Contents

SYNOPSIS 7

Molecular Epidemiology of Reemergent Rabies in Yunnan Province, Southwestern China 7

Human Rabies Case Data 8

Sample Collection 8

Detection of RABV Antigen 8

Reverse Transcription PCR 9

DNA Sequencing 9

Phylogenetic Analysis 9

Distribution of Human Cases 9

RABV Detection in Specimens 11

Nucleoprotein Gene Sequencing 11

Molecular Diversity and Phylogenetic Analysis 11

Conclusions 11

References 15

Encephalitis Caused by PathogensTransmitted through Organ Transplants, United States, 2002-2013 17

West Nile Virus 18

Rabies Virus 19

Lymphocytic Choriomeningitis Virus 20

Balamuthia mandrillaris Amebae 20

Discussion 21

References 24

Confirmed Bacillus anthracis Infection among Persons Who Inject Drugs, Scotland, 2009-2010 26

Methods 27

Approval 27

Data Collection 27

Data Analysis 27

Results 28

Initial Findings 28

Clinical Impression, Treatment, and SOFA Score at Presentation 30

Confirmation of B. anthracis Infection 30

Hospital Course 30

Discussion 31

Acknowledgments 36

References 36

RESEARCH 38

Distance from Construction Site and Risk for Coccidioidomycosis, Arizona, USA 38

Methods 39

Results 40

Discussion 42

Acknowledgment 44

References 44

Swine-to-Human Transmission of Influenza A(H3N2) Virusat Agricultural Fairs, Ohio, USA, 2012 46

Materials and Methods 47

Results 48

Discussion 49

Acknowledgments 52

References 53

Genomic Epidemiology of Salmonella enterica Serotype Enteritidis based on Population Structure of Prevalent Lineages 55

Methods 56

Isolates 56

WGS 56

SNP Detection 56

Phylogenetic Analyses 56

Results 57

Divergent Isolates and Serotypes 57

High-Quality Core Genome SNPs and Phylogeny 57

Population Dynamics 57

Discussion 57

Acknowledgments 62

References 62

Pneumocystis jirovecii Pneumonia in Patients with or without AIDS, France 64

Materials and Methods 65

Patients and Management 65

Data Collection 66

Statistical Analyses 66

Results 66

Causes of Immunodeficiency 66

Clinical Manifestations of PCP 67

Diagnosis and Treatment of PCP 68

Risk Factors for Death 68

Discussion 69

Acknowledgments 70

References 70

Passive Surveillance for Azole-Resistant Aspergillus fumigatus, United States, 2011-2013 72

Materials and Methods 73

Fungal Isolates 73

Itraconazole Susceptibility Assay 73

Genetic Profiling of cyp51A 73

Results 73

Characteristics of A. fumigatus Isolates 73

Genetic Analysis of the cyp51A Gene 74

Discussion 74

Acknowledgments 76

References 76

Feeding Period Required by Amblyomma aureolatum Ticks for Transmission of Rickettsia rickettsii to Vertebrate Hosts 78

Materials and Methods 79

Results 80

Discussion 81

Acknowledgments 83

References 83

DISPATCHES 85

Methicillin-Sensitive Staphylococcus aureus CC398 in Intensive Care Unit, France 85

The Study 85

Conclusions 86

Acknowledgments 87

References 88

Household-Level Spatiotemporal Patterns of Incidence of Cholera, Haiti, 2011 90

The Study 90

Conclusions 91

References 93

Incidence of Cronobacter spp. Infections, United States, 2003-2009 94

The Study 94

Conclusions 96

Acknowledgments 96

References 97

Investigation and Control of Anthrax Outbreak at the Human-Animal Interface, Bhutan, 2010 98

The Study 98

Acknowledgments 100

References 100

Family Cluster of Middle East Respiratory Syndrome Coronavirus Infections, Tunisia, 2013 101

The Cases 101

Conclusions 103

Acknowledgments 104

References 104

Pork Consumption and Seroprevalence of Hepatitis E Virus, Thailand, 2007-2008 105

