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.

During the global clade II mpox outbreak, cases have disproportionately affected gay, bisexual, and other men who have sex with men (MSM). Cruise ship travel-associated mpox infections have not been previously described. During January 25-April 18, 2024, CDC was notified of eight mpox cases among cruise travelers on four ships: four among crew members and four among passengers. Seven cases were laboratory-confirmed as clade II Monkeypox virus. All exposure histories indicated male-to-male sexual contact. No patients were hospitalized, and none died. Crew members with mpox received their diagnoses on board and were isolated while infectious. Contacts were identified, monitored, and assessed for mpox postexposure prophylaxis (mpox vaccination). No crew members with mpox had been vaccinated against mpox. Passengers with mpox received their diagnoses after cruising on voyages marketed to gay and bisexual men, with symptom onset dates suggesting voyage exposures. For one cruise ship, two of the three reports of mpox among passengers were received after health departments were notified of potential cruise-associated exposures, and letters were sent to other passengers. Three of the four passengers with mpox had received 2 doses of JYNNEOS vaccine in 2022. Cruise lines should consider educating crew members on symptoms, risks, and preventive measures related to mpox and working with medical personnel to facilitate mpox vaccination as preexposure prophylaxis for eligible crew members. Cruise passengers who are eligible, predominantly MSM, should receive mpox vaccine before cruise travel. For cruise voyages marketed to gay and bisexual men, having mpox vaccine available on board would facilitate timely postexposure prophylaxis, if indicated; mpox prevention messaging and education before and during a voyage are also recommended.

OBJECTIVES: Cruise ship settings can facilitate transmission of respiratory infections. In March 2020, a COVID-19 outbreak occurred on the Grand Princess cruise ship. We describe the public health response, including a large-scale US federal quarantine intended to limit spread to communities not yet affected by COVID-19. METHODS: All US residents and symptomatic people requiring hospitalization disembarked beginning on March 9 and were transported to designated US military bases for federal quarantine or to hospitals or alternate care sites for medical care. Foreign nationals remained on board (crew) or were repatriated (passengers). People under federal quarantine were monitored daily for symptoms and tested voluntarily for SARS-CoV-2 upon arrival, as tests became available, and if symptoms developed. RESULTS: Of 3582 travelers (passengers and crew) on board, 2013 (56%) went to military bases, 59 (2%) went to hospitals or alternate care sites, 419 (12%) were repatriated, and the remainder (crew) quarantined on board. Overall, 1144 travelers (32%) were tested for SARS-CoV-2; of those, 155 (14%) had a positive test result. Among 2013 US residents quarantined, 1054 (52%) were tested. Of those, 115 (11%) had a positive test result, 37 (32%) of whom were symptomatic at testing. Proportions tested across bases ranged from 28% to 89%; test positivity ranged from 10% to 16%. Of 31 travelers hospitalized, the median (IQR) stay was 4 (4-9) nights, and 9 (29%) travelers died of SARS-CoV-2 complications. CONCLUSIONS: The Grand Princess outbreak was the first confirmed COVID-19 outbreak on a cruise ship in US waters. Multiagency public health responses allowed for isolation and quarantine, potentially helping to slow transmission into US communities. Ensuring that cruise ships have plans for communicable disease control and mitigation helps protect passenger and crew well-being.

In April 2024, following the annual International Committee on Taxonomy of Viruses (ICTV) ratification vote on newly proposed taxa, the phylum Negarnaviricota was expanded by 1 new order, 1 new family, 6 new subfamilies, 34 new genera and 270 new species. One class, two orders and six species were renamed. Seven families and 12 genera were moved; ten species were renamed and moved; and nine species were abolished. This article presents the updated taxonomy of Negarnaviricota as currently accepted by the ICTV, providing an essential annual update on the classification of members of this phylum that deepen understandings of their evolution, and supports critical public health measures for virus identification and tracking.

Climate change poses profound threats to human safety, health, and well-being. Public health agencies, especially state, territorial, local, and Tribal health departments, can play an essential role in climate change adaptation and mitigation. Public health climate action can protect health, promote health equity, and increase climate change resilience. The Centers for Disease Control and Prevention has updated its original climate and health framework for practitioners and expanded its utility by developing practical guidance. The revised framework, Building Resilience Against Climate Effects, supports health departments and their partners by providing an accessible approach that can be tailored to different contexts. The framework has been updated to center justice, equity, and belonging; integrate climate change mitigation or reduction of greenhouse gas emissions that cause climate change; and address agency capacity. The Building Resilience Against Climate Effects framework also emphasizes collaboration, especially cross-sectoral and community partnerships, communication, and evaluation. Framework elements, key tactics, and guiding principles are presented in a pragmatic, step-by-step implementation guide. The implementation guide can be used by state, territorial, local, and Tribal health departments to galvanize or expand their engagement with public health climate action, which grows more urgent each year. (Am J Public Health. Published online ahead of print May 22, 2025:e1-e12. https://doi.org/10.2105/AJPH.2025.308061).

