Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-30 (of 88 Records) |
Query Trace: Erdman D [original query] |
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Clinical and laboratory findings of the first imported case of Middle East respiratory syndrome coronavirus to the United States.
Kapoor M , Pringle K , Kumar A , Dearth S , Liu L , Lovchik J , Perez O , Pontones P , Richards S , Yeadon-Fagbohun J , Breakwell L , Chea N , Cohen NJ , Schneider E , Erdman D , Haynes L , Pallansch M , Tao Y , Tong S , Gerber S , Swerdlow D , Feikin DR . Clin Infect Dis 2014 59 (11) 1511-8 BACKGROUND: The Middle East respiratory syndrome coronavirus (MERS-CoV) was discovered September 2012 in the Kingdom of Saudi Arabia (KSA). The first US case of MERS-CoV was confirmed on 2 May 2014. METHODS: We summarize the clinical symptoms and signs, laboratory and radiologic findings, and MERS-CoV-specific tests. RESULTS: The patient is a 65-year-old physician who worked in a hospital in KSA where MERS-CoV patients were treated. His illness onset included malaise, myalgias, and low-grade fever. He flew to the United States on day of illness (DOI) 7. His first respiratory symptom, a dry cough, developed on DOI 10. On DOI 11, he presented to an Indiana hospital as dyspneic, hypoxic, and with a right lower lobe infiltrate on chest radiography. On DOI 12, his serum tested positive by real-time reverse transcription polymerase chain reaction (rRT-PCR) for MERS-CoV and showed high MERS-CoV antibody titers, whereas his nasopharyngeal swab was rRT-PCR negative. Expectorated sputum was rRT-PCR positive the following day, with a high viral load (5.31 × 10(6) copies/mL). He was treated with antibiotics, intravenous immunoglobulin, and oxygen by nasal cannula. He was discharged on DOI 22. The genome sequence was similar (>99%) to other known MERS-CoV sequences, clustering with those from KSA from June to July 2013. CONCLUSIONS: This patient had a prolonged nonspecific prodromal illness before developing respiratory symptoms. Both sera and sputum were rRT-PCR positive when nasopharyngeal specimens were negative. US clinicians must be vigilant for MERS-CoV in patients with febrile and/or respiratory illness with recent travel to the Arabian Peninsula, especially among healthcare workers. |
Outbreak of Acute Respiratory Illness Associated with Adenovirus Type 4 at the U.S. Naval Academy, 2016
Rogers AE , Lu X , Killerby M , Campbell E , Gallus L , Kamau E , Froh IB , Nowak G , Erdman DD , Sakthivel SK , Gerber SI , Schneider E , Watson JT , Johnson LA . MSMR 2019 26 (2) 21-27 Human adenoviruses (HAdVs) are known to cause respiratory illness outbreaks at basic military training (BMT) sites. HAdV type-4 and -7 vaccines are routinely administered at enlisted BMT sites, but not at military academies. During August-September 2016, U.S. Naval Academy clinical staff noted an increase in students presenting with acute respiratory illness (ARI). An investigation was conducted to determine the extent and cause of the outbreak. During 22 August-11 September 2016, 652 clinic visits for ARI were identified using electronic health records. HAdV-4 was confirmed by realtime polymerase chain reaction assay in 18 out of 33 patient specimens collected and 1 additional HAdV case was detected from hospital records. Two HAdV-4 positive patients were treated for pneumonia including 1 hospitalized patient. Molecular analysis of 4 HAdV-4 isolates identified genome type 4a1, which is considered vaccine-preventable. Understanding the impact of HAdV in congregate settings other than enlisted BMT sites is necessary to inform discussions regarding future HAdV vaccine strategy. |
Middle East respiratory syndrome coronavirus infection dynamics and antibody responses among clinically diverse patients, Saudi Arabia
Al-Abdely HM , Midgley CM , Alkhamis AM , Abedi GR , Lu X , Binder AM , Alanazi KH , Tamin A , Banjar WM , Lester S , Abdalla O , Dahl RM , Mohammed M , Trivedi S , Algarni HS , Sakthivel SK , Algwizani A , Bafaqeeh F , Alzahrani A , Alsharef AA , Alhakeem RF , Jokhdar HAA , Ghazal SS , Thornburg NJ , Erdman DD , Assiri AM , Watson JT , Gerber SI . Emerg Infect Dis 2019 25 (4) 753-766 Middle East respiratory syndrome coronavirus (MERS-CoV) shedding and antibody responses are not fully understood, particularly in relation to underlying medical conditions, clinical manifestations, and mortality. We enrolled MERS-CoV-positive patients at a hospital in Saudi Arabia and periodically collected specimens from multiple sites for real-time reverse transcription PCR and serologic testing. We conducted interviews and chart abstractions to collect clinical, epidemiologic, and laboratory information. We found that diabetes mellitus among survivors was associated with prolonged MERS-CoV RNA detection in the respiratory tract. Among case-patients who died, development of robust neutralizing serum antibody responses during the second and third week of illness was not sufficient for patient recovery or virus clearance. Fever and cough among mildly ill patients typically aligned with RNA detection in the upper respiratory tract; RNA levels peaked during the first week of illness. These findings should be considered in the development of infection control policies, vaccines, and antibody therapeutics. |
