, April 2020
  M. Shakiba et al.
• COVID-19–Related Misinformation and Parents of Patients with Pediatric Cancer
  J. Guidry et al.
• Intrauterine Transmission of SARS-CoV-2
  E. S. Stonoga et al. View Abstract Email this Article

  We documented fetal death associated with intrauterine transmission of severe acute respiratory syndrome coronavirus 2. We found chronic histiocytic intervillositis, maternal and fetal vascular malperfusion, microglial hyperplasia, and lymphocytic infiltrate in muscle in the placenta and fetal tissue. Placenta and umbilical cord blood tested positive for the virus by PCR, confirming transplacental transmission.

• Protective Immunity and Persistent Lung Sequalae in Domestic Cats after SARS-CoV-2 Infection
  S. Chiba et al.
• Puumala Virus Infection in Family, Switzerland
  P. Vetter et al.
• Asymptomatic or Mildly Symptomatic Long-Term Humoral Immune Response to SARS-CoV-2, Vietnam
  H. Mai et al.
• Genomic Diversity of Burkholderia pseudomallei Isolates, Colombia
  C. Duarte et al.
• COVID-19 Infection Control Measures in Long-Term Care Facility, Pennsylvania, USA
  S. T. Shimotsu et al. View Abstract Email this Article

  Residents of long-term care facilities are at risk for coronavirus disease. We report a surveillance exercise at such a facility in Pennsylvania, USA. After introduction of a testing strategy and other measures, this facility had a 17-fold lower coronavirus disease case rate compared with those of neighboring facilities.

• Severe Acute Respiratory Syndrome Coronavirus 2 Outbreak Related to a Nightclub, Germany, 2020
  N. Muller et al. View Abstract Email this Article

  We report an outbreak of coronavirus disease with 74 cases related to a nightclub in Germany in March 2020. Staff members were particularly affected (attack rate 56%) and likely caused sustained viral transmission after an event at the club. This outbreak illustrates the potential for superspreader events and corroborates current club closures.

• COVID-19 and Infant Hospitalizations for Seasonal Respiratory Virus Infections, New Zealand, 2020
  A. Trenholme et al. View Abstract Email this Article

  In March 2020, a national elimination strategy for coronavirus disease was introduced in New Zealand. Since then, hospitalizations for lower respiratory tract infection among infants <2 years of age and cases of respiratory syncytial or influenza virus infection have dramatically decreased. These findings indicate additional benefits of coronavirus disease control strategies.

• Evidence of SARS-CoV-2 RNA in an Oropharyngeal Swab Specimen, Milan, Italy, Early December 2019
  A. Amendola et al. View Abstract Email this Article

  We identified severe acute respiratory syndrome coronavirus 2 RNA in an oropharyngeal swab specimen collected from a child with suspected measles in early December 2019, ≈3 months before the first identified coronavirus disease case in Italy. This finding expands our knowledge on timing and mapping of novel coronavirus transmission pathways.

• SARS-CoV-2 Infection and Mitigation Efforts among Office Workers, Washington, DC, USA
  S. Sami et al.
• Prevalence and Time Trend of SARS-CoV-2 Infection in Puducherry, India, August–October 2020
  S. Kar et al.
• Rift Valley Fever and Crimean-Congo Hemorrhagic Fever Viruses in Ruminants, Jordan
  M. M. Obaidat et al.

Books and Media

• The Rules of Contagion: Why Things Spread—and Why They Stop
  V. J. Morley

Perspective

• Parallels and Mutual Lessons in Tuberculosis and COVID-19 Transmission, Prevention, and Control
  P. C. Hopewell et al. View Abstract Email this Article

  The coronavirus disease (COVID-19) pandemic has had unprecedented negative effects on global health and economies, drawing attention and resources from many other public health services. To minimize negative effects, the parallels, lessons, and resources from existing public health programs need to be identified and used. Often underappreciated synergies relating to COVID-19 are with tuberculosis (TB). COVID-19 and TB share commonalities in transmission and public health response: case finding, contact identification, and evaluation. Data supporting interventions for either disease are, understandably, vastly different, given the diseases’ different histories. However, many of the evolving issues affecting these diseases are increasingly similar. As previously done for TB, all aspects of congregate investigations and preventive and therapeutic measures for COVID-19 must be prospectively studied for optimal evidence-based interventions. New attention garnered by the pandemic can ensure that knowledge and investment can benefit both COVID-19 response and traditional public health programs such as TB programs.

Research

• SARS-CoV-2 Antibody Seroprevalence among Healthcare Personnel in Hospitals and Nursing Homes, Rhode Island, USA, July–August 2020
  L. J. Akinbami et al.
• Population-Based Geospatial and Molecular Epidemiologic Study of Tuberculosis Transmission Dynamics, Botswana, 2012–2016
  N. M. Zetola et al.

Dispatches

• Bedaquiline as Treatment for Disseminated Nontuberculous Mycobacterial Infection in 2 Patients Co-Infected with HIV
  E. Gil et al.
• Implementation of an Animal Sporotrichosis Surveillance and Control Program, Southeastern Brazil
  S. M. Moreira et al.
• Extraintestinal Seeding of Salmonella enterica Serotype Typhi, Pakistan
  S. Irfan et al.
• Human Infection with a Eurasian Avian-Like Swine Influenza A (H1N1) Virus, the Netherlands, September 2019
  A. Parys et al.

Research Letters

• Validity of Diagnosis Code–Based Claims to Identify Pulmonary NTM Disease in Bronchiectasis Patients
  J. H. Ku et al.
• Histoplasmosis—a Common Disease Caused by a Well-Hidden Fungus in an Unusual Setting
  Y. Schmiedel et al.
• Severe Pulmonary Disease Caused by Mycolicibacter kumamotonensis
  K. Manika et al.
• Limited Capability of Testing Mycobacterium tuberculosis for Drug Susceptibility
  H. Z. Farooq et al.
• COVID-19–Associated Fusobacterium nucleatum Bacteremia, Belgium
  L. Wolff et al. View Abstract Email this Article

  We report 4 cases of Fusobacterium nucleatum bacteremia associated with coronavirus disease (COVID-19). Three cases occurred concomitantly with COVID-19 diagnosis; 1 occurred on day 15 of intensive care. None of the patients had known risk factors for F. nucleatum bacteremia. F. nucleatum infection could represent a possible complication of COVID-19.

Dispatch

• Improving Treatment and Outcomes for Melioidosis in Children, Northern Cambodia, 2009–2018
  A. Chandna et al.