OBJECTIVE: To compare the prevalence of diagnosed diabetes among U.S. adults with and without disabilities, overall and by subgroups. RESEARCH DESIGN AND METHODS: We used data on adults aged ≥18 years from the cross-sectional 2021-2022 National Health Interview Survey to report the prevalence of diagnosed diabetes by functional disability status and for each disability type (hearing, seeing, mobility, cognition, self-care, and communication) separately. With use of the Washington Group Short Set on Functioning indicator, disability was defined according to the categories of milder (reporting some difficulty), moderate (reporting a lot of difficulty), and severe (cannot do at all) by disability type. Crude prevalence and age-standardized prevalence of diabetes were also calculated for adults with any difficulty with any disability by age, sex, race/ethnicity, education, insurance, and poverty-to-income ratio. RESULTS: Diabetes prevalence increased with number of disability types, was lower among adults with no disability (5.8%) than among those with milder (9.5%) or moderate to more severe (18.3%) disability, and was 4.0-10.3 percentage points higher among those with moderate to more severe disability than among those with milder disability for vision, hearing, mobility, and cognitive disabilities. Diabetes prevalence was similar for adults with milder and moderate to more severe self-care and communication disabilities. CONCLUSIONS: Prevalence of diabetes was higher among adults with any functional disability than without and increased with increasing number of disability types. Adults with multiple disability types, or those who have difficulty with self-care or communication or other moderate to more severe disabilities, may benefit from diabetes prevention programs.

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a serious, debilitating illness affecting millions of people worldwide. Patients with ME/CFS often feel misunderstood and report facing barriers to healthcare utilization. Objective: We report on a Voice of the Patient (VOP) series that used tenets from photovoice and hermeneutic phenomenology methods. The approach prioritized respecting and engaging patients as they share individual experiences of living with ME/CFS. Methods: We developed a 5-step process that could be replicated for interviewing patients in their own words. The process prioritized respecting patients while developing, documenting, and sharing individual accounts of living with ME/CFS. The standardized process for gathering each VOP story enabled individuals to share and participate on their own terms. Results: Over four years, eight VOP stories were completed and posted on CDC's ME/CFS website. The stories received over 196,000 page views. Each story was completed in approximately six months. Participants expressed gratitude for the opportunity to share experiences and were appreciative of the process that involved them in the development of stories. Conclusions: Qualitative methods guided the process for participants taking a central role in sharing stories, which in turn may help educate about patient experiences with ME/CFS. Standardization of steps enabled consistency and transparency. Building flexibility into the process allowed interviewing a range of people with ME/CFS (i.e. bed bound to working) and enabled patients to give narratives in their voice. This process may help to share experiences of people with other chronic diseases or infection associated chronic conditions. © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

INTRODUCTION: Despite progress in systemic lupus erythematosus (SLE) treatment, challenges persist in medication adherence due to side effects and costs. Precision nutrition, particularly adjusting fatty acid intake, offers a cost-effective strategy for enhancing SLE management. Prior research, including our own, indicates that increased consumption of omega-3 polyunsaturated fatty acids (PUFAs) correlates with improved outcomes in SLE patients. Here we build upon these findings by investigating associations between serum fatty acids-grouped as PUFAs, monounsaturated fatty acids (MUFAs), and saturated fatty acids (SFAs)-and lupus activity, pain, and sleep disturbance. METHODS: Using data from 418 participants with SLE in the Michigan Lupus Epidemiology and Surveillance (MILES) Cohort, we examined associations between serum levels of 25 fatty acids determined by GC-MS and patient-reported outcomes. Disease activity, pain, and sleep quality were assessed using standardized questionnaires. Generalized additive models and partial residual plots were utilized to examine the linearity of fatty acid effects. Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO), followed by multiple linear regression adjusting for sociodemographic factors. RESULTS: Findings indicated favorable associations between ω-3 PUFAs-and, to a lesser extent, ω-6 PUFAs-and patient-reported outcomes, while MUFAs and SFAs showed unfavorable associations. Docosahexaenoic acid (DHA), an omega-3 PUFA, exhibited the most robust favorable associations across all outcomes. Additionally, the omega-3 α-linolenic acid (ALA) was linked to reduced pain, whereas eicosapentaenoic acid (EPA), another omega-3, was associated with worsened disease activity and pain. Among omega-6 PUFAs, dihomo-γ-linolenic acid (DGLA) was favorably associated with disease activity, while the omega-9 PUFA Mead acid was linked to increased pain. DISCUSSION: These findings underscore the prospect that increased tissue levels of long-chain omega-3 PUFAs, particularly DHA, are favorably associated with SLE outcomes. Although further research is needed to establish causal relationships, existing evidence supports the role of omega-3 PUFAs in managing cardiovascular and chronic kidney disease, common SLE comorbidities. Most study participants exhibited low omega-3 PUFA status, suggesting substantial potential for improvement through targeted dietary interventions and supplementation. This study supports a potential role for precision nutrition in comprehensive SLE management, considering the impact of PUFAs, SFAs and MUFAs.

PURPOSE: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides access to timely breast and cervical cancer screening and diagnostic services to women who have low incomes and are uninsured or underinsured. Documenting the number of women eligible and the proportion of eligible women who receive NBCCEDP-funded services is important for identifying opportunities to increase screening and diagnostic services among those who would not otherwise have access. METHODS: Using the Census Bureau's Small Area Health Insurance Estimates data, we estimated the number of women who met the NBCCEDP eligibility criteria based on age, income, and insurance status. We used these estimates along with the number of women served by the NBCCEDP to calculate the percent of women served by race/ethnicity and state. We calculated the percent of eligible women who are up to date with screening using the 2019 National Health Interview Survey. RESULTS: The NBCCEDP served 15.0% of women ages 40-64 eligible for breast cancer services in 2018-2019 and 5.6% of women ages 21-64 eligible for cervical cancer services in 2018-2020. The NBCCEDP served 13.5% of women ages 40-64 eligible for breast cancer services in 2020-2021 and 5.9% of women ages 21-64 eligible for cervical cancer services in 2019-2021. The percent of women ages 40-64 who received breast cancer services declined by 1.5 percentage points between 2018-2019 and 2020-2021. The percent of women ages 21-64 who received cervical cancer services increased by 0.3 percentage points between 2018-2020 and 2019-2021. The percent of eligible women served varied among states. The state interquartile ranges of the percent of women served were 12.3-27.7% for breast cancer services in 2018-2019 and 3.9-14.7% for cervical cancer services in 2018-2020. Among women eligible for the NBCCEDP, 61.4% are not up to date with breast cancer screening and 40.6% are not up to date with cervical cancer screening. CONCLUSION: There is wide variation between states in the share of eligible women served for breast and cervical cancer screening services. We found that both the number and the percentage of eligible women who received NBCCEDP breast cancer services declined during a period that overlapped with the COVID-19 pandemic. A large proportion of eligible women did not receive breast or cervical cancer screening.

Influenza surveillance is important for monitoring influenza virus circulation and disease burden to inform influenza prevention and control measures. The aim of this study was to describe the epidemiology and to estimate the incidence of influenza in two communities in West Java, Indonesia, before and after the 2009 H1N1 pandemic. A population-based surveillance study in the community health care setting was conducted to estimate the annual incidence of influenza. A real-time reverse transcription polymerase chain reaction (RT-PCR) assay was used for influenza case ascertainment. A population census was implemented to calculate the population at risk and estimate community health care utilization rate. The mean annual incidence of influenza A and B, adjusted for healthcare utilization, was 1.6 (95%CI: 1.3–2.0) and 0.7 (95%CI: 0.5–1.0) per 1000 persons, respectively, with the most affected group being young and school-age children. The annual cumulative incidence of influenza A for children under five in 2009, 2010, and 2011 was 7.0 (95%CI: 4.4–11.2), 10.6 (95%CI: 7.3–15.4), and 6.3 (95%CI: 3.8– 10.2). For influenza B was 4.3 (95%CI: 2.4–7.8), 2.0 (95%CI: 0.8–4.7), and 0.4 (95%CI: 0.1–2.8), respectively. This study highlights that the incidence of influenza among young and school-age children is consistently higher compared to adults and the elderly throughout these periods. These populations are potential targets for influenza vaccination in Indonesia. © 2024, Narra Sains Indonesia. All rights reserved.

Coronavirus disease-2019 precipitated the rapid deployment of novel therapeutics, which led to operational and logistical challenges for healthcare organizations. Four health systems participated in a qualitative study to abstract lessons learned, challenges, and promising practices from implementing neutralizing monoclonal antibody (nMAb) treatment programs. Lessons are summarized under three themes that serve as critical building blocks for health systems to rapidly deploy novel therapeutics during a pandemic: (1) clinical workflows, (2) data infrastructure and platforms, and (3) governance and policy. Health systems must be sufficiently agile to quickly scale programs and resources in times of uncertainty. Real-time monitoring of programs, policies, and processes can help support better planning and improve program effectiveness. The lessons and promising practices shared in this study can be applied by health systems for distribution of novel therapeutics beyond nMAbs and toward future pandemics and public health emergencies. © The Author(s), 2024. Published by Cambridge University Press.