Powassan virus (POWV) and Eastern equine encephalitis virus (EEEV) are regionally endemic arboviruses in the United States that can cause neuroinvasive disease and death. Recent identification of EEEV transmission through organ transplantation and POWV transmission through blood transfusion have increased concerns about infection risk. After historically high numbers of cases of both viruses were reported in 2019, we conducted a seroprevalence survey using blood donation samples from selected endemic counties. Specimens were screened for virus-specific neutralizing antibodies, and population seroprevalence was estimated using weights calibrated to county population census data. For POWV, median county seroprevalence in 4 states was 0.84%, ranging from 0% (95% CI 0%-2.28%) to 11.5% (95% CI 0.82%-40.9%). EEEV infection was identified in a single county (estimated seroprevalence 1.62% [95% CI 0.04%-8.75%]). Although seroprevalence estimates in sampled areas were generally low, additional investigation of higher-prevalence areas could inform risk for transmission from asymptomatic blood and organ donors.

BACKGROUND: Early childhood experiences, whether positive or adverse, significantly impact health across the lifespan. Children and youth in low-resource settings face unique challenges that increase their vulnerability to poor mental health. OBJECTIVE: To examine the relationship between adverse childhood experiences (ACEs) and suicidal thoughts or behaviors as well as psychological distress, and to explore the moderating role of parent-related positive childhood experiences (PPCEs) on this association. PARTICIPANT AND SETTING: We used data from the 2019 Kenya Violence Against Children and Youth Survey. METHODS: Analyses were restricted to youth ages 18-24. ACEs were dichotomized (into those who have experienced at least one ACEs and those who have not), and logistic regression was used to examine the relationship between ACEs, PPCEs, and suicidal thoughts or behaviors and psychological distress stratified by sex. RESULTS: Significantly more males (75.8 %) than females (57.6 %) experienced at least 1 ACE in their lifetime (p = 0.0003). PPCEs are common; however, significantly more males (59.9 %) than females (41.2 %) had a strong father-child relationship (p = 0.0003). ACEs were positively associated with suicidal thoughts or behaviors and psychological distress, with notable sex-specific differences in the associations. Conversely, PPCEs were negatively associated with those outcomes, but there were also sex-specific differences in the associations. No significant interaction effect was observed between ACEs, PPCEs, and the mental health outcomes. CONCLUSION: Suicidal thoughts or behaviors and psychological distress are pervasive problems that are common among youth in Kenya, and the associations with ACEs vary by sex. A multilevel approach and evidenced-based intervention strategies that consider the context of sociocultural norms are crucial to prevention and response efforts.

Leptospirosis (caused by pathogenic bacteria in the genus Leptospira) is prevalent worldwide but more common in tropical and subtropical regions. Transmission can occur following direct exposure to infected urine from reservoir hosts, or a urine-contaminated environment, which then can serve as an infection source for additional rats and other mammals, including humans. The brown rat, Rattus norvegicus, is an important reservoir of Leptospira spp. in urban settings. We investigated the presence of Leptospira spp. among brown rats in Boston, Massachusetts and hypothesized that rat population dynamics in this urban setting influence the transportation, persistence, and diversity of Leptospira spp. We analyzed DNA from 328 rat kidney samples collected from 17 sites in Boston over a seven-year period (2016-2022); 59 rats representing 12 of 17 sites were positive for Leptospira spp. We used 21 neutral microsatellite loci to genotype 311 rats and utilized the resulting data to investigate genetic connectivity among sampling sites. We generated whole genome sequences for 28 Leptospira spp. isolates obtained from frozen and fresh tissue from some of the 59 positive rat kidneys. When isolates were not obtained, we attempted genomic DNA capture and enrichment, which yielded 14 additional Leptospira spp. genomes from rats. We also generated an enriched Leptospira spp. genome from a 2018 human case in Boston. We found evidence of high genetic structure among rat populations that is likely influenced by major roads and/or other dispersal barriers, resulting in distinct rat population groups within the city; at certain sites these groups persisted for multiple years. We identified multiple distinct phylogenetic clades of L. interrogans among rats that were tightly linked to distinct rat populations. This pattern suggests L. interrogans persists in local rat populations and its transportation is influenced by rat population dynamics. Finally, our genomic analyses of the Leptospira spp. detected in the 2018 human leptospirosis case in Boston suggests a link to rats as the source. These findings will be useful for guiding rat control and human leptospirosis mitigation efforts in this and other similar urban settings.

