CONTEXT: Congenital cytomegalovirus (cCMV) infection is the most common infectious cause of birth defects and the leading non-genetic cause of sensorineural hearing loss in the United States. Prior national cCMV infection prevalence estimates were based on one multi-site screening study conducted between 2007 and 2012 and were not adjusted for sociodemographic characteristics, such as maternal race and ethnicity or age. OBJECTIVE: This study sought to estimate national and state-specific prevalence of cCMV infection in the United States, adjusted for maternal race and ethnicity and maternal age group, by pooling estimates from published studies. DESIGN: We searched PubMed for U.S. cCMV newborn screening studies conducted between 2003 and 2023. From included studies, we abstracted maternal race and ethnicity- and age group-stratified cCMV prevalence to estimate strata-specific pooled prevalence. We obtained strata-specific weights from live birth data. MAIN OUTCOME MEASURE: Estimated adjusted national and state-specific prevalence estimates from 2018 to 2022. RESULTS: Four studies (conducted 2004-2005, 2008, 2007-2012, and 2016-2021) were included for data abstraction. Overall, infants born to non-Hispanic Black (9.3 [8.2-10.5] per 1000) or non-Hispanic American Indian and Alaska Native (8.5 [2.1-33.2] per 1000) mothers had the highest cCMV prevalence. The estimated race and ethnicity-adjusted prevalence was 4.6-4.7 per 1000 live births nationally and ranged from 3.9 to 6.5 per 1000 across states from 2018 to 2022. Southern states and Alaska consistently had the highest cCMV prevalence. The estimated maternal age group-adjusted prevalence was 4.3-4.4 per 1000 live births nationally and ranged from 3.8 to 5.1 per 1000 across states from 2018 to 2022. CONCLUSIONS: States with larger proportions of racial and ethnic minorities had higher estimated prevalence of cCMV infection compared to states with larger proportions of White persons. These estimates may be useful for informing cCMV surveillance at the jurisdiction level and developing tailored, culturally relevant education and prevention strategies for persons at higher risk.

Measles, a highly contagious respiratory virus with the potential to cause severe complications, hospitalization, and death, was declared eliminated from the United States in 2000; however, with ongoing global transmission, infections in the United States still occur. On March 7, 2024, the Chicago Department of Public Health (CDPH) confirmed a case of measles in a male aged 1 year residing in a temporary shelter for migrants in Chicago. Given the congregate nature of the setting, high transmissibility of measles, and low measles vaccination coverage among shelter residents, measles virus had the potential to spread rapidly among approximately 2,100 presumed exposed shelter residents. CDPH immediately instituted outbreak investigation and response activities in collaboration with state and local health departments, health care facilities, city agencies, and shelters. On March 8, CDPH implemented active case-finding and coordinated a mass vaccination campaign at the affected shelter (shelter A), including vaccinating 882 residents and verifying previous vaccination for 784 residents over 3 days. These activities resulted in 93% measles vaccination coverage (defined as receipt of ≥1 recorded measles vaccine dose) by March 11. By May 13, a total of 57 confirmed measles cases associated with residing in or having contact with persons from shelter A had been reported. Most cases (41; 72%) were among persons who did not have documentation of measles vaccination and were considered unvaccinated. In addition, 16 cases of measles occurred among persons who had received ≥1 measles vaccine dose ≥21 days before first known exposure. This outbreak underscores the need to ensure high vaccination coverage among communities residing in congregate settings.

Introduction Influenza epidemics and pandemics cause significant morbidity and mortality. An effective response to a potential pandemic requires the infrastructure to rapidly detect, characterize, and potentially contain new and emerging influenza strains at a population level. The objective of this study is to use data gathered simultaneously from community and hospital sites to develop a model of how influenza enters and spreads in a population.Methods and Analysis Starting in the 2018-19 season, we have been enrolling individuals with acute respiratory illness from community sites throughout the Seattle metropolitan area, including clinics, childcare facilities, Seattle-Tacoma International Airport, workplaces, college campuses, and homeless shelters. At these sites, we collect clinical data and mid-nasal swabs from individuals with at least two acute respiratory symptoms. Additionally, we collect residual nasal swabs and data from individuals who seek care for respiratory symptoms at four regional hospitals. Samples are tested using a multiplex molecular assay, and influenza whole genome sequencing is performed for samples with influenza detected. Geospatial mapping and computational modeling platforms are in development to characterize the regional spread of influenza and other respiratory pathogens.Ethics and Dissemination The study was approved by the University of Washington’s Institutional Review Board. Results will be disseminated through talks at conferences, peer-reviewed publications, and on the study website (www.seattleflu.org).Strengths and limitations of this study- Large-scale multiple-arm study of respiratory illness characterization with collection of samples from individuals in the community as well as in ambulatory care and hospital settings- Integration of sociodemographic, clinical, and geospatial data on a regional level- Multiplex molecular testing for multiple viral and bacterial pathogens and whole genome sequencing of influenza for detailed molecular epidemiologic characterization and transmission mapping- Geographically and socioeconomically diverse sampling of community-based acute respiratory illnessesCompeting Interest StatementAmanda Adler, Elisabeth Brandstetter, Michael Famulare, Chris D. Frazar, Peter D. Han, Reena K. Gulati, James Hadfield, Michael L. Jackson, Anahita Kiavand, Louise E. Kimball, Kirsten Lacombe, Jennifer Logue, Victoria Lyon, Kira L. Newman, Thomas R. Sibley, Jay Shendure, Lea Starita, Monica L. Zigman Suchsland, and Caitlin Wolf declare no competing interests. Helen Y Chu receives research support from Sanofi, Cepheid, and Genentech/Roche and is a consultant for Merck. Janet Englund receives research support to her institution from Astrazeneca, GlaxoSmithKline, Merck, and Novavax and is a consultant for Sanofi Pasteur and Meissa Vaccines.Funding StatementThe Seattle Flu Study is funded through the Brotman Baty Institute. The funder was not involved in the design of the study, does not have any ownership over the management and conduct of the study, the data, or the rights to publishAuthor DeclarationsAll relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.YesAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable YesThe data will be accessed only by authorized individuals on the study team. Access to deidentified, aggregated data and analysis code will be publicly available on the study web page (www.seattleflu.org). http://www.seattleflu.org