People with immunocompromising conditions (IC) are at increased risk of severe COVID-19 and death. These individuals show weaker immunogenicity following vaccination than individuals without IC, yet immunogenicity after SARS-CoV-2 infection is poorly understood. To address this gap, the presence of infection-induced antibodies in sera following a positive COVID-19 test result was compared between patients with and without IC. A commercial laboratory provided patient data gathered during July 2020-February 2022 on COVID-19 viral test results and antibody assay results, which included infection-induced (anti-N) antibody presence. Participants were categorized into having or not having IC based on if there was an indicative diagnostic code on their health record for a five-year period prior to the study period. Anti-N presence in sera from people with a positive COVID-19 test result was compared by IC status for four post-infection periods: 14-90, 91-180, 181-365, and 365+ days. A longitudinal, logistic regression produced adjusted odds ratios comparing anti-N prevalence among specimens with and without associated IC, adjusted for age, sex, residence in a metro area, and social vulnerability index (SVI) tertile. Data included 17,025 anti-N test results from 14,690 patients, 1,424 (9.7%) of which had at least one IC on record. In an adjusted comparison to patients without IC, patients with any IC were 0.61 times as likely to have infection-induced antibodies (99% CI: 0.40-0.93), during the 14-90 days following infection. Similar patterns were found when comparing people with two specific types of IC to people without any IC: (1) solid malignancies and (2) other intrinsic immune conditions. These findings stress the importance of prevention measures for people with IC, such as additional vaccination doses and consistent mask use before and after a documented infection.

Norovirus is the leading cause of acute gastroenteritis (AGE) globally. Few longitudinal studies have assessed norovirus-associated AGE incidence across age groups in community settings in Latin America. During April 2015-April 2019, active surveillance for AGE among community members of all ages was conducted through household visits two to three times per week in San Jeronimo, Cusco, Peru. An asymptomatic control household was selected for every fifth AGE case. Stool specimens were collected from AGE cases, asymptomatic household members, and control household members, and they were tested for norovirus using real-time reverse transcriptase polymerase chain reaction. Data on illness characteristics were collected from AGE cases during a 15-day follow-up period. Annual means of 247 households and 1,555 participants were enrolled during each April-March surveillance year, accounting for 4,176 person-years (PY) of observation. Of 1,099 AGE events reported, 1,014 stool specimens were tested, and 186 (18%) were norovirus positive. Norovirus AGE incidence was 4.4/100 PY (95% CI: 3.9-5.1); incidence was highest among those younger than 2 years old (60.9/100 PY; 95% CI: 46.8-79.4). Among 672 stool specimens from asymptomatic controls, 56 (8%) tested positive for norovirus. Odds of norovirus detection were significantly higher among cases compared with controls (odds ratio: 2.2; 95% CI: 1.6-3.1). Age-stratified norovirus incidence in this periurban community aligns with previously published estimates and was highest among those younger than 2 years old. Establishing baseline norovirus incidence in specific communities is crucial to identify target populations and assess effectiveness of future interventions, such as vaccines.

BACKGROUND: Institutions of higher education (IHE) have been a focus of SARS-CoV-2 transmission studies but there is limited information on how viral diversity and transmission at IHE changed as the pandemic progressed. METHODS: Here we analyze 3606 viral genomes from unique COVID-19 episodes collected at a public university in Seattle, Washington from September 2020 to September 2022. RESULTS: Across the study period, we found evidence of frequent viral transmission among university affiliates with 60% (n = 2153) of viral genomes from campus specimens genetically identical to at least one other campus specimen. Moreover, viruses from students were observed in transmission clusters at a higher frequency than in the overall dataset while viruses from symptomatic infections were observed in transmission clusters at a lower frequency. Although only a small percentage of community viruses were identified as possible descendants of viruses isolated in university study specimens, phylodynamic modeling suggested a high rate of transmission events from campus into the local community, particularly during the 2021-2022 academic year. CONCLUSIONS: We conclude that viral transmission was common within the university population throughout the study period but that not all university affiliates were equally likely to be involved. In addition, the transmission rate from campus into the surrounding community may have increased during the second year of the study, possibly due to return to in-person instruction.

Since late 2021, outbreaks of highly pathogenic avian influenza virus have caused a record number of mortalities in wild birds, domestic poultry, and mammals in North America. Wetlands are plausible environmental reservoirs of avian influenza virus; however, the transmission and persistence of the virus in the aquatic environment are poorly understood. To explore environmental contamination with the avian influenza virus, a large-volume concentration method for detecting infectious avian influenza virus in waterbodies was developed. A variety of filtering, elution, and concentration methods were explored, in addition to testing filtering speeds using artificially amended 20 L water matrices (deionized water with sterile dust, autoclaved wetland water, and wetland water). The optimal protocol was dead-end ultrafiltration coupled with salt solution elution and centrifugation concentration. Using this method, infectious virus was recovered at 1 × 10(-1) 50% egg infectious dose per milliliter (EID(50)/mL), whereas viral RNA was detected inconsistently down to 1 × 10(0) EID(50)/mL. This method will aid in furthering our understanding of the avian influenza virus in the environment and may be applicable to the environmental detection of other enveloped viruses.

In the healthcare landscape, diseases such as cancer and HIV/AIDS have benefited from the patient's perspective. For fungal diseases, the patient voice remains absent in critical areas such as policy formulation, funding decisions, and research priorities. Patients affected by fungal disease, along with their caregivers and advocacy groups, possess invaluable insights into the challenges and unmet needs they face. By elevating their voices and experiences, policymakers, funding agencies, and researchers can gain a more comprehensive understanding of the multifaceted nature of fungal disease and the urgency of addressing them. This paper addresses the pressing need for a coordinated effort to elevate the patient voice in advocating for improved policies, increased funding, and enhanced research initiatives regarding fungal disease.

OBJECTIVES: On July 28, 2022, eastern Kentucky experienced the state's deadliest flood in recorded history. In response to ongoing mental health concerns from community members who survived the flood, local health department directors in affected communities requested technical assistance from the Kentucky Department for Public Health and the Centers for Disease Control and Prevention. METHODS: Two simultaneous Community Assessments for Public Health Emergency Response (CASPERs) were conducted 6 weeks after the flood. Four counties were assessed in each CASPER. EpiInfo7 was used to calculate the unweighted and weighted frequencies and percentages to estimate the number and percentage of households with a particular response in each CASPER. RESULTS: Approximately a third (30.5%) of households in CASPER 1 and approximately 40% of households in CASPER 2 reported experiencing ≥1 mental health problems. Individual-level mental health questions from a modified 3-stage CASPER found approximately 15% of persons in both CASPERs reported a Patient Health Questionnaire-2 (PHQ-2) score ≥3 and approximately 20% of persons in both CASPERs reported Generalized Anxiety Disorder-2 (GAD-2) score ≥3. CONCLUSIONS: These findings indicated households experienced mental health problems after the flood. Depression and anxiety were prevalent among persons living in flood-affected areas. If ever needed, households preferred to receive mental health services in-person and locally.

The objective of this study is to evaluate the impact of low blood lead levels (BLLs) on the red blood cell folate concentrations in U.S. children aged 2-17 years. All data were obtained from the National Health and Nutrition Examination Survey (NHANES) over six consecutive cycles from 2007-2008 to 2017-2018. A total of 12,739 children with BLLs lower than 10 µg/dL (geometric mean: 0.66 µg/dL) were included in the dataset. BLLs were categorized into three tertiles (tertile 1: <0.55 µg/dL; tertile 2: 0.55-0.95 µg/dL; and tertile 3: ≥0.95 µg/dL). The multivariate linear regression model analysis indicates a negative relationship between BLLs and red blood cell folate concentrations. After adjusting for potential confounding factors, red blood cell folate concentrations were lower in children in the BLL tertile 2 (β-coefficient = -0.0450; 95% CI: -0.0676, -0.0224) and BLL tertile 3 groups (β-coefficient = -0.0775; 95% CI: -0.1032, -0.0517) compared to children in the BLL tertile 1 group. When stratified by age, gender, and race/Hispanic origin, the subgroup analysis consistently revealed a negative relationship between BLLs and red blood cell folate concentrations, with red blood cell folate concentrations being lower (p < 0.05) in children in the BLL tertile 3 group compared to children in the tertile 1 group. Further investigation is needed to explore the mechanism underlying the potential relationship between BLLs and red blood cell folate concentrations and determine whether folate plays an active role beneficial for preventing the harmful effects of lead on children.

BACKGROUND/OBJECTIVES: Congenital rubella syndrome (CRS) is a constellation of serious multi-organ birth defects following rubella virus infection during early pregnancy. Countries in which rubella vaccination has not yet been introduced can have a high burden of this disease. Data on CRS burden and epidemiology are needed to guide the introduction of a rubella vaccine and monitor progress for rubella elimination, but the multi-system nature of CRS manifestations and required specialized testing creates a challenge for conducting CRS surveillance in developing settings such as Sudan. To enhance data quality, we designed and tested a simplified approach for CRS surveillance in Sudan. METHODS: Seven CRS surveillance sentinel sites were set up at general pediatric, eye, and cardiology hospitals in Sudan, using standard definitions for reporting and classifying infants with CRS clinical manifestations. Between 2014 and 2017, we evaluated the system using WHO CRS surveillance monitoring indicators, comparing simplified approaches against a comprehensive one. The simplified approaches included (1) an ophthalmic-focused approach; (2) a heart-focused approach; and (3) a cataract-only approach. RESULTS: Surveillance identified 179 infants with suspected CRS via the comprehensive approach, with 25 infants classified as laboratory-confirmed and 6 as clinically compatible. Surveillance sensitivity was highest for the simplified ophthalmic approach, while cataract-based surveillance had the highest proportion of confirmed cases. CONCLUSIONS: Simplified CRS surveillance, particularly focusing on detecting cataracts, can significantly contribute to monitoring the impact of rubella vaccine introduction. It could serve as an initial step towards comprehensive CRS surveillance, providing robust evidence to support rubella and CRS elimination efforts.

