CONTEXT: Public health fellowship programs play a vital role in strengthening the workforce across state, tribal, local, and territorial (STLT) public health agencies. PROGRAM: The US Centers for Disease Control and Prevention's Epidemic Intelligence Service (EIS) and Laboratory Leadership Service (LLS) fellowships provide structured opportunities for trainees to be placed within STLT public health agencies, where they are intended to contribute directly to essential public health functions. Through these assignments, the objective is for trainees to gain practical experience while STLT public health agencies benefit from additional capacity and public health expertise. EVALUATION: Findings from a rapid evaluation showed that EIS and LLS trainees offer crucial support to STLT public health agencies' delivery of Foundational Public Health Services. The trainees also provide surge support during emergency response events, including infectious disease outbreaks and environmental toxins. DISCUSSION: Public health fellowships are a collaborative model of how federal programs can help alleviate longstanding public health workforce challenges, including difficulties recruiting, hiring, and retaining qualified professionals. Integration of trainees into STLT public health agency operations fosters knowledge transfer, strengthens local capabilities, and supports sustained delivery of public health services. Our findings provide additional evidence that public health fellowship programs can serve as essential support for the national public health workforce.

BACKGROUND: The Centers for Disease Control and Prevention offered a multicomponent intervention called Local Opioid Overdose Prevention and Response (LOOPR). Five sites (Bell, KY, Boone, WV, Manchester, NH, St. Francois, MO, and Ware, GA) were selected to implement academic detailing (AD). AD is a strategy for communicating safer opioid prescribing practices to clinicians. This is the first study to assess changes in county-level opioid prescribing behaviors after implementing a multicomponent prevention program emphasizing AD. OBJECTIVES: We examined three opioid prescribing behaviors (percentage of opioid prescribers in the top centile nationally, opioid prescribing rate, and average number of opioid prescriptions per prescriber) before and after program implementation in each site and a paired control. We used paired interrupted time series to examine the effect of LOOPR on each outcome for each site and control. RESULTS: Five jurisdictions incorporated AD as part of LOOPR. In addition, Bell County, KY implemented three other interventions (coalition establishment, communication campaign, and community-based overdose prevention program). Manchester City, NH (community-based overdose prevention program and public health/public safety partnership) and St. Francois, MO (communication campaign and public health/public safety partnership) implemented two additional interventions. Boone County, WV and Ware County, GA only incorporated AD. Though not always statistically significant, all sites showed decreasing or stabilizing trends after implementation of LOOPR for most outcomes. CONCLUSIONS/IMPORTANCE: This study shows AD is a versatile strategy and customizable activity that can be implemented in many settings as a separate activity or integrated with various prevention programs, making it particularly suitable for community-level interventions.

Background: In August 2023, the Centers for Disease Control and Prevention recommended nirsevimab, a long-acting monoclonal antibody, for all U.S. infants aged <8 months entering or born during their first respiratory syncytial virus (RSV) season. Our aim was to estimate nirsevimab effectiveness against RSV-associated emergency department (ED) encounters and hospitalisation among U.S. infants during the 2023–2024 RSV season. Methods: We conducted a test-negative analysis using electronic health record (EHR) data from 6 healthcare systems, including ED encounters and hospitalizations with a diagnosis of RSV-like illness (RLI) during October 8, 2023–March 31, 2024, among infants aged <8 months as of October 1, 2023, or born during the study period. Nirsevimab effectiveness was estimated by comparing children who received nirsevimab with those who did not among RSV-positive and RSV-negative encounters, adjusting for age, race and ethnicity, sex, calendar day, and geographic region and excluding infants whose mother received RSV vaccination during pregnancy. Findings: Among 5039 ED encounters with RLI among infants in their first RSV season, 2045 (41%) were RSV-positive and 446 (9%) received nirsevimab, with a median time since dose of 52 days (interquartile range [IQR]: 27–84 days). Among 1025 hospitalizations with RLI among infants in their first RSV season, 605 (59%) were RSV-positive and 95 (9%) received nirsevimab, with a median time since dose of 48 days (IQR: 24–82 days). Nirsevimab effectiveness was 77% (95% CI: 69%–83%) against RSV-associated ED encounters and 98% (95% CI: 95%–99%) against RSV-associated hospitalisation. Interpretation: Nirsevimab was effective in preventing RSV-associated ED encounters and hospitalisation among infants in their first RSV season, with greatest protection against hospitalisation. However, these estimates reflect a short interval from nirsevimab administration to RLI onset. Since nirsevimab is a passive immunization and concentration is expected to wane over time, it is important to continue monitoring effectiveness to assess effectiveness with increased time since dose. Funding: This work was supported by the Centers for Disease Control and Prevention (contracts 75D30121D12779 to Westat and 75D30123C18039 to Kaiser Foundation Hospitals). © 2025 Elsevier B.V., All rights reserved.

