Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-22 (of 22 Records) |
Query Trace: Kwit N[original query] |
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Using insurance claims data to estimate blastomycosis incidence, Vermont, USA, 2011-2020
Borah BF , Meddaugh P , Fialkowski V , Kwit N . Emerg Infect Dis 2024 30 (2) 372-375 The epidemiology of blastomycosis in Vermont, USA, is poorly understood. Using insurance claims data, we estimated the mean annual blastomycosis incidence was 1.8 patients/100,000 persons during 2011-2020. Incidence and disease severity were highest in north-central counties. Our findings highlight a need for improved clinical awareness and expanded surveillance. |
Characteristics of hard tick relapsing fever caused by borrelia miyamotoi, United States, 2013-2019
McCormick DW , Brown CM , Bjork J , Cervantes K , Esponda-Morrison B , Garrett J , Kwit N , Mathewson A , McGinnis C , Notarangelo M , Osborn R , Schiffman E , Sohail H , Schwartz AM , Hinckley AF , Kugeler KJ . Emerg Infect Dis 2023 29 (9) 1719-29 Borrelia miyamotoi, transmitted by Ixodes spp. ticks, was recognized as an agent of hard tick relapsing fever in the United States in 2013. Nine state health departments in the Northeast and Midwest have conducted public health surveillance for this emerging condition by using a shared, working surveillance case definition. During 2013-2019, a total of 300 cases were identified through surveillance; 166 (55%) were classified as confirmed and 134 (45%) as possible. Median age of case-patients was 52 years (range 1-86 years); 52% were male. Most cases (70%) occurred during June-September, with a peak in August. Fever and headache were common symptoms; 28% of case-patients reported recurring fevers, 55% had arthralgia, and 16% had a rash. Thirteen percent of patients were hospitalized, and no deaths were reported. Ongoing surveillance will improve understanding of the incidence and clinical severity of this emerging disease. |
Correctional-Facility-Outbreak-Associated COVID-19 Cases Among Asymptomatic Persons Identified Through Universal Testing: Vermont, 2020.
Pringle JC , Fritch WM , Boire Y , Meddaugh P , Prue T , Dunsmore B , Fox H , Reid H , Robinson ME , Kwit N . J Correct Health Care 2022 28 (3) 155-163 On April 6, 2020, a confirmed COVID-19 case in a correctional facility employee (Staff A) was reported to the Vermont Department of Health (VDH). Staff A worked in the facility while symptomatic, without reporting symptoms, for 10 days. VDH and the facility conducted two facility-wide testing events, implemented symptom monitoring, and initiated contact tracing. All 197 incarcerated persons and 115 (71%) staff were tested for SARS-CoV-2; 45 (23%) incarcerated persons and 17 (10%) staff had positive results (confirmed case), of whom 37 (82%) incarcerated persons and 1 (6%) staff had asymptomatic infections. Case detection enabled isolation of incarcerated persons and staff, work exclusion of staff with COVID-19, and quarantine of staff and incarcerated persons who had close contact with persons with COVID-19. Broad-based SARS-CoV-2 testing identified more cases than symptom monitoring. |
Potential quantitative effect of a laboratory-based approach to Lyme disease surveillance in high-incidence states
Kugeler KJ , Cervantes K , Brown CM , Horiuchi K , Schiffman E , Lind L , Barkley J , Broyhill J , Murphy J , Crum D , Robinson S , Kwit NA , Mullins J , Sun J , Hinckley AF . Zoonoses Public Health 2022 69 (5) 451-457 Historically, public health surveillance for Lyme disease has required clinical follow-up on positive laboratory reports for the purpose of case classification. In areas with sustained high incidence of the disease, this resource-intensive activity yields a limited benefit to public health practice. A range of burden-reducing strategies have been implemented in many states, creating inconsistencies that limit the ability to decipher trends. Laboratory-based surveillance, or surveillance based solely on positive laboratory reports without follow-up for clinical information on positive laboratory reports, emerged as a feasible alternative to improve standardization in already high-incidence