Eyewash stations are an essential component of laboratory safety programs, providing first aid in case of ocular exposure to hazardous materials. However, the presence of microbial contamination in these devices poses a potential risk of ocular infection to laboratory employees. This cross-sectional study aimed to evaluate the microbial quality and performance of 40 eyewash stations fixed in 10 buildings in a laboratory setting. Water quality parameters, including temperature, pH, turbidity, and the presence of Acanthamoeba spp., were measured at various time points (first draw, after 2 min of flushing, and 15 min flushing) from samples collected from each of the 40 eyewash stations. Performance and operational data were also measured according to the American National Standards Institute (ANSI)/International Safety Equipment Association (ISEA) Z358.1-2014 standard. Our results showed variable compliance with this standard across measures of physical condition, performance, access, and maintenance. Out of the 147 water samples collected (130 eyewash samples, 17 building reference samples), 28 samples were suspected to contain Acanthamoeba spp. or other free-living amoeba based on initial testing. Further analysis using polymerase chain reaction (PCR) confirmed the presence of Acanthamoeba spp. in 5 out of 28 samples. The results of this study provide insights into the potential risk of ocular infections associated with using eyewash stations and provide the basis for the recommendations on maintenance protocols to minimize the risk of microbial contamination.

Hypertension in pregnancy, which includes both chronic hypertension and pregnancy-associated hypertension, is on the rise in the United States and is associated with an increased incidence of maternal and neonatal complications and future cardiovascular disease. Recent clinical recommendations suggest a lower blood pressure threshold for initiating treatment of chronic hypertension in pregnancy. Here we present a new quality improvement resource for outpatient clinicians to support changes to care processes for managing chronic hypertension in pregnancy and the postpartum period.

Background: Evidence from the surveillance systems of antimicrobial-resistant (AMR) gonorrhea suggests substantial variation in the prevalence of AMR gonorrhea across populations. However, little is known about the extent to which the population-level demographic, socioeconomic, and health factors (e.g., population density, poverty level, or the prevalence of other sexually-transmitted diseases) are associated with the burden of AMR gonorrhea. We developed a hierarchical Bayesian spatial–temporal logistic regression model to investigate the association between multiple spatially- and temporally-varying predictors and the proportion of isolates with resistance to each one of ciprofloxacin, penicillin, and tetracycline between 2000 and 2019 in the United States (US). Methods: The model was informed by data from the Gonococcal Isolate Surveillance Project (GISP), a sentinel surveillance system to monitor trends in the AMR gonorrhea in the US. During our study period, GISP included 112,487 isolates from the first 25 symptomatic men who have been diagnosed with urethral gonorrhea each month after attending participating sexually-transmitted disease clinics in one of about 30 select cities. Findings: Among 112,487 isolates collected between 2000 and 2019, 16.5%, 13.7%, and 22.2% were resistance to ciprofloxacin, penicillin, and tetracycline. Denser populations were associated with higher prevalence of ciprofloxacin and penicillin resistance (odd ratio (OR): 1.5, 95% with credible interval: [1.29, 1.74] and 1.36 [1.22, 1.52], respectively); West was associated with higher prevalence of ciprofloxacin resistance (OR with respect to Midwest: 14.42 [2.02, 59.27]) and Southeast was associated with higher prevalence of ciprofloxacin and penicillin resistance (OR with respect to Midwest: 6.66 [1.59, 18.20] and 7.59 [2.3, 22.94]); higher prevalence of HIV was associated with higher prevalence of ciprofloxacin and tetracycline resistance (OR: 1.18 [1.01, 1.37] and 1.14 [1.02, 1.28]); and higher incidence of gonorrhea was associated with higher prevalence of tetracycline resistance (OR: 1.08 [1.05, 1.11]). Interpretation: Geographic location and certain population-level characteristics including population density and HIV prevalence could provide insight about the population-level risk of AMR gonorrhea at a county-level. These results could guide the expansion of AMR surveillance systems or access to drug susceptibility testing in areas with characteristics associated with increased prevalence of AMR gonorrhea. Funding: US National Institutes of Health. © 2025 The Author(s)

