BACKGROUND: Syphilis cases continue to climb in the United States, with a 159% increase among women between 2018 and 2022. Congenital syphilis (CS) cases continued along the same trajectory, with a 183% increase over the same time frame. Adherence to the screening guidelines may assist in reducing this trend. Our analysis aimed to determine the proportion of commercially insured women receiving syphilis screening during pregnancy. MATERIALS AND METHODS: We analyzed the 2022 Merative MarketScan Database containing commercially insured medical claims to determine syphilis screening rates among insured pregnant women aged 18 to 49 years, insured for 8 months before childbirth. Screening events were classified into 3 categories: first (1-13 weeks), second (14-27 weeks), and third (28+ weeks). Percentages and odds ratios were calculated for pregnancy categories by age category, trimester, Centers for Medicare & Medicaid Services regions, employment, and type of health insurance. RESULTS: Of the 170,005 pregnant women in the sample, 79.6% were screened for syphilis at least once, and 95.1% resided in a state requiring syphilis testing during pregnancy. The highest percentage of pregnant women was screened during the third trimester, and the majority of those screened received at least 2 tests during pregnancy. Women in states with laws had 14% greater odds for receiving any screening during pregnancy. DISCUSSION: Despite Centers for Disease Control and Prevention syphilis screening recommendations, only 79.6% received screening among this insured population. Effective communication on the importance of syphilis screening for all medical providers and their patients may increase the screening rates and decrease the incidence of CS.

Background: Performance of thyroid function assays can vary significantly. To address this issue, the Centers for Disease Control and Prevention (CDC) Clinical Standardization Programs conducted an interlaboratory comparison of free thyroxine (fT4) immunoassays (IAs) and laboratory-developed tests (LDTs). This assessment aimed to determine the current performance characteristics of these assays as a first step toward measurement standardization. Thyrotropin (TSH) IAs were also evaluated. Methods: Assays measured 41 blinded individual-donor sera, including a sample from a pregnant woman (for fT4 analysis only) and three serum pools, with 11.3-32.1 pmol/L (0.881-2.49 ng/dL) fT4 and 0.337-21.6 mIU/L TSH in duplicate over 2 days. Passing-Bablok regression analysis performed pre-recalibration compared assays performance to the CDC fT4 reference measurement procedure (RMP) or TSH all-lab mean (ALM). Additionally, the impact of linear regression-based recalibration of assays to the CDC fT4 RMP or TSH ALM was estimated. Inter-assay agreement of sample classification according to the assay-specific reference interval (RI) was assessed pre- and post-recalibration. Results: A total of 21 fT4 and 17 TSH assays participated. Pre-recalibration, median biases of TSH measurements to the ALM were -1.2% [confidence interval or CI -1.8% to -0.4%], and good classification agreement among TSH assays was observed. fT4 assays all showed a negative median bias to the RMP, with higher bias among IAs (median: -20.3%, CI [-21.5% to -19.4%]) than LDTs (median: -4.5%, [CI -6.1% to -3.2%]). Of the individual-donor sera, only 21 out of 40 samples were classified uniformly by all fT4 assays, indicating poor inter-assay agreement. Post-recalibration, agreement improved to 33 out of 40 individual-donor sera correctly classified by all tested IAs and LDTs. Similar improvement in post-recalibration median percent bias was observed for fT4 IAs (median: -0.2, [CI -1.2% to 0.6%]) and LDTs (median: -0.3%, [CI -2.5% to 1.4%]). Conclusions: The comparison among fT4 assays emphasizes the need for measurement standardization to improve accuracy and comparability. This and previous studies demonstrate the possibility to develop common fT4 RIs via standardization, enabling the use of evidence-based clinical guidelines universally in patient care. Recalibration can effectively address high variability in fT4 assays, ensuring consistent diagnostic classification.

BACKGROUND: Patients hospitalised with influenza have heterogeneous clinical presentations and disease severity, which may complicate epidemiologic study design or interpretation. We applied latent class analysis to identify clinically distinct subgroups of adults hospitalised with influenza. METHODS: We analysed cross-sectional study data on adults (≥18 years) hospitalised with laboratory-confirmed influenza from the population-based U.S. Influenza Hospitalization Surveillance Network (FluSurv-NET) including 13 states during 2017-2018 and 2018-2019 influenza seasons (October 1 through April 30). Adults were included if they were residents of the FluSurv-NET catchment area, hospitalised with laboratory-confirmed influenza during these two seasons, and had both the main case report form and the supplemental disease severity case report form completed. We constructed a latent class model to identify subgroups from multiple observed variables including baseline characteristics (age and comorbidities) and clinical course (symptoms at admission, respiratory support requirement, and development of new complications and exacerbations of underlying conditions). FINDINGS: Among the 43,811 influenza-associated hospitalizations reported during the 2017-2018 and 2018-2019 influenza seasons, 15,873 (36.2%) were included in our analytic population: among them, 7069 (44.5%) were male and 8804 (55.5%) were female. We identified five subgroups. Subgroup A included persons of all ages with few comorbidities and 87.9% (255/290) of pregnant women. Subgroup B included older adults with comorbidities (cardiovascular disease (79.7% [3650/4581]) and diabetes (50.6% [2320/4581])). Almost all patients in subgroups C and D had asthma or chronic lung disease and high proportions with exacerbations of underlying conditions (59.7% [889/1489] and 65.1% [2274/3496], respectively). Subgroup E had the highest proportion with new complications (90.3% [1383/1531]). Subgroups D and E had the highest proportions with severe disease indicators: 21.0% (733/3496) and 50.4% (771/1531) required ICU admission, 7.2% (253/3496) and 28.0% (428/1531) required invasive mechanical ventilation, and 3.3% (116/3496) and 11.4% (174/1531) died in-hospital, respectively. INTERPRETATION: The five identified subgroups of adults hospitalised with influenza had varying distributions of age, comorbid conditions, and clinical courses characterized by new complications versus exacerbations of existing conditions. Stratifying by these subgroups may strengthen analyses that assess the impact of influenza vaccination and antiviral treatment on risk of severe disease. Limitations included that results were based on a convenience sample within FluSurv-NET sites and were likely not representative of all adults hospitalised with influenza in the United States. Influenza testing was also clinician-driven, likely leading to under-ascertainment. FUNDING: Centers for Disease Control and Prevention.