Probable donor-derived human adenovirus type 34 infection in 2 kidney transplant recipients from the same donor
Pettengill MA , Babu TM , Prasad P , Chuang S , Drage MG , Menegus M , Lamson DM , Lu X , Erdman D , Pecora N . Open Forum Infect Dis 2019 6 (3) ofy354 Human adenovirus type 34 (HAdV-34) infection is a recognized cause of transplant-associated hemorrhagic cystitis and, in rare cases, tubulointerstitial nephritis. The source of such infections is often difficult to assess, that is, whether acquired as a primary infection, exposure to a pathogen in the transplanted organ, or reactivation of an endogenous latent infection. We present here 2 cases of likely transplant-acquired HAdV-34 infection from the same organ donor, manifesting as tubulointerstitial nephritis in 1. |
Evaluation of a temperature-restricted, mucosal tuberculosis vaccine in guinea pigs
Gupta T , LaGatta M , Helms S , Pavlicek RL , Owino SO , Sakamoto K , Nagy T , Harvey SB , Papania M , Ledden S , Schultz KT , McCombs C , Quinn FD , Karls RK . Tuberculosis (Edinb) 2018 113 179-188 Tuberculosis (TB) is currently the leading cause of death in humans by a single infectious agent, Mycobacterium tuberculosis. The Bacillus Calmette-Guérin (BCG) vaccine prevents pulmonary TB with variable efficacy, but can cause life-threatening systemic infection in HIV-infected infants. In this study, TBvac85, a derivative of Mycobacterium shottsii expressing M. tuberculosis Antigen 85B, was examined as a safer alternative to BCG. Intranasal vaccination of guinea pigs with TBvac85, a naturally temperature-restricted species, resulted in serum Ag85B-specific IgG antibodies. Delivery of the vaccine by this route also induced protection equivalent to intradermal BCG based on organ bacterial burdens and lung pathology six weeks after aerosol challenge with M. tuberculosis strain Erdman. These results support the potential of TBvac85 as the basis of an effective TB vaccine. Next-generation derivatives expressing multiple M. tuberculosis immunogens are in development. |
Infectious MERS-CoV isolated from a mildly ill patient, Saudi Arabia
Al-Abdely HM , Midgley CM , Alkhamis AM , Abedi GR , Tamin A , Binder AM , Alanazi K , Lu X , Abdalla O , Sakthivel SK , Mohammed M , Queen K , Algarni HS , Li Y , Trivedi S , Algwizani A , Alhakeem RF , Thornburg NJ , Tong S , Ghazal SS , Erdman DD , Assiri AM , Gerber SI , Watson JT . Open Forum Infect Dis 2018 5 (6) ofy111 Middle East respiratory syndrome coronavirus (MERS-CoV) is associated with a wide range of clinical presentations, from asymptomatic or mildly ill to severe respiratory illness including death. We describe isolation of infectious MERS-CoV from the upper respiratory tract of a mildly ill 27-year-old female in Saudi Arabia 15 days after illness onset. |
Multihospital Outbreak of a Middle East Respiratory Syndrome Coronavirus Deletion Variant, Jordan: A Molecular, Serologic, and Epidemiologic Investigation.
Payne DC , Biggs HM , Al-Abdallat MM , Alqasrawi S , Lu X , Abedi GR , Haddadin A , Iblan I , Alsanouri T , Al Nsour M , Sheikh Ali S , Rha B , Trivedi SU , Rasheed MAU , Tamin A , Lamers MM , Haagmans BL , Erdman DD , Thornburg NJ , Gerber SI . Open Forum Infect Dis 2018 5 (5) ofy095 Background: An outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV) in Jordan in 2015 involved a variant virus that acquired distinctive deletions in the accessory open reading frames. We conducted a molecular and seroepidemiologic investigation to describe the deletion variant's transmission patterns and epidemiology. Methods: We reviewed epidemiologic and medical chart data and analyzed viral genome sequences from respiratory specimens of MERS-CoV cases. In early 2016, sera and standardized interviews were obtained from MERS-CoV cases and their contacts. Sera were evaluated by nucleocapsid and spike protein enzyme immunoassays and microneutralization. Results: Among 16 cases, 11 (69%) had health care exposure and 5 (31%) were relatives of a known case; 13 (81%) were symptomatic, and 7 (44%) died. Genome sequencing of MERS-CoV from 13 cases revealed 3 transmissible deletions associated with clinical illness during the outbreak. Deletion variant sequences were epidemiologically clustered and linked to a common transmission chain. Interviews and sera were collected from 2 surviving cases, 23 household contacts, and 278 health care contacts; 1 (50%) case, 2 (9%) household contacts, and 3 (1%) health care contacts tested seropositive. Conclusions: The MERS-CoV deletion variants retained human-to-human transmissibility and caused clinical illness in infected persons despite accumulated mutations. Serology suggested limited transmission beyond that detected during the initial outbreak investigation. |
Reassessment of High Prevalence Human Adenovirus Detections Among Residents of Two Refugee Centers in Kenya Under Surveillance for Acute Respiratory Infections.