areas. To inform expectations of a laboratory-based surveillance model, we conducted a retrospective analysis of Lyme disease data collected during 2012-2018 from 10 high-incidence states. The number of individuals with laboratory evidence of infection ranged from 1302 to 20,994 per state and year. On average, 55% of those were ultimately classified as confirmed or probable cases (range: 29%-86%). Among all individuals with positive laboratory evidence, 18% (range: 2%-37%) were determined to be 'not a case' upon investigation and 23% (range: 2%-52%) were classified as suspect cases due to lack of associated clinical information and thus were not reported to the Centers for Disease Control and Prevention (CDC). The number of reported cases under a laboratory-based approach to surveillance in high-incidence states using recommended two-tier testing algorithms is likely to be, on average, 1.2 times higher (range: 0.6-1.8 times) than what was reported to CDC during 2012-2018. A laboratory-based surveillance approach for high-incidence states will improve standardization and reduce burden on public health systems, allowing public health resources to focus on prevention messaging, exploration of novel prevention strategies and alternative data sources to yield information on the epidemiology of Lyme disease. |
Anaplasmosis-related fatality in Vermont: A case report
Leikauskas JA , Read JS , Kelso P , NicholsHeitman K , Armstrong PA , Kwit NA . Vector Borne Zoonotic Dis 2022 22 (3) 188-190 Human granulocytic anaplasmosis is an acute febrile tick-borne illness caused by the bacterium Anaplasma phagocytophilum. An anaplasmosis-related fatality in a Vermont resident with multiple comorbidities is described. Clinicians should be aware of the risk factors for severe outcomes of this emerging disease and promptly treat when suspected. |
COVID-19 in a Correctional Facility Employee Following Multiple Brief Exposures to Persons with COVID-19 - Vermont, July-August 2020.
Pringle JC , Leikauskas J , Ransom-Kelley S , Webster B , Santos S , Fox H , Marcoux S , Kelso P , Kwit N . MMWR Morb Mortal Wkly Rep 2020 69 (43) 1569-1570 On August 11, 2020, a confirmed case of coronavirus disease 2019 (COVID-19) in a male correctional facility employee (correctional officer) aged 20 years was reported to the Vermont Department of Health (VDH). On July 28, the correctional officer had multiple brief encounters with six incarcerated or detained persons (IDPs)* while their SARS-CoV-2 test results were pending. The six asymptomatic IDPs arrived from an out-of-state correctional facility on July 28 and were housed in a quarantine unit. In accordance with Vermont Department of Corrections (VDOC) policy for state prisons, nasopharyngeal swabs were collected from the six IDPs on their arrival date and tested for SARS-CoV-2, the virus that causes COVID-19, at the Vermont Department of Health Laboratory, using real-time reverse transcription-polymerase chain reaction (RT-PCR). On July 29, all six IDPs received positive test results. VDH and VDOC conducted a contact tracing investigation(†) and used video surveillance footage to determine that the correctional officer did not meet VDH's definition of close contact (i.e., being within 6 feet of infectious persons for ≥15 consecutive minutes)(§)(,)(¶); therefore, he continued to work. At the end of his shift on August 4, he experienced loss of smell and taste, myalgia, runny nose, cough, shortness of breath, headache, loss of appetite, and gastrointestinal symptoms; beginning August 5, he stayed home from work. An August 5 nasopharyngeal specimen tested for SARS-CoV-2 by real-time RT-PCR at a commercial laboratory was reported as positive on August 11; the correctional officer identified two contacts outside of work, neither of whom developed COVID-19. On July 28, seven days preceding his illness onset, the correctional officer had multiple brief exposures to six IDPs who later tested positive for SARS-CoV-2; available data suggests that at least one of the asymptomatic IDPs transmitted SARS-CoV-2 during these brief encounters. |
COVID-19 in Correctional and Detention Facilities - United States, February-April 2020.