Objectives. HIV preexposure prophylaxis (PrEP) use has increased since its US Food and Drug Administration approval in 2012. Our objective was to describe trends in PrEP use by US women. Methods. Using national pharmacy and HIV surveillance data, we calculated the PrEP-to-diagnosis ratio (PDR), a measure of PrEP prescriptions each year compared with HIV diagnoses the previous year, for women from 2017 to 2023. We also calculated PDRs in 2023 for the 20 counties with the highest numbers of diagnosed HIV infections among women and reviewed reports of public health activities conducted by recipients of Centers for Disease Control and Prevention HIV prevention funding. Results. The PDR for women was 1.5 in 2017, and it increased to 5.8 by 2023. In the 20 counties with the highest number of diagnosed HIV infections among women, PDRs ranged from 2.2 to 16.9. Counties with the highest PDRs conducted PrEP activities designed for women. Conclusions. PrEP is a highly effective HIV prevention intervention that can empower women to protect their health, but its use has been low. Public health and clinical interventions designed for women can increase their PrEP use and support ending the US HIV epidemic. (Am J Public Health. Published online ahead of print April 24, 2025:e1-e4. https://doi.org/10.2105/AJPH.2025.308056).

BACKGROUND: This report represents a collaborative effort by the major cancer surveillance organizations to present the definitive US statistics for cancer incidence and mortality. METHODS: Cancer incidence data were obtained from population-based cancer registries funded by the Centers for Disease Control and Prevention and the National Cancer Institute and compiled by the North American Association of Central Cancer Registries. Cancer death data were obtained from the National Center for Health Statistics' National Vital Statistics System. Statistics are reported by cancer type, sex, race and ethnicity, and age. The potential impact of the coronavirus disease 2019 (COVID-19) pandemic on incidence was assessed by using state-level changes compared with previous years, the stringency of COVID-19 policy restrictions, the magnitude of COVID-19 death rates, and changes in the use of mammography. RESULTS: Overall cancer incidence rates per 100,000 were 500 among males and 437 among females. Excluding 2020, cancer incidence rates remained stable (2013-2021) among males and increased 0.3% per year on average (2003-2021) among females. The overall cancer death rate per 100,000 was 173 among males and 126 among females. Cancer death rates decreased by 1.5% per year (2018-2022), slowing from a previous 2.1% decline. Cancer incidence in 2020 declined from prepandemic levels for all demographic groups examined. However, the magnitude of decline was not strongly associated with the study's proxies for health care capacity, health care access, or COVID-19 policies. CONCLUSIONS: Overall cancer mortality declined over 20 years, even during the COVID-19 pandemic. Disruptions in health care use early in the pandemic resulted in incidence declines in 2020, but 2021 incidence returned to prepandemic levels.

BACKGROUND: Environmental cleaning is a key infection prevention and control (IPC) intervention in healthcare settings. The U.S. Centers for Disease Control and Prevention (CDC), with Infection Control Africa Network (ICAN), developed best practices for global healthcare environmental cleaning in resource-limited settings to help fill gaps in guidance in low- and middle-income countries (LMICs). We aimed to evaluate the feasibility, appropriateness, and acceptability of a quality improvement toolkit developed to assist with implementing the CDC/ICAN best practices at Lagos University Teaching Hospital in Nigeria. METHODS: A mixed-methods approach was used to evaluate the implementation of the toolkit from March through September of 2021. A monitoring checklist assessed feasibility after three defined steps within the toolkit. Key informant interviews and electronic surveys were conducted with toolkit team members at three time points during implementation to assess appropriateness and acceptability. A deductive analytic process was used to code and analyze interview data based on constructs of appropriateness and acceptability. Additional codes and sub-themes that emerged during analysis followed an inductive process. RESULTS: Within the interviews and surveys, themes identified for the appropriateness included concern related to (1) time commitment for the toolkit activities and (2) resources required to sustain improvements. Themes identified for acceptability included (1) perceived challenges with time commitment and resource requirements, (2) perceived effectiveness of toolkit structure and usability, (3) perceived benefits and success associated with knowledge gained about environmental cleaning and environmental cleaning staff, (4) perceived benefits and success associated with the training for cleaning staff undertaken during toolkit implementation, and (5) perceived benefits and success associated with the multidisciplinary team approach with the inclusion of facility leadership and a project coordinator. CONCLUSIONS: The results showed that the toolkit materials were feasible within the local context and highlighted perceived effectiveness, benefits, and success of the toolkit process and experience contributing to a high level of acceptability. Challenges relating to time commitment and concern for sustainability have implications for the appropriateness of this toolkit, similar approaches to quality improvement, and the need for strengthening support for IPC improvements at the facility and national levels in resource-limited healthcare settings in LMICs.

