key: cord-0000878-2mfbqs8i authors: Sun, Rui-Qin; Cai, Ru-Jian; Chen, Ya-Qiang; Liang, Peng-Shuai; Chen, De-Kun; Song, Chang-Xu title: Outbreak of Porcine Epidemic Diarrhea in Suckling Piglets, China date: 2012-01-03 journal: Emerg Infect Dis DOI: 10.3201/eid1801.111259 sha: 9b5ccd6bdaec71cd24d8c9122c6a6b868bdd22a0 doc_id: 878 cord_uid: 2mfbqs8i nan the genera Eptesicus and Rhinolophus in South Korea. However, nucleotide sequencing showed the presence of prototypical Hantaan virus indicating a spillover infection or laboratory contamination (7) . Further screening is necessary to confi rm N. hispida as a natural reservoir host of the virus. Although the presented bat-associated sequence is obviously distinct from other hantaviruses, which suggests association with a novel natural host, a spillover infection from another, yet unrecognized host cannot be ruled out. However, detection of the virus exclusively in 1 organ (lung but not in liver, kidney, and spleen; data not shown) suggests a persistent infection that is typically observed in natural hosts of hantaviruses (8) . To date, only a few reports exist on cases of hemorrhagic fever with renal syndrome in Africa (9,10). However, underreporting must be assumed because the symptoms resemble those of many other febrile infections. Moreover, in cases of infections by non-rodent-associated hantaviruses, cross-reactivity with routinely used rodent-borne virus antigens should be limited and may hamper human serodiagnostics (1). The results suggest that bats, which are hosts of many emerging pathogens (5), may act as natural reservoirs for hantavirus. The effect of this virus on public health remains to be determined. To the Editor: Beginning in October 2010, porcine epidemic diarrhea (PED), caused by a coronaviral infection affecting pigs, emerged in China in an outbreak characterized by high mortality rates among suckling piglets. The outbreak overwhelmed >10 provinces in southern China, and >1,000,000 piglets died. This outbreak was distinguished by ≈100% illness among piglets after birth (predominantly within 7 days and sometimes within only a few hours) and death rates of 80%-100% (online Technical Appendix Table 1 , wwwnc. cdc.gov/EID/pdfs/11-1259-Techapp. pdf). Few sows or boars showed any clinical signs during the outbreak, which is not consistent with a recent report from Thailand (1). In that outbreak during late 2007, pigs of all ages were affected, exhibiting different degrees of diarrhea and no appetite. We characterized the genetic variation of the PED virus (PEDV) that caused a large-scale outbreak in China during 2010-2011 and compared it with viruses in other outbreaks. We also report a possible novel transmission pathway for PEDV. A total of 177 samples (intestine, stool, and maternal milk) were collected from pigs from different farms who had diarrhea; 100% of farms had >1 porcine sample positive for PEDV. A total of 125/177 porcine samples were confi rmed as positive for PEDV by reverse transcription PCR using primers as described (2) . PEDV was detected in 105 (82.0%) of 128 fecal samples and 20 (40.8%) of 49 sow milk samples. Piglets infected with PEDV showed mild hemorrhage, undigested curdled milk in the stomach, and thin-walled intestines with severe mucosal atrophy and foamy fl uid (data not shown). The spike (S) gene of the family Coronaviridae has a high degree of variation and can induce neutralizing antibody (3). Reverse transcription PCR products of the 651-bp partial S gene of PEDV and the deduced amino acid sequences were aligned by using ClustalW (www.genome. jp/tools/clustalw), and a neighborjoining tree with 1,000 bootstraps was constructed. Sequences of the S genes from this outbreak were 99.1%-100.0% homologous and had 88.7%-98.9% nt identity with all reference strains (online Technical Appendix Table 2 ), 98.5%-98.9% with Thailand strains, and 94.5%-95.1% with vaccine strain CV777. The partial S gene deduced amino acid sequences were compared and also showed a high degree of homology (98.0%-100.0%); they had 85.3%-98.7% identity with all reference strains listed in online Technical Appendix Table 2 , 98.0%-98.7% with Thailand strains, and 93.3%-94.7% with vaccine strain CV777 (data not shown). Phylogenetic analysis indicated that the PEDV in the China outbreak was different from foreign and other domestic strains on the basis of the reported partial S gene sequences. All new strains were clustered in the same branch, close to the cluster of Thailand strains, and