IMPORTANCE: Evidence is needed on the economic favorability of a 2023-2024 COVID-19 vaccination program to support policy decisions on recommendations for COVID-19 vaccination. OBJECTIVE: To measure the cost-effectiveness of vaccination with a 2023-2024 COVID-19 mRNA vaccine in adults aged 18 years or older compared with no updated vaccination (with a 2023-2024 vaccine). DESIGN, SETTING, AND PARTICIPANTS: This decision analytic modeling study used a simulation model to compare outcomes for hypothetical cohorts of vaccinated and unvaccinated, immunocompetent adults stratified by age (18-49 years, 50-64 years, and >/=65 years). Parameters were drawn from primary and published data to represent characteristics of the US adult population. The interventions included vaccination with a 2023-2024 mRNA vaccine against COVID-19-associated illness compared with no updated vaccination (with a 2023-2024 vaccine) using a 1-year analytic time frame. A phase 2 analysis also considered an intervention strategy of vaccination with an additional dose of 2023-2024 COVID-19 mRNA vaccine. MAIN OUTCOME AND MEASURE: The incremental cost-effectiveness ratio as reported in 2023 US dollars per quality-adjusted life-year. RESULTS: Vaccination averted substantial numbers of cases, hospitalizations, intensive care unit stays, and deaths across age groups. For adults aged 18 to 49 years and 50 to 64 years, vaccination yielded incremental cost-effectiveness ratios of $115 588 and $25 787 per quality-adjusted life-year gained, respectively. For individuals aged 65 years or older, vaccination was cost saving. Sensitivity analyses indicated that the results were most sensitive to the cost per vaccine dose, vaccine effectiveness, and probability of hospitalization. In phase 2 analyses, an additional dose strategy was only economically favorable in higher-risk scenarios for individuals aged 65 years or older. CONCLUSIONS AND RELEVANCE: In this modeling study, economic favorability of COVID-19 vaccination varied by age. Cost-effectiveness results for individuals in the 2 older age groups were favorable and generally robust to changes in parameter inputs, while results for the younger age group were sensitive to parameter input changes. As the evidence base for COVID-19 vaccination and burden of illness evolves, it may be important to continue to update and revise the economic evaluation of vaccination. The Advisory Committee on Immunization Practices considered these results in its decision to recommend vaccination with the 2023 to 2024 COVID-19 mRNA vaccines.

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: Public health threats (PHTs) influence how and in what ways managers communicate with employees. Employee resources and information during uncertain times has been noted as a reoccurring gap, especially as it relates to personal protective equipment (PPE). This study explored general and PPE-specific communication practices with 22 healthcare and emergency medical service (EMS) managers to support workers, particularly in the context of preparedness and response. METHODS: Data collection occurred in two phases that involved interviews and small group discussions to identify, examine, and better frame and execute communication practices. Qualitative analysis was informed by the 4i FACT framework and the social ecological model (SEM) to identify relevant communication practices and intervention points within health delivery settings. RESULTS: Results elucidated perceived, effective leadership practices and interpersonal influences in the workplace. Tangible leadership communication practices were identified as important intervention points within the SEM, with a focus on proactive behaviors to procure necessary PPE and disseminate information. Participants emphasized one-on-one interactions with employees, and the use of trusted messengers to share health-related messages. They also highlighted the challenges of PPE shortages and the importance of access to resources across different job roles, organizations, and work settings. CONCLUSIONS/APPLICATION TO PRACTICE: This study contributes insights into communication practices during a public health emergency, offering a nuanced understanding of managerial approaches, PPE-related communication, and the broader contextual factors influencing information dissemination. Further, the integration of frameworks like 4i FACT and SEM provides a structured perspective for future communication strategies, supporting tailored approaches across organizations.

