Antimicrobial susceptibility of Francisella tularensis isolates in the United States, 2009-2018
Choat J , Young J , Petersen JM , Dietrich EA . Clin Infect Dis 2024 78 S4-s6 Francisella tularensis is the causative agent of tularemia. We tested the susceptibility of 278 F. tularensis isolates from the United States received during 2009-2018 to 8 antimicrobial drugs (ciprofloxacin, levofloxacin, doxycycline, tetracycline, gentamicin, streptomycin, chloramphenicol, and erythromycin). All isolates were susceptible to all tested drugs. |
Public health priorities for gastroschisis: Summary of a meeting sponsored by the Centers for Disease Control and Prevention and the March of Dimes
Tepper NK , Chowdhury J , Moore CA , Werler MM , Mishkin K , Reefhuis J . Birth Defects Res 2024 116 (1) e2299 BACKGROUND: Gastroschisis has increased worldwide over several decades; however, there are significant gaps in understanding risk factors for development of the defect, particularly those that might be modifiable. Despite advances in survival, little is known about longer-term outcomes for affected individuals. METHODS: On April 27- and 28, 2023, the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC) and March of Dimes sponsored a meeting entitled "Public Health Priorities for Gastroschisis". The meeting goals were to review current knowledge on gastroschisis, discuss research gaps, and identify future priorities for public health surveillance, research, and action related to gastroschisis. Meeting participants encompassed a broad range of expertise and experience, including public health, clinical care of individuals with gastroschisis, affected individuals and families, and representatives from professional organizations and federal agencies. RESULTS: Several goals were identified for future public health surveillance and research, including focused theory-driven research on risk factors and increased study of longer-term effects of gastroschisis through improved surveillance. Certain public health actions were identified, that which could improve the care of affected individuals, including increased education of providers and enhanced resources for patients and families. CONCLUSIONS: These efforts may lead to an improved understanding of pathogenesis, risk factors, and outcomes and to improved care throughout the lifespan. |
Standardisation and harmonisation of thyroid-stimulating hormone measurements: historical, current, and future perspectives
Cowper B , Lyle AN , Vesper HW , Van Uytfanghe K , Burns C . Clin Chem Lab Med 2024 Thyroid-stimulating hormone (TSH) is an important clinical marker in the diagnosis and management of thyroid disease. TSH measurements are reported in milli-International Units per Litre (mIU/L), traceable to a World Health Organisation (WHO) reference material. There is a wide variety of commercial immunoassays for TSH measurements available, which have historically been poorly harmonised due to a lack of commutability of the WHO reference materials with patient samples. This led to the recent development of a serum-based reference panel for TSH, traceable to the WHO reference material, available via the International Federation for Clinical Chemistry and Laboratory Medicine (IFCC), aimed at harmonisation of TSH immunoassays. This report describes recent developments in the TSH reference system, including establishment of the 4th WHO International Standard for TSH, and aims to clarify the relationship between the available reference materials and their intended uses. This 4th WHO IS is widely available and defines the unit of TSH activity, therefore its continued existence is of paramount importance, however it continues to show a lack of commutability with patient in many TSH immunoassays. This makes the C-STFT TSH panel, albeit available in restricted numbers, a critical resource to ensure better TSH assay harmonisation. |
Some patients with type 2 diabetes may benefit from intensive glycaemic and blood pressure control: A post-hoc machine learning analysis of ACCORD trial data
Jiao T , Kianmehr H , Lin Y , Li P , Singh Ospina N , Ghayee HK , Ruzieh M , Fonseca V , Shi L , Zhang P , Shao H . Diabetes Obes Metab 2024 AIM: The action to control cardiovascular risk in diabetes (ACCORD) trial showed a neutral average treatment effect of intensive blood glucose and blood pressure (BP) controls in preventing major adverse cardiovascular events (MACE) in individuals with type 2 diabetes. Yet, treatment effects across patient subgroups have not been well understood. We aimed to identify patient subgroups that might benefit from intensive glucose or BP controls for preventing MACE. MATERIALS AND METHODS: As a post-hoc analysis of the ACCORD trial, we included 10 251 individuals with type 2 diabetes. We applied causal forest and causal tree models to identify participant characteristics that modify the efficacy of intensive glucose or BP controls from 68 candidate variables (demographics, comorbidities, medications and biomarkers) at the baseline. The exposure was (a) intensive versus standard glucose control [glycated haemoglobin (HbA1c) <6.0% vs. 7.0%-7.9%], and (b) intensive versus standard BP control (systolic BP <120 vs. <140 mmHg). The primary outcome was MACE. RESULTS: Compared with standard glucose control, intensive one reduced MACE in those with baseline HbA1c <8.5% [relative risk (RR): 0.79, 95% confidence interval (CI): 0.67-0.93] and those with estimated glomerular filtration rate ≥106 ml/min/1.73 m(2) (RR: 0.74, 95% CI: 0.55-0.99). Intensive BP control reduced MACE in those with normal high-density lipoprotein levels (women >55 mg/dl, men >45 mg/dl; RR: 0.51, 95% CI: 0.34-0.74). Risk reductions were not significant in other patient subgroups. CONCLUSIONS: Our findings suggest heterogeneous treatment effects of intensive glucose and BP control and could provide biomarkers for future clinical trials to identify more precise HbA1c and BP treatment goals for individualized medicine. |
Prevalence of cardiometabolic diseases among racial and ethnic subgroups in adults - Behavioral Risk Factor Surveillance System, United States, 2013-2021
Koyama AK , McKeever Bullard K , Xu F , Onufrak S , Jackson SL , Saelee R , Miyamoto Y , Pavkov ME . MMWR Morb Mortal Wkly Rep 2024 73 (3) 51-56 Although diabetes and cardiovascular disease account for substantial disease prevalence among adults in the United States, their prevalence among racial and ethnic subgroups is inadequately characterized. To fill this gap, CDC described the prevalence of diagnosed cardiometabolic diseases among U.S. adults, by disaggregated racial and ethnic subgroups, among 3,970,904 respondents to the Behavioral Risk Factor Surveillance System during 2013-2021. Prevalence of each disease (diabetes, myocardial infarction, angina or coronary heart disease, and stroke), stratified by race and ethnicity, was based on self-reported diagnosis by a health care professional, adjusting for age, sex, and survey year. Overall, mean respondent age was 47.5 years, and 51.4% of respondents were women. Prevalence of cardiometabolic diseases among disaggregated race and ethnicity subgroups varied considerably. For example, diabetes prevalence within the aggregated non-Hispanic Asian category (11.5%) ranged from 6.3% in the Vietnamese subgroup to 15.2% in the Filipino subgroup. Prevalence of angina or coronary heart disease for the aggregated Hispanic or Latino category (3.8%) ranged from 3.1% in the Cuban subgroup to 6.3% in the Puerto Rican subgroup. Disaggregation of cardiometabolic disease prevalence data by race and ethnicity identified health disparities among subgroups that can be used to better help guide prevention programs and develop culturally relevant interventions. |
Nationwide hepatitis C serosurvey and progress towards HCV elimination in the country of Georgia, 2021
Gamkrelidze A , Shadaker S , Tsereteli M , Alkhazashvili M , Chitadze N , Tskhomelidze I , Gvinjilia L , Khetsuriani N , Handanagic S , Averhoff F , Cloherty G , Chakhunashvili G , Drobeniuc J , Imnadze P , Zakhashvili K , Armstrong PA . J Infect Dis 2023 228 (6) 684-693 BACKGROUND: The country of Georgia initiated its hepatitis C virus (HCV) elimination program in 2015, at which point a serosurvey showed the adult prevalence of HCV antibody (anti-HCV) and HCV RNA to be 7.7% and 5.4%, respectively. This analysis reports hepatitis C results of a follow-up serosurvey conducted in 2021, and progress towards elimination. METHODS: The serosurvey used a stratified, multistage cluster design with systematic sampling to include adults and children (aged 5-17 years) providing consent (or assent with parental consent). Blood samples were tested for anti-HCV and if positive, HCV RNA. Weighted proportions and 95% confidence intervals (CI) were compared with 2015 age-adjusted estimates. RESULTS: Overall, 7237 adults and 1473 children were surveyed. Among adults, the prevalence of anti-HCV was 6.8% (95% CI, 5.9-7.7). The HCV RNA prevalence was 1.8% (95% CI, 1.3-2.4), representing a 67% reduction since 2015. HCV RNA prevalence decreased among those reporting risk factors of ever injecting drugs (51.1% to 17.8%), and ever receiving a blood transfusion (13.1% to 3.8%; both P < .001). No children tested positive for anti-HCV or HCV RNA. CONCLUSIONS: These results demonstrate substantial progress made in Georgia since 2015. These findings can inform strategies to meet HCV elimination targets. |
Pregnancy and infant outcomes following SARS-CoV-2 infection in pregnancy during Delta variant predominance - surveillance for emerging threats to pregnant people and infants: Pregnancy and infant outcomes during SARS-CoV-2 Delta variant predominance
Reeves EL , Neelam V , Carlson JM , Olsen EO , Fox CJ , Woodworth KR , Nestoridi E , Mobley E , Montero Castro S , Dzimira P , Sokale A , Sizemore L , Hall AJ , Ellington S , Cohn A , Gilboa SM , Tong VT . Am J Obstet Gynecol MFM 2023 6 (2) 101265 BACKGROUND: SARS-CoV-2 infection in pregnancy is associated with an increased risk of adverse birth outcomes such as preterm birth, stillbirth, and maternal and infant complications. Previous research suggests an increased risk of severe COVID-19 illness and stillbirth in pregnant people during delta variant predominance in 2021; however, those studies did not assess timing of infection during pregnancy, and few of them described COVID-19 vaccination status. OBJECTIVE: Using a large population-based cohort, this study compared pregnancy and infant outcomes and described demographic and clinical characteristics of pregnant people with SARS-CoV-2 infection prior to and during the delta variant period. STUDY DESIGN: This retrospective cohort analysis included persons with confirmed SARS-CoV-2 infection in pregnancy from 6 US jurisdictions reporting to the Surveillance for Emerging Threats to Pregnant People and Infants Network. Data were collected through case reports of polymerase chain reaction-positive pregnant persons and linkages to birth certificates, fetal death records, and immunization records. We described clinical characteristics and compared frequency of spontaneous abortion (<20 weeks of gestation), stillbirth (≥20 weeks), preterm birth (<37 weeks), small for gestational age, and term infant neonatal intensive care unit admission between the time periods of pre-delta and delta variant predominance. Study time periods were determined by when variants constituted more than 50% of sequences isolated according to regional SARS-CoV-2 genomic surveillance data, with time periods defined for pre-delta (March 3, 2020-June 25, 2021) and Delta (June 26, 2021-December 25, 2021). Adjusted prevalence ratios were estimated for each outcome measure using Poisson regression and were adjusted for continuous maternal age, race and ethnicity, and insurance status at delivery. RESULTS: Among 57,563 pregnancy outcomes, 57,188 (99.3%) were liveborn infants, 65 (0.1%) were spontaneous abortions, and 310 (0.5%) were stillbirths. Most pregnant persons were unvaccinated at the time of SARS-CoV-2 infection, with a higher proportion in pre-delta (99.4%) than in the delta period (78.4%). Of those with infections during delta and who were previously vaccinated, the timing from last vaccination to infection was a median of 183 days. Compared to pre-delta, infections during delta were associated with a higher frequency of stillbirths (0.7% vs 0.4%; adjusted prevalence ratio, 1.55; 95% confidence interval, 1.14-2.09) and preterm births (12.8% vs 11.9%; adjusted prevalence ratio, 1.14; 95% confidence interval, 1.07-1.20). The delta period was associated with a lower frequency of neonatal intensive care unit admission (adjusted prevalence ratio, 0.74; 95% confidence interval, 0.67-0.82) than in the pre-delta period. During the delta period, infection during the third trimester was associated with a higher frequency of preterm birth (adjusted prevalence ratio, 1.41; 95% confidence interval, 1.28-1.56) and neonatal intensive care unit admission (adjusted prevalence ratio, 1.21; 95% confidence interval, 1.01-1.45) compared to the first and second trimester combined. CONCLUSION: In this US-based cohort of persons with SARS-CoV-2 infection in pregnancy, the majority were unvaccinated, and frequencies of stillbirth and preterm birth were higher during the delta variant predominance period than in the pre-delta period. During the delta period, frequency of preterm birth and neonatal intensive care unit admission was higher among infections occurring in the third trimester vs those earlier in pregnancy. These findings demonstrate population-level increases of adverse fetal and infant outcomes, specifically in the presence of a COVID-19 variant with more severe presentation. |
