Recurrent Zoonotic Transmission of Nipah Virus into Humans, Bangladesh, 2001�C2007

Human Nipah outbreaks recur in a specific region and time of year in Bangladesh. Fruit bats are the reservoir host for Nipah virus. We identified 23 introductions of Nipah virus into human populations in central and northwestern Bangladesh from 2001 through 2007. Ten introductions affected multiple persons (median 10). Illness onset occurred from December through May but not every year. We identified 122 cases of human Nipah infection. The mean age of case-patients was 27 years; 87 (71%) died. In 62 (51%) Nipah virus–infected patients, illness developed 5–15 days after close contact with another Nipah case-patient. Nine (7%) Nipah case-patients transmitted virus to others. Nipah case-patients who had difficulty breathing were more likely than those without respiratory difficulty to transmit Nipah (12% vs. 0%, p = 0.03). Although a small minority of infected patients transmit Nipah virus, more than half of identified cases result from person-to-person transmission. Interventions to prevent virus transmission from bats to humans and from person to person are needed.     

Rift Valley Fever, Mayotte, 2007�C2008

After the 2006–2007 epidemic wave of Rift Valley fever (RVF) in East Africa and its circulation in the Comoros, laboratory case-finding of RVF was conducted in Mayotte from September 2007 through May 2008. Ten recent human RVF cases were detected, which confirms the indigenous transmission of RFV virus in Mayotte.     

Plasmodium vivax Malaria among Military Personnel, French Guiana, 1998�C2008

We obtained health surveillance epidemiologic data on malaria among French military personnel deployed to French Guiana during 1998–2008. Incidence of Plasmodium vivax malaria increased and that of P. falciparum remained stable. This new epidemiologic situation has led to modification of malaria treatment for deployed military personnel.     

Reemergence of Syphilis in Martinique, 2001�C2008

Syphilis reemerged in Martinique in 2004 and initially affected 3 HIV-infected patients. By March 2008, syphilis was diagnosed for 37 men and 18 women. As of October 31, 2009, this outbreak had not yet been brought under control. It initially affected mainly men who had sex with men before it spread to heterosexual persons, minority group members, and crack cocaine users.     

Increasing Incidence of Nontuberculous Mycobacteria, Taiwan, 2000�C2008

To assess the species distribution and epidemiologic trends of nontuberculous mycobacteria, we examined isolates from patients in Taiwan. During 2000–2008, the proportion increased significantly from 32.3% to 49.8%. Associated disease incidence increased from 2.7 to 10.2 cases per 100,000 patients. Mycobacterium avium complex and M. abscessus were most frequently isolated.     

Tuberculosis Transmission and Use of Methamphetamines in Snohomish County, WA, 1991�C2006