far from the cluster of vaccine strain CV777 (Figure) . In the China outbreak, PEDV caused severe diarrheal disease in piglets; heavy economic losses in many provinces resulted, despite use of commercial vaccines (inactivated Phylogenic analysis showed that strain CV777 did not cluster with current common strains and showed 4) . To our knowledge, fecal-oral transmission is probably the main or only route of PEDV transmission (5) (6) (7) . In our study, if a fecal sample from a sick piglet was found to be positive for PEDV, we also collected and studied milk from its mother. These results showed that PEDV was present in sow milk (online Technical Appendix Table 3 ), but the detection rate was lower for these samples (40.8%) than for the fecal samples (82.0%). On the basis of these results, we hypothesize that sow milk could represent a possible (and potentially major) route for the vertical transmission of PEDV from sow to suckling piglet. This hypothesis could be indirectly verifi ed by our fi eld observation that piglet death rates decreased as a result of fostering (data not shown). Our fi ndings show that PEDV was identifi ed not only in fecal samples from sick piglets, as expected, but also in the milk of the sow, which suggests vertical transmission of the virus. Human pathogenic hantaviruses and prevention of infection Hantavirus in African wood mouse, Guinea Novel hantavirus sequences in shrew, Guinea Molecular evolution of Azagny virus, a newfound hantavirus harbored by the West African pygmy shrew (Crocidura obscurior Bats: important reservoir hosts of emerging viruses Molecular phylogenetics and the origins of placental mammals Genomic characterization of M and S RNA segments of hantaviruses isolated from bats Hantavirus-induced immunity in rodent reservoirs and humans First human case of haemorrhagic fever with renal syndrome in the Central African Republic Serological evidence of human hantavirus infections in Guinea, West Africa Chinese-like strain of porcine epidemic diarrhea virus Differential detection of transmissible gastroenteritis virus and porcine epidemic diarrhea virus by duplex RT-PCR Critical epitopes in transmissible gastroenteritis virus neutralization Light microscopy and ultrahistology of intestinal changes in pigs infected with epizootic virus diarrhoea (EVD): comparison with transmissible gastroenteritis (TGE) virus and porcine rotavirus infections Large-scale spatial-transmission models of infectious disease Identifi cation of the membrane protein of porcine epidemic diarrhea virus Coronavirus-like particles associated with diarrhea in baby pigs in Quebec We thank the technicians from the pig farms for assistance in sample collection and Bin Wu for assistance in fi gure preparation. We also thank the Guangdong Province Pig Industry Innovation Projects for their support. To the Editor: Urban trench fever caused by Bartonella quintana has been reported in persons who abuse alcohol and in homeless persons in large cities worldwide. Symptoms vary from asymptomatic intermittent bacteremia to serious complications (1) . Pediculus humanus mites, the known vector of the infection, are not always identifi ed, which raises the possibility that other vectors might also be involved (2) . We report on an outbreak of B. quintana infection among a young family of high socioeconomic status and their visiting relatives.The family resides in a regional city (population 104,000) in northern Czech Republic in an old, renovated apartment located on the top fl oor, just under the roof. In the summer of 2007, hundreds of ectoparasitic mites migrated from a whole in the roof and settled on the inner side of a permanently open window before infesting family members. Two weeks later (day 1 of symptom onset), a papular rash and pruritic vesicular lesions were noted by the parents on the body and legs of their 2 children, a 1-year-old girl and a 3-year-old boy. On day 3, the girl's body temperature rose to 38.0°C, and the boy's temperature rose to 39.5°C. The rash resolved in ≈10 days in both children. Vesicular lesions on the girl's buccal mucosal membrane resolved in 5 days. Excoriated areas resulting from spontaneous rupture of lesions or scratching were still visible on day 14.On day 4, a fever (temperature, 38.5°C) and intense tibialgia, which persisted for 5 days, developed in the 33-year-old father of the infected children. On day 5, a vesicular rash, which resolved in 10 days, developed in the 33-year-old mother. The children's