OBJECTIVES: Historically, the most frequent cause of death reported to the Centers for Disease Control and Prevention (CDC) among travelers on conveyances has been cardiovascular disease, mirroring all-cause mortality in the US population. Infectious disease transmission, particularly during large-scale outbreaks, also poses a risk to travelers. To determine leading causes of death on conveyances and whether they were affected by the COVID-19 pandemic, we describe causes of death on conveyances reported to CDC from 2008 through 2022. METHODS: We queried CDC's Port Health Activity Reporting System for traveler deaths on, or immediately after disembarking from, an aircraft or maritime vessel or during land-border crossings reported to CDC from July 1, 2008, through December 31, 2022. We examined data on cause of death, age, travel mode, and traveler type (passenger vs crew). We also calculated crude annual mortality rates for each conveyance type. To assess factors associated with deaths due to infectious diseases (vs deaths due to noninfectious conditions), we performed logistic regression. RESULTS: During the analysis period, 2910 deaths on conveyances were reported. Across all conveyances, the most common causes were cardiovascular- or pulmonary-related conditions (2116 of 2910; 73%) for each year except 2020, when COVID-19 was the most common. Crew (vs passengers) had significant associations with death due to infectious causes (vs noninfectious causes; adjusted odds ratio = 2.12; 95% CI, 1.32-3.40). CONCLUSIONS: Travelers with cardiovascular- or pulmonary-related conditions should consult their health care providers prior to international travel. All travelers should check travel recommendations such as those currently available on CDC travel pages. Public health authorities should consider population-based mitigation measures aimed at transmission risk reduction to limit morbidity and mortality during infectious disease outbreaks.

BACKGROUND: In September 2023, the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention (CDC) recommended Pfizer's Respiratory Syncytial Virus (RSV) vaccine for pregnant women at 32-36 weeks' gestation using seasonal administration to prevent RSV-associated lower respiratory tract disease (LRTD) in infants aged <6 months. In clinical trials among pregnant women at 24-36 weeks' gestation, more preterm births and hypertensive disorders of pregnancy were noted among Pfizer's RSV vaccine recipients compared with placebo, but the differences were not statistically significant. Post-licensure safety monitoring of the Pfizer RSV vaccine in pregnant women is important to help inform immunization policies. OBJECTIVE: We assessed reports after Pfizer's RSV Vaccine in pregnant women submitted in the Vaccine Adverse Event Reporting System (VAERS), a passive surveillance system. METHODS: We searched VAERS for U.S. reports of adverse events (AEs) or vaccination errors in pregnant women vaccinated with the Pfizer RSV vaccine. We analyzed reports received from August 20, 2023 through June 3, 2024. Clinicians reviewed reports and available medical records. RESULTS: VAERS received 121 reports of pregnant women who received the Pfizer RSV vaccines. Injection site and systemic reactions were described in 44 (36 %) reports. The most commonly reported pregnancy-specific outcomes were preterm birth in 37 (31 %) and hypertensive disorders of pregnancy in 9 (7 %). CONCLUSIONS: During the first U.S. RSV season in which the Pfizer RSV vaccine was approved and recommended for use during pregnancy, the types of AEs reported were consistent with prelicensure studies. Preterm birth was described commonly in the reports. Studies assessing potential association between Pfizer's maternal RSV vaccine and preterm birth are ongoing. CDC and Food and Drug Administration (FDA) will continue to monitor the safety of this vaccine in future seasons.

Screening nonhuman primates (NHPs) for tuberculosis (TB) is important to protect the health of NHP colonies and people who interact with them. Screening is especially important for imported NHPs from countries where TB is prevalent and biosecurity practices may be lax. There are a variety of testing methods available for TB screening and diagnosis in NHPs; all have limitations, and their performance in different settings is incompletely characterized. The US Centers for Disease Control and Prevention (CDC) collects TB testing results as part of its regulatory oversight of NHP importation. We collated the results of tuberculin skin tests (TSTs), interferon-γ release assays (IGRAs), multiplexed fluorometric immunoassay (MFIA), Mycobacterium tuberculosis complex PCR, staining for acid-fast bacilli (AFB), and culture of bacteria from tissues for imported NHPs in CDC-mandated quarantine during fiscal years 2021 to 2024. We used these data to assess test performance and intertest agreement for the different tests used. Among 107 imported NHPs tested, TST and IGRA were the most common antemortem tests performed, but they agreed poorly with each other and with culture. AFB staining and PCR exhibited moderate agreement and high positive predictive values using culture as the gold standard. The most commonly affected tissues were lungs and tracheobronchial lymph nodes, regardless of the Mycobacterium sp. identified. Further research is needed to identify and validate additional methods for TB testing in NHPs, particularly for antemortem screening. Tissue acid-fast staining and PCR exhibited high positive predictive values and could be useful to inform policies and clinical decisions about colony management and occupational health while awaiting culture results.

INTRODUCTION: There is high interest in long-acting injectable antiretroviral therapy (LAI-ART) among people with HIV (PWH), with many conveniences for uptake and persistence. However, both patients and clinicians have expressed important barriers to effective implementation, including concerns about frequent clinic visits and strain on clinic resources. Administration of LAI-ART by a trained layperson injector (such as family, friend or partner of the patient) can help mitigate some of these patient-identified and clinician-identified barriers. Alternative LAI-ART delivery methods have the potential to increase the PWH and layperson injector's confidence, empowerment, convenience, privacy and self-management skills and ultimately facilitate LAI-ART uptake and persistence. METHODS AND ANALYSIS: INVITE-Home (innovative administration of long-acting injectables for HIV treatment enhancement at home) will support the expansion of LAI-ART in non-clinical settings by developing, implementing and evaluating a comprehensive, theory-informed training to support the administration of LAI-ART by a trained layperson injector. First, INVITE-Home will design and develop an innovative, theory-based layperson injector training to improve acceptability and uptake of LAI-ART in home-based settings, grounded in qualitative evaluation of training barriers and needs of PWH, layperson injectors and clinicians to develop the training. In Aim 2, INVITE-Home will enhance understanding of home-based LAI-ART using the training, by examining implementation and effectiveness of home-based LAI-ART injections. ETHICS AND DISSEMINATION: This study and its protocols have been approved by the University of California, San Francisco (UCSF) Institutional Review Board and the scientific staff of HIV Research Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, at the Centers for Disease Control and Prevention. Study staff will disseminate findings locally (eg, to partnering clinics, via the UCSF Center for AIDS Prevention Studies' Community Engagement Core), statewide (eg, the California Department of Public Health's Office of AIDS) and nationally at conferences related to HIV. TRIAL REGISTRATION NUMBER: NCT06488846.

