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Although commendable progress for combating malaria in endemic areas has been achieved and a dozen countries have been declared malaria-free since 2000 (1), increasing international travel has led to a [...]

Outbreaks of hepatitis A have been previously reported among gay, bisexual, and other men who have sex with men (MSM) (1). Numerous outbreaks of hepatitis A among MSM were reported [...]

Dengue virus (DENV) is not endemic in the continental United States (1); most cases occur among travelers to DENV-endemic areas (2). In Florida, USA, DENV infections are primarily reported among [...]

On August 27, 2024, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). Beginning in late 2023, Oropouche virus was identified as the cause of large outbreaks in Amazon regions with known endemic transmission and in new areas in South America and the Caribbean. The virus is spread to humans by infected biting midges and some mosquito species. Although infection typically causes a self-limited febrile illness, reports of two deaths in patients with Oropouche virus infection and vertical transmission associated with adverse pregnancy outcomes have raised concerns about the threat of this virus to human health. In addition to approximately 8,000 locally acquired cases in the Americas, travel-associated Oropouche virus disease cases have recently been identified in European travelers returning from Cuba and Brazil. As of August 16, 2024, a total of 21 Oropouche virus disease cases were identified among U.S. travelers returning from Cuba. Most patients initially experienced fever, myalgia, and headache, often with other symptoms including arthralgia, diarrhea, nausea or vomiting, and rash. At least three patients had recurrent symptoms after the initial illness, a common characteristic of Oropouche virus disease. Clinicians and public health jurisdictions should be aware of the occurrence of Oropouche virus disease in U.S. travelers and request testing for suspected cases. Travelers should prevent insect bites when traveling, and pregnant persons should consider deferring travel to areas experiencing outbreaks of Oropouche virus disease. [ABSTRACT FROM AUTHOR]

Zika virus is a flavivirus that was first isolated in 1947 from a rhesus macaque in the Zika Forest in Uganda. Zika virus is primarily transmitted to humans by infected [...]

Eight cases of locally acquired, mosquito-transmitted (i.e., autochthonous) Plasmodium vivax malaria, which has not been reported in the United States since 2003, were reported to CDC from state health departments in Florida and Texas during May 18--July 17, 2023. As of August 4, 2023, case surveillance, mosquito surveillance and control activities, and public outreach and education activities continue in both states. U.S. clinicians need to consider a malaria diagnosis in patients with unexplained fever, especially in areas where autochthonous malaria has been recently reported, although the risk for autochthonous malaria in the United States remains very low. Prompt diagnosis and treatment of malaria can prevent severe disease or death and limit ongoing transmission to local Anopheles mosquitoes and other persons. Preventing mosquito bites and controlling mosquitoes at home can prevent mosquitoborne diseases, including malaria. Before traveling internationally to areas with endemic malaria, travelers should consult with a health care provider regarding recommended malaria prevention measures, including potentially taking malaria prophylaxis. Malaria is a nationally notifiable disease; continued reporting of malaria cases to jurisdictional health departments and CDC will also help ensure robust surveillance to detect and prevent autochthonous malaria in the United States. [ABSTRACT FROM AUTHOR]

Anthrax is a naturally occurring disease, affecting herbivores that ingest bacterial spores when consuming contaminated vegetation or soil (1). Bacillus anthracis spores are highly resistant to weather extremes and can [...]

The article describes the epidemiologic and clinical features of children and adolescents aged <18 years with monkeypox in the U.S. from May to September 24, 2022. Data shows the demographic characteristics of children and adolescents by sex, race or ethnicity and exposure setting and route, as well as clinical features and treatment including condition, symptoms, location and number of lesion and treatment outcomes.

Medscape EDUCATION ACTIVITY Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. This activity has been [...]

Congenital lymphocytic choriomeningitis virus syndrome: A disease that mimics congenital toxoplasmosis or cytomegalovirus infection. Diseases of the central nervous system caused by lymphocytic choriomeningitis virus and other arenaviruses. Onsite investigation at a mail-order hatchery following a multistate salmonella illness outbreak linked to live poultry-United States, 2018. Salmonella illness outbreaks linked to backyard poultry purchasing during the COVID-19 pandemic: United States, 2020. [Extracted from the article]

Author(s): Nathan D. Grubaugh [1]; Jason T. Ladner [2]; Moritz U. G. Kraemer [3, 4, 5]; Gytis Dudas [6]; Amanda L. Tan [7]; Karthik Gangavarapu [1]; Michael R. Wiley [2, [...]

Dengue is the most common mosquito-borne viral infection worldwide (1); however, it has been eliminated from the continental United States. No locally acquired cases have been reported outside the Texas-Mexico [...]