Estimated rates of progression to tuberculosis disease for persons infected with Mycobacterium tuberculosis in the United States
Ekramnia M , Li Y , Haddad MB , Marks SM , Kammerer JS , Swartwood NA , Cohen T , Miller JW , Horsburgh CR , Salomon JA , Menzies NA . Epidemiology 2024 35 (2) 164-173 BACKGROUND: In the United States, over 80% of tuberculosis (TB) disease cases are estimated to result from reactivation of latent TB infection (LTBI) acquired more than 2 years previously ("reactivation TB"). We estimated reactivation TB rates for the US population with LTBI, overall, by age, sex, race-ethnicity, and US-born status, and for selected comorbidities (diabetes, end-stage renal disease, and HIV). METHODS: We collated nationally representative data for 2011-2012. Reactivation TB incidence was based on TB cases reported to the National TB Surveillance System that were attributed to LTBI reactivation. Person-years at risk of reactivation TB were calculated using interferon-gamma release assay (IGRA) positivity from the National Health and Nutrition Examination Survey, published values for interferon-gamma release assay sensitivity and specificity, and population estimates from the American Community Survey. RESULTS: For persons aged ≥6 years with LTBI, the overall reactivation rate was estimated as 0.072 (95% uncertainty interval: 0.047, 0.12) per 100 person-years. Estimated reactivation rates declined with age. Compared to the overall population, estimated reactivation rates were higher for persons with diabetes (adjusted rate ratio [aRR] = 1.6 [1.5, 1.7]), end-stage renal disease (aRR = 9.8 [5.4, 19]), and HIV (aRR = 12 [10, 13]). CONCLUSIONS: In our study, individuals with LTBI faced small, non-negligible risks of reactivation TB. Risks were elevated for individuals with medical comorbidities that weaken immune function. |
SARS-CoV-2 shedding and evolution in patients who were immunocompromised during the omicron period: a multicentre, prospective analysis
Raglow Z , Surie D , Chappell JD , Zhu Y , Martin ET , Kwon JH , Frosch AE , Mohamed A , Gilbert J , Bendall EE , Bahr A , Halasa N , Talbot HK , Grijalva CG , Baughman A , Womack KN , Johnson C , Swan SA , Koumans E , McMorrow ML , Harcourt JL , Atherton LJ , Burroughs A , Thornburg NJ , Self WH , Lauring AS . Lancet Microbe 2024 BACKGROUND: Prolonged SARS-CoV-2 infections in people who are immunocompromised might predict or source the emergence of highly mutated variants. The types of immunosuppression placing patients at highest risk for prolonged infection have not been systematically investigated. We aimed to assess risk factors for prolonged SARS-CoV-2 infection and associated intrahost evolution. METHODS: In this multicentre, prospective analysis, participants were enrolled at five US medical centres. Eligible patients were aged 18 years or older, were SARS-CoV-2-positive in the previous 14 days, and had a moderately or severely immunocompromising condition or treatment. Nasal specimens were tested by real-time RT-PCR every 2-4 weeks until negative in consecutive specimens. Positive specimens underwent viral culture and whole genome sequencing. A Cox proportional hazards model was used to assess factors associated with duration of infection. FINDINGS: From April 11, 2022, to Oct 1, 2022, 156 patients began the enrolment process, of whom 150 were enrolled and included in the analyses. Participants had B-cell malignancy or anti-B-cell therapy (n=18), solid organ transplantation or haematopoietic stem-cell transplantation (HSCT; n=59), AIDS (n=5), non-B-cell malignancy (n=23), and autoimmune or autoinflammatory conditions (n=45). 38 (25%) participants were real-time RT-PCR-positive and 12 (8%) were culture-positive 21 days or longer after initial SARS-CoV-2 detection or illness onset. Compared with the group with autoimmune or autoinflammatory conditions, patients with B-cell dysfunction (adjusted hazard ratio 0·32 [95% CI 0·15-0·64]), solid organ transplantation or HSCT (0·60 [0·38-0·94]), and AIDS (0·28 [0·08-1·00]) had longer duration of infection, defined as time to last positive real-time RT-PCR test. There was no significant difference in the non-B-cell malignancy group (0·58 [0·31-1·09]). Consensus de novo spike mutations were identified in five individuals who were real-time RT-PCR-positive longer than 56 days; 14 (61%) of 23 were in the receptor-binding domain. Mutations shared by multiple individuals were rare (<5%) in global circulation. INTERPRETATION: In this cohort, prolonged replication-competent omicron SARS-CoV-2 infections were uncommon. Within-host evolutionary rates were similar across patients, but individuals with infections lasting longer than 56 days accumulated spike mutations, which were distinct from those seen globally. Populations at high risk should be targeted for repeated testing and treatment and monitored for the emergence of antiviral resistance. FUNDING: US Centers for Disease Control and Prevention. |
Clinical outcomes of US adults hospitalized for COVID-19 and influenza in the Respiratory Virus Hospitalization Surveillance Network, October 2021-September 2022
Kojima N , Taylor CA , Tenforde MW , Ujamaa D , O'Halloran A , Patel K , Chai SJ , Daily Kirley P , Alden NB , Kawasaki B , Meek J , Yousey-Hindes K , Anderson EJ , Openo KP , Reeg L , Tellez Nunez V , Lynfield R , Como-Sabetti K , Ropp SL , Shaw YP , Spina NL , Barney G , Bushey S , Popham K , Moran NE , Shiltz E , Sutton M , Abdullah N , Talbot HK , Schaffner W , Chatelain R , Price A , Garg S , Havers FP , Bozio CH . Open Forum Infect Dis 2024 11 (1) ofad702 Severe outcomes were common among adults hospitalized for COVID-19 or influenza, while the percentage of COVID-19 hospitalizations involving critical care decreased from October 2021 to September 2022. During the Omicron BA.5 period, intensive care unit admission frequency was similar for COVID-19 and influenza, although patients with COVID-19 had a higher frequency of in-hospital death. |
Meningococcal disease in persons with HIV reported through active surveillance in the United States, 2009-2019
Rudmann KC , Cooper G , Marjuki H , Reingold A , Barnes M , Petit S , Moore A , Harrison LH , Lynfield R , Khanlian SA , Anderson BJ , Martin T , Schaffner W , McNamara LA , Rubis AB . Open Forum Infect Dis 2024 11 (1) ofad696 Persons with HIV (PWH) are at increased risk for bacterial infections, and previous publications document an increased risk for invasive meningococcal disease (IMD) in particular. This analysis provides evidence that PWH face a 6-fold increase in risk for IMD based on Active Bacterial Core surveillance data collected during 2009-2019. |
Surveillance for rubella virus in samples obtained from non-immunodeficient individuals
Patel S , Russo P , M HR , Maurer K , Hao L , Beard RS , Perelygina L , Sullivan KE . Pediatr Allergy Immunol 2024 35 (1) e14082 |
Respiratory syncytial virus-associated hospitalizations among children <5 years old: 2016 to 2020
Curns AT , Rha B , Lively JY , Sahni LC , Englund JA , Weinberg GA , Halasa NB , Staat MA , Selvarangan R , Michaels M , Moline H , Zhou Y , Perez A , Rohlfs C , Hickey R , Lacombe K , McHenry R , Whitaker B , Schuster J , Pulido CG , Strelitz B , Quigley C , Dnp GW , Avadhanula V , Harrison CJ , Stewart LS , Schlaudecker E , Szilagyi PG , Klein EJ , Boom J , Williams JV , Langley G , Gerber SI , Hall AJ , McMorrow ML . Pediatrics 2024 BACKGROUND: Respiratory syncytial virus (RSV) is the leading cause of hospitalization in US infants. Accurate estimates of severe RSV disease inform policy decisions for RSV prevention. METHODS: We conducted prospective surveillance for children <5 years old with acute respiratory illness from 2016 to 2020 at 7 pediatric hospitals. We interviewed parents, reviewed medical records, and tested midturbinate nasal ± throat swabs by reverse transcription polymerase chain reaction for RSV and other respiratory viruses. We describe characteristics of children hospitalized with RSV, risk factors for ICU admission, and estimate RSV-associated hospitalization rates. RESULTS: Among 13 524 acute respiratory illness inpatients <5 years old, 4243 (31.4%) were RSV-positive; 2751 (64.8%) of RSV-positive children had no underlying condition or history of prematurity. The average annual RSV-associated hospitalization rate was 4.0 (95% confidence interval [CI]: 3.8-4.1) per 1000 children <5 years, was highest among children 0 to 2 months old (23.8 [95% CI: 22.5-25.2] per 1000) and decreased with increasing age. Higher RSV-associated hospitalization rates were found in premature versus term children (rate ratio = 1.95 [95% CI: 1.76-2.11]). Risk factors for ICU admission among RSV-positive inpatients included: age 0 to 2 and 3 to 5 months (adjusted odds ratio [aOR] = 1.97 [95% CI: 1.54-2.52] and aOR = 1.56 [95% CI: 1.18-2.06], respectively, compared with 24-59 months), prematurity (aOR = 1.32 [95% CI: 1.08-1.60]) and comorbid conditions (aOR = 1.35 [95% CI: 1.10-1.66]). CONCLUSIONS: Younger infants and premature children experienced the highest rates of RSV-associated hospitalization and had increased risk of ICU admission. RSV prevention products are needed to reduce RSV-associated morbidity in young infants. |
The capacity of HIV care facilities to implement strategies recommended by the Ending the HIV Epidemic-The Medical Monitoring Project Facility Survey
Beer L , Williams D , Tie Y , McManus T , Yuan AX , Crim SM , Demeke HB , Creel D , Blackwell AD , Craw JA , Weiser J . J Acquir Immune Defic Syndr 2023 94 (4) 290-300 BACKGROUND: Data are needed to assess the capacity of HIV care facilities to implement recommended Ending the HIV Epidemic activities. SETTING: US HIV care facilities. METHODS: We analyzed 2021 survey data from 514 facilities that were recruited from a census of facilities providing care to a national probability sample of US adults with HIV. We present weighted estimates of facility characteristics, services, and policies and estimates of the proportion of all US HIV patients attending these facilities. RESULTS: Among HIV care facilities, 37% were private practices, 72% were in areas with population >1 million, and 21% had more than 1000 HIV patients. Most provided preexposure prophylaxis (83%) and postexposure prophylaxis (84%). More than 67% of facilities provided HIV-specific stigma or discrimination training for all staff (covering 70% of patients) and 66% provided training on cultural competency (covering 74% of patients). A majority of patients attended facilities that provided on-site access to HIV/sexually transmitted infection (STI) transmission risk reduction counseling (89%); fewer had on-site access to treatment for substance use disorders (35%). We found low provision of on-site assistance with food banks or meal delivery (14%) and housing (33%). Approximately 71% of facilities reported using data to systematically monitor patient retention in care. On-site access to adherence tools was available at 58% of facilities; 29% reported notifying patients of missed prescription pickups. CONCLUSION: Results indicate some strengths that support Ending the HIV Epidemic-recommended strategies among HIV care facilities, such as high availability of preexposure prophylaxis/postexposure prophylaxis, as well as areas for improvement, such as provision of staff antistigma trainings and adherence supports. |
Reliability of the 2020 school health profiles principal and lead health education teacher questionnaires
Jones SE , Brener ND , Queen B , Hershey-Arista M , Harris W , Underwood JM . J Sch Health 2024 BACKGROUND: School Health Profiles assesses school health policies and practices among US secondary schools. METHODS: The 2020 School Health Profiles principal and teacher questionnaires were used for a test-retest reliability study. Cohen's kappa coefficients tested the agreement in dichotomous responses to each questionnaire variable at 2 time points. The aggregate prevalence estimates between time 1 and time 2 were compared for each questionnaire item via overlapping 95% confidence intervals. Chi-square tests examined whether the prevalence at time 2 differed between paper and web administration for both questionnaires. RESULTS: For the principal (N = 50) and teacher (N = 34) data, there were no significant differences in the prevalence of any items between time 1 and time 2. For the principal survey, the mean kappa for 191 variables was 0.49. For the teacher survey, the mean kappa for 260 variables was 0.65. Overall, 60.7% of principal and 91.1% of teacher questionnaire items had at least "moderate" reliability. CONCLUSIONS: School Health Profiles offers education and health agencies a reliable tool to monitor school policies and practices. |
Quickstats: Percentage* of children and adolescents aged ≤17 years who visited an urgent care center or a clinic in a drug store or grocery store in the past 12 months,(†) by age group and year - National Health Interview Survey,(§) United States, 2021-2022
Briones Elizabeth M , Adjaye-Gbewonyo Dzifa . MMWR Morb Mortal Wkly Rep 2024 73 (3) 68 |
Implementation of an awareness level training to prepare the workforce for future infectious disease outbreaks
