Emerging Infectious Diseases Volume 17 Issue 4

2011·6.3 MB·English

by  CDC

Peer-Reviewed Journal Tracking and Analyzing Disease Trends pages 579–768
EDITOR-IN-CHIEF
D. Peter Drotman
Managing Senior Editor EDITORIAL BOARD
Polyxeni Potter, Atlanta, Georgia, USA
Dennis Alexander, Addlestone Surrey, United Kingdom
Senior Associate Editor Timothy Barrett, Atlanta, GA, USA
Brian W.J. Mahy, Bury St. Edmunds, Suffolk, UK Barry J. Beaty, Ft. Collins, Colorado, USA
Associate Editors Martin J. Blaser, New York, New York, USA
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Michel Drancourt, Marseille, France Vincent Deubel, Shanghai, China
Paul V. Effl er, Perth, Australia Ed Eitzen, Washington, DC, USA
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Peter Gerner-Smidt, Atlanta, GA, USA Kathleen Gensheimer, Cambridge, MA, USA
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J. Glenn Morris, Gainesville, Florida, USA
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Tanja Popovic, Atlanta, Georgia, USA
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Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 4, April 2011
April 2011
On the Cover Hand Hygiene Campaigns, Infl uenza,
Eugène-Ernest Hillemacher and Absenteeism in Schoolchildren,
(1818–1887) Cairo, Egypt ................................................619
Edward Jenner Vaccinating a Boy (1884) M. Talaat et al.
Oil on canvas (73.1 cm × 92.7 cm) Overall absences decreased in the intervention group.
Copyright Wellcome Library, London
Orthopoxvirus DNA in Eurasian
Lynx, Sweden ..............................................626
About the Cover p. 763
M. Tryland et al.
Synopsis This virus in lynx poses a possible threat to humans.
Legionella longbeachae
Genome Sequence of SG33 Strain
and Legionellosis .......................................579
and Recombination between
H. Whiley and R. Bentham
Myxoma Viruses .........................................633
A global increase in infections is associated with soils
C. Camus-Bouclainville et al.
and potting mixes.
The poxvirus vaccine sequence has multiple origins.
Research
Shedding of Pandemic (H1N1) 2009
Carriage of Streptococcus pneumoniae Virus among Health Care Personnel,
3 Years after Start of Vaccination Seattle, Washington ...................................639
Program .......................................................584 M. Kay et al.
J. Spijkerman et al. Shedding may occur even after treatment.
Carriage of vaccine serotype decreased, but carriage
of nonserotypes increased. Complete Sequence and Molecular
p. 682
Epidemiology of IncK Epidemic Plasmid
Nosocomial Pandemic (H1N1) 2009, Encoding bla .....................................645
CTX-M-14
United Kingdom, 2009–2010 ......................592 J.L. Cottell et al.
J.E. Enstone et al. This plasmid is disseminated worldwide in Escherichia
Infections were underestimated and associated with coli isolated from humans and animals.
severe illness and death.
Genomic Analysis of Highly Virulent
Isolate of African Swine Fever Virus.........599 H275Y Mutant Pandemic (H1N1) 2009
p. 685
D.A.G. Chapman et al. Virus in Immunocompromised Patients ...653
Sequence information will facilitate research on C. Renaud et al.
vaccine development. Oseltamivir resistance emerges frequently in these
patients.
Diarrheagenic Pathogens in
Polymicrobial Infections ............................606
B. Lindsay et al.
One third of diarrheal infections were caused by Mumps Complications and Effects
multiple pathogens, often in nonrandom combinations. of Mumps Vaccination, England
and Wales, 2002–2006 ................................661
Bordetella petrii Infection with
C.-F. Yung et al.
Long-lasting Persistence in Human .........612
Vaccination can reduce the odds of more severe
A. Le Coustumier et al.
illness in those with mumps.
Infection can persist in persons with chronic
obstructive pulmonary disease.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 4, April 2011
Coxiella burnetii from Ruminants in
Q Fever Outbreak, the Netherlands ..........668
H.I.J. Roest et al. April 2011
A unique genotype, related to a human case,
predominated in the dairy goat population. 726 Establishment of Vaccinia Virus Cantagalo
Strain in Amazon Biome, Brazil
Policy Reviews J.C. Quixabeira-Santos et al.
