Early Release

Synopses

• National Surveillance of Human Ehrlichiosis Caused by Ehrlichia ewingii, United States, 2013–2021
  S. N. Adams et al.
• Two Human Cases of Fatal Meningoencephalitis Associated with Potosi and Lone Star Viruses, United States, 2020–2023
  C. Y. Chiu et al.

Research

• Short-Lived Neutralizing Antibody Responses to Monkeypox Virus in Smallpox Vaccine–Naive Persons after JYNNEOS Vaccination
  K. Phipps et al. View Abstract

  JYNNEOS, a third-generation smallpox vaccine, is integral to monkeypox virus (MPXV) control efforts, but the durability of this modified vaccinia Ankara–Bavarian Nordic (MVA-BN) vaccine’s effectiveness is undefined. We optimized and used a plaque reduction neutralization test (PRNT) with authentic clade IIa MPXV and vaccinia virus to assess antibody responses over 12 months in 8 donors vaccinated with 2 doses of JYNNEOS. One donor previously received the ACAM2000 vaccine; 7 donors were smallpox vaccine–naive. IgG responses of the donors to vaccinia virus (L1, B5, and A33) or MPXV (E8, H3, A35) antigens and PRNT titers to both viruses peaked at 8 weeks postvaccination and waned rapidly thereafter in naive donors. MPXV PRNT titers were especially low; no naive donors demonstrated 90% plaque reduction. These data indicate a need for improved correlates of MPXV immunity to enable MVA-BN durability studies, given that recent clinical data support MVA-BN vaccine efficacy against MPXV despite low antibody responses.

• Cyclospora Genotypic Variations and Associated Epidemiologic Characteristics, United States, 2018–2021
  J. Shen et al.
• Epidemiologic and Genomic Surveillance of Vibrio cholerae and Effectiveness of Single-Dose Oral Cholera Vaccine, Democratic Republic of the Congo
  C. George et al. View Abstract

  We conducted 4 years of epidemiologic and genomic surveillance of single-dose effectiveness of a killed whole-cell oral cholera vaccine (kOCV) and Vibrio cholerae transmission in the Democratic Republic of the Congo. We enrolled 1,154 patients with diarrhea; 342 of those had culture-confirmed cholera. We performed whole-genome sequencing on clinical and water V. cholerae isolates from 200 patient households, which showed annual bimodal peaks of V. cholerae clade AFR10e infections. A large clonal cholera outbreak occurred 14 months after a kOCV campaign of >1 million doses, likely because of low (9%) vaccine coverage in informal settlements. Clinical and water isolates collected in the same household were closely related, suggesting person-to-person and water-to-person transmission. Single-dose kOCV vaccine effectiveness 24 months after vaccination was 59.8% (95% CI 19.7%–79.9%), suggesting modest single-dose kOCV protection. kOCV campaigns combined with water, sanitation, and hygiene programs should be used to reduce cholera in disease-endemic settings worldwide.

• Respiratory Shedding of Infectious SARS-CoV-2 Omicron XBB.1.41.1 Lineage among Captive White-Tailed Deer, Texas, USA
  F. C. Ferreira et al. View Abstract

  White-tailed deer (Odocoileus virginianus) have high value for research, conservation, agriculture, and recreation and might be key SARS-CoV-2 reservoirs. In November 2023, we sampled 15 female deer in a captive facility in Texas, USA. All deer had neutralizing antibodies to SARS-CoV-2; respiratory swab samples from 11 deer were SARS-CoV-2–positive by quantitative reverse transcription PCR, and 1 deer also had a positive rectal swab sample. Six of the 11 respiratory swab samples yielded infectious virus; replication kinetics of most samples displayed lower growth 24–48 hours postinfection in vitro than Omicron lineages isolated from humans in Texas in the same period. Virus growth was similar between groups by 72 hours, suggesting no strong attenuation of deer-derived virus. All deer viruses clustered in XBB Omicron clade and demonstrated more mutations than expected compared with contemporaneous viruses in humans, suggesting that crossing the species barrier was accompanied by a high substitution rate.

