2952 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 27, No. 11, November 2021 RESEARCH LETTERS 2. Touzard-Romo F, Tapé C, Lonks JR. Co-infection with SARS-CoV-2 and human metapneumovirus. R I Med J. 2020;103:75–6. PubMed 3. Wu X, Cai Y, Huang X, Yu X, Zhao L, Wang F, et al. Co-infection with SARS-CoV-2 and infuenza A virus in patient with pneumonia, China. Emerg Infect Dis. 2020;26:1324–6. https://doi.org/10.3201/eid2606.200299 4. Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323:2052–59. https://doi.org/10.1001/jama.2020.6775 5. Arashiro T, Nakamura S, Asami T, Mikuni H, Fujiwara E, Sakamoto S, et al. SARS-CoV-2 and Legionella co-infection in a person returning from a Nile Cruise. J Travel Med. 2020;27:taaa053. PubMed https://doi.org/10.1093/jtm/taaa053 6. Cox MJ, Loman N, Bogaert D, O’Grady J. Co-infections: potentially lethal and unexplored in COVID-19. Lancet Microbe.2020;1:e11. https://doi.org/10.1016/ S2666-5247(20)30009-4 7. ESCMID. ESCMID Study Group for Legionella Infections [cited 2020 Sep 24]. https://www.escmid.org/research_projects/ study_groups/study_groups_g_n/legionella_infections 8. Public Health England. Legionnaires’ disease in residents of England and Wales: 2016 [cited 2020 May 6]. https://www. gov.uk/government/publications/legionnaires-disease-in- residents-of-england-and-wales-2016 9. Adler H, Ball R, Fisher M, Mortimer K, Vardhan MS. Low rate of bacterial co-infection in patients with COVID-19. Lancet Microbe. 2020;1:e62. https://doi.org/10.1016/ S2666-5247(20)30036-7 Address for correspondence: Vicki Chalker, United Kingdom Health Security Agency, 61 Colindale Ave, London NW9 5EQ, UK; email: Vicki.chalker@phe.gov.uk Invasive Malaria Vector Anopheles stephensi Mosquitoes in Sudan, 2016–2018 Ayman Ahmed, Patricia Pignatelli, Arwa Elaagip, Muzamil M. Abdel Hamid, Omnia Fateh Alrahman, David Weetman Author afliations: Liverpool School of Tropical Medicine, Liverpool, UK (A. Ahmed, P. Pignatelli, D. Weetman); University of Khartoum, Khartoum, Sudan (A. Ahmed, A. Elaagip, M.M. Abdel Hamid, O. Fateh Alrahman) DOI: https://doi.org/10.3201/eid2711.210400 A nopheles stephensi mosquitoes are effcient vectors of Plasmodium vivax and P. falciparum. Their na- tive range centers on the Indian subcontinent, from which they are increasingly expanding their geo- graphic distribution (1). Recent establishment in Ethi- opia (2) and Djibouti (3) is especially worrying. We document the emergence of An. stephensi mosquitoes in Sudan. Among study sites in a study originally inves- tigating insecticide resistance in the dominant ma- laria vector in Sudan, Anopheles arabiensis mosqui- toes, we selected 12 sites in the eastern half of the country to represent the different ecologic zones (Appendix Figure 1, https://wwwnc.cdc.gov/ EID/article/27/11/21-0400-App1.pdf). We col- lected Anopheles spp. larvae from all sites in 2016 and from most again in late 2017 or early 2018 (Ap- pendix Table 1). We reared the larvae to adults, checked them morphologically, and initially iden- tifed the species as An. gambiae s.l. We extracted DNA from a subset for molecular identifcation of the species by PCR (3). Of these, 149 DNA samples failed to amplify when we used the standard pro- tocol for identifcation of the An. gambiae complex, and we investigated them further. We performed mitochondrial cytochrome oxidase 1 amplifcation and sequencing by using the universal primers C1- J-2183 and TL2-N-3014 on the frst batch (4); to pro- vide conformity with other studies in East Africa, we used Folmer primers LCO1490 and HCO2198 on a second batch (4). To confrm species identi- ty, we performed BLAST (https://blast.ncbi.nlm. nih.gov/Blast.cgi) searches. We supplemented se- quences generated for the mosquitoes from Sudan by using the Folmer primers with sequences from other studies downloaded from GenBank, assem- bled them by using Clustal within MEGAX (5), and displayed the results as a maximum-likelihood tree with 1,000 bootstraps. Sequence analysis demonstrated that many of the samples failing diagnostic PCR were not An. gambiae s.l. mosquitoes; most samples identifed by BLAST were An. stephensi mosquitoes (Appendix Table 1). The relative frequencies of An. stephensi mosquito detection were similarly high (>40%) among those Anopheles stephensi mosquitoes are urban malaria vectors in Asia that have recently invaded the Horn of Africa. We detected emergence of An. stephensi mos- quitoes in 2 noncontiguous states of eastern Sudan. Results of mitochondrial DNA sequencing suggest the possibility of distinct invasions, potentially from a neighboring country.