Gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV infection in the United States, especially Black MSM (BMSM) and Hispanic/Latino MSM (HLMSM). Long-acting preexposure prophylaxis (LA PrEP) is effective in preventing HIV; however, medical mistrust may contribute to barriers in uptake among BMSM and HLMSM. We assessed the role of medical mistrust in BMSM and HLMSM's unwillingness to use LA PrEP. BMSM and HLMSM aged ≥18 years without a previous HIV diagnosis or current PrEP use were recruited through dating and general interest websites/apps. Using Poisson regression with robust standard errors, we conducted multivariate analyses to assess the association between medical mistrust and willingness to use LA PrEP (i.e., injection or rod implanted in the arm) separately for each racial/ethnic group. Over 90% of the 1,126 BMSM and 924 HLMSM in this study were willing to use some form of PrEP; however, only 74% of BMSM and 81% of HLMSM were willing to use PrEP injections, and significantly fewer BMSM (30%) were willing to receive a PrEP implant compared with 44% of HLMSM. After controlling for sociodemographic, behavioral, and clinical covariates, medical mistrust was associated with lower willingness to use LA PrEP for BMSM, but not for HLMSM. Addressing and reducing medical mistrust among BMSM is important to increase the use of LA PrEP as an effective HIV prevention strategy. Addressing structural barriers and building trust within healthcare systems are crucial steps in reducing disparities in HIV infection among BMSM and HLMSM.

Objective: To compare clinical and socioeconomic characteristics of U.S. Medicare beneficiaries overall and with diagnosed diabetes by age group (18–64 years and ≥65 years) and insurance type (traditional fee-for-service [FFS] vs Medicare Advantage [MA]) and to compare the prevalence of diabetes among beneficiaries by age group and type of insurance. Methods: In this retrospective, cross-sectional study from the U.S. Medicare Current Beneficiary Survey (MCBS), we combined data from 2017 to 2022 and conducted an unadjusted, pooled analysis of administrative and survey data, weighted to represent U.S. Medicare beneficiaries. We used logistic regression to assess difference by insurance type in care satisfaction. Results: Beneficiaries more likely to enroll in MA than FFS were the same groups at high risk of diabetes, including non-Hispanic Black (18–64: 21.2 % vs 15.9 %; ≥65: 11.4 % vs 6.5 %) and Hispanic (18–64: 14.4 % vs 8.9 %; ≥65: 11.0 % vs 5.4 %) populations, those with less than a high school education (≥65: 16.4 % vs 9.2 %) or annual income <$25,000 (18–64: 69.0 % vs 64.0 %; ≥65: 34.5 % vs 21.6 %), and full dual-eligible beneficiaries (≥65: 10.5 % vs 6.1 %). Beneficiaries with diabetes enrolled in MA did not differ from those enrolled in FFS in diabetes self-management or satisfaction with healthcare. Conclusions: Subgroups of people at highest risk of diabetes were more likely to enroll in MA. Our findings support studies reporting that people with diabetes self-select into MA, and their lack of difference in satisfaction between FFS and MA may support studies that report MA is no less effective than FFS in diabetes care. © 2025 The Authors

BACKGROUND: Candida (Candidozyma) auris, a multidrug resistant organism, can cause severe, invasive infections. We characterized C. auris epidemiology in New York before and during the COVID-19 pandemic. METHODS: Multiple statewide databases were linked to assess demographic and clinical characteristics and outcomes among C. auris screening cases (patients tested for colonization screening) and clinical cases (patients tested to diagnose disease). Cases diagnosed during 2017-2022 were divided into four phases and compared, including pre-COVID-19, first wave, ongoing mitigation, and vaccine era. Joinpoint analysis was used to assess monthly percentage change (MPC) and significant temporal trends among clinical cases. RESULTS: During the first wave, higher proportions of C. auris cases were among Black and Hispanic patients (clinical and screening), patients from high social vulnerability index neighborhoods (clinical), and patients aged <60 years (screening), compared with pre-COVID-19. Increased proportions of Hispanic patients and those aged <60 years among screening cases persisted through ongoing mitigation and vaccine era. MPC of clinical cases was stable throughout the analysis period at 1.97%, and no significant joinpoints were observed. CONCLUSIONS: The influx of COVID-19 hospitalizations might have driven shifts in characteristics of clinical and screening C. auris cases. Clinical C. auris incidence increased during 2017-2022, but the incidence slope did not increase during or after the onset of COVID-19.

BACKGROUND: Understanding parental reasons for not having their child receive an influenza vaccination and how reasons have changed over time can help immunization programs and providers tailor interventions to increase uptake of influenza vaccine among children. The objectives of this study were to estimate the percentage of children 6 months-17 years with a parent who reported selected reasons for non-receipt of influenza vaccination (or "non-vaccination") during 2015-2024, assess whether there has been an increase or decrease in the reporting of each reason for non-vaccination, particularly pre versus post COVID-19 pandemic, and if reasons for non-vaccination differ by sociodemographic characteristics. METHODS: National Immunization Survey-Flu (NIS-Flu) parentally reported data for the 2015-16, 2016-17, 2019-20, 2022-23, and 2023-24 seasons were analyzed. Percentages of children not vaccinated against influenza whose parent reported each reason for non-vaccination, overall, by state, and by sociodemographic characteristics were calculated. Tests of association between sociodemographic characteristics and across seasons were conducted for each reason for non-vaccination using t-tests. RESULTS: The most commonly reported reasons for non-receipt of influenza vaccination across all seasons studied were: belief their child is unlikely to get very sick from influenza, concern about side effects/safety, and belief influenza vaccines do not work very well (48.2 %, 43.3 %, and 37.0 %, respectively, in 2023-24). Parental reporting of thinking their child is unlikely to get very sick from influenza increased more than other reasons for non-vaccination since the COVID-19 pandemic. Across all seasons studied, very few reported access-related reasons. Reasons for non-vaccination varied by state and by demographic characteristics. CONCLUSIONS: This study suggests that concern about influenza has decreased since the COVID-19 pandemic. A strong provider recommendation for influenza vaccination, including information about the safety of the vaccine and seriousness of influenza, could help increase influenza vaccination coverage among children.

INTRODUCTION: Arthritis is a common chronic disease, affecting an estimated 53.2 million adults (21.2%) in the US. "Arthritis" is a general term, describing over 100 conditions with different etiologies, pathogeneses, symptoms, and treatments. Few studies have examined the prevalence and distribution of arthritis subtypes in the US. METHODS: We used National Health and Nutrition Examination Survey data from 2017 to March 2020 to estimate the prevalence of arthritis subtypes overall and by sociodemographic characteristics. RESULTS: The overall prevalence of any type of diagnosed arthritis among US adults aged 20 years or older in this study was 27.9% (67.1 million). Among adults with diagnosed arthritis, osteoarthritis (49.6%, 33.2 million) was the most common arthritis subtype, followed by rheumatoid arthritis (15.8%, 10.6 million) and psoriatic arthritis (1.4%, 1.0 million). More than 1 in 10 reported some other type of unlisted arthritis (11.5%, 7.7 million), and 1 in 5 did not know their arthritis subtype (21.6%, 14.4 million). Prevalence of not knowing arthritis type was approximately 1 in 4 for adults identifying as non-Hispanic Black (26.7%) or other Hispanic (29.5%) and for adults who reported low family income (26.7%) and was approximately 1 in 3 for adults identifying as Mexican American (31.9%), having less than a high school education (31.8%), or not having health insurance (36.1%). CONCLUSION: Understanding arthritis type is important for improving treatment, self-management, and health outcomes associated with arthritis. Improving organizational and personal health literacy are potential strategies that may reduce the prevalence of not knowing arthritis type.