BACKGROUND: Despite the disproportionate morbidity and mortality expeHealth Equity and Health Disparitiesrienced by American Indian and Alaska Native (AI/AN) persons during the coronavirus disease 2019 (COVID-19) pandemic, few studies have reported vaccine effectiveness (VE) estimates among these communities. METHODS: We conducted a test-negative case-control analysis among AI/AN persons aged ≥12 years presenting for care from January 1, 2021, through November 30, 2021, to evaluate the effectiveness of mRNA COVID-19 vaccines against COVID-19-associated outpatient visits and hospitalizations. Cases and controls were patients with ≥1 symptom consistent with COVID-19-like illness; cases were defined as those test-positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and controls were defined as those test-negative for SARS-CoV-2. We used unconditional multivariable logistic regression to estimate VE, defined as 1 minus the adjusted odds ratio for vaccination among cases vs controls. RESULTS: The analysis included 207 cases and 267 test-negative controls. Forty-four percent of cases and 78% of controls received 2 doses of either BNT162b2 or mRNA-1273 vaccine. VE point estimates for 2 doses of mRNA vaccine were higher for hospitalized participants (94.6%; 95% CI, 88.0-97.6) than outpatient participants (86.5%; 95% CI, 63.0-95.0), but confidence intervals overlapped. CONCLUSIONS: Among AI/AN persons, mRNA COVID-19 vaccines were highly effective in preventing COVID-associated outpatient visits and hospitalizations. Maintaining high vaccine coverage, including booster doses, will reduce the burden of disease in this population.

We previously reported on a series of patients diagnosed with ALS whom had an extraordinary course defined by substantial and sustained improvement in weakness and function. For this study, twenty-five of these "ALS Reversals" completed extensive environmental exposure questionnaires. These responses were then compared to a large database of prior responses from patients with typically progressive ALS (n = 6187). The results demonstrated that the "Reversal" participants have had a diverse number of exposures with substantial heterogeneity. In general, this was similar to the control group; however, there were a few specific differences that could be further explored in future research.

BACKGROUND: During the 2009 influenza A(H1N1)pdm09 pandemic, 77 countries received donated monovalent A(H1N1)pdm09 vaccine through the WHO Pandemic Influenza A(H1N1) Vaccine Deployment Initiative. However, 47% did not receive their first shipment until after the first wave of virus circulation, and 8% did not receive their first shipment until after the WHO declared the end of the pandemic. Arguably, these shipments were too late into the pandemic to have a substantial effect on virus transmission or disease burden during the first waves of the pandemic. OBJECTIVES: In order to evaluate the potential benefits of earlier vaccine availability, we estimated the number of illnesses and deaths that could be averted during a 2009-like influenza pandemic under five different vaccine-availability timing scenarios. METHODS: We adapted a model originally developed to estimate annual influenza morbidity and mortality burden averted through US seasonal vaccination and ran it for five vaccine availability timing scenarios in nine low- and middle-income countries that received donated vaccine. RESULTS: Among nine study countries, we estimated that the number of averted cases was 61-216,197 for actual vaccine receipt, increasing to 2,914-283,916 had vaccine been available simultaneously with the United States. CONCLUSIONS: Earlier delivery of vaccines can reduce influenza case counts during a simulated 2009-like pandemic in some low- and middle-income countries. For others, increasing the number of cases and deaths prevented through vaccination may be dependent on factors other than timely initiation of vaccine administration, such as distribution and administration capacity.

INTRODUCTION: Influenza epidemics and pandemics cause significant morbidity and mortality. An effective response to a potential pandemic requires the infrastructure to rapidly detect, characterise, and potentially contain new and emerging influenza strains at both an individual and population level. The objective of this study is to use data gathered simultaneously from community and hospital sites to develop a model of how influenza enters and spreads in a population. METHODS AND ANALYSIS: Starting in the 2018-2019 season, we have been enrolling individuals with acute respiratory illness from community sites throughout the Seattle metropolitan area, including clinics, childcare facilities, Seattle-Tacoma International Airport, workplaces, college campuses and homeless shelters. At these sites, we collect clinical data and mid-nasal swabs from individuals with at least two acute respiratory symptoms. Additionally, we collect residual nasal swabs and data from individuals who seek care for respiratory symptoms at four regional hospitals. Samples are tested using a multiplex molecular assay, and influenza whole genome sequencing is performed for samples with influenza detected. Geospatial mapping and computational modelling platforms are in development to characterise the regional spread of influenza and other respiratory pathogens. ETHICS AND DISSEMINATION: The study was approved by the University of Washington's Institutional Review Board (STUDY00006181). Results will be disseminated through talks at conferences, peer-reviewed publications and on the study website (www.seattleflu.org).