PROBLEM/CONDITION: Approximately 800 foodborne illness outbreaks occur in the United States each year. These outbreaks include approximately 15,000 illnesses, 800 hospitalizations, and 20 deaths. Although illnesses from outbreaks account for a small portion of all foodborne illnesses, outbreak investigations reveal how these illnesses originate by offering crucial data through epidemiologic, environmental health, and laboratory analyses and aid in outbreak mitigation and prevention. PERIOD COVERED: 2014-2022. DESCRIPTION OF SYSTEM: The Foodborne Disease Outbreak Surveillance System (FDOSS), via the National Outbreak Reporting System (NORS), captures data from foodborne enteric illness outbreak investigations in the United States. Epidemiology or communicable disease control and environmental health programs of state and local health departments collect and voluntarily report the data to NORS, which is managed by CDC. These data include information about cases (e.g., case counts, symptoms, duration of illness, and health care-seeking behaviors), laboratory specimens, settings of exposure, implicated food items, and contributing factors (i.e., how the outbreak occurred). A foodborne illness outbreak is defined as two or more cases of a similar illness associated with a common exposure (e.g., shared food, venue, or experience). Data collected from an outbreak investigation help the investigator identify contributing factors to the outbreak. Contributing factors are food preparation practices, behaviors, and environmental conditions that lead to pathogens getting into food, growing in food, or surviving in food and are grouped into three categories: contamination (when pathogens and other hazards get into food), proliferation (when pathogens that are already present in food grow), and survival (when pathogens survive a process intended to kill or reduce them). RESULTS: A total of 2,677 (40.5%) foodborne illness outbreaks reported during 2014-2022 with information on contributing factors were included in this analysis. Foodborne outbreak periods were categorized into three time frames: 2014-2016 (first), 2017-2019 (second), and 2020-2022 (third). Of the 2,677 outbreaks, 1,142 (42.7%) occurred during the first time frame, 1,130 outbreaks (42.2%) during the second time frame, and 405 outbreaks (15.1%) during the third time frame. The proportion of bacterial outbreaks increased from the first (41.9%) to the third time frame (48.4%), and the proportion of viral outbreaks decreased (33.3% to 23.2%). Over the three time frames, the proportion of outbreaks with a contamination contributing factor decreased (85.6%, 83.6%, and 81.0%, respectively). The proportion of outbreaks with a proliferation contributing factor category decreased from the first (40.3%) to the second time frame (35.0%), then increased during the third time frame (35.1%), and the proportion of outbreaks with a survival contributing factor category decreased from the first (25.7%) to the second time frame (21.9%), then increased during the third time frame (25.7%). The proportion of outbreaks with aquatic animals as an implicated food item increased from the first (12.0%) to the second time frame (18.5%), then decreased during the third time frame (18.3%). The proportion of outbreaks with land animals as an implicated food item decreased from the first (16.7%) to the second time frame (14.2%), then increased during the third time frame (15.1%).For outbreaks with a contamination contributing factor, the proportion of food contaminated by an animal or environmental source before arriving at the point of final preparation increased over the three time frames (22.2%, 27.7%, and 32.3%, respectively), and the proportion of outbreaks with contamination from an infectious food worker through barehand contact with food decreased (20.5%, 15.2%, and 8.9%, respectively). For the proliferation category, the proportions of outbreaks associated with allowing foods to remain out of temperature control for a prolonged period during preparation and during food service or display decreased over the three time frames (15.2%, 12.2%, and 9.9%, respectively; and 13.6%, 10.4%, and 8.9%, respectively), and the proportion of improper cooling of food decreased from the first (9.4%) to the second time frame (8.8%), then increased during the third time frame (10.9%). For the survival category, the proportion of outbreaks associated with inadequate time and temperature control during initial cooking/thermal processing of food decreased from the first (12.1%) to the second time frame (9.6%) and increased during the third time frame (12.1%).For bacterial outbreaks, cross-contamination of foods was among the top five contributing factors during the first (22.0%) and second time frames (20.8%) but not during the third time frame. Inadequate time and temperature control during initial cooking of food was among the top five contributing factors during all three time frames (23.8%, 20.4% and 20.9%, respectively). Improper cooling was not among the top five contributing factors during the first and second time frames but was during the third time frame (17.3%). For viral outbreaks, contamination from an infectious food worker through barehand contact with food was among the most common contributing factors during the first (47.1%) and second time frames (37.7%) and decreased to the third most common contributing factor during the third time frame (28.7%). Contamination from an infectious food worker through gloved-hand contact with food was among the top five contributing factors during the first (32.1%) and second time frame (25.5%) and was the most common contributing factor during the third time frame (42.5%). INTERPRETATION: Many foodborne illness outbreaks occur because of contamination of food by an animal or environmental source before arriving at the point of final preparation. Most viral outbreaks are caused by contamination from ill food workers. The decrease in the proportion of viral outbreaks and the proportion of outbreaks with a contamination contributing factor during 2020-2022 might be attributed to effects from the COVID-19 pandemic. Nonpharmaceutical interventions (e.g., increased glove use, cleaning and disinfection, and closure of restaurant dining areas) implemented during the COVID-19 pandemic likely led to a reduction in norovirus, which is typically spread by infectious food workers. Two common contributing factors to bacterial outbreaks are allowing foods to remain out of temperature control for a prolonged period and inadequate time and temperature control during cooking. Proper time and temperature controls are needed to effectively eliminate bacterial pathogens from contaminated foods and ensure safe food operations. PUBLIC HEALTH ACTION: Retail food establishments can follow science-based food safety guidelines such as the Food and Drug Administration Food Code and Hazard Analysis and Critical Control Points (HACCP) plans. Restaurant managers can mitigate contamination by ill food workers by implementing written policies concerning ill worker management, developing contingency plans for staffing during worker exclusions, and addressing reasons why employees work while sick. Health department staff members who investigate outbreaks and conduct routine inspections can encourage restaurants to follow their HACCP plans and other verified food safety practices, such as cooling, to prevent outbreaks.

A computer vision (CV) method to automatically measure the revised NIOSH lifting equation asymmetry angle (A) from a single camera is described and tested. A laboratory study involving ten participants performing various lifts was used to estimate A in comparison to ground truth joint coordinates obtained using 3-D motion capture (MoCap). To address challenges, such as obstructed views and limitations in camera placement in real-world scenarios, the CV method utilized video-derived coordinates from a selected set of landmarks. A 2-D pose estimator (HR-Net) detected landmark coordinates in each video frame, and a 3-D algorithm (VideoPose3D) estimated the depth of each 2-D landmark by analyzing its trajectories. The mean absolute precision error for the CV method, compared to MoCap measurements using the same subset of landmarks for estimating A, was 6.25° (SD = 10.19°, N = 360). The mean absolute accuracy error of the CV method, compared against conventional MoCap landmark markers was 9.45° (SD = 14.01°, N = 360). © 2013 IEEE.

OBJECTIVE: Evacuation can reduce morbidity and mortality by ensuring households are safely out of the path of, and ensuing impacts from, a disaster. Our goal was to characterize potential evacuation behaviors among a nationally representative sample. METHODS: We added 10 questions to the existing Porter Novelli's (PN) ConsumerStyles surveys in Fall 2020, Spring 2021, and Fall 2021.We conducted a weighted analysis using SAS 9.4 to examine distributions and estimate associations of potential evacuation behaviors of each survey separately. RESULTS: When asked about barriers to evacuation if public authorities announced a mandatory evacuation because of a large-scale disaster, ~7% reported nothing would prevent them from evacuating. Over half of respondents across the 3 surveys (51.1%-52.4%) had no preparedness plans, and almost two-thirds of respondents (63.7%-66.2%) did not have an emergency supply kit. CONCLUSIONS: Knowing potential evacuation behaviors can help frame messages and provide a starting point for interventions to improve disaster preparedness and response. Overall, data show that there is much work to be done regarding evacuation behaviors and overall preparedness in the United States. These data can be used to tailor public messaging and work with partners to increase knowledge about evacuation.