Beginning in 2016, the Japanese Ministry of Health, Labour and Welfare (MHLW) began stationing liaisons within the US Department of Health and Human Services (HHS) Administration for Strategic Preparedness and Response to strengthen cooperation on bilateral health security engagement and collaboration. Notable accomplishments include the establishment of the US-Japan Health Security Committee and collaborations between the US-Japan Disaster Medical Assistance Team on mass event responses, such as the repatriation of American citizens from the Diamond Princess in February 2020 and the COVID-19 response. Japan has also embedded liaisons at the US Centers for Disease Control and Prevention to advance collaboration on public health. In 2021, with COVID-19 highlighting the importance of collaboration on pandemic preparedness, MHLW established a liaison program with the US National Institute of Allergy and Infectious Diseases. These liaisons with HHS agencies have paid dividends to health security collaboration, particularly by enabling greater connections between technical experts in MHLW and HHS.

BACKGROUND: Engineering infection controls include a wide range of interventions used indoors to reduce occupants' exposure to respiratory pathogens. PURPOSE: To identify and describe primary studies evaluating the effects of engineering infection control interventions designed to reduce the spread of respiratory infections transmitted through indoor air. DATA SOURCES: MEDLINE, Embase, Global Health, Cochrane Central Register of Controlled Trials, CINAHL, Scopus, and Environmental Science Collection from database inception to 12 December 2023. STUDY SELECTION: English-language primary research articles evaluating engineering infection control interventions. DATA EXTRACTION: Publication information, population characteristics, intervention details, and all relevant outcomes were abstracted by a reviewer and verified by a second, senior reviewer. DATA SYNTHESIS: A total of 672 studies published between 1929 and 2024 were identified. Most (n = 606) evaluated environmental samples only, 57 included human participants, and 9 included sentinel animal subjects. About half of the studies included at least 1 intervention classified as pathogen inactivation (n = 405), with fewer involving pathogen removal (n = 200) or air exchange or dilution (n = 143). Across all studies, about half (n = 332) measured the quantity of viable nonpathogenic organisms from air samples, followed by the quantity of nonbiological particulates (n = 197) or viable pathogenic organisms (n = 149). Harms, such as toxic byproducts, were rarely measured. LIMITATION: Exclusion of non-English-language publications and gray literature. CONCLUSION: There is substantial heterogeneity in the available evidence. Gaps in evidence include studies measuring efficacy outcomes that are highly relevant for human infection transmission or harms. Refinements in classification of interventions and outcomes could strengthen reporting of these evaluations. PRIMARY FUNDING SOURCE: National Institute for Occupational Safety and Health at the Centers for Disease Control and Prevention. (Registered on Open Science Framework [https://osf.io/5zmhd]).

BACKGROUND: According to the Centers for Disease Control and Prevention (CDC), there was a 480 % increase in overdose deaths among all women from 1999 to 2021 (Jones et al., 2024). Women are uniquely impacted by substance use and overdose due to biological and cultural differences compared to men. CDC launched the Overdose Data to Action (OD2A) cooperative agreement in 2019 with the goal of helping to mitigate the opioid overdose crisis across the United States by supporting state and local health departments. METHODS: This study focused on a review of programmatic data submitted by OD2A jurisdictions that detail their prevention activities to identify how jurisdictions implemented activities to address the unique needs of women. The team conducted systematic content analysis using multiple rounds of coding. RESULTS: Most activities were tailored for pregnant women or women who had recently given birth and focused on expanding capacity to meet their needs. The most common activities were capacity-building activities to enhance efforts to address overdose needs for women (specifically pregnant women), resource development/sharing, and implementation/evaluation of best or promising practices for women. CONCLUSION: While it is important that activities tailored for pregnant women continue, our study showed a gap in activities tailored to other populations of women where the problem may be the greatest, such as women who are incarcerated, women who engage in sex work, and other female sub-populations. To address overdose rates in women, future efforts would benefit from continuing activities for pregnant women but also attempting to reach other at-risk female populations.

As part of Centers for Disease Control and Prevention's (CDC) Prevention Research Center (PRC) Vaccine Confidence Network (PRC VCN), 26 academic institutions were funded to increase COVID-19 vaccine confidence and uptake in their communities. Six sites (in communities located in Alabama, Illinois, Massachusetts, New York, South Carolina, and Texas) formed a workgroup to identify emergent themes, and share challenges and opportunities across projects. This essay describes their efforts to engage trusted messengers in vaccine activities, and discusses strategies to develop and sustain these types of partnerships in the future. All sites recruited trusted messengers with strong community relationships to engage in multiple activities to promote COVID-19 vaccine confidence and uptake. CDC and the PRCs provided data-driven, evidence-based training and support to enable trusted messengers to fully participate in the projects. We posit that trusted messengers are essential partners for informing public health campaigns, developing effective messages, and building trust with local communities. Flexible federal funding and local coordination are essential for creating and sustaining trusted messenger approaches that combine community needs and data-informed evidence to promote timely public health responses.

