Investigation of a Large Diphtheria Outbreak and Cocirculation of Corynebacterium pseudodiphtheriticum Among Forcibly Displaced Myanmar Nationals, 2017-2019.

BACKGROUND: Diphtheria, a life-threatening respiratory disease, is caused mainly by toxin-producing strains of Corynebacterium diphtheriae, while nontoxigenic corynebacteria (eg, Corynebacterium pseudodiphtheriticum) rarely causes diphtheria-like illness. Recently, global diphtheria outbreaks have resulted from breakdown of health care infrastructures, particularly in countries experiencing political conflict. This report summarizes a laboratory and epidemiological investigation of a diphtheria outbreak among forcibly displaced Myanmar nationals in Bangladesh. METHODS: Specimens and clinical information were collected from patients presenting at diphtheria treatment centers. Swabs were tested for toxin gene (tox)-bearing C. diphtheriae by real-time polymerase chain reaction (RT-PCR) and culture. The isolation of another Corynebacterium species prompted further laboratory investigation. RESULTS: Among 382 patients, 153 (40%) tested tox positive for C. diphtheriae by RT-PCR; 31 (20%) PCR-positive swabs were culture confirmed. RT-PCR revealed 78% (298/382) of patients tested positive for C. pseudodiphtheriticum. Of patients positive for only C. diphtheriae, 63% (17/27) had severe disease compared to 55% (69/126) positive for both Corynebacterium species, and 38% (66/172) for only C. pseudodiphtheriticum. CONCLUSIONS: We report confirmation of a diphtheria outbreak and identification of a cocirculating Corynebacterium species. The high proportion of C. pseudodiphtheriticum codetection may explain why many suspected patients testing negative for C. diphtheriae presented with diphtheria-like symptoms.

A Framework to Monitor Changes in Transmission and Epidemiology of Emerging Pathogens: Lessons From Nipah Virus.

It is of uttermost importance that the global health community develops the surveillance capability to effectively monitor emerging zoonotic pathogens that constitute a major and evolving threat for human health. In this study, we propose a comprehensive framework to measure changes in (1) spillover risk, (2) interhuman transmission, and (3) morbidity/mortality associated with infections based on 6 epidemiological key indicators derived from routine surveillance. We demonstrate the indicators' value for the retrospective or real-time assessment of changes in transmission and epidemiological characteristics using data collected through a long-standing, systematic, hospital-based surveillance system for Nipah virus in Bangladesh. We show that although interhuman transmission and morbidity/mortality indicators were stable, the number and geographic extent of spillovers varied significantly over time. This combination of systematic surveillance and active tracking of transmission and epidemiological indicators should be applied to other high-risk emerging pathogens to prevent public health emergencies.

Inference of Nipah virus evolution, 1999-2015.

Despite near-annual human outbreaks of Nipah virus (NiV) disease in Bangladesh, typically due to individual spillover events from the local bat population, only twenty whole-genome NiV sequences exist from humans and ten from bats. NiV whole-genome sequences from annual outbreaks have been challenging to generate, primarily due to the low viral load in human throat swab and serum specimens. Here, we used targeted enrichment with custom NiV-specific probes and generated thirty-five additional unique full-length genomic sequences directly from human specimens and viral isolates. We inferred the temporal and geographic evolutionary history of NiV in Bangladesh and expanded a tool to visualize NiV spatio-temporal spread from a Bayesian continuous diffusion analysis. We observed that strains from Bangladesh segregated into two distinct clades that have intermingled geographically in Bangladesh over time and space. As these clades expanded geographically and temporally, we did not observe evidence for significant branch and site-specific selection, except for a single site in the Henipavirus L polymerase. However, the Bangladesh 1 and 2 clades are differentiated by mutations initially occurring in the polymerase, with additional mutations accumulating in the N, G, F, P, and L genes on external branches. Modeling the historic geographical and temporal spread demonstrates that while widespread, NiV does not exhibit significant genetic variation in Bangladesh. Thus, future public health measures should address whether NiV within in the bat population also exhibits comparable genetic variation, if zoonotic transmission results in a genetic bottleneck and if surveillance techniques are detecting only a subset of NiV.