730 Vaccinia Virus Infections in Martial Arts
Remaining Questions about
Gym, Maryland, 2008
Clinical Variola Major .................................676 C.M. Hughes et al.
J.M. Lane
734 Hepatitis A Virus Vaccine Escape Variants
There are serious public health issues regarding this and Potential New Serotype Emergence
disease. U. Pérez-Sautu et al.
Should Remaining Stockpiles Another Dimension
of Smallpox Virus (Variola)
Be Destroyed? ............................................681 738 Edward Jenner Museum
R.S. Weinstein W. Foege
Relegating smallpox to the autoclave of extinction
would be ill-advised. Letters
p. 720
Dispatches 741 Acute Cytomegalovirus Pneumonitis
in Patient with Lymphomatoid
Granulomatosis
684 Parapoxvirus Infections of Red Deer, Italy
A. Scagliarini et al. 742 Livestock-associated Staphylococcus
aureus in Childcare Worker
688 Bacterial Meningitis and Haemophilus
infl uenzae Type b Conjugate Vaccine, 744 Sequence Analysis of Feline
Malawi Coronaviruses and the Circulating
D.W. McCormick and E.M. Molyneux Virulent/Avirulent Theory
691 Rapid Genotyping of Swine Infl uenza 746 Effects of Vaccination against Pandemic
Viruses (H1N1) 2009 among Japanese Children
P.W.Y. Mak et al. 747 Pandemic (H1N1) 2009 in 3 Wildlife
695 Molecular Discrimination of Sheep Bovine Species, San Diego, California
p. 759
Spongiform Encephalopathy from Scrapie 749 Hemagglutinin 222 Variants in Pandemic
L. Pirisinu et al. (H1N1) 2009 Virus
699 Recent Clonal Origin of Cholera in Haiti 751 Effect of School Closure from Pandemic
A. Ali et al. (H1N1) 2009, Chicago, Illinois
702 Drug-Resistant Pandemic (H1N1) 2009, 753 Imported Rabies, European Union and
South Korea Switzerland, 2001–2010
S.Y. Shin et al.
754 Cytomegalovirus Viremia, Pneumonitis,
705 Seasonality of Cat-Scratch Disease, and Tocilizumab Therapy
France, 1999–2009
756 Concurrent Infl uenza and Shigellosis,
D. Sanguinetti-Morelli et al.
Papua New Guinea, 2009
708 Characteristics of Children Hospitalized for
Pandemic (H1N1) 2009, Malaysia
H.I.M. Ismail et al. In Memoriam
711 Human Metapneumovirus Infection in Wild
759 In Memoriam: Frank John Fenner
Mountain Gorillas
(1914–2010)
G. Palacios et al.

714 Highly Pathogenic Avian Infl uenza Virus
About the Cover
Infection in Feral Raccoons, Japan
T. Horimoto et al.
763 The Fragrance of the Heifer’s Breath
718 Secondary and Tertiary Transmission of
Vaccinia Virus from a US Military Service Etymologia
Member 680 Variola and Vaccination
G.E. Young et al. Erratum
722 High Rates of Staphylococcus aureus 758 Vol. 16, No. 12
USA400 Infection, Northern Canada
G.R. Golding et al.
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 4, April 2011
Legionella longbeachae
and Legionellosis
Harriet Whiley and Richard Bentham
Reported cases of legionellosis attributable to legionelloses typically are associated with water systems
Legionella longbeachae infection have increased worldwide. in the built environment, such as cooling towers, spas,
In Australia and New Zealand, L. longbeachae has been showers, and other warm water systems (1,2). Protozoa
a known cause of legionellosis since the late 1980s. All play a major role in the multiplication and dissemination
cases for which a source was confi rmed were associated
of Legionella spp. in natural environments. The parasitism
with potting mixes and composts. Unlike the situation
of amoebae and ciliates is well documented, and this
with other Legionella spp., L. longbeachae–contaminated
parasitic capability is the basis of human disease through
water systems in the built environment that cause disease
infection of human lung macrophages (1,2).