RATIONALE: Individuals surviving TB disease may experience chronic sequelae that reduce survival and quality-of-life. These post-TB sequalae are not generally considered in estimates of the health impact of TB disease. OBJECTIVES: To estimate the TB-attributable reductions in life expectancy and quality-adjusted life expectancy for individuals developing TB disease in the United States, including post-TB sequelae. METHODS: We extracted national surveillance data on individuals diagnosed with TB during 2015-2019, including demographics, vital status at diagnosis, treatment duration, treatment outcome, and co-prevalent conditions. Using a mathematical model we simulated life expectancy and quality-adjusted life-years (QALYs) for the TB cohort, as compared to a no-TB counterfactual (same distribution of age, sex, race/ethnicity, and co-prevalent conditions as the TB cohort but without TB-attributable mortality and disutility). We disaggregated results to report the proportion due to post-TB sequelae, and stratified outcomes by age, sex, and race. MEASUREMENTS AND MAIN RESULTS: Estimated life expectancy after TB diagnosis was 30.3 (95% uncertainty interval: 29.9, 30.7) years for the TB cohort versus 32.3 (31.9, 32.7) without TB, a difference of 2.03 (1.84, 2.21) years and 1.93 (1.69, 2.18) QALYs. Life-years lost were greatest for 65-74-year-olds versus other age groups, for men versus women, and for American Indian or Alaska Native individuals versus persons from other race/ethnicities. Overall, 41% (35, 46) of life-years and 48% (42, 54) of QALYs lost were estimated to result from post-TB sequelae. CONCLUSIONS: In the United States, a substantial fraction of the life-years and QALYs lost from TB are attributable to post-TB sequelae. Evidence is needed on approaches to prevent and repair post-TB lung damage, in the context of frequent co-prevalent health conditions.

Influenza viruses can be aerosolized when slaughtering infected chickens, which increases the risk of zoonotic transmission. We conducted pilot experiments to measure the concentrations of airborne particles <2.5 µm during slaughtering and defeathering of chickens to help identify methods that can minimize workers’ exposure to potentially hazardous aerosol particles. By using two types of airborne particle monitors stationed at different heights and angles in a controlled environment, we measured aerosolized particulate matters during exsanguination of 10 slaughtered chickens and use of a mechanical device for defeathering 10 chickens. For the slaughtering experiments, the median particle concentrations at 148 cm height were 67 µg/m3 (IQR 44–121) with a baseline count 10 µg/m3 (IQR 10–10) for the Particle and Temperature Sensor + (PATS+) monitors and 34 µg/m3 (IQR 34–64) with a baseline count 25 µg/m3 (IQR 16–44) for the SidePak™ monitor. For the defeathering experiments, the median particle concentrations recorded by the PATS+ monitors were not significantly different between 148 cm (41 µg/m3, IQR 29–49; baseline 12 µg/m3, IQR 10–19) and 107 cm height (37 µg/m3, IQR 29–44; baseline 13 µg/m3, IQR 10–22). Our protocol can be used to test the generation of airborne particles that are <2.5 µm during different slaughtering and defeathering techniques used in the live bird markets to identify procedures that produce the lowest concentrations of small aerosol particles. © 2025

BACKGROUND: HIV coinfection worsens health outcomes for persons with chronic hepatitis C virus (HCV) infection; however, access to comprehensive Ryan White (RW) HIV care may improve the health of persons with HIV and HCV. METHODS: In a retrospective cohort study, we used surveillance data from Philadelphia's hepatitis and HIV registries for newly reported HCV infections from November 2015 to October 2021. We plotted Kaplan-Meier curves and performed Cox regressions on time to HCV clearance by HIV coinfection status, adjusting for demographic characteristics and HCV report year. RESULTS: A total of 10 251 persons with newly reported HCV infection were included, of whom 9898 (96.6%) had HCV monoinfection and 353 (3.4%) had HIV coinfection. HCV reports were mostly among residents who were non-Hispanic/Latine White (n = 3609, 35.2%) and non-Hispanic/Latine Black (n = 3221, 31.4%) and assigned male sex at birth (n = 6931, 67.8%). At every month of follow-up, having HIV was associated with a higher likelihood of HCV clearance as compared with HCV monoinfection (adjusted hazard ratio, 1.2; 95% CI, 1.1-1.4; P < .05). For persons with HIV coinfection, participation in RW support services 2 to 6 times monthly was associated with an increased likelihood (adjusted hazard ratio, 1.7-3.1) of HCV clearance at every month of follow-up as compared with persons without RW participation (P < .05). CONCLUSIONS: Among newly reported HCV infections, the likelihood of HCV clearance was higher among persons with HIV coinfection who participated in RW support services. Frequent receipt of supportive services, such as those provided by the national, federally funded RW system, is crucial for HCV elimination.

