BACKGROUND: Improvements in outcomes among children and adolescents diagnosed with cancer are attributable to many factors-including clinical trials such as those administered through the Children's Oncology Group (COG), as well as population-based resources like the National Childhood Cancer Registry (NCCR). The objective of this study was to link COG trial data with the NCCR to evaluate overall enrollment patterns. METHODS: Data were received from the NCCR and COG, which were linked using an array of variables and then compared to evaluate enrollment patterns in COG studies from 2007-2018. Multivariable logistic regression was used to identify characteristics associated with not being enrolled in a COG study. RESULTS: Among 134,696 NCCR cancer patients, 51,062 matched with COG study enrollees. There were several differences in demographic and clinical characteristics between those enrolled and not enrolled in COG studies. Enrollment was higher among children aged 0-4 years compared to adolescents aged 15-19 years (53.7% vs 20.1%). Differences by race/ethnicity were also observed; for example, those who identified as non-Hispanic White were more likely to be enrolled than those who identified as non-Hispanic Asian/Pacific Islander (38.8% vs 32.9%). In a multivariable logistic regression model, several characteristics were significantly associated with not being enrolled in a COG study, including age at diagnosis, year of diagnosis, race/ethnicity, and cancer type. CONCLUSION: Our results suggest that several groups are underrepresented in COG clinical trials. This information can help guide the prioritization of population groups for engagement in future studies.

In this 2017-2019 community-based cohort, 245 healthy children were followed from birth to age two years. 46 EV-D68 infections were detected by nasal swabs, all between 08/2018-11/2018, with no detections in other study periods. 46% of infections met ARI criteria, of which 33% were medically attended; none required hospitalization.

BACKGROUND: In August 2020, the Centers for Disease Control and Prevention (CDC) released guidance to prevent transmission of coronavirus disease 2019 (COVID-19) in K-12 education settings. Schools varied in the degree to which they were able to implement COVID-19 prevention strategies during the height of the pandemic. METHODS: An evaluation team conducted interviews with state education staff and focus groups with district and school staff over 2 years to explore contextual factors that influenced the implementation of CDC's recommended COVID-19 prevention strategies. RESULTS: Eight implementation drivers influenced COVID-19 response efforts in school settings, including COVID-19 guidance, political climate, communication challenges, state health and education agency support, partnerships, physical and financial resources, staffing, and student needs. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: Evaluation results offer insights for future guidance and support for schools and educators as they continue efforts to prevent the spread of COVID-19 and other infectious diseases for safe in-person learning. CONCLUSIONS: The authors describe key drivers and conditions that influenced, facilitated, and/or impeded schools' implementation of COVID-19 prevention strategies. Federal, state, district, and school leadership can use the results to bolster future emergency preparedness and response efforts to protect student and school employee health.

In April 2024, following the annual International Committee on Taxonomy of Viruses (ICTV) ratification vote on newly proposed taxa, the phylum Negarnaviricota was expanded by 1 new order, 1 new family, 6 new subfamilies, 34 new genera and 270 new species. One class, two orders and six species were renamed. Seven families and 12 genera were moved; ten species were renamed and moved; and nine species were abolished. This article presents the updated taxonomy of Negarnaviricota as currently accepted by the ICTV, providing an essential annual update on the classification of members of this phylum that deepen understandings of their evolution, and supports critical public health measures for virus identification and tracking.

During September 2023, five animal shelter workers reported developing dermatitis after contact with dry pet food bags donated by a pet store. We investigated to determine outbreak source and mitigate further spread. A case was defined as the onset of pruritus within 12 hours of contact with pet food bags or surfaces contaminated by them, occurring between September 1 and 8, 2023, in any setting. We interviewed persons presenting pruritis and requested photographs of their lesions, which a dermatologist reviewed. In total, seven cases were identified, including five among shelter workers and two among drivers who handled the pet food donation. Six (86%) persons reported contact with the exterior of donated pet food bags; all six persons who touched the unopened pet food bags experienced dermatitis. The dermatologist determined lesions were consistent with arthropod exposure. To assess arthropod contamination on the pet food bags, we adhered masking tape to their exterior and collected ≥20 samples; an entomologist examined these samples. Itch mites, Pyemotes herfsi, were present on all pet food bag samples. Although Pyemotes-associated outbreaks are rare in public health literature, practitioners can consider raising awareness of this dermatitis source.

