A Peer-Reviewed Journal Tracking and Analyzing Disease Trends pages 1357–1522 EDITOR-IN-CHIEF D. Peter Drotman EDITORIAL STAFF EDITORIAL BOARD Founding Editor Dennis Alexander, Addlestone Surrey, United Kingdom Joseph E. McDade, Rome, Georgia, USA Ban Allos, Nashville, Tennessee, USA Managing Senior Editor Michael Apicella, Iowa City, Iowa, USA Polyxeni Potter, Atlanta, Georgia, USA Barry J. Beaty, Ft. Collins, Colorado, USA Associate Editors Martin J. Blaser, New York, New York, USA Charles Ben Beard, Ft. Collins, Colorado, USA David Brandling-Bennet, Washington, D.C., USA Donald S. Burke, Baltimore, Maryland, USA David Bell, Atlanta, Georgia, USA Charles H. Calisher, Ft. Collins, Colorado, USA Patrice Courvalin, Paris, France Arturo Casadevall, New York, New York, USA Stephanie James, Bethesda, Maryland, USA Thomas Cleary, Houston, Texas, USA Brian W.J. Mahy, Atlanta, Georgia, USA Anne DeGroot, Providence, Rhode Island, USA Takeshi Kurata, Tokyo, Japan Vincent Deubel, Lyon, France Martin I. Meltzer, Atlanta, Georgia, USA Ed Eitzen, Washington, D.C., USA Duane J. Gubler, Ft. Collins, Colorado, USA David Morens, Washington, D.C., USA Scott Halstead, Arlington, Virginia, USA J. Glenn Morris, Baltimore, Maryland, USA David L. Heymann, Geneva, Switzerland Tanja Popovic, Atlanta, Georgia, USA Sakae Inouye, Tokyo, Japan Patricia M. Quinlisk, Des Moines, Iowa, USA Charles King, Cleveland, Ohio, USA Gabriel Rabinovich, Buenos Aires, Argentina Keith Klugman, Atlanta, Georgia, USA Didier Raoult, Marseilles, France S.K. Lam, Kuala Lumpur, Malaysia Bruce R. Levin, Atlanta, Georgia, USA Pierre Rollin, Atlanta, Georgia, USA Myron Levine, Baltimore, Maryland, USA Mario Raviglione, Geneva, Switzerland Stuart Levy, Boston, Massachusetts, USA David Walker, Galveston, Texas, USA John S. MacKenzie, Brisbane, Australia Henrik C. Wegener, Copenhagen, Denmark Tom Marrie, Edmonton, Alberta, Canada Copy Editors John E. McGowan, Jr., Atlanta, Georgia, USA Angie Frey, Ronnie Henry, Anne Mather, Carol Snarey, Stephen S. Morse, New York, New York, USA Philip P. Mortimer, London, United Kingdom Cathy Young Fred A. Murphy, Davis, California, USA Production Barbara E. Murray, Houston, Texas, USA Reginald Tucker, Ann Kitchen, Maureen Marshall P. Keith Murray, Ames, Iowa, USA Editorial Assistant Stephen Ostroff, Atlanta, Georgia, USA Carolyn Collins Rosanna W. Peeling, Geneva, Switzerland David H. Persing, Seattle, Washington, USA www.cdc.gov/eid Gianfranco Pezzino, Topeka, Kansas, USA Emerging Infectious Diseases Richard Platt, Boston, Massachusetts, USA Emerging Infectious Diseases is published monthly by the Leslie Real, Atlanta, Georgia, USA National Center for Infectious Diseases, Centers for Disease David Relman, Palo Alto, California, USA Control and Prevention, 1600 Clifton Road, Mailstop D61, Nancy Rosenstein, Atlanta, Georgia, USA Atlanta, GA 30333, USA. Telephone 404-371-5329, Connie Schmaljohn, Frederick, Maryland, USA fax 404-371-5449, email [email protected]. Tom Schwan, Hamilton, Montana, USA Ira Schwartz, Valhalla, New York, USA The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the Centers for Disease Tom Shinnick, Atlanta, Georgia, USA Control and Prevention or the institutions with which the authors Bonnie Smoak, Bethesda, Maryland, USA are affiliated. Rosemary Soave, New York, New York, USA P. Frederick Sparling, Chapel Hill, North Carolina, USA All material published in Emerging Infectious Diseases is in Jan Svoboda, Prague, Czech Republic the public domain and may be used and reprinted without special Bala Swaminathan, Atlanta, Georgia, USA permission; proper citation, however, is required. Robert Swanepoel, Johannesburg, South Africa Use of trade names is for identification only and does not Phillip Tarr, Seattle, Washington, USA imply endorsement by the Public Health Service or by the U.S. Timothy Tucker, Cape Town, South Africa Department of Health and Human Services. Elaine Tuomanen, Memphis, Tennessee, USA Mary E. Wilson, Cambridge, Massachusetts, USA ∞ Emerging Infectious Diseases is printed on acid-free paper that meets John Ward, Atlanta, Georgia, USA the requirements of ANSI/NISO 239.48-1992 (Permanence of Paper) Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 10, No. 8, August 2004 A Peer-Reviewed Journal Tracking and Analyzing Disease Trends Vol. 10, No. 8, August 2004 On the Cover Emily Carr (1871–1945). Big Raven (1931) Oil on canvas, 87.3 cm x 114.4 cm, Vancouver Art Gallery, Emily Carr Trust About the Cover p. 1518 Perspective p. 1365 SARS in Hospital Workers, Bacterial Gene and Protein Hong Kong . .1399 Expression in the Host . .1357 J.T.F. Lau et al. J.D. Boyce et al. The SARS attack rate for hospital workers in Hong DNA microarrays and proteomics are used to Kong was 1.20% and was significantly higher in study bacterial gene and protein expression during nonmedical support staff. infections. Clinical West Nile Virus Infection . .1405 Synopsis A. Labowitz Klee et al. Vibrio vulnificus in Taiwan . .1363 Patients recovering from West Nile virus infection may experience sequelae for months. P.