Fatal Oropouche Virus Infections in Nonendemic Region, Brazil, 2024

# Articles from *Emerging Infectious Diseases*

#### Volume 30, Number 10—October 2024

        [PDF - 9.97 MB - 246 pages]    

Last Issue - Volume 30, Number 9—September 2024                    Podcasts                

            -                      Synopses                 
            -                      Research                 
            -                      Dispatches                 
            -                      Research Letters                 
            -                      EIN Research Letter                 
            -                      Etymologia                 
            -                      Corrections                 
            -                      About the Cover                 

##### Synopses

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Medscape CME Activity
***Pasteurella* Infections in South Korea and Systematic Review and Meta-analysis of *Pasteurella* Bacteremia**        [PDF - 1.56 MB - 11 pages]    
S. Jeong et al.

*Pasteurella* spp. can cause fatal zoonotic infections in humans. We performed a multicenter study to investigate the prevalence and clinical features of *Pasteurella* infections in South Korea during 2018‒2022. We also conducted a collaborative systematic review and meta-analysis of the global burden of *Pasteurella* bacteremia. The study included 283 cases found an increasing trend in *Pasteurella* infections. Blood cultures were positive in 8/35 (22.9%) cases sampled, for overall bacteremia-associated rate of 2.8% (8/283). Aging was a significant risk factor for bacteremia (odds ratio 1.05 [95% CI 1.01–1.10]), according to multivariate analyses. For the meta-analysis, we included a total of 2,012 cases from 10 studies. The pooled prevalence of bacteremia was 12.4% (95% CI 7.3%–18.6%) and of mortality 8.4% (95% CI 2.7%–16.5%). Our findings reflect the need for greater understanding of the increase in *Pasteurella* infections and the global burden of *Pasteurella* bacteremia to determine appropriate case management.

| EID                                                                                                                                                                                                                                                                               | Jeong S, Chang E, Lee N, Kim H, Kim H, Kim J, et al. Pasteurella Infections in South Korea and Systematic Review and Meta-analysis of Pasteurella Bacteremia. Emerg Infect Dis. 2024;30(10):1987-1997. https://doi.org/10.3201/eid3010.240245 |
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| Jeong S, Chang E, Lee N, et al. Pasteurella Infections in South Korea and Systematic Review and Meta-analysis of Pasteurella Bacteremia. *Emerging Infectious Diseases*. 2024;30(10):1987-1997. doi:10.3201/eid3010.240245.                                                       |
| Jeong, S., Chang, E., Lee, N., Kim, H., Kim, H., Kim, J....Song, W. (2024). Pasteurella Infections in South Korea and Systematic Review and Meta-analysis of Pasteurella Bacteremia. *Emerging Infectious Diseases*, *30*(10), 1987-1997. https://doi.org/10.3201/eid3010.240245. |

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**Campylobacteriosis Outbreak Linked to Municipal Water, Nebraska, USA, 2021**        [PDF - 744 KB - 8 pages]    
L. Jansen et al.

In September 2021, eight campylobacteriosis cases were identified in a town in Nebraska, USA. We assessed potential exposures for a case–control analysis. We conducted whole-genome sequencing on *Campylobacter* isolates from patients’ stool specimens. We collected large-volume dead-end ultrafiltration water samples for *Campylobacter* and microbial source tracking testing at the Centers for Disease Control and Prevention. We identified 64 cases in 2 waves of illnesses. Untreated municipal tap water consumption was strongly associated with illness (wave 1 odds ratio 15.36; wave 2 odds ratio 16.11). Whole-genome sequencing of 12 isolates identified 2 distinct *Campylobacter jejuni* subtypes (1 subtype/wave). The town began water chlorination, after which water testing detected coliforms. One dead-end ultrafiltration sample yielded nonculturable *Campylobacter* and avian-specific fecal rRNA genomic material. Our investigation implicated contaminated, untreated, municipal water as the source. Results of microbial source tracking supported mitigation with continued water chlorination. No further campylobacteriosis cases attributable to water were reported.

| EID                                                                                                                                                                                                                                                               | Jansen L, Birn R, Koirala S, Oppegard S, Loeck B, Hamik J, et al. Campylobacteriosis Outbreak Linked to Municipal Water, Nebraska, USA, 2021. Emerg Infect Dis. 2024;30(10):1998-2005. https://doi.org/10.3201/eid3010.231509 |
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| Jansen L, Birn R, Koirala S, et al. Campylobacteriosis Outbreak Linked to Municipal Water, Nebraska, USA, 2021. *Emerging Infectious Diseases*. 2024;30(10):1998-2005. doi:10.3201/eid3010.231509.                                                                |
| Jansen, L., Birn, R., Koirala, S., Oppegard, S., Loeck, B., Hamik, J....Buss, B. (2024). Campylobacteriosis Outbreak Linked to Municipal Water, Nebraska, USA, 2021. *Emerging Infectious Diseases*, *30*(10), 1998-2005. https://doi.org/10.3201/eid3010.231509. |

##### Research

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Medscape CME Activity
**Age- and Sex-Specific Differences in Lyme Disease Health-Related Behaviors, Ontario, Canada, 2015–2022**        [PDF - 1.05 MB - 10 pages]    
J. A. Adams et al.

We investigated differences in risk factors and preventive behaviors by age and sex among persons with reported Lyme disease in Ontario, Canada, during 2015–2022. Incidence rates peaked among children 5–9 and adults 50–79 years of age. Median age was higher for female than male case-patients (54 vs. 51 years). Male case-patients reported more activity in wooded and tall grass areas than did female case-patients; fewer male case-patients reported sharing living space with outdoor-exposed companion animals. As age increased, more case-patients reported activity in blacklegged tick habitats, exposure to ticks, and wearing adequate clothing, but fewer reported sharing living space with outdoor-exposed companion animals. Adoption of preventive behaviors was relatively low and did not differ by sex. Male case-patients, children 5–9 years of age and their parents or caregivers, and adults >59 years of age represent populations that would benefit from tailored public health messaging on Lyme disease prevention. 

| EID                                                                                                                                                                                                                                                                                                              | Adams JA, Osasah V, Paphitis K, Danish A, Mather RG, Russell CA, et al. Age- and Sex-Specific Differences in Lyme Disease Health-Related Behaviors, Ontario, Canada, 2015–2022. Emerg Infect Dis. 2024;30(10):2006-2015. https://doi.org/10.3201/eid3010.240191   |
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| Adams JA, Osasah V, Paphitis K, et al. Age- and Sex-Specific Differences in Lyme Disease Health-Related Behaviors, Ontario, Canada, 2015–2022. *Emerging Infectious Diseases*. 2024;30(10):2006-2015. doi:10.3201/eid3010.240191.                                                                                |
| Adams, J. A., Osasah, V., Paphitis, K., Danish, A., Mather, R. G., Russell, C. A....Nelder, M. P. (2024). Age- and Sex-Specific Differences in Lyme Disease Health-Related Behaviors, Ontario, Canada, 2015–2022. *Emerging Infectious Diseases*, *30*(10), 2006-2015. https://doi.org/10.3201/eid3010.240191.   |

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**Associations between Minority Health Social Vulnerability Index Scores, Rurality, and Histoplasmosis Incidence, 8 US States**        [PDF - 1.70 MB - 9 pages]    
D. J. Smith et al.

To explore associations between histoplasmosis and race and ethnicity, socioeconomic status, and rurality, we conducted an in-depth analysis of social determinants of health and histoplasmosis in 8 US states. Using the Minority Health Social Vulnerability Index (MH SVI), we analyzed county-level histoplasmosis incidence (cases/100,000 population) from the 8 states by applying generalized linear mixed hurdle models. We found that histoplasmosis incidence was higher in counties with limited healthcare infrastructure and access as measured by the MH SVI and in more rural counties. Other social determinants of health measured by the MH SVI tool either were not significantly or were inconsistently associated with histoplasmosis incidence. Increased awareness of histoplasmosis, more accessible diagnostic tests, and investment in rural health services could address histoplasmosis-related health disparities.

| EID                                                                                                                                                                                                                                                                                                                         | Smith DJ, Rajeev M, Boyd K, Benedict K, Hennessee I, Rothfeldt L, et al. Associations between Minority Health Social Vulnerability Index Scores, Rurality, and Histoplasmosis Incidence, 8 US States. Emerg Infect Dis. 2024;30(10):2016-2024. https://doi.org/10.3201/eid3010.231700 |
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| Smith DJ, Rajeev M, Boyd K, et al. Associations between Minority Health Social Vulnerability Index Scores, Rurality, and Histoplasmosis Incidence, 8 US States. *Emerging Infectious Diseases*. 2024;30(10):2016-2024. doi:10.3201/eid3010.231700.                                                                          |
| Smith, D. J., Rajeev, M., Boyd, K., Benedict, K., Hennessee, I., Rothfeldt, L....Toda, M. (2024). Associations between Minority Health Social Vulnerability Index Scores, Rurality, and Histoplasmosis Incidence, 8 US States. *Emerging Infectious Diseases*, *30*(10), 2016-2024. https://doi.org/10.3201/eid3010.231700. |

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**One Health Investigation into Mpox and Pets, United States**        [PDF - 385 KB - 8 pages]    
C. N. Morgan et al.

Monkeypox virus (MPXV) is zoonotic and capable of infecting many mammal species. However, whether common companion animals are susceptible to MPXV infection is unclear. During July 2022–March 2023, we collected animal and environmental swab samples within homes of confirmed human mpox case-patients and tested for MPXV and human DNA by PCR. We also used ELISA for orthopoxvirus antibody detection. Overall, 12% (22/191) of animal and 25% (14/56) of environmental swab samples from 4 households, including samples from 4 dogs and 1 cat, were positive for MPXV DNA, but we did not detect viable MPXV or orthopoxvirus antibodies. Among MPXV PCR-positive swab samples, 82% from animals and 93% from environment amplified human DNA with a statistically significant correlation in observed cycle threshold values. Our findings demonstrate likely DNA contamination from the human mpox cases. Despite the high likelihood for exposure, we found no indications that companion animals were infected with MPXV.

| EID                                                                                                                                                                                                                                                         | Morgan CN, Wendling NM, Baird N, Kling C, Lopez L, Navarra T, et al. One Health Investigation into Mpox and Pets, United States. Emerg Infect Dis. 2024;30(10):2025-2032. https://doi.org/10.3201/eid3010.240632 |
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| Morgan CN, Wendling NM, Baird N, et al. One Health Investigation into Mpox and Pets, United States. *Emerging Infectious Diseases*. 2024;30(10):2025-2032. doi:10.3201/eid3010.240632.                                                                      |
| Morgan, C. N., Wendling, N. M., Baird, N., Kling, C., Lopez, L., Navarra, T....Doty, J. B. (2024). One Health Investigation into Mpox and Pets, United States. *Emerging Infectious Diseases*, *30*(10), 2025-2032. https://doi.org/10.3201/eid3010.240632. |

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**Pathogenicity of Highly Pathogenic Avian Influenza A(H5N1) Viruses Isolated from Cats in Mice and Ferrets, South Korea, 2023**        [PDF - 1.26 MB - 9 pages]    
I. Kim et al.

The prevalence of highly pathogenic avian influenza (HPAI) A(H5N1) viruses has increased in wild birds and poultry worldwide, and concomitant outbreaks in mammals have occurred. During 2023, outbreaks of HPAI H5N1 virus infections were reported in cats in South Korea. The H5N1 clade 2.3.4.4b viruses isolated from 2 cats harbored mutations in the polymerase basic protein 2 gene encoding single amino acid substitutions E627K or D701N, which are associated with virus adaptation in mammals. Hence, we analyzed the pathogenicity and transmission of the cat-derived H5N1 viruses in other mammals. Both isolates caused fatal infections in mice and ferrets. We observed contact infections between ferrets, confirming the viruses had high pathogenicity and transmission in mammals. Most HPAI H5N1 virus infections in humans have occurred through direct contact with poultry or a contaminated environment. Therefore, One Health surveillance of mammals, wild birds, and poultry is needed to prevent potential zoonotic threats.

| EID                                                                                                                                                                                                                                                                                               | Kim I, Nam J, Kim C, Choi Y, Lee H, An B, et al. Pathogenicity of Highly Pathogenic Avian Influenza A(H5N1) Viruses Isolated from Cats in Mice and Ferrets, South Korea, 2023. Emerg Infect Dis. 2024;30(10):2033-2041. https://doi.org/10.3201/eid3010.240583 |
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| Kim I, Nam J, Kim C, et al. Pathogenicity of Highly Pathogenic Avian Influenza A(H5N1) Viruses Isolated from Cats in Mice and Ferrets, South Korea, 2023. *Emerging Infectious Diseases*. 2024;30(10):2033-2041. doi:10.3201/eid3010.240583.                                                      |
| Kim, I., Nam, J., Kim, C., Choi, Y., Lee, H., An, B....Kim, E. (2024). Pathogenicity of Highly Pathogenic Avian Influenza A(H5N1) Viruses Isolated from Cats in Mice and Ferrets, South Korea, 2023. *Emerging Infectious Diseases*, *30*(10), 2033-2041. https://doi.org/10.3201/eid3010.240583. |

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**Epidemiologic Quantities for Monkeypox Virus Clade I from Historical Data with Implications for Current Outbreaks, Democratic Republic of the Congo**        [PDF - 893 KB - 5 pages]    
V. Marziano et al.

We used published data from outbreak investigations of monkeypox virus clade I in the Democratic Republic of the Congo to estimate the distributions of critical epidemiological parameters. We estimated a mean incubation period of 9.9 days (95% credible interval [CrI] 8.5–11.5 days) and a mean generation time of 17.2 days (95% CrI 14.1–20.9 days) or 11.3 days (95% CrI 9.4–14.0 days), depending on the considered dataset. Presymptomatic transmission was limited. Those estimates suggest generally slower transmission dynamics in clade I than in clade IIb. The time-varying reproduction number for clade I in the Democratic Republic of the Congo was estimated to be below the epidemic threshold in the first half of 2024. However, in the South Kivu Province, where the newly identified subclade Ib has been associated with sustained human-to-human transmission, we estimated an effective reproduction number above the epidemic threshold (95% CrI 0.96–1.27).

| EID                                                                                                                                                                                                                                                                                                             | Marziano V, Guzzetta G, Longini I, Merler S. Epidemiologic Quantities for Monkeypox Virus Clade I from Historical Data with Implications for Current Outbreaks, Democratic Republic of the Congo. Emerg Infect Dis. 2024;30(10):2042-2046. https://doi.org/10.3201/eid3010.240665 |
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| Marziano V, Guzzetta G, Longini I, et al. Epidemiologic Quantities for Monkeypox Virus Clade I from Historical Data with Implications for Current Outbreaks, Democratic Republic of the Congo. *Emerging Infectious Diseases*. 2024;30(10):2042-2046. doi:10.3201/eid3010.240665.                               |
| Marziano, V., Guzzetta, G., Longini, I., & Merler, S. (2024). Epidemiologic Quantities for Monkeypox Virus Clade I from Historical Data with Implications for Current Outbreaks, Democratic Republic of the Congo. *Emerging Infectious Diseases*, *30*(10), 2042-2046. https://doi.org/10.3201/eid3010.240665. |

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**Rapid Increase in Seroprevalence of *Borrelia burgdorferi* Antibodies among Dogs, Northwestern North Carolina, USA, 2017–2021**        [PDF - 1.08 MB - 9 pages]    
P. K. Pretsch et al.