INTRODUCTION: Municipalities can improve access to food through transit planning. The primary objective of this study was to describe the prevalence of public transit supports for food access among a sample of US municipalities and their association with the municipalities' sociodemographic characteristics. METHODS: This study used a nationally representative sample (N = 1,956) of US municipalities with a population of at least 1,000 that responded to the 2021 National Survey of Community-Based Policy and Environmental Supports for Healthy Eating and Active Living. We assessed 4 outcomes: public transit availability and planning, presence of demand responsive transportation (DRT), DRT services to food retail destinations (farmers markets and supermarkets), and consideration of these locations in transit planning. We used χ(2) tests to compare the prevalence of outcomes by municipal characteristics and multivariable logistic regression to calculate odds ratios to assess the relationship between municipal characteristics and having DRT. RESULTS: Approximately half (weighted 53.2%) of municipalities reported having or planning for public transit, of which 27.1% and 52.6% reported considering service to farmers markets or supermarkets, respectively. Approximately one-third (35.5%) of municipalities reported having DRT, of which 52.0% and 84.4% reported services to farmers markets or supermarkets, respectively. All outcomes significantly differed by municipal characteristics. We found higher odds of having DRT in municipalities with 2,500 to 50,000 people or more (vs <2,500 people); those with 50% or less of the population being non-Hispanic White (vs >50% non-Hispanic White); and municipalities containing low-income/low-access tracts. The odds of having DRT were lower in rural (vs urban) municipalities and in those in Northeast and South (vs the Midwest). CONCLUSION: Results suggest opportunities for municipalities to use transit planning to improve food access, especially in northeastern, southern, smaller, or rural communities.

BACKGROUND: Hypertension is a major risk factor for cardiovascular and renal diseases, significantly contributing to morbidity and mortality. The COVID-19 pandemic has heightened concerns about the impact of hypertension on severe COVID-19 outcomes. METHODS: We analyzed 2020-2021 data from the MarketScan Commercial and Health and Productivity Management databases, focusing on adults aged 18-64 years with continuous employer-sponsored private insurance, excluding pregnancy or capitated plans. We compared medical costs, healthcare utilization (emergency department [ED] visits, inpatient admissions, outpatient visits, and outpatient prescription drugs), and productivity losses (sick absences, short-term disability [STD], and long-term disability [LTD]) between individuals with and without hypertension, stratified by COVID-19 diagnosis. We used multivariable regression models, including an interaction term for hypertension and COVID-19 diagnosis, to estimate differences in outcomes, adjusting for demographics and comorbidities. RESULTS: Among 1,296,596 adults, 21% had hypertension. Those with hypertension were older, less likely female, less likely urban residents, and had more comorbidities. Excess medical costs associated with hypertension were $8,572 per patient over the two-year period (95% CI $8,182-$8,962). Patients with versus without hypertension had 0.200 (95% CI, 0.195-0.205) more ED visits, 0.081 (95% CI, 0.077-0.085) more inpatient admissions, 5.984 (95% CI, 5.892-6.075) more outpatient visits, and 20.25 (95% CI, 20.09-20.41) more prescriptions per patient over the two-year period. They also had more sick absences (1.13 days; 95% CI 0.93-1.34) and STD occurrences (3.88 days; 95% CI 3.56-4.20) per patient. Among those with hypertension, individuals with versus without COVID-19 had $3,495 (95% CI, $2,135-$4,856) higher medical costs and 2.588 (95% CI, 1.112-4.065) more STD days per patient over the two-year period. CONCLUSIONS: Hypertension was associated with higher medical costs, healthcare utilization, and productivity losses, exacerbated by COVID-19.