Wu X , Lu X , Schneider E , Ahmed JA , Njenga MK , Breiman RF , Eidex RB , Erdman DD . J Med Virol 2018 91 (3) 385-391 Human adenoviruses (HAdVs) were previously detected at high prevalence by real-time RT-PCR (rRT-PCR) in the upper respiratory tract of residents of two Kenyan refugee camps under surveillance for acute respiratory illness (ARI) between October 2006 and April 2008. We sought to confirm this finding and characterize the HAdVs detected. Of 2148 respiratory specimens originally tested, 511 (23.8%) screened positive for HAdV and 510 were available for retesting. Of these, 421 (82.4%) were confirmed positive by repeat rRT-PCR or PCR and sequencing. Other respiratory viruses were co-detected in 55.8% of confirmed HAdV-positive specimens. Species B and C viruses predominated at 82.8% and HAdV-C1, -C2, and -B3 were the most commonly identified types. Species A, D and F HAdVs, that are rarely associated with ARI, comprised the remainder. Viral loads were highest among species B HAdVs, particularly HAdV-B3. Species C showed the widest range of viral loads and species A, D and F were most often present at low loads and more often with co-detections. These findings suggest that many HAdV detections were incidental and not a primary cause of ARI among camp patients. Species/type, co-detections and viral load determinations may permit more accurate HAdV disease burden estimates in these populations. This article is protected by copyright. All rights reserved. |
Respiratory syncytial virus testing capabilities and practices among National Respiratory and Enteric Virus Surveillance System laboratories, United States, 2016
Allen KE , Chommanard C , Haynes AK , Erdman DD , Gerber SI , Kim L . J Clin Virol 2018 107 48-51 BACKGROUND: Laboratory tests to detect respiratory syncytial virus (RSV) vary in sensitivity and specificity. Diagnostic testing practices can impact RSV disease diagnosis and burden estimates. OBJECTIVES: We surveyed a sample of laboratories that participated in the National Respiratory and Enteric Virus Surveillance System (NREVSS) in 2015-2016 to understand RSV testing, diagnostic capabilities, and practices. STUDY DESIGN: We distributed surveys in fall 2016 to NREVSS laboratories using an internet survey platform. We conducted a descriptive analysis of survey responses and stratified results by self-identified children's hospital laboratories (CHL, i.e. laboratories affiliated with or in a children's hospital) or general hospital laboratories (GHL, i.e. laboratories that performed analysis on specimens from only adults or adults and children). RESULTS: We sampled 367 (82.5%) of 445 eligible NREVSS laboratories with a 35.7% response rate; 11.5% (n = 15) were CHLs. All CHLs had PCR-based assay capability to test for RSV compared to 48.7% of GHLs (p < 0.001), and it was the most frequent method used by CHLs (n = 9, 75.0%). GHLs used rapid antigen detection tests most frequently (n = 65, 60.2%) to detect RSV compared to CHLs (p = 0.02, n = 3, 25.0%). Almost half (n = 41, 48.2%) of GHLs reported specimen submission from adults >/=50 years for RADTs. CONCLUSIONS: Laboratory testing and diagnostic capabilities differed by whether laboratories self-identified as a CHL or GHL. Many GHLs reported use of RADTs in adults >/=50 years, a less sensitive diagnostic method for this population compared to PCR-based assays. RADT use in adults might miss RSV cases and affect diagnoses and disease burden estimates. |
Use of multiple imputation to estimate the proportion of respiratory virus detections among patients hospitalized with community-acquired pneumonia
Bozio CH , Flanders WD , Finelli L , Bramley AM , Reed C , Gandhi NR , Vidal JE , Erdman D , Levine MZ , Lindstrom S , Ampofo K , Arnold SR , Self WH , Williams DJ , Grijalva CG , Anderson EJ , McCullers JA , Edwards KM , Pavia AT , Wunderink RG , Jain S . Open Forum Infect Dis 2018 5 (4) ofy061 Background: Real-time polymerase chain reaction (PCR) on respiratory specimens and serology on paired blood specimens are used to determine the etiology of respiratory illnesses for research studies. However, convalescent serology is often not collected. We used multiple imputation to assign values for missing serology results to estimate virus-specific prevalence among pediatric and adult community-acquired pneumonia hospitalizations using data from an active population-based surveillance study. Methods: Presence of adenoviruses, human metapneumovirus, influenza viruses, parainfluenza virus types 1-3, and respiratory syncytial virus was defined by positive PCR on nasopharyngeal/oropharyngeal specimens or a 4-fold rise in paired serology. We performed multiple imputation by developing a multivariable regression model for each virus using data from patients with available serology results. We calculated absolute and relative differences in the proportion of each virus detected comparing the imputed to observed (nonimputed) results. Results: Among 2222 children and 2259 adults, 98.8% and 99.5% had nasopharyngeal/oropharyngeal specimens and 43.2% and 37.5% had paired serum specimens, respectively. Imputed results increased viral etiology assignments by an absolute difference of 1.6%-4.4% and 0.8%-2.8% in children and adults, respectively; relative differences were 1.1-3.0 times higher. Conclusions: Multiple imputation can be used when serology results are missing, to refine virus-specific prevalence estimates, and these will likely increase estimates. |
Adenovirus type 4 respiratory infections among civilian adults, northeastern United States, 2011-2015(1)
Kajon AE , Lamson DM , Bair CR , Lu X , Landry ML , Menegus M , Erdman DD , St George K . Emerg Infect Dis 2018 24 (2) 201-209 Human adenovirus type 4 (HAdV-4) is most commonly isolated in military settings. We conducted detailed molecular characterization on 36 HAdV-4 isolates recovered from civilian adults with acute respiratory disease (ARD) in the northeastern United States during 2011-2015. Specimens came from college students, residents of long-term care facilities or nursing homes, a cancer patient, and young adults without co-morbidities. HAdV-4 genome types 4a1 and 4a2, the variants most frequently detected among US military recruits in basic training before the restoration of vaccination protocols, were isolated in most cases. Two novel a-like variants were recovered from students enrolled at a college in Tompkins County, New York, USA, and a prototype-like variant distinguishable from the vaccine strain was isolated from an 18-year-old woman visiting a physician's office in Ulster County, New York, USA, with symptoms of influenza-like illness. Our data suggest that HAdV-4 might be an underestimated causative agent of ARD among civilian adults. |