The revised Standards for Adult Immunization Practice ("Standards"), published in 2014, recommend routine vaccination assessment, strong provider recommendation, vaccine administration or referral, and documentation of vaccines administered into immunization information systems (IIS). We assessed clinician and pharmacist implementation of the Standards in the United States from 2016 to 2018. Participating clinicians (family and internal medicine physicians, obstetricians-gynecologists, specialty physicians, physician assistants, and nurse practitioners) and pharmacists responded using an internet panel survey. Weighted proportion of clinicians and pharmacists reporting full implementation of each component of the Standards were calculated. Adjusted prevalence ratio (APR) estimates of practice characteristics associated with self-reported implementation of the Standards are also presented. Across all medical specialties, the percentages of clinicians and pharmacists implementing the vaccine assessment and recommendation components of the Standards were >80.0%. However, due to low IIS documentation, full implementation of the Standards was low overall, ranging from 30.4% for specialty medicine to 45.8% in family medicine clinicians. The presence of an immunization champion (APR, 1.40 [95% confidence interval {CI}, 1.26 to 1.54]), use of standing orders (APR, 1.41 [95% CI, 1.27 to 1.57]), and use of a patient reminder-recall system (APR, 1.39 [95% CI, 1.26 to 1.54]) were positively associated with adherence to the Standards by clinicians. Similar results were observed for pharmacists. Nonetheless, vaccination improvement strategies, i.e., having standing orders in place, empowering an immunization champion, and using patient recall-reminder systems were underutilized in clinical settings; full implementation of the Standards was inconsistent across all health care provider practices.

BACKGROUND: Annual vaccination against seasonal influenza is widely recognized as the primary intervention method in preventing morbidity and mortality from influenza, but coverage among adults is suboptimal in the United States. Safety and effectiveness perceptions regarding vaccines are consistently cited as factors that influence adults' decisions to accept or reject vaccination. Therefore, we conducted this analysis in order to understand sociodemographic, attitude, and knowledge factors associated with these perceptions for influenza vaccine among adults in three different age groups. METHODS: Probability-based Internet panel surveys using nationally representative samples of adults aged >/=19 years in the United States were conducted during February-March of 2017 and 2018. We asked respondents if they believed the influenza vaccine was safe and effective. We calculated prevalence ratios using chi-square and pairwise t-tests to determine associations between safety and effectiveness beliefs and sociodemographic variables for adults aged 19-49, 50-64, and >/=65 years. RESULTS: Survey completion rates were 58.2% (2017) and 57.2% (2018); we analyzed 4597 combined responses. Overall, most adults reported the influenza vaccine was safe (86.3%) and effective (73.0%). However, fewer younger adults reported positive perceptions compared with older age groups. Respondents who believed the vaccine was safe also reported it was effective. CONCLUSIONS: Generally, adults perceived the influenza vaccine as safe and effective. Considering this, any improvements to these perceptions would likely be minor and have a limited effect on coverage. Future research to understand why, despite positive perceptions, adults are still choosing to forego the vaccine may be informative.

BACKGROUND: Infectious disease forecasting aims to predict characteristics of both seasonal epidemics and future pandemics. Accurate and timely infectious disease forecasts could aid public health responses by informing key preparation and mitigation efforts. MAIN BODY: For forecasts to be fully integrated into public health decision-making, federal, state, and local officials must understand how forecasts were made, how to interpret forecasts, and how well the forecasts have performed in the past. Since the 2013-14 influenza season, the Influenza Division at the Centers for Disease Control and Prevention (CDC) has hosted collaborative challenges to forecast the timing, intensity, and short-term trajectory of influenza-like illness in the United States. Additional efforts to advance forecasting science have included influenza initiatives focused on state-level and hospitalization forecasts, as well as other infectious diseases. Using CDC influenza forecasting challenges as an example, this paper provides an overview of infectious disease forecasting; applications of forecasting to public health; and current work to develop best practices for forecast methodology, applications, and communication. CONCLUSIONS: These efforts, along with other infectious disease forecasting initiatives, can foster the continued advancement of forecasting science.

In case of an emergency in an underground coal mine, miners who fail to escape from the mine can enter a refuge alternative (RA) for protection from adverse conditions, such as high carbon monoxide levels. One of the main concerns with the use of both portable and built-in-place (BIP) RAs, especially for hot or deep mines, is the interior temperature rise due to the occupants' metabolic heat and the heat released by devices such as the carbon dioxide (CO2) scrubbing system. The humidity within the RA will also increase through occupants' respiration and perspiration and from the chemical reaction within the CO2 scrubbing system. Heat and humidity buildup can subject the occupants to hazardous thermal conditions. To protect RA occupants, Mine Safety and Health Administration regulations mandate a maximum apparent temperature of 95F within an occupied RA. The National Institute for Occupational Safety and Health (NIOSH) tested both an air-conditioned borehole air supply (BAS) and a cryogenic air supply for RAs in the NIOSH Experimental Mine in Bruceton, Pennsylvania. The BAS was tested on a 60-person BIP RA, while the cryogenic air supply was tested on a 30-person BIP RA and a portable 23-person tent-type RA. Multiple tests were conducted with both air supplies to assess their ability to cool RAs. The test results show that the BAS and the cryogenic air supply were able to maintain the apparent temperature within the tested RAs under the 95F limit. The BAS and the cryogenic air supply are potential RA heat mitigation strategies that mines could use to prevent heat/humidity buildup within RAs.