Wallace M , Hagan L , Curran KG , Williams SP , Handanagic S , Bjork A , Davidson SL , Lawrence RT , McLaughlin J , Butterfield M , James AE , Patil N , Lucas K , Hutchinson J , Sosa L , Jara A , Griffin P , Simonson S , Brown CM , Smoyer S , Weinberg M , Pattee B , Howell M , Donahue M , Hesham S , Shelley E , Philips G , Selvage D , Staley EM , Lee A , Mannell M , McCotter O , Villalobos R , Bell L , Diedhiou A , Ortbahn D , Clayton JL , Sanders K , Cranford H , Barbeau B , McCombs KG , Holsinger C , Kwit NA , Pringle JC , Kariko S , Strick L , Allord M , Tillman C , Morrison A , Rowe D , Marlow M . MMWR Morb Mortal Wkly Rep 2020 69 (19) 587-590 An estimated 2.1 million U.S. adults are housed within approximately 5,000 correctional and detention facilities(dagger) on any given day (1). Many facilities face significant challenges in controlling the spread of highly infectious pathogens such as SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19). Such challenges include crowded dormitories, shared lavatories, limited medical and isolation resources, daily entry and exit of staff members and visitors, continual introduction of newly incarcerated or detained persons, and transport of incarcerated or detained persons in multiperson vehicles for court-related, medical, or security reasons (2,3). During April 22-28, 2020, aggregate data on COVID-19 cases were reported to CDC by 37 of 54 state and territorial health department jurisdictions. Thirty-two (86%) jurisdictions reported at least one laboratory-confirmed case from a total of 420 correctional and detention facilities. Among these facilities, COVID-19 was diagnosed in 4,893 incarcerated or detained persons and 2,778 facility staff members, resulting in 88 deaths in incarcerated or detained persons and 15 deaths among staff members. Prompt identification of COVID-19 cases and consistent application of prevention measures, such as symptom screening and quarantine, are critical to protecting incarcerated and detained persons and staff members. |
Francisella tularensis infection in dogs: 88 cases (2014-2016)
Kwit NA , Middaugh NA , VinHatton ES , Melman SD , Onischuk L , Aragon AS , Nelson CA , Mead PS , Ettestad PJ . J Am Vet Med Assoc 2020 256 (2) 220-225 OBJECTIVE: To characterize the epidemiology, clinical signs, and treatment of dogs with Francisella tularensis infection in New Mexico. ANIMALS: 87 dogs in which 88 cases of tularemia (1 dog had 2 distinct cases) were confirmed by the New Mexico Department of Health Scientific Laboratory Division from 2014 through 2016 and for which medical records were available. PROCEDURES: Dogs were confirmed to have tularemia if they had a 4-fold or greater increase in anti-F tularensis antibody titer between acute and convalescent serum samples or F tularensis had been isolated from a clinical or necropsy specimen. Epidemiological, clinical, and treatment information were collected from the dogs' medical records and summarized. RESULTS: All 88 cases of tularemia were confirmed by paired serologic titers; the first (acute) serologic test result was negative for 84 (95%) cases. The most common reported exposure to F tularensis was wild rodent or rabbit contact (53/88 [60%]). Dogs had a median number of 3 clinical signs at initial evaluation; lethargy (81/88 [92%]), pyrexia (80/88 [91%]), anorexia (67/88 [76%]), and lymphadenopathy (18/88 [20%]) were most common. For 32 (36%) cases, the dog was hospitalized; all hospitalized dogs survived. CONCLUSIONS AND CLINICAL RELEVANCE: Dogs with F tularensis infection often had nonspecific clinical signs and developed moderate to severe illness, sometimes requiring hospitalization. Veterinarians examining dogs from tularemia-enzootic areas should be aware of the epidemiology and clinical signs of tularemia, inquire about potential exposures, and discuss prevention methods with owners, including reducing exposure to reservoir hosts and promptly seeking care for ill animals. |
Fatal Lyme carditis in New England: Two case reports