Fatal overdoses involving synthetic opioids such as fentanyl increased sharply during the past decade. Recent data indicate declines in deaths with illegally manufactured fentanyls detected beginning in mid-2023. However, timely data on nonfatal overdoses involving fentanyl are limited. Emergency department (ED) data from CDC's National Syndromic Surveillance Program during October 2020-March 2024 were analyzed. Quarterly trends in rates of suspected nonfatal overdose of unintentional or undetermined intent involving fentanyl or fentanyl analogs (fentanyl-involved nonfatal overdoses) (i.e., the number of ED visits for fentanyl-involved nonfatal overdose per 10,000 total ED visits) were analyzed overall and by age group, sex, and race and ethnicity. During quarter (Q) 4 (October-December) 2020 to Q3 (July-September) 2023, rates of fentanyl-involved nonfatal overdose ED visits increased 8.7% per quarter, from 1.4 to 3.5 per 10,000 ED visits, then declined 11.0% per quarter, to 2.9 per 10,000 ED visits, from Q3 2023 to Q1 (January-March) 2024. Trends increased among a majority of demographic groups through mid-2023, with the highest rates and the largest increases among non-Hispanic American Indian or Alaska Native persons (e.g., 11.9 per 10,000 ED visits in Q3 2023, and an average quarterly increase of 9.0%, respectively). Providers in EDs have an important role in preventing fentanyl-involved nonfatal overdoses. Buprenorphine, a medication used to treat opioid use disorder that can be initiated in an ED, might benefit persons who use EDs as a main source of medical care. In addition, comprehensive services, including screening and treatment of co-occurring mental health conditions, as well as evidence-based prevention, treatment, and recovery support services, might be initiated in EDs because these might be particularly important in communities at high risk for fentanyl overdoses.

BACKGROUND: Lee County Mosquito Control District (LCMCD) is an independent taxing district that works to protect human health and improve quality of life in Lee County, Florida, USA. With local dengue transmission in southern Florida, LCMCD prioritized the control of Aedes aegypti. Due to the cryptic larval habitats of Ae. aegypti and insecticide resistance, effective control using conventional methods is difficult. Thus, the sterile insect technique (SIT) program, using X-ray irradiated male mosquitoes, was created to target Ae. aegypti. The goal of this program was to suppress Ae. aegypti through establishing a robust SIT program and performing a pilot study in the field to assess the impacts of SIT releases. MAIN TEXT: The SIT program at LCMCD released sterile male Ae. aegypti from 2020 to 2022 in Captiva Island, Florida. The SIT program works within a larger Integrated Mosquito Management (IMM) framework and is not a standalone tool. The SIT program consists of nine employees, one of which is dedicated to quality assurance. Quality assurance assessments are performed routinely and periodically. Due to widespread destruction throughout Captiva and Sanibel Islands from Hurricane Ian in September 2022, the SIT pilot in Captiva Island was concluded and moved to Fort Myers, Florida. During the pilot study on Captiva Island, various lessons were learned and this knowledge has been applied to efforts in Fort Myers. CONCLUSIONS: LCMCD has established a successful SIT program to suppress populations of Ae. aegypti. Through connections with the International Atomic Energy Agency (IAEA) and the University of Florida, LCMCD received guidance from experts in the field to help ensure the program's success. Stable funding through taxes levied specifically for mosquito control provided essential consistency, allowing the program to grow and evolve. Consistent trapping routines provided immense amounts of entomological data. Thoughtful and intentional community engagement was essential in ensuring acceptance of the SIT program in Lee County. Following the phased conditional approach suggested by IAEA, LCMCD has built an effective and resilient SIT program. The integration of the SIT as a tool of an area-wide mosquito control program is a feature that distinguishes LCMCD's SIT program from others.

BACKGROUND: Many medications can have blood pressure (BP)-elevating effects, which might negatively impact BP control among people with hypertension. This study examines trends in prescription fills for BP-elevating and antihypertensive medications, individually and concurrently, among US individuals. METHODS: Quarterly trends of concurrent and individual fills for BP-elevating and antihypertensive medications were reported using the nationwide sample from IQVIA's Total Patient Tracker database, covering 94% of all retail prescription fills in the United States. We identified 1387 products containing BP-elevating medications and 240 products containing antihypertensive medications. Percentage change from Q1/2017 and average quarterly percent change from the joinpoint regression were used to present trends overall and by sex and age group (0-17, 18-44, 45-64, 65-74, and ≥75 years). RESULTS: From 2017 to 2023, fills remained stable for BP-elevating medications alone and increased for antihypertensive medications alone (9.5% increase; from 10.1% to 11.0%; P<0.001). Concurrent fills for antihypertensive and BP-elevating medications increased by 15.9% (from 5.4% to 6.2%; P<0.001). Fills for BP-elevating medications were higher among adult women compared with men; among women aged 18 to 44 years, this was primarily due to the use of combined oral contraceptives. In Q4/2023, fills for BP-elevating medications were most common among those aged 65 to 74 years (females=30.7%; males=20.4%). CONCLUSIONS: These results provide the first nationwide trends in concurrent prescription fills for BP-elevating and antihypertensive medications, indicating an increasing trend. Our findings might inform clinician decision-making regarding medication selection for patients with hypertension.