have not been reported. Spatially and temporally linked
L. longbeachae was fi rst isolated in 1980 from a
outbreaks of legionellosis associated with this organism
also have not been reported. Sporadic cases of disease patient with pneumonia in Long Beach, California, USA
seem to be limited to persons who have had direct contact (3). A second serogroup of L. longbeachae was discovered
with potting soil or compost. Long-distance travel of the during the same year (4). Neither of these reports suggested
organism resulting in infection has not been reported. These a recognized source of infection.
factors indicate emergence of an agent of legionellosis that In Europe, L. pneumophila is responsible for 95%
differs in etiology from other species and possibly in route of of cases of Legionnaires’ disease. Of the remaining 5%,
disease transmission.
the most common causative agent is L. longbeachae (5).
In Australia, New Zealand, and Japan, reported cases of
Legionella spp. were fi rst identifi ed as organisms L. longbeachae infection occur as often as cases of L.
of public health signifi cance in 1976 and are now pneumophila infection (6–8). Within the past decade, the
recognized as the causative agent of legionellosis. L. number of L. longbeachae reports has increased markedly
pneumophila was the species responsible for this initial across Europe and parts of Asia (9–15).
disease outbreak and has remained the major cause
of legionellosis (1,2). The clinical manifestations of Potting Mixes
legionellosis range from no symptoms to acute atypical L. pneumophila is primarily aquatic and endemic
pneumonia and multisystem disease (2). The term to warm water in the built environment (e.g., cooling
legionellosis refers collectively to the clinical syndromes towers, shower heads, and water fountains) and in natural
resulting from Legionella spp. infection, i.e., Legionnaires’ environments (e.g., rivers and lakes) (1,2). It is transmitted
disease (a Legionella spp.–derived pneumonic infection) from the environment through inhalation of aerosol or
and Pontiac fever (an acute, self-limited febrile illness aspiration of Legionella spp.–contaminated particles (1,2).
that has been linked serologically and by culture to L. longbeachae is rarely isolated from aquatic environments
Legionella spp.) (1,2). Community- and hospital-acquired (16,17). The primary environmental reservoir of L.
longbeachae remains unknown; however, the major source
Author affi liation: Flinders University, Adelaide, South Australia, of human infection is considered to be commercial potting
Australia mixes and other decomposing materials, such as bark
and sawdust (5,8,18,19). No reports of L. longbeachae
DOI: 10.3201/eid1704.100446
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 4, April 2011 579
SYNOPSIS
infection from water systems in the built environment have emerging trend of increasing numbers of reported L.
been confi rmed. longbeachae cases (12,18).
Recent analysis of the L. longbeachae genome
has demonstrated that it is highly adapted to the soil Detection
environment. The genome encodes for a range of proteins Detection of Legionella spp. by culture techniques is
that might assist in the invasion and degradation of plant insensitive. Overgrowth of culture media with competing
material (20). These enzyme systems are not present in fl ora is a major problem (1,2). This problem is heightened
L. pneumophila. This work supports the hypothesis of for detection of L. longbeachae in potting mixes. Potting
a possible environmental association with certain plant mixes have a high microbial load and contain spore-
species (8,18). forming bacteria and fungi associated with composting.
The link between potting mix and legionellosis was As a result, heat pretreatment of potting mixes tends to
established in 1989 when a cluster of L. longbeachae stimulate germination of spores and rapid overgrowth of
infections was detected in South Australia. Investigations the agar medium, rather than reduce competing fl ora. Acid
identifi ed commercial potting mixes as the source of pretreatment is the preferred option (18). The variable nature,
disease (18). Since then, L. longbeachae commonly has pH, buffering capacity, and humic content of commercial
been isolated from fresh potting mixes and some of its compost and potting mixes means that the duration of acid
components but less commonly from natural soils, which pretreatment is best tailored to the individual sample rather
suggests that the composting process may be a catalyst than being generically applied (12,18).
for growth. The heat and high moisture content during Molecular methods (quantitative PCR) have been used
composting may allow for multiplication of several recently to quantitatively detect Legionella spp. in potting
Legionella species to detectable levels (18). The route mixes when culture methods gave negative results (11).
of transmission of L. longbeachae from contaminated Improved but nonquantifi able detection in potting soils
environmental samples remains unknown (7,18). also have been reported after amoebic enrichment of soil
In 1990, a study determining the incidence of samples (8).