The Study 105

Conclusions 107

Acknowledgments 107

References 107

Asymptomatic, Mild, and Severe Influenza A(H7N9) Virus Infection in Humans, Guangzhou, China 109

The Study 109

Conclusions 111

Acknowledgments 113

References 113

Mutations of Novel Influenza A(H10N8) Virus in Chicken Eggs and MDCK Cells 115

The Study 115

Conclusions 116

References 116

Genetic Variation among African Swine Fever Genotype II Viruses, Eastern and Central Europe 118

The Study 118

Conclusions 119

Acknowledgments 120

References 121

Novel Circovirus from Mink, China 122

The Study 122

Conclusions 123

References 123

Factors Contributing to Decline in Foodborne Disease Outbreak Reports, United States 125

The Study 125

Conclusions 126

Acknowledgments 127

References 127

Risk Factors for Severe Influenza A Virus Pneumonia in Adult Cohort, Mexico, 2013-14 128

The Study 128

Conclusions 130

Acknowledgments 131

References 131

Common Exposure to STL Polyomavirus During Childhood 133

The Study 133

Conclusions 134

References 135

Enhanced MERS Coronavirus Surveillance of Travelers from the Middle East to England 136

The Study 136

Conclusions 138

Acknowledgments 138

References 138

LETTERS 139

Live Poultry Market Closure and Control of Avian Influenza A(H7N9), Shanghai, China 139

Shiga Toxin 2A-Encoding Bacteriophages in Enteroaggregative Escherichia coli O104:H4 Strains 141

Rio Mamore Virus and Hantavirus Pulmonary Syndrome, Brazil 142

Reemergence of Brucella melitensis in Wildlife, France 144

Clostridium tetani Osteitis without Tetanus 145

Rate of Congenital Toxoplasmosis in Large Integrated Health Care Setting, California, USA, 1998-2012 147

Invasive Infection Caused by Carbapenem-Resistant Acinetobacter soli, Japan 148

Spread of Vaccinia Virus to Cattle Herds, Argentina, 2011 150

Cerebellitis Associated with Influenza A(H1N1)pdm09, United States, 2013 152

Potential Human Adaptation Mutation of Influenza A(H5N1) Virus, Canada 154

Genetic Changes of Reemerged Influenza A(H7N9) Viruses, China 156

Carbapenem-Resistant Enterobacter cloacae Isolates Producing KPC-3, North Dakota, USA 157

Urethritis Caused by Novel Neisseria meningitidis Serogroup W in Man Who Has Sex with Men, Japan 159

Highly Pathogenic Avian Influenza A(H5N8) Virus from Waterfowl, South Korea, 2014 161

Worker Health and Safety Practices in Research Facilities Using Nonhuman Primates, North America 163

Mortierella wolfii-Associated Invasive Disease 165

Antibody against Arenaviruses inHumans, Southwestern United States 166

Porcine Coronavirus HKU15 Detected in 9 US States, 2014 168

Schistosomiasis Haematobium, Corsica, France 169

ABOUT THE COVER 172

The Art of Intertwining Life and Work 172

Etymologia : Bacillus anthracis 37

Encephalitis Caused by PathogensTransmitted through Organ Transplants, United States, 2002-2013 23

Table 1. Infectious agents associated with encephalitis reported among clusters of solid organ transplant recipients in the United States, 2002-2013 23

Confirmed Bacillus anthracis Infection among Persons Who Inject Drugs, Scotland, 2009-2010 29

Table 1. Sogns and symptoms prompting hospital visits for persons who inject drugs who had Bacillus anthracis Infection, Scotland,UK, 2009-2010 29

Table 2. Clinical and laboratory findings, confirmatory laboratory results, and therapies administered during hospitalization of persons who inject drugs and had Bacillus anthracis infection, Scotland, UK, 2009-2010 31

Table 3. Initial administration of antibacterial drugs to persons who inject drugs and had Bacillus anthracis Infection, Scotland, UK, 2009-2010 33