A new DNA microarray is formed with the help of the glass slides which is capable of identifying and discriminating the various bacterial species at the same time depending on the 16S ribosomal DNA (rDNA) polymorphisms. Finally pairing the 16S rDNA PCR with a microarray sensor seems to be ideal for analytical investigation and inspection of the commercially significant fish pathogens.

To the Editor: Leptospirosis is caused by pathogenic spirochetes of the genus Leptospira and transmitted through direct contact of skin or mucous membranes with urine or tissues of Leptospira-infected animals [...]

Campylobacter causes an estimated 1.3 million diarrheal illnesses in the United States annually (1). In August 2017, the Florida Department of Health notified CDC of six Campylobacter jejuni infections linked to company A, a national pet store chain based in Ohio. CDC examined whole-genome sequencing (WGS) data and identified six isolates from company A puppies in Florida that were highly related to an isolate from a company A customer in Ohio. This information prompted a multistate investigation by local and state health and agriculture departments and CDC to identify the outbreak source and prevent additional illness. Health officials from six states visited pet stores to collect puppy fecal samples, antibiotic records, and traceback information. Nationally, 118 persons, including 29 pet store employees, in 18 states were identified with illness onset during January 5, 2016-February 4, 2018. In total, six pet store companies were linked to the outbreak. Outbreak isolates were resistant by antibiotic susceptibility testing to all antibiotics commonly used to treat Campylobacter infections, including macrolides and quinolones. Store record reviews revealed that among 149 investigated puppies, 142 (95%) received one or more courses of antibiotics, raising concern that antibiotic use might have led to development of resistance. Public health authorities issued infection prevention recommendations to affected pet stores and recommendations for testing puppies to veterinarians. This outbreak demonstrates that puppies can be a source of multidrug-resistant Campylobacter infections in humans, warranting a closer look at antimicrobial use in the commercial dog industry. [ABSTRACT FROM AUTHOR]

In August 2022, the Florida Department of Health notified CDC of a nurse who acquired monkeypox through an occupational exposure while providing care to a patient with monkeypox. To date, occupationally acquired Monkeypox virus (MPXV) infections in health care personnel (HCP) have been rarely reported during the 2022 multinational outbreak (1,2). This report describes the first reported U.S. case and recommends approaches for preventing occupationally acquired MPXV infections in HCP. [ABSTRACT FROM AUTHOR]

In August 2022, the Florida Department of Health (FDOH) was notified of a suspected case of monkeypox in an infant aged <2 months who was admitted to a Florida hospital with a rash and cellulitis. This case report highlights findings from the related epidemiologic investigation and describes the public health actions taken. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.* This is the youngest patient with confirmed monkeypox infection in Florida to date. [ABSTRACT FROM AUTHOR]

Bacillus cereus isolates have been described harboring Bacillus anthracis toxin genes, most notably B. cereus G9241, and capable of causing severe and fatal pneumonias. This report describes the characterization of a B. cereus isolate, BcFL2013, associated with a naturally occurring cutaneous lesion resembling an anthrax eschar. Similar to G9241, BcFL2013 is positive for the B. anthracis pXO1 toxin genes, has a multi-locus sequence type of 78, and a pagA sequence type of 9. Whole genome sequencing confirms the similarity to G9241. In addition to the chromosome having an average nucleotide identity of 99.98% when compared to G9241, BcFL2013 harbors three plasmids with varying homology to the G9241 plasmids (pBCXO1, pBC210 and pBFH_1). This is also the first report to include serologic testing of patient specimens associated with this type of B. cereus infection which resulted in the detection of anthrax lethal factor toxemia, a quantifiable serum antibody response to protective antigen (PA), and lethal toxin neutralization activity. [ABSTRACT FROM AUTHOR]

Background: Failure to recognize and appropriately manage dengue early in the clinical course may result in late initiation of supportive treatment for severe disease. In Florida, travel-related and autochthonous dengue occur and are likely under-recognized. The objective of this study was to evaluate physician knowledge of dengue and its management before and after an educational intervention in Florida. Methods: From 2012-13 we conducted 14 grand-rounds style lectures on dengue clinical management attended by 413 physicians, and analyzed data from the pre- and post-tests. Results: Of those attending, 231 and 220 completed the pre-and post-tests, respectively. Overall, the mean pre-test score for knowledge-based questions was 74.3 and average post-test score was 94.2%, indicating a mean increase of 19.9% (P < 0.0001, 95% CI 17.7-22.4). Reported confidence in dengue recognition and management also increased. Non-US trained physicians and those who had treated more than ten dengue cases performed significantly better in the pre-test. Post-test scores did not differ by subgroup. Conclusions: The train-the-trainer approach with grand-rounds style presentations appear to be an effective intervention to improve knowledge of dengue among physicians. [ABSTRACT FROM AUTHOR]

