Encephalitis Caused by Pathogens Transmitted through Organ Transplants,United States, 2002–2013

The cause of encephalitis among solid organ transplant recipients may be multifactorial; the disease can result from infectious or noninfectious etiologies. During 2002–2013, the US Centers for Disease Control and Prevention investigated several encephalitis clusters among transplant recipients. Cases were caused by infections from transplant-transmitted pathogens: West Nile virus, rabies virus, lymphocytic choriomeningitis virus, and Balamuthia mandrillaris amebae. In many of the clusters, identification of the cause was complicated by delayed diagnosis due to the rarity of the disease, geographic distance separating transplant recipients, and lack of prompt recognition and reporting systems. Establishment of surveillance systems to detect illness among organ recipients, including communication among transplant center physicians, organ procurement organizations, and public health authorities, may enable the rapid discovery and investigation of infectious encephalitis clusters. These transplant-transmitted pathogen clusters highlight the need for greater awareness among clinicians, pathologists, and public health workers, of emerging infectious agents causing encephalitis among organ recipients.     

Risk Assessment and Screening for Sexually Transmitted Infections, HIV, and Hepatitis Virus Among Long-Distance Truck Drivers in New Mexico, 2004�C2006

Objectives. We examined sexually transmitted infection (STI), HIV, and hepatitis virus prevalence and risk behaviors among truck drivers.Methods. We asked participants about their risk behaviors, and we screened them for STIs, HIV, and hepatitis infections. We used logistic regression to identify factors associated with outcomes.Results. Of the 652 enrolled participants, 21% reported sex with sex workers or casual partners in the prior year. Driving solo (odds ratio [OR] = 15.04; 95% confidence interval [CI] = 1.92, 117.53; P = .01), history of injection drug use (IDU; OR = 2.69; 95% CI = 1.19, 6.12; P = .02), and history of an STI (OR = 2.47; 95% CI = 1.19, 5.09; P = .01) were independently associated with high-risk sexual behaviors. Fourteen percent of participants reported drug use in the previous year, and 11% reported having ever injected drugs. Participants tested positive as follows: 54 for HCV antibodies (8.5%), 66 for hepatitis B anticore (anti-HBc) antibodies (10.4%), 8 for chlamydia (1.3%), 1 for gonorrhea (0.2%), 1 for syphilis (0.2%), and 1 for HIV (0.2%). History of injecting drugs (OR = 26.91; 95% CI = 11.61, 62.39; P < .01) and history of anti-HBc antibodies (OR = 7.89; 95% CI = 3.16, 19.68; P < .01) were associated with HCV infection.Conclusions. Our results suggest a need for hepatitis C screening and STI risk-reduction interventions in this population.Studies in Africa, Southeast Asia, Eastern Europe, and South America have linked long-distance truck drivers and commercial sex workers with the dissemination of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection.^1–15 Evidence suggests that the spread of HIV throughout central Africa was facilitated by truck traffic along the Kinshasa-Mombasa highway.^1,2 High rates of STIs and HIV have been observed among long-distance truck drivers in India and Bangladesh, where truck drivers are implicated in the spread of STIs and HIV into rural areas and areas surrounding international border crossings.^7–11 Results from studies in Eastern Europe suggest risky behavior and increased syphilis rates among truck drivers.^12,13 Additionally, studies among truck drivers in Brazil show low levels of perceived risk of infection despite high rates of syphilis and high levels of risky behaviors, e.g., unprotected sex with multiple partners, including commercial sex workers, and high levels of drug use.^14,15Little is known about the roles that long-distance truck drivers and sex workers at truck stops might play in spreading STIs or HIV in the United States. An ecological study in North Carolina examining reported syphilis cases during an outbreak found that the counties along interstate highways had higher syphilis rates than other counties in the state.¹⁶ The authors theorized that truck drivers and sex workers might have played a role in this finding, but there were no data to support this. A 1995 ethnographic study in Florida examining STI risk behaviors of truck drivers found low levels of perceived STI or HIV risk but high levels of risky behaviors.¹⁷ However, no laboratory studies were conducted; therefore, there are no data estimating the prevalence of STIs among long-distance truck drivers in the United States.To examine the environments in which STIs, HIV, and hepatitis virus are transmitted, and to assess the prevalence of STIs, HIV infection, and hepatitis virus infection and risk behaviors among truck drivers, we conducted a risk assessment and screening for STIs, HIV, and hepatitis among truck drivers traveling through New Mexico.     

Subclinical Influenza Virus A Infections in Pigs Exhibited at Agricultural Fairs,Ohio, USA, 2009–2011

Agricultural fairs are associated with bidirectional, interspecies transmission of influenza virus A between humans and pigs. We examined pigs exhibited at agricultural fairs in Ohio during 2009–2011 for signs of influenza-like illness and collected nasal swab specimens from a representative subset of these animals. Influenza virus A was recovered from pigs at 12/53 (22.6%) fairs during the 3-year sampling period. Pigs at 10/12 (83.3%) fairs from which influenza virus A was recovered did not show signs of influenza-like illness. Hemagglutinin, neuraminidase, and matrix gene combinations of the isolates were consistent with influenza virus A concurrently circulating among swine herds in the United States. Subclinical influenza virus A infections in pigs at agricultural fairs may pose a risk to human health and create challenges for passive surveillance programs for influenza virus A in swine herds.     

Transmission Potential of Influenza A(H7N9) Virus,China, 2013–2014

To determine transmission potential of influenza A(H7N9) virus, we used symptom onset data to compare 2 waves of infection in China during 2013–2014. We found evidence of increased transmission potential in the second wave and showed that live bird market closure was significantly less effective in Guangdong than in other regions.     

Prevalence of Sexually Transmitted Infection/Human Immunodeficiency Virus Counseling Services Received by Teen Males, 1995–2002

PurposeTo examine whether improvements have been made in the delivery of sexually transmitted infection and/or human immunodeficiency virus (STI/HIV) counseling services to teen males.MethodsAnalysis was performed using the 1995 National Survey of Adolescent Males (N = 1,729, response rate = 75%) and the 2002 National Survey of Family Growth (N = 1,121, response rate = 78%), which are two nationally representative surveys of 15–19-year-old males. Main outcome measure included discussion about STIs/HIV with a doctor/nurse. Weighted bivariate and multivariate Poisson regression analyses examined the association of outcome measures and survey year among males engaging in various types of sexual behaviors (e.g., varying partner numbers, higher risk sex) unadjusted and adjusted for sociodemographic and health care access factors.ResultsIn 2002, STI/HIV counseling receipt in the past year was reported by one-third of males who reported three or more female partners, anal sex with female partners, or oral/anal sex with male partners. Only 26% of males reporting high-risk sex (e.g., sex with prostitute, person with HIV or often/always high with sex) reported STI/HIV counseling receipt. Overall, no improvements were found between 1995 and 2002 in STI/HIV counseling, even after controlling for sociodemographic and health care access factors.ConclusionsMechanisms are needed to raise the importance of STI/HIV counseling services among sexually active male teens as well as to improve health care providers' delivery of these services.