Human adenovirus surveillance - United States, 2003-2016
Binder AM , Biggs HM , Haynes AK , Chommanard C , Lu X , Erdman DD , Watson JT , Gerber SI . MMWR Morb Mortal Wkly Rep 2017 66 (39) 1039-1042 Human adenoviruses (HAdVs) are nonenveloped, double-stranded DNA viruses in the family Adenoviridae; seven species (A-G) and >60 genotypes are known to cause human infection. Clinical manifestations associated with HAdV infection include fever, acute respiratory illness, gastroenteritis, and conjunctivitis. HAdV infection can be severe, particularly among immunocompromised patients, and can cause respiratory failure, disseminated infection, hemorrhagic cystitis, neurologic disease, and death. Illness tends to occur sporadically and without demonstrated seasonality. Outbreaks of HAdV have been reported globally in communities, and in closed or crowded settings, including dormitories, health care settings, and among military recruits, for whom a vaccine against HAdV type 4 (HAdV-4) and HAdV type 7 (HAdV-7) has been developed. CDC summarized HAdV detections voluntarily reported through the National Adenovirus Type Reporting System (NATRS) after initiation of surveillance in 2014 to describe trends in reported HAdVs circulating in the United States. Reporting laboratories were also encouraged to report available results for specimens collected before surveillance began. Overall, the number of reporting laboratories and HAdV type identifications reported to NATRS has increased substantially from the start of official reporting in 2014 through 2016; this report describes specimens collected during 2003-2016. The most commonly reported HAdV types were HAdV type 3 (HAdV-3) and HAdV type 2 (HAdV-2), although HAdV types reported fluctuated considerably from year to year. In the United States, information on recently circulating HAdV types is needed to inform diagnostic and surveillance activities by clinicians and public health practitioners. Routine reporting to NATRS by all U.S. laboratories with the capacity to type HAdVs could help strengthen this surveillance system. |
Rhinovirus Viremia in Patients Hospitalized with Community Acquired Pneumonia.
Lu X , Schneider E , Jain S , Bramley AM , Hymas W , Stockmann C , Ampofo K , Arnold SR , Williams DJ , Self WH , Patel A , Chappell JD , Grijalva CG , Anderson EJ , Wunderink RG , McCullers JA , Edwards KM , Pavia AT , Erdman DD . J Infect Dis 2017 216 (9) 1104-1111 Background: Rhinoviruses (RVs) are ubiquitous respiratory pathogens that often cause mild or subclinical infections. Molecular detection of RV from the upper respiratory tract can be prolonged, complicating etiologic association in persons with severe lower respiratory tract infections. Little is known about RV viremia and its value as a diagnostic indicator in persons hospitalized with community-acquired pneumonia (CAP). Methods: Sera from RV-positive children and adults hospitalized with CAP were tested for RV by real-time RT-PCR. RV species and type were determined by partial genome sequencing. Results: Overall, 57/570 (10%) RV-positive patients were viremic and all were children <10 years old [57/375 (15.2%)]. Although RV-A was the most common RV species detected from respiratory specimens (48.8%), almost all viremias were RV-C (98.2%). Viremic patients had fewer co-detected pathogens and were more likely to have chest retractions, wheezing and a history of underlying asthma/reactive airway disease than patients without viremia. Conclusions: More than one out of seven RV-infected children <10 years old hospitalized with CAP were viremic. In contrast with other RV species, RV-C infections were highly associated with viremia and more often the only respiratory pathogen identified, suggesting that RV-C viremia may be an important diagnostic indicator in pediatric pneumonia. |
Notes from the field: Epidemic keratoconjunctivitis outbreak associated with human adenovirus type 8 - U.S. Virgin Islands, June-November 2016
Killerby ME , Stuckey MJ , Guendel I , Sakthivel S , Lu X , Erdman DD , Schneider E , Fagan R , Davis MS , Watson JT , Gerber SI , Biggs HM , Ellis EM . MMWR Morb Mortal Wkly Rep 2017 66 (30) 811-812 On October 11, 2016, the U.S. Virgin Islands Department of Health (USVI DOH) was notified by a local ophthalmologist of an unexpected increase in the number of patients with suspected epidemic keratoconjunctivitis (EKC) during the preceding month. EKC is a severe form of acute conjunctivitis caused by human adenoviruses (HAdVs). Clinical illness typically lasts 1 to 3 weeks and is usually self-limited; treatment is supportive. HAdVs can survive for weeks in the environment and are resistant to common disinfectants. USVI DOH and CDC investigated during October 11-November 29, 2016 to determine the scope of the outbreak, and provide infection control recommendations. |
Acute respiratory infections among returning Hajj pilgrims-Jordan, 2014
Al-Abdallat MM , Rha B , Alqasrawi S , Payne DC , Iblan I , Binder AM , Haddadin A , Nsour MA , Alsanouri T , Mofleh J , Whitaker B , Lindstrom SL , Tong S , Ali SS , Dahl RM , Berman L , Zhang J , Erdman DD , Gerber SI . J Clin Virol 2017 89 34-37 BACKGROUND: The emergence of Middle East Respiratory Syndrome coronavirus (MERS-CoV) has prompted enhanced surveillance for respiratory infections among pilgrims returning from the Hajj, one of the largest annual mass gatherings in the world. OBJECTIVES: To describe the epidemiology and etiologies of respiratory illnesses among pilgrims returning to Jordan after the 2014 Hajj. STUDY DESIGN: Surveillance for respiratory illness among pilgrims returning to Jordan after the 2014 Hajj was conducted at sentinel health care facilities using epidemiologic surveys and molecular diagnostic testing of upper respiratory specimens for multiple respiratory pathogens, including MERS-CoV. RESULTS: Among the 125 subjects, 58% tested positive for at least one virus; 47% tested positive for rhino/enterovirus. No cases of MERS-CoV were detected. CONCLUSIONS: The majority of pilgrims returning to Jordan from the 2014 Hajj with respiratory illness were determined to have a viral etiology, but none were due to MERS-CoV. A greater understanding of the epidemiology of acute respiratory infections among returning travelers to other countries after Hajj should help optimize surveillance systems and inform public health response practices. |
Serology Enhances Molecular Diagnosis of Respiratory Virus Infections Other than Influenza in Children and Adults Hospitalized with Community-Acquired Pneumonia.
