We report an increase in GII.17 norovirus outbreaks and sporadic infections of acute gastroenteritis in Austria, Germany, France, Ireland, the Netherlands, England and the United States during the 2023/24 season. A decrease in GII.4 coincided with GII.17 prevalence increasing to between 17% and 64% of all GII detections. Overall, 84% of the GII.17 strains clustered closely with strains first reported in Romania in 2021 and two new sub-lineages were identified. Norovirus surveillance and molecular characterisation should be prioritised this winter.

We studied whether ambient air pollution is associated with interstitial lung abnormalities (ILAs) and high attenuation areas (HAAs), which are qualitative and quantitative measurements of subclinical interstitial lung disease (ILD) on computed tomography (CT).We performed analyses of community-based dwellers enrolled in the Multi-Ethnic Study of Atherosclerosis (MESA) study. We used cohort-specific spatio-temporal models to estimate ambient pollution (fine particulate matter (PM2.5), nitrogen oxides (NOx), nitrogen dioxide (NO2) and ozone (O3)) at each home. A total of 5495 participants underwent serial assessment of HAAs by cardiac CT; 2671 participants were assessed for ILAs using full lung CT at the 10-year follow-up. We used multivariable logistic regression and linear mixed models adjusted for age, sex, ethnicity, education, tobacco use, scanner technology and study site.The odds of ILAs increased 1.77-fold per 40 ppb increment in NOx (95% CI 1.06 to 2.95, p = 0.03). There was an overall trend towards an association between higher exposure to NOx and greater progression of HAAs (0.45% annual increase in HAAs per 40 ppb increment in NOx; 95% CI -0.02 to 0.92, p = 0.06). Associations of ambient fine particulate matter (PM2.5), NOx and NO2 concentrations with progression of HAAs varied by race/ethnicity (p = 0.002, 0.007, 0.04, respectively, for interaction) and were strongest among non-Hispanic white people.We conclude that ambient air pollution exposures were associated with subclinical ILD.

RATIONALE: The impact of a broad range of occupational exposures on subclinical interstitial lung disease (ILD) has not been studied. OBJECTIVES: To determine whether occupational exposures to vapors, gas, dust, and fumes (VGDF) are associated with high-attenuation areas (HAA) and interstitial lung abnormalities (ILA), which are quantitative and qualitative computed tomography (CT)-based measurements of subclinical ILD, respectively. METHODS: We performed analyses of participants enrolled in MESA (Multi-Ethnic Study of Atherosclerosis), a population-based cohort aged 45-84 years at recruitment. HAA was measured at baseline and on serial cardiac CT scans in 5,702 participants. ILA was ascertained in a subset of 2,312 participants who underwent full-lung CT scanning at 10-year follow-up. Occupational exposures were assessed by self-reported VGDF exposure and by job-exposure matrix (JEM). Linear mixed models and logistic regression were used to determine whether occupational exposures were associated with log-transformed HAA and ILA. Models were adjusted for age, sex, race/ethnicity, education, employment status, tobacco use, and scanner technology. MEASUREMENTS AND MAIN RESULTS: Each JEM score increment in VGDF exposure was associated with 2.64% greater HAA (95% confidence interval [CI], 1.23-4.19%). Self-reported vapors/gas exposure was associated with an increased odds of ILA among those currently employed (1.76-fold; 95% CI, 1.09-2.84) and those less than 65 years old (1.97-fold; 95% CI, 1.16-3.35). There was no consistent evidence that occupational exposures were associated with progression of HAA over the follow-up period. CONCLUSIONS: JEM-assigned and self-reported exposures to VGDF were associated with measurements of subclinical ILD in community-dwelling adults.

Background. Awareness of human immunodeficiency virus (HIV) status among all people with HIV is critical for epidemic control. We aimed to assess accurate knowledge of HIV status, defined as concordance with serosurvey test results from the 2010 Malawi Demographic Health Survey (MDHS), and to identify risk factors for seropositivity among adults (aged 15-49) reporting a most recently negative test within 12 months. Methods. Data were analyzed from the 2010 MDHS. A logistic regression model was constructed to determine factors independently associated with HIV seropositivity after a recently negative test. All analyses controlled for the survey's complex design. Results. A total of 11 649 adults tested for HIV during this MDHS reported ever being sexually active. Among these, HIV seroprevalence was 12.0%, but only 61.7% had accurate knowledge of their status. Forty percent (40.3%; 95% confidence interval [CI], 36.8-43.8) of seropositive respondents reported a most recently negative test. Of those reporting that this negative test was within 12 months (n = 3630), seroprevalence was 7.2% for women (95% CI, 5.7-9.2), 5.2% for men (95% CI, 3.9-6.9), higher in the South, and higher in rural areas for men. Women with higher education and men in the richest quintile were at higher risk. More than 1 lifetime union was significantly associated with recent HIV infection, whereas never being married was significantly protective. Conclusions. Self-reported HIV status based on prior test results can underestimate seroprevalence. These results highlight the need for posttest risk assessment and support for people who test negative for HIV and repeat testing in people at high risk for HIV infection.