Table 4. Types of initial surgery and tissue findings on gross examination for persons who inject drugs and had Bacillus anthracis Infection, Scotland, UK, 2009-2010 35

Distance from Construction Site and Risk for Coccidioidomycosis, Arizona, USA 42

Table 1. Characteristics of participants, at enrollment and 1 year later, in a study of distance from a construction site as a risk factor for coccidioidomycosis, Arizona, USA, 2012-2013 42

Table 2. Characteristics of participants, by cellular immunity conversion status at 1-year follow up, in a study of distance from a construction site as a risk factor for coccidioidomycosis, Arizona, USA, 2012-2013 43

Swine-to-Human Transmission of Influenza A(H3N2) Virusat Agricultural Fairs, Ohio, USA, 2012 47

Table 1. Influenza A virus-specific results, 40 agricultural fairs, Ohio, USA, 2012 47

Table 2. Genetic distances between influenza A(H3N2) viruses isolated from swine and humans at 10 agricultural fairs, Ohio, USA, 2012 49

Genomic Epidemiology of Salmonella enterica Serotype Enteritidis based on Population Structure of Prevalent Lineages 59

Table 1. Dating of nodes in the maximum-likelihood tree of Salmonella enterica serotype Enteritidis using BEAST and strict and relaxed mutation rates 59

Pneumocystis jirovecii Pneumonia in Patients with or without AIDS, France 67

Table 1. Clinical characteristics of 544 patients with and without AIDS at diagnosis with PCP, France, January 1, 2007-December 31, 2010 67

Table 2. Clinical management of 544 AIDS and non-AIDS patients after diagnosis with PCP, France, January 1, 2007-December 31, 2010 68

Feeding Period Required byAmblyomma aureolatum Ticks forTransmission of Rickettsia rickettsiito Vertebrate Hosts 80

Table 1. Fever, seroconversion to Rickettsia rickettsii antigens, and ear and/or scrotal lesions in guinea pigs exposed to R. rickettsii-infected Amblyomma aureolatum unfed nymphs through different feeding periods, Brazil 80

Table 2. Fever, seroconversion to Rickettsia rickettsii antigens, and ear and/or scrotal lesions in guinea pigs that were exposed to R. rickettsii-infected Amblyomma aureolatum unfed adult male ticks, Brazil 81

Table 3. Fever, seroconversion to Rickettsia rickettsii antigens, and ear and/or scrotal lesions in guinea pigs that were infested by previously fed R. rickettsii-infected Amblyomma aureolatum adult male ticks through different feeding periods, 82

Methicillin-Sensitive Staphylococcus aureus CC398 in Intensive Care Unit, France 87

Table 1. Demographic and clinical characteristics of 33 patients colonized or infected with Staphylococcus aureus, intensive care unit, France, 2011 87

Table 2. Microbiological characteristics of 29 Staphylococcus aureus clonal complex 398 isolates from intensive care unit, France, 2011 88

Household-Level Spatiotemporal Patterns of Incidence of Cholera, Haiti, 2011 91

Table 1. Case count and date ranges of cholera case reports by community, Haiti, 2011 91

Pork Consumption and Seroprevalence of Hepatitis E Virus, Thailand, 2007-2008 106

Table 1. Univariate analysis results of demographic variables associated with hepatitis E IgG seroprevalence in young men, Thailand, 2007-2008 106

Table 2. Hepatitis E IgG seroprevalence and average percentage of population who are Muslim and follow Islamic dietary laws that proscribe pork consumption, by region, Thailand, 2007-2008 106

Asymptomatic, Mild, and Severe Influenza A(H7N9) Virus Infection in Humans, Guangzhou, China 110

Table 1. Investigation of weekly reported number of patients with pneumonia, PUE, and ILI and confirmed cases of influenza A(H7N9) virus infection, Guangzhou, China, April 1, 2013-March 7, 2014 110

Table 2. Demographic, epidemiologic, and clinical characteristics of patients with severe and mild influenza A(H7N9) cases, Guangzhou, China, April 1, 2013-March 7, 2014 112