Objectives. We investigated a cluster of tuberculosis (TB) cases among persons using methamphetamines in Snohomish County, Washington, to determine the extent of the outbreak, examine whether methamphetamine use contributed to TB transmission, and implement strategies to prevent further infections.Methods. We screened contacts to find and treat persons with TB disease or infection. We then formed a multidisciplinary team to engage substance abuse services partners and implement outreach strategies including novel methods for finding contacts and a system of incentives and enablers to promote finding, screening, and treating patients with TB and their infected contacts.Results. We diagnosed and completed treatment with 10 persons with TB disease. Eight of 9 adult patients and 67% of their adult contacts reported using methamphetamines. Of the 372 contacts, 319 (85.8%) were screened, 80 (25.1%) were infected, 71 (88.8%) started treatment for latent infection, and 57 (80.3%) completed treatment for latent infection.Conclusions. Collaborative approaches integrating TB control, outreach, incentives, and enablers resulted in high rates of treatment adherence and completion among patients and infected contacts. TB control programs should collaborate with substance abuse programs to address addiction, overcome substance abuse–related barriers to treatment, treat TB, and prevent ongoing transmission.Illegal drug use is a risk factor for tuberculosis (TB).¹ Numerous studies have documented that alcohol abuse and illegal drug use (hereafter referred to as substance abuse) are factors that contribute to TB transmission and act as barriers to TB control and prevention.^2–8 Persons who abuse substances are less likely to seek medical care^9,10 and initiate, adhere to, and complete treatment for latent TB infection (LTBI)^11–13 or TB disease.^14–16 Nearly 1 out of every 3 US-born persons with TB who is aged older than 15 years abuses substances.¹⁷ Substance abuse among persons with TB is important to public health because it is associated with sputum-smear positivity at diagnosis and failure to complete treatment of TB, both indicators of increased transmission.¹⁷ Additionally, substance abuse often takes place in enclosed spaces with poor ventilation and high volumes of human traffic, potentially increasing the likelihood of TB transmission.¹⁷TB control programs have been slow to engage the substance abuse treatment community in collaboratively addressing substance abuse–fueled transmission of TB.^10,18 We are not aware of national guidelines that specifically address the control of TB transmission among populations that abuse alcohol and use illegal drugs. Our review of the scientific literature indicates that this is the first report documenting methamphetamine use as a barrier to controlling TB transmission.In 2006, the incidence of TB disease in Snohomish County, Washington, was 3.8 cases per 100 000 persons; the incidence of TB disease for the state of Washington was 4.1 per 100 000 persons.¹⁹ From August 2005 through January 2006, the Snohomish Health District TB Control Program detected an emerging cluster of 6 persons with TB. Five of the 6 persons were known to spend time together (i.e., they were socially linked) and reported using methamphetamines. The recent clustering of these persons in time and space, along with matching genotype patterns of M. tuberculosis, suggested recent transmission of TB.²⁰Initial attempts to identify contacts of the cluster (i.e., persons exposed to and potentially infected by the original 6 persons with TB) were unsuccessful. Even after repeated interviews, patients refused or remained reluctant to name their contacts. Local TB control staff suspected that this reluctance was related to the patients'' use of methamphetamines and their unwillingness to provide names of persons with whom they used illegal substances. To address the substance abuse–related barriers to controlling the outbreak, we expanded our epidemiological investigation and TB control efforts to include alternative measures to find additional persons with TB, provide treatment of these persons, identify and screen their contacts, and provide treatment to those who tested positive for LTBI.     

Epidemiology of Cryptococcus gattii, British Columbia, Canada, 1999�C2007

British Columbia, Canada, has the largest reported population of Cryptococcus gattii–infected persons worldwide. To assess the impact of illness, we retrospectively analyzed demographic and clinical features of reported cases, hospitalizations, and deaths during 1999–2007. A total of 218 cases were reported (average annual incidence 5.8 per million persons). Most persons who sought treatment had respiratory illness (76.6%) or lung cryptococcoma (75.4%). Persons without HIV/AIDS hospitalized with cryptococcosis were more likely than those with HIV/AIDS to be older and admitted for pulmonary cryptococcosis. The 19 (8.7%) persons who died were more likely to be older and to have central nervous system disease and infection from the VGIIb strain. Although incidence in British Columbia is high, the predominant strain (VGIIa) does not seem to cause greater illness or death than do other strains. Further studies are needed to explain host and strain characteristics for regional differences in populations affected and disease outcomes.     

Determinants of Multidrug-Resistant Tuberculosis Clusters, California, USA, 2004�C2007

Laboratory and epidemiologic evidence suggests that pathogen-specific factors may affect multidrug-resistant (MDR) tuberculosis (TB) transmission and pathogenesis. To identify demographic and clinical characteristics of MDR TB case clustering and to estimate the effect of specific isoniazid resistance–conferring mutations and strain lineage on genotypic clustering, we conducted a population-based cohort study of all MDR TB cases reported in California from January 1, 2004, through December 31, 2007. Of 8,899 incident culture-positive cases for which drug susceptibility information was available, 141 (2%) were MDR. Of 123 (87%) strains with genotype data, 25 (20%) were aggregated in 8 clusters; 113 (92%) of all MDR TB cases and 21 (84%) of clustered MDR TB cases occurred among foreign-born patients. In multivariate analysis, the katG S315T mutation (odds ratio 11.2, 95% confidence interval 2.2–∞; p = 0.004), but not strain lineage, was independently associated with case clustering.     