BACKGROUND: During the COVID-19 pandemic, the US President's Emergency Plan for AIDS Relief supported oral caregiver-assisted HIV self-testing (CG-HIVST) to address the gap in HIV diagnosis of children. We aimed to investigate caregiver uptake, results return, acceptability, and potential social harms of CG-HIVST. METHODS: This prospective, interventional, study was done at 32 health facilities in Uganda and 15 health facilities in Zambia. Caregivers aged 18 years and older (plus emancipated minors aged 15-17 years in Uganda) living with HIV who were currently accessing HIV care and considered index cases, with no positive responses to an intimate partner violence screen, and with one or more children aged 18 months to 14 years with unknown HIV status were eligible to participate. Eligible caregivers were offered oral HIVST kits to screen their children and primary outcomes were described by caregiver and child characteristics. Following HIVST kit administration, caregivers were surveyed using a standardised questionnaire to document their perceptions, adverse events, and social harm. Primary outcomes were the uptake of HIVST and the number and proportion of returned screening test results, reactive results, reactive screens with confirmatory HIV testing, confirmatory testing with a positive result, and children who were confirmed HIV-positive who were linked to treatment. This study was registered with ClinicalTrials.gov, NCT04774666 and NCT04754386, and is completed. FINDINGS: From Feb 1 to Oct 31, 2021, 12 998 interested caregivers were screened for eligibility, 4023 of whom were eligible. 3903 (97·0%) accepted HIVST kits to screen their child for HIV (1609 [41·2%] in Zambia and 2294 [58·8%] in Uganda). Among caregivers, 3094 (79·3%) of 3903 were female, and 809 (20·7%) were male. 7601 children were enrolled (3779 [49·7%] were female and 3822 [50·3%] were male). 4766 (97·9%) of 4866 test results were returned in Uganda and 2647 (96·8%) of 2735 in Zambia. 119 (1·6%) of 7413 children had reactive HIVST results, requiring confirmatory testing. Of 116 children with confirmatory testing, 43 were confirmed HIV-positive (HIV prevalence 0·7% [n=32] in Uganda and 0·4% [n=11] in Zambia) and 100% were linked to antiretroviral therapy. Adverse events were rare (11 [0·4%] of 2720) and minor, and there were no reports of social harm or violence. Caregivers surveyed reported the HIVST kit was easy to use (2637 [97·0%] of 2718), they would use it again (2650 [99·1%] of 2674), and they would recommend it to other parents (2615 [97·8%] of 2674). INTERPRETATION: Our findings suggest that oral CG-HIVST is acceptable, feasible, and safe, with no reports of social harm, and has the potential to expand access to HIV testing for children while reducing the service delivery burden on health facilities. FUNDING: US President's Emergency Plan for AIDS Relief and Wellcome Trust.

BACKGROUND: West Nile virus (WNV) is the most common cause of mosquito-borne disease in the continental USA, with an average of ~1200 severe, neuroinvasive cases reported annually from 2005 to 2021 (range 386-2873). Despite this burden, efforts to forecast WNV disease to inform public health measures to reduce disease incidence have had limited success. Here, we analyze forecasts submitted to the 2022 WNV Forecasting Challenge, a follow-up to the 2020 WNV Forecasting Challenge. METHODS: Forecasting teams submitted probabilistic forecasts of annual West Nile virus neuroinvasive disease (WNND) cases for each county in the continental USA for the 2022 WNV season. We assessed the skill of team-specific forecasts, baseline forecasts, and an ensemble created from team-specific forecasts. We then characterized the impact of model characteristics and county-specific contextual factors (e.g., population) on forecast skill. RESULTS: Ensemble forecasts for 2022 anticipated a season at or below median long-term WNND incidence for nearly all (> 99%) counties. More counties reported higher case numbers than anticipated by the ensemble forecast median, but national caseload (826) was well below the 10-year median (1386). Forecast skill was highest for the ensemble forecast, though the historical negative binomial baseline model and several team-submitted forecasts had similar forecast skill. Forecasts utilizing regression-based frameworks tended to have more skill than those that did not and models using climate, mosquito surveillance, demographic, or avian data had less skill than those that did not, potentially due to overfitting. County-contextual analysis showed strong relationships with the number of years that WNND had been reported and permutation entropy (historical variability). Evaluations based on weighted interval score and logarithmic scoring metrics produced similar results. CONCLUSIONS: The relative success of the ensemble forecast, the best forecast for 2022, suggests potential gains in community ability to forecast WNV, an improvement from the 2020 Challenge. Similar to the previous challenge, however, our results indicate that skill was still limited with general underprediction despite a relative low incidence year. Potential opportunities for improvement include refining mechanistic approaches, integrating additional data sources, and considering different approaches for areas with and without previous cases.