INTRODUCTION: Increasing walking for transportation is a strategy to integrate physical activity into daily life. We examined reported environmental, access, and individual reasons for not walking to places near home among US adults, by sociodemographic characteristics and geographic location. METHODS: We used data from the 2022 SummerStyles survey on 3,967 US adults aged 18 years or older. We calculated prevalence of reporting 11 selected reasons for not walking to places within 10 minutes of home, overall and by sex, race or ethnicity, age, education, income, US census region, and metropolitan residence (an area with at least 1 urban area of ≥50,000 inhabitants) versus nonmetropolitan residence. We used Bonferroni-corrected pairwise comparisons and orthogonal polynomial contrasts (ordered groups) to compare prevalence by subgroup. RESULTS: Overall, 79.0% of respondents identified at least 1 reason for not walking to places near home (within 10 minutes). Commonly reported reasons were hot and humid conditions (36.0%), no places to walk within 10 minutes (24.9%), a preference for driving (22.1%), and inconvenience (21.5%). The reasons varied significantly across sociodemographic and geographic subgroups. The prevalence of reporting none of the listed reasons was higher among males than females, higher among non-Hispanic Black and non-Hispanic Asian adults than non-Hispanic White adults, and higher among adults from the Northeast versus the South. CONCLUSION: Eight of 10 US adults reported at least 1 environmental, access, or individual reason for not walking to places near home. Designing communities to make walking for transportation more accessible, convenient, and desirable may help address the leading reasons reported, which may support adults in adding more physical activity to their daily lives.

Obesity affects approximately one in five U.S. adolescents. Although an increasing number of medications are approved for adolescent obesity as an adjunct to health behavior and lifestyle treatment, national data on the prevalence and correlates of obesity medication prescribing for adolescents are sparse. Ambulatory electronic medical record data were analyzed to assess trends in the proportion of U.S. adolescents aged 12-17 years with obesity (body mass index ≥95th percentile) who were prescribed Food and Drug Administration (FDA) -approved obesity medications during 2018-2023. Log-binomial models were used to estimate characteristics of adolescents associated with receiving an obesity medication prescription in 2023. The proportion of U.S. adolescents who were prescribed obesity medications increased substantially in 2023 (by approximately 300% compared with 2020), the year after FDA expanded its approval of two obesity medications to include adolescents and after publication of the 2023 American Academy of Pediatrics clinical practice guideline. Despite this substantial relative increase, 0.5% of adolescents with obesity were prescribed an obesity medication in 2023, with a majority (83%) of prescriptions received by adolescents with severe obesity. Semaglutide (Wegovy, indicated for persons aged ≥12 years with obesity), and phentermine or phentermine-topiramate were most commonly prescribed. Prescribing prevalence was higher among girls than among boys (adjusted prevalence ratio [aPR] = 2.05), among adolescents aged 15-17 years than among those aged 12-14 years (aPR = 2.24), and among those with severe (class 2 or class 3) obesity than among those with class 1 obesity (aPR = 4.03 and 12.78, respectively). Prescribing prevalence was lower among Black or African American adolescents than among White adolescents (aPR = 0.61). Continued monitoring of the use of these medications could help guide strategies to ensure that all adolescents with obesity have access to evidence-based obesity treatment, including medications and health behavior and lifestyle interventions.

Mpox emerged on the global scale in 2022 and predominately affected gay, bisexual, and other men who have sex with men (GBMSM). Stigma related to mpox is a potential harm for individuals experiencing multiple levels of marginalization who may already be discriminated against in family, health care, and other social domains. To understand perceived mpox stigma among cisgender GBMSM in the United States, we conducted a study within the American Men's Internet Survey with 824 cisgender GBMSM >= 15 years from August 5 to 15, 2022. Perceived mpox stigma was most prevalent among non-Hispanic Black individuals (13.9%) compared to non-Hispanic White individuals (6.0%) and particularly among men aged 25-29 (15.1%) compared to men aged 40+ (5.6%). In adjusted logistic regression models, mpox stigma was significantly associated with knowing someone who tested for mpox (adjusted odds ratio (aOR) = 4.3 95% confidence interval, CI [2.1, 9.0]), knowing someone who was vaccinated for mpox (aOR = 2.1; 95% CI [1.2, 3.7]), or having an unexplained rash in the 3 months prior to survey completion (aOR = 3.6; 95% CI [1.9, 7.0]). These initial findings suggested people who were more connected to mpox-affected social networks and also those who had symptoms consistent with mpox were more likely to experience stigma. Taken together, these data suggest the potential harmful impact of mpox-related stigma by affecting those who would most benefit from services. Moreover, these data suggest the importance of real-time stigma measurement and mitigation for both rapidly emergent and chronic infectious diseases to improve equity, reduce fear and misinformation, and optimize the impact of public health responses. (PsycInfo Database Record (c) 2025 APA, all rights reserved) Impact Statement Stigma can have far-reaching consequences. It can exacerbate health disparities, influence social networks, and discourage individuals from seeking preventative health care, including vaccination. This study's findings highlight that, even if not widespread, stigma can concentrate in marginalized groups and drastically affect individuals' lives. By acknowledging and addressing stigma, public health agencies and providers can foster inclusivity, limit fear, promote trust in health care systems, and improve the overall health and resilience of communities. (PsycInfo Database Record (c) 2025 APA, all rights reserved)

OBJECTIVE: Longer-acting pre-exposure prophylaxis (LA-PrEP) products have potential to increase PrEP uptake and continuation. This study sought to elicit preferences for LA-PrEP product and delivery program characteristics among populations disproportionately impacted by HIV to identify factors important to adoption and anticipate potential use challenges. DESIGN: Cross-sectional, online discrete choice experiment. METHODS: We recruited 940 men who have sex with men (MSM), people who inject drugs (PWID), and Black heterosexual men and women (BHMW) with PrEP indications. In a series of 10 tasks, participants chose between two hypothetical LA-PrEP options composed of 5 attributes (product type, side effects, clinic type, appointment duration, cost), or neither (their current HIV prevention method). Analysis used random-parameters logit models. RESULTS: Respondents chose an LA-PrEP method over their current HIV prevention option in 96.8% of tasks. Cost was the most important determinant of LA-PrEP choice for all populations (relative importance [RI] of 10]. Side effects and product type were 1/3 to 1/2 as important as cost (RI 3.5-5.1). MSM and PWID most preferred the 12-month implant followed by semiannual dual injections and least preferred the monthly oral pill and 2-month single injection. BHMW most preferred the monthly pill and semiannual injections and least preferred the 12-month implant and 2-month injection. Clinic type and appointment duration had minimal influence (RI 0.1-2.1). CONCLUSIONS: Results suggest high demand for LA-PrEP among populations with disproportionately high HIV incidence. To facilitate use, programs should offer a range of LA-PrEP products, minimize out-of-pocket costs, and counsel on side effects.