• Prions in Muscles of Cervids with Chronic Wasting Disease, Norway
  T. T. Vuong et al. View Abstract

  Chronic wasting disease (CWD) is an emerging prion disease in Nordic countries and has been detected in reindeer, moose, and red deer since 2016. CWD sporadically detected in moose and red deer in 3 Nordic countries demonstrated pathologic and strain characteristics different from CWD in reindeer, including an unexpected lack of prions outside the central nervous system as measured by standard diagnostic tests. Using protein misfolding cyclic amplification, we detected prions in the lymphoreticular system of moose and red deer with CWD in Norway and, remarkably, in muscles of both of those species and in CWD-infected reindeer. One moose lymph node and 1 moose muscle sample showed infectivity when experimentally transmitted to bank voles. Our findings highlight the systemic nature of CWD strains in Europe and raise questions regarding the risk of human exposure through edible tissues.

• Streptococcus pyogenes emm Type 3.93 Emergence, the Netherlands and England
  M. A. Davies et al.
• Contribution of Limited Molecular Testing to Low Ehrlichiosis Diagnosis in High Incidence Area, North Carolina, USA
  A. Siegler et al. View Abstract

  Indirect immunofluorescence antibody assays have been the primary method for laboratory diagnosis of ehrlichiosis. Detection of Ehrlichia spp. DNA by using PCR is now widely available through commercial laboratories. To prepare for Ehrlichia spp. PCR introduction, we assessed ehrlichiosis testing practices, quantified the proportion of samples eligible for PCR testing, and estimated the potential effect of implementing PCR at the University of North Carolina health system in North Carolina, USA, which is in an area with a high-incidence of ehrlichiosis. We found <1% of patient samples underwent PCR testing, even though rates of serodiagnostic algorithm completion (testing of acute and convalescent samples) were low (18.4%). Our findings show a need to educate providers on diagnostic and treatment guidelines for ehrlichiosis and raise awareness of the availability and advantage of PCR testing.

• Sudan Virus Persistence in Immune-Privileged Organs of Nonhuman Primates
  B. B. Beavis et al. View Abstract

  After the 2022–2023 Sudan virus (SUDV) disease outbreak in Uganda, we studied SUDV persistence in nonhuman primates that had survived acute infection without therapeutic intervention. We identified SUDV persistence in the vitreous chamber and immediately adjacent tissue in the eyes as well as in the seminiferous tubules in the testes but not in common target organs typically infected during the acute phase of disease. Specifically, SUDV persists primarily in macrophages in the eyes and Sertoli cells in the testes. Ocular and testicular SUDV persistence in nonhuman primates is accompanied by tissue damage, including inflammatory cell invasion. Our study suggests that long-term follow-up efforts are needed to reduce possible recrudescent disease and reignition of outbreaks caused by virus persistence in human survivors of SUDV infection.

• Global Epidemiology of Outbreaks of Unknown Cause Identified by Open-Source Intelligence, 2020–2022
  D. Honeyman et al.

Dispatches

• Reemergence of Echinococcus granulosus Infections after 2004 Termination of Control Program in Magallanes Region, Chile
  C. A. Alvarez Rojas and J. Alvarez View Abstract

  After termination of a control program in 2004, Echinococcus granulosus infections have reemerged in Magallanes Region, Chile. Prevalence in sheep >2 years of age in 2023 resembled levels observed at the start of the program. Resurgence underscores the need for continued surveillance, particularly in younger sheep, to monitor recent transmission trends.

• Infection by Tickborne Bacterium Candidatus Midichloria Associated with First Trimester Pregnancy Loss, Tennessee, USA
  J. Newman et al. View Abstract

  A previously healthy 26-year-old woman in middle Tennessee, USA, experienced a first trimester pregnancy loss after multiple tick bites. Histopathology, 16S rRNA sequencing, and electron microscopy examination of the products of conception revealed an infection by a bacterium within the Candidatus Midichloria genus.

• Seoul Virus Infection and Subsequent Guillain-Barré Syndrome in Traveler Returning to France from Kenya, 2022
  T. M. Lepage et al. View Abstract

  Seoul virus (SEOV) is a worldwide ratborne orthohantavirus. We describe an SEOV infection in an adult returning to France from Kenya, followed by Guillain-Barré syndrome. We confirmed SEOV infection by PCR and sequencing. Although transmission might have occurred in Kenya, the epidemiologic information available is not sufficient to confirm that possibility.