BACKGROUND AND OBJECTIVES: Respiratory syncytial virus (RSV) commonly causes hospitalization among US infants. A maternal vaccine preventing RSV in infants, RSV bivalent prefusion F maternal vaccine (RSVpreF), was approved by the US Food and Drug Administration and recommended by the Advisory Committee on Immunization Practices. Our objective was to evaluate the health benefits and cost-effectiveness of vaccinating pregnant persons in the United States using RSVpreF. METHODS: We simulated RSV infection and disease with and without seasonal RSVpreF vaccination in half of the pregnant persons in the annual US birth cohort during weeks 32 through 36 of gestation. Model inputs came from peer-reviewed literature, Food and Drug Administration records, and epidemiological surveillance databases. The results are reported using a societal perspective in 2022 US dollars for a 1-year time frame, discounting future health outcomes and costs at 3%. Sensitivity and scenario analyses were performed. RESULTS: Year-round maternal vaccination with RSVpreF would prevent 45 693 outpatient visits, 15 866 ED visits, and 7571 hospitalizations among infants each year. Vaccination had a societal incremental cost of $396 280 per quality-adjusted life-year (QALY) saved. Vaccination from September through January cost $163 513 per QALY saved. The most influential inputs were QALYs lost from RSV disease, the cost of the vaccine, and RSV-associated hospitalization costs; changes in these inputs yielded outcomes ranging from cost-saving to $800 000 per QALY saved. CONCLUSIONS: Seasonal maternal RSV vaccination designed to prevent RSV lower respiratory tract infection in infants may be cost-effective, particularly if administered to pregnant persons immediately before or at the beginning of the RSV season.

BACKGROUND: The United States Preventive Services Task Force recommends annual alcohol screening and brief behavioral intervention (alcohol SBI) with general adult and pregnant populations. Implementation of alcohol SBI in primary care has encountered numerous barriers to adapting procedures and infrastructure to support its routine delivery. This collection of case studies describes the implementation strategies used by 4 academic health system teams that were funded by the Centers for Disease Control and Prevention to implement alcohol SBI within healthcare systems to prevent alcohol-exposed pregnancies. METHODS: We used constructs from the Framework for Reporting Adaptations and Modifications-Expanded (FRAME) to describe planned and unplanned adaptations to implementation strategies, and the SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix to identify key questions, challenges, and recommendations for improving alcohol SBI implementation. Participating systems were 2 regional affiliates of a national reproductive healthcare organization, an integrated non-profit healthcare system, and an urban medical center and its affiliated network of community health centers. RESULTS: Planned adaptations included expanding the target population for brief interventions to include patients drinking at low levels who could become pregnant, modifying workflows and systems to support routine screening, and customizing training content and logistics. Unplanned adaptations included varying site recruitment and pre-implementation awareness-building strategies to enhance local receptivity of systems with decentralized management, and pivoting from in-person to virtual training during the COVID-19 pandemic. Fewer unplanned adaptations were observed for health systems with centralized management structures and practice teams that were fully engaged in implementation planning, training, roll-out, and problem-solving. CONCLUSIONS: Unplanned adaptations were observed across the 4 cases and emphasized the importance of flexible, adaptive designs when implementing evidence-based practice in dynamic settings. Participation of the health system in planning, including decisions to modify electronic health records and workflows, supported adapting to unplanned circumstances to achieve implementation goals.

The Ministry of Public Health and Population in Haiti is committed to malaria elimination. In 2017, we used novel methods to conduct a census, monitor progress, and return to sampled households (HH) before a cross-sectional survey in La Chapelle and Verrettes communes in Artibonite department ("the 2017 Artibonite HH census"). Geospatial PDFs with digitized structures and basemaps were loaded onto tablets. Enumerators captured GPS coordinates and details of each HH and points of interest. The census used 1 km2 enumeration areas (EAs) to draw a representative sample. Three remote sampling frames were compared with the 2017 Artibonite HH census. First, 2003 census EAs with 2012 population estimates from the Haitian Institute of Statistics and Informatics were standardized to the study EAs. The second sampling frame used the 2016 LandScanTM population estimates and study EAs. The third sampling frame used structures ≥3 m2 manually digitized using Maxar satellite images. In each study EA, 70% of structures were estimated to be inhabited with 4.5 persons/HH. The census identified 33,060 inhabited HHs with an estimated population of 121,593 and 6,126 points of interest. Using daily coverage maps and including digitized structures were novel methods that improved the census quality. Manual digitization was closest to the census sampling frame results with 30,514 digitized structures in the study area. The LandScanTM method performed better in urban areas; however, it produced the highest number of HHs to sample. If a census is not possible, when feasible, remotely digitizing structures and estimating occupancy may provide a close estimate.

