The large amounts of opioids and the emergence of increasingly potent illicitly manufactured synthetic opioids circulating in the unregulated drug supply in North America and Europe are fueling not only the ongoing public health crisis of overdose deaths but also raise the risk of another type of disaster: deliberate opioid release with the intention to cause mass harm. Synthetic opioids are highly potent, rapidly acting, can cause fatal ventilatory depression, are widely available, and have the potential to be disseminated for mass exposure, for example, if effectively formulated, via inhalation or ingestion. As in many other chemical incidents, the health consequences of a deliberate release of synthetic opioid would manifest quickly, within minutes. Such an incident is unlikely, but the consequences could be grave. Awareness of the risk of this type of incident and preparedness to respond are required to save lives and reduce illness. Coordinated planning across the entire local community emergency response system is also critical. The ability to rapidly recognize the opioid toxidrome, education on personal protective actions, and training in medical management of individuals experiencing an opioid overdose are key components of preparedness for an opioid mass casualty incident.

Up to 26% of US adults live with a hearing, vision, cognition, mobility, self-care, or independent living disability.1,2 Most people with disabilities are not inherently at elevated risk for becoming infected with or having severe illness from viruses such as SARS-CoV-2, the virus that causes COVID-19. However, some people with disabilities might have an elevated risk of infection or severe illness because of their underlying medical conditions or systemic health and social inequities. 3 As such, understanding barriers to equitable COVID-19 vaccination for people with disabilities and ways to address those barriers is a timely public health objective.

BACKGROUND: Screening US blood donors for Trypanosoma cruzi infection is identifying autochthonous, chronic infections. Two donors in Mississippi were identified through screening and investigated as probable domestically acquired vector-borne infections, and the US T. cruzi Infection Study was conducted to evaluate the burden of and describe putative risk factors for vector-borne infection in the United States. STUDY DESIGN AND METHODS: Blood donors who tested enzyme-linked immunosorbent assay repeat reactive and positive by radioimmunoprecipitation assay, and whose mode of infection could not be identified, were evaluated with a questionnaire to identify possible sources of infection and by additional serologic and hemoculture testing for T. cruzi infection. RESULTS: Of 54 eligible donors, 37 (69%) enrolled in the study. Fifteen (41%) enrollees had four or more positive serologic tests and were considered positive for T. cruzi infection; one was hemoculture positive. Of the 15, three (20%) donors had visited a rural area of an endemic country, although none had stayed for 2 or more weeks. All had lived in a state with documented T. cruzi vector(s) or infected mammalian reservoir(s), 13 (87%) reported outdoor leisure or work activities, and 11 (73%) reported seeing wild reservoir animals on their property. CONCLUSION: This report adds 16 cases, including one from the Mississippi investigation, of chronic T. cruzi infection presumably acquired via vector-borne transmission in the United States to the previously reported seven cases. The estimated prevalence of autochthonous infections based on this study is 1 in 354,000 donors. Determining US foci of vector-borne transmission is needed to better assess risk for infection.