INTRODUCTION: Older adults (defined as adults who are 50 and over) accounted for 1 in 6 persons newly diagnosed with HIV in 2022. The objectives of this analysis were to present the most currently available data about older adults reached by the Centers for Disease Control and Prevention's (CDC) HIV programs. METHODS: From 2019 through 2022, CDC funded 61 health departments and 160 community-based organizations in the United States and Puerto Rico and the U.S. Virgin Islands to provide HIV testing, pre-exposure prophylaxis (PrEP) referrals, and linkage to HIV medical care and report on their program outcomes to CDC. We conducted descriptive analysis as well as multivariable robust Poisson regression analysis to assess the association between demographic characteristics and outcomes of HIV tests among older adults. RESULTS: Between 2019 and 2022, the percentage of CDC-funded HIV tests provided to older adults increased, (16.9% in 2019, 17.3% in 2020, 18.3% in 2021, and 18.4% in 2022). In 2022, older adults accounted for 11% of new diagnoses. Among those, (876), 779 people had linkage data, and of those, 579 (74.1%) were linked to HIV medical care within 30 days after diagnosis. Of those older adults with a negative test result and available data, 90,422 (41.3%) were eligible for a PrEP referral and 39,382 (44.3%) were referred to a PrEP provider. DISCUSSION: Continued efforts are needed to provide focused HIV prevention messaging specifically for older adults and to make available relevant information about HIV to health care providers.

Long COVID, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and other poorly understood post-acute infection syndromes (PAIS) can present with unexplained symptoms or conditions that may be misunderstood by healthcare providers, causing delays in diagnosis and care. To address these issues, the Centers for Disease Control and Prevention (CDC) funded the Long COVID and Fatiguing Illness Recovery Program (LC&FIRP), initiated as a pilot project to assess whether providing tele-mentoring and other online education for primary care providers could help them improve the quality of life and support the recovery of their patients with these conditions. The LC&FIRP multi-disciplinary team-based care approach is built on the Extension for Community Healthcare Outcomes (ECHO) learning model, which is an evidence-based virtual learning framework developed by the University of New Mexico and designed to disseminate and implement best practices, especially in under-resourced areas. A distinctive feature of LC&FIRP was the inclusion of lived-experience experts. To explore the influence of lived-experience experts on the care patients received, we collected the educational recommendations provided by the lived-experience experts during webinar sessions (January 2022-March 2024) and grouped these by themes. The major themes that emerged included validation of patients' illness experience; attitudes and beliefs about Long COVID, ME/CFS, and PAIS; understanding patients' challenges and communicating with empathy; navigating referrals; recognizing and supporting disability; and supporting self-care. Investigators also interviewed patients of the Family Health Centers of San Diego (FHCSD) about their experiences receiving care from participating primary care providers and employed content analysis methods to code interview transcripts to identify themes among patients' perspectives. Positive comments from the patients about topics emphasized by the lived-experience experts provided evidence of providers' uptake and application of the experts' recommendations and support the value of involving lived-experience experts in medical education to improve health services.

OBJECTIVE: During the COVID-19 pandemic, the United States Centers for Disease Control and Prevention provided strategies, such as extended use and reuse, to preserve N95 filtering facepiece respirators (FFR). We aimed to assess the prevalence of N95 FFR contamination with SARS-CoV-2 among healthcare personnel (HCP) in the Emergency Department (ED). DESIGN: Real-world, prospective, multicenter cohort study. N95 FFR contamination (primary outcome) was measured by real-time quantitative polymerase chain reaction. Multiple logistic regression was used to assess factors associated with contamination. SETTING: Six academic medical centers. PARTICIPANTS: ED HCP who practiced N95 FFR reuse and extended use during the COVID-19 pandemic between April 2021 and July 2022. PRIMARY EXPOSURE: Total number of COVID-19-positive patients treated. RESULTS: Two-hundred forty-five N95 FFRs were tested. Forty-four N95 FFRs (18.0%, 95% CI 13.4, 23.3) were contaminated with SARS-CoV-2 RNA. The number of patients seen with COVID-19 was associated with N95 FFR contamination (adjusted odds ratio, 2.3 [95% CI 1.5, 3.6]). Wearing either surgical masks or face shields over FFRs was not associated with FFR contamination, and FFR contamination prevalence was high when using these adjuncts [face shields: 25% (16/64), surgical masks: 22% (23/107)]. CONCLUSIONS: Exposure to patients with known COVID-19 was independently associated with N95 FFR contamination. Face shields and overlying surgical masks were not associated with N95 FFR contamination. N95 FFR reuse and extended use should be avoided due to the increased risk of contact exposure from contaminated FFRs.

OBJECTIVES: In August 2024, the U.S. Centers for Disease Control and Prevention updated U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC), which provides recommendations for safe use of contraception for women with certain characteristics and medical conditions. This paper provides a summary of the evidence and context for new and updated U.S. MEC recommendations. STUDY DESIGN: The 2024 U.S. MEC was updated through a rigorous, multi-year process of determining priorities that would have high impact on clinical care, conducting systematic reviews of the evidence, and considering perspectives of health care providers and patients on how the evidence could best support updated recommendations. RESULTS: New U.S. MEC recommendations were added for chronic kidney disease, specifically for three subconditions: current nephrotic syndrome, hemodialysis, and peritoneal dialysis. Revisions were made to several existing recommendations, such as those for sickle cell disease, anticoagulant therapy use, various thrombogenic conditions, cirrhosis, liver tumors, solid organ transplantation, and intrauterine device placement in the postpartum period. Updated recommendations include those that reflect decreased safety concerns for some medical conditions (e.g., progestin-only contraception and some liver diseases) and increased safety concerns for others (e.g., combined hormonal contraception and depot medroxyprogesterone acetate for women with sickle cell disease). Recommendations for new contraceptive methods were added. CONCLUSIONS: Evidence-based clinical guidelines can be used by health care providers to support patient-centered contraceptive counseling and services and remove unnecessary barriers to accessing and using contraception. Provider tools including a mobile app are available to help with implementation of the updated recommendations. IMPLICATIONS: Keeping U.S. MEC up-to-date is critical for supporting contraceptive decision-making and improving access to contraception and reproductive health care. This includes new research to address current evidence gaps, rigorous methodology for continuous evidence identification and synthesis, state-of-the-art methods for guideline development, and a broad range of dissemination and implementation strategies.