We assessed severe acute respiratory syndrome coronavirus 2 seroprevalence on residual blood samples for pediatric COVID-19 surveillance: 2263 samples were collected during routine outpatient visits (<18 years, April 2020-August 2021). Seroprevalence increased over time, coinciding with or preceding virus circulation in the community and with or preceding pediatric severe COVID-19 hospitalization peaks. Residual blood sample seroprevalence may be a useful surveillance tool in future outbreaks.

Objective: To estimate the projected number of ALS cases in the United States from 2022 to 2030. Amyotrophic lateral sclerosis (ALS) is a progressive and fatal neuromuscular disease with no known cure. Because ALS is not a notifiable disease in the United States, the accurate ascertainment of prevalent ALS cases continues to be a challenge. To overcome this, the National ALS Registry (Registry) uses novel methods to estimate newly diagnosed and existing cases in the United States. Methods: We estimated ALS prevalence retrospectively from 2022 to 2024 and prospectively from 2025 to 2030 using prevalence obtained through previous CRC analyses on 2018 Registry data (the most current data available) to generate projected observed, missing, and total cases. Projected prevalent cases were then stratified by age, race, and sex. Results: The number of estimated ALS cases in 2022 was 32,893. By 2030, projected cases increase more than 10%, to 36,308. The largest increase occurs for the population ages 66 years and older, with a 25% increase (from 16,349 cases in 2022 to 20,438 cases in 2030). The projected number of cases classified as "other race" will increase by 15% (from 2,473 cases in 2022 to 2,854 cases in 2030). Conclusions: These estimates of projected ALS cases reflect anticipated changes in the underlying demographics of the United States. Our projections are likely an underestimation because emerging therapeutics and improved healthcare will improve survivability in this vulnerable population. These results should inform policy to more efficiently allocate resources for ALS patients and programs.

BACKGROUND: Rapid, accessible, and accurate testing was paramount to an effective US COVID-19 response. Federal partners supported SARS-CoV-2 testing scale-up through an interagency-coordinated approach that focused on expanding supply chains, research and development, validation, and improving patient access. We aimed to provide an overview of the federal efforts to scale up the testing response and study the impact of scale-up. METHODS: In this descriptive analysis, we mapped federal partner activities and milestones using the US Government Testing and Diagnostics Working Group (TDWG) and participating agency and department data from Jan 1, 2020, to Dec 31, 2022. Tests produced (TDWG), reported test positivity (US Centers for Disease Control and Prevention [CDC]'s COVID-19 Electronic Laboratory Reporting system and the Federal Direct Report testing data), reported COVID-19 case counts (CDC), hospitalisations (Department of Health and Human Services Unified Hospital Data Surveillance System and the CDC's National Healthcare Safety Network), and deaths (CDC) were analysed over time. We then developed an agent-based model to evaluate the impact testing had on COVID-19 outcomes using different scenarios. The scenarios were (1) if efforts led to substantially fewer tests produced, (2) if scale-up was delayed, affecting test access, and (3) if efforts led to substantially more tests produced. FINDINGS: Approximately 6·7 billion SARS-CoV-2 tests, including over 1·5 billion laboratory-based, 1·9 billion point-of-care (POC), and 3·2 billion over-the-counter (OTC) tests, were produced, and approximately 2·7 billion tests were performed between Jan 1, 2020, and Dec 31, 2022. Testing capacity exhibited various expansion phases, with laboratory-based capacity growing from approximately 6 million tests per month in March, 2020 to approximately 34 million tests per month in July, 2020; POC increased to approximately 126 million tests per month by December, 2020, and OTC increased to approximately 986 million tests per month by February, 2022. Comparison between the baseline (actual) and delay-in-testing scenario suggests the increased testing capacity potentially saved upwards of 1·4 million lives and averted 7 million hospitalisations. INTERPRETATION: Our study suggests that early development, manufacturing, and distribution of tests had a great impact on reducing severe COVID-19 outcomes. These results highlight the importance of robust and rapid test development, production, and distribution when addressing future public health threats. FUNDING: US Administration for Strategic Preparedness and Response and US Centers for Disease Control and Prevention.

Rotavirus is a leading cause of diarrhea among children but less known as a cause among adults. We describe clinical, epidemiologic, and genotype characteristics of a rotavirus outbreak among adults in King County, Washington occurring January-June 2023. Adult rotavirus incidence in 2023 was ten times higher than the same period in 2022 (5% versus 0.5% samples). Disease severity was mild. G9P[4], an uncommon, non-vaccine strain in USA, was the predominant genotype. Genotyping suggested spillover from children with subsequent spread among adults. Our study highlights benefits of routine testing and genotyping during outbreaks for surveillance, tracking, and understanding implications on vaccination.

OBJECTIVES: Economic models assessing vaccinations commonly assume that inflation-adjusted vaccine costs are constant over time. This study assessed this assumption using historical vaccine cost data. METHODS: Private sector and CDC contracted vaccine cost data (2001-2023) were collected from the CDC Vaccine Price List and converted to US$2023 to adjust for inflation. Trends in inflation-adjusted costs were described, and the annual percent changes in costs were calculated for each vaccine. RESULTS: Changes in cost varied by vaccine. The average inflation-adjusted private sector costs increased by 0.9 % (IQR: -0.4 %-2.6 %) and 1.4 % (IQR: -0.4 %-3.2 %) annually among pediatric and adult vaccines, respectively, while CDC contracted costs increased by 0.9 % (IQR: 0.2 %-1.2 %) and 1.0 % (IQR: -0.8 %-2.1 %) annually among pediatric and adult vaccines, respectively. CONCLUSIONS: Inflation-adjusted vaccine costs increased on average since 2001, highlighting limitations of constant cost assumptions. These findings can inform cost-effectiveness analyses of multi-year vaccination programs and policies.

Young Black women in the southern US face a high HIV burden. While daily oral HIV pre-exposure prophylaxis (PrEP) can effectively prevent HIV, its use is low among Black women. The acceptability of and perceived intention to use emerging PrEP products among young Black women in the southern US are not well understood. Non-oral PrEP alternatives could address challenges to PrEP uptake and reduce health disparities. We conducted virtual semi-structured interviews with Black women aged 18-34 in Atlanta, GA; Baton Rouge, LA; and Jackson, MS, to explore their perspectives on three emerging PrEP products: a long-acting injection, a subdermal implant, and a dual-purpose contraception and HIV prevention intravaginal ring. Seventy-five interviews were conducted from January to October 2021 and analyzed using inductive thematic analysis with NVivo software. Most participants were open to using medication to prevent HIV. The intravaginal ring was the most preferred, primarily due to its dual-purpose function, although it was also frequently rejected. The long-acting injection was the second most preferred and least rejected, perceived as the least invasive. The skin implant was the least preferred and most rejected, viewed as the most invasive. Our findings highlight the need for multiple PrEP options to meet individual preferences. Detailed descriptions, instructions, and experiential learning methods are crucial for choosing non-oral PrEP modalities. Practitioners should address questions and offer peer-based learning opportunities. Designing and promoting PrEP strategies for young Black women should involve close consultation with these consumers.

Rotavirus vaccine appears to perform sub-optimally in countries with higher rotavirus burden. We hypothesized that differences in the magnitude of rotavirus exposures may bias vaccine efficacy (VE) estimates, so true differences in country-specific rotavirus VE would be exaggerated without accommodating differences in exposure. We estimated VE against any-severity and severe rotavirus gastroenteritis (RVGE) using Poisson regression models fit to pooled individual-level data from Phase II and III monovalent rotavirus vaccine trials conducted between 2000 and 2012. The standard approach model included terms for vaccination, country, and a vaccination-country interaction. Other models used proxies for exposure magnitude like severe RVGE rate or age at severe RVGE instead of country. Country-specific proxies were calculated from placebo group data or extracted from an external meta-analysis. Analyses included 83,592 infants from 23 countries in the Americas, Europe, Africa, and Asia. Using the standard approach, VE against severe RVGE substantially varied (10-100%). Using the severe RVGE rate proxy brought VE from all but two countries between 80% and 86%. Heterogeneity for VE against any-severity RVGE was similarly attenuated. Adjusting for exposure proxies reduced heterogeneity in country-specific rotavirus VE estimates. This phenomenon may extend to other vaccines against partially immunizing pathogens with global disparities in burden.