Mutations of Novel Influenza A(H10N8) Virus in Chicken Eggs and MDCK Cells 116

Table 1. Mutations and heterogeneities of influenza A(H10N8) virus detected in a tracheal aspirate sample from a human, the first passage in embryonated chicken eggs, and the second and third passages in MDCK cells 116

Genetic Variation among African Swine Fever Genotype II Viruses, Eastern and Central Europe 119

Table 1. African swine fever virus isolates from eastern Europe selected for a study of the genetic variation among genotype II viruses in eastern and central Europe, 2007-2014 119

Novel Circovirus from Mink, China 123

Table 1. Oligonucleotide sequences of primers used in study of novel circovirus isolated from mink, Dalian, China 123

Table 2. Prevalence of mink circovirus DNA in mink, Dalian, China 123

Factors Contributing to Decline in Foodborne Disease Outbreak Reports, United States 126

Table 1. Number of survey respondents reporting difficulty in distinguishing between foodborne disease outbreaks and outbreaks caused by other modes of transmission in the National Outbreak Reporting System, United States, 2013 126

Risk Factors for Severe Influenza A Virus Pneumonia in Adult Cohort, Mexico, 2013-14 129

Table 1. Characteristics of patients with severe pneumonia who required mechanical ventilation compared with patients who did not require mechanical ventilation, San Luis Potosi, Mexico, 2013-2014 129

Table 2. Demographic features of adult patients admitted with confirmed influenza virus pneumonia during December 5, 2013-February 7, 2014, compared with patients with confirmed influenza A(H1N1)pdm09 infection during the 2009-10 pandemic... 130

Enhanced MERS Coronavirus Surveillance of Travelers from the Middle East to England 137

Table 1. Results of MERS coronavirus testing of 77 travelers from the Middle East to England by key clinical and epidemiologic characteristics where information available, September 2012-October 2013 137

Table 2. Positive predictive value of signs and symptoms among 77 travelers from the Middle East tested for MERS-CoV, Enhanced MERS-CoV Surveillance System, England, September 2012-October 2013 137

Spread of Vaccinia Virus to Cattle Herds, Argentina, 2011 151

Table 1. Diagnosis of Orthopoxvirus infection in beef and dairy cattle during a study of the spread of vaccinia virus to cattle herds, Argentina, 2011 151

Highly Pathogenic Avian Influenza A(H5N8) Virus from Waterfowl, South Korea, 2014 162

Table 1. Nucleotide homology of genes of influenza virus strain A/waterfowl/Korea/S005/2014 (H5N8) to the closest related influenza virus strains 162

Worker Health and Safety Practices in Research Facilities Using Nonhuman Primates, North America 164

Table 1. Health and safety practices reported by 26 research facilities that use nonhuman primates, North America, December 2012 164

Molecular Epidemiology of Reemergent Rabies in Yunnan Province, Southwestern China 8

Figure 1. Distribution of rabies cases, 2000-2012, and clades of rabies virus isolates, 2008-2012, Yunnan Province, China. Shown are the 16 prefectures in Yunnan Province. Black stars indicate 52 specimens collected in the present study 8

Figure 2. Temporal trends of rabies-affected prefectures, counties, and human cases, Yunnan Province, China, 2000-2012. Yunnan Province is divided into 16 prefectures and 129 counties 9

Figure 3. Distribution of rabies cases in 16 prefectures in Yunnan Province, China, 2000-2012, and data analysis of human and animal specimens. Except for Dali, Lijiang, Nujiang, and Diqing Prefectures, 12 prefectures had reported human cases.... 10

Figure 4. Phylogenetic relationship of nucleoprotein gene sequences of rabies virus isolates from Yunnan Province, China, 2008-2012, with isolates from neighboring provinces in China. Number sat each node indicate degree of bootstrap support (only... 12

Figure 5. Phylogenetic relationship of nucleoprotein gene sequences of rabies virus isolates from Yunnan Province, China, 2008-2012, with those from neighboring countries in Asia. Numbers at each node indicate degree of bootstrap support (only... 13