BACKGROUND: Pneumococcus is a leading cause of pneumonia and meningitis. Zambia introduced a 10-valent pneumococcal conjugate vaccine (PCV10) in July 2013 using a 3-dose primary series at ages 6, 10, and 14 weeks with no booster. We evaluated the impact of PCV10 on meningitis and pneumonia hospitalizations. METHODS: Using hospitalization data from first-level care hospitals, available at the Ministry of Health, and from the largest pediatric referral hospital in Lusaka, we identified children aged <5 years who were hospitalized with pneumonia or meningitis from January 2010-December 2016. We used time-series analyses to measure the effect of PCV10 on monthly case counts by outcome and age group (<1 year, 1-4 years), accounting for seasonality. We defined the pre- and post-PCV10 periods as January 2010-June 2013 and July 2014-December 2016, respectively. RESULTS: At first-level care hospitals, pneumonia and meningitis hospitalizations among children aged <5 years accounted for 108 884 and 1742 admissions in the 42 months pre-PCV10, respectively, and 44 715 and 646 admissions in the 30 months post-PCV10, respectively. Pneumonia hospitalizations declined by 37.8% (95% confidence interval [CI] 21.4-50.3%) and 28.8% (95% CI 17.7-38.7%) among children aged <1 year and 1-4 years, respectively, while meningitis hospitalizations declined by 72.1% (95% CI 63.2-79.0%) and 61.6% (95% CI 50.4-70.8%), respectively, in these age groups. In contrast, at the referral hospital, pneumonia hospitalizations remained stable and a smaller but significant decline in meningitis was observed among children aged 1-4 years (39.3%, 95% CI 16.2-57.5%). CONCLUSIONS: PCV10 introduction was associated with declines in meningitis and pneumonia hospitalizations in Zambia, especially in first-level care hospitals.

In early summer 2018, four cases of Colorado tick fever (CTF) were reported in residents of central Oregon; CTF virus infection was confirmed using CDC’s reverse transcription–polymerase chain reaction (RT-PCR) assay (1). CTF is caused by a coltivirus that is transmitted by infected Rocky Mountain wood ticks (Dermacentor andersoni) (2). The tick is found throughout the western United States and Canada, typically at 4,000–10,000 feet (1,219–3,048 meters) above sea level in grassy areas near sage brush (3). CTF virus causes an acute febrile illness with nonspecific symptoms, and although fatal cases are rare, up to 30% of persons with CTF virus disease require hospitalization (4). Because there is no definitive treatment for CTF virus disease, clinical management is supportive. Biphasic illness pattern, leukopenia, absence of rash, and place of exposure can help distinguish CTF from other arthropod-borne infections (2,5). CTF is a reportable condition in six states, including Oregon, but is not nationally notifiable. Over the past decade, the Oregon Health Authority has reported an average of less than one case of CTF per year.

BACKGROUND: The Advisory Committee for Immunization Practices recommends that all pregnant women receive the seasonal influenza vaccine and the tetanus toxoid, diphtheria toxoid, and acellular pertussis (Tdap) vaccine during every pregnancy. However, vaccination coverage rates are suboptimal among pregnant women in the United States, leaving these women and their unborn children at risk of vaccine-preventable diseases and their complications. OBJECTIVES: We sought to understand the current landscape of published literature regarding maternal immunization, including barriers to and predictors of vaccine acceptance, and identify gaps in the research in order to inform strategies for future programmatic improvement. METHODS: We conducted a literature search using MEDLINE (OVID), PsychINFO, and CINAHL (Ebsco) databases. The search included published, English-language manuscripts that identified patient, provider, or system-level barriers to, predictors of, or interventions that improved uptake of maternal vaccines among pregnant women in the US. Studies were reviewed using an inductive thematic analysis approach. RESULTS: We included 75 studies in our review. Pregnant women identified 25 different barriers to accepting recommended maternal immunizations; barriers related to vaccine safety perceptions were the most common. Healthcare providers identified 24 different barriers to vaccinating their pregnant patients. The most commonly cited barriers among healthcare providers were financial concerns. Eighteen different predictors of vaccine acceptance were identified. Receipt of a healthcare provider's recommendation was the factor most frequently reported as a reason for vaccination among pregnant women. CONCLUSIONS: We were able to identify gaps in the literature regarding maternal immunization and make recommendations for future research. Efforts to address the challenges of maternal immunization in the United States should include increasing the focus on Tdap, implementing more high-level assessments of safety perceptions and associated concerns, and determining most effective interventions.