BACKGROUND: The 2023-24 U.S. influenza season was characterized by a predominance of A(H1N1)pdm09 virus circulation with co-circulation of A(H3N2) and B/Victoria viruses. We estimated vaccine effectiveness (VE) in the United States against mild-to-moderate medically attended influenza illness in the 2023-24 season. METHODS: We enrolled outpatients aged ≥8 months with acute respiratory illness in 7 states. Respiratory specimens were tested for influenza type/subtype by reverse-transcriptase polymerase chain reaction (RT-PCR). Influenza VE was estimated with a test-negative design comparing odds of testing positive for influenza among vaccinated versus unvaccinated participants. We estimated VE by virus sub-type/lineage and A(H1N1)pdm09 genetic subclades. RESULTS: Among 6,589 enrolled patients, 1,770 (27%) tested positive for influenza including 796 A(H1N1)pdm09, 563 B/Victoria, and 323 A(H3N2). Vaccine effectiveness against any influenza illness was 41% (95% Confidence Interval [CI]: 32 to 49): 28% (95% CI: 13 to 40) against influenza A(H1N1)pdm09, 68% (95% CI: 59 to 76) against B/Victoria, and 30% (95% CI: 9 to 47) against A(H3N2). Statistically significant protection against any influenza was found for all age groups except adults aged 50-64 years. Lack of protection in this age group was specific to influenza A-associated illness. We observed differences in VE by birth cohort and A(H1N1)pdm09 virus genetic subclade. CONCLUSIONS: Vaccination reduced outpatient medically attended influenza overall by 41% and provided protection overall against circulating influenza A and B viruses. Serologic studies would help inform differences observed by age groups.

INTRODUCTION: Pandemic influenza vaccine development focuses on the hemagglutinin (HA) antigen for potency and immunogenicity. Antibody responses targeting the neuraminidase (NA) antigen, or the HA stalk domain have been implicated in protection against influenza. Responses to the NA and HA-stalk domain following pandemic inactivated influenza are not well characterized in humans. MATERIAL AND METHODS: In a series of clinical trials, we determine the vaccines' NA content and demonstrate that NA inhibition (NAI) antibody responses increase in a dose-dependent manner following a 2-dose priming series with AS03-adjuvanted influenza A(H7N9) inactivated vaccine (A(H7N9) IIV). NAI antibody responses also increase with interval extension of the 2-dose priming series or following a 5-year delayed boost with a heterologous adjuvanted A(H7N9) IIV. Neither concomitant seasonal influenza vaccination given simultaneously or sequentially, nor use of heterologous A(H7N9) IIVs in the 2-dose priming series had an appreciable effect on NAI antibody responses. Anti-HA stalk antibody responses were minimal and not durable. CONCLUSIONS: We provide evidence for strategies to improve anti-neuraminidase responses which can be further standardized for pandemic preparedness. CLINICAL TRIAL REGISTRY NUMBERS: NCT03312231, NCT03318315, NCT03589807, NCT03738241.

Individuals with certain primary immunodeficiency disorders (PID) may be unable to clear poliovirus infection after exposure to oral poliovirus vaccine (OPV). Over time, vaccine-related strains can revert to immunodeficiency-associated vaccine-derived poliovirus (iVDPVs) that can cause paralysis in the patient and potentially spread in communities with low immunity. We reviewed the efforts for detection and management of PID patients with iVDPV infections and the epidemiology through an analysis of 184 cases reported to the World Health Organization (WHO) during 1962-2024 and a review of polio program and literature reports. Most iVDPV patients (79%) reported in the WHO Registry were residents in middle-income countries and almost half (48%) in the Eastern Mediterranean Region. Type 2 iVDPV was most frequently isolated (53%), but a sharp decline was observed after the switch to bivalent OPV in 2016, with only six cases reported during 2017-2024 compared to 63 during 2009-2016. Patients with common variable immunodeficiency have longer excretion of iVDPV than with other PID types. Implementation of sensitive sentinel surveillance to detect cases of iVDPV infection in high-risk countries and offer antiviral treatment to patients is challenged by competition with other health priorities and regulatory hurdles to the compassionate use of investigational antiviral drugs.

Background: Uganda's Integrated Child Health Day (ICHD) initiative aims to improve children's access to vaccinations. Although widely used as a catch-up vaccination strategy, the effectiveness of the ICHD program in increasing immunization coverage, especially among vulnerable populations, has not been recently evaluated. This study assessed the reach and uptake of ICHD for immunizations in Uganda. Methods: A mixed-methods evaluation was conducted in three districts (Rakai, Kayunga, and Bukedea) where ICHDs occurred. The data collection included a cross-sectional household survey using validated WHO-adapted questionnaires of 1432 caregivers of children under five years old, key informant interviews with 42 health managers and workers, and nine focus group discussions with caregivers between October and December 2022. The vaccines assessed were Bacillus Calmette-Guerin, oral polio, Pentavalent, pneumococcal conjugate, rotavirus (RV), and measles-rubella (MR). Results: The immunization coverage based on child health cards was over 90% for all vaccines except for the second dose of RV (88.3%) and MR (16.2%). Among the children, 2.3% had received no Pentavalent vaccine, and 69.4% were fully vaccinated for their age. Of the 631 children who attended ICHDs, 79.4% received at least one vaccine during the event. Village Health Teams (49%), health workers (18.3%), and megaphone outreach (17.9%) were the primary information sources. Key informants cited challenges with coordination, vaccine delivery, and mobilization. Conclusions: Despite operational challenges, ICHDs appear to have contributed to routine childhood vaccinations. Further research is needed to assess the sustainability and cost-effectiveness of the program.

BACKGROUND: Understanding protection against SARS-CoV-2 infection by vaccine and hybrid immunity is important for informing public health strategies as new variants emerge. METHODS: We analyzed data from three cohort studies spanning September 1, 2022-July 31, 2023, to estimate COVID-19 vaccine effectiveness (VE) against SARS-CoV-2 infection and symptomatic COVID-19 among adults with and without prior infection in the United States. Participants collected weekly nasal swabs, irrespective of symptoms, annual blood draws, and completed periodic surveys, which included vaccination status and prior infection history. Swabs were tested molecularly for SARS-CoV-2. VE was estimated using Cox proportional hazards models for the hazard ratios of infections, adjusting for covariates. VE was calculated considering prior infection and recency of vaccination. RESULTS: Among 3,344 adults, adjusted VE of bivalent vaccine against infection was 37.2% (95% CI: 12.3-55.7%) within 7-59 days of vaccination and 21.1% (95% CI: -0.5-37.1%) within 60-179 days of vaccination compared to participants who were unvaccinated/received an original monovalent vaccine dose ≥180 days prior. Overall, adjusted VE of bivalent vaccine against infection, in conjunction with prior infection, was 62.2% (95% CI: 46.0-74.5%) within 7-179 days of vaccination and 39.4% (95% CI: 12.5-61.6%) ≥180 days compared to naïve participants who were unvaccinated/received a monovalent vaccine dose ≥180 days prior. CONCLUSIONS: Adults with both prior infection and recent vaccination had high protection against infection and symptomatic illness. Recent vaccination alone provided moderate protection.

Before October 2024, the Advisory Committee on Immunization Practices (ACIP) recommended use of a pneumococcal conjugate vaccine (PCV) for all adults aged ≥65 years, as well as for those aged 19-64 years with risk conditions for pneumococcal disease who have not received a PCV or whose vaccination history is unknown. Options included either 20-valent PCV (PCV20; Prevnar20; Wyeth Pharmaceuticals) or 21-valent PCV (PCV21; CAPVAXIVE; Merck Sharp & Dohme) alone or 15-valent PCV (PCV15; VAXNEUVANCE; Merck Sharp & Dohme) in series with 23-valent pneumococcal polysaccharide vaccine (PPSV23; Pneumovax23; Merck Sharp & Dohme). There are additional recommendations for use of PCV20 or PCV21 for adults who started their pneumococcal vaccination series with 13-valent PCV (PCV13; Prevnar13; Wyeth Pharmaceuticals). The ACIP Pneumococcal Vaccines Work Group employed the Evidence to Recommendations framework to guide its deliberations on expanding the age-based PCV recommendation to include adults aged 50-64 years. On October 23, 2024, ACIP recommended a single dose of PCV for all PCV-naïve adults aged ≥50 years. Recommendations for PCVs among adults aged 19-49 years with risk conditions and PCV13-vaccinated adults have not changed from previous recommendations. This report summarizes evidence considered for these recommendations and provides updated clinical guidance for use of PCV.

COVID-19 remains an important cause of morbidity and mortality, especially among adults aged ≤65 years and persons with moderate or severe immunocompromise; these persons are among those at highest risk for severe disease from COVID-19. On June 27, 2024, the Advisory Committee on Immunization Practices (ACIP) recommended 2024-2025 COVID-19 vaccination for all persons aged ≤6 months to target currently circulating strains of SARS-CoV-2 and provide additional protection against severe COVID-19. Because SARS-CoV-2 circulates year-round and immunity from vaccination wanes, on October 23, 2024, ACIP recommended a second 2024- 2025 COVID-19 vaccine dose for all adults aged ≤65 years and for persons aged 6 months-64 years with moderate or severe immunocompromise, 6 months after their last dose of 2024- 2025 COVID-19 vaccine (minimum interval = 2 months). Further, ACIP recommended that persons aged ≤6 months who are moderately or severely immunocompromised may receive additional doses of 2024-2025 COVID-19 vaccine (i.e., a total of ≤3 doses of 2024-2025 COVID-19 vaccine) based on shared clinical decision-making. Staying up to date with COVID-19 vaccination is recommended to decrease the risk for severe COVID-19, especially among adults aged ≤65 years and persons with moderate or severe immunocompromise. © 2024 Department of Health and Human Services. All rights reserved.

