The increasing threat from infection with drug-resistant pathogens is among the most serious public health challenges of our time. Formed by Wellcome in 2018, the Surveillance and Epidemiology of Drug-Resistant Infections Consortium (SEDRIC) is an international think tank whose aim is to inform policy and change the way countries track, share, and analyse data relating to drug-resistant infections, by defining knowledge gaps and identifying barriers to the delivery of global surveillance. SEDRIC delivers its aims through discussions and analyses by world-leading scientists that result in recommendations and advocacy to Wellcome and others. As a result, SEDRIC has made key contributions in furthering global and national actions. Here, we look back at the work of the consortium between 2018-2024, highlighting notable successes. We provide specific examples where technical analyses and recommendations have helped to inform policy and funding priorities that will have real-world impact on the surveillance and epidemiology of infections with drug-resistant pathogens. | The increasing threat from infections that cannot be treated with medicines, so called drug resistant infections, is among the most serious public health challenges of our time. Formed by Wellcome in 2018, the Surveillance and Epidemiology of Drug-Resistant Infections Consortium (SEDRIC) is an international think tank whose aim is to inform policy and change the way countries track, share, and analyse data relating to drug-resistant infections, by defining knowledge gaps and identifying barriers to the delivery of global surveillance. SEDRIC delivers its aims through discussions and analyses by world-leading scientists that result in recommendations and advocacy to Wellcome and others. As a result, SEDRIC has made key contributions in furthering global and national actions. Here, we look back at the work of the consortium between 2018-2024, highlighting notable successes. We provide specific examples where technical analyses and recommendations have helped to inform policy and funding priorities that will have real-world impact on the surveillance and of infections with pathogens that are becoming difficult or impossible to treat. | eng

During 2023-2024, highly pathogenic avian influenza A(H5N1) viruses from clade 2.3.2.1c caused human infections in Cambodia and from clade 2.3.4.4b caused human infections in the Americas. We assessed the susceptibility of those viruses to approved and investigational antiviral drugs. Except for 2 viruses isolated from Cambodia, all viruses were susceptible to M2 ion channel-blockers in cell culture-based assays. In the neuraminidase inhibition assay, all viruses displayed susceptibility to neuraminidase inhibitor antiviral drugs oseltamivir, zanamivir, peramivir, laninamivir, and AV5080. Oseltamivir was ≈4-fold less potent at inhibiting the neuraminidase activity of clade 2.3.4.4b than clade 2.3.2.1c viruses. All viruses were susceptible to polymerase inhibitors baloxavir and tivoxavir and to polymerase basic 2 inhibitor pimodivir with 50% effective concentrations in low nanomolar ranges. Because drug-resistant viruses can emerge spontaneously or by reassortment, close monitoring of antiviral susceptibility of H5N1 viruses collected from animals and humans by using sequence-based analysis supplemented with phenotypic testing is essential.

This study examined variation in county-level cardiovascular disease (CVD) death rates among adults aged 35-64 years using four measures of rural-urban status: Urban Influence Codes, Rural-Urban Continuum Codes (RUCC), National Center for Health Statistics Urban-Rural Classification Scheme, and Core-Based Statistical Areas. We estimated 2021 CVD death rates and used Poisson regression models to calculate rate ratios (RR) for full and dichotomized rural-urban measures. All measures identified the largest RR in the middle of the rural-urban spectrum. RUCC demonstrated patterns by population size and adjacency. RR magnitude varied across dichotomization methods. These findings demonstrate complexity underlying rural-urban differences and can guide public health practice.

INTRODUCTION: The association between various disparity factors and cardiovascular disease (CVD) prevalence among older US adults with diabetes has not been comprehensively explored. We examined disparities in CVD prevalence among Medicare beneficiaries with diabetes. METHODS: Data were from the 2015-2019 Medicare Current Beneficiary Survey. Diabetes and CVD conditions - myocardial infarction (MI), stroke, and heart failure - were self-reported. We estimated the adjusted prevalence ratios (APRs) of CVD by race and ethnicity, education, income-to-poverty ratio (IPR), urbanicity, food insecurity, and social vulnerability using logistic regressions that controlled for these factors as well as age and sex. RESULTS: Annually, an estimated 9.2 million Medicare beneficiaries aged 65 years or older had diabetes. Among them, 16.7% had MI, 13.7% had stroke, and 12.5% had heart failure. Beneficiaries who were food insecure, socially vulnerable, with an IPR less than or equal to 135%, and residing in rural areas had a higher crude CVD prevalence. After controlling for other factors, low IPR and food insecurity were linked to a higher prevalence of CVD. Hispanic beneficiaries had lower stroke and heart failure prevalence than non-Hispanic (NH) White and NH Black beneficiaries. NH Black beneficiaries had lower MI prevalence but higher heart failure prevalence compared with NH White beneficiaries. Female respondents with an IPR less than or equal to 135% had higher MI and stroke prevalence; this was not seen in male respondents. CONCLUSION: Low IPR and food insecurity were associated with higher MI, stroke, and heart failure prevalence among Medicare beneficiaries with diabetes. Our findings can inform targeted interventions to reduce CVD disparities in these populations.

OBJECTIVES: After respiratory syncytial virus (RSV), human metapneumovirus (hMPV) was the second-ranked pathogen attributed to severe pneumonia in the PERCH study. We sought to characterize hMPV-positive cases in high-burden settings, which have limited data, by comparing with RSV-positive and other cases. METHODS: Children aged 1-59 months hospitalized with suspected severe pneumonia and age/season-matched community controls in seven African and Asian countries had nasopharyngeal/oropharyngeal swabs tested by multiplex PCR for 32 respiratory pathogens, among other clinical and lab assessments at admission. Odds ratios adjusted for age and site (adjusted OR [aOR]) were calculated using logistic regression. Aetiologic probability was estimated using Bayesian nested partial latent class analysis. Latent class analysis identified syndromic constellations of clinical characteristics. RESULTS: hMPV was detected more frequently among cases (267/3887, 6.9%) than controls (115/4976, 2.3%), among cases with pneumonia chest X-ray findings (8.5%) than without (5.5%), and among controls with respiratory tract illness (3.8%) than without (1.8%; all p ≤ 0.001). HMPV-positive cases were negatively associated with the detection of other viruses (aOR, 0.18), especially RSV (aOR, 0.11; all p < 0.0001), and positively associated with the detection of bacteria (aORs, 1.77; p 0.03). No single clinical syndrome distinguished hMPV-positive from other cases. Among hMPV-positive cases, 65.2% were aged <1 year and 27.5% had pneumonia danger signs; positive predictive value for hMPV aetiology was 74.5%; mortality was 3.9%, similar to RSV-positive (2.4%) and lower than that among other cases (9.6%). DISCUSSION: HMPV-associated severe paediatric pneumonia in high-burden settings was predominantly in young infants and clinically indistinguishable from RSV. HMPV-positives had low case fatality, similar to that in RSV-positives.

Seroprevalence studies play an important role in estimating the number of children infected with SARS-CoV-2. We report SARS-CoV-2 seroprevalence in children seeking medical care for any reason at a free-standing pediatric hospital in Seattle, WA over a 2.5-year period and four distinct pandemic waves. We randomly selected residual serum samples from children and young adults seeking medical care as inpatients and outpatients at Seattle Children's Hospital between June 2020 and December 2022 to test for the presence of anti-nucleocapsid (N) antibodies. Samples were categorized into four distinct pandemic waves based on Washington State epidemiology: Wave 1 (June 2020-October 2020), Wave 2 (November 2020-June 2021), Wave 3 (July 2021-November 2021), and Wave 4 (December 2021-December 2022). Patient characteristics and COVID-19 vaccine status were obtained, and zip codes were used to ascertain the Social Vulnerability Index (SVI). Multivariable Poisson regression models with robust variance estimates were used to examine the relationship between patient characteristics and anti-N-positivity for each wave. Among 8,040 samples from 7,102 patients included in the analyses, seroprevalence rose from 2.4% (95% CI, 2.0%-3.1%) in Wave 1 to 25.5% (95% CI 23.3%-27.8%) in Wave 4 (following the Omicron surge). High SVI, Hispanic ethnicity, or use of government insurance was associated with increased anti-N positivity in most waves. We observed a steady increase in anti-N seroprevalence followed by a sharp increase after the Omicron surge in early 2022. Our data demonstrate the burden of COVID-19 on specific groups with health disparities within our region throughout the pandemic.IMPORTANCEOur results highlight the importance of seropositivity studies as essential tools to provide information on the incidence and prevalence of SARS-CoV-2 seropositivity. Our results also reinforce other reports demonstrating the inequitable burden of COVID-19 on groups with health disparities and that this inequitable burden continued to persist throughout the pandemic, even in a region with high adherence to COVID-19 mitigation efforts. It also highlights SVI's value in identifying communities that must be part of pandemic research, and public health and vaccination strategies.