• Eastern Africa Origin of SAT2 Topotype XIV Foot-and-Mouth Disease Virus Outbreaks, Western Asia, 2023
  A. Di Nardo et al. View Abstract

  We describe detection of SAT2 topotype XIV foot-and-mouth disease viruses in western Asia during 2022–2023. Sequences show the viruses originated in eastern Africa and were introduced into western Asia on >1 occasion. The rapid spread in naive animals highlights risks for onward transmission and potential endemicity in Asia.

• Borrelia spielmanii–Associated Neuroborreliosis in Patient Receiving Rituximab, Belgium
  T. Carette et al. View Abstract

  A 58-year-old woman in Belgium with a history of follicular lymphoma treated with rituximab sought care for a rapid sensory-motor deficit. Seronegative neuroborreliosis caused by Borrelia spielmanii was diagnosed, likely related to humoral deficiency. High CXC motif chemokine ligand 13 levels and PCR confirmed the diagnosis. Ceftriaxone treatment led to full recovery.

• Acute Q Fever Patients Requiring Intensive Care Unit Support in Tropical Australia, 2015–2023
  C. Price et al. View Abstract

  Acute Q fever is classically described as a mild illness. We report 9 patients with acute Q fever in Queensland, Australia, who required intensive care unit support to survive. Clinicians should consider an acute Q fever diagnosis and its empirical treatment in critically ill persons in the appropriate clinical context.

• Two Human Infections with Diverse Europe-1 Crimean-Congo Hemorrhagic Fever Virus Strains, North Macedonia, 2024
  D. Jakimovski et al. View Abstract

  Until 2023, North Macedonia had not reported a Crimean-Congo hemorrhagic fever (CCHF) case for >50 years. In 2024, increased clinical vigilance identified and characterized 2 novel CCHF cases. Genetic analysis and the identification of possible reassortment indicate North Macedonia as an interaction zone between CCHF virus isolates from Turkey and Kosovo.

• Diphtheria Toxin–Producing Corynebacterium ramonii in Inner-City Population, Vancouver, British Columbia, Canada, 2019–2023
  C. F. Lowe et al. View Abstract

  We conducted patient chart reviews and whole-genome sequencing of wound specimens containing presumptive Corynebacterium ulcerans from Vancouver, British Columbia, Canada, during July 2019–July 2023. Sequencing confirmed 8/14 isolates were C. ramonii and identified 2 distinct clusters. Molecular methods should be used to clinically differentiate potential toxin-producing Corynebacterium spp.

• Comparison of Contemporary and Historic Highly Pathogenic Avian Influenza A(H5N1) Virus Replication in Human Lung Organoids
  M. Flagg et al. View Abstract

  We compared virus replication and host responses in human alveolar epithelium infected with highly pathogenic avian influenza (HPAI) A(H5N1) viruses. A/Vietnam/1203/2004 replicated most efficiently, followed by A/Texas/37/2024, then A/bovine/Ohio/B24OSU-342/2024. Induction of interferon-stimulated genes was lower with A/Texas/37/2024 and A/bovine/Ohio/B24OSU-342/2024, which may indicate a reduced disease severity of those viruses.

• Detection of Chronic Wasting Disease Prions in Raw, Processed, and Cooked Elk Meat, Texas, USA
  R. Benavente et al. View Abstract

  We describe chronic wasting disease (CWD) prion detection in raw and cooked meat from a CWD-positive elk. We found limited zoonotic potential in CWD prions from those meat products. Nonetheless, risk for transmission to humans is still unclear, and monitoring of circulating and emerging CWD prion strains for zoonotic potential is warranted.

• Dengue and Other Arbovirus Infections among Schoolchildren, Haiti, 2021
  R. Louis et al. View Abstract

  In 2021, we screened 91 children in Haiti with acute undifferentiated febrile illness for arbovirus infections. We identified a major outbreak of dengue virus type 2, with 67% of the children testing positive. Two others were positive for chikungunya East/Central/South African IIa subclade, and 2 were positive for Zika virus.