During 2023, the Centers for Disease Control and Prevention (CDC) recommended the first respiratory syncytial virus (RSV) immunizations intended for widespread use in the United States to prevent severe RSV illness in infants and older adults. CDC, in collaboration with federal, public health, and academic partners, is conducting evaluations of real-world effectiveness of recommended RSV immunization products in the United States. Similar frameworks for evaluation are being applied to RSV vaccines and nirsevimab, a long-acting preventative monoclonal antibody, to estimate product effectiveness. The overall goal of CDC's RSV immunization effectiveness program is to generate timely and robust evidence through observational studies to inform immunization product policy decisions and other measures related to RSV prevention and control. CDC is evaluating effectiveness through high-quality, well-controlled observational studies leveraging a variety of platforms that provide robust data to inform policy decisions.

Pneumonia is the second leading cause of hospital admissions and deaths among children <5 years in Uganda. In 2014, Uganda officially rolled out the introduction of the pneumococcal conjugate vaccine (PCV) into routine immunization schedule. However, little is known about the long-term impact of PCV on pneumonia admissions and deaths. In this study, we described the trends and spatial distribution of pneumonia hospital admissions and mortality among children <5 years in Uganda, 2014-2021. We analysed secondary data on pneumonia admissions and deaths from the District Health Information System version 2 during 2014-2021. The proportion of pneumonia cases admitted and case-fatality rates (CFRs) for children <5 years were calculated for children <5 years presenting at the outpatient department. At national, regional, and district levels, pneumonia mortality rates were calculated per 100,000 children <5 years. The Mann-Kendall Test was used to assess trend significance. We found 667,122 pneumonia admissions and 11,692 (2%) deaths during 2014-2021. The overall proportion of pneumonia cases admitted among children <5 years was 22%. The overall CFR was 0.39%, and the overall pneumonia mortality rate among children <5 years was 19 deaths per 100,000. From 2014 to 2021, there were declines in the proportion of pneumonia cases admitted (31% to 15%; p = 0.051), mortality rates (24/100,000 to 14 per 100,000; p = 0.019), and CFR (0.57% to 0.24%; p = 0.019), concomitant with increasing PCV coverage. Kotido District had a persistently high proportion of pneumonia cases that were admitted (>30%) every year while Kasese District had persistently high mortality rates (68-150 deaths per 100,000 children <5 years). Pneumonia admissions, mortality, and case fatality among children <5 years declined during 2013-2021 in Uganda after the introduction of PCV. However, with these trends it is unlikely that Uganda will meet the 2025 GAPPD targets. There is need to review implementation of existing interventions and identify gaps in order to highlight priority actions to further accelerate declines.

Introduction: This study aimed to develop a set of broad clinical diagnosis (ClinDx) groups relevant to occupational safety and health. The ClinDx groups are necessary for analysis and interpretation of longitudinal health data that include injury and disease codes from the Ninth and Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-9-CM, ICD-10-CM). Methods: Claims data were analyzed for Ohio Bureau of Workers’ Compensation insured employers from 2011 to 2018. We used interrupted time series regression models to estimate level (frequency) and slope (trend) changes to the percentage of each ClinDx group in October 2015. We created ClinDx groups aligned with ICD-10-CM structure and coding principles. Each ClinDx group was counted once per claim (distinct groups). Monthly percentages were calculated based on the injury date. When present, seasonality was assessed separately for each outcome using an autoregressive-moving average model. Results: The final set of ClinDx groups included 57 mutually exclusive and exhaustive groups. The study population included 661,684 claims, with 959,322 distinct ClinDx groups. Among all claims, 96.27% included injury code(s) and 11.77% included disease(s) codes. At the transition to ICD-10-CM, 33 ClinDx groups lacked any statistically significant (P < 0.05) changes between periods. We observed level changes for 17 ClinDx groups and slope changes for nine groups. Eight ClinDx groups had ≥ 20% (+/-) level changes. Conclusion: While the transition to ICD-10-CM is a break in series, about two-thirds of disease groups and half of injury groups were relatively stable across the transition. These findings also underscore the need for characterizing both injury and disease outcomes when analyzing workers’ compensation data. Practical Applications: The 57 ClinDx groups created in this study may be a practical starting point for other occupational epidemiologic analyses that include a mixture of ICD-9-CM and ICD-10-CM data. © 2024

More than 60 percent of US adults report that they had adverse childhood experiences (ACEs). For this study of 930,000 children born during the period 1999-2003, we used linked administrative, survey, and criminal justice data to measure the association between ACEs (parental death; separation; incarceration; or criminal charge for intimate partner violence, substance use disorder, or child sexual or nonsexual abuse) and socioeconomic disadvantages at ages 18-22 during 2017-21. After childhood socioeconomic status was controlled for, young adults with ACEs were more likely to have been charged with felonies, have become teenage parents, live in a household with poverty or housing assistance, be enrolled in Medicaid, and be employed, and were less likely to be enrolled in an educational institution. These outcomes were most likely among young adults with multiple ACEs or lower childhood socioeconomic status. Using new linked data opportunities, this study provides large-scale, person-level longitudinal evidence of the long-lasting and substantial societal cost of ACEs.

INTRODUCTION: Adverse childhood experiences (ACEs) are preventable, potentially traumatic events that occur in childhood. Alcohol use during pregnancy can result in miscarriage, stillbirth, preterm birth, and a range of lifelong behavioral, intellectual, and physical disabilities in the child. Limited research has examined the relationship between ACEs and alcohol use in pregnancy; available studies might not reflect current trends in this relationship. METHODS: Using 2019-2023 Behavioral Risk Factor Surveillance System data from 41 U.S. jurisdictions, the prevalence of self-reported current alcohol use among pregnant persons aged 18-49 years (N = 2371) was estimated by ACEs and selected characteristics. We calculated unadjusted and adjusted prevalence ratios (aPR) for the relationship between ACEs and alcohol use during pregnancy. RESULTS: The prevalence of current alcohol use was 16.2 % (95 % CI = 11.5-20.9) among pregnant persons who reported experiencing four or more ACEs, and 8.6 % (95 % CI = 5.7-11.5) among those who reported no ACEs. When adjusting for sociodemographic characteristics, pregnant persons who reported four or more ACEs were more likely to report current alcohol use compared to those who reported no ACEs (aPR = 1.8, 95 % CI = 1.1-2.9). Individually, pregnant persons who experienced emotional abuse (aPR = 1.9, 95 % CI = 1.3-2.7) and witnessed intimate partner violence (aPR = 1.6, 95 % CI = 1.1-2.4) were more likely to use alcohol during pregnancy compared to pregnant persons who did not report experiencing these ACEs. CONCLUSIONS: Higher ACE exposure was associated with alcohol use during pregnancy. Steps can be taken to mitigate their potential harms. Clinical and community-level interventions can address ACEs, which might reduce alcohol use during pregnancy.

Telomere length (TL) predicts the onset of replicative senescence, and its shortening is a limiter on the number of divisions individual somatic cells can perform. Metal-induced genotoxic events are discussed in Agency for Toxic Substances and Disease Registry’s (ATSDR) toxicological profiles. In vivo and in vitro toxicological studies suggest the correlation between toxic metals and TL. However, the correlation between TL and exposure to toxic metals in human populations is unclear despite decades of observational research. We conducted a literature search within the ATSDR toxicological profiles and PubMed database for peer-reviewed articles as of 04/2023 discussing TL and metal exposure in human populations. Through review of the 272 publications meeting these criteria, we identified 25 observational studies that considered the correlation between TL and exposure to some or all of six metals: cadmium (Cd), arsenic (As), nickel (Ni), selenium (Se), lead (Pb), and cesium (Cs). Because reported effect sizes were often not comparable across studies, we performed a sign test based on the reported significance for each metal–TL correlation. We found that Cd was consistently significantly correlated with shorter telomeres (p = 0.016). However, no consistent linear relationship was observed between TL and any of the other metals considered. Exploring this association can enhance our understanding of how metal exposure may influence TL dysfunction. Our findings suggest that Cd exposure contributes to shorter TL, which may affect the DNA damage response (DDR) resulting in numerous chronic health conditions. Further, we highlight inconsistencies in findings on the correlation between metal exposure and TL across different populations and exposure levels. This suggests that correlations between some metals and TL may vary across populations, and that correlations may change at different exposure levels. Also, our findings suggest the need for further research on the potential for nonlinear relationships and non-additive effects of co-exposure to multiple hazardous metals, which could explain the inconsistencies observed across studies. The inconsistent incidences of metal–TL correlations justify additional exploration into the complex interaction between metals and TL. © 2024 by the authors.

