BACKGROUND: Jamestown Canyon virus, a mosquito-borne virus, can cause asymptomatic infection, febrile illness, or neuroinvasive disease in humans. Previous studies have found Jamestown Canyon virus-specific antibodies in a 4-54% of people in various U.S. regions. To understand baseline seroprevalence in regions with the highest number of reported disease cases, we performed a serosurvey among blood donors. METHODS: We randomly selected blood donation specimens collected during December 2019-April 2020 from residents of counties reporting ≥2 disease cases in 2019 or one case in 2019 and ≥1 case during 2010-2018. Specimens were screened for Jamestown Canyon virus-specific neutralizing antibodies and, if positive, tested for IgM antibodies. We estimated county population seroprevalence by calibrating sample weights to population census data. RESULTS: Fourteen counties in three states, Massachusetts, Minnesota, and Wisconsin, met the inclusion criteria. Within each state, average county seroprevalence ranged from 16.8% (95% CI: 9.3%-27.0%) to 18.8% (95% CI: 14.0%-24.4%) for Jamestown Canyon virus neutralizing antibodies and from 7.6% (95% CI: 4.2%-12.5%) to 13.5% (95% CI: 9.6%-18.3%) for both neutralizing and IgM antibodies. CONCLUSIONS: Estimated Jamestown Canyon virus seroprevalence, including for IgM antibodies, is elevated in endemic areas, complicating the interpretation of serologic testing in diagnosing acute disease in symptomatic individuals. Diagnosing Jamestown Canyon virus disease requires a high degree of clinical suspicion, ruling out other possible causes of illness, and if possible, collecting acute and convalescent samples. New assays to detect acute infection could improve diagnosis and public health surveillance for Jamestown Canyon virus disease.

The measurement of fine (diameter: 100 nanometers-2.5 micrometers) and ultrafine (UF: < 100 nanometers) titanium dioxide (TiO(2)) particles is instrument dependent. Differences in measurements exist between toxicological and field investigations for the same exposure metric such as mass, number, or surface area because of variations in instruments used, operating parameters, or particle-size measurement ranges. Without appropriate comparison, instrument measurements create a disconnect between toxicological and field investigations for a given exposure metric. Our objective was to compare a variety of instruments including multiple metrics including mass, number, and surface area (SA) concentrations for assessing different concentrations of separately aerosolized fine and UF TiO(2) particles. The instruments studied were (1) DustTrak™ DRX, (2) personal DataRAMs™ (PDR), (3) GRIMM(TM), and (4) diffusion charger (DC). Two devices of each field-study instrument (DRX, PDR, GRIMM, and DC) were used to measure various metrics while adjusting for gravimetric mass concentrations of fine and UF TiO(2) particles in controlled chamber tests. An analysis of variance (ANOVA) was used to apportion the variance to inter-instrument (between different instrument-types), inter-device (within instrument), and intra-device components. Performance of each instrument-device was calculated using root mean squared error compared to reference methods: close-faced cassette and gravimetric analysis for mass and scanning mobility particle sizer (SMPS) real-time monitoring for number and SA concentrations. Generally, inter-instrument variability accounted for the greatest (62.6% or more) source of variance for mass, and SA-based concentrations of fine and UF TiO(2) particles. However, higher intra-device variability (53.7%) was observed for number concentrations measurements with fine particles compared to inter-instrument variability (40.8%). Inter-device variance range(0.5-5.5%) was similar for all exposure metrics. DRX performed better in measuring mass closer to gravimetric than PDRs for fine and UF TiO(2). Number concentrations measured by GRIMMs and SA measurements by DCs were considerably (40.8-86.9%) different from the reference (SMPS) method for comparable size ranges of fine and UF TiO(2). This information may serve to aid in interpreting assessments in risk models, epidemiologic studies, and development of occupational exposure limits, relating to health effect endpoints identified in toxicological studies considering similar instruments evaluated in this study.