More than 800 foodborne illness outbreaks have been reported to the United States Centers for Disease Control and Prevention (CDC) annually. Researchers have suggested that improving food safety culture in restaurants (i.e., shared values, beliefs, and norms about food safety) is an important way to reduce foodborne outbreaks. However, we know relatively little about the connections between food safety culture and food safety outcomes in restaurants. To bridge these gaps in knowledge, state and local health department staff with CDC's Environmental Health Specialists Network (EHS-Net) conducted a study in which they interviewed managers and administered written surveys to food workers in 321 restaurants across eight EHS-Net jurisdictions. Data on restaurant characteristics (e.g., the existence of food safety policies) were collected through interviews with restaurant managers. Data on food worker characteristics (e.g., food safety knowledge) were collected through a worker survey. The survey also assessed worker beliefs about food safety in their restaurants (i.e., food safety culture). Analyses showed that several restaurant characteristics, including the existence of food safety policies and methods for monitoring policy implementation, were significantly and positively associated with workers' perceptions of their restaurant's food safety culture. The worker characteristics of having had food safety training and possessing food safety knowledge were also significantly and positively related to worker food safety culture beliefs. These findings suggest that management actions, such as providing food safety training, implementing food safety policies, and monitoring compliance with those policies, are associated with a strong food safety culture.

BACKGROUND: The 2023-2024 influenza season included sustained elevated activity from December 2023-February 2024 and continued activity through May 2024. Influenza A(H1N1), A(H3N2), and B viruses circulated during the season. METHODS: During September 1, 2023-May 31, 2024, a multistate sentinel surveillance network of 24 medical centers in 20 U.S. states enrolled adults aged ≥18 years hospitalized with acute respiratory illness (ARI). Consistent with a test-negative design, cases tested positive for influenza viruses by molecular or antigen test, and controls tested negative for influenza viruses and SARS-CoV-2. Vaccine effectiveness (VE) against influenza-associated hospitalization was calculated as (1 - adjusted odds ratio for vaccination) × 100%. RESULTS: Among 7690 patients, including 1170 influenza cases (33% vaccinated) and 6520 controls, VE was 40% (95% CI: 31%-48%) with varying estimates by age (18-49 years: 53% [34%-67%]; 50-64 years: 47% [31%-60%]; ≥65 years: 31% [16%-43%]). Protection was similar among immunocompetent patients (40% [30%-49%]) and immunocompromised patients (32% [7-50%]). VE was statistically significant against influenza B (67% [35%-84%]) and A(H1N1) (36% [21%-48%]) and crossed the null against A(H3N2) (19% [-8%-39%]). VE was higher for patients 14-60 days from vaccination (54% [40%-65%]) than >120 days (18% [-1%-33%]). CONCLUSIONS: During 2023-2024, influenza vaccination reduced the risk of influenza A(H1N1)- and influenza B-associated hospitalizations among adults; effectiveness was lower in patients vaccinated >120 days prior to illness onset compared with those vaccinated 14-60 days prior.

Foodborne norovirus outbreaks are often associated with food contamination during preparation by an ill employee. The US Food and Drug Administration's Food Code outlines food safety provisions to prevent illness transmission in food establishments. An updated full version of the Food Code is released every four years; adoption of specific provisions is at the discretion of state governments. Food safety laws of the 50 states and District of Columbia (51 jurisdictions) were assessed for adoption as of March 2020, of four norovirus-related provisions included in the 2017 Food Code: 1) prohibition of barehand contact with ready-to-eat (RTE) food, 2) exclusion of food employees with vomiting or diarrhea, 3) person in charge being a certified food protection manager (CFPM), and 4) written response plan for vomiting or diarrheal events. We compared the frequency of adoption of the 2017 Food Code provisions to a previous assessment of adoption of these provisions in the 2013 Food Code. Prohibition of barehand contact with RTE food was adopted by 45 jurisdictions (88%), an increase from 39 jurisdictions (76%) in the previous analysis. Forty jurisdictions (78%) required exclusion of food employees with vomiting or diarrhea for ≥24 hours after symptom cessation, an increase from 30 jurisdictions (59%). Provisions requiring the person in charge to be a CFPM and written response plan for contamination events were new to the 2017 Food Code; 5 jurisdictions (10%) required the person in charge to be a CFPM and 9 (18%) required a written response plan. Adoption of provisions prohibiting barehand contact with RTE food and requiring exclusion of ill food employees increased. Newer provisions, requiring a person in charge as a CFPM and a written contamination response plan, were not as widely adopted. Increased adoption of Food Code provisions and improved compliance may decrease norovirus transmission in food establishments.