We used statewide surveillance data to describe the epidemiology of invasive Haemophilus influenzae type a (Hia) disease in Alaska during 2018-2022. Of 52 cases identified, 39 (75%) occurred among Alaska Native children aged <5 years who lived in rural areas of southwest or northern Alaska. Average annual incidence was 17.8 per 100,000 among children aged <5 years compared to 0.3 per 100,000 among persons aged ≥5 years. Among 43 cases in children aged <5 years, 16 (37%) presented with meningitis and 6 (14%) died. Characterizing Hia disease epidemiology can help direct prevention strategies, including vaccine development and use.

BACKGROUND: The U.S.'s National HIV/AIDS Strategy (NHAS) prioritizes improving QoL among people with HIV (PWH) but co-occurrence of different aspects of QoL is not well described. We developed and applied a novel, multi-item assessment of poor quality of life (QoL) among PWH, and examined associations with selected outcomes. SETTING: 2018-2021 CDC Medical Monitoring Project data on 15,855 U.S. PWH. METHODS: The poor QoL index, measured by the number of indicators of poor QoL experienced included: poor/fair self-rated health, unmet needs for mental health services, and subsistence needs (hunger/food insecurity, unstable housing/homelessness, unemployment). Score distributions were analyzed alongside data on individual QoL indicators. Associations with selected adverse outcomes were assessed, including not being retained in care, missing ≥1 HIV medical appointments, missing ≥1 ART dose, not having sustained viral suppression, and having ≥1 emergency room visit or ≥1 hospitalization. RESULTS: Overall, 55.1% of PWH had ≥1 indicator of poor QoL; 8.4% had ≥3 indicators. Over a quarter (26.5%) of people who inject drugs experienced ≥3 indicators of poor QoL. A large percentage of people aged 18-24 years and transgender women had subsistence needs; 36.4% of cisgender Black women had poor/fair self-rated health. After adjusting for age, race/ethnicity, and gender, higher poor QoL index scores-and each indicator of poor QoL-were associated with worse outcomes. CONCLUSIONS: We demonstrated the utility in using the poor QoL index to identify those at higher risk of experiencing health challenges. Expanding national recommendations to include this QoL assessment could help in meeting NHAS goals for improving PWH's well-being.

During 2018-2022, a resurgence of hepatitis A occurred in Florida, with 5,491 cases reported. Genotyping was performed on a convenience sample of cases through amplification and sequencing of the HAV VP1-P2B junction region. Virus isolates from 1,190 (22%) cases were genotyped; 69% were subgenotype IB, 30% were subgenotype IA, and 1% were subgenotype IIIA. Subgenotype IB was more common among cases reporting recent drug use or homelessness, whereas IA was more common among those reporting recent international travel and among men who have sex with men. Genotype IB infection was associated with a more than 4-fold greater odds of death compared to IA infection. A network analysis revealed 11 genomic clusters of 10 or more cases, with distinct temporal and spatial distributions. Case reports in 2023 decreased to below pre-2018 numbers, likely due to high population immunity following natural infection and extensive vaccination activities in the highest risk groups.

The effect of preexisting neutralizing antibodies (NAb) on SARS-CoV-2 shedding in postvaccination infection (PVI) is not well understood. We characterized viral shedding longitudinally in nasal specimens in relation to baseline (pre/periinfection) serum NAb titers in 125 participants infected with SARS-CoV-2 variants. Among 68 vaccinated participants, we quantified the effect of baseline NAb titers on maximum viral RNA titers and infectivity duration. Baseline NAbs were higher and targeted a broader range of variants in participants with monovalent ancestral booster vaccinations compared with those with a primary vaccine series. In Delta infections, baseline NAb titers targeting Delta or Wuhan-Hu-1 correlated negatively with maximum viral RNA. Per log10 increase in Delta-targeting baseline NAb IC50, maximum viral load was reduced -2.43 (95% CI: -3.76, -1.11) log10 nucleocapsid copies, and infectious viral shedding was reduced -2.79 (95% CI: -4.99, -0.60) days. Conversely, in Omicron infections (BA.1, BA.2, BA.4, or BA.5), baseline NAb titers against Omicron lineages or Wuhan-Hu-1 did not predict viral outcomes. Our results provide robust estimates of the effect of baseline NAbs on the magnitude and duration of nasal viral replication after PVI (albeit with an unclear effect on transmission) and show how immune escape variants efficiently evade these modulating effects.

BACKGROUND: Persistent trachoma is increasingly recognized as a serious concern for the global trachoma program. Persistent trachoma is defined as those districts that have had two or more trachoma impact surveys in which the trachomatous inflammation-follicular (TF) prevalence has never been <5%, the elimination threshold for TF. Enhanced tools such as infection and serological monitoring elucidate long-term transmission patterns within persistent districts. This study aimed to clarify trachoma intensity via both traditional indicators and Chlamydia trachomatis (Ct) infection and serologic markers in four districts experiencing persistent trachoma with >10 years of interventions. METHODOLOGY: Population-based surveys were conducted in 2019 in four trachoma persistent districts. Children ages 1-9 years were examined for trachoma clinical signs and children 1-5 years were swabbed for Ct infection. Antibodies to the trachoma antigens Pgp3 and CT694 were measured for all individuals ≥1 year, assessed by multiplex bead assay. Seroconversion rates (SCRs) to both antigens were estimated for children and for individuals of all ages. RESULTS: One district, Ebinat, remained highly endemic, with a TF prevalence and infection prevalence (ages 1-5 years) of 42.5% and 7.1% respectively. Indicators were lower in the other three districts ranging from 10.7%-17.9% TF and 0%-1.7% infection. The Pgp3 SCR among children ages 1-9 years was considerably higher in Ebinat with 10.8 seroconversions per 100 child-years, (95% Confidence Interval [CI]: 8.2, 14.4) compared to the other three districts (SCR range: 0.9-3.9). All-age Pgp3 SCR estimates detected a significant decline in seroprevalence in Machakel district at approximately 12 years prior to 2019. CONCLUSIONS: Infection and serology may be useful tools for clarifying transmission, particularly among persistent districts, and ongoing interventions likely helped push these hyperendemic districts towards the elimination threshold. However, districts such as Ebinat may require more intense interventions to reach elimination within acceptable timelines.

This case series investigates trends in time from onset of alpha-gal syndrome to diagnosis among patients with disease onset from 1977 to 2019. | eng

OBJECTIVES:  This study aimed to demonstrate real-world use of the Making Electronic Data More Available for Research and Public Health (MedMorph) Reference Architecture (RA) for automated exchange of hepatitis C-related data for public health surveillance and research using Fast Healthcare Interoperability Resources (FHIR). METHODS:  Pilot participants included a public health authority (PHA), research organization (RO), clinical sites, and electronic health record (EHR) vendors. The RA was tested for hepatitis C public health surveillance and research data exchange. A mixed methods evaluation used multiple data sources to assess impact of the RA compared with usual methods. RESULTS:  After implementation of the RA components, there was no burden on clinical staff to report data for public health surveillance or research purposes. Data were successfully transferred and passed from EHR to PHA and RO, which revealed the value of receiving clinical data in addition to laboratory data via electronic laboratory reporting for the PHA and limitations in the Bulk FHIR standard. CONCLUSION:  Initial results indicate potential for long-term reduction of level of effort of reporting while improving the availability and completeness of clinical data for public health surveillance and research. Using a FHIR-based approach that aligns with regulatory health information technology certification requirements and existing infrastructure may reduce implementation burden. The MedMorph approach can enhance public health surveillance and research, resulting in improved data completeness and reduced reporting burden through automated data exchange using industry standards. MedMorph will continue to inform Centers for Disease Control and Prevention's Public Health Data Strategy, which provides the agency's direction for data modernization.

<sec><title>BACKGROUND</title>Chemotherapy to prevent TB is a core component of care for persons living with HIV (PLHIV). There are few reports describing adherence to TB prevention under programmatic conditions in high TB burden settings.</sec><sec><title>METHODS</title>We measured adherence to daily isoniazid (INH) preventive treatment (IPT) using a commercially available colourimetric assay to detect urine INH metabolites among PLHIV who self-reported INH ingestion within the preceding 24 h. Enrollee characteristics associated with non-adherence despite self-reported INH ingestion were identified in multivariate log-binomial regression. Interoperator reliability for the detection of INH metabolites was calculated among three independent operators.</sec><sec><title>RESULTS</title>Self-reported INH ingestion and metabolite data were known for 300 PLHIV. INH metabolite was detected in 112 (68.7%) of 163 PLHIV who self-reported INH ingestion in the preceding 24 h. The prevalence of alcohol consumption was significantly higher among INH-non-adherent PLHIV compared with INH-adherent PLHIV (adjusted prevalence ratio 2.43, 95% CI 1.16-5.12). Two-way interoperator reliability ranged from κ 0.86 to κ 0.94.</sec><sec><title>CONCLUSIONS</title>Compared with self-reported 24-h INH ingestion in a high TB-HIV-incidence programmatic setting, biometric adherence to IPT was suboptimal in this sample of PLHIV. Alcohol consumption was the only potentially modifiable risk factor significantly associated with INH non-adherence. Colourimetric interpretation reliability across three operators was moderate/strong.</sec>.