BACKGROUND: Black and Hispanic women in the United States continue to bear disproportionate incidence of HIV related to sexual transmission and injection drug use. Specifically, women with substance use disorders (SUDs) are more likely to engage in vaginal or anal condomless sex associated with HIV transmission. Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool but is not widely used by racial or ethnic minority women. Effective interventions for engaging women with SUDs in HIV prevention interventions that are culturally appropriate and, therefore, more appealing to racial or ethnic minority women with SUDs are critically needed. OBJECTIVE: This 3-phased study, including a pilot randomized controlled trial (RCT), will assess the initial efficacy, feasibility, and acceptability of an addiction clinic-based behavioral and PrEP services intervention to increase the uptake and adherence to PrEP among racial or ethnic minority women. METHODS: A 3-phased mixed methods research design will involve formative qualitative methods using thematic analysis to design the intervention (phase 1), theatre testing to adapt and refine the intervention (phase 2), and RCT methods to pilot test the intervention for efficacy, feasibility, and acceptability (phase 3). The pilot RCT will enroll and randomize 60 women to either the standard SUD treatment program or SUD treatment integrated with PrEP services. The addiction clinic-based behavioral intervention will include 4 motivational counseling sessions guided by the Information-Motivation-Behavioral Skills Model to increase the uptake of PrEP. A mobile health app will be used to engage participants with the intention of motivating PrEP initiation and supporting adherence to PrEP. Following phase 3, generalized linear modeling will be used to model effects of the proportion of participants who fill their prescription and take at least 1 dose as a function of the intervention group. RESULTS: Findings from individual qualitative interviews informed the development of the addiction clinic-based behavioral intervention. Study recruitment for the randomized pilot (phase 3) launched in May 2024. Additional statistical analyses will be performed upon completion of the study. CONCLUSIONS: This addiction clinic-based behavioral intervention aims to increase PrEP uptake and adherence among racial or ethnic minority women who engage in sexual and substance use behaviors associated with increased susceptibility to HIV transmission. The addiction clinic-based behavioral intervention has the potential to reduce HIV-related disparities among Black and Hispanic women with SUDs. Findings from this study will provide a foundation for future HIV prevention interventions for racial or ethnic minority women with SUDs. TRIAL REGISTRATION: ClinicalTrials.gov NCT06158607; https://clinicaltrials.gov/study/NCT06158607?term=NCT06158607&rank=1. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/64961.

PROBLEM/CONDITION: Candidemia, a bloodstream infection caused by Candida spp., is a common cause of health care-associated bloodstream infections in the United States. Candidemia is associated with substantial health care costs, morbidity, and mortality. PERIOD COVERED: 2017-2021. DESCRIPTION OF SYSTEM: CDC's Emerging Infections Program (EIP), a collaboration among CDC, state health departments, and academic partners, was used to conduct active, population-based laboratory surveillance for candidemia at city or county sites located in 10 states (California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee), representing a combined population of approximately 21.5 million persons, or 7% of the U.S. population in 2019. Connecticut began reporting cases on January 1, 2019, and conducts statewide surveillance. Although candidemia is not a nationally notifiable condition, cases of Candida auris infection are nationally notifiable, and cases of candidemia caused by C. auris could be included in both national case counts and EIP surveillance. A culture-confirmed candidemia case is defined as a positive blood culture for any Candida sp. from a resident in the surveillance catchment area. Subsequent positive blood cultures for Candida within 30 days of the initial positive culture (index date) in the same patient are considered part of the same case. Clinical laboratories serving each catchment area report candidemia cases, and trained surveillance officers abstract information from medical charts for all cases. Corresponding isolates are sent to CDC for species confirmation and antifungal susceptibility testing. RESULTS: A total of 7,381 candidemia cases were identified during the surveillance period (2017-2021). The overall incidence was 7.4 cases per 100,000 population. Across age groups, sexes, racial and ethnic groups, and surveillance sites, incidence was generally stable or increased slightly from 2017 to 2021, with the lowest overall incidence in 2019 (6.8) and the highest in 2021 (7.9). In 2021, candidemia incidence was highest in patients aged ≥65 years (22.7) and infants (aged <1 year) (8.0). Incidence was higher in males (8.7) compared with females (7.0) and higher in non-Hispanic Black or African American (Black) patients (12.8) compared with non-Black patients (5.6). Incidence was highest in Maryland (14.5), followed by Tennessee (10.1) and Georgia (10.0); incidence was lowest in Oregon (4.8). Increases occurred in the percentage of cases classified as health care onset (52.2% in 2017 to 58.0% in 2021). Overall, among 7,381 cases (in 6,235 patients), 63.7% occurred in patients who had a central venous catheter, 80.7% involved recent systemic antibiotic receipt, and 9.0% occurred in patients who had a history of injection drug use. The percentage of cases with a positive SARS-CoV-2 test during the 90 days before or after the index date increased from 10.4% in 2020 to 17.7% in 2021. From 2017 to 2021, the percentage of cases involving an intensive care unit stay before the index date increased from 38.3% to 44.9%. Echinocandins (e.g., micafungin) were used as treatment in 49.8% of cases, and azoles were used in 47.7%. The all-cause in-hospital mortality rate was 32.6%; this increased from 26.8% in 2019 to 36.1% in 2021. Overall, Candida albicans accounted for 37.1% of cases, followed by Candida glabrata (30.4%) and Candida parapsilosis (13.5%); however, C. glabrata was the most frequent species in California (38.4%) and Maryland (32.9%). Candida auris infections accounted for 0.4% of cases. Among 6,576 Candida isolates for which interpretive breakpoints exist and isolates were available for testing, 5.6% were fluconazole resistant, and <1% were echinocandin resistant. Antifungal resistance was stable for all antifungals tested across years. INTERPRETATION: Candidemia remains an important health care-associated infection. The disproportionate incidence among older adults, males, and Black patients is consistent with previous reports, and the overall incidence of candidemia has not changed substantially compared with previous EIP findings based on data collected during 2012-2016 (8.7 per 100,000 population). The higher mortality rate associated with candidemia during 2020-2021 likely reflects consequences of the COVID-19 pandemic, including strained health care systems and an increased population of patients who were susceptible to candidemia because of COVID-19-related critical illness. PUBLIC HEALTH ACTION: Strict implementation of measures to prevent health care-associated bloodstream infections is important to help prevent candidemia cases. Health care officials and providers should be vigilant for candidemia as a complication of critical illness. Continued surveillance is needed to monitor for emerging populations at risk for candidemia and changes in antifungal resistance patterns, which can help guide antifungal treatment selection.