IMPORTANCE: In 2023, the first respiratory syncytial virus (RSV) vaccines were recommended for US adults 60 years or older, but few data are available about which patients were most likely to receive vaccine to inform future RSV vaccine outreach efforts. OBJECTIVE: To assess patient- and community-level characteristics associated with RSV vaccine receipt and patient knowledge and attitudes related to RSV disease and RSV vaccines. DESIGN, SETTING, AND PARTICIPANTS: During the first season of RSV vaccine use from October 1, 2023, to April 30, 2024, adults 60 years or older hospitalized with RSV-negative acute respiratory illness were enrolled in this cross-sectional study from 26 hospitals in 20 US states. Sociodemographic and clinical data were abstracted from health records, and structured interviews were conducted for knowledge and attitudes about RSV disease and RSV vaccines. EXPOSURES: Age, sex, race and ethnicity, pulmonary disease, immunocompromised status, long-term care facility residence, medical insurance, social vulnerability index (SVI), and educational level. MAIN OUTCOMES AND MEASURES: The exposures were identified a priori as possible factors associated with RSV vaccine receipt and were entered into a modified Poisson regression model accounting for state clustering, to assess for association with RSV vaccine receipt. Knowledge and attitudes were summarized with frequencies and proportions. RESULTS: Among 6746 hospitalized adults 60 years or older, median age was 73 (IQR, 66-80) years and 3451 (51.2%) were female. Among the 6599 patients with self-reported race and ethnicity, 699 (10.6%) were Hispanic, 1288 (19.5%) were non-Hispanic Black, 4299 (65.1%) were non-Hispanic White, and 313 (4.7%) were other race or ethnicity. There were 700 RSV-vaccinated (10.4%) and 6046 unvaccinated (89.6%) adults. Among 3219 unvaccinated adults who responded to RSV knowledge questions, 1519 (47.2%) had not heard of RSV or were unsure; 2525 of 3218 (78.5%) were unsure if they were eligible for RSV vaccine or thought they were not. In adjusted analyses, characteristics associated with RSV vaccination were being 75 years or older (adjusted risk ratio [ARR], 1.23; 95% CI, 1.10-1.38, P < .001), being male (ARR, 1.15; 95% CI, 1.01-1.30; P = .04), and having pulmonary disease (ARR, 1.39; 95% CI, 1.16-1.67; P < .001), immunocompromised status (ARR, 1.30; 95% CI, 1.14-1.48; P < .001), low (ARR, 1.47; 95% CI, 1.18-1.83, P < .001) or moderate (ARR, 1.47; 95% CI, 1.21-1.79; P < .001) SVI, and educational level consisting of 4 or more years of college (ARR, 2.91; 95% CI, 2.14-3.96; P < .001), at least some college or technical training (ARR, 1.85; 95% CI, 1.35-2.53; P < .001), or grade 12 education or General Educational Development (ARR, 1.44; 95% CI, 1.03-2.00; P = .03). RSV vaccination was less likely among residents of long-term care facilities, patients with Medicaid coverage, and uninsured patients. CONCLUSIONS AND RELEVANCE: In this cross-sectional study of hospitalized adults, knowledge of RSV disease and RSV vaccine eligibility was low. Older adults and those with certain medical conditions were more likely to have received vaccine, suggesting appropriate prioritization, but sociodemographic differences in vaccine uptake occurred.

BACKGROUND: Jamestown Canyon virus, a mosquito-borne virus, can cause asymptomatic infection, febrile illness, or neuroinvasive disease in humans. Previous studies have found Jamestown Canyon virus-specific antibodies in a 4-54% of people in various U.S. regions. To understand baseline seroprevalence in regions with the highest number of reported disease cases, we performed a serosurvey among blood donors. METHODS: We randomly selected blood donation specimens collected during December 2019-April 2020 from residents of counties reporting ≥2 disease cases in 2019 or one case in 2019 and ≥1 case during 2010-2018. Specimens were screened for Jamestown Canyon virus-specific neutralizing antibodies and, if positive, tested for IgM antibodies. We estimated county population seroprevalence by calibrating sample weights to population census data. RESULTS: Fourteen counties in three states, Massachusetts, Minnesota, and Wisconsin, met the inclusion criteria. Within each state, average county seroprevalence ranged from 16.8% (95% CI: 9.3%-27.0%) to 18.8% (95% CI: 14.0%-24.4%) for Jamestown Canyon virus neutralizing antibodies and from 7.6% (95% CI: 4.2%-12.5%) to 13.5% (95% CI: 9.6%-18.3%) for both neutralizing and IgM antibodies. CONCLUSIONS: Estimated Jamestown Canyon virus seroprevalence, including for IgM antibodies, is elevated in endemic areas, complicating the interpretation of serologic testing in diagnosing acute disease in symptomatic individuals. Diagnosing Jamestown Canyon virus disease requires a high degree of clinical suspicion, ruling out other possible causes of illness, and if possible, collecting acute and convalescent samples. New assays to detect acute infection could improve diagnosis and public health surveillance for Jamestown Canyon virus disease.

We assessed the impact of pneumococcal conjugate vaccines on pneumococcal otitis media (OM) among children living in Navajo and White Mountain Apache Tribal lands. During the PCV7 era (2000-2009), the proportion of vaccine-type OM declined. However, vaccine-type OM (predominantly 3, 19A, and 19F) persisted in the PCV13 era (2010-2019).

