By December 31, 2014, the Ebola epidemic in West Africa had resulted in treatment of 10 Ebola case-patients in the United States; a maximum of 4 patients received treatment at any one time (1). Four of these 10 persons became clinically ill in the United States (2 infected outside the United States and 2 infected in the United States), and 6 were clinically ill persons medically evacuated from West Africa (Technical Appendix 1 Table 6). | To plan for possible future cases in the United States, policy makers requested we produce a tool to estimate future numbers of Ebola case-patients needing treatment at any one time in the United States. Gomes et al. previously estimated the potential size of outbreaks in the United States and other countries for 2 different dates in September 2014 (2). Another study considered the overall risk for exportation of Ebola from West Africa but did not estimate the number of potential cases in the United States at any one time (3).

Five laboratory-acquired brucellosis (LAB) cases that occurred in the United States between 2008 and 2011 are presented. The Centers for Disease Control and Prevention (CDC) reviewed the recommendations published in 2008 and the published literature to identify strategies to further prevent LAB. The improved prevention strategies are described.

Brucellosis is a bacterial zoonotic disease which has been associated with laboratory-acquired infections. No recent reviews have addressed the characteristics of laboratory-acquired brucellosis (LAB). English-language literature was reviewed to identify reports of laboratory exposures to Brucella spp. and LAB cases between 1982 and 2007. Evaluation of twenty-eight case reports identified 167 potentially exposed laboratory workers of which 71 had LAB. Nine reports were identified that summarized an additional 186 cases of LAB. Only 18 (11%) exposures were due to laboratory accidents, 147 (88%) exposures were due to aerosolization of organisms during routine identification activities and 2 (1%) exposures were unknown. Brucella melitensis was the causative agent for 80% (135/167) of the exposures. Workers with high risk exposures were 9.3 times more likely to develop LAB than workers with low risk exposures (95% CI, 3.0-38.6; P<0.0001); they were also 0.009 times as likely to develop LAB if they took antimicrobial PEP than those who did not take PEP (95% CI, 0-0.042; P<0.0001). Median incubation period in case and summary reports was eight weeks (range 1-40 weeks). Antimicrobial PEP is effective in preventing LAB. The incubation period may be used to identify appropriate serological and symptom surveillance timeframes for exposed laboratory workers.

A 25-year-old immunocompetent woman presented with a progressively worsening lesion on her left ankle. Two weeks earlier, while hiking in the local mountains of Napa Valley, CA, she first noticed an asymptomatic, black adherent crust on the lower aspect of her left leg. One week later the area developed a pruritic plaque with a central bulla. Four days before her current presentation the blister fluid was cultured and she was treated with a topical corticosteroid. After 3 days there was no improvement and her left foot began to swell. She never experienced fever, chills, or other systemic symptoms. | Her medical history was unremarkable and her only medication was an oral contraceptive. She worked at a wine consulting business and she was an avid hiker. She denied any recent travel, or contact with farm animals or other animal products. | On examination her left foot had nontender, pitting edema extending up to the mid calf. Above the left lateral malleolus was a 6-cm, erythematous, edematous, pruritic plaque with an annular bulla and central eschar (Fig 1). There was no lymphadenopathy.

Burkholderia pseudomallei is a bacterium endemic to Southeast Asia and northern Australia, but it has not been found to occur endemically in the United States. We report an ostensibly autochthonous case of melioidosis in the United States. Despite an extensive investigation, the source of exposure was not identified.

We conducted a 10-year retrospective evaluation of the epidemiology and identification of Nocardia isolates submitted to the Centers for Disease Control and Prevention for antimicrobial susceptibility testing. The species most commonly identified were N. nova (28%), N. brasiliensis (14%), and N. farcinica (14%). Of 765 isolates submitted, 61% were resistant to sulfamethoxazole and 42% were resistant to trimethoprim-sulfamethoxazole.

The seventh International Conference on Emerging Infectious Diseases (ICEID) was held in Atlanta, Georgia, USA, July 11-14, 2010. The conference goal was to bring together public health professionals to encourage exchange of scientific and public health information on global emerging infectious disease issues. The conference was organized by the Centers for Disease Control and Prevention (CDC), American Society for Microbiology, the Council of State and Territorial Epidemiologists, the Association of Public Health Laboratories, and the World Health Organization; additional support was provided by 40 other multidisciplinary public health partners.

During January to April 2007, hospital staff reported 3 patients with Rhodococcus equi bloodstream infections. Isolates were analyzed at the Centers for Disease Control and Prevention, Atlanta, GA, to confirm identification and to assess strain relatedness; 2 were R. equi but genetically distinct, and 1 was identified as Gordonia polyisoprenivorans. Rapid reference laboratory support prevented an unnecessary outbreak investigation.