OBJECTIVES: About 13% of pregnant women with substance use disorder (SUD) receive treatment and many may encounter challenges in accessing perinatal care, making it critical for this population to receive uninterrupted care during a global pandemic. METHODS: From October 2021-January 2022, we conducted an online survey of pregnant and postpartum women and interviews with clinicians who provide care to this population. The survey was administered to pregnant and postpartum women who used substances or received SUD treatment during the COVID-19 pandemic. RESULTS: Two hundred and ten respondents completed the survey. All respondents experienced pandemic-related barriers to routine health care services, including delays in prenatal care and SUD treatment. Disruptions in treatment were due to patient factors (38.2% canceled an appointment) and clinic factors (25.5% had a clinic cancel their appointment). Respondents were generally satisfied with telehealth (M = 3.97, SD = 0.82), though half preferred a combination of in-person and telehealth visits. Clinicians reported telehealth improved health care access for patients, however barriers were still observed. CONCLUSIONS: Although strategies were employed to mitigate barriers in care during COVID-19, pregnant and postpartum women who used substances still experienced barriers in receiving consistent care. Telehealth may be a useful adjunct to enhance care access for pregnant and postpartum women during public health crises.

Animal to human transmission of SARS-CoV-2 has not previously been reported in a zoo setting. A vaccinated African lion with physical limitations requiring hand feeding tested positive for SARS-CoV-2 after development of respiratory signs. Zoo employees were screened, monitored prospectively for development of symptoms, then re-screened as indicated, with confirmation by RT-PCR and whole-genome virus sequencing when possible. Trace-back investigation narrowed the source of infection to one of five people. Three exposed employees subsequently developed symptoms, two with viral genomes identical to the lion's. Forward contact tracing investigation confirmed probable lion-to-human transmission. Close contact with large cats is a risk factor for bidirectional zoonotic SARS-CoV-2 transmission that should be considered when occupational health and biosecurity practices at zoos are designed and implemented. SARS-CoV-2 rapid testing and detection methods in big cats and other susceptible animals should be developed and validated to facilitate timely implementation of One Health investigations. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.

We describe animal-to-human transmission of SARS-CoV-2 in a zoo setting in Indiana, USA. A vaccinated African lion with physical limitations requiring hand feeding tested positive for SARS-CoV-2 after onset of respiratory signs. Zoo employees were screened, monitored prospectively for onset of symptoms, then rescreened as indicated; results were confirmed by using reverse transcription PCR and whole-genome virus sequencing when possible. Traceback investigation narrowed the source of infection to 1 of 6 persons. Three exposed employees subsequently had onset of symptoms, 2 with viral genomes identical to the lion's. Forward contact tracing investigation confirmed probable lion-to-human transmission. Close contact with large cats is a risk factor for bidirectional zoonotic SARS-CoV-2 transmission that should be considered when occupational health and biosecurity practices at zoos are designed and implemented. SARS-CoV-2 rapid testing and detection methods for big cats and other susceptible animals should be developed and validated to enable timely implementation of One Health investigations.

Since May 2022, approximately 20,000 cases of monkeypox have been identified in the United States, part of a global outbreak occurring in approximately 90 countries and currently affecting primarily gay, bisexual, and other men who have sex with men (MSM) (1). Monkeypox virus (MPXV) spreads from person to person through close, prolonged contact; a small number of cases have occurred in populations who are not MSM (e.g., women and children), and testing is recommended for persons who meet the suspected case definition* (1). CDC previously developed five real-time polymerase chain reaction (PCR) assays for detection of orthopoxviruses from lesion specimens (2,3). CDC was granted 510(k) clearance for the nonvariola-orthopoxvirus (NVO)-specific PCR assay by the Food and Drug Administration. This assay was implemented within the Laboratory Response Network (LRN) in the early 2000s and became critical for early detection of MPXV and implementation of public health action in previous travel-associated cases as well as during the current outbreak (4-7). PCR assays (NVO and other Orthopoxvirus laboratory developed tests [LDT]) represent the primary tool for monkeypox diagnosis. These tests are highly sensitive, and cross-contamination from other MPXV specimens being processed, tested, or both alongside negative specimens can occasionally lead to false-positive results. This report describes three patients who had atypical rashes and no epidemiologic link to a monkeypox case or known risk factors; these persons received diagnoses of monkeypox based on late cycle threshold (Ct) values ≥34, which were false-positive test results. The initial diagnoses were followed by administration of antiviral treatment (i.e., tecovirimat) and JYNNEOS vaccine postexposure prophylaxis (PEP) to patients' close contacts. After receiving subsequent testing, none of the three patients was confirmed to have monkeypox. Knowledge gained from these and other cases resulted in changes to CDC guidance. When testing for monkeypox in specimens from patients without an epidemiologic link or risk factors or who do not meet clinical criteria (or where these are unknown), laboratory scientists should reextract and retest specimens with late Ct values (based on this report, Ct ≥34 is recommended) (8). CDC can be consulted for complex cases including those that appear atypical or questionable cases and can perform additional viral species- and clade-specific PCR testing and antiorthopoxvirus serologic testing.

As ownership of NTP species is increasing, the number and size of outbreaks associated with NTPs in recent years has also increased. Non-traditional pet owners and members of the public who may come into contact with NTPs should be aware of the potential health risks and understand that even apparently healthy animals can transmit pathogens. The recommendations in this Compendium provide public health professionals, animal health professionals, industry, and healthcare providers (including veterinarians, physicians, and allied health professionals) resources to prevent disease transmission and spread. These recommendations aim to benefit all partners by preventing human infections,maintaining animal health and welfare, and providing economic benefits. © 2022 Mary Ann Liebert Inc.. All rights reserved.