BACKGROUND AIMS: The National Health and Nutrition Examination Survey (NHANES) underestimates the true prevalence of hepatitis C virus (HCV) infection. By accounting for populations inadequately represented in NHANES, we created two models to estimate the national hepatitis C prevalence among US adults during 2017-2020. APPROACH RESULTS: The first approach (NHANES+) replicated previous methodology by supplementing hepatitis C prevalence estimates among the US noninstitutionalized civilian population with a literature review and meta-analysis of hepatitis C prevalence among populations not included in the NHANES sampling frame. In the second approach (persons who inject drugs [PWID] adjustment), we developed a model to account for underrepresentation of PWID in NHANES by incorporating the estimated number of adult PWID in the United States and applying PWID-specific hepatitis C prevalence estimates. Using the NHANES+ model, we estimated HCV RNA prevalence of 1.0% (95% confidence interval [CI]: 0.5%-1.4%) among US adults in 2017-2020, corresponding to 2,463,700 (95% CI: 1,321,700-3,629,400) current HCV infections. Using the PWID adjustment model, we estimated HCV RNA prevalence of 1.6% (95% CI: 0.9%-2.2%), corresponding to 4,043,200 (95% CI: 2,401,800-5,607,100) current HCV infections. CONCLUSIONS: Despite years of an effective cure, estimated prevalence of hepatitis C in 2017-2020 remains unchanged from 2013-2016 when using comparable methodology. When accounting for increased injection drug use, estimated prevalence of hepatitis C is substantially higher than previously reported. National action is urgently needed to expand testing, increase access to treatment, and improve surveillance, especially among medically underserved populations, to support hepatitis C elimination goals.

The high-consequence pathogen Bacillus anthracis causes human anthrax and often results in lethal infections without the rapid administration of effective antimicrobial treatment. Antimicrobial resistance profiling is therefore critical to inform post-exposure prophylaxis and treatment decisions, especially during emergencies such as outbreaks or where intentional release is suspected. Whole-genome sequencing using a rapid long-read sequencer can uncover antimicrobial resistance patterns if genetic markers of resistance are known. To identify genomic markers associated with antimicrobial resistance, we isolated B. anthracis derived from the avirulent Sterne strain with elevated minimal inhibitory concentrations to clarithromycin. Mutants were characterized both phenotypically through broth microdilution susceptibility testing and observations during culturing, as well as genotypically with whole-genome sequencing. We identified two different in-frame insertions in the L22 ribosomal protein-encoding gene rplV, which were subsequently confirmed to be involved in clarithromycin resistance through the reversion of the mutant gene to the parent (drug-susceptible) sequence. Detection of the rplV insertions was possible with rapid long-read sequencing, with a time-to-answer within 3 h. The mutations associated with clarithromycin resistance described here will be used in conjunction with known genetic markers of resistance for other antimicrobials to strengthen the prediction of antimicrobial resistance in B. anthracis.IMPORTANCEThe disease anthrax, caused by the pathogen Bacillus anthracis, is extremely deadly if not treated quickly and appropriately. Clarithromycin is an antibiotic recommended for the treatment and post-exposure prophylaxis of anthrax by the Centers for Disease Control and Prevention; however, little is known about the ability of B. anthracis to develop resistance to clarithromycin or the mechanism of that resistance. The characterization of clarithromycin-resistant isolates presented here provides valuable information for researchers and clinicians in the event of a release of the resistant strain. Additionally, knowledge of the genetic basis of resistance provides a foundation for susceptibility prediction through rapid genome sequencing to inform timely treatment decisions.

STUDY OBJECTIVE: In the early months of the coronavirus disease 2019 (COVID-19) pandemic and before vaccine availability, there were concerns that infected emergency department (ED) health care personnel could present a threat to the delivery of emergency medical care. We examined how the pandemic affected staffing levels and whether COVID-19 positive staff were potentially infectious at work in a cohort of US ED health care personnel in 2020. METHODS: The COVID-19 Evaluation of Risks in Emergency Departments (Project COVERED) project was a multicenter prospective cohort study of US ED health care personnel conducted from May to December 2020. During surveillance, health care personnel completed weekly electronic surveys and underwent periodic serology and nasal reverse transcription polymerase chain reaction testing for SARS-CoV-2, and investigators captured weekly data on health care facility COVID-19 prevalence and health care personnel staffing. Surveys asked about symptoms, potential exposures, work attendance, personal protective equipment use, and behaviors. RESULTS: We enrolled 1,673 health care personnel who completed 29,825 person weeks of surveillance. Eighty-nine (5.3%) health care personnel documented 90 (0.3%; 95% confidence interval [CI] 0.2% to 0.4%) person weeks of missed work related to documented or concerns for COVID-19 infection. Health care personnel experienced symptoms of COVID-19 during 1,256 (4.2%) person weeks and worked at least one shift whereas symptomatic during 1,042 (83.0%) of these periods. Seventy-five (4.5%) participants tested positive for SARS-CoV-2 during the surveillance period, including 43 (57.3%) who indicated they never experienced symptoms; 74 (98.7%; 95% CI 90.7% to 99.9%) infected health care personnel worked at least one shift during the initial period of infection, and 71 (94.7%) continued working until laboratory confirmation of their infection. Physician staffing was not associated with the facility or community COVID-19 levels within any time frame studied (Kendall tau's 0.02, 0.056, and 0.081 for no shift, one-week time shift, and 2-week time shift, respectively). CONCLUSIONS: During the first wave of the pandemic, COVID-19 infections in ED health care personnel were infrequent, and the time lost from the workforce was minimal. Health care personnel frequently reported for work while infected with SARS-CoV-2 before laboratory confirmation. The ED staffing levels were poorly correlated with facility and community COVID-19 burden.