OBJECTIVES: To determine the impact of increased long-acting injectable antiretroviral therapy (Cabotegravir-rilpivirine [CAB/RPV]) use among persons with diagnosed HIV (PWDH) with viral suppression (VLS), per 2021 US Food and Drug Administration (FDA) guidelines, on HIV incidence and levels of VLS in the US. METHODS: We used the HOPE compartmental model to simulate CAB/RPV use during 2023-2035. We first simulated a baseline scenario (no CAB/RPV), in which 69% of PWDH had VLS. We then introduced CAB/RPV in 2023 under two scenarios: (1) where CAB/RPV improved the duration of VLS post-cessation of ART use compared to oral ART; (2) where CAB/RPV additionally improved adherence. We compared cumulative 2023-35 incidence and percentage of PWDH with VLS at year-end 2035 to baseline. RESULTS: When CAB/RPV increased the duration of VLS only, cumulative incidence was reduced up to 9%, and VLS increased up to 4%. When CAB/RPV also improved ART adherence, incidence was reduced up to 19.5%, and VLS increased up to 9%. CONCLUSIONS: CAB/RPV, even if only used among PWDH with VLS, may reduce HIV incidence and increase VLS, due to longer-lasting VLS post-cessation of usage. If CAB/RPV also improves ART adherence, incidence is further reduced. Improved clinical efficacy of CAB/RPV may translate to improved population-level outcomes, even in limited use cases.

Mosquito control using pyrethrins and synthetic pyrethroids (PSP) is important for preventing vector-borne diseases. Although the benefits associated with PSP use are well-documented, public concern exists regarding potential human adverse health effects. The aim of this scoping review was to describe adverse human health effects associated with PSP use for community adult mosquito control. A literature search using the databases MEDLINE, EMBASE, Agricultural and Environmental Science Collection, CAB Abstracts, and Scopus obtained 6,154 original peer-reviewed articles published during 1 January 2000 to 22 May 2024. Articles were independently reviewed for inclusion using predetermined exclusion and inclusion criteria. Data were extracted from 10 included articles. Study designs included cohort (n = 5), cross-sectional (n = 2), and risk assessment (n = 4). One article included 2 study designs. Of the cohort studies, one was prospective and the remainder were retrospective. A causal relationship between PSP application for adult mosquito control and adverse human health impacts was not identified. No increases in acute health manifestations were reported. The 4 risk assessments estimated that PSP exposures were not above the regulatory level of concern; a meta-analysis determined the likelihood of PSP exposures exceeding the regulatory level of concern was <0.0001. The limited evidence indicated that PSP applied appropriately for control of nuisance mosquitoes or mosquitoes that transmit arboviruses do not pose acute or chronic human health risks. Continued investigation into potential human health impacts of PSP would help inform guidelines for adult mosquito control and help inform public health decision making.

White-tailed deer (Odocoileus virginianus) are a ubiquitous species in North America. Their high reproductive potential leads to rapid population growth, and they exhibit a wide range of biological adaptations that influence their interactions with vectors and pathogens. This review aims to characterize the intricate interplay between white-tailed deer and the transmission cycles of various tick- and mosquito-borne pathogens across their range in the eastern United States and southeastern Canada. The first part offers insights into the biological characteristics of white-tailed deer, their population dynamics, and the consequential impacts on both the environment and public health. This contextual backdrop sets the stage for the two subsequent sections, which delve into specific examples of pathogen transmission involving white-tailed deer categorized by tick and mosquito vectors into tick-borne and mosquito-borne diseases. This classification is essential, as ticks and mosquitoes serve as pivotal elements in the eco-epidemiology of vector-borne diseases, intricately linking hosts, the environment, and pathogens. Through elucidating these associations, this paper highlights the crucial role of white-tailed deer in the transmission dynamics of tick- and mosquito-borne diseases. Understanding the interactions between white-tailed deer, vectors, and pathogens is essential for effective disease management and public health interventions.

