Differentiating New from Newly Detected: Melioidosis in Yap, Federated States of Micronesia

Leisha D. Nolen Bacterial Special Pathogens Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;
Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, Georgia;

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Eric Lirow Yap Memorial Hospital, FSM Department of Health and Social Affairs, Yap, Federated States of Micronesia;

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Jay E. Gee Bacterial Special Pathogens Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;

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Mindy G. Elrod Bacterial Special Pathogens Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;

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Cari B. Kolton Bacterial Special Pathogens Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;

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Lindy Liu Bacterial Special Pathogens Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;

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William A. Bower Bacterial Special Pathogens Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;

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Marissa K. Person Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

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Maria Marfel Yap Memorial Hospital, FSM Department of Health and Social Affairs, Yap, Federated States of Micronesia;

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David D. Blaney Bacterial Special Pathogens Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia;

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Melioidosis is a bacterial infection caused by exposure to water or soil that contains Burkholderia pseudomallei (Bp). Burkholderia pseudomallei is endemic to many tropical and subtropical areas of the world. In 2013, the first case of melioidosis was recognized in Yap, the Federated States of Micronesia. Six additional cases were identified in the subsequent 3 years. An investigation was initiated to understand the epidemiology of melioidosis in Yap. Serum from family and community members of the identified cases were tested for antibodies to Bp. Archived serum from a 2007 Zika serosurvey were also tested for antibodies to Bp. Sequencing of bacterial isolates was performed to understand bacterial phylogeny. Soil and water were tested for the presence of Bp in the environment by culture and PCR. None of the affected patients had a history of travel to melioidosis-endemic countries. Two of the 34 (5.8%) samples from the field investigation and 67 (11.7%) of the historical samples demonstrated serologic evidence of prior Bp exposure. No Bp were detected from 30 soil or water samples. Genotype analysis showed highly related Bp isolates that were unique to Yap. Melioidosis is likely to be endemic to Yap; however, it has only recently been recognized by the clinical community in country. Further investigation is needed to understand the local sites that harbor Bp and represent the highest risk to the community.

Author Notes

Address correspondence to Leisha D. Nolen, 1600 Clifton Rd. NE, Atlanta, GA 30320. E-mail: xdf8@cdc.gov

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Funding: The Centers for Disease Control and Prevention baseline funding supported this work.

Authors’ addresses: Leisha D. Nolen, Arctic Investigations Program, Centers for Disease Control and Prevention, Anchorage, AK. E-mail: xdf8@cdc.gov. Eric Lirow and Maria Marfel, Yap Memorial Hospital, FSM Department of Health and Social Affairs, Yap, Federated States of Micronesia, E-mails: elirow@fsmhealth.fm and mmarfel@fsmhealth.fm. Jay E. Gee, Mindy G. Elrod, Cari B. Kolton, Lindy Liu, William A. Bower, and David D. Blaney, Bacterial Special Pathogens Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA. E-mails: xzg4@cdc.gov, wzg0@cdc.gov, fts3@cdc.gov, fuz3@cdc.gov, wab4@cdc.gov, and znr5@cdc.gov. Marissa K. Person, Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA. E-mail: wnu6@cdc.gov.

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