Powassan virus (POWV) and Eastern equine encephalitis virus (EEEV) are regionally endemic arboviruses in the United States that can cause neuroinvasive disease and death. Recent identification of EEEV transmission through organ transplantation and POWV transmission through blood transfusion have increased concerns about infection risk. After historically high numbers of cases of both viruses were reported in 2019, we conducted a seroprevalence survey using blood donation samples from selected endemic counties. Specimens were screened for virus-specific neutralizing antibodies, and population seroprevalence was estimated using weights calibrated to county population census data. For POWV, median county seroprevalence in 4 states was 0.84%, ranging from 0% (95% CI 0%-2.28%) to 11.5% (95% CI 0.82%-40.9%). EEEV infection was identified in a single county (estimated seroprevalence 1.62% [95% CI 0.04%-8.75%]). Although seroprevalence estimates in sampled areas were generally low, additional investigation of higher-prevalence areas could inform risk for transmission from asymptomatic blood and organ donors.

The use of mobile phone surveys (MPS) for regionally or nationally representative data allows for quick, efficient and affordable data collection for monitoring trends and generating results to guide action. By digitizing this process, data flows can be expanded to include metadata and paradata that allow survey administrators to evaluate and improve survey processes and parameters. Between 2017 and early 2022, the Centers for Disease Control and Prevention provided technical support to country partners to implement MPS gathering indicators on noncommunicable diseases within adult populations in seven countries. These surveys resulted in 37 591 completed interviews containing no personal identifiable information. When combined, these surveys result in over 25 million rows of paradata representing timestamped interactions between the data collection platform and each survey respondent. Using exploratory data analysis, five key metrics were identified which had implications on MPS process optimization: timing of engagement, question randomization, contacts to complete, errors and mode effect. The use of survey paradata allows for real-time process evaluations and identifies factors that can improve efficiency and effectiveness of MPS methods.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been widespread since 2020 and will likely continue to cause substantial recurring epidemics. However, understanding the underlying infection burden and dynamics, particularly since late 2021 when the Omicron variant emerged, is challenging. Here, we leverage extensive surveillance data available in New York City (NYC) and a comprehensive model-inference system to reconstruct SARS-CoV-2 dynamics therein through August 2023. METHODS: We fit a metapopulation network SEIRSV (Susceptible-Exposed-Infectious-(re)Susceptible-Vaccination) model to age- and neighborhood-specific data of COVID-19 cases, emergency department visits, and deaths in NYC from the pandemic onset in March 2020 to August 2023. We further validate the model-inference estimates using independent SARS-CoV-2 wastewater viral load data. RESULTS: The validated model-inference estimates indicate a very high infection burden-the number of infections (i.e., including undetected asymptomatic/mild infections) totaled twice the population size ( > 5 times documented case count) during the first 3.5 years. Estimated virus transmissibility increased around 3-fold, whereas estimated infection-fatality risk (IFR) decreased by >10-fold during this period. The detailed estimates also reveal highly complex variant dynamics and immune landscape, and higher infection risk during winter in NYC over the study period. CONCLUSIONS: This study provides highly detailed epidemiological estimates and identifies key transmission dynamics and drivers of SARS-CoV-2 during its first 3.5 years of circulation in a large urban center (i.e., NYC). These transmission dynamics and drivers may be relevant to other populations and inform future planning to help mitigate the public health burden of SARS-CoV-2. | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in late 2019, causing the COVID-19 pandemic and multiple epidemics since. Using comprehensive surveillance data and mathematical tools, this study estimated SARS-CoV-2 infection burden and severity over time as well as examined key factors affecting the epidemic patterns, during its first 3.5 years of circulation in New York City. Study findings highlight the emergence of new SARS-CoV-2 strains and higher infection risk in winter as key epidemic drivers during the study period; these may be observed in other populations and could inform future planning to help mitigate the public health burden of SARS-CoV-2. | eng

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.