A kidney transplant patient without known tick exposure developed encephalitis three weeks after transplantation. During the transplant hospitalization, the patient had received a blood transfusion from an asymptomatic donor later discovered to have been infected with Powassan virus. This report describes a probable instance of transfusion-transmitted Powassan virus infection.

OBJECTIVE: To evaluate species identification and rabies virus (RABV) characterization among samples from bats submitted for rabies testing in the United States and assess whether a standardized approach to specimen selection for RABV characterization could enhance detection of a sentinel event in virus dissemination among bats. SAMPLE: United States public health rabies surveillance system data collected in January 2010 through December 2015. PROCEDURES: The number of rabies-tested bats for which species was reported and the number of RABV-positive samples for which virus characterization would likely provide information regarding introduction of novel RABV variants and translocation and host-shift events were calculated. These specimens were designated as specimens of epizootiological importance (SEIs). Additionally, the estimated test load that public health laboratories could expect if all SEIs underwent RABV characterization was determined. RESULTS: Species was reported for 74,928 of 160,017 (47%) bats submitted for rabies testing. Identified SEIs were grouped in 3 subcategories, namely nonindigenous bats; bats in southern border states, Florida, Puerto Rico, and the US Virgin Islands; and bats of species that are not commonly found to be inflected with RABV. Annually, 692 (95% CI, 600 to 784) SEIs were identified, of which only 295 (95% CI, 148 to 442) underwent virus characterization. Virus characterization of all SEIs would be expected to increase public health laboratories' overall test load by 397 (95% CI, 287 to 506) samples each year. CONCLUSIONS AND CLINICAL RELEVANCE: Species identification and RABV characterization may aid detection of a sentinel event in bat RABV dissemination. With additional resources, RABV characterization of all SEIs as a standardized approach to testing could contribute to knowledge of circulating bat RABV variants.

As of December 4, 2019, a total of 2,291 cases of hospitalized e-cigarette, or vaping, product use-associated lung injury (EVALI) have been reported from 50 states, the District of Columbia, and two U.S. territories (Puerto Rico and the U.S. Virgin Islands) (1). State health departments, including the Indiana State Department of Health (ISDH), are working with their local health departments and with CDC, the Food and Drug Administration, and other clinical and public health partners in investigating this outbreak of EVALI. On August 7, 2019, ISDH issued an advisory regarding patients hospitalized in Wisconsin with severe acute lung injury who reported the use of e-cigarette, or vaping, products (2); health care providers were requested to notify ISDH of similar cases. On August 8, 2019, ISDH received reports of five similar cases among Indiana residents. Suspected cases EVALI reported to ISDH were investigated further only among patients who required hospitalization. Established case definitions were used to classify cases.* Medical record abstractions and patient interviews were completed using nationally standardized forms to ascertain patient characteristics, medical care received, and product-use behaviors.

In the midwestern United States, the principal vector for Lyme disease (Borrelia burgdorferi) and babesiosis (Babesia microti) is the Ixodes scapularis tick, which has been documented in 77 of 92 Indiana counties (Indiana State Department of Health [ISDH], unpublished data, 2018) (1). The average annual Lyme disease incidence in Indiana is low (1.3 cases per 100,000 population during 2011–2015) (2); however, rates in some northwestern counties are higher (3). A two-tiered serologic testing algorithm is recommended for diagnosing Lyme disease (4). Babesiosis is rare in Indiana, with no confirmed cases and one probable case reported during 2011–2015. Blood smear examination or polymerase chain reaction (PCR) analysis are typically recommended for the diagnosis of acute babesiosis (5). In June 2016, a physician in northwestern Indiana informed ISDH of a high prevalence of clinically diagnosed Lyme disease among his patients. He further reported that eight patients evaluated during 2015–2016 had tested positive for B. microti immunoglobulin G (IgG) or immunoglobulin M (IgM) antibodies by enzyme immunoassay (EIA) at a commercial laboratory. To further evaluate these findings, ISDH and CDC conducted a laboratory investigation using specimens from some of the patients.

OBJECTIVES: We assessed the perceived utility of data collected through ArboNET, the national arboviral surveillance system, and evaluated state health department user satisfaction with system function. METHODS: We used an online assessment tool to collect information about types of arboviral surveillance conducted, user satisfaction with ArboNET's performance, and use of data collected by the system. Representatives of all 53 reporting jurisdictions were asked to complete the assessment during spring 2009. RESULTS: Representatives of 48 (91%) jurisdictions completed the assessment. Two-thirds of respondents were satisfied with ArboNET's overall performance. Most concerns were related to data transmission, particularly the lack of compatibility with the National Electronic Disease Surveillance System (NEDSS). Users found mosquito (85%), human disease (80%), viremic blood donor (79%), and veterinary disease (75%) surveillance data to be useful. While there was disagreement about the usefulness of avian mortality and sentinel animal surveillance, only 15% of users supported eliminating these categories. Respondents found weekly maps and tables posted on the U.S. Geological Survey (92%) and CDC (88%) websites to be the most useful reports generated from ArboNET data. Although many jurisdictions were willing to report additional clinical or laboratory data, time and resource constraints were considerations. Most respondents (71%) supported review and possible revision of the national case definition for human arboviral disease. CONCLUSIONS: As a result of this assessment, CDC and partner organizations have made ArboNET NEDSS-compatible and revised national case definitions for arboviral disease. Alternative data-sharing and reporting options are also being considered. Continued evaluation of ArboNET will help ensure that it continues to be a useful tool for national arboviral disease surveillance.