Zhang Y , Sakthivel SK , Bramley A , Jain S , Haynes A , Chappell JD , Hymas W , Lenny N , Patel A , Qi C , Ampofo K , Arnold SR , Self WH , Williams DJ , Hillyard D , Anderson EJ , Grijalva CG , Zhu Y , Wunderink RG , Edwards KM , Pavia AT , McCullers JA , Erdman DD . J Clin Microbiol 2016 55 (1) 79-89 Both molecular and serological assays have been used previously to determine the etiology of community-acquired pneumonia (CAP). However, the correlation of these methods and added diagnostic value of serology has not been fully evaluated. Using data from patients enrolled in the Centers for Disease Control and Prevention Etiology of Pneumonia in the Community (EPIC) study, we compared real-time RT-PCR and serology for diagnosis of respiratory syncytial virus (RSV), human metapneumovirus (HMPV), parainfluenza viruses 1-3 (PIV) and adenovirus (AdV) infections. Of 5126 patients enrolled, RT-PCR and serology test results were available for 2023, including 1087 children <18 years of age and 936 adults. For RSV, 287 (14.2%) patients were positive by RT-PCR and 234 (11.6%) were positive by serology; HMPV, 172 (8.5%) tested positive by RT-PCR and 147 (7.3%) by serology; PIVs, 94 (4.6%) tested positive by RT-PCR and 92 (4.6%) by serology; and AdV, 111 (5.5%) positive by RT-PCR and 62 (3.1%) by serology. RT-PCR provided the most positive detections overall, but serology increased diagnostic yield for RSV (by 11.8%), HMPV (by 25.0%), AdV (by 32.4%), and PIV (by 48.9%). Method concordance estimated by Cohen's kappa (kappa) coefficient ranged from good (RSV, 0.73 kappa) to fair (AdV, 0.27 kappa). Heterotypic seroresponses observed between PIV and persistent low-level AdV shedding may account for higher method discordance observed with each of these viruses. Serology can be a helpful adjunct to RT-PCR for research-based assessment of the etiologic contribution of non-influenza respiratory viruses to CAP. |
Exposures among MERS case-patients, Saudi Arabia, January-February 2016
Alhakeem RF , Midgley CM , Assiri AM , Alessa M , Al Hawaj H , Saeed AB , Almasri MM , Lu X , Abedi GR , Abdalla O , Mohammed M , Algarni HS , Al-Abdely HM , Alsharef AA , Nooh R , Erdman DD , Gerber SI , Watson JT . Emerg Infect Dis 2016 22 (11) 2020-2022 Risk factors for primary acquisition of Middle East respiratory syndrome (MERS) coronavirus (CoV) include recent direct contact with dromedary camels (1), but secondary transmission, associated with healthcare settings (2–4) or household contact (5), accounts for most reported cases. Because persons with MERS often do not report any of these risk factors, we investigated MERS cases in Saudi Arabia during an apparent period of limited hospital transmission. Through telephone interviews of case-patients and information from routine investigations, we aimed to characterize exposures and to explore additional factors potentially important in disease transmission. We also genetically sequenced MERS-CoV from respiratory specimens to identify circulating strains. | For confirmed MERS cases (6) reported in Saudi Arabia during January–February 2016, we assessed exposures during the 2 weeks before illness onset (exposure period), including direct (1) and indirect camel contact; indirect contact was defined as 1) having visited settings where camels were kept but without having direct contact or 2) exposure to friends or household members who themselves had direct camel exposure (1). We assessed whether case-patients had worked at, visited, or been admitted to a healthcare setting or had contact with a person known to have MERS during the case-patient’s exposure period. We also asked about recent travel and if any household members were healthcare personnel. For persons too ill to participate or deceased, we interviewed relatives or close friends. |
Multistate outbreak of human Salmonella typhimurium infections linked to pet hedgehogs - United States, 2011-2013
Anderson TC , Marsden-Haug N , Morris JF , Culpepper W , Bessette N , Adams JK , Bidol S , Meyer S , Schmitz J , Erdman MM , Gomez TM , Barton Behravesh C . Zoonoses Public Health 2016 64 (4) 290-298 Zoonotic Salmonella infections cause approximately 130 000 illnesses annually in the United States. Of 72.9 million US households owning at least one pet, five million own small mammals; 3000 hedgehogs were documented by USDA in USDA-licensed breeding facilities and pet stores in 2012. State health department collaborators and PulseNet, the national bacterial subtyping network, identified human infections of a Salmonella Typhimurium outbreak strain, which were investigated by CDC, USDA-APHIS and state public and animal health officials. A case was defined as an illness in a person infected with the outbreak strain identified between 1 December 2011 and 3 June 2013. Investigators collected information on patient exposures, cultured animal and environmental specimens for Salmonella, and conducted traceback investigations of USDA-licensed hedgehog facilities. There were 26 cases in 12 states. Illness onset dates ranged from 26 December 2011 to 8 April 2013. The median patient age was 15 years (range = <1-91 years); 58% were female. Among 