Legionella spp. in potting mix found that more than two
thirds (33/45) of Australian potting mixes and none (0/19) Disease Prevalence
of European potting mixes tested positive for Legionella Clinical presentations of L. longbeachae infections
spp. (18). The authors postulated that the discrepancy are similar to those of other legionelloses (21). Risk
between incidence of L. longbeachae infection in factors for infection in common with other Legionella
Australia and the rest of the world, particularly Europe, infections are smoking, preexisting medical conditions,
was attributable to the content of commercial potting mix. and immunosuppression. Gardening activities and use
In Australia, potting mix is made mostly from composted of potting mixes are risk factors that are so far unique to
pine waste products, such as sawdust and hammer-milled L. longbeachae infection (7). The disease predominantly
bark. In Europe, peat is the main component of potting mix affects persons <50 years of age, and reports suggest the
(16,18). In 2001, a similar study in Japan found that 2 of 24 median age for infection is slightly higher for L. longbeachae
commercial potting mixes contained L. longbeachae. The than for L. pneumophila (2,7,16,21). In addition, fewer
main component of Japanese potting mix is composted deaths tend to be associated with L. longbeachae infection
wood products, particularly composted oak. The Japanese than with L. pneumophila (21). The virulence factors
study also found that an amoebic enrichment of the associated with L. longbeachae clearly differ from those of
potting mixes resulted in 9 of 24 potting mixes testing L. pneumophila, which may help explain the differences in
positive for L. longbeachae. This fi nding demonstrated disease prevalence and severity (20).
that L. longbeachae can parasitize soil protozoa and that Recently, L. longbeachae–derived Legionnaires’
it was present in potting mixes but at numbers lower than disease has increased worldwide. In the Netherlands
the limit detected by using culture (8). Genomic analysis during 2000–2004, the fi rst 5 reported cases of L.
subsequently confi rmed this parasitic capability (20). In longbeachae–derived pneumonia were reported (13).
2008, testing for Legionella spp. was conducted on 46 Potting mix was associated with infection when analysis
commercial potting mixes in Switzerland. Two of 46 found a genotypically identical strain of L. longbeachae
were culture positive for L. longbeachae and almost half in the patient’s sputum and in the potting mix. Two other
(21/46) for Legionella spp. Most (41/46) of the potting patients of the 5 had indistinguishable genotypes, 1 of
mixes tested positive by quantitative PCR for Legionella whom had visited the same gardening center as the index
spp. Two thirds of these potting mixes contained peat as patient. Unfortunately, further analysis of the cluster was
the base component. This result contradicted previous not possible because 3 of the patients died after hospital
studies on European potting mixes but supported the admission (13).
580 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 4, April 2011
L. longbeachae and Legionellosis
In Thailand, a population-based survey was conducted Experimentally, both L. pneumophila and L.
during 2003–2004 on 556 pneumonia patients >18 years of longbeachae infected the ciliate Tetrahymena pyriformis,
age who received chest radiographs and etiologic testing. although protozoan susceptibility to infection varied
This study found no positive cases of L. pneumophila and according to strain differences and available nutrients (24).
20 (5%) cases of L. longbeachae. The global increase in In addition, although in situ L. pneumophila can infect and
infection rates is associated with soils and potting mixes multiply within Acanthamoeba castellanii, L. longbeachae
This study did not identify an environmental source of is unable to do so (25). Recently both L. pneumophila and
infection (10). In 2004, a 25-year-old woman in Spain who L. longbeachae have been shown to colonize and persist
had systemic lupus erythematosus died of community- within the intestinal tracts of Caenorhabditis nematodes in
acquired L. longbeachae–derived pneumonia (14). laboratory assays and soil environments. Legionella spp.