Brucella suis infection in the United States is typically from feral swine exposure. We describe a case of B. suis cardiac implantable device infection in a man exposed to meat and blood from feral swine in Florida, USA. The infection was diagnosed using culture, molecular diagnostics, and whole-genome sequencing.

BACKGROUND: Wastewater-based surveillance is an important tool for monitoring the COVID-19 pandemic. However, it remains challenging to translate wastewater SARS-CoV-2 viral load to infection number, due to unclear shedding patterns in wastewater and potential differences between variants. OBJECTIVES: We utilized comprehensive wastewater surveillance data and estimates of infection prevalence (i.e., the source of the viral shedding) available for New York City (NYC) to characterize SARS-CoV-2 fecal shedding pattern over multiple COVID-19 waves. METHODS: We collected SARS-CoV-2 viral wastewater measurements in NYC during August 31, 2020 - August 29, 2023 (N = 3794 samples). Combining with estimates of infection prevalence (number of infectious individuals including those not detected as cases), we estimated the time-lag, duration, and per-infection fecal shedding rate for the ancestral/Iota, Delta, and Omicron variants, separately. We also developed a procedure to identify occasions with intensified transmission. RESULTS: Models suggested fecal viral shedding likely starts around the same time as and lasts slightly longer than respiratory tract shedding. Estimated fecal viral shedding rate was highest during the ancestral/Iota variant wave, at 1.44 (95% CI: 1.35 - 1.53) billion RNA copies in wastewater per day per infection (measured by RT-qPCR), and decreased by around 20% and 50-60% during the Delta wave and Omicron period, respectively. We identified around 200 occasions during which the wastewater SARS-CoV-2 viral load exceeded the expected level in any of the city's 14 sewersheds. These anomalies disproportionally occurred during late January, late April-early May, early August, and from late-November to late-December, with frequencies exceeding the expectation assuming random occurrence (P < 0.05; bootstrapping test). DISCUSSION: These estimates may be useful in understanding changes in underlying infection rate and help quantify changes in COVID-19 transmission and severity over time. We have also demonstrated that wastewater surveillance data can support the identification of time periods with potentially intensified transmission.

Road traffic deaths are preventable but remain a major public health problem. Crashes cause more than 40,000 deaths annually in the United States, and traffic-related pedestrian deaths have increased rapidly. To examine change in pedestrian and overall traffic death rates (deaths per 100,000 population) within an international context, CDC analyzed 2013-2022 data from the United States and 27 other high-income countries in the International Road Traffic and Accident Database, as well as early 2023 U.S. estimates. Between 2013 and 2022, U.S. pedestrian death rates increased 50% (from 1.55 to 2.33 per 100,000 population), while other countries generally experienced decreases (median decrease = 24.7%). During this period, overall U.S. traffic death rates increased 22.5% (from 10.41 to 12.76), but decreased by a median of 19.4% in 27 other high-income countries. Among all countries examined, the United States had the highest pedestrian death rates overall and among persons aged 15-24 and 25-64 years. Projected 2023 U.S. estimates suggest a potential decline in pedestrian (2%) and overall traffic (4%) deaths, compared with those in 2022. Accelerated adoption of a Safe System approach, focused on creating safer roadways and vehicles, establishing safer speeds, supporting safer road users, and improving post-crash care, can help reduce U.S. pedestrian and overall traffic deaths.

Little cigars are similar to cigarettes, with respect to dimensions, filters, and overall appearance. Some smokers also use little cigars as substitutes for cigarettes. Comparison of little cigars with cigarettes is relevant to understanding their respective public health impact. To understand their relative toxicities, mainstream smoke yields of benzo[a]pyrene (B[a]P), a human carcinogen, were measured for 60 commercial little cigars. The little cigars were smoked on a linear smoking machine using the International Organization of Standardization (ISO) nonintense and Canadian Intense (CI) smoking regimens followed by analysis with a validated gas chromatography/mass spectrometry (GC/MS) method. The average analytical quantitative variability of the measured little cigar constituents was lower compared to previously tested commercial cigarettes (%RSD 9.6 vs 14.5, respectively). B[a]P yields ranged from 14.5-44.0 ng/cigar (ISO) and 24.0-65.7 ng/cigar (CI). The mean ISO yield is 25.5 ng/cigar versus the CI yield of 42.2 ng/cigar, which are 2.5- and 2-fold greater, respectively, than the corresponding mean cigarette yields. When normalized to tobacco weight, B[a]P yields of the little cigars are 1.5- (ISO) and 1.3- (CI) fold greater than cigarette yields. B[a]P smoke yields are known to correlate with tobacco weight. The little cigar B[a]P yield correlations to tobacco weight (CI R(2) = 0.35; ISO R(2) = 0.24) are similar to cigarette yield correlations (CI R(2) = 0.31; ISO R(2) = 0.21). Other physical properties (i.e., filter length, filter ventilation, and packing density) that may impact B[a]P smoke yields for the little cigars had very weak correlations. Except for cigarette packing density, cigars and cigarettes have similar correlations between B[a]P yields and physical design parameters. In summary, the little cigars, although physically similar to cigarettes, differ in smoke chemistry by generating higher B[a]P yields, even when normalized to tobacco weight.