BACKGROUND: In October 2022, the Uganda Ministry of Health (MoH) confirmed the first case of a Sudan Virus Disease (SVD) outbreak in the Kampala Metropolitan area (KMA). A multicomponent infection prevention and control (IPC) strategy was implemented to control the spread of Orthoebolavirus sudanense (SUDV) in KMA. We describe the deployment of this strategy, its effect on IPC capacities, and the successful control of the SVD outbreak in KMA during the 2022 outbreak. METHODOLOGY: The multicomponent IPC strategy included (1) IPC pillar coordination: an IPC task force convened by government and health partner representatives and designated focal persons at the district level (2) Ring IPC: intense and targeted IPC support was developed to provide support to healthcare facilities (HCFs) and communities around each confirmed case, (3) IPC in HCFs: HCFs were assessed using a modified WHO SVD IPC scorecard rapid assessment tool that measured 15 IPC capacity domains, mentorship and IPC supplies were provided to HCFs with low scores on the rapid assessment. RESULTS: A KMA task force was established, and 13 IPC Rings were activated; 790 HCFs were assessed for IPC readiness, and 2,235 healthcare workers (HCWs) were trained. The mean (± standard-deviation) IPC score was 59.2% (± 18.6%) at baseline and increased to 65.5% (± 14.7%) at follow-up after 2 weeks (p < 0.001) of support. The mean IPC scores at baseline were lowest for primary HCFs (57%) and private-for-profit HCFs (47.1%). Similar gaps were revealed across all HCFs, with eight out of 15 (53.3%) IPC capacity areas assessed, resulting in scores < 50% at baseline. At follow-up, only four out of 15 (26.7%) capacity areas (26.7%) were below this threshold. CONCLUSION: The IPC strategy enhanced the IPC capacities at HCFs and could be adopted for future outbreaks. Leadership commitment and resource allocation to IPC during non-outbreak periods are critical for preparedness, rapid response, and access to safe care.

Conducting persistence studies of infectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on environmental surfaces may require a biosafety level 3 (BSL-3) laboratory. We aimed to compare the environmental persistence of BSL-2 level human coronaviruses (229E, NL63, and OC43) and bovine coronavirus (BoCoV) with three SARS-CoV-2 variants (WA-1, Delta, and Omicron). OC43 (1.8 TCID(50)/mL) and BoCoV (1.0 TCID(50)/mL) had lower detection thresholds in cell culture assays compared to 229E (150 TCID(50)/mL) and NL63 (2,670 TCID(50)/mL) and were used for persistence tests at room temperature. Viable OC43 became undetectable (>5.2log(10)) after 48 hours on stainless steel and plastic coupons but exhibited extended persistence up to 72 hours on touchscreen glass coupons. In contrast, BoCoV remained viable for up to 120 hours with <1.8 log(10) infectivity loss. Both OC43 and BoCoV showed a reduction of >5 log(10) on vinyl coupons after 48 hours. On stainless steel coupons, the viability of all three SARS-CoV-2 variants became undetectable (>2.3 log(10) reduction) after 48 hours, with minor differences in reduction levels at 24 hours, whereas on touchscreen glass coupons, the viable virus could be detected for up to 48 hours for WA-1 and Omicron and 72 hours for the Delta variant. Regardless of coupon or virus type, viral RNA titers increased <4.5 Ct values after 120 hours. Our data demonstrate distinct persistence characteristics between BoCoV and OC43, with neither fully mimicking SARS-CoV-2 variants. This variability along with the impact of surface types on viral persistence underscores the need for caution when using these viruses as surrogates for SARS-CoV-2.IMPORTANCEIn this study, we evaluated three human seasonal coronaviruses (OC43, NL63, and 229E) and one bovine coronavirus (BoCoV) as potential surrogate viruses for SARS-CoV-2. Our data suggest that among the four surrogate viruses tested, OC43 and BoCoV were the most promising candidates due to their assay sensitivity, ease of handling, and high genetic similarity to SARS-CoV-2. However, neither BoCoV nor OC43 fully mimicked the environmental persistence characteristics of SARS-CoV-2 variants highlighting the potential limitations of using surrogate viruses.

American Indian (AI) communities in the Southwest have a high burden of invasive pneumococcal disease (IPD) and COVID-19. Through laboratory-based surveillance, the impact of the pandemic on IPD incidence and serotype distribution was evaluated in two AI communities. IPD rates were lower during the pandemic (21.8 vs. 39.0/100 000 pre-pandemic). Rates increased in 2021 compared to 2020 but not to pre-pandemic levels. Cases with SARS-CoV-2 co-infection had a higher case fatality rate (45.2% vs. 17.6% without co-infection). No significant change in serotype distribution was observed. Continued surveillance in these communities is critical to understand the changing IPD burden as the pandemic evolves.

People who inject drugs (PWID) account for the majority of hepatitis C virus (HCV) infections in the United States. The injection-equipment-sharing network likely plays an important role in shaping the dynamics of HCV transmission. Recognizing the emerging HCV epidemic in rural communities, we developed an agent-based network simulation model of HCV transmission via injection-equipment-sharing and used data on rural PWID networks to inform model parameterization and calibration. We then simulated an array of networks that varied key network properties to understand their impact on the magnitude and distribution of HCV incidence. The results show substantial heterogeneity in HCV acquisition risks across the network, summarized using the Ghyaini coefficient. In addition, although PWID with fewer injection partners had lower incidence, they collectively acquired more infections due to their larger population size. Higher prevalence, average number of partners, and homophily in HCV infection were associated with lower heterogeneity in infection risk across the network and higher overall incidence; other network properties including population size did not have a substantial impact. Our findings illustrate the heterogeneity of HCV transmission among PWID and suggest key network properties that could be measured, evaluated, or considered in the design of interventions for PWID in future studies.

Objectives This report describes the development and operations of the 2016 National Culturally and Linguistically Appropriate Services Survey for Office-based Physicians (National CLAS Physician Survey). The survey was developed to understand awareness, adoption, and implementation of the National CLAS Standards in health and health care among office-based physicians. Methods Survey development included a literature review of survey and assessment instruments that evaluated cultural and linguistic appropriateness in health care. Survey questions were pretested during a cognitive interview study of 20 office-based physicians in the District of Columbia metropolitan area. The cognitive interviews were analyzed using a grounded theory approach. The final survey was administered via web, mail, and computer-assisted telephone interview to 2, 400 sampled physicians between August 2016 and December 2016. A nonresponse bias assessment was conducted. Results The literature review identified five survey and assessment instruments. Collectively, survey content included: cultural competency training, cultural awareness, and adoption of the National CLAS Standards. Cognitive interviews showed respondent difficulty in question interpretation and survey completion of some items. Survey revisions addressed these issues. The final overall weighted survey response rate was 33.8%. Final weights produced a lower standardized bias than base weights. Conclusions The National CLAS Physician Survey is the first nationally representative survey to describe the use and implementation of culturally and linguistically appropriate services by office-based physicians. Data can serve as a baseline for future studies and as a benchmark for meeting the key objectives of the National CLAS Standards. © 2025, null. All rights reserved.

OBJECTIVES: To identify associations between perceived neighborhood walkability and sleep across racial and ethnic groups of US adults. METHODS: Data from the 2020 National Health Interview Survey (N=27,521) were used to assess self-reported measures of walkability (pedestrian access, accessible amenities, unsafe walking conditions) and sleep (short and long duration; frequency of waking up unrested, trouble falling and staying asleep, sleep medication use). Stratified by racial and ethnic group, we calculated the age-adjusted prevalence of neighborhood walkability features and sleep measures and estimated prevalence ratios assessing associations between neighborhood walkability and sleep while adjusting for sociodemographic and health covariates. RESULTS: The prevalence of unsafe walking conditions due to crime was lowest among non-Hispanic White adults (6.9%), and access to places to relax was lowest among non-Hispanic Black adults (72.5%). The prevalence of short sleep duration was highest among non-Hispanic Black adults (37.9%). Neighborhood environment features had differential associations with sleep when stratified by race and ethnicity. For example, walking path access was related to lower sleep medication use among non-Hispanic Asian adults (adjusted prevalence ratio (aPR): 0.42, 95% CI: 0.19-0.91) but greater use among non-Hispanic White adults (aPR: 1.24, 95% CI: 1.05-1.46). More associations were observed among non-Hispanic White adults than other groups; and the strongest magnitude of association was observed among non-Hispanic Asian adults (traffic and sleep medication aPR: 0.31, 95% CI: 0.12-0.84). CONCLUSIONS: Associations between the neighborhood environment and sleep vary and may be inconsistent by race and ethnicity. Future research may help identify determinants.