Workman B , Fulk F , Carreón T , Nabors L . Disaster Med Public Health Prep 2024 18 e9 OBJECTIVE: The COVID-19 pandemic underscores the need for workforce awareness-level training for infectious disease outbreaks. A training program was created and evaluated to provide strategies for emergency preparedness as well as worker health and safety during a disease outbreak. METHODS: Participants (N = 292) completed instructor-led synchronous online training modules between January 2022 and February 2023. Training covered 5 areas: vaccine awareness, infectious disease transmission and prevention, pandemic awareness, and inapparent infections, as well as workplace controls to reduce or remove hazards. Participants completed a survey before and after training to assess knowledge change in the five areas. Chi-square analyses assessed how predictors were related to knowledge change. RESULTS: Overall, an increase in knowledge was observed between pre- (80.9%) and post-training (92.7%). Participants from small businesses, with less work experience, and in non-health care roles were under-informed. Knowledge of disease transmission and prevention improved for non-health care professions and workers with less experience. All participants gained knowledge in identifying and ranking safeguards to protect workers from injuries and illness at job sites. CONCLUSIONS: Training improved employee knowledge about safe work practices and pandemic preparedness. Studies should continue to evaluate the effectiveness of preparedness training to prepare the workforce for infectious disease outbreaks and pandemics. |
Maternal and paternal preconception serum concentrations of per and polyfluoroalkyl substances in relation to birth outcomes
Zhang Y , Mustieles V , Martin L , Sun Y , Hillcoat A , Fang X , Bibi Z , Torres N , Coburn-Sanderson A , First O , Souter I , Petrozza JC , Botelho JC , Calafat AM , Wang YX , Messerlian C . Environ Sci Technol 2024 Prenatal per and polyfluoroalkyl substances (PFAS) exposure is associated with adverse birth outcomes. There is an absence of evidence on the relationship between maternal and paternal preconception PFAS exposure and birth outcomes. This study included 312 mothers and 145 fathers with a singleton live birth from a preconception cohort of subfertile couples seeking fertility treatment at a U.S. clinic. PFAS were quantified in serum samples collected before conception. Gestational age (GA) and birthweight (BW) were abstracted from delivery records. We also assessed low birthweight (BW < 2500 g) and preterm birth (GA < 37 completed weeks). We utilized multivariable linear regression, logistic regression, and quantile-based g computation to examine maternal or paternal serum concentrations of individual PFAS and mixture with birth outcomes. Maternal serum concentrations of perfluorooctanesulfonate (PFOS), perfluorohexanesulfonate (PFHxS), and the total PFAS mixture were inversely associated with birthweight. Maternal PFOS concentration was associated with a higher risk of low birthweight. Conversely, paternal PFOS and PFHxS concentrations were imprecisely associated with higher birthweight. No associations were found for gestational age or preterm birth. The findings have important implications for preconception care. Future research with larger sample sizes would assist in validating these findings. |
Effect of ground beef irradiation on annual nontyphoidal Salmonella and Escherichia coli O157 burden and direct healthcare costs in the United States: A simulation study
Khan MA , Collier SA , Ablan M , Canning M , Robyn M , Marshall KE . J Food Prot 2024 100231 Over 20% of E. coli O157 illnesses and over 5% of Salmonella illnesses are estimated to be attributable to beef consumption in the United States. Irradiating ground beef is one possible method to reduce disease burden. We simulated the effect of ground beef irradiation on illnesses, hospitalizations, deaths, and direct healthcare costs from ground beef-associated E. coli O157 and Salmonella illnesses in the United States. To estimate the fraction of illnesses, hospitalizations, deaths, and direct healthcare costs preventable by ground beef irradiation, we multiplied the disease burden attributable to ground beef; the estimated percentage of ground beef sold that is not currently irradiated; the percentage of unirradiated ground beef that would be irradiated; and the percentage reduction in risk of illness after irradiation. We multiplied this fraction by estimates of burden and direct healthcare costs to calculate the numbers or amounts averted. Model inputs were obtained from the literature and expert opinion. We used Monte Carlo simulation to incorporate uncertainty in inputs into model estimates. Simulation outcomes were summarized with means and 95% uncertainty intervals (UI). Irradiating 50% of the currently unirradiated ground beef supply would avert 3,285 (95% UI: 624-9,977) E. coli O157 illnesses, 135 (95% UI: 24-397) hospitalizations, 197 (95% UI: 34-631) hemolytic uremic syndrome cases, 2 (95% UI: 0-16) deaths, and $2,972,656 (95% UI: $254,708-$14,496,916) in direct healthcare costs annually. For Salmonella, irradiation would avert 20,308 (95% UI: 9,858-38,903) illnesses, 400 (95% UI: 158-834) hospitalizations, 6 (95% UI: 0-18) deaths, and $7,318,632 (95% UI: $1,436,141-$26,439,493) in direct healthcare costs. Increasing ground beef irradiation could reduce E. coli O157 and Salmonella burden in the United States. Additional studies should assess whether targeted irradiation of higher-risk ground beef products could prevent similar numbers of illnesses with less total product irradiated. |
Large-scale validation of skin prion seeding activity as a biomarker for diagnosis of prion diseases
Zhang W , Orrú CD , Foutz A , Ding M , Yuan J , Shah SZA , Zhang J , Kotobelli K , Gerasimenko M , Gilliland T , Chen W , Tang M , Cohen M , Safar J , Xu B , Hong DJ , Cui L , Hughson AG , Schonberger LB , Tatsuoka C , Chen SG , Greenlee JJ , Wang Z , Appleby BS , Caughey B , Zou WQ . Acta Neuropathol 2024 147 (1) 17 Definitive diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD) relies on the examination of brain tissues for the pathological prion protein (PrP(Sc)). Our previous study revealed that PrP(Sc)-seeding activity (PrP(Sc)-SA) is detectable in skin of sCJD patients by an ultrasensitive PrP(Sc) seed amplification assay (PrP(Sc)-SAA) known as real-time quaking-induced conversion (RT-QuIC). A total of 875 skin samples were collected from 2 cohorts (1 and 2) at autopsy from 2-3 body areas of 339 cases with neuropathologically confirmed prion diseases and non-sCJD controls. The skin samples were analyzed for PrP(Sc)-SA by RT-QuIC assay. The results were compared with demographic information, clinical manifestations, cerebrospinal fluid (CSF) PrP(Sc)-SA, other laboratory tests, subtypes of prion diseases defined by the methionine (M) or valine (V) polymorphism at residue 129 of PrP, PrP(Sc) types (#1 or #2), and gene mutations in deceased patients. RT-QuIC assays of the cohort #1 by two independent laboratories gave 87.3% or 91.3% sensitivity and 94.7% or 100% specificity, respectively. The cohort #2 showed sensitivity of 89.4% and specificity of 95.5%. RT-QuIC of CSF available from 212 cases gave 89.7% sensitivity and 94.1% specificity. The sensitivity of skin RT-QuIC was subtype dependent, being highest in sCJDVV1-2 subtype, followed by VV2, MV1-2, MV1, MV2, MM1, MM1-2, MM2, and VV1. The skin area next to the ear gave highest sensitivity, followed by lower back and apex of the head. Although no difference in brain PrP(Sc)-SA was detected between the cases with false negative and true positive skin RT-QuIC results, the disease duration was significantly longer with the false negatives [12.0 ± 13.3 (months, SD) vs. 6.5 ± 6.4, p < 0.001]. Our study validates skin PrP(Sc)-SA as a biomarker for the detection of prion diseases, which is influenced by the PrP(Sc) types, PRNP 129 polymorphisms, dermatome sampled, and disease duration. |
Deaths of U.S. citizens undergoing cosmetic surgery - Dominican Republic, 2009-2022
Hudson M , Matos JA , Alvarez B , Safstrom J , Torres F , Premjee S , Bonilla L , Park B , Bancroft E , Garcia M . MMWR Morb Mortal Wkly Rep 2024 73 (3) 62-65 Although infections resulting from cosmetic surgery performed outside the United States have been regularly reported, deaths have rarely been identified. During 2009-2022, 93 U.S. citizens died after receiving cosmetic surgery in the Dominican Republic. The number of deaths increased from a mean of 4.1 per year during 2009-2018 to a mean of 13.0 during 2019-2022 with a peak in of 17 in 2020. A subset of post-cosmetic surgery deaths occurring during peak years was investigated, and most deaths were found to be the result of embolic events (fat emboli or venous thromboembolism) for which a high proportion of the patients who died had risk factors, including obesity and having multiple procedures performed during the same operation. These risk factors might have been mitigated or prevented with improved surgical protocols and postoperative medical care, including prophylactic measures against venous thromboembolism. U.S. citizens interested in receiving elective cosmetic surgery outside the United States should consult with their health care professionals regarding their risk for adverse outcomes. Public health authorities can support provider education on the importance of preoperative patient evaluation and the potential danger of performing multiple cosmetic procedures in one operation. |
An interactive modeling tool for projecting the health and direct medical cost impact of changes in the sexually transmitted diseases prevention program budgets
Martin EG , Ansari B , Gift TL , Johnson BL , Collins D , Williams AM , Chesson HW . J Public Health Manag Pract 2024 30 (2) 221-230 CONTEXT: Estimating the return on investment for public health services, tailored to the state level, is critical for demonstrating their value and making resource allocation decisions. However, many health departments have limited staff capacity and expertise to conduct economic analyses in-house. PROGRAM: We developed a user-friendly, interactive Excel-based spreadsheet model that health departments can use to estimate the impact of increases or decreases in sexually transmitted infection (STI) prevention funding on the incidence and direct medical costs of chlamydia, gonorrhea, syphilis, and STI-attributable HIV infections. Users tailor results to their jurisdictions by entering the size of their population served; the number of annual STI diagnoses; their prior annual funding amount; and their anticipated new funding amount. The interface was developed using human-centered design principles, including focus groups with 15 model users to collect feedback on an earlier model version and a usability study on the prototype with 6 model users to finalize the interface. IMPLEMENTATION: The STI Prevention Allocation Consequences Estimator ("SPACE Monkey 2.0") model will be publicly available as a free downloadable tool. EVALUATION: In the usability testing of the prototype, participants provided overall positive feedback. They appreciated the clear interpretations, outcomes expressed as direct medical costs, functionalities to interact with the output and copy charts into external applications, visualization designs, and accessible information about the model's assumptions and limitations. Participants provided positive responses to a 10-item usability evaluation survey regarding their experiences with the prototype. DISCUSSION: Modeling tools that synthesize literature-based estimates and are developed with human-centered design principles have the potential to make evidence-based estimates of budget changes widely accessible to health departments. |
Trends in out-of-pocket costs for and characteristics of pharmacy-dispensed naloxone by payer type
Jiang X , Strahan AE , Zhang K , Guy GP Jr . Jama 2024 This study examines mean yearly out-of-pocket cost for naloxone dispensed from retail pharmacies by payer between 2018 and 2022 and by prescription characteristics and payer in 2022. | eng |
Covid-19 pandemic and equity of global human papillomavirus vaccination: descriptive study of World Health Organization-Unicef vaccination coverage estimates
