BACKGROUND: In the United States, 2 doses of measles-mumps-rubella (MMR)-containing vaccines are recommended routinely during childhood; a third dose may be given under certain circumstances. We present observed seroprotection rates and estimate long-term dynamics of measles, mumps, and rubella neutralizing antibody (nAb) levels among 2- and 3-dose MMR (MMR2 and MMR3, respectively) vaccinees. METHODS: Persons who received MMR2 at age 4-12 years or MMR3 at age 18-31 years were enrolled in 1994-1995 and 2009-2010, respectively. Per cohort, sera were collected before vaccination (baseline) and at various intervals ranging from 1 month to 10 years postvaccination to assess nAb levels. Annual changes in nAb levels per virus and cohort were estimated through 10 years postvaccination using generalized estimating equations. Models were stratified by baseline nAb levels. RESULTS: Among MMR2 participants (n = 621), 93.7%, 73.4%, and 83.9% had protective nAb levels against measles, mumps, and rubella, respectively, at the 10-year visit; among MMR3 participants (n = 665), 90.5%, 69.1%, and 100% had protective nAb levels, respectively, at the 9-11-year visit. Estimated nAb levels declined annually across both cohorts, all viruses, and baseline nAb strata, though patterns and magnitude varied. More than one-quarter of participants had mumps nAb levels below the presumed seroprotection threshold at the terminal visits. CONCLUSIONS: These findings indicate that even when MMR antibodies wane, protection against disease is largely retained. Waning of mumps antibodies was greater than for measles and rubella in both 2- and 3-dose vaccinees, likely because a greater proportion failed to mount a robust initial response.

In Lesotho, the Ministry of Health and key donors have made significant advancements to develop digital health solutions specific to HIV services including an eRegister which is interoperable with the health management information system, pharmacy services and the laboratory information system. New investments from the Millennium Challenge Corporation will expand digital health services to all reported communicable and non-communicable disease areas at health facilities throughout the country. This paper explores how digital health interventions designed to support comprehensive HIV care can be leveraged to provide universal digital health coverage. Specifically, three priority areas will be addressed: (i) governance, security, and system architecture (ii) power, connectivity, and equipment (iii) human resources and change management.

BACKGROUND: Influenza vaccine effectiveness can be reduced in older adults and among repeatedly vaccinated groups. Results from year 1 of "PIVOT," a randomized trial among adults aged ≥65 years in Hong Kong, showed that adjuvanted (Adj), high-dose (HD), and recombinant hemagglutinin (rHA) vaccines induced greater antibody responses against vaccine viruses than standard-dose (SD) influenza vaccine. Here, we examine the breadth of A(H3N2)-reactive antibodies induced during the first 2 study years (2017/2018, 2018/2019), and compare participants who received influenza vaccination annually, or not at all, for 5 years preceding enrollment. METHODS: 14-20 PIVOT participants per vaccine and prior vaccination group (0/5 or 5/5 prior years) who provided sera on days 0, 30, and 182 in year 1 and days 0 and 30 in year 2 were assessed. Hemagglutination inhibition (HAI) antibody titers were measured against 30 viruses spanning 1968 to 2018. RESULTS: In year 1, rHA and Adj but not HD vaccines induced titers ≥40 and titer rises ≥4-fold (seroconversion) against significantly more strains than SD vaccine among participants vaccinated 0/5 prior years. Only rHA and Adj vaccines induced titers ≥40 against post-vaccine strains. Antibody responses were poor among participants vaccinated 5/5 compared with 0/5 prior years and only rHA increased the breadth of seroconversion compared with the SD vaccine in this group. Antibody responses were weaker across groups in year 2. CONCLUSIONS: The results suggest that Adj and particularly rHA vaccines may improve the breadth of protection against A(H3N2) viruses but may not overcome attenuating effects of repeated vaccination in older adults. CLINICAL TRIALS REGISTRATION: NCT03330132.

Work-related injuries from overexertion, particularly lifting, are a major concern in occupational safety. Traditional assessment tools, such as the Revised NIOSH Lifting Equation (RNLE), require significant training and practice for deployment. This study presents an approach that integrates tactile gloves with computer vision (CV) to enhance the assessment of lifting-related injury risks, addressing the limitations of existing single-modality methods. Thirty-one participants performed 2747 lifting tasks across three lifting risk categories (LI < 1, 1 ≤ LI ≤ 2, LI > 2). Features including hand pressure measured by tactile gloves during each lift and 3D body poses estimated using CV algorithms from video recordings were combined and used to develop prediction models. The Convolutional Neural Network (CNN) model achieved an overall accuracy of 89 % in predicting the three lifting risk categories. The results highlight the potential for a real-time, non-intrusive risk assessment tool to assist ergonomic practitioners in mitigating musculoskeletal injury risks in workplace environments.

This paper presents the development of a fast-responding and accurate detection model for early-stage thermal runaway of a lithium-ion battery utilizing acoustics and deep learning paradigms. A series of single-cell battery tests with different state-of-charge and battery orientations is conducted to collect acoustic data. Using data augmentation, 1330 acoustic samples of early-stage thermal runaway are obtained. To facilitate the development of a detection model that can be used in real-life settings, 1128 acoustic samples, including various human activities, are also used. Utilizing 10-s acoustic data as the input and a convolutional neural network model structure as the backbone, excellent model performance is achieved. The overall accuracy is about 93 % with a precision and recall score of about 92 % and 97 %, respectively. Parametric studies are also carried out to evaluate the robustness of the proposed model structure and the effectiveness of the data augmentation methods. In addition, the model performance against two entire tests is assessed using leave-one test-out cross-validation. It is hoped that the proposed work can help to develop a robust detection device that can provide early warning of thermal runaways and allow users to have extra time to mitigate the potential extreme fire hazards and/or to safely evacuate. © 2025

OBJECTIVES: Serologic testing is a useful adjunct for the diagnosis of Lyme disease, a major public health problem in certain US regions. We aimed to determine whether Lyme disease serologic testing and results differed by sex and age group. METHODS: We identified 2 cohorts of individuals across all ages who underwent serologic testing for Lyme disease at a national reference laboratory in 2019 (cohort 1) and 2022 (cohort 2). If an individual had multiple tests in the same year, we included only the first test. We excluded individuals who had been tested in the previous 5 years. RESULTS: Cohorts 1 and 2 consisted of 578 052 and 550 674 people, respectively. Fewer males than females were tested in cohort 1 (42.7% vs 57.3%) and cohort 2 (42.3% vs 57.7%), although similar numbers were tested for both sexes among nonadults. More males than females had a positive test result in cohort 1 (53.9% more males) and cohort 2 (52.9% more males). The odds ratio of receiving a positive test result among males versus females was 2.09 (95% CI, 2.01-2.17) in cohort 1 and 2.12 (95% CI, 2.05-2.19) in cohort 2. Among people with positive test results, females (except children) were more likely than males to have positive immunoglobulin M and negative immunoglobulin G results, which can serve as a marker of early infection (odds ratio = 1.43 [95% CI, 1.31-1.55] in cohort 1 and 1.38 [95% CI, 1.29-1.47] in cohort 2). CONCLUSIONS: Further studies are needed to understand whether the observed differences in Lyme disease testing and positivity result from sex- and age-associated disparities in social behavior, health care seeking, clinical practice, or other factors.

OBJECTIVE: We investigated associations between per- and polyfluoroalkyl substances (PFAS) and changes in diabetes indicators from pregnancy to 12 years after delivery among women with a history of gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS: Eighty Hispanic women with GDM history were followed from the third trimester of pregnancy to 12 years after delivery. Oral and intravenous glucose tolerance tests were conducted during follow-up. Plasma PFAS concentrations were measured at the third trimester of pregnancy and first postpartum visit. A linear mixed-effects model was used to analyze associations between PFAS and trajectories of diabetes indicators, adjusted for age, breastfeeding status, daily total calorie intake, and body fat percentage. RESULTS: Increased 2-(N-methyl-perfluorooctane sulfonamido) acetate level was associated with faster increase in concentrations of fasting glucose (P = 0.003). Increased perfluorononanoate (PFNA) and linear perfluorooctanoate (n-PFOA) concentrations were associated with faster increase in fasting insulin concentrations (P = 0.04 for PFNA; P = 0.02 for n-PFOA) and faster decrease in acute insulin response to glucose (P = 0.04 for PFNA; P = 0.02 for n-PFOA). CONCLUSIONS: PFAS exposure is associated with glucose intolerance, insulin resistance, and β-cell dysfunction, thus increasing type 2 diabetes risk.

Salmonella enterica bacteria are a leading cause of foodborne illness in the United States; however, most Salmonella illnesses are not associated with known outbreaks, and predicting the source of sporadic illnesses remains a challenge. We used a supervised random forest model to determine the most likely sources responsible for human salmonellosis cases in the United States. We trained the model by using whole-genome multilocus sequence typing data from 18,661 Salmonella isolates from collected single food sources and used feature selection to determine the subset of loci most influential for prediction. The overall out-of-bag accuracy of the trained model was 91%; the highest prediction accuracy was for chicken (97%). We applied the trained model to 6,470 isolates from humans with unknown exposure to predict the source of infection. Our model predicted that >33% of the human-derived Salmonella isolates originated from chicken and 27% were from vegetables.

The effect of preexisting neutralizing antibodies (NAb) on SARS-CoV-2 shedding in postvaccination infection (PVI) is not well understood. We characterized viral shedding longitudinally in nasal specimens in relation to baseline (pre/periinfection) serum NAb titers in 125 participants infected with SARS-CoV-2 variants. Among 68 vaccinated participants, we quantified the effect of baseline NAb titers on maximum viral RNA titers and infectivity duration. Baseline NAbs were higher and targeted a broader range of variants in participants with monovalent ancestral booster vaccinations compared with those with a primary vaccine series. In Delta infections, baseline NAb titers targeting Delta or Wuhan-Hu-1 correlated negatively with maximum viral RNA. Per log10 increase in Delta-targeting baseline NAb IC50, maximum viral load was reduced -2.43 (95% CI: -3.76, -1.11) log10 nucleocapsid copies, and infectious viral shedding was reduced -2.79 (95% CI: -4.99, -0.60) days. Conversely, in Omicron infections (BA.1, BA.2, BA.4, or BA.5), baseline NAb titers against Omicron lineages or Wuhan-Hu-1 did not predict viral outcomes. Our results provide robust estimates of the effect of baseline NAbs on the magnitude and duration of nasal viral replication after PVI (albeit with an unclear effect on transmission) and show how immune escape variants efficiently evade these modulating effects.

BACKGROUND: To generate COVID-19 vaccine safety data in Nigeria, passive reporting was supplemented with cohort event monitoring (CEM), an active surveillance system. We described reactogenicity within 7 days and adverse events up to 3 months after each AstraZeneca or Moderna COVID-19 vaccine dose while assessing the feasibility of implementing CEM in a low- to middle-income country (LMIC) during a mass vaccination campaign. METHODS: Participants were aged ≥18 years with access to mobile phones who received the first dose of an authorized COVID-19 vaccine from participating health facilities in 6 states of Nigeria during September and October 2021. Data collectors interviewed participants via phone on days 0, 3, 7, and thereafter every 7 days for 3 months. The same schedule was restarted if a participant received a second vaccine dose. Proportions of participant-reported adverse events following COVID-19 vaccine receipt were calculated. Investigation and causality assessment were conducted on deaths using the World Health Organization causality guidelines. RESULTS: We enrolled 12,317 participants (AstraZeneca 6990; Moderna 5327); 6167/6990 (88.2 %) AstraZeneca and 4879/5327 (91.6 %) Moderna recipients completed a follow-up interview days 0-7 after the first dose; among them, 2685/6167 (43.5 %) AstraZeneca and 3533/4879 (72.4 %) Moderna recipients reported local reactions and 2456/6167 (39.8 %) AstraZeneca and 2087/4879 (42.8 %) Moderna recipients reported systemic reactions. Overall, 3891/6990 (55.7 %) AstraZeneca and 3978/5327 (72.8 %) Moderna recipients received a second dose of COVID-19 vaccine, among whom 897/3891 (23 %) AstraZeneca and 1979/3978 (49.7 %) Moderna recipients reported local reactions and 727/3891 (18.7 %) AstraZeneca and 1680/3978 (42.2 %) Moderna recipients reported systemic reactions. Among all enrolled, 11 died; there was no evidence to suggest any deaths were vaccine-related. CONCLUSIONS: No unexpected patterns of adverse events were detected, providing additional data on the safety of these COVID-19 vaccines in Nigerian adults. We demonstrated that implementing CEM was feasible and may be valuable for safety monitoring of vaccines introduced in LMICs.

BACKGROUND: Polybrominated diphenyl ethers (PBDEs), synthetic chemicals previously used as flame retardants in commercial products, impact human behaviors, mood symptoms and cognitive abilities. OBJECTIVE: We estimated the association of gestational PBDE serum concentrations with early adolescent self- and caregiver-reported ratings of executive function in a prospective pregnancy and birth cohort. METHODS: We measured gestational serum concentrations of five PBDE congeners and created a summary exposure variable (∑(5)BDE: 28, -47, -99, -100 and -153). At age 12 years, we assessed executive function for 237 adolescents using self- and caregiver-reports with the Behavior Rating Inventory of Executive Functioning (BRIEF-2). We used multivariable linear regression models to estimate covariate-adjusted associations of lipid standardized, log(10)-transformed gestational PBDE concentrations with BRIEF-2 T-scores. We evaluated potential effect measure modification (EMM) of sex by examining sex-stratified regression models. RESULTS: As higher scores indicate greater deficits in executive function, gestational PBDE concentrations were positively associated with adolescent-reported BRIEF-2 T-scores for Global Executive Composite (BDE-28: β = 6.31 (95%CI: 2.59, 10.03), BDE-47: (β = 3.32 (95%CI: 0.1, 6.54), ∑(5)BDE: (β = 3.70 (95%CI: 0.37, 7.03), Behavior Regulation Index (BDE-28: β = 5.36 (95%CI: 1.56, 9.15), BDE-99: β = 3.53 (95%CI: 0.33, 6.74), ∑(5)BDE: β = 3.93 (95%CI: 0.57, 7.3), Emotion Regulation Index (BDE-28: β = 4.76 (95%CI: 0.88, 8.64) and the Cognitive Regulation Index (BDE-28: β = 6.69 (95%CI: 3.08, 10.31), BDE-47: β = 3.45 (95%CI: 0.3, 6.59), ∑(5)BDE: β = 3.57 (95%CI: 0.32, 6.82) and several other scales. We observed stronger associations with gestational PBDE concentrations for all congeners among males, especially for the caregiver-rated scales (all EMM p-values <0.1). DISCUSSION: This study provides evidence that gestational PBDE serum concentrations may adversely influence offspring executive function during adolescence.

Foodborne illness is a continuous public health risk. The recognition of signals indicating a cluster of foodborne illness is key to the detection, mitigation, and prevention of foodborne adverse event incidents and outbreaks. With increased internet availability and access, novel data streams (NDSs) for foodborne illness reports initiated by users outside of the traditional public health framework have emerged. These include, but are not limited to, social media websites, web-based product reviews posted to retailer websites, and private companies that host public-generated notices of foodborne illnesses. Information gathered by these platforms can help identify early signals of foodborne illness clusters or help inform ongoing public health investigations. Here we present an overview of NDSs and 3 investigations of foodborne illness incidents by the US Food and Drug Administration that included the use of NDSs at various stages. Each example demonstrates how these data were collected, integrated into traditional data sources, and used to inform the investigation. NDSs present a unique opportunity for public health agencies to identify clusters that may not have been identified otherwise, due to new or unique etiologies, as shown in the 3 examples. Clusters may also be identified earlier than they would have been through traditional sources. NDSs can further provide investigators supplemental information that may help confirm or rule out a source of illness. However, data collected from NDSs are often incomplete and lack critical details for investigators, such as product information (eg, lot numbers), clinical or medical details (eg, laboratory results of affected individuals), and contact information for report follow-up. In the future, public health agencies may wish to standardize an approach to maximize the potential of NDSs to catalyze and supplement adverse event investigations. Additionally, the collection of essential data elements by NDS platforms and data-sharing processes with public health agencies may aid in the investigation of foodborne illness clusters and inform subsequent public health and regulatory actions.

Firefighters are occupationally exposed to many chemicals, including polycyclic aromatic hydrocarbons (PAHs), which are formed by the incomplete combustion of organic matter during fire response and training activities. However, due to the harsh environments in which firefighters work, as well as consideration for time and physical safety while wearing bulky equipment, traditional active sampling methods may not be feasible to measure PAH exposures. Silicone passive samplers offer an alternative approach to assess exposure during fire responses and live fire training due to their heat resistance and ease of deployment in remote or time-limited environments. In this study, the primary objective was to investigate and determine the statistical strength of the relationship between active air sampling methods and passive silicone samplers for PAHs. In this study, silicone wristbands were paired with active sampling devices in a series of burn experiments to compare PAH measurements. Silicone-based measurements correlated strongly with active air samples for the dominant PAHs found, naphthalene and phenanthrene; however, detection was limited in the wristbands when air concentrations were low in active samples. In situations where PAH levels are expected to be high and the potential for contaminant loss via off-gassing is low, silicone samplers may be a useful tool for industrial hygienists to measure PAHs in fire and other emergency responses in extreme environments.

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)

Candida species are the predominant cause of fungal infections in patients treated in hospital, contributing substantially to morbidity and mortality. Candidaemia and other forms of invasive candidiasis primarily affect patients who are immunocompromised or critically ill. In contrast, mucocutaneous forms of candidiasis, such as oral thrush and vulvovaginal candidiasis, can occur in otherwise healthy individuals. Although mucocutaneous candidiasis is generally not life-threatening, it can cause considerable discomfort, recurrent infections, and complications, particularly in patients with underlying conditions such as diabetes or in those taking immunosuppressive therapies. The rise of difficult-to-treat Candida infections is driven by new host factors and antifungal resistance. Pathogens, such as Candida auris (Candidozyma auris) and fluconazole-resistant Candida parapsilosis, pose serious global health risks. Recent taxonomic revisions have reclassified several Candida spp, potentially causing confusion in clinical practice. Current management guidelines are limited in scope, with poor coverage of emerging pathogens and new treatment options. In this Review, we provide updated recommendations for managing Candida infections, with detailed evidence summaries available in the appendix.

Purpose: To investigate the prevalence, patterns, and predictors of SARS-CoV-2 RNA and culturable virus in tears of a case-ascertained household cohort. Design: Prospective, longitudinal case-ascertained household cohort identified through convenience sampling. MethodsThis analysis was restricted to individuals who were non-hospitalized, symptomatic, and tested positive for SARS-CoV-2 by nasal RT-PCR. Tears and anterior nasal biospecimens were serially collected throughout the acute period. Tears specimens were collected by the study staff using Schirmer test strips, and nasal specimens were self-collected. For both, SARS-CoV-2 RNA was quantified using qRT-PCR, and culturable virus was detected using presence of cytopathic effect (CPE) in tissue culture; positive CPE was confirmed by a qRT-PCR step. A series of cross-sectional unadjusted analyses were performed investigating the relationship between different sociodemographic determinants and biological factors associated with tears RNA positivity.

BACKGROUND: Gestational exposure to non-persistent endocrine-disrupting chemicals (EDCs) may be associated with adverse pregnancy outcomes. While many EDCs affect the endocrine system, their effects on endocrine-related metabolic pathways remain unclear. This study aims to explore the global metabolome changes associated with EDC biomarkers at delivery. METHODS: This study included 75 pregnant individuals who delivered at the University of Cincinnati Hospital from 2014 to 2017. We measured maternal urinary biomarkers of paraben/phenol (12), phthalate (13), and phthalate replacements (4) from the samples collected during the delivery visit. Global serum metabolome profiles were analyzed from maternal blood (n = 72) and newborn (n = 63) cord blood samples collected at delivery. Fifteen of the 29 urinary biomarkers were excluded due to low detection frequency or potential exposures during hospital stay. We assessed metabolome-wide associations between 14 maternal urinary biomarkers and maternal/newborn metabolome profiles. Additionally, performed enrichment analysis to identify potential alterations in metabolic pathways. RESULTS: We observed metabolome-wide associations between maternal urinary concentrations of phthalate metabolites (mono-isobutyl phthalate), phthalate replacements (mono-2-ethyl-5-carboxypentyl terephthalate, mono-2-ethyl-5-hydroxyhexyl terephthalate) and phenols (bisphenol-A, bisphenol-S) and maternal serum metabolome, using q-value < 0.2 as a threshold. Additionally, associations of phthalate metabolites (mono-n-butyl phthalate, monobenzyl phthalate) and phenols (2,5-dichlorophenol, BPA) with the newborn metabolome were noted. Enrichment analyses revealed associations (p-gamma < 0.05) with amino acid, carbohydrate, lipid, glycan, vitamin, and other cofactor metabolism pathways. CONCLUSION: Maternal paraben, phenol, phthalate, and phthalate replacement biomarker concentrations at delivery were associated with maternal and newborn serum global metabolome.

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

BACKGROUND: Infections by Streptococcus pneumoniae and influenza viruses are vaccine-preventable diseases causing great morbidity and mortality. We evaluated pneumococcal and influenza vaccination practices during pre-international travel health consultations. METHODS: We evaluated data on pretravel visits over a 10-year period (1 July 2012 through 31 June 2022) from 31 sites in Global TravEpiNet (GTEN), a consortium of US healthcare facilities providing pretravel health consultations. Data were collected using an online structured questionnaire utilized by GTEN providers. We obtained summary statistics and performed multivariable logistic regression models to identify characteristics associated with receiving the vaccinations. RESULTS: At 116 865 pretravel visits, 28 754 (25%) travelers were eligible to receive pneumococcal vaccination and 56 150 (48%) travelers were eligible to receive influenza vaccination. A total of 19 557 (68%) pneumococcal vaccine-eligible travelers were not offered the vaccine at the pretravel visit. Among influenza vaccine-eligible travelers, 8592 (15%) were not offered the vaccine, and an additional 16 931 (30%) travelers declined the vaccine. Influenza vaccine was not available for 8014 (14%) eligible travelers. Nonadministration of the influenza vaccine was most frequent in the months of April through September. Compared to nonacademic centers or centers in the South or Midwest, travelers seen in academic centers or centers in the Northeast were more likely to receive either vaccine. CONCLUSIONS: Increasing awareness of global influenza transmission patterns and improving access to routine vaccines at the pretravel encounter may enhance vaccination for respiratory pathogens in departing US international travelers.

Background: On the basis of recent clinical trial data for the treatment of drug-susceptible and drug-resistant tuberculosis (TB), the American Thoracic Society, U.S. Centers for Disease Control and Prevention, European Respiratory Society, and Infectious Diseases Society of America have updated clinical practice guidelines for TB treatment in children and adults in settings in which mycobacterial cultures, molecular and phenotypic drug susceptibility tests, and radiographic studies, among other diagnostic tools, are available on a routine basis. Methods: A Joint Panel representing multiple interdisciplinary perspectives convened with American Thoracic Society methodologists to review evidence and make recommendations using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) and GRADE-ADOLOPMENT (adoption, adaptation, and, as needed, de novo development of recommendations) methodology. Results: New drug-susceptible TB recommendations include the use of a novel 4-month regimen for people with pulmonary TB and a shortened 4-month regimen for children with nonsevere TB. Drug-resistant TB recommendation updates include the use of novel regimens containing bedaquiline, pretomanid, and linezolid with or without moxifloxacin. Conclusions: All-oral, shorter treatment regimens for TB are now recommended for use in eligible individuals. Copyright © 2025 by the American Thoracic Society.

Deaths of parents and grandparent caregivers threaten child well-being owing to losses of care, financial support, safety and family stability, but are relatively unrecognized as a public health crisis. Here we used cause-specific vital statistics death registrations in a modeling approach to estimate the full magnitude of orphanhood incidence and prevalence among US children aged 0-17 years between 2000 and 2021 by cause, child age, race and ethnicity, sex of deceased parent and state, and also accounted for grandparent caregiver loss using population survey data. In 2021, we estimate that 2.91 million children (4.2% of children) had in their lifetime experienced prevalent orphanhood and caregiver death combined, with incidence increasing by 49.5% and prevalence by 7.9% since 2000. Populations disproportionately affected by orphanhood included 5.2% of all adolescents; 6.4% and 4.7%, respectively, of non-Hispanic American Indian or Alaska Native, and non-Hispanic Black children; and children in southern and eastern states. In 2021, drug overdose was the leading cause of orphanhood among non-Hispanic white children, but not among minoritized subgroups. Effective policies and programs to support nearly three million bereaved children are needed to reduce the acute and long-term negative effects of orphanhood.

INTRODUCTION: Pandemic influenza vaccine development focuses on the hemagglutinin (HA) antigen for potency and immunogenicity. Antibody responses targeting the neuraminidase (NA) antigen, or the HA stalk domain have been implicated in protection against influenza. Responses to the NA and HA-stalk domain following pandemic inactivated influenza are not well characterized in humans. MATERIAL AND METHODS: In a series of clinical trials, we determine the vaccines' NA content and demonstrate that NA inhibition (NAI) antibody responses increase in a dose-dependent manner following a 2-dose priming series with AS03-adjuvanted influenza A(H7N9) inactivated vaccine (A(H7N9) IIV). NAI antibody responses also increase with interval extension of the 2-dose priming series or following a 5-year delayed boost with a heterologous adjuvanted A(H7N9) IIV. Neither concomitant seasonal influenza vaccination given simultaneously or sequentially, nor use of heterologous A(H7N9) IIVs in the 2-dose priming series had an appreciable effect on NAI antibody responses. Anti-HA stalk antibody responses were minimal and not durable. CONCLUSIONS: We provide evidence for strategies to improve anti-neuraminidase responses which can be further standardized for pandemic preparedness. CLINICAL TRIAL REGISTRY NUMBERS: NCT03312231, NCT03318315, NCT03589807, NCT03738241.

BACKGROUND: Infection by Cryptococcus gattii can lead to pulmonary or central nervous system (CNS) disease, or both. Whether site of infection and disease severity are associated with C. gattii species and lineages or with certain underlying medical conditions, or both is unclear. We conducted a retrospective cohort study to identify factors associated with site of infection and mortality among C. gattii cases. METHODS: We extracted data on 258 C. gattii cases from Australia, Canada and the United States reported from 1999 to 2011. We conducted unadjusted and multivariable logistic regression analyses to evaluate factors associated with site of infection and C. gattii mortality among hospitalized cases (N=218). RESULTS: Hospitalized C. gattii cases with CNS and other extrapulmonary disease were younger, more likely to reside in Australia and be infected with VGI lineage but less likely to have comorbidities and die as compared to pulmonary cases. The odds of having CNS and/or other extrapulmonary disease were 9 times higher in cases with VGI infection (aOR=9.21, 95%CI=3.28-25.89). Age >70 years (aOR=6.69, 95%CI=2.44-18.30), chronic lung disease (aOR=2.62, 95%CI=1.05-6.51) and an immunocompromised status (aOR=2.08, 95%CI=1.05-6.51) were associated with higher odds of C. gattii mortality. CONCLUSIONS: Among hospitalized cases, C. gattii species and lineage are associated with site of infection but not with the risk of death, whereas older age and comorbidities increase the risk of death.

OBJECTIVE: To investigate the biodynamics of human-exoskeleton interactions during patient handling tasks using a subject-specific modeling approach. BACKGROUND: Exoskeleton technology holds promise for mitigating musculoskeletal disorders caused by manual handling and most alarmingly by patient handling jobs. A deeper, more unified understanding of the biomechanical effects of exoskeleton use calls for advanced subject-specific models of complex, dynamic human-exoskeleton interactions. METHODS: Twelve sex-balanced healthy participants performed three simulated patient handling tasks along with a reference load-lifting task, with and without wearing the exoskeleton, while their full-body motion and ground reaction forces were measured. Subject-specific models were constructed using motion and force data. Biodynamic response variables derived from the models were analyzed to examine the effects of the exoskeleton. Model validation used load-lifting trials with known hand forces. RESULTS: The use of exoskeleton significantly reduced (19.7%-27.2%) the peak lumbar flexion moment but increased (26.4%-47.8%) the peak lumbar flexion motion, with greater moment percent reduction in more symmetric handling tasks; similarly affected the shoulder joint moments and motions but only during two more symmetric handling tasks; and significantly reduced the peak motions for the rest of the body joints. CONCLUSION: Subject-specific biodynamic models simulating exoskeleton-assisted patient handling were constructed and validated, demonstrating that the exoskeleton effectively lessened the peak loading to the lumbar and shoulder joints as prime movers while redistributing more motions to these joints and less to the remaining joints. APPLICATION: The findings offer new insights into biodynamic responses during exoskeleton-assisted patient handling, benefiting the development of more effective, possibly task- and individual-customized, exoskeletons.

Structural firefighters are exposed to an array of polycyclic aromatic hydrocarbons (PAHs) as a result of incomplete combustion of both synthetic and natural materials. PAHs are found in both the particulate and vapor phases in the firefighting environment and are significantly associated with acute and chronic diseases, including cancer. Using a fireground exposure simulator (FES) and standing mannequins dressed in four different firefighter personal protective equipment (PPE) conditions, each with varying levels of protective hood interface and particulate-blocking features, the efficacy of the hoods was assessed against the ingress of PAHs (specifically, naphthalene). The authors also explored the effectiveness of a 100% cotton turtleneck at further attenuating the amount of naphthalene reaching the surface of the mannequin's neck. Air samples were collected at the breathing zone, abdomen, and thigh heights from the 6 ft-2 in mannequins used in this study. Naphthalene was the most abundant PAH (55% of the total PAH concentrations) in the FES and existed primarily in the vapor phase (92% vapor in the breathing zone). Additionally, bulk base layer and under the base layer polytetrafluoroethylene (PTFE) filter samples (used as skin surrogates) were collected from the neck region of the mannequins and analyzed for PAHs. A larger percentage of naphthalene was collected on the filter under the traditional knit hoods than on the cotton base layer, suggesting a small protective effect of the base layer against solid-phase naphthalene. Previous studies investigating naphthalene by employing air sampling under PPE have found a larger protective effect of base layers against the ingress of naphthalene vapor. PAHs that exist primarily as particulate in the fire environment were largely not detected on the base layers or PTFE filters under the gear. Further research is needed that involves more sensitive methods and non-static human subjects.

BACKGROUND: Tuberculosis (TB) Building and Strengthening Infection Control Strategies (TB BASICS) aimed to achieve improvements in TB infection prevention and control (IPC) through structured training and mentorship. METHODS: TB BASICS was implemented in six Chinese provinces from 2017-2019. Standardized, facility-based risk assessments tailored to inpatient, laboratory, and outpatient departments were conducted quarterly for 18 months. Knowledge, attitudes, and practices surveys were administered to healthcare workers (HCW) at nine participating facilities during the first and last assessments. Kruskal-Wallis rank sum test assessed score differences between departments (alpha = 0.05). RESULTS: Fifty-seven departments received risk assessments. IPC policies and practices improved substantially during follow up. Facility-based assessment scores were significantly lower in outpatient departments than other departments (p <0.05). All indicators achieved at least partial implementation by the final assessment. Low scores persisted for implementing isolation protocols, while personal protective equipment use among staff was consistent among all departments. Overall, we observed minimal change in IPC knowledge among HCW. In general, HCW had favorable views of their own IPC capabilities, but reported limited agency to improve institutional IPC. CONCLUSIONS: TB BASICS demonstrated improvements in TB IPC implementation. Structured training and mentorship engaged HCW to maintain confidence and competency for TB prevention.

In the fight against the spread of infectious disease, university campuses present a unique set of obstacles because of the prevalence of communal living arrangements and the difficulties of restricting sociability and group gatherings. In the last few years, the dynamics of the pandemic have evolved, and so too have the challenges university campuses face in ensuring their communities’ health and safety. This study introduces a complex and adaptable hybrid model, which was developed, applied, and validated using data from the peak incidents of SARS-CoV-2 during 2020–2021. It combines an agent-based model (ABM) with a modified SEIR system dynamics approach. Recognizing the shifting landscape of the pandemic, this model has been designed to function as both a historical case study of COVID-19 dynamics on a university campus and a framework for addressing future pandemic threats. By simulating disease propagation considering contact distance (i.e., 0–3 feet, 3–6 feet), contact duration (e.g., indoor layout, capacity, ventilation), and individual behaviors (e.g., partying, gathering, sporting, off-campus activities), the model serves as a comprehensive analysis tool. It incorporates GIS-based campus data, real-time Wi-Fi occupancy data, student schedule-based behavioral patterns to closely emulate campus life. The testing frequency (e.g., mandatory, voluntary), methods (e.g., PCR, antigen, antibody, saline gargle, saliva), and different containment policies (e.g., mask-wearing, vaccination) enhance the model's predictive capabilities. The model's flexible structure allows stakeholders to adapt it to current and emerging scenarios. Retrospective analyses indicate that strategies like indoor mask mandates, frequent testing, and high vaccination rates were pivotal in managing spread of disease. The model's predictive accuracy, as evidenced by high accurate rate (i.e., 85.1% accuracy with an average deviation of 4.42 cases per day) when comparing the model output to actual campus data, underscores its value as a decision-making aid for university administrators in the ongoing efforts to foster a resilient and healthy campus environment. © 2024 Elsevier Ltd

Since the last case of indigenous rubella virus (RuV) was detected in 2009 in the Region of the Americas, sporadic rubella and congenital rubella cases have been confirmed, and subsequently, a low number of associated sequences have been reported. Fifty-one sequences of wild-type RuV, representing four genotypes (1E, 1G, 1J, and 2B), were reported from five countries, with confirmed sources of exposure for 46 cases. Phylogenetic analysis revealed the diversity of these viruses, showing no associations with sustained endemic transmission from previously endemic strains. Notably, 13 sequences were associated with travel from countries where no genetic information of wild-type viruses was available. In addition to sequences from postnatal and congenital infections, 23 sequences were collected from patients with diseases associated with RuV persistent infection. These findings highlight the Region's success in maintaining rubella elimination, emphasize its valuable contribution to global RuV molecular epidemiology, and address potential challenges in progressing toward the goal of rubella eradication.