The Marie Skłodowska-Curie Symposia on Cancer Research and Care (MSCS-CRC) promote collaborations between cancer researchers and care providers in the United States, Canada and Central and Eastern European Countries (CEEC) to accelerate the development of new cancer therapies, new strategies for early detection and prevention, and improve cancer care and the quality of life for patients and their families. The 4th MSCS-CRC (September 25-27, 2024, Buffalo, New York) brought together 147 participants from the US, Canada, Croatia, Czechia, Lithuania, Poland, Romania and Ukraine, and involved representatives of the US Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI) and their counterparts from Poland, Ukraine Lithuania and other CEECs. They were accompanied by New York State (NYS) and local representatives of the NYS Empire State Development, and of the Translational Research Consortium of Cancer Centers (TRCCC), involving 13 cancer centers from the Northeastern US and Canada, as well as several Pharma and Biotech companies. The 4th Meeting focused on prevention and early detection of smoking- and HPV-related cancers, reducing disparities in cancer detection-, care and outcomes, and increasing the feasibility and reducing costs of high-end treatments, such as cell therapies for patients with advanced cancers. The second focus area were the available sources of funding of regional and international collaborations in these areas. The relevance of the successful model TRCC to promoting the oncology training and research collaborations in the CEE Countries was discussed. The 5th MSCR-CRC meeting will take place September 3-5, 2025, in Warsaw, Poland.

BACKGROUND: Seasonal influenza causes an estimated 120 000 to 710 000 hospitalizations annually in the United States. Treatment with antiviral medications, such as oseltamivir, can reduce risks of hospitalization among people with influenza-associated illness. The US Centers for Disease Control and Prevention recommends initiating antiviral treatment as soon as possible for outpatients with suspected or confirmed influenza who have severe or progressive illness or are at higher risk of influenza complications. METHODS: We developed a probabilistic model to estimate the impact of antiviral treatment in reducing hospitalizations among US outpatients with influenza. Parameters were informed by seasonal influenza surveillance platforms and stratified by age group and whether individuals had a condition associated with higher risk of influenza complications. We modeled different scenarios for influenza antiviral effectiveness and outpatient testing and prescribing practices, then compared our results with a baseline scenario in which antivirals were not used. RESULTS: Across the modeled scenarios, antiviral treatment resulted in 1215 to 14 184 fewer influenza-associated hospitalizations on average when compared with the baseline scenario (0.2%-2.7% reduction). The greatest effects occurred among adults aged ≥65 years and individuals with conditions associated with higher risk of influenza complications. Modeling 50% improvements in access to care, testing, prescribing, and treatment resulted in greater potential impacts, with over 71 000 (13.3%) influenza-associated hospitalizations averted on average compared to baseline. CONCLUSIONS: Our results support recommendations to prioritize outpatient antiviral treatment among older adults and others at higher risk of influenza complications. Improving access to prompt testing and treatment among outpatients with suspected influenza could reduce hospitalizations substantially.

The use of mobile phone surveys (MPS) for regionally or nationally representative data allows for quick, efficient and affordable data collection for monitoring trends and generating results to guide action. By digitizing this process, data flows can be expanded to include metadata and paradata that allow survey administrators to evaluate and improve survey processes and parameters. Between 2017 and early 2022, the Centers for Disease Control and Prevention provided technical support to country partners to implement MPS gathering indicators on noncommunicable diseases within adult populations in seven countries. These surveys resulted in 37 591 completed interviews containing no personal identifiable information. When combined, these surveys result in over 25 million rows of paradata representing timestamped interactions between the data collection platform and each survey respondent. Using exploratory data analysis, five key metrics were identified which had implications on MPS process optimization: timing of engagement, question randomization, contacts to complete, errors and mode effect. The use of survey paradata allows for real-time process evaluations and identifies factors that can improve efficiency and effectiveness of MPS methods.

BACKGROUND: Monitoring temporal trends in firearm injury-related emergency department (ED) visits is challenging because traditional surveillance systems lack detailed temporal information. OBJECTIVE: To describe temporal patterns of ED visits for firearm injury using data from the Centers for Disease Control and Prevention's (CDC) Firearm Injury Surveillance Through Emergency Rooms (FASTER) program. DESIGN: Cross-sectional analysis of firearm injury-related ED visits. SETTING: 9 states (Florida, Georgia, New Mexico, North Carolina, Oregon, Utah, Virginia, Washington, and West Virginia) and the District of Columbia from 1 January 2018 to 31 August 2023. PATIENTS: ED visits for firearm injury (n = 93 022) from CDC's FASTER program. MEASUREMENTS: ED visits for firearm injury per 100 000 ED visits, analyzed by time of day (in 30-minute intervals), day of the week, day of the year, and holidays. RESULTS: From January 2018 through August 2023, there were 93 022 firearm injury ED visits (73.9 per 100 000 ED visits), or approximately 1 firearm injury every 30 minutes overall. Rates of firearm injury ED visits were highest between 2:30 and 3:00 a.m. and lowest between 10:00 and 10:30 a.m. Nighttime peaks and daily rates were highest on Friday and Saturday. Monthly rates were highest in July and lowest in February; daily rates were disproportionately high on most holidays, especially Independence Day and New Year's Eve. LIMITATIONS: Data are limited to 9 states and the District of Columbia and are not nationally representative. The analysis of ED visits for firearm injury does not distinguish injury intent and is based on arrival time rather than actual injury time. CONCLUSION: Distinct temporal patterns in firearm injury ED visits highlight resource allocation considerations for prevention and response efforts. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention.

INTRODUCTION: A complex and ongoing issue in firearm violence prevention research is correctly classifying injury intent (e.g., homicide, suicide, or unintentional). Emerging rule-based approaches to improve classification use the number of bullet wounds to infer intent of the injury when additional information is not available. Using the Centers for Disease Control and Prevention's National Violent Death Reporting System (NVDRS), which captures detailed information on intent of firearm injuries from coroner/medical examiner reports, law enforcement reports, and death certificates, this study examined potential evidence to support intent determination based on the number of bullet wounds. METHODS: 2003-2021 NVDRS data on fatal firearm injuries was analyzed in 2023. ANOVA was used to test statistical significance of differences in average number of bullet wounds by intent, and Tukey's Honest Significant Difference Test was used to determine specific differences by intent. RESULTS: A total of 299,362 fatal firearm injury decedents were identified. The average number of bullet wounds significantly differed by intent: suicide, 1.02; homicide, 2.72; and unintentional injury, 1.01 (P<.001). Homicide decedents had a significantly higher average number of wounds than unintentional injury decedents and suicide decedents (ΔM homicide-unintentional injury [1.71; 95% CI: 1.62 - 1.79; P<.001] and ΔM homicide-suicide [1.70; 95% CI: 1.68 - 1.72; P<.001]). CONCLUSIONS: The number of bullet wounds may be a useful indicator for classifying intent of firearm injuries, particularly for interpersonal assault, and when other supporting information is not available for medical coding. Accurate counts of firearm injuries by intent are critical for public health surveillance and prevention planning.

CONTEXT: Many people living in the 5 inhabited US territories experience high rates of natural hazard exposure and social vulnerability to disaster impacts. Public health workforce development and evidence-based, culturally competent approaches to disaster preparedness, response, and recovery are needed in these regions. PROGRAM: In 2020, the Natural Hazards Center established the Public Health Disaster Research Award Program with funding from the Centers for Disease Control and Prevention. The program's goal is to advance public health disaster research and practice by funding, training, mentoring, and connecting researchers, students, and practitioners in historically underserved areas with high natural hazard risk. Between 2020 and 2022, 26 research teams received up to $50 000 each to investigate public health disasters in 1 or more US territories. The program also supported awardees by providing individual consultations, online trainings, feedback on report drafts, and a virtual group workshop on the public health implications of research. Awardees authored final reports and presented at a public webinar. EVALUATION: In 2023, the Natural Hazards Center developed and distributed an online survey to all principal investigators. The survey evaluated how awardees advanced knowledge about public health disasters in the US territories; what skills, resources, and connections they acquired; and how they translated their research into public health applications and otherwise disseminated their findings. DISCUSSION: Our evaluation showed that the program is advancing knowledge of understudied hazard contexts and socially vulnerable populations in the US territories and supports awardees in sharing their findings with academics, policymakers, and practitioners. Moreover, it expanded the public health disaster workforce by bringing professionals from a diverse range of disciplines and institutions into the field, and by investing in students, early career scholars, and investigators based in US territories. Researchers are working with local partners to apply their findings to practice.

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 first dose of measles-rubella (MR) vaccine is routinely administered to infants aged 9 months as part of a standard two-dose schedule. However, during large measles outbreaks and in other settings of increased circulation or increased risk, WHO recommends administering a supplementary dose at age 6 months to protect young infants. We aimed to assess the immunogenicity and safety of a first dose of MR vaccine administered to infants aged 6 months and its effect on the immune response to the routine MR vaccine at age 9 months. METHODS: This open-label, randomised trial enrolled healthy infants aged 6 months in Matlab, Bangladesh, who had never received an MR vaccine dose and had no history of measles or rubella. Using a computer-generated block randomisation scheme, infants were randomly assigned (1:1) to receive either two doses of the MR vaccine, one at age 6 months and the second at age 9 months (two-dose group), or one dose at age 9 months (one-dose group). Baseline characteristics were recorded for all enrolled participants at age 6 months. Blood samples were drawn for antibody assays before each vaccination and at final follow up when infants were aged 11 months. The primary outcome was immunogenicity of a first MR vaccine in infants aged 6 months or 9 months and the immunogenicity of a second MR vaccine in infants aged 9 months who received their first MR vaccine at 6 months. Immunogenicity was measured as the proportion of infants who seroconverted in the 12 weeks after vaccination at age 6 months or the 8 weeks after vaccination at age 9 months. Seroconversion was defined as a 4-times increase in IgG concentrations relative to the pre-vaccination concentrations or achieving seroprotective antibody concentrations between study timepoints. The modified intention-to-treat analysis included all infants who received MR vaccines per group assignment and had antibody results at baseline, 9 months, and 11 months. All enrolled infants were included in the safety analysis of the immediate reactions (observed by study staff at the fixed-site clinic in the first 30 min after vaccination), adverse events within 48 h of vaccination among infants in the two-dose group receiving their first MR vaccine at age 6 months, and adverse events observed by study staff or parents at any time during the study. The trial is registered on ClinicalTrials.gov, NCT03071575, and is closed to enrolment. FINDINGS: Between March 9, 2017, and March 18, 2018, 620 infants were enrolled and randomly assigned to the two study groups (312 in the two-dose group and 308 in the one-dose group). Of the 301 infants vaccinated at 6 months, 282 seroconverted for measles (94%, 95% CI 90-96), and 283 seroconverted for rubella (94%, 91-96). By 11 months, after receiving a second dose at age 9 months, 297 (cumulative 99%, 95% CI 97-100) infants seroconverted for measles and 297 infants seroconverted for rubella (cumulative 99%, 96-100). Of the 292 infants vaccinated at 9 months only, 291 seroconverted for both antigens by age 11 months (100%, 95% CI 98-100). 123 adverse events were observed; 72 in the two-dose group and 51 in the one-dose group, with no differences in severity (p=0·78) or outcomes (p=0·71) by study group. 12 (17%) events in the two-dose group and seven (14%) in the one-dose group were severe; most events were mild, resolved without sequelae, and were unrelated to the MR vaccine. One death occurred in the one-dose group before the infant received the 9-month dose of the vaccine, and therefore was deemed to be unrelated to the MR vaccine. INTERPRETATION: The data presented support use of MR vaccine at 6 months to protect young infants during measles outbreaks and in settings with increased risk or high transmission. We recommend additional studies to evaluate longer-term immunity based on age at vaccination. FUNDING: US Centers for Disease Control and Prevention. TRANSLATIONS: For the French and Spanish translations of the abstract see Supplementary Materials section.

Implementation science has emerged and matured as an essential field for HIV treatment and prevention, designed to bridge the gap between research and practice by identifying opportunities to overcome barriers to implementation of effective interventions, and to accelerate the replication and scale-up of HIV care innovations. In this article, we describe activities and collaborations among the Centers for Disease Control and Prevention, the Health Resources and Services Administration, and the National Institutes of Health to optimize the impact of national federal funding opportunities aimed at identifying effective and replicable HIV care and prevention interventions, improving HIV health outcomes, and reducing HIV incidence in the U.S. These activities are outlined in the context of the Ending the HIV Epidemic in the U.S. Initiative, which was enacted across U.S. Department of Health and Human Services agencies, providing new funding and outlining an operational plan to further guide federal agencies in their specific roles and funding areas.In describing these activities and opportunities, we aim to demonstrate how implementation science is being increasingly leveraged to accelerate progress towards ending HIV through scale-up and dissemination efforts. Continued collaboration through federal implementation science will be instrumental in reaching Ending the HIV Epidemic goals.

OBJECTIVES: To explore how artificial intelligence (AI) can enhance infodemiology, which distributes and scans information in the electronic medium, to process social media posts for HIV pre-exposure prophylaxis (PrEP). DESIGN: Systematic Review. METHODS: We searched in the U.S. Centers for Disease Control and Prevention's Prevention Research Synthesis database through June 2024 (PROSPERO: CRD42023458870). We included infodemiology studies published in English and reported using AI to process social media posts on PrEP. Two reviewers independently screened citations, extracted data, and conducted a risk of bias assessment using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. Findings are narratively summarized. RESULTS: Of the 135 citations screened, eight infodemiology studies were identified, analyzing over 58.9 million posts. Infodemiology studies found the PrEP topics commonly discussed in communities (e.g., barriers of uptake), rumors that may raise public health concerns (e.g., PrEP is a prevention method against COVID-19 infection), geographic locations where concerns regarding risk of acquiring HIV were raised (e.g., most HIV-related posts were from the 10 states with the highest numbers of new HIV diagnoses), and predicted HIV trends (e.g., HIV-related tweets were negatively correlated with the county-level HIV incidence rate in the following year). CONCLUSIONS: Despite the limitations of this review including a small number of studies reviewed, our review suggests social media posts may provide information on real-time PrEP-related concerns, and AI can accelerate and enhance the processing of mass data to identify the information that communities need and the areas/locations that may need HIV prevention intervention.

BACKGROUND: Community-level social vulnerabilities may affect HIV outcomes. This analysis assessed the association between county-level social vulnerability and Centers for Disease Control and Prevention (CDC)-funded HIV testing program outcomes. SETTING: HIV testing data from 60 state and local health departments and 119 community-based organizations were submitted to CDC during 2020-2022. METHODS: HIV testing data were combined with the county-level Minority Health Social Vulnerability Index, which measures economic, medical, and social vulnerability. We calculated absolute and relative disparity measures for HIV testing program outcomes (ie, HIV positivity, linkage to HIV medical care, interview for partner services, referral to preexposure prophylaxis providers) between high and low social vulnerability counties. We compared differences in HIV testing program outcomes by demographic factors and test site type. RESULTS: The majority (85.8%) of the 4.9 million tests were conducted in high social vulnerability counties. HIV positivity (1.1%) and linkage to medical care after a new diagnosis (77.5%) were higher in high social vulnerability counties. However, interview for partner services after a new diagnosis (72.1%) and referrals to preexposure prophylaxis providers among eligible HIV-negative persons (48.1%) were lower in high social vulnerability counties. Additionally, the relative disparity in HIV testing program outcomes varied by demographic factors and test site type. CONCLUSIONS: CDC-funded HIV testing programs reach the most vulnerable communities. However, testing outcomes vary by community vulnerability, demographic factors, and test site type. Continued monitoring of the relationship between county-level social vulnerability and HIV testing program outcomes would guide HIV testing efforts and allocate resources effectively to achieve the national goal of ending the HIV epidemic.

We report a single case of invasive pneumococcal disease (IPD) by serotype 4, multilocus sequence type 10172 (ST10172) isolate with vanG-type resistance genes and reduced vancomycin susceptibility. The isolate was recovered during 2022 from a 66-year-old resident with bacteremic pneumococcal pneumonia within a Centers for Disease Control and Prevention Active Bacterial Core surveillance (ABCs) site hospital. The patient had received 23-valent pneumococcal polysaccharide vaccine and there was no evidence of concurrent or prior receipt of vancomycin in the previous year. Serotype 4/ST10172 IPD has shown increases within western ABCs sites, and the recent acquisition of a vanG element warrants close monitoring of this lineage.

BACKGROUND: Among the 119.9 million U.S. adults with hypertension, an estimated 92.9 million have systolic blood pressure ≥ 130 mm Hg or diastolic blood pressure ≥ 80 mm Hg. Million Hearts® is an initiative co-led since 2011 by the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare and Medicaid Services (CMS). The program drives improvement in hypertension control by celebrating high-achieving clinicians, practices, and health systems each year as Million Hearts Hypertension Control Champions. Champions have validated control rates of 80% or higher. METHODS: Using data from each Champion, we summarized their key characteristics and quantified their use of various evidence-based strategies. We calculated summary statistics for application data provided by Champions based on the initiative's five-year cycles of operation (2012-2015; 2017-2020; 2022-2024). RESULTS: From 2012 to 2024, a total of 199 Hypertension Control Champions from 44 states were recognized; mean prevalence of systolic blood pressure < 140 mm Hg and diastolic blood pressure < 90 mm Hg was 82%. Overall, Champions reported using multiple evidence-based strategies to help their patients achieve hypertension control. The top 3 strategies were electronic medical record (EMR) usage, patient supports including self-measured blood pressure monitoring (SMBP), and team-based care. CONCLUSIONS: The Million Hearts® Hypertension Control Champions demonstrate that hypertension control may be achievable among patients across diverse settings by implementation of evidence-based approaches.

BACKGROUND: The human eye represents a potential site of influenza A virus (IAV) replication, and an entry point for the virus to reach the respiratory tract. The frequent detection of conjunctivitis among farm workers with confirmed infection with clade 2.3.4.4b A(H5N1) IAV from this ongoing outbreak represents an atypical disease presentation for this virus subtype. We aimed to investigate whether the occurrence of ocular complications reported following clade 2.3.4.4b A(H5N1) virus infection was associated with an enhanced capacity of this virus to replicate in mammalian ocular tissue and cause infection following ocular exposure. METHODS: Primary human nasal and corneal tissue constructs were infected with A(H5N1) A/Texas/37/2024 (Texas/37), A(H1N1)pdm09 A/Nebraska/14/2019 (Neb/14), and A(H7N7) A/Netherlands/219/2003 (NL/219) viruses (multiplicity of infection [MOI] of 0·01-0·02, 33°C). Corneal tissue constructs were also infected with an expanded panel of IAVs (Texas/37, A[H5N1] A/Michigan/90/2024 [MI/90], A[H5N1] A/Chile/25945/2023 [Chile/25945], NL/219, A/Netherlands/230/2003 [NL/230], and Neb/14; MOI of 0·01, 37°C). In-vitro infections of tissue constructs were used to assess replication kinetics by infectious virus titration. Induction of innate host antiviral responses in infected corneal tissue constructs was assessed by PCR array (MOI of 2·00, 37°C). Ferrets (serologically naive or pre-immune to A[H1N1]pdm09 virus) were inoculated by the ocular route with Texas/37 A(H5N1) virus-using a liquid inoculum (10⁶ plaque forming units [PFU]), aerosol inhalation (15-16 PFU), or ocular-only aerosol exposure (18-132 PFU)-to assess pathogenicity and tropism of the virus following different exposure routes. Transmissibility was assessed by placing serologically naive or pre-immune ferrets inoculated by ocular-only aerosol exposure in direct contact with serologically naive ferrets, monitoring pathogenicity in contact animals, and measuring viral titres in nasal washes of both inoculated and contact ferrets. FINDINGS: Nasal and corneal tissue constructs supported replication of all IAVs tested. In corneal tissue constructs, A(H7N7) and A(H1N1)pdm09 viruses reached 10-fold higher overall titres than A(H5N1) isolates. Relatively few genes (n=13) related to antiviral responses were significantly differentially expressed in corneal tissue constructs infected with IAV, with no consistent differential expression among clade 2.3.4.4b A(H5N1) viruses associated with either conjunctivitis or severe respiratory disease, although strain-specific differences were observed. Serologically naive ferrets inoculated by liquid ocular, aerosol inhalation, or aerosol-only ocular routes with Texas/37 virus exhibited a systemic and fatal infection in all animals, transmitting the virus to naive cagemates. By contrast, reduced disease severity following ocular-only aerosol inoculation was observed in animals with pre-existing heterosubtypic immunity. No serologically naive ferrets placed in direct contact with pre-immune ferrets inoculated with Texas/37 virus by the ocular-only aerosol route became infected. INTERPRETATION: A clade 2.3.4.4b A(H5N1) virus from the dairy cattle outbreak in the USA that was first detected in March, 2024, does not appear to possess features indicative of an ocular tropism. However, this virus can maintain a virulent and transmissible phenotype in ferrets following ocular exposure, highlighting the importance of ocular protection. FUNDING: US Centers for Disease Control and Prevention.

PURPOSE: Chlamydia and gonorrhea are the 2 most common bacterial sexually transmitted infections in the United States. Nonadherence to the Centers for Disease Control and Prevention treatment guidelines remains a concern. We examined how well chlamydia and gonorrhea treatment in primary care settings adhered to guidelines. METHODS: We used electronic health records from the PRIME registry to identify patients with diagnosis codes or positive test results for chlamydia and/or gonorrhea from 2018 to 2022. Outcomes were the first dates of antibiotic administered within 30 days after a positive test result for the infection. Descriptive statistics were calculated for patient sociodemographic characteristics. We used a multivariate parametric accelerated failure time analysis with shared frailty modeling to assess associations between these characteristics and time to treatment. RESULTS: We identified 6,678 cases of chlamydia confirmed by a positive test and 2,206 cases of gonorrhea confirmed by a positive test; 75.3% and 69.6% of these cases, respectively, were treated. Females, individuals aged 10-29 years, suburban dwellers, and patients with chlamydia-gonorrhea coinfection had higher treatment rates than comparator groups. Chlamydia was infrequently treated with the recommended antibiotic, doxycycline (14.0% of cases), and gonorrhea was infrequently treated with the recommended antibiotic, ceftriaxone (38.7% of cases). Time to treatment of chlamydia was longer for patients aged 50-59 years (time ratio relative to those aged 20-29 years = 1.61; 95% CI, 1.12-2.30) and for non-Hispanic Black patients (time ratio relative to White patients = 1.17; 95% CI, 1.04-1.33). CONCLUSIONS: Guideline adherence remains suboptimal for chlamydia and gonorrhea treatment across primary care practices. Efforts are needed to develop interventions to improve quality of care for these sexually transmitted infections.

In the United States, New Delhi metallo-beta-lactamase (NDM)-producing carbapenem-resistant Enterobacterales (CRE) are frequently associated with healthcare encounters. From September 2021 to September 2022, 21 patients with NDM-CRE identified from urine and without healthcare exposure were reported to the Centers for Disease Control and Prevention. Isolates were genetically similar to healthcare-associated strains.

BACKGROUND: Despite the availability of highly effective HIV pre-exposure prophylaxis (PrEP), uptake and adherence to PrEP among young men who have sex with men (YMSM) remains low, limiting its impact on the prevention of HIV infection. Strategies that incorporate an array of prevention options and provide YMSM and their providers with tailored education and support tools, including tools to support shared decision-making, are needed. OBJECTIVE: The goals of the Centers for Disease Control and Prevention (CDC)-funded PrEP Choice study include the development and deployment of CDC guideline-consistent PrEP provider training and the implementation of evidence-based provider- and client-facing PrEP education and support tools. Under this initiative, the CDC funded 2 research projects, Florida State University (the Expanding PrEP in Communities of Color [EPICC] project), and Columbia University (the mChoice project). METHODS: Providers from both projects will complete the PrEP Choice online training, which was developed to educate providers on PrEP options and how to engage clients in open discussions around sexual health and PrEP options. EPICC project providers will also attend online tailored motivational interviewing (TMI) training sessions, and mChoice project providers will view a training video on cultural competency and humility in PrEP care. Following training, each project will enroll a cohort of 400 participants receiving care from study providers and follow them for 12-18 months. Participants will complete online surveys every 3 months and provide biomarkers to assess PrEP adherence. Electronic health record (EHR) data will be collected every 6 months to provide additional information on clinic attendance, PrEP prescriptions, and HIV/sexually transmitted infection (STI) testing. Each project will provide cohort participants with a unique digital health tool to support the PrEP choice and ongoing adherence. The study will assess the effectiveness of training and educational and support tools in practice and the critical factors associated with the successful uptake of and adherence to PrEP by participants. The study will also monitor patterns of PrEP use among YMSM, including types of PrEP and switching between types. RESULTS: Formative work to develop and prepare the tools for implementation was completed in 2023. The EPICC project began provider training in early 2024, and the mChoice project began in spring 2024. Cohort enrollment for both projects began after provider training began. CONCLUSIONS: Given the changing PrEP landscape, implementation of provider education and tools to maximize uptake and adherence is needed. By delivering culturally competent and interactive provider training on PrEP options, the study will help providers counsel and guide participants on the effective and safe use of PrEP. The digital health tools created will support participant adherence to help them optimize PrEP benefits. Through the cohort design, the PrEP Choice study will provide real-world data about PrEP use that will be critical for informing future guidelines and tools. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/64186.

BACKGROUND: Centers for Disease Control and Prevention recommends test-of-cure (TOC) for persons with pharyngeal gonorrhea (GC) 7-14 days after treatment. We investigated the yield and feasibility of routine pharyngeal GC TOC to detect treatment failures. METHODS: During May 2021-July 2022, four U.S. STD clinics implemented pharyngeal GC TOC. Sites collected demographic, clinical, and behavioral data on all treated pharyngeal GC and positive TOC cases. Cases were dispositioned with the suspected reason for positive TOC. To assess perceived feasibility, sites participated in qualitative interviews. RESULTS: During the study period, 1,968 pharyngeal GC infections were diagnosed. Among 1,829 treated cases, 97.3% (n = 1,777) received ceftriaxone and 45.7% (n = 836) returned for TOC, varying by site (range: 35.5%- 70.8%). Among those with TOC, 4.7% (n = 39) were positive by NAAT. Of these, 48.7% had culture attempted; six positive TOC (15.4%) were also positive by culture. Most positive TOC (66.7%) were attributed to re-infection (n = 13) or false-positive results (n = 13). Six (15.4%) were treatment failures. Four failed recommended treatment and had a positive culture: two were susceptible to ceftriaxone and two did not have antimicrobial susceptibility results. Seven positive TOC (17.9%) had insufficient data to disposition. Sites perceived TOC to be feasible, though substantial resources were required.ConclusionRoutine pharyngeal GC TOC yielded 5% positivity, though treatment failure was rare (<1%), and no cases of cephalosporin-resistant GC were identified. Low TOC return rates, limited culture collection, and limited culture yield highlight challenges to determining the cause of a positive TOC and the limitations of TOC in identifying cephalosporin resistance.

BACKGROUND: Clusters of rapid HIV transmission indicate larger underlying networks that are not effectively reached by HIV prevention, testing, and care services. Starting in 2018, the Centers for Disease Control and Prevention (CDC) funded 59 U.S. health departments (HDs) to detect and respond to HIV clusters; HDs began reporting clusters to CDC in January 2020. METHODS: For clusters reported to CDC, we described cluster characteristics at detection, including detection method; size; HIV transmission category, defined as that of >50% of cluster members; and HD investigation and response activities. RESULTS: During 2020-2022, 45 HDs reported 322 HIV clusters, with most detected by molecular analysis of HIV sequences (75%). Most were detected in the South (46%) and three-quarters were predominant sexual transmission. Median cluster size at detection for molecular clusters was 10 persons (interquartile range 7-18). Among 205 clusters with follow-up data, investigation and response activities were conducted for 95%, including direct outreach to persons in clusters for partner services (64%), medical chart reviews (42%), and focused testing events (13%). Limited data on named partners tested showed that 11% received new HIV diagnoses. CONCLUSIONS: HD HIV cluster detection activities detected many clusters. Response activities were tailored for different clusters and intervened in networks with rapid transmission and high undiagnosed infection, as indicated by high positivity among partners. Cluster detection and response is an important tool to identify and address gaps in HIV prevention, testing, and care that facilitate rapid transmission.

Science involves perceiving patterns (events that are repeated) in observations, hypothesizing causal explanations (underlying processes), and testing them. Mathematical models either describe or provide explanations for patterns. The equations of descriptive models have convenient mathematical properties while those of mechanistic ones correspond to processes. The parameters of descriptive models are fitted to observations by choosing values that minimize discrepant predictions. Because mechanistic models are hypotheses about the processes underlying patterns, their parameters should not be fitted, but rather, based insofar as possible on first principles or estimated independently. The precision of mathematics facilitates comparing the predictions of mechanistic models to the patterns that they purport to explain and, until concordant, identifying and remedying the cause(s) of disparities. The findings and conclusions in this report are those of the authors and do not necessarily represent the official positions of the Centers for Disease Control and Prevention or National Science Foundation.

Background: Although short-term outcomes of Long COVID have been described, longer-term physical and mental health outcomes of Long COVID are less well-established. This study sought to assess differences in long-term physical and mental health outcomes extending up to three years among those with current, resolved, and no Long COVID, as well as duration of Long COVID and vaccination status. Methods: This was a prospective, multisite, study of participants with SARS-CoV-2 infection from 12/7/2020-8/29/2022, with data collected through 4/2/2024. Surveys included validated tools for physical and mental health. Data were analyzed by Long COVID status (never-had, resolved, current), Long COVID duration and vaccination status. Findings: Of 3663 participants, 2604 (71.1%) never had Long COVID, 994 (27.1%) reported current Long COVID, and 65 (1.8%) reported resolved Long COVID. Compared to never having Long COVID, current Long COVID had lower/worse scores for Patient-Reported Outcomes Measurement Information System (PROMIS) version 29 Physical (7.8; 95% confidence interval [CI] 7.3–8.3) and Mental Health (9.4; 95% CI 8.8–10.1) and higher likelihood of moderate-to-high stress (adjusted odds ratio [aOR]: 2.0; 95% CI 1.6–2.4), moderate-to-high loneliness (aOR: 1.6; 95% CI 1.4–2.0), moderate-to-severe fatigue (aOR: 3.0; 95% CI 2.5–3.7), insufficient activity (aOR for Speedy Nutrition and Physical Activity Assessment ≤4: 0.6; 95% CI 0.5–0.7; aOR for Exercise Vital Sign ≤150 min/week: 0.7, 95% CI 0.6–1.0), and worse dyspnea (aOR: 5.0; 95% CI 4.3–5.8). Resolved Long COVID had lower scores for PROMIS Physical by 2.0 (95% CI 0.2–3.8) and Mental Health by 2.3 (95% CI 0.2–4.4) than the never-had-Long COVID cohort. Number of COVID-19 vaccinations was associated with better outcomes across all measures. Interpretation: Among participants followed up to 3 years after initial infection, those with current Long COVID had worse physical and mental health outcomes. The majority of those with Long COVID did not resolve, with less than 2% having resolved Long COVID. The resolved Long COVID cohort had moderately worse physical and mental health compared with those never-having-Long COVID. COVID-19 vaccination was associated with better outcomes. Funding: Centers for Disease Control and Prevention. © 2025 The Author(s)

Seasonal cyclosporiasis outbreaks occur in the United States every year. To better understand the disease, the Centers for Disease Control and Prevention developed a novel genotyping system that successfully clusters nonclonal eukaryotes. We examined temporal-geographic distributions of Cyclospora cluster consensus genotypes (CCGs) and applied regression analyses to identify correlations between Cyclospora spp. parasites and clinical manifestations or epidemiologic risk factors, using data collected during 2018-2021. No CCG was uniquely associated with or consistently detected in a state during the study, suggesting that cyclosporiasis in the United States is likely caused by frequent parasite introductions. We identified positive associations between infection with C. ashfordi and C. cayetanensis and consumption of specific produce items: cilantro, mango, and onion for C. ashfordi and iceberg lettuce, carrot, and cauliflower for C. cayetanensis. Our findings can guide future research into public health interventions aimed at reducing the burden of cyclosporiasis in the United States.

Human ehrlichiosis is a potentially fatal tickborne disease caused by 3 species: Ehrlichia chaffeensis, E. ewingii, and E. muris eauclairensis. In the United States, 234 confirmed cases of E. ewingii ehrlichiosis were reported to the Centers for Disease Control and Prevention through the National Notifiable Diseases Surveillance System during 2013-2021; average annual incidence was 0.08 cases/1 million population. E. ewingii ehrlichiosis was reported more commonly among older, White, non-Hispanic, and male patients. Incidence and case counts generally increased yearly, except for 2020 and 2021. The highest number of cases were reported from Missouri and Arkansas. We report the geographic expansion of E. ewingii ehrlichiosis and the continued public health challenge of clarifying clinical manifestations of this infection. Clinician education will be essential to implement molecular assays to properly diagnose E. ewingii infection in patients and gain a better understanding of the epidemiology of this emerging disease.

Child care programs can be one setting for promoting physical activity (PA). To support technical assistance providers in promoting PA best practices, Nemours Children's Health with the Centers for Disease Control and Prevention developed a set of trainings known as Physical Activity Learning Sessions (PALS). PALS centers on PA best practices, and state partners are encouraged to embed the program into early care and education (ECE) systems, such as training and TA networks. From 2019 to 2023, 22 states and 802 individuals completed a PALS train-the-trainer (TTT) course. This brief highlights findings from the 2022-2023 PALS evaluation, examining the extent to which PALS provided ECE trainers with effective training materials, affected trainer confidence in providing PA trainings to ECE providers, and was integrated into state systems. The PALS evaluation included a mixed-methods design consisting of pre-, post-, and 6-month post-TTT surveys of trainers. Among trainers, 87% of 125 respondents said they were confident training ECE providers on PA practices after completing the PALS TTT. Nearly 67% of participants planned to deliver a PALS training to ECE providers within 6 months of completing the TTT. Surveys from 16 of 18 PALS state leads suggested PALS has been embedded in state ECE systems. PALS counts for training credit of some type in 10 states, including licensing, provider credentials, and Quality Rating and Improvement Systems. Additional evaluation efforts could determine the impact of PALS on PA practices and policies among ECE providers and programs.