Background The US Centers for Disease Control and Prevention ensured adequate performance of the routine triglycerides methods used in Japan by a chromotropic acid reference measurement procedure used by the Centers for Disease Control and Prevention lipid standardization programme as a reference point. We examined standardized data to clarify the performance of routine triglycerides methods. Methods The two routine triglycerides methods were the fluorometric method of Kessler and Lederer and the enzymatic method. The methods were standardized using 495 Centers for Disease Control and Prevention reference pools with 98 different concentrations ranging between 0.37 and 5.15 mmol/L in 141 survey runs. The triglycerides criteria for laboratories which perform triglycerides analyses are used: accuracy, as bias ≤5% from the Centers for Disease Control and Prevention reference value and precision, as measured by CV, ≤5%. Results The correlation of the bias of both methods to the Centers for Disease Control and Prevention reference method was: y (%bias) = 0.516 x (Centers for Disease Control and Prevention reference value) -1.292 ( n = 495, R2 = 0.018). Triglycerides bias at medical decision points of 1.13, 1.69 and 2.26 mmol/L was -0.71%, -0.42% and -0.13%, respectively. For the combined precision, the equation y (CV) = -0.398 x (triglycerides value) + 1.797 ( n = 495, R2 = 0.081) was used. Precision was 1.35%, 1.12% and 0.90%, respectively. It was shown that triglycerides measurements at Osaka were stable for 36 years. Conclusions The epidemiologic laboratory in Japan met acceptable accuracy goals for 88.7% of all samples, and met acceptable precision goals for 97.8% of all samples measured through the Centers for Disease Control and Prevention lipid standardization programme and demonstrated stable results for an extended period of time.

OBJECTIVE: To determine whether laws and regulations in Botswana, South Africa and Zambia - three countries with a high tuberculosis and HIV infection burden - address elements of the World Health Organization (WHO) policy on tuberculosis infection control. METHODS: An online desk review of laws and regulations that address six selected elements of the WHO policy on tuberculosis infection control in the three countries was conducted in November 2015 using publicly available domestic legal databases. The six elements covered: (i) national policy and legal framework; (ii) health facility design, construction and use; (iii) tuberculosis disease surveillance among health workers; (iv) patients' and health workers' rights; (v) monitoring of infection control measures; and (vi) relevant research. FINDINGS: The six elements were found to be adequately addressed in the three countries' laws and regulations. In all three, tuberculosis case-reporting is required, as is tuberculosis surveillance among health workers. Each country's legal and regulatory framework also addresses the need to respect individuals' rights and privacy while safeguarding public health. These laws and regulations create a strong foundation for tuberculosis infection control. Although the legal and regulatory frameworks thoroughly address tuberculosis infection control, their dissemination, implementation and enforcement were not assessed, nor was their impact on public health. CONCLUSION: Laws and regulations in Botswana, South Africa and Zambia address all six selected elements of the WHO policy on tuberculosis infection control. However, the lack of data on their implementation is a limitation. Future research should assess the implementation and public health impact of laws and regulations.

Neonatal abstinence syndrome (NAS) is a constellation of physiologic and neurobehavioral signs exhibited by newborns exposed to addictive prescription or illicit drugs taken by a mother during pregnancy. The number of hospital discharges of newborns diagnosed with NAS has increased more than 10-fold (from 0.4 to 4.4 discharges per 1,000 live births) in Florida since 1995, far exceeding the three-fold increase observed nationally. In February 2014, the Florida Department of Health requested the assistance of CDC to 1) assess the accuracy and validity of using Florida's hospital inpatient discharge data, linked to birth and infant death certificates, as a means of NAS surveillance and 2) describe the characteristics of infants with NAS and their mothers. This report focuses only on objective two, describing maternal and infant characteristics in the 242 confirmed NAS cases identified in three Florida hospitals during a 2-year period (2010-2011). Infants with NAS experienced serious medical complications, with 97.1% being admitted to an intensive care unit, and had prolonged hospital stays, with a mean duration of 26.1 days. The findings of this investigation underscore the important public health problem of NAS and add to current knowledge on the characteristics of these mothers and infants. Effective June 2014, NAS is now a mandatory reportable condition in Florida. Interventions are also needed to 1) increase the number and use of community resources available to drug-abusing and drug-dependent women of reproductive age, 2) improve drug addiction counseling and rehabilitation referral and documentation policies, and 3) link women to these resources before or earlier in pregnancy.