OBJECTIVE: Without timely screening, diagnosis, and intervention, hearing loss can cause significant delays in a child's speech, language, social, and emotional development. In 2019, Texas had nearly twice the average rate of loss to follow-up (LFU) or loss to documentation (LTD; i.e., missing documentation of services received) among infants who did not pass their newborn hearing screening compared to the United States overall (51.1% vs. 27.5%). We aimed to identify factors contributing to LFU/LTD among infants who do not pass their newborn hearing screening in Texas. STUDY DESIGN: Data were collected through semi-structured qualitative interviews with 56 providers along the hearing care continuum, including hospital newborn hearing screening program staff, audiologists, primary care physicians, and early intervention (EI) program staff located in three rural and urban public health regions in Texas. Following recording and transcription of the interviews, we used qualitative data analysis software to analyze themes using a conventional content analysis approach. RESULTS: Frequently cited barriers included problems with family access to care, difficulty contacting patients, problems with communication between providers and referrals, lack of knowledge among providers and parents, and problems using the online reporting system. Providers in rural areas more often mentioned problems with family access to care and contacting families compared to providers in urban areas. CONCLUSION: These findings provide insight into strategies that public health professionals and health care providers can use to work together to help further increase the number of children identified early who may benefit from EI services.

BACKGROUND: SARS-CoV-2, the virus that causes COVID-19 disease, was first identified in Wuhan, China in December 2019, with subsequent worldwide spread. The first U.S. cases were identified in January 2020. METHODS: To determine if SARS-CoV-2 reactive antibodies were present in sera prior to the first identified case in the U.S. on January 19, 2020, residual archived samples from 7,389 routine blood donations collected by the American Red Cross from December 13, 2019 to January 17, 2020, from donors resident in nine states (California, Connecticut, Iowa, Massachusetts, Michigan, Oregon, Rhode Island, Washington, and Wisconsin) were tested at CDC for anti-SARS-CoV-2 antibodies. Specimens reactive by pan-immunoglobulin (pan Ig) enzyme linked immunosorbent assay (ELISA) against the full spike protein were tested by IgG and IgM ELISAs, microneutralization test, Ortho total Ig S1 ELISA, and receptor binding domain / Ace2 blocking activity assay. RESULTS: Of the 7,389 samples, 106 were reactive by pan Ig. Of these 106 specimens, 90 were available for further testing. Eighty four of 90 had neutralizing activity, 1 had S1 binding activity, and 1 had receptor binding domain / Ace2 blocking activity >50%, suggesting the presence of anti-SARS-CoV-2-reactive antibodies. Donations with reactivity occurred in all nine states. CONCLUSIONS: These findings suggest that SARS-CoV-2 may have been introduced into the United States prior to January 19, 2020.

BACKGROUND: In fall 2017, 3 solid organ transplant (SOT) recipients from a common donor developed encephalitis within 1 week of transplantation, prompting suspicion of transplant-transmitted infection. Eastern equine encephalitis virus (EEEV) infection was identified during testing of endomyocardial tissue from the heart recipient. METHODS: We reviewed medical records of the organ donor and transplant recipients and tested serum, whole blood, cerebrospinal fluid, and tissue from the donor and recipients for evidence of EEEV infection by multiple assays. We investigated blood transfusion as a possible source of organ donor infection by testing remaining components and serum specimens from blood donors. We reviewed data from the pretransplant organ donor evaluation and local EEEV surveillance. RESULTS: We found laboratory evidence of recent EEEV infection in all organ recipients and the common donor. Serum collected from the organ donor upon hospital admission tested negative, but subsequent samples obtained prior to organ recovery were positive for EEEV RNA. There was no evidence of EEEV infection among donors of the 8 blood products transfused into the organ donor or in products derived from these donations. Veterinary and mosquito surveillance showed recent EEEV activity in counties nearby the organ donor's county of residence. Neuroinvasive EEEV infection directly contributed to the death of 1 organ recipient and likely contributed to death in another. CONCLUSIONS: Our investigation demonstrated EEEV transmission through SOT. Mosquito-borne transmission of EEEV to the organ donor was the likely source of infection. Clinicians should be aware of EEEV as a cause of transplant-associated encephalitis.