Ultrafast studies of excess electrons in liquid acetonitrile: revisiting the solvated electron/solvent dimer anion equilibrium.

We examine the ultrafast relaxation dynamics of excess electrons injected into liquid acetonitrile using air- and water-free techniques and compare our results to previous work on this system [Xia, C. et al. J. Chem. Phys. 2002, 117, 8855]. Excess electrons in liquid acetonitrile take on two forms: a "traditional" solvated electron that absorbs in the near-IR, and a solvated molecular dimer anion that absorbs weakly in the visible. We find that excess electrons initially produced via charge-transfer-to-solvent excitation of iodide prefer to localize as solvated electrons, but that there is a subsequent equilibration to form the dimer anion on an ~80 ps time scale. The spectral signature of this interconversion between the two forms of the excess electron is a clear isosbestic point. The presence of the isosbestic point makes it possible to fully deconvolute the spectra of the two species. We find that solvated molecular anion absorbs quite weakly, with a maximum extinction coefficient of ~2000 M(-1)cm(-1). With the extinction coefficient of the dimer anion in hand, we are also able to determine the equilibrium constant for the two forms of excess electron, and find that the molecular anion is favored by a factor of ~4. We also find that relatively little geminate recombination takes place, and that the geminate recombination that does take place is essentially complete within the first 20 ps. Finally, we show that the presence of small amounts of water in the acetonitrile can have a fairly large effect on the observed spectral dynamics, explaining the differences between our results and those in previously published work.

Ultrafast Studies of Exciton Migration and Polaron Formation in Sequentially Solution-Processed Conjugated Polymer/Fullerene Quasi-Bilayer Photovoltaics.

We examine the ultrafast dynamics of exciton migration and polaron production in sequentially processed 'quasi-bilayer' and preblended 'bulk heterojunction' (BHJ) solar cells based on conjugated polymer films that contain the same total amount of fullerene. We find that even though the polaron yields are similar, the dynamics of polaron production are significantly slower in quasi-bilayers than BHJs. We argue that the different polaron production dynamics result from the fact that (1) there is significantly less fullerene inside the polymer in quasi-bilayers than in BHJs and (2) sequential processing yields polymer layers that are significantly more ordered than BHJs. We also argue that thermal annealing improves the performance of quasi-bilayer solar cells not because annealing drives additional fullerene into the polymer but because annealing improves the fullerene crystallinity. All of the results suggest that sequential processing remains a viable alternative for producing polymer/fullerene solar cells with a nanometer-scale architecture that differs from BHJs.

Counterion dependent dye aggregates: nanorods and nanorings of tetra(p-carboxyphenyl)porphyrin.

Atomic force microscopy (AFM) of porphyrin aggregates formed on silica from acidic aqueous solution is used to investigate the basis for the previously reported counterion dependence of the optical spectra of aggregates of H(2)TCPP(2+), the diacid form of tetra(p-carboxyphenyl)porphyrin (TCPP). Resonance light scattering confirms the presence of excitonically coupled porphyrin aggregates in solutions of H(2)TCPP(2+) in both aqueous HCl and HNO(3). Aggregates formed in aqueous HNO(3) solutions show resonance light scattering (RLS) at wavelengths within both the H and J aggregate absorption bands and are imaged on the surface of silica as nanorods about 3 to 4 nm in height. H(2)TCPP(2+) aggregates in aqueous HCl solution exhibit RLS when excited within the blue-shifted Soret band (H band) and produce AFM images on silica of ring-shaped structures ranging from about 200 to 2000 nm in diameter. Fluorescence excitation and emission spectra reveal quenching of the Q-band emission in the aggregates at a pH less than 1 and confirm the existence of a single species, assigned to a dimer, at a pH just above 1. The morphology of the nanostructures as revealed by AFM provides insight into the structural basis for the counterion-dependent optical properties of H(2)TCPP(2+) aggregates.