We evaluated spatial-temporal risk for Lyme disease in northwestern North Carolina, USA, by using individual-level canine *Borrelia burgdorferi* seroprevalence data collected during 2017–2021 at routine veterinary screenings for tickborne diseases. Seroprevalence in dogs increased from 2.2% (47/2,130) in 2017 to 11.2% (339/3,033) in 2021. The percentage of incident seropositivity increased from 2.1% (45/2,130) in 2017 to 7.6% (231/3,033) in 2021. Exploratory geographic analyses found canine seroprevalence shifted from clustered (2017, Moran’s *I* = 0.30) to dispersed (2021, Moran’s *I* = −0.20). Elevation, slope, aspect, and forest land cover density were associated with canine seroprevalence within various household buffer regions in 2017. Slope was associated with seroprevalence at the household level in 2021. Results support the use of individual-level canine seroprevalence data for monitoring human risk for Lyme disease. Establishing sentinel veterinary clinics within Lyme disease–emergent communities might promote prevention and control efforts and provide opportunities for educational and behavioral interventions.

| EID                                                                                                                                                                                                                                                                                                                                                 | Pretsch PK, Tyrlik-Olk K, Sandborn H, Giandomenico DA, Barbarin AM, Williams C, et al. Rapid Increase in Seroprevalence of Borrelia burgdorferi Antibodies among Dogs, Northwestern North Carolina, USA, 2017–2021. Emerg Infect Dis. 2024;30(10):2047-2055. https://doi.org/10.3201/eid3010.240526   |
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| Pretsch PK, Tyrlik-Olk K, Sandborn H, et al. Rapid Increase in Seroprevalence of Borrelia burgdorferi Antibodies among Dogs, Northwestern North Carolina, USA, 2017–2021. *Emerging Infectious Diseases*. 2024;30(10):2047-2055. doi:10.3201/eid3010.240526.                                                                                        |
| Pretsch, P. K., Tyrlik-Olk, K., Sandborn, H., Giandomenico, D. A., Barbarin, A. M., Williams, C....Boyce, R. M. (2024). Rapid Increase in Seroprevalence of Borrelia burgdorferi Antibodies among Dogs, Northwestern North Carolina, USA, 2017–2021. *Emerging Infectious Diseases*, *30*(10), 2047-2055. https://doi.org/10.3201/eid3010.240526.   |

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**Virulence of *Burkholderia pseudomallei* ATS2021 Unintentionally Imported to United States in Aromatherapy Spray**        [PDF - 8.22 MB - 14 pages]    
C. K. Cote et al.

In the United States in 2021, an outbreak of 4 cases of *Burkholderia pseudomallei*, the etiologic agent of melioidosis and a Tier One Select Agent (potential for deliberate misuse and subsequent harm), resulted in 2 deaths. The causative strain, *B. pseudomallei* ATS2021, was unintentionally imported into the United States in an aromatherapy spray manufactured in India. We established that ATS2021 represents a virulent strain of *B. pseudomallei* capable of robust formation of biofilm at physiologic temperatures that may contribute to virulence. By using mouse melioidosis models, we determined median lethal dose estimates and analyzed the bacteriologic and histopathologic characteristics of the organism, particularly the potential neurologic pathogenesis that is probably associated with the *bimABm* allele identified in *B. pseudomallei* strain ATS2021. Our data, combined with previous case reports and the identification of endemic *B. pseudomallei*strains in Mississippi, support the concept that melioidosis is emerging in the United States.

| EID                                                                                                                                                                                                                                                                                                                 | Cote CK, Mlynek KD, Klimko CP, Biryukov SS, Mou S, Hunter M, et al. Virulence of Burkholderia pseudomallei ATS2021 Unintentionally Imported to United States in Aromatherapy Spray. Emerg Infect Dis. 2024;30(10):2056-2069. https://doi.org/10.3201/eid3010.240084 |
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| Cote CK, Mlynek KD, Klimko CP, et al. Virulence of Burkholderia pseudomallei ATS2021 Unintentionally Imported to United States in Aromatherapy Spray. *Emerging Infectious Diseases*. 2024;30(10):2056-2069. doi:10.3201/eid3010.240084.                                                                            |
| Cote, C. K., Mlynek, K. D., Klimko, C. P., Biryukov, S. S., Mou, S., Hunter, M....DeShazer, D. (2024). Virulence of Burkholderia pseudomallei ATS2021 Unintentionally Imported to United States in Aromatherapy Spray. *Emerging Infectious Diseases*, *30*(10), 2056-2069. https://doi.org/10.3201/eid3010.240084. |

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**Economic Analysis of National Program for Hepatitis C Elimination, Israel, 2023**        [PDF - 1.33 MB - 9 pages]    
Y. Dadon et al.

In 2021, the Israel Ministry of Health began a national hepatitis C elimination program. Implementing a World Health Organization goal, Israel’s program involved targeted screening, barrier minimization, workup simplification, awareness campaigns, and a patient registry. We evaluated program costs for testing and treatment. By May 15, 2023, the program had identified 865,382 at-risk persons, of whom 555,083 (64.3%) were serologically screened for hepatitis C virus (HCV), which was detected in 24,361 (4.4%). Among 20,928 serologically positive patients, viremia was detected in 13,379 (63.9%), of whom 10,711 (80%) were treated, and 4,618 (96.5%) of 4,786 persons receiving posttreatment HCV RNA testing had sustained virologic response. We estimated costs of ₪14,426 (new Israel shekel; ≈$3,606 USD) per person whose HCV infection was diagnosed and successfully treated. The program yielded screening and treatment in almost two thirds of the identified at-risk population. Although not eliminated, HCV prevalence will likely decrease substantially by the 2030 target.

| EID                                                                                                                                                                                                                                                                     | Dadon Y, Mimouni FB, Toren A, Morgenstern T, Barak L, Mendlovic J. Economic Analysis of National Program for Hepatitis C Elimination, Israel, 2023. Emerg Infect Dis. 2024;30(10):2070-2078. https://doi.org/10.3201/eid3010.240210 |
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| Dadon Y, Mimouni FB, Toren A, et al. Economic Analysis of National Program for Hepatitis C Elimination, Israel, 2023. *Emerging Infectious Diseases*. 2024;30(10):2070-2078. doi:10.3201/eid3010.240210.                                                                |
| Dadon, Y., Mimouni, F. B., Toren, A., Morgenstern, T., Barak, L., & Mendlovic, J. (2024). Economic Analysis of National Program for Hepatitis C Elimination, Israel, 2023. *Emerging Infectious Diseases*, *30*(10), 2070-2078. https://doi.org/10.3201/eid3010.240210. |

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**Population Structure and Antimicrobial Resistance in *Campylobacter jejuni* and *C. coli* Isolated from Humans with Diarrhea and from Poultry, East Africa**        [PDF - 2.73 MB - 11 pages]    
N. P. French et al.

Campylobacteriosis and antimicrobial resistance (AMR) are global public health concerns. Africa is estimated to have the world’s highest incidence of campylobacteriosis and a relatively high prevalence of AMR in *Campylobacter* spp. from humans and animals. Few studies have compared *Campylobacter* spp. isolated from humans and poultry in Africa using whole-genome sequencing and antimicrobial susceptibility testing. We explored the population structure and AMR of 178 *Campylobacter* isolates from East Africa, 81 from patients with diarrhea in Kenya and 97 from 56 poultry samples in Tanzania, collected during 2006–2017. Sequence type diversity was high in both poultry and human isolates, with some sequence types in common. The estimated prevalence of multidrug resistance, defined as resistance to >3 antimicrobial classes, was higher in poultry isolates (40.9%, 95% credible interval 23.6%–59.4%) than in human isolates (2.5%, 95% credible interval 0.3%–6.8%), underlining the importance of antimicrobial stewardship in livestock systems.

| EID                                                                                                                                                                                                                                                                                                                                                                  | French NP, Thomas KM, Amani NB, Benschop J, Bigogo GM, Cleaveland S, et al. Population Structure and Antimicrobial Resistance in Campylobacter jejuni and C. coli Isolated from Humans with Diarrhea and from Poultry, East Africa. Emerg Infect Dis. 2024;30(10):2079-2089. https://doi.org/10.3201/eid3010.231399 |
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| French NP, Thomas KM, Amani NB, et al. Population Structure and Antimicrobial Resistance in Campylobacter jejuni and C. coli Isolated from Humans with Diarrhea and from Poultry, East Africa. *Emerging Infectious Diseases*. 2024;30(10):2079-2089. doi:10.3201/eid3010.231399.                                                                                    |
| French, N. P., Thomas, K. M., Amani, N. B., Benschop, J., Bigogo, G. M., Cleaveland, S....Zadoks, R. N. (2024). Population Structure and Antimicrobial Resistance in Campylobacter jejuni and C. coli Isolated from Humans with Diarrhea and from Poultry, East Africa. *Emerging Infectious Diseases*, *30*(10), 2079-2089. https://doi.org/10.3201/eid3010.231399. |

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**Evidence of Lineage 1 and 3 West Nile Virus in Person with Neuroinvasive Disease, Nebraska, USA, 2023**        [PDF - 1.10 MB - 9 pages]    
E. Davis et al.

West Nile virus (WNV) is the most common cause of human arboviral disease in the contiguous United States, where only lineage 1 (L1) WNV had been found. In 2023, an immunocompetent patient was hospitalized in Nebraska with West Nile neuroinvasive disease and multisystem organ failure. Testing at the Centers for Disease Control and Prevention indicated an unusually high viral load and acute antibody response. Upon sequencing of serum and cerebrospinal fluid, we detected lineage 3 (L3) and L1 WNV genomes. L3 WNV had previously only been found in Central Europe in mosquitoes. The identification of L3 WNV in the United States and the observed clinical and laboratory features raise questions about the potential effect of L3 WNV on the transmission dynamics and pathogenicity of WNV infections. Determining the distribution and prevalence of L3 WNV in the United States and any public health and clinical implications is critical.

| EID                                                                                                                                                                                                                                                                                                    | Davis E, Velez J, Hamik J, Fitzpatrick K, Haley J, Eschliman J, et al. Evidence of Lineage 1 and 3 West Nile Virus in Person with Neuroinvasive Disease, Nebraska, USA, 2023. Emerg Infect Dis. 2024;30(10):2090-2098. https://doi.org/10.3201/eid3010.240595 |
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| Davis E, Velez J, Hamik J, et al. Evidence of Lineage 1 and 3 West Nile Virus in Person with Neuroinvasive Disease, Nebraska, USA, 2023. *Emerging Infectious Diseases*. 2024;30(10):2090-2098. doi:10.3201/eid3010.240595.                                                                            |
| Davis, E., Velez, J., Hamik, J., Fitzpatrick, K., Haley, J., Eschliman, J....Hughes, H. R. (2024). Evidence of Lineage 1 and 3 West Nile Virus in Person with Neuroinvasive Disease, Nebraska, USA, 2023. *Emerging Infectious Diseases*, *30*(10), 2090-2098. https://doi.org/10.3201/eid3010.240595. |

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***Bartonella* spp. in Phlebotominae Sand Flies, Brazil**        [PDF - 1.51 MB - 9 pages]    
D. Lee et al.

*Bartonella* spp. are opportunistic, vectorborne bacteria that can cause disease in both animals and humans. We investigated the molecular occurrence of *Bartonella* spp. in 634 phlebotomine sand fly specimens, belonging to 44 different sand fly species, sampled during 2017–2021 in north and northeastern Brazil. We detected *Bartonella* sp. DNA in 8.7% (55/634) of the specimens by using a quantitative real-time PCR targeting the 16S-23S internal transcribed spacer intergenic region. Phylogenetic analysis positioned the *Lutzomyia longipalpis* sand fly–associated *Bartonella gltA* gene sequence in the same subclade as *Bartonella ancashensis* sequences and revealed a *Bartonella* sp. sequence in a *Dampfomyia beltrani* sand fly from Mexico. We amplified a bat-associated *Bartonella nuoG* sequence from a specimen of *Nyssomyia antunesi* sand fly. Our findings document the presence of *Bartonella* DNA in sand flies from Brazil, suggesting possible involvement of these insects in the epidemiologic cycle of *Bartonella* species.

| EID                                                                                                                                                                                                                                                                   | Lee D, Fernandes Shimabukuro P, Brilhante A, Cadina Arantes P, Sanches G, Franco E, et al. Bartonella spp. in Phlebotominae Sand Flies, Brazil. Emerg Infect Dis. 2024;30(10):2099-2107. https://doi.org/10.3201/eid3010.240397 |
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| Lee D, Fernandes Shimabukuro P, Brilhante A, et al. Bartonella spp. in Phlebotominae Sand Flies, Brazil. *Emerging Infectious Diseases*. 2024;30(10):2099-2107. doi:10.3201/eid3010.240397.                                                                           |
| Lee, D., Fernandes Shimabukuro, P., Brilhante, A., Cadina Arantes, P., Sanches, G., Franco, E....André, M. (2024). Bartonella spp. in Phlebotominae Sand Flies, Brazil. *Emerging Infectious Diseases*, *30*(10), 2099-2107. https://doi.org/10.3201/eid3010.240397.  |

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**Early Introductions of *Candida auris* Detected by Wastewater Surveillance, Utah, USA, 2022–2023**        [PDF - 1.19 MB - 10 pages]    
J. Chavez et al.

*Candida auris* is considered a nosocomial pathogen of high concern and is currently spreading across the United States. Infection control measures for *C. auris* focus mainly on healthcare facilities, yet transmission levels may already be significant in the community before outbreaks are detected in healthcare settings. Wastewater-based epidemiology (culture, quantitative PCR, and whole-genome sequencing) can potentially gauge pathogen transmission in the general population and lead to early detection of *C. auris* before it is detected in clinical cases. To learn more about the sensitivity and limitations of wastewater-based surveillance, we used wastewater-based methods to detect *C. auris* in a southern Utah jurisdiction with no known clinical cases before and after the documented transfer of colonized patients from bordering Nevada. Our study illustrates the potential of wastewater-based surveillance for being sufficiently sensitive to detect *C. auris* transmission during the early stages of introduction into a community.

| EID                                                                                                                                                                                                                                                                                          | Chavez J, Crank K, Barber C, Gerrity D, Iverson T, Mongillo J, et al. Early Introductions of Candida auris Detected by Wastewater Surveillance, Utah, USA, 2022–2023. Emerg Infect Dis. 2024;30(10):2107-2117. https://doi.org/10.3201/eid3010.240173   |
|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Chavez J, Crank K, Barber C, et al. Early Introductions of Candida auris Detected by Wastewater Surveillance, Utah, USA, 2022–2023. *Emerging Infectious Diseases*. 2024;30(10):2107-2117. doi:10.3201/eid3010.240173.                                                                       |
| Chavez, J., Crank, K., Barber, C., Gerrity, D., Iverson, T., Mongillo, J....Rossi, A. (2024). Early Introductions of Candida auris Detected by Wastewater Surveillance, Utah, USA, 2022–2023. *Emerging Infectious Diseases*, *30*(10), 2107-2117. https://doi.org/10.3201/eid3010.240173.   |

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**Temporal Characterization of Prion Shedding in Secreta of White-Tailed Deer in Longitudinal Study of Chronic Wasting Disease, United States**        [PDF - 1.15 MB - 10 pages]    
N. D. Denkers et al.