Background: In 2009-2010, 93 cases of dengue were identified in Key West, Florida. This was the first outbreak of autochthonous transmission of dengue in Florida since 1934. In response to this outbreak, a multifaceted public education outreach campaign was launched. The aim of this study is to compare dengue prevention knowledge, attitudes, perceptions, and prevention practices among residents of subsidized public housing to the general population in Key West and to assess whether there were barriers preventing effective outreach from reaching specific vulnerable populations. Methods: A randomized population-based evaluation of knowledge, attitudes, and behaviors toward dengue prevention consisting of 521 separate household interviews was undertaken in July of 2011. A subset analysis was performed on interviews collected from 28 public housing units within four subsidized public housing complexes. Analysis was performed to determine whether knowledge, attitudes, and behaviors exhibited by public housing residents differed from the non-public housing study population. Results: Public housing residents recalled fewer outreach materials ( p=0.01) and were 3.4 times (95% confidence interval [CI] 1.4-8.3) more likely not to recall any outreach materials. Public housing residents were less likely to correctly identify how dengue transmission occurs (61% vs. 89%), where mosquitoes lay their eggs (54% vs. 85%), or to identify any signs or symptoms related to dengue (36% vs. 64%). Public housing residents were less likely to perform dengue prevention practices such as removing standing water or always using air conditioning. Conclusions: Examination of public housing residents identified an at-risk population that recalled less exposure to outreach materials and had less knowledge about dengue infection and prevention than the randomized study population. This provides public health systems the opportunity to target or modify future health messages and interventions to this group. Differences identified in the demographics of this population suggest that alternative methods or non-English materials may be required to reach desired outcomes. [ABSTRACT FROM AUTHOR]

Background: Although dengue is endemic in Puerto Rico (PR), 2007 and 2010 were recognized as epidemic years. In the continental United States (US), outside of the Texas-Mexico border, there had not been a dengue outbreak since 1946 until dengue re-emerged in Key West, Florida (FL), in 2009–2010. The objective of this study was to use electronic and manual surveillance systems to identify dengue cases in Veterans Affairs (VA) healthcare facilities and then to clinically compare dengue cases in Veterans presenting for care in PR and in FL. Methodology: Outpatient encounters from 1/2007–12/2010 and inpatient admissions (only available from 10/2009–12/2010) with dengue diagnostic codes at all VA facilities were identified using VA's Electronic Surveillance System for Early Notification of Community-based Epidemics (ESSENCE). Additional case sources included VA data from Centers for Disease Control and Prevention BioSense and VA infection preventionists. Case reviews were performed. Categorical data was compared using Mantel-Haenszel or Fisher Exact tests and continuous variables using t-tests. Dengue case residence was mapped. Findings: Two hundred eighty-eight and 21 PR and FL dengue cases respectively were identified. Of 21 FL cases, 12 were exposed in Key West and 9 were imported. During epidemic years, FL cases had significantly increased dengue testing and intensive care admissions, but lower hospitalization rates and headache or eye pain symptoms compared to PR cases. There were no significant differences in clinical symptoms, laboratory abnormalities or outcomes between epidemic and non-epidemic year cases in FL and PR. Confirmed/probable cases were significantly more likely to be hospitalized and have thrombocytopenia or leukopenia compared to suspected cases. Conclusions: Dengue re-introduction in the continental US warrants increased dengue surveillance and education in VA. Throughout VA, under-testing of suspected cases highlights the need to emphasize use of diagnostic testing to better understand the magnitude of dengue among Veterans. Author Summary: Dengue is an important tropical disease seen throughout the world in tropical climate zones and is spread by Aedes mosquitoes. Most cases of dengue in the continental US are imported. In July 2009 through 2010, dengue virus was found to be circulating in Key West, Florida (FL). Dengue virus has been transmitted in Puerto Rico (PR) for many years. This study used electronic and manual surveillance systems to identify dengue cases in VA healthcare facilities and clinically compared dengue cases in Veterans presenting for care in PR as well as in FL. We found that FL dengue cases were similar to those in PR and that Centers for Disease Control and Prevention defined confirmed/probable cases were more likely to be hospitalized within our VA system, and have either lower platelet or white blood cell counts than suspected cases. During July 2009–2010, FL cases were more likely to be tested for dengue and have intensive care admissions, but had lower hospitalization rates and headache or eye pain symptoms compared to PR cases. No one method of capturing dengue cases was perfect. It is important to educate healthcare workers about this disease to help with direct patient care as well as surveillance. [ABSTRACT FROM AUTHOR]