Marx GE , Leikauskas J , Lindstrom K , Mann E , Reagan-Steiner S , Matkovic E , Read JS , Kelso P , Kwit NA , Hinckley AF , Levine MA , Brown C . Ann Intern Med 2019 172 (3) 222-224 Background: Lyme disease is the most common vector-borne disease in the United States, and it is hyperendemic in the Northeast (1). In the United States, the spirochete Borrelia burgdorferi causes Lyme disease and is transmitted by the bite of an infected black-legged tick. Carditis is a rare manifestation that can usually be treated successfully with a short course of antibiotics (2). However, it can present with many symptoms, and its severity can change rapidly and unpredictably (3). Death can occur when Lyme carditis is untreated. Before this report, only 9 fatal cases were reported in the literature (4, 5). | | Objective: To remind clinicians of the importance of early recognition and treatment of Lyme carditis. |
Francisella tularensis transmission by solid organ transplantation, 2017
Nelson CA , Murua C , Jones JM , Mohler K , Zhang Y , Wiggins L , Kwit NA , Respicio-Kingry L , Kingry LC , Petersen JM , Brown J , Aslam S , Krafft M , Asad S , Dagher HN , Ham J , Medina-Garcia LH , Burns K , Kelley WE , Hinckley AF , Annambhotla P , Carifo K , Gonzalez A , Helsel E , Iser J , Johnson M , Fritz CL , Basavaraju SV . Emerg Infect Dis 2019 25 (4) 767-775 In July 2017, fever and sepsis developed in 3 recipients of solid organs (1 heart and 2 kidneys) from a common donor in the United States; 1 of the kidney recipients died. Tularemia was suspected only after blood cultures from the surviving kidney recipient grew Francisella species. The organ donor, a middle-aged man from the southwestern United States, had been hospitalized for acute alcohol withdrawal syndrome, pneumonia, and multiorgan failure. F. tularensis subsp. tularensis (clade A2) was cultured from archived spleen tissue from the donor and blood from both kidney recipients. Whole-genome multilocus sequence typing indicated that the isolated strains were indistinguishable. The heart recipient remained seronegative with negative blood cultures but had been receiving antimicrobial drugs for a medical device infection before transplant. Two lagomorph carcasses collected near the donor's residence were positive by PCR for F. tularensis subsp. tularensis (clade A2). This investigation documents F. tularensis transmission by solid organ transplantation. |
Evaluating the risk of tick-borne relapsing fever among occupational cavers - Austin, TX, 2017
Campbell SB , Klioueva A , Taylor J , Nelson C , Tomasi S , Replogle A , Kwit N , Sexton C , Schwartz A , Hinckley A . Zoonoses Public Health 2019 66 (6) 579-586 Tick-borne relapsing fever (TBRF) is a potentially serious spirochetal infection caused by certain species of Borrelia and acquired through the bite of Ornithodoros ticks. In 2017, Austin Public Health, Austin, TX, identified five cases of febrile illness among employees who worked in caves. A cross-sectional serosurvey and interview were conducted for 44 employees at eight organizations that conduct cave-related work. Antibodies against TBRF-causing Borrelia were detected in the serum of five participants, four of whom reported recent illness. Seropositive employees entered significantly more caves (Median 25 [SD: 15] versus Median 4 [SD: 16], p = 0.04) than seronegative employees. Six caves were entered more frequently by seropositive employees posing a potentially high risk. Several of these caves were in public use areas and were opened for tours. Education of area healthcare providers about TBRF and prevention recommendations for cavers and the public are advised. |
Francisella tularensis exposure among National Park Service employees during an epizootic: Devils Tower National Monument, Wyoming, 2015