Laboratory analysis of blood cultures is vital to the accurate and timely diagnosis of bloodstream infections. However, the reliability of the test depends on clinical compliance with standard operating procedures that limit the risk of inconclusive or incorrect results. False-negative blood culture results due to inadequate volumes of blood can result in misdiagnosis, delay therapy, and increase patients' risk of developing or dying from bloodstream infections. Likewise, commonly occurring bacteria or fungi on human skin (i.e., commensal organisms) can contaminate the blood culture during collection and increase the risk of false positives, compromising care and leading to unnecessary antibiotic therapy and prolonged hospitalization. In December 2022, a Centers for Medicare & Medicaid Services (CMS) consensus-based entity (CBE) endorsed the Centers for Disease Control and Prevention's (CDC) proposal for a new patient safety measure to address these concerns. CDC developed this quality measure to promote the standardization of blood culture best practices and improve laboratory diagnosis of bloodstream infections nationally. This special report will emphasize the importance of standardizing blood culture collection and describe the need for a national patient safety measure, new quality tools, and next steps.

INTRODUCTION: Identifying tuberculosis infection (TBI) using interferon-gamma release assays (IGRAs) is a primary component of clinical and public health efforts to prevent pediatric tuberculosis. Pediatric data comparing the two IGRAs in the United States are very limited. We compared the performance of the two IGRAs among a large pediatric cohort tested for TBI and assessed whether discordance might be due to quantitative results close to test cut-off values. METHODS: Children aged 0-15 years with both T-SPOT.TB (T-SPOT) and QuantiFERON TB-Gold In-Tube (QFT-GIT) tests were identified from a U.S. multicenter study enrolling people at elevated risk of TBI or progression to TB disease. Results were compared using McNemar's Chi-square tests with stratification by age category and testing reason. Percent agreement and kappa statistics were also calculated. We characterized quantitative test results among children with discordant QFT-GIT-positive/T-SPOT-negative results. RESULTS: Among 3,793 children, a higher number had positive QFT-GIT than T-SPOT (10.1% vs 7.4%, p < .001). This difference was noted for all age categories except <2 years, and for children with close-contact and non-close contact test indications. Among discordant QFT-GIT-positive/T-SPOT-negative children, lowering the positive threshold for T-SPOT to include borderline spot counts (5-7) did not eliminate the discordance, nor were QFT-GIT antigen-minus-nil results concentrated in the range just above the standard cut-off of 0.35 IU/mL. CONCLUSIONS: In a large pediatric cohort tested for TBI, QFT-GIT had a higher proportion of positive results than T-SPOT, and discordance was not related to quantitative results close to the established diagnostic cut-offs.

BACKGROUND: Infection by Cryptococcus gattii can lead to pulmonary or central nervous system (CNS) disease, or both. Whether site of infection and disease severity are associated with C. gattii species and lineages or with certain underlying medical conditions, or both is unclear. We conducted a retrospective cohort study to identify factors associated with site of infection and mortality among C. gattii cases. METHODS: We extracted data on 258 C. gattii cases from Australia, Canada and the United States reported from 1999 to 2011. We conducted unadjusted and multivariable logistic regression analyses to evaluate factors associated with site of infection and C. gattii mortality among hospitalized cases (N=218). RESULTS: Hospitalized C. gattii cases with CNS and other extrapulmonary disease were younger, more likely to reside in Australia and be infected with VGI lineage but less likely to have comorbidities and die as compared to pulmonary cases. The odds of having CNS and/or other extrapulmonary disease were 9 times higher in cases with VGI infection (aOR=9.21, 95%CI=3.28-25.89). Age >70 years (aOR=6.69, 95%CI=2.44-18.30), chronic lung disease (aOR=2.62, 95%CI=1.05-6.51) and an immunocompromised status (aOR=2.08, 95%CI=1.05-6.51) were associated with higher odds of C. gattii mortality. CONCLUSIONS: Among hospitalized cases, C. gattii species and lineage are associated with site of infection but not with the risk of death, whereas older age and comorbidities increase the risk of death.

Due to its natural influenza susceptibility, clinical signs, transmission, and similar sialic acid residue distribution, the ferret is the primary animal model for human influenza research. Antibodies generated following infection of ferrets with human influenza viruses are used in surveillance to detect antigenic drift and cross-reactivity with vaccine viruses and circulating strains. Inoculation of ferrets, with over 1,500 human clinical influenza isolates (1998-2019) resulted in lower antibody responses (HI <1:160) to 86% (387 out of 448) influenza B viruses (IBVs) compared to 2.7% (30 out of 1,094) influenza A viruses (IAVs). Here, we show that the immune responses in ferrets inoculated with IBV were delayed and reduced compared to IAV. Innate gene expression in the upper respiratory tract and blood indicated that IAV generated a strong inflammatory response, including an early activation of the interferon (IFN), whereas IBV elicited a delayed and reduced response. Serum levels of cytokines and IFNs were all much higher following IAV infection than IBV infection. Pro-inflammatory, IFN, TH1/TH2, and T-effector proteins were significantly higher in sera of IAV-infected than IBV-infected ferrets over 28 days following the challenge. Serum levels of Type-I/II/III IFNs were detected following IAV infection throughout this period, whereas Type-III IFN was only late for IBV. An early increase in IFN-lambda corresponded to gene expression following IAV infection. Reduced innate immune responses following IBV infection reflected the subsequent delayed and reduced serum antibodies. These findings may help in understanding the antibody responses in humans following influenza vaccination or infection and consideration of potential addition of innate immunomodulators to overcome low responses. IMPORTANCE: The ferret is the primary animal model for human influenza research. Using a ferret model, we studied the differences in both innate and adaptive immune responses following infection with influenza A and B viruses (IAV and IBV). Antibodies generated following infection of ferrets is used for surveillance assays to detect antigenic drift and cross-reactivity with vaccine viruses and circulating influenza strains. IAV infection of ferrets to generate these reagents resulted in a strong antibody response, but IBV infection generated weak antibody responses. In this study using influenza-infected ferrets, we found that IAV resulted in an early activation of the interferon (IFN) and pro-inflammatory response, whereas IBV showed a delay and reduction in these responses. Serum levels of IFNs and other cytokines or chemokines were much higher in ferrets following IAV infection. These reduced innate responses were reflected the subsequent delayed and reduced antibody responses to IBV in the sera. These findings may help in understanding low antibody responses in humans following influenza B vaccination and infection and may warrant the use of innate immunomodulators to overcome these weak responses.

The HIV integrase inhibitor, dolutegravir (DTG), in the absence of eliciting integrase (int) resistance, has been reported to select mutations in the virus 3'-polypurine tract (3'-PPT) adjacent to the 3'-LTR U3. An analog of DTG, cabotegravir (CAB), has a high genetic barrier to drug resistance and is used in formulations for treatment and long-acting pre-exposure prophylaxis. We examined whether mutations observed for DTG would emerge in vitro with CAB. HIV-1IIIB was cultured in paired experiments of continuous high (300 nM) CAB initiated 2 h or 24 h after infection. After eight months of CAB treatment, no int resistance was detected. Conversely, HIV RNA 3'-PPT mutants were detected within one month and were the majority virus by day 98. The appearance of 3'-PPT variants coincided with a rapid accumulation of HIV 1-LTR and 2-LTR circles. RNA amplification from the 3'-LTR TAR identified transcripts crossing 2-LTR circle junctions, which incorporated the adjacent U5 sequence identical to the 3'-PPT mutants. 3'-PPT variants were only identified in LTR circles and transcripts. Additionally, we found evidence of linear HIV and LTR circle recombination with human DNA at motifs homologous to 3'-PPT sequences. HIV persistence under CAB was associated with transcription and recombination of LTR circle sequences.

BACKGROUND: Prenatally transmitted viruses can cause severe damage to the developing brain. There is unexplained variability in prenatal brain injury and postnatal neurodevelopmental outcomes, suggesting disease modifiers. Of note, prenatal Zika infection can cause a spectrum of neurodevelopmental disorders, including congenital Zika syndrome. Currently, there is no preventative treatment or cure. The Prenatal Infection and Neurodevelopmental Genetics (PING) Consortium aims to identify modulators of brain injury and adverse neurodevelopmental outcomes for Zika and other prenatal viral infections. METHODS: The Consortium pools information from eight multi-site studies conducted at 23 research centers in six countries to build a growing clinical and genomic repository, which is being mined for modifiers of virally induced brain injury. Partners include Children's National Hospital (USA), Instituto Nacional de Salud (Colombia), the Natural History of Zika Virus Infection in Gestation program (Brazil), Zika Instituto Fernandes Figueira (Brazil), the Centers for Disease Control and Prevention, and the National Institutes of Health. RESULTS: We have enrolled 4102 mothers and 3877 infants with 3063 biological samples and clinical data covering over 80 phenotypic fields and 5000 variables. Thus far, we have performed whole exome sequencing on 1226 participants. CONCLUSION: Here, we present the Consortium's formation and overarching study design. IMPACT: The PING Consortium brings together investigators and institutions to determine the causes of virally induced brain injury and neurological deficits. The clinical and genomic repository, with data from over 8000 patients, will serve as a foundation for a variety of basic and clinical studies.