Genetic Characterization of Foot-and-Mouth Disease Viruses, Ethiopia, 1981�C2007

Foot-and-mouth disease (FMD) is endemic to sub-Saharan Africa. To further understand its complex epidemiology, which involves multiple virus serotypes and host species, we characterized the viruses recovered from FMD outbreaks in Ethiopia during 1981–2007. We detected 5 of the 7 FMDV serotypes (O, A, C, Southern African Territories [SAT] 1, and SAT 2). Serotype O predominated, followed by serotype A; type C was not recognized after 1983. Phylogenetic analysis of virus protein 1 sequences indicated emergence of a new topotype within serotype O, East Africa 4. In 2007, serotype SAT 1 was detected in Ethiopia and formed a new distinct topotype (IX), and serotype SAT 2 reappeared after an apparent gap of 16 years. The diversity of viruses highlights the role of this region as a reservoir for FMD virus, and their continuing emergence in Ethiopia will greatly affect spread and consequent control strategy of the disease on this continent.     

Ebola Hemorrhagic Fever Associated with Novel Virus Strain, Uganda, 2007�C2008

During August 2007–February 2008, the novel Bundibugyo ebolavirus species was identified during an outbreak of Ebola viral hemorrhagic fever in Bundibugyo district, western Uganda. To characterize the outbreak as a requisite for determining response, we instituted a case-series investigation. We identified 192 suspected cases, of which 42 (22%) were laboratory positive for the novel species; 74 (38%) were probable, and 77 (40%) were negative. Laboratory confirmation lagged behind outbreak verification by 3 months. Bundibugyo ebolavirus was less fatal (case-fatality rate 34%) than Ebola viruses that had caused previous outbreaks in the region, and most transmission was associated with handling of dead persons without appropriate protection (adjusted odds ratio 3.83, 95% confidence interval 1.78–8.23). Our study highlights the need for maintaining a high index of suspicion for viral hemorrhagic fevers among healthcare workers, building local capacity for laboratory confirmation of viral hemorrhagic fevers, and institutionalizing standard precautions.     

Changing Patterns of Human Campylobacteriosis, England and Wales, 1990�C2007

To explore hypotheses for age-related changes in the incidence of Campylobacter infections in England and Wales during 1990–2007, we analyzed electronic laboratory data. Disease incidence was reduced among children, and the greatest increase in risk was for those >60 years of age. Risk factors for campylobacteriosis in the elderly population should be identified.     

Cluster of Serogroup W135 Meningococci, Southeastern Florida, 2008�C2009

Recently, 14 persons in southeastern Florida were identified with Neisseria meningitidis serogroup W135 invasive infections. All isolates tested had matching or near-matching pulsed-field gel electrophoresis patterns and belonged to the multilocus sequence type 11 clonal complex. The epidemiologic investigation suggested recent endemic transmission of this clonal complex in southeastern Florida.     

Prevalence and Seasonality of Influenza-like Illness in Children, Nicaragua, 2005�C2007

Although information about seasonality and prevalence of influenza is crucial for development of effective prevention and control strategies, limited data exist on the epidemiology of influenza in tropical countries. To better understand influenza in Nicaragua, we performed a prospective 2-year cohort study of influenza-like illness (ILI) involving 4,276 children, 2–11 years of age, in Managua, during April 2005–April 2007. One peak of ILI activity occurred during 2005, in June–July; 2 peaks occurred during 2006, in June–July and November–December. The rate of ILI was 34.8/100 person-years. A household risk factor survey administered to a subset (61%) of participants identified the following risk factors: young age, asthma, and increasing person density in the household. Influenza virus circulation was confirmed during each ILI peak by laboratory testing of a subset of samples. Our findings demonstrate a high rate of ILI, with seasonal peaks, in children in Nicaragua.