INTRODUCTION: Timely access to stroke care reduces death and disability due to stroke. Studies have investigated disparities in access by sociodemographic characteristics but not comorbidity prevalence. We used updated data to assess both types of disparities in drive times to certified stroke centers nationwide. METHODS: We conducted a cross-sectional spatial analysis of drive time from each contiguous US census tract (N = 72,517), using population-weighted centroids, to any certified stroke care (n = 1,825) or advanced (ie, endovascular-capable) stroke care (n = 426), using 2022 data from multiple state and nationwide databases. We compared median comorbidity prevalence and sociodemographic characteristics for census tracts within versus beyond a 60-minute drive time, using US Centers for Disease Control and Prevention PLACES 2020 data. RESULTS: Median (interquartile range) drive time was 11.8 (7.6-21.6) minutes to any certified stroke care, and 23.0 (12.6-53.9) minutes to advanced stroke care. Approximately 20% of the US adult population (n = 49 million) resided in census tracts beyond a 60-minute drive from advanced stroke care; most (65%) were rural. Census tracts more than 60 minutes from advanced stroke care had significantly higher prevalence of stroke, high blood pressure, coronary heart disease, high cholesterol, diabetes, chronic kidney disease, fair or poor self-rated health status, smoking, and obesity. They also had higher poverty rates, lower educational attainment, lower median income, and higher proportions of non-Hispanic White people and people older than 65 years. CONCLUSION: Residents in census tracts lacking timely access to stroke care have higher prevalence of health risk factors. The results highlight areas where education, telehealth infrastructure, and facility placement could improve stroke systems of care.

<sec><title>BACKGROUND</title>In February 2022, the U.S. Centers for Disease Control and Prevention (CDC) recommended a 4-month rifapentine-moxifloxacin based regimen (4-HPMZ) for treating drug-susceptible pulmonary TB. We describe 4-HPMZ implementation, treatment outcomes, and regimen tolerability at New York City (NYC) Health Department TB clinics.</sec><sec><title>METHODS</title>A multidisciplinary workgroup developed a 4-HPMZ implementation plan and protocol based on CDC patient eligibility guidance. Treatment outcomes were classified as 'completed' when 4-HPMZ was completed within 5 months or 'discontinued' when 4-HPMZ was stopped due to clinical or programmatic reasons. Adverse events (AEs) included abnormal lab results, or any medication-related concern reported by patients.</sec><sec><title>RESULTS</title>Between April 2022 to December 2023, 617 patients with TB visited NYC Health Department TB clinics; for 4-HPMZ, 333 (54%) were ineligible and 284 (46%) were eligible. Of the eligible patients, 40 (14%) were prescribed 4-HPMZ; of these, 36 initiated 4-HPMZ treatment, 13 (36%) completed treatment, and 23 (64%) discontinued. A total of 15 patients (42%) discontinued due to AEs.</sec><sec><title>CONCLUSION</title>Significant programmatic and clinical challenges were associated with initiation and completion of 4-HPMZ treatment. As a result, few patients completed treatment. Further assessment is needed to identify populations most likely to initiate and complete 4-HPMZ.</sec>.

INTRODUCTION: Sexual violence (SV) affects millions globally and has a well-documented bidirectional association with HIV. Post-exposure prophylaxis (PEP) is a critical, yet often underutilized, HIV prevention tool in post-SV care. Despite its potential impact to reduce HIV transmission, SV care remains an overlooked service delivery point for HIV prevention. The U.S. Centers for Disease Control and Prevention (CDC), as part of the President's Emergency Plan for AIDS Relief (PEPFAR), supports PEP provision within broader post-violence care (PVC) services. Understanding PEP utilization is crucial for optimizing service delivery and HIV prevention efforts. METHODS: Using Monitoring Evaluation and Reporting data from fiscal years 2018-2023, we conducted a descriptive analysis of clients who received PVC and SV services through CDC-supported programming in 14 sub-Saharan African countries. RESULTS: From 2018 to 2023, the annual number of clients receiving any PVC, and specifically SV, services increased by 233% (in 2018, n = 206,764; in 2023, n = 689,349) and 163% (in 2018, n = 42,848; in 2023, n = 112,838), respectively. Fewer than half of SV clients completed PEP (38% in 2018, n = 16,103; 31% in 2023, n = 35,118). Across all years combined, most SV clients (female: 185,414; male: 59,618) were aged 15-19 years. The age band and sex with the lowest proportion of clients completing PEP were males aged 15-19 (4%, n = 2296). CONCLUSIONS: The findings underscore a critical gap between the scaling of SV services and the completion of PEP within violence response programmes. Innovative implementation science approaches may help to identify and address barriers inhibiting effective PEP delivery and uptake within PVC service delivery programmes. Enhancing PEP uptake and completion can support mitigating the bidirectional relationship between violence and HIV acquisition, particularly among vulnerable populations like adolescents and young adults. Low PEP coverage also reflects missed opportunities, particularly among adolescent girls and young women, who experience disproportionate rates of HIV acquisition.