During 2008–2009, Scotland recorded a cluster of replicated within the intestinal tract but did not invade
Legionnaires’ disease caused by L. longbeachae. Potting surrounding tissue and were excreted as differentiated
mix was associated with all 3 cases of infection. L. forms similar in structure to protozoan cysts. This study
longbeachae isolates from patients and potting mix were suggested that nematodes may serve as natural hosts for
genotyped by amplifi ed fragment-length polymorphism. Legionella spp. and assist in their propagation throughout
The genotypes isolated from the fi rst 2 patients matched soil environments. The ability of L. longbeachae to infect
the genotypes from the associated potting mixes. No isolate protozoan and metazoan hosts allows for long-term
was available from the third patient, but the genotype from contamination of environmental sites (26). The ability to
the potting mix matched the genotype from the fi rst patient. survive protozoan cyst formation might also explain ability
The fi rst 2 patients had contact with the same brand of of L. longbeachae to endure the composting process and
potting mix, which contained composted green waste (heat survive in desiccated potting mixes (16,18).
treated at 65°C for 5–10 days) and 30%–50% peat that had
not been heat treated. The second patient also had contact Disease Transmission
with a second brand of potting mix that contained 75%– Spatially and temporally linked Legionnaires’ disease
80% peat that had not been heat treated. The third patient outbreaks associated with L. longbeachae have never been
had contact with compost made from expanded wood fi ber, confi rmed. The fi rst cluster of cases detected in South
coir, and bark (22). Australia was reported as seasonally but not geographically
These reports contrast with previous reports of L. related (27). Seasonal clustering of cases during spring and
longbeachae in Europe. In 1999, the European Working autumn has been noted in Australia and overseas (22,27).
Group on Legionella Infections reported only 2 cases of L. Cases of disease typically are sporadic and statistically
longbeachae from a total of 337 (<1%) reported Legionella associated with potting mix use and gardening activities
spp. infections (22). In 2008, L. longbeachae was noted (28,29). The route of disease transmission remains
as the dominant species among non–L. pneumophila uncertain, although close proximity or direct contact
infections in Europe (23). with composts and potting mixes support hand-to-mouth,
The number of reported L. longbeachae cases might aspiration, or aerosolization routes of infection (7). No
not truly represent the total numbers because the infection reports have been published that detail infection associated
in many patients might go undiagnosed. Standard routine with long-distance travel of L. longbeachae, which
diagnostic testing for pneumonia patients involves a contrasts markedly with the considerable distances traveled
legionellosis urine antigen test, which detects only L. by other Legionella spp. during disease outbreaks (2).
pneumophila serogroup 1 (22). Also, many patients with A recent report detailed an outbreak of L. longbeachae
Pontiac fever might not require hospitalization and might infection in a commercial nursery (28). In this instance,
not be aware they have a Legionella spp. infection (1). Pontiac fever was the clinical presentation. Workers were in
an enclosed facility without respiratory protection and with
Survival in the Environment considerable potential for dust and aerosol generation. This
The mechanisms that enable Legionella spp. to is the fi rst report of either Pontiac fever or a temporally and
infect protozoa also enable opportunistic infection of the spatially confi rmed outbreak of legionellosis associated
alveolar macrophages within human lungs. Legionella spp. with L. longbeachae (28).
infect and multiply within protozoan hosts in the absence Reported cases of infection in Asia, Europe, and the
of any other supporting nutrients (2). The relationship United States follow a similar pattern of sporadic disease
between L. pneumophila and a range of protozoan hosts linked to direct exposure to potting mix and compost
has been documented in detail (1,2). The relationship (9,10,13,22,29). The rarity of outbreaks of disease and
between L. longbeachae and protozoan hosts is not as well prerequisite for direct exposure suggest an alternative route
understood. of transmission of disease to other Legionella spp., and the
Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 4, April 2011 581
SYNOPSIS
literature alludes to this information (7,18). Concentrations include human health risk assessment, Legionella spp. ecology,
of the organism per gram of potting mix have been reported and control and bioremediation of contaminated soils.
that are comparable to those associated with Legionnaires’
disease per milliliter attributed to water systems (1,2,12).