We evaluated whether sexually transmitted infection (STI) clinic visits and chlamydia/gonorrhea tests in five jurisdictions had returned to pre-COVID levels by 2022. Patient volume and chlamydia/gonorrhea testing have not returned to pre-COVID levels, especially among people <30 years.

BACKGROUND: Cardiac rehabilitation (CR) can improve cardiovascular health. We identified whether CR participation was associated with fewer subsequent inpatient hospitalizations and emergency department visits and less Medicare and out-of-pocket expenditures, and whether outcomes varied by amount of participation. METHODS: This retrospective study used Medicare fee-for-service claims data, including beneficiaries with a CR-qualifying event in 2016. Participants attended ≥2 sessions of CR within 365 days of the event. Propensity score matching was used to identify CR-eligible nonparticipants. Difference-in-differences analyses were used to compare differences in outcomes before (2014-2015) and after (2018-2019; 2-year CR period=2016-2017) the CR period between participants and nonparticipants. RESULTS: We identified 57 668 CR-eligible beneficiaries after matching, with equal numbers of participants and nonparticipants. Nearly 65% of beneficiaries had a percutaneous coronary intervention, 33.5% had an acute myocardial infarction, 17.5% had a coronary artery bypass graft, and 16.8% had a heart valve repair/replacement. Compared with nonparticipants, participants had 47.6 fewer subsequent annual inpatient hospitalizations per 1000 beneficiaries (95% CI, -58.8 to -36.3) and $1005 lower subsequent annual Medicare expenditures per beneficiary (95% CI, -$1352 to -$659). Compared with no participation, medium participation (12-23 sessions), high participation (24-35 sessions), and CR completion (≥36 sessions) were associated with fewer inpatient hospitalizations and lower Medicare expenditures per year. CONCLUSIONS: CR was associated with fewer subsequent annual inpatient hospitalizations and lower subsequent annual Medicare expenditures. A higher amount of participation was associated with a further reduction in hospitalizations and expenditures. These findings can inform programs and policies that encourage CR participation.

BACKGROUND: Gestational exposure to non-persistent endocrine-disrupting chemicals (EDCs) may be associated with adverse pregnancy outcomes. While many EDCs affect the endocrine system, their effects on endocrine-related metabolic pathways remain unclear. This study aims to explore the global metabolome changes associated with EDC biomarkers at delivery. METHODS: This study included 75 pregnant individuals who delivered at the University of Cincinnati Hospital from 2014 to 2017. We measured maternal urinary biomarkers of paraben/phenol (12), phthalate (13), and phthalate replacements (4) from the samples collected during the delivery visit. Global serum metabolome profiles were analyzed from maternal blood (n = 72) and newborn (n = 63) cord blood samples collected at delivery. Fifteen of the 29 urinary biomarkers were excluded due to low detection frequency or potential exposures during hospital stay. We assessed metabolome-wide associations between 14 maternal urinary biomarkers and maternal/newborn metabolome profiles. Additionally, performed enrichment analysis to identify potential alterations in metabolic pathways. RESULTS: We observed metabolome-wide associations between maternal urinary concentrations of phthalate metabolites (mono-isobutyl phthalate), phthalate replacements (mono-2-ethyl-5-carboxypentyl terephthalate, mono-2-ethyl-5-hydroxyhexyl terephthalate) and phenols (bisphenol-A, bisphenol-S) and maternal serum metabolome, using q-value < 0.2 as a threshold. Additionally, associations of phthalate metabolites (mono-n-butyl phthalate, monobenzyl phthalate) and phenols (2,5-dichlorophenol, BPA) with the newborn metabolome were noted. Enrichment analyses revealed associations (p-gamma < 0.05) with amino acid, carbohydrate, lipid, glycan, vitamin, and other cofactor metabolism pathways. CONCLUSION: Maternal paraben, phenol, phthalate, and phthalate replacement biomarker concentrations at delivery were associated with maternal and newborn serum global metabolome.

Structural variants of the synthetic opioid fentanyl are a major threat to public health. Following an investigation showing that many derivatives are poorly detected by commercial lateral flow and related assays, we created hapten conjugate vaccines using an immunogenic virus-like particle carrier and eight synthetic fentanyl derivatives designed to mimic the structural features of several of the more dangerous analogues. Immunization of mice elicited strong antihapten humoral responses, allowing the screening of hundreds of hapten-specific hybridomas for binding strength and specificity. A panel of 13 monoclonal IgG antibodies were selected, each showing a different pattern of recognition of fentanyl structural variations, and all proving to be highly efficient at capturing parent fentanyl compounds in competition ELISA experiments. These results provide antibody reagents for assay development as well as a demonstration of the power of the immune system to create binding agents capable of both broad and specific recognition of small-molecule targets.

Parenteral nutrition (PN) is a nutrient solution administered intravenously (IV) to premature babies. PN causes elevations of some amino acids in blood samples that are also biomarkers used in newborn screening (NBS). Therefore, PN status must be annotated by clinicians on dried blood spot (DBS) cards to reduce NBS laboratory burdens associated with potential false results; however, NBS laboratories continue to receive DBSs with misannotated PN status. N-acetyltyrosine (NAT), a water-soluble tyrosine analog used to increase tyrosine bioavailability in PN solutions, can be used as a blood-based biomarker of PN administration in NBS assays. Residual DBS specimens and manufactured DBSs were used in analyses. The assay was developed and validated using flow injection analysis tandem mass spectrometry (FIA-MS/MS) for the detection of NAT. NAT was only present in neonate DBSs with annotated PN administration and was multiplexed into first-tier newborn screening assays. NAT was highly correlated with amino acids present in PN solutions, such as arginine, leucine, methionine, phenylalanine, and valine. In our sample cohort, we determined an NAT cutoff could aid the identification of misannotated neonates administered PN. We also report the Amadori rearrangement product valine-hexose (Val-Hex) was quantifiable in neonates administered PN, which we suspect forms in the PN solution and/or IV lines. Here, we present the first known use of NAT as a biomarker of PN administration, which is currently being piloted by two U.S. NBS laboratories. NAT and Val-Hex can aid the identification of misannotated DBSs from neonates administered PN, thus decreasing false positive rates.

Characterization of serological responses to Plasmodium falciparum (Pf) is of interest to understand disease burden and transmission dynamics; however, their interpretation is challenging. Dried blood spots from 30,815 participants aged 6 months to 15 years from the 2018 Nigeria HIV/AIDS Indicator and Impact Survey were analyzed by multiplex bead-based assay to measure immunoglobulin G (IgG) to Pf-stage-specific MSP-1, AMA-1, GLURPR0, LSA-1, and CSP. These IgG levels were analyzed by principal component analysis (PCA). PC1 and PC2 scores explained 41% and 17% of the total variance, respectively. PC1 unit vectors represented seropositivity. PC2 unit vectors for blood-stage antigens were in opposite directions to liver-stage and sporozoite antigens. PC2 scores were correlated with MSP-1 positively (R = 0.52, P < 0.001) and CSP negatively (R=-0.65, P < 0.001) and may help identify areas with prior exposure but higher risk for increased infections or epidemics. PCA of Pf serology can provide summary scores to possibly inform future programmatic interventions.

This study examines trends in buprenorphine dispensing from retail pharmacies to adolescents and young adults aged 10 to 24 years in the US from 2020 to 2023. | eng

Event management systems (EMS) are key tools for epidemic intelligence, integrating surveillance signals and incident response, although international standards to inform development are lacking. We describe the Nigeria Centre for Disease Control and Prevention (NCDC) SITAware, a software capable of operating with low internet bandwidth to generate notifications, reports, and spatiotemporal dashboards and provide event-level data for real-time accountability and postevent learning. SITAware was enabled by local institutional ownership, co-created at low cost, and integrated into existing workflows. In 2022, SITAware was used to manage ≈300 incidents, and NCDC implemented it subnationally. NCDC's experience may inform EMS development and implementation in similar settings.