BACKGROUND: The Standards for Adult Immunization Practice (Standards), revised in 2014, emphasize that adult-care providers assess vaccination status of adult patients at every visit, recommend vaccination, administer needed vaccines or refer to a vaccinating provider, and document vaccinations administered in state/local immunization information systems (IIS). Providers report numerous systems- and provider-level barriers to vaccinating adults, such as billing, payment issues, lower prioritization of vaccines due to competing demands, and lack of information about the use and utility of IIS. Barriers to vaccination result in missed opportunities to vaccinate adults and contribute to low vaccination coverage. Clinicians' (physicians, physician assistants, nurse practitioners) and pharmacists' reported barriers to assessment, recommendation, administration, referral, and documentation, provider vaccination practices, and perceptions regarding their adult patients' attitudes toward vaccines were evaluated. METHODS: Data from non-probability-based Internet panel surveys of U.S. clinicians (n=1714) and pharmacists (n=261) conducted in February-March 2017 were analyzed using SUDAAN. Weighted proportion of reported barriers to assessment, recommendation, administration, referral, and documentation in IIS were calculated. RESULTS: High percentages (70.0%-97.4%) of clinicians and pharmacists reported they routinely assessed, recommended, administered, and/or referred adults for vaccination. Among those who administered vaccines, 31.6% clinicians' and 38.4% pharmacists' submitted records to IIS. Reported barriers included: (a) assessment barriers: vaccination of adults is not within their scope of practice, inadequate reimbursement for vaccinations; (b) administration barriers: lack of staff to manage/administer vaccines, absence of necessary vaccine storage and handling equipment and provisions; and (c) documentation barriers: unaware if state/city has IIS that includes adults or not sure how their electronic system would link to IIS. CONCLUSION: Although many clinicians and pharmacists reported implementing most of the individual components of the Standards, with the exception of IIS use, there are discrepancies in providers' reported actual practices and their beliefs/perceptions, and barriers to vaccinating adults remain.

INTRODUCTION: Despite the proven effectiveness of immunization in preventing morbidity and mortality, adult vaccines remain underutilized. The objective of this study was to describe clinicians' and pharmacists' self-reported implementation of the Standards for Adult Immunization Practice ("the Standards"; i.e., routine assessment, recommendation, and administration/referral for needed vaccines, and documentation of administered vaccines, including in immunization information systems). METHODS: Two Internet panel surveys (one among clinicians and one among pharmacists) were conducted during February-March 2017 and asked respondents about their practice's implementation of the Standards. T-tests assessed associations between clinician medical specialty, vaccine type, and each component of the Standards (March-August 2017). RESULTS: Implementation of the Standards varied substantially by vaccine and provider type. For example, >80.0% of providers, including obstetrician/gynecologists and subspecialists, assessed for and recommended influenza vaccine. However, 24.3% of obstetrician/gynecologists and 48.9% of subspecialists did not stock influenza vaccine for administration. Although zoster vaccine was recommended by >89.0% of primary care providers, <58.0% stocked the vaccine; by contrast, 91.6% of pharmacists stocked zoster vaccine. Vaccine needs assessments, recommendations, and stocking/referrals also varied by provider type for pneumococcal; tetanus, diphtheria, acellular pertussis; tetanus diphtheria; human papillomavirus; and hepatitis B vaccines. CONCLUSIONS: This report highlights gaps in access to vaccines recommended for adults across the spectrum of provider specialties. Greater implementation of the Standards by all providers could improve adult vaccination rates in the U.S. by reducing missed opportunities to recommend vaccinations and either vaccinate or refer patients to vaccine providers.

Underground refuge alternatives require an air source to supply breathable air to the occupants. This requires pressure relief valves to prevent unsafe pressures from building up within the refuge alternative. The U.S. Mine Safety and Health Administration (MSHA) mandates that pressure relief valves prevent pressure from exceeding 1.25 kPa (0.18 psi), or as specified by the manufacturer, above mine atmospheric pressure when a fan or compressor is used for the air supply. The U.S. National Institute for Occupational Safety and Health (NIOSH) tested a variety of pressure relief valves using an instrumented test fixture consisting of data acquisition equipment, a centrifugal blower, ductwork and various sensors to determine if the subject pressure relief valves meet the MSHA requirement. Relief pressures and flow characteristics, including opening pressure and flow rate, were measured for five different pressure relief valves under a variety of conditions. The subject pressure relief valves included two off-the-shelf modified check valves, two check valves used in MSHA-approved built-in-place refuge alternatives, and a commercially available valve that was designed for a steel refuge alternative and is currently being used in some built-in-place refuge alternatives. The test results showed relief pressures ranging from 0.20 to 1.53 kPa (0.03 to 0.22 psi) and flow rates up to 19.3 m3/min (683 scfm). As tested, some of the pressure relief valves did not meet the 1.25 kPa (0.18 psi) relief specification.

Healthcare delivery has advanced due to the implementation of point-of-care testing, which is often performed within minutes to hours in minimally equipped laboratories or at home. Technologic advances are leading to point-of-care kits that incorporate nucleic acid-based assays, including polymerase chain reaction, isothermal amplification, ligation, and hybridization reactions. As a limited number of single-nucleotide polymorphisms are associated with clinically significant human immunodeficiency virus (HIV) drug resistance, assays to detect these mutations have been developed. Early versions of these assays have been used in research. This review summarizes the principles underlying each assay and discusses strategic needs for their incorporation into the management of HIV infection.