-R. Hsueh et al. Clinical features of 84 patients with Vibrio vulnificus infection in Taiwan are analyzed, and Serotype III Streptococcus isolates are typed. agalactiae . .1412 J.F. Bohnsack et al. Although largely unrelated, many bovine type III Research GBS appear to share a common ancestor with an important human clone. West Nile Virus in California . .1369 W. Reisen et al. The spread of WNV in California is tracked. Thrombocytopenia and Hantavirus Infections . .1420 Crimean-Congo Hemorrhagic F.M. Rasche et al. Fever, Turkey . .1379 Low platelet counts are a novel predictive marker suitable for risk-adapted patient management. S.S. Karti et al. Nineteen cases of suspected Crimean-Congo hemorrhagic fever are reported from Turkey. Pharmacy Data for Tuberculosis Surveillance . .1426 Antigenic Variants of D.S. Yokoe et al. Influenza Viruses . .1385 Pharmacy data help locate tuberculosis cases and assess their management. M.-S. Lee and J.S.-E. Chen Models based on amino acid changes in influenza hemagglutinin protein were compared to predict Methicillin-resistant antigenic variants of influenza A/H3N2 viruses. Staphylococcus aureus . .1432 D.L. Monnet et al. Mycobacterium ulcerans Relationships between antimicrobial use and MRSA Disease . .1391 prevalence were analyzed in Aberdeen, Scotland. M. Debacker et al. Hospital data show that Buruli ulcer is highly p. 1382 endemic in southern Benin. Encephalitis in California . .1442 R.T. Trevejo Epidemiologic features of hospitalized patients provide little evidence of unrecognized arboviral A Peer-Reviewed Journal Tracking and Analyzing Disease Trends Vol. 10, No. 8, August 2004 encephalitis. 1490 Flies and Campylobacter Human Herpesviruses Infection Infection in Children . .1450 B. Hald et al. A. Ansari et al. Human herpesviruses 6 and 7 were infrequently found in cerebrospinal fluid of children with central 1493 Rickettsia parkeri in nervous system infection. Amblyomma triste J.M. Venzal et al. Group G Streptococcal Bacteremia . .1455 1496 Hantavirus Infection R. Cohen-Poradosu et al. W.S. Mendes et al. Recurrent group G Streptococcus bacteremia, associated with lymphatic disorders and possibly 1499 West Nile Virus in British emm stG840.0, is described. Columbia M. Aquino et al. Dispatches 1461 Media Response to SARS Letters N. Wilson et al. p. 1465 1502 SARS Transmission and Commercial Aircraft 1465 Crimean-Congo Hemorrhagic Fever 1503 Estimating SARS Incubation A. Papa et al. Period (Replies) 1504 Detecting Bioterror Attack 1468 Recombinant Human (Replies) Enterovirus 71 Y.-F. Chan and S. AbuBakar 1506 Aeromonas spp., Hong Kong 1471 Syphilis in the HIV Era 1507 Trichinella in Crocodiles S. Kassutto and J.P. Doweiko 1509 Staphylococcus aureus, Singapore 1474 Swimming and Campylobacter Infections 1510 Balamuthia Amebic Encephalitis D. Schönberg-Norio et al. 1512 SARS Alert Applicability 1478 Rickettsia in Maryland 1514 SARS in Taiwan (Reply) N.C. Ammerman et al. 1482 Escherichia coli O157:H7 Book Review Genetic Marker 1517 Ebola and Marburg Viruses J.T. LeJeune et al. 1486 SARS Risk Perception, News & Notes the Netherlands p. 1469 J. Brug et al. About the Cover 1518 North American Birds and West Nile Virus P. Potter Genomic-scale Analysis of Bacterial Gene and Protein Expression in the Host John D. Boyce,* Paul A. Cullen,* and Ben Adler* The developing complementary technologies of DNA and space (in different cells or tissues within the host). We microarrays and proteomics are allowing the response of thus endeavor to understand how the pathogen adapts to bacterial pathogens to different environments to be probed the host microenvironment, what selective pressures are at the whole genome level. Although using these technolo- acting on the pathogen in each microenvironment, what gies to analyze pathogens within a host is still in its infancy, bacterial factors are responsible for the host damage, and initial studies indicate that these technologies will be valu- able tools for understanding how the pathogen reacts to the how the immune system is evaded. Although analyses that in vivo microenvironment. Some bacterial pathogens have give information on the expression of a few genes provide been shown to substantially modify their surface compo- insight and have been responsible for a large proportion of nents in response to the host immune system and modify the bacterial pathogenesis literature currently available, their energy