Initial Costs of Ebola Treatment Centers in the United States

Academy (Table ). Of these specimens, 12 (41%) were P1 type 1, 15 (52%) were P1 type 2a, and only 2 (7%) were P1 type 2c.A polyclonal distribution with 8 distinct MLVA types was observed, with the MLVA type M representing 11 (38%) of the identified MLVA types.Without the MPN1 marker, 3 MLVA types were observed.No macrolide resistance-associated mutation was detected, similar to what was observed in the 32 specimens collected in 2013.This finding is consistent with the low prevalence of macrolide resistance reported in northern Europe (6,7).We report 2 outbreaks of M. pneumoniae infections that occurred in the first and last quarter of 2013 in western Russia (Smolensk region).Despite the high predominance of P1 type 1 strains reported in the recent literature (1,2,7), these 2 outbreaks, reported in semiclosed settings involved only the newly described P1 type 2c variant; 1 outbreak represented a monoclonal phenomenon.In the Smolensk region, the circulation of both type 1 and 2 strains was observed a few years before the outbreak; most of these strains were P1 type 2a variants, and only a minority were type 2c variants, suggesting that the new type 2c variant had spread throughout this region of Russia since at least 2006.In other parts of the world, a switch between type 1 and type 2 strains might be occurring.Indeed, in the United States, P1 type 1 isolates predominated before 2010 but dropped to 50% of isolates in 2013, and type 2 and type 2 variant strains increased (9).This cyclic pattern of type 1 or type 2 predominance in the population has previously been reported (10).In conclusion, we detected no macrolide resistance in western Russia.The P1 type 2c variant spread throughout this region and can be responsible for monoclonal outbreaks.The epidemiologic monitoring of M. pneumoniae P1 types will assess the potential switch to P1 type 2 in the United States and other parts of the world and detect the possible emergence of the P1 type 2c variant.

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