Objectives: In 2019, the Council of State and Territorial Epidemiologists ratified a multitiered standardized surveillance case definition (SSCD) for neonatal abstinence syndrome (NAS) to minimize variability in definitions across states. This evaluation of the tier 1 NAS SSCD aimed to identify common challenges and opportunities for enhancement to support consistent implementation of the definition. Methods: This mixed-methods analysis consisted of 3 virtual focus groups in March 2021 with site principal investigators, medical record abstractors, and data analysts (1 focus group each) from 4 jurisdictions piloting the tier 1 NAS SSCD. We analyzed focus group transcripts to create a codebook. We collected written reports in February 2022 from the 4 jurisdictions, conducted thematic analysis of focus group transcripts and written reports to identify themes, and collected surveillance data on infants identified with NAS born from January 2020 through December 2021 from the pilot sites. We analyzed surveillance data to further inform identified themes. We examined agreement among tier 1 classifications assigned independently by each pilot site and the Centers for Disease Control and Prevention to cases of NAS. Results: Three major themes emerged in the data: challenges abstracting data on withdrawal signs from the medical record, difficulty determining the time frame of prenatal substance exposure, and challenges assigning case classifications. In a comparison of tier 1 classifications assigned by the Centers for Disease Control and Prevention and the sites, 82.1% of cases in the dataset were concordant. Conclusions: We identified several opportunities to modify the SSCD to promote consistency and ease implementation across jurisdictions. Promoting consistent implementation supports comparability of NAS incidence estimates across jurisdictions, evaluation of prevention efforts, and allocation of resources to support families. © 2024, Association of Schools and Programs of Public Health.

STUDY QUESTION: Does the fertility status of an individual act as a biomarker for their future health? SUMMARY ANSWER: Data support an association between reproductive health and overall health for men and women. WHAT IS ALREADY KNOWN: Various chronic conditions, such as diabetes, obesity and cancer, can compromise fertility, but there are limited data for the converse situation, in which fertility status can influence or act as a marker for future health. Data reveal an association between infertility and incident cardiovascular disease and cancer in both men and women. STUDY DESIGN SIZE AND DURATION: A National Institute of Child Health and Human Development-Centers for Disease Control and Prevention workshop in April 2016 was convened that brought together experts in both somatic diseases and conditions, and reproductive health. Goals of the workshop included obtaining information about the current state of the science linking fertility status and overall health, identifying potential gaps and barriers limiting progress in the field, and outlining the highest priorities to move the field forward. PARTICIPANTS/MATERIALS SETTING AND METHODS: Approximately 40 experts participated in the workshop. MAIN RESULTS AND THE ROLE OF CHANCE: While the etiology remains uncertain for infertility, there is evidence for an association between male and female infertility and later health. The current body of evidence suggests four main categories for considering biological explanations: genetic factors, hormonal factors, in utero factors, and lifestyle/health factors. These categories would be key to include in future studies to develop a comprehensive and possibly standardized look at fertility status and overall health. Several themes emerged from the group discussion including strategies for maximizing use of existing resources and databases, the need for additional epidemiologic studies and public health surveillance, development of strategies to frame research so results could ultimately influence clinical practice, and the identification of short and long-term goals and the best means to achieve them. LIMITATIONS REASONS FOR CAUTION: Further research may not indicate an association between fertility status and overall health. WIDER IMPLICATIONS OF THE FINDINGS: Currently medical care is compartmentalized. Reproductive medicine physicians treat patients for a short period of time before they transition to others for future care. Going forward, it is critical to take an interdisciplinary patient care approach that would involve experts in a broad range of medical specialties in order to more fully understand the complex interrelationships between fertility and overall health. If infertility is confirmed as an early marker of chronic disease then screening practices could be adjusted, as they are for patients with a family history of malignancy. STUDY FUNDING/COMPETING INTERESTS: Funding for the workshop was provided by the Fertility and Infertility Branch, National Institute of Child Health and Human Development, National Institutes of Health and the Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control. There are no conflicts of interest to declare. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Institutes of Health. TRIAL REGISTRATION NUMBER: Not applicable.

BACKGROUND: Syphilis is a public health concern as cases are rising each year. If untreated, syphilis is associated with significant morbidity and risk of vertical transmission during pregnancy. For people with late latent and unknown duration stages, 3 injections of benzathine penicillin G (BPG) at 1-week intervals are recommended. Our study quantified treatment for people diagnosed with late latent and unknown duration syphilis in Maricopa County, Arizona with a secondary analysis of pregnant women to assess completion of 3 injections of BPG in multiple time intervals. METHODS: Maricopa County syphilis case data were extracted from the state-run database (PRISM). Records were reviewed for people with late latent and unknown duration syphilis during January 1, 2016, to December 31, 2021. Treatment types and time intervals between treatments were analyzed. RESULTS: Of a total of 14,924 people with syphilis reported in Maricopa County, 5372 (36.0%) were staged as late latent or unknown duration syphilis. Completion of 3 BPG injections in the time frame of 7 to 9 days was 42.9% (n = 2302). Completion among pregnant women (n = 406) with 3 injections was 68.7% (n = 279). CONCLUSIONS: The completion rate of 3 BPG injections for people with late latent or unknown duration syphilis is low. An unmet need exists to identify barriers to treatment including access to BPG and public health follow-up after the first injection. Prioritized effort is needed to identify and classify patients as having earlier stages of syphilis that require only 1 BPG injection.

Arthritis includes approximately 100 conditions that affect the joints and surrounding tissues. It is a leading cause of activity limitations, disability, and chronic pain, and is associated with dispensed opioid prescriptions, substantially contributing to health care costs. Combined 2019-2021 National Health Interview Survey data were analyzed to update national prevalence estimates of self-reported diagnosed arthritis. An estimated 21.2% (18.7% age-standardized) of U.S. adults aged ≥18 years (53.2 million) had diagnosed arthritis during this time frame. Age-standardized arthritis prevalences were higher among women (20.9%) than men (16.3%), among veterans (24.2%) than nonveterans (18.5%), and among non-Hispanic White (20.1%) than among Hispanic or Latino (14.7%) or non-Hispanic Asian adults (10.3%). Adults aged ≥45 years represent 88.3% of all U.S. adults with arthritis. Unadjusted arthritis prevalence was high among adults with chronic obstructive pulmonary disease (COPD) (57.6%), dementia (55.9%), a disability (54.8%), stroke (52.6%), heart disease (51.5%), diabetes (43.1%), or cancer (43.1%). Approximately one half of adults aged ≥65 years with COPD, dementia, stroke, heart disease, diabetes, or cancer also had a diagnosis of arthritis. These prevalence estimates can be used to guide public health policies and activities to increase equitable access to physical activity opportunities within the built environment and other arthritis-appropriate, evidence-based interventions.

