Objectives | Given recent increases in congenital syphilis (CS) in the United States, we describe national trends in the number of CS-related stillbirths, describe CS-related stillbirths by gestational age, and compare characteristics of women delivering CS-related stillbirths to those delivering full term and preterm liveborn CS infants to provide important clinical insight. | | Methods | CS is nationally notifiable with case reports submitted to Centers for Disease Control and Prevention (CDC). We analyzed reported cases of CS born during 20152019, categorizing birth outcomes as stillbirth, preterm <37 weeks, or full term 37 weeks; cases with unknown vital status or gestational age were excluded. We calculated frequencies of maternal clinical characteristics by birth outcome, including receipt of prenatal care, stage of syphilis, and highest reported titer during pregnancy. | | Results | Of the 5,269 CS cases reported to CDC for 20152019, 5,127 (97.3%) had known vital status and gestational age. Among these, 307 (6.0%) were stillbirths. While the number of CS-related stillbirths increased each year during 20152019 (from 2994), the proportion of CS cases reported as stillbirths did not vary considerably across the period (range: 5.1%7.3%). Median gestational age at delivery for CS-related stillbirths was 30 weeks (interquartile range: 2733 weeks). Most CS cases were born to mothers with early latent (31.4%) or late/unknown duration (59.7%) syphilis, though mothers of stillborn infants were 2.3 times as likely as mothers of full term liveborn infants to have secondary syphilis (10.8% vs. 4.6%). Adverse pregnancy outcomes were more likely to have a high maternal syphilis titer; 80.8% of stillbirth, 58.1% of preterm, and 40.2% of full-term deliveries occurred among women with a titer 1:32 during pregnancy. Among women delivering a CS-related stillbirth, 33 (10.7%) had evidence of syphilis seroconversion during pregnancy. Most mothers delivering a CS-related stillbirth (53.4%) did not receive prenatal care, compared to mothers delivering full term liveborn CS infants (18.4%). | | Conclusions | Increases in CS-related stillbirths in the United States reflect increases in CS cases; without prevention efforts, CS could become a larger contributor to overall U.S. stillbirth levels. Understanding when CS-related stillbirths occur, as well as the differences between women delivering CS-related stillbirths and women delivering liveborn CS infants (higher titer, syphilis stage, and prenatal care) may aid with stillbirth prevention. Overcoming barriers to prenatal care is essential for preventing CS stillbirths. Low rates of prenatal care also highlight the importance of syphilis testing outside traditional settings and at the time of stillbirth delivery. Delivery may provide a rare interaction with the healthcare system enabling syphilis testing and treatment, and prevention of future CS-related adverse outcomes.

The sexually transmitted disease (STD) Prevention Conference occurs every 2 years, bringing together experts from government, academia, medicine, industry, and beyond. This conference is a place where advancements in STD diagnostics, treatments, and program science are unveiled alongside earnest conversations about the prevention and control challenges facing the field of STDs in the 21st century. Planning for the 2020 Conference began in late 2018—organized around the theme “2020 Vision: Disrupting Epidemics and Dismantling Disparities.” The theme spoke both to an interest in reducing the overall STD burden and to an interest in reducing that burden in such a way that centers health equity—ambitious but reasonable goals for a new decade.

INTRODUCTION: Public health responses often lack the infrastructure to capture the impact of public health emergencies on pregnant women and infants, with limited mechanisms for linking pregnant women with their infants nationally to monitor long-term effects. In 2019, the Centers for Disease Control and Prevention (CDC), in close collaboration with state, local, and territorial health departments, began a 5-year initiative to establish population-based mother-baby linked longitudinal surveillance, the Surveillance for Emerging Threats to Mothers and Babies Network (SET-NET). OBJECTIVES: The objective of this report is to describe an expanded surveillance approach that leverages and modernizes existing surveillance systems to address the impact of emerging health threats during pregnancy on pregnant women and their infants. METHODS: Mother-baby pairs are identified through prospective identification during pregnancy and/or identification of an infant with retrospective linking to maternal information. All data are obtained from existing data sources (e.g., electronic medical records, vital statistics, laboratory reports, and health department investigations and case reporting). RESULTS: Variables were selected for inclusion to address key surveillance questions proposed by CDC and health department subject matter experts. General variables include maternal demographics and health history, pregnancy and infant outcomes, maternal and infant laboratory results, and child health outcomes up to the second birthday. Exposure-specific modular variables are included for hepatitis C, syphilis, and Coronavirus Disease 2019 (COVID-19). The system is structured into four relational datasets (maternal, pregnancy outcomes and birth, infant/child follow-up, and laboratory testing). DISCUSSION: SET-NET provides a population-based mother-baby linked longitudinal surveillance approach and has already demonstrated rapid adaptation to COVID-19. This innovative approach leverages existing data sources and rapidly collects data and informs clinical guidance and practice. These data can help to reduce exposure risk and adverse outcomes among pregnant women and their infants, direct public health action, and strengthen public health systems.