BACKGROUND: In Mozambique, 1.6 million people are living with HIV, and over 60% of the population lives in rural areas lacking access to health services. Mobile health clinics, implemented in 2013 in 2 provinces, are beginning to offer antiretroviral therapy (ART) and basic primary care services. Prior to introduction of the mobile health clinics in the communities, we performed a rapid ethnographic assessment to understand barriers to accessing HIV care and treatment services and acceptability and potential use of the mobile health clinics as an alternative means of service delivery. METHODS: We conducted assessments in Gaza province in January 2013 and in Zambezia Province in April-May 2013 in districts where mobile health clinic implementation was planned. Community leaders served as key informants, and chain-referral sampling was used to recruit participants. Interviews were conducted with community leaders, health care providers, traditional healers, national health system patients, and traditional healer patients. Interviewees were asked about barriers to health services and about mobile health clinic acceptance. RESULTS: In-depth interviews were conducted with 117 participants (Gaza province, n = 57; Zambezia Province, n = 60). Barriers to accessing health services included transportation and distance-related issues (reliability, cost, and travel time). Participants reported concurrent use of traditional and national health systems. The decision to use a particular health system depended on illness type, service distance, and lack of confidence in the national health system. Overall, participants were receptive to using mobile health clinics for their health care and ability to increase access to ART. Hesitations concerning mobile health clinics included potentially long wait times due to high patient loads. Participants emphasized the importance of regular and published visit schedules and inclusion of community members in planning mobile health clinic services. CONCLUSION: Mobile health clinics can address many barriers to uptake of HIV services, particularly related to transportation issues. Involvement of community leaders, providers, traditional healers, and patients, as well as regularly scheduled mobile clinic visits, are critical to successful service delivery implementation in rural areas.

We read with interest Sayoki Mfinanga and colleagues’ recent TB-HAART randomised trial in sub-Saharan Africa.1 Initiation of antiretroviral therapy (ART) within 2 weeks of the start of pulmonary tuberculosis treatment for patients with CD4 cell counts more than 220 cells per μL did not confer any advantage over delayed ART initiation on a composite outcome of tuberculosis treatment failure, recurrence, and death. The authors concluded that comanagement of HIV infection and tuberculosis in sub-Saharan Africa remains challenging because of toxic effects, drug inter-actions, risk of antiretroviral drug resistance, pill burden, immune reconstitution inflammatory syndrome, and cost. Thus, they argued that WHO guidelines should be updated to recommend the delay of ART initiation until completion of tuberculosis treatment for patients with HIV and CD4 cell counts more than 220 cells per μL. | Although the authors noted concern about potential toxic effects of early ART initiation, their study showed no harm in terms of mortality, grade 3 and 4 adverse events, and immune reconstitution inflammatory syndrome. However, several studies have shown that even a short deferral of ART comes at the expense of recovery of CD4-positive T cells. Deferment of ART until the completion of tuberculosis treatment could also lead to loss to follow-up and subsequent morbidity and mortality.2 Initiation of ART during tuberculosis treatment enables linkage between HIV and tuberculosis treatment programmes and could improve adherence. ART integration into tuberculosis treatment settings could help to improve ART uptake among patients with tuberculosis who also have HIV.3

For many Americans, what we eat daily is determined by the available foods in institutional settings such as schools, day care centers, workplaces, hospitals, correctional facilities, and senior centers. Guidelines supporting healthy and sustainable food service at institutions can assist in increasing the availability of healthy choices, thus influencing the diet of a large portion of the US population. The increase in market demand for healthier foods due to institutional guidelines can affect the food system at large, potentially leading to a general overall increase in the production and availability of healthier foods. Healthy and sustainable food service guidelines, such as the US Department of Health and Human Services (HHS)8 and the General Services Administration (GSA) Health and Sustainability Guidelines for Federal Concessions and Vending Operations (HHS/GSA Guidelines) or the 2009 Institute of Medicine school meal nutrition recommendations, can be used for procuring, preparing, serving, and selling healthier foods and beverages with the intent of improving the quality of dietary intake and increasing the ecological benefits to the food system (1, 2). | The 2012 Experimental Biology symposium “Healthy and Sustainable Food Service Guidelines: Emerging Evidence from Implementation at the United States Federal Government, New York City, Los Angeles County, and Kaiser Permanente” presented emerging data on the process and early outcomes of implementing food service guidelines. The actions by these 4 unique entities represent large-scale efforts at chronic disease prevention. Due to the unique characteristics of each of these settings, the strategies for developing, evaluating, and implementing food service guidelines vary widely.

The "Spanish influenza" of 1918 claimed an unprecedented number of lives, yet the determinants of virulence for this virus are still not fully understood. Here, we used functional genomics and an in vitro human lung epithelial cell infection model to define the global host transcriptional response to the eight-gene 1918 virus. To better understand the role of the 1918 virus NS1 gene, we also evaluated the host response to a reassortant 1918 virus containing the NS1 gene from A/Texas/36/91 (a seasonal isolate of human influenza virus), as well as the host response to a reassortant of A/Texas/36/91 containing the 1918 NS1 gene. Genomic analyses revealed that the 1918 virus blocked the transcription of multiple interferon-stimulated genes and also downregulated a network of genes associated with lipid metabolism. In contrast, the expression of genes encoding chemokines and cytokines, which serve to attract infiltrating immune cells, was upregulated. Viruses containing the NS1 gene from A/Texas/36/91 induced a significant increase in type I interferon signaling but did not repress lipid metabolism. The 1918 NS1 gene may therefore have contributed to the virulence of the 1918 pandemic virus by disrupting the innate immune response, inducing hypercytokinemia, and by blocking the transcription of certain lipid-based proinflammatory mediators that function as part of the host antiviral response.