23 persons with available information, 8 (35%) were hospitalized and one outbreak strain-associated death was reported. Of 25 patients with available information, 20 (80%) reported pet hedgehog contact in the week before illness onset. The outbreak strain was isolated from animal and environmental samples collected from three ill persons' homes in three states. Hedgehogs were purchased in geographically distant states from USDA-licensed breeders (10/17, 59%); a USDA-licensed pet store (1/17, 6%); unlicensed or unknown status breeders (3/17, 18%); and private individuals (3/17, 18%). Traceback investigations of USDA-licensed facilities did not reveal a single source of infection. Public and animal health collaboration linked pet hedgehog contact to human infections of Salmonella Typhimurium, highlighting the importance of a One Health investigative approach to zoonotic salmonellosis outbreaks. More efforts are needed to increase awareness among multiple stakeholders on the risk of illness associated with pet hedgehogs. |
Increase in Middle East Respiratory Syndrome-Coronavirus Cases in Saudi Arabia Linked to Hospital Outbreak With Continued Circulation of Recombinant Virus, July 1-August 31, 2015.
Assiri AM , Biggs HM , Abedi GR , Lu X , Bin Saeed A , Abdalla O , Mohammed M , Al-Abdely HM , Algarni HS , Alhakeem RF , Almasri MM , Alsharef AA , Nooh R , Erdman DD , Gerber SI , Watson JT . Open Forum Infect Dis 2016 3 (3) ofw165 During July-August 2015, the number of cases of Middle East respiratory syndrome (MERS) reported from Saudi Arabia increased dramatically. We reviewed the 143 confirmed cases from this period and classified each based upon likely transmission source. We found that the surge in cases resulted predominantly (90%) from secondary transmission largely attributable to an outbreak at a single healthcare facility in Riyadh. Genome sequencing of MERS coronavirus from 6 cases demonstrated continued circulation of the recently described recombinant virus. A single unique frameshift deletion in open reading frame 5 was detected in the viral sequence from 1 case. |
Multistate outbreak of human Salmonella Typhimurium infections linked to live poultry from agricultural feed stores and mail-order hatcheries, United States 2013
Anderson TC , Nguyen TA , Adams JK , Garrett NM , Bopp CA , Baker JB , McNeil C , Torres P , Ettestad PJ , Erdman MM , Brinson DL , Gomez TM , Barton Behravesh C . One Health 2016 2 144-149 Live poultry-associated salmonellosis is an emerging public health issue in the United States. Public and animal health officials collaborated to investigate one of the largest (356 cases, 39 states) of these outbreaks reported to date. A case was defined as illness in a person infected with the outbreak strain of Salmonella Typhimurium with illness onset between 1 March and 22 October 2013. The median patient age was seven years (range: < 1–87 years); 58% of ill persons were children ≤ 10 years, 51% were female, 25% were hospitalized; 189 (76%) of 250 patients reported live poultry exposure in the week before illness; and 149 (95%) of 157 reported purchasing live poultry from agricultural feed stores. Traceback investigations identified 18 live poultry sources, including 16 mail-order hatcheries. Environmental sampling was conducted at two mail-order hatcheries. One (2.5%) of 40 duplicate samples collected at one hatchery yielded the outbreak strain. Live poultry are an important source of human salmonellosis, particularly among children, highlighting the need for educational campaigns and comprehensive interventions at the mail-order hatchery and agricultural feed store levels. Prevention and control efforts depend on a One Health approach, involving cooperation between public and animal health officials, industry, health professionals, and consumers. |
A polyvalent inactivated rhinovirus vaccine is broadly immunogenic in rhesus macaques
Lee S , Nguyen MT , Currier MG , Jenkins JB , Strobert EA , Kajon AE , Madan-Lala R , Bochkov YA , Gern JE , Roy K , Lu X , Erdman DD , Spearman P , Moore ML . Nat Commun 2016 7 12838 As the predominant aetiological agent of the common cold, human rhinovirus (HRV) is the leading cause of human infectious disease. Early studies showed that a monovalent formalin-inactivated HRV vaccine can be protective, and virus-neutralizing antibodies (nAb) correlated with protection. However, co-circulation of many HRV types discouraged further vaccine efforts. Here, we test the hypothesis that increasing virus input titres in polyvalent inactivated HRV vaccine may result in broad nAb responses. We show that serum nAb against many rhinovirus types can be induced by polyvalent, inactivated HRVs plus alhydrogel (alum) adjuvant. Using formulations up to 25-valent in mice and 50-valent in rhesus macaques, HRV vaccine immunogenicity was related to sufficient quantity of input antigens, and valency was not a major factor for potency or breadth of the response. Thus, we have generated a vaccine capable of inducing nAb responses to numerous and diverse HRV types. |
Spike gene deletion quasispecies in serum of patient with acute MERS-CoV infection.