Casey RM , Akaba H , Hyde TB , Bloem P . BMJ Med 2024 3 (1) e000726 OBJECTIVE: To analyse progress in global vaccination against human papillomavirus (HPV) during the covid-19 pandemic, with a particular focus on equity. DESIGN: Descriptive study of World Health Organization-Unicef vaccination coverage estimates. SETTING: WHO-Unicef estimates of global, regional, and national HPV vaccination coverage, before (2010-19) and during (2020-21) the covid-19 pandemic. PARTICIPANTS: Girls aged 9-14 years who received a HPV vaccine globally before (12.3 million in 2019) and during (2020-21) the covid-19 pandemic (10.6 million in 2021). MAIN OUTCOME MEASURES: Mean programme and population adjusted coverage for first dose HPV vaccine (HPV1) by country, country income (World Bank income categories), sex, and WHO region, before (2010-19) and during (2020-21) the covid-19 pandemic, based on WHO-Unicef estimates of HPV vaccination coverage. Annual number of national HPV vaccine programme introduced since the first HPV vaccine licence was granted in 2006, based on data reported to WHO-Unicef. Number of girls vaccinated before (2019) versus during (2020-21) the covid-19 pandemic period. RESULTS: Mean coverage of HPV vaccination programmes among girls decreased from 65% in 2010-19 to 50% in 2020-21 in low and middle income countries compared with an increase in high income countries from 61% to 69% for the same periods. Population adjusted HPV1 coverage was higher among girls in high income countries before and during the covid-19 pandemic than in girls in low and middle income countries. During the covid-19 pandemic, population adjusted HPV1 coverage among boys in high income countries was higher and remained higher than coverage among girls in low and middle income countries. Globally, 23 countries recorded a severe reduction in their HPV programme (≥50% reduction in coverage), and another 3.8 million girls globally did not receive a HPV vaccine in countries with existing HPV vaccination programmes in 2020-21 compared with 2019. A reduction was seen in the annual rate of new introductions of national HPV vaccine programmes during 2020-21, affecting countries in all income categories, followed by an increase in introductions during 2022. During the second half of 2023, several low and middle income countries with large birth cohorts and a high relative burden of cervical cancer have yet to introduce HPV vaccination. CONCLUSIONS: Although HPV vaccines have been available for more than 15 years, global HPV vaccination coverage is low. During the covid-19 pandemic period (2020-21 globally), worsening coverage, delayed introductions of national vaccine programmes, and an increase in missed girls globally (ie, girls who did not receive a HPV vaccine compared with the previous year in countries with an existing HPV vaccination programme) that disproportionately affected girls in low and middle income countries were found. Urgent and innovative recovery efforts are needed to accelerate national introduction of HPV vaccination programmes and achieve high coverage of HPV vaccination worldwide. |
The intersection of health and housing: Analysis of the research portfolios of the National Institutes of Health, Centers for Disease Control and Prevention, and U.S. Department of Housing and Urban Development
Walton L , Skillen E , Mosites E , Bures RM , Amah-Mbah C , Sandoval M , Thigpen Tart K , Berrigan D , Star C , Godette-Greer D , Kowtha B , Vogt E , Liggins C , Lloyd J . PLoS One 2024 19 (1) e0296996 BACKGROUND: Housing is a major social determinant of health that affects health status and outcomes across the lifespan. OBJECTIVES: An interagency portfolio analysis assessed the level of funding invested in "health and housing research" from fiscal years (FY) 2016-2020 across the National Institutes of Health (NIH), the United States Department of Housing and Urban Development (HUD), and the Centers for Disease Control and Prevention (CDC) to characterize the existing health and housing portfolio and identify potential areas for additional research and collaboration. METHODS/RESULTS: We identified NIH, HUD, and CDC research projects that were relevant to both health and housing and characterized them by housing theme, health topic, population, and study design. We organized the assessment of the individual housing themes by four overarching housing-to-health pathways. From FY 2016-2020, NIH, HUD, and CDC funded 565 health and housing projects combined. The Neighborhood pathway was most common, followed by studies of the Safety and Quality pathway. Studies of the Affordability and Stability pathways were least common. Health topics such as substance use, mental health, and cardiovascular disease were most often studied. Most studies were observational (66%); only a little over one fourth (27%) were intervention studies. DISCUSSION: This review of the research grant portfolios of three major federal funders of health and housing research in the United States describes the diversity and substantial investment in research at the intersection between housing and health. Analysis of the combined portfolio points to gaps in studies on causal pathways linking housing to health outcomes. The findings highlight the need for research to better understand the causal pathways from housing to health and prevention intervention research, including rigorous evaluation of housing interventions and policies to improve health and well-being. |
Hepatitis C virus outbreak at a pain clinic in Los Angeles
Alarcón J , Dao BL , Santos M , Jewell MP , Donabedian C , Stanley AN , Terashita DM , Balter SE , Gounder P . Infect Control Hosp Epidemiol 2024 1-2 |
Notes from the field: Nontuberculous mycobacteria infections after cosmetic surgery procedures in Florida - nine states, 2022-2023
Saunders KE , Reyes JM , Cyril L , Mitchell M , Colter S , Erskine J , McNamara KX , Hunter JC , Perkins KM , Charles A . MMWR Morb Mortal Wkly Rep 2024 73 (3) 66-67 |
Evaluation of intussusception following pentavalent rotavirus vaccine (rotateq) administration in five countries in Africa
Tate JE , Mwenda JM , Keita AM , Tapsoba TW , Ngendahayo E , Kouamé BD , Samateh AL , Aliabadi N , Sissoko S , Traore Y , Bayisenga J , Sounkere-Soro M , Jagne S , Burke RM , Onwuchekwa U , Ouattara M , Bikoroti JB , N'Zue K , Leshem E , Coulibaly O , Ouedraogo I , Uwimana J , Sow S , Parashar UD . Clin Infect Dis 2024 78 (1) 210-216 BACKGROUND: A low-level risk of intussusception following rotavirus vaccination has been observed in some settings and may vary by vaccine type. We examined the association between RotaTeq vaccination and intussusception in low-income settings in a pooled analysis from 5 African countries that introduced RotaTeq into their national immunization program. METHODS: Active surveillance was conducted at 20 hospitals to identify intussusception cases. A standard case report form was completed for each enrolled child, and vaccination status was determined by review of the child's vaccination card. The pseudo-likelihood adaptation of self-controlled case-series method was used to assess the association between RotaTeq administration and intussusception in the 1-7, 8-21, and 1-21 day periods after each vaccine dose in infants aged 28-245 days. RESULTS: Data from 318 infants with confirmed rotavirus vaccination status were analyzed. No clustering of cases occurred in any of the risk windows after any of the vaccine doses. Compared with the background risk of naturally occurring intussusception, no increased risk was observed after dose 1 in the 1-7 day (relative incidence = 2.71; 95% confidence interval [CI] = 0.47-8.03) or the 8-21 day window (relative incidence = 0.77; 95%CI = 0.0-2.69). Similarly, no increased risk of intussusception was observed in any risk window after dose 2 or 3. CONCLUSIONS: RotaTeq vaccination was not associated with increased risk of intussusception in this analysis from 5 African countries. This finding mirrors results from similar analyses with other rotavirus vaccines in low-income settings and highlights the need for vaccine-specific and setting-specific risk monitoring. |
Strengthening the WHO Regional Office for Africa (WHO AFRO) COVID-19 vaccination information system
Shragai T , Bukhari A , Atagbaza AO , Oyaole DR , Shah R , Volkmann K , Kamau L , Sheillah N , Farham B , Wong MK , Lam E , Mboussou F , Impouma B . BMJ Glob Health 2024 9 (1) This manuscript describes the process and impact of strengthening the WHO Regional Office for Africa (WHO AFRO)'s COVID-19 vaccination information system. This system plays a critical role in tracking vaccination coverage, guiding resource allocation and supporting vaccination campaign roll-out for countries in the African region. Recognising existing data management issues, including complex reporting prone to human error, compromised data quality and underutilisation of collected data, WHO AFRO introduced significant system improvements during the COVID-19 pandemic. These improvements include shifting from an Excel-based to an online Azure-based data collection system, automating data processing and validation, and expansion of collected data. These changes have led to improvements in data quality and quantity including a decrease in data non-validity, missingness, and record duplication, and expansion of data collection forms to include a greater number of data fields, offering a more comprehensive understanding of vaccination efforts. Finally, the creation of accessible information products-including an interactive public dashboard, a weekly data pack and a public monthly bulletin-has improved data use and reach to relevant partners. These resources provide crucial insights into the region's vaccination progress at national and subnational levels, thereby enabling data-driven decision-making to improve programme performance. Overall, the strengthening of the WHO AFRO COVID-19 vaccination information system can serve as a model for similar efforts in other WHO regions and contexts. The impact of system strengthening on data quality demonstrated here underscores the vital role of robust data collection, capacity building and management systems in achieving high-quality data on vaccine distribution and coverage. Continued investment in information systems is essential for effective and equitable public health efforts. |
The U.S. COVID-19 vaccination program: A look back and future directions
Hall E , Mahon BE , Peacock G . Vaccine 2024 |
CIC2022: An informatics-driven strategy for improving immunization healthcare data quality using 2D barcoding and barcode scanning practices
Reza F , Jones C , Reed JH . Appl Clin Inform 2024 Manual data entry is time-consuming, inefficient, and error prone. In contrast, leveraging two-dimensional (2D) barcodes and barcode scanning tools is a rapid, efficient, and effective practice for automatically entering data accurately and completely during vaccine inventorying and administration. CDC pilots in a variety of healthcare settings documented the clinical and public health impact of 2D barcode scanning practices on data quality and completeness, time savings, workflow efficiencies, and staff experience. A sample of 50 million emergency use authorization (EUA) COVID-19 vaccine records were analyzed for accuracy and completeness across three data fields: lot number, expiration date, and National Drug Code (NDC). These vaccines did not include a 2D barcode containing these data fields, thus necessitating manual entry of vaccine data at administration. During a CDC pilot with clinic sites, comparison was made between automatically scanned and manually entered data for routine vaccines for accuracy and completeness across these data fields. Analysis of 50 million manually entered EUA vaccine administration records indicated significant gaps in data accuracy and completeness across three data fields observed. Over half of the 50 million EUA vaccine NDCs (53%) and one-third of the expiration dates (35%) analyzed had missing or inaccurate data recorded. Pilot data also showed many errors when manually entered. However, when 67,951 (out of 72,979) vaccines were scanned during the pilot, nearly all entries were complete and accurate across all three data fields (ranging from 99.7% to 99.999% accurate). Vaccine 2D barcode scanning practices increased data accuracy and completeness (up to 99.999% accurate) across data fields assessed. When used consistently, vaccine 2D barcode scanning can resolve the issues demonstrated in manually entered data. To realize these benefits, the immunization community should widely adopt scanning practices. To increase use, CDC has developed a Vaccine 2D Barcode National Adoption Strategy and resources to guide implementation. |
Fostering governance and information partnerships for chronic disease surveillance: The Multi-State EHR-Based Network for Disease Surveillance
Kraus EM , Saintus L , Martinez AK , Brand B , Begley E , Merritt RK , Hamilton A , Rubin R , Sullivan A , Karras BT , Grannis S , Brooks IM , Mui JY , Carton TW , Hohman KH , Klompas M , Dixon BE . J Public Health Manag Pract 2024 30 (2) 244-254 CONTEXT: Electronic health records (EHRs) are an emerging chronic disease surveillance data source and facilitating this data sharing is complex. PROGRAM: Using the experience of the Multi-State EHR-Based Network for Disease Surveillance (MENDS), this article describes implementation of a governance framework that aligns technical, statutory, and organizational requirements to facilitate EHR data sharing for chronic disease surveillance. IMPLEMENTATION: MENDS governance was cocreated with data contributors and health departments representing Texas, New Orleans, Louisiana, Chicago, Washington, and Indiana through engagement from 2020 to 2022. MENDS convened a governance body, executed data-sharing agreements, and developed a master governance document to codify policies and procedures. RESULTS: The MENDS governance committee meets regularly to develop policies and procedures on data use and access, timeliness and quality, validation, representativeness, analytics, security, small cell suppression, software implementation and maintenance, and privacy. Resultant policies are codified in a master governance document. DISCUSSION: The MENDS governance approach resulted in a transparent governance framework that cultivates trust across the network. MENDS's experience highlights the time and resources needed by EHR-based public health surveillance networks to establish effective governance. |