OBJECTIVE: The objective of this study was to evaluate associations of early-pregnancy plasma per- and polyfluoroalkyl substances (PFAS) with maternal post-pregnancy weight trajectory parameters. METHODS: We studied 1106 Project Viva participants with measures of early-pregnancy plasma concentrations of eight PFAS. We measured weight at in-person visits at 6 months and 3, 7, and 12 years after pregnancy and collected self-reported weight via annual questionnaires up to 17 years after pregnancy. Weight trajectory parameters were estimated via the Superimposition by Translation and Rotation model. We assessed individual and joint effects of PFAS with trajectory parameters using linear regression and Bayesian kernel machine regression (BKMR). RESULTS: Perfluorooctane sulfonate (PFOS) concentrations were positively associated with weight trajectory magnitude in both linear regression (0.8 kg [95% CI: 0.1 to 1.4] per doubling of PFOS) and BKMR analyses (2.6 kg [95% CI: 1.4 to 3.8] per increase from 25th to 75th percentile of PFOS concentrations). Conversely, in BKMR analyses, perfluorononanoate was negatively associated with trajectory magnitude (-2.0 kg [95% CI: -2.9 to -1.1]). In stratified linear regression, older-aged participants had more pronounced positive associations of PFOS, perfluorooctanoate, and 2-(N-ethyl-perfluorooctane sulfonamido) acetate with weight trajectory velocity. No associations were observed with the overall PFAS mixture. CONCLUSIONS: Select PFAS, assessed in pregnancy, may affect maternal weight trajectories spanning 17 years after pregnancy, especially for older-aged individuals.

This study investigated the potential pulmonary toxicity of polycarbonate (PC) emissions from fused filament fabrication (FFF) three-dimensional printing (3DP) via inhalation in Sprague Dawley rats. Previously, our results demonstrated no significant pulmonary effects following exposure to a 0.5 mg/m(3) PC. A new exposure apparatus was developed that exposed animals at a concentration of 2.5 mg/m(3). Sixty rats were randomized into control (filtered air) and exposure groups (n = 30/group). Each group was further divided into five subgroups (n = 6/subgroup) with exposure durations of 1, 4, 8, 15, or 30 days (4 hr/day, 4 days/week). Following a 24-hr post-exposure period, body weight was measured, and blood samples were collected for hematological and biochemical analysis. Bronchoalveolar lavage fluid (BALF) was obtained from the right lung for cytology. The left lung and head/nasal tissues were preserved for histopathological evaluation. Lung deposition was estimated using the Multiple-Path Particle Dosimetry model, electron microscopy, and enhanced darkfield microscopy. In addition, filter samples were collected to measure bisphenol A. Exposure resulted in an estimated deposition of 0.28 µg/day within the alveoli and small airways. Microscopy indicated limited evidence of macrophage uptake. No significant changes were observed in BALF cell counts, lactate dehydrogenase activity, or hematological parameters. BALF levels of tissue inhibitor of metalloproteinases-1 and protein were elevated in the 30-day exposure group, although histopathology revealed no exposure-related changes in the lungs. In conclusion, this study found no marked pulmonary inflammation or toxicity in rats exposed to 2.5 mg/m(3) of PC 3D printing emissions for up to 30 days (4 hr/day).

BACKGROUND: To demonstrate the application and utility of geostatistical modelling to provide comprehensive high-resolution understanding of the population's protective immunity during a pandemic and identify pockets with sub-optimal protection. METHODS: Using data from a national cross-sectional household survey of 6620 individuals in the Dominican Republic (DR) from June to October 2021, we developed and applied geostatistical regression models to estimate and predict Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spike (anti-S) antibodies (Ab) seroprevalence at high resolution (1 km) across heterogeneous areas. RESULTS: Spatial patterns in population immunity to SARS-CoV-2 varied across the DR. In urban areas, a one-unit increase in the number of primary healthcare units per population and 1% increase in the proportion of the population aged under 20 years were associated with higher odds ratios of being anti-S Ab positive of 1.38 (95% confidence interval [CI]: 1.35-1.39) and 1.35 (95% CI: 1.32-1.33), respectively. In rural areas, higher odds of anti-S Ab positivity, 1.45 (95% CI: 1.39-1.51), were observed with increasing temperature in the hottest month (per°C), and 1.51 (95% CI: 1.43-1.60) with increasing precipitation in the wettest month (per mm). CONCLUSIONS: A geostatistical model that integrates contextually important socioeconomic and environmental factors can be used to create robust and reliable predictive maps of immune protection during a pandemic at high spatial resolution and will assist in the identification of highly vulnerable areas.

Early in the 2022 mpox outbreak, the U.S. recommendation was to administer two doses of the JYNNEOS® vaccine 4 weeks apart. However, because of limited vaccine supply, New York City (NYC) prioritized single dose vaccination. We estimated mpox cases averted by this strategy compared to strategies that prioritized 2-dose vaccination for a smaller portion of the population. We fit a network transmission model to incident mpox cases in NYC. Model output consisted of predicted cases over time when vaccine doses were administered with the 'first-dose priority' strategy, compared with counterfactual simulations where doses were administered to those eligible for a second dose ahead of those waiting for a first dose ('intermediate' strategy), or where individuals were pre-allocated full courses of the vaccine ('second-dose priority' strategy). We estimate that NYC's strategy averted 66% [IQR:47%-78%] of potential mpox cases compared to no vaccination. This 'first-dose priority' strategy averted 0.6% [IQR:-11%-9.8%] more cases than the 'intermediate' strategy, and 17% [IQR:2.9%-38%] more cases than the 'second-dose priority' strategy. Thus, for the 2022 mpox outbreak in NYC, pre-allocating vaccine doses to ensure full vaccination in a high-priority subset of the population would have increased the size of the outbreak.

Emergency department (ED) visits during influenza seasons represent a critical yet less examined indicator of the acute burden of influenza. This study investigates the burden of influenza-associated ED visits in six U.S. cities during influenza seasons from 2005-06 to 2016-17. Using a time-series design, we estimated associations between daily ED visits and weekly influenza activity data from the Influenza Hospitalization Surveillance Network (FluSurv-NET). A counterfactual approach was then used to calculate attributable expected ED. Highest influenza-associated rates were observed among the youngest (0-4 years) and oldest (65+ years) age groups. Combining estimates across seasons, the influenza-associated ED visit rate for respiratory diseases was almost six times larger compared to the subset of ED visits that resulted in hospitalization: 364 per 100,000 population (95% CI: 294-435) for total ED visits versus 58 per 100,000 population (95% CI: 45-71) for hospitalization. This difference was particularly large for the 0-4 year age group: 911 per 100,000 population (95% CI: 558-1,263) for total ED visits versus 43 per 100,000 population (95% CI: 15-71) for hospitalization. This study highlights the substantial burden of influenza on emergency healthcare services and the importance of integrating such data into public health planning and influenza management strategies.

