Recurrent Bordetella holmesii Bacteremia and Nasal Carriage in a Patient Receiving Rituximab

were seropositive. Because antibodies may be detectable 10 days–3 weeks after experimental infection for the first time (8), the presumed period of infection was between midJanuary and mid-February. At this time, the highest temperatures again rose above 6°C for a few days (Figure 1, panel A). Although the within-herd seroprevalence was >90% in ewes after confirmed or suspected SBV infection in 2011 (9), in this study, conducted during the cold season, only 12 (13%) of 90 tested sheep were positive by ELISA. Three animals seroconverted between mid-January and mid-February. Thus, SBV transmission appears to be possible at a low level, most likely because of the low activity of the involved insect vectors. In addition to the SBV cases found on the sheep holding in Mecklenburg–Western Pomerania, an additional 52 confirmed SBV cases (defined as virus detection by qRTPCR or isolation in cell culture) in adult ruminants were reported to the German Animal Disease Reporting System from January 1 through February 20, 2013 (Figure, panel B). Most affected animal holdings were located in Bavaria, but cases were also reported from Thuringia, Saxony, Brandenburg, Mecklenburg–Western Pomerania, Hesse, and Lower Saxony. In conclusion, transmission of SBV by hematophagous insects seems possible, even during the winter in central Europe, if minimum temperatures rise above a certain threshold for several consecutive days.