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A Peer-Reviewed Journal Tracking and Analyzing Disease Trends pages 1197–1362 EDITOR-IN-CHIEF D. Peter Drotman EDITORIAL STAFF EDITORIAL BOARD Founding Editor Dennis Alexander, Addlestone Surrey, United Kingdom Ban Allos, Nashville, Tennessee, USA Joseph E. McDade, Rome, Georgia, USA Michael Apicella, Iowa City, Iowa, USA Managing Senior Editor Barry J. Beaty, Ft. Collins, Colorado, USA Polyxeni Potter, Atlanta, Georgia, USA Martin J. Blaser, New York, New York, USA David Brandling-Bennet, Washington, D.C., USA Associate Editors Donald S. Burke, Baltimore, Maryland, USA Charles B. Beard, Ft. Collins, Colorado, USA Charles H. Calisher, Ft. Collins, Colorado, USA David Bell, Atlanta, Georgia, USA Arturo Casadevall, New York, New York, USA Thomas Cleary, Houston, Texas, USA Patrice Courvalin, Paris, France Anne DeGroot, Providence, Rhode Island, USA Stephanie James, Bethesda, Maryland, USA Vincent Deubel, Providence, Rhode Island, USA Brian W.J. Mahy, Atlanta, Georgia, USA Ed Eitzen, Washington, D.C., USA Takeshi Kurata, Tokyo, Japan Duane J. Gubler, Ft. Collins, Colorado, USA Scott Halstead, Arlington, Virginia, USA Martin I. Meltzer, Atlanta, Georgia, USA David L. Heymann, Geneva, Switzerland David Morens, Washington, D.C., USA Sakae Inouye, Tokyo, Japan Tanja Popovic, Atlanta, Georgia, USA Charles King, Cleveland, Ohio, USA Keith Klugman, Atlanta, Georgia, USA Patricia M. Quinlisk, Des Moines, Iowa, USA S.K. Lam, Kuala Lumpur, Malaysia Gabriel Rabinovich, Buenos Aires, Argentina Bruce R. Levin, Atlanta, Georgia, USA Didier Raoult, Marseilles, France Myron Levine, Baltimore, Maryland, USA Stuart Levy, Boston, Massachusetts, USA Pierre Rollin, Atlanta, Georgia, USA John S. MacKenzie, Brisbane, Australia Mario Raviglione, Geneva, Switzerland Tom Marrie, Edmonton, Alberta, Canada Copy Editors John E. McGowan, Jr., Atlanta, Georgia, USA Stephen S. Morse, New York, New York, USA Carol Snarey, Anne Mather, Cathy Young, Philip P. Mortimer, London, United Kingdom Mary Anne Castranio Fred A. Murphy, Davis, California, USA Production Barbara E. Murray, Houston, Texas, USA Reginald Tucker, Ann Kitchen P. Keith Murray, Ames, Iowa, USA Stephen Ostroff, Atlanta, Georgia, USA Editorial Assistant Rosanna W. Peeling, Geneva, Switzerland Carolyn Collins David H. Persing, Seattle, Washington, USA Gianfranco Pezzino, Topeka, Kansas, USA www.cdc.gov/eid Richard Platt, Boston, Massachusetts, USA Emerging Infectious Diseases Leslie Real, Atlanta, Georgia, USA Emerging Infectious Diseases is published monthly by the David Relman, Palo Alto, California, USA National Center for Infectious Diseases, Centers for Disease Nancy Rosenstein, Atlanta, Georgia, USA Control and Prevention (CDC), 1600 Clifton Road, Mailstop D61, Connie Schmaljohn, Frederick, Maryland, USA Atlanta, GA 30333, USA. Telephone 404-371-5329, Tom Schwan, Hamilton, Montana, USA fax 404-371-5449, email [email protected]. Ira Schwartz, Valhalla, New York, USA Tom Shinnick, Atlanta, Georgia, USA The opinions expressed by authors contributing to this journal Robert Shope, Galveston, Texas, USA do not necessarily reflect the opinions of the Centers for Disease 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 Phillip Tarr, Seattle, Washington, USA Use of trade names is for identification only and does not 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 David Walker, Galveston, Texas, USA ∞ Emerging Infectious Diseases is printed on acid-free paper that meets Mary E. Wilson, Cambridge, Massachusetts, USA the requirements of ANSI/NISO 239.48-1992 (Permanence of Paper) Emerging Infectious Diseases • Vol. 9, No. 10, October 2003 A Peer-Reviewed Journal Tracking and Analyzing Disease Trends Vol.9, No.10, October 2003 Characterization of Waterborne Outbreak–associated Campylobacter jejuni, Walkerton, Ontario . .1232 C.G. Clark et al. Cultural Contexts of Ebola in Northern Uganda . .1242 B.S. Hewlett and R.P. Amola 1918 Influenza Pandemic Caused by Highly Conserved Viruses with Two Receptor-Binding Variants . .1249 A.H. Reid et al. On the Cover: Jacques-Louis David (1748-1825). Cephamycin Resistance in Clinical Isolates Coronation of Empress Josephine by Napoleon I at Notre Dame de and Laboratory-derived Strains of Paris, 2 December 1804 (1806-1807) Escherichia coli, Nova Scotia, Canada . .1254 Oil on canvas, 6.1 m x 9.31 m. Photo: Peter Willi B. Clarke et al. Réunion des Musées Nationaux/Art Resource, NY. Chateaux de Versailles et de Trianon, Versailles, France