Background: A contemporary description and estimates for rates of chronic kidney disease (CKD) in type 1 diabetes are needed to inform risk reduction strategies. The study aim was to assess prevalence and severity of CKD based on a population with type 1 diabetes receiving care at a large United States health system. Methods: Type 1 diabetes was identified through the Providence health system electronic health records during 2013–2022. Prevalent CKD was defined cross-sectionally by ≥ 90-day persistence of estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2, urine albumin-to-creatinine ratio ≥30 mg/g, or urine protein-to-creatinine ratio ≥0.15 g/g. Multivariable logistic regression models analyzed variable associations with CKD and severe kidney disease (eGFR < 45 mL/min/1.73 m2, dialysis, or transplant). Findings: The study population (N = 23,589) was 48.6% female with a mean ± SD age of 38 ± 17 years. CKD prevalence was 27.1%. Higher odds of CKD were found for females (odds ratio: 1.36 [95% confidence interval]: 1.26–1.47); age 60–79 years (reference 12–17 years; 2.22 [1.83–2.69]); Asian (reference White; 1.71 [1.20–2.44]), Black or African American (1.76 [1.45–2.14]), and Other race (1.33 [1.04–1.71]) populations. CKD odds were higher with hypertension, heart failure, and atherosclerotic cardiovascular disease. Severe kidney disease was present in 10.8% with higher odds among Black or African American (2.08 [1.23–3.54]) and Native Hawaiian or Pacific Islander (2.62 [1.28–5.38]) populations. Interpretation: CKD was present in nearly one of three persons with type 1 diabetes with higher risks for females, older adults, racial and ethnic minorities, and those with cardiovascular diseases. Severe kidney disease was found in over one-tenth and more likely in Black or African American and Native Hawaiian or Pacific Islander populations. Focus on disproportionately affected groups who may benefit from monitoring and interventions to improve clinical outcomes will be important for public health and health system strategies to reduce risks of CKD and severe kidney disease in type 1 diabetes. Funding: This work was supported in part by CDC project numbers 75D301-21-P-12254 and 75D301-23-C-18264, and in part by Brigham Research Institute. © 2025 The Author(s)

Persons with HIV (PWH) have disproportionate hepatitis C virus (HCV) infection prevalence and liver-related morbidity and mortality. These sequelae may be alleviated by curative direct-acting antiviral (DAA) treatment; however, longitudinal effects of DAAs on clinical biomarkers are not well-characterized. We included PWH enrolled in the HIV Outpatient Study (HOPS) who were prescribed DAAs and DAA-naïve PWH of comparable age, sex, race/ethnicity, and fibrosis-4 (FIB-4) profiles. We contrasted the DAA effect on longitudinal trajectories of immunological and hepatic markers using generalized linear mixed models (GLMM) from 2010 to 2020. Of 347 PWH/HCV coinfection, median age was 53.8 years, 30.5% were women, 67.1% were publicly insured, 44.4% were non-Hispanic Black, and 153 (44.1%) were prescribed DAAs (median follow-up = 3.55 years). In multivariable GLMM analysis, DAA treatment was associated with [mean (95% confidence interval)] faster decline in alanine aminotransferase of -7.86 mu/µL/year (-15.39, -0.33) and faster increase in platelets of 6.99 mu/µL/year (2.89, 11.09). Changes in aspartate aminotransferase were comparable between groups. FIB-4 decreased in the DAA-treated but not the DAA-naïve group: -0.26 (-0.41, -0.11) versus 0.02 (-0.16, 0.20)/year, respectively. There was a faster increase in cluster of differentiation (CD)4 count of 0.05 (0.03-0.08) and CD8 count of 0.04 (0.02-0.07) log cells/mL/year in the DAA-treated compared with the DAA-naïve group (p < .001), but not in the CD4/CD8 ratio (p = .36). Among U.S. PWH/HCV coinfection treated with DAAs, we found modest changes in immunological markers and substantial improvements in hepatic markers modeled over 4 years of DAA treatment. Curative DAA treatment is critical to mitigate advanced liver fibrosis.

PURPOSE: To estimate the number of screenings received, life-years (LYs) saved, and number of screenings per LY saved per woman who participated in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) (Program) compared with those who did not participate (no Program). METHODS: We developed a time-to-event simulation model to compare the outcomes of women participating in the Program vs. no Program, categorized by race/ethnicity. Model input parameters included data from the Program's minimum data elements, United States Cancer Statistics, National Health Interview Survey, and published literature. The Program's impact was calculated as the difference in LYs between the Program and no Program using data from 2010 to 2019. RESULTS: Among 1 million women of all races/ethnicities who participated in the NBCCEDP in the last 10 years, 457,152 (standard deviation [SD]: 848) received more screenings than those who did not participate. These participants saved an average of 0.027 LYs per woman screened. In addition, we estimated that about 17 screenings would be required to save an additional 1 LY per woman screened in the Program compared with no Program. Per woman screened by race/ethnicity, non-Hispanic Black women had the highest estimated 0.075 LYs saved, followed by Hispanic women with 0.025 LYs, non-Hispanic White with 0.014 LYs, and non-Hispanic American Indian/Alaska Native and Asian/Pacific Islander had the least health outcome with 0.011 LYs. CONCLUSION: The reported findings underscore the importance of providing preventive health services to populations that might not otherwise have access to these services.

BACKGROUND AND OBJECTIVES: In 2023, the Advisory Committee on Immunization Practices recommended either Abrysvo, a vaccine administered during pregnancy, or nirsevimab, a monoclonal antibody administered to infants after birth, to protect infants from respiratory syncytial virus (RSV). Our objective was to assess the proportion of infants immunized against RSV through antenatal RSV vaccination or receipt of nirsevimab among linked pregnancy-infant dyads. METHODS: Using data from 10 Vaccine Safety Datalink health systems and a validated algorithm, we identified pregnant women aged 12 to 55 years with a live birth of 32 weeks' gestation or more from September 22, 2023, through March 31, 2024. We identified RSV vaccination using electronic health records supplemented with immunization information system (registry) data. Among infants from eligible pregnancies, we identified nirsevimab administered through March 31, 2024. We assessed infant RSV immunization, defined as exposure to antenatal RSV vaccination or receipt of nirsevimab, stratified by race and ethnicity, age, and birth month. RESULTS: A total of 36 949 eligible infants were included from 43 722 pregnancies. Overall, 72% of infants were immunized against RSV; estimates were highest among infants born to non-Hispanic (NH) Asian mothers (84%). Disparities were identified by race, with 60% coverage among infants born to NH Black or NH Middle Eastern or North African mothers. Coverage was 59% to 78% by birth month, with nirsevimab more commonly administered to infants born earlier in the season. CONCLUSIONS: In this population of infants, 72% were immunized against RSV. Although overall coverage was high, disparities in immunization by race and ethnicity are a call to action.