Encephalitis Caused by PathogensTransmitted through Organ Transplants, United States, 2002-2013 18

Figure 1. Photomicrographs showing histopathologic features and immunolocalization of West Nile virus antigens in central nervous system tissue from a kidney transplant recipient with transplant-transmitted West Nile virus infection. A) Mononuclear... 18

Figure 2. Photomicrographs showing histopathologic features and immunolocalization of rabies virus antigens in central nervous system tissue from a kidney transplant recipient with donor-derived rabies infection. A) Typical intracytoplasmic eosinophilic... 20

Figure 3. Photomicrographs showing histopathologic features and immunolocalization of lymphocytic choriomeningitis virus (LCMV) antigens in liver tissue from a liver transplant recipient with donor-derived LCMV infection. A) Massive hepatic necrosis, 21

Figure 4. Brain images showing contrast-enhanced lesions in the right occipital and left parietal lobes of a 4-year-old boy with encephalitis caused by infection with Balamuthia mandrillaris amebae. A) T2-weighted fluid-attenuated inversion recovery... 22

Figure 5. Photomicrographs showing histopathologic features and immunolocalization of Balamuthia mandrillaris antigens in central nervous system tissue from a donor with B. mandrillaris infection. A) Typical amebic trophozoites with prominent... 22

Confirmed Bacillus anthracis Infection among Persons Who Inject Drugs, Scotland, 2009-2010 28

Figure 1. Key events for 16 survivors (A) and 11 nonsurvivors (B) in an outbreak of Bacillus anthracis infection in persons who inject drugs, Scotland, UK, 2009-2010. Patients are numbered in the order in which they sought care. Time period is from... 28

Figure 2. Physical examination findings for persons who inject drugs and were part of an outbreak of Bacillus anthracis infection, Scotland, UK, 2009-2010. Included are data from 27 patients for whom data were available. Median (interquartile range)... 30

Figure 3. Laboratory findings for persons who inject drugs and were part of an outbreak of Bacillus anthracis infection, Scotland, UK, 2009-2010. Included are the 27 patients for whom data were available. Shown are median (interquartile range) for... 32

Figure 4. Treatments at time patients sought care, SOFA scores, and treatments anytime during hospitalization of persons who inject drugs and were part of an outbreak of Bacillus anthracis infection, Scotland, UK, 2009-2010. Included are the 27 patients... 34

Distance from Construction Site and Risk for Coccidioidomycosis, Arizona, USA 40

Figure 1. Flowchart of study participants in a study of the acquisition of immunity to Coccidioides spp. among persons working adjacent to and 13 miles away from a construction project requiring extensive excavation of soil, Arizona, USA, 2012-2013 40

Figure 2. Serial flow cytometry images showing immunologic conversion from negative to positive for participants in a study of distance from a construction site as a risk factor for coccidioidomycosis, Arizona, USA, 2012-2013. Conversion was... 41

Swine-to-Human Transmission of Influenza A(H3N2) Virusat Agricultural Fairs, Ohio, USA, 2012 48

Figure 1. Distribution of agricultural fairs and human infection with influenza A variant virus (H3N2v), by week of the Ohio fair season, June-October 2012. Black bar sections, fairs with swine positive for influenza A virus; gray bar... 48

Figure 2. Hemagglutinin phylogeny. A) Phylogenetic relationships of the hemagglutinin sequences of swine-origin subtype H3 influenza A viruses from agricultural fairs, Ohio, USA, 2012. B) Expanded view of isolates. Isolates recovered from swine... 51

Figure 3. Neuraminidase phylogeny. A) Phylogenetic relationships of the neuraminidase sequences of swine-origin subtype N2 influenza A viruses from agricultural fairs, Ohio, USA, 2012. B) Expanded view of isolates. Isolates recovered from swine... 52

Genomic Epidemiology of Salmonella enterica Serotype Enteritidis based on Population Structure of Prevalent Lineages 58