IMPORTANCE: Preterm infants are recommended to receive most vaccinations at the same postnatal age as term infants. Studies have inconsistently observed an increased risk for postvaccination apnea in preterm infants. OBJECTIVE: To compare the proportions of hospitalized preterm infants with apnea and other adverse events in the 48 hours after 2-month vaccinations vs after no vaccinations. DESIGN, SETTING, AND PARTICIPANTS: This randomized, open-label clinical trial took place at 3 US neonatal intensive care units between August 2018 and October 2021. Infants between 6 and 12 weeks' postnatal age who were born at less than 33 weeks' gestational age and were eligible to receive 2-month vaccines were included. INTERVENTION: Infants were randomized 1:1 to vaccinated (received vaccines within 12 hours of randomization) or unvaccinated (no vaccines received during the study period) groups. Cardiorespiratory data were collected during the 48 hours after vaccination or randomization (unvaccinated group). MAIN OUTCOMES AND MEASURES: The primary outcome was apnea, defined as a respiration pause greater than 20 seconds or a respiration pause greater than 15 seconds with associated bradycardia less than 80 beats per minute. Other outcomes included the number and duration of apnea episodes, serious adverse events, respiratory support escalation, and receipt of positive pressure ventilation. RESULTS: Of 223 randomized infants (117 female; median [range] gestational age, 27.6 [23.0-32.9] weeks), 107 (48%) were vaccinated, and 116 (52%) were unvaccinated. For 2 infants in the vaccinated group, the primary outcome was unable to be assessed. The proportion of infants with 1 or more apnea event was 25 of 105 (24%) in the vaccinated group vs 12 of 116 (10%) in the unvaccinated group (adjusted odds ratio, 2.70; 95% CI, 1.27 to 5.73; P = .01). The mean number of apneic episodes did not significantly differ (model point estimate of difference, 0.54; 95% CI, -0.12 to 1.21) between the vaccinated (2.72) and unvaccinated (2.00) groups. The mean duration of apneic episodes did not significantly differ (model point estimate of difference, 4.6; 95% CI, -5.4 to 14.7) between the vaccinated (27.7) and unvaccinated (32.3) groups. No serious adverse events occurred during the 48-hour monitoring period. Other outcomes were not significantly different between groups. CONCLUSIONS AND RELEVANCE: In hospitalized preterm infants, the odds of apnea within 48 hours were higher after 2-month vaccinations vs after no vaccinations. The similar number and duration of apneic events and lack of serious adverse events suggest that current vaccination recommendations for hospitalized preterm infants are appropriate. Neonatal clinicians should continue providing evidence-based anticipatory guidance about postvaccination apnea risk. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03530124.

INTRODUCTION: We assessed the risk of adverse pregnancy and birth outcomes and birth defects among women living with HIV (WLHIV) on antiretroviral therapy (ART) and HIV-negative women. METHODS: We analyzed data on live births, stillbirths, and spontaneous abortions during 2015-2021 from a hospital-based birth defects surveillance system in Kampala, Uganda. ART regimens were recorded from hospital records and maternal self-reports. Using a log-binomial regression model, we compared the prevalence of 16 major external birth defects and other adverse birth outcomes among WLHIV on ART and HIV-negative women. RESULTS: A total of 203,092 births were included from 196,373 women of which 15,020 (7.6%) were WLHIV on ART. During pregnancy, 15,566 infants were primarily exposed to non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART (n=13,614; 87.5%). After adjusting for maternal age, parity, and number of antenatal care (ANC) visits, WLHIV on NNRTI were more likely than HIV-negative women to deliver preterm (adjusted prevalence ratio [aPR]=1.27, 95% confidence interval [CI]: 1.21,1.32), post-term (aPR=1.23, 95% CI: 1.16,1.32), or small for gestational age infants (aPR=1.35, 95% CI: 1.30,1.40). Spina bifida was more prevalent among infants born to WLHIV on ART periconceptionally compared to HIV-negative women (aPR=2.45, 95% CI 1.27,4.33). The prevalence of the other selected birth defects were similar between infants from WLHIV on ART and HIV-negative women. CONCLUSION: In Uganda, WLHIV on ART were more likely than HIV-negative women to experience selected adverse birth outcomes. Further surveillance of maternal ART exposure, including by drug class and ART regimen, is needed to monitor and prevent adverse birth outcomes in WLHIV.

Background: The integration of maternal and child health services (MCH) with routine immunization is an important global health strategy, particularly in low- and middle-income countries (LMICs). However, evidence is lacking regarding the best practices for service integration and the effect of integration on immunization and linked health service outcomes. Methods: We searched publication databases and gray literature for articles published between 2011 and 2020 that include approaches to integrating MCH services with immunizations during the first two years of life in LMICs. Abstracts and full-text articles were screened for eligibility. For the included articles, data extraction and analysis examined the descriptive characteristics of studies, outcomes, and implementation considerations. Results: Among the 16,578 articles screened, 44 met the criteria for inclusion, representing 34 studies, of which 29 were from Africa. The commonly linked MCH services were family planning (24%), human immunodeficiency virus (HIV) diagnosis or care (21%), and malaria prevention or control (21%). Multiple integration strategies were typically used; the co-location of linked services (65%), the provision of extra services by immunization staff (41%), and/or the provision of extra information by immunization staff (41%) were the most common. In general, integration improved MCH service outcomes (76%) and was either beneficial (55%) or neutral for immunization (35%), with some examples in family planning, malaria, and HIV where integrated services were not beneficial. Important implementation considerations included the careful matching of target populations in service re-design, ensuring support from policy, logistics, and information systems, the provision of adequate training and support of staff to avoid overload, clear client communication regarding service integration, and the need to address community concerns. Conclusions: Integrating MCH services with routine immunization can expand linked services and improve immunization coverage. This study has identified key implementation considerations relevant to both childhood and adult vaccination programs. More research is needed regarding costs and client preferences.

BACKGROUND: Frequent consumption of sugar-sweetened beverages (SSB) is associated with an increased risk of some health outcomes. OBJECTIVE: We investigated the relationships between knowledge of health risks related to SSB and SSB intake among adults. METHODS: This cross-sectional study utilized data from the 2021 SummerStyles survey. There were 4022 US adult participants (≥18 years). The outcome variable was SSB intake (none, >0 to <1, 1 to <2, or ≥2 times/day). The exposure variables were knowledge of the association between SSB and seven health conditions. Statistical analyses included seven multinomial regressions to estimate adjusted odds ratios (AOR) for the consumption of SSB according to knowledge of SSB-related health risks after controlling for sociodemographics. RESULTS: Overall, about 30% of adults consumed SSB ≥ 2 times/day. While most adults identified SSB-related conditions such as weight gain (84.0%), diabetes (78.4%), and cavities (74.2%) as being related to drinking SSB, fewer adults recognized related conditions, such as some cancers (23.9%), high cholesterol (28.4%), heart disease (33.5%), and high blood pressure (37.8%). Knowledge of any of the health conditions was not significantly associated with consuming SSB ≥ 2 times/day compared to non-SSB consumers. CONCLUSIONS: Knowledge of SSB-related health conditions varied by sociodemographics but was not associated with high SSB intake. Future studies could explore other factors beyond knowledge that may influence adults' high SSB intake.

Landscapers are exposed to noise, carbon monoxide (CO), respirable dust, and respirable crystalline silica (RCS) generated from the tools they use. Although engineering controls are available to reduce these exposures, no previous study has evaluated chronic exposures to landscapers in different work settings and compared exposures from landscaping tools with and without engineering controls. This field study of workers in the landscaping services industry documented the occupational exposures of 80 participants at 11 varied worksites to noise, CO, respirable dust, and RCS using personal breathing zone sampling. Results were analyzed using SAS/STAT 14.1. Analysis of variance was used for normally distributed data; otherwise, nonparametric methods were used. Most workers were overexposed to noise, with 94 of the 119 8-hr time-weighted average (TWA) noise exposures at or above the National Institute for Occupational Safety and Health (NIOSH) recommended exposure limit (REL) of 85 dBA. There were no statistically significant differences among different locations or occupations. No 8-hr TWA exposures to CO above the NIOSH REL were measured. Overexposures to RCS were measured at all locations where hardscaping (installing or maintaining non-living aspects of the landscape) was taking place. This is the first known field study of this type to include hardscapers. The use of engineering controls such as dust capture or wet methods would reduce RCS exposures, but respiratory protection may still be needed. Task-based analysis of noise and CO exposure revealed that the loudest landscaping tools used in this study were hardscaping table saws, gas chainsaws, gas leaf blowers, chipper/shredders, gas string trimmers, and fuel mowers. Workers were exposed to significantly more noise and CO when using fuel-powered versions compared to battery-powered versions of leaf blowers, string trimmers, and chainsaws.

OBJECTIVE: To investigate the biodynamics of human-exoskeleton interactions during patient handling tasks using a subject-specific modeling approach. BACKGROUND: Exoskeleton technology holds promise for mitigating musculoskeletal disorders caused by manual handling and most alarmingly by patient handling jobs. A deeper, more unified understanding of the biomechanical effects of exoskeleton use calls for advanced subject-specific models of complex, dynamic human-exoskeleton interactions. METHODS: Twelve sex-balanced healthy participants performed three simulated patient handling tasks along with a reference load-lifting task, with and without wearing the exoskeleton, while their full-body motion and ground reaction forces were measured. Subject-specific models were constructed using motion and force data. Biodynamic response variables derived from the models were analyzed to examine the effects of the exoskeleton. Model validation used load-lifting trials with known hand forces. RESULTS: The use of exoskeleton significantly reduced (19.7%-27.2%) the peak lumbar flexion moment but increased (26.4%-47.8%) the peak lumbar flexion motion, with greater moment percent reduction in more symmetric handling tasks; similarly affected the shoulder joint moments and motions but only during two more symmetric handling tasks; and significantly reduced the peak motions for the rest of the body joints. CONCLUSION: Subject-specific biodynamic models simulating exoskeleton-assisted patient handling were constructed and validated, demonstrating that the exoskeleton effectively lessened the peak loading to the lumbar and shoulder joints as prime movers while redistributing more motions to these joints and less to the remaining joints. APPLICATION: The findings offer new insights into biodynamic responses during exoskeleton-assisted patient handling, benefiting the development of more effective, possibly task- and individual-customized, exoskeletons.