The introduction of the Sustainable Development Goals by the United Nations has set a global target for achieving Universal Health Coverage, requiring resilient health systems capable of addressing public health emergencies and ensuring health security. Public health surveillance, crucial for detecting and responding to infectious disease outbreaks, is key to building health system resilience. Due to the high levels of mobility and political instability in the Middle East and North Africa (MENA) region, unique challenges arise in cross-border health surveillance. This review aims to highlight the importance of cross-border public health surveillance in strengthening health systems across MENA to achieve equitable health outcomes.A mixed-methods approach was utilized, combining a systematic literature review with semi-structured in-depth interviews (IDIs) involving 28 stakeholders from seven MENA countries. The literature review adhered to PRISMA guidelines, while the IDIs provided qualitative insights into current surveillance practices and challenges. Findings from the literature review and IDIs were triangulated and analyzed using the WHO Health Systems Strengthening (HSS) Building Blocks Framework to identify key challenges and recommendations for improving cross-border surveillance.Results indicate that existing cross-border surveillance systems in MENA face challenges in data collection, analysis, and sharing, with disparities across countries based on income levels and political contexts. Key challenges include delayed and incomplete data sharing, insufficient funding across sectors, inadequate training, inconsistent data definitions, and limited integration of health data for mobile populations. Recommendations emphasize strengthened governance and leadership to facilitate regional cooperation and information sharing, sustainable financing for implementing a One Health approach, utilizing innovative information systems, workforce development to enhance data collection and analysis, and secure supply chains for medicines and vaccines and equitable service delivery for all mobile populations.In conclusion, the WHO HSS Building Block Framework provides a comprehensive approach to assessing and improving cross-border public health surveillance and enhancing health security and equity in MENA. Strengthening cross-border surveillance systems may help MENA countries meet IHR requirements, achieve greater health security, and advance health equity among all types of mobile populations. Despite limitations, the study offers critical insights for improving cross-border surveillance strategies in the region.

Globally, human norovirus (HuNoV) is the leading cause of foodborne illnesses. Norovirus transmission to fresh produce can occur via several sources, including contaminated irrigation water. HuNoV RNA has been detected in freshwater resources, but knowledge about virus infectivity is limited due to a historical lack of a HuNoV cell culture. Recently, HuNoV was shown to replicate in human intestinal enteroids (HIE). The objective of this study was to use HIE to evaluate the persistence of infectious HuNoV in raw (i.e. biologically active) surface freshwater. The virus was spiked into freshwater microcosms sampled from three freshwater ponds and then incubated inside an environmental chamber at 20-15 °C and 50-80 % relative humidity (day-night) and 12 h photoperiod. The water was tested for infectious HuNoV, intact HuNoV capsids, indigenous bacteria, and other water quality parameters over a period of 2 weeks. The persistence of infectious HuNoV in the three freshwater microcosms ranged from ≤1 day to ≥7 days. Decay rates for RNA from intact HuNoV capsids ranged from 0.04 to 0.54/day, predicting a 4.2 to 57.5 days, respectively for 1 log reduction. The intact virus showed a significant negative and positive linear relationship with indigenous bacteria and dissolved oxygen, respectively. Using multiple logistic regression, HuNoV RNA >4.4 log genomic equivalent/ml (Cycle threshold values <32) predicted higher probability of detecting infectious HuNoV in contaminated raw freshwater using HIE. Overall, our results provide valuable insights for enhancing quantitative microbial risk assessment models for pre-harvest agricultural water to understand the public health risks associated with the detection of HuNoV RNA in freshwater.

BACKGROUND: In the United States, older adults have elevated prevalence of latent tuberculosis infection (LTBI) and incidence of tuberculosis (TB). OBJECTIVE: To estimate the health benefits and cost-effectiveness of LTBI testing and treatment among the Medicare-eligible population. DESIGN: Model-based cost-effectiveness analysis. DATA SOURCES: Nationally representative surveys and published evidence. TARGET POPULATION: Medicare-eligible persons aged 65 years or older with at least 1 of 15 factors associated with elevated TB risk, as identified by guidelines from the U.S. Preventive Services Task Force (USPSTF) and other organizations. TIME HORIZON: Lifetime. PERSPECTIVE: Societal. INTERVENTION: One-time offer of LTBI testing and treatment versus no intervention. OUTCOME MEASURES: Lifetime TB cases and deaths averted, quality-adjusted life-years (QALYs) gained, costs, and incremental cost-effectiveness ratios (ICERs). RESULTS OF BASE-CASE ANALYSIS: In 2022, there were an estimated 29.9 million Medicare-eligible persons (95% uncertainty interval [UI], 28.4 to 31.6 million persons) aged 65 years or older with elevated TB risks, including 14.7 million (95% UI, 13.4 to 16.0 million) with USPSTF-recommended factors. In the target population, 4.9 million persons (95% UI, 4.0 to 5.8 million persons) (16.4% [95% UI, 13.9% to 19.1%]) were estimated to have LTBI. Testing and treatment of LTBI was estimated to prevent 10 946 TB cases (95% UI, 4684 to 20 579 cases) and 2579 TB deaths (95% UI, 1106 to 4882 deaths), with 13 234 lifetime QALYs (95% UI, 5343 to 25 519 lifetime QALYs) gained. For the overall target population and for persons with USPSTF-recommended factors, ICERs were $192 000 (95% UI, $92 000 to $503 000) and $155 000 (95% UI, $77 000 to $393 000) per QALY gained, respectively. RESULTS OF SENSITIVITY ANALYSIS: The ICER was $109 000 (95% UI, $49 000 to $285 000) per QALY gained for 65-year-olds newly eligible for Medicare. LIMITATION: Health benefits from averted post-TB sequelae were not estimated. CONCLUSION: Medicare-eligible persons represent approximately one third of all U.S. persons with LTBI. Testing and treatment of LTBI in this population could lead to substantial reductions in TB and TB-related mortality, particularly among 65-year-olds newly eligible for Medicare. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention.