Figure 1. Comparison of Salmonella enterica serotype Enteritidis phylogenies inferred from Illumina data and combined data of Illumina (San Diego, CA, USA) and Roche 454 (Indianapolis, IN, USA). The tree on the right incudes 80 Illumina sequenced... 58

Figure 2. Inferred number of Salmonella enterica serotype Enteritidis lineages over time based on a constant effective population size model using BEAST (16). Blue shading indicates 95% CIs 59

Figure 3. Salmonella enterica serotype Enteritidis genetic lineage III. Isolates from human blood and stool samples are indicated by red and blue, respectively. Four clades are highlighted and designated A-D, representing individual outbreak clades identified... 60

Figure 4. Salmonella enterica serotype Enteritidis clades associated with the 2010 US shelled eggs outbreak. Red indicates isolates sequenced as part of the outbreak investigation using Roche 454 technology (Indianapolis, IN, USA); blue indicates... 61

Pneumocystis jirovecii Pneumonia in Patients with or without AIDS, France 67

Figure 1. Flowchart of selection of patients with Pneumocystis jirovecii pneumonia (PCP) for study and underlying conditions among non-AIDS patients, France, January 1, 2007-December 31, 2010. Miscellaneous conditions: inflammatory... 67

Figure 2. Survival in 544 patients with Pneumocystis jirovecii pneumonia by A) number of days from admission to treatment initiation and B) underlying disease (AIDS versus non-AIDS), France, January 1, 2007-December 31, 2010. p＜0.0001... 69

Passive Surveillance for Azole-Resistant Aspergillus fumigatus, United States, 2011-2013 74

Figure 1. Distribution of Aspergillus fumigatus isolates, United States, 2011-2013. A total of 1,026 clinical isolates were received from 22 states during October 2011-October 2013 74

Figure 2. Itraconazole susceptibility profile for Aspergillus fumigatus isolates, United States, 2011-2013. The MIC (μg/mL) required by each isolate was determined by using the Etest method. Approximately 5% of the isolates require an MIC... 75

Feeding Period Required by Amblyomma aureolatum Ticks for Transmission of Rickettsia rickettsii to Vertebrate Hosts 79

Figure 1. An adult male Amblyomma aureolatum tick attached to the hand of a person who became infested while in direct contact with a naturally infested dog in the metropolitan area of Sao Paulo, Brazil 79

Figure 2. A typical area where infection with Rickettsia rickettsii occurs, manifested as Rocky Mountain spotted fever, in the metropolitan area of São Paulo, Brazil. Humans have constructed their homes in the Atlantic rainforest fragment (habitat of the... 83

Methicillin-Sensitive Staphylococcus aureus CC398 in Intensive Care Unit, France 86

Figure 1. Flowchart of selection for methicillin-sensitive Staphylococcus aureus clonal complex (CC) 398 from intensive care unit, France, 2011. HCWs, health care workers; ST, sequence type 86

Figure 2. Principal clonal complexes (CCs) among 125 isolates of Staphylococcus aureus from intensive care unit, France, 2011. HCWs, health care workers 86

Household-Level Spatiotemporal Patterns of Incidence of Cholera, Haiti, 2011 91

Figure 1. Findings of the Cooperative Cholera Mapping Project in Haiti, 2011. A) Geographic distribution of household cholera cases per day. B) Temporal pattern, color-coded by community, compared with reported cases in the Ouest Department (black).... 91

Figure 2. Space-time clusters of cholera in 4 communities in Haiti, 2011. A) Grand Goave, winter; B) Grand Goave, summer; C) Leogane, summer; and D) Petit Goave, summer. Stars represent primary cluster centers and triangles, secondary cluster centers.... 92

Incidence of Cronobacter spp. Infections, United States, 2003-2009 95

Figure 1. Isolations of Cronobacter spp., by specimen source and patient age group, Foodborne Diseases Active Surveillance Network (FoodNet), 2003-2009. Data are based on a sample from laboratories in 6 states (California, Colorado, Maryland,... 95