Harrist A , Cherry C , Kwit N , Bryan K , Pappert R , Petersen J , Buttke D , Wong D , Nelson C . Vector Borne Zoonotic Dis 2019 19 (5) 316-322 Introduction: Tularemia is a zoonotic infection caused by the highly infectious bacterium Francisella tularensis. Persons having outdoor professions are more likely than others to be exposed to F. tularensis through increased contact with arthropods, infected animals, and contaminated aerosols. Materials and Methods: After a tularemia epizootic during July and August 2015 at Devils Tower National Monument and an associated tularemia infection in a park employee, we assessed seroprevalence of F. tularensis antibodies, risk factors for F. tularensis seropositivity, and use of protective measures among park employees. Results: Seroprevalence among participating employees was 13% (3/23). Seropositive employees reported multiple risk factors for F. tularensis exposure through both job-related and recreational activities. Activities reported by more seropositive than seronegative employees included using a power blower (67% vs. 5%, p = 0.03), collecting animal carcasses (100% vs. 30%, p = 0.047), and hunting prairie dogs recreationally (67% vs. 5%, p = 0.03). Seropositive employees reported exposure to more ticks (median 30, range 25-35) than seronegative employees (median 6, range 0-25, p = 0.001). Most employees used protective measures (e.g., insect repellent) inconsistently but increased use after receiving educational materials. Conclusions: Educating and enabling at-risk employees to use protective measures consistently, both at work and during recreational activities, can reduce exposure during epizootics. |
Tularemia ( Francisella tularensis) in a black-tailed prairie dog ( Cynomys ludovicianus) colony
Cherry CC , Kwit NA , Ohms RE , Hammesfahr AM , Pappert R , Petersen JM , Nelson CA , Buttke DE . J Wildl Dis 2019 55 (4) 944-946 Tularemia is a bacterial zoonosis caused by Francisella tularensis. We conducted a serosurvey of black-tailed prairie dogs ( Cynomys ludovicianus) in Devils Tower National Monument, Wyoming, following an epizootic in voles ( Microtus spp.) due to F. tularensis. Only 1 of 44 (2%) sampled prairie dogs was seropositive for F. tularensis, providing evidence of survival and potentially limited spread among free-ranging prairie dogs. |
Human tularaemia associated with exposure to domestic dogs-United States, 2006-2016
Kwit NA , Schwartz A , Kugeler KJ , Mead PS , Nelson CA . Zoonoses Public Health 2018 66 (4) 417-421 Dogs have been implicated in the zoonotic transmission of numerous pathogens. Whereas cats are known to transmit Francisella tularensis to humans via bite and other routes, the role of dogs in facilitating infection is much less understood. We reviewed tularaemia case investigation records collected through national surveillance during 2006-2016 to summarize those with dog involvement, characterize the nature of dog-related exposure and describe associated clinical characteristics. Among 1,814 human tularaemia cases, 735 (41%) supplemental case investigation records were available for review; and of those, 24 (3.3%) were classified as dog-related. Median age of patients was 51 years (range: 1-82); 54% were female. Two thirds (67%) of cases presented with ulceroglandular/glandular tularaemia; pneumonic (13%) and oropharyngeal (13%) illness occurred less frequently. Dog-related exposures were classified as follows: direct contact via bite, scratch or face snuggling/licking (n = 12; 50%); direct contact with dead animals retrieved by domestic dogs (n = 8; 33%); and contact with infected ticks acquired from domestic dogs (n = 4; 17%). Prevention of dog-related tularaemia necessitates enhanced tularaemia awareness and tick avoidance among pet owners, veterinarians, health care providers and the general public. |
Notes from the field: Reference laboratory investigation of patients with clinically diagnosed Lyme disease and babesiosis - Indiana, 2016
Brown JA , Allman R , Herwaldt BL , Gray E , Rivera HN , Qvarnstrom Y , Kwit N , Schriefer ME , Hinckley A , Pontones P . MMWR Morb Mortal Wkly Rep 2018 67 (41) 1160-1161 In the midwestern United States, the principal vector for Lyme disease (Borrelia burgdorferi) and babesiosis (Babesia microti) is the Ixodes scapularis tick, which has been documented in 77 of 92 Indiana counties (Indiana State Department of Health [ISDH], unpublished data, 2018) (1). The average annual Lyme disease incidence in Indiana is low (1.3 cases per 100,000 population during 2011–2015) (2); however, rates in some northwestern counties are higher (3). A two-tiered serologic testing algorithm is recommended for diagnosing Lyme disease (4). Babesiosis is rare in Indiana, with no confirmed cases and one probable case reported during 2011–2015. Blood smear examination or polymerase chain reaction (PCR) analysis are typically recommended for the diagnosis of acute babesiosis (5). In June 2016, a physician in northwestern Indiana informed ISDH of a high prevalence of clinically diagnosed Lyme disease among his patients. He further reported that eight patients evaluated during 2015–2016 had tested positive for B. microti immunoglobulin G (IgG) or immunoglobulin M (IgM) antibodies by enzyme immunoassay (EIA) at a commercial laboratory. To further evaluate these findings, ISDH and CDC conducted a laboratory investigation using specimens from some of the patients. |
Risk factors for clinician-diagnosed Lyme arthritis, facial palsy, carditis, and meningitis in patients from high-incidence states
Kwit NA , Nelson CA , Max R , Mead PS . Open Forum Infect Dis 2018 5 (1) ofx254 Background: Clinical features of Lyme disease (LD) range from localized skin lesions to serious disseminated disease. Information on risk factors for Lyme arthritis, facial palsy, carditis, and meningitis is limited but could facilitate disease recognition and elucidate pathophysiology. Methods: Patients from high-incidence states treated for LD during 2005-2014 were identified in a nationwide insurance claims database using the International Classification of Diseases, Ninth Revision code for LD (088.81), antibiotic treatment history, and clinically compatible codiagnosis codes for LD manifestations. Results: Among 88022 unique patients diagnosed with LD, 5122 (5.8%) patients with 5333 codiagnoses were identified: 2440 (2.8%) arthritis, 1853 (2.1%) facial palsy, 534 (0.6%) carditis, and 506 (0.6%) meningitis. Patients with disseminated LD had lower median age (35 vs 42 years) and higher male proportion (61% vs 50%) than nondisseminated LD. Greatest differential risks included arthritis in males aged 10-14 years (odds ratio [OR], 3.5; 95% confidence interval [CI], 3.0-4.2), facial palsy (OR, 2.1; 95% CI, 1.6-2.7) and carditis (OR, 2.4; 95% CI, 1.6-3.6) in males aged 20-24 years, and meningitis in females aged 10-14 years (OR, 3.4; 95% CI, 2.1-5.5) compared to the 55-59 year referent age group. Males aged 15-29 years had the highest risk for complete heart block, a potentially fatal condition. Conclusions: The risk and manifestations of disseminated LD vary by age and sex. Provider education regarding at-risk populations and additional investigations into pathophysiology could enhance early case recognition and improve patient management. |
Notes from the field: High volume of Lyme disease laboratory reporting in a low-incidence state - Arkansas, 2015-2016
Kwit NA , Dietrich EA , Nelson C , Taffner R , Petersen J , Schriefer M , Mead P , Weinstein S , Haselow D . MMWR Morb Mortal Wkly Rep 2017 66 (42) 1156-1157 Although Arkansas lies within the geographic range of the principal Lyme disease tick vector, Ixodes scapularis, because of ecologic and entomologic factors, the risk for human infection is low, and no confirmed Lyme disease cases were reported in Arkansas during 2008–2014 (1). However, during 2015–2016, the Arkansas Department of Health (ADH) received several hundred potentially positive serologic laboratory reports for Lyme disease. Recommended serologic testing for Lyme disease is a two-tiered process; only if the first-tier enzyme immunoassay is positive or equivocal should the second-tier western blot be performed. A positive overall result can only be concluded when results of both individual tests are documented (2). Laboratory reports submitted to ADH during 2015–2016 did not always include complete or overall positive two-tiered serology results or associated clinical information needed to make a case determination. To facilitate Lyme disease surveillance in the setting of a high volume of reports and to ascertain whether local transmission of Lyme disease has occurred, ADH and CDC reviewed laboratory reports and clinical data, classified cases according to the surveillance definition, and investigated cases with potential for confirmation of Lyme disease. |