PROBLEM/CONDITION: Approximately 800 foodborne illness outbreaks occur in the United States each year. These outbreaks include approximately 15,000 illnesses, 800 hospitalizations, and 20 deaths. Although illnesses from outbreaks account for a small portion of all foodborne illnesses, outbreak investigations reveal how these illnesses originate by offering crucial data through epidemiologic, environmental health, and laboratory analyses and aid in outbreak mitigation and prevention. PERIOD COVERED: 2014-2022. DESCRIPTION OF SYSTEM: The Foodborne Disease Outbreak Surveillance System (FDOSS), via the National Outbreak Reporting System (NORS), captures data from foodborne enteric illness outbreak investigations in the United States. Epidemiology or communicable disease control and environmental health programs of state and local health departments collect and voluntarily report the data to NORS, which is managed by CDC. These data include information about cases (e.g., case counts, symptoms, duration of illness, and health care-seeking behaviors), laboratory specimens, settings of exposure, implicated food items, and contributing factors (i.e., how the outbreak occurred). A foodborne illness outbreak is defined as two or more cases of a similar illness associated with a common exposure (e.g., shared food, venue, or experience). Data collected from an outbreak investigation help the investigator identify contributing factors to the outbreak. Contributing factors are food preparation practices, behaviors, and environmental conditions that lead to pathogens getting into food, growing in food, or surviving in food and are grouped into three categories: contamination (when pathogens and other hazards get into food), proliferation (when pathogens that are already present in food grow), and survival (when pathogens survive a process intended to kill or reduce them). RESULTS: A total of 2,677 (40.5%) foodborne illness outbreaks reported during 2014-2022 with information on contributing factors were included in this analysis. Foodborne outbreak periods were categorized into three time frames: 2014-2016 (first), 2017-2019 (second), and 2020-2022 (third). Of the 2,677 outbreaks, 1,142 (42.7%) occurred during the first time frame, 1,130 outbreaks (42.2%) during the second time frame, and 405 outbreaks (15.1%) during the third time frame. The proportion of bacterial outbreaks increased from the first (41.9%) to the third time frame (48.4%), and the proportion of viral outbreaks decreased (33.3% to 23.2%). Over the three time frames, the proportion of outbreaks with a contamination contributing factor decreased (85.6%, 83.6%, and 81.0%, respectively). The proportion of outbreaks with a proliferation contributing factor category decreased from the first (40.3%) to the second time frame (35.0%), then increased during the third time frame (35.1%), and the proportion of outbreaks with a survival contributing factor category decreased from the first (25.7%) to the second time frame (21.9%), then increased during the third time frame (25.7%). The proportion of outbreaks with aquatic animals as an implicated food item increased from the first (12.0%) to the second time frame (18.5%), then decreased during the third time frame (18.3%). The proportion of outbreaks with land animals as an implicated food item decreased from the first (16.7%) to the second time frame (14.2%), then increased during the third time frame (15.1%).For outbreaks with a contamination contributing factor, the proportion of food contaminated by an animal or environmental source before arriving at the point of final preparation increased over the three time frames (22.2%, 27.7%, and 32.3%, respectively), and the proportion of outbreaks with contamination from an infectious food worker through barehand contact with food decreased (20.5%, 15.2%, and 8.9%, respectively). For the proliferation category, the proportions of outbreaks associated with allowing foods to remain out of temperature control for a prolonged period during preparation and during food service or display decreased over the three time frames (15.2%, 12.2%, and 9.9%, respectively; and 13.6%, 10.4%, and 8.9%, respectively), and the proportion of improper cooling of food decreased from the first (9.4%) to the second time frame (8.8%), then increased during the third time frame (10.9%). For the survival category, the proportion of outbreaks associated with inadequate time and temperature control during initial cooking/thermal processing of food decreased from the first (12.1%) to the second time frame (9.6%) and increased during the third time frame (12.1%).For bacterial outbreaks, cross-contamination of foods was among the top five contributing factors during the first (22.0%) and second time frames (20.8%) but not during the third time frame. Inadequate time and temperature control during initial cooking of food was among the top five contributing factors during all three time frames (23.8%, 20.4% and 20.9%, respectively). Improper cooling was not among the top five contributing factors during the first and second time frames but was during the third time frame (17.3%). For viral outbreaks, contamination from an infectious food worker through barehand contact with food was among the most common contributing factors during the first (47.1%) and second time frames (37.7%) and decreased to the third most common contributing factor during the third time frame (28.7%). Contamination from an infectious food worker through gloved-hand contact with food was among the top five contributing factors during the first (32.1%) and second time frame (25.5%) and was the most common contributing factor during the third time frame (42.5%). INTERPRETATION: Many foodborne illness outbreaks occur because of contamination of food by an animal or environmental source before arriving at the point of final preparation. Most viral outbreaks are caused by contamination from ill food workers. The decrease in the proportion of viral outbreaks and the proportion of outbreaks with a contamination contributing factor during 2020-2022 might be attributed to effects from the COVID-19 pandemic. Nonpharmaceutical interventions (e.g., increased glove use, cleaning and disinfection, and closure of restaurant dining areas) implemented during the COVID-19 pandemic likely led to a reduction in norovirus, which is typically spread by infectious food workers. Two common contributing factors to bacterial outbreaks are allowing foods to remain out of temperature control for a prolonged period and inadequate time and temperature control during cooking. Proper time and temperature controls are needed to effectively eliminate bacterial pathogens from contaminated foods and ensure safe food operations. PUBLIC HEALTH ACTION: Retail food establishments can follow science-based food safety guidelines such as the Food and Drug Administration Food Code and Hazard Analysis and Critical Control Points (HACCP) plans. Restaurant managers can mitigate contamination by ill food workers by implementing written policies concerning ill worker management, developing contingency plans for staffing during worker exclusions, and addressing reasons why employees work while sick. Health department staff members who investigate outbreaks and conduct routine inspections can encourage restaurants to follow their HACCP plans and other verified food safety practices, such as cooling, to prevent outbreaks.

This study examines respiratory syncytial virus (RSV) genomic surveillance results from 2 large US networks after the introduction of RSV vaccines. | eng

HIV testing decreased during the COVID-19 pandemic among persons who inject drugs (PWID), though it is unclear how these changes in HIV testing affected different sub-groups of PWID. We estimated the change in past-year HIV testing between 2018 and 2022 overall and by sociodemographic and health care characteristics among PWID. Past-year HIV testing significantly decreased between 2018 and 2022 overall and across most sub-groups of PWID, including PWID accessing and not accessing medical and harm reduction services. Integrating HIV testing across medical and harm reduction services accessed by PWID and expanding community-based HIV testing might increase HIV testing among PWID.

Stigma toward homosexuality plays an important role in the increased risk of acquiring or transmitting HIV among men who have sex with men (MSM). This study describes associations between three dimensions of homosexuality-related stigma (enacted, perceived and internalized) and HIV risk behaviors among HIV-negative MSM in Hanoi, Vietnam. A total of 1675 HIV-negative MSM were recruited from the baseline of a cohort study from 2017 to 2019 through respondent-driven, time-location and internet-based sampling strategies. Stigma was measured by a locally validated instrument, with a higher score indicated a higher level of stigma (from 1 to 4). Enacted stigma (mean = 2.10), perceived stigma (mean = 2.62) and internalized stigma (mean = 2.55) were found. About 25% of participants reported group sex and 6.3% reported drug use before or during group sex in the last 6 months. Enacted stigma was significantly associated with group sex (adjusted OR = 1.48; 95% CI 1.20-1.84) and drug use before or during group sex (adjusted OR = 1.68; 95% CI 1.19-2.36). Internalized stigma was significantly associated with group sex (adjusted OR = 1.27; 95% CI 1.05-1.53) and drug use before or during group sex (adjusted OR = 1.44; 95% CI 1.04-1.99). The results highlight the need for multifaced interventions at a multiple socio-ecological levels to reduce stigma toward homosexuality.

BACKGROUND: While studies have examined effects of parental job loss early in the COVID-19 pandemic, few have assessed economic impacts of student job loss. METHODS: The Adolescent Behaviors and Experiences Survey (ABES) was a one-time online, nationally-representative survey administered by CDC in 2021 to understand high school students' experiences. We assessed associations between student, parent, and dyadic employment experiences and two measures of economic stress: housing instability and food insufficiency. RESULTS: Parental job loss was common and associated with both adverse economic outcomes. The adjusted prevalence rate (aPR) for housing instability was 2.79, 95% confidence interval (CI) = 1.73-4.51. A new finding is that student employment may also play a role in food sufficiency. Student job loss was significantly associated with both any food insufficiency and frequent food insufficiency (aPR = 1.61, 95% CI = 1.35-1.93 and aPR = 1.96, 95% CI = 1.43-2.70, respectively). DISCUSSION: Analysis of associations between employment status before and during the COVID-19 public health emergency and measures of household economic insecurity reveals social safety net gaps. Our finding that student employment may affect household food sufficiency highlights the need to better understand the role of student employment in household economic stress.

BACKGROUND: To generate COVID-19 vaccine safety data in Nigeria, passive reporting was supplemented with cohort event monitoring (CEM), an active surveillance system. We described reactogenicity within 7 days and adverse events up to 3 months after each AstraZeneca or Moderna COVID-19 vaccine dose while assessing the feasibility of implementing CEM in a low- to middle-income country (LMIC) during a mass vaccination campaign. METHODS: Participants were aged ≥18 years with access to mobile phones who received the first dose of an authorized COVID-19 vaccine from participating health facilities in 6 states of Nigeria during September and October 2021. Data collectors interviewed participants via phone on days 0, 3, 7, and thereafter every 7 days for 3 months. The same schedule was restarted if a participant received a second vaccine dose. Proportions of participant-reported adverse events following COVID-19 vaccine receipt were calculated. Investigation and causality assessment were conducted on deaths using the World Health Organization causality guidelines. RESULTS: We enrolled 12,317 participants (AstraZeneca 6990; Moderna 5327); 6167/6990 (88.2 %) AstraZeneca and 4879/5327 (91.6 %) Moderna recipients completed a follow-up interview days 0-7 after the first dose; among them, 2685/6167 (43.5 %) AstraZeneca and 3533/4879 (72.4 %) Moderna recipients reported local reactions and 2456/6167 (39.8 %) AstraZeneca and 2087/4879 (42.8 %) Moderna recipients reported systemic reactions. Overall, 3891/6990 (55.7 %) AstraZeneca and 3978/5327 (72.8 %) Moderna recipients received a second dose of COVID-19 vaccine, among whom 897/3891 (23 %) AstraZeneca and 1979/3978 (49.7 %) Moderna recipients reported local reactions and 727/3891 (18.7 %) AstraZeneca and 1680/3978 (42.2 %) Moderna recipients reported systemic reactions. Among all enrolled, 11 died; there was no evidence to suggest any deaths were vaccine-related. CONCLUSIONS: No unexpected patterns of adverse events were detected, providing additional data on the safety of these COVID-19 vaccines in Nigerian adults. We demonstrated that implementing CEM was feasible and may be valuable for safety monitoring of vaccines introduced in LMICs.