Dengue, a mosquitoborne viral infection, is a public health threat in Puerto Rico, where multiple dengue virus (DENV) serotypes circulate. Dengue causes an acute febrile illness that can progress to severe disease or death. The last outbreak declared by the Puerto Rico Department of Health occurred during 2013. In January 2024, the number of dengue cases in Puerto Rico surpassed the epidemic threshold and remained elevated, prompting the Puerto Rico Department of Health to declare a public health emergency in March 2024. In collaboration with CDC, a dengue outbreak response was initiated to monitor the outbreak and implement vector-control measures alongside public health campaigns to raise awareness about increasing dengue case numbers and strategies to prevent mosquito bites. During 2024, a total of 6,291 confirmed dengue cases were reported; the highest numbers of cases were reported in the municipalities of San Juan (1,200; 17.3%), Carolina (354; 5.1%), and Rincón (252; 3.6%). DENV serotype 3 predominated, accounting for 59.2% of cases with known serotype. Approximately one half of ill patients (52.3%) required hospitalization, with the highest percentages of hospitalizations (33.9%) and severe dengue cases (28.4%) occurring among persons aged 10-19 years. Overall, severe dengue was identified in 4.2% of cases, with 11 reported fatalities (0.2%). Transmission remains elevated in multiple regions, underscoring the need for tailored public health measures, including vaccination among eligible populations, vector management, community outreach, and provider education to facilitate improved outcomes. To reduce the risk for mosquito bites, residents of and visitors to Puerto Rico should consider using repellents, wearing protective clothing, and staying in places with door and window screens.

A Rocky Mountain spotted fever (RMSF) epidemic has spread through the state of Baja California, Mexico over the last decade and a half, beginning in Mexicali, and subsequently to Tijuana and to Ensenada by 2018. In October of 2022, we surveyed dogs and homes in randomly selected Áreas Geoestadisticas Básicas (AGEBs) with and without reported human cases. Brown dog ticks (Rhipicephalus sanguineus sensu lato) were found on 33.9% of dogs and in the yards of 23.6% of homes. Homes from AGEBs with cases had over a 6-fold increased odds of ticks being present in the yard than AGEBs without reported cases. Both dogs that were permitted to roam and the presence of roaming dogs in the neighborhood were strongly associated with tick infestation of dogs and homes. No ticks or blood samples were polymerase chain reaction-positive for Rickettsia (R.) rickettsii, the causative agent of RMSF, although 54.6% of dogs were seropositive for spotted fever group rickettsiae, and 17.4% were seropositive for typhus group rickettsiae. R. massiliae and R. felis were detected in eight (1.3%) and 29 (4.8%) ticks, respectively; and R. felis was also detected in eight (4.6%) dog blood samples. Although the pathogenic potential of these other rickettsial species and their role in RMSF transmission remains unclear, our data on tick burdens in dogs and homes as risk factors for RMSF exposure provide further support to the pivotal need to reduce tick burdens and the numbers of roaming dogs to successfully manage the RMSF epidemic in northern Mexico.

CONTEXT: Federal public health travel restrictions (FPHTR) in the United States are implemented for persons who meet specific criteria to prevent spread of communicable diseases of public health concern. FPHTR can mitigate the risk of disease transmission during air travel and mitigating disease translocation between geographic areas. OBJECTIVE: To characterize and determine the extent of FPHTR implementation during the COVID-19 pandemic. DESIGN: Secondary data analysis. SETTING AND PARTICIPANTS: This report reviewed the U.S. public health response for 3010 persons traveling within, into, and out of, the U.S. who were placed on federal public health travel restrictions during the COVID-19 outbreak from January 1, 2020 to April 6, 2022. MAIN OUTCOME MEASURE: Total number and characteristics of persons with SARS-CoV-2 infection or high-risk exposure added to FPHTR. RESULTS: During this period, FPHTR were implemented for 3010/5460 (55%) persons who were reported to CDC as having tested positive for SARS-CoV-2, or being identified as close contacts of a person with COVID-19, with intention to travel. Of those added to FPHTR lists, 2023/3010 (67%) had confirmed SARS-CoV-2 infection, 975/3010 (32%) were close contacts, and 12/3010 (0.4%) were reasonably believed to have COVID-19 but later confirmed to have another diagnosis and removed. Twenty-six percent (793/3010) of SARS-CoV-2-related FPHTR were for persons reported to CDC after testing positive for SARS-CoV-2 at a testing site located within a U.S. airport. CONCLUSIONS: The extensive application of FPHTR for more than 3000 persons over a period of 29 months during the COVID-19 pandemic was unprecedented. The additional use of FPHTR required extraordinary effort and collaboration among CDC staff and local/state public health agencies for case investigation, reporting, exchange of information, and communication with travelers for case management. Use of this tool should be considered within the context current transmission risk and disease severity.