Figure 2. A) Cronobacter spp. incidence rates, by age group (overall and range by site) in the Foodborne Diseases Active Surveillance Network (FoodNet), 2003-2009. B) Cronobacter spp. incidence rates for invasive isolates by age group (overall and range... 96

Investigation and Control of Anthrax Outbreak at the Human-Animal Interface, Bhutan, 2010 99

Figure 1. Phylogeny of major Bacillus anthracis groups as determined by using canonical single nucleotide polymorphisms as described by Van Ert et al. (12). Arrows indicate the lineages/groups of genotyped B. anthracis isolates from India (12),... 99

Figure 2. Signs of anthrax in infected animals (A-C) and humans (D-G), Bhutan, 2010. A) The carcass of an affected bull, showing bloating. B) Bleeding of unclotted blood from a cow's nostril. C) Rod-shaped Bacillus anthracis bacilli from 1 of the... 99

Family Cluster of Middle East Respiratory Syndrome Coronavirus Infections, Tunisia, 2013 102

Figure 1. Clinical course of disease for patients with confirmed Middle East respiratory syndrome coronavirus Infection, Tunisia, 2013. RH, regional hospital; DH, district hospital; rRT-PCR, real-time reverse transcription PCR 102

Figure 2. Midpoint-rooted phylogenetic trees of the full-length nucleocapsid (N) (panel A) and spike (S) (panel B) open-reading frames (ORFs) of isolates obtained from index case-patient with Middle East respiratory syndrome coronavirus (MERS-CoV)... 103

Pork Consumption and Seroprevalence of Hepatitis E Virus, Thailand, 2007-2008 105

Figure 1. Map of Thailand, showing hepatitis E IgG seroprevalence in young Thai men, 2007-2008, grouped by reported province of residence during the 2 years before entry in to the Royal Thai Army. Circle indicates Bankok, the capital... 105

Asymptomatic, Mild, and Severe Influenza A(H7N9) Virus Infection in Humans, Guangzhou, China 111

Figure 1. Weekly number of confirmed influenza A(H7N9) cases detected by real-time reverse transcription PCR, percentage of pneumonia patients with pneumonia of unknown etiology (PUE), and percentage of patients with influenza-like illness (ILI)... 111

Figure 2. Timeline of illness for 2 family clusters of persons with confirmed influenza A(H7N9) virus infection, Guangzhou, China, 2014. ICU, intensive care unit; rRT-PCR, real-time reverse transcription PCR 113

Genetic Variation among African Swine Fever Genotype II Viruses, Eastern and Central Europe 120

Figure 1/Figure 2. Minimum evolution (ME) phylogenetic tree of African swine fever virus (ASFV) isolates from Lithuania and Poland based on the C-terminal end of the p72 coding gene relative to the 22 p72 genotypes (labeled I-XXII), including 88 nt sequences.... 120

Figure 2/Figure 3. Partial nucleotide sequence alignment of the intergenic region between I73R and I329L in African swine fever virus (ASFV) isolates from eastern and central Europe, including a virus isolated in 2007 in Georgia (Georgia2007; GenBank... 121

Novel Circovirus from Mink, China 124

Figure 1. Phylogenetic tree constructed on the basis of the Rep protein sequence of the mink circovirus by using the neighbor-joiningmethod in MEGA5 (http://www. megasoftware.net). Representative members of the genera Circovirus and Cyclovirus... 124

Factors Contributing to Decline in Foodborne Disease Outbreak Reports, United States 126

Figure 1. Total number of foodborne disease outbreaks and number caused by norovirus and Salmonella spp. as reported to the Foodborne Disease Outbreak Surveillance System, United States, 1998-2012. Data current as of April 22, 2014... 126

Risk Factors for Severe Influenza A Virus Pneumonia in Adult Cohort, Mexico, 2013-14 131

Figure 1. Patients with confirmed influenza pneumonia admitted to "Dr Ignacio Morones Prieto" (Hospital Central), in San Luis Potosi, Mexico during 2009-10 and 2013-14, according to age group 131