During early August 2020, county-level incidence of coronavirus disease 2019 (COVID-19) generally decreased across the United States, compared with incidence earlier in the summer (1); however, among young adults aged 18-22 years, incidence increased (2). Increases in incidence among adults aged ≥60 years, who might be more susceptible to severe COVID-19-related illness, have followed increases in younger adults (aged 20-39 years) by an average of 8.7 days (3). Institutions of higher education (colleges and universities) have been identified as settings where incidence among young adults increased during August (4,5). Understanding the extent to which these settings have affected county-level COVID-19 incidence can inform ongoing college and university operations and future planning. To evaluate the effect of large colleges or universities and school instructional format* (remote or in-person) on COVID-19 incidence, start dates and instructional formats for the fall 2020 semester were identified for all not-for-profit large U.S. colleges and universities (≥20,000 total enrolled students). Among counties with large colleges and universities (university counties) included in the analysis, remote-instruction university counties (22) experienced a 17.9% decline in mean COVID-19 incidence during the 21 days before through 21 days after the start of classes (from 17.9 to 14.7 cases per 100,000), and in-person instruction university counties (79) experienced a 56.2% increase in COVID-19 incidence, from 15.3 to 23.9 cases per 100,000. Counties without large colleges and universities (nonuniversity counties) (3,009) experienced a 5.9% decline in COVID-19 incidence, from 15.3 to 14.4 cases per 100,000. Similar findings were observed for percentage of positive test results and hotspot status (i.e., increasing among in-person-instruction university counties). In-person instruction at colleges and universities was associated with increased county-level COVID-19 incidence and percentage test positivity. Implementation of increased mitigation efforts at colleges and universities could minimize on-campus COVID-19 transmission.

Poverty, crowded housing, and other community attributes associated with social vulnerability increase a community's risk for adverse health outcomes during and following a public health event (1). CDC uses standard criteria to identify U.S. counties with rapidly increasing coronavirus disease 2019 (COVID-19) incidence (hotspot counties) to support health departments in coordinating public health responses (2). County-level data on COVID-19 cases during June 1-July 25, 2020 and from the 2018 CDC social vulnerability index (SVI) were analyzed to examine associations between social vulnerability and hotspot detection and to describe incidence after hotspot detection. Areas with greater social vulnerabilities, particularly those related to higher representation of racial and ethnic minority residents (risk ratio [RR] = 5.3; 95% confidence interval [CI] = 4.4-6.4), density of housing units per structure (RR = 3.1; 95% CI = 2.7-3.6), and crowded housing units (i.e., more persons than rooms) (RR = 2.0; 95% CI = 1.8-2.3), were more likely to become hotspots, especially in less urban areas. Among hotspot counties, those with greater social vulnerability had higher COVID-19 incidence during the 14 days after detection (212-234 cases per 100,000 persons for highest SVI quartile versus 35-131 cases per 100,000 persons for other quartiles). Focused public health action at the federal, state, and local levels is needed not only to prevent communities with greater social vulnerability from becoming hotspots but also to decrease persistently high incidence among hotspot counties that are socially vulnerable.

Among 146 nasopharyngeal (NP) and oropharyngeal (OP) swab pairs collected </=7 days since illness onset, CDC real-time RT-PCR SARS-CoV-2 assay diagnostic results were 95.2% concordant. However, NP swab Ct values were lower (indicating more virus) in 66.7% of concordant-positive pairs, suggesting NP swabs may more accurately detect amount of SARS-CoV-2.

Globally, approximately 170,000 confirmed cases of coronavirus disease 2019 (COVID-19) caused by the 2019 novel coronavirus (SARS-CoV-2) have been reported, including an estimated 7,000 deaths in approximately 150 countries (1). On March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic (2). Data from China have indicated that older adults, particularly those with serious underlying health conditions, are at higher risk for severe COVID-19-associated illness and death than are younger persons (3). Although the majority of reported COVID-19 cases in China were mild (81%), approximately 80% of deaths occurred among adults aged ≥60 years; only one (0.1%) death occurred in a person aged ≤19 years (3). In this report, COVID-19 cases in the United States that occurred during February 12-March 16, 2020 and severity of disease (hospitalization, admission to intensive care unit [ICU], and death) were analyzed by age group. As of March 16, a total of 4,226 COVID-19 cases in the United States had been reported to CDC, with multiple cases reported among older adults living in long-term care facilities (4). Overall, 31% of cases, 45% of hospitalizations, 53% of ICU admissions, and 80% of deaths associated with COVID-19 were among adults aged ≥65 years with the highest percentage of severe outcomes among persons aged ≥85 years. In contrast, no ICU admissions or deaths were reported among persons aged ≤19 years. Similar to reports from other countries, this finding suggests that the risk for serious disease and death from COVID-19 is higher in older age groups.