COVID-19 vaccines mitigate severe disease, yet uptake remains low among people experiencing homelessness (PEH) despite the risk of transmission in congregate settings like homeless shelters. This study evaluated retrospective COVID-19 vaccination intent and decision-making between March 2020-October 2021 to identify modifiable factors to improve vaccine acceptance among PEH. We conducted 31 semi-structured interviews and eight focus group discussions across six homeless shelters in Seattle-King County, Washington. Residents and staff aged >= 18 years were recruited through purposive sampling for interviews and convenience sampling for focus groups. Thematic analysis was conducted. Participants reported that too much contradictory and changing information about COVID-19 vaccines led to confusion. Information deemed trustworthy contributed to individual's knowledge and in some cases changed their vaccination intent. While many intended to get vaccinated without external motivators, others were motivated by incentives and requirements. Despite intention to vaccinate, participants reported barriers to COVID-19 vaccine access including availability of vaccine doses, timely eligibility for vaccination, and availability of appointments. Participants presented recommendations to improve COVID-19 information content and dissemination, access, and use of incentives in shelter settings. Future research should test recommended vaccination strategies rooted in the voices and experiences of PEH to determine feasibility and effectiveness in shelter settings. (PsycInfo Database Record (c) 2025 APA, all rights reserved)

INTRODUCTION: Despite the increased scrutiny on vaccine safety following the coronavirus disease 2019 (COVID-19) pandemic, Morocco's Centre of Antipoison and Pharmacovigilance (CAPM) remained concerned that the pharmacovigilance system in Morocco was insufficiently implemented, including limited adverse event (AE) reporting, poor data use, and inconsistent training nationwide. OBJECTIVES: We sought to assess the status of pharmacovigilance activities (PAs) prior to formally institutionalizing them across university hospital centers (UHCs), given their position as the main providers of healthcare in Morocco and key sources for reporting serious AEs. METHODS: We assessed seven UHCs (housing 30 hospitals) in 2023 using a structured questionnaire with pharmacovigilance focal points developed from the World Health Organization's indicators of pharmacovigilance and the Global Benchmarking Tool. Data were grouped into 28 PAs and scored from 0 (not implemented) to 3 (fully implemented). We then calculated an implementation rate for each site on the basis of percent of PAs fully implemented (≥ 70%, well established; > 40% to < 70%, partially implemented; and ≤ 40%, not implemented). A desk review was also performed at the sites. Using the results of the assessment, three working groups of pharmacovigilance stakeholders developed recommendations to be formally adopted by UHCs. RESULTS: Basic elements of pharmacovigilance (notification forms and VigiFlow(®) or Excel databases) were present at all the UHCs assessed. In total, 14 hospitals (47%) had well-established PAs, including advanced activities such as signal detection of adverse events following the use of medicines and vaccines, as well as causality assessment; 9 hospitals (30%) were partially implementing pharmacovigilance, and 7 hospitals (23%) had no established activities or very basic activities. Within four UHCs, activities had not been implemented at the same level from one hospital to another and vaccine vigilance was largely deprioritized. The working groups made recommendations for improving collaboration, standardizing procedures, and outlining a new organizational structure for pharmacovigilance, which was institutionalized by a formal agreement among UHCs in July 2023. CONCLUSIONS: The assessment revealed a subgroup of centers with well-established AE signal detection and causality assessment abilities, which could play a leading role in the country. After the site assessment, our collaborative approach of bringing together focal points to identify next steps and generate buy-in helped to formalize pharmacovigilance across centers.