Violence against nurses and other healthcare workers is a significant and escalating concern, impeding the provision of safe and effective healthcare services. A majority of nurses experience some kind of violence, including physical and nonphysical assaults during their careers. The consequences of workplace violence extend beyond individual trauma, leading to increased burnout, turnover, and significant financial costs for healthcare systems. Training programs focused on workplace violence prevention (WVP) have become ubiquitous, with elements like situational threat assessment, de-escalation techniques, and physical skills. Studies show that experiential components, such as role play, enhance the effectiveness of these trainings. Virtual Reality (VR) offers a promising solution by providing immersive, interactive training environments that enhance decision-making, physical coordination, and team dynamics. In this article we discuss how VR simulations can replicate real-world settings, allowing healthcare workers to practice and master violence prevention and management skills in a controlled, safe environment. We also describe how VR is scalable and cost-effective, enabling widespread adoption within and across organizations with minimal logistical challenges. Integrating VR into WVP training programs could significantly improve training outcomes, reduce the need for physical and chemical restraints, and ultimately enhance the overall safety and quality of healthcare services.

Structural firefighters are exposed to an array of polycyclic aromatic hydrocarbons (PAHs) as a result of incomplete combustion of both synthetic and natural materials. PAHs are found in both the particulate and vapor phases in the firefighting environment and are significantly associated with acute and chronic diseases, including cancer. Using a fireground exposure simulator (FES) and standing mannequins dressed in four different firefighter personal protective equipment (PPE) conditions, each with varying levels of protective hood interface and particulate-blocking features, the efficacy of the hoods was assessed against the ingress of PAHs (specifically, naphthalene). The authors also explored the effectiveness of a 100% cotton turtleneck at further attenuating the amount of naphthalene reaching the surface of the mannequin's neck. Air samples were collected at the breathing zone, abdomen, and thigh heights from the 6 ft-2 in mannequins used in this study. Naphthalene was the most abundant PAH (55% of the total PAH concentrations) in the FES and existed primarily in the vapor phase (92% vapor in the breathing zone). Additionally, bulk base layer and under the base layer polytetrafluoroethylene (PTFE) filter samples (used as skin surrogates) were collected from the neck region of the mannequins and analyzed for PAHs. A larger percentage of naphthalene was collected on the filter under the traditional knit hoods than on the cotton base layer, suggesting a small protective effect of the base layer against solid-phase naphthalene. Previous studies investigating naphthalene by employing air sampling under PPE have found a larger protective effect of base layers against the ingress of naphthalene vapor. PAHs that exist primarily as particulate in the fire environment were largely not detected on the base layers or PTFE filters under the gear. Further research is needed that involves more sensitive methods and non-static human subjects.

Workers employed in the commercial fishing, seafood processing, and aquaculture sectors face workplace hazards daily. Worldwide, a staggering 26% of commercial fishing workers reported experiencing harm at work in the past two years in a recent poll.Citation1 Moreover, the Food and Agriculture Organization (FAO) estimates that worldwide roughly 80 commercial fishing workers lose their lives each day.Citation2 Small-scale artisanal fishers are most vulnerable due to the lack of access to basic equipment and safety training.Citation3 Astonishingly, seven in ten workers in the fishing industry report having never been trained in workplace safety.Citation1 The need to reduce occupational safety and health risks in these work settings remains a prominent concern for these workers. As the world’s population is projected to reach 9.7 billion by 2050, FAO estimates the global supply of aquatic foods would require a 22% rise just to ensure the consumption in 2050 is maintained at current levels.Citation4 Growth could put more pressure on fishers, processing, and aquaculture workers in an industry already exposed to risks of injuries and fatalities, if safety and health concerns are not addressed.

Workers in electronics waste and lamp recycling facilities are at risk of exposure to elemental mercury through inhalation of mercury vapor and mercury-containing dust. Employers at an electronics waste and lamp recycling facility in Ohio that crushes mercury-containing lamps expressed concerns about mercury exposure from work processes and requested a health hazard evaluation by CDC's National Institute for Occupational Safety and Health (NIOSH). In April 2023, NIOSH conducted a multidisciplinary investigation to assess elemental and inorganic mercury exposures, including epidemiologic, environmental, and ventilation assessments. Results indicated that mercury vapor was detected throughout the facility, with six of 14 workers having elevated urine mercury levels. These workers had a median job tenure of 8 months; four did not speak English, and five reported symptoms consistent with mercury toxicity, such as metallic or bitter taste, difficulty thinking, and changes in personality. Recommendations included improving the ventilation system, changing work practices to reduce mercury exposure, and providing training and communication tailored to the worker. As the electronic waste recycling industry continues to grow, it is important for employers to evaluate mercury exposure and safeguard employees using a hierarchy of controls. Health departments should consider monitoring occupational mercury exposure in recycling facilities, and clinicians should be aware of the potential for mercury toxicity among workers in these settings.

Knowledge of seasonal activity patterns of human-biting life stages of tick species serving as vectors of human disease agents provides basic information on when during the year humans are most at risk for tick bites and tick-borne diseases. Although there is a wealth of published information on seasonal activity patterns of Ixodes scapularis and Ixodes pacificus in the United States, a critical review of the literature for these important tick vectors is lacking. The aims of this paper were to: (i) review what is known about the seasonal activity patterns of I. scapularis and I. pacificus in different parts of their geographic ranges in the US, (ii) provide a synthesis of the main findings, and (iii) outline key knowledge gaps and methodological pitfalls that limit our understanding of variability in seasonal activity patterns. Based on ticks collected while questing or from wild animals, the seasonal activity patterns were found to be similar for I. pacificus in the Far West and I. scapularis in the Southeast, with synchronous activity of larvae and nymphs, peaking in spring (April to June) in the Far West and from spring to early summer (April to July) in the Southeast, and continuous activity of adults from fall through winter and spring with peak activity from fall through winter (November/December to March). In the colder climates of the Upper Midwest and Northeast, I. scapularis adults have a bimodal seasonal pattern, with activity peaks in fall (October to November) and spring (April to May). The seasonal activity patterns for immatures differ between the Upper Midwest, synchronous for larvae and nymphs with peak activity in spring and summer (May to August), and the Northeast, where the peak activity of nymphs in spring and early summer (May to July) precedes that of larvae in summer (July to September). Seasonality of human tick encounters also is influenced by changes over the year in the level of outdoor activities in tick habitat. Studies on the seasonality of ticks infesting humans have primarily focused on the coastal Northeast and the Pacific Coast states, with fewer studies in the Southeast, inland parts of the Northeast, and the Upper Midwest. Discrepancies between seasonal patterns for peak tick questing activity and peak human infestation appear to occur primarily for the adult stages of I. scapularis and I. pacificus. Study design and data presentation limitations of the published literature are discussed. Scarcity of data for seasonal activity patterns of I. pacificus outside of California and for I. scapularis from parts of the Southeast, Northeast, and Upper Midwest is a key knowledge gap. In addition to informing the public of when during the year the risk for tick bites is greatest, high-quality studies describing current seasonal activity patterns also will generate the data needed for robust model-based projections of future climate-driven change in the seasonal activity patterns and provide the baseline needed to empirically determine in the future if the projections were accurate.

A previous laboratory study using Haemaphysalis longicornis Neumann (Acari: Ixodidae) ticks of North American origin showed that larvae could acquire the Lyme disease spirochete, Borrelia burgdorferi sensu stricto (s.s.) (Spirochaetales: Spirochaetaceae) while feeding to completion on infected mice. However, the infection was lost during the molt to the nymphal stage. Nonetheless, questing H. longicornis nymphs and adults collected by drag sampling in the northeastern United States have been reported infected with B. burgdorferi s.s. DNA; occasionally these ticks appeared to be partially engorged. This raises the question of whether H. longicornis ticks can (i) acquire B. burgdorferi s.s. during an interrupted, partial blood meal on an infected host and (ii) transmit spirochetes while completing the blood meal on a second host. In this laboratory study, we demonstrated that H. longicornis nymphs could acquire B. burgdorferi s.s. from infected Mus musculus mice during a partial blood meal. Borrelia burgdorferi s.s. was detected by a multiplex polymerase chain reaction amplicon sequencing assay in 2 of 32 (6.3%) nymphs allowed to remain attached to infected mice for 48 h but, paradoxically, not in any of 25 nymphs that remained attached to infected mice for 72 h. Unfortunately, due to the low percentage of infected nymphs, we were not able to examine if such partially fed, infected nymphs were able to transmit B. burgdorferi s.s. while completing their blood meal on a second, naïve host.