Mathematical modeling of healthcare associated infections (HAIs) and multidrug resistant organisms (MDROs) improves our understanding of pathogens transmission dynamics and provides a framework for evaluating prevention strategies. One way of improving the communication among modelers is by providing a standardized way of describing and reporting models thereby instilling confidence in the reproducibility and generalizability of such models. We updated the Overview, Design concepts, and Details protocol developed by Grimm et al. for describing agent-based models (ABMs) to better align with elements commonly included in healthcare-related ABMs. The MInD-Healthcare framework includes the following nine key elements: 1. Purpose and scope; 2. Entities, state variables, and scales; 3. Initialization; 4. Process overview and scheduling; 5. Input data; 6. Agent interactions and organism transmission; 7. Stochasticity; 8. Submodels; 9. Model verification, calibration, and validation. Our objective is that this framework will improve the quality of evidence generated utilizing these models.

A century ago, the world was ensnared in the Great War, 1914–1918, now known as the First World War. During that war, an estimated 9 million combatants and as many as 7 million civilians died, and it brought to an end the German, Russian, Austro-Hungarian, and Ottoman Empires. Infectious diseases played a prominent role in that war, resulting in more casualties than did war-inflicted wounds. With several decades of knowledge about bacterial organisms, armies had implemented sanitation measures such as latrines and water purification methods to control diarrheal and dysenteric diseases. Vaccine successes had been documented for smallpox and typhoid. However, louse-borne typhus killed 2–3 million soldiers and civilians on the Eastern Front, and the war’s end in November 1918 was hastened by an influenza pandemic that had begun in January 1918 and eventually claimed the lives of an estimated 50 million. | | Because of the huge numbers of casualties, control of media was important for maintaining positive public opinion and support for the war efforts; all combatant countries developed central censorship and propaganda offices. The United States entered the war in April 1917, fully two-and-a-half years into the conflict, and created its own Committee on Public Information and its own Censorship Board. For the Austro-Hungarian forces, the central censorship and propaganda institution was the War Press Office, or Kriegspressequartier, which eventually included more than 750 writers, journalists, photographers, and filmmakers, and some 150 visual artists. Painters and photographers worked in the field of combat, many as military officers, and sketched quick impressions, which they could later render more elaborate or refined, when they were away from the dangers of the front. Among these many painters was a young artist, Ernst Liebenauer (1884–1970), who had studied under reknowned realist Christian Griepenkerl at the Wiener Akademie der Bildenden Künste (Viennese Academy of Fine Arts) and later at the Spezialschule für Historienmalerei (Special School for Historical Painting) under another well-known Austrian portrait and landscape painter, Franz Rumpler. During the war, Liebenauer focused on military subjects, but after the war, he became a painter of landscapes, still life, portraits, and mythical scenes. He was best known as an illustrator of children’s books and fairy tales, including versions of Daniel Defoe’s Robinson Crusoe and the works of the Brothers Grimm.

BACKGROUND: Transfusion-transmitted malaria (TTM) is a rare occurrence with serious consequences for the recipient. A case study is presented as an example of best practices for conducting a TTM investigation. CASE REPORT: A 15-year-old male with a history of sickle cell disease developed fever after a blood transfusion. He was diagnosed with Plasmodium falciparum malaria and was successfully treated. The American Red Cross, New York State Department of Health, and the Centers for Disease Control and Prevention investigated the eight donors who provided components to the transfusion. The investigation to identify a malaria-positive donor included trace back of donors, serologic methods to identify donor(s) with a history of malaria exposure, polymerase chain reaction (PCR) testing, microsatellite analysis to identify the parasite in a donor and match its genotype to the parasite in the recipient, and reinterview of all donors to clarify malaria risk factors. RESULTS: One donor had evidence of infection with P. falciparum by PCR, elevated antibody titers, and previously undisclosed malaria risk factors. Reinterview revealed that the donor immigrated to the United States from Togo just short of 3 years before the blood donation. The donor was treated for asymptomatic low parasitemia infection. CONCLUSION: This investigation used standard procedures for investigating TTM but also demonstrated the importance of applying sensitive laboratory techniques to identify the infected donor, especially a donor with asymptomatic infection with low parasitemia. Repeat interview of all donors identified as having contributed to the transfused component provides complementary epidemiologic information to confirm the infected donor.