Chronic wasting disease (CWD) affects cervids in North America, Asia, and Scandinavia. CWD is unique in its efficient spread, partially because of contact with infectious prions shed in secreta. To assess temporal profiles of CWD prion shedding, we collected saliva, urine, and feces from white-tailed deer for 66 months after exposure to low oral doses of CWD-positive brain tissue or saliva. We analyzed prion seeding activity by using modified amyloid amplification assays incorporating iron oxide bead extraction, which improved CWD detection and reduced false positives. CWD prions were detected in feces, urine, and saliva as early as 6 months postinfection. More frequent and consistent shedding was observed in deer homozygous for glycine at prion protein gene codon 96 than in deer expressing alternate genotypes. Our findings demonstrate that improved amplification methods can be used to identify early antemortem CWD prion shedding, which might aid in disease surveillance of cervids.

| EID                                                                                                                                                                                                                                                                                                                                                             | Denkers ND, McNulty EE, Kraft CN, Nalls AV, Westrich JA, Hoover EA, et al. Temporal Characterization of Prion Shedding in Secreta of White-Tailed Deer in Longitudinal Study of Chronic Wasting Disease, United States. Emerg Infect Dis. 2024;30(10):2118-2127. https://doi.org/10.3201/eid3010.240159 |
|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Denkers ND, McNulty EE, Kraft CN, et al. Temporal Characterization of Prion Shedding in Secreta of White-Tailed Deer in Longitudinal Study of Chronic Wasting Disease, United States. *Emerging Infectious Diseases*. 2024;30(10):2118-2127. doi:10.3201/eid3010.240159.                                                                                        |
| Denkers, N. D., McNulty, E. E., Kraft, C. N., Nalls, A. V., Westrich, J. A., Hoover, E. A....Mathiason, C. K. (2024). Temporal Characterization of Prion Shedding in Secreta of White-Tailed Deer in Longitudinal Study of Chronic Wasting Disease, United States. *Emerging Infectious Diseases*, *30*(10), 2118-2127. https://doi.org/10.3201/eid3010.240159. |

##### Dispatches

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**Presumed Transmission of 2 Distinct Monkeypox Virus Variants from Central African Republic to Democratic Republic of the Congo**        [PDF - 2.18 MB - 7 pages]    
E. Vakaniaki et al.

We linked 4 mpox cases in South Ubangi, Democratic Republic of the Congo, to transboundary transmission from Central African Republic. Viral genome sequencing demonstrated that the monkeypox virus sequences belonged to distinct clusters of subclade Ia. This finding demonstrates the borderless nature of mpox and highlights the need for vigilant regional surveillance.

| EID                                                                                                                                                                                                                                                                                                                                                  | Vakaniaki E, Kinganda-Lusamaki E, Merritt S, Kasongo F, Malembi E, Lunyanga L, et al. Presumed Transmission of 2 Distinct Monkeypox Virus Variants from Central African Republic to Democratic Republic of the Congo. Emerg Infect Dis. 2024;30(10):2128-2134. https://doi.org/10.3201/eid3010.241118 |
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| Vakaniaki E, Kinganda-Lusamaki E, Merritt S, et al. Presumed Transmission of 2 Distinct Monkeypox Virus Variants from Central African Republic to Democratic Republic of the Congo. *Emerging Infectious Diseases*. 2024;30(10):2128-2134. doi:10.3201/eid3010.241118.                                                                               |
| Vakaniaki, E., Kinganda-Lusamaki, E., Merritt, S., Kasongo, F., Malembi, E., Lunyanga, L....Mbala-Kingebeni, P. (2024). Presumed Transmission of 2 Distinct Monkeypox Virus Variants from Central African Republic to Democratic Republic of the Congo. *Emerging Infectious Diseases*, *30*(10), 2128-2134. https://doi.org/10.3201/eid3010.241118. |

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**Highly Pathogenic Avian Influenza A Virus in Wild Migratory Birds, Qinghai Lake, China, 2022**        [PDF - 1.17 MB - 5 pages]    
X. Zhang et al.

In July 2022, an outbreak of highly pathogenic avian influenza A(H5N1) virus clade 2.3.4.4b occurred among migratory birds at Qinghai Lake in China. The virus circulated in June, and reassortants emerged after its introduction into the area. Surveillance in 2023 showed that the virus did not establish a stable presence in wild waterfowl.

| EID                                                                                                                                                                                                                                                                  | Zhang X, Wu J, Wang Y, Hao M, Liu H, Fan S, et al. Highly Pathogenic Avian Influenza A Virus in Wild Migratory Birds, Qinghai Lake, China, 2022. Emerg Infect Dis. 2024;30(10):2135-2139. https://doi.org/10.3201/eid3010.240460 |
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| Zhang X, Wu J, Wang Y, et al. Highly Pathogenic Avian Influenza A Virus in Wild Migratory Birds, Qinghai Lake, China, 2022. *Emerging Infectious Diseases*. 2024;30(10):2135-2139. doi:10.3201/eid3010.240460.                                                       |
| Zhang, X., Wu, J., Wang, Y., Hao, M., Liu, H., Fan, S....Chen, J. (2024). Highly Pathogenic Avian Influenza A Virus in Wild Migratory Birds, Qinghai Lake, China, 2022. *Emerging Infectious Diseases*, *30*(10), 2135-2139. https://doi.org/10.3201/eid3010.240460. |

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**Circovirus Hepatitis in Immunocompromised Patient, Switzerland**        [PDF - 1.30 MB - 5 pages]    
B. Hamelin et al.

We identified a novel human circovirus in an immunocompromised 66-year-old woman with sudden onset of self-limiting hepatitis. We detected human circovirus 1 (HCirV-1) transcripts in hepatocytes and the HCirV-1 genome long-term in the patient’s blood, stool, and urine. HCirV-1 is an emerging human pathogen that persists in susceptible patients.

| EID                                                                                                                                                                                                                                                             | Hamelin B, Pérot P, Pichler I, Haslbauer JD, Hardy D, Hing D, et al. Circovirus Hepatitis in Immunocompromised Patient, Switzerland. Emerg Infect Dis. 2024;30(10):2140-2144. https://doi.org/10.3201/eid3010.240678  |
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| Hamelin B, Pérot P, Pichler I, et al. Circovirus Hepatitis in Immunocompromised Patient, Switzerland. *Emerging Infectious Diseases*. 2024;30(10):2140-2144. doi:10.3201/eid3010.240678.                                                                        |
| Hamelin, B., Pérot, P., Pichler, I., Haslbauer, J. D., Hardy, D., Hing, D....Mertz, K. D. (2024). Circovirus Hepatitis in Immunocompromised Patient, Switzerland. *Emerging Infectious Diseases*, *30*(10), 2140-2144. https://doi.org/10.3201/eid3010.240678.  |

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**Mpox Epidemiology and Vaccine Effectiveness, England, 2023**        [PDF - 367 KB - 4 pages]    
H. Charles et al.

Reported mpox cases in England continued at a low but steady frequency during 2023. Of 137 cases reported in 2023, approximately half were acquired overseas and half were in vaccinated persons. Estimated effectiveness of 2-dose vaccine was 80%, and no vaccinated mpox patient was hospitalized.

| EID                                                                                                                                                                                                                                                        | Charles H, Thorley K, Turner C, Bennet KF, Andrews N, Bertran M, et al. Mpox Epidemiology and Vaccine Effectiveness, England, 2023. Emerg Infect Dis. 2024;30(10):2145-2148. https://doi.org/10.3201/eid3010.240292 |
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| Charles H, Thorley K, Turner C, et al. Mpox Epidemiology and Vaccine Effectiveness, England, 2023. *Emerging Infectious Diseases*. 2024;30(10):2145-2148. doi:10.3201/eid3010.240292.                                                                      |
| Charles, H., Thorley, K., Turner, C., Bennet, K. F., Andrews, N., Bertran, M....Sinka, K. (2024). Mpox Epidemiology and Vaccine Effectiveness, England, 2023. *Emerging Infectious Diseases*, *30*(10), 2145-2148. https://doi.org/10.3201/eid3010.240292. |

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**Dengue Virus Serotype 3 Origins and Genetic Dynamics, Jamaica**        [PDF - 1.84 MB - 6 pages]    
S. A. Redman et al.

We identified 3 clades of dengue virus serotype 3 belonging to genotype III isolated during 2019–2020 in Jamaica by using whole-genome sequencing and phylogenomic and phylogeographic analyses. The viruses likely originated from Asia in 2014. Newly expanded molecular surveillance efforts in Jamaica will guide appropriate public health responses.

| EID                                                                                                                                                                                                                                                                         | Redman SA, Perez LJ, Forberg K, Francis K, Walker JP, Thompson TK, et al. Dengue Virus Serotype 3 Origins and Genetic Dynamics, Jamaica. Emerg Infect Dis. 2024;30(10):2149-2154. https://doi.org/10.3201/eid3010.240170 |
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| Redman SA, Perez LJ, Forberg K, et al. Dengue Virus Serotype 3 Origins and Genetic Dynamics, Jamaica. *Emerging Infectious Diseases*. 2024;30(10):2149-2154. doi:10.3201/eid3010.240170.                                                                                    |
| Redman, S. A., Perez, L. J., Forberg, K., Francis, K., Walker, J. P., Thompson, T. K....Anzinger, J. J. (2024). Dengue Virus Serotype 3 Origins and Genetic Dynamics, Jamaica. *Emerging Infectious Diseases*, *30*(10), 2149-2154. https://doi.org/10.3201/eid3010.240170. |

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**Oropouche Fever, Cuba, May 2024**        [PDF - 1.09 MB - 5 pages]    
A. Benitez et al.

Phylogenetic analyses showed that the virus responsible for a May 2024 Oropouche fever outbreak in Cuba was closely related to viruses from Brazil in 2023. Pools of *Ceratopogonidae* spp. biting midges and *Culex quinquefasciatus* mosquitoes were positive for Oropouche viral RNA. No cases were severe. Virus extension to new areas may increase case numbers and severity.

| EID                                                                                                                                                                                                                                | Benitez A, Alvarez M, Perez L, Gravier R, Serrano S, Hernandez D, et al. Oropouche Fever, Cuba, May 2024. Emerg Infect Dis. 2024;30(10):2155-2159. https://doi.org/10.3201/eid3010.240900 |
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| Benitez A, Alvarez M, Perez L, et al. Oropouche Fever, Cuba, May 2024. *Emerging Infectious Diseases*. 2024;30(10):2155-2159. doi:10.3201/eid3010.240900.                                                                          |
| Benitez, A., Alvarez, M., Perez, L., Gravier, R., Serrano, S., Hernandez, D....Guzman, M. G. (2024). Oropouche Fever, Cuba, May 2024. *Emerging Infectious Diseases*, *30*(10), 2155-2159. https://doi.org/10.3201/eid3010.240900. |

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**Highly Pathogenic Avian Influenza A(H5N1) Virus Clade 2.3.4.4b Infections in Seals, Russia, 2023**        [PDF - 1.82 MB - 5 pages]    
I. Sobolev et al.

Highly pathogenic avian influenza A(H5N1) virus was detected in dead seals on Tyuleniy Island in eastern Russia, in the Sea of Okhotsk. Viruses isolated from dead northern fur seals belong to clade 2.3.4.4b and are closely related to viruses detected predominantly in the Russian Far East and Japan in 2022–2023.

| EID                                                                                                                                                                                                                                                                                                        | Sobolev I, Alekseev A, Sharshov K, Chistyaeva M, Ivanov A, Kurskaya O, et al. Highly Pathogenic Avian Influenza A(H5N1) Virus Clade 2.3.4.4b Infections in Seals, Russia, 2023. Emerg Infect Dis. 2024;30(10):2160-2164. https://doi.org/10.3201/eid3010.231728 |
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| Sobolev I, Alekseev A, Sharshov K, et al. Highly Pathogenic Avian Influenza A(H5N1) Virus Clade 2.3.4.4b Infections in Seals, Russia, 2023. *Emerging Infectious Diseases*. 2024;30(10):2160-2164. doi:10.3201/eid3010.231728.                                                                             |
| Sobolev, I., Alekseev, A., Sharshov, K., Chistyaeva, M., Ivanov, A., Kurskaya, O....Shestopalov, A. (2024). Highly Pathogenic Avian Influenza A(H5N1) Virus Clade 2.3.4.4b Infections in Seals, Russia, 2023. *Emerging Infectious Diseases*, *30*(10), 2160-2164. https://doi.org/10.3201/eid3010.231728. |

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**Autochthonous Human *Babesia divergens* Infection, England**        [PDF - 1.24 MB - 4 pages]    
G. A. Zabala et al.

We describe a case of autochthonous human *Babesia divergens* infection in an immunocompetent woman in England. The patient had fever, hemolysis, multiorgan failure, and 18% parasitemia. We confirmed *B. divergens* by 18S rDNA PCR and sequencing. Clinicians should consider babesiosis as a differential diagnosis in patients with unexplained hemolysis.

| EID                                                                                                                                                                                                                                                           | Zabala GA, Lever R, Chan X, Bristowe H, Kilbride E, Richards D, et al. Autochthonous Human Babesia divergens Infection, England. Emerg Infect Dis. 2024;30(10):2165-2168. https://doi.org/10.3201/eid3010.240866 |
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| Zabala GA, Lever R, Chan X, et al. Autochthonous Human Babesia divergens Infection, England. *Emerging Infectious Diseases*. 2024;30(10):2165-2168. doi:10.3201/eid3010.240866.                                                                               |
| Zabala, G. A., Lever, R., Chan, X., Bristowe, H., Kilbride, E., Richards, D....Chiodini, P. L. (2024). Autochthonous Human Babesia divergens Infection, England. *Emerging Infectious Diseases*, *30*(10), 2165-2168. https://doi.org/10.3201/eid3010.240866. |

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**Bluetongue Virus in the Iberian Lynx (*Lynx pardinus*), 2010–2022**        [PDF - 1.13 MB - 5 pages]    
J. Caballero-Gómez et al.