BACKGROUND: Wilms tumor (WT) is the most common pediatric malignancy of the kidney. Past studies describing WT incidence and survival used surveillance data with < 30% of the US population. We evaluated differences in WT incidence and survival comparing demographic groups and tumor characteristics. METHODS: We analyzed new cases of WT among patients aged < 20 years at diagnosis by using incidence data from US Cancer Statistics (USCS) for 2003-2020 and 5-year relative survival (RS) data from the National Program of Cancer Registries (NPCR) for 2001-2019. To assess incidence trends, average annual percent change (AAPC) was calculated by using joinpoint regression. Relative survival (RS) and all-cause survival were calculated overall and by demographic and clinical variables. RESULTS: During 2003-2020, 8218 cases of WT were reported in USCS, which represented an age-adjusted incidence rate of 5.7 cases per million. Rates were the highest among females (6.3), children aged 0-4 years (17.2), and non-Hispanic Black patients (7.1). Overall, trends remained stable (AAPC = -0.4, 95% CI: -1.4 to 0.4). Among 7567 cases of WT in NPCR, 5-year RS was 92.6%. Patients with the lowest survival include the following: those aged 10-19 years (hazard ratio [HR] = 1.65, 95% CI: 1.02-2.65); non-Hispanic Black patients (HR = 1.39, 95% CI: 1.11-1.76); those with regional stage (HR = 1.93, 95% CI: 1.47-2.54) or distant stage (HR = 5.12, 95% CI: 3.99-6.57); and patients from nonmetropolitan counties (HR = 1.46, 95% CI: 1.09-1.96). Individuals diagnosed during 2011-2019 (HR = 0.64, 95% CI: 0.53-0.77) had higher survival than those diagnosed during 2001-2010. CONCLUSIONS: The highest WT incidence rates were patients who were female, 0-4 years, and non-Hispanic Black. Survival improved during the study period; survival differed by race, ethnicity, metropolitan status, and age. Further studies to delineate the causes of these disparities may improve outcomes.

This report extends the development of normative standards for estimating occupational hearing loss using data from the United States National Health and Nutrition Examination Survey (NHANES) conducted by the National Center for Health Statistics. A proposed revision of the International Organization for Standardization (ISO) 1999:2013 standard ("Acoustics-Estimation on noise-induced hearing loss") uses a linear interpolation of hearing threshold data to estimate the 25th and 75th percentiles for men and women at 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz. This paper revisits the NHANES data to provide these estimates, avoiding other types of interpolations that could misrepresent the population data.

This study assessed the impact of a passive back-support exoskeleton (Laevo V2.5; Laevo, Netherlands) on trunk and hip postures, lower back muscle activity and heart rate during four common patient handling tasks: task 1, lying to sitting; task 2, sitting to standing; task 3, standing to sitting; task 4, bed-to-wheelchair transfer. Eight participants performed these tasks with and without the exoskeleton. Significant reductions (19%; p < 0.05) in erector spinae muscle activity were observed during tasks 2 and 4. Moreover, peak bilateral hip flexion angles decreased by up to 29° across tasks, with a notable decrease in median hip flexion angles in three tasks, except for task 3. These findings suggest that the exoskeleton may offer benefits in reducing lower back muscular strain during certain patient transfer tasks, indicating its potential utility in healthcare settings. Further research is needed to fully assess its effectiveness and practicality in improving patient-handling techniques.

To assess the prevalence of several parasitic infections in Kiribati, dried blood spots collected during trachoma prevalence surveys in the two major population centers in 2015, 2016, and 2019 were tested using multiplex bead-based serologic assays to detect IgG antibodies against four pathogens of public health interest: Toxoplasma gondii (T. gondii), Taenia solium (T. solium), Strongyloides stercoralis (S. stercoralis), and Toxocara canis (T. canis). In Kiritimati Island, the seroprevalences of T. solium recombinant antigen for detection of cysticercosis antibodies (T24H) and recombinant antigen for detection of taeniasis antibodies (ES33) were ≤4% in both surveys, whereas in Tarawa, the T24H seroprevalence was 2% (2016) and 7% (2019) and the ES33 seroprevalence was ≤3% in both surveys. At both sites, the seropositivity of S. stercoralis recombinant antigen for detection of Strongyloides was 0-4%, and for T. canis, the C-type lectin-1 antigen was 0-1% in all surveys. For T. gondii, the surface antigen glycoprotein 2A antigen seroprevalences on Kiritimati Island were 41% (2015) and 36% (2019), and in Tarawa, they were 36% (2016) and 22% (2019), suggesting that T. gondii infections are common in Kiribati, whereas the other pathogens are not.