The electric and magnetic fields of an infinite straight wire carrying a steady current which is turned on abruptly are determined using Jefimenko's equations, starting from the standard assumption that the wire is electrically neutral in its rest frame. Some nontrivial aspects of the solution are discussed in detail.

An animal model that fully recapitulates severe COVID-19 presentation in humans has been a top priority since the discovery of SARS-CoV-2 in 2019. Although multiple animal models are available for mild to moderate clinical disease, a non-transgenic model that develops severe acute respiratory disease has not been described. Mink experimentally infected with SARS-CoV-2 developed severe acute respiratory disease, as evident by clinical respiratory disease, radiological, and histological changes. Virus was detected in nasal, oral, rectal, and fur swabs. Deep sequencing of SARS-CoV-2 from oral swabs and lung tissue samples showed repeated enrichment for a mutation in the gene encoding for nonstructural protein 6 in open reading frame 1a/1ab. Together, these data indicate that American mink develop clinical features characteristic of severe COVID19 and as such, are uniquely suited to test viral countermeasures. Copyright The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. This article is a US Government work. It is not subject to copyright under 17 USC 105 and is also made available for use under a CC0 license.

Overexertion in lifting tasks is one of the leading causes of occupational injuries. The load weight is the key information required to evaluate the risk of a lifting task. However, weight varies across different objects and is unknown in many circumstances. Existing methods of estimating the load weight without manual weighing focused on analyzing body kinematics or muscle activations, which either utilize indirect indicators or require intrusive sensors. This study proposed using tactile gloves as a new modality to predict the load weight. Hand pressure data measured by tactile gloves during each lift was formulated as a two-dimensional matrix containing spatial and temporal information. Different types of deep neural networks were adopted, and a ResNet 18 regression model achieved the best performance. Specifically, it achieved a predicted R-squared of 0.821 and a mean absolute error of 1.579 kg. In addition, to understand the model’s decision-making logic and the hand force exertion pattern during lifting, the Shapley Additive Explanations (SHAP) technique was utilized to determine the importance of each sensor at each frame. The results demonstrated that the right hand was more important than the left hand for the model to predict the load weight. Additionally, fingers were more important than palms, and the middle phase of a lifting task was more important than its beginning and ending phases. Overall, this study demonstrated the feasibility of using tactile gloves to predict the load weight and provided new scientific insights on hand force exertion patterns during lifting. IEEE

Research on mode of administration of surveys increasingly appears in the literature. Little research includes comparisons by sample frame as well as by mode. This research examines differences in efficiency using two types of sample frames (address-based samples [ABS] or random digit dialing [RDD] samples) and multiple modes (web-based surveys, mailed questionnaire, and telephone interview) among adult respondents. Matching telephone numbers to addresses was conducted on both samples. A test of the effectiveness of making modifications to drop point locations in the ABS was also undertaken. A higher proportion of addresses were matched to telephone numbers in an ABS but with less accuracy than matching telephone numbers to addresses in an RDD sample. Costs per competed interview were lower using the RDD than when using the ABS. Efforts to specify apartment numbers in drop point locations in the ABS were not found to be cost effective. Overall, for both demographic and substantive question outcomes, survey frame has less of an impact than survey mode on measures of response rate and cost.

The National Immunization Surveys (NIS) include dual frame random-digit-dial telephone surveys used to monitor vaccination coverage in the United States among children age 19-35 months (NIS-Child) and adolescents age 13-17 years (NIS-Teen), and to assess influenza vaccination for children age 6 months-17 years (NIS-Flu). The surveys collect household-reported demographic and access-to-care data during telephone interviews with the survey-eligible child's parent or guardian. The parent or guardian is then asked for consent to contact the child's vaccination provider(s) to obtain a provider-reported immunization history using a mailed questionnaire. The success of the NIS relies heavily on getting a respondent to answer the telephone, and the caller ID display is the earliest opportunity to convey information to a respondent about the identity of the caller. An evaluation was conducted in Quarter 4 of 2017 to determine the impact on contact rates of using an alternate caller ID display. The caller ID for the NIS surveys was previously set to display "NORC UCHICAGO", identifying the contractor administering the surveys, with a Chicago-based telephone number. It was hypothesized that having the caller ID display the name of the more recognizable survey sponsor instead of the contractor would increase contact rates. Half of the sample was randomly flagged to display the "NORC UCHICAGO" caller ID text as a control, and the other half was flagged to display "CDC NATL IMMUN" as a treatment. This paper presents the study design, results, conclusions, limitations, and recommendations for future research.

Following its emergence in Wuhan, China, in late November or early December 2019, the SARS-CoV-2 virus has rapidly spread throughout the world. On March 11, 2020, the World Health Organization declared Coronavirus Disease 2019 (COVID-19) a pandemic. Genome sequencing of SARS-CoV-2 strains allows for the reconstruction of transmission history connecting these infections. Here, we analyze 346 SARS-CoV-2 genomes from samples collected between 20 February and 15 March 2020 from infected patients in Washington State, USA. We found that the large majority of SARS-CoV-2 infections sampled during this time frame appeared to have derived from a single introduction event into the state in late January or early February 2020 and subsequent local spread, strongly suggesting cryptic spread of COVID-19 during the months of January and February 2020, before active community surveillance was implemented. We estimate a common ancestor of this outbreak clade as occurring between 18 January and 9 February 2020. From genomic data, we estimate an exponential doubling between 2.4 and 5.1 days. These results highlight the need for large-scale community surveillance for SARS-CoV-2 introductions and spread and the power of pathogen genomics to inform epidemiological understanding.