Clinical infection and death caused by bluetongue virus infection has been reported in the Eurasian lynx. Bluetongue virus surveillance in the Iberian lynx revealed widespread and repeated exposure to serotypes 1 and 4 in wild and captive populations of this species. This exposure is possibly from a spillover event from sympatric ruminants.

| EID                                                                                                                                                                                                                                                                                                | Caballero-Gómez J, Sánchez-Sánchez M, Lorca-Oró C, de Mera I, Zorrilla I, López G, et al. Bluetongue Virus in the Iberian Lynx (Lynx pardinus), 2010–2022. Emerg Infect Dis. 2024;30(10):2169-2173. https://doi.org/10.3201/eid3010.240235        |
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| Caballero-Gómez J, Sánchez-Sánchez M, Lorca-Oró C, et al. Bluetongue Virus in the Iberian Lynx (Lynx pardinus), 2010–2022. *Emerging Infectious Diseases*. 2024;30(10):2169-2173. doi:10.3201/eid3010.240235.                                                                                      |
| Caballero-Gómez, J., Sánchez-Sánchez, M., Lorca-Oró, C., de Mera, I., Zorrilla, I., López, G....García-Bocanegra, I. (2024). Bluetongue Virus in the Iberian Lynx (Lynx pardinus), 2010–2022. *Emerging Infectious Diseases*, *30*(10), 2169-2173. https://doi.org/10.3201/eid3010.240235.         |

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**Chlorine Inactivation of *Elizabethkingia* spp. in Water**        [PDF - 649 KB - 4 pages]    
D. A. Holcomb et al.

We performed chlorine inactivation experiments for *Elizabethkingia anophelis* and *E. meningoseptica* bacterial strains from clinical and environmental sources. Free chlorine concentration × contact time values <0.04 mg·min/L achieved 99.9% inactivation of *Elizabethkingia* species, indicating chlorine susceptibility. Measures to control biofilm producing pathogens in plumbing are needed to prevent *Elizabethkingia* bacterial infections.

| EID                                                                                                                                                                                                                                                            | Holcomb DA, Riner D, Cowan B, Salah Z, Jennings WC, Mattioli MC, et al. Chlorine Inactivation of Elizabethkingia spp. in Water. Emerg Infect Dis. 2024;30(10):2174-2177. https://doi.org/10.3201/eid3010.240917 |
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| Holcomb DA, Riner D, Cowan B, et al. Chlorine Inactivation of Elizabethkingia spp. in Water. *Emerging Infectious Diseases*. 2024;30(10):2174-2177. doi:10.3201/eid3010.240917.                                                                                |
| Holcomb, D. A., Riner, D., Cowan, B., Salah, Z., Jennings, W. C., Mattioli, M. C....Murphy, J. L. (2024). Chlorine Inactivation of Elizabethkingia spp. in Water. *Emerging Infectious Diseases*, *30*(10), 2174-2177. https://doi.org/10.3201/eid3010.240917. |

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**Oxacillinase-484–Producing Enterobacterales, France, 2018–2023**        [PDF - 1.12 MB - 5 pages]    
C. Emeraud et al.

We examined the emergence and characteristics of oxacillinase-484–producing Enterobacterales in France during 2012–2023. Genomic analysis identified 2 predominant sequence types in *Escherichia coli*: ST410 and ST1722. Plasmid analysis revealed that *bla*OXA-484 genes were carried mostly on an IncX3-type plasmid associated with genetic elements including insertion sequences IS*3000* and IS*Kpn19*.

| EID                                                                                                                                                                                                                                                                  | Emeraud C, Bernabeu S, Girlich D, Rezzoug I, Jousset AB, Birer A, et al. Oxacillinase-484–Producing Enterobacterales, France, 2018–2023. Emerg Infect Dis. 2024;30(10):2178-2182. https://doi.org/10.3201/eid3010.240814     |
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| Emeraud C, Bernabeu S, Girlich D, et al. Oxacillinase-484–Producing Enterobacterales, France, 2018–2023. *Emerging Infectious Diseases*. 2024;30(10):2178-2182. doi:10.3201/eid3010.240814.                                                                          |
| Emeraud, C., Bernabeu, S., Girlich, D., Rezzoug, I., Jousset, A. B., Birer, A....Dortet, L. (2024). Oxacillinase-484–Producing Enterobacterales, France, 2018–2023. *Emerging Infectious Diseases*, *30*(10), 2178-2182. https://doi.org/10.3201/eid3010.240814.     |

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**Clustering of Polymorphic Membrane Protein E Clade in *Chlamydia trachomatis* Lineages from Men Who Have Sex with Men**        [PDF - 1.26 MB - 5 pages]    
M. Mitobe et al.

Several *Chlamydia trachomatis* lineages identified through outer membrane protein A genotyping or multilocus sequence typing have been circulating worldwide among men who have sex with men. In a study in Tokyo, Japan, we demonstrate that such lineages commonly belong to a specific polymorphic membrane protein E clade across genotypes.

| EID                                                                                                                                                                                                                                                                                                                   | Mitobe M, Kubota H, Kobayashi K, Miyake H, Takano M, Mizushima D, et al. Clustering of Polymorphic Membrane Protein E Clade in Chlamydia trachomatis Lineages from Men Who Have Sex with Men. Emerg Infect Dis. 2024;30(10):2183-2187. https://doi.org/10.3201/eid3010.240852 |
|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Mitobe M, Kubota H, Kobayashi K, et al. Clustering of Polymorphic Membrane Protein E Clade in Chlamydia trachomatis Lineages from Men Who Have Sex with Men. *Emerging Infectious Diseases*. 2024;30(10):2183-2187. doi:10.3201/eid3010.240852.                                                                       |
| Mitobe, M., Kubota, H., Kobayashi, K., Miyake, H., Takano, M., Mizushima, D....Sadamasu, K. (2024). Clustering of Polymorphic Membrane Protein E Clade in Chlamydia trachomatis Lineages from Men Who Have Sex with Men. *Emerging Infectious Diseases*, *30*(10), 2183-2187. https://doi.org/10.3201/eid3010.240852. |

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**Investigation of a Human Case of *Francisella tularensis* Infection, United Kingdom, 2023**        [PDF - 479 KB - 3 pages]    
A. Thompson et al.

Tularemia, caused by *Francisella tularensis*, is not known to occur in the United Kingdom. We report a case of tularemia diagnosed in July 2023 in a UK patient with no travel in the 6 weeks before symptom onset. We describe the subsequent multiagency investigation into possible routes of acquisition. 

| EID                                                                                                                                                                                                                                                                                        | Thompson A, Brooks T, Houlihan C, Rampling T, Umpleby H, Hansford K, et al. Investigation of a Human Case of Francisella tularensis Infection, United Kingdom, 2023. Emerg Infect Dis. 2024;30(10):2188-2190. https://doi.org/10.3201/eid3010.240479 |
|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Thompson A, Brooks T, Houlihan C, et al. Investigation of a Human Case of Francisella tularensis Infection, United Kingdom, 2023. *Emerging Infectious Diseases*. 2024;30(10):2188-2190. doi:10.3201/eid3010.240479.                                                                       |
| Thompson, A., Brooks, T., Houlihan, C., Rampling, T., Umpleby, H., Hansford, K....Gordon, N. (2024). Investigation of a Human Case of Francisella tularensis Infection, United Kingdom, 2023. *Emerging Infectious Diseases*, *30*(10), 2188-2190. https://doi.org/10.3201/eid3010.240479. |

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**Rift Valley Fever Epizootic, Rwanda, 2022**        [PDF - 470 KB - 3 pages]    
E. Remera et al.

A Rift Valley fever epizootic affected livestock in Rwanda during March–October 2022. We confirmed 3,112 infections with the virus, including 1,342 cases, 1,254 abortions, and 516 deaths among cattle, goats, and sheep. We recommend a One Health strategy for investigations and response to protect animal and human health.

| EID                                                                                                                                                                                                                                           | Remera E, Rwagasore E, Nsekuye O, Semakula M, Gashegu M, Rutayisire R, et al. Rift Valley Fever Epizootic, Rwanda, 2022. Emerg Infect Dis. 2024;30(10):2191-2193. https://doi.org/10.3201/eid3010.240264 |
|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Remera E, Rwagasore E, Nsekuye O, et al. Rift Valley Fever Epizootic, Rwanda, 2022. *Emerging Infectious Diseases*. 2024;30(10):2191-2193. doi:10.3201/eid3010.240264.                                                                        |
| Remera, E., Rwagasore, E., Nsekuye, O., Semakula, M., Gashegu, M., Rutayisire, R....Ahmed, A. (2024). Rift Valley Fever Epizootic, Rwanda, 2022. *Emerging Infectious Diseases*, *30*(10), 2191-2193. https://doi.org/10.3201/eid3010.240264. |

##### Research Letters

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**Correlation between Viral Wastewater Concentration and Respiratory Tests, Oregon, USA**        [PDF - 490 KB - 3 pages]    
N. Lininger et al.

We evaluated the association between wastewater concentration and weekly percent positivity of patient testing for SARS-CoV-2, influenza, and respiratory syncytial virus in Oregon, USA. We found strong, positive correlations for SARS-CoV-2 (ρ = 0.84, p<0.001), influenza (ρ = 0.73, p<0.001) and respiratory syncytial virus (ρ = 0.69, p<0.001).

| EID                                                                                                                                                                                                                                                                                 | Lininger N, Falender R, Cieslak P, Novak A, Hendrick M, Kaya D, et al. Correlation between Viral Wastewater Concentration and Respiratory Tests, Oregon, USA. Emerg Infect Dis. 2024;30(10):2194-2196. https://doi.org/10.3201/eid3010.240637 |
|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Lininger N, Falender R, Cieslak P, et al. Correlation between Viral Wastewater Concentration and Respiratory Tests, Oregon, USA. *Emerging Infectious Diseases*. 2024;30(10):2194-2196. doi:10.3201/eid3010.240637.                                                                 |
| Lininger, N., Falender, R., Cieslak, P., Novak, A., Hendrick, M., Kaya, D....Sutton, M. (2024). Correlation between Viral Wastewater Concentration and Respiratory Tests, Oregon, USA. *Emerging Infectious Diseases*, *30*(10), 2194-2196. https://doi.org/10.3201/eid3010.240637. |

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**Spatiotemporal Epidemiology of Oropouche Fever, Brazil, 2015–2024**        [PDF - 562 KB - 3 pages]    
P. Martins-Filho et al.

We assessed the spatiotemporal dynamics of Oropouche fever in Brazil during 2015–2024. We found the number of cases substantially increased during that period, particularly in the Amazon region. Our findings underscore the need for improved surveillance and public health measures in response to the disease’s potential spread beyond endemic areas.

| EID                                                                                                                                                                                                                         | Martins-Filho P, Carvalho T, dos Santos C. Spatiotemporal Epidemiology of Oropouche Fever, Brazil, 2015–2024. Emerg Infect Dis. 2024;30(10):2196-2198. https://doi.org/10.3201/eid3010.241088   |
|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Martins-Filho P, Carvalho T, dos Santos C. Spatiotemporal Epidemiology of Oropouche Fever, Brazil, 2015–2024. *Emerging Infectious Diseases*. 2024;30(10):2196-2198. doi:10.3201/eid3010.241088.                            |
| Martins-Filho, P., Carvalho, T., & dos Santos, C. (2024). Spatiotemporal Epidemiology of Oropouche Fever, Brazil, 2015–2024. *Emerging Infectious Diseases*, *30*(10), 2196-2198. https://doi.org/10.3201/eid3010.241088.   |

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**Respiratory Syncytial Virus Prevalence and Risk Factors among Healthy Term Infants, United States**        [PDF - 545 KB - 4 pages]    
F. Cacho et al.

In a population-based birth cohort study of respiratory syncytial virus surveillance in the United States, 897/1,680 (53.4%) children were infected during infancy; 25 (2.8%) of those were hospitalized. Among symptomatic infants, 143/324 (44.1%) had lower respiratory tract infections. These data provide benchmarks to monitor effects of maternal vaccines and extended half-life monoclonal antibodies.

| EID                                                                                                                                                                                                                                                                                                                 | Cacho F, Gebretsadik T, Anderson LJ, Chappell JD, Rosas-Salazar C, Ortiz JR, et al. Respiratory Syncytial Virus Prevalence and Risk Factors among Healthy Term Infants, United States. Emerg Infect Dis. 2024;30(10):2199-2202. https://doi.org/10.3201/eid3010.240609 |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Cacho F, Gebretsadik T, Anderson LJ, et al. Respiratory Syncytial Virus Prevalence and Risk Factors among Healthy Term Infants, United States. *Emerging Infectious Diseases*. 2024;30(10):2199-2202. doi:10.3201/eid3010.240609.                                                                                   |
| Cacho, F., Gebretsadik, T., Anderson, L. J., Chappell, J. D., Rosas-Salazar, C., Ortiz, J. R....Hartert, T. (2024). Respiratory Syncytial Virus Prevalence and Risk Factors among Healthy Term Infants, United States. *Emerging Infectious Diseases*, *30*(10), 2199-2202. https://doi.org/10.3201/eid3010.240609. |

----

**Prosthetic Valve Endocarditis Caused by *Pasteurella dagmatis*, Germany**        [PDF - 897 KB - 3 pages]    
F. A. Rottmann et al.

An 81-year-old male patient in Germany had prosthetic valve endocarditis caused by *Pasteurella dagmatis* after a domestic cat bite. We surgically treated a paravalvular abscess and administered definitive antibiotic therapy consisting of penicillin G and levofloxacin. The patient was discharged from the intensive care unit in good condition 21 days after the surgery.

| EID                                                                                                                                                                                                                                | Rottmann FA, Schorle P, Giesen R, Jäger C. Prosthetic Valve Endocarditis Caused by Pasteurella dagmatis, Germany. Emerg Infect Dis. 2024;30(10):2202-2204. https://doi.org/10.3201/eid3010.240727  |
|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Rottmann FA, Schorle P, Giesen R, et al. Prosthetic Valve Endocarditis Caused by Pasteurella dagmatis, Germany. *Emerging Infectious Diseases*. 2024;30(10):2202-2204. doi:10.3201/eid3010.240727.                                 |
| Rottmann, F. A., Schorle, P., Giesen, R., & Jäger, C. (2024). Prosthetic Valve Endocarditis Caused by Pasteurella dagmatis, Germany. *Emerging Infectious Diseases*, *30*(10), 2202-2204. https://doi.org/10.3201/eid3010.240727.  |

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**SARS-CoV-2 and Other Coronaviruses in Rats, Berlin, Germany, 2023**        [PDF - 1.32 MB - 4 pages]    
K. Wernike et al.

We tested 130 rats captured in Berlin for coronaviruses. SARS-CoV-2 antibodies were detected in 1 rat, but all animals were negative by reverse transcription PCR, suggesting SARS-CoV-2 was not circulating in the rat population. However, alphacoronaviruses were found. Monitoring rodent populations helps to determine coronavirus occurrence, transmission, and zoonotic potential.

| EID                                                                                                                                                                                                                                                             | Wernike K, Mehl C, Aebischer A, Ulrich L, Heising M, Ulrich RG, et al. SARS-CoV-2 and Other Coronaviruses in Rats, Berlin, Germany, 2023. Emerg Infect Dis. 2024;30(10):2205-2208. https://doi.org/10.3201/eid3010.241079 |
|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Wernike K, Mehl C, Aebischer A, et al. SARS-CoV-2 and Other Coronaviruses in Rats, Berlin, Germany, 2023. *Emerging Infectious Diseases*. 2024;30(10):2205-2208. doi:10.3201/eid3010.241079.                                                                    |
| Wernike, K., Mehl, C., Aebischer, A., Ulrich, L., Heising, M., Ulrich, R. G....Beer, M. (2024). SARS-CoV-2 and Other Coronaviruses in Rats, Berlin, Germany, 2023. *Emerging Infectious Diseases*, *30*(10), 2205-2208. https://doi.org/10.3201/eid3010.241079. |

----

**Establishment of *Amblyomma maculatum* Ticks and *Rickettsia parkeri* the Northeastern United States**        [PDF - 938 KB - 4 pages]    
G. Molaei et al.

