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In this study, simulated GE did not drop below average during outbreak 1 on site II, but it did drop below average prior to outbreak 2. On site I, however, simulated GE dropped below average prior to both outbreaks.
Live-poultry markets were the source of this outbreak (1 ).
AM – Examined and treated the patients and also accompanied SS for investigations of Outbreak 1.
During May 2013 March 2014, the Netherlands was affected by a large measles outbreak (1 ).
The patient was from the Municipality of Banabuiú, ≈400 km from the location of outbreak 1.
Since the outbreak, 1 additional human isolate of DT104A was identified from a resident of the same neighboring region.
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It has been shown using mathematical models that this pattern of high peak and low peak outbreaks can be explained by the variation in the number of susceptible individuals in the population, which is considerably diminished following a large outbreak [ 1, 4, 12].
The strain is also designated CDC 5058 and has the same pulsed-field gel electrophoretic type and other genetic characteristics as organisms causing this outbreak [1], [2].
Since 2004, 21 highly pathogenic avian influenza (HPAI) H5N1 outbreaks in domestic poultry have been confirmed in Cambodia including six H5N1 outbreaks in Kampong Cham Province (5 outbreaks) and Prey Veng Province (1 outbreak) [1], [2].
Thus, more cases with severe neurological complications, such as meningoencephalitis, requiring intensive-care units, and the first cases of vertical maternal fetal transmission were reported during this outbreak [ 1- 4, 23, 24].
In fact, recent studies indicated that GII.P16/GII.13 NoVs were already circulating in Spain and Italy in 2010, 2 years before the large-scale German outbreak [ 1, 24].
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