Implementation of an HIV case based surveillance using standards-based health information exchange in Rwanda
Oluoch T , Byiringiro B , Tuyishime E , Kitema F , Ntwali L , Malamba S , Wilmore S , Remera E . Stud Health Technol Inform 2024 310 875-880 As Rwanda approaches the UNAIDS Fast Track goals which recommend that 95% of HIV-infected individuals know their status, of whom 95% should receive treatment and 95% of those on treatment achieve viral suppression, the country currently relies on an inefficient paper, and disjointed electronic, systems for case-based surveillance (CBS). Rwanda has established an ecosystem of interoperable systems based on open standards to support HIV CBS. Data were successfully exchanged between an EMR, a client registry, laboratory information system and DHIS-2 Tracker, and subsequently, a complete analytic dataset was ingested into MS-Power Business Intelligence (MS-PowerBI) for analytics and visualization of the CBS data. Existing challenges included inadequate workforce capacity to support mapping of data elements to HL7 FHIR resources. Interoperability optimization to support CBS is work in progress and rigorous evaluations on the effect on health information exchange on monitoring patient outcomes are needed. |
Data-exchange between electronic medical record and viral-load laboratory database towards improving HIV care in Ethiopia
Petros A , Desalegn DM , Dessie GF , Mumme BA , Abebe K , Haile DM , Bogale HB , Mohammed MS , Tesfaye Y , Tedla Y , Gutta GA , Bekedami DL , Melaku Z , Habte D , Lulseged S . Stud Health Technol Inform 2024 310 1366-1367 Electronic viral load (VL) Test Ordering and Result Reporting System (ETORRS) was introduced to create data exchange between the existing VL database and the electronic medical record (EMR) system, with the aim of reducing laboratory test results turnaround time (TAT), improving data quality, and supporting timely clinical response for patients with high VL. This use case is an illustrative example of initiating and adopting the principles of health information exchange for a priority health program. |
Mild traumatic brain injuries and risk for affective and behavioral disorders
Delmonico RL , Tucker LY , Theodore BR , Camicia M , Filanosky C , Haarbauer-Krupa J . Pediatrics 2024 153 (2) OBJECTIVES: Recent studies document an association between mild traumatic brain injuries (mTBIs) in children and postinjury psychiatric disorders. However. these studies were subject to limitations in the design, lack of long-term follow-up, and poorly defined psychiatric outcomes. This study determines the incidence and relative risk of postinjury new affective and behavior disorders 4 years after mTBIs. METHODS: A cohort study of mTBI cases and matched comparisons within an integrated health care system. The mTBI group included patients ≤17 years of age, diagnosed with mTBI from 2000 to 2014 (N = 18 917). Comparisons included 2 unexposed patients (N = 37 834) per each mTBI-exposed patient, randomly selected and matched for age, sex, race/ethnicity, and date of medical visit (reference date to mTBI injury). Outcomes included a diagnosis of affective or behavioral disorders in the 4 years after mTBI or the reference date. RESULTS: Adjusted risks for affective disorders were significantly higher across the first 3 years after injury for the mTBI group, especially during the second year, with a 34% increase in risk. Adjusted risks for behavioral disorders were significant at years 2 and 4, with up to a 37% increase in risk. The age group with the highest risk for postinjury affective and behavioral disorders was 10- to 13-year-old patients. CONCLUSIONS: Sustaining an mTBI significantly increased the risks of having a new affective or behavioral disorder up to 4 years after injury. Initial and ongoing screening for affective and behavior disorders following an mTBI can identify persistent conditions that may pose barriers to recovery. |
Potential underreporting of treated patients using a Clostridioides difficile testing algorithm that screens with a nucleic acid amplification test
Guh AY , Fridkin S , Goodenough D , Winston LG , Johnston H , Basiliere E , Olson D , Wilson CD , Watkins JJ , Korhonen L , Gerding DN . Infect Control Hosp Epidemiol 2024 1-9 OBJECTIVE: Patients tested for Clostridioides difficile infection (CDI) using a 2-step algorithm with a nucleic acid amplification test (NAAT) followed by toxin assay are not reported to the National Healthcare Safety Network as a laboratory-identified CDI event if they are NAAT positive (+)/toxin negative (-). We compared NAAT+/toxin- and NAAT+/toxin+ patients and identified factors associated with CDI treatment among NAAT+/toxin- patients. DESIGN: Retrospective observational study. SETTING: The study was conducted across 36 laboratories at 5 Emerging Infections Program sites. PATIENTS: We defined a CDI case as a positive test detected by this 2-step algorithm during 2018-2020 in a patient aged ≥1 year with no positive test in the previous 8 weeks. METHODS: We used multivariable logistic regression to compare CDI-related complications and recurrence between NAAT+/toxin- and NAAT+/toxin+ cases. We used a mixed-effects logistic model to identify factors associated with treatment in NAAT+/toxin- cases. RESULTS: Of 1,801 cases, 1,252 were NAAT+/toxin-, and 549 were NAAT+/toxin+. CDI treatment was given to 866 (71.5%) of 1,212 NAAT+/toxin- cases versus 510 (95.9%) of 532 NAAT+/toxin+ cases (P < .0001). NAAT+/toxin- status was protective for recurrence (adjusted odds ratio [aOR], 0.65; 95% CI, 0.55-0.77) but not CDI-related complications (aOR, 1.05; 95% CI, 0.87-1.28). Among NAAT+/toxin- cases, white blood cell count ≥15,000/µL (aOR, 1.87; 95% CI, 1.28-2.74), ≥3 unformed stools for ≥1 day (aOR, 1.90; 95% CI, 1.40-2.59), and diagnosis by a laboratory that provided no or neutral interpretive comments (aOR, 3.23; 95% CI, 2.23-4.68) were predictors of CDI treatment. CONCLUSION: Use of this 2-step algorithm likely results in underreporting of some NAAT+/toxin- cases with clinically relevant CDI. Disease severity and laboratory interpretive comments influence treatment decisions for NAAT+/toxin- cases. |
Application of the aza-Wittig reaction for efficient synthesis of diversely substituted benzo[f]Chromeno[2,3-d]pyrimidine and benzo[f]chromeno[2,3-d][1,2,4]triazolopyrimidine derivatives
Hassan M , Barsy MA , El Rady EA , Al-Ayed AS , Frempong M , Sadek KU . J Heterocycl Chem 2024 An efficient synthesis of novel benzo[f]Chromeno[2,3-d]pyrimidine and unknown benzo[f]chromeno[2,3-d][1,2,4]triazolopyrimidine derivatives is described utilizing ethyl-2-amino-4-phenyl-4H-benzo[f]chromene-3-carboxylate as precursor via aza-Wittig reaction. The process proved to be simple, high-yielding, and efficient. © 2024 Wiley Periodicals LLC. |
Differential interferon responses to influenza A and B viruses in primary ferret respiratory epithelial cells
Rowe T , Davis W , Wentworth DE , Ross T . J Virol 2024 e0149423 Influenza B viruses (IBV) cocirculate with influenza A viruses (IAV) and cause periodic epidemics of disease, yet antibody and cellular responses following IBV infection are less well understood. Using the ferret model for antisera generation for influenza surveillance purposes, IAV resulted in robust antibody responses following infection, whereas IBV required an additional booster dose, over 85% of the time, to generate equivalent antibody titers. In this study, we utilized primary differentiated ferret nasal epithelial cells (FNECs) which were inoculated with IAV and IBV to study differences in innate immune responses which may result in differences in adaptive immune responses in the host. FNECs were inoculated with IAV (H1N1pdm09 and H3N2 subtypes) or IBV (B/Victoria and B/Yamagata lineages) and assessed for 72 h. Cells were analyzed for gene expression by quantitative real-time PCR, and apical and basolateral supernatants were assessed for virus kinetics and interferon (IFN), respectively. Similar virus kinetics were observed with IAV and IBV in FNECs. A comparison of gene expression and protein secretion profiles demonstrated that IBV-inoculated FNEC expressed delayed type-I/II IFN responses and reduced type-III IFN secretion compared to IAV-inoculated cells. Concurrently, gene expression of Thymic Stromal Lymphopoietin (TSLP), a type-III IFN-induced gene that enhances adaptive immune responses, was significantly downregulated in IBV-inoculated FNECs. Significant differences in other proinflammatory and adaptive genes were suppressed and delayed following IBV inoculation. Following IBV infection, ex vivo cell cultures derived from the ferret upper respiratory tract exhibited reduced and delayed innate responses which may contribute to reduced antibody responses in vivo.IMPORTANCEInfluenza B viruses (IBV) represent nearly one-quarter of all human influenza cases and are responsible for significant clinical and socioeconomic impacts but do not pose the same pandemic risks as influenza A viruses (IAV) and have thus received much less attention. IBV accounts for greater severity and deaths in children, and vaccine efficacy remains low. The ferret can be readily infected with human clinical isolates and demonstrates a similar course of disease and immune responses. IBV, however, generates lower antibodies in ferrets than IAV following the challenge. To determine whether differences in initial innate responses following infection may affect the development of robust adaptive immune responses, ferret respiratory tract cells were isolated, infected with IAV/IBV, and compared. Understanding the differences in the initial innate immune responses to IAV and IBV may be important in the development of more effective vaccines and interventions to generate more robust protective immune responses. |
National population-based estimates for major birth defects, 2016-2020
Stallings EB , Isenburg JL , Rutkowski RE , Kirby RS , Nembhard WN , Sandidge T , Villavicencio S , Nguyen HH , McMahon DM , Nestoridi E , Pabst LJ . Birth Defects Res 2024 116 (1) e2301 BACKGROUND: We provide updated crude and adjusted prevalence estimates of major birth defects in the United States for the period 2016-2020. METHODS: Data were collected from 13 US population-based surveillance programs that used active or a combination of active and passive case ascertainment methods to collect all birth outcomes. These data were used to calculate pooled prevalence estimates and national prevalence estimates adjusted for maternal race/ethnicity for all conditions, and maternal age for trisomies and gastroschisis. Prevalence was compared to previously published national estimates from 1999 to 2014. RESULTS: Adjusted national prevalence estimates per 10,000 live births ranged from 0.63 for common truncus to 18.65 for clubfoot. Temporal changes were observed for several birth defects, including increases in the prevalence of atrioventricular septal defect, tetralogy of Fallot, omphalocele, trisomy 18, and trisomy 21 (Down syndrome) and decreases in the prevalence of anencephaly, common truncus, transposition of the great arteries, and cleft lip with and without cleft palate. CONCLUSION: This study provides updated national estimates of selected major birth defects in the United States. These data can be used for continued temporal monitoring of birth defects prevalence. Increases and decreases in prevalence since 1999 observed in this study warrant further investigation. |
Post-mortem investigation of deaths due to pneumonia in children aged 1-59 months in sub-Saharan Africa and South Asia from 2016 to 2022: an observational study
Mahtab S , Blau DM , Madewell ZJ , Ogbuanu I , Ojulong J , Lako S , Legesse H , Bangura JS , Bassat Q , Mandomando I , Xerinda E , Fernandes F , Varo R , Sow SO , Kotloff KL , Tapia MD , Keita AM , Sidibe D , Onyango D , Akelo V , Gethi D , Verani JR , Revathi G , Scott JAG , Assefa N , Madrid L , Bizuayehu H , Tirfe TT , El Arifeen S , Gurley ES , Islam KM , Alam M , Zahid Hossain M , Dangor Z , Baillie VL , Hale M , Mutevedzi P , Breiman RF , Whitney CG , Madhi SA . Lancet Child Adolesc Health 2024 BACKGROUND: The Child Health and Mortality Prevention Surveillance (CHAMPS) Network programme undertakes post-mortem minimally invasive tissue sampling (MITS), together with collection of ante-mortem clinical information, to investigate causes of childhood deaths across multiple countries. We aimed to evaluate the overall contribution of pneumonia in the causal pathway to death and the causative pathogens of fatal pneumonia in children aged 1-59 months enrolled in the CHAMPS Network. METHODS: In this observational study we analysed deaths occurring between Dec 16, 2016, and Dec 31, 2022, in the CHAMPS Network across six countries in sub-Saharan Africa (Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa) and one in South Asia (Bangladesh). A standardised approach of MITS was undertaken on decedents within 24-72 h of death. Diagnostic tests included blood culture, multi-organism targeted nucleic acid amplifications tests (NAATs) of blood and lung tissue, and histopathology examination of various organ tissue samples. An interdisciplinary expert panel at each site reviewed case data to attribute the cause of death and pathogenesis thereof on the basis of WHO-recommended reporting standards. FINDINGS: Pneumonia was attributed in the causal pathway of death in 455 (40·6%) of 1120 decedents, with a median age at death of 9 (IQR 4-19) months. Causative pathogens were identified in 377 (82·9%) of 455 pneumonia deaths, and multiple pathogens were implicated in 218 (57·8%) of 377 deaths. 306 (67·3%) of 455 deaths occurred in the community or within 72 h of hospital admission (presumed to be community-acquired pneumonia), with the leading bacterial pathogens being Streptococcus pneumoniae (108 [35·3%]), Klebsiella pneumoniae (78 [25·5%]), and non-typeable Haemophilus influenzae (37 [12·1%]). 149 (32·7%) deaths occurred 72 h or more after hospital admission (presumed to be hospital-acquired pneumonia), with the most common pathogens being K pneumoniae (64 [43·0%]), Acinetobacter baumannii (19 [12·8%]), S pneumoniae (15 [10·1%]), and Pseudomonas aeruginosa (15 [10·1%]). Overall, viruses were implicated in 145 (31·9%) of 455 pneumonia-related deaths, including 54 (11·9%) of 455 attributed to cytomegalovirus and 29 (6·4%) of 455 attributed to respiratory syncytial virus. INTERPRETATION: Pneumonia contributed to 40·6% of all childhood deaths in this analysis. The use of post-mortem MITS enabled biological ascertainment of the cause of death in the majority (82·9%) of childhood deaths attributed to pneumonia, with more than one pathogen being commonly implicated in the same case. The prominent role of K pneumoniae, non-typable H influenzae, and S pneumoniae highlight the need to review empirical management guidelines for management of very severe pneumonia in low-income and middle-income settings, and the need for research into new or improved vaccines against these pathogens. FUNDING: Bill & Melinda Gates Foundation. |