Mass Antibiotic Treatment for Group A About the Cover, pg. 1361 Streptococcus Outbreaks in Two Long-Term Care Facilities . .1260 A. Smith et al. Perspective Anthelmintic Baiting of Foxes against Urban Syndromic Surveillance and Contamination with Echinococcus multilocularis . .1266 Bioterrorism-related Epidemics . .1197 D. Hegglin et al. J.W. Buehler et al. Cephalosporin-resistant Escherichia coli Research among Summer Camp Attendees with Salmonellosis . .1273 Illness in Intensive Care Staff after G. Prats et al. Brief Exposure to Severe Acute Respiratory Syndrome . .1205 Multijurisdictional Approach to D.C. Scales et al. Biosurveillance, Kansas City . .1281 M.A. Hoffman et al. Superantigens and Streptococcal Toxic Shock Syndrome . .1211 Environmental Risk and Meningitis T. Proft et al. Epidemics in Africa . .1287 A.M. Molesworth et al. Hazards of Healthy Living: Bottled Water and Salad Vegetables as Risk Factors for Campylobacter Infection . .1219 Dispatches M.R. Evans et al. Severe Acute Respiratory Syndrome: Lessons from Singapore . .1294 Escherichia coli O157 Exposure in K. Singh et al. Wyoming and Seattle: Serologic Evidence of Rural Risk . .1226 All material published in Emerging Infectious Diseases is in the public J.P. Haack et al. domain and may be used and reprinted without special permission; proper citation, however, is appreciated. A Peer-Reviewed Journal Tracking and Analyzing Disease Trends Vol.9, No.10, October 2003 West Nile Virus Transmission in Chlamydia trachomatis Infections in Resident Birds, Dominican Republic . .1299 Female Soldiers, Israel . .1344 O. Komar et al. E.S. Bamberger et al. West Nile Virus Encephalitis and Letters Myocarditis in Wolf and Dog . .1303 C.A. Lichtensteiger et al. Clostridium tertium in Necrotizing Fascitis and Gangrene . .1347 Weissella confusa Infection in P. Ray et al. Primate (Cercopithecus mona) . .1307 A.I. Vela et al. Dengue Hemorrhagic Fever, Uttaradit, Thailand . .1348 J. Patumanond et al. Mycobacterium tuberculosis Beijing Genotype, the Netherlands . .1310 Antimicrobial Drug–resistant Salmonella M.W. Borgdorff et al. Typhimurium (Reply to Helms) . .1350 J. Dahl Saliva and Meningococcal Transmission . .1314 H.J. Orr et al. Antimicrobial Drug–resistant Salmonella Typhimurium (Reply to Dahl) . .1350 Small Colony Variants of Staphylococcus M. Helms aureus and Pacemaker-related Infection . .1316 H. Seifert et al. Serogroup A Neisseria meningitidis Outside Meningitis Belt in Southwest Cameroon . .1351 West Nile Virus Detection in American Crows . .1319 P. Cunin et al. S.A. Yaremych et al. West Nile Virus Meningitis in Patient Severe Histoplasmosis in Travelers to Nicaragua . .1322 with Common Variable Immunodeficiency . .1353 M. Weinberg et al. A.M. Alonto et al. Mayaro Virus in Wild Mammals, French Guiana . .1326 Isolation of Enterobacter sakazakii from B. de Thoisy et al. Midgut of Stomoxys calcitrans . .1355 J.V. Hamilton et al. The European Commission’s Task Force on Bioterrorism . .1330 A. Tegnell et al. Book Review Exotic Viral Diseases: A Global Guide . .1357 Wild-type Measles Virus in Brain Tissue of M. Bell Children with Subacute Sclerosing Panencephalitis, Argentina . .1333 P.R. Barrero et al. News & Notes Conference Summary Cat or Dog Ownership and Seroprevalence of Drug-resistant Streptococcus pneumoniae Ehrlichiosis, Q Fever, and Cat-Scratch Disease . .1337 and Methicillin-resistant Staphylococcus M. Skerget et al. aureus Surveillance . .1358 L.A. Hawley et al. Flying Squirrel–associated Typhus, United States . .1341 About the Cover . .1360 M.G. Reynolds et al. P. Potter PERSPECTIVE Syndromic Surveillance and Bioterrorism-related Epidemics James W. Buehler,* Ruth L. Berkelman,* David M. Hartley,† and Clarence J. Peters‡ To facilitate rapid detection of a future bioterrorist Establishing a diagnosis is critical to the public health attack, an increasing number of public health departments response to a bioterrorism-related epidemic, since the are investing in new surveillance systems that target the diagnosis will guide the use of vaccinations, medications, early manifestations of bioterrorism-related disease. and other interventions. Absent a bioterrorism attack, pre- Whether this approach is likely to detect an epidemic soon- dicting whether syndromic surveillance will trigger an er than reporting by alert clinicians remains unknown. The detection of a bioterrorism-related epidemic will depend on investigation that yields a diagnosis before clinicians make population characteristics,