BACKGROUND: Data on large scale community-level interventions on fruit and vegetable consumption targeting minority communities are lacking. This study examined whether a multicommunity intervention decreased disparities in fruit and vegetable consumption. MATERIALS AND METHODS: The Racial and Ethnic Approaches to Community Health (REACH) 2010 program was conducted among 16 black communities. Five-year trends (2001-2006) in self-reported fruit and vegetable consumption among the target population were compared with trends among white and black populations in 14 states where communities were located. RESULTS: The geometric mean of combined fruit and vegetable consumption in the REACH communities increased 7.4 % (P0.001) but did not change among white and black populations in comparison states (P0.05). Increased consumption in REACH communities was higher in the lower quintiles of consumptions. The disparity in fruits and vegetables consumption between comparison white population and blacks in REACH communities decreased by 33 %-from 0.66 to 0.44 times per day. The target population of 1.2 million people consumed fruits and vegetables about 21.9 million additional times per year as a result of the REACH program. CONCLUSION: This large community-based participatory intervention successfully reduced isparities in fruit and vegetable consumption between comparison white population and 16 disadvantaged black communities.

Most Americans do not eat enough fruits and vegetables with significant variation by state. State-level self-reported frequency of fruit and vegetable consumption is available from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (BRFSS). However, BRFSS cannot be used to directly compare states' progress toward national goals because of incongruence in units used to measure intake and because distributions from frequency data are not reflective of usual intake. To help states track progress, we developed scoring algorithms from external data and applied them to BRFSS 2011 data to estimate the percentage of each state's adult population meeting US Department of Agriculture Food Patterns fruit and vegetable intake recommendations. We used 24-hour dietary recall data from the National Health and Nutrition Examination Survey, 2007-2010, to fit sex- and age-specific models that estimate probabilities of meeting recommendations as functions of reported consumption frequency, race/ethnicity, and poverty-income ratio adjusting for intraindividual variation. Regression parameters derived from these models were applied to BRFSS to estimate the percentage meeting recommendations. We estimate that 7%-18% of state populations met fruit recommendations and 5%-12% met vegetable recommendations. Our method provides a new tool for states to track progress toward meeting dietary recommendations.

OBJECTIVES: To examine the association of timing of introduction and frequency of fruit and vegetable intake during infancy with frequency of fruit and vegetable intake at age 6 years in a cohort of US children. METHODS: We analyzed data on fruit and vegetable intake during late infancy, age of fruit and vegetable introduction, and frequency of fruit and vegetable intake at 6 years from the Infant Feeding Practices Study II and the Year 6 Follow-Up (Y6FU) Study. We determined the percent of 6-year-old children consuming fruits and vegetables less than once per day and examined associations with infant fruit and vegetable intake using logistic regression modeling, controlling for multiple covariates (n = 1078). RESULTS: Based on maternal report, 31.9% of 6-year-old children consumed fruit less than once daily and 19.0% consumed vegetables less than once daily. In adjusted analyses, children who consumed fruits and vegetables less than once daily during late infancy had increased odds of eating fruits and vegetables less than once daily at age 6 years (fruit, adjusted odds ratio: 2.48; vegetables, adjusted odds ratio: 2.40). Age of introduction of fruits and vegetables was not associated with intake at age 6 years. CONCLUSIONS: Our study suggests that infrequent intake of fruits and vegetables during late infancy is associated with infrequent intake of these foods at 6 years of age. These findings highlight the importance of infant feeding guidance that encourages intake of fruits and vegetables and the need to examine barriers to fruit and vegetable intake during infancy.