We document a case of *Rickettsia parkeri* rickettsiosis in a patient in Connecticut, USA, who became ill after a bite from a Gulf Coast tick (*Amblyomma maculatum*). We used PCR to amplify *R. parkeri* DNA from the detached tick. The patient showed a 4-fold rise in IgG reactive with *R. parkeri* antigens. 

| EID                                                                                                                                                                                                                                                           | Molaei G, Khalil N, Ramos CJ, Paddock CD. Establishment of Amblyomma maculatum Ticks and Rickettsia parkeri the Northeastern United States. Emerg Infect Dis. 2024;30(10):2208-2211. https://doi.org/10.3201/eid3010.240821 |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Molaei G, Khalil N, Ramos CJ, et al. Establishment of Amblyomma maculatum Ticks and Rickettsia parkeri the Northeastern United States. *Emerging Infectious Diseases*. 2024;30(10):2208-2211. doi:10.3201/eid3010.240821.                                     |
| Molaei, G., Khalil, N., Ramos, C. J., & Paddock, C. D. (2024). Establishment of Amblyomma maculatum Ticks and Rickettsia parkeri the Northeastern United States. *Emerging Infectious Diseases*, *30*(10), 2208-2211. https://doi.org/10.3201/eid3010.240821. |

----

**Fort Sherman Virus Infection in Human, Peru, 2020**        [PDF - 1.14 MB - 4 pages]    
E. F. de Oliveira-Filho et al.

Fort Sherman virus (FSV) was isolated in Panama in 1985 from a US soldier. We report a case of human FSV infection in a febrile patient from northern coastal Peru in 2020. FSV infections spanning ≈35 years and a distance of 2,000 km warrant diagnostics, genomic surveillance, and investigation of transmission cycles.

| EID                                                                                                                                                                                                                                                                        | de Oliveira-Filho EF, Cabezas Sánchez C, Manosalva D, Romero M, Sarmiento N, Ñique A, et al. Fort Sherman Virus Infection in Human, Peru, 2020. Emerg Infect Dis. 2024;30(10):2211-2214. https://doi.org/10.3201/eid3010.240124   |
|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| de Oliveira-Filho EF, Cabezas Sánchez C, Manosalva D, et al. Fort Sherman Virus Infection in Human, Peru, 2020. *Emerging Infectious Diseases*. 2024;30(10):2211-2214. doi:10.3201/eid3010.240124.                                                                         |
| de Oliveira-Filho, E. F., Cabezas Sánchez, C., Manosalva, D., Romero, M., Sarmiento, N., Ñique, A....Drexler, J. (2024). Fort Sherman Virus Infection in Human, Peru, 2020. *Emerging Infectious Diseases*, *30*(10), 2211-2214. https://doi.org/10.3201/eid3010.240124.   |

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**Fatal Renal Abscess Caused by *Porphyromonas gingivalis* and Subcapsular Hemorrhage, Japan**        [PDF - 968 KB - 3 pages]    
Y. Atagi et al.

A 61-year-old man in Japan with abdominal pain was suspected of having a renal tumor. Despite initial treatment, his condition rapidly deteriorated, leading to death. Postmortem examination revealed a renal abscess and sepsis caused by *Porphyromonas gingivalis*. This case underscores the need to consider atypical pathogens in renal masses.

| EID                                                                                                                                                                                                                                                            | Atagi Y, Homma Y, Yamashi S, Kikuchi K, Nagashima Y. Fatal Renal Abscess Caused by Porphyromonas gingivalis and Subcapsular Hemorrhage, Japan. Emerg Infect Dis. 2024;30(10):2214-2217. https://doi.org/10.3201/eid3010.240078 |
|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Atagi Y, Homma Y, Yamashi S, et al. Fatal Renal Abscess Caused by Porphyromonas gingivalis and Subcapsular Hemorrhage, Japan. *Emerging Infectious Diseases*. 2024;30(10):2214-2217. doi:10.3201/eid3010.240078.                                               |
| Atagi, Y., Homma, Y., Yamashi, S., Kikuchi, K., & Nagashima, Y. (2024). Fatal Renal Abscess Caused by Porphyromonas gingivalis and Subcapsular Hemorrhage, Japan. *Emerging Infectious Diseases*, *30*(10), 2214-2217. https://doi.org/10.3201/eid3010.240078. |

##### EIN Research Letter

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**Infectious Disease Physicians’ Knowledge and Practices Regarding Wastewater Surveillance, United States, 2024**        [PDF - 318 KB - 4 pages]    
C. Adams et al.

A survey of US infectious disease physicians indicated that few regularly reviewed wastewater surveillance (WWS) data but many reported examples of how WWS has affected or could affect their clinical practice. WWS data can be useful for physicians, but increased communication between public health professionals and physicians regarding WWS could improve its utility.

| EID                                                                                                                                                                                                                                                                                                                        | Adams C, Horter L, Beekmann SE, Polgreen PM, Ricaldi JN, Louis S, et al. Infectious Disease Physicians’ Knowledge and Practices Regarding Wastewater Surveillance, United States, 2024. Emerg Infect Dis. 2024;30(10):2218-2221. https://doi.org/10.3201/eid3010.240719   |
|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Adams C, Horter L, Beekmann SE, et al. Infectious Disease Physicians’ Knowledge and Practices Regarding Wastewater Surveillance, United States, 2024. *Emerging Infectious Diseases*. 2024;30(10):2218-2221. doi:10.3201/eid3010.240719.                                                                                   |
| Adams, C., Horter, L., Beekmann, S. E., Polgreen, P. M., Ricaldi, J. N., Louis, S....Santibañez, S. (2024). Infectious Disease Physicians’ Knowledge and Practices Regarding Wastewater Surveillance, United States, 2024. *Emerging Infectious Diseases*, *30*(10), 2218-2221. https://doi.org/10.3201/eid3010.240719.    |

##### Etymologia

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**Pasteurellaceae [pas′′-tər-ə-lā′-sē-ī]**        [PDF - 324 KB - 1 page]    
C. Partin

| EID                                                                                                                                                           | Partin C. Pasteurellaceae [pas′′-tər-ə-lā′-sē-ī]. Emerg Infect Dis. 2024;30(10):2204. https://doi.org/10.3201/eid3010.240735            |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------|
| Partin C. Pasteurellaceae [pas′′-tər-ə-lā′-sē-ī]. *Emerging Infectious Diseases*. 2024;30(10):2204. doi:10.3201/eid3010.240735.                               |
| Partin, C. (2024). Pasteurellaceae [pas′′-tər-ə-lā′-sē-ī]. *Emerging Infectious Diseases*, *30*(10), 2204. https://doi.org/10.3201/eid3010.240735.            |

##### Corrections

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**Correction: Vol. 30, No. 1**        [PDF - 216 KB - 1 page]    
| EID                                                                                                                         | Correction: Vol. 30, No. 1. Emerg Infect Dis. 2024;30(10):2217. https://doi.org/10.3201/eid3010.c23010 |
|-----------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------|
| Correction: Vol. 30, No. 1. *Emerging Infectious Diseases*. 2024;30(10):2217. doi:10.3201/eid3010.c23010.                   |
| (2024). Correction: Vol. 30, No. 1. *Emerging Infectious Diseases*, *30*(10), 2217. https://doi.org/10.3201/eid3010.c23010. |

----

**Correction: Vol. 30, Supplement 1**        [PDF - 216 KB - 1 page]    
| EID                                                                                                                                | Correction: Vol. 30, Supplement 1. Emerg Infect Dis. 2024;30(10):2217. https://doi.org/10.3201/eid3010.c13010 |
|------------------------------------------------------------------------------------------------------------------------------------|---------------------------------------------------------------------------------------------------------------|
| Correction: Vol. 30, Supplement 1. *Emerging Infectious Diseases*. 2024;30(10):2217. doi:10.3201/eid3010.c13010.                   |
| (2024). Correction: Vol. 30, Supplement 1. *Emerging Infectious Diseases*, *30*(10), 2217. https://doi.org/10.3201/eid3010.c13010. |

##### About the Cover

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**Following the Flood**        [PDF - 1.14 MB - 2 pages]    
B. Breedlove

| EID                                                                                                                                     | Breedlove B. Following the Flood. Emerg Infect Dis. 2024;30(10):2222-2223. https://doi.org/10.3201/eid3010.ac3010 |
|-----------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------|
| Breedlove B. Following the Flood. *Emerging Infectious Diseases*. 2024;30(10):2222-2223. doi:10.3201/eid3010.ac3010.                    |
| Breedlove, B. (2024). Following the Flood. *Emerging Infectious Diseases*, *30*(10), 2222-2223. https://doi.org/10.3201/eid3010.ac3010. |

*Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.*

October Supplement

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November 2024

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December 2024

#### Volume 30, Supplement—October 2024

##### Synopses

              -         Role of Department of Defense Global Emerging Infections Surveillance Program in Pandemic Preparedness and Response, United States     K. Creppage et al. 
              -         Serosurveillance for  Plasmodium falciparum  Malaria in Peruvian Army Peacekeeping Personnel, Central African Republic, 2021–2022     J. A. Ventocilla et al. 
              -         Support of Force Health Protection through Global Emerging Infections Surveillance Program, 1997–2024     J. M. Early et al. 

##### Research

              -         Molecular Surveillance of Multidrug-Resistant Bacteria among Refugees from Afghanistan in 2 US Military Hospitals during Operation Allies Refuge, 2021     C. Anderson et al. 
              -         Scrub Typhus Outbreak among Soldiers in Coastal Training Area, Australia, 2022     R. Suhr et al. 
              -         Molecular Characterization of Noroviruses Causing Acute Gastroenteritis Outbreaks among US Military Recruits, 2013–2023     M. S. Anderson et al. 

Top

#### Volume 30, Number 11—November 2024

##### Perspective

              -         Flexible Development Programs for Antibacterial Drugs to Address Unmet Medical Needs     M. Ghosh et al. 

##### Synopses

              -         Clinical and Genomic Epidemiology of Coxsackievirus A21 and Enterovirus D68 in Homeless Shelters, King County, Washington, 2019–2021     S. N. Cox et al. 
              -         Tuberculosis Posttreatment Mortality Rates, Georgia, USA, 2008–2019     S. Gorvetzian et al. 
              -         Wastewater Surveillance for Poliovirus in Selected Jurisdictions, United States, 2022–2023     E. R. Whitehouse et al. 
              -  Vibrio parahemolyticus  Food Poisoning Associated with Consumption of Oysters, Australia, 2021–2022     E. Fearnley et al. 
              -         Reemergence of Oropouche Virus in the Americas and Risk for Spread in United States and Its Territories, 2024     S. J. Guagliardo et al. 

##### Research

              -         Risk for Facial Palsy after COVID-19 Vaccination, South Korea, 2021–2022     D. Yoon et al. 
              -         Spatial-Temporal Ecologic Analysis of COVID-19 Vaccination Coverage and Outcomes, Oklahoma, USA, February 2020–December 2021     K. Ding et al. 
              -         Detection of Predominant Azole-Resistant  Candida tropicalis  Genotype in Orchards Causing Human Candidemia, Taiwan     K. Tseng et al. 

##### Dispatches

              -         Clinical and Molecular Characterization of Human  Burkholderia mallei  Infection, Brazil     K. G. Luz et al. 
              -  Emerging Monkeypox Virus Sublineage C.1 Causing Community Transmission, Vietnam, 2023  H. Hoa et al. View Abstract  
We studied a community cluster of 25 mpox cases in Vietnam caused by emerging monkeypox virus sublineage C.1 and imported into Vietnam through 2 independent events; 1 major cluster carried a novel APOBEC3-like mutation. Three patients died; all had advanced HIV co-infection. Viral evolution and its potential consequences should be closely monitored.
 
              -  Fatal Oropouche Virus Infections in Nonendemic Region, Brazil, 2024  A. Bandeira et al. View Abstract  
We report acute Oropouche virus infections in 2 previously healthy women from a nonendemic region of Brazil outside the Amazon Basin. Infections rapidly progressed to hemorrhagic manifestations and fatal outcomes in 4–5 days. These cases highlight the critical need for enhanced surveillance to clarify epidemiology of this neglected disease.
 
              -         Virus Serotypes and Lineages during Dengue Outbreak, Valle del Cauca, Colombia, 2023–2024     N. D. Grubaugh et al. 
              -         Co-Circulation of 2 Oropouche Virus Lineages, Amazon Basin, Colombia, 2024     J. Usuga et al. 
              -         Genomic Epidemiology of Human Respiratory Syncytial Virus, Minnesota, USA, July 2023–February 2024     D. Evans et al. 
              -         Transmission of Severe Fever Thrombocytopenia Syndrome Virus to a Human Patient from a New Nonindigenous Tick Host, Japan     Q. Xu et al. 

##### Research Letters

              -         Epidemiology of  Streptococcus pyogenes  Disease Before, During, and After COVID-19 Pandemic, Germany, 2005–2023     I. Burckhardt and F. Burckhardt 
              -  Outbreak of Listeriosis Likely Associated with Baker’s Yeast Products, Switzerland, 2022–2024  R. Stephan et al. View Abstract  
We traced back a nationwide outbreak of human listeriosis in Switzerland to a persisting production line contamination of a factory producing baker’s yeast with *Listeria monocytogenes* serotype 1/2a sequence type 3141. We used whole-genome sequencing to match clinical isolates to isolates from product samples.
 
              -         Mpox Hepatic and Pulmonary Lesions in HIV/Hepatitis B Virus Co-Infected Patient, France     R. Calin et al. 
              -         Thermal Inactivation of Influenza A Virus in Dairy Milk     C. Caceres et al. 

##### Letter

              -         Foodborne Outbreak Size Is Dependent on How the Outbreak Is Detected     C. W. Hedberg et al. 

Top

#### Volume 30, Number 12—December 2024

##### Research

              -         Cost-Effectiveness Analysis of Japanese Encephalitis Vaccination for Children <15 Years of Age, Bangladesh     A. Nguyen et al. 
              -         Clinical Manifestations, Antifungal Drug Susceptibility, and Treatment Outcomes for Emerging Zoonotic Cutaneous Sporotrichosis, Thailand     P. Jirawattanadon et al. 
              -         Effect of Sexual Partnerships on Zika Virus Transmission in Virus-Endemic Region, Northeast Brazil     T. Magalhaes et al. 

##### Dispatch

              -  Mycobacterium leprae  in Nine-Banded Armadillos ( Dasypus novemcinctus ), Ecuador     D. Romero-Alvarez et al. 

Top

 Medscape, LLC is pleased to provide online continuing medical education (CME) for selected journal articles, allowing clinicians the opportunity to earn CME credit. In support of improving patient care, these activities have been planned and implemented by Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. CME credit is available for one year after publication.