Mosquito-transmitted viruses such as dengue are a global and growing public health challenge. Without widely available vaccines, mosquito control is the primary tool for fighting the spread of these viruses. New mosquito control technologies are needed to complement existing methods, given current challenges with scalability, acceptability, and effectiveness. A field trial was conducted in collaboration with the Communities Organized to Prevent Arboviruses project in Ponce, Puerto Rico, to measure entomological and epidemiological effects of reducing Aedes aegypti populations using Wolbachia incompatible insect technique. We packed and shipped Wolbachia-males from California and released them into 19 treatment clusters from September 2020 to December 2020. Preliminary evaluation revealed sub-optimal Wolbachia-male densities and impact on the wild-type population. In 2021, we shifted to a phased release strategy starting in four clusters, reducing the mosquito population by 49% (CI 29-63%). We describe the investigation into male quality and other factors that may have limited the impact of Wolbachia-male releases. Laboratory assays showed a small but significant impact of packing and shipping on male fitness. However, mark-release-recapture assessments suggest that male daily survival rates in the field may have been significantly impacted. We compared induced-sterility levels and suppression of the wild population and found patterns consistent with mosquito population compensation in response to our intervention. Analysis of epidemiological impact was not possible due to very low viral transmission rates during the intervention period. Our entomological impact data provide evidence that Wolbachia incompatible-male releases reduced Ae. aegypti populations, although efficacy will be maximized when releases are part of an integrated control program. With improvement of shipping vessels and shipped male fitness, packing and shipping male mosquitoes could provide a key solution for expanding access to this technology. Our project underscores the challenges involved in large and complex field effectiveness assessments of novel vector control methods.

OBJECTIVE: To explore the role of local public health organisations in antimicrobial stewardship (AMS) and antimicrobial resistance (AMR) surveillance. METHODS: A scoping review was conducted. Peer-reviewed and grey literature from countries within the organisation for economic co-operation and development was searched between 1999 and 2023 using the concepts of local public health, AMR and AMS. Thematic analysis was performed to identify themes. RESULTS: There were 63 citations illustrating 122 examples of AMS and AMR surveillance activities with local public health involvement. Common AMS activities (n = 105) included healthcare worker education (n = 22), antimicrobial use (AMU) evaluation (n = 21), patient/public education (n = 17), clinical practice guidelines (n = 10), and antibiograms (n = 10). Seventeen citations described local public health activities in AMR surveillance; the majority focussed on communicable diseases (n = 11) and/or AMR organisms (n = 6). CONCLUSIONS: Local public health capabilities should be leveraged to advance high-impact activities to mitigate AMR, particularly in the areas of knowledge translation/mobilisation, optimising surveillance and establishing strategic collaborations. POLICY IMPLICATIONS: Future work should focus on better understanding barriers and facilitators, including funding, to local public health participation in these activities.

INTRODUCTION: Little is known about the recency, correlates, and content of health care provider (HCP) counseling about physical activity (PA) among adults with arthritis. METHODS: We analyzed data from the Porter Novelli FallStyles cross-sectional survey of noninstitutionalized US adults. Among adults with arthritis, we assessed the recency of HCP counseling about PA; counseling content, including PA assessment/screening and advice/counseling; and recommendations. Data were weighted by sex, age, household income, race and ethnicity, household size, education, census region, and metropolitan status. RESULTS: Among adults with arthritis (n = 1,113), 16.8% received HCP counseling within the past 6 months, 9.6% received counseling between 6 months and a year ago; 27.7% received HCP counseling more than a year ago; 30.4% never received HCP counseling; and 15.5% did not recall. Prevalence of HCP counseling about PA was higher for those reporting obesity (prevalence ratio [PR] = 1.3) and chronic pain (PR = 1.2), compared with those without these conditions. The most and least common content of HCP counseling were assessment of PA level (74.7%) and receiving a physical activity prescription (6.1%), respectively. The most frequent recommendations for PA type were flexibility exercises (40.1%), aerobic activities (39.8%), specific modalities of PA (eg, swimming, walking, dancing; 38.1%), and muscle-strengthening exercises (36.6%). Only 4.4% received a recommendation for arthritis-appropriate PA programs. CONCLUSION: HCP counseling about PA among adults with arthritis for arthritis symptom management is lacking in frequency, actionable content, and recommendations to engage in evidence-based PA interventions. Dissemination and implementation of policies and programs facilitating frequent high-quality HCP counseling and recommendation to PA programs for arthritis remains a public health priority.

INTRODUCTION: Childhood mental, behavioral, and developmental disorders (MBDD) are common and are associated with poor health and well-being. Monitoring the prevalence of MBDDs among children and factors that may influence health outcomes is important to understanding risk and promoting population health. METHOD: We examined trends in parent-reported lifetime MBDDs among children and associated health promotion and risk indicators from 2016 through 2021 by using data from the National Survey of Children's Health. Estimates of prevalence and average annual percentage change were stratified by specific MBDDs and demographic characteristics (eg, sex, age, race and ethnicity). Children with any MBDDs versus none were compared overall and by MBDD subgroup on health care, family, and community indicators. RESULTS: From 2016 through 2021, MBDD prevalence among children aged 3 to 17 years increased from 25.3% to 27.7%; increases were specific to anxiety, depression, learning disability, developmental delay, and speech or language disorder. Unmet health care needs increased annually by an average of approximately 5% among children with MBDDs. Each year from 2016 to 2021, approximately 60% of children with MBDDs received mental or developmental services in the past 12 months. Each year, a higher percentage of parents of children with MBDDs compared with children without MBDDs reported poor mental health (14.7% MBDD, 5.7% no MBDD) and economic stress (21.6% MBDD, 11.5% no MBDD). CONCLUSION: Increasing prevalence of certain MBDDs and MBDD-associated indicators, before and during the COVID-19 pandemic, highlights the need for improved pediatric mental health training for health care providers, for prevention and intervention efforts, and for policies addressing economic stability and equitable access to mental health services.