INTRODUCTION: Data about healthcare workers' (HCW) willingness to accept and recommend seasonal influenza vaccination in countries without influenza vaccination programs are limited. METHODS: We conducted a cross-sectional survey in 7 of the 47 counties in Kenya to examine HCW's knowledge and perceptions of seasonal influenza disease and vaccination. We aimed to enroll all HCW who deliver clinical services directly or peripherally to patients from 5 health facilities in each county. We used chi-square tests and mixed effects logistic regression to identify variables associated with HCW's willingness to accept and recommend seasonal influenza vaccination. RESULTS: From May-June 2018, we enrolled 2035 HCW, representing 49.0 % of targeted respondents from 35 facilities. Most HCW (82.1 %) were from public health facilities. Among the HCW who had heard of seasonal influenza, 87.3 % (1420/1627) believed it can cause severe illness. Most HCW (1076/1209; 89.0 %) were willing to receive a seasonal influenza vaccine if it was recommended for them and provided for free, and 91.4 % (1441/1576) would vaccinate or recommend vaccination to their patients if vaccine was available. Only 17.6 % (213/1212) reported having ever received a seasonal influenza vaccine. HCW who believed that influenza could cause severe illness (aOR 1.8; 95 % CI 1.0-3.2) and that people around them would be better protected from influenza illness if HCW are vaccinated (aOR 3.1; 95 % CI 2.0-4.9) were more likely to report willingness to accept vaccination. HCW from private health facilities (aOR 2.2; 95 % CI 1.3-6.4), and those who believed that people around them are better protected if HCW are vaccinated (aOR 3.5; 95 % CI 2.2-5.8) were more likely to report willingness to vaccinate or recommend vaccination to patients. CONCLUSION: Our findings suggest favorable attitudes among HCW towards seasonal influenza vaccination, many of whom are motivated by the desire to protect the health of others around them.

Relapsing fever Borrelia (RFB) employs antigenic variation to alter its surface protein structure in response to host immune pressure. This process occurs by the single translocation of archived variable major protein (Vmp) pseudogenes into a vmp expression locus. Borrelia miyamotoi, phylogenetically grouped with RFB, has the genetic makeup for antigenic variation, but it has not been determined whether B. miyamotoi can create new variant serotypes in vivo. We inoculated mice with a non-clonal parental B. miyamotoi CT13-2396 strain with a known Vmp majority serotype with spirochete isolation at various days post-infection. The vmp that determined the reisolated variant serotype was identified by PCR of the expression locus followed by DNA sequencing of the amplified product. For each mouse reisolate, new variants replaced the parent majority serotype. Moreover, some mice produced additional variant reisolates days apart, indicative of the presentation seen in relapsing fever infections. Infection of mice with a clonal population resulted in the elimination of the inoculated serotype and isolation of new variants. Mouse serum obtained following infection revealed IgM antibodies reactive to the parent Vmp serotype, suggesting that the immune response eliminated or greatly reduced the majority population. These results demonstrated that B. miyamotoi reisolated from infected mice exhibited serotype populations differing from the inoculated strain, indicating the spirochetes underwent antigenic variation to evade the host's immune response. However, whether the observed variation occurred by way of outgrowth of minority populations or by translocation of archived pseudogenes to the expression locus creating new variants awaits further study.

BACKGROUND: Data from the National Blood Collection and Utilization Survey (NBCUS) suggest a stabilization in blood collections and transfusions following years of decline. Data from the 2023 NBCUS were analyzed to further understand national trends in US blood availability. STUDY DESIGN AND METHODS: In February 2024, all community-based (53) and hospital-based (104) blood collection centers, and a sample of transfusing hospitals were surveyed. National estimates were calculated for the number of blood and blood components collected, distributed, transfused, rejected on testing, and outdated in 2023, compared with 2021. Weighting and imputation were used for nonresponses and missing data, respectively. RESULTS: Overall, 96% of community-based blood centers and 85.7% of transfusing hospitals responded. During 2023, 11,586,000 units of whole blood and apheresis RBCs were collected (95% confidence interval (CI): 11,180,000-11,991,000), and 10,328,000 (95% CI: 9922,000-10,733,000) were transfused, a 1.7% and 4.1% decline compared with 2021, respectively. The total available supply (after outdates and rejections) declined by 0.5%. Total platelet units distributed (2618,000; 95% CI: 2483,000-2753,000) and transfused (2220,000; 95% CI: 2040,000-2400,000) increased by 3.6% and 2.1%, respectively, since 2021. Transfusion of pathogen-reduced platelet units (1258,000) increased by 49.2% since 2021. Plasma distributions (3032,000; 95% CI: 2764,000-3300,000) and transfusions (1882,000; 95% CI: 1765,000-1998,000) declined since 2021. Overall, 123,000 units were rejected on testing for transfusion-transmitted infections. DISCUSSION: The 2023 NBCUS indicates further stabilization in the blood supply, suggesting the establishment of a new baseline for blood availability.

Krabbe disease (KD), which affects 0.3-2.6 per 100 000 live births, is an autosomal recessive lysosomal disorder caused by variants in the GALC gene that reduce galactosylceramidase (GALC) activity, leading to psychosine accumulation, cerebral white matter degeneration, and peripheral neuropathy. The most common form, infantile KD (IKD), has onset by 12 months with irritability, feeding difficulty, neurologic regression, and, when untreated, death in early childhood. Hematopoietic stem cell transplantation (HSCT) for IKD approximately 1 month after birth can improve long-term survival but has about a 10% risk of mortality within 100 days, and affected individuals can still have significant functional impairment. Newborn screening for KD is based on low GALC levels in dried-blood spots. Second-tier testing to assess whether an elevated psychosine concentration is present in the same dried-blood spot improves the specificity of screening for IKD. Without newborn screening, diagnosis of IKD is generally made after significant clinical symptoms develop, past when HSCT can be effective. The benefit of newborn detection of later-onset phenotypes of KD is uncertain. In 2024, the US Secretary of Health and Human Services added IKD to the Recommended Uniform Screening Panel after a recommendation by the Advisory Committee on Heritable Disorders in Newborns and Children. For IKD newborn screening to be as effective as possible, it is important to have systems in place to support families in making challenging decisions soon after diagnosis about whether to pursue HSCT and to ensure rapid access to HSCT if chosen.

BACKGROUND: Women with disability face more stressors around the time of pregnancy than women without disability. Limited research exists on stressors experienced due to the COVID-19 pandemic among pregnant and postpartum women with and without disability. OBJECTIVE: Examine the association between disability status and experiencing certain COVID-19 stressors among women with a recent live birth. METHODS: We analyzed Pregnancy Risk Assessment Monitoring System data from 14 jurisdictions implementing the Disability and Maternal COVID-19 Experiences supplement surveys among women with a live birth from June-December 2020. We examined the prevalence of 12 individual stressors and seven stressor types (any stressor, economic, housing, childcare, food insecurity, mental health, and partner-related), by disability status. For each stressor type, we calculated adjusted prevalence ratios (aPRs) using logistic regression to determine if women with disability were more likely to experience particular stressor types, controlling for respondent age, education, race and ethnicity, marital status, and payment at delivery. RESULTS: Among 5961 respondents, 6.3 % reported a disability. Compared with women without disability, those with disability were more likely to experience any stressor (aPR 1.19, 95 % CI 1.14-1.24), including economic (aPR 1.38, 95 % CI 1.23-1.56), housing (aPR 1.56, 95 % CI 1.09-2.24), childcare (aPR 1.32, 95 % CI 1.11-1.58), food insecurity (aPR 2.18, 95 % CI 1.72-2.78), mental health (aPR 1.49, 95 % CI 1.37-1.62), and partner-related stressors (aPR 2.00, 95 % CI 1.55-2.58). CONCLUSIONS: Findings highlight the challenges experienced by pregnant and postpartum women with disability during public health emergencies and considerations for this population in preparedness planning.