Notes from the Field: Fatal pneumonic tularemia associated with dog exposure - Arizona, June 2016
Yaglom H , Rodriguez E , Gaither M , Schumacher M , Kwit N , Nelson C , Terriquez J , Vinocur J , Birdsell D , Wagner DM , Petersen J , Kugeler K . MMWR Morb Mortal Wkly Rep 2017 66 (33) 891 On June 15, 2016, Arizona public health officials were notified of a presumptive positive Francisella tularensis blood culture result from a woman aged 73 years with pulmonary sarcoidosis who had recently died from respiratory failure. She had been taking amoxicillin for a dental infection. She was evaluated on June 6 for 4 days of fever, myalgia, anorexia, and diarrhea. Because of suspected colitis she was advised to discontinue amoxicillin; she declined hospital admission. Two days later, she was hospitalized for shortness of breath and confusion. Chest radiography revealed a right lower lobe pneumonia and an effusion. This was treated with cefepime and intravenous doxycycline. On June 8, her stool tested positive for Clostridium difficile toxin A/B by polymerase chain reaction, requiring treatment with metronidazole and vancomycin. Her condition deteriorated, and she died on June 11. Tularemia was not suspected as cause of illness until June 17 when a blood culture collected on June 6 was confirmed as F. tularensis, a Tier 1 select agent; no laboratory exposures occurred. | The patient lived in a semirural area of northern Arizona, did not engage in outdoor activities, and had no known history of insect bites, exposure to animal carcasses or untreated water. She traveled to Hawaii May 16–26, returning approximately 11 days before illness onset. Postmortem exam revealed no bites, abscesses, or lymphadenopathy. |
Male-to-Male Sexual Transmission of Zika Virus - Texas, January 2016
Deckard DT , Chung WM , Brooks JT , Smith JC , Woldai S , Hennessey M , Kwit N , Mead P . MMWR Morb Mortal Wkly Rep 2016 65 (14) 372-4 Zika virus infection has been linked to increased risk for Guillain-Barre syndrome and adverse fetal outcomes, including congenital microcephaly. In January 2016, after notification from a local health care provider, an investigation by Dallas County Health and Human Services (DCHHS) identified a case of sexual transmission of Zika virus between a man with recent travel to an area of active Zika virus transmission (patient A) and his nontraveling male partner (patient B). At this time, there had been one prior case report of sexual transmission of Zika virus (1). The present case report indicates Zika virus can be transmitted through anal sex, as well as vaginal sex. Identification and investigation of cases of sexual transmission of Zika virus in nonendemic areas present valuable opportunities to inform recommendations to prevent sexual transmission of Zika virus. |
Travel-associated Zika virus disease cases among U.S. residents - United States, January 2015-February 2016
Armstrong P , Hennessey M , Adams M , Cherry C , Chiu S , Harrist A , Kwit N , Lewis L , McGuire DO , Oduyebo T , Russell K , Talley P , Tanner M , Williams C , Basile J , Brandvold J , Calvert A , Cohn A , Fischer M , Goldman-Israelow B , Goodenough D , Goodman C , Hills S , Kosoy O , Lambert A , Lanciotti R , Laven J , Ledermann J , Lehman J , Lindsey N , Mead P , Mossel E , Nelson C , Nichols M , O'Leary D , Panella A , Powers A , Rabe I , Reagan-Steiner S , Staples JE , Velez J . MMWR Morb Mortal Wkly Rep 2016 65 (11) 286-9 Zika virus is an emerging mosquito-borne flavivirus. Recent outbreaks of Zika virus disease in the Pacific Islands and the Region of the Americas have identified new modes of transmission and clinical manifestations, including adverse pregnancy outcomes. However, data on the epidemiology and clinical findings of laboratory-confirmed Zika virus disease remain limited. During January 1, 2015-February 26, 2016, a total of 116 residents of 33 U.S. states and the District of Columbia had laboratory evidence of recent Zika virus infection based on testing performed at CDC. Cases include