Figure 2. A) Proportion of patients with confirmed influenza pneumonia that required mechanical ventilation according to the duration of symptomatology on admission (0-4 days versus ＞5days) during the 2009-10 pandemic and 2013-14 season... 131

Common Exposure to STL Polyomavirus During Childhood 134

Figure 1. STL polyomavirus (STLPyV) ELISA. A) Electron microscopy image shows purified STLPyV VP1 capsomeres. Scale bar＝100 nm. B) Serum samples were pre-incubated in the absence (white bars) or presence of soluble STLPyV VP1 pentamers (gray... 134

Figure 2. Age-specific seropositivity for STL polyomavirus (STLPyV) from serum specimens collected in Denver, Colorado, USA (A), and St. Louis, Missouri, USA (B). A total of 500 serum specimens from Denver and 417 from St. Louis were tested for... 134

Live Poultry Market Closure and Control of Avian Influenza A(H7N9), Shanghai, China 140

Figure 1. Illness onset dates for 33 confirmed cases of influenza A(H7N9) infection in Shanghai (A) and 78 cases in other provinces (B) in China, February 12-May 10, 2013. Solid vertical line indicates date live poultry markets (LPMs) in Shanghai... 140

Rio Mamore Virus and Hantavirus Pulmonary Syndrome, Brazil 143

Figure 1. Phylogenetic relationships among hantaviruses were estimated by using the Bayesian Markov chain Monte Carlo method implemented in MrBayes version 3.1.2 (8). The relationships were based on the initial 905-nt fragment of the small segment.... 143

Clostridium tetani Osteitis without Tetanus 146

Figure 1. Radiograph of left leg of patient with Clostridium tetani infection, showing delayed bone consolidation 11 months after fracture 146

Invasive Infection Caused by Carbapenem-Resistant Acinetobacter soli, Japan 149

Figure 1. Results of double-disk synergy testing of the Acinetobacter soli isolate HK001 identified in a man in Japan. Testing was performed by using disks containing sodium mercaptoacetic acid (SMA) and the carbapenems imipenem, meropenem, and... 149

Cerebellitis Associated with Influenza A(H1N1)pdm09, United States, 2013 153

Figure 1. A) Magnetic resonance images of the brain of a woman with cerebellitis associated with influenza A(H1N1)pdm09, United States, 2013. T1-weighted axial MRI brain sequence showing hypo-intensity of bilateral cerebellar hemispheres. B) T2-weighted... 153

Carbapenem-Resistant Enterobacter cloacae Isolates Producing KPC-3, North Dakota, USA 158

Figure 1. Genetic typing of carbapenem-resistant Enterobacter cloacae identified from patients at Sanford Health in Fargo, North Dakota, USA. Repetitive sequence-based PCR was used. The dendrogram at left displays the percentage similarity among... 158

Urethritis Caused by Novel Neisseria meningitidis Serogroup W in Man Who Has Sex with Men, Japan 160

Figure 1. Pulsed-field gel electrophoresis (PFGE) patterns for N. meningitidis strains isolated from a man with urethritis (case 1) and his male sex partner (case 2), Japan. PFGE was performed with the restriction enzyme NheI. Results showed the same PFGE... 160

Mortierella wolfii-Associated Invasive Disease 165

Figure 1. Histopathologic findings from a 34-year-old man with X-linked gp91phox gene mutation chronic granulomatous disease. A) Liver biopsy results showing numerous irregular and nonseptate hyphae with bulbous dilations. Gomori methenamine... 165

Porcine Coronavirus HKU15 Detected in 9 US States, 2014 168

Figure 1. US states with swine samples positive for porcine coronavirus (PorCoV) HKU15, between February and April 2014. A total of 435 samples from 10 states were selected to be tested for the presence of PorCoV. Of those samples, 109 (25%) from... 168

Schistosomiasis Haematobium, Corsica, France 170

Figure 1. Corsica, France, showing malacologic survey sampling sites (oval) in 3 rivers (Tarcu, Cavu, and Osu). Bulinus truncatus snails were found at sites 1, 2, 3, 5, and 6 170