• Bjerkandera adusta Fungi as Causative Agent of Invasive Chronic Rhinosinusitis
  Y. Kurata et al. View Abstract

  We report an invasive mycosis case in Japan caused by Bjerkandera adusta, a fungal species not previously reported as a causative pathogen of invasive mycosis. B. adusta was identified by using phylogenetic analysis. Voriconazole was used successfully for treatment. Immunodeficient patients may be susceptible to infection by rare causative fungi.

• Bacteremia and Community-Acquired Pneumonia Caused by Pantoea stewartii Subspecies indologenes, Australia
  L. Huang et al. View Abstract

  We report infection with the phytopathogen Pantoea stewartii subspecies indologenes in a macadamia farmer from southeast Queensland, Australia. The patient had bloodstream infection and pneumonia develop after an unidentified inoculation event. Investigation determined that the most likely mode of transmission was inhalation from an environmental source on the farm.

• Amebiasis in Mexico, 2014–2023
  A. Antonio-Campos et al.
• Outbreak of Serotype 1 Invasive Pneumococcal Disease, Kibera Urban Informal Settlement, Nairobi, Kenya, 2023
  T. Komo et al. View Abstract

  Use of 10-valent pneumococcal conjugate vaccine in Kenya has led to substantial reductions in vaccine-type pneumococcal carriage and invasive pneumococcal disease. However, analysis of recent surveillance data indicates an outbreak of vaccine-type serotype 1 in 2023 in Kibera, Kenya. Continued monitoring of invasive pneumococcal disease in Kenya is warranted.

Research Letters

• Venezuelan Equine Encephalitis Virus Infection in Nonhuman Primate, Guatemala, 2023
  W. K. Jo et al. View Abstract

  We isolated Venezuelan equine encephalitis virus (VEEV) subtype IE phylogenetically related to Gulf Coast strains in a spider monkey (Ateles geoffroyi) released from a rescue center in Guatemala. Serologic testing of 118 monkeys indicated no additional VEEV infections. Infection of a primate warrants intensified surveillance of VEEV transmission cycles in North America.

• Sin Nombre Virus as Unlikely Reverse Zoonotic Threat
  J. Prévost et al. View Abstract

  We inoculated clinical materials into deer mice to attempt isolation of Sin Nombre virus. We did not observe productive infection in the natural rodent reservoir. Genomic comparisons between rodent reservoirs and human disease may provide insight into hantavirus evolution and genetic determinants, but reverse zoonosis of Sin Nombre virus appears unlikely.

• Acute Encephalopathy Associated with Human Adenovirus Type 14 Infection in 7-Year-Old Girl, Japan
  S. Mizuno et al. View Abstract

  Only 2 cases of human adenovirus type 14 (HAdV-14) have been reported in Japan since 1980. We report a 7-year-old girl with acute encephalopathy associated with HAdV-14 infection genetically similar to strains from the United States. The patient had not had contact with international travelers. HAdV-14 surveillance should be strengthened in Japan.

• Zika Virus Infection in Pregnant Traveler Returning to Denmark from Phuket, Thailand, 2024
  I. Rubin et al. View Abstract

  We report a case of Zika virus (ZIKV) infection in a pregnant woman from Denmark who traveled to Thailand during her first trimester. Late in the second trimester, severe microcephaly was diagnosed in the fetus, and ZIKV infection was confirmed. Travelers and clinicians should be aware of ongoing ZIKV risk in Thailand.

• Burkholderia pseudomallei Sequence Type 46 Transmission from Asia to Australia
  E. M. Meumann et al. View Abstract

  Melioidosis is caused by the environmental pathogen Burkholderia pseudomallei. Among 1,331 patients with melioidosis during 1989–2023 in the Darwin Prospective Melioidosis Study in Australia, we identified 6 locally acquired cases caused by B. pseudomallei sequence type 46. Because of global transmission and expansion of endemicity, clinicians should increase awareness of melioidosis.

• Ixodes scapularis Tick Parasitizing Dog in Dawson County, Montana, USA, 2023
  P. E. Stewart et al. View Abstract

  In October 2023, a partially engorged female Ixodes tick was removed from a dog in Bozeman, Montana, USA, that had recently spent time in eastern Montana. The tick was identified as I. scapularis according to morphologic characteristics and genomic sequencing, suggesting an expanded geographic distribution requiring continued public health surveillance.