INTRODUCTION: Data on sexual violence (SV) prevalence in Nigeria is limited; however, 2014 data indicate that 24.8% of females aged 18-24 years experienced SV in childhood and only 3.5% received any form of services. Initiation of post-exposure prophylaxis (PEP) to prevent HIV acquisition following SV is most effective when started immediately and is not recommended after 72 hours. Police stations are often entry points for survivors; however, lengthy processes may result in delays and missed PEP opportunities. Using an ongoing phased approach, we introduced PEP into selected police stations in Nigeria's Federal Capital Territory in order to explore expanding access to time-sensitive HIV prevention within non-health services. METHODS: Our intervention phase consisted of the provision of training of police officers and the provision of PEP starter packs coupled with linkage to referral facilities. During two time periods (pre-intervention: January-March 2023) and (during intervention: July-September 2023), we evaluated routinely reported programme data from 27 U.S. Centers for Disease Control and Prevention-supported health facilities for changes in the provision of SV services and PEP initiation. We used geospatial mapping to assess the proximity of participating health facilities to police stations and to see changes in both SV and PEP service provision. The statistical significance of the difference in PEP uptake proportion during the two periods was determined using the Wilcoxon signed rank test at a 0.05 level of significance. RESULTS: Of the total 27 health facilities, 24 were within a 5-km radius of a participating police station. Total SV service provision increased from 114 cases to 218 cases, representing a 91.2% increase and with most of this increase seen among females. PEP initiation increased by 289.3% at the two time points, with 56 initiations pre-intervention to 218 PEP initiations during the intervention. CONCLUSIONS: Our findings showed promise in increasing immediate access to PEP in non-health services and highlighted the feasibility of police stations and health facilities collaboration to address urgent health needs. There was an overall increase in PEP initiations by referral and non-referral facilities which could be the result of demand creation and increased access at police stations.

Background: Malaria is a mosquito borne disease caused by parasites of the genus Plasmodium. In 2023, the United States (US) experienced nine cases of autochthonous Plasmodium vivax malaria transmission; seven in Florida, one in Texas, and another in Arkansas. These were the first autochthonous cases since 2003 when a cluster was identified in Florida. The aim of this study was to genetically characterize the implicated P. vivax isolates in order to complement epidemiologic investigations of these cases. Methods: A custom Illumina AmpliSeq sequencing panel capturing 495 amplicons was designed. This panel was used to ascertain whether these 2023 cases were related, and assess if they were associated with a single or separate introduction events. Sequence data were hierarchically clustered and a Naïve Bayes classification approach was used to assign genotypes to a probable geographic origin based on 113 ‘geo-informative’ SNPs captured by the panel. Genotypes associated with the 2023 Arkansas, Texas, and Florida cases were clustered alongside those sequenced from archived blood samples from the 2003 Florida case-patients, a set of reference strains, and other travel-associated specimens. Microsatellite analysis was performed on a subset of samples from these autochthonous cases to complement the AmpliSeq analysis. Findings: The 2023 autochthonous Florida cases were genetically linked as were the 2003 Florida cases. The 2023 and 2003 Florida clusters were genetically distinct, and the two Florida clusters were distinct from the 2023 Texas and Arkansas cases, which were also distinct from each other. These genotypes classified to the Central or South American region using the Naïve Bayes classifier, including those from the 2003 cluster. Interpretation: These data support that at least three distinct P. vivax introduction events in the US in 2023, involving parasites possessing genetic signatures consistent with Central or South America. Funding: This work was supported by the National Center for Emerging and Zoonotic Infectious Diseases at the US Centers for Disease Control and Prevention. © 2025

Newborn bloodspot screening for one or more lysosomal storage disorders (NBS-LSD) is currently performed by many public health NBS laboratories globally. The screening tests measure activities of selected lysosomal enzymes on dried blood spot (DBS) specimens collected from newborns by the heel stick method Because these assays measure enzyme activity, the quantitative results are dependent on the particular analytical method. DBS quality control (DBS QC) materials with assay-specific certified values that span the relevant range from typical to LSD-affected newborns are an important component of quality assurance in NBS laboratories. The Newborn Screening Quality Assurance Program (NSQAP) at the U.S. Centers for Disease Control and Prevention (CDC) provides public health NBS laboratories with DBS QC sets for NBS-LSD comprising four admixtures of pooled umbilical cord blood and a base pool made from leukodepleted peripheral blood and heat-inactivated serum. To evaluate the suitability of these materials for use with digital microfluidics fluorometry (DMF) assays which can currently measure the activity of four enzymes (acid α-galactosidase (GLA); acid β-glucocerebrosidase (GBA); acid α-glucosidase (GAA); and iduronidase (IDUA)), CDC collaborated with the Newborn Screening Unit at the Missouri State Public Health Laboratory (MSPHL). Using MSPHL criteria, we found that the certified results from each of two DBS QC lots collectively spanned the range from typical (screen negative) to enzyme deficient (screen positive) newborn DBS levels for each of the four lysosomal enzymes measured. The range included borderline results that would require repeat screening of the newborn under the MSPHL protocol. We conclude that these DBS QC preparations are suitable for use as external quality control materials for DMF assays used to detect LSDs in newborns.