Lu X , Rowe LA , Frace M , Stevens J , Abedi GR , El Nile O , Banassir T , Al-Masri M , Watson JT , Assiri A , Erdman DD . J Med Virol 2016 89 (3) 542-545 The spike glycoprotein of the Middle East respiratory coronavirus (MERS-CoV) facilitates receptor binding and cell entry. During investigation of a multi-facility outbreak of MERS-CoV in Taif, Saudi Arabia, we identified a mixed population of wild-type and variant sequences with a large 530 nucleotide deletion in the spike gene from the serum of one patient. The out of frame deletion predicted loss of most of the S2 subunit of the spike protein leaving the S1 subunit with an intact receptor binding domain. This finding documents human infection with a novel genetic variant of MERS-CoV present as a quasispecies. |
Quantitative Real-time PCR Assays for Detection and Type-Specific Identification of the Endemic Species C Human Adenoviruses.
Lu X , Erdman DD . J Virol Methods 2016 237 174-178 Human adenoviruses (HAdVs) are medically important respiratory pathogens. Among the 7 recognized species (A-G), species C HAdVs (serotypes 1, 2, 5 and 6) are globally endemic and infect most people early in life. Species C HAdV infections are most often subclinical or mild and can lead to persistent shedding from the gastrointestinal and upper respiratory tracts. They can also cause severe disseminated disease in newborn and immunocompromised persons, where rapid and quantitative detection and identification of the virus would help guide therapeutic intervention. To this end, we developed quantitative type-specific real-time PCR (qPCR) assays for HAdV-1, -2, -5 and -6 targeting the HAdV hexon gene. All type-specific qPCR assays reproducibly detected as few as 5 copies/reaction of quantified hexon recombinant plasmids with a linear dynamic range of 8 log units (5 to 5x107 copies). No non-specific amplifications were observed with concentrated nucleic acid from other HAdV types or other common respiratory pathogens. Of 199 previously typed HAdV field isolates and positive clinical specimens, all were detected and correctly identified to type by the qPCR assays; 10 samples had 2 HAdV types and 1 sample had 3 types identified which were confirmed by amplicon sequencing. The species C HAdV qPCR assays permit rapid, sensitive, specific and quantitative detection and identification of four recognized endemic HAdVs. Together with our previously developed qPCR assays for the epidemic respiratory HAdVs, these assays provide a convenient alternative to classical typing methods. |
Epidemiology of a Novel Recombinant MERS-CoV in Humans in Saudi Arabia.
Assiri AM , Midgley CM , Abedi GR , Bin Saeed A , Almasri MM , Lu X , Al-Abdely HM , Abdalla O , Mohammed M , Algarni HS , Alhakeem RF , Sakthivel SK , Nooh R , Alshayab Z , Alessa M , Srinivasamoorthy G , AlQahtani SY , Kheyami A , HajOmar WH , Banaser TM , Esmaeel A , Hall AJ , Curns AT , Tamin A , Alsharef AA , Erdman D , Watson JT , Gerber SI . J Infect Dis 2016 214 (5) 712-21 BACKGROUND: The Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe respiratory illness in humans. Fundamental questions about circulating viruses and transmission routes remain. METHODS: We assessed routinely collected epidemiologic data for MERS-CoV cases reported in Saudi Arabia during January 01 - June 30, 2015, and conducted a more detailed investigation of cases reported during February 2015. Available respiratory specimens were obtained for sequencing. RESULTS: During the study period, 216 MERS-CoV cases were reported. Spike gene or full genome sequences (n=17) were obtained from 99 individuals. Most (72 of 99, 73%) sequences formed a discrete, novel recombinant clade (NRC-2015), which was detected in 6 regions and became predominant by June, 2015. No clinical differences were noted between clades. Among 87 cases reported during February 2015, 13 had no recognized risks for secondary acquisition; 12 of these 13 also denied camel contact. Most viruses (8 of 9) from these 13 individuals belonged to NRC-2015. DISCUSSION: Our findings document the spread and eventual predominance of NRC-2015 in humans in Saudi Arabia during the first half of 2015. Our identification of cases without recognized risk factors but with similar virus sequences suggests that additional study is needed to better understand risk factors for MERS-CoV infection. |
Human adenovirus associated with severe respiratory infection, Oregon, USA, 2013-2014
Scott MK , Chommanard C , Lu X , Appelgate D , Grenz L , Schneider E , Gerber SI , Erdman DD , Thomas A . Emerg Infect Dis 2016 22 (6) 1044-51 Several human adenoviruses (HAdVs) can cause respiratory infections, some severe. HAdV-B7, which can cause severe respiratory disease, has not been recently reported in the United States but is reemerging in Asia. During October 2013-July 2014, Oregon health authorities identified 198 persons with respiratory symptoms and an HAdV-positive respiratory tract specimen. Among 136 (69%) hospitalized persons, 31% were admitted to the intensive care unit and 18% required mechanical ventilation; 5 patients died. Molecular typing of 109 specimens showed that most (59%) were HAdV-B7, followed by HAdVs-C1, -C2, -C5 (26%); HAdVs-B3, -B21 (15%); and HAdV-E4 (1%). Molecular analysis of 7 HAdV-B7 isolates identified the virus as genome type d, a strain previously identified only among strains circulating in Asia. Patients with HAdV-B7 were significantly more likely than those without HAdV-B7 to be adults and to have longer hospital stays. HAdV-B7 might be reemerging in the United States, and clinicians should consider HAdV in persons with severe respiratory infection. |
Use of Transportable Radiation Detection Instruments to Assess Internal Contamination From Intakes of Radionuclides Part I: Field Tests and Monte Carlo Simulations.