BACKGROUND: An infodemic is an overflow of information of varying quality that surges across digital and physical environments during an acute public health event. It leads to confusion, risk-taking, and behaviors that can harm health and lead to erosion of trust in health authorities and public health responses. Owing to the global scale and high stakes of the health emergency, responding to the infodemic related to the pandemic is particularly urgent. Building on diverse research disciplines and expanding the discipline of infodemiology, more evidence-based interventions are needed to design infodemic management interventions and tools and implement them by health emergency responders. OBJECTIVE: The World Health Organization organized the first global infodemiology conference, entirely online, during June and July 2020, with a follow-up process from August to October 2020, to review current multidisciplinary evidence, interventions, and practices that can be applied to the COVID-19 infodemic response. This resulted in the creation of a public health research agenda for managing infodemics. METHODS: As part of the conference, a structured expert judgment synthesis method was used to formulate a public health research agenda. A total of 110 participants represented diverse scientific disciplines from over 35 countries and global public health implementing partners. The conference used a laddered discussion sprint methodology by rotating participant teams, and a managed follow-up process was used to assemble a research agenda based on the discussion and structured expert feedback. This resulted in a five-workstream frame of the research agenda for infodemic management and 166 suggested research questions. The participants then ranked the questions for feasibility and expected public health impact. The expert consensus was summarized in a public health research agenda that included a list of priority research questions. RESULTS: The public health research agenda for infodemic management has five workstreams: (1) measuring and continuously monitoring the impact of infodemics during health emergencies; (2) detecting signals and understanding the spread and risk of infodemics; (3) responding and deploying interventions that mitigate and protect against infodemics and their harmful effects; (4) evaluating infodemic interventions and strengthening the resilience of individuals and communities to infodemics; and (5) promoting the development, adaptation, and application of interventions and toolkits for infodemic management. Each workstream identifies research questions and highlights 49 high priority research questions. CONCLUSIONS: Public health authorities need to develop, validate, implement, and adapt tools and interventions for managing infodemics in acute public health events in ways that are appropriate for their countries and contexts. Infodemiology provides a scientific foundation to make this possible. This research agenda proposes a structured framework for targeted investment for the scientific community, policy makers, implementing organizations, and other stakeholders to consider.

BACKGROUND: An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention. OBJECTIVE: In this paper, we summarize the Fifth World Health Organization (WHO) Infodemic Management Conference structure, proceedings, outcomes, and proposed actions seeking to identify the interdisciplinary approaches and frameworks needed to enable the measurement of the burden of infodemics. METHODS: An iterative human-centered design (HCD) approach and concept mapping were used to facilitate focused discussions and allow for the generation of actionable outcomes and recommendations. The discussions included 86 participants representing diverse scientific disciplines and health authorities from 28 countries across all WHO regions, along with observers from civil society and global public health-implementing partners. A thematic map capturing the concepts matching the key contributing factors to the public health burden of infodemics was used throughout the conference to frame and contextualize discussions. Five key areas for immediate action were identified. RESULTS: The 5 key areas for the development of metrics to assess the burden of infodemics and associated interventions included (1) developing standardized definitions and ensuring the adoption thereof; (2) improving the map of concepts influencing the burden of infodemics; (3) conducting a review of evidence, tools, and data sources; (4) setting up a technical working group; and (5) addressing immediate priorities for postpandemic recovery and resilience building. The summary report consolidated group input toward a common vocabulary with standardized terms, concepts, study designs, measures, and tools to estimate the burden of infodemics and the effectiveness of infodemic management interventions. CONCLUSIONS: Standardizing measurement is the basis for documenting the burden of infodemics on health systems and population health during emergencies. Investment is needed into the development of practical, affordable, evidence-based, and systematic methods that are legally and ethically balanced for monitoring infodemics; generating diagnostics, infodemic insights, and recommendations; and developing interventions, action-oriented guidance, policies, support options, mechanisms, and tools for infodemic managers and emergency program managers.

INTRODUCTION: Around one-third of Americans reported they were unwilling to get a COVID-19 vaccine in April 2021. This focus group study aimed to provide insights on the factors contributing to unvaccinated adults' hesitancy or refusal to get vaccinated with COVID-19 vaccines. METHOD: Ipsos recruited 59 unvaccinated US adults who were vaccine hesitant (i.e., conflicted about or opposed to receiving a COVID-19 vaccination) using the Ipsos KnowledgePanel. Trained facilitators led a total of 10 focus groups via video-conference in March and April 2021. Two coders manually coded the data from each group using a coding frame based on the focus group discussion guide. The coding team collaborated in analyzing the data for key themes. RESULTS: Data analysis of transcripts from the focus groups illuminated four main themes associated with COVID-19 vaccine hesitancy: lack of trust in experts and institutions; concern about the safety of COVID-19 vaccines; resistance towards prescriptive guidance and restrictions; and, despite personal reluctance or unwillingness to get vaccinated, acceptance of others getting vaccinated. DISCUSSION: Vaccine confidence communication strategies should address individual concerns, describe the benefits of COVID-19 vaccination, and highlight evolving science using factural and neutral presentations of information to foster trust.

An animal model that fully recapitulates severe COVID-19 presentation in humans has been a top priority since the discovery of SARS-CoV-2 in 2019. Although multiple animal models are available for mild to moderate clinical disease, models that develop severe disease are still needed. Mink experimentally infected with SARS-CoV-2 developed severe acute respiratory disease, as evident by clinical respiratory disease, radiological, and histological changes. Virus was detected in nasal, oral, rectal, and fur swabs. Deep sequencing of SARS-CoV-2 from oral swabs and lung tissue samples showed repeated enrichment for a mutation in the gene encoding nonstructural protein 6 in open reading frame 1ab. Together, these data indicate that American mink develop clinical features characteristic of severe COVID-19 and, as such, are uniquely suited to test viral countermeasures.