Shorebirds, including sanderlings ( Calidris alba) and ruddy turnstones ( Arenaria interpres), were observed scavenging beached fish, such as thread herring ( Opisthonema oglinum), scaled sardine ( Harengula jaguana) and mullet ( Mugil spp.) killed during a 2005 Karenia brevis red tide along the central west coast of Florida. Brevetoxin concentrations in dead fish tissues were analyzed to determine the potential exposure risk to scavenging shorebirds. This component of brevetoxin cycling in the food web has not previously been explored and the risks or benefits of this behavior for shorebirds are not currently understood. Toxin levels in freshly dead fish tissues ranged from 32 to 95,753 ng PbTx g-1. Brevetoxins in shorebird livers were also confirmed (26-1313 ng PbTx g-1) in dead birds collected opportunistically from local beaches and rehabilitation centers during the red tide event, suggesting that brevetoxin exposure is a risk factor for mortality. These findings underscore the need to assess the ecological impacts of K. brevis blooms on Florida's migratory and resident shorebird populations. [ABSTRACT FROM AUTHOR]

The article presents the results of an investigation of three clusters of rash illness linked to the white-marked tussock moth caterpillar among persons at two child care centers and one elementary school, conducted by the Hillsborough County Health Department (HCHD) Epidemiology Department of Tampa, Florida. Most of the persons were affected by the rashes had direct contact with caterpillars. Recommendations for the three facilities experiencing outbreaks of rash illnesses in 2011 are given.

The article discusses cases of severe leptospirosis in Florida and Missouri with signs similar to those of pandemic H1N1. The first patient had a fever, myalgia, calf pain, headache, and malaise. The second patient has a history of obesity and was hospitalized due to fever, myalgia, and calf pain among others while the third patient has a history of obesity and diabetes mellitus. According to the authors, leptospirosis should be included in the differential diagnosis of acute febrile illness in industrialized countries.

The article reports on the compendium of measures for animal-linked disease prevention in public areas. It mentions its recommendations of standardization for veterinarians, operators of animal venues and public health officials with disease management. It also notes the admonition of the National Association of State Public Health Veterinarians Inc. (NASPHV) on possible transmission of disease through human-animal contact in locations including zoos, fairs and school farms.

The article reports on the serologic and risk-factory survey of residents and staff in a Miami-Dade County, Florida long-term care facility which was conducted to determine the prevalence of and associations with Strongyloides infection. The survey was initiated after three patients in the facility tested positive for Strongloides stercoralis presence from 2011 to 2012. Blood samples were assessed via S. stercoralis-specific antibody testing by crude antigen enzyme-linked immunoabsorbent assay.

Ehrlichiosis is a tick-borne disease that ranges in severity from asymptomatic infection to fatal sepsis. A case of Ehrlichia ewingii infection likely transmitted by transfusion of leukoreduced platelets is described and public health implications are discussed.Ehrlichiosis is a tick-borne disease that ranges in severity from asymptomatic infection to fatal sepsis. Ehrlichiosis acquired from transfusion of blood products has not been documented in the literature to date. A case of Ehrlichia ewingii infection likely transmitted by transfusion of leukoreduced platelets is described, and public health implications are discussed. [ABSTRACT FROM AUTHOR]

On June 16, 2021, rabies virus infection was confirmed in a dog included in a shipment of rescue animals imported into the United States from Azerbaijan. A multistate investigation was conducted to prevent secondary rabies cases, avoid reintroduction of a dog-maintained rabies virus variant (DMRVV), identify persons who might have been exposed and would be recommended to receive rabies postexposure prophylaxis, and investigate the cause of importation control failures. Results of a prospective serologic monitoring (PSM) protocol suggested that seven of 32 (22%) animals from the same shipment as the dog with confirmed rabies virus infection and who had available titer results after rabies vaccine booster had not been adequately vaccinated against rabies before importation. A requirement for rabies vaccination certificates alone will not adequately identify improper vaccination practices or fraudulent paperwork and are insufficient as a stand-alone rabies importation prevention measure. Serologic titers before importation would mitigate the risk for importing DMRVV., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Patricia A. Zinna reports that she is the New Jersey State Representative for the Humane Society Veterinary Medical Association. No other potential conflicts of interest were disclosed.

The Zika epidemic in the Americas has challenged surveillance and control. As the epidemic appears to be waning, it is unclear whether transmission is still ongoing, which is exacerbated by discrepancies in reporting. To uncover locations with lingering outbreaks, we investigated travel-associated Zika cases to identify transmission not captured by reporting. We uncovered an unreported outbreak in Cuba during 2017, a year after peak transmission in neighboring islands. By sequencing Zika virus, we show that the establishment of the virus was delayed by a year and that the ensuing outbreak was sparked by long-lived lineages of Zika virus from other Caribbean islands. Our data suggest that, although mosquito control in Cuba may initially have been effective at mitigating Zika virus transmission, such measures need to be maintained to be effective. Our study highlights how Zika virus may still be "silently" spreading and provides a framework for understanding outbreak dynamics. VIDEO ABSTRACT., (Copyright © 2019 Elsevier Inc. All rights reserved.)