According to the Dietary Guidelines for Americans, persons in the United States aged ≥2 years should increase their intake of certain nutrient-rich foods, including fruits and vegetables. Fruits and vegetables contribute important nutrients that are underconsumed in the United States. Higher intake of fruits and vegetables might reduce the risk for many chronic diseases including heart disease, stroke, diabetes, and some types of cancer. In addition, replacing high-calorie foods with fruits and vegetables can aid in weight management. However, most persons in the United States do not consume the recommended amounts of fruits and vegetables and other healthier food groups (e.g., whole grains or fat-free or low-fat dairy foods).

Few studies take into account the influence of family size on household resources when assessing income disparities in fruit and vegetable (F/V) consumption. Poverty income ratio (PIR) is a measure that utilizes both reported income and household size. We sought to examine state-specific disparities in meeting Healthy People 2010 objectives for F/V consumption by percent PIR. This analysis included 353,005 adults in 54 states and territories reporting data to the 2009 Behavioral Risk Factor Surveillance System in the United States. Percent PIR was calculated using the midpoint of self-reported income range and family size. The prevalences consuming at least two fruits and at least three vegetables per day were examined by percent PIR (<130% [greatest poverty], 130% to <200%, 200% to <400%, and ≥ 400% [least poverty]). The percent of adults consuming vegetables at least three times daily was significantly lower (21.3%) among those living at greatest poverty (<130% PIR) compared with 30.7% among those with least poverty (≥ 400% PIR). Daily consumption of vegetables at least three times was significantly lower among those with greatest poverty in a majority of states and territories surveyed (43 of 54). The overall percent of adults consuming fruits at least 2 times daily was also lower among those living at greatest vs least poverty, but the difference was smaller (32.0% vs 34.2%), with 14 states reporting a difference that was significantly lower among those with greatest poverty. Our study revealed that in 2009 a significantly lower proportion of US adults living at greatest poverty consumed fruits at least two times daily or vegetables at least three times daily compared with those with the least poverty, with greater disparity in vegetable intake. Policy and environmental strategies for increased affordability, access, availability, and point-of-decision information are approaches that may help disparate households purchase and consume F/V.

High intake of fruits and vegetables (FV) is associated with a decreased risk for many chronic diseases and may assist in weight management, but few children and adolescents consume the recommended amounts of FV. The pediatric practitioner can positively influence FV consumption of children through patient-level interventions (eg, counseling, connecting families to community resources), community-level interventions (eg, advocacy, community involvement), and health care facility-level interventions (eg, creating a healthy food environment in the clinical setting). This article reviews the importance of FV consumption, recommended intakes for children, and strategies by which pediatric practitioners can influence FV consumption of children.

INTRODUCTION: Although Hispanics are a rapidly growing ethnic minority in the United States, the effect of acculturation on the proportion of Hispanics who meet national objectives for fruit and vegetable consumption has not been fully investigated. Our objective was to determine the extent to which ethnicity and acculturation (indicated by survey language preference) are associated with fruit and vegetable consumption among Hispanics in the United States. METHODS: Fruit and vegetable consumption among adult respondents to the 2009 Behavioral Risk Factor Surveillance System was determined from data collected from the 31 states and 2 territories that offered the fruit and vegetable screener in Spanish and English (n = 287,997). Logistic regression analyses were used to determine whether ethnicity (Hispanic vs non-Hispanic white) and survey language preference (English vs Spanish) were related to meeting objectives of consuming fruit 2 or more times per day and vegetables 3 or more times per day. RESULTS: More Hispanics (37.6%) than non-Hispanic whites (32.0%) and more Spanish-speaking Hispanics (41.0%) than English-speaking Hispanics (34.7%) ate fruit 2 or more times per day. Conversely, more non-Hispanic whites (28.5%) than Hispanics (18.9%) and more English-speaking Hispanics (21.8%) than Spanish-speaking Hispanics (15.8%) ate vegetables 3 or more times per day. All associations remained significant after controlling for covariates. CONCLUSION: Our findings have implications regarding how brief screeners can be used to determine possible dietary disparities among the Hispanic population in the United States and to monitor population goals to eliminate racial and ethnic health disparities.