#### Active CME Articles

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Medscape CME Activity
***Pasteurella* Infections in South Korea and Systematic Review and Meta-analysis of *Pasteurella* Bacteremia**        [PDF - 1.56 MB - 11 pages]    
S. Jeong et al.

*Pasteurella* spp. can cause fatal zoonotic infections in humans. We performed a multicenter study to investigate the prevalence and clinical features of *Pasteurella* infections in South Korea during 2018‒2022. We also conducted a collaborative systematic review and meta-analysis of the global burden of *Pasteurella* bacteremia. The study included 283 cases found an increasing trend in *Pasteurella* infections. Blood cultures were positive in 8/35 (22.9%) cases sampled, for overall bacteremia-associated rate of 2.8% (8/283). Aging was a significant risk factor for bacteremia (odds ratio 1.05 [95% CI 1.01–1.10]), according to multivariate analyses. For the meta-analysis, we included a total of 2,012 cases from 10 studies. The pooled prevalence of bacteremia was 12.4% (95% CI 7.3%–18.6%) and of mortality 8.4% (95% CI 2.7%–16.5%). Our findings reflect the need for greater understanding of the increase in *Pasteurella* infections and the global burden of *Pasteurella* bacteremia to determine appropriate case management.

| EID                                                                                                                                                                                                                                                                               | Jeong S, Chang E, Lee N, Kim H, Kim H, Kim J, et al. Pasteurella Infections in South Korea and Systematic Review and Meta-analysis of Pasteurella Bacteremia. Emerg Infect Dis. 2024;30(10):1987-1997. https://doi.org/10.3201/eid3010.240245 |
|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Jeong S, Chang E, Lee N, et al. Pasteurella Infections in South Korea and Systematic Review and Meta-analysis of Pasteurella Bacteremia. *Emerging Infectious Diseases*. 2024;30(10):1987-1997. doi:10.3201/eid3010.240245.                                                       |
| Jeong, S., Chang, E., Lee, N., Kim, H., Kim, H., Kim, J....Song, W. (2024). Pasteurella Infections in South Korea and Systematic Review and Meta-analysis of Pasteurella Bacteremia. *Emerging Infectious Diseases*, *30*(10), 1987-1997. https://doi.org/10.3201/eid3010.240245. |

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Medscape CME Activity
**Age- and Sex-Specific Differences in Lyme Disease Health-Related Behaviors, Ontario, Canada, 2015–2022**        [PDF - 1.05 MB - 10 pages]    
J. A. Adams et al.

We investigated differences in risk factors and preventive behaviors by age and sex among persons with reported Lyme disease in Ontario, Canada, during 2015–2022. Incidence rates peaked among children 5–9 and adults 50–79 years of age. Median age was higher for female than male case-patients (54 vs. 51 years). Male case-patients reported more activity in wooded and tall grass areas than did female case-patients; fewer male case-patients reported sharing living space with outdoor-exposed companion animals. As age increased, more case-patients reported activity in blacklegged tick habitats, exposure to ticks, and wearing adequate clothing, but fewer reported sharing living space with outdoor-exposed companion animals. Adoption of preventive behaviors was relatively low and did not differ by sex. Male case-patients, children 5–9 years of age and their parents or caregivers, and adults >59 years of age represent populations that would benefit from tailored public health messaging on Lyme disease prevention. 

| EID                                                                                                                                                                                                                                                                                                              | Adams JA, Osasah V, Paphitis K, Danish A, Mather RG, Russell CA, et al. Age- and Sex-Specific Differences in Lyme Disease Health-Related Behaviors, Ontario, Canada, 2015–2022. Emerg Infect Dis. 2024;30(10):2006-2015. https://doi.org/10.3201/eid3010.240191   |
|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Adams JA, Osasah V, Paphitis K, et al. Age- and Sex-Specific Differences in Lyme Disease Health-Related Behaviors, Ontario, Canada, 2015–2022. *Emerging Infectious Diseases*. 2024;30(10):2006-2015. doi:10.3201/eid3010.240191.                                                                                |
| Adams, J. A., Osasah, V., Paphitis, K., Danish, A., Mather, R. G., Russell, C. A....Nelder, M. P. (2024). Age- and Sex-Specific Differences in Lyme Disease Health-Related Behaviors, Ontario, Canada, 2015–2022. *Emerging Infectious Diseases*, *30*(10), 2006-2015. https://doi.org/10.3201/eid3010.240191.   |

----

Medscape CME Activity
**Clinical Aspects and Disease Severity of *Streptococcus dysgalactiae* Subspecies *equisimilis* Bacteremia, Finland**        [PDF - 573 KB - 9 pages]    
V. Nevanlinna et al.

We conducted a prospective study of 159 cases of *Streptococcus dysgalactiae* subspecies *equisimilis* (SDSE) bacteremia in 157 patients at 2 hospitals in Finland during November 2015–November 2019. Cellulitis was associated with nonsevere disease (p = 0.008); necrotizing fasciitis was associated with severe disease (p = 0.004). Fifty percent of patients had >1 clinical characteristic associated with risk for death. The case-fatality rate was 6%, and 7% of patients were treated in an intensive care unit. Blood leukocyte counts on days 2 (p = 0.032) and 3 (p = 0.020) and C-reactive protein levels on days 3 (p = 0.030) and 4 (p = 0.009) after admission were predictors of severe disease. The Pitt bacteremia score was an accurate predictor of death. Using the Pitt bacteremia score, leukocyte counts, and CRP responses during initial treatment can improve treatment strategies and survival for patients with SDSE.

| EID                                                                                                                                                                                                                                                                                            | Nevanlinna V, Aittoniemi J, Huttunen R, Luukkaala T, Rantala S. Clinical Aspects and Disease Severity of Streptococcus dysgalactiae Subspecies equisimilis Bacteremia, Finland. Emerg Infect Dis. 2024;30(9):1770-1778. https://doi.org/10.3201/eid3009.240278 |
|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Nevanlinna V, Aittoniemi J, Huttunen R, et al. Clinical Aspects and Disease Severity of Streptococcus dysgalactiae Subspecies equisimilis Bacteremia, Finland. *Emerging Infectious Diseases*. 2024;30(9):1770-1778. doi:10.3201/eid3009.240278.                                               |
| Nevanlinna, V., Aittoniemi, J., Huttunen, R., Luukkaala, T., & Rantala, S. (2024). Clinical Aspects and Disease Severity of Streptococcus dysgalactiae Subspecies equisimilis Bacteremia, Finland. *Emerging Infectious Diseases*, *30*(9), 1770-1778. https://doi.org/10.3201/eid3009.240278. |

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Medscape CME Activity
**Mortality Rate and Cause of Death in Adults with Extrapulmonary Nontuberculous Mycobacteria Infection, Denmark**        [PDF - 576 KB - 9 pages]    
A. A. Pedersen et al.

Evidence on mortality rates and causes of death associated with extrapulmonary nontuberculous mycobacteria (NTM) infection is limited. This nationwide register-based study in Denmark used diagnostic codes to match adult patients with extrapulmonary NTM infection 1:4 to controls. During 2000–2017, we identified 485 patients, who had significantly more comorbidities than controls. The 5-year mortality rate for patients was 26.8% (95% CI 23.1%–31.0%) and for controls, 10.9% (95% CI 9.6%–12.4%). The median age at death was 76 (interquartile range 63–85) years for patients and 84 (interquartile range 73–90) years for controls. The adjusted hazard rate of death for patients was 1.34 (95% CI 1.10–1.63; p = 0.004). Patients and controls mainly died of cardiovascular disease and solid malignant neoplasms. Hematologic malignancies and HIV were more frequently causes of death in patients. Mortality rates are substantial among patients with extrapulmonary NTM infection, predominantly caused by underlying conditions.

| EID                                                                                                                                                                                                                                                                                                                 | Pedersen AA, Dahl VN, Løkke A, Holden IK, Fløe A, Ibsen R, et al. Mortality Rate and Cause of Death in Adults with Extrapulmonary Nontuberculous Mycobacteria Infection, Denmark. Emerg Infect Dis. 2024;30(9):1790-1798. https://doi.org/10.3201/eid3009.240475   |
|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Pedersen AA, Dahl VN, Løkke A, et al. Mortality Rate and Cause of Death in Adults with Extrapulmonary Nontuberculous Mycobacteria Infection, Denmark. *Emerging Infectious Diseases*. 2024;30(9):1790-1798. doi:10.3201/eid3009.240475.                                                                             |
| Pedersen, A. A., Dahl, V. N., Løkke, A., Holden, I. K., Fløe, A., Ibsen, R....Johansen, I. S. (2024). Mortality Rate and Cause of Death in Adults with Extrapulmonary Nontuberculous Mycobacteria Infection, Denmark. *Emerging Infectious Diseases*, *30*(9), 1790-1798. https://doi.org/10.3201/eid3009.240475.   |

----

Medscape CME Activity
**Retrospective Study of Infections with *Corynebacterium diphtheriae* Species Complex, French Guiana, 2016–2021**        [PDF - 1.81 MB - 10 pages]    
M. Gaillet et al.

Human infections with *Corynebacterium**diphtheriae* species complex (CdSC) bacteria were rare in French Guiana until 2016, when the number of cases diagnosed increased. We conducted an epidemiologic, multicenter, retrospective study of all human CdSC infections diagnosed in French Guiana during January 1, 2016–December 31, 2021. A total of 64 infectious episodes were observed in 60 patients; 61 infections were caused by *C. diphtheriae* and 3 by *C*. *ulcerans*. Estimated incidence increased from 0.7 cases/100,000 population in 2016 to 7.7 cases/100,000 population in 2021. The mean patient age was 30.4 (+23.7) years, and male-to-female ratio was 1.7:1 (38/22). Of the 61 *C. diphtheriae* isolates, 5 tested positive for the diphtheria toxin gene, and all results were negative by Elek test; 95% (61/64) of cases were cutaneous, including the *C. ulcerans* cases. The increase in reported human infections underscores the need to raise awareness among frontline healthcare practitioners to improve prevention.

| EID                                                                                                                                                                                                                                                                                                       | Gaillet M, Hennart M, Rose V, Badell E, Michaud C, Blaizot R, et al. Retrospective Study of Infections with Corynebacterium diphtheriae Species Complex, French Guiana, 2016–2021. Emerg Infect Dis. 2024;30(8):1545-1554. https://doi.org/10.3201/eid3008.231671   |
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| Gaillet M, Hennart M, Rose V, et al. Retrospective Study of Infections with Corynebacterium diphtheriae Species Complex, French Guiana, 2016–2021. *Emerging Infectious Diseases*. 2024;30(8):1545-1554. doi:10.3201/eid3008.231671.                                                                      |
| Gaillet, M., Hennart, M., Rose, V., Badell, E., Michaud, C., Blaizot, R....Brisse, S. (2024). Retrospective Study of Infections with Corynebacterium diphtheriae Species Complex, French Guiana, 2016–2021. *Emerging Infectious Diseases*, *30*(8), 1545-1554. https://doi.org/10.3201/eid3008.231671.   |

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Medscape CME Activity
**Archaea in the Human Microbiome and Potential Effects on Human Infectious Disease**        [PDF - 991 KB - 9 pages]    
S. Duller and C. Moissl-Eichinger

Archaea represent a separate domain of life, next to bacteria and eukarya. As components of the human microbiome, archaea have been associated with various diseases, including periodontitis, endodontic infections, small intestinal bacterial overgrowth, and urogenital tract infections. Archaea are generally considered nonpathogenic; the reasons are speculative because of limited knowledge and gene annotation challenges. Nevertheless, archaeal syntrophic principles that shape global microbial networks aid both archaea and potentially pathogenic bacteria. Evaluating archaea interactions remains challenging, requiring clinical studies on inflammatory potential and the effects of archaeal metabolism. Establishing a culture collection is crucial for investigating archaea functions within the human microbiome, which could improve health outcomes in infectious diseases. We summarize potential reasons for archaeal nonpathogenicity, assess the association with infectious diseases in humans, and discuss the necessary experimental steps to enable mechanistic studies involving archaea.

| EID                                                                                                                                                                                                                       | Duller S, Moissl-Eichinger C. Archaea in the Human Microbiome and Potential Effects on Human Infectious Disease. Emerg Infect Dis. 2024;30(8):1505-1513. https://doi.org/10.3201/eid3008.240181 |
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| Duller S, Moissl-Eichinger C. Archaea in the Human Microbiome and Potential Effects on Human Infectious Disease. *Emerging Infectious Diseases*. 2024;30(8):1505-1513. doi:10.3201/eid3008.240181.                        |
| Duller, S., & Moissl-Eichinger, C. (2024). Archaea in the Human Microbiome and Potential Effects on Human Infectious Disease. *Emerging Infectious Diseases*, *30*(8), 1505-1513. https://doi.org/10.3201/eid3008.240181. |

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Medscape CME Activity
**Infectious Diseases and Clinical Xenotransplantation**        [PDF - 636 KB - 8 pages]    
J. A. Fishman and N. J. Mueller

Xenotransplantation, transplantation into humans of vascularized organs or viable cells from nonhuman species, is a potential solution to shortages of transplantable human organs. Among challenges to application of clinical xenotransplantation are unknown risks of transmission of animal microbes to immunosuppressed recipients or the community. Experience in allotransplantation and in preclinical models suggests that viral infections are the greatest concern. Worldwide, the distribution of swine pathogens is heterogeneous and cannot be fully controlled by international agricultural regulations. It is possible to screen source animals for potential human pathogens before procuring organs in a manner not possible within the time available for surveillance testing in allotransplantation. Infection control measures require microbiological assays for surveillance of source animals and xenograft recipients and research into zoonotic potential of porcine organisms. Available data suggest that infectious risks of xenotransplantation are manageable and that clinical trials can advance with appropriate protocols for microbiological monitoring of source animals and recipients.

| EID                                                                                                                                                                                        | Fishman JA, Mueller NJ. Infectious Diseases and Clinical Xenotransplantation. Emerg Infect Dis. 2024;30(7):1311-1318. https://doi.org/10.3201/eid3007.240273 |
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| Fishman JA, Mueller NJ. Infectious Diseases and Clinical Xenotransplantation. *Emerging Infectious Diseases*. 2024;30(7):1311-1318. doi:10.3201/eid3007.240273.                            |
| Fishman, J. A., & Mueller, N. J. (2024). Infectious Diseases and Clinical Xenotransplantation. *Emerging Infectious Diseases*, *30*(7), 1311-1318. https://doi.org/10.3201/eid3007.240273. |

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Medscape CME Activity
**Carbapenem-Resistant and Extended-Spectrum β-Lactamase–Producing Enterobacterales in Children, United States, 2016–2020**        [PDF - 912 KB - 11 pages]    
H. N. Grome et al.