Antimalarial therapeutic efficacy studies are vital for monitoring drug efficacy in malaria-endemic regions. The WHO recommends genotyping polymorphic markers including msp-1, msp-2, and glurp for distinguishing recrudescences from reinfections. Recently, WHO proposed replacing glurp with microsatellites (Poly-α, PfPK2, TA1). However, suitable combinations with msp-1 and msp-2, as well as the performance of different algorithms for classifying recrudescence, have not been systematically assessed. This study investigated various microsatellites alongside msp-1 and msp-2 for molecular correction and compared different genotyping algorithms across three sites in Uganda. Microsatellites 313, Poly-α, and 383 exhibited the highest diversity, while PfPK2 and Poly-α revealed elevated multiplicity of infection (MOI) across all sites. The 3/3 match-counting algorithm classified significantly fewer recrudescences than both the ≥ 2/3 and Bayesian algorithms at probability cutoffs of ≥ 0.7 and ≥ 0.8 (P < 0.05). The msp-1/msp-2/2490 combination identified more recrudescences using the ≥ 2/3 and 3/3 algorithms in the artemether-lumefantrine (AL) treatment arm, while msp-1/msp-2/glurp combination classified more cases of recrudescence using the ≥ 2/3 in the dihydroartemisinin-piperaquine (DP) arm. Microsatellites PfPK2 and Poly-α, potentially sensitive to detecting minority clones, are promising replacements for glurp. Discrepancies in recrudescence classification between match-counting and Bayesian algorithms highlight the need for standardized PCR correction practices.

Larval source management (LSM) has a long history of advocacy and successes but is rarely adopted where funds are limited. The World Health Organization (WHO) guidelines on malaria prevention recommend the use of LSM as a supplementary intervention to the core vector control methods (insecticide-treated nets and indoor residual spraying), arguing that its feasibility in many settings can be limited by larval habitats being numerous, transient, and difficult to find or treat. Another key argument is that there is insufficient high-quality evidence for its effectiveness to support wide-scale implementation. However, the stagnation of progress towards malaria elimination demands that we consider additional options to the current emphasis on insecticidal commodities targeting adult mosquitoes inside homes. This letter is the result of a global, crossdisciplinary collaboration comprising: (a) detailed online expert discussions, (b) a narrative review of countries that have eliminated local malaria transmission, and (c) a mathematical modeling exercise using two different approaches. Together, these efforts culminated in seven key recommendations for elevating larval source management as a strategy for controlling malaria and other mosquito-borne diseases in Africa (Box 1). LSM encompasses the use of larvicide (a commodity) as well as various environmental sanitation measures. Together, these efforts lead to the long-term reduction of mosquito populations, which benefits the entire community by controlling both disease vector and nuisance mosquitoes. In this paper, we argue that the heavy reliance on large-scale cluster-randomized controlled trials (CRTs) to generate evidence on epidemiological endpoints restricts the recommendation of approaches to only those interventions that can be measured by functional units and deliver relatively uniform impact and, therefore, are more likely to receive financial support for conducting these trials. The explicit impacts of LSM may be better captured by using alternative evaluation approaches, especially high-quality operational data and a recognition of locally distinct outcomes and tailored strategies. LSM contributions are also evidenced by the widespread use of LSM strategies in nearly all countries that have successfully achieved malaria elimination. Two modelling approaches demonstrate that a multifaceted strategy, which incorporates LSM as a central intervention alongside other vector control methods, can effectively mitigate key biological threats such as insecticide resistance and outdoor biting, leading to substantial reductions in malaria cases in representative African settings. This argument is extended to show that the available evidence is sufficient to establish the link between LSM approaches and reduced disease transmission of mosquito-borne illnesses. What is needed now is a significant boost in the financial resources and public health administration structures necessary to train, employ and deploy local-level workforces tasked with suppressing mosquito populations in scientifically driven and ecologically sensitive ways. In conclusion, having WHO guidelines that recognize LSM as a key intervention to be delivered in multiple contextualized forms would open the door to increased flexibility for funding and aid countries in implementing the strategies that they deem appropriate. Financially supporting the scale-up of LSM with high-quality operations monitoring for vector control in combination with other core tools can facilitate better health. The global health community should reconsider how evidence and funding are used to support LSM initiatives.