BACKGROUND: In August 2020, the Centers for Disease Control and Prevention (CDC) released guidance to prevent transmission of coronavirus disease 2019 (COVID-19) in K-12 education settings. Schools varied in the degree to which they were able to implement COVID-19 prevention strategies during the height of the pandemic. METHODS: An evaluation team conducted interviews with state education staff and focus groups with district and school staff over 2 years to explore contextual factors that influenced the implementation of CDC's recommended COVID-19 prevention strategies. RESULTS: Eight implementation drivers influenced COVID-19 response efforts in school settings, including COVID-19 guidance, political climate, communication challenges, state health and education agency support, partnerships, physical and financial resources, staffing, and student needs. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Evaluation results offer insights for future guidance and support for schools and educators as they continue efforts to prevent the spread of COVID-19 and other infectious diseases for safe in-person learning. CONCLUSIONS: The authors describe key drivers and conditions that influenced, facilitated, and/or impeded schools' implementation of COVID-19 prevention strategies. Federal, state, district, and school leadership can use the results to bolster future emergency preparedness and response efforts to protect student and school employee health.

The 2009 influenza pandemic has caused health challenges around the world. Mozambique has faced challenges in implementing surveillance systems, which are obstacles to the timely detection of outbreaks and epidemics. It is intended to evaluate the performance of the influenza sentinel surveillance system between 2016 and 2021. A descriptive-cross-sectional evaluation of the influenza sentinel surveillance system was conducted at the sentinel posts in Maputo. The sample was calculated, and a simple random sampling technique was used to select the 372 patient record forms. Microsoft Excel and Tableau were used for frequency calculations. Based on the Centers for Disease Control - 2001 script, data quality, stability, sensitivity, representativeness, timeliness, and positive predictive value were evaluated. 28.0% (1,305/4,660) of the analyzed samples had positive results, and 56.1% (2,617/4,660) were male. The system obtained data completeness and consistency of 69.9% (3,260/4,660) and 68% (355/372), respectively. It obtained a sensitivity of 77.5% (842/1,086) in 2017, a representative in 98.4% 1,285/1,305 of the neighborhoods, the opportunity of 50.4% (2,349/4,660), and a positive predictive value of 31.4% (410/1,305). The system proved to be useful, providing reliable data on influenza viral circulation. Continuous influenza monitoring would promote prevention interventions in the most vulnerable groups.

Over the past decade, genomic characterization of Bordetella pertussis isolates recovered from US pertussis patients has unveiled noteworthy structural gene order variations. Whole-genome sequencing (WGS) shows that although B. pertussis exhibits little gene sequence variation, genomes from clinical isolates frequently differ in gene order through rearrangement between insertion sequence elements. To better understand rates of genome rearrangement and single nucleotide polymorphism (SNP) in B. pertussis, intra-patient genomic diversity was examined. Five states submitted, on average, five isolates per patient specimen following culture confirmation to the US Centers for Disease Control and Prevention for molecular characterization. Analysis of 149 patient specimen sets revealed only rare SNP variation, while isolate sets from 12 patients included genomic rearrangements that did not impact vaccine antigen production. To investigate the frequency and stability of such rearrangements during laboratory culture, replicate cultures of two pairs of isolates differing by duplication and inversion were subcultured for eight serial passages. WGS confirmed the initial presence of rare duplication mutations that became dominant in later passages, as well as the stable maintenance of a large, inverted genomic region during passage. These findings suggest that B. pertussis exhibits genomic diversity within a single clinical diagnostic specimen and acquires genomic variations during serial laboratory passages, indicative of bacterial genomic plasticity. Importantly, these rearrangements did not impact the frequency or distribution of SNPs. These results underscore the importance of minimizing the laboratory passaging of clinical isolates used for infectious disease surveillance. IMPORTANCE: The whooping cough-causing bacterium Bordetella pertussis can alter its genetic structure while conserving areas essential for vaccine efficacy. By examining B. pertussis from infected patients, we demonstrate the significance of reducing laboratory manipulation of bacteria to maintain reliable monitoring data from laboratory cultures. Public health officials can use these data to develop efficient disease control tactics and better understand B. pertussis's adaptability. This study highlights the importance of immunizations and the necessity of thorough genetic surveillance in the fight against this chronic and avoidable respiratory illness.

The Centers for Disease Control and Prevention (CDC) funds tuberculosis (TB) Centers of Excellence (COEs) that support TB control and prevention efforts in the United States. In 2018, the TB COEs conducted a multiphased assessment among U.S. staff involved in TB service delivery to identify needs related to TB training, resources, and medical consultation. Representatives from each TB COE and CDC's Division of TB Elimination formed a workgroup to guide the design of the needs assessment. The group used an online survey for data collection. Participants were staff working in some capacity on TB within the United States, Puerto Rico, and the U.S. Virgin Islands. Staff could be in non-public health (e.g., community health center, hospital, laboratory, private practice) or public health (state or local health department staff responsible for TB) settings and did not have to be a clinical health care provider (N = 1,482). We identified four priority areas for future TB training and education efforts. These areas include (1) focus on key topics; (2) tailor training and products to different professions, settings, and skill levels; (3) keep learners updated on the latest resources and best practices; and (4) use a mix of training methods and formats. The findings highlighted future priorities for TB training and education and were shared with health department TB programs throughout the United States.