BACKGROUND AND PURPOSE: Rehabilitation is recommended after a stroke to enhance recovery and improve outcomes, but hospital's use of inpatient rehabilitation facilities (IRFs) or skilled nursing facility (SNF) and the factors associated with referral are unknown. METHODS: We analyzed clinical registry and claims data for 31 775 Medicare beneficiaries presenting with acute ischemic stroke from 918 Get With The Guidelines-Stroke hospitals who were discharged to either IRF or SNF between 2006 and 2008. Using a multilevel logistic regression model, we evaluated patient and hospital characteristics, as well as geographic availability, in relation to discharge to either IRF or SNF. After accounting for observed factors, the median odds ratio was reported to quantify hospital-level variation in the use of IRF versus SNF. RESULTS: Of 31 775 patients, 17 662 (55.6%) were discharged to IRF and 14 113 (44.4%) were discharged to SNF. Compared with SNF patients, IRF patients were younger, more were men, had less health-service use 6 months prestroke, and had fewer comorbid conditions and in-hospital complications. Use of IRF or SNF varied significantly across hospitals (median IRF use, 55.8%; interquartile range, 34.8%-75.0%; unadjusted median odds ratio, 2.59; 95% confidence interval, 2.44-2.77). Hospital-level variation in discharge rates to IRF or SNF persisted after adjustment for patient, clinical, and geographic variables (adjusted median odds ratio, 2.87; 95% confidence interval, 2.68-3.11). CONCLUSIONS: There is marked unexplained variation among hospitals in their use of IRF versus SNF poststroke even after accounting for clinical characteristics and geographic availability. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov.Unique identifier: NCT02284165.

Mast Climbing Work Platforms (MCWPs) are becoming more common at construction sites and are being used as an alternative to traditional scaffolding. Although their use is increasing, little to no published information exists on the potential safety hazards they could pose for workers. As a last line of defense, a personal fall-arrest system can be used to save a worker in a fall incident from the platform. There has been no published information on whether it is safe to use such a personal fall-arrest system with MCWPs. In this study, the issues of concern for occupational safety included: (a) the overall stability of the freestanding mast climber during a fall-arrest condition and (b) whether that fall-arrest system could potentially present safety hazards to other workers on the platform during a fall-arrest condition. This research project investigated those safety concerns with respect to the mast climber stability and the workers using it by creating fall-arrest impact forces that are transmitted to the equipment and by subsequently observing the movement of the mast climber and the working deck used by the workers. This study found that when the equipment was erected and used according to the manufacturer's recommendations during a fall-arrest condition, destabilizing forces were very small and there were no signs of potential of MCWP collapse. However, potential fall hazards could be presented to other workers on the platform during a fall arrest. Workers near an open platform are advised to wear a personal fall-arrest system to reduce the risk of being ejected. Due to the increasing use of MCWPs at construction sites, there is a corresponding need for evidence and science-based safety guidelines or regulations and further research should be conducted to continue to fill the knowledge gap with MCWP equipment. © 2017

According to Mine Safety and Health Administration (MSHA) data, during 2008-2012 in the U.S., there were, on average, 65 lost-time accidents per year during routine mining and maintenance activities involving remote-controlled continuous mining machines (CMMs). To address this problem, the National Institute for Occupational Safety and Health (NIOSH) is currently investigating the implementation and integration of existing and emerging technologies in underground mines to provide automated, intelligent proximity detection (iPD) devices on CMMs. One research goal of NIOSH is to enhance the proximity detection system by improving its capability to track and determine identity, position, and posture of multiple workers, and to selectively disable machine functions to keep workers and machine operators safe. Posture of the miner can determine the safe working distance from a CMM by way of the variation in the proximity detection magnetic field. NIOSH collected and analyzed motion capture data and calculated joint angles of the back, hips, and knees from various postures on 12 human subjects. The results of the analysis suggests that lower body postures can be identified by observing the changes in joint angles of the right hip, left hip, right knee, and left knee.

The U.S. National Institute for Occupational Safety and Health (NIOSH) has been researching refuge alternatives (RAs) since 2007. RAs typically have built-in pressure relief valves (PRVs) to prevent the unit from reaching unsafe pressures. The U.S. Mine Safety and Health Administration requires that these valves vent the chamber at a maximum pressure of 1.25 kPa (0.18 psi, 5.0 in. H2O), or as specified by the manufacturer, above mine atmospheric pressure in the RA. To facilitate PRV testing, an instrumented benchtop test fixture was developed using an off-the-shelf centrifugal blower and ductwork. Relief pressures and flow characteristics were measured for three units: (1) a modified polyvinyl chloride check valve, (2) an off-the-shelf brass/cast-iron butterfly check valve and (3) a commercially available valve that was designed specifically for one manufacturer's steel prefabricated RAs and had been adapted for use in one mine operator's built-in-place RA. PRVs used in tent-style RAs were not investigated. The units were tested with different modifications and configurations in order to check compliance with Title 30 Code of Federal Regulations, or 30 CFR, regulations. The commercially available relief valve did not meet the 30 CFR relief pressure specification but may meet the manufacturer's specification. Alternative valve designs were modified to meet the 30 CFR relief pressure specification, but all valve designs will need further design research to examine survivability in the event of a 103 kPa (15.0 psi) impulse overpressure during a disaster.