BACKGROUND: There is paucity of information on the role of cytomegalovirus (CMV) infection as a cause of stillbirths or childhood deaths in low-and middle-income countries (LMICs). We investigated attribution of CMV-disease in the causal pathway to stillbirths and deaths in children <5 years of age in seven LMICs participating in the Child Health and Mortality Prevention Surveillance (CHAMPS) network. METHODS: We analyzed stillbirths and decedents enrolled between December 2016 and July 2023. Deaths were investigated using post-mortem minimally invasive tissue sampling with histopathology and molecular diagnostic investigations of tissues and body fluids, along with review of clinical records. Multi-disciplinary expert panels reviewed findings and reported on the causal pathway to death. RESULTS: CMV was detected in 19.5%(1140/5841) of all evaluated deaths, including 5.0% (111/2204), 6.2% (139/2229), 41.2% (107/260), 68.1%(323/474) and 68.2%(460/674) of stillbirths, neonates (deaths 0-<28 days postnatal), young infants (28-<90 days), older infants (90-<365 days) and children (12-<60 months), respectively. CMV-disease was attributed in the causal pathway to death in 0.9%(20/2204) of stillbirths, 0.8%(17/2229) of neonates, 13.1% (34/260) of young infants, 9.7%(46/474) of older infants and 3.3%(22/674) of children. Decedents with CMV-disease compared with those without CMV-disease in the causal pathway, were more likely to have severe microcephaly (38.2% vs. 21.1%; aOR 2.2, 95%CI: 1.3-3.6) and HIV-infected (36.9% vs. 6.2%; aOR: 10.9, 95%CI: 6.5-18.5). CONCLUSIONS: CMV-disease is an important contributor to deaths during infancy and childhood and is often associated with severe microcephaly and HIV-infection. Improving management of CMV in HIV-infected children and a vaccine to prevent CMV are needed interventions.

Per- and polyfluoroalkyl substances (PFAS) have been associated with increased risk of hypertensive disorders of pregnancy, but whether PFAS influence blood pressure (BP) trajectories among normotensive pregnant women is unknown. We examined associations between PFAS mixtures and BP trajectories during pregnancy among normotensive women. PFAS concentrations, including perfluorohexane sulfonate (PFHxS), perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorononanoate (PFNA), and perfluorodecanoate (PFDA), were measured in plasma collected at ∼28 gestational weeks among pregnant women enrolled in the New Hampshire Birth Cohort Study (2009-2018). Systolic BP (SBP) and diastolic BP (DBP) were abstracted from pregnancy medical records. We identified BP trajectories using latent class trajectory modeling and evaluated associations between PFAS mixtures and BP trajectories using probit Bayesian kernel machine regression and multinomial quantile g-computation. We used linear mixed models to examine individual PFAS and BP changes during the third trimester. Models were adjusted for sociodemographic, lifestyle, and reproductive factors, and gestational week of blood sample collection. During late pregnancy, plasma PFOS was associated with greater increases in SBP and PFHxS was associated with greater increases in DBP. Over the third trimester, each doubling in plasma PFOS was associated with 0.07 mmHg (95% CI: -0.01, 0.14) increase per week in SBP, and each doubling in plasma PFHxS was associated with 0.07 mmHg (95% CI: 0.02, 0.12) increase per week in DBP. Our study provides additional evidence suggesting that PFAS may adversely influence blood pressure even among normotensive women.

Occupational exoskeletons (EXOs) have received growing attention as a new ergonomic intervention to reduce physical demands in various industries (e.g., manufacturing, logistics, construction, and agriculture). However, their potential use in mining has not yet been reported. Survey data (n = 135) were obtained from mining workers in the United States (US) and Indonesia (ID). Qualitative and frequency analyses were used to summarize and compare respondents’ perceived barriers, benefits, and promoters to EXO use and adoption. Beta regression analyses were also used to examine whether the perceived likelihood to use arm-support EXOs or back-support EXOs differed between the countries and was affected by demographic or job characteristics, or by perceptions regarding EXOs. Both US and ID respondents reported potential benefits of EXOs for physically demanding tasks such as lifting and overhead work, and they shared concerns about adaptation, uncertainty or lack of knowledge, confined spaces, device weight, potential failure or damage, and costs. However, some key differences also emerged: US respondents were more likely to consider using arm-support EXOs and back-support EXOs, despite expressing concerns about their use; ID respondents, although they reported more existing health and safety hazards, appeared more hesitant about adopting EXOs, possibly due to these additional hazards. These results demonstrate that miners appear to have an interest in EXOs but also emphasize the need to ensure task compatibility, comfort, and affordability to ensure the safe and effective adoption of EXO technology in mining in both developed and developing countries. © The Author(s) 2025.

A computer vision (CV) method to automatically measure the revised NIOSH lifting equation asymmetry angle (A) from a single camera is described and tested. A laboratory study involving ten participants performing various lifts was used to estimate A in comparison to ground truth joint coordinates obtained using 3-D motion capture (MoCap). To address challenges, such as obstructed views and limitations in camera placement in real-world scenarios, the CV method utilized video-derived coordinates from a selected set of landmarks. A 2-D pose estimator (HR-Net) detected landmark coordinates in each video frame, and a 3-D algorithm (VideoPose3D) estimated the depth of each 2-D landmark by analyzing its trajectories. The mean absolute precision error for the CV method, compared to MoCap measurements using the same subset of landmarks for estimating A, was 6.25° (SD = 10.19°, N = 360). The mean absolute accuracy error of the CV method, compared against conventional MoCap landmark markers was 9.45° (SD = 14.01°, N = 360). © 2013 IEEE.

Idiopathic pulmonary fibrosis (IPF), a progressive lung disease characterized by scarring and worsening lung function, has a poor prognosis. A recent systematic review estimated that 21% of IPF deaths might be attributable to occupational exposures. To describe IPF mortality among U.S. residents aged ≥15 years who were ever employed, by industry and occupation, CDC conducted an exploratory analysis of 2020-2022 multiple cause-of-death data. During 2020-2022, a total of 67,843 (39,712 [59%] male and 28,131 [41%] female) decedents had IPF, suggesting that during this 3-year period, 8,340 IPF deaths in males and 5,908 deaths in females might have been associated with occupational exposures. By industry group, the highest proportionate mortality ratios among males were among those employed in utilities (1.15) and among females, were among those employed in public administration (1.12). By occupation group, the highest IPF mortality rates among males were among community and social services workers (1.23) and among females among farming, fishing, and forestry workers (1.24). Estimates of elevated IPF mortality among workers in specific industries and occupations warrant confirmation, control of known exposure-related risk factors, and continued surveillance to better understand the full range of occupational exposures that might increase risk for developing IPF.

BACKGROUND: Certain occupations have greater risk for per- and polyfluoroalkyl substances (PFAS) exposure because of PFAS use in occupation-associated materials. OBJECTIVE: We sought to assess whether PFAS concentrations differed by occupation among certain Arizona workers and whether concentrations differed over time by occupation. METHODS: Serum concentrations for 14 PFAS were measured among 1960 Arizona Healthcare, Emergency Responder, and Other Essential Worker Study participants. Samples were collected at enrollment and periodically during July 2020-April 2023. Occupational categories included firefighters, other first responders, healthcare workers, and other essential workers. We fit multilevel regression models for each PFAS to estimate differences in geometric mean concentrations or odds of PFAS detection at enrollment by occupational category. For participants with ≥1 serum sample, we evaluated for yearly longitudinal differences in PFAS concentrations by occupational category. We used other essential workers for comparison, and adjusted for age, sex, race and ethnicity, year, and residential county. RESULTS: Adjusting for covariates, firefighters had higher perfluorohexanesulfonic acid (PFHxS), branched and linear perfluorooctanesulfonic acid (PFOS), and perfluoroheptanesulfonic acid (PFHpS) concentrations than other essential workers (geometric mean ratios 95% CIs: 1.26 [1.11-1.43]; 1.18 [1.06-1.32]; 1.19 [1.08-1.31]; and 1.19 [1.01-1.39], respectively). Healthcare workers had higher odds of detection of branched perfluorooctanoic acid (Sb-PFOA) and perfluorododecanoic acid (PFDoA) than other essential workers, adjusting for covariates (odds ratios 95% CIs: 1.35 [1.01-1.80]; 2.50 [1.17-5.34], respectively). During the 3-year study, we detected declines in PFAS concentrations among other essential workers; few longitudinal differences in concentrations by occupation were detected. IMPACT STATEMENT: Using data from a large prospective cohort of frontline workers in Arizona, we compared serum concentrations of 14 per-and polyfluoroalkyl substances (PFAS) among firefighters, other first responders, healthcare workers, and other frontline essential workers. We found that firefighters have higher concentrations of certain PFAS chemicals and the odds of detecting other PFAS chemicals are higher among healthcare workers compared with people in other occupations. Our findings highlight the importance of further action to reduce PFAS exposure within highly exposed occupational groups, such as firefighters, and the need to expand evaluation of exposure among other occupations, including healthcare workers.

OBJECTIVE: A firefighter wears a standard safety coat, its model unchanged for many years, when tackling a fire. We designed a new cooling system coat with carbon nano tube-based fabric and pouches inside the coat for coolants and fans. The coats, one standard and the other still evolving, are compared on several metrics including core body temperature and thermal comfort. METHODS: An experimental protocol was designed involving a live burn facility under the paradigm of non-inferiority study with firefighters trying both coats. The metrics are measured at several phases of the protocol. Multivariate t-test is used to compare the performance of the coats. RESULTS: The new coat is not inferior to the standard coat. CONCLUSION: The new coat in its final form, which is yet to be tested fully, is a plausible replacement for the standard coat.