We conducted surveillance for carbapenem-resistant Enterobacterales (CRE) during 2016–2020 at 10 US sites and extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) during 2019–2020 at 6 US sites. Among 159 CRE cases in children (median age 5 years), CRE was isolated from urine for 131 (82.4%) and blood from 20 (12.6%). Annual CRE incidence rate (cases/100,000 population) was 0.47–0.87. Among 207 ESBL-E cases in children (median age 6 years), ESBL-E was isolated from urine of 196 (94.7%) and blood of 8 (3.9%). Annual ESBL-E incidence rate was 26.5 in 2019 and 19.63 in 2020. CRE and ESBL-E rates were >2-fold higher among infants than other age groups. Most CRE and ESBL-E cases were healthcare-associated community-onset (68 [43.0%] for CRE vs. 40 [23.7%] for ESBL-E) or community-associated (43 [27.2%] for CRE vs. 109 [64.5%] for ESBL-E). Programs to detect, prevent, and treat multidrug-resistant infections must include pediatric populations (particularly the youngest) and outpatient settings.

| EID                                                                                                                                                                                                                                                                                                                           | Grome HN, Grass JE, Duffy N, Bulens SN, Ansari U, Campbell D, et al. Carbapenem-Resistant and Extended-Spectrum β-Lactamase–Producing Enterobacterales in Children, United States, 2016–2020. Emerg Infect Dis. 2024;30(6):1104-1114. https://doi.org/10.3201/eid3006.231734      |
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| Grome HN, Grass JE, Duffy N, et al. Carbapenem-Resistant and Extended-Spectrum β-Lactamase–Producing Enterobacterales in Children, United States, 2016–2020. *Emerging Infectious Diseases*. 2024;30(6):1104-1114. doi:10.3201/eid3006.231734.                                                                                |
| Grome, H. N., Grass, J. E., Duffy, N., Bulens, S. N., Ansari, U., Campbell, D....Guh, A. Y. (2024). Carbapenem-Resistant and Extended-Spectrum β-Lactamase–Producing Enterobacterales in Children, United States, 2016–2020. *Emerging Infectious Diseases*, *30*(6), 1104-1114. https://doi.org/10.3201/eid3006.231734.      |

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Medscape CME Activity
**Crimean-Congo Hemorrhagic Fever Virus for Clinicians—Epidemiology, Clinical Manifestations, and Prevention**        [PDF - 1.59 MB - 10 pages]    
M. G. Frank et al.

Crimean-Congo hemorrhagic fever (CCHF) is a tickborne infection that can range from asymptomatic to fatal and has been described in >30 countries. Early identification and isolation of patients with suspected or confirmed CCHF and the use of appropriate prevention and control measures are essential for preventing human-to-human transmission. Here, we provide an overview of the epidemiology, clinical features, and prevention and control of CCHF. CCHF poses a continued public health threat given its wide geographic distribution, potential to spread to new regions, propensity for genetic variability, and potential for severe and fatal illness, in addition to the limited medical countermeasures for prophylaxis and treatment.  A high index of suspicion, comprehensive travel and epidemiologic history, and clinical evaluation are essential for prompt diagnosis. Infection control measures can be effective in reducing the risk for transmission but require correct and consistent application.

| EID                                                                                                                                                                                                                                                   | Frank MG, Weaver G, Raabe V. Crimean-Congo Hemorrhagic Fever Virus for Clinicians—Epidemiology, Clinical Manifestations, and Prevention. Emerg Infect Dis. 2024;30(5):854-863. https://doi.org/10.3201/eid3005.231647   |
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| Frank MG, Weaver G, Raabe V. Crimean-Congo Hemorrhagic Fever Virus for Clinicians—Epidemiology, Clinical Manifestations, and Prevention. *Emerging Infectious Diseases*. 2024;30(5):854-863. doi:10.3201/eid3005.231647.                              |
| Frank, M. G., Weaver, G., & Raabe, V. (2024). Crimean-Congo Hemorrhagic Fever Virus for Clinicians—Epidemiology, Clinical Manifestations, and Prevention. *Emerging Infectious Diseases*, *30*(5), 854-863. https://doi.org/10.3201/eid3005.231647.   |

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Medscape CME Activity
**Crimean-Congo Hemorrhagic Fever Virus for Clinicians—Diagnosis, Clinical Management, and Therapeutics**        [PDF - 1.20 MB - 10 pages]    
M. G. Frank et al.

Crimean-Congo hemorrhagic fever virus (CCHFV) is the most geographically widespread tickborne viral infection worldwide and has a fatality rate of up to 62%. Despite its widespread range and high fatality rate, no vaccines or treatments are currently approved by regulatory agencies in the United States or Europe. Supportive treatment remains the standard of care, but the use of antiviral medications developed for other viral infections have been considered. We reviewed published literature to summarize the main aspects of CCHFV infection in humans. We provide an overview of diagnostic testing and management and medical countermeasures, including investigational vaccines and limited therapeutics. CCHFV continues to pose a public health threat because of its wide geographic distribution, potential to spread to new regions, propensity for genetic variability, potential for severe and fatal illness, and limited medical countermeasures for prophylaxis and treatment. Clinicians should become familiar with available diagnostic and management tools for CCHFV infections in humans.

| EID                                                                                                                                                                                                                                              | Frank MG, Weaver G, Raabe V. Crimean-Congo Hemorrhagic Fever Virus for Clinicians—Diagnosis, Clinical Management, and Therapeutics. Emerg Infect Dis. 2024;30(5):864-873. https://doi.org/10.3201/eid3005.231648   |
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| Frank MG, Weaver G, Raabe V. Crimean-Congo Hemorrhagic Fever Virus for Clinicians—Diagnosis, Clinical Management, and Therapeutics. *Emerging Infectious Diseases*. 2024;30(5):864-873. doi:10.3201/eid3005.231648.                              |
| Frank, M. G., Weaver, G., & Raabe, V. (2024). Crimean-Congo Hemorrhagic Fever Virus for Clinicians—Diagnosis, Clinical Management, and Therapeutics. *Emerging Infectious Diseases*, *30*(5), 864-873. https://doi.org/10.3201/eid3005.231648.   |

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Medscape CME Activity
**Deaths Associated with Pediatric Hepatitis of Unknown Etiology, United States, October 2021–June 2023**        [PDF - 1.13 MB - 10 pages]    
O. Almendares et al.

During October 2021–June 2023, a total of 392 cases of acute hepatitis of unknown etiology in children in the United States were reported to Centers for Disease Control and Prevention as part of national surveillance. We describe demographic and clinical characteristics, including potential involvement of adenovirus in development of acute hepatitis, of 8 fatally ill children who met reporting criteria. The children had diverse courses of illness. Two children were immunocompromised when initially brought for care. Four children tested positive for adenovirus in multiple specimen types, including 2 for whom typing was completed. One adenovirus-positive child had no known underlying conditions, supporting a potential relationship between adenovirus and acute hepatitis in previously healthy children. Our findings emphasize the importance of continued investigation to determine the mechanism of liver injury and appropriate treatment. Testing for adenovirus in similar cases could elucidate the role of the virus.

| EID                                                                                                                                                                                                                                                                                                                         | Almendares O, Baker JM, Sugerman DE, Parashar UD, Reagan-Steiner S, Kirking HL, et al. Deaths Associated with Pediatric Hepatitis of Unknown Etiology, United States, October 2021–June 2023. Emerg Infect Dis. 2024;30(4):644-653. https://doi.org/10.3201/eid3004.231140   |
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| Almendares O, Baker JM, Sugerman DE, et al. Deaths Associated with Pediatric Hepatitis of Unknown Etiology, United States, October 2021–June 2023. *Emerging Infectious Diseases*. 2024;30(4):644-653. doi:10.3201/eid3004.231140.                                                                                          |
| Almendares, O., Baker, J. M., Sugerman, D. E., Parashar, U. D., Reagan-Steiner, S., Kirking, H. L....Tate, J. E. (2024). Deaths Associated with Pediatric Hepatitis of Unknown Etiology, United States, October 2021–June 2023. *Emerging Infectious Diseases*, *30*(4), 644-653. https://doi.org/10.3201/eid3004.231140.   |

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Medscape CME Activity
**Concurrent Outbreaks of Hepatitis A, Invasive Meningococcal Disease, and Mpox, Florida, USA, 2021–2022**        [PDF - 1.82 MB - 11 pages]    
T. J. Doyle et al.

In 2022, concurrent outbreaks of hepatitis A, invasive meningococcal disease (IMD), and mpox were identified in Florida, USA, primarily among men who have sex with men. The hepatitis A outbreak (153 cases) was associated with hepatitis A virus genotype IA. The IMD outbreak (44 cases) was associated with *Neisseria meningitidis* serogroup C, sequence type 11, clonal complex 11. The mpox outbreak in Florida (2,845 cases) was part of a global epidemic. The hepatitis A and IMD outbreaks were concentrated in Central Florida and peaked during March–­June, whereas mpox cases were more heavily concentrated in South Florida and had peak incidence in August. HIV infection was more common (52%) among mpox cases than among hepatitis A (21%) or IMD (34%) cases. Where feasible, vaccination against hepatitis A, meningococcal disease, and mpox should be encouraged among at-risk groups and offered along with program services that target those groups.

| EID                                                                                                                                                                                                                                                                                                 | Doyle TJ, Gumke M, Stanek D, Moore J, Buck B, Locksmith T, et al. Concurrent Outbreaks of Hepatitis A, Invasive Meningococcal Disease, and Mpox, Florida, USA, 2021–2022. Emerg Infect Dis. 2024;30(4):634-643. https://doi.org/10.3201/eid3004.231392   |
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| Doyle TJ, Gumke M, Stanek D, et al. Concurrent Outbreaks of Hepatitis A, Invasive Meningococcal Disease, and Mpox, Florida, USA, 2021–2022. *Emerging Infectious Diseases*. 2024;30(4):634-643. doi:10.3201/eid3004.231392.                                                                         |
| Doyle, T. J., Gumke, M., Stanek, D., Moore, J., Buck, B., Locksmith, T....Chacreton, D. (2024). Concurrent Outbreaks of Hepatitis A, Invasive Meningococcal Disease, and Mpox, Florida, USA, 2021–2022. *Emerging Infectious Diseases*, *30*(4), 634-643. https://doi.org/10.3201/eid3004.231392.   |

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Medscape CME Activity
**Disseminated Leishmaniasis, a Severe Form of *Leishmania braziliensis* Infection**        [PDF - 1004 KB - 9 pages]    
P. Machado et al.

Disseminated leishmaniasis (DL) is an emergent severe disease manifesting with multiple lesions. To determine the relationship between immune response and clinical and therapeutic outcomes, we studied 101 DL and 101 cutaneous leishmaniasis (CL) cases and determined cytokines and chemokines in supernatants of mononuclear cells stimulated with leishmania antigen. Patients were treated with meglumine antimoniate (20 mg/kg) for 20 days (CL) or 30 days (DL); 19 DL patients were instead treated with amphotericin B, miltefosine, or miltefosine and meglumine antimoniate. High levels of chemokine ligand 9 were associated with more severe DL. The cure rate for meglumine antimoniate was low for both DL (44%) and CL (60%), but healing time was longer in DL (p = 0.003). The lowest cure rate (22%) was found in DL patients with >100 lesions. However, meglumine antimoniate/miltefosine treatment cured all DL patients who received it; therefore, that combination should be considered as first choice therapy.

| EID                                                                                                                                                                                                                                                                                 | Machado P, Lago A, Cardoso TM, Magalhaes A, Carvalho LP, Lago T, et al. Disseminated Leishmaniasis, a Severe Form of Leishmania braziliensis Infection. Emerg Infect Dis. 2024;30(3):510-518. https://doi.org/10.3201/eid3003.230786 |
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| Machado P, Lago A, Cardoso TM, et al. Disseminated Leishmaniasis, a Severe Form of Leishmania braziliensis Infection. *Emerging Infectious Diseases*. 2024;30(3):510-518. doi:10.3201/eid3003.230786.                                                                               |
| Machado, P., Lago, A., Cardoso, T. M., Magalhaes, A., Carvalho, L. P., Lago, T....Carvalho, E. M. (2024). Disseminated Leishmaniasis, a Severe Form of Leishmania braziliensis Infection. *Emerging Infectious Diseases*, *30*(3), 510-518. https://doi.org/10.3201/eid3003.230786. |

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Medscape CME Activity
**Molecular Epidemiology of Underreported Emerging Zoonotic Pathogen *Streptococcus suis* in Europe**        [PDF - 2.15 MB - 10 pages]    
J. Brizuela et al.

*Streptococcus suis*, a zoonotic bacterial pathogen circulated through swine, can cause severe infections in humans. Because human *S. suis* infections are not notifiable in most countries, incidence is underestimated. We aimed to increase insight into the molecular epidemiology of human *S. suis* infections in Europe. To procure data, we surveyed 7 reference laboratories and performed a systematic review of the scientific literature. We identified 236 cases of human *S. suis* infection from those sources and an additional 87 by scanning gray literature. We performed whole-genome sequencing to type 46 zoonotic *S. suis* isolates and combined them with 28 publicly available genomes in a core-genome phylogeny. Clonal complex (CC) 1 isolates accounted for 87% of typed human infections; CC20, CC25, CC87, and CC94 also caused infections. Emergence of diverse zoonotic clades and notable severity of illness in humans support classifying *S. suis* infection as a notifiable condition. 

| EID                                                                                                                                                                                                                                                                                                        | Brizuela J, Roodsant TJ, Hasnoe Q, van der Putten B, Kozakova J, Slotved H, et al. Molecular Epidemiology of Underreported Emerging Zoonotic Pathogen Streptococcus suis in Europe. Emerg Infect Dis. 2024;30(3):413-422. https://doi.org/10.3201/eid3003.230348 |
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| Brizuela J, Roodsant TJ, Hasnoe Q, et al. Molecular Epidemiology of Underreported Emerging Zoonotic Pathogen Streptococcus suis in Europe. *Emerging Infectious Diseases*. 2024;30(3):413-422. doi:10.3201/eid3003.230348.                                                                                 |
| Brizuela, J., Roodsant, T. J., Hasnoe, Q., van der Putten, B., Kozakova, J., Slotved, H....Schultsz, C. (2024). Molecular Epidemiology of Underreported Emerging Zoonotic Pathogen Streptococcus suis in Europe. *Emerging Infectious Diseases*, *30*(3), 413-422. https://doi.org/10.3201/eid3003.230348. |

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Medscape CME Activity
**Prevalence of SARS-CoV-2 Infection among Children and Adults in 15 US Communities, 2021**        [PDF - 2.24 MB - 10 pages]    
J. Justman et al.