The NIOSH Total Worker Health Program: The third decade
Chosewood LC , Schill AL , Chang CC , Childress AM , Hudson HL , Tamers SL , Howard J . J Occup Environ Med 2024 66 (1) 6-8 |
Hired crop worker injury risks on farms in the United States during three different periods between 2002 and 2015
Layne LA , Siordia C . Am J Ind Med 2024 BACKGROUND: Hired crop workers have high incidence of work-related injuries, but little has been documented about potential risks at the national level. METHODS: Data were obtained from a national probability sample of hired crop workers in the United States (U.S.) during 2002-2004 (period I), 2008-2010 (period II), and 2014-2015 (period III). Multivariable logistic regression models of work-related injury were constructed using an occupational exposure adjustment for weeks worked in the previous year. RESULTS: Hired crop workers reporting that their employer did not provide clean drinking water and disposable cups every day were estimated to be at greater odds of injury during all three periods. Having at least some English-speaking ability was associated with increased odds of injury in two periods, while owning a dwelling in the U.S. showed greater injury risk during period II but was associated with lower risk during period III. Other items significantly associated with injury during at least one of the study periods in the final multivariable logistic models included being a direct-hire, a migrant worker, U.S.-born, receiving public aid, and having a health condition. CONCLUSIONS: Hired crop workers are an extremely marginalized population of workers in the U.S. Innovative intervention methods must extend beyond traditional occupational models to focus on the overall health of hired crop workers, including increasing healthcare access, ending agricultural exceptionalism to provide equal regulatory protections afforded to workers in other industries, and adequate enforcement of existing regulations. These findings contribute to the understanding of correlates related to increased work-related injury among hired crop workers, and have implications in fields of prevention, intervention, and policy. |
Provider experiences with daily use of elastomeric half-mask respirators in healthcare
Lane M , Pompeii L , Rios J , Benavides E , Kasbaum M , Patlovich S , Ostrosky-Zeichner L , Hornbeck A , McClain C , Fernando R , Sietsema M , Kraft C . Am J Infect Control 2024 BACKGROUND: During public health emergencies, demand for N95® filtering facepiece respirators (N95 FFRs) can outpace supply. Elastomeric half mask respirators (EHMRs) are a potential alternative that are reusable and provide the same or higher levels of protection. This study sought to examine the practical aspects of EHMR use among healthcare personnel (HCP). METHODS: Between September and December 2021, 183 HCP at two tertiary referral centers participated in this three-month EHMR deployment, wearing the EHMR whenever respiratory protection was required according to hospital protocols (i.e., when an N95 FFR would typically be worn) and responding to surveys about their experience. RESULTS: Participants wore EHMRs typically 1-3 hours per shift, reported disinfecting the respirator after 85% of removals, and reported high confidence in using the EHMR following the study. EHMRs caused minimal interference with patient care tasks, though they did inhibit communication. DISCUSSION: HCP who had not previously worn an EHMR were able to wear it as an alternative to an N95 FFR without much reported interference with their job tasks and with high disinfection compliance. CONCLUSION: This study highlights the feasibility of deployment of EHMRs during a public health emergency when an alternative respirator option is necessary. |
A cluster-based law enforcement body armor sizing system: Concept, procedure, and design practice
Hsiao H , Kau TY , Bradtmiller B . Appl Ergon 2024 117 104201 Given the evolution of human body dimensions, the increasing diversity within the law enforcement workforce, the growing risks of assault faced by law enforcement officers (LEOs), and the absence of a national standard for body armor sizing, there is a critical need to explore LEO body size classification. This exploration will facilitate the development of an armor sizing structure that adequately accommodates the current LEO population. This study aimed to address this need by developing a LEO body armor sizing scheme and creating a sizing chart/app. Additionally, a plan was devised for a series of 'sizing vests' that would enhance LEO armor accommodation and facilitate fit assessment. Torso anthropometric data pertaining to body armor sizing were collected from 756 male and 218 female LEOs across different regions of the United States. Based on the collected data, a nine-size system for male LEOs and an eight-size scheme for female LEOs were suggested. Furthermore, a sizing chart/app was proposed to enable LEOs to swiftly identify an armor size that is most likely to fit an individual, considering a few anthropometric characteristics known to LEOs. To supplement the sizing chart/app, a series of 'sizing vests' were recommended. These vests would provide LEOs with a physical means to assess and determine the best-fitting armor size, offering an alternative to relying solely on the sizing chart/app. We recommend that armor manufacturers adopt these new sizing systems and create prototypes of armor that can be evaluated within this sizing structure. This evaluation process will facilitate improved fit and enhanced protection for LEOs. |
Tularemia from veterinary occupational exposure
Marx GE , Curren E , Olesen M , Cronquist L , Schlosser L , Nichols M , Bye M , Cote A , McCormick DW , Nelson CA . Clin Infect Dis 2024 78 S71-s75 Tularemia is a disease caused by Francisella tularensis, a highly infectious bacteria that can be transmitted to humans by direct contact with infected animals. Because of the potential for zoonotic transmission of F. tularensis, veterinary occupational risk is a concern. Here, we report on a human case of tularemia in a veterinarian after an accidental needlestick injury during abscess drainage in a sick dog. The veterinarian developed ulceroglandular tularemia requiring hospitalization but fully recovered after abscess drainage and a course of effective antibiotics. To systematically assess veterinary occupational transmission risk of F. tularensis, we conducted a survey of veterinary clinical staff after occupational exposure to animals with confirmed tularemia. We defined a high-risk exposure as direct contact to the infected animal's body fluids or potential aerosol inhalation without use of standard personal protective equipment (PPE). Survey data included information on 20 veterinary occupational exposures to animals with F. tularensis in 4 states. Veterinarians were the clinical staff most often exposed (40%), followed by veterinarian technicians and assistants (30% and 20%, respectively). Exposures to infected cats were most common (80%). Standard PPE was not used during 80% of exposures; a total of 7 exposures were categorized as high risk. Transmission of F. tularensis in the veterinary clinical setting is possible but overall risk is likely low. Veterinary clinical staff should use standard PPE and employ environmental precautions when handling sick animals to minimize risk of tularemia and other zoonotic infections; postexposure prophylaxis should be considered after high-risk exposures to animals with suspected or confirmed F. tularensis infection to prevent tularemia. |
Using the number of N95® filtering facepiece respirator models as an indicator of supply chain stability in a US health-care system
Furek A , Edirisooriya M , Casey M , Haas EJ . Disaster Med Public Health Prep 2024 18 e10 OBJECTIVES: Personal protective equipment (PPE) supply chain disruptions force US health-care entities to adopt conservation strategies such as procurement from different respirator manufacturers. This research seeks to better understand how the number of respirator models on hand can serve as an indicator of N95 filtering facepiece respirator (FFR) supply chain stability or disruption. METHODS: Researchers looked at differences in the mean number of N95 FFR models, averaged weekly, from 10 hospitals in a health-care system over 15 wk from June 1 to September 10, 2020. Participating hospitals entered near-daily PPE inventory data by manufacturer and model number. RESULTS: A linear mixed effect model was run in SPSS v. 26 using a random intercept for hospitals, with week as a fixed predictor and mean number of respirator models (averaged weekly) on hand as the dependent variable. Each week showed a small but significant effect compared with the past week (P < 0.001), where the average weekly number of respirator models on hand decreased. CONCLUSIONS: The limited data may indicate a resolution of supply chain disruptions and warrant further investigation. Consequently, the number of respirator models may be applicable as an indicator of supply chain stability and be more easily ascertained and tracked by health-care entities. |
Burden of child mortality from malaria in high endemic areas: results from the CHAMPS Network using minimally invasive tissue sampling
Ogbuanu IU , Otieno K , Varo R , Sow SO , Ojulong J , Duduyemi B , Kowuor D , Cain CJ , Rogena EA , Onyango D , Akelo V , Tippett Barr BA , terKuile F , Kotloff KL , Tapia MD , Keita AM , Juma J , Assefa N , Assegid N , Acham Y , Madrid L , Scott JAG , Arifeen SE , Gurley ES , Mahtab S , Dangor Z , Wadula J , Dutoit J , Madhi SA , Mandomando I , Torres-Fernandez D , Kincardett M , Mabunda R , Mutevedzi P , Madewell ZJ , Blau DM , Whitney CG , Samuels AM , Bassat Q . J Infect 2024 BACKGROUND: Malaria is a leading cause of childhood mortality worldwide. However, accurate estimates of malaria prevalence and causality among patients who die at the country level are lacking due to the limited specificity of diagnostic tools used to attribute etiologies. Accurate estimates are crucial for prioritizing interventions and resources aimed at reducing malaria-related mortality. METHODS: Seven Child Health and Mortality Prevention Surveillance (CHAMPS) Network sites collected comprehensive data on stillbirths and children <5 years, using minimally invasive tissue sampling (MITS). A DeCoDe (Determination of Cause of Death) panel employed standardized protocols for assigning underlying, intermediate, and immediate causes of death, integrating sociodemographic, clinical, laboratory (including extensive microbiology, histopathology, and malaria testing), and verbal autopsy data. Analyses were conducted to ascertain the strength of evidence for cause of death (CoD), describe factors associated with malaria-related deaths, estimate malaria-specific mortality, and assess the proportion of preventable deaths. FINDINGS: Between December 3, 2016, and December 31, 2022, 2673 deaths underwent MITS and had a CoD attributed from four CHAMPS sites with at least 1 malaria-attributed death. No malaria-attributable deaths were documented among 891 stillbirths or 924 neonatal deaths, therefore this analysis concentrates on the remaining 858 deaths among children aged 1-59 months. Malaria was in the causal chain for 42.9% (126/294) of deaths from Sierra Leone, 31.4% (96/306) in Kenya, 18.2% (36/198) in Mozambique, 6.7% (4/60) in Mali, and 0.3% (1/292) in South Africa. Compared to non-malaria related deaths, malaria-related deaths skewed towards older infants and children (p<0.001), with 71.0% among ages 12-59 months. Malaria was the sole infecting pathogen in 184 (70.2%) of malaria-attributed deaths, whereas bacterial and viral co-infections were identified in the causal pathway in 24·0% and 12.2% of cases, respectively. Malnutrition was found at a similar level in the causal pathway of both malaria (26.7%) and non-malaria (30.7%, p=0.256) deaths. Less than two-thirds (164/262; 62.6%) of malaria deaths had received antimalarials prior to death. Nearly all (98·9%) malaria-related deaths were deemed preventable. INTERPRETATION: Malaria remains a significant cause of childhood mortality in the CHAMPS malaria-endemic sites. The high bacterial co-infection prevalence among malaria deaths underscores the potential benefits of antibiotics for severe malaria patients. Compared to non-malaria deaths, many of malaria-attributed deaths are preventable through accessible malaria control measures. FUNDING: This work was supported by the Bill & Melinda Gates Foundation [OPP1126780]. |
