To understand the potential human health effects of exposure to hazardous substances among first responders from the East Palestine train derailment, an electronic self-administered Assessment of Chemical Exposures (ACE) survey was created and available to first responders between February-March 2023. Among the 339 completed responder surveys analyzed, most reported working at least 1 day during the incident between February 3-8, 2023. Most (79%) reported inhaling, touching, or swallowing potentially harmful substances and did not report using a face mask or respirator while working (75%). Nearly half reported at least 1 new or worsening physical symptom after incident response. These findings support several recommendations to mitigate exposure to hazardous substances among first responders during future incidents, including using a hierarchy of controls framework to reduce exposure to hazards, timely communication of possible hazardous substances involved in the event, and using the Emergency Responder Health Monitoring Surveillance (ERHMS) framework.

Aedes aegypti (L.), the primary mosquito vector of arboviruses such as dengue and Zika, has a global distribution that includes the southern United States. Control of this peridomestic mosquito is challenging. Ultra-low volume (ULV) pyrethroid sprays are commonly used against adult mosquitoes to break transmission during a disease outbreak, although efficacy data are limited. This study examined the impacts of ULV sprays on Ae. aegypti vectorial capacity as measured by vector abundance and age structure in two cities in Maricopa County, AZ with robust Ae. aegypti populations and a well-developed vector management program. We assessed impacts of routine ULV applications conducted by Maricopa Vector Control Division during the summer rainy seasons of 2017 to 2019 to determine whether existing practices mainly targeting Culex spp. also suppressed Ae. aegypti. The insecticide formulations applied for Culex spp. control (Duet and Permanone 30-30) did not affect Ae. aegypti abundance, but Duet applications slightly reduced female mosquito age. Deltagard, the insecticide product used specifically against Ae. aegypti, was only applied three times in 2018 over small areas, so efficacy assessment was difficult. Deltagard was associated with a small decline in Ae. aegypti abundance. CDC bottle bioassays of Ae. aegypti collected in the study area showed resistance to permethrin and deltamethrin. Overall, the lack of significant mosquito population suppression or age structure changes after insecticide applications suggest that current tools used by Maricopa Vector Control Division are unlikely to effectively control Ae. aegypti populations in the event of a disease outbreak.

BACKGROUND: Medications for opioid use disorder (MOUD) are key to preventing opioid overdose. Despite the high risk of opioid overdose among recently incarcerated people who use drugs, missed opportunities for engagement in MOUD treatment persist in this population. We examined the association between unmet need for MOUD and non-fatal opioid overdose among recently incarcerated people who inject drugs (PWID) and assessed prevalence of non-fatal opioid overdose by selected characteristics. METHODS: We analyzed 2022 data from the National HIV Behavioral Surveillance (NHBS) system among PWID from 20 large U.S. cities. Adjusted prevalence ratios (aPR) and 95 % confidence intervals (95 % CI) were calculated to examine the association between unmet need for MOUD and non-fatal opioid overdose. RESULTS: Among 1648 recently incarcerated PWID, 28 % reported an unmet need for MOUD and 39 % reported a non-fatal opioid-involved overdose in the past 12 months. Experiencing homelessness in the last 12 months (aPR=1.43, 95 % CI=1.27-1.61) and living in the Midwest region of the U.S. (aPR=1.18, 95 % CI=1.01-1.38) were significantly associated with reporting a non-fatal opioid overdose. Recently incarcerated PWID with an unmet need for MOUD were 1.4 times as likely to report a non-fatal opioid overdose in the past 12 months (50 %; aPR=1.42, 95 % CI=1.29-1.56) compared with recently incarcerated PWID without an unmet need for MOUD (35 %). CONCLUSIONS: Unmet need for MOUD was significantly associated with non-fatal opioid overdose among PWID who were incarcerated in the past 12 months, suggesting the need to investigate specific strategies to improve to MOUD treatment among recently incarcerated PWID.

CONTEXT: In response to the first reported mpox cases in May 2022, the US government implemented plans to bring testing, treatment, and vaccines to communities disproportionately affected by mpox-including the population of men who have sex with men (MSM) and Black/African American and Hispanic/Latino men, 2 subpopulations experiencing vaccination disparities. We describe the development and implementation of the US Mpox Vaccine Equity Pilot Program (MVEPP), characteristics of completed vaccination projects, and challenges that occurred. We also discuss opportunities for reducing vaccination disparities in future outbreaks. PROGRAM: To address reported vaccination disparities, the US government launched MVEPP in 2 phases. Phase 1 centered around public events attended by large numbers of gay, bisexual, and other MSM, such as Pride festivals. Phase 2 asked health departments to propose mpox vaccination projects specifically aimed at reducing or eliminating racial/ethnic and other demographic disparities in mpox vaccination. IMPLEMENTATION: MVEPP received 35 vaccination project proposals. We analyzed data from 22 completed projects that resulted in 25 675 doses of JYNNEOS administered. We note 3 innovative strategies that were implemented in several projects: direct collaboration with organizations providing services to MSM and transgender women; implementation of MVEPP projects in unique nonclinical community settings and at venues frequented by MSM and transgender women; and offering an array of services as part of mpox vaccination projects, rather than offering only mpox vaccination. EVALUATION: MVEPP highlighted the importance of recognizing and working to eliminate racial/ethnic and other disparities in access to medical countermeasures during a public health emergency. Jurisdictions developed and implemented innovative strategies to bring mpox vaccination and related services to communities disproportionately affected by mpox-including MSM and the subpopulations of Black/African American and Hispanic/Latino MSM. Lessons learned from MVEPP may inform efforts to reduce disparities during future public health responses.