Neuraminidase (NA) inhibitors (NAIs) are the only antivirals that are effective for prophylaxis and the treatment of seasonal influenza A and B infections. There are currently two NAIs approved in most countries: oseltamivir (Tamiflu; F. Hoffmann - La Roche) and zanamivir (Relenza; GlaxoSmithKline plc.). The development of drug resistance is a major drawback for any antiviral therapy, and these specific anti-influenza drugs are not excluded from this rule. Thus, the proper use of NAIs and worldwide monitoring for the presence and spread of drug resistant influenza viruses are of the utmost importance. The existence of a global surveillance network for influenza, underpinning vaccine strain selection, is a valuable asset when seeking to track the emergence of antiviral resistance. | The Instituto Adolfo Lutz, São Paulo, SP, Brazil, plays a role in national and global influenza surveillance. The objective of the present study was to monitor antiviral resistance to assist public health authorities with decisions regarding prophylaxis and treatment strategies. | Using the real time polymerase chain reaction assay (rRT-PCR), influenza viruses of type A, subtype H1N1pdm09 and H3N2, as well as type B viruses, were identified and antiviral resistance testing was conducted using pyrosequencing2 and Sanger dideoxy sequence analysis5. | Prior to the emergence of the pandemic virus in 2009, the presence of the oseltamivir resistance-conferring marker, H275Y, was identified in seasonal influenza A (H1N1). In 2014, influenza virus surveillance identified the same marker, H275Y, in an influenza A (H1N1) pdm09 strain isolated from a 20 year-old pregnant woman living in Mato Grosso/Cuiabá, the Midwest region of Brazil. The virus was collected in March 2014. In addition, two permissive secondary NA mutations; V241I and N369K were detected in the virus isolated in the Midwest region of Brazil1. These mutations are known to negate the impact of the NA H275Y oseltamivir resistance mutation on viral replicative fitness. This patient was treated with oseltamivir, rocephin, azithromycin and made a full recovery from the respiratory disease. | The choice of assay for assessing the susceptibility of the influenza virus to NAIs depends on factors pertaining to appropriateness of the setting, cost, sustainability, speed in obtaining valid results, reliability in terms of predictive values, and accessibility. The high sensitivity of genotypic assays allows for testing of clinical specimens, thus eliminating the need for virus propagation in cell culture. In addition, rapid genotypic testing facilitates more appropriate patient management and can significantly advance and assist in large-scale epidemiological studies of drug-resistant variants4. |

OBJECTIVES: Little is known about the impact closing a health care facility has on immunization coverage of children utilizing that facility as a medical home. The authors assessed the impact of closing a Medicaid managed care facility in Philadelphia on immunization coverage of children, primarily low income children from racial/ethnic minority groups, utilizing that facility for routine immunizations. STUDY DESIGN: Observational longitudinal cohort case study. METHODS: Eligible children were born 03/01/05-06/30/07, present in Philadelphia's immunization information system (IIS), and were active clients of the facility before it closed in September 2007. IIS-recorded immunization coverage at ages 5, 7, 13, 16 and 19 months through January 2009 was compared between clinic children age-eligible to receive specific vaccines before clinic closing (preclosure cohorts) and children not age-eligible to receive those vaccines prior to closing (postclosure cohorts). RESULTS: Of 630 eligible children, 99 (16%) had no additional IIS-recorded immunizations. Third dose DTaP vaccine coverage at age seven months among preclosure cohorts was 54.4% vs. 40.3% among postclosure cohorts [risk ratio 1.31 (1.15,1.49)]. Fourth dose DTaP coverage at 19 months was 65.9% vs. 57.7% [risk ratio 1.24 (1.08,1.42)]. MMR coverage at 16 months was 79.5% vs. 69.9% [risk ratio 1.47 (1.22, 1.76)]. Coverage for the 431331 vaccination series at 19 months was 63.8% vs. 53.8% [risk ratio 1.28 (1.12,1.88)]. CONCLUSIONS: Immunization coverage declined at key age milestones for active clients of a Medicaid managed care that closed as compared with preclosure cohorts of clients from the same facility. When a primary health care facility closes, efforts should be made to ensure that children who had received vaccinations at that facility quickly establish a new medical home.

According to the literature, pneumonia diagnosis relies on the assessment of clinical samples such induced sputum, bronchoscopic lower respiratory tract washes or direct lung needle aspirates. Sometimes, none of these antemortem specimens are able to be collected from cases of very severe pneumonia in which the patients die during or soon after admission, leaving an important gap in our knowledge of causes of fatal pneumonia.1, 3, 4 We would like to inform that two cases of fatal pneumonia, due to influenza virus infection, was diagnosed by conventional and real-time polymerase chain reaction (PCR) from blood sample postmortem. On 29 June 2006 the Institute Adolfo Lutz, São Paulo, Brazil, received a postmortem blood sample from a 3-year-old child living is Ribeirão Preto city, state of São Paulo. According to her parents on 24 June 2006 she presented with mild influenza-like symptoms, and died on 26 June 2006. | RNA was isolated from the blood sample by using the ‘QIAamp Viral RNA Mini Kit’ (QIAGEN, Santa Clarita, CA, USA) according to the manufacturers instructions. Following influenza virus investigation by one-step RT-PCR (Reverse – Transcriptase Polimerase Chain Reaction) technique using Universal Type A, Universal Type B and specific primers to virus strains H1, H3 and H5 kindly provided by the Centers Disease Control and Prevention (CDC), Georgia, Atlanta.

The tip-over of scissor lifts in operation has frequently resulted in the death and/or severe injuries of workers. The objective of this study is to enhance the understanding of its major mechanisms and factors influencing scissor lift stability. Both experimental and modeling approaches were used in this study. Two series of experiments were performed under possible tip-over scenarios: curb impact and pothole depression. Based on the dynamic characteristics identified from the experimental results, a lumped-parameter model of the scissor lift was developed. It was applied to investigate the effect of scissor structure flexibility on the tip-over potential of the lift, to understand tip-over mechanisms, and to explore preventive strategies. This study found that the fundamental natural frequencies of the lift were generally in a range of 0.30 - 2.08 Hz, which are likely related to the tip-over. Increasing flexibility of the lift structure generally increased the tip-over potential. The tip-over threshold was also a function of both ground slope and tilt speed of the lift. The results suggest that the lift should not be elevated on largely deformable and/or uneven surfaces such as bridged wood board or a soft soil base. The worker on the lift platform should avoid any large continuous periodic movement or forceful action in the horizontal plane, especially when the lift is fully elevated. Besides the tilt angle of the lift, the tilt speed should be monitored to help prevent the tip-over.