BACKGROUND: Communities experiencing more social vulnerability are disproportionately harmed by environmental disasters, disease, and injury. This cross-sectional study examined whether US county-level vulnerability scores were associated with 2019 passenger vehicle occupant or pedestrian death rates. METHODS: County-level vulnerability was measured by 2020 Centers for Disease Control and Prevention Social Vulnerability Index scores. Scores were based on 16 community-level characteristics categorised into 4 themes: socioeconomic status; household characteristics; race and ethnicity and housing type and transportation. Counties were divided into quartiles from least to most vulnerable, based on the score distribution among all counties. Deaths were identified from the 2019 Fatality Analysis Reporting System. Death rates per 100 000 population were stratified by vulnerability quartile and urbanicity. Large central metropolitan county results used the second least vulnerability quartile as reference. RESULTS: Among 328 320 065 people across 3140 counties, there were 22 942 occupant and 6272 pedestrian deaths. Occupant death rates were higher in most vulnerable counties compared with least for all urbanicity levels (large central metropolitan: 4.0 vs 2.8; large fringe metropolitan: 7.4 vs 5.2; medium/small metropolitan: 8.9 vs 7.0; non-metropolitan: 18.5 vs 12.2) with disparities prominent in counties experiencing more socioeconomic and household vulnerability. Pedestrian death rates were highest in most vulnerable counties compared with least (large central metropolitan: 2.5 vs 1.4; large fringe metropolitan: 3.3 vs 1.0; medium/small metropolitan: 2.8 vs 0.8; non-metropolitan: 2.4 vs 0.9) with disparities prominent for all four vulnerability types. CONCLUSIONS: Tailoring prevention strategies to communities experiencing infrastructure inadequacies, improving safe transportation options and reducing poverty may help reduce crash death disparities.

BACKGROUND: The serum bactericidal antibody using human complement (hSBA) assay, the accepted surrogate measure of meningococcal vaccine efficacy, is limited by human sera and complement requirements. Pfizer developed and validated the flow-cytometry-based Meningococcal Antigen Surface Expression (MEASURE) assay to quantify surface-expressed factor H binding protein (fHbp) levels on intact meningococci. Surface expression of fHbp is correlated with hSBA assay killing by MenB-fHbp (Trumenba(Ⓡ))-induced antibody, meaning the MEASURE assay can be used to predict meningococcal serogroup B (MenB) strain susceptibility to antibodies elicited by MenB-fHbp. This study aimed to evaluate interlaboratory precision and reproducibility of the MEASURE assay. METHODS: The MEASURE assay was transferred to UK Health Security Agency (UKHSA) and US Centers for Disease Control and Prevention (CDC) laboratories. MEASURE assay results from 42 MenB strains encoding sequence-diverse fHbp variants that express fHbp at different levels were compared between the UKHSA, CDC, and Pfizer laboratories. Intermediate precision within each laboratory was determined. RESULTS: Pairwise comparisons of fHbp expression levels for all 42 MenB test strains showed >97 % agreement across the 3 laboratories when strains were grouped above or below a mean fluorescence intensity level of 1000, the threshold previously established as indicative of susceptibility to MenB-fHbp-induced antibodies in the hSBA assay. Each laboratory met assay precision criteria of ≤30 % total relative standard deviation. CONCLUSIONS: Quantification of fHbp surface expression using the MEASURE assay is robust and reproducible across different laboratories. Previously determined cutoffs corresponding to predicted susceptibility to vaccine-induced antibodies can be applied to MEASURE data generated across laboratories.

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).

BACKGROUND: In November, 2020, WHO authorised novel oral polio vaccine type 2 (nOPV2) use under Emergency Use Listing in response to outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2). Although no concerns were identified in nOPV2 trials, the Global Advisory Committee on Vaccine Safety requested more extensive vaccine safety data during emergency use. The Uganda Ministry of Health declared a cVDPV2 outbreak in 2021 and responded with an nOPV2 campaign in January, 2022. More than 9 million children aged 0-59 months were vaccinated, providing an opportunity to generate robust safety data. METHODS: We monitored the safety of nOPV2 for 42 days post-vaccination using: routine passive surveillance for adverse events following immunisation (AEFI); ongoing acute flaccid paralysis (AFP) surveillance; active, hospital-based surveillance for pre-specified adverse events of special interest (AESI); and active, cohort event monitoring. AFP cases were reviewed by the National Polio Expert Committee. Serious AEFI and all AESI and AFP cases with nOPV2 receipt underwent causality assessment by the National AEFI Committee. FINDINGS: Across surveillance systems, 1128 children vaccinated with nOPV2 experienced one or more AEFI: 43 children identified through passive surveillance, 128 suspected AFP cases, five AESI cases, and 952 children with reported AEFI through cohort event monitoring. Overall, 109 adverse events were considered serious; six (fever, gastroenteritis (n=3), acute disseminated encephalomyelitis, and encephalitis) were determined by the National AEFI Committee to be consistent with causal association to immunisation with nOPV2. No cases of vaccine-associated paralytic poliomyelitis were detected. One death was detected, considered inconsistent with causal association to immunisation with nOPV2, per the National AEFI Committee. INTERPRETATION: No new safety concerns were identified with nOPV2 use in Uganda following a national vaccination campaign, providing valuable data that informed WHO prequalification and product licensure. FUNDING: Centers for Disease Control and Prevention. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.

BACKGROUND: School professionals, including classroom teachers, school administrators, psychologists, teachers' aides, and nurses, often interact with students with concussions. To ensure they have the knowledge to identify and manage concussions, the U.S. Centers of Disease Control and Prevention developed the HEADS UP to Schools online training. METHODS: The HEADS UP to Schools training includes a pre-test and post-test consisting of 16 knowledge questions in three areas (symptom recognition, school support and accommodation, and guidance and recommendations for school staff) and five self-efficacy questions. Pre- and post-test responses of 8750 individuals were compared and analyzed to evaluate the effectiveness of the training. RESULTS: Respondent scores significantly improved between pre- and post-test responses for all knowledge questions and self-efficacy questions. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Schools and school districts may consider offering this training to staff to help ensure that at least one person at each school is trained on concussion and to increase awareness of evidence-based practices. CONCLUSIONS: Knowledge and self-efficacy on concussion identification and management improved among school professionals who completed the HEADS UP to Schools training. Future research to assess whether concussion knowledge and self-efficacy are maintained long term may be beneficial.