Advancing data science among the federal public health workforce: The data science upskilling program, Centers for Disease Control and Prevention
Bertulfo MCP , Kirkcaldy RD , Franzke LH , Papagari Sangareddy SR , Reza F . J Public Health Manag Pract 2024 30 (2) E41-e46 CONTEXT: Data can guide decision-making to improve the health of communities, but potential for use can only be realized if public health professionals have data science skills. However, not enough public health professionals possess the quantitative data skills to meet growing data science needs, including at the Centers for Disease Control and Prevention (CDC). PROGRAM: The Data Science Upskilling (DSU) program increases data science literacy among staff and fellows working and training at CDC. The DSU program was established in 2019 as a team-based, project-driven, on-the-job applied upskilling program. Learners, within interdisciplinary teams, use curated learning resources to advance their CDC projects. The program has rapidly expanded from upskilling 13 teams of 31 learners during 2019-2020 to upskilling 36 teams of 143 learners during 2022-2023. EVALUATION: All 2022-2023 cohort respondents to the end-of-project survey reported the program increased their data science knowledge. In addition, 90% agreed DSU improved their data science skills, 93% agreed it improved their confidence making data science decisions, and 96% agreed it improved their ability to perform data science work that benefits CDC. DISCUSSION: DSU is an innovative, inclusive, and successful approach to improving data science literacy at CDC. DSU may serve as an upskilling model for other organizations. |
Estimating the ratio of fatal to non-fatal overdoses involving all drugs, all opioids, synthetic opioids, heroin or stimulants, USA, 2010-2020
Casillas SM , Pickens CM , Tanz LJ , Vivolo-Kantor AM . Inj Prev 2024 INTRODUCTION: US drug overdose deaths are at historic levels. For every fatal drug overdose, there are many more non-fatal; however, minimal nationally representative data exist on trends in the ratio of fatal to non-fatal drug overdoses and how this differs by drug type. METHODS: Data from the Centers for Disease Control and Prevention's National Vital Statistics System were used to assess the number of fatal overdoses; data from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample database were used to estimate the number of non-fatal overdoses treated in emergency departments. Counts of fatal and non-fatal overdoses by drug type (all drug, all opioid, synthetic opioid, heroin, stimulant, and opioid and stimulant polysubstance) were calculated from 2010 to 2020 (for non-fatal synthetic opioid-involved overdoses, from 2016 to 2020 only). Trends in overdose counts and the ratio of fatal to non-fatal overdoses were assessed. RESULTS: On average, counts of fatal overdoses increased quarterly among all drug types, and non-fatal overdoses increased among most drug types. Over the 11-year period, the greatest average quarterly percent change (AQPC) in fatal overdose counts was among synthetic opioid-involved overdoses (AQPC: 7.1%; 95% CI: 6.0 to 8.2) and for non-fatal overdoses was among heroin-involved overdoses (AQPC: 4.3%; 95% CI: 3.9 to 4.8). During 2010‒2020, there was approximately 1 fatal overdose per 15 non-fatal. The ratio of fatal to non-fatal drug overdoses increased among every drug type except heroin; ratio increases were driven by greater relative increases in fatal overdoses compared with non-fatal. CONCLUSIONS: Assessment of the ratio of fatal to non-fatal drug overdoses can be used to understand the lethality of different drugs and inform response and prevention efforts. |
Xylazine use among people who inject drugs, Philadelphia 2022
Tan M , Nassau T , Kuncio D , Higgins D , Teixeira da Silva D , Tomlinson D , Brady KA . J Addict Med 2024 OBJECTIVES: Xylazine is commonly mixed with illicit opioids in Philadelphia, and potential associations with wound issues, infectious diseases, and overdoses are of public health concern. We used data from the National HIV Behavioral Surveillance Survey among persons who inject drugs (PWIDs) in Philadelphia to better identify individuals at risk and inform patients and clinicians about xylazine risk factors. METHODS: We compared characteristics of participants who reported using xylazine to those who reported not using xylazine in the past 12 months. Among those who reported xylazine use, we compared characteristics between people who prefer and did not prefer to use xylazine. RESULTS: In this sample of PWIDs, most prefer not to use xylazine, yet use is common. Compared with PWIDs not using xylazine, PWIDs who use xylazine were more likely to have recent homelessness, polysubstance use, overdose history, and hepatitis C virus infection (P < 0.05 for all comparisons). Compared with concordant xylazine use, discordant xylazine use was associated with lower preference for fentanyl, heroin as the primary injection drug, and lower use of syringe service programs (P < 0.05 for all comparisons). CONCLUSIONS: Public health entities should prioritize studying the use and health effects of xylazine in their jurisdictions and consider supporting point-of-care and drug-checking surveillance in addition to raising awareness of xylazine in the drug supply. |
The medications for opioid use disorder study: Methods and initial outcomes from an 18-month study of patients in treatment for opioid use disorder
Dever JA , Hertz MF , Dunlap LJ , Richardson JS , Wolicki SB , Biggers BB , Edlund MJ , Bohm MK , Turcios D , Jiang X , Zhou H , Evans ME , Guy GP Jr . Public Health Rep 2024 333549231222479 OBJECTIVE: Opioid use disorder (OUD) affects approximately 5.6 million people in the United States annually, yet rates of the use of effective medication for OUD (MOUD) treatment are low. We conducted an observational cohort study from August 2017 through May 2021, the MOUD Study, to better understand treatment engagement and factors that may influence treatment experiences and outcomes. In this article, we describe the study design, data collected, and treatment outcomes. METHODS: We recruited adult patients receiving OUD treatment at US outpatient facilities for the MOUD Study. We collected patient-level data at 5 time points (baseline to 18 months) via self-administered questionnaires and health record data. We collected facility-level data via questionnaires administered to facility directors at 2 time points. Across 16 states, 62 OUD treatment facilities participated, and 1974 patients enrolled in the study. We summarized descriptive data on the characteristics of patients and OUD treatment facilities and selected treatment outcomes. RESULTS: Approximately half of the 62 facilities were private, nonprofit organizations; 62% focused primarily on substance use treatment; and 20% also offered mental health services. Most participants were receiving methadone (61%) or buprenorphine (32%) and were predominately non-Hispanic White (68%), aged 25-44 years (62%), and female (54%). Compared with patient-reported estimates at baseline, 18-month estimates suggested that rates of abstinence increased (55% to 77%), and rates of opioid-related overdoses (7% to 2%), emergency department visits (9% to 4%), and arrests (15% to 7%) decreased. CONCLUSIONS: Our results demonstrated the benefits of treatment retention not only on abstinence from opioid use but also on other quality-of-life metrics, with data collected during an extended period. The MOUD Study produced rich, multilevel data that can lay the foundation for an evidence base to inform OUD treatment and support improvement of care and patient outcomes. |
Telemedicine trends and lessons learned during the COVID-19 pandemic-World Trade Center Health Program, 2020-2021
Azofeifa A , Liu R , Dupont H , Reissman DB . Public Health Rep 2024 333549231223143 The World Trade Center (WTC) Health Program, a limited federal health care program for eligible people exposed to the terrorist attacks on September 11, 2001, expanded telemedicine services during the COVID-19 pandemic (2020-2021). We analyzed service use trends from January 2020 through December 2021 to describe how the program implemented telemedicine services. About three-quarters (75%) of telemedicine visits were for mental health-related services. In the second quarter of 2020 (April-June), the number of telemedicine visits per 1000 members (n = 367) increased, exceeding in-person visits (n = 152) by 1.4-fold. The number of telemedicine visits per 1000 members decreased gradually during the rest of the study period but still represented 38% of total visits by the end of 2021. Changes in telemedicine visits were offset by comparable changes for in-person visits, such that the rate of total visits was essentially constant during the study period. Multivariate logistic regression models showed differences in telemedicine visit rates by member type and by demographic characteristics. Survivor members (vs responder members), those self-identified as non-Hispanic Other races (vs non-Hispanic White), those with preferred language not English (vs preferred language English), and those not living in the New York metropolitan area (vs living in the New York metropolitan area) were less likely to use telemedicine. Implementing telemedicine services in the WTC Health Program during the COVID-19 pandemic underscored the importance of extensive collaboration among partners, the capacity to rapidly develop necessary technical guidance, and the flexibility to address frequent regulatory guidance updates in a timely fashion. These lessons learned may guide similar health care providers posed with time-sensitive disruptions of in-person services. |
Case report: Locally acquired leptospirosis in a Minnesota boy and his dog
Thielen BK , Holzbauer S , Templen B , Schafer IJ , Artus A , Galloway R , Ireland M , Femrite T , Schleiss MR . Am J Trop Med Hyg 2024 110 (1) 123-126 Leptospirosis affects numerous animal species, including domestic dogs, but documented transmission to humans is rare. Here, we describe epidemiologically linked cases in a 12-year-old Minnesota boy and his pet dog. While human leptospirosis is often thought of as a disease of tropical locations, this case report describes a rare documented example of local transmission in the northern United States, a region historically not perceived to be at high risk of Leptospira species transmission to humans. This case highlights an unusual presentation, with facial nerve palsy, underappreciated epidemiological risks, and diagnostic challenges of this reemerging infection. |
Francisella tularensis bone and joint infections: United States, 2004-2023
Beeson AM , Baker M , Dell B , Schnitzler H , Oltean HN , Woodall T , Riedo F , Schwartz A , Petersen J , Hinckley AF , Marx GE . Clin Infect Dis 2024 78 S67-s70 Tularemia is caused by the highly infectious bacterium Francisella tularensis, which is recognized as a Tier 1 bioterrorism agent. Tularemia has a range of recognized clinical manifestations, but fewer than 20 bone or joint infections from 6 countries have been reported in the literature to date. This series includes 13 cases of F. tularensis septic arthritis or osteomyelitis in the United States during 2004-2023 and describes exposures, clinical presentation, diagnosis, and outcomes for this rare but severe form of tularemia. Clinicians should consider F. tularensis in patients with compatible exposures or a history of joint replacement or immunosuppression. |
Neuroinvasive Francisella tularensis infection: Report of 2 cases and review of the literature
Cash-Goldwasser S , Beeson A , Marzec N , Ho DY , Hogan CA , Budvytiene I , Banaei N , Born DE , Gephart MH , Patel J , Dietrich EA , Nelson CA . Clin Infect Dis 2024 78 S55-s63 BACKGROUND: Neuroinvasive infection with Francisella tularensis, the causative agent of tularemia, is rare. Establishing clinical suspicion is challenging if risk factors or clinical features classically associated with tularemia are absent. Tularemia is treatable with antibiotics; however, there are limited data to inform management of potentially fatal neuroinvasive infection. METHODS: We collected epidemiologic and clinical data on 2 recent US cases of neuroinvasive F. tularensis infection, and performed a literature review of cases of neuroinvasive F. tularensis infection published after 1950. RESULTS: One patient presented with focal neurologic deficits and brain lesions; broad-range molecular testing on resected brain tissue detected F. tularensis. The other patient presented with meningeal signs; tularemia was suspected based on animal exposure, and F. tularensis grew in cerebrospinal fluid (CSF) culture. Both patients received combination antibiotic therapy and recovered from infection. Among 16 published cases, tularemia was clinically suspected in 4 cases. CSF often displayed lymphocytic pleocytosis. Among cases with available data, CSF culture was positive in 13 of 16 cases, and F. tularensis antibodies were detected in 11 of 11 cases. Treatment typically included an aminoglycoside combined with either a tetracycline or a fluoroquinolone. Outcomes were generally favorable. CONCLUSIONS: Clinicians should consider neuroinvasive F. tularensis infection in patients with meningitis and signs suggestive of tularemia or compatible exposures, lymphocyte-predominant CSF, unrevealing standard microbiologic workup, or lack of response to empiric bacterial meningitis treatment. Molecular testing, culture, and serologic testing can reveal the diagnosis. Favorable outcomes can be achieved with directed antibiotic treatment. |