BACKGROUND: Globally, opioid use remains a major public health problem. In 2019, 480,000 deaths were related to opioid use. Locally, mortality from opioid-involved overdose is high among Illinois residents, with 83 % of ∼4000 overdose deaths during 2022 involving opioids. Treatment for opioid use disorder with buprenorphine, methadone, and naltrexone is approved, safe, and effective. However, significant barriers to treatment remain for many persons. METHODS: In response to new prescribing policy flexibilities, in May 2022, the Chicago Department of Public Health and the Substance Use Prevention and Recovery Division of the Illinois Department of Human Services partnered with a statewide opioid treatment provider, Family Guidance Centers. The partnership started an immediate opioid use disorder treatment helpline program. We performed a descriptive analysis using aggregate data from all calls for assistance with substance use received by the Illinois Helpline during May 9, 2022-March 7, 2024. RESULTS: A total of 2649 unique calls were made to the helpline from persons seeking assistance with substance use, and 1698 unique callers were connected to Family Guidance Centers for treatment initiation. Most callers were prescribed buprenorphine by telemedicine, followed by methadone during in-person treatment. In total, 1515 (89.2 %) of 1698 callers with opioid use disorder were initiated on buprenorphine or methadone through the program. CONCLUSION: A state-wide low-barrier access to medications by telemedicine program is an effective treatment model for the initiation of medications for opioid use disorder.

BACKGROUND: Kenya launched a Rabies Elimination Strategy in 2014, aiming to end human rabies deaths by 2030. In March 2022, Lamu County reported increased cases of human dog bites and suspected rabies deaths to the Ministry of Health (MoH). We aimed to establish the extent of the rabies outbreak in humans and animals and determine the challenges to achieving rabies elimination by 2030. METHODS: We extracted dog bite reports from the Kenya Health Information System (KHIS), national surveillance database system, and reviewed medical records at health facilities in Lamu County for suspected human rabies deaths from 2020 to 2022. We obtained information about animal bites and illnesses in deceased persons, checked the availability of anti-rabies vaccines in health facilities, and administered rabies knowledge and practice questionnaires to health workers. For categorical data, frequencies and proportions were determined. RESULTS: There were 787 dog bite cases and six human rabies cases. Only a third (2/6) of the rabies cases were uploaded to the KHIS. The county used targeted dog vaccination, and samples were not collected from the biting dogs. Regarding the availability of human rabies vaccines, half (8/16) of the facilities had the human rabies vaccine, and 19% (3/16) had both the human rabies vaccine and rabies immunoglobulin (RIG). Rabies vaccine stock-outs were common at 73% (11/16). Only 25% (18/73) of the health workers reported their first action would be to clean the bite wound with running water and soap for 15 min. Additionally, 86% (54/63) did not know the recommended human rabies vaccine and RIG dosage and schedule, while 25% (18/73) of healthcare workers were satisfied with the existing information-sharing mechanisms between veterinary and human health departments for rabies prevention and control. CONCLUSIONS: There was underreporting of rabies cases, a lack of awareness of bite wound management at health facilities, and persistent stockouts of human rabies vaccines. We suggest training healthcare workers on animal bite case management and improving One Health information exchange.

Zika virus (ZIKV) is a flavivirus transmitted primarily by the bite of infected Aedes species mosquitoes. Although typically asymptomatic or causing mild symptoms and infrequent neurological disease in older children and adults, infection during pregnancy can result in severe congenital malformations and neurodevelopmental deficits. We conducted a review of published literature and official data sources to describe recent Zika epidemiological trends, building on WHO updates posted in 2019 and 2022. Globally, cases declined after the height of ZIKV transmission in the Americas in 2015-2016; however, transmission continues across multiple regions, with intermittent outbreaks reported. As of December 2023, there is documented evidence of current or prior autochthonous mosquito-borne ZIKV transmission in 92 countries and territories; most recently, Guinea, Mali, and Sri Lanka were included on the basis of recent or retrospective testing of specimens collected during surveillance activities or studies. The abundance of asymptomatic and mild infections and limited diagnostic testing suggest that transmission in many locations likely remains underrecognized. Public health authorities, clinicians, communities at risk, and travelers should remain alert to the possibility of ZIKV transmission and implement measures to limit the risk of infection with ZIKV and other Aedes-borne arboviruses. To strengthen surveillance for ZIKV infections and congenital disease, targeted surveillance using clear case definitions and epidemiologically appropriate laboratory testing algorithms should be applied.