Community transmission of coronavirus disease 2019 (COVID-19) was first detected in the United States in February 2020. By mid-March, all 50 states, the District of Columbia (DC), New York City (NYC), and four U.S. territories had reported cases of COVID-19. This report describes the geographic distribution of laboratory-confirmed COVID-19 cases and related deaths reported by each U.S. state, each territory and freely associated state,* DC, and NYC during February 12-April 7, 2020, and estimates cumulative incidence for each jurisdiction. In addition, it projects the jurisdiction-level trajectory of this pandemic by estimating case doubling times on April 7 and changes in cumulative incidence during the most recent 7-day period (March 31-April 7). As of April 7, 2020, a total of 395,926 cases of COVID-19, including 12,757 related deaths, were reported in the United States. Cumulative COVID-19 incidence varied substantially by jurisdiction, ranging from 20.6 cases per 100,000 in Minnesota to 915.3 in NYC. On April 7, national case doubling time was approximately 6.5 days, although this ranged from 5.5 to 8.0 days in the 10 jurisdictions reporting the most cases. Absolute change in cumulative incidence during March 31-April 7 also varied widely, ranging from an increase of 8.3 cases per 100,000 in Minnesota to 418.0 in NYC. Geographic differences in numbers of COVID-19 cases and deaths, cumulative incidence, and changes in incidence likely reflect a combination of jurisdiction-specific epidemiologic and population-level factors, including 1) the timing of COVID-19 introductions; 2) population density; 3) age distribution and prevalence of underlying medical conditions among COVID-19 patients (1-3); 4) the timing and extent of community mitigation measures; 5) diagnostic testing capacity; and 6) public health reporting practices. Monitoring jurisdiction-level numbers of COVID-19 cases, deaths, and changes in incidence is critical for understanding community risk and making decisions about community mitigation, including social distancing, and strategic health care resource allocation.

Increasingly applied to identify mutations conferring antimicrobial resistance (AMR), disease outbreaks, and pathways of disease spread, whole genome sequencing (WGS)—the process of determining the complete DNA sequence of an organism’s genome at a single time—has emerged as a powerful tool for public health. Genomic analyses played central roles in recent outbreak investigations, such as of a high-profile outbreak of carbapenem-resistant Klebsiella pneumoniae at the US National Institutes of Health Clinical Center, the 2010 outbreak of cholera in Haiti, the 2014–2015 HIV outbreak in Indiana, the epidemic of Zika virus in the Americas, and large outbreaks of foodborne and waterborne illness.1–7 Whole genome sequencing findings have informed development of novel molecular diagnostics and explorations of human microbiomes.8,9 Whereas DNA sequencing methods were painstakingly performed manually decades ago, the development of automated methods in the 1990s, followed by rapidly accelerating speed of sequencing, plummeting cost, increasing computational capacity, growing number of sequences in publically available repositories (e.g., GenBank), and increasing availability of bioinformatics tools in the past decade, have supported a dramatic expansion of WGS.

Background: Several clusters of serogroup C meningococcal disease among men who have sex with men (MSM) have been reported in the United States in recent years. The epidemiology and risk of meningococcal disease among MSM is not well-described. Methods: All meningococcal disease cases among men aged 18-64 years reported to the National Notifiable Disease Surveillance System between January 2012 and June 2015 were reviewed. Characteristics of meningococcal disease cases among MSM and men not known to be MSM (non-MSM) were described. Annualized incidence rates among MSM and non-MSM were compared through calculation of the relative risk and 95% confidence intervals. Isolates from meningococcal disease cases among MSM were characterized using standard microbiological methods and whole genome sequencing. Results: Seventy-four cases of meningococcal disease were reported among MSM and 453 among non-MSM. Annualized incidence of meningococcal disease among MSM was 0.56 cases per 100,000 population, compared to 0.14 among non-MSM, for a relative risk of 4.0 (95% CI: 3.1-5.1). Among the 64 MSM with known status, 38 (59%) were HIV-infected. HIV-infected MSM had 10.1 times (95% CI: 6.1-16.6) the risk of HIV-uninfected MSM. All isolates from cluster-associated cases were serogroup C sequence type 11. Conclusions: MSM are at increased risk for meningococcal disease, although the incidence of disease remains low. HIV infection may be an important factor for this increased risk. Routine vaccination of HIV-infected persons with a quadrivalent meningococcal conjugate vaccine in accordance with Advisory Committee on Immunization Practices recommendations should be encouraged.