Anigstein R , Erdman MC , Ansari A . Health Phys 2016 110 (6) 612-22 The detonation of a radiological dispersion device or other radiological incidents could result in the dispersion of radioactive materials and intakes of radionuclides by affected individuals. Transportable radiation monitoring instruments could be used to measure photon radiation from radionuclides in the body for triaging individuals and assigning priorities to their bioassay samples for further assessments. Computer simulations and experimental measurements are required for these instruments to be used for assessing intakes of radionuclides. Count rates from calibrated sources of Co, Cs, and Am were measured on three instruments: a survey meter containing a 2.54 x 2.54-cm NaI(Tl) crystal, a thyroid probe using a 5.08 x 5.08-cm NaI(Tl) crystal, and a portal monitor incorporating two 3.81 x 7.62 x 182.9-cm polyvinyltoluene plastic scintillators. Computer models of the instruments and of the calibration sources were constructed, using engineering drawings and other data provided by the manufacturers. Count rates on the instruments were simulated using the Monte Carlo radiation transport code MCNPX. The computer simulations were within 16% of the measured count rates for all 20 measurements without using empirical radionuclide-dependent scaling factors, as reported by others. The weighted root-mean-square deviations (differences between measured and simulated count rates, added in quadrature and weighted by the variance of the difference) were 10.9% for the survey meter, 4.2% for the thyroid probe, and 0.9% for the portal monitor. These results validate earlier MCNPX models of these instruments that were used to develop calibration factors that enable these instruments to be used for assessing intakes and committed doses from several gamma-emitting radionuclides. |
Deletion variants of Middle East respiratory syndrome coronavirus from humans, Jordan, 2015
Lamers MM , Raj VS , Shafei M , Ali SS , Abdallh SM , Gazo M , Nofal S , Lu X , Erdman DD , Koopmans MP , Abdallat M , Haddadin A , Haagmans BL . Emerg Infect Dis 2016 22 (4) 716-9 We characterized Middle East respiratory syndrome coronaviruses from a hospital outbreak in Jordan in 2015. The viruses from Jordan were highly similar to isolates from Riyadh, Saudi Arabia, except for deletions in open reading frames 4a and 3. Transmissibility and pathogenicity of this strain remains to be determined. |
Multiorgan WU polyomavirus infection in bone marrow transplant recipient
Siebrasse EA , Nguyen NL , Willby MJ , Erdman DD , Menegus MA , Wang D . Emerg Infect Dis 2016 22 (1) 24-31 WU polyomavirus (WUPyV) was detected in a bone marrow transplant recipient with severe acute respiratory distress syndrome who died in 2001. Crystalline lattices of polyomavirus-like particles were observed in the patient's lung by electron microscopy. WUPyV was detected in the lung and other tissues by real-time quantitative PCR and identified in the lung and trachea by immunohistochemistry. A subset of WUPyV-positive cells in the lung had morphologic features of macrophages. Although the role of WUPyV as a human pathogen remains unclear, these results clearly demonstrate evidence for infection of respiratory tract tissues in this patient. |
Multifacility Outbreak of Middle East Respiratory Syndrome in Taif, Saudi Arabia.
Assiri A , Abedi GR , Saeed AA , Abdalla MA , Al-Masry M , Choudhry AJ , Lu X , Erdman DD , Tatti K , Binder AM , Rudd J , Tokars J , Miao C , Alarbash H , Nooh R , Pallansch M , Gerber SI , Watson JT . Emerg Infect Dis 2016 22 (1) 32-40 Middle East respiratory syndrome (MERS) coronavirus (MERS-CoV) is a novel respiratory pathogen first reported in 2012. During September 2014-January 2015, an outbreak of 38 cases of MERS was reported from 4 healthcare facilities in Taif, Saudi Arabia; 21 of the 38 case-patients died. Clinical and public health records showed that 13 patients were healthcare personnel (HCP). Fifteen patients, including 4 HCP, were associated with 1 dialysis unit. Three additional HCP in this dialysis unit had serologic evidence of MERS-CoV infection. Viral RNA was amplified from acute-phase serum specimens of 15 patients, and full spike gene-coding sequencing was obtained from 10 patients who formed a discrete cluster; sequences from specimens of 9 patients were closely related. Similar gene sequences among patients unlinked by time or location suggest unrecognized viral transmission. Circulation persisted in multiple healthcare settings over an extended period, underscoring the importance of strengthening MERS-CoV surveillance and infection-control practices. |
Identification of Source of Brucella suis Infection in Human by Using Whole-Genome Sequencing, United States and Tonga.
Quance C , Robbe-Austerman S , Stuber T , Brignole T , DeBess EE , Boyd L , LeaMaster B , Tiller R , Draper J , Humphrey S , Erdman MM . Emerg Infect Dis 2016 22 (1) 79-82 Brucella suis infection was diagnosed in a man from Tonga, Polynesia, who had butchered swine in Oregon, USA. Although the US commercial swine herd is designated brucellosis-free, exposure history suggested infection from commercial pigs. We used whole-genome sequencing to determine that the man was infected in Tonga, averting a field investigation. |
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