Miners depend most heavily on visual cues to recognize underground mining hazards; consequently, illumination plays a critical role in miners' safety. Some hazards are located in the miners' peripheral field of view (10 degrees to about 60 degrees off axis) or on axis (0 degrees). The objective of this research was to determine if there were visual performance improvements when using solid-state cap lamps with light-emitting diodes (LEDs) as compared to incandescent light bulbs commonly used in miner cap lamps. Recent research has indicated that an increased short-wavelength content of the spectral power distribution of LEDs relative to incandescent lamps improves peripheral visual performance for low-light (mesopic) conditions. The visual performances of nine subjects were quantified by measuring the subjects' speed and accuracy in detecting floor objects located on axis and at + / - 20 degrees off axis. The objects were located near field (1.83 m) and far field (3.66 m). Upon presentation of the objects, the subjects would count and point to each object using a red-laser pointer. The object detection response time and number of missed objects were recorded. The results of the visual performance comparison for an LED, a prototype LED, and an incandescent cap lamp are presented. There were no missed objects when the subjects used the LED-based cap lamps, but there were three missed-object occurrences when the subjects used the incandescent cap lamp. The mean detection time when using the incandescent cap lamp was 55.3 percent greater than that of the prototype LED cap lamp and 43.5 percent greater than that of the LED cap lamp. It can be inferred from these data that the spectral distribution of LED-based cap lamps could enable significant visual performance improvements as compared to incandescent cap lamps.

Researchers at the National Institute for Occupational Safety and Health (NIOSH) are investigating different lighting technologies with the objective of improving mine safety. This paper presents the results from an ongoing study that compares discomfort glare for different light-emitting diode (LED) cap lamps using the de Boer glare rating scale. The cap lamps tested included two commercially-available LED cap lamps and one NIOSH prototype LED cap lamp tested at three different illumination levels. Prior research indicated that the NIOSH prototype enabled much better visual performance as compared to other LED cap lamps. It uses three LEDs that produce multiple illumination areas in comparison to commercially-available cap lamps that use one LED and projects a narrow spot pattern. Across subjects and cap lamp test conditions, measured illuminances (averaged at both eyes) varied from 0.62 to 3.73 lx, whereas the de Boer glare ratings varied from 4.86 to 7.71. An analysis of variance based on 15 subjects indicated a significant difference in the discomfort glare due to cap lamps (F4, 52 = 18.01, p 0.001). Post hoc tests indicate that one of the commercially available cap lamps exhibited lower discomfort scores, with no statistically significant differences detected between the others. Thus, the NIOSH prototype cap lamp does not cause excessive discomfort glare yet enables better visual performance. 2011 IEEE.

This study evaluated the effectiveness of a commercial rollover protective structure (ROPS) and size-extended ROPS in protecting a 95th percentile male operator during tractor overturns. Six rear upset tests (commercial ROPS) and ten side upset tests (commercial and size-extended ROPS) were conducted. A 95th percentile instrumented male manikin was used in all tests. Head injury criterion (HIC15), 80 g limit on resultant head acceleration, neck injury criterion (Nij), and peak axial force (extension-compression) were employed to evaluate injury potential. In all rear tests, the manikin's head impact with the ground was within the tolerance limits for head/neck injuries. Based on limited trials in the side tests, the study observed a small to moderate chance of neck injuries under the commercial and size-extended ROPS conditions; the injury risk was not statistically significant between these two test conditions. This study identified a risk of non-fatal injuries for large-size operators in side overturns, although the prevention effectiveness of commercial versus size-extended ROPS cannot be determined without further testing. These findings may have implications for future ROPS designs.

OBJECTIVE: Examine impact of provider chart audits and parental outreach in improving immunization coverage among children not up-to-date (NUTD) for immunizations in Philadelphia's immunization information system (IIS). METHODS: We identified 10-month-old children NUTD for age-appropriate immunizations using Philadelphia's IIS. Immunization rates at 10, 13, and 19 months were compared before and after contact with providers and parents. RESULTS: Of 5 610 children NUTD in the IIS at 10 months and living in areas with populations at risk for underimmunization, provider chart audits indicated that 3 612 (64%) were actually up-to-date (UTD); the majority of these (2 203) received additional age-appropriate immunizations and were also UTD at 19 months. Of 1 998 children truly NUTD at 10 months, half received overdue immunizations by 13 months following contact with parents via telephone, postcards, and home visits, but only 23 percent were UTD for age-appropriate vaccines at 19 months. CONCLUSIONS: Provider chart audits improved IIS data completeness, indicating that providers need to submit more complete and timely data to the IIS. Outreach to parents likely contributed to half of the children NUTD at 10 months receiving overdue immunizations by 13 months. However, most were again NUTD at 19 months, indicating that outreach efforts should be continued through 19 months or until children are brought UTD. Furthermore, in spite of outreach, about half of the NUTD children were not brought UTD by 13 or 19 months. New strategies should be developed to ensure that these children receive recommended vaccinations.