Paratyphoid B fever (PTB) is caused by an invasive lineage (phylogroup 1, PG1) of Salmonella enterica serotype Paratyphi B (SPB). However, little was known about the global population structure, geographic distribution, and evolution of this pathogen. Here, we report a whole-genome analysis of 568 historical and contemporary SPB PG1 isolates, obtained globally, between 1898 and 2021. We show that this pathogen existed in the 13th century, subsequently diversifying into 11 lineages and 38 genotypes with strong phylogeographic patterns. Following its discovery in 1896, it circulated across Europe until the 1970s, after which it was mostly reimported into Europe from South America, the Middle East, South Asia, and North Africa. Antimicrobial resistance recently emerged in various genotypes of SPB PG1, mostly through mutations of the quinolone-resistance-determining regions of gyrA and gyrB. This study provides an unprecedented insight into SPB PG1 and essential genomic tools for identifying and tracking this pathogen, thereby facilitating the global genomic surveillance of PTB.

Intimate partner violence (IPV) can include emotional, physical, or sexual violence. IPV during pregnancy is a preventable cause of injury and death with negative short- and long-term impacts for pregnant women, infants, and families. Using data from the 2016-2022 Pregnancy Risk Assessment Monitoring System in nine U.S. jurisdictions, CDC examined associations between IPV during pregnancy among women with a recent live birth and the following outcomes: prenatal care initiation, health conditions during pregnancy (gestational diabetes, pregnancy-related hypertension, and depression), substance use during pregnancy, and infant birth outcomes. Overall, 5.4% of women reported IPV during pregnancy. Emotional IPV was most prevalent (5.2%), followed by physical (1.5%) and sexual (1.0%) IPV. All types were associated with delayed or no prenatal care; depression during pregnancy; cigarette smoking, alcohol use, marijuana or illicit substance use during pregnancy; and having an infant with low birth weight. Physical, sexual, and any IPV were associated with having a preterm birth. Physical IPV was associated with pregnancy-related hypertension. Evidence-based prevention and intervention strategies that address multiple types of IPV are important for supporting healthy parents and families because they might reduce pregnancy complications, depression and substance use during pregnancy, and adverse infant outcomes.

In response to notable increases in tick-associated illnesses in the United States, recent public health policies encouraged multi-sector collaborative approaches to preventing vector-borne diseases. Primary prevention strategies focus on educating the public about risks for tick-borne diseases and encouraging adoption of personal protection strategies. Accurate descriptions of when and where people are at risk for tick-borne diseases aid in the optimization of prevention messaging. Tick and tick-borne pathogen data can be used to fill gaps in epidemiological surveillance. However, the utility of acarological data is limited by their completeness. National maps showing the distribution of medically important tick species and the pathogens they carry are often incomplete or non-existent. Recent policies encourage accelerated efforts to monitor changes in the distribution and abundance of medically important ticks and the presence and prevalence of human pathogens that they carry, and to provide actionable, evidence-based information to the public, health care providers and public health policy makers. In 2018, the Centers for Disease Control and Prevention initiated a national tick surveillance program focused on Ixodes ticks. The national program coordinated and expanded upon existing efforts led by public health departments and academic institutions. Here, we describe experiences of state public health departments engaged in Ixodes tick surveillance, including information on why they initiated Ixodes surveillance programs, programmatic objectives, and strategies for maintaining tick surveillance programs. We share experiences and challenges in interpreting or communicating tick surveillance data to stakeholders and explore how the acarological data are used to complement epidemiological data.

BACKGROUND: clinical guidelines recommend initiation of antiviral therapy as soon as possible for patients hospitalized with confirmed or suspected influenza. METHODS: A multicenter US observational sentinel surveillance network prospectively enrolled adults (aged ≥18 years) hospitalized with laboratory-confirmed influenza at 24 hospitals during October 1, 2022-July 21, 2023. A multivariable proportional odds model was used to compare peak pulmonary disease severity (no oxygen support, standard supplemental oxygen, high-flow oxygen/non-invasive ventilation, invasive mechanical ventilation, or death) after the day of hospital admission among patients starting oseltamivir treatment on the day of admission (early) versus those who did not (late or not treated), adjusting for baseline (admission day) severity, age, sex, site, and vaccination status. Multivariable logistic regression models were used to evaluate the odds of intensive care unit (ICU) admission, acute kidney replacement therapy or vasopressor use, and in-hospital death. RESULTS: A total of 840 influenza-positive patients were analyzed, including 415 (49%) who started oseltamivir treatment on the day of admission, and 425 (51%) who did not. Compared with late or not treated patients, those treated early had lower peak pulmonary disease severity (proportional aOR: 0.60, 95% CI: 0.49-0.72), and lower odds of intensive care unit admission (aOR: 0.24, 95% CI: 0.13-0.47), acute kidney replacement therapy or vasopressor use (aOR: 0.40, 95% CI: 0.22-0.67), and in-hospital death (aOR: 0.36, 95% CI: 0.18-0.72). CONCLUSION: Among adults hospitalized with influenza, treatment with oseltamivir on day of hospital admission was associated reduced risk of disease progression, including pulmonary and extrapulmonary organ failure and death.