During January–August 2021, the Community Prevalence of SARS-CoV-2 Study used time/location sampling to recruit a cross-sectional, population-based cohort to estimate SARS-CoV-2 seroprevalence and nasal swab sample PCR positivity across 15 US communities. Survey-weighted estimates of SARS-CoV-2 infection and vaccine willingness among participants at each site were compared within demographic groups by using linear regression models with inverse variance weighting. Among 22,284 persons >2 months of age and older, median prevalence of infection (prior, active, or both) was 12.9% across sites and similar across age groups. Within each site, average prevalence of infection was 3 percentage points higher for Black than White persons and average vaccine willingness was 10 percentage points lower for Black than White persons and 7 percentage points lower for Black persons than for persons in other racial groups. The higher prevalence of SARS-CoV-2 infection among groups with lower vaccine willingness highlights the disparate effect of COVID-19 and its complications.

| EID                                                                                                                                                                                                                                                                                        | Justman J, Skalland T, Moore A, Amos CI, Marzinke MA, Zangeneh SZ, et al. Prevalence of SARS-CoV-2 Infection among Children and Adults in 15 US Communities, 2021. Emerg Infect Dis. 2024;30(2):245-254. https://doi.org/10.3201/eid3002.230863 |
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| Justman J, Skalland T, Moore A, et al. Prevalence of SARS-CoV-2 Infection among Children and Adults in 15 US Communities, 2021. *Emerging Infectious Diseases*. 2024;30(2):245-254. doi:10.3201/eid3002.230863.                                                                            |
| Justman, J., Skalland, T., Moore, A., Amos, C. I., Marzinke, M. A., Zangeneh, S. Z....Ahmed, S. (2024). Prevalence of SARS-CoV-2 Infection among Children and Adults in 15 US Communities, 2021. *Emerging Infectious Diseases*, *30*(2), 245-254. https://doi.org/10.3201/eid3002.230863. |

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Medscape CME Activity
**Multicenter Retrospective Study of Invasive Fusariosis in Intensive Care Units, France**        [PDF - 1.68 MB - 10 pages]    
J. Demonchy et al.

Invasive fusariosis can be life-threatening, especially in immunocompromised patients who require intensive care unit (ICU) admission. We conducted a multicenter retrospective study to describe clinical and biologic characteristics, patient outcomes, and factors associated with death and response to antifungal therapy. We identified 55 patients with invasive fusariosis from 16 ICUs in France during 2002­–­­2020. The mortality rate was high (56%). Fusariosis-related pneumonia occurred in 76% of patients, often leading to acute respiratory failure. Factors associated with death included elevated sequential organ failure assessment score at ICU admission or history of allogeneic hematopoietic stem cell transplantation or hematologic malignancies. Neither voriconazole treatment nor disseminated fusariosis were strongly associated with response to therapy. Invasive fusariosis can lead to multiorgan failure and is associated with high mortality rates in ICUs. Clinicians should closely monitor ICU patients with a history of hematologic malignancies or stem cell transplantation because of higher risk for death.

| EID                                                                                                                                                                                                                                                                                 | Demonchy J, Biard L, Clere-Jehl R, Wallet F, Mokart D, Moreau A, et al. Multicenter Retrospective Study of Invasive Fusariosis in Intensive Care Units, France. Emerg Infect Dis. 2024;30(2):215-224. https://doi.org/10.3201/eid3002.231221 |
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| Demonchy J, Biard L, Clere-Jehl R, et al. Multicenter Retrospective Study of Invasive Fusariosis in Intensive Care Units, France. *Emerging Infectious Diseases*. 2024;30(2):215-224. doi:10.3201/eid3002.231221.                                                                   |
| Demonchy, J., Biard, L., Clere-Jehl, R., Wallet, F., Mokart, D., Moreau, A....Zafrani, L. (2024). Multicenter Retrospective Study of Invasive Fusariosis in Intensive Care Units, France. *Emerging Infectious Diseases*, *30*(2), 215-224. https://doi.org/10.3201/eid3002.231221. |

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Medscape CME Activity
**Early-Onset Infection Caused by *Escherichia coli* Sequence Type 1193 in Late Preterm and Full-Term Neonates**        [PDF - 1.35 MB - 9 pages]    
C. Malaure et al.

Using whole-genome sequencing, we characterized *Escherichia coli* strains causing early-onset sepsis (EOS) in 32 neonatal cases from a 2019–2021 prospective multicenter study in France and compared them to *E. coli* strains collected from vaginal swab specimens from women in third-trimester gestation. We observed no major differences in phylogenetic groups or virulence profiles between the 2 collections. However, sequence type (ST) analysis showed the presence of 6/32 (19%) ST1193 strains causing EOS, the same frequency as in the highly virulent clonal group ST95. Three ST1193 strains caused meningitis, and 3 harbored extended-spectrum β-lactamase. No ST1193 strains were isolated from vaginal swab specimens. Emerging ST1193 appears to be highly prevalent, virulent, and antimicrobial resistant in neonates. However, the physiopathology of EOS caused by ST1193 has not yet been elucidated. Clinicians should be aware of the possible presence of *E. coli* ST1193 in prenatal and neonatal contexts and provide appropriate monitoring and treatment. 

| EID                                                                                                                                                                                                                                                                                                 | Malaure C, Geslain G, Birgy A, Bidet P, Poilane I, Allain M, et al. Early-Onset Infection Caused by Escherichia coli Sequence Type 1193 in Late Preterm and Full-Term Neonates. Emerg Infect Dis. 2024;30(1):20-28. https://doi.org/10.3201/eid3001.230851 |
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| Malaure C, Geslain G, Birgy A, et al. Early-Onset Infection Caused by Escherichia coli Sequence Type 1193 in Late Preterm and Full-Term Neonates. *Emerging Infectious Diseases*. 2024;30(1):20-28. doi:10.3201/eid3001.230851.                                                                     |
| Malaure, C., Geslain, G., Birgy, A., Bidet, P., Poilane, I., Allain, M....Bonacorsi, S. (2024). Early-Onset Infection Caused by Escherichia coli Sequence Type 1193 in Late Preterm and Full-Term Neonates. *Emerging Infectious Diseases*, *30*(1), 20-28. https://doi.org/10.3201/eid3001.230851. |

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Medscape CME Activity
***Auritidibacter ignavus*, an Emerging Pathogen Associated with Chronic Ear Infections**        [PDF - 1.54 MB - 5 pages]    
S. Roth et al.

We describe detection of the previously rarely reported gram-positive bacterium *Auritidibacter ignavus* in 3 cases of chronic ear infections in Germany. In all 3 cases, the patients had refractory otorrhea. Although their additional symptoms varied, all patients had an ear canal stenosis and *A. ignavus* detected in microbiologic swab specimens. A correct identification of *A. ignavus* in the clinical microbiology laboratory is hampered by the inability to identify it by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Also, the bacterium might easily be overlooked because of its morphologic similarity to bacterial species of the resident skin flora. We conclude that a high index of suspicion is warranted to identify *A. ignavus* and that it should be particularly considered in patients with chronic external otitis who do not respond clinically to quinolone ear drop therapy.

| EID                                                                                                                                                                                                                                                                | Roth S, Linxweiler M, Rehner J, Schmartz G, Becker SL, Kühn J. Auritidibacter ignavus, an Emerging Pathogen Associated with Chronic Ear Infections. Emerg Infect Dis. 2024;30(1):8-12. https://doi.org/10.3201/eid3001.230385  |
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| Roth S, Linxweiler M, Rehner J, et al. Auritidibacter ignavus, an Emerging Pathogen Associated with Chronic Ear Infections. *Emerging Infectious Diseases*. 2024;30(1):8-12. doi:10.3201/eid3001.230385.                                                           |
| Roth, S., Linxweiler, M., Rehner, J., Schmartz, G., Becker, S. L., & Kühn, J. (2024). Auritidibacter ignavus, an Emerging Pathogen Associated with Chronic Ear Infections. *Emerging Infectious Diseases*, *30*(1), 8-12. https://doi.org/10.3201/eid3001.230385.  |

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Medscape CME Activity
**Invasive *Nocardia* Infections across Distinct Geographic Regions, United States**        [PDF - 1.33 MB - 9 pages]    
S. Gupta et al.

We reviewed invasive *Nocardia* infections in 3 noncontiguous geographic areas in the United States during 2011–2018. Among 268 patients with invasive nocardiosis, 48.2% were from Minnesota, 32.4% from Arizona, and 19.4% from Florida. Predominant species were *N. nova* complex in Minnesota (33.4%), *N. cyriacigeorgica* in Arizona (41.4%), and *N. brasiliensis* in Florida (17.3%). Transplant recipients accounted for 82/268 (30.6%) patients overall: 14 (10.9%) in Minnesota, 35 (40.2%) in Arizona, and 33 (63.5%) in Florida. Manifestations included isolated pulmonary nocardiosis among 73.2% of transplant and 84.4% of non–transplant patients and central nervous system involvement among 12.2% of transplant and 3.2% of non–transplant patients. *N. farcinica* (20.7%) and *N. cyriacigeorgica* (19.5%) were the most common isolates among transplant recipients and *N. cyriacigeorgica* (38.0%), *N. nova complex* (23.7%), and *N. farcinica* (16.1%) among non–transplant patients. Overall antimicrobial susceptibilities were similar across the 3 study sites. 

| EID                                                                                                                                                                                                                                                                                      | Gupta S, Grant LM, Powers HR, Kimes KE, Hamdi A, Butterfield RJ, et al. Invasive Nocardia Infections across Distinct Geographic Regions, United States. Emerg Infect Dis. 2023;29(12):2417-2425. https://doi.org/10.3201/eid2912.230673 |
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| Gupta S, Grant LM, Powers HR, et al. Invasive Nocardia Infections across Distinct Geographic Regions, United States. *Emerging Infectious Diseases*. 2023;29(12):2417-2425. doi:10.3201/eid2912.230673.                                                                                  |
| Gupta, S., Grant, L. M., Powers, H. R., Kimes, K. E., Hamdi, A., Butterfield, R. J....Vikram, H. R. (2023). Invasive Nocardia Infections across Distinct Geographic Regions, United States. *Emerging Infectious Diseases*, *29*(12), 2417-2425. https://doi.org/10.3201/eid2912.230673. |

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Medscape CME Activity
**Risk Factors for Enteric Pathogen Exposure among Children in Black Belt Region of Alabama, USA**        [PDF - 1.55 MB - 9 pages]    
D. Capone et al.

We collected stool from school-age children from 352 households living in the Black Belt region of Alabama, USA, where sanitation infrastructure is lacking. We used quantitative reverse transcription PCR to measure key pathogens in stool that may be associated with water and sanitation, as an indicator of exposure. We detected genes associated with >1 targets in 26% of specimens, most frequently *Clostridioides difficile* (6.6%), atypical enteropathogenic *Escherichia coli* (6.1%), and enteroaggregative *E. coli* (3.9%). We used generalized estimating equations to assess reported risk factors for detecting >1 pathogen in stool. We found no association between lack of sanitation and pathogen detection (adjusted risk ratio 0.95 [95% CI 0.55–1.7]) compared with specimens from children served by sewerage. However, we did observe an increased risk for pathogen detection among children living in homes with well water (adjusted risk ratio 1.7 [95% CI 1.1–2.5]) over those reporting water utility service.

| EID                                                                                                                                                                                                                                                                                            | Capone D, Bakare T, Barker T, Chatham A, Clark R, Copperthwaite L, et al. Risk Factors for Enteric Pathogen Exposure among Children in Black Belt Region of Alabama, USA. Emerg Infect Dis. 2023;29(12):2434-2442. https://doi.org/10.3201/eid2912.230780 |
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| Capone D, Bakare T, Barker T, et al. Risk Factors for Enteric Pathogen Exposure among Children in Black Belt Region of Alabama, USA. *Emerging Infectious Diseases*. 2023;29(12):2434-2442. doi:10.3201/eid2912.230780.                                                                        |
| Capone, D., Bakare, T., Barker, T., Chatham, A., Clark, R., Copperthwaite, L....Brown, J. (2023). Risk Factors for Enteric Pathogen Exposure among Children in Black Belt Region of Alabama, USA. *Emerging Infectious Diseases*, *29*(12), 2434-2442. https://doi.org/10.3201/eid2912.230780. |

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Medscape CME Activity
***Campylobacter fetus* Invasive Infections and Risks for Death, France, 2000–2021**        [PDF - 853 KB - 9 pages]    
S. Zayet et al.

*Campylobacter fetus* accounts for 1% of *Campylobacter* spp. infections, but prevalence of bacteremia and risk for death are high. To determine clinical features of *C. fetus* infections and risks for death, we conducted a retrospective observational study of all adult inpatients with a confirmed *C. fetus* infection in Nord Franche-Comté Hospital, Trevenans, France, during January 2000–December 2021. Among 991 patients with isolated *Campylobacter* spp. strains, we identified 39 (4%) with culture-positive *C. fetus* infections, of which 33 had complete records and underwent further analysis; 21 had documented bacteremia and 12 did not. Secondary localizations were reported for 7 (33%) patients with *C. fetus* bacteremia, of which 5 exhibited a predilection for vascular infections (including 3 with mycotic aneurysm). Another 7 (33%) patients with *C. fetus* bacteremia died within 30 days. Significant risk factors associated with death within 30 days were dyspnea, quick sequential organ failure assessment score >2 at admission, and septic shock.

| EID                                                                                                                                                                                                                                                                                 | Zayet S, Klopfenstein T, Gendrin V, Vuillemenot J, Plantin J, Toko L, et al. Campylobacter fetus Invasive Infections and Risks for Death, France, 2000–2021. Emerg Infect Dis. 2023;29(11):2189-2197. https://doi.org/10.3201/eid2911.230598   |
|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Zayet S, Klopfenstein T, Gendrin V, et al. Campylobacter fetus Invasive Infections and Risks for Death, France, 2000–2021. *Emerging Infectious Diseases*. 2023;29(11):2189-2197. doi:10.3201/eid2911.230598.                                                                       |
| Zayet, S., Klopfenstein, T., Gendrin, V., Vuillemenot, J., Plantin, J., Toko, L....Royer, P. (2023). Campylobacter fetus Invasive Infections and Risks for Death, France, 2000–2021. *Emerging Infectious Diseases*, *29*(11), 2189-2197. https://doi.org/10.3201/eid2911.230598.   |

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Medscape CME Activity
**Group A *Streptococcus* Primary Peritonitis in Children, New Zealand**        [PDF - 916 KB - 7 pages]    
A. Taylor et al.

Group A *Streptococcus* (GAS) primary peritonitis is a rare cause of pediatric acute abdomen (sudden onset of severe abdominal pain); only 26 pediatric cases have been reported in the English language literature since 1980. We discuss 20 additional cases of pediatric primary peritonitis caused by GAS among patients at Starship Children’s Hospital, Auckland, New Zealand, during 2010–2022. We compare identified cases of GAS primary peritonitis to cases described in the existing pediatric literature. As rates of rates of invasive GAS increase globally, clinicians should be aware of this cause of unexplained pediatric acute abdomen. 

| EID                                                                                                                                                                                                                                                              | Taylor A, Elliott BM, Atkinson J, Roberts S, Voss L, Best EJ, et al. Group A Streptococcus Primary Peritonitis in Children, New Zealand. Emerg Infect Dis. 2023;29(11):2203-2209. https://doi.org/10.3201/eid2911.230211 |
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| Taylor A, Elliott BM, Atkinson J, et al. Group A Streptococcus Primary Peritonitis in Children, New Zealand. *Emerging Infectious Diseases*. 2023;29(11):2203-2209. doi:10.3201/eid2911.230211.                                                                  |
| Taylor, A., Elliott, B. M., Atkinson, J., Roberts, S., Voss, L., Best, E. J....Webb, R. (2023). Group A Streptococcus Primary Peritonitis in Children, New Zealand. *Emerging Infectious Diseases*, *29*(11), 2203-2209. https://doi.org/10.3201/eid2911.230211. |

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