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Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 4, April 2011 583
RESEARCH
Carriage of Streptococcus
pneumoniae 3 Years after Start of
Vaccination Program, the Netherlands
Judith Spijkerman, Elske J.M. van Gils, Reinier H. Veenhoven, Eelko Hak, Ed P.F. Yzerman,
Arie van der Ende, Alienke J. Wijmenga-Monsuur, Germie P.J.M. van den Dobbelsteen,
and Elisabeth A.M. Sanders
To evaluate the effectiveness of the 7-valent persons (1). All pneumococcal disease is preceded by
pneumococcal conjugate vaccine (PCV7) program, we nasopharyngeal colonization (2). To date, slightly >90
conducted a cross-sectional observational study on serotypes have been identifi ed. Young children, among
nasopharyngeal carriage of Streptococcus pneumoniae whom nasopharyngeal carriage rates are highest, are the
3 years after implementation of the program in the
main reservoir for pneumococcal spread in families and the
Netherlands. We compared pneumococcal serotypes in
community (3).
329 prebooster 11-month-old children, 330 fully vaccinated
In the United States and other industrialized
24-month-old children, and 324 parents with age-matched
countries, widespread use of the 7-valent pneumococcal
pre-PCV7 (unvaccinated) controls (ages 12 and 24 months,
conjugate vaccine (PCV7) (Prevenar; Pfi zer, New York,
n = 319 and n = 321, respectively) and 296 of their parents.
PCV7 serotype prevalences before and after PCV7 NY, USA) for children has led to a dramatic decline
implementation, respectively, were 38% and 8% among in PCV7-serotype invasive pneumococcal disease
11-month-old children, 36% and 4% among 24-month- (IPD), not only in vaccinated children (4) but also in
old children, and 8% and 1% among parents. Non-PCV7 unvaccinated persons of all ages (5,6). This indirect
serotype prevalences were 29% and 39% among 11-month- effect has substantially contributed to favorable cost-
old children, 30% and 45% among 24-month-old children, effectiveness estimates of the vaccination program (7,8).
and 8% and 15% among parents, respectively; serotypes
However, shifts toward nasopharyngeal carriage of non-
11A and 19A were most frequently isolated. PCV7
PCV7 serotypes may eventually counterbalance the direct
serotypes were largely replaced by non-PCV7 serotypes.
and indirect benefi ts of the vaccine, assuming that non-
Disappearance of PCV7 serotypes in parents suggests
PCV7 serotypes will display similar disease potential
strong transmission reduction through vaccination.
(9–12). Early evaluation of the effect of pneumococcal
vaccination on serotype distribution in disease is hampered
Streptococcus pneumoniae (pneumococcus) is a major by the relative infrequency of IPD and the diffi culty of
cause of respiratory and invasive disease worldwide, identifying causative agents in respiratory diseases such
particularly in children <5 years of age and elderly as pneumonia or in otitis media. Therefore, surveillance
of nasopharyngeal carriage of pneumococci in vaccinated
Author affi liations: University Medical Center, Utrecht, the and in unvaccinated persons provides another useful
Netherlands (J. Spijkerman, E.J.M. van Gils, E.A.M. Sanders); tool for monitoring how vaccination affects circulating
Spaarne Hospital, Hoofddorp, the Netherlands (J. Spijkerman, pneumococcal serotypes.
E.J.M. van Gils, R.H. Veenhoven); University Medical Center, In the Netherlands, as part of the national immunization
Groningen, the Netherlands (E. Hak); Regional Laboratory of Public program (NIP), vaccination with PCV7 was introduced for
Health, Haarlem, the Netherlands (E.P.F. Yzerman); Academic all infants born after March 31, 2006, in a 3+1 schedule
Medical Center, Amsterdam, the Netherlands (A. van der Ende); of vaccinations at 2, 3, 4, and 11 months with no catch-
and Netherlands Vaccine Institute, Bilthoven, the Netherlands (A.J. up campaign. To evaluate how this PCV7 vaccination
Wijmenga-Monsuur, G.P.J.M. van den Dobbelsteen) program affected prevalence of pneumococcal serotypes
after 3 years, we conducted a cross-sectional observational
DOI: 10.3201/eid1704101115
584 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 4, April 2011