one congenital infection and 115 persons who reported recent travel to areas with active Zika virus transmission (n = 110) or sexual contact with such a traveler (n = 5). All 115 patients had clinical illness, with the most common signs and symptoms being rash (98%; n = 113), fever (82%; 94), and arthralgia (66%; 76). Health care providers should educate patients, particularly pregnant women, about the risks for, and measures to prevent, infection with Zika virus and other mosquito-borne viruses. Zika virus disease should be considered in patients with acute onset of fever, rash, arthralgia, or conjunctivitis, who traveled to areas with ongoing Zika virus transmission (http://www.cdc.gov/zika/geo/index.html) or who had unprotected sex with a person who traveled to one of those areas and developed compatible symptoms within 2 weeks of returning. |
Zika virus infection among U.S. pregnant travelers - August 2015-February 2016
Meaney-Delman D , Hills SL , Williams C , Galang RR , Iyengar P , Hennenfent AK , Rabe IB , Panella A , Oduyebo T , Honein MA , Zaki S , Lindsey N , Lehman JA , Kwit N , Bertolli J , Ellington S , Igbinosa I , Minta AA , Petersen EE , Mead P , Rasmussen SA , Jamieson DJ . MMWR Morb Mortal Wkly Rep 2016 65 (8) 211-4 After reports of microcephaly and other adverse pregnancy outcomes in infants of mothers infected with Zika virus during pregnancy, CDC issued a travel alert on January 15, 2016, advising pregnant women to consider postponing travel to areas with active transmission of Zika virus. On January 19, CDC released interim guidelines for U.S. health care providers caring for pregnant women with travel to an affected area (1), and an update was released on February 5 (2). As of February 17, CDC had received reports of nine pregnant travelers with laboratory-confirmed Zika virus disease; 10 additional reports of Zika virus disease among pregnant women are currently under investigation. No Zika virus-related hospitalizations or deaths among pregnant women were reported. Pregnancy outcomes among the nine confirmed cases included two early pregnancy losses, two elective terminations, and three live births (two apparently healthy infants and one infant with severe microcephaly); two pregnancies (approximately 18 weeks' and 34 weeks' gestation) are continuing without known complications. Confirmed cases of Zika virus infection were reported among women who had traveled to one or more of the following nine areas with ongoing local transmission of Zika virus: American Samoa, Brazil, El Salvador, Guatemala, Haiti, Honduras, Mexico, Puerto Rico, and Samoa. This report summarizes findings from the nine women with confirmed Zika virus infection during pregnancy, including case reports for four women with various clinical outcomes. U.S. health care providers caring for pregnant women with possible Zika virus exposure during pregnancy should follow CDC guidelines for patient evaluation and management (1,2). Zika virus disease is a nationally notifiable condition. CDC has developed a voluntary registry to collect information about U.S. pregnant women with confirmed Zika virus infection and their infants. Information about the registry is in preparation and will be available on the CDC website. |
Human plague - United States, 2015
Kwit N , Nelson C , Kugeler K , Petersen J , Plante L , Yaglom H , Kramer V , Schwartz B , House J , Colton L , Feldpausch A , Drenzek C , Baumbach J , DiMenna M , Fisher E , Debess E , Buttke D , Weinburke M , Percy C , Schriefer M , Gage K , Mead P . MMWR Morb Mortal Wkly Rep 2015 64 (33) 918-919 Since April 1, 2015, a total of 11 cases of human plague have been reported in residents of six states: Arizona (two), California (one), Colorado (four), Georgia (one), New Mexico (two), and Oregon (one). The two cases in Georgia and California residents have been linked to exposures at or near Yosemite National Park in the southern Sierra Nevada Mountains of California. Nine of the 11 patients were male; median age was 52 years (range = 14-79 years). Three patients aged 16, 52, and 79 years died. |
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