• Henipavirus in Northern Short-Tailed Shrew, Alabama, USA
  R. H. Parry et al. View Abstract

  RNA metagenomic analysis of tissues from 4 wild-caught northern short-tailed shrews in Alabama, USA, revealed a novel henipavirus (family Paramyxoviridae). Phylogenetic analysis supported the placement of the virus within the shrew henipavirus clade, related to human-infecting shrewborne henipaviruses. Our study results highlight the presence of henipavirus infections in North America.

• Human Infection with Avian Influenza A(H9N2) Virus, Vietnam, April 2024
  M. Duong et al. View Abstract

  In April 2024, Vietnam confirmed its first human case of influenza A(H9N2) in a 37-year-old man, marking a critical point in regional infectious disease monitoring and response. This case underscores the importance of robust surveillance systems and One Health collaboration in managing emerging zoonotic threats.

• Bayou Hantavirus Cardiopulmonary Syndrome, Louisiana 2022–23
  E. Ortega et al.
• Mycoplasma phocimorsus in Woman with Tendinous Panaritium after Cat Scratch, Denmark
  A. Skafte-Holm et al. View Abstract

  A panaritium developed in a woman in Demark after her cat scratched her. Analysis of tissue by 16S rRNA gene sequencing revealed Mycoplasma phocimorsus, known to cause seal finger. The source of the bacterium likely transmitted by the cat is unknown, but awareness of potential zoonotic transmission from cats should be raised.

Books and Media

• Ending Epidemics: A History of Escape from Contagion
  C. Partin
• 2000 Years of Pandemics: Past, Present, and Future
  N. M. M’ikanatha and K. Hamilton

Etymologia

• Mycoplasma phocimorsus (mῑ-kō-′plaz-mǝ fō-ki-′mȯr-sǝs), panaritium (pan-ə-′rish-ē-əm)
  C. Partin

Online Reports

• Arbovirus Epidemics as Global Health Imperative, Africa, 2023
  S. T. Bangoura et al.
• Adaptive Design for Phase II/III Platform Trial of Lassa Fever Therapeutics
  J. Bourner et al.

About the Cover

• A Pictorial Human Case of “Furious Rabies”
  A. Perciaccante et al.

Synopsis

• Corynebacterium diphtheriae Infections, South Africa, 2015–2023
  M. du Plessis et al.

Research

• Mycobacterium nebraskense Isolated from Patients in Connecticut and Oregon, USA
  M. L. Metersky et al.
• Genomic Characterization of Circulating Dengue Virus, Ethiopia, 2022–2023
  A. Abera et al.
• High Prevalence of AtpE Mutations in Bedaquiline-Resistant Mycobacterium tuberculosis Isolates, Russia
  D. Zimenkov et al.
• Effect of Prior Influenza A(H1N1)pdm09 Virus Infection on Pathogenesis of Human Influenza A(H5N1) Clade 2.3.4.4b Virus Isolate in Ferret Model
  X. Sun et al.
• Efficacy and Safety of 4-Month Rifapentine-Based Tuberculosis Treatments in Persons with Diabetes
  E. V. Kurbatova et al.
• Impact, Costs, and Cost-Effectiveness of Tuberculosis Outbreak Investigations, United States
  S. Shrestha et al.

Dispatches

• Macrolide-Resistant Mycoplasma pneumoniae Infections among Children after COVID-19 Pandemic, Ohio, USA
  A. L. Leber et al.
• Cefotaxime-Resistant Neisseria meningitidis ST-4821 Causing Fulminant Meningitis
  Y. Shao et al.
• Reemergence of Brucella abortus, Israel, 2021
  S. Bardenstein et al.

Research Letters

• Neurosarcocystosis in Patient with HIV-Induced Immunodeficiency
  T. Skarpengland et al.
• Fluoroquinolone Resistance in Drug-Resistant Tuberculosis, Kharkiv, Ukraine, 2019–2023
  O. Konstantynovska et al.
• Community-Acquired Pneumonia Caused by Avian Chlamydia abortus, the Netherlands
  J. Gooskens et al.
• Evaluation of High-Dose Isoniazid Use in Multidrug-Resistant Tuberculosis Treatment
  V. Gerussi et al.
• Lack of Competence of US Mosquito Species in Circulating Oropouche Virus
  A. F. Payne et al.