There have been over 507 million cases of COVID-19, the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulting in 6 million deaths globally. Wastewater surveillance has emerged as a valuable tool in understanding SARS-CoV-2 burden in communities. The National Wastewater Surveillance System (NWSS) partnered with the United States Geological Survey (USGS) to implement a high-frequency sampling program. This report describes basic surveillance and sampling statistics as well as a comparison of SARS-CoV-2 trends between high-frequency sampling 3-5 times per week, referred to as USGS samples, and routine sampling 1-2 times per week, referred to as NWSS samples. USGS samples provided a more nuanced impression of the changes in wastewater trends, which could be important in emergency response situations. Despite the rapid implementation time frame, USGS samples had similar data quality and testing turnaround times as NWSS samples. Ensuring there is a reliable sample collection and testing plan before an emergency arises will aid in the rapid implementation of a high-frequency sampling approach. High-frequency sampling requires a constant flow of information and supplies throughout sample collection, testing, analysis, and data sharing. High-frequency sampling may be a useful approach for increased resolution of disease trends in emergency response. © 2022 American Chemical Society. All rights reserved.

BACKGROUND: Comparing disease severity between SARS-CoV-2 variants among populations with varied vaccination and infection histories can help characterize emerging variants and support healthcare system preparedness. METHODS: We compared COVID-19 hospitalization risk among New York City residents with positive laboratory-based SARS-CoV-2 tests when 98% of sequencing results were Delta (August-November 2021) or Omicron (BA.1 and sublineages, January 2022). A secondary analysis defined variant exposure using patient-level sequencing results during July 2021-January 2022, comprising 1-18% of weekly confirmed cases. RESULTS: Hospitalization risk was lower among patients testing positive when Omicron (16,025/488,053, 3.3%) than when Delta predominated (8268/158,799, 5.2%). In multivariable analysis adjusting for demographic characteristics and prior diagnosis and vaccination status, patients testing positive when Omicron predominated, compared with Delta, had 0.72 (95% CI: 0.63, 0.82) times the hospitalization risk. In a secondary analysis of patients with sequencing results, hospitalization risk was similar among patients infected with Omicron (2042/29,866, 6.8%), compared with Delta (1780/25,272, 7.0%), and higher among the subset who received two mRNA vaccine doses (adjusted relative risk 1.64; 95% CI: 1.44, 1.87). CONCLUSIONS: Hospitalization risk was lower among patients testing positive when Omicron predominated, compared with Delta. This finding persisted after adjusting for prior diagnosis and vaccination status, suggesting intrinsic virologic properties, not population-based immunity, explained the lower severity. Secondary analyses demonstrated collider bias from the sequencing sampling frame changing over time in ways associated with disease severity. Representative data collection is necessary to avoid bias when comparing disease severity between previously dominant and newly emerging variants.

COVID-19 caused significant declines in colorectal cancer (CRC) screening. Health systems and clinics, faced with a new rapidly spreading infectious disease, adapted to maintain patient safety and address the effects of the pandemic on healthcare delivery. This study aimed to understand how CDC-funded Colorectal Cancer Control Program recipients and their partner health systems and clinics may have modified evidence-based intervention (EBI) implementation to promote CRC screening during the COVID-19 pandemic; to identify barriers and facilitators to implementing modifications; and to extract lessons that can be applied to support CRC screening, chronic disease management, and clinic resilience in the face of future public health crises. Nine recipients were selected to reflect the diversity inherent among all CRCCP recipients. Recipient and clinic partner staff answered unique sets of pre-interview questions to inform tailoring of interview guides that were developed using constructs from the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) and Consolidated Framework for Implementation Research (CFIR). The study team then interviewed recipient, health system, and clinic partner staff incorporating pre-interview responses to focus each conversation. We employed a rapid qualitative analysis approach then conducted virtual focus groups with recipient representatives to validate emergent themes. Three modifications that emerged from thematic analysis include: (1) offering mailed fecal immunochemical test (FIT) kits for CRC screening with mail or drop off return; (2) increasing the use of patient education and engagement strategies; and (3) increasing the use of or improving automated patient messaging systems. With improved tracking and automated reminder systems, mailed FIT kits paired with tailored patient education and clear instructions for completing the test could help primary care clinics catch up on the backlog of missed screenings during COVID-19. Future research can assess the effectiveness and cost-effectiveness of offering mailed FIT kits on maintaining or improving CRC screening, especially among people who are medically underserved.

Observer, manual single-frame video, and automated computer vision measures of the Hand Activity Level (HAL) were compared. HAL can be measured three ways: 1) observer rating (HAL(O)), 2) calculated from single-frame multimedia video task analysis for measuring frequency (F) and duty cycle (D) (HAL(F)), or 3) from automated computer vision (HAL(C)). This study analyzed videos collected from three prospective cohort studies to ascertain HAL(O), HAL(F), and HAL(C) for 419 industrial videos. Although the differences for the three methods were relatively small on average (<1), they were statistically significant (p<.001). A difference between the HAL(C) and HAL(F) ratings within 1 point on the HAL scale was the most consistent, where more than two thirds (68%) of all the cases were within that range and had a linear regression through the mean coefficient of 1.03 (R(2) =0.89). The results suggest that the computer vision methodology yields comparable results as single-frame video analysis. | The ACGIH Hand Activity Level (HAL) was obtained for 419 industrial tasks using three methods: observation, calculated using single-frame video analysis and computer vision. The computer vision methodology produced results that were comparable to single-frame video analysis. | eng