To determine the potency of the inactivated rotavirus vaccine (IRV), we developed an enzyme immunoassay (EIA) using a biotin-conjugated RV VP7-specific monoclonal antibody. RV VP7, a pivotal structural protein in the outer capsid layer, governs RV G genotypes and prompts host immune responses, including neutralizing antibodies. This EIA showed high specificity, good linearity, high precision, and high accuracy, with a low limit of detection (LOD) and a limit of quantitation (LOQ) of 0.037 µg/ml RV antigen. The EIA was evaluated and proved suitable for establishing the long-term stability of IRV drug substance (DS) and aluminum-formulated drug product (DP) when stored at -70±10°C and 5±3 °C, respectively. Our results support the use of this EIA to examine the stability and determine the potency, antigen dose, lot-to-lot consistency, and lot release of IRV products. This RV potency assay may serve as an alternative to in vivo potency tests, making it suitable for quality control tests of cGMP IRV lots in clinical trials.

Endurance exercise training (ExT) induces metabolic, structural, and functional adaptations via lipidomic modifications, yet the systematic elucidation of lipidome alterations in response to ExT remains incomplete. As a part of the Molecular Transducers of Physical Activity Consortium (MoTrPAC), we leveraged non-targeted and targeted lipidomics for the systematic discovery of lipid alterations in the brown adipose tissue, heart, hippocampus, kidney, liver, lung, skeletal muscle gastrocnemius, subcutaneous white adipose tissue, and plasma in response to 1, 2, 4 or 8 weeks of ExT in 6-month-old male and female Fischer-344 rats. This study demonstrates that these tissues, each with distinct lipidomic features, underwent dynamic, sexually dimorphic lipid remodeling. Exercise trained animals showed reduced whole-body adiposity and improved cardiorespiratory fitness, along with enhanced utilization of lipid stores and dynamic triacylglycerol remodeling compared to sedentary controls in all tissues except hippocampus. They also showed modifications in phospholipids, lysophospholipids, oxylipins, and ceramides in several tissues. Coordinated changes across tissues reflect systemic tissue communication, with liver-plasma-heart connection potentially playing a key role in systemic lipid metabolism during ExT. These data will improve our understanding of lipid-associated biological processes underlying the health-promoting benefits of ExT.

Rocky Mountain spotted fever (RMSF) is a tickborne disease endemic in areas of the Americas. Persistent high incidence of the disease exists in northern Mexico, perpetuated by local populations of brown dog ticks (Rhipicephalus sanguineus sensu lato) and free-roaming dogs. Six cases of RMSF caused by Rickettsia rickettsii, including three deaths, were reported to the California Department of Public Health during July 2023-January 2024. All six patients were eventually determined to have had exposure to R. rickettsii in Tecate, Mexico, a municipality on the U.S. border that had not been previously described as a high-risk RMSF area. Identification and reporting of the cases were complicated by challenges in diagnosis. The serious nature of the disease and delays in initiating appropriate treatment can result in life-threatening consequences. Epidemiologic collaborations among local, state, federal, and international public health agencies were essential to identifying Tecate as the location of exposure. Further collaborations will be important for directing future prevention measures. Increased health care provider awareness of RMSF is critical on both sides of the border to facilitate earlier diagnosis and initiation of appropriate treatment.

BACKGROUND: On 20 September 2022, the Ugandan Ministry of Health declared an outbreak of Ebola disease caused by Sudan ebolavirus. METHODS: From 6 October 2022 to 10 January 2023, Centers for Disease Control and Prevention (CDC) staff conducted public health assessments at five US ports of entry for travellers identified as having been in Uganda in the past 21 days. CDC also recommended that state, local and territorial health departments ('health departments') conduct post-arrival monitoring of these travellers. CDC provided traveller contact information, daily to 58 health departments, and collected health department data regarding monitoring outcomes. RESULTS: Among 11 583 travellers screened, 132 (1%) required additional assessment due to potential exposures or symptoms of concern. Fifty-three (91%) health departments reported receiving traveller data from CDC for 10 114 (87%) travellers, of whom 8499 (84%) were contacted for monitoring, 1547 (15%) could not be contacted and 68 (1%) had no reported outcomes. No travellers with high-risk exposures or Ebola disease were identified. CONCLUSION: Entry risk assessment and post-arrival monitoring of travellers are resource-intensive activities that had low demonstrated yield during this and previous outbreaks. The efficiency of future responses could be improved by incorporating an assessment of risk of importation of disease, accounting for individual travellers' potential for exposure, and expanded use of methods that reduce burden to federal agencies, health departments, and travellers.