IMPORTANCE: The oral microbiome likely plays key roles in human health. Yet, population-representative characterizations are lacking. OBJECTIVE: To characterize the composition, diversity, and correlates of the oral microbiome in US adults. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed data from the population-representative National Health and Nutrition Examination Survey (NHANES) from 2009 to 2012. Microbiome data were made publicly available in 2024. NHANES participants were aged 18 to 69 years and provided oral rinse samples in 1 of 2 consecutive NHANES cycles (2009-2010 and 2011-2012). EXPOSURES: Demographic, socioeconomic, behavioral, anthropometric, metabolic, and clinical characteristics. MAIN OUTCOMES AND MEASURES: Oral microbiome measures, characterized through 16S ribosomal RNA gene sequencing, included α diversity (observed amplicon sequence variants [ASVs], Faith phylogenetic diversity, Shannon-Weiner Index, and Simpson Index); β diversity (unweighted UniFrac, weighted UniFrac, and Bray-Curtis dissimilarity); and prevalence and relative abundance at phylum level through genus level. Analyses accounted for the NHANES complex sample design. RESULTS: This study included 8237 US adults aged 18 to 69 years, representing 202 314 000 individuals (102 813 000 men [50.8%]; mean [SD] age, 42.3 [14.4] years; 9.3% self-reported as Mexican American, 12.1% as non-Hispanic Black, 64.7% as non-Hispanic White, 5.9% as other Hispanic, and 8.1% as other non-Hispanic individuals). The oral microbiome encompassed 37 bacterial phyla, 99 classes, 212 orders, 446 families, and 1219 genera. Five phyla (Firmicutes, Actinobacteria, Bacteroidetes, Proteobacteria, and Fusobacteria) and 6 genera (Veillonella, Streptococcus, Prevotella 7, Rothia, Actinomyces, and Gemella) were present in nearly all US adults (weighted prevalence, >99%). These genera were the most abundant, accounting for 65.7% of total abundance. Observed ASVs showed a quadratic pattern with age (peak at 30 years), were similar by sex, significantly lower among non-Hispanic White individuals, and increased with greater body mass index (BMI), alcohol use, and periodontal disease severity. All covariates together accounted for a modest proportion of oral microbiome variability as measured by β diversity: R2 = 8.7% (95% CI, 8.4%-9.1%) for unweighted UniFrac, R2 = 7.2% (95% CI, 6.6%-7.7%) for weighted UniFrac, and R2 = 6.3% (95% CI, 3.1%-6.7%) for Bray-Curtis matrices. By contrast, relative abundance of a few genera explained a high percentage of variability in β diversity for weighted UniFrac: Aggregatibacter (R2 = 22.4%; 95% CI, 22.1%-22.8%), Lactococcus (R2 = 21.6%; 95% CI, 20.9%-22.3%), and Haemophilus (R2 = 18.4%; 95% CI, 18.1%-18.8%). Prevalence and relative abundance of numerous genera were associated with age, race and ethnicity, smoking, BMI categories, alcohol use, and periodontal disease severity. CONCLUSIONS AND RELEVANCE: This cross-sectional study of the oral microbiome in US adults showed that a few genera were universally present and a different set of genera explained a high percentage of oral microbiome diversity across the population. This comprehensive characterization provides a contemporary reference standard for future studies.

Trichomonas vaginalis (TV) and bacterial vaginosis (BV) are highly prevalent vaginal infections. Both are associated with pelvic inflammatory disease and HIV acquisition and transmission, though the underlying mechanisms are incompletely understood. We characterized the effect of TV and BV infection on inflammatory markers in the vagina among reproductive-aged women in Atlanta, Georgia. Cervicovaginal lavage specimens were collected from HIV seronegative women at a baseline visit and again three months later. Eighteen individual cytokines, 17 T cell subsets, BV, and TV were measured at both timepoints. After natural log transformation, the median cytokine concentration and number of T cells were compared by infection status statistically using the Kruskal-Wallis test. A cytokine inflammation score and a T cell score were created using principal components analysis. The scores were then used as outcomes in separate linear mixed regression models with a random intercept. Sixty women had baseline data and 43 were seen for follow-up. The median age was 30 years, 78% self-reported Black race. TV and BV prevalence at the baseline visit was 15% and 37%, respectively. The concentration of 16 out of 18 cytokines differed by infection status. In multivariable modeling, neither TV nor BV were associated with cytokine score. Most CD4+ T cell subsets (7 out of 9) differed by infection status. In a multivariable model, TV infection was associated with a higher T cell score (1.54; 95%CI 0.00, 3.08). BV was not associated with a higher T cell score. Increased concentration of vaginal mucosal T cells may explain the observed association between TV infection and HIV risk.

Medetomidine, a nonopioid sedative not approved for use in humans, has periodically been detected in illegally manufactured opioids across North America since 2022. On May 11, 2024, the Chicago Department of Public Health (CDPH) and the Illinois Department of Public Health were alerted by hospitals and the Illinois Poison Center to an increase in emergency medical services responses for suspected opioid-involved overdoses with atypical symptoms, mostly clustered on Chicago's West Side. CDPH and CDC investigated and identified 12 confirmed, 26 probable, and 140 suspected overdoses involving medetomidine mixed with opioids among patients treated at three hospitals in Chicago's West Side during May 11-17, 2024. Medetomidine had not been previously identified in Chicago's illegal drug supply. Fentanyl was identified in all drug samples and blood specimens containing medetomidine. Most patients were male, non-Hispanic Black or African American, and aged 45-64 years; most patients with confirmed cases experienced bradycardia and had no or only a partial response to naloxone. This cluster is the largest reported for confirmed medetomidine-involved overdoses. Multisector surveillance, including by health care providers, toxicology laboratories, and public health personnel, was essential for quickly identifying and responding to new adulterants in the illegal drug supply. Because all specimens and samples in this investigation that contained medetomidine also contained natural or synthetic opioids, administering naloxone for all suspected opioid-involved overdoses remains crucial.

Objectives. To characterize the intersection of social determinants of health, measured as the availability of community opportunities for healthy living, and sexually transmitted infections (STIs) in California. Methods. Geocoded 2013-2021 California bacterial STI cases were aggregated into Healthy Places Index (HPI) quartiles. Communities in the lowest scoring HPI quartile have the fewest opportunities for healthy living, while communities in the highest scoring quartile have the most opportunities. Results. As community opportunities became more available, bacterial STI risk decreased. Asian people had the lowest bacterial STI rates, while Black/African American people had the highest. As community opportunities increased, White people had the largest overall STI risk reduction, Native Hawaiian and other Pacific Islander people had the smallest reduction, Hispanic/Latino people had equivalent gonorrhea and early syphilis risk, and American Indian/Alaska Native people had equivalent chlamydia risk. Conclusions. Although STI incidence decreased as community opportunities increased, people of different racial and ethnic identities were differentially affected. Because the availability of community opportunities is not enough to mitigate racial health disparities, more work is needed to ensure community-level STI prevention efforts are accessible and inclusive. (Am J Public Health. 2025;115(5):799-807. https://doi.org/10.2105/AJPH.2024.307963).

Young Black and Latino men who have sex with men are disproportionately affected by the U.S. HIV Epidemic, yet pre-exposure prophylaxis (PrEP) uptake remains low. To understand barriers and facilitators to PrEP uptake and persistence, we used a concurrent mixed methods design (quantitative: online surveys, n = 19; qualitative: individual interviews, n = 15) from providers (e.g., nurse practitioners, clinicians, and social workers) at 4 clinics providing PrEP services in Birmingham, Alabama and New York City. Although all providers were comfortable prescribing daily oral PrEP, they had concerns about on-demand PrEP (e.g., complex dosing schedule) and injectable PrEP (e.g., insurance barriers). Provider training is needed to address barriers to providing PrEP modalities beyond daily oral PrEP and increase uptake among young Black and Latino men who have sex with men. Additionally, in order to increase uptake of injectable PrEP, rising PrEP costs due to changes in the 340B Drug Pricing Program will need to be addressed.