Systematic review of tularemia during pregnancy
Fleck-Derderian S , Davis KM , Winberg J , Nelson CA , Meaney-Delman D . Clin Infect Dis 2024 78 S47-s54 BACKGROUND: Tularemia is caused by the gram-negative bacterium Francisella tularensis. Although rare, tularemia during pregnancy has been associated with pregnancy complications; data on efficacy of recommended antimicrobials for treatment are limited. We performed a systematic literature review to characterize clinical manifestations of tularemia during pregnancy and examine maternal, fetal, and neonatal outcomes with and without antimicrobial treatment. METHODS: We searched 9 databases, including Medline, Embase, Global Health, and PubMed Central, using terms related to tularemia and pregnancy. Articles reporting cases of tularemia with ≥1 maternal or fetal outcome were included. RESULTS: Of 5891 articles identified, 30 articles describing 52 cases of tularemia in pregnant patients met inclusion criteria. Cases were reported from 9 countries, and oropharyngeal and ulceroglandular tularemia were the most common presenting forms. A plurality (46%) of infections occurred in the second trimester. Six complications were observed: lymph node aspiration, lymph node excision, maternal bleeding, spontaneous abortion, intrauterine fetal demise, and preterm birth. No deaths among mothers were reported. Of 28 patients who received antimicrobial treatment, 1 pregnancy loss and 1 fetal death were reported. Among 24 untreated patients, 1 pregnancy loss and 3 fetal deaths were reported, including one where F. tularensis was detected in placental and fetal tissues. CONCLUSIONS: Pregnancy loss and other complications have been reported among cases of tularemia during pregnancy. However, risk of adverse outcomes may be lower when antimicrobials known to be effective are used. Without treatment, transplacental transmission appears possible. These data underscore the importance of prompt recognition and treatment of tularemia during pregnancy. |
Tularemia: A storied history, an ongoing threat
Nelson CA , Sjöstedt A . Clin Infect Dis 2024 78 S1-s3 |
Systematic review: Clinical features, antimicrobial treatment, and outcomes of human tularemia, 1993-2023
Nelson CA , Winberg J , Bostic TD , Davis KM , Fleck-Derderian S . Clin Infect Dis 2024 78 S15-s28 BACKGROUND: Francisella tularensis, the causative agent of tularemia, is endemic throughout the Northern Hemisphere and requires as few as 10 organisms to cause disease, making this potential bioterrorism agent one of the most infectious bacterial pathogens known. Aminoglycosides, tetracyclines, and, more recently, fluoroquinolones are used for treatment of tularemia; however, data on the relative effectiveness of these and other antimicrobial classes are limited. METHODS: Nine databases, including Medline, Global Health, and Embase, were systematically searched for articles containing terms related to tularemia. Articles with case-level data on tularemia diagnosis, antimicrobial treatment, and patient outcome were included. Patient demographics, clinical findings, antimicrobial administration, and outcome (eg, intubation, fatality) were abstracted using a standardized form. RESULTS: Of the 8878 publications identified and screened, 410 articles describing 870 cases from 1993 to 2023 met inclusion criteria. Cases were reported from 35 countries; more than half were from the United States, Turkey, or Spain. The most common clinical forms were ulceroglandular, oropharyngeal, glandular, and pneumonic disease. Among patients treated with aminoglycosides (n = 452 [52%]), fluoroquinolones (n = 339 [39%]), or tetracyclines (n = 419 [48%]), the fatality rate was 0.7%, 0.9%, and 1.2%, respectively. Patients with pneumonic disease who received ciprofloxacin had no fatalities and the lowest rates of thoracentesis/pleural effusion drainage and intubation compared to those who received aminoglycosides and tetracyclines. CONCLUSIONS: Aminoglycosides, fluoroquinolones, and tetracyclines are effective antimicrobials for treatment of tularemia, regardless of clinical manifestation. For pneumonic disease specifically, ciprofloxacin may have slight advantages compared to other antimicrobials. |
Tularemia clinical manifestations, antimicrobial treatment, and outcomes: An analysis of US surveillance data, 2006-2021
Wu HJ , Bostic TD , Horiuchi K , Kugeler KJ , Mead PS , Nelson CA . Clin Infect Dis 2024 78 S29-s37 BACKGROUND: Tularemia, a potentially fatal zoonosis caused by Francisella tularensis, has been reported from nearly all US states. Information on relative effectiveness of various antimicrobials for treatment of tularemia is limited, particularly for newer classes such as fluoroquinolones. METHODS: Data on clinical manifestations, antimicrobial treatment, and illness outcome of patients with tularemia are provided voluntarily through case report forms to the US Centers for Disease Control and Prevention by state and local health departments. We summarized available demographic and clinical information submitted during 2006-2021 and evaluated survival according to antimicrobial treatment. We grouped administered antimicrobials into those considered effective for treatment of tularemia (aminoglycosides, fluoroquinolones, and tetracyclines) and those with limited efficacy. Logistic regression models with a bias-reduced estimation method were used to evaluate associations between antimicrobial treatment and survival. RESULTS: Case report forms were available for 1163 US patients with tularemia. Francisella tularensis was cultured from a clinical specimen (eg, blood, pleural fluid) in approximately half of patients (592; 50.9%). Nearly three-quarters (853; 73.3%) of patients were treated with a high-efficacy antimicrobial. A total of 27 patients (2.3%) died. After controlling for positive culture as a proxy for illness severity, use of aminoglycosides, fluoroquinolones, and tetracyclines was independently associated with increased odds of survival. CONCLUSIONS: Most US patients with tularemia received high-efficacy antimicrobials; their use was associated with improved odds of survival regardless of antimicrobial class. Our findings provide supportive evidence that fluoroquinolones are an effective option for treatment of tularemia. |
The Brief Case: A traveler's tale-imported scrub typhus in a child returning from Bangladesh
Sultana R , Tiwari M , Gleaton AN , Ramos CJ , Paddock CD , Bianchi-Hayes J , Handel AS . J Clin Microbiol 2023 61 (12) |
Dengue
Paz-Bailey G , Adams LE , Deen J , Anderson KB , Katzelnick LC . Lancet 2024 Dengue, caused by four closely related viruses, is a growing global public health concern, with outbreaks capable of overwhelming health-care systems and disrupting economies. Dengue is endemic in more than 100 countries across tropical and subtropical regions worldwide, and the expanding range of the mosquito vector, affected in part by climate change, increases risk in new areas such as Spain, Portugal, and the southern USA, while emerging evidence points to silent epidemics in Africa. Substantial advances in our understanding of the virus, immune responses, and disease progression have been made within the past decade. Novel interventions have emerged, including partially effective vaccines and innovative mosquito control strategies, although a reliable immune correlate of protection remains a challenge for the assessment of vaccines. These developments mark the beginning of a new era in dengue prevention and control, offering promise in addressing this pressing global health issue. |
2020 Ebola virus disease outbreak in Équateur Province, Democratic Republic of the Congo: a retrospective genomic characterisation
Kinganda-Lusamaki E , Whitmer S , Lokilo-Lofiko E , Amuri-Aziza A , Muyembe-Mawete F , Makangara-Cigolo JC , Makaya G , Mbuyi F , Whitesell A , Kallay R , Choi M , Pratt C , Mukadi-Bamuleka D , Kavunga-Membo H , Matondo-Kuamfumu M , Mambu-Mbika F , Ekila-Ifinji R , Shoemaker T , Stewart M , Eng J , Rajan A , Soke GN , Fonjungo PN , Otshudiema JO , Folefack GLT , Pukuta-Simbu E , Talundzic E , Shedroff E , Bokete JL , Legand A , Formenty P , Mores CN , Porzucek AJ , Tritsch SR , Kombe J , Tshapenda G , Mulangu F , Ayouba A , Delaporte E , Peeters M , Wiley MR , Montgomery JM , Klena JD , Muyembe-Tamfum JJ , Ahuka-Mundeke S , Mbala-Kingebeni P . Lancet Microbe 2024 BACKGROUND: The Democratic Republic of the Congo has had 15 Ebola virus disease (EVD) outbreaks, from 1976 to 2023. On June 1, 2020, the Democratic Republic of the Congo declared an outbreak of EVD in the western Équateur Province (11th outbreak), proximal to the 2018 Tumba and Bikoro outbreak and concurrent with an outbreak in the eastern Nord Kivu Province. In this Article, we assessed whether the 11th outbreak was genetically related to previous or concurrent EVD outbreaks and connected available epidemiological and genetic data to identify sources of possible zoonotic spillover, uncover additional unreported cases of nosocomial transmission, and provide a deeper investigation into the 11th outbreak. METHODS: We analysed epidemiological factors from the 11th EVD outbreak to identify patient characteristics, epidemiological links, and transmission modes to explore virus spread through space, time, and age groups in the Équateur Province, Democratic Republic of the Congo. Trained field investigators and health professionals recorded data on suspected, probable, and confirmed cases, including demographic characteristics, possible exposures, symptom onset and signs and symptoms, and potentially exposed contacts. We used blood samples from individuals who were live suspected cases and oral swabs from individuals who were deceased to diagnose EVD. We applied whole-genome sequencing of 87 available Ebola virus genomes (from 130 individuals with EVD between May 19 and Sept 16, 2020), phylogenetic divergence versus time, and Bayesian reconstruction of phylogenetic trees to calculate viral substitution rates and study viral evolution. We linked the available epidemiological and genetic datasets to conduct a genomic and epidemiological study of the 11th EVD outbreak. FINDINGS: Between May 19 and Sept 16, 2020, 130 EVD (119 confirmed and 11 probable) cases were reported across 13 Équateur Province health zones. The individual identified as the index case reported frequent consumption of bat meat, suggesting the outbreak started due to zoonotic spillover. Sequencing revealed two circulating Ebola virus variants associated with this outbreak-a Mbandaka variant associated with the majority (97%) of cases and a Tumba-like variant with similarity to the ninth EVD outbreak in 2018. The Tumba-like variant exhibited a reduced substitution rate, suggesting transmission from a previous survivor of EVD. INTERPRETATION: Integrating genetic and epidemiological data allowed for investigative fact-checking and verified patient-reported sources of possible zoonotic spillover. These results demonstrate that rapid genetic sequencing combined with epidemiological data can inform responders of the mechanisms of viral spread, uncover novel transmission modes, and provide a deeper understanding of the outbreak, which is ultimately needed for infection prevention and control during outbreaks. FUNDING: WHO and US Centers for Disease Control and Prevention. |
Content Index (Achived Edition)
- Antimicrobial Resistance and Antibiotic Stewardship
- Chronic Diseases and Conditions
- Communicable Diseases
- Community Health Services
- Disaster Preparedness and Emergency Services
- Environmental Health
- Food Safety
- Genetics and Genomics
- Global Health
- Health Economics
- Health Equity and Health Disparities
- Healthcare Associated Infections
- Immunity and Immunization
- Informatics
- Injury and Violence
- Laboratory Sciences
- Maternal and Child Health
- Occupational Safety and Health
- Parasitic Diseases
- Public Health Leadership and Management
- Substance Use and Abuse
- Telehealth and Telemedicine
- Zoonotic and Vectorborne Diseases
About
CDC Science Clips is an online, continuously updated, searchable database of scientific literature published by CDC authors. Each article features an Altmetric Attention Score to track social and mainstream media mentions. If you are aware of a CDC-authored publication that does not appear in this database, please let us know.
- Page last reviewed:Feb 1, 2024
- Page last updated:Apr 29, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure