Introduction: Falls represent a prevalent cause of injury, disability, and mortality in the United States among older adults (ages 65+). Falls are not an inherent part of aging and adopting evidence-based fall prevention strategies can reduce fall risk. Caregivers are well-positioned to increase awareness and uptake of fall prevention strategies among older adults but may not be aware of all effective strategies. The objective of this study was to assess caregivers’ beliefs and awareness related to older adult falls and evidence-based prevention strategies. Methods: Questions about falls were included in the SummerStyles survey, part of the 2022 suite of Porter Novelli ConsumerStyles surveys. Questions covered demographic and health characteristics of respondents, caregiver status, and knowledge of evidence-based fall prevention strategies. We compared demographic, health, and fall prevention knowledge by caregiver status and age. Results: Caregivers were more likely to be women, 65+, and report low income and fair/poor health compared to non-caregivers. Most (88.8%) caregivers did not believe older adult falls are inevitable. Most caregivers (94.0%) reported knowing at least one evidence-based fall prevention strategy, but many also identified strategies with limited evidence, such as being more careful (75.1%), as effective. Few caregivers recognized interventions like Tai Chi (13.4%) and medication management (23.3%) as effective. However, caregivers often recognized the importance of making homes safer (84.8%) and strength or balance exercises (76.4%). Conclusions: Our findings highlight the need for expanded education aimed at caregivers to raise awareness about fall risks and all evidence-based fall prevention strategies. Practical applications: Public health efforts can benefit from effectively educating and empowering older adults and their caregivers to play a proactive role in fall prevention and aging without injury. Results can facilitate targeted education and support of caregivers and creation of caregiver-driven programs to address fall risk and prevention. © 2024 National Safety Council and Elsevier Ltd

We conducted public health investigations of 8 organ transplant recipients who tested positive for severe acute respiratory syndrome coronavirus 2 infection. Findings suggest the most likely source of transmission was community or healthcare exposure, not the organ donor. Transplant centers should educate transplant candidates and recipients about infection prevention recommendations.

Background: Culture-independent diagnostic tests (CIDTs) are increasingly used to diagnose Campylobacter infection in the Foodborne Diseases Active Surveillance Network (FoodNet). Because CIDTs have different performance characteristics compared with culture, which has been used historically and is still used to diagnose campylobacteriosis, adjustment of cases diagnosed by CIDT is needed to compare with culture-confirmed cases for monitoring incidence trends. Methods: We identified the necessary parameters for CIDT adjustment using culture as the gold standard, and derived formulas to calculate positive predictive values (PPVs). We conducted a literature review and meta-analysis to examine the variability in CIDT performance and Campylobacter prevalence applicable to FoodNet sites. We then developed a Monte Carlo method to estimate test-type and site-specific PPVs with their associated uncertainties. Results: The uncertainty in our estimated PPVs was largely derived from uncertainty about the specificity of CIDTs and low prevalence of Campylobacter in tested samples. Stable CIDT-adjusted incidences of Campylobacter cases from 2012 to 2015 were observed compared with a decline in culture-confirmed incidence. Conclusions: We highlight the lack of data on the total numbers of tested samples as one of main limitations for CIDT adjustment. Our results demonstrate the importance of adjusting CIDTs for understanding trends in Campylobacter incidence in FoodNet.

Campylobacter fetus currently comprises three recognized subspecies, which display distinct host association. C fetus subsp. fetus and C fetus subsp. venerealis are both associated with endothermic mammals, primarily ruminants, whereas C fetus subsp. testudinum is primarily associated with ectothermic reptiles. Both C. fetus subsp. testudinum and C. fetus subsp. fetus have been associated with severe infections, often with a systemic component, in immunocompromised humans. To study the genetic factors associated with the distinct host dichotomy in C. fetus, whole-genome sequencing and comparison of mammal- and reptile-associated C fetus was performed. The genomes of C fetus subsp. testudinum isolated from either reptiles or humans were compared to elucidate the genetic factors associated with pathogenicity in humans. Genomic comparisons showed conservation of gene content and organization amongst C fetus subspecies, but a clear distinction between mammal- and reptile-associated C fetus was observed. Several genomic regions appeared to be subspecies specific, including a putative tricarballylate catabolism pathway, exclusively present in C fetus subsp. testudinum strains. Within C fetus subsp. testudinum, sapA, sapB, and sapAB type strains were observed. The recombinant locus iamABC (mlaFED) was exclusively associated with invasive C fetus subsp. testudinum strains isolated from humans. A phylogenetic reconstruction was consistent with divergent evolution in host-associated strains and the existence of a barrier to lateral gene transfer between mammal- and reptile-associated C fetus Overall, this study shows that reptile-associated C fetus subsp. testudinum is genetically divergent from mammal-associated C fetus subspecies.

BACKGROUND: Human papillomavirus (HPV) vaccine should reduce cervical dysplasia before cervical cancer. However, dysplasia diagnosis is screening-dependent. Accurate screening estimates are needed. PURPOSE: To estimate the percentage of women in a geographic population that has had cervical cancer screening. METHODS: We analyzed claims data for (Papanicolau) Pap tests from 2008-2012 to estimate the percentage of insured women aged 18-39 years screened. We estimated screening in uninsured women by dividing the percentage of insured Behavioral Risk Factor Surveillance Survey respondents reporting previous-year testing by the percentage of uninsured respondents reporting previous-year testing, and multiplying this ratio by claims-based estimates of insured women with previous-year screening. We calculated a simple weighted average of the two estimates to estimate overall screening percentage. We estimated credible intervals using Monte-Carlo simulations. RESULTS: During 2008-2012, an annual average of 29.6% of women aged 18-39 years were screened. Screening increased from 2008 to 2009 in all age groups. During 2009-2012, the screening percentages decreased for all groups, but declined most in women aged 18-20 years, from 21.5% to 5.4%. Within age groups, compared to 2009, credible intervals did not overlap during 2011 (except age group 21-29 years) and 2012, and credible intervals in the 18-20 year group did not overlap with older groups in any year. CONCLUSIONS: This introduces a novel method to estimate population-level cervical cancer screening. Overall, percentage of women screened in Portland, Oregon fell following changes in screening recommendations released in 2009 and later modified in 2012.

Serotyping forms the basis of national and international surveillance networks for Salmonella, one of the most prevalent foodborne pathogens worldwide (1-3). Public health microbiology is currently being transformed by whole genome sequencing (WGS) which opens the door to serotype determination using WGS data. SeqSero (www.denglab.info/SeqSero) is a novel web-based tool for determining Salmonella serotypes using high-throughput genome sequencing data. SeqSero is based on curated databases of Salmonella serotype determinants (rfb gene cluster, fliC and fljB alleles) and is predicted to determine serotype rapidly and accurately for nearly the full spectrum of Salmonella serotypes (more than 2,300 serotypes), from both raw sequencing reads and genome assemblies. The performance of SeqSero was evaluated by testing: 1) raw reads from genomes of 308 Salmonella isolates of known serotype; 2) raw reads from genomes of 3,306 Salmonella isolates sequenced and made publicly available by GenomeTrakr, a U.S. national monitoring network operated by the Food and Drug Administration; and 3) 354 other publicly available draft or complete Salmonella genomes. We also demonstrated Salmonella serotype determination from raw sequencing reads of fecal metagenomes from mice orally infected with this pathogen. SeqSero can help to maintain the well-established utility of Salmonella serotyping when integrated into a platform of WGS-based pathogen subtyping and characterization.

A polyphasic study was undertaken to determine the taxonomic position of 13 Campylobacter fetus-like strains from humans (n=8) and reptiles (n=5). The results of matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) and genomic data from sap analysis, 16S rRNA and hsp60 sequence comparison, pulsed- field gel electrophoresis (PFGE), amplified fragment length polymorphism (AFLP) analysis, DNA-DNA hybridization and whole genome sequencing demonstrate that these strains are closely related to C. fetus but clearly differentiated from the present C. fetus subspecies. Therefore this unique cluster of 13 strains represents a novel subspecies within the species C. fetus, for which the name Campylobacter fetus subsp. testudinum subsp. nov. is proposed, with strain 03-427T (=ATCC BAA-2539T = LMG 27499T) as the type strain. Although this novel taxon cannot be differentiated from C. fetus subsp. fetus and C. fetus subsp. venerealis using conventional phenotypic tests, MALDI-TOF MS analysis revealed the presence of multiple phenotypic biomarkers which distinguish C. fetus subsp. testudinum from the present C. fetus subspecies.

From August to September 2008, the Centers for Disease Control and Prevention (CDC) assisted the Alaska Division of Public Health with an outbreak investigation of campylobacteriosis occurring among the residents of Southcentral Alaska. During the investigation, pulsed-field gel electrophoresis (PFGE) of Campylobacter jejuni isolates from human, raw pea and wild bird fecal samples confirmed the epidemiologic link between illness and the consumption of raw peas contaminated by Sandhill cranes from 15 of 43 epidemiologically-linked human isolates. However, an association between the remaining epidemiologically-linked human infections and the pea and wild bird isolates was not established. To better understand the molecular epidemiology of the outbreak, C. jejuni isolates (n=130; 59 humans, 40 peas and 31 wild birds) were further characterized by multi-locus sequence typing (MLST). Here, we present the molecular evidence to demonstrate the association of many more human C. jejuni infections associated with the outbreak with raw peas and wild bird feces. Among all sequence types (STs) identified, 26 (67%) of 39 were novel and exclusive to the outbreak. Five clusters of overlapping STs (n=32 isolates; 17 humans, 2 peas and 13 wild birds) were identified. In particular, Cluster E (n=7 isolates, ST-5049) consisted of isolates from humans, peas and wild birds. Novel STs clustered closely with isolates typically associated with wild birds and the environment, but distinct from lineages commonly seen in human infections. Novel STs and alleles recovered from human outbreak isolates allowed additional infections caused by these rare genotypes to be attributed to the contaminated raw peas.