Macrophages are major innate immune cells for the clearance of inhaled nanoparticles but may undergo cell death upon phagocytosis of certain nanoparticles due to their resistance to lysosomal degradation and high toxicity to the cell. Here we investigated the pyroptotic effect of exposure to fibrogenic multiwalled carbon nanotubes (MWCNTs) on macrophages, an inflammatory form of cell death. We first evaluated MWCNT-induced cell death in M1 and M2 macrophages that mediate the temporal inflammatory response to MWCNTs in mammalian lungs. Macrophages were differentiated from human monocytic THP-1 cells, followed by polarization to M1 or M2 cells. MWCNTs caused concentration- and time-dependent cytotoxicity in M1 and, to a lesser extent, M2 cells. Carbon black, an amorphous carbonous material control for CNTs, did not cause apparent toxicity in the cells. MWCNTs increased the production and secretion of IL-1β, accompanied by activation of caspase-1, in M1, but not M2, cells. Moreover, MWCNTs induced the formation of apoptosis-associated speck-like protein containing a C-terminal caspase recruitment domain specks and the release of cathepsin B in M1 cells, revealing activation of the nucleotide-binding, oligomerization domain-like receptor family pyrin domain containing 3 (NLRP3) inflammasome via lysosomal damage. MWCNTs induced the cleavage of gasdermin D (GSDMD) to form the 31 kDa N-terminal fragment (GSDMD-N), the pore-forming peptide causing pyroptotic cell death. Increased IL-1β release was completely suppressed by AC-YVAD-CMK (a caspase-1 inhibitor), MCC-950 (an NLRP3 inflammasome inhibitor), or CA-074 Me (a cathepsin B inhibitor), alongside the blockage of MWCNT-induced cleavage of GSDMD. The study demonstrates that MWCNTs trigger pyroptosis in M1 macrophages and boost sterile inflammation by activating the NLRP3 inflammasome pathway. SIGNIFICANCE STATEMENT: The nucleotide-binding, oligomerization domain-like receptor family pyrin domain containing 3 inflammasome mediates the inflammatory response to fibrogenic nanoparticles in the lung via multiple means. The current study uncovers the induction of pyroptotic death of macrophages as a major means of nanotoxicity and sterile inflammation via the nucleotide-binding, oligomerization domain-like receptor family pyrin domain containing 3 pathway by nanoparticles.

PROBLEM/CONDITION: Autism spectrum disorder (ASD). PERIOD COVERED: 2022. DESCRIPTION OF SYSTEM: The Autism and Developmental Disabilities Monitoring Network is an active surveillance program that estimates prevalence and characteristics of ASD and monitors timing of ASD identification among children aged 4 and 8 years. In 2022, a total of 16 sites (located in Arizona, Arkansas, California, Georgia, Indiana, Maryland, Minnesota, Missouri, New Jersey, Pennsylvania, Puerto Rico, Tennessee, Texas [two sites: Austin and Laredo], Utah, and Wisconsin) conducted surveillance for ASD among children aged 4 and 8 years and suspected ASD among children aged 4 years. Surveillance included children who lived in the surveillance area at any time during 2022. Children were classified as having ASD if they ever received 1) an ASD diagnostic statement in a comprehensive developmental evaluation, 2) autism special education eligibility, or 3) an ASD International Classification of Diseases, Ninth Revision (ICD-9) code in the 299 range or International Classification of Diseases, Tenth Revision (ICD-10) code of F84.0, F84.3, F84.5, F84.8, or F84.9. Children aged 4 years were classified as having suspected ASD if they did not meet the case definition for ASD but had an evaluator's suspicion of ASD documented in a comprehensive developmental evaluation. RESULTS: Among children aged 8 years in 2022, ASD prevalence was 32.2 per 1,000 children (one in 31) across the 16 sites, ranging from 9.7 in Texas (Laredo) to 53.1 in California. The overall observed prevalence estimate was similar to estimates calculated using Bayesian hierarchical and random effects models. ASD was 3.4 times as prevalent among boys (49.2) than girls (14.3). Overall, ASD prevalence was lower among non-Hispanic White (White) children (27.7) than among Asian or Pacific Islander (A/PI) (38.2), American Indian or Alaska Native (AI/AN) (37.5), non-Hispanic Black or African American (Black) (36.6), Hispanic or Latino (Hispanic) (33.0), and multiracial children (31.9). No association was observed between ASD prevalence and neighborhood median household income (MHI) at 11 sites; higher ASD prevalence was associated with lower neighborhood MHI at five sites.Record abstraction was completed for 15 of the 16 sites for 8,613 children aged 8 years who met the ASD case definition. Of these 8,613 children, 68.4% had a documented diagnostic statement of ASD, 67.3% had a documented autism special education eligibility, and 68.9% had a documented ASD ICD-9 or ICD-10 code. All three elements of the ASD case definition were present for 34.6% of children aged 8 years with ASD.Among 5,292 (61.4% of 8,613) children aged 8 years with ASD with information on cognitive ability, 39.6% were classified as having an intellectual disability. Intellectual disability was present among 52.8% of Black, 50.0% of AI/AN, 43.9% of A/PI, 38.8% of Hispanic, 32.7% of White, and 31.2% of multiracial children with ASD. The median age of earliest known ASD diagnosis was 47 months and ranged from 36 months in California to 69.5 months in Texas (Laredo).Cumulative incidence of ASD diagnosis or eligibility by age 48 months was higher among children born in 2018 (aged 4 years in 2022) than children born in 2014 (aged 8 years in 2022) at 13 of the 15 sites that were able to abstract records. Overall cumulative incidence of ASD diagnosis or eligibility by age 48 months was 1.7 times as high among those born in 2018 compared with those born in 2014 and ranged from 1.4 times as high in Arizona and Georgia to 3.1 times as high in Puerto Rico. Among children aged 4 years, for every 10 children meeting the case definition of ASD, one child met the definition of suspected ASD.Children with ASD who were born in 2018 had more evaluations and identification during ages 0-4 years than children with ASD who were born in 2014 during the 0-4 years age window, with an interruption in the pattern in early 2020 coinciding with onset of the COVID-19 pandemic.Overall, 66.5% of children aged 8 years with ASD had a documented autism test. Use of autism tests varied widely across sites: 24.7% (New Jersey) to 93.5% (Puerto Rico) of children aged 8 years with ASD had a documented autism test in their records. The most common tests documented for children aged 8 years were the Autism Diagnostic Observation Schedule, Autism Spectrum Rating Scales, Childhood Autism Rating Scale, Gilliam Autism Rating Scale, and Social Responsiveness Scale. INTERPRETATION: Prevalence of ASD among children aged 8 years was higher in 2022 than previous years. ASD prevalence was higher among A/PI, Black, and Hispanic children aged 8 years than White children aged 8 years, continuing a pattern first observed in 2020. A/PI, Black, and Hispanic children aged 8 years with ASD were also more likely than White or multiracial children with ASD to have a co-occurring intellectual disability. Identification by age 48 months was higher among children born in 2018 compared with children born in 2014, suggesting increased early identification consistent with historical patterns. PUBLIC HEALTH ACTION: Increased identification of autism, particularly among very young children and previously underidentified groups, underscores the increased demand and ongoing need for enhanced planning to provide equitable diagnostic, treatment, and support services for all children with ASD. The substantial variability in ASD identification across sites suggests opportunities to identify and implement successful strategies and practices in communities to ensure all children with ASD reach their potential.