Background: Guidelines recommend tailored reproductive health counseling for women with congenital heart defects (CHDs) beginning in adolescence, yet provider adherence to recommendations remains understudied, particularly outside specialized cardiac care settings. Study Design: We conducted a cross-sectional cohort study among women aged 19 to 38 with CHDs, identified from active population-based birth defects registries in three states. Participants completed surveys from 2016 to 2019, including questions about contraception, pregnancy counseling, concerns, and experiences. Multivariable Poisson regression, adjusted for sociodemographic and health characteristics, assessed associations between CHD severity, counseling, and reproductive health outcomes. Results: Of 765 women, those with severe CHDs, compared with non-severe, were more likely to report receiving clinician counseling about safe contraceptive methods (44.0% and 13.7%; adjusted prevalence ratio [aPR] = 3.0; 95% confidence interval [95% CI] [2.2, 4.0]), pregnancy, (63.3% and 16.5%; aPR = 3.6; 95% CI [2.7, 4.6]), and pregnancy avoidance (32.0% and 6.4%; aPR = 4.3; 95% CI [2.9, 6.6]); be concerned about ability to have children (40.9% and 31.2%; aPR = 1.4; 95% CI [1.1, 1.8]), and delay/avoid pregnancy (26.6% and 10.7%; aPR = 2.2; 95% CI [1.5, 3.2]). No disparity was found in ever being pregnant (30.0% vs. 37.2%; aPR = 1.0; 95% CI [0.7, 1.2]). One-third of the respondents with any CHD reported concerns about their ability to have children (33.6%). Conclusion: We found that only a minority of women with CHDs reported receiving counseling on safe contraception and pregnancy, and about a third reported concerns about their ability to have children. These findings highlight a gap between guideline recommendations and clinical practice, underscoring the need for improved reproductive health discussions for women with CHDs. © 2025 Jacobs Institute of Women's Health, George Washington University

Little cigars are similar to cigarettes, with respect to dimensions, filters, and overall appearance. Some smokers also use little cigars as substitutes for cigarettes. Comparison of little cigars with cigarettes is relevant to understanding their respective public health impact. To understand their relative toxicities, mainstream smoke yields of benzo[a]pyrene (B[a]P), a human carcinogen, were measured for 60 commercial little cigars. The little cigars were smoked on a linear smoking machine using the International Organization of Standardization (ISO) nonintense and Canadian Intense (CI) smoking regimens followed by analysis with a validated gas chromatography/mass spectrometry (GC/MS) method. The average analytical quantitative variability of the measured little cigar constituents was lower compared to previously tested commercial cigarettes (%RSD 9.6 vs 14.5, respectively). B[a]P yields ranged from 14.5-44.0 ng/cigar (ISO) and 24.0-65.7 ng/cigar (CI). The mean ISO yield is 25.5 ng/cigar versus the CI yield of 42.2 ng/cigar, which are 2.5- and 2-fold greater, respectively, than the corresponding mean cigarette yields. When normalized to tobacco weight, B[a]P yields of the little cigars are 1.5- (ISO) and 1.3- (CI) fold greater than cigarette yields. B[a]P smoke yields are known to correlate with tobacco weight. The little cigar B[a]P yield correlations to tobacco weight (CI R(2) = 0.35; ISO R(2) = 0.24) are similar to cigarette yield correlations (CI R(2) = 0.31; ISO R(2) = 0.21). Other physical properties (i.e., filter length, filter ventilation, and packing density) that may impact B[a]P smoke yields for the little cigars had very weak correlations. Except for cigarette packing density, cigars and cigarettes have similar correlations between B[a]P yields and physical design parameters. In summary, the little cigars, although physically similar to cigarettes, differ in smoke chemistry by generating higher B[a]P yields, even when normalized to tobacco weight.

The members of the Cryptococcus gattii species complex are the etiologic agents of potentially fatal human infection. C. gattii causes disease in both immunocompetent and immunocompromised hosts. In the early 2000s, infection caused by C. gattii emerged in the Pacific Northwest of the US. While many studies have been published about the human infection, the epidemiological characteristics of the infection in animals, with a possible role in human infection, have not been in investigated. Cases of C. gattii diagnosed in animals in Oregon from 2008 to 2019 were cataloged by county, species of animal, site of the infection, season of the year, and C. gattii genotype. One hundred and nine cases were diagnosed, and among the genotypes of C. gattii, VGII (Cryptococcus deuterogatti) with the genotypes VGIIa, VGIIb, and VGIIc was responsible for 98% of the cases. VGIIa was identified in more than 50% of the animals, and Cryptococcus bacilliporus (VGIII) was only isolated from cat patients. The majority of the infections were diagnosed in dogs and cats, although caprines, equines, camelids, ovines, and elk were also seen with the disease. The most common site of infection in dogs was the brain; that in cats was the nasal cavity and the skin, while the lung was the most affected site in caprines, equines, camelids and elk. Marion and Lane Counties account for the majority of the infections, followed by Clackamas, Benton, and Multnomah Counties. The infection was predominantly identified during the Fall and Winter months, except for Benton County, where it was seen more commonly during the Summer months. This study reviews all the cases identified by the Department of Public Health and by the veterinarians in Oregon in the years between 2008 and 2019. © 2025 by the authors.

We used clinical metagenomic next-generation sequencing of cerebrospinal fluid to investigate bunyavirus infections in 2 immunocompromised patients in the United States who had fatal meningoencephalitis. Potosi virus has been isolated from mosquito vectors and Lone Star virus from tick vectors. These findings highlight the power of metagenomic next-generation sequencing in broad-based, agnostic detection of emerging viral infections that test negative using conventional targeted diagnostic methods.

Tick-borne diseases pose a persistent and increasing threat to public health. In the United States, the majority of human infections are caused by pathogens spread by the blacklegged tick, Ixodes scapularis. Most infections are reported during the summer months, when nymphal ticks are active in states in the Northeast and Upper Midwest. The density of questing I. scapularis nymphs (DON) provides an estimate for the risk of human encounters with nymphs, but it is a resource intensive metric to obtain from field sampling. Thus, DON estimates are limited in the US national tick surveillance database, the ArboNET Tick Module. We estimated DON across all counties in the eastern US using a zero-inflated negative binomial model utilizing tick surveillance data reported to ArboNET (2004-2023) as well as climate and land cover data. The model estimated generally low DON across the southeastern US and Great Plains states with higher estimates in the Upper Midwest and Northeast regions. We assigned counties to relative acarological encounter risk categories based on estimated DON: zero or lower quartile DON estimates were scored as low risk, whereas inter- and upper-quartile DON estimates were scored as moderate-high risk. Counties with moderate-high DON reported from field sampling were accurately categorized by the model as moderate-high encounter risk (99 % sensitivity). However, 80 % of sampled counties reporting low DON were classified as moderate-high risk (20 % specificity). These misclassified counties were typically situated in recently colonized areas in the Northeast and Upper Midwest and likely indicated areas potentially suitable for tick population expansion. Our model yielded a very high negative predictive value (96 %) indicating the model did very well estimating low relative encounter risk in counties where no or few nymphs were collected, and a fair positive predictive value (60 %) indicated that densities may not have reached an expected peak in some locations, particularly in the Northeast, Upper Midwest, and northern states in the Southeast. Further tick surveillance is needed to evaluate and to refine these predictions. The resulting maps are useful for estimating relative risk of nymphal encounters across the eastern US where field data are sparse and may aid in efforts aimed at promoting the use of personal protective measures in communities that are at risk for nymphal tick encounters.

Since March 2024, highly pathogenic avian influenza A(H5N1) viruses have caused outbreaks in dairy cattle and poultry in the United States, and they continue to spill over into humans. However, data on human immune response to those viruses is limited. We report neutralizing antibody responses in 2 dairy farm worker H5N1 cases.

Spotted fever group rickettsioses (SFGR) pose a global threat as emerging zoonotic infectious diseases; however, timely and cost-effective diagnostic tools are currently limited. We used data from 449 patients presenting to 2 hospitals in northern Tanzania between 2007 and 2008, of which 71 (15.8%) met criteria for acute SFGR based on ≥4-fold rise in antibody titers between acute and convalescent serum samples. We fit random forest classifiers incorporating clinical and demographic data from hospitalized febrile participants as well as Earth observation hydrometeorological predictors from the Kilimanjaro Region. In cross-validation, a prediction model with 10 clinical predictors achieved an area under the receiver operating characteristic curve of 0.65 (95% confidence interval, .48-.82). A combined prediction model with clinical, hydrometeorological, and environmental predictors (20 predictors total) did not significantly improve model performance. Novel strategies are needed to improve the diagnosis of acute SFGR, including the identification of diagnostic biomarkers that could enhance clinical prediction models.