OBJECTIVE: The objective of this study was to generate updated estimates for the incidence rate, cost burden, and case fatality rate (CFR) of neonatal herpes simplex virus (nHSV) infections in the US in 2019. METHODS: A nationally representative sample of US pediatric discharges was assessed using data from the Healthcare Cost and Utilization Project Kids' Inpatient Database to estimate the incidence, costs, and fatality of nHSV in 2019. Cases were estimated using herpes simplex virus International Classification of Diseases, Tenth Revision, Clinical Modification codes (B00.xx, A60.xx, or P35.2) among infants aged 28 days or younger admitted to the hospital and with hospital stays more than 5 days or resulting in death. A matching algorithm was developed to deduplicate records of readmissions or transfers from another hospital. Estimates were generated overall and by sociodemographic factors including race, US region, primary payer, and median household income. RESULTS: In total, 561 nHSV cases were estimated in the US in 2019, resulting in an incidence rate of 15.7 per 100 000 hospital births. The highest incidence rate was in the South (21.3; 95% confidence interval [CI], 19.0-23.9) and in infants born to Black birth parents (27.3; 95% CI, 22.8-32.4). The total cost to the US health care system was estimated at $28.9 million. The CFR among infants with nHSV was estimated to be 4.6%. CONCLUSION: This study updates the incidence rate, cost burden, and CFR of nHSV in 2019, an increase compared with past estimates, and highlights the racial and geographic disparities across the US. Public health interventions for early detection and prevention are critical to mitigate these disparities.

INTRODUCTION: Although preventable, dental caries remains highly prevalent. Many children do not receive preventive dental services routinely in clinical settings. This review examined the effectiveness of school (preschool through high school) fluoride varnish delivery programs (SFVDP) in preventing caries. METHODS: Community Guide systematic review methods were followed. In 2024, databases were searched for studies published through December 2023 on SFVDP effectiveness in increasing fluoride varnish (FV) receipt and decreasing caries. Included studies had to be written in English, published in peer-reviewed journals, and conducted in upper-middle or high-income countries. Data synthesis conducted in 2024 used median RR and interquartile interval (IQI) to summarize findings across studies. RESULTS: Of 31 included studies with 60,780 students, 25 were randomized controlled trials-20 with good quality of execution. Most studies were conducted in low socioeconomic status (SES) areas among students at elevated caries risk. SFVDP reduced caries initiation by 32% (IQI: 21%, 37%) in permanent teeth (19 studies, 25,826 students) and by 25% (IQI: 4%, 37%) in primary teeth (12 studies, 4,304 students). Stratified assessments indicated findings were largely applicable to different settings, populations, and intervention characteristics. Two studies found SFVDP significantly increased the number of annual FV applications and two found that SFVDP effectiveness was inversely related to SES. DISCUSSION: About 30% of states report having no SFVDPs. Possible barriers to implementation include that Medicaid in some states only reimburses dental and medical professionals and does not reimburse non-dental providers for FV delivered to children older than 6 years.

OBJECTIVE: Promoting health during adolescence can support long-term well-being, especially for teens diagnosed with attention-deficit/hyperactivity disorder (ADHD), who face increased risks due to the disorder's impact on development and health behaviors. ADHD is often associated with difficulties in social interactions, a higher likelihood of bullying involvement, and co-occurring mental health conditions. These factors may also be influenced by health factors such as physical activity, sleep quality, and screen time usage. Nationally representative teen self-reports provide a novel perspective on ADHD-related health outcomes compared with relying on parent reports. METHOD: We used nationally representative data from the National Health Interview Survey (NHIS) and NHIS-Teen from July 2021 to December 2022, to examine teen-reported health and well-being factors, stratified by parent-reported ADHD diagnoses among teens aged 12 to 17 years. Weighted prevalence estimates and adjusted prevalence ratios (aPR) adjusting for teen age, sex, and family income, all with 95% confidence intervals (CIs), were calculated. RESULTS: Just over 10% of teens had ADHD and they reported higher prevalence of bullying victimization (aPR = 1.64, CI = 1.27-2.11), difficulties making friends (aPR = 1.83, CI = 1.15-2.90), difficulty getting out of bed (aPR = 1.29, CI = 1.02-1.64), irregular wake times (aPR = 2.17, CI = 1.45-3.25), and >4 hours daily screen time (aPR = 1.26, CI = 1.05-1.52) than teens without ADHD; teens with ADHD reported a lower prevalence of lacking peer support (aPR = 0.70, CI = 0.51-0.96). CONCLUSION: Teens with ADHD face distinct challenges related to social-emotional well-being and health behaviors that support overall wellness. Findings may inform opportunities for health promotion among teens with ADHD.

BACKGROUND: Since 2013, national trends in behavioral factors that increase STI risk among adolescent and young adult (A/YA) females have been mixed (e.g., fewer sex partners, lower condom use). We used data from a national sample of A/YA females to examine racial disparities in CT prevalence considering these trends. METHODS: Using 2011-March 2020 National Health and Nutrition Examination Survey data, we estimated the prevalence, unadjusted and adjusted prevalence ratios (APRs) of a positive CT urine test among sexually experienced non-Hispanic Black (Black), Hispanic, non-Hispanic Other race (NHO), and non-Hispanic White (White) A/YA females. Percentages were categorized by race/ethnicity, and each compared to the average of the other race/ethnic groups (e.g., Black vs. Hispanic, NHO and White). Covariates included age group, health insurance coverage, number of sex partners and condom use (both past year). RESULTS: Overall, the prevalence of CT infection among A/YA females was 5.8% (95% CI: 4.5%-7.3%). CT prevalence was higher among Black females (vs. Hispanic, NHO, and White) (11.7%; 95%CI: 8.7%-15.2%) and lower among White females (vs. Black, Hispanic, and NHO) (3.2%; 95%CI: 1.7%-5.5%). Compared with the average CT prevalence for Hispanic, NHO, and White females, Black females had a higher adjusted CT prevalence (APR: 2.48, 95%CI: 1.63-3.75). CONCLUSIONS: Nationally, CT prevalence was 2.5 times as high among Black A/YA females than the average prevalence for Hispanic, NHO, and White females. Inclusion of behavioral STI risk factors did not attenuate this association. Research incorporating sexual network-level factors associated with CT transmission may provide additional insights.

IMPORTANCE: Invasive group A Streptococcus (GAS) infections are associated with substantial morbidity, mortality, and economic burden. OBJECTIVE: To update trends in invasive GAS disease incidence rates in 10 US states between 2013 and 2022. DESIGN, SETTING, AND PARTICIPANTS: Clinical, demographic, and laboratory data for invasive GAS cases were collected as part of population-based surveillance in the Active Bacterial Core surveillance network covering 34.9 million persons across 10 US states. A case was defined as isolation of GAS from a normally sterile site or from a wound in a patient with necrotizing fasciitis or streptococcal toxic shock syndrome between January 1, 2013, and December 31, 2022. Demographic and clinical data were collected from medical record review. From 2013 to 2014, available isolates were emm typed and antimicrobial susceptibilities determined using conventional methods; from 2015 onward, whole-genome sequencing was used. MAIN OUTCOMES AND MEASURES: Incidence rates by sex, age, race, and selected risk factors; clinical syndromes, outcomes, and underlying patient conditions; and isolate characteristics, including antimicrobial susceptibility. RESULTS: Surveillance in 10 US states identified 21 312 cases of invasive GAS from 2013 through 2022, including 1981 deaths. The majority of cases (57.5%) were in males. Among case-patients, 1272 (6.0%) were aged 0 to 17 years, 13 565 (63.7%) were aged 18 to 64 years, and 6474 (30.4%) were 65 years or older; 5.5% were American Indian or Alaska Native, 14.3% were Black, and 67.1% were White. Incidence rose from 3.6 per 100 000 persons in 2013 to 8.2 per 100 000 persons in 2022 (P < .001 for trend). Incidence was highest among persons 65 years or older; however, the relative increase over time was greatest among adults aged 18 to 64 years (3.2 to 8.7 per 100 000 persons). Incidence was higher among American Indian or Alaska Native persons than in other racial and ethnic groups. People experiencing homelessness, people who inject drugs, and residents of long-term care facilities had substantially elevated GAS incidence rates. Among tested isolates, those nonsusceptible to macrolides and clindamycin increased from 12.7% in 2013 to 33.1% in 2022. CONCLUSIONS: Invasive GAS infections increased substantially in 10 US states during a surveillance period from 2013 to 2022. Accelerated efforts to prevent and control GAS are needed, especially among groups at highest risk of infection.

BACKGROUND: Black or African American and Hispanic/Latino gay, bisexual, and other men who have sex with men (BMSM and HLMSM) in the United States (US) are disproportionately affected by HIV. We analyze the cost and cost-effectiveness of HIV self-testing through online recruitment of BMSM and HLMSM into an HIV self-testing study. SETTING: 11 US states, February 2020-February 2021. METHODS: BMSM and HLMSM aged ≥18 years without previous HIV diagnosis or current pre-exposure prophylaxis use were recruited through dating and general interest websites/apps (sites). Using the healthcare provider perspective and a 16-month timeframe, we assessed economic costs (2022 US Dollars) of online recruitment, HIV self-test (HIVST) distribution, and participant support. A time-motion study tracked staff time spent on study implementation activities. We reported incremental program cost, cost per HIVST used, and cost per new HIV diagnosis comparing recruitment via dating versus general interest sites. RESULTS: The total cost was $275,776 to enroll 1,306 participants through dating sites, and support 1,005 MSM who used an HIVST (11.74% positivity). The total cost was $168,099 to enroll 600 participants through general interest sites, and support 511 MSM who used an HIVST (5.48% positivity). Recruitment via dating versus general interest sites was more costly and more effective, with incremental cost-effectiveness ratios (ICERs) of $218/HIVST used and $1,196/new diagnosis, relatively low cost per new HIV diagnosis compared with those estimated in other HIV testing interventions. ICERs were higher for HLMSM versus BMSM. CONCLUSIONS: HIV self-testing through dating and general interest site recruitment may be an effective and cost-effective approach to increase new HIV diagnoses.

During the 2023-2024 respiratory syncytial virus (RSV) season, vaccination was recommended for adults ≥60 years based on shared clinical decision-making with their healthcare providers. We examined RSV vaccine uptake and characteristics associated with uptake among age-eligible Kaiser Permanente Southern California (KPSC) patients. Our study cohort included all patients ≥60 years from September 23, 2023 (i.e., date RSV vaccination first became available at KPSC; N = 1,003,132) to April 9, 2024 (i.e., end of local RSV season). To identify sociodemographic and clinical characteristics associated with RSV vaccination, we used multivariable robust Poisson regression to estimate the adjusted relative risk (aRR) and 95 % CI. Overall, 7.6 % of patients were vaccinated for RSV. In multivariable regression analyses, those aged 70-79.9 years (aRR: 1.36; 95 % CI: 1.34-1.39) and aged ≥80 years (aRR: 1.35; 95 % CI: 1.32-1.38) were more likely to be vaccinated, compared with those aged 60-69.9 years. Compared with Non-Hispanic White patients, Asian (aRR: 0.95; 95 % CI: 0.93-0.97), Hispanic (aRR: 0.52; 95 % CI: 0.51-0.54), Non-Hispanic Black (aRR: 0.69; 95 % CI: 0.67-0.71), Pacific Islander (aRR: 0.91; 95 % CI: 0.84-0.98), and Native American or Alaska Native (aRR: 0.80; 95 % CI: 0.70-0.92) patients were less likely to be vaccinated. Those in higher neighborhood deprivation quartiles were less likely to be vaccinated (Q2: aRR: 0.86; 95 % CI: 0.85-0.88; Q3: aRR: 0.77; 95 % CI: 0.76-0.79; and Q4: aRR: 0.67; 95 % CI: 0.65-0.68), compared with those in the lowest deprivation quartile. We found low vaccination uptake and identified disparities in vaccination that might exacerbate existing disparities in RSV infection and severe RSV disease among certain populations. CDC's ACIP recently updated their recommendations for all adults 75+ years, and this might begin to address these disparities.

Introduction: Motor-vehicle crash (MVC) deaths increased by a record 10% from 2020 to 2021 in the United States and disproportionately impacted persons of certain racial/ethnic groups. Methods: Mortality data from the National Vital Statistics System was used to describe MVC death rate trends during 2019–2022 by six racial/ethnic groups: non-Hispanic (NH) American Indian or Alaska Native (AIAN), NH Asian, NH Black, NH Native Hawaiian or Other Pacific Islander (NHOPI), NH White, and Hispanic. Age-adjusted death rates per 100,000 population, 95% confidence intervals (CIs), and annual percent change in rates were calculated. Results: Overall MVC death rates increased during 2019–2022, and rates were highest among NH AIAN and NH Black persons across all years. During 2019–2020, death rates increased the most among NH Black persons (+26.0%). During 2020–2021, rates increased among all racial/ethnic groups, with the greatest increase among NH NHOPI persons (+66.7%) and NH AIAN persons (+27.8%). Conclusions: These findings highlight stark differences by racial/ethnic group in MVC death rates and changes in these rates. Between 2019 and 2022, NH AIAN, NH Black, and NH NHOPI populations experienced the largest increases in MVC death rates, although there was large variation in rates and trends. Widespread adoption of a comprehensive suite of prevention strategies, such as the Safe System approach, while targeting subpopulations with the greatest burden of MVC deaths could reduce these differences and the overall burden of MVCs. Practical Applications: These findings show which subpopulations could experience the